AH1 Exam 1 Blueprint
1. Tuberculosis
a. Priority actions
i. Check ABC’s first thing upon entering room - #1 priority
ii. Wear N95 or powered air purifying respirator
iii. Negative airflow room
iv. PPE
v. Cough and expectorate sputum into trash bag
vi. Administer heated and humidified oxygen therapy as prescribed o
Encourage foods that a rich in protein, iron and vitamins C and B
b. Assessment findings
i. Progressive fatigue
ii. Malaise
iii. Anorexia
iv. Weight loss
v. Chronic productive cough
vi. Purulent sputum, possibly blood tinged
vii. Night sweats
viii. Hemoptysis
ix. Pleuritis
x. Low grade temperature
c. Pt. education
i. Airborne precaution is not needed for home setting.
ii. Exposed family members should be tested or TB
iii. Continue medication for 6-12 months; Multidrug resistant for 2 years;
Follow-care
iv. for 1 year
v. Every 2-4 weeks= sputum samples
1. 3 consistent neg. sample= not infectious o Wear mask in public
places
vi. Dispose contaminated tissues into a plastic bag
d. Medications
i. Rifampin (Rifadin)
1. Side effects: discoloration of urine, stools, and other bodily fluids
(orange), oral contraceptives become ineffective.
2. Adverse effects: hepatitis (symptoms of fever, nausea, vomiting, loss
of appetite, jaundice, unusual bleeding)
ii. Isoniazid (INH) – primary antitubercular drug, most widely used
1. Adverse effects: peripheral neuropathy (emergency!), hepatotoxicity,
abdominal pain, jaundice, visual changes.
iii. Pyrazinamide (PZA)
1. Adverse effects: increased uric acid
iv. Ethambutol
, 1. Adverse effects: visual problems (stop meds)
v. Streptomycin
1. Adverse effects: ototoxic (ears)
2. Only for multi-drug resistant TB
e. Complications
i. Miliary TB:
1. Invades bloodstream and can spread to multiple body organs
2. Headaches, neck stiffness, drowsiness
3. Pericarditis:
a. Dyspnea, swollen neck veins, pleuritic pain, and hypotension
due to accumulation of fluid in the pericardial sac that
inhibits the heart’s ability to pump effectively
4. Treatment: same as pulmonary TB
2. COPD
a. Risk factors
i. Advanced age
ii. Cigarette smoking
iii. Alpha1-antitrypsin (AAT) deficiency
iv. Exposure to environmental factors (air pollution)
b. Priority actions
i. Administer 2-4 L/min of O2 via nasal cannula or up to 40% venturi mask
ii. Position pt in high-Fowlers
iii. Encourage effective coughing
iv. Monitor serum levels for toxicity (theophylline)
v. Watch for tremors and tachycardia (albuterol)
vi. Monitor heart rate. Palpitations can occur, which can indicate toxicity of
ipratropium.
vii. Suctioning
viii. Pursed lip breathing
ix. Manage anxiety
x. Hydrate and prevent weight loss and infection
c. Oxygenation & limits
i. Too much oxygen knocks out respiratory drive
ii. Ideal oxygenation for COPD is 88-92%
iii. Emphysema: Loss of lung elasticity and hyperinflation of lung tissue
1. Cause destruction of the alveoli, leading to decreased surface area for
gas exchange, carbon dioxide retention, and respiratory acidosis
2. Pink Puffer
iv. Chronic bronchitis: Inflammation of the bronchi and bronchioles due to
chronic exposure to irritants
1. Blue bloaters
2. Affects middle-age to older adults
d. Assessment findings
i. Wheezing
ii. Pursed lip breathing
, iii. Chronic cough (productive – esp. in morning)
iv. Barrel chest
v. Accessory muscles
vi. Dyspnea (esp. upon exertion)
vii. Prolonged expiratory time
viii. Hyperresonance on percussion due to trapped air
ix. Crackles and wheezes
x. Rapid and shallow respirations
xi. Bronchitis – increased sputum
xii. Digital clubbing
xiii. Easily fatigued
xiv. Frequent respiratory infections
xv. Use of accessory muscles
xvi. Orthopneic
xvii. Cor pulmonale
xviii. Thin in appearance
e. Medications
i. Bronchodilators for maintenance
1. Beta blockers (ie albuterol, salmeterol)
a. Short acting
2. Cholinergic antagonists (ipratropium): block PNS, allows for SNS
effect of bronchodilation and decreased secretions
a. Long acting
3. Methylxantines (theophylline): relaxes smooth muscles of bronchi
a. Use only if other tx is ineffective
ii. Anti-inflammatory agents:
1. Decrease airway inflammation
2. Corticosteroids (Fluticasone and prednisone)
a. Adverse effects: immunosuppression, fluid retention,
hyperglycemia, hypokalemia, poor wound healing, black,
tarry stools.
3. Leukotriene antagonists (monteklaust)
4. Mast cell stabilizers (cromolyn)
5. Monoclonal antibodies (omalizumab)
iii. Mucolytics thin secretions and make them easier to expel (guaifenesin,
nebulizer tx such as acetylcysteine and dornase alfa)
1. Guaifenesin and DXM used together frequently
f. Pt. education
i. Increase fluids to thin secretions
ii. High calorie foods to promote energy
iii. Hand hygiene
iv. Smoking cessation
v. Family should not smoke around 02
3. Emphysema
a. Risk factors
i. Tobacco or marijuana smoke
1. Tuberculosis
a. Priority actions
i. Check ABC’s first thing upon entering room - #1 priority
ii. Wear N95 or powered air purifying respirator
iii. Negative airflow room
iv. PPE
v. Cough and expectorate sputum into trash bag
vi. Administer heated and humidified oxygen therapy as prescribed o
Encourage foods that a rich in protein, iron and vitamins C and B
b. Assessment findings
i. Progressive fatigue
ii. Malaise
iii. Anorexia
iv. Weight loss
v. Chronic productive cough
vi. Purulent sputum, possibly blood tinged
vii. Night sweats
viii. Hemoptysis
ix. Pleuritis
x. Low grade temperature
c. Pt. education
i. Airborne precaution is not needed for home setting.
ii. Exposed family members should be tested or TB
iii. Continue medication for 6-12 months; Multidrug resistant for 2 years;
Follow-care
iv. for 1 year
v. Every 2-4 weeks= sputum samples
1. 3 consistent neg. sample= not infectious o Wear mask in public
places
vi. Dispose contaminated tissues into a plastic bag
d. Medications
i. Rifampin (Rifadin)
1. Side effects: discoloration of urine, stools, and other bodily fluids
(orange), oral contraceptives become ineffective.
2. Adverse effects: hepatitis (symptoms of fever, nausea, vomiting, loss
of appetite, jaundice, unusual bleeding)
ii. Isoniazid (INH) – primary antitubercular drug, most widely used
1. Adverse effects: peripheral neuropathy (emergency!), hepatotoxicity,
abdominal pain, jaundice, visual changes.
iii. Pyrazinamide (PZA)
1. Adverse effects: increased uric acid
iv. Ethambutol
, 1. Adverse effects: visual problems (stop meds)
v. Streptomycin
1. Adverse effects: ototoxic (ears)
2. Only for multi-drug resistant TB
e. Complications
i. Miliary TB:
1. Invades bloodstream and can spread to multiple body organs
2. Headaches, neck stiffness, drowsiness
3. Pericarditis:
a. Dyspnea, swollen neck veins, pleuritic pain, and hypotension
due to accumulation of fluid in the pericardial sac that
inhibits the heart’s ability to pump effectively
4. Treatment: same as pulmonary TB
2. COPD
a. Risk factors
i. Advanced age
ii. Cigarette smoking
iii. Alpha1-antitrypsin (AAT) deficiency
iv. Exposure to environmental factors (air pollution)
b. Priority actions
i. Administer 2-4 L/min of O2 via nasal cannula or up to 40% venturi mask
ii. Position pt in high-Fowlers
iii. Encourage effective coughing
iv. Monitor serum levels for toxicity (theophylline)
v. Watch for tremors and tachycardia (albuterol)
vi. Monitor heart rate. Palpitations can occur, which can indicate toxicity of
ipratropium.
vii. Suctioning
viii. Pursed lip breathing
ix. Manage anxiety
x. Hydrate and prevent weight loss and infection
c. Oxygenation & limits
i. Too much oxygen knocks out respiratory drive
ii. Ideal oxygenation for COPD is 88-92%
iii. Emphysema: Loss of lung elasticity and hyperinflation of lung tissue
1. Cause destruction of the alveoli, leading to decreased surface area for
gas exchange, carbon dioxide retention, and respiratory acidosis
2. Pink Puffer
iv. Chronic bronchitis: Inflammation of the bronchi and bronchioles due to
chronic exposure to irritants
1. Blue bloaters
2. Affects middle-age to older adults
d. Assessment findings
i. Wheezing
ii. Pursed lip breathing
, iii. Chronic cough (productive – esp. in morning)
iv. Barrel chest
v. Accessory muscles
vi. Dyspnea (esp. upon exertion)
vii. Prolonged expiratory time
viii. Hyperresonance on percussion due to trapped air
ix. Crackles and wheezes
x. Rapid and shallow respirations
xi. Bronchitis – increased sputum
xii. Digital clubbing
xiii. Easily fatigued
xiv. Frequent respiratory infections
xv. Use of accessory muscles
xvi. Orthopneic
xvii. Cor pulmonale
xviii. Thin in appearance
e. Medications
i. Bronchodilators for maintenance
1. Beta blockers (ie albuterol, salmeterol)
a. Short acting
2. Cholinergic antagonists (ipratropium): block PNS, allows for SNS
effect of bronchodilation and decreased secretions
a. Long acting
3. Methylxantines (theophylline): relaxes smooth muscles of bronchi
a. Use only if other tx is ineffective
ii. Anti-inflammatory agents:
1. Decrease airway inflammation
2. Corticosteroids (Fluticasone and prednisone)
a. Adverse effects: immunosuppression, fluid retention,
hyperglycemia, hypokalemia, poor wound healing, black,
tarry stools.
3. Leukotriene antagonists (monteklaust)
4. Mast cell stabilizers (cromolyn)
5. Monoclonal antibodies (omalizumab)
iii. Mucolytics thin secretions and make them easier to expel (guaifenesin,
nebulizer tx such as acetylcysteine and dornase alfa)
1. Guaifenesin and DXM used together frequently
f. Pt. education
i. Increase fluids to thin secretions
ii. High calorie foods to promote energy
iii. Hand hygiene
iv. Smoking cessation
v. Family should not smoke around 02
3. Emphysema
a. Risk factors
i. Tobacco or marijuana smoke
