postureLungs

Deblina Roy M.Sc. Nursing 1st year

K.G.M.U Institute of Nursing

Postural drainage

define postural drainage describe the various lobes of the

lungs discuss the components of postural

drainage describe the settings of the

postural drainage enumerate the indications and

contra indications of postural drainage

describe the steps of the procedure

describe the hazards ,limitations discuss the nursing care for the

procedure.

At the end of the class you will be

able to :-

Postural drainage therapy is designed to improve the mobilization of bronchial secretions and the matching of ventilation and perfusion, and to normalize functional residual capacity based on the effects of gravity and external manipulation of the thorax. This includes turning, postural drainage, percussion, vibration, and cough.

Definition

TurningPostural drainage External manipulation

of the thorax1. Percussion2. Vibration

Components of postural drainage

therapy

Critical care In-patient acute care Extended care and

skilled nursing facility care

Home care Outpatient/

ambulatory care Pulmonary diagnostic

(bronchoscopy) laboratory

Postural drainage therapy

SETTING:

Turning:

1. Inability or reluctance of patient to change body position. (eg, mechanical ventilation, neuromuscular disease, drug-induced paralysis)

2. poor oxygenation associated with position (eg, unilateral lung disease)

3. potential for or presence of atelectasis

4. presence of artificial airway.

Indications

Postural drainage:1. evidence or suggestion of difficulty

with secretion clearance2. difficulty clearing secretions with

expectorated sputum production greater than 25-30 mL/day (adult)

3. evidence or suggestion of retained secretions in the presence of an artificial airway

4. presence of atelectasis caused by or suspected of being caused by mucus plugging

5. diagnosis of diseases such as cystic fibrosis, bronchiectasis, or cavitating lung disease

6. presence of foreign body in airway

Indications

External Manipulation of the Thorax1. sputum volume

or consistency suggesting a need for additional manipulation

Indications

Positioning All positions are contraindicated for intracranial pressure (ICP) > 20 mm

Hg(59,60) head and neck injury until stabilized (A) active hemorrhage with hemodynamic

instability (A) recent spinal surgery (eg, laminectomy)

or acute spinal injury acute spinal injury or active hemoptysis empyema bronchopleural fistula pulmonary edema associated with

congestive heart failure large pleural effusions 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

Contraindications

Trendelenburg position is contraindicated for

intracranial pressure (ICP) > 20 mm Hg patients in whom increased intracranial

pressure is to be avoided (eg, neurosurgery, aneurysms, eye surgery)

uncontrolled hypertension distended abdomen esophageal surgery recent gross hemoptysis related to

recent lung carcinoma treated surgically or with radiation therapy

uncontrolled airway at risk for aspiration (tube feeding or recent meal)

Reverse Trendelenburg is

contraindicated in the presence of hypotension or vasoactive medication

Contraindications

based more on tradition and anecdotal report than on scientific evidence

Airway clearance may be less than optimal in patients with ineffective cough.

Optimal positioning is difficult in critically ill patients.

LIMITATIONS OF METHOD:

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, goggles, gown, and mask as

indicated for caregiver protection optional: hand-held and

mechanical percussor or vibrator oxygen delivery device recent chest x-ray, if available stethoscope for auscultation

Equipment

Various positions to drain various lung segements

excessive sputum production effectiveness of cough history of pulmonary problems

treated successfully with PDT (eg, bronchiectasis, cystic fibrosis, lung abscess)

decreased breath sounds or crackles or rhonchi suggesting secretions in the airway

change in vital signs Abnormal chest x-ray consistent

with atelectasis, mucus plugging, or infiltrates

deterioration in arterial blood gas values or oxygen saturation

Assessments

Outcome Assessment

Turning Postural drainage therapy

Frequency of therapy

Outcome assessment

Infection control

Assessment DiagnosisGoal Planning Intervension evaluation

Nursing process

Summary

conclusion

Conclusion

Potter PA. Perry AC. Fundamentals of nursing 7th ed. Elsevir,Mosby.New york:2012 Pp-265-78

Pryor JA, Webber BA. An evaluation of the forced expiration technique as an adjunct to postural drainage. Physiotherapy 1979;65(10):305-307.

Bateman JRM, Newman SP, Daunt KM, Pavis D, Clarke SW. Regional lung clearance of excessive bronchial secretions during chest physiotherapy in patients with stable chronic airways obstruction. Lancet 1979;1:294-297.

Postural drainage Wikipedia free encyclopedia . available from http:// postural drainage

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