CHEST PHYSIOTHERAPY

TABLE OF CONTENTS

• OBJECTIVES
• DEFINITION
• PURPOSE
• INDICATIONS
• CONTRAINDICATIONS
• EQUIPMENT.
• TECHNIQUES
• PROCEDURES
 OBJECTIVES

ON COMPLETION OF THE LEARNING MODULE, THE STUDENTS MUST BE ABLE TO:

1. DEFINE CHEST PHYSIOTHERAPY
2. IDENTIFY THE PURPOSE OF CHEST PHYSIOTHERAPY
3.IDENTIFY THE TECHNIQUES OF PHYSIOTHERAPY
4.DEFINE POSTURAL DRAINAGE
5.IDENTIFY THE EQUIPMENT’S
6. DISCUSS THE DIFFERENT POSITIONS IN PERFORMING POSTURAL DRAINAGE
 DEFINITION

• CHEST PHYSIOTHERAPY ARE TREATMENTS WHICH ARE PERFORMED ON PEOPLE SUFFERING FROM
MUCUS DYSFUNCTION IN RESPIRATORY DISEASE CONDITIONS LIKE ASTHMA, CHRONIC OBSTRUCTIVE
PULMONARY DISEASE, BRONCHITIS, BRONCHIECTASIS AND CYSTIC FIBROSIS. WITH THESE
RESPIRATORY CONDITIONS, THEY ALL HAVE A COMMON REQUIREMENT OF CHEST PHYSIOTHERAPY TO
ASSIST THE MUCUS CLEARANCE DUE TO DEFECTS WITH MUCOCILIARY CLEARANCE.
• TECHNIQUES INCLUDE CHEST PERCUSSION USING CLAPPING: THE THERAPIST LIGHTLY CLAPS THE
PATIENT'S CHEST, BACK, AND AREA UNDER THE ARMS. PERCUSSION, WHILE EFFECTIVE IN THE
TREATMENT OF INFANTS AND CHILDREN, IS NO LONGER USED IN ADULTS DUE TO THE INTRODUCTION
OF MORE EFFECTIVE AND SELF-MANAGEMENT FOCUSED TREATMENTS.
 PURPOSE

• PREVENT AN ACCUMULATION OF SECRETIONS

• IMPROVE MOBILIZATION OF SECRETIONS
• PROMOTE MORE EFFICIENT BREATHING PATTERNS
• IMPROVE THE DISTRIBUTION OF VENTILATION
• IMPROVE CARDIOPULMONARY EXERCISE TOLERANCE
 INDICATIONS

• ATELECTASIS CAUSED BY SECRETIONS

• RETAINED SECRETIONS
• ABNORMAL BREATHING PATTERN DUE TO PULMONARY DYSFUNCTION
• MUSCULOSKELETAL DEFORMITY THAT MAKES BREATHING PATTERN OR COUGH
INEFFECTIVE
• COPD PATIENT WITH DECREASED EXERCISE TOLERANCE
 CONTRAINDICATIONS

• UNTREATED TENSION PNEUMOTHORAX

• ABNORMAL COAGULATION PROFILE OR ANTICOAGULATION THERAPY
• SKIN PROBLEMS
• STATUS ASTHMATICUS- ACUTE ATTACK
• POST-OP- NEUROSURGERY, ORTHOPEDIC WITH LIMITED POSITIONING
• HEMOPTYSIS
• UNSTABLE CARDIOVASCULAR SYSTEM, ANEURYSM, PULMONARY EDEMA, CHF, LARGE PLEURAL
EFFUSION
• WITHIN AN HOUR OF EATING
 EQUIPMENT

• STETHOSCOPE
• PILLOWS OR FOLDED TOWELS FOR POSITIONING
• TILT OR POSTURAL DRAINAGE TABLE (IF AVAILABLE) OR ADJUSTABLE HOSPITAL BED
• GLOVES
• EMESIS BASIN
• FACIAL TISSUES
• SUCTION EQUIPMENT
• EQUIPMENT FOR ORAL CARE
• TRASH BAG
 TECHNIQUES

• ALWAYS REMEMBER:
• POSITION PATIENT IN PROPER POSITION
• ENSURE THAT THE PATIENT IS COMFORTABLE
• EACH POSITION SHOULD BE MAINTAINED FOR 5-10 MINS
• ALLOW PATIENT TIME TO REST BETWEEN POSITIONS
• COUGHING PATIENTS SHOULD BE ALLOWED TO SIT UP.
 TECHNIQUE: POSTURAL DRAINAGE
THERAPY

A) LOWER LOBES: POSTERIOR BASAL SEGMENTS

• ELEVATE THE FOOT OF THE BED 30 DEGREES. HAVE THE
PATIENT LIE PRONE WITH HIS HEAD LOWERED. POSITION
PILLOWS UNDER HIS CHEST AND ABDOMEN. PERCUSS HIS
LOWER RIBS ON BOTH SIDES OF HIS SPINE.
 TECHNIQUE: POSTURAL DRAINAGE
THERAPY

B) LOWER LOBES: LATERAL BASAL SEGMENT

ELEVATE THE FOOT OF THE BED 30 DEGREES. INSTRUCT THE PATIENT
TO LIE ON HIS ABDOMEN WITH HIS HEAD LOWERED AND HIS UPPER
LEG FLEXED OVER A PILLOW FOR SUPPORT. THEN HAVE HIM ROTATE
A QUARTER TURN UPWARD. PERCUSS HIS LOWER RIBS ON THE
UPPERMOST PORTION OF HIS LATERAL CHEST WALL.
 TECHNIQUE: POSTURAL DRAINAGE
THERAPY

C) LOWER LOBES: ANTERIOR BASAL SEGMENTS

• ELEVATE THE FOOT OF THE BED 30 DEGREES. INSTRUCT THE PATIENT
TO LIE ON HIS SIDE WITH HIS HEAD LOWERED. THEN PLACE PILLOWS
AS SHOWN. PERCUSS WITH A SLIGHTLY CUPPED HAND OVER HIS
LOWER RIBS JUST BENEATH THE AXILLA. IF AN ACUTELY ILL PATIENT
HAS TROUBLE BREATHING IN THIS POSITION, ADJUST THE BED TO AN
ANGLE HE CAN TOLERATE. THEN BEGIN PERCUSSION.
TECHNIQUE: POSTURAL DRAINAGE THERAPY

D) LOWER LOBES: SUPERIOR SEGMENTS

• WITH THE BED FLAT, HAVE THE PATIENT LIE ON
HIS ABDOMEN. PLACE TWO PILLOWS UNDER HIS
HIPS. PERCUSS ON BOTH SIDES OF HIS SPINE AT
THE LOWER TIP OF HIS SCAPULAE.
 TECHNIQUE: POSTURAL DRAINAGE
THERAPY

E) RIGHT MIDDLE LOBE: MEDIAL AND LATERAL SEGMENTS

• ELEVATE THE FOOT OF THE BED 15 DEGREES. HAVE THE PATIENT LIE ON
HIS LEFT SIDE WITH HIS HEAD DOWN AND HIS KNEES FLEXED. THEN HAVE
HIM ROTATE A QUARTER TURN BACKWARD. PLACE A PILLOW BENEATH
HIM. PERCUSS WITH YOUR HAND MODERATELY CUPPED UNDER THE
RIGHT NIPPLE. FOR A WOMAN, CUP YOUR HAND SO THAT ITS HEEL IS
UNDER THE ARMPIT AND YOUR FINGERS EXTEND FORWARD BENEATH
THE BREAST.
 TECHNIQUE: POSTURAL DRAINAGE
THERAPY
F) LEFT UPPER LOBE: SUPERIOR AND INFERIOR SEGMENTS, LINGULAR PORTION

• ELEVATE THE FOOT OF THE BED 15 DEGREES. HAVE THE PATIENT LIE ON HIS RIGHT SIDE WITH HIS
HEAD DOWN AND KNEES FLEXED. THEN HAVE HIM ROTATE A QUARTER TURN BACKWARD. PLACE A
PILLOW BEHIND HIM, FROM SHOULDERS TO HIPS. PERCUSS WITH YOUR HAND MODERATELY CUPPED
OVER HIS LEFT NIPPLE. FOR A WOMAN, CUP YOUR HAND SO THAT ITS HEEL IS BENEATH THE ARMPIT
AND YOUR FINGERS EXTEND FORWARD BENEATH THE BREAST.
 TECHNIQUE: PERCUSSION THERAPY

• -CUPPING HANDS WITH THUMBS ON THE SIDES

• - USING HANDS, RHYTHMICALLY TAP THE CHEST TO DISLODGE RETAINED
SECRETIONS.
-FORCE SHOULD BE EQUAL AND ONLY ENOUGH TO MOVE SECRETIONS
-SHOULD NOT CAUSE PATIENT DISCOMFORT
 TECHNIQUE: VIBRATION THERAPY

• -PERFORMED ONLY ON PEAK EXHALTION

• -PLACE ONE HAND ON TOP OF THE OTHER AND PLACE ON AREA TO BE VIBRATED
-TENSE ARMS FROM SHOULD TO HANDS
-APPLY VIBRATION MOTION
 CPT POST-TREATMENT
EVALUATION
1.AUSCULTATED LUNG FIELDS. CLEARANCE OF SECRETIONS USUALLY RELIEVES GARGLES
EARLY INSPIRATORY CRACKLES & PALPABLE CREPITUS.(ABNORMAL POPPING OR CRACKING
SOUND IN THE LUNGS.
2. INSPECTED CHARACTER & AMOUNT OF SPUTUM.
3.REVIEWED DIAGNOSTIC REPORTS.

4. OBTAINED VITAL SIGNS & PULSE OXIMETRY.

5. IDENTIFIED UNEXPECTED OUTCOMES.

RECORDING AND REPORTING

1.RECORDED ALL PERTINENT INFORMATION IN APPROPRIATE LOG

2. CHARTED ALL PERTINENT INFORMATION ABOUT PATIENT CAREGIVER INSTRUCTION.