Chest Fisiotherapy

oleh Ayu Susanti S.Kep.Ners

A. Definition Physiotherapy is a way or form of treatment to restore the function of an organ of the body by using natural energy such as electricity, light, water, heat, cold, massage, and exercises which use adapted to the tolerance limit of tolerance so that the obtained effects of treatment.

B. Purposes :
Restore and maintain the function of the respiratory muscles Helps cleanse the bronchial secretions and prevent the buildup of secret Improve the movement and flow of secret

C. The motion of chest physiotherapy : Drainage postural Percussion Vibrate

D. Contra indications
Characteristically absolute Heart failure Asmaticus status Renjatan and massive bleeding Characteristically relative Serious lung infection Costae broken New wound of operation trace The possibility of malignant lung tumors Sense convulsion

1. Drainage Postural Is one of the intervention to remove secretions from the various segments of the lung by using the influence of gravity

a. Indication
1. Prophylaxis to prevent accumulation of secretions, for patients: Using ventilation Long bed rest Increase sputum production Uneffective cough 2. Mobilization of retained secretions, for patients with:
Atelectasis Lung abces Pneumonia Pre and post operative General weakness and trouble with swallowing or coughing

b. Contra indications
Pneumotoraks tention Hemaptusis Disorders of the cardiovascular system Lung edem Extensive pleural effusions

c. Patient preparation
Loosen clothing, especially around the neck and waist Explain how the treatment / action Check the pulse and TD Does the patient have a cough reflex or require suction to remove the secret

d.Tools preparation
Pillow for positioning The bed which can adjust the Trendelenburg position Paper towels and sputum container

e. Working procedures
Management approach in children & families Adjust the head lower 30 degrees Place the sputum in a position that places are easy to reach by children Instruct children to cough effectively, or if you need to do suctioning mucus Encourage your child to do abdominal breathing

 Postural drainage done twice a day, when performed in a position not more than 40 minutes, each of the positions 3-10 minutes Adjust the position of the child to the normal position slowly Perform oral hygiene and clean with a tissue Auscultation of breath sounds in all lung lobes

f. Assessment of the action :

On auscultation,are breath sounds increased and at the left & right The inspection of both sides of the chest is moving at the same time Have had productive cough, is very thin or thick secretions The condition of patients after action How visible effect on the vital sign Is there improvement thoracic photo

g. Criteria to discontinue the action

The patient is unfever within 24-48 hours The sound is relatively clear or normal breathing Photos thoracic relatively clear Patients able to breathe deeply and cough

h. Position for postural drainage :

apical lobe bronchus and right anterior upper left: Clients sit in a chair leaning against the pillows. apical lobe bronchus and right posterior upper left: Clients sit in a chair, leaning forward on a pillow or a table anterior lobe bronchus and right upper left: Client lying flat with a small pillow under the knees upper left lingual lobe bronchus: Clients lie on your side with the right arm above the head in Trendelenburg position, feet elevated 30 cm

 the right center bronchus : The client lying on the left, elevate feet 30 cm anterior lobe bronchus and right lower left: The client lying supine with tredelenburg position, legs elevated 45-50 cm, allow the knee to bend over a pillow lateral lobe bronchus bottom right: Clients lie down to right at the position with feet elevated tredelenburg 25-50 cm superior lobe bronchus right & bottom left: Clients lie on his stomach with a pillow under the stomach posterior basal bronchus right and left: Clients lie prone in Trendelenburg position with legs elevated 45-50 cm

2. Clapping / percussion
a. meaning, is claping on the chest wall or back of the hand shaped like a bowl b. Goal, releasing the retained secretions or attached to the bronchial c. Percussion should be performed with caution in circumstances: o Broken ribs o Subcutaneous Emphysema neck area & chest o New Skin graft o Burns, skin infections o Pulmonary embolism o Untreated tension pneumothorax

d. Working procedures
Close the area to be made clapping with a towel to reduce the discomfort Instruct the patient to relax, breath in with a purse lips breathing Percussion in each lung segment for 1-2 minutes with both hands to form a bowl

3. Vibrating
In general, done at the same time with the clapping Vibration held at the peak of inspiration and continued until the end expiration Vibration is done by laying hands on the chest and then overlap with the encouragement of vibrating Contra indications: fractures and hemoptysis

 The working Procedure:

Place your palms above the overlap area will be conducted vibrational lung with the strongest hand position is outside Instruct the patient to breath in a purse lips breathing Perform vibration or shook hands with a toehold on the wrist patient when the patient expiration and stopped when inspiration Rest of patients Repeat vibrations up to 3 times, asking the patient to cough.