Chest Physiotherapy & Effective Cough Techniques

Chest Physiotherapy, Postural Drainage and Effective Cough A. Chest Physiotherapy 1. Theoretical ConceptsChest physiotherapy is a series of nursing procedures consisting of percussion, vibration and postural drainage. a. PercussionPercussion or clapping is a strong blow to the skin with the hand shaped like a bowl Objective : Mechanically it can release secretions that stick to the bronchial walls Equipment : Towel if necessary, safety pins if necessary Procedure : 1) Cover the area to be percussed with a towel or clothing to reduce discomfort 2) Encourage the client to take deep and slow breaths to increase relaxation 3) Fingers and thumbs come together and flex to form a bowl 4) Alternately flexion and extension of the wrist quickly to pat the chest 5) Percuss each lung segment for 1-2 minutes 6) Percussion should not be performed on areas with structures that are prone to injury, such as the mammae, sternum, spinal column and kidneys. b. Vibration Vibration is a series of strong vibrations produced by hands placed flat on the client's chest wall Objective : Vibration is used after percussion to increase expiratory air turbulence and release thick mucus. Often performed interchangeably with percussion Procedure : 1) Place your hands, palms facing down, on the chest area to be drained, one hand on top of the other with fingers pressed together.joint and extension. Alternatively, the hands can be placed next to each other 2) Encourage the client to inhale deeply and exhale slowly through the nose or pursed lips 3) During the exhalation period, tense all the muscles of the hands and arms and use almost all the heels of the hands, vibrate (shock) the hands, move them downwards. Stop vibration if client inhales 4) Vibration for 5 exhalations on the affected lung segment 5) After each vibration, encourage the client to cough and expel secretions into the sputum container c. Postural Drainage Postural drainage is the drainage of secretions from various lung segments by gravity Equipment : - Pillow two or three - Positioning board - Facial tissue - A glass of water - Pot sputum Position for postural drainage 1) Apical bronchus of the right and left upper anterior lobes 2) Apical bronchi of the right and left upper posterior lobes 3) Right and left upper anterior lobe bronchus 4) Left upper lingual lobe bronchus 5) Right middle lobe bronchus 6) Right and left lower anterior lobe bronchus 7) Right lower lateral lobe bronchus 8) Left lower lateral lobe bronchus 9) Right superior and left lower lobe bronchus 10) Right and left posterior basal bronchus Steps : 1) Wash your hands 2) Select the blocked area to be drained based on assessment of all lung fields, clinical data and chest radiographs 3) Lay the client in a position to drain the blocked area (the first area selected may vary from client to client). Help clients choose positions according to their needs. Teach clients to position posture and arms and positions as needed. Place pillows for support and comfort. 4) Ask the client to maintain the position for 10-15 minutes 5) During 10-15 minutes of drainage in this position, do chest percussion and vibration over the area that is draining 6) After drainage in the first position, ask the client to sit and cough. Collect the excreted secretions in a sputum pot. If the client cannot cough, suction should be performed 7) Ask the client to rest for a while if necessary 8) Ask the client to drink a little water 9) Repeat steps 3 through 8 until all selected blocked areas have been drained. Each action takes no more than 30-60 minutes 10) Repeat the chest assessment in all lung fields 11) Wash your hands 12) Document in nursing notes B. Deep Breathing and Effective Coughing 1. Deep Breathing This is a form of breathing exercise that consists of abdominal (diaphragmatic) breathing andpurse lip breathing Objective : Abdominal or diaphragmatic breathing allows full, deep breaths with minimal effort. Purse lip breathing helps clients control excessive breathing Indication : Chest expansion pestriction, for example in COPD patients (eg asthma, bronchitis) or clients in the recovery stage from thoracic surgery Procedure : a. Arrange a comfortable position for the patient in a half-sitting position on a bed or chair or in a lying position on a bed with one pillow b. Flex the patient's knees to relax the abdominal muscles c. Place one or two hands on your abdomen, just below the ribs d. Inhale deeply through your nose, keeping your mouth closed. Count to 3 during inspiration e. Concentrate and feel the movement of the abdomen rising as far as possible, stay relaxed and prevent arching in the back. If you have difficulty raising your abdomen, take a quick, strong breath through your nose f. Then exhale through your lips like blowing and exhale slowly and strongly, so that a blowing sound is formed without puffing out the cheeks.This purse lip breathing technique causes resistance to the expulsion of air from the lungs, increases pressure in the bronchi and minimizes the collapse of narrow airways g. Concentrate and feel the lowering of the abdomen and contraction of the abdominal muscles during expiration. Count to 7 during expiration h. Use this exercise every time you feel short of breath and increase it gradually over 5-10 minutes, 4 times a day. Regular practice will help with effortless breathing. This exercise can be done in a straight sitting position, standing and walking. 2. Effective cough Namely training to remove secretions. Equipment : a. Pot sputum b. Lysol 2-3% c. Padding towel d. Pin e. Pillow if needed f. Tissue g. Bent Procedure: a. After using bronchodilator medication (if prescribed), inhale deeply through your nose and hold your breath for a few seconds b. Cough twice, the first cough to release mucus and the second cough to remove secretions, if the patient feels chest pain, when coughing press the chest with a pillow. Collect the secretions in a sputum pot containing lysol c. To cough out, lean forward slightly and exhale forcefully with a sound“blowing” d. Inhale with alternating short, rapid breaths (inhales) to prevent mucus from moving back into the narrow airway e. Rest f. Avoid prolonged use during coughing as it can cause fatigue and hypoxia