The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching?
A. Make inhalation longer than exhalation.
B. Exhale through an open mouth.
C. Use diaphragmatic breathing.
D. Use chest breathing.
Correct Answer: C. Use diaphragmatic breathing.
In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. When the client has COPD, air often becomes trapped in the lungs, pushing down on the diaphragm. The neck and chest muscles must then assume an increased share of the work of breathing. This can leave the diaphragm weakened and flattened, causing it to work less efficiently.
Option A: Exhalation should be longer than inhalation to prevent collapse of the bronchioles. Never allow a patient to force expiration. expiration should be relaxed or lightly controlled. forced expiration only increases turbulence in the airways leading to bronchospasm and increased airway restriction.
Option B: The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. The client should tighten his stomach muscles, letting them fall inward as he exhales through pursed lips. The hand on his upper chest must remain as still as possible.
Option D: Diaphragmatic breathing — not chest breathing — increases lung expansion. Controlled breathing techniques, which emphasize diaphragmatic breathing are designed to improve the efficiency of ventilation, decrease the work of breathing, increase the excursion of the diaphragm, and improve gas exchange and oxygenation.
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