(5) Coughing, in conjunction with deep breathing, helps to remove retained
mucus from the respiratory tract. Coughing is painful for the postoperative patient. While
in a semi-Fowler's position, the patient should support the incision with a pillow or folded
bath blanket and follow these guidelines for effective coughing:
Inhale and exhale deeply and slowly through the nose three times.
Take a deep breath and hold it for 3 seconds.
(c) Give two or three "hacking" coughs while exhaling with the mouth
open and the tongue out.
Take a deep breath with the mouth open.
Cough deeply once or twice.
Take another deep breath.
Repeat these steps every 2 hours while awake.
(6) An incentive spirometer may be ordered to help increase lung volume,
inflation of alveoli, and facilitate venous return. Most patients learn to use this device and
can carry out the procedure without a nurse in attendance. Monitor the patient from time
to time to motivate them to use the spirometer and to be sure that they use it correctly.
(a) While in an upright position, the patient should take two or three
normal breaths, then insert the spirometer's mouthpiece into his mouth.
Inhale through the mouth and hold the breath for 3 to 5 seconds.
Exhale slowly and fully.
(d) Repeat this sequence 10 times during each waking hour for the first 5
post-op days. Do not use the spirometer immediately before or after meals.
b. Cardiovascular System. Venous return from the legs slows during surgery
and may actually decrease in some surgical positions. With circulatory stasis of the legs,
thrombophlebitis and emboli are potential complications of surgery. Venous return is
increased by flexion and contraction of the leg muscles.
(1) To prevent thrombophlebitis, instruct the patient to exercise the legs while
on bedrest. Leg exercises are easier if the patient is in a supine position with the head of
the bed slightly raised to relax abdominal muscles. Leg exercises (figure 8-8) should be
individualized using the following guidelines.