Making coughing more comfortable post op?

[BA_anthropology]

I'm a second semester nursing student and I had a patient two days ago who refused to cough in addition to deep breathing, 12 hours after surgery. She was 71-years-old and a 45-year, pack-a-day smoker who had a lumbar decompression and fusion and refused to add pain from coughing. As her O2 plummeted to 90%, then quickly to 88%, we put her her 2 Liters of O2 nasal cannula which she complained was irritating her throat. She maintained 95% O2 with the cannula, but it was still disturbing that she refused to cough post op!!!!

I know that after abdominal surgeries, a binder can help ease the pain of coughing. Any suggestions to make coughing easier for a back surgery patient?

[KY RN]

Try having her place a pillow across her incision when she coughs.

[cschoppe]

Yes, have her place a pillow over her incision to splint it while she is coughing and make sure she is well medicated to help stay on top of her pain. I hope that she is also using an incentive spirometer as well.

[canesdukegirl, BSN, RN]

She had a lumbar decompression, so her incision is lower back.

If the NC is bothering her, see if you can add a humidifier. She should be doing IS as well. The best thing she can do is to get up and walk with assistance so she is not having all of that yuck pooling in her lower lobes.

[belgarion]

They make a "coughing splint". It's about half the size and stiffer than a regular bed pillow. I used one when I had surgery a few years back and it made coughing much easier to take.

[casi, ASN, RN]

Bracing with a pillow, pain meds, lots of ambulation, and a lot of education regarding the real risk of post-op pneumonia

[BA_anthropology]

Thanks for the suggestions! I'll see if the hospital where I am has a coughing splint, otherwise I'll try the pillow. She was using her IS, ambulating as soon as she was cleared by PT to do so, as well as spending time in her chair.

[steelydanfan]

Thanks for the suggestions! I'll see if the hospital where I am has a coughing splint, otherwise I'll try the pillow. She was using her IS, ambulating as soon as she was cleared by PT to do so, as well as spending time in her chair.

The deep breathing part is MUCH more important than the coughing part. If your pt. can pull 1200-1500 on the IS and breath hold for 3 seconds, she's good (mind you she's a LOL with restrictive problems). If she HAS airway secretions, this should stimulate a cough.

Splint with a pillow, stuffed bear, WHATEVER; it's not the tool, it's her feeling abdominal and back support.