Download Chest Physiotherapy: Physio in-service:

Treatment protocol for cardiopulmonary conditions
Condition:
Pulmonary TB: Chronic, infectious disease caused by Mycobacterium tuberculosis
Signs and Symptoms:
 Persistent cough
 Loss of weight and appetite
 Night sweats
 Haemoptysis
 Chest pain: sharp pleuritic pain, or dull ache
 SOB
 Lethargy
 Low-grade fever
 Associated pneumonia
Management:
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Drug regime: NB to educate patients to continue RX for 6 months!!!
 First line (2 months): Pyrazinamide, Isoniazid and Rifampicin
 Continuation phase (4 months): Isoniazid and Rifampicin
Isoniazid: kills majority of bacilli rapidly, so that pt is non-infectious
Rifampicin: kills persisting bacteria
Aim of Physiotherapy Treatment:
Objectives:
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Loosen and assist the removal of secretions
Improve respiratory function
Prevent chest deformities due to calcifications and thickening of pleura
Assist in strengthening and mobility
Precautions and contra indications:
Chest physio is contra-indicated in presence of cavities, haemoptysis, severe
respiratory distress or within the first 2 weeks of anti-TB drug therapy
Precautions:
 Avoid percussion techniques due to risk of haemoptysis and pneumothorax
 Do not suction in pt with active TB
 IPPB should not be given if signs of cavitation
Treatment Guidelines:
Physiotherapy: Chest physio not indicated for TB as the condition is due to
granulomas, not secretions! But patients can be treated for associated conditions:
 Collapsed lobe:
 Re-expansion ex’s
 Thoracic mobility ex’s
 Diaphragmatic breathing ex’s.
 In the presence of a secondary chest infection when ,on clinical examination
secretions are present, the following can be used in therapy:
 Postural drainage
 Deep breathing
 Coughing
 The use of saline nebulisation preceding treatment
Compiled by: Samantha Martin
Date: 31/05/07
Reviewed: M Bez, Jan 2010