A client who underwent a pneumonectomy has the nursing diagnosis of ineffective airway clearance related to increased secretions and decreased coughing effectiveness due to pain. Which of the following interventions can help the client achieve effective airway clearance? 

Help the client cough and deep breathe every 1 or 2 hours (while awake) during the first 24-to-48 postoperative hours.
Offer sips of water frequently.
Place the client on semi- or high-Fowler’s position once the vital signs are stable.
Schedule coughing and deep breathing sessions at times when pain medication is maximally effective.

Explanation

•Patients should be placed upright to help lung expansion and facilitate ventilation with minimal effort.

•Increasing the volume of air in the lungs promotes expulsion of secretions.

•Schedule coughing and deep breathing sessions at times when pain medication is maximally effective. This should be scheduled every 1-2 hours while the patient is awake in the first 2 days post-op.

•Offering frequent sips of water helps to address airway clearance by encouraging hydration, which keeps secretions thinner and makes coughing more effective. 

•Lateral positioning should be avoided due to risk of compressing remaining lung because the mediastinum is no longer held in place on both sides by lung tissue.

•Closed-chest drainage is not used after pneumonectomy because there is no lung to re-expand.

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