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test 3 > copd asthma > Flashcards

copd asthma Flashcards

1
Q

Risk factors for COPD

A

Smoking cigarrette pipe, cigar marjana
2nd hand smoke
genetic factors
Environment

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2
Q

Respiratory infections can have what affect on COPD

A

exacerbation increase airway inflammation

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3
Q

Environmental pollutants (dust fumes, chemicals)can have what affect on COPD

A

Causes increased hyperinflation, gas trapping and reduced expiratory flow

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4
Q

Pneumonia, PE, and Heart Failure can mimic exacerbation

A

COPD

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5
Q

What is required to establish Diagnosis of COPD

A

spirometry

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6
Q

Mild Classification of severity airflow limitation in COPD (based on post-bronchodilator FEV1

A

Gold 1- FEV1 > 80%

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7
Q

Moderate Classification of severity airflow limitation in COPD (based on post-bronchodilator FEV1

A

Gold2 50%< FEV1 < 80

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8
Q

severe Classification of severity airflow limitation in COPD (based on post-bronchodilator FEV1

A

Gold3

30< FEV1 <50

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9
Q

very severe Classification of severity airflow limitation in COPD (based on post-bronchodilator FEV1

A

Gold4

FEV1<30

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10
Q

Medicare spo2 has to drop to what for coverate

A

30

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11
Q

Labs required for COPD

A

ABG, CMP, CBC BNP Alpha 1 testing

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12
Q

Why is CBC tested for COPD

A

Polycythemia

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13
Q

Why is CBC tested for COPD

A

Polycythemia

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14
Q

Chest xray done for COPD what will be seen

A

increased bronhco vascular markings and cardiomegaly

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15
Q

Chest xray done for COPD and you see small heart hyperinflation, bullous changes

A

Emphysema

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16
Q

Chest xray done and you see cardiomegaly and broncho vascular markings

A

COPD

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17
Q

Patient comes in with COPD and depression what would be best treatment

A

wellbutrin

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18
Q

What vaccinations are best for COPD to prevent infectoin

A

flu and pneumo vac

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19
Q

What guidelines must be met before placing chronic o2 for home use

A

medicare

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20
Q

Group A treatment

A

Short or long bronchodilator

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21
Q

Group B Treatment copd

A

LABA ro LAMA

if symptoms persist then combo LABA/LAMA

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22
Q

Group C (exacerbation)

A

start with lama

if exacerbation continue go to laba/lama or laba/ics

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23
Q

Group D (> exacerbation and persistant symptom)

A

LABA/LAMA/ICS
if worsen add Daliresp
if FEV1 <50

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24
Q

Group d and former smoker what should be added for chronic bronchitis

A

azithromycin or erythromycin

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25
Q

Pharmo Treatment used for moderate to severe copd

A

ics/laba

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26
Q

Pharmo Treatment used for low rate exacerbation copd

A

laba/lama to increase bronchodilatin

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27
Q

what is alpha 1 antitrypsin augmentaion used for

A

people wiht alpha 1 genetic defect must have weekly treatemnt to preserve lung function

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28
Q

is oxygen a pharmacological treatment

A

no

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29
Q

Supplemental o2 indicated for pao2 of or sao2 of

A

pao2 <55

sa02 <88

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30
Q

Supplemental o2 indicated for pao2 of or sao2 of

A

pao2 less than 55

sa02 less than 88

31
Q

Supplemental o2 indicated for pao2 of or sao2 of

A

pao2 less than 55

sa02 less than 88

32
Q

how many calories are needed for copd patients

A

3000 per day

33
Q

What are the benefits of Lung volume reduction surgery

A

parts are resected to reduce hyperinflation respiratory muscles can be more effectiv and incre mech effication

34
Q

What can Brethine be used for

A

Terbutaline
bronchodilator
used for bronchospams

35
Q

Can asthma be transfered throght genetic

A

yes

36
Q

What happens during asthma? (how is asthma discribed)

A

inflamations which casues edema, increase fluid leakage (mucus secreation)and smooth muscle thickening
leads to intermittent airflow abstruction
Hyperresponsiveness of airway

37
Q

CBC during asthma attack would show increase of what wbc

A

eosinophillia, serum igE sputum eosinophils

38
Q

Nonpharm strategies for asthma

A

smoking cessation
avoid NSAIDS
Remove sensitizer
encourage regular activity (advise to to use inhalier first)

39
Q

Treatment in special populations should asthma treatment be given to pregnancy

A

yes benefit out weigh risk

40
Q

Daily Controller Medications for step1

A 
None needed
SABA prn ( no more than 3-4 x day)
41
Q

Daily Controller Medications for step2

A

low dose ICS

also Theophyline or cromone or leukotriene mods

42
Q

Daily Controller Medications for step3

A

low to medium ICS and LABA

43
Q

Daily Controller Medications for step4

A

High ICS plus LABA plus one or more of the following:

  • SR theophylline
  • Leukotriene modifier
  • Long acting oral beta2-agonist (brethine)
  • Oral glucocorticosteroid
44
Q

—indicates what % of the total FVC was expelled from the lungs during the first second of forced exhalation

A

FEV1/FVC

45
Q

Measures if treatment is effective in improving airway diseases such as COPD.

A

Peak Expiratory Flow Rate (PEFR)

46
Q

A measure of how much air can be exhaled from the lungs. It is an indicator of large airway obstruction

A

Forced Expiratory Flow (FEF)

47
Q

This value represents the amount of air that can be forcibly exhaled from the lungs in the first 25% of the total forced vital capacity test.

A

FEF25

48
Q

This measurement represents the total amount of air expelled from the lungs during the first half (50%) of the forced vital capacity test.

A

FEF50

49
Q

This measurement is representative of the total amount of air exhaled from the lungs during the middle half of the forced vital capacity test. Many clinicians refer to this value because of it’s indicative of an obstructive lung disease.

A

FEF25%-75%

50
Q

Functional Vital Capacity—normal is

A

80% or greater

51
Q

Force expiratory volume in one second FEV1%– normal

A

80 or greatter

52
Q

the FEV1/FVC % ratio

A

greater than 0.7 or 70% is normal

- If 69% or less indicated of obstructive disease

53
Q

PEF (peak expiratory flow)—

A

assesses ventilator capacity– index of the activity of the disease process (more in Asthma`

54
Q

forced expiratory flow at 25–75% of FVC (FEF25–75%)

A

commonly cited as an indicator of small airways obstruction

55
Q

complete PFTs can be ordered to assess

A

obstructive dysfunction
lung volumes,
air trapping,
gas exchange abnormalities

56
Q

Asthma Exacerbation that come into ED what should the steps be to treat

A

Duonebs every 20min for 3 doses then every 3 to 4 min

  1. provide O2 6-8L/min
  2. Brethine subq for bronchspasm
  3. iv/oral steroid
  4. Heliox
  5. Intubation
  6. ECMO (status asthmaticus with no improvement and po2 decreas)
57
Q

Most allergen are encountered where

A

indoors

58
Q

Ominous asthmatic signs

A

fatigue
cyanosis with increased PCO2 (normal or elevated)
paradoxical chest/abdominal movement
signs of impending failure

59
Q

the volume of gas contained in the lung at the end of maximal inspiration

A

total lung capacity

60
Q

the amount of air left in the lungs after a maximal exhalation

A

residual volume

61
Q

measurement of the lungs ability to add oxygen to the blood and extract carbon monoxide from the lungs. The lower the value, the more likely you will become SOB during exertion

A

Diffusing capacity of lung for carbon monoxide

62
Q

With asthma Hospitalization is recommended when FEV1 is

A

FEV 1 is less than 30% or less than 40% after hour of vigorous therapy

63
Q

Person having asthma attack comes in, peak flow is less than 60 liter/minute what should be recommended?,. After hour of treatment what should be recommend next

A

Hospitalization is recommended for patient with ashtma that has a peak flow less than 60 liters/min or doesnt improve over 50% after hour of treatment

64
Q

initial labs of ABG showing respiratory alkalosis show

A

hypoxia on ABG

65
Q

Asthma signs and symptoms

A

Distressed at rest
RR increased

PULSUS PARADOXUS >12mmHg (BP drops during respiration)
Hyperresonance (2/2 air trapping)
cant speak sentences

cough
tight chest
tacycardia

66
Q

Patient having asthma attack has Pco2 of 48 you understand this means

A

this is an ominous sign indicates emergency situation

67
Q

Patient haveing asthma attack has PCO2 of normal ranges you understand this means

A

indicates patient is very sick.

68
Q

Chest xray for asthma would be done how often

A

No recommend unless ruling out other conditions.

69
Q

What would chest xray should if taken during asthma

A

hyperinflation

70
Q

Inpatient treatment of worsening asthma or status asthmaticus

A

1) SABA (1st line) (or Duoneb)
2) o2 humidified
3) fluids (IV D5 half NS)
4) Iv steroids (hydrocorticone 300mg)
5) Continuous monitoring Spo2
6) ABGs if spo2 less than 90
7) possibly intubate

71
Q

Status asthmaticus pco2 and po2

A

pco2 greater than 50

po2 less than 50

72
Q

ASTHMA treatment pneumonic

A 
A- albuterol
S- Steroid
T- Theophylline (rare)
H- humidified O2
M- magnesium ( severe)
A- anticholinergids
73
Q

Patient with asthma comes into clinic with exacerbations. after using inhaled bronchodilator we would expect to see general improvement of

A

FVC or FEV1 of 15%
or
FEF 25-75% of 25%

test 3 (8 decks)

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