8.4 Potential Complications

Catching Deterioration Early

The LPN/VN's job in Reduction of Risk Potential is to recognize early warning signs, act within scope, and report promptly. Exam items often give a timeframe and a cluster of symptoms and ask for the likely complication or the priority action.

Post-Surgical Complication Timeline

Worked example: a hip-replacement patient on day 9 develops sudden dyspnea, sharp chest pain, HR 124, SpO2 88% — the post-op immobility plus this cluster points to pulmonary embolism; the priority is oxygen and head-of-bed elevation while calling the provider, not waiting to recheck the probe.

Respiratory Distress Red Flags

Dyspnea, tachypnea over 24, accessory-muscle use, nasal flaring, restlessness, and falling SpO2. Cyanosis is a late sign. Distinguish a partial airway obstruction (weak cough, stridor) from complete (cannot speak, cough, or breathe) — the latter needs abdominal thrusts immediately.

Cardiovascular Emergencies

Women and diabetics may present atypically (fatigue, indigestion, jaw pain) for MI — a classic NCLEX distractor.

Neurological Decline

Rising intracranial pressure (ICP) shows worsening headache, decreasing level of consciousness, unequal/sluggish pupils, projectile vomiting, and posturing. Cushing's triad — bradycardia, hypertension with widening pulse pressure, and irregular respirations — is a late, ominous sign of brainstem compression. For stroke, use BE-FAST: Balance, Eyes, Face, Arm, Speech, Time to call 911.

Infection and Sepsis

qSOFA flags possible sepsis with any two of: respiratory rate ≥ 22, altered mental status, systolic BP ≤ 100 mmHg. Wound infection shows spreading redness, warmth, purulent drainage, increased pain, fever, and high WBC — report and obtain cultures before antibiotics when ordered.

Diabetic Emergencies

Hypoglycemia, rule of 15: if conscious, give 15 g fast-acting carbohydrate (4 oz juice or glucose tablets) and recheck in 15 minutes; if unconscious, give glucagon IM or IV dextrose (D50).

Anaphylaxis and Escalation

Anaphylaxis is multisystem: stridor/wheeze, hypotension/tachycardia, urticaria/angioedema, and GI cramping. Epinephrine is the first-line drug. Across all of these, escalate immediately for any single critical value, a sudden change, patient or family concern, or your own sense that something is wrong — the NCLEX rewards reporting deterioration over delaying for another reassessment.

Fluid and Electrolyte Complications

Fluid shifts cause many tested complications. Fluid volume overload appears as bounding pulse, distended neck veins, crackles, weight gain, and dyspnea — slow or stop the infusion, raise the head of bed, give oxygen, and notify the RN. Fluid volume deficit appears as tachycardia, hypotension, dry mucous membranes, poor skin turgor, and concentrated urine. Daily weight is the most reliable measure of fluid status, where a 1 kg change equals about 1 liter of fluid.

Electrolyte extremes drive arrhythmias: hyperkalemia gives peaked T waves, hypokalemia gives flattened T waves and U waves, and hypocalcemia causes positive Chvostek's and Trousseau's signs and tetany.

Falls, Pressure Injury, and Medication Errors

Reduction of Risk Potential also covers preventable harm. Falls are the leading inpatient adverse event; screen every patient, keep the bed low with the call light in reach, and answer call lights promptly. Pressure injuries are staged 1 (non-blanchable redness) through 4 (exposed bone/muscle), plus unstageable and deep-tissue injury — reposition at least every 2 hours and offload bony prominences. For medication safety, verify the rights of medication administration, question any order that falls outside normal parameters, and report errors honestly so the patient can be monitored.

The unifying NCLEX principle is anticipation: identify the at-risk patient, put preventive measures in place, and escalate the first sign of trouble within the LPN/VN scope.