AGACNP Pulmonary Review fully solved graded A+ 2023/2024

AGACNP Pulmonary ReviewWhat does missing/blunting/shadowing of the costophrenic angle on CXR indicate? - correct answer Pleural effusion If an AP xray shows pleural effusion, what should be your next action? - correct answer Order a lateral view CSR Describe characteristics of Asthma - correct answer -Increased responsiveness of the trachea and bronchi to various stimuli and manifested by widespread narrowing of the airways -Hypertrophy of smooth muscle -Mucosal edema and hyperemia -Thickening of epithelial basement membrane -Hypertrophy of mucous glands -Acute inflammation -Plugging of airways by thick, viscid mucus ***Bronchoconstricted ***Dehydrated What are some of the most common allergens that aggravate asthma? - correct answer *Most important allergens are encountered indoors* Where are the most important/common allergens encountered? - correct answer *Most important allergens are encountered indoors* Dust mites Pets (cat, dog) Cockroaches Indoor molds Exercise Cigarette smoke What are s/s of Asthma - correct answer respiratory distress at rest difficulty speaking in sentences Diaphoresis Use of accessory muscles Respiratory rate > 28 bpm Pulse > 110 bpm cough chest tightness ***Pulsus paradoxus > 12 mmHg ***Hyperresonance What are ominous s/s of decompensation related to asthma? - correct answer fatigue absent breath sounds paradoxical chest/abdominal movement inability to maintain recumbency cyanosis Describe labs/diagnostics associated with asthma - correct answer slight elevated CBC with eosinophilia PFT abnormalities Respiratory alkalosis with mild hypoxemia on ABG When is hospitalization required for asthma? - correct answer *if FEV1 does not improve after initiating bronchodilator *If peak flow is <60 liter/minute initially or does not improve with treatment Describe xray findings associated with asthma - correct answer hyperinflation Is asthma an obstructive or restrictive disease? - correct answer Obstructive Describe physical exam findings of a person in asthma/respiratory alkalosis - correct answer breathing too much panic pain distress Describe breathing pattern found in respiratory acidosis - correct answer not breathing enough Describe the Stepwise approach for managing asthma in adults - correct answer Step 1: -SABA (albuterol [proventil], levalbuterol) as needed -PRN inhaled corticosteroid -MOA: bronchial smooth muscle relaxation Step 2: -Daily low-dose inhaled corticosteroids (budesonide [pulmicort], fluticasone [flovent], triamcinolone [azmacort], - + LABA -Alt: cromolyn, LTRA, Step 3: -Low-dose ICS + LABA [Advair, symbicort] -Alt: low-dose ICS + LTRA, theophylline, or zileuton Step 4: -Medium dose ICS + LABA