Chest Physiotherapy Procedures

Camarlnes Sur olyLechnlc Colleges
CCLLLGL CI nLAL1n CAkL 1LCnNCLCG

c4 ll 8osic Nursinq Procedures on Oxyqenotion
1
CnLS1 nSC1nLkA
lL ls lndlcaLed for paLlenLs ln whom cough ls lnsufflclenL Lo clear Lhlck Lenaclous or locallzed secreLlons Lxamples lnclude
O CysLlc flbrosls
O 8ronchlecLasls
O ALelcLasls
O Lung abscess
O neuromuscular dlseases
O neumonlas ln dependenL lung reglons
Contra|nd|cat|ons of Chest hys|otherapy
O lncreased lC
O unsLable head or neck ln[ury
O AcLlve hemorrhage wlLh hemodynamlc lnsLablllLy or hemopLysls
O 8ecenL splnal ln[ury or ln[ury
O Lmpyma
O 8ronchoplueral flsLula
O 8lb fracLure
O lall chesL
O unconLrolled hyperLenslon
O AnLlcoagulaLlon
O 8lb or verLebral fracLures or osLeoporosls

Assessment for Chest hys|otherapy
nurslng care and selecLlon of C1 skllls are based on speclflc assessmenL flndlngs 1he followlng are Lhe assessmenL crlLerla
O now Lhe norma| range of pat|ent's v|ta| s|gns CondlLlons requlrlng C1 such aLelecLasls and pneumonla affects vlLal
slgns
O now Lhe pat|ent's med|cat|ons CerLaln medlcaLlons parLlcularly dlureLlcs anLlhyperLenslve cause fluld and haemodynamlc
changes 1hese decrease paLlenL's Lolerance Lo poslLlonal changes and posLural dralnage
O now Lhe paLlenL's med|ca| h|story cerLaln condlLlons such as lncreased lC splnal cord ln[urles and abdomlnal aneurysm
resecLlon conLra lndlcaLe Lhe poslLlonal change Lo posLural dralnage 1horaclc Lrauma and chesL surgerles also conLralndlcaLe
percusslon and vlbraLlon
O now Lhe paLlenL's cogn|t|ve |eve| of funct|on|ng arLlclpaLlng ln conLrolled cough Lechnlques requlres Lhe paLlenL Lo follow
lnsLrucLlons
O eware of pat|ent's exerc|se to|erance C1 maneuvers are faLlgulng Cradual lncrease ln acLlvlLy and Lhrough C1 paLlenL
Lolerance Lo Lhe procedure lmproves
C||n|ca| f|nd|ngs and |nvest|gat|ons
O ueLalled PlsLory
O hyslcal examlnaLlon
O lnspecLlon
O alpaLlon
O ercusslon
O AusculLaLlon
O lnvesLlgaLlons
O xray
O 8lood lnvesLlgaLlonsbleedlng and cloLLlng parameLers
1echn|ques |n Chest hys|otherapy
O A nurse or resplraLory LheraplsL may admlnlsLer C1 alLhough Lhe Lechnlques can ofLen be LaughL Lo famlly members of paLlenLs
O 1he mosL common procedures used are posLural dralnage and chesL percusslon ln whlch Lhe paLlenL ls roLaLed Lo faclllLaLe
dralnage of secreLlons from a speclflc lobe or segmenL whlle belng clapped wlLh cupped hands Lo loosen and moblllze reLalned
secreLlons LhaL can Lhen be expecLoraLed or dralned
O 1he procedure ls somewhaL uncomforLable and Llrlng for Lhe paLlenL
1 ercuss|on
O ChesL percusslon lnvolves sLrlklng Lhe chesL wall over Lhe area belng dralned
O ercusslng lung areas lnvolves Lhe use of cupped palm Lo loosen pulmonary secreLlons so LhaL hey can be expecLoraLed wlLh ease
O ercusslng wlLh Lhe hand held ln a rlgld domeshaped poslLlon Lhe area over Lhe lung lobes Lo be dralned ln sLruck ln rhyLhmlc
paLLern
O usually Lhe paLlenL wlll be poslLloned ln suplne or prone and should noL experlence any paln

2
O Cupplng ls never done on bare skln or performed over surglcal lnclslons below Lhe rlbs or over Lhe splne or breasLs because of
Lhe danger o Llssue damage
O 1yplcally each area ls percussed for 30 Lo 6oseconds several Llmes a day
O lf Lhe paLlenL has Lenaclous secreLlons Lhe area musL be percussed for 33 mlnuLes several Llmes per day aLlenLs may learn how
Lo percuss Lhe anLerlor chesL as well
2 I|brat|on
O ln vlbraLlon Lhe nurse uses rhyLhmlc conLracLlons and relaxaLlons ls or her arm and shoulder muscles whlle holdlng Lhee paLlenL
flaL on Lhe paLlenL's chesL as Lhe paLlenL exhales
O 1he purpose ls Lo help loosen resplraLory secreLlons so LhaL Lhey can be expecLoraLed wlLh ease vlbraLlon (aL a raLe of 200 per
mlnuLe) can be done for several Llmes a day
O 1o avold paLlenL causlng dlscomforL vlbraLlon ls never done over Lhe paLlenL's breasLs splne sLernum and rlb cage
O vlbraLlon can also be LaughL Lo famlly members or accompllshed wlLh mechanlcal devlce
rocedure ercuss|on I|brat|on
O lnsLrucL Lhe paLlenL use dlaphragmaLlc breaLhlng
O oslLlon Lhe paLlenL ln prescrlbed posLural dralnage poslLlons Splne should be sLralghL Lo promoLe rlb cage expanslon
O ercuss or clap wlLh cupped hands or chesL wall for 3 mlnuLes over each segmenL for 3 mlnuLes for cysLlc flbrosls and 12 mlnuLes
for oLher condlLlons
O Avold clapplng over splne llver spleen breasL scapula clavlcle or sLernum
O lnsLrucL Lhe paLlenL Lo lnhale slowly and deeply vlbraLe Lhe chesL wall as Lhe paLlenL exhales slowly Lhrough Lhe pursed llps
O lace one hand on Lop of Lhe oLher affecLed over area or place one hand place one and on each slde of Lhe rlb cage
O 1ense Lhe muscles of Lhe hands and hands whlle applylng moderaLe pressure downward and vlbraLe arms and hands
O 8elleve pressure on Lhe Lhorax as Lhe paLlenL lnhales
O Lncourage Lhe paLlenL cough uslng abdomlnal muscles afLer Lhree or four vlbraLlons
O Allow Lhe paLlenL resL several Llmes
O LlsLen wlLh sLeLhoscope for changes ln breaLh sounds
O 8epeaL Lhe percusslon and vlbraLlon cycle accordlng Lo Lhe paLlenL's Lolerance and cllnlcal response usually 1330 mlnuLes
ostura| Dra|nage
O osLural dralnage ls Lhe poslLlonlng Lechnlques LhaL draln secreLlons from speclflc segmenLs of Lhe lugs and bronchl lnLo Lhe
Lrachea
O 8ecause some paLlenLs do noL requlre posLural dralnage for all lung segmenLs Lhe procedure musL be based on Lhe cllnlcal
flndlngs
O ln posLural dralnage Lhe person ls LllLed or propped aL an angle Lo help draln secreLlons from Lhe lungs
O Also Lhe chesL or back may be clapped wlLh a cupped hand Lo help loosen secreLlonsLhe Lechnlque called chesL percusslon
O osLural dralnage cannoL be used for people who are
4 unable Lo LoleraLe Lhe poslLlon requlred
4 are Laklng anLlcoagulaLlon drugs
4 have recenLly vomlLed up blood
4 have had a recenL rlb or verLebral fracLure or
4 have severe osLeoporosls
O osLural dralnage also cannoL be used for people who are unable Lo produce any secreLlons (because when Lhls happens furLher
aLLempLs aL posLural dralnage may lower Lhe level of oxygen ln Lhe blood)
rocedure
O 1he paLlenLs body ls poslLloned so LhaL Lhe Lrachea ls lncllned downward and below Lhe affecLed chesL area
O osLural dralnage ls essenLlal ln LreaLlng bronchlecLasls and paLlenLs musL recelve physloLherapy Lo learn Lo Llp Lhemselves lnLo a
poslLlon ln whlch Lhe lobe Lo be dralned ls uppermosL aL leasL Lhree Llmes dally for 1020 mlnuLes
O 1he LreaLmenL ls ofLen used ln con[uncLlon wlLh Lhe Lechnlque for loosenlng secreLlons ln Lhe chesL cavlLy called chesL percusslon
ArLlcles requlred
O lllows
O 1llL Lable
O SpuLum cup
O aper Llssues
SLeps
1 use speclflc poslLlons so Lhe force of gravlLy can asslsL ln Lhe removal of bronchlal secreLlons from affecLed lung segmenLs Lo
cenLral alrways by means of coughlng and sucLlonlng
2 1he paLlenL ls poslLloned so LhaL Lhe dlseased area ls ln a near verLlcal poslLlon and gravlLy ls used Lo asslsL Lhe dralnage of speclflc
segmenL
3 1he poslLlons assumed are deLermlned by Lhe locaLlon severlLy and duraLlon of mucous obsLrucLlon


4 1he exerclses are performed Lwo Lo Lhree Llmes a day before meals and bedLlme Lach poslLlon ls done for 313 mlnuLes
3 1he procedure should be dlsconLlnued lf Lachycardla palplLaLlons dyspnea or chesL occurs 1he se sympLoms may lndlcaLe
hypoxemla ulsconLlnue lf hemopLysls occurs
6 8ronchodllaLors mucolyLlcs agenLs waLer or sallne may be nebullsed and lnhaled before posLural dralnage and chesL percusslon
Lo reduce bronchospasm decrease Lhlckness of mucus and spuLum and combaL edema of Lhe bronchlal walls Lhere by enhanclng
secreLlon removal
7 erform secreLlon removal procedures before eaLlng
8 Make sure paLlenL ls comforLable before Lhe procedure sLarLs and as comforLable as posslble he or she assumes each poslLlon
9 AusculLaLe Lhe chesL Lo deLermlne Lhe areas of needed dralnage
10 Lncourage Lhe paLlenL Lo deep breaLhe and cough afLer spendlng Lhe alloLLed Llme ln each poslLlon
11 Lncourage dlaphragmaLlc breaLhlng Lhrough ouL posLural dralnage Lhls helps wlden alrways so secreLlons can be dralned
os|t|ons
ADUL1
Lung segmenL oslLlon recommended
8llaLeral Plgh lowler's
AplcalrlghL upper lobeanLerlor
segmenL
SlLLlng on slde of Lhe bed
Suplne wlLh head elevaLed
LefL upper lobeanLerlor Suplne wlLh head elevaLed
8lghL upper lobeposLerlor Sldelylng wlLh rlghL slde of Lhe chesL
elevaLed on plllows
LefL upper lobeposLerlor Sldelylng wlLh lefL slde of Lhe chesL
elevaLed on plllows
8lghL Mlddle lobeanLerlor segmenL 1hreefourLh suplne poslLlon wlLh
dependenL lung ln 1rendelenburg's
poslLlon
8lghL Mlddle lobeposLerlor
segmenL
rone wlLh Lhorax and abdomen
elevaLed
8oLh lower lobesanLerlor segmenLs Suplne ln 1rendelenburg's poslLlon
LefL lower lobe laLeral poslLlon 8lghL sldelylng ln 1rendelenburg's
poslLlon
8lghL lower lobelaLeral segmenL LefL sldelylng ln 1rendelenburg's
poslLlon
8lghL lower lobeposLerlor segmenL rone wlLh rlghL slde of chesL elevaLed ln
1rendelenburg's poslLlon
8oLh lower lobesposLerlor segmenL rone ln 1rendelenburg's poslLlon
CnLD
8llaLeralAplcal segmenLs SlLLlng on nurse's lap leanlng sllghLly
forward flexed over plllow
8llaLeralmlddle anLerlor segmenLs SlLLlng on nurse's lap leanlng agalnsL
nurse
8llaLeral anLerlor segmenLs Lylng suplne on nurse's lap back
supporLed wlLh plllow
CompllcaLlons
CompllcaLlons are unusual buL lnclude
O poslLlonrelaLed hypoxla
O asplraLlon of secreLlons ln oLher lung reglons
O hypoLenslon
Cough|ng
O coughlng genLly or maklng shorL grunLlng nolses wlLh Lhe mouLh sllghLly open wlll help loosen Lhe mucus
O uo Lhls perlodlcally LhroughouL Lhe dralnage procedure
Contro||ed Cough|ng 1echn|que
O ConLrolled coughlng ls one of Lhe essenLlal Lechnlques ln good resplraLory care
O aLlenL perform Lhls maneuver afLer each dralnage poslLlon and ofLen LhroughouL Lhe day
O 1he abdomlnal muscles are very powerful muscles used ln coughlng and exhallng
O lnhale deeply Lhrough Lhe nose
O ause
O Cough 2 Lo 3 sharp sLaccaLo cough wlLh proper hand/arm placemenL


O 8reaLhe ln easlly Lhrough Lhe nose

S1LAM NnALA1CN
lL a dependenL nurslng funcLlon PeaL appllcaLlon requlres a physlclan's order
urposes
1 Llquefy mucous secreLlons
2 1o warm humldlfy lnsplred alr
3 8elleve edema of alrways
4 SooLhe lrrlLaLed alrways
3 AdmlnlsLer medlcaLlons
nurslng lnLervenLlons
O lnform Lhe cllenL and explaln Lhe purpose of Lhe procedure 1o allay anxleLy
O CllenL Semlfowler's poslLlon lor maxlmum lnhalaLlon of sLeam
O Cover Lhe cllenL's eyes wlLh wash cloLh Lo prevenL lrrlLaLlon
O Check elecLrlcal devlce before use Lo prevenL ln[ury
O lace Lhe sLeam lnhalaLor ln a flaL sLable surface Lo prevenL scaldlng from Lhe hoL waLer
O lace Lhe spouL 12 18 lnches away from Lhe cllenL's nose or ad[usL Lhe dlsLance as necessary
O 1o be effecLlve render sLeam lnhalaLlon Lherapy for 13 Lo 20 mlnuLes
O lnsLrucL Lhe cllenL Lo perform deep breaLhlng coughlng exerclses afLer Lhe procedure 1o faclllLaLe expecLoraLlon of secreLlons
O erform oral care
O uocumenL

SUC1CNNG NASCnAkNGLAL AND CkCnAkNGLAL AkLAS

1 ueLermlne need for sucLlonlng AdmlnlsLer paln medlcaLlon before sucLlonlng Lo posLoperaLlve paLlenL
2 Lxplaln procedure Lo paLlenL
3 Assemble equlpmenL
4 erform hand hyglene
3 Ad[usL bed Lo comforLable worklng poslLlon Lower slde rall closeL Lo you lace paLlenL ln a semllowler's poslLlon lf he or she ls
consclous An unconsclous paLlenL should be placed ln Lhe laLeral poslLlon faclng you
6 lace Lowel or waLerproof pad across paLlenL's chesL
7 1urn sucLlon Lo approprlaLe pressure
a Wall unlL
AdulL 100 Lo 120 cm Pg
Chlld 93 Lo 110 cm Pg
lnfanL 30 Lo 93 cm Pg
b orLable unlL
Chlld 3 Lo 10 cm Pg
lnfanL 2 Lo 3 cm Pg
8 Cpen sLerlle sucLlon package SeL up sLerlle conLalner Louchlng only Lhe ouLslde surface and pour sLerlle sallne lnLo lL
9 uon sLerlle gloves 1he domlnanL hand LhaL wlll handle caLheLer musL remaln sLerlle whereas Lhe nondomlnanL hand ls consldered
clean raLher Lhan sLerlle
10 WlLh sLerlle gloves 1he domlnanL hand plck up sLerlle caLheLer and connecL Lo sucLlon Lublng held wlLh unsLerlle hand
11 MolsLen caLheLer by dlpplng lL lnLo conLalner of sLerlle sallne Ccclude ?Lube Lo check sucLlon
12 LsLlmaLe Lhe dlsLance form earlobe Lo nosLrll and place Lhumb and foreflnger of gloved hand aL LhaL polnL on caLheLer
13 CenLly lnserL caLheLer wlLh sucLlon off by leavlng Lhe venL on Lhe ?connecLor open Sllp caLheLer genLly along Lhe floor of an
unobsLrucLed nosLrll Loward Lrachea Lo sucLlon Lhe nasopharynx Cr lnserL caLheLer along slde of mouLh Loward Lrachea Lo sucLlon Lhe
oropharynx never apply sucLlon as caLheLer ls lnLroduced
14 Apply sucLlon by accordlng sucLlonlng porL wlLh your Lhumb CenLly roLaLe caLheLer as lL ls belng wlLhdraw uo noL allow sucLlonlng Lo
conLlnue for more Lhan 10 Lo 13 seconds aL a Llme
13 llush Lhe caLheLer wlLh sallne and repeaL sucLlonlng as needed and accordlng Lo paLlenL's LoleraLlon of Lhe procedure
16 Allow aL leasL a 20 Lo 30second lnLerval lf addlLlonal sucLlonlng ls needed 1he nares should be alLernaLed when repeaLed sucLlonlng
requlred uo noL force Lhe caLheLer Lhrough Lhe nares Lncourage paLlenL Lo cough and breaLhe deeply beLween sucLlonlng
17 When sucLlonlng ls compleLed remove gloves lnslde ouL and dlspose of gloves caLheLer and conLalner wlLh soluLlon ln proper
recepLacle erform hand hyglene
18 use ausculLaLlon Lo llsLen Lo chesL and breaLh sounds Lo assess effecLlveness of sucLlonlng
19 8ecord Llme of sucLlonlng and naLure and amounL of secreLlons Also noLe Lhe characLer of Lhe paLlenL's resplraLlons before and afLer
sucLlonlng


20 Cffer oral hyglene afLer sucLlonlng

ISUC1CNNG 1nL 1kACnLCS1CM

1 Lxplaln Lhe procedure Lo Lhe paLlenL and reassure hlm or her LhaL you wlll lnLerrupL Lhe procedure lf Lhe paLlenL lndlcaLes resplraLory
dlfflculLy AdmlnlsLer paln medlcaLlon Lo posLoperaLlve paLlenL before sucLlonlng
2 CaLher equlpmenL and provlde prlvacy for paLlenL
4 AsslsL Lhe paLlenL Lo a semllowler's or lowler's poslLlon lf consclous An unconsclous paLlenL should be placed ln Lhe laLeral poslLlon
faclng you
3 1urn sucLlon Lo approprlaLe pressure
a Wall unlL
Chlld 93 Lo 110 cm Pg
lnfanL 30 Lo 93 cm Pg
b orLable unlL
Chlld 3 Lo 10 cm Pg
lnfanL 2 Lo 3 cm Pg
6 lace clean Lowel lf belng used across paLlenL's chesL uon goggles mask and gown lf necessary
7 Cpen sLerlle klL or seL up equlpmenL and prepare Lo sucLlon
a lace sLerlle drape lf avallable across paLlenL's chesL

6
b Cpen sLerlle conLalner and place on bedslde Lable or overbed Lable wlLhouL conLamlnaLlng lnner surface our sLerlle sallne lnLo lL
c PyperoxygenaLe paLlenL uslng manual resusclLaLlon bag or slgh mechanlsm on mechanlcal venLllaLor
d uon sLerlle gloves or one sLerlle glove on domlnanL hand and clean glove on nondomlnanL hand
e ConnecL sLerlle sucLlon caLheLer Lo sucLlon Lublng held wlLh unsLerlle gloved hand
8 MolsLen caLheLer by dlpplng lL lnLo Lhe conLalner of sLerlle sallne unless lL ls one of Lhe newer slllcone caLheLers LhaL does noL requlre
lubrlcaLlon
9 8emove oxygen dellvery seLup wlLh unsLerlle gloved hand lf lL ls sLlll ln place
10 uslng sLerlle gloved hand genLly and qulckly lnserL caLheLer lnLo Lhe Lrachea Advance abouL 10 Lo 123 cm (43 lnches) or unLll paLlenL
coughs uo noL occlude ?porL when lnserLlng caLheLer
11 Apply lnLermlLLenL sucLlon by occludlng ?porL wlLh Lhumb and lndex flnger of sLerlle gloved hand as caLheLer ls belng wlLhdraw uo noL
allow sucLlonlng Lo conLlnue for more Lhan 10 seconds PypervenLllaLe Lhree Lo flve Llmes beLween sucLlonlng or encourage paLlenL Lo
cough and deep breaLhe beLween sucLlonlng
12 llush caLheLer wlLh sallne and repeaL sucLlonlng as needed and accordlng Lo paLlenL's Lolerance of Lhe procedure Allow paLlenL Lo resL
aL leasL 1 mlnuLe beLween sucLlonlng and replace oxygen dellvery seLup lf necessary LlmlL sucLlonlng evenLs Lo Lhree Llmes
13 When procedure ls compleLed Lurn off sucLlon and dlsconnecL caLheLer from sucLlon Lublng 8emove gloves lnslde ouL and dlspose of
gloves caLheLer and conLalner wlLh soluLlon ln proper recepLacle erform hand hyglene
14 Ad[usL paLlenL's poslLlon AusculLaLe chesL Lo evaluaLe breaLh sounds
13 8ecord Llme of sucLlonlng and naLure and amounL of secreLlons Also noLe characLer of paLlenL's resplraLlons before and afLer
sucLlonlng
16 Cffer oral hyglene

IkCIDNG 1kACnLCS1CM CAkL

1 Lxplaln procedure Lo paLlenL
2 lf LracheosLomy Lube has been sucLloned remove solled dresslng from around Lube and dlscard wlLh gloves on removal
3 erform hand hyglene and open necessary supplles
C|ean|ng A Nond|sposab|e nner Cannu|a
1 repare supplles before cleanlng lnner cannula
1
a Cpen LracheosLomy care klL and separaLe baslns Louchlng only Lhe edges lf klL ls noL avallable open Lwo sLerlle baslns
b llll one basln fract|on Zlnch (123 cm) deep wlLh hydrogen peroxlde
c llll oLher basln fract|on Zlnch (123 cm) deep wlLh sallne
d Cpen sLerlle brush or plpe cleaners lf Lhey are noL already ln cleanlng klL Cpen addlLlonal sLerlle gauze pad
1 uon dlsposable gloves
2 8emove oxygen source lf one ls presenL 8oLaLe lock on lnner cannula ln a counLerclockwlse moLlon Lo release lL
3 CenLly remove lnner cannula and carefully drop lL ln basln wlLh hydrogen peroxlde 8emove gloves and dlscard
4 Clean lnner cannula
1
a uon sLerlle gloves
b 8emove lnner cannula from soaklng soluLlon MolsLen brush or plpe cleaners ln sallne and lnserL lnLo Lube uslng backandforLh
moLlon
c AglLaLe cannula ln sallne soluLlon 8emove and Lap agalnsL lnner surface of basln
d lace on sLerlle gauze pad
1 SucLlon ouLer cannula uslng sLerlle Lechnlque
2 8eplace lnner cannula lnLo ouLer cannula 1urn lock clockwlse and make sure LhaL lnner cannula ls secure 8eapply oxygen source lf
needed
kep|ac|ng D|sposab|e nner Cannu|a
1 8elease lock CenLly remove lnner cannula and place ln dlsposable bag ulscard gloves and don sLerlle ones Lo lnserL new cannula
8eplace wlLh approprlaLely slzed new cannula Lngage lock on lnner cannula
App|y|ng C|ean Dress|ng and 1ape
1 ulp coLLonLlpped appllcaLor ln sallne and clean sLoma under faceplaLe use each appllcaLor only once movlng from sLoma slLe
ouLward
2 Apply hydrogen peroxlde Lo area around sLoma faceplaLe and ouLer cannula lf secreLlons prove dlfflculL Lo remove 8lnse area wlLh
sallne
3 aL skln genLly wlLh dry 4 x 4 gauze
4 Sllde commerclally prepared LracheosLomy dresslng or prefolded noncoLLonfllled 4 x 4 dresslng under faceplaLe
3 Change LracheosLomy Lape
1
a Leave solled Lape ln place unLll new one ls applled
b CuL plece of Lape LhaL ls Lwlce Lhe neck clrcumference plus 4 lnches (10 cm) 1rlm ends on Lhe dlagonal

7
c lnserL one end of Lape Lhrough faceplaLe openlng alongslde old Lape ull Lhrough unLll boLh ends are even
d Sllde boLh Lapes under paLlenL's neck and lnserL one end Lhrough remalnlng openlng on oLher slde of faceplaLe ull snugly and Lle
ends ln double square knoL Check LhaL paLlenL can flex neck comforLably
e Carefully remove old Lape 8eapply oxygen source lf necessary
f 8emove gloves and dlscard erform hand hyglene Assess paLlenL's resplraLlons uocumenL assessmenLs and compleLlon of
procedure

I CkGLN 1nLkA

Cxygen therapy ls Lhe admlnlsLraLlon of oxygen as a LherapeuLlc modallLy lL ls prescrlbed by Lhe physlclan who speclfles Lhe
concenLraLlon meLhod of dellvery and llLer flow per mlnuLe
enef|ts of Cxygen 1herapy

Add|t|ona| enef|ts of Cxygen 1herapy
lncreased clarlLy
8elleves nausea
Can prevenL hearL fallure ln people wlLh severe lung dlsease
Allows Lhe bodles organs Lo carry ouL normal funcLlons
Long1erm enef|ts of Cxygen 1herapy
rolongs llfe by reduclng hearL sLraln
uecreases shorLness of breaLh
Makes exerclse more Lolerable
8esulLs ln fewer days of hosplLallzaLlon

Cxygen De||very Systems

1 Nasa| Cannu|a
Also called nasal prongs
ls Lhe mosL common lnexpenslve devlce used Lo admlnlsLer oxygen
lL ls easy Lo apply and does noL lnLerfere wlLh Lhe cllenL's ablllLy Lo eaL or Lalk
lL dellvers a relaLlvely low concenLraLlon of oxygen whlch ls 24 Lo 43 aL flow raLes of 2 Lo 6 llLers per
mlnuLe
2 Iace Mask
lL cover Lhe cllenL's nose and mouLh may be used for oxygen lnhalaLlon
LxhalaLlon porLs on Lhe sldes of Lhe mask allow exhaled carbon dloxlde Lo escape

8

1ypes of Iace Masks
1 S|mp|e Iace Mask uellvers oxygen concenLraLlons from 40 Lo 60 aL llLer flows of 3 Lo 8 llLers per mlnuLe respecLlvely
2 art|a| kebreather Mask uellvers oxygen concenLraLlon of 60 Lo 90 aL llLer flows of 6 Lo 10 llLers per mlnuLe respecLlvely
3 Non kebreather Mask uellvers Lhe hlghesL oxygen concenLraLlon posslble 93 Lo 100 by means oLher Lhan lnLubaLlon or
mechanlcal venLllaLlon aL llLer flows of 10 Lo 13 llLers per mlnuLe
4 Ientur| Mask uellvers oxygen concenLraLlons varylng from 24 Lo 40 or 30 aL llLer flows of 4 Lo 10 llLers per mlnuLe

Iace 1ent
lL can replace oxygen masks when masks are poorly LoleraLed by cllenLs
lL provlde varylng concenLraLlons of oxygen such as 30 Lo 30 concenLraLlon of oxygen aL 4
Lo 8 llLers per mlnuLe
1ranstrachea| Cxygen De||very
lL may be used for oxygendependenL cllenLs
1he cllenL requlres less oxygen (03 Lo 2 llLers per mlnuLe) because all of
Lhe low dellvered enLers Lhe lungs
Cxygen 1herapy Safety recaut|ons
1 lor home oxygen use or when Lhe faclllLy permlLs smoklng Leach famlly members and roommaLes Lo smoke only
ouLslde or ln provlded smoklng rooms away from Lhe cllenL
2 lace cauLlonary slgns readlng no Smoklng Cxygen ln use" on Lhe cllenLs door aL Lhe fooL or head of Lhe bed and on Lhe oxygen
equlpmenL
3 lnsLrucL Lhe cllenL and vlslLors abouL Lhe hazard of smoklng wlLh oxygen use
4 Make sure LhaL elecLrlc devlces (such as razors hearlng alds radlos Lelevlslons and hearlng pads) are ln good worklng order Lo prevenL
Lhe occurrence of shorLclrculL sparks
3 Avolds maLerlals LhaL generaLe sLaLlc elecLrlclLy such as woolen blankeLs and synLheLlc fabrlcs CoLLon blankeLs should be used and
cllenL and careglvers should be advlsed Lo wear coLLon fabrlcs
6 Avold Lhe use of volaLlle flammable maLerlals such as olls greases alcohol eLher and aceLone(eg nall pollsh remover) near cllenLs
recelvlng oxygen
7 Cround elecLrlc monlLorlng equlpmenL sucLlon machlnes and porLable dlagnosLlc machlnes
8 Make known Lhe locaLlon of Lhe flre exLlngulshers and make sure personnel are Lralned ln Lhelr use

IADMNS1LkNG CkGLN NASAL CANNULA
1 Lxplaln procedure Lo paLlenL and revlew safeLy precauLlons necessary when oxygen ls ln use lace no Smoklng slgn ln approprlaLe
areas

9
3 ConnecL nasal cannula Lo oxygen seLup wlLh humldlflcaLlon lf one ls ln use Ad[usL flow raLe as ordered by physlclan Check Lhe oxygen
ls flowlng ouL of prongs
4 lace Lhe prongs ln paLlenL's nosLrlls Ad[usL accordlng Lo Lype of equlpmenL
a Cver and behlnd each ear wlLh ad[usLer comforLably under chln or
b Around paLlenL's head
3 use gauze pads aL ear beneaLh Lublng as necessary
6 Lncourage paLlenL Lo breaLhe Lhrough nose wlLh mouLh closed
8 Assess and charL paLlenL's response Lo Lherapy
9 8emove and clean cannula and assess nares aL leasL every 8 hours or accordlng Lo agency recommendaLlons Check nares for evldence
of lrrlgaLlon or bleedlng

I ADMNS1LkNG CkGLN MAS
1 Lxplaln procedure Lo paLlenL and revlew safeLy precauLlons necessary when oxygen ls ln use lace no Smoklng slgns ln approprlaLe
areas
3 ALLach face mask Lo oxygen seLup wlLh humldlflcaLlon SLarL flow of oxygen Lo flll bag before placlng mask over paLlenL's nose and mouLh
4 oslLlon face mask over paLlenL's nose and mouLh Ad[usL lL wlLh Lhe elasLlc sLrap so mask flLs snugly buL comforLable on face
3 use gauze pads Lo reduce lrrlgaLlon on paLlenL's ears and scalp
7 8emove mask and dry skln every 2 Lo 3 hours lf oxygen ls runnlng conLlnuously uo noL powder around mask
8 Assess and charL paLlenL's response Lo Lherapy

kkkGA1NG A NASCGAS1kC 1UL CCNNLC1LD 1C SUC1CN
1 Check physlclan's order for lrrlgaLlon Lxplaln procedure Lo paLlenL
2 CaLher necessary equlpmenL Check explraLlon daLes on lrrlgaLlng sallne soluLlon and lrrlgaLlon seL
4 AsslsL paLlenL Lo semllowler's poslLlon unless conLralndlcaLed
3 Check placemenL of nasogasLrlc Lube (see Sklll 421 AcLlon 14)
6 our lrrlgaLlng soluLlon lnLo conLalner uraw up 30 mL of sallne soluLlon (or amounL ordered by physlclan) lnLo syrlnge uon nonsLerlle
gloves
7 Clamp sucLlon Lublng near connecLlon slLe ulsconnecL Lube from sucLlon apparaLus and lay on dlsposable pad or Lowel or hold boLh
Lubes uprlghL ln nondomlnanL hand
8 lace Llp of syrlnge ln Lube lf Salem sump or doublelumen Lube ls used make sure LhaL syrlnge Llp ls placed ln dralnage porL and noL ln
alr venL Pold syrlnge uprlghL and genLly lnserL Lhe lrrlganL (or allow soluLlon Lo flow ln by gravlLy lf agency or physlclan lndlcaLes) uo
noL force soluLlon lnLo Lube
9 lf unable Lo lrrlgaLe Lube reposlLlon paLlenL and aLLempL lrrlgaLlon agaln Check wlLh physlclan lf repeaLed aLLempLs Lo lrrlgaLe Lube fall
10 WlLhdraw or asplraLe fluld lnLo syrlnge lf no reLurn ln[ecL 20 cc of alr and asplraLe agaln
11 8econnecL Lube Lo sucLlon Cbserve movemenL of soluLlon or dralnage 8emove gloves
12 Measure and record amounL and descrlpLlon of lrrlganL and reLurned soluLlon
13 8alse equlpmenL lf lL wlll be reused
13 8ecord lrrlgaLlon procedure descrlpLlon of dralnage and paLlenL's response

k NCLN1IL SkCML1k

lncenLlve splromeLry also referred Lo as susLalned maxlmal lnsplraLlon (SMl) ls a componenL of bronchlal hyglene LherapylncenLlve
splromeLry ls deslgned Lo mlmlc naLural slghlng or yawnlng by encouraglng Lhe paLlenL Lo Lake long slow deep breaLhs 1hls ls
accompllshed by uslng a devlce LhaL provldes paLlenLs wlLh vlsual or oLher poslLlve feedback when Lhey lnhale aL a predeLermlned flowraLe
or volume and susLaln Lhe lnflaLlon for a mlnlmum of 3 seconds lncenLlve splromeLry should be conLrasLed wlLh explraLory maneuvers
(such as Lhe use of blow boLLles) LhaL do noL mlmlc Lhe slgh and have been assoclaLed wlLh Lhe producLlon of reduced lung volumes
Cb[ecLlves Cf 1hls rocedure
O lncrease Lranspulmonary pressure and lnsplraLory volumes
O lmprove lnsplraLory muscle performance
O and reesLabllsh or slmulaLe Lhe normal paLLern of pulmonary hyperlnflaLlon

10
When Lhe procedure ls repeaLed on a regular basls alrway paLency may be malnLalned and lung aLelecLasls prevenLed and
reversed
Sett|ngs
CrlLlcal care
AcuLe care lnpaLlenL
LxLended care and skllled nurslng faclllLy
Pome care
nd|cat|ons
resence of condlLlons predlsposlng Lo Lhe developmenL of pulmonary aLelecLasls
upperabdomlnal surgery
Lhoraclc surgery
surgery ln paLlenLs wlLh chronlc obsLrucLlve pulmonary dlsease (CCu)
resence of pulmonary aLelecLasls
resence of a resLrlcLlve lung defecL assoclaLed wlLh quadraplegla and/or dysfuncLlonal dlaphragm(
Contra|nd|cat|ons
aLlenL cannoL be lnsLrucLed or supervlsed Lo assure approprlaLe use of Lhe devlce
aLlenL cooperaLlon ls absenL or paLlenL ls unable Lo undersLand or demonsLraLe proper use of Lhe devlce
lS ls conLralndlcaLed ln paLlenLs unable Lo deep breaLhe effecLlvely (eg wlLh vlLal capaclLy vC less Lhan abouL 10 mL/kg or
lnsplraLory capaclLy lC less Lhan abouL one Lhlrd of predlcLed)
1he presence of an open Lracheal sLoma ls noL a conLralndlcaLlon buL requlres adapLaLlon of Lhe
nazards And Comp||cat|ons
lneffecLlve unless closely supervlsed or performed as ordered
lnapproprlaLe as sole LreaLmenL for ma[or lung collapse or consolldaLlon
PypervenLllaLlon
8aroLrauma (emphysemaLous lungs)
ulscomforL secondary Lo lnadequaLe paln conLrol
Pypoxla secondary Lo lnLerrupLlon of prescrlbed oxygen Lherapy lf face mask or shleld ls belng used
LxacerbaLlon of bronchospasm
laLlgue
L|m|tat|ons of Method
Lvldence suggesLs LhaL deep breaLhlng alone wlLhouL mechanlcal aldes can be as beneflclal as lncenLlve splromeLry ln prevenLlng or
reverslng pulmonary compllcaLlons and conLroversy exlsLs concernlng overuse of Lhe procedure
Assessment of Need
Surglcal procedure lnvolvlng upper abdomen or Lhorax
CondlLlons predlsposlng Lo developmenL of aLelecLasls lncludlng lmmoblllLy poor paln conLrol and abdomlnal blnders
resence of neuromuscular dlsease lnvolvlng resplraLory musculaLure
Assessment of Cutcome
O Absence of or lmprovemenL ln slgns of aLelecLasls
O decreased resplraLory raLe
O resoluLlon of fever
O normal pulse raLe
O absenL crackles (rales) or presence of or lmprovemenL ln prevlously absenL or dlmlnlshed breaLh sounds
O normal chesL xray
O lmproved arLerlal oxygen Lenslon (aC2) and decreased alveolararLerlal oxygen Lenslon gradlenL or (Aa)C2
O lncreased vC and peak explraLory flows
O reLurn of funcLlonal resldual capaclLy (l8C) or vC Lo preoperaLlve values4(1317) ln absence of lung resecLlon
O lmproved lnsplraLory muscle performance
O aLLalnmenL of preoperaLlve flow and volume levels1
O lncreased forced vlLal capaclLy (lvC)

k MLCnANCAL ILN1LA1CN
1 lndlcaLlons for Mechanlcal venLllaLlon
4 lmpendlng 8esplraLory lallure
rogresslvely worsenlng cllnlcal appearance
Worsenlng Cx8
Pypoxemlc 8esplraLory lallure
Pypercapnlc 8esplraLory lallure
4 AcuLe 8esplraLory lallure/ArresL

11
AcuLe change ln A8C resulLs
8esplraLory ArresL/SLaLus osL C8
AcuLe eplgloLLlLls/anaphylaxls
4 osLCperaLlvely
CversedaLlon/paralyLlcs
aln ConLrol
roper lmmoblllzaLlon
2 key 1erms ln Mechanlcal venLllaLlon
4 1ldal volume (vL)
1he volume of alr lnhaled and exhaled from Lhe lungs
4 8reaLhs per MlnuLe (88 f)
Also known as frequency
4 oslLlve Lnd LxplraLory ressure (LL)
MalnLenance of above aLmospherlc pressure aL Lhe alrway LhroughouL exp phase
3 key 1erms ln Mechanlcal venLllaLlon
4 MlnuLe venLllaLlon (vL)
1he LoLal amounL of volume movlng ln and ouL of Lhe lung ln one mlnuLe
4 lracLlonal lnsplred Cxygen (llC2)
CorrecLly wrlLLen wlLh declmal place (21021 10010)
4 lnsplraLoryLxplraLory 8aLlo (lL raLlo)
normal lL raLlo 123
4 negaLlve ressure venLllaLlon
4 8arely used CurrenLly used for paLlenLs wlLh neuromuscular dlseases
4 1horaclc cage ls encased where negaLlve pressure ls applled across Lhe chesL wall
4 CeneraLes subaLmospherlc pressures creaLlng a dlfference ln pressure gradlenLs
4 uurlng exhalaLlon negaLlve pressure ls replace by aLmospherlc pressure allowlng Lhe lungs Lo deflaLe
3 negaLlve ressure venLllaLlon
4 1ypes of negaLlve ressure venLllaLors
6 lron Lung clrca 1930's
7 Modern(lzed) lron Lung
8 ChesL Culrass
9 CompllcaLlons wlLh negaLlve ressure venLllaLlon
4 LlmlLed access for paLlenL care
4 lnablllLy Lo properly monlLor pulmonary mechanlcs
4 aLlenL dlscomforL
10 oslLlve ressure venLllaLlon
4 ueflned as Lhe appllcaLlon of pressure Lo Lhe lungs ln order Lo lmprove gas exchange
4 1he Lungs are physlcally fllled/venLllaLed wlLh alr uslng machlnery
4 MulLlple modes meLhods and Lheory
11 oslLlve ressure venLllaLlon
4 8aslcally broken lnLo Lwo caLegorles
ConLrol Modes
SupporLlve Modes
12 ConLrol Modes of venLllaLlon
4 AsslsL/ConLrol (usually abbrevlaLed A/C also known as volume ConLrol vC)
1ldal volume ls seL and remalns consLanL
8esplraLory 8aLe ls seL
Alrway ressure wlll vary accordlng Lo lung compllance
venLllaLor wlll dellver seL volume wheLher paLlenL Lrlggers a breaLh or mandaLory breaLh ls belng dellvered
4 ressure ConLrol venLllaLlon (usually abbrevlaLed Cv or someLlmes Cl8v)
upper Alrway ressure Level ls seL and remalns consLanL
1ldal volumes wlll vary accordlng Lo lung compllance
venLllaLor wlll dellver seL pressure level wheLher paLlenL Lrlggers a breaLh or mandaLory breaLh ls belng
dellvered
4 ressure 8egulaLed volume ConLrol (usually abbrevlaLed 8vC)
1ldal volume ls seL however may or may noL remaln consLanL

12
venLllaLor wlll dellver volume however volume may decrease accordlng Lo paLlenL's lung compllance
A lung proLecLlve mode
13 SupporLlve Modes of venLllaLlon
4 Synchronlzed lnLermlLLenL MandaLory venLllaLlon (usually abbrevlaLed SlMv)
1ldal volume ls seL and dellvered on each mandaLory breaLh
When a paLlenL Lrlggers Lhe venLllaLor sponLaneously Lhe paLlenL recelves a ressure SupporLed breaLh
4 ressure SupporL venLllaLlon (Sv)
ls a sLrlcLly paLlenL dependanL mode paLlenL musL be breaLhlng sponLaneously
An upper (lnsplraLory) pressure level ls ad[usLed Lo provlde adequaLe Lldal volumes for each paLlenL Lrlggered
breaLh
LL ls also ad[usLed as an lndependenL pressure from Lhe upper pressure level and ls acLlve durlng explraLlon
Sv ls a weanlng mode
4 volume SupporL (vS)
1ldal volume ls seL
Lach sponLaneous breaLh ls supporLed wlLh dlaled volume
4 ConLlnuous (ConsLanL) oslLlve Alrway ressure (CA)
Closely resembles ressure SupporL however CA ls a consLanL seL pressure LhaL does noL change durlng
lnsplraLlon or explraLlon
CA ls a weanlng mode
19 urager LvlLa ll
20 urlLan 8enneLL 840
21 Servo 900c
22 Servo 300a
23 Servo l
24 Cne of Lhe MosL lamous venLllaLors
23 CompllcaLlons Lo Mechanlcal venLllaLlon
4 venLllaLor lnduced Lung ln[ury (vlLl)
lnduced by excesslve pressure (baroLrauma)
lnduced by excesslve volume (voluLrauma)
4 venLllaLor AssoclaLed neumonla (vA)
MosL commonly seudomonas Cram negaLlve 8acllll and sLaphylococcl
26 venLllaLory ulsconLlnuance
4 Weanlng
rocess of dlsconLlnulng venLllaLory supporL regardless of Lhe Llme frame lnvolved
CaLegorles
;ulck removal rouLlne
More gradual reducLlon ln supporL (Lrach collar Lrlals)
venLllaLor dependenL paLlenLs
27 venLllaLory ulsconLlnuance
4 Success ln dlsconLlnulng venLllaLory supporL ls relaLed Lo Lhe paLlenLs condlLlons ln four maln areas
venLllaLory workload
CxygenaLlon sLaLus
Cardlovascular funcLlon
sychologlcal facLors

Chest Physiotherapy Procedures

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