Chest Physiotherapy PDF

**CHEST PHYSIOTHEARPY** **MEANING** Method of facilitating respiratory function by removing thick, tenacious secretions from the respiratory using techniques of percussion, vibration and postural drainage. **PURPOSE** - To remove tenacious secretions from bronchial walls in conditions like...

**CHEST PHYSIOTHEARPY** **MEANING** Method of facilitating respiratory function by removing thick, tenacious secretions from the respiratory using techniques of percussion, vibration and postural drainage. **PURPOSE** - To remove tenacious secretions from bronchial walls in conditions like bronchiectasis and chronic bronchitis. **INDICATIONS** - Patients who bring out copious sputum. - Patients who are at risk of atelectasis. **CONTRAINDICATIONS** - Undrained lung abscess - Lung tumor - Pneumothorax - Diseases of chest wall - Lung hemorrhage/hemoptysis - Painful chest conditions, e.g. pleural effusion - Tuberculosis - Osteoporosis - Increased intracranial pressure - Spinal injuries. **ARTICLES** **Articles** **Purposes** ------------------------------ -------------------------- Paper tissues To wipe the face Pillows To provide comfort Sputum mug with disinfectant To collect the sputum Stethoscope To auscultate the chest Kidney tray To receive the wet waste **PROCEDURE** +-----------------------------------+-----------------------------------+ | **Steps** | **Rationale** | +===================================+===================================+ | Identify patient check doctors | Ensures that right procedure is | | order | done on the right patient | +-----------------------------------+-----------------------------------+ | Explain the procedure to the | Assure the patient and promotes | | patient time of last meal | cooperation. Postural drainage | | | should be avoided immediately | | | after meal times as it can induce | | | vomiting | +-----------------------------------+-----------------------------------+ | Wash the hands and dry | Reduces transmission of | | | microorganisms | +-----------------------------------+-----------------------------------+ | Instruct the patient to perform | This method of breathing helps | | diaphragmatic breathing | the patient to relax and widens | | | airways | +-----------------------------------+-----------------------------------+ | Position the patient in | Position should be selected | | prescribed postural drainage | according to the area of lung | | position, after consulting with | that is to be drained | | physician | | +-----------------------------------+-----------------------------------+ | Cover area with towel | Reduces discomfort to the patient | +-----------------------------------+-----------------------------------+ | **Percussion** | Percussion helps in dislodging | | | mucous plugs and mobilizes | | Clap with cupped hands over chest | secretions into main stem bronchi | | wall for 1-2 minutes in each lung | and trachea. The air trapped | | areas. Percuss from | under cupped hand set up | | | vibrations through chest wall | | - Lower ribs to shoulder on the | freeing secretions | | back | | | | Percussion on these areas may | | - Lower ribs to top of chest in | cause injuries | | front | | | | | | - Avoid clapping over spine, | | | liver, breast, clavicle or | | | sternum | | +-----------------------------------+-----------------------------------+ | **Vibrations** | | | | | | Remove towel and place hand, palm | | | down on chest area to be drained | | | with one hand over the other and | | | fingers together or place hands | | | side by side | | +-----------------------------------+-----------------------------------+ | Instruct patient to inhale deeply | | | and exhale slowly through pursed | | | lips and perform abdominal | | | breathing | | +-----------------------------------+-----------------------------------+ | Tense all the muscles on the hand | Vibration frees the mucus from | | and arm and vibrate the hand | bronchial walls | | especially heels with moderate | | | pressure during exhalation | | +-----------------------------------+-----------------------------------+ | Stop vibrations and relieve | Pressure applied to chest wall | | pressure on inspiration | inhibits chest expansion during | | | inspiration | +-----------------------------------+-----------------------------------+ | Vibrate for 5 exaltations over | Coughing or huffing aids in the | | each lung area which a co is | movement and expulsion of | | affected. After 3-4 vibrations, | secretion from the respiratory | | encourage patient to cough/huff | tract | | and expectorate sputum into | | | sputum mug | | | | | | Allow patient to rest for several | | | minutes | | +-----------------------------------+-----------------------------------+ | Auscultate with stethoscope for | Presence of crackles/rhonchi | | change in breath sounds | indicates mucous present in | | | bronchi | +-----------------------------------+-----------------------------------+ | Repeat percussion and vibration | To get maximum effectiveness | | cycles according to patient\'s | | | tolerance and clinical condition, | | | usually for 10-15 minutes | | +-----------------------------------+-----------------------------------+ **AFTERCARE** - Wash the hands - Assist the patient to comfortable position - Assist with oral hygiene - Record the procedure and patient\'s response in nurse\'s record