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http://projects.csail.mit.edu/courseware/?term=macbeth-essay-act-1 macbeth essay act 1 •• family history, social history, precipitating factors, history of exacerbations, and development of symptoms are important components of an asthma diagnosis. Symptoms •• patients usually complain of wheezing, shortness of breath, coughing (usually worse at night), and chest tightness. •• patients may be anxious and agitated. In acute severe asthma, patients may be unable to communicate in complete sentences. •• mental status changes (eg, confusion, irritability, agitation) may indicate impending respiratory failure. •• the presence of precipitating factors (eg, smoke, mold, or viral illness) worsens symptoms. •• symptoms usually have a pattern (eg, worse at night, seasonal symptoms). Signs •• vital signs may reflect tachypnea, tachycardia, and hypoxemia. •• on inspection, there may be hyperexpansion of the thorax and use of accessory muscles. •• auscultation of the lungs may detect end-expiratory wheezes in mild exacerbations or wheezing throughout inspiration and expiration in severe exacerbations. •• bradycardia and absence of wheezing may indicate impending respiratory failure.

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http://ccsa.edu.sv/study.php?online=thesis-statement-argumentative-essay-gay-marriage thesis statement argumentative essay gay marriage K. Hypocalcemia associated with hyperphosphatemia presenting after day of life (dol) #3. I. The goal of initial therapy is to reduce renal phosphate load while increasing calcium intake. Reduce phosphate intake by feeding the infant human milk or a low-phosphorus formula (similac pm 60/40 is most widely used, but other relatively low-mineral formulas, including nestle good start, may be used). Ii. Avoid the use of preterm formulas, lactose-free or other special formulas, or transitional formulas. These have high levels of phosphorus or may be more limited in calcium bioavailability. Iii. Increase the oral calcium intake using supplements (e.G., 20--40 mgl kg/day of elemental calcium added to similac pm 60/40). Phosphate binders are generally not necessary and may not be safe for use, especially in premature infants. Iv. Gradually wean calcium supplements over 2 to 4 weeks. Monitor serum calcium and phosphorus levels one to two times weekly. V. The use of vitamin d or active vitamin d (1,25[0h]zd) in this circumstance is controversial and not usually necessary. If a serum 25(0h)d level was obtained and is <10 to 12 nglml, then 1,000 iu of vitamin d should be given daily and the value rechecked in 14 to 21 days. Rarely should higher doses of vitamin d be given to neonates. I. Rare defects in vitamin d metabolism are treated with vitamin danalogs, for example, dihydrotachysterol (hytakerol) and calcitriol (rocaltrol). The rapid onset of action and short half-life of these drugs lessen the risk of rebound hypercalcemia. Ii. Hypercalcemia a general principles i. Definition a. Neonatal hypercalcemia (serum total calcium level > 11 mgldl, serum ionized calcium level > 1.45 mmol/l) may be asymptomatic and discovered incidentally during routine screening.

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