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pulmonary Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

pulmonary embolism

A

cough, frothy pink tinged sputum. “IMPENDING DOOM”

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2
Q

impending respiratory failure (asthma pt)

A

RR >25bpm, tachy, cyanosis, “quiet” lungs no wheezing.

Adrenaline injected STAT, call 911. 02 4-5L, albuterol.

after tx, good sign is breath sounds and wheezing.

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3
Q

normal findings of lungs

A

upper lobes: bronchial breath sounds (louder)

lower lobes: vesicular (soft and low)

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4
Q

normal egophonys

A

normal: “eee”
abnormal “bah”
normal “eee is louder over the large bronchi” vs lower lobe

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5
Q

tactile fremitus

A

normal: stronger vibrations on the upper lobes

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6
Q

whispered pectoriloquy

A

patient to whisper “99 or 1-2-3”

normal: voice lounder upper lobes, muffled lower lobes
abnormal: clear sounds lower, muffled upper

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7
Q

percussion

A

normal: resonance
tympany or hyperresonace: COPDY, emphsema
dull: pneumonia with consolidation, pleural effusion (liquid or tumor), solid organ (liver)

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8
Q

pulmomary fxn tests

A

obstructive dysfuncion - reduction in airflow
asthma, copd

restrictive- reduction of lung volume dt decreased lung compliance
ie; pulmonary fibrosis, pleural disease

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9
Q

COPD

A

includes both emphysema and chronic bronchitis

loss of elastic recoil of the lungs and alveolar damage

risk: smoking and age

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10
Q

chronic bronchitis

A

cough with excessive mucus 3 months or more

for a minimum of 2 or more consecutive years

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11
Q

emphysema

A

permanent alveolar damage
expiratory respiratory phase is longer

risk: smoking, age, occupation, alpha 1 trypsin deficiency
classic case: elderly male, smoker, c/o sob during exertion. frequent cough, yellow sputum, barrel chest, weight loss (emphysema).

objective: >AP diameter,

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12
Q

copd general tx

A

smoking cession
flu, penumococcal vaccine
pulmonary drainage

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13
Q

copd medications

A

1st line: anticholinergics Ipatropium (atrovent) or tiotropium (spiriva)

and/or

b2 agonist: salmetrol (serevent), formoteral, albuterol (combivent)

2nd line: prednisoe (medrol dose pack), fluticason, adviar

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14
Q

copd medications safety

A

albuterol (b2 agonist)- careful with htn, hyperthyroid

anticholingergics (atrovent, spiriva), avoid if narrow angle glaucoma, bhp, bladder neck obstruction dt vasoconstriction

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15
Q

long term use of corticosteroids >6mos= risk of pneumonia

when treating COPID, pick antibiotic doxy or fluoro (agains H. influenza gram -

A

true

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16
Q

CAP

A 
bacterial infection
s. pneumoniae
h.influenze
m. catarrhalis
cystic firbosis

classic case: elder with high fever, productive cough, rust colored sputum, pleuritic chest pain

objective: rhonchi, wheeze, crackles, dullness on percussion

INCREASE tactile fremitius and egophany

xray is gold standard for diagnosing CAP ( NOT sputum), repeat 6 wks after clearing

cxr lobar consolidation

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17
Q

tx of CAP

A

Macrolide or doxy (tetracycline)

with comorbidity (kidney, chf, liver) fluroquinolonie as ONE drug therapy (leva, gemi, maxi)

or

high dose amoxi (augmentin) plus macrolide

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18
Q

curb 65

A

confusion, urea in blood, rr>30bpm, blood pressure

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19
Q

prevention of pneumonia

A

flu for everyone >50 yo
pneumovax if >65 yo

healthy patients - one lifetime dose at 65 yo

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20
Q

prevent of pneumonia for high risk patients

A

pneumovax booster in 5-7 years

19 yo if asplenia

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21
Q

atypical pneumonia

A

children/young adults
“walking pneumonia” highly contagious

M. Penumoniae
C. Penumoniae
Legionella pneumoniae- found in moisture (water, air conditioners)

classic case; youg adult several weeks fatigue, coughing non productive, cold like s/s.

wheezing, pus in throat, diffuse interstitial infiltrates on X-ray.

medications: macrolide (same as 1st line CAP), anitussive prn (dextromethorphan, tessalon perles)

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22
Q

acute bronchitis

A

aka treacheobronchitis, usually viral and self limiting
tx: fluids, antitusstives (dextromethorphan, tessalon perles, f

guaifensin prn, albuterol, if severe medrol dose pack

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23
Q

pertussis

A

bacterial
whopping cough

last 2 weeks or longer, “hacking cough”, may vomit.

labs: nasopharyngeal swab (PCR), ELISA, cbc

tx: marcolides
TDAP booster

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24
Q

typical vs atypical pneumonia

A

typical: (CAP) older pt. high fever (>100.4), productive cough, rust colored sputum, chest pain
* S. pneumoniae, H. inlfluenzae, M. catarrhalis

atypical: children/young adults. fatigue, nonproductive cough, low grade fever (cold like s/s)
* *M. pneumonia, C. pneumoniae, Legionella penumonaie

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25
Q

COPD 1st line

A

atrovent add salmeterol if poorly controlled

26
Q

COPD plus smoker

A

most likely H. Influenza

27
Q

if healthy adult has cough for >2-3 weeks and previously treated with antibiotic, assume pertussis. r/o pneumonia

A

true

28
Q

what age tdap vs td

A

11 and up

29
Q

best mucolytic

A

fluid

30
Q

afrin dosage

A

bid up to THREE days only. >3 days=rebound rhinitis medicamentosa

31
Q

common cold s/s and tx

A

s/s: acute fever, sore throat, sneezing, clear mucus (coryza.
tx: fluids, rest, acetaminonphen, nsaids

oral decongestants- sudafed/psudoephedrine
topical nasal decong-afrin
antitussives (robitussin/dextromethorphan)
antihistamine (diphenhydramine/benadryl)

32
Q

TB

A

lungs most common (85%)

latent TB: not infectious.

33
Q

reactived TB on cxr

A

cavitations and adenopathy and graulomas on the hila of the lungs

34
Q

prior BCG vaccine

A

if >5 yrs since last bcd, a positive TB is most likely a TB infection

35
Q

first line rx TB

A

isoniazid

rifampin

36
Q

miliary TB

A

affects multiple organs, more common

37
Q

infectious TB or reactivated TB

A

90 % are reactived in US dt low immunity

38
Q

tx plan for TB

A

report TB to local health department
all TB test for HIV
use 4 drugs, INH, rifampin, ehtambutal, and pyrazidamide tid (then narrow down drugs after C&S)

classic case: adult c/o fever, night sweats, cough, weight loss (late sign), blood in cough ( late sign)

39
Q

warning for ethambutal rx

A

can cause optic neuritis. avoid if pt has abnormal vision (blindness, etc)

40
Q

medications INH for tb (hiv vs non hiv)

A

non hiv- INH 300 mg for 9 months
HIV- for 12 mos

chest baseline liver fxn and monitor

41
Q

PPD test result

A

look for induration, NOT RED!. i.e.: bright red color but no induration = negative

5mm or less: HIV, immunocompromised, previous TB on chest X-ray, child with close TB contact

10mm or less: recent immigrant, child 15mm- no known risk factor for TB

42
Q

tb skin test

A

mantoux. inject .1ml of 5th-ppid sub dermal.

43
Q

tb blood test

A

quantiFERon-tb gold or t-spot (aka igra). blood test measure y-interferon.

igra-results available in 24 hours. use if hx of previous bcg vaccine

44
Q

TB

A

hiv
recent contacts with infectious TB
chest x ray with fibrotic changes ( previous tb)
any child who had close contact or has tb symptoms (

45
Q

TB

A

recent immigrants last 5 years (asia, africa, latin america, india, pacific islands)
child

46
Q

asthma

A

reversible airway obstruction caused by inflammation of the bronchial tree.

goal: less than 2 days/week of rescue medication (albuterol)

objective -wheezing with prolonged expirator phase, tacky

47
Q

asthma medication

“rescue’

A

short acting b2 agonist

albuterol (ventolin HFA)
pirbuterol (Maxair)
levalbuterol (xopenex)
2 inhalations q 4-6 hrs prn

onset: 15-30 min, lasts 4-6 hours

48
Q

long term asthma medication

A

take every day
long acting b2 agonist (LABA), bid.
LABA- increase death with asthma
LABA not to be used as rescue drugs

49
Q

LABA rx

A

salmeterol (serevent) bid
formeterol (foradil) bid
salmetrerol plus fluticasone (advair)

50
Q

sustained release theophylline

A

acts as bronchodilator
monitor: macdrolides, quinolones, anticonvsulants, chest blood level

use of spacer or chamber.

51
Q

1st line tx for asthmatic exacerbation

A

adrenaline injection

52
Q

long term inhaled steroids recommendation

A

supplement calcium with bit D 1500mg for menopausal women ( high risk osteoporosis), bone density (males and females), eye exams (risk of cataracts/glaucoma)

53
Q

asthma tx in a nutshell

A

1) every pt on b2agonist (albuterol)
2) inhaled corticosteroids (Triamcinolone/azmacort, Fluticasone/flovent bid. (oral thrush risk, rinse with h20)
3) add b2 long actin (salmeterol or combo, adviar)
4) add leukotriene inhibitors, theophilline, or mast cell

54
Q

asthma exacerbation

A

PEF

55
Q

PEF

A

measure effectiveness of tx. blow hard during expiration using spirometer (3 times). highest value is PR

HAG (heigh, age, gender)

56
Q

spirometer paramters

A 
green - 80-100% (maintain or reduce medications)
yellow (50-80%), increase therapy
red zone (
57
Q

step 1

>80% PEF, s/s

A

albuterol (ventolin) prn

58
Q

step 2
>80%
>2 days/ week symptoms

A

albuterol (ventolin) PLUS

ICS (fluticasone/flovent)
triamcinolone (azmacort)

risk of oral thrush

59
Q

step 3

PEF 60-80, daily s/s

A

albuterol
ICS
LABA

ICS
(fluticasone/flovent)
triamcinolone (azmacort)

LABA- salmeterol (ADVAIR)

60
Q

step 4

A

high dose ICS (fluticasone/flovent)
triamcinolone (azmacort)
LABA- salmeterol (ADVAIR)

oral corticosteroid ( prednisone) daily

61
Q

exercise asthma

A

use 2 puffs of saba (albuterol/ventolin, levalbuterol/xopenex, pirbuterol/maxair) 10-15 min before exercise. last 4 hours

joy's deck for FNP (24 decks)

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