Percussion and vibration is ordered on a patient with retained pulmonary secretions. Which action by the student nurse should the nursing instructor question?
a. Performs percussion for 3 to 5 minutes in each position as tolerated
b. Uses the wrist and elbow to create movement when performing percussion
c. While the patient inhales, gently pushes down and vibrates the chest wall with the flat part of the hand
d. Repeats the vibration 3 times and then instructs the patient to take a deep breath and cough while exhaling
C
Vibration is performed while the patient is exhaling, not inhaling. Percussion is performed for 3 to 5 minutes in each position. When clapping, most arm movement comes from the elbow and wrist joints. Vibration is repeated 3 times and then the patient cascade coughs by taking a deep breath and doing a series of small coughs until the end of the breath.
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