CH II: chest physiotherapy [discussion]

chest percussion; tracheobronchial tree

_____ refers to a series of manipulative techniques designed to assist with bronchial hygiene: the mobilization of secretions from the _____

1. Prophylaxis to prevent retained secretions

2. Improve mobilization of secretions

3. Improve distribution of ventilation

4. Promote more efficient breathing patterns

5. Promote effective cough

goals of chest percussion include:

1. Acute pulmonary disease with copious secretions

2. Acute lobar atelectasis

Acute conditions that are indications to chest percussion include:

1. Exacerbation of COPD w/ scant secretions <25 ml per day

2. Pneumonia w/o sputum production, e.g., viral

3. Status asthmaticus

4. Status Post (S/P) coronary artery bypass graft surgery (CABG)

Acute conditions of questionable benefits that are indications to chest percussion include:

1. Chronic production of large amounts (>30 ml/day) of secretions

2. Cystic fibrosis

3. Bronchiectasis

4. Chronic bronchitis

5. Lung abscess

Chronic conditions that are indications to chest percussion include:

lung abscess

pus within the lungs is termed as what?

empyema

pus within pleural space is termed as what?

Chest tube drainage

what intervention is required for empyema?

1. Hypoxemia when affected side is dependent

2. Cardiovascular instability

3. Internal hemorrhage post surgery

4. Hemoptysis after lung surgery

5. Fractured ribs, e.g., osteoporosis

6. Increased ICP

7. Dyspnea

8. Pain

9. Vomiting

10. Wheezing

11. Bronchospasm

12. Acute hypotension

13. Aggravate lung contusion

Hazards/complications of chest percussion include:

1. Hemoptysis after lung resection

2. Uncontrolled hypertension

3. ICP > 20 mm Hg

4. Status: Post neurosurgery, aneurysm, eye surgery

5. Suspected TB

6. Osteomyelitis

7. Osteoporosis

8. Chest pain

9. Resected tumors of the thorax or neck

Contraindications of chest percussion include:

trap air; popping

When using the hand percussion technique, cupped hand will _____ to cause a _____ sound on contact

1. cover sheet

2. patient gown

Before using the hand percussion technique, use 1 of 2 things over px’s skin. These 2 things are:

extended; tensed

When using the vibes percussion technique, arms are _____ and _____ when pushed firmly.

chest; exhalation

When using the vibes percussion technique, arms are tensed when pushed firmly against px’s _____ during _____.

chest; exhalation

When using the shaking percussion technique, shake hands on px’s _____ during _____.

1. hand

2. vibes

3. shaking

Percussion techniques include:

false. this is for CHEST PERCUSSION

this is the correct hand position for vibration. true or false?

1. before meals

2. at least 1-2 hours after eating

3. early morning

4. at bed time

When is it best to do CPT?

makes it less likely that a patient will feel sick to the stomach/throw up

rationale for doing CPT before meals/at least 1-2 hours after eating?

helps remove the mucus that built up overnight

rationale for doing CPT at early morning?

1. takes out the mucus of the day

2. helps the child cough less at night

rationale for doing CPT at bed time?

take off all of it

person doing the CPT should do what on the jewelry on their hands or wrists?

1. it is tight

2. it has thick seams

3. it has buttons

remove clothes of px ONLY if?

1. wear a t-shirt

2. put a soft cloth over the spot that will be percussed

after removal of clothing of px as appropriate, what is done to px prior to percussion?

false. this is for VIBRATION

this is the correct hand position for chest percussion. true or false?

vibration

this process helps to gently shake mucus and secretions into the large airways, making them easier to cough up.

1. flat; chest wall; lung segment

2. arm; shoulder

3. light

4. shaking

vibration is done by:

1. place your _____ hand firmly against the _____, atop the appropriate _____ to be drained

2. stiffen your _____ and _____

3. apply _____ pressure

4. create _____ movement

postural drainage; tracheobronchial tree; gravity

_____ is method of removing pooled secretions in the _____ by positioning the patient to allow _____ to assist in the movement of secretions.

1. Facilitate mobilization of secretions in the bronchial tree

2. Improve distribution of ventilation

3. Improve gas exchange by improving V/Q mismatch

goals of postural drainage include:

eurt

Indications of postural drainage are same as for chest percussion. true or false?

eurt

postural drainage is indicated for those who do not tolerate percussion. true or false?

1. Unstable hemodynamics

2. Untreated hypertension

3. Internal and external head injuries

4. Gross obesity

5. Empyema

6. Severe dyspnea at rest in high Fowlers or supine

7. Recent meals or tube feedings

8. Spinal cord injuries

contraindications of postural drainage include:

allow ≥ 30 mins after meals/tube feedings

for recent meals/tube feedings to not be a contraindication to postural drainage, what is done prior?

near vertical position

in postural drainage, patient is positioned so that the diseased area are in _____.

1. location of mucus obstruction

2. severity of mucus obstruction

3. duration of mucus obstruction

in postural drainage, position assumed is determined by:

1. tachycardia

2. palpitations

3. dyspnea

4. chest pain

postural drainage is discontinued if the following symptoms occur:

1. explain to patient

2. unconscious; large

3. Trendelenburg position

in terms of moving px into position in postural drainage procedure, nurse must:

1. _____ what you will be doing

2. ask for help if patient is _____ and _____

3. move patient into position prior to placing bed into _____

1. alert; SOB

2. move into position; assist

in terms of explaining to patient what you will be doing prior to postural drainage, nurse must consider:

1. If patient is _____, let him or her know to let you know if he or she experiences:

   1. _____

   2. Headache

   3. Pain

2. If patient is ambulatory, ask him or her to _____; _____ if necessary

1. turned; you [nurse]

2. pain; breathing distress

3. between knees; bone to bone contact

4. pillow

in terms of positioning patient for safety and comfort in postural drainage procedure, nurse must: [1st-4th step]

1. Patient should always be _____ and face _____

2. Monitor patient’s facial expressions for _____, discomfort, and signs of _____

3. Adjust patient’s arms and legs using pillows placed _____; avoid _____

4. Support the head with a _____

5. back and abdomen

6. IV lines; urinary catheter

7. your [nurse’s]

8. up; opposite

in terms of positioning patient for safety and comfort in postural drainage procedure, nurse must: [5th-8th step]

5. Tuck pillow behind _____ and _____ for stability

6. Watch for _____ and _____

7. Urinary catheter should be placed on _____ side

8. Make sure side rails are _____ at side _____ you [nurse]

1. diaphragmatic

2. prescribed

3. cupped; 1-2

4. slowly and deeply; pursed lip

steps for postural drainage include:

1. Instruct the client to use _____ breathing

2. Position the patient in _____ postural drainage position

3. Percuss with _____ hands over the chest wall for _____ minutes

4. Instruct the patient to inhale _____. Vibrate the chest wall as the patient exhale slowly through _____ breathing.

1. spine

2. liver

3. kidneys

4. spleen

5. breast

6. scapula

7. clavicle

8. sternum

when doing postural drainage, avoid clapping over what organs?

1. top; rib cage

2. moderate; downward

3. thorax; inhales

4. cough; 3-4

in context of instructing the patient to inhale slowly and deeply & vibrating the chest wall as the patient exhale slowly through pursed lip breathing, several steps are done:

1. Place one hand on:

   1. _____ of the other over affected area

   2. Each side of the _____

2. Tense muscles of the hands and arms while applying _____ pressure ______ and vibrate arms and hands

3. Relieve patient’s _____ as the patient _____

4. Encourage to _____ after _____ vibrations.

false, this is used for chest palpation, percussion, AND auscultation too

the pattern in the image is used for chest palpation and percussion ONLY. true or false?

rest station to—walang need sagutan, for now

appreciate your lungs challenge

both upper lobes apical

what position is this?

left upper lobe anterior

what position is this?

left upper lobe posterior

what position is this?

left upper lobe lingula

what position is this?

right upper lobe anterior

what position is this?

right upper lobe posterior

what position is this?

right middle lobe

what position is this?

both lower lobes superior

what position is this?

both lower lobes anterior

what position is this

both lower lobes posterior

what position is this?

left lower lobe lateral segment

what position is this?

right lower lobe lateral segment

what position is this?

upper lobes apical segments

what part of lungs is shaded in the image?

1. bed/flat surface

2. headboard of bed/caregiver

To drain mucus from the upper lobe apical segments, the patient sits in a comfortable position on _____/_____ and leans on a pillow against _____/_____.

1. collar bone and very top of shoulder blades; 3-5

2. deep breath; during percussion

3. percuss

After px is positioned to drain mucus from the upper lobe apical segment, nurse:

1. Percusses and vibrates over muscular area between _____ and _____ on both sides for _____ minutes

2. Encourages the patient to take a _____ and cough _____ in order to help clear the airways

3. Does not _____ over bare skin

upper lobes posterior segments

what part of lungs is shaded in the image?

1. chair/side of bed; dangling

2. both; upper back

To drain mucus from the upper lobe posterior segments,

1. Patient sits comfortably in _____/_____ and leans over, arms _____ against pillow

2. Caregiver percusses and vibrates using _____ hand/s over _____ on both right and left sides

upper lobes anterior segments

what part of lungs is shaded in the image?

1. flat; head and legs

2. front of chest; collar bone and nipple

To drain mucus from the upper lobe anterior segments,

1. patient lies _____ on the bed or table with a pillow for comfort under their _____ and _____

2. caregiver percusses and vibrates the right and left sides of the _____, between the _____ and _____

lingula

what part of lungs is shaded in the image?

1. down; right; quarter-turn towards back; behind; bent

2. just outside nipple area

To drain mucus from the lingula,

1. Patient lies with their head _____ toward the foot of the bed on the _____ side, hips and legs up on pillows. The body should be rotated about a _____ towards _____. A pillow can also be placed _____ the patient and their legs slightly _____ with another pillow between the knees.

2. Caregiver percusses and vibrates _____.

middle lobe

what part of lungs is shaded in the image?

1. head-down; right; as high as possible; slightly bent

2. just outside right nipple area

To drain mucus from the middle lobe,

1. Patient lies _____ on his side, a quarter-turn toward back with the _____ arm up and out of the way. The legs and hips should be elevated _____. A pillow may be placed in back of the patient and between _____ legs.

2. Caregiver percusses and vibrates _____.

lower lobes anterior basal segments

what part of lungs is shaded in the image?

1. right; foot; as high as possible on pillows; slightly bent

To drain mucus from the lower lobes anterior basal segments,

1. Patient lies on his _____ side with his head facing the _____ of the bed and a pillow behind his back. The hips and legs should be elevated _____ on _____. The knees should be _____ and a pillow should be placed between them for comfort.

lower lobes posterior basal segments

what part of lungs is shaded in the image?

1. stomach; elevated

2. lower part; spine; spine and lower ribs

To drain mucus from the lower lobes posterior basal segments,

1. Patient lies on their ______, with the hips and legs _____ by pillows

2. Caregiver percusses and vibrates at the _____ of the back, over the left and right sides of the _____, careful to avoid the _____ and _____.

lower lobes lateral base segments

what part of lungs is shaded in the image?

1. right/left; one-quarter of a turn; top

2. uppermost; lower; left/right; opposite

To drain mucus from the lower lobes lateral base segments,

1. Patient lies on his _____ side, leaning forward about _____ with hips and legs elevated on pillows. The _____ leg may be flexed over a pillow for support and comfort.

2. Caregiver percusses and vibrates over the _____ portion of the _____ part of the _____ ribs. This should then be repeated on the _____ side, with percussion and vibration over the uppermost portion of the right side of the lower ribs.

lower lobes superior segments

what part of lungs is shaded in the image?

1. stomach; 2; under hips

2. bottom; shoulder blades; spine itself

To drain mucus from the lower lobes superior segments,

1. Patient lies on his _____ on a flat bed or table. _____ pillows should be placed _____.

2. Caregiver percusses and vibrates over the _____ part of the _____, on both the right and left sides of the spine, avoiding direct percussion or vibration over the _____.

Upper lobe; anterior segment (sitting, leaning back slightly)

what position is this?

Upper lobe; apical segment (sitting, leaning forward slightly)

what position is this?

Upper lobe; anterior segment (lying flat on back)

what position is this?

Middle lobe (on side, tilted back slightly)

what position is this?

Posterior lobe (lying on stomach)

what position is this?

Lingula (lying on side)

what position is this?

Lower right lobe (lying on side, tilted forward)

what position is this?

Lower left lobe (lying on stomach)

what position is this?