NR 661 Week 4 VISE Assessment, Familiarize Yourself Study Guide

Know presentation, DX and Management Diagnoses List 1. Acute bronchitis- DESCRIPTION Acute cough due to inflammation of the bronchioles, bronchi, and trachea; usually follows an upper respiratory infection or exposure to a chemical irritant. ETIOLOGY • Adenovirus • Rhinovirus • Influenza A and B • Parainfluenza RISK FACTORS • Upper respiratory infection • Air pollutants • Smoking and/or secondary exposure • Reflux esophagitis • Allergy • Chronic obstructive pulmonary disease • Acute and chronic sinusitis • Infants • Older adults • Immunosuppression ASSESSMENT FINDINGS • Cough: dry and nonproductive, then productive; may be purulent • URI symptoms • Fatigue • Fever due to bacterial infection; more common in smokers and patients with COPD • Fever due to viral cause (unusual after first few days) • Burning sensation in chest • Crackles, wheezes • Chest wall pain DIFFERENTIAL DIAGNOSIS • Pneumonia • Tuberculosis • Asthma DIAGNOSTIC STUDIES • Decision criteria for chest radiographs: tachypnea, hypoxia, fever, abnormal lung exam • Only consider chest X-ray if high index of suspicion for pneumonia or superimposed heart failure • Consider PPD: expect negative results • PREVENTION • Smoking cessation • Avoid known respiratory irritants • Treat underlying conditions that contribute to risk (asthma, gastroesophageal reflux disease, etc.) • Influenza immunization for high-risk populations NONPHARMACOLOGIC MANAGEMENT • Increase fluid intake • Use humidifier • Rest • Smoking cessation • Consider honey in children older than 1 year • Patient education about disease, treatment, expected cause of cough, and emergency actions PHARMACOLOGIC MANAGEMENT • Cough suppressants for nighttime relief • Avoid antihistamines • Antibiotics if organism is bacterial • Antivirals if influenza diagnosed • Decongestants and antihistamines are ineffective unless sinusitis or allergy is underlying • Bronchodilators if wheezing or prior history of asthma Although antibiotics are commonly prescribed, they are NOT recommended. ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT Class Drug Generic name (Trade name®) Dosage How Supplied Comments Cough Suppressants Suppress cough in the medullary center of the brain dextromethorphan/guaifenesi n Adult: 10 mL q 4 hr Max: 4 doses in 24 hours Children 6-12 years: 5 mL q 4-6 hr; Max: 4 doses in 24 hr Children <6 years: not recommended • Do not use if taking an MAO inhibitor or for 2 weeks after stopping an MAO inhibitor • Contraindicated in Parkinson’s disease • Potential drug interaction with some SSRIs • Avoid in patients who are having difficulty clearing secretions Robitussin DM various generics Dextromethorphan 10 mg/5 mL Guaifenesin 100 mg/5 mL Although antibiotics are commonly prescribed, they are NOT recommended. ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT dextromethorphan Adult and ≥12 years: 10 mL q 6-8 hr prn for cough Max: 4 doses in 24 hr Children 6-12 years: 5 mL every 6- 8 hr prn for cough Max: 4 doses in 24 hr 4-6 years: 2.5 mL every 6-8 hr prn for cough Max: 4 doses in 24 hr • Do not use if taking an MAO inhibitor or for 2 weeks after stopping an MAO inhibitor • Contraindicated in Parkinson’s disease • Potential drug intervention with some SSRIs • Avoid in patients who are having difficulty clearing secretions • Do not use if on a sodium restricted diet Delsym Dextromethorphan 15 mg/5 mL (alcohol free/orange or grape flavor) Adult: 10 mL q 12 hr Children 6-12 years: 5 mL q 12 hr Children 4-6 years: 2.5 mL q 12 hr ..........................................................................continued.............DOWNLOAD FOR BEST SCORES