A home health nurse visits a client with chronic obstructive pulmonary disease. The nurse teaches the client to use abdominal breathing to perform the "huff" cough technique to facilitate secretion removal. Place the steps in the correct order. All options must be used.

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11ecbb05_ca56_32de_b433_658531ee6b77_MD0009_00 Clients with chronic obstructive pulmonary disease (COPD) often develop ineffective coughing patterns due to weakened muscles and narrowed airways prone to collapse under increased pressure. Therefore, clients with COPD are unable to cough effectively and require additional teaching to effectively expectorate secretions and prevent overexertion. Huff coughing is a series of low-pressure coughs using the following steps: Sit upright in a chair with feet spread shoulder-width apart and lean forward with shoulders relaxed; forearms supported on thighs or pillows; head and knees slightly flexed; and feet touching the floor (Option E). Perform a slow, deep inhalation through the mouth or nose using the diaphragmatic muscle (Option B). Hold breath for 2-3 seconds, keeping the throat open, and then perform a quick, forceful exhalation, creating an audible "huff" sound (Option A). Repeat the "huff" once or twice more to expectorate any mucus (Option C). Rest for 5-10 regular breaths and repeat as necessary until all mucus is cleared (Option D). Educational objective: Clients with chronic obstructive pulmonary disease benefit from breathing techniques to facilitate effective coughing. Huff coughing is a forced expiratory technique in which the client sits relaxed, upright, and leaning forward; slowly inhales using the diaphragmatic muscle; holds breath for 2-3 seconds and then quickly exhales; and repeats as necessary until remaining secretions are clear.

A Home Health Nurse Visits a Client with Chronic Obstructive