Postural Drainage.txt

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MagusB81
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114721
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Postural Drainage.txt
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2011-11-05 18:59:59
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Postural drainage
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Quiz for RESP 131
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  1. What is the proper drainage positions for ANTERIOR APICAL of the right and left upper lobes?
    • - Position the patient sitting and leaning back at about a 45-degree angle
    • - Area of percussion is just below the clavicle
  2. What is the proper drainage positions for Right and Left anterior segments or upper lobe?
    • - Position the patient supine with the bed flat
    • - Area for percussion is just above the nipple
  3. What is the proper drainage positions for left lingula lung segments?
    • - Position the patient 1/4 turn from supine and resting on the right side with the foot of the bed elevated 12 inches
    • - Area to percuss is just above the left nipple and under the armpit
  4. What is the proper drainage positions for the Right Middle Lobe segments?
    • - Position the patient 1/4 turn from supine with the foot of the bed elevated 12 inches
    • - Area to percuss is just above the right nipple and under the armpit
  5. What is the proper drainage positions for ANTERIOR basal segments of the right and left lung?
    • - Position the patient supine with the foot of the bed elevated 18 to 20 inches
    • - Area to percuss is over the lower ribs
  6. What is the proper drainage positions for POSTERIOR basal segments of the right and left lung?
    • - Position the patient prone with the foot of the bed elevated 18 to 20 inches.
    • - Area to percuss is over the lower ribs
  7. What is the proper drainage positions for LEFT LATERAL segments of the lower lobes?
    • - Position the patient on the right side with the foot of the bed elevated 18 to 20 inches
    • - Area to percuss is over the lower ribs
  8. What is the proper drainage positions for RIGHT LATERAL segments of the lower lobes?
    • - Position the patient on the left side with the foot of the bed elevated 18 to 20 inches
    • - Area to percuss is over the lower ribs
  9. What is the proper drainage positions for POSTERIOR APICAL of the right and left upper lobes?
    • - Position the patient sitting and leaning back at about a 45-degree angle
    • - Area of percussion is just below the clavicle
  10. What is the proper drainage positions for POSTERIOR segment of the LEFT upper lobe?
    • - Position the patient 1/4 turn from prone and resting on the right side with the head of the bed elevated 18 inches.
    • - Area for percussion is over the left scapula
  11. What is the proper drainage positions for POSTERIOR segment of the RIGHT upper lobe?
    • - Position the patient 1/4 turn from prone and resting on the left side with the bed flat.
    • - Area for percussion is over the right scapula
  12. What is the proper drainage positions for SUPERIOR segments of the right and left lower lobes?
    • - Position the patient prone with the bed flat
    • - Area to percuss is just below the lower margin of the scapula
  13. Each position consists of placing the target lung segment(s) superior to the what?
    carina
  14. Necessity of performing postural drainage on upper lobes?
    True. Start with clearing secretions at the most superior level
  15. Performance of postural drainage after meals (or has eaten within the last hour) is a what?
    False. Contraindication due to uncontrolled airway at risk for aspiration
  16. Use of supplemental oxygen on all patients receiving postural drainage?
    False. Must determine if the patient needs oxygen or not for therapy beforehand
  17. Diseases placing patients at risk for the development of hemoptysis is an indication for postural drainage?
    False. This is a contraindication
  18. Factors involved in the performance of properly administered postural drainage.
    • 1. Place target lung segment(s) superior to the carina
    • 2. 3-15 minutes for each position
    • 3. External Manipulation of the Thorax by:
    • - Percussion: cupping, clapping, and tapotement. Applies kinetic energy to the chest wall and lung
    • - Vibration: application of a fine tremorous action
  19. What two factors would you utilize in selecting particular segments for postural drainage?
    Auscultation and Chest X-ray
  20. List (in writing) at least five factors that should be recorded when charting any postural drainage treatment.
    • 1. Change in sputum production
    • 2. Change in breath sounds of lung fields being drained
    • 3. Patient subjective response to therapy
    • 4. Change in vital signs
    • 5. Change in chest X-ray
    • 6. Change in arterial blood gas values or oxygen saturation
    • 7. Change in ventilator variables
  21. How long should each position be held?
    3-15 minutes
  22. The purpose of percussion is to do what?
    intermittently apply kinetic energy to the chest wall and lung
  23. How should percussion be performed?
    striking the thorax with cupped hand or mechanical device directly over the lung segment
  24. What are vibrations?
    application of a fine tremorous action
  25. What are the different purposes for turning?
    • - inability or reluctance of patient to change body position
    • - poor oxygenation associated with position
    • - potential for or presence of atlectasis
    • - presence of artificial airway
  26. The correct setting (cycles per second) when using the G-5 percussor vibrator is?
    36 cps, or Low Speed Setting.
  27. What are various factors that can assist in the performance of postural drainage on an infant?
    • 1. Postural drainage is applied best while holding the infant and maneuvering them in your arms
    • 2. Percussion is effectively applied by tapping the designated ares with 2 to 3 fingers and little force
    • 3. Use of a rocking chair if available
  28. List (in writing) three contraindications for the use of postural drainage
    • 1. Intracranial pressure >20 mmHg
    • 2. active hemorrhage with hemodynamic instability
    • 3. recent spinal surgery or acute spinal injury
    • 4. acute spinal injury or active hemoptysis
    • 5. empyema
    • 6. bronchopleural fistula
    • 7. pulmonary edema associated with CHF
    • 8. large pleural effusions
    • 9. pulmonary embolism
    • 10. aged, confused, or anxious patients who do not tolerate position changes
    • 11. rib fracture, with or without flail chest
    • 12. surgical wound or healing tissue
  29. What factor(s) can act to improve the effectiveness of a patient�s cough?
    "huff" coughing
  30. What is the most vital factor in sputum management?
    a good cough
  31. What areas of the right lung are contained in the upper lobe bronchus?
    • 1. Apical
    • 2. Posterior
    • 3. Anterior
  32. What areas of the left lung are contained in the upper lobe bronchus?
    • 1. Apical
    • 2. Posterior
    • 3. Anterior
  33. What areas of the right lung are contained in the middle lobe bronchus?
    • 4. Lateral
    • 5. Medial
  34. What areas of the left lung are contained in the middle lobe bronchus?
    • 4. Superior Lingular
    • 5. Inferior Lingular
  35. What areas of the right lung are contained in the Lower lobe bronchus?
    • 6. Superior
    • 7. Medial Basal
    • 8. Anterior Basal
    • 9. Lateral Basal
    • 10. Posterior Basal
  36. What areas of the left lung are contained in the Lower lobe bronchus?
    • 6. Superior
    • 7-8 Anteromedial Basal
    • 9. Lateral Basal
    • 10. Posterior Basal
  37. Normal airway clearance for upper airway
    Cough, sneeze, or blowing nose
  38. Normal clearance of larynx
    Cough
  39. Normal clearance of tracheobronchial tree
    Cough, mucal cilliary escalator
  40. Normal clearance of respiratory unit
    Cough
  41. Identify 10 conditions that would lead to ineffective secretion clearance
    Spinal injury, general debility, post-surgery, immobility, any neuromuscular disease, fistic fibrosis, bronchi ecstasies, chronic bronchitis, pain, asthma
  42. Identify three hazards of coughing
    Increased ICP, airway obstruction, shortness of breath due to peroximal coughing
  43. How much sputum needs to be produced to be considered copious
    >30ml
  44. Explain the role of hydration in mobilization of secretions
    Keeps the sol layer of mucus moist and ensure the mucus being fluid
  45. What is meant by keep the good lung down.
    It when positioning the body for drainage. The good lung is down and bad is up. It improves perfusion and v/q relationship
  46. What is an exception to the keep good side down rule?
    Inability to tolerate position change
  47. When is prone positioning indicated?
    When draining the lower lobes
  48. Explain how prone may help improve the patient condition
    Improves the v/q relationship and enhances mucus removal
  49. Why is it recomended not to let the patient cough in the trendelenburg position?
    Patient may not be able to clear secretions resulting in airway obstruction
  50. Thoratic surgery patient. Ordered to have CPT. what contraindications or precautions/ recomendations should be made?
    Percusioning and vibrations may need to be avoided. Avoid areas on or around insisions. Recomend automatic is needs to be done.
  51. Patient is cyanotic during CPT. What modifications can be made to help patient with CPT?
    Place on O2 via NC. If still not tollerant, decrease angles.
  52. How would you monitor the modifications made for a cyanotic patient?
    Pulse OX. Asses color or level of dyspnea
  53. How would you assess what postions to use for CPT?
    CXR, auscultation, percusion, and palpation
  54. Describe appropriate possition for a PT that has problems in RML and RLL
    • 1/4 turn of supine to tthe left and trendelenburg.
    • Prone and left lateral possition in trendelenburg.
  55. The patient is unable to adequately cough spontaneously after postural drainage. what tech. could be done to improve their cough effort and to remove any mobilized secretions?
    Directed cough measures: lateral compression, assited w/ manual recessatator, and quad cough technique w/ abdominal compression. aough a lot or suctioning if able
  56. Identify the possible hazards of PEP mask therapy. State at least one situation in which the procedure may be contraindicated.
    Ptential for pneumothorax. Untreated pneumothorax
  57. Ordered CPT on patient that cannot have head lowered. What mods. should be made if any?
    Therapy is not indicated and it would be a risk to the patient.
  58. a 65yr old PT w/ COPD has begun breathing exercises. What data would indicate beneficial effects of this program? (objective and subjective)
    • Obj: Reduction of number and length of hospitalizations. Less frequent exaacerbations/ reduced need for medication. Therefore reducing cost of care.
    • Subj: Less frequent or sever dyspnea, more energy, and improved attitude.

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