Respiratory Management Of ALS: Amyotrophic Lateral Sclerosis

Respiratory Management Of ALS: Amyotrophic Lateral Sclerosis

by Lee Guion
     
 

ISBN-10: 0763755451

ISBN-13: 9780763755454

Pub. Date: 01/16/2009

Publisher: Jones & Bartlett Learning

The Respiratory Management of Motor Neuron Disease brings together the latest research, expert opinions, and treatment options for respiratory symptom management. It provides a detailed, step-by-step approach to assessment of upper and lower airway structures and how motor neuron loss impairs function. Treatment options emphasize symptom management and enhanced

Overview

The Respiratory Management of Motor Neuron Disease brings together the latest research, expert opinions, and treatment options for respiratory symptom management. It provides a detailed, step-by-step approach to assessment of upper and lower airway structures and how motor neuron loss impairs function. Treatment options emphasize symptom management and enhanced quality of life. Palliative care, end-of-life decision making, and long term mechanical ventilation in patients with MND/ALS are included.This textbook encourages critical thinking through 1) inclusion of researchable questions at the end of chapters, and 2) discussion of different approaches to patient assessment and symptom management when medical evidence is lacking. Students will be encouraged to use their understanding of anatomy, physiology, pharmacology, lung expansion and secretion mobilization techniques to review, support or challenge current practices in MND/ALS.

Respiratory therapy students, respiratory care practitioners, nurses in neurology clinics, primary care physicians, and pulmonologists whose practice includes patients with motor neuron disease will all benefit from the detailed review of bulbar and thoracic muscles, loss of function, and treatment recommendations.

Product Details

ISBN-13:
9780763755454
Publisher:
Jones & Bartlett Learning
Publication date:
01/16/2009
Edition description:
1E
Pages:
258
Product dimensions:
6.20(w) x 9.10(h) x 0.80(d)

Table of Contents

Preface ix

Acknowledgments xiii

Chapter 1 Amyotrophic Lateral Sclerosis Overview: Definition, Epidemiology, History 1

Introduction 2

Definition 2

Clinical Subtypes of MND 3

Classification 3

Diagnostic Criteria 4

Clinical Rating Scales 4

Epidemiology 4

Public Figures with ALS 7

Clinical Presentation 8

Clinical Diagnosis 9

Stages of Functional Decline in ALS 9

Clinical Markers of Respiratory Decline in ALS 11

Drug Treatment 12

Symptom Management 15

Multidisciplinary Care 15

Topics for Research 21

Summary 22

References 22

Chapter 2 Neuroanatomy and Respiratory Physiology 27

Introduction 28

Functional Neurorespiratory Anatomy 28

Pathobiology 30

Neurodegenerative Action 31

Cognitive Impairment in ALS 32

Neurochemistry of the Pulmonary System 34

Innervation of the Respiratory Muscles 36

Summary 39

References 39

Questions for Research 41

Chapter 3 The Upper Airway 43

Introduction to the Upper Airway 47

Anatomy and Physiology 48

Structures of the Upper Airway 48

Clinical Implications of Impaired Upper Airway 52

Assessment Techniques 54

Symptom Management 56

Communication Augmentation for Patients 58

Communication Techniques for Caregivers and Medical Personnel 59

Summary 60

References 60

Questions for Research 62

Chapter 4 The Lower Airway 63

The Normal Lung 64

Larynx-The Dividing Line 64

Conducting Airways 66

Respiratory Units 67

Lower-Airway Defense Systems 68

Bronchial Mucus 72

Lower Respiratory Tract Infections 76

Summary 77

References 78

Questions for Research 80

Chapter 5 Clinical Respiratory Assessment of ALS 81

Introduction 81

ALS Functional Rating Score 85

RespiratoryInsufficiency: Signs, Symptoms, and Significance 85

Co-morbidities 96

Summary 97

References 97

Questions for Future Research 99

Appendix 5-1 Respiratory Assessment 101

Appendix 5-2 ALSFRS-R 105

Appendix 5-3 Measures of Dyspnea 107

Chapter 6 Pulmonary Function and Respiratory Assessment of Neuromuscular Patients: Objective Measures of Lung Function 111

Introduction 113

Measures of Lung Mechanics and Strength 113

Spirometry 114

Vital Capacity (VC) 114

Expiratory Volume 116

Clinical Uses of PFT 117

MIP 117

MEP 119

PCF 120

Sniff Nasal Inspiratory Pressure Test 121

Other Measures of Pulmonary Function 122

Noninvasive Measures of Pulmonary Function 123

Monitoring of Respiratory Function During Sleep 125

Laboratory Measures 126

Summary 128

References 128

Questions for Research 130

Chapter 7 Volume Expansion, Secretion Mobilization, and Cough Assistance in Amyotrophic Lateral Sclerosis 131

Introduction 132

Patient Assessment 133

Lung Volume Recruitment 134

Airway Secretion Management 139

High-Frequency Chest Wall Compression 142

Cough Techniques 144

New Therapies 148

Summary 148

References 149

Questions for Research 152

Chapter 8 Noninvasive Positive Pressure Ventilation 153

Introduction 154

History 154

Definition 155

Physiological Effects of NPPV 156

Benefits of NPPV 157

Timing of NPPV 160

Acceptance of NPPV 160

Acclimatization 161

Adherence 162

NPPV and Cognitive Impairment 162

Nutrition and NPPV 163

NPPV in Neuromuscular Disease 163

NPPV Setting Guidelines 165

Monitoring NPPV Settings 166

Initiating NPPV in Advanced ALS 166

Challenges to NPPV 167

The Bulbar Patient 170

Summary 171

References 172

Questions for Research 175

Chapter 9 Tracheostomy and Mechanical Ventilation 177

Introduction 181

Indications for Tracheostomy and MV 181

Advantages of Tracheostomy and MV 182

Drawbacks to Tracheostomy and MV 183

Making the Decision for MV 184

Characteristics of Patients Who Choose MV 185

Measuring QoL 185

Challenges of MV 186

Mechanical Ventilators for Home Use 189

Preparing for Hospital Discharge Following Tracheostomy and MV 192

Summary 192

References 193

Chapter 10 Home Care of the Amyotrophic Lateral Sclerosis Patient 197

Introduction 198

Goals of Respiratory Care in the Home 200

Types of Respiratory Support 201

NPPV 201

Tracheostomy and Mechanical Ventilation 204

Challenges of Managing Mechanically Ventilated Patients in the Home 207

References 209

Chapter 11 Palliative Care and End-of-Life Care 211

Introduction 212

End-of-Life Choices 213

Respiratory Failure 222

RCP Attitudes Toward Terminating Life Support 230

Respiratory Controversies at End of Life 231

Summary 234

References 234

Appendix 11-1 A Values History Questionaire 239

Resources 241

Professional Associations for Respiratory Care Practitioners 241

Organizations for People with ALS, Their Families, and Medical Professionals 242

Resources for People with ALS 244

Respiratory Assistive Devices and Supplies 244

Advanced Directives 245

Resources for Respiratory Care Practitioners 246

Resources for Home Care Providers 247

Ethical Considerations in Health Care 247

General Resources About ALS 248

Index 251

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