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Teaching an Effective cough
Renal Anatomy and physiology
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Teaching an Effective Cough
Because an effective cough is an integral component of air way clearance , a patient must be taught the importance of an effective cough , how to produce an efficient and con trolled voluntary cough , and when to cough. The following sequence and procedures are used when teaching an effective cough
Assess the patient's voluntary or reflexive cough.
Have the patient assume a relaxed , comfortable position for deep breathing and coughing. Sitting or leaning for ward usually is the best position for coughing. The patient's neck should be slightly flexed to make cough ing more comfortable.
Teach the patient controlled diaphragmatic breathing , emphasizing deep inspirations.
Demonstrate a sharp , deep , double cough.
Demonstrate the proper muscle action of coughing ( con traction of the abdominals ). Have the patient place the hands on the abdomen and make three huffs with expiration to feel the contraction of the abdominals. Have the patient practice making a " K " sound to experience tightening the vocal cords , closing the glottis , and contracting the abdominals.
When the patient has put these actions together instruct the patient to take a deep but relaxed inspiration , followed by a sharp double cough. The second cough dur ing a single expiration is usually more productive.
Use an abdominal binder or glossopharyngeal breathing in selected patients with inspiratory or abdominal mus cle weakness to enhance the cough , if necessary. Precautions that should be observed while teaching a patient an effective cough.
Additional Techniques to Facilitate a Cough and Improve Airway Clearance
To maximize airway clearance , several techniques can be used to stimulate a stronger cough , make coughing more comfortable or improve the clearance of secretions.
Manual - Assisted Cough
If a patient has abdominal weakness ( e. , as the result of a mid - thoracic or cervical spinal cord injury ) , manual pres sure on the abdominal area assists in developing greater intra - abdominal pressure for a more forceful cough. Manu al pressure for cough assistance can be applied by the therapist or the patient.
Therapist - Assisted Techniques
With the patient in a supine or semireclining position , the therapist places the heel of one hand on the patient's abdomen at the epigastric area just distal to the xiphoid process. The other hand is placed on top of the first , keeping the fingers open or interlocking them. After the
patient inhales as deeply as possible , the therapist manually assists the patient as he or she attempts to cough. The abdomen is compressed with an inward and upward force , which pushes the diaphragm upward to cause a more forceful and effective cough. This same maneuver can be performed with the patient in a chair. The therapist or family member can stand in back of the patient and apply manual pres sure during expiration. PRECAUTION Avoid direct pressure on the xiphoid process during the maneuver. Self - Assisted Techniques patient While in a sitting position , the patient crosses the arms across the abdomen or places the interlocked hands below the xiphoid process. After a deep inspiration , the patient pushes inward and upward on the abdomen with the wrists or forearms and simultaneously leans forward while attempting to cough.
Splinting
If chest wall pain from recent surgery or trauma is restrict ing the cough , teach the patient to splint over the painful area during coughing. Have the patient press the hands or a pillow firmly over the incision to support the painful area with each cough .If the patient cannot reach the painful area.
Humidification
If secretions are very thick , work with the patient after humidification therapy or ultrasonic nebulizer therapy , both of which enhance the mucociliary transport system and facilitate a productive cough.
Tracheal Stimulation
Tracheal stimulation , sometimes called a tracheal tickle , may be used with infants or disoriented patients who can not cooperate during treatment Tracheal stimulation is a somewhat uncomfortable maneuver , performed to elicit a reflexive cough. The therapist places two fingers at the sternal notch and applies a circular motion with pressure downward into the trachea to facilitate a reflexive cough.
Suctioning : Alternative to Coughing
Endotracheal suctioning may be the only means of clear ing the airways in patients who are unable to cough or huff voluntarily or after reflex stimulation of the cough mechanism,60 Suctioning is indicated in all patients with artificial airways. The suctioning procedure clears only the trachea and the main stem bronchi.
PRECAUTION
Only individuals who have been taught proper suctioning technique should use this alternative means of clearing the airways. Suctioning , if performed incorrectly , can introduce an infection into the airways or damage the delicate mucosal lining of the trachea and bronchi. Improper suctioning also can cause hypoxemia , an abnormal heart rate , and atelectasis. A complete description of the proper endotracheal s uctioning technique may be found in other resources.
If the patient has unstable angina If the patient has chest wall pain , for example after thoracic surgery or trauma
Vibration
Vibration , another manual technique , often is used in con junction with percussion help move secretions to larger airways. It is applied only during the expiratory phase as the patient is deep breathing Vibration is applied by placing both hands directly on the skin and over the chest wall ( or one hand on top of the other ) and gently compressing and rapidly vibrating the chest wall as the patient breathes out , Pressure is applied in the same direction as the chest is moving. The vibrating action is achieved by the therapist isometrically contracting ( tens ing ) the muscles of the upper extremities from shoulders to hands.
Shaking
Shaking is a more vigorous form of vibration applied dur ing exhalation using an intermittent bouncing maneuver coupled with wide movements of the therapist's hands. The therapist's thumbs are locked together , the open hands are placed directly on the patient's skin , and fingers are wrapped around the chest wall. The therapist simultaneous ly compresses and shakes the chest wall.
Postural Drainage Positions Positions for postural drainage are based on the anatomy of the lungs and the tracheobronchial tree .The shaded area in each illustration indicates the area of the chest wall where percussion or vibration is applied.
Teaching an Effective cough
Course: Renal Anatomy and physiology
University: Rajiv Gandhi University of Health Sciences
