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Known for its integration of theoretical knowledge and practical skills, this book emphasizes the importance of assessment of need, contraindications, hazardscomplications, monitoring, and outcomes assessment in respiratory care.Concise, direct, and easy to understand, this fifth edition has been updated to reflect recent advances in the field in order to ensure that readers have the knowledge and skills needed to practice the art and the science of respiratory care.LIST OF PERFORMANCE EVALUATIONS ix NEW TO THIS EDITION xi PREFACE xiii INTRODUCTION TO THE TEXT xiv ACKNOWLEDGMENTS xv CONTRIBUTORS xvi SECTION I: PATIENT ASSESSMENT CHAPTER 1 BASICS OF ASEPSIS 3 Microorganism Transmission Centers for Disease Control and Prevention Guidelines Hand Hygiene Aseptic Gowning Aseptic Application of Gloves Aseptic Removal of Isolation Attire CHAPTER 2 BASIC PATIENT ASSESSMENT: VITAL SIGNS AND BREATH SOUNDS 19 Body Temperature Pulse Respiratory Rate Blood Pressure Sound Stethoscopes Breath Sounds Anatomical Positions for Auscultation Measuring Body Temperature Measuring Oral Temperature Measuring the Pulse Measuring Respiratory Rate Assessing Blood Pressure Auscultation of Breath Sounds CHAPTER 3 ADVANCED PATIENT ASSESSMENT: INSPECTION, PALPATION, AND PERCUSSION 37 Chest Landmarks for Assessment Assessment Techniques and Abnormal Findings Preexamination and Other Considerations Inspection of the Chest CHAPTER 4 RADIOLOGIC ASSESSMENT 51 Production of a Chest Radiograph Radiodensity of Common Materials X-Ray Views of the Chest The Normal Chest Radiograph Common Abnormalities on the Chest Radiograph Ventilation-Perfusion Scanning Pulmonary Angiography Computed Tomography of the Chest Chest Film Orientation Rotation and Penetration Viewing the Chest Radiograph CHAPTER 5 PULMONARY FUNCTION TESTING 75 American Thoracic Society Indications Rationale for Bedside Monitoring Equipment Used in Measuring Bedside Parameters Bedside Measurements Basic Spirometry Capacities and Their Significance The Forced Vital Capacity Tracing Maximum Voluntary Ventilation ATPS to BTPS Conversion Flow- Volume Loops Measurement of Functional Residual Capacity and Residual Volume Diffusion: Single Breath Carbon Monoxide Test Hazards of Pulmonary Function Testing Bedside Monitoring: Equipment Assembly and Testing Preparation of the Collins Water Seal Spirometer Patient Factors in Spirometry Measuring the Bedside Pulmonary Function Parameters Basic Spirometry: Using the Collins Water Seal Spirometer Pulmonary Function Tests Measuring and Calculating Components of a Pulmonary Function Testing Tracing Measuring and Calculating the Forced Vital Capacity Acceptability and Reproducibility Criteria Maximum Voluntary Ventilation Conversion From ATPS to BTPS Calculating Predicted Values Interpretation of the Results CHAPTER 6 ELECTROCARDIOGRAPHY 109 Electrical Physiology of the Heart The Normal ECG and the Electrical Activity of the Heart The Twelve Leads of an ECG Normal Sinus Rhythm Dangerous and Life-Threatening Arrhythmias ECG Artifact Electrocardiograph Equipment Equipment Required for an Electrocardiogram Patient Positioning Lead Placement Arrhythmia Recognition Operating the Electrocardiograph Machine Artifact Recognition Proper Handling of an Electrocardiographic Tracing CHAPTER 7 PHLEBOTOMY 127 Obligations Related to Performance of Phlebotomy Maintaining a Safe Environment Equipment Venipuncture Technique CHAPTER 8 ARTERIAL BLOOD GAS SAMPLING 139 Anatomical Locations for Arterial Puncture Complications of Arterial Puncture Blood Gas Sampling Errors Capillary Blood Gas Sampling Supplies Needed for Arterial Puncture Puncture Techniques Indwelling Arterial Catheter Sampling Supplies for Capillary Sampling Capillary Sampling Techniques CHAPTER 9 HEMODYNAMIC MONITORING 159 Pascals Law Transducers Central Venous Pressure Catheters Pulmonary Artery Catheters or Swan-Ganz Catheters Normal Pressure Ranges Clinical Applications of the Pulmonary Artery Catheter Case Studies Illustrating the Application of a Pulmonary Artery Catheter Assessment of the Effects Caused by Positive-Pressure Ventilation Arterial Lines Hazards with Indwelling Vascular Catheters Equipment Required for Hemodynamic Monitoring Equipment Setup and Preparation Zeroing the Transducer Identification of the Phlebostatic Axis Waveform Damping Obtaining a Pulmonary Artery Wedge Pressure Overwedging of the Balloon Cardiac Output Determination Arterial Line Maintenance Zeroing an Arterial Line CHAPTER 10 NONINVASIVE MONITORING 181 Rationale for Noninvasive Monitoring Noninvasive Monitoring Equipment Limitations of Noninvasive Monitoring Hazards of Noninvasive Monitoring Assembly, Troubleshooting, and Calibration SECTION II: THERAPEUTICS CHAPTER 11 DOCUMENTATION AND GOALS ASSESSMENT 201 The Medical Record Goals Assessment and Documentation Documentation Guidelines and Abbreviations CHAPTER 12 OXYGEN SUPPLY SYSTEMS 215 Medical Gas Cylinders Medical Gas Piping Systems Using Medical Gas Cylinders Use of Portable Liquid Oxygen Systems Use of an Oxygen Concentrator Use of AirOxygen Blenders CHAPTER 13 OXYGEN ADMINISTRATION 241 Indications for Oxygen therapy Low-Flow Oxygen Devices High-Flow Oxygen Delivery Systems Clinical Applications of Low-Flow and High-Flow Oxygen Systems Humidification Enclosures Types of Oxygen Analyzers Hazards of Oxygen therapy CHAPTER 14 INTRODUCTION TO RESPIRATORY CARE PHARMACOLOGY 263 Receptor Site Theory Mechanisms of Bronchospasm Sympathomimetic Drugs Phosphodiesterase Inhibitors Anticholinergic Drugs Corticosteroids in Respiratory Care Combination Therapy Drugs Cromolyn Sodium and Asthma Management Mucoactive Agents Use of Bland Aerosols in Respiratory Care Aerosolized Antimicrobial Agents Metered Dose Inhalers Dry Powder Inhalers (DPI) Metered Dose Inhaler Use of a Spacer with a Metered Dose Inhaler Dry Powder Inhalers CHAPTER 15 HUMIDITY AND AEROSOL THERAPY 283 What is Humidity and What is Aerosol Equipment for Humidity and Aerosol Therapy Humidity and Aerosol therapy AerosolOxygen Delivery Devices CHAPTER 16 BRONCHIAL HYGIENE THERAPY 303 Body Alignment and Stance General Guidelines for Moving Patients Safety Devices Chest Percussion and Postural Drainage Other Therapies for Bronchial Hygiene General Guidelines Patient Positioning Use of Restraints Percussion Technique Positive Expiratory Pressure Therapy Flutter Valve Therapy Vibratory PEP (Acapella) Therapy Administration High- Frequency Chest Wall Oscillation Therapy Administration CoughassistTM Mi-E Administration Adjunctive Breathing Techniques CHAPTER 17 HYPERINFLATION THERAPY 349 Hyperventilation Modalities Goals of and Indications for Hyperinflation Therapy Hazards and Complications of Hyperventilation Therapy Incentive Spirometers The Bird Mark 7A Ventilator Percussionaire IPV-1 Incentive Spirometry IPPB Therapy Intrapulmonary Percussive Ventilation Therapy CHAPTER 18 BRONCHOSCOPY ASSISTING 377 Therapeutic and Diagnostic Bronchoscopy Indications for Bronchoscopy Rigid and Flexible Bronchoscopes Types of Instruments Types of Sample Testing and Analysis Solutions Used to Fix or Prepare Samples for Testing Personal Protective Equipment Bronchoscopy Room or Suite Medications Employed for Anesthesia and Analgesia Patient Monitoring Hazards and Complications of Bronchoscopy Equipment Preparation Documentation Preparation Patient Preparation Supplemental Oxygen restrictions require it.
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