y Group of therapies used in combination to

mobilize pulmonary secretions
y Includes postural drainage, chest percussion, and

vibration
y Should be followed by productive coughing and

suctioning of the client
y Recommended for clients who produce greater

than 30 mL of sputum per day or have evidence of atelectasis

unless contrainidcated. y Dependent nursing function .y can be safely used with infants and young children.

y Know the client¶s normal range of vital signs. y Know the client¶s medications. y Know the client¶s level of cognitive function. . y Be aware of the client¶s exercise tolerance. y Know the client¶s medical history.

y Sends waves of varying amplitude and frequency through the chest. changing the consistency and location of sputum. y Performed by striking the chest wall alternately with cupped hands. and the hands are cupped.y Involves striking the chest wall over the area being drained. y Hand is positioned so that the fingers and thumb touch. .

y Caution should be taken to percuss the lung fields and not the scapular regions. osteoporosis. . y Contraindicated in patients with bleeding disorders.y Performed over a single layer of clothing. or fractured ribs.

y Percuss each affected lung segment for 1-2 minutes.y Cover the area with a towel or gown to reduce discomfort. y Alternately flex and extend the wrists rapidly to slap the chest. y Ask the client to breathe slowly and deeply to promote relaxation. .

.y If done correctly. popping sound. sternum. kidneys. the percussion action should produce a hollow. y Percussion is avoided over the breasts. spinal column. scapula.

y Fine. y Increases the exhalation of trapped air and may shake mucus loose and induce cough. facilitating secretion removal. shaking pressure applied to the chest wall only during exhalation. y Increase velocity and turbulence of exhaled air. .

moving downward. and using mostly the heel of the hand.y Place hands. Stop vibrating when the client inhales. palms down. tense all the hand and arm muscles. the hands may be placed side by side. one hand over the other with the fingers together and extended. y During exhalation. . Alternatively. on the chest area to be drained. vibrate the hands. y Ask the client to inhale deeply and exhale slowly through the nose or pursed lips.

y After each vibration. encourage the client to cough and expectorate secretions in the sputum container. .y Vibrate during five exhalations over one affected lung segment.

y Use of positioning technique that draw secretions from specific segments of the lungs and bronchi into the trachea. y Procedures can include most lung segments. . y Drainage by gravity of secretions from various lung segments. enhance matching of ventilation and perfusion. It is based on clinical assessments. normalize functional and residual capacity.

before lunch. and before bedtime. severity. . y Nurse must evaluate the client¶s tolerance of postural drainage.y The positions assumed are determined by the location. y Prior to postural drainage. in the late afternoon. the patient may be given a bronchodilator medication or nebulization y Best time for postural drainage includes before breakfast. and duration of mucus obstruction.

severe osteoporosis. and gross hemoptysis. tuberculosis. pneumothorax. lung tumors. diseases of the chest wall. lung hemorrhage. . uncontrolled hypertension.y Indicated for difficult with secretion clearance. evidence of retained secretions. increased ICP. and lung conditions that cause increased production of secretions. y Contraindicated in undrained lung abscess. painful chest conditions.

dyspnea.y The procedure should be discontinued if tachycardia. Discontinue if hemoptysis occurs. . or chest pain occurs. These symptoms may indicate hypoxemia. palpitations.

y Bilateral .Supine with head of bed elevated 1530 degrees y Left upper lobe -.Side lying with right side of chest elevated on pillows .Supine with head elevated y Right upper lobe -.High-Fowler¶s position y Apical segments: Right upper lobe -.anterior segment .anterior segment .posterior segment .

Side lying with left side of chest elevated on pillows y Right middle lobe -.anterior segment ± Three- fourths supine position with dependent lung in Trendelenburg¶s position y Right middle lobe -.posterior segment .posterior segment ± prone with thorax and abdomen elevated y Both lower lobes -.anterior segments ± Supine in Trendelenburg¶s position .y Left upper lobe -.

lateral segment ± left lateral in Trendelenburg¶s position y Right lower lobe ± lateral segment ± right side- lying in Trendelenburg¶s position y Right lower lobe ± posterior segment ± prone in Trendelenburg¶s position with abdomen and thorax elevated y Both lower lobes ± posterior segments ± prone in Trendelenburg¶s position with abdomen and thorax elevated .y Left lower lobe -.

leaning against nurse y Bilateral lobes ± anterior segments ± lying supine position on nurse¶s lap.y Bilateral ± apical segments ± sitting on nurse¶s lap. back supported with pillow . flexed over pillow y Bilateral ± middle anterior segments ± sitting on nurse¶s lap. leaning slightly forward.

y Instruct the patient to inhale slowly and deeply.y Instruct the patient to do diaphragmatic deep breathing. y Percuss (clap) with cupped hands over chest wall. Vibrate the chest wall as the patient exhales slowly through pursed lips. . y Position the patient in prescribed postural drainage positions.

y Listen with a stethoscope for changes in breath sounds. y Allow the patient to rest several minutes.y Removal of secretions may be done by coughing or suctioning.) . y Repeat the percussion and vibration cycle according to the patient¶s tolerance and clinical response (15-30 min.

y Document amount. color. and character of expectorated secretions. .

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