NURS 6501 Exam 2 Already Passed!!
Clinical Presentation of Acute Bronchitis
cough (productive or not) is most likely but fever, muscle aches, and fatigue can also be
present. Burning substernal pain with breathing in. Cough lasts longer than 7 days but
shouldn't last more than 3 weeks.
Best Treatment Viral Bronchitis
most people improve on their own
antitussives like dextromethorphan or benzonatate helps short term
codeine or hydrocodone if cough is severe
antipyretics, bed rest and increased fluid consuption
classic signs of asthma
intermittent dyspnea, wheezing, coughing (worse at night), SOB, chest tightness. Hx or
presence of respiratory sx AND demonstrated variable expiratory airflow obstruction.
Inflammation and bronchial hyper-responsiveness.
PE: wheezing, eachypnea, tachycardia, prolonged expiratory phase of respiration,
pale/swollen nasal membranes, cobblestone pharyngeal wall, cough, nasal polyps.
Asthma Triggers
tobacco smoke, beta blockers, aspirin, and NSAIDs
URI are #1
molds, pollen, dust mites, cockroaches, and animal danger
best diagnostic test for asthma
FEV1 (spirometry)
mild is 80% or more
moderate is 60-80
severe is less than 60
Rule of 2 for asthma
symptoms requiring SABA more than twice a week
nocturnal symptoms more than twice per month
refill of quick relief inhaler more than two times per year
mild asthma
Symptoms <2x/week, FEV1 >80% of best
moderate asthma
Symptoms >2x/week, FEV1 >60-80%
severe asthma
Continuous symptoms, FEV1<60%, frequent nocturnal symptoms, hospitalizations
stepwise treatment of asthma
intermittent: SABA
mild persistent: low dose ICS or leukotriene modifier
moderate persistent: low dose ICS + LABA, med ICS, LAMA +ICS
severe persistent: med or high ICS + LABA (may add leukotriene modifier, tiotripium,
biologic agent)
black box warning for asthma treatment
must prescribe ICS with LABA, never a LABA alone
criteria for diagnosing asthma with pulmonary function test results
, variability testing before and after bronchodilator, from one office visit to another or
before after bronchoprovocation challenge.
Increase FEV of 12% or more, accompanied by an absolute increase in FEV1 of at least
200 mL
hemoptysis
coughing up blood
hematemesis
vomiting blood
epistaxis
nosebleed
pleural effusion
abnormal amount of fluid within the pleural space. The pleura is a serous membrane
covering the lung parenchyma, mediastinum, diaphragm and rib cage. Two pleural
membranes: parietal (lines chest cavity) and visceral (covers both lungs). Occurs when
fluid formation exceeds fluid absorption. CHF is one of most common causes.
pleural effusion symptoms
dyspnea, nonproductive cough, pleuritic chest pain and activity intolerance. Dyspnea
worsens with recumbent positions, cough worsens as size of effusion increases.
Pleuritic pain is sharp, unilateral and localized to affected area, exacerbated by deep
inspiration cough or movement of upper body.
first line of treatment fo community acquire pneumonia for healthy adult
a macrolide is first line (Azithromycin, Erythromycin); doxycycline if pt unable to take
macrolide.
first line of treatment of community acquired pneumonia for individuals with
comorbidities
fluoroquinolone or a beta lactam plus a macrolide antibiotic is recommended.
first line of treatment of community acquired pneumonia for pts in ICU
a beta lactam (ceftriaxone, cefotaxime or ampicillin-sulbactam) plus either azithromycin
and fluoroquinolone (levofloxacin etc).
bacterial community acquired pneumonia gram positive bacteria
S. pneumoniae, common in individuals with comorbidities like diabetes, COPD,
asplenia, advanced age, cigarette smoking, congestive heart failure, dementia,
alcoholism or immunosuppression
abrupt onset of high fever with chills, productive cough with purulent sputum and signs
of consolidation like egophony, increased fremitus, dullness to percussion, rales and
rhonchi. .
bacterial community acquired pneumonia gram negative bacteria
H. influenzae, typically caused by an encapsulated strain. older adults and those with
underlying lung conditions are most susceptible to bacterium. Abrupt onset of fever,
shaking chills, cough with purulent sputum.
older adults presentation of pneumonia
lethargy, lack of appetite, increased falls and mental status changes
pneumonia presentation
fever, chills, malaise, cough with or without sputum production. Rales that do not clear
with a cough, bronchial breath sounds, egophony. Younger individuals (<48) typically
Clinical Presentation of Acute Bronchitis
cough (productive or not) is most likely but fever, muscle aches, and fatigue can also be
present. Burning substernal pain with breathing in. Cough lasts longer than 7 days but
shouldn't last more than 3 weeks.
Best Treatment Viral Bronchitis
most people improve on their own
antitussives like dextromethorphan or benzonatate helps short term
codeine or hydrocodone if cough is severe
antipyretics, bed rest and increased fluid consuption
classic signs of asthma
intermittent dyspnea, wheezing, coughing (worse at night), SOB, chest tightness. Hx or
presence of respiratory sx AND demonstrated variable expiratory airflow obstruction.
Inflammation and bronchial hyper-responsiveness.
PE: wheezing, eachypnea, tachycardia, prolonged expiratory phase of respiration,
pale/swollen nasal membranes, cobblestone pharyngeal wall, cough, nasal polyps.
Asthma Triggers
tobacco smoke, beta blockers, aspirin, and NSAIDs
URI are #1
molds, pollen, dust mites, cockroaches, and animal danger
best diagnostic test for asthma
FEV1 (spirometry)
mild is 80% or more
moderate is 60-80
severe is less than 60
Rule of 2 for asthma
symptoms requiring SABA more than twice a week
nocturnal symptoms more than twice per month
refill of quick relief inhaler more than two times per year
mild asthma
Symptoms <2x/week, FEV1 >80% of best
moderate asthma
Symptoms >2x/week, FEV1 >60-80%
severe asthma
Continuous symptoms, FEV1<60%, frequent nocturnal symptoms, hospitalizations
stepwise treatment of asthma
intermittent: SABA
mild persistent: low dose ICS or leukotriene modifier
moderate persistent: low dose ICS + LABA, med ICS, LAMA +ICS
severe persistent: med or high ICS + LABA (may add leukotriene modifier, tiotripium,
biologic agent)
black box warning for asthma treatment
must prescribe ICS with LABA, never a LABA alone
criteria for diagnosing asthma with pulmonary function test results
, variability testing before and after bronchodilator, from one office visit to another or
before after bronchoprovocation challenge.
Increase FEV of 12% or more, accompanied by an absolute increase in FEV1 of at least
200 mL
hemoptysis
coughing up blood
hematemesis
vomiting blood
epistaxis
nosebleed
pleural effusion
abnormal amount of fluid within the pleural space. The pleura is a serous membrane
covering the lung parenchyma, mediastinum, diaphragm and rib cage. Two pleural
membranes: parietal (lines chest cavity) and visceral (covers both lungs). Occurs when
fluid formation exceeds fluid absorption. CHF is one of most common causes.
pleural effusion symptoms
dyspnea, nonproductive cough, pleuritic chest pain and activity intolerance. Dyspnea
worsens with recumbent positions, cough worsens as size of effusion increases.
Pleuritic pain is sharp, unilateral and localized to affected area, exacerbated by deep
inspiration cough or movement of upper body.
first line of treatment fo community acquire pneumonia for healthy adult
a macrolide is first line (Azithromycin, Erythromycin); doxycycline if pt unable to take
macrolide.
first line of treatment of community acquired pneumonia for individuals with
comorbidities
fluoroquinolone or a beta lactam plus a macrolide antibiotic is recommended.
first line of treatment of community acquired pneumonia for pts in ICU
a beta lactam (ceftriaxone, cefotaxime or ampicillin-sulbactam) plus either azithromycin
and fluoroquinolone (levofloxacin etc).
bacterial community acquired pneumonia gram positive bacteria
S. pneumoniae, common in individuals with comorbidities like diabetes, COPD,
asplenia, advanced age, cigarette smoking, congestive heart failure, dementia,
alcoholism or immunosuppression
abrupt onset of high fever with chills, productive cough with purulent sputum and signs
of consolidation like egophony, increased fremitus, dullness to percussion, rales and
rhonchi. .
bacterial community acquired pneumonia gram negative bacteria
H. influenzae, typically caused by an encapsulated strain. older adults and those with
underlying lung conditions are most susceptible to bacterium. Abrupt onset of fever,
shaking chills, cough with purulent sputum.
older adults presentation of pneumonia
lethargy, lack of appetite, increased falls and mental status changes
pneumonia presentation
fever, chills, malaise, cough with or without sputum production. Rales that do not clear
with a cough, bronchial breath sounds, egophony. Younger individuals (<48) typically
