Assessment:
Listen to breath sound. Assess patient respiratory status. Observe the quality or characteristic of secretions. Identify what are the underlying complications. Note time of eating.
Planning/Implementation:
Gather materials needed, as follows: Pillows, Container for sputum, Hospital bed and towel. Establish the location of such lung segment. If the entire lung is to undergo chest physiotherapy, the most affected lobe or segment should be drained first. Protect patient from falling by keeping side rails up when possible. If possible, arrange for privacy during procedure. Stay with the patient during initial procedure. Administer treatment every two to four hours as ordered. Prepare patient by discussing certain exercises. Explain the importance of practicing PVD exercise after an operation to counteract affect of hypoventilation and to prevent complications. Demonstrate steps, allowing time fore patients practice. Place towel over skin to prevent reddened areas when performing. Instruct patient especially those with COPD, to perform diaphragmatic breathing with daily activities (sitting/walking) and to practice graded exercises to improve general physical fitness. Auscultate all lobes for adventitious sounds – prior to initiating PVD. Check chart for physicians order which is needed to perform postural drainage. Identify the specific segments of the lung, to be drained. Wash your hands for infection control. Proper poisoning of the patient. Placing one large or 2 small pillow to place under the patients hips to provide correct position. Obtain pillows and a sputum cup and tissues for the patient to use for expectorated secretions. Obtain clean gloves if the patient is unable to manage his/her secretions. Identify the patient to be sure you are performing the procedures for correct patient. Explain to the patient in the purpose and method of postural drainage, using the basic principles of health teaching. Position the patient. Drain the upper lobes. Have the patient sit up if possible. Have the patient lean to the right side. Have the patient lean forward at a 30º to 45º angle for 5 minutes. Have the patient lean backward at a 30º to 45º angle for 5 minutes. Have the patient lie in the abdomen, back and both sides while horizontal to drain the remaining segment of the upper lobes. Drain the lower lobes. Have the patient cough forcefully (lying on the abdomen) to expel secretions. Return the patient to a comfortable position after mouth care, and allow for a rest period.
Evaluation:
Coughing is more productive and effective. Lungs cleared for any breath sounds upon auscultation. Complications are prevented. Patient resting comfortably.
