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99 Cards in this Set
- Front
- Back
stress coping process
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short lived, quick.
compensatory process with physiological and psychological components |
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day to day stress
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has greatest impact on health
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physiologic response to stress (what ns?)
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SNS (norepinephrine) is activated. cascade of neural and hormonal events.
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effects of stress
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peripheral vasoconstriction
bronchodilation pupils dilate dec GI activity inc blood sugar/fatty acids feeling of tension inc sweating inc rate of blood coag |
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maladaptive stress
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drugs and alcohol
type a personality denial avoidance |
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infant body fluid
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70-80%
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adults body fluid
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60%
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geriatric body fluid
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45-50%
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fluid loss sxs (4)
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mild lightheadedness
convulsions coma death |
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intracellular (what ion? how much % body water?)
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2/3 of body fluid
K+ is prime cation |
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what is extracellular fluid (3 things)
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intravascular and interstital
1/3 body fluid Na+ prime cation |
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input/outpt volume
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2600 mL/day
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inc volume
inc weight |
causes more fluid to leak out into intravascular area, into interstitial area
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hydrostatic pressure
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wt and volume
more volume IV causes inc BP pushing pressure - water out of vessel |
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osmotic pressure
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the pressure which needs to be applied to a solution to prevent the inward flow of water thru membrane
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osmolality
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# particles in kg of fluid (1L H2O)
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normal osmolarity of plasma
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250-375 mOsm/L
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Renin-Angiotensin-Aldosterone
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holds on to Na, H2O
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ADH
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holds onto urine
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Atrial Natiuretic Peptide
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inc absorption of Na/H20 (lose Na/H20 to urine)
activate when renal blood flow is low. SNS kicks in |
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RAS system
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renin -> angiotensin 1 -> angiotensin 2 -> inc BP
renin -> secretion of aldosterone -> retain H2O and inc BV and BP |
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hypervolemia/ FVE
caused by |
excessive IV infusions
replace water w/o Na ADH secretion Aldosterone (renal, adrenal, CHF, liver failure) excess salt intake |
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what FVE looks like
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fast wt gain
peripheral/periorbital edema JVD, bounding HR, inc BP inc CVP, RA pressure SOB, crackles dec Hct, Na (dilution) headache, confusion |
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normal CVP in RA
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6-12 cm H2O
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causes of edema
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inc capillary hydrostatic pressure
dec plasma protiens obst lymphatics kidney malfuction inc capillary permeability meds: steroids, NSAIDs, estrogen |
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edema (2 types)
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generalized (anascarca)
localized |
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1st space
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intravascular fluid
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2nd space
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interstital fluid (pitting edema)
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3rd space
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pericardium, pulmonary edema, etc
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intervention for FVE
(what position?) |
dec interstital fluid
promote circulation skin integrity semi-fowlers postition i&o / weights |
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FVD hypovolemia causes
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decreased intake
increased ouptput decreased abs of fluid |
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assessment for FVD
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dry mothe, sordes
dec skin turgor inc temp olig/anuria inc hct, serum na, bun restless dec bp dec cvp, flat veins |
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interventions for FVD
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fluids
i&o /weights skin integrity hypovolemic shock |
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na range
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135-145
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K range
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3.5-5.5
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chloride range
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96-106
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CO2
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24-30
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bun
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10-20
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creatinine
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0.7-1.5
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glucose
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80-110
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urine ph
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4.5-8.0
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urine spec gravity
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1.010-1.020
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hyponatremia sxs (6)
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AMS
headache anorexia, N/v, cramps muscel twitches |
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hypernatremia sxs
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restelssness
AMS twitching |
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hypokalemia sxs
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slow reflexes
fatigue constipation lo T wave, U wave |
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hyperkalemia sxs
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peaked t wave
nausea irregular HR acidosis |
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hypokalemia sxs (4)
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slow reflexes, numbness
fatigue constipation lo T wave, U wave |
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hyperkalemia sxs
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peaked t wave
nausea irregular HR acidosis |
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hypotonic crystalloids
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.33, .45 NS
D5W fluid out of vessels |
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hypertonic crystalloids
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D5W .45NS
d5w .9 NS 3% NS 5% NS fluid into vessels |
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isotonic crystalloids
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0.9% NS
LR too much too fast - FVE |
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albumin 5, 25%
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keep fluid in vessels
good for shock tx |
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dextran, hetastarch
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synthetic
fluid into vessels |
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mannitol 5,25%
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fluid out of vessels
oliguric diuresis eliminates cerebral edema |
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hypercalemia sxs
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lethargy, wekaness
dec reflexes constipation |
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hypocalcemia sxs (6)
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muscle cramp, twitching
tetany - convulsions cardiac arrythmias trousseaus chvosteks sign |
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blood ph
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7.35-7.45
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pCO2
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35-45
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HCO3
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22-26
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resp acidosis cause
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depressed resp center
decreased lung surface |
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resp alkalosis cause
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hyperventiliation
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METABOLIC acidosis cause
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DM
starvation ASA overdose renal failure diarrhea tissue anoxia (anerobic) |
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metabolic alkalosis causes
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loss of HCL
excessive bicarbonate fluid and electrolyte loss |
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shock
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inatequate circulation to brain, heart, lo 02 delivered
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hypovoloemic shock cause
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loss in volume
trauma, surgery, burns, FVD |
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cardiogenic shock
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pump failure
MI arrythmias |
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distributive shock
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pooling of blood - massive vasodilation
neurogenic - spinal injury allergy septic |
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intervetions for shock
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ABC!
oxygen fluids |
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meds for shock
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sympathomimetic (dopamin, dobutamine)
vasodilators (nitroglyerine) |
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diabetes insipidus
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low ADH
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cushings
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hi aldosterone
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addisons
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lo aldosterone
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parietal pleura
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lines thorax
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visceral pleura
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lines lungs
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what produces surfactant
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alveoli
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NIF
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negative inspiratory force
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ventilation
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move air in and out
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respiration
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gas exchange at cellular level
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inpiration
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diaphram contracts (down)
thoracic cavity expands negative inspiratory force active |
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expiration
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diaphragm relax (up)
thorax decreases positive force pushes air out passive |
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orthopnea
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pillows at night
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cyanosis
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late sign of hypoxia
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stridor
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high pitched sound
medical emergency usually obstruction |
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PEEP
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usually 5-10 cm
keep open alveoli inc delivery of O2 lower conc of O2 needed |
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pneumonia position
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sit up
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COPD
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slow progressive destruction of alveoli
loss of lung elasticity CO2 retained (r. acid) decreased gas exchange expiration becomes active emphysema chronic bronchitis |
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risk for COPD
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cigs
air pollution AAT deficiency |
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Sxs emphysema
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SOB, shallow
chest rigid productive cough long expiration wheezes clubbing R side HF |
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treat emphysema
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stop smoking
increase fluid position, 02 therapy |
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meds for emphysema
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broncodilator: antolin, atroven (B2)
corticosteriods: beclovent aminophylline |
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forced expiratory volume
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how fast air can be moved in and out
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forced vital capacity
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how much volume can be moved in and out
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sxs chronic bronchitis (4)
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excessive mucus
cough dyspnea lasting 3 mo+ in 2 consec yrs |
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chronic bronchitis cause
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smoking
recurrent lower RT infections |
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chronic bronchitis treat
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no smoking
treat LRT at first sign increase fluid to liquefy |
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asthma
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reversible
bronchoconstriction swelling of mucus lining thick secretion no anatomical changes |
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sxs asthma
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cough
wheezeing dyspnea anxiety pale color diaphoresis tachy pulse hypoxia, hypercapnea |
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treat asthma
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avoid triggers
oxygen breathing exercises comfort |
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asthma meds
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beta 2 agonisits
corticosteriods mast cell stabilizers methylxanthines leukotrienes |