The document describes techniques used to mobilize pulmonary secretions including postural drainage, chest percussion, and vibration. These techniques should be followed by coughing and suctioning. Postural drainage involves positioning the patient to drain specific lung segments using gravity. The document provides details on techniques, contraindications, positions used for different lung segments, and the nursing process for administration.
The document describes techniques used to mobilize pulmonary secretions including postural drainage, chest percussion, and vibration. These techniques should be followed by coughing and suctioning. Postural drainage involves positioning the patient to drain specific lung segments using gravity. The document provides details on techniques, contraindications, positions used for different lung segments, and the nursing process for administration.
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The document describes techniques used to mobilize pulmonary secretions including postural drainage, chest percussion, and vibration. These techniques should be followed by coughing and suctioning. Postural drainage involves positioning the patient to drain specific lung segments using gravity. The document provides details on techniques, contraindications, positions used for different lung segments, and the nursing process for administration.
Direitos autorais:
Attribution Non-Commercial (BY-NC)
Formatos disponíveis
Baixe no formato PPT, PDF, TXT ou leia online no Scribd
Group of therapies used in combination to mobilize
pulmonary secretions
Includes postural drainage, chest percussion, and
vibration
Should be followed by productive coughing and
suctioning of the client
Recommended for clients who produce greater than
30 mL of sputum per day or have evidence of atelectasis can be safely used with infants and young children, unless contrainidcated.
Dependent nursing function
Know the client’s normal range of vital signs.
Know the client’s medications.
Know the client’s medical history.
Know the client’s level of cognitive function.
Be aware of the client’s exercise tolerance.
Involves striking the chest wall over the area being drained.
Hand is positioned so that the fingers and thumb
touch, and the hands are cupped.
Sends waves of varying amplitude and frequency
through the chest, changing the consistency and location of sputum.
Performed by striking the chest wall alternately
with cupped hands. Performed over a single layer of clothing.
Contraindicated in patients with bleeding
disorders, osteoporosis, or fractured ribs.
Caution should be taken to percuss the
lung fields and not the scapular regions. Cover the area with a towel or gown to reduce discomfort.
Ask the client to breathe slowly and deeply to promote
relaxation.
Alternately flex and extend the wrists rapidly to slap
the chest.
Percuss each affected lung segment for 1-2 minutes.
If done correctly, the percussion action should produce a hollow, popping sound.
Percussion is avoided over the breasts, sternum,
spinal column, kidneys, scapula. Fine, shaking pressure applied to the chest wall only during exhalation.
Increase velocity and turbulence of exhaled air,
facilitating secretion removal.
Increases the exhalation of trapped air and may
shake mucus loose and induce cough. Place hands, palms down, on the chest area to be drained, one hand over the other with the fingers together and extended. Alternatively, the hands may be placed side by side.
Ask the client to inhale deeply and exhale slowly
through the nose or pursed lips.
During exhalation, tense all the hand and arm
muscles, and using mostly the heel of the hand, vibrate the hands, moving downward. Stop vibrating when the client inhales. Vibrate during five exhalations over one affected lung segment.
After each vibration, encourage the client to
cough and expectorate secretions in the sputum container. Use of positioning technique that draw secretions from specific segments of the lungs and bronchi into the trachea.
Drainage by gravity of secretions from various lung
segments, enhance matching of ventilation and perfusion, normalize functional and residual capacity.
Procedures can include most lung segments. It is
based on clinical assessments. The positions assumed are determined by the location, severity, and duration of mucus obstruction.
Prior to postural drainage, the patient may be given a
bronchodilator medication or nebulization Best time for postural drainage includes before breakfast, before lunch, in the late afternoon, and before bedtime.
Nurse must evaluate the client’s tolerance of postural
drainage. Indicated for difficult with secretion clearance, evidence of retained secretions, and lung conditions that cause increased production of secretions.
Contraindicated in undrained lung abscess, lung
tumors, pneumothorax, diseases of the chest wall, lung hemorrhage, painful chest conditions, tuberculosis, severe osteoporosis, increased ICP, uncontrolled hypertension, and gross hemoptysis. The procedure should be discontinued if tachycardia, palpitations, dyspnea, or chest pain occurs. These symptoms may indicate hypoxemia. Discontinue if hemoptysis occurs. Bilateral - High-Fowler’s position
Apical segments: Right upper lobe -- anterior segment
- Supine with head of bed elevated 15-30 degrees
Left upper lobe -- anterior segment - Supine with head
elevated
Right upper lobe -- posterior segment - Side lying with
right side of chest elevated on pillows Left upper lobe -- posterior segment - Side lying with left side of chest elevated on pillows
Right middle lobe -- anterior segment – Three-fourths supine position
with dependent lung in Trendelenburg’s position
Right middle lobe -- posterior segment – prone with thorax and abdomen elevated
Both lower lobes -- anterior segments – Supine in Trendelenburg’s
position Left lower lobe -- lateral segment – left lateral in Trendelenburg’s position
Right lower lobe – lateral segment – right side-lying in
Trendelenburg’s position
Right lower lobe – posterior segment – prone in
Trendelenburg’s position with abdomen and thorax elevated
Both lower lobes – posterior segments – prone in
Trendelenburg’s position with abdomen and thorax elevated Bilateral – apical segments – sitting on nurse’s lap, leaning slightly forward, flexed over pillow
Bilateral – middle anterior segments – sitting on