Respiratory Flashcards
s/s of pulmonary emboli
dyspnea, coughing up pink-frothy sputum, tachycardia
s/s of impending respiratory failure in asthmatic patient
tachypnea, cyanosis, “quiet” lung sounds without breath sounds
trx for impending respiratory failure in asthmatic patient
adrenaline injection STAT, call 911, apply oxygen, albuterol neb
vesicular breath sounds are common in
lower lobes
normal egophony
“eee”; abnormal is “bahh”
normal tactile fremitus
when patient says “ninety nine”, strong vibrations felt on upper lobes, softer on lower lobes
normal percussion to lungs
resonance
abnormal percussion to lungs
hyperresonance in COPD; dull in pneumonia
COPD is characterized as
loss of elastic recoil and alveolar damage
chronic bronchitis is characterized as
cough with mucus production for more than 3 months for at least 2 consecutive years
risk factors for COPD
smoking, increased age, occupational exposure, alpha1 typsin genetic deficiency
physical exam in those with COPD
barrel chest, prolonged expiration, hyperresonance on percussion, decreased tactile fremitus
contraindications for anticholinergic inhalers
BPH, glaucoma, bladder neck obstruction
treatment for mild COPD (Class I)
short acting anticholinergic or SABA PRN
treatment for moderate COPD (Class II)
Long acting anticholinergic or LABA + SABA PRN
treatment for severe COPD (Class III)
ICS + LABA or LA anticholinergic + SABA PRN
treatment for very severe COPD (Class IV)
ICS + LABA + LA anticholinergic + SABA PRN
long acting beta agonists (LABA) examples
salmetrol, formoterol
short acting beta agonists (SABA) examples
albuterol (Proair, ventolin), levoalbuterol (Xopenex)
acute cough is for
less than 3 weeks
subacute cough is for
3-8 weeks
chronic cough is for
more than 8 weeks
common causes of cough
asthma, GERD, infection
Most common cause of acute bronchitis
virus
common cause of community acquired pneumonia
Streptococcus pneumoniae
common cause of atypical pneumonia
Mycoplasma pneumonia, chlamydophila pneumonia
Suspect DRSP in these people
age greater than 65, abtx therapy in the past 3 months, alcoholics, those with co-morbids, immunosuppression, exposure to children
suspect atypical pneumonia in these people
healthy adults
s/s of pneumonia
cough, purulent sputum, fever, chills, SOB
trx for healthy individuals with atypical pneumonia
macrolide or doxycycline
trx for those with DRSP
respiratory quinolone
trx for those with DRSP who are allergic to quinolones
beta lactam + macrolide or doxycycline
consider referral to hospital in these people with pneumonia
CRB65: Confusion RR greater than 30 BP less than 90/60 Age greater than 65
Pneumonia vaccine recommendations
PPSV23 for adults 19-64 who are at increased risk (asthma, COPD, heart surgery);
PCV13 and PPSV23 1 year later in ALL adults older than 65, and in those 19-64 with asplenia, immunocompromised
symptoms of COPD
chronic and progressive dyspnea, cough, and sputum production
Diagnosis of COPD
spirometry shows FEV1/FVC less than 70%
characteristics of COPD stage I
FEV1/FVC less than 70%;
FEV1 is greater than 80%
characteristics of COPD Stage II
FEV1/FVC less than 70%;
FEV1 is between 50-80%
characteristics of COPD stage III
FEV1/FVC less than 70%;
FEV1 is between 30-50%
characteristics of COPD stage IV
FEV1/FVC less than 70%;
FEV1 is less than 30%
short acting bronchodilators have a greater risk of this kind of arrhythmia
afib and aflutter
types of bronchodilators
beta 2 agonists and anticholinergics
SE of inhaled anticholinergics
“Oh this drug, it makes me pink. Sometimes, I can’t think or even blink. I can’t see, I can’t pee, I can’t spit, I can’t shit”.
Flushing, confusion, glaucoma, urinary retention, dry mouth, constipation.
Inhaled steroids are started in COPD when
stage III or IV
trx for exacerbations of COPD
prednisone 40 mg daily x 5 days
Most effective intervention for preventing exacerbations and progression of COPD
stop smoking
health promotion for COPD
annual flu, pneumonia vaccine, exercise
Goal of asthma management
prevent exacerbations
triad s/s of asthma
wheezing, cough, SOB; symptoms worse at night
risk factors of asthma
young age, family hx, atopic disease
intermittent asthma
symptoms less than twice a week
mild persistent asthma
symptoms more than twice a week but not daily
moderate persistent asthma
symptoms daily
severe persistent asthma
throughout the day
trx for intermittent asthma
SABA
trx for mild persistent asthma
low dose ICS + SABA
trx for moderate persistent asthma
medium dose ICS + LABA + SABA
Education for asthma patient
RTC if SABA is used more than twice a week, patient needs step up therapy.
LABA can be used alone in
COPD
med combination with highest risk of death in asthma patient
LABA and SABA; all patients with asthma need a form of ICS
physical exam of those with pneumonia
crackles, dull percussion, increased tactile fremitus
trx for acute bronchitis
symptomatic
trx for pertussis
macrolides
s/s of common cold
fever, sore throat, runny nose, nasal congestion; self-limited for 4-10 days
Prior BCG vaccine
not a contraindication for PPD testing if more than 5 years
trx for TB
at least two drugs (rifampin and INH) to prevent resistance
ethambutal for TB can cause
optic neuritis
PPD is positive if less than or equal to 5 mm in people with
hx of HIV, recent contact with infected TB person, children with symptoms, immunocompromised
PPD is positive if less than or equal to 10 mm in people with
immigrants, drug users, healthcare workers, homeless, jail, nursing home
two step testing for TB
do first PPD, if negative, then repeat in 1-3 weeks, if still negative, then patient is truly negative
theophylline
can be used for asthma as a bronchodilator; however it has a narrow level and has many drug interactions
Leukotriene inhibitors
montelukast, zileuton
mast cell stabilizer
cromolyn sodium
Zileuton requires
monitoring LFTs
peak expiratory flow is measured by
HAG: height, age, gender
croup is mostly caused by
parainfluenza type 1
croup is common in those
less than 3
s/s of croup
stridor, barking cough, fever
Primary spontaneous pneumothorax occurs mostly in
tall, thin men who smoke
complication of COPD
right ventricular hypertrophy (cor pulmonale)
cautiously give nicotine in those with
coronary artery disease, nicotine is a potent vasoconstrictor
black box warning with Chantix
increase in hostility, agitation, suicide; increase risk of heart attacks
common causes of pleuritic chest pain
viral, bacterial infections; TB
trx for pleuritic chest pain
indomethacin
