Holy Angel University

School of Nursing and Allied Medical Sciences

NCM 103 RLE 2021-2022

PROMOTING OXYGENATION
Jenny Rose Leynes-Ignacio, EdD, MAN, RN, LPT
 Holy Angel University
School of Nursing and Allied Medical Sciences
NCM 103 RLE 2020-2021

PROMOTING OXYGENATION
Jenny Rose Leynes-Ignacio, EdD, RN, LPT
 Learning Outcomes
After completing this chapter, you will be able to:
1. Describe nursing measures to promote respiratory function and
oxygenation.
2. Explain the use of therapeutic measures inhalation therapy,
oxygen therapy, artificial airways, airway suctioning, and chest
tubes to promote respiratory function.
3. State outcome criteria for evaluating client responses to
measures that promote adequate oxygenation.
4. Verbalize the steps used in:
1. Breathing and coughing techniques
2. Administering oxygen by cannula, face mask, or face tent.
3. Oropharyngeal, nasopharyngeal, and nasotracheal
suctioning.
RESPIRATORY SYSTEM
Promoting Oxygenation

Normal oxygenation depends on

essentially three factors.

• The integrity of the airway system to

transport air to and from the lungs.

• A properly functioning alveolar

system in the lungs to oxygenate
venous blood and to remove
carbon dioxide from the blood.

• A properly functioning
cardiovascular system to carry
nutrients and wastes to and from
body cells.
Nursing interventions to
help client maintain
normal respirations
includes:

1. Positioning the client to

allow for maximum
chest expansion
1. Fowler, semi-
fowler or high-
fowler’s position
2. Orthopneic
position
3. Tripod position
2. Encouraging or
providing frequent
changes in position
 3. Encouraging
deep breathing
and coughing
exercises
Nursing
interventions
to help client
maintain 4. Encouraging
ambulation
normal
respirations
includes:
5. Implementing
measures that promote
comfort, such as giving
pain medications as
ordered.
 Promoting Oxygenation

COUGHING AND DEEP BREATHING EXERCISES

Breathing exercises are designed to help patients achieve

more efficient and controlled ventilations, to decrease the
work of breathing and to correct respiratory defects.

For clients with conditions that increase secretions or impair

mobilization of secretions
 1. Deep Breathing Exercise

Breathing exercise are

frequently indicated for:
Clients with restricted
chest expansion, e.g.,
Chronic Obstructive
Pulmonary Disease
(COPD)
Clients recovering from
thoracic surgery.
A commonly employed
breathing exercise is
abdominal (diaphragmatic)
and pursed-lip breathing
1.1 Pursed-Lip breathing
• Patients who experience dyspnea and
feelings of panic can often gain control of
their respiration by using pursed-lip
breathing.

• Helps the client develop control over

breathing.

• The pursed lips creates a resistance to

the air flowing out of the lungs, thereby
prolonging exhalation and preventing
airway collapse by maintaining positive
airway pressure.

• The client purses the lips as if about to

whistle and breathes out slowly and
gently , tightening the abdominal
muscles to exhale more effectively.
 Pursed-Lip breathing

Step 1
 Breathe in slowly through your
nose for a count of 3.
Step 2
 Purse your lips as if you were
going to whistle.
Step 3
 Breathe out gently through pursed
lips, taking twice as long to exhale
as you took to breathe in. Let the
air escape naturally. Do not force
the air out of your lungs. Keep
doing pursed lip breathing until
you are not short of breath.
Pursed-Lip breathing
1.2 Abdominal or
Diaphragmatic Breathing

• Permits deep full breaths with

little effort.

• Many people with COPD have

the tendency to breathe in a
shallow, rapid, and exhausting
pattern. This type of upper
chest breathing can be changed
to diaphragmatic which will be
reducing the rate, increasing the
tidal volume, and reducing the
functional residual capacity.
 Abdominal or Diaphragmatic Breathing
1. Place client in a comfortable place to lie down or in sitting position.
When in lying position support head, neck and under the knees by
putting a pillow
2. Client may choose to close eyes or not.
3. The client is instructed to place one hand on the stomach and the
other on the middle of the chest.
4. The client then should breathe slowly to the count of four through
the nose, letting the abdomen protrude as far as it will go. Fill lungs
entirely and then hold the air in the lungs for another count of four.
5. Next, as the client exhale through pursed lips, count to four again
and feel your belly deflate and move back in toward the floor.
6. Hold for another count of four before repeating the exercise at least
two more times.
7. These steps should be repeated for 1minute followed by rest for 2
minutes at least 20 minutes per day (can be divided in two or four
sessions)
 Abdominal, Belly or
Diaphragmatic Breathing
1.3 Using Incentive Spirometer
• The client draws air through the spirometry device, which
measures the volume of air displaced by moving a float
ball or similar device up a column. Goals can be marked
on the spirometer and the client can compare his or her
progress, with the desired goal.
• Often performed in the care of postoperative clients and is
usually done every 1 to 2 hours while awake.
 Teaching Patients to use an
Incentive Spirometer
Assist the patient to upright position if
possible.
Demonstrate how to steady the device
with one hand and hold mouthpiece
with the other hand.
Instruct patient to exhale normally and
then place lips securely around
mouthpiece.
Instruct patient not to breathe through
his nose.
Instruct the patient to inhale slowly
and as deeply as possible through the
mouthpiece.
Tell patient to hold breath and count to
three. Check position of gauge to
determine progress and level attained.
Instruct patient to remove lips from
mouthpiece and exhale normally.
2. Coughing • Effective coughing techniques
may need to be taught to the
client experiencing either short-
term or chronic airway
obstruction.

• Coughing is an important
element of postoperative care
in order to prevent pulmonary
complications.

• One technique that may be

useful is “huffing”, or
delivering a series of short,
forceful exhalations, prior to
actual coughing. The intent is
to raise the sputum to the level
where it can then be coughed
out.
 2. Coughing
▪ If the client is recovering from thoracic
or abdominal surgery, splinting the
incision by holding a pillow firmly
against it will reduce the pain caused by
coughing.

▪ In most cases, assisting the client to a

sitting position will increase the
effectiveness of the cough.

▪ Assess the sputum produced by

coughing, noting the amount, color and
odor.

▪ Recognize that the client may become

fatigued after coughing and need a rest
period; also offer oral care such as
mouth rinse after sputum has been
expectorated.
 Coughing
STEP 1. STEP 5.
 Take a slow deep breath using  Inhale by sniffing gently. Taking
diaphragmatic breathing. Building in a big breath after coughing only
up a volume of air behind the causes you to cough again and
mucus helps to propel it toward may drive the mucus back into the
the mouth. lungs.
STEP 2. STEP 6.
 Pause  Rest.
STEP 3.  A drink of water taken prior to
coughing can be
 Cough twice with your mouth
slightly open. The first cough helpful. Coughing is easier when
you are in a sitting position with
loosens, and the second cough
your head slightly
moves the mucus.
forward. Controlled, effective
STEP 4. coughing should make a hollow
 Pause. sound.
 Huff Coughing Technique
(Forced Expiratory Technique)

Sit up Sit up straight with chin tilted slightly up

Take a slow deep breath to fill lungs about

Take three quarters full.

Hold Hold breath for two or three seconds.

Exhale forcefully, but slowly, in a continuous

Exhale exhalation to move mucus from the smaller
to the larger airways.

Repeat this maneuver two more times and

Repeat then follow with one strong cough to clear
mucus from the larger airways.

Do a cycle of four to five huff coughs as

Do part of your airway clearance.
 3. OXYGEN THERAPY
 refers to the administration of the supplemental oxygen by a
device such as nasal cannula, nasal catheter or mask.
 General Information:
 1. The procedure is indicated after surgery or for any
condition that caused hypoxia such as pneumonia,
congestive heart failure, lung tumors or degenerative lung
disease.

 2. A dependent nursing function, oxygen therapy

requires a physician’s order specifying administration
method, amount of oxygen to be given, and duration of
treatment.

 3. Special storage facilities, flow control devices,

humidifying devices and oxygen delivery equipment are
required.
 Oxygen
1.Oxygenis a colorless, tasteless,
odorless gas.
2.It
is considered a safety hazard if exposed
to intense heat, combustible materials,
sparks or fires.
3.Because oxygen is a dry gas, it dehydrates
both tissues and secretions; it is humidified
by adding water through a bubbler or
humidifier.
4.Oxygen is available at the bedside through
piped-in (or wall) and portable (in a
cylinder) units.
5.Portableoxygen is stored in small or large
green cylinders under high pressure and
labeled “oxygen”; large cylinders can be
heavy and difficult to handle.
 Oxygen
 Oxygen is a colorless,
tasteless, odorless gas.

 Oxygen is available at the

bedside through
 piped-in (or wall) and
portable (in a cylinder)
units.

 Portable oxygen
 Oxygen
 oxygen is a dry gas; it
dehydrates both tissues
and secretions; it is
humidified by adding
water through a bubbler
or humidifier.
 Oxygen flow is
controlled by a flow
meter (regulator), and
instrument that
regulated the amount of
oxygen (in liters per
minute) released from a
source.
 Precautions for Oxygen Administration
To prevent fires and injuries, the following precautions must be
taken:

• Avoid open flames in the patient’s room.

• Place NO SMOKING signs in appropriate place in the

patient’s room or home. Instruct the patient and visitors
about the hazard of smoking when oxygen is in use.

• Check to see that electric equipment used in the room such

as electric bell cords, razors, radios, and suctioning
equipment, is in good working order and emits no spark.

• Avoid wearing and using synthetic fabrics that build up

static electricity.

• Avoid using oils in the area. Oil can ignite spontaneously in

the presence of oxygen.
Oxygen Administration
1. Nasal Cannula

Purposes:
• To provide oxygen to a
client with hypoxia or
hypoxemia.

• To provide oxygen to a
client at risk of hypoxia
or hypoxemia (for
example, to a woman in
labor with a fetus at risk
for hypoxia).
1. Nasal Cannula
 The cannula is a disposable, plastic
device with two protruding
prongs for insertion into the
nostrils;
 the cannula is connected to an
oxygen source with a humidifier
and flow meter.
 The cannula does not impede
eating or speaking and is easy to
use at home.
 Disadvantages of this system
are that in can easily be dislodged
and can cause dryness of the nasal
mucosa.
PROCEDURES:
a. Administering Oxygen with Nasal Cannula
1. Assess the client for signs and symptoms of hypoxia; ensure a
patent airway and remove airway secretions if necessary;
review the client’s most recent ABG results.
2. Consult the physician’s order for oxygen delivery method, flow
rate and duration of therapy; notify the institution’s respiratory
therapy department, if one exists.
3. Assemble required oxygen delivery equipment; nasal cannula,
oxygen tubing, oxygen source distilled water for
humidification, flow meter.
4. Wash hands, then add sterile water to the indicated level on
the humidification bottle or use prefilled disposable bag or
bottle.
5. Attach a nasal cannula to the humidified oxygen source,
using connective tubing as necessary.
PROCEDURES:
a. Administering Oxygen with Nasal Cannula
6. Adjust the oxygen flow rate to the prescribed amount; if the
physician’s order does not specify rate, set 2 L/m and then
ask the physician to specify rate.
7. Ensure that oxygen is flowing from the cannula outlets and
that water in the humidifying device is bubbling.
8. Place cannula tips or nasal prongs into the client’s nostrils.
9. Adjust the tubing around the client’s ears and use a plastic
slide to secure the tubing under the chin or place an elastic
band around the client’s head above the ears.
10. Provide sufficient slack in the tubing and secure it to the
patient’s gown.
11. Recheck and adjust oxygen flow as necessary to maintain
the prescribed rate.
Sample Documentation
 2/23/22 0730
Returned from XRay Room with
complaints of dyspnea. Resp.
26/min, shallow. P-92, BP 160/90.
Skin warm, no cyanosis. Lung
sounds clear, no retractions. O2
per nasal cannula applied @ 2
L/min.––––J. Ignacio, RN

 2/23/22 0930
No further complaints of dyspnea.
RR= 20 bpm, PR=88bpm, B=
140/90mmHg, SpO2 96%. O2 per
nasal cannula continues @ 2
L/min.––––J. Ignacio, RN
Nasal Cannula Oxygen
Administration
 2. Nasal, or Oropharyngeal Catheter

 A nasal, or oropharyngeal catheter is another efficient means

for administering oxygen, but it is infrequently used because it is
uncomfortable for the patient and may cause trauma to
respiratory mucous membranes.
 It is inserted into the throat through one nostril and must be
changed to the other nostril every 8 hours. Gastric distention
often occurs because the gas flow can be misdirected into the
stomach.
3. Oxygen Face Mask
 Disposable and reusable
face masks are available in
plastic or rubber.

 The mask should be fitted

carefully to the patient’s face
to avoid leakage of oxygen.

 The most commonly used

types of masks include the:
1. simple mask
2. partial rebreather mask
3. Nonrebreather mask
4. venturi mask
 3.1. Simple
Oxygen Mask
 This mask has vents
on its sides that
allow room air to
leak in at many
places, thereby
diluting the source
oxygen, and exhaled
carbon dioxide to
escape. Often, it is
used when an
increased delivery of
oxygen is needed for
short periods.
Oxygen Face Mask (Simple)
O2 Administration
3.2. Partial Rebreather Mask
• Is equipped with reservoir bag for
the collection of the first part of the
patient’s exhaled air. The remaining
exhaled air exists through vents.
• The air in the reservoir is mixed
with 100% oxygen for the next
inhalation. The patient thus
rebreathes about one third of the
expired air from the reservoir bag.
• The type of mask permits the
conservation of oxygen.
• An additional advantage is that the
patient can inhale room air through
openings in the mask if the oxygen
supply is briefly interrupted.
 2. Partial
Rebreather
Mask

 The
disadvantages
are those of any
mask; eating
and drinking are
difficult. A tight
seal is required,
and there is the
potential for skin
breakdown
3.3. Non-rebreather Mask

 This provides the highest

concentration of oxygen
with a mask to
spontaneously breathing
patient.
 It is similar to the partial
rebreather mask except
two one-way valves
prevent rebreathing
exhaled air.
 The reservoir bag is filled
with oxygen that enters
the mask on inspiration.
Non-rebreather Mask
O2 Administration
 3.4. Venturi
Mask
 Got its name from the Venturi
effect, which allows the mask
to deliver the most precise
concentrations of oxygen.
 The mask has a large tube with
an oxygen inlet. As the tube
narrows, the pressure drops,
causing air to be sucked in
through side ports.
 Nursing responsibility to make
sure the ports are always open.
 Venturi Mask
O2 Administration
 Oxygen hood

4. Oxygen Tent “bubble helmet”

 Oxygen also can be

administered by way of a
tent--a light, portable
structure made of clear
plastic and attached to a
motor-driven unit. The motor
helps to circulate and cool
the air in the tent.
 The cooling device functions
like an electric refrigeration
unit. A thermostat in the unit
kept the tent at the
temperature considered
most comfortable for the
patient.
 The tent fits over the top part
of the bed to that the
patient’s head and thorax
are inside.
4. Oxygen Tent
 It has side openings through which nursing care can be
administered.
 It is commonly used with children who need a cool and
highly humidified airflow. The tent does not allow the
maintenance of a satisfactory or precise oxygen
administration and thus is rarely used except for children.
b. Administering Oxygen with a Mask
1. Follow the first steps in using a nasal cannula.
2. Place the client in a semi-fowler’s position or high-
fowler’s position.
3. For a simple mask, set oxygen flow to the
prescribed amount, usually 6 to 10 lpm.
4. As the client exhaled, position the mask from the
nose downward; fasten the elastic band over the
client’s ears and tighten so that the mask fits
snugly.
5. Check for leaks around the mask edges.
6. For a partial rebreathing or nonrebreathing mask,
open the oxygen flow to 8 to 10 lpm; after placing
the mask to the client’s face, pull it back and slip
the thumb to the reservoir bag outlet and allow the
bag to fill completely; remove the thumb and
adjust the mask as needed.
 5. Using Artificial Airways
Oropharyngeal and Nasopharyngeal
Airways
 An oropharyngeal or nasopharyngeal
airway is a semi-circular tube of plastic
or rubber inserted into the back of the
pharynx through the mouth or nose in a
spontaneously breathing patient.
 It is used to keep the tongue clear of
the airway permit suctioning of
secretions. (prevent aspiration)
 It is often used for postoperative
patients until they regain
consciousness.
 It is important to not use tape to hold it
in place because the patient should be
able to expel through the airway once
he or she becomes alert.
 Oropharyngeal and
Nasopharyngeal Airways
 6. Endotracheal Tube
 An endotracheal tube is a polyvinylchloride airway
that is inserted through the nose or the mouth into the
trachea using a laryngoscope as a guide.

 It is use to administer oxygen by mechanical ventilator,

to suction secretions easily, or to bypass upper airway
obstruction.

 Although uncomfortable and easy to manipulate with

the tongue, orotracheal insertion is often the method of
choice, especially in an emergency, because insertion
is easier, and a larger-sized tube can be used making
ventilation easier.
Instruments for Intubation
7. Tracheostomy
A tracheostomy is an artificial opening made into the trachea.
The curved tracheostomy tube inserted into this opening is made of
semi-flexible plastic, rigid plastic, or metal and comes in multiple sizes
with varied angles. A tracheostomy tube consists of an outer cannula
or main shaft, the inner cannula and an obturator.
Nebulization
NEBULIZATION
Patients use nebulizers to disperse fine particles of
medication into the deeper passages of the respiratory
tract where absorption occurs.

Inhaled medication may be administered to:

• open narrow airways,
• to liquefy or loosen thick secretions, or
• to reduce inflammation in airways.

2 Common types
1. Small volume nebulizer
2. Metered dose inhaler (MDI)
Small volume nebulizer
 Small Volume Nebulizer
• is used until all the medication in the nebulizer cup has
been inhaled
The basic steps Wash Wash your hands well.

to set up and
use your Connect Connect the hose to an air compressor.

nebulizer are as Fill the medicine cup with your prescription. To

follows: Fill avoid spills, close the medicine cup tightly and
always hold the mouthpiece straight up and
down.

Attach Attach the hose and mouthpiece to the medicine

cup.

Place the mouthpiece in your mouth. Keep your

Place lips firm around the mouthpiece so that all of
the medicine goes into your lungs.
Breathe through your mouth until all the
Breathe medicine is used. This takes 10 to 15 minutes. If
through needed, use a nose clip so that you breathe
only through your mouth. Small children usually
do better if they wear a mask.

Turn off Turn off the machine when done.

Wash Wash the medicine cup and mouthpiece with

water and air dry until your next treatment.
How to Properly Use a Nebulizer?
How to Properly Clean a Nebulizer?
 Metered Dose
Inhaler (MDI)
 deliversa controlled
dose of medication
with each
compression of the
canister, whereas a
small volume
nebulizer is used until
all the medication in
the nebulizer cup has
been inhaled.
How to use MDI?
How to Properly Use MDI?
SUCTIONING
SUCTIONING
▪ If the patient is unable to remove secretions with
coughing after the application of artificial airways,
secretions can be aspirated with suctioning device.

▪ Suctioning irritates the mucosa and removes oxygen in

the respiratory tract, possibly causing hypoxemia. Thus,
the patient must be hyper oxygenated before
suctioning.

▪ Tracheal suctioning may be performed by passing a

sterile catheter through the mouth, through the nose,
through the endotracheal tube, or through a
tracheostomy tube.
SUCTIONING
➢ When performed correctly, suctioning provides
comfort by relieving respiratory distress.

➢ When performed incorrectly, it can increase anxiety

and pain and cause respiratory arrest.

➢ Possible complications includes infection, cardiac

arrhythmias, hypoxia, mucosa trauma and death.
 Performing Nasopharyngeal and
Oropharyngeal Suctioning
Equipment:
• Suction source (wall suction regulator with collection bottle
or portable suction machine.
• Sterile suction kit (contains suction catheter, sterile gloves,
sterile solution container; may contain a small container of
sterile normal saline).
• Sterile water-soluble lubricant
• Extension tubing connected to suction device.
• Small bottle of sterile water or normal saline if not included in
the kit
• Personal protective devices: gown, mask and goggles or
face shield if splattering is likely (e.g., a client with vigorous
productive cough).
Performing Nasopharyngeal and
Oropharyngeal Suctioning
PROCEDURES:
1. Assess the client’s need for suctioning; inability to effectively clear
the airway by coughing and expectoration; coarse bubbling or
gurgling noises with respiration.

2. Choose the most appropriate route (nasopharyngeal or

oropharyngeal) for your client. If nasopharyngeal approach is
considered, inspect the nares with the penlight to determine
patency. Alternatively, you may assess patency by occluding
each nare in turn with finger pressure while asking the client to
breathe through the remaining nare.

3. Explain the procedure to the client. Advise that suctioning may

cause coughing or gagging but emphasize the importance of
clearing the airway.
4. Wash your hands.
5. Position the client in a high Fowler’s or semi Fowler’s position.
If the client is unconscious or otherwise unable to protect his or her
airway, place in a side-lying position.
6. Connect extension tubing to suction device if not already in place
and adjust suction control to between 110 and 120 mmHg.
7. Put on gown and mask and goggles or face shield if indicated.
8. Using sterile technique, open the suction kit. Consider the inside
wrapper of the kit to be sterile and spread the wrapper out
carefully to create a small sterile field.
9. Open a packet of sterile water-soluble lubricant and squeeze out
the contents of the packet onto the sterile field.
10.If sterile solution (water or saline) is not included in the kit, pour
about 100 ml of solution into the sterile container provided in the
kit.
12. Carefully lift the wrapped gloves from the kit without touching the
inside of the kit or the gloves themselves. Lay the wrapped gloves
down next to the suction kit and open the wrapper. Put on the
gloves using sterile gloving technique.
13. If a cup of sterile solution is included in the suction kit, open it.
14. Designate one hand as sterile (able to touch only sterile items) and
the other as clean (able to touch only nonsterile items).
15. Using your sterile hand, pick up the suction catheter. Grasp the
plastic connector end between your thumb and forefinger and coil
the tip around your remaining fingers.
16. Pick up the extension tubing with your clean hand. Connect the
suction catheter to the extension tubing, taking care not to
contaminate the catheter.
17. Position your clean hand with the thumb over the catheter’s suction
port.
18.Dip the catheter tip into the sterile solution and activate the suction.
Observe as the solution is drawn into the catheter.
19.For
oropharyngeal suctioning, ask the patient to open his or her
mouth. Without activating the suction, gently insert the catheter and
advance it until you reach the pool of secretions or until client the
coughs
20.Fornasopharyngeal suctioning, estimate the distance from the tip of
the client’s nose to the earlobe and grasp the catheter between
your thumb and forefinger at a point equal to this distance from the
catheter’s lip.
21.Dip
the tip of the suction catheter into the water-soluble lubricant to
coat catheter tip liberally.
22.Insertthe catheter tip into the nares with the suction control port
uncovered. Advance the catheter gently with a slight forward slant.
Slight rotation of the catheter may be used to ease insertion.
Advance the catheter to the point marked by your thumb and
forefinger.
23. If resistance is met, do not force the catheter.
Withdraw it and attempt insert via the opposite nare.
24. Apply suction intermittently by occluding the suction
control port with your thumb; at the same time, slowly
rate the catheter by rolling it between your thumb
and fingers while slowly withdrawing it. Apply suction
for no longer than 15 seconds at a time.
25. Repeat step 24 until all secretions had been cleared,
allowing brief rest period between suctioning
episodes.
26. Withdraw the catheter by looping it around your
fingers as you pull it out.
27. Dip the catheter tip into the sterile solution and apply
suction.
28. Disconnect the catheter from the extension tubing.
Holding the coiled catheter in your gloved hand,
remove the glove by pulling it over the catheter.
Discard catheter and gloves in an appropriate
container.
29. Discard remaining supplies in the appropriate container.
30. Wash your hands.
31. Provide the client with oral hygiene if indicated or
desired.
32. Document the procedure, noting the amount, color,
and odor of secretions and the client’s response to the
procedure.
Nasotracheal, Nasopharyngeal and
Oropharyngeal Suctioning
PROVIDING
POSTURAL
DRAINAGE
PROVIDING POSTURAL DRAINAGE
In postural drainage, gravity is used to drain secretions from
the lungs. The patient is positioned in a way that promotes
the drainage of secretion from the smaller pulmonary
branches into larger ones, where they can be removed by
drainage or coughing. Postural drainage is often preceded
by vibration, percussion, or both to loosen secretions. Postural
drainage is carried out as follows.
1. Having tissues and emesis basin close at hand for the
patient to use when coughing and expectorating
secretions.
2. Placing the patient in an appropriate position to
promote drainage from the lobes of the lungs, as
follows:
 Use high Fowler’s position to drain the apical sections of the upper
lobes of the lungs.
 Place the patient in a lying position, half on the abdomen and half
on the side, right and left, to drain the posterior sections of the upper
lobes of the lungs.
 Place the patient lying on the left side with a pillow under the chest
wall to drain the right lobe of the lungs.
 Place the patient in Trendelenburg’s position to drain the lower lobes
of the lungs.
PROVIDING POSTURAL DRAINAGE
3. Carry out postural drainage two to four times a
day for 20 to 30 minutes. Discontinue the
drainage if the patient begins to feel weak or
faint.
4. Delay postural drainage for 1 to 2 hours after
meals to avoid vomiting.

* Those with congestive heart failure or

increased intracranial pressure particularly will
not be able to tolerate a head-down position.
 PERCUSSION (Physiotherapy)
 involves using a
cupped hand to beat
firmly on the chest
wall; a firm rubber cup
size appropriate to the
client’s body size may
also be used.

 Cup your hands when

performing chest
percussions.
VIBRATIONS
 Vibration gently shakes the
mucus into the larger airways.

 place a hand firmly on the

chest wall over the part of the
lung being drained and tenses
the muscles of the arm and
shoulder to create a fine
shaking motion.

 Vibration is done with the

flattened hand or place 1 hand
over the other hand

 Exhalation should be as slow

and as complete as possible.
PROVIDING Chest Physical Therapy
(Chest Physiotherapy)
Remember in Physiotherapy
 Generally, each treatment session can last for 20 to
40 minutes.
 best done before meals or one and a half to two hours
after eating, to decrease the chance of vomiting.
 Early morning and bedtimes are usually
recommended.
 The length of CPT and the number of times of day it is
done may need to be increased if the person is more
congested or getting sick.
 The doctor will help you know what positions, how
often and how long CPT should be done.
Remember:
 Refrain from percussing over the spine, liver, kidneys, or
spleen to avoid injury to the spine or internal organs.
 Avoid performing percussion on bare skin or the female
client'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 client.
 Bronchodilators should be given before the procedure
as ordered
 Antibiotics are given after the procedure as ordered
 Ex. Doctor’s order: Salbutamol neb, 1 nebule
q6 then apply CPT for 10-15 minutes
 Return Demonstration:
Breathing and Coughing Techniques
Learning Objective: Students will be able to demonstrate
breathing and coughing techniques accurately.

 Purposes:

• Describe nursing measures to promote respiratory

function and oxygenation.
• Verbalize and demonstrate the steps used in:
o pursed-lip breathing
o diaphragmatic breathing
o huff-cough technique
Thank you for listening!