Obstructive Pulmonary Flashcards
What is bronchiecstasis?
Dilated bronchioles
House bacteria, mucus and infection
Cystic Fibrosis is cause in kids
Bacterial infection cause in adults
Hallmark of bronchiecstasis?
Cough with tenacious, thick, purulent sputum
What are main organs affected by cystic fibrosis?
Lungs
Pancreas
GI tract
Liver
How is GI affected by CF?
Pancreas clogs so:
Malabsorption
Osteoporosis/penia
Failure to thrive
Slow digestion»Obstruction
Diabetes
Meconium ileus at birth may be indicator of…
Cystic fibrosis
Slow gastic emptying
S/sx of CF in childhood
Failure to thrive
Malnourished
Steatorrhea
Acute/persisient respiratory symptoms
Delayed puberty
Reproductive issues
How is CF diagnosed?
Sweat test
What is connection between asthma and GERD?
GERD can worsen asthma symptoms.
Asthma meds can cause GERD.
What is the asthma triad?
Nasal polyps
Asthma
Sensitivity to aspirin/NSAIDS
What should we teach patients who are on ACE inhibitors?
Can cause a dry hacking cough and exacerbate asthma symptoms
What is timing of early phase/late phase response of asthma?
Early:Minutes, usually resolves in 1-2 hours
Late: Can last for 24 hours
What is pathos of asthma?
- Trigger
- Immune response/Mast cell dump
- Vasodilation with increased cap permeability
- Edema, congestion, mucus, thickening of walls
- Hyper response of bronchi
What is the ONLY adventitious lung sound we hear in asthma?
Wheezes
What is cough variant asthma?
Asthma that only presents as a cough
What is R-I-S kit?
Drug sedation kit to prep patient for ET tube
What is “peak expiratory flow rate” PEFR?
Test of lung function with a peak flow meter.
This is done by having patient exhale as hard and fast as possible and will be measured.
What is FEV1?
Force expired volume in 1 second.
It is used as a measurement of asthma severity.
>80% is good
<60% is severe
<25% is an emergency
What is meant by the word atopy?
Genetic predisposition to developing asthma
How is drug therapy to control asthma usually approached?
Stair steps.
They will always have a SABA (a rescue inhaler).
They will also use an ICS (an inhaled corticosteroid) daily.
Then meds will be added until they reach controlled level.
What is considered the MOST EFFECTIVE meds for asthma control?
ICS’s for
Short term and long term control
What are side effects of ICS’s? How do we combat that?
Oral candida, hoarseness, dry cough
Candida: Use spacer or have patient gargle after use
What are the two main classes of bronchodilators?
Beta 2 Adrenergic agonists
Anticholinergics
Side effects of bronchodilators.
Tremors
Tachycardia
Anxiety
Nausea
Palpitations
How much is too much SABA use to control asthma attacks?
> 2 x weekly
If SABA use is over this, need another controller med added to program.
What is difference in way you inhale while taking a dry powder inhaler (DPI) and a metered dose inhaler (MDI)? What is the difference in prepping the device?
You inhale quickly with DPI
You inhale slowly with MDI
You usually shake MDI and you don’t shake DPI
How long should you hold your breath after dosing with inhaler?
10 seconds
How should you instruct patients to breathe while doing nebulizer treatment?
Breathe slowly and deeply through mouth and hold each inspiration for 2-3 seconds
What should we instruct patient to do after doing nebulizer or inhaler?
Cough to clear secretions
How often should nebulizers be washed?
Daily with soap and water and then soaked in 1:1 water/vinegar solution for 20 min. Rinse and dry.
Should MDI be shaken before use?
Yes (unless directions say otherwise)
What are the two meds in a Dual-Neb?
Albuterol (beta 2 agonist)
Ipratropium (anticholinergic)
What is dose of SABA to control asthma attack?
2–4 puffs q 20 min for 3 times
How long does it take for an ICS to start working?
2—4 weeks
What classes of meds are only used in asthma? (not in COPD)
ICS’s
Leukotriene inhibitors
Monoclonal antibodies
Suffix for all LABAs?
–terol
Suffix for all ICS’s?
–sone
–sonide
Suffix for all leukotriene inhibitors?
—lukast
What is the 1st thing we do in asthma attack?
Auscultate
What is AATD?
A genetic disorder that makes a person develop COPD at young age.
Think about this when a patient 30–45 yo, non smoker presents with COPD
Polycythemia is sign of ___
COPD
What is advantage of Venturi mask?
Precision
What does BNP tell you?
How well your heart is managing fluid balance
How is huff breathing done?
Position: Sitting, Relaxed, feet on floor
Inhale slowly through mouth
Hold breath 2-3 seconds
Exhale strong and quick as if trying to fog up mirror
Repeat 1-2 times without coughing
Cough when mucus is felt
How is pursed lip breathing done?
Inhale slowly and deeply through nose.
Exhale through pursed lips with puffed cheeks.
Make exhalation 3x longer than inhalation.
8-10 reps 3x daily
