Republic of the Philippines

Laguna State Polytechnic University

Province of Laguna
College of Nursing and Allied Health
A.Y. 2021-22

Purpose:

To help maintain pertinent airway by using gravity and positioning to loosen thick mucus
secretions from the bronchial airway. And therefore, promotes better breathing.
Equipment:

 Stethoscope
 Pulse oximeter
 Water in pitcher and glass
 Tissues and paper bag
 Chair
 Extra pillows
 Clear graduated screw-top container
 Oral hygiene care: toothbrush, toothpaste, mouthwash, or chlorhexidine oral rinse if ordered
 Suction equipment
 Clean gloves
 Patient education material
USING POSTURAL DRAINAGE

ASSESSMENT
1. Identified patient with at least two
identifiers.
2. Assessed patient for history of decreased
LOC and muscle weakness or disease
processes.
3. Reviewed medical record; assessed for
signs and symptoms consistent with
atelectasis, lobar collapse pneumonia, or
bronchiectasis; ineffective coughing; thick,
sticky, tenacious, and discolored secretions
that are difficult to cough up.
4. Auscultated all lung fields for decreased
breath sounds and adventitious lung sounds.
5. Assessed vital signs and pulse oximetry
before postural drainage system.
6. Determined patient’s and caregiver’s
understanding of and ability to perform home
postural drainage.
7. Determined patient’s level of comfort.
PLANNING
1. Identified expected outcomes.
 Lung sounds improve or become
clear.
 Sputum is more easily coughed and
expectorated or suctioned out.
RATIONALE
 Ensures correct patient. Complies with
the Joint commission standards and
improves patient safety.
 Conditions that pose risk for impaired
airway clearance require CPT.
 Indicates need to perform postural
drainage. X-ray film data and signs
and symptoms indicate accumulation
of pulmonary secretions and
ineffective airway clearance.
 Findings identify bronchial drainage.
 Provides baseline to evaluate patient’s
response to therapy
 Identify potential areas for instruction.
Home care CPT is indicated in
patients with chronic conditions such
as cystic fibrosis, chronic bronchitis or
bronchiectasis.
 Determines patient’s level of pain and
pre-procedure analgesia is needed.
 Clearing of airways documents
effectiveness of procedure.
 CPT provides mechanical stimulus to
loosen secretions from wall of airway;
thus, secretions are easier to
expectorate.

 Secretions appear more normal in  When infection is present, returning to

color and consistency. normal indicates resolving infection.

 Pulse oximetry (SpO2) levels increase  As secretions are removed, patient

exchange of respiratory gases
 Republic of the Philippines
Laguna State Polytechnic University
Province of Laguna
College of Nursing and Allied Health
A.Y. 2021-22
and dyspnea decreases.
 Chest x-ray film shows improvements:
lobar collapse and atelectasis are
decreased or eliminated.
2. Explained procedure to patient and family:
a. Administer analgesia 20 minutes
before CPT maneuvers if necessary.
b. Explained purpose and rationale for
procedure, explained details of
procedure.
c. Encouraged high fluid intake program
unless contraindicated, maintained
record of fluid I&O.
d. Planned treatment so they did not
overlap with meals or tube feeding,
stopped gastric tube feedings for 30 to
45 minutes before postural drainage,
checked for residual feeding in
patient’s stomach, held treatment if
necessary.
e. Scheduled treatments at appropriate
times.
f. Had patient remove any restrictive
clothing.
IMPLEMENTATION
1. Provided privacy, performed hand hygiene,
applied gloves.
2. Used findings from physical assessment
and chest x-ray film to select congested areas
for drainage.
3. Assisted patient to appropriate position,
placed pillows for support and comfort,
draped patient appropriately.
4. Had patient maintain position for 10 to 15
minutes.
5. Performed chest percussion and vibration
after 15 minutes.
6. Had patient sit up and cough, saved
secretions if necessary, suctioned if necessary.
7. Had patient rest briefly if necessary, noted
pulse oximeter readings.
8. Had patient take sips of water.
improves, and dyspnea gradually
declines.
 CPT improves atelectasis and
facilitates removal of secretions from
airways. As a result there is visual
improvement on chest x-ray film
 Pain control is essential for patient to
actively participate in CPT maneuvers
and cough forcefully to clear airways.
 Helps promote cooperation. Well-
prepared patient is usually more
relaxed and comfortable, which is
essential for effective drainage.
 Fluids thin secretions and make them
easier to cough up. Patients need close
monitoring and encouragement when
first starting high fluid intake
program.
 Performing postural drainage when
patient’s stomach is empty helps avoid
gastric reflux or vomiting and
aspiration of stomach contents.
 Scheduling of CPT avoids conflict
with other interventions and/or
diagnostic testing.
 Helps patient relax and promotes deep
breathing.
 Maintains privacy. Reduces
transmission of microorganisms.
 Individualized treatment helps relieve
specific areas of congestion identified
during patient assessment.
 Proper patient positioning promotes
drainage of pulmonary secretions.
 In adults draining each area takes
time.
 Provides mechanical forces to help
move airway secretions.
 Any secretions moved to central
airways are removed by cough or
 suctioning before placing patient into
next drainage position. Coughing is
most effective when patient is sitting
up and leaning forward.
 Short rest periods between postures
prevent fatigue and increase tolerance.
Pulse oximeter values may fall
slightly.
 Keeping mouth moist aids in
 Republic of the Philippines
Laguna State Polytechnic University
Province of Laguna
College of Nursing and Allied Health
A.Y. 2021-22
9. Repeated step 3-8, ensure each treatment
did not exceed 30 to 60 minutes.
10. Offered or assisted patient with oral
hygiene.
11. Removed gloves and performed hand
hygiene.
EVALUATION
1. Auscultated lung fields.
2. Inspected character and amount of sputum.
3. Reviewed diagnostic reports.
4. Obtained vital signs and pulse oximetry
5. Asked patient to explain importance of
positioning.
6. Identified unexpected outcomes.
a. Patient experiences severe dyspnea,
bronchospasm, hypoxemia, or
hypercarbia and/or is unable to
tolerate treatment.
b. No improvement in chest assessment
or chest x-ray film examination
results.
c. Hemoptysis occurs; or patient
develops acute hypotension, severe
chest pain, vomiting, aspiration,
and/or dysrhythmias.
RECORDING AND REPORTING
expectoration of secretions.
 Postural drainage is used only to drain
areas involved and is based on
individual assessment.
 Promotes comfort and reduces bad
breath.
 Reduces transmission of
microorganisms.
 Clearance of secretions usually
relieves gurgling, early inspiratory
crackles, and palpable crepitus.
 Determines if there are more
secretions coughed up and if they are
adequately thinned.
 Provides objective data on
improvements in lung function.
 Procedure can result in dysrhythmias
and decreases in oxygen saturation in
some patients.
 To determine if the patient fully
understands the procedure and if not
plan a better health teaching method
for the patient.
Related Interventions:
 Discontinue, modify, or shorten
treatments.
 Administer bronchodilator or
nebulizer therapy 20 minutes before
CPT.
 Suction and ventilate with bag-valve-
mask as needed and closely monitor
arterial blood gas (ABG) levels, O2
saturation, and vital signs.
 Initially increase treatments and
encourage and teach coughing
exercises.
 Increase hydration.
 Notify health care provider because
patient may need sputum culture,
change in antibiotics, mucolytics, or a
bronchoscopy to remove thick mucus
plugs.
 Stop therapy, place patient in high-
Fowler’s position, and obtain vital
signs.
 Call for help and notify health care
provider.
 Remain with patient; keep patient
comfortable, calm, warm, and quiet.
 If patient vomits or aspirates, suction
airway and place him or her on his or
her side.
 Prepare for possible oxygen
administration
 Republic of the Philippines
Laguna State Polytechnic University
Province of Laguna
College of Nursing and Allied Health
A.Y. 2021-22

1. Record all pertinent information for  A complete and well-organized

appropriate log.
2. Documented evaluation of patient learning.
records are essential for good medical
practice and continuity of care.
 Good documentation is important to
protect patients as it promotes their
safety and quality of care.