Additional Information
Book Details
Abstract
Wilkin’s Clinical Assessment in Respiratory Care, 8th Edition, is the world-leading respiratory care text devoted exclusively to patient assessment. This comprehensive book prepares you to assist physicians in the decision-making process regarding treatment, evaluation of the treatment’s effectiveness, and determining if changes in the treatment need to be made. Written by Dr. Albert Heuer, and Dr. Craig Scanlan, it emphasizes learning objectives through well-organized need-to-know information and tips. Plus, this streamlined edition helps you focus on key content and prepare for the CRT credentialing exam by aligning material within the book to the NBRC exam matrices.
- Case studies offer real-life clinical scenarios challenging you to interpret data and make accurate patient assessments.
- Questions to Ask boxes identify what practitioners should ask patients (i.e., coughing, sputum, shortness of breath) or questions to ask themselves on various subjects (i.e., lung sounds they are hearing, blood pressure, respiratory rate) in order to provide effective patient care.
- Learning objectives, chapter outlines, chapter overviews, and key terms lists in each chapter, help you focus on key content.
- Key Point summaries emphasize the learning objectives and provide an overview of important material.
- Simply Stated boxes highlight and promote understanding of important concepts.
- A comprehensive approach provides you with the important information you need to know in order to effectively assess patients.
- NEW! Thoroughly updated content reflects the most recent changes to the NBRC exam.
- NEW! Inclusion of the latest technological advancements relates to the assessment of critical care and non-critical care patients.
- NEW! Full-color design enhances learning and understanding by making key concepts easy to find.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| CONTENTS | ES1 | ||
| Wilkins’ Clinical Assessment in Respiratory Care | i | ||
| Wilkins’ Clinical Assessment in Respiratory Care | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| CONTRIBUTORS | vi | ||
| REVIEWERS | vii | ||
| PREFACE | viii | ||
| NEW TO THIS EDITION | viii | ||
| FEATURES | viii | ||
| LEARNING AIDS | ix | ||
| FOR THE INSTRUCTOR | ix | ||
| FOR STUDENTS | ix | ||
| CONTENTS | x | ||
| 1 -Preparing for the Patient Encounter | 1 | ||
| INDIVIDUALIZED CARE | 2 | ||
| Providing Empathetic Two-Way Communication | 2 | ||
| Respecting Patient Needs and Preferences | 3 | ||
| Ensuring Privacy and Confidentiality | 3 | ||
| Being Sensitive to Cultural Values | 5 | ||
| PATIENT INVOLVEMENT | 6 | ||
| Assessing Learning Needs and Providing Patient Education | 6 | ||
| Sharing Goal-Setting and Decision-Making Responsibilities | 7 | ||
| Encouraging Patient and Family Participation in Care and Safety | 7 | ||
| PROVIDER COLLABORATION | 8 | ||
| Enhancing Interprofessional Communication | 8 | ||
| Coordinating Patient Care | 10 | ||
| Sharing Responsibility | 10 | ||
| KEY POINTS | 11 | ||
| ASSESSMENT QUESTIONS | 12 | ||
| 2 - The Medical History and the Interview | 14 | ||
| PATIENT INTERVIEW | 15 | ||
| Principles of Communication | 15 | ||
| Structuring the Interview | 15 | ||
| Questions and Statements Used to Facilitate Conversational Interviewing | 16 | ||
| Alternative Sources for a Patient History | 16 | ||
| CARDIOPULMONARY HISTORY AND COMPREHENSIVE HEALTH HISTORY | 17 | ||
| Variations in Health Histories | 17 | ||
| General Content of Health Histories | 17 | ||
| Background Information | 17 | ||
| Screening Information | 18 | ||
| Description of Present Health Status or Illness | 18 | ||
| Review of Systems | 18 | ||
| Chief Complaint | 18 | ||
| History of Present Illness | 18 | ||
| Describing Symptoms | 20 | ||
| Past History | 20 | ||
| Disease and Procedure History | 22 | ||
| Drug and Smoking History | 23 | ||
| Family History | 23 | ||
| Occupational and Environmental History | 24 | ||
| REVIEWING THE PATIENT’S MEDICAL RECORD | 26 | ||
| Admission Note | 26 | ||
| Physician Orders | 26 | ||
| Progress Notes | 27 | ||
| DNAR/DNR Status and Advance Directives | 27 | ||
| ASSESSMENT STANDARDS FOR PATIENTS WITH PULMONARY DYSFUNCTION | 27 | ||
| KEY POINTS | 28 | ||
| ASSESSMENT QUESTIONS | 29 | ||
| 3 - Cardiopulmonary Symptoms | 31 | ||
| COUGH | 32 | ||
| Causes and Clinical Presentation | 32 | ||
| Descriptions | 33 | ||
| SPUTUM PRODUCTION | 34 | ||
| Causes and Descriptions | 34 | ||
| HEMOPTYSIS | 35 | ||
| Definition | 35 | ||
| Causes | 35 | ||
| Descriptions | 36 | ||
| Hemoptysis versus Hematemesis | 36 | ||
| SHORTNESS OF BREATH (DYSPNEA) | 37 | ||
| Subjectiveness of Dyspnea | 37 | ||
| Dyspnea Scoring Systems | 37 | ||
| Causes, Types, and Clinical Presentations of Dyspnea | 38 | ||
| Clinical Types of Dyspneas | 39 | ||
| Acute and Chronic Dyspnea | 39 | ||
| Descriptions | 40 | ||
| CHEST PAIN | 41 | ||
| Pulmonary Causes of Chest Pain | 41 | ||
| Descriptions | 44 | ||
| DIZZINESS AND FAINTING (SYNCOPE) | 45 | ||
| Definition | 45 | ||
| Causes | 45 | ||
| Descriptions | 46 | ||
| SWELLING OF THE ANKLES (DEPENDENT EDEMA) | 46 | ||
| Definition | 46 | ||
| Causes | 47 | ||
| Descriptions | 47 | ||
| FEVER, CHILLS, AND NIGHT SWEATS | 47 | ||
| Definitions | 47 | ||
| Causes | 48 | ||
| Fever with Pulmonary Disorders | 48 | ||
| HEADACHE, ALTERED MENTAL STATUS, AND PERSONALITY CHANGES | 50 | ||
| Personality Changes | 50 | ||
| SNORING AND DAYTIME SOMNOLENCE (SLEEPINESS) | 50 | ||
| Incidence and Causes of Snoring | 50 | ||
| Clinical Presentation | 51 | ||
| GASTROESOPHAGEAL REFLUX | 51 | ||
| KEY POINTS | 51 | ||
| ASSESSMENT QUESTIONS | 53 | ||
| 4 - Vital Signs | 55 | ||
| OBTAINING VITAL SIGNS AND CLINICAL IMPRESSION | 56 | ||
| FREQUENCY OF VITAL SIGNS MEASUREMENT | 56 | ||
| TRENDS IN THE VITAL SIGNS | 57 | ||
| COMPARING VITAL SIGNS INFORMATION | 57 | ||
| HEIGHT AND WEIGHT | 58 | ||
| GENERAL CLINICAL PRESENTATION | 58 | ||
| Pain Level and Type | 59 | ||
| Level of Consciousness (Sensorium) | 59 | ||
| Glasgow Coma Scale | 60 | ||
| TEMPERATURE | 60 | ||
| Fever | 60 | ||
| Hypothermia | 61 | ||
| Measurement of Body Temperature | 61 | ||
| Rectal Measurement | 61 | ||
| Tympanic (Ear) Measurement | 61 | ||
| Oral Measurement | 61 | ||
| Axillary Measurement | 62 | ||
| PULSE | 62 | ||
| Measurement of Pulse Rate | 62 | ||
| Pulse Rhythm and Pattern | 63 | ||
| RESPIRATORY RATE AND PATTERN | 63 | ||
| Measurement of Respiratory Rate and Pattern | 64 | ||
| BLOOD PRESSURE | 64 | ||
| Measurement of Blood Pressure | 65 | ||
| Auscultatory Blood Pressure Measurement | 66 | ||
| Errors in Blood Pressure Measurement | 68 | ||
| Effects of the Respiratory Cycle on Blood Pressure and Pulse Intensity | 68 | ||
| KEY POINTS | 69 | ||
| ASSESSMENT QUESTIONS | 69 | ||
| 5 - Fundamentals of Physical Examination | 71 | ||
| EXAMINATION OF THE HEAD AND NECK | 73 | ||
| Head and Face | 73 | ||
| Eyes | 74 | ||
| Neck | 74 | ||
| LUNG TOPOGRAPHY | 75 | ||
| Imaginary Lines | 75 | ||
| Thoracic Cage Landmarks | 76 | ||
| Lung Fissures | 77 | ||
| Tracheal Bifurcation | 77 | ||
| Diaphragm | 77 | ||
| Lung Borders | 77 | ||
| EXAMINATION OF THE THORAX | 77 | ||
| Inspection | 77 | ||
| Thoracic Configuration | 77 | ||
| Breathing Pattern and Effort | 78 | ||
| Inspection for Central Cyanosis | 80 | ||
| Palpation | 80 | ||
| Vocal Fremitus | 80 | ||
| Thoracic Expansion | 81 | ||
| Skin and Subcutaneous Tissues | 81 | ||
| Percussion of the Chest to Assess Resonance | 81 | ||
| Percussion over Lung Fields | 82 | ||
| Diaphragmatic Excursion | 83 | ||
| Auscultation of the Lungs | 83 | ||
| Stethoscope | 83 | ||
| Technique | 84 | ||
| Terminology | 85 | ||
| Mechanisms and Significance of Lung Sounds | 87 | ||
| EXAMINATION OF THE PRECORDIUM | 90 | ||
| Review of Heart Topography | 90 | ||
| Inspection and Palpation | 90 | ||
| Auscultation of Heart Sounds | 91 | ||
| EXAMINATION OF THE ABDOMEN | 92 | ||
| EXAMINATION OF THE EXTREMITIES | 93 | ||
| Clubbing | 93 | ||
| Cyanosis | 93 | ||
| Pedal Edema | 94 | ||
| Capillary Refill | 94 | ||
| Peripheral Skin Temperature | 94 | ||
| Assessment of Hydration: Skin Turgor | 94 | ||
| KEY POINTS | 95 | ||
| ASSESSMENT QUESTIONS | 96 | ||
| 6 - Neurologic Assessment | 99 | ||
| Functional Neuroanatomy | 100 | ||
| Assessment of Consciousness | 101 | ||
| Assessing Consciousness | 101 | ||
| Glasgow Coma Scale | 104 | ||
| Mini-Mental State Examination | 106 | ||
| Assessment of Consciousness in the Intensive Care Unit | 106 | ||
| Cranial Nerve Examination | 107 | ||
| Sensory Examination | 107 | ||
| Motor Examination | 107 | ||
| Deep Tendon, Superficial, and Brainstem Reflexes | 110 | ||
| Deep Tendon Reflexes | 110 | ||
| Superficial Reflexes | 110 | ||
| Brainstem Reflexes | 111 | ||
| Gag Reflex | 111 | ||
| Pupillary Reflex | 112 | ||
| Corneal Reflex | 112 | ||
| Oculocephalic and Oculovestibular Reflexes | 113 | ||
| Coordination, Balance, and Gait Examination | 113 | ||
| Vital Organ Function and the Neurologic System | 113 | ||
| Control of Breathing | 113 | ||
| Control of the Cardiovascular System | 115 | ||
| Ancillary Testing of the Neurologic System | 115 | ||
| Imaging of the Neurologic System | 115 | ||
| Electroencephalography | 116 | ||
| Lumbar Puncture | 117 | ||
| Intracranial Pressure Monitoring | 117 | ||
| Declaration of Brain Death | 117 | ||
| Key Points | 118 | ||
| Assessment Questions | 118 | ||
| Bibliography | 119 | ||
| 7 -\rClinical Laboratory Studies | 120 | ||
| CLINICAL LABORATORY OVERVIEW | 121 | ||
| Phases of Laboratory Testing | 121 | ||
| Composition of Blood | 121 | ||
| Specimen Integrity and Effect on Test Results | 122 | ||
| Laboratory Test Parameters | 122 | ||
| HEMATOLOGY | 122 | ||
| Complete Blood Count | 122 | ||
| White Blood Cells | 122 | ||
| Red Blood Cells | 125 | ||
| Platelet Count | 127 | ||
| Erythrocyte Sedimentation Rate | 128 | ||
| Coagulation Screening Tests | 128 | ||
| CHEMISTRY | 129 | ||
| Basic Metabolic Panel | 129 | ||
| Electrolytes | 129 | ||
| Glucose | 131 | ||
| Blood Urea Nitrogen and Creatinine | 131 | ||
| Renal Panel | 132 | ||
| Glomerular Filtration Rate | 132 | ||
| Urinalysis | 132 | ||
| Hepatic Panel | 132 | ||
| Proteins | 132 | ||
| Liver-Associated Enzymes | 133 | ||
| Bilirubin | 133 | ||
| Lipid Panel | 133 | ||
| Cardiac Biomarkers | 133 | ||
| MICROBIOLOGY | 134 | ||
| Preanalytical Phase: Specimen Selection, Collection, and Transport | 135 | ||
| Microscopic Examination of Specimens | 135 | ||
| Culture and Sensitivity | 135 | ||
| Examination of Pulmonary Secretions | 135 | ||
| Sputum Collection | 135 | ||
| Sputum Examination | 136 | ||
| Bronchoalveolar Lavage | 136 | ||
| Pleural Fluid Examination | 137 | ||
| HISTOLOGY AND CYTOLOGY | 137 | ||
| SKIN TESTING | 138 | ||
| RECOMMENDED LABORATORY TESTS | 138 | ||
| KEY POINTS | 139 | ||
| ASSESSMENT QUESTIONS | 141 | ||
| 8 - Interpretation of Blood Gases | 144 | ||
| INDICATIONS FOR BLOOD GAS AND OXIMETRY ANALYSIS | 145 | ||
| SAMPLING AND MEASUREMENT | 145 | ||
| Invasive Blood Sampling | 145 | ||
| Arterial Puncture | 145 | ||
| Indwelling Catheter (A-Line) | 147 | ||
| Noninvasive Measurements | 147 | ||
| Pulse Oximetry | 147 | ||
| Transcutaneous Analysis | 149 | ||
| Capnography | 149 | ||
| ASSESSMENT OF OXYGENATION | 150 | ||
| Partial Pressure of Oxygen (Pao2) | 150 | ||
| Hypoxemia: Severity and Causes | 150 | ||
| Alveolar Air Equation | 150 | ||
| Hemoglobin (Hb) and Hb Saturation (Sao2, Spo2) | 150 | ||
| Dyshemoglobins | 152 | ||
| Arterial O2 Content (Cao2) | 153 | ||
| O2 Delivery and Hypoxia | 153 | ||
| ASSESSMENT OF ACID-BASE BALANCE | 154 | ||
| pH | 154 | ||
| Partial Pressure of Carbon Dioxide (Paco2) | 154 | ||
| Plasma Bicarbonate (HCO3–) | 154 | ||
| Base Excess | 155 | ||
| Henderson-Hasselbalch Equation | 155 | ||
| SIMPLE ACID-BASE IMBALANCES | 155 | ||
| Respiratory Acidosis | 155 | ||
| Respiratory Alkalosis | 156 | ||
| Metabolic Acidosis | 156 | ||
| Metabolic Alkalosis | 157 | ||
| COMBINED ACID-BASE DISTURBANCES | 157 | ||
| Respiratory and Metabolic Acidosis | 157 | ||
| Cardiac Arrest | 157 | ||
| Chronic Obstructive Pulmonary Disease | 157 | ||
| Poisoning and Drug Overdose | 157 | ||
| Metabolic and Respiratory Alkalosis | 158 | ||
| Critically Ill Patients | 158 | ||
| Ventilator-Induced Alkalosis | 158 | ||
| MIXED ACID-BASE DISTURBANCES | 158 | ||
| Mixed Metabolic Acidosis and Respiratory Alkalosis | 159 | ||
| Mixed Metabolic Alkalosis and Respiratory Acidosis | 159 | ||
| ENSURING VALID MEASUREMENT AND USE OF BLOOD GAS DATA | 159 | ||
| Preanalytic Errors | 159 | ||
| Analytic Errors | 160 | ||
| Postanalytic Errors | 160 | ||
| Internal Validity Checks | 160 | ||
| External Validity Checks | 160 | ||
| SYSTEMATIC INTERPRETATION OF BLOOD GASES | 160 | ||
| Oxygenation Assessment | 160 | ||
| Step 1 | 160 | ||
| Step 2 | 160 | ||
| Step 3 | 160 | ||
| Step 4 | 160 | ||
| Acid-Base Assessment | 161 | ||
| Step 1 | 161 | ||
| Step 2 | 161 | ||
| Step 3 | 161 | ||
| KEY POINTS | 161 | ||
| ASSESSMENT QUESTIONS | 164 | ||
| 9 - Pulmonary Function Testing | 168 | ||
| LUNG VOLUMES AND CAPACITIES | 169 | ||
| SPIROMETRY | 171 | ||
| Indications and Contraindications | 171 | ||
| Forced Vital Capacity | 171 | ||
| Flow-Volume Loops | 173 | ||
| Maximal Voluntary Ventilation | 173 | ||
| Spirometry Quality Assurance | 173 | ||
| Equipment Calibration | 173 | ||
| Technique Validation | 174 | ||
| Interpretation of Spirometry Test Results | 175 | ||
| STATIC LUNG VOLUMES | 178 | ||
| Indications and Contraindications | 178 | ||
| Methods | 178 | ||
| Closed-Circuit Helium Dilution | 178 | ||
| Open-Circuit Nitrogen Washout | 179 | ||
| Body Plethysmography | 180 | ||
| Interpretation | 181 | ||
| DIFFUSING CAPACITY OF THE LUNG (DLCO) | 181 | ||
| Indications | 181 | ||
| Equipment and Quality Assurance | 182 | ||
| Test Procedure and Calculations | 182 | ||
| Interpretation | 183 | ||
| SPECIALIZED TESTS | 183 | ||
| Airway Resistance | 184 | ||
| Lung and Chest Wall Compliance | 184 | ||
| Airway Hyperresponsiveness and Inflammation | 185 | ||
| Bronchoprovocation Testing | 185 | ||
| Exhaled Nitric Oxide (FENO) Analysis | 186 | ||
| Exercise Tests | 187 | ||
| 6-Minute Walk Test | 187 | ||
| Cardiopulmonary Exercise Testing | 188 | ||
| INFECTION CONTROL | 189 | ||
| KEY POINTS | 190 | ||
| ASSESSMENT QUESTIONS | 192 | ||
| 10 - Chest Imaging | 196 | ||
| PRODUCTION OF THE RADIOGRAPH | 197 | ||
| INDICATIONS FOR THE CHEST RADIOGRAPH EXAMINATION | 199 | ||
| RADIOGRAPHIC VIEWS | 199 | ||
| Standard and Special Views | 199 | ||
| Portable Chest Image (Anteroposterior View) | 200 | ||
| EVALUATION OF THE CHEST RADIOGRAPH | 200 | ||
| Review of Clinical Findings | 200 | ||
| Systematic Approach to the Chest Radiograph | 200 | ||
| Interpretation | 201 | ||
| Silhouette Sign | 202 | ||
| Air Bronchogram | 203 | ||
| Limitations | 203 | ||
| CLINICAL AND RADIOGRAPHIC FINDINGS IN LUNG DISEASES | 203 | ||
| Atelectasis | 203 | ||
| Compression Atelectasis | 203 | ||
| Obstructive Atelectasis | 203 | ||
| Pneumothorax | 204 | ||
| Hyperinflation | 205 | ||
| Interstitial Lung Disease | 205 | ||
| Congestive Heart Failure | 207 | ||
| Pleural Effusion | 208 | ||
| Lung Consolidation | 209 | ||
| POSTPROCEDURAL CHEST RADIOGRAPH EVALUATION | 209 | ||
| Tracheal Intubation | 209 | ||
| Central Venous Pressure Line | 210 | ||
| Pulmonary Artery Catheter Placement | 211 | ||
| Nasogastric Feeding Tubes | 211 | ||
| Chest Tubes | 211 | ||
| COMPUTED TOMOGRAPHY | 212 | ||
| Lung Tumors | 213 | ||
| Screening for Lung Cancer | 213 | ||
| Pulmonary Embolism | 213 | ||
| Chronic Interstitial Lung Disease | 214 | ||
| Acquired Immunodeficiency Syndrome | 214 | ||
| Occupational Lung Disease | 214 | ||
| Pneumonia | 214 | ||
| Bronchiectasis | 214 | ||
| Chronic Obstructive Pulmonary Disease | 214 | ||
| MAGNETIC RESONANCE IMAGING | 215 | ||
| RADIONUCLIDE LUNG SCANNING | 215 | ||
| POSITRON EMISSION TOMOGRAPHY | 216 | ||
| PULMONARY ANGIOGRAPHY | 216 | ||
| CHEST ULTRASOUND | 216 | ||
| FLUOROSCOPY | 217 | ||
| INTERVENTIONAL RADIOLOGY | 217 | ||
| RADIATION SAFETY | 218 | ||
| KEY POINTS | 218 | ||
| ASSESSMENT QUESTIONS | 218 | ||
| 11 - Interpretation of Electrocardiogram Tracings | 221 | ||
| WHAT IS AN ELECTROCARDIOGRAM? | 222 | ||
| WHAT IS THE VALUE OF AN ELECTROCARDIOGRAM? | 222 | ||
| WHEN SHOULD AN ELECTROCARDIOGRAM BE OBTAINED? | 222 | ||
| CARDIAC ANATOMY AND PHYSIOLOGY | 223 | ||
| CAUSES AND MANIFESTATIONS OF DYSRHYTHMIAS | 226 | ||
| IMPORTANT ABBREVIATIONS AND ACRONYMS | 226 | ||
| BASIC ELECTROCARDIOGRAM WAVES | 227 | ||
| Electrocardiogram Paper and Measurements | 228 | ||
| Evaluating Heart Rate | 230 | ||
| ELECTROCARDIOGRAM LEADS | 231 | ||
| Limb Leads | 231 | ||
| Chest Leads | 231 | ||
| Evaluating the Mean QRS Axis | 232 | ||
| STEPS OF ELECTROCARDIOGRAM INTERPRETATION | 233 | ||
| NORMAL SINUS RHYTHM | 235 | ||
| IDENTIFICATION OF COMMON DYSRHYTHMIAS | 235 | ||
| Sinus Bradycardia | 235 | ||
| Sinus Tachycardia | 235 | ||
| Sinus Dysrhythmia | 236 | ||
| Paroxysmal Atrial Tachycardia | 236 | ||
| Atrial Flutter | 237 | ||
| Atrial Fibrillation | 237 | ||
| Premature Ventricular Contractions | 237 | ||
| Ventricular Tachycardia | 238 | ||
| Ventricular Fibrillation | 240 | ||
| Asystole | 240 | ||
| Pulseless Electrical Activity | 241 | ||
| Atrioventricular Heart Block | 241 | ||
| First-Degree AV Block | 241 | ||
| Second-Degree AV Block Type I (Mobitz I) | 241 | ||
| Second-Degree AV Block Type II (Mobitz II) | 242 | ||
| Third-Degree AV Block | 242 | ||
| Idioventricular Rhythm | 242 | ||
| Junctional Rhythm | 243 | ||
| EVIDENCE OF CARDIAC ISCHEMIA, INJURY, OR INFARCTION | 243 | ||
| ASSESSING CHEST PAIN | 244 | ||
| ELECTROCARDIOGRAM PATTERNS WITH CHRONICÂ LUNG DISEASE | 245 | ||
| KEY POINTS | 246 | ||
| ASSESSMENT QUESTIONS | 247 | ||
| 12 -\rNeonatal and Pediatric Assessment | 250 | ||
| ASSESSMENT OF THE NEWBORN | 251 | ||
| History | 251 | ||
| Maternal History | 251 | ||
| Family History | 252 | ||
| Pregnancy History | 252 | ||
| Labor and Delivery History | 252 | ||
| Postnatal History | 254 | ||
| Fetal Assessment | 254 | ||
| Physical Examination of the Newborn and Infant | 255 | ||
| Growth and Gestational Age Assessment | 255 | ||
| Vital Sign Assessment | 257 | ||
| Morphometric Measurements | 259 | ||
| Lung Topography | 259 | ||
| Techniques of Examination | 259 | ||
| Inspection | 259 | ||
| Palpation | 261 | ||
| Auscultation | 262 | ||
| Transillumination | 262 | ||
| Clinical Laboratory Data | 262 | ||
| Hematology | 263 | ||
| Blood Chemistry | 264 | ||
| Microbiology | 266 | ||
| Newborn Blood Gases | 266 | ||
| Fetal Hemoglobin | 266 | ||
| Arterial Blood Gases | 266 | ||
| Capillary Blood Gases | 266 | ||
| Venous Blood Gases | 267 | ||
| Noninvasive Monitors | 267 | ||
| Pulmonary Function Testing | 268 | ||
| Volumes | 268 | ||
| Mechanics | 269 | ||
| Chemoreceptor Response | 269 | ||
| Radiographs | 270 | ||
| Apnea Monitoring | 272 | ||
| ASSESSMENT OF CRITICALLY ILL INFANTS | 273 | ||
| Airway | 273 | ||
| Tracheostomy | 273 | ||
| Hemodynamic Assessments | 273 | ||
| ASSESSMENT OF THE OLDER INFANT AND CHILD | 274 | ||
| History | 274 | ||
| Physical Examination | 275 | ||
| Clinical Laboratory Data | 276 | ||
| Blood Gases | 276 | ||
| Pulmonary Function Testing | 276 | ||
| Pediatric Bronchoscopy | 277 | ||
| Radiographs | 277 | ||
| KEY POINTS | 278 | ||
| ASSESSMENT QUESTIONS | 279 | ||
| 13 - Older Patient Assessment | 282 | ||
| PATIENT-CLINICIAN INTERACTION | 283 | ||
| Principles of Communication | 283 | ||
| Reducing Communication Barriers | 283 | ||
| Communicating with Older Adults with Dementia | 284 | ||
| AGE-RELATED SENSORY DEFICIT | 284 | ||
| Hearing Impairment | 284 | ||
| Assessing for Hearing Impairment | 284 | ||
| Compensating for Hearing Impairment | 285 | ||
| Vision Impairment | 285 | ||
| Assessing for Vision Impairment | 285 | ||
| Compensating for Vision Loss or Impairment | 285 | ||
| AGING OF THE ORGAN SYSTEMS | 285 | ||
| Age-Related Changes | 285 | ||
| Cardiovascular System | 286 | ||
| Pulmonary System | 286 | ||
| Pulmonary Defense Mechanisms | 287 | ||
| Immunity | 287 | ||
| Unusual Presentations of Illness | 287 | ||
| Pneumonia | 287 | ||
| Myocardial Infarction | 288 | ||
| Asthma | 288 | ||
| Chronic Obstructive Pulmonary Disease | 288 | ||
| HIV/AIDS and Associated Complications | 288 | ||
| PATIENT ASSESSMENT | 289 | ||
| Vital Signs | 289 | ||
| Temperature | 289 | ||
| Pulse | 289 | ||
| Blood Pressure | 289 | ||
| Respiratory Rate | 290 | ||
| Inspection and Palpation | 290 | ||
| Inspection | 290 | ||
| Palpation | 291 | ||
| Pulmonary Auscultation | 291 | ||
| Cardiac Auscultation | 292 | ||
| Heart Sounds | 292 | ||
| Heart Murmurs | 292 | ||
| DIAGNOSTIC TESTS | 292 | ||
| Gas Exchange | 292 | ||
| Arterial Blood Gases | 293 | ||
| Pulse Oximetry | 293 | ||
| Pulmonary Function Studies | 293 | ||
| Laboratory Values | 294 | ||
| Hematology | 294 | ||
| Blood Chemistry | 294 | ||
| COMPREHENSIVE GERIATRIC ASSESSMENT | 295 | ||
| Functional Ability | 295 | ||
| Activities of Daily Living | 295 | ||
| Instrumental Activities of Daily Living | 295 | ||
| KEY POINTS | 296 | ||
| ASSESSMENT QUESTIONS | 297 | ||
| 14 - Respiratory Monitoring in Critical Care | 299 | ||
| VENTILATORY ASSESSMENT | 300 | ||
| Lung Volumes and Flows | 300 | ||
| Why Monitor Lung Volumes? | 300 | ||
| Who Should Be Monitored for Lung Volumes? | 300 | ||
| What Do We Measure? | 301 | ||
| Airway Pressures | 304 | ||
| Peak Pressure | 304 | ||
| Plateau Pressure | 304 | ||
| Mean Airway Pressure | 305 | ||
| Maximum Inspiratory Pressure | 306 | ||
| Auto–Positive End-Expiratory Pressure | 306 | ||
| Compliance | 307 | ||
| Airway Resistance | 307 | ||
| Integrating Pressure, Flow, and Volume | 308 | ||
| Evaluating the Patient-Ventilator Interface | 308 | ||
| Monitoring Pressure, Flow, and Volume in the Intensive Care Unit | 308 | ||
| Flow-Time Waveforms | 311 | ||
| Fractional Gas Concentrations | 315 | ||
| Fraction of Inspired Oxygen Concentration | 316 | ||
| Exhaled Carbon Dioxide | 316 | ||
| EVALUATION OF OXYGENATION | 318 | ||
| Evaluation of Oxygen Transport | 318 | ||
| Oxygen Reserves | 318 | ||
| Cardiac Output | 319 | ||
| Oxyhemoglobin Dissociation Curve | 320 | ||
| Monitoring the Adequacy of Arterial Oxygenation | 320 | ||
| Partial Pressure of Arterial Oxygen | 320 | ||
| Alveolar-to-Arterial Oxygen Tension Difference | 320 | ||
| Ratio of Pao2 to PAo2 (a/A Ratio) | 320 | ||
| Ratio of Pao2 to FIo2 (P/F Ratio) | 321 | ||
| Oxygenation Index | 321 | ||
| Intrapulmonary Shunt | 321 | ||
| Pulse Oximetry | 321 | ||
| MONITORING TISSUE OXYGEN DELIVERY AND UTILIZATION | 322 | ||
| Oxygen Delivery and Availability | 322 | ||
| Oxygen Consumption | 322 | ||
| Mixed Venous Oxygen Tension | 323 | ||
| Mixed Venous Oxygen Saturation | 323 | ||
| Arterial-to-Mixed Venous Oxygen Content Difference | 324 | ||
| Oxygen Extraction Ratio | 324 | ||
| Blood Lactate | 324 | ||
| Regional Tissue Oxygenation (Near-Infrared Spectroscopy) | 324 | ||
| KEY POINTS | 326 | ||
| ASSESSMENT QUESTIONS | 328 | ||
| 15 - Vascular Pressure Monitoring | 331 | ||
| ARTERIAL PRESSURE MONITORING | 332 | ||
| Indications for Arterial Pressure Monitoring | 332 | ||
| Arterial Catheter Insertion Sites | 333 | ||
| Equipment Setup | 333 | ||
| Procedure for Inserting an Arterial Line | 333 | ||
| Arterial Pressure Waveforms | 334 | ||
| Respiratory Variations | 334 | ||
| Use of Arterial Pressure Waveform to Estimate Cardiac Output | 336 | ||
| Interpretation of Arterial Pressure Measurements | 336 | ||
| Complications Associated with Arterial Lines | 336 | ||
| Ischemia | 336 | ||
| Hemorrhage | 336 | ||
| Infection | 337 | ||
| CENTRAL VENOUS PRESSURE MONITORING | 337 | ||
| Indications for Central Venous Pressure Monitoring | 337 | ||
| Central Venous Pressure Catheters and Insertion Sites | 337 | ||
| Procedure for Inserting a Central Venous Pressure Catheter | 338 | ||
| Central Venous and Atrial Pressure Waveforms | 338 | ||
| Respiratory Variations | 338 | ||
| Interpretation of Central Venous Pressure Measurements | 339 | ||
| Central Venous Pressure as a Reflection of Left Ventricular Function | 340 | ||
| Complications of Central Venous Pressure Monitoring | 340 | ||
| INDICATIONS FOR PULMONARY ARTERY PRESSURE MONITORING | 341 | ||
| Pulmonary Artery Catheters and Insertion Sites | 342 | ||
| Placement of the Pulmonary Artery Catheter | 343 | ||
| Interpretation of Pulmonary Artery Pressures | 344 | ||
| Pulmonary Artery Systolic Pressure | 344 | ||
| Pulmonary Artery Diastolic Pressure | 344 | ||
| Wedge Pressure | 345 | ||
| Complications of Pulmonary Artery Catheters | 347 | ||
| CENTRAL LINE BUNDLE | 348 | ||
| KEY POINTS | 349 | ||
| ASSESSMENT QUESTIONS | 350 | ||
| 16 - Cardiac Output Measurement | 353 | ||
| CARDIAC OUTPUT | 354 | ||
| VENOUS RETURN | 354 | ||
| MEASURES OF CARDIAC OUTPUT AND PUMP FUNCTION | 355 | ||
| Cardiac Index | 355 | ||
| Cardiac Work | 355 | ||
| Ventricular Stroke Work | 355 | ||
| Ventricular Volume | 356 | ||
| Ejection Fraction | 356 | ||
| DETERMINANTS OF PUMP FUNCTION | 356 | ||
| Heart Rate | 356 | ||
| Preload | 357 | ||
| Ventricular Function Curves | 357 | ||
| Ventricular Compliance | 357 | ||
| Factors That Affect Venous Return, Preload, and Cardiac Output | 358 | ||
| Clinical Applications of Ventricular Function Curves | 358 | ||
| Effects of Mechanical Ventilation on Preload and Venous Return | 359 | ||
| Afterload | 360 | ||
| Ventricular Wall Stress | 360 | ||
| Peripheral Resistance | 360 | ||
| Calculating Systemic and Pulmonary Vascular Resistance | 361 | ||
| Contractility | 361 | ||
| Factors Related to Contractility | 361 | ||
| Variables Used to Assess Contractility | 362 | ||
| METHODS OF MEASURING CARDIAC OUTPUT | 364 | ||
| Invasive Methods | 364 | ||
| Fick Cardiac Output | 364 | ||
| Pulmonary Artery Thermodilution Cardiac Output | 365 | ||
| Transpulmonary Indicator Dilution Cardiac Output | 366 | ||
| Continuous Cardiac Output Monitoring | 366 | ||
| Transesophageal, Transtracheal, and Intravascular Doppler Monitoring | 368 | ||
| Noninvasive Methods | 368 | ||
| Continuous Measurement of Cardiac Performance Using Transthoracic Electrical Bioimpedance | 368 | ||
| Periodic Noninvasive Measurement of Cardiac Performance | 369 | ||
| KEY POINTS | 370 | ||
| ASSESSMENT QUESTIONS | 371 | ||
| 17 - Bronchoscopy | 374 | ||
| CHARACTERISTICS AND CAPABILITIES OF THE BRONCHOSCOPE | 375 | ||
| INDICATIONS FOR BRONCHOSCOPY | 377 | ||
| Nodules and Masses | 377 | ||
| Hemoptysis | 378 | ||
| Pneumonia | 378 | ||
| Interstitial Lung Diseases | 379 | ||
| Foreign Bodies | 379 | ||
| COMPLICATIONS OF BRONCHOSCOPY | 380 | ||
| PREPARATION | 380 | ||
| Personnel and Equipment Preparation | 380 | ||
| Patient Preparation | 381 | ||
| PROCEDURE | 382 | ||
| SPECIMEN COLLECTION AND PROCESSING | 382 | ||
| POSTPROCEDURE CONSIDERATIONS | 383 | ||
| OUTPATIENT VERSUS INPATIENT BRONCHOSCOPY | 383 | ||
| ROLE OF THE RESPIRATORY THERAPIST | 384 | ||
| KEY POINTS | 385 | ||
| ASSESSMENT QUESTIONS | 385 | ||
| 18 - Nutrition Assessment | 387 | ||
| MALNUTRITION AND THE PULMONARY SYSTEM | 388 | ||
| EFFECT OF PULMONARY DISEASE ON NUTRITIONAL STATUS | 389 | ||
| INTERDEPENDENCE OF RESPIRATION AND NUTRITION | 389 | ||
| Nutritional Depletion and Respiration | 392 | ||
| Therapeutic Interactions of Respiration and Nutrition | 393 | ||
| RESPIRATORY SYSTEM AND NUTRITIONAL NEEDS | 393 | ||
| Neurologic Component | 393 | ||
| Respiratory Muscle Component | 393 | ||
| Cardiovascular Component | 394 | ||
| Protein | 394 | ||
| Carbohydrate | 394 | ||
| Fat | 394 | ||
| Vitamins and Minerals | 394 | ||
| Fluids | 394 | ||
| Gas Exchange Component (Lungs) | 394 | ||
| METABOLISM | 395 | ||
| NUTRITIONAL REQUIREMENTS | 395 | ||
| Energy | 397 | ||
| Protein | 398 | ||
| Nitrogen | 398 | ||
| Protein Quality and Adequacy | 398 | ||
| Effects and Consequences of Extreme Intakes of Protein | 398 | ||
| Acid-Base Balance | 398 | ||
| Nitrogen Balance | 398 | ||
| Fat | 399 | ||
| Key Functions of Fat | 399 | ||
| Types of Dietary Fats and Health Implications | 399 | ||
| Vitamins, Minerals, Phytochemicals, and Other Nutrients | 399 | ||
| Fluids and Electrolytes | 400 | ||
| Fluid Concerns | 400 | ||
| Water | 400 | ||
| Intravenous Fluids | 400 | ||
| Phosphorus | 401 | ||
| METHODS OF MEETING NUTRITIONAL REQUIREMENTS | 401 | ||
| Condition-Specific Nutritional Considerations | 401 | ||
| Chronic Obstructive Pulmonary Disease | 401 | ||
| Patients Receiving Mechanical Ventilation | 401 | ||
| Cystic Fibrosis | 401 | ||
| Guidelines for Nutritional Management of Cystic Fibrosis | 402 | ||
| Nutrition Guidelines | 402 | ||
| NUTRITIONAL ASSESSMENT | 402 | ||
| Data Gathering and Interpretation | 402 | ||
| History | 402 | ||
| Physical Examination | 403 | ||
| Anthropometric Measurements of Physical Assessment | 403 | ||
| Laboratory Biochemical Tests | 405 | ||
| ROLE OF THE RESPIRATORY THERAPIST IN NUTRITIONAL ASSESSMENT | 406 | ||
| Inspection Findings | 406 | ||
| Auscultation Findings | 407 | ||
| Laboratory Findings | 407 | ||
| KEY POINTS | 407 | ||
| ASSESSMENT QUESTIONS | 409 | ||
| 19 - Sleep and Breathing Assessment | 412 | ||
| NORMAL STAGES OF SLEEP | 413 | ||
| Non–Rapid Eye Movement Sleep | 413 | ||
| Rapid Eye Movement Sleep | 414 | ||
| PHYSIOLOGY DURING SLEEP | 415 | ||
| SLEEP DISORDERS | 415 | ||
| EVALUATION OF SLEEP DISORDERS | 415 | ||
| Epworth Sleepiness Scale | 416 | ||
| Berlin Questionnaire | 417 | ||
| STOP-BANG Assessment | 417 | ||
| PHYSICAL EXAMINATION | 418 | ||
| Additional Testing | 419 | ||
| The Polysomnogram | 419 | ||
| SLEEP DISORDERED BREATHING | 421 | ||
| Obstructive Sleep Apnea | 421 | ||
| Signs, Symptoms, and Additional Health Consequences | 421 | ||
| Children and Infants with Obstructive Sleep Apnea | 422 | ||
| Obstructive Sleep Apnea Treatment Options | 422 | ||
| Upper Airway Resistance Syndrome | 423 | ||
| Central Sleep Apnea | 423 | ||
| Signs and Symptoms of Central Sleep Apnea | 424 | ||
| Mixed Sleep Apnea | 424 | ||
| Children with Central Sleep Apnea | 424 | ||
| Hypoventilation Syndromes | 425 | ||
| KEY POINTS | 425 | ||
| ASSESSMENT QUESTIONS | 427 | ||
| 20 - Assessment of the Home Care Patient | 429 | ||
| IMPORTANCE OF RESPIRATORY HOME CARE | 430 | ||
| THE HOME CARE PATIENT | 430 | ||
| HOME CARE ASSESSMENT TOOLS AND RESOURCES | 431 | ||
| ROLE AND QUALIFICATIONS OF THE HOME CARE RESPIRATORY THERAPIST | 432 | ||
| ASSESSMENT AND THE HOME VISIT | 433 | ||
| Initial Visit and Assessment | 433 | ||
| Medical History | 433 | ||
| Physical Examination | 434 | ||
| Physical and Functional Limitations | 434 | ||
| Medication Review | 435 | ||
| Psychosocial Evaluation | 435 | ||
| Nutritional Review | 436 | ||
| Cultural, Ethnic, and Religious Considerations | 436 | ||
| Environmental Assessment | 436 | ||
| Home Care Equipment | 437 | ||
| Equipment Maintenance | 437 | ||
| Patient Education and Training | 438 | ||
| Plan of Care | 438 | ||
| Follow-up Care | 438 | ||
| Discharging the Patient | 439 | ||
| TELEMEDICINE, TELEMONITORING, AND EHEALTH | 439 | ||
| KEY POINTS | 440 | ||
| ASSESSMENT QUESTIONS | 441 | ||
| 21 - Documentation | 443 | ||
| THE JOINT COMMISSION | 444 | ||
| GENERAL PURPOSES OF DOCUMENTATION | 444 | ||
| THE JOINT COMMISSION AND LEGAL ASPECTS OF THE MEDICAL RECORD | 444 | ||
| TYPES OF MEDICAL RECORDS | 447 | ||
| Electronic Health Records | 447 | ||
| ORGANIZING PATIENT INFORMATION | 448 | ||
| Step 1: Data Collection | 448 | ||
| Step 2: Assessment | 448 | ||
| Step 3: The Plan | 450 | ||
| Step 4: Implementation of the Plan | 450 | ||
| Step 5: Evaluation of the Results of the Plan and Implementation | 451 | ||
| CHARTING METHODS | 451 | ||
| Subjective, Objective, Assessment, and Plan Charting | 451 | ||
| Assessment, Plan, Implementation, and Evaluation Charting | 451 | ||
| Problem, Intervention, and Plan Charting | 451 | ||
| Situation, Background, Assessment, and Recommendation Charting | 451 | ||
| KEY POINTS | 452 | ||
| ASSESSMENT QUESTIONS | 455 | ||
| GLOSSARY | 457 | ||
| INDEX | 466 | ||
| A | 466 | ||
| B | 467 | ||
| C | 469 | ||
| D | 473 | ||
| E | 474 | ||
| F | 475 | ||
| G | 476 | ||
| H | 476 | ||
| I | 478 | ||
| J | 478 | ||
| K | 478 | ||
| L | 479 | ||
| M | 479 | ||
| N | 480 | ||
| O | 482 | ||
| P | 483 | ||
| Q | 486 | ||
| R | 486 | ||
| S | 488 | ||
| T | 490 | ||
| U | 491 | ||
| V | 491 | ||
| W | 492 | ||
| X | 492 | ||
| Z | 492 | ||
| ABBREVIATIONS | ES2 |