Postural Drainage.ppt

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POSTURAL DRAINAGE Conducted by: Ms.Monika Clinical instructor Army college of nursing

Definition :

Definition Postural Drainage removes mucus from certain parts of the lungs by using gravity and proper positioning to bring the secretions into the throat where it is easier to remove them. The lungs are divided into segments called lobes, the right lung is divided into three lobes (right upper lobe, right middle lobe and right lower lobe) while the left lung has only two lobes (left upper lobe and lower lobe).


Equipment bed or table that can be adjusted for a range of positions from Trendelen-burg to Reverse Trendelenburg position pillows for supporting patient light towel for covering area of chest during percussion tissues and/or basin for collecting expectorated sputum suction equipment for patients unable to clear secretion gloves, gown, and mask as indicated for caregiver protection oxygen delivery device recent chest x-ray, if available stethoscope for auscultation


SCHEDULING TREATMENT The treatment often works best in the morning. This allows the mucus to be removed that has built up during the night. Sometimes a treatment can be done at night to reduce the need for coughing during sleep. Make sure you wait at least 1-2 hours after eating before starting you treatment. This helps to prevent nausea and or vomiting.


MONITORING OF CLIENT The following should be chosen as appropriate for monitoring a patient's response to postural drainage therapy, before, during, and after therapy. Subjective response--pain, discomfort, dyspnea , response to therapy Pulse rate, dysrhythmia, Breathing pattern and rate, symmetrical chest expansion, Sputum production (quantity, color, consistency, odor) and cough effectiveness Skin color Breath sounds blood pressure ,oxygen saturation by pulse oximetry (if hypoxemia is suspected


POSITIONS The lungs consist of 5 lobes -- 3 on the right and 2 on the left side of the chest cavity, each of which are further divided into segments. The goal of postural drainage and chest percussion is to help drain mucus from each of these lobes into the larger airways of the lungs so it can be coughed up more readily.


PERCUSSION involves using a cupped hand and alternately clapping with both hands on the patient's chest wall. This should be performed over the lung segment that is to be drained. Your hand should be NOT be flat, but cupped at all times, as if you were holding liquid in it. T he percussion technique should be vigorous and rhythmical, but it should not involve pain. If the patient does complain of pain, this means that your hand may not be cupped properly and needs to be softened or readjusted. When done properly, you should hear a hollow sound with each percussion. Chest percussion should be done over the ribs, with careful attention to avoiding percussing over the spine, breastbone, or lower back to prevent damage to internal organs


VIBRATION Vibration is an airway clearance technique that, coupled with chest percussion , is applied during postural drainage to help Vibration helps to gently shake mucus and secretions into the large airways, making them easier to cough up. During vibration, place your flat hand firmly against the chest wall, atop the appropriate lung segment to be drained. Stiffen your arm and shoulder, apply light pressure and create a shaking movement, similar to that of a vibrator. Tell the client to breathe in deeply during vibration therapy, and exhale slowly and completely. Taking a deep breath and then exhaling slowly and forcefully without straining will hopefully stimulate a productive cough.


POSITION (1) To drain mucus from the upper lobe apical segments, the patient sits in a comfortable position on a bed or flat surface and leans on a pillow against the headboard of the bed or the caregiver. The caregiver percusses and vibrates over the muscular area between the collar bone and very top of the shoulder blades (shaded areas of the diagram) on both sides for 3 to 5 minutes. Encourage the patient to take a deep breath and cough during percussion in order to help clear the airways. Do not percuss over bare skin.

Position 2 :

Position 2 The patient sits comfortably in a chair or the side of the bed and leans over, arms dangling, against a pillow. The caregiver percusses and vibrates with both hands over upper back on both the right and left sides.

Position #3 Upper Lobe Anterior Segments :

Position #3 Upper Lobe Anterior Segments the patient lies flat on the bed or table with a pillow for comfort under his or her head and legs. The caregiver percusses and vibrates the right and left sides of the front of the chest, between the collar bone and nipple.

Position #4 Lingula:

Position #4 Lingula The patient lies with their head down toward the foot of the bed on the right side, hips and legs up on pillows. The body should be rotated about a quarter-turn towards the back. A pillow can also be placed behind the patient and their legs slightly bent with another pillow between the knees. The caregiver percusses and vibrates just outside the nipple area

Lingula of lung:

Lingula of lung Anterior of lung Oblique fissure Cardiac notch Lingula of left lung

Position #5 Middle Lobe :

Position #5 Middle Lobe The patient lies head-down on his left side, a quarter-turn toward the back with the right arm up and out of the way. The legs and hips should be elevated as high as possible. A pillow may be placed in back of the patient and between slightly bent legs. The caregiver percusses and vibrates just outside the right nipple area.

Position #6 Lower Lobes Anterior Basal Segments:

Position #6 Lower Lobes Anterior Basal Segments The patient lies on his right side with his head facing the foot of the bed and a pillow behind his back. The hips and legs should be elevated as high as possible on pillows. The knees should be slightly bent and a pillow should be placed between them for comfort. The caregiver percusses and vibrates over the lower ribs on the left side, as shown in the shaded part of the diagram. This should then be repeated on the opposite side, with percussion and vibration over the lower ribs on the right side of the chest.

Position #7Lower Lobes Posterior Basal Segments :

Position #7Lower Lobes Posterior Basal Segments The patients lies on his or her stomach, with the hips and legs elevated by pillows. The caregiver percusses and vibrates at the lower part of the back, over the left and right sides of the spine, careful to avoid the spine and lower ribs.

Position #9 and #10 Lower Lobes Lateral Basal Segments :

Position #9 and #10 Lower Lobes Lateral Basal Segments The patient lies on his right side, leaning forward about one-quarter of a turn with hips and legs elevated on pillows. The top leg may be flexed over a pillow for support and comfort. The caregiver percusses and vibrates over the uppermost portion of the lower part of the left ribs, as shown in the shaded area. This should then be repeated on the opposite side, with percussion and vibration over the uppermost portion of the right side of the lower ribs


STEPS 1. Use specific positions so the force of gravity can assist in the removal of bronchial secretions from affected lung segments to central airways by means of coughing and suctioning. 2. The patient is positioned gravity is used to assist the drainage of specific segment. 3. The positions assumed are determined by the location, severity, and duration of mucous obstruction. 4. The exercises are performed two to three times a day, before meals and bedtime. Each position is done for 3-15 minutes.


Cont………..d 5. The procedure should be discontinued if tachycardia, palpitations, dyspnea occurs. These symptoms may indicate hypoxemia. Discontinue if hemoptysis occurs. 6. Bronchodilators, mucolytics agents, water, or saline may be nebulised and inhaled before postural drainage to decrease thickness of mucus and sputum, there by enhancing secretion removal


Cont…d 8. Make sure patient is comfortable before the procedure starts and as comfortable as possible he or she assumes each position. 9. Auscultate the chest to determine the areas of needed drainage. 10. Encourage the patient to deep breathe and cough after spending the allotted time in each position. 11. Encourage diaphragmatic breathing through out postural drainage: this helps widen airways so secretions can be drained.


contraindications All positions are contraindicated for intracranial pressure (ICP) > 20 mm Hg head and neck injury until stabilized (A) active hemorrhage with hemodynamic instability (A) recent spinal surgery (or acute spinal injury acute spinal injury or active hemoptysis pulmonary edema associated with congestive heart failure pulmonary embolism aged, confused, or anxious patients who do not tolerate position changes rib fracture, with or without flail chest surgical wound or healing tissue


COMPLICATIONS Hypoxemia Increased Intracranial Pressure Acute Hypotension during Procedure Pulmonary Hemorrhage pain or Injury to Muscles, Ribs, or Spine Vomiting and Aspiration Dysrhythmias

Effective outcome:

Effective outcome These represent individual criteria that indicate a positive response to therapy: 1.Change in breath sounds of lung fields being drained With effective therapy, breath sounds may 'worsen' following the therapy as secretions move into the larger airways An increase in adventitious breath sounds can be a marked improvement over absent or diminished breath sounds. Note any effect that coughing may have on breath sounds. One of the favorable effects of coughing is clearing of adventitious breath sounds.

2 Patient subjective response to therapy:

2 Patient subjective response to therapy The caregiver should ask patient how he or she feels before, during, and after therapy. Feelings of pain, discomfort, shortness of breath, dizziness, and nausea should be considered in decisions to modify or stop therapy. Easier clearance of secretions and increased volume of secretions during and after treatments support continuation.

3Change in vital signs:

3Change in vital signs Moderate changes in respiratory rate and/or pulse rate are expected. Bradycardia, tachycardia, or an increase in irregularity of pulse, or fall or dramatic increase in blood pressure are indications for stopping therapy.

4 Change in chest x-ray:

4 Change in chest x-ray The chest x-ray will be cleared. 5 Change in arterial blood gas values or oxygen saturation Oxygenation should improve as atelectasis resolves. It will also increase compliance

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