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As a result of emphysema there is a significant loss of alveolar attachments, which contributes to peripheral airway collapse. There are two major types of emphysema according to the distribution within the acinus and they are; (i) centrolobular emphysema which involves dilatation and destruction of the respiratory bronchioles; and (ii) panlobular emphysema which involves destruction of the whole of the acinus. According to theory, centrolobular is the most common type of emphysema in COPD and is more prominent in the upper zones, while panlobular predominates in patients with alpha-1 antitrypsin deficiency and is more prominent in the lower zones. In relation to patients D.Z. with emphysema, the walls between the tiny air sacs in the lungs are damaged due to long-term cigarette smoking effect on his lungs as evidenced by patient c/o difficulty breathing at rest and productive cough with thick yellow-green sputum r/t a

1) Suppose that the wages of young high school graduates fell. In what sense has the true “cost” of a college education been changed by this development.

Emphysema is the most common cause of death from respiratory disease in the United States and is generally caused by several years of heavy cigarette smoking (Olendorf, 2000). When a person smokes, the body’s immune system tries to fight off the invading smoke by using certain substances. These substances can also attack the cells of the lungs, but normally the body is able to release other substances to prevent this. In the case of people who are smokers, this doesn’t happen and the original substances that were released to fight off the smoke also end up injuring the cells of the lungs as well. Eventually, the lungs will not be able to supply enough oxygen to the blood and a host of problems can occur with this. Risk factors that have been identified for emphysema include exposure to tobacco smoke either through active or passive smoking (2nd hand smoke), occupational exposure such as dust or chemicals, ambient air pollution, or genetic abnormalities, including a deficiency of alpha-antitrypsin, an enzyme inhibitor that normally counteracts the destruction of lung tissue by certain other enzymes (Smeltzer, 2010). The symptoms of emphysema develop gradually over many years. It is generally characterized by three primary symptoms: chronic cough, sputum production, and dyspnea on exertion. Other signs and symptoms include weight loss and the development of a

Implementation of a computer system to replace paper documentation would require the involvement of an interdisciplinary team. This team would be comprised of several members, each with a specific job. The first member selected would be a Clinical Nurse Informaticist. This team member would be charged with giving valuable input on the software needed for nurses to properly care for and chart on their patients. With the knowledge of nursing practice and informatics, this team member would very valuable in bringing the two together in the most efficient way possible. The next team

Writing has many tools and devices that can be used to influence the purpose and meaning of the a piece of work. In the two pieces of work, "Private License Plate Scanners Amassing Vast Databases Open to Highest Bidders-which is written in a way that it is anti-license plate tracking- and "Who Has the Right to Track You?'-which is written to be for license plate tracking- many different tools and devices are used by the authors. These pieces of work describe the benefits and drawbacks of collecting data and tracking fellow citizens, but use different forms of pathos, ethos, and logos to portray what they are trying to say. Also, both articles state how many are opposed to this tracking, arguing that it is against the First Amendment,

Chronic inflammation leads to structural changes, narrowing of the small airways, and destruction of lung tissue, which diminishes the ability of the airways to remain open during expiration

When the respiratory tissue damaged, the body’s inflammatory responses cause the lining of the airways to become swollen and thickened as a result of constant irritation that leads to an excessive mucus secretion in effort to protect the lungs from inhaled irritants such as cigarette smoking, air pollution, passive smoking, occupational dusts and chemicals (Currie 2009).

COPD is characterized by chronic inflammation found in the airways lung parenchyma, and pulmonary vasculature (Huether and McCance, 2012). The pathogenesis of COPD is complex and involves many mechanisms. However, the primary process is inflammation (Huether and McCance, 2012). The inflammatory process starts with inhalation of toxic particles and gases. The airways become inflamed, resulting in excess mucus production; Peripheral ways undergo repeated cycles of injury and repair of the airway walls with resultant structural remodeling (Huether and McCance, 2012). The lungs can be inflated quickly but can only partially deflate.

Asthma is a long term disease that inflames and narrows the airways in the lungs. When a person has asthma, cells and tissues in the airways become susceptible to inflammation when they come in contact with different substances. These substances can be harmless but with asthma, these substances can become very dangerous. This inflammation in the airways then leads to airway narrowing. The body’s response to ease the inflammation is the release of histamine and leukotrienes. When histamine and leukotirens are released, the muscles in the airways contract which makes the airways to become narrow. The nerves in the airway also become more sensitive which leads to harsh coughing and wheezing.

The presence of airflow obstruction which is largely irreversible is a major feature of COPD. It is proposed to be the result of a combination of small airways narrowing, airway wall inflammation [89] and emphysema-related loss of lung elastic recoil [1, 90, 91]. The pathologic features of COPD are structural changes of the lung, including emphysema and small airway remodelling [92]. Small airway remodelling in COPD is characterized by adventitial fibrosis and mucus cell hyperplasia, and may involve increased airway smooth muscle (ASM) mass, particularly in severe disease [92-96]. This is indicated by persistent infiltration of inflammatory cells, including macrophages, neutrophils and T- and B-lymphocytes in the airway wall [94-96]. Small airway remodelling could also result from direct effects of CS and LPS exposure on structural cells of the airway wall, independent of inflammation [9].

In regards to chronic bronchitis and emphysema, the pathophysiological changes are the “chronic inflammation and small airways, resulting in reduced airflow and gradual destruction of the alveoli.” In patients with chronic bronchitis,

Asthma is characterized by reversible airway obstruction and airway hyper-responsiveness that is associated with airway inflammation and airway remodelling. Two prominent pathological features of asthma are the increase of airway smooth muscle (ASM) mass and the deposition of extracellular matrix (ECM) proteins, which contribute to the development of airway inflammation and remodelling. The deposition of increased ECM proteins such as fibronectin and collagen in ASM layer has been observed in asthma. Evidence suggests that increased ECM deposition could induce ASM phenotype switching from the contractile phenotype to the proliferative phenotype, accompanied by increased expression of cell adhesion receptors and costimulatory molecules as well

Currently, soluble mediators are used as indirect markers of airway inflammation. Among them endothelin-1, which is produced by the bronchial epithelium, alveolar macrophage, and pulmonary endothelium, may stimulate mucus secretion, promote airway edema, increase vascular and airway smooth muscle proliferation, and up-regulate production of various cytokines [123]. Endothelin-1 has been proposed as one possible mediator responsible for increased airflow obstruction via bronchospasm induction, which is higher in the sputum of patients with stable COPD [124] as compared with healthy

antitrypsin that is produced in the liver and travels through the blood to the lungs. However, alpha-1

The torrential downpour outside of the old Miami Tower was stampeding against the window. Ferociously, the seawater level over the past 2 years have risen 7 feet and is constantly climbing due to the vicious weather conditions and backlog from sewage. Ever since the flooding started the water has blocked off the roads and tunnels which made transportation near impossible. In our small civilization, we have a system that is based off on a basic monarchy where the king’s son or daughter becomes the holder of the throne when their father dies. The man who created the society 20 years ago had lived in poverty his whole life, but he strived to make sure everyone was safe and happy. When the flooding first started he didn’t have the money or