Chest physiotherapy is a therapy used to optimize lung clearance through techniques like postural drainage, percussion, vibration, and cough. It requires a physician's order specifying the frequency, areas to drain, and any adjunct therapies. The therapy aims to improve mobilization of secretions and lung ventilation by positioning the patient in specific drainage positions and using techniques like percussion, vibration, and cough stimulation. Close monitoring is needed due to potential side effects like increased intracranial pressure, excessive secretions, cardiovascular stress, nausea, or bronchospasm.
Chest physiotherapy involves techniques like percussion, vibration, and postural drainage to mobilize pulmonary secretions in patients who have difficulty coughing them up. It is indicated for conditions involving thick secretions like cystic fibrosis or bronchiectasis. The techniques are contraindicated in situations involving bleeding or instability. Assessment involves a physical exam and reviewing medications and imaging before techniques are applied in specific positions targeting different lung lobes and segments to drain secretions into larger airways.
Breathing exercises, also called ventilatory training, are interventions used to improve pulmonary function and endurance. They work to retrain respiratory muscles, improve ventilation, lessen the work of breathing, and enhance gas exchange. Common breathing exercises include diaphragmatic breathing and pursed lip breathing. Diaphragmatic breathing focuses on using the diaphragm as the primary breathing muscle to make breathing more efficient. Precautions are taken to avoid forced exhalation or overbreathing and contraindications exist for certain conditions.
Respiratory therapists work to treat and care for patients with heart and lung disorders. The field is growing rapidly due to an aging population and increased treatment for lung diseases. Therapists work in hospitals, clinics, and homes to treat conditions like asthma, COPD, and pneumonia. Duties include administering medication and oxygen, assessing patients, and operating ventilators. To become a respiratory therapist, one can earn an associate's or bachelor's degree in respiratory care. The career offers job security, competitive pay, and the opportunity to help others in need of lung care.
An incentive spirometer is a device used to improve lung function and prevent complications after surgery or with respiratory conditions. It measures the volume of air inhaled and provides visual feedback to encourage deep breathing. Patients perform slow, deep breaths through the device to train inspiratory muscles. Indications for its use include surgery requiring hospitalization over one day, prolonged bed rest, and respiratory diseases. It can help reduce postoperative lung issues like pneumonia and collapse of air spaces in the lungs. Precautions are taken with infections, bleeding, or recent surgery. The device is inexpensive and easy for patients to use with guided breathing techniques.
This document provides information on postural drainage positions and techniques for clearing secretions from the lungs. It describes the goals of preventing accumulation and removing secretions from different lung segments. Various positions are outlined to drain each lung segment, such as sitting forward or lying on the side. The techniques of percussion and vibration are explained to dislodge and mobilize mucus when combined with deep breathing and coughing. Contraindications to postural drainage are also listed.
Chest physiotherapy involves techniques like turning, postural drainage, chest percussion and vibration, and directed coughing to help clear excess mucus from the lungs. The goals are to move secretions into the central airways using gravity and external chest manipulation so they can be eliminated by coughing or suctioning. This improved clearing of secretions helps maximize ventilation and lung volume. Proper preparation includes ensuring the child is not hungry, doing a respiratory assessment, positioning for drainage, and potentially administering bronchodilators to relax airways. Equipment used includes oxygen, suction, monitors, tissues and pillows. Chest PT is contraindicated for certain injuries or conditions that could be exacerbated by the techniques.
Dr. Abhijit Diwate discusses physiotherapy management of ICU patients. Key points include:
1) Physiotherapists assess patients, set goals like pain relief and secretion clearance, and use techniques like positioning, manual hyperinflation, percussion and breathing exercises.
2) Assessment involves examining the chest and determining ventilator settings. Goals are to prevent complications and improve function.
3) Common techniques are positioning, mobilization, manual hyperinflation, percussion, coughing/huffing, and breathing exercises to clear secretions and strengthen respiratory muscles.
Chest physiotherapy involves techniques like percussion, vibration, and postural drainage to mobilize pulmonary secretions in patients who have difficulty coughing them up. It is indicated for conditions involving thick secretions like cystic fibrosis or bronchiectasis. The techniques are contraindicated in situations involving bleeding or instability. Assessment involves a physical exam and reviewing medications and imaging before techniques are applied in specific positions targeting different lung lobes and segments to drain secretions into larger airways.
Breathing exercises, also called ventilatory training, are interventions used to improve pulmonary function and endurance. They work to retrain respiratory muscles, improve ventilation, lessen the work of breathing, and enhance gas exchange. Common breathing exercises include diaphragmatic breathing and pursed lip breathing. Diaphragmatic breathing focuses on using the diaphragm as the primary breathing muscle to make breathing more efficient. Precautions are taken to avoid forced exhalation or overbreathing and contraindications exist for certain conditions.
Respiratory therapists work to treat and care for patients with heart and lung disorders. The field is growing rapidly due to an aging population and increased treatment for lung diseases. Therapists work in hospitals, clinics, and homes to treat conditions like asthma, COPD, and pneumonia. Duties include administering medication and oxygen, assessing patients, and operating ventilators. To become a respiratory therapist, one can earn an associate's or bachelor's degree in respiratory care. The career offers job security, competitive pay, and the opportunity to help others in need of lung care.
An incentive spirometer is a device used to improve lung function and prevent complications after surgery or with respiratory conditions. It measures the volume of air inhaled and provides visual feedback to encourage deep breathing. Patients perform slow, deep breaths through the device to train inspiratory muscles. Indications for its use include surgery requiring hospitalization over one day, prolonged bed rest, and respiratory diseases. It can help reduce postoperative lung issues like pneumonia and collapse of air spaces in the lungs. Precautions are taken with infections, bleeding, or recent surgery. The device is inexpensive and easy for patients to use with guided breathing techniques.
This document provides information on postural drainage positions and techniques for clearing secretions from the lungs. It describes the goals of preventing accumulation and removing secretions from different lung segments. Various positions are outlined to drain each lung segment, such as sitting forward or lying on the side. The techniques of percussion and vibration are explained to dislodge and mobilize mucus when combined with deep breathing and coughing. Contraindications to postural drainage are also listed.
Chest physiotherapy involves techniques like turning, postural drainage, chest percussion and vibration, and directed coughing to help clear excess mucus from the lungs. The goals are to move secretions into the central airways using gravity and external chest manipulation so they can be eliminated by coughing or suctioning. This improved clearing of secretions helps maximize ventilation and lung volume. Proper preparation includes ensuring the child is not hungry, doing a respiratory assessment, positioning for drainage, and potentially administering bronchodilators to relax airways. Equipment used includes oxygen, suction, monitors, tissues and pillows. Chest PT is contraindicated for certain injuries or conditions that could be exacerbated by the techniques.
Dr. Abhijit Diwate discusses physiotherapy management of ICU patients. Key points include:
1) Physiotherapists assess patients, set goals like pain relief and secretion clearance, and use techniques like positioning, manual hyperinflation, percussion and breathing exercises.
2) Assessment involves examining the chest and determining ventilator settings. Goals are to prevent complications and improve function.
3) Common techniques are positioning, mobilization, manual hyperinflation, percussion, coughing/huffing, and breathing exercises to clear secretions and strengthen respiratory muscles.
Monitoring of patient in intensive care unit (ICU)Raj Mehta
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The document provides guidance on monitoring patients in the intensive care unit. It outlines various patient parameters that should be routinely monitored, including behaviors, vital signs, physical examination findings, and laboratory investigations. Any changes or new findings require determining the underlying cause. Key things to monitor include oxygen saturation, respiratory rate, blood pressure, heart rate, urine output, temperature, breath sounds, and laboratory tests such as arterial blood gases. Timely monitoring and response are important for detecting issues and managing critical care patients.
Chest physiotherapy involves techniques like postural drainage, percussion, and vibration to mobilize pulmonary secretions and make them easier to cough up. It aims to assist coughing, improve lung ventilation, and reeducate breathing muscles. Specific positions drain different lung lobes by gravity. Therapies are contraindicated in some injuries or conditions and require monitoring for side effects like hypoxemia, bronchospasm, or increased intracranial pressure. Proper positioning, techniques, and secretion removal are important parts of the chest physiotherapy procedure.
This document discusses various chest mobilization techniques used in physical therapy to improve chest wall mobility and ventilation. Some key techniques described include rib torsion, lateral stretching, and trunk rotation. Chest mobilization can help increase the length of intercostal muscles and improve biomechanics of chest movement. Specific exercises mentioned involve flexion/extension, lateral flexion, and trunk rotation while sitting. Counterrotation and butterfly techniques are also outlined to reduce neuromuscular tone and increase thoracic mobility. Controlled breathing can also be incorporated into walking exercises.
Incentive spirometry is a device used to encourage deep breathing through visual or other feedback. It aims to prevent or treat lung atelectasis by improving inspiratory volumes and muscle performance. It is indicated for patients at risk of lung collapse after surgery or with conditions limiting breathing. Effective use requires slow, deep breaths holding for 5 seconds, 10-15 breaths every 1-4 hours while awake. Potential risks include fatigue, hypoxemia or respiratory alkalosis if not used properly. There is low evidence for its effectiveness in preventing complications after upper abdominal surgery.
Chest physiotherapy involves techniques like percussion, vibration, and postural drainage to mobilize pulmonary secretions in patients who have difficulty coughing. The goals are to move secretions to central airways using gravity and then eliminate them by coughing or suctioning. Common techniques include postural drainage, percussion, vibration, and the active cycle of breathing technique. Chest physiotherapy is often used to treat conditions that cause excess secretions like cystic fibrosis.
This document provides an overview of common surgical procedures and the role of physiotherapy in pre- and post-operative care. It discusses operations involving the gallbladder (cholecystectomy), large intestine (colostomy), stomach (gastrectomy), hernias, breast (mastectomy), kidney (nephrectomy), and prostate (prostatectomy). For each procedure, it describes the purpose, surgical approach, potential complications, and how physiotherapists focus on pulmonary care, mobility exercises, and education to aid recovery.
1) Suctioning refers to clearing secretions from the airways of patients unable to do so themselves, such as those with artificial airways like endotracheal or tracheostomy tubes. It is indicated for patients who cannot cough effectively.
2) There are various suction equipment including pumps, tubing, connectors, and catheters that are used through different entry modes like nasopharyngeal, oropharyngeal, or through artificial airways. Proper technique and sizing is important to avoid hazards.
3) Hazards of suctioning include infection, mucosal trauma, hypoxia, and increased intracranial pressure, so pre-oxygenation and careful technique
The document discusses physiotherapy management techniques for ICU patients which include body positioning, mobilization, manual hyperinflation, suctioning, continuous rotational therapy, limb exercises, percussion, vibration, breathing exercises, inspiratory muscle training, and cough augmentation techniques like lung volume recruitment, manually assisted coughing, and insufflation-exsufflation devices. The goals of physiotherapy in the ICU are to optimize oxygen transport and cardiopulmonary function, maintain mobility and strength, and improve treatment outcomes by coordinating with other healthcare providers.
The document discusses chest physiotherapy techniques which are used to mobilize secretions in the lungs through external maneuvers like percussion, postural drainage, and vibration. It explains the indications for chest physiotherapy in patients with excessive secretions or ineffective cough from conditions like cystic fibrosis or pneumonia. The techniques involve positioning patients and using cupped hands to clap or vibrate the chest wall to loosen mucus so it can be coughed up.
This document discusses various abdominal operations including indications, investigations, pre-op preparation, anesthesia types, common incisions, and procedures for operations like cholecystectomy, appendicectomy, hernia repair, prostatectomy, and nephrectomy. It provides an overview of anatomy and procedures for different abdominal surgeries.
Postural drainage is a technique used to clear secretions from the lungs by placing patients in positions that utilize gravity. It involves tilting or propping patients at angles to drain secretions from the lungs into the central airways. Manual techniques like percussion, vibration, and shaking are used alongside positioning to loosen secretions and enhance their removal. Postural drainage is effective for conditions with increased mucus production and is commonly used for patients who have difficulty coughing up secretions due to illness, surgery, or prolonged bed rest.
Pre & post operative physiotherapy in abdominal surgerieskajal sansoya
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This document discusses pre-operative and post-operative physiotherapy for abdominal surgeries. Pre-operative physiotherapy includes patient education to reduce anxiety and prepare for recovery, as well as exercises to strengthen the core and lower limbs. Post-operative care involves monitoring vitals, respiratory care, mobilization, and exercises to strengthen muscles at risk from incisions. A rehabilitation program progresses from isometric exercises to strengthening, cardio, and sports-specific exercises over 3-4 weeks. Respiratory physiotherapy techniques help clear secretions and improve breathing.
The document discusses ICU management of patients after respiratory surgeries. It covers types of respiratory surgeries including lung, pleural, and chest wall surgeries. Post-operative complications involve pulmonary issues like hypoxia and pneumonia, as well as circulatory and wound complications. Physiotherapy management focuses on airway clearance techniques for intubated patients such as suctioning and manual hyperinflation. For non-intubated patients, techniques include incentive spirometry, breathing exercises, and early mobilization to prevent complications and aid recovery.
This document discusses various breathing exercises used in airway clearance therapy. It describes techniques like diaphragmatic breathing, pursed lip breathing, and segmental breathing. Diaphragmatic breathing aims to strengthen the diaphragm muscle and improve gas exchange. Pursed lip breathing is designed to make breaths more effective for those with lung conditions like COPD by slowing respiration. Segmental breathing consciously directs breathing to specific chest segments to promote lung expansion. Precautions and procedures are provided for safely performing these exercises.
Chest physiotherapy aims to assist in removing excess bronchial secretions through techniques like postural drainage, percussion, and vibration. It is indicated to help clear secretions in conditions like bronchiectasis, cystic fibrosis, and pneumonia. Contraindications include unstable cardiovascular conditions, recent surgeries, and pulmonary edema. Assessment involves evaluating the patient's history, symptoms, and lung examination to determine an appropriate treatment plan.
Bronchial hygiene therapy involves noninvasive techniques to clear secretions and improve lung function. It includes techniques like positioning, coughing, breathing exercises, and chest manipulation. The goals are to prevent accumulation and promote removal of secretions to improve respiratory status. Indications are excessive sputum production and ineffective cough. Contraindications include conditions that increase risk of aspiration or compromise hemodynamics.
This document provides an overview of pulmonary rehabilitation. It defines pulmonary rehabilitation as a multidisciplinary program aimed at improving the physical and psychological condition of patients with chronic respiratory diseases. The core components of pulmonary rehab include physical therapy, exercise training, education, and psychosocial support. Physical therapy techniques are used to improve breathing mechanics and reduce dyspnea. Supervised exercise training focuses on building endurance, strength, and functional capacity. Education empowers patients by teaching disease self-management. Psychosocial support addresses the emotional impacts of chronic lung disease. Research shows that pulmonary rehab improves quality of life and reduces symptoms, healthcare utilization, and mortality risk for patients with respiratory conditions like COPD.
Postural drainage involves using gravity and different body positions to clear secretions from the lungs. The document describes various positions to drain different areas of the lungs, such as sitting forward or back in a chair for the upper lobes, or lying on the side or stomach in a Trendelenburg position for the middle and lower lobes. It also mentions percussion and vibration are used along with positioning during the procedure, and aftercare is the same as for chest physiotherapy.
Pulmonary rehabilitation is a multidisciplinary program for patients with chronic lung diseases. It aims to reduce symptoms, improve quality of life, and return patients to their highest possible functional capacity. The program includes evaluation, exercise prescription tailored to each individual patient, education, counseling, and follow-up care. Exercise is a core component and focuses on aerobic activities at a moderate intensity to increase endurance and functional status.
A treatment intervention employs positioning, chest percussion, vibration, and manual hyperinflation to mobilize secretions in the lungs and assist in their expulsion. It is used prophylactically for high-risk surgery patients and those unable to cough effectively, and therapeutically for conditions like atelectasis and retained secretions. The techniques aim to prevent accumulation and improve drainage of secretions while promoting relaxed breathing.
This document discusses various techniques of chest physiotherapy including airway clearance techniques, facilitating effective coughing, and techniques to facilitate ventilation patterns. It describes specific techniques such as postural drainage, percussion, vibration and manual hyperinflation that are used to clear mucus from the lungs. It also discusses mobilization exercises and how treatment is prescribed based on factors like the underlying pathology, oxygen transport capacity, and intensity, duration and frequency of sessions. Contraindications and precautions for different techniques are provided.
Monitoring of patient in intensive care unit (ICU)Raj Mehta
Â
The document provides guidance on monitoring patients in the intensive care unit. It outlines various patient parameters that should be routinely monitored, including behaviors, vital signs, physical examination findings, and laboratory investigations. Any changes or new findings require determining the underlying cause. Key things to monitor include oxygen saturation, respiratory rate, blood pressure, heart rate, urine output, temperature, breath sounds, and laboratory tests such as arterial blood gases. Timely monitoring and response are important for detecting issues and managing critical care patients.
Chest physiotherapy involves techniques like postural drainage, percussion, and vibration to mobilize pulmonary secretions and make them easier to cough up. It aims to assist coughing, improve lung ventilation, and reeducate breathing muscles. Specific positions drain different lung lobes by gravity. Therapies are contraindicated in some injuries or conditions and require monitoring for side effects like hypoxemia, bronchospasm, or increased intracranial pressure. Proper positioning, techniques, and secretion removal are important parts of the chest physiotherapy procedure.
This document discusses various chest mobilization techniques used in physical therapy to improve chest wall mobility and ventilation. Some key techniques described include rib torsion, lateral stretching, and trunk rotation. Chest mobilization can help increase the length of intercostal muscles and improve biomechanics of chest movement. Specific exercises mentioned involve flexion/extension, lateral flexion, and trunk rotation while sitting. Counterrotation and butterfly techniques are also outlined to reduce neuromuscular tone and increase thoracic mobility. Controlled breathing can also be incorporated into walking exercises.
Incentive spirometry is a device used to encourage deep breathing through visual or other feedback. It aims to prevent or treat lung atelectasis by improving inspiratory volumes and muscle performance. It is indicated for patients at risk of lung collapse after surgery or with conditions limiting breathing. Effective use requires slow, deep breaths holding for 5 seconds, 10-15 breaths every 1-4 hours while awake. Potential risks include fatigue, hypoxemia or respiratory alkalosis if not used properly. There is low evidence for its effectiveness in preventing complications after upper abdominal surgery.
Chest physiotherapy involves techniques like percussion, vibration, and postural drainage to mobilize pulmonary secretions in patients who have difficulty coughing. The goals are to move secretions to central airways using gravity and then eliminate them by coughing or suctioning. Common techniques include postural drainage, percussion, vibration, and the active cycle of breathing technique. Chest physiotherapy is often used to treat conditions that cause excess secretions like cystic fibrosis.
This document provides an overview of common surgical procedures and the role of physiotherapy in pre- and post-operative care. It discusses operations involving the gallbladder (cholecystectomy), large intestine (colostomy), stomach (gastrectomy), hernias, breast (mastectomy), kidney (nephrectomy), and prostate (prostatectomy). For each procedure, it describes the purpose, surgical approach, potential complications, and how physiotherapists focus on pulmonary care, mobility exercises, and education to aid recovery.
1) Suctioning refers to clearing secretions from the airways of patients unable to do so themselves, such as those with artificial airways like endotracheal or tracheostomy tubes. It is indicated for patients who cannot cough effectively.
2) There are various suction equipment including pumps, tubing, connectors, and catheters that are used through different entry modes like nasopharyngeal, oropharyngeal, or through artificial airways. Proper technique and sizing is important to avoid hazards.
3) Hazards of suctioning include infection, mucosal trauma, hypoxia, and increased intracranial pressure, so pre-oxygenation and careful technique
The document discusses physiotherapy management techniques for ICU patients which include body positioning, mobilization, manual hyperinflation, suctioning, continuous rotational therapy, limb exercises, percussion, vibration, breathing exercises, inspiratory muscle training, and cough augmentation techniques like lung volume recruitment, manually assisted coughing, and insufflation-exsufflation devices. The goals of physiotherapy in the ICU are to optimize oxygen transport and cardiopulmonary function, maintain mobility and strength, and improve treatment outcomes by coordinating with other healthcare providers.
The document discusses chest physiotherapy techniques which are used to mobilize secretions in the lungs through external maneuvers like percussion, postural drainage, and vibration. It explains the indications for chest physiotherapy in patients with excessive secretions or ineffective cough from conditions like cystic fibrosis or pneumonia. The techniques involve positioning patients and using cupped hands to clap or vibrate the chest wall to loosen mucus so it can be coughed up.
This document discusses various abdominal operations including indications, investigations, pre-op preparation, anesthesia types, common incisions, and procedures for operations like cholecystectomy, appendicectomy, hernia repair, prostatectomy, and nephrectomy. It provides an overview of anatomy and procedures for different abdominal surgeries.
Postural drainage is a technique used to clear secretions from the lungs by placing patients in positions that utilize gravity. It involves tilting or propping patients at angles to drain secretions from the lungs into the central airways. Manual techniques like percussion, vibration, and shaking are used alongside positioning to loosen secretions and enhance their removal. Postural drainage is effective for conditions with increased mucus production and is commonly used for patients who have difficulty coughing up secretions due to illness, surgery, or prolonged bed rest.
Pre & post operative physiotherapy in abdominal surgerieskajal sansoya
Â
This document discusses pre-operative and post-operative physiotherapy for abdominal surgeries. Pre-operative physiotherapy includes patient education to reduce anxiety and prepare for recovery, as well as exercises to strengthen the core and lower limbs. Post-operative care involves monitoring vitals, respiratory care, mobilization, and exercises to strengthen muscles at risk from incisions. A rehabilitation program progresses from isometric exercises to strengthening, cardio, and sports-specific exercises over 3-4 weeks. Respiratory physiotherapy techniques help clear secretions and improve breathing.
The document discusses ICU management of patients after respiratory surgeries. It covers types of respiratory surgeries including lung, pleural, and chest wall surgeries. Post-operative complications involve pulmonary issues like hypoxia and pneumonia, as well as circulatory and wound complications. Physiotherapy management focuses on airway clearance techniques for intubated patients such as suctioning and manual hyperinflation. For non-intubated patients, techniques include incentive spirometry, breathing exercises, and early mobilization to prevent complications and aid recovery.
This document discusses various breathing exercises used in airway clearance therapy. It describes techniques like diaphragmatic breathing, pursed lip breathing, and segmental breathing. Diaphragmatic breathing aims to strengthen the diaphragm muscle and improve gas exchange. Pursed lip breathing is designed to make breaths more effective for those with lung conditions like COPD by slowing respiration. Segmental breathing consciously directs breathing to specific chest segments to promote lung expansion. Precautions and procedures are provided for safely performing these exercises.
Chest physiotherapy aims to assist in removing excess bronchial secretions through techniques like postural drainage, percussion, and vibration. It is indicated to help clear secretions in conditions like bronchiectasis, cystic fibrosis, and pneumonia. Contraindications include unstable cardiovascular conditions, recent surgeries, and pulmonary edema. Assessment involves evaluating the patient's history, symptoms, and lung examination to determine an appropriate treatment plan.
Bronchial hygiene therapy involves noninvasive techniques to clear secretions and improve lung function. It includes techniques like positioning, coughing, breathing exercises, and chest manipulation. The goals are to prevent accumulation and promote removal of secretions to improve respiratory status. Indications are excessive sputum production and ineffective cough. Contraindications include conditions that increase risk of aspiration or compromise hemodynamics.
This document provides an overview of pulmonary rehabilitation. It defines pulmonary rehabilitation as a multidisciplinary program aimed at improving the physical and psychological condition of patients with chronic respiratory diseases. The core components of pulmonary rehab include physical therapy, exercise training, education, and psychosocial support. Physical therapy techniques are used to improve breathing mechanics and reduce dyspnea. Supervised exercise training focuses on building endurance, strength, and functional capacity. Education empowers patients by teaching disease self-management. Psychosocial support addresses the emotional impacts of chronic lung disease. Research shows that pulmonary rehab improves quality of life and reduces symptoms, healthcare utilization, and mortality risk for patients with respiratory conditions like COPD.
Postural drainage involves using gravity and different body positions to clear secretions from the lungs. The document describes various positions to drain different areas of the lungs, such as sitting forward or back in a chair for the upper lobes, or lying on the side or stomach in a Trendelenburg position for the middle and lower lobes. It also mentions percussion and vibration are used along with positioning during the procedure, and aftercare is the same as for chest physiotherapy.
Pulmonary rehabilitation is a multidisciplinary program for patients with chronic lung diseases. It aims to reduce symptoms, improve quality of life, and return patients to their highest possible functional capacity. The program includes evaluation, exercise prescription tailored to each individual patient, education, counseling, and follow-up care. Exercise is a core component and focuses on aerobic activities at a moderate intensity to increase endurance and functional status.
A treatment intervention employs positioning, chest percussion, vibration, and manual hyperinflation to mobilize secretions in the lungs and assist in their expulsion. It is used prophylactically for high-risk surgery patients and those unable to cough effectively, and therapeutically for conditions like atelectasis and retained secretions. The techniques aim to prevent accumulation and improve drainage of secretions while promoting relaxed breathing.
This document discusses various techniques of chest physiotherapy including airway clearance techniques, facilitating effective coughing, and techniques to facilitate ventilation patterns. It describes specific techniques such as postural drainage, percussion, vibration and manual hyperinflation that are used to clear mucus from the lungs. It also discusses mobilization exercises and how treatment is prescribed based on factors like the underlying pathology, oxygen transport capacity, and intensity, duration and frequency of sessions. Contraindications and precautions for different techniques are provided.
Chest physiotherapy is a group of treatments used to clear excess mucus from the lungs through techniques like postural drainage, percussion, vibration, and deep breathing exercises. Postural drainage uses gravity and positioning to drain mucus into the throat where it can be coughed or suctioned out. Percussion and vibration help break up thick secretions so they can be more easily removed. Chest physiotherapy is indicated when a patient has excessive mucus, a reduced cough, or signs of retained secretions on imaging. It aims to improve lung function and oxygen intake. Outcomes are monitored through changes in sputum, breath sounds, vital signs, imaging and blood oxygen levels. Risks include low oxygen, increased intracranial
This document discusses chest x-ray findings and physiotherapy treatment for several pulmonary diseases. It describes Adult Respiratory Distress Syndrome (ARDS) characterized by increased vascular permeability and pulmonary infiltrates on x-ray. Physiotherapy may include manual hyperinflation if secretions are present but is otherwise contraindicated in severe hypoxia. Pulmonary edema, pneumonia, pleural effusion, and atelectasis are also discussed along with their characteristic x-ray findings and appropriate physiotherapy treatments such as breathing exercises, postural drainage, and incentive spirometry.
This document discusses chest physiotherapy techniques for managing critically ill patients from a physiotherapist's perspective. It describes techniques like positioning, chest percussion, vibration and manual hyperinflation which help mobilize secretions in the lungs. The goals of these techniques are to prevent accumulation of secretions, improve drainage and promote better breathing patterns and respiratory function. Specific techniques covered include various positioning methods, chest tapotements like clapping, vibration and rib springing, as well as manual hyperinflation and airway suctioning. Evidence on the benefits of positioning include increased lung volumes and compliance and improved ventilation.
The poem expresses frustration that the speaker was only taught about European historical figures and events in school, but not about important people and movements from his own culture and history. He lists several famous Europeans he learned about, such as Dick Whittington, Lord Nelson, and Columbus, but was not taught about seminal figures from his own history, like Toussaint L'Ouverture, Nanny of the Maroons, and Mary Seacole. Through this contrast, the poem criticizes the dominance of the Western perspective in education and calls for the inclusion of diverse historical narratives.
This introductory lecture in thoracic surgery covers the following topics:
Development of the lung.
Developmental Anomalies.
Anatomy of the lungs and the bronchial tree.
Diagnostic procedures in thoracic surgery.
Closed tube thoracostomy.
Aspirated tracheobronchial foreign bodies.
Pulmonary hydatid cysts.
PHYSICAL THERAPY MANAGEMENT OF CARDIORESPIRATORY DYSFUNCTIONAbdul Rehman S Mulla
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This document discusses physical therapy management of cardiorespiratory dysfunctions. It begins by outlining various cardiorespiratory conditions that physical therapists can help treat through exercise and activity prescription. These include acute conditions like pneumonia, chronic obstructive pulmonary disease, and heart conditions like heart failure. The document then goes on to describe specific physical therapy treatments for these conditions, including cardiovascular and respiratory exercises, chest physiotherapy techniques, and breathing exercises. It provides illustrations to enhance understanding of respiratory system anatomy and various lung pathologies.
Sequelae & Complications of Pneumonectomycairo1957
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Pneumonectomy, or surgical removal of an entire lung, carries several potential sequelae and complications. Post-pneumonectomy pulmonary edema, which occurs within 72 hours of surgery and has a mortality rate over 50%, may be due to high oxygen levels or reperfusion injury. Over months, the remaining lung expands and the mediastinum shifts to fill the space, potentially leading to post-pneumonectomy syndrome through tracheal compression years later. Pulmonary function generally declines less than 50% with FEV1 and FVC decreasing the least. Mortality risk depends on preoperative lung function tests and cardiopulmonary exercise capacity.
This document discusses the potential risks and dangers of dry needling as a physiotherapy treatment. It outlines several risks such as pneumothorax (puncturing the lung), injury to blood vessels, nerves or internal organs if not performed properly. It provides details on the clinical features of a pneumothorax and safety precautions practitioners should take like needling obliquely near the thorax. Minor risks include needling pain, exacerbating symptoms, and faintness. Proper anatomical knowledge and techniques are important to minimize risks when performing dry needling.
The document discusses various thoracic surgeries and chest injuries. It covers topics like cardiac tamponade, rib fractures, flail chest, decortication, tuberculosis, thoracocentesis, thoracotomy, wedge resection, and pneumonectomy. The causes, symptoms, investigations, and treatments are summarized for each condition.
Diuretic renal scans use radioactive tracers like DTPA, MAG3, or LLEC to evaluate kidney function and rule out obstruction. DTPA/MAG3 scans provide information on renal blood flow, GFR, tubular function, and excretion. DMSA scans use Technetium99m to visualize renal cortex and assess renal scarring. Bone scans use Technetium99m HDP to detect bone metastases, tumors, and infections. HIDA scans use Technetium99m Hepatolite to evaluate gallbladder function and detect causes of jaundice like cholecystitis. Lung V/Q scans use radioactive gas and injections to detect perfusion mismatches diagnostic of pulmonary embolism
one of the most commonly used techniques of the lung drainage is the postural drainage its non invasive and easy technique ans very useful in hospital as well as home settings.
Pneumothorax is the presence of air in the pleural space and can be spontaneous, due to trauma, or iatrogenic. It is classified as primary spontaneous which occurs without lung disease usually in young males, secondary spontaneous which occurs with underlying lung pathology, or traumatic. Types include closed which seals off, open with a bronchopleural fistula, and tension which increases pressure. Clinical features include chest pain and shortness of breath. Diagnosis is made with chest x-ray showing increased radiolucency. Small primary pneumothoraces may resolve on their own while secondary pneumothoraces and those with symptoms require tube thoracostomy drainage. Recurrent cases require pleurodesis or surgery.
This document outlines principles of physiotherapy for patients undergoing abdominal surgery. It discusses pre-operative assessment including reviewing notes, respiratory and circulatory function, and patient history. It also covers pre-operative training such as breathing, coughing, and posture exercises. Post-operative assessment includes checking surgery notes, vital signs, mobility, and pain. Treatments focus on preventing chest and circulatory complications through breathing exercises and early mobilization, as well as maintaining muscle power, range of motion, and good posture.
This document discusses social mobilization, which is defined as motivating communities to organize and actively participate in their own development. It involves five main approaches: political mobilization to gain policy commitment, community mobilization to inform local leaders, government mobilization to enlist cooperation, corporate mobilization to gain business support, and beneficiary mobilization to motivate program participants. Key elements of social mobilization include partnership building, community participation through various levels of involvement, using media to raise awareness, and advocacy to mobilize resources and create policy change. The Pantawid Pamilyang Pilipino Program is provided as an example of beneficiary mobilization through its conditional cash transfers.
The document discusses the role of physiotherapy in the pediatric intensive care unit (PICU). The PICU treats extremely sick pediatric patients with conditions like respiratory, neurological, and cardiovascular disorders. Physiotherapy is important for critically ill PICU patients to prevent long-term muscle weakness, facilitate weaning from ventilation, and promote safe discharge. Key physiotherapy techniques discussed include positioning, percussion and vibrations to clear secretions, breathing exercises like active cycle of breathing, and airway suctioning. The goals are both short-term maintenance of muscle function and long-term rehabilitation and reintegration into society.
post operative complications MEDICAL.pptxasispodar
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The document discusses postoperative complications, their prevention and management. Some key points:
- Surgical patients are at risk of complications during and after surgery, ranging from minor to serious. The risk depends on the surgery, patient health, and care. Complications increase costs, length of stay, and suffering.
- Prevention techniques include pre-assessment, managing pre-existing conditions, proper antibiotics and analgesia, early mobilization, and maintaining asepsis during surgery.
- Management of complications involves respiratory care like deep breathing exercises; circulatory care like ambulation; pain control; fluid and electrolyte monitoring; encouraging activity; and wound care like inspection and dressing.
The document discusses postoperative care for maxillofacial surgery patients. It covers 3 phases of care: early recovery in the post-anesthesia care unit, intermediate recovery in the ward, and late recovery after discharge. In the ward, nurses comprehensively assess patients using the SOAP format and monitor their vital signs, fluid intake/output, and surgical site. Pain management, antibiotic prophylaxis, and early mobilization are also emphasized to aid recovery.
Pulmonary rehabilitation in criticaly ill patientsSamiaa Sadek
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Pulmonary rehabilitation for critically ill patients aims to decrease complications through early mobilization and physical therapy. It includes mobilization exercises, respiratory muscle training, and pulmonary expansion techniques. Mobilization involves passive and active limb movements, as well as positioning changes, while respiratory training uses devices for resistive breathing and hyperpnea. Pulmonary expansion therapies clear secretions and apply positive airway pressures through various mechanical devices. Together these components address deconditioning, weakness, and lung volume reduction in critically ill survivors.
This document provides information on lung transplantation and the role of physiotherapy. It discusses the types of lung transplants including single lung, double lung, lobar, and heart-lung transplants. The causes for transplantation and post-operative care are described. Pre-operative physiotherapy aims to prepare the patient while post-operative physiotherapy focuses on clearing secretions, expanding the lungs, and regaining mobility and fitness over several weeks of treatment and rehabilitation. Modalities like incentive spirometry, postural drainage, and positive pressure breathing may be used as needed.
This document outlines the procedure for obtaining arterial blood samples via radial or brachial artery puncture. It describes selecting the appropriate artery, performing the modified Allen test to ensure adequate collateral circulation, prepping and puncturing the skin with a needle at a 35-40 degree angle to draw blood into a heparinized syringe. Pressure must be applied for 5-10 minutes after puncture depending on factors like anticoagulation. Guidelines specify analyzing the sample for gases, documenting details, and instructing patients on the purpose and discomfort of the procedure. Aseptic technique and safety precautions are emphasized to avoid infection or damage from the puncture.
This document provides information on anaesthesia for thoracoscopic surgery. It discusses that thoracoscopy is minimally invasive thoracic surgery using small incisions and instruments to examine the inside of the chest. It can be used for diagnostic procedures and some operations. The document discusses patient positioning, monitoring requirements, pre-operative evaluation and preparation, choices of anaesthesia including local/regional and general, management of anaesthesia including ventilation issues, and post-operative care considerations like pain management and respiratory care.
Anesthetic Management of Abdominal Surgery.pptxTadesseFenta1
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This document outlines an anesthesia course for abdominal and genitourinary surgery. The course aims to enable anesthetists to safely manage anesthesia for patients undergoing abdominal, gastrointestinal, hepatobiliary, anal, and genitourinary surgeries. It covers preoperative evaluation, risks associated with abdominal surgery, anesthetic techniques for different procedures, postoperative complications, and management of patients with hepatic or cardiovascular disease. The course assessments include assignments, quizzes, and a final written exam.
1) The document summarizes the main changes to resuscitation guidelines published in 2015 by the European Resuscitation Council compared to 2010.
2) Key changes include an increased emphasis on the importance of early bystander CPR, use of public access defibrillators, and minimizing interruptions to chest compressions.
3) The guidelines also provide new recommendations for special circumstances like cardiac arrest during surgery or from electrolyte abnormalities.
Enhanced Recovery After Surgery (ERAS) is a multidisciplinary approach to perioperative care designed to reduce surgical stress, accelerate recovery, and shorten hospital stays. Key elements include preoperative education and counseling, no mechanical bowel prep, carbohydrate loading before surgery, short-acting anesthesia, minimizing fluids and tubes, early feeding and mobilization, multimodal pain control to reduce opioids, and clear discharge criteria. Implementing ERAS has been shown to reduce complications by 50% and shorten hospital stays by 30% compared to traditional care pathways.
Perioperative nursing involves caring for patients before, during, and after surgery. The goals are to prepare patients psychologically and physically for surgery, monitor them and provide assistance during the procedure, and support recovery afterwards. Key aspects of perioperative nursing include obtaining consent, assessing the patient's health status, providing education and instructions, monitoring vital signs during surgery, and teaching postoperative exercises to aid healing.
D. Obtaining telephone consent from a family member in accordance with hospital policy is the most appropriate action in this situation since the client is unable to provide consent due to sedation.
Journal Presentation on article Comparative efficacy of different combination...Shubham Jain
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Journal Presentation on article Comparative efficacy of different combinations of acapella, active cycle of breathing technique, and external diaphragmatic pacing in perioperative patients with lung cancer
Lobectomy is a surgical procedure where a lobe of the lung is removed, and is the primary treatment for early-stage lung cancer. The surgery can be performed via open thoracotomy or minimally invasive VATS or RATS techniques. Post-operative physiotherapy protocols focus on pain management, lung expansion exercises, early mobilization, airway clearance techniques, and range of motion exercises to optimize recovery.
This document discusses airway secretion clearance techniques in the ICU, including mechanical insufflation-exsufflation (MIE). It provides a timeline of MIE devices including the CoughAssist. A case study describes how MIE was used successfully via face mask in an 18-year-old post-op patient to avoid intubation. Typical treatment protocols for the CoughAssist E-70 are outlined. Studies show MIE can improve respiratory parameters and allow extubation of restrictive patients to noninvasive ventilation. The evidence suggests MIE is safe and effective for both obstructive and restrictive lung diseases.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
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Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
Allopurinol, a uric acid synthesis inhibitor acts by inhibiting Xanthine oxidase competitively as well as non- competitively, Whereas Oxypurinol is a non-competitive inhibitor of xanthine oxidase.
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
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TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
âEnvironmental sanitation means the art and science of applying sanitary, biological and physical science principles and knowledge to improve and control the environment therein for the protection of the health and welfare of the publicâ.The overall importance of sanitation are to provide a healthy living environment for everyone, to protect the natural resources (such as surface water, groundwater, soil ), and to provide safety, security and dignity for people when they defecate or urinate .Sanitation refers to public health conditions such as drinking clean water, sewage treatment, etc. All the effective tools and actions that help in keeping the environment clean come under sanitation. Sanitation refers to public health conditions such as drinking clean water, sewage treatment. All the effective tools and actions that help in keeping the environment clean and promotes public health is the necessary in todays life.
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
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GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
As the world population is aging, Health tourism has become vitally important and will be increased day by day. Because
of the availability of quality health services and more favorable prices as well as to shorten the waiting list for medical
services regionally and internationally. There are some aspects of managing and doing marketing activities in order for
medical tourism to be feasible, in a region called as clustering in a region with main stakeholders groups includes Health
providers, Tourism cluster, etc. There are some related and affecting factors to be considered for the feasibility of medical
tourism within this study such as competitiveness, clustering, Entrepreneurship, SMEs. One of the growth phenomenon
is Health tourism in the city of Izmir and Turkey. The model of five competitive forces of Porter and The Diamond model
that is an economical model that shows the four main factors that affect the competitiveness of a nation and its industries
in this study. The short literature of medical tourism and regional clustering have been mentioned.
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
BBB and BCF
control the entry of compounds into the brain and
regulate brain homeostasis.
restricts access to brain cells of bloodâborne compounds and
facilitates nutrients essential for normal metabolism to reach brain cells
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
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Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) CosmeticsMuskanShingari
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Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It typically manifests as pimples, blackheads, or whiteheads, often on the face, chest, shoulders, or back. Acne can range from mild to severe and may cause emotional distress and scarring in some cases.
**Causes:**
1. **Excess Oil Production:** Hormonal changes during adolescence or certain times in adulthood can increase sebum (oil) production, leading to clogged pores.
2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
4. **Genetics:** A family history of acne can increase the likelihood of developing the condition.
**Types of Acne:**
- **Whiteheads:** Closed plugged pores.
- **Blackheads:** Open plugged pores with a dark surface.
- **Papules:** Small red, tender bumps.
- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
**Treatment:**
Treatment depends on the severity and type of acne but may include:
- **Topical Treatments:** Such as benzoyl peroxide, salicylic acid, or retinoids to reduce bacteria and unclog pores.
- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
- **Procedures:** Such as chemical peels, extraction of comedones, or light therapy for more severe cases.
**Prevention and Management:**
- **Cleanse:** Regularly wash skin with a gentle cleanser.
- **Moisturize:** Use non-comedogenic moisturizers to keep skin hydrated without clogging pores.
- **Avoid Irritants:** Such as harsh cosmetics or excessive scrubbing.
- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
Acne treatment can take time, and consistency in skincare routines and treatments is crucial. Consulting a dermatologist can help tailor a treatment plan that suits individual needs and reduces the risk of scarring or long-term skin damage.
PGx Analysis in VarSeq: A Userâs PerspectiveGolden Helix
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Since our release of the PGx capabilities in VarSeq, weâve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your labâs goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
1. UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Chest Physiotherapy
Policy 7.3.9
Page 1 of 10
Chest Physiotherapy
Formulated: 11/78
Effective: 10/12/94
Revised: 08/22/03
Reviewed: 5/31/05
Chest Physiotherapy
Purpose To standardize the use of chest physiotherapy as a form of therapy using one
or more techniques to optimize the effects of gravity and external
manipulation of the thorax by postural drainage, percussion, vibration and
cough. A mechanical percussor may also be used to transmit vibrations to
lung tissues.
Policy Respiratory Care Services provides skilled practitioners to administer chest
physiotherapy to the patient according to physicianâs orders.
Accountability/Training
⢠Chest Physiotherapy is administered by a Licensed Respiratory Care
Practitioner trained in the procedure(s).
⢠Training must be equivalent to the minimal entry level in the Respiratory
Care Service with the understanding of age specific requirements of the
patient population treated.
Physician's
Order
A written order by a physician is required specifying:
⢠Frequency of therapy.
⢠Lung, lobes and segments to be drained.
⢠Any physical or physiological difficulties in positioning patient.
⢠Cough stimulation as necessary.
⢠Type of supplemental oxygen, and/or adjunct therapy to be used.
Indications This therapy is indicated as an adjunct in any patient whose cough alone
(voluntary or induced) cannot provide adequate lung clearance or the
mucociliary escalator malfunctions. This is particularly true of patients with
voluminous secretions, thick tenacious secretions, and patients with neuro-
muscular disorders.
Drainage positions should be specific for involved segments unless
contraindicated or if modification is necessary. Drainage usually in
conjunction with breathing exercises, techniques of percussion, vibration
and/or suctioning must have physician's order.
NOTE: Therapy must be designed specific to the patient and his immediate
problem - a therapy that is brief, effective and safe.
Diseases frequently requiring postural drainage:
Bronchiectasis, cystic fibrosis, COPD, Bronchitis, lung abscess.
Contrain-
dications
⢠Untreated tension pneumothorax (absolute contraindication)
Prone, supine and/or Trendelenburg positions may not be tolerated in a
patient with the following conditions: Check with the physician.
Contrain- ⢠Unstable cardiovascular disorders: arrhythmias, hypotension,
hypertension, organic heart disease, congestive heart failure, and
______________________________________________________________
Continued next page
2. UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Chest Physiotherapy
Policy 7.3.9
Page 2 of 10
Chest Physiotherapy
Formulated: 11/78
Effective: 10/12/94
Revised: 08/22/03
Reviewed: 5/31/05
dications
Continued
pulmonary edema. Acute head or neck surgery/injury or disease:
increased intracranial pressure, increased edema around airway.
⢠Dyspnea: orthopnea, severe lung disease, pulmonary emboli, large
pleural effusion, anxiety, angina.
⢠Undiagnosed chest pain.
⢠Chronic obstructive pulmonary disease with cor pulmonale, orthopnea,
dyspnea on exertion.
⢠Active cases of tuberculosis
⢠Pulmonary edema, congestive heart failure.
⢠Distended abdomen, pregnancy, obesity, ascites.
⢠Severe surgical emphysema.
⢠Neuromuscular disease
⢠Aneurysm or decrease in circulation of main blood vessels.
⢠Post eye surgery.
⢠Hiatal hernia, esophageal anastomosis.
⢠Hemoptysis.
⢠Neonate prone to intracranial bleeding.
⢠Pain or discomfort restricting patient's cooperation.
⢠Vomiting
⢠Surgically undrained empyema.
Careful positioning is indicated in patients with:
⢠Fractures.
⢠Recent spine surgery.
⢠Broncho-pleural fistula (keep involved side down).
⢠Immediate post-op pneumonectomy.
⢠Certain orthopedic injuries/surgeries.
Vigorous chest percussion is relatively contraindicated in patients with the
following problems:
⢠Acute medical/surgical emergencies, poor or unstable cardiovascular
disorders.
⢠Fragile, fractured ribs or osteoporosis, or extremely unstable chest wall.
⢠Fresh burns, skin grafts or infection on thorax.
⢠Acute bronchospasm, untreated.
⢠Incision or trauma to chest or upper abdomen.
⢠Recent spinal fusion or surgery.
⢠Pulmonary emboli.
⢠Temporary transvenous pacemaker Resectable pulmonary tumors
(percussion usually not done over tumor)
⢠Pain preventing patient's cooperation.
______________________________________________________________
Continued next page
3. UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Chest Physiotherapy
Policy 7.3.9
Page 3 of 10
Chest Physiotherapy
Formulated: 11/78
Effective: 10/12/94
Revised: 08/22/03
Reviewed: 5/31/05
Contrain-
dications
Continued
⢠Extraparenchymal complications (pneumothorax, pleural effusion,
empyema).
⢠Subcutaneous emphysema.
⢠Untreated pneumothorax.
⢠Acute lung abscess. Simulated cough is relatively contraindicated in the
following cases:
⢠Suspected or real intra-abdominal injury, disorder, bleeding, recent
surgery.
⢠Organomegaly.
⢠Pregnancy.
⢠Diaphragm injury or surgery.
Goals To improve the mobilization of bronchial secretions and the matching of
ventilation and perfusion to normalize functional residual capacity (FRC).
Equipment ⢠Tilt bed and/or pillows.
⢠Towels or thick pad (or cushioned infant mask).
⢠Sputum cup/tissue.
⢠Stethoscope.
Procedure
Step Action
1 Verify physician's orders and check ID bracelet
2 Collect needed equipment.
3 Wash hands.
4 Explain procedure and rationale to the patient.
5 Check patient's pulse and respiratory rate. Auscultate
chest.
6 Position patient according to segmental drainage chart.
Allow 30-45 minutes after patient's completion of a meal.
7 If patient's status does not allow full positioning, position
him as close as possible to proper angle. (i.e., use pillows
under hips if patient will not tolerate Trendelenburg. If
position still is not tolerated, try positioning patient flat).
Inform physician if positions are not tolerated.
8 Place folded towel or thick pad across patient's chest
over area to be percussed (adults and older children).
Procedure
______________________________________________________________
Continued next page
4. UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Chest Physiotherapy
Policy 7.3.9
Page 4 of 10
Chest Physiotherapy
Formulated: 11/78
Effective: 10/12/94
Revised: 08/22/03
Reviewed: 5/31/05
Continued
Step Action
9 Cup hands with fingers and thumbs closed, use
mechanical percussor, or use neonatal percussor on
premature infants. Begin percussion over lung segment
(see attached chart) by flexion and extension of wrists.
The therapist's shoulders and elbows should be relaxed.
10 Percuss back and forth or in a circular motion, not
continuously over one spot. Avoid spine, kidneys, base of
the rib cage, and bony prominences such as sternum,
clavicle, spine, and over scapula. Use caution in areas of
breast.
11 Force of percussion and length of time must be tailored to
individual patient according to the patient's age, condition
of chest, tolerance, pain, secretion consistency and
amount.
Note: Percussion should not be painful or uncomfortable to the
patient. If it is, other techniques must be considered.
Amount of time for percussion varies: 30-45 seconds to 2-
3 minutes per segment depending on amount of secretions
and how easily moved. Aim for brief, effective, safe
treatment. If using a mechanical percussor, the same
precautions apply.
12 Check patient's vital signs frequently. If significant changes
occur, notify the physician after repositioning the patient.
13 Percussion may stimulate patient to cough. Add vibration
on exhalation to assist mobilization of secretions; return to
percussion as necessary. Encourage patient to cough
frequently using stimulation/suction if ordered by
physician.
14 If no cough is induced, proceed to voluntary cough
technique or reflexive cough techniques as indicated by
physician order.
15 Maintain position for amount of time required to clear
lungs or as limited by patient's tolerance.
Procedure
Continued
Step Action
16 Do not leave patient unattended.
______________________________________________________________
Continued next page
5. UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Chest Physiotherapy
Policy 7.3.9
Page 5 of 10
Chest Physiotherapy
Formulated: 11/78
Effective: 10/12/94
Revised: 08/22/03
Reviewed: 5/31/05
17 Auscultate chest. Check patient's pulse and respiratory
rate.
18 Chart therapy and results on the RCS flow sheet and
treatment card including:
⢠Areas (lobes) percussed.
⢠Postural drainage positions (specific).
⢠The position of the patient is left in at the end of
therapy.
Vibration:
Step Action
1 Check patient's medical record for orders and change in
status. Check ID bracelet.
2 Collect equipment needed.
3 Wash hands.
4 Explain procedure and rationale to the patient.
5 Check patient's pulse and respiratory rate. Auscultate
chest.
6 Position patient according to segmental drainage chart.
Allow 30-45 minutes after patient's completion of a meal.
7 If patient's status does not allow full positioning, position
him as close as possible to proper angle. (i.e., use pillows
under hips if patient will not tolerate Trendelenburg. If
position still is not tolerated, try positioning patient flat).
Inform physician if positions are not tolerated.
8 The therapist molds his hands parallel to the patient's ribs
anteriorly and posteriorly over area of lung to be treated.
Keep wrists and elbows at right angles.
9 Feel the normal movement of the chest as the patient deep
breathes or is given a deep breath. For compression
vibration, during prolonged exhalation compress the chest
Procedure
Continued
Step Action
9 while vibrating the chest wall with the hands, moving in
short frequent (isotonic) movements - lateral to medial
______________________________________________________________
Continued next page
6. UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Chest Physiotherapy
Policy 7.3.9
Page 6 of 10
Chest Physiotherapy
Formulated: 11/78
Effective: 10/12/94
Revised: 08/22/03
Reviewed: 5/31/05
10 Maintain position until therapy is effective or as limited by
patient's tolerance.
11 Check the patient's vital signs frequently. If significant
changes occur, notify physician after repositioning patient.
12 If no cough is induced, proceed to voluntary cough
techniques or reflexive cough techniques as indicated by
physician order.
13 Do not leave patient unattended.
14 Auscultate chest.
15 Chart therapy and results on the RCS flow sheet and
treatment card per RCS Policy 7.1.1 and 7.1.2.
Diaphragm Assist:
Step Action
1 Check patient's medical record for orders and change in
status. Check ID bracelet.
2 Collect above equipment.
3 Wash hands.
4 Explain procedure and rationale to the patient.
5 Check patient's pulse and respiratory rate. Auscultate
chest.
6 Position patient according to segmental drainage chart.
Allow 30-45 minutes after patient's completion of a meal.
7 Place you hand horizontally with palm over umbilicus -
one hand on top of the other. Hand should be over gut
area that is displaced by diaphragm so that force exerted
will simulate abdominal contraction.
Procedure
continued
Step Action
8 Ask for or give patient deep breath (AMBU, Intermittent
Positive Pressure Breathing therapy). At beginning of
exhale (keep mouth or vocal cords open for unobstructed
flow of air). Apply a firm, thrust under diaphragm in a
45ď° combined down and forward motion.
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Continued next page
7. UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Chest Physiotherapy
Policy 7.3.9
Page 7 of 10
Chest Physiotherapy
Formulated: 11/78
Effective: 10/12/94
Revised: 08/22/03
Reviewed: 5/31/05
9 Listen to sound of forced expiration and the absence or
presence of secretions and then mobilization. Auscultate
chest. Repeat therapy as necessary or as tolerated by
patient.
10 Auscultate chest.
11 Chart therapy, outcome, and patient tolerance on the
patient's Respiratory Care Service flow sheet. Record the
treatment time on the department treatment card. Notify
M.D./R.N. of anything unusual; chart this notification on
the RCS Patient flow sheet per RCS policies # 7.1.1 and #
7.1.2,
Note: If unable to clear lungs with above manipulation
techniques, tracheal suctioning may be indicated.
Physician's order required.
Continuation of Therapy:
Step Action
1 Check physician's order sheet.
2 Monitor patient response to therapy.
3 Record appropriate information on Respiratory Care
Service flow sheet per policies # 7.1.1 and # 7.1.2, and on
department treatment card.
Discontinuation of Therapy:
Step Action
1 Check physician's order sheet or check for 72-hour
expiration. Patient's condition must not indicate need for
therapy.
Procedure
continued
Step Action
2 Must check for change in status that might contraindicate
this therapy
3 Explain change in therapy to patient.
4 Record on Respiratory Care Service flow sheet, and
treatment card date and time of discontinuance and
therapist's signature. Progress note with relevant clinical
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Continued next page
8. UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Chest Physiotherapy
Policy 7.3.9
Page 8 of 10
Chest Physiotherapy
Formulated: 11/78
Effective: 10/12/94
Revised: 08/22/03
Reviewed: 5/31/05
data as to reason why therapy is being discontinued must
be recorded in progress note section of the patient chart to
notify MD of discontinuance
Infection
Control
Follow procedures outlined in Healthcare Epidemiology Policies and
Procedures #2.24; Respiratory Care Services
http://www.utmb.edu/policy/hcepidem/search/02-24.pdf
Undesirable
Side Effects
⢠Increased intracranial pressure.
⢠Secretions may accumulate excessively in airways:
⢠Increased mobilization of secretions in patients unable to cough can result
in compromised respiration; therefore, precautions must be taken to have
appropriate tools available and functioning before drainage for safe lung
ventilation and lung clearing (i.e., oxygen source and tracheal suctioning
equipment), if indicated by physician's order. Added stress may be placed
on the cardiovascular system.
⢠Effect of gravity on the cardiovascular system in certain drainage positions
is the reverse of normal. A patient whose cardiovascular system is already
compromised for whatever reason may not tolerate these changes as
indicated by fluctuations in vital si8gns or subjective discomfort in the
patient. The physician must be notified and therapy must be discontinued
under these situations, per physician order.
⢠Shifting of the abdominal contents against the diaphragm in certain
position may cause a decreased excursion in this muscle. This in turn will
prevent the patient from taking a deep breath resulting in a decreased tidal
volume, especially in patients with distended abdomen or neuromuscular
weakness. Intermittent Positive Pressure Breathing therapy or use of an
ambu bag to ventilate an intubated patient is usual in this situation.
⢠Nausea/Vomiting:
⢠Reflux of gastric contents may take place in patients susceptible to this
phenomenon, in certain drainage positions and with diaphragm assist.
Drainage after meals should be avoided especially in infants and patients
Undesirable
Side Effects
continued
with esophageal reflux. A "burning" in the back of the patient's throat is a
symptom of this phenomenon and cause for discontinuation of therapy to
Prevent aspiration.
⢠Damage to ribs (fracture, spread, or costochondritis) when chest
manipulation is used.
⢠Pain should not occur with these procedures. If present, the procedure
should be discontinued.
⢠Bronchospasm can be induced in patients susceptible to this difficulty. If
the patient experiences difficulty in breathing and/or wheezing, the
procedure should be discontinued. Position the patient for best breathing
mechanics and notify physician.
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Continued next page
9. UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Chest Physiotherapy
Policy 7.3.9
Page 9 of 10
Chest Physiotherapy
Formulated: 11/78
Effective: 10/12/94
Revised: 08/22/03
Reviewed: 5/31/05
⢠Pulmonary hemorrhage is possible using the percussion technique.
Abdominal organ bruising or bleeding is possible with diaphragm assist
technique. At first sign, discontinue therapy, take vital signs, and notify
physician.
⢠Headache.
⢠Dizziness.
Assessment of
Outcome
⢠Sound of voluntary or reflex cough mechanic.
⢠Increase in the patient's own ability to clear secretions.
⢠Increased tolerance for procedure (vs., clinical appearance, ABGs).
⢠Sputum amount, consistency, color, and frequency.
⢠Auscultation of chest.
⢠Improved chest x-ray.
Patient
Teaching
Instruct the patient as follows:
⢠Explain to the patient why chest manipulation techniques are being
received. Relate it to disease or injury condition.
⢠Tell the patient that everything will be done to make the procedure as
comfortable as possible.
⢠Instruct the patient in proper breathing techniques such as "huffing" and
effective cough.
⢠Explain any adjuncts to therapy.
⢠If the patient is coherent, at the end of the patient teaching aspects of this
procedure, patient should be able to verbalize and demonstrate
understanding of the procedure.
References AARC Clinical Practice Guidelines, Postural Drainage Therapy, Respiratory
Care, 1991; 36; 1418-1426
Scanlan CL, Myslinski MJ; Bronchial hygiene therapy. In: Egan's
Fundamentals of Respiratory Care, Eighth Edition, Mosby; June 2, 2003.
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Continued next page
10. UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Chest Physiotherapy
Policy 7.3.9
Page 10 of 10
Chest Physiotherapy
Formulated: 11/78
Effective: 10/12/94
Revised: 08/22/03
Reviewed: 5/31/05
References
Continued
Frownfelter DL, Dean E. Principles and Practice of Cardiopulmonary Physical
Therapy. 3rd edition. St. Louis: Mosby; 1996.
Langenderfer B. Alternatives to percussion and postural drainage. A review
of mucus clearance therapies: percussion and postural drainage, autogenic
drainage, positive expiratory pressure, flutter valve, intrapulmonary
percussive ventilation, and high-frequency chest compression with the
ThAIRapy Vest. J Cardiopulmonary Rehabilitation. 1998; 18:283-289.
Frownfelter DL; Chest physical therapy and airway care. In: Barnes TA, Ed.
Core Textbook of Respiratory Care Practice. 2nd edition. St. Louis: Mosby-
Year Book; 1994.