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| Key conclusions from the Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference on Early Identification and Intervention Populations for CKD screening, risk stratification, and treatment Conclusion 1. Persons with hypertension, diabetes, or cardiovascular disease should be screened for CKD. Conclusion 2. CKD screening and treatment programs should also be implemented in other high-risk individuals and populations based on comorbidities, environmental exposures, or genetic risk factors. Conclusion 3. The initiation, frequency, and cessation of CKD screening should be individualized based on kidney and cardiovascular risk profiles and individual preferences. Measurements for early CKD Conclusion 4. CKD screening and risk stratification must consist of a dual assessment of estimated glomerular filtration rate (eGFR) and albuminuria (UACR). Conclusion 5. Accurate GFR estimation includes both creatinine and cystatin C measurements for initial diagnosis and staging. Conclusion 6. The combination of creatinine, cystatin C, and UACR for CKD screening is affordable in high-income settings. Interventions for CKD Conclusion 7. A key rationale for CKD screening is the availability of many effective interventions to delay CKD progression and reduce cardiovascular risk. Conclusion 8. Accurate diagnosis and staging of CKD are necessary to utilize treatments effectively. Conclusion 9. Patient engagement is a critical component of efforts to screen for and treat CKD. Health system and economic factors Conclusion 10. CKD screening and treatment efforts require multi-stakeholder implementation strategies to overcome barriers to high-quality CKD care. Conclusion 11. Financial and nonfinancial incentives need to be aligned toward CKD screening, risk stratification, and treatment. Conclusion 12. CKD screening in high-risk groups is likely to be cost-effective. Conclusion 13. CKD screening approaches may differ in LMIC countries. CKD, chronic kidney disease; eGFR, estimated gl

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AntigenicRelationshipbetweenHumanCoronavirus StrainDC43andHemagglutinatingEncephalomyelitisVirus Strain 67N ofSwine:AntibodyResponsesinHumanandAnimalSera

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Phosphorus and My diet , do need to watch my phosphorous in my diet? 

What is phosphorus? 

Phosphorus is a mineral found in your bones. Along with calcium, phosphorus is needed to build strong healthy bones, as well as, keeping other parts of your body healthy. 

Why is phosphorus important to you? 

Normal working kidneys can remove extra phosphorus in your blood. When you have chronic kidney disease (CKD), your kidneys cannot remove phosphorus very well. High phosphorus levels can cause damage to your body. Extra phosphorus causes body changes that pull calcium out of your bones, making them weak. High phosphorus and calcium levels also lead to dangerous calcium deposits in blood vessels, lungs, eyes, and heart. Over time this can lead to increased risk of heart attack, stroke or death. Phosphorus and calcium control are very important for your overall health. 

What is a safe blood level of phosphorus? 

A normal phosphorus level is 2.5 to 4.5 mg/dL. Ask your kidney doctor or dietitian what your last phosphorus level was and write it down to help keep track of it. 

Will dialysis help with phosphorus control? 

Yes. Dialysis can remove some phosphorus from your blood. It is important for you to understand how to limit build-up of phosphorus between your dialysis treatments. 

How can I control my phosphorus level? 

You can keep you phosphorus level normal by understanding your diet and medications for phosphorus control. Phosphorus can be found in foods (organic phosphorus) and is naturally found in protein-rich foods such as meats, poultry, fish, nuts, beans and dairy products. Phosphorus found in animal foods is absorbed more easily than phosphorus found in plant foods. 

Phosphorus that has been added to food in the form of an additive or preservative (inorganic phosphorus) is found in foods such as fast foods, ready to eat foods, canned and bottled drinks, enhanced meats, and most processed foods. Phosphorus from food additives is completely absorbed. Avoiding phosphorus additives can lower your intake of phosphorus. Phosphorus additives are found on the list of ingredients on the nutrition facts label. Look for “PHOS” to find phosphorus additives in the food. 

Phosphorus additives found in foods include: 

  • Dicalcium phosphate 
  • Disodium phosphate 
  • Monosodium phosphate 
  • Phosphoric acid 
  • Sodium hexameta-phosphate 
  • Trisodium phosphate 
  • Sodium tripolyphosphate 
  • Tetrasodium pyrophosphate 

Your kidney dietitian and doctor will help you with this. Below is a list of foods high in phosphorous and lower phosphorus alternatives to enjoy: 

HIGH PHOSPHORUS FOOD TO LIMIT OR AVOID 

 Beverages beer/ale chocolate drinks 
 cocoa dark colas 
 drinks made with milk 
canned iced teas 
pepper type soda (Dr Pepper) 
 bottled beverages with phosphate additives Lower phosphorus alternatives to enjoy: water, coffee, tea, rice milk (unenriched), apple juice, cranberry juice, grape juice, lemonade, ginger ale, lemon lime soda, orange soda, root beer  
Dairy Products cheese  
 custard ice cream 
 milk pudding 
 cream soups Lower phosphorus alternatives to enjoy: rice milk, almond milk, cottage cheese, vegan cheese, sherbet, popsicles yogurt (Greek type acceptable) 
Protein oysters sardines 
 beef liver chicken liver 
 fish roe organ meats 
 Lower phosphorus alternatives to enjoy: chicken, turkey, fish, beef, veal, eggs, lamb, pork  
Other foods chocolate candy 
caramels 
oat bran muffin Lower phosphorus alternatives to enjoy: apples, berries, grapes, carrot sticks, cucumber, rice cakes, unsalted pretzels, unsalted popcorn, unsalted crackers, pound cake, sugar cookies 
most processed/prepared foods/deli meats/hot dogs/bacon/sausage 
pizza 
brewer’s yeast 
chocolate 
caramel candies 

What medications are for phosphorus control? 

Your kidney doctor may order a medicine called a phosphate binder for you to take with meals and snacks. This medicine will help control the amount of phosphorus your body absorbs from the foods you eat. 

There are many different kinds of phosphate binders. Pills, chewable tablets, powders, and liquids are available. Some types also contain calcium, while others do not. You should only take the phosphate binder that is ordered by your doctor or dietitian. 

Acknowledgment: Reviewed by the Council on Renal Nutrition (04/2019) 

www.cdc.com 

www.who.com/phosphorous 

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Potassium  

Is potassium is important to watch CKD patients ? 

What is potassium and why is it important to you? 

Potassium is a mineral found in many of the foods you eat. It plays a role in keeping your heartbeat regular and your muscles working right. It is the job of healthy kidneys to keep the right amount of potassium in your body. However, when your kidneys are not healthy, you often need to limit certain foods that can increase the potassium in your blood to a dangerous level. You may feel some weakness, numbness and tingling if your potassium is at a high level. If your potassium becomes too high, it can cause an irregular heartbeat or a heart attack. 

What is a safe level of potassium in my blood? 

Ask your doctor or dietitian about your monthly blood potassium level and enter it here: 

If it is 3.5-5.0………………………You are in the SAFE zone 
If it is 5.1-6.0………………………You are in the CAUTION zone 
If it is higher than 6.0……………..You are in the DANGER zone 

How can I keep my potassium level from getting too high? 

  • You should limit foods that are high in potassium. Your renal dietitian will help you plan your diet so you are getting the right amount of potassium. 
  • Eat a variety of foods but in moderation. 
  • If you want to include some high potassium vegetable in your diet, leach them before using. Leaching is a process by which some potassium can be pulled out of the vegetable. Instructions for leaching selected high potassium vegetables can be found at the end of this fact sheet. Check with your dietitian on the amount of leached high potassium vegetables that can be safely included in your diet. 
  • Do not drink or use the liquid from canned fruits and vegetables, or the juices from cooked meat. 
  • Remember that almost all foods have some potassium. The size of the serving is very important. A large amount of a low potassium food can turn into a high- potassium food. 
  • If you are on dialysis, be sure to get all the treatment or exchanges prescribed to you. 

What is a normal amount of potassium intake per day for the average healthy individual? 

A normal amount of potassium in a typical diet of a healthy American is about 3500 to 4500 milligrams per day. A potassium restricted diet is typically about 2000 milligrams per day. Your physician or dietitian will advise you as to the specific level of restriction you need based on your individual health. A kidney dietitian is trained to help you make modifications to you diet in order to prevent complications for kidney disease. 

What foods are high in potassium (greater than 200 milligrams per portion)? 

The following table lists foods that are high in potassium. The portion size is ½ cup unless otherwise stated. Please be sure to check portion sizes. While all the foods on this list are high in potassium, some are higher than others. 

High-Potassium Foods   
Fruits Vegetables Other Foods 
Apricot, raw (2 medium) 
dried (5 halves) 
Acorn Squash Bran/Bran products 
Avocado (¼ whole) Artichoke Chocolate (1.5-2 ounces) 
Banana (½ whole) Bamboo Shoots Granola 
Cantaloupe Baked Beans Milk, all types (1 cup) 
Dates (5 whole) Butternut Squash Molasses (1 Tablespoon) 
Dried fruits Refried Beans Nutritional Supplements: 
  Use only under the 
  direction of your doctor 
  or dietitian. 
Figs, dried Beets, fresh then boiled  
Grapefruit Juice Black Beans  
Honeydew Broccoli, cooked Nuts and Seeds (1 ounce) 
Kiwi (1 medium) Brussels Sprouts Peanut Butter (2 tbs.) 
Mango(1 medium) Chinese Cabbage Salt Substitutes/Lite Salt 
Nectarine(1 medium) Carrots, raw Salt Free Broth 
Orange(1 medium) Dried Beans and Peas Yogurt 
Orange Juice Greens, except Kale Snuff/Chewing Tobacco 
Papaya (½ whole) Hubbard Squash   
Pomegranate (1 whole) Kohlrabi   
Pomegranate Juice Lentils   
Prunes Legumes   
Prune Juice White Mushrooms, cooked (½ cup)   
Raisins Okra   
  Parsnips   
  Potatoes, white and sweet   
  Pumpkin   
  Rutabagas   
  Spinach, cooked   
  Tomatoes/Tomato products   
  Vegetable Juices   

What foods are low in potassium? 

The following table list foods which are low in potassium. A portion is ½ cup unless otherwise noted. Eating more than 1 portion can make a lower potassium food into a higher potassium food. 

Low-Potassium Foods   
Fruits Vegetables Other Foods 
Apple (1 medium) Alfalfa sprouts Rice 
Apple Juice Asparagus (6 spears raw) Noodles 
Applesauce Beans, green or wax 
Broccoli (raw or cooked from frozen) 
Pasta 
Apricots, canned in juice Cabbage, green and red 
Carrots, cooked 
Bread and bread products (Not Whole Grains) 
Blackberries Cauliflower Cake: angel, yellow 
Blueberries Celery (1 stalk) Coffee: limit to 8 ounces 
Cherries Corn, fresh (½ ear) frozen (½ cup) Pies without chocolate or high potassium fruit 
Cranberries Cucumber Cookies without nuts or chocolate 
Fruit Cocktail Eggplant Tea: limit to 16 ounces 
Grapes Kale   
Grape Juice Lettuce   
Grapefruit (½ whole) Mixed Vegetables   
Mandarin Oranges White Mushrooms, raw (½ cup)   
Peaches, fresh (1 small) 
canned (½ cup) 
Onions   
Pears, fresh (1 small) 
canned (½ cup) 
Parsley   
Pineapple Peas, green   
Pineapple Juice Peppers   
Plums (1 whole) Radish   
Raspberries Rhubarb   
Strawberries Water Chestnuts, canned   
Tangerine (1 whole) Watercress   
Watermelon (limit to 1 cupYellow Squash  
  Zucchini Squash   

How do I get some of the potassium out of my favorite high-potassium vegetables? 

The process of leaching will help pull potassium out of some high-potassium vegetables. It is important to remember that leaching will not pull all of the potassium out of the vegetable. You must still limit the amount of leached high-potassium vegetables you eat. Ask your dietitian about the amount of leached vegetables that you can safely have in your diet. 

How to leach vegetables. 

For Potatoes, Sweet Potatoes, Carrots, Beets, Winter Squash, and Rutabagas: 

  1. Peel and place the vegetable in cold water so they won’t darken. 
  1. Slice vegetable 1/8 inch thick. 
  1. Rinse in warm water for a few seconds. 
  1. Soak for a minimum of two hours in warm water. Use ten times the amount of water to the amount of vegetables. If soaking longer, change the water every four hours. 
  1. Rinse under warm water again for a few seconds. 
  1. Cook vegetable with five times the amount of water to the amount of vegetable. 

Read more about Potassium and Your CKD Diet. 

References: 
Bowes & Church Food Values of Portions Commonly Used, 17th Ed., Pennington, JA, Lippincott, 1998. 
Diet Guide for Patients with Kidney Disease, Renal Interest Group-Kansas City Dietetic Association, 1990. 

www.cdc.com 

www.webmd.com 

www.kidneynest.com 

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Frequently Asked Questions | NIDDK


eGFR

1. What is a GFR estimating equation?
Glomerular filtration rate (GFR) is a marker of kidney function. It is rarely measured outside of the research setting. An estimating equation estimates GFR using laboratory measurements and demographic variables that describe the patient. The two most commonly used estimating equations are the Modification of Diet in Renal Disease (MDRD) Study equation and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Both equations incorporate four variables: serum creatinine, age, race, and gender. Both equations give similar values for patients with advanced kidney disease (eGFR less than 60 mL/min/1.73 m2). However, for patients with less advanced disease, the CKD-EPI equation gives better estimates of GFR and should be used when the eGFR is greater than 60 mL/min/1.73 m2.

2. Why use an estimated GFR instead of simple creatinine?
Serum creatinine may be increased or decreased due to changes in muscle mass rather than changes in kidney function. In these situations, the serum creatinine may over or underestimate kidney function. Estimating equations utilizing serum creatinine include variables which are related to muscle mass (age, gender, and race) and may provide a more accurate indication of kidney function.

3. How is a GFR estimating equation developed?
Estimating equations are developed from study populations in which a measured GFR has been obtained. Through regression analysis, equations are developed which provide an estimate of GFR utilizing patient characteristics (e.g. serum creatinine, age, gender, and race) which are routinely available. Thus, estimating equations are developed in populations and may be most useful in describing risk in populations of patients. The estimated GFR will be less accurate for individual patients who have characteristics, especially muscle mass, that are different from the average in the population used to develop an estimating equation.

4. Why is there more than one GFR estimating equation?
There are several GFR estimating equations currently used to assess kidney function, and each equation has been developed in different study populations. Estimating equations change over time; as new equations are developed and validated in larger populations, older ones become obsolete. For example, the MDRD Study equation has been validated in CKD patients with lower levels of GFR who were predominantly Caucasian, non-diabetic, and did not have a kidney transplant. The MDRD equation has not been validated in children less than 18 years of age, pregnant women, the elderly above the age of 85, or in some racial or ethnic subgroups such as Hispanics. The CKD-EPI equation has been validated in a broader group of persons consisting of predominately Caucasians and Blacks with and without kidney diseases, diabetes, and solid organ transplants who had a wide range of GFR and ages. As a result, CKD-EPI appears to offer some improvement for eGFR between 60 and 120 mL/min/1.73 m2.

5. How do we measure the performance of a GFR estimating equation?
Estimating equations reflect the best estimate for the population in which they were developed. However, there can be significant imprecision when using the equation when assessing an individual. The conventional measure of precision has been the P30, which describes the percent of GFR estimates that are within 30% of the measured GFR. Measures of P30 using the same equations vary in different studies depending on the age, muscle mass, and amount of kidney disease prevalent in different population groups that have been investigated.

6. Are certain equations better for estimating GFR in certain situations?
GFR estimating equations are derived from and validated in studies in specific populations and include multiple variables, so it’s important to recognize that a particular equation will be best suited for use with individual patients with demographic and disease conditions most similar to those of the population used to develop an equation. The MDRD Study Equation was developed in CKD patients with lower levels of GFR (mean GFR 40mL/min/1.73 m2) who were predominantly Caucasian, non-diabetic, and did not have a kidney transplant. The CKD-EPI Equation has been validated in a group of predominately Caucasians and Blacks with and without kidney disease, diabetes, and solid organ transplants who had a wide range of GFR (2 to 198 mL/min.1.73 m2) and ages (18-97 years). Neither the MDRD Study nor the CKD-EPI equations have been validated in children, pregnant women, or in some racial or ethnic subgroups. However, the CKD-EPI equation has been evaluated in a broader range of conditions than has the MDRD equation.

7. Is there a role for the Cockcroft-Gault equation?
Creatinine measurement has now been standardized. Unfortunately, the creatinine method used in the development of the Cockcroft-Gault equation is no longer in use and samples from the study are not available to evaluate how the results might compare to standardized creatinine values. There is no version of the Cockcroft Gault equation for use with standardized creatinine results. A large simulation study compared eGFR by MDRD Study equation and estimated creatinine clearance (eCrCl) by the Cockcroft-Gault equation calculated from standardized creatinine values to each other and to measured GFR for the purpose of drug dosing. The results suggested that, for the majority of patients and for most drugs tested that did not have narrow thresholds for toxicity, there was little difference in the drug dose that would be administered using either equation to estimate kidney function. However, for drugs with a narrow therapeutic index, the Cockcroft-Gault equation was less reliable in assessing the risk of kidney damage.

8. Is there a role for collecting 24 hour urine to calculate a creatinine clearance?
For most people, creatinine clearance calculated from a 24 hour urine collection does not provide a better indication of kidney function than does an estimated value of GFR. However, for people for whom serum creatinine may be increased or decreased due to changes in muscle mass rather than changes in kidney function (e.g. amputation, cachexia, body building), a calculated creatinine clearance may be helpful.

9. Why don’t you endorse one equation?
eGFR provides a better indication of kidney function than serum creatinine alone and NIDDK promotes routine reporting of eGFR with serum creatinine. However, estimating equations provide only an estimate of kidney function, not the actual GFR. Development of estimating equations is a dynamic field with improved versions of existing and new equations, and equations incorporating new markers (e.g. cystatin C) appearing on a constant basis. All estimating equations are imperfect and none offer an overwhelming advantage for all clinical situations. The goal of NIDDK’s educational effort around eGFR is to explain the routine and appropriate use of eGFR to clinicians rather than to disseminate and implement each incremental advance in estimating GFR.

10. What are considered average estimated GFR (eGFR) values for adults?

The table below shows population estimates for mean (average) estimated glomerular filtration rate (eGFR) by age. These means, derived from the NHANES III survey of over 10,000 individuals, demonstrate that eGFR varies across age groups and that kidney function tends to decline with age. There is no difference between races or sexes when eGFRs are expressed per meter squared body surface area.

Reference Table for Population Mean eGFRs From NHANES III4

Age (Years)Mean eGFR*
Age (Years)20-29Mean eGFR* 116 mL/min/1.73 m2
Age (Years)30-39Mean eGFR* 107 mL/min/1.73 m2
Age (Years)40-49Mean eGFR* 99 mL/min/1.73 m2
Age (Years)50-59Mean eGFR* 93 mL/min/1.73 m2
Age (Years)60-69Mean eGFR* 85 mL/min/1.73 m2
Age (Years)70+Mean eGFR* 75 mL/min/1.73 m2

*In general, the NIDDK recommends laboratories report eGFR values greater than or equal to 60 as “≥ 60 mL/min/1.73 m2,” not as an exact number. Reasons for this recommendation are given in the Reporting GFR section of the website.

11. Can eGFRs be used in hospitalized patients?
Estimated GFR derived from the MDRD Study or CKD-EPI equation can be used in patients who are in the hospital. However, it is important to pay attention to potential inaccuracies due to the non-steady state of serum creatinine, co-morbidities that cause malnutrition, and the use of medications that interfere with the measurement of serum creatinine.5

UACR

1. Why is it important to measure urine albumin?
Urine albumin is one indicator of kidney damage. Albumin is the predominant protein normally found in the blood. Normally only very small amounts of albumin appear in the urine (less than 30 mg per day). When the kidneys are damaged, increased amounts of albumin leak into the urine. This condition is called albuminuria. For many people, albuminuria is the earliest sign of CKD. In addition, urine albumin excretion is an early predictor of cardiovascular disease morbidity and mortality and progression of kidney disease.

2. Once a patient is found to have albuminuria, why repeat the measurement?
Like all physiologic variables, albumin excretion varies and may be caused by physiologic stress factors other than persistent kidney damage. The presence of increased urine albumin should be confirmed with a second determination within three months. Additional measurements over time can inform management and prognosis.

3. Which test should be used to measure urine albumin?
To test for urine albumin, a urine albumin-to-creatinine ratio (UACR) on a spot urine sample will provide an excellent indication of 24 hour albumin excretion in most clinical situations. It is generally not necessary to collect a 24 hour urine specimen. It is recommended to perform a follow up confirming UACR test on a first morning sample of urine.

4. What is the UACR?
UACR is a ratio between two measured substances—albumin and creatinine—in the urine. UACR is usually expressed as mg albumin/g creatinine and estimates 24-hour urine albumin excretion. Unlike a dipstick test for albumin, UACR is unaffected by variation in urine concentration. Albuminuria is diagnosed when UACR is greater than 30 mg/g.

5. How do I interpret the UACR results?
Albuminuria is present when UACR is greater than 30 mg/g and is a marker for CKD. Change in albuminuria may reflect response to therapy and risk for progression. A decrease in urine albumin may be associated with improved renal and cardiovascular outcomes.

6. Why not use a dipstick to sample urine in the measurement of albumin?
Urine dipstick tests afford low sensitivity and may fail to detect early stage kidney disease, when the level of albuminuria is below the sensitivity of the test strip used.

7. What is the role of the urine protein/creatinine ratio?
The protein-to-creatinine ratio is similar to the albumin-creatinine-ratio; it is obtained on a spot urine specimen and indicates 24 hour total protein excretion. Total urine protein includes urine albumin. However, because of the wide range of proteins included, it is not feasible to standardize total protein measurement and it is likely that use of this test will decrease over time.

8. When will the urine albumin test be standardized?
To begin addressing urine albumin measurement and reporting issues, NIDDK and the International Federation of Clinical Chemistry and Laboratory Medicine convened a group of international experts in March 2007. They identified the issues associated with the urine albumin measurement and developed a plan to improve harmonization and standardization of this test. Several NIDDK-funded studies are underway addressing a number of issues including urine albumin and creatinine reference materials, and urine albumin reference measurement procedures. As a result of these efforts, we expect the urine albumin test to be standardized in the near future.

References

www.cdc.com

www.who.com

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Urinalysis – Understand the Test & Your Results


Also Known As

Urine Test

Urine Analysis

UA

When you have symptoms, such as abdominal pain, back pain, frequent or painful urination; sometimes as part of a health examination, pregnancy check-up, hospital admission, or pre-surgical work-up

One to two ounces of urine—a sufficient sample is required for accurate results; sometimes you may be directed to collect a sample using a “clean-catch” technique: women should spread the labia of the vagina and clean from front to back; men should wipe the tip of the penis. Start to urinate, let some urine fall into the toilet, then collect one to two ounces of urine in the container provided, then void the rest into the toilet.

A urinalysis is a group of physical, chemical, and microscopic tests. The tests detect and/or measure several substances in the urine, such as byproducts of normal and abnormal metabolism, cells, cellular fragments, and bacteria.

Urine is produced by the kidneys, two fist-sized organs located on either side of the spine at the bottom of the ribcage. The kidneys filter wastes out of the blood, help regulate the amount of water in the body, and conserve proteins, electrolytes, and other compounds that the body can reuse. Anything that is not needed is eliminated in the urine, traveling from the kidneys through ureters to the bladder and then through the urethra and out of the body. Urine is generally yellow and relatively clear, but each time a person urinates, the color, quantity, concentration, and content of the urine will be slightly different because of varying constituents.

Many disorders may be detected in their early stages by identifying substances that are not normally present in the urine and/or by measuring abnormal levels of certain substances. Some examples include glucose, protein, bilirubin, red blood cells, white blood cells, crystals, and bacteria. They may be present because:

  1. There is an elevated level of the substance in the blood and the body responds by trying to eliminate the excess in the urine.
  2. Kidney disease is present.
  3. There is a urinary tract infection present, as in the case of bacteria and white blood cells.

A complete urinalysis consists of three distinct testing phases:

  1. Visual examination, which evaluates the urine’s color and clarity
  2. Chemical examination, which tests chemically for about 9 substances that provide valuable information about health and disease and determines the concentration of the urine
  3. Microscopic examination, which identifies and counts the type of cells, casts, crystals, and other components such as bacteria and mucus that can be present in urine

See below for details on each of these examinations.

A microscopic examination is typically performed when there is an abnormal finding on the visual or chemical examination, or if a healthcare practitioner specifically orders it.

Abnormal findings on a urinalysis may prompt repeat testing to see if the results are still abnormal and/or may be followed by additional urine and blood tests to help establish a diagnosis.

How is the sample collected for testing?

One to two ounces of urine is collected in a clean container. A sufficient sample is required for accurate results.

Urine for a urinalysis can be collected at any time. In some cases, a first morning sample may be requested because it is more concentrated and more likely to detect abnormalities.

Sometimes, you may be asked to collect a “clean-catch” urine sample. For this, it is important to clean the genital area before collecting the urine. Bacteria and cells from the surrounding skin can contaminate the sample and interfere with the interpretation of test results. With women, menstrual blood and vaginal secretions can also be a source of contamination. Women should spread the labia of the vagina and clean from front to back; men should wipe the tip of the penis. Start to urinate, let some urine fall into the toilet, then collect one to two ounces of urine in the container provided, then void the rest into the toilet.

A urine sample will only be useful for a urinalysis if taken to the healthcare provider’s office or laboratory for processing within a short period of time. If it will be longer than an hour between collection and transport time, then the urine should be refrigerated or a preservative may be added.

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Symptoms of Coronavirus (COVID-19)
cdc.gov/coronavirus
317142-A May 20, 2020 10:44 AM
Know the symptoms of COVID-19, which can include the following:
Seek medical care immediately if someone has emergency warning signs of COVID-19. • Trouble breathing • Persistent pain or pressure in the chest • New confusion • Inability to wake or stay awake • Bluish lips or face Cough Chills Muscle pain Shortness of breath or difficulty breathing
New loss of
taste or smell
Sore throat
Symptoms can range from mild to severe illness, and appear 2-14
days after you are exposed to the virus that causes COVID-19.
This list is not all possible symptoms. Please call your medical provider for any
other symptoms that are severe or concerning to you.
Fever

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mayoclinic.org

Coronavirus disease 2019 (COVID-19) – Symptoms and causes


Overview

Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In 2019, a new coronavirus was identified as the cause of a disease outbreak that originated in China.

The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.

Public health groups, including the U.S. Centers for Disease Control and Prevention (CDC) and WHO, are monitoring the pandemic and posting updates on their websites. These groups have also issued recommendations for preventing and treating the illness.

Symptoms

Signs and symptoms of coronavirus disease 2019 (COVID-19) may appear two to 14 days after exposure. This time after exposure and before having symptoms is called the incubation period. Common signs and symptoms can include:

  • Fever
  • Cough
  • Tiredness

Other symptoms can include:

  • Shortness of breath or difficulty breathing
  • Muscle aches
  • Chills
  • Sore throat
  • Loss of taste or smell
  • Headache
  • Chest pain

This list is not all inclusive. Other less common symptoms have been reported, such as nausea, vomiting and diarrhea. Children have similar symptoms to adults and generally have mild illness.

The severity of COVID-19 symptoms can range from very mild to severe. Some people may have only a few symptoms, and some people may have no symptoms at all. People who are older or who have existing chronic medical conditions, such as heart disease, lung disease, diabetes, severe obesity, chronic kidney or liver disease, or who have compromised immune systems may be at higher risk of serious illness. This is similar to what is seen with other respiratory illnesses, such as influenza.

Some people may experience worsened symptoms, such as worsened shortness of breath and pneumonia, about a week after symptoms start. COVID-19 Self-Assessment Tool Assess your symptoms and find out if you’re a candidate for a coronavirus disease 2019 (COVID-19) test.

When to see a doctor

If you have COVID-19 symptoms or you’ve been in contact with someone diagnosed with COVID-19, contact your doctor or clinic right away for medical advice. Tell your health care team about your symptoms and possible exposure before you go to your appointment.

If you have emergency COVID-19 signs and symptoms, seek care immediately. Emergency signs and symptoms can include:

  • Trouble breathing
  • Persistent chest pain or pressure
  • New confusion
  • Blue lips or face

If you have signs or symptoms of COVID-19, contact your doctor or clinic for guidance. Let your doctor know if you have other chronic medical conditions, such as heart disease or lung disease. During the pandemic, it’s important to make sure health care is available for those in greatest need.

Causes

Infection with the new coronavirus (severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2) causes coronavirus disease 2019 (COVID-19).

The virus appears to spread easily among people, and more continues to be discovered over time about how it spreads. Data has shown that it spreads from person to person among those in close contact (within about 6 feet, or 2 meters). The virus spreads by respiratory droplets released when someone with the virus coughs, sneezes or talks. These droplets can be inhaled or land in the mouth or nose of a person nearby.

It can also spread if a person touches a surface with the virus on it and then touches his or her mouth, nose or eyes.

Risk factors

Risk factors for COVID-19 appear to include:

  • Recent travel from or residence in an area with ongoing community spread of COVID-19 as determined by CDC or WHO
  • Close contact (within 6 feet, or 2 meters) with someone who has COVID-19 or being coughed or sneezed on by an infected person

Complications

Although most people with COVID-19 have mild to moderate symptoms, the disease can cause severe medical complications and lead to death in some people. Older adults or people with existing chronic medical conditions are at greater risk of becoming seriously ill with COVID-19.

Complications can include:

  • Pneumonia and trouble breathing
  • Organ failure in several organs
  • Heart problems
  • Blood clots
  • Acute kidney injury
  • Additional viral and bacterial infections

Prevention

Although there is no vaccine available to prevent COVID-19, you can take steps to reduce your risk of infection. WHO and CDC recommend following these precautions for avoiding COVID-19:

  • Avoid large events and mass gatherings.
  • Avoid close contact (within about 6 feet, or 2 meters) with anyone who is sick or has symptoms.
  • Stay home as much as possible and keep distance between yourself and others (within about 6 feet, or 2 meters) if COVID-19 is spreading in your community, especially if you have a higher risk of serious illness. Keep in mind some people may have COVID-19 and spread it to others, even if they don’t have symptoms or don’t know they have COVID-19.
  • Wash your hands often with soap and water for at least 20 seconds, or use an alcohol-based hand sanitizer that contains at least 60% alcohol.
  • Cover your face with a cloth face covering in public spaces, such as the grocery store, where it’s difficult to avoid close contact with others, especially if you’re in an area with ongoing community spread. Only use nonmedical cloth masks — surgical masks and N95 respirators should be reserved for health care providers.
  • Cover your mouth and nose with your elbow or a tissue when you cough or sneeze. Throw away the used tissue.
  • Avoid touching your eyes, nose and mouth.
  • Avoid sharing dishes, glasses, bedding and other household items if you’re sick.
  • Clean and disinfect high-touch surfaces, such as doorknobs, light switches, electronics and counters, daily.
  • Stay home from work, school and public areas if you’re sick, unless you’re going to get medical care. Avoid public transportation, taxis and ride-sharing if you’re sick..

If you have a chronic medical condition and may have a higher risk of serious illness, check with your doctor about other ways to protect yourself.

Travel

If you’re planning to travel, first check the CDC and WHO websites for updates and advice. Also look for any health advisories that may be in place where you plan to travel. You may also want to talk with your doctor if you have health conditions that make you more susceptible to respiratory infections and complications.

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When your state is reopening :


The novel coronavirus pandemic has wreaked havoc on many areas in the United States, prompting nearly all states to issue stay-at-home orders and close businesses in an effort to stem the tide of the virus.

But the ensuing, unprecedented economic shutdown has caused devastation of its own — with some 33 million filing for unemployment, an economic contraction not seen since the Great Recession and businesses of all sizes scrambling to adapt and survive. It has also prompted calls to get the economy moving again — raising the issue about how to do so safely as the virus continues to tear through the country.

There is no unified approach among states and only non-binding national guidelines. Complicating matters is that the virus is impacting different states in a dramatic way. And within states, there is dramatic variation as well.

As 45 states, plus Puerto Rico, begin easing restrictions to some extent, no state has yet to see a decline in terms of new reported cases for 14 days in a row, according to an ABC News analysis, and questions remain about whether there will be a resurgence of the virus.

Here is a look at when stay-at-home orders will be lifted, what each state’s reopening plan looks like, and what phase each state is in in terms of reopening:

Tune into ABC at 1 p.m. ET and ABC News Live at 4 p.m. ET every weekday for special coverage of the novel coronavirus with the full ABC News team, including the latest news, context and analysis.

ALABAMA

1) Status of the stay-at-home order While the stay-at-home order was lifted in Alabama on April 30, the state is currently under a Safer at Home Order, which relaxes some of those restrictions, until May 22.

2) What is the reopening plan? Beginning May 11, non-work gatherings will no longer be subject to a 10 person limit, but 6 feet of distancing between people is still required. Bars and restaurants are allowed to open with 50% capacity, and must maintain social distancing guidelines. Close-contact providers, such as barbershops and hair salons, are allowed to open and must maintain social distancing guidelines. Beaches have no limit on gatherings, but anyone on the beach must maintain social distancing guidelines. Gyms will also be reopening. Elective surgeries are allowed, but individuals are encouraged to stay home, and all retail stores that open must maintain 50% occupancy rate and social distancing and sanitation rules. Nightclubs, theaters and bowling alleys remain closed. Schools are still closed for in-person instructions. The governor has yet to announce what the next step is in order to begin to return to normal.

3) What phase of reopening is the state in? Alabama has three phases to re-opening: Stay at Home, Safer at Home, and Safer Apart. It is currently in phase 2, Safer At Home.

ALASKA

1) Status of the stay-at-home order Alaska moved into phase 1 of its reopening plan on April 24, which partially lifted many of the stay-at-home restrictions issued by Gov. Mike Dunleavy. On Friday, May 8, the state moved into phase 2.

2) What is the reopening plan? Phase 1 of Alaska’s reopening plan lifted many travel, camping and childcare restrictions, as well as allowed some businesses to reopen with varying restrictions. The state then entered its second phase on May 8, which allowed most non-essential businesses to reopen. This means that gyms, retail stores, restaurants, religious gatherings, swimming pools, bars, libraries and museums are all open to the public, but must maintain strict capacity numbers. Beyond that, the plan is vague and timing is TBD. Phase 3 allows 75% of business capacity and gatherings including non-household members. Phase 4 calls for personal protective measures and minimal community mitigation and phase 5 is “normal business practices.”

3) What phase of reopening is the state in? Alaska is in phase 2 of its “Reopen Alaska Responsibly Plan.”

ARIZONA

1) Status of the stay-at-home order On April 29, Gov. Doug Ducey extended the state’s stay-at-home order – “Stay home, Stay healthy, Stay connected” – in an amendment called “Returning Stronger,” which allowed some retail businesses to resume partial operations on May 4 with curbside delivery. The modified order remains in place until May 15.

2) What is the reopening plan? Arizona’s “Return Stronger” reopening plan entered its second phase on May 8. Now, retail operations can resume partial in-person operations and salons and barbershops can return to work, as long as their customers have an appointment. On May 13, gyms and pools could reopen with restrictions in place, and professional sports leagues can restart without spectators after May 15.

3) What phase of reopening is the state in? On Monday, May 11, Arizona entered the latest phase of its preliminary reopening plan, allowing customers to dine at restaurants as long as they follow social distancing protocol. Ducey told his constituents to expect many updates and modifications throughout the month of May.

MORE: Here’s how hair salons are reopening amid COVID-19

ARKANSAS

© Andrew Demillo/AP Cole Downing, a bartender, wears a protective mask as he cleans chairs and tables at the Flying Saucer Draught Emporium in Little Rock, Ark., May 11,2020.

1) Status of the stay-at-home order While Arkansas never had an official stay-at-home order in place, restaurants, venues, elective surgeries and casinos were all force to stop operations due to the spread of the novel coronavirus.

2) What is the reopening plan? Gov. Asa Hutchinson is reopening the state in three phases, all of which have their own stages. On May 6, barbershops, salons, massage therapy clinics and similar businesses were allowed to reopen only to customers who had appointments. Strict guidelines, such as pre-screening of both employees and customers for COVID-19 symptoms, is required. Places of worship are also open. Some cities within Arkansas are imposing stricter stay-at-home policies than others, such as Little Rock.

Slide 1 of 50: MARINA DEL REY, CALIFORNIA – MAY 13: A customer maintains a social distance while queuing outside Starbucks on May 13, 2020 in Marina del Rey, California. COVID-19 has spread to most countries around the world, claiming over 295,000 lives and infecting more than 4.3 million people. (Photo by A customer maintains a social distance while queuing outside Starbucks on May 13 in Marina del Rey, California. An employee sets a table for pick up orders at a restaurant in the Crystal City neighborhood of Arlington, Virginia, as businesses try to adapt to the ever-changing situation amid the coronavirus pandemic, on May 13. A woman walks past a mural in front of a store displaying a hopeful message amid the coronavirus pandemic on May 13 in Arlington, Virginia. Passengers, some wearing facemasks and protective suits, wait for a flight at Terminal 1 of John F. Kennedy Airport amid the novel coronavirus pandemic on May 13 in Queens, New York. A sign urging social distancing due to coronavirus, is seen outside of the US Capitol in Washington, D.C on May 13. Hundreds of motor coaches representing companies from across the country drive laps around the National Mall to protest the economic impact the novel coronavirus pandemic is having on their business, on May 13 in Washington, D.C. Organized by the American Bus Association and the United Motorcoach Association, the ‘rolling rally’ is demanding relief and a return to work for its national workforce. Masked visitors attend the re-opening of the Farmer’s Market, in Manhattan Beach, California on May 12, after being closed for eight weeks. Mississippi Army National Guard Sgt. Newman Kazery, right, elbow bumps with Charles Jenkins, a supply tech and disabled Navy veteran, as he goes to work at the G.V. (Sonny) Montgomery VA Medical Center in Jackson on May 12. Kazery was one of 50 members of the Mississippi Air and Army National Guard that stood outside the medical facility and applaud both incoming and outgoing medical shifts honoring medical personnel for their efforts in working with the coronavirus on the final day of National Nurses Week. The New Orleans Health Department, LCMC Health, and LSU Health Sciences offer free coronavirus disease walk-up testing at the Treme Recreation Center in New Orleans, Louisiana, on May 12.  Homemade face masks for sale blow in the wind outside of a business, on May 12 in San Antonio. Texas. San Antonio continues to encourage face masks or coverings as well as social distancing in an an effort to fight the new coronavirus pandemic.  A man wearing a face mask hurries across York Road after shopping for groceries, on May 12 in Towson, Maryland. Americans are slowly getting back on the road after hunkering down amid the coronavirus pandemic, though driving still is well below what it was before many states issued stay-at-home orders. Airport workers hold an in-vehicle circular rally for better protections amid the coronavirus disease outbreak, at Reagan National Airport in Arlington, Virginia, on May 12.  Jill Evans sorts students’ belongings as she packs them in her kindergarten classroom at Walnut Grove Elementary school on May 12 in Olathe. Teachers were gathering belongings and classwork of their students so they could be picked up by parents next week. The school closed on March 13, as all Kansas schools were ordered shut to help prevent the spread of the coronavirus and eventually ordered closed for the remainder of the school year. Evans, who will be teaching at a different school next fall said she will miss saying goodbye to her students at the end of the school year.  Hundreds of people wait in line for hours at a downtown Brooklyn office for their EBT Food Stamp cards on May 12 in New York City. Across America, people are reeling from the loss of jobs and incomes as unemployment soars to historical levels following the COVID-19 outbreak.  A cyclist rides through the nearly empty financial district in Boston, Massachusetts, on May 12.  A demonstrator holds a sign outside Tesla’s primary vehicle factory after CEO Elon Musk announced he was defying local officials’ restrictions by reopening the plant in Fremont, California, on May 12. Healthcare workers at John H. Stroger, Jr. Hospital of Cook County take photos with co-workers after they watched the U.S. Navy’s Blue Angels flight demonstration squadron fly over in Chicago on May 12. The flyover was a salute to first responders in the wake of the coronavirus pandemic. Amid concerns of the spread of COVID-19, a little girl wears a mask at El Rancho grocery store in Dallas, Texas on May 12. The South Carolina Supreme Court met on May 12 in Columbia, South Carolina., for its first- ever oral arguments via teleconference. The Court heard concerns over potential difficulties of voting in this year’s elections due to the coronavirus outbreak, as social distancing recommendations remain in place. Law enforcement officers surround the executive mansion as people gather in downtown to protest stay-at-home orders during a ReOpen NC rally in Raleigh, North Carolina on May 12. House Speaker Nancy Pelosi, walks to speak about the so-called Heroes Act on May 12 on Capitol Hill in Washington D.C. Pelosi unveiled a more than $3 trillion coronavirus aid package, providing nearly $1 trillion for states and cities, “hazard pay” for essential workers and a new round of cash payments to individuals.  People wait to vote at a voting station for the special election between Democratic state assembly woman Christy Smith and Republican businessman and ex-Navy pilot Mike Garcia to replace former Democratic Congresswoman Katie Hill in the state’s 25th Congressional District, in Santa Clarita, California on May 12. The U.S. Navy Blue Angels fly over Detroit in solidarity with healthcare and frontline workers as the coronavirus pandemic continues on May 12 in Detroit, Michigan. Laura Anderson grabs a can of food for a box on May 12 in Indianapolis, Indiana. The Salvation Army, with the help of the Midwest Food Bank and the Indiana National Guard, packed 5,000 boxes at Lucas Oil Stadium to help Hoosier families in need. Senators Tim Kaine and Richard Burr greet each other with an elbow bump before the Senate Committee for Health, Education, Labor, and Pensions hearing on COVID-19  on May 12 in Washington, D.C. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases is expected to testify remotely before the committee. People line up in their cars at the drive-thru COVID-19 testing site at the Bergen Community College main campus, in Paramus, New Jersey on May 12. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases speaks remotely during a Senate Health, Education, Labor and Pensions Committee hearing on Capitol Hill on May 12 in Washington, D.C. President Donald Trump speaks about the coronavirus during a press briefing in the Rose Garden of the White House on May 11 in Washington, D.C. People walk past shuttered stores in the Sunset Park neighborhood of Brooklyn during the current coronavirus outbreak on May 11 in New York.  Karle Manke, 77, cuts a customer’s hair at his barbershop which he opened on May 4 and has since been issued two citations, defying the coronavirus disease (COVID-19) executive order of Governor Gretchen Whitmer, in Owosso, Michigan on May 11. Manke says he will keep his shop open and running and is encouraging customers to abide by social distancing rules and to wear masks.  Assemblywoman Cottie Petrie-Norris, chair of the Assembly Accountability & Administrative Review Committee, questions Mark Ghilarducci, director of the Governor’s Office of Emergency Services, about the state’s purchase of protective equipment to battle the coronavirus, during an oversight hearing in Sacramento, Calif. on May 11. A King County Metro bus driver wipes down a handrail before stepping onto a bus on May 11 in Seattle,

Washington. The coronavirus pandemic has plunged Puget Sound-area transit agencies into a crisis-planning mode, as ridership and revenue have plunged and predictions that people will not be returning to buses and trains in large numbers anytime soon.  From left, Brody, 9, Ailbe, 5, and Riggs, 6, play with coins in a fountain on a hot day at Desert Ridge Marketplace during the phased reopening from coronavirus disease (COVID-19) restrictions in north Phoenix, Arizona on May 11. A worker exits a Tesla Model 3 electric vehicle at Tesla’s primary vehicle factory after CEO Elon Musk announced he was defying local officials’ coronavirus disease (COVID-19) restrictions by reopening the plant in Fremont, California on May 11. A mural honoring healthcare workers at Montefiore Medical Center in New York on May 11. Nicki Raman serves Beth Derry and Scott Deckard at the Peppermint Downtown Thai restaurant on May 11 in Palm Beach, Florida. Workers divide bulk food into bags for donation by SOMOS, in partnership with World Central Kitchen and Maestro Cares Foundation on May 11 in New York. A man wearing a face mask walks past The Forever Marilyn statue by Seward Johnson, which is also wearing a mask amid the Coronavirus outbreak at National Harbor, Maryland on May 11. Massachusetts US Army National Guard soldiers distribute food at John Ruiz Park to people suffering from food insecurity due to the coronavirus pandemic on May 11 in Chelsea, Massachusetts. Featuring 437 beds for coronavirus patients, a new field hospital built by the U.S. Army Corps of Engineers and members of the National Guard is shown inside the Walter E. Washington Convention Center on May 11 in Washington, D.C. A man carries flowers while crossing a street on Mother’s Day at the Los Angeles Flower Market Sunday on May 10 in Los Angeles, CA. A shopper pushes his cart past a display of packaged meat in a grocery store on May 10 in southeast Denver, CO. Problems triggered by the new coronavirus have triggered shortages of meat in some parts of the country.  Doug Hassebroek plants flowers under a tree outside their home wearing a mask as a precautionary measure during the outbreak of coronavirus disease (COVID-19) in Brooklyn, New York on May 10. A person sweeps the street in front of businesses that are closed due to the coronavirus pandemic on May 10, in Miami Beach, Florida.  Thousands of people wait in line to pick up bundles of food and goods during the weekly food pantry service run by Grace Ministries of the North Shore in Everett, Massachusetts, on May 10. Pastor Bobby Contreras, center, leads his church in music as churchgoers, using social distancing practices, return to in-person services at Alamo Heights Baptist Church, on May 10, in San Antonio. Beach-goers look for parking spots for their cars at Daytona Beach as sections of Volusia County beaches reopened today for the parking of vehicles next to posts spaced 12 feet apart on May 9. A firefighter smiles while walking towards a medical worker outside of NYU Langone Health hospital during the nightly ‘Clap Because We Care’ cheer for medical staff and essential workers amid the coronavirus pandemic on May 9, in New York City.  A group of Indiana University students who just finished graduating from the Kelley School of business during a video ceremony this weekend celebrate afterwards by jumping into waters of the Showalter Fountain and posing for photographs on May 9.  A New York City Police Department (NYPD) officer sits beside an art piece titled “-Thank You” by Benat Iglesias Lopez and his four-year-old son Teo which was made to thank frontline workers, outside Central Park during the outbreak of the coronavirus disease (COVID-19) in the Manhattan borough of New York City, New York on May 9. 50/50 SLIDES

Slideshow by photo services

3) What phase of reopening is the state in? Arkansas is in phase 1 of its reopening plan. On May 11, elective dental services are allowed to resume, as well as dine-in services at restaurants, which must operate at 33% capacity along with strict social distancing and sanitation operations. On May 18, large indoor venues, such as movie theaters, museums, casinos, and bowling alleys are set to re-open, but an audience of 50 people or less is required, along with strict social distancing and sanitation rules. Phase 2 is expected to include loosening some capacity restrictions on businesses.

CALIFORNIA

© Aric Crabb/The Mercury News via Getty Images A California State Lifeguard vehicle patrols Manresa State Beach. May 10, 2020, in Santa Cruz County.

1) Status of the stay-at-home order Gov. Gavin Newsom’s stay-at-home order is in place until further notice, keeping bars, gyms and hair salons closed. As of May 8, many retail stores, including bookstores, clothing stores, toy stores and florist shows are allowed to increase pickup and delivery operations, manufacturers can operate but must move breakrooms outside and warehouses were advised to use personal protective equipment when making deliveries. Many California beaches are allowed to allow “active recreation,” but beachgoers must avoid crowding. Los Angeles county’s Safer at Home order will remain in place for the next few months, but some restrictions will continue to be lifted.

2) What is the reopening plan? California has four stages to its reopening plan, which is called the “Resilience Roadmap: Safety and Preparedness.” The second stage is reopening lower-risk workplaces, then higher-risk workplaces and stage 4 is the end of stay-at-home order. While the state prepares to enter stage 2, each county will enter each phase differently based on if it meets California’s Public Health Criteria. Stage 2 will allow in-dining services in restaurants, and will allow shopping malls and outdoor museums to reopen.

3) What phase of reopening is the state in? California is currently in the early part of stage 2.

MORE: California begins to ease restrictions as cases continue to rise

COLORADO

© Nick Puckett via Reuters Crowd of people are seen at the C&C in Castle Rock restaurant, celebrating Mother’s Day amid the coronavirus disease (COVID-19) outbreak, in Castle Rock, Colo., May 10, 2020.

1) Status of the stay-at-home order The last day of Colorado’s stay-at-home order was April 26, and since then the state has been operating under a “Safer at Home” policy, under which strictures are eased but people are encouraged to stay home. Counties, such as Denver, Boulder, and Jefferson, are moving into the “Safer at Home” phases on their own.

2) What is the reopening plan? Gov. Jared Polis allowed retail businesses to reopen on May 1, as long as they operated at 50% capacity and with social distancing and safe sanitation practices. At the beginning of May, under safety guidelines, personal services were also allowed to reopen, including businesses such as hair salons, dry cleaners, massage therapists, and pet groomers. On May 4, non-critical offices were allowed to reopen at a lower capacity.

3) What phase of reopening is the state in? Colorado is in its second phase of re-opening (level 2), and by mid-May restaurants and bars are expected to reopen in some type of in-dining capacity.

CONNECTICUT

1) Status of the stay-at-home order The stay-at-home order in Connecticut is set to expire on May 20. This means gatherings of more than five people are prohibited, restaurants and bars are still closed for in-person dining experiences and movie theaters, hair salons and gyms are still closed.

2) What is the reopening plan? Gov. Ned Lamont announced that upon meeting certain criteria, such as a 14-day decline of hospitalizations, Connecticut could move to begin to reopen its economy. This is expected to happen as early as May 20. The first phase includes businesses such as restaurants, offices, hair salons, retail stores and outdoor museums and zoos, which could reopen while adhering to strict social distancing and sanitation practices. The decision to reopen rests entirely with the affected businesses.

3) What phase of reopening is the state in? Connecticut has still not moved into its reopening plan.

MORE: Bringing America Back: The post-pandemic workplace and more to know

DELAWARE

1) Status of the stay-at-home order Delaware’s stay-at-home order is scheduled to last until May 15. While restaurants are still closed for dine-in services, the beaches are open to exercise or walk on and golf courses are open to anyone who has been in Delaware for more than 14 days.

2) What is the reopening plan? Gov. John Carney has said that he will only consider reopening Delaware’s economy after seeing 28 days of declining COVID-19 cases. Delaware has three phases to reopening. Phase 1 would allow for elective surgeries to resume, restaurants to re-open for dine-in services, and gyms to reopen with strict capacity and social distancing rules. Phase 2 would allow schools and bars to reopen with a certain capacity, and phase 3 would further lift restrictions and allow vulnerable individuals to no longer shelter in place.

3) What phase of reopening is the state in? Even though the stay-at-home order is scheduled to end on May 15, Carney says Delaware won’t enter phase 1 until there is a decline in COVID-19 cases.

DISTRICT OF COLUMBIA

1) Status of the stay-at-home order Washington’s stay-at-home order was extended to June 8. Right now, restaurants are closed for in-person dining services, gyms are closed and individuals using private transportation services are required to wear face masks.

2) What is the reopening plan? There are three phases to reopening the nation’s capital: emergency response, stabilization and long-term recovery. In order to move into the stabilization phase, the district needs to meet certain criteria, such as a decline in new cases for at least 14 days. The second phase of reopening will mean easing restrictions, but practicing strict sanitation and social distancing practices.

3) What phase of reopening is the state in? Washington is still in its first phase of reopening: emergency response.

FLORIDA

1) Status of the stay-at-home order As of May 4, Gov. Ron DeSantis lifted some restrictions, allowing some beach access, in-dining services in restaurants so long as they limit capacity to 25%, access to libraries and museums, so long as they limit capacity to 25% as well and elective medical procedures to take place. On May 8, DeSantis announced that barber shops and salons can reopen in most of Florida starting on Monday, May 11, but shops in southern Florida will remain closed. Bars, gyms, schools, and vacation rentals remain closed.

2) What is the reopening plan? There are four phases to reopening Florida (0-3) or what Gov. DeSantis is calling the “Safe. Smart. Step-by-Step” plan. Florida has already entered phase 1 of reopening its economy. Phase 2 will allow for non-essential travel, as well as reopening bars, so long as they operate at 50% capacity. Phase 2 will also allow retail businesses, gyms, personal service businesses and restaurants to operate at 75% capacity. Phase 3 allows for businesses to operate at full capacity but requires strict sanitation practices.

3) What phase of reopening is the state in? Florida is in phase 1 of it’s reopening plan, which means bars and vacation rentals are still closed.

MORE: VA health care workers sound alarms over hospital reopening plans

GEORGIA

1) Status of the stay-at-home order Gov. Brian Kemp was one of the first governors to ease restrictions amid the coronavirus pandemic, allowing for the reopening of hair salons, barber shops, restaurants, theaters, gyms, and churches on April 27. While these businesses are open, strict social distancing and sanitation guidelines are still in place. The official stay-at-home order expired on April 30.

2) What is the reopening plan? Phase 1 of Georgia’s reopening plan, “Reviving a Healthy Georgia,” lifted some restrictions, but social distancing, sanitation and public health safety measures are still in place until June 12. Residents are encouraged to stay at home. Non-essential travel is still discouraged, and bars, nightclubs, amusement parks, public swimming pools, and live performance venues remain closed until May 31. Mayor Kiesha Lance Bottoms of Atlanta has issued an indefinite stay-at-home order for the city of Atlanta.

3) What phase of reopening is the state in? Georgia is currently in its phase 1 of reopening its economy.

HAWAII

© Caleb Jones/AP A surfer returns to Waikiki Beach in Honolulu, April 21, 2020. Hawaii has some of the lowest coronavirus infection and mortality rates in the U.S.

1) Status of the stay-at-home order As of May 7, Gov. David Ige lifted the stay-at-home order and issued a statewide “Safer at Home” order, which runs until May 31. While gatherings of more than 10 people are still prohibited, some restrictions have been lifted. Surfing and swimming in the ocean are allowed, and exercising on the beach is allowed so long as social distancing measures are kept. On May 7, pet groomers, landscaping services, repair services, non-profit organizations, and some retail apparel stores were allowed to open in certain counties. Elective surgeries are also allowed.

2) What is the reopening plan? Hawaii does not have an official plan of reopening phases, but Ige has issued seven supplementary proclamations relating to the COVID-19 pandemic. As of right now, public gathering locations, such as gyms, playgrounds, and theaters are still closed to the public, and sunbathing or lounging on beaches is prohibited. Restaurants are still closed for in-dining services, and strict sanitation measures are required for any business is in operation.

3) What phase of reopening is the state in? Hawaii is in phase 1 of its reopening plan, calling it the “stabilization phase.”

MORE: Does warmer weather slow coronavirus?

IDAHO

1) Status of the stay-at Home Order On May 1, Gov. Brad Little issued a “Stay Healthy” order, allowing places of worship, day care, organized youth activities and restaurants for curbside pickup to reopen, as long as they adhere to strict social distancing rules.

2) What is the reopening plan? Idaho’s reopening plan, “Idaho Rebounds: Our Path to Prosperity,” has four stages of reopening. In stage 1, businesses such as gyms, bars and hair salons remain closed, restaurants are take-out only, but day care and places or worship can reopen with limited capacity. In stage 2, restaurants can open their dining rooms with the approval of local public health districts, and gyms and hair salons can reopen too as long as they adhere to business protocols. Gatherings of 10 people or less are permitted. Phase 3 includes allowing non-essential travel to take place and people coming into Idaho no longer have to quarantine for 14 days. In phase 3, gatherings of less than 50 people are permitted as long as social distancing practices are kept. Phase 4 opens up bars and larger venues, such as movie theaters, and social distancing protocols are still in place.

3) What phase of reopening is the state in? Idaho is stage 1 and plans to be in stage 2 by May 16 if all the criteria to move onto the next stage are met. It plans on allowing non-essential travel to resume on May 30, and officials hope to enter stage 4 by June 13.

ILLINOIS

1) Status of the stay-at-home order As of May 5, Gov. J.B. Pritzker lifted some restrictions, allowing non-essential retail stores to reopen for curbside pickup and delivery. Activities such as golf, fishing, and boating are allowed so long as individuals practice social distancing measures. Animal grooming services were also allowed to reopen.

2) What is the reopening plan? The plan to reopen Illinois, called “Restore Illinois,” will take place in five stages, and at any point it can return to a previous stage, according to Pritzker. Phase 1, when the disease is spreading rapidly, consists of strict stay-at-home guidelines and only essential business are open. Phase 2 allows for reopening retail stores for pickup and delivery, and lifts restrictions on some outdoor activities. Phase 3 will allow for reopening salons, manufacturing, offices and barbershops with limited capacity. Gatherings of 10 people or fewer are allowed, and gyms could return for personal training and outdoor classes. Phase 4 will mean gatherings of 50 or less people are allowed, which means restaurants, bars, schools, and child care facilities can reopen under the guidance of the public health department. Phase 5 will allow large events, such as concerts, to be permitted, but safety regulations will still be in place.

3) What phase of reopening is the state in? Illinois is currently in phase 2. In order to move into phase 3, contact tracing needs to be implemented and the case positivity rate needs to be lowered. It is possible that Illinois will move into phase three as early as May 29.

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INDIANA

1) Status of the stay-at-home order Indiana’s stay-at-home order expired on May 1, and beginning on May 4, Gov. Mike Holcomb allowed public libraries, as well as manufacturers and industrial operations to reopen as long as they accord with CDC guidelines. Local non-essential travel is now allowed, and gatherings of 25 people or less may take place as long as social distancing measures are kept. Beginning on May 8, religious services were allowed to take place in houses of worship, and on May 11 bars and restaurants were allowed to reopen at 50% capacity and personal services, such as hair salons and tattoo parlors, were open to clients with appointments.

2) What is the reopening plan? Indiana’s reopening plan, called “Back on Track Indiana Plan,” has five stages. Under stage 1, restaurants were take-out only, gatherings of 10 people or less were allowed, schools were closed, but golf courses remained open. Stage 1 ended May 4. In phase 2, retail businesses are allowed to operate at 50% capacity, hair salons and tattoo parlors are allowed to see customers with appointments only, and restaurants may operate at 50% capacity. Bars, gyms, theaters, casinos, playgrounds and community swimming pools remain closed. Stage 3 will mean expanding the capacity of retail stores and restaurants, and opening gyms, movie theaters, and playgrounds. Social gatherings of up to 100 people will be permitted and there will be no travel restrictions. Bars, entertainment venues, and K-12 schools will remain closed. Stage 4 will consist of opening bars and allowing for sports tournaments to resume, as well as allowing retail stores to operate at full capacity. Gatherings of 250 people or less will be permitted. Sporting events and conventions would still not be allowed. Stage 5 will mean sporting events and amusement park operations are allowed to resume, as long as social distancing practices are met. Opening K-12 schools and overnight camps will still be determined.

3) What phase of reopening is the state in? Indiana is currently in stage 2 of its reopening plan. Indiana plans to move to stage 3 on May 24, stage 4 on June 14, and stage 5 on July 4.

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IOWA

1) Status of the stay-at-home order Gov. Kim Reynolds never issued a stay-at-home order for the state of Iowa, but she has issued a series of disaster proclamations. Iowa’s state of emergency has been extended to May 28. On May 1, depending on the county, restaurants were allowed to open at 50% capacity, along with further sanitation and social distancing guidelines. As of May 8, more of Iowa’s restrictions were lifted, allowing retail stores to operate at 50% capacity, dental services to resume, campgrounds to open, and fitness centers to open to customers with appointments only. All of these establishments must maintain appropriate social distancing and sanitation measures. Right now, Iowans are allowed to gather for religious services, so long as reasonable safety measures are met.

2) What is the reopening plan? Iowa does not have a formal reopening plan, but the governor has issued 14 proclamations so far.

KANSAS

1) Status of the stay-at-home order Starting on May 4, Gov. Laura Kelly began to reopen Kansas, lifting the statewide stay-at-home order. This means gatherings of 10 people or less are allowed, libraries, retail stores, and childcare facilities are open and restaurants are allowed to operate as long as physical barriers are in place, but most establishments still remain closed.

2) What is the reopening plan? Kansas’ plan of reopening, “Ad Astra: A Plan to Reopen Kansas,” consists of four phases. Phase 1 lifts the stay-at-home order. Phase 2 allows for gatherings of 30 people or less, and reopens community centers and bars and nightclubs to operate at a 50% capacity, but summer camps and large venues are still closed. Phase 3 allows for 90 person gatherings and all education and establishments may open, and non-essential travel may resume. The last phase, “Phase Out,” allows for unrestricted travel and social distancing when applicable.

3) What phase of reopening is the state in? Currently, Kansas is in phase 1 of its reopening. It plans to enter phase 2 no sooner than May 18, which will allow bars, gyms, hair salons, barbershops, nail salons and tattoo parlors to reopen. Theaters, museums, nightclubs, and community centers will remain closed. “Phase Out” will begin no earlier than June 15.

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KENTUCKY

© Greg Eans/The Messenger-Inquirer via AP Helen Wood, a groomer at The Dapper Dog, an all-breed grooming salon, gives a trim to Gracie, a Great Pyrenees, May 11, 2020, in Owensboro, Ky.

1) Status of the stay-at-home order While Kentucky is currently still under a stay-at-home order, some businesses were allowed to reopen on Monday, May 11, including manufacturing and distribution, construction, vehicle or vessel dealerships, office based businesses, photography and pet grooming and boarding with limited capacity. Horse racing is also expected to begin, but without any spectators. On May 8, a federal judge ruled that Kentucky churches can hold in-person services starting on Sunday, May 10, despite Gov. Andy Beshear’s order barring in-person services in order to prevent the spread of COVID-19.

2) What is the reopening plan? The next step to reopening Kentucky is expected to take place on May 18 with government offices and agencies reopening and then on May 20, which will allow retail stores and funeral homes to reopen. On May 22, restaurants are allowed to open at 33% capacity, and on May 25, social gatherings of no more than 10 people will be allowed. Salons and cosmetology businesses will be allowed to reopen then too. From June 1 to July 1, further strictures are expected to be relaxed starting with bowling alleys and gyms and ending with bars and groups of 50 people.

3) What phase of reopening is the state in? Kentucky is in phase 1 of its “Healthy at Work” program.

LOUISIANA

1) Status of the stay-at-home order Gov. John Bel Edwards extended Louisiana’s stay-at-home order until May 15. As of right now, bars, casinos, personal care services, such as salons and gyms, are still closed. Restaurants are allowed for takeout, and customers going to shopping malls can only do curbside pickup.

2) What is the reopening plan? On May 11, Edwards announced that on Friday, May 15 the state will move into its first phase of reopening. The 10-person gathering restriction will be lifted, and churches, restaurants, bars coffee shops, cafes, gyms, movie theaters, casinos, museums, zoos, barbers, hair salons, and nail salons will be able to reopen at 25% capacity and must follow state social distancing and sanitation guidelines. Massage establishments, spas, tattoo parlors, and amusement parks will remain closed. There has been no announcement about further phases.

3) What phase of reopening is the state in? While Louisiana is still under a stay-at-home order, it will enter phase one on Friday.

MAINE

1) Status of the Stay at Home Order Gov. Janet Mills is opening up Maine’s economy month by month. At the beginning of May, she allowed for drive-in church services to begin, hair salons, barbershops, and dog groomers were permitted to reopen, and some outdoor activities, such as golfing and hiking, were allowed.

2) What is the reopening plan? Maine’s reopening plan, called “Restarting Maine’s Economy,” will reopen the state in phases. In June, stage 2 begins with businesses such as retail, restaurants, gyms, and nail salons are expected to reopen. Day camps and campgrounds will also be allowed to open. In July, stage 3 begins. This means bars, hotels, spas, and gyms will be allowed to operate. Stage 4 is still to be determined. There is also a rural reopening plan, which allowed retail and restaurants in certain counties “which have not experienced community transmission of the virus” to open in-store and in-dining services “with enhanced safety precautions.”

3) What phase of reopening is the state in? Maine is currently in stage 1.

MARYLAND

1) Status of the stay-at-home order Starting on May 6, Gov. Larry Hogan lifted some restrictions on his stay-at-home order, which is still in effect indefinitely, allowing Marylanders to play golf and tennis, as well as boat, fish, camp, and go to the beach, as long as social distancing is kept. Restaurants remain closed and are only available for take-out, and personal services, such as hair salons, remain closed too. Elective surgeries are allowed to be performed.

2) What is the reopening plan? Maryland’s reopening plan, “Maryland Strong: Roadmap to Recovery,” has three stages: low risk, medium risk, and high risk, and each stage has phases within them. Low risk, the first stage, will allow certain small businesses and personal services to reopen. It will also allow for limited outdoor gym and fitness classes, and religious gatherings to be held outdoors. Phase 2 will consist of raising the cap on social gatherings, and opening up restaurants, gyms and childcare facilities. Phase 3 — high-risk — will allow for larger gatherings to take place, and high-capacity bars and venues to reopen. Hogan emphasized that these stages are subject to change.

3) What phase of reopening is the state in? Maryland is not yet in its first official stage of recovery, as it remains under a stay-at-home order.

MASSACHUSETTS

1) Status of the stay-at-home order Massachusetts is still under a stay-at-home order, which is set to expire on May 18. Restaurants are only available for take-out, personal services are not open, schools remain closed, and gatherings of more than 10 people are prohibited. Wearing face masks in public is required.

2) What is the reopening plan? Gov. Charlie Baker announced on May 11 that Massachusetts will have four phases to reopening. Phase 1, “Start,” will allow limited industries that have little face-to-face interaction and to resume work with severe restrictions. Phase 2, “Cautious,” will allow additional industries to resume operations with capacity limits and further restrictions. Phase 3, “Vigilant,” will more industries to reopen. Phase 4 will be the “New Normal.” This will only happen once when a vaccine or therapy comes out. The government cautioned that poor health metrics may lead to a reversion in phases.

3) What phase of reopening is the state in? Currently, Massachusetts is in a pre-reopening phase, and remains under a stay-at-home order until May 18.

MICHIGAN

1) Status of the stay-at-home order While Gov. Gretchen Whitmer extended Michigan’s stay-at-home order until May 28, she did announce that “construction, real-estate activities, and work that is traditionally and primarily performed outdoors” could resume beginning on May 11. Auto companies were also allowed to resume work beginning May 11. Restaurants are still only open for take-out, retail shops, other than grocery stores, remain closed, and large gatherings are still prohibited. Hiking, biking, walking, golfing, and boating are permitted.

2) What is the reopening plan? Michigan has a six-phase plan for reopening, called the “Safe Start” plan. Michigan is currently in its third phase. Phase 4 will consist of allowing small gatherings and retail stores to be allowed to open with limited capacity. Phase 5, called “containing,” will mean bars and restaurants are allowed to open with limited capacity, schools will reopen, and all outdoor activities are allowed, but gatherings will still limited. The final phase will only occur when the pandemic is over, and is the governor’s “ultimate goal.” Under that phase, social distancing will be relaxed, all businesses will be allowed to open and events of all sizes will be allowed with new safety procedures.

3) What phase of reopening is the state in? Michigan is currently in its third phase, and is expected to move onto its fourth phase only when the number of new cases and deaths has fallen for a period of time. On May 15, businesses such as landscapers, lawn-service companies, hotels, bike repair and maintenance shops, and golf are expected to reopen. Non-essential retailers will also be allowed to reopen for curbside pick-up and delivery.

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MINNESOTA

© Jim Mone/AP The Southtown Starbucks Coffee business, which was closed March 20, 2020, and reopened late last week, has a “WELCOME BACK” to customers on the windows, May 11, 2020, in Bloomington, Minn,

1) Status of the stay-at-home order On April 30, Gov. Tim Walz announced that Minnesota will extend its stay-at-home order until May 18. While critical workers are still going to work if they are unable to work from home, businesses like restaurants are still only operating via take-out. Some restrictions were lifted on May 4, allowing customer-facing retail businesses to engage in curbside pick-up or delivery. The governor also issued an executive order allowing for industrial jobs that are not customer-facing to return to work as long as social distancing and sanitary procedures are in place.

2) What is the reopening plan? The state has not yet issued exact phases to reopening the economy, but the governor has issued a series of executive orders, which have lifted some restrictions on the economy.

3) What phase of reopening is the state in? Minnesota remains under a stay-at-home order, but residents can expect more restrictions to be lifted on May 18.

MISSISSIPPI

1) Status of the stay-at-home order On April 27, Gov. Tate Reeves’ stay-at-home order expired, which was replaced with a “safer-at-home” order that is in effect until May 25. As of May 7, restaurants, bars, and retail stores are allowed to open as long as they adhered to strict sanitation and social distancing rules, and they should only be operating at 50% capacity. Parks and public swimming pools were also reopened, but residents need to maintain six feet of distance between one another. Salons, bars, movie theaters, museums, and gyms will remain closed.

2) What is the reopening plan? Mississippi is opening and lifting restrictions in phases. Phase 1 opened retail stores at a limited capacity, and phase 2 consisted of reopening restaurants at a limited capacity. Reeves has not yet announced a phase 3.

3) What phase of reopening is the state in? Mississippi is in its second phase of reopening its economy.

MISSOURI

1) Status of the stay-at-home order Effective on May 4, Missouri lifted many of its restrictions with the expiration of its stay-at-home order. Now, retail stores can open to the public as long as they operate at a significantly lower capacity and restaurants are open to the public as long as social distancing measures are followed. Schools are still closed and social distancing measures must be followed at all times, regardless of location.

2) What is the reopening plan? Gov. Mike Parson’s reopening plan is called the “Show Me Strong Recovery Plan.” While many restrictions have been lifted, further phases have not yet been announced. Missouri’s state of emergency lasts through June 15.

3) What phase of reopening is the state in? Missouri is in its first phase of reopening its economy, which is expected to last until May 31.

MONTANA

1) Status of the stay-at-home order Montana’s stay-at-home order expired on April 24, allowing retail stores and religious services to open, with limited capacity. As of May 4, restaurants and bars were allowed to open, too, but needed to adhere to strict social distancing policies. Movie theaters, concert halls, gyms, and hot tubs are still closed. As of May 7, schools were given the option to return to in-person teaching.

2) What is the reopening plan? Montana is reopening in three phases. In phase 1, groups of more than 10 people are prohibited and physical distance between people is mandated. Businesses that open are supposed to close common areas and spaces. Restaurants, bars, and personal care facilities, such as salons, are allowed to open, but they must screen customers for symptoms of COVID-19 and reduce their capacity. In phase 2, gatherings of 50 people are allowed and gyms, pools, and hot tubs will be permitted to be operational. In phase 3, there is no limit to group size, and businesses can return to having a full staff. Interstate tourism and travel will be opened, but physical distancing is still recommended.

3) What phase of reopening is the state in? Montana is currently in phase 1 of reopening, and there has been no announcement yet as to when Montana will move into phase 2.

NEBRASKA

1) Status of the stay-at-home order Nebraska never had a stay-at-home order, but it is still easing into reopening its economy. For the month of May, Gov. Pete Ricketts is encouraging his constituents to stay home, socially distance at work, shop alone and only once a week, and socially distance from one another while out of their homes. As of May 4, places of worship no longer have a 10-person limit, but families must physically distance themselves from one another.

2) What is the reopening plan? Nebraska’s reopening plan, “Steps to Get Nebraska Growing,” consists of various directive health measures being issued county-by-county. Depending on the county, beauty salons, tattoo parlors and massage services were allowed to open so long as everyone was wearing a mask, on May 4. Many restaurants were also allowed to reopen then, but must operate at 50% of their occupancy maximum. Child care facilities will also be allowed to have 15 kids at a time. Additional counties were allowed to reopen businesses on May 11.

3) What phase of reopening is the state in? Ricketts does not have specific phases of reopening, but he has begun to lift restrictions. He has not yet announced when further restrictions will be eased.

NEVADA

© Ethan Miller/Getty Images Maintenance contractor Tod Brandenburg measures six-foot distances between tables as he sets up a patio area at Kona Grill in Boca Park Fashion Village, May 9, 2020, in Las Vegas, Nevada.

1) Status of the stay-at-home order While Nevada’s stay-at-home order is in effect until May 15, it entered Phase 1 of its reopening plan on May 9.

2) What is the reopening plan? Nevada’s reopening plan, “Roadmap to Recovery,” will consist of phases. Phase 1, which began on May 9, will last until May 30. It will allow for non-essential businesses to reopen with strict restrictions. Dine-in restaurants were allowed to reopen, but can only maintain 50% capacity and employees must wear face masks. This does not include casino restaurants. Hair salons and nail salons are allowed to reopen, but must have partitions between stations and proper social distancing standards. Retail stores can open but must maintain 50% of fire code capacity. Outdoor malls are allowed to reopen. Indoor malls are closed to the public but can implement a curbside pickup system. Gatherings of up to 10 people are allowed, but people are encouraged to stay home. However, businesses like bars, nightclubs, gyms, movie theaters, strip clubs, sporting venues, and gaming establishments will remain closed. Restrictions on non-essential travel will remain in place. The state has announced that in the next phase of reopening, businesses will still face restrictions, but regulations will be loosened.

3) What phase of reopening is the state in? Nevada is now in phase 1 of its reopening plan, and will not move onto phase 2 for at least three weeks. In order to move to the next phase, certain public health requirements need to be met.

NEW HAMPSHIRE

1) Status of the stay-at-home order While the state’s first stay-at-home order ended, Gov. Chris Sununu announced a new executive order, Stay at Home 2.0, which will remain in effect until May 31. Right now, as long as facilities have enough personal protective equipment, elective medical procedures are allowed to resume. Starting on May 1, manufacturing facilities, campgrounds, and state parks were allowed to reopen, but with strict social distancing measures in place.

2) What is the reopening plan? During the month of May, New Hampshire’s businesses will reopen in phases. On May 11, hair salons and barber shops, as well as drive-in theaters, retail shops, and golf courses were allowed to open, but with strict measures in place. Retail stores must operate at 50% capacity. On May 18, restaurants are allowed to re-open for outdoor seating only, and distancing and sanitation measures must be in place. Beaches, gyms, theaters, and schools remain closed.

3) What phase of reopening is the state in? New Hampshire is currently in phase 1 of its reopening plan, which consists of various reopening dates in May, but it has not yet announced when phase two will begin.

NEW JERSEY

1) Status of the stay-at-home order New Jersey’s stay-at-home order remains in place until further notice. Gov. Phil Murphy announced the reopening plan – “The Road Back: Restoring Economic Health through Public Health” on April 27, which aims to loosen restrictions as certain public health milestones are achieved. Restaurants are still open for take-out, schools are still closed and social distancing measures are in place across the state.

2) What is the reopening plan? While there has been no announcement of a reopening timeline, Murphy has reopened beaches and state parks with social distancing restrictions.

3) What phase of reopening is the state in? New Jersey is in its pre-reopening phase, and has not yet announced when an official reopening date will occur. Reopening the state depends on certain public health criteria, including a 14-day decline in COVID-19 cases and hospitalizations.

NEW MEXICO

1) Status of the stay-at-home order New Mexico’s stay at home restrictions were modified on April 30, with an extension of the state’s stay-at-home order in place until May 15.The restrictions in place require New Mexicans to remain at home except for outings essential to health, safety and welfare. Restaurants and dine-in outlets may only provide curbside and delivery service as before.

2) What is the reopening plan? While most restrictions remain in place, as of May 1 non-essential retailers may provide curbside pickup and delivery services. Pet services and state parks are allowed to reopen with limitations and golf courses are open now too. Gun stores are permitted to operate, but only by appointment. However, gatherings of more than five individuals are prohibited, and grocers and other essential retail service must continue to operate at 20% maximum capacity. Gov. Michelle Lujan Grisham has announced that there will be four phases to reopening: the preparation phase, which the state will be in until Mid-May. Phase one, which is anticipated to begin in mid-May will allow all retailers to operate under 20% capacity, restaurants to have dine-in services at 50% capacity, gyms, hotels, and houses of worship can operate as long as they continue following health guidelines. Theaters, casinos, mass gatherings, and vacation rentals are still closed. Phase 2, which is expected to begin in early June will allow theaters, bars and casinos to operate under sanitation and social distancing guidelines. Mass gatherings, such as concerts or large events, are still prohibited. Phase three, expected to begin in early July if New Mexicans continue practicing social distancing, will allow schools to reopen by August. Mass gatherings larger than 100 people is still prohibited, and spectator sports and concerts will be permitted with modifications.

3) What phase of reopening is the state in? New Mexico is currently in its preparation phase for reopening its economy. In a press release, the governor said New Mexico will not move to the next phase of reopening until the spread of the virus is mitigated.

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NEW YORK

© Jeenah Moon/Getty Images A woman holds flowers inside a bodega on May 10, 2020 in New York City.

1) Status of the stay-at-home order New York’s stay-at-home order, “PAUSE,” remains in place until May 15, with restaurants still operating under a take-out only policy, gyms still closed and social distancing restrictions in full force.

2) What is the reopening plan? Gov. Andrew Cuomo’s “New York Forward” plan is divided into four phases. Phase 1 includes construction, manufacturing and retail for curbside pickup. It will also allow agriculture, fishing and forestry. For regions to move into phase 1, they must meet seven metrics, including a decline in hospitalizations and increase in contact tracing. Phase 2 includes professional services, such as finance, insurance, retail, administrative support, and real estate businesses to reopen. Phase 3 includes restaurants and food service, with the final phase, Phase 4, opening the remaining arts, entertainment, recreation and educational sectors.

3) What phase of reopening is the state in? New York is still under its stay-at-home order and reopening will occur by region and industry based on whether certain metrics are met. Phase 1 is expected to begin on May 15 for three upstate regions.

NORTH CAROLINA

1) Status of the stay-at-home order North Carolina’s stay-at-home order is still in effect, but the state moved into its first phase of reopening on May 8. The state is beginning to ease restrictions as it enters phase 1 of reopening its economy. Bars, movie theaters, restaurants, bowling alleys, salons, and gyms are still closed.

2) What is the reopening plan? Gov. Roy Cooper’s “North Carolina: Staying Ahead of the Curve” plan allows for some retail businesses and services – with social distancing and cleaning measures in place – to reopen in phase 1. Parks have also reopened, and gatherings of 10 people or less are allowed. Phase 2, expected within two to three weeks after phase one, lifts the stay at home order and brings limited opening of restaurants, bars, and other businesses as well as an increased limit on social gatherings numbers. Phase 3, the final stage, will allow for further decreased restrictions and is expected four to six weeks after phase two begins. The state can move to a previous phase if infection spike.

3) What phase of reopening is the state in? North Carolina is in phase 1 of its three-phase plan of reopening, but the stay-at-home order remains in effect until phase 2 begins.

NORTH DAKOTA

1) Status of the stay-at-home order While North Dakota never had a stay-at-home order, schools will remain closed for the rest of the school year. Many businesses, such as bars, restaurants, recreational facilities, gyms, salons, and movie theaters, were allowed to open with restrictive measures in place.

2) What is the reopening plan? Gov. Doug Burgum’s “ND Smart Restart” plan has allowed certain businesses to reopen. In an executive order, he allowed salons, barbershops, massage therapy services, athletic facilities, and movie theaters to reopen on May 1, and strongly advised them to follow the health and safety standards issued by the state which consisted of limited capacity and social distancing guidelines. Burgum has not yet announced when his next executive order lifting more restrictions will take place.

3) What phase of reopening is the state in? Even though North Dakota did not have a stay-at-home order, many of its businesses were forced to shut down. It is in the beginning stages of reopening its economy.

OHIO

1) Status of the stay-at-home order Ohio’s “Stay Healthy and Safe at Home Order” is in effect until May 29, but restrictions have been lifted. Residents of Ohio can now go visit their doctors, and offices, manufacturing, and construction work resumed as of May 4th.

2) What is the reopening plan? Gov. Mike DeWine’s “Responsible Restart Ohio” plan allows for partial reopening in phases. The next phase began May 12, when consumer and retail services were allowed to reopen pursuant to the mandatory safety requirements for customers and employees set by the state. Schools, dine-in restaurants, bars, beauty businesses, entertainment venues, and gyms remain closed. DeWine has not yet announced when the next phase of his plan will begin.

3) What phase of reopening is the state in? While Gov. DeWine encourages constituents to remain at home, but he is beginning the early stages or reopening the economy as some businesses begin to reopen with extensive social distancing measures in place.

OKLAHOMA

1) Status of the stay-at-home order Oklahoma has been lifting restrictions since April 24, and most retail establishments were eligible to resume operations by May 1 with restrictions in place for consumer safety.

2) What is the reopening plan? Under Gov. Kevin Skitt’s “Open Up & Recover Safely (OURS) Plan,” Oklahoma has three phases to reopening. Phase 1 consisted of two parts — opening personal care businesses on April 24 and opening up dining, gyms, theaters, and sporting venues on May 1, all of which need to adhere to CDC guidelines. Places of worship are also open, as long as every other pew is left empty to allow for social distancing. Bars will remain closed. Phase 2, which is expected to begin on May 15, will allow non-essential travel to resume, bars to reopen at limited capacity and organized sporting events, funerals and weddings to take place. Phase 3 is set to begin on June 1, and is Oklahoma’s final step in the reopening plan. It will allow for unrestricted staffing at work sites and for summer camps to reopen.

3) What phase of reopening is the state in? Oklahoma is currently in phase 1 of its reopening plan.

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OREGON

1) Status of the stay-at-home order Oregon’s “Stay Home, Save Lives,” order was extended indefinitely by Gov. Kate Brown. However, some restrictions can be lifted county-by-county in her “Building a Safe and Strong Oregon” reopening plan.

2) What is the reopening plan? According to the reopening plan, there will be no statewide reopening. Instead, counties will have to submit an application to move into phase 1, and those applications will be processed by the state using metrics such as reduction in cases, contact tracing, and hospital visits. Counties were able to apply for phase 1 starting on May 8 and will not be eligible to open up until Friday, May 15. A county has to stay in phase 1 for at least 21 days before it can apply for phase 2. Phase 1 will include restaurants and bars opening for sit-down services with adequate physical distancing and mandatory facemasks for employees. Personal care facilities, like salons, will open in a limited way with physical distancing. Retail stores are also allowed to open, but must maintain physical distancing and have one-way flows down aisles. Gatherings of up to 25 people are allowed, but physical distancing is still mandatory. Details of phase 2 are still being finalized, but will likely include increased gathering size, some office work and visits to long-term care facilities. The highest-risk activities, grouped under phase 3, such as live sporting events, festivals, and conventions will not return until there is a reliable treatment or vaccines, and large gatherings through September should be cancelled or modified.

3) What phase of reopening is the state in? Oregon is currently in a pre-phase of opening, and is expected to take its first step in reopening the economy on May 15.

PENNSYLVANIA

1) Status of the stay-at-home order As of May 8, Pennsylvania’s stay-at-home order has been lifted, and many counties began to move into phase 2 of the state’s reopening plan.

2) What is the reopening plan? Pennsylvania has three color-coded stages to reopening. “Red” means the say-at-home order is still in effect. But for many rural counties, the second phase, “Yellow,” began on May 8. For many northwest and north-central regions the “Red” stage lapsed with the expiration of the stay-at-home order. The “Yellow” stage will allow for some in-person retail stores to reopen with social distancing measures in place, and gatherings of less than 25 people will be allowed. Restaurants and bars will remain take-out only, and gyms, wellness facilities, and personal care services such as hair salons will remain closed. Theaters and casinos will also remain closed. The final stage – “Green” – has yet to be announced. However, some counties in Pennsylvania did not move into the “Yellow” phase – the counties that remain in the “Red” phase are under a stay-at-home order until June 4.

3) What phase of reopening is the state in? As of Friday, much of Pennsylvania entered its second phase of reopening.

PUERTO RICO

1) Status of the stay-at-home order Puerto Rico’s statewide curfew was extended until May 25, which is in effect from 7 p.m. to 5 a.m. Right now, the finance and real estate sectors are open, and on May 11, the construction and manufacturing sectors were allowed to reopen too. Parks, gyms, and beaches remain closed. People are allowed to run, bike, and walk their dogs from 5 a.m. to 3 p.m.

2) What is the reopening plan? Gov. Wanda Vazquez is expected to allow laundromats, moving services, retail trade, barbershops, and beauty salons to reopen soon.

3) What phase of reopening is the state in? Puerto Rico has begun to lift restrictions, but has not yet made announcement on when the next restrictions will be lifted.

RHODE ISLAND

1) Status of the stay-at-home order Rhode Island’s stay-at-home order expired on May 8 as the state entered its first phase of reopening.

2) What is the reopening plan? Gov. Gina Raimondo announced that her plan for “Reopening RI: Charting the Course” began on May 9. In phase 1, titled “Testing the Water,” the state will loosen some restrictions on businesses and social activity. Under that phase, elective medical procedures may resume, childcare options will be available, and retail locations will be allowed to reopen for in-store pickup. Most restaurants will remain take-out only, but some pilot programs will begin, allowing for some outdoor seating. Hair salons and barber shops will also begin opening, but with limited seating and significant restrictions. Manufacturing will remain open while schools will remain closed. There is no set timeline to begin either “Phase Two: Navigating Our Way” or “Phase Three: Picking Up Speed” – both of which will ease restrictions and reopen more businesses.

3) What phase of reopening is the state in? Rhode Island is currently in phase 1 of its reopening plan.

SOUTH CAROLINA

1) Status of the stay-at-home order While South Carolina Gov. Henry McMaster has been lifting restrictions since late April, he modified his “Work or Home” order on May 4, allowing the state to move into its first phase of reopening. Right now, businesses like department stores, home improvement stores, and book stores have reopened and are following state guidelines, and beaches are now open too, as long as residents follow CDC guidelines and remain physically distant from one another.

2) What is the reopening plan? South Carolina is officially in its first phase of the “Accelerate South Carolina” reopening plan. Phase 1 opened up the economy by allowing outdoor dining services for restaurants, with restrictions in place that follow physical distancing requirements, retail stores to reopen with 20% capacity, and businesses like laundromats, post offices, and day cares to reopen too.

3) What phase of reopening is the state in? The plan is now in phase 1, with no specific timeline announced for phases 2 and 3 at this time. Tattoo parlors, hair and nail salons, spas, theaters, gyms, museums, bars and stadiums remain closed at this time.

SOUTH DAKOTA

1) Status of the stay-at-home order Gov. Kristi Noem never issued a stay-at-home order for South Dakota, but the state is beginning to reopen its economy. As of April 28, businesses have been reopening.

2) What is the reopening plan? Noem signed an executive order to start her “Back to Normal” plan on April 28, which allowed businesses to reopen as long as they could follow social distancing norms, sanitation, and good hygiene. Telework will begin to slow as workers go back into the office and schools will continue to operate from home.

3) What phase of reopening is the state in? While South Dakota has begun to operate under this “Back to Normal” plan, the governor has not announced if there are any further steps.

MORE: Meat plant workers concerned over increase in COVID-19 cases

TENNESSEE

1) Status of the stay-at-home order Tennessee’s stay-at-home order expired April 30, with the majority of counties in the state reopening under social distancing restrictions on May 1. Outdoor recreation, restaurants, retail and personal care businesses were all included in the first stage of the reopening plan, and must operate with social distancing and sanitation in mind.

2) What is the reopening plan? Gov. Bill Lee’s reopening plan, the “Tennessee Pledge,” encourages all opened establishments to follow CDC and OSHA guidelines to protect consumers and employees, such as wearing masks and screening employees reporting for work for COVID-19 symptoms. Restaurants must operate with 50% capacity, and exercise facilities must do the same. There has been no announcement yet of what phase 2 of the plan will look like.

3) What phase of reopening is the state in? Tennessee is in phase 1 of its reopening plan.

MORE:Teacher who went viral for memorizing 75 handshakes beats COVID-19

TEXAS

© Sergio Flores/AFP via Getty Images A worker paints a woman’s nails at a nail salon amid the coronavirus pandemic in Austin, Texas, May 8, 2020, following a slow reopening of the Texas economy.

1) Status of the stay-at-home order Texas’ stay-at-home order ended April 30. Gov. Greg Abbott allowed retail stores, restaurants, movie theaters, malls, and museums to operate at 25% capacity starting May 1, saying businesses should operate with social distancing and sanitation measures in mind.

2) What is the reopening plan? Under Abbott’s “Open Texas” plan, personal care businesses such as barbershops, hair salons, and tanning salons were allowed to resume operations starting on May 8. Gyms and exercise facilities, manufacturers, and offices are permitted to reopen on May 18, and must keep social distancing and sanitation requirements in mind. There have been no further announcements of how Texas will further ease restrictions. Public swimming pools, bars, interactive amusement venues, such as bowling alleys, and tattoo parlors remain closed.

3) What phase of reopening is the state in? Texas is in phase 2 of its reopening plan.

UTAH

1) Status of the stay-at-home order While Utah never issued a stay-at home order, business operations for gyms and dine-in restaurants were closed, and there were strict limitations on the personal service, retail, events and entertainments industries. But starting May 1, Utah began to lift some of its restrictions, allowing for previously closed businesses, such as dine-in restaurants, hair salons, malls, and national parks, to reopen under tight restrictions.

2) What is the reopening plan? Utah’s plan to reopen has three stages: urgent, stabilization and begin recovery. As of May 1st, Utah entered into the stabilization phase, which is expected to last until the fall. Depending on the risk level for each business and the community it is operating within, restrictions will either be placed or lifted. Schools and churches remain closed.

3) What phase of reopening is the state in? Utah is currently in its second phase of reopening the economy, and it is predicting to not enter the next phase for several months.

VERMONT

1) Status of the stay-at-home order While Vermont’s stay at home order is in force until May 15, as of May 6 Vermonters can socialize in small groups and participate in outdoor activities, while all but essential businesses remain closed. Restaurants are still take-out only, and schools and gyms remain closed.

2) What is the reopening plan? Gov. Scott’s “Play Smart and Play Safe” plan to reopen the state now allows people to gather in groups of 10 or fewer and elective health care procedures are able to resume. Manufacturing, construction, and distribution businesses can operate with 10 people or less. Outdoor retailers can operate, as long as 10 people or less are present and social distancing measures are in place. The plan does not indicate what is to come in later phases, but indicates that a further loosening of restrictions may be expected soon. Child care centers are expected to open on June 1.

3) What phase of reopening is the state in? Vermont is in its first phase of reopening.

VIRGINIA

1) Status of the stay-at-home order While Virginia’s stay-at-home-order is in effect until June 10, Gov. Ralph Northam has begun to lift some restrictions, and is expected to lift more soon. Under the current regulations, Virginia has resumed elective medical procedures and reopened dentist offices to non-emergency appointments. Beaches and parks reopen for the purpose of socially-distant exercise, and restaurants and bars remain closed for dining-in purposes.

2) What is the reopening plan? Northam’s “Forward Virginia Plan” has three phases. Under phase 1 of the reopening, set to begin on May 15 at the earliest, some businesses, such as retailers or personal care businesses, which were required to close will be allowed to reopen as long as they adhere to CDC guidelines. However, Northam has made it clear that they will be placed under extreme limits like operating at half-capacity. Churches can resume church services, but must also remain at 50% capacity. Movie theaters and indoor gyms will remain closed, and restaurants are only allowed to reopen if they offer outdoor seating. Outdoor fitness classes are allowed to resume too. The state’s rule on prohibiting gatherings of more than 10 people will remain in effect until June 10. Northam said phase 2 would not happen for at least two weeks after moving into phase 1, and further details of phases 2 and 3 have not been provided at this time. While much of Virginia is set to enter phase 1 on May 15, Northam announced that much of Northern Virginia will remain under a stay-at-home order.

3) What phase of reopening is the state in? Virginia is still under a stay-at-home order, and is still in its pre-phase 1 planning stages of reopening.

MORE: State of food supply chain as meat processing plants struggle

WASHINGTON

1) Status of the stay-at-home order While Washington’s “Stay at Home, Stay Healthy” order is set to expire May 31, Gov. Jay Inslee has made moves to begin to reopen the economy. Before, only essential activities and socially distant exercises were permitted, but Inslee eased some restrictions on May 8. Gyms, most dine-in restaurants, and entertainment venues are still closed.

2) What is the reopening plan? Under Gov. Inslee’s “Safe Start” Plan, currently in Phase 1, construction, vehicle sales, spiritual drive-in services and car washes are allowed to operate with restrictions. Retail curb-side pick-up orders and landscaping businesses were allowed to reopen, and pet walkers were allowed to restart their businesses. Non-urgent medical procedures can and drive-in spiritual services can resume too. Phase 2 allows gatherings of no more than 5 people, construction, retail with restriction, professional services and restaurants with less than 50% capacity. Washington has four phases to reopening.

3) What phase of reopening is the state in? Washington is in phase 1 of its reopening plan with the exception of some small counties with no COVID cases that were allowed to enter into phase 2.

WEST VIRGINIA

1) Status of the stay-at-home order West Virginia’s stay-at-home order was replaced with a “Safer at Home” order on May 4, which encourages – but does not require – residents to stay at home.

2) What is the reopening plan? Gov. Jim Justice has released his reopening plan, “West Virginia Strong – The Comeback.” The state is now in Week 3 of the plan, as small businesses with 10 or fewer employees, restaurants with takeaway service or outdoor seating, religious services, pet groomers, funeral homes, and barbershops are permitted to open. Many outpatient healthcare facilities are also allowed to reopen. Week 3 commenced on May 11, which allowed the addition of wellness centers and drive-in movie theaters to reopen. In the coming weeks, a greater relaxation of restrictions is expected. Week 4 will allow indoor dining at restaurants, large specialty retail stores and a range of outdoor activities. The final week, beginning Monday June 8, will allow low-contact youth sports.

3) What phase of reopening is the state in? West Virginia is in Week 3 of its reopening plan.

WISCONSIN

1) Status of the stay-at-home order Wisconsin’s “Safer at Home” order was extended to May 26. While essential businesses may remain open with strict social distancing and sanitation guidelines in place, Gov. Tony Evers has begun lifting restrictions on other businesses too. Right now, golf courses are open, all businesses and libraries are open to curbside pickup, single-worker construction and landscaping jobs can resume, and dog groomers can also reopen their businesses.

2) What is the reopening plan? Evers announced the “Badger Bounce Back” program for reopening the state in phases. Phase 1, after the Safer at Home order expires, will include allowing gatherings up to 10 people, restaurants opening with social distancing requirements, the reopening of in-person K-12 schooling and childcare operations. Phase 2 will expand the restrictions up to 50 people, allow restaurants to open with full operations, and allow bars and other non-essential businesses to reopen with social distancing measures in place. Post-secondary education institutions can resume in-person operations too. Phase 3 will see a resuming of all business activity and gatherings with minimal protective measures.

3) What phase of reopening is the state in? Wisconsin has not yet entered its first phase of reopening its economy.

WYOMING

1) Status of the stay-at-home order While Wyoming never issued a stay-at-home order, Gov. Mark Gordon announced easing of restrictions on May 1. Now, gyms, barbershops, hair salons, and other personal care services can resume operations with proper sanitation and social distancing restrictions in place. Gatherings of more than 10 people are still prohibited.

2) What is the reopening plan? Restrictions vary by country, and each county can propose its own modifications to the states requirements as it sees fit.Gordon stated that bars and restaurants are likely able to reopen indoor dining facilities soon.

3) What phase of reopening is the state in? Wyoming is in its first phase to reopening its economy.

What to know about coronavirus:

References:

www.cdc.com

www.msn.com

www.webmd.com

www.enzbox.com

www.kidneynest.com

www.nih.com

www.cms.com

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Therapy Tratment for covid -19 patients , Increase lung capacity , helps in Shortness of breath.
Chest physical therapy is the term for a group of treatments designed to improve respiratory efficiency, promote expansion of the lungs, strengthen respiratory muscles, and eliminate secretions from the respiratory system.
Purpose

The purpose of chest physical therapy, also called chest physiotherapy, is to help patients breathe more freely and to get more oxygen into the body. Chest physical therapy includes postural drainage, chest percussion, chest vibration, turning, deep breathing exercises, and coughing. It is usually done in conjunction with other treatments to rid the airways of secretions. These other treatments include suctioning, nebulizer treatments, and the administration of expectorant drugs.

Chest physical therapy can be used with newborns, infants, children, and adults. People who benefit from chest physical therapy exhibit a wide range of problems that make it difficult to clear secretions from their lungs. Some people who may receive chest physical therapy include people with cystic fibrosis or neuromuscular diseases like Guillain-Barré syndrome, progressive muscle weakness (myasthenia gravis), or tetanus. People with lung diseases such as bronchitis, pneumonia, or chronic obstructive pulmonary disease (COPD) also benefit from chest physical therapy. People who are likely to aspirate their mucous secretions because of diseases such as cerebral palsy or muscular dystrophy also receive chest physical therapy, as do some people who are bedridden, confined to a wheelchair, or who cannot breathe deeply because of postoperative pain.
Precautions
Contraindications for chest physical therapy :

bleeding from the lungs
neck or head injuries
fractured ribs
collapsed lungs
damaged chest walls
tuberculosis
acute asthma
recent heart attack
pulmonary embolism
lung abscess
active hemorrhage
some spine injuries
recent surgery, open wounds, or burns

Chest physical therapy can be performed in a variety of settings including critical care units, hospitals, nursing homes, outpatient clinics, and at the patient’s home. Depending on the circumstances, chest physical therapy may be performed by anyone from a respiratory care therapist to a trained member of the patient’s family. Different patient conditions warrant different levels of training.

Chest physical therapy consists of a variety of procedures that are applied depending on the patient’s health and condition. Hospitalized patients are reevaluated frequently to establish which procedures are most effective and best tolerated. Patients receiving long term chest physical therapy are reevaluated about every three months.
Turning

Turning from side to side permits lung expansion. Patients may turn themselves or be turned by a caregiver. The head of the bed is also elevated to promote drainage if the patient can tolerate this position. Critically ill patients and those dependent on mechanical respiration are turned once every one to two hours around the clock.
Coughing

Coughing helps break up secretions in the lungs so that the mucus can be suctioned out or expectorated. Patients sit upright and inhale deeply through the nose. They then exhale in short puffs or coughs. Coughing is repeated several times a day.
Deep breathing

Deep breathing helps expand the lungs and forces better distribution of the air into all sections of the lung. The patient either sits in a chair or sits upright in bed and inhales, pushing the abdomen out to force maximum amounts of air into the lung. The abdomen is then contracted, and the patient exhales. Deep breathing exercises are done several times each day for short periods.
Postural drainage

Postural drainage uses the force of gravity to assist in effectively draining secretions from the lungs and into the central airway where they can either be coughed up or suctioned out. The patient is placed in a head or chest down position and is kept in this position for up to 15 minutes. Critical care patients and those depending on mechanical ventilation receive postural drainage therapy four to six times daily. Percussion and vibration may be performed in conjunction with postural drainage.
Percussion

Percussion is rhythmically striking the chest wall with cupped hands. It is also called cupping, clapping, or tapotement. The purpose of percussion is to break up thick secretions in the lungs so that they can be more easily removed. Percussion is performed on each lung segment for one to two minutes at a time.
Vibration

As with percussion, the purpose of vibration is to help break up lung secretions. Vibration can be either mechanical or manual. It is performed as the patient breathes deeply. When done manually, the person performing the vibration places his or her hands against the patient’s chest and creates vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. The procedure is repeated several times each day for about five exhalations.
Preparation

The only preparation needed for chest physical therapy is an evaluation of the patient’s condition and determination of which chest physical therapy techniques would be most beneficial.
Aftercare

Patients practice oral hygiene procedures to lessen the bad taste or odor of the secretions they spit out.
Key terms

Coughing — Coughing helps break up secretions in the lungs so that the mucus can be suctioned out or expectorated. Patients sit upright and inhale deeply through the nose. They then exhale in short puffs or coughs. Coughing is repeated several times per day.

Deep breathing — Deep breathing helps expand the lungs and forces better distribution of the air into all sections of the lung. The patient either sits in a chair or sits upright in bed and inhales, pushing the abdomen out to force maximum amounts of air into the lung. The abdomen is then contracted, and the patient exhales. Deep breathing exercises are done several times each day for short periods.

Percussion — This consists of rhythmically striking the chest wall with cupped hands. It is also called cupping, clapping, or tapotement. The purpose of percussion is to break up thick secretions in the lungs so that they can be more easily removed. Percussion is performed on each lung segment for one to two minutes at a time.

Postural drainage — This technique uses the force of gravity to assist in effectively draining secretions from the lungs and into the central airway where they can either be coughed up or suctioned out. The patient is placed in a head or chest down position and is kept in this position for up to 15 minutes. Critical care patients and those depending on mechanical ventilation receive postural drainage therapy four to six times daily. Percussion and vibration may be performed in conjunction with postural drainage.

Turning — Turning from side to side permits lung expansion. Patients may turn themselves or be turned by a caregiver. The head of the bed is also elevated to promote drainage if the patient can tolerate this position. Critically ill patients and those dependent on mechanical respiration are turned once every one to two hours around the clock.

Vibration — The purpose of vibration is to help break up lung secretions. Vibration can be either mechanical or manual. It is performed as the patient breathes deeply. When done manually, the person performing the vibration places his or her hands against the patient’s chest and creates vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. The procedure is repeated several times each day for about five exhalations.
Risks

Risks and complications associated with chest physical therapy depend on the health of the patient. Although chest physical therapy usually poses few problems, in some patients it may cause

oxygen deficiency if the head is kept lowered for drainage
increased intracranial pressure

temporary low blood pressure
bleeding in the lungs
pain or injury to the ribs, muscles, or spine
vomiting
inhaling secretions into the lungs
heart irregularities

Normal Values

The patient is considered to be responding positively to chest physical therapy if some, but not necessarily all, of these changes occur:

increased volume of sputum secretions
changes in breath sounds
improved vital signs
improved chest x ray
increased oxygen in the blood as measured by arterial blood gas values
patient reports of eased breathing

Resources
O

Cystic Fibrosis Foundation. 6931 Arlington Road, Bethesda, MD 20814. (800) 344-4823. http://www.cff.org.

Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
physical

[fiz´ĭ-kal]

pertaining to the body, to material things, or to physics.

physical fitness a state of physiologic well being that is achieved through a combination of good diet, regular physical exercise, and other practices that promote good health.

physical therapist a rehabilitation professional who promotes optimal health and functional independence through the application of scientific principles to prevent, identify, assess, correct, or alleviate acute or chronic movement dysfunction, physical disability, or pain. A physical therapist is a graduate of a physical therapy program approved by a nationally recognized accrediting body or has achieved the documented equivalent in education, training, or experience; in addition, the therapist must meet any current legal requirements of licensure or registration and be currently competent in the field.

Persons wishing to practice as qualified physical therapists must be licensed. All 50 states of the United States, the District of Columbia, and the Commonwealth of Puerto Rico require such licensure. All applicants for licensure must have a degree or certificate from an accredited physical therapy educational program. To qualify for licensure they must pass a state licensure examination.

Physical therapy assistants and aides work under the supervision of professional physical therapists. Training requirements for physical therapy assistants are not uniform throughout the United States. In 39 of the states licensure is available to graduates of an accredited two-year associate degree program; some require the passing of a written examination. Physical therapy aides can qualify for that position by training on the job in hospitals and other health care facilities.

Further information about the curriculum for physical therapists and physical therapist assistants, available programs of study, requirements for practice, and other relevant information can be obtained by contacting the American Physical Therapy Association, 1111 N. Fairfax St., Alexandria, VA 22314, telephone (703) 684–2782.

physical therapy the profession practiced by licensed physical therapists. According to guidelines published by the American Physical Therapy Association, physical therapy should be defined as the examination, treatment, and instruction of persons in order to detect, assess, prevent, correct, alleviate, and limit physical disability and bodily malfunction. The practice of physical therapy includes the administration, interpretation, and evaluation of tests and measurements of bodily functions and structures and the planning, administration, evaluation, and modification of treatment and instruction, including the use of physical measures, activities, and devices, for preventive and therapeutic purposes. Additionally, it provides consultative, educational, and other advisory services for the purpose of reducing the incidence and severity of physical disability, bodily malfunction, movement dysfunction, and pain.

chest physical therapy a form of respiratory therapy in which the patient is positioned to facilitate removal of secretions (postural drainage) and the chest wall is clapped to help loosen the secretions (percussion).
therapy

[ther´ah-pe]

activity therapy in the nursing interventions classification, a nursing intervention defined as the prescription of and assistance with specific physical, cognitive, social, and spiritual activities to increase the range, frequency, or duration of an individual’s (or group’s) activity.

animal-assisted therapy in the nursing interventions classification, a nursing intervention defined as the purposeful use of animals to provide affection, attention, diversion, and relaxation.

antiplatelet therapy the use of platelet inhibitors such as aspirin, dipyridamole, or sulfinpyrazone, to inhibit platelet adhesion or aggregation and so prevent thrombosis, alter the course of atherosclerosis, or prolong vascular graft patency.

art therapy in the nursing interventions classification, a nursing intervention defined as facilitation of communication through drawings or other art forms.

aversion therapy (aversive therapy) a form of behavior therapy that uses aversive conditioning, pairing undesirable behavior or symptoms with unpleasant stimulation in order to reduce or eliminate the behavior of symptoms. The term is sometimes used synonymously with aversive conditioning.

client-centered therapy a form of psychotherapy in which the emphasis is on the patient’s self-discovery, interpretation, conflict resolution, and reorganization of values and life approach, which are enabled by the warm, nondirective, unconditionally accepting support of the therapist, who reflects and clarifies the patient’s discoveries.

cognitive therapy (cognitive-behavioral therapy) a directive form of psychotherapy based on the theory that emotional problems result from distorted attitudes and ways of thinking that can be corrected. Using techniques drawn in part from behavior therapy, the therapist actively seeks to guide the patient in altering or revising negative or erroneous perceptions and attitudes.

collapse therapy a formerly common treatment for pulmonary tuberculosis in which the diseased lung was collapsed in order to immobilize it and allow it to rest. pneumonolysis and thoracoplasty are methods still sometimes used to collapse a lung and allow access during thoracic surgery.

continuous renal replacement therapy hemodialysis or hemofiltration done 24 hours a day for an extended period, usually in a critically ill patient.

convulsive therapy treatment of mental disorders, primarily depression, by induction of convulsions. The type almost universally used now is electroconvulsive therapy (ECT), in which the convulsions are induced by electric current. In the past, drugs were sometimes used.

diet therapy treatment of disease by regulation of the diet.

estrogen replacement therapy administration of an estrogen to treat estrogen deficiency, such as that occurring after menopause; there are a number of indications, including the prevention of postmenopausal osteoporosis and coronary artery disease, and the prevention and treatment of vasomotor symptoms such as hot flashes and of thinning of the skin and vaginal epithelium, atrophic vaginitis, and vulvar atrophy. In women with a uterus, a progestational agent is usually included to prevent endometrial hyperplasia. Called also hormone replacement therapy.

exercise therapy: ambulation in the nursing interventions classification, a nursing intervention defined as promotion of and assistance with walking to maintain or restore autonomic and voluntary body functions during treatment and recovery from illness or injury.

exercise therapy: balance in the nursing interventions classification, a nursing intervention defined as use of specific activities, postures, and movements to maintain, enhance, or restore balance.

exercise therapy: joint mobility in the nursing interventions classification, a nursing intervention defined as the use of active or passive body movement to maintain or restore joint flexibility.

exercise therapy: muscle control in the nursing interventions classification, a nursing intervention defined as the use of specific activity or exercise protocols to enhance or restore controlled body movement.

family therapy

  1. group therapy of the members of a family, exploring and improving family relationships and processes, understanding and modifying home influences that contribute to mental disorder in one or more family members, and improving communication and collective, constructive methods of problem-solving.
  2. in the nursing interventions classification, a nursing intervention defined as assisting family members to move their family toward a more productive way of living.

hemodialysis therapy in the nursing interventions classification, a nursing intervention defined as management of extracorporeal passage of the patient’s blood through a hemodialyzer. See also hemodialysis.

hemofiltration therapy in the nursing interventions classification, a nursing intervention defined as cleansing of acutely ill patient’s blood via a hemofilter controlled by the patient’s hydrostatic pressure. See also hemofiltration.

hormone replacement therapy the administration of hormones to correct a deficiency; usually used to denote estrogen replacement therapy occurring after menopause.

host modulating therapy efforts to control periodontal disease by directly targeting the host response; an example is the use of drugs that do this, such as sub-antimicrobial doses of doxycycline, nonsteroidal antiinflammatory drugs, or bisphosphonates.

humidification therapy (humidity therapy) the therapeutic use of air supersaturated with water to prevent or correct a moisture deficit in the respiratory tract; see also humidity therapy.

inhalation therapy the term formerly used for respiratory care (def. 3).

intravenous therapy (IV therapy) in the nursing interventions classification, a nursing intervention defined as administration and monitoring of intravenous infusions of fluids and medications.

leech therapy in the nursing interventions classification, a nursing intervention defined as the application of medicinal leeches to help drain replanted or transplanted tissue engorged with venous blood.

marital therapy a type of family therapy aimed at understanding and treating one or both members of a couple in the context of a distressed relationship, but not necessarily addressing the discordant relationship itself. In the past, the term has also been used in a narrower sense to mean what is defined as marriage therapy, but that is increasingly considered a subset of marital therapy. Called also couples therapy.

marriage therapy a subset of marital therapy that focuses specifically on the bond of marriage between two people, enhancing and preserving it.

milieu therapy

  1. treatment, usually in a psychiatric treatment center, that emphasizes the provision of an environment and activities appropriate to the patient’s emotional and interpersonal needs.
  2. in the nursing interventions classification, a nursing intervention defined as the use of people, resources, and events in the patient’s immediate environment to promote optimal psychosocial functioning.

music therapy

  1. the use of music to effect positive changes in the psychological, physical, cognitive, or social functioning of individuals with health or educational problems. Music therapy is used for a wide variety of conditions, including mental disorders, developmental and learning disabilities, Alzheimer’s disease and other conditions related to aging, brain injury, substance abuse, and physical disability. It is also used for the management of acute and chronic pain and for the reduction of stress.
  2. in the nursing interventions classification, a nursing intervention defined as using music to help achieve a specific change in behavior or feeling.

neoadjuvant therapy in single-agent therapy or combined modality therapy for cancer, initial use of one modality, such as chemotherapy or radiotherapy, to decrease tumor burden prior to use of another modality, usually surgery.

nutrition therapy in the nursing interventions classification, a nursing intervention defined as administration of food and fluids to support metabolic processes of a patient who is malnourished or at high risk for becoming malnourished. See also nutrition.

optometric vision therapy a treatment plan prescribed to correct or improve specific dysfunctions of the vision system; it includes, but is not limited to, the treatment of strabismus (turned eye), other dysfunctions of binocularity (eye teaming), amblyopia (lazy eye), accommodation (eye focusing), ocular motor function (general eye movement ability), and visual-motor and visual-perceptual abilities.

oral rehydration therapy (ORT) oral administration of a solution of electrolytes and carbohydrates in the treatment of dehydration.

peritoneal dialysis therapy in the nursing interventions classification, a nursing intervention defined as administration and monitoring of dialysis solution into and out of the peritoneal cavity. See also peritoneal dialysis.

recreation therapy in the nursing interventions classification, a nursing intervention defined as the purposeful use of recreation to promote relaxation and enhancement of social skills.

reminiscence therapy in the nursing interventions classification, a nursing intervention defined as using the recall of past events, feelings, and thoughts to facilitate pleasure, quality of life, or adaptation to present circumstances.

replacement therapy treatment to replace deficient formation or loss of body products by administration of the natural body products or synthetic substitutes. See also replacement. Called also substitution therapy.

root canal therapy that aspect of endodontics dealing with the treatment of diseases of the dental pulp, consisting of partial (pulpotomy) or complete (pulpectomy) extirpation of the diseased pulp, cleaning and sterilization of the empty root canal, enlarging and shaping the canal to receive sealing material, and obturation of the canal with a nonirritating hermetic sealing agent. Called also pulp canal therapy.

simple relaxation therapy in the nursing interventions classification, a nursing intervention defined as the use of techniques to encourage and elicit relaxation for the purpose of decreasing undesirable signs and symptoms such as pain, muscle tension, or anxiety.

speech therapy the use of special techniques for correction of speech disorders.

swallowing therapy in the nursing interventions classification, a nursing intervention defined as facilitating swallowing and preventing complications of impaired swallowing.

thrombolytic therapy the administration of drugs for thrombolysis (dissolution of a thrombus in an artery), to reduce the size of occlusion and thereby reduce damage to muscular tissue; the coronary artery is a commonly used site. Agents commonly used are streptokinase and tissue plasminogen activator (t-PA).

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