Goal: The patient and/or significant other verbalizes an understanding of the instructions and is able to demonstrate the activities.
1. Check the patient’s chart for the type of surgery and review the medical orders.
2. Gather the necessary supplies and bring to the bedside stand or overbed table.
3. Perform hand hygiene and put on PPE, if indicated.
4. Identify the patient.
5. Close curtains around bed and close the door to the room, if possible. Explain what you are going to do and why you are going to do it to the patient.
6. Identify the patient’s learning needs. Identify the patient’s level of knowledge regarding deep breathing exercises, coughing, and splinting of the incision. If the patient has had surgery before, ask about this experience.
7. Explain the rationale for performing deep breathing exercises, coughing, and splinting of the incision.
8. Provide teaching about deep breathing exercises.
a. Assist or ask the patient to sit up (semi- or high-Fowler’s position) and instruct the patient to place the palms of both hands along the lower anterior rib cage.
b. Instruct the patient to exhale gently and completely.
c. Instruct the patient to breathe in through the nose as deeply as possible and hold breath for 3 seconds.
d. Instruct the patient to exhale through the mouth, pursing the lips like when whistling.
e. Have the patient practice the breathing exercise three times. Instruct the patient that this exercise should be performed every 1 to 2 hours for the first 24 hours after surgery.
9. Provide teaching regarding coughing and splinting (providing support to the incision).
a. Ask the patient to sit up (semi-Fowler’s position) and apply a folded bath blanket or pillow against the part of the body where the incision will be (e.g., abdomen or chest).
b. Instruct the patient to inhale and exhale through the nose three times.
c. Ask the patient to take a deep breath and hold it for 3 seconds and then cough out three short breaths.
d. Ask the patient to take a breath through the mouth and strongly cough again two times. e. Instruct the patient that he or she should perform these actions every 2 hours when awake after surgery.
10. Validate patient’s understanding of information. Ask the patient to give a return demonstration. Ask the patient if he or she has any questions. Encourage the patient to practice the activities and ask questions, if necessary.
11. Remove PPE, if used. Perform hand hygiene.
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