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 Group of therapies used in combination to mobilize

pulmonary secretions

 Includes postural drainage, chest percussion, and


vibration

 Should be followed by productive coughing and


suctioning of the client

 Recommended for clients who produce greater than


30 mL of sputum per day or have evidence of
atelectasis
 can be safely used with infants and young
children, unless contrainidcated.

Dependent nursing function


 Know the client’s normal range of vital signs.

 Know the client’s medications.

 Know the client’s medical history.

 Know the client’s level of cognitive function.

 Be aware of the client’s exercise tolerance.


 Involves striking the chest wall over the area
being drained.

 Hand is positioned so that the fingers and thumb


touch, and the hands are cupped.

 Sends waves of varying amplitude and frequency


through the chest, changing the consistency and
location of sputum.

 Performed by striking the chest wall alternately


with cupped hands.
Performed over a single layer of clothing.

Contraindicated in patients with bleeding


disorders, osteoporosis, or fractured ribs.

Caution should be taken to percuss the


lung fields and not the scapular regions.
 Cover the area with a towel or gown to reduce
discomfort.

 Ask the client to breathe slowly and deeply to promote


relaxation.

 Alternately flex and extend the wrists rapidly to slap


the chest.

 Percuss each affected lung segment for 1-2 minutes.


 If done correctly, the percussion action should
produce a hollow, popping sound.

 Percussion is avoided over the breasts, sternum,


spinal column, kidneys, scapula.
 Fine, shaking pressure applied to the chest wall
only during exhalation.

 Increase velocity and turbulence of exhaled air,


facilitating secretion removal.

 Increases the exhalation of trapped air and may


shake mucus loose and induce cough.
 Place hands, palms down, on the chest area to be
drained, one hand over the other with the fingers
together and extended. Alternatively, the hands
may be placed side by side.

 Ask the client to inhale deeply and exhale slowly


through the nose or pursed lips.

 During exhalation, tense all the hand and arm


muscles, and using mostly the heel of the hand,
vibrate the hands, moving downward. Stop
vibrating when the client inhales.
 Vibrate during five exhalations over one affected
lung segment.

 After each vibration, encourage the client to


cough and expectorate secretions in the sputum
container.
 Use of positioning technique that draw secretions
from specific segments of the lungs and bronchi into
the trachea.

 Drainage by gravity of secretions from various lung


segments, enhance matching of ventilation and
perfusion, normalize functional and residual capacity.

 Procedures can include most lung segments. It is


based on clinical assessments.
 The positions assumed are determined by the
location, severity, and duration of mucus obstruction.

 Prior to postural drainage, the patient may be given a


bronchodilator medication or nebulization
 Best time for postural drainage includes before
breakfast, before lunch, in the late afternoon, and
before bedtime.

 Nurse must evaluate the client’s tolerance of postural


drainage.
 Indicated for difficult with secretion clearance,
evidence of retained secretions, and lung
conditions that cause increased production of
secretions.

 Contraindicated in undrained lung abscess, lung


tumors, pneumothorax, diseases of the chest
wall, lung hemorrhage, painful chest conditions,
tuberculosis, severe osteoporosis, increased ICP,
uncontrolled hypertension, and gross hemoptysis.
 The procedure should be discontinued if
tachycardia, palpitations, dyspnea, or chest pain
occurs. These symptoms may indicate hypoxemia.
Discontinue if hemoptysis occurs.
 Bilateral - High-Fowler’s position

 Apical segments: Right upper lobe -- anterior segment


- Supine with head of bed elevated 15-30 degrees

 Left upper lobe -- anterior segment - Supine with head


elevated

 Right upper lobe -- posterior segment - Side lying with


right side of chest elevated on pillows
 Left upper lobe -- posterior segment - Side lying with left side of chest
elevated on pillows

 Right middle lobe -- anterior segment – Three-fourths supine position


with dependent lung in Trendelenburg’s position

 Right middle lobe -- posterior segment – prone with thorax and abdomen
elevated

 Both lower lobes -- anterior segments – Supine in Trendelenburg’s


position
 Left lower lobe -- lateral segment – left lateral in
Trendelenburg’s position

 Right lower lobe – lateral segment – right side-lying in


Trendelenburg’s position

 Right lower lobe – posterior segment – prone in


Trendelenburg’s position with abdomen and thorax elevated

 Both lower lobes – posterior segments – prone in


Trendelenburg’s position with abdomen and thorax elevated
 Bilateral – apical segments – sitting on nurse’s
lap, leaning slightly forward, flexed over pillow

 Bilateral – middle anterior segments – sitting on


nurse’s lap, leaning against nurse

 Bilateral lobes – anterior segments – lying supine


position on nurse’s lap, back supported with pillow
 Instruct the patient to do diaphragmatic deep
breathing.

 Position the patient in prescribed postural


drainage positions.

 Percuss (clap) with cupped hands over chest wall.

 Instruct the patient to inhale slowly and deeply.


Vibrate the chest wall as the patient exhales
slowly through pursed lips.
 Removal of secretions may be done by coughing or
suctioning.

 Allow the patient to rest several minutes.

 Listen with a stethoscope for changes in breath sounds.

 Repeat the percussion and vibration cycle according to


the patient’s tolerance and clinical response (15-30
min.)
 Document amount, color, and character of
expectorated secretions.