CHEST PHYSIOTHERAPY

PURPOSES:
Improve respiratory efficiency Promote expansion of the lungs Strengthen respiratory muscles Eliminate secretions from the respiratory system Cardiac status (Acute MI, CHF: avoid

trendelenburg position)

Any structural deformities of the chest wall and spine (Fracture Ribs, Disease

GOALS:
To help the patient breathe more freely and to get more oxygen into the body by removing bronchial secretions to improve ventilation To increase the efficiency of respiratory muscles: o Postural Drainage o Chest Percussion and Vibration o Breathing Retraining o Effective Coughing Technique

due to increased intracranial pressure like head or brain injuries: avoid trendelenburg position)

EQUIPMENT:
Kidney Basin or Sputum Cup Chair or Foot Stool Newspaper Tissue Paper Pillows for positioning Hospital Bed that can be placed in trendelenburg position Mouthwash A glass of water

Auscultating the chest before and after the procedure The position providing drainage of the lungs Proper care in handing and disposing secretions Performed 2 to 4 times daily, before meals and at bedtime Administer bronchodilator or medications per doctors order To thin the mucous before the airway clearance session It must be given prior to CPT or Nebulization (can liquefy secretions) Check the diagnosis: <Congestive Heart

Failure, Respiratory Failure wherein fluid is restricted>

o Increased in 3 to 4 L of fluid per day o Increased in 2 to 3 L of fluid per day
Primary Brochi

1. Postural Drainage Uses specific position that allows the force of gravity to assist in effectively draining secretions from the lungs and into the central airway where they can either by coughed up out from peripheral to central airways To relieve or prevent bronchial obstruction caused by accumulation of secretions To prepare patient for operation or procedure on bronchopulmonary area PRINCIPLE: Positioning the patient to allow draining

Secondary/ Lobar Bronchi

Tertiary/ Segmental Bronchi L:8 Pulmonaty segments R: 10 Pulmonary Segments

of secretions from peripheral to central airways

SPECIAL CONSIDERATION:
The nurse should be aware of the patients diagnosis as well as: Lung lobes or segments are involved

Note to Remember!! The first CPT can be done at a length of 5 to 10 minutes and can increase depending on the client tolerance but must not exceed to 60 minutes If the patient doesnt have the ability to cough out suggest suctioning

Chest Physiotherapy Carmela Dawn M. Marco

BSN III-3 @2012

If you patient is having an infectious disease wear N95 mask for TB patient or gloves can be Avoid to percuss the:
o o o o o o o Scapula Sternum Clavicle Liver Kidney Spleen Breast

SEQUENCE:
Postural Drainage Percussion for 1-2 minutes Vibration in first and repeat it 3 times Cough Out!! o Cascade Coughing Inhale slowly, hold your breath for 1 to 2 seconds and the cough during exhalation (Just a small cough) o Huff Coughing Inhale, hold your breath then cough saying HUFF o Assistive Coughing Inhale, then pressing an inwardupward movement between below the xiphoid process and just above the umbilicus

CONTRAINDICATED: Lung Abscess Pneumothorax Disease of the Chest Wall (Kyphoscoliosis) Lung Hemorrhage Painful Chest Condition (Chest Flail adjacent to 3 or more ribs) Tuberculosis INDICATED: Broncholectasis Emphysema Cystic Fibrosis Chronic Bronchitis DOCUMENTATION: Date and Time Procedure, Duration and Frequency Patients reaction during and after the therapy Note the amount, color, viscosity and character of expelled sputum Evaluate pulse and skin color

2.

Percussion Consist of rhythmically clapping

Chest Physiotherapy Carmela Dawn M. Marco

BSN III-3 @2012