5 курс / Пульмонология и фтизиатрия / Clinical_Manifestations_and_Assessment_of_Respiratory

Steam inhalation, 607 Steeple point, 593, 593f

Stenosis of the pulmonary artery, 581

Stereotactic ablative radiotherapy (SABR), 391–392 Stereotactic body radiation (SBRT), 391–392 Stereotactic radiosurgery (SRS), 392 Sternocleidomastoids, 42, 43f

Stool fecal fat test, 248

Streptococcus, 283, 283f

Streptococcus pneumoniae pneumonia, 283 Streptokinase, for pulmonary embolism, 324 Streptomycin, 308

Stress echocardiogram, 115 Stridor, 28t–29t

Stroke

cerebral perfusion pressure (CPP), 448 clinical manifestations, 448

diagnosis, 448–449

etiology and epidemiology, 448

intracranial pressure (ICP) monitoring, 448–449 management, 449

posterior cerebral artery (PCA), 448 rapid sequence intubation (RSI), 449

Stroke volume (SV), 19, 99 Stroke volume index (SVI), 99 Stryker frame, usage, 428

Subcarinal lymph nodes/tumor, presence of, 122f Subclavicular thrill, 578

Subcutaneous emphysema, 24, 107, 542–543 Subepithelial mechanoreceptors, 52 Subglottic airway obstruction, 589 Subglottic croup, 589

Subject, in SOAPIER, 180

Subjective Objective Assessment Plan (SOAP) case example, 181b

form, 180 predesigned, 181f “progress note”, 181

Sublingual allergen immunotherapy (SLIT), for asthma, 232

Submucosal bronchial region, chronic inflammatory cells (increased), 190f Subpulmonic pleural effusion, 104f

Substernal retraction, 489, 490f, 530 Substernal retractions, 45, 46f Sucking chest wound, 347, 348f Suction catheters, 510t–511t Suctioning, 498b, 514b–515b

Sudden infant death syndrome (SIDS), 489 Summary-making, 5

Sunbursts, 531 Superior vena cava, 481

syndrome, 380

Supplemental oxygen, for laryngotracheobronchitis, bacterial tracheitis, and epiglottitis, 594 Suppressor T cells, 127

Supraglottic airway obstruction, 589 Supraglottic croup, 589

Surfactant administration protocol for newborn, 500b–501b

respiratory distress syndrome, 538

Surgery, for scoliosis, 370–371 SV, Stroke volume

SVI, Stroke volume index Swallowing mechanics, 286 Sweat chloride, elevation, 245 Sweat test, 245–247

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interpretations, 248b pilocarpine, application, 248f

Symmetric reduction, 62

Syncope, in pulmonary embolism, 326 Syncytium, 550

Syndrome of inappropriate antidiuretic hormone (SIADH), 548 Systemic corticosteroids, usage, 254

Systemic hypotension, in pulmonary embolism, 326 Systemic lupus erythematosus (SLE), 404 Systemic sclerosis, 402–403

Systole, 15–16 cardiac, 17

Systolic blood pressure, 17 Systolic thrill, 582–583

T

Tachycardia, 17 sinus, 94

example of, 94f ventricular, 96

Tachypnea, 17

from inability to increase lung volume, 508

Tactile fremitus, 24 Talking too much, 7 TB, Tuberculosis

T cells, 127 role, 127

TDPs, Therapist-driven protocols Telemedicine, 184

Temperature body, 13–15, 14f core, 13

Temporal pulse site, 15–16

Tensilon test (edrophonium test), 434 Tension pneumothorax, 543

iatrogenic, 548

lung, involvement, 543f

Terminal saccular phase, fetal lung development, 480 TET, Total expiratory time

Tet spells, 582

Tetralogy of Fallot (TOF), 581–583, 582f clinical manifestations of, 582–583

diagnosis of, 582

etiology and epidemiology of, 582 heart, anatomic alterations, 581–582 treatment, 583

Thebesian veins, 157 Therapeutic bronchoscopy, 121

Therapeutic thoracentesis, 123–124 Therapist-driven protocols (TDPs), 184

AARC's support, 132

aerosolized medication therapy protocol, 134, 144f–146f, 145 airway clearance therapy protocol, 134, 140f–141f, 145–147 Assess, Treat, and Teach Protocols, 136

assessment program, absence, 133f flexibility, 132

hospital-approved, 132

oxygen therapy protocol, 138f–139f, 145 program, 131–154, 133f

assessment form, 148f

assessment process skills, requirement for, 133–136 components of, 148f

essential cornerstones of, 136–138 “knowledge base” requirement for, 133 overview of, 134f

promise of, 133f summary of, 138

respiratory care protocol severity assessment, 137t safe and ready respiratory therapist, 132

“Therapy selection menu,”, 136–137

Thermal injuries, 606–616, 607f

acute upper airway obstruction assessment, 610 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

etiology and epidemiology of, 608 general emergency care, 613

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

laboratory tests and procedures, clinical data, 610–611 lung expansion therapy protocol, 614

lungs, anatomic alterations, 607 management of, 613–614 mechanical ventilation protocol, 614 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

Thermodilution method, 85

Third heart sound, in pulmonary embolism, 326 Thoracentesis, 120, 123–124, 124f

catheter, positioning, 124f therapeutic thoracentesis, 123–124

Thoracic cage, landmarks of, 22, 22f Thoracolumbosacral orthosis (TLSO), 370 Thoracoscope, insertion, 122

Thoracostomy chest tube, for pneumothorax, 353 Thorax, flexibility, 489

Three-dimensional conformal radiation therapy (3D-CRT), 391 Three-dimensional echocardiography, 115 Thrombocytopenia, 128

Thrombolytic agents, for pulmonary embolism, 324 Thrombus, 321

Thrush, 290

Thumb sign, 593, 593f Thymectomy, 435, 437 Thymic tumors, 435 Thymoma, presence, 435 Tidal volume (VT), 34 Tiotropium, usage, 252 Titration polysomnogram, 463

TLSO, Thoracolumbosacral orthosis TNM, Tumor, node, metastasis Tobacco smoke, 192

asthma and, 224

TOF, Tetralogy of Fallot Tomograms, 107 TomoTherapy, 123

Total expiratory time (TET), 58 Total lung capacity (TLC), 55 Total oxygen content, 82

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of blood, case example of, 82

Total oxygen delivery (DO2), 84–85 increase and decrease, factors, 85b

Total recording time (TRT), 466 Total sleep time (TST), 466

Touch, nonverbal communication and, 8 Trachea, 106

Tracheal intubation, correct positioning for, 507f

Tracheobronchial tree, normal histology and mucous production of, 48–50, 49f Tracheoesophageal fistula, 287

Tracheostomy

laryngotracheobronchitis, bacterial tracheitis, and epiglottitis, 595–596 neuromuscular disease, 453–454

speech, 453–454 tubes, 510t–511t

Traditional chart, 180 Transairway pressure, 37–38 Transbronchial lung biopsy, 122

Transcutaneous gas monitoring, 491 Transient pulmonary hypertension, 535

Transient tachypnea of the newborn (TTN), 528–533 admitting history, 532

airway clearance protocol, 529 alveolar fluid, excessive, 529f arterial blood gases, 530b bilateral infiltration, 531f

cardiopulmonary clinical manifestations associated with, 530–531 cardiovascular silhouette, 531f

case study, 532–533

chest assessment findings, 530 chest radiograph, 531

clinical manifestations, 530 discussion, 533

etiology and epidemiology, 528–529 interstitial edema, 529f

laboratory tests and procedures, clinical data, 530 lungs

anatomic alterations, 528 expansion therapy protocol, 532

management of, 529–532 mechanical ventilation protocol, 532 oxygen therapy protocol, 529 oxygenation indices, 531b pathologic or structural changes, 528 patient bedside, clinical data, 530 physical examination, 530, 532 pulmonary capillary congestion, 529f

pulmonary function test findings, 530b radiologic findings, 531

respiratory assessment and plan, 532–533 respiratory care treatment protocols, 529–532 respiratory rate, increased (tachypnea), 530 vital signs, 530

Transillumination, increased, 545 Translucent column, 106

Transposition of the great arteries, 583–584, 583f admitting history, 586

case study, 586

clinical manifestations of, 584 diagnosis of, 584

discussion, 586

etiology and epidemiology of, 584 heart, anatomic alterations, 583–584 physical examination, 586 respiratory assessment and plan, 586 treatment, 584

Transthoracic echocardiogram (TTE), 114–115

Transudate, 114, 123–124, 312

Transversus abdominis, 44, 44f–45f

Trapezius, 42, 44f

Trauma

barotrauma, 174–176 pulmonary, 541

volutrauma, 174–176 pulmonary, 541

Traumatic pneumothorax, 347, 348f Treatment-resistant asthma, 239 Tripod position, 42

TRT, Total recording time

True shunts (absolute shunts), 157–158 TST, Total sleep time

TTN, Transient tachypnea of the newborn Tubercle, 301

Tuberculosis (TB), 192, 300–310 acute ventilatory changes in, 306 admitting history, 309

airway clearance therapy protocol, 308 among health care workers, 303 arterial blood gases, 306b

bacilli, 301

blood pressure in, 306

cardiopulmonary manifestations associated with, 306–307 case study, 309

chest assessment findings in, 306 chest pain in, 306

cough in, 306 cyanosis in, 306 diagnosis of, 303–305

acid-fast staining in, 304, 304f

Mantoux tuberculin skin test in, 304, 304f QuantiFERON-TB Gold Test, 305

sputum culture in, 304–305, 305f Xpert MTB/RIF Assay for, 305

digital clubbing in, 306 discussion, 309 disseminated, 302–303, 302f dormant, 301–302

etiology and epidemiology, 303 exudative pleural effusion and, 359 heart rate, increased, 306 hemodynamic indices, 307b hemoptysis and, 306

increased respiratory rate in, 306 infectious control measures protocols, 308 isolation procedures for, 303

laboratory tests and procedures abnormal, 307

clinical data, 306 latent, 301–302

lungs, anatomic alterations, 301–303 management of, 308

mechanical ventilation protocol, 308 miliary, 307f

multidrug-resistant, 303 noncompliance in, 308 oxygen therapy protocol, 308 oxygenation indices, 306b

patient bedside, clinical data in, 306 peripheral edema and venous distention in, 306 pharmacologic agents for, 308

physical examination, 306, 309 primary, 301–302, 301f

pulmonary function test findings, 306b radiologic findings in, 307, 307f reactivation, 302

respiratory assessment and plan, 309 respiratory care treatment protocols for, 308 respiratory rate, increased (tachypnea), 306 sputum production in, 306

vital signs, 306

Tubular bronchiectasis (cylindrical bronchiectasis), 260, 266f, 268f

Tumor, node, metastasis (TNM) classification system, 382t–383t staging system, 382

subsets, 383t–385t

T wave, 94

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Tympany, 25

Type A chronic obstructive pulmonary disease (pink puffer), 196–197 Type B chronic obstructive pulmonary disease (blue bloater), 196–197 Type I (hypoxemic) respiratory failure, 156–161

Type II (hypercapnic) respiratory failure, 161–162 Type III respiratory failure, 164–165

U

Ultrasonic Doppler, 17

Ultrasound, 114, 115f imaging, 114

for pulmonary embolism, 322–323 scanning, 114

Umbilical arteries atrophy, 482

internal iliac (hypogastric) arteries, 480

Umbilical vein, 481 round ligament, 482

Upper airway

anatomic alterations of, 589–590 obstruction, in pediatric patient, 508b

UPPP, Uvulopalatopharyngoplasty

Urokinase, for pulmonary embolism, 324

Uvulopalatopharyngoplasty (UPPP), 471

V

VALI, Ventilator-associated lung injury Valley fever, 289

Valved holding chamber (VHC) technique, 240 Valvular stenosis, 581

VAP, Ventilator-associated pneumonia

Variable positive airway pressure adapt (VPAP Adapt), 472 adaptive servoventilator responds, 472f

Varicella (chickenpox), 291

Varicose bronchiectasis (fusiform bronchiectasis), 260, 267f Vasoconstriction, 13

induced by alveolar hypoxia, 327 induced by humoral agents, 327

Vasodilation, 13

VATS, Video-assisted thoracoscopy surgery VC, Vital capacity

Venous admixture, 158–159 flail chest, 341, 341f hypoxemia, 38

occurs, 158f pneumothorax, 349, 349f relationship of, 74f results of, 159

Venous distention bronchiectasis, 263

chronic interstitial lung disease, 406 kyphoscoliosis, 368

pulmonary embolism, 326 tuberculosis, 306

Ventilated patients, charting the progress of, 177, 177b Ventilation

correct positioning for, 507f dead-space, 160f

Ventilation strategy, acute respiratory distress syndrome, 420 Ventilation-perfusion (V/Q) ratio, 38, 74–75, 159f

mismatch, 159 cause of, 160

Ventilation-perfusion scan lung scan, 113–114

for pulmonary embolism, 323–324, 328, 329f

Ventilator circuit, 510t–511t Ventilator graphics, 172–174, 175f

Ventilator hazards, 174–177

Ventilator initiation and management, 169f–171f Ventilator malfunction, 176

Ventilator weaning, 172f–173f Ventilator-associated lung injury (VALI), 174 Ventilator-associated pneumonia (VAP), 286 Ventilator-induced lung injury (VILI), 174, 541

predisposing factors for, 542

Ventilatory, efficiency, 75 Ventilatory failure

hypercapnic respiratory failure, 156, 161–163 acute ventilatory failure, 162t

chronic ventilatory failure, 162t types of, 162–163

ventilatory support for, 168f in pediatric patient, 508b

Ventilatory pattern abnormal, 34–41

pathophysiologic basis of, 36–41 airway resistance and, 37–38

central chemoreceptors and, 39–40, 40f–41f lung compliance and, 37, 37f–38f

normal, 34

peripheral chemoreceptors and, 40f pulmonary reflexes and, 40–41

Ventilatory support management, 166t–167t neuromuscular disease, 454–455

persistent pulmonary hypertension of the newborn, 494–495 strategy, 164–165

Ventilator-induced lung injury, drowning and, 602–603 Ventral respiratory group (VRG), 39–40

Ventricular fibrillation, 96 example of, 96f

Ventricular septal defect (VSD), 580–581, 580f–581f, 584 clinical manifestations of, 580–581

diagnosis of, 580

etiology and epidemiology of, 580 heart, anatomic alterations, 580 treatment, 581

Ventricular tachycardia, 96 example of, 96f

Venturi mask, 513b–514b

Verbal messages, nonproductive, 6–7 Vertebral injury, 442f

Vertebral line, 22

Vesicular breath sounds, 26f–27f, 27

Video-assisted thoracoscopy surgery (VATS), 122–123, 123f, 391 spinal cord injury, 444

VILI, Ventilator-induced lung injury Viral organisms, 120

Virchow triad, 321–322 Vital capacity (VC), 58 Vital signs, 13–21

age-specific, 504 blood pressure, 17–21

body temperature, 13–15, 14f in neonatal patient, 488–489

normal values, 489t pulse, 15–17

range of values for, 13t respiration, 17

Vitamin A, for chronic lung disease of infancy, 566t Vocal fremitus, 24

Voice style, nonverbal communication and, 8 Volume scans, 107–108

Volume-assured pressure support (VAPS), 454 Volume-support ventilation (VSV), 172 Volutrauma, 174–176, 539

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pulmonary, 541

drowning and, 602–603

VPAP Adapt, Variable positive airway pressure adapt VSD, Ventricular septal defect

VO2, Oxygen consumption

V/Q ratio, Ventilation-perfusion ratio VT, Tidal volume

W

Walking, for pulmonary embolism, 324 Walking pneumonia, 282

Warfarin, for pulmonary embolism, 324 Warming techniques, drowning and, 603 WBC, White blood cell

Wegener granulomatosis, 405 nodules, presence, 409f

Westermark sign, 328

Wet drowning, 599–605, 600f etiology and epidemiology of, 600 lungs, anatomic alterations, 599–600 management of, 602–603

“Wet lung” syndrome, 528 Wheezing, 28t–29t, 30f

Whirlpool therapy (hydrotherapy), 429 Whispering pectoriloquy, 28t–29t, 30f White blood cell (WBC)

cell, increase (causes), 126t count, 125–128

differential WBC count, 125b

Whiteout, presence, 537f Work efficiency, 75

Work of breathing (WOB), 36 Work-aggravated asthma, 226

X

Xpert MTB/RIF Assay, for tuberculosis, 305

Z

Ziehl-Neelsen stain, 304

ZZ alpha1-antitrypsin phenotype, 192