Anterior upper segment (upper lobes)Sitting up slightly with pillow under legs
Anterior segmentslaying supine with pillow under legs
Left lingular (left lower)Raise bed about 12 inches (on the feet) (Trendelenburg) with left arm and back raised a little
Posterior segments (lower lobes)Legs raised about 18 inches (30 degrees) (Trendelenburg) prone with pillow under stomach
superior segments (middle)prone with a pillow under stomach

Goals of CPT1. Prevent accumulation of secretions. 2. improve mobilization of secretions 3. regain most efficient breathing pattern 4. improve distribution of ventilation 5. improve cardiopulmonary exercise tolerance
Techniques utilized in CPTClearance techniques, exercise protocols, breathing retraining methods
What position do your hands go for manual percussionSlow rhythmic clapping with cupped hands, over lung segment for 3-5 minutes
Diseases that benefit from CPTCF, bronchiectasis, chronic bronchitis, aspiration pneumonia, ciliary dyskinetic syndrome, COPD with decreased exercise tolerance
Volume of sputum produced per day that indicates need for CPTmore than 25- 30 ml per day
PD (postural drainage)position them to have gravity do it’s job
CPT (chest physical therapy)clearance techniques, exercise protocols, and breathing retaining methods
How long should each postural drainage be held3-5 minutes for each position
procedure for performing chest wall percussion and vibrationPercussion-Cupping on lung segment. have them do purse lip breathing Vibration- done after percussion and vibrate towards the carina (have them inhale and do this while they are exhaling)
When should vibration be performed?When the patient exhales
4 chronic conditions that may cause copious secretionscystic fibrosis, atelectasis, bronchitis, aspiration pneumonia
Contraindications for postural drainageunstabilized head neck injury, hemorrhage, hemoptysis, rib fracture, flail chest, surgical wound, pulmonary embolism
Contraindications for percussion and vibrationrecent pacemaker placement, lung contusion, blood clotting, burns, wounds, osteoporosis, chest wall pain
When patient is hooked up to EKG, IV, or other devices what do you do?Notify someone i;e nurse or monitor.
What should be charted after completing CPTposition and time, sputum, tolerance, and problems
Adverse reactions that can occurhypoxemia, increased ICP, acute hypotension, pulmonary hemorrhage, pain, vomiting, aspiration, bronchospasm, arrhythmias
What do you if any adverse reactions occurstop treatment, put them back to normal position, and notify Dr.
When is the best time to do CPT (relating to food)Before means or 1.5 to 2 hours after meals
Most common adverse reaction to Trendelenburg positionhypertension
Advantage on mechanical percussorseasier on therapist, more consistent percussion, some pt tolerate it better
disadvantage of mechanical percussorsnot always easy to find, some pt don’t tolerate it well
How do administer CPT on children or neonatesone hand or smaller cups or use the flapper
Most commonly affected lung segment in aspirationsuperior basal segment
How do you know where to CPTx-rays, progress reports, auscultation (listening)
Indications for positive outcome of CPTmobilization of secretions, increased breath sounds, clearer chest x-ray, increased sat of O2
Appropriate frequency and pressure settings on vest10 Hz is most common
Define autogenic drainagemethod of directed cough, Pt uses diaphragmatic breathing to mobilize secretions
3 phases of autogenic drainage1. unstick secretions 2. collect secretions 3. evacuate secretions
What can you use instead of CPT1. insufflation/exsufflation device 2. flutter valve, 3. IPV intrapulmonary percussive ventilation
PEP therapyPositive expiratory pressure; similar to CPAP and EPAP. High-frequency oscillations created as pt exhales
hazards or complications from PEP therapypulmonary barotrauma, increased ICP, air swallowing, vomiting, aspiration
MetaNebaka percussionaire…delivers both continuous airway pressure and high mini bursts…. Delivers bursts of gas at rates of 100-225 cycles/min
LevelsChemical level -> cellular -> Tissue
Levelsorgans -> system -> organism (whole human)
Knee-chest(on stomach)rectal exam
lithotomy(on the back, feet in stirrups)women PAP
Dorsal Recumbent(on back, knees bent)women- vagina /men- rectal
Sim(on side)” “
Prone(belly down, flat)Back exam (spine)
Fowler(sitting up)45-60 higher fowler/ 30- semi fowler
Supine(on back, arms to the side or above head)chest, heart, abdomen, and extremities
erectsame as anatomic
trendelenburghead lower than feet- drainage
Anatomicstanding erect, arms at the side, looking straight ahead
CardiologistTreat heart disease
Heart weight1 lb
3 Layers of heart1) Endocardium- Inner2) Myocardium- Middle3) Pericardium- outermost (alphabetical)
Ishemiadamage to the heart
necrosisdead tissue
3 Routesveins, capillaries, and arteries
veinstoward the heart
capillariesNourish, and remove waste,
ArteriesAway from the heart
systole (BP)contraction of heart
diastole (BP)relaxation
avarage BP120/80
average BPM60-100
How long after a patient has had a meal is it ok to perform CPT? BK1 Hour
What is the primary reason for performing CPT? BKTo loosen secretions in the lungs
How long is a patient generally left in a position? BK3-15 minutes
What type of patients is CPT most effective with? BKPatients with copious secretions
Is it necessary to drain parts of the lungs that do not have secretions? BKNo
What is Trendelenburg position? BKHead down with feet raised 18 inches
What is an ABSOLUTE CONTRAINDICATION of CPT? BKUntreated pneumothorax
If you are draining a patient’s left lateral segment, should the patient be on their right or left side? BKRight side
Is the patient lying supine or prone when giving therapy to the superior segments? BKProne
Which of the following is not a contraindication of CPT: COPD, Obesity, Copious secretions, or Head injury? BKCopious secretions
Should a therapist coordinate therapy with administering pain medication? BKYes, therapists should not perform therapy on their patients if they are in pain
What should you do if a patient has had surgery or bad pains where you need to perform therapy? BKYou should modify the position needed for the therapy so you are still able to give them the therapy they need.


What should CPT includepostural drainage, chest percussion, chest vibration
Goalsapprove secretions, better RR, and distribution
What do you chart after treatmentposition and time, sputum, tolerance, and problems
When is vibration performedon exhalation or expiration
HOw much is considered copious for secretionmore than 25- 40 ml per day
Diseases that cause copious secretionCF, atelectasis, bronchitis, aspiration pneumonia
How do you know what position to put the patientProgress notes, auscultation (listening), and x-ray
What is considered a flail chest2 or more fractures on the same rib; on 2-3 ribs
Most common side effect from Trendelburg?hypertension
When do you monitor more aggressively while CPTIf the patient has cardiac problems,
How many minutes do you do CPT3-5 for each position
Supineflat on back
proneflat on stomach
trendleburghead down /
What does purse lip breathing docreates back pressure and therefore the alveoli opens up
where is the lingulaupper left lower lobe
How does PEP therapy move secretions (acapella)fills under aerated or nonaerated segments through collateral ventilation – prevents airway collapse during expiration
Chest x-rays on COPDmore blackness (air trapping) -angle of rib decreases (straighter) – heart shadow is compressed (long and narrow) – Diaphragm is flat