NSG 6420 MIDTERM EXAM QUESTIONS AND ANSWERS

NSG 6420 MIDTERM EXAM QUESTIONS AND ANSWERS COPD Stage I -Answer-MILD FEV1/FVC 70% FEV1/80% *Chronic cough/sputum production *Pt unaware lung function is abnormal COPD Stage II -Answer-MODERATE FEV1/FVC 70% FEV1 50-80% SOB with exertion Cough and sputum production present COPD Stage III -Answer-SEVERE FEV1/FVC 70% FEV1 30-50% Greater SOB Reduced exercise capacity Fatigue Repeated exacerbations with impact on QOL COPD Stage IV -Answer-VERY SEVERE FEV1/FVC70% FEV130% Resp. Failure Cor Pulmonale (elevation of JVP and pitting ankle edema) QOL very impaired Exacerbations may be life threatening How does FEV1 decrease? -Answer-Inflammation Narrowing of peripheral airways Airway collapse in severe emphysema COPD diagnosis? -Answer-SPIROMETRY is key Primarily Inflammatory with superimposed bronchospasm -Answer-Asthma Most common chronic respiratory disorder among all age groups -Answer-Asthma Atophy -Answer-exaggerated IgE mediated immune response; all atophic disorders are type I hypersensitivity disorders Type I hypersensitivity reaction -Answer-Immediate hypersensitivity IgE-mediated Antigen binds to IgE that is bound to tissue mast cells and blood basophils, triggering release of preformed mediators (histamine, proteases, chemotactic factors) and synthesis of other mediators (prostaglandins, leukotrienes, platelet-activating factor, cytokines) -causes vasodilation, increased cap. permeability, mucus hypersecretion **atopic disorders (allergic asthma, rhinitis, conjunctivitis), anaphylaxis, some cases of angioedema, urticarial, and latex and some food allergies **Develop 1h after exposure to antigen Allergic triad of symptoms -Answer-allergies, eczema, and asthma Samter's Triad -Answer-Nasal polyps, asthma, and ASA allergy Most common symptom of asthma -Answer-wheezing Common only symptom of asthma? -Answer-Cough -can often delay dx of asthma AKA cough variant asthma Best way to confirm asthma dx? -Answer-bronchial provocation Intermittent asthma -Answer-sx /2days/week PM awakenings /2/month SABA use /2 days/week No interference with norm. activity 0-1 exacerbations requiring oral steroids / yr Tx for intermittent asthma -Answer-step 1 Mild asthma -Answer-Sx /2days/week but not daily pm awakenings 3-4x/month SABA use 2 days/week but not daily minor limitation Intermittent asthma lung function -Answer-normal FEV1 bt exacerbations FEV180% predicted FEV1/FVC normal Mild asthma lung function -Answer-FEV180% pred. FEV1/FVC normal Mild asthma tx -Answer-Step 2 Moderate asthma -Answer-Sx: daily PM awakenings: 1x/week but not nightly SABA use: daily some limiation mod. asthma lung function -Answer-60FEV180 predicted FEV1/FVC reduced 5% Mod. asthma tx -Answer-step 3 and consider shot course of oral steroid Severe asthma -Answer-Sx: thruout day pm awakenings: often 7x/week extremely limited severe asthma lung function -Answer-FEV160% predicted FEV1/FVC reduced 5%