Obstructive Pulmonary

Question 1

What is bronchiecstasis?

Answer 1

Dilated bronchioles
House bacteria, mucus and infection
Cystic Fibrosis is cause in kids
Bacterial infection cause in adults

Question 2

Hallmark of bronchiecstasis?

Answer 2

Cough with tenacious, thick, purulent sputum

Question 3

What are main organs affected by cystic fibrosis?

Answer 3

Lungs
Pancreas
GI tract
Liver

Question 4

How is GI affected by CF?

Answer 4

Pancreas clogs so:
Malabsorption
Osteoporosis/penia
Failure to thrive
Slow digestion»Obstruction
Diabetes

Question 5

Meconium ileus at birth may be indicator of…

Answer 5

Cystic fibrosis
Slow gastic emptying

Question 6

S/sx of CF in childhood

Answer 6

Failure to thrive
Malnourished
Steatorrhea
Acute/persisient respiratory symptoms
Delayed puberty
Reproductive issues

Question 7

How is CF diagnosed?

Answer 7

Sweat test

Question 8

What is connection between asthma and GERD?

Answer 8

GERD can worsen asthma symptoms.
Asthma meds can cause GERD.

Question 9

What is the asthma triad?

Answer 9

Nasal polyps
Asthma
Sensitivity to aspirin/NSAIDS

Question 10

What should we teach patients who are on ACE inhibitors?

Answer 10

Can cause a dry hacking cough and exacerbate asthma symptoms

Question 11

What is timing of early phase/late phase response of asthma?

Answer 11

Early:Minutes, usually resolves in 1-2 hours
Late: Can last for 24 hours

Question 12

What is pathos of asthma?

Answer 12

1. Trigger
2. Immune response/Mast cell dump
3. Vasodilation with increased cap permeability
4. Edema, congestion, mucus, thickening of walls
5. Hyper response of bronchi

Question 13

What is the ONLY adventitious lung sound we hear in asthma?

Answer 13

Wheezes

Question 14

What is cough variant asthma?

Answer 14

Asthma that only presents as a cough

Question 15

What is R-I-S kit?

Answer 15

Drug sedation kit to prep patient for ET tube

Question 16

What is “peak expiratory flow rate” PEFR?

Answer 16

Test of lung function with a peak flow meter.
This is done by having patient exhale as hard and fast as possible and will be measured.

Question 17

What is FEV1?

Answer 17

Force expired volume in 1 second.
It is used as a measurement of asthma severity.
>80% is good
<60% is severe
<25% is an emergency

Question 18

What is meant by the word atopy?

Answer 18

Genetic predisposition to developing asthma

Question 19

How is drug therapy to control asthma usually approached?

Answer 19

Stair steps.
They will always have a SABA (a rescue inhaler).
They will also use an ICS (an inhaled corticosteroid) daily.
Then meds will be added until they reach controlled level.

Question 20

What is considered the MOST EFFECTIVE meds for asthma control?

Answer 20

ICS’s for
Short term and long term control

Question 21

What are side effects of ICS’s? How do we combat that?

Answer 21

Oral candida, hoarseness, dry cough

Candida: Use spacer or have patient gargle after use

Question 22

What are the two main classes of bronchodilators?

Answer 22

Beta 2 Adrenergic agonists
Anticholinergics

Question 23

Side effects of bronchodilators.

Answer 23

Tremors
Tachycardia
Anxiety
Nausea
Palpitations

Question 24

How much is too much SABA use to control asthma attacks?

Answer 24

> 2 x weekly
If SABA use is over this, need another controller med added to program.

Question 25

What is difference in way you inhale while taking a dry powder inhaler (DPI) and a metered dose inhaler (MDI)? What is the difference in prepping the device?

Answer 25

You inhale quickly with DPI You inhale slowly with MDI You usually shake MDI and you don't shake DPI

Question 26

How long should you hold your breath after dosing with inhaler?

Answer 26

10 seconds

Question 27

How should you instruct patients to breathe while doing nebulizer treatment?

Answer 27

Breathe slowly and deeply through mouth and hold each inspiration for 2-3 seconds

Question 28

What should we instruct patient to do after doing nebulizer or inhaler?

Answer 28

Cough to clear secretions

Question 29

How often should nebulizers be washed?

Answer 29

Daily with soap and water and then soaked in 1:1 water/vinegar solution for 20 min. Rinse and dry.

Question 30

Should MDI be shaken before use?

Answer 30

Yes (unless directions say otherwise)

Question 31

What are the two meds in a Dual-Neb?

Answer 31

Albuterol (beta 2 agonist) Ipratropium (anticholinergic)

Question 32

What is dose of SABA to control asthma attack?

Answer 32

2--4 puffs q 20 min for 3 times

Question 33

How long does it take for an ICS to start working?

Answer 33

2---4 weeks

Question 34

What classes of meds are only used in asthma? (not in COPD)

Answer 34

ICS's Leukotriene inhibitors Monoclonal antibodies

Question 35

Suffix for all LABAs?

Answer 35

--terol

Question 36

Suffix for all ICS's?

Answer 36

--sone --sonide

Question 37

Suffix for all leukotriene inhibitors?

Answer 37

---lukast

Question 38

What is the 1st thing we do in asthma attack?

Answer 38

Auscultate

Question 39

What is AATD?

Answer 39

A genetic disorder that makes a person develop COPD at young age. Think about this when a patient 30--45 yo, non smoker presents with COPD

Question 40

Polycythemia is sign of ___

Answer 40

COPD

Question 41

What is advantage of Venturi mask?

Answer 41

Precision

Question 42

What does BNP tell you?

Answer 42

How well your heart is managing fluid balance

Question 43

How is huff breathing done?

Answer 43

Position: Sitting, Relaxed, feet on floor Inhale slowly through mouth Hold breath 2-3 seconds Exhale strong and quick as if trying to fog up mirror Repeat 1-2 times without coughing Cough when mucus is felt

Question 44

How is pursed lip breathing done?

Answer 44

Inhale slowly and deeply through nose. Exhale through pursed lips with puffed cheeks. Make exhalation 3x longer than inhalation. 8-10 reps 3x daily