1. 1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

2. 2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Chapter 16 Bronchial Hygiene

3. 3 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Body Alignment and Stance When the body is aligned properly, the ability to move is done smoothly. Minimal strain is placed on muscles, tendons, bones, and joints. Correct body alignment facilitates: –Patient comfort –Prevention of disability

4. 4 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. General Guidelines for Moving Patients Before attempting to move a patient: –Check on the patient’s general condition –Ascertain if a change of position is contraindicated Some patients may have conditions that limit movement and position.

5. 5 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Safety Devices Bed Rails Restraints Nurse Call Buttons Code Switch

6. 6 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Chest Percussion and Postural Drainage Postural Drainage –Patient is positioned in specific ways that allow gravity to facilitate the removal of pulmonary secretions Chest Percussion –Clapping on the chest wall with cupped hands Vibration –Isometric maneuver performed with the arm and hand

7. 7 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Postural Drainage Equipment Requirements –Minimum of four pillows to position the patient Position Modifications –Any problems with the cardiovascular system, intracranial pressure, and the arterial partial pressure of oxygen (PaO 2 ) may require the position to be modified.

8. 8 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Percussion Areas to Avoid: –Bony structures, the spine, the abdomen, and breast tissue in a female patient Adjunctive Devices for Chest Percussion –DHD Healthcare Palm Cups R –Ballard Medical percussors Mechanical percussors –Facilitates chest percussion

9. 9 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Physician’s Order A complete order for postural drainage and chest percussion includes : –Frequency –Duration of therapy –The location or target area

10. 10 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Contraindications and Hazards Primarily limited to presence of cardiovascular instability and other specific diseases of the pulmonary system The safety of patients rests on the judgment of the therapist.

11. 11 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Other Therapies for Bronchial Hygiene Positive expiratory pressure therapy Oscillating PEP therapy Flutter valve therapy High-frequency chest wall oscillation therapy Adjunctive breathing techniques Respironics Coughassist TM MI-E

12. 12 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Positive Expiratory Pressure Therapy Application of positive pressure during active exhalation to increase functional residual capacity following a large tidal breath –Allows gas to move distally to obstructed areas –When the patient coughs forcefully, removal of secretions is facilitated.

13. 13 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Oscillating PEP Therapy Uses a counterweighted magnet and lever to create a vibratory effect during exhalation –As the lever opens and closes, flow is interrupted causing vibration to the lung parenchyma.

14. 14 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Flutter Valve Therapy A weighted ball resting on a conical seat. The ball rises, then falls, blocking the outlet, and then rises again during exhalation –Opening and closing of the valve causes pressure pulses to be transmitted throughout the lung parenchyma.

15. 15 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. High-Frequency Chest Wall Oscillation Therapy Application of pressure pulses to the thoracic cage via a pneumatic inflatable vest –Patient applies the vest and connects it to the air-pulse generator, which rapidly inflates and deflates the vest – Causes oscillatory pressure pulses to be transmitted throughout the thorax

16. 16 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Adjunctive Breathing Techniques Breathing exercises that are taught to the patient for self-administration –Diaphragmatic breathing, unilateral chest expansion, pursed-lip breathing, and directed cough techniques –Causes hyperinflation of the lungs, facilitating secretion removal by coughing

17. 17 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Respironics Coughassist TM MI-E Electrically powered pneumatic insufflation/exsufflation device that applies both positive and negative pressure to the airway –Rapid shifts from positive to negative pressure assist the patient in generating expiratory flow rates to facilitate coughing.

18. 18 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. General Guidelines Bed Rails –Always in the up position, unless working with a patient on that side Positioning of the Therapist –Position as close to the patient and the side of the bed as possible

19. 19 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Patient Positioning Fowler’s and Semi-Fowler’s positions Supine position Prone position Side-lying position Sims’ position Trendelenburg position

20. 20 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Assisting a Patient Into a Chair Lower the bed and raise the head of the bed to full Fowler’s position. Assist the patient into a dangling position at the side of the bed. (continues)

21. 21 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Assisting a Patient Into a Chair (continued) Spread the patient’s feet and position your foot closer between the patient’s feet. Grasp the patient under the arms and assist to a standing position. Pivot the patient 90° and lower him or her into the chair.

22. 22 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Use of Restraints Chest and Waist Restraints –Prevent the patient from falling or climbing out of bed –Help a patient who is sitting in a chair or wheelchair Wrist and Ankle Restraints –Reduce the mobility of the limb they are attached to

23. 23 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Percussion Technique Position the hands. Practice percussing your own thigh. (continues)

24. 24 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Percussion Technique (continued) Practice percussion on a laboratory partner –Frequency of 50 to 60 percussions per minute –Observe for red marks on the surface of the skin. –Position your partner into the 12 drainage positions, identify the landmarks for percussion, properly perform the technique, observe your partner for any adverse effects.