Question Answer
Anterior upper segment (upper lobes) Sitting up slightly with pillow under legs
Anterior segments laying 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

Question Answer
Goals of CPT 1. 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 CPT Clearance techniques, exercise protocols, breathing retraining methods
What position do your hands go for manual percussion Slow rhythmic clapping with cupped hands, over lung segment for 3-5 minutes
Diseases that benefit from CPT CF, bronchiectasis, chronic bronchitis, aspiration pneumonia, ciliary dyskinetic syndrome, COPD with decreased exercise tolerance
Volume of sputum produced per day that indicates need for CPT more 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 held 3-5 minutes for each position
procedure for performing chest wall percussion and vibration Percussion-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 secretions cystic fibrosis, atelectasis, bronchitis, aspiration pneumonia
Contraindications for postural drainage unstabilized head neck injury, hemorrhage, hemoptysis, rib fracture, flail chest, surgical wound, pulmonary embolism
Contraindications for percussion and vibration recent 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 CPT position and time, sputum, tolerance, and problems
Adverse reactions that can occur hypoxemia, increased ICP, acute hypotension, pulmonary hemorrhage, pain, vomiting, aspiration, bronchospasm, arrhythmias
What do you if any adverse reactions occur stop 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 position hypertension
Advantage on mechanical percussors easier on therapist, more consistent percussion, some pt tolerate it better
disadvantage of mechanical percussors not always easy to find, some pt don’t tolerate it well
How do administer CPT on children or neonates one hand or smaller cups or use the flapper
Most commonly affected lung segment in aspiration superior basal segment
How do you know where to CPT x-rays, progress reports, auscultation (listening)
Indications for positive outcome of CPT mobilization of secretions, increased breath sounds, clearer chest x-ray, increased sat of O2
Appropriate frequency and pressure settings on vest 10 Hz is most common
Define autogenic drainage method of directed cough, Pt uses diaphragmatic breathing to mobilize secretions
3 phases of autogenic drainage 1. unstick secretions 2. collect secretions 3. evacuate secretions
What can you use instead of CPT 1. insufflation/exsufflation device 2. flutter valve, 3. IPV intrapulmonary percussive ventilation
PEP therapy Positive expiratory pressure; similar to CPAP and EPAP. High-frequency oscillations created as pt exhales
hazards or complications from PEP therapy pulmonary barotrauma, increased ICP, air swallowing, vomiting, aspiration
MetaNeb aka percussionaire…delivers both continuous airway pressure and high mini bursts…. Delivers bursts of gas at rates of 100-225 cycles/min
Question Answer
Levels Chemical level -> cellular -> Tissue
Levels organs -> 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
erect same as anatomic
trendelenburg head lower than feet- drainage
Anatomic standing erect, arms at the side, looking straight ahead
Cardiologist Treat heart disease
Heart weight 1 lb
3 Layers of heart 1) Endocardium- Inner2) Myocardium- Middle3) Pericardium- outermost (alphabetical)
Ishemia damage to the heart
necrosis dead tissue
3 Routes veins, capillaries, and arteries
veins toward the heart
capillaries Nourish, and remove waste,
Arteries Away from the heart
systole (BP) contraction of heart
diastole (BP) relaxation
avarage BP 120/80
average BPM 60-100

Question Answer
How long after a patient has had a meal is it ok to perform CPT? BK 1 Hour
What is the primary reason for performing CPT? BK To loosen secretions in the lungs
How long is a patient generally left in a position? BK 3-15 minutes
What type of patients is CPT most effective with? BK Patients with copious secretions
Is it necessary to drain parts of the lungs that do not have secretions? BK No
What is Trendelenburg position? BK Head down with feet raised 18 inches
What is an ABSOLUTE CONTRAINDICATION of CPT? BK Untreated pneumothorax
If you are draining a patient’s left lateral segment, should the patient be on their right or left side? BK Right side
Is the patient lying supine or prone when giving therapy to the superior segments? BK Prone
Which of the following is not a contraindication of CPT: COPD, Obesity, Copious secretions, or Head injury? BK Copious secretions
Should a therapist coordinate therapy with administering pain medication? BK Yes, 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? BK You should modify the position needed for the therapy so you are still able to give them the therapy they need.


Question Answer
What should CPT include postural drainage, chest percussion, chest vibration
Goals approve secretions, better RR, and distribution
What do you chart after treatment position and time, sputum, tolerance, and problems
When is vibration performed on exhalation or expiration
HOw much is considered copious for secretion more than 25- 40 ml per day
Diseases that cause copious secretion CF, atelectasis, bronchitis, aspiration pneumonia
How do you know what position to put the patient Progress notes, auscultation (listening), and x-ray
What is considered a flail chest 2 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 CPT If the patient has cardiac problems,
How many minutes do you do CPT 3-5 for each position
Basal lower
Supine flat on back
prone flat on stomach
trendleburg head down /
What does purse lip breathing do creates back pressure and therefore the alveoli opens up
where is the lingula upper 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 COPD more blackness (air trapping) -angle of rib decreases (straighter) – heart shadow is compressed (long and narrow) – Diaphragm is flat