a question about post-op temp and incentive spirometry

nursynurseRN · Jan 13, 2011

Sometimes when people are under heavy sedation they don't breathe as deep as they should. Using an IS 10x an hour helps reduce pulmonary stasis which is a known cause of infection and fever and the correct use of I.S. encourages lung inflation, thereby potentially avoiding stasis and infection and reduing temperature.

carolmaccas66, BSN, RN · Jan 13, 2011

I don't specialise in post op, but did a 6 week clinical in OT, including recovery, post op wards, etc.

I would tell you to think about reasons why a patient's temp goes up. It could be a burgeoning infection, anxiety, is their BP high/low? Did they have a high temp before in recovery? (you would get or ask all this info from the recovery handover nurse).

I don't remember going over spirometers when doing recovery but it might be to do with the fact that patients become very anxious, leading to shortness of breath, so the spirometer corrects their O2 saturation.

But if someone had a high temp in recovery/post op, what would you be thinking of and checking? Well firstly maybe do a set of obs, look at their wounds/drains, check their obs every 15 minutes (which you would be doing in receovery anyway), are they on narcotics/a fent pump (affects respiration)? Do they have an epidural/PICC/IV that needs checking (look for signs of infection, redness, swelling, heat, pain, ooze), check catheter sites - is urine flowing at 30-50mls per hour? What colour is the urine (depending on the surgery it will look different) - does urine look too cloudy/bloody? Should you do a urine dipstick? Send off a sample perhaps? Do an ECG if any abnormal obs or patient has cardiac Hx. Do they have a Hx diabetes or thyroid problems maybe - any other medical conditions you need to take into account?

These are some of the things I would be thinking of, but most times people had infections with high temps, and at our hospital got put on prophylactic ABs anyway.

Like I said am not an OT nurse so others may have other, better suggestions.

And don't forget when patients get high temps, they get very cold as well so have lots of blankets on standby.

GHGoonette, BSN, RN · Jan 13, 2011

Breathing exercises may form part of what we refer to as "lung physio" and are indicated in post-op patients where there is shallow breathing and a reluctance to cough. Inactivity/bedrest may result in fluid accumulation in the lower part of the lungs leading to hypostatic pneumonia. We frequently see a slight increase in temp post operatively, as part of the body's normal inflammatory response, but it's not a major problem in patients who have had minor surgery, and who are mobilized the same day, unless it's really climbing towards the ceiling...but that's entirely another scenario.

Here's a nice article on spirometry:

Incentive Spirometry

BB8789 · Jan 13, 2011

Thank you all for your replies!

So, is it like because of all the "junk" in the lungs, the temp goes up because of "impending" infection? So deep breathing and coughing it up gets rid of it so the temp goes down.

Is that correct?

GHGoonette, BSN, RN · Jan 13, 2011

It will help reverse the effects of pulmonary fluid accumulation and prevent infection. If the patient has an infective focus elsewhere, say for example in the bladder or in the surgical wound, thus causing a rise in temperature, breathing and coughing exercises will not help for that. The indication is then for antibiotics and possibly irrigation of the affected area.

Click on the link and read the article, it explains it quite well.

BB8789 · Jan 13, 2011

thank you! = )

RNgrrl09 · Jan 13, 2011

If the patient is not breathing as deep, they are also retaining co2 which causes the temp to go up. Cellular respiration is the combustion of dextrose, when we breathe, we release the CO2 along with the heat that is produced from this combustion.

cherrybreeze, ADN, RN · Jan 13, 2011

The way I explain it to patients is this:

When you have pain (ie, from an abdominal incision) or sedation (from anesthesia and/or narcotic medications), you don't breathe as deeply as you should. This results in atelectasis, meaning the tubes at the very bottom of your lungs stick together because they don't get air when you breathe shallowly. This results in elevated temperature. Coughing, deep breathing (making your belly rise), and incentive all help to open those tubes up, thereby decreasing the temperature.

Make sense? Hope that helps!

CharmedJ7 · Jan 13, 2011

If the patient is not breathing as deep, they are also retaining co2 which causes the temp to go up. Cellular respiration is the combustion of dextrose, when we breathe, we release the CO2 along with the heat that is produced from this combustion.

This is an interesting explanation. Although of course deep breathing decreases the risk of atelectasis and pneumonia, it doesn't quite follow that the beginning of an infectious process is what causes the low-grade fever so a couple puffs on the IS will clear it - I just am not sure I entirely believe that, it would suggest the act of IS is itself clearing the infection, whereas I as I understand it IS more reduces the odds of infection or limits the progression perhaps.

This is an interesting explanation from an older thread:

"I agree it doesnt decrease the temperature. However, it does help dry up the atelectic secreations in the lungs that are causing the temp to go up. Using the incentive spirometer correctly will quickly open and dry up the lungs so there isnt anything for the bacteria/germs to grow in. Ive seen temps go down with consistent use over a period of a few hours given the temp hasnt reached over 100."

Same thread, also interesting:

"A study conducted to determine the relation of postoperative fever and atelectasis found, however, no relation between atelectasis and fever postoperatively.[9]"

My guess? No one really knows WHY or IF it helps, but there's a lot of interesting potential mechanisms and a lot of anecdotal 'evidence' that it does some good. I'm still really curious as to the why, but honestly, even if it doesn't help with fever, I'd still encourage my patients to do it b/c it certainly helps with atelectasis and oxygen saturation, and that's enough for me.

klone, MSN, RN · Jan 13, 2011

A lot of people didn't really answer the physiology behind why using the IS directly causes the temp to go down. If the temp is up d/t infection, the use of the IS will not "cure" the infection. I think RNGrrl09's explanation is most plausible.

When I had girl-bits surgery a few years ago, I was AMAZED at how effective the IS was. I would wake up every few hours through the night and feel really tight and slightly SOB, and half a dozen puffs on that thing cleared it up immediately. I was surprised at how I could actually FEEL the atelactasis taking place.

ObtundedRN, BSN, RN · Jan 13, 2011

I'm a big fan of the IS. I've seen it over the course of my shift with lots of encouragment of it's use, show great improvements in my patients. Being in critical care, there isn't always too many patients that can actually use the IS. But when they can, I'm usually the first one to pull it out. I actually get kinda upset when I find a patient without one, and could have started using one several days prior.

Many people somewhat explained it. The temp is r/t infection trying to set in due to hypoventilation, and the IS helps to open those airways and move static secretions. And I was always taught that temp on the day of surgery is r/t ventilation. If you get an infection at the surgical site, it will probably be 2 or 3 days before you see a fever set in (probably not always true, but i think its fairly accurate to say that).