1. The client/caregiver can list the benefits of controlled, effective coughing.
   1. To conserve energy and decrease fatigue
   2. To remove mucus from airways
   3. To prevent respiratory complications
2. The client/caregiver can demonstrate positioning methods for effective coughing.
   1. Sit upright on a chair or edge of bed with feet firmly on the floor, leaning forward slightly.
   2. If unable to sit upright, elevate the head of the bed and flex knees, or lie on the side keeping the upper body flexed forward and knees bent toward the body.
3. The client/caregiver can demonstrate controlled coughing.
   1. Take a deep breath, placing your hands on your stomach while allowing your stomach to expand.
   2. Hold your breath for 2 seconds.
   3. Cough twice with mouth open. The first cough loosens mucus and the second cough helps to remove it.
   4. Cough the mucus into a tissue and dispose of it.
   5. Breathe slowly through the nose. Fast mouth breathing can drive mucus back into the lungs.
4. The client/caregiver can demonstrate cascade coughing, another version of controlled coughing.
   1. Take a slow deep breath and contract your abdominal muscles
   2. Hold your breath for 2 seconds.
   3. Open your mouth and perform a series of coughs from the beginning to the end of the expiration. This clears large and small airways.
   4. Then breathe slowly through the nose and rest.
5. The client/caregiver can list other general measures to promote effective coughing and clearing of airways.
   1. Take pain medication as needed.
   2. Support incision with a pillow to decrease pain when coughing.
   3. Increase fluids to 2000 ml per day, unless contraindicated, to thin mucus.
   4. Use medications as ordered.
6. The client/caregiver can list possible complications of ineffective coughing.
   1. Collapse of airways
   2. Rupture of alveoli
   3. Pneumothorax

References

Canobbio, M. M. (2006). Mosby’s handbook of patient teaching . St. Louis: Mosby Inc.
Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.
Timby, B. K. (2005). Fundamental nursing skills and concepts. Philadelphia: J. B. Lippincott Williams &
Wilkins.