AGNP-Exam 2 Questions with complete solutions 2023

AGNP-Exam 2 Questions with complete solutions 2023 aldosterone Hormone that stimulates the kidney to retain sodium ions and water HAP nosocomial VAP 48-72 hours after intubation CAP community acquired pneumonia acute inflammation of pulmonary parenchyma acquired in community CAP antibiotics Macrlides (Zpack) Cephalsporins (rocephin/cefepime, zosyn for broad) Fluroquinolones (levaquin/moxifloxacin)-po and iV HCAP acquired in HCFacility IV therapy, wound care or iv chemo within 30 days NH or LTF hospitalization 2-3 days within last 90 hospital or dialysis in last 30 HCAP Antibiotics add vanco for MRSA add flagyl for possible aspiration G+C for PNA Strep pneumoniae (COPD) Strep pyogenes (Group A) Strep agalactiae (group B) S. Aureus G+R for PNA bacillus anthracis nocardia sp. (chronic PNA ) G-C for PNA Nieressa Menigits G-R for PNA klebsilla pneumoniae pseudomona aeroginosa (COPD and CF) Anaerobes for PNA Acintebactor Sp. Burkholderia pseudomallei hemophillis influenza (COPD) Bordetella pertusus -Whooping proteus sp. serratia sp. Atypical Pathogens for PNA M Tuberculosis (chronic PNA) legionella pneumophilia mycloplasma pneumonia chlamydia tracematis chlamydia pneumonia Risk factors for PNA- 1 travel, animal, occupation, envirnmental (ie air condition) Aspirations risk for PNA etoh, AMS, anatomic abnormalities drug use dysphagia GERD, seizures PNA S&S chest pain SOB productive cough hemoptosis decreased exc. tolerance abdominal pain from pluritis PNA S&S- 2 fever, chills, rigors, malage, mylagiz, HA PNA bacterial sputum green ,yellow PNA viral sputum white, stable WBC, drycough PNA diagnostics CBC, CMP, BC, ABG vs. VBG, EKG cxr, chest Ct lactic acid bronch procalcitonin Procalcitonin (PCT) bacterial inflammation marker Treatment for PNA respiratory support antibiotics prevention Prevention of PNA PCV12- adults 65, children 2 PPSV23- 65 or smokers 19-64 Causes of Plural Effusion CHF PNA liver disease ESRD nephrotic syndrome cancer P.E. Lupus or other autoimmune conditions S/S of pleural effusion small: asymptomatic mod-large-SOB, chest pain, fever, cough Diagnostics of pleural effusion CXR US Chest Ct Thoracentesis: Diagnostic vs. therapuetic Plural Fluid Analysis Transudate-clear exudate-WBC, protein and blood Plural fluids Light's criteria PFluid protein/serum protein 0.5 PF LDH/Serum LDH 0.6 PFLDH 2/3 of upper normal serum LDH Chemical eval of plural fluid protein ldh low glucose tumor markers Nucleated cells in Plural fluid 50000-empyemia 10000-bacterial PNA, acute pancreatis, lups 5000- TB, Malignancy Treatment for plural effusion 1. underlying cause 2. thoracentesis 3. chest tube 4. pluraldesis (doxycycline) 5. Plural drain -pleurx 6. plural decortication Noncardiac pulmonary edema cause Barbituate or opiate overdoes, inhalation of gases, rapid administration of IV fluids' *Main reason: ARDs ARDS (acute respiratory distress syndrome) Acute diffuse, inflammatory lung injury leading to increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue Berlins ARDS 1. onset within 7 days of event 2. bilateral opacities 3. no need to exclude HF 4. No clear risk factors ARDS management Ventilator support: Mode, TV, Fio2, PEEP Additional ARDS Management sedation paralytics nitric oxide, prostacyclin prone position ECMO Non-cardiac pulmonary edema 1. reperfusion PEdema 2. Re-expansion PEdema 3. opiod overdose 4. High altitude PEdema Cardiogenic PEdema 1. lt ventricular dysfunction 2. heart enzymes 3. EKG 4. CXR/CT 5. BNP (high- HF, normal- lung disease) Treatment PEdema 1. O2 2. Preload reducer: NTB, Diuretics, Fluid restriction 3. afterload reducer: Nitroprusside 4. Manage BP 5. Morphine Unilateral pulmonary edema causea 1. papillary dsyfunctio, MVR 2. dependent lung (not turned enough) 3. rapid removal fluid 4. Aspiration of gastric content 5. Unilateral infusion of fluid through misplaced catheter 6. **bronchial obstruction TRALI (transfusion related acute lung injury) usually within 6h of blood transfusion SOB Fever Chills low BP low O2 infiltrates, normal EF exudate fluid little response to diuretics TACO transfusion associated circulatory overload within 6 hours resp. distress tachycardia high BP worsening P.Edema positive fluid balance no fever, JVP effected low EF CURB-65 1) Confusion 2) BUN19 3) RR30 4) BP90/60 5) 65yo One or less indicates patient can be treated outpatient, 1 =hospitalization Spirometry measures the volume of air entering or leaving the lungs spirometry perform pre and post bronchodilator and look for reversibility Asthma spirometry results compare FEVi and FEVI% -1. 200 ml increase 2. 12 increase from baseline peak expiratory flow Measures flow (not volume) correlates to FEVI can be monitored at home compare against personal best need 2 consecutive readings FVC (forced vital capacity) The amount of air forcefully expired after a maximal inspiration FEVI forced expiratory volume (in a second) FEVI% predicted based on age, ht, sex and ethnicity FEVI/FVC ratio corrects restricted lung volumes -corrects for kyphosis, fibrosis GOLD for COPD "Global Initiative for Chronic Obstructive Lung Disease" Gold 1- mild 90% Gold 2-Moderate 50-80% Gold 3- Severe 30-50% Gold 4-very severe 30% N/C 1-6L 24-44% FIO2 Face Mask 5-8L 35-55% FIO2 Venturi mask 24-50% FiO2 Partial NRB -Gives 50-70% at 6-11 L Oxymask 1-15L/min; 98% FIO2 (Leakage) NRB 6-10 l 70-100% FIO2 High flow nasal cannula O2 can be adjusted from 4 L in infants up to 40 L or more in adolescents. Deliver a combo of room air and oxygen. CPAP (continuous positive airway pressure) pressurized air delivered to lungs to keep them expanded during exhalation BiPAP settings 1. IPAP (8 minimum) 2. EPAP- 4 minimum 3. back up rate 4. FIO2 *blows off CO2