Definition
Postoperative exercises are designed to help patients recover from surgery as quickly as possible and to prevent possible complications.
Exercises included
- Ambulation.
- Diaphragmatic breathing.
- Leg exercises.
- Arm and shoulder exercises.
- Turning in bed.
Ambulation Exercise
Assisting a patient to walk after a period of being immobile following surgery.
Purposes
- To exercise muscles and joints for regaining strength.
- To increase patient’s sense of independence.
- To increase mobility.
- To prevent postoperative complication
Procedure
| Nursing Action | Rationale | |
| 1 | Assess patient’s condition, vital signs, and any contraindications. | Predicts the patient’s tolerance for ambulation. |
| 2 | Check the time when patient received last dose of sedative drug. | |
| 3 | Assess patient’s ability to walk. | |
| 4 | Keep a foot stool beside bed, if required. | Assists in getting out of bed safely. |
| 5 | Keep a chair with backrest and extra pillows ready near the bed. | |
| 6 | Make sure that the floor is clean and dry. Ensure that slippers worn by patient are made of nonskid material. | Clutter free and well-lighted area prevents falls during ambulation. |
| 7 | Explain procedure and purpose of ambulation. | Promotes patient cooperation for ambulation. |
| 8 | Ensure that patient is adequately dressed and well groomed. | |
| 9 | free all drains attached to bedside. Empty uro bag. Ensure that the drainage bag is held below hip level. | Urine bag held below hip level prevents back flow of urine. |
| 10 | Raise head end of bed 40-60° and assist patient to sit up. Bring patient’s legs to edge of bed and allow feet to dangle. | Prevents orthostatic hypotension. |
| 11 | Check for dizziness, drowsiness, pain, etc. Ensure that pain medication was administered half an hour before ambulation, if ordered. | Ensures that patient is able to tolerate ambulation. |
| 12 | Assist patient to get out of bed slowly and to stand with head erect and back straight. | |
| 13 | Support patient on either side by holding at inferior aspect of upper arms and assist him to walk with even gait. Supportive or assistive devices like Zimmer frame or walker crutches can be provided as per the need of the patient. | Provides confidence for patient and prevents accidental fall. |
| 14 | After walking, allow patient to rest in chair for some time and then assist back to bed. Check vital signs and note untoward changes if any. | |
| 15 | Connect the drains back in position and make patient comfortable and leave the unit neat. | |
| 16 | Record in patient’s chart the distance walked, duration of ambulation, and patient’s response. | Gives information about the patient’s response to the exercise. |
Special consideration
- Have chair or wheel chair readily available in case patient cannot tolerate the exercise.
- Use safety-walking belt if available.
Diaphragmatic (deep breathing) Exercise
Definition
Lung expanision exercise to be performed by patient to reduce postoperative respiratory complications.
Purposes
- To enhance lung expansion and gas exchange.
- To prevent complications such as respiratory infections and atelectasis.
Procedure
| Nursing Action | Rationale | |
| 1 | Assess patient’s risk for postoperative respiratory complications. Identify presence of chronic pulmonary condition or any condition that affects chest wall movement, history of smoking, and presence of reduced hemoglobin. | General anesthesia predisposes patient to respiratory problems because lungs are not fully inflated during surgery. Cough reflex is suppressed and mucus collects within air passages postoperatively. Patient may have reduced lung volume and requires greater efforts to cough and deep breath. Inadequate lung expansion can lead to atelectasis and pneumonia |
| 2 | Explain procedure to patient including the advantages of diaphragmatic breathing. | Helps in obtaining cooperation of patient. |
| 3 | Assess patient’s ability to cough and deep breath by instructing patient to take deep breaths. Observe movements of shoulders and chest wall. Measure chest expansion during deep breath. Ask patient to cough after taking a deep breath | Reveals maximum potential for chest expansion and ability to cough forcefully. Serves as baseline to measure patient’s ability to perform exercises postoperatively. |
| 4 | Assess patient’s willingness and capability to learn exercise, note factors such as attention span, anxiety, level of consciousness, and language known. | Ability to learn depends on readiness, ability, and learning environment. |
| 5 | Assess family member’s willingness to learn and support patient postoperatively. | Presence of families postoperatively can be a potential motivating factor for patient’s recovery. Family members can coach patients on exercise performance. |
| 6 | Assess patient’s medical orders-both preoperative and postoperative. | Determines if patient requires adaptations in the way exercises are performed. |
| 7 | Assist patient to comfortable sitting or standing position. If patient chooses to sit, assist to side of bed or to upright position in chair. | Upright position facilitates diaphragmatic excursion |
| 8 | Stand or sit facing patient for demonstrating breathing exercise to Patient | Patient will be able to observe breathing exercise performed by nurse. |
| 9 | Instruct patient to place palm of one hand on chest and another on abdomen and concentrate on filling up the abdomen by inhaling slowly through the nose. On exhalation, the patient uses pursed lip breathing. | |
| 10 | Demonstrate for patient the exercise and instruct to perform every 2 hours while awake, during postoperative period until mobile. Explain that abdominal organs descend and chest wall expands during inspiration | Slow deep breaths prevent panting or hyperventilation. Inhaling through nose warms, humidifies, and filters air. Explanation and demonstration focus on normal ventilatory movement of chest wall. |
| 11 | Repeat breathing exercise three to five times. | Allows patient to observe slow, rhythmical breathing pattern. |
| 12 | Have patient practice the exercise. Patient is instructed to take 10 slow deep breaths every 2 hours while awake during postoperative period until mobile. | Repetition of exercise reinforces learning. Regular deep breathing will prevent postoperative complications. |
| 13 | Record the procedure. | Gives information about patient’s response to the exercise. |
Controlled coughing
Lung exercise involving voluntary coughing, performed by patient to encourage expulsion of sputum and increase lung function.
Purposes
- To promote lung expansion and gas exchange,
- To prevent complications like infection and atelectasis.
- To loosen and bring out secretions.
| Nursing Action | Rationale | |
| 1 | Explain procedure to patient. | Helps in obtaining cooperation of the patient. |
| 2 | Explain importance of maintaining upright position. | Position facilitates diaphragmatic excursion and enhances thoracic expansion. |
| 3 | If surgical incision is either abdominal or thoracic, teach patient to place a small pillow or folded sheet over incisional area and splint incision. Instruct to press gently against incisional area holding a small pillow or folded sheet over it during breathing and coughing exercise | Surgical incision cuts through muscle tissues and nerve endings. Deep breathing and coughing exercises place additional stress on suture line and causes discomfort. Splinting incision with hands or pillows provides firm support and reduces incisional pulling. |
| 4 | Demonstrate coughing: Taking two slow deep breaths inhaling through nose and exhaling through mouth. | Deep breath expands lungs fully so that air moves behind mucus and facilitates effect of coughing. |
| 5 | Breathe deeply a third time and hold breath to count of 3, perform 2-3 consecutive coughs without inhaling between coughs | Consecutive coughs help remove mucus more effectively and completely than one forceful cough. |
| 6 | Caution patient against just clearing the throat instead of coughing. | Clearing throat does not remove mucus from deep airways. |
| 7 | Instruct the patient to cough two or three times every 2 hours while awake. | Value of deep coughing with splinting is stressed to effectively expectorate mucus with minimal discomfort. |
| 8 | instruct patients to examine sputum for consistency, odor, amount, and color changes. | Change in consistency odor, amount, and color of sputum may indicate the presence of pulmonary complications such as infection. |
| 9 | Record the procedure, observations made and patient’s response. |
Leg exercise
Definition
Assisting patient to move lower limbs.
Purposes
- To improve circulation and prevent thrombophlebitis and thrombus formation.
- To relieve pain or discomfort.
Procedure
| Nursing Action | Rationale | |
| 1 | Explain procedure to the patient. | Helps in obtaining cooperation of the patient. |
| 2 | Help patient assume supine semi-Fowler’s position in bed. Demonstrate leg exercises by performing active range of motion exercises and explaining each exercise. | Supine position provides normal anatomical position of lower extremities. |
| 3 | Rotate each ankle in complete circle. Instruct patient to draw an imaginary circle with big toe. Repeat five times | Leg exercises maintain joint mobility and venous return. |
| 4 | Alternate dorsiflexion and plantar flexion by moving both feet up and down. Direct patient to feel calf muscles, contract, and relax alternately | Stretches and contracts gastrocnemius muscles. |
| 5 | instructs patients to continue leg exercise by alternately flexing and extending knees. Repeat five times | Contracts muscles of upper legs and maintains knee mobility. |
| 6 | Instruct patient to alternately raise each leg straight up from bed surface, keeping legs straight. Repeat five times [ | Promotes contraction and relaxation of quadriceps muscles. |
| 7 | Have patient continue to practice exercises at least every 2 hours, while awake. Patient is instructed to coordinate turning and leg exercises with diaphragmatic breathing and coughing exercises. | Repetition of sequence of exercises reinforces learning. |
| 8 | Record exercises that have been demonstrated to patient and weather. Patient performs exercises independently. | Ensures continuity of exercises. |
| 9 | Record physical assessment findings in nurse’s notes or flow sheets. | Document baseline for later comparison |
| 10 | Report any problem patient has in practicing exercises. | Informs staff so that reinforcement can be provided. |
Arm and shoulder strengthening exercise
Definition
Assisting patient to move upper limbs and accessory appendages.
Purposes
- To relieve pain or discomfort.
- To strengthen and regain the flexibility of the supporting muscles and ligaments.
- Prevents complication after major surgery involving the structures, e.g., mastectomy, surgery of wrist, elbow, etc.
Procedure
| Nursing Action | Rationale | |
| 1 | Explain procedure to the patient. | Helps in obtaining cooperation of the patient. |
| 2 | Help patient assume supine semi-Fowler’s position in bed. Demonstrate arm and shoulder exercises by performing active range of motion exercises and explaining each exercise. | Supine position provides normal anatomical position of lower extremities. |
| 3 | Instruct patient to lift the affected arm (on the side where surgery was) as normally as possible as while combing hair, bathe, get dressed, or while eating. | Such exercises help relieve swelling that may result after a major surgery involving the upper appendages. |
| 4 | Instruct patient to lie down and raise affected arm above the level of heart for 45 minutes. Do these 2 or 3 times a day. Put arm on pillows so that hand is higher than wrist and elbow is a little higher than shoulder. | This will help decrease the swelling that may happen after surgery. |
| 5 | instructs the patient to exercise the affected arm while it is raised above the level of the heart by opening and closing hand 15 to 25 times. Next, bend and straighten the elbow. Repeat these 3 to 4 times a day. | This exercise helps reduce swelling by pumping lymph fluid out of your arm. |
| 6 | Wand exercises Instruct patient to lie supine with their knees bent and feet flat. Hold the wand/stick like object across belly in both hands with the palms facing up. Instruct to lift the wand up over the head as far as they can. Use the unaffected arm to help lift the wand until there is a feeling of stretch in the affected arm. Hold for 5 seconds. Lower arms and repeat 5 to 7 times. | This exercise helps increase the ability to move shoulders forward. |
| 7 | Side bends : In this, instruct patient to sit in a chair or in a semi- sitting position and clasp hands together in front of them. Lift arms slowly over head, straightening your arms. When arms are overhead, ask patient to bend trunk to the right keeping your arms overhead. Return to the starting position and bend to the left. Repeat 5 to 7 times. | |
| 8 | Have patient continue to practice exercises at least every 2 hours, while. awake. Patient is instructed to coordinate turning and leg exercises with diaphragmatic breathing and coughing exercises. Other exercises like side bends, shoulder squeeze, etc., can also | Reception of sequence of exercises reinforces learning |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
