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copd asthma Flashcards

(73 cards)

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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
Pharmo Treatment used for moderate to severe copd
ics/laba
26
Pharmo Treatment used for low rate exacerbation copd
laba/lama to increase bronchodilatin
27
what is alpha 1 antitrypsin augmentaion used for
people wiht alpha 1 genetic defect must have weekly treatemnt to preserve lung function
28
is oxygen a pharmacological treatment
no
29
Supplemental o2 indicated for pao2 of or sao2 of
pao2 <55 | sa02 <88
30
Supplemental o2 indicated for pao2 of or sao2 of
pao2 less than 55 | sa02 less than 88
31
Supplemental o2 indicated for pao2 of or sao2 of
pao2 less than 55 | sa02 less than 88
32
how many calories are needed for copd patients
3000 per day
33
What are the benefits of Lung volume reduction surgery
parts are resected to reduce hyperinflation respiratory muscles can be more effectiv and incre mech effication
34
What can Brethine be used for
Terbutaline bronchodilator used for bronchospams
35
Can asthma be transfered throght genetic
yes
36
What happens during asthma? (how is asthma discribed)
inflamations which casues edema, increase fluid leakage (mucus secreation)and smooth muscle thickening leads to intermittent airflow abstruction Hyperresponsiveness of airway
37
CBC during asthma attack would show increase of what wbc
eosinophillia, serum igE sputum eosinophils
38
Nonpharm strategies for asthma
smoking cessation avoid NSAIDS Remove sensitizer encourage regular activity (advise to to use inhalier first)
39
Treatment in special populations should asthma treatment be given to pregnancy
yes benefit out weigh risk
40
Daily Controller Medications for step1
``` None needed SABA prn ( no more than 3-4 x day) ```
41
Daily Controller Medications for step2
low dose ICS | also Theophyline or cromone or leukotriene mods
42
Daily Controller Medications for step3
low to medium ICS and LABA
43
Daily Controller Medications for step4
High ICS plus LABA plus one or more of the following: - SR theophylline - Leukotriene modifier - Long acting oral beta2-agonist (brethine) - Oral glucocorticosteroid
44
—indicates what % of the total FVC was expelled from the lungs during the first second of forced exhalation
FEV1/FVC
45
Measures if treatment is effective in improving airway diseases such as COPD.
Peak Expiratory Flow Rate (PEFR)
46
A measure of how much air can be exhaled from the lungs. It is an indicator of large airway obstruction
Forced Expiratory Flow (FEF)
47
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.
FEF25
48
This measurement represents the total amount of air expelled from the lungs during the first half (50%) of the forced vital capacity test.
FEF50
49
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.
FEF25%-75%
50
Functional Vital Capacity—normal is
80% or greater
51
Force expiratory volume in one second FEV1%-- normal
80 or greatter
52
the FEV1/FVC % ratio
greater than 0.7 or 70% is normal | - If 69% or less indicated of obstructive disease
53
PEF (peak expiratory flow)—
assesses ventilator capacity– index of the activity of the disease process (more in Asthma`
54
forced expiratory flow at 25–75% of FVC (FEF25–75%)
commonly cited as an indicator of small airways obstruction
55
complete PFTs can be ordered to assess
obstructive dysfunction lung volumes, air trapping, gas exchange abnormalities
56
Asthma Exacerbation that come into ED what should the steps be to treat
Duonebs every 20min for 3 doses then every 3 to 4 min 2. provide O2 6-8L/min 3. Brethine subq for bronchspasm 4. iv/oral steroid 5. Heliox 6. Intubation 7. ECMO (status asthmaticus with no improvement and po2 decreas)
57
Most allergen are encountered where
indoors
58
Ominous asthmatic signs
fatigue cyanosis with increased PCO2 (normal or elevated) paradoxical chest/abdominal movement signs of impending failure
59
the volume of gas contained in the lung at the end of maximal inspiration
total lung capacity
60
the amount of air left in the lungs after a maximal exhalation
residual volume
61
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
Diffusing capacity of lung for carbon monoxide
62
With asthma Hospitalization is recommended when FEV1 is
FEV 1 is less than 30% or less than 40% after hour of vigorous therapy
63
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
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
initial labs of ABG showing respiratory alkalosis show
hypoxia on ABG
65
Asthma signs and symptoms
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
Patient having asthma attack has Pco2 of 48 you understand this means
this is an ominous sign indicates emergency situation
67
Patient haveing asthma attack has PCO2 of normal ranges you understand this means
indicates patient is very sick.
68
Chest xray for asthma would be done how often
No recommend unless ruling out other conditions.
69
What would chest xray should if taken during asthma
hyperinflation
70
Inpatient treatment of worsening asthma or status asthmaticus
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
Status asthmaticus pco2 and po2
pco2 greater than 50 | po2 less than 50
72
ASTHMA treatment pneumonic
``` A- albuterol S- Steroid T- Theophylline (rare) H- humidified O2 M- magnesium ( severe) A- anticholinergids ```
73
Patient with asthma comes into clinic with exacerbations. after using inhaled bronchodilator we would expect to see general improvement of
FVC or FEV1 of 15% or FEF 25-75% of 25%

test 3 (8 decks)

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