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Sharlene and MB's PT party > Pulmonary- Manual Secretion Removal Techniques > Flashcards

Pulmonary- Manual Secretion Removal Techniques Flashcards

1
Q

What is postural drainage

A

placing pt. in varying positions for optimal gravity drainage of secretions and increased expansion of the involved segment

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2
Q

indications for postural drainage

A
  • increased pulmonary secretions
  • aspiration
  • atelectasis or collapse
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3
Q

Basic procedure for postural drainage

A
  • explain procedure to pt.
  • place pt. in appropriate postural drainage position
  • observe for signs of intolerance
  • duration can be up to 20 min per position
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4
Q

What is percussion

A
  • a force rhythmically applied w/ PT’s cupped hands to a specific area of the chest wall that corresponds to the involved lung segment
  • used to increase the amount of secretions cleared from the tracheobronchial tree
  • used in conjunction w/ postural drainage
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5
Q

Indications for use of percussion and shaking (vibration)

A
  • excessive pulmonary secretions
  • aspiration
  • atelectasis or collapse due to mucous plugging obstructing the airways
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6
Q

Considerations before using percussion or shaking: general guidelines

A

pain made worse by using technique

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7
Q

Considerations before using percussion or shaking: circulatory system

A
  • aneurysm precautions

- hemoptysis

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8
Q

Considerations before using percussion or shaking: MSK

A
  • fractured rib
  • flail chest
  • degenerative bone disease
  • bone metastases
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9
Q

Considerations before using percussion or shaking: coagulation disorders

A
  • increased PTT
  • increased pro-thrombin time (PT)
  • decreased platelet count (<50,000)
  • meds interfering w/ coagulation
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10
Q

Considerations prior to using postural drainage in Trendelenburg position: circulatory system

A
  • PE
  • CHF
  • HTN
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11
Q

Considerations prior to using postural drainage in Trendelenburg position: abdominal problems

A
  • obesity
  • ascites
  • pregnancy
  • hiatal hernia
  • nasea and vomitting
  • recent food consumption
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12
Q

Considerations prior to using postural drainage in Trendelenburg position: neurologic

A
  • recent neurosurgery
  • increased intracranial pressure
  • aneurysm precautions
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13
Q

Considerations prior to using postural drainage in Trendelenburg position: pulmonary

A

SOB

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14
Q

Procedure for percussion

A
  • explain procedure to pt.
  • place pt. in appropriate postural drainage position
  • cover area to be percussed with light weight cloth to prevent erythema
  • Percuss. duration depends on needs and pt. tolerance. 3-5 min of percussion per postural drainage position w/ clinically assessed improvement is a guideline
  • force of percussion causes the pt.’s voice to quiver
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15
Q

What is shaking aka vibration

A
  • following a deep inhalation, a bouncing maneuver is applied to the rib cage throughout exhalation
  • used to hasten the removal of secretions from the tracheo-bronchial tree
  • commonly used following percussion in appropriate postural drainage position
  • modification may be required depending on pt. tolerance
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16
Q

Procedure for shaking

A
  • explain procedure to pt.
  • place pt. in appropriate postural position
  • perform percussion first if appropriate
  • as pt. inhales deeply, PT’s hands are placed w/ fingers parallel to ribs
  • as pt. exhales, PT hands provide a jarring bouncing motion to the rib cage below
  • duration depends on pt. needs and tolerance and clinical improvement. 5-10 deep inhalations with shaking technique is generally acceptable practice
  • ***more than 10 would risk hyperventilation and less than 5 would be ineffective
17
Q

List of airway clearance techniques

A
  • cough
  • huffing
  • assisted cough
  • tracheal stimulation
  • endotrachial suctioning
18
Q

Huffing

A
  • more effective in pt. w/ collapsible airways (chronic obstructive diseases)
  • prevents high intrathoracic pressure that causes premature airway closure
19
Q

Procedure for assisted cough

A
  • position pt. against solid surface (trendelnburg, reclined supine, sitting, ect..)
  • PT’s hand is is placed below pt.’s subcostal angle
  • pt. inhales deeply
  • as pt. attempts to cough, Pt’s hands push inward and upward assisting rapid exhalation of air
  • any secretions raised should be removed
20
Q

type of pt. assisted cough is intended for

A

anyone w/ weak abdominal muscle that are unable to generate an effective cough, such as SCI pt.

21
Q

What is tracheal stimulation

A
  • used w/ pts. who are unable to cough on command such as infants, TBI, CVA
  • Procedure: PT’s thumb or finger is placed just above the suprasternal notch, and a quick inward and downward pressure on the trachea elicits the cough reflex
22
Q

when to use endotrachial suctioning

A

only when other less invasive techniques fail to adequately remove secretions.

23
Q

Complications with endotrachial suctioning

A
  • hypoxemia
  • bradycardia or tachycardia
  • hypotension or hypertension
  • increased intracranial pressure
  • atelectasis
  • tracheal damage
  • infections
24
Q

Positions for postural drainage: Upper Lobes- Apical segments

A
  • bed or drainage table is flat
  • pt. leans back (basically in sitting position) on pillow at 30 degree angle against PT
  • PT claps w/ markedly cupped hands over area between clavicle and top of scapula on each side
25
Q

Positions for postural drainage: Upper Lobes- Posterior Segments

A
  • bed or drainage table is flat
  • pt. leans over (pt. in seated position) folded pillow at 30 degree angle
  • PT stands behind and claps over upper back on both sides
26
Q

Positions for postural drainage: Upper Lobes- Anterior Segments

A
  • bed or drainage table is flat
  • pt. supine w/ pillow under knees
  • PT claps between clavicle and nipple on each side
27
Q

Positions for postural drainage: R Middle lobe

A
  • foot of table or bed elevated 12 inches
  • pt. lies supine and rotates 1/4 turn backward on L side (sort of between side lying and supine)
  • pillow may be placed behind shoulder to hip and knees flexed
  • PT claps over R nipple area.
  • In females, PT may use cupped hand w/ heel of hand under armpit and fingers extending forward under breast
28
Q

Positions for postural drainage: L Upper Lobe (lingular segments)

A
  • foot of table or bed elevated 12 inches
  • pt. lies supine on R side and rotates 1/4 turn (sort of between side lying and supine)
  • pillow may be placed behind shoulder to hip and knees flexed
  • PT claps over L nipple area.
  • In females, PT may use cupped hand w/ heel of hand under armpit and fingers extending forward under breast
29
Q

Positions for postural drainage: Lower Lobe- Anterior Basal Segments

A
  • foot of table or bed elevated 18 inches
  • pt. lies on R side w/ pillow under knees
  • PT claps over over L lower ribs.
  • To drain R anterior basal segments, pt. is L sidelying and clap over R lower ribs
30
Q

Positions for postural drainage: Lower Lobes- Lateral Basal segments

A
  • foot of table or bed elevated 18 inches
  • pt. prone, then rotates 1/4 turn upward (sort of L sidelying-ish)
  • upper leg is flexed over pillow for support
  • Pt claps over upper most portion of lower ribs
  • if draining L side, position pt. into the R side-lying-ish position
31
Q

Positions for postural drainage: Lower Lobes- Posterior Basal segments

A
  • foot of table or bed elevated 18 inches
  • pt. prone w/ pillow under hips
  • PT claps over lower ribs close to spine on each side
32
Q

Positions for postural drainage: Lower Lobes- Superior segments

A
  • bed or drainage table is flat
  • pt. prone w/ 2 pillows under hips
  • PT claps over middle of back at tip of scapula on each side of the spine

Sharlene and MB's PT party (35 decks)

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