Lung Flashcards
Asthma is confirmed by airflow limitation with a reduction of FEV1/FVC below what value for adults and for children?
0.8 for adults
0.9 for children
where does air get trapped during an asthmatic attack?
in alveoli
what would you find upon inspecting a patient with asthma?
-hyperexpansion of thorax
-use of accessory muscles
-hunched shoulders
-nasal secretions, mucosal swelling and/or nasal polys
-atopic dermatitis/Eczema
what would you find upon palpating a patient with asthma?
usually nothing abnormal
what would you find upon using percussion on a patient with asthma?
usually nothing abnormal
what would you find upon using auscultation on a patient with asthma?
-wheezing
-prolonged phase of forced expiration
what assessment tool do we use for asthma?
what is the one exclusion criteria when using this assessment?
GINA
excludes reliever taken before exercise
what is the dosing for an albuterol nebulizer?
2.5 mg 3-4 times as needed
what is the dosing for a levalbuterol inhaler?
how about nebulizer?
when would we use it over albuterol?
2 puffs q4-6h prn
0.63 mg tid q6-8h
pts with a history of tachycardia to albuterol
according to GINA guidelines, what is the preferred inhaler to use as pts reliever inhaler?
low dose budesonide/formoterol in place of albuterol
For severe asthma, what is the recommended treatment plan according to GINA guidelines?
add-on LAMA and consider high-dose ICS-formoterol
all asthma patients should have an action plan which includes:
-pts usual asthma meds
-when/how to incr meds or start oral corticosteroids
-when/how to access medical care if symptoms fail to respond
what are symptoms of a pt experiencing a mild-moderate asthma exacerbation?
how would you treat the pt?
if treatment doesn’t work what should you do?
-resp rate increased
-not using accessory muscles
-pulse 100-120 bpm
-talks in phrases
-O2 sat 90-95%
SABA: 4-10 puffs with MDI + spacer q20 minutes
Prednisolone: adults 1 mg/kg up to 50 mg (or prednisone 40 mg)
children 1-2 mg/kg up to 40mg
*continue treatment with SABA and reassess within 1 hour
transfer to hospital: give inhaled SABA, ipatropium, O2, and systemic corticosteroid
what are symptoms of a pt experiencing a severe or life-threatening asthma exacerbation?
how would you treat pt?
-resp rate over 30/min
-talks in words, hunched forward
-accessory muscles in use
-pulse 120bpm or more
-O2 sat less than 90%
transfer to hospital: give inhaled SABA, ipatropium, O2, and systemic corticosteroid
after an asthma exacerbation, what treatment plan should be arranged for discharge?
-reliver continue prn
-controller: start, restart, or step up
-check inhaler technique and adherence
-corticosteroids continue for 5-7 days (adults) or 3-5 days (children)
what are the two types of COPD and describe them
chronic bronchitis “blue bloater”: inflammation of the bronchioles
emphysema “pink puffer”: destruction of alveoli
how do we diagnose COPD based on the patients FEV1/FVC?
if it is below 0.7 after using a bronchdilator
Physical Exam Findings for COPD:
Inspection?
Palpation?
Percussion?
Auscultation?
*Signs may not be present until disease has progressed, so a lack of physical signs does not exclude COPD diagnosis
I: cyanosis, barrel chest, use of accessory muscles
Palp: usually normal
Perc: hyperresonance
Aus: possible wheezing, crackles, prolonged expiration
what is the assessment tool used for COPD
mMRC Dyspnea scale (grades 0-4:)
if a patient with COPD states they only get breathless with strenuous exercise, what mMRC grade would you mark them under?
grade 0
if a pt with COPD says they get short of breath when walking up a slight hill, what mMRC grade would you mark them under?
Grade 1
if a pt with COPD says they walk slower than normal due to breathlessness or have to stop for breath, what mMRC grade would you mark them under?
Grade 2
if a pt with COPD says they have to stop for breath after walking about 100 meters or after a few minutes, what mMRC grade would you mark them under?
Grade 3
if a pt with COPD says they are too breathless to leave the house or when dressing/undressing, what mMRC grade would you mark them under?
Grade 4
if pt has had 2 or more exacerbations or 1 or more leading to hospitalization, what category are they considered using the GOLD assessment?
what meds are in this category?
E
LABA + LAMA
*consider adding ICS if blood eosinophil count is over 300
if pt has had 0-1 moderate exacerbations not leading to hospitalization, what category are they considered using the GOLD assessment?
what if their mMRC is 0-1/ CAT <10?
what meds are in this category?
what if their mMRC is 2 or more/ CAT 10 or more?
what meds are in this category?
A or B
A: a bronchodilator
B: LABA + LAMA
what drug is used in COPD to treat exacerbations if the pt is a former smoker?
azithromycin
what would be considered a mild COPD exacerbation in regards to:
RR, HR, resting SaO2
RR: less than 24
HR: less than 95
O2: over 92
what would be considered a moderate COPD exacerbation in regards to:
RR, HR, resting SaO2
if obtained, ABG may show?
RR: more than 24
HR: more than 95
O2: under 92
ABG may show hypoxemia and/or hypercapnia (PaCO2 over 45 with no acidosis)
what would be considered a severe COPD exacerbation?
same as moderate except ABG shows hypercapnia and acidosis (PaCO2 over 45 and pH less than 7.35
what are the nonpharm treatments for COPD?
-smoking cessation
-physical activity
-pulomonary rehabilitation
-oxygen therapy
-vaccines
-lung cancer screenings
-nutrition support
what are common viruses that cause community-acquired pneumonia?
influenza, adenovirus, respiratory syncytial virus, and parainfluenza
what are typical bacterias that cause community-acquired pneumonia?
H. influenza, M catarrhalis, and staph
when do we hospitalize patients with community-acquired pneumonia?
we hospitalize based on the CURB-65 assessment
what is the CURB-65 assessment and how do we interpret the results?
Confusion: increased
Urea: over 7
RR: 30 or more breaths/min
BP: systolic < 90 or diastolic < 60
Age: 65 or older
each factor that attributes to the pt is worth 1 point. if they score at least 2 they should be hospitalized
what antibiotic treatments are used in otherwise healthy pts?
Amox 1g tid (preferred)
doxy 100mg bid
azithro 500mg od1 then 250mg days 2-5.
clarithromycin 500mg bid
what antibiotic treatments are used in pts with comorbidities/risk factors for antibiotic resistant pathogens for penumonia?
(list the comorbidities)
comorbidities: chronic heart, lung, or renal disease, alcoholism, asplenia, diabetes, or malignancy
Amox/clav, cefpodox, or cefurox with macrolide or doxy
what are symptoms of pulmonary edema caused by heart failure?
orthopnea (trouble breathing while laying down), wheezing, rapid weight gain, swelling of lower extremities
what signs of heart failure might you see upon a physical examination in regards to:
inspection?
palpation?
percussion?
auscultation?
I: cyanosis
Palp: normal
perc: possible dullness
auc: crackles
what assessment of symptoms tool is used for heart failure?
NYHA class I-IV
exacerbations of HF are usually treated with?
loop diuretics, potassium supp (if needed), and sodium/fluid restriction
Tuberculosis is a multi-system disease caused by?
Mycobacterium tuberculosis
which drug class is a TB risk factor?
TNF-alpha antagonists
what are the treatment options for TB?
isoniazid 6-9 months qd or rifampin 4 months qd
pertussis is caused by?
bordatella pertussis
what are the 3 stages of pertussis?
catarrhal stage (mild cough)
paroxysmal stage (2-6 weeks, worsening cough, cyanosis, vomiting)
convalescent stage (cough lessens)
how is pertussis diagnosed?
culture tests
what is bronchitis?
an inflammatory condition caused by bacteria, viruses, allergens, smoke, or irritants
what are symptoms of bronchitis?
fever, N/V/D not common
conjunctivitis (pink eye), adenopathy (Large or swollen lymph glands), and runny nose
for chest percussion, interpret the following:
Hyperresonance
Resonance
Dullness
increased thoracic gas, suggests hyperexpansion caused by: asthma, emphysema, or pneumothorax
vibration of the lung parenchyma. Normal percussion note
fluid or soft tissue within pleura or lung parenchyma caused by: pneumonia, pulmonary edema, or lung cancer
