deep breathing and coughing exercises, movements used to improve pulmonary gas exchange or to maintain respiratory function, especially after prolonged inactivity or general anesthesia. Incisional pain after surgery in the chest or abdomen often inhibits normal respiratory movements. ▪ METHOD: The patient is assisted to a comfortable position, supine or sitting up. An analgesic may be given before the exercises if pain is present. Inhalation through the nose and exhalation through the mouth are encouraged. With the incision supported, the patient is asked to cough after a deep inhalation. If pain prevents the patient from producing a deep, effective cough, a series of short barklike coughs (also known as machine gun or huf-huf coughs) may be encouraged. ▪ INTERVENTIONS: Simple techniques and encouragement significantly improve the effectiveness of the exercises. Positioning increases comfort, allows the abdominal contents to fall away from the diaphragm, and encourages full expansion of the chest wall on inspiration. If an incision is present, it may be supported with the hands or with a book or pillow held against the abdomen. The patient is often reluctant to breathe deeply or to cough. Adequate analgesia, encouragement, and explanation of the benefits of the exercises may overcome that resistance. Various devices are available for use in deep breathing and coughing, such as those used during atelectasis to strengthen the muscles used in expiration and to empty the alveoli of retained gas. ▪ OUTCOME CRITERIA: When shallow breathing replaces deep breathing, mucus tends to dry in the airway, damaging the membranes that line the passages. Coughing and deep breathing improve ventilation and gas exchange by clearing the mucus and allowing moisturized air to enter the bronchi, bronchioles, and alveoli, preventing atelectosis and pneumonia.
