Case 6

Question 1

Review:

types of COPD

Answer 1

Emphysema

Chronic bronchitis

Question 2

A combined assessment of COPD encompasses what assessments

Answer 2

mMRC or CAT and the GOLD staging

Question 3

mMRC and the CAT assess what in COPD patients

Answer 3

The effect of COPD on their lives (limitation to acitivities, how often they cought, how tight their chest is etc…)

Question 4

using the combined assessment the goal is to…..

Answer 4

assess symtoms and asses the risk of future exacerbations

Question 5

using the combined assessment your patient is in group A…. what is your plan

Answer 5

SABA prn or short acting anticholinergic PRN

Question 6

the plan for a group B patient

Answer 6

LABA or long acting anticholinergic

Question 7

the plan for group C patient

Answer 7

ICS + LABA or long acting anticholinergic

Question 8

The plan for group D patient

Answer 8

ICS + LABA or ICS +LABA + long acting anticholinergic

Question 9

Short acting bronchodilators

Answer 9

SABA: albuterol (proair, proventil, ventolin)
Short acting anticholinergic: ipatropium (atrovent)
Combination: ipatropium and albuterol (duoneb)

Question 10

LABAs

Answer 10

Sameterol (serevent)
Formoterol (Perforomist)
Aformoterol (Brovana)
Indacaterol (arcapta neohaler)
Olodaterol (striverdi respimat )

Question 11

LAMAs

Answer 11

Tiotropium (spiriva)
Aclindium (tudorza)
Umeclidinium (incruse ellipta)
Glycopyrronium (seebri neohaler)

Question 12

ICS+LABA

Answer 12

Fluticisone/ salmeterol (Advair)
Budesonide/ formoterol (symbicort)
Mometasone-formoterol (Dulera- off lable COPD)
Fluticasone furoate / vilanterol (Breo Ellipta)

Question 13

To get someone long term oxygen approved their O2 sats must be\_\_\_\_\_ .
a. 90%
b.89%
C. 88%
d. 91%

Answer 13

c. 88 percent

also do not forget to get a O2 sat while pt is walking

Question 14

To Qualify for hopsice…..

Answer 14

2 physicians must sign off that a patient is terminally ill with less tan 6 months to live

they are qualifications for individual diseases

Question 15

Your patient has reached six months on hospice and is still alive. This means that they must be taken off immediately……t or f?

Answer 15

False. A patient needs to be reevaluated for hopsice every six months. It may be the case that they stay on hopsice

Question 16

For pulmonary disease hopice eligibility

Answer 16

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

Question 17

Since jan of 2019 PAs can do alot more with hospice care but they still cannot

Answer 17

certify terminal illness
Admit a pt to hospice
They may not take the position of the physician
encounter for recertification (but NPs can)

Question 18

Some signs of dimished blood perfusion during the dying process

Answer 18

tachycardia, hypotension, peripheral cooling, cyanosis, mottling of the skin, loss of periph pulses

Question 19

Accumulation of fluid in the upper airway can be heard during the dying process this is called____

Answer 19

death rattle

Question 20

Morphine is a medication given for comfort during end of life care. It may also help with_____. Its liquid form is called____

Answer 20

dyspnea

roxanol

Question 21

Another medication commoly given in conjunction with morphine _______

Answer 21

ativan

Question 22

Some steps to help with the death rattle

Answer 22

position on the side
Scopolamine patch
atropine gtts
glycopyrrolate injection

Question 23

Medications to give for nausea

Answer 23

Haloperidol 
Rectal prochloperazine (compazine) 
Ondansterone (Zofran)

Question 24

Glucocorticoids (dexamethasone) can be given for what?

Answer 24

Comfort, pain, nausea, anorexia , and asthenia