A nurse is reinforcing discharge teaching on actions that improve gas exchange to a client diagnosed with emphysema. Which of the following instructions should be included in the teaching?

Choice D rationale Emphysema involves the destruction of alveolar walls and a loss of elastic recoil, leading to permanent air trapping. Breathing in through the nose and out through pursed lips helps maintain positive pressure in the airways during exhalation. This prevents early airway closure and allows more air, specifically trapped carbon dioxide, to be expelled from the lungs. This technique improves the ventilation-perfusion ratio and enhances the overall efficiency of gas exchange, providing significant relief from chronic dyspnea. Choice A rationale A low-protein diet is generally inappropriate for clients with emphysema. These individuals often have a high metabolic demand due to the increased work of breathing and are at risk for weight loss and muscle wasting. Protein is essential for maintaining the strength of respiratory muscles and supporting the immune system to prevent secondary infections. Unless there is a coexisting condition like advanced renal failure, these clients usually require a high-calorie, high-protein diet to maintain their nutritional status. Choice B rationale Limiting fluid intake is counterproductive for clients with emphysema unless they have comorbid heart failure. Adequate hydration is necessary to keep pulmonary secretions thin and easy to clear. When secretions become thick due to fluid restriction, they can block the already compromised airways, further impairing gas exchange and increasing the likelihood of atelectasis or pneumonia. Encouraging fluids helps maintain patent airways by facilitating the movement of mucus out of the lower respiratory tract through coughing. Choice C rationale The supine position is often poorly tolerated by clients with emphysema because it allows the abdominal contents to press against the diaphragm, limiting its downward movement. This reduces the total volume of the thoracic cavity and makes it much harder for the client to breathe. Most clients with chronic obstructive pulmonary disease prefer an upright, sitting, or "tripod" position, which maximizes chest expansion and utilizes gravity to assist with the work of the diaphragm during inspiration.