+++++++++++++++++Management for Complications of Diagnostic tests Bleeding Mgmt: 3 Apply pressure dressing over external bleeding site 4 Increase

IV infusion rate 5 Blood transfusion - process of receiving blood products into one's circulation intravenously. - used in a variety of medical conditions to replace lost components of the blood. - used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, white blood cells, plasma, clotting factors, and platelets. Peritoneal leak Mgmt: 6 Surgical suture - medical device used to hold body tissues together after an injury or surgery. -It generally consists of a needle with an attached length of thread. A number of different shapes, sizes, and thread materials have been developed over its millennia of history. Iron deficiency Anemia Mgmt: 7 Oral medications(ferrous sulfate, ferrous gluconate) 8 O2 therapy for DOB 9 Blood transfusion as needed Increased ICP Mgmt: 10 Position: semi fowler's and lateral position to help drain CSF from subarachnoid space of the spinal cord. It also promotes maximum lung expansion. 11 Note: HOB at 90 degrees may cause brain herniation -adequate oxygenation to promote acid-base balance 12 Note: Acidosis and alkalosis may increased ICP 13 Safety- because patients have altered LOC and may have seizure 14 Rest: physical and emotional stress may further increase ICP Infection Mgmt: 15 Monitor blood counts weekly especially WBC

16 Good personal hygiene, nutrition, adequate rest Management for Complications of Treatment and Procedure: Thoracentesis Complication: 17 pneumothorax- If a pneumothorax is small, it may go away without treatment. If it's large, you may need to have a tube placed through your skin and chest wall into the pleural space to remove the air or gas. Chemotherapy 1. Complication: Hypercalcemia Mgmt: 18 Calcitonin and oral glucocorticoids to lower serum calcium 2. Complication: Tumor Lysis Syndrome 19 IV hydration 20 Allupurinol to decrease uric acid concentration 21 Sodium bicarbonate with IV hydration to promote fecal excretion of excess phosphate 22 Lowering of serum potassium level

External Radiation therapy Complications: 1. Skin Reaction Mgmt: 23 Keep area dry 24 Wash area with water no soap and pat dry 25 Do not apply ointment, powders or lotions 26 Do not apply heat 27 Use soft cotton fabrics for clothing 28 Do not erase markings on the skin- this serve as guide for areas of irradiation. 2. Hemorrhage Mgmt: 29 Monitor platelet count 30 Avoid physical trauma or use of aspirin 31 Teach signs of hemorrhage (gum bleeding, nose bleeding, black

32 33 34 35 36 37 38 39

stools) Use direct pressure over injection sites Stomatitis and Xerostomia (dry mouth) Administer analgesics before meals as prescribed Bland diet Avoid smoking and alcohol Good oral hygiene with saline rinses every 2 hours Sugarless lemon drops or mint to increase salivation BT as ordered

Manipulation of bowel Complications: Constipation and gas cramps Mgmt: 40 Ask client about usual remedy for constipation and try it if appropriate 41 Perform manual extraction for fecal impaction, if necessary 42 Administer an oil retention enema (180-200ml) if prescribed to help soften the fecal mass and facilitate evacuation 43 Administer a return- flow enema or insert a rectal tube to decrease painful flatulence 44 Administer GI stimulants, laxatives, stool softeners as prescribed Tracheostomy Complication: Pneumonia Mgmt: 45 Monitor temp, pulse and respiration 46 Monitor patients LOC 47 Check for signs of dyspnea 48 Elevate head of bed and ensure proper administration of prescribed oxygen 49 Turn patient frequently 50 Encourage patient to take 10 deep breaths hourly, holding each breath to a count of 5 and exhaling 51 Use a spirometer or any device that encourages the patient to ventilate more effectively 52 Assist patient in coughing in an effort to bring up mucus secretions 53 Encourage and assist the patient to ambulate as early as the health care provider will allow Surgery of rectum, anus, vagina, or lower abdomen Complication: Urinary retention Mgmt: 54 Assist client to sit or stand ( if permissible) because many patients are unable to void while lying in bed 55 Run the tap water frequently; the sound or sight of running water relaxes

spasm of the bladder sphincter 56 Use warmth to relax sphincters (sitz bath) 57 Administer bethanecol chloride IM if prescribed 58 Catheterize only when other measures are unsuccessful Abdominal Surgery Complication: Wound evisceration Mgmt: 59 Stay with the patient and have someone notify the surgeon immediately 60 If intestines are exposed, cover with sterile, moist saline dressings 61 Monitor vital signs and watch for shock 62 Keep the patient on absolute bed rest 63 Instruct patient to bend knees, with head of bed elevated in semi-fowlers position to relieve tension on abdomen 64 Assure patient that wound will be properly cared for; attempt to keep patient quiet and relaxed 65 Prepare the patient for surgery and repair of the wound Amputation Complication: Depression Mgmt: 66 Clarify misconceptions on surgery and its future complications 67 Listen to, reassure and support patient 68 If appropriate, introduce patient to representatives of amputee support groups 69 Involve patients partner and support people in care; psychiatric consultation is obtained for severe depression Spinal Anesthesia 1. Dangerous Complication: Hypotension Mgmt: 70 Report BP less than 100mmHg systolic or any significant decrease 71 Place client flat 72 Administer O2 73 Increase IV rate if client is not prone to Congestive Heart Failure 2. Complication: Spinal headache Mgmt: 74 Ensure adequate hydration before, during and after procedure 75 Maintain recumbent position 6 to 12 hours after procedure 76 Administer analgesics 3. Complication: Nausea and Vomiting Mgmt: 77 Antiemetics as ordered 78 Anticipate nausea if client becomes hypotensive

79 Suction or position client to prevent aspiration