Chest physiotherapy

It is also called as CPT

1. CHEST PHYSIOTHERAPY PRE SENTED BY MS. SHEELA M JOHN M.SC. NURSING 2 nd YEAR 05/01/2021 MS.SHEELA M JOHN 1

2. DE F INITION 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. 05/01/2021 MS.SHEELA M JOHN 2

3. US E S Assist in coughing Reeducate breathing muscles Improve ventilation of the lungs 05/01/2021 MS.SHEELA M JOHN 3

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. 05/01/2021 MS.SHEELA M JOHN 4

5. IN DIC A TION Itis indicated for patients in whom cough is insu f f icien t t o c l ea r thi c k , t e n ac i ous , o r l o ca li ze d secretions. Cystic fibrosis Bronchiectasis Atelectasis Lung abscess Pneumonia 05/01/2021 MS.SHEELA M JOHN 5

6. CONTRAINDICATION Increased ICP Unstable head or neckinjury Active hemorrhage or hemoptysis Recent spinal injury Rib fracture Flail chest Uncontrolled hypertension Anticoagulation Thoracic surgeries 05/01/2021 MS.SHEELA M JOHN 6

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. 05/01/2021 MS.SHEELA M JOHN 7

8. 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 05/01/2021 MS.SHEELA M JOHN 8

9. 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 05/01/2021 MS.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 05/01/2021 MS.SHEELA M JOHN 10

11. 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. 05/01/2021 MS.SHEELA M JOHN 11

12. 05/01/2021 MS.SHEELA M JOHN 12

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. 05/01/2021 MS.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, 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 severaltimes per day. 05/01/2021 MS.SHEELA M JOHN 14

15. 05/01/2021 MS.SHEELA M JOHN 15

16. 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 musclesover the patient’s chest. During vibration, place your flat hand firmly against the chest wall, on the appropriatelung segment to be drained. Vibrate the chest wall asthe patient exhales slowly through the pursedlips. 05/01/2021 MS.SHEELA M JOHN 16

17. After each vibration, encourage the clientto cough and expectorate secretions into the sputum container. 05/01/2021 MS.SHEELA M JOHN 17

18. 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 tohelp drain mucus from the affected lobes into the larger airways of the lungs so it can be coughed up morereadily. 05/01/2021 MS.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 the lungs. 05/01/2021 MS.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. 05/01/2021 MS.SHEELA M JOHN 20

21. 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. 05/01/2021 MS.SHEELA M JOHN 21

22. Lung segment Position Recommended Apical areas of the -Ask the patient to upper lobes 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. 05/01/2021 MS.SHEELA M JOHN 22

23. 05/01/2021 MS.SHEELA M JOHN 23

24. Lung segment Position Reco mme n d e d Posterior section Position supine of the upper with a pillow lobes. under the hips and knees flexed 05/01/2021 MS.SHEELA M JOHN 24

25. Lung segment Position Recommended Middle or lower lobes With the bed in the Trendelenburg position, position the patient inSims’ position. Todrain 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 underher stomach. 05/01/2021 MS.SHEELA M JOHN 25

26. 05/01/2021 MS.SHEELA M JOHN 26

27. 05/01/2021 MS.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 in position. Th e seque n c e f or ches t ph y s i o th e r ap y is usually as follows: Positioning, percussion, vibration, and removal of secretions by coughing or suction 05/01/2021 MS.SHEELA M JOHN 28

29. 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 05/01/2021 MS.SHEELA M JOHN 29

30. COMPLICATION Hypoxemia Increased intracranial pressure Acute hypotension Pulmonary hemorrhage Pain Injuries to muscles Vomiting and aspiration Bronchospasm Dysrhythmias Excessive lung volume 05/01/2021 MS.SHEELA M JOHN 30