Question

The nurse is caring for a patient with an alteration in airway clearance. What nursing actions would be a priority to promote airway clearance (select all that apply.)?

A. Maintain adequate fluid intake.
B. Maintain a 30-degree elevation.
C. Splint the chest when coughing.
D. Maintain a semi-Fowler's position.
E. Instruct patient to cough at end of exhalation.

Answer 1

To enhance airway clearance in a patient, important nursing actions include ensuring adequate hydration, maintaining a semi-Fowler's position, splinting the chest when coughing, and instructing the patient to cough at the end of exhalation.

Step-by-step explanation:

To promote airway clearance in a patient with an alteration in airway clearance, several nursing actions would be a priority. These include:

• Maintain adequate fluid intake to help thin secretions, making them easier to clear.
• Maintain a semi-Fowler's position, which is typically a 30 to 45-degree elevation, to help with breathing and promote the drainage of secretions.
• Splint the chest when coughing, which can help reduce discomfort and provide support, encouraging more effective coughing.
• Instruct the patient to cough at the end of exhalation, which can help enhance the force of the cough and improve the removal of secretions.

These interventions are aimed at improving the patient's respiratory function by facilitating the expulsion of mucus and other secretions from the airways.