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NUR720 FNP Review > Pulmonary/Resp Disorders > Flashcards

Pulmonary/Resp Disorders Flashcards

(61 cards)

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1
Q

pulmonary embolism

A

cough, frothy pink tinged sputum. “IMPENDING DOOM”

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2
Q

impending respiratory failure (asthma pt)

A

RR >25bpm, tachy, cyanosis, “quiet” lungs no wheezing.

Adrenaline injected STAT, call 911. 02 4-5L, albuterol.

after tx, good sign is breath sounds and wheezing.

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3
Q

normal findings of lungs

A

upper lobes: bronchial breath sounds (louder)

lower lobes: vesicular (soft and low)

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4
Q

normal egophonys

A

normal: “eee”
abnormal “bah”
normal “eee is louder over the large bronchi” vs lower lobe

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5
Q

tactile fremitus

A

normal: stronger vibrations on the upper lobes

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6
Q

whispered pectoriloquy

A

patient to whisper “99 or 1-2-3”

normal: voice lounder upper lobes, muffled lower lobes
abnormal: clear sounds lower, muffled upper

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7
Q

percussion

A

normal: resonance
tympany or hyperresonace: COPDY, emphsema
dull: pneumonia with consolidation, pleural effusion (liquid or tumor), solid organ (liver)

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8
Q

pulmomary fxn tests

A

obstructive dysfuncion - reduction in airflow
asthma, copd

restrictive- reduction of lung volume dt decreased lung compliance
ie; pulmonary fibrosis, pleural disease

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9
Q

COPD

A

includes both emphysema and chronic bronchitis

loss of elastic recoil of the lungs and alveolar damage

risk: smoking and age

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10
Q

chronic bronchitis

A

cough with excessive mucus 3 months or more

for a minimum of 2 or more consecutive years

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11
Q

emphysema

A

permanent alveolar damage
expiratory respiratory phase is longer

risk: smoking, age, occupation, alpha 1 trypsin deficiency
classic case: elderly male, smoker, c/o sob during exertion. frequent cough, yellow sputum, barrel chest, weight loss (emphysema).

objective: >AP diameter,

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12
Q

copd general tx

A

smoking cession
flu, penumococcal vaccine
pulmonary drainage

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13
Q

copd medications

A

1st line: anticholinergics Ipatropium (atrovent) or tiotropium (spiriva)

and/or

b2 agonist: salmetrol (serevent), formoteral, albuterol (combivent)

2nd line: prednisoe (medrol dose pack), fluticason, adviar

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14
Q

copd medications safety

A

albuterol (b2 agonist)- careful with htn, hyperthyroid

anticholingergics (atrovent, spiriva), avoid if narrow angle glaucoma, bhp, bladder neck obstruction dt vasoconstriction

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15
Q

long term use of corticosteroids >6mos= risk of pneumonia

when treating COPID, pick antibiotic doxy or fluoro (agains H. influenza gram -

A

true

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16
Q

CAP

A 
bacterial infection
s. pneumoniae
h.influenze
m. catarrhalis
cystic firbosis

classic case: elder with high fever, productive cough, rust colored sputum, pleuritic chest pain

objective: rhonchi, wheeze, crackles, dullness on percussion

INCREASE tactile fremitius and egophany

xray is gold standard for diagnosing CAP ( NOT sputum), repeat 6 wks after clearing

cxr lobar consolidation

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17
Q

tx of CAP

A

Macrolide or doxy (tetracycline)

with comorbidity (kidney, chf, liver) fluroquinolonie as ONE drug therapy (leva, gemi, maxi)

or

high dose amoxi (augmentin) plus macrolide

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18
Q

curb 65

A

confusion, urea in blood, rr>30bpm, blood pressure

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19
Q

prevention of pneumonia

A

flu for everyone >50 yo
pneumovax if >65 yo

healthy patients - one lifetime dose at 65 yo

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20
Q

prevent of pneumonia for high risk patients

A

pneumovax booster in 5-7 years

19 yo if asplenia

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21
Q

atypical pneumonia

A

children/young adults
“walking pneumonia” highly contagious

M. Penumoniae
C. Penumoniae
Legionella pneumoniae- found in moisture (water, air conditioners)

classic case; youg adult several weeks fatigue, coughing non productive, cold like s/s.

wheezing, pus in throat, diffuse interstitial infiltrates on X-ray.

medications: macrolide (same as 1st line CAP), anitussive prn (dextromethorphan, tessalon perles)

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22
Q

acute bronchitis

A

aka treacheobronchitis, usually viral and self limiting
tx: fluids, antitusstives (dextromethorphan, tessalon perles, f

guaifensin prn, albuterol, if severe medrol dose pack

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23
Q

pertussis

A

bacterial
whopping cough

last 2 weeks or longer, “hacking cough”, may vomit.

labs: nasopharyngeal swab (PCR), ELISA, cbc

tx: marcolides
TDAP booster

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24
Q

typical vs atypical pneumonia

A

typical: (CAP) older pt. high fever (>100.4), productive cough, rust colored sputum, chest pain
* S. pneumoniae, H. inlfluenzae, M. catarrhalis

atypical: children/young adults. fatigue, nonproductive cough, low grade fever (cold like s/s)
* *M. pneumonia, C. pneumoniae, Legionella penumonaie

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25
COPD 1st line
atrovent add salmeterol if poorly controlled
26
COPD plus smoker
most likely H. Influenza
27
if healthy adult has cough for >2-3 weeks and previously treated with antibiotic, assume pertussis. r/o pneumonia
true
28
what age tdap vs td
11 and up
29
best mucolytic
fluid
30
afrin dosage
bid up to THREE days only. >3 days=rebound rhinitis medicamentosa
31
common cold s/s and tx
s/s: acute fever, sore throat, sneezing, clear mucus (coryza. tx: fluids, rest, acetaminonphen, nsaids oral decongestants- sudafed/psudoephedrine topical nasal decong-afrin antitussives (robitussin/dextromethorphan) antihistamine (diphenhydramine/benadryl)
32
TB
lungs most common (85%) | latent TB: not infectious.
33
reactived TB on cxr
cavitations and adenopathy and graulomas on the hila of the lungs
34
prior BCG vaccine
if >5 yrs since last bcd, a positive TB is most likely a TB infection
35
first line rx TB
isoniazid | rifampin
36
miliary TB
affects multiple organs, more common
37
infectious TB or reactivated TB
90 % are reactived in US dt low immunity
38
tx plan for TB
report TB to local health department all TB test for HIV use 4 drugs, INH, rifampin, ehtambutal, and pyrazidamide tid (then narrow down drugs after C&S) classic case: adult c/o fever, night sweats, cough, weight loss (late sign), blood in cough ( late sign)
39
warning for ethambutal rx
can cause optic neuritis. avoid if pt has abnormal vision (blindness, etc)
40
medications INH for tb (hiv vs non hiv)
non hiv- INH 300 mg for 9 months HIV- for 12 mos chest baseline liver fxn and monitor
41
PPD test result
look for induration, NOT RED!. i.e.: bright red color but no induration = negative 5mm or less: HIV, immunocompromised, previous TB on chest X-ray, child with close TB contact 10mm or less: recent immigrant, child 15mm- no known risk factor for TB
42
tb skin test
mantoux. inject .1ml of 5th-ppid sub dermal.
43
tb blood test
quantiFERon-tb gold or t-spot (aka igra). blood test measure y-interferon. igra-results available in 24 hours. use if hx of previous bcg vaccine
44
TB
hiv recent contacts with infectious TB chest x ray with fibrotic changes ( previous tb) any child who had close contact or has tb symptoms (
45
TB
recent immigrants last 5 years (asia, africa, latin america, india, pacific islands) child
46
asthma
reversible airway obstruction caused by inflammation of the bronchial tree. goal: less than 2 days/week of rescue medication (albuterol) objective -wheezing with prolonged expirator phase, tacky
47
asthma medication | "rescue'
short acting b2 agonist albuterol (ventolin HFA) pirbuterol (Maxair) levalbuterol (xopenex) 2 inhalations q 4-6 hrs prn onset: 15-30 min, lasts 4-6 hours
48
long term asthma medication
take every day long acting b2 agonist (LABA), bid. LABA- increase death with asthma LABA not to be used as rescue drugs
49
LABA rx
salmeterol (serevent) bid formeterol (foradil) bid salmetrerol plus fluticasone (advair)
50
sustained release theophylline
acts as bronchodilator monitor: macdrolides, quinolones, anticonvsulants, chest blood level use of spacer or chamber.
51
1st line tx for asthmatic exacerbation
adrenaline injection
52
long term inhaled steroids recommendation
supplement calcium with bit D 1500mg for menopausal women ( high risk osteoporosis), bone density (males and females), eye exams (risk of cataracts/glaucoma)
53
asthma tx in a nutshell
1) every pt on b2agonist (albuterol) 2) inhaled corticosteroids (Triamcinolone/azmacort, Fluticasone/flovent bid. (oral thrush risk, rinse with h20) 3) add b2 long actin (salmeterol or combo, adviar) 4) add leukotriene inhibitors, theophilline, or mast cell
54
asthma exacerbation
PEF
55
PEF
measure effectiveness of tx. blow hard during expiration using spirometer (3 times). highest value is PR HAG (heigh, age, gender)
56
spirometer paramters
``` green - 80-100% (maintain or reduce medications) yellow (50-80%), increase therapy red zone ( ```
57
step 1 | >80% PEF, s/s
albuterol (ventolin) prn
58
step 2 >80% >2 days/ week symptoms
albuterol (ventolin) PLUS ICS (fluticasone/flovent) triamcinolone (azmacort) risk of oral thrush
59
step 3 | PEF 60-80, daily s/s
albuterol ICS LABA ICS (fluticasone/flovent) triamcinolone (azmacort) LABA- salmeterol (ADVAIR)
60
step 4
high dose ICS (fluticasone/flovent) triamcinolone (azmacort) LABA- salmeterol (ADVAIR) oral corticosteroid ( prednisone) daily
61
exercise asthma
use 2 puffs of saba (albuterol/ventolin, levalbuterol/xopenex, pirbuterol/maxair) 10-15 min before exercise. last 4 hours

NUR720 FNP Review (24 decks)

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