9780815127987

Egan's Fundamentals of Respiratory Care

by ; ; ;
  • ISBN13:

    9780815127987

  • ISBN10:

    0815127987

  • Format: Hardcover
  • Copyright: 1999-02-01
  • Publisher: Elsevier Science Health Science div
  • View Upgraded Edition

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Supplemental Materials

What is included with this book?

Summary

An outstanding revision of the classic EGAN'S FUNDAMENTALS, this comprehensive text provides excellent coverage of the role of respiratory care practitioners, scientific bases for treatment, and clinical applications. It progresses from the foundations of respiratory care to applied anatomy and physiology, assessment, discussion of specific respiratory illnesses, basic therapy, acute and critical care, and preventive and long-term care. Special features have been designed with the student in mind and include outlines, active learning objectives, key terms and glossary, "Mini-Clinis," "Rules of Thumb," and bulleted key-point summaries. To improve students' clinical-skill application, CPGs and TDPs are included in appropriate chapters to familiarize students with the use of patient care guidelines and decision trees. NEW TO THIS EDITION: * Showcases NEW chapters on ECG and Lab Assessment, Nutrition, and Sleep Disorders. * Supplies NEW section, "Synopsis of Cardiopulmonary Disease," with eight chapters that discuss cardiopulmonary diseases. * Includes NEW Clinical Practice Guidelines (CPGs) to give students important information regarding indications/contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring. * Provides NEW Therapist-Driven Protocols (TDPs) to guide students in decision making as they assess patients, initiate care and evaluate outcomes. * More than double the number of "Mini-Clinis" (short, critical-thinking vignettes) that demonstrate how content covered in the text applies to patient care. * Presents key content in bulleted points at the end of each chapter to identify key concepts in each chapter. * Incorporates a NEW "Rules of Thumb" feature throughout the text to highlight rules, formulas, and key points important to clinical practice. * Offers a newly revised student workbook and a NEW computerized test bank as ancillaries.

Table of Contents

SECTION 1 Foundations of Respiratory Care 3(76)
1 Quality Respiratory Care
3(16)
Elements of a Hospital-Based Respiratory Care Program: Roles Supporting Quality Care
4(8)
Medical Direction
4(1)
Respiratory Care Protocols as a Measure to Enhance Quality of Respiratory Care
4(3)
Respiratory Care Practioners
7(1)
Respiratory Care Practioners' Designations and Credentials
7(5)
Technical Direction
12(1)
Monitoring Quality Respiratory Care
12(1)
Peer Review Organizations
13(1)
Effect of New Patient Care Delivery Models on the Quality of Respiratory Care
13(6)
Hospital Restructuring and Redesign
13(2)
Patient-Focused Care
15(1)
Protocols
16(3)
2 Patient Safety, Communicatior, and Recordkeeping
19(20)
Safety Considerations
20(6)
Patient Movement and Ambulation
20(2)
Electrical Safety
22(3)
Fire Hazards
25(1)
Communication
26(7)
Health Communication
26(1)
Factors Affecting Communication
27(2)
Effective Health Communication
29(1)
Improving Communication Skills
29(2)
Conflict and Conflict Resolution
31(2)
Recordkeeping
33(6)
Components of a Traditional Medical Record
33(1)
Legal Aspects of Recordkeeping
33(2)
Practical Aspects of Recordkeeping
35(1)
The Problem-Oriented Medical Record
35(4)
3 Principles of Infection Control
39(24)
Spread of Infection
40(2)
Source
40(1)
Host
40(1)
Transmission Route
41(1)
Spread of Infection to the Lungs
42(1)
Infection Control Strategies
42(1)
Decreasing Host Susceptibility
42(1)
Eliminating the Source of Pathogens
42(1)
Interrupting Routes of Transmission
43(1)
Equipment Processing
43(4)
Cleaning
43(1)
Disinfection
43(3)
Sterilization
46(1)
Equipment Handling Procedures
47(5)
Maintenance of In-Use Equipment
47(3)
Processing Reusable Equipment
50(2)
Disposable Equipment
52(1)
Fluids and Medications Precautions
52(1)
Barrier Measures and Isolation Precautions
52(6)
General Barrier Measures
53(1)
Isolation Precautions
54(4)
Surveillance
58(5)
Equipment Processing Quality Control
58(1)
Sampling of In-Use Equipment
59(1)
Microbiological Identification
60(3)
4 Ethical and Legal Implications of Practice
63(16)
Ethical Dilemmas of Practice
64(7)
Codes of Ethics
64(1)
Ethical Theories and Principles
65(3)
Ethical Viewpoints and Decision Making
68(3)
Legal Issues Affecting Respiratory Care
71(3)
Interaction of Ethics and the Law
74(1)
Healthcare and Change
74(5)
SECTION 2 Technological Bases for Respiratory Care 79(60)
5 Physical Principles in Respiratory Care
79(30)
States of Matter
80(3)
Internal Energy of Matter
80(1)
Internal Energy and Temperature
80(1)
Heat and the First Law of Thermodynamics
81(1)
Heat Transfer
82(1)
Change of State
83(13)
Liquid-Solid Phase Changes (Melting and Freezing)
83(1)
Properties of Liquids
83(4)
Liquid-Vapor Phase Changes
87(5)
Properties of Gases
92(4)
Gas Behavior Under Changing Conditions
96(3)
Gas Laws
97(1)
Effect of Water Vapor
98(1)
Properties of Gases at Extremes of Temperature and Pressure
98(1)
Critical Temperature and Pressure
99(1)
Fluid Dynamics
99(5)
Pressures in Flowing Fluids
99(1)
Patterns of Flow
100(1)
Transitional Flow
101(1)
Flow, Velocity, and Cross-Sectional Area
101(1)
The Bernoulli Effect
102(1)
Fluid Entrainment
103(1)
The Venturi and Pitot Tubes
103(1)
Fluidics and the Coanda Effect
104(1)
Electricity
104(5)
Basic Electrical Circuitry
104(2)
Ohm's Law
106(3)
6 Computer Applications in Respiratory Care
109(30)
How Computers Work
110(7)
Hardware
110(3)
Software
113(4)
How Computers Communicate
117(1)
Host-Remote Systems
117(1)
Computer Networks
117(1)
Computer Applications in Respiratory Care
118(15)
Information Management
118(2)
Clinical Applications
120(8)
Integrated Approaches
128(1)
Using the Internet
128(5)
Nontechnical Issues Related to Computers
133(6)
Confidentiality
133(1)
Technical Skills
134(1)
Software Errors and Risk of Patient Harm
134(1)
Lay Access to Medical Information
134(5)
SECTION 3 Applied Anatomy and Physiology 139(156)
7 The Respiratory System
139(36)
The Thorax
140(12)
Overview
140(1)
Gross Structure and Function
140(12)
Innervation of the Lung and Thoracic Musculature
152(2)
Somatic Innervation
152(1)
Autonomic Innervation
153(1)
Vascular Supply
154(3)
Pulmonary Circulation
155(1)
Bronchial Circulation
155(1)
Lymphatics
156(1)
Anatomy of the Respiratory Tract
157(13)
Upper Respiratory Tract
157(6)
Lower Respiratory Tract
163(7)
Other Functions of the Lung
170(5)
8 The Cardiovascular System
175(20)
Functional Anatomy
176(8)
The Heart
176(5)
The Vascular System
181(3)
Control of the Cardiovascular System
184(8)
Regulation of Peripheral Vasculature
184(1)
Regulation of Cardiac Output
184(3)
Cardiovascular Control Mechanisms
187(5)
Events of the Cardiac Cycle
192(3)
9 Ventilation
195(20)
Mechanics of Ventilation
196(8)
Pressure Differences During Breathing
196(1)
Forces Opposing Inflation of the Lung
197(7)
Mechanics of Exhalation
204(1)
Work of Breathing
205(3)
Mechanical
205(2)
Metabolic
207(1)
Distribution of Ventilation
208(3)
Regional Factors
208(1)
Local Factors
209(2)
Efficiency and Effectiveness of Ventilation
211(4)
Efficiency
211(2)
Clinical Significance
213(1)
Effectiveness
213(2)
10 Gas Exchange and Transport
215(26)
Diffusion
216(4)
Whole-Body Diffusion Gradients
216(1)
Determinants of Alveolar Gas Tensions
216(2)
Mechanism of Diffusion
218(2)
Systemic Diffusion Gradients
220(1)
Normal Variations from Ideal Gas Exchange
220(2)
Anatomical Shunts
220(1)
Regional Inequalities in Ventilation and Perfusion
221(1)
Oxygen Transport
222(7)
Physically Dissolved Oxygen
222(1)
Chemically Combined Oxygen (Oxyhemoglobin)
223(2)
Total Oxygen Content of the Blood
225(1)
Normal Loading and Unloading of Oxygen (Arteriovenous Differences)
225(2)
Factors Affecting Oxygen Loading and Unloading
227(2)
Measurement of Hemoglobin Affinity for Oxygen
229(1)
Carbon Dioxide Transport
229(3)
Transport Mechanisms
229(2)
Carbon Dioxide Dissociation Curve
231(1)
Abnormalities of Gas Exchange and Transport
232(9)
Impaired Oxygen Delivery
232(4)
Impaired Carbon Dioxide Removal
236(5)
11 Solutions, Body Fluids, and Electrolytes
241(16)
Solutions
242(5)
Definition of a Solution
242(1)
Concentration of Solutions
242(1)
Osmotic Pressure of Solutions
243(1)
Quantifying Solute Content and Activity
244(1)
Calculating Solute Content
245(1)
Quantitative Classification of Solutions
245(2)
Electrolytic Activity and Acid-Base Balance
247(2)
Characteristics of Acids, Bases, and Salts
247(1)
Designation of Acidity and Alkalinity
248(1)
Body Fluids and Electrolytes
249(8)
Fluids
249(3)
Electrolytes
252(5)
12 Acid-Base Balance
257(26)
Hydrogen Ion Regulation in Body Fluids
258(4)
Strong and Weak Acids and Bases: Equilibrium Constants
258(1)
Buffer Solution Characteristics
259(1)
Bicarbonate and Nonbicarbonate Buffer Systems
259(1)
pH of a Buffer System: Henderson-Hasselbalch Equation
260(1)
Physiological Roles of Bicarbonate and Nonbicarbonate Buffer Systems
261(1)
Acid Excretion
262(4)
Lungs
262(1)
Kidneys
263(3)
Acid-Base Disturbances
266(2)
Normal Acid-Base Balance
266(1)
Primary Respiratory Disturbances
267(1)
Primary Metabolic (Nonrespiratory) Disturbances
267(1)
Compensation: Restoring pH to Normal
267(1)
Clinical Acid-Base States
268(15)
Systematic Acid-Base Classification
268(2)
Respiratory Acidosis
270(2)
Respiratory Alkalosis
272(1)
Metabolic Acidosis
273(3)
Metabolic Alkalosis
276(2)
Metabolic Acid-Base Indicators
278(2)
Mixed Acid-Base States
280(3)
13 Regulation of Breathing
283(12)
Medullary Respiratory Center
284(1)
Dorsal Respiratory Groups
284(1)
Ventral Respiratory Groups
284(1)
Inspiratory Ramp Signal
285(1)
Pontine Respiratory Centers
285(1)
Apneustic
285(1)
Pneumotaxic
285(1)
Reflex Control of Breathing
285(2)
The Hering-Breuer Inflation Reflex
285(1)
Deflation Reflex
286(1)
Head's Paradoxical Reflex
286(1)
Irritant Receptors
286(1)
J Receptors
286(1)
Peripheral Proprioceptors
286(1)
Muscle Spindles
286(1)
Chemical Control of Breathing
287(3)
Central Chemoreceptors
287(1)
Peripheral Chemoreceptors
287(2)
Control of Breathing During Chronic Hypercapnia
289(1)
Ventilatory Response to Exercise
290(1)
Abnormal Breathing Patterns
290(1)
Effect of Carbon Dioxide on Cerebral Blood Flow
291(4)
SECTION 4 Assessment of Respiratory Disorders 295(130)
14 Bedside Assessment of the Patient
295(26)
Interviewing the Patient and Taking a Medical History
296(4)
Principles of Interviewing
296(1)
Common Cardiopulmonary Symptoms
297(3)
Format for the Medical History
300(1)
Physical Examination
300(21)
General Appearance
300(1)
Level of Consciousness
301(1)
Vital Signs
302(3)
Examination of the Head and Neck
305(1)
Examination of the Thorax and Lungs
306(9)
Cardiac Examination
315(2)
Abdominal Examination
317(1)
Examination of the Extremities
317(4)
15 Electrocardiogram and Laboratory Assessment
321(16)
The Electrocardiogram
322(9)
Basic Principles of Electrophysiology
322(1)
The Conduction System
322(2)
Basic ECG Waves
324(1)
Interpreting the ECG
325(6)
Interpreting Clinical Laboratory Tests
331(6)
Complete Blood Count
331(2)
Blood Chemistry Tests
333(2)
Microbiology Tests
335(2)
16 Analysis and Monitoring of Gas Exchange
337(34)
Analysis versus Monitoring
338(1)
Invasive versus Noninvasive Procedures
338(1)
Measuring FIO(2)
338(1)
Instrumentation
338(1)
Procedure
339(1)
Problem-Solving and Troubleshooting
339(1)
Sampling and Analyzing Blood Gases
339(14)
Sampling
339(9)
Analyzing
348(5)
Blood Gas Monitoring
353(5)
Transcutaneous
353(3)
Intraarterial (In Vivo)
356(1)
On Demand (Ex Vivo)
357(1)
Oximetry
358(5)
Hemoximetry
358(1)
Pulse Oximetry
359(4)
Capnometry and Capnography
363(8)
Instrumentation
363(3)
Procedure
366(1)
Problem-Solving and Troubleshooting
366(5)
17 Pulmonary Function Testing
371(32)
Pulmonary Function Testing
372(2)
Purposes
372(1)
Organization
372(1)
Equipment
373(1)
Infection Control
374(1)
Principles of Measurement
374(16)
Lung Volumes and Capacities
374(6)
Pulmonary Mechanics: Spirometry
380(6)
Diffusion
386(4)
Interpretation of Test Results
390(13)
Pathophysiological Considerations
390(8)
Interpretation of the Pulmonary Function Report
398(5)
18 A Synopsis of Thoracic Imaging: Chest X-ray, CT, and MRI
403(22)
Overview of the Plain Chest Radiograph
404(2)
Evaluation of the Pleura
406(4)
Hydrothorax
406(2)
Pneumothorax
408(2)
Evaluation of the Lung Parenchyma
410(9)
Assessing Lung Volume
413(3)
Evaluation of Catheters, Lines, and Tubes
416(3)
The Solitary Pulmonary Nodule (SPN)
419(1)
The Mediastinum
419(6)
SECTION 5 Synopsis of Cardiopulmonary Disease 425(146)
19 Pulmonary Infections
425(16)
Classification
426(1)
Pathogenesis
426(1)
Microbiology
427(1)
Clinical Manifestations
428(1)
The Chest Radiograph
429(1)
Risk Factors for Mortality and Assessing the Need for Hospitalization
430(2)
Diagnostic Studies
432(3)
Community-Acquired Pneumonia
432(2)
Nosocomial Pneumonia
434(1)
Therapy
435(3)
Prevention
438(3)
20 Obstructive Lung Disease: COPD, Asthma, and Related Diseases
441(22)
Chronic Obstructive Pulmonary Disease (COPD)
442(8)
Overview and Definitions
442(1)
Epidemiology
442(1)
Risk Factors and Pathophysiology
443(1)
Clinical Signs and Symptoms
444(1)
Management
445(1)
Establishing the Diagnosis
445(1)
Optimizing Lung Function
446(1)
Maximizing Functional Status
447(1)
Preventing Progression of COPD and Enhancing Survival
448(1)
Miscellaneous Therapies
448(2)
Asthma
450(9)
Definition
450(1)
Incidence
450(1)
Etiology and Pathogenesis
450(1)
Clinical Presentation and Diagnosis
451(1)
Management
452(1)
Objective Measurement and Monitoring
453(1)
Pharmacotherapy Emergency Department and Hospital
454(2)
Management
456(1)
Immunotherapy
457(1)
Environmental Control
457(1)
Patient Education
457(1)
Special Considerations in Asthma Management
457(2)
Bronchiectasis
459(1)
Clinical Presentation
459(1)
Evaluation
459(1)
Management
459(1)
Cystic Fibrosis
459(4)
Clinical Presentation and Pulmonary Manifestations
459(1)
Diagnosis
460(1)
Management
460(3)
21 Interstitial Lung Disease
463(12)
Classification of ILD
465(1)
Clinical Signs and Symptoms of ILD
465(3)
Physical Examination
465(1)
Radiographic Features
466(1)
Physiological Features
467(1)
Specific Types of ILD
468(3)
Occupational
468(1)
Drug Related
469(1)
Connective Tissue Disease
469(1)
Allergic, or Hypersensitivity, Responses
470(1)
Idiopathic and Unclassified Disease
470(1)
Treatment Issues
471(4)
Avoiding Exposure
471(1)
Medical Treatment
471(1)
Transplantation
472(1)
Oxygen Therapy
473(1)
Pulmonary Rehabilitation and Exercise Therapy
473(1)
Vaccinations
473(2)
22 Pleural Diseases
475(16)
The Pleural Space
476(1)
Overview and Definitions
476(1)
Pleural Effusions
477(6)
Transudative
477(2)
Exudative
479(2)
Physiological Importance
481(1)
Diagnostic Tests
481(2)
Pneumothorax
483(8)
Traumatic
484(1)
Spontaneous
484(1)
Complications
485(1)
Diagnosis
485(1)
Therapy
486(3)
Bronchopleural Fistula
489(1)
Pleurodesis
489(2)
23 Pulmonary Vascular Disease
491(16)
Venous Thromboembolic Disease
492(9)
Pathogenesis
492(1)
Pathology
492(1)
Pathophysiology
493(1)
Clinical Features
494(1)
Diagnostic Modalities
495(2)
Treatment
497(4)
Primary Pulmonary Hypertension
501(6)
Pathogenesis
501(1)
Epidemiology and Clinical Findings
501(1)
Diagnosis
501(1)
Treatment of Pulmonary Hypertension
502(5)
24 Acute Lung Injury, Pulmonary, Edema, and Multiple System Organ Failure
507(18)
Epidemiology
508(1)
ARDS Risk Factors
508(1)
Pathophysiology
509(4)
Liquid and Solute Transport in the Lungs
509(2)
Hydrostatic Pulmonary Edema
511(1)
Nonhydrostatic Pulmonary Edema
511(2)
Clinical Presentation: Differentiating Hydrostatic from Nonhydrostatic Pulmonary Edema in the Clinical Setting
513(1)
Therapeutic Approach to ARDS
514(11)
Supportive Care for ARDS/MODS
514(4)
Innovative Ventilatory Strategies for ARDS
518(3)
Pharmacologic Treatments for ARDS
521(4)
25 Lung Neoplasms
525(14)
Etiology
526(1)
Pathogenesis and Pathology
527(5)
Clinical Manifestations
529(2)
Radiographic Manifestations
531(1)
Solitary Pulmonary Nodule
531(1)
Diagnosis
532(3)
Staging
532(3)
Screening
535(1)
Treatment
535(4)
26 Neuromuscular and Other Diseases of the Chest Wall
539(14)
General Principles Relating to Neuromuscular Weakness of the Ventilatory Muscles
540(2)
Specific Neuromuscular Diseases
542(7)
Disorders of the Muscle (Myopathic Disease)
542(1)
Disorders of the Neuromuscular Junction
543(2)
Disorders of the Nerves
545(1)
Disorders of the Spinal Cord
546(2)
Disorders of the Brain
548(1)
Disorders of the Thoracic Cage
549(4)
Kyphoscoliosis
549(1)
Flail Chest
550(1)
Ankylosing Spondylitis
550(3)
27 Disorders of Sleep
553(18)
Definitions
554(1)
Pathophysiology
554(2)
Obstructive Sleep Apnea
554(1)
Central Sleep Apnea
554(2)
The Overlap Syndrome
556(1)
Clinical Features
556(1)
Laboratory Testing
557(3)
Treatment
560(6)
Behavioral Interventions/Risk Counseling
560(1)
Positional Therapy
560(1)
Medical Interventions
560(5)
Surgical Interventions
565(1)
Conclusions
566(5)
SECTION 6 Basic Therapeutics 571(248)
28 Airway Pharmacology
571(18)
Principles of Pharmacology
572(2)
The Pharmaceutical Phase
572(1)
The Pharmacokinetic Phase
572(1)
The Pharmacodynamic Phase
572(1)
Airway Receptors and Neural Control of the Lung
572(2)
Adrenergic Bronchodilators
574(3)
Indications for Use
574(1)
Mode of Action and Effects
574(1)
Adrenergic Bronchodilator Agents
574(2)
Adverse Effects
576(1)
Assessment of Bronchodilator Therapy
576(1)
Anticholinergic Bronchodilator
577(2)
Indication for Use
577(1)
Mode of Action
577(1)
Adverse Effects
578(1)
Assessment
579(1)
Mucus-Controlling Agents
579(3)
Acetylcysteine
579(1)
Dornase Alfa
580(1)
Bland Water Aerosols
581(1)
Inhaled Corticosteroids
582(1)
Indications and Purposes
582(1)
Mode of Action
582(1)
Adverse Effects
583(1)
Assessment of Drug Therapy
583(1)
Mediator Antagonists
583(3)
Indication for Use
584(1)
Modes of Action
584(1)
Adverse Effects
584(1)
Assessment of Drug Therapy
585(1)
Controllers versus Relievers
585(1)
Aerosolized Antinfective Agents
586(3)
Pentamidine Isethionate
586(1)
Ribavirin
586(1)
Aerosolized Antibiotics
587(2)
29 Airway Management
589(40)
Establishing an Artificial Airway
590(13)
Clinical Practice Guideline
590(1)
Routes
590(1)
Equipment
590(2)
Procedures
592(11)
Airway Trauma Associated with Tracheal Tubes
603(3)
Laryngeal Lesions
604(1)
Tracheal Lesions
604(2)
Prevention
606(1)
Airway Maintenance
606(6)
Securing the Airway and Confirming Placement
606(1)
Providing for Patient Communication
606(1)
Ensuring Adequate Humidification
607(1)
Minimizing Nosocomial Infections
607(1)
Facilitating Secretion Clearance
608(1)
Providing Cuff Care
609(2)
Troubleshooting Airway Emergencies
611(1)
Extubation
612(4)
Assessing Patient Readiness for Extubation
612(1)
Procedure
612(1)
Airway Clearance Techniques
616(13)
Suctioning
616(4)
Bronchoscopy
620(9)
30 Emergency Life Support
629(32)
Causes and Prevention of Sudden Death
630(1)
Basic Life Support
630(15)
Determining Unresponsiveness
630(2)
Restoring the Airway
632(1)
Restoring Ventilation
632(3)
Restoring Circulation
635(4)
One-versus Two-Rescuer CPR
639(1)
Early Defibrillation
639(1)
Evaluating the Effectiveness of CPR
640(1)
Hazards and Complications
640(2)
Contraindications to CPR
642(1)
Health Concerns and CPR
642(1)
Dealing with an Obstructed Airway
643(2)
Advanced Cardiac Life Support
645(16)
Support for Oxygenation
645(1)
Airway Control
645(4)
Ventilation
649(1)
Bag-Valve-Masks
649(2)
Restoring Cardiac Function
651(6)
Monitoring During Advanced Cardiac Life Support
657(1)
Postresuscitative Patient Care
657(1)
Respiratory Management
658(1)
Cardiovascular Management
658(3)
31 Humidity and Bland Aerosol Therapy
661(22)
Humidity Therapy
662(11)
Physiological Control of Heat and Moisture Exchange
662(1)
Indications for Humidification and Warming of Inspired Gases
662(1)
Equipment
663(8)
Problem-Solving and Troubleshooting
671(2)
Bland Aerosol Therapy
673(6)
Equipment for Bland Aerosol Therapy
673(4)
Sputum Induction
677(1)
Problem-Solving and Troubleshooting
677(2)
Selecting the Appropriate Therapy
679(4)
32 Aerosol Drug Therapy
683(32)
Characteristics of Therapeutic Aerosols
684(3)
Output
684(1)
Particle Size
684(1)
Deposition
684(3)
Aging
687(1)
Hazards of Aerosol Therapy
687(1)
Infection
687(1)
Airway Reactivity
687(1)
Pulmonary and Systemic Effects
687(1)
Drug Reconcentration
687(1)
Aerosol Drug Delivery Systems
688(11)
Metered-Dose Inhalers
688(3)
Dry Powder Inhalers
691(2)
Small-Volume Jet Nebulizers
693(3)
Large-Volume Jet Nebulizers
696(2)
Small-Volume Ultrasonic Nebulizers
698(1)
Hand-Bulb Atomizers
699(1)
Advantages and Disadvantages
699(1)
Selecting an Aerosol Drug Delivery System
699(3)
Assessment-Based Bronchodilator Therapy Protocols
702(3)
Sample Protocol
702(1)
Assessing Patient Response
702(3)
Special Considerations
705(4)
Continuous Nebulization for Refractory Bronchospasm
705(1)
Aerosol Administration to Intubated Patients
706(3)
Controlling Environmental Contamination
709(6)
Chambers and Booths
710(1)
Personal Protective Equipment
711(4)
33 Storage and Delivery of Medical Gases
715(22)
Characteristics of Medical Gases
716(2)
Oxygen (O(2))
716(1)
Air
716(1)
Carbon Dioxide (CO(2))
717(1)
Helium (He)
717(1)
Nitrous Oxide (N(2)O)
717(1)
Nitric Oxide (NO)
718(1)
Storage of Medical Gases
718(6)
Gas Cylinders
718(4)
Bulk Oxygen
722(2)
Distribution and Regulation of Medical Gases
724(13)
Central Piping Systems
724(1)
Safety Indexed Connector Systems
724(3)
Regulating Gas Pressure and Flow
727(10)
34 Medical Gas Therapy
737(34)
Oxygen Therapy
738(25)
General Goals and Clinical Objectives
738(1)
Clinical Practice Guideline
738(1)
Assessing the Need for Oxygen Therapy
738(2)
Precautions and Hazards of Supplemental Oxygen
740(2)
Oxygen Delivery Systems: Design and Performance
742(1)
Low-Flow Systems
743(5)
Reservoir Systems
748(3)
High-Flow Systems
751(10)
Selecting a Delivery Approach
761(2)
Protocol-Based Oxygen Therapy
763(1)
Hyperbaric Oxygen Therapy
763(2)
Physiological Effects
763(1)
Methods of Administration
763(1)
Indications
764(1)
Complications and Hazards
765(1)
Problem-Solving and Troubleshooting
765(1)
Other Medical Gas Therapies
765(6)
Nitric Oxide Therapy
766(2)
Helium Therapy
768(3)
35 Lung Expansion Therapy
771(20)
Causes and Types of Atelectasis
772(1)
Who Needs Lung Expansion Therapy?
772(1)
What are the Clinical Signs of Atelectasis?
773(1)
How Does Lung Expansion Therapy Work?
773(1)
Incentive Spirometry
774(3)
Physiological Basis
774(1)
Indications
774(1)
Contraindications
775(1)
Hazards and Complications
775(1)
Equipment
775(1)
Administering Incentive Spirometry
776(1)
Intermittent Positive Pressure Breathing (IPPB)
777(6)
Definition and Physiological Principle
778(1)
Indications for IPPB
778(1)
Contraindications for IPPB
779(1)
Hazards and Complications for IPPB
779(1)
Administering IPPB
779(3)
Discontinuation and Follow-Up
782(1)
Monitoring and Troubleshooting
782(1)
Positive Airway Pressure Therapy
783(3)
Definitions and Physiological Principle
783(1)
Indications
783(1)
Contraindications
783(1)
Hazards and Complications
783(1)
Equipment
784(1)
Administering Intermittent CPAP
784(2)
Selecting an Approach
786(5)
36 Bronchial Hygiene Therapy
791(28)
Physiology of Airway Clearance
792(2)
Normal Clearance
792(1)
Abnormal Clearance
793(1)
Diseases Associated with Abnormal Clearance
794(1)
General Goals and Indications
794(1)
Bronchial Hygiene Therapy for Acute Conditions
795(1)
Bronchial Hygiene Therapy for Chronic Conditions
795(1)
Bronchial Hygiene Therapy to Prevent Retention of Secretions
795(1)
Determining the Need for Bronchial Hygiene Therapy
795(1)
Bronchial Hygiene Methods
796(15)
Postural Drainage Therapy
796(7)
Coughing and Related Expulsion Techniques
803(4)
Positive Airway Pressure Adjuncts
807(3)
High-Frequency Compression/Oscillation
810(1)
Mobilization and Exercise
811(1)
Selecting Bronchial Hygiene Techniques
811(1)
Selection Factors
811(1)
Clearance Strategies for Specific Conditions
812(1)
Protocol-Based Bronchial Hygiene
812(7)
SECTION 7 Acute and Critical Care 819(230)
37 Respiratory Failure and the Need for Ventilatory Support
819(14)
Respiratory Failure
820(3)
Acute Hypoxemic Respiratory Failure (Type I)
820(1)
Acute Hypercapnic Respiratory Failure (Type II)
821(1)
Chronic Hypercapnic Respiratory Failure: Type I and Type II
822(1)
Indications for Ventilatory Support
823(2)
Parameters Indicating the Need for Ventilatory Support
824(1)
Hypoxemic (Type I) Respiratory Failure
824(1)
Hypercapnic (Type II) Respiratory Failure
825(1)
Mechanisms of Hypercapnic Respiratory Failure
825(1)
Decreased Ventilatory Drive
825(1)
Respiratory Muscle Fatigue and Weakness
825(1)
Increased Work of Breathing
826(1)
Choosing a Ventilatory Support Strategy for Different Causes of Respiratory Failure
826(2)
Ventilatory Support in Hypoxemic Respiratory Failure
827(1)
Ventilatory Support in Hypercapnic Respiratory Failure
827(1)
Special Considerations During Ventilatory Support
828(1)
Increased Intracranial Pressure
828(1)
Obstructive Lung Disease (OLD)
828(1)
Less Frequently Used Modes of Ventilation
829(4)
Independent Lung Ventilation
829(1)
High-Frequency Ventilation
829(1)
Pressure Assist Ventilation
830(1)
Airway Pressure Ventilation and Pressure Release Ventilation
830(1)
Proportional Assist Ventilation
830(3)
38 Ventilator Modes and Functions
833(36)
How Ventilators Work
834(24)
Input Power
834(1)
Power Conversion and Transmission
835(1)
Control Scheme
836(15)
Output
851(2)
Alarm Systems
853(2)
Ventilator Classification
855(3)
Clinical Application of Ventilator Modes
858(11)
Continuous Mandatory Ventilation (CMV)
858(2)
Intermittent Mandatory Ventilation (IMV)
860(3)
Continuous Spontaneous Ventilation (CSV)
863(6)
39 Physics and Physiology of Ventilatory Support
869(24)
Spontaneous Breathing
870(1)
Negative Pressure Ventilation
870(1)
Positive Pressure Ventilation
870(1)
Physiological Effects of PPV on the Respiratory System
870(4)
Physiological Effects of Modes of Ventilation
874(5)
Volume Controlled Modes
874(1)
Pressure Controlled Modes
875(4)
Physiological Effects of Flow Pattern, Flow Rate, and Inspiratory Hold
879(1)
Physiological Effects of Triggering Mechanisms
879(1)
Positive End-Expiratory Pressure (PEEP)
879(2)
Air Trapping and Auto-PEEP
880(1)
Effects of Mode and Trigger Variable on Work of Breathing
881(2)
Detrimental Pulmonary Effects of PPV
883(2)
Alteration in V/Q ratio
883(1)
Relationship between Ventilation and Paco(2)
883(1)
Hyperventilation and Respiratory Alkalosis
884(1)
Lung Tissue Damage and Barotrauma
884(1)
Cardiovascular Effects of PPV
885(4)
Spontaneous versus Positive Pressure Ventilation
885(1)
Factors Affecting the Cardiovascular Effect of PPV
886(3)
Other Effects of PPV
889(4)
Renal Effects
889(1)
Hepatic and Gastrointestinal Effects
890(3)
40 Initiating and Adjusting Ventilatory Support
893(28)
The Management Process
894(1)
Airway Access
894(1)
Nonivasive Positive Pressure Ventilation
895(1)
Initial Ventilatory Support Settings
895(11)
Mode of Ventilatory Support
895(1)
Minute Ventilation: Tidal Volume and Rate
896(1)
Oxygen Concentration
899(1)
Trigger, or Sensitivity, Level
899(1)
Inspiratory Flow and Time
899(2)
Positive End-Expiratory Pressure
901(1)
Humidification and Airway Temperature
902(1)
Periodic Sights
903(1)
Limits and Alarms
903(1)
Adjustments of Ventilatory Support for Specific Disorders
904(2)
Preliminary Assessment and Data Gathering
906(2)
Patient-Ventilator Interaction
907(1)
Arterial Blood Gas Analysis
908(1)
Chest Radiograph
908(1)
Goal-Setting for Ventilator Support
908(1)
Adjusting Ventilatory Support Settings
909(12)
Adjusting Ventilation: Rate and Delivered Volume
909(2)
Adjusting Oxygenation
911(1)
Adjusting Mean Airway Pressure
912(1)
Adjusting Patient-Ventilator Interaction
913(5)
Adjusting the Alarm Settings
918(3)
41 Monitoring and Management of the Patient in the ICU
921(46)
General Principles of Monitoring
922(1)
Data Collection
922(1)
Data Analysis
922(1)
Decision-Making
922(1)
General Patient Assessment
923(4)
Vital Signs
923(2)
Physical Assessment
925(1)
Chest Radiographs
925(1)
Clinical Laboratory Studies
926(1)
Fluid Balance
926(1)
Nutrition
926(1)
Physiological Monitoring
927(15)
Assessing Oxygenation
928(1)
Adequacy of Pulmonary Oxygenation
928(1)
Efficiency of Pulmonary Oxygenation
929(1)
Adequacy of Tissue Oxygenation
930(1)
Assessing Ventilation
931(1)
Adequacy of Ventilation
932(3)
Efficiency of Ventilation
935(2)
Assessing Ventilatory Mechanics
937(1)
Use of C(eff) to Guide Selection of PEEP Levels
938(1)
Work of Breathing
939(1)
Assessing Ventilatory Capacity
940(1)
Respiratory Drive
940(1)
Respiratory Muscle Strength
940(1)
Respiratory Muscle Endurance and Fatigue
940(2)
Assessment of Hemodynamics
942(8)
Arterial Pressure Monitoring
942(1)
Pulmonary Artery Monitoring
943(5)
Cardiac Output Determinations
948(1)
Hemodynamic Profiles
949(1)
Pitfalls and Complications
949(1)
Management of the Patient-Ventilator System
950(17)
Routine Checks
950(1)
Components of a Patient-Ventilator System Check
951(2)
Documenting the Physician's Orders
953(1)
Verifying Proper Ventilator Operation
953(1)
Clinical Observations of the Patient
953(1)
Hazards and Complications
954(1)
Assessing Flow, Volume, and Pressure Waveforms
955(4)
Troubleshooting
959(4)
Transporting Patients Receiving Ventilatory Support
963(4)
42 Discontinuing Ventilatory Support
967(26)
Definitions
968(1)
Categories for Discontinuing Ventilatory Support
968(1)
Reasons for Ventilator Dependence
968(2)
Ventilatory Workload, or Demand
969(1)
Ventilatory Capacity
969(1)
Discontinuing Ventilatory Support
969(1)
Patient Evaluation
970(4)
The Most Important Criterion
970(1)
Ventilation
971(2)
Oxygenation
973(1)
Acid-Base Balance
973(1)
Metabolic Factors
973(1)
Renal Function and Electrolytes
973(1)
Cardiovascular Function
973(1)
Psychological Factors and CNS Assessment
973(1)
Integrated Indexes
974(1)
Evaluation of the Airway
974(1)
Preparing the Patient
974(2)
Optimizing the Patient's Medical Condition
974(2)
Methods
976(5)
Rapid Ventilator Discontinuance
976(1)
Patients Requiring Weaning
976(1)
T-Tube Trials
976(1)
IMV and SIMV
977(2)
Pressure Support Ventilation
979(1)
IMV/SIMV with PSV
979(1)
Continuous Positive Airway Pressure
980(1)
Mandatory Minute Volume Ventilation
980(1)
Newer Techniques
981(1)
Computer-Based Weaning
981(1)
Flow-by, Flow Trigger, and Tracheal Pressure Sensing
981(1)
Volume Support and Volume Assured Pressure Support
982(1)
Noninvasive Positive Pressure ventilation
982(1)
Other Techniques to Facilitate Weaning
982(1)
Selecting an Approach
982(2)
Monitoring the Patient During Weaning
984(2)
Ventilatory Status
984(2)
Extubation
986(2)
Effects of Artificial Airways Related to Weaning
986(2)
Failure
988(1)
Chronically Ventilator-Dependent Patients
988(2)
Terminal Weaning
990(3)
43 Neonatal and Pediatric Respiratory Care
993(56)
Development of the Respiratory System
994(1)
Transition from Uterine to Extrauterine Life
995(4)
Fetal Circulation
995(1)
Placental Circulation
995(2)
Cardiopulmonary Events at Birth
997(2)
Anatomical and Physiological Differences
999(2)
Anatomical Differences
999(1)
Physiological Differences
1000(1)
Assessment of the Newborn
1001(6)
Maternal Factors
1001(1)
Fetal Assessment
1001(1)
Evaluation of the Newborn
1002(4)
Respiratory Assessment of the Infant
1006(1)
General Management of the Critically III Neonate
1007(1)
Temperature Regulation
1008(1)
Fluid and Electrolyte Balance
1008(1)
Nutrition
1008(1)
Infection Control
1008(1)
Basic Respiratory Care
1008(7)
Oxygen Therapy
1009(1)
Bronchial Hygiene Therapy
1010(1)
Humidity and Aerosol Therapy
1011(1)
Aerosol Drug Therapy
1012(1)
Airway Management
1012(3)
Neonatal Resuscitation
1015(1)
Continuous Positive Airway Pressure
1015(2)
Methods of Administration
1016(1)
Mechanical Ventilation
1017(8)
Basic Principles
1017(2)
Initiation of Mechanical Ventilation
1019(1)
Assessment of Mechanical Ventilation
1020(2)
Weaning from CMV
1022(1)
High-Frequency Ventilation
1023(1)
Complications of Mechanical Ventilation
1024(1)
Extracorporeal Life Support
1025(3)
Neonatal-Pediatric Transport
1025(3)
Common Disorders of the Newborn
1028(7)
Meconium Aspiration Syndrome
1028(1)
Respiratory Distress Syndrome
1030(1)
Transient Tachypnea of the Newborn (TNN)
1031(2)
Apnea of Prematurity
1033(1)
Bronchopulmonary Dysplasia
1034(1)
Persistent Pulmonary Hypertension of the Newborn
1034(1)
Congenital Abnormalities Affecting Respiration
1034(1)
Pediatric Respiratory Disorders
1035(14)
Sudden Infant Death Syndrome (SIDS)
1035(2)
Gastroesophageal Reflux Disease
1037(1)
Bronchiolitis
1037(1)
Croup
1038(1)
Epiglottitis
1039(1)
Cystic Fibrosis (CF)
1040(1)
Asthma
1041(1)
Pneumonia
1041(1)
Acute Respiratory Failure
1042(1)
SECTION 8 Preventative and Long-Term Care 1049(92)
44 Patient Education and Health Promotion
1049(12)
Patient Education
1050(3)
Cognitive Domain
1050(1)
Affective Domain
1050(1)
Psychomotor Domain
1051(1)
Developing a Lesson Plan
1051(1)
Teaching Tips
1051(2)
The Teachable Moment
1053(1)
Caregiver Education
1053(1)
Practical Guidelines
1053(1)
Health Education
1053(2)
Health Promotion and Disease Prevention
1055(2)
Implications for Respiratory Care Practitioners
1057(1)
Healthcare Institutions
1057(1)
Work Site
1057(1)
Home
1057(1)
Community
1057(1)
Educational Institutions
1057(1)
Health Promotion, Disease Prevention and Medical Care Costs
1058(3)
45 Nutritional Aspects of Health and Disease
1061(22)
Maintaining Health through Good Nutrition
1062(4)
Dietary Guidelines
1062(2)
Macronutrients and Energy Requirements
1064(1)
Micronutrients and Dietary Supplements
1065(1)
Dietary Fiber
1066(1)
Fluid Intake
1066(1)
Malnutrition
1066(1)
Protein-Energy Malnutrition
1066(1)
Micronutrient Malnutrition
1066(1)
Respiratory Consequences of Malnutrition
1067(1)
Nutritional Assessment
1067(7)
History and Physical Examination
1068(1)
Anthropometry
1069(1)
Clinical Laboratory Tests
1069(1)
Pulmonary Function Parameters
1070(1)
Total Caloric Requirements
1070(4)
General Aspects of Nutritional Support
1074(3)
Meeting Overall Energy Needs
1074(1)
Providing the Appropriate Combination of Substrates
1074(1)
Timing of Nutritional Support
1075(1)
Routes of Administration
1075(1)
Nutritional Support in Specific Circumstances
1077(6)
General Guidelines for Critically III Patients
1077(1)
Systemic Inflammatory Response Syndrome
1077(1)
Mechanical Ventilation
1078(1)
Chronic Obstructive Pulmonary Disease
1078(1)
Cystic Fibrosis
1079(4)
46 Cardiopulmonary Rehabilitation
1083(20)
Definitions and Goals
1084(1)
Historical Perspective
1084(1)
Scientific Bases
1084(4)
Physical Reconditioning
1084(1)
Psychosocial Support
1085(3)
Pulmonary Rehabilitation Programming
1088(15)
Program Goals and Objectives
1088(1)
Benefits and Potential Hazards
1089(1)
Patient Evaluation and Selection
1090(3)
Program Design
1093(5)
Program Implementation
1098(2)
Cost, Fees, and Reimbursement
1100(1)
Program Results
1101(2)
47 Respiratory Care in Alternative Settings
1103(38)
Definitions and Goals
1104(3)
Subacute Care
1104(1)
Home Care
1105(2)
Standards
1107(1)
Governmental Laws and Regulations
1107(1)
Private Sector Accreditation
1107(1)
Traditional Acute Care Versus Postacute Care
1107(1)
Discharge Planning
1107(4)
Multidisciplinary Team
1108(1)
Site and Support Service Evaluation
1108(3)
Oxygen Therapy in Alternative Settings
1111(9)
The Oxygen Therapy Prescription
1111(1)
Supply Methods
1111(6)
Delivery Methods
1117(3)
Ventilatory Support in Alternative Settings
1120(9)
Patient Selection
1120(1)
Settings and Approaches
1120(1)
Standards and Guidelines
1121(1)
Special Challenges in Providing Home Ventilatory Support
1122(1)
Invasive versus Noninvasive Ventilatory Support
1122(3)
Equipment
1125(4)
Evaluation and Followup
1129(1)
Other Modes of Postacute Respiratory Care
1129(4)
Bland Aerosol Therapy
1129(1)
Aerosol Drug Administration
1129(1)
Airway Care and Clearance Methods
1130(1)
Nasal CPAP (Continuous Positive Airway Pressure)
1130(2)
Apnea Monitoring
1132(1)
Patient Assessment and Documentation
1133(3)
Institutional Subacute and Long-Term Care
1133(3)
Home Care
1136(1)
Equipment Disinfection and Maintenance
1136(5)
Appendixes 1141(12)
Appendix 1 Temperature Correction of Barometric Reading 1141(1)
Appendix 2 Factors to Convert Gas Volumes from ATPS to STPD 1142(1)
Appendix 3 Factors to Convert Gas Volumes from STPD to BTPS at Given Barometric Pressures 1143(1)
Appendix 4 Table of Normal Values 1144(3)
Appendix 5 Guidelines and Consensus Statements Pertinent to Respiratory Care Practice 1147(6)
Glossary 1153(48)
Index 1201

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