How a nurse will teach breathing exercise for a patient with chronic bronchitis?

JIPMER Nursing Officer-2017

Medical & Surgical Nursing

Medium

Appeared in: JIPMER Nursing Officer-2017

Explanation

Patients with chronic bronchitis (a type of COPD) often have a flattened, weak diaphragm and overuse accessory muscles for breathing.
Diaphragmatic breathing, also known as abdominal breathing, is specifically taught to strengthen the diaphragm.
This technique reduces the respiratory rate, increases tidal volume (the amount of air moved per breath), and decreases the overall work of breathing.
By making breathing more efficient, it helps improve gas exchange and reduce feelings of dyspnea (shortness of breath).

Option A: Patients with chronic bronchitis already tend to use chest breathing, which involves accessory muscles. This pattern is inefficient, tiring, and increases oxygen consumption. The goal of therapy is to move away from this pattern.
Option C: Open mouth breathing does not help with the primary problem in COPD, which is airway collapse during exhalation. The correct technique is pursed-lip breathing, which creates back-pressure to keep airways open longer.
Option D: Focusing only on deep inhalation can worsen the problem of air trapping and lung hyperinflation in COPD. The key is controlled and prolonged exhalation to effectively empty the lungs.

Clinical Relevance

Nursing practice connection: Use the key finding related to Breathing retraining techniques for chronic bronchitis (COPD) to guide bedside assessment, documentation, and the next nursing action.
Teaching patients diaphragmatic and pursed-lip breathing empowers them to manage episodes of dyspnea, which can reduce anxiety and prevent emergency room visits.
Mastering these techniques can improve a patient's exercise tolerance and ability to perform activities of daily living (ADLs).
As a nurse, it is crucial to not just explain the technique but also to have the patient demonstrate it back to ensure correct performance and provide feedback.

How to Approach the Question

First, identify the patient's diagnosis: chronic bronchitis, which is a type of COPD.
Recall the key pathophysiological changes in COPD: air trapping, airway inflammation, and a flattened, inefficient diaphragm.
Consider the goal of breathing exercises for this condition: to improve breathing efficiency, reduce the work of breathing, and clear trapped air.
Evaluate each option based on this goal. Diaphragmatic breathing directly targets the weakened diaphragm.
Eliminate options that describe the problematic breathing pattern (chest breathing) or are incorrect techniques (open mouth breathing).
Recognize that focusing only on inhalation without controlled exhalation is incomplete and potentially harmful for a COPD patient.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 8-10

E6 Nursing Fundamentals Taylor p. 724-726