positioning

Question 1

positioning to relieve dyspnoea
Indications

Methods

Answer 1

weakness of diaphragm
inhibitions of diaphragm due to pain
inability to correctly use diaphragm

Methods
high side lying
forward lean sitting / standing - arms supported
avoid breath holding

Forward lean position - improves function of flattened diaphragm by increasing intra-abdominal press

Question 2

Positioning to maximise drainage of secretions

Answer 2

Postural drainage - gravity assisted drainage of secretions

Area to be drained should be uppermost

Question 3

Apices

Mid-lobe/lingula

Lower lobes

order or Rx?

Modification

Answer 3

siting

12-14 inches

18-20 inches

Rx most affected area first
modification - reduce required angle of head

Question 4

CIs

Answer 4

Head and neck pathology

• immediate post-op
• nosebleeds
• ICP>20mmHg

Abdominal pathology

• Pregnancy - late stages
• obesity

General

• before/ after meal
• timing of feed
• drips/ drains
• recent vomiting
• oesophageal reflux

Question 5

position to maximise good V/Q matching

Answer 5

good lung down 
Upright 
- most optimal position 
maximise FRC
increase diameter of airways 
compression of heart and lungs is minimised 
optimal configuration of thorax

Question 6

Hierarchy of positioning for V/Q matching

Answer 6

• prone - most optimal position after upright
• side lying = good lung down - defeat in left lung right side lying
• intermediate between upright and supine
  side lying - self ventilation
  bilateral pathology = preferably R side lying
  Supine
  decreased FRC x 5-% from upright
  decrease VC vol;
  increase WOB, hemidiaphragms displaced cephaldad