Drugs These drugs may be used in the treatment of ARF: • antibiotics to treat infection • bronchodilators to maintain airway patency • corticosteroids to decrease inflammation • positive inotropic agents to increase cardiac output • vasopressors to maintain blood pressure • diuretics to reduce edema and fluid overload • opioids such as morphine to reduce respiratory rate and pro- mote comfort by relieving anxiety • anxiolytics such as lorazepam to reduce anxiety • sedatives, such as propofol, if the patient requires mechani- cal ventilation and is having difficulty tolerating it • fluid restriction to reduce volume and cardiac workload (for patients with ARF who have cor pulmonale). Battling illness Treating ARF
• White blood cell (WBC) count detects the underlying infection. • Abnormally low hemoglobin level and hematocrit signal blood loss, which indicates decreased O 2 -carrying capacity. • Pulmonary artery catheterization helps to distinguish pulmo- nary and cardiovascular causes of ARF and monitors hemody- namic pressures. Asbestosis Asbestosis is characterized by diffuse interstitial pulmonary fibro- sis. Prolonged exposure to airborne asbestos particles causes pleural plaques and tumors of the pleura and peritoneum. As- bestosis may develop 15 to 20 years after the period of regular ex- posure to asbestos has ended. (See A close look at asbestosis .) A carcinogenic coworker Asbestos is a potent cocarcinogen, increasing a cigarette smoker’s risk for lung cancer. An asbestos worker who smokes is 90 times more likely to develop lung cancer than a smoker who has never worked with asbestos. How it happens Asbestosis is caused by prolonged inhalation of asbestos fibers. People at high risk in- clude workers in the mining, milling, con- struction, fireproofing, and textile industries. Asbestos is also used in paints, plastics, and brake and clutch linings. Family members of asbestos work- ers may develop asbestosis from exposure to stray fibers shaken off the workers’ clothing. The general public may be exposed to fibrous asbestos dust in deterio- rating buildings or in waste piles from asbestos plants. The best info on asbestosis Here’s what happens in asbestosis: • Inhaled asbestos fibers travel down the airway and penetrate respiratory bronchioles and alveolar walls. • Fibers become encased in a brown, iron-rich, proteinlike sheath in sputum or lung tissue. • Interstitial fibrosis may develop in lower lung zones, affecting lung parenchyma and the pleurae. 82 RESPIRATORY SYSTEM A close look at asbestosis After years of exposure to asbestos, healthy lung tissue progresses from simple asbestosis to massive pulmonary fi- brosis, as shown below. Simple asbestosis Progressive massive pulmonary fibrosis Asbestosis occurs when lung spaces become filled with asbestos fibers.
• Raised hyaline plaques may form in the parietal pleura, the dia- phragm, and the pleura adjacent to the pericardium.
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