Postoperative Management and Complications
Postoperative management and complications tests recognition and escalation in the PACU and on the ward: airway, hemodynamics, pain, nausea, wound, drains, and thromboembolism. The RNFA must distinguish expected recovery from a developing complication.
Core rules and concepts
- Airway and breathing: assess rate, depth, oxygen saturation, and capnography when available; snoring, stridor, or falling saturation suggests obstruction or hypoventilation, not just sleep.
- Circulation: hypotension with tachycardia may be bleeding, hypovolemia, sepsis, or cardiac dysfunction; check drains, dressing, urine output, and mental status.
- Pain and PONV: use multimodal analgesia and antiemetics; uncontrolled pain can mask deterioration but also drive tachycardia.
- Wound and drains: assess dehiscence, hematoma, and drainage character and volume; report an expanding neck hematoma immediately because it can obstruct the airway.
- VTE and infection: early ambulation and prophylaxis; fever, redness, purulence, and leukocytosis suggest SSI; anastomotic leak may present with tachycardia and abdominal pain before fever.
Worked example
After colectomy, a patient has heart rate 118, blood pressure 96/60, urine output 15 mL/hour, and a drain with 200 mL of bloody fluid. The RNFA does not attribute this to pain alone. The team checks hemoglobin, resumes fluid resuscitation, and notifies the surgeon; ongoing blood loss is treated before the patient becomes unstable.
Traps
Attributing tachycardia only to pain; ignoring low urine output; delaying report of a neck hematoma; and assuming a low-grade fever on postoperative day one is always infection.