Blood investigations-bleeding and clotting parameters Techniques in Chest Physiotherapy A nurse or respiratory therapist may administer CPT, although the techniques can often be taught to family members of patients. The most common procedures used are postural drainage and chest percussion, in which the patient is rotated to facilitate drainage of secretions from a specific lobe or segment while being clapped with cupped hands to loosen and mobilize retained secretions that can then be expectorated or drained. The procedure is somewhat uncomfortable and tiring for the patient. Percussion Chest percussion involves striking the chest wall over the area being drained.
Patients in correctional facilities and nursing homes People living in medically underserved, low-income areas Tuberculosis TB is caused by inhalation of aerosol droplets carrying the organism. Tubercle bacilli multiply in the lung and migrate via the lymphatic and cardiovascular system to other organs including the spleen, liver, bones, meninges, joints, genitalia, endometrium, and placenta.
As the patient develops immunity to the organism, the affected areas heal, scar, and become calcified. Despite this repair process, some viable organisms may remain. A 5-mm or greater induration is considered positive in patients infected with HIV, those who have close contact with a person with TB, or those with a chest radiograph demonstrating old, healed TB.
A mm or greater induration is considered positive in patients who are immigrants from endemic areas, homeless, live in a nursing home or correctional facility, inject drugs, are part of a high-risk minority population, or have another medical disease that increases their risk of contracting TB.
A mm or greater induration is considered positive in all other patients. Patients who have had a prior BCG vaccination should have their skin test interpreted in the same manner. Conversely, false-positive tests can occur in patients infected with nontuberculous mycobacteria.
The most common symptoms of pulmonary TB are cough, weight loss, fever, fatigue, and hemoptysis. Diagnosis is usually obtained by culture from expectorated sputum, although occasionally a more invasive means, such as bronchoscopy, is needed to obtain samples.
Treatment recommendations have changed recently because of the increased prevalence of drug-resistant TB in the United States. This regimen should be continued until drug susceptibility test results are available. Since streptomycin sulfate can interfere with fetal auditory development and can cause congenital deafness, its use is not recommended in the pregnant patient.
Although there are no data on the teratogenicity of pyrazinamide, it should be avoided if possible in the pregnant patient. The pregnant patient, who is not at high risk for drug-resistant TB, should be treated with isoniazid, rifampin, and ethambutol for a total of 9 months.
If the risk of drug resistance is high, pyrazinamide may be added with the understanding there are unknown risks. Pyridoxine should be given to all patients receiving isoniazid to avoid nerve damage to the mother. The current recommendations of the ATS and CDC for prophylactic treatment of a pregnant patient with a positive skin test and no evidence of active disease are stated as follows Although no harmful effects of isoniazid to the fetus have been observed, preventive therapy generally should be delayed until after delivery.
There does not appear to be any substantial increase in tuberculosis risk for women as a result of pregnancy. However, for pregnant women likely to have been recently infected or with high risk medical conditions, especially HIV infection, isoniazid preventive therapy should begin when infection is documented.
Congenital TB of the newborn occurs as a result of placental transmission to the fetus via the umbilical vein or by aspiration of infected amniotic fluid. Factors that predispose the pregnant patient to aspiration during labor and delivery include increased intragastric pressure caused by abdominal compression, decreased gastroesophageal sphincter tone due to progesterone effects, delayed gastric emptying, repeated abdominal palpations during examinations, and alteration of consciousness secondary to analgesics and anesthesia.
The clinical presentation includes tachypnea, cyanosis, hypoxemia, hypotension, tachycardia, and bronchospasm. The chest radiograph shows either isolated or diffuse infiltrates. When smaller volumes are aspirated the symptoms usually do not become apparent until 6 to 8 hours after the event.
Large volumes can cause immediate asphyxiation. The pH of the aspirate is also important. Minimal injury has been found when the pH is greater than 2. Unless there are complications due to secondary bacterial pneumonia, improvement is usually seen after a few days 75 ; however, the condition may also progress to respiratory failure and ARDS.
The most common bacterial pathogens, including S. Antibiotics should be started early if bacterial infection is suspected. Pleural Disease Small, benign pleural effusions may occur in the immediate postpartum period in patients with no history of underlying cardiac or pulmonary disease.
In contrast, a moderate to large pleural effusion is suspicious of an underlying cardiopulmonary disorder. A normal venogram excludes the possibility of DVT. This enables visualization of the calf veins, popliteal veins, and most of the superficial femoral veins, but not the iliac veins.
The limited visualization decreases the sensitivity of the test. Impedance plethysmography is a good test for diagnosis of a proximal DVT located above the popliteal vein in the nonpregnant patient. In the pregnant patient, however, especially during the third trimester, this test may be difficult to interpret because of compression of the iliac vein by the uterus, which causes a false-positive test.
It is not a good test for the diagnosis of DVT below the knee. Duplex ultrasonography is also good for identification of a proximal DVT, but it does not visualize the iliac vein well. It can be used in place of impedance plethysmography.
Radioactive fibrinogen uptake scanning is contraindicated in the pregnant patient. Symptoms of a DVT include calf pain and swelling.Adult Review of Systems (ROS) Overview. The review of systems (or symptoms) is a list of questions, arranged by organ system, designed to uncover dysfunction and disease.
I’m so glad that you are here! Our TMC Practice Exam (Therapist Multiple Choice) is designed to mimic the actual TMC Exam, as you would see from the National Board of Respiratory regardbouddhiste.com you do well on this practice exam, you have a good chance at doing well when you sit to take the real thing.
Photomicrograph of Bordetella (Haemophilus) pertussis bacteria using Gram stain technique. CDC. BLOOD LYMPHOCYTOSIS IN A PATIENT WITH PERTUSSIS. The lymphocytes in this blood smear from an month-old child with a Bordetella pertussis infection have lobulated nuclei. Lymphocytosis is characteristic of this disorder and the lymphocyte morphology is often atypical.
Photomicrograph of Bordetella (Haemophilus) pertussis bacteria using Gram stain technique. CDC. BLOOD LYMPHOCYTOSIS IN A PATIENT WITH PERTUSSIS. The lymphocytes in this blood smear from an month-old child with a Bordetella pertussis infection have lobulated nuclei.
Lymphocytosis is characteristic of this disorder and the lymphocyte morphology is often atypical.
2 Epistaxis continued 90% anterior bleeds 10% posterior bleeds May require nasal packing Surgery for severe bleed.