Chest Physiotherapy

Definition
Chest Physiotherapy is the removal of excess secretions (also called mucus, phlegm, sputum) from inside the lungs, by physical means. It is used to assist a cough, re-educate breathing muscles and to try to improve ventilation of the lungs.

Purpose
The purpose of chest physiotherapy, also called chest physiotherapy, is to help patients breathe more freely and to get more oxygen into the body. Chest physiotherapy includes postural drainage, chest percussion, and chest vibration, turning, deep breathing exercises, and coughing. It is usually done in conjunction with other treatments to rid the airways of secretions. These other treatments include suctioning, nebulizer treatments, and the administration of expectorant drugs. Chest physiotherapy can be used with newborns, infants, children, and adults. People who benefit from chest physiotherapy exhibit a wide range of problems that make it difficult to clear secretions from their lungs. Some people who may receive chest physiotherapy include people with cystic fibrosis or neuromuscular diseases like Guillain-Barré syndrome, progressive muscle weakness (myasthenia gravis), or tetanus. People with lung diseases such as bronchitis, pneumonia, or chronic obstructive pulmonary disease (COPD) also benefit from chest physiotherapy. People who are likely to aspirate their mucous secretions because of diseases such as cerebral palsy or muscular dystrophy also receive chest physiotherapy, as do some people who are bedridden, confined to a wheelchair, or who cannot breathe deeply because of postoperative pain.

Indications of Chest Physiotherapy
It is indicated for patients in whom cough is insufficient to clear thick, tenacious, or localized secretions. Examples include:
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Cystic fibrosis Bronchiectasis Atelctasis Lung abscess Neuromuscular diseases Pneumonias in dependent lung regions.

Contraindications of Chest Physiotherapy
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Increased ICP Unstable head or neck injury Active hemorrhage with hemodynamic instability or hemoptysis Recent spinal injury or injury Empyma Bronchoplueral fistula Rib fracture Fail chest Uncontrolled hypertension Anticoagulation Rib or vertebral fractures or osteoporosis

2. or chest occurs. palpitations. 11. Encourage diaphragmatic breathing throughout postural drainage: this helps widen airways so secretions can be drained Positions . and combat edema of the bronchial walls. mucolytics agents. These symptoms may indicate hypoxemia. water. The lungs are divided into segments called lobes. and gravity is used to assist the drainage of specific segment. Encourage the patient to deep breathe and cough after spending the allotted time in each position. Scheduling Treatment: The treatment often works best in the morning. This allows the mucus to be removed that has built up during the night. 3. Perform secretion removal procedures before eating 8. Sometimes a treatment can be done at night to reduce the need for coughing during sleep. Discontinue if hemoptysis occurs. decrease thickness of mucus and sputum. Make sure patient is comfortable before the procedure starts and as comfortable as possible he or she assumes each position 9. The patient is positioned so that the diseased area is in a near vertical position. The exercises are performed two to three times a day.Postural Drainage It removes mucus from certain parts of the lungs by using gravity and proper positioning to bring the secretions into the throat where it is easier to remove them. the right lung is divided into three lobes (right upper lobe. This helps to prevent nausea and or vomiting. or saline may be nebulised and inhaled before postural drainage and chest percussion to reduce bronchospasm. thereby enhancing secretion removal 7. and duration of mucous obstruction 4. dyspnea. CPT just before meals may cause you to become tired and may decrease appetite. Use specific positions so the force of gravity can assist in the removal of bronchial secretions from affected lung segments to central airways by means of coughing and suctioning. before meals and bedtime. Steps: 1. right middle lobe and right lower lobe) while the left lung has only two lobes (left upper lobe and lower lobe). severity. Each position is done for 3-15 minutes 5. Make sure you wait at least 1-2 hours after eating before starting you treatment. Auscultate the chest to determine the areas of needed drainage 10. 6. Bronchodilators. The positions assumed are determined by the location. The procedure should be discontinued if tachycardia.

Instruct the patient use diaphragmatic breathing 2. you should be in a sitting position at about a 45 degree angle. Vibration As with percussion. Possible techniques to achieve this position are: ‡If a hospital bed is available. Deep breathing exercises are done several times each day for short periods. ‡Lower head and chest over the side of the bed. Other treatments for CPT: Deep breathing Deep breathing helps expand the lungs and forces better distribution of the air into all sections of the lung. clapping. It should be done over a thin article or clothing or towel. It should always be done over the rib cage. pushing the abdomen out to force maximum amounts of air into the lung. The patient either sits in a chair or sits upright in bed and inhales. put in Trendelenburg position (head lower than feet) ‡Place 3-5 wood blocks. in a stack that is 5 inches high. The purpose of percussion is to break up thick secretions in the lungs so that they can be more easily removed. breast. clavicles or breast bone (sternum). that are 2 inches by 4 inches.held pecussors cups or mechanical precussor may be used. Percussion Percussion is rhythmically striking the chest wall with cupped hands. and the patient exhales. The procedure is repeated several times each day for about five exhalations. the person performing the vibration places his or her hands against the patient's chest and creates vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. It should last 3-5 minutes per area that is being drained. soft plastics hand. It is also called cupping. When done manually. you should be positioned with your chest above your head. Vibration can be either mechanical or manual. Spine should be straight to promote rib cage expansion . the purpose of vibration is to help break up lung secretions. The abdomen is then contracted. To drain the upper portions of your lungs. never on bare skin. with head lower than feet. or tapotement. ‡Place on a tilt table. It is performed as the patient breathes deeply. ‡ Procedure: Percussion and Vibration 1. If cupping is hard to do. under the foot of a regular bed. Position the patient in prescribed postural drainage positions. Areas that have a lot of mucus drainage may require more time. Percussion is performed on each lung segment for one to two minutes at a time. Blocks should have indentations or a 1 inch rim on top so that the bed does not slip ‡Stack 18-20 inches of pillow under hips.‡To drain the middle and lower portions of your lungs. Never percuss over the spine.

Complications: oxygen deficiency if the head is kept lowered for drainage increased intracranial pressure temporary low blood pressurebleeding in the lungs pain or injury to the ribs. It's sometimes used alongside other clearance tech such as postural drainage or chest percussion. scapula. Coughing Coughing helps break up secretions in the lungs so that the mucus can be suctioned out or expectorated. Avoid clapping over spine. Coughing is repeated several times a day. clavicle or sternum 5. liver. Listen with stethoscope for changes in breath sounds 8. How to perform: -try to maintain a good breathing pattern with relaxed shoulders and neck (avoid to use accessory muscle during the ACBT)-breathe through your nose and out through your mouth.3. Vibrate the chest wall as the patient exhales slowly through the pursed lips.‡ Encourage the patient cough. 6. spleen. or spine vomitinginhaling secretions into the lungs heart irregularities . Active cycle of breathing Is a tech which uses breathing easy to remove phlegm from lungs. Uses alternating depth breathing to move phlegm from small airways at the bottom of your lungs to larger airways near the top where they can be cleared more easily with huffing or coughing. Instruct them to hold their breath for a count of three. muscles. using abdominal muscles. Patients sit upright and inhale deeply through the nose. Repeat the percussion and vibration cycle according to the patient¶s tolerance and clinical response: usually 15-30 minutes. Percuss or clap with cupped hands or chest wall for 5 minutes over each segment for 5 minutes for cystic fibrosis and 1-2 minutes for other conditions 4. Procedure Have patient take a slow deep breath through their nose. lying or postural drainage positions but initially u should start it in sitting position. The patient should open their mouth and cough three times as they exhale. after three or four vibrations.‡ Place one hand on top of the other affected over area or place one hand place one and on each side of the rib cage. Can be performed either in sitting. Allow the patient rest several times 7.‡ Tense the muscles of the hands and hands while applying moderate pressure downward and vibrate arms and hands‡ Relieve pressure on the thorax as the patient inhales. Instruct the patient to inhale slowly and deeply. breast. They then exhale in short puffs or coughs.

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