BRONCHOPULMONARY HYGIENE TECHNIQUES

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CHAPTER 8 BRONCHOPULMONARY HYGIENE TECHNIQUES

PRETEST QUESTIONS

Answer the pretest questions before studying the chapter. This will help you determine your strong and weak areas in the material covered.

1. Postural drainage and percussion are not indicated in which of the following conditions?

A. Bronchiectasis
B. Cystic fibrosis
C. Pulmonary edema
D. Acute atelectasis

2. In which of the following airway clearance techniques is the patient instructed to alter VT in three phases before a cough effort?

A. Intrapulmonary percussive ventilation
B. Autogenic lung drainage
C. Positive expiratory pressure (PEP) therapy
D. Chest percussion or vibration

3. The respiratory care practitioner receives an order for postural drainage on a patient to mobilize secretions from the anterior segment of the right upper lobe of the lung. How should the patient be positioned for the lung to drain most effectively?

A. Patient lying supine with pillows under the knees
B. Patient lying on right side in Trendelenburg position
C. Patient lying on stomach in Trendelenburg position
D. Patient lying on left side, rotated back 25 degrees, with the bed flat

4. A 34-year-old patient using a 40% aerosol mask has right lower lobe pneumonia. He becomes short of breath and his SpO2 decreases from 96% to 89% when lying on his right side. What should the respiratory therapist recommend?

A. Increase the O2 to 80%
B. Place the patient on his left side
C. Have the patient begin using CPAP
D. Suction the patient

See answers and rationales at the back of the text

REVIEW

I. CHEST PHYSICAL THERAPY

CRT Exam Content Matrix: IIA14a, IIIA1a-b, IIIC1a, IIIC4, IIIF1, IIIF2f1-2

RRT Exam Content Matrix: IIIA1a-b, IIIC1a, IIIF1

A. Chest physical therapy (CPT) is a variety of techniques aimed at the mobilization of pulmonary secretions and promotion of greater use of the respiratory muscles, which should result in an increase in the distribution of ventilation. Techniques included in CPT are
1. Postural drainage
2. Chest percussion
3. Chest vibration
4. Cough techniques
5. Breathing exercises (see Chapter 15 on respiratory home care)
B. Goals of CPT
1. To prevent the accumulation of pulmonary secretions
2. To improve the mobilization of retained secretions
3. To improve the distribution of ventilation
4. To decrease airway resistance
C. Indications for CPT
1. Lung conditions that cause increased difficulty in mobilizing pulmonary secretions
a. Bronchiectasis
b. Cystic fibrosis

image Exam Note

CPT is indicated for patients who produce more than 30 mL of secretions per day and have difficulty clearing them from the airway.

2. Acute respiratory failure with retained pulmonary secretions
3. Acute atelectasis
4. Ventilation and perfusion abnormalities resulting from retained pulmonary secretions
5. Inefficient breathing patterns in patients with COPD
6. Prevention of postoperative respiratory complications
D. Contraindications for CPT
1. Patients with ICP greater than 20 mm Hg
2. Recent spinal surgery or injury
3. Head and neck injury (until stabilized)
4. Active hemoptysis
5. Empyema
6. Bronchopleural fistula
7. Rib fractures
8. Pulmonary edema associated with congestive heart failure
9. Large pleural effusions
10. Tube feeding or recent meal
11. Subcutaneous emphysema
12. Pulmonary tuberculosis
13. Lung contusion
14. Osteoporosis
E. Postural Drainage Positions

image

FIGURE 8-1 Position to drain the posterior basal segment of the lower lobe of the lung.

image

FIGURE 8-2 Position to drain the lateral basal segment of the lower lobe of the lung.

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FIGURE 8-3 Position to drain the superior segment of the lower lobe of the lung.

image

FIGURE 8-4 Position to drain the anterior basal segment of the lower lobe of the lung.

image

FIGURE 8-5 Position to drain the lateral and medial segments of the right middle lobe of the lung.

image

FIGURE 8-6 Position to drain the superior and inferior lingular segments of the left lung.

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FIGURE 8-7 Position to drain the apical segment of the upper lobe of the lung.

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FIGURE 8-8 Position to drain the anterior segment of the upper lobe of the lung.

image

FIGURE 8-9

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