CHAPTER 13 Perioperative Care^487
Pain medications can adversely affect respiratory status by decreasing respiratory
drive. Patients at increased risk for respiratory complications may develop pneu-
monia in the postoperative period due to diminished airflow, increased respiratory
secretions, and inflammatory processes. Patients with increased risk for clotting or
DVT, or those with hypercoagulable states are at risk for developing a pulmonary
embolism.
HALLMARK SIGNS AND SYMPTOMS
- Shortness of breath due to diminished airflow and resultant decreased oxy-
genation - Chest pain in the area of atelectasis due to collapse of the alveolar sacs within
that area of the lung - Productive cough due to pneumonia
- Fever due to infection in pneumonia
- Sudden onset chest pain and shortness of breath in pulmonary embolism as
clot blocks arterial blood flow within the lung - Diminished oxygen levels as gas exchange is impaired in atelectasis, pneu-
monia, or pulmonary embolism
INTERPRETING TEST RESULTS
- Pulse oximetry shows diminished oxygenation.
- Chest x-ray shows area of collapse in atelectasis, infiltrate in pneumonia,
wedge infiltrate in pulmonary embolism. - CT scan shows alveolar collapse in atelectasis, area of infiltrate in pneumonia.
- Spiral CT or helical CT shows clot in pulmonary embolism.
- WBC elevated in bacterial pneumonia.
TREATMENT
- Administer supplemental oxygen.
- Administer antibiotics for pneumonia—initially intravenously, then orally:
- macrolides
- fluoroquinolones