A client is transferred from the post-anesthesia recovery unit to the surgical unit following an open cholecystectomy. Which interventions are most important for the nurse to perform to prevent postoperative pneumonia? Select all that apply.

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Strategies to prevent postoperative pneumonia include the following: Adequate pain control is a priority so that the client can move, deep breathe, and cough more effectively and comfortably. Opioids are effective for relieving postoperative pain, but because they depress respirations and the cough reflex, assessing the client's response to the medication and level of sedation is important. Ambulate within 8 hours after surgery, if possible. Mobilization/early ambulation decreases atelectasis and hypoventilation, and promotes coughing, deep breathing, and lung expansion. Usually, it can be initiated within 4-8 hours after surgery. Coughing with splinting every hour. Splinting of the incision and adequate pain management are useful for promoting an effective cough (huff, cascade) that clears the airway of secretions. Coughing with splinting Deep breathing and use of the incentive spirometer every hour. Deep breathing in conjunction with the use of the incentive spirometer promotes ventilation and oxygenation. It opens the pores of Kohn that permit air from well-ventilated alveoli to move into collapsed alveoli, and it helps to prevent/decrease atelectasis and hypoventilation caused by the effects of anesthesia, analgesia, and pain. Place in Fowler's position. Elevating the head of the bed 45-60 degrees helps to promote oxygenation and prevent aspiration. Turn and reposition the client at least every 2 hours. Swab mouth with chlorhexidine swabs every 12 hours. Mouth care prevents ventilator-associated and postoperative pneumonia. Use hand hygiene (all personnel) to decrease transmission of microorganisms. (Option A) Adequate pain control is a priority. The decision to hold opioids is usually based on sedation level. Giving pain medicine only for severe pain is not appropriate. If the client is awake and complains of pain, adequate analgesia should be provided (oral or IV). (Option E) Use of pneumatic compression devices promotes venous return and helps to prevent venous thrombosis, not pneumonia. Educational objective: Strategies to prevent postoperative pneumonia include adequate pain management, positioning, coughing and deep breathing, mobilization and early ambulation, twice daily chlorhexidine mouth care, and precautions for limiting the transmission of microorganisms.

A Client Is Transferred from the Post-Anesthesia Recovery Unit to the Surgical