Nursing Guidance and Training Techniques for Effective Coughing

8.2.3.2.1 Definition

Patients should be guided through effective cough precautionary measures, which is conducive to the discharge of secretions at the far end of the airway, so as to improve lung ventilation, keep the respiratory tract open, reduce repeated infections, and improve the patient’s lung function.

• 8.2.3.2.2 Purpose
• 1) Keep the respiratory tract unobstructed and avoid sputum accumulation.
• 2) Discharge of airway secretions effectively and promote disease recovery.
• 3) Prevent infection and reduce postoperative complications.
• 8.2.3.2.3 Key Points of Operation
• 1) Instruct patients to take a comfortable and relaxed position. Guide them to inhale slowly and deeply, close the glottis briefly, and increase the pressure in the pleural cavity. Then tell them to quickly open the glottis and force the abdomen to expel gas, which will also cause coughing. Inhale once and cough three times continuously.
• 2) Stop coughing and exhale the rest of the gas in the half-closed lip as far as possible.
• 3) Inhale slowly and deeply again and repeat the above actions. Rest and breathe normally after doing this two to three times in a row. Start again after a few minutes, combined with the back clapping technique if necessary. (To perform the back clapping technique, close the fingers into a cup, and tap evenly and rhythmically with the strength of the wrist, from bottom to top and from outside to inside. The intensity should be appropriate, so as not to make patients feel pain).
• 4) Patients should be instructed to cover the sputum with tissue to avoid splashing. After sputum excretion, let them take a comfortable position and conduct pulmonary auscultation.

• 8.2.3.2.4 Precautions
• 1) Education and cooperation of patients

a. Explain the significance and purpose of respiratory function training before training. Try to avoid causing patients emotional tension during training by explaining well and obtaining their cooperation.

b. Tell the patients to be prepared.

2) Effective coughing and right position

a. According to the needs of the disease, take comfortable positions. Take five to six deep breaths first and hold the breath at the end of deep inhalation, then cough several times to bring sputum to the pharynx, and cough hard to expel it.

b. Let the patients take a sitting position with a pillow on both legs and positioned against the abdomen to promote diaphragm elevation. Lean forward and bend head and neck when coughing, and cough with mouth open to expel sputum.

c. Ask patients to take a lateral position with knees bent that is conducive to the diaphragmatic muscle, abdominal muscle contraction, and increased abdominal pressure. Frequently change the position, which benefits sputum coughing.

3) Precautions for effective cough training

a. Avoid paroxysmal coughing and keep quiet breathing for a while after coughing for three times. People with a history of cerebrovascular rupture, embolism, or hemangioma should avoid coughing vigorously.

b. Based on the patient’s body shape, nutritional status, cough tolerance degree, select an effective cough training mode, time, and frequency. In general, it should be arranged 1 to 2 hours before or 2 hours after the patient’s meal. Patients with continuous nasogastric feeding should be discontinued 30 minutes before operation.

c. Check the patient’s chest and abdomen for wounds and take appropriate measures to avoid or relieve the pain caused by cough. Ask the patient to gently press the wound area or use a pillow to press the wound so as to counteract or resist the local pull and pain in the wound caused by coughing.

d. Follow the principle of labor-saving and safety. Closely observe the changes in patients’ consciousness and vital signs during operation.

e. The operator should keep a distance of 1-2 meters from the patient and instruct them to use tissue paper.

f. Evaluation indexes of effective cough and sputum excretion: Decreased sputum volume per day < 25 mL; respiratory sounds are improved at the lesion site, without moist rales; patients’ good response to the treatment; improved blood oxygen saturation and chest radiograph.

Nursing Guidance and Training Techniques of Postural Drainage

8.2.3.3.1 Definition

Postural drainage refers to gravity drainage of secretions combined with thoracic manipulation, such as back clapping and tremor, most of which can achieve obvious clinical effects.

8.2.3.3.2 Purpose

Changing patients’ positions by using the principle of gravity is conducive to secretion discharge. It can also improve pulmonary ventilation, increase ventilation blood flow ratio, prevent or reduce pulmonary infection, maintain the patency of the respiratory tract, reduce repeated infection, and improve the patient’s lung function.

• 8.2.3.3.3 Key Points of Operation
• 1) Postural drainage is conducted by different postures according to the lesion site. If the lesion is in the upper lobe of both lungs, take the sitting position or other appropriate posture; if the lesion is in the anterior segment of the upper lobe of the left lung and the middle lobe of the right lung, the head can be taken with a height of 30° lower than the foot; if the lesion is in the left lower lobe and right lower lobe, the head can be taken with a height of 45° lower than the foot to facilitate drainage.
• 2) If the secretions do not come out after 5-10 minutes of drainage, perform the next position. Hie total time should not be more than 30-45 minutes, generally once in the morning and afternoon.
• 8.2.3.3.4 Precautions
• 1) Education and cooperation of patients

a. Explain the purpose and method of postural drainage before sputum discharge. Eliminate the patient’s tension so that they can cooperate well.

b. Inform the patients and family members in a precise manner. Tell the patients to drink warm water during sputum discharge, to dilute the sputum and discharge efficiently.

2) Precautions for postural drainage

a. Postural drainage and sputum excretion: It is suitable for patients with broncho-pulmonary disease who have large amounts of sputum. The principle of this activity is that it elevates the affected lung’s position, makes the opening of drainage bronchus downward, and takes the corresponding position according to the lesion site and the patients own experience. Drain the area with the most sputum first, then move on to another area. During drainage, encourage patients to breathe deeply and cough effectively, supplemented by percussive tremors. Perform drainage for 15 minutes each time, one to three times a day. Nurses or family members should assist in the drainage process to prevent falling out of bed. Pay attention to the patient’s reaction during the drainage, and stop immediately if the patient experiences hemoptysis, dizziness, and cyanosis dyspnea, sweating, fine pulse speed, fatigue, and other conditions.

b. During drainage, try to make the patients comfortable and relaxed, and guide them to breathe easily without excessive ventilation or shortness of breath. The drainage position should not be performed rigidly, for example, adopt the positions that are acceptable to the patients and that easily discharge sputum. Observe the patient’s face and expression, and adjust the posture or stop the drainage at any time if the patient is not in good condition. The specialist should prepare sputum aspirator and stay with patients during treatment to avoid suffocating and falling from bed. Allow patients to sit up slowly and rest for a while after drainage to prevent postural hypotension.

c. Avoid paroxysmal cough during the training process and pay attention to calm breathing for a while after coughing three times. People with a history of cerebrovascular rupture, embolism, or hemangioma should avoid coughing vigorously.

d. Drainage should be arranged in the morning after waking up because the bronchial ciliary movement is weakened at night, and airway secretions are prone to retention during sleep.