What intervention can the nurse provide to decrease the viscosity of secretions?

The highest priority is the patency of the airway. 

An initial respiratory assessment builds a baseline for further examinations. It allows for trending the improvements or worsening of the patient’s condition. 

Oxygenation should be maintained at 90%. If the patient cannot keep a saturation above 90%, supplemental oxygen might be required. 

Diminished; No breath sounds.
Absent breath sounds might indicate an obstruction.

Wheezing. 
Might indicate a partial airway obstruction from narrowing of the airway due to, for example, bronchospasm.

Crackles (previously called rales).
Might indicate fluid or secretions in the airway.

Rhonchi. 
May be caused by an obstruction of the trachea or bronchus.

Note the pitch, intensity, and duration during the assessment. These sounds can occur during inspiration and/or expiration. 

The presence of fluid or solid tissue can increase sounds. Increased vocal resonance indicates the presence of atelectasis, pleural effusion, pneumonia, or a solid mass. 

Pallor and cyanosis may be indicators for deficient gas exchange and perfusion. 

Pale or blue nail beds may indicate a lack of perfusion. Clubbing of the fingernails means that the patient might have a long term history of compromised gas exchange and perfusion. Clubbing can be seen in conditions such as COPD or cystic fibrosis.

These characteristics provide information about the lung status of the patient. Yellow or greenish color sputum might be an indication of infection. Blood tinged, foamy sputum can be an indication of pulmonary edema. 

Flaring of nostrils Use of accessory musclesTripod position Dyspnea 
These signs are compensatory mechanisms that indicate a lack of adequate gas exchange. The patient’s endurance will decrease over time. The number of times the patient has to pause to complete a sentence shows the level of respiratory distress. 

Anxiety over the feeling of not being able to breathe can often worsen the patient’s respiratory distress.

Lack of adequate oxygenation to the brain can cause restlessness and confusion. Prolonged cerebral hypoxia can cause lethargy and somnolence. 

Hypertension and tachycardia might be related to increased work of breathing, leading to increased respiratory distress and hypoxia. An elevated temperature can occur as a response to an infectious or inflammatory process. 

pH: 7.35 to 7.45
Pco2: 35 to 45 mm Hg 
HCO3: 22 to 27 mEq/L
Po2: 80 to 100 mm Hg
O2 saturation: 96% to 100%

Blood gases reveal how well the patient oxygenates. Blood gases allow for close monitoring of patients’ treatment results so that adjustments can be made. 

RBCs transport oxygen to the tissues. A decreased number of RBCs can lead to hypoxemia. An increased number of WBCs can be a manifestation of infection or inflammation. 

Results provide specific information about the exact bacteria growth so that treatment can be targeted with the appropriate antibiotics. 

Long-term respiratory conditions such as COPD or cystic fibrosis can require a constant increased work of breathing. This leads to a high need for calories. However, patients may be too exhausted and fatigued to eat and, therefore, cannot maintain an adequate calorie intake.

Mucous membranes 
Skin turgor
Neck veins
BP and HR (BP might be low because of inadequate intravascular volume; HR may increase as a compensatory response)

Adequate hydration may help loosen thick secretion. Thin secretion may be easier to expectorate. 

Imaging results provide a more detailed picture of the disease process and allow for a more targeted treatment. Frequent images also provide a baseline and allow for comparison during the treatment process. 

Sitting upright provides for an ideal body alignment for maximum lung expansion. Respiratory muscles, such as the diaphragm, have enough space to expand and contract. 

Adequate oxygenation facilitates gas exchange and perfusion. 

Instructions on using the incentive spirometer:

Assume an upright position seal lips around the mouthpiece 
Inhale slowly to raise the indicator to the goal marking 
Remove the mouthpiece and hold your breath for a few seconds before you exhale. 
Repeat the process up to ten times per hour

The incentive spirometer helps open up the lungs and alveoli where gas exchange takes place. It can prevent lung complications such as developing pneumonia. The use of the flutter valve creates a vibrating effect of the upper chest, loosening hardened mucus and secretions.

For example, instruct the patient to take a deep breath in and hold for several seconds. Cough two to three times during exhalation. 
Induced coughing and deep breathing helps improve clearing secretions and increases oxygenation. 

Bronchodilators 
Expectorants 
Antibiotics 
Diuretics 
Steroids

All these medications either treat inflammatory or infectious processes or help improve breathing by reducing airway resistance. 

The patient might benefit from specialized treatment plans such as chest physiotherapy or scheduled nebulizer treatments. 

Increased fluid intake may help thinning secretions; however, some patients do not tolerate high fluid intake due to cardiac compromise, such as heart failure. 

Bronchoscopy is an exploratory procedure that allows the removal of obstructions and obtainment of samples for testing. If the patient’s oxygenation cannot be maintained with noninvasive measures, intubation is indicated.  

Keeping the chest in an upright position helps with lung expansion and reduces aspiration of secretions. 

Rotoprone beds allow for patients to be placed in the prone position. Frequent position changes reduce pooling of secretions and therefore reduces the risk of developing infectious processes. 

Changing positions frequently for the bed-bound patient may reduce respiratory complications and improve the ability to come off the ventilator. 

During intubation or having a tracheostomy, the patient cannot clear his or her secretions. Suctioning, as needed, will keep the airway clear. 

Information about the disease and its possible outcomes might improve compliance with the treatment plan. 

These breathing exercises increase oxygenation, help reduce secretions, and help reduce dyspneic episodes. 

Regular and correct usage of prescribed medications promotes safety and the best outcome possible. 

Teaching about smoking cessation or other factors affecting ventilation is vital for the patient’s recovery.  Avoiding allergens or other irritants may reduce bronchospasms and other respiratory problems. 

Being familiar with suctioning techniques promotes patient safety. 

In case of emergency, the family will be able to provide necessary life support measures before first responders arrive.