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chestphysiotherapy-181007072756 (1).pptx
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- 2. DEFINITION •Chest physiotherapy isa 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 incoughing • Reeducate breathing muscles • Improve ventilation of the lungs
- 4. THERAPIES INCLUDES INCHEST 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 • Itis indicatedfor patients in whom cough is insufficient to clear thick, tenacious,or localized secretions. • Examples: • Cysticfibrosis • Bronchiectasis • Atelectasis • Lungabscess • Pneumonia
- 6. CONTRAINDICATION • IncreasedICP • Unstableheadorneckinjury • Activehemorrhageor hemoptysis • Recentspinalinjury • Ribfracture • Flailchest • Uncontrolledhypertension • Anticoagulation • Thoracicsurgeries
- 7. PRECAUTION • Keep suctionapparatus & 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 • Increasedintracranial pressure • Acute hypotension • Pulmonary hemorrhage • Pain • Injuries to muscles • Vomiting and aspiration • Bronchospasm • Dysrhythmias • Excessive lung volume
- 9. EQUIPMENT'S USED INCHEST 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 Heartrate 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 • Chestpercussioninvolves rhythmically clapping on the chest wall over thearea being drained to force secretions intolarger airways for expectoration. • Position the hand so the fingers and thumb touch and the hands are cupped.
- 14. • Perform chestpercussion by vigorously striking the chest wall alternately with cupped hands. • The procedure should produce a hollow sound and should not bepainful. • Perform percussion over asingle layerof clothing, not over buttons orzippers.
- 15. • Percussion iscontraindicated 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 aday. • If the patient has tenacious secretions, the area must be percussed for 3-5 minutes severaltimes per day.
- 17. VIBRATION • Vibration isagentle,shakingpressureapplied tothe chestwall to movesecretionsinto larger airways. • The nurse usesrhythmic contractions and relaxations of arm and shoulder musclesover the patient’schest. • During vibration, place your flat hand firmly against the chest wall, on the appropriatelung segmentto bedrained. • Vibrate the chest wall asthe patient exhales slowly through the pursedlips.
- 18. •After each vibration,encourage the clientto cough and expectorate secretions into the sputum container.
- 19. POSTURALDRAINAGE • Postural drainageis a technique in which different positions are assumed to facilitate the drainage of secretions from the bronchialairways. • Gravityhelpsto movethe secretionsto the trachea to be coughed upeasily. • Thegoal of postural drainage is tohelp drain mucus from the affected lobes into the larger airways of the lungs soit can be coughed up morereadily.
- 20. • All thepatients 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 thelungs.
- 21. • The lowerlobes 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.
- 22. • Postural drainagetreatments are scheduled two or three times daily, depending on the degreeof lungcongestion. • 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 caninducevomiting. • Help the patient assume the appropriate position, based on the lung field that requires drainage.
- 23.
- 24. Lung segment PositionRecommended Apicalareas of the -Ask the patient to upperlobes sit at the edge of thebed. -If the patient is not able to sit at the edge of the bed, use high- Fowler’sposition.
- 26. Lungsegment Position Recommended Posterior sectionPosition supine of the upper with a pillow lobes. under the hips and knees flexed
- 27. Lungsegment PositionRecommended Middle orlowerlobes With the bed in the Trendelenburg position, position the patient inSims’ position. Todrain the left lung, position the patient on hisrightside. Forthe right lung, position the patient on his left side. Posteriorlower lobes. Keepingthe bed flat, position the patient prone with a pillow underher stomach.
- 30. • After positioningthe client have the patient remain in the desired position for 10 to 15 minutes, if tolerated. • Perform percussion and vibration by keeping the client inposition. • The sequence for chest physiotherapy is usuallyasfollows: • Positioning, percussion, vibration, and removal of secretionsby coughingorsuction
- 31. POST CPT • Patientshould 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