A nurse is contributing to the plan of care for a client who has COPD. Which of the following interventions should the nurse include in the plan of care?

Choice B rationale Pursed-lip breathing is a technique used to improve gas exchange in clients with chronic obstructive pulmonary disease. By exhaling through narrowed lips, the client creates positive expiratory pressure, which helps keep the airways open longer. This prevents the collapse of small airways and promotes the removal of trapped carbon dioxide. This intervention reduces the work of breathing, decreases the respiratory rate, and helps alleviate the sensation of dyspnea, which is common in chronic lung disease. Choice A rationale Clients with chronic obstructive pulmonary disease often have thick, tenacious secretions that are difficult to expectorate. Restricting fluid intake to less than 1 L/day would lead to dehydration and further thicken these secretions, increasing the risk of respiratory infections and airway obstruction. Instead, unless contraindicated by heart failure, these clients should be encouraged to increase fluid intake to approximately 2 to 3 L/day to help liquefy mucus and facilitate easier clearance from the bronchi. Choice C rationale Chronic obstructive pulmonary disease leads to air trapping and hyperinflation of the lungs, often causing the diaphragm to become flattened and less effective. Clients frequently use accessory muscles in the upper chest and neck to breathe, which is inefficient and tiring. The nurse should instead teach diaphragmatic or abdominal breathing. This technique focuses on using the diaphragm more effectively to increase lung expansion and reduce the oxygen cost of breathing compared to shallow chest breathing. Choice D rationale Lying down immediately after meals can increase intra-abdominal pressure and push the diaphragm upward, which further restricts lung expansion and exacerbates shortness of breath. This position also increases the risk of gastroesophageal reflux, which can trigger bronchospasm in susceptible clients. It is better for the client to remain in an upright or semi-Fowler's position after eating to ensure maximum thoracic space for ventilation and to facilitate the digestive process without compromising respiratory status.