A nurse is reinforcing teaching with a client who is preoperative following abdominal surgery about deep breathing and coughing exercises. Which of the following client statements should indicate to the nurse an understanding of the instructions?
A.
“I start to use the incentive spirometer when I can get out of bed.”
B.
“I breathe deeply and cough every 4 hours.”
C.
“I splint my incision with a pillow to cough.”
D.
“I lie flat in bed to cough and deep breathe.”
The Correct Answer and Explanation is:
The correct answer is C: “I splint my incision with a pillow to cough.”
Explanation:
Deep breathing and coughing exercises are critical components of postoperative care, particularly following abdominal surgery, to promote lung expansion, prevent atelectasis (collapse of lung tissue), and clear secretions from the respiratory tract. Here’s a detailed explanation of why statement C indicates an understanding of the instructions and why the other options do not:
- Splinting the Incision (Option C):
- Explanation: Splinting the incision with a pillow is a recommended practice to minimize pain and provide support to the surgical area while coughing. This technique helps reduce the strain on the abdominal muscles and the surgical site, making the coughing process more comfortable and effective. It also helps to prevent wound dehiscence (opening of the wound) and supports the healing process. By placing a pillow over the incision and gently applying pressure, the client can reduce discomfort and achieve a more productive cough.
- Using the Incentive Spirometer (Option A):
- Explanation: The incentive spirometer should be used frequently throughout the day, starting as soon as possible after surgery, not just when the patient is out of bed. Early use helps promote lung expansion and reduces the risk of postoperative complications like pneumonia. The statement reflects a misunderstanding of the importance of early and frequent use of the spirometer.
- Breathing Deeply and Coughing Every 4 Hours (Option B):
- Explanation: Deep breathing and coughing should be performed more frequently than every 4 hours, especially in the immediate postoperative period. Typically, clients are encouraged to perform these exercises every 1 to 2 hours while awake. This frequency helps maintain optimal lung function and prevent complications associated with reduced lung activity.
- Lying Flat in Bed to Cough and Deep Breathe (Option D):
- Explanation: Lying flat in bed can make deep breathing and coughing more difficult and uncomfortable, particularly after abdominal surgery. It is generally recommended for clients to be in an upright or semi-Fowler’s position to facilitate better lung expansion and easier coughing. This position also helps reduce the risk of complications such as aspiration and facilitates easier clearing of secretions.
In summary, statement C demonstrates a correct understanding of the postoperative care instructions for deep breathing and coughing exercises. Proper splinting of the incision is essential to reduce pain and support the surgical site while the client performs these exercises.