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?

Hypostatic Pneumonia Hypostatic pneumonia is a type of pneumonia that occurs when fluid or secretions settle in the lower lobes of the lungs, typically due to a lack of movement or staying in one position for too long. In this case, the client has paraplegia, which is a form of significant immobility. This condition prevents the client from effectively clearing their airway and results in decreased lung expansion.

Analysis of Evidence The clinical findings on Day 2 clearly indicate a progression toward an infectious respiratory process caused by this immobility:

• Respiratory Status: The oxygen saturation has dropped from 95% to 89%, and the respiratory rate has increased from 20/min to 24/min (tachypnea).

• Symptoms: The client has transitioned from a simple cough to a productive cough and is now experiencing confusion, which is a common sign of hypoxia in clinical settings.

• Infection Markers: The client's temperature has risen to 38.4°C (101.1°F), and the WBC count is elevated at 12,500/mm³, indicating a systemic inflammatory response or infection.

• Tachycardia: The heart rate has increased to 105/min, which is a compensatory mechanism for decreased oxygenation and the presence of a fever.

While the client's Hgb is slightly low (11.0 g/dL), it does not explain the acute onset of fever, confusion, and productive cough. Furthermore, there are no signs of fluid volume overload (such as edema or high BP) or calorie deficiency that would trigger these specific respiratory and febrile symptoms.