NURS 6501 Exam 2 Already Passed!!

NURS 6501 Exam 2 Already Passed!! Clinical Presentation of Acute Bronchitis cough (productive or not) is most likely but fever, muscle aches, and fatigue can also be present. Burning substernal pain with breathing in. Cough lasts longer than 7 days but shouldn't last more than 3 weeks. Best Treatment Viral Bronchitis most people improve on their own antitussives like dextromethorphan or benzonatate helps short term codeine or hydrocodone if cough is severe antipyretics, bed rest and increased fluid consuption classic signs of asthma intermittent dyspnea, wheezing, coughing (worse at night), SOB, chest tightness. Hx or presence of respiratory sx AND demonstrated variable expiratory airflow obstruction. Inflammation and bronchial hyper-responsiveness. PE: wheezing, eachypnea, tachycardia, prolonged expiratory phase of respiration, pale/swollen nasal membranes, cobblestone pharyngeal wall, cough, nasal polyps. Asthma Triggers tobacco smoke, beta blockers, aspirin, and NSAIDs URI are #1 molds, pollen, dust mites, cockroaches, and animal danger best diagnostic test for asthma FEV1 (spirometry) mild is 80% or more moderate is 60-80 severe is less than 60 Rule of 2 for asthma symptoms requiring SABA more than twice a week nocturnal symptoms more than twice per month refill of quick relief inhaler more than two times per year mild asthma Symptoms 2x/week, FEV1 80% of best moderate asthma Symptoms 2x/week, FEV1 60-80% severe asthma Continuous symptoms, FEV160%, frequent nocturnal symptoms, hospitalizations stepwise treatment of asthma intermittent: SABA mild persistent: low dose ICS or leukotriene modifier moderate persistent: low dose ICS + LABA, med ICS, LAMA +ICS severe persistent: med or high ICS + LABA (may add leukotriene modifier, tiotripium, biologic agent) black box warning for asthma treatment must prescribe ICS with LABA, never a LABA alone criteria for diagnosing asthma with pulmonary function test results variability testing before and after bronchodilator, from one office visit to another or before after bronchoprovocation challenge. Increase FEV of 12% or more, accompanied by an absolute increase in FEV1 of at least 200 mL hemoptysis coughing up blood hematemesis vomiting blood epistaxis nosebleed pleural effusion abnormal amount of fluid within the pleural space. The pleura is a serous membrane covering the lung parenchyma, mediastinum, diaphragm and rib cage. Two pleural membranes: parietal (lines chest cavity) and visceral (covers both lungs). Occurs when fluid formation exceeds fluid absorption. CHF is one of most common causes. pleural effusion symptoms dyspnea, nonproductive cough, pleuritic chest pain and activity intolerance. Dyspnea worsens with recumbent positions, cough worsens as size of effusion increases. Pleuritic pain is sharp, unilateral and localized to affected area, exacerbated by deep inspiration cough or movement of upper body. first line of treatment fo community acquire pneumonia for healthy adult a macrolide is first line (Azithromycin, Erythromycin); doxycycline if pt unable to take macrolide. first line of treatment of community acquired pneumonia for individuals with comorbidities fluoroquinolone or a beta lactam plus a macrolide antibiotic is recommended. first line of treatment of community acquired pneumonia for pts in ICU a beta lactam (ceftriaxone, cefotaxime or ampicillin-sulbactam) plus either azithromycin and fluoroquinolone (levofloxacin etc). bacterial community acquired pneumonia gram positive bacteria S. pneumoniae, common in individuals with comorbidities like diabetes, COPD, asplenia, advanced age, cigarette smoking, congestive heart failure, dementia, alcoholism or immunosuppression abrupt onset of high fever with chills, productive cough with purulent sputum and signs of consolidation like egophony, increased fremitus, dullness to percussion, rales and rhonchi. . bacterial community acquired pneumonia gram negative bacteria H. influenzae, typically caused by an encapsulated strain. older adults and those with underlying lung conditions are most susceptible to bacterium. Abrupt onset of fever, shaking chills, cough with purulent sputum. older adults presentation of pneumonia lethargy, lack of appetite, increased falls and mental status changes pneumonia presentation fever, chills, malaise, cough with or without sputum production. Rales that do not clear with a cough, bronchial breath sounds, egophony. Younger individuals (48) typically exhibit fever. Older adults have lethargy, lack of appetite, increased falls and mental status changes. CXR shows consolidation. influenza presentation abrupt onset of symptoms fever, myalgias, headache, sore throat, dry cough, rhinitis, nasal congestion, fatigue, chills. Temperature rises fast and decreases by the 2nd or third day. Symptoms last 1-2 weeks, cough can last up to 2 weeks treatment of influenza early treatment with oseltamivir and zanamivir (contraindicated in asthma or chronic lung disease d/t SE of bronchospasm) is recommended for those at high risk to prevent influenza pneumonia (treat if they present 48 hrs from onset of symptoms, also treat healthcare providers that care for patients who are high risk. Can also use peramivir IV x1 dose. Otherwise, rest, fluid intake, antipyretics and NSAIDs. D dimer test screen whether or not a clot has just been dissolved by fibrinolysis (part of a fibrin protein), CT angiogram to diagnose a PE. D dimers have a good negative predictive value but poor positive predictive value of PE. D dimer is not helpful postoperatively, trauma, hospitalization or in critically ill patients as coagulation and fibrolysis is high. HTN meds for African Americans thiazides (chlorothiazide, hydrochlorothiazide) and calcium channel blockers (amlodipine, diltiazem, nicardipine) HTN meds for Asian Americans Calcium channel blockers and ACE inhibitors four patient groups that meet indications for starting statin therapy All diabetics (40-75 years old) All with elevated LDL (190) Patients age 40-75 years old (based on 10 year risk) Hx of ASCVD chronic stable angina beta blockers and calcium channel antagonists are first line options short acting nitrates for symptom relief low dose aspirin and statin are prescribed to prevent cardiovascular events 3 cardiac conditions with high risk of adverse outcomes prosthetic cardiac valves prosthetic material used for cardiac valve repair prior episode of infectious endocarditis unrepaired cyanotic congenital heart disease cardiac transplant recipients with development of valvulopathy orthostatic hypotension symptoms Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position. Lightheadedness, dizziness, nausea, vomiting, loss of consciousness can occur. Common causes of secondary hypertension