Mays M, Leiner S
Health Care for the Homeless in San Francisco, USA.
J Nurse Midwifery. 1996 Mar-Apr;41(2):139-54. doi: 10.1016/0091-2182(96)00003-1.
This article reviews the clinical management of common respiratory illness that primary care providers encounter in an outpatient setting. The latest recommendations from the American Thoracic Society, the National Heart, Lung, and Blood Institute, and the Centers for Disease Control and Prevention are summarized. The article discusses the causative organisms and antibiotics of choice for community-acquired pneumonia, and how to determine which patients require hospitalization. The appropriate use of asthma medications is described in detail, along with strategies for reducing aeroallergen exposure and for educating patients. An extensive section covers the interpretation of tuberculin skin tests and use of prophylactic isoniazid for prevention therapy of latent tuberculous infection, as well as the treatment of active tuberculosis. Controversies regarding antibiotics for both acute and chronic bronchitis are discussed along with other treatment options including over-the-counter medications, bronchodilators, and non-pharmacologic interventions. Finally, a strategy for dealing with the complaint of chronic cough is outlined. Although many of these conditions require active comanagement by collaborating physicians, the nurse-midwife will be better able to communicate with an advocate for her clients if she possesses expanded and current knowledge of treatment strategies.
本文回顾了基层医疗服务提供者在门诊环境中遇到的常见呼吸道疾病的临床管理。总结了美国胸科学会、国家心肺血液研究所和疾病控制与预防中心的最新建议。文章讨论了社区获得性肺炎的致病微生物和首选抗生素，以及如何确定哪些患者需要住院治疗。详细描述了哮喘药物的合理使用，以及减少空气过敏原暴露和对患者进行教育的策略。一个广泛的章节涵盖了结核菌素皮肤试验的解读以及使用预防性异烟肼进行潜伏性结核感染的预防治疗，以及活动性结核病的治疗。讨论了关于急性和慢性支气管炎抗生素使用的争议以及其他治疗选择，包括非处方药物、支气管扩张剂和非药物干预措施。最后，概述了处理慢性咳嗽主诉的策略。尽管其中许多病症需要合作医生进行积极的共同管理，但如果助产士拥有扩展的和最新的治疗策略知识，她将能够更好地与客户的支持者进行沟通。
