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Front Back
  • Superior segments of right and left lower lobes
  • Postition patient prone with bed flat
  • area to percuss just below lower margin of scapula
  • Posterior LLL & RLL
  • Posterior basal segments
  • Postition patient prone with foot of bed elevated 18-20 inches
  • Percuss over lower ribs
  • Right middle lobe
  • Postition patient 1/4 turn from supine with foot of bed elevated 12 inches.
  • Percuss just above right nipple and under armpit
  • Posterior Apical Segments, R.U.L, L.U.L
  • Position patient sitting and leaning forward at 45 degree angle
  • Percussion just above scapula with fingers extending up onto shoulders
  • Anterior segments R.U.L and L.U.L.
  • Position patient supine with bed flat
  • Percussion is just above the nipple
  • Anterior L.L.L. and R.L.L
  • Anterior basal segments of the right and left lung.
  • Position patient supine with foot of bed elevated 18 to 20 inches
  • Pecussion over lower ribs
  • Anterior L.L.L. and R.L.L.
  • Left lateral segment of the lower lobes.
  • Position patient on left side with foot of bed elevated 18-20 inches.
  • Percussion over lower ribs
  • L.U.L
  • Left lingula
  • Position pt 1/4 turn from supine, resting on right side with foot of bed elevated 12 inches.
  • Percussion just above left nipple and under armpit
  • R.U.L. and L.U.L
  • Anterior apical segments
  • Position pt. sitting back at 45 degree angle
  • Percussion just below clavicle
  • Posterior L.L.L. and R.L.L.
  • Right lateral segment of lower lobes
  • Position pt. on left side with foot of bed elevated 18-20 in
  • Percuss lower ribs
  • L.U.L
  • Posterior segment
  • Position pt. 1/4 turn from prone on rt side w/head of bed elevated 18 inches.
  • Percussion over left scapula
  • R.U.L
  • Posterior segment of right upper lobe
  • Position pt. 1/4 turn from prone resting on left side with bed flat
  • Percussion just above right scapula
Chest Physiotherapy Goals
  • To prevent accumulation and improve mobilization of bronchial secretions.
  • To improve efficiency and distribution of ventilation.
Describe postural draining
The drainage of secretions by the effect of gravity, from one or more lung segments to the central airways where they can be removed by coughing or suction.
Define percussion
The rhythmic striking of the thorax with cupped hand or mechanical device directly over lung segments being drained.
Define vibration
  • The application of fine tremorous action over area being drained
  • Manually performed by pressing in the directions that the ribs and soft tissue move during expiration only.

Postural Drainage -  Relative Contraindications for all positions.
  • Inter Cranial Pressure (ICP) >20mm Hg 
  • Recent spinal surgery or acute spinal injury
  • Active hemoptysis (coughing up blood)
  • Empyema (pus in pleural space)
  • Bronchopleural fluids
  • Pulmonary edema associated w/CHF
 

Postural Drainage -  Relative Contraindications for all positions.
  • Aged, confused or anxious pts
  • Pulmonary embolism (blockage)
  • Rib fracture with or without flail chest
  • Surgical wound or healing tissue
  • Large pleural effusions
Identify three lobes of right lung
  • Right upper lobe
  • Right middle lobe
  • Right lower lobe
Identify two lobes of left lung
  • Left upper lobe
  • Left lower lobe
Identify segments of right upper lobe
  • Apical
  • Posterior
  • Anterior
Identify segments of right middle lobe
  • Lateral
  • Medial
Identify segments of right lower lobe
  • Superoir
  • Medial basal
  • Anterior basal
  • Lateral basal
  • Posterior basal
Identify segments of left upper lobe (LUL) upper division
  • Apical posterior
  • Anterior
Identify segments of left upper lob lower division
  • Superior lingula
  • Inferior lingula
Identify segments of left lower lung
  • Superior
  • Anterior basal
  • Lateral basal
  • Posterior basal
Cystic Fibrosis Etiology
  • CF gene on chromosome 7
  • Several different mutations
  • 80% of mutations identified
  • Most common delta F508
  • Carriers show no signs of disease. Can be identified thru genetic testing.
Cystic Fibrosis Incidence
  • Caucasian 1/2500 live births
  • Black 1/17000
  • Orientals 1/90000
  • 5% of caucasians carry autosomal recessive gene trait that causes CF
Cystic Fibrosis Definition
Genetically transmitted disorder that produces suppurative pulmonary disease and pancreatic insufficiency
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