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Table of Contents


	Introduction	xvii
PART I	ASSESSMENT OF RESPIRATORY DISEASE	1
SECTION I	CLINICAL DATA OBTAINED AT THE PATIENT’S BEDSIDE	2
1	The Patient Interview	2
	Patient History	3
	Patient Interview	3
	Techniques of Communication	3
	Closing the Interview	8
2	The Physical Examination and its Basis in Physiology	9
	Vital Signs	11
	Systematic Examination of the Chest and Lungs	19
	In-Depth Discussion of the Common Clinical Manifestations Observed during Inspection	28
	Normal and Abnormal Sputum Production	42
SECTION II	CLINICAL DATA OBTAINED FROM LABORATORY TESTS AND SPECIAL PROCEDURES	47
3	Pulmonary Function Study Assessments	47
	Normal Lung Volumes and Capacities	48
	Forced Expiratory Flow Rate and Volume Measurements	49
	Pulmonary Diffusion Capacity	53
4	Arterial Blood Gas Assessments	58
	Acid-Base Abnormalities	59
	The Hazards of Oxygen Therapy in Patients with Chronic Ventilatory Failure with Hypoxemia	67
5	Oxygenation Assessments	70
	Oxygen Transport Review	71
	Oxygen Dissolved in the Blood Plasma	71
	Oxygen Bound to Hemoglobin	71
	Total Oxygen Content	71
	Oxygenation Indices	72
	Hypoxemia versus Hypoxia	75
6	Cardiovascular System Assessments	79
	The Electrocardiogram	80
	Common Heart Arrhythmias	80
	Noninvasive Hemodynamic Monitoring Assessments	83
	Invasive Hemodynamic Monitoring Assessments	83
7	Radiologic Examination of the Chest	87
	The Fundamentals of Radiography	88
	The Standard Positions and Techniques of Chest Radiography	88
	Inspecting the Chest Radiograph	91
8	Other Important Tests and Procedures	103
	Sputum Examination	104
	Skin Tests	105
	Endoscopic Examinations	105
	Thoracentesis	106
	Pleurodesis	107
	Hematology, Blood Chemistry, and Electrolyte Findings	107
SECTION III	THE THERAPIST-DRIVEN PROTOCOL PROGRAM-THE ESSENTIALS	114
9	The Therapist-Driven Protocol Program and the Role of the Respiratory Care Practitioner	114
	The “Knowledge Base” Required for a Successful Therapist-Driven Protocol Program	116
	The “Assessment Process Skills” Required for a Successful Therapist-Driven Protocol Program	116
	Overview Summary of a Good Therapist-Driven Protocol Program	138
	Common Anatomic Alterations of the Lungs	140
10	Recording Skills: The Basis for Data Collection, Organization, Assessment Skills, and Treatment Plans	154
	Types of Patient Records	155
	Heath Insurance Portability and Accountability Act	157
PART II	OBSTRUCTIVE AIRWAY DISEASES	163
11	Chronic Obstructive Pulmonary Disease (COPD): Chronic Bronchitis, and Emphysema	164
	Anatomic Alterations of the Lungs Associated with Chronic Bronchitis	167
	Anatomic Alterations of the Lungs Associated with Emphysema	167
	Etiology and Epidemiology	168
	Diagnosis of Chronic Obstructive Pulmonary Disease	168
	Key Distinguishing Features Between Emphysema and Chronic Bronchitis	169
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Chronic Bronchitis and Emphysema	172
	General Management of Chronic Obstructive Pulmonary Disease	176
	Case Study 1: Chronic Bronchitis	179
	Case Study 2: Emphysema	181
	Case Study 3: COPD	183
	Self-Assessment Questions	184
12	Asthma	186
	National Asthma Education and Prevention Program	187
	Global Initiative for Asthma	187
	Anatomic Alterations of the Lungs	188
	Etiology and Epidemiology	188
	Diagnosis of Asthma	191
	Overview of Cardiopulmonary Clinical Manifestations Associated with Asthma	192
	General Management of Asthma	194
	Case Study: Asthma	197
	Self-Assessment Questions	198
13	Bronchiectasis	200
	Anatomic Alterations of the Lungs	201
	Etiology and Epidemiology	201
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Bronchiectasis	202
	General Management of Bronchiectasis	208
	Case Study: Bronchiectasis	209
	Self-Assessment Questions	210
14	Cystic Fibrosis	213
	Anatomic Alterations of the Lungs	214
	Etiology and Epidemiology	214
	Screening and Diagnosis	215
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Cystic Fibrosis	217
	General Management of Cystic Fibrosis	221
	Case Study: Cystic Fibrosis	223
	Self-Assessment Questions	225
PART III	INFECTIOUS PULMONARY DISEASES	227
15	Pneumonia	228
	Anatomic Alterations of the Lungs	229
	Etiology and Epidemiology	229
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Pneumonia	236
	General Management of Pneumonia	240
	Case Study: Pneumonia	241
	Self-Assessment Questions	242
16	Lung Abscess	244
	Anatomic Alterations of the Lungs	245
	Etiology and Epidemiology	245
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Lung Abscess	246
	General Management of Lung Abscess	247
	Case Study: Lung Abscess	249
	Self-Assessment Questions	250
17	Tuberculosis	251
	Anatomic Alterations of the Lungs	252
	Etiology and Epidemiology	253
	Diagnosis	254
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Tuberculosis	255
	General Management of Tuberculosis	258
	Case Study: Tuberculosis	259
	Self-Assessment Questions	260
18	Fungal Diseases of the Lung	261
	Anatomic Alterations of the Lungs	262
	Etiology and Epidemiology	262
	Primary Pathogens	262
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Fungal Diseases of the Lungs	264
	General Management of Fungal Disease	267
	Case Study: Fungal Diseases of the Lungs	268
	Self-Assessment Questions	270
PART IV	PULMONARY VASCULAR DISEASES	271
19	Pulmonary Edema	272
	Anatomic Alterations of the Lungs	273
	Etiology and Epidemiology	273
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Pulmonary Edema	275
	General Management of Pulmonary Edema	276
	Case Study: Pulmonary Edema	279
	Self-Assessment Questions	280
20	Pulmonary Embolism	281
	Anatomic Alterations of the Lungs	282
	Etiology and Epidemiology	282
	Diagnosis and Screening	282
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Pulmonary Embolism	284
	General Management of Pulmonary Embolism	288
	Case Study: Pulmonary Embolism	290
	Self-Assessment Questions	292
PART V	RIGHT AND PLEURAL TRAUMA	295
21	Flail Chest	296
	Anatomic Alterations of the Lungs	297
	Etiology and Epidemiology	297
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Flail Chest	297
	General Management of Flail Chest	300
	Case Study: Flail Chest	301
	Self-Assessment Questions	302
22	Pneumothorax	303
	Anatomic Alterations of the Lungs	304
	Etiology and Epidemiology	304
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Pneumothorax	306
	General Management of Pneumothorax	309
	Case Study: Spontaneous Pneumothorax	311
	Self-Assessment Questions	312
PART VI	DISORDERS OF THE PLEURA AND OF THE CHEST	313
23	Effusion and Empyema	314
	Anatomic Alterations of the Lungs	315
	Etiology and Epidemiology	315
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Pleural Effusion and Empyema	317
	General Management of Pleural Effusion	318
	Case Study: Pleural Effusion and Empyema	320
	Self-Assessment Questions	322
24	Kyphoscoliosis	323
	Anatomic Alterations of the Lungs	324
	Etiology and Epidemiology	324
	Diagnosis	325
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Kyphoscoliosis	326
	General Management of Kyphoscoliosis	327
	Respiratory Care Treatment Protocols	328
	Case Study: Kyphoscoliosis	330
	Self-Assessment Questions	333
PART VII	ENVIRONMENTAL LUNG DISEASES	335
25	Interstitial Lung Diseases	336
	Anatomic Alterations of the Lungs	338
	Etiology and Epidemiology	338
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Interstitial Lung Diseases	346
	General Management of Interstitial Lung Diseases	349
	Case Study: Interstitial Lung Diseases	350
	Self-Assessment Questions	353
PART VIII	NEOPLASTIC DISEASE	355
26	Cancer of the Lung	356
	Anatomic Alterations of the Lungs	357
	Etiology and Epidemiology	357
	Screening and Diagnosis	359
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Cancer of the Lung	361
	General Management of Cancer of the Lung	366
	Case Study: Cancer of the Lung	368
	Self-Assessment Questions	370
PART IX	DIFFUSE ALVEOLAR DISEASE	371
27	Acute Respiratory Distress Syndrome	372
	Anatomic Alterations of the Lungs	373
	Etiology and Epidemiology	373
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Acute Respiratory Distress Syndrome	374
	General Management of Acute Respiratory Distress Syndrome	375
	Case Study: Acute Respiratory Distress Syndrome	377
	Self-Assessment Questions	378
PART X	NEUROLOGIC DISORDERS AND SLEEP APNEA	379
28	Guillain-Barré Syndrome	380
	Anatomic Alterations of the Lungs Associated with Guillain-Barré Syndrome	381
	Etiology and Epidemiology	381
	Clinical Presentation	382
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Guillain-Barré Syndrome	382
	General Management of Guillain-Barré Syndrome	383
	Case Study: Guillain-Barré Syndrome	385
	Self-Assessment Questions	387
29	Myasthenia Gravis	388
	Anatomic Alterations of the Lungs Associated with Myasthenia Gravis	389
	Etiology and Epidemiology	389
	Screening and Diagnosis	389
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Myasthenia Gravis	391
	General Management of Myasthenia Gravis	392
	Case Study: Myasthenia Gravis	393
	Self-Assessment Questions	395
30	Sleep Apnea	396
	Normal Sleep Stages	397
	Types of Sleep Apnea	398
	Diagnosis	401
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Sleep Apnea	402
	General Management of Sleep Apnea	403
	Case Study: Obstructive Sleep Apnea	407
	Self-Assessment Questions	409
PART XI	NEWBORN AND EARLY CHILDHOOD RESPIRATORY DISORDERS	411
31	Newborn and Early Childhood Respiratory Disorders	412
	Clinical Manifestations Common with Newborn and Early Childhood Respiratory Disorders	413
	Assessment of the Newborn	415
	Self-Assessment Questions	418
32	Meconium Aspiration Syndrome	419
	Anatomic Alterations of the Lungs	420
	Etiology and Epidemiology	421
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Meconium Aspiration Syndrome	421
	General Management of Meconium Aspiration Syndrome	423
	Case Study: Meconium Aspiration Syndrome	424
	Self-Assessment Questions	425
33	Transient Tachypnea of the Newborn	426
	Anatomic Alterations of the Lungs	427
	Etiology and Epidemiology	427
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Transient Tachypnea of the Newborn	427
	General Management of Transient Tachypnea of the Newborn	429
	Case Study: Transient Tachypnea of the Newborn	430
	Self-Assessment Questions	431
34	Respiratory Distress Syndrome	432
	Anatomic Alterations of the Lungs	433
	Etiology and Epidemiology	433
	Diagnosis	434
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Respiratory Distress Syndrome	435
	General Management of Respiratory Distress Syndrome	436
	Case Study: Respiratory Distress Syndrome	437
	Self-Assessment Questions	438
35	Pulmonary Air Leak Syndromes	439
	Anatomic Alterations of the Lungs	440
	Etiology and Epidemiology	441
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Pulmonary Air Leak Syndromes	442
	General Management of Pulmonary Air Leak Syndromes	443
	Case Study: Pulmonary Air Leak Syndromes	444
	Self-Assessment Questions	445
36	Respiratory Syncytial Virus Infection (Bronchiolitis or Pneumonitis)	446
	Anatomic Alterations of the Lungs	447
	Etiology and Epidemiology	447
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Respiratory Syncytial Virus	448
	General Management of Respiratory Syncytial Virus (Bronchiolitis, Pneumonitis)	449
	Case Study: Respiratory Syncytial Virus Infection	451
	Self-Assessment Questions	452
37	Bronchopulmonary Dysplasia	453
	Anatomic Alterations of the Lungs	454
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Bronchopulmonary Dysplasia	457
	Etiology and Epidemiology	458
	General Management of Bronchopulmonary Dysplasia	458
	Case Study: Bronchopulmonary Dysplasia	460
	Self-Assessment Questions	461
38	Congenital Diaphragmatic Hernia	462
	Anatomic Alterations of the Lungs	462
	Etiology and Epidemiology	463
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Diaphragmatic Hernia	463
	General Management of a Diaphragmatic Hernia	465
	Case Study: Diaphragmatic Hernia	466
	Self-Assessment Questions	467
39	Croup Syndrome: Laryngotracheobronchitis and Acute Epiglottitis	468
	Anatomic Alterations of the Upper Airway	469
	Etiology and Epidemiology	470
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Laryngotracheobronchitis and Epiglottitis	471
	General Management of Laryngotracheobronchitis and Epiglottitis	473
	Case Study 1: Laryngotracheobronchitis	474
	Case Study 2: Acute Epiglottitis	475
	Self-Assessment Questions	476
PART XII	IMPORTANT TOPICS	477
40	Near Drowning	478
	Anatomic Alterations of the Lungs	479
	Etiology and Epidemiology	479
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Near Wet Drowning	480
	General Management	481
	Case Study: Near Drowning	482
	Self-Assessment Questions	483
41	Smoke Inhalation and Thermal Injuries	484
	Anatomic Alterations of the Lungs	485
	Etiology and Epidemiology	486
	Body Surface Burns	487
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Smoke Inhalation and Thermal Injuries	488
	General Management of Smoke Inhalation and Thermal Injuries	490
	Case Study: Smoke Inhalation and Thermal Injury	492
	Self-Assessment Questions	493
42	Postoperative Atelectasis	495
	Anatomic Alterations of the Lungs	496
	Etiology and Epidemiology	496
	Overview of the Cardiopulmonary Clinical Manifestations Associated with Postoperative Atelectasis	497
	General Management of Postoperative Atelectasis	498
	Case Study: Postoperative Atelectasis	499
	Self-Assessment Questions	500
Appendix I	Symbols and Abbreviations Commonly Used in Respiratory Physiology	501
Appendix II	Agents Used to Treat Bronchospasm and Airway Inflammation	503
Appendix III	Antibiotics	506
Appendix IV	Antifungal Agents	508
Appendix V	Mucolytic and Expectorant Agents	509
Appendix VI	Positive Inotropes and Vasopressors	510
Appendix VII	Diuretic Agents	511
Appendix VIII	The Ideal Alveolar Gas Equation	512
Appendix IX	Physiologic Dead Space Calculation	513
Appendix X	Units of Measure	514
Appendix XI	Poiseuille’s Law	517
Appendix XII	Pco₂//pH Nomogram	519
Appendix XIII	Calculated Hemodynamic Measurements	521
Appendix XIV	Dubois Body Surface Area Chart	524
Appendix XV	Cardiopulmonary Profile	525
	Glossary	528
	Index	549