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| Pulmonary Hypertension (PAH)is a disease characterized by | elevated pulmonary artery pressure, PVR leading to right ventricular failure & death.
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| Pulmonary hypertension 2 causes | Primary cause: familial or idiopathicSecondary: other disease i.e HIV infection, collagen vascular disorders, pulmonary embolus, portal hypertension, congenital hear disease, interstitial lung disease,COPD, & sleep apnea
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| Management of PAH | diuretics (manage volume overload due to right ventricular failure, O2 (hypoxia potent vasoconstrictor, maintain spO2 > 90%digoxin (inotropic agent for HF)Ca channel blockers (used if pt exhibits vasoreactivity during initial treatment)
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| Caring for the PAH patient | increase CO, decrease pulmonary artery pressure, improve quality of life, conserve O2
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| Common signs & symptoms seen in PAH patients | dyspnea,fatigue,presyncope or syncope,peripheral edema,ascites(worsening symptoms could mean progression of disease and possible increase in medications)
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| 2 most common COPD subtypes | emphysema,chronic bronchitis (contributing factors smoking, environmental pollutants, toxic exposure, predisposing genetic factors i.e. alpha1 antitrypsin deficiency)
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| Symptoms of COPD | increase dyspnea, DOE,sputum production,cough, exhaustion,decrease in expiratory airflow that does not respond to treatment, anxiety,tachycardia,ventricular dysrhthmias
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| Assessing COPD patient | check VS, breath sounds, work of breathing, airway clearance, & LOC
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| Interventions of COPD patient | maintaining oxygenation & ventilation
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| In COPD patients Chest x-ray will show | flatten diaphragm
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| Chronic bronchitis is diagnosed if | chronic cough with sputum production for three months of the year for 2 consecutive years.
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| In chronic bronchitis the mucus glands | are increased in size and the bronchial wall is thickened & presence of cor pulmunale with increase right sided heart failure
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| Pulmonary embolism is when an | emboli dislodge in 1 of the pulmonary vessels, disrupting blood flow to an area of the lung
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| The most common origin of blood clots | deep veins of the legs
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| 3 predisposing factors contributing to pulmonary emboli | Vircho's triad: venous stasis,altered coagulability of the blood,damage to the vessel walls
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| In massive pulmonary embolus | the clot is large enough to obstruct blood flow to 50% or more of the pulmonary vascular bed, patient becomes hypoxemic, increase bronchial constriction can result in to pulmonary hypertension
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| PE is diagnosed via | ABG, ventilation-perfusion scan, spiral CT, pulmonary angiogram, physical assessment
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| PE signs & symptoms | dyspnea,pleurtic type chest pain,dry cough,anxiety with a feeling of impending doom, tachypnea,rales,fever
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| PE treatment | prevent further emboli, heparin, warfarin, IVC filter to prevent further migration of emboli from the lower extremities, oxygenation & ventilation to reverse effects of pulmonary hypertension i.e. intubation & mechanical ventilation
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| Atelactasis | groups of alveoli that have collapsed or are unable to expand
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| Atelactasis contributes to | alveolar hypoventilation and ventilation-perfusion mismatch
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| Atelactasis assessment findings | inspiratory crackles or popping (noise created as ventilatory pressure exceeds the surface tension within the alveoli), changes in VS, slight temperature, mildly increased heart rate & respiratory rate
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| Atelactasis treatment | low-flow oxygen, IS, some mechanism of positive airway pressure
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| Pneumonia (PNA) | inflammation of the lung caused by an infecting agent that usually leads to an area of consolidation within the parenchyma & may result because of decrease in the integrity of the patients immune system or exposure to virulent infecting organism
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| PNA symptoms | fever,chills,cough (productive/non-productive,crackles @ the end of expiratory not cleared by cough or deep breathing)pain @ area of consolidation,limited chest expansion on affected side chest x-ray with pulmonary infiltrates
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| PNA treatment | ID organism through sputum & blood cultures, antibiotic therapy, hypoxemia treated with oxygen, systemic hydration (iv fluids & nutrition), mechanical ventilation if acute respiratory failure
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| Asthma | a chronic disorder of the airways that results in airflow obstruction, bronchial hyper-responsiveness & an underlying inflammation,
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| In asthma the airflow obstruction is triggered by | allergens, viruses or other irritants. airflow is largerly reversible
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| Asthma attack or status asthmaticus or acute asthma is when | the asthma worsens & there is increased SOB, cough, wheezing, & chest tightness as airway continue to narrow
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| Immune response is stimulated by | exposure to an irritant that sets up inflammation in the airways, contributes to bronchospasm, increased mucus production, & mucosal edema, ventilation-perfusion mismatch leads to hypoxemia & tissue hypoxia causing further vasoconstriction
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| Asthma treatment | decrease peak expiratory flow, if PEF < 25% admit to ICU
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