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Respiratory Care Procedures
( Chest Physiotherapy )
Objectives: 1. To mobilize & eliminate secretions 2. To reexpand lung tissue 3. To promote efficient use of respiratory muscles 4. To help prevent or treat atelectasis 5. To help prevent complications Contraindications: 1. Active pulmonary bleeding with hemoptysis & immediate post hemorrhage stage 2. Fractured ribs or unstable chest wall 3. Lung contusions 4. Pulmonary tuberculosis 5. Untreated pneumothorax 6. Acute asthma or bronchospasm 7. Lung abscess or tumor 8. Bony metastasis 9. Head Injury 10. Recent MI

Chest Tapping
( Percussion & Vibration ) Percussion
 

is the manual application of light blows to the chest wall sometimes called clapping or cupping

or recovering from thoracic surgery or trauma  ask the patient to exhale after a deep inspiration & vibrate as the patient exhales Special Considerations:  because chest percussion can induce bronchospasm. cup your hands & clap them over the chest wall or back to determine if correctly done. or nebulizer therapy) should p[recede chest physiotherapy  refrain from percussing over the spine. or according to the doctor’s order while the patient is in postural drainage position of choice. kidneys or spleen to avoid injury to the spine or internal organs  avoid performing percussion on bare skin or female patient’s breasts . over each area. any adjunct treatment ( like IPPB. up to 5 min.. liver. aerosol. patient who is frail. to mechanically dislodge tenacious secretions from the bronchial walls usually carried out for only 1 or2 min. cupping should produce a hollow sound & should not be painful for the patient instruct the patient to take slow deep breaths during percussion Vibration  is a series of vigorous quivering produced through hands that are placed flat against the chest wall  performed with the same purpose as percussion & is as effective if done correctly  often done alternately with percussion or can replace percussion if the patient is experiencing chest pain.2      done over specific congested lung areas.

Bedridden 2. or zippers) or place a thin towel over the chest wall  remember to remove jewelry that might scratch or bruise the patient  Nursing Alert: Vigorous percussion & vibration can cause rib fracture. snaps. Patients who have respiratory disease 5. Patients who have inhaled respiratory anesthetics 4. Immobilized patient 3. Incentive Spirometers a.3  percuss over soft clothing (but not over buttons. Volume-Oriented or Electronic Device b. especially in patient with osteoporosis Teaching the Patient Deep Breathing Exercise Indicated for: 1. Patients who have undergone abdominal or chest surgery Special Considerations:  Relieve the patient’s pain  Position the patient to promote maximum expansion of lungs  Have the patient inspire & expire slowly  Teach breathing exercise preoperatively  Observe the patient’s breathing to see whether complete lung expansion occurs Mechanisms for Encouraging Deep Breathing 1. Flow-Oriented or Mechanical Incentive Spirometer .

to raise may collapse alveoli is therefore not recommended  Teach coughing exercise preoperatively  Postoperatively. coughing could lead to pneumothorax Postural Drainage Exercise    Postural Drainage .4 2. splint the patient’s incision using the hands or pillow. Intermittent Positive Pressure Breathing (IPPB) Teaching the Patient to Cough Effectively  Coughing is always combined with deep breathing but deep breathing may be done without coughing Special Considerations:  When the patient has no secretions.positioning the patient so that the force of gravity helps drain the lung secretions performed in conjunction of vibrations sequence: a) Positioning d) Deep breathing b) Percussion e) Coughing or Suctioning c) Vibration ********* . or if possible teach the patient to splint it himself to minimize pain during coughing  Nursing Alert: for emphysematous patient with bleb.

at least 2 hrs. continues with the middle lobes & ends with the upper lobes  in localized disease – drainage begins with the affected lobes & then proceeds to the other lobes to avoid spreading the disease to uninvolved areas  if used for a patient with chronic respiratory problem but no current acute difficulty. to decrease the possibility of vomiting & aspiration of food or vomitus  maintain adequate hydration in the patient receiving chest PT to prevent mucus dehydration & promote easier mobilization  before therapy. only those that drain specific affected areas  for optimal effectiveness & safety. it is recommended that 5 mins. be spent initially in each position  not all positions are necessary for every patient. modify the therapy according to patient’s condition  PDE is best tolerated if done between meals. secretions drain best with the patient positioned so that bronchi are perpendicular to the floor: upper lobes = head-up position lower & middle lobes = head-down position Special Considerations:  in generalized disease – drainage usually begins with the lower lobes.5 usually. bronchodilators or moisturizing nebulization therapy may be given  . after the patient has eaten. each position needs to be held for 15 seconds to drain the lung segments adequately  for acute respiratory problem.