Station 3: Positioning

Question 1

What is postural drainage?

Answer 1

Is the use of gravity by putting a patient in a position to help the clearance of sputum

Question 2

What is ventilation? And where is it greater?

Answer 2

• The movement of air into and out of the alveoli
• Greater in the apices of the lungs in a normal upright individual

Question 3

What is perfusion? And where is it greater?

Answer 3

• The blood flow to alveoli
• Greater in the bases of the lungs in a normal upright individual

Question 4

What is V/Q mismatch?

Answer 4

Occurs when ventilation and perfusion is not matched in the lungs
- Position exactly on their side to reduce this mismatch

Question 5

Why do we put the affected lung upwards?

Answer 5

• The lung that is affected doesn’t have as good ventilation as the non-affected lung
• Therefore, there is wasted perfusion
• Putting someone on their side with affected lung up, means that the blood will flow by gravity more towards the alveoli in the non-affected lung.
• Therefore greater V/Q ratio
• Gas exchange is more effective and the patients tissues are getting more oxygen

Question 6

Postural drainage: Affected anterior apex both or single lung
AND clinical reasoning

Answer 6

• Sat semi up right (no more than 45 degrees)
• Back flat on plinth
• Pillow under knees to bend legs slightly
  CR: This position will help drain any thick and sticky mucus that is stuck on the apex/apices into the middle of lung where it can then be moved towards the upper airway with MT, mobilising and ACBT

Question 7

Postural drainage: Affected posterior middle/upper lobe
AND CR

Answer 7

• Lay flat on your front
• Place a pillow under your chest on the side so you have a slight lean
  The side that is propt up by a pillow is the affected side
  CR: This will help any of the thick sticky mucus that is stuck on the posterior sides of upper lobes and drain them medially to be moved into the upper airway with MT, mobilising and ACBT

Question 8

Postural drainage: Affected anterior middle lobe/s
AND CR

Answer 8

• Lay flat on your back
• Place a pillow under the knees
  CR: this will help the thick sticky mucus that is stuck to drain more medially to be moved up into the upper airways with MT, mobilising and ACBT

Question 9

Postural drainage: affected posterior apex of lobe/s
AND CR

Answer 9

• Leaning forward through your arms across thighs
• Pillows under knees
  CR: this will help the thick sticky mucus that is stuck to drain downwards more medially in the lungs to then be moved into the upper airways with MT, mobilising and ACBT