Cardiovascular Complications

WHAT WENT WRONG?
Patients may develop cardiovascular complications due to the physiological stress
of surgery, side effects of the anesthesia or other medications, or comorbidities.
Myocardial infarction (MI), cardiac arrhythmias, or hypotension are likely during
or in the immediate postoperative period. When getting the patient out of bed for
the first time after surgery, it is good practice to have the patient sit on the side of
the bed for a minute or two before standing up to ascertain if the patient feels dizzy
due to a drop in blood pressure associated with position change. Deep vein throm-
bosis (DVT) is a later vascular complication associated with inflammation and
decreased mobility after surgery.

SIGNS AND SYMPTOMS

• Chest pain which may radiate to back, neck, jaw, or arm due to ischemia in MI
• Shortness of breath due to altered cardiac output and tissue perfusion
• Dizziness or lightheadedness due to diminished cardiac output and cerebral
tissue perfusion or cardiac arrhythmia
• Palpitations due to cardiac arrhythmia
• Cardiac arrhythmias due to myocardial irritability—possibly due to ischemia,
medication side effect, or electrolyte imbalance
• Low blood pressure due to diminished cardiac output
• Unilateral calf pain and lower extremity swelling due to DVT

TEST RESULTS

• Cardiac monitor or EKG shows arrhythmia.
• BP below normal level.
• Doppler ultrasound of extremity shows clot within blood vessel.

TREATMENT
• Monitor cardiac rhythm.
• Administer antiarrhythmic medications to stabilize cardiac rhythm.
• Administer intravenous fluids to expand circulating blood volume to raise
blood pressure.
• Administer blood-thinning medications to decrease likelihood of clot enlarg-
ing or additional clots forming:
• heparin
• low–molecular weight heparin
• warfarin

NURSING DIAGNOSES
• Decreased cardiac output
• Ineffective cardiopulmonary tissue perfusion
• Ineffective peripheral tissue perfusion
• Impaired physical mobility

NURSING INTERVENTIONS
• Monitor vital signs for changes.
• Check blood pressure lying down and sitting up for orthostatic change.
• Monitor cardiovascular status for cardiac rhythm, heart sounds, peripheral
pulses, capillary refill, and pulse deficit.
• Assess for peripheral edema.
• Ask patient about calf pain or tenderness.
• Monitor intravenous site for signs of infiltration.
• Encourage ambulation and leg exercises to prevent development of DVT.
• Monitor proper use of elastic stockings or sequential compression devices
postoperatively.