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Optimum respiratory health is not possible without clearing secretions in the airway. Normally, a healthy person can get rid of these secretions in two ways: (1) mucociliary clearance system and (2) coughing. However, presence of diseases such as asthma, cystic fibrosis, cerebral palsy, dystrophy of the muscles and immunodeficiency, can cause poor lung health and inability to clear out excretions. Inability to clear the lungs of these discharges can lead to complications and causes an individual to experience difficulty of breathing. When breathing becomes a hard work it can lead to inflammatory episodes, respiratory infections, increase mucus production and worst airway obstruction. This is where chest physiotherapy comes in. It helps in minimizing the risks of ineffective airway clearance due to obstruction.

Description:

Chest physiotherapy, also known as chest physical therapy, is a group of techniques that mobilizes or loosens thick secretions in the lungs and respiratory tract. It includes postural drainage, chest percussion and vibration, coughing and deep breathing exercises.

Purpose:

Performing chest physical therapy techniques expand the lungs, strengthen the muscles used for breathing, thereby improving lung function and helping one breath better. It helps treat patients diagnosed with cystic fibrosis and COPD (chronic obstructive pulmonary disease). Post-operatively, it helps in keeping lungs clear from thick secretions preventing pneumonia. Performing the techniques to a bedridden patient is critically important as helps prevent or treat atelectasis and pneumonia.

Contraindications:

  1. Active pulmonary bleeding with hemoptysis and the immediate posthemorrhagic stage
  2. Fractured ribs or an unstable chest wall
  3. Lung contusions
  4. Pulmonary tuberculosis
  5. Untreated pneumothorax
  6. Acute asthma or bronchospasm
  7. Lung abscess or tumor
  8. Bony metastasis
  9. Head injury
  10. Recent myocardial infarction
  11. Vomiting
  12. Immediately after eating

Equipment Needed:

  1. Stethoscope
  2. Pillows
  3. Tilt or postural drainage table or adjustable hospital bed
  4. Emesis basin
  5. Facial tissues
  6. Suction equipment
  7. Equipment for oral care
  8. Trash bag (optional)
  9. Sterile specimen container
  10. Mechanical ventilator
  11. Supplemental oxygen

Preparation of Equipment:

  1. Gather equipment at the patient’s bedside.
  2. Set up suction equipment, if needed, and test its function.

Implementation:

  1. Confirm patient identity.
  2. Explain the procedure to the patient, provide privacy and wash hands.
  3. Auscultate patient’s lungs to determine baseline respiratory status.
  4. Position patient as ordered. In generalized diseases, drainage start at the lower lobes moving on to the middle lobes and ends with the upper lobes. For localized diseases, drainage begin with the affected lobes then to the other lobes to prevent spreading of diseases to uninvolved areas.
  5. Instruct patient to remain in each position for 3-15 minutes. (see various position for postural drainage below) During this time, perform percussion and vibration as ordered.
  6. After postural drainage, vibration or percussion, instruct the patient to cough. Doing this removes loosened discharges. Instruct patient to inhale deeply though his nose and then exhale in three short buffs. Then have him/her inhale deeply again and cough through a slightly opened mouth. Three consecutive coughs are highly effective. An effective cough sounds deep, low and hollow whereas an ineffective one is high-pitched.
  7. Provide oral hygiene since oral secretions may have a foul taste or smell.
  8. Auscultate the patient’s lungs to evaluate effectiveness of therapy.

Chest Physiotherapy Techniques:

  1. Postural Drainage

It is the sequential repositioning of the patient to encourage emptying of peripheral pulmonary discharges by gravity to the major bronchi or trachea when performed with percussion and vibration. The following are the various postural drainage position and the areas of the lungs affected:

postural drainage positions
Photo credit: mosby’s nursing suite

Positions for Postural Drainage

Adult
BilateralHigh fowler’s position
Apical segmentsSitting on side of bed
Right upper lobe – anterior segmentSupine with head elevated
Left upper lobe – anterior segmentSupine with head elevated
Right upper lobe – posterior segmentSide lying with right side of chest elevated on pillows
Left upper lobe – posterior segmentSide lying with left side of chest elevated on pillows
Right middle lobe – anterior segment¾ supine position with dependent lung in Trendelenburg position
Right middle lobe – posterior segmentProne with thorax and abdomen elevated
Both lower lobes – anterior segmentSupine in Trendelenburg
Left lower lobe – lateral segmentRight side-lying in Trendelenburg position
Right lower lobe – lateral segmentLeft side-lying in Trendelenburg position
Right lower lobe – posterior segmentProne with right side of chest elevated in Trendelenburg position
Both lower lobes – posterior segmentProne in Trendelenburg position
Child
Bilateral – apical segmentsSitting on nurse’s lap leaning slightly forward flexed over pillow
Bilateral – middle anterior segmentsSitting on nurse’s lap, leaning against the nurse
Bilateral lobes – anterior segmentsLying supine on nurse’s lap, back supported with pillow

 Chart Source: Fundamentals of Nursing 3rd Edition, Potter and Perry

  1. Percussion

Percussion loosens and mobilizes retained secretions with cupped hands. To facilitate dislodgment of thick, tenacious secretion from the bronchial walls, the nurse claps the specific lobe or segment with cupped hands.

  1. Vibration

Vibration is an alternative method to percussion. Since the latter is quite uncomfortable and tiring, vibration is done to patients who are in pain, frail or recovering from thoracic surgery or trauma.

There are variety of techniques employed by nurses to treat lung diseases, included in the choices are postural drainage, suctioning and breathing exercises. The choice of therapy is based on the patient’s diagnosis and overall condition.

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Daisy Abastar holds a degree in Bachelor of Science in Nursing. Her work experiences include Nursing Local Board Examination Reviewer, Clinical Instructor, NC2 Examination Reviewer and Caregiver Lecturer. Subjects handled: Psychiatric, Obstetric, Pediatric and Fundamentals of Nursing. She also specialized in these areas: ER, Orthopedic Ward and the DR. In addition to passing NLE, she also passed IELTS examination. Her written works are combined learning from theoretical to actual nursing background and ongoing research.