Postural drainage and manual techniques Flashcards
What is the rationale behind using this treatment (Pain/Increase ROM/Strengthen etc)? (postural drainage)
clearance of respiratory secretions in many acute and chronic conditions
the effect of gravity can assist secretions to move towards larger airways to aid clearance
What are the physiological effects of the treatment? (postural drainage)
improved secretion clearance
improved ventilation
improved oxygenation to tissues
What structures are affected by the technique? (postural drainage)
diaphragm position and function
alveoli
bronchi
bronchioles
What principles are used in carrying out the technique? (postural drainage)
patients should be positioned with the area to be drained upper most to allow secretions to be moved with gravity to the larger airways.
sometimes the ideal position isn’t achievable due to the type of bed being used, pt factors, or pt preference
Precautions and contraindications? (postural drainage)
head down position contraindications:
young children and babies
cerebral oedema (swelling of brain)
head/neck trauma
risk of aspiration or recently eaten meal
headaches
haemoptysis (coughing up blood)
hiatus hernia (burning in chest is a symptom)
precautions:
nausea, vomiting, dizziness
cardiovascular instability
raised ICP (symptoms of severe headache and blurred vision)
burns, wounds, or healing tissue
recent thoracic, abdominal or spinal surgery
Learn the anatomy of the lungs from diagram on LC and GN and learn what position pt should be in for each lobe secretion
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Why is postural drainage often combined with manual techniques?
the speed of mucus transport on its own is less than 10mm/min, so its combined to aid effectiveness
What is the rationale behind using this treatment (Pain/Increase ROM/strengthen etc)? (manual techniques)
send kinetic energy through the chest wall
compression of air in airways sets up vibration, loosening secretions from the walls of the airways
What are the physiological effects of the treatment? (manual techniques)
loosens pulmonary secretions
mucus clearance
enhance VQ matching by optimising the airflow distribution within the lungs
stimulation of cough reflex
bronchodilation by stimulating the relaxation of bronchi smooth muscle
improved blood circulation
What structures are affected by the technique? (manual techniques)
bronchioles
bronchi
alveoli
airflow
What principles are used in carrying out the technique? (manual techniques)
shoulders, elbows and wrists relaxed for percussions
-stiff for vibrations and shaking
What is percussion, what should be used, how should it be carried out and can it be done in inspiration or expiration?
rhythmical clapping on the thorax using a cupped hand, soft rubber device called a palm cup in children
towel should be used over surface of chest for comfort
can be done single or double handed at a speed that is comfortable for the pt
can be carried out throughout inspiration and expiration
What are vibrations, how to perform then and when to carry them out (inspiration/expiration)?
small oscillatory mvmts rhythmically compressing the chest wall at a high frequency and a low amplitude.
place flat hand firmly against the chest wall, over the appropriate lung segment to be drained
no towel needed as it will dampen the effectiveness
stiffen your arm and shoulder, apply light pressure and create an oscillating movement with pressure directed inwards and towards the centre of the chest, ask pt to breathe in deeply and exhale slowly and completely
vibrations should be carried out at the beginning or slightly before expiration to generate sufficient expiratory flow to be effective
What is shaking and when should it be carried out?
coarser (rougher) oscillatory movement at a lower frequency and higher amplitude to vibrations
carried out in the same manner as vibrations and should be done on expiration
What are the contraindications of manual techniques?
head and neck injury until stabilised
active haemorrhage
recent spinal surgery
acute spinal injury-unless agreed with a consultant
active haemoptysis
pulmonary embolism
rib fracture
undrained pneumothorax
recent epidural or spinal infusion
open wounds or skin infection of the ribs
osteomyelitis of the ribs (inflammation of bone tissue usually due to infection)
