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PC617-Pulmonary Disorders Flashcards

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1
Q

Tuberculosis

A

Mycobacterium tuberculosis

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2
Q

Primary TB

A

LTBI

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3
Q

Secondary TB

A

Usually pulmonary

apex of the lung (high oxygen area)

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4
Q

TB clinical manifestations

A 
fatigue
anorexia
weight loss
night sweats
low grade diurnal fever
cough
chest pain
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5
Q

TB exam

A

Rales in upper posterior area
maybe evidence of plueral effusion
lymphadenopathy

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6
Q

TB testing

A

Mantoux test- read in 48-72 hours
two step testing -healthcare workers who have not been tested in over 12 months over 45 yrs of age
Anergy-Immune system compromised
QFT-G-blood test. comes back in 24 hours (expensive)
Chest x-ray- if positive, to exclude pulmonary disease; if neg, then prophylaxis with INH

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7
Q

TB Tx with INH

A 
Induration >5mm  Consider positive with
-HIV clients
Close contacts of positive case
person with fibrolytic lesions
-organ transplant recipients
-Other immunocompromised clients
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8
Q

TB DX

A

Induration >10mm
-recent immigrant
-residents in high risk community (jail, nursing home, etc)
-low income population, medically underserved
-children younger than 4
infants, children, adolescents exposed to adult with TB

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9
Q

TB DX-

A

Induration >15

person with no risk factors

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10
Q

TB Tx

A

Treat even if they had BCG vaccine
Side effects of INH-
Liver disease, Hepatitis

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11
Q

TB Tx

A

Add B6 to decrease risk of person getting peripheral neuropathy in those with diabetes, uremia, alcoholic, pregnant, seizure disorder
If positive x-ray- refer and report to HD

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12
Q

INH

A

Take for 9 mos. 5mg/kg or up to 300mg daily

Do not do Mantoux test if +Hx of TB

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13
Q

Influenza

A 
Acute infection of the respiratory tract
-Spread by droplet
-highly contagious
-Fever, chills, nasal congestion,with clear drainage, sore throat,-cough is most prominent
Fever peaks in about 24 hrs`
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14
Q

Influenza tests

A

Rapid test or expensive cell cultures. Takes 2-7 days

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15
Q

Influenza Treatment

A

rest, fluids, antipyretic

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16
Q

Antiviral meds

A

Oseltamivir and Zanamivir-Reduce only by a day
Must start within 48 hours
May use prophylactically in high risk persons
Influenza vaccine is best prevention

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17
Q

Asthma

A

Chronic inflammatory disorder

Triggered by allergens, infections, exercise, ASA, etc.

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18
Q

Asthma S/S

A

episodic wheezing with dyspnea
wheezing
breathlessness, anxiety, sptum production
Most COMMON-cough

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19
Q

Exercise Induced Asthma-least brought on by swimming and could be caused by change in movement of air

A

Can treat with SABA or in children Cromolyn as 2nd choice if happens often.

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20
Q

Asthma

A

Acute severe asthma can be brought on by self-mediating with SABA

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21
Q

Chronic Stable Asthma

A

controlled with meds

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22
Q

Look at the step system and tx

Study These Flashcards
A

On Asthma flashcards

23
Q

Spirometry

Study These Flashcards
A

get personal best.
Mild asthma will have decreased PEFR, FEV1, MMEFR
Bronchospasm=decreased FEV1, MMEFR and FEV1/FVC ratio

24
Q

To diagnose Asthma

Study These Flashcards
A

decreased obstruction after inhalation of bronchodilator

25
EIA
Tx with SABA and spacer, check for heart disease Cromolyn for long term use if needed Very safe
26
Mild Asthma
Add ICS and remind to rinse mouth and spit after use. Could get thrush. Remind client it will not work for 2-3 weeks
27
ACUTE Bronchitis
Transcient inflammation fo the trachea and major bronchi | Begins with URI, cough that causes burning pain in chest and when symptoms subside, client still has cough
28
Acute Bronchitis
Coarse rales, wheezes and rhonchi Dx: s/s. No testing Cough, normal VS
29
Acute Bronchitis
Could be caused by viral illness, socioeconomic deprivatoin, anxiety, depressoin, stress
30
Acute Bronchitis
Refer if not responding to treatment in 2 weeks. Education-side effects of medication. Cough may persist for 10-14 days Tx;: rest, fluids, inhaler, Dextramethorphan
31
Pneumonia-Bacterial
most common organism-CAP=streptococcus pneumoniae | leading cause of death from infectious disease
32
Pneumonia
Tactile fremitis, fine rales, Temp over 102, RR high, If over 60 may need to be hospitalized
33
Pneumonia
increased tactile fremitis egophany consolidation
34
Pneumonia-Bacteria | Consider hospitalization if HR>30, multilobar infiltrates, BUN>20, WBC,4000, confusion/disorientation
If treating as outpatient -Need to do cultures Treat with Macrolides or Doxycycline as 1st line If co-morbidities or high risk resistance- treat with -Moxifloxacin, gemifloxacin, levofloxacin If not these, Macrolide +augmentin
35
Gram Negative Pneumonia
Haemophilus influenza - older adults - w/ COPD - chest pain - x-ray with consolidation
36
Atypical Pneumonia-Mycoplasma Pneumonia
Fine rales, interstitial changes in lungs, but no consolidation, blister on TM, WBC normal or slightly elevated. Younger people who live in dorms, etc.
37
Pneumonia education
rest, increased fluids, antipyretic, take all medications, avoid cough suppresent, follow up in 24 hours or have come back in 24-48 hours
38
Smoking
Most preventable disease 1 in 5 deaths related to smoking only 7% succeed in quitting
39
Six stages of change
What are they
40
Precontemplation- Not even considering
FNP should listen to their perception and raise doubts
41
Contemplation-Shows awareness
FNP should evoke reasons to change
42
Dtermination-"I've got to do something"
Determine the steps with client
43
Action-Patient stops
Help with the steps
44
Maintenance-Sustains change
Prevent relapse
45
Relapse-slips occure 3-4 times before actual success
Avoid discouragement
46
Ask the 4 A's
Ask-about smoking at every visit Advise-about benefits assist-help with barriers Arrange-a follow up visit
47
Concerns for stopping smoking
Women-weight gain Men-Tell them it effects breathing and affects athletic image Adolescents-Point out appearance effects Adults-Health concers
48
Pregnant women
Causes low bithweight babies, asthma for small children in a smokers home, otitis media in infants/toddlers
49
Pharmo interventions for smoking
Many
50
Nocotine replacements
gum, patch, inhaler, nasal spray | these add nocotine to the body, so warn client to not smoke
51
Bupropion -Wellbutrin; Zyban)
Not with seizure disporder, reduce if liver problems, effects dopamine. Take 1-2 weeks before you stop smoking, not with eating disorders
52
Varenicline (chantix)
Increases risk for heart attacks, binds nicotine receptors in the pleasure area. Can cause neuro-psychiatric problems, thoughts of suicide
53
Cold Turkey
has the most success
54
Nic-Vax
facilitates nicotine antibody development that prevents nicotine from getting to the brain

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