5 курс / Пульмонология и фтизиатрия / Clinical_Manifestations_and_Assessment_of_Respiratory

Clinical Manifestations and

Assessment of Respiratory

Disease

EIGHTH EDITION

Terry Des Jardins, MEd, RRT

Professor Emeritus

Former Director

Department of Respiratory Care

Parkland College

Champaign, Illinois

Faculty/Staff Member

University of Illinois College of Medicine at Urbana–Champaign

Urbana, Illinois

George G. Burton, MD, FACP, FCCP, FAARC

Associate Dean for Medical Affairs

Kettering College

Kettering, Ohio

Clinical Professor of Medicine and Anesthesiology

Wright State University School of Medicine

Dayton, Ohio

Medical Illustrations by

Timothy H. Phelps, MS, FAMI, CMI

Associate Professor

Johns Hopkins University School of Medicine

Baltimore, Maryland

Table of Contents

Cover image

Title Page

Copyright

Dedication

Reviewers

Preface

Anatomic Alterations of the Lungs

Etiology

Overview of the Cardiopulmonary Clinical Manifestations Associated With the Disorder Management of the Disease

Case Study

Self-Assessment Questions

Appendices and Glossary

References

Approach

Acknowledgments

Introduction

The Assessment Process—An Overview

The Assessment Process—Role of the Respiratory Therapist

Specific Components of the Assessment Process

Part I Assessment of Cardiopulmonary Disease

Section I Bedside Diagnosis

Chapter 1 The Patient Interview

Patient History

The Patient Interview

Techniques of Communication

Closing the Interview

Pitfalls and Weaknesses Associated With the Patient Interview

A Note of Reassurance

Self-Assessment Questions

Chapter 2 The Physical Examination

Vital Signs

Systematic Examination of the Chest and Lungs

Self-Assessment Questions

Chapter 3 The Pathophysiologic Basis for Common Clinical Manifestations

Normal Ventilatory Pattern

Abnormal Ventilatory Patterns

The Onset/Offset Patterns Associated With Various Cardiopulmonary Disorders

Use of the Accessory Muscles of Inspiration

Use of the Accessory Muscles of Expiration

Nasal Flaring

Splinting and Decreased Chest Expansion Caused by Pleuritic and Nonpleuritic Chest Pain

Abnormal Chest Shape and Configuration

Abnormal Extremity Findings

Distended Neck Veins and Jugular Venous Distention

Normal and Abnormal Sputum Production

Cough

Self-Assessment Questions

Section II Clinical Data Obtained from Laboratory Tests and Special Procedures—Objective Findings

Chapter 4 Pulmonary Function Testing

Normal Lung Volumes and Capacities

Forced Expiratory Flow Rate and Volume Measurements

Pulmonary Diffusion Capacity

Assessment of Respiratory Muscle Strength

Cardiopulmonary Exercise Testing

Other Diagnostic Tests for Asthma

Self-Assessment Questions

Chapter 5 Blood Gas Assessment

Acid-Base Abnormalities

Errors Associated With Arterial Blood Gas Measurements

Self-Assessment Questions

Chapter 6 Assessment of Oxygenation

Oxygen Transport Review

Total Oxygen Content of Blood

Oxyhemoglobin Dissociation Curve

Oxygenation Indices

Hypoxemia Versus Hypoxia

Self-Assessment Questions

Chapter 7 Assessment of the Cardiovascular System

The Electrocardiogram

Common Heart Arrhythmias

Noninvasive Hemodynamic Monitoring Assessments

Invasive Cardiovascular Monitoring Assessments

Cardiovascular (Hemodynamic) Monitoring in Respiratory Diseases

Self-Assessment Questions

Chapter 8 Radiologic Examination of the Chest

Fundamentals of Radiography

Standard Positions and Techniques of Chest Radiography

Inspecting the Chest Radiograph

Echocardiogram

Radiation Safety

Self-Assessment Questions

Chapter 9 Other Important Tests and Procedures

Sputum Examination

Skin Tests

Endoscopic Examinations

Video-Assisted Thoracoscopy Surgery

Thoracentesis

Pleurodesis

Hematology, Blood Chemistry, and Electrolyte Findings

Self-Assessment Questions

Section III The Therapist-Driven Protocol Program—The Essentials

Chapter 10 The Therapist-Driven Protocol Program

The “Knowledge Base” Required for a Successful Therapist-Driven Protocol Program

The “Assessment Process Skills” Required for a Successful Therapist-Driven Protocol Program

The Essential Cornerstones of a Successful Therapist-Driven Protocol Program

Common Anatomic Alterations of the Lungs

Self-Assessment Questions

Chapter 11 Respiratory Insufficiency, Respiratory Failure, and Ventilatory Management Protocols

Classifications of Respiratory Failure

Mechanical Ventilation

Ventilator Hazards

Self-Assessment Questions

Chapter 12 Recording Skills and Intraprofessional Communication

Types of Patient Records

Telemedicine

Health Insurance Portability and Accountability Act

Self-Assessment Questions

Part II Obstructive Lung Disease

Introduction

Introduction

Chapter 13 Chronic Obstructive Pulmonary Disease, Chronic Bronchitis, and Emphysema

Anatomic Alterations of the Lungs Associated With Chronic Bronchitis

Anatomic Alterations of the Lungs Associated With Emphysema

Etiology and Epidemiology

Risk Factors

Diagnosis and Assessment of Chronic Obstructive Pulmonary Disease

Key Distinguishing Features Between Emphysema and Chronic Bronchitis

Overview of the Cardiopulmonary Clinical Manifestations Associated with Chronic Bronchitis and Emphysema (Chronic Obstructive Pulmonary Disease)

General Management of Chronic Obstructive Pulmonary Disease

Etiology and Epidemiology

Community-Acquired Typical Pneumonia

Community-Acquired Atypical Pneumonia

Chronic Pneumonia

Fungal Diseases: Anatomic Alterations of the Lungs

Primary Pathogens

Pneumonia in the Immunocompromised Host

Necrotizing Pneumonia and Lung Abscess

Overview of the Cardiopulmonary Clinical Manifestations Associated With Pneumonia General Management of Pneumonia

Case Study Pneumonia

Self-Assessment Questions

Chapter 19 Tuberculosis

Anatomic Alterations of the Lungs

Etiology and Epidemiology

Tuberculosis Among Health Care Workers

Diagnosis

Overview of the Cardiopulmonary Clinical Manifestations Associated With Tuberculosis General Management of Tuberculosis

Case Study Tuberculosis

Self-Assessment Questions

Part V Pulmonary Vascular Disease

Chapter 20 Pulmonary Edema

Anatomic Alterations of the Lungs

Etiology and Epidemiology

Overview of the Cardiopulmonary Clinical Manifestations Associated With Pulmonary Edema General Management of Pulmonary Edema

Case Study Pulmonary Edema

Self-Assessment Questions

Chapter 21 Pulmonary Vascular Disease

Pulmonary Embolism

Pulmonary Hypertension

Self-Assessment Questions

Part VI Chest and Pleural Trauma

Chapter 22 Flail Chest

Anatomic Alterations of the Lungs

Etiology and Epidemiology

Overview of the Cardiopulmonary Clinical Manifestations Associated With Flail Chest General Management of Flail Chest

Case Study Flail Chest

Self-Assessment Questions

Chapter 23 Pneumothorax

Anatomic Alterations of the Lungs

Etiology, Epidemiology, and Symptoms

Overview of the Cardiopulmonary Clinical Manifestations Associated With Pneumothorax General Management of Pneumothorax

Case Study Spontaneous Pneumothorax

Self-Assessment Questions

Part VII Disorders of the Pleura and the Chest Wall

Chapter 24 Pleural Effusion and Empyema

Anatomic Alterations of the Lungs

Pleural Anatomy and Pathophysiology

Etiology and Epidemiology

Overview of the Cardiopulmonary Clinical Manifestations Associated With Pleural Effusion and Empyema General Management of Pleural Effusion

Case Study Pleural Disease

Self-Assessment Questions

Chapter 25 Kyphoscoliosis

Anatomic Alterations of the Lungs

Etiology and Epidemiology

Scoliosis

Kyphosis

Overview of the Cardiopulmonary Clinical Manifestations Associated With Kyphoscoliosis General Management of Scoliosis

Respiratory Care Treatment Protocols

Case Study Kyphoscoliosis

Self-Assessment Questions

Part VIII Lung Cancer

Chapter 26 Cancer of the Lung

Anatomic Alterations of the Lungs

Etiology and Epidemiology

Screening and Diagnosis

Overview of the Cardiopulmonary Clinical Manifestations Associated With Cancer of the Lung General Management of Lung Cancer

Case Study Cancer of the Lung

Self-Assessment Questions

Part IX Environmental Lung Diseases

Chapter 27 Interstitial Lung Diseases

Anatomic Alterations of the Lungs

Etiology and Epidemiology

Overview of the Cardiopulmonary Clinical Manifestations Associated With Chronic Interstitial Lung Diseases General Management of Interstitial Lung Disease

Case Study Interstitial Lung Disease

Self-Assessment Questions

Part X Diffuse Alveolar Disease

Chapter 28 Acute Respiratory Distress Syndrome

Anatomic Alterations of the Lungs

Etiology and Epidemiology

Diagnostic Criteria for Acute Respiratory Distress Syndrome

Overview of the Cardiopulmonary Clinical Manifestations Associated With Acute Respiratory Distress Syndrome General Management of Acute Respiratory Distress Syndrome

Case Study Acute Respiratory Distress Syndrome

Self-Assessment Questions

Part XI Neuro-Respiratory Disorders

Chapter 29 Guillain-Barré Syndrome

Anatomic Alterations of the Lungs Associated With Guillain-Barré Syndrome

Etiology and Epidemiology

Clinical Presentation

Overview of the Cardiopulmonary Clinical Manifestations Associated With Guillain-Barré Syndrome General Management of Guillain-Barré Syndrome

Case Study Guillain-Barré Syndrome

Self-Assessment Questions

Chapter 30 Myasthenia Gravis

Anatomic Alterations of the Lungs Associated With Myasthenia Gravis

Etiology and Epidemiology

Screening and Diagnosis

Overview of the Cardiopulmonary Clinical Manifestations Associated With Myasthenia Gravis General Management of Myasthenia Gravis

Case Study Myasthenia Gravis

Self-Assessment Questions

Chapter 31 Cardiopulmonary Assessment and Care of Patients with Neuromuscular Disease

Chronic Neuromuscular Diseases

Overview of the Cardiopulmonary Clinical Manifestations Associated With Neuromuscular Diseases General Management of Neuromuscular Disease

Ventilatory Management of Patients With Neuromuscular Disease

Case Study Amyotrophic Lateral Sclerosis

Self-Assessment Questions

Part XII Sleep-Related Breathing Disorders

Chapter 32 Sleep Apnea

Obstructive Sleep Apnea

Central Sleep Apnea

Mixed Apnea

Sleep-Related Hypoventilation and Hypoxemia Syndromes

Diagnosis of Obstructive Sleep Apnea

Overview of the Cardiopulmonary Clinical Manifestations Associated With Sleep Apnea

General Management of Obstructive Sleep Apnea

General Management of Central Sleep Apnea

Case Study Obstructive Sleep Apnea

Self-Assessment Questions

Part XIII Newborn and Early Childhood Cardiopulmonary Disorders

Chapter 33 Newborn Assessment and Management

Fetal Development and Transition at Birth

Delivery Room Management of the Newborn

Assessment of the Newborn

Special Newborn Conditions and Topics

Self-Assessment Questions

Chapter 34 Pediatric Assessment and Management

Special Challenges in Pediatric Care

Common Infant and Pediatric Cardiopulmonary Disorders

Assessment of the Infant and Pediatric Patient

Pediatric Treatment Protocols

Self-Assessment Questions

Chapter 35 Meconium Aspiration Syndrome

Anatomic Alterations of the Lungs

Etiology and Epidemiology

Overview of the Cardiopulmonary Clinical Manifestations Associated With Meconium Aspiration Syndrome General Management of Meconium Aspiration Syndrome

Case Study Meconium Aspiration Syndrome

Self-Assessment Questions

Chapter 36 Transient Tachypnea of the Newborn

Anatomic Alterations of the Lungs

Etiology and Epidemiology

Overview of the Cardiopulmonary Clinical Manifestations Associated With Transient Tachypnea of the Newborn General Management of Transient Tachypnea of the Newborn

Case Study Transient Tachypnea of the Newborn

Self-Assessment Questions

Chapter 37 Respiratory Distress Syndrome

Anatomic Alterations of the Lungs

Etiology and Epidemiology

Diagnosis

Overview of the Cardiopulmonary Clinical Manifestations Associated With Respiratory Distress Syndrome General Management of Respiratory Distress Syndrome

Case Study Respiratory Distress Syndrome

Self-Assessment Questions

Chapter 38 Pulmonary Air Leak Syndromes

Anatomic Alterations of the Lungs

Etiology and Epidemiology

Overview of the Cardiopulmonary Clinical Manifestations Associated With Pulmonary Air Leak Syndromes General Management of Pulmonary Air Leak Syndromes

Case Study Pulmonary Air Leak Syndromes

Self-Assessment Questions

Chapter 39 Respiratory Syncytial Virus Infection (Bronchiolitis)

Anatomic Alterations of the Lungs

Etiology and Epidemiology

Overview of the Cardiopulmonary Clinical Manifestations Associated With Respiratory Syncytial Virus Infection General Management of Respiratory Syncytial Virus Infection (Bronchiolitis)