Patient Postural Drainage Procedure

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Questions and Answers

What is the purpose of teaching a patient deep breathing and effective cough before starting postural drainage?

To help the patient clear secretions more effectively.

How can percussion aid in postural drainage?

Percussion helps in forcing secretions to drain into large airways.

What is the role of vibration in postural drainage?

Vibration involves rapidly vibrating the chest while the person breathes out.

Why is it important to observe any tubes connected to the patient before postural drainage?

To prevent their disconnection during the procedure. Signup and view all the answers

How can the affected lobe for postural drainage be determined?

By methods like percussion, auscultation, and X-ray. Signup and view all the answers

What should be considered when determining the frequency of treatment for postural drainage?

The pathology and condition of the patient. Signup and view all the answers

What is the primary purpose of postural drainage?

The primary purpose of postural drainage is to expel secretions from the lungs through huffing and coughing, followed by relaxed and controlled breathing. Signup and view all the answers

How many lobes does the right lung consist of?

The right lung consists of 3 lobes. Signup and view all the answers

What is the direction of the medial basal segment in the lower lobe of the right lung?

The medial basal segment in the lower lobe of the right lung is directed medially and downwards. Signup and view all the answers

What is the direction of the anterior bronchus (segment) in the upper lobe of the right lung?

The anterior bronchus (segment) in the upper lobe of the right lung is directed forward and downward. Signup and view all the answers

How many lobes does the left lung consist of?

The left lung consists of 2 lobes. Signup and view all the answers

What is the direction of the superior segment of the lingula in the upper lobe of the left lung?

The superior segment of the lingula in the upper lobe of the left lung is directed upward and laterally. Signup and view all the answers

What is the purpose of the positive expiratory pressure (PEP) technique?

To help move and clear secretions higher up in the airways. Signup and view all the answers

How does the PEP device help open up the airways?

By giving a small degree of resistance to the breath out, which splints open the airways. Signup and view all the answers

What is the recommended position for treatment with a PEP device?

Sitting with the elbows supported. Signup and view all the answers

How are secretions cleared after using the PEP device?

One or two huffs, or a huff and a cough, with breathing control. Signup and view all the answers

What is the difference between PEP and Bubble PEP?

Bubble PEP uses plastic tubing in a bottle of water and soap to produce bubbles, instead of a mask or mouthpiece. Signup and view all the answers

How is Bubble PEP beneficial for young children?

It provides a fun way for children to do PEP therapy. Signup and view all the answers

What are the main benefits of using threshold loading devices for inspiratory muscle training?

The main benefits of using threshold loading devices for inspiratory muscle training are that they are more reliable and reproducible as training devices, and they can be used to improve both endurance (by increasing the length of treatment) and muscle strength (by increasing the resistance). Signup and view all the answers

How does the threshold loading device work to strengthen the inspiratory muscles?

The threshold loading device works by providing resistance to airflow during inhalation, which forces the inspiratory muscles to work harder to overcome the resistance and draw in air. This strengthens the inspiratory muscles over time. Signup and view all the answers

How can the effectiveness of inspiratory muscle training be monitored?

The effectiveness of inspiratory muscle training can be monitored by measuring maximal inspiratory mouth pressures, which will increase as the inspiratory muscles become stronger. Signup and view all the answers

What are some of the patient populations that have benefited from inspiratory muscle training?

Inspiratory muscle training has been used with patients with chronic obstructive lung disease, neuromuscular disorders, and those being weaned from mechanical ventilation. Signup and view all the answers

How is the resistance of the threshold loading device adjusted for individual patients?

The appropriate resistance for the individual patient is selected on assessment, in order to provide the optimal training stimulus for that patient. Signup and view all the answers

What is the typical duration of an inspiratory muscle training session using the threshold loading device?

The patient inhales through the tube for a specific period of time, typically 20 to 30 minutes, and this time is gradually increased as the patient's strength and endurance improve. Signup and view all the answers

Describe the difference between a 'flow resistive' and a 'threshold loading' respiratory muscle training device.

A 'flow resistive' device alters the load on respiratory muscles by changing the size of the aperture, while a 'threshold loading' device requires a predetermined pressure to initiate inspiration or expiration. Signup and view all the answers

Explain how the load on respiratory muscles is affected by the patient's breathing pattern in a 'flow resistive' device.

The load is increased by decreasing the aperture size. Breathing slowly and deeply reduces the pressure on respiratory muscles compared to quick and shallow breathing. Signup and view all the answers

What is the key feature of a 'threshold loading' device in terms of pressure during inspiration or expiration?

A 'threshold loading' device requires a predetermined pressure to initiate either inspiration or expiration, which remains constant once initiated. Signup and view all the answers

How can a patient achieve a maximal training effect with respiratory muscle training devices?

To achieve a maximal training effect, inspiratory or expiratory time and the frequency of breathing should be controlled. Signup and view all the answers

What are the key factors that determine the pressure required to keep a 'threshold loading' device open?

The pressure required to keep a 'threshold loading' device open is determined by the magnitude of the threshold load. Signup and view all the answers

How does altering the aperture size in a 'flow resistive' device affect the load on respiratory muscles?

Decreasing the aperture size increases the load on respiratory muscles, provided the breathing frequency, tidal volume, and inspiratory or expiratory time are constant. Signup and view all the answers

Study Notes

Pre-Procedure Preparation

Explain the procedure to the patient
Teach the patient deep breathing and effective coughing before starting postural drainage
If the patient has a large amount of sputum, ask them to cough a few times or be suctioned before the postural drainage
Frequency of treatment depends on the patient's condition

Tools Preparation

Tilting table and sufficient pillows for positioning and comfort
Sputum cup: measurable, transparent, and has a cover

Determining Area of Secretions

Determine the affected lobe from the physician
Percussion: dullness is elicited over the secretion
Referral from the physician
Auscultation
X-ray: white patches in the lung fields
By asking the patient (in which position you get more secretions?)

Postural Drainage and Percussion

Positioning the person so that mucus can flow downwards (in the direction of gravity) from a given lung segment into the airways where cough is stimulated or performed voluntarily
Percussion: rhythmically clapping the chest with a cupped hand, over the lung segment, forces secretions to drain into large airways
Vibration: rapidly vibrating the chest while the person takes a long breath out (often through pursed lips)
Huffing and coughing: to expel the secretions, followed by relaxed, controlled breathing

Anatomy of Lung Lobes and Segments

Right lung: consists of 3 lobes
- Upper lobe has:
  - Apical (superior) bronchus (segment)
  - Anterior bronchus (segment)
  - Posterior bronchus (segment)
- Middle lobe has:
  - Lateral bronchus (segment)
  - Medial bronchus (segment)
- Lower lobe has:
  - Apical (superior) basal segment
  - Anterior basal segment
  - Posterior basal segment
  - Lateral basal segment
  - Medial basal segment
Left lung: consists of 2 lobes
- Upper lobe has:
  - Apical (superior) segment
  - Anterior segment
  - Posterior segment
  - Lingula:
    - Superior segment
    - Inferior segment
- Lower lobe has:
  - Apical basal segment
  - Anterior basal segment
  - Posterior basal segment
  - Lateral basal segment
  - Medial basal segment

Devices Used for Treatment of Chest Patient

Positive Expiratory Pressure (PEP) technique:
- Applies a back pressure to the airways during the breath out
- Helps to open up the airways and get air behind secretions to help move them higher up the airways
PEP devices:
- Some have a mask and some have a mouthpiece
- Gives a small degree of resistance to the breath out
- This resistance splints open the airways
Bubble PEP:
- Modification of PEP
- Useful in young children
- Uses a length of plastic tubing placed in a bottle of water and soap to produce lots of bubbles
- Fun way of getting small children to do PEP therapy
Threshold loading devices:
- Increase the pressure generated by the inspiratory or expiratory muscles
- More reliable and reproducible as training devices
- Can be used to improve endurance and muscle strength
Inspiratory resistance training:
- Method of improving the strength and endurance of the muscles of inspiration
- Improves ventilation and lessens the occurrence of inspiratory muscle fatigue
- Used with patients with chronic obstructive lung disease, neuromuscular disorders, and those being weaned from mechanical ventilation
Respiratory muscle training devices:
- Used to increase strength and endurance in the muscles of either inspiration or expiration
- Patient breathes through a mouthpiece or face mask with a resistance applied to either the inspiratory or expiratory limb of a valve

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