Pulmonary Interventions

Question 1

Describe postural drainage.
How long is each session and how long is each positioned maintained?
when is it best to do this technique?

Answer 1

• the patient is positioned to facilitate gravity drainage of secretions from airways. The positioned is maintained for 5-10 minutes.
• each treatment session can last 20-40 minutes
• best done before meals or at least 2 hours after eating to decrease chance of vomiting
  -either at bedtime or early morning

Question 2

what are precautions for postural drainage?

Answer 2

pulmonary edema, hemoptysis, massive obesity, large pleural effusion, massive ascites

Question 3

what are relative contraindications for postural drainage?

Answer 3

increased cranial pressure, hemodynamically unstable, recent esophageal anastomosis, recent spinal fusion, recent head trauma, diaphragmatic hernia, recent eye surgery

Question 4

describe percussion

Answer 4

technique of clapping the chest wall in a rhythmic manner alternating cupped hands striking over the affected area of the chest wall, often paired with breathing techniques and postural drainage

Question 5

describe vibration

Answer 5

technique to produce a fine shaking of the chest wall during the expiratory phase of breathing

Question 6

what are precautions for percussion and vibration

Answer 6

uncontrolled bronchospasms, osteoporosis, rib fractures, metastatic cancer, tumor obstruction, anxiety, coagulopathy, convulsive disorder, recent pacemaker

Question 7

what are relative contraindications for percussion and vibration

Answer 7

hemoptysis, untreated tension pneumothorax, platelet count below 20000, unstable hemodynamic status, open wounds, pulmonary embolism, subcutaneous emphysema, recent skin grafts

Question 8

what are precautions for percussion

Answer 8

avoid irritated skin, excessive force, rib fracture or chest tube, osteoporosis, pain over thorax, hemoptysis from abscess or lung contusion, increased cranial pressure, severe clotting disorder, emphysema, unstable angina, NO trendelenburg for HTN or CHF or pulmonary edema, avoid side lying with arthritis

Question 9

what are precautions for vibration

Answer 9

avoid shearing or pinching of soft tissue, palmar grip, digging fingers into skin, do not perform over rib fractures, unstable spine injuries

Question 10

what are contraindications for positive expiratory pressure therapy

Answer 10

• patient is uncooperative or will not comply, unable to tolerate the increased work of breathing, ICP, hemodynamic instability, head or neck trauma, active hemoptysis, middle ear pathology, untreated pneumothorax, nausea