NR 601 MIDTERM EXAM 2
What is the major difference between varicose veins and atherosclerosis?
Vessels that are affected
Pt has had poorly controlled
... [Show More] HTN >10yrs. Indicate the most likely position of his PMI.
c. 5th ICS left of MCL
43yo hispanic male has audible diastolic murmur best heard at the mitral point. No audible click. He has been monitored for 2yrs. What is the most likely murmur?
d. Mitral stenosis
What are PFTs?
Group of tests that provide quantifiable measurement of lung function, used to dx resp abnormalities or assess progression/resolution of lung dz.
What is FEV1?
Forced Expiratory Volume in 1 second (80-120%)
What is FVC?
Forced Vital Capacity (80-120%)
What is normal FEV1/FVC ratio?
<0.7 (70%)
What is GOLD 1 criteria?
Mild
FEV1 >/= 80% predicted
What is GOLD 2 criteria?
Moderate
FEV1 50-79% predicted
What is GOLD 3 criteria?
Severe
FEV1 30-49% predicted
What is GOLD 4 criteria?
Very severe
FEV1 <30% predicted
What are the signal symptoms of COPD?
Dyspnea
Chronic cough w/sputum
Decreased activity tolerance
Wheezing
What are characteristics of COPD?
Common, preventable, treatable.
Characterized by persistent airflow limitation.
Usually progressive, associated with enhanced chronic inflammatory response in airways and lungs to noxious particles/gases
Airway fibrosis, luminal plugs, airway inflammation, increased airway resistance, small airway dz.
Decreased elastic recoil of alveoli.
What are risk factors for COPD?
Smoking (increasing w/number of pack years)
Second hand smoke
Environmental pollution (endotoxins, coal dust, mineral dust)
What is seen on phys exam in COPD?
May be normal in early states
As severity progresses: lung hyperinflation, decreased breath sounds, wheezes at bases, distant heart tones (b/c of hyperinflation, so S1/S2 sounds off in distance), accessory muscle use, pursed lip breathing, increased expiratory phase, neck vein distention.
How is COPD diagnosed?
Spirometry is gold standard (pre and post bronchodilator).
Irreversible airflow limitation is hallmark.
How is COPD treated?
Bronchodilators: beta agonists (long/short), anticholinergics (long/short), or combo.
What is the MOA of beta agonists?
Stimulates beta-2-adrenergic receptors, increasing cyclic AMP, resulting in relaxing airways.
What is the MOA of anticholinergics?
Block the effect of acetylcholine on muscarinic type 3 receptors, resulting in bronchodilation.
Why are long-acting beta agonists prescribed for COPD?
They are for moderate airflow limitation.
They relieve symptoms, increase exercise tolerance, reduce number of exacerbations, improve QOL.
What are some non pulmonary diagnoses that result in COPD-type symptoms?
CHF
What are some Hyperventilation syndrome
Panic attacks
Vocal cord dysfunction
Obstructive sleep apnea
Aspergillosis
Chronic fatigue syndrome
What are signal symptoms of asthma?
Wheezing
Shortness of breath
Cough (esp at night)
Chest tightness [Show Less]