airway clearance / postural drainage. goals prevent accumulation of secretions in patients at risk...
TRANSCRIPT
Goals
• Prevent accumulation of secretions in patients at risk for pulmonary complications– i.e.) chronic bronchitis, CF, prolonged bedrest, painful
incisions, and pts. vent dependent
• Remove accumulated secretions from lungs in patients with pulmonary complications– i.e.) PNA, atelectasis, COPD, very weak/elderly, and
pts. with artificial airways
Considerations for Treatment
• Positioning• Scheduling of Rx• Know ALL
Precautions and Contraindications
• Monitor & Document Necessary Vitals & Breath Sounds
Relative Contraindications to PD
• Severe hemoptysis• Severe pulmonary edema• CHF• Large pleural effusion• PE• Aortic Aneurysm• PTX• Cardiac arrhythmia• Severe hypertension or hypotension• Recent MI• Unstable angina• S/p recent neurosurgery (head-down position may cause intracranial
pressure)-modify position*These pts. will need positional modifications to ensure pt. safety if used*
Activity #1
• Practice placing your partner in each of the postural drainage positions– Be sure to explain to your partner what you
are doing and why you are doing it!
Percussion
• Know additional contraindications
• Lumbrical position
• “It is not the force but the cupping that is effective”
• Perform 2-5 minutes per lung segment
Vibration
• Performed after percussion or in lieu of
• During exhalation• Repeat 6-8 trials• Finish with huffing or
coughing
Shaking
• “Bounce” ribcage on exhalation
• Simultaneously compress and shake
• Repeat 6-8 trials after percussion
Rib Springing
• More vigorous shaking• Apply 3-4 quick “springs”
with exhalation, assist lower ribcage with exhalation, resist 1/3 inhalation, release and ribs “spring” upward with deeper inhale
• Useful for atelectasis or airway obstruction
Activity #2
• Perform the following for the R middle lobe or lingula:– Percussion (3 minutes)– Vibration (6-8 cycles)– Shaking (6-8 cycles)– Rib Springing (6-8 cycles)
• Perform percussion for at least 3 minutes• Perform one-hand and two-handed techniques• Be sure to explain to your partner what you are
doing and why you are doing it!
Activity #3
• Pick a card and perform the position and technique indicated
• Remember to:– Auscultate the indicated lung segment before and after
treatment application
– Explain to your partner what you are doing and why you are doing it!
• Write a note for this session in SOAP format
References• Kisner, C. Colby, L. Therapeutic Exercise: Foundations and
Techniques. 5th edition. pgs. 870-873. 2007.• Watchie, J. Cardiovascular and Pulmonary Physical Therapy: A
Clinical Manual. 2nd edition. pgs. 328-336. 2010.• http://images.all-freedownload.com/images/graphicmedium/stethoscop
e_98771.jpg• http://image.shutterstock.com/display_pic_with_logo/54820/54820,12
63862109,54/stock-photo-filling-out-a-medical-prescription-with-gold-pen-44871028.jpg
• http://iupucbio2.iupui.edu/anatomy/images/Chapt24/FG24_10a.jpg• http://0.tqn.com/d/copd/1/0/k/2/-/-/Cupped_hand.jpg• http://0.tqn.com/d/copd/1/0/m/2/-/-/Flat_Hand.jpg• http://upload.wikimedia.org/wikipedia/commons/thumb/8/88/
Gray112.png/250px-Gray112.png• http://calcentrist.org/shaking%20money.jpg