Chest Physical Therapy - PowerPoint PPT Presentation

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Chest Physical Therapy

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Initially performed by physical therapists and nurses (has been ... Mechanical percussors and vibrators. Flow-resistive breathing devices (PEP) Flutter Valve ... – PowerPoint PPT presentation

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Title: Chest Physical Therapy


1
Chest Physical Therapy
2
CPT Introduction
  • Initially performed by physical therapists and
    nurses (has been used since early 1900s)
  • Early 1970s resp. care personnel began to
    incorporate techniques for airway maint.
  • Consists of pulmonary drainage, chest percussion,
    chest vibration, directed coughing and breathing,
    and conditioning exercises

3
Pulmonary Drainage
  • Purpose is to increase the removal of bronchial
    secretions by so positioning the patient that
    gravity will aid their cephalad movement
  • Objectives are to - liquefy viscous
    secretions in conjunction with aerosol
    therapy - loosen tenacious secretions
  • - remove accumulated secretions

4
P D (contd)
  • Rationale for P.D. is to aid in lung ventilation
    and pulmonary hygiene by removing secretions that
    cause increased airway resist., obstruction, and
    infection
  • Indications for P. D.
  • - excessive prod. of or failure to remove
    secretions - restrictive
    diseases(ineffective cough) - aspiration
  • - prophylactic care

5
Contraindications of P D
  • Abscess - rupture may cause flooding of
    air passages and contamination of lung
  • Severe airway resistance
  • Rib fx.
  • Hemoptysis
  • Diaphragmatic disorders
  • Head trauma and increased ICP
  • HTN and other cardiac problems

6
Conditions requir. modified P D
  • Hypoxia
  • Exhaustion
  • Pain
  • Post-Op patient
  • Tracheostomy
  • Disoriented patient
  • Obese patient

7
P D program planning
  • Frequency of tx. - Rx., usually Tid or Qid
  • Coord. of tx. - in conjunction with other
    tx.s
  • Length of tx. - adjust to pt. tolerance,
    usu. 30 minutes
  • Time of tx. - a.c. or 1/2-1 hour p.c.
  • Level of hypoxia (should not increase)

8
PD prog. planning (contd)
  • Humidity therapy - if Rx. give 15 - 20 min.
    before tx.
  • Adjunct therapy given before tx. - i.e., IPPB,
    SVN

9
Assessment of Patient
  • Patient position
  • - from supine to prone PaO2 may decrease 47
    mmHg - V. S. may change with position
  • Vital Signs - obtain before, during, and
    after P.D.
  • - B.P. should not change gt 10mmHg
  • - pulse should not increase to 120/min. or
    increase gt 20 above baseline - respir. should
    not increase gt 10

10
Assessment (contd)
  • Skin - color, temperature
  • Cough - measure ability to generate an
    effective cough, i.e., VC, MEFR
  • LOC - if changes noted during tx., stop
    tx., notify correct personnel

11
Prioritizing Draining Specific Areas
  • Right lung has 3 lobes which subdivide into ten
    bronchopulmonary segments
  • Left lung has 2 lobes which communicate with ten
    pulmonary segments
  • Drain involved areas first
  • Drain lower lobes
  • Drain middle lobe and lingular region next
  • Drain upper lobes last

12
Percussion (clapping)
  • Technique of striking patients chest wall to
    loosen bronchial secretions as an aid to postural
    drainage
  • Is the process of alternately but rhythmically
    striking the chest wall with one cupped hand and
    then the other or with a mechanical percussor
  • Cupped hand creates an air pocket that traps air
    between the hand and chest and vibration is sent
    to bronchi to loosen secret.

13
Percussion (contd)
  • Performed in conjunction with P. D. for 5 min. in
    each position
  • Need Rx.
  • Avoid to bare skin, surgical wounds, spinal cord,
    kidneys, sternum, any bony prominences, or
    female breasts
  • Hold cupped hand approx. 3 inches from chest wall
    and use waving motion at a slow-to- moderate rate

14
Relative Contraindications to Percussion
  • Thoracic or abdominal trauma
  • Acute medical emergencies
  • Empyema, pleural effusion, pneumothorax,
    hemoptysis
  • Abscess

15
Chest Vibration
  • Used in conjuction with P.D. and percussion
  • Uses fine vibrations transmitted to the
    secretions by using one hand on top of the other
    and producing an even vibratory motion with the
    hands
  • Performed only during exhalation
  • Instruct patient to inhale through nose and
    exhale slowly through pursed lips

16
Breathing Exercises1. Diaphragmatic Breathing
  • Performed in different positions starting in a
    semi-Fowler, then sitting, then standing, then
    walking.
  • Place your hand on patients diaphragm and
    instruct patient to push your hand up
  • Allow patient to put their own hand on diaphragm
    and repeat exercise

17
Segmental Breathing
  • Patient is asked to ventilate specific areas of
    the lungs
  • Place your hand or the patients hand over
    surface landmark of the lung segments to be
    ventilated
  • Ask patient to try to push the hand up on
    inspiration
  • The tactile input and stretch will enable a
    deeper inspiration

18
Lateral Costal Breathing Exercise
  • Unilateral or bilateral costal breathing
    exercises increase ventilation to the lower lobes
    and aid diaphragmatic breathing
  • Used when patient cannot tolerate the hand on the
    abdomen, e.g., abdominal surgery, pregnancy, or
    ascites

19
Pursed Lip Breathing
  • Pursed lips breathing exerts a positive back
    pressure on the airways that allows the patient
    to exhale without the airways collapsing and
    trapping air in the lungs
  • Ask patient to exhale during the exertion phase
    of an activity
  • Emphasize a slow, relaxed exhalation will result
    in a more effective exhalation

20
Cough Control
  • Cough is the second line of defense in clearing
    the upper airways and segmental bronchi
  • Most patients can be taught to remove secretions
    with a normal cough maneuver, i.e., a deep
    inspiration followed by compression of the thorax
    against a closed glottis, followed by expulsion
  • COPD patients may need to use huffing

21
Autogenic Drainage
  • Uses breathing control in which the rate,
    location, and depth of respiration is voluntarily
    adjusted
  • Have 3 phases - phase 1 is intended to
    unstick mucus - phase 2 is collection -
    phase 3 is evacuation of secretions

22
Adjuncts for CPT
  • Mechanical percussors and vibrators
  • Flow-resistive breathing devices (PEP)
  • Flutter Valve
  • High Frequency Chest Wall Oscillation
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