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Chest physiotherapy and postural drainage
Chest physiotherapy (CPT) is a technique used to mobilize secretions in the lungs through methods like percussion, vibration, and postural drainage, particularly for patients with ineffective coughs or thick secretions. Indications for CPT include conditions like cystic fibrosis and pneumonia, while contraindications include increased intracranial pressure and unstable injuries. Nursing considerations emphasize patient assessment, the effectiveness of techniques, and the evaluation of patient tolerance and responses during therapy.
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Chest physiotherapy and postural drainage
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- 2. CHEST PHYSIOTHERAPY PREPARED BY: RN ArpanaBhusal BNS 2 7/24/2022
- 3. CONTENTS • DEFINITION • INDICATIONS •CONTRA- INDICATIONS • PATIENT’S ASSESSMENT FOR CPT • CPT TECHNIQUES – PERCUSSION – VIBRATION – POSTURAL DRAINAGE • NURSING CONSIDERATIONS FOR CPT 3 7/24/2022
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- 5. Definition • Chest physiotherapy(CPT) is a technique used to mobilize or loosen secretions in the lungs and respiratory tract. • This is especially helpful for patients with large amount of secretions or ineffective cough. 5 7/24/2022
- 6. Contd….. • Chest physiotherapyconsists of external mechanical maneuvers; such as chest percussion, postural drainage, vibration to augment mobilization and clearance of airway secretions, diaphragmatic breathing with pursed-lips, coughing and controlled coughing. 6 7/24/2022
- 7. Indications • It isindicated for patients in whom cough is insufficient to clear; thick, tenacious, or localized secretions. Examples include: Cystic fibrosis Bronchiectasis Atlectasis Lung abscess Neuromuscular diseases Pneumonias in dependent lung regions. 7 7/24/2022
- 8. Contraindications • Increased ICP •Unstable head or neck injury • Active hemorrhage with hemodynamic instability or hemoptysis • Recent spinal injury or injury • Empyema 8 7/24/2022
- 9. Contd…. • Broncho-plueral fistula •Rib fracture • Uncontrolled hypertension • Anticoagulation • Osteoporosis 9 7/24/2022
- 10. Patient’s assessment forCPT Nursing care and selection of CPT skills are based on specific assessment findings. The following are the assessment criteria: • Know the normal range of patient’s vital signs. Conditions requiring CPT; such as atelectasis and pneumonia etc affects vital signs. • Know the patient’s medications. Certain medications, particularly diuretics, antihypertensive drugs causes fluid and hemodynamic changes. These decrease patient’s tolerance to positional changes and postural drainage. 10 7/24/2022
- 11. Cont.. • Know thepatient’s medical history; certain conditions such as increased ICP, spinal cord injuries contraindicate the positional change to postural drainage. • Thoracic trauma and chest surgeries also contraindicate percussion and vibration. • Know the patient’s cognitive level of functioning. Participating in controlled cough techniques requires the patient to follow instructions. • Beware of patient’s exercise tolerance. CPT maneuvers are fatiguing. 11 7/24/2022
- 12. TECHNIQUES Chest physiotherapy consistsof three techniques: 1. Percussion/Clapping/Cupping 2. Vibration 3. Postural drainage 12 7/24/2022
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- 14. PERCUSSION • Chest percussioninvolves striking the chest wall over the area being drained. • Percussing lung areas involves the use of cupped palm to loosen pulmonary secretions so that hey can be expectorated with ease. • Percussing with the hand held in a rigid dome-shaped position, the area over the lung lobes to be drained in struck in rhythmic pattern. • Usually the patient will be positioned in supine or prone and should not experience any pain. 14 7/24/2022
- 15. Cont.. • Cupping isnever done on bare skin or performed over surgical incisions, below the ribs, or over the spine or breasts because of the danger of tissue damage. • Typically, each area is percussed for 30 to 60 seconds several times a day. • If the patient has tenacious secretions, the area must be percussed for 3-5 minutes several times per day. Patients may learn how to percuss the anterior chest as well. 15 7/24/2022
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- 18. VIBRATION • In vibration,the nurse uses rhythmic contractions and relaxations of her arm and shoulder muscles while holding the palm flat on the patient’s chest as the patient exhales. 18 7/24/2022
- 19. Contd…. • The purposeis to help loosen respiratory secretions so that they can be expectorated with ease. • To avoid patient’s discomfort, vibration is never done over the patient’s breasts, spine, sternum, and rib cage. • Vibration can also be taught to family members or accomplished with mechanical device. 19 7/24/2022
- 20. Procedure for percussion& vibration • Instruct the patient use diaphragmatic breathing. • Position the patient in prescribed postural drainage positions. Spine should be straight to promote rib cage expansion. • Percuss with cupped hands on chest wall for 5 minutes over each segment (5 minutes for cystic fibrosis and 1-2 minutes for other conditions). • Instruct the patient to inhale slowly and deeply. Vibrate the chest wall as the patient exhales slowly through the pursed lips. • Place one hand on top of the other over affected area or place one hand on each side of the rib cage. 20 7/24/2022
- 21. Cont.. • Tense themuscles of the hands while applying moderate pressure downward and vibrate arms and hands. • Relieve pressure on the thorax as the patient inhales. • Encourage the patient to cough, using abdominal muscles, after three or four vibrations. • Allow the patient rest several times. • Listen with stethoscope for changes in breath sounds. • Repeat the percussion and vibration cycle according to the patient’s tolerance and clinical response: usually 15-30 minutes. 21 7/24/2022
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- 23. POSTURAL DRAINAGE • Posturaldrainage is the positioning techniques that drain secretions from specific segments of the lungs and bronchi into the trachea. • Because some patients do not require postural drainage for all lung segments, the procedure must be based on the clinical findings. 23 7/24/2022
- 24. Contd…. • In posturaldrainage, the person is tilted or propped at an angle to help drain secretions from the lungs. • Also, the chest or back may be clapped with a cupped hand to help loosen secretions- the technique called chest percussion. 24 7/24/2022
- 25. Cont.. • Postural drainagecannot be used for people who are: unable to tolerate the position required, are taking anticoagulation drugs, have recently vomited up blood, have had a recent rib or vertebral fracture, or Have severe osteoporosis. • Postural drainage also cannot be used for people who are unable to produce any secretions (because when this happens, further attempts at postural drainage may lower the level of oxygen in the blood). 25 7/24/2022
- 26. ARTICLES • Pillows • Tilttable • Sputum cup • Paper tissues 26 7/24/2022
- 27. Steps • Use specificpositions. So, the force of gravity can assist in the removal of bronchial secretions from affected lung segments to central airways by means of coughing and suctioning. • The positions assumed are determined by the location, severity, and duration of mucous obstruction. • The exercises are performed two to three times a day, before meals and bedtime. Each position is done for 3-15 minutes. 27 7/24/2022
- 28. Contd…. • The procedureshould be discontinued if tachycardia, palpitations, dyspnea, or chest pain occurs. These symptoms may indicate hypoxemia. Discontinue if hemoptysis occurs. • Bronchodilators, mucolytic agents, water, or saline may be nebulized and inhaled before postural drainage and chest percussion to reduce bronchospasm, decrease thickness of mucus and sputum, and combat edema of the bronchial walls, there by enhancing secretion removal. 28 7/24/2022
- 29. Cont.. • Perform secretionremoval procedures before eating because after eating procedure can induce vomiting. • Make sure patient is comfortable before the procedure starts and as comfortable as possible he or she assumes, in each position. • Auscultate the chest to determine the areas needed for drainage. 29 7/24/2022
- 30. Cont.. • Encourage thepatient to deep breath and cough after spending the allotted time in each position. • Encourage diaphragmatic breathing throughout postural drainage: this helps widen airways so secretions can be drained. 30 7/24/2022
- 31. DIFFERENT POSITIONS FORPOSTURAL DRAINAGE 31 7/24/2022
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- 35. Coughing • Coughing isa common reflex action that clears your throat of mucus or foreign irritants. • Coughing gently or making short grunting noises with the mouth slightly open will help loosen the mucus. • Do this periodically throughout the drainage procedure. 35 7/24/2022
- 36. Controlled coughing technique •Controlled coughing is one of the essential techniques in good respiratory care. • Patient performs this maneuver after each drainage position and often throughout the day. • The abdominal muscles are very powerful muscles used in coughing and exhaling. • Inhale deeply through the nose. • Pause. • Cough 2 to 3 sharp staccato cough with proper hand/arm placement. • Breathe in easily through the nose. 36 7/24/2022
- 37. Nursing considerations forchest physiotherapy 1. Assess baseline breath sounds, oxygen saturation, and ability to tolerate procedure. 2. Administer prescribed bronchodilators, mucolytics and analgesics. 3. Position client: a. Fowler position for incentive spirometry and to drain upper lungs. b. Side lying and prone position for postural drainage. 37 7/24/2022
- 38. Contd….. 4. Teach theuse of incentive spirometer. a. after exhaling, form seal around the mouthpiece with lips. b. take slow, continuous deep breath and hold indicator afloat for several seconds before exhaling. c. Repeat 10 times per hour or as per protocol. 5. Perform percussion and vibration for several minutes over affected areas being managed with postural drainage. 38 7/24/2022
- 39. Contd…. 6. Encourage coughingand expectoration of secretions. Provide tissue and appropriate receptacle. 7.Provide rest periods as needed; avoid scheduling near meal time. 8. Evaluate color and amount of secretions and quality of breath sounds after procedure. 9. Encourage a 2- 3 L fluid intake daily to liquefy secretions. 39 7/24/2022
- 40. Documentation • Following chestphysiotherapy, the nurse should auscultate the client’s lungs, compare the findings to the baseline data, and document the amount, color, and character of expectorated secretions. 40 7/24/2022
- 41. Complications Complications are unusualbut include: • Position-related hypoxia • Aspiration of secretions in other lung regions • Headache, dizziness etc. 41 7/24/2022
- 42. REFERENCE • Mandal G.N,Textbook of medical surgical nursing (adult nursing) published by Makalu publication house, 3rd edition. • Brunner and siddarth, Textbook of Medical- Surgical Nursing, 13th edition. • https://www.slideshare.net/sivanandareddy5 2/cpt-postural-drainage 42 7/24/2022
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