A nurse is reinforcing teaching with the parents of a child who is starting to use a spacer with a metered-dose inhaler (MDI) to treat asthma. Which of the following information should the nurse include in the teaching?

A. "You should inhale through your nose and exhale through your mouth during purse-lipped breathing."

Pursed-lip breathing is a breathing technique commonly used by individuals with COPD to help improve breathing efficiency and manage dyspnea (shortness of breath). During purse-lip breathing, the individual inhales slowly through the nose and exhales slowly and gently through pursed lips, creating a slight resistance to the airflow. This technique helps to keep the airways open longer during exhalation, reduces air trapping, and improves oxygenation.

B. "Your inspiration should be longer than expiration during purse-lipped breathing."

Pursed-lip breathing typically involves making both the inspiration and expiration longer than usual. The focus is on slowing down the breathing rate and extending the exhalation phase to promote better gas exchange and reduce respiratory effort.

C. "You should cough forcefully during exhalation when you are purse-lipped breathing."

Pursed-lip breathing is a gentle breathing technique used to promote relaxation and control of breathing. Forceful coughing during exhalation is not part of purse-lip breathing and may not be appropriate, especially for individuals with COPD who are prone to airway irritation and bronchospasm.

D. "You should be flat on your back when you perform purse-lipped breathing."

The position for performing purse-lip breathing is not specific to lying flat on the back. Individuals can perform purse-lip breathing in various positions that are comfortable and allow for effective breathing, such as sitting upright or leaning slightly forward. The key is to find a position that facilitates relaxation and optimal lung expansion.

A. Instruct the client to use a pursed-lip breathing technique.

Pursed-lip breathing is a technique commonly used to help relieve dyspnea, particularly in individuals with COPD. This technique involves breathing in through the nose and exhaling slowly through pursed lips, which helps to prolong exhalation, reduce airway collapse, and improve oxygen exchange. While pursed-lip breathing can be beneficial, it should not be the priority action when the client reports difficulty breathing. Before initiating any breathing techniques, the nurse should first assess the client's respiratory status to determine the severity of the breathing difficulty and whether additional interventions are necessary.

B. Evaluate the client's respiratory status.

This is the correct priority action in this scenario. When a client with COPD reports difficulty breathing, the nurse's first step should be to thoroughly assess the client's respiratory status. This assessment involves evaluating respiratory rate, depth, effort, oxygen saturation levels, auscultating lung sounds, and assessing for signs of respiratory distress. By conducting a comprehensive assessment, the nurse can determine the severity of the client's symptoms, identify any potential exacerbating factors or complications, and make informed decisions regarding appropriate interventions.

C. Increase the oxygen flow to 3 L/min.

While increasing the oxygen flow may be a consideration if the client's oxygen saturation is low, it should not be the immediate priority without first assessing the client's respiratory status. Increasing oxygen flow without proper assessment could potentially worsen hypercapnia in some COPD patients and may not address the underlying cause of the client's difficulty breathing. Therefore, this action should be based on assessment findings rather than being the initial response.

D. Have the client cough and expectorate secretions.

Coughing and expectorating secretions can be helpful in clearing the airways and improving breathing in individuals with COPD, especially if secretions are contributing to the difficulty breathing. However, similar to the pursed-lip breathing technique, this action should not be the priority without first assessing the client's respiratory status. The nurse should determine whether secretions are indeed present and causing the difficulty breathing before instructing the client to cough and expectorate. Therefore, this option should follow a thorough respiratory assessment.