1. Assess home environment for factors that exacerbate airway clearance problems (e.g., presence of allergens, lack of adequate humidity in air, stressful family relationships).
2. Limit client exposure to persons with upper respiratory infections.
3. Provide/teach percussion and postural drainage per physician orders. Teach adaptive breathing techniques.
R/ : Adaptive breathing, percussion, and postural drainage loosen secretions and allow more effective oxygenation.
4. Determine client compliance with medical regimen.
5. Teach client when and how to use inhalant or nebulizer treatments at home.
6. Teach client/family importance of maintaining regimen and having prn drugs easily accessible at all times.
R/ : Success in avoiding emergency or institutional care may rest solely on medication compliance or availability.
7. Identify an emergency plan, including criteria for use.
R/ : Ineffective airway clearance can be life threatening.
8. Refer for home health aide services for assist with ADLs.
R/ : Clients with decreased oxygenation and copious respiratory secretions are often unable to maintain energy for ADLs.
9. Assess family for role changes and coping skills. Refer to medical social services as necessary.
R/ : Clients with decreased oxygenation are unable to maintain role activities and therefore experience frustration and anger, which may pose a threat to family integrity.
10. Provide family with support for care of a client with a chronic or terminal illness.
R/ : Severe compromise to respiratory function creates fear in clients and caregivers. Fear inhibits effective coping.
Client/Family Teaching
1. Teach importance of not smoking. Be aggressive in approach, ask to set a date for smoking cessation, and recommend nicotine replacement therapy (nicotine patch or gum). Refer to smoking cessation programs, and encourage clients who relapse to keep trying to quit.
R/ : All health care clinicians should be aggressive in helping smokers quit (AHCPR Guidelines, 1996).
2. Teach client how to use a flutter clearance device if ordered, which vibrates to loosen mucus and gives positive pressure to keep airways open. R/ : This device has been shown to effectively decrease mucous viscosity and elasticity (App et al, 1998), increase amount of sputum expectorated (Langenderfer, 1998; Bellone et al, 2000), and increase peak expiratory flow rate (Burioka et al, 1998).
3. Teach client how to use peak expiratory flow rate (PEFR) meter if ordered and when to seek medical attention if PEFR reading drops. Also teach how to use metered dose inhalers and self-administer inhaled corticosteroids following precautions to decrease side effects (Owen, 1999).
4. Teach client how to deep breathe and cough effectively. Teach how to use the ELTGOL method-an airway clearance method that uses lateral posture and diferent lung volumes to control expiratory flow of air to avoid airway compression.
R/ : Controlled coughing uses the diaphragmatic muscles, making the cough more forceful and effective. The ELTGOL method was shown to be more effective in secretion removal in chronic bronchitis than postural drainage (Bellone et al, 2000).
5. Teach client/family to identify and avoid specific factors that exacerbate ineffective airway clearance, including known allergens and especially smoking (if relevant) or exposure to second-hand smoke.
6. Educate client and family about the significance of changes in sputum characteristics, including color, character, amount, and odor.
R/ : With this knowledge the client and family can identify early the signs of infection and seek treatment before acute illness occurs.
7. Teach client/family need to take antibiotics until prescription has run out.
R/ : Taking the entire course of antibiotics helps to eradicate bacterial infection, which decreases lingering, chronic infection.
