1. Surgical Client Part 2 Dr. Belal Hijji, RN, PhD April 15, 2012

2. 2 Learning Outcomes After this lecture, students will be able to: –Describe the various exercises that should be taught to a patient preoperatively to prevent post-operative complications.

3. 3 Introduction Preoperative teaching for patients undergoing surgery includes instruction in breathing and leg exercises used to prevent postoperative complications, such as pneumoniab and deep vein thrombosis.

4. 4 Postoperative Exercises Diaphragmatic breathing refers to a flattening of the dome of the diaphragm during inspiration, with resultant enlargement of the upper abdomen as air rushes in. During expiration, the abdominal muscles contract. Diaphragmatic Breathing

5. 5 Incentive Spirometry Incentive spirometry is a method of deep breathing that provides visual feedback to help the patient inhale deeply and slowly and achieve maximum lung inflation (See below). Its goal is to maximize lung inflation and prevent or reduce atelectasis [lung collapse]. Nursing Management Nursing management of the patient using incentive spirometry includes placing the patient in the proper position, teaching the technique for using the incentive spirometer, setting realistic goals for the patient, and recording the results of the therapy.

6. 6 Controlled Coughing The nurse instructs the patient in controlled coughing, which is more effective and reduces the fatigue associated with undirected forceful coughing. Directed coughing consists of a slow, maximal inspiration followed by breath-holding for several seconds and then two or three coughs. “Huff” coughing may also be effective.

7. 7 Turning Turn on your side with the uppermost leg flexed most and supported on a pillow. Grasp the side rail as an aid to maneuver to the side. Practice diaphragmatic breathing and coughing while on your side.

8. 8 Leg exercises Lie in a semi-Fowler’s position and perform the following simple exercises to improve circulation. Bend your knee and raise your foot—hold it a few seconds, then extend the leg and lower it to the bed. Do this five times with one leg, then repeat with the other leg. Then trace circles with the feet by bending them down, in toward each other, up, and then out. Repeat these movements five times. NB: All the afore-mentioned exercises need to be demonstrated in the skills lab.