After Surgery: Incentive Spirometry, Ambulation, Opioid Safety, and Complication Warning Signs
Teach incentive spirometer use 10 times every hour while awake, deep breathing and coughing with a pillow splint, and walking several times a day. Teach scheduled pain control with opioid safety: no alcohol, no driving, and a bowel regimen to prevent constipation. Call 911 for sudden shortness of breath, chest pain, heavy bleeding, or a wound that opens.
Who needs this teaching
Clients discharged after surgery and the caregiver who helps at home. Common postoperative complications are atelectasis, pneumonia, venous thromboembolism, surgical site infection, constipation, and urinary retention.
The priority teaching points
- Pulmonary hygiene. Use the incentive spirometer 10 times every hour while awake. Sit upright, exhale, seal the lips around the mouthpiece, inhale slowly and deeply, and hold the breath for 3 to 5 seconds. Then take deep breaths and cough while splinting the incision with a pillow. These measures expand the alveoli and prevent atelectasis and pneumonia.
- Ambulation. Walk several times a day and increase the distance gradually. Ambulation promotes venous return, lung expansion, and peristalsis. Perform ankle pumps while in bed or seated. Take prescribed anticoagulant prophylaxis for the full duration.
- Pain control. Take pain medication on schedule as prescribed, before pain becomes severe and before activity. Controlled pain allows deep breathing, coughing, and walking. Count acetaminophen in combination products toward the daily limit, no more than 4,000 mg daily in most adults, or the lower limit the provider sets.
- Opioid safety. Do not drink alcohol or take sedatives, sleep aids, or benzodiazepines with opioids; the combination causes respiratory depression. Do not drive or operate machinery. Store opioids locked and out of reach of children. Dispose of unused tablets at a drug take-back site. Keep naloxone at home when prescribed, and teach the caregiver to use it.
- Bowel function and nutrition. Opioids and reduced activity cause constipation. Drink fluids unless restricted, eat fiber-rich foods, walk, and take the prescribed stool softener or laxative. Eat adequate protein to promote wound healing.
- Incision care. Perform hand hygiene before touching the incision. Keep it clean and dry. Shower as the surgeon instructs; do not soak in a bathtub, hot tub, or pool until cleared. Leave adhesive strips in place until they fall off.
- Activity limits. Avoid heavy lifting, pushing, and pulling for the period and weight limit the surgeon sets. Lifting increases intra-abdominal pressure and strains the incision.
- Complication signs. Surgical site infection: increasing redness, swelling, warmth, or pain, purulent drainage, and fever of 101 F (38.3 C) or higher. Deep vein thrombosis: unilateral leg edema, warmth, and pain. Urinary retention: inability to void for 8 hours, or frequent small voids with suprapubic distention. Wound evisceration: cover the wound with a clean, moist dressing, lie with the knees bent, and call 911.
Red flags the client reports
| Call the provider the same day | Call 911 or the local emergency number |
|---|---|
| Increasing redness, swelling, warmth, or purulent drainage at the incision | Sudden shortness of breath |
| Temperature of 101 F (38.3 C) or higher | Chest pain |
| Swelling, warmth, or pain in one leg | Bleeding that soaks the dressing or does not stop with pressure |
| Inability to void for 8 hours, or suprapubic distention | Wound opening, or tissue protruding through the incision |
| Abdominal distention, nausea, or vomiting with no bowel movement | Slow or shallow breathing, or difficulty waking |
Teach-back questions
- "Show me how you use your incentive spirometer."
- "How often will you walk each day?"
- "What will you avoid while you take your opioid pain medicine?"
- "Which signs at your incision mean you call?"
- "What will you do if your wound opens?"
Teaching tips
- Observe a return demonstration of incentive spirometer use and splinted coughing.
- Write the lifting limit, shower date, and follow-up appointment on the handout.
- Teach the caregiver the signs of opioid-induced respiratory depression.
Read more on NCLEXPace
- Perioperative Nursing: Safety Across the Surgical Journey
- Pain Management and Naloxone: Relieve Pain, Protect Breathing
- Immobility and VTE: Prevent the Clot Before It Travels
Sources
- Harding MM, Kwong J, Hagler D, Reinisch C. Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 12th ed. Elsevier; 2023; Chapter: Pain.
- Restrepo RD, et al. AARC Clinical Practice Guideline: Incentive Spirometry: 2011. Respir Care. 2011;56(10):1600-1604.
- Chou R, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists. J Pain. 2016;17(2):131-157.
- Dowell D, et al. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep. 2022;71(3):1-95.
- Berrios-Torres SI, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017;152(8):784-791.
Why this matters for the NCLEX
Teaching is effective when the client states, "I will use my incentive spirometer 10 times every hour while I am awake," and "I will hold a pillow against my incision when I cough." Statements requiring further teaching include, "I will stay in bed until my pain is gone," "A glass of wine will help my pain pill work," and "I will rub my sore, swollen calf."
Frequently asked questions
Why does the client take pain medication before walking and deep breathing?
Uncontrolled pain causes shallow breathing and immobility. Controlled pain allows effective coughing, deep breathing, and ambulation, which prevent atelectasis and venous thromboembolism.
What does the client do if the incision opens and tissue protrudes?
Cover the wound with a clean, moist dressing, lie down with the knees bent, and call 911. Do not push the tissue back into the wound.
More patient teaching on Perioperative / Pre & Post-Op
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