CHEST PHYSIO THERAPY

Reported by : Marivic J. Miagar Adam Dexter H. Mayuga

Chest Physiotherapy
Chest physiotherapy (CPT) is a broad, non-specific term used to describe treatments generally performed by physiotherapists and respiratory therapists whereby breathing is improved by the indirect removal of mucus from the breathing passages of a patient.

Chest Physiotherapy
There are 3 kinds of chest physiotherapy: a) Postural drainage b) Chest percussion and vibration c) Breathing retaining

Postural
Drainage

Postural Drainage
Postural drainage is the drainage of secretions, by the effect of gravity, from one or more lung segments to the central airways (where they can be removed by cough or mechanical aspiration). Postural drainage is accomplished by positioning the patient so that the angle of the lung segment allows the gravity to be drain to loosen the thick, sticky mucus in the lungs.

Equipment used
Bed with lock devices

Pillows or Cushion

Card board boxes

Procedure of Postural Drainage

Auscultate the patients chest Wash your hands. Make sure that the patient is comfortable as possible in each position. Provide an emesis basin, sputum cup or paper tissues. Assist the patient in appropriate position after determining the lung to be treated. To determine the areas of needed drainage. To prevent spread of microorganisms To collect the expelled sputum of the patient after the procedure. To assist drainage of the specific segments and so the diseased areas are in a near vertical position, and gravity.

 The nurse instruct the patient to remain each position for 10 to 15 minutes and to breathe in slowly through the nose and out through pursed lips.
Encourage the patient to deep breathe and cough after spending the allotted time in each position (normally 3 to 15 minutes). The secretions may need to suction mechanically if the patient cannot cough.

To help keep the airways open so that the secretions can drain while in each position

To remove or expelled the secretions from the lungs.

To help the patient remove the secretions.

Nursing Responsibilities
Assess the patients diagnosis as well as the lung lobes or segments involved, the cardiac status and any structural deformities of the chest wall and spine. Auscultate the chest before and after the procedure
To determine the indicated position for the patient To determine if it is contraindicated for the patient. To identify the areas that need drainage and assess the effectiveness of treatment.

The nurse teaches the family members who will assist the patient at home

To evaluate breath sounds before and after treatment.

 The nurse explores the strategies that will enable the patient to assume the indicated positions at home. Postural drainage is usually performed two to four times daily, before meals and at bedtime. Prescribed bronchodilators, water or saline may be nebulized and inhaled before postural drainage.

This may require the creative use of objects readily available at home, such as pillows, cushions, or cardboard boxes.
To prevent nausea, vomiting and aspiration.

To dilate the bronchioles, reduce bronchospasm, decrease the thickness of mucus and sputum, and combat the edema of the bronchial walls.

 After the procedure, the nurse notes the amount, color and character of the expelled sputum.

To determine the improvement of the patients condition.

If suctioning is required at home, instruct caregivers in safe suctioning technique and care of the suctioning equipment
The procedure should be discontinued if tachycardia, palpitations, dyspnea, or chest pain occurs.

To provide safety of the patient.

These symptoms may indicate hypoxemia. Discontinue if hemoptysis occurs.

Anatomy of the lung- External

Position For Postural Drainage

Position no. 1
Upper Front Chest Upper Lobes Have your child sit upright. Clap on both sides of upper front chest over the muscular area between the collarbone and the top of the shoulder blade.

Position no. 1
Upper Front Chest Upper Lobes Have your child sit upright. Clap on both sides of upper front chest over the muscular area between the collarbone and the top of the shoulder blade

Position no. 2
Upper Back Chest Upper Lobes Have your child sit up and lean forward on a pillow over the back of a sofa or soft chair at a 30 degree angle. Stand or sit behind your child and clap both sides of the upper back. Take care not to clap on your childs backbone.

Position no. 4
Upper Front Chest Upper Lobes Have your child lie on his or her back with arms to sides. Stand behind your childs head. Clap both sides of your childs chest between the collarbone and nipple.

Position no. 5
Left Side Front Chest Have your child lie with left side up and raise his or her left arm over head. Clap over the lower ribs just below the nipple area on front side of left chest. Do not clap on your childs stomach.

Position no. 6
Right Side Front Chest Have your child lie with right side up and raise right arm over head. Clap over the lower chest just below the nipple area on front side of right chest. Do not clap lower ribcage.

Position no. 7
Lower Back Chest Lower Lobes Have your child lie on his or her stomach. Clap both sides at the bottom of chest just above the bottom edge of the ribcage. Do not clap lower ribcage or over the backbone.

Position no. 8 and 9

Left Lower Side Back Chest Lower Lobe Have your child lie with left side up and roll toward you a quarter turn so you can reach your childs back. Clap on lower left side of chest just above the bottom edge of the ribcage.

Position no. 10
Right Lower Side Back Lower Lobe Have your child lie right side up and roll toward you a quarter turn so you can reach your childs back. Clap on lower right side of the chest just above the bottom edge of the ribcage.

Contraindicated for postural drainage:

CHF pulmonary edema pleural effusion pneumothorax cardiac arrythmia unstable angina recent MI pulmonary embolus hemoptysis