# 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? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542725 > language: ko > subject: Fundamentals ## 문제 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? ## 보기 1. Administer the prescribed preoperative sedative 2 hours before surgery 2. Ensure the patient has been NPO for at least 6 hours before surgery 3. Complete the preoperative checklist and verify surgical consent 4. Teach deep breathing, coughing, and leg exercises **✔ 정답** **정답: 4** ## 해설 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. ## 심화 해설 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].References (research sources) - [1]Importance of early postoperative mobilization: comprehensive review.Research articleAlsuwaylihi A, O'Connor D, Joshi GP, Kehlet H, Lobo DN. (2025) · DOI: 10.1093/bjsopen/zrag016 ## 임상 시나리오 Clinical Practice Guide: Preoperative Teaching 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. Evidence-Based Rationale 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. Nursing Actions and Patient Education - **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. Interprofessional Collaboration 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. ## 핵심 개념 - **Atelectasis** — Collapse of lung tissue, a common postoperative complication due to shallow breathing from pain and anesthesia. - **Enhanced Recovery After Surgery (ERAS)** — Multimodal, evidence-based perioperative care protocols designed to achieve early recovery by maintaining preoperative organ function and reducing the stress response. - **Splinted Coughing** — A technique where a patient supports their surgical incision with a pillow or hands to reduce pain while coughing effectively to clear secretions. - **Venous Thromboembolism (VTE)** — A condition including deep vein thrombosis and pulmonary embolism, often prevented postoperatively with early ambulation and leg exercises. ## 같은 주제 문제 - [A nurse is assessing a patient 24 hours after abdominal surgery. 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