A nurse is caring for an adolescent client who has cystic fibrosis.
Which of the following actions should the nurse instruct the client to take prior to initiating postural drainage?

Choice A rationale:

Sun protection is necessary when using self-tanning creams. These products do not provide protection against harmful UV rays. Failure to use sun protection measures, such as sunscreen and protective clothing, can lead to skin damage and increase the risk of skin cancer.

Choice B rationale:

The risk of injury from firearms does not necessarily decrease as children enter adolescence. Adolescents, like any other age group, should be educated about the dangers of firearms and the importance of firearm safety. Access to firearms should be restricted, and proper storage and education about safe handling are essential.

Choice C rationale:

Driving skills can be impaired when friends are present, especially for new and inexperienced drivers. Peer pressure and distractions from friends can lead to risky behaviors and impaired judgment, increasing the risk of accidents. It is crucial to educate adolescents about the importance of focused and responsible driving.

Choice D rationale:

Medroxyprogesterone is a hormonal contraceptive and does not provide protection against gonorrhea or other sexually transmitted infections (STIs). Safe sex practices, including the use of barrier methods such as condoms, are essential in preventing the transmission of STIs.

The correct answer is: b: Perform the procedure prior to meals.

Choice A rationale: The rationale for Choice A involves understanding the technique of percussion in postural drainage for cystic fibrosis management. Percussion is a component of chest physiotherapy that involves rhythmic clapping or tapping on the chest wall to help loosen and mobilize secretions within the airways. However, holding the hand flat during percussion may not effectively transmit the necessary force to the chest wall for optimal secretion mobilization. Instead, cupping the hands allows for better resonance and transmission of percussion force, enhancing the effectiveness of the procedure.

Choice B rationale: Performing postural drainage prior to meals is the recommended timing for several reasons. Firstly, initiating the procedure before meals allows the child's stomach to be relatively empty, reducing the risk of discomfort, nausea, or vomiting during the procedure. Secondly, performing postural drainage before meals helps prevent aspiration of stomach contents, which can occur if the child vomits during or after the procedure. Aspiration poses significant risks, including lung infection and respiratory distress, particularly in individuals with compromised respiratory function such as those with cystic fibrosis.

Choice C rationale: While bronchodilators may play a role in managing airway obstruction in cystic fibrosis, administering them after postural drainage is not a standard practice. Bronchodilators are typically used to alleviate bronchoconstriction and improve airflow in the lungs. However, their administration after postural drainage may not be directly related to the immediate goals of the procedure, which are to mobilize and clear pulmonary secretions. The timing of bronchodilator administration is often guided by the individual's clinical condition and the presence of symptoms such as wheezing or shortness of breath.

Choice D rationale: Performing postural drainage twice daily may not provide adequate frequency for managing secretions in individuals with cystic fibrosis. The goal of postural drainage is to facilitate the removal of thick, tenacious mucus from the airways to improve respiratory function and reduce the risk of complications such as infections. In cystic fibrosis, mucus clearance is essential for maintaining pulmonary health and preventing exacerbations. Therefore, a more frequent regimen, often including multiple sessions of postural drainage per day, may be necessary to achieve optimal therapeutic outcomes and prevent mucus accumulation and airway obstruction.