Teaching a Patient to Deep Breathe, Cough, Move in Bed, and Perform Leg Exercises ~ Nursing

Teaching a Patient to Deep Breathe, Cough, Move in Bed, and Perform Leg Exercises

Equipment
For Teaching Deep Breathing and Coughing:
■ Folded blanket or a pillow (if teaching will include splinting of a surgical incision site).
■ Tissues.

For Moving in Bed:
■ Small pillow or folded blanket.
■ Pillows.

Assessment
■ Assess cognitive level, level of consciousness, and pain level.
■ Assess the patient’s belief about the ability of the surgical incision to remain intact.
■ Determine whether the surgical procedure or a physical disability will limit the patient’s participation.
■ Determine whether the surgical procedure may entail special exercises or equipment.
■ Assess whether special equipment (e.g., braces, slings, or abductor wedges) may be needed when turning a patient in bed.
■ Be Safe! For orthopedic surgeries, consult the surgeon before teaching the patient any leg exercises.
■ Be Safe! Identify postoperative restrictions on movement (e.g., some spinal surgeries require the patient to logroll [move from head to toe as one unit]; some neurological procedures require limiting the amount of time the patient’s head of bed is above 30°).
■ Be Safe! Coughing and deep-breathing exercises are contraindicated for a patient who has had nasal, ophthalmic, or neurological surgery.

Post-Procedure Reassessment
■ Make sure that the patient performs correctly a return demonstration of the procedures taught.

Key Points
■ Assess the patient’s readiness to learn.

Deep Breathing and Coughing
■ Demonstrate how to splint a chest or abdominal incision.
■ Use pillows to support the patient who is unable to maintain a side-lying position.
■ Ensure that the patient is clear about the difference between coughing and merely clearing her throat. Turning in Bed
■ To turn to the left side: Start in supine position, bend the right leg, grasp the siderail with the right hand, and pull on the rail while
pushing with the right foot. To turn to the right, repeat the process using the opposite limbs.

Leg Exercises:
■ Teach the patient to alternately flex and extend her knees.
■ Teach the patient to alternately dorsiflex and plantar flex her feet.
■ Teach the patient to rotate her ankles in a complete circle.

Documentation
■ Checklists and charts often have special areas in which to document patient teaching.
■ Identify:
■ The person who completed the teaching.
■ The person to whom the procedures were taught.
■ What procedures were taught.
■ Whether the patient understood the teaching.
■ Also include the name and type of any printed materials given.