Postural Drainage - wheezing – high pitched sound produces by narrow

● It is a drainage by gravity of secretions from various lung airways, usually heard with bronchial asthma –
segments. constriction of bronchi
● If the secretions remain in the lungs or respiratory airways, 5. Assess vital signs and pulse oximetry before postural drainage
this can promote bacterial growth and can lead to infection. treatment.
● If the secretions obstruct the smaller airways it can cause 6. Determine patient’s and caregiver’s understanding of an ability to
atelectasis or collapse of the lungs. perform home postural drainage.
● If the secretions accumulate on the major airways such as 7. Determine patient’s level of comfort.
trachea and the right and left main bronchi, this can usually
cough out into the pharynx which they can be expectorated. Planning
This can be swallowed or can be effectively remove by 1. Identify expected outcomes.
suctioning. 2. Explain procedure to patient and family.
● It if doesn’t expectorated, you can perform postural drainage. 3. Administer analgesia 20 minutes before CPT
● Postural drainage – lung segments are drained using gravity maneuvers if necessary.
as the patient lies or as the patient sits at different positions. 4. Explain purpose and rationale for procedure, explained details of
● After positioning the client, you can perform percussion and procedure.
vibration which is performed at the back, front, or side of the 5. Encourage high fluid intake program unless contraindicated,
persons chest, and followed by deep breathing and coughing maintain record of fluid I&O.
of the client. 6. Plan treatments so they did not overlap with meals or tube feeding,
stopped gastric tube feedings for 30 to 45 minutes before postural
Type of Position drainage, checked for residual feeding in patient’s stomach, held
Chair Position treatment if necessary.
✓ You need to choose a flat surface such as floor or ● Postural drainage is best before meal. Postural drainage is
on the bed. tiring. It can also induce vomiting
✓ The patient can lean forward over the back of the 7. Schedule treatments at appropriate time.
chair at an angle of 30 degrees. ● Client may be given a bronchodilator medication or
✓ The patient will hold this position for 5 minutes nebulization to loosen secretions.
to aid mucous drainage in the posterior segment ● Postural drainage treatment is scheduled 2-3 times a day
of the lungs. depending on the degree of lung congestion.
✓ The patient should inhale deeply through the 8. Had patient remove any restricted clothing.
nose and exhale through the mouth.
✓ Physical therapist recommends practicing Implementation
postural drainage in an empty stomach to 1. Provide privacy, perform hand hygiene, apply gloves.
prevent nausea and vomiting. 2. Use findings from physical assessment and chest xray film to select
congested areas for drainage.
Wedge Pillow Position 3. Assist patient to appropriate position, place pillows for support and
✓ You can try this technique on the bed on flat surface. comfort, drape patient appropriately.
✓ The patient will lie on the stomach over a wedge pillow or a bean ● Modified postural drainage position produces less
bag. cardiovascular stress than head down position in patient with
✓ They will tilt their body forward such as the hips are higher than the severe heart disease.
level of the chest. ● Semi fowler, Fowlers, High fowlers – use in patient with
✓ This posture lowers the back portion of the lungs and it can help difficulty in breathing, because in this position, gravity pulls
expectorate or drain the effusion from the part. the diaphragm downward allowing the greater chest and lung
✓ Hold position for 5 minutes. expansion.
✓ Take a deep breath keeping their cheeks puff. 4. Had patient maintain position for 10-15 minutes.
✓ This position can lead to accidental injury to the neck part and the 5. Perform chest percussion and vibration after 15 minutes.
back. Need cooperation with physical therapist. 6. Had patient sit up and cough, save secretions if necessary, suction
if necessary.
Lying on the Side Position 7. Had patient rest briefly if necessary, note pulse oximeter readings.
✓ This technique requires to lie at the side instead of the stomach. 8. Had patient take sips of water.
✓ The hips should be higher than the chest. Pillows will be placed 9. Repeat steps 3-8, ensured each treatment did not exceed 30-60
under the hips of the patient. minutes.
✓ This posture tilts the lungs and the gravity moves the mucous out. 10. Offer or assist patient with oral hygiene.
✓ This posture can be practiced 3-5 minutes after getting out of bed 11. Remove gloves and perform hand hygiene.
in the morning.
✓ To prevent waking up at night due to lung congestion, lie down on Evaluation
this posture before going to bed to prevent lung congestion. 1. Auscultate lung fields.
✓ The patient should wait at least 2 hours after meal again before ● Evaluate if nabago or nawala if may narinig na adventitious
attempting or before performing this procedure. This is because this lung sounds.
can cause vomiting. 2. Inspect character and amount of sputum.
3. Review diagnostic reports.
Assessment 4. Obtain vital signs and pulse oximetry.
1. Identify patient using at least two identifiers. ● BP – if natolerate ba ni patient yung procedure.
2. Assess patient for history of decreased LOC and muscle weakness ● RR – if may rise and fall of chest, shoulder, abdomen.
or disease processes. 5. Ask patient to explain importance of positioning.
● Rationale: hindi magiging responsive or cooperative si 6. Identify unexpected outcomes.
patient kapag decreased ang LOC.
3. Review medical record; assess signs and symptoms consistent with Recording and Reporting
atelectasis (collapse of lungs), lobar collapse pneumonia, or 1. Record all pertinent information in the appropriate log.
bronchiectasis; ineffective coughing; thick, sticky, tenacious, and 2. Document evaluation of patient learning.
discolored secretions that are difficult to cough up.
● Kapag ganito, magpperform tayo ng suctioning.
4. Auscultate all lung fields for decreased breath sounds and
adventitious lung sounds.
● Normal breath sounds: vesicular breath sounds (air in and
out). Soft, low pitch, rusting in quality.
● Adventitious lung sounds:
- rails – small clicking, bubbling, rattling, usually
heard when patient inhales)
- rhonchi – snoring
- stridor – wheeze