VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 112 Skills Lab)

SKILLS LABORATORY MODULE NO. 3

CHEST PHYSIOTHERAPY

LEARNING OBJECTIVES:
By the end of the module, the student will be able to:
1. Give the indications for chest physiotherapy.
2. Give the contraindications of chest physiotherapy.
3. Describe procedure of performing chest physiotherapy which includes postural drainage, chest
percussion & vibration, and coughing and deep-breathing exercises.
4. Explain rationale for each step of procedure accurately.

 Important Information related to this Module:

A. Indications of Chest Physiotherapy:
▪ To mobilize and eliminate secretions, re-expand lung tissue, and promote efficient use of
respiratory muscles in patients who expectorate large amounts of sputum, such as those with
bronchiectasis and cystic fibrosis and in those with artificial airway (tracheostomy & ET)
▪ Helps prevent or treat atelectasis in bedridden clients and may also help prevent pneumonia.

B. Contraindications of Chest Physiotherapy:

▪ Active hemorrhage with hemodynamic instability
▪ Active pulmonary bleeding with hemoptysis
▪ Acute asthma or bronchospasm
▪ Bony metastasis
▪ Bronchopleural Fistula
▪ Conditions with increased intracranial pressure (ICP) such as hemorrhagic stroke
▪ Fractured ribs, flail chest or an unstable chest wall
▪ Empyema, lung abscess or tumor
▪ Lung contusions
▪ Pulmonary tuberculosis
▪ Recent myocardial infarction
▪ Recent head injury or spinal cord injury
▪ Recent spinal & intracranial surgery
▪ Uncontrolled hypertension
▪ Unstable head or neck injury
▪ Untreated pneumothorax
 VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 112 Skills Lab)

 Nursing Skills to Develop in this Module & Materials/Equipment Needed:

▪ Performing Chest Physiotherapy:
- Stethoscope
- Tissue
- Adjustable Hospital Bed
- Pillows
- Kidney basin (for client’s secretions)

 Procedure Guidelines:
A. Performing Chest Physiotherapy
1. Explain the procedure to the patient, provide privacy, and perform hand hygiene.
2. Auscultate the patient's lungs to determine baseline respiratory status and assess ability to clear
secretions. Take note of where adventitious breath sounds are heard to determine affected lung
segment.
3. Perform postural drainage by positioning client properly – lung segment to be drained is uppermost.
(see illustrations below)

* Affected Lung Segment: Lower Lobes – Posterior Basal Segments

* Affected Lung Segment: Lower Lobes – Lateral Basal Segments

* Affected Lung Segment: Lower Lobes – Superior Segments

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VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 112 Skills Lab)

* Affected Lung Segment: Right Middle Lobe – Medial & Lateral Segments

* Affected Lung Segment: Left Upper Lobe – Superior & Inferior Segments

* Affected Lung Segment: Upper Lobes – Anterior Segments

* Affected Lung Segment: Upper Lobes – Apical Segments

* Affected Lung Segment: Upper Lobes – Posterior Segments

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 VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 112 Skills Lab)

4. Instruct the patient to remain in each position for 10 to 15 minutes. During this time, perform
percussion and vibration as ordered on area over affected lung segment.
5. To perform percussion , instruct the patient to breathe slowly and deeply, using the diaphragm, to
promote relaxation. Hold your hands in a cupped shape, with fingers flexed and thumbs pressed tightly
against your index fingers. Percuss each segment for 1 to 2 minutes by alternating your hands against
the patient in a rhythmic manner. Listen for a hollow sound on percussion to verify correct performance
of the technique. (see illustration below)

6. To perform vibration , ask the patient to inhale deeply and then exhale slowly through pursed lips.
During exhalation, firmly press your fingers and the palms of your hands against the chest wall. Tense
the muscles of your arms and shoulders in an isometric contraction to send fine vibrations through the
chest wall. Vibrate during five exhalations over each chest segment. (see illustration below)

7. After postural drainage, percussion, or vibration, instruct the patient to cough to remove loosened
secretions. First, tell him to inhale deeply through his nose and then exhale in three short huffs. Then
have him inhale deeply again and cough through a slightly open mouth. Three consecutive coughs are
highly effective. An effective cough sounds deep, low, and hollow; an ineffective one, high-pitched. Have
the patient perform exercises for about 1 minute and then rest for 2 minutes. Gradually progress to a
10-minute exercise period four times daily.
8. Provide oral hygiene because secretions may have a foul taste or a stale odor.
9. Auscultate the patient's lungs to evaluate the effectiveness of therapy.
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 VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 112 Skills Lab)

 Special Considerations for Chest Physiotherapy:

▪ For optimal effectiveness and safety, modify chest physiotherapy according to the patient's condition.
For example, initiate or increase the flow of supplemental oxygen, if indicated. Also, suction the patient
who has an ineffective cough reflex. If the patient tires quickly during therapy, shorten the sessions
because fatigue leads to shallow respirations and increased hypoxia.
▪ Maintain adequate hydration in the patient receiving chest physiotherapy to prevent mucus dehydration
and promote easier mobilization. AVOID performing postural drainage immediately before or within 1½
hours after meals (Rationale: to avoid nausea, vomiting, and aspiration of food or vomitus).
▪ Because chest percussion can induce bronchospasm, any adjunct treatment (for example, intermittent
positive-pressure breathing, aerosol, or nebulizer therapy) should precede or be carried out BEFORE
chest physiotherapy.
▪ REFRAIN from percussing over the spine, liver, kidneys, or spleen to avoid injury to the spine or internal
organs. Also avoid performing percussion on bare skin or the female patient's breasts. Percuss over soft
clothing (but not over buttons, snaps, or zippers), or place a thin towel over the chest wall. Remember to
remove jewelry that might scratch or bruise the patient.
▪ Explain coughing and deep-breathing exercises preoperatively so that the patient can practice them
when he's pain-free and better able to concentrate. Postoperatively, splint the patient's incision using
your hands or, if possible, teach the patient to splint it himself to minimize pain during coughing.

 References & Suggested Readings:

▪ Berman, A., Snyder, S., & Frandsen, G.(2016). Kozier & Erb’s Fundamentals of Nursing: Concepts,
Process and Practice (10th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
▪ Nettina, S. & Mills, E.J. (2006). Lippincott manual of nursing practice (8th ed.). Philadelphia, PA:
Lippincott, Williams & Wilkins.
▪ Schilling-McCann, J. (2009). Lippincott’s nursing procedures (5th ed.). Philadelphia, PA: Lippincott,
Williams & Wilkins.
▪ Hinkle, J., & Cheever, K. (2014). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (13th ed.).
Philadelphia, PA: Wolter Kluwer Health/Lippincott, Williams & Wilkins.