chest physiotherapy

FOREWORD

Praise and thanksgiving let us pray to Allah SWT for the gift and the joy that
has been lavished on us all, so that the task of this paper we can finish well.
Sholawat and greetings may always gushing bestowed upon the end-time
prophet habibana nabiyana wa Muhammad, and his family and his friends, due
to the intercession we can move from an age of ignorance to the days bright
with the light of Islam.
This paper stacking author entitled " chest physiotherapy " in order to
deepen and broaden the scientific field of "English" tailored to the subjects in
STIKes Muhammadiyah Tasikmalaya on this semester.
The author realizes that this task can not be separated from the guidance,
advice, counsel, both material and spiritual support from various parties,
therefore, on this occasion we would like to thank especially the English
Lecturer subjects and we also realize that this task is still a lot deficiencies that
criticism and suggestions highly appreciated. Hopefully, this task can benefit us
all. Amen.
Tasikmalaya, 24 June 2014

Author

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chest physiotherapy
TABLE OF CONTENTS

FOREWORD.........................................................................................................................1
TABLE OF CONTENT...........................................................................................................2
CHAPTER I : INTRODUCTION
A. Background................................................................................................................3
B. purpose......................................................................................................................3
C. benefits......................................................................................................................3
CHAPTER II : THEORY
A. Definition ..................................................................................................................4
B. Guidelines for chest fhysiotherapy..................................................................................4
C. Distribution chest fhysiotherapy.....................................................................................4
CHAPTER III : INTERVENTION
A. Postural drainage.........................................................................................................8
B. Percussion..................................................................................................................8
C. Vibration....................................................................................................................8
CHAPTER IV: CLOSING
A. Conclusion.................................................................................................................11
B. Suggestion..................................................................................................................11
REFERENCES......................................................................................................................12

CHAPTER I
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chest physiotherapy
INTRODUCTION
A.Background
Various treatment modalities are used when treating patients with various types of respiratory
disorders. This modality of choice based on the interference oxygenation and ventilation if there
is a problem with the gas, the gas diffusion or both. Therapeutic modalities range from simple
non-invasive one chest physiotherapy, until the action is very invasive and complex (intubation,
mechanical ventilation, surgery) (Brunner & Sudarth, 2002).
Postural drainage in patients who experience respiratory problems and impaired mucus.
Mucus is a cover that protects the inside of the lungs and airways. Mucus captures dust and dirt
in the air we breathe and prevent lung irritation. If there is an infection or other irritants, the body
produces more mucus thicker to help avoid pulmonary infeksi.Bila this thick mucus clogging the
airway, breathing becomes more difficult. Physiotherapy is a group with combination therapy
used to mobilize pulmonary secretions. This therapy consists of postural drainage, chest
percussion, and vibration.
B. Purpose
The goal is to throw the chest fisiotrapi brokil secretion, improve ventilation and increase the
efficiency of muscle - the respiratory muscles.
C. Benefits
1. Nurse
To deepen knowledge in dealing with patients experiencing respiratory problems caused by the
buildup of secretions of respiratory canals.
2. Student
To increase knowledge, especially in dealing with patients who have breathing problems due to
accumulation of secretions.
3. Families
to be applied at home when the child has a breathing disorder caused by a number of respiratory
mucus canals.

CHAPTER II
THEORY
A.Definition
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chest physiotherapy
Chest physiotherapy (FTD) is a group with combination therapy used to mobilize pulmonary
secretions. This therapy consists of postural drainage, chest percussion, and vibration. Fisotrapi
chest should be followed by a productive cough and suction on clients who have a decreased
ability to cough. Fisiotrapi chest is recommended for clients - clients who produce sputum with
more than 30 cc per day or show evidence atelektasisi with chest X-ray, Eid et al, (1991) presents
a practical clinical synopsis on FTD maneuvers for various clinical problems.
B. Guidelines for chest Physiotherapy
Nursing care based on the findings of the special assessment following guidelines will help
nurses to perform a physical assessment and make the next decision.
Find out about normal signs - vital signs of the client; conditions such as atelectasis and
peunomonia requiring FTD can affect vital signs. The degree of change will be related to the
degree of hypoxia, the overall kardiopulmunar, and activity tolerance.
Know medicines clients: certain drugs, especially diuretics and antihypertensive drugs cause
changes in fluid and hemodynamic changes. This decreased tolerance to changing client postural
drainage positions. Steroid drugs increase the risk of the client to experience a pathological
fracture of the ribs and often a contraindication to wobble ribs.
Know the client's medical history: certain drugs such as increased intracranial pressure,
spenalis cord injury, and abdominal aneurysm resection is contraindicated in changes in postural
drainage positions. Trauma or surgical thorasik also be contraindicated for percussion, vibration.
Know the level of cognitive functioning clients. Client's participation in a controlled coughing
techniques are clients follow instructions. Cognitive limitations or koginetal obtained will change
the client's ability to learn and participate in these techniques.

C. Distribution Chest Physiotherapy (FTD)

1. Postural Drainage
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Postural drainage is the use of techniques that dispense position setting secretion of certain
segments of the lung and bronchus into the trachea at. Cough or suksioning normally can
dispose of the tracheal secretions. Postural drainage procedures can include large segments of the
lung. Because the client may not require postural drainage of lung segments. The procedure is
based on clinical findings. For example, a client who suffered a lower lobe atelectasis requiring
postural drainage only on the affected area, while children who suffer from cystic fibrosis require
postural drainage in all segments of the lung.
Postural drainage uses a specific position that allows gravity to assist in removing bronchial
secretions. Secretion flow of bronkilus affected bronchi and trachea into the throw with cough or
inhalation. Postural drainage is used to eliminate or prevent obtruksi caused by the accumulation
of bronchial secretions.
Because patients usually sit in an upright sitting position, secretion is likely to accumulate in
the lower part of the lungs. If postural drainage is used, the patient was placed in begantian in
different positions, so that gravity helps to drain secretions from the bronchial airway to the
smaller bronchi and trachea large. Secretion then discarded with cough. By asking the patient to
inhale a bronchodilator and mucolytic agents prescribed before postural drainage helps drain
bronchial branching.
Exercise postural drainage can be directed to all segments of the lung. Lower lobe bronchi and
middle lobe flow more effectively if the head is lower.
Bronkhi upper lobe flow more effectively when the head erect. Often, the patient was placed
in five positions, one position for each lobe mendrainase: head lower, pronation, leteral right and
left, and sit up straight.
Nursing interventions. Nurses must be vigilant about the patient's diagnosis of lung lobes also
ill patients cardiac status, and any structural deformity of the chest wall and spine.
Mengauskultasi chest before and after the procedure to help identify areas that require drainage
and effectiveness measures, thus providing immediate feedback on the effectiveness of the
actions.
Postural drainage is usually done two to four times daily, before meals (to prevent nausea,
vomiting and aspiration), and at bed-time. If prescribed, bronchodilators, water, or saline can
dinebuisasikan and inhaled before postural drainage to dilate the bronchioles, reducing
bronchospasm, decrease the viscosity of mucus and sputum, and bronchial wall edema resolve.
The patient made as comfortable as possible at every position and emesis basin, sputum cups, as
well as tissue paper disiapakan. Patients were instructed to calm down in any position as long as
10 minutes to 15 minutes and to breathe slowly through the nose and breath menghebuskan
gently with lips pressed together to help maintain the airway open so that secretions can be
streamed while in various positions. If the position can not be tolerated, the patient is helped to
take a position that is modified.

2. Percussion chest
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Chest percussion performed by tapping the chest wall above the area to be in the drainage.
Hands are positioned so that the fingers and thumb touch each other and form a bowl hand.
Percussion on the surface of the chest wall will send waves of various amplitudes and
frequencies through the chest thus changing the consistency and location of sputum. Chest
percussion is done by changing the movement of the hand against the wall. Percussion
performed over a layer of clothing, not above buttons, snap buttons, or zippers. One layer of
clothing will prevent blow on the client's skin. Double layer of fabric or thicker will withstand
vibration.
Percussion be contraindicated for clients who experience bleeding, osteoprosis, or invoice ribs.
In doing percussion on the lung field, the nurse must be careful and do not memperkusi scapular
region, if not careful, there will be trauma to the musculoskeletal structures beneath the skin.
Percussion is done by forming a bowl in the palm of the hand and lightly ditepukkan on the chest
wall in a rhythmic motion above the lung segment to be drained. Wrist flexion and extension
alternately so that the chest is struck or tapped in ways that cause pain. Delicate clothes can be
placed over the chest segments tapped to prevent skin irritation from direct contact da redness.
Percussion, alternating with vibration, done for 3 to 5 minutes for each position. Patients using
difragmatig breathing during the procedure to improve relaksi (See Exercise Re-Breathing). As
vigilance, percussion drainisme hose above the chest, sternum, spine, kidneys, spleen, or breast
(in women) avoided. Percussion performed with caution in the elderly because of the increased
incidence of osteoporosis and risk of fracture ribs .

3. Vibration
Vibration is vibration technique gives competence and manuals on the chest wall during
breathing akshalasi phase. This maneuver helps to increase the air velocity at the expiration of
the small airways, thereby freeing mucus. After three or four times the vibration patient is
encouraged to cough, using the abdominal muscles. (Contracting the abdominal muscles
increases the effectiveness of cough.)
Vibration is a subtle pressure swing given to the chest wall only during exhalation. This
technique is expected to improve the speed and air turbulence are removed, facilitating secretion
expenditure (Dettenmeier, 1992). Vibration increased spending teperangkap air and mucus to
wiggle loose and cause coughing. Vibration is not recommended for infants and young children.
Cough and sputum clearance programs are scheduled, along with hydration, will reduce the
amount of sputum in patients sirklus tergantumg repeated percussion and vibration tolerance and
clinical response in patients. Breath sounds were evaluated before and after the procedure.

Nursing interventions.

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When performing chest physiotherapy, it is important to ensure that patients have a

comfortable, patient not wear tight clothing, and new patients are not eating. Top area of the lung
was first addressed. Medications are given to relieve pain, as applicable, before percussion and
vibration; incision bandaged; and pillows used to support as needed. Position diverse but focus
on areas that temaksud emphasized. Upon completion of the action, the patient is helped to take a
comfortable position.
Action terminated in the event of adverse symptoms: increased pain, increased vital breath,
weakness of the head, headache, or hemotipsis. Therapy is indicated until the patient has normal
breathing, can mobilize secretions, and have a normal breath, and when gambara rintogen normal
chest.

CHAPTER III
INTERVENTION
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Procedure
Perform auscultation of napa sklien
Instruct the client to say when experiencing nausea, chest pain, dyspnoea.
Give medications that can help thin secretions.
Loosen clothing clients
a. Postural drainage
1. Select the area to be clogged drainage.
2. Lay the client in a position to mendrainase clogged area.
3. Put a pillow for support.
4. Ask the client to maintain that position for 10-15 minutes.
5. During these times, doing chest percussion and vibration over the area drained.
6. Upon drainage in the first position, ask the client to sit and effective cough. Absorb secretion
in sputum pot.
7. Ditch the patient, ask the client to drink a little water.
8. Repeat for other nasal area.
9. Measures no more than 30-60 minutes.

b. Percussion
1. Understanding
an action taken by the nurse in order to remove secretions by means of tapping the chest wall.
2. Destination
issued bronchial secretions are thick and attached to the bronchi of bronkeolus then to trackea,
done only in the posterior for 3 to 5 minutes caution in the elderly because it can undergo
osteophorosis.

3. preparation

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chest physiotherapy
patients:
1. Explain the procedure to the patient and the patient's participation
2. Provide a comfortable position
tools:
1.seputum pot
2 tissue
3.underdug
4. step
a. Done by forming a bowl in the palm of the hand and with ringgan in a pat on the chest wall in
a rhythmic motion in the upper lung segments which will be piped.
b. Wrist flexion and extension alternately so that the chest in at / in pat teidak ways that cause
pain.
c. carefully done in the elderly because of the increased incidence of osteoporosis and risk of
fracture ribs.

c. vibration
1. Understanding
Is giving compress and vibration engineering manuals on the chest wall during breathing
ekhalasi pase
2. Destination
To increase the porosity of the inspired air of the small airways, thereby freeing mucus .
3. The preparation
patients:
Explain the procedure to the patient and the patient's participation
Provide a comfortable position
tools:
Seputum pot
2. Tissue
3. Underdug
d. Step .

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chest physiotherapy

1. The wrists and elbows keep it rigid and vibrational motions in doing ole shoulder muscles .
2. Vibration after 3-4 times the patient is encouraged to cough by using the abdominal muscles.

CHAPTER IV
CLOSING
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A. Conclusion
1. Chest Physiotherapy is to remove secretions bronkil improve ventilation and increase the
efficiency of the respiratory muscles.
2. Chest physiotherapy consisting of postural drainage, chest percussion and vibration.
3. Postural Drainage can be performed on patients who suffer from respiratory and mucous
disorder
4. Postural Drainage can be done in stages, the first action and the next is between 5-10 minutes.
Tujuannyan is to maximize the amount of secretion obtained.
5. Measures Chest Physiotherapy terminated in the event of adverse symptoms such as increased
pain, increased breath, weakness of the head, headache, or hemotipsis.
B. Suggestion
1. Nurse
To be more skillful in applying Postural drainage techniques appropriately so as to maximize
spending secretions.
2. Student
To determine the postural drainage techniques correctly, add science to assess breathing patterns
can be more effective and skilled in managing patients with respiratory disorders
3. Families
To be able to apply at home postural drainage in case of respiratory distress due to a buildup of
mucus in children.

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REFERENCES

o Potter dan Perry(2006), Fundamental Keperawatan, Jakarta, EGC

o Stuart dan Bruner ( ), Keperawatan Medikal Bedah, Jakarta, EGC
o Wong, Donna L (2003), Pedoman Klinis Keperawatan Pediatrict edisi 4, EGC, Jakarta

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