Midterm Exam: NR571/ NR 571 Complete Review (Latest 2023/ 2024 Update) Complex Diagnosis & Management in Acute Care |Questions and Verified Answers|100% Correct – Chamberlain
Midterm Exam: NUR571/ NUR 571
Complete Review (Latest 2023/ 2024 Update)
Complex Diagnosis & Management in Acute
Care |Questions and Verified Answers|100%
Correct – Chamberlain
Q: pulmonary diagnosis
Answer:
PFTs, arterial blood gases and radiography are for
Q: PTFs
Answer:
for intraoperative or postoperative respiratory complications. for bron- chodilator therapy, risk
evaluation for patients before thoracic or upper abdominal surgery.
Q: PFTs Evaluating
Answer:
lung volumes or the ability to fully expand
flow rates, rate of inflow and outflow of air maximal voluntary ventilation or airflow through the
major airways by completing rapid inspiration expiration maneuvers evaluation of diffusing
capacity or the ability of the oxygen to get into the blood
Q: PFTs Measures
Answer:
Spirometry evaluates the amount of air exhaled and inhaled during forced maneuvers
Lung volume refers to the total amount of air in the lungs with maximal inspiration. diffusing
capacity measures gas exchange and is often done in conjunction with a pulse oximetry reading.
Q: Normal PFTs
Answer:
FEV1 (80% to 120%), FVC (80% to 120%), Absolute FEV1/FVC Ratio (Within 5% of the
predicted ratio), TLC
(80% to 120%), FRC (75% to 120%), RV (75% to 120%), DLCO (>60% to <120%),
Q: Restrictive Lung Disease=
Answer:
decrease in the total volume of air that the lungs can hold. decrease in the elasticity, inability of
the chest wall to expand during inhalation
Q: associated with restrictive lung function
Answer:
interstitial lung disease such as idiopathic pulmonary fibrosis, sarcoidosis, obesity, including
obesity hypoventilation syndrome, scoliosis, neuromuscular diseases such as muscular dystrophy
or ama- teur amyotrophic lateral sclerosis (ALS) associated
Q: Obstructive Lung Disease
Answer:
impede exhaled air from the lungs due to the narrowing of the airways or actual damage to the
lung parenchyma.
Q: associated with obstructive lung function
Answer:
asthma, chronic (COPD), cystic fibrosis, bronchiectasis are associated
Q: PTs Diagnostic Approach
Answer:
Determine if the FEV1/FVC ratio is low. (obstructive defect present)
Determine if the FVC is low. (restrictive pattern indicating restrictive lung disease, a mixed
pattern, or pure obstructive lung disease with air trapping).
Grade the severity of the abnormality.
Determined the reversibility of the obstructive defect..
Bronchoprovocation is done when a provider suspects exercise or allergen-induced
Q: Bronchodilator Response
Answer:
FEV1 or the FEV increases by at least 12% the obstructive pattern is considered reversible, with
Q: Bronchoprovocation
Answer:
for exercise, or allergen-induced asthma, involves a methacholine challenge or a mannitol
inhalation challenge.
Q: Restrictive and obstructive disorders
Answer:
Severity according to the American
Thoracic Society’s (ATS) based on FEV1 abnormality for
Q: restrictive processes
Answer:
The pattern of reduced FEV1 and FVC with preserves
FEV1/FVC ratio is often seen with
Q: airflow obstruction
Answer:
low FEV1 and low FEV1/FVC ratio, and low FEV1 and FVC
with a decreased FEV1/FVC ratio equals
Q: Complications with asthma
Answer:
sleep disturbance, limitation of physical activity, increased weight gain due to inactivity,
increased sick days from work, and perma- nent narrowing of the airways resulting in decreased
reserves are complications of
Q: acute asthma exacerbation S/S
Answer:
chest tightness, expiratory wheezing, dysp- nea, and non-productive cough, escalation at night,
anxiety s/s
Q: Physical Exam acute asthma exacerbation
Answer:
tachypnea, tachycardia, de- creased oxygen saturation, expiratory wheezing, and a prolonged
expiratory phase use of accessory muscles, hypercapnia develops, hypoxemia impaired ventilation/perfusion results in acidosis are present exam for
Q: acute asthma exacerbation impending death!
Answer:
The absence of breath sounds and a pCO2 > 70 mmHg are signs of
Q: Differential Diagnosis for asthma
Answer:
airway obstruction related to a mechanical or foreign body, airway obstruction related to a
structural abnormality such as a tumor, aspiration or severe gastroesophageal reflux disease,
paradoxical vocal cord motion disorder, heart failure, COPD, vasculitis, bronchiectasis,
pulmonary emboli interstitial lung disease are differential
Q: Diagnostic Testing for asthma
Answer:
physical exam findings, lung function, and oxygen saturation, peak expiratory flow (PEF),
spirometry, Chest x-ray, Labs are test
Q: Asthma Exacerbations-Mild or Moderate
Answer:
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aortic stenosis harsh mid-systolic murmur @ 2nd right intercostal space/RUSB, radiates to carotid, increased w/ squatting and leaning forward., CP, tachy, SOB, dizzy, syncope, edema, bad sleeping
EKG findings in mitral valve regurgitation
Heparin-induced thrombocytopenia (HIT)
Pneumonia lung infection, caused by a bacterial, viral, or fungal infection. bacteria are the most common(the alveoli (inflamed and filled with fluid)
Characterized of PNA productive cough, difficulty breathing, chest pain, fatigue, confusion (especially in older patients), fever, chills, nausea, and vomiting are s/s
Risk factors for developing pneumonia under 2 or over 65, weakened immune system, smoking, chronic lung or other diseases, and being hospitalized are risk factor for
Asthma is a chronic lung disease, affects lung function, develops in childhood, all ages. environmental and genetic factors, can cause a flare-up of symptoms (asthma attack)
characterized inflammation, mucus formation, and narrowing of airways are for
triggers allergens (such as pollen and pet dander), irritants (such as smoke and chemicals), medicines, existing infections, and exercise may are trigger
Chronic obstructive pulmonary disease (COPD) an airflow-limiting condition that affects the lungs, (includes both emphysema and chronic bronchitis
Emphysema affects the alveoli, alveolar walls are broken down causing alveolar air spaces to become permanently and abnormally enlarged, less surface area for gas exchange, limiting airflow.
Chronic bronchitis a condition that affects the bronchi and bronchioles, the airways become narrowed and blocked with mucus, limiting airflow.
Cause of COPD smoking, secondhand smoke (SHS), pollution, and industrial or chemical fumes can cause
Common symptoms of shortness of breath, fatigue, and coughing s/s
Pulmonary function tests (PFTs valuable tools that can be used in the assessment, diagnosis, and management of suspected or previously diagnosed respiratory diseases. for develop a plan of care, predict risk of respiratory complications, and monitor response to treatment. to provide an objective assessment of pulmonary function
pulmonary diagnosis PFTs, arterial blood gases and radiography are for
PTFs for intraoperative or postoperative respiratory complications. for bronchodilator therapy, risk evaluation for patients before thoracic or upper abdominal surgery.
PFTs Evaluating lung volumes or the ability to fully expandflow rates, rate of inflow and outflow of air maximal voluntary ventilation or airflow through the major airways by completing rapid inspiration expiration maneuvers evaluation of diffusing capacity or the ability of the oxygen to get into the blood
PFTs Measures
Normal PFTs FEV1 (80% to 120%), FVC (80% to 120%), Absolute FEV1/FVC Ratio (Within 5% of the predicted ratio), TLC(80% to 120%), FRC (75% to 120%), RV (75% to 120%), DLCO (>60% to <120%), Restrictive Lung Disease decrease in the total volume of air that the lungs can hold. decrease in the elasticity, inability of the chest wall to expand during inhalation associated with restrictive lung function interstitial lung disease such as idiopathic pulmonary fibrosis, sarcoidosis, obesity, including obesity hypoventilation syndrome, scoliosis, neuromuscular diseases such as muscular dystrophy or amateur amyotrophic lateral sclerosis (ALS) associated Obstructive Lung Disease impede exhaled air from the lungs due to the narrowing of the airways or actual damage to the lung parenchyma. associated with obstructive lung function asthma, chronic (COPD), cystic fibrosis, bronchiectasis are associated Determine if the FEV1/FVC ratio is low. (obstructive defect present)Determine if the FVC is low. (restrictive pattern indicating restrictive lung disease, a mixed pattern, or pure obstructive lung disease with air trapping).Grade the severity of the abnormality.Determined the reversibility of the obstructive defect..Bronchoprovocation is done when a provider suspects exercise or allergen-induced Bronchodilator Response FEV1 or the FEV increases by at least 12% the obstructive pattern is considered reversible, with Bronchoprovocation for exercise, or allergen-induced asthma, involves a methacholine challenge or a mannitol inhalation challenge. Restrictive and obstructive disorders Severity according to the American Thoracic Society’s (ATS) based on FEV1 abnormality for restrictive processes The pattern of reduced FEV1 and FVC with preserves FEV1/FVC ratio is often seen with airflow obstruction low FEV1 and low FEV1/FVC ratio, and low FEV1 and FVC with a decreased FEV1/FVC ratio equals Complications with asthma sleep disturbance, limitation of physical activity, increased weight gain due to inactivity, increased sick days from work, and permanent narrowing of the airways resulting in decreased reserves are complications of acute asthma exacerbation S/S chest tightness, expiratory wheezing, dyspnea, and non-productive cough, escalation at night, anxiety s/s Physical Exam tachypnea, tachycardia, decreased oxygen saturation, expiratory wheezing, and a prolonged expiratory phase use of accessory muscles, hypercapnia develops, hypoxemia impaired ventilation/perfusion results in acidosis are present exam for acute asthma exacerbation impending death! The absence of breath sounds and a pCO2 > 70 mmHg are signs of
Differential Diagnosis for asthma airway obstruction related to a mechanical or foreign body, airway obstruction related to a structural abnormality such as a tumor, aspiration or severe gastroesophageal reflux disease, paradoxical vocal cord motion disorder, heart failure, COPD, vasculitis, bronchiectasis, pulmonary emboliinterstitial lung disease are differential
Diagnostic Testing for asthma physical exam findings, lung function, and oxygen saturation, peak expiratory flow (PEF), spirometry, Chest x-ray, Labs are test
Asthma Exacerbations-Mild or Moderate Talks in phrases, prefers to sit rather than lying down, not agitated, no accessory muscle use, HR 100-120, O2 saturation 90-95 % on room a
Asthma Exacerbations-Severe Talks in words, leans forward when sitting, appears agitated, RR>30/min, accessory muscle usage, HR>120, O2 saturation< 90% on room air Asthma Exacerbations-Life-threatening Unable to speak, drowsy, or confused is considered Asthma Exacerbations goals of emergent treatment correcting hypoxemia, rapid reversal of airflow obstruction, and reducing the risk of relapse through intensified therapy are goals hospitalization Oxygen saturation < 92-94 % one hour after the patient’s initial treatment (asthma exacerbations) strongly predicts the need for emergency medication treat for asthma exacerbation bronchodilators, systemic corticosteroids, and oxygen, available resources are treatment Asthma medication info Bronchodilators provide smooth muscle relaxation and relief of symptoms. Controllers target the underlying inflammation. Guidelines for the Diagnosis and Management of Asthma. “use of short-acting beta-agonists (SABA-“”albuterol””) as a “”rescue”” agent and inhaled corticosteroids for control in mild to moderate diseases are” Emergency room treatment of acute asthma exacerbation O2, Inhaled SABA Therapy, Epinephrine(only in anaphylaxis), Systemic Corticosteroids(within 1 hour), High Dose Inhaled Corticosteroids(within 1 hour) Ensure Adequate Hydration are ER treat I A short-acting anticholinergic, when administered with a SABA, may improve symptoms in adolescents and adults. Not recommended for routine use but may be beneficial in adults who fail to respond to initial treatment and have persistent hypoxemia. Not for asthma exacerbation leukotriene receptor antagonists, inhaled corticosteroid-long-acting beta agonist combinations, sedatives, and helium-oxygen therapy, Intravenous aminophylline and theophylline Considerations in pulmonology referral inadequate control of symptoms. life-threatening asthma exacerbation, or therapeutic goals of therapy after 3-6 months are not met Follow-up after discharge of asthma exacerbation 72 hours to evaluate the efficacy of the prescribed treatment plan. patient’s role for asthma recognizing and control trigger exposures; taking and managing medications as prescribed; tracking symptoms and knowing when to seek treatment; seeking immediate treatment for worsening symptoms are the provider’s role for asthma prescribing and educating the patient on the proper administration of medication, developing a customized patient symptom monitoring and treatment plan; scheduling routine follow-up visits, and knowing when to refer the patient to a specialist for further management. hallmark of COPD Extensive airway destruction is seen, in the advanced stages of risk factors in COPD smoking( main reason), exposure to secondhand smoke, environmental irritants, occupational exposures, childhood pulmonary infections, HIV, genetic predisposition respiratory infections COPD patients are also prone to frequent ?, and are the cause of acute exacerbation COPD baseline symptoms exertional dyspnea, wheezing, chest tightness, fatigue, and chronic cough/ in (acute exacerbation), respiratory distress are s/s Common complaints COPD exacerbation air hunger; increased cough; a change in color, viscosity, or amount of mucus; more noticeable wheezing than normal; dizziness or lightheadedness (due to hyperventilation and hypercapnia); worsened fatigue; trouble sleeping; headaches; severe anxiety, fear, or sense of impending doom; chest tightness; and fever may be present. Objective findings acute COPD exacerbation tachypnea, tachycardia, hypoxia, hypercapnia, inspiratory and expiratory wheezing, decreased breath sounds due to limited airflow, acidosis may be present, which can lead to death differentials for COPD pneumonia, upper respiratory tract infection, pulmonary emboli, reactive airway disease, congestive heart failure, pneumothorax, arrhythmias and myocardial infarction, upper airway obstruction, environmental irritants, dehydration resulting in thickened bronchial secretions are differentials Diagnostic Testing for COPD history and physical exam, Chest x-ray(hyperinflation and a flattened diaphragm), Labs, EKG, Spirometry are test mild to moderate COPD exacerbation bronchodilator therapy long-acting B2 agonists (LABA), long-acting Antimuscarinic Agents (LAMA), inhaled corticosteroids (ICS), systemic corticosteroids, antibiotics when signs of bacterial infection COPD exacerbation needs emergency room severe worsening of dyspnea, hypoxia, altered mental status, new onset of cardiac symptoms, initial treatment has failed to respond, presence of serious comorbidities, inadequate home support, signs of acute respiratory failure Emergency Room Treatment COPD acute exacerbations Oxygen (88-92), SABA, Systemic Corticosteroids, Antibiotics,(ABG)-oxygenation, CO2 retention, and acidosis, treatment for decision to discharge COPD Is the patient in respiratory distress after treatment? Does the patient require continued supplemental oxygen? Is the patient hypercapnic despite treatment? if yes to any they need to stay Secondary prevention strategies in COPD smoking cessation, vaccinations including pneumonia and flu vaccines, physical activity, nutritional counseling and support, pulmonary rehabilitation, Medication management of COPD exacerbation Steps of PNA · agent to reach the alveoli’s by microaspiration· alveolar macrophage, is overcome· inflammatory response· recruitment of phagocytic cells by (TNF) and interleukin-1 (IL-1)· Cytokines produce a systemic inflammatory response· signs, symptoms, and laboratory abnormalities of PNA Pneumonia serious affects infants and young children, people older than age 65, and people with health problems or weakened immune systems are prone 5 distinct categories of PNA · Community-acquired pneumonia(CAP)· Hospital-acquired pneumonia (HAP)· Ventilator-acquired pneumonia (VAP)· Healthcare-acquired pneumonia (HCAP)· Aspiration Pneumonia Community Acquired Pneumonia (CAP) Infection outside of the healthcare hospital system. most common type, generally presents as an acute infection. Hospital Acquired Pneumonia (HAP) Infection during a hospital stay. affects those hospitalized or further immunocompromised. The bacteria often resistant to line antibiotics complicates hospital stay. Ventilator Acquired Pneumonia (VAP) Occurring more than 48 hours after endotracheal intubation Healthcare-acquired pneumonia (HCAP) Infection from healthcare facilities, dialysis center or long-term care centers or a history of hospitalization the last three months. Aspiration Pneumonia Infection is due to material from the stomach or mouth entering the lungs. any of the above settings from the community where the patient is at home to the skilled nursing facilities that provide long-term care. Bacteria Virus Influenza A and B, Respiratory syncytial virus (RSV), Rhinovirus, Parainfluenza, Adenovirus, Varicella-Zoster, Coronavirus are Fungai pneumonia Coccidioidomycosis, Pneumocystis pneumoniaSporotrichosis are risk factors of pneumonia prior hospitalizations, malnutrition, alcoholismdecreased pulmonary clearance secondary to chronic lung disease, cigarette smoking, alcohol and drug use, viral infections, and pollution, diminished neutrophil function secondary to diabetes mellitus, corticosteroids, renal insufficiency, cirrhosis, or genetic defects, defective IgG production secondary to immunodeficiency or HIV are risk factors Common subjective complaints PNA productive cough, fever and chills, dyspnea, increasing respiratory distress, general fatigue or malaise are s/s Objective findings of PNA tachypnea, tachycardia, abnormal lung sounds (rales, rhonchi, and/or wheezing), tactile fremitus, fever, appearance of being acutely ill are Noninfectious differentials for pneumonia cardiac-related conditions such as pulmonary edema and pulmonary emboli, respiratory-related conditions to include asthma and COPD, neoplasms, immunologic disorder such as sarcoidosis, other non-pulmonary sources of infection Diagnostic Testing for PNA chest x-ray (upright posteroanterior (PA) position), CBC, inflammatory markers, chemistry, blood and sputum cultures, ABG Complications associated with pneumonia acute respiratory failure, development of an empyema (pus that fills the pleural space), permanent lung scarring, sepsis, need for mechanical ventilation, and death are Pneumonia Severity Index (PSI) clinical prediction rule, to calculate the probability of morbidity and mortality among patients with community-acquired pneumonia. (PSI) scoring treatment score 1 and 11= outpatient treat, 111=Brief Hospitalization, IV=Inpatient, V=ICU clinical prediction rule, predicting mortality in community-acquired pneumonia. Confusion, Blood Urea nitrogen, Respiratory rate, Blood pressure, age Inpatient treatment for pneumonia cardiac and pulse oximetry, intravenous hydration, fever reduction, elevation of bed > 30°, and oral care with antiseptics such as chlorhexidine
CAP antibiotic 1st=empiricTypical-Haemophilus influenza and streptococcus(fluoroquinolone or macrolide)Atypical-Mycoplasma pneumoniae, and legionella(fluoroquinolones, macrolides, and tetracyclines)
HAP and HCAP antibiotic anti-pseudomonas beta-lactam such as a cephalosporin like cefepime, a carbapenem like meropenem, and a fluoroquinolone such as ciprofloxacin are for
VAP antibiotics empiric (second or third-generation cephalosporins and fluoroquinolones) till confirm
aspiration pneumonia antibiotic empiric antibiotic therapy should include a 3rd generation cephalosporin in combination with a macrolide or fluoroquinolone
inpatient discharge follow up PNA within one week, continuation of antibiotics, worsening conditions go to ED are.
follow-up should be within 72 hours from the initial visit are
Prevention of pneumonia smoking cessation, required vaccines to include pneumonia and flu, adequate hydration, handwashing, addressing overall health status, being aware of signs and symptoms that require medical attention are
Common findings in HAP Respiratory issues >48 after hospitalized,(fever, abnormal chest examination, purulent sputum, tachypnoea, impaired oxygenation)
Prevention strategies in VAP Minimize ventilator exposure, Provide excellent oral hygiene care, Coordinate care for subglottic suctioning, Maintain optimal positioning and encourage mobility, Ensure adequate staffing, Nurses perfectly positioned are