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FNP Review > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Treatment of CAP

A

Previously healthy pts- Macrolides- azithromycin, clarithromycin, erythromycin or doxycycline.

Pts with co-morbidities, immunosuppressed or recent ABT- Respiratory fluroquinolones, advanced macrolide (azithromycin plus beta-lactam such as HD amoxicillin, HD augmentin , ceftriaxone, cefuroxime (Ceftin)

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2
Q

Atypical organisms in CAP

A

M. Pneumoniae
C. Pneumoniae
Legionella

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3
Q

Symptoms of asthma

A

Recurrent cough, wheeze, sob & chest tightness.

Sx WORSE AT NIGHT, WITH EXERCISE, with viral respiratory infections, allergens or pulmonary irritants (smoking)

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4
Q

Asthma definition

A

Chronic disorder of the airways, characterized by variable, recurrent sx of airflow obstruction, bronchial hypertesponsiveness, & underlying inflammation.
FEV1 >12 from baseline post SABA

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5
Q

Intermittent asthma classification

A 
Sx = 2days/wk 
Nighttime awakenings = 2x/mth 
SABA use = 2days/wk
Interference w/ daily life- none
FEV1 >80% predicted
FEV1/FVC normal
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6
Q

Mild persistent asthma classification

A 
Sx >2 days/wk, but not daily 
Nighttime awakenings 3-4 x's/mth
SABA use >2 days/wk not >1x/day 
Minor limitation of normal activity
FEV1 >80% predicted 
FEV1/FVC normal
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7
Q

Moderate Persistent asthma classification

A 
Sx daily 
Nighttime awakenings >1x/wk not wkly
SABA daily
Some interference with daily living 
FEV1 >60% but
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8
Q

Severe persistent asthma classification

A 
Sx throughout the day 
Nighttime awakenings often 7d/wk
SABA several times/day
Extreme limitation with normal activity
FEV1 5%
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9
Q

Risk factors/genetic characteristics for developing asthma (IgE)

A

The body’s predisposition to develop an antibody called Immunoglobulin IgE- in response to environmental allergens.
Includes allergic rhinitis, asthma, hay fever & eczema.
IgE is high in pts with allergic asthma, allergic rhinitis & eczema.

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10
Q

IgA and autoimmune conditions

A

IgA levels may be high in autoimmune conditions. IgA is found in high concentrations in the body’s mucus membranes, particularly resp. passages, GI tract, saliva & tears. IgA plays a role in allergic reactions.

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11
Q

Conditions that go along with asthma

A

Increased nasal secretions or nasal polyps.

Atopic dermatitis, eczema, or allergic skin conditions

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12
Q

Long term (controller) meds for asthma

A

Inhaled corticosteroids (Qvar, pulmicort, Flovent, asmanex)

Long-acting beta2 agonists (Formoterol, salmeterol)

Leukotriene modifiers (Singulair)

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13
Q

Quick relief (rescue) med for asthma

A

Short acting beta2 agonists (ProAir, ventolin, xopenex)

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14
Q

Xolair (omalizumab)

A

Anti-IgE injection injection 1-2 xmth to help the body from reacting to asthma triggers. May be used when other asthma meds have not worked.

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15
Q

Physical exam findings in COPD

A 
Hyperresonance
Decreased tactile fremitus 
Wheeze (expiratory, then inspiratory) 
Low, flat diaphragm
Increased AP diameter (barrel chest-most often in COPD, also seen in poorly-controlled asthma.
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16
Q

Most common COPD sx

A

Chronic cough, chronic sputum production, chronic bronchitis, activity intolerance. Sx typically progressive over time.

17
Q

Alpha-1 antitrypsin deficiency screening (COPD)

A

Test for enzyme deficiency that
leads to esophageal collapse.
(Check with strong family hx, European ancestry

18
Q

COPD GOLD stage 1

A

Mild

FEV1>80% predicted

19
Q

COPD GOLD stage 2

A

Moderate

50%-

20
Q

COPD GOLD stage 3

A

Severe

30%-

21
Q

COPD GOLD stage 4

A

Very severe

FEV1

22
Q

COPD treatments

A

SABA- prn for bronchospasm
LABA- daily controller med
LAMA (muscarinic antagonist)-daily to reduce exacerbations
ICS-added if FEV1 falls

23
Q

Indication to initiate long-term (>15 hrs/day) oxygen therapy

A

PaO256% [0.56 proportion ])

24
Q

COPD exacerbation

A

Characterized by a change in the pts baseline dyspnea, cough, and/or sputum beyond the day to day variability sufficient to warrant a change in management.

25
Q

Treatment of COPD exacerbation

A

Bronchodilators- SABA prn, consider adding LABA, LAMA (tiotropium bromide) if not already on one.
*If baseline FEV1

26
Q

ABT tx for mild to moderate exacerbations

A

Amoxicillin
TMP-SMX
Doxycycline

27
Q

ABT tx for severe exacerbations

A

Beta-lactam (Augmentin, Cephalosporins)

Macrolides (Azithromycin, clarithromycin)

Respiratory fluroquinolones (Moxifloxacin, levofloxicin)

28
Q

Emphysema definition

A

Enlargement of air spaces secondary to alveolar wall destruction (secondary to neutrophil produced elastases)
Without elastin, the airways collapse upon expiration.

29
Q

Cor pulmonale

A

Right ventricular enlargement, hypertrophy or dilation secondary to lung disease.
EKG changes- right ventricular hypertrophy & right axis deviation.

30
Q

Tx of Cor pulmonale

A

Oral corticosteroids
Hospitalization
24 hour nocturnal requirements
Refer to pulmonology, poss cardiology

31
Q

TB organism & sx

A

Mycobacterium tuberculosis
Sx- productive cough, purulent yellow sputum, repeated occurrences of cold like sx, with rhinorrhea, & nasal congestion. Hemoptysis

32
Q

3 categories of positive reactions to PPD (mantoux) test.

A

5mm =positive in HIV pts
10mm= positive in recent immigrants
15mm= positive on everyone

33
Q

Treatment of TB

A

Duration of treatment 6mths

  • 2 month course isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), & ethambutol ((EMB)
  • 4 month course of INH & RIF
34
Q

Pulmonary HTN

A

Pulmonary artery pressure is inappropriately high for a given level of blood flow through the lungs.
Characterized by- right side heart failure, progressive dyspnea

35
Q

Management of pulmonary HTN

A

Activity limitations
Low salt diet
Avoid OTC meds
Lasix/warfarin

36
Q

Inhaled anthrax presentation

Cutaneous anthrax presentation

(Treatment)

A

Inhaled- widened mediastinum due to hemorrhage visible on CXR or thoracic CT

Cutaneous- pustular lesions that eventually forms ulcer with eschar

Treatment- Fluroquinolones, expert consultation

FNP Review (15 decks)

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