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ACNP Pulmonary: Questions & Detailed Solutions
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ACNP Pulmonary: Questions & Detailed Solutions
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ACNP Pulmonary: Questions & Detailed SolutionsAsthma Right Ans - Characterized by an increased responsiveness of the
trachea and bronchi to various stimuli, and manifested by widespread
narrowing of the airways; hypertrophy of smooth muscle , mucosal edema
and hyperemia, thickening of epitherial basement membrane, hypertrophy of
mucus glans, acute inflammation, and plugging of airways by thick, viscid
mucus
Caused by: most important allergens are encountered indoors
Dust mites
Pets
Cockroaches
Indoor molds
Exercise
Cigarette smoke
S/S of Asthma Right Ans - 1. Respiratory distress at rest
2. Difficulty speaking in sentences
3. Diaphoresis
4. Use of accessory muscles
5. Respiratory rate>28 bpm
6. Pulse>110 bpm
**7. Pulsus paradoxus>12 mm Hg
8. Hyperresonance= air trapping
9. Cough
10. Chest tightness
Astham Ominous Signs Right Ans - Fatigue
Absent breath sounds
Paradoxical chest/abdominal movements
Inabilit to maintain recumbency
Cyanosis
Labs and Diagnostics of Asthma Right Ans - Slight WBC elevation with
eosinophilia
PFTs reveal abnormalities typical of OBSTRUCTIVE dysfunction
-Hospitalization is recommended if the initial FEV1 is <30% predicted or does
not increase to at least 40% after 1 hour vigorous therapy
, - Hospitalization is recommended if peak flow is <60 L/min initially or does
not improve to >50% after 1 hour of treatment
General improvement in FVC or FEV1 of 15% of FEF 25-75 of 25% after
inhaled bronchodilator
Initially respiratory alkalosis with mild hypoxemia on ABG
Hypercapnea is an ominous finding
A pCO2>45 indicates an emergency situation
Chest xray unnecessary unless to r/o other conditions-may show
hyperinflation (normal, expected finding)
Outpatient Management of Asthma Right Ans - 1.Short acting B2
adrenergic agonist- Albuterol for symptom relief or before exercise
2. Daily maintenance with inhaled corticosteroids- Budesonide,
Triamcinolone
-S/E include candidal infection of the oropharyn, dry mouth, sore throat
3. Short acting B2 adrenergic agonist for symptom breakthrough
4. If symptoms persist, increase inhaled corticosteroid OR add long acting B2
adrenergic agonist- Salmeterol; other options include Theophylline or
antimediators
5. Inhaled anticholinergics- Ipratropium, may be added if necessary--good for
a lot of secretions
6. Antiluekotrienes useful in the maintenance of chronic asthma - Montelukast
Inpatient Management of Asthma Right Ans - Supplemental O2 at 2-3 lpm
In mild to moderate, ABG not necessary if saO2>90% by pulse ox
In severe, check initial ABG
Adequate hydration by oral or IV routes
Inhalation sympathomimetics:
- Alupent
-Proventil, Ventolin
Corticosteroids in patients who do not respond to sympathomimetics
-Methylprednisolone
Parenteral sympathomimetics in patients unable to cooperate
-Aqueous epinephrine
Anticholinergic (atrovent) mdi
Status Asthmaticus Right Ans - Term used to describe severe, acute asthma
presneting in an unremitting, poorly responsive, life threatening manner.
Clinical findings are not reliable indicators of the severity of asthma.
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