NURS 5461 M4 Pulmonary New Exam 100% Verified
Cough - ANSWER take a thorough HX. DDX: rx drugs*postnasal drip*COPD*asthma*post
infection*GERD*chf*Interstital lung disease*
RX for Cough - ANSWER Treat underling Disease*smoking cessation*
medications--ipratropiaum, cromolyn, atrovent, dextromethorphan,
antihistamines/decongestant, benzonatate(Tessalon), codeine is last resort. see
eppocrates guideline
Dyspnea - ANSWER good eaxm-s3,s4? murmurs? edema? check peak flow on
spriometry
DDX:asthma, COPD, Pneumonia,CHF, IHD, Anemia, panic.
Hemoptysis - ANSWER 85% inflammatory (bronchitis, TB, pneumonia), otherwise likely
neoplasia
--Treat underlying cause
URI - ANSWER Only 25% are bacterial, otherwise viral (cold, flu)
Laryngitis - ANSWER parainfluenza, RSV, or flu are common etiologies
Acute Bronchitis - ANSWER self limited inflammation of trachea and major bronchi, 3rd
most common reason HCP visit.
+cough-lasting up to 3w w/wo phlegm+dyspnea+/- wheezing+/-pleurisy
usually viral-corona, flu, rhinovirus
DDX:cold, asthma,pertussis,pneumona
BUT--Cough w/nl VS, absence of Tachypnea, tachycardia, rales, egophany ('e' to 'a')
*suggest acute bronchitis*
, Acute Bronchitis RX: - ANSWER SABA (Albuterol,ventolin Proair) is DOC (whz, cough for
up to two weeks) also antitussives, Phenergan DM incr. fluids and rest ATBX not
justified, no evidence that mucolytics (mucinex)are helpful
Chronic Bronchitis - ANSWER cough+sputum production x3m for 2y. Infl of cells lining
bronchial walls=hyperplasia=narrowing-most common w/COPD.
Etiologies, H. Influenzae, S pneumoniae, Moraxella, catarrhalis, or viral (flu, etc)
Chronic Bronchitis RX - ANSWER 1st line severe exacerbation>Augmentin 875 bid, or
Doxy 100mg bid, or Bactrim 1(DS) BID, OR cefuroxime 500MG Bid for 7 days or Zpak
500mg day one then 250mg x 4 days
**Cipro 500-750bid only if pseudomonas
SABA(Albuterol, Ventolin Proair), and prednisone 3-40 qd x7d. **no need to taper id
<14d Rx
CAP - ANSWER non hosp acquired pneumonia (bacteria, fungua, virus, parasite)
consolidation on CXR.
Healthy pt <60 suspect legoinella
*S. Pneumoniae is predominate organism
Pneumococcal PNA clinical features (CAP) - ANSWER S pneumoniae (gram +), abrupt
onset, prod. cough, rusty sputum, fever, chills, pleuritic CP
*MORE SUBTLE IN OLDER PTS: altered mental status and weakness, fever blunted
cough/ fatigus may last 3-4w
atypical PNA (CAP) - ANSWER *Most Common in <40, mycoplasma, legionella,
chlamydia (atypical pahtogens)
present w. headache, dry cough ~6w, myalgia, but may be indistinguishable from
pneumococcal
chlamydia presents w/ severe pharyngitis, laryngitis, fever, cough, may improve then
Cough - ANSWER take a thorough HX. DDX: rx drugs*postnasal drip*COPD*asthma*post
infection*GERD*chf*Interstital lung disease*
RX for Cough - ANSWER Treat underling Disease*smoking cessation*
medications--ipratropiaum, cromolyn, atrovent, dextromethorphan,
antihistamines/decongestant, benzonatate(Tessalon), codeine is last resort. see
eppocrates guideline
Dyspnea - ANSWER good eaxm-s3,s4? murmurs? edema? check peak flow on
spriometry
DDX:asthma, COPD, Pneumonia,CHF, IHD, Anemia, panic.
Hemoptysis - ANSWER 85% inflammatory (bronchitis, TB, pneumonia), otherwise likely
neoplasia
--Treat underlying cause
URI - ANSWER Only 25% are bacterial, otherwise viral (cold, flu)
Laryngitis - ANSWER parainfluenza, RSV, or flu are common etiologies
Acute Bronchitis - ANSWER self limited inflammation of trachea and major bronchi, 3rd
most common reason HCP visit.
+cough-lasting up to 3w w/wo phlegm+dyspnea+/- wheezing+/-pleurisy
usually viral-corona, flu, rhinovirus
DDX:cold, asthma,pertussis,pneumona
BUT--Cough w/nl VS, absence of Tachypnea, tachycardia, rales, egophany ('e' to 'a')
*suggest acute bronchitis*
, Acute Bronchitis RX: - ANSWER SABA (Albuterol,ventolin Proair) is DOC (whz, cough for
up to two weeks) also antitussives, Phenergan DM incr. fluids and rest ATBX not
justified, no evidence that mucolytics (mucinex)are helpful
Chronic Bronchitis - ANSWER cough+sputum production x3m for 2y. Infl of cells lining
bronchial walls=hyperplasia=narrowing-most common w/COPD.
Etiologies, H. Influenzae, S pneumoniae, Moraxella, catarrhalis, or viral (flu, etc)
Chronic Bronchitis RX - ANSWER 1st line severe exacerbation>Augmentin 875 bid, or
Doxy 100mg bid, or Bactrim 1(DS) BID, OR cefuroxime 500MG Bid for 7 days or Zpak
500mg day one then 250mg x 4 days
**Cipro 500-750bid only if pseudomonas
SABA(Albuterol, Ventolin Proair), and prednisone 3-40 qd x7d. **no need to taper id
<14d Rx
CAP - ANSWER non hosp acquired pneumonia (bacteria, fungua, virus, parasite)
consolidation on CXR.
Healthy pt <60 suspect legoinella
*S. Pneumoniae is predominate organism
Pneumococcal PNA clinical features (CAP) - ANSWER S pneumoniae (gram +), abrupt
onset, prod. cough, rusty sputum, fever, chills, pleuritic CP
*MORE SUBTLE IN OLDER PTS: altered mental status and weakness, fever blunted
cough/ fatigus may last 3-4w
atypical PNA (CAP) - ANSWER *Most Common in <40, mycoplasma, legionella,
chlamydia (atypical pahtogens)
present w. headache, dry cough ~6w, myalgia, but may be indistinguishable from
pneumococcal
chlamydia presents w/ severe pharyngitis, laryngitis, fever, cough, may improve then
