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:
Powered by https:\/\/learnexams.com\/search\/study?query=nr571<\/a><\/p>\n\n\n\n
TLC (total lung capacity)<\/a><\/p>\n\n\n\n the total volume of gas within the lungs after a maximal inspiration<\/a><\/p>\n\n\n\n VC (vital capacity)<\/a><\/p>\n\n\n\n the volume of gas expired after a maximal inspiration followed by a maximal expiration.<\/a><\/p>\n\n\n\n FRC (functional residual capacity)<\/a><\/p>\n\n\n\n the volume of gas within the lungs at the end of expiration during normal tidal breathing at rest<\/a><\/p>\n\n\n\n PFTs measure three distinct parameters which include<\/a><\/p>\n\n\n\n spirometry, lung volume, and diffusing capacity.<\/a><\/p>\n\n\n\n PFT’s are useful in evaluating:<\/a><\/p>\n\n\n\n -lung volumes or the ability to fully expand spirometry<\/a><\/p>\n\n\n\n Spirometry evaluates the amount of air exhaled and inhaled during forced maneuvers which provide the following measurements:<\/a><\/p>\n\n\n\n -FVC<\/em><\/a><\/p>\n\n\n\n -FEV1<\/em><\/a><\/p>\n\n\n\n -FEV1\/FVC ratio<\/em><\/a><\/p>\n\n\n\n Forced Vital Capacity (FVC)<\/a><\/p>\n\n\n\n total volume a patient exhales for the total duration of the test<\/a><\/p>\n\n\n\n Normal: 80% to 120%<\/strong><\/a><\/p>\n\n\n\n forced expiratory volume (FEV1)<\/a><\/p>\n\n\n\n forced expiratory volume in 1 second, or total volume of air exhaled in the 1st second of maximal effort<\/a><\/p>\n\n\n\n Normal: 80% to 120%<\/strong><\/a><\/p>\n\n\n\n FEV1\/FVC ratio<\/a><\/p>\n\n\n\n the percentage of the FVC expired and 1 second<\/a><\/p>\n\n\n\n Normal: Within 5% of the predicted ratio<\/strong><\/a><\/p>\n\n\n\n Lung Volume<\/a><\/p>\n\n\n\n Lung volume refers to the total amount of air in the lungs with maximal inspiration. This is evaluated using the following measurements:<\/a><\/p>\n\n\n\n -ERV<\/em><\/a><\/p>\n\n\n\n -IRV<\/em><\/a><\/p>\n\n\n\n -RV<\/em><\/a><\/p>\n\n\n\n -Vt<\/em><\/a><\/p>\n\n\n\n -FRC<\/em><\/a><\/p>\n\n\n\n Expired Reserve Volume (ERV)<\/a><\/p>\n\n\n\n the maximal volume of air exhaled from end-expiration<\/a><\/p>\n\n\n\n Inspired Reserve Volume (IRV)<\/a><\/p>\n\n\n\n the maximal volume of air held from end-inspiration<\/a><\/p>\n\n\n\n residual volume (RV)<\/a><\/p>\n\n\n\n the volume of air remaining in the lungs after a maximal exhalation<\/a><\/p>\n\n\n\n Normal: 75% to 120%<\/strong><\/a><\/p>\n\n\n\n Tidal Volume (VT or TV)<\/a><\/p>\n\n\n\n the volume of air inhaled or XL during each respiratory cycle<\/a><\/p>\n\n\n\n Functional Residual Capacity (FRC)<\/a><\/p>\n\n\n\n the volume of air in the lungs at resting end-expiration<\/a><\/p>\n\n\n\n Normal: 75% to 120%<\/strong><\/a><\/p>\n\n\n\n diffusing capacity<\/a><\/p>\n\n\n\n The diffusing capacity measures gas exchange and is often done in conjunction with a pulse oximetry reading. This is evaluated using the following measurements:<\/a><\/p>\n\n\n\n -TLC<\/em><\/a><\/p>\n\n\n\n -VC<\/em><\/a><\/p>\n\n\n\n -DLCO<\/em><\/a><\/p>\n\n\n\n Total Lung Capacity (TLC)<\/a><\/p>\n\n\n\n the volume of air in the lungs at maximal inflation<\/a><\/p>\n\n\n\n Normal: 80% to 120%<\/strong><\/a><\/p>\n\n\n\n vital capacity (VC)<\/a><\/p>\n\n\n\n the largest volume measured on complete exhalation after full inspiration<\/a><\/p>\n\n\n\n DLCO<\/a><\/p>\n\n\n\n the diffusing capacity of the lung for carbon monoxide<\/a><\/p>\n\n\n\n Normal: >60% to <120%<\/strong><\/a><\/p>\n\n\n\n Classification of Pulmonary Disorders Based On PFT: Restrictive lung disease is diagnosed by a decrease in the total volume of air that the lungs can hold Classification of Pulmonary Disorders Based On PFT: Obstructive lung diseases are conditions that impede exhaled air from the lungs due to narrowing of the airways or actual damage to the lung parenchyma. A systematic approach is helpful to accurately interpret PFTs and includes the following steps:<\/a><\/p>\n\n\n\n 1. Determine if the FEV1\/FVC ratio is low. This finding will indicate that there is an obstructive defect present.<\/p>\n\n\n\n 2. Determine if the FVC is low. This finding will indicate a restrictive pattern indicating restrictive lung disease, a mixed pattern, or pure obstructive lung disease with air trapping.<\/p>\n\n\n\n 3. Grade the severity of the abnormality. If there is an obstructive defect, restrictive pattern, or mix pattern you should grade the severity of the abnormality based on the FEV1 percentage predicted based on the American Thoracic Society’s (ATS) system for grading PFT abnormalities.<\/p>\n\n\n\n 4. Determined the reversibility of the obstructive defect. If the patient does have an obstructive defect, the determination should be made if it is reversible based on the increase in FEV1 or FVC after bronchodilator treatment.<\/p>\n\n\n\n 5. Bronchoprovocation is done when a provider suspects exercise or allergen-induced asthma may be causing the abnormality. <\/p>\n\n\n\n -If the FEV 1 is 70% or less predicted on standard spirometry, bronchoprovocation should be used to make the final diagnosis. This involves a methacholine challenge or a mannitol inhalation challenge.<\/p>\n\n\n\n What is a Bronchodilator Response used for<\/a><\/p>\n\n\n\n Determined the reversibility of disease when an obstructive pattern is present <\/a><\/p>\n\n\n\n If either the FEV1 or the FEV increases by at least 12% the obstructive pattern is considered reversible.<\/a><\/p>\n\n\n\n Risk Factors for Asthma<\/a><\/p>\n\n\n\n Allergen exposure in those with a predisposition to atopy<\/a><\/p>\n\n\n\n Occupational exposure<\/a><\/p>\n\n\n\n Air pollution<\/a><\/p>\n\n\n\n Infections (viral and Mycoplasma<\/em>)<\/a><\/p>\n\n\n\n Tobacco<\/a><\/p>\n\n\n\n Obesity<\/a><\/p>\n\n\n\n Diet<\/a><\/p>\n\n\n\n Fungi in allergic airway mycoses<\/a><\/p>\n\n\n\n Acute irritants and reactive airway dysfunction syndrome (RADS)<\/a><\/p>\n\n\n\n High-intensity exercise in elite athletes<\/a><\/p>\n\n\n\n Clinical Pearl<\/a><\/p>\n\n\n\n What happens to the oxygen saturation after initial tx that is a strong predictor in the need for hospitalization?<\/a><\/p>\n\n\n\n Oxygen saturation < 92-94 % one hour after the patient’s initial treatment is a strong predictor of the need for hospitalization.<\/a><\/p>\n\n\n\n Inpatient vs. Outpatient for asthma exacerbation<\/a><\/p>\n\n\n\n -provider driven<\/a><\/p>\n\n\n\n -Most mild exacerbations can be managed in the primary or urgent care setting.<\/a><\/p>\n\n\n\n -Patients with signs of severe or life-threatening symptoms of an acute asthma exacerbation should be transferred to an ED<\/a><\/p>\n\n\n\n -initiated with bronchodilators, systemic corticosteroids, and oxygen if able<\/a><\/p>\n\n\n\n Provider questions to consider for patients classified as moderate severity should include the following:<\/a><\/p>\n\n\n\n 1.Was the patient’s asthma controlled before this exacerbation? -If not, inpatient management may be indicated with close monitoring and medication adjustment.<\/p>\n\n\n\n 2. Has the patient achieved symptom relief and improved peak flow readings with treatment that was administered? <\/p>\n\n\n\n -If so, a period of observation should be done to assure a rebound attack does not occur.<\/p>\n\n\n\n Patients admitted with high risk of asthma related death should receive very close inpatient monitoring, possibly ICU. This includes:<\/a><\/p>\n\n\n\n -previous severe exacerbation (intubation\/ICU admit) Asthma Exacerbation Severity:<\/a><\/p>\n\n\n\n MILD <\/a><\/p>\n\n\n\n -dyspnea w\/ activity Asthma Exacerbation Severity:<\/a><\/p>\n\n\n\n MODERATE<\/a><\/p>\n\n\n\n -dyspnea limits typical daily activity Asthma Exacerbation Severity:<\/a><\/p>\n\n\n\n LIFE THREATENING<\/a><\/p>\n\n\n\n -dyspnea significantly limiting speech Asthma Exacerbation Severity:<\/a><\/p>\n\n\n\n SEVERE<\/a><\/p>\n\n\n\n -dyspnea at rest that interferes w\/ conversation Secondary Asthma Triggers<\/a><\/p>\n\n\n\n Allergens Standard treatment for acute asthma exacerbation (5)<\/a><\/p>\n\n\n\n 1. Supplemental Oxygen Supplemental Oxygen for acute asthma exacerbation<\/a><\/p>\n\n\n\n Delivered by nasal cannula or mask to keep O2 saturation 93-95%. Can correct hypoxemia<\/a><\/p>\n\n\n\n Inhaled SABA Therapy for acute asthma exacerbation<\/a><\/p>\n\n\n\n repetitive or continuous (MDI) or nebulizer can quickly reverse airflow obstruction.<\/a><\/p>\n\n\n\n Inhaled Short Acting B2-antagonist(SABA): <\/a><\/p>\n\n\n\n -albuterol nebulizer<\/strong><\/a><\/p>\n\n\n\n -Levalbuterol (R-albuterol)<\/strong><\/a><\/p>\n\n\n\n what are the names of 2 inhaled SABA?<\/a><\/p>\n\n\n\n albuterol![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=100,onerror=redirect,w=120\/https:\/\/o.quizlet.com\/MmDfmZ75ZMs0xgl.Bj6UMQ.jpg\")
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-flow rates or the 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<\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=100,onerror=redirect,w=120\/https:\/\/o.quizlet.com\/yuTAsrJhG4sqMRW-ATPCFw.png\")
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<\/figure>\n\n\n\n
Restrictive Lung Disease<\/a><\/p>\n\n\n\n
It often results from a decrease in the elasticity of the lungs or may be related to the inability of the chest wall to expand during inhalation.<\/a><\/p>\n\n\n\n
Obstructive Lung Disease<\/a><\/p>\n\n\n\n
EX: asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, bronchiectasis<\/a><\/p>\n\n\n\n
->2 admits\/>3 ER visits in the last 12 mo
-use of >2 canisters of short acting B-antagonist (SABA) per month
-reduced ability to perceive airway obstruction or worsening symptoms
-comor. such as CVD, or other chronic lung disease<\/a><\/p>\n\n\n\n
-Spiro metric Measurement (PEF or FEV1): >70% personal best
-Triage\/Admission: home<\/a><\/p>\n\n\n\n
-Spiro metric Measurement (PEF or FEV1): 40-69% personal best
-Triage\/Admission: Often requires ED visit +\/- admit (if no rapid ED improvements)<\/a><\/p>\n\n\n\n
-Spiro metric Measurement (PEF or FEV1): <25% personal best
-Triage\/Admission: Hospital Admission or ICU<\/a><\/p>\n\n\n\n
-Spiro metric Measurement (PEF or FEV1): <40% personal best
-Triage\/Admission: Hospital Admission or ICU<\/a><\/p>\n\n\n\n
Irritants
Viral infections
Exercise and cold, dry air
Air pollution
Drugs
Occupational exposures
Hormonal changes
Pregnancy<\/a><\/p>\n\n\n\n
2. Inhaled SABA Therapy
3. Systemic Corticosteroids
4. High Dose Inhaled Corticosteroids
5. Ensure Adequate Hydration<\/a><\/p>\n\n\n\n
Levalbuterol (R-albuterol)<\/a><\/p>\n\n\n\n