During patient care, you find that some patients do not master how to cough effectively. When you ask the patient to inhale deeply and cough, you often do not get a satisfactory result. Therefore, it is important to teach patients to master coughing techniques. We will now describe our experience in instructing patients in coughing techniques.
I. Deep breathing exercise
The patient is encouraged to inhale deeply through the nasal cavity to achieve maximum alveolar re-expansion and air humidification, and then exhale through the contracted lips. Periodic deep breathing can prevent airway occlusion and inhalation of secretions causing distal tracheal obstruction, as well as induce coughing.
1, abdominal breathing can be adapted to a variety of diseases, especially chest surgery and emphysema patients.
The patient takes a supine, semi-recumbent or semi-sitting position. Both knees are gently bent to loosen the abdominal muscles. One hand is placed on the sternal stalk to control the rise and fall of the chest, and the other hand is placed on the umbilicus to feel the degree of abdominal bulge and breathing when the bulging abdomen sinks by 1/3 with a slight upward push to help the abdominal muscles contract. This breathing is deep inhalation abdomen Xu convex rumble after holding the breath for about 2s, and then shrink lips slowly exhale, abdomen concave. Exhalation time is twice the time of inhalation.
2, bilateral lower chest expansion, long-term bed-ridden or lower lung inflammation people mostly use this breathing. It makes the hands placed in the 6th rib position under the armpit respectively to feel the magnitude of chest activity during inhalation. After deep inhalation, hold the breath for about 2s, then mouthwash and exhale slowly.
3, blowing action, chronic obstructive pulmonary emphysema, bronchial asthma, coughing weak people more with blowing action that let the patient do a deep abdominal breathing, rapid small mouth outward after blowing, let the patient then take a deep breath, and violently exhale a breath, then let the patient take a deeper breath, and then stronger blow a breath, when the patient is ready to cough.
II. Coughing position
The coughing position is similar to breathing.
1. When the patient coughs in bed, he or she adopts a forward-bending seated position while cross-legged.
2. When coughing in bed, the patient bends his knees and lies on his side. The bent knee side position is better than the semi-recumbent position.
3. In the sitting “smooth cough” position, the patient sits in a chair or on the edge of the bed, bends both shoulders slightly inward, with the head slightly downward, places a small pillow on top of the stomach and clamps it with both hands.
III. Effective coughing methods
1. For a weak cough and sticky sputum, use the “sitting position with a smooth cough” while using hand pressure on the abdomen to assist in coughing, i.e., inhale deeply through the nose and bend the upper body slowly and slightly forward while using a pillow to gently press the stomach down to make the air
exhale through the mouth and lips. Then inhale again with the nose and return the body to its original sitting position. After 4 repeated deep breaths, bend the upper body slightly forward while coughing strongly for 2 or 3 times (between two coughs, do not breathe sharply), and after coughing, return to the original position. After breathing calmly, then bend the upper body slowly forward and cough again.
2, through the abdominal breathing method, and then close the abdomen and open the mouth and slightly extend the tongue for heavy coughing. Cough twice after inhaling enough air at one time, the first cough loosens the mucus, the second cough then makes the sputum run into the upper respiratory tract, and slightly stretches the tongue and opens the mouth to make the vocal chambers open so as to facilitate the expulsion of gas. This coughing method is often instructed for post-open-heart surgery and patients with chronic obstructive pulmonary disease.
3. After poor function of the rectus abdominis muscle or abdominal surgery, the patient is instructed to make a deep and slow inhalation and then hold the breath slightly for about 25, when the vocal cords are closed and the septum is elevated to increase the intrathoracic pressure, then relax the throat and open the mouth to eject the gas as soon as possible for 2 or 3 times in a row.
4.Stimulate tracheal cough
Those who have an incompetent cough or do not cough should stimulate tracheal coughing. Before stimulating tracheal coughing, the patient should be in a sitting or semi-reclined position.
4. Assist the patient to cough
1. To reduce wound pain and tension caused by postoperative coughing. Teach the patient to use both hands or other soft objects to press firmly on the wound when coughing. And teach the family members to place both hands under the 6th and 8th ribs of the patient’s axilla and press hard at the moment of coughing. For abdominal surgery, the family members should press the wound edge with both hands when coughing to protect the incision.
2, suffering from chronic obstructive pulmonary disease, such as pleural fluid exudation, silicosis, they often can not inhale deeply, reducing the ability to push secretions out. When these patients inhale, hold both sides of the patient’s chest with your hands and use a little pressure on his chest to reduce the patient’s excessive force when coughing. At this point, have the patient open his mouth and cough twice with his tongue slightly extended. The pressure helps the speed of gas expulsion.
3.Patients with poor abdominal muscle function should cough with deep breaths and forcefully move the patient’s abdomen upward and inward against the transverse septum.
4. Patients with obstructive pulmonary disease are usually able to inhale deeply, but are unable to expel secretions. Therefore, the patient is taught to perform a series of short machine-gun coughs during inspiration to reduce gas volume to facilitate expulsion of sputum and to lower intrathoracic pressure to help the patient build up strength.
Postoperative pain is a major obstacle to coughing. To encourage the patient to cough up the sputum, it is important to first let him/her know that even if we use postural drainage, percussion and chest vibration, they can only encourage the secretion to move upward, not expel it from the airway. Phlegmolytic drugs also do little more than reduce the viscosity of the sputum and make it dilute and easy to cough up, but the effect is not quick, and only coughing can accomplish this mission. Therefore, it is important to explain the reason and purpose to the patient and family members before the operation, and patiently teach them to master the coughing method. Not only show and teach, but also teach back and keep improving coughing skills. At the same time, the family also participates in teaching and learning, acting as the patient’s counselor, a role that plays an important role in the recovery process of the patient’s mind and body. The nurse plays an important role in guiding the patient’s cough. The teaching is not in the form, it is in the effect. It is in how the nurse’s responsibility helps the patient to exclude various factors that affect the cough, cough up the sputum, and turn the condition into a peaceful one.