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ADMINISTERING PERCUSSION, VIBRATION, and POSTURAL DRAINAGE TO ADULTS

Definition: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________

Indication:______________________________________________________________________________________________________________

Contraindication:________________________________________________________________________________________________________

Considerations: __________________________________________________________________________________________________________________________________________________________________________________________________________________

Purpose:

1. _____________________________________________________________________________________________________________

2. _____________________________________________________________________________________________________________

Equipment:1. A bed that can be placed in Trendelenburg position.

2. Towel

PROCEDURE RATIONALE 1 2 3 4

1. Provide visual and auditory privacy.

2. Assist the client to the appropriate position for postural

drainage.

Drainage of the upper lobe

3. Have the client lie back at a 30o angle. Percuss and vibrate

between the clavicles and above the scapulae.

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PROCEDURE RATIONALE 1 2 3 4

4. Have the client sit upright in a chair or in bed with the head

bent slightly forward. Percuss and vibrate the area between

the clavicles and scapulae.

5. Have the client lie on a flat bed with pillows under the knees to

flex them. Percuss and vibrate the upper chest below the

clavicles down to the nipple line, except for women. The

breasts of women are not percussed, because percussion may

cause pain.

Drainage of the right middle lobe and lower division of the left

upper lobe

6. Elevate the foot of the bed about 15o or 40cm and have the

client lie on the left side. Help the client to lean back slightlyagainst pillows extending at the back from the shoulder to the

hip. A pillow may be placed between the knees for comfort.

For a male, percuss and vibrate over the right side of the chest

at the level of the nipple between the 4rth and 6 th ribs For a

female, position the heel of your hand toward the axilla and

your cupped fingers extending forward beneath the breast to

percuss and vibrate beneath the breast.

7. Elevate the foot of the bed as in step 6, and have the client lie

as in step 6 except on the right side.Percuss and vibrate theright side of the chest as in step7.

PROCEDURE RATIONALE 1 2 3 4

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Drainage of the lower lobes

8. Have the client lie on the abdomen on a flat bed, and place

two pillows under the hips. Percuss and vibrate the middle

area of the back on both sides of the spine.

9. Have the client lie on the unaffected side, with the upper arm

over the head. Elevate the foot of the bed about 30o or 45

cm , or to the height tolerated by the client. Place one pillow

between the knees. Another under the head is

optional.Percuss and vibrate the affected side of the chest over

the lower ribs, inferior to the axilla.

10.Have the client lie partly on the unaffected side and partly on

the abdomen. Elevate the foot of the bed about 30o or 45cm

(18in.), or to the height tolerated by the client. As analternative, elevate the hips with pillows. Percuss and vibrate

the uppermost side of the lower ribs.

11.Have the client lie prone. Elevate the foot of the bed about 30o

or 45cm (18in.), or to the height tolerated by the client.

Elevate the hips on two or three pillows to produce a jackknife

position from the knees to the shoulders.Percuss and vibrate

over the lower ribs on both sides close to the spine, but not

directly over the spine or the kidneys.

PROCEDURE RATIONALE 1 2 3 4

PERCUSSION

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PROCEDURE RATIONALE 1 2 3 4

VIBRATION

18.Place your flattened hands, one over the other (or side by

side) against the affected chest area.

19.Ask the client to inhale deeply through the mouth and exhale

slowly through pursed lips or the nose.

20. During the exhalation, straighten your elbows, and lean

slightly against the clients chest while tensing your arm and

shoulder muscles in isometric contractions.

21.Vibrate during five exhalations over one affected lung

segment.

22.Encourage the client to cough and expectorate secretions into

the sputum container. Offer the client mouthwash.

23.Auscultate the clients lungs, and compare the findings to the

baseline data.

24.Document the percussion, vibration, and postural drainage and

assessments. Note the amount, color, and character of

expectorated secretions.