Postural Drainage and Interventions

Question 1

What is postural drainage?

Answer 1

Placing the patient in varying positions for optimal gravity drainage of secretions and increased expansion of the involved segment

Question 2

What are 3 indications for use of postural drainage?

Answer 2

1. Increased pulmonary secretions
2. Aspiration
3. Atelectasis or collapse

Question 3

What is percussion? How long should percussion be performed?

Answer 3

A force rhythmically applied with the therapist’s cupped hands to the specific area of the chest wall that corresponds to the involved lung segment

3-5 minutes of percussion per postural drainage position with clinically assessed improvement is guideline.

Question 4

What is shaking (vibration)?

Answer 4

Following a deep inhalation, a bouncing maneuver is applied to the rib cage throughout exhalation; to hasten the removal of secretions from the tracheobronchial tree

5-10 deep inhalations with the shaking technique is generally acceptable practice

Question 5

What position should the bed or table be for postural drainage of the upper, middle and lower lobes?

Answer 5

Upper = flat
Middle = foot of bed/table elevated 16 inches 
Lower = foot of bed/table elevated 20 inches

Question 6

What position should the patient be asked to cough in? When should this ideally be done?

Answer 6

Patient asked to cough in the upright sitting position

Should be performed after each lung has been treated (following postural drainage techniques)

Question 7

Describe huffing. What group benefits from this type of airway clearance technique?

Answer 7

More effective in patients with collapsible airways (i.e. COPD); prevents the high intrathoracic pressure that causes premature airway closure

1. Ask patient to inhale deeply
2. Immediately the patient forcibly expels the air, saying “Ha, ha.”

Question 8

What is assisted coughing? When is this technique typically used?

Answer 8

Therapist’s hands/fists become the force behind the patient’s exhaled air

Used when the patient’s abdominal muscles cannot generate an effective cough

Question 9

Describe how assisted coughing is performed.

Answer 9

1. Position the patient against a solid surface
2. Place hand below the patient’s subcostal angle
3. Ask patient to inhale deeply
4. As patient attempts to cough, push hand inward and upwards, assisting rapid exhalation of air

Question 10

When is tracheal stimulation performed? How is it performed?

Answer 10

Used with patients who are unable to cough on command, such as infants or patients with brain injury or stroke

Place fingers or thumb just above the suprasternal notch, a quick inward and downward pressure on the trachea elicits the cough reflex

Question 11

_____ is used only when all other airway clearance techniques fail to adequately remove secretions.

Answer 11

Endotracheal suctioning

Question 12

What is autogenic drainage?

Answer 12

A independent program used to sense peripheral secretions and clear them without the tracheobronchial irritation of coughing

Question 13

Describe the phases of autogenic drainage.

Answer 13

1. Unstick phase: quite breathing at low lung volumes to effect peripheral secretions
2. Collect phase: breathing at mid lung volumes to affect secretions in the midline airways
3. Evacuation phase: breathing from mid to high lung volumes to clear secretions from central airways; replaces cough as the means to clear secretions

Question 14

What is a flutter or acapella device?

Answer 14

Patient uses an external device that vibrates the airways on exhalation to improve airway clearance with intermittent, positive expiratory pressure

Question 15

What is a low pressure positive expiratory pressure (PEP) mask?

Answer 15

The patient uses positive expiratory resistance via face mask to help remove airway secretions

Low pressure PEP = 10-20 cm H2O

Question 16

What is a high pressure positive expiratory pressure (PEP) mask?

Answer 16

The patient with an unstable airway uses high expiratory pressures via face mask to assist in removal of airway secretions

High pressure PEP = 50-120 cm H2O

Question 17

What is high frequency chest wall oscillation?

Answer 17

Patient wears a vest that fills with air and then rapidly increases/decreases pressure.

Pressure oscillation loosens secretions in the airway

Question 18

Explain how diaphragmatic breathing is performed. (6)

Answer 18

1. Position patient in semi-reclined position
2. Place your hands gently over the patient’s subcostal angle
3. Apply gentle pressure throughout the exhalation phase
4. Increase firm pressure at the end of exhalation
5. Ask patient to exhale against resistance of hand
6. Release pressure allowing a full inhalation

Question 19

When is segmental breathing typically used?

Answer 19

Used with patients with pleuritic, incisional, or post-trauma pain that causes decreased movement in a segment of the thorax, and those at risk for developing atelectasis

Question 20

Explain how segmental breathing is performed. (5)

Answer 20

1. Position patient to facilitate inhalation to a certain segment (i.e. upright sitting or postural drainage position)
2. Apply gentle pressure to the thorax over the area of hypoventilation during exhalation
3. Increase to firm pressure just prior to inspiration
4. Ask patient to breathe in against the resistance of therapist’s hand
5. Release resistance, allowing a full inhalation

Question 21

What population of patients is pursed lip breathing primarily used for?

Answer 21

Patients with obstructive disease who experience dyspnea at rest or with minimal activity/exercise, or with ineffective breathing patterns during activity/exercise.

Question 22

Describe the general conditioning program, prescribed to patients with pulmonary disease, using the FITT principle.

Answer 22

Frequency = 3-5 times per week
Intensity = Near or at target heart rate 
Time = 20-30 minutes of continous exercise 
Type = any aerobic activity that allows for graded work load (i.e. bike, walking, arm ergometry)