Comprehensive Respiratory System Disorders Q 38

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The nurse is planning to teach a client with COPD how to cough effectively. Which of the following instructions should be included?

  

     A. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation.

     B. Lie flat on back, splint the thorax, take two deep breaths and cough.

     C. Take several rapid, shallow breaths and then cough forcefully.

     D. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.

    

    

Correct Answer: A. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation.

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The goal of effective coughing is to conserve energy, facilitate the removal of secretions, and minimize airway collapse. The client should assume a sitting position with feet on the floor if possible. The client should bend forward slightly and, using pursed-lip breathing, exhale. After resuming an upright position, the client should use abdominal breathing to slowly and deeply inhale. After repeating this process 3 or 4 times, the client should take a deep abdominal breath, bend forward and cough 3 or 4 times upon exhalation (“huff” cough).

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Option B: Lying flat does not enhance lung expansion; sitting upright promotes full expansion of the thorax. Sit on a chair or on the edge of the bed, with both feet on the floor. Lean slightly forward. Relax. The patient should breathe in through their nose and out through their nose or mouth until they are ready to progress to the next stage.

Option C: Shallow breathing does not facilitate removal of secretions, and forceful coughing promotes collapse of airways. The client should lean forward, press the arms against the abdomen. Cough 2-3 times through a slightly open mouth. Coughs should be short and sharp. The first cough loosens the mucus and moves it through the airways. The second and third cough enables the client to cough the mucus up and out.

Option D: A side-lying position does not allow for adequate chest expansion to promote deep breathing. Sitting the patient out of bed or up in bed optimizes lung expansion. Critical care patients can sit out of bed if they are hemodynamically stable (this allows for better lung expansion). Ensure you have two to three clinicians assisting with any intravenous lines, cardiac monitoring, drain tubes, etc.

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