<p> Children’s Community Respiratory Physiotherapy </p><p>… … // Chest Physiotherapy Programme</p><p>…’s normal daily programme (when she is well)</p><p> How often? o Physiotherapy is to be performed 2 times per day. o First thing in morning and before bedtime.</p><p> Assess o Assess …’s chest before treatment by palpation (see below)</p><p> Positioning o Ensure … is either sat up in her chair, or lying in alternate side lying in bed </p><p> Percussion o Ensure … has a top on or a blanket/towel over her skin to protect it. o Pat …’s chest for 2-3 minutes using a cupped hand o The pats should sound dull not “slappy” o Repeat these pats in each position chosen</p><p> Suction o Use Yanker suction as required if …’s cough is effective o Use a suction pressure of 120mmhg. If secretions are thick/sticky/difficult to remove, the pressure can be increased to a maximum of 200mmhg if required.</p><p> Reassess o Reassess chest to ensure clear</p><p>When … has increased secretions or signs of worsening respiratory status</p><p> Assess o Assess …’s chest before treatment by palpation.</p><p> How often? o Physiotherapy can be increased as many times a day as necessary (at least 3)</p><p>Children’s Community Respiratory Physiotherapy </p><p> Positioning o If you feel … has reduced expansion on one side lie her with that side uppermost o If you feel … has secretions more on one side than the other, then lie her with the side that has more secretions uppermost. Note - both sides still may need treating. o If secretions are both sides or you cannot detect a difference between sides then repeat the process below lying on both sides</p><p> Physiotherapy in the position(s) chosen o Ensure … has a top on or a blanket/towel over her skin to protect it. o Pat …’s chest for 2-3 minutes using a cupped hand o The pats should sound dull not “slappy” o Repeat these pats in each position chosen</p><p> Suction o Following percussion (if …’s cough is not effective) suction using a size ….. catheter o The catheter should only go down as far as it takes to instigate a cough to a maximum of …..cms o Use a suction pressure of 120mmhg. If secretions are thick/sticky/difficult to remove, the pressure can be increased to a maximum of 200mmhg if required.</p><p> Re-examine chest o Re examine …’s chest to see if her expansion has improved/ secretions have been removed/ signs of deterioration have improved. If not you may need to repeat the above process if … is not too tired; or rest and repeat later.</p><p>IF YOU ARE CONCERNED THAT …’S CHEST IS GETTING WORSE PLEASE RING ME AND/OR SEEK MEDICAL ADVICE. IF YOU ARE UNABLE TO CLEAR SECRETIONS AND/OR UNABLE TO MAINTAIN OXYGEN SATURATIONS PLEASE RING ME AND/OR SEEK MEDICAL ADVICE.</p><p>Indications of Worsening Respiratory Status</p><p>Sweating Becoming pale / blue Increasing respiratory rate Decreasing oxygen saturations</p><p>Children’s Community Respiratory Physiotherapy </p><p>Increasing work of breathing shown by pulling in under/between the ribs, tracheal tug, nasal flaring Increasing quantity and thickness of secretions Darkening colour of secretions i.e. yellow / green Chest feels “rattly” when this is not normal for them or more “rattly” than normal Decreased activity / sleeping more Decreased strength of cough Wet sounding cough when previously dry Increased frequency of cough Reduced speech volume or wet sounding voice if this is unusual for them Stringing less words together in a sentence before they have to take a breath Temperature </p><p>How to examine …’s chest PALPATION</p><p>Place one hand either side of the chest. Initially at the top and then under the armpits</p><p>If expansion is less on one side then that is usually the side with the problem.</p><p>If secretions are felt more on one side then that is the side with the problem.</p><p>If you have any questions about your chest physiotherapy programme, please contact your respiratory physiotherapist M………… on 07…………. </p><p>Children’s Community Respiratory Physiotherapy </p><p>Service Evaluation of the Children’s Community Respiratory Physiotherapy Service</p><p>Dear Parent or Carer,</p><p>We are looking at the children’s community respiratory physiotherapy service to see if parents and carers find it useful. We would be extremely grateful if you could please answer the following questions. Your answers will help us to improve the service.</p><p>It helps us to know the name of your child so that we don’t keep asking the same person, but we do assure you that your comments will not adversely affect the way we treat your child and all information that you give us will be kept anonymous.</p><p>1. How satisfied are you with the service you have received?</p><p>Very Satisfied Neither satisfied Dissatisfied Very satisfied nor dissatisfied Dissatisfied</p><p>□ □ □ □ □ </p><p>Do you have any comments on your satisfaction/ dissatisfaction with the service?</p><p>______</p><p>______</p><p>______</p><p>2. Are you able to tell us two ways in which the service has particularly helped you and your child?</p><p>______</p><p>______</p><p>______</p><p>Children’s Community Respiratory Physiotherapy </p><p>3. Have you had to call out the rapid response physiotherapist?</p><p>Yes □ No □ Not sure □ </p><p>If yes, was the service ‘timely’ and ‘helpful’?</p><p>Completely Somewhat Not sure Not Not at very all</p><p>Timely? □ □ □ □ □</p><p>Helpful? □ □ □ □ □ </p><p>Do you have any comments on these aspects of the service?</p><p>______</p><p>______</p><p>______</p><p>4. Have there been any problems for you or your child as a result of the service?</p><p>______</p><p>______</p><p>______</p><p>Name of your child </p><p>Date</p><p>Thank you for taking the time to complete this questionnaire</p><p>Please return to: Dr HG in the enclosed envelope.</p>