Chest Physiotherapy By Dr. Hanan Said Ali

Objectives Define breathing and coughing exercise. Mention purpose of these exercise. Explain why should we do these exercises? Mention types of breathing and coughing exercise. Explain how to do these exercise. Define Postural Drainage. Explain how to perform Postural Drainage. Explain how to perform Chest Percussion

Breathing and coughing exercise:- The purpose of these exercise is Increase ventilation in the lower lobes and promote maximum expiration of lungs and chest walls Strengthen and improve the efficiency of respiratory muscle . Promote relaxation and relative anxiety .

Breathing and coughing exercise:- The purpose of these exercise is Comt. Keep air way clearance. Prevent post operative pulmonary complications. Eliminate the useless uncoordinated pattern and decrease the work of breathing.

Breathing and coughing exercise:-

Breathing and coughing exercise:- Why Should I Do These Exercises? Deep breathing and coughing exercises facilitate the respiratory function by helping in removing secretion from airway tract. Voluntary coughing in conjunction with deep breathing facilitates the movement and expectoration of secretion in the respiratory tract. Frequent deep breathing exercise automatically initiates the cough reflex.

Breathing and coughing exercise:- Who Should Perform These Exercises? Patients on bed rest or those who have undergone any surgical procedure, for example abdominal or chest surgery. Patients prone to pulmonary problems. Patients susceptible to accumulating respiratory secretions.

Breathing and coughing exercise:-

Breathing and coughing exercise:- How Frequently Should These Exercises be Performed? Deep breathing should be performed every hour while awake. Patients who have had abdominal or chest surgery need to perform deep breathing at least three to four times daily. Each session should include a minimum of five deep breaths. Deep breathing exercise may be performed every hour, especially by patients who are prone to pulmonary problems.

Breathing and coughing exercise:- Deep Breathing Exercises There are two types of deep breathing exercises. 1. Diaphragmatic Breathing Exercise; Diaphragmatic breathing strengthens the diaphragm, decreases the use of accessory muscles and allows for better emptying of the lungs.

Breathing and coughing exercise:- 2. Pursed-lip breathing; Pursed lip breathing slows the respiratory rate, decreases the dynamic compression of the airways and thus keeps them open longer.

Breathing and coughing exercise:- Indications: Inpatients with acute and chronic obstructive ventilator disorders. In patients having upper abdominal or thoracic surgery. Contraindications: Increased intracranial pressure Acute unstable head ,neck, or spinal injury.

Procedure steps Rational Count the individual respiratory rate and assess for depth and chest expansion. Auscultate the patient's lungs especially noting areas where there rare diminished breath sounds or areas where moisture is present To have base line data to help choosing the appropriate respiratory care modality. Check the patient for pain or other factors that may limit respiratory effort Pain medication should be administered 30 min. before procedure

Procedure Cont. steps Rational Planning:   3- Appropriate time for procedure (better before meals , and at bed time. To have patient relaxed . Full stomach limits the movement of the diaphragm. 4. Ask the patient to clear the nasal passages. 5. Provide the patient with: -Tissue paper -A pillow or towel for post operative patients To expel sputum To support the incision.

Procedure Cont. steps Rational 6. The patient's back should kept straight . 7. The patient should stand firmly or sit in semi – fowler's position To promote full expansion of the lungs 8. Explain procedure.

Procedure Cont steps Rational Implementation: Diaphragmatic breathing Place one hand on stomach just bellow the ribs and the other hand at mid chest the knees should be flexed. Instruct the patient to inhale slowly and deeply through the nose letting the abdomen protrudes as far as it will

Procedure Cont steps Rational Instruct the patient to hold his breath for at least 3 seconds. Instruct the patient to exhale slowly through pursed lips while tightening the abdominal muscles . Press firmly inward and up ward on the abdomen while breathing out . To allow slower and complete emptying of the lungs.

Procedure Cont steps Rational These procedure should be done for 1 min. followed by a rest period of 2min.Work up to 10 min. four times daily in different positions ; lying sitting standing and walking. It helps the patient breath in a controlled manner during activities that produce dyspnea. If shortness of breath occur stop exercise.

Procedure Cont steps Rational Pursed – lip breathing 1-Have the patient inhale slowly through the nose to the count of 2. 2-Have the patient exhale slowly and evenly against pursed lips to the count of 4 while contacting (tightening) the abdominal muscles. Avoid exhaling forcefully. Pursing the lips increases the intrabronchial , intra- alveolar pressure (helps maintain them open)

Procedure Cont steps Rational Deep breathing and coughing exercise 1-Position patient in sitting or semi-flower's position 2. Provide him with tissues paper and a towel if he's post operative. To facilitate deep inhalation   To expel sputum To provide support for the site of wound. 3 -Instruct the patient to place one hand on stomach just below the ribs and the other hand at mid chest , the knees should be flexed.

Procedure Cont steps Rational 4 -Instruct the patient to take slow deep inspiration and watch for chest movement and instruct him to hold breath to count of 5 . 5. Ask the patient to exhale forcefully and then release air while flexing forward. 6. Repeat for 3 deep coughs or until mucus is expectorated. To move secretions mouth ward to be easily expelled. 7. Offer oral hygiene if the patient expectorate sputum.

Procedure Cont steps Rational Evaluation: Evaluate the following items A-Respiratory rate equal to or less than before procedure. B-Chest expansion equal or greater. C-Lung clear E-Patient resting comfortably

Postural Drainage Purpose: Maintain a patient airway by mobilizing secretions into larger airway where they can be coughed or suctioned. Increase respiratory gas exchange by increasing the available surface area at the alveolar level. Decrease the incidence of respiratory infection.

Postural Drainage Assessment Check the chart for a physician's order ,which is needed to perform postural drainage. Auscultate lungs to determine location and degree of retained secretion. Verify assessment with recent chest radiographs.

Postural Drainage Contraindications Increased intracranial pressure. Spinal fractures. Heart diseases.

Postural Drainage Planning: Individualize the following goals for performing postural drainage: a-Maintain a patient airway. b-Mobilize secretions. Obtain all necessary equipment: a. Pillows and positioning aids b-Tissues paper. c-Suction equipment.(if indicated)

Postural Drainage Procedures steps Rational 1-Wash hands 2-Loosen any tight clothing. 3-Lower head of bed slowly so that client's head is positioned in no greater than 25 downward angle Gravity helps mobilize secretion

Postural Drainage Procedures

Postural Drainage Procedures steps Rational 4-Place sputum container and tissues in client's reach 5 –Tell client to remain in position for 3-15 minutes. Percussion may be added to help mobilize secretions. 6-instruct client to expectorate secretions. 7-Instruct client to turn to other side , then to supine position , then repeat procedure .N.B .client should deep breathe between position changes.

Postural Drainage Procedures steps Rational 8-Assist client to slowly return to normal sitting position after coughing . 9- Auscultate chest areas for improved breath sounds . 10- Don gloves . 11- Note character and measure sputum , then discard.

Postural Drainage Procedures steps Rational 12-Remove gloves and wash hands. 13-Offer oral hygiene following secretion expectation. Evaluation: Compare patient respiratory assessment pre and post postural drainage to identifies the effect of postural drainage.

Postural Drainage Procedures To drain the upper portions of your lungs, you should be in a sitting position at about a 45 degree angle.

Chest Percussion procedure steps Rational 1-Cover area to be percussed with gown or cloth towel 2-Holding arms with elbows slightly flexed, cup your hands with thumbs and fingers closed .Keeping wrists loose and relaxed 4. Rhythmically flex and extend wrists to clap over area to be drained This motion produces vibrations that loosen secretions for easier removal with coughing or suctioning 3-Percuss by alternating hands .

Chest Percussion procedure steps Rational 5 -slowly and rhythmically percuss each area for 3-5 minutes 6 -Do not percuss over bone ,breasts ,or other tender area . Vibrations are not transmitted to the chest wall through bone or breast tissue and percussion in these areas can cause discomfort. 7 -Encourage client to cough after percussion of lung areas.

Chest Percussion procedure steps Rational 8 -Auscultate all lung areas for changes in breath sounds. 9 -Don gloves ,note character and measure quantity of sputum and discard.

Thank You