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Respiratory Care Procedures

( Chest Physiotherapy )
Objectives: 1. To mobilize & eliminate secretions 2. To reexpand lung tissue 3. To promote efficient use of respiratory muscles 4. To help prevent or treat atelectasis 5. To help prevent complications Contraindications: 1. Active pulmonary bleeding with hemoptysis & immediate post hemorrhage stage 2. Fractured ribs or unstable chest wall 3. Lung contusions 4. Pulmonary tuberculosis 5. Untreated pneumothorax 6. Acute asthma or bronchospasm 7. Lung abscess or tumor 8. Bony metastasis 9. Head Injury 10. Recent MI

Chest Tapping
( Percussion & Vibration ) Percussion

is the manual application of light blows to the chest wall sometimes called clapping or cupping

done over specific congested lung areas, to mechanically dislodge tenacious secretions from the bronchial walls usually carried out for only 1 or2 min., up to 5 min. over each area, or according to the doctors order while the patient is in postural drainage position of choice, cup your hands & clap them over the chest wall or back to determine if correctly done, cupping should produce a hollow sound & should not be painful for the patient instruct the patient to take slow deep breaths during percussion

Vibration
is a series of vigorous quivering produced through hands that are placed flat against the chest wall performed with the same purpose as percussion & is as effective if done correctly often done alternately with percussion or can replace percussion if the patient is experiencing chest pain, patient who is frail, or recovering from thoracic surgery or trauma ask the patient to exhale after a deep inspiration & vibrate as the patient exhales Special Considerations: because chest percussion can induce bronchospasm, any adjunct treatment ( like IPPB, aerosol, or nebulizer therapy) should p[recede chest physiotherapy refrain from percussing over the spine, liver, kidneys or spleen to avoid injury to the spine or internal organs avoid performing percussion on bare skin or female patients breasts

percuss over soft clothing (but not over buttons, snaps, or zippers) or place a thin towel over the chest wall remember to remove jewelry that might scratch or bruise the patient Nursing Alert: Vigorous percussion & vibration can cause rib fracture, especially in patient with osteoporosis

Teaching the Patient Deep Breathing Exercise

Indicated for: 1. Bedridden 2. Immobilized patient 3. Patients who have inhaled respiratory anesthetics 4. Patients who have respiratory disease 5. Patients who have undergone abdominal or chest surgery Special Considerations: Relieve the patients pain Position the patient to promote maximum expansion of lungs Have the patient inspire & expire slowly Teach breathing exercise preoperatively Observe the patients breathing to see whether complete lung expansion occurs Mechanisms for Encouraging Deep Breathing 1. Incentive Spirometers a. Volume-Oriented or Electronic Device b. Flow-Oriented or Mechanical Incentive Spirometer

2. Intermittent Positive Pressure Breathing (IPPB)

Teaching the Patient to Cough Effectively

Coughing is always combined with deep breathing but deep breathing may be done without coughing

Special Considerations: When the patient has no secretions, to raise may collapse alveoli is therefore not recommended Teach coughing exercise preoperatively Postoperatively, splint the patients incision using the hands or pillow, or if possible teach the patient to splint it himself to minimize pain during coughing Nursing Alert: for emphysematous patient with bleb, coughing could lead to pneumothorax

Postural Drainage Exercise

Postural Drainage - positioning the patient so that the force of gravity helps drain the lung secretions performed in conjunction of vibrations sequence: a) Positioning d) Deep breathing b) Percussion e) Coughing or Suctioning c) Vibration

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usually, secretions drain best with the patient positioned so that bronchi are perpendicular to the floor: upper lobes = head-up position lower & middle lobes = head-down position Special Considerations: in generalized disease drainage usually begins with the lower lobes, continues with the middle lobes & ends with the upper lobes in localized disease drainage begins with the affected lobes & then proceeds to the other lobes to avoid spreading the disease to uninvolved areas if used for a patient with chronic respiratory problem but no current acute difficulty, each position needs to be held for 15 seconds to drain the lung segments adequately for acute respiratory problem, it is recommended that 5 mins. be spent initially in each position not all positions are necessary for every patient, only those that drain specific affected areas for optimal effectiveness & safety, modify the therapy according to patients condition PDE is best tolerated if done between meals; at least 2 hrs. after the patient has eaten, to decrease the possibility of vomiting & aspiration of food or vomitus maintain adequate hydration in the patient receiving chest PT to prevent mucus dehydration & promote easier mobilization before therapy, bronchodilators or moisturizing nebulization therapy may be given