Case 6 Flashcards
Review:
types of COPD
Emphysema
Chronic bronchitis
A combined assessment of COPD encompasses what assessments
mMRC or CAT and the GOLD staging
mMRC and the CAT assess what in COPD patients
The effect of COPD on their lives (limitation to acitivities, how often they cought, how tight their chest is etc…)
using the combined assessment the goal is to…..
assess symtoms and asses the risk of future exacerbations
using the combined assessment your patient is in group A…. what is your plan
SABA prn or short acting anticholinergic PRN
the plan for a group B patient
LABA or long acting anticholinergic
the plan for group C patient
ICS + LABA or long acting anticholinergic
The plan for group D patient
ICS + LABA or ICS +LABA + long acting anticholinergic
Short acting bronchodilators
SABA: albuterol (proair, proventil, ventolin)
Short acting anticholinergic: ipatropium (atrovent)
Combination: ipatropium and albuterol (duoneb)
LABAs
Sameterol (serevent) Formoterol (Perforomist) Aformoterol (Brovana) Indacaterol (arcapta neohaler) Olodaterol (striverdi respimat )
LAMAs
Tiotropium (spiriva)
Aclindium (tudorza)
Umeclidinium (incruse ellipta)
Glycopyrronium (seebri neohaler)
ICS+LABA
Fluticisone/ salmeterol (Advair)
Budesonide/ formoterol (symbicort)
Mometasone-formoterol (Dulera- off lable COPD)
Fluticasone furoate / vilanterol (Breo Ellipta)
To get someone long term oxygen approved their O2 sats must be\_\_\_\_\_ . a. 90% b.89% C. 88% d. 91%
c. 88 percent
also do not forget to get a O2 sat while pt is walking
To Qualify for hopsice…..
2 physicians must sign off that a patient is terminally ill with less tan 6 months to live
they are qualifications for individual diseases
Your patient has reached six months on hospice and is still alive. This means that they must be taken off immediately……t or f?
False. A patient needs to be reevaluated for hopsice every six months. It may be the case that they stay on hopsice
For pulmonary disease hopice eligibility
Dypnea at rest or responds poor to bronchodilators
Disease progression (visits to ER and hospital, or more doctor visits)
Hypoxemia on RA 88 % or less
Right heart failure
unintentional progressive weight loss. >10% of body weight in the last 6 months
Resting tachycardia >100 bpm
Since jan of 2019 PAs can do alot more with hospice care but they still cannot
certify terminal illness
Admit a pt to hospice
They may not take the position of the physician
encounter for recertification (but NPs can)
Some signs of dimished blood perfusion during the dying process
tachycardia, hypotension, peripheral cooling, cyanosis, mottling of the skin, loss of periph pulses
Accumulation of fluid in the upper airway can be heard during the dying process this is called____
death rattle
Morphine is a medication given for comfort during end of life care. It may also help with_____. Its liquid form is called____
dyspnea
roxanol
Another medication commoly given in conjunction with morphine _______
ativan
Some steps to help with the death rattle
position on the side
Scopolamine patch
atropine gtts
glycopyrrolate injection
Medications to give for nausea
Haloperidol Rectal prochloperazine (compazine) Ondansterone (Zofran)
Glucocorticoids (dexamethasone) can be given for what?
Comfort, pain, nausea, anorexia , and asthenia
