5 курс / Пульмонология и фтизиатрия / Clinical_Manifestations_and_Assessment_of_Respiratory
.pdfClinical 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
Overview of GOLD's Management of Stable Chronic Obstructive Pulmonary Disease Case Study Chronic Bronchitis
Case Study Emphysema
Case Study Example of Classic Chronic Obstructive Pulmonary Disease
Self-Assessment Questions
Chapter 14 Asthma
National Asthma Education and Prevention Program
Global Initiative for Asthma
Anatomic Alterations of the Lungs
Etiology and Epidemiology
Diagnosis of Asthma
Overview of the Cardiopulmonary Clinical Manifestations Associated With Asthma General Management of Asthma
Respiratory Care Treatment Protocols
Case Study Asthma
Self-Assessment Questions
Chapter 15 Cystic Fibrosis
Anatomic Alterations of the Lungs
Etiology and Epidemiology
Overview of the Cardiopulmonary Clinical Manifestations Associated With Cystic Fibrosis General Management of Cystic Fibrosis
Lung or Heart-Lung Transplantation
Case Study Cystic Fibrosis
Self-Assessment Questions
Chapter 16 Bronchiectasis
Anatomic Alterations of the Lungs
Etiology and Epidemiology
Diagnosis
Overview of the Cardiopulmonary Clinical Manifestations Associated With Bronchiectasis General Management of Bronchiectasis
Medications Commonly Prescribed by the Physician
Case Study Bronchiectasis
Self-Assessment Questions
Part III Loss of Alveolar Volume
Chapter 17 Atelectasis
Anatomic Alterations of the Lungs
Etiology
Overview of the Cardiopulmonary Clinical Manifestations Associated With Postoperative Atelectasis General Management of Postoperative Atelectasis
Case Study Postoperative Atelectasis
Self-Assessment Questions
Part IV Infectious Pulmonary Disease
Chapter 18 Pneumonia, Lung Abscess Formation, and Important Fungal Diseases
Pneumonia: Anatomic Alterations of the Lungs
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)