Postural Drainage Therapy – Flashcards

the drainage of secretions by the effect of gravity from small airways to large airways

Rhythmic striking of the thorax with a cupped hand or mechanical device to facilitate the loosening of retained secretions

Applications of rapid though fine tremorous movement during expiration to facilitate the movement of secretions

- Unstable spinal cord injuries - Traction of arm abductors - Severe diarrhea - Marked agitation - A rise in ICP - A large drop in BP; greater than 10 % - Worsening dyspnea, hypoxia and cardiac arrhythmias

- Ventilator disconnection - Accidental extubation - Accidental aspiration of ventilator circuit condensate - Disconnection of lines

Segmental bronchus is drained in a vertical position relative to gravity. Moves secretions from distal lung lobes or segments into the central airways, hopefully to be removed by coughing or suctioning. Positions held from 3 - 15 minutes. Depending on patient toleration. Greater success if there is adequate systemic and airway hydration

- Inability to mobilize retained secretions - Atelectasis caused by or suspected of being caused by mucus plugging - Presence of foreign body in airway

Stop the therapy, Stay with the patient, Stabilize

Breath sounds. Blood pressure. O2 saturation by pulse oximetry (if hypoxemia is suspected). Intracranial pressure

-Presumed effectiveness may be based on tradition and anecdotal reports rather than scientific evidence - Similar to IPPB this therapy has been excessively used in patients in whom it is not indicated - Airway clearance difficult in patient's with ineffective cough - Optimal positioning difficult in critically ill patients

- Intracranial pressure (ICP) > 20 mmHg - Head and neck injuring until stabilized (Absolute) - Active hemorrhage (Absolute) - Hemodynamic instability - Recent spinal surgery or acute spinal injury - Empyema - Bronchopleural fistula - Pulmonary edema associated with congestive heart failure (CHF) - Large pleural effusion - Pulmonary embolism - Aged, confused or uncooperative patients who do not tolerate positioning - Rib fractures with or without flail chest - Surgical wound or healing tissue

- Intracranial pressure (ICP) > 20 mmHg - Patients in whom increased ICP is to be avoided - neurosurgery, eye surgery - Uncontrolled hypertension - Distended abdomen - Esophageal surgery - Gross hemoptysis - Uncontrolled airway at risk for aspiration - tube feeding or recent meal

- Subcutaneous emphysema - Recent epidural spinal infusion or spinal anesthesia - Recent skin graphs on thorax - Burns, open wounds and skin infections of the thorax - Recently placed transvenous or subcutaneous pacemakers

- Increase in sputum production - Improvement in breath sounds - Restoration of normal vital signs - Resolution of abnormal chest x-ray - Normalization of ABG values or O2 saturation - Improvement in lung status for ventilator patient's - Improvement in lung status for ventilator patient's