one of the most commonly used techniques of the lung drainage is the postural drainage its non invasive and easy technique ans very useful in hospital as well as home settings.
3. 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.
4. 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.
6. Critical care
In-patient acute care
Extended care and
skilled nursing facility
care
Home care
Outpatient/ambulator
y care
Pulmonary diagnostic
(bronchoscopy)
laboratory
Postural drainage
therapy
SETTING:
7. 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.
8. Postural drainage:
1. evidence or suggestion of
difficulty with secretion
clearance
2. 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
10. 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
11. 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
12. 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.
13. 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
14.
15.
16.
17.
18. 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
27. 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.
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