BOOK
SPEC - Egan's Fundamentals of Respiratory Care,12-Month Access, eBook
Robert M. Kacmarek | James K. Stoller | Al Heuer
(2016)
Additional Information
Book Details
Abstract
Designed for optimal student learning for over 40 years, Egan’s Fundamentals of Respiratory Care, 11th Edition provides you with the strong background you need to succeed in the field of respiratory care. Nicknamed "the Bible for respiratory care," it helps you gain a thorough understanding of the role of respiratory therapists, the scientific basis for treatment, and clinical applications. Comprehensive chapters correlate to the most up-to-date 2015 NBRC Detailed Content Outline for the TM-CE to successfully prepare you for clinical and credentialing exam success. Always in step with the ever-changing field of respiratory care, this easy-to-read new edition features five new chapters, as well as new information on online charting systems, patient databases, research databases, meaningful use, simulation, and an expanded discussion of the electronic medical record system.
- User-friendly full-color design calls attention to special features to enhance learning.
- Evolve learning resources include PowerPoint slides, Test Bank questions, an English-Spanish glossary, an image collection, a Body Spectrum Anatomy Coloring Book, and student lecture notes that enhance instructors’ teaching and students’ learning.
- Student Workbook reflects the text’s updated content and serves as a practical study guide offering numerous case studies, experiments, and hands-on activities.
- Therapist-Driven Protocols (TDPs) used by RTs in hospitals to assess a patient, initiate care, and evaluate outcomes, are incorporated throughout the text to develop your critical thinking skills and teach the value of following an established protocol.
- Expert authorship from the leading figures in respiratory care ensures that critical content is covered thoroughly and accurately.
- Excerpts of 40 published Clinical Practice Guidelines provide you with important information regarding patient care, indications/contraindications, hazards and complications, assessment of need, and assessment of outcome and monitoring.
- UNIQUE! Egan's trusted reputation as the preeminent fundamental respiratory care textbook for more than 40 years maintains its student focus and comprehensive coverage while keeping in step with the profession.
- Updated content reflects changes in the industry to ensure it is both current and clinically accurate and prepares you for a career as a respiratory therapist in today’s health care environment.
- UNIQUE! Mini Clinis give you an opportunity to apply text content to actual patient care through short, critical-thinking case scenarios. Mini Clinis can also be used as a point of focus in class discussion to strengthen students' critical thinking skills.
- UNIQUE! Rules of Thumb highlight rules, formulas, and key points that are important to clinical practice.
- Bulleted learning objectives aligned with summary checklists to highlight key content at the beginning and at the end of each chapter, paralleling the three areas tested on the 2015 NBRC Therapist Multiple-Choice Examination: recall, analysis, and application.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Half title page | i | ||
| Evolve page | ii | ||
| Egan's Fundamentals of Respiratory Care | iii | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vi | ||
| Reviewers | x | ||
| Preface | xi | ||
| Organization | xi | ||
| Features | xi | ||
| New to This Edition | xi | ||
| Learning Aids | xii | ||
| Workbook | xii | ||
| For the Instructor | xii | ||
| Evolve Resources | xii | ||
| Table Of Contents | xiii | ||
| I Foundations of Respiratory Care | 1 | ||
| 1 History of Respiratory Care | 2 | ||
| Chapter Outline | 2 | ||
| Chapter Objectives | 2 | ||
| Key Terms | 2 | ||
| Definitions | 3 | ||
| History of Respiratory Medicine and Science | 3 | ||
| Ancient Times | 3 | ||
| The Middle Ages, the Renaissance, and the Enlightenment Period | 6 | ||
| Nineteenth and Early Twentieth Centuries | 7 | ||
| Development of the Respiratory Care Profession | 7 | ||
| Clinical Advances in Respiratory Care | 7 | ||
| Oxygen Therapy | 7 | ||
| Aerosol Medications | 8 | ||
| Mechanical Ventilation | 8 | ||
| Airway Management | 10 | ||
| Cardiopulmonary Diagnostics and Pulmonary Function Testing | 10 | ||
| Professional Organizations and Events | 10 | ||
| American Association for Respiratory Care (AARC) | 10 | ||
| Respiratory Care Week | 11 | ||
| Fellow of the American Association for Respiratory Care (FAARC) | 12 | ||
| Board of Medical Advisors (BOMA) | 12 | ||
| American Respiratory Care Foundation (ARCF) | 12 | ||
| International Council for Respiratory Care (ICRC) | 12 | ||
| National Board for Respiratory Care (NBRC) | 12 | ||
| Committee on Accreditation for Respiratory Care (CoARC) | 13 | ||
| Respiratory Care Education | 13 | ||
| Future of Respiratory Care | 14 | ||
| 2015 and Beyond | 14 | ||
| Summary Checklist | 16 | ||
| References | 16 | ||
| 2 Delivering Evidence-Based Respiratory Care | 18 | ||
| Chapter Outline | 18 | ||
| Chapter Objectives | 18 | ||
| Key Terms | 18 | ||
| Elements of a Hospital-Based Respiratory Care Program: Roles Supporting Quality Care | 19 | ||
| Medical Direction | 19 | ||
| Respiratory Therapists | 19 | ||
| Designations and Credentials of Respiratory Therapists | 19 | ||
| Professionalism | 21 | ||
| Technical Direction | 22 | ||
| Respiratory Care Protocols | 22 | ||
| Evidence-Based Medicine | 30 | ||
| Summary Checklist | 33 | ||
| References | 33 | ||
| 3 Quality, Patient Safety, Communication, and Recordkeeping | 35 | ||
| Chapter Outline | 35 | ||
| Chapter Objectives | 35 | ||
| Key Terms | 36 | ||
| Quality Considerations | 36 | ||
| What Is Quality? | 36 | ||
| The Methods of Quality Improvement | 36 | ||
| Plan-Do-Study-Act Cycle | 37 | ||
| Plan Phase | 37 | ||
| Do Phase | 37 | ||
| Study (or Check) Phase | 38 | ||
| Act Phase | 38 | ||
| The Plan-Do-Study-Act Cycle Starts Over | 38 | ||
| Six Sigma | 38 | ||
| Origin of the Term Six Sigma | 38 | ||
| Lean Management | 38 | ||
| What Is Quality in Health Care? | 39 | ||
| Disease Management | 40 | ||
| Monitoring Quality in Respiratory Care | 40 | ||
| Peer Review Organizations | 42 | ||
| Safety Considerations | 42 | ||
| Patient Movement and Ambulation | 42 | ||
| Basic Body Mechanics | 42 | ||
| Moving the Patient in Bed | 43 | ||
| Ambulation | 43 | ||
| Electrical Safety | 44 | ||
| Fundamentals of Electricity | 44 | ||
| Preventing Shock Hazards | 47 | ||
| Ground Electrical Equipment Near the Patient | 47 | ||
| Fire Hazards | 47 | ||
| General Safety Concerns | 48 | ||
| Direct Patient Environment | 48 | ||
| Disaster Preparedness | 48 | ||
| Magnetic Resonance Imaging Safety | 48 | ||
| Medical Gas Cylinders | 48 | ||
| Communication | 49 | ||
| Communication in Health Care | 49 | ||
| Factors Affecting Communication | 50 | ||
| Improving Communication Skills | 50 | ||
| Practitioner as Sender | 51 | ||
| Practitioner as Receiver and Listener | 51 | ||
| Providing Feedback | 52 | ||
| Minimizing Barriers to Communication | 52 | ||
| Conflict and Conflict Resolution | 53 | ||
| Sources of Conflict | 53 | ||
| Poor Communication | 53 | ||
| Structural Problems | 53 | ||
| Personal Behavior | 53 | ||
| Role Conflict | 53 | ||
| Conflict Resolution | 53 | ||
| Competing | 53 | ||
| Accommodating | 53 | ||
| Avoiding | 53 | ||
| Collaborating | 53 | ||
| Compromising | 53 | ||
| Recordkeeping | 54 | ||
| Components of a Traditional Medical Record | 54 | ||
| Legal Aspects of Recordkeeping | 54 | ||
| Practical Aspects of Recordkeeping | 54 | ||
| Problem-Oriented Medical Record | 56 | ||
| Summary Checklist | 58 | ||
| References | 58 | ||
| 4 Principles of Infection Prevention and Control | 59 | ||
| Chapter Outline | 59 | ||
| Chapter Objectives | 59 | ||
| Key Terms | 59 | ||
| Spread of Infection | 60 | ||
| Sources of Infectious Agents | 60 | ||
| Susceptible Hosts | 60 | ||
| Modes of Transmission | 60 | ||
| Contact Transmission | 61 | ||
| Droplet Transmission | 61 | ||
| Airborne Transmission | 61 | ||
| Miscellaneous Types of Aerosol Transmission | 61 | ||
| Other Sources of Infection Not Involving Person-to-Person Transmission | 62 | ||
| Infection Prevention Strategies | 62 | ||
| Creating a Safe Culture | 62 | ||
| Maintaining a Healthy Workforce | 62 | ||
| Eliminating the Source of Pathogens | 63 | ||
| Interrupting Transmission | 63 | ||
| Standard Precautions | 63 | ||
| Hand Hygiene | 63 | ||
| Gloves | 63 | ||
| Mouth, Nose, Eye, and Face Protection | 63 | ||
| Respiratory Protection | 64 | ||
| Gowns, Aprons, and Protective Apparel | 64 | ||
| Cough Etiquette | 64 | ||
| Transmission-Based Precautions | 65 | ||
| Protective Environment | 68 | ||
| Transport of Infected Patients | 68 | ||
| Medical Devices and Bundles | 68 | ||
| Disinfection and Sterilization | 68 | ||
| Spaulding Approach to Disinfection and Sterilization of Patient Care Equipment | 68 | ||
| Cleaning | 69 | ||
| Disinfection | 70 | ||
| Chemical Disinfection | 70 | ||
| Sterilization | 70 | ||
| Steam Sterilization | 71 | ||
| Immediate Use Sterilization | 72 | ||
| Low-Temperature Sterilization Technologies | 72 | ||
| Equipment Handling Procedures | 73 | ||
| Maintenance of In-Use Equipment | 73 | ||
| Nebulizers | 73 | ||
| Ventilators and Ventilator Circuits | 73 | ||
| Bag-Mask Devices | 74 | ||
| Suction Systems | 74 | ||
| Oxygen Therapy Apparatus | 74 | ||
| Pulmonary Function Equipment | 74 | ||
| Other Respiratory Care Devices | 74 | ||
| Processing Reusable Equipment | 74 | ||
| Respiratory Care Equipment | 74 | ||
| Disposable Equipment | 76 | ||
| Fluids and Medications Precautions | 76 | ||
| Handling Contaminated Articles and Equipment | 76 | ||
| Handling Laboratory Specimens | 77 | ||
| Surveillance for Hospital-Acquired Infections | 77 | ||
| Summary Checklist | 79 | ||
| References | 79 | ||
| 5 Ethical and Legal Implications of Practice | 81 | ||
| Chapter Outline | 81 | ||
| Chapter Objectives | 81 | ||
| Key Terms | 82 | ||
| Philosophical Foundations of Ethics | 82 | ||
| Ethical Dilemmas of Practice | 83 | ||
| Codes of Ethics | 83 | ||
| Ethical Theories and Principles | 84 | ||
| Autonomy | 85 | ||
| Veracity | 85 | ||
| Nonmaleficence | 85 | ||
| Beneficence | 86 | ||
| Confidentiality | 86 | ||
| Justice | 88 | ||
| Role Duty | 88 | ||
| Ethical Viewpoints and Decision Making | 88 | ||
| Formalism | 88 | ||
| Consequentialism | 88 | ||
| Mixed Approaches | 89 | ||
| Virtue Ethics | 90 | ||
| Intuitionism | 90 | ||
| Comprehensive Decision-Making Models | 91 | ||
| Legal Issues Affecting Respiratory Care | 91 | ||
| Systems of Law | 92 | ||
| Public (Criminal and Administrative) Law | 92 | ||
| Civil Law | 92 | ||
| Tort Law. | 92 | ||
| Professional Negligence. | 92 | ||
| Malpractice. | 94 | ||
| Intentional Torts. | 94 | ||
| Strict Liability. | 94 | ||
| Breach of Contract. | 95 | ||
| Civil Suits. | 95 | ||
| Avoiding Lawsuits | 95 | ||
| Health Insurance Portability and Accountability Act of 1996 | 96 | ||
| Medical Supervision | 96 | ||
| Scope of Practice | 97 | ||
| Basic Elements of a Practice Act. | 97 | ||
| Licensure Laws and Regulations. | 97 | ||
| Providing Emergency Care Without Physician Direction. | 97 | ||
| Interaction of Ethics and the Law | 98 | ||
| Professional Licensure Issues | 98 | ||
| Licensure Statute | 98 | ||
| Section 3758.5. Reporting Violations | 98 | ||
| California Respiratory Care Practice Act | 98 | ||
| Section 3758.6. Report on Supervisor | 98 | ||
| Understanding the Causes of Discipline | 98 | ||
| Engaging Counsel | 99 | ||
| Respiratory Therapists Who Speak Out About Wrongdoing | 99 | ||
| Patient Protection and Affordable Care Act | 99 | ||
| National Labor Relations Act | 99 | ||
| False Claims Act | 100 | ||
| Health Care and Change | 100 | ||
| Health Care Advance Directives | 100 | ||
| Summary Checklist | 100 | ||
| References | 101 | ||
| 6 Physical Principles of Respiratory Care | 102 | ||
| Chapter Outline | 102 | ||
| Chapter Objectives | 102 | ||
| Key Terms | 102 | ||
| States of Matter | 103 | ||
| Internal Energy of Matter | 103 | ||
| Laws of Thermodynamics | 103 | ||
| Heat Transfer | 103 | ||
| Conduction | 103 | ||
| Convection | 104 | ||
| Radiation | 104 | ||
| Evaporation and Condensation | 104 | ||
| Temperature | 104 | ||
| Absolute Zero | 104 | ||
| Temperature Scales | 104 | ||
| Change of State | 105 | ||
| Liquid-Solid Phase Changes (Melting and Freezing) | 105 | ||
| Melting | 105 | ||
| Freezing | 106 | ||
| Properties of Liquids | 106 | ||
| Pressure in Liquids | 106 | ||
| Buoyancy (Archimedes’ Principle) | 107 | ||
| Viscosity | 107 | ||
| Cohesion and Adhesion | 108 | ||
| Surface Tension | 108 | ||
| Capillary Action | 109 | ||
| Liquid-Vapor Phase Changes | 109 | ||
| Boiling | 110 | ||
| Evaporation, Vapor Pressure, and Humidity | 110 | ||
| Influence of Temperature. | 111 | ||
| Humidity. | 111 | ||
| Influence of Pressure. | 113 | ||
| Influence of Surface Area. | 113 | ||
| Properties of Gases | 113 | ||
| Kinetic Activity of Gases | 113 | ||
| Molar Volume and Gas Density | 113 | ||
| Molar Volume. | 113 | ||
| Density. | 114 | ||
| Gaseous Diffusion | 114 | ||
| Gas Pressure | 114 | ||
| Measuring Atmospheric Pressure. | 114 | ||
| Clinical Pressure Measurements. | 115 | ||
| Partial Pressures (Dalton’s Law) | 116 | ||
| Solubility of Gases in Liquids (Henry’s Law) | 117 | ||
| Gas Behavior Under Changing Conditions | 117 | ||
| Gas Laws | 117 | ||
| Effect of Water Vapor | 117 | ||
| Corrected Pressure Computations | 118 | ||
| Correction Factors | 119 | ||
| Properties of Gases at Extremes of Temperature and Pressure | 119 | ||
| Critical Temperature and Pressure | 119 | ||
| Fluid Dynamics | 120 | ||
| Pressures in Flowing Fluids | 120 | ||
| Patterns of Flow | 121 | ||
| Laminar Flow | 121 | ||
| Turbulent Flow | 121 | ||
| Transitional Flow | 122 | ||
| Flow, Velocity, and Cross-Sectional Area | 122 | ||
| Bernoulli Principle | 123 | ||
| Fluid Entrainment | 123 | ||
| Fluidics and the Coanda Effect | 123 | ||
| Summary Checklist | 124 | ||
| References | 125 | ||
| 7 E-Medicine in Respiratory Care | 126 | ||
| Chapter Outline | 126 | ||
| Chapter Objectives | 126 | ||
| Key Terms | 126 | ||
| The Electronic Health Record and the Electronic Medical Record | 127 | ||
| Computerized Physician Order Entry | 127 | ||
| Enterprise Software Packages | 127 | ||
| Applications in Patient Care | 129 | ||
| Applications in Diagnostics | 129 | ||
| Hemodynamic Monitoring | 129 | ||
| Blood Gas Laboratories and Point-of-Care Applications | 129 | ||
| Medical Imaging and Picture Archiving and Communication Systems | 129 | ||
| Pulmonary Function Testing and Interpretation | 129 | ||
| Interpretation of Pulmonary Function Tests | 129 | ||
| Applications in Treatment | 130 | ||
| Applications in the Acute Care Setting | 130 | ||
| Mechanical Ventilators. | 130 | ||
| Therapist-Driven Protocols. | 130 | ||
| Applications in Nonacute Care Settings and Chronic Diseases | 130 | ||
| Asthma. | 131 | ||
| Chronic Obstructive Pulmonary Disease. | 131 | ||
| Applications in Disease Prevention | 131 | ||
| Treatment of Tobacco Use and Dependence | 132 | ||
| Education of the Public and Health Care Consumer | 132 | ||
| Informatics and Clinical Decision Support | 132 | ||
| Business Intelligence | 132 | ||
| Clinical Decision Support | 133 | ||
| Evidence Supporting Clinical Decision Support | 133 | ||
| Mobile Applications | 133 | ||
| Administrative Decision Support | 133 | ||
| American Association for Respiratory Care Benchmarking System | 134 | ||
| Research | 134 | ||
| Telemedicine and Telemonitoring | 134 | ||
| Sources of Health Information | 135 | ||
| Health Information Sources for Respiratory Therapists and Other Clinicians | 135 | ||
| Health Information Sources for Consumers | 135 | ||
| Applications in Health Care Administration | 135 | ||
| Documentation, Workload, Staffing, and Scheduling | 136 | ||
| Financial Management | 136 | ||
| Quality Assurance | 136 | ||
| Regulatory Compliance | 138 | ||
| Web Analytics | 138 | ||
| Human Resources | 138 | ||
| Privacy and Confidentiality | 138 | ||
| Applications in Training and Education | 139 | ||
| Clinical Simulations | 139 | ||
| Full-Scale Physiologic Clinical Simulators | 140 | ||
| Clinical Education Applications | 140 | ||
| National Board for Respiratory Care Credentialing | 140 | ||
| Learning Management Systems | 141 | ||
| American Association for Respiratory Care | 141 | ||
| Future of E-Medicine | 143 | ||
| Summary Checklist | 143 | ||
| References | 143 | ||
| 8 Fundamentals of Respiratory Care Research | 146 | ||
| Chapter Outline | 146 | ||
| Chapter Objectives | 146 | ||
| Key Terms | 146 | ||
| Overview of Respiratory Care Research | 146 | ||
| The Importance of Research in Health Care | 147 | ||
| How to Review the Literature | 147 | ||
| Bibliographic Databases | 147 | ||
| Synthesized Databases | 148 | ||
| Portals | 148 | ||
| Electronic Journals and Books | 148 | ||
| General Internet Resources | 148 | ||
| Suggestions for Conducting Searches | 148 | ||
| How to be a Scientist | 148 | ||
| How to Develop a Study Idea | 148 | ||
| How to Write a Study Protocol | 150 | ||
| How to Analyze the Data | 150 | ||
| How to Get a Scientific Paper Published | 151 | ||
| How to Write the Abstract | 151 | ||
| How to Make a Poster | 151 | ||
| How to Write a Paper | 153 | ||
| How to Respond to Reviews | 155 | ||
| Summary | 155 | ||
| Summary Checklist | 156 | ||
| References | 156 | ||
| II Applied Anatomy and Physiology | 157 | ||
| 9 The Respiratory System | 158 | ||
| Chapter Outline | 158 | ||
| Chapter Objectives | 158 | ||
| Key Terms | 158 | ||
| Development of the Respiratory System | 159 | ||
| Transition From Uterine to Extrauterine Life | 164 | ||
| Placental Structure and Function | 164 | ||
| Fetal Circulation | 165 | ||
| Cardiopulmonary Events at Birth | 166 | ||
| Postnatal Lung Development | 168 | ||
| Upper Airway | 168 | ||
| Lower Airway and Alveoli | 169 | ||
| Development of Vascular, Lymphatic, and Nervous Systems | 169 | ||
| Chest Wall Development, Diaphragm, and Lung Volume | 169 | ||
| Respiratory System in the Adult | 171 | ||
| Surface Features of the Thorax | 171 | ||
| Components of the Thoracic Wall | 171 | ||
| Rib Movement | 175 | ||
| Respiratory Muscles | 175 | ||
| Pleural Membranes, Space, and Fluid | 180 | ||
| Mediastinum | 181 | ||
| Lungs | 181 | ||
| Pulmonary Vascular, Lymphatic, and Nervous Systems | 183 | ||
| Pulmonary Circulation | 183 | ||
| Respiratory Function of Pulmonary Circulation | 184 | ||
| Nonrespiratory Function of the Pulmonary Circulation | 185 | ||
| Bronchial Circulation | 185 | ||
| Lymphatics | 185 | ||
| Nervous Control of the Lungs | 186 | ||
| Efferent Pathways | 186 | ||
| Afferent Pathways | 188 | ||
| Anatomy of the Respiratory Tract | 189 | ||
| Upper Respiratory Tract | 189 | ||
| Nasal Cavity and Sinuses | 189 | ||
| Oral Cavity | 191 | ||
| Pharynx | 191 | ||
| Larynx | 192 | ||
| Speech. | 193 | ||
| Breath Hold, Effort Closure, and Cough. | 194 | ||
| Patent Upper Airway | 194 | ||
| Lower Respiratory Tract | 195 | ||
| Trachea and Bronchi | 195 | ||
| Lobar and Segmental Pulmonary Anatomy | 197 | ||
| Histology of the Airway Wall | 197 | ||
| Respiratory Zone Airways | 200 | ||
| Alveoli | 201 | ||
| Blood-Gas Barrier | 202 | ||
| Summary Checklist | 206 | ||
| References | 207 | ||
| 10 The Cardiovascular System | 209 | ||
| Chapter Outline | 209 | ||
| Chapter Objectives | 209 | ||
| Key Terms | 209 | ||
| Functional Anatomy | 209 | ||
| Heart | 209 | ||
| Anatomy of the Heart | 209 | ||
| Properties of the Heart Muscle | 213 | ||
| Microanatomy of the Heart Muscle | 213 | ||
| Vascular System | 214 | ||
| Systemic Circulation | 214 | ||
| Vascular Resistance | 215 | ||
| Determinants of Blood Pressure | 216 | ||
| Control of the Cardiovascular System | 217 | ||
| Regulation of Peripheral Vasculature | 217 | ||
| Local Control | 217 | ||
| Central Control | 217 | ||
| Regulation of Cardiac Output | 217 | ||
| Changes in Stroke Volume | 217 | ||
| Changes in Heart Rate | 220 | ||
| Cardiovascular Control Mechanisms | 220 | ||
| Cardiovascular Control Centers | 220 | ||
| Peripheral Receptors | 222 | ||
| Response to Changes in Overall Volume | 223 | ||
| Events of the Cardiac Cycle | 223 | ||
| Summary Checklist | 225 | ||
| References | 225 | ||
| Bibliography | 225 | ||
| 11 Ventilation | 226 | ||
| Chapter Outline | 226 | ||
| Chapter Objectives | 226 | ||
| Key Terms | 226 | ||
| Mechanics of Ventilation | 227 | ||
| Pressure Differences During Breathing | 227 | ||
| Forces Opposing Inflation of the Lung | 229 | ||
| Surface Tension Forces | 229 | ||
| Elastic Forces Opposing Lung Inflation | 230 | ||
| Compliance | 231 | ||
| Combined Compliances | 233 | ||
| Resistive Forces Opposing Lung Inflation | 233 | ||
| Tissue Viscous Resistance. | 233 | ||
| Airway Resistance. | 233 | ||
| Combined Resistances | 233 | ||
| Factors Affecting Resistance. | 234 | ||
| Distribution of Resistance. | 234 | ||
| Static Versus Dynamic Mechanics | 235 | ||
| Mechanics of Exhalation | 235 | ||
| Work of Breathing | 236 | ||
| Mechanical Work | 237 | ||
| Metabolic Work | 238 | ||
| Distribution of Ventilation | 239 | ||
| Regional Factors Affecting Distribution | 240 | ||
| Differences in Thoracic Expansion | 240 | ||
| Transpulmonary Pressure Gradients | 240 | ||
| Local Factors Affecting Distribution | 241 | ||
| Time Constants | 241 | ||
| Frequency Dependence of Compliance | 241 | ||
| Efficiency and Effectiveness of Ventilation | 242 | ||
| Efficiency | 242 | ||
| Minute Ventilation | 242 | ||
| Alveolar Ventilation | 243 | ||
| Anatomic Dead Space | 243 | ||
| Alveolar Dead Space | 243 | ||
| Physiologic Dead Space | 243 | ||
| Ratio of Dead Space to Tidal Volume | 243 | ||
| Effectiveness | 245 | ||
| Summary Checklist | 245 | ||
| References | 246 | ||
| 12 Gas Exchange and Transport | 247 | ||
| Chapter Outline | 247 | ||
| Chapter Objectives | 247 | ||
| Key Terms | 247 | ||
| Diffusion | 248 | ||
| Whole-Body Diffusion Gradients | 248 | ||
| Determinants of Alveolar Gas Tensions | 248 | ||
| Alveolar Carbon Dioxide | 248 | ||
| Alveolar Oxygen Tensions | 249 | ||
| Changes in Alveolar Gas Partial Tensions | 249 | ||
| Mechanism of Diffusion | 250 | ||
| Barriers to Diffusion | 250 | ||
| Fick’s First Law of Diffusion | 250 | ||
| Pulmonary Diffusion Gradients | 251 | ||
| Time Limits to Diffusion | 251 | ||
| Systemic Diffusion Gradients | 252 | ||
| Variations from Ideal Gas Exchange | 252 | ||
| Anatomic Shunts | 252 | ||
| Inequalities in Ventilation and Perfusion | 252 | ||
| Ventilation-Perfusion Ratio | 252 | ||
| Effect of Alterations in Ventilation-Perfusion Ratio | 252 | ||
| Causes of Regional Differences in Ventilation-Perfusion Ratio | 253 | ||
| Oxygen Transport | 254 | ||
| Chemically Combined Oxygen (Oxyhemoglobin) | 254 | ||
| Hemoglobin and Oxygen Transport | 254 | ||
| Hemoglobin Saturation | 255 | ||
| Total Oxygen Content of the Blood | 255 | ||
| Oxyhemoglobin Dissociation Curve | 255 | ||
| Normal Loading and Unloading of Oxygen (Arteriovenous Differences) | 257 | ||
| Fick Equation | 258 | ||
| Factors Affecting Oxygen Loading and Unloading | 258 | ||
| pH (Bohr Effect) | 258 | ||
| Body Temperature | 258 | ||
| Organic Phosphates (2,3-Diphosphoglycerate) | 259 | ||
| Abnormal Hemoglobin | 259 | ||
| Measurement of Hemoglobin Affinity for Oxygen | 260 | ||
| Carbon Dioxide Transport | 260 | ||
| Transport Mechanisms | 260 | ||
| Dissolved in Physical Solution | 260 | ||
| Chemically Combined With Protein | 260 | ||
| Ionized as Bicarbonate | 260 | ||
| Carbon Dioxide Dissociation Curve | 262 | ||
| Abnormalities of Gas Exchange and Transport | 263 | ||
| Impaired Oxygen Delivery | 263 | ||
| Hypoxemia | 263 | ||
| Decreased Partial Pressure of Oxygen in Arterial Blood. | 263 | ||
| Hemoglobin Deficiencies. | 266 | ||
| Reduction in Blood Flow (Shock or Ischemia) | 266 | ||
| Circulatory Failure (Shock). | 266 | ||
| Local Reductions in Perfusion (Ischemia). | 266 | ||
| Dysoxia | 266 | ||
| Impaired Carbon Dioxide Removal | 267 | ||
| Inadequate Minute Ventilation | 267 | ||
| Increased Dead Space Ventilation | 267 | ||
| Ventilation-Perfusion Imbalances | 267 | ||
| Summary Checklist | 268 | ||
| References | 268 | ||
| 13 Solutions, Body Fluids, and Electrolytes | 269 | ||
| Chapter Outline | 269 | ||
| Chapter Objectives | 269 | ||
| Key Terms | 269 | ||
| Solutions, Colloids, and Suspensions | 270 | ||
| Definition of a Solution | 270 | ||
| Concentration of Solutions | 271 | ||
| Starling Forces | 271 | ||
| Osmotic Pressure of Solutions | 272 | ||
| Quantifying Solute Content and Activity | 272 | ||
| Equivalent Weights | 273 | ||
| Gram Equivalent Weight Values. | 273 | ||
| Gram Equivalent Weight of an Acid. | 273 | ||
| Gram Equivalent Weight of a Base. | 273 | ||
| Conversion of Gram Weight to Equivalent Weight. | 274 | ||
| Milligram Equivalent Weights. | 274 | ||
| Solute Content by Weight | 274 | ||
| Calculating Solute Content | 274 | ||
| Quantitative Classification of Solutions | 274 | ||
| Dilution Calculations | 274 | ||
| Electrolytic Activity and Acid-Base Balance | 275 | ||
| Characteristics of Acids, Bases, and Salts | 275 | ||
| Acids | 275 | ||
| Acids With Single Ionizable Hydrogen. | 275 | ||
| Acids With Multiple Ionizable Hydrogens. | 275 | ||
| Bases | 275 | ||
| Hydroxide Bases. | 275 | ||
| Nonhydroxide Bases. | 275 | ||
| Ammonia. | 276 | ||
| Carbonates. | 276 | ||
| Protein Bases. | 276 | ||
| Designation of Acidity and Alkalinity | 277 | ||
| Nanomolar Concentrations | 277 | ||
| pH Scale | 277 | ||
| Body Fluids and Electrolytes | 278 | ||
| Body Water | 278 | ||
| Distribution | 278 | ||
| Composition | 278 | ||
| Regulation | 278 | ||
| Water Losses. | 278 | ||
| Water Replacement. | 279 | ||
| Ingestion. | 279 | ||
| Metabolism. | 279 | ||
| Transport Between Compartments | 279 | ||
| Electrolytes | 280 | ||
| Sodium (Na+) | 280 | ||
| Chloride (Cl−) | 281 | ||
| Bicarbonate (HCO3−) | 281 | ||
| Potassium (K+) | 282 | ||
| Calcium (Ca++) | 283 | ||
| Magnesium (Mg++) | 283 | ||
| Phosphorus (P) | 283 | ||
| Summary Checklist | 283 | ||
| References | 284 | ||
| 14 Acid-Base Balance | 285 | ||
| Chapter Outline | 285 | ||
| Chapter Objectives | 285 | ||
| Key Terms | 285 | ||
| Hydrogen Ion Regulation in Body Fluids | 286 | ||
| Strong and Weak Acids and Bases: Equilibrium Constants | 286 | ||
| Buffer Solution Characteristics | 287 | ||
| Bicarbonate and Nonbicarbonate Buffer Systems | 287 | ||
| pH of a Buffer System: Henderson-Hasselbalch Equation | 288 | ||
| Clinical Use of Henderson-Hasselbalch Equation | 288 | ||
| Physiologic Roles of Bicarbonate and Nonbicarbonate Buffer Systems | 289 | ||
| Bicarbonate Buffer System | 289 | ||
| Nonbicarbonate Buffer System | 290 | ||
| Acid Excretion | 290 | ||
| Lungs | 290 | ||
| Kidneys | 290 | ||
| Basic Kidney Function | 291 | ||
| Reabsorption of Bicarbonate Ion | 291 | ||
| Excess Hydrogen Ion Excretion and Role of Urinary Buffers | 292 | ||
| Acid-Base Disturbances | 294 | ||
| Normal Acid-Base Balance | 294 | ||
| Primary Respiratory Disturbances | 294 | ||
| Primary Metabolic (Nonrespiratory) Disturbances | 294 | ||
| Compensation: Restoring pH to Normal | 295 | ||
| Effect of the Carbon Dioxide Hydration Reaction on [HCO3−] | 295 | ||
| Clinical Acid-Base States | 295 | ||
| Systematic Acid-Base Classification | 295 | ||
| Step 1: Categorize pH | 296 | ||
| Step 2: Determine Respiratory Involvement | 296 | ||
| Step 3: Determine Metabolic (Nonrespiratory) Involvement | 297 | ||
| Step 4: Assess for Compensation | 297 | ||
| Respiratory Acidosis | 297 | ||
| III Assessment of Respiratory Disorders | 319 | ||
| 16 Bedside Assessment of the Patient | 320 | ||
| Chapter Outline | 320 | ||
| Chapter Objectives | 320 | ||
| Key Terms | 320 | ||
| Interviewing the Patient and Taking a Medical History | 321 | ||
| Principles of Interviewing | 321 | ||
| Structure and Technique for Interviewing | 322 | ||
| Common Cardiopulmonary Symptoms | 323 | ||
| Dyspnea | 323 | ||
| Breathlessness. | 323 | ||
| Positional Dyspnea. | 323 | ||
| Language of Dyspnea. | 324 | ||
| Assessing Dyspnea in the Interview. | 324 | ||
| Psychogenic Dyspnea: Panic Disorders and Hyperventilation. | 324 | ||
| Cough | 325 | ||
| Sputum Production | 325 | ||
| Hemoptysis | 326 | ||
| Chest Pain | 326 | ||
| Fever | 326 | ||
| Pedal Edema | 326 | ||
| Format for the Medical History | 327 | ||
| Physical Examination | 327 | ||
| General Appearance | 327 | ||
| Level of Consciousness | 328 | ||
| Vital Signs | 328 | ||
| Body Temperature | 329 | ||
| Pulse Rate | 329 | ||
| Respiratory Rate | 330 | ||
| Blood Pressure | 330 | ||
| Examination of the Head and Neck | 332 | ||
| Head | 332 | ||
| Neck | 332 | ||
| Examination of the Thorax and Lungs | 332 | ||
| Inspection | 332 | ||
| Thoracic Configuration. | 332 | ||
| Thoracic Expansion. | 332 | ||
| Breathing Pattern and Effort. | 333 | ||
| Palpation | 335 | ||
| Vocal and Tactile Fremitus. | 336 | ||
| Skin and Subcutaneous Tissues. | 336 | ||
| Percussion of the Chest | 336 | ||
| Percussion Over Lung Fields. | 336 | ||
| Clinical Implications. | 336 | ||
| Auscultation of the Lungs | 336 | ||
| Stethoscope. | 336 | ||
| Technique. | 337 | ||
| Terminology. | 337 | ||
| Lung Sounds in Pulmonary Disease | 338 | ||
| Mechanisms and Significance of Lung Sounds. | 338 | ||
| Normal Breath Sounds. | 338 | ||
| Bronchial Breath Sounds. | 338 | ||
| Diminished Breath Sounds. | 338 | ||
| Wheezes and Stridor. | 338 | ||
| Crackles. | 339 | ||
| Pleural Friction Rub. | 340 | ||
| Voice Sounds. | 340 | ||
| Cardiac Examination | 340 | ||
| Inspection and Palpation | 340 | ||
| Auscultation of Heart Sounds | 340 | ||
| Abnormal Heart Sounds | 340 | ||
| Abdominal Examination | 340 | ||
| Examination of the Extremities | 341 | ||
| Clubbing | 341 | ||
| Cyanosis | 341 | ||
| Pedal Edema | 342 | ||
| Capillary Refill | 342 | ||
| Peripheral Skin Temperature | 342 | ||
| Summary Checklist | 343 | ||
| References | 343 | ||
| Bibliography | 343 | ||
| 17 Interpreting Clinical and Laboratory Data | 345 | ||
| Chapter Outline | 345 | ||
| Chapter Objectives | 345 | ||
| Key Terms | 345 | ||
| Interpreting Clinical Laboratory Tests | 345 | ||
| Introduction to Laboratory Medicine | 346 | ||
| Reference Range | 346 | ||
| Critical Test Value | 346 | ||
| Complete Blood Count | 346 | ||
| White Blood Cell Count | 347 | ||
| Red Blood Cell Count | 348 | ||
| Electrolyte Tests | 348 | ||
| Basic Concepts for Understanding Electrolyte Balance | 348 | ||
| Basic Chemistry Panel | 349 | ||
| Glucose | 349 | ||
| Anion Gap | 350 | ||
| Lactate | 351 | ||
| Enzyme Tests | 351 | ||
| Liver Function Tests | 351 | ||
| Pancreatic and Muscle Enzyme Tests | 351 | ||
| Cardiac Enzyme and Protein Tests | 352 | ||
| Coagulation Studies | 352 | ||
| Infection Monitoring | 353 | ||
| Microbiology Tests | 353 | ||
| Sputum Gram Stain | 353 | ||
| Sputum Culture | 353 | ||
| Acid-Fast Testing | 353 | ||
| Sweat Chloride | 354 | ||
| Clinical Application of Laboratory Data | 354 | ||
| Coagulation Disorders | 354 | ||
| Electrolyte Disorders | 354 | ||
| Summary Checklist | 354 | ||
| References | 355 | ||
| Bibliography | 355 | ||
| 18 Interpreting the Electrocardiogram | 356 | ||
| Chapter Outline | 356 | ||
| Chapter Objectives | 356 | ||
| Key Terms | 356 | ||
| Basic Principles of Electrophysiology | 357 | ||
| Impulse-Conducting System | 357 | ||
| Electrocardiogram Procedural Summary | 358 | ||
| Basic Electrocardiographic Waves | 359 | ||
| Electrocardiographic Paper and Measurements | 360 | ||
| Interpreting the Electrocardiogram | 360 | ||
| Steps to Follow | 360 | ||
| Axis Evaluation | 361 | ||
| Recognizing Arrhythmias | 362 | ||
| Normal Sinus Rhythm. | 362 | ||
| Sinus Tachycardia. | 362 | ||
| Sinus Bradycardia. | 362 | ||
| Sinus Arrhythmia. | 363 | ||
| First-Degree Heart Block. | 363 | ||
| Second-Degree Heart Block. | 364 | ||
| Third-Degree Heart Block. | 364 | ||
| Atrial Flutter. | 364 | ||
| Atrial Fibrillation. | 365 | ||
| Premature Ventricular Contractions. | 365 | ||
| Ventricular Tachycardia. | 366 | ||
| Ventricular Fibrillation. | 366 | ||
| Pulseless Electrical Activity | 367 | ||
| Summary Checklist | 367 | ||
| References | 368 | ||
| 19 Analysis and Monitoring of Gas Exchange | 369 | ||
| Chapter Outline | 369 | ||
| Chapter Objectives | 369 | ||
| Key Terms | 369 | ||
| Analysis Versus Monitoring | 370 | ||
| Invasive Versus Noninvasive Procedures | 370 | ||
| Measuring Fractional Inspired Oxygen | 370 | ||
| Instrumentation | 370 | ||
| Procedure | 370 | ||
| Problem-Solving and Troubleshooting | 371 | ||
| Sampling and Analyzing Blood Gases | 371 | ||
| Sampling | 371 | ||
| Arterial Puncture and Interpretation | 371 | ||
| Equipment. | 371 | ||
| Procedure. | 371 | ||
| Indications for Blood Gas Sampling. | 372 | ||
| Problem-Solving and Troubleshooting. | 373 | ||
| Getting a Good Sample. | 373 | ||
| Pre-analytic Error. | 374 | ||
| Interpretation of Arterial Blood Gases. | 375 | ||
| Indwelling Catheters (Arterial, and Central Venous Pressure, and Pulmonary Artery Lines) | 376 | ||
| Equipment. | 376 | ||
| Procedure. | 376 | ||
| Problem-Solving and Troubleshooting. | 377 | ||
| Capillary Blood Gases | 377 | ||
| Equipment. | 378 | ||
| Procedure. | 378 | ||
| Problem-Solving and Troubleshooting. | 378 | ||
| Analyzing | 378 | ||
| Instrumentation | 379 | ||
| Procedure | 380 | ||
| Quality Assurance | 381 | ||
| Recordkeeping. | 381 | ||
| Performance Validation. | 381 | ||
| Preventive Maintenance and Function Checks. | 381 | ||
| Automated Calibration. | 381 | ||
| Internal Statistical Quality Control. | 382 | ||
| External Quality Control (Proficiency Testing). | 382 | ||
| Remedial Action. | 383 | ||
| Point-of-Care Testing | 383 | ||
| Instrumentation. | 383 | ||
| Clinical Performance. | 384 | ||
| Blood Gas Monitoring | 384 | ||
| Transcutaneous Blood Gas Monitoring | 384 | ||
| Instrumentation | 385 | ||
| Procedure | 386 | ||
| Problem-Solving and Troubleshooting | 386 | ||
| Tissue Oxygen | 386 | ||
| Instrumentation | 386 | ||
| Oximetry | 387 | ||
| Hemoximetry | 387 | ||
| Instrumentation | 388 | ||
| Procedure and Quality Assurance | 388 | ||
| Problem-Solving and Troubleshooting | 388 | ||
| Pulse Oximetry | 388 | ||
| Instrumentation | 389 | ||
| Procedure | 391 | ||
| Problem-Solving and Troubleshooting | 391 | ||
| Venous Oximetry | 392 | ||
| IV Review of Cardiopulmonary Disease | 493 | ||
| 24 Pulmonary Infections | 494 | ||
| Chapter Outline | 494 | ||
| Chapter Objectives | 494 | ||
| Key Terms | 494 | ||
| Classification | 495 | ||
| Pathogenesis | 495 | ||
| Microbiology | 496 | ||
| Clinical Manifestations | 498 | ||
| Chest Radiograph | 499 | ||
| Risk Factors for Mortality and Assessing the Need for Hospitalization | 500 | ||
| Diagnostic Studies | 502 | ||
| Community-Acquired Pneumonia | 502 | ||
| Health Care–Associated Pneumonia, Hospital-Acquired Pneumonia, and Ventilator-Associated Pneumonia | 504 | ||
| Antibiotic Therapy | 505 | ||
| Community-Acquired Pneumonia | 505 | ||
| Health Care–Associated Pneumonia, Hospital-Acquired Pneumonia, and Ventilator-Associated Pneumonia | 507 | ||
| Prevention | 508 | ||
| Community-Acquired Pneumonia | 508 | ||
| Health Care–Associated Pneumonia, Hospital-Acquired Pneumonia, and Ventilator-Associated Pneumonia | 508 | ||
| Tuberculosis | 509 | ||
| Epidemiology | 509 | ||
| Pathophysiology | 509 | ||
| Primary Tuberculosis | 509 | ||
| Reactivation and Endobronchial Tuberculosis | 509 | ||
| Tuberculomas | 510 | ||
| Complications | 510 | ||
| Extrapulmonary Tuberculosis | 510 | ||
| Diagnosis | 510 | ||
| Precautions | 511 | ||
| Treatment | 511 | ||
| Role of the Respiratory Therapist in Pulmonary Infections | 511 | ||
| Summary Checklist | 511 | ||
| References | 511 | ||
| 25 Obstructive Lung Disease: Chronic Obstructive Pulmonary Disease, Asthma, and Related Diseases | 514 | ||
| Chapter Outline | 514 | ||
| Chapter Objectives | 514 | ||
| Key Terms | 514 | ||
| Chronic Obstructive Pulmonary Disease | 515 | ||
| Overview and Definitions | 515 | ||
| Epidemiology | 515 | ||
| Risk Factors and Pathophysiology | 516 | ||
| Clinical Signs and Symptoms | 517 | ||
| Management | 519 | ||
| Establishing the Diagnosis | 519 | ||
| Optimizing Lung Function | 519 | ||
| Stable Chronic Obstructive Pulmonary Disease | 519 | ||
| Acute Exacerbation of Chronic Obstructive Pulmonary Disease | 521 | ||
| Maximizing Functional Status | 522 | ||
| Preventing Progression of Chronic Obstructive Pulmonary Disease and Enhancing Survival | 522 | ||
| Additional Therapies | 524 | ||
| Asthma | 525 | ||
| Definition | 525 | ||
| Incidence | 525 | ||
| Etiology and Pathogenesis | 525 | ||
| Clinical Presentation and Diagnosis | 525 | ||
| Management | 527 | ||
| Objective Measurement and Monitoring | 528 | ||
| Pharmacotherapy | 529 | ||
| Corticosteroids | 529 | ||
| Leukotriene Inhibitors | 529 | ||
| Beta-2–Adrenergic Agonists | 529 | ||
| Methylxanthines | 532 | ||
| Anticholinergics | 532 | ||
| Anti–Immunoglobulin E Therapy | 532 | ||
| Emergency Department and Hospital Management | 532 | ||
| Bronchial Thermoplasty | 532 | ||
| Immunotherapy | 533 | ||
| Environmental Control | 533 | ||
| Patient Education | 533 | ||
| Special Considerations in Asthma Management | 533 | ||
| Exercise-Induced Asthma | 533 | ||
| Occupational Asthma | 534 | ||
| Cough-Variant Asthma | 534 | ||
| Nocturnal Asthma | 534 | ||
| Aspirin Sensitivity | 534 | ||
| Gastroesophageal Reflux | 534 | ||
| Asthma During Pregnancy | 534 | ||
| Sinusitis | 535 | ||
| Surgery | 535 | ||
| Bronchiectasis | 535 | ||
| Clinical Presentation | 535 | ||
| Evaluation | 535 | ||
| Management | 535 | ||
| Role of the Respiratory Therapist in Obstructive Lung Disease | 535 | ||
| Summary Checklist | 536 | ||
| References | 536 | ||
| 26 Interstitial Lung Disease | 540 | ||
| Chapter Outline | 540 | ||
| Chapter Objectives | 540 | ||
| Key Terms | 540 | ||
| Characteristics of Interstitial Lung Disease | 542 | ||
| Clinical Signs and Symptoms | 542 | ||
| Physical Examination | 542 | ||
| Radiographic Features | 542 | ||
| Physiologic Features | 543 | ||
| Selected Specific Types of Interstitial Lung Disease and Therapies | 544 | ||
| Exposure-Related Disease | 544 | ||
| Tobacco-Associated Lung Disease | 544 | ||
| Drug-Related and Radiation-Related Disease | 545 | ||
| Hypersensitivity Pneumonitis | 545 | ||
| Occupational Disease | 546 | ||
| Associated Systemic Disease | 547 | ||
| Connective Tissue Disease | 547 | ||
| Sarcoidosis | 548 | ||
| Lymphangioleiomyomatosis | 548 | ||
| Interstitial Lung Disease of Unknown Cause | 548 | ||
| Idiopathic Interstitial Pneumonias | 548 | ||
| Idiopathic Pulmonary Fibrosis. | 549 | ||
| Nonspecific Interstitial Pneumonia. | 549 | ||
| Organizing Pneumonia. | 549 | ||
| Lymphocytic Interstitial Pneumonia | 550 | ||
| Nonspecific Therapies | 550 | ||
| Oxygen Therapy | 550 | ||
| Pulmonary Rehabilitation and Exercise Therapy | 551 | ||
| Vaccinations and Infection Avoidance | 551 | ||
| Transplantation | 551 | ||
| Summary | 551 | ||
| Role of the Respiratory Therapist | 551 | ||
| Summary Checklist | 552 | ||
| References | 552 | ||
| 27 Pleural Diseases | 554 | ||
| Chapter Outline | 554 | ||
| Chapter Objectives | 554 | ||
| Key Terms | 554 | ||
| The Pleural Space | 554 | ||
| Pleural Effusions | 556 | ||
| Transudative Effusions | 556 | ||
| Congestive Heart Failure | 557 | ||
| Nephrotic Syndrome | 557 | ||
| Hypoalbuminemia | 558 | ||
| Liver Disease | 558 | ||
| Atelectasis | 558 | ||
| Lymphatic Obstruction | 558 | ||
| Rare Causes | 558 | ||
| Exudative Effusions | 558 | ||
| Parapneumonic Effusion | 558 | ||
| Viral Pleurisy | 558 | ||
| Tuberculous Pleurisy | 558 | ||
| Malignant | 559 | ||
| Postoperative Effusion | 559 | ||
| Chylothorax | 559 | ||
| Hemothorax | 559 | ||
| Connective Tissue Diseases | 559 | ||
| Uremic Effusion | 559 | ||
| Miscellaneous Causes | 559 | ||
| Physiologic Importance | 559 | ||
| Mechanics of Ventilation | 559 | ||
| Hypoxemia | 560 | ||
| Diagnostic Tests | 560 | ||
| Chest Radiography | 560 | ||
| Ultrasonography and Computed Tomography | 560 | ||
| Thoracentesis | 560 | ||
| Chest Thoracotomy Tubes | 561 | ||
| Thoracoscopy | 561 | ||
| Pleurodesis | 561 | ||
| Pleuroperitoneal Shunt and Indwelling Catheter | 562 | ||
| Pneumothorax | 562 | ||
| Traumatic | 562 | ||
| Blunt and Penetrating Chest Trauma | 562 | ||
| Iatrogenic | 563 | ||
| Neonatal | 563 | ||
| Spontaneous | 563 | ||
| Primary | 563 | ||
| Secondary | 563 | ||
| Catamenial Pneumothorax | 563 | ||
| Complications | 563 | ||
| Tension Pneumothorax | 563 | ||
| Reexpansion Pulmonary Edema | 564 | ||
| Diagnosis | 564 | ||
| Therapy | 565 | ||
| Oxygen | 565 | ||
| Observation | 565 | ||
| Simple Aspiration | 565 | ||
| Chest Tubes | 565 | ||
| Small Bore. | 565 | ||
| Large Bore. | 565 | ||
| Bronchopleural Fistula | 566 | ||
| Pleurodesis | 566 | ||
| Role of the Respiratory Therapist in Pleural Diseases | 568 | ||
| Summary Checklist | 568 | ||
| References | 568 | ||
| 28 Pulmonary Vascular Disease | 570 | ||
| Chapter Outline | 570 | ||
| Chapter Objectives | 570 | ||
| Key Terms | 570 | ||
| Venous Thromboembolic Disease | 571 | ||
| Pathogenesis | 571 | ||
| Pathology | 572 | ||
| Pathophysiology | 572 | ||
| Clinical Features | 572 | ||
| Chest Radiograph | 573 | ||
| Electrocardiogram | 573 | ||
| Arterial Blood Gases | 573 | ||
| Diagnostic Modalities | 573 | ||
| By-Products of Thrombin and Plasmin | 573 | ||
| Testing for Lower-Extremity Deep Venous Thromboembolism | 574 | ||
| Testing for Pulmonary Embolism | 574 | ||
| Treatment | 576 | ||
| Prophylaxis | 576 | ||
| Management of Venous Thromboembolism: Anticoagulation | 577 | ||
| Management of Deep Venous Thrombosis. | 577 | ||
| Management of Pulmonary Embolism. | 578 | ||
| Prognosis | 578 | ||
| Pulmonary Hypertension | 579 | ||
| Pathogenesis | 579 | ||
| Epidemiology and Clinical Findings | 579 | ||
| Diagnosis | 580 | ||
| Management | 580 | ||
| General Measures | 580 | ||
| Calcium Channel Blockers | 581 | ||
| Prostanoids | 581 | ||
| Endothelin-Receptor Antagonists | 582 | ||
| Phosphodiesterase-5 Inhibitors | 582 | ||
| Soluble Guanylate Cyclase Stimulators | 582 | ||
| Surgical Therapy | 582 | ||
| Atrial Septostomy. | 582 | ||
| Lung Transplantation. | 582 | ||
| Pulmonary Hypertension in Chronic Lung Disease | 582 | ||
| Role of the Respiratory Therapist in Pulmonary Vascular Disease | 583 | ||
| Summary Checklist | 583 | ||
| References | 583 | ||
| 29 Acute Respiratory Distress Syndrome | 588 | ||
| Chapter Outline | 588 | ||
| Chapter Objectives | 588 | ||
| Key Terms | 589 | ||
| Physiology of Pulmonary Edema | 589 | ||
| Liquid and Solute Transport in the Lungs | 589 | ||
| Hydrostatic Versus Nonhydrostatic Edema | 590 | ||
| Hydrostatic Pulmonary Edema | 591 | ||
| Nonhydrostatic Pulmonary Edema | 591 | ||
| Gas Exchange and Lung Mechanics in Pulmonary Edema | 594 | ||
| Definition and Diagnosis | 594 | ||
| Distinguishing Acute Respiratory Distress Syndrome from Nonhydrostatic Pulmonary Edema in Clinical Practice | 595 | ||
| Histopathologic Findings | 596 | ||
| Key Features | 597 | ||
| Risk Factors (Triggers) and Host Susceptibility | 597 | ||
| Epidemiology and Outcomes | 597 | ||
| Therapeutic Approach | 598 | ||
| Mechanical Ventilation and Other Respiratory Supportive Care | 599 | ||
| Setting Tidal Volume | 600 | ||
| Selecting the Mode of Mechanical Ventilation | 600 | ||
| Positive End Expiratory Pressure | 601 | ||
| Respiratory Rate and Inspiratory Time | 603 | ||
| Nonventilatory Supportive Care | 604 | ||
| Conservative Fluid Management. | 604 | ||
| Sedation and Analgesia | 604 | ||
| Nutrition | 605 | ||
| Mobility | 605 | ||
| Adjunctive Strategies to Improve Lung Function | 605 | ||
| Prone Positioning | 605 | ||
| Neuromuscular Blockade | 606 | ||
| Inhaled Vasodilators | 606 | ||
| Corticosteroids | 607 | ||
| Beta-2 Agonists | 607 | ||
| Exogenous Surfactant Administration | 608 | ||
| Alternative and Rescue Ventilation Strategies | 608 | ||
| Inverse-Ratio Ventilation | 608 | ||
| Airway Pressure Release Ventilation | 608 | ||
| High-Frequency Ventilation | 609 | ||
| Extracorporeal Support | 609 | ||
| The Role of the Respiratory Therapist in Acute Respiratory Distress Syndrome | 610 | ||
| Summary Checklist | 610 | ||
| References | 611 | ||
| 30 Respiratory Management of Trauma, Obesity, Near Drowning, and Burns | 615 | ||
| Chapter Outline | 615 | ||
| Chapter Objectives | 615 | ||
| Key Terms | 615 | ||
| Life-Threatening Trauma | 616 | ||
| Epidemiology | 616 | ||
| Clinical Assessment and Specific Pathophysiologic Concerns | 616 | ||
| Head, Neck, and Upper Airway Injuries | 617 | ||
| Lower Respiratory Injuries | 617 | ||
| Special Considerations in Patients With Chest Trauma | 619 | ||
| Respiratory Management | 619 | ||
| Obesity | 620 | ||
| Epidemiology | 620 | ||
| Specific Pathophysiologic Concerns | 621 | ||
| Clinical Assessment | 622 | ||
| Respiratory Management | 622 | ||
| Oxygen Therapy | 623 | ||
| Aerosolized Pharmacology | 623 | ||
| Noninvasive Ventilation | 623 | ||
| Approach to Noninvasive Ventilation | 623 | ||
| Invasive Mechanical Ventilation | 623 | ||
| Intubation. | 623 | ||
| Tidal Volume, Minute Volume, and Respiratory Rate. | 623 | ||
| Lung Recruitment. | 624 | ||
| Positioning. | 624 | ||
| Ventilator Discontinuation. | 625 | ||
| Near Drowning | 625 | ||
| Epidemiology | 625 | ||
| Specific Pathophysiologic Concerns | 625 | ||
| Respiratory Management | 626 | ||
| Airway Clearance Therapy | 626 | ||
| Mechanical Ventilation | 626 | ||
| Positioning | 627 | ||
| Burns | 627 | ||
| Epidemiology | 627 | ||
| Clinical Assessment | 627 | ||
| Pathophysiology of Burn Patients | 629 | ||
| Specific Concerns | 629 | ||
| Respiratory Management | 630 | ||
| Oxygen Therapy | 630 | ||
| Early Endotracheal Intubation | 630 | ||
| Fiberoptic Bronchoscopy | 630 | ||
| Active Humidification | 630 | ||
| Mechanical Ventilation | 630 | ||
| Summary Checklist | 631 | ||
| References | 632 | ||
| 31 Lung Cancer | 634 | ||
| Chapter Outline | 634 | ||
| Chapter Objectives | 634 | ||
| Key Terms | 634 | ||
| Epidemiology | 634 | ||
| New Cases | 634 | ||
| Deaths | 635 | ||
| Tobacco-Related Products | 635 | ||
| Occupational Agents and Other Risks | 636 | ||
| Classification | 636 | ||
| Pathophysiology | 636 | ||
| Clinical Features | 636 | ||
| Diagnosis | 639 | ||
| Staging | 640 | ||
| Preoperative Evaluation for Lung Resection Surgery | 641 | ||
| Screening | 643 | ||
| Treatment and Outcomes | 644 | ||
| Non–Small Cell Lung Cancer | 644 | ||
| Early Stage Non–Small Cell Carcinoma | 645 | ||
| Locally and Regionally Advanced Non–Small Cell Carcinoma | 646 | ||
| Metastatic Non–Small Cell Carcinoma | 646 | ||
| Small Cell Lung Cancer | 646 | ||
| Future Scenario | 647 | ||
| Role of the Respiratory Therapist in Managing Patients with Lung Cancer | 647 | ||
| Summary Checklist | 647 | ||
| References | 648 | ||
| 32 Neuromuscular and Other Diseases of the Chest Wall | 650 | ||
| Chapter Outline | 650 | ||
| Chapter Objectives | 650 | ||
| Key Terms | 650 | ||
| General Principles Related to Neuromuscular Weakness of the Ventilatory Muscles | 651 | ||
| Pathophysiology and Pulmonary Function Testing | 652 | ||
| Clinical Signs and Symptoms | 653 | ||
| Monitoring and Assessing Patients With Muscle Weakness for Respiratory Insufficiency | 653 | ||
| Management of Respiratory Muscle Weakness | 654 | ||
| Specific Neuromuscular Diseases | 655 | ||
| Disorders of the Muscle (Myopathic Disease) | 655 | ||
| Duchenne Muscular Dystrophy and Becker Muscular Dystrophy | 655 | ||
| Myotonic Dystrophy | 656 | ||
| Polymyositis | 656 | ||
| Critical Illness Myopathy | 657 | ||
| Disorders of the Neuromuscular Junction | 658 | ||
| Myasthenia Gravis | 658 | ||
| Lambert-Eaton Syndrome | 660 | ||
| Disorders of the Nerves | 660 | ||
| Guillain-Barré Syndrome | 660 | ||
| Phrenic Nerve Damage and Diaphragmatic Paralysis | 661 | ||
| Critical Illness Polyneuropathy | 662 | ||
| Disorders of the Spinal Cord | 662 | ||
| Amyotrophic Lateral Sclerosis | 662 | ||
| Spinal Cord Trauma | 663 | ||
| Disorders of the Brain | 664 | ||
| Stroke | 664 | ||
| Traumatic Brain Injury | 664 | ||
| Disorders of the Thoracic Cage | 665 | ||
| Kyphoscoliosis | 665 | ||
| Flail Chest | 666 | ||
| Ankylosing Spondylitis | 666 | ||
| The Role of Respiratory Therapists in Caring for Patients with Neuromuscular Weakness and Other Diseases of the Chest Wall | 666 | ||
| Summary Checklist | 667 | ||
| References | 667 | ||
| 33 Disorders of Sleep | 670 | ||
| Chapter Outline | 670 | ||
| Chapter Objectives | 670 | ||
| Key Terms | 670 | ||
| Pathophysiology | 672 | ||
| Obstructive Sleep Apnea | 672 | ||
| Central Sleep Apnea | 673 | ||
| Overlap Syndrome | 673 | ||
| Hypoventilation Syndromes | 673 | ||
| Clinical Features | 673 | ||
| Screening Questionnaires | 674 | ||
| Laboratory Testing | 674 | ||
| Treatment | 676 | ||
| Behavioral Interventions and Risk Counseling | 676 | ||
| Positional Therapy | 677 | ||
| Medical Interventions | 677 | ||
| Positive Pressure Therapy | 677 | ||
| Continuous Positive Airway Pressure Therapy. | 677 | ||
| Bilevel Pressure Therapy. | 678 | ||
| Autotitrating Devices. | 679 | ||
| Side Effects and Troubleshooting Strategies. | 679 | ||
| Oral Appliances | 680 | ||
| Medications | 680 | ||
| Surgical Interventions | 682 | ||
| Palatal Surgery | 682 | ||
| Maxillofacial Surgery | 682 | ||
| Additional Therapies | 682 | ||
| Role of the Respiratory Therapist in Disorders of Sleep | 682 | ||
| Summary Checklist | 684 | ||
| References | 685 | ||
| 34 Neonatal and Pediatric Respiratory Disorders | 688 | ||
| Chapter Outline | 688 | ||
| Chapter Objectives | 688 | ||
| Key Terms | 688 | ||
| Neonatal Respiratory Disorders | 689 | ||
| Lung Parenchymal Disease | 689 | ||
| Respiratory Distress Syndrome | 689 | ||
| Background. | 689 | ||
| Pathophysiology. | 689 | ||
| Clinical Manifestations. | 690 | ||
| Treatment. | 690 | ||
| Transient Tachypnea of the Newborn | 691 | ||
| Background. | 691 | ||
| Clinical Manifestations. | 692 | ||
| Treatment. | 692 | ||
| Meconium Aspiration Syndrome | 692 | ||
| Background. | 692 | ||
| Pathophysiology. | 692 | ||
| Clinical Manifestations. | 693 | ||
| Treatment. | 693 | ||
| Bronchopulmonary Dysplasia | 693 | ||
| Background. | 693 | ||
| Pathophysiology. | 694 | ||
| Clinical Manifestations. | 694 | ||
| Treatment. | 694 | ||
| Control of Breathing | 694 | ||
| Apnea of Prematurity | 694 | ||
| Background. | 694 | ||
| Cause. | 695 | ||
| Treatment. | 695 | ||
| Pulmonary Vascular Disease | 696 | ||
| Persistent Pulmonary Hypertension of the Newborn | 696 | ||
| Background. | 696 | ||
| Pathophysiology. | 696 | ||
| Clinical Manifestations. | 696 | ||
| Treatment. | 696 | ||
| Congenital Abnormalities Affecting Respiration | 696 | ||
| Airway Diseases | 696 | ||
| Lung Malformations | 697 | ||
| Congenital Diaphragmatic Hernia | 697 | ||
| Abdominal Wall Abnormalities | 698 | ||
| Neuromuscular Control | 698 | ||
| Congenital Heart Disease | 698 | ||
| Cyanotic Heart Diseases | 698 | ||
| Tetralogy of Fallot. | 698 | ||
| Transposition of the Great Arteries. | 700 | ||
| Hypertension of the Newborn | 700 | ||
| Acyanotic Heart Diseases | 700 | ||
| Ventricular Septal Defect. | 700 | ||
| Atrial Septal Defect. | 700 | ||
| Patent Ductus Arteriosus. | 700 | ||
| Left Ventricular Outflow Obstructions. | 700 | ||
| Neonatal Resuscitation | 701 | ||
| Pediatric Respiratory Disorders | 701 | ||
| Sudden Infant Death Syndrome | 701 | ||
| Cause | 701 | ||
| Prevention | 702 | ||
| Gastroesophageal Reflux Disease | 702 | ||
| Bronchiolitis | 702 | ||
| Clinical Manifestations | 702 | ||
| Prophylaxis. | 702 | ||
| Treatment. | 703 | ||
| Croup | 703 | ||
| Clinical Manifestations | 703 | ||
| Treatment | 704 | ||
| Epiglottitis | 704 | ||
| Clinical Manifestations | 704 | ||
| Treatment | 705 | ||
| Cystic Fibrosis | 705 | ||
| Clinical Manifestations | 705 | ||
| Diagnosis | 706 | ||
| Monitoring | 706 | ||
| Treatment | 706 | ||
| Prognosis | 707 | ||
| Role of the Respiratory Therapist in Neonatal and Pediatric Respiratory Disorders | 707 | ||
| Summary Checklist | 707 | ||
| References | 708 | ||
| V Basic Therapeutics | 715 | ||
| 35 Airway Pharmacology | 716 | ||
| Chapter Outline | 716 | ||
| Chapter Objectives | 716 | ||
| Key Terms | 716 | ||
| Principles of Pharmacology | 717 | ||
| Drug Administration Phase | 717 | ||
| Pharmacokinetic Phase | 717 | ||
| Pharmacodynamic Phase | 717 | ||
| Airway Receptors and Neural Control of the Lung | 717 | ||
| Adrenergic Bronchodilators | 718 | ||
| Indications for Use | 718 | ||
| Indication for Short-Acting Agents | 718 | ||
| Indication for Long-Acting Agents | 718 | ||
| Indication for Racemic Epinephrine | 719 | ||
| Mode of Action and Effects | 719 | ||
| Adrenergic Bronchodilator Agents | 719 | ||
| Ultra-Short-Acting Catecholamines | 720 | ||
| Short-Acting Noncatecholamine Agents | 720 | ||
| Single-Isomer Beta Agonists. | 720 | ||
| Long-Acting Adrenergic Bronchodilators | 721 | ||
| Adverse Effects | 721 | ||
| Assessment of Bronchodilator Therapy | 722 | ||
| Anticholinergic Bronchodilators | 723 | ||
| Indications for Use | 723 | ||
| Indication for Anticholinergic Bronchodilators | 723 | ||
| Indication for Combined Anticholinergic and Beta-Agonist Bronchodilators | 723 | ||
| Mode of Action | 723 | ||
| Adverse Effects | 724 | ||
| Assessment | 725 | ||
| Mucus-Controlling Agents | 725 | ||
| N-Acetyl Cysteine | 725 | ||
| Indications for Use | 725 | ||
| Mode of Action | 725 | ||
| Side Effects | 725 | ||
| Dornase Alfa | 726 | ||
| Indication for Use | 726 | ||
| Mode of Action | 726 | ||
| Side Effects | 726 | ||
| Other Mucoactive Agents | 726 | ||
| Assessment of Mucoactive Drug Therapy | 727 | ||
| Before Treatment | 727 | ||
| During Treatment and Short Term | 727 | ||
| Long Term | 727 | ||
| General Contraindications | 727 | ||
| Inhaled Corticosteroids | 727 | ||
| Indications and Purposes | 727 | ||
| Mode of Action | 727 | ||
| Adverse Effects | 727 | ||
| Special Considerations | 727 | ||
| Assessment of Drug Therapy | 729 | ||
| Long Term | 729 | ||
| Nonsteroidal Antiasthma Drugs | 729 | ||
| Indication for Use | 729 | ||
| Mode of Action | 730 | ||
| Adverse Effects | 731 | ||
| Assessment of Drug Therapy | 732 | ||
| Long Term | 732 | ||
| Aerosolized Antiinfective Agents | 732 | ||
| Pentamidine Isethionate | 732 | ||
| Indication for Use | 732 | ||
| Adverse Effects | 732 | ||
| Assessment | 732 | ||
| Long Term. | 733 | ||
| Ribavirin | 733 | ||
| VI Acute and Critical Care | 971 | ||
| 44 Respiratory Failure and the Need for Ventilatory Support | 972 | ||
| Chapter Outline | 972 | ||
| Chapter Objectives | 972 | ||
| Key Terms | 972 | ||
| Hypoxemic Respiratory Failure (Type I) | 973 | ||
| Ventilation/Perfusion Mismatch | 973 | ||
| Clinical Presentation | 973 | ||
| Shunt | 974 | ||
| Clinical Presentation | 974 | ||
| Alveolar Hypoventilation | 975 | ||
| Diffusion Impairment | 975 | ||
| VII Patient Education and Long-Term Care | 1249 | ||
| 54 Patient Education and Health Promotion | 1250 | ||
| Chapter Outline | 1250 | ||
| Chapter Objectives | 1250 | ||
| Key Terms | 1250 | ||
| Patient Education | 1251 | ||
| Cultural Diversity and Health Literacy | 1251 | ||
| Performance Objectives | 1251 | ||
| Learning Domains | 1251 | ||
| Cognitive Domain | 1252 | ||
| Psychomotor Domain | 1252 | ||
| Affective Domain | 1253 | ||
| Teaching Tips | 1253 | ||
| Teaching Children as Compared With Teaching Adults | 1253 | ||
| Evaluation of Patient Education | 1253 | ||
| Health Education | 1254 | ||
| Health Promotion and Disease Prevention | 1255 | ||
| Disease Management | 1258 | ||
| Implications for the Respiratory Therapist | 1262 | ||
| Health Care Institutions | 1262 | ||
| Work Site | 1262 | ||
| Home | 1262 | ||
| Community | 1262 | ||
| Educational Institutions | 1262 | ||
| Summary Checklist | 1262 | ||
| References | 1263 | ||
| 55 Cardiopulmonary Rehabilitation | 1264 | ||
| Chapter Outline | 1264 | ||
| Chapter Objectives | 1264 | ||
| Key Terms | 1264 | ||
| Definitions and Goals | 1265 | ||
| Historical Perspective | 1265 | ||
| Scientific Basis | 1265 | ||
| Physical Reconditioning | 1265 | ||
| Psychosocial Support | 1266 | ||
| Structure of a Pulmonary Rehabilitation Program | 1268 | ||
| Program Goals and Objectives | 1268 | ||
| Patient Evaluation and Selection | 1269 | ||
| Patient Evaluation | 1269 | ||
| Patient Selection | 1271 | ||
| Program Design | 1272 | ||
| Format | 1272 | ||
| Content | 1273 | ||
| Physical Reconditioning | 1273 | ||
| Educational Component | 1275 | ||
| Respiratory Structure, Function, and Pathology, Including a Discussion of Dyspnea. | 1275 | ||
| Breathing Control Methods. | 1276 | ||
| Methods of Relaxation and Stress Management. | 1276 | ||
| Exercise Techniques and Personal Routines. | 1276 | ||
| Secretion Clearance and Bronchial Hygiene Techniques. | 1276 | ||
| Home Oxygen and Aerosol Therapy. | 1276 | ||
| Medications. | 1276 | ||
| Dietary Guidelines. | 1276 | ||
| Recreational and Vocational Counseling. | 1276 | ||
| Psychosocial and Behavioral Components | 1276 | ||
| Program Implementation | 1276 | ||
| Staffing | 1276 | ||
| Facilities | 1276 | ||
| Scheduling | 1277 | ||
| Class Size | 1277 | ||
| Equipment | 1277 | ||
| Cost, Fees, and Reimbursement | 1278 | ||
| Program Results | 1280 | ||
| Potential Hazards | 1281 | ||
| Cardiac Rehabilitation | 1281 | ||
| Conclusion | 1282 | ||
| Summary Checklist | 1282 | ||
| References | 1282 | ||
| 56 Respiratory Care in Alternative Settings | 1284 | ||
| Chapter Outline | 1284 | ||
| Chapter Objectives | 1284 | ||
| Key Terms | 1285 | ||
| More Recent Developments and Trends | 1285 | ||
| Relevant Terms and Goals | 1286 | ||
| Long-Term Subacute Care Hospitals | 1286 | ||
| Subacute Care | 1286 | ||
| Home Care | 1286 | ||
| Standards | 1286 | ||
| Regulations | 1286 | ||
| Private Sector Accreditation | 1287 | ||
| Traditional Acute Care Versus Alternative Setting Care | 1287 | ||
| Discharge Planning | 1288 | ||
| Multidisciplinary Team | 1288 | ||
| Site and Support Service Evaluation | 1288 | ||
| Oxygen Therapy in Alternative Settings | 1291 | ||
| Oxygen Therapy Prescription | 1291 | ||
| Supply Methods | 1291 | ||
| Compressed Oxygen Cylinders | 1291 | ||
| Liquid Oxygen Systems | 1293 | ||
| Oxygen Concentrators | 1294 | ||
| Problem Solving and Troubleshooting | 1294 | ||
| Delivery Methods | 1295 | ||
| Transtracheal Oxygen Therapy | 1295 | ||
| Demand-Flow Oxygen Systems | 1296 | ||
| Selecting a Long-Term Oxygen Delivery System | 1296 | ||
| Problem Solving and Troubleshooting | 1296 | ||
| Ventilatory Support in Alternative Settings | 1297 | ||
| Patient Selection | 1298 | ||
| Settings and Approaches | 1298 | ||
| Standards and Guidelines | 1298 | ||
| Special Challenges in Providing Home Ventilatory Support | 1298 | ||
| Prerequisites | 1298 | ||
| Planning | 1300 | ||
| Caregiver Education | 1300 | ||
| Invasive Versus Noninvasive Ventilatory Support | 1301 | ||
| Equipment | 1301 | ||
| Selecting Appropriate Ventilator | 1301 | ||
| Positive Pressure Ventilators | 1302 | ||
| Negative Pressure Ventilators | 1303 | ||
| Evaluation and Follow-Up | 1304 | ||
| Other Modes of Respiratory Care in Alternative Sites | 1304 | ||
| Bland Aerosol Therapy | 1304 | ||
| Aerosol Drug Administration | 1304 | ||
| Airway Care and Clearance Methods | 1304 | ||
| Nasal Continuous Positive Airway Pressure Therapy | 1305 | ||
| Equipment | 1305 | ||
| Determining Proper Continuous Positive Airway Pressure Level | 1305 | ||
| Use and Maintenance | 1305 | ||
| Problem Solving and Troubleshooting | 1305 | ||
| Apnea Monitoring | 1307 | ||
| Patient Assessment and Documentation | 1307 | ||
| Institutional Long-Term Care | 1307 | ||
| Screening | 1307 | ||
| Treatment Planning and Ongoing Assessment | 1308 | ||
| Discharge Summary | 1308 | ||
| Home Care | 1308 | ||
| Equipment Disinfection and Maintenance | 1308 | ||
| Palliative Care | 1309 | ||
| Summary Checklist | 1309 | ||
| References | 1310 | ||
| Glossary | 1312 | ||
| A | 1312 | ||
| B | 1314 | ||
| C | 1315 | ||
| D | 1317 | ||
| E | 1318 | ||
| F | 1319 | ||
| G | 1320 | ||
| H | 1320 | ||
| I | 1322 | ||
| J | 1322 | ||
| K | 1322 | ||
| L | 1323 | ||
| M | 1323 | ||
| N | 1324 | ||
| O | 1325 | ||
| P | 1325 | ||
| Q | 1328 | ||
| R | 1328 | ||
| S | 1329 | ||
| T | 1330 | ||
| U | 1332 | ||
| V | 1332 | ||
| W | 1332 | ||
| X | 1332 | ||
| Z | 1332 | ||
| Index | 1333 | ||
| A | 1333 | ||
| B | 1337 | ||
| C | 1339 | ||
| D | 1343 | ||
| E | 1344 | ||
| F | 1346 | ||
| G | 1347 | ||
| H | 1347 | ||
| I | 1350 | ||
| J | 1352 | ||
| K | 1352 | ||
| L | 1352 | ||
| M | 1354 | ||
| N | 1356 | ||
| O | 1358 | ||
| P | 1360 | ||
| Q | 1364 | ||
| R | 1364 | ||
| S | 1366 | ||
| T | 1368 | ||
| U | 1369 | ||
| V | 1369 | ||
| W | 1371 | ||
| X | 1372 | ||
| Y | 1372 | ||
| Z | 1372 | ||
| Inside Back Cover | ibc1 |