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POSTURAL DRAINAGE PROCEDURE IN NURSING CARE
The method of Postural drainage with steps of procedure with articles
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POSTURAL DRAINAGE PROCEDURE IN NURSING CARE
- 1. Prepared By Dr. PeterJasper Youtham Professor/ HOD Medical Surgical Nursing Amaltas University
- 2.
- 3. Postural drainageis achieved by positioning the patient, where gravity assists in drainage of secretion. It's often used in conjunction with other therapies like percussion and vibration to loosen and remove mucus, especially in individuals with chronic respiratory conditions. This method aims to prevent mucus buildup, which can lead to infections and breathing difficulties.
- 4. Postural drainageis a method of drainage of secretions by gravity from various lungs segments by the application of specific positions. The goal is to loosen and mobilize mucus so it can be coughed up more easily, preventing complications like lung collapse or infection.
- 5. To maintainthe full expansion of lungs. To prevent collapse and consolidation. To drain secretion before and after surgery as needed. To aid for easy breathing.
- 6. ANATOMY AND PHYSIOLOGY The respiratory tract consists of nose, pharynx, larynx, trachea, bronchi and lungs It is lined with ciliated mucous membrane.. MICROBIOLOGY- Provide sputum cup to the patient to collect the sputum Tr. Benzoin or menthol is used in steam inhalation as antiseptic PHYSICS- When the secretions are accumulated in the bronchial tubes and larynx the water vapour therapy is given In anoxia the oxygen in the tissues is reduced below normal. CHEMISTRY- Oxygen deficiency induces an increase in breathing. Carbon-di-oxide stimulates the respiratory center by increasing hydrogen ion concentration.
- 7. PHARMACOLOGY Oxygen isgiven to supply a deficiency in the body. The usual flow of oxygen for adult ranges from 4 to 6 lit. per minute PSYCHOLOGY- As the patient is anxious, worried and apprehended due to O2 deficiency, he must be assured and made comfortable. The nurse should visit the patient often to reassure him and to know his progress
- 8. Pre-operative patientswith excessive secretions. Post-operative patients with excessive secretions. Bronchial or lobar pneumonia Lung abscess. When the patient is unable to initiate a voluntary cough or effort to expel the sputum When musculo-skeletal abnormalities interfere with the effective expulsive cough mechanism.
- 9. Patient whohad increased cyanosis and exhaustion. Patient with increased intra cranial pressure and head injury Patient with unstable vital signs. Patient who are unable to remain in that particular position even with the assistance. CONTRAINDICATIONS
- 10. MEDICATIONS Priorto postural drainage, bronchodilator medicine may be administered to encourage drainage and expulsion of secretions. HOT STEAM INHALATION Steam when inhaled provides warmth and moisture to the mucus membranes, which facilitates the expectoration of secretions.
- 11. It alsorelaxes the smooth muscles of respiratory passages. The moisture liquefies the secretions and helps its expulsion from air passages CUPPING PERCUSSION Percussion is a technique of carefully striking the chest wall over the involved area with cupped hands. The percussion loosens the secretion in the affected area.
- 12. It isperformed directly over the affected area with both hands in a rhythmical pattern. A hollow, deep sound is produced when it is done correctly. The hands must not slap the chest wall. Areas to avoid percussion are, over the spinal column, the heart, the kidney and the areas of increased pain. Percussion is done for one to two minutes and usually confined to the most congested areas.
- 13. VIBRATION Itis the technique of applying manual compression and tremor to the chest wall during the exhalation phase of respiration. The manoeuvre helps to increase the velocity of air expired from the small airway, thus freeing the mucus. After three to four vibrations, the patient is asked to cough using the abdominal muscle.
- 14. Various positionsare used for postural drainage DRAINAGE OF ANTERIOR UPPER LOBE: - sitting in an upright position in a chair provides drainage of the uppermost lung segments. To drain the anterior upper segment, the patient needs to bend his body backward at an angle of 80o. This can be achieved by asking the patient to sit on a chair with inclined back support or by placing him in a semi-Fowler’s position.
- 15. DRAINAGE OFTHE POSTERIOR UPPER LOBE: -to drain this, the patient should bend forward about angle 30o. This position can be achieved by providing cardiac table with pillows on it in front of the patient to lean it or by making him sit on the chair and lean forward.
- 16. DRAINAGE OFLATERAL UPPER SEGMENTS: - the patient needs to bend side ways about 45o first to one side, then to the other, leaning on the arm of the chair to support this position.
- 17. DRAINAGE OFTHE RIGHT MIDDLE LOBE: - to drain, the patient is positioned flat on the bed on his left side with a pillow under his chest. The right shoulders and body are swung forward.
- 18. DRAINAGE OFTHE LEFT MIDDLE LUNG SEGMENT:- left lung has no middle lobe. To drain left middle segment, the patient is positioned flat on his right side, with a pillow under his chest.
- 19. DRAINAGE OFANTERIOR BASILAR SEGMENTS: -Drainage of the lower lobe can be accomplished by positioning the patient’s bed in a Trendelenberg position or by elevating his hips with the use of several pillows. The hip must positioned higher than the shoulders. The patient lies on his back and the shoulders should rest flatly against the mattress.
- 20. DRAINAGE OFTHE POSTERIOR BASILAR SEGMENTS:- the patient lies on the abdomen in a trendelenberg position or his hips elevated by pillows.
- 21. DRAINAGE OFLATERAL BASILAR SEGMENTS:-To drain this, the side lying position is used as described in drainage of the middle lung segments. The hip should be elevated higher than the shoulders. When no specific instruction is received, the patient is placed in such a position where gravity helps in drainage from bronchi. Special beds may be used for this purpose.
- 22. NOTE: -nelson’s bed can be used for giving various positions for postural drainage
- 23. ARTICLES REQUIRED ARTICLES REQUIREDRATIONALE A chair or foot stool of a proper height to be used to support hands To give comfort to the patient A kidney tray or sputum cup To spit out sputum A mouth wash To wash the mouth if the patient has vomited A screen To maintain the privacy of the patient A pillow To support the patient in different positions A small hand towel To wipe the face
- 24. TRAY SETTING Towel Sputum cup Kidneytray Towel
- 25. The nursemust know the patient’s diagnosis, the lung lobes or segments involved, the cardiac status and any structural deformities of the chest wall and spine. Auscult the chest area before and after the procedure to determine the area and the effectiveness of the treatment. Postural drainage is usually done before meals. Broncho-dilators and nebulization if ordered can be given prior to postural drainage. Instruct the patient to remain in each position for 5 to 10 minutes and to breathe in slowly through his nose and then breathe out slowly through pursed lips to help widen the airways.
- 26. PROCEDURE STEPS OF PROCEDURERATIONALE Collect the articles and arrange them properly To facilitate the work Explain the procedure and screen the patient. position the patient for drainage from lungs. To reassure the patient and to give confidence to him Continue treatment by sequential positioning for 10 minutes Watch the patient repeatedly for signs of collapse, fatigue, breathing pattern. Put him in a comfortable position immediately. To detect and prevent adverse effects. To give comfort and confidence to the patient The length of treatment depends on the tolerance of the patient To avoid complication and fatigue
- 27. Supportive measure likesteam inhalation, cupping and vibration technique could be given to the patient. Proper position to be provided along with cupping and vibration technique. For adequate drainage. To reassure the patient of nurses’ presence Periodically to encourage the patient to cough and spit out the sputum To clear the airway and to collect the sputum After procedure, give a mouth wash to the patient To clean and provide comfort to the patient. For aesthetic sense Record the procedure with date and time. To follow up for the further treatment
- 28. The patientmay become very tired after this procedure or may complain of headache or dizziness in his first few attempts. After postural drainage, help the patient to take his mouth wash. The patient should rest in bed for half an hour after the procedure. Note the colour, amount, viscosity and character if the ejected sputum after the procedure. Observe the patient’s pulse. Note the response of the patient to the therapy.