⚠️ Reduction of Risk · Lesson 2 of 6 · 8 min

Post-op Days 1 Through 10: What Goes Wrong When

📆 Day one: lungs. Day three: wound and bladder. Day five: the incision might open. Post-op complications keep a schedule, and the exam quizzes you on the calendar.

💡 Key idea

Lungs first, then wounds, bladder, bowel and clots, then dehiscence at days 5 to 10. Evisceration: moist sterile gauze, low Fowler's with knees up, NPO, call the surgeon.

🧠 Why it matters

FIRST 48 HOURS: ATELECTASIS and hypoventilation, shown by a low-grade fever, crackles and a falling saturation; prevent with the incentive spirometer 10 times an hour while awake, coughing with the incision splinted, and early ambulation. HEMORRHAGE and HYPOVOLEMIA: tachycardia, hypotension, cool pale skin, restlessness and low urine output; check the dressing and under the client. URINARY RETENTION: expect voiding within 6 to 8 hours; bladder scan if not. DAYS 3 TO 5: WOUND INFECTION with fever, redness, warmth and purulent drainage; PARALYTIC ILEUS with distention, no flatus and absent bowel sounds, treated with NPO status, a nasogastric tube and ambulation; DEEP VEIN THROMBOSIS with unilateral calf swelling and warmth, prevented with compression devices, early ambulation and prophylactic anticoagulants. DAYS 5 TO 10: DEHISCENCE (the incision separates) and EVISCERATION (organs protrude), often after a 'pop' with a gush of serosanguineous fluid in obese, diabetic or coughing clients. For evisceration: cover the organs with sterile gauze soaked in sterile normal saline, place the client in low Fowler's with the knees bent to reduce tension, keep NPO, do not push anything back in, and call the surgeon. MALIGNANT HYPERTHERMIA occurs during or soon after anesthesia: a rising end-tidal carbon dioxide, muscle rigidity and tachycardia come first, then a dangerous temperature; treat with dantrolene and cooling.

🏥 In the real world

🫢 On post-op day six, a client with a large abdominal incision coughs hard, says 'something gave way', and the nurse finds a loop of bowel on the dressing. Sterile saline-moistened gauze goes over the bowel, the bed is lowered to low Fowler's with the knees flexed, the client is kept NPO, and the surgeon is called. Pushing it back or sitting the client up would have made it worse.

📌 Takeaways

48 hours: atelectasis, hemorrhage, urinary retention
Days 3 to 5: wound infection, ileus, DVT
Days 5 to 10: dehiscence and evisceration; cover, low Fowler's, NPO, surgeon

📖 Terms in this lesson

Evisceration: Organs protruding through an opened surgical incision; cover with moist sterile gauze and call the surgeon.

Dehiscence: Separation of the edges of a surgical incision, often around days five to ten.

Paralytic ileus: A bowel that stops moving after surgery, with distention, no flatus and absent bowel sounds.

✅ Test yourself

A client on the first post-operative day has a temperature of 38.1 °C (100.6 °F), diminished breath sounds in the bases and an oxygen saturation of 92%. What is the most likely cause?

Deep vein thrombosis
Urinary tract infection
Wound infection
Atelectasis

Answer: D · Atelectasis

Early post-op fever with diminished basilar breath sounds is classic for atelectasis; wound infection and DVT occur later.

A client's abdominal incision has opened and intestines are visible. Which action should the nurse take first?

Gently push the intestines back inside and apply a pressure dressing
Place the client in high Fowler's position
Cover the intestines with moist sterile gauze
Give the client a glass of water to stay hydrated

Answer: C · Cover the intestines with moist sterile gauze

Moist sterile gauze protects the tissue. The client is kept NPO in low Fowler's with knees flexed, and the surgeon is called immediately.

Which post-operative finding on day 4 should the nurse report as a possible paralytic ileus?

Passing flatus and tolerating clear liquids
Absent bowel sounds and no flatus
Mild incisional pain with movement
Two soft formed bowel movements since surgery

Answer: B · Absent bowel sounds and no flatus

Distention, absent bowel sounds and no flatus indicate ileus; the client is kept NPO and a nasogastric tube may be needed.

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