NURS 642 Exam 4 Questions and Verified Answers/Accurate Solutions| Already Graded A+
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 ASA AND CLOPIDOGREL
VALVE DISEASE MS. ARD
(MITRAL STENOSIS, AORTIC REGURG = DIASTOLIC)
MR. ASS
(MITRAL REGURG AND AORTIC STENOSIS = SYSTOLIC)
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 ASA AND CLOPIDOGREL
VALVE DISEASE MS. ARD
(MITRAL STENOSIS, AORTIC REGURG = DIASTOLIC)
MR. ASS
(MITRAL REGURG AND AORTIC STENOSIS = SYSTOLIC)
