Chest Physical Therapy-mine

Chest Physical Therapy Prepared by: Nestlee Sio Cabaccan RN,MSN

What is chest physiotherapy? 

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Percussion and vibration over the thorax to loosen secretion from the affected area of the lungs (W. saunders 7th edition). It is a treatment that helps to remove the excess secretions (also called mucus, phlegm, sputum ) from inside the lungs, by physical means.

Purpose:  

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It is used to assists a cough re- educate breathing muscles to try to improve ventilation of the lungs. reduces the chance of lung infection and makes breathing more comfortable.

What are the excess secretions and what causes them? 

When there is a chest infection or occasionally in other situations, this fluid increases and become thick and putrid.

When should chest physiotherapy be done?   

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Chest physiotherapy should never be done straight after a meal or drink. For a meal wait one hour and after a drink wait ½ hour. Chest physiotherapy should be done when secretions need removing and this may be once a day or it may be 4-5 times a day. It is often useful to do physio first thing in the morning getting out of bed. The chest will have been relaxed at night and the secretions may be easier to remove.

Underlying Principles: 

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The patient is positioned so that the diseases area are in near vertical position. The position assumed are determined by location, severity, and duration of mucus obstruction. Discontinue the procedure if tachycardia, palpitations, dyspnea, chestpain or other symptoms occur.

Contraindications: Increase bronchospasm from CPT.  History of pathological fracture.  Flail chest.  Chest incisions. 

Cycle of PT program Assessment / reassessment Problems identification Analysis of findings

Implementation of treatment

Planning of treatment

Complication of retained secretion  Atelectasis  Hypoxemia

Airway clearance techniques  Postural drainage position  Percussion  Vibration  FET

How chest physiotherapy is done? Postural Drainage  Uses gravity to drain secretions from the segments of the lungs.  Can be combined with CTP.  Done 1 hour before meal and 2-3 hours after meal.

Percussion and vibration 

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Percussion is rhythmically striking the chest wall with cupped hands. It is also called cupping, clapping, or tapotement. The purpose of percussion is to break up thick secretions in the lungs so that they can be more easily removed.

Vibration  Technique applying manual compression and tremor to the chest wall during the exhalation phase of respiration.

STEPS 1. 2. 3.

Instruct the client to use diaphragmatic breathing. Position the patient in prescribed postural drainage position. Percuss with cupped hands over the chest wall for 1-2 minutes from: a. the lower ribs to the shoulder back. b. lower ribs to the top of the chest in front.

Avoid clapping over the spine, liver, kidneys, spleen, breast, scapula, clavicle, or sternum. 5. Instruct the patient to inhale slowly and deeply. Vibrate the chest wall as the patient exhale slowly through purse lip breathing. c. Place one hand on top of the other over affected area or place one hand on each side of the rib cage. d. Tense the muscles of the hands and arms while applying moderate pressure downward and vibrate arms and hands. e. Relieve the patients thorax as the patient inhales. f. Encourage to cough after 3-4 vibrations. 

6. Allow the patient to rest for several times. 7. Listen with stethoscope for changes in breath sound. 8. Repeat the percussion and vibration cycle according to the patients tolerance and his clinical response, usually 15-20 minutes. – appearance of moist sound, indicate movement of air around mucus in the bronchi.

Positions To drain the middle and lower portions of your lungs, you should be positioned with your chest above your head. Possible techniques to achieve this position are:  If a hospital bed is available, put in Trendelenburg position (head lower than feet)  Place 3-5 wood blocks, that are 2 inches by 4 inches, in a stack that is 5 inches high, under the foot of a regular bed. Blocks should have indentations or a 1 inch rim on top so that the bed does not slip  Stack 18-20 inches of pillow under hips.  Place on a tilt table, with head lower than feet.  Lower head and chest over the side of the bed.

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To drain the upper portions of your lungs, you should be in a sitting position at about a 45 degree angle.

Chest Physical Therapy Positions for Infants and Children Upper Lobes  Lean forward 30°.  Percuss between the clavicle and the shoulder blade on each side of the chest.

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Lean back 30°. Percuss between the clavicle and the nipple on each side of the chest.

Lower Lobes  The body should be positioned with the child’s head down 30°and lying on the right side.  Percuss on the left side below the underarm.  Note: If your child has Cystic Fibrosis and is under the age of 5, you will not be tilting the chest area, but will keep the chest horizontal.

Horizontal

Head down 30º