Stridor, decreasing oxygen saturation, or a respiratory rate under 10 indicates airway/respiratory compromise; intervene and call for help immediately.
Before you read
Test yourself first: 5 questions
Question 1 of 5
The nurse cares for a client after transsphenoidal hypophysectomy (pituitary removal). Which instruction is most important in the early postoperative period?
Answer: B. After transsphenoidal surgery the nasal mucosa and surgical site must be protected from increased intracranial and sinus pressure. The client is taught to avoid bending, straining, sneezing forcefully, coughing, and blowing the nose, all of which raise pressure and can disrupt the graft or cause a cerebrospinal fluid leak. Toothbrushing is avoided until the incision heals.
Question 2 of 5
A nurse is monitoring T-tube drainage on the first postoperative day after a cholecystectomy. Which amount of bile-colored drainage is within expected limits?
Answer: A. On the first postoperative day, a T-tube commonly drains a moderate amount of bile, around 300 to 500 mL, which then gradually decreases over the following days as the duct heals and bile flows into the duodenum. Output greater than 1,000 mL/day or sudden cessation should be reported, but several hundred milliliters is expected initially.
Question 3 of 5
A client is recovering from surgery and reports a sudden onset of shortness of breath, pleuritic chest pain, and anxiety, with an oxygen saturation of 88 percent. What complication does the nurse suspect first?
Answer: A. Sudden dyspnea, pleuritic chest pain, hypoxia, and anxiety after surgery strongly suggest pulmonary embolism, often from a postoperative DVT. The nurse raises the head of the bed, applies oxygen, and notifies the provider. These acute findings are not typical of constipation, mild wound pain, or simple postoperative fatigue.
Question 4 of 5
On the third postoperative day, a client who has been NPO and on IV fluids has a serum sodium of 128 mEq/L, headache, and confusion. The nurse recognizes which electrolyte imbalance?
Answer: A. A serum sodium of 128 mEq/L is below the normal range, indicating hyponatremia, which can cause headache, confusion, and in severe cases seizures, sometimes from excess hypotonic IV fluid postoperatively. The findings and value are not consistent with hypernatremia, hyperkalemia, or hypercalcemia.
Question 5 of 5
A nurse is caring for a client on postoperative day 2 after a total knee arthroplasty who reports sudden chest pain, shortness of breath, and tachycardia. Which complication does the nurse suspect first?
Answer: A. Sudden dyspnea, pleuritic chest pain, and tachycardia in a postoperative orthopedic patient are classic signs of pulmonary embolism, often from a deep vein thrombosis. This is a medical emergency requiring immediate oxygen, provider notification, and evaluation.
Keep the streak going with more questions like these, each with a full rationale.
What is postoperative care?
Priorities follow the ABCs: maintain a patent airway, monitor for hemorrhage and shock, control pain, and prevent complications like atelectasis, DVT, paralytic ileus, and infection. The immediate recovery period in the PACU is highest risk for airway compromise and bleeding.
Key points to remember
- Airway obstruction from the tongue or secretions and respiratory depression from anesthesia/opioids are the most immediate postoperative dangers.
- Hypotension with tachycardia, restlessness, and decreasing urine output signals hypovolemia or hemorrhage, not just normal recovery.
- Atelectasis and pneumonia are common when patients do not deep breathe; absent bowel sounds and distension suggest paralytic ileus.
- DVT and pulmonary embolism risk rises with immobility; unilateral calf swelling, warmth, or sudden dyspnea are warning signs.
- Low-grade fever in the first 24-48 hours is often atelectasis, while fever after 48-72 hours suggests infection (wound, urinary, or respiratory).
- Urine output should be at least 30 mL/hr; less indicates inadequate perfusion or volume.
Nursing priorities
- Assess and maintain a patent airway first; position to prevent aspiration and apply oxygen, monitoring SpO2 and respiratory rate.
- Monitor vital signs frequently and check the dressing and drains for bleeding, marking and timing any drainage.
- Encourage coughing, deep breathing, and incentive spirometer use, and promote early ambulation to prevent atelectasis and DVT.
- Assess pain regularly and medicate so the patient can move and breathe deeply, monitoring for opioid-induced sedation.
- Track intake/output, assess for return of bowel sounds before advancing diet, and apply sequential compression devices as ordered.
Labs & values
Patient teaching
- Splint the incision and use the incentive spirometer hourly while awake to prevent pneumonia.
- Get up and walk as soon as cleared to reduce clots, ileus, and lung complications.
- Report increasing pain, fever, redness or drainage at the incision, or calf pain after discharge.
Red flags: report now
- Stridor, decreasing oxygen saturation, or a respiratory rate under 10 indicates airway/respiratory compromise; intervene and call for help immediately.
- Rapid bright-red bleeding saturating the dressing, falling blood pressure, and rising heart rate signal hemorrhage; apply pressure and notify the surgeon.
- Sudden chest pain, dyspnea, and hypoxia suggest pulmonary embolism; this is an emergency.
- Urine output under 30 mL/hr for consecutive hours must be reported as a sign of shock or renal compromise.
References
Clinical references for this topic
