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?

Teaching exercises with return demonstration is priority to prevent serious complications like pneumonia and DVT. Other options (sedative, NPO, checklist) are important but do not directly prevent these complications.

Preoperative Priority to Prevent Postoperative Complications

The correct answer is teaching deep breathing, coughing, and leg exercises. While all listed interventions are important components of preoperative care, the nurse's priority action to actively prevent specific postoperative complications is patient education on these pulmonary and circulatory exercises. This directly aligns with the core principles of Enhanced Recovery After Surgery (ERAS) protocols, which emphasize proactive patient preparation to improve postoperative outcomes.

Physiological Rationale and Clinical Application

The rationale for prioritizing this teaching is rooted in the physiological stress of major abdominal surgery and the subsequent risk of immobilization. The provided evidence highlights that early postoperative mobilization is a critical component of ERAS protocols designed to improve outcomes ^[1]. However, for a patient to mobilize effectively and safely after surgery, they must first master the foundational skills taught preoperatively.

- Deep Breathing and Coughing Exercises: General anesthesia and abdominal incisions cause pain that naturally leads to shallow breathing. This creates alveolar hypoventilation and can progress to atelectasis (collapse of lung tissue) and pneumonia. Teaching diaphragmatic breathing and effective splinted coughing preoperatively empowers the patient to actively expand their lungs and clear secretions immediately after surgery, directly preventing these respiratory complications.

- Leg Exercises: Surgery creates a hypercoagulable state, and postoperative immobility leads to venous stasis, two components of Virchow's triad that significantly increase the risk of deep vein thrombosis (DVT). Teaching ankle pumps, quadriceps sets, and calf raises preoperatively activates the calf muscle pump, promoting venous return and directly working to prevent thrombus formation. This preoperative education is the essential bridge to the early mobilization emphasized in the review, as a patient who understands and has practiced these exercises is far more likely to perform them independently and progress to ambulation sooner, thereby reaping the physiological and clinical advantages of mobilization ^[1].

Analysis of Other Options

- Option 1: Administering a sedative is a dependent nursing action that manages anxiety but does not directly teach a skill to prevent a physiological complication like atelectasis or DVT.
- Option 2: Ensuring NPO status is a critical safety intervention to prevent aspiration, a complication of anesthesia induction, not a postoperative complication from immobility or hypoventilation.
- Option 3: Completing the checklist and verifying consent is a vital legal and safety step, but it is a documentation and verification task, not a direct preventive intervention against physiological postoperative decline.

The nurse's role in prevention is most actively demonstrated by equipping the patient with the skills and knowledge to participate in their own recovery. Teaching these exercises before surgery directly prepares the patient for the early and safe mobilization that is fundamental to reducing postoperative morbidity ^[1].