Chest physiotherapy

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project (Chest physiotherapy) PowerPoint (24 to30 slides) sailed 5 line , topic 35 , under 24 , add photos and videos)
outline same on pdf cope pesincluding new research &scholar pea pear form 2021

Introduction)

 Definition of chest physiotherapy

 Purposes of chest physiotherapy

 Indication chest physiotherapy

 Contraindications of chest physiotherapy

 The physiological mechanism of airway clearance

 Assessment for chest physiotherapy

 Techniques of chest physiotherapy

 Percussion

 Vibration

 Postural drainage

 Coughing, controlled coughing technique and deep breathing

 The complications of chest physiotherapy

 Conclusion

 References

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Prepared by
Dr. Rasha Gad
1
Objectives
Intended learning outcomes (ILOS)
At the end of this lecture, each PhD student will be able to:
 Define the chest physiotherapy
 List the purposes of chest physiotherapy
 Enumerate the physiological mechanism of airway clearance
• Normal Clearance
• Abnormal Clearance
 Enumerate the indication chest physiotherapy
 List contraindications of chest physiotherapy
 Enumerate assessment for chest physiotherapy
 Identify the techniques of chest physiotherapy
 Percussion
 Vibration
 Postural drainage
 Coughing ,controlled coughing technique and deep breathing
 List the complications of chest physiotherapy
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Outlines
 Introduction
 Definition of chest physiotherapy
 Purposes of chest physiotherapy
 Indication chest physiotherapy
 Contraindications of chest physiotherapy
 The physiological mechanism of airway clearance
 Assessment for chest physiotherapy
 Techniques of chest physiotherapy
 Percussion
 Vibration
 Postural drainage
 Coughing, controlled coughing technique and deep breathing
 The complications of chest physiotherapy
 Conclusion
 References
3
Introduction
• Chest physiotherapy is the term for a group of treatments designed to
eliminate secretions thus helps to decrease work of breathing, promote the
expansion of the lungs, and prevent the lungs from collapse, Like Postural
drainage, positioning, and chest percussion and vibration.
• These may be used in sequence in different lung drainage positions and
should be preceded by bronchodilator therapy and followed by deep
breathing and coughing or other bronchial hygiene therapy ( BHT)
Definition
• Chest physiotherapy (CPT) is a technique used to mobilize or loose
secretions in the lungs and respiratory tract.
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Purposes
1. To facilitate removal of retained or profuse airway secretions.
2. To optimize lung compliance and prevent it from collapsing.
3. To decrease the work of breathing.
4. To optimize the ventilation-perfusion ratio
5. To improve gas exchange.
Indication
• It is indicated for patients in whom cough is insufficient to clear thick,
tenacious, or localized secretions. Examples include:
1. Cystic fibrosis
2. Bronchiectasis
3. Atelctasis
4. Lung abscess
5. Neuromuscular diseases
6. Pneumonias in dependent lung regions.
Contraindications
1. Increased ICP
2. Unstable head or neck injury
3. Active hemorrhage with hemodynamic instability or hemoptysis
4. Recent spinal injury or injury
5. Empyma
6. Bronchoplueral fistula
7. Rib or vertebral fractures or osteoporosis
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8. Fail chest
9. Uncontrolled hypertension
10.Anticoagulation
The physiological mechanism of airway clearance
 A normal clearance
 A normal clearance requires an open airway, a functional mucociliary
escalator, and an effective cough. Airways normally are kept open by
structural support mechanisms and kept clear by the proper function of their
ciliated mucosa.
 The effective cough is a must for normal airway clearance.
 Cough is one of the most important protective reflexes. By ridding the
larger airways of excessive mucus and foreign matter, the cough assists the
normal mucociliary clearance and helps ensure airway patency. There are
four distinct phases to a normal cough: irritation, inspiration, compression,
and expulsion
 Abnormal Clearance
1. The flow of air through the tracheobronchial tree and its interaction with the
mucus lining is complex. This physiology of flow in liquid line airway is
called a two-phase gas-liquid flow. In endobronchial diseases, the mucus
layer may exceed 5 mm in thickness and ciliary clearance becomes
ineffective.
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2. One of the mechanisms by which cough affects sputum clearance in
endobronchial diseases is two phases gas-liquid flow: the transfer of
momentum and energy from the high-speed flow of air to the mucus that
lines the bronchi. The high transmural pressure produced during cough leads
to dynamic compression of the airway inhibiting mucociliary clearances
.Thus , forced expiratory technique (FET) was introduced to solve this
problem.
3. One of the mechanisms by which cough affects sputum clearance in
endobronchial diseases is two phases gas-liquid flow: the transfer of
momentum and energy from the high-speed flow of air to the mucus that
lines the bronchi. The high transmural pressure produced during cough leads
to dynamic compression of the airway inhibiting mucociliary clearances
.Thus , forced expiratory technique (FET) was introduced to solve this
problem.
Assessment for chest physiotherapy
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Nursing care and selection of CPT skills are based on specific assessment findings.
The following are the assessment criteria:
1. Know the normal range of patient’s vital signs.
2. Conditions requiring CPT, such atelectasis, and pneumonia, affects vital
signs.
3. Know the patient’s medications. Certain medications, particularly
diuretics antihypertensive cause fluid and hemodynamic changes. These
decrease patient’s tolerance to positional changes and postural drainage.
4. Nursing care and selection of CPT skills are based on specific assessment
findings. The following are the assessment criteria:
 Know the normal range of patient’s vital signs.
 Conditions requiring CPT, such atelectasis, and pneumonia, affects
vital signs.
 Know the patient’s medications. Certain medications, particularly
diuretics antihypertensive cause fluid and hemodynamic changes.
These decrease patient’s tolerance to positional changes and
postural drainage.
Clinical findings and investigations
1. Detailed History
2. Physical examination
a. Inspection
b. Palpation
c. Percussion
d. Auscultation
3. Investigations
a. X-ray
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b. Blood investigations-bleeding and clotting parameters
Precaution
-keep suction apparatus, emergency airway and oxygen therapy while providing
chest physiotherapy.
-Patient should be monitored throughout therapy.
-Adrenergic bronchodilators in solution should be available in case of
bronchospasm during therapies.
-Providing coughing instruction prior to therapy.
-Suctioning of trachea is essential.
Equipment used in CPT:
-Trendelenburg bed
-pillows, patient gown and towel
-sterilized clothes
-basin, stethoscope
-suction apparatus
-mechanical percusser
-cardiac monitor, pulse oximeter
– chest radiograph
-emergency airway
Procedure of chest physiotherapy
-Assess the chest x-ray for pulmonary findings
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-Assess respiratory rate of patient
-Assess breathing, rhythm, skin color, BP, HR of patient.
-Assess the patient’s ability to take deep breath
-Perform chest physiotherapy
-Monitor the following throughout the therapy:

Reaction

discomfort and dyspnea

Heart rate and rhythm

Respiratory rate

Sputum production, breathe sound

skin color

Mental status

oxygen saturation

Blood pressure

Modify the techniques of CPT according patient tolerance.
Techniques of chest physiotherapy
1. . percussion
 Chest percussion involves rhythmically clapping on the chest wall
over the area being drained.
 Position the hand so the fingers and thumb touch and the hands are
cupped.
 Perform chest percussion by vigorously striking the chest wall
alternately with cupped hands
 The procedure should produce a hollow sound and should not be
painful.
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 Usually the patient will be positioned in supine or prone should be
straight to promote rib cage expansion
 Perform percussion over a single layer of clothing, not over
buttons.
 Don’t percuss over the spine, sternum, stomach or lower back as
trauma can occur to the spleen, liver, or kidneys.
 Typically, each area is percussed for 30 to 60 seconds several
times a day.
 Percuss or clap with cupped hands or chest wall for 5 minutes over
each segment for 5 minutes for cystic fibrosis and 1-2 minutes for
other conditions.
 If the patient has tenacious secretions, the area must be percussed
for 3-5 minutes several times per day.
https://ssl.adam.com/graphics/images/en/22871.jpg
2. Vibration:
o Is a gentle, shaking pressure applied to the chest wall to move secretions into
larger airways
o The purpose is to help loosen respiratory secretions so that they can be
expectorated with ease. Vibration (at a rate of 200 per minute) can be done for
several times a day.
o To avoid patient causing discomfort, vibration is never done over the patient’s
breasts, spine, sternum, and rib cage.
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o Vibration can also be taught to family members or accomplished with mechanical
device.
o During vibration, place your flat hand firmly against the chest wall, on the
appropriate lung segment to be drained. • Vibrate the chest wall as the patient
exhales slowly through the pursed lips.
o After each vibration, encourage the patient to cough and expectorate secretions
into the sputum container.
o Instruct the patient use diaphragmatic breathing
o Tense the muscles of the hands and hands while applying moderate pressure
downward and vibrate arms and hands.
o Relieve pressure on the thorax as the patient inhales.
o Encourage the patient cough, using abdominal muscles, after three or four
vibrations.
o Allow the patient rest several times
o Listen with stethoscope for changes in breath sounds
o Repeat the percussion and vibration cycle according to the patient’s tolerance and
clinical response: usually 15-30 minutes
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https://cdn.shopify.com/s/files/1/1840/5479/files/Chest_Percussions_large.jpg?v=1499112831
3. Postural drainage
 Postural drainage is a technique in which different positions are assumed to facilitate the
drainage of secretions from the bronchial airways.
 Gravity helps to move the secretions to the trachea to be coughed up easily.
 The goal of postural drainage is to help drain mucus from the affected lobes into the
larger airways of the lungs so it can be coughed up more readily.
 The focus of postural drainage should be on the lobes affected by atelectasis and on
increasing mucus removal with suctioning or by cough effort. Postural drainage is not
indicated in all positions for all critically ill patients.
 The nurse must closely monitor the patient who is in a head-down position for aspiration,
respiratory distress, and dysrhythmias.
 Alternate techniques may include gentle percussion and using a mechanical percussor to
stimulate mucus movement while avoiding surgical areas.
https://rnspeak.com/wp-content/uploads/2014/12/postural-drainage-positions.jpg
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Positions
Adult
Lung segment
Position recommended
Bilateral
High Fowler’s
Apical-right upper lobe-anterior segment Sitting on side of the bed
Supine with head elevated
Adult
Right Middle lobe-anterior segment
Three-fourth 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 position
Right side-lying in Trendelenburg’s position
Right lower lobe-lateral segment
Left side-lying in Trendelenburg’s position
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Right lower lobe-posterior segment
Prone with right side of chest elevated in
Trendelenburg’s position
Both lower lobes-posterior segment
Prone in Trendelenburg’s position
Left upper lobe-anterior
Supine with head elevated
Right upper lobe-posterior
Side-lying with right side of the chest elevated on
pillows
Left upper lobe-posterior
Side-lying with left side of the chest elevated on
pillows
Postural Drainage Indications:
Postural Drainage should only be recommended for certain patients under certain
conditions. Here are some examples:
o
To mobilize retained secretions so that they can be suctioned or expectorated
o
Cystic Fibrosis
o
Atelectasis
o
Bronchiectasis
o
Foreign body obstruction
Postural Drainage Contraindications:
There are certain situations in which Postural Drainage would not be
recommended. Here are some examples:
o
Head, neck, or spinal injury
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o
Hemodynamic instability
o
Increased intracranial pressure
o
Hemoptysis
o
Bronchopleural fistula
o
Pulmonary edema as a result of CHF
o
Pleural effusion
o
Flail Chest
Procedure
Equipment required
1. Pillows
2. Tilt table
3. Sputum cup
4. Paper tissues
Steps
 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.
 The positions assumed are determined by the location, severity, and duration of mucous
obstruction.
 All the patients do not require postural drainage for all the lung segments. So the
procedure must be based on the clinical findings.
 In postural drainage, the person is tilted or propped at an angle to help drain secretions
from the lungs.
 The lower lobes require drainage most frequently because the upper lobes drain by
gravity.
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 Before postural drainage, the client may be given a bronchodilator medication or
nebulization therapy to loosen secretions.
 Postural drainage treatments are scheduled two or three times daily, depending on the
degree of lung congestion. Each position is done for 3-15 minutes.
 The best times include before breakfast, before lunch, in the late afternoon, and before
bedtime.
 It is best to avoid hours shortly after meals because postural drainage at these times can
be tiring and can induce vomiting.
 Help the patient assume the appropriate position, based on the lung field that requires
drainage.
 The procedure should be discontinued if tachycardia, palpitations, dyspnea, or chest
occurs. The symptoms may indicate hypoxemia. Discontinue if hemoptysis occurs.
 chest percussion to reduce bronchospasm, decrease thickness of mucus and sputum, and
combat edema of the bronchial walls, thereby enhancing secretion removal
 Make sure patient is comfortable before the procedure starts and as comfortable as
possible he or she assumes each position.
4. Coughing
 Coughing helps to break up secretions in the lungs so that the mucus can be expectorated
or suctioned out if necessary. Patients sit upright and inhale deeply through the nose.
They then exhale in short puffs or coughs. This procedure is repeated several times a day.
Controlled Coughing Technique
1. Controlled coughing is one of the essential techniques in good
respiratory care.
2. Patient perform this maneuver after each drainage position and often
throughout the day.
3. The abdominal muscles are very powerful muscles used in coughing
and exhaling.
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4. Inhale deeply through the nose.
5. Cough 2 to 3 sharp staccato cough with proper hand/arm placement.
6. Breathe in easily through the nose

Deep breathing
Deep breathing helps expand the lungs and forces an improved distribution of the air into all
sections of the lungs. The patient either sits in a chair or sits upright in bed and inhales then
pushes the abdomen out to force maximum amounts of air into the lung. The abdomen is then
contracted, and the patient exhales. Deep breathing exercises are done several times each day for
short periods.
https://www.mountnittany.org/assets/images/krames/Image_201608102119_716.jpg
 After positioning the client have the patient remain in the desired position for 10 to 15
minutes, if tolerated.
 Perform percussion and vibration by keeping the client in position.
 The sequence for chest physiotherapy is usually as follows: Positioning, percussion,
vibration, and removal of secretions by coughing or suction.
POST CPT:
 Patient should be advised to practice oral hygiene procedure to decrease the bad taste
and odor.
 Record the procedure
 Report all significant findings
 Disinfect all non-disposable equipment used and store appropriately
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Complications
1. Oxygen deficiency if the head is kept lowered for drainage
2. Increased intracranial pressure
3. Temporary lowering of blood pressure
4. Bleeding in the lungs
5. Pain or injury to the ribs, muscles, or spine
6. Vomiting
7. Inhalation of secretions into the lungs
8. Heart irregularities
Conclusion
 Chest physiotherapy is an effective procedure in chronic pulmonary disorders. This is
especially helpful for patients with large amount of secretions or ineffective cough. It is
performed by professionally trained nurses in most settings.
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References
Spapen, H. D., De Regt, J., & Honoré, P. M. (2017). Chest physiotherapy in
mechanically ventilated patients without pneumonia—a narrative review.
Journal of Thoracic Disease, 9(1), E44.
Wang, T. H., Wu, C. P., & Wang, L. Y. (2018). Chest physiotherapy with early
mobilization may improve extubation outcome in critically ill patients in the
intensive care units. The clinical respiratory journal, 12(11), 2613-2621
Montero-ruiz, A., Fuentes, L. A., Pérez ruiz, E., García-agua soler, N., Riusdiaz, F., Caro aguilera, P., … & Martín-montañez, e. (2020). Effects of
music therapy as an adjunct to chest physiotherapy in children with cystic
fibrosis: A randomized controlled trial. Plos one, 15(10), e0241334.
Siriwat, R., Deerojanawong, J., Sritippayawan, S., Hantragool, S., &
Cheanprapai, P. (2018). Mechanical insufflation-exsufflation versus
conventional chest physiotherapy in children with cerebral palsy.
Respiratory care, 63(2), 187-193.
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