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Respiratory Disease Assessment & Management &Therapy
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1. Information Gathering - Asthma
(Defined: Abnormal constriction of the bronchials
resulting in sputum productionand narrowed
airways. - Correct Answer: LEVEL I : Accessory muscle use, Tachycardia
LEVEL II : Dyspnea, Wheezing, Congested cough, Wet, clammy skin
LEVEL III : ABGs—possible respiratory acidosis, could be hypoxic, Chest X-ray—
hyperinflation, scattered infiltrates, flattened diaphragms. In allergic cases, may
see elevated eosinophil count which can cause yellow sputum
LEVEL IV : PFT—Decreased flows in FEV1 but diffusion is normal as manifested by
DLCO
2. Decision Making - Asthma
,(Defined: Abnormal constriction of the bronchials
resulting in sputum productionand narrowed
airways. - Correct Answer: Oxygen therapy for hypoxemia
Aerosolized bronchodilator therapy
Continuous bronchodilator therapy, Albuterol (7-10 mg/hr)
Xanthine medication given IV (Aminophylline, etc)
Promote pulmonary hygiene
Inhaled sterioids such as oral or IV prednisone
3. 4. Information Gathering - Status Asthmaticus
(Defined: Asthma that will not respond to bronchodilation therapy,usually persists
more
than 24 hours.) - Correct Answer: LEVEL I : Historically non-responsive to
bronchodilators. Patient will report the need to take many bronchodilator
treatments before feeling better. Accessory muscle use and retractions
Dyspnea, Wheezing, Congested cough, Wet, clammy skin
LEVEL II : Pulses paradoxus
LEVEL III : ABGs—possible respiratory acidosis when tiring, alkalosis at first due to
anxiety, could be hypoxic
Chest X-ray—hyperinflation, scattered infiltrates, flattened diaphragms.
4. Decision Making - Status Asthmaticus
,(Defined: Asthma that will not respond to bronchodilation therapy,usually persists
more
than 24 hours.) - Correct Answer: May deteriorate quickly, so if progression is
shown, intubate, mechanically ventilate before full ventilatory failure.
Use subcutaneous epinephrine—1 mL of 1:1000 strength. May need to give every
20—30 minutes for up to three consecutive doses (if no improvement between
doses)
Continuous beta II agonist (bronchodilator medication). Albuterol 7-10 mg/hr.
5. Information Gathering : Myasthenia Gravis
(Defined: Neuromuscular abnormality where muscles
experience paralysis starting from the head down to the feet including ventilatory
muscles.) - Correct Answer: LEVEL I : May have a history of Myasthenia Gravis
if not a new onset, Droopy facial muscles and eyelids (Ptosis)
LEVEL II : Patient will describe slowly feeling weakness generally but feels better
with rest. Double vision (diplopia)
Dysphagia (difficulty swallowing) Drooping eyelid (Ptosis)
Shrinking Vt, VC, MIP
LEVEL IV : Tensilon Challenge Test—positive for Myasthenic crisis if improvement
is noted upon the administration of Tensilon.
6. Decision Making : Myasthenia Gravis
, (Defined: Neuromuscular abnormality where muscles
experience paralysis starting from the head down to the feet including ventilatory
muscles.) - Correct Answer: If Tensilon improves condition then,
anticholinesterase therapy is indicated including: Neostigmine (prostigmine),
Mestinon (pyridostigmine) Ok to do additional Tensilon challenge test to observe
progression. If symptoms improve with Tensilon and then worsen, must reverse
with Atropine. This condition is termed a cholinergic crisis. Always monitor
spontaneous ventilatory volumes (Vt and VC) as well as MIP. Never treat
Myasthenia gravis with Tensilon—only use to diagnose. Use the above mentioned
drugs to provide maintenance.
Be totally prepared to intubate and mechanically ventilate prior to Tensilon
challenge since it could take out the respiratory drive
When VC falls off rapidly (especially if below 1.0 L) , then intubate and
mechanically ventilate.
7. Information Gathering : Drug Overdose
(Defined: Potential loss of ventilatory drive as a
result of drug overdose (usually a narcotic). ) - Correct Answer: LEVEL I :
Historical drug use as told by previous admissions or family, Sometimes poor self-
hygiene, emaciated
LEVEL II : Looks and acts sleepy, difficult to arouse, Respiratory rate and pattern is
low and/or shallow
LEVEL III : ABG—often show pure respiratory acidosis and/or ventilatory failure
8. Decision Making : Drug Overdose