postural drainage, percussion and shaking

conditions that may utilize these techniques

cystic fibrosis

CHF w secretion issues not edema

bronchial pathology

-prevent accumulation of secretions in pt at risk for pulm complications

-remove accumulated secretions from lungs

indications

pt w secretion retention may have impaired ventilation, resp and aerobic capacity due to secretion production and accumulation

postural drainage, percussion, and shaking can help remove secretion and improve ventilation and gas exchange

Contradictions postural drainage

severe hemoptysis (coughing up blood)

untreated acute conditions
-severe pulm edema
-CHF
-large pleural effusion
-pulm embolism

pneumothorax

cardiovascular instability
-cardiac arrhythmia
-severe HTN/hypotension
-recent MI
-unstable angina

recent neurosurgery
-head-down positioning may cause inc Intracranial pressure, if PD is required, modified positions can be used

Contraindications for percussions

over fx, spinal fusion or osteoporotic bone

over tumor area

if pt has pulm embolus

if pt has condition in which hemorrhage could easily occur, like low platelet count, or receiving anticoagulation therapy

if pt has unstable angina

if pt has chest wall pain, after thoracic sx or trauma

precautions for trendelengberg position

circulatory: CHF (w pulm edema), HTN

Pulmonary: pulm edema, SOB made worse w lowered head pos

abdominal: obesity, abdominal distention, hiatal hernia, nausea, recent food consumption or any specific precautions

precuation for sidelying position

vascular: axillofemoral bypass graft

Musculoskeletal: arthritis, recent rib fx, shld bursitis, tendonitis, any pt specific precaution

postural drainage

pt hould be positioned so that bronchus of involved lung segment is perpendicular to the ground

percussion

force is applied rhythmically within therapist's cupped hands to the pt chest wall over the targeted segment,

administered 3-5min over each targeted segment

shaking/ vibration

bouncing maneuver applied to the rib cage throughout the expiratory phase of breathing

airway clearance

coughing or huffing is typically used. huffing helps prevent an inc in the intrathoracic pressure