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Special Clientele > Postural Drainage > Flashcards

Postural Drainage Flashcards

1
Q

Postural drainage

A

Method of removing secretions from lungs by using gravity. Placing the segmental bronchus in the most vertical position.

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2
Q

Goals of Postural drainage

A
  • 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.
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3
Q

To remove secretions already accumulated

A
  • Acute or chronic: lung disease
  • Very weak or elderly
  • Pt with artificial airways
  • Pt with atelectasis
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4
Q

Beneficial for people who

A
  • Produce more than 30 mL of sputum a day
  • Have difficulty clearing it.
  • Bring up more sputum by this means than otherwise.
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5
Q

Avoid head down positioning for

A
  • 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
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6
Q

Untreated tension pneumothorax

A

Positive pressure in the pleural space

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7
Q

Hemoptysis

A

Blood in sputum

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8
Q

Postoperatively Following

A
  • 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.
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9
Q

Aneurysm (Precaution)

A

or decrease in circulation of main blood vessels

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10
Q

Aged or nervous pt

A

who become agitated or upset

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11
Q

Pulmonary embolism

A

Thats all folks!

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12
Q

Recent Laminectomy

A

If treated, log rol pt and align vertebrae properly: spinal precautions no B,L,T.

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13
Q

Large pleural Effusion

A

Lung is unable to expand due to fluid in pleural space.

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14
Q

Subcutaneous emphysema, Headache

A

Just a precaution

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15
Q

Symptomatic hiatal hernia

A

Stomach bulges up through the opening in the diaphragm that the esophagus goes through normally.

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16
Q

Abdominal distension

A

Substance causes outward expansion beyond normal girth. pregnancy, obesity.

17
Q

Preparation for Treatment

A

-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.

18
Q

Prepare patient

A
  • 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.
19
Q

Treatment:

A
  • 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.
20
Q

Therapist should be in ________ of the patient in order to _______ _______ quickly but care should be taken not to have patient cough directly at therapist.

A

Front

Observe changes

21
Q

Position should be maintained at least __________ longer if large amounts of secretions are present.

A

5-10 minutes

22
Q

If several positions are to be used limit total treatment time to _________ (treat different areas in Am and PM if necessary.

A

30-40 minutes

23
Q

Pt should be encouraged to perform

A

deep breathing during drainage but do not allow hyperventilation or SOB
Effective cough when necessary

24
Q

Therapist should perform what appropriately?

A

Percussion, shaking or vibration

25
Q

If pt does not cough spontaneously have patient?

A

Take several deep breaths and apply vibrations during expiration to help elicit cough

26
Q

If productive cough is not obtained after 5-10 min. of positioning what do you do?

A

Go on to the next position; mobilized secretions may not be coughed up by patient until 30 min. to 1 hour after treatment.

27
Q

At the conclusion of treatment.

A
  • Have pt sit up slowly and rest for a short while
  • Watch for signs of postural hypotension when rising from head down position.
  • Advise the pt that their cough may be productive for up to 1 hr. after treatment.
28
Q

Assess Effectiveness of treatment and document

A
  • Type, color consistency, and amount of secretions
  • Time frames for various positions
  • Breathing ex’s performed
  • How pt tolerated treatment
  • Vital signs after treatment
  • Auscultate over drained segments & note changes in breath sounds.
  • Observe breathing pattern to determine whether it is deeper, less rapid, more relaxed, or less labored
  • Check symmetry of chest wall expansion
29
Q

Postural drainage can be discontinued when

A
  • Chest x-ray is relatively clear
  • Pt is afebrile ( having not fear ) for 24-48 hrs.
  • Normal or near-normal breath sounds are heard
  • Pt is on regular home program.
30
Q

Precaustions and Contradictions

A
  • Discuss with healthcare team if postural drainage is safe for the pt before performing.
  • Head Down Positioning
  • Untreated tension pneumothorax
  • Hemoptysis
  • Postoperative following (ie: limited in postioning, surgical complications, Pneumoonectomy, aorta surgery)
  • Aneurysm
  • Aged or nervous pt’s
  • Pulmonary embolism
  • Recent Laminectomy
  • Large Pleural Effusion
  • Subcutaneous emphysema
  • Headache
  • Symptomatic Hiatal Hernia
  • Abdominal Distenion
  • Pregnancy
  • Obesity

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