nbrc cse practice questions & answers
Information Gathering - Emphysema:
(Abnormal condition of the alveoli resulting destruction and loss of
elasticity.) - answer LEVEL I : Cyanosis, Barrel chest, increased A-P
diameter, Accessory muscle use, Digital clubbing of the nail beds,
Significant history of smoking and/or occupational exposure to smoke
or other pulmonary irritant
LEVEL II : Dyspnea, Wheezing breath sounds
LEVEL III : Chest X-ray—flattened diaphragms, hyperlucency, diminished
pulmonary vascular markings.
CBC—polycythemia, increased WBC due to possible infection.
ABGs—Compensated respiratory acidosis (high PaCO2, normal pH),
moderate to severe hypoxemia.
Sputum culture—often positive for bacteria.
LEVEL IV : FT—flows are decreased especially middle sized airways (FEF
25-75%) Fev1 and Fev1/FVC%, reduced DLCO (less than 20).
Descision Making - Empysema:
(Abnormal condition of the alveoli resulting destruction and loss of
elasticity.) - answer Oxygen therapy—low FIO2 (0.24 to 0.28) or 1 to 2
lpm nasal cannula
,Oxygen conserving devices such as liquid oxygen or trans-tracheal
oxygen
Home care education on devices and equipment cleaning
Rehabilitation efforts (specifics not usually required)
Aids to help quit smoking such as nicotine replacement therapy
Bronchodilation medication via MDI or aerosol nebulizers
Antibiotics for infection
Smoking cessation products (nicotine replacement therapy).
Information Gathering - Chronic Bronchitis
(Defined: Condition where the patient has a productive cough 25% of
the year for at least two consecutive years.) - answer LEVEL I :
Productive cough, purulent sputum production
Exposure to pulmonary irritants, like history of smoking
Frequent infections
LEVEL II : Dyspnea
LEVEL III : Chest X-ray—could be normal, or may show hyperlucency,
diminished, pulmonary markings.
CBC—possibly increased WBC due to possible infection.
ABGs—could be normal or very slight respiratory acidosis and
hypoxemia
,LEVEL IV : PFT—flows are decreased especially middle sized airways
(FEF 25-75%) FEV1, Normal DLCO
Decision Making - Chronic Bronchitis
(Defined: Condition where the patient has a productive cough 25% of
the year for at least two consecutive years.) - answer Anything that
promotes good pulmonary hygiene such as chest physiotherapy,
hydration therapy when sputum is thick.
Fluid therapy if dehydrated.Oxygen therapy for hypoxemia
Aerosolized bronchodilator therapy, Antibiotic Tetracycline may be
preferable
Information Gathering - Bronchiectasis
(Defined: Abnormal condition where the bronchi
secrete large volumes of pus during abnormal
dilation.) - answer LEVEL I : Productive cough, often with blood, digital
clubbing of the nail beds, significant history if infections (recurrent)
LEVEL II : Dyspnea
LEVEL III : Chest X-ray—generally normal
Sputum culture—gram negative bacteria
, LEVEL IV : Bronchogram is the primary test. Characterized by a "tree in
winter pattern"
Decision Making - Bronchiectasis
(Defined: Abnormal condition where the bronchi
secrete large volumes of pus during abnormal
dilation.) - answer Anything that promotes good pulmonary hygiene
such as chest physiotherapy, hydration therapy when sputum is thick.
Fluid therapy if dehydrated.Oxygen therapy for hypoxemia
Aerosolized bronchodilator therapy. May have to consider surgical
intervention on some highly affected segments
Information Gathering - OSA
(Defined: the cessation of breathing during sleep.
Is usually obstructive in nature but sometimes can be central or a
combination of the two (mixed). - answer LEVEL I : Spouse or bed
partner will complain of snoring and will often report witnessing
periods of apnea that exceed 10 seconds. Excessive upper airway tissue,
obesity, thick neck (greater than 16 inch collar size. Ability to fall asleep
quickly
Sleepiness during daytime and while watching TV or in front of a
computer
Information Gathering - Emphysema:
(Abnormal condition of the alveoli resulting destruction and loss of
elasticity.) - answer LEVEL I : Cyanosis, Barrel chest, increased A-P
diameter, Accessory muscle use, Digital clubbing of the nail beds,
Significant history of smoking and/or occupational exposure to smoke
or other pulmonary irritant
LEVEL II : Dyspnea, Wheezing breath sounds
LEVEL III : Chest X-ray—flattened diaphragms, hyperlucency, diminished
pulmonary vascular markings.
CBC—polycythemia, increased WBC due to possible infection.
ABGs—Compensated respiratory acidosis (high PaCO2, normal pH),
moderate to severe hypoxemia.
Sputum culture—often positive for bacteria.
LEVEL IV : FT—flows are decreased especially middle sized airways (FEF
25-75%) Fev1 and Fev1/FVC%, reduced DLCO (less than 20).
Descision Making - Empysema:
(Abnormal condition of the alveoli resulting destruction and loss of
elasticity.) - answer Oxygen therapy—low FIO2 (0.24 to 0.28) or 1 to 2
lpm nasal cannula
,Oxygen conserving devices such as liquid oxygen or trans-tracheal
oxygen
Home care education on devices and equipment cleaning
Rehabilitation efforts (specifics not usually required)
Aids to help quit smoking such as nicotine replacement therapy
Bronchodilation medication via MDI or aerosol nebulizers
Antibiotics for infection
Smoking cessation products (nicotine replacement therapy).
Information Gathering - Chronic Bronchitis
(Defined: Condition where the patient has a productive cough 25% of
the year for at least two consecutive years.) - answer LEVEL I :
Productive cough, purulent sputum production
Exposure to pulmonary irritants, like history of smoking
Frequent infections
LEVEL II : Dyspnea
LEVEL III : Chest X-ray—could be normal, or may show hyperlucency,
diminished, pulmonary markings.
CBC—possibly increased WBC due to possible infection.
ABGs—could be normal or very slight respiratory acidosis and
hypoxemia
,LEVEL IV : PFT—flows are decreased especially middle sized airways
(FEF 25-75%) FEV1, Normal DLCO
Decision Making - Chronic Bronchitis
(Defined: Condition where the patient has a productive cough 25% of
the year for at least two consecutive years.) - answer Anything that
promotes good pulmonary hygiene such as chest physiotherapy,
hydration therapy when sputum is thick.
Fluid therapy if dehydrated.Oxygen therapy for hypoxemia
Aerosolized bronchodilator therapy, Antibiotic Tetracycline may be
preferable
Information Gathering - Bronchiectasis
(Defined: Abnormal condition where the bronchi
secrete large volumes of pus during abnormal
dilation.) - answer LEVEL I : Productive cough, often with blood, digital
clubbing of the nail beds, significant history if infections (recurrent)
LEVEL II : Dyspnea
LEVEL III : Chest X-ray—generally normal
Sputum culture—gram negative bacteria
, LEVEL IV : Bronchogram is the primary test. Characterized by a "tree in
winter pattern"
Decision Making - Bronchiectasis
(Defined: Abnormal condition where the bronchi
secrete large volumes of pus during abnormal
dilation.) - answer Anything that promotes good pulmonary hygiene
such as chest physiotherapy, hydration therapy when sputum is thick.
Fluid therapy if dehydrated.Oxygen therapy for hypoxemia
Aerosolized bronchodilator therapy. May have to consider surgical
intervention on some highly affected segments
Information Gathering - OSA
(Defined: the cessation of breathing during sleep.
Is usually obstructive in nature but sometimes can be central or a
combination of the two (mixed). - answer LEVEL I : Spouse or bed
partner will complain of snoring and will often report witnessing
periods of apnea that exceed 10 seconds. Excessive upper airway tissue,
obesity, thick neck (greater than 16 inch collar size. Ability to fall asleep
quickly
Sleepiness during daytime and while watching TV or in front of a
computer
