Chest physical therapy is the term for a

group of treatments designed to

improve respiratory efficiency, promote

expansion of the lungs, strengthen

respiratory muscles, and

eliminate secretions from the respiratory

system

Chest Physiotherapy is the removal of

excess secretions (also called

mucus, phlegm, sputum) from inside the

lungs, by physical means. It is used to

assist a cough, re-educate breathing

muscles and to try to improve ventilation

of the lungs.

The lungs are kept moist with a thin film

of fluid to stop them drying out.

When there is a chest infection or

occasionally in other situations, this fluid

increases and becomes thick .

In the normal situation, these secretions

are removed by coughing

but this is not always possible in the

presence of weakness, or in chronic lung

disease.

Although antibiotics can control the

infection, they do not remove the

secretions that occur.

Some will be reabsorbed into the body

but very thick ones will remain.

It is important to remove the secretions to

allow more effective breathing and

increase the amount of oxygen getting

into the body.

to help patients breathe more freely and

to get more oxygen into the body

It is usually done in conjunction with

other treatments to rid the airways of

secretions.

These other treatments include

› suctioning,

› nebulizer treatments,

› the administration of expectorant drugs.

Chest physiotherapy includes :-

1. postural drainage

1. chest percussion

2. chest vibration

3. turning

2. deep breathing exercises

3. coughing

4. positive expiratory pressure (PEP) valve

It removes mucus from certain parts of the lungs by using gravity and properpositioning to bring the secretions into the throat where it is easier to remove them.

The lungs are divided into segments called lobes, the right lung is divided intothreelobes(right upper lobe, right middle lobe and right lower lobe)

while the left lung has only twolobes (left upper lobe and lower lobe

Postural drainage uses the force of gravity to assist in effectively draining secretions from the lungs and into the central airway where they can either be coughed up or suctioned out.

The patient is placed in a head or chest down position and is kept in this position for up to 15 minutes. Critical care patients and those depending on mechanical ventilation receive postural drainage therapy four to six times daily. Percussion and vibration may be performed in conjunction with postural drainage.

Percussion is rhythmically striking the

chest wall with cupped hands. It is also

called cupping, clapping.

The purpose of percussion is to break up

thick secretions in the lungs so that they

can be more easily removed.

Percussion is performed on each lung

segment for one to two minutes at a

time.

is the placement of hands along the ribs in the direction of

expiratory movement of the chest.

A small rapid vibration (tremor) and slight pressure is applied

during exhalation to accentuate this phase of the respiratory

cycle. The maneuver mimics the forced exhalation of a

cough.

Mechanical devices used to perform vibration differ from the

manual method in that the mechanical device is continuously

applied during both inspiration and exhalation

TurningTurning from side to side permits lung expansion. Patients may turn themselves or be turned by a caregiver. The head of the bed is also elevated to promote drainage if the patient can tolerate this position. Critically ill patients and those dependent on mechanical respiration are turned once every one to two hours around the clock.

CoughingCoughing helps break up secretions in the lungs so that the mucus

can be suctioned out

Patients sit upright and inhale deeply through the nose.

They then exhale in short puffs or coughs. Coughing is repeated several times a day.

Deep breathingDeep breathing helps expand the lungs and forces better

distribution of the air into all sections of the lung. The patient either sits in a chair or sits upright in bed and inhales, pushing the abdomen out to force maximum amounts of air into the lung. The abdomen is then contracted, and the patient exhales. Deep breathing exercises are done several times each day for short periods.

1) Excessive sputum production2) Reduced effectiveness of cough

3) History of success in treating a pulmonary problem with CPT

4) Adventitious breath sounds suggestive of secretions in the airways which persist after coughing

5) Change in vital signs

6) Abnormal chest radiograph suggesting atelectasis, mucus plugging.

7) Significant deterioration in the indices of gas exchange from baseline status

1. Sputum retention not responsive to spontaneous or directed coughing

2. History of pulmonary problems treated successfully with postural drainage therapy

3. Decreased breath sounds or adventitious sounds suggesting secretions in the airway

4. Change in vital signs-increase in breathing frequency, tachycardia

5. Abnormal chest radiograph consistent with atelectasis, mucus plugging, or infiltrates

6. Deterioration in arterial blood gas values or oxygen saturation

1) Change in sputum production.

2) Change in breath sounds.

3) Patient subjective response to therapy.

4) Change in vital signs.

5) Change in chest radiograph.

6) Change in arterial blood gas values or oxygen saturation.

1) Hypoxemia.

2) Increases in Intracranial Pressure.

3) Acute hypotension during therapy.

4) Pulmonary Hemorrhage.

5) Pain or Injury to Muscles, Ribs or Spine.

the patient's reaction to the therapy including subjective responses to pain

discomfort and dyspnea

heart rate and rhythm

respiratory rate and pattern including work of breathing

cough and sputum production including color, quantity, consistency, and odor

breath sounds

oxygen saturation by pulse oximeter

blood pressure

http://www.answers.com/topic/chest-

physical-therapy

http://www.livingwithcerebralpalsy.com/

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http://www.jtsma.org.uk/in013.html

http://www.jazannurses.com/vb/nurses1

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