Post-Operative: Integument

• What should be checked at the incision site during a surgical wound assessment?

  Approximated edges and intact closures
• What indicates a potential infection in a surgical wound?

  Erythema, increasing pain, and purulent drainage
• What is the expected healing progression for a surgical wound?

  Mild swelling and redness should gradually subside
• What should be ensured about the dressing during a post-operative assessment?

  Dressing should be clean, dry, and intact
• What type of drainage is common post-operatively?

  Serosanguinous drainage
• What does excessive bleeding or a rapid increase in drainage indicate?

  It may indicate complications
• What color and consistency of drainage suggests infection?

  Thick yellow/green or foul-smelling drainage
• What should be checked regarding lines, tubes, and drains?

  Ensure they are patent and properly secured
• How should the output from drains be monitored?

  Monitor amount, color, and consistency of drainage
• What does an unexpected sudden stop or increase in drain output indicate?

  It may indicate complications
• What are the expected post-operative integumentary findings?

  • Surgical site with approximated edges and intact closures
  • Mild swelling, redness, and serosanguinous drainage initially
  • Dressing clean, dry, and intact
  • Drainage appropriate for surgery (amount, color, consistency)
  • Lines, tubes, and drains patent and properly secured
• What is a common complication after surgery related to the integument?

  Wound infection
• What does dehiscence refer to in post-operative care?

  Edges of wound unintentionally not-approximated
• What is evisceration in the context of wound complications?

  Dehiscence with visible or protruding organs
• What is a potential complication that can occur due to prolonged pressure on the skin?

  Pressure sores
• What are the preventative interventions for post-operative wound care?

  • Wound assessment
  • Change dressing frequency per drainage and orders
  • Repositioning and ambulation if appropriate
  • Teach wound protection actions (e.g. bracing with pillow)
  • Monitor drains, empty prn & measure/document