A patient has retained secretions in the right and left lower ...

[EY67]

A patient has retained secretions in the right and left lower lobe superior bronchi. A nurse is demonstrating to family members how to perform percussion and vibration. Which action by the nurse is appropriate?
 
  a. Positioning the patient in a chair leaning forward on a table
  b. Asking the patient to lie flat on the stomach with a pillow under the stomach
  c. Assisting the patient to the right side with the arm overhead and the feet elevated
  d. Asking the patient to lie on the left side with the head elevated

Question 2

The home health nurse evaluates the provision of intermittent tube feedings by the patient's family member. The nurse notes that additional teaching is required when she notices that the family member:
 
  a. keeps the formula refrigerated between feedings.
  b. keeps the feeding tube capped between feedings.
  c. begins the feeding before checking tube placement.
  d. irrigates the tube with 30 to 60 mL of water before and after feedings.

[dantucker]

Answer to Question 1

B
Have the patient lie flat on the stomach with a pillow under the stomach. Percuss and vibrate below the scapula on either side of the spine. Sitting up and leaning forward is the position for drainage of the left and right upper lobe posterior apical branch. Having the patient lying on the right side in Trendelenburg's position with the arm overhead facilitates drainage of the left upper lobe lingular bronchi. On the left side with the head elevated is not a correct position for any drainage procedure.

Answer to Question 2

C
For intermittent tube-fed patients, test placement immediately before each feeding and before each administration of medication. Each administration of feeding/medication can lead to aspiration if the tube is displaced. For intermittent feeding, have a syringe ready and be sure that the formula is at room temperature. When tube feedings are not being administered, cap or clamp the proximal end of the feeding tube. Draw up in the syringe 30 mL of normal saline or tap water. This amount of solution will flush the length of the tube.