AHN 572 pulmonary 1 QUESTIONS WITH COMPLETE 100% VERIFIED SOLUTIONS 2024/2025, Study Guides, Projects, Research of Nursing

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AHN 572 pulmonary 1 QUESTIONS WITH COMPLETE 100% VERIFIED SOLUTIONS 2024/2025 Epiglottitis symptoms rapid onset sore throat, out of proportion to exam findings epiglottitis risk diabetics treatment epiglottitis abx, 2/3rd gen cephalosporins, iv decadron 2nd gen - cefoxitin, cefotetan 3rd gen - ceftraixone, ceftazidime epiglottitis monitoring airway/continuous pulse ox epiglottitis x ray Thumbprint sign on the lateral neck view pharyngitis cause group a beta hemolytic streptococcus Pharyngitis symptoms fever, anterior cervical adenopathy, sore throat pharyngitis treatment penicillin preferred (pcn v, amoxicillin, pcn g), cephalosporins (cephalexin, cefadroxil, cefuroxime, cefpodoxime, cefdinir, cefixime) 1st generation cephalosporins cefazolin 2nd generation cephalosporins ceftin, cefoxitin, cefotetan 3rd generation cephalosporins cefpodoxime, ceftraixone, ceftazidime, cefotaxime 4th generation cephalosporins Cefepime 5th generation cephalosporins -Ceftaroline Carbapenems imipenem, meropenem, ertapenem, doripenem monobactams aztreonam Beta-lactams zosyn, unasyn, augmentin macrolides azithromycin, clarithromycin Fluoroquinolones Moxifloxacin, gemifloxacin, levofloxacin Aminoglycosides gentamicin, tobramycin, amikacin Glycopeptides Vancomycin Oxazolidinones Linezolid CAP symptoms fever, cough, dyspnea, sweats, chills, rigors, CP, pleurisy, hemoptysis, fatigue, myalgias, HA CAP exam findings inspiratory crackles, bronchial breath sounds, dullness to percussion, fever, tachypnea, tachycardia, desaturation CAP: Diagnostic Tests sputum culture - pt with severe disease/pt treated for mrsa or pseudomonas urinary antigen for s. pneumoniae or legionella rapid antigen flu test ABG CBC Blood culture CAP imaging infiltrates on CXR patchy opacities lobar consolidation air bronchograms O2 parameters MI or stroke - supplement if less than 90% at risk for hypercapnia 88-92% 100% O2 cluster HA, sickle cell, pneumothorax, carbon monoxide poisoning continuous symptoms, nighttime waking every night, extreme limitations FEV1 <60% severe asthma step 4 tx med ICS plus LABA or low dose ICS plus LTRA, theophylline, or zileuto severe asthma step 5 tx high dose ICS plus LABA and omalizumab for pt with allergies severe asthma step 6 tx high dose ICS plus LABA plus PO corticosteroids consider omalizumab mild asthma exacerbation increase SABA possible PO steroids if pt on ICS moderate asthma exacerbation SABA plus steroids PEF < 70 = steroids severe asthma exacerbation oxygen, SABA, steroids, ipratropium IV magnesium 2g Long Acting Beta Agonists (LABA) salmeterol, aformoterol, formoterol used in combo with ICS NOT for monotherapy Inhaled Corticosteroids 1st line asthma tx wash mouth after use beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone LABA-ICS combination medication symbicort (budesonide/ formoterol) advair (fluticasone/salmeterol) dulera (mometasone/formoterol) Long acting anticholinergics Tiotropium (Spiriva) Leukotriene Modifiers Montelukast (Singulair) alt to low dose ICS in mild asthma phosphodiesterase inhibitor Theophylline mild bronchodilator, antiinflammatory, immunomodulatory, strengthens diaphragmatic contractility, enhances mucocilliary clearance mast cell modulators cromolyn/nedocromil prevent asthma symptoms and improve airway function SABA albuterol, levalbuterol most effective bronchodilator during exacerbation Anticholinergics Ipratropium for those intolerant to SABA or with BB induced bronchospasm cans be combined with albuterol Systemic Corticosteroids prompt control for those not responding to SABA methylprednisolone, prednisolone, prednisone refractory poorly controlled asthmas long term steroids use need vitamin d and calcium supplements steroid adrenal suppression osteoporosis, thin skin, muscle wasting/weakness adverse effects of steroids oral candidiasis, dysphonia, ecchymosis, cataracts, glaucoma, HTN, sleep disturbances COPD diagnosis spirometry with airflow limitation, that's incompletely reversible after bronchodilator FEV1/FEV <0.7 gold 0 at risk for copd +cough and sputum remove toxins/lifestyle mods GOLD 1 FEV1 > 80%, asymptomatic or cough +/-sputum SABA GOLD 2 Moderate - 50% > FEV1 < 80% asymptomatic or cough + sputum SABA + LABA GOLD 3 FEV1 30-50%, daily symptoms SABA + LABA + ICS GOLD 4 Very Severe FEV1 < 30% predicted or < 50% with respiratory failure multiple symptoms May need long term O2 consider surgery gold A 0-1 exacerbations, no hospitalizations low risk, few symptoms SABA or combo with ipratropium gold b 0-1 exacerbations, no hospitalizations low risk, more symptoms SABA, LABA or LAMA or LABA/LAMA combo gold c > 2 exacerbations or 1+ hospitalizations high risk, few symptoms SABA, LAMA (tiotropium), or LAMA/LABA combo gold d >2 exacerbations and +1 hospitalizations high risk, more symptoms SABA, LAMA/LABA, or LABA+ICS romflumist for chronic bronchitis theophylline COPD exacerbation 0-1 outpt management 2 inpt vs obs admission > 3 inpt with possible icu (4/5) Non mrsa hap/vap treatment zosyn 4g q6h cefepime 2g q8 levofloxacin 750mg q24 MRSA hap or vap tx zosyn, cefepime, levofloxacin, cipro 400mg q8, aztreonam 2g q8 plus vancomycin 15mg/kg q8 linezolid 600mg q12 pseudomonas hap or vap tx zosyn, cefepime, imipenem 500mg q6, meropenem 1g q8 plus amikacin 15-20mg/kg qd, gentamicin 5-7mg/kg, tobramycin 5-7mg/kg, levofloxacin, cipro, aztreonam pseudomonas + MRSA vap or hap tx zosyn, cefepime, ceftazidime, imipenem, meropenem, aztreonam plus amikacin, gentamicin, tobramycin, levofloxacin, Cipro, aztreonam plus vancomycin, linezolid CAP tx outpatient healthy pt macrolides (azithromycin or clarithromycin)- conditional based on resistance levels amoxicillin 1 g TID doxycycline 100mg bid CAP steroid use only for sepsis, respiratory failure with FiO2> 50, and one of the following: metabolic acidosis (pH < 7.3, lactic > 4, CRP > 150) avoid steroid use in recent GI bleeder, poorly controlled DM, immunocompromised Test for TB Sputum culture am x 3 PPD (mantoux) (if the PPD is positive a CXR is done) CXR nucleic acid amplification interferon gamma assay (quantiferon or Tspot) PPD results > 5mm if pt HIV, recent TB contact, immunocompromised or suggestive CXR > 10mm recent immigration, IVDU, high risk resident, pt with gastrectomy, underweight, DM, silicosis, CKD, etc >15mm with no risk factors TB treatment RIPE (rifampin, isoniazid, pyrazinamide, ethambutol) DOT recommended 6-9mo regimen sinusitis presentation HA, pain in face that worsens when leaning forward, purulent drainage, fever, malaise, nasal congestion acute maxillary sinusitis most common unilateral face pressure, tenderness over cheek, referred pain upper incisor, possible r/t dental abscess Acute ethmoiditis pain/pressure over high lateral wall of nose btw eyes, radiates to orbits sphenoid sinusitis headache in the middle of the head Acute frontal sinusitis pain/tenderness in forehead, esp with palpation of medial end of eyebrows hospital sinusitis assoc with prolonged NG bronchiectasis abx amoxicillin/clavulanate doxycycline cipro bronchiectasis alt tx bronchial hygiene - hydration, mucolytics, CPT, pul rehab anti-inflammatory- steroids CXR in COPD hyper-expansion, flattened diaphragm, air pockets (bullae) CXR in CF peribronchial cuffing, mucus plug, bronchiectasis (ring shadows and cysts), increased interstitial markings, small rounded peripheral opacities, focal atelectasis, ptx pneumonia on cxr infiltrates, patchy opacities, lobar consolidation, air bronchograms pleural effusion on CXR blunting of costophrenic angle, loss of demarcation of diaphragm and heart, mediastinal shift to uninvolved side bronchiectasis symptoms -Chronic cough with copious amounts of purulent, foul-smelling sputum (> 10 mL per day) -Hemoptysis -Dyspnea -Wheeing -Pleuritic chest pain -Weight loss -anemia Flu symptoms fever, HA, myalgias, weakness, chronic bronchitis daily productive cough> 3mo it more in 2 consecutive years Flu treatment supportive, osteltamivir for flu a and b flu complications pneumonia, MI, CVD, sudden death, reye syndrome, seizure and encephalopathy Center criteria fever > 38 tender ant cervical adenopathy lack of cough pharyngotonsillar exudate suggests group a hemolytic streptococcus h1n1/avian flu fever, cough, dyspnea, seizure, encephalopathy, malaise,