Lung Flashcards by Jeff Lattman

Asthma is confirmed by airflow limitation with a reduction of FEV1/FVC below what value for adults and for children?

0.8 for adults
0.9 for children

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where does air get trapped during an asthmatic attack?

in alveoli

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what would you find upon inspecting a patient with asthma?

-hyperexpansion of thorax
-use of accessory muscles
-hunched shoulders
-nasal secretions, mucosal swelling and/or nasal polys
-atopic dermatitis/Eczema

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what would you find upon palpating a patient with asthma?

usually nothing abnormal

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what would you find upon using percussion on a patient with asthma?

usually nothing abnormal

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what would you find upon using auscultation on a patient with asthma?

-wheezing
-prolonged phase of forced expiration

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what assessment tool do we use for asthma?
what is the one exclusion criteria when using this assessment?

GINA
excludes reliever taken before exercise

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what is the dosing for an albuterol nebulizer?

2.5 mg 3-4 times as needed

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what is the dosing for a levalbuterol inhaler?
how about nebulizer?
when would we use it over albuterol?

2 puffs q4-6h prn
0.63 mg tid q6-8h
pts with a history of tachycardia to albuterol

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according to GINA guidelines, what is the preferred inhaler to use as pts reliever inhaler?

low dose budesonide/formoterol in place of albuterol

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For severe asthma, what is the recommended treatment plan according to GINA guidelines?

add-on LAMA and consider high-dose ICS-formoterol

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all asthma patients should have an action plan which includes:

-pts usual asthma meds
-when/how to incr meds or start oral corticosteroids
-when/how to access medical care if symptoms fail to respond

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what are symptoms of a pt experiencing a mild-moderate asthma exacerbation?

how would you treat the pt?

if treatment doesn’t work what should you do?

-resp rate increased
-not using accessory muscles
-pulse 100-120 bpm
-talks in phrases
-O2 sat 90-95%

SABA: 4-10 puffs with MDI + spacer q20 minutes
Prednisolone: adults 1 mg/kg up to 50 mg (or prednisone 40 mg)
children 1-2 mg/kg up to 40mg
*continue treatment with SABA and reassess within 1 hour

transfer to hospital: give inhaled SABA, ipatropium, O2, and systemic corticosteroid

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what are symptoms of a pt experiencing a severe or life-threatening asthma exacerbation?

how would you treat pt?

-resp rate over 30/min
-talks in words, hunched forward
-accessory muscles in use
-pulse 120bpm or more
-O2 sat less than 90%

transfer to hospital: give inhaled SABA, ipatropium, O2, and systemic corticosteroid

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after an asthma exacerbation, what treatment plan should be arranged for discharge?

-reliver continue prn
-controller: start, restart, or step up
-check inhaler technique and adherence
-corticosteroids continue for 5-7 days (adults) or 3-5 days (children)

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what are the two types of COPD and describe them

chronic bronchitis “blue bloater”: inflammation of the bronchioles
emphysema “pink puffer”: destruction of alveoli

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how do we diagnose COPD based on the patients FEV1/FVC?

if it is below 0.7 after using a bronchdilator

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Physical Exam Findings for COPD:
Inspection?
Palpation?
Percussion?
Auscultation?
*Signs may not be present until disease has progressed, so a lack of physical signs does not exclude COPD diagnosis

I: cyanosis, barrel chest, use of accessory muscles
Palp: usually normal
Perc: hyperresonance
Aus: possible wheezing, crackles, prolonged expiration

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what is the assessment tool used for COPD

mMRC Dyspnea scale (grades 0-4:)

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if a patient with COPD states they only get breathless with strenuous exercise, what mMRC grade would you mark them under?

grade 0

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if a pt with COPD says they get short of breath when walking up a slight hill, what mMRC grade would you mark them under?

Grade 1

if a pt with COPD says they walk slower than normal due to breathlessness or have to stop for breath, what mMRC grade would you mark them under?

Grade 2

if a pt with COPD says they have to stop for breath after walking about 100 meters or after a few minutes, what mMRC grade would you mark them under?

Grade 3

if a pt with COPD says they are too breathless to leave the house or when dressing/undressing, what mMRC grade would you mark them under?

Grade 4

if pt has had 2 or more exacerbations or 1 or more leading to hospitalization, what category are they considered using the GOLD assessment? what meds are in this category?

E LABA + LAMA *consider adding ICS if blood eosinophil count is over 300

if pt has had 0-1 moderate exacerbations not leading to hospitalization, what category are they considered using the GOLD assessment? what if their mMRC is 0-1/ CAT <10? what meds are in this category? what if their mMRC is 2 or more/ CAT 10 or more? what meds are in this category?

A or B A: a bronchodilator B: LABA + LAMA

what drug is used in COPD to treat exacerbations if the pt is a former smoker?

azithromycin

what would be considered a mild COPD exacerbation in regards to: RR, HR, resting SaO2

RR: less than 24 HR: less than 95 O2: over 92

what would be considered a moderate COPD exacerbation in regards to: RR, HR, resting SaO2 if obtained, ABG may show?

RR: more than 24 HR: more than 95 O2: under 92 ABG may show hypoxemia and/or hypercapnia (PaCO2 over 45 with no acidosis)

what would be considered a severe COPD exacerbation?

same as moderate except ABG shows hypercapnia and acidosis (PaCO2 over 45 and pH less than 7.35

what are the nonpharm treatments for COPD?

-smoking cessation -physical activity -pulomonary rehabilitation -oxygen therapy -vaccines -lung cancer screenings -nutrition support

what are common viruses that cause community-acquired pneumonia?

influenza, adenovirus, respiratory syncytial virus, and parainfluenza

what are typical bacterias that cause community-acquired pneumonia?

H. influenza, M catarrhalis, and staph

when do we hospitalize patients with community-acquired pneumonia?

we hospitalize based on the CURB-65 assessment

what is the CURB-65 assessment and how do we interpret the results?

Confusion: increased Urea: over 7 RR: 30 or more breaths/min BP: systolic < 90 or diastolic < 60 Age: 65 or older each factor that attributes to the pt is worth 1 point. if they score at least 2 they should be hospitalized

what antibiotic treatments are used in otherwise healthy pts?

Amox 1g tid (preferred) doxy 100mg bid azithro 500mg od1 then 250mg days 2-5. clarithromycin 500mg bid

what antibiotic treatments are used in pts with comorbidities/risk factors for antibiotic resistant pathogens for penumonia? (list the comorbidities)

comorbidities: chronic heart, lung, or renal disease, alcoholism, asplenia, diabetes, or malignancy Amox/clav, cefpodox, or cefurox with macrolide or doxy

what are symptoms of pulmonary edema caused by heart failure?

orthopnea (trouble breathing while laying down), wheezing, rapid weight gain, swelling of lower extremities

what signs of heart failure might you see upon a physical examination in regards to: inspection? palpation? percussion? auscultation?

I: cyanosis Palp: normal perc: possible dullness auc: crackles

what assessment of symptoms tool is used for heart failure?

NYHA class I-IV

exacerbations of HF are usually treated with?

loop diuretics, potassium supp (if needed), and sodium/fluid restriction

Tuberculosis is a multi-system disease caused by?

Mycobacterium tuberculosis

which drug class is a TB risk factor?

TNF-alpha antagonists

what are the treatment options for TB?

isoniazid 6-9 months qd or rifampin 4 months qd

pertussis is caused by?

bordatella pertussis

what are the 3 stages of pertussis?

catarrhal stage (mild cough) paroxysmal stage (2-6 weeks, worsening cough, cyanosis, vomiting) convalescent stage (cough lessens)

how is pertussis diagnosed?

culture tests

what is bronchitis?

an inflammatory condition caused by bacteria, viruses, allergens, smoke, or irritants

what are symptoms of bronchitis?

fever, N/V/D not common conjunctivitis (pink eye), adenopathy (Large or swollen lymph glands), and runny nose

for chest percussion, interpret the following: Hyperresonance Resonance Dullness

increased thoracic gas, suggests hyperexpansion caused by: asthma, emphysema, or pneumothorax vibration of the lung parenchyma. Normal percussion note fluid or soft tissue within pleura or lung parenchyma caused by: pneumonia, pulmonary edema, or lung cancer