FNP2 Quiz 3- Respiratory

  1. Cough and cold meds should not be given to any child what age? Why?
    • under 6 yrs
    • caused too many ER visits;
    • cough syrup can suppress cough too much and lead to pneumonia
  2. Bronchiolitis is most common when? Which ages are primarily affected?
    • First 2 yrs of life
    • 2-7 mos
  3. URI and wheezing does not indicate what?
  4. _______ is the common culprit for bronchiolitis.
  5. RSV is the main cause of _________ and __________ in kids UNDER 1 YOA.
    • Bronchiolitis
    • Pneumonia
  6. ______% of all kids will be infected with RSV before 2 yoa.
    98 (slide 17)
  7. Coughing, wheezing, copious clear nasal secretions - what should you think?
  8. Incubation from first exposure to first s/s of RSV is how long?
    about 4 days
  9. Kids will shed RSV from lower respiratory tract for how long?
    10 days to 3 weeks
  10. How is RSV spread?
    droplets (including those on hard surfaces)
  11. Under which circumstances should Synagis not be given?
    • otherwise healthy infants
    • gestational age of 29 weeks or more
  12. Who CAN be given Synagis?
    • infants with hemodynamically significant heart disease or chronic lung disease of prematurity
    • preterm infants at least the first 28 days of life
  13. Another word for Laryngotracheobronchitis.
  14. Tx for croup.
    • cool mist humidifier
    • PO steroids 
    • IM decadron (lasts 24 hrs)
  15. Pertussis infrequently occurs in what age?
    under 3 months
  16. How long does each phase of Pertussis last?
    two weeks
  17. What are the phases of Pertussis?
    • Catarrhal
    • Paroxysmal
    • Convalescent
  18. How long does the culture for B. pertussis take?
    7 days
  19. Tx for Pertussis.
    • Azithromycin or erythromycin (not in infants)
    • Azithro Day 1: 10mg/kg; Day 2-5: 5 mg/kg
  20. Antimicrobial therapy given in the ________ stage of Pertussis does not alter the course.
  21. How long can Pertussis last?
    100 days
  22. _______, _________, and _______ are all manifestations of CF.
    • Dry frequent cough,
    • bronchitis,
    • pneumonia
  23. Any cough in a child w/o precursor illness should alert you to what?
    foreign body!
  24. If a child has aspirated a small object, it can cause symptoms ______ later.
    days to weeks
  25. Hoarseness, chronic croupy cough, unilateral wheezing, blood-streaked sputum, metallic taste, atelectasis.
    Think foreign body!
  26. What might you hear with stethoscope in a kid who has aspirated something?
  27. Most common cause of pneumonia > 5yoa; most common cause < 5 yoa.
    • Mycoplasm
    • Strep pneumo
  28. After the neonatal period, most common causes of bacterial pneumonia in otherwise healthy kids.
    • Strep pneumo
    • M. cat
    • Group A strep
  29. Tachypnea, cough, sudden onset. Think what?
    bacterial pneumonia
  30. Do not use ________ for pneumonia (counterproductive!).
    cough suppressants
  31. Bacterial pneumonia tx for under 5.
    • Amox 90 mg/kg/day, OR
    • Augmentin
  32. Bacterial pneumonia tx for > 5 yrs.
    • Azithro OR 
    • Augmentin
    • (can use clarithro but is poorly tolerated d/t taste)
  33. Different age groups for treating asthma.
    • 0-4 yrs
    • 5-11 yrs
    • >12 yrs
  34. For patients not well controlled on low-dose inhaled corticosteroid (ICS), ______________ BEFORE adding adjunctive therapy is preferred in the 0-4 years olds.
    increasing the dose of their ICS to medium
  35. For patients not well controlled on low-dose inhaled corticosteroid, ______________  are considered as equal options for children 5-11 years of age and youths ≥12 years of age and adults.
    • increasing the dose of ICS to medium dose OR
    • adding adjunctive therapy to a low dose of ICS
  36. In children 5 and under, what is the most common cause of asthma-like symptoms?
    viral URI
  37. Kids younger than 5 yrs who have had 4 or more episodes of wheezing or dry repetitive cough in the last year that has lasted more than a day and has affected their sleep are more likely to have persistent asthma after 5 yrs old if they also have one of which factors?
    • parental h/o asthma
    • dx of atopic dermatitis
    • evidence of sensitivity to aero allergens or foods
  38. How is reversibility of asthma determined in kids 5 or older?
    • Increase of FEV1 of ≥ 12% from baseline that reverses or improves with use of albuterol, OR
    • increase ≥10% of predicted FEV1 after inhalation of a short-acting bronchodilator
  39. For asthma kids, ask about family h/o what?
    • asthma,
    • eczema, or
    • allergic rhinitis
  40. For asthma kids, ask about coughing at what time?
    at night or early morning
  41. Level of severity of asthma is in direct relationship to what?
    • symptoms per week
    • nocturnal symptoms per month
  42. What type of inhalers do not need spacers and are difficult for kids under 5?
    dry powder
  43. Most common admitting dx for kids.
  44. Be cautious in asthma pts (adults) with what OTC meds? What Rx meds?
    • ASA
    • NSAIDs
    • Beta Blockers
  45. Which step of asthma is this: symptoms 2 or less x week; nighttime symptoms 2 or less x month; no interference with normal activity.
  46. Which step of asthma is this: symptoms more than 2 days/week but not daily; nighttime symptoms 3-4 x month.
    mild persistent.
  47. Which step of asthma is this: clinical feature b4 tx; daily symptoms; nighttime symptoms > 1xweek but not nightly; daily use of short-acting B agonist.
    moderate persistent
  48. Which step of asthma is this: clinical features b4 tx; symptoms throughout day; often 7/week nighttime wakening; extremely limited activity.
    severe persistent
  49. RF for asthma related death includes how much use of SABA?
    more than 2 canisters per month
  50. RF for asthma related death includes ________ hospitalizations or ______ ED visits in 1 year
    • two or more
    • > 3
  51. SO2 should be maintained at > than ______ % in adults, and > _____ % in pregnant women.
    • 90
    • 95
  52. Which asthma pts should be given systemic steroids?
    • moderate-to-severe exacerbations and
    • do not respond completely to initial Beta2 agonist therapy
  53. Intravenous __________ has a bronchodilator activity in acute asthma, but is CI in _________.
    • Mg++
    • renal insufficiency
  54. Drug-resistant RF in relation to pneumonia.
    • age >65
    • beta-lactam therapy w/in 3 mos
    • alcoholism
    • steroid use 10mg/day x 2 weeks
    • exposure to child in a daycare program
  55. What type of pathogen might cause a pneumonia with these s/s? chills, rigors, malnourished, homeless.
    H. Flu
  56. For a pt with pneumonia who was previously healthy and no recent abx therapy w/in 3 mos, what can you Rx?
    • Macrolide (strong)
    • Doxycycline (weak)
  57. For a pt with pneumonia who was previously healthy and HAS recent abx therapy w/in 3 mos, what can be prescribed?
    • Respiratory quinolone OR
    • beta lactam plus macrolide (esp if pregnant; no quins)
  58. What is CURB-65?
    • Confusion
    • BUN elevation
    • RR over 30
    • low BP
    • age >65
    • *if more than 2, consider admission
  59. Dry, nonproductive cough, malaise, fatigue, fever, headache, diarrhea, rash, insidious onset (2-3 wk incubation). Young adults more common.
    Mycoplasma pneumonia
  60. Cough from mycoplasm pneumonia can last how long after the organism is eradicated?
    up to 6 weeks!
  61. Usually you will hear ____________ in the lungs with mycoplasm pneumonia.
    fine crackles
  62. Fever, myalgias, artralgia, h/a, dry hacky cough, sore throat (more over larynx→ hoarseness), low-grade fever.
    Chlamydophila Pneumoniae
  63. Acute onset, high fever, dry cough, chills, tachypnea, bradycardia, diarrhea, hyponatremia, elevated LDH.
    Legionella Pneumophilia
  64. ___________ pneumonia is spread by droplets and inhalation of contaminated water sources.
    Legionella Pneumophilia
  65. This type of pneumonia can cause CNS symptoms.
    Legionella Pneumophilia
  66. Common pneumonia organisms for COPD pts.
    • S. pneumoniae
    • H. influenzae
    • M. catarrhalis
    • Legionella
  67. Common pneumonia organisms for alcoholics.
    • S. pneumoniae (DRSP)
    • anaerobes
    • gram-negative bacilli (Kebsiella pneumoniae)
    • TB
  68. Common pneumonia organisms for nursing home residents.
    • S. pneumoniae (DRSP)
    • H. influenzae
    • anaerobes
    • gram-negative bacilli
    • TB
  69. Frequently described by pt as, "I have a chest cold".
  70. Causative agents of bronchitis.
    • Influenza A and B
    • parainfluenza
    • Coronavirus (type 1-3)
    • Rhinovirus
    • Respiratory syncytial virus (RSV)
    • Human metapneumovirus
  71. What may be beneficial for a pt whose peak flow has decreased (meaning airflow obstruction)?
    albuterol/B-2 agonist inhaler
  72. No use of antibiotics in the initial treatment of Acute Bronchitis; an exception would be if pt is > 65 yrs with acute cough and 2 or more of what?
    • Admission to hospital in the previous year
    • DM 1 or 2
    • H/o HF
    • Current use of glucocorticoids
  73. Drug of choice for pertussis.
  74. What's the best way to evaluate an obstructive component to a cough?
    Peak flow
Card Set
FNP2 Quiz 3- Respiratory