chest physical therapy


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Chest Physical Therapy

 

Definition

Chest physical therapy is the term for a group of treatments designed to improve respiratory efficiency, promote expansion of the lungs, strengthen respiratory muscles, and eliminate secretions from the respiratory system.

Purpose

The purpose of chest physical therapy, also called chest physiotherapy, is to help patients breathe more freely and to get more oxygen into the body. Chest physical therapy includes postural drainage, chest percussion, chest vibration, turning, deep breathing exercises, and coughing. It is usually done in conjunction with other treatments to rid the airways of secretions. These other treatments include suctioning, nebulizer treatments, and the administration of expectorant drugs.
Chest physical therapy can be used with newborns, infants, children, and adults. People who benefit from chest physical therapy exhibit a wide range of problems that make it difficult to clear secretions from their lungs. Some people who may receive chest physical therapy include people with cystic fibrosis or neuromuscular diseases like Guillain-Barré syndrome, progressive muscle weakness (myasthenia gravis), or tetanus. People with lung diseases such as bronchitis, pneumonia, or chronic obstructive pulmonary disease (COPD) also benefit from chest physical therapy. People who are likely to aspirate their mucous secretions because of diseases such as cerebral palsy or muscular dystrophy also receive chest physical therapy, as do some people who are bedridden, confined to a wheelchair, or who cannot breathe deeply because of postoperative pain.

Precautions

Chest physical therapy should not be performed on people with
  • bleeding from the lungs
  • neck or head injuries
  • fractured ribs
  • collapsed lungs
  • damaged chest walls
  • tuberculosis
  • acute asthma
  • recent heart attack
  • pulmonary embolism
  • lung abscess
  • active hemorrhage
  • some spine injuries
  • recent surgery, open wounds, or burns

Description

Chest physical therapy can be performed in a variety of settings including critical care units, hospitals, nursing homes, outpatient clinics, and at the patient's home. Depending on the circumstances, chest physical therapy may be performed by anyone from a respiratory care therapist to a trained member of the patient's family. Different patient conditions warrant different levels of training.
Chest physical therapy consists of a variety of procedures that are applied depending on the patient's health and condition. Hospitalized patients are reevaluated frequently to establish which procedures are most effective and best tolerated. Patients receiving long term chest physical therapy are reevaluated about every three months.

Turning

Turning from side to side permits lung expansion. Patients may turn themselves or be turned by a caregiver. The head of the bed is also elevated to promote drainage if the patient can tolerate this position. Critically ill patients and those dependent on mechanical respiration are turned once every one to two hours around the clock.

Coughing

Coughing helps break up secretions in the lungs so that the mucus can be suctioned out or expectorated. Patients sit upright and inhale deeply through the nose. They then exhale in short puffs or coughs. Coughing is repeated several times a day.

Deep breathing

Deep breathing helps expand the lungs and forces better distribution of the air into all sections of the lung. The patient either sits in a chair or sits upright in bed and inhales, pushing the abdomen out to force maximum amounts of air into the lung. The abdomen is then contracted, and the patient exhales. Deep breathing exercises are done several times each day for short periods.

Postural drainage

Postural drainage uses the force of gravity to assist in effectively draining secretions from the lungs and into the central airway where they can either be coughed up or suctioned out. The patient is placed in a head or chest down position and is kept in this position for up to 15 minutes. Critical care patients and those depending on mechanical ventilation receive postural drainage therapy four to six times daily. Percussion and vibration may be performed in conjunction with postural drainage.

Percussion

Percussion is rhythmically striking the chest wall with cupped hands. It is also called cupping, clapping, or tapotement. The purpose of percussion is to break up thick secretions in the lungs so that they can be more easily removed. Percussion is performed on each lung segment for one to two minutes at a time.

Vibration

As with percussion, the purpose of vibration is to help break up lung secretions. Vibration can be either mechanical or manual. It is performed as the patient breathes deeply. When done manually, the person performing the vibration places his or her hands against the patient's chest and creates vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. The procedure is repeated several times each day for about five exhalations.

Preparation

The only preparation needed for chest physical therapy is an evaluation of the patient's condition and determination of which chest physical therapy techniques would be most beneficial.

Aftercare

Patients practice oral hygiene procedures to lessen the bad taste or odor of the secretions they spit out.

Key terms

Coughing — Coughing helps break up secretions in the lungs so that the mucus can be suctioned out or expectorated. Patients sit upright and inhale deeply through the nose. They then exhale in short puffs or coughs. Coughing is repeated several times per day.
Deep breathing — Deep breathing helps expand the lungs and forces better distribution of the air into all sections of the lung. The patient either sits in a chair or sits upright in bed and inhales, pushing the abdomen out to force maximum amounts of air into the lung. The abdomen is then contracted, and the patient exhales. Deep breathing exercises are done several times each day for short periods.
Percussion — This consists of rhythmically striking the chest wall with cupped hands. It is also called cupping, clapping, or tapotement. The purpose of percussion is to break up thick secretions in the lungs so that they can be more easily removed. Percussion is performed on each lung segment for one to two minutes at a time.
Postural drainage — This technique uses the force of gravity to assist in effectively draining secretions from the lungs and into the central airway where they can either be coughed up or suctioned out. The patient is placed in a head or chest down position and is kept in this position for up to 15 minutes. Critical care patients and those depending on mechanical ventilation receive postural drainage therapy four to six times daily. Percussion and vibration may be performed in conjunction with postural drainage.
Turning — Turning from side to side permits lung expansion. Patients may turn themselves or be turned by a caregiver. The head of the bed is also elevated to promote drainage if the patient can tolerate this position. Critically ill patients and those dependent on mechanical respiration are turned once every one to two hours around the clock.
Vibration — The purpose of vibration is to help break up lung secretions. Vibration can be either mechanical or manual. It is performed as the patient breathes deeply. When done manually, the person performing the vibration places his or her hands against the patient's chest and creates vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. The procedure is repeated several times each day for about five exhalations.

Risks

Risks and complications associated with chest physical therapy depend on the health of the patient. Although chest physical therapy usually poses few problems, in some patients it may cause
  • oxygen deficiency if the head is kept lowered for drainage
  • increased intracranial pressure
  • temporary low blood pressure
  • bleeding in the lungs
  • pain or injury to the ribs, muscles, or spine
  • vomiting
  • inhaling secretions into the lungs
  • heart irregularities

Normal results

The patient is considered to be responding positively to chest physical therapy if some, but not necessarily all, of these changes occur:
  • increased volume of sputum secretions
  • changes in breath sounds
  • improved vital signs
  • improved chest x ray
  • increased oxygen in the blood as measured by arterial blood gas values
  • patient reports of eased breathing

Resources

Organizations

Cystic Fibrosis Foundation. 6931 Arlington Road, Bethesda, MD 20814. (800) 344-4823. http://www.cff.org.

physical

 [fiz´ĭ-kal]
pertaining to the body, to material things, or to physics.
physical fitness a state of physiologic well being that is achieved through a combination of good diet, regular physical exercise, and other practices that promote good health.
physical therapist a rehabilitation professional who promotes optimal health and functional independence through the application of scientific principles to prevent, identify, assess, correct, or alleviate acute or chronic movement dysfunction, physical disability, or pain. A physical therapist is a graduate of a physical therapy program approved by a nationally recognized accrediting body or has achieved the documented equivalent in education, training, or experience; in addition, the therapist must meet any current legal requirements of licensure or registration and be currently competent in the field.

Persons wishing to practice as qualified physical therapists must be licensed. All 50 states of the United States, the District of Columbia, and the Commonwealth of Puerto Rico require such licensure. All applicants for licensure must have a degree or certificate from an accredited physical therapy educational program. To qualify for licensure they must pass a state licensure examination.

Physical therapy assistants and aides work under the supervision of professional physical therapists. Training requirements for physical therapy assistants are not uniform throughout the United States. In 39 of the states licensure is available to graduates of an accredited two-year associate degree program; some require the passing of a written examination. Physical therapy aides can qualify for that position by training on the job in hospitals and other health care facilities.

Further information about the curriculum for physical therapists and physical therapist assistants, available programs of study, requirements for practice, and other relevant information can be obtained by contacting the American Physical Therapy Association, 1111 N. Fairfax St., Alexandria, VA 22314, telephone (703) 684–2782.
physical therapy the profession practiced by licensed physical therapists. According to guidelines published by the American Physical Therapy Association, physical therapy should be defined as the examination, treatment, and instruction of persons in order to detect, assess, prevent, correct, alleviate, and limit physical disability and bodily malfunction. The practice of physical therapy includes the administration, interpretation, and evaluation of tests and measurements of bodily functions and structures and the planning, administration, evaluation, and modification of treatment and instruction, including the use of physical measures, activities, and devices, for preventive and therapeutic purposes. Additionally, it provides consultative, educational, and other advisory services for the purpose of reducing the incidence and severity of physical disability, bodily malfunction, movement dysfunction, and pain.
chest physical therapy a form of respiratory therapy in which the patient is positioned to facilitate removal of secretions (postural drainage) and the chest wall is clapped to help loosen the secretions (percussion).

therapy

 [ther´ah-pe]
activity therapy in the nursing interventions classification, a nursing intervention defined as the prescription of and assistance with specific physical, cognitive, social, and spiritual activities to increase the range, frequency, or duration of an individual's (or group's) activity.
aerosol therapy see aerosol therapy.
animal-assisted therapy in the nursing interventions classification, a nursing intervention defined as the purposeful use of animals to provide affection, attention, diversion, and relaxation.
anticoagulant therapy see anticoagulant therapy.
antineoplastic therapy see antineoplastic therapy.
antiplatelet therapy the use of platelet inhibitors such as aspirin, dipyridamole, or sulfinpyrazone, to inhibit platelet adhesion or aggregation and so prevent thrombosis, alter the course of atherosclerosis, or prolong vascular graft patency.
art therapy in the nursing interventions classification, a nursing intervention defined as facilitation of communication through drawings or other art forms.
aversion therapy (aversive therapy) a form of behavior therapy that uses aversive conditioning, pairing undesirable behavior or symptoms with unpleasant stimulation in order to reduce or eliminate the behavior of symptoms. The term is sometimes used synonymously with aversive conditioning.
behavior therapy see behavior therapy.
carbon dioxide–oxygen therapy see carbon dioxide–oxygen therapy.
chest physical therapy see under physical therapy.
client-centered therapy a form of psychotherapy in which the emphasis is on the patient's self-discovery, interpretation, conflict resolution, and reorganization of values and life approach, which are enabled by the warm, nondirective, unconditionally accepting support of the therapist, who reflects and clarifies the patient's discoveries.
cognitive therapy (cognitive-behavioral therapy) a directive form of psychotherapy based on the theory that emotional problems result from distorted attitudes and ways of thinking that can be corrected. Using techniques drawn in part from behavior therapy, the therapist actively seeks to guide the patient in altering or revising negative or erroneous perceptions and attitudes.
collapse therapy a formerly common treatment for pulmonary tuberculosis in which the diseased lung was collapsed in order to immobilize it and allow it to rest. pneumonolysis and thoracoplasty are methods still sometimes used to collapse a lung and allow access during thoracic surgery.
combined modality therapy treatment of cancer using two or more types of therapy, such as with chemoradiotherapy. Called also multimodality therapy.
compression therapy treatment of venous insufficiency, varicose veins, or venous ulceration of the lower limbs by having the patient wear compressing garments such as support hose.
continuous renal replacement therapy hemodialysis or hemofiltration done 24 hours a day for an extended period, usually in a critically ill patient.
convulsive therapy treatment of mental disorders, primarily depression, by induction of convulsions. The type almost universally used now is electroconvulsive therapy (ECT), in which the convulsions are induced by electric current. In the past, drugs were sometimes used.
couples therapy marital t.
diet therapy treatment of disease by regulation of the diet.
electroconvulsive therapy (ECT) (electroshock therapy) see electroconvulsive therapy.
endocrine therapy treatment of disease by means of hormones; called also hormonal or hormone therapy.
estrogen replacement therapy administration of an estrogen to treat estrogen deficiency, such as that occurring after menopause; there are a number of indications, including the prevention of postmenopausal osteoporosis and coronary artery disease, and the prevention and treatment of vasomotor symptoms such as hot flashes and of thinning of the skin and vaginal epithelium, atrophic vaginitis, and vulvar atrophy. In women with a uterus, a progestational agent is usually included to prevent endometrial hyperplasia. Called also hormone replacement therapy.
exercise therapy: ambulation in the nursing interventions classification, a nursing intervention defined as promotion of and assistance with walking to maintain or restore autonomic and voluntary body functions during treatment and recovery from illness or injury.
exercise therapy: balance in the nursing interventions classification, a nursing intervention defined as use of specific activities, postures, and movements to maintain, enhance, or restore balance.
exercise therapy: joint mobility in the nursing interventions classification, a nursing intervention defined as the use of active or passive body movement to maintain or restore joint flexibility.
exercise therapy: muscle control in the nursing interventions classification, a nursing intervention defined as the use of specific activity or exercise protocols to enhance or restore controlled body movement.
family therapy
1. group therapy of the members of a family, exploring and improving family relationships and processes, understanding and modifying home influences that contribute to mental disorder in one or more family members, and improving communication and collective, constructive methods of problem-solving.
2. in the nursing interventions classification, a nursing intervention defined as assisting family members to move their family toward a more productive way of living.
gold therapy chrysotherapy.
group therapy see group therapy.
helium-oxygen therapy see helium-oxygen therapy.
hemodialysis therapy in the nursing interventions classification, a nursing intervention defined as management of extracorporeal passage of the patient's blood through a hemodialyzer. See also hemodialysis.
hemofiltration therapy in the nursing interventions classification, a nursing intervention defined as cleansing of acutely ill patient's blood via a hemofilter controlled by the patient's hydrostatic pressure. See also hemofiltration.
highly active antiretroviral therapy (HAART) the aggressive use of extremely potent antiretroviral agents in the treatment of human immunodeficiency virus infection.
hormonal therapy (hormone therapy) endocrine therapy.
hormone replacement therapy the administration of hormones to correct a deficiency; usually used to denote estrogen replacement therapy occurring after menopause.
host modulating therapy efforts to control periodontal disease by directly targeting the host response; an example is the use of drugs that do this, such as sub-antimicrobial doses of doxycycline, nonsteroidal antiinflammatory drugs, or bisphosphonates.
humidification therapy (humidity therapy) the therapeutic use of air supersaturated with water to prevent or correct a moisture deficit in the respiratory tract; see also humidity therapy.
immunosuppressive therapy therapeutic immunosuppression.
inhalation therapy the term formerly used for respiratory care (def. 3).
intravenous therapy (IV therapy) in the nursing interventions classification, a nursing intervention defined as administration and monitoring of intravenous infusions of fluids and medications.
leech therapy in the nursing interventions classification, a nursing intervention defined as the application of medicinal leeches to help drain replanted or transplanted tissue engorged with venous blood.
marital therapy a type of family therapy aimed at understanding and treating one or both members of a couple in the context of a distressed relationship, but not necessarily addressing the discordant relationship itself. In the past, the term has also been used in a narrower sense to mean what is defined as marriage therapy, but that is increasingly considered a subset of marital therapy. Called also couples therapy.
marriage therapy a subset of marital therapy that focuses specifically on the bond of marriage between two people, enhancing and preserving it.
milieu therapy
1. treatment, usually in a psychiatric treatment center, that emphasizes the provision of an environment and activities appropriate to the patient's emotional and interpersonal needs.
2. in the nursing interventions classification, a nursing intervention defined as the use of people, resources, and events in the patient's immediate environment to promote optimal psychosocial functioning.
multimodality therapy combined modality therapy.
music therapy
1. the use of music to effect positive changes in the psychological, physical, cognitive, or social functioning of individuals with health or educational problems. Music therapy is used for a wide variety of conditions, including mental disorders, developmental and learning disabilities, Alzheimer's disease and other conditions related to aging, brain injury, substance abuse, and physical disability. It is also used for the management of acute and chronic pain and for the reduction of stress.
2. in the nursing interventions classification, a nursing intervention defined as using music to help achieve a specific change in behavior or feeling.
neoadjuvant therapy in single-agent therapy or combined modality therapy for cancer, initial use of one modality, such as chemotherapy or radiotherapy, to decrease tumor burden prior to use of another modality, usually surgery.
nutrition therapy in the nursing interventions classification, a nursing intervention defined as administration of food and fluids to support metabolic processes of a patient who is malnourished or at high risk for becoming malnourished. See also nutrition.
occupational therapy see occupational therapy.
optometric vision therapy a treatment plan prescribed to correct or improve specific dysfunctions of the vision system; it includes, but is not limited to, the treatment of strabismus (turned eye), other dysfunctions of binocularity (eye teaming), amblyopia (lazy eye), accommodation (eye focusing), ocular motor function (general eye movement ability), and visual-motor and visual-perceptual abilities.
oral rehydration therapy (ORT) oral administration of a solution of electrolytes and carbohydrates in the treatment of dehydration.
oxygen therapy see oxygen therapy.
peritoneal dialysis therapy in the nursing interventions classification, a nursing intervention defined as administration and monitoring of dialysis solution into and out of the peritoneal cavity. See also peritoneal dialysis.
physical therapy see physical therapy.
play therapy see play therapy.
pulp canal therapy root canal therapy.
PUVA therapy [psoralen + ultraviolet A], a form of photochemotherapy for skin disorders such as psoriasis and vitiligo; oral psoralen administration is followed two hours later by exposure to ultraviolet a radiation.
radiation therapy see radiation therapy.
recreation therapy in the nursing interventions classification, a nursing intervention defined as the purposeful use of recreation to promote relaxation and enhancement of social skills.
reminiscence therapy in the nursing interventions classification, a nursing intervention defined as using the recall of past events, feelings, and thoughts to facilitate pleasure, quality of life, or adaptation to present circumstances.
renal replacement therapy therapy such as hemodialysis or transplantation that takes the place of nonfunctioning kidneys. See also continuous renal replacement therapy.
replacement therapy treatment to replace deficient formation or loss of body products by administration of the natural body products or synthetic substitutes. See also replacement. Called also substitution therapy.
respiratory therapy respiratory care.
root canal therapy that aspect of endodontics dealing with the treatment of diseases of the dental pulp, consisting of partial (pulpotomy) or complete (pulpectomy) extirpation of the diseased pulp, cleaning and sterilization of the empty root canal, enlarging and shaping the canal to receive sealing material, and obturation of the canal with a nonirritating hermetic sealing agent. Called also pulp canal therapy.
shock therapy obsolete term for convulsive therapy.
simple relaxation therapy in the nursing interventions classification, a nursing intervention defined as the use of techniques to encourage and elicit relaxation for the purpose of decreasing undesirable signs and symptoms such as pain, muscle tension, or anxiety.
speech therapy the use of special techniques for correction of speech disorders.
substitution therapy replacement therapy.
swallowing therapy in the nursing interventions classification, a nursing intervention defined as facilitating swallowing and preventing complications of impaired swallowing.
thrombolytic therapy the administration of drugs for thrombolysis (dissolution of a thrombus in an artery), to reduce the size of occlusion and thereby reduce damage to muscular tissue; the coronary artery is a commonly used site. Agents commonly used are streptokinase and tissue plasminogen activator (t-PA).
thyroid replacement therapy treatment of hypothyroidism by administration of thyroxine, usually in the form of levothyroxine sodium. Called also thyrotherapy.
ultraviolet therapy see ultraviolet therapy.

chest phys·ic·al ther·a·py

(CPT) (chestfiz'i-kăl thār'ă-pē)
A type of respiratory care performed to promote coughing and the removal of lung secretions through percussion (clapping) and vibration on the affected areas, postural drainage, and breathing exercises; usually contraindicated in persons with bleeding abnormalities, anticoagulant therapy, chest and/or head/neck trauma, recent myocardial infarctions, or pacemaker insertion.
Synonym(s): chest physiotherapy, pulmonary rehabilitation, pulmonary toileting.

chest physical therapy

, chest physiotherapy,

CPT, Chest PT.

A type of respiratory care usually incorporating postural drainage, cough facilitation, and breathing exercises used for loosening and removing lung secretions. It may include percussion (clapping) and vibration over the affected areas of the lungs, simultaneous with postural drainage to remove secretions. Auscultation of breath sounds is done before and after the procedure.