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22 Cards in this Set

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  • Back

what are some indications/ diagnoses for postural drainage?

cystic fibrosis, bronchiolitis, COPD, bronchiectasis, lung abcess

what are some contraindications for postural drainage?

intracranial pressure over 20 mm Hg, unstable head/neck injury, active hemorrhage, recent spinal surgery or injury, active hemoptysis (blood in sputum), empyema, bronchopleural fistula, pulmonary edema w/ CHF, large pleural effusion, pulmonary embolism, confusion, rib fx, surgical wound/healing tissue.

POSITIONING: pg 240



apical segments right and left upper lobes

the pt is in a sitting position, leaning back 30 to 40 degrees. percussion and vibration are performed above the clavicles.


POSITIONING:



posterior segment right upper lobe

the pt is turned 1/4 from prone on the left side with the bed horizontal and the head and shoulders raised on a pillow. percussion and vibration are performed around the medial border of the right scapula

POSITIONING:



posterior segment left upper lobe

the pt is turned 1/4 from prone on the right side with the head of the bed elevated 45 degrees and the head and shoulders raised on a pillow. percussion and vibration are performed around the medial border of the left scapula.

POSITIONING:



lingula left upper lobe

the pt is turned 1/4 from supine on the right side with the foot of the bed elevated 12 inches. percussion and vibration are performed over the left chest between the axilla and the left nipple

POSITIONING:



anterior segments right and left upper lobes

the pt is in supine with the bed horizontal . percussion and vibration are performed below the clavicles

POSITIONING:



right middle lobe

the pt is turned 1/4 from supine on the left side with the foot of the bed elevated 12 inches. percussion and vibration are performed over the right chest between the axilla and the right nipple

POSITIONING:



superior segments left and right lower lobes

the pt is in prone with the bed horizontal. percussion and vibration are performed below the inferior border of the left and right scapulae

POSITIONING:



anterior basal segments left and right lower lobes

the pt is in supine with the foot of the bed elevated 18 inches. percussion and vibration are performed over the lower ribs on the left and right side.


POSITIONING:



posterior basal segments left and right lower lobes

the pt is in prone with the foot of the bed elevated 18 inches. percussion and vibration are performed over the lower ribs on the left and right side.

POSITIONING:



lateral basal segments lower lobes

the pt is in sidelying with the foot of the bed elevated 18 inches. percussion and vibration performed over the lower ribs. the pt lies on the right side for the left lower lobe and lies on the left side for the right lower lobe.

segments of the upper lobes

anterior apical segments


posterior apical segments


anterior segments


posterior segments


lingular segments

segment of the middle lobe

right middle lobe

segments of the lower lobes

basal segments


lateral segments


superior segments

what is the technique for percussion

cupping/clapping over the lung segment being drained. lasts several minutes and should not be painful

what is the technique for vibration

place one hand on top of the other of the affected area or one hand over each side of the rib cage, vibrate chest wall as pt exhales by tensing the muscles of the hand and arms while applying moderate pressure downward. perform in direction in which the ribs move on expiration. have pt cough/huff after 2-3 vibrations

huffing:


what is it and what is the technique

forced expiratory maneuver performed with the glottis open.



inhale deeply through open mouth, contract abdomen during rapid exhalation to huff or make " ha ha ha" sounds



do not perform with droplet precautions

active cycle of breathing (ACB)


what is it and what is the technique

forced expiratory technique to assist secretion clearance in pts with asthma. always ouples breathing exercises with huffing



has 3 phases:


breathing control- gentle relaxed breathing


thoracic expansion exercises- 3-4 deep, slow,relaxed inhalations to inspiratory reserve with passive exhalation.


forced expiratory techniques- 1-2 huffs at mid-low lung volumes



coughing

inhale maximally, close glottis, hold breath 2-3 sec. contract expiratory muscles to increase pressure against the closed glottis, cough sharply 2-3 times through a slightly opened mouth

autogneic draining


what is it and what is the technique

controlled breathing mobilizes secretions by changing expiratory airflow w/o using postural drainage or coughing



in sitting, perform controlled breathing at 3 lung volumes.


unsticking phase-slowly breathe in through the nose at low lung volumes followed by a 2-3 sec breath hold, then exhale down into the expiratory reserve volume


evacuating phase- deeper inspirations from low-mid inspiratory reserve volume with breath holding followed by a huff


exhale through pursed lips

high frequency airway oscillation


what is it and what is the technique

vests are used for clearing excess mucus from lung airways



an air pulse generator delivers air via hoses to an inflatable vest worn by the pt. once the vest is inflated, repeatedly compress and release the chest wall. the air pulses are delivered at frequencies between 5 to 20 hertz. 13 hertz provide the best results for secretion clearance. pt is an upright position during the 10-30 min tx