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Pulmonary HygienePulmonary Hygiene
Postural Drainage & Percussion
Frequently Known As
“Pulmonary Toilet”
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Postural Drainage & PercussionPostural Drainage & Percussion
Postural Drainage : Positioning the patient so that retained secretions in the bronchopulmonary tree can drain by gravity out of the lungs.
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Percussion : A rhythmic percussion on the thoracic wall to loosen secretions and assist the mucociliary elevator to rid the lungs of retained secretions
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Percussion…How Is Done ?Percussion…How Is Done ?
It is performed with a cupped hand and with most of the motion coming from the hand and wrist
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A cyclic tapotement over the thoracic wall makes a popping sound
Very little movement comes from the elbow and shoulder
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Both hands participate - the right hand is constantly in motion setting a regular rhythm while the left hand is the dissonant rhythm hand
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Hand PositionHand Position
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Research has shown that a 30-45 minute PD & P session can clear the lung fields of secretions. An x-ray of the lungs pre and post treatment demonstrates a dramatically improved lung.
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Left Lung Atelectasis - PostmortemLeft Lung Atelectasis - Postmortem
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Hemothorax On X-RayHemothorax On X-Ray
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Left Lung Atlectasis On X-RayLeft Lung Atlectasis On X-Ray
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Positioning The PatientPositioning The Patient
Positioning the patient is important to allow the bronchi of each bronchopulmonary segment to be vertical so that the fluid inside the bronchus will move toward the mainstem bronchi and out of the lung.
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Positioning The PatientPositioning The Patient
The Sitting Positions :
Apical Segments of Right & Left upper Lobes
Anterior Segment of the Left Upper Lobe
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The Apical Segment Of The Right The Apical Segment Of The Right & Left Upper Lobes& Left Upper Lobes
The bronchial feed into these segments are :
forward upward lateral
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Postural Position :
High Long Sitting Angled 30-45 degrees backward in reclined sitting
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Percussion & Auscultation :
Over the trapezius between the clavicle anteriorly and the scapula posteriorly
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Left Anterior BP Segment Of The Left Anterior BP Segment Of The Left Upper LobeLeft Upper Lobe
The bronchial feed into this segment is :
obliquely upward forward
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Postural Position :
45 - 60 degrees reclined long sitting
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Percussion & Auscultation :
Over the Pectoralis Major muscle on the left side
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Positioning The PatientPositioning The Patient
The Near-Prone & Prone Positions
Posterior BP Segment Of The Left &The Right Upper Lobe
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Superior or Apical BP Segment Of The Right And the Left Lower Lobes
Posterior Basilar BP Segment Of The Right & Left Lower Lobes
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Posterior BP SegmentPosterior BP Segment Of The Left Upper Lobe Of The Left Upper Lobe
The bronchial feed into this segment is :
Posterior Obliquely Upward
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Postural Position :
Prone onto right side with left shoulders pillowed & rotated up off of the bed
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Percussion & Auscultation :
Over the scapula
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Posterior BP SegmentPosterior BP Segment Of The Right Upper Lobe Of The Right Upper Lobe
The bronchial feed into this segment is :
Posterior Obliquely upward
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Postural Position :
Prone onto left side with right shoulders pillowed & rotated up off of the bed
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Percussion & Auscultation :
Over the scapula
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Superior or Apical BP Segment Of Superior or Apical BP Segment Of The Right & Left Lower LobesThe Right & Left Lower Lobes
The bronchial feed into these segments is :
Posterior
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Postural Position :
Prone flat
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Percussion & Auscultation :
Over the thorax just at the inferior angle of the scapula
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Posterior Basilar BP Segment Of Posterior Basilar BP Segment Of The Right & Left Lower LobesThe Right & Left Lower Lobes
The bronchial feed into these segments is :
Posterior Obliquely downward
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Postural Position :
Prone with head below horizon
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Percussion & Auscultation :
Over the posterior thorax just above the inferior border of the thoracic cage
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Positioning The PatientPositioning The Patient
Supine Positions : Anterior BP Segment Of The Right Upper Lobe
Anterior Basilar BP Segments Of The Right & Left Lower Lobes
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Anterior BP Segment Of The Anterior BP Segment Of The Right Upper LobeRight Upper Lobe
The bronchial feed into this segment is :
Forward
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Postural Position :
Supine flat
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Percussion & Auscultation :
Over the Pectoralis Major muscle on the right side
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Anterior Basilar BP Segments Of Anterior Basilar BP Segments Of The Right & Left Lower LobesThe Right & Left Lower Lobes
The bronchial feed into these segments is :
Forward Obliquely Downward
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Postural Position :
Supine & inclined with head below horizon
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Percussion & Auscultation :
Over the thoracic wall on the anterior surface just above the inferior border of the thorax
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Positioning The PatientPositioning The Patient
The Right Side-Lying Positions
The Lingula Of The Left Upper Lobe
Lateral Basilar BP Segment Of The Left Lower Lobes
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The Lingula Of The Left Upper The Lingula Of The Left Upper LobeLobe
The bronchial feed into these segments is :
Lateral Obliquely Downward
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Postural Position :
Right side-lying inclined with head below horizon
Left shoulder rotated down toward the bed
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Percussion & Auscultation :
Over the thoracic wall on the left lateral surface over the nipple and the thorax in the mid-axillary line
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Lateral Basilar BP Segment Of Lateral Basilar BP Segment Of The Left Lower Lobes & Right The Left Lower Lobes & Right
Cardiac BP Segment Of The Right Cardiac BP Segment Of The Right Lower LobesLower Lobes
The bronchial feed into these segments is :
Left Side = Lateral
Right Side = Medial Obliquely Downward
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Postural Position :
Right side-lying inclined with head below horizon
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Percussion & Auscultation :
Over the thoracic wall on the left lateral surface in the mid-axillary line
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The Cardiac or Medial Basilar BP Segment Of The Right Lower Lobes Cannot Be Auscultated Nor Percussed
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Positioning The PatientPositioning The Patient
The Left Side-Lying Positions
The Right Middle Lobes Lateral Basilar BP Segment Of The Right Lower Lobes
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The Right Middle LobesThe Right Middle Lobes
The bronchial feed into these segments are :
Lateral Forward Obliquely Downward
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Postural Position :
Left side-lying inclined with head below horizon and the right shoulders rotated down towards the bed
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Percussion & Auscultation :
Over the thoracic wall on the right thoracic wall over the nipple extending into the mid-axillary line
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Lateral Basilar BP Segment Of Lateral Basilar BP Segment Of The Right Lower LobesThe Right Lower Lobes
The bronchial feed into this segment is :
Lateral Obliquely Downward
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Postural Position :
Left side-lying inclined with head below horizon
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Percussion & Auscultation :
Over the right thoracic wall in the mid-axillary line at the inferior border of the thorax