Group of therapies used in combination to mobilize pulmonary secretions

Includes postural drainage, chest percussion, and vibration

Should be followed by productive coughing and suctioning of the client

Recommended for clients who produce greater than 30 mL of sputum per day or have evidence of atelectasis

can be safely used with infants and young children, unless contrainidcated.

Dependent nursing function

Know the client’s normal range of vital signs.

Know the client’s medications.

Know the client’s medical history.

Know the client’s level of cognitive function.

Be aware of the client’s exercise tolerance.

Involves striking the chest wall over the area being drained.

Hand is positioned so that the fingers and thumb touch, and the hands are cupped.

Sends waves of varying amplitude and frequency through the chest, changing the consistency and location of sputum.

Performed by striking the chest wall alternately with cupped hands.

Performed over a single layer of clothing.

Contraindicated in patients with bleeding disorders, osteoporosis, or fractured ribs.

Caution should be taken to percuss the lung fields and not the scapular regions.

Cover the area with a towel or gown to reduce discomfort.

Ask the client to breathe slowly and deeply to promote relaxation.

Alternately flex and extend the wrists rapidly to slap the chest.

Percuss each affected lung segment for 1-2 minutes.

If done correctly, the percussion action should produce a hollow, popping sound.

Percussion is avoided over the breasts, sternum, spinal column, kidneys, scapula.

Fine, shaking pressure applied to the chest wall only during exhalation.

Increase velocity and turbulence of exhaled air, facilitating secretion removal.

Increases the exhalation of trapped air and may shake mucus loose and induce cough.

Place hands, palms down, on the chest area to be drained, one hand over the other with the fingers together and extended. Alternatively, the hands may be placed side by side.

Ask the client to inhale deeply and exhale slowly through the nose or pursed lips.

During exhalation, tense all the hand and arm muscles, and using mostly the heel of the hand, vibrate the hands, moving downward. Stop vibrating when the client inhales.

Vibrate during five exhalations over one affected lung segment.

After each vibration, encourage the client to cough and expectorate secretions in the sputum container.

Use of positioning technique that draw secretions from specific segments of the lungs and bronchi into the trachea.

Drainage by gravity of secretions from various lung segments, enhance matching of ventilation and perfusion, normalize functional and residual capacity.

Procedures can include most lung segments. It is based on clinical assessments.

The positions assumed are determined by the location, severity, and duration of mucus obstruction.

Prior to postural drainage, the patient may be given a bronchodilator medication or nebulization

Best time for postural drainage includes before breakfast, before lunch, in the late afternoon, and before bedtime.

Nurse must evaluate the client’s tolerance of postural drainage.

Indicated for difficult with secretion clearance, evidence of retained secretions, and lung conditions that cause increased production of secretions.

Contraindicated in undrained lung abscess, lung tumors, pneumothorax, diseases of the chest wall, lung hemorrhage, painful chest conditions, tuberculosis, severe osteoporosis, increased ICP, uncontrolled hypertension, and gross hemoptysis.

The procedure should be discontinued if tachycardia, palpitations, dyspnea, or chest pain occurs. These symptoms may indicate hypoxemia. Discontinue if hemoptysis occurs.

Bilateral - High-Fowler’s position

Apical segments: Right upper lobe -- anterior segment - Supine with head of bed elevated 15-30 degrees

Left upper lobe -- anterior segment - Supine with head elevated

Right upper lobe -- posterior segment - Side lying with right side of chest elevated on pillows

Left upper lobe -- posterior segment - Side lying with left side of chest elevated on pillows

Right middle lobe -- anterior segment – Three-fourths supine position with dependent lung in Trendelenburg’s position

Right middle lobe -- posterior segment – prone with thorax and abdomen elevated

Both lower lobes -- anterior segments – Supine in Trendelenburg’s position

Left lower lobe -- lateral segment – left lateral in Trendelenburg’s position

Right lower lobe – lateral segment – right side-lying in Trendelenburg’s position

Right lower lobe – posterior segment – prone in Trendelenburg’s position with abdomen and thorax elevated

Both lower lobes – posterior segments – prone in Trendelenburg’s position with abdomen and thorax elevated

Bilateral – apical segments – sitting on nurse’s lap, leaning slightly forward, flexed over pillow

Bilateral – middle anterior segments – sitting on nurse’s lap, leaning against nurse

Bilateral lobes – anterior segments – lying supine position on nurse’s lap, back supported with pillow

Instruct the patient to do diaphragmatic deep breathing.

Position the patient in prescribed postural drainage positions.

Percuss (clap) with cupped hands over chest wall.

Instruct the patient to inhale slowly and deeply. Vibrate the chest wall as the patient exhales slowly through pursed lips.

Removal of secretions may be done by coughing or suctioning.

Allow the patient to rest several minutes.

Listen with a stethoscope for changes in breath sounds.

Repeat the percussion and vibration cycle according to the patient’s tolerance and clinical response (15-30 min.)

Document amount, color, and character of expectorated secretions.