Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FNP > Pulmonary > Flashcards

Pulmonary Flashcards

You may prefer our related Brainscape-certified flashcards:
Family Nurse Practitioner (FNP) flashcards
1
Q

How is a cough classified?

A

Length of time it has occurred

Acute: Less than 3 weeks
Sub-Acute: 3-8 weeks
Chronic: Over 8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the four common etiologies for an acute cough lasting less than 3 weeks?

A

Acute respiratory infection (bronchitis), exacerbation of COPD/asthma, pneumonia, pulmonary embolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 7 common etiologies for a sub-acute to chronic cough?

A

GERD, asthma, infection (atypical pneumonia, pertussis), Ace Inhibitors (dry cough after 1-3 weeks), chronic bronchitis (smokers), bronchiectasis (chronic cough, viscid sputum, bronchial wall thickening on CT), and lung CA (less than 2%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

A 34-year-old non-smoker Who is otherwise healthy has been diagnosed with acute bronchitis. His symptoms have persisted for the past four days. What’s an appropriate treatment for him?

A

Likely viral. Treat symptomatically.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the three most common bugs in community acquired pneumonia?

A

Strep pneumo - 14% - rust colored sputum; most common cause of death from Pneumonia
Mycoplasma pneumoniae - 16% - most common
Chlamydophila pneimoniae - 12%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What characteristics should make the nurse practitioner suspect that a pneumonia is secondary to DRSP?

A

Recent antibiotic exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In what cases would you suspect DRSP?

A

Older, sicker patients with recent antibiotic exposure

1) Age over 65
2) Beta-lactam, Macrolide, or respiratory quinolone therapy in the three months prior
3) alcoholism
4) medical comorbidities
5) immunosuppressive illness or therapy
6) exposure to a child in daycare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What patient is most likely to harbor an atypical pathogen?

1) 19 year old type 1 diabetic
2) A 27-year-old with asthma; recent sinus infection treated with Augmentin
3) A 39-year-old smoker of one pack per day
4) A 48-year-old who has teenagers in the household

A

A 48-year-old who has teenagers in the household.

The other three options are indicative of DRSP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the usual clinical signs and symptoms in a patient who has pneumonia?

A

Cough 90%, purulent sputum production, fever - more than 80%, chills 40-50%, shortness of breath - over 24 BPM, pleuritic chest pain - over 30%, increased respiration and heart rate (older patients), leukocytosis 15-30000/mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Guidelines for treatment of pneumonia. What is the first choice for an individual who is healthy with no anabiotic exposure in the last 3 months?

A

Macrolide x 5 days (azithromycin or clarithromycin) or doxycycline BID daily

Discourage quinolone use initially!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If DRSP is suspected, what is the treatment guidelines for pneumonia?

A

Respiratory quinolone x 5 days
(-floxacin)
Or beta-lactam (PCN or cephalosporin) PLUS macrolide
Or beta-lactam plus doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the criteria for hospital admission for patients with pneumonia?

A 
CRB 65
C= confusion 
R= respiratory rate above 30
B= BP under 90 systolic or under 60 diastolic
65 = age over 65
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Who should get the pneumococcal vaccine? (PPSV23)

A

Adults 19 to 64 who are at increased risk of pneumococcal disease (Individuals with chronic diseases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Who should get the PCV 13 (Prevnar) Plus the PPSV23 (after 1 year)

A

All adults over 65 years old
Those aged 19 to 64 with asplenia, immunocompromise conditions, CSF leaks, cochlear implant’s, advanced CKD, steroid use
* Not recommended for healthy adults under 65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the definition of COPD?

A

A common preventable and treatable disease; persistent airflow limitation, usually progressive, enhanced chronic inflammatory response of the airways and lung to noxious particles or gases

Exacerbations and comorbidities contribute to severity

4th leading cause of death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the risk factors for COPD?

A

Cigarette smoke, occupational dust and chemicals, environmental tobacco smoke, indoor and outdoor air pollution, genes, infections, socioeconomic status, aging populations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the symptoms of COPD?

A

Chronic and progressive dyspnea, cough, and sputum production that varies from day to day

The dyspnea is progressive, persistent, and worsens with exercise.

The cough may be intermittent and unproductive

The chronic sputum production is common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the differential diagnoses for COPD?

A

COPD - midlife on that, slow progression of symptoms; history of exposure to lung irritants

Heart failure - dilated heart, pulmonary Edema, no airflow limitation

asthma - early in life on that usually, wide variation in symptoms from day today, symptoms may worsen in early a.m. or evening nighttime, history of allergic rhinitis/eczema/family history

tuberculosis - any age; infiltrate on chest x-ray. Sputum confirmation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you diagnose COPD?

A

Symptoms: shortness of breath, chronic cough, sputum

Exposure to risk factors: Tobacco, occupation, indoor /outdoor pollution

**Spirometry is required to establish diagnoses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What confirms a diagnoses of COPD?

A

Spirometry: Post bronchodilator shows FEV1/FVC ratio less than .70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is an FVC?

A

Forced vital capacity = Max volume of air exhaled during a forceful maneuver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is an FEV1?

A

Forced expired volume in one second: maximal volume of air expired and one second after maximal inspiration; how quickly long as can be emptied

23
Q

What is the normal FEV1/FVC ratio in healthy adults?

A

0.7-0.8

24
Q

Recommended treatment for mild COPD

A

Short acting bronchodilator PRN (-terol)

25
Q

What is the recommended treatment for moderate COPD?

A

Short acting bronchodilator when needed
Regular treatment with one or more long acting bronchodilators (-terol)
Rehabilitation

26
Q

What is the treatment for severe COPD?

A

Short acting bronchodilator when needed
Regular treatment with one or more long-acting bronchodilator’s
Rehabilitation
Inhaled glucocorticoids if significant symptoms, long function response, or if repeated exacerbations (-one; -ide)

27
Q

Short acting bronchodilator use is associated with greater risk of arrhythmias and new users. Which arrhythmias?

A

Atrial fibrillation; atrial flutter

This puts patients at risk for a CVA

28
Q

What are the adverse affects of anti-cholinergics?

A

Urinary retention/BPH, increased intraocular pressure (contraindicated in glaucoma), dry mouth, constipation, confusion

29
Q

What is the treatment for COPD exacerbations?

A

Oral steroids. Chronic you should be avoided due to unfavorable risk to benefit ratio. Causes increased blood sugar, mood instability, and osteopenia.

*Prednisones 40 mg x 5 days

30
Q

What is the single most effective intervention for preventing exacerbations of COPD?

A

Smoking cessation

31
Q

What is the single most effective intervention for preventing the progression of COPD?

A

Smoking cessation

32
Q

Health promotion for COPD

A

Smoking cessation
Regular exercise
Pneumonia and influenza vaccines

33
Q

What characteristic best distinguishes asthma from COPD?

1) severity of shortness of breath
2) need for rescue medicine
3) use of steroids for exacerbations
4) presence of inflammation

A

The presence of inflammation. Asthma is a disease of inflammation no matter how mild or severe!

34
Q

What is included in effective asthma management?

A

Prevention. Regularly scheduled visits depending on the level of control.

35
Q

What are the triad of symptoms for suspected asthma?

A

Wheezing, cough, chest tightness/SOB

36
Q

What is included in the history of suspected asthma?

A

The triad of symptoms, Family history of asthma or personal history of other atopic disease, history of variable respiratory symptoms, predictable pattern of respiratory symptoms when exposed to a precipitate such as URI, mold, exercise, stress. Night symptoms

37
Q

What are the differential diagnoses of asthma?

A

GERD, COPD, heart failure, obesity, panic disorder, bronchogenic carcinoma

38
Q

How do you diagnose asthma?

A

Variable Expiratory airflow limitation (FEV1/FVC ratio)

Respiratory symptoms

39
Q

What are the two kinds of asthma?

A

Intermittent and persistent

40
Q

How do you differentiate between intermittent and persistent asthma?

A

How often the patient has symptoms

41
Q

How is intermittent asthma classified by symptoms and what is the treatment?

A

Less than two times per week. Treated with a short acting beta agonist. If SABA is used more than two times per week step up the therapy to a low dose in hailed steroid

42
Q

How is mild persistent asthma classified and what is the treatment?

A

Low-dose inhaled steroid daily and a SABA for PRN use

If the SABA is used more than two times per week you step up therapy to a medium dose inhaled steroid

43
Q

How is moderate persistent asthma classified and what is the treatment?

A

Patient is having daily symptoms. Pre-scribe a medium does inhaled steroid plus A long acting beta agonist.

Use a SABA for rescue.

If the SABA is used more than twice per week step up therapy to high dose inhaled steroid plus LABA
Consider referral

44
Q

What medication does every asthma patient have to have?

A

A short acting bronchodilator

45
Q

How often should asthma patients be followed up with?

A

1 to 3 months after initiating treatment
Every 3 to 12 months for routine follow-up
After an exacerbation see patient one week later

46
Q

What is considered in the health promotion of a patient with asthma?

A

Flu and pneumonia vaccine, regular exercise

Asthma action plan
The patient should know the name of meds and how to use inhaler properly. Know when to use rescue med

47
Q

A 70-year-old smoker presents with right unilateral wheezing. A chest x-ray demonstrates right enlarged hilar nodes. What should be done next?

A

A CT chest with contrast.

Pick a test that is quick, cheap, noninvasive, and you can do in the office

48
Q

A patient who was on lisinopril developed a cost. What finding in this patient supports a diagnoses of ace inhibitor related cough?

A

Cough started four days after lisinopril was begun

49
Q

A 24-year-old college student who is otherwise healthy and a non-smoker has community acquired pneumonia pneumonia. She was taking Augmentin for the past three days and her fever persists. How should she be managed?

A

Stop Augmentin and start azithromycin. Macrolide is the first line treatment in otherwise healthy patients with community acquired pneumonia

50
Q

What in hell medication combo creates the greatest risk of sudden death in an asthma patient?

A

Do not use a long acting beta agonist without a steroid in asthma patients

51
Q

A 63-year-old patient with COPD complains of a pounding heart after taking his inhaler which one is least likely the culprit?

A

The steroid

52
Q

A 78-year-old male smoker with stage to COPD has received a prescription for ipatropium. What problem is likely after he begins the ipratropium?

A

Increased intraocular pressure given a history of glaucoma.

Anti-cholinergics cause an increase in IOP

53
Q

A 55-year-old patient was diagnosed with pneumonia seven days ago and was started on Levaquin. He has had a normal temperature for two days but complains of fatigue and lingering cough. How should this be handled?

A

Have him continue to rest for another 3 to 5 days. Patient needs time!

54
Q

A patient who has moderate persistent asthma takes fluticasone twice daily but is still having symptoms what medication listed below will be a little benefit in the management of this patient wheezing and coughing?

1) Theiphylline
2) Albuterol
3) Tiotropium
4) Salmeterol

A

Theophylline and Tiotropium.

The other two are examples of a SABA and a LABA and are helpful and treatment of asthma

FNP (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions