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ANCC AGPCNP Adult-Gero Review Questions and Answers.
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ANCC AGPCNP Adult-Gero ReviewQuestions and Answers.
Acute cough -
\< 3 weeks
Subacute cough -
\3-8 weeks
Chronic cough -
\>8 weeks
Acute Bronchitis -
\inflammation of the bronchioles
Acute bronchitis etiology -
\almost always viral
Acute Bronchitis symptoms -
\cough that usually lasts 10-20 days
Acute Bronchitis Treatment -
\OTC antitussive, NSAIDs, antibiotics NOT recommended
Pneumonia etiology -
\*S. pneumoniae
*M. pneumoniae
*C. pneumoniae
Pneumonia treatment -
\*healthy with no recent antibiotics=macrolide or doxy
*comorbidities or recent antibiotic=DRSP=resp quinolone OR beta-lactam + macrolide
OR beta-lactam +Doxy
Pneumonia length of treatment -
\*minimum 5 days
*average 5-10 days
*re-evaluate after 48-72 hrs if poor response
Pneumovax -
\*PPSV: 19-64 with increased risk
*PCV13 + PPSV23: all adults >/= 65, or 19-64 with asplenia, immunocompromised,
CSF leaks, cochlear implant, advanced CKD
,COPD -
\persistent airflow limitation that is usually progressive and associated with enhanced
chronic inflammatory response in the airways and lung to noxious particles or gases
COPD Diagnosis -
\*symptoms compatible with COPD (DOE, cough, sputum)
*spirometry=FEV1/FVC ration <70% plus FEV1 <80% predicted
*no alternative explanation for symptoms
*Alpha-1 antitrypsin deficiency
COPD Stage 1 -
\Mild: FEV1/FVC <70%, with or without symptoms
COPD Stage 2 -
\Moderate: FEV1/FVC <70%, dyspnea with exertion, with or without cough and sputum
production
COPD Stage 3 -
\Severe: FEV1/FVC <70%, increased dyspnea, reduced exercise capacity, fatigue, and
repeated exacerbations
COPD Sage 4 -
\Very severe: FEV1/FVC <70%, FEV1 <30% predicted or <50% plus respiratory failure
COPD treatment: Stage 1 -
\SABA PRN
COPD Treatment: Stage 2 -
\SABA PRN + LABA routinely
COPD Treatment: Stage 3 -
\SABA PRN + LABA + inhaled steroids
COPD Treatment: Stage 4 -
\SABA PRN + LABA + inhaled steroids + treatment of complications, rehab, long-term
O2 therapy, consider surgical treatments
Bronchodilators: SABA -
\`rescue med; works immediately and effects last for about 4 hours
Suffix: "terol"
Bronchodilators: LABA -
\not a rescue med; takes 10-20 minutes to work, lasts for 12 hours
Inhaled anticholinergic -
\works by preventing bronchoconstriction
,Suffix: "tropium"
Inhaled steroids -
\Reduces inflammation
best in combo with LABA
Suffix: "one" or "ide"
COPD exacerbations -
\an acute event characterized by a worsening of the pt's respiratory symptoms beyond
the normal day to day variations and leads to a change in medication
Exacerbation management -
\CBC, sputum culture, bronchodilator/anticholinergic or both nebulized, systemic
steroids, antibiotics (80% of time caused by infection) for increased dyspnea, sputum
production, purulence
COPD health promotion -
\*smoking cessation--> most important and cost effective (encourage at each visit)
*regular exercise
*pneumovax/influenza vaccine annually
Asthma -
\a chronic respiratory disease characterized by REVERSIBLE AIRWAY
OBSTRUCTION, inflammation, and airway hyper-responsiveness
Asthma -
\majority (75%) diagnosed by age 7
Asthma: triad of symptoms -
\wheezing (expiratory), cough, chest tightness/SOB
Asthma course -
\predictible pattern of respiratory symptoms when exposed to a precipitant (URI, mold,
exercise)
Asthma stages: intermittent -
\symptoms < twice per week
Asthma stages: mild persistent -
\symptoms > twice per week, but < once daily
Asthma stages: moderate persistent -
\daily symptoms (but not all day)
Asthma stages: severe persistent -
\continuous symptoms
, Asthma Treatment: Step 1 -
\SABA PRN
Asthma Treatment: Step 2 -
\low dose ICS
Asthma Treatment: Step 3 -
\Low dose ICS + LABA OR medium dose ICS alone
Asthma Treatment: Step 4 -
\medium dose ICS + LABA
Asthma Treatment: Step 5 -
\high dose ICS + LABA + consider omalizumab for pts with allergies
Asthma Treatment: Step 6 -
\high dose ICS + LABA + PO steroid
Anemia -
\reduction in one or more RBC measurements
Anemia Etiology -
\blood loss (most common)
*melena
*hematemesis
*trauma
Anemia etiology -
\Bone marrow not making enough RBCs
*lack of nutrients: iron, B12, folate
*disorders: aplastic anemia, myelodysplastic syndromes
*bone marrow suppression: chemo
*Low levels of erythropoietin (CKD)
*anemia of inflammation: malignancy, anemia of chronic disease
Anemia etiology -
\Increased destruction of RBCs
*inherited disorders: sickle cell, thalassemias
*malaria
*hemolytic anemia
RBC Size: MCV -
\microcytic: <80
normocytic: 80-96
macrocytic: >96
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