KETTERING CSE EXAM SCRIPT TESTED
QUESTIONS FULL SOLUTION PREMIUM
STUDY MATERIAL
●● Emphysema/Chronic Bronchitis Patient Assessment
Answer: General Appearance:
Barrel Chest
Increased AP diameter
Clubbing
Cyanosis
Respiratory Pattern:
Dyspnea
Accessory Muscle Use
Pursed lip breathing
Breath Sounds:
Diminished aeration with bilateral expiratory wheeze
Ronchi (more prevalent with Chronic Bronchitis)
Diagnostic Chest Percussion:
,Tympanic or hyperrasonant
Cough:
Congested
Productive of thick sputum
Side note: Chronic Bronchitis is a confirmed diagnosis with a daily,
productive cough for a minimum of 3 consecutive months each year for
a minimum of 2 consecutive years
●● Emphysema/Chronic Bronchitis Diagnostic Testing
Answer: Chest X-Ray:
Hyperlucency
Hyperinflation
Increased A-P diameter
Flattened Diaphragm
ABGs:
Compensated respiratory acidosis with hypoxemia and hypercapnia
PFTs:
Decreased flows (FEV1, FEV1/FVC, FEF 25-75%)
FEV1/FVC < 70% confirms obstructions
,Also: Increased FRC and normal Increased TLC
●● Airflow Severity (FEV1.0) post Bronchodilator
Answer: Mild: FEV1 > 80% predicted
Moderate: FEV1 50-79% predicted
Severe: FEV1 30-49% predicted
Very Severe: FEV1 <30% predicted
●● COPD treatment
Answer: a. Low flow oxygen, target Spo, is 88 - 92%.
b. Aerosolized bronchodilators (SABA, LABA, anticholinergic,
LAMA).
c. Bronchial hygiene as indicated.
d. Inhaled corticosteroids.
e. Antibiotics if indicated by sputum culture.
f. Referral to smoking cessation program, including nicotine
replacement therapy.
, g. Pulmonary rehabilitation, proper nutrition and monitor fluid intake.
h. Consider NPPV for acute exacerbations of ventilatory failure.
Refer patient and family to appropriate education programs.
1) Nutritional management.
2) Avoiding infections - signs/symptoms to look for.
3) Exercise program.
4)
Methods to aid in secretion clearance.
5) Home oxygen and aerosol therapy.
6) Medication and their use.
●● Short Acting Bronchodilators (SABA)
Answer: Albuterol (ventolin)
Xopenex
Ipratropium bromide (Atrovent)
●● Long Acting Bronchodilators (LABA)
Answer: Salmeterol (seravent)
QUESTIONS FULL SOLUTION PREMIUM
STUDY MATERIAL
●● Emphysema/Chronic Bronchitis Patient Assessment
Answer: General Appearance:
Barrel Chest
Increased AP diameter
Clubbing
Cyanosis
Respiratory Pattern:
Dyspnea
Accessory Muscle Use
Pursed lip breathing
Breath Sounds:
Diminished aeration with bilateral expiratory wheeze
Ronchi (more prevalent with Chronic Bronchitis)
Diagnostic Chest Percussion:
,Tympanic or hyperrasonant
Cough:
Congested
Productive of thick sputum
Side note: Chronic Bronchitis is a confirmed diagnosis with a daily,
productive cough for a minimum of 3 consecutive months each year for
a minimum of 2 consecutive years
●● Emphysema/Chronic Bronchitis Diagnostic Testing
Answer: Chest X-Ray:
Hyperlucency
Hyperinflation
Increased A-P diameter
Flattened Diaphragm
ABGs:
Compensated respiratory acidosis with hypoxemia and hypercapnia
PFTs:
Decreased flows (FEV1, FEV1/FVC, FEF 25-75%)
FEV1/FVC < 70% confirms obstructions
,Also: Increased FRC and normal Increased TLC
●● Airflow Severity (FEV1.0) post Bronchodilator
Answer: Mild: FEV1 > 80% predicted
Moderate: FEV1 50-79% predicted
Severe: FEV1 30-49% predicted
Very Severe: FEV1 <30% predicted
●● COPD treatment
Answer: a. Low flow oxygen, target Spo, is 88 - 92%.
b. Aerosolized bronchodilators (SABA, LABA, anticholinergic,
LAMA).
c. Bronchial hygiene as indicated.
d. Inhaled corticosteroids.
e. Antibiotics if indicated by sputum culture.
f. Referral to smoking cessation program, including nicotine
replacement therapy.
, g. Pulmonary rehabilitation, proper nutrition and monitor fluid intake.
h. Consider NPPV for acute exacerbations of ventilatory failure.
Refer patient and family to appropriate education programs.
1) Nutritional management.
2) Avoiding infections - signs/symptoms to look for.
3) Exercise program.
4)
Methods to aid in secretion clearance.
5) Home oxygen and aerosol therapy.
6) Medication and their use.
●● Short Acting Bronchodilators (SABA)
Answer: Albuterol (ventolin)
Xopenex
Ipratropium bromide (Atrovent)
●● Long Acting Bronchodilators (LABA)
Answer: Salmeterol (seravent)
