Asthma/COPD Flashcards
(17 cards)
S&S of asthma
-resp distress at rest -*difficulty speaking in sentences -*hyperresonance (=air trapping) *pulsus paradoxus >12mmHg -use of accessory muscles -tachypnea (>28) -tachycardia (>110) -cough -chest tightness
When is hospitalization recommended in asthma?
-if initial FEV1 is <30% predicted or does not increase to at least 40% predicted after 1 hr of vigorous therapy -if peak flow is <60L/min initially or does not improve to >50% predicted after 1 hr of tx
What would initial ABG of asthmatic patient demonstrate?
respiratory alkalosis w/mild hypoxemia
Outpatient management of asthma
- SABA- for sxs relief or before exercise
- LCS for daily maintenance
- if sxs persist despite above, increase LCS or add LABA (salmeterol)
- inhaled anticholinergics may be added if necessary (i.e lots of secretions)–> Ipratropium
What class of medications is useful in the maintenance of chronic asthma?
antileukotrienes (Montelukast- Singulair)
Management of inpatient asthma
- supplemental O2 (2-3L/min)
- severe attacks–> ABG
- hydration (IVF)
- Inhaled sympathomimetics: Albuterol , Metaproterenol
*Corticosteroids in those who do not respond to sympathomimetics
-Anticholinergics
Dose of albuterol (Proventil, Ventolin) in treating asthma exacerbation
0.3cc in 3ml NSS q30-60min
Dose of metaproterenol (alupent)
0.3 cc in 2.2ml NSS q30-60min
Dose of methylprednisolone in asthma exacerbation
60-125mg IV x 1 then 20mg IV q4-6hrs until attack broken
Dose of atrovent in asthma exacerbation
MDI 2-6 puffs q4-6hr
Dose of steroids in status asthmaticus
Methylprednisolone 60-125mg or hydrocortisone 300mg IV
definition of chronic bronchitis
excessive secretion of bronchial mucus; manifested by productive cough x 3 mon or more in at least 2 consecutive years
S&S of chronic bronchitis
BLUE BLOATER (obese) -intermittent mild-mod dyspnea -onset of sxs after age 35 -*copious sputum production (purulent) -*chest AP normal -*percussion normal -hyperinflation, bulla, blebs + flattened diaphragm on CXR -Hct inc -hypercapnea, hypoxemia on ABG
S&S if Emphysema
PINK PUFFER (thin, wasted) -progressive, constant dyspnea -onset of sxs after age 50 -mild sputum (clear) -Chest AP increased -percussion hyperresonant -HCT normal -TLC inc -flattened diaphragm on CXR
Which COPD exacerbation patients should receive ABX?
those w/purulent sputum
ABX for treatment of COPD exacerbation
Ampicillin or Amoxicillin 500mg QID
OR Doxycycline 100mg BID
OR Bactrim DS 1 tab daily
In patient management of COPD exacerbation
O2 1-2L
pharmacologic progression as for in patient asthma exac
ABX for those w/purulent sputum