Secretion Management - PowerPoint PPT Presentation

1 / 20
About This Presentation
Title:

Secretion Management

Description:

Pain. Chest Percussion. Contraindications. Hemoptysis after lung resection ... Chest pain. Resected tumors of the thorax or neck. Chest Percussion. Hazards ... – PowerPoint PPT presentation

Number of Views:413
Avg rating:3.0/5.0
Slides: 21
Provided by: kennet51
Category:

less

Transcript and Presenter's Notes

Title: Secretion Management


1
Secretion Management
  • Chest Percussion
  • And
  • Postural Drainage

2
Chest Percussion
  • Defn chest percussion refers to a series of
    manipulative techniques designed to assist with
    bronchial hygiene the mobilization of secretions
    from the tracheobronchial tree.

3
Chest Percussion
  • Integrated modalities
  • Postural drainage
  • Vibration
  • Cough assistance
  • Breathing instruction

4
Chest Percussion
  • Goals
  • Prophylaxis to prevent retained secretions
  • Improve mobilization of secretions
  • Improve distribution of ventilation
  • Promote more efficient breathing patterns
  • Promote effective cough

5
Chest Percussion
  • Indications
  • Acute conditions
  • Acute pulmonary disease with copious secretions
  • Acute lobar atelectasis
  • Acute conditions of questionable benefits
  • Exacerbation of COPD w/scant secretions
  • Pneumonia w/o sputum production, e.g., viral
  • Status asthmaticus
  • Status Post (S/P) coronary artery bypass graft
    surgery (CABG)

6
Chest Percussion
  • Indications
  • Chronic conditions
  • Chronic production of large amounts (30 ml/day)
    of secretions
  • Cystic fibrosis
  • Bronchiectasis
  • Chronic bronchitis
  • Lung abcess
  • Collection of pus within the lungs as opposed to
    empyema, which is pus in the pleural space.
    Chest tube drainage is required for empyema.

7
Chest Percussion
  • Hazards/Complications
  • Hypoxemia when affected side is dependent
  • Cardiovascular instability
  • Internal hemorrhage post Sx
  • Hemoptysis after lung surgery
  • Fractured ribs, e.g., osteoporosis
  • Increased ICP
  • Dyspnea
  • Pain

8
Chest Percussion
  • Contraindications
  • Hemoptysis after lung resection
  • Uncontrolled hypertension
  • ICP 20 mm Hg
  • S/P neurosurgery, aneurysm, eye surgery
  • Suspected TB
  • Osteomyelitis
  • Osteoporosis
  • Chest pain
  • Resected tumors of the thorax or neck

9
Chest Percussion
  • Hazards/Complications
  • Vomiting
  • Wheezing
  • Bronchospasm
  • Acute hypotension
  • Aggravate lung contusion, coagulopathies

10
Percussion Techniques
  • Hand
  • Cupped hand will trap air to cause a popping
    sound on contact
  • Use the cover sheet or patient gown over skin
  • Vibes
  • Arms extended tensed when pushing firmly against
    pts chest during exhalation
  • Shaking
  • Shaking hands on pts chest during exhalation
  • Percussor, Swedish massager, etc.
  • Good for pts who do not tolerate hand percussion

11
Postural Drainage
  • Defn method of removing pooled secretions in
    the tracheobronchial tree by positioning the
    patient to allow gravity to assist in the
    movement of secretions.

12
Postural Drainage
  • Goals
  • Facilitate mobilization of secretions in the
    bronchial tree
  • Improve distribution of ventilation
  • Improve gas exchange by improving V/Q mismatch
  • Indications
  • Same as for chest percussion
  • OK for those who do not tolerate percussion

13
Postural Drainage
  • Contraindications
  • Unstable hemodynamics
  • Untreated hypertension
  • Internal and external head injuries
  • Gross obesity
  • Empyema
  • Severe dyspnea at rest in high Fowlers or supine
  • Recent meals or tube feedings (allow 30 mins
    after)
  • Spinal cord injuries

14
Postural Drainage
  • Bed position
  • Flat
  • Tredenlenburg 15-18 foot of bed ?
  • Reverse Trendelenburg 15-18 head of bed ?
  • High Fowlers 30-45º head upright
  • Semi or mid Fowlers 15-30 º head upright

15
Postural Drainage
  • Body position
  • Dependent position down side
  • Independent position upside
  • Prone
  • Supine
  • Lateral
  • 3/4 prone
  • 3/4 supine

16
Postural Drainage
  • Moving patients into position
  • Explain to patient what you will be doing
  • If patient alert, let him or her know to let you
    know if he or she experiences SOB, headache,
    pain, etc.
  • If patient is ambulatory, ask him or her to move
    into position assist if necessary
  • Ask for help if patient is unconscious and large
  • Move patient into position prior to placing bed
    into Trendelenburg

17
Postural Drainage
  • Positioning patient for safety and comfort
  • Patient should always be turned and face YOU
  • Monitor patients facial expressions for pain,
    discomfort, and signs of breathing distress
  • Adjust patients arms and legs using pillows b/t
    the knees avoid bone to bone contact
  • Support the head with a pillow
  • Tuck pillow behind back and abdomen for stability
  • Watch those IV lines and urinary catheter
  • Urinary catheter should be on your side
  • Make sure side rails are up opposite you

18
Lung Segments
  • Right lung (10 segments)
  • RUL
  • Apical segment of the RUL
  • Anterior segment of the RUL
  • Posterior segment of the RUL
  • RML
  • Middle (medial) segment of the RML
  • Lateral segment of the RML

19
Lung Segments
  • Right lung
  • RLL
  • Anterior basal or segment of the RLL
  • Lateral basal or segment of the RLL
  • Medial basal (cardiac lobe) or segment of the RLL
  • Posterior basal or segment of the RLL
  • Superior basal or segment of the RLL

20
Lung Segments
  • Left lung (8 segments)
  • LUL
  • Apical-posterior segment of the LUL
  • Anterior segment of the LUL
  • LML
  • Superior lingula
  • Inferior lingula
  • LLL
  • Anterior-medial basal or segment of the LLL
  • Posterior basal or segment of the LLL
  • Lateral basal or segment of the LLL
  • Superior basal or segment of the LLL
Write a Comment
User Comments (0)
About PowerShow.com