Final Review – NURS 5335 Family 2
(8 Questions- Respiratory)
Asthma:
Categories:
Intermittent- < 2X a week
Mild Persistant – > 2X a week but less than daily Moderate persistant – Daily symptoms but not all day
Stepwise:
Rule of 2: For moving up on the steps (Not controlled if...
Final Review – NURS 5335 Family 2
(8 Questions- Respiratory)
Asthma:
Categories:
Intermittent- < 2X a week
Mild Persistant – > 2X a week but less than daily Moderate persistant – Daily symptoms but not all day
Stepwise:
Rule of 2: For moving up on the steps (Not controlled if…)
●You use rescue inhaler >2 X per week
●Awaken with asthma at night more than 2X per month
●Refill your rescue inhaler >2X per year
Step 1: Symptoms > 2 X week then start SABA prn Step 2: add low dose ICS
Step 3: Low dose ICS + LABA or medium dose ICS
Step 4: Medium dose ICS + LABA (consider allergy immunotherapy, and consider referral to specialist) Step 5: High dose ICS + LABA and consider Omalizumab (immune modulator)
Step 6: High dose ICS + LABA + corticosteroid and consider Omalizumab
Assess Control and outside influences at every step. Make sure treatment of outside causes will not prevent a step up.
Step down if asthma is controlled at least 3 months.
Pearls:
●All asthmatics get a SABA
●SABA can be taken 3 treatments at 20 minute intervals
●A short course of corticosteroids may be needed
●Consider specialist at steps 4, 5, 6
●Pneumo and flu vaccine yearly
●NEVER give LABA alone
●Take SABA 30 minutes before exercise to decrease risk of exercise induced asthma
●PE below 55 in acute asthma exacerbation give steroid (prednisone) COPD
Gold Standards:
Mild: FEV1< or equal to 80% of predicted Moderate: 50% -80% of FEV1 predicted Severe: 30% - 50% of FEV1 predicted Very Severe- <30% of FEV1 predicted
Treatment:
Mild: SABD’s only
Moderate: SABD’s + antibiotics and/or oral corticosteroids
Severe: hospitalization or visit to ER (may also be associated with acute respiratory failure)
Medications:
SABA, LABA, Anticholinergics (tropiums), Combo SABA with anticholinergic, Combo LABA with anticholinergic, methylzanthines, inhaled corticosteroids, combo LABA with corticosteroids, systemic corticosteroids, phosphodiesterase-4 inhibitors.
NEVER use a leukotriene receptor blocker in COPD treatment. For exacerbation use 40mg prednisone for 5 days
Pearls:
●SABA indicated for all levels of COPD.
●Based on post-bronchodilator FEV1. Diagnosis is FEV1/FVC <0.70 which confirms persistent airflow limitation. 0.7-0.8 is normal in adults.
●Risk factors: Host factors (genetics, etc.), Tobacco use, Occupation, Indoor/outdoor pollution,
infections, etc.
●Symptoms: Wheezing, chest tightness, fatigue, weight loss, depression, anxiety, syncope, rib fx,
ankle swelling.
●Smoking cessation is #1 most effective and cost effective intervention to reduce risk and
progression
●Also encourage exercise, PPSV and flu immunizations
URI
AOM:
S&S: decreased tympanic membrane mobility
Causes: Strep pneumoniae, Haemophilis influenzae, and Morexella catarrhalis Treatment: observe for 48-72 hours first, 75% of cases resolve on their own. Amoxicillin 80-90 mg/kg per day first line
Amoxicillin/clavulanate or 2nd or 3rd gen cephalosporin is second line.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller registered_nurse. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $11.49. You're not tied to anything after your purchase.
