Egan's Fundamentals of Respiratory Care

by Wilkins & Stoller

• ISBN13: 9780323018135
• ISBN10: 0323018130
• Edition: 8th
• Format: Hardcover
• Copyright: 2003-06-11
• Publisher: Mosby

Summary

This comprehensive, student-focused textbook provides the fundamental knowledge that respiratory care students need as they enter the health care field. For more than 30 years, instructors have relied on Egan's for the most accurate, timely information on pathophysiology, assessment, and treatment of neonatal, pediatric, and adult diseases of the chest. Fundamental concepts are addressed in easy-to-follow discussions on respiratory anatomy and physiology, patient assessment, basic therapeutics, and acute and critical care. The 8th edition continues this book's gold-standard tradition with a brand new, full-color design and thoroughly updated content, including new chapters on neonatal and pediatric disorders and noninvasive positive pressure ventilation. It also features new and expanded coverage on smoking cessation, hemodynamic monitoring, stress testing, polysomnography, and more. Instructor resources are available to qualified adopters; contact your sales representative for more information. Short, critical-thinking vignettes in each chapter, called Mini Clinis, raise questions and expose students to possible problems they may encounter during actual patient care. Rule of Thumb icons in each chapter highlight rules, formula, and key points that help readers learn concepts important to clinical practice. Excerpts of Clinical Practice Guidelines (CPGs), developed by the American Association for Respiratory Care (AARC), give important information regarding indications/contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring to familiarize readers with using CPGs in the practice setting. Learning Objectives tell readers what is important about each chapter, often paralleling the three areas tested on the NBRC exam: recall, analysis, and application. Therapist-Driven Protocols (TDPs) - decision trees developed by hospitals - help RTs assess a patient, initiate care, and evaluate outcomes. Key terms tell readers what terms will be learned by studying the chapter. Key Point Summaries highlight key content at the end of each chapter in a bulleted section. Current issues related to assessment and treatment of chest diseases are covered, including neonatal, pediatric, and adult diseases of the chest. New chapters on neonatal & pediatric disorders and noninvasive positive pressure ventilation (NIPPV) provide essential information on these important areas. All chapters have been reviewed and rewritten to reflect changes in the field and the most up-to-date material to prepare students for careers as RTs in today's health-care environment, including: an added discussion on smoking cessation (Chapter 44), polysomnography (Chapter 27), and arterial blood gas sampling (Chapter 16). Full color throughout makes the text more reader-friendly and drawing out special features. New illustrations highlight and clarify important concepts discussed the text.

Table of Contents

SECTION I Foundations of Respiratory Care	1	(134)
Quality and Evidence-Based Respiratory Care	3	(18)
Elements of a Hospital-Based Respiratory Care Program: Roles Supporting Quality Care	4	(4)
Medical Direction	4	(1)
Respiratory Therapists	4	(1)
Respiratory Therapists' Designations and Credentials	5	(2)
Professionalism	7	(1)
Technical Direction	7	(1)
Methods for Enhancing Quality Respiratory Care	8	(7)
Respiratory Care Protocols	8	(5)
Monitoring Quality Respiratory Care	13	(2)
Peer Review Organizations	15	(1)
New Patient Care Delivery Models and Quality of Respiratory Care	15	(3)
Hospital Restructuring and Redesign	15	(1)
Patient-Focused Care	16	(1)
Protocols	16	(1)
Disease Management	17	(1)
Evidence-Based Medicine	18	(3)
Patient Safety, Communication, and Recordkeeping	21	(20)
Safety Considerations	22	(6)
Patient Movement and Ambulation	2	(22)
Electrical Safety	24	(3)
Fire Hazards	27	(1)
Communication	28	(6)
Health Communication	29	(1)
Factors Affecting Communication	30	(1)
Effective Health Communication	30	(1)
Improving Communication Skills	31	(2)
Conflict and Conflict Resolution	33	(1)
Recordkeeping	34	(7)
Components of a Traditional Medical Record	34	(1)
Legal Aspects of Recordkeeping	35	(2)
Practical Aspects of Recordkeeping	37	(1)
The Problem-Oriented Medical Record	37	(4)
Principles of Infection Control	41	(28)
Spread of Infection	42	(3)
Source	42	(1)
Host	43	(1)
Transmission Route	43	(2)
Spread of Infection to the Lungs	45	(1)
Infection Control Strategies	45	(1)
Decreasing Host Susceptibility	45	(1)
Eliminating the Source of Pathogens	45	(1)
Interrupting Routes of Transmission	46	(1)
Equipment Processing	46	(5)
Cleaning	46	(1)
Disinfection	47	(2)
Sterilization	49	(2)
Equipment Handling Procedures	51	(5)
Maintenance of In-Use Equipment	51	(3)
Processing Reusable Equipment	54	(1)
Disposable Equipment	54	(2)
Fluids and Medications Precautions	56	(1)
Barrier Measures and Isolation Precautions	56	(8)
General Barrier Measures	56	(4)
Isolation Precautions	60	(4)
Surveillance	64	(5)
Equipment Processing Quality Control	64	(1)
Sampling of In-Use Equipment	65	(1)
Microbiological Identification	65	(4)
Ethical and Legal Implications of Practice	69	(16)
Philosophical Foundation of Ethics	70	(1)
Ethical Dilemmas of Practice	70	(1)
Codes of Ethics	71	(1)
Ethical Theories and Principles	72	(4)
Autonomy	72	(1)
Veracity	72	(1)
Nonmaleficence	73	(1)
Beneficence	74	(1)
Confidentiality	74	(1)
Justice	75	(1)
Role Duty	75	(1)
Ethical Viewpoints and Decision Making	76	(2)
Formalism	76	(1)
Consequentialism	76	(1)
Mixed Approaches	76	(1)
Virtue Ethics	76	(1)
Intuitionism	77	(1)
Comprehensive Decision-Making Models	77	(1)
Legal Issues Affecting Respiratory Care	78	(3)
Systems of Law	78	(2)
Medical Supervision	80	(1)
Interaction of Ethics and the Law	81	(1)
Healthcare and Change	82	(3)
Physical Principles of Respiratory Care	85	(28)
States of Matter	86	(3)
Internal Energy of Matter	86	(1)
Internal Energy and Temperature	86	(1)
Heat and the First Law of Thermodynamics	87	(1)
Heat Transfer	88	(1)
Change of State	89	(13)
Liquid-Solid Phase Changes (Melting and Freezing)	89	(1)
Properties of Liquids	90	(3)
Liquid-Vapor Phase Changes	93	(4)
Properties of Gases	97	(5)
Gas Behavior Under Changing Conditions	102	(3)
Gas Laws	102	(1)
Effect of Water Vapor	102	(2)
Properties of Gases at Extremes of Temperature and Pressure	104	(1)
Critical Temperature and Pressure	104	(1)
Fluid Dynamics	105	(8)
Pressures in Flowing Fluids	105	(1)
Patterns of Flow	106	(1)
Flow, Velocity, and Cross-Sectional Area	107	(1)
The Bernoulli Effect	108	(1)
Fluid Entrainment	109	(1)
Fluids and the Coanda Effect	110	(3)
Computer Applications in Respiratory Care	113	(22)
How Computers Work	114	(5)
Hardware	114	(3)
Software	117	(2)
How Computers Communicate	119	(1)
Computer Networks	119	(1)
Computer Applications in Respiratory Care	120	(12)
Information Management	120	(2)
Clinical Applications	122	(4)
Integrated Approaches	126	(2)
Using the Internet	128	(4)
Nontechnical Issues Related to Computers	132	(3)
Confidentiality	132	(1)
Technical Skills	132	(1)
Software Errors and Risk of Patient Harm	132	(1)
Lay Access to Medical Information	132	(3)
SECTION II Applied Anatomy and Physiology	135	(172)
The Respiratory System	137	(50)
The Genetic Framework	139	(1)
Development of the Respiratory System	140	(2)
Transition From Uterine to Extrauterine Life	142	(3)
Placental Circulation	142	(1)
Fetal Circulation	143	(1)
Cardiopulmonary Events at Birth	144	(1)
Postnatal Lung Development	145	(6)
Head and Upper Airway	145	(1)
Conducting Airways and Peripheral Airway Growth	146	(1)
Alveolar and Vascular Growth	147	(1)
Lymphatic Circulatory System	147	(1)
Nervous Pathways and the Control of Breathing	148	(1)
Metabolic and Ventilatory Requirements	148	(1)
Chest Wall Development and Lung Volumes	149	(1)
Compliance, Airway Resistance, and Pressure-Volume Relationships	149	(2)
The Respiratory System in the Adult	151	(13)
The Thorax	151	(1)
Gross Structure and Function	152	(12)
Innervation of the Lung and Thoracic Masculature	164	(2)
Somatic Innervation	164	(1)
Autonomic Innervation	164	(2)
Vascular Supply	166	(2)
Pulmonary Circulation	166	(1)
Bronchial Circulation	167	(1)
Lymphatics	167	(1)
Anatomy of the Respiratory Tract	168	(16)
Upper Respiratory Tract	168	(6)
Lower Respiratory Tract	174	(10)
Other Functions of the Lung	184	(3)
The Cardiovascular System	187	(20)
Functional Anatomy	188	(8)
The Heart	188	(5)
The Vascular System	193	(3)
Control of the Cardiovascular System	196	(6)
Regulation of Peripheral Vasculature	196	(1)
Regulation of Cardiac Output	196	(3)
Cardiovascular Control Mechanisms	199	(3)
Events of the Cardiac Cycle	202	(5)
Ventilation	207	(22)
Mechanics of Ventilation	208	(9)
Pressure Differences During Breathing	208	(1)
Forces Opposing Inflation of the Lung	209	(8)
Mechanics of Exhalation	217	(1)
Work of Breathing	218	(2)
Mechanical	218	(2)
Metabolic	220	(1)
Distribution of Ventilation	220	(4)
Regional Factors	221	(1)
Local Factors	222	(2)
Efficiency and Effectiveness of Ventilation	224	(5)
Efficiency	224	(2)
Clinical Significance	226	(1)
Effectiveness	226	(3)
Gas Exchange and Transport	229	(26)
Diffusion	230	(5)
Whole-Body Diffusion Gradients	230	(1)
Determinants of Alveolar Gas Tensions	230	(2)
Mechanism of Diffusion	232	(2)
Systemic Diffusion Gradients	234	(1)
Normal Variations From Ideal Gas Exchange	235	(1)
Anatomical Shunts	235	(1)
Regional Inequalities in Ventilation and Perfusion	235	(1)
Oxygen Transport	236	(8)
Physically Dissolved Oxygen	236	(1)
Chemically Combined Oxygen (Oxyhemoglobin)	237	(1)
Total Oxygen Content of the Blood	238	(2)
Normal Loading and Unloading of Oxygen (Arteriovenous Differences)	240	(1)
Factors Affecting Oxygen Loading and Unloading	241	(2)
Measurement of Hemoglobin Affinity for Oxygen	243	(1)
Carbon Dioxide Transport	244	(3)
Transport Mechanisms	244	(1)
Carbon Dioxide Dissociation Curve	245	(2)
Abnormalities of Gas Exchange and Transport	247	(8)
Impaired Oxygen Delivery	247	(5)
Impaired Carbon Dioxide Removal	252	(3)
Solutions, Body Fluids, and Electrolytes	255	(16)
Solutions	256	(5)
Definition of a Solution	256	(1)
Concentration of Solutions	256	(1)
Osmotic Pressure of Solutions	256	(2)
Quantifying Solute Content and Activity	258	(1)
Calculating Solute Content	259	(1)
Quantitative Classification of Solutions	260	(1)
Electrolytic Activity and Acid-Base Balance	261	(2)
Characteristics of Acids, Bases, and Salts	261	(1)
Designation of Acidity and Alkalinity	262	(1)
Body Fluids and Electrolytes	263	(8)
Fluids	263	(3)
Electrolytes	266	(5)
Acid-Base Balance	271	(26)
Hydrogen Ion Regulation in Body Fluids	272	(4)
Strong and Weak Acids and Bases: Equilibrium Constants	273	(1)
Buffer Solution Characteristics	273	(1)
Bicarbonate and Nonbicarbonate Buffer Systems	273	(1)
pH of a Buffer System: Henderson-Hasselbalch Equation	274	(2)
Physiological Roles of Bicarbonate and Nonbicarbonate Buffer Systems	276	(1)
Acid Excretion	277	(2)
Lungs	277	(1)
Kidneys	277	(2)
Acid-Base Disturbances	279	(3)
Normal Acid-Base Balance	281	(1)
Primary Respiratory Disturbances	281	(1)
Primary Metabolic (Nonrespiratory) Disturbances	281	(1)
Compensation: Restoring pH to Normal	281	(1)
Clinical Acid-Base States	282	(15)
Systematic Acid-Base Classification	282	(2)
Respiratory Acidosis	284	(2)
Respiratory Alkalosis	286	(2)
Metabolic Acidosis	288	(2)
Metabolic Alkalosis	290	(3)
Metabolic Acid-Base Indicators	293	(1)
Mixed Acid-Base States	294	(3)
Regulation of Breathing	297	(10)
Medullary Respiratory Center	298	(1)
Dorsal Respiratory Groups	298	(1)
Ventral Respiratory Groups	299	(1)
Inspiratory Ramp Signal	299	(1)
Pontine Respiratory Centers	299	(1)
Apneustic Center	299	(1)
Pneumotaxic Center	299	(1)
Reflex Control of Breathing	300	(1)
The Hering-Breuer Inflation Reflex	300	(1)
Deflation Reflex	300	(1)
Head's Paradoxical Reflex	300	(1)
Irritant Receptors	300	(1)
J Receptors	300	(1)
Peripheral Proprioceptors	300	(1)
Muscle Spindles	300	(1)
Chemical Control of Breathing	301	(3)
Central Chemoreceptors	301	(1)
Peripheral Chemorrecptors	302	(1)
Control of Breathing During Chronic Hypercania	303	(1)
Ventilatory Response to Exercise	304	(1)
Abnormal Breathing Patterns	304	(1)
Effect of Carbon Dioxide on Cerebral Blood Flow	305	(2)
SECTION III Assessment of Respiratory Disorders	307	(142)
Bedside Assessment of the Patient	309	(26)
Interviewing the Patient and Taking a Medical History	310	(5)
Principles of Interviewing	310	(2)
Common Cardiopulmonary Symptoms	312	(3)
Format for the Medical History	315	(1)
Physical Examination	315	(20)
General Appearance	315	(1)
Level of Consciousness	316	(1)
Vital Signs	317	(3)
Examination of the Head and Neck	320	(1)
Examination of the Thorax and Lungs	321	(9)
Cardiac Examination	330	(2)
Abdominal Examination	332	(1)
Examination of the Extremities	332	(3)
Electrocardiogram and Laboratory Test Assessment	335	(20)
The Electrocardiogram	336	(11)
Basic Principles of Electrophysiology	336	(1)
The Conduction System	336	(2)
Basic ECG Waves	338	(2)
Interpreting the ECG	340	(7)
Interpreting Clinical Laboratory Tests	347	(8)
Complete Blood Count	347	(2)
Blood Chemistry Tests	349	(2)
Microbiology Tests	351	(4)
Analysis and Monitoring of Gas Exchange	355	(36)
Analysis Versus Monitoring	356	(1)
Invasive Versus Noninvasive Procedures	356	(1)
Measuring FIO2	356	(2)
Instrumentation	356	(1)
Procedure	357	(1)
Problem-Solving and Troubleshooting	357	(1)
Sampling and Analyzing Blood Gases	358	(14)
Sampling	358	(7)
Analyzing	365	(7)
Blood Gas Monitoring	372	(5)
Transcutaneous	372	(3)
Intraarterial (In Vivo)	375	(1)
On Demand (Ex Vivo)	376	(1)
Oximetry	377	(6)
Hemoximetry	377	(2)
Pulse Oximetry	379	(4)
Capnometry and Capnography	383	(8)
Instrumentation	383	(2)
Interpretation	385	(1)
Procedure	386	(1)
Problem-Solving and Troubleshooting	387	(4)
Pulmonary Function Testing	391	(36)
Pulmonary Function Testing	392	(3)
Purposes	392	(1)
Organization	393	(1)
Equipment	393	(1)
Infection Control	394	(1)
Principles of Measurement	395	(16)
Lung Volumes and Capacities	395	(8)
Pulmonary Mechanics: Spirometry	403	(5)
Diffusing Capacity	408	(3)
Interpretation of Test Reults	411	(16)
Pathophysiological Patterns	411	(12)
Interpretation of the Pulmonary Function Report	423	(4)
A Synopsis of Thoracic Imaging	427	(22)
Overview of the Plain Chest Radiograph	428	(1)
Overview of the Normal Anatomy Seen on the Chest Radiograph	429	(1)
Technical Adequacy of a Radiograph	429	(2)
The Pleura	431	(4)
Hydrothorax	431	(2)
Pneumothorax	433	(1)
Abnormal Air Collection in the Thorax: Common Etiologies	434	(1)
Lung Parenchyma	435	(8)
Assesing Lung Volume	437	(2)
Catheters, Lines, and Tubes	439	(3)
Solitary Pulmonary Nodule	442	(1)
The Mediastinum	443	(6)
SECTION IV Synopsis of Cardiopulmonary Disease	449	(176)
Pulmonary Infections	451	(18)
Classification	452	(1)
Pathogenesis	452	(2)
Microbiology	454	(1)
Clinical Manifestations	455	(1)
Chest Radiograph	456	(1)
Risk Factors for Mortality and Assessing the Need for Hospitalization	456	(3)
Diagnostic Studies	459	(3)
Community-Acquired Pneumonia	459	(2)
Nosocomial Pneumonia	461	(1)
Therapy	462	(3)
Prevention	465	(4)
Obstructive Lung Disease: COPD, Asthma, and Related Diseases	469	(22)
Chronic Obstructive Pulmonary Disease	470	(8)
Overview and Definitions	470	(1)
Epidemiology	470	(1)
Risk Factors and Pathophysiology	471	(1)
Clinical Signs and Symptoms	472	(1)
Management	473	(5)
Asthma	478	(9)
Definition	478	(1)
Epidemiology	479	(1)
Etiology and Pathogenesis	479	(1)
Clinical Presentation and Diagnosis	479	(2)
Management	481	(1)
Objective Measurement and Monitoring	481	(1)
Pharmacotherapy	482	(3)
Emergency Department and Hospital Management	485	(1)
Immunotherapy	485	(1)
Environmental Control	485	(1)
Patient Education	486	(1)
Special Considerations in Asthama Management	486	(1)
Bronchiectasis	487	(4)
Clinical Presentation	487	(1)
Evaluation	488	(1)
Management	488	(3)
Interstitial Lung Disease	491	(12)
Classification of ILD	492	(1)
Pathophysiology	492	(1)
Clinical Signs and Symptoms of ILD	492	(5)
Physical Examination	493	(1)
Radiographic Features	493	(2)
Physiological Features	495	(2)
Specific Types of ILD	497	(3)
Occupational	497	(1)
Drug Related	498	(1)
Connective Tissue Disease	498	(1)
Allergic, or Hypersensitivity Responses	499	(1)
Idiopathic and Unclassified Disease	499	(1)
Treatment Issues	500	(3)
Medical Treatment	500	(1)
Oxygen Therapy	500	(1)
Avoiding Exposure	500	(2)
Pulmonary Rehabilitation and Exercise Therapy	502	(1)
Vaccinations	502	(1)
Transplantation	502	(1)
Pleural Diseases	503	(18)
The Pleural Space	504	(1)
Overview and Definitions	504	(1)
Pleural Effusions	505	(6)
Transudative	505	(2)
Exudative	507	(2)
Physiological Importance	509	(1)
Diagnostic Tests	509	(2)
Pneumothorax	511	(10)
Traumatic	511	(1)
Spontaneous	512	(1)
Complications	513	(1)
Diagnosis	514	(1)
Therapy	514	(2)
Bronchopleural Fistula	516	(1)
Pleurodesis	517	(4)
Pulmonary Vascular Disease	521	(16)
Venous Thromboembolic Disease	522	(9)
Pathogenesis	522	(1)
Pathology	523	(1)
Pathophysiology	523	(1)
Clinical Features	524	(1)
Diagnostic Modalities	525	(2)
Treatment	527	(4)
Primary Pulmonary Hypertension	531	(6)
Pathogenesis	531	(1)
Epidemiology and Clinical Findings	531	(1)
Diagnosis	532	(1)
Management of Pulmonary Hypertension	532	(5)
Acute Lung Injury, Pulmonary Edema, and Multiple System Organ Failure	537	(20)
Epidemiology	538	(1)
ARDS Risk Factors	539	(1)
Pathophysiology	539	(5)
Normal Physiology	539	(1)
Pulmonary Blood Flow	539	(1)
The Lung Interstitium	540	(1)
Liquid and Solute Transport in the Lungs	540	(1)
Pulmonary Edema	541	(2)
Gas Exchange and Lung Mechanics During ARDS	543	(1)
The Role of Organ-Organ Interactions in the Pathogenesis of ARDS and MODS	543	(1)
Histopathology and Clinical Correlates of ARDS	544	(2)
Exudative Phase (1 to 3 Days)	544	(1)
Fibroproliferative Phase (3 to 7 Days)	544	(1)
Differentiating Hydrostatic From Nonhydrostatic Pulmonary Edema in the Clinical Setting	545	(1)
Therapeutic Approach to ARDS	546	(11)
Supportive Care of Patients with ARDS and MODS	546	(1)
Hemodynamics and Fluid Management During ARDS	546	(2)
Mechanical Ventilation During ARDS	548	(2)
Innovative Ventilation Strategies for ARDS	550	(3)
Pharmacologic Therapies for ARDS	553	(4)
Lung Neoplasms	557	(14)
Etiology	558	(1)
Pathogenesis and Pathology	559	(5)
Clinical Manifestations	560	(2)
Radiographic Manifestations	562	(1)
Solitary Pulmonary Nodule	563	(1)
Diagnosis	564	(2)
Staging	564	(1)
Screening	565	(1)
Treatment	566	(5)
Non-Small Cell Lung Cancer	566	(2)
Prevention	568	(3)
Neuromuscular and Other Diseases of the Chest Wall	571	(16)
General Principles Relating to Neuromuscular Weakness of the Ventilatory Muscles	572	(3)
Clinical Signs and Symptoms	573	(1)
Pathophysiology and Pulmonary Function Testing	573	(1)
Monitoring and Assessing Patients for Respiratory Insufficiency	574	(1)
Management of Respiratory Muscle Weakness	574	(1)
Specific Neuromuscular Diseases	575	(7)
Disorders of the Muscle (Myopathic Disease)	575	(1)
Disorders of the Neuromuscular Junction	576	(2)
Disorders of the Nerves	578	(1)
Disorders of the Spinal Cord	579	(2)
Disorders of the Brain	581	(1)
Disorders of the Thoracic Cage	582	(5)
Kyphoscoliosis	582	(1)
Fail Chest	583	(1)
Ankylosis Spondylitis	583	(4)
Disorders of Sleep	587	(18)
Definitions	589	(1)
Pathophysiology	589	(2)
Obstructive Sleep Apnea	589	(1)
Central Sleep Apnea	590	(1)
Overlap Syndrome	590	(1)
Clinical Features	591	(1)
Laboratory Testing	591	(2)
Treatment	593	(7)
Behavioral Interventions and Risk Counseling	593	(1)
Positional Therapy	594	(1)
Medical Interventions	594	(5)
Surgical Interventions	599	(1)
Conclusions	600	(5)
Neonatal and Pediatric Respiratory Disorders	605	(20)
Neonatal Respiratory Disorders	606	(10)
Lung Parenchymal Disease	606	(5)
Control of Breathing	611	(1)
Pulmonary Vascular Disease	612	(1)
Congenital Abnormalities Affecting Respiration	613	(1)
Congenital Heart Disease	614	(2)
Pediatric Respiratory Disorders	616	(9)
Sudden Infant Death Syndrome	616	(1)
Gastroesophageal Reflux Disease	617	(1)
Bronchilolitis	617	(2)
Group	619	(1)
Epiglottitis	619	(1)
Cystic Fibrosis	620	(5)
SECTION V Basic Therapeutics	625	(286)
Airway Pharmacology	627	(26)
Principles of Pharmacology	628	(2)
The Drug Administration Phase	628	(1)
The Pharmacokinetic Phase	628	(1)
The Pharmacodynamic Phase	629	(1)
Airway Receptors and Neural Control of the Lung	629	(1)
Adrenergic Bronchodilators	630	(4)
Indications for Use	630	(1)
Mode of Action and Effects	630	(1)
Adrenergic Bronchodilator Agents	631	(2)
Adverse Effects	633	(1)
Assessment of Bronchodilator Therapy	634	(1)
Anticholinergic Bronchodilators	634	(3)
Indications for Use	635	(1)
Mode of Action	635	(1)
Adverse Effects	636	(1)
Assessment	637	(1)
Mucus-Controlling Agents	637	(3)
Acetylcysteine	637	(1)
Dornase Alfa	638	(1)
Other Mucoactive Agents	639
Assessment of Mucoactive Drug Therapy	369	(271)
Inhaled Corticosteroids	640	(1)
Indications and Purposes	640	(1)
Mode of Action	640	(1)
Adverse Effects	640	(1)
Assessment of Drug Therapy	640	(1)
Nonsteroidal Antiasthma Drugs	641	(4)
Indications for Use	642	(1)
Mode of Action	643	(1)
Adverse Effects	644	(1)
Assessment of Drug Therapy	644	(1)
Aerosolized Antiinfective Agents	645	(8)
Pentamidine Isethionate	645	(1)
Ribavirin	646	(1)
Inhaled Tobramycin	646	(1)
Inhaled Zanamivir	647	(1)
Inhaled Antifungal Therapy	648	(5)
Airway Management	653	(52)
Suctioning	654	(7)
Endotracheal Suctioning	655	(4)
Nasotracheal Suctioning	659	(2)
Sputum Sampling	661	(1)
Establishing an Artificial Airway	661	(15)
Clinical Practice Guideline	661	(1)
Routes	661	(3)
Airway Tubes	664	(3)
Procedures	667	(9)
Airway Trauma Associated With Tracheal Tubes	676	(3)
Laryngeal Lesions	677	(1)
Tracheal Lesions	677	(1)
Prevention	678	(1)
Airway Maintenance	679	(9)
Securing the Airway and Confirming Placement	679	(1)
Providing for Patient Communication	679	(2)
Ensuring Adequate Humidification	681	(1)
Minimizing Nosocomial Infections	681	(1)
Facilitating Secretion Clearance	681	(1)
Providing Cuff Care	681	(3)
Care of the Tracheostomy and Tube	684	(1)
Changing a Tracheostomy Tube	685	(1)
Troubleshooting Airway Emergencies	685	(3)
Extubation/Decannulation	688	(4)
Assessing Patient Readiness for Extubation	688	(1)
Procedures	689	(3)
Alternative Airway Devices	692	(3)
Laryngeal Mask Airway	692	(1)
Double Lumen Airway	693	(1)
Surgical Emergency Airways	694	(1)
Bronchoscopy	695	(10)
Rigid Tube Bronchoscopy	695	(1)
Flexible Fiberoptic Bronchoscopy	695	(10)
Emergency Life Support	705	(32)
Causes and Prevention of Sudden Death	706	(1)
Basic Life Support	706	(16)
Determining Unresponsiveness	707	(1)
Restoring the Airway	707	(1)
Restoring Ventilation	708	(3)
Restoring Circulation	711	(3)
One-Versus Two-Rescuer Adult CPR	714	(1)
Automated External Defibrillation	714	(2)
Evaluating the Effectiveness of CPR	716	(1)
Hazards and Complications	716	(4)
Contraindications to CPR	720	(1)
Health Concerns and CPR	720	(1)
Dealing With an Obstructed Airway	720	(2)
Advanced Cardiac Life Support	722	(15)
Support for Oxygenation	722	(1)
Airway Control	722	(4)
Ventilation	726	(1)
Bag-Valve Masks	726	(1)
Restoring Cardiac Function	727	(7)
Monitoring During Advanced Cardiac Life Support	734	(1)
Postresuscitative Patient Care	734	(1)
Respiratory Management	735	(1)
Cardiovascular Management	735	(2)
Humidity and Bland Aerosol Therapy	737	(24)
Humidity Therapy	738	(13)
Physiological Control of Heat and Moisture Exchange	738	(1)
Indications for Humidification and Warming of Inspired Gases	738	(2)
Equipment	740	(8)
Problem Solving and Troubleshooting	748	(3)
Bland Aerosol Therapy	751	(5)
Sputum Induction	755	(1)
Problem Solving and Troubleshooting	756	(1)
Selecting the Appropriate Therapy	756	(5)
Aerosol Drug Therapy	761	(40)
Characteristics of Therapeutic Aerosols	762	(4)
Output	762	(1)
Particle Size	762	(1)
Deposition	763	(1)
Aging	764	(2)
Hazards of Aerosol Therapy	766	(1)
Infection	766	(1)
Airway Reactivity	766	(1)
Pulmonary and Systemic Effects	766	(1)
Drug Reconcentration	766	(1)
Aerosol Drug Delivery Systems	766	(20)
Metered-Dose Inhalers	767	(5)
Dry Powder Inhalers	772	(3)
Pneumatic (Jet) Nebulizers	775	(7)
Ultrasonic Nebulizers	782	(1)
Hand-Bulb Atomizers	783	(1)
New-Generation Nebulizers	783	(2)
Advantages and Disadvantages	785	(1)
Selecting an Aerosol Drug Delivery System	786	(1)
Assessment-Based Bronchodilator Therapy Protocols	786	(6)
Sample Protocol	786	(1)
Assessing Patient Response	787	(2)
Patient Education	789	(3)
Special Considerations	792	(4)
Continuous Nebulization for Refractory Bronchospasm	792	(2)
Aerosol Administration to Intubated Patients	794	(2)
Controlling Environmental Contamination	796	(5)
Negative-Pressure Rooms	796	(1)
Booths and Stations	796	(1)
Personal Protective Equipment	797	(4)
Storage and Delivery of Medical Gases	801	(26)
Characteristics of Medical Gases	802	(3)
Oxygen (O2)	802	(1)
Air	803	(1)
Carbon Dioxide (CO2)	804	(1)
Helium (He)	804	(1)
Nitrous Oxide (N2O)	804	(1)
Nitric Oxide (NO)	804	(1)
Storage of Medical Gases	805	(8)
Gas Cylinders	805	(6)
Bulk Oxygen	811	(2)
Distribution and Regulation of Medical Gases	813	(14)
Central Piping Systems	813	(1)
Safety Indexed Connector Systems	814	(3)
Regulating Gas Pressure and Flow	817	(10)
Medical Gas Therapy	827	(36)
Oxygen Therapy	828	(24)
General Goals and Clinical Objectives	828	(1)
Clinical Practice Guideline	829	(1)
Assessing the Need for Oxygen Therapy	829	(1)
Precautions and Hazards of Supplemental Oxygen	829	(4)
Oxygen Delivery Systems: Design and Performance	833	(17)
Selecting a Delivery Approach	850	(1)
Protocol-Based Oxygen Therapy	851	(1)
Hyperbaric Oxygen Therapy	852	(3)
Physiological Effects	853	(1)
Methods of Administration	853	(1)
Indications	853	(1)
Complications and Hazards	854	(1)
Troubleshooting	855	(1)
Other Medical Gas Therapies	855	(8)
Nitric Oxide Therapy	855	(3)
Helium Therapy	858	(5)
Lung Expansion Therapy	863	(20)
Causes and Types of Atelectasis	864	(1)
Indications for Lung Expansion Therapy	864	(1)
Clinical Signs of Atelectasis	865	(1)
Lung Expansion Therapy	866	(1)
Incentive Spirometry	866	(4)
Physiological Basis of IS	866	(2)
Indications for IS	868	(1)
Contraindications for IS	868	(1)
Hazards and Complications of IS	868	(1)
Equipment	869	(1)
Administering IS	869	(1)
Intermittent Positive Pressure Breathing (IPPB)	870	(7)
Definition and Physiological Principle	871	(1)
Indications for IPPB	871	(3)
Contraindications for IPPB	874	(1)
Hazards and Complications of IPPB	874	(1)
Administering IPPB	874	(2)
Discontinuation and Follow-Up	876	(1)
Monitoring and Troubleshooting	877	(1)
Positive Airway Pressure (PAP) Therapy	877	(4)
Definitions and Physiological Principle	878	(1)
Indications for CPAP	878	(1)
Contraindications for CPAP	878	(1)
Hazards and Complications of CPAP	879	(1)
Equipment	879	(1)
Administering Intermittent CPAP	879	(2)
Selecting an Approach	881	(2)
Bronchial Hygiene Therapy	883	(28)
Physiology of Airway Clearance	884	(2)
Normal Clearance	884	(1)
Abnormal Clearance	885	(1)
Diseases Associated With Abnormal Clearance	886	(1)
General Goals and Indications	886	(1)
Bronchial Hygiene Therapy for Acute Conditions	887	(1)
Bronchial Hygiene Therapy for Chronic Conditions	887	(1)
Bronchial Hygiene Therapy to Prevent Retention of Secretions	887	(1)
Determining the Need for Bronchial Hygiene Therapy	887	(1)
Bronchial Hygiene Methods	888	(18)
Postural Drainage Therapy	888	(7)
Coughing and Related Expulsion Techniques	895	(5)
PAP Adjuncts	900	(3)
High-Frequency Compression/Oscillation	903	(1)
High-Frequency Chest Wall Oscillation	903	(1)
Mobilization and Exercise	904	(1)
Selecting Bronchial Hygiene Techniques	905	(1)
Section Factors	905	(1)
Clearance Strategies for Specific Conditions	905	(1)
Protocol-Based Bronchial Hygiene	906	(5)
SECTION VI Acute and Critical Care	911	(278)
Respiratory Failure and the Need for Ventilatory Support	913	(16)
Acute Hypoxemic Respiratory Failure (Type I)	914	(3)
Ventilation/Perfusion Mismatch	914	(1)
Shunt	915	(1)
Alveolar Hypoventilation	915	(1)
Diffusion Impairment	915	(1)
Perfusion/Diffusion Impairment	916	(1)
Decreased Inspired Oxygen	916	(1)
Differentiating the Causes of Acute Hypoxemic Respiratory Failure	916	(1)
Acute Hypercapnic Respiratory Failure (Type II)	917	(2)
Decreased Ventilatory Drive	918	(1)
Respiratory Muscle Fatigue or Failure	918	(1)
Increased Work of Breathing	918	(1)
Chronic Respiratory Failure: Type I and Type II	919	(2)
Acute-on-Chronic Respiratory Failure	920	(1)
Complications of Acute Respiratory Failure	920	(1)
Indications for Ventilatory Support	921	(1)
Parameters Indicating the Need for Ventilatory Support	921	(1)
Hypoxemic Respiratory Failure	921	(1)
Hypercapnic Respiratory Failure (Ventilatory Failure)	922	(1)
Mechanisms of Hypercapnic Respiratory Failure	922	(1)
Decreased Ventilatory Drive	922	(1)
Respiratory Muscle Fatigue and Weakness	922	(1)
Increased Work of Breathing	923	(1)
Choosing a Ventilatory Support Strategy for Different Causes of Respiratory Failure	923	(2)
Ventilatory Support in Hypoxemic Respiratory Failure	924	(1)
Ventilatory Support in Hypercapnic Respiratory Failure (Ventilatory Failure)	925	(1)
Special Considerations During Ventilatory Support	925	(4)
Increased Intracranial Pressure	925	(1)
Obstructive Lung Disease	925	(4)
Mechanical Ventilators	929	(34)
How Ventilators Work	930	(18)
Input Power	930	(1)
Power Transmission and Conversion	931	(1)
Control System	931	(4)
Phase Variables	935	(13)
Output Waveforms	948	(2)
Pressure	948	(1)
Volume	949	(1)
Flow	950	(1)
Effects of Calibration Errors and the Patient Circuit	950	(1)
Clinical Application of Modes	950	(13)
Volume Control Versus Pressure Control	950	(1)
Continuous Mandatory Ventilation (CMV)	951	(4)
Intermittent Mandatory Ventilation (IMV)	955	(3)
Continuous Spontaneous Ventilation (CSV)	958	(5)
Physiology of Ventilatory Support	963	(40)
Pressure and Pressure Gradients	964	(4)
Airway, Alveolar, and Intrathoracic Pressure, Volume, and Flow During Spontaneous Ventilation	965	(1)
Airway, Alveolar, and Intrathoracic Pressure, Volume, and Flow During Negative Pressure Mechanical Ventilation	966	(2)
Airway, Alveolar, and Intrathoracic Pressure, Volume, and Flow During Positive Pressure Mechanical Ventilation	968	(1)
Effects of Mechanical Ventilation on Oxygenation	968	(3)
Increased Inspired Oxygen	968	(1)
Alveolar Oxygen and the Alveolar Air Equation	968	(1)
Arterial Oxygenation and Oxygen Content	968	(2)
Decreased Shunt	970	(1)
Increased Tissue Oxygen Delivery	970	(1)
Effects of Mechanical Ventilation on Ventilation	971	(2)
Increased Minute Ventilation	971	(1)
Increased Alveolar Ventilation	971	(1)
Decreased Ventilation/Perfusion Ratio	971	(1)
Alveolar and Arterial Carbon Dioxide	972	(1)
Changes in Acid-Base Balance	972	(1)
Effects of Positive Pressure Mechanical Ventilation on Lung Mechanics	973	(5)
Time Constants	973	(1)
Increased Pressure	974	(2)
Increased Lung Volume	976	(1)
Decreased Work of Breathing	977	(1)
Minimizing Adverse Pulmonary Effects of Positive Pressure Mechanical Ventilation	978	(2)
Decreasing Pressure	978	(1)
Positive End-Expiratory Pressure/Continuous Positive Airway Pressure	979	(1)
Effects of Ventilatory Pattern	980	(1)
Trigger Site and Work of Breathing	980	(1)
Physiological Effects of Ventilatory Modes	980	(6)
Volume-Controlled Modes	980	(2)
Pressure-Controlled Modes	982	(3)
Continuous Positive Airway Pressure	985	(1)
Bilevel Continuous Positive Airway Pressure	985	(1)
Automatic Tube Compensation	985	(1)
Proportional Assist Ventilation	985	(1)
Patient Positioning to Optimize Oxygenation and Ventilation	986	(1)
Cardiovascular Effects of Positive Pressure Mechanical Ventilation	986	(2)
Thoracic Pump and Venous Return During Spontaneous and Mechanical Ventilation	986	(1)
Compensation in Healthy Persons	987	(1)
Pulmonary Vascular Pressure, Blood Flow, and Pulmonary Vascular Resistance	987	(1)
Right and Left Ventricular Function	987	(1)
Endocardial Blood Flow	988	(1)
Cardiac Output, Cardiac Index, and Systemic Blood Pressure	988	(1)
Minimizing the Cardiovascular Effects of Positive Pressure Mechanical Ventilation	988	(2)
Mean Pleural Pressure	988	(1)
Decreasing the Mean Airway Pressure	989	(1)
Fluid Management and Cardiac Output	989	(1)
Pharmacological Maintenance of Cardiac Output and Blood Pressure	990	(1)
Effects of Positive Pressure Mechanical Ventilation on Other Body Systems	990	(4)
Increased Intracranial Pressure	990	(1)
Effect on Renal Function	991	(1)
Decreased Liver and Splanchnic Perfusion	992	(1)
Decreased Gastrointestinal Function	992	(1)
Effect on the Central Nervous System	993	(1)
Complications of Mechanical Ventilation	994	(5)
Negative Pressure Ventilation	994	(1)
Positive Pressure Ventilation	994	(1)
Complications Related to Pressure	995	(1)
Complications Related to Volume Are the Result of Alveolar Overdistension	995	(1)
Auto-Positive End-Expiratory Pressure	996	(1)
Oxygen Toxicity	997	(1)
Ventilator-Associated (Nosocomial) Pneumonia	997	(2)
Aberrant Work of Breathing	999	(1)
Ventilator Malfunction	999	(4)
Initiating and Adjusting Ventilatory Support	1003	(56)
Indications for Mechanical Ventilatory Support	1004	(5)
Definitions	1004	(1)
Disease States or Conditions Necessitating Mechanical Ventilation	1005	(1)
Clinical Manifestations of Respiratory Failure	1005	(1)
Physiologic Values Associated With the Need for Mechanical Ventilatory Support	1006	(1)
Indications for Mechanical Ventilation	1006	(2)
Goals of Mechanical Ventilatory Support	1008	(1)
Ventilatory Management Strategies for Specific Disorders	1009	(3)
Normal Pulmonary Mechanics	1009	(1)
Acute Respiratory Distress Syndrome	1010	(1)
Chronic Obstructive Pulmonary Disease	1010	(1)
Acute Severe Asthma Exacerbation	1010	(1)
Postoperative Ventilatory Support	1011	(1)
Myocardial Ischemia and Congestive Heart Failure	1011	(1)
Neuromuscular Disorders	1011	(1)
Head Trauma	1011	(1)
Unilateral Lung Disease	1012	(1)
Bronchopleural Fistula	1012	(1)
Ventilator Initiation	1012	(3)
Negative Pressure Ventilation	1012	(1)
Noninvasive Positive Pressure Ventilation	1013	(1)
Establishment of the Airway	1013	(1)
Pressure-Controlled Versus Volume-Controlled Ventilation	1013	(1)
Full Ventilatory Support Versus Partial Ventilatory Support	1014	(1)
Choice of a Ventilator	1015	(1)
Initial Ventilator Settings	1015	(20)
Choice of Mode	1015	(6)
Tidal Volume and Rate	1021	(2)
Trigger Sensitivity	1023	(1)
Inspiratory Flow, Time, and I:E Ratio for Volume Ventilation	1024	(5)
Oxygen Percentage	1029	(1)
Positive End-Expiratory Pressure and Continuous Positive Airway Pressure	1030	(1)
Pressure Support	1030	(1)
Limits and Alarms	1031	(1)
Humidification	1031	(1)
Periodic Sighs	1032	(3)
Adjusting Ventilatory Support	1035	(2)
Patient-Ventilator Interaction	1035	(2)
Oxygenation	1037	(6)
Oxygen Concentration	1037	(1)
Positive End-Expiratory Pressure and Continuous Positive Airway Pressure	1037	(5)
Other Techniques for Improving Oxygenation	1042	(1)
Ventilation	1043	(16)
Adjusting Tidal Volume and Rate	1044	(4)
Pressure-Support Ventilation and PaCO2	1048	(1)
Pressure-Control Ventilation and PaCO2	1048	(2)
High-Frequency Ventilation and PaCO2	1050	(1)
Permissive Hypercapnia	1050	(2)
Alternative Lung Protective Strategies for Acute Lung Injury and Acute Respiratory Distress Syndrome	1052	(1)
Acid-Base Homeostasis	1053	(6)
Noninvasive Positive Pressure Ventilation	1059	(22)
Types of Noninvasive Ventilation	1060	(1)
Goals of and Indications for Noninvasive Positive Pressure Ventilation	1061	(2)
Acute Care Setting	1061	(2)
Chronic Care Setting	1063	(1)
Chronic Care Setting	1063	(3)
Patient Selection and Exclusion Criteria for Noninvasive Positive Pressure Ventilation	1064	(1)
Acute Care Setting	1064	(1)
Predictors of Success During Noninvasive Positive Pressure Ventilation	1065	(1)
Chronic Care Setting	1065	(1)
Equipment Used in the Application of Noninvasive Positive Pressure Ventilation	1066	(8)
Patient Interfaces	1066	(4)
Ventilators Used for Noninvasive Positive Pressure Ventilation	1070	(4)
Instituting and Managing Noninvasive Positive Pressure Ventilation	1074	(2)
Initiation of Noninvasive Positive Pressure Ventilation	1074	(1)
Noninvasive Ventilator Adjustments	1075	(1)
Monitoring	1075	(1)
Location	1076	(1)
Weaning from NPPV	1076	(1)
Complications of Noninvasive Positive Pressure Ventilation	1076	(2)
Time and Cost Associated With Noninvasive Positive Pressure Ventilation	1078	(3)
Monitoring and Management of the Patient in the Intensive Care Unit	1081	(40)
Principles of Monitoring	1082	(2)
Pathophysiology and Monitoring	1084	(1)
Respiratory Monitoring	1084	(16)
Gas Exchange	1084	(6)
Monitoring Lung and Chest Wall Mechanics	1090	(3)
Monitoring Breathing Effort and Patterns	1093	(7)
Cardiac and Cardiovascular Monitoring	1100	(9)
Electrocardiography	1104
Arterial Blood Pressure Monitoring	1007	(100)
Central Venous-Right Atrial Pressure Monitoring	1107	(1)
Pulmonary Arterial Pressure Monitoring	1107	(2)
Neurological Monitoring	1109	(3)
History	1109	(1)
Neurological Examination	1109	(2)
Intracranial Pressure Monitoring	1111	(1)
Glasgow Coma Score	1112	(1)
Monitoring Renal Function	1112	(1)
Monitoring Liver Function	1112	(1)
Nutritional Monitoring	1113	(1)
Assessment of Nutritional Status	1113	(1)
Functional Assessment	1113	(1)
Metabolic Assessment	1113	(1)
Estimating Nutritional Requirements	1114	(1)
Global Monitoring Indices	1114	(1)
Acute Physiology and Chronic Health Evaluation (APACHE)	1114	(1)
Troubleshooting	1115	(6)
Discontinuing Ventilatory Support	1121	(34)
Definitions	1123	(1)
Categories for Discontinuing Ventilatory Support	1123	(1)
Reasons for Ventilatory Dependence	1123	(2)
Ventilatory Workload, or Demand	1123	(1)
Ventilatory Capacity	1124	(1)
Discontinuing Ventilatory Support	1124	(1)
Patient Evaluation	1125	(5)
The Most Important Criterion	1125	(1)
Weaning Indices	1126	(1)
Ventilation	1127	(1)
Oxygenation	1128	(1)
Acid-Base Balance	1128	(1)
Metabolic Factors	1129	(1)
Renal Function and Electrolytes	1129	(1)
Cardiovascular Function	1129	(1)
Psychological Factors and Central Nervous System Assessment	1129	(1)
Integrated Indices	1130	(1)
Evaluation of the Airway	1130	(1)
Preparing the Patient	1130	(2)
Optimizing the Patient's Medical Condition	1130	(1)
Patient's Psychological and Communication Needs	1131	(1)
Methods	1132	(7)
Rapid Ventilator Discontinuation	1132	(1)
Patients Who Need Progressive Weaning of Ventilatory Support	1133	(1)
Traditional T-Tube Trials	1133	(1)
Continuous Positive Airway Pressure	1133	(1)
Intermittent Mandatory Ventilation and Synchronized Intermittent Mandatory Ventilation	1134	(1)
Pressure Support Ventilation	1134	(2)
Intermittent Mandatory Ventilation/Synchronized Intermittent Mandatory Ventilation With Pressure Support Ventilation	1136	(1)
Daily Spontaneous Breathing Trials	1136	(3)
Newer Techniques	1139	(4)
Mandatory Minute Volume Ventilation	1139	(1)
Adaptive Support Ventilation	1140	(1)
Computer-Based Weaning	1140	(1)
Flow-By, Flow Triger, Tracheal Pressure Sensing	1141	(1)
Automatic Tube Compensation	1141	(1)
Volume Support and Volume-Assured Pressure Support	1141	(1)
Proportional Assist Ventilation and Proportional Pressure Support	1141	(1)
Noninvasive Positive Pressure Ventilation	1142	(1)
Other Techniques for Facilitatating Weaning	1142	(1)
Selecting an Approach	1143	(2)
Monitoring the Patient During Weaning	1145	(2)
Ventory Status	1145	(1)
Oxygenation	1146	(1)
Cardiovascular Status	1146	(1)
Extubation	1147	(2)
Effects of Artificial Airways Related to Weaning	1147	(2)
Failure	1149	(1)
Chronically Ventilator-Dependent Patients	1149	(2)
Terminal Weaning	1151	(4)
Neonatal and Pediatric Respiratory Care	1155	(34)
Assessment of the Newborn	1156	(7)
Maternal Factors	1156	(1)
Fetal Assessment	1156	(1)
Evaluation of the Newborn	1157	(2)
Respiratory Assessment of the Infant	1159	(4)
General Management of the Critically III Neonate	1163	(1)
Temperature Regulation	1163	(1)
Fluid and Electrolyte Balance	1164	(1)
Nutrition	1164	(1)
Infection Control	1164	(1)
Basic Respiratory Care	1164	(8)
Oxygen Therapy	1164	(1)
Bronchial Hygiene Therapy	1165	(1)
Humidity and Aerosol Therapy	1166	(2)
Aerosol Drug Therapy	1168	(1)
Airway Management	1168	(3)
Neonatal Resuscitation	1171	(1)
Continuous Positive Airway Pressure	1172	(1)
Methods of Administration	1172	(1)
Mechanical Ventilation	1173	(10)
Basic Principles	1173	(2)
Goals of Mechanical Ventilation	1175	(4)
Assessment of Mechanical Ventilation	1179	(1)
Weaning From Mechanical Ventilation	1180	(1)
High-Frequency Ventilation	1181	(2)
Complications of Mechanical Ventilation	1183	(1)
Nitric Oxide	1183	(1)
Extracorporeal Life Support (ECLS)	1184	(5)
Neonatal-Pediatric Transport	1185	(4)
SECTION VII Preventative and Long-Term Care	1189	(98)
Patient Education and Health Promotion	1191	(10)
Patient Education	1192	(2)
Cognitive Domain	1192	(1)
Affective Domain	1192	(1)
Psychomotor Domain	1193	(1)
Teaching Tips	1193	(1)
Teaching Children Versus Adult Learners	1193	(1)
Evaluation of Patient Education	1194	(1)
The Teachable Moment	1194	(1)
Practice Guidelines	1194	(1)
Health Education	1194	(3)
Health Promotion and Disease Prevention	1197	(1)
Implication for RRTs	1198	(1)
Healthcare Institutions	1199	(1)
Work Site	1199	(1)
Home	1199	(1)
Community	1199	(1)
Educational Institutions	1199	(1)
Health Promotion, Disease Prevention, and Medical Care Costs	1199	(2)
Nutritional Aspects of Health and Disease	1201	(24)
Maintaining Health Through Good Nutrition	1202	(4)
Dietary Guidelines	1202	(1)
Macronutrients and Energy Requirements	1202	(3)
Micronutrients and Dietary Supplements	1205	(1)
Dietary Fiber	1206	(1)
Fluid Intake	1206	(1)
Antioxidants	1206	(1)
Malnutrition	1206	(2)
Protein-Energy Malnutrition	1206	(1)
Micronutrient Malnutrition	1207	(1)
Respiratory Consequences of Malnutrition	1207	(1)
Nutritional Assessment	1208	(7)
History and Physical Examination	1208	(1)
Anthropometry	1209	(1)
Clinical Laboratory Tests	1210	(1)
Pulmonary Function Parameters	1211	(1)
Total Caloric Requirements	1211	(4)
General Aspects of Nutritional Support	1215	(3)
Meeting Overall Energy Needs	1215	(1)
Providing the Appropriate Combination of Substrates	1215	(1)
Timing of Nutritional Support	1216	(1)
Routes of Administration	1216	(2)
Nutritional Support in Specific Circumstances	1218	(7)
General Guidelines for Critically Ill Patients	1218	(1)
Systemic Inflammatory Response Syndrome	1218	(1)
Mechanical Ventilation	1219	(1)
Chronic Obstructive Pulmonary Disease	1219	(2)
Cystic Fibrosis	1221	(4)
Cardiopulmonary Rehabilitation	1225	(22)
Definitions and Goals	1226	(1)
Historical Perspective	1226	(1)
Scientific Bases	1227	(4)
Physical Reconditioning	1227	(2)
Psychosocial Support	1229	(2)
Pulmonary Rehabilitation Programming	1231	(16)
Program Goals and Objectives	1231	(1)
Benefits and Potential Hazards	1231	(2)
Patient Evaluation and Selection	1233	(3)
Program Design	1236	(4)
Program Implementation	1240	(3)
Cost, Fees, and Reimbursement	1243	(1)
Program Results	1244	(3)
Respiratory Care in Alternative Settings	1247	(40)
Recent Developments and Trends	1248	(1)
Definitions and Goals	1249	(1)
Subacute Care	1249	(1)
Home Care	1250	(1)
Standards	1250	(1)
Governmental Laws and Regulations	1250	(1)
Private Sector Accreditation	1250	(1)
Traditional Acute Care Versus Postacute Care	1251	(1)
Discharge Planning	1251	(3)
Multidisciplinary Team	1251	(2)
Site and Support Service Evaluation	1253	(1)
Oxygen Therapy in Alternative Settings	1254	(9)
The Oxygen Therapy Prescription	1254	(3)
Supply Methods	1257	(3)
Delivery Methods	1260	(3)
Ventilatory Support in Alternative Settings	1263	(10)
Patient Selection	1263	(1)
Settings and Approaches	1263	(1)
Standards and Guidelines	1264	(1)
Special Challenges in Providing Home Ventilatory Support	1264	(4)
Invasive Versus Noninvasive Ventilatory Support	1268	(1)
Equipment	1268	(3)
Evaluation and Follow-up	1271	(2)
Other Modes of Postacute Respiratory Care	1273	(4)
Bland Aerosol Therapy	1273	(1)
Aerosol Drug Administration	1273	(1)
Airway Care and Clearance Methods	1273	(1)
Nasal CPAP	1274	(3)
Apnea Monitoring	1277	(1)
Patient Assessment and Documentation	1277	(3)
Institutional Subacute and Long-Term Care	1277	(3)
Home Care	1280	(1)
Equipment Disinfection and Maintenance	1280	(1)
Palliative Care	1281	(6)
Appendix 1: Temperature Correction of Barometric Reading	1287	(1)
Appendix 2: Factors to Convert Gas Volumes From ATPS to STPD	1288	(1)
Appendix 3: Factors to Convert Gas Volumes From STPD to BTPS at Given Barometric Pressures	1289	(1)
Appendix 4: Table of Normal Values	1290	(3)
Glossary	1293