The nurse assesses a client with left-sided pneumonia who has an intermittent, productive cough with copious amounts of thick, yellow sputum. Which of the following interventions help to facilitate secretion removal? Select all that apply.

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Pneumonia is an inflammatory reaction in the lungs, often due to infection, that causes alveoli to fill with cellular debris and thick, purulent exudate (ie, consolidation), which may cause impaired ventilation and oxygenation. Interventions to facilitate secretion removal in clients with pneumonia include: Performing chest physiotherapy (percussion, vibration, postural drainage) to loosen and break up thickened secretions (Option A) Assisting the client to perform huff coughing, which raises secretions from the lower to the upper airway for expectoration (Option C) Ensuring adequate hydration through increased oral fluid intake (≥2-3 L/day) and administration of prescribed IV fluids, which thins pulmonary secretions to promote improved secretion clearance Positioning the head of the bed to 45-60 degrees (ie, Fowler position) to promote effective coughing and optimal lung expansion (Option B) Cough suppressants reduce the urge to cough triggered by airway irritants (eg, purulent secretions) and ultimately impair secretion removal. (Option D) Pursed-lip breathing prolongs exhalation and prevents airway collapse, which alleviates dyspnea relating to air trapping (eg, chronic obstructive pulmonary disease). However, it does not facilitate secretion removal. (Option E) Side-lying positioning is utilized in hypoxic clients with unilateral pneumonia to increase perfusion to the healthy lung by gravity and improve oxygenation by positioning the client with the unaffected (good) side down. However, side-lying position alone does not improve secretion clearance Educational objective: Clients with pneumonia often develop thick secretions that impair oxygenation and require intervention to promote secretion clearance. Interventions to mobilize secretions include coughing and deep breathing, chest physiotherapy, Fowler positioning, and hydration.

The Nurse Assesses a Client with Left-Sided Pneumonia Who Has