Skill 1 Teaching DEEP Breathing AND Coughing Exercise PDF

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Summary

Leaflet for skills that you can use for return demonstration. This is needed in nursing school so you can pass....

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Name: _____________Fatima Zahra H. Hussain________________________________

Date: ______________

Evaluator/Signature:

Grade: _____________

Fesanmie Amarillo, RN, MAN

TEACHING DEEP BREATHING AND COUGHING EXERCISES Definition: Deep breathing and coughing remove secretions from the airways and facilitates respiratory function. Voluntary coughing exercises in conjunction with deep breathing facilitates the movement and expectoration of secretion in the respiratory tract. Frequent deep breathing automatically initiates the cough reflex.

Purpose:      

To facilitate a wide exchange of gases To maximize the amount of oxygen available To prevent orthostatic pneumonia To make client relaxed To help client cope with pain To help reduce the chances of client complications after surgery

Indication:      

Patients on bedrest or those who have undergone any surgical procedure (e.g. abdominal or chest surgery). Patients prone to pulmonary problems. Patients susceptible to accumulating respiratory problems. Patients who have had abdominal or chest surgery need to perform deep breathing at least 3-4 turns daily. Each session should include a minimum of 5 deep breaths. Deep breathing should be performed every hour while awake. Deep breathing may be performed every hour, especially by patients who are prone to pulmonary problems.

ACTION

RATIONALE

PERFORMED

REMARKS

YES

NO

1. Assess the client’s condition and identify Assessment is needed as to avoid complications and to ensure a smooth anything that may affect the success of the performance. It is also to avoid future errors that could harm the patient. procedure. Abdominal (diaphragmatic) and Pursed-Lip Explaining the procedure helps the client understand its purpose and Breathing makes him less anxious. It will promote the cooperation of the client. 2. Explain to the client that diaphragmatic breathing can help the person breath more deeply and with less effort. 3. Have the client assume either a comfortable semi-Fowler’s position with knees flexed, back Upright position allows increased diaphragmatic excursion secondary to supported, and with one head pillow or a supine downward shift of internal organs from gravity. Pillow provides client position with one head pillow and knees flexed. comfort. After learning, the client can practice. 4. Have the client place one or both hands on the To increase the awareness of the position of the diaphragm and its function abdomen just below the ribs. in breathing. This will allow the client to feel the diaphragm as it moves during breathing. 5. Instruct the client to breath in deeply through the nose with the mouth closed, to stay relaxed, not Inhaling through the nose allows air to be filtered, warmed, and to arch the back, and to concentrate on feeling humidified. the abdomen rise as far as possible. 6. If the client has difficulty raising the abdomen, instruct the person to take a quick, forceful inhalation through the nose. 7. Instruct the client to purse the lips as if about to whistle; to breath out slowly and gently, making a slow “whooshing“ sound; to avoid puffing out the cheeks; to concentrate on feeling the abdomen fall or sink; and to tighten the abdominal muscles while breathing out.

ACTION

To help the client raise his abdomen.

Pursing the lips increases intratracheal pressure. Exhaling through the mouth offers less resistance to expired air. Slow expulsion of air frequently initiates the coughing reflex, which facilitates expectoration of mucus and prevents hyperventilation.

RATIONALE

PERFORMED

REMARKS

YES 8. If the client has COPD, teach the “double cough” technique. Have the client a. Breath in through the nose and inflate the lungs to the mid inspiration point, rather than to the full deep inspiration point.

Several consecutive coughs are more effective than one single cough at moving mucus up and out of the respiratory tract. Since COPD patients have long-term coughs with mucus, encouraging them to perform this maximizes the secretions of mucus.

Simultaneously exhale and cough two or more abrupt, sharp coughs in rapid succession. 9. Instruct the client to use this exercise whenever Performing this exercise will facilitate pulmonary ventilation, promote feeling shortness of breath to increase it airway clearance without overtiring the client and helps the diaphragm to gradually 5-10 minutes four times a day. return to its responsibility of helping the client breathe. Coughing Exercise When you breathe in through your nose, the air is filtered, warmed, 10. Instruct the patient to inhale and exhale through humidified, and mixed with nitric oxide which kills deadly bacteria and works as a vasodilator on the airway, arteries, and capillaries. More the nose three times. oxygen is also absorbed. 11. Ask the patient to take a deep breath and hold it for three seconds and then cough out three short Holding your breath for three seconds helps the alveoli to re-expand. breaths. 12. Ask the patient to take a breath through his/her To clear the phlegm out of the client’s airways. mouth and strongly cough again. 13. Instruct the patient that he/she should perform Performing these exercises every 2 to 3 hours will facilitate pulmonary ventilation and promote airway clearance by getting rid of the mucus these actions at least every 2 hours. without overtiring the client. Apical Expansion Exercises 14. Place your fingers below the client’s clavicles This is to avoid moving the accessory muscles and helps the client to feel and exert moderate pressure, or have the client his chest move as he breathes. place his or her fingers over the same area.

NO

ACTION

RATIONALE

15. Instruct the client to inhale through the nose and Breathing through nose increases absorption of oxygen, expands the apex/ to concentrate on pushing the upper chest upper chest and fewer muscles are engaged. upward and forward against the fingers. 16. Have the client hold the inhalation for a few Holding your breath helps the alveoli to re-expand. seconds. 17. Have the client exhale through the mouth or nose slowly, quietly and passively while concentrating This facilitates breathing rhythms. on moving the upper chest inward and downward. 18. Instruct the client to perform the exercise for at Increases oxygen levels and promotes airway clearance by getting rid of least five respirations four times a day. the mucus and state air. Basal Expansion Exercises 19. Place the palms of your hands in the area of the This procedure will allow the client to feel the lower ribs along midlower ribs along the mid-axillary lines, and exert axillary lines expands. moderate pressure, or have the client place his or her hands over the same areas. 20. Instruct the client to inhale through the nose and Inhaling through the nose increases the oxygen absorbed and helps to concentrate on moving the lower chest facilitate expansion of the lower chest. outward against the hands. 21. Have the client hold the inhalation for a few Holding your breath helps the alveoli to re-expand. seconds. 22. Have the client exhale through the nose or mouth slowly, quietly and passively. If the person has COPD, observe the rate and character of the exhalation. Normal exhalation is slow, and the This procedure helps move any secretions that may be present at the upper chest appears relaxed. If the exhalation bottom of the lungs and increases lung volume. appears difficult or there is in drawing of the upper chest, encourage pursed-lip exhalation.

PERFORMED YES NO

REMARKS

ACTION 23. Have the client exhale through the nose or mouth slowly, quietly and passively. If the person has COPD, observe the rate and character of the exhalation. Normal exhalation is slow, and the upper chest appears relaxed. If the exhalation appears difficult or there is in drawing of the upper chest, encourage pursed-lip exhalation. 24. Instruct the client to perform this exercise at least five respirations four times a day. 25. Correct the patient’s breathing technique as necessary.

RATIONALE

Helps move secretions that are present at the bottom of the lungs. It also helps increasing the volume of the lungs.

Performing the procedure 4 times a day increases oxygen levels and maximize phlegm movement out from the lungs. So as the client may prevent breathing complication.

Learner’s Reflection: (What did you learn most of the activity? What is its impact to you?) What is the importance of this skill? 

The importance of this skill is that it helps a patient’s breathing. It clears the lungs, and lowers the risk of pneumonia. It also helps in speeding up recovery.

How do you feel about the procedure? 

I feel that this skill is important to master. As a student nurse, this could be a big help in purpose of patient education. I will definitely remember this.

What are the limitations and challenges you experienced with the set up you have at home? 

There are a lot of people living in our house and so it’s hard to ask for everyone’s cooperation to stay silent while I was filming my video. However, I am glad that I was still able to finish my video.

Instructor’s Comments:

PERFORMED YES NO

REMARKS

References: Lynn, P. (2011). Taylor's Clinical Nursing Skills: A Nursing Process Approach. 3rd Edition. Philadelphia: LWW Smith-Temple, J & Johnson, J.Y. (2006). Nurses’ Guide to Clinical Procedures. 5 th Edition. Philadelphia: LWW. Hilton, P.A. (2004). Fundamental of Nursing Skills. Philadelphia: Whurr Publishers Ltd. Mills, E. J. (2004). Nursing Procedures. 4th Edition. Philadephia: LWW....