# A nurse is teaching a 65-year-old client recovering from open upper abdominal surgery how to prevent postoperative atelectasis. Which interventions should the nurse include in the teaching? Select all that apply.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=363997&lang=en  
> language: en  
> subject: System-Specific Assessments  
> category: ROR

## Question

A nurse is teaching a 65-year-old client recovering from open upper abdominal surgery how to prevent postoperative atelectasis. Which interventions should the nurse include in the teaching? Select all that apply.

1

Splint the abdominal incision with a pillow before deep breathing or coughing

2

Turn, cough, and deep breathe every 2 hours

3

Remain in bed for the first 48 hours to allow incisional healing

4

Ambulate in the hallway as soon as the provider order allows

5

Use the incentive spirometer 10 times every hour while awake

## Explanation

Postoperative atelectasis prevention is built around lung re-expansion and early mobility. Incentive spirometry, splinting the incision to allow effective coughing, turn-cough-deep breathe (TCDB) every 2 hours, and early ambulation all promote alveolar opening and clear secretions. Bed rest for 48 hours is incorrect because immobility worsens atelectasis, increases DVT risk, and slows recovery.

## In-depth explanation

Clinical Judgment
Atelectasis prevention bundle: incentive spirometer 10/h, splinted cough, TCDB q2h, early ambulation. Avoid prolonged bed rest. Open upper abdominal incisions have the highest risk because pain limits inspiration. Adequate analgesia and incentive spirometry coaching improve compliance.

Memory Tip
Atelectasis prevention: SPIRO + SPLINT + TCDB + WALK

KR vs US
ERAS (Enhanced Recovery After Surgery) protocols in US, Europe, Korea, and Japan all emphasize multimodal opioid-sparing analgesia plus early mobilization to prevent atelectasis. Korean ERAS pathways use the same incentive spirometer and TCDB schedule as US benchmarks.

## Clinical scenario

Clinical Practice Guide
Postoperative pulmonary care bundle:
- Incentive spirometer 10 breaths every hour while awake; mark goal volume on the device
- Splinted cough: hug a pillow against the incision
- TCDB every 2 hours (turn, cough, deep breathe)
- Early ambulation: out of bed within 24 hours, then progressive distance
- Pain control sufficient to allow deep breathing
- Monitor for signs of atelectasis: fever >38, tachypnea, decreased breath sounds, crackles, hypoxia

Caution
Atelectasis is the most common postoperative pulmonary complication and can progress to pneumonia within 48-72 hours. Auscultate breath sounds every shift in upper abdominal and thoracic surgery clients.

## Key concepts

- **Atelectasis** — Collapse of alveoli causing decreased gas exchange. Postoperative cause: shallow breathing from pain, immobility, and anesthetic effects. Signs: fever within 24-48 hours postop, tachypnea, decreased breath sounds at lung bases, crackles, hypoxia.
- **Incentive spirometer** — Hand-held device that promotes deep inspiration to expand alveoli and clear secretions. Goal volume marked on device. Use 10 breaths every hour while awake postoperatively. Hold each breath at maximum inspiration for 3-5 seconds.
- **Early ambulation** — Standard postoperative intervention beginning within 24 hours unless contraindicated. Promotes lung expansion, gut motility, DVT prevention, and faster recovery. Part of ERAS protocols. Begins with sitting, then standing, then short walks.

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