1122 UNIT X / Responses to Altered Respiratory Function
techniques, preventing exacerbations, and managing pre-
scribed therapies.
Pursed-lip and diaphragmatic breathing techniques help
minimize air trapping and fatigue. Pursed-lip breathing helps
maintain open airways by maintaining positive pressures
longer during exhalation. Teach the client to:
1. Inhale through the nose with the mouth closed.
2. Exhale slowly through pursed lips, as though whistling or
blowing out a candle, making exhalation twice as long as
inhalation.
Diaphragmatic or abdominal breathing helps conserve energy
by using the larger and more efficient muscles of respiration.
Teach the client to:
1. Place one hand on the abdomen, the other on the chest.
2. Inhale, concentrating on pushing the abdominal hand out-
ward while the chest hand remains still.
3. Exhale slowly, while the abdominal hand moves inward
and the chest hand remains still.
Repeat these exercises as often as necessary until the tech-
niques become incorporated into normal breathing.
Several different coughing techniques may be useful. For
controlled cough technique, teach the client to:
1. Following prescribed bronchodilator treatment, inhale
deeply, and hold breath briefly.
2. Cough twice, the first time to loosen mucus, the second to
expel secretions.
3. Inhale by sniffing to prevent mucus from moving back into
deep airways.
4. Rest. Avoid prolonged coughing to prevent fatigue and
hypoxemia.
For huff coughing, teach the client to:
1. Inhale deeply while leaning forward.
2. Exhale sharply with a “huff” sound, to help keep airways
open while mobilizing secretions.
In addition, include the following topics when teaching for
home care.
•Maintaining adequate fluid intake, at least 2.0 to 2.5 quarts
of fluid daily
•Avoiding respiratory irritants, including cigarette smoke,
both primary and secondary, other smoke sources, dust,
aerosol sprays, air pollution, and very cold dry air
•Preventing exposure to infection, especially upper respira-
tory infections
•Importance of pneumococcal vaccine and annual influenza
immunization
•Prescribed exercise program, maintaining ADLs, and bal-
ancing rest and exercise
•Maintaining nutrient intake (e.g., eating small frequent
meals and using nutritional supplements to provide adequate
calories)
•Ways of reducing sodium intake if prescribed
•Identifying early signs of an infection or exacerbation and
the importance of seeking medical attention for the follow-
ing: fever, increased sputum production, purulent (green or
yellow) sputum, upper respiratory infection, increased
shortness of breath or difficulty breathing, decreased activ-
ity tolerance or appetite, increased need for oxygen
•Prescribed medications, including purpose, proper use, and
expected effects
•Avoiding use of over-the-counter medications unless ap-
proved by the physician.
•Other prescribed therapies, such as use of home oxygen,
percussion, postural drainage, and nebulizer treatments
•Use, cleaning, and maintenance of any required special
equipment
•Importance of wearing an identification band and carrying a
list of medications at all times in case of an emergency.
Provide referrals to home care services such as home health,
assistance with ADLs as needed, home maintenance services,
respiratory therapy and home oxygen services, and other agen-
cies such as Meals-on-Wheels and senior services as indicated.
Anna Mercurio, known as “Happy” by all her
friends, is an 83-year-old widow who lives with
her two adult sons. Over the past 15 years,Mrs. Mercurio has be-
come increasingly short of breath while gardening and walking,
two favorite activities. She also has developed a chronic cough
that is particularly bad in the mornings. Ten years ago, her fam-
ily physician told her that she had emphysema. She is admitted
to the hospital with possible pneumonia and acute exacerba-
tion of COPD.
ASSESSMENT
Jeff Harris, RN, admits Mrs. Mercurio to the medical unit. In the
nursing history,Mr. Harris notes that she denies ever smoking,but
says that her husband and two sons have been smokers “for prac-
tically their whole lives.”She says she lived an active life before de-
veloping lung disease, but now her breathing and cough have
progressed so that she now must rest after just a few minutes of
housework or other activity.Her cough is productive of moderate
to large amounts of sputum, particularly in the mornings. She
Nursing Care Plan
A Client with COPD
