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PNCB CPNP-PC > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Respiratory Assessment

-1- of -2-

A
  1. Type and location

2. breath sounds

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2
Q

Respiratory Assessment - Transmitted voice sounds

-1-: auscultate while patient says -2-; if more of a long -3-, possible -4-

A
  1. Egophony
  2. “EEE”
  3. “AAA”
  4. consolidation
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3
Q

Respiratory Assessment - Transmitted voice sounds

Bronchophony: -1- chest wall; ask pt to say -2- repeatedly; -3- auscultation = -4-

A
  1. Hold stethoscope at
  2. “99”
  3. clear, distinct
  4. abnormal (consolidation)
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4
Q

Respiratory Assessment - Transmitted voice sounds

-1-: auscultate as patient -2-; if -3- and distinct, -4-

A
  1. Whisper pectoriloquy
  2. whispers, “1, 2, 3”;
  3. clear
  4. possible consolidation
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5
Q

Respiratory Assessment
> -1- if -2- of age and -3-
> Inspect -4-

A
  1. PFTs
  2. greater than 8 years
  3. cooperative
  4. work of breathing (nasal flaring, intercostal or supraclavicular contractions, grunting, head bobbing)
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6
Q

Respiratory Assessment - Obstructive Disease

Characterized by -1- rates; -2- within -3- or -4-

A
  1. reduced airflow
  2. lung volumes
  3. normal range
  4. larger
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7
Q

Respiratory Assessment - Obstructive Disease

Typical of a child -1- (air trapping) which results in decreased rates and FEV1 (e.g., -2-, -3-, -4-)

A
  1. having trouble exhaling (Obstructive, breathing Out)
  2. asthma
  3. chronic bronchiolitis
  4. cystic fibrosis
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8
Q

Respiratory Assessment - Restrictive Disease
> characterized by -1- and -2-
> Typical of a child that has -3-, thus affecting the -4- (e.g., -5-)

A
  1. reduced volumes
  2. expiratory flow rates
  3. trouble inhaling air
  4. volume
  5. pneumonia
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9
Q

Bronchiolitis
Def: a disease of the lower respiratory tract that causes -1- leading to obstruction of the -2-
> Typically noted among children -3- of age

A
  1. inflammation
  2. small respiratory airways
  3. < 3 years
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10
Q

Bronchiolitis

> Most cases result from a -1- (e.g., -2-, -3-, -4-, -5-, among others)

A
  1. viral infection
  2. RSV
  3. rhinovirus
  4. parainfluenza
  5. adenovirus
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11
Q

Bronchiolitis - S/S
> -1- symptoms lasting for several days
> moderate fever: -2-

A
  1. URI

2. 102F (38.9C)

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12
Q

Bronchiolitis - S/S

Gradual development of -1- (e.g., -2-, -3-, -4-, cyanosis, prolonged expiration)

A
  1. respiratory distress
  2. nasal flaring
  3. grunting
  4. intercostal retractions
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13
Q

Bronchiolitis - S/S
Respiratory Distress
> -1- (-2-)
> -3-

A
  1. Tachypnea
  2. 60-80/minute
  3. non-productive cough
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14
Q 
Bronchiolitis - S/S
Respiratory Distress
> -1-
> progressive -2-
> -3-
A
  1. paroxysmal wheezing
  2. stridor
  3. cyanosis
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15
Q

Bronchiolitis - S/S

Palpable -1- (-2- due to -3-)

A
  1. liver & spleen
  2. pushed down
  3. hyperinflated lungs
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16
Q

Bronchiolitis - Lab/Dx
> -1- with -2-; may have scattered areas of consolidation
> -3- of nasal washing may be -4- (-5-)

A
  1. CXR
  2. hyperinflated lungs
  3. immunofluorescence assay (IFA)
  4. positive for RSV
  5. or flu
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17
Q

Bronchiolitis - Mgmt
> Infants with mild distress can be treated as outpatients with -1-
> -2- in -3- infants with -4- IM every -5- during RSV season

A
  1. supportive care
  2. Prevention of RSV
  3. high-risk
  4. palivizumab (Synagis)
  5. month
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18
Q

Bronchiolitis - Mgmt
> The -1- for those who -2- Synagis includes the following:
» -3- of age with -4- treated w/in -5-

A
  1. criteria
  2. should receive
  3. < 2 years
  4. chronic lung disease
  5. 6 months of RSV season
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19
Q 
Bronchiolitis - Mgmt - Synagis criteria
> -1- during the first year of life
> Infants between -2- may be treated if -3- are present: 
>> exposure to -4-
>> -5- impairments
A
  1. Premature infant (<32 weeks gestation)
  2. 33 and 35 weeks gestation
  3. certain risk factors
  4. high URI populations/environmental irritants
  5. mechanical or neuromuscular
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20
Q 
Asthma - Pathophys
> -1-
> Mucosal -2- and hyperemia
> -3- and -4- by -5-
> thickening of epithelial basement membrane: -6-
A
  1. hypertrophy of smooth muscle
  2. edema
  3. acute inflammation
  4. plugging of airways
  5. thick, viscid mucus
  6. remodeling
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21
Q 
Asthma - Causes
> Most common -1- are encountered indoors, so you need -2-
>> -3-
>> -4-
>> -5-
A
  1. allergens
  2. a detailed history
  3. pets
  4. dust mites
  5. cockroaches
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22
Q

Asthma - Causes
> Allergens
» Indoor -1-
> -2-

A
  1. molds

2. exercise

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23
Q 
Asthma - Causes
> Airway irritants
>> -1-
>> -2-
>> -3- or -4-
>> -5-
A
  1. cigarettes
  2. air pollution
  3. paints
  4. sealants
  5. cleaning agents
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24
Q 
Asthma - Causes
> Airway irritants
>> -1-
>> -2-
>> -3-
A
  1. cold air
  2. medications
  3. respiratory infections
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25
Q

Asthma - S/S
> Respiratory -1-
> -2- or -3- in sentences
> -4-

A
  1. distress at rest
  2. difficulty catching breath
  3. speaking
  4. diaphoresis
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26
Q 
Asthma - S/S
> Use of -1-
> -2- may be -3-
> Chest -4-
> -5-
A
  1. accessory muscles
  2. nighttime symptoms
  3. common
  4. Chest Tightness
  5. HYPERRESONANCE
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27
Q

Asthma - Ominous signs
> -1- –> -2-
> -3-

A
  1. absent breath sounds
  2. ED
  3. Cyanosis
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28
Q

Asthma - Lab/Dx
> -1- reveal -2- that are typical of -3-
> A -4- in unnecessary unless used to -5-

A
  1. PFTs
  2. abnormalities
  3. obstructive dysfunction
  4. CXR
  5. r/o other conditions (infection)
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29
Q 
Asthma - Classification of Severity (age 5-11)
> SABA Rescue Inhaler Use
>> Mod Persistent: -1-
>> Severe persistent: -2-
>Activity Level
>> Severe Persistent: -3-
> Lung Function
>> Intermittent: -4-
>> Moderate persistent: -5-
A
  1. Daily
  2. > 1/day
  3. Extremely Limited
  4. > 80% FEV1 p during exacerbations (otherwise normal)
  5. 60-80% FEV1p
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30
Q 
Asthma - Classification of Severity (age 5-11)
> Intermittent
>> SABA Rescue inhaler use: -1-
> Mild Persistent
>> Symptoms: -2-
> Severe Persistent
>> Symptoms: -3-
>> Nighttime Awakenings: -4-
>> Lung Functioning: -5-
A
  1. 2- d/wk (Rule of 2s)
  2. > 2d/wk
  3. throughout the day
  4. frequently, sometimes nightly
  5. FEV1 < 60% predicted
31
Q 
Asthma - Classification of Severity (age 5-11)
> Intermittent
>> Symptoms: -1-
> Mild Persistent
>> Nighttime awakenings: -2-
>> SABA Rescue inhaler use: -3-
>> Activity level: -4-
> Moderate persistent
>> Activity level: -5-
A
  1. 2- d/wk (Rule of 2s)
  2. 3-4/month
  3. > 2 d/wk, not daily
  4. minor limitation
  5. Some limitation
32
Q 
Asthma - Classification of Severity (age 5-11)
> Intermittent
>> Nighttime awakenings: -1-
>> Activity level: -2-
> Mild Persistent
>> Lung Function: -3-
> Moderate persistent
>> Symptoms: -4-
>> Nighttime awakenings: -5-
A
  1. 2- /month (Rule of 2s)
  2. No impairment
  3. FEV1 >80% predicted (never normal)
  4. Daily (in waves)
  5. > 1/wk, not nightly
33
Q

Asthma - Mgmt
NHLBI/NAEPP Asthma Guidelines
> Focus on…

A

…achieving and maintaining control (keeping up activity)

34
Q

Asthma - Mgmt - Asthma Control

> -1- is/are part of the preferred treatment plan for -2- across all age groups; closely monitor growth

A
  1. Inhaled corticosteroids

2. persistent asthma

35
Q

Asthma - Mgmt - Asthma Control

> Moderate to severe persistent asthma (-1-): -2- in -3- as a -4- and -5-

A
  1. 4+ years old
  2. ICS w/ formoterol
  3. a single inhaler
  4. daily controller
  5. reliever therapy
36
Q

Asthma - Mgmt - Asthma Control

> When -1-, combination therapy is recommended and -2- are the preferred agents to combine with ICS in patients -3-

A
  1. stepping up treatment
  2. Long-acting beta-2 adrenergic agonists (LABAs, like Advair)
  3. > 12 years of age
37
Q

Asthma - Mgmt - Asthma Control
> mgmt guidelines by three distinct age groupiongs: -1-, -2-, and -3- years of age
» With consideration for: -4- and -5-

A
  1. 0-4
  2. 5-11
  3. 12+ years
  4. current impairment
  5. future risk
38
Q

Asthma - Mgmt - Asthma Control
> More -1-
» initially -2- until -3-
» If -3-, -4- and follow up -5-

A
  1. frequent monitoring
  2. every 2-4 weeks
  3. control is achieved
  4. uncontrolled
  5. escalate treatment steps
  6. every 2 wks-
39
Q 
Asthma - Mgmt - Asthma Control
> Severe Persistent
>> Lung Function
>>> 0-4: -1-
>> Systemic Corticosteroid Use
>>> 5-11: -2-
>> Recommended Step
>>> 0-4: -3-
> Mild Persistent
>> Recommended Step: -4-
A
  1. N/A (Lung function not tested in this age group, any severity)
  2. Risk relative to FEV1 (lower prediction percentage, higher risk)
  3. Step 3 (Med ICS! + sys corticosteroids?); REFER (moderate too)
  4. Step 2 (add Low-Dose ICS alternative: Cromolyn or montelukast)
40
Q 
Asthma - Mgmt - Asthma Control
> Intermittent
>> FEV1/FVC: -1-
>> Systemic Corticosteroid Use: -2-
>> Recommended Step: -3-
> Severe Persistent
>> Systemic Corticosteroid Use
>>> 0-4 years: -4-
>> Recommended Step
>>> 5-11: -5-
A
  1. > 85%
  2. < 2/year
  3. Step 1: SABA+PRN for both age groups
  4. 2+ uses in 6 months; high-risk children: 4+ >1-day wheezing episodes in a year
  5. step 3: Med dose ICS; OR Step 5 ICS + sys corticosteroids?
41
Q 
Asthma - Mgmt - Asthma Control
> FEV1/FVC
>> Mild Persistent: -1-
>> Moderate: -2-
>> Severe: -3-
> Recommended Step
>> Moderate: -4-
A
  1. > 80%
  2. 75-80%
  3. < 75%
  4. Step 3: Med dose ICS + sys corticosteroids?
42
Q

Pneumonia

Def: Inflammation of the -1- as microorganisms gain access by -2-, inhalation, or hematogenous dissemination

A
  1. lower respiratory tract

2. aspiration

43
Q

PNA
Etiologies by Cohort
> -1-: GABHS, -3- (-4-); -5-

A
  1. Newborns
  2. chlamydia
  3. GABHS & chlamydia are transferred vertically
  4. E. Coli
44
Q

PNA
Etiologies by Cohort
> Children < 6 years: -2-, -3-, -4-, (-5-)

A
  1. RSV
  2. H. influenzae
  3. s. pneumoniae
  4. CAP
45
Q

PNA
Etiologies by Cohort
-1- through -2-: -3-, -4-, -5-

A
  1. Preschool
  2. young adulthood
  3. S. pneumoniae
  4. mycoplasma
  5. chlamydia
46
Q

PNA
Etiologies by Cohort
> -1-: -2- or -3-
> Depending on age group, -4- of all PNAs are -5-

A
  1. immunocompromised or malnourished
  2. (P. jirovecii PNA) PJP
  3. fungi
  4. 50 - 80%
  5. viral
47
Q 
PNA
S/S
> -1-
> -2-
> -3- on physical exam
> -4- oxygenation in severe distress
> -5-
A
  1. fever
  2. shaking chills
  3. lung consolidation
  4. pulse-ox: decreased
  5. Egophony: EEE to AAA (evidence of consolidation)
48
Q 
PNA
Lab/Dx
> Infiltrates by CXR
>> patchy infiltrates w/ -5-
>> lobar consolidation w/ -6-
> -2- is common with -3- PNA
> -4-: may be warranted if cough is productive (age dependent)
A
  1. increased WBC
  2. bacterial
  3. sputum culture
  4. E. Coli
  5. S. Pneumoniae
49
Q 
PNA
Mgmt of CAP
> Pharm Tx r/t etiology
>> -1-: -2-
>> -3- such as -4- for -5-
A
  1. amoxicillin
  2. s. pnuemoniae
  3. macrolides
  4. azithromycin
  5. m. pneumoniae
50
Q

PNA
Mgmt of CAP
> Pharm Tx r/t etiology
» -1- or -2-: -3-

A
  1. Amoxicillin
  2. 3rd gen cephalosporin
  3. H. influenzae
51
Q 
PNA
Mgmt of CAP
> -1- PNA
>> Supportive measures: -2-
>> -3- only if -4- are present
A
  1. Viral
  2. hydration and antipyretics
  3. ABX
  4. secondary bacterial infections
52
Q 
PNA
Mgmt of CAP
> Viral PNA
>> Humidified -1- and -2- (at the -3-)
>> -4- to improve -5-
A
  1. oxygen
  2. chest physiotherapy
  3. hospital
  4. bronchodilators
  5. airway clearance
53
Q

PNA
Mgmt of CAP
> Supportive measures: -1-

A
  1. force fluids
54
Q

Cystic Fibrosis

-1- with a -2- mutation, which produces a -3- in -4- resulting in -5-

A
  1. AUTOSOMAL RECESSIVE disorder
  2. chromosome 7, long arm
  3. defect
  4. epithelial chloride transport
  5. Dehydrated, thick secretions
55
Q

CF

A chronic multisystem disorder affecting the -1-, -2-, -3-, and -4-

A
  1. Respiratory
  2. GI
  3. hepatobiliary
  4. reproductive tracts
56
Q

CF

Characterized by -1-, progressive -2-, and pancreatic insufficiency w/ intestinal -3-

A
  1. recurrent infections
  2. obstructive lung disease
  3. malabsorption
57
Q

CF
> Most common in the -1-
> Life expectancy -2-

A
  1. caucasian population

2. 30+ years (improving)

58
Q

CF - S/S
> Viscid -1- (or -1- -2-) in -3-
> Recurrent -4-
> Large, liquid, bulky, foul stool (-5-)

A
  1. meconium
  2. ileus
  3. newborns
  4. respiratory infections
  5. steatorrhea
59
Q 
CF - S/S
> -1- skin
> -2- deficiencies
> -3- to -4-
> -5-
A
  1. Salt-tasting
  2. fat-soluble vitamin
    3 & 4. FTT
  3. infertility
60
Q 
CF - Lab/Dx
> Pilocarpine iontophoresis (-1-)
> -2-: obstructive pattern
> -3- (alkalosis)
> -4-: cystic lesions, atelectasis
A
  1. sweat test
  2. PFTs
  3. Hyponatremic, Hypochloremic, dehydration
  4. CXR
61
Q 
CF - Mgmt
Referral for spec mgmt
> -1-
> -2-
> anti-inflammatory control (i.e., -3-)
> -4-
> -5- support
A
  1. respiratory secretion care
  2. chest PT
  3. steroids
  4. nutritional status (ADEK)
  5. psychosocial
62
Q

Pertussis

Def: AKA -1-; contagious respiratory illness cause by -2-; can cause serous complicatoins in -3- (-4-)

A
  1. whooping cough
  2. b. pertussis
  3. infants & young children
  4. before the first & second Dtap (2&4 months)
63
Q 
Pertussis - S/S
-1- last for 1-2 weeks
> -2- nose
> -3-
> Mild, -4-
A
  1. early symptoms
  2. runny
  3. low-grade fever
  4. occasional cough
64
Q

Pertussis - S/S
-1- symptoms can last for 10+ wks
> -2- followed by a -3- sound

A
  1. late-stage
  2. paroxysms
  3. “whoop”
65
Q

Pertussis - Dx

… test

A

PCR

66
Q

Pertussis - Tx
> Abx (-1-), within -2- of -3-
> Do not -4-

A
  1. az-/clarithromycin
  2. first 3 weeks
  3. infection
  4. use cough medications (they don’t help)
67
Q

Pertussis - Tx

-1- to avoid -2- and small, frequent -3- to prevent -4-

A
  1. Fluids
  2. dehydration
  3. meals
  4. vomiting
68
Q

Respiratory syncytial virus (RSV) is the -1- of bronchiolitis and pneumonia in children -2- of age. For children under 6 months, -3-. In developed countries, the fatality rate is -4-, with deaths attributable to respiratory arrest/failure or -5-.

A
  1. most common etiology
  2. under 1 year
  3. 1-2% require hospitalization
  4. <1%
  5. severe dehydration/electrolyte disturbances
69
Q

RSV Bronchiolitis
-1- are seen in children with comorbidities such as -2- and immunodeficiency, as well as in those with complex medical needs.

In infants -3- of age, RSV infection may result in symptoms of irritability, -4-, lethargy, and/or apnea with or without fever.

A
  1. Higher mortality rates
  2. congenital heart disease
  3. under six months
  4. poor feeding
70
Q

RSV Bronchiolitis
In -1-, rhinorrhea and decreased appetite may appear -2- days before cough, often followed by sneezing, fever, and sometimes -3-.

A
  1. older infants/young children
  2. one to three
  3. wheezing
71
Q

RSV Bronchiolitis
Paroxysms of coughing may trigger -1-, that along with poor oral intake and tachypnea, increase the -2-.
Therefore, the -3- of an infant with bronchiolitis needs to be carefully monitored. Typically an infant with a good -3- will have -4- wet diapers -5-.

A
  1. vomiting
  2. risk of dehydration
  3. hydration status
  4. at least 6
  5. per 24 hours
72
Q

RSV Bronchiolitis
The first -1- hours after the onset of cough are the most critical. The child can be -2- but gradually improves over a period of several days. -3- is expected for more than -4- and a fever of up to 102˚ F (38.9˚ C) is common in the -5- of illness, which further contributes to the risk of dehydration.

A
  1. 48 to 72
  2. ill-appearing
  3. Wheezing
  4. 5 days
  5. first 3-7 days
73
Q

RSV Bronchiolitis

Coughing commonly continues for -1- and may cause the infant to -2-, also affecting the infant’s -3-.

A
  1. 2-3 weeks
  2. vomit on occasion
  3. hydration

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