Tension pneumothorax is the result of increased air in the pleural space and causes shifting of bodily organs and an increase in intrathoracic pressure. The patient usually presents with cyanosis, air hunger, violent agitation, tracheal deviation, neck vein distension, and hyperresonance to percussion. Hemothorax is an accumulation of blood in the pleural space, and the patient usually presents with dyspnea, diminished breath sounds, dullness to percussion, and shock, depending on blood loss. Flail chest is a fracture of two or more ribs, and the patient presents with paradoxical movement of the chest wall and respiratory distress. Cardiac tamponade occurs when blood collects in the pericardial sac, and the patient presents with muffled, distant heart sounds, hypotension, neck vein distension, and increased central venous pressure.
The goals for a patient recovering from ARDS are SaO2 greater than 90%, patent airways, PaO2 within normal limits for age or baseline values on room air, and clear lungs on auscultation. SaO2 above 90% and PaO2 within normal limits indicate satisfactory arterial oxygenation. Airways should be kept patent and clear off any secretions. Clear lungs indicate that there are no secretions obstructing the airway, and the lungs are functional. PaO2 above normal levels means that the patient is hyperventilating.
STUDY TIP: Regular exercise, even if only a 10-minute brisk walk each day, aids in reducing stress. Although you may have been able to enjoy regular sessions at the health club or at an exercise class several times a week, you now may have to cut down on that time without giving up a set schedule for an exercise routine. Using an exercise bicycle that has a book rack on it at home, the YMCA, or a health club can help you accomplish two goals at once. You can exercise while beginning a reading assignment or while studying notes for an exam. Listening to lecture recordings while doing floor exercises is another option. At least a couple of times a week, however, the exercise routine should be done without the mental connection to school; time for the mind to unwind is necessary, too.
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Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, upper respiratory infections, drug and food additives, psychologic factors, and gastroesophageal reflux disease (GERD). Decreased humidity is not a trigger.
An increased risk of pulmonary embolism is associated with obesity, malignancy, heavy cigarette smoking, and prolonged air travel with reduced mobility. Other risk factors include deep vein thrombosis, immobilization, surgery within the last three months, oral contraceptives and hormone therapy, heart failure, pregnancy, and clotting disorders. Pneumonia is not a risk factor.
During routine tracheostomy care, the required sterile equipment should be assembled near the patient's bed. Hands should be washed before the procedure. Clean gloves and goggles are to be worn. At first, the inner cannula is unlocked and cleaned in sterile water or saline solution. The inner cannula should be replaced after cleaning. The stoma is then cleaned with sterile gauze to remove dried secretions. Retention sutures, if present, should be properly positioned and secured. Subsequently, tracheostomy ties are changed.
Active TB disease may manifest initially with constitutional symptoms such as fatigue, malaise, anorexia, unexplained weight loss, low-grade fevers, and night sweats. Dyspnea is a late symptom that may signify considerable pulmonary disease or a pleural effusion. Hemoptysis, which occurs in less than 10% of patients with TB, is also a late symptom.