Cough Nursing Care Plans Diagnosis and Interventions
Cough NCLEX Review and Nursing Care Plans
A cough is a frequent reflex response used to expel mucous or exogenous irritants from the throat.
While everyone coughs occasionally to clean their throat, several diseases might induce more regular coughing. An acute cough lasts fewer than three weeks and significantly improves within two weeks.
On the other hand, a subacute cough lasts between three and eight weeks and improves towards the end. A chronic cough lasts for more than two months.
Individuals who spit up blood or have a “barking” cough should see a doctor. They should also consult their doctor if their cough does not improve after a few weeks, which could suggest a more severe health problem.
Signs and Symptoms of Cough
- runny or stuffy nose
- postnasal drip
- sore throat
- difficulty of breathing
Causes of Cough
Cough can occur due to several situations, both short-term and long-term. Some of the triggers are as follows:
- Viruses. There are numerous reasons, but colds and the flu are the most prevalent. A productive cough helps prevent other illnesses by clearing out mucus from the lungs. Most of them will most likely disappear within a few days.
- Allergies and asthma. Inhaling an allergen, such as mold can cause an allergic reaction in the lungs. Coughing is thus the only way to get rid of it.
- Irritants. Cold air, cigarette smoke, or strong perfume are some of the triggers of cough, even if an individual is not allergic to them.
- Postnasal drip. Coughing is caused by mucus dripping down the nose and throat due to constrictive breathing. Among the many causes of a postnasal drip are common colds and flu, sinus infections, and allergies.
- Acid reflux. Heartburn usually occurs when stomach acid flows back into the throat. Stomach acid can irritate the windpipe, vocal cords, and throat, causing the cough reflex.
- Chronic obstructive pulmonary disease or COPD. Emphysema, chronic bronchitis, and asthma fall into this category. As these conditions weaken the tubes in the airways and the tiny sacs that remove carbon dioxide and deliver oxygen into the blood, they can cause a person’s body to lose oxygen and carbon dioxide. Smoking is the most typical cause of COPD, although there are many more.
- Blood pressure medications. Angiotensin-converting enzyme (ACE) inhibitors, routinely used to treat high blood pressure and heart failure, have been linked to chronic cough in certain patients.
- Infections. Coughing can continue even after other indications of pneumonia, flu, a cold, or other upper respiratory infection have subsided. Pertussis, widely referred to as whooping cough, is a frequent but under-recognized cause of persistent cough in adults. Chronic cough can also be caused by fungal respiratory infections, tuberculosis (TB), or lung infection with nontuberculous mycobacterium tuberculosis organisms.
- Other causes. Sleep apnea and pharmacological side effects are very prominent causes of apneic episodes. In order to rule out a more severe issue, one should have a persistent cough checked out by a medical professional.
Cough may also be caused by the following:
- Aspiration of food in adults and unfamiliar objects in children.
- Damaged or widened airways (Bronchiectasis)
- Inflammation of the tiny airways of the lung (Bronchiolitis)
- Reflux of the laryngopharynx (stomach acid flows up into the throat)
- Cancer of the lungs
- Cystic fibrosis (CF)
- Eosinophilic bronchitis without asthma (airway inflammation not caused by asthma)
- Clusters of inflammatory cells in different parts of the body, most commonly the lungs (Sarcoidosis)
- Severe scarring of the lungs due to an unidentified reason (Pneumofibrosis idiopathic)
Risk Factors to Cough
Cough is more likely to occur if one has any of the following risk factors:
- Cigarette smoking. If individuals are smoking excessively, they are more likely to develop a chronic cough. Tobacco toxins and second-hand smoke are directly responsible for causing cough in the lungs.
- Being exposed to a person suffering from a respiratory infection. There is a high likelihood that respiratory infections will spread from person to person.
- Allergies. People with allergies are more susceptible to coughing due to allergy triggers.
- Environmental. Irritants in the air in some workplaces may cause cough. In addition, it is more likely to occur in locations with high pollution levels and in areas where coal is utilized as a source of heat and cooking.
- Chronic lung diseases. Individuals with asthma, bronchiectasis, COPD, or scars from past lung infections are more likely to develop coughing.
- Gender. Women have a more sensitive cough response than men, contributing to their greater risk of chronic coughing.
Complications of Cough
- Insomnia. A chronic cough can be tedious since it disturbs sleep.
- Hoarseness. Chronic coughing can induce vocal cord inflammation, resulting in voice alterations.
- Headaches. Coughing makes a lot of noise. It is also possible to suffer from a noise-induced headache from being exposed to sharp, sudden noises on a regular basis.
- Rupture of nasal and subconjunctival veins. The tiny veins in the nose and below the eyes can rupture when coughing due to raised pressure in the vessels. An example of this would be a nosebleed.
- Pain. Because of the frequent movement of the chest wall and back, it is possible to strain and pain the muscles in the back and chest when coughing constantly.
- Inability to control urinary movement. Coughing raises the blood pressure and the pressure in the abdomen (including the bladder). As a result of such a condition, urine may leak when coughing, significantly if the pelvic floor is already compromised.
Diagnosis of Cough
- Physical exam and history taking. The healthcare provider will ask about the patient’s medical history and conduct a physical examination. A comprehensive medical history and physical examination might provide critical information about a chronic cough. In addition, the doctor may request tests to determine the source of the chronic cough.
- Laboratory Tests
- Phlegm or mucus analysis. The cellular and acellular components taken from the patient’s upper respiratory tract are investigated using an analytical method in sputum analysis. This method is critical in diagnosing and treating lower respiratory infections and other chronic health issues.
- Blood and skin tests. Both blood and skin tests identify allergens by detecting antibodies called Immunoglobulin E. (IgE). IgE antibodies are found in a patient’s blood and skin, where they recognize allergens and cause an allergic reaction, allowing the doctor to establish what circumstances are causing the patient’s condition to escalate.
- Imaging Tests
- X-ray. Although a conventional chest X-ray will not identify the most common causes of coughing, such as postnasal drip, acid reflux, or asthma, it may be used to screen for lung cancer, pneumonia, and other lung disorders. A sinus X-ray may indicate symptoms of a sinus infection.
- Echocardiogram. A doctor may request this test on rare occasions to confirm that the heart is operating correctly and is not the source of the cough.
- CT Scan. This procedure can help determine what is causing the cough by providing a more detailed image of the airways and chest.
- Noninvasive Test
- Lung function test. It will determine the source of respiratory issues.
- Scope Tests
- Bronchoscopy. The specialist will examine the lungs and airways using a thin, flexible tube coupled with a laser and camera (bronchoscope). A biopsy of the internal lining of the airway (mucosa) can also be performed to check for other abnormalities.
- Rhinoscopy. The doctor will examine the nasal airways, sinuses, and upper airway with a fiberoptic scope (rhinoscope).
Treatment of Cough
- Corticosteroids, antihistamines, and decongestants. These medications are commonly used to alleviate allergies and postnasal drip.
- Inhaled asthma medications. Corticosteroids and bronchodilators, which lower swelling and dilate the airways, are the most effective therapies for asthma-related cough.
- Antibiotics. The doctor might recommend antibiotics to treat the infection if the chronic cough is caused by a bacterial, fungal, or mycobacterial illness.
- Acid inhibitors. When lifestyle adjustments fail to relieve acid reflux, the patient may be prescribed drugs that inhibit acid production. Some individuals require surgery to correct the condition.
- Cough Suppressant. While the doctor is diagnosing the cause of the cough and starting treatment, he or she may also recommend a cough suppressant to speed up symptom alleviation.
- Lifestyle and Home remedies. The following remedies can be recommended while doing a health teaching session with the patient:
- Drink plenty of fluids. Liquid aids in the thinning of mucus in the throat. Warm drinks like broth, tea, or juice might help relieve the sore throat.
- Cough lozenges. They can help to relieve a dry cough and soothe an inflamed throat.
- Consider consuming honey. A teaspoon of honey may aid with cough relief. Honey should not be given to children under one year because it contains bacteria that are dangerous to infants.
- Moisten the air. Take a steamy shower or use a cool-mist humidifier.
- Avoid tobacco smoking. Cigarette smoking and second-hand smoke irritate the lungs and can aggravate coughing caused by other reasons. If the patient smokes, advise them to consult the doctor about programs and items that can assist them in quitting.
- Avoid triggers. Anyone suffering from allergies or asthma will benefit from removing allergens from their house. It is also recommended that air conditioners be used to filter the air.
Nursing Diagnosis for Cough
Nursing Care Plan for Cough 1
Nursing Diagnosis: Ineffective Airway Clearance related to copious bronchial secretions secondary to pertussis, as evidenced by whooping cough, unusual breath sounds (crackles, rhonchi, wheezes), abnormal breathing rate, pattern, and depth, breathlessness, copious secretions, hypoxemia or cyanosis, failure to clear airway secretions, and orthopnea.
- The patient’s airways will remain clean and open, as evidenced by regular breath sounds, standard rate and depth of respiration, and the capacity to cough up secretions after medications and breathing exercises.
- The patient will have greater air exchange.
- The patient will categorize ways to improve secretion removal.
- The patient will recognize and avoid particular circumstances that interfere with good airway clearance.
|Nursing Intervention for Cough||Rationale|
|Educate the patient about proper coughing and deep breathing exercises. For example, allow the patient to take a deep breath, hold it for two seconds, and cough up to three times in a row.||Coughing is the most convenient approach to eliminate most secretions. Thus, assist the patient throughout breathing exercises. Deep breathing enhances oxygenation prior to coughing.|
|Consult a pulmonary clinical nurse specialist, home care nurse, or respiratory therapist as required.||Consultants can help ensure that suitable therapies are provided to the patient.|
|Explain to the patient the hazards of smoking in further detail, especially secondhand smoke.||Chemical irritants and allergens can exacerbate mucus production and bronchospasm.|
|Conduct cardiopulmonary resuscitation (CPR) maneuvers on patients with a completely blocked airway.||This procedure can ease airway blockages and prolong life until definitive treatment is available.|
|If coughing is unsuccessful, perform nasotracheal suctioning as needed.||Suctioning is necessary when patients cannot cough out secretions properly due to weakness, thick mucus plugs, or extensive or tenacious mucus production.|
|If feasible, keep the patient in an upright position. Monitor the patient’s position regularly to avoid them from sliding down in bed.||The upright position prevents stomach contents from pushing upward, preventing lung expansion. This position encourages more significant lung expansion and air exchange.|
|Provide the patient with medications such as antibiotics, mucolytic drugs, bronchodilators, and expectorants while keeping track of efficacy and side effects.||A range of drugs is available to treat specific issues. Most medications enhance airway secretion clearance and may lower airway obstruction.|
Nursing Care Plan for Cough 2
Nursing Diagnosis: Ineffective Breathing Pattern related to respiratory tract inflammatory process secondary to acute nasopharyngitis, as evidenced by a dry and persistent cough and irregular breathing rate, rhythm, and depth.
- The patient will successfully expectorate sputum.
- The patient will continue to breathe effectively, as shown by calm breathing at a regular rate and depth and the absence of dyspnea.
- The patient’s respiration rate will remain within the normal or target limits.
|Nursing Intervention for Cough||Rationale|
|Facilitate diaphragmatic breathing in a patient with dry and persistent cough.||This approach relaxes muscles while increasing oxygen levels in the patient.|
|Evaluate the patient’s skin color, warmth, and capillary refill. Compare central and peripheral cyanosis.||A lack of oxygenation causes blue or cyanosis color of the lips, tongue, and fingers. Be informed that Inside-of-the-mouth cyanosis is a medical emergency for the patient.|
|Assess the usefulness of inspiratory muscle exercise.||This training enhances respiratory muscle control and inspiratory muscle strength.|
|As directed by the doctor, administer respiratory medicines and oxygen.||Beta-adrenergic agonist drugs relax the smooth muscles of the airways and produce bronchodilation, which opens the airways.|
|Assess the patient about potential causative and aggravating circumstances of ineffective breathing.||Understanding these factors can help the healthcare team create an intervention to avoid or control future occurrences of respiratory issues.|
|Educate the patient or significant other on appropriate breathing, coughing, and splinting techniques.||These techniques enable adequate secretion mobilization.|
|Educate the patient on drugs, including indications, dose, frequency, and side effects. As necessary, combine an evaluation of the metered-dose inhaler and nebulizer treatments.||This information facilitates medication administration that is both effective and safe.|
Nursing Care Plan for Cough 3
Nursing Diagnosis: Impaired Gas Exchange related to thick respiratory secretions secondary to pulmonary tuberculosis as evidenced by cough, nasal flaring, dyspnea, or breathing difficulty.
- The patient will report improved and reduced dyspnea.
- The patient will exhibit improved ventilation and satisfactory oxygenation of tissues by ABGs within allowable limits.
- The patient will show no indications of respiratory distress.
|Nursing Intervention for Cough||Rationale|
|Examine the patient for dyspnea on a scale of 0 to 10, tachypnea, irregular or reduced breathing sounds, increased respirations, restricted chest wall expansion, and exhaustion.||Pulmonary tuberculosis can induce a little patch of bronchopneumonia to diffuse severe inflammation, necrosis, pulmonary edema, and lung fibrosis. The effects on the respiratory system might range from mild dyspnea to severe respiratory distress. A 0 to 10 scale to assess dyspnea clarifies the difficulty level and condition variations.|
|As needed, provide oxygen therapy.||This intervention aids in the correction of hypoxemia caused by reduced ventilation or decreased alveolar lung surface.|
|Assess the change in mentation level of the patient. Take note of any cyanosis or skin color changes, particularly mucosal membranes and nail beds.||Secretion buildup or airway obstruction can impair the gas exchange of essential tissues and organs.|
|Demonstrate and stimulate pursed-lip exhalation, particularly in patients with fibrosis or parenchymal deterioration.||This intervention generates resistance against outflowing air to avoid airway compression or constriction, assisting in air distribution through the lungs and relieving or reducing shortness of breath.|
|bed rest or activity restrictions, and aid with self-care activities as needed.||During respiratory distress, reducing oxygen use and demand may help alleviate symptoms.|
Nursing Care Plan for Cough 4
Impaired Breathing Pattern
Nursing Diagnosis: Impaired Breathing Pattern related to laryngo tracheobronchial obstruction secondary to croup as evidenced by a barking cough, stridor on inspiration, hoarseness, and significant respiratory retraction.
Desired Outcome: The patient will have suitable ventilation as demonstrated by a respiration rate within age-related parameters, the elimination of retractions, accessory muscle use and grunting, normal breath sounds, and oxygen saturation of greater than 94%.
|Nursing Intervention for Cough||Rationale|
|Examine the pulse, breathing, and lung sounds of the patient.||An increased pulse or breathing rate, as well as a loud, high-pitched crowing breath sound (stridor), indicate impaired breathing pattern.|
|As directed, administer humidified supplementary oxygen through a tent or hood.||Humidified oxygen enables appropriate oxygenation while preventing mucous membrane dryness.|
|Take note of any changes in the patient’s state of consciousness.||Restlessness, perplexity, and irritation are early signs of oxygen deprivation in the brain (hypoxemia).|
|Place the patient in an upright position that is comfortable for him or her.||If required, use pillows or cushions. Through maximum lung expansion, this technique ensures adequate ventilation.|
|Allow the patient to have enough relaxation intervals and emphasize the value of cuddling to keep the child comfortable.||Continuous sobbing raises oxygen demands, and respiratory muscle fatigue can exacerbate airway blockage. This technique is suitable for pediatric patients.|
|Encourage secretion clearance with gentle suctioning and coughing exercises.||This technique improves airway clearance by mobilizing secretions.|
|Administer corticosteroid as prescribed by the doctor.||Corticosteroids are used to diminish airway inflammation and congestion.|
|Use a pulse oximeter to monitor the patient’s oxygen saturation; As per doctor’s advice, measure the patient’s arterial blood gasses (ABGs) as well.||This intervention assesses oxygenation status and allows for the early diagnosis of hypoxemia or hypercapnia.|
Nursing Care Plan for Cough 5
Nursing Diagnosis: Activity Intolerance related to exhaustion and sleep interruption secondary to pneumonia as evidenced by a persistent cough, verbal complaints of lethargy, fatigue, exhaustion, exertional breathlessness, difficulty breathing, palpitations, and the formation or exacerbation of pallor or cyanosis in response to activity.
Desired Outcome: The patient will experience or exhibit a considerable increase in activity tolerance, with no breathlessness or undue fatigue, and vital signs within the patient’s accepted level.
|Nursing Intervention for Cough||Rationale|
|Ascertain the patient’s responsiveness to activities. Take note of any reports of breathlessness, increased lethargy, weariness, or vital signs abnormalities during and after physical activity.||This approach determines the patient’s capabilities and needs. This intervention makes the treatment selection easier.|
|This intervention will help in speeding up the patient’s recovery. Reduce the patient’s tension and over-stimulus. Encourage the patient to have plenty of rest.||This technique attempts to promote relaxation and recovery as quickly as possible.|
|Explain to the patient the significance of rest in the treatment regimen and the relevance of balancing rest activities.||During the acute period of his or her condition, bedrest is maintained to reduce metabolic requirements and conserve energy for recuperation. Following that, activity constraints are established by the individual patient’s tolerance to activity and the recovery of respiratory distress.|
|As indicated, provide a quiet atmosphere for the patient and limit visits during the acute phase of his or her condition.||Encourage the use of stress management and recreational activities as needed.|
|Pace activity for less active patients.||Excessive and persistent coughing may deplete an already exhausted patient. Fatigue may exacerbate ineffective coughing.|
|Help the patient find a comfortable position during sleep or rest time.||The patient may be more relaxed with the elevated head of the bed, sleeping in a recliner, or leaning forward towards an overbed desk with pillow support.|
|As needed, assist the patient with self-care activities. Allow for a gradual increase in activity during the recuperation phase and demand.||This intervention reduces tiredness and aids in the balance of oxygen supply and demand.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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