Surgery Today - Signs of recovery or complication



While the patient may be concerned about pain following surgery, the physicians and nurses are more likely to direct their attention toward other signs and symptoms that will help them to gauge the rate of recovery, such as the patient's body temperature, skin coloring, urine output, and his ability to cough. The health professionals are well aware that surgery, and drugs or anesthetics administered in conjunction with surgery, can be disruptive to normal bodily activities. A major operation is more likely to cause changes in the patient's physiology than a minor operation.

Vital Signs

Nurses can be expected to make regular checks of temperature, pulse, and respiration because these common measures of the body functions (sometimes called vital signs ) can provide early-warning signals of possible post operative complications. A patient may have a temperature of 100° F. even after a major operation, but because of increased metabolic activity of the body following surgery, a slightly elevated thermometer reading is considered normal. The pulse and respiration also may be slightly above the patient's rate before surgery, but the mild change again is caused by the normal stress reaction of the body. However, a temperature rising above 100° F. and/or a significantly faster pulse or respiration rate suggests that a complication may have developed.

If a nurse seems interested in the patient's ability to cough, it is because the cough reflex helps the patient get rid of mucus accumulation in his lungs, especially after the use of a general anesthetic. If coughing is difficult, a plastic tube may be inserted into the patient's throat to help clear the breathing passages. Normal breathing can also be restored by steam inhalation, aerosol sprays of water or special medications, or positive pressure breathing equipment that forces air into the lungs. Failure to expand the air passages of the lungs leads to serious respiratory complications.

Urine output is also checked. This is just one more way of watching the rate of recovery of a patient and alerting the staff to any signs of complications. If for some reason the patient is unable to pass urine, a catheter , or plastic tube, is inserted into the bladder to drain it. The volume of urine drained is collected and measured.

The Incision Area

Some blood may accumulate under the skin in the area of the incision or in nearby tissues, causing a discoloration of the skin. But this effect is seldom a serious matter, and the discoloration gradually vanishes. In some cases of excess blood accumulation, the surgeon may simply remove one or two sutures and drain away the blood. Any continued bleeding about the incision would, of course, be a complication.

A more common complication is infection of the incision area by bacteria that enter the wound. An infection may develop any time from one day to one week after an operation. However, most postoperative infections of incision wounds are easily controlled by antibiotics, drainage, or natural defenses against disease. The surgeon or other physicians will make regular inspections of the incision during the first few days after surgery to make sure it is healing properly.

Postoperative Nourishment

A light meal may be offered the patient a few hours after surgery. The patient may or may not feel like eating, especially if he still feels a bit nauseated from the effects of a general anesthetic. At this stage fluid intake is probably more important, especially if the patient has not been allowed to have even a sip of water since the previous evening. If the surgery was not performed on the stomach or intestinal tract, a small amount of water or tea may be permitted within a few hours after the operation. It is unlikely in any case that the patient will feel a great desire for fluid, because intravenous solutions may have been dripping slowly into a vein since he entered the operating room. Intravenous solutions can satisfy hunger as well as thirst because they may contain proteins, carbohydrates, and essential vitamins and minerals dissolved in a finely formulated broth. Perhaps unnoticed by the patient, the amount of fluid intake will be routinely measured by members of the hospital staff.

Ambulation

Ambulation—getting the patient out of bed and moving about—is an important part of postoperative care. Experience has shown that recovery from surgery is more effective if the patient spends increasing amounts of time each day in simple physical activity. The degree of ambulation depends upon the magnitude of the surgery and the general physical health of the patient. But in a typical case of hernia surgery or an appendectomy, the patient may be asked, on the first or second day after the operation, to sit on the edge of his bed and dangle his legs for a while. On the second or third day, he may be allowed to walk about the room, and may in fact prefer to walk to the bathroom rather than use a bedpan or urinal. On the following day, he may walk up and down the halls with the help of a nurse or other hospital staff member.

Each patient is encouraged to handle the ambulation phase of recovery at his own pace, and there are few hard and fast rules. Of two persons entering the operating room on the same day for the same kind of elective surgery, one may feel like walking to the bathroom a few hours after surgery while the second may prefer to remain in bed and use a bedpan a week after surgery. The surgeon and attending physicians may encourage and in some cases even insist upon early ambulation, however, because it reduces the rate of complications.

Back at Home

Dressings used to cover the incision are changed regularly, as the incision is inspected once each day, more frequently if warranted. If the patient is anxious to be discharged from the hospital as early as possible, the surgeon may give him instructions for changing his own dressings. The surgeon will also outline a plan for recovery procedures to be followed after he leaves the hospital. The plan will include a schedule of visits to the surgeon's office for removal of stitches that may remain and a final inspection of the incision. The surgeon will also offer his advice on how the patient should plan a return to normal activities, including a return to his job and resumption of sports or recreational programs.



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