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FNP~Lower Resp D/O

Dx and Management

QuestionAnswer
Acute Bronchitis is... inflammation of the bronchi (upper airway)with persistent cough and sputum production
s/sx's of acute bronchitis... ~productive cough ~ H/A ~chest pain ~wheeze ~fever (higher in bacterial)
Acute Bronchitis PE may show... ~no lung consolidation (no crackles, can be clear with ausc) ~resonant ~clears with cough (yucky sounding)
Acute Bronchitis (viral) would present with what type of temperature? afebrile or low grade
Acute Bronchitis (bacterial) would present with what type of temperature? more pronounced that viral
PNA & Flu causes the highest death rate in what age group? elderly
What kind of antibx are usually recommended to treat "bacterial" Acute Bronchitis? ~Macrolides "mycin": Azithro, Clarithro ~Doxy or TCN ~Septra/Bactrim
T/F: Bronchodilators are often used in the management of Acute Bronchitis True
Asthma is defined as... an inflammatory dz of lungs characterized by reversible airway obstruction
Initial management of Asthma would be... Short acting B2 adrenergic agonist (Albuterol) Sx relief or before exercise
What is used for asthma daily maintenance... inhaled corticosteroids (Pulmicort, Azmacort, Q~Var)
An example of a long acting B2 adrenergic agonist is... Serevent; other options theophylline
Antileukotrienes are useful in the maintenance of what type of asthma? Singulair (po)
COPD is a term collectively used for... chronic bronchitis and emphysema
Chronic bronchitis is characterized by a cough for ___ months or more in at least ___ consecutive years 3 months; 2 years
Emphysema is defined as... abnormal, permanent enlargement of air spaces distal to the terminal bronchiole
Intermittent mild to mod dyspnea...Chronic Bronchitis/Emphysema? Chronic Bronchitis
Onset of sx's after age 50...Chronic Bronchitis/Emphysema Emphysema
Mild sputum (clear)...Chronic Bronchitis/Emphysema Emphysema
Onset of sx's after age 35...Chronic Bronchitis/Emphysema Chronic Bronchitis
Progressive, constant dyspnea...Chronic Bronchitis/Emphysema Chronic Bronchitis
Copious sputum (purulent)...Chronic Bronchitis/Emphysema Chronic Bronchitis
Body habitus (thin, wasted)~"pink puffer"...Chronic Bronchitis/Emphysema Emphysema
Chest A:P diameter...Chronic Bronchitis/Emphesema Emphesema
Body habitus (stocky, obese)~blue bloater...Chronic Bronchitis/Emphysema Chronic Bronchitis
Chest A:P diameter norma...Chronic Bronchitis/Emphysema Chronic Bronchitis
Bulla, blebs, hyperinflation on CXR...Chronic Bronchitis/Emphysema Emphysema
Hematocrit increased...Chronic Bronchitis/Emphysema Chronic Emphysema
Percussion hyperresonant...Chronic Bronchitis/Emphysema Emphysema
Hematocrit normal...Chronic Bronchitis/Emphysema Emphysema
Percussion normal...Chronic Bronchitis/Emphysema Chronic Bronchitis
Total lung capacity increased...Chronic Bronchitis/Emphysema Emphysema
Mainstay treatment of COPD... Atrovent or Spiriva
Asthma stepwise approach... ~Short acting: Albuterol >>Daily maintenance "corticosteroids": ~"cort"...Pulmicort, Azmacort >>long acting.. Servent >>anticholinergics (if thick secretions)...Atrovent >>chronic asthma..."antileukotrines": Singulair (po)
Pneumonia is defined as... inflammation of the lower resp tract
Most common etiologic agent for community acquired pneumoniae (CAP) in adults is... Strep. pneumoniae
T/F: in pneumonia, lungs usually clear after cough False...clears with bronchitis
Lung exam in pneumonia... ~(+) lung consolidation ~crackles ~lungs DO NOT clear after cough ~egophony ~dull to percussion
CXR will show______ in pneumonia infiltrates
Macrolides are used for what type of CAP patient <60 with no comorbidities and no recent abx (within 3 mos)
Examples of macrolides... ~azithromycin (Zithromax) ~clarithromycin (Biaxin) ~erythromycin, or doxy
Patients > or equal to 60yo and/or with other health problems would require what kind of tx for CAP? ~Beta lactam(-ceph's or -cillans)+ macro or doxy) or a Fluoroquinolone (resp quinolones) such as *levofloxacin (Levaquin), moxifloxacin (Avelox)
At what age would hospitalizaton and IV treatment be done for a pt with CAP? > or equal to 65 (elderly)
T/F: lung cancer is the leading cause of deaths in men and women True
Most common ages in lung cancer? 50-70
Common presentation of cough in lung cancer smokers cough, dry and hacking
T/F: lung cancer shows areas of dullness with percusion True
Is obstructive dz characterized by reduced airflow rates or reduced volumes? reduced airflow; lung volume is within normal range
T/F: reduced volume is usually present in restictive dz True
Obstructive diseases are... asthma, COPD (emphysema, bronchitis)
Restrictive dz's are... PNA, CF, pulmoary fibrosis, sarcoidosis, lungectomy
FVC measures... volume of gas forcefully expelled from the lungs after manimal inspiration
FEV1 measures... volume of gas expelled in the first second of the FVC maneuver
Appearance of pleural effusion "transudates" clear
Appearance of pleural effusion "exudates" ream colored, due to higher protein content
Appearance of pleural effusion "empyema" pus
Appearance of pleural effusion "hemorrhagic pleural effusion" blood
Postinfectious cough is considered when... cough has been present for 3-8 weeks following sx's of an acute reps infeciton
Tx of post infectious cough... Atrovent
Tx of post infectious cough that interferes with quality of life... inhaled corticosteroids, which may take a week before providing relief
Tx for sever paroxysms of post infectious cough... 30-40mg of Prednisone per day for a short period of time
Mast cell stabilizer... Cromolyn
Preferred tx of intermittent asthma... SABA prn
Preferred tx of mild persistent asthma... Low-dose inhaled corticosteroid (ICS)
Preferred tx of moderate persistent asthma... Medium dose-ICS or Low-dose ICS + SABA and either LTRA, theophylline
Preferred tx of severe persistent asthma (Step 4) Medium dose-ICS + LABA
Preferred tx of severe persistent asthma (Step 5) High-dose ICS + LABA
Preferred tx of sever persistent asthma (Step 6) High-dose ICS + LABA + oral corticosteroid
COPD Gram (+) resp bacteria... S. pneumoniae
COPD Gram (-) resp bacteria... H. influenzae, M. catarrhalis
COPD Atypical pathogens resp bacteria... M. pneumoniae, C. pneumoniae, Legionella sp.
COPD viral associations... Rhinovirus, Influenza virus
Created by: KimmiNP
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