Editing Reduction of Risk Potential (section)

== Potential Complications of Procedures and Treatments ==

=== Postoperative Complications ===

;Hemorrhage and hypovolemic shock
Tachycardia, tachypnea, cool clammy skin, restlessness and anxiety as early signs of cerebral hypoperfusion, narrowing pulse pressure, then hypotension and decreased urine output. Restlessness is a classic early sign that precedes the drop in blood pressure (Ignatavicius et al., 2021).

;Atelectasis and pneumonia
Decreased or absent breath sounds, crackles, low-grade fever, and hypoxemia. Prevented with incentive spirometry, deep breathing and coughing, splinting the incision, early ambulation, and adequate pain control so the client can take deep breaths (Ignatavicius et al., 2021; Potter et al., 2023).

;Venous thromboembolism
Unilateral calf swelling, warmth, and pain; pulmonary embolism presents as sudden dyspnea, pleuritic chest pain, tachycardia, anxiety, and hypoxemia. Prevented with early ambulation, sequential compression devices, and prophylactic anticoagulation. Do not massage a suspected deep vein thrombosis (Harding et al., 2023).

;Wound dehiscence and evisceration
Dehiscence is separation of wound layers; evisceration is protrusion of viscera. A sudden gush of serosanguineous drainage often precedes dehiscence, and the client may report that something "gave way." Nursing action for evisceration: stay with the client, position supine with knees slightly flexed to reduce abdominal tension, cover the protruding tissue with '''sterile gauze moistened with sterile normal saline''', do not attempt to reinsert the tissue, keep the client nothing by mouth, monitor for shock, and notify the surgeon immediately (Ignatavicius et al., 2021).

;Paralytic ileus
Absent bowel sounds, distension, nausea and vomiting, and no flatus. Managed with nothing by mouth, nasogastric decompression, ambulation, and electrolyte correction (Harding et al., 2023).

;Urinary retention
Common after anesthesia and with anticholinergic and opioid therapy. Assess with a bladder scanner before catheterizing (Potter et al., 2023).

=== Immobility Complications ===

Pressure injury, deep vein thrombosis, pneumonia and atelectasis, constipation, muscle atrophy and contractures, disuse osteoporosis with hypercalcemia, orthostatic hypotension, and delirium. Prevention is repositioning on a schedule, pressure redistribution surfaces, skin inspection, nutrition and hydration, range of motion, and progressive mobilization (Potter et al., 2023).

=== Intravenous Therapy Complications ===

* '''Infiltration''': coolness, pallor, swelling, and sluggish flow. Stop the infusion, remove the catheter, and elevate (Potter et al., 2023).
* '''Extravasation''' of a vesicant such as many chemotherapeutic agents: stop immediately, leave the catheter in place initially to attempt aspiration and antidote instillation per protocol, and notify the provider (Harding et al., 2023).
* '''Phlebitis''': redness, warmth, tenderness, and a palpable cord. Discontinue and restart at another site; apply warm compresses.
* '''Air embolism''': sudden dyspnea, chest pain, and hypotension. Clamp the line, position the client on the '''left side in Trendelenburg''', administer oxygen, and notify the provider.
* '''Fluid overload''': dyspnea, crackles, jugular venous distension, bounding pulse, hypertension, and rapid weight gain. Slow the infusion to a keep-open rate, raise the head of the bed, and notify the provider.
* '''Catheter-related bloodstream infection''': prevented with maximal sterile barriers on insertion, scrubbing the hub, dressing integrity, and prompt removal when no longer needed (Potter et al., 2023).

=== Blood Transfusion Complications ===

Verify the product and client with two qualified persons per policy, use normal saline as the only compatible solution, use appropriate filtered tubing, start slowly, and '''remain with the client for the first 15 minutes''', when most severe reactions begin. If any reaction is suspected: '''stop the transfusion immediately''', keep the vein open with normal saline using '''new tubing''' so no additional blood enters, assess vital signs, notify the provider and the blood bank, and return the blood product and tubing per policy (Ignatavicius et al., 2021; Potter et al., 2023).

* '''Acute hemolytic reaction''' (ABO incompatibility): fever, chills, low back or flank pain, hypotension, dark or red urine, and a sense of impending doom. Life threatening (Ignatavicius et al., 2021).
* '''Febrile nonhemolytic reaction''': the most common reaction, presenting with fever and chills.
* '''Allergic reaction''': urticaria and pruritus, ranging to anaphylaxis with wheezing and hypotension.
* '''Transfusion-associated circulatory overload''': dyspnea, crackles, hypertension, and jugular venous distension, especially in older adults and in heart failure.
* '''Transfusion-related acute lung injury''': acute hypoxemia with bilateral pulmonary infiltrates and no evidence of volume overload (Harding et al., 2023).

=== Chest Tube Considerations ===

Keep the drainage system below the level of the chest, keep connections taped and secure, and keep the tubing free of dependent loops. Tidaling with respiration in the water seal chamber is expected in a functioning system and stops when the lung has re-expanded or the tubing is obstructed. '''Continuous''' bubbling in the water seal chamber indicates an air leak in the system or around the insertion site. Gentle continuous bubbling in the suction control chamber of a wet system is expected. Do not routinely clamp or strip the tubing. If the tube is accidentally pulled out, cover the site immediately with a sterile occlusive dressing taped on three sides and notify the provider. If the system breaks, place the distal end of the tube in sterile water or saline (Harding et al., 2023; Ignatavicius et al., 2021).

=== Selected Surgery-Specific Complications ===

* '''Thyroidectomy''': airway obstruction from swelling or hematoma, hemorrhage (check behind the neck and shoulders where blood pools), hypocalcemia and tetany from parathyroid injury, laryngeal nerve damage with hoarseness, and thyroid storm. Keep suction, oxygen, an emergency airway setup, and calcium gluconate available (Ignatavicius et al., 2021).
* '''Total hip arthroplasty''': dislocation. Maintain abduction, avoid hip flexion beyond the surgeon's limit (frequently 90 degrees), avoid crossing the legs and internal rotation, and use elevated seating. Report acute pain with shortening and rotation of the affected leg (Ignatavicius et al., 2021).
* '''Transurethral resection of the prostate''': bleeding and clot obstruction of continuous bladder irrigation. Bright red drainage with clots, bladder spasm, and decreased output require irrigation adjustment and prompt reporting; also monitor for dilutional hyponatremia (Harding et al., 2023).
* '''Craniotomy''': increased intracranial pressure, evidenced by decreasing level of consciousness first, pupillary changes, and Cushing triad late.
* '''Carotid endarterectomy''': neck hematoma with airway compromise and new neurologic deficits.
* '''Mastectomy with lymph node dissection''': lymphedema. Avoid blood pressure measurement, venipuncture, and injections in the affected arm (Harding et al., 2023).