Chest physiotherapy involves techniques like postural drainage, percussion, and vibration to mobilize pulmonary secretions and clear the lungs. It aims to assist coughing, improve breathing muscle function, and enhance lung ventilation. Specific positions are used to facilitate drainage of secretions from different lung segments via gravity. The treatment is monitored closely and may require modification based on a patient's tolerance. Potential risks include hypoxemia, increased intracranial pressure, and bronchospasm.

1. PRESENTED BY
MS. SHEELA M JOHN
M.SC. NURSING 2nd YEAR
12/01/2021MS.SHEELA M JOHN 1

2. •Chest physiotherapy is a group of
therapies used in combination to
mobilize pulmonary secretions. Chest
physiotherapy is the removal of excess
secretions from the lungs by physical
means.
12/01/2021MS.SHEELA M JOHN 2

3. • Assist in coughing
• Reeducate breathing muscles
• Improve ventilation of the lungs
12/01/2021
MS.SHEELA M JOHN
3

4. • Postural drainage
• Chest percussion
• Vibration
Chest physiotherapy should be followed by
productive coughing & suctioning of the
patient . chest physiotherapy should never be
done straight after a meal or drink.
12/01/2021MS.SHEELA M JOHN 4

5. • Itis indicated for patients in whom cough is
insufficient to clear thick, tenacious,or localized
secretions.
• Cysticfibrosis
• Bronchiectasis
• Atelectasis
• Lungabscess
• Pneumonia
12/01/2021MS.SHEELA M JOHN 5

6. • IncreasedICP
• Unstable head orneckinjury
• Activehemorrhageorhemoptysis
• Recentspinalinjury
• Ribfracture
• Flailchest
• Uncontrolledhypertension
• Anticoagulation
• Thoracicsurgeries 12/01/2021MS.SHEELA M JOHN 6

7. • Keep suction apparatus & emergency airway &
oxygen therapy while providing chest
physiotherapy.
• Patient should be monitored throughout therapy.
• Adrenergic bronchodilators in solution should be
available in case of bronchospasm during therapies.
• Provide coughing instruction prior to therapy.
• Suctioning of trachea is essential. 12/01/2021MS.SHEELA M JOHN 7

8. • Trendelenberg bed
• Pillows , Patient gown and towl
• Sterilized clothes
• Basin , Stethoscope
• Suction apparatus
• Mechanical percussor
• Cardiac monitoring , Pulse oximeter
• Chest radiograph
• Emergency airway
12/01/2021MS.SHEELA M JOHN 8

9. • Assess the chest x-ray for pulmonary findings.
• Assess respiratory rate of patient.
• Assess breathing , rhythm , skin colour , BP, HR of
patient.
• Assess the patient`s ability to take deep breath
• Perform chest physiotherapy
• Monitor the following throughout the therapy
12/01/2021MS.SHEELA M JOHN 9

10. Reaction
Discomfort and dyspnea
Heart rate and rhythm
Respiratory rate
Sputum production , Breathe sound
Skin color
Mental status
Oxygen saturation
Blood pressure
• Modify the techniques of CPT according to patient
tolerance
12/01/2021MS.SHEELA M JOHN 10

11. • Chest percussion involves
rhythmically clapping on thechest
wall over theareabeing drained to
force secretions into larger airways
for expectoration.
• Position the hand so the fingers and
thumb touch and the hands are
cupped. 12/01/2021MS.SHEELA M JOHN 11

12. 12/01/2021MS.SHEELA M JOHN 12

13. • Perform chest percussion by vigorously
striking the chest wall alternately with
cupped hands.
• Theprocedureshouldproducea hollow
sound and should not bepainful.
• Perform percussion over a single
layerof clothing, not overbuttons
orzippers.
12/01/2021MS.SHEELA M JOHN 13

14. • Percussion is contraindicated in patients
with bleeding disorders, osteoporosis,
fractured ribs and open wounds and
surgeries.
• Don’t percuss over the spine, sternum,
stomach or lower back as trauma can
occur to thespleen, liver, orkidneys.
• Typically, each area is percussed for 30
to 6o seconds several times aday.
• If the patient has tenacious secretions, the
area must be percussed for 3-5 minutes
severaltimes per day.
12/01/2021MS.SHEELA M JOHN 14

15. 12/01/2021MS.SHEELA M JOHN 15

16. • Vibration isagentle,shakingpressureapplied
to the chest wall to move secretions into
largerairways.
• The nurse usesrhythmic contractions and
relaxationsof arm andshouldermusclesover
the patient’schest.
• During vibration, place your flat hand firmly
against the chest wall, on the appropriatelung
segment to bedrained.
• Vibrate the chest wall asthe patient exhales
slowly through thepursedlips. 12/01/2021MS.SHEELA M JOHN 16

17. •After each vibration, encourage the
clientto cough and expectorate
secretionsinto the sputumcontainer.
12/01/2021MS.SHEELA M JOHN 17

18. POSTURALDRAINAGE
• Postural drainage is a technique in which
different positions are assumed to
facilitate the drainage of secretions
from the bronchialairways.
• Gravityhelpsto movethe secretionsto
the trachea to becoughedupeasily.
• The goal of postural drainage is tohelp
drain mucus from the affected lobes into
the larger airwaysof the lungs so it can
be coughed upmorereadily. 12/01/2021MS.SHEELA M JOHN 18

19. • All the patients do not require postural
drainage for all the lung segments. So the
procedure must be based on the clinical
findings.
• In postural drainage, the person is tilted or
propped at an angle to help drain secretions
from thelungs.
12/01/2021MS.SHEELA M JOHN 19

20. • The lower lobes require drainage most
frequently because the upper lobes drain by
gravity.
• Before postural drainage, the client may be
given a bronchodilator medication or
nebulization therapy to loosensecretions.
12/01/2021MS.SHEELA M JOHN 20

21. • Postural drainage treatments are scheduled
two or three times daily, depending on the
degreeof lungcongestion.
• The best times include before breakfast, before
lunch, in the late afternoon, and before
bedtime.
• It is best to avoid hours shortly after meals
because postural drainage at these times can be
tiring andcaninducevomiting.
• Help the patient assume the appropriate
position, based on the lung field that requires
drainage. 12/01/2021MS.SHEELA M JOHN 21

22. Lung segment PositionRecommended
Apical areas of the -Askthe patient to
upperlobes sit at the edge of
thebed.
-If the patient is not
able to sit at the edge
of the bed, use high-
Fowler’sposition.
12/01/2021MS.SHEELA M JOHN 22

23. 12/01/2021MS.SHEELA M JOHN 23

24. Lungsegment Position
Recommended
Posterior section Position supine
of the upper with a pillow
lobes. under the hips
and knees
flexed
12/01/2021MS.SHEELA M JOHN 24

25. Lungsegment PositionRecommended
Middle orlower lobes With the bed in the
Trendelenburg position,
position the patientinSims’
position.
Todrain the left lung,
position the patient
on hisrightside.
Forthe right lung,position the
patient on his leftside.
Posteriorlower lobes. Keepingthe bed flat,position
the patient prone with a
pillow underher stomach.
12/01/2021MS.SHEELA M JOHN 25

26. 12/01/2021MS.SHEELA M JOHN 26

27. 12/01/2021MS.SHEELA M JOHN 27

28. • After positioning the client have the patient
remain in the desired position for 10 to 15
minutes, if tolerated.
• Perform percussion and vibration by keeping
the client inposition.
• The sequence for chest physiotherapy is
usually asfollows:
• Positioning, percussion, vibration, and removal
of secretionsbycoughingorsuction
12/01/2021MS.SHEELA M JOHN 28

29. • Patient should be advised to practice oral
hygiene procedure to decrease the bad taste
and odor.
• Record the procedure
• Report all significant findings
• Disinfect all non disposable equipment used
and store appropriately
12/01/2021MS.SHEELA M JOHN 29

30. • Hypoxemia
• Increased intracranial pressure
• Acute hypotension
• Pulmonary hemorrhage
• Pain
• Injuries to muscles
• Vomiting and aspiration
• Bronchospasm
• Dysrhythmias
• Excessive lung volume 12/01/2021MS.SHEELA M JOHN 30