The nurse is instructing a patient, recovering from thoracic surgery, on pulmonary hygiene. Which of the following will facilitate the removal of lung secretions causing the least amount of pain to the patient?
1. Instruct the patient to cough 3 to 4 times with each exhalation.
2. Assist the patient to a sitting position to lean over the bedside table while coughing.
3. Provide the patient with a pillow to splint the incision while coughing.
4. Guide the patient to cough with the glottis open.
4
Rationale: Pulmonary hygiene is an integral part of post-thoracic surgery care. Patients must be able to take a deep breath and generate an exhalation sufficiently strong to clear secretions. There are two types of coughs however the "huff" cough or coughing with the glottis open is a gentle maneuver, and is effective. This is the type of cough the nurse should assist the patient with performing. The "cascade" cough is a series of 3 - 4 coughs on one exhalation. This type of cough could cause the patient more discomfort. Splinting the incisional area does decrease pain with cough however splinting should be done with a towel or a folded sheet and not a pillow. The patient should not be assisted to a sitting position to lean over the bedside table to cough.
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