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a. The value of preoperative instruction to the patient is very important. Each patient should be taught as an individual, in terms of his anxieties, need, and hope. Patients should be taught postoperative exercises they will be required to do and their role in preventing complications. The postoperative exercises include turning, deep breathing, coughing, and extremity movement.

(1) Turning. Turning in bed and early ambulation helps patients maintain blood circulation, stimulate respiratory functions, and decrease the stasis of gas in the intestines and resulting discomfort. Practice before surgery usually makes it easier for the patient to do it postoperatively. In some instances, the patient may need special aids, such as a pillow between the legs, to help maintain body alignment. See Figure 1-2.


Figure 1-2. Turning techniques.

A. Patient turned away from the nurse with arms and legs crossed.

B. Patient turned toward the nurse with arms and legs crossed.

C. Patient on side in middle of bed with a pillow in front of the bottom leg with the top leg on the pillow in flexed position, a pillow against the back, a small pillow supports the arm and hand, pillow under head and shoulder.

(2) Deep breathing. Deep breathing helps prevent postoperative pneumonia and atelectasis (incomplete expansion of the lung or a portion of the lung). In deep breathing, the patient should inhale and exhale as much air as possible. You are to explain the procedure and its purpose to the patient. Instruct the patient to:

(a) Inhale slowly through the nose, distending the abdomen and exhaling slowly through pursed lips (see Figure 1-3).

(b) Deep breathe as often as possible, preferably 5 to 10 times every hour during the postoperative, immobilized period.

Figure 1-3. Deep breathing exercise.

(3) Coughing. Coughing is done to mobilize and expel respiratory system secretions which, because of the effects of anesthesia, tend to pool in the lungs and may cause pneumonia. The patient should be in a sitting or lying position. Instruct the patient to:

(a) Lean forward slightly while sitting in bed.

(b) Take a deep breath.

(c) Inhale fully with the mouth slightly open.

(d) Let out three to four sharp "hacks."

(e) With mouth open, take in a deep breath and give one or two strong coughs.

(f) Repeat steps (a) through (e) ten times, as tolerated.

NOTE: The above steps should be repeated every two hours during the postoperative phase or as prescribed.

Figure 1-4. Coughing exercise.

(g) The patient may lace his fingers and hold them tightly across the incision before coughing. This is used as a splint to minimize pressure and helps to control pain when the patient is coughing. A small pillow or folded towel may be used in place of laced fingers. See Figure 1-4.

NOTE: Encourage the patient to perform deep breathing exercises before coughing. This stimulates cough reflex.

(4) Extremity exercises. These exercises help to prevent circulatory problems, such as thrombophlebitis, by facilitating venous return to the heart. It also decreases postoperative "gas pains." See Figure 1-5 for legs and feet exercises. The patient should:

(a) Flex and extend each joint, particularity the hip, knee, and ankle joints, keeping the lower back flat as the leg is lowered and straightened.

(b) Move each foot in a circular motion.

Figure 1-5. Legs and feet exercises.

b. Time of Instruction. The best time to teach patients is relatively close to the time of surgery, which is usually the afternoon or evening before the surgery.

(1) If instruction is given several days in advance, the patient may forget.

(2) If instruction is given just before surgery, the patient may be too apprehensive to listen or too heavily sedated to comprehend.

(3) If the patient is undergoing minor surgery (one-day or same-day surgery), the patient may receive preoperative instructions several hours before surgery.


David L. Heiserman, Editor

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Revised: June 06, 2015