Problem 9 - Clinical Nursing Skills and Techniques

Question

A frail older adult needs chest physiotherapy because during assessment adventitious lung sounds revealed retained respiratory secretions. Which approach would be most appropriate to help this patient get rid of these secretions? 1 Encouraging him to increase his oral fluid intake 2 Teaching him how to forcefully cough 3 Performing postural drainage on the affected lobes 4 Using vibration and shaking over the affected lobes

Step-by-Step Solution

Answer

Perform postural drainage on the affected lobes (Option 3).

Step 1: Identify the Problem

The patient has retained respiratory secretions as indicated by adventitious lung sounds. The goal is to find an approach that effectively helps in clearing these secretions.

Step 2: Review Options

Consider the four approaches presented: 1. Increasing oral fluid intake 2. Teaching forceful coughing 3. Performing postural drainage 4. Using vibration and shaking

Step 3: Evaluate Effectiveness

Option 1, increasing fluid intake, can help thin secretions but doesn't actively remove them. Option 2, forceful coughing, is useful but might not be effective alone for frail patients. Option 3, postural drainage, involves position adjustments to facilitate drainage from lobes. Option 4, using vibration and shaking, helps mobilize secretions but is often combined with postural drainage for best results.

Step 4: Determine Most Appropriate Method

While shaking or vibrating (Option 4) can be helpful, it is most effective when combined with postural drainage (Option 3). Postural drainage allows gravity to assist in clearing secretions from the lungs, making it a more comprehensive approach for frail adults.

Key Concepts

Respiratory Secretions

Respiratory secretions are fluids produced by the cells lining our airways. They play a critical role in keeping our respiratory system healthy, primarily by trapping dust, germs, and other particles. Normally, these secretions are expelled naturally. However, problems can arise when secretions become too thick, plentiful, or if the body is too weak to clear them effectively.
Managing respiratory secretions is vital, especially for frail or older adults, as they can lead to complications such as infections or breathing difficulties if not handled properly.
Key aspects of managing these secretions include ensuring they remain thin and mobile. Techniques such as hydration, medication like mucolytics, and chest physiotherapy can help in effectively managing them. In the context of chest physiotherapy, specialized techniques are employed to mobilize and clear these secretions from the lungs.

Postural Drainage

Postural drainage is a technique used in chest physiotherapy to aid the clearance of respiratory secretions. This approach employs gravity to help drain secretions from different areas of the lungs to the larger airways, where they can be coughed out or suctioned.
During postural drainage, a patient is positioned in various ways that allow gravity to work its magic on the specific lobes or segments of the lungs.

• Pillows may be used to adjust the patient's body.
• The head is positioned in ways to allow drainage.

This technique can be very effective but requires the patient to remain in the positions for some time, usually 5-15 minutes per position, depending on the physician’s advice.
It is generally advisable for frail older adults as it conserves their energy and aids in clearing out retained secretions efficiently.

Vibration and Shaking

Vibration and shaking are techniques used in chest physiotherapy, often in combination with postural drainage, to help mobilize secretions in the lungs.
These techniques help break up thick mucus by applying mechanical energy externally.

• Vibration involves placing hands on the chest area and creating a gentle oscillating pressure during expiration.
• Shaking is a similar approach but involves more brisk and forceful movements, often synchronized with the patient's breathing rhythm.

These methods are particularly beneficial when secretions are tenacious and need assistance to be moved toward the airways. They are simple, non-invasive, and can be administered by a trained caregiver or healthcare professional. Incorporating these techniques helps ensure a comprehensive approach to clearing respiratory secretions, especially when dealing with frail patients.

Adventitious Lung Sounds

Adventitious lung sounds refer to abnormal sounds heard over the lungs when listening with a stethoscope. These sounds can indicate the presence of fluid, mucus, or other conditions in the lungs that require attention.
Common types of adventitious lung sounds include:

• Crackles: Often associated with fluid or mucus in the small airways.
• Wheezes: High-pitched sounds usually due to narrowed airways.
• Rhonchi: deeper sounds suggesting thick secretions or obstruction.

Detecting these sounds is crucial in identifying respiratory issues early and addressing them effectively with the appropriate interventions. In the context of our topic, adventitious lung sounds indicate the presence of retained respiratory secretions that need to be cleared to prevent respiratory complications in the patient.