1. CHEST PHYSIOTHERAPY (CPT) PREPARED BY: DR. IRENE ROCO ASST. PROFESSOR

2. CHEST PHYSIOTHERAPY (CPT) TECHNIQUE USED TO MOBILIZE OR LOOSE SECRETIONS IN THE LUNGS AND RESPIRATORY TRACT. THIS IS ESPECIALLY HELPFUL FOR PATIENTS WITH LARGE AMOUNT OF SECRETIONS OR INEFFECTIVE COUGH.TECHNIQUE USED TO MOBILIZE OR LOOSE SECRETIONS IN THE LUNGS AND RESPIRATORY TRACT. THIS IS ESPECIALLY HELPFUL FOR PATIENTS WITH LARGE AMOUNT OF SECRETIONS OR INEFFECTIVE COUGH.

3. CHEST PHYSIOTHERAPY (CPT) CONSISTS OF EXTERNAL MECHANICAL MANEUVERS, SUCH AS: CHEST PERCUSSION CHEST PERCUSSION POSTURAL DRAINAGE POSTURAL DRAINAGE VIBRATION TO AUGMENT MOBILIZATION AND CLEARANCE OF AIRWAY SECRETIONS, VIBRATION TO AUGMENT MOBILIZATION AND CLEARANCE OF AIRWAY SECRETIONS, DIAPHRAGMATIC BREATHING WITH PURSED-LIPS DIAPHRAGMATIC BREATHING WITH PURSED-LIPS COUGHING AND CONTROLLED COUGHING. COUGHING AND CONTROLLED COUGHING.

4. INDICATIONS OF CHEST PHYSIOTHERAPY PATIENTS IN WHOM COUGH IS INSUFFICIENT TO CLEAR THICK, TENACIOUS, OR LOCALIZED SECRETIONS LIKE: PATIENTS IN WHOM COUGH IS INSUFFICIENT TO CLEAR THICK, TENACIOUS, OR LOCALIZED SECRETIONS LIKE: CYSTIC FIBROSISCYSTIC FIBROSIS BRONCHIECTASISBRONCHIECTASIS ATELECTASISATELECTASIS LUNG ABSCESSLUNG ABSCESS NEUROMUSCULAR DISEASESNEUROMUSCULAR DISEASES PNEUMONIAS IN DEPENDENT LUNG REGIONSPNEUMONIAS IN DEPENDENT LUNG REGIONS

5. CONTRAINDICATIONS INCREASED ICP INCREASED ICP UNSTABLE HEAD OR NECK INJURY UNSTABLE HEAD OR NECK INJURY ACTIVE HEMORRHAGE WITH HEMODYNAMIC INSTABILITY OR HEMOPTYSIS ACTIVE HEMORRHAGE WITH HEMODYNAMIC INSTABILITY OR HEMOPTYSIS RECENT SPINAL INJURY OR INJURY RECENT SPINAL INJURY OR INJURY EMPYEMA EMPYEMA BRONCHOPLEURAL FISTULA BRONCHOPLEURAL FISTULA RIB FRACTURE RIB FRACTURE FAIL CHEST FAIL CHEST UNCONTROLLED HYPERTENSION UNCONTROLLED HYPERTENSION ANTICOAGULANT THERAPY ANTICOAGULANT THERAPY RIB OR VERTEBRAL FRACTURES OR OSTEOPOROSIS RIB OR VERTEBRAL FRACTURES OR OSTEOPOROSIS

6. ASSESSMENT FOR CHEST PHYSIOTHERAPY NURSING CARE AND SELECTION OF CPT SKILLS ARE BASED ON SPECIFIC ASSESSMENT FINDINGS. THE FOLLOWING ARE THE ASSESSMENT CRITERIA: 1. NORMAL RANGE OF PATIENT’S VITAL SIGNS. CONDITIONS REQUIRING CPT, SUCH ATELECTASIS, AND PNEUMONIA, AFFECTS VITAL SIGNS. SUCH ATELECTASIS, AND PNEUMONIA, AFFECTS VITAL SIGNS. 2. PATIENT’S MEDICATIONS. CERTAIN MEDICATIONS, PARTICULARLY DIURETICS ANTIHYPERTENSIVE CAUSE FLUID AND HAEMODYNAMIC CHANGES. ANTIHYPERTENSIVE CAUSE FLUID AND HAEMODYNAMIC CHANGES.

7. 3. MEDICAL HISTORY - CONTRAINDICATIONS FOR POSTURAL DRAINAGE (INCREASED ICP, SPINAL CONTRAINDICATIONS FOR POSTURAL DRAINAGE (INCREASED ICP, SPINAL CORD INJURIES AND ABDOMINAL ANEURYSM RESECTION) CORD INJURIES AND ABDOMINAL ANEURYSM RESECTION) CONTRAINDICATIONS FOR PERCUSSION AND VIBRATION ( THORACIC TRAUMA CONTRAINDICATIONS FOR PERCUSSION AND VIBRATION ( THORACIC TRAUMA AND CHEST SURGERIES AND CHEST SURGERIES 4. COGNITIVE LEVEL OF FUNCTIONING - PARTICIPATING IN CONTROLLED COUGH TECHNIQUES REQUIRES THE PATIENT TO FOLLOW INSTRUCTIONS. TECHNIQUES REQUIRES THE PATIENT TO FOLLOW INSTRUCTIONS. 5. EXERCISE TOLERANCE. CPT MANEUVERS ARE FATIGUING. GRADUAL INCREASE IN ACTIVITY AND THROUGH CPT, PATIENT TOLERANCE TO THE PROCEDURE ACTIVITY AND THROUGH CPT, PATIENT TOLERANCE TO THE PROCEDURE IMPROVES. IMPROVES. ASSESSMENT FOR CHEST PHYSIOTHERAPY

8. CHEST PHYSIOTHERAPY A NURSE OR RESPIRATORY THERAPIST MAY ADMINISTER CPT, ALTHOUGH THE TECHNIQUES CAN OFTEN BE TAUGHT TO FAMILY MEMBERS OF PATIENTS. THE PROCEDURE IS SOMEWHAT UNCOMFORTABLE AND TIRING FOR THE PATIENT

9. SEQUENCE FOR CHEST PHYSIOTHERAPY 1.POSITIONING (POSTURAL DRAINAGE) 2.CHEST PERCUSSION 3.VIBRATION EACH POSITION IS USUALLY ASSUMED FOR 10-15 MINUTES EACH POSITION IS USUALLY ASSUMED FOR 10-15 MINUTES BEGINNING TREATMENTS MAY START WITH SHORTER TIMES AND GRADUALLY INCREASE BEGINNING TREATMENTS MAY START WITH SHORTER TIMES AND GRADUALLY INCREASE

10. I - POSTURAL DRAINAGE THE POSITIONING TECHNIQUES THAT DRAIN SECRETIONS FROM SPECIFIC SEGMENTS OF THE LUNGS AND BRONCHI INTO THE TRACHEA.THE POSITIONING TECHNIQUES THAT DRAIN SECRETIONS FROM SPECIFIC SEGMENTS OF THE LUNGS AND BRONCHI INTO THE TRACHEA. THE PERSON IS TILTED OR PROPPED AT AN ANGLE TO HELP DRAIN SECRETIONS FROM THE LUNGS.THE PERSON IS TILTED OR PROPPED AT AN ANGLE TO HELP DRAIN SECRETIONS FROM THE LUNGS. SCHEDULED TWO OR THREE TIMES DAILY (BEFORE BREAKFAST, BEFORE LUNCH, LATE AFTERNOON OR BEFORE MIDNIGHT ) DEPENDING ON THE DEGREE OF LUNG CONGESTIONSCHEDULED TWO OR THREE TIMES DAILY (BEFORE BREAKFAST, BEFORE LUNCH, LATE AFTERNOON OR BEFORE MIDNIGHT ) DEPENDING ON THE DEGREE OF LUNG CONGESTION

11. I - POSTURAL DRAINAGE THE LOWER LOBES REQUIRE DRAINAGE MORE FREQUENTLY BECAUSE THE UPPER LOBES DRAIN BY GRAVITY BRONCHODILATOR OR NEBULIZATION THERAPY MAY BE GIVEN BEFORE POSTURAL DRAINAGEBRONCHODILATOR OR NEBULIZATION THERAPY MAY BE GIVEN BEFORE POSTURAL DRAINAGE BECAUSE SOME PATIENTS DO NOT REQUIRE POSTURAL DRAINAGE FOR ALL LUNG SEGMENTS, THE PROCEDURE MUST BE BASED ON THE CLINICAL FINDINGS.BECAUSE SOME PATIENTS DO NOT REQUIRE POSTURAL DRAINAGE FOR ALL LUNG SEGMENTS, THE PROCEDURE MUST BE BASED ON THE CLINICAL FINDINGS.

12. NURSES’ ROLES EVALUATE THE CLIENT’S TOLERANCE OF POSTURAL DRAINAGE BY ASSESSING STABILITY OF VITAL SIGNS (PR, RR) EVALUATE THE CLIENT’S TOLERANCE OF POSTURAL DRAINAGE BY ASSESSING STABILITY OF VITAL SIGNS (PR, RR) NOTE SIGNS OF INTOLERANCE SUCH AS PALLOR, DIAPHORESIS, DYSPNEA, NAUSEA AND FATIGUE NOTE SIGNS OF INTOLERANCE SUCH AS PALLOR, DIAPHORESIS, DYSPNEA, NAUSEA AND FATIGUE

13. II - CHEST PERCUSSION INVOLVES STRIKING THE CHEST WALL OVER THE AREA BEING DRAINED WITH THE USE OF CUPPED PALM IN RHYTHMIC PATTERN TO LOOSEN PULMONARY SECRETIONS POSITION: SUPINE OR PRONE CUPPING IS NEVER DONE ON BARE SKIN OR PERFORMED OVER SURGICAL INCISIONS, BELOW THE RIBS, OR OVER THE SPINE OR BREASTS BECAUSE OF THE DANGER O TISSUE DAMAGE. EACH AREA IS PERCUSSED FOR 30 TO 6OSECONDS SEVERAL TIMES A DAY. IF THE PATIENT HAS TENACIOUS SECRETIONS, THE AREA MUST BE PERCUSSED FOR 3-5 MINUTES SEVERAL TIMES PER DAY.

14. III - VIBRATION SERIES OF VIGOROUS QUIVERINGS PRODUCED BY HANDS THAT ARE PLACED FLAT AGAINST THE CLIENT’S CHEST WALL USED AFTER PERCUSSION TO INCREASE THE TURBULENCE OF THE EXHALED AIR PURPOSE IS TO HELP LOOSEN RESPIRATORY SECRETIONS SO THAT THEY CAN BE EXPECTORATED WITH EASE. VIBRATION (AT A RATE OF 200 PER MINUTE) CAN BE DONE FOR SEVERAL TIMES A DAY. TO AVOID PATIENT CAUSING DISCOMFORT, VIBRATION IS NEVER DONE OVER THE PATIENT’S BREASTS, SPINE, STERNUM, AND RIB CAGE. VIBRATION CAN ALSO BE TAUGHT TO FAMILY MEMBERS OR ACCOMPLISHED WITH MECHANICAL DEVICE.

15. III - VIBRATION POSITION THE PATIENT IN PRESCRIBED POSTURAL DRAINAGE POSITIONS. SPINE SHOULD BE STRAIGHT TO PROMOTE RIB CAGE EXPANSION PATIENT USE DIAPHRAGMATIC BREATHING PERCUSS OR CLAP WITH CUPPED HANDS OR CHEST WALL FOR 5 MINUTES OVER EACH SEGMENT FOR CYSTIC FIBROSIS AND 1-2 MINUTES FOR OTHER CONDITIONS AVOID CLAPPING OVER SPINE, LIVER, SPLEEN, BREAST, SCAPULA, CLAVICLE OR STERNUM VIBRATE THE CHEST WALL AS THE PATIENT EXHALES SLOWLY THROUGH THE PURSED LIPS.

16. REFERENCES KOZIER & ERBS’ FUNDAMENTALS OF NURSING. EIGHTH ED. 2008 POTTER PERRY. BASIC NURSING 6TH ED..MOSBY, MISSOURI, 2006.