The nurse is planning care to address ineffective airway clearance for a client with lung cancer. Which interventions should the nurse include in the client's plan of care? Select all that apply
A) Increase fluid intake to 3000 mL per day.
B) Turn, cough, and deep breathe every 2 hours.
C) Chest percussion every 8 hours
D) Smoking cessation education
E) Administer pneumococcal vaccine.
Answer: A, B, C
An adequate fluid intake is needed. Clients with pneumonia should increase their fluid intake in order to decrease the viscosity of respiratory secretions. Turning, coughing, deep breathing and chest percussion can help clear secretions. Administering the pneumococcal vaccine and educating the client on smoking cessation are important in treating a client with pneumonia, but they would be aligned with a different nursing diagnosis.
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