Postural drainage

one of the most commonly used techniques of the lung drainage is the postural drainage its non invasive and easy technique ans very useful in hospital as well as home settings.

1. posture Lungs

2. Deblina Roy M.Sc. Nursing 1 st year K.G.M.U Institute of Nursing Postural drainage

3. define postural drainage describe the various lobes of the lungs discuss the components of postural drainage describe the settings of the postural drainage enumerate the indications and contra indications of postural drainage describe the steps of the procedure describe the hazards ,limitations discuss the nursing care for the procedure. At the end of the class you will be able to :-

4. Postural drainage therapy is designed to improve the mobilization of bronchial secretions and the matching of ventilation and perfusion, and to normalize functional residual capacity based on the effects of gravity and external manipulation of the thorax. This includes turning, postural drainage, percussion, vibration, and cough. Definition

5. Turning Postural drainage External manipulation of the thorax Percussion Vibration Components of postural drainage therapy

6. Critical care  In-patient acute care  Extended care and skilled nursing facility care  Home care  Outpatient/ambulatory care Pulmonary diagnostic (bronchoscopy) laboratory Postural drainage therapy SETTING:

7. Turning : Inability or reluctance of patient to change body position. ( eg , mechanical ventilation, neuromuscular disease, drug-induced paralysis) poor oxygenation associated with position ( eg , unilateral lung disease)  potential for or presence of atelectasis  presence of artificial airway. Indications

8. Postural drainage: evidence or suggestion of difficulty with secretion clearance difficulty clearing secretions with expectorated sputum production greater than 25-30 mL/day (adult) evidence or suggestion of retained secretions in the presence of an artificial airway presence of atelectasis caused by or suspected of being caused by mucus plugging diagnosis of diseases such as cystic fibrosis, bronchiectasis, or cavitating lung disease  presence of foreign body in airway   Indications

9. External Manipulation of the Thorax sputum volume or consistency suggesting a need for additional manipulation Indications

10.  Positioning   All positions are contraindicated for intracranial pressure (ICP) > 20 mm Hg(59,60) head and neck injury until stabilized (A) active hemorrhage with hemodynamic instability (A) recent spinal surgery ( eg , laminectomy) or acute spinal injury acute spinal injury or active hemoptysis empyema bronchopleural fistula pulmonary edema associated with congestive heart failure large pleural effusions pulmonary embolism aged, confused, or anxious patients who do not tolerate position changes rib fracture, with or without flail chest  surgical wound or healing tissue Contraindications

11. Trendelenburg position is contraindicated for  intracranial pressure (ICP) > 20 mm Hg patients in whom increased intracranial pressure is to be avoided ( eg , neurosurgery, aneurysms, eye surgery)  uncontrolled hypertension  distended abdomen  esophageal surgery recent gross hemoptysis related to recent lung carcinoma treated surgically or with radiation therapy  uncontrolled airway at risk for aspiration (tube feeding or recent meal)    Reverse Trendelenburg is contraindicated in the presence of hypotension or vasoactive medication   Contraindications

12.   based more on tradition and anecdotal report than on scientific evidence  Airway clearance may be less than optimal in patients with ineffective cough.  Optimal positioning is difficult in critically ill patients. LIMITATIONS OF METHOD:

13. bed or table that can be adjusted for a range of positions from Trendelen -burg to Reverse Trendelenburg position pillows for supporting patient light towel for covering area of chest during percussion tissues and/or basin for collecting expectorated sputum suction equipment for patients unable to clear secretion gloves, goggles, gown, and mask as indicated for caregiver protection optional: hand-held and mechanical percussor or vibrator oxygen delivery device recent chest x-ray, if available stethoscope for auscultation Equipment

14. Various positions to drain various lung segements

15. excessive sputum production effectiveness of cough  history of pulmonary problems treated successfully with PDT ( eg , bronchiectasis, cystic fibrosis, lung abscess)  decreased breath sounds or crackles or rhonchi suggesting secretions in the airway  change in vital signs Abnormal chest x-ray consistent with atelectasis, mucus plugging, or infiltrates  deterioration in arterial blood gas values or oxygen saturation Assessments

16. Outcome Assessment

17. Turning Postural drainage therapy Frequency of therapy

18. Outcome assessment

19. Infection control

20. Assessment Diagnosis Goal Planning Intervension evaluation Nursing process

21. Summary

22. conclusion

23. Conclusion

24. Potter PA. Perry AC. Fundamentals of nursing 7 th ed. Elsevir,Mosby.New york:2012 Pp-265-78 Pryor JA, Webber BA. An evaluation of the forced expiration technique as an adjunct to postural drainage. Physiotherapy 1979;65(10):305-307. Bateman JRM, Newman SP, Daunt KM, Pavis D, Clarke SW. Regional lung clearance of excessive bronchial secretions during chest physiotherapy in patients with stable chronic airways obstruction. Lancet 1979;1:294-297. Postural drainage Wikipedia free encyclopedia . available from http:// postural drainage BIBLIOGRPHY

25. Thank you