Adult Nurse Practitioner Review for Certification on the Respiratory System
Terms in this set (64)
a lower-pitched, booming sound found when too much air is present, as in emphysema or pneumothorax
predominates over normal lung tissue
indicates abnormal density, suchs as tumor, atelctasis, pneumonia, plerual effusion
-palpable vibrations sensed by the palmar base--> should be equal bilaterally
-pneumonia causes increased fremitus
-obstruction, thickening of lungs causes decreased fremitus
Increased loudness of whispering "1-2-3" while listening using a stethoscope on the lung fields on a patient's back. Usually it is not heard when whispered. With small amounts of consolidation, the whispered voice is transmitted very clearly and distinctly, although still somewhat faint: it sounds as if the person is whispering right into stethoscope "one-two-three". Represents lung consolidation as in pneumonia or cancer.
Term to include both emphysema and chronic bronchitis. The disease is characterized by the loss of elastic recoil of the lungs & alveoolar damage that takes decades.
Common risk factors for COPD
Cigarette smoking and older age
what is the definition of asthma?
chronic airway inflammation with superimposed bronchospasm
PE of a patient with asthma flare?
hyperresonance on thoracic percussion
decreased tactile fremitis
wheeze (expiratory first, then inspiratory later)
prolonged expiratory phase of forced exhalation
^ AP diameter
reduced FEV1 or PEF
TX of moderate persistent asthma
beta 2 agonist
Stimulates Beta 2 receptors, bronchodilation. Used for COPD and asthma. Ex: Albuterol or Ventolin (isoproterenol)
leukotriene receptor antagonist
-binds to D4 leukotriene receptors in respiratory tissues
-Drug Effects: inflammatory inhibitor
-prevent bronchial smooth muscle contraction
-decreased mucous secretion
-decreased vascular permeability
-prevents migration of neutrophils and lymphocytes
inhaled corticosteroids: role in asthma
reduce s/s and improves pulmonary function in pts with mild asthma
-reduce or eliminates need for oral corticosteroids in pts with more severe dz
-reduce bronchial reactivity
-guidelines recommend for pts who require B-2-agonist more than occasionally
asthma rx goals
prevent chronic and troublesome s/s
require infrequent use (<= /> expectations of and satisfaction with asthma care
prevent recurrent exacerbations of asthma and minimize the need for ED visits or hospitalizations
minimize adverse AEs of medications
long acting beta-2-agonists (2):
short acting beta-2-agonists (3):
albuterol (inh, tab), levalbuterol (inh), terbutaline (inh, tab, sc)
SE of ICS
Clinical findings of asthma
-major symptoms during an attack: wheezing, cough, dyspnea, chest tightness
-wheezing usually more pronounced during expiration
What is the therapeutic objective of using inhaled ipratropium bromide in the treatment of acute asthma exacerbation?
inhibition of muscarinic cholinergic receptors
ipratropium bromide (atrovent)
Contraindications: Hypersensitivity to Atropine or Soybeans.
S.E.: Palpitations, Nervousness, Dizziness, HA, N/V and Dry Mouth.
Spiriva, Combivent, MOA - inhibit smooth muscle, bronchodilation, onset 15m, SE - anticholinergic effect
Step 1 approach for managing asthma
Step 2 approach for managing asthma
Low Dose ICS. Alt: Cromolyn, LTRA, Nedocromil, or Thophyline
Step 3 approach for managing asthma
Preferred: Low-dose ICS + LABA or med-dose ICS
Alternatives: Low-dose ICS + either LTRA, Theophiline, or Zileufon
Step 4 approach for managing asthma
Preferred: Med-dose ICS or LABA. Alternative: Med-dose ICS + either LTRA, Theophylline, or Zileuton
Step 5 approach for managing asthma
Preferred: High-dose ICS + LABA and Consider Omalizumab for pts who have allergies
Step 6 approach for managing asthma
Preferred: high-dose ICS + LABA + oral corticosteroid and consider omalizumab for pts who have allergies
mast cells stabilizers
-inhibit mast cell activation
-must be taken prophylactically because cannot reverse sx
-inhalers for asthmatics: cromolyn sodium, nedocromil sodium
-nasal spray and eye drops for allergic rhinitis: cromolyn, triamcinolone
Characteristic of early stage of chronic bronchitis?
excessive mucus production
Characteristic of emphysema?
enlargement of air spaces distal to the terminal bronchiole
What organism is associate with COPD exacerbation in a person with advance disease and repeated exacerbation?
COPD rx goals
relief of acute s/s
minimize exacerbation frequency
prevent progression of pulmonary remodeling
Treatment of COPD
1. Ipratropium (atrovent) QID (anticholinergic)
2. Add albuterol (short-acting B2 Agnoist) inhaler or atrovent/albuterol mix (combivent)
3. add theophylline-but narrow therapeutic profile and drug-drug interaction
4. Start O2 therapy
5. Consider prednisone for excerbations
How is COPD diagnosed?
- pulmonary function testing
- postbronchodilatory ratio of FEV₁(forced expiratory volume in one second)/FVC(forced vital capacity) of <=0.7 shows non-reversible airflow limits
- severity categorized by degree of impairment in FEV:FVC ratio
Mild COPD (Gold 1)
FEV 1 2:: 80% predicted
Mod COPD (Gold 2)
50% FEV 1 < 80% predicted
Severe COPD (Gold 3)
30% FEV 1 <50% predicted
Very Severe COPD (Gold 4)
FEY1 < 30% predicted
You examine a 28 year old woman who has emigrated from a country where TB is endemic. She has documentation of receiving bacille Calmette-Guerin (BCG) vaccine as a child. With this information, you consider that:
Isoniazid therapy should be given for 6 months before TST is undertaken
Does a 45 year old woman with type 2 DM & CXR finding consistent with previous TB and 7 mm induration have TB?
A 21 year old man with no identifiable TB risk factors and a 10 mm induration?
A 31 year old man with HIV and a 6 mm induration
A 45 year old woman from a country where TB is endemic who has an 11 mm induration
A 42 year old woman with RA who is taking etanercept (enbrel) who has a 7 mm induration?
What is the clinical presentation of TB?
Evolved 4-6 weeks
Mild blood tinged sputum
An induration of >/= 10mm is considered positive in
recent immigrants (< 5yrs)
injection drug user
resident & employees of high risk congregate settings
mycobacterology lab personnel
person with clinical conditions that places them at high risk
children <4 yo
infants, children, adol., exposed to adults in high risk categories.
Treatment of TB
Uses 3 drugs initially because of higher rates of resistant strains against INH and rifampin. Used for 6-9 months
Treatment of CAP-a 42 yo man with no comorbidity & no recent antimicrobial use
Treatment of CAP-46 yo that can't take a macrolide
Treatment of CAP-78 yo with COPD
high dose of amoxicillin with a macrolide
Treatment of CAP-69 yo with HF & DM
Treatment of CAP-58 yo woman who has a dry cough, headache, malaise, no recent ABX and no comorbidity who takes not meds
What is a quality of respiratory floroquinolone?
activity against drug resistant S. pneumoniae (DRSP)
The mechanism of resistance of DRSP is through t the cell's
alteration in protein binding site
The primary mechanism of antimicrobial resistance of H. Influenzae is through the organism's:
What is a characteristic of a macrolide
effective against atypical pathogens
How long should you treat CAP with ABX?
What are the modifying factors for increased P. aeruginosa risk?
structural lung disease
Which strategies help facilitate the development of resistant pathogens?
longer course of therapy
lower antimicrobial dosage
prescribing a broader spectrum agent
When should you give influenza & antipneumoccocal vaccine to a 62 yo hospitalized with CAP?
Protein Synthesis Inhibitor. MOA: 1) Reversibly binds the 50s ribosomal subunit. 2) Blocks translocation of newly synthesis peptidyl tRNA from A site to P-site. 3) Blocks transpeptidation. Bacteriostatic effect. Subclass: (mECA or ACE) Erythromycin, Clarithromycin, Azithromycin
Which type of meds provide enhanced activity against DRSP and atypical organism coverage and stability in the presence of beta-lactamase?
Respiratory fluoroquinolones (e.g., levofloxacin [Levaquin], gemifloxacin [Factive], moxifloxacin [Avelox])
Pertussis (whooping cough) is most often transmitted via:
Which of the following is an appropriate antimicrobial therapy for the person with pertussis?