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5 курс / Пульмонология и фтизиатрия / Clinical_Manifestations_and_Assessment_of_Respiratory

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Ptosis, 434

Pulmonary air leak syndrome, 541–549 admitting history, 547

airway clearance protocol, 544–546 arterial blood gases, 545b

cardiopulmonary clinical manifestations associated with, 545–546 case study, 547–548

chest assessment findings, 545 chest radiograph, 546 discussion, 548

etiology and epidemiology, 544 illustration, 542f

laboratory tests and procedures, clinical data, 545 lungs

anatomic alterations, 542–543 expansion therapy protocol, 546

management of, 544–546 mechanical ventilation protocol, 546 needle thoracentesis, 546, 547f neonatal, risk factors, 544b

oxygen therapy protocol, 544 oxygenation indices, 546b patient bedside, clinical data, 545 physical examination, 545, 547

pulmonary function test findings, 545b radiologic findings, 546

respiratory assessment and plan, 547–548 respiratory care treatment protocols, 544–546 respiratory rate, increased (tachypnea), 545 transillumination, increased, 545

vital signs, 545

Pulmonary alveolar proteinosis, 405 Pulmonary angiogram, 112–113

abnormality of, 113f

for pulmonary embolism, 324, 328, 329f

Pulmonary artery, catheter, 97–98 Pulmonary barotrauma, 541

drowning and, 602–603

Pulmonary capillary blood (CcO2), 84 Pulmonary capillary congestion, 528, 529f Pulmonary capillary wedge pressure (PCWP), 97

position, 98f

Pulmonary catheter, insertion of, 98f Pulmonary diffusion capacity, 62–65, 65t Pulmonary edema, 311–319

admitting history, 318 afterload reducers in, 314 arterial blood gases, 315b

cardiogenic, 312–313, 313b, 316–317

cardiopulmonary manifestations associated with, 315–317 case study, 318–319

cephalogenic, 313 Cheyne-Stokes respiration in, 315

chronic lung disease of infancy caused by, 564t clinical data in, 315

decompression, 313

decreased intrapleural pressure in, 313 decreased oncotic pressure in, 313 discussion, 319

etiology and epidemiology of, 312–313 hemodynamic indices, 316b high-altitude, 313–314

increased capillary permeability in, 313 increased respiratory rate in, 315 laboratory tests and procedures

abnormal, 316 clinical data, 315

lungs

anatomic alterations, 311–312, 312f expansion therapy protocol, 317–318

lymphatic insufficiency in, 313 management of, 314–318 mechanical ventilation protocol, 318 noncardiogenic, 313–314, 314b, 317 oxygen therapy protocols, 317

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oxygenation indices, 316b

paroxysmal nocturnal dyspnea and orthopnea in, 315 photographic negative, 409

physical examination, 315, 318 positive inotropic agents for, 314–317 preload reducers for, 314

pulmonary function test findings, 315b radiologic findings in, 316–317, 316f–317f respiratory assessment and plan, 318 respiratory care treatment protocols for, 317–318 respiratory rate, increased (tachypnea), 315 vital signs in, 315

Pulmonary embolectomy, for pulmonary embolism, 330 Pulmonary embolism (PE), 321–330

abnormal electrocardiographic patterns in, 328 admitting history, 335

aerosolized medication protocol, 330 arterial blood gases, 327b

cardiopulmonary clinical manifestations associated with, 325–328 case study, 335–337

chest radiograph, 328 chest x-ray, 323 clinical data, 325–327

common tests for, 322–324 blood tests, 322

chest x-ray, 323

computed tomography pulmonary angiogram, 323, 328, 329f D-dimer blood test, 322

magnetic resonance angiography, 324 magnetic resonance imaging, 324 pulmonary angiogram, 324, 328, 329f ultrasonography, 322–323

ventilation-perfusion scan, 323–324, 328, 329f deep vein thrombosis and, 321

diagnosis and screening of, 322–324 discussion, 336–337

etiology and epidemiology of, 321–322 heart rate, increased, 326 hemodynamic indices, 327b

laboratory tests and procedures, clinical data, 327–328 lungs

anatomic alterations, 321, 321f expansion therapy protocol, 330

management of, 324–330 oxygen therapy protocol, 330 oxygenation indices, 327b

physical examination, 325–327, 335 preventive measures for, 324–330 radiologic findings in, 328 respiratory assessment and plan, 335

respiratory care treatment protocols for, 330 respiratory rate, increased (tachypnea), 325 risk factors associated with, 322b

signs and symptoms, 323b transudative pleural effusion and, 358 vital signs, 325

Wells clinical prediction rule for, 323t

Pulmonary emphysema, microscopic, 191f Pulmonary fibrosis, 398

end stage pulmonary fibrosis, 398

Pulmonary flow to systemic flow (QP/QT) ratio, 578–579 Pulmonary function test (PFT) findings

acute respiratory distress syndrome, 418b asthma, 227b

bronchiectasis, 263b–264b chronic bronchitis, 200b

chronic interstitial lung disease, 406b chronic lung disease of infancy, 563b congenital diaphragmatic hernia, 571b cystic fibrosis, 249b

emphysema, 200b flail chest, 342b

Guillain-Barré syndrome, 427b kyphoscoliosis, 368b

lung cancer, 386

meconium aspiration syndrome, 523b myasthenia gravis, 436b

near wet drowning, 601b neuromuscular disease, 450b pleural effusion and empyema, 360b pneumonia, 294b

pneumothorax, 350b postoperative atelectasis, 275b pulmonary air leak syndrome, 545b pulmonary edema, 315b

respiratory distress syndrome, 536b respiratory syncytial virus infection, 553b sleep apnea, 468b

smoke inhalation and thermal injuries, 610b transient tachypnea of the newborn, 530b tuberculosis, 306b

Pulmonary function testing, 54–68 asthma, diagnostic tests for, 66

impulse oscillometry in, 66, 67f cardiopulmonary exercise testing in, 65–66, 66b

expense and complexity of, general hierarchy of, 55t

forced expiratory flow rate, volume measurements and, 58–62 flow-volume loop in, 61–62, 62f, 63t–65t

forced expiratory flow 25% to 75%, 60, 60f

forced expiratory flow between 200 and 1200 mL of forced vital capacity in, 60, 60f forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio, 59–60 forced expiratory volume timed in, 58, 60f

forced vital capacity in, 58, 59f maximum voluntary ventilation in, 61, 61f peak expiratory flow rate in, 61, 61f

myasthenia gravis, 435

normal lung volumes and capacities in, 55–58, 56t obstructive lung disorders, 55, 56t, 57f

restrictive lung disorders, 55, 56t pulmonary diffusion capacity in, 62–65, 65t

residual volume, indirect measurements of, lung capacities containing, 55–58, 58f–59f respiratory muscle strength, assessment of, 65

Pulmonary hyperperfusion, 535

Pulmonary hypertension, 157, 330–337, 333f, 570 clinical classification of, 331b

common signs and symptoms of, 331b–332b diagnosis of, 330

management of, 330 severity of, 333t

test and procedures for, 332t treatment selections for, 334f, 334t

Pulmonary hypoperfusion, 535 Pulmonary hypoplasia, 569–570 Pulmonary infarction, 321

transudative pleural effusion and, 358

Pulmonary interstitial emphysema (PIE), 542–543, 542f lung, hyperinflation, 543f

overdistention, association, 542

Pulmonary Langerhans cell histiocytosis (PLCH), 405 Pulmonary nodule, 107

Pulmonary oxygen toxicity, 494 Pulmonary reflexes, 97

ventilatory pattern and, 40–41

Pulmonary shunt fraction (QS/QT), 86–88 study calculation in, 88b

Pulmonary shunting, 157–159, 158f clinical significance of, 88t

hypoxemia and, 38 types of, 159t

Pulmonary vascular disease, 320–338 case study, 335–337

emerging role of the respiratory therapist in, 330–335 pulmonary embolism, 321–330

pulmonary hypertension, 330–337

Pulmonary vascular resistance (PVR), 99, 491–492 Pulmonary vascular system

decreased cross-sectional area of, because of the embolus, 327 loss of, 113

Pulmonary vasculitides, 405

Pulmonary ventilation-perfusion ratio, 159f Pulmonary volutrauma, 541

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drowning and, 602–603

Pulmonary/systemic vascular resistance ratio (PVR/SVR ratio), 492–493 Pulmozyme (dornase alpha), usage, 252

Pulse, 13, 15–17 heart rate, 97 pressure, 17–18 rate of, 17, 17b rhythm of, 17 sites for, 16f strength of, 17

Pulse oximetric saturation to fractional concentration of inspired oxygen ratio (SpO2/FIO2 ratio), 84

Pulse oximetry, 13

in neonatal patient, 487 sampling, reliable, 491, 491f

screening test, 576

Pulsus alternans, 17 Pulsus paradoxus, 17, 21

Purified protein derivative (PPD), 304, 304f Pursed-lip breathing, 45, 45f

PVR, Pulmonary vascular resistance P wave, 94–95

Pyrazinamide, 308 Pyrexia, 14

Pyridostigmine (Mestinon), selection, 437 Pyrolysis, 608

Q

Q fever, 285 QRS complex, 94

Qs/QT, Pulmonary shunt fraction QuantiFERON-TB Gold Test, 305 Quartz silicosis, 400

Questions

closed or direct, 4, 4b leading or biased, 7 open-ended, 4, 4b

R

Racemic epinephrine, for laryngotracheobronchitis, bacterial tracheitis, and epiglottitis, 595 Radial pulse site, 15–16

Radiation safety, 116–117 techniques, 117

Radiation therapy, 378, 401 acute pneumonitic phase, 401 BCNU, impact, 401

late fibrotic phase, 401 small cell lung cancer, 393

Radiofrequency ablation (RFA), 391, 471 Radiography

anteroposterior, 102–103

chest, positions and techniques of, 102–103 exposure quality, 105–106

lateral, 103, 104f decubitus, 103

technical quality of, 105–106

Radiologic examination, of chest, 101–118 Radiologic terms, 105t

Radiology, fundamentals of, 102 RAP, Right atrial pressure

Rapid and shallow breathing pattern (hallmark clinical manifestation), 530 Rapid eye movement (REM) sleep, 30-second epoch, 466f

RDI, Respiratory disturbance index Reactance (Xrs) pressure oscillations, 66 Reactivation tuberculosis, 302 Reassurance, 6

Recording, 179

Rectus abdominis, 42, 44f Red blood cell (RBC)

count, 125 indices, 126t

production, increase, 90

Reflection, 5 Refractory asthma, 239

Refractory hypoxemia, 164t Reinfection tuberculosis, 302 Relapsing fever, 14

Relative shunt (shunt-like effect), 158 types of, 158f

Reliever medications, for asthma, 231, 232t Religion, 3

Religious and spirituality considerations, in patient interview, 3 Remittent fever, 14

Remodeling, 220 Renal dyspnea, 35

Repetitive nerve stimulation (RNS), 435 RERAs, Respiratory effort-related arousals

Residual volume (RV), indirect measurements of, lung capacities containing, 55–58, 58f–59f Residual volume/total lung capacity ratio (RV/TLC × 100), 56t

Resistance pressure oscillation, 66 Respiration, 17

muscles, 443f

Respiratory acid-base disturbances, 70

Respiratory acidosis, metabolic acidosis (combination), 72 Respiratory bronchioles, fibrotic thickening, 398 Respiratory care

blood chemistry tests, monitoring of, 128t electrolytes, monitoring of, 129t

protocol

guide, 182f–183f severity assessment, 137t

Respiratory disorders

associated with hypercapnic respiratory failure, 162b chronic ventilatory failure, association, 75b

clinical manifestations of, 156 clinical scenarios and, 156 hemodynamic changes in, 99t hemodynamic monitoring in, 99

hypoxemic respiratory failure and, 157b lungs, anatomic alterations, 152, 153t organisms, associated with, 120b oxygenation index changes, 89t pathophysiologic mechanisms, 156

activation in, 147b

pulmonary shunting associated with, 159t

Respiratory distress, signs of, 488, 488t, 504–505, 506b Respiratory distress syndrome (RDS), 534–540

admitting history, 539

alveolar type II cells (granular pneumocytes), 535 alveoli, cross-sectional view, 535f

arterial blood gases, 536b beractant (Survanta), 537–538 calfactant (Infasurf), 537–538

cardiopulmonary clinical manifestations associated with, 536–537 case study, 539–540

chest assessment findings, 536 chest radiograph, 537

continuous positive airway pressure (CPAP), 537 diagnosis of, 537

discussion, 539–540 early stages of, 535f

etiology and epidemiology, 535–537 identification, names, 534b

infant, chest x-ray films, 538f

laboratory tests and procedures, clinical data, 536 lungs

anatomic alterations, 534–535 expansion therapy protocol, 538

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management of, 537–538 mechanical ventilation protocol, 538 oxygen therapy protocol, 538 oxygenation indices, 536b pathologic or structural changes, 535 patient bedside, clinical data, 536 physical examination, 536, 539 poractant alfa (Curosurf), 537–538

pulmonary function test findings, 536b radiologic findings, 537

respiratory assessment and plan, 539 respiratory care treatment protocols, 538 respiratory rate, increased (tachypnea), 536 surfactant administration protocol, 538 type II, 528

vital signs, 536

whole body x-ray film, 537f

Respiratory disturbance index (RDI), 466 calculation, 467

Respiratory disturbances, polysomnography measurements (usage), 461t Respiratory effort–related arousals (RERAs), 459–460

Respiratory efforts, 463f

Respiratory equipment, pediatric, sizing of, 508, 510t–511t Respiratory failure, 156

classifications of, 156–163

hypoxemic respiratory failure-type I, 156–161

Respiratory impedance (Zrs), 66 Respiratory infections, 192

Respiratory infectious disease panel (RIDP), 240, 551–552 Respiratory muscle strength, assessment of, 65 Respiratory protective devices, tuberculosis and, 303 Respiratory rate, 13

normal values, in children, 505t

Respiratory syncytial virus (RSV), 224, 285 Respiratory syncytial virus infection, 550–558

admitting history, 556

aerosolized medication protocol, 555–556 trial, 556

airway clearance protocol, 554–555 antigen assay tests, 551–552 arterial blood gases, 553b bronchodilators, 555

cardiopulmonary clinical manifestations associated with, 553–554 case study, 556–558

chest assessment findings, 553 chest radiograph, 554

chest x-ray film, 554f corticosteroids, 556 discussion, 557–558

etiology and epidemiology, 550–552

heart rate (pulse) and blood pressure, increased, 553 high-flow nasal cannula, 552–554

example, 557f impact, 551f

laboratory testing for, 551–552 procedures, clinical data, 553

lungs, anatomic alterations, 550 management, 552–556

protocol, bronchiolitis score, 555t monitoring of, 552

oxygen therapy protocol, 552–554, 556 oxygenation indices, 553b palivizumab (Synagis), 552

patient bedside, clinical data, 553 physical examination, 553, 556 polymerase chain reaction (PCR), 551–552 prophylaxis, 552

pulmonary function test findings, 553b radiologic findings, 554

rehydration, 555–556

respiratory assessment and plan, 556–557 respiratory care treatment protocols, 554–556 respiratory infectious disease panel (RIDP), 551–552 respiratory rate, increased (tachypnea), 553

RSV-enzyme immunoassay (RSV-EIA), 551–552 season (US), 552f

smoking counseling, 556 transmission, 551

vital signs, 553

Respiratory therapist, clinical manifestations, assessments, and treatment selections by, 134t–135t Respiratory therapy protocols, ACCP definition of, 132

Restrictive lung disorders, 55, 56t

forced expiratory flow rate and volume findings in, 65t lung volumes and capacities in, 57f

Resuscitation techniques, in neonatal patient, 486–488, 487f Retinopathy of prematurity (ROP), 495

Retractions, substernal and intercostal, 45, 46f Revision, in SOAPIER, 180

RFA, Radiofrequency ablation Rheumatoid arthritis, 403

treatment, 401

Rheumatoid disease, pleural effusion, 409f Rheumatoid pneumoconiosis, 403 Rhonchial fremitus, 24

Rib series (radiograph), 107

Richmond Agitation-Sedation Scale (RASS), 172, 175t Rickettsiae, 291

Rickettsial infections, 291

RIDP, Respiratory infectious disease panel Rifampin, 308

Right atrial pressure (RAP), 99 Right lateral decubitus view, 104f

Right lung squamous cell carcinoma, 387f

Right ventricular heave or lift, in pulmonary embolism, 326, 327f Right ventricular hypertrophy, 581–582

Right ventricular stroke work index (RVSWI), 99 Right-sided heart failure, 358

left-sided versus, 330, 333b

Right-to-left shunting, 491

in persistent pulmonary hypertension of the newborn, 494

RNS, Repetitive nerve stimulation Rod instrumentation, 371

ROP, Retinopathy of prematurity Rosettes, 127

Round ligament, 482 R-R interval, 95 Rubella virus, 285, 291 RV, Residual volume

RVSWI, Right ventricular stroke work index

S

SABR, Stereotactic ablative radiotherapy Saccular bronchiectasis, 260, 265f, 267f–268f Saddle embolus, 321

Salmeterol, usage, 252

San Joaquin Valley disease, 289 Sarcoidosis, 404

honeycomb cysts, 408f

SARS, Severe acute respiratory syndrome Sawtooth pattern, 468f

SBRT, Stereotactic body radiation Scalenes, 41, 43f

Scaphoid abdomen, 571, 573 Scheuermann disease, 367 SCLC, Small cell lung carcinoma Scleroderma, 402–403 Sclerosants, 125

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Scoliosis, 365–367 adolescent, 366 congenital, 366

conservative treatment for, 369 diagnosis of, 366–367 idiopathic, 366

infantile, 366 juvenile, 366

management of, 369–371 neuromuscular, 366 nonstructural, 366 structural, 366

surgery for, 370–371

Second heart sound, increased in pulmonary embolism, 326 splitting, in pulmonary embolism, 326

Secondary apnea, 486

Secondary central sleep apnea, 460–461 Secondary hypertension, 20

Secondary tuberculosis, 302 Seesaw chest, 489 Segmentectomy, 391

Sepsis, acute respiratory distress syndrome, 417 Serology, histoplasmosis, 289

Seronegative myasthenia gravis, 433 Seropositive myasthenia gravis, 433

Severe acute respiratory syndrome (SARS), 291–292 Severe hypoxemia, 88–89

Severity assessment, 134–136 case example, 136b

respiratory care protocol, 137t

Sex, asthma and, 221

SFEMG, Single-fiber electromyography Short-acting beta2-agonist (SABA), for asthma, 231

Shunt-like effects (relative shunt), 158 types of, 158f

SIADH, Syndrome of inappropriate antidiuretic hormone Silence, 5

Silent aspiration, 287 Silica, 400

exposure, occupations (association), 401b

Silicosis, 400

Silverman scoring system, 492f Simple mask, 513b–514b

Simple transposition of the great arteries, 584 Single-fiber electromyography (SFEMG), 435 Sinoatrial (SA) node, 94

Sinus arrhythmia, 17, 95 example of, 95f

Sinus bradycardia, 94 examples of, 94f

Sinus rhythm, premature ventricular complex (impact), 96f Sinus tachycardia, 94

example of, 94f

Sinusitis, cystic fibrosis, 251

Situation, Background, Assessment, and Recommendation (SBAR) technique, 503, 503b, 503t Sjögren syndrome, 403

Skin

color, altered, 46 tests, 120

SLE, Systemic lupus erythematosus Sleep

airway, obstruction, 470f events, terms/phrases, 460t

in-home portable monitoring, 467b nocturnal asthma, 224

respiratory disturbances (frequency calculation), polysomnography measurements (usage), 461t

total recording time (TRT), 466 total sleep time (TST), 466 waveforms, stages, 464t–465t

Sleep apnea, 458–476 arterial blood gases, 468b cardiac arrhythmias, 469

cardiopulmonary clinical manifestations associated with, 468–469 central, 460–462

diagnosis, 463–467 hemodynamic indices, 469b

laboratory tests and procedures, clinical data, 468–469 mixed, 462

obstructive, 459–460 oxygen therapy, 473 oxygenation indices, 469b

patient bedside, clinical data, 468 pharmacologic therapy, 473 positive airway pressure, 470–471

pulmonary function testing findings, 468b radiologic findings, 469

sawtooth pattern, 468f screening programs, 475 treatment, 473

Sleep disorder categories, 459b diagnosis, inability, 467b

scalp electrodes, application, 461f

Sleep-related breathing disorders, 459 sleep events, terms/phrases, 460t

stand-alone sleep-related breathing disorders, 462

Sleep-related hypoventilation/hypoxemia syndromes (SRHHSs), 462 Sleeve resection, 391

Small cell carcinoma, 378 illustration, 379f

tumor, bronchoscopic view, 391f

Small cell lung carcinoma (SCLC), 378–379 aerosolized medication protocol, 393 chemotherapy, 393

extensive stage, 385

5-year survival rate, 385, 385t limited stage, 382–385

lung expansion therapy protocol, 393 oxygen therapy protocol, 393 radiation therapy, 393

respiratory care treatment protocols, 393 staging, 382–385

surgery, 393 treatment option, 393

Smoke inhalation, 606–616, 607f admitting history, 614

aerosolized medication therapy protocol, 614 airway clearance therapy protocol, 614 airway management, 613

arterial blood gases, 610b

body surface burns, 608–609, 608t bronchoscopy, 613

cardiopulmonary clinical manifestations associated with, 610–612 case study, 614–615

chest assessment findings, 610 chest radiograph, 612, 612f cough and sputum production, 610 discussion, 615

early stage, 607

etiology and epidemiology of, 608 general emergency care, 613

hemodynamic indices cardiogenic pulmonary edema, 611b hyperbaric oxygen therapy, 613

intermediate stage, 607–608

laboratory tests and procedures, clinical data, 610–611 late stage, 608

lung expansion therapy protocol, 614 lungs, anatomic alterations, 607–608 management of, 613–614 mechanical ventilation protocol, 614

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oxygen therapy protocol, 613–614 oxygenation indices, 611b patient bedside, clinical data, 610 pharmacology, 613

physical examination, 610, 614 pulmonary function test findings, 610b radiologic findings, 612

respiratory assessment and plan, 614–615 respiratory care treatment protocols, 613–614 respiratory rate, increased (tachypnea), 610

toxic substances and sources associated with, 609t vital signs, 610

Smokers and ex-smokers, asthma in, 226 SOAP, Subjective Objective Assessment Plan SOAPIER acronym, 180

Socioeconomic status, 192 Soft tissues, extrathoracic, 107 Sonography, 114 Source-oriented record, 180

Speaking valve, Passy Muir type, 453, 454f Special populations, asthma in, 226 Spectral Doppler, 115

Speech, tracheostomy, 453–454 Spinal cord injury

American Spinal Injury Association (ASIA) Impairment Scale, classification, 443 causes, 443t

clinical presentation, 442–443 diagnosis, 443

diaphragm pacing, 444 etiology and epidemiology, 442 intubation risk, 444 management, 443–444

paradoxical abdominal breathing, 442–443 video-assisted thorascopic surgery (VATS), 444

Spinal fluid, albuminocytologic dissociation, 426 Spinal fusion, for scoliosis, 371

SpineCor brace, 370, 370f

Spiral computed tomography, principle of, 107f Spiral scans, 107–108

Spirituality, 3

Spirometry testing, usage, 261 Splinting, 45–46

Split-night attended in-laboratory polysomnograph, 463 Spontaneous pneumothorax, 347–348, 348f

case study, 353–354

Sputum

color of, 52f, 52t correlation, 120t examination, 120

for asthma, 228

Sputum culture

results and sensitivity, bronchiectasis, 264 for tuberculosis, 304–305, 305f

Sputum production abnormal, 50–51

in smoke inhalation and thermal injuries, 610 in tuberculosis, 306

Squamous cell carcinoma (epidermoid cell carcinoma), 378–379 illustration, 379f

SRHHSs, Sleep-related hypoventilation/hypoxemia syndromes SRS, Stereotactic radiosurgery

Stand-alone sleep-related breathing disorders, 462 Standard Mendelian pattern, 244, 247f

Standard of care, 209

Staphylococcus, 283

Staphylococcus aureus, bacterial tracheitis and, 590 Starbursts, 531

Starling equation, 312