1. CHEST PHYSIOTHERAPY
PREPARED BY
MS. MAHALAKSHMI.L
M.SC. NURSING 1ST YEAR

2. DEFINITION
•Chest physiotherapy is a group of
therapies used in combination to
mobilize pulmonary secretions. Chest
physiotherapy is the removal of excess
secretions from the lungs by physical
means.

3. USES
• Assist in coughing
• Reeducate breathing muscles
• Improve ventilation of the lungs

4. THERAPIES INCLUDES IN CHEST
PHYSIOTHERAPY
• Postural drainage
• Chest percussion
• Vibration
Chest physiotherapy should be followed by
productive coughing & suctioning of the
patient . chest physiotherapy should never be
done straight after a meal or drink.

5. INDICATION
• Itisindicated for patients in whom coughis
insufficient to clear thick, tenacious,or localized
secretions.
• Examples:
• Cysticfibrosis
• Bronchiectasis
• Atelectasis
• Lungabscess
• Pneumonia

6. CONTRAINDICATION
• IncreasedICP
• Unstable heador neckinjury
• Activehemorrhageor hemoptysis
• Recentspinalinjury
• Ribfracture
• Flailchest
• Uncontrolledhypertension
• Anticoagulation
• Thoracicsurgeries

7. PRECAUTION
• Keep suction apparatus & emergency airway &
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.
• Provide coughing instruction prior to therapy.
• Suctioning of trachea is essential.

8. COMPLICATION
• Hypoxemia
• Increased intracranial pressure
• Acute hypotension
• Pulmonary hemorrhage
• Pain
• Injuries to muscles
• Vomiting and aspiration
• Bronchospasm
• Dysrhythmias
• Excessive lung volume

9. EQUIPMENT'S USED IN CHEST
PHYSIOTHERAPY
• Trendelenberg bed
• Pillows , Patient gown and towl
• Sterilized clothes
• Basin , Stethoscope
• Suction apparatus
• Mechanical percussor
• Cardiac monitoring , Pulse oximeter
• Chest radiograph
• Emergency airway

10. PROCEDURE OF CHEST
PHYSIOTHERAPY
• Assess the chest x-ray for pulmonary findings.
• Assess respiratory rate of patient.
• Assess breathing , rhythm , skin colour , BP, HR of
patient.
• Assess the patient`s ability to take deep breath
• Perform chest physiotherapy
• Monitor the following throughout the therapy

11. 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 to patient
tolerance

12. PERCUSSION/ CLAPPING
• Chestpercussion involves
rhythmically clapping on the chest
wall over thearea being drained to
force secretions intolarger airways
for expectoration.
• Position the hand so the fingers and
thumb touch and the hands are
cupped.

14. • Perform chest percussion by vigorously
striking the chest wall alternately with
cupped hands.
• Theprocedure should produce ahollow
sound and should not bepainful.
• Perform percussion over asingle
layerof clothing, not over buttons
orzippers.

15. • Percussion is contraindicated in patients
with bleeding disorders, osteoporosis,
fractured ribs and open wounds and
surgeries.
• Don’t percuss over the spine, sternum,
stomach or lower back as trauma can
occur to thespleen, liver, or kidneys.
• Typically, each area is percussed for 30
to 6o secondsseveral times aday.
• If the patient has tenacious secretions, the
area must be percussed for 3-5 minutes
severaltimes per day.

17. VIBRATION
• Vibration isagentle, shakingpressureapplied
to the chest wall to move secretions into
larger airways.
• Thenurseusesrhythmic contractions and
relaxations of arm and shoulder musclesover
the patient’schest.
• During vibration, place your flat hand firmly
againstthe chest wall, on the appropriatelung
segmentto bedrained.
• Vibrate the chest wall asthe patientexhales
slowly through the pursedlips.

18. •After each vibration, encourage the
clientto cough and expectorate
secretions into the sputum container.

19. POSTURALDRAINAGE
• Postural drainage is a technique in which
different positions are assumed to
facilitate the drainage of secretions
from the bronchialairways.
• Gravity helps to move the secretions to
the trachea to be coughed upeasily.
• Thegoal of postural drainage is tohelp
drain mucus from the affected lobes into
the larger airways of the lungs soit can
be coughed up morereadily.

20. • 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 thelungs.

21. • The lower lobes require drainage most
frequently because the upper lobes drain by
gravity.
• Before postural drainage, the client may be
given a bronchodilator medication or
nebulization therapy to loosensecretions.

22. • Postural drainage treatments are scheduled
two or three times daily, depending on the
degreeof lungcongestion.
• 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 caninducevomiting.
• Help the patient assume the appropriate
position, based on the lung field that requires
drainage.

23. LUNGLOBESAND SEGMENTS

24. Lung segment PositionRecommended
Apical areas of the
upperlobes
-Ask the patient to
sit at the edge of
thebed.
-If the patient is not
able to sit at the edge
of the bed, use high-
Fowler’sposition.

26. Lungsegment Position
Recommended
Posterior section
of the upper
lobes.
Position supine
with a pillow
under the hips
and knees
flexed

27. Lungsegment PositionRecommended
Middle orlower lobes With the bed in the
Trendelenburg position,
position the patient inSims’
position.
Todrain the left lung,
position the patient
on hisrightside.
Forthe right lung, position the
patient on his left side.
Posteriorlower lobes. Keepingthe bed flat, position
the patient prone with a
pillow underher stomach.

30. • 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 inposition.
• The sequence for chest physiotherapy is
usually asfollows:
• Positioning, percussion, vibration, and removal
of secretions by coughing orsuction

31. 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