Month: October 2015

DEFINITION:-
It is a collection of air in the pleural space normally the pressure in the pleural space is negetive compare to atmospheric presure. This negetive pressure is require to maintain lung inflation.

ETIOLOGY:-
It may be due to internal or external trauma which can be differentiate according to the type of trauma & site of involve it.
TYPES:-
1. Closed pneumothorax:-
There is no association with external injury or wound this is most common form of sponteneous pneumothorax.

Cause:-
A. Injury to the lungs due tio any mechanical ventilation

B. Injury to the lungs due to any broken ribs
C. Rupture of the bells & belbs
D. Perforation
E. Under weight smokers

2. Open pneumothorax:-
In this type of pneumothorax air enter into pleural space due to external injury or trauma. for eg:- stab wound , gun shoot , any surgical procedure of thorax
3. Tension pneumothorax:-
Pneumothorax with rapid accumulation of air into pleural space causinghigh intrapleural pressure with result in tension of heart & blood vessel.
Clinical features :-
1. Lungs may collapse
2. Mediastinal shift

4.Hemothorax-
Accumulation of bloos in intrapleural space . it is mostly associated with open pneumothorax.

Causes:-
1. Cheast trauma
2. Lung malignancy
3. Comlication of anticoagulant therapy
4. Pulmonary embolism
5. Tearing of pleural adhesions
5.Cyclothorax:
If pneumothorax is mild tachycardia &dyspnea will occur . if it is severe in condition respiratory distress, severe dyspnea, rapid breathing &air hunger which isa severe form of respiratory distress , chest pain , cough with or without haemoptysis , anxiety

DIAGNOSTIC EVALUATION:-
1. Physical examination on auscultation no breath sounds over the affected area
2. Cheast x rays shows the pressure & shadow of pneumothorax
3. Examination of purcussion shows hyper ressonance.
Medical management :-
1. It depends on cause or severity of the diseasecondition in mild cases constructive treatment ilke oxygen administration should be provided
2. In severe cases cheast drainage should be done small chest trube is inserted into the second intercostal space , in caes of severe accumulation the tube is inserted into 4th intercostal space to remove the accumulated air .


SURGICAL MANAGEMENT:-
1. In case of repeated pneumothorax pleuroctomy may be done
2. Pleurodysis:-
Artificial production of adhesions between visceral 7 parietal pleura with the help of chemical agent.
3. Needle venting :-
Pricking a large bore needle into the thorax to remove accumulated air
NURSING MANAGEMENT :-
1. PROVIDE SUPPLIMENT OXYGEN PLACE THE PATIENT IN SEMIFOWLERS POSITION.
2. OBTAIN TRAY FOR DRAIN OUT THE ACCUMULATED SUBSTANCES
3. AFTER DRAINAGE ASK THE PATIENT TO REPORT ANY INCREASE DYSPNEA
4. PALOPATED FOR SUBCUTENEOUS EMPHYSEMA IN UPPER CHEAST & NECK REGION.

Defination- Major histocompatibility complex is tightly linked clusterof genes whose product play role in intercellular recognition and to make defference between self and nonself molecule.MHC molecule act as a antigen presenting structure. T cell recognize antigen only when it is combined with an MHC molecule.
Types- MHC molecule have two types
1) Class I MHC molecule 2) Class II MHC molecule
Structure- Type I MHC- It has a 45 KD alpha chain associated noncovalently with a 12 KD beta 2 microglobulin molecule. Alpha chain is a trans membraneglycoprotein encoded by A, B, C region in human HLA complexes and by K, D/L region in mice. Association of alpha chain and beta 2 microglobulin require for expression of class I molecule on cell membrane. Alpha chain bind to plasma membrane by its hydrophobic transmembrane segment and hydrophilic cytoplasmic tail. Alpha chain is made up of three external domain(α1,α2,α3). Each domain have 90 amino acid, a trans membrane domain have 25 hydrophobic amino acid, a short segment of hydrophilic amino acid and a cytoplasmic segment of 30 amino acid. Peptide which bind to class I MHC is made up of 8-9 amino acid.
Type II MHC- Class II MHC bind to peptide and present these peptides to CD4 T celles. These peptides derived from exogenous protein. Peptide degred with in the endocytic processing pathway Class II MHC peptide contain 13-18 amino acid. Peptide binding cleft in class II MHC molecule is open at both ends and allow peptide to extend at both ends like a long hot dog in a buns.Peptide have an internal sequence containing 7-10 amino acid. This sequence has an aromatic or hydrophobic residue at the amino terminus and 3 additional hydrophobic residue in the middle portion and carboxy terminal end of the peptide.