Respiratory Midterm II

Question 1

Common goals for common cold (rhinovirus)

Answer 1

• Relief of symptoms
• Reduction of the risk for complications
• Prevention of spread to others

Question 2

HRV mechanisms Transmission?

Answer 2

• Airborne transmission by small particles (droplets)
• Airborne transmission by large particles
• Direct contact

Question 3

Decongestant SE’s (pseudoephedrine, Oxymetolazine HCL, Phenylephrine HCL)

Answer 3

Palpitations, headaches, increased blood pressure,

dizziness, GI upset, tremor, insomnia

Question 4

Expectorant SE’s (Guaifenesin)

Answer 4

Drowsiness, headache, dizziness, GI upset

Question 5

Antitussives

Answer 5

Dextromethorphan, Tessalon Perles

Question 6

Risk Factors for Acute Rhinosinusitis?

Answer 6

• Winter season; air pollution 
• Septal deviation; nasal polyps 
• Allergic rhinitis 
• Tobacco smoke 
• Cystic fibrosis 
• Gastroesophageal reflux 
• Asthma
-Prior upper respiratory tract infection 
• Dental infections 
• Immunodeficiency 
• Intranasal medications or illicit drugs 
• Mechanical ventilation 
• Nasogastric tubes

Question 7

NonPharm treatment for URI

Answer 7

• Adequate rest and hydration
• Elevating the head of the bed while sleeping
• Use of a humidifier
• Avoidance of environmental factors such as allergens, cigarette smoke, and pollution

Question 8

What are some diagnostic observations of asthma?

Answer 8

• The presence of symptoms consistent with asthma – Wheeze, shortness of breath, cough, and chest
tightness
• The presence of variable airflow limitation
– Measured by spirometry – Airflow obstruction reversibilit

Question 9

All persons with asthma, regardless of the severity of asthma, require what kind of medication?

Answer 9

Short-acting beta2-adrenergic agonist bronchodilator for quick relief of acute symptoms.

Question 10

Drugs used to treat asthma?

Answer 10

• Beta2-adrenergic agonists
• Corticosteroids
• Leukotriene modifiers
• Mast cell stabilizers
• Methylxanthines
• Monoclonal antibodies

Question 11

1st line of asthma therapy?

Answer 11

• A short-acting rescue bronchodilator to be used as needed is required for all persons with asthma.

Question 12

Persons with mild persistent asthma (Step 2) use?

Answer 12

Low-dose ICS

Question 13

Persons with moderate persistent asthma (Steps 3 and 4) use?

Answer 13

Medium-dose ICS

Question 14

Persons with severe persistent asthma (Steps 5 and 6) use?.

Answer 14

High-dose ICS

Question 15

Persons with Step 2 mild persistent asthma could use this as an alternative?

Answer 15

Cromolyn, a leukotriene modifier, or theophylline

Question 16

Persons with Step 3 moderate persistent asthma would use this method as an alternative?

Answer 16

A combination of low-dose inhaled corticosteroid plus a leukotriene modifier or theophylline

Question 17

Persons with Step 4 moderate persistent asthma would use this alternative?

Answer 17

A combination of medium-dose inhaled corticosteroid plus a leukotriene modifier or theophylline

Question 18

What is considered a mild asthma exacerbation?

Answer 18

Dyspnea with activity and an initial peak expiratory flow 70% or better than predicted or personal best; may be managed at home.

Question 19

What is considered a moderate asthma exacerbation?

Answer 19

Dyspnea that interferes with or limits usual activity and an initial peak expiratory flow 40% to 69% of predicted or personal best.

Question 20

What is considered a severe asthma exacerbation?

Answer 20

Dyspnea at rest that interferes with conversation and a peak expiratory flow less than 25% of predicted or personal best.

Question 21

COPD Diagnostics?

Answer 21

• Chronic cough with our without chronic sputum production.
• Persistent progressive dyspnea that worsens with exercise.
• May or may not complain of chest tightness.
• May or may not have audible wheezing, cyanosis, barrel-shaped chest, low diaphragms, and signs of cor pulmonale.
• Spirometry is required for diagnosis of COPD.

Question 22

Drugs Used for COPD?

Answer 22

Short acting Beta Agonists, Short Acting Anticholinergics, Long-acting Beta Agonists and Long acting Anticholinergics

Question 23

Other treatments used for COPD include?

Answer 23

• Immunizations
• Oxygen
• Antibiotics

Question 24

Management steps for acute COPD exacerbation?

Answer 24

• Increasing the dose and/or frequency of the short-acting bronchodilator (SABA or SAMA)
• Adding a 5-day course of oral corticosteroids if the FEV1 is less than 50% of predicted
• Adding a 5- to 10-day course of antibiotics if all three cardinal symptoms COPD exacerbation symptoms are present, the person has purulent sputum plus one other cardinal symptoms, or the person required endotracheal intubation and mechanical ventilation
• Supplemental oxygen to maintain the PaO2 55 mm Hg

Question 25

Patient education for COPD

Answer 25

* Drug information * Patient-oriented information sources * Nutrition/lifestyle changes * Complementary and alternative medications * Respiratory devices

Question 26

Indications for antibiotics in bronchitis?

Answer 26

* Concomitant (COPD) * High fevers * Purulent sputum * Respiratory symptoms for more than 4 to 6 days * Patients over 65 years of age * Those with chronic diseases

Question 27

Causes for Chronic Bronchitis?

Answer 27

* Most common cause is tobacco smoke. * Colonization of the lower airways with bacteria such as H. influenzae, M. catarrhalis, and S. pneumoniae may occur. * There is presence of gastroesophageal reflux and hypersecretion of mucus in patients with asthma. * Viral infections account for nearly one third of acute exacerbations. * Exposures to environmental pollution or unknown factors contribute to the remainder of acute exacerbations.

Question 28

What are the cardinal symptoms of an exacerbation of COPD?

Answer 28

* Increase in dyspnea (shortness of breath) * Increase in sputum volume * Increase in or presence of sputum purulence

Question 29

What are the indications for hospitalization due to pneumonia?

Answer 29

* Severe vital sign abnormality: pulse >140/min; systolic blood pressure <90 mm Hg; respiratory rate >30/min * Altered mental status (newly diagnosed): disorientation to person, place, or time; stupor or coma * Arterial hypoxemia: PO2 <60 mm Hg on room air * Suppurative pneumonia-related infection: empyema, septic arthritis, meningitis, endocarditis * Inability to tolerate oral medications * Severe electrolyte, hematologic, metabolic laboratory value not known to be chronic * Lack of adequate outpatient support services for follow-up treatment

Question 30

What are indications needed for diagnosis of community acquired pneumonia?

Answer 30

– Symptoms of acute infection and acute infiltrates detected by chest x-ray, OR – Auscultatory findings consistent with pneumonia on physical examination

Question 31

The primary goals for eradicating CAP?

Answer 31

* Eradicating the offending microorganism through the selection of appropriate antibiotic therapy * Complete clinical cure * Preventing complications from pneumonia (e.g., respiratory failure, sepsis, empyema) * Minimizing adverse effects of medications