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AGACNP > pulmonary > Flashcards

pulmonary Flashcards

1
Q

airway changes in asthma

A

narrowed airways, hypertrophy of smooth muscle, mucosal edema, thickened epithelial basement membrane, hypertrophy of mucus glands, acute inflammation, plugging by thick mucus

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2
Q

what would ABG demonstrate in asthma exacerbation?

A

mild hypoxemia- low PO2,

respiratory alkalosis- elevated pH, decreased pCO2- hyperventillation

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3
Q

how does levalbuterol (Xopenex) work? what is it used for?

A

stimulates enzymes that convert ATP to cAMP- relaxes bronchial smooth muscles

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4
Q

maintanence for asthma

A

low dose inhaled corticosteroid- budesonide (fluticasone) +/- long acting beta agonist (LABA)- salmeterol
combo inhalers: symbicort, advair

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5
Q

severe asthma treatment

A

high dose ICS + LABA + oral corticosteroid

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6
Q

what is anaphylaxis epinephrine dosing?

A
  1. 3-0.5 mg subcutaneous

1: 1000 mg/mL

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7
Q

status asthmaticus treatment

A

airway support: oxygen, ABG q 10-20 minutes, intubation, pulse oximetry
IV fluids, IV steroids,
atrovent or inhaled sympathomimetics

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8
Q

COPD: chronic bronchitis vs emphysema

A

bronchitis- intermittent dyspnea, earlier onset, copious sputum, stocky/ obese body habitus, percussion normal, increased hematocrit
emphysema- progressive/ constant dyspnea, later onset 50+, mild clear sputum, thin body habitus, increased A-P diameter, percussion hyper resonant, TLC increased

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9
Q

COPD: FEV1, TLC, FRC, RV

A

FEV1- expiratory flow reduced
TLC increased
Functional Residual Capacity- increased
Residual Volume- increased

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10
Q

PPD testing

A

shows exposure of TB, not diagnostic for active disease

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11
Q

active TB diagnostics

A

culture of M. tuberculosis x 3
acid fast bacillus smears- presume evidence of active TB
small homogenous infiltrate in upper lobes by CXR

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12
Q

TB medication regimen (RIPE)

A 
Rifampin 600 mg
isoniasid 300 mg
pyrazinamide 1.5-2.0 gm
ethambutol 15 mg/kg daily 
RIPE
1st 3 drugs daily for 2 months, then 4 more months of INH and RIF daily
if HIV, treat for 9 months
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13
Q

monitoring for TB

A

weekly sputum smears and cultures in 1st 6 weeks, then monthly until negative cultures.
possibly monthly labs: LFTs, CBC, serum creatinine

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14
Q

ethambutol considerations (TB drug)

A

test for visual acuity and red/green color perception

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15
Q

if positive PPD, what is treatment

A

6 months of INH (isoniazid)

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16
Q

what defines positive PPD?

A

5 mm measurement HIV
10 mm measurement in immigrants
15 mm measurement in general population

17
Q

what is most common community acquired pneumonia CAP bug

A

strep. pneumoniae

18
Q

mortality score for CAP: PORT

A

Patient Outcomes Research Team score- based on age (-10 for women) and points for each 20 relevant characteristics
PORT > 130- ICU
PORT 70-130 inpatient stay

19
Q

CURB 65 scoring

A 
Confusion- mental test score < 8
BUN > 19
Respiratory rate > 30
SBP < 90 or DBP < 60
Age > 65
moderate to high risk- hospitalization
20
Q

what are macrolid antibiotics?

A

azithromycin, clarithromycin, erythromycin, and roxithromycin

21
Q

antibiotic coverage for inpatient CAP- nonsevere (acute care) or severe (ICU)

A

beta-lactam (PCN and cephalosporins), + macrolid (azithro) OR fluroquinolone (levaquin, ciprofloxacin)
severe (need pseudamonas coverage): pip-tazo OR meropenem, or cefepime + AMG (amikacin) / azithro
if MRSA- above + vanc or linezolid

22
Q

outpatient CAP coverage

A

amoxicillin or doxycycline or macrolide (azithro)

23
Q

what is viral CAP coverage

A

zanamivir, peramivir, zanamivir

possible to have secondary bacteria infection

24
Q

what are HAP bugs?

A

Staph aureus
Strep pneumoniae
Haemophilus influenzae

25
Q

HAP coverage routine, vs MRSA, vs high risk of mortality

A

routine HAP: 1 antibiotic: pip-tazo OR cefepime OR levofloxacin OR imipenem or meropenem
MRSA coverage- add vanco or linezolid
high mortality: TWO agents PLUS MRSA coverage- avoid 2 beta lactams
pip-tazo, cefepime, levo or cipro, imipenem or meropenem, amikacin or gentamicin or tobramycin
azteronam

cefepime, meropenem, vancomycin (common UVA regimen)

26
Q

VAP coverage

A

MRSA and double antipseudomonal coverage: beta-lactam and non-beta lactam antibiotics
vancomycin + Piptazo OR cefepime OR meropenem OR aztreonam + levo OR cipro OR amikacin OR gentamicin OR colistin

27
Q

needle thoracostomy placement:

A

2nd intercostal space, mid clavicular line

28
Q

chest tube placement:

A

4th or 5th ICS, mid axillary line

29
Q

sarcoidosis

A

interstitial lung disease; CXR, PFTs, ABGs, biopsy of lung parenchyma for diagnosis (bronchoscopy)
tx: corticosteroids,
immunosuppressive agents: azathioprine, methotrexate, cyclophosphamide

30
Q

control ventillator setting

A

preset TV and RR

31
Q

assist control ventilator

A

preset volume, but patient can trigger extra breath

32
Q

pressure support

A

respiratory rate determined by patient, inspiratory effort unassisted but preset airway pressure with each breath (PEEP)

33
Q

SIMV

A

preset RR and TV, but patient can take extra breaths at whatever TV they normally do- likely lower

34
Q

when is BiPAP commonly used?

A

for COPD patients, or to wean from the ventilator

35
Q

obstructive disease PFTs:

A

reduced airflow rates; decreased FVC/ FEV1, but lung volumes are normal or above normal

36
Q

restrictive disease PFTs, diagnoses

A

morbid obesity, sarcoidosis, pulmonary fibrosis

reduced volumes- TLC, FRC, RV, and reduced expiratory flow rate

37
Q

pleural fluid exudate characteristics:

A

protein to serum protein ratio > 0.5
LDH to serum LDH ratio > 0.6
pleural fluid LDH (lactate dehydrogenase) greater than 2/3 upper limit of normal serum LDH
exudate- cream looking: protein and LDH

38
Q

transudate fluid

A

clear looking, no protein/ LDH elevation

39
Q

CXR findings can determine type of pneumonia….

A

Bacterial: bronchopneumonia, lobar pneumonia
Viral: bilateral interstitial infiltrates
Aspiration: R middle lobe or diffuse involvement

AGACNP (19 decks)

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