Adult 1 Exam 2 Outline - Exam 2 Outline Main Topics PVS...

Exam 2 Outline: Main Topics
PVS Problems : Done by Jodi
Respiratory Problems
Upper Respiratory Infection (URI)
 Bacterial infections: 25%
 Influenza
 Common cold
 Acute laryngitis
 Acute epiglottitis
 Respiratory syncytial virus (RSV)
URI: Management
 Discussion of antibiotics, oseltamivir, zanamivir
 Cough suppressants
 Rest
 Fluids
 Antipyretics
Asthma
Three principle triggers
1. Allergens and environmental factors
 Inhaled substances
 Food additives
 Medications
2. Infections
 Upper respiratory infection
3. Psychological factors
 Stress
Asthma: Management
 Identification of exacerbating factors
 Daily monitoring of peak expiratory flow
 See online resource on asthma attack trigger diary
 Written instructions to manage an acute attack
 Education and follow-up
Asthma: Medications
 Relievers
 SABA
 Controllers
 Oral systemic corticosteroids
 Low, medium, or high-dose ICS
 LTRA, cromolyn, nedocromil, or theophylline, zileutin
 LABA
 Step-up and step-down therapy
 Six steps

Chronic Obstructive Pulmonary Disease (COPD)
 Obstructive (impaired expiratory flow rate)
 Reversible
 Asthma
 Irreversible
 Chronic bronchitis and emphysema
 Restrictive (reduced lung volumes)
 Musculoskeletal disorders
 Tumors
 Lung resection, ILD
 Chronic Obstructive Pulmonary Disease (COPD) (cont’d)
 “Blue bloaters”
 Chronic bronchitis and pulmonary hypertension
 Edema, cyanosis, polycythemia
 “Pink puffers”
 Emphysema, severe dyspnea
 Relatively normal ABGs
 “Barrel chest”
COPD: Objective Findings
 AP/lateral chest diameter 1:1
 Distant breath sounds
 End-expiratory wheezes
 Prolonged exhalation
 Neck vein distension
 Pedal and ankle edema
 Clubbing
 Fatigue
COPD: Diagnostic Tests
 PFTs
 FEV
1
/FVC ratio <70% diagnostic for COPD
 Chest x-ray (although normal in early COPD)
 Chest CT
 CBC with diff, blood chemistry, alpha
1
-antitrypsin
 Sputum with Gram stain
 ECG
COPD: Pharmacological Therapy
 Inhaled beta-2 agonist bronchodilators
 Inhaled anticholinergic bronchodilators
 Corticosteroids
 Xanthines
 Antibiotics
 Diuretics
 Mucolytics and expectorants
 COPD:
Requirements for Home Oxygen
 PaO
2
of 55 mm Hg or less
 Oxygen saturation below 85%

 A PaO
2
of 55 to 59 mm Hg if erythrocytosis (HCT of 56% or more), cor pulmonale (P wave more than 3
mm in leads II, III, and aVF), edema, or CHF
 Goal on 1-2 L/min for 15 hours day is O
2
sat. of 90% or PaO
2
of 60 mm Hg
COPD: Patient Education
 Smoking cessation
 Yearly influenza shot and every 5 year pneumovax
 Physical rehabilitation
 Support groups
 Teach pursed-lip breathing and O
2
therapy
 Assess for depression and treat if present
 Discuss advance directives
Community-Acquired Pneumonia (CAP)
 Streptococcus pneumoniae, Haemophilus influenzae, Legionella pneumophila, Staphylococcus aureus
 Viral pneumonia
 Mycoplasma