NURS 642 Exam 4 Questions and Answers
pulmonary tuberculosis phases
Intensive phase (< 8wks)• Continuation Phase (4mo after)•
Latent Phase (6-9mo)
pulmonary tuberculosis 4 medications of treatment during the intensive phase
•Pyrazinamide, Rifampin,
Isoniazid,
Ethambutol
Medications during the continuation phase of TB
INH AND RIFAMPIN
LATENT PHASE TB MEDICATIONS
•INH x 9mo: daily or twice weekly
•INH x 6mo: daily or twice weekly
•INH + RIF x 3mo once weekly
•RIF x 4 months daily
Active Infection must be R/O BY
Negative Sputum cx q8h x 3•
IF acid-fast bacillus(AFB)/Mycobacterium TB (Mtb)
Limit high risk visitors
TB Symptoms:
Cough > 3wks (hemoptysis), Night sweats, Fever, Pleuritic CP
Elderly: Most likely non-specific
TB DAIGNOSIS
,•Rapid Diagnosis: MTB/RIF Assay (Checks Mtb and rifampin resistance)
•CXR (Mainstay)
Findings (Rarely Normal): Active lesions vs. scarring of past infection
•PPD (Assesses does NOT diagnose): Often negative <8-10 wks
PPD SKIN TEST
Often negative <8-10 wks
•Cut-Offs: 48 - 72 hr after administration (Induration)
•15 mm: those without risk factors
•10 mm: "healthy" with risk factors (such as healthcare workers, foreign-born persons)
•5 mm: household contact, CXR suspicious, and immunocompromised
pleural effusion
abnormal accumulation of fluid in the pleural space
Breast and lung cancer: 50% may develop pleural effusions (poor prognosis)
TRANSUDATIVE PLEURAL EFFUSION
Systemic causes: CHF, nephrotic sx, cirrhosis:
No pulm dz (HF ~90%)
Aspiration fluid: Similar glucose to serum and low WBC (<1000)
HF = Diuretics
Exudative pleural effusion
Pulm dz, infection (Malignancy ~50%)
Aspiration fluid: High Protein & LDH on (exudes proteins)
PLEURAL EFFUSION DIAGNOSIS
,Once blunting of the costovertebral angles (which requires at least 250cc) is seen the diagnosis
is made.
CXR (Upright PA & Lateral - 175mL to visualize)
High Suspicion and <175mL = Lateral Decubitus (75mL)
HUMAN INFLUENZA
PRIMARILY B AND C - START ANTIVIRALS ASAP
STATIN INITIATION
•Do not: initiate if K > 5.5, combine with ARB, pregnant
•ACC/AHA Guidelines:
1. Patients with any form of clinical ASCVD
2. Patients with primary LDL >/= 190 (ASCVD)
3. Patients with DM, 40-7yo w/ LDL 70 to 189
4. Patients w/o DM, 40-75yo w/ estimated 10-year ASCVD risk ≥ 7.5%
HTN, PRIMARY
(95%): No one identifiable cause (Genetic or lifestyle)
OSA, High Na diet, ETOH, Smoking, NSAIDs
HTN, SECONDARY
Something is Causing (Cushings)
•High Suspicion Age < 50
HTN TREATMENT
< 55Y/O
GOAL SPB <140/90
1st line: Lifestyle modification
, Look for secondary cause in young patients
Non-blacks: Thiazide, CCB, ACEI, ARB
Black: Thiazide, CCB
HTN TX FOR CKD
Goal BP < 140/90
ACE-inhibitor or ARB (regardless of race of DM)
HTN GOAL > 55 Y/O
BP GOAL < 150/90
ACC/AHA GUIDELINES FOR HTN ACS/MI, HF, REDUCED EF
•β blocker or ACE-I for EF ≤ 40% and symptomatic, stable HF
•Β blocker AND ACE-I or ARB for MI or ACS with reduced EF
HTN MAY LEAD TO
PAD: Critical limb ischemia (CLI) is the most severe
HALLMARK SIGN OF CRITICAL LIMB ISCHEMIA
CLAUDICATION• - - Elderly: Atypical Signs (Limb heaviness, numbness, soreness)
DX OF CLAUDICATION
Ankle brachial index (+PAD < 0.9)
0.71 - 0.90: mild
0.41 - 0.70: moderate
≤ 0.40: severe
TREATMENT FOR CLAUDICATION
pulmonary tuberculosis phases
Intensive phase (< 8wks)• Continuation Phase (4mo after)•
Latent Phase (6-9mo)
pulmonary tuberculosis 4 medications of treatment during the intensive phase
•Pyrazinamide, Rifampin,
Isoniazid,
Ethambutol
Medications during the continuation phase of TB
INH AND RIFAMPIN
LATENT PHASE TB MEDICATIONS
•INH x 9mo: daily or twice weekly
•INH x 6mo: daily or twice weekly
•INH + RIF x 3mo once weekly
•RIF x 4 months daily
Active Infection must be R/O BY
Negative Sputum cx q8h x 3•
IF acid-fast bacillus(AFB)/Mycobacterium TB (Mtb)
Limit high risk visitors
TB Symptoms:
Cough > 3wks (hemoptysis), Night sweats, Fever, Pleuritic CP
Elderly: Most likely non-specific
TB DAIGNOSIS
,•Rapid Diagnosis: MTB/RIF Assay (Checks Mtb and rifampin resistance)
•CXR (Mainstay)
Findings (Rarely Normal): Active lesions vs. scarring of past infection
•PPD (Assesses does NOT diagnose): Often negative <8-10 wks
PPD SKIN TEST
Often negative <8-10 wks
•Cut-Offs: 48 - 72 hr after administration (Induration)
•15 mm: those without risk factors
•10 mm: "healthy" with risk factors (such as healthcare workers, foreign-born persons)
•5 mm: household contact, CXR suspicious, and immunocompromised
pleural effusion
abnormal accumulation of fluid in the pleural space
Breast and lung cancer: 50% may develop pleural effusions (poor prognosis)
TRANSUDATIVE PLEURAL EFFUSION
Systemic causes: CHF, nephrotic sx, cirrhosis:
No pulm dz (HF ~90%)
Aspiration fluid: Similar glucose to serum and low WBC (<1000)
HF = Diuretics
Exudative pleural effusion
Pulm dz, infection (Malignancy ~50%)
Aspiration fluid: High Protein & LDH on (exudes proteins)
PLEURAL EFFUSION DIAGNOSIS
,Once blunting of the costovertebral angles (which requires at least 250cc) is seen the diagnosis
is made.
CXR (Upright PA & Lateral - 175mL to visualize)
High Suspicion and <175mL = Lateral Decubitus (75mL)
HUMAN INFLUENZA
PRIMARILY B AND C - START ANTIVIRALS ASAP
STATIN INITIATION
•Do not: initiate if K > 5.5, combine with ARB, pregnant
•ACC/AHA Guidelines:
1. Patients with any form of clinical ASCVD
2. Patients with primary LDL >/= 190 (ASCVD)
3. Patients with DM, 40-7yo w/ LDL 70 to 189
4. Patients w/o DM, 40-75yo w/ estimated 10-year ASCVD risk ≥ 7.5%
HTN, PRIMARY
(95%): No one identifiable cause (Genetic or lifestyle)
OSA, High Na diet, ETOH, Smoking, NSAIDs
HTN, SECONDARY
Something is Causing (Cushings)
•High Suspicion Age < 50
HTN TREATMENT
< 55Y/O
GOAL SPB <140/90
1st line: Lifestyle modification
, Look for secondary cause in young patients
Non-blacks: Thiazide, CCB, ACEI, ARB
Black: Thiazide, CCB
HTN TX FOR CKD
Goal BP < 140/90
ACE-inhibitor or ARB (regardless of race of DM)
HTN GOAL > 55 Y/O
BP GOAL < 150/90
ACC/AHA GUIDELINES FOR HTN ACS/MI, HF, REDUCED EF
•β blocker or ACE-I for EF ≤ 40% and symptomatic, stable HF
•Β blocker AND ACE-I or ARB for MI or ACS with reduced EF
HTN MAY LEAD TO
PAD: Critical limb ischemia (CLI) is the most severe
HALLMARK SIGN OF CRITICAL LIMB ISCHEMIA
CLAUDICATION• - - Elderly: Atypical Signs (Limb heaviness, numbness, soreness)
DX OF CLAUDICATION
Ankle brachial index (+PAD < 0.9)
0.71 - 0.90: mild
0.41 - 0.70: moderate
≤ 0.40: severe
TREATMENT FOR CLAUDICATION
