Monday, August 27, 2018

Pulmonary - Chest Physical Therapy

Goals for Chest Physical Therapy include:

  • Improve overall function
  • improve ventilation throughout all lobes
  • improve breathing patterns
  • mobilize secretions
  • expel secretions
Techniques:
  1. Percussion:
    1. A technique using cupped hands that strike over a particular lung segment in alternating fashion during inspiration and expiration in order to mobilize secretions.  This rhythmic sequence should last for several minutes and not be painful
  2. Vibration:
    1. A technique using both hands (one on top of another) directly over the chest wall to provide pressure and manual vibration during exhalation.  Vibration should be used in conjunction with percussion and only during expiration.  Pressure should be applied in the same direction as chest wall movement during expiration.
Positioning:
  1. Trendelenburg Position:
    1. This position places the person in a "head down" position in supine with the bottom of the bed inclined to approximately 45*.  This position is ideal to assist with secretion drainage from the lower lobes of the lungs.  It can also assist with increasing blood pressure in the case of hypotension.  Patients with congestive heart failure, pulmonary edema, hypertension, shortness of breath or other circulatory problems will not tolerate this position
  2. Reverse Trendelenburg Position:
    1. The reverse Trendelenburg places a person in supine with their head raised above their trunk and lower extremities.  This position may be used with patients diagnosed with hypertension or other cardiac conditions.  This position also decreases the weight of the abdominal contents on the diaphragm providing it with less resistance to movement during breathing.
  3. Semi-Fowlers Position
    1.  This position places a patient in supine with the head of the bed elevated to 45* and pillows under the patient's knees for support and maintenance of a proper lumbar curve.  This position is used quite often for patients with CHF or other cardiac pathologies.
Examples of Chest Physical Therapy for Bronchial Drainage:
  1. Anterior Segment Left and Right Lobes
    1. In SUPINE, lie flat on back with pillow under knees for comfort, clap on both sides just below the clavicles and above the nipple line.
  2.  Left Posterior Segment
    1. In SIDE lying, lie on right side with head and shoulders elevated on pillows.  Make 1/4th turn forward and clap over the left scapula.
  3. Right Middle Lobe
    1. In SIDE lying, elevate bottom of bed 14-16 inches.  Lie on left side.  Place pillow behind from the shoulders to the hips and slight back onto it; clap over selected lobe.
  4. Posterior Basal Segment of Left and Right Lobes
    1. In PRONE, elevate bottom of bed 18-20 inches.  Lie on stomach and place pillow under the hips, clap at the lower ribs on both sides.
Image result for Posterior Basal Segment of Left and Right Lobes bronchial drainage


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