respiratory patterns

Idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis is a chronic and ultimately fatal disease characterized by a progressive decline in lung function. The term pulmonary fibrosis means scarring of lung tissue and is the cause of worsening dyspnea (shortness of breath). Fibrosis is usually associated with a poor prognosis.

The term idiopathic is used because the cause of pulmonary fibrosis is still unknown. IPF usually occurs in adult individuals of between 50 and 70 years of age, particularly those with a history of cigarette smoking, and affects more men than women.

  • Signs and symptoms

In many patients, symptoms are present for a considerable time before diagnosis. The most common clinical features of IPF include the following: dry, non-productive cough on exertion; progressive exertional dyspnea (shortness of breath with exercise); dry, inspiratory bibasilar “velcro-like” crackles on auscultation (a crackling sound in the lungs during inhalation similar to Velcro being torn apart slowly, heard with a stethoscope); clubbing of the digits, a disfigurement of the finger tips or toes; abnormal pulmonary function test results, with evidence of restriction and impaired gas exchange. These features are due to chronic oxygen deficiency in blood.

  • Diagnosis

If IPF is suspected, diagnosis can be challenging but a multidisciplinary approach involving a pulmonologist, radiologist and pathologist expert in interstitial lung disease has been shown to improve the accuracy of IPF diagnosis. Currently, a diagnosis of IPF requires:

  • Exclusion of known causes of ILD, e.g., domestic and occupational environmental exposures, connective tissue disorders, or drug exposure/toxicity
  • The presence of a typical radiological UIP pattern on HRCT.

Typical HRCT of the chest of IPF demonstrates fibrotic changes in both lungs, with a predilection for the bases and the periphery and it can identify UIP by the presence of:

  1. Reticular opacities, often associated with traction bronchiectasis
  2. Honeycombing manifested as cluster cystic airspaces, typically of comparable diameters (3–10 mm) but occasionally large. Usually sub-pleural and characterized by well-defined walls and disposed in at least two lines. Generally one line of cysts is not sufficient to define honeycombing
  3. Ground-glass opacities are common but less extensive than the reticulation
  4. Distribution characteristically basal and peripheral though often patchy.
  • Treatment

Fibrosis is usually associated with a poor prognosis. A number of treatments have been investigated in the past for IPF, including interferon gamma-1β, bosentan, ambrisentan, and anticoagulants, but these are no longer considered effective treatment options. Many of these earlier studies were based on the hypothesis that IPF is an inflammatory disorder.

CARE OF NEONATAL PUPPIES

PHYSIOLOGY AND HUSBANDRY 

Immediately after birth puppies have immature physiological responses when compared with adults:

(a) they have limited ability to regulate or control body temperature
(b) they have poor control of fluid balance or energy levels
© their immune system is not completely developed
(d) they may display irregular respiratory patterns
• each of these affect their susceptibility and response to disease and this results
in a high mortality rate seen in commercial kennels (10–30%), especially within
the first 3 weeks of life
• importantly, however, mortality rates can be significantly reduced with appropriate
monitoring and care
• after birth pups are entirely reliant upon the dam; they are born with their eyes
and external ear canals closed, they have limited smell and relatively low
myelination of nerve fibres
• the eyes begin to open at 10–14 days and the external ear canal at 14–16 days,
with cells sloughing off from the ear canal for 1 week after the canal opens
• pups have limited locomotion ability – restricted to simple ‘rooting’ behaviour
(a scrabbling of the fore limbs to provide forward motion and a circular movement
of the head in attempt to locate a nipple) which can result in them becoming
stuck in corners unless moved by the dam

BEHAVIOUR

• the early behavioural periods of the pup are closely linked to the underlying
physiology; the periods are defined as (1) neonatal, and (2) transitional, and
these precede the socialization period.

The neonatal period
• this extends from birth until the pups open their eyes
• during this time the pup is predominantly sleeping, whilst sucking and voiding
account for only 10–20% of time
• the pup is totally dependent upon the dam and can react to stimuli (such as
warmth) but do so only by the rooting response noted above
• voiding of faeces and urine only occurs following stimulation of the perineum
by the dam licking this area
The transitional period
• extends from approximately 10 days until 4 weeks of age
• there is progressive myelination of the nervous system, the pups can now experience
pain, see, hear, and progressively they are able to move their hind limbs
• locomotion ability increases and the pups start to explore the nest, follow the
dam and play with each other
• there are increased periods of wakefulness which can account for 40% of time.

APPEARANCE OF THE NORMAL HEALTHY NEONATAL PUP

• has a round and full abdomen and skin that is warm and elastic
• sucks enthusiastically for a short period approximately every 2–3 hours
• birth weight should increase by 5–10% per day; rate of weight gain has been
linked to survival, and daily weight gain should be monitored to allow quick
identification of any puppies who are at risk
• spend approximately 80% of their time sleeping with an activated sleep pattern (twitching movements when asleep)                                                        • only cry when hungry or disturbed

• have a body temperature of 35–37 °C in the first few days and 38 °C
thereafter
• have an irregular respiratory rate: 10–20 breaths per minute which increases
after the first few days
• have a high heart rate: 150–220 beats per minute which increases after the first few days

CARE OF NEONATES AFTER PARTURITION

• immediately after parturition the dam should sever the umbilical cord and lick
the puppy to remove the fetal membranes; this encourages respiration and
warms and dries the pup
• the bitch should then encourage the pup to move to the teat and suck
• assistance may be necessary where the dam does not or cannot exhibit these
behaviours and can include:
(a) removal of fetal membranes and fluid from the mouth and nose using a
dry towel, bulb syringe or pipette
(b) encouraging fluid to drain away by holding the puppy cupped in the hand
with the head tilted downward and hind quarters elevated whilst supporting
the head and neck (pups should not be swung to clear the airway as
this can result in brain trauma)
© rubbing the puppy briskly to help stimulate breathing and to warm and
dry the pup
(d) artificial respiration if there are less than 10 breaths per minute; use of
oxygen via intubation or tracheotomy can be very helpful
(f) clamping and severing the umbilical cord 1 cm from the abdomen and
treating with diluted chlorhexidine

Clinical examination
• once the puppies are stabilized they should be sexed, weighed and checked for
congenital abnormalities such as anal atresia, limb deformities, cleft palate and
harelip, which can affect between 1% and 15% of newborn puppies depending
on the breed
Reducing hypothermia
• pups are wet after birth and at risk of hypothermia; this risk can be reduced
by adequate drying, ensuring energy intake, providing a proper nest area,
encouraging huddling and providing external heat sources
• even in ideal situations it can take 5 hours before their body temperature
returns to normal                                                                                                 • the ideal environment is a temperature of 30–33 °C in the first 24 hours, 26–
28 °C in the first week and lower temperatures thereafter; it is helpful for the
nest area to be controlled at this temperature but for there to be cooler areas
that the bitch can escape to
• bedding should be changed frequently to ensure it is clean and dry
Ensuring energy intake
• pups are born with low glycogen reserves and poor body fat reserves with little
ability to generate energy and so they can be predisposed to hypoglycaemia in
the first 15 days of life
• the first milk, called colostrum, provides high levels of antibodies and energy
• ensuring that puppies suck soon after birth can help prevent hypoglycaemia,
especially following hypothermia or hypoxia
• the availability of teats, poor milk production, an inexperienced, difficult or ill
dam, weak pups or continual disturbance by humans can all affect food intake
• alternative sources of colostrum, including commercially available products,
should be provided in these cases
Ensuring normal growth and identifying sick pups
• pups that are normal grow at a rapid and predictable rate; this can easily be
monitored by assessing the weight of the pups on a daily basis
• daily weighing requires that each pup is uniquely identifiable and use of marks
placed on ears or different places on the tail using nail varnish or marker pens
facilitates this
• daily weighing seems onerous but is the best way to identify pups that are not
feeding well and are predisposed to becoming ill

Ensuring voiding
• until puppies are 3 weeks old there is no voluntary control of urination or
defecation and this is stimulated by the dam licking the perineal area
• the dam should be observed to ensure she is fulfilling this function
Preventative healthcare
• should have included immunization of bitches before breeding or during pregnancy
(for canine herpes virus) to provide passive immunity in colostrum
• de-worming programme should start at 3 weeks of age and progress after
weaning 
Artificial rearing
• may be required in large litters where the dam has insufficient teats or milk,
where there is inadequate milk production, where the dam is a poor mother
or due to death of the dam
• in some cases it is possible to foster some or all pups to another bitch that has
lost her pups or has a small litter
• pups in large litters may be rotated between artificial rearing and being reared
by the dam, allowing them to stay in the nest which will allow adequate
socialization
• in cases where the dam dies during birth, colostrum can be expressed from the
bitch or canine colostrum from a commercially available or frozen source
should be administered
• commercially available milk replacements are advised when the mother’s milk
is inadequate or unavailable and should be fed at a temperature of 37–38 °C;
the total volume to be fed is based on puppy weight and growth and be evenly
divided across feedings every 3 hours in the first week with the interval gradually
increased to every 6–8 hours by 4 weeks of age
• if puppies will not suck, milk can be administered via orogastric tube or feeding
bottle; all food should be fed at the appropriate temperature, best measured
with a thermometer and not by sprinkling on the back of a hand
Bottle feeding
• commercially available bottles and teats are preferred; they are more efficient
and introduce less gas into the stomach than trying to feed from a syringe or
using a dropper bottle
• bottles should be sterilized between use and commercially available chemical
sterilization for human baby utensils works well
• do not enlarge the nipple hole as, whilst this makes feeding faster, pups swallow
a lot of air and their stomachs become distended; worse still the pups can
aspirate milk and this results in development of bronchopneumonia                   • it is easiest to hold the pup on your lap and hold its head elevated to allow it
to suck from the bottle; the pup will normally paddle its front feet as a normal
response during sucking
• it can be difficult to be sure of the exact volume of food taken by each pup
Tube feeding
• feeding by orogastric tube is quick, effective and allows the exact amount of
food administered to be recorded
• normally a 6 French gauge soft plastic feeding tube with a rounded end is used
• the tube is placed alongside the pup and the distance between the mouth and
the last rib is marked on the tube; ¾ of this distance is the length that will be
placed into the pup
• the pup is best restrained on your lap and the tube is pushed gently into the
pup’s mouth; most pups will swallow the tube and it can be seen running down
the left side of the neck (in the oesophagus)
• when neonates are being reared artificially, urination and defecation must be
initiated after every meal by stimulating of the perineal region with cotton wool
• the urine produced by well hydrated puppies should be colourless
Starting weaning
• solid foods can be introduced starting at 3 weeks of age by mixing puppy food
with the milk formula and allowing it to soften
• this ‘gruel’ can be offered in small amounts four times a day; in many cases it
is easiest to feed from a finger to get the pup’s interest and then to place the
finger into the gruel                                                                                                • as the pup gets older less milk can be used so the gruel is stiffened into a ‘paste’; usually no milk substitute is used at about 6 weeks of age
• as the dam is gradually removed from the pups they will start to play and rest
together and will not be stressed by her absence; some pups settle better if they have an upended cardboard box in which to sleep
• pups should be encourage to establish a toileting area away from the sleeping area; here the paper can be replaced regularly
• all pups should be regularly handled, including opening their mouths, looking
in their ears and exposing them to different sounds

(Source: Dog breeding, whelping and puppy care / Gary C.W. England, Wiley-Blackwell Publishing, 2013)

Mulder and Scully Meet the Lust Monster

Author: @hips-bef0re-hands
Rating: NSFW
Timeline: During MASMTWM 
Tacky title? I know! 

———-

Mulder walked down the dimly lit path hidden within the internal walls of the motel. Glancing around, he realized he had an inside look of various rooms including Scully’s.

Removing the fake, glass eyes shielding the openings, Mulder peered through two small holes in the tunnel into Scully’s room.

At first, he thought she was asleep. Her eyes were closed and there was a soft smile playing at her lips. It wasn’t until she shifted her position, bit her lip and let out a small moan that he realized that she was not sleeping at all.

Keep reading

2

PLEASE REBLOG.

This is our little niece, Allisha/Delic. She’s only 2 years old and 7 months and she was placed in the ICU (Intensive Care Unit) last friday. When she first came into the the hospital she was diagnosed to have Food Poisoning until it got worse. She started to have a seizure, Mycharditis and an abnormal respiratory pattern. Then the doctors said she has Dengue and a viral infection in her heart and brain. That’s when she was placed in ICU. But then they ruled out Dengue as her diagnosis when her platelet count suddenly went up, and they’re still taking tests on our niece to find out what truly is wrong with her. I dared not to take a picture of her in the ICU since my mom scolded me about it saying, “I don’t want to remember this happening to Shobei”. Money is scarce in our family since both me and my sister are in college taking medical courses and there’s a down payment of 30,000 pesos for using the ICU each day. We don’t need money, we just need prayers and moral support for Delic’s recovery. That’s all I can ask of you. We Tumblr people have helped people just by reblogging, so now I ask of you for help. Pray for little Allisha’s health and that we could somehow get the money to pay for her hospital bills.

Thank you so much and God Bless little Allisha.