A nurse is caring for a patient scheduled for major abdominal surgery in the morning. Which preoperative intervention should the nurse prioritize to prevent postoperative complications?

A 62-year-old patient is admitted to the surgical unit for an open colectomy scheduled the following morning. The nurse enters the room to complete the preoperative preparation. The patient has a history of hypertension and a 30-pack-year smoking history. The surgical consent is signed, and the patient has been NPO since midnight. The nurse's priority is to reduce the risk of postoperative pulmonary and circulatory complications.

Preoperative education on deep breathing, coughing, and leg exercises is a cornerstone of Enhanced Recovery After Surgery (ERAS) protocols. Proactive teaching directly mitigates the physiological stress of surgery and immobilization. General anesthesia and abdominal incisions cause pain that leads to shallow breathing, resulting in alveolar hypoventilation, atelectasis, and pneumonia. Simultaneously, venous stasis from immobility increases the risk of venous thromboembolism (VTE). Teaching these skills preoperatively, when the patient is alert and pain-free, ensures they can perform them correctly in the immediate postoperative period, directly preventing these complications.

• Assess Readiness: Evaluate the patient's baseline respiratory function, physical mobility, and cognitive ability to learn and perform the exercises.
• Teach Diaphragmatic Breathing: Instruct the patient to place one hand on the abdomen and inhale slowly through the nose, feeling the abdomen rise. Exhale slowly through pursed lips. Perform 5-10 repetitions every hour while awake.
• Teach Splinted Coughing: Demonstrate how to support the future abdominal incision with a folded pillow or interlaced fingers. Instruct the patient to take a deep breath, hold it for 2 seconds, and then cough twice with the mouth slightly open. This clears secretions while minimizing incisional pain.
• Teach Leg Exercises: Instruct the patient to perform ankle pumps (dorsiflexion and plantarflexion) and circular ankle rotations 10 times every hour. Demonstrate quadriceps-setting exercises by pressing the back of the knee into the bed. These exercises activate the calf muscle pump to promote venous return.
• Confirm Understanding: Use the teach-back method. Ask the patient to demonstrate each exercise and explain its purpose. Document the education and the patient's response in the medical record.

Coordinate with the respiratory therapist for incentive spirometry training, which complements deep breathing exercises. Communicate the patient's mastery of these exercises to the post-anesthesia care unit (PACU) nurse to ensure continuity of care and early mobilization. Align this teaching with the surgeon's ERAS order set, which may include early oral intake and multimodal analgesia to facilitate ambulation.