Postural Drainage Flashcards
Postural drainage
Method of removing secretions from lungs by using gravity. Placing the segmental bronchus in the most vertical position.
Goals of Postural drainage
- To prevent accumulation of secretions in pt at rist for pulmonary complications.
- Pulmonary disease associated with increased production or viscosity of mucus.
- prolonged bed rest
- Postsurgical pt’s who have received general anesthesia or have painful incisions
- Pt on a ventilator stable enough to tolerate treatment.
- Pt with greatly increased work of breathing.
To remove secretions already accumulated
- Acute or chronic: lung disease
- Very weak or elderly
- Pt with artificial airways
- Pt with atelectasis
Beneficial for people who
- Produce more than 30 mL of sputum a day
- Have difficulty clearing it.
- Bring up more sputum by this means than otherwise.
Avoid head down positioning for
- Unstable Cardiovascular System
- Neurosurgery
- Esophageal anatomosis
- Recent Cardiac Surgery
- Pulmonary Edema
- CHF
- Trauma, Burns or recent surgery to head and neck
- Breathlessness or Orthopnea
- History of seizures or prone seizures
- Acute SCI, or instability
- Cerebral Edema
- Recent Tube feeding with complaints of nausea
- Ventilator pt’s
- Pt’s with shunts
Untreated tension pneumothorax
Positive pressure in the pleural space
Hemoptysis
Blood in sputum
Postoperatively Following
- certain orthopedic pt who are limited in positioning
- surgical complications such as tear in pericardial sac. Fluid can fill in the pericardium: the sac that the heart is enclosed in.
- Pneumonectomy
- Surgery to aorta: aneurysm or valve.
Aneurysm (Precaution)
or decrease in circulation of main blood vessels
Aged or nervous pt
who become agitated or upset
Pulmonary embolism
Thats all folks!
Recent Laminectomy
If treated, log rol pt and align vertebrae properly: spinal precautions no B,L,T.
Large pleural Effusion
Lung is unable to expand due to fluid in pleural space.
Subcutaneous emphysema, Headache
Just a precaution
Symptomatic hiatal hernia
Stomach bulges up through the opening in the diaphragm that the esophagus goes through normally.
Abdominal distension
Substance causes outward expansion beyond normal girth. pregnancy, obesity.
Preparation for Treatment
-Determine area to be drained: chest evaluation, pt’s chart, x-rays, conferring with MD etc.
-Determine pt’s general medical condition, vital signs, arrythmias, level of consciousness, ability to tolerate treatment, acute or chronic condition.
-Determine best treatment time: consider meals or tube feeding, pain, coordinate with other treatments, (Some believe before aerosol { provide moisture and meds to lungs} or IPPB {intermittent positive pressure breathing for hypoventilation} Treatments are best, some believe after is best)
choose the best time for the patient. Some have more productive cough in the morning & some need clearing of lungs before sleeping.
Prepare patient
- Loosen tight or binding clothing: around neck or waist
- Explain treatment to pt
- Seek relaxed atmosphere and rapport with pt
- Observe and adjust/protect tubes, IV’s, airways
- Get help with positioning if necessary
- Check Vital signs before treatment
- Have pt cough or be suctioned prior if Lg. amounts of secretions; repeat before changing positions
- Have sputum cup and or tissues available
- Have sufficient pillows for positioning.
Treatment:
- Some need to be drained in all positions
- Others need drainage only in segments
- Drain affected lung first( breathe with good lung during treatment & can drain good lung last if necessary)
- With generalized secretions, drain lower first, middle second, & upper last ( sequence reversed for infants or bed bound; lying prone or supine)
- Positions may need to be modified: SOB with lying flat, head down contraindications, chest tubes or monitoring wires may limit modifications should be documented.
Therapist should be in ________ of the patient in order to _______ _______ quickly but care should be taken not to have patient cough directly at therapist.
Front
Observe changes
Position should be maintained at least __________ longer if large amounts of secretions are present.
5-10 minutes
If several positions are to be used limit total treatment time to _________ (treat different areas in Am and PM if necessary.
30-40 minutes
Pt should be encouraged to perform
deep breathing during drainage but do not allow hyperventilation or SOB
Effective cough when necessary
Therapist should perform what appropriately?
Percussion, shaking or vibration
