Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Respiratory NP
Info & Q: NP EXAM
| Question | Answer |
|---|---|
| When you hear "crackles" you must think? | water or fluid |
| Crackles are most commonly associated with fluid overoad conditions such as? | pulmonary edema, CHF and brochitis |
| When you hear "wheezing" you must think? | narrow airway |
| Wheezing is most commonly associated wtih conditions such as? | asthma, foreign body aspiration, tumor, bronchitis |
| The main complaint that a pt has with acute bronchitis is? | cough |
| Acute bronchitis is usually this type of infection? | viral |
| Acute bronchitis usually accompanies or follows ________? | URI |
| What patients might cause you to think that their acute bronchitis might be "bacterial" instead of viral? | Smokers, immunocompromised (RA because of tx, HIV, Steroid), chronic illness (CHF, DM, Lupus) |
| The guidelines often grade interventions, what grade do you want to use? | A |
| If you palpate a Right supraclavicular node in a patient with a cough, what are the red flags? What is included in your Dx Diff? | -supraclavicular nodes drain the chest and breast -it is unilateral -Cancer |
| A pt with acute bronchitis can expect their cough to resolve in about how long? | less than 3 weeks |
| What is the significance of the sputum in a pt that has acute bronchitis? | The sputum has no significance; it is related to the sloughing of epithelial cells in the trachea and bronchi; it may be green and thick or clear and white |
| When considering Pertusis as a Dx Diff, what signs and symptoms may be present? What group of pts might we Dx Diff for Pertusis? | 1.-characteristic but infreq Whoop -minimal or no fever 2. teens and young adults |
| What hx questions are asked for Pertusis? | -have you come into contact with anyone that has pertusis? -what is your vaccine hx? (vaccine could wear down) |
| What is the tx for Pertusis? | - <6 mos old hospitalization - Erythromycin 40-50mg/kg/day divided into 4 doses for 14 days |
| What are 2 "atypical" pneumonia bugs? | -chlamydophilia pneumonia (TWAR) - very common in CAP -m. pneumonia (walking pneumonia) |
| What are 2 "typical" pneumonia bugs? | -Strep pneumonia (most commonly asso with death; rust colored sputum) -H flu(Smokers, COPD, elderly) |
| Differentiate between a nosocomial infection and a communitiy acquired infection (CAP)? | -a nosocomial infection is acquired during a hospitalization or long-term care facility -community infection is acquired form the "community" or environment |
| A pt with pneumonia but no fever probably has what type of pneumonia? | m. pneumonia (walking pneu) |
| Presentation of pt with pneumonia: Constitutional symptoms of pneumonia include: | -Cough, purulent sputum, SOB, chest pain, increased respirations and pulse -fever, malaise and fatigue |
| When is the pneumococcal vaccine given? | -Once at age 65 or older -age 19-64 if increase risk (smoke, chronic disease, steroid) -Now if age 65 and/or 5 yrs since last inj |
| How will the pneumonia vaccine protect you? | It will prevent you from getting the "typical bug" Strep Pneumonia (the one with rust colored sputum that KILLS), You might still get one of the "atypical bugs" (C. pneu or M. pneu) |
| A clinical finding that may be absent in an elderly patient that has bacterial pneumonia is what? | fever (inconsistent sign) |
| An elderly patient with CAP that has renal insufficiency, what are we looking out for? | Pt with renal insuff will not be able to get rid of antibiotics as quickly so we need to give lower dose; but with lower dose there is increase risk for failure so watch closely |
| A patient is dx with pneumonia, If the pt is previously healthy and has not had an antibiotic in the last 90 days give? | -Macrolide (azithromycin, clarithromycin) -if can't then give doxycycline |
| Why give Macrolide (azithromycin, clarithromycin) or doxycycline for pneumonia? | -these target atypical pathogens, which happen to be the most likely bugs (c. pneumonia, m. pneumonia) |
| A patient is dx with pneumonia, he has had an antibiotic in the last 90 days and diabetic then we should give? | -Avoid drug from the same class -guidelines suggest a respiratory "fluroquinolone" -this will help to prevent resistence |
| List 3 Respiratory Fluroquinolones: | 1. moxifloxacin (Avelox) 2. gemifloxacin (Factive) 3. levofloxacin (Levaquin) |
| How long do we treat pt with pneumonia? | -minimally for 5 days -usuall for 10 days |
| Hospital admit criteria for patients is? | CURB 65 |
| CURB 65: | Confusion Urea >7 Resp >30 Bp <90/<60 65 years old |
| After patient with pneumonia gets better what do we want to do? | give the pneumococcal vaccine |
| What test do you use to dx COPD? | Pulmonary Func Test |
| What is the cardinal symptom of COPD? | Dyspnea; first complaint that he comes in with; he will have had the cough and sputum for a while now |
| A pt with emphysema or COPD with have what on CXR? | a flattened diaphragm |
| What position does the COPD or emphysema patient get in when they are short of breath? | They lean over to move the diaphragm up |
| COPD Drugs - Beta agonist; where are your beta receptors? | Beta 1 - heart (one heart) Beta 2 - lungs (two lungs) |
| What happens when the Beta 1 receptors are stimulated? | increase heart rate |
| What hapens when the Beta 2 receptors are stimulated? | dilate the bronchiols |
| What are the types of beta agonist drugs? | Short acting beta agonist Long acting beta agonist |
| We might refer to short acting beta agonist as? How soon do they start to work? Last? | "rescue meds" start working immediately; last about 4 hrs |
| Long acting beta agonist start working in about _____ and last for _____. | -20 minutes and last for about 12 hrs; these are NOT rescue meds |
| What are the classes of drugs we are concerned with when treating COPD ? | 1. Beta agonist 2. Anticholinergics 3. Theophylline 4. Steroids |
| What is the mechanism of action for the anticholinergics? | prevent brochoconstriction |
| What is the suffix for anticholinergics? | "tropium" |
| What is the mechanism of action for the beta 2 agonist? | bronchodilation |
| What are some examples of anticholinergics used to tx COPD ? | ipratropium (atrovent), tiotropium |
| What is an example of a short acting beta agonist used to treat COPD ? | albuterol |
| What is an example of a long acting beta agonist used to treat COPD ? | salmeterol, fomoterol |
| What is the suffix for beta agonist drugs used to treat COPD ? | "terol" |
| What is the mechanism of action for theophylline? | bronchodilator |
| What is the problem with theophylline? | Drug - Drug interaction; theophylline is metabolized in the liver by the cytochrome P450 system so is erythromycin; liver now busy and develop increase in theophylline leading to theophylline toxicity |
| Patients receiving theophylline treatment need to watch what? | SE: nervousness, stimulant (feel shaky), arrythimias (put on CR Monitor) |
| What is the mechanism of action for steroids? | reduce inflammation |
| The suffix for steroids is? | "one" "ide" |
| Examples of steroids is ? | predisone, budesonide |
| What is the last thing we want to give COPD patient for tx purpose? | O2 (they forget to breath) |
| A pt dx with COPD should leave the clinic with a Rx for ? | Albuterol (rescue med)short acting beta agonist |
| A 60 year old male smoking since 20, what drug should we avoid and WHY? | Beta blocker because of the potential to want to tx with "beta agonist" |
| Is Asthma reversible inflammation? | Yes |
| Asthma is a disease of inflammation so give what? | Steroids |
| What do we do to dx Asthma? | Pulmonary Function Test |
| What is the "spacer" for that is used with ICS? | to improve the delivery of med |
| Asthma symptoms less 2 times per week is what class ? | intermittent |
| Asthma symptoms more than 2 times per week but not every day is what class? | mild persistent |
| Asthma symtoms daily is what class? | moderate persistent |
| Continual asthma symptoms is what class? | severe persistent |
| Asthma symtoms less than twice a week tx with? | brochodilator prn |
| If patient is using the brochodilator more than two times per week tx with? | (mild persit) steroid daily and brochodilator prn (rescue) |
| Daily asthma symptoms, not particularly just wheeze maybe cough need tx with? | (mod persist) daily steroid and long acting brochodilator (advair - fluticasone and salmeterol) |
| Asthma symptoms continuously daily need what tx? | PUNT |
| What is the primary screen tool for TB? | Mantoux Skin Test (PPD) |
| How do we dx TX? | Sputum speciman |
| If patient has positive skin test then why do we get CXR? | To see if patient has active disease; (sputum takes about 4 weeks to grow) |
| What is the immunization BCG for? | TB |
| Long term use of steroids (inhaled and oral) we must think potential SE? | Eyes and Bones |
Created by:
dprest
Popular Nursing sets