Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NP Cert Exam > 1 Pulmonary > Flashcards

1 Pulmonary Flashcards

0
Q

Common etiologies of cough

A 
Asthma
GERD
Infxn
ACE inhibitors
Chronicbronchitis- smokers
Lung cancer- 2%.  Smokers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Acute cough vs chronic cough

A

Acute less than 3wks

Sub acute 3-8
>=8 wks chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute bronchitos tx

And etiology

A

Treat synptoms only!!!! Dont give abx

98% are virus

Upper and lower airway sxs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

50 yo pt with sxs acute bronchitis.

If has fever, the standard of care is to:

A

Get a chest Xray- AP and Lat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When acute cough present, these factors warrant a chest Xray:

A

Fever >38C or100.4 F
Abn vitals: increased RR or HR ( w/o fever in elderly),
>= 75 yrs with cough

Elderly: pneumonia presents as tachypnea, decreased O2 sat, or change in MS behavior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Acute bronchitis: how long will cough last?

Pharm mngt: what helps?

A

Can last up to 3 wks! Last thing to go…

Nothing helps cough- but could give them antitussive or nsaid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Clinical sxs of pneumonia- CAP

A 
Cough
Sputum production
Fever
Chills
SOB. >=24 RR
Chest pain 
Increased RR and HR-
Leukocytosis 15-30,000/mm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Gold standard for CAP Dx:

A

Chest xray PA and LAT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

85% CAP is bacterial. What r they?

A
  1. Strep pneumo- most common cause of death**. Rust colored sputum
  2. Atypical organisms:
    - M.pneumoniae
    - Chlamydophila pneumoniae
    * use macrolide (azithro or clarithromycin) or doxycycline

If pt with comorbitities or Abxs in last 90d:

Then you MUST suspect drug resistant strep pneumo!!! DRSP. Use resp quinalone (gemifloxacin, moxifloxacin, or levofloxacin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CAP: If pt with comorbitities or Abxs in last 90d:

What abxs to use??

A

Then you MUST suspect drug resistant strep pneumo!!! DRSP. Use resp quinalone (gemifloxacin, moxifloxacin, or levofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk factors for DRSP:

A

Abxs in last 90 d- pcn, cephalosporin, macrolide, quinolone

Alcoholism, liver or renal disease

Co-morbitities

Immunosuppression

Exposure to child in day care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

DRSP abxs

First and if allergy

A

Resp quinolone: gemifloxacin. Levofloxacin (levoquin) moxifloxacin

OR
If allergy

Beta lactam (Pcn or Ceph) plus macrolide (‘thromyacin)

Beta lactam plus doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Beta lactam abx

A

PCN or Cephalosporin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Resp quinolone: first line for DRSP

A

gemifloxacin. Levofloxacin (levoquin) moxifloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Macrolide

A

Thromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Summary of tx for CAP

  • Most pts
  • If DRSP suspected
A

Most pts. Macrolide (thromycin) or doxy

If DRSP suspected.

Resp quinolone(floxacin) or

Beta lactam(pcn or ceph) plus macrolide or doxy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How long to treat CAP?

With Azithromycin (Macrolide)?

A

Usually 10 days
Give abxs 3 more d after clinically stable

Azithro has long half life so <5 d om

17
Q

When is Follow up chest Xray needed after pneumonia?

A

If >40 years or a smoker, consider xray in 7-12 weeks after Tx

To exclude underlying disease like malignancy

18
Q

When does pneumonia need hospitalization?

*mneumonic

A

CRB-65

C-confusion
R-RR>=30/min
B-BP=
65

Score of 0 or 1, then outpatient tx

Septic shock- hypotension, tachycardia the organ failure. That is why they push IV fluids

19
Q

Pneumococcal vaccine. PPSV23

Who gets?
What bacteria does it protect against?

A

For Strep pneumo- most lethal!

*All adults >=65
*give one time only- NO boosters. Can give same time as flu shot
A second dose is recommended for people 65 years and older who got their first dose when they were younger than 65 and it has been 5 or more years since the first dose.

*Adults 19-64 years with increased risks/comorbids. Smokers asthma and chronic disease. Can give age 2-64 pta high risk

New vaccine- PPSV13 (give it along with normal vaccine PPSV23) only for aslenia, immunocomprimising conditions, CDF leaks, cochlear implants, adv CKD

20
Q

COPD

2 types?

How much of population has?

Pack year calculation?

A

COPD= chronic bronchitis and emphysema

Affects 10% of pop. >40yrs
smokers!!!! Amt and duration contributes to severity

#packs of cigs/day X # of years
Ex. Smoked 2ppd for 15 yrs= 30 pack yr hx
21
Q

COPD

Chronic Bronchitis

A

Production of sputum for at least 3 m annually for 2 yrs with cough.
Chronic mucous production results from hyperplasia of the mucous membranes lining the bronchial walls

22
Q

COPD

Emphysema

A

Lung disease with permanent enlargement of the aveolar ducts and air spaces distal to the terminal bronchioles.
Results in air trapping and loss of elastic recoil of lungs

23
Q

What is common early sx of COPD

A

*Exertional dyspnea. DOE

Get SOB on way to mailbox!

24
Q

Consider COPD in any pt who presents with:

Differential of COPD:

A

Chronic cough
Sputum produx
Dyspnea
Inhalation exposure tob smoke dust chemicals

Differential:

CHF
Asthma
Bronchiectasis
TB
Constrictive bronchiolitis
25
Q

COPD is ranked in how many stages?

And What meds for each stage?

Anticholinergic s.e.

A

IV

I. Mild COPD. SABA prn

II. Mod COPD. SABA prn. And LABA regularly

III Severe COPD SABA and LABA and steroids (inh glucocorticoids- sign sxs, acute exacerbations, ..)

IV Very severe COPD SABA and LABA and steroids (inh glucocorticoids- sign sxs, acute exacerbations, ..) and long term Oxygen therapy if resp failure. Consider surgical tx

  • this list doesnt include Anticholinergics, (Ipatropium- Atrovent… “Tropium”). Which r used often and great in combo w bronchodilators
    Anticholinergics w LOTS Of s.e. Constipation, inc IOP, dry mouth, urinary retention, blurred vision, glaucoma,
    “I cant see
    I cant pee
    I cant spit
    I cant shit
26
Q

MEMORIZE!!!

Defing characteristic of COPD no matter what stage:

And

ALL COPD pts need this (safety issue)

A

FEV1/FVC <70 percent
Forced expiratory volume in 1 sec, forced vital capacity
If u dont hv this something else is making u sick…

Must have a SABA- like Albuterol
Short acting beta agonist (stimulates beta cells- beta 1 -heart. Beta 2-lungs)

27
Q

What study can screen for lung cancer secondary to cigarette smoking?

Who needs it?

A

Chest CT. Annual Low dose CT

Screen ALL smokers 55-79 yrs w/ 30 ppd who currently smoke or quit w/in past 15 yrs
Annually!!!

Lung CA is leading cause of CA related death in men and women
20% redux in mortality w screening

28
Q

Supraclavicular nodes have high rate of:

right:

Left:

A

Malignancy!!!

Right: lungs
Mediastinum
Esophagus

Left: abdominal malignancy
(Stomach liver pancreas ovaris prostate)

29
Q

Anticholinergics for COPD

A

Ipatropium- Atrovent… “Tropium”

Which r used often and great in combo w bronchodilators

Anticholinergics w LOTS Of s.e.   Constipation, inc IOP, dry mouth, urinary retention, blurred vision, glaucoma, 
"I cant see
I cant pee
I cant spit
I cant shit
30
Q

4 grps meds used for COPD

A
  1. Beta agonists.
    - SABAs. Albuterol. Rescue med
    - LABAs. Salmeterol (serovent) not rescue (takes 10-20 min to work but lasts 12hrs)
  2. Inh Anticholinergics
    “Tropium”. Ipatropium-Atrovent
    Grt combo w bronchodilators
    Lots s.e.!!
  3. Inh steroids
    “One” or “ide”
    Fluticasone. Mometasone… Grt combo w bronchodilators
  4. Steroid plus bronchodilators
    Fluticasone plus salmeterol (Advair), budesonide plus formeterol(Symbicort)
    -No generics. Very $$$$$$!!!!
31
Q

Exam: Stage 3 COPD using albuterol. What should u add next? (Hx of glaucoma)

A

Add a LABA next! *Salmeterol BID

Not inh steroid and bronchodilator (steroid only for exacerbations or SEVERE COPD, not just sxs w exertion)
No Tiotropium- bc antocholinergic bad w Hx glaucoma

32
Q

Manage COPD exacerbations (inc cough/sputum produx, SOB)

From virus, pollution, PE, MI, HF….

A
  1. SABA
  2. Glucocorticoid- nebulize
  3. Antbx prn
    4 other
33
Q

Diference between COPD and asthma

A

COPD is progressive, not reversible.

Asthma is reversible airway obstruction inflammation and airway hyper responsiveness

75% diagnosed by age 7

34
Q

Health promotion COPD

A

Smoking cessation single most effective

Regular exercise
PPSV vaccine (anyone w comorbids one time, otherwise one shot at 65 yrs)
Influenza annually
Know names and use of meds

35
Q

Combo inhaler for copd and asthma- u dont have to know what meds r in them just what it means

A

Usually aLABA and a steroid

36
Q

see quiz questions at end of Resp packet

An ACE cough

A

Can get ry away or later, but dry and will occurs with all ACE if get with one

37
Q

COPD pt w rapid HR after taking breathing med:

What is least likely culprit:
Steroid
Albuterol
Ipatropium
Salmeterol
A

Steroid least likely

All 3 could cause inc HR: albuterol, ipatropium (atrovent an anticholinergic) and salmeterol a LABA

38
Q

A stage III COPD has SOB at rest. What contraindicated Ipatropium use?

Dyssrythmia
Cataracts
Osteoporosis
Glaucoma

A

Glaucoma bc anticholinergic inc IOP

39
Q

63 yo has asthma and got pneumococcal vaccine 10 yrs ago. When should he get again.

A

Get again at 65 yrs

40
Q

55yo has asthma and 102 temp, wheezes and pure lent sputum how should she be managed.

A

Levofloxacin (bc DRSP likely) and nebulized albuterol q4-6hrs

Not w steroids!!!

41
Q

What are possible s.e. of chronic inh steroid use ?

A

Osteoporosis
Cataracts
Glaucoma

NP Cert Exam (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions