28 terms

procedures unit 4

chest physical therapy and airway clearance
what is CPT
a general term used for clearing the airway of secreation and improving distribution of ventilation through better use of inspiratory muscles.
what are the techniques for cpt
postural drainage, chest percussion and vibration, cough techniques, and breathing exercise training
what are the goals of cpt
prevent accumulation of pulmonary secretions, improve mobilization of retained secretions, improve distribution of ventilation, improve cardiopulmonary exercise tolerance
if ordered with a SVN, IPPB or MDI when should you do CPT
what are indications for CPT
retained secretions, decreased cilia function, ineffective cough, v/q abnormalities retain from secretions
what diseases indicate CPT
bronciactisis, CF, COPD, Pneumonia, Acute atelectasis, any condition with copius secretions
what is postural drainage
postural drainage uses gravity to aid in mobilizing secretions this is accomplished bypositioning the body for optimal drainage to the segments needing to be drained
face down
face up on your spine
sitting straight up
semi reclined position
head down feet up body straight 18-30 degree angle
semi trendelenburg
12-15 degree angle head down feet up body straight
reverse trendelenburg
body straight head up feet down
hazards of PD
aspiration, increase ICP, hypoxemia
contraindications of PD
unstable head/neck injuries, spainal injury, hemoptysis, hemorrahage, hemodynamic instability, pulmonary edema associated with CHF, large pleural effusion, rib fracture, pulmonary embolism, ICB > 20mm hg, empyema, surgical wound or healing tissue
when should trendelenburg position not be used
with head trauma patients, aneurysm, uncontrolled hypertension, post neurosurgery, eye surgery, or estophagel surgery
what is percussion
is almost always used in conjuction with posterial drainage it may be administered manually by "clapping" with a cupped hand over the appropriate are, or with one of various percussion devices
what is the purpose of percussion
mechanically dislodge secreations
what are indication for percussion
when secreations are hard to dislodge
what are contraindications for percussion
rib cage trauma, soft tissue trauma, hemoptysis, metastatic conditions, pulmonary emboli, pulmonary abscess, head trauma, unstable cardiovascular system, unstable post op status,untreated tb, recent epidural spianl infusion or spinal anesthesia, sub q emphysema, recent skin grafts on thorax, burns, open wounds, skin infections, recently placed pacemaker
how long should you wait to do CPT on a patient whom has just eaten?
one hour/try to coordinate with pain meds
percussion should never be performed over
clavicals, scapulas, sternum, spine, breast
When vibration is used in conjuction with PD when is it performed?
on exhalation
what is the purpose of vibration
to move secreations to larger airways
what are contraindications for vibration
rib cage trauma, soft tissue trauma
how do you monitor effectiveness of CPT through patient assesments
breath sounds, texture, color, chest expansion, cough improvement, toleration, vital signs, chest xrays
when should you discontinue CPT
clear breath sounds, clear xrays, patient is ambilating well, strong cough, afebrile for 24 hours