3-3. COMPLICATIONS TO BE PREVENTED FOR THE SURGICAL PATIENT IN THE RECOVERY ROOM
The first hours after surgery require alert attention to prevent occurrence of complications that may happen while the patient is in the recovery room. Each nurse will be able to relate to the complications that are respiratory distress and hypovolemic shock.
a. Facts Concerning Respiratory Distress.
(1) Respiratory distress is caused by laryngospasms (a complication that may happen after the patient's endotracheal tube is removed by the anesthetist or anesthesiologist), by aspiration of vomitus, or by preoperative medications. Some preoperative medications can depress respirations, especially morphine.
(2) If the patient's breathing is obstructed because his tongue has fallen back and has obstructed the nasopharynx, the lower jaw is pulled forward and an oropharyngeal airway is inserted (see Figure 3-2).
(3) The airway is left in place until the patient is conscious. The airway prevents the tongue of the unconscious patient from blocking the air passages.
Figure 3-2. An oropharyngeal airway in place.
b. Nursing Implications to Prevent Respiratory Distress.
(1) Monitory respiratory status as ordered.
(2) Report labored and shallow or rapid respirations to the Charge Nurse.
(3) Maintain patent airway either with oropharyngeal airway in place or removed.
(4) Suction the patient via nose and/or orally as ordered.
(5) Maintain the patient's position to facilitate lung expansion, usually the Fowler's position (see Figure 3-3).
(6) Administer oxygen as ordered.
(7) Maintain patient's position to prevent aspiration of vomitus (see Figure 3-4).
(a) Position the patient's head on one side and place an emesis basin under the cheek.
(b) Use tissues to wipe vomitus from the nose or mouth in order to avoid possible aspiration of the vomitus into the lungs.
Figure 3-3. Patient in Fowler's position.
Figure 3-4. Care of patient vomiting.
c. Facts About Hypovolemic Shock. Hemorrhage secondary to surgery, which may be internal or external, may cause hypovolemic shock. The loss of blood or fluid volume does not have to be rapid or in copious amounts to cause shock.
d. Nursing Implications for the Early Detection of Pending Hypovolemic Shock.
(1) Inspect the surgical dressing and report bleeding to the Charge Nurse.
(2) If the patient has a large dressing in place, always check under the patient because the blood may drain down the sides and pool under the patient. There may be no evidence of bleeding on the top of the dressing.
(3) Reinforce the original dressing after indicating outline of blood perimeter stain on original dressing.
(4) Report to the Charge Nurse the color and amount of blood. Bright red blood indicates fresh bleeding; brownish blood indicates bleeding that is not fresh.
(5) Record all of the above events in the Nursing Notes.
(6) Monitor vital signs as ordered and report:
(a) Fall in blood pressure.
(b) Rapid, weak pulse.
(d) Cool, moist skin.
(7) Administer narcotics only after checking doctor's orders and consulting with the Charge Nurse. Narcotics may precipitate shock in patients in whom shock is imminent.
(8) Administer fluids to replace volume as ordered by the physician. Fluids include whole blood products, plasma expanders, and IV fluids.