Chest PT/Postural Drainage

Question 1

All positions are contraindicated for…

Answer 1

ICP > 20mmHg
head/neck injury until stabilized
active hemorrhage w/ hemodynamic instability
recent spinal surgery or acute spinal injury
active hemoptysis
empyema
bronchopleural fistula
large pleural effusion
pulmonary embolism
confused or anxious patients
rib fracture
surgical would or healing tissue

Question 2

Trendelenburg position contraindicated for…

Answer 2

uncontrolled HTN
distended abdomen
esophageal surgery
recent gross hemoptysis related to lung carcinoma treated surgically or with radiation
uncontrolled airway at risk for aspiration

Question 3

Apical Segments

Answer 3

patient in long sitting and lean 30deg against PT on pillow

Percuss over muscular area between collarbone & top of shoulder blade

Question 4

Posterior segments of Upper lobe

Answer 4

patient sits on a flat table w/ legs dangling off edge and leaning forward over a folded pillow at 30deg

Percuss on upper back (interscapular area)

Question 5

Anterior segments of the Upper lobe

Answer 5

patient lies on FLAT table w/ pillow under knees and head

percuss between collarbone and nipple

Question 6

Lingula & Middle lobe

Answer 6

Lingula:
elevate foot of table 14in (15deg)
patient lies head down on right side and rotates 1/4 backward w/ pillow behind back

percuss just outside the left nipple area
(for women, heel of hand under the armpit w/ fingers extended forward beneath breast)

^^ opposite for middle lobe

Question 7

Anterior basal segments of the lower lobe

Answer 7

elevate foot of table 18in (30deg)

patient lies on R/L side w/ head down & pillow behind back and between knees
(treatment side UP)
**just sidelying w/ arm resting in front of patient

percuss over lower ribs on R/L side

Question 8

Posterior basal segments of the lower lobe

Answer 8

elevate foot of table 18in (30deg)

patient lies on abdomen, head down, with pillow under hips and head, arms flexed by side

percuss on L/R sides of spine, not over spine or low back/ribs

Question 9

Lateral Basal segments of the lower lobe

Answer 9

elevate foot of table 18in (30deg)

patient lies on R/L side, head down, and leans forward 1/4 turn toward the table w/ knees flexed

percuss over the uppermost portion of the lower ribs

Question 10

Superior segments of the lower lobe

Answer 10

patient lies on abdomen on FLAT table w/ two pillows under the hip

percuss over middle part of the back at the bottom of the shoulder blade