Chest physiotherapy

1. CHEST PHYSIOTHERAPY Prepared by Ms. Mahalakshmi.L M.Sc. Nursing 1 st year

2. definition 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.

3. uses Assist in coughing Reeducate breathing muscles Improve ventilation of the lungs

4. Therapies includes in chest physiotherapy 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.

5. indication It is indicated for patients in whom cough is insufficient to clear thick, tenacious, or localized secretions. Examples: Cystic fibrosis Bronchiectasis Atelectasis Lung abscess Pneumonia

6. contraindication Increased ICP Unstable head or neck injury Active hemorrhage or hemoptysis Recent spinal injury Rib fracture Flail chest Uncontrolled hypertension Anticoagulation Thoracic surgeries

7. precaution 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.

8. complication Hypoxemia Increased intracranial pressure Acute hy potension Pulmonary hemorrhage Pain Injuries to muscles Vomiting and aspiration Bronchospasm Dysrhythmias Excessive lung volume

9. Equipment's used in chest physiotherapy Trendelenberg bed Pillows , Patient gown and towl Sterilized clothes Basin , Stethoscope Suction apparatus Mechanical percussor Cardiac monitoring , Pulse oximeter Chest radiograph Emergency airway

10. Procedure of chest physiotherapy 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

11. 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. Percussion / Clapping Chest percussion involves rhythmically clapping on the chest wall over the area being drained to force secretions into larger airways for expectoration. Position the hand so the fingers and thumb touch and the hands are cupped.

13. Perform chest percussion by vigorously striking the chest wall alternately with cupped hands. The procedure should produce a hollow sound and should not be painful. Perform percussion over a single layer of clothing, not over buttons or zippers.

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 the spleen, liver, or kidneys. Typically, each area is percussed for 30 to 6o seconds several times a day. If the patient has tenacious secretions, the area must be percussed for 3-5 minutes several times per day.

15. Vibration Vibration is a gentle, shaking pressure applied to the chest wall to move secretions into larger airways. The nurse uses rhythmic contractions and relaxations of arm and shoulder muscles over the patient’s chest. During vibration, place your flat hand firmly against the chest wall, on the appropriate lung segment to be drained. Vibrate the chest wall as the patient exhales slowly through the pursed lips.

16. After each vibration, encourage the client to cough and expectorate secretions into the sputum container.

17. Postural Drainage Postural drainage is a technique in which different positions are assumed to facilitate the drainage of secretions from the bronchial airways. Gravity helps to move the secretions to the trachea to be coughed up easily. The goal of postural drainage is to help drain mucus from the affected lobes into the larger airways of the lungs so it can be coughed up more readily.

18. 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 the lungs.

19. 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 loosen secretions.

20. Postural drainage treatments are scheduled two or three times daily, depending on the degree of lung congestion. 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 and can induce vomiting. Help the patient assume the appropriate position, based on the lung field that requires drainage.

21. Lung Lobes And Segments

22. Lung segment Position Recommended Apical areas of the upper lobes -Ask the patient to sit at the edge of the bed. -If the patient is not able to sit at the edge of the bed, use high-Fowler’s position.

23. Lung segment Position Recommended Posterior section of the upper lobes. Position supine with a pillow under the hips and knees flexed

24. Lung segment Position Recommended Middle or lower lobes With the bed in the Trendelenburg position, position the patient in Sims’ position. To drain the left lung, position the patient on his right side. For the right lung, position the patient on his left side. Posterior lower lobes. Keeping the bed flat, position the patient prone with a pillow under her stomach.

25. 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 in position. The sequence for chest physiotherapy is usually as follows: Positioning, percussion, vibration, and removal of secretions by coughing or suction

26. Post cpt 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