Laguna State Polytechnic University

Republic of the Philippines
Laguna State Polytechnic University

Province of Laguna
College of Nursing and Allied Health
A.Y. 2021-22
Purpose:
To help maintain pertinent airway by using gravity and positioning to loosen thick mucus
secretions from the bronchial airway. And therefore, promotes better breathing.
Equipment:
 Stethoscope
 Pulse oximeter
 Water in pitcher and glass
 Tissues and paper bag
 Chair
 Extra pillows
 Clear graduated screw-top container
 Oral hygiene care: toothbrush, toothpaste, mouthwash, or chlorhexidine oral rinse if ordered
 Suction equipment
 Clean gloves
 Patient education material
Province of Laguna
A.Y. 2021-22
USING POSTURAL DRAINAGE
ASSESSMENT RATIONALE
1. Identified patient with at least two identifiers.  Ensures correct patient. Complies
with the Joint commission standards
and improves patient safety.
2. Assessed patient for history of decreased  Conditions that pose risk for
LOC and muscle weakness or disease impaired airway clearance require
processes. CPT.
3. Reviewed medical record; assessed for signs  Indicates need to perform postural
and symptoms consistent with atelectasis, lobar drainage. X-ray film data and signs
collapse pneumonia, or bronchiectasis; and symptoms indicate accumulation
ineffective coughing; thick, sticky, tenacious, of pulmonary secretions and
and discolored secretions that are difficult to ineffective airway clearance.
cough up.
Province of Laguna
A.Y. 2021-22
4. Auscultated all lung fields for decreased  Findings identify bronchial drainage.
breath sounds and adventitious lung sounds.
5. Assessed vital signs and pulse oximetry  Provides baseline to evaluate

before postural drainage system. patient’s response to therapy
6. Determined patient’s and caregiver’s  Identify potential areas for

understanding of and ability to perform home instruction. Home care CPT is
postural drainage. indicated in patients with chronic
conditions such as cystic fibrosis,
chronic bronchitis or bronchiectasis.
7. Determined patient’s level of comfort.  Determines patient’s level of pain
and pre-procedure analgesia is
needed.
PLANNING
1. Identified expected outcomes.
 Lung sounds improve or become clear.  Clearing of airways documents
effectiveness of procedure.
 Sputum is more easily coughed and  CPT provides mechanical stimulus
expectorated or suctioned out. to loosen secretions from wall of
airway; thus, secretions are easier to
expectorate.
 Secretions appear more normal in color  When infection is present, returning

and consistency. to normal indicates resolving
infection.
 Pulse oximetry (SpO2) levels increase  As secretions are removed, patient

Province of Laguna
A.Y. 2021-22
and dyspnea decreases. exchange of respiratory gases

improves, and dyspnea gradually
 Chest x-ray film shows improvements: declines.
lobar collapse and atelectasis are
decreased or eliminated.  CPT improves atelectasis and
facilitates removal of secretions
from airways. As a result there is
visual improvement on chest x-ray
film
2. Explained procedure to patient and family:

a. Administer analgesia 20 minutes before  Pain control is essential for patient to
CPT maneuvers if necessary. actively participate in CPT
maneuvers and cough forcefully to
clear airways.
b. Explained purpose and rationale for  Helps promote cooperation. Well-

procedure, explained details of prepared patient is usually more
procedure. relaxed and comfortable, which is
essential for effective drainage.
c. Encouraged high fluid intake program  Fluids thin secretions and make them
unless contraindicated, maintained easier to cough up. Patients need
record of fluid I&O. close monitoring and encouragement
when first starting high fluid intake
program.
d. Planned treatment so they did not

overlap with meals or tube feeding,  Performing postural drainage when
stopped gastric tube feedings for 30 to patient’s stomach is empty helps
45 minutes before postural drainage, avoid gastric reflux or vomiting and
checked for residual feeding in patient’s aspiration of stomach contents.
stomach, held treatment if necessary.
 Scheduling of CPT avoids conflict

with other interventions and/or
e. Scheduled treatments at appropriate diagnostic testing.
times.
f. Had patient remove any restrictive  Helps patient relax and promotes
clothing. deep breathing.
Province of Laguna
A.Y. 2021-22
IMPLEMENTATION
1. Provided privacy, performed hand hygiene,  Maintains privacy. Reduces
applied gloves. transmission of microorganisms.
2. Used findings from physical assessment and  Individualized treatment helps

chest x-ray film to select congested areas for relieve specific areas of congestion
drainage. identified during patient assessment.
3. Assisted patient to appropriate position,  Proper patient positioning promotes

placed pillows for support and comfort, draped drainage of pulmonary secretions.
patient appropriately.
POSITION 1
POSITION 2
POSITION 3
POSITION 4
POSITION 5
Province of Laguna
A.Y. 2021-22
POSITION 6
POSITION 7
POSITION 8
POSITION 9
POSITION 10
POSITION 11
POSITION 12
4. Had patient maintain position for 10 to 15  In adults draining each area takes
minutes. time.
5. Performed chest percussion and vibration  Provides mechanical forces to help
after 15 minutes. move airway secretions.
6. Had patient sit up and cough, saved  Any secretions moved to central
secretions if necessary, suctioned if necessary. airways are removed by cough or
 suctioning before placing patient
into next drainage position.
Coughing is most effective when
patient is sitting up and leaning
forward.
Province of Laguna
A.Y. 2021-22
7. Had patient rest briefly if necessary, noted  Short rest periods between postures
pulse oximeter readings. prevent fatigue and increase
tolerance. Pulse oximeter values may
fall slightly.
8. Had patient take sips of water.  Keeping mouth moist aids in

expectoration of secretions.
9. Repeated step 3-8, ensure each treatment did  Postural drainage is used only to
not exceed 30 to 60 minutes. drain areas involved and is based on
individual assessment.
10. Offered or assisted patient with oral  Promotes comfort and reduces bad
hygiene. breath.
11. Removed gloves and performed hand  Reduces transmission of

hygiene. microorganisms.
Province of Laguna
A.Y. 2021-22
EVALUATION
1. Auscultated lung fields.  Clearance of secretions usually
relieves gurgling, early inspiratory
crackles, and palpable crepitus.
2. Inspected character and amount of sputum.  Determines if there are more

secretions coughed up and if they are
adequately thinned.
3. Reviewed diagnostic reports.  Provides objective data on

improvements in lung function.
4. Obtained vital signs and pulse oximetry.  Procedure can result in dysrhythmias
and decreases in oxygen saturation
in some patients.
5. Asked patient to explain importance of  To determine if the patient fully

positioning. understands the procedure and if not
plan a better health teaching method
Province of Laguna
A.Y. 2021-22
for the patient.

6. Identified unexpected outcomes. Related Interventions:
a. Patient experiences severe dyspnea,  Discontinue, modify, or shorten
bronchospasm, hypoxemia, or treatments.
hypercarbia and/or is unable to tolerate  Administer bronchodilator or
treatment. nebulizer therapy 20 minutes before
CPT.
 Suction and ventilate with bag-
valve-mask as needed and closely
monitor arterial blood gas (ABG)
levels, O2 saturation, and vital signs.
b. No improvement in chest assessment or  Initially increase treatments and

chest x-ray film examination results. encourage and teach coughing
exercises.
 Increase hydration.
 Notify health care provider because
patient may need sputum culture,
change in antibiotics, mucolytics, or
a bronchoscopy to remove thick
mucus plugs.
c. Hemoptysis occurs; or patient develops
 Stop therapy, place patient in high-
acute hypotension, severe chest pain,
Fowler’s position, and obtain vital
vomiting, aspiration, and/or
signs.
dysrhythmias.
 Call for help and notify health care
provider.
 Remain with patient; keep patient
comfortable, calm, warm, and quiet.
 If patient vomits or aspirates, suction
airway and place him or her on his
or her side.
 Prepare for possible oxygen
administration
RECORDING AND REPORTING
1. Record all pertinent information for  A complete and well-organized
appropriate log. records are essential for good
medical practice and continuity of
care.
2. Documented evaluation of patient learning.  Good documentation is important to
protect patients as it promotes their
safety and quality of care.
BY: KRISTINE LOUISE E. JAVER

BSN3C
Province of Laguna
A.Y. 2021-22
REFERENCES:
https://opentextbc.ca/clinicalskills/chapter/3-4-positioning-a-patient-in-bed/
https://www.modernhealthcare.com/article/20180714/TRANSFORMATION01/180719963/fail-
safe-patient-id-matching-remains-just-out-of-reach
https://www.jotform.com/pdf-templates/patient-medical-record-template
https://www.yumpu.com/en/document/view/32338457/medical-record-nursing-history-and-
assessment-for-
https://www.registerednursern.com/lung-auscultation-points-sounds/
https://www.nucleotype.com/vital-signs/
https://pulmccm.org/randomized-controlled-trials/checking-residuals-during-tube-feeding-on-
mechanical-ventilation-unnecessary-jama/
https://www.template.net/business/schedule-templates/patient-schedule-template/
https://www.theguardian.com/lifeandstyle/2016/jan/24/everything-you-ever-wanted-to-know-
about-coughs
https://www.indiatoday.in/information/story/how-to-use-pulse-oximeter-1794840-2021-04-25
https://www.tasteofhome.com/article/drinking-water-all-day-two-weeks/
https://www.brusselsdental.com/procedures/cleanings-prevention/home-care/
https://www.istockphoto.com/photos/removing-glove
https://erj.ersjournals.com/content/34/2/361
https://www.yumpu.com/en/document/view/54319224/diagnostic-report
https://www.hopkinsmedicine.org/health/conditions-and-diseases/vital-signs-body-temperature-
pulse-rate-respiration-rate-blood-pressure
https://blog.simtalkblog.com/blog/the-challenges-of-teaching-auscultation
https://www.youtube.com/watch?v=LJU_zVMnF3o&t=357s

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Laguna State Polytechnic University

USING POSTURAL DRAINAGE

5. Assessed vital signs and pulse oximetry  Provides baseline to evaluate

6. Determined patient’s and caregiver’s  Identify potential areas for

 Secretions appear more normal in color  When infection is present, returning

 Pulse oximetry (SpO2) levels increase  As secretions are removed, patient

and dyspnea decreases. exchange of respiratory gases

2. Explained procedure to patient and family:

b. Explained purpose and rationale for  Helps promote cooperation. Well-

d. Planned treatment so they did not

 Scheduling of CPT avoids conflict

2. Used findings from physical assessment and  Individualized treatment helps

3. Assisted patient to appropriate position,  Proper patient positioning promotes

8. Had patient take sips of water.  Keeping mouth moist aids in

11. Removed gloves and performed hand  Reduces transmission of

2. Inspected character and amount of sputum.  Determines if there are more

3. Reviewed diagnostic reports.  Provides objective data on

5. Asked patient to explain importance of  To determine if the patient fully

for the patient.

b. No improvement in chest assessment or  Initially increase treatments and

BY: KRISTINE LOUISE E. JAVER

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