On the third postoperative day following thoracic surgery, which action is indicated?

• A. Begin ambulation as tolerated
• B. Withhold all fluids until nausea subsides
• C. Provide warm prune juice before bedtime
• D. Encourage heavy laxatives to move bowels

Answer: (C)

Postoperative constipation management is the focus here. After thoracic surgery, opioids and reduced mobility commonly slow bowel motility, so a gentle approach to encourage a bowel movement is appropriate. Providing warm prune juice before bedtime uses sorbitol, a natural osmotic laxative, to draw water into the stool and stimulate peristalsis. The warmth can also help relax the bowel and promote motility, making it a safe, low-risk option on the third day when constipation is a likely concern.

In contrast, withholding fluids would worsen constipation and dehydration, and heavy laxatives can cause cramping and excessive straining, which is undesirable after thoracic surgery due to the stress it places on the incisions and respiratory effort. Ambulation is beneficial for overall recovery and preventing atelectasis, but the targeted, patient-friendly step to address bowel movement at this moment is the prune juice.