Post-operative support for the person affected by cancer is imperative for well-being across all domains of health. There are significant implications for overall survival. Individuals who navigate a post-operative complication successfully are more likely to commence adjuvant therapies with less toxicity and thus complete therapy in a timely manner, ensuring effective dose intensity.42
Increased risks of post-operative complications have been identified in oesophageal, pancreatic and lung cancers. Conditions frequently observed in individuals who died within a 30-day post-operative period include atelectasis, hypokalaemia, dehydration, hypotension and hypovolemia.42 Identification and adoption of evidence based interventions, based on prevalence and risk of complications, may reduce morbidity and mortality post-operatively.42
Other potential nursing care issues and considerations in the care of individuals having surgery for cancer include:43
- ARDS (Acute respiratory distress syndrome)
- aspiration pneumonia
- poor wound healing
Pain and anxiety in the person with cancer may be a result of the cancer disease process as well as a potential post-operative complication, requiring astute assessment and targeted interventions to manage.43
Surgery can cause mechanical or physiological barriers to adequate nutrition. Such complications are most notable and severe in malignancies which involve the alimentary canal. A person's ability to chew, salivate, swallow, smell or taste may be impaired. Surgery for upper gastrointestinal cancers can result in gastric paresis, early satiety, malabsorption, and hyperglycaemia. Curative or palliative surgery for head and neck cancer can alter fluid and electrolyte imbalance, dumping syndrome and vitamin and mineral deficiencies.44
Individualised nutrition plans need to consider the person's pre-existing nutritional status and function and provide aggressive management to prevent associated complications including pneumonia, ileus, sepsis, wound dehiscence, and diminished tolerance of subsequent antineoplastic therapies.43
Prepare an in-service on the key principles of post-operative nursing care for new staff in the area in which you work.
Outline the components of a nutritional assessment post-operatively.
Describe signs and symptoms of pulmonary embolism and outline the nursing and medical management of pulmonary embolism.
Define anastomotic leak and:
- Describe clinical examples
- Identify signs and symptoms
- Outline prevention strategies
- Outline management strategies.
Outline the pre- and post-procedural considerations for a person who is thrombocytopenic (platelets 35) and who is to have a Hickman's catheter inserted under radiology guidance.
Discharge from hospital
Post-discharge, people affected by cancer may have questions, concerns and/or physical symptoms requiring interventions. Issues could include poor adjustment related to altered body image, inability to function as they did before surgery, and depression related to their cancer diagnosis.45 Fear of recurrence and anxiety is prominent in the immediate post-operative period.46 Fast track surgery, supported by SCN coordination and follow-up, can help people to manage successfully at home.47
Outline how you would coordinate the care and address the needs of a person with cognitive impairment who is to have major surgery in your unit from the point of treatment planning to preparation for discharge.
Outline the key components of a discharge plan for the person who has had surgery for cancer.
List referral processes and support services available to a person discharged home following surgery for cancer.