MedSurg Week 5

COPD — Definition and main airflow problem?

Persistent obstruction; expiration is prolonged.

COPD — Chronic bronchitis versus emphysema mechanisms?

Bronchitis: inflamed, mucus-filled airways. Emphysema: alveolar/recoil loss causes air trapping.

COPD — Main environmental and inherited risks?

Smoking, dust/chemicals, pollution; alpha-1 antitrypsin deficiency.

COPD — Baseline assessment and exacerbation cues?

Compare usual symptoms/O2 with increased dyspnea, sputum, or oxygen need.

COPD — Spirometry versus ABGs: what does each assess?

Spirometry: post-bronchodilator FEV1/FVC <0.70. ABGs: oxygenation, CO2, acid-base status.

COPD — Stable medication foundation and ICS use?

Bronchodilators are foundational; ICS benefits selected patients.

COPD — Exacerbation medications beyond bronchodilators?

Systemic steroids reduce inflammation; antibiotics only when indicated and prescribed.

COPD — Oxygen target and CO2 safety principle?

Often 88-92% when hypercapnia risk exists; follow orders and do not withhold needed oxygen.

COPD — Upright positioning and pursed-lip breathing?

Sit upright; pursed-lip breathing slows expiration and reduces air trapping.

COPD — Long-term nonmedication priorities?

Smoking cessation, pulmonary rehabilitation, and an exacerbation action plan.

COPD — Reassessment and signs of improvement?

Recheck effort, air entry, mentation, SpO2/ABGs; improvement approaches baseline oxygen need.

COPD — Three common symptoms?

Dyspnea, chronic cough, and sputum production.

COPD priority — Target SpO2 but new drowsiness: action?

Assess ventilation, activate urgent help, and prepare ventilatory support.

COPD — What does cor pulmonale mean?

Right-heart dysfunction related to lung disease.

COPD priority — Immediate assessment during an exacerbation?

Airway, effort, speech, mentation, SpO2, and hemodynamics.

COPD priority — Hypoxemic exacerbation: immediate support?

Sit upright, give controlled oxygen, administer ordered short-acting bronchodilator.

COPD escalation — Persistent hypoxemia, exhaustion, or worsening acidosis?

Activate urgent help; prepare ventilatory support.

COPD priority — Sudden unilateral absent sounds and chest pain?

Suspect pneumothorax; assess stability, provide oxygen, obtain urgent help.

Asthma — Mechanism and diagnostic emphasis?

Variable obstruction from inflammation, bronchospasm, mucus; confirm variable airflow limitation.

Asthma — Common symptoms and triggers?

Wheeze/cough/tightness/dyspnea; allergens, smoke, infection, exercise, cold air.

Asthma — Poor-control cues and nursing follow-up?

Night waking/frequent reliever use; review control, adherence, technique, and plan.

Asthma — ICS role and LABA safety?

ICS reduces exacerbations; LABA requires ICS. Continue prescribed controller therapy.

Asthma — Acute attack medications?

Rapid inhaled bronchodilator; severe attacks may need ipratropium, systemic steroid, selected IV magnesium.

Asthma — How do you reassess treatment and interpret less wheeze?

Recheck speech, effort, air entry, SpO2/peak flow; less wheeze helps only with better airflow/mentation.

Asthma — Peak-flow zones and actions?

Green 80-100%: maintenance. Yellow 50-79%: step-up. Red <50%: emergency plan/urgent care.

Asthma — Signs of impending respiratory failure?

Silent chest, exhaustion, altered mentation, worsening gas exchange, or rising CO2.

Asthma — Key attack-severity assessments?

Speech, alertness, effort, air movement, and SpO2.

Asthma — Can ICS-formoterol be a reliever?

Yes, in selected prescribed regimens.

Asthma — What is status asthmaticus?

Severe attack that responds inadequately to conventional treatment.

Asthma priority — Quieter chest plus drowsiness: action?

Activate emergency support; prepare advanced airway management.

Asthma — Best self-management teaching tool?

A written asthma action plan.

Asthma priority — Dyspnea and inability to speak full sentences?

Assess severity urgently; upright position, oxygen, ordered rapid bronchodilator.

Asthma escalation — Rising CO2 with weak effort?

Urgent airway support; prepare assisted ventilation.

Pneumonia — Mechanism and usual findings?

Alveolar inflammation/exudate; fever, cough, crackles, dyspnea, hypoxemia.

Pneumonia — HAP versus VAP timing?

HAP: >=48 hours after admission. VAP: >48 hours after intubation.

Pneumonia — Imaging and sputum collection?

Chest imaging; sputum from a deep cough, not saliva.

Pneumonia priority — Cultures before urgent antibiotics?

Collect promptly when ordered/feasible; never delay urgent treatment.

Pneumonia — Airway clearance and hydration safety?

Upright, effective cough, mobility, appropriate hydration; tailor fluids for heart/kidney disease.

Pneumonia — Aspiration risks and prevention?

Dysphagia, reduced consciousness/cough; swallow evaluation, safe feeding/positioning, oral care.

Pneumonia — What to reassess and what indicates improvement?

Recheck effort, oxygen need, mentation, sounds, vitals; stable BP and better intake support improvement.

Pneumonia — Older adult's atypical presentation?

Confusion, weakness, or functional decline.

Pneumonia — Core ordered treatments?

Antimicrobials when indicated and oxygen for hypoxemia.

Pneumonia priority — Falling BP plus confusion: action?

Activate urgent response; assess breathing/perfusion and prepare sepsis treatment.

Pneumonia priority — Falling SpO2 despite more oxygen: action?

Assess breathing and oxygen delivery; activate urgent support.

Pneumonia — Major complications?

Respiratory failure, sepsis, pleural effusion, and empyema.

Pneumonia — Key discharge teaching?

Medication adherence, gradual activity, prevention, and warning signs.

Pneumonia priority — Patient coughs during feeding?

Pause feeding; assess breathing and swallowing safety.

Pneumonia escalation — Persistent fever or clinical decline?

Reassess complications, treatment response, and alternative diagnoses; notify provider.

Aspiration — Pneumonitis versus pneumonia and antibiotic use?

Pneumonitis: chemical injury; antibiotics depend on infection. Pneumonia: infection.

Bronchitis — What separates it from pneumonia?

Primarily airway inflammation versus alveolar infection; assess imaging and clinical findings.

Acute bronchitis — Cause and sputum-color interpretation?

Usually viral; colored sputum alone does not prove bacterial infection.

TB — Organism, route, and exposure risk?

M. tuberculosis; airborne; close contact with infectious pulmonary/laryngeal TB.

TB — Disease symptoms and latent infection contagiousness?

Prolonged cough, fever, sweats, weight loss/fatigue; latent infection is not contagious.

TB — TST/IGRA meaning and skin-test reading?

Tests identify infection, not active disease; read induration at 48-72 hours.

TB priority — Suspected infectious disease: isolation and PPE?

Airborne isolation; fit-tested staff respirator; patient surgical/procedure mask for transport.

TB — Isoniazid and pyrazinamide risks?

Isoniazid: liver toxicity/neuropathy. Pyrazinamide: liver toxicity/hyperuricemia.

TB — Rifampin and ethambutol teaching?

Rifampin: orange fluids/interactions. Ethambutol: report blurred or changed color vision.

TB — Adherence and stopping-isolation principles?

Complete treatment to prevent failure/resistance; stop isolation only by infection-control criteria.

TB — What increases progression risk?

Impaired immunity.

TB — Tests for suspected active pulmonary disease?

Chest imaging and sputum molecular testing, smear, and culture.

TB — What does RIPE stand for?

Rifampin, isoniazid, pyrazinamide, ethambutol.

TB priority — New blurred or altered color vision on ethambutol?

Report promptly for medication and vision evaluation.

TB priority — Jaundice or dark urine during treatment?

Report urgently for possible liver toxicity.

Oxygen — What does it treat, and what does SpO2 not assess?

Treats hypoxemia; SpO2 does not measure CO2 removal.

Oxygen — Nasal cannula: use and adult flow?

Mild stable need, eating/talking; usually 1-6 L/min in adults.

Oxygen — Venturi mask: use and safety check?

Controlled concentration; correct adapter flow and unobstructed entrainment ports.

Oxygen — Nonrebreather: use, flow, and reservoir?

Severe hypoxemia while arranging help; 10-15 L/min and inflated reservoir.

Oxygen — High flow nasal oxygen versus trach delivery?

High flow: heated humidified oxygen. Trach: humidified collar/T-piece to stoma airway.

Oxygen — Adverse effects to monitor?

Dryness, pressure injury, toxicity from prolonged excessive oxygen; titrate appropriately.

Oxygen — What does FiO2 mean?

Fraction of inspired oxygen.

Oxygen — Typical simple-mask flow?

5-10 L/min; maintain adequate flow to clear CO2.

Oxygen — Nonrebreather reservoir collapses: action?

Check flow, supply, and setup immediately; reassess the patient.

Oxygen — Reassess after changing therapy?

SpO2, effort, mentation, rate/depth, and hemodynamics.

Oxygen — Persistent distress despite target SpO2: action?

Assess ventilation and escalate support as needed.

Oxygen — Essential home safety rule?

No smoking or open flames around oxygen.

Oxygen escalation — Increasing oxygen need despite treatment?

Reassess cause and breathing; escalate respiratory support.

NIV — Meaning and role in hypercapnic COPD?

Noninvasive ventilation; bilevel NIV may support suitable patients with CO2 retention/acidosis.

NIV safety — What abilities must the patient retain?

Protect the airway and manage secretions.

NIV escalation — New drowsiness or inability to protect airway?

Activate urgent airway help; prepare invasive support if needed.

Airway obstruction — Severe warning signs?

Unable to speak, weak/no cough, poor airflow; stridor suggests upper-airway narrowing.

Airway obstruction — Unresponsive choking patient and finger sweeps?

Begin CPR; remove visible objects when opening airway. No blind sweeps.

Airway obstruction — Conscious adult with severe choking?

Activate help; alternate 5 back blows and 5 abdominal thrusts per BLS.

Airway priority — Patient still has an effective cough?

Encourage coughing and monitor for worsening obstruction.

Airway priority — Severe stridor with inability to handle secretions?

Activate emergency airway help; provide oxygen and prepare airway support.

Trach — Indications and humidification rationale?

Bypass obstruction, prolonged ventilation, secretions; humidify because upper airway is bypassed.

Trach — Routine priorities and aspiration limitation?

Assess patency; secure tube, humidify, stoma/cannula care, indicated suction. Cuff does not prevent aspiration.

Trach — Speaking-valve safety requirements?

Fully deflated cuff and patent upper-airway exhalation route.

Trach — Suction indication, preparation, and technique?

Retained secretions/obstruction; preoxygenate appropriately; sterile open suction.

Trach — Suction time and saline safety?

Maximum 15 seconds per procedure; generally avoid saline instillation.

Trach — Communication, swallowing, and home-care teaching?

Swallow assessment/communication; teach tube care, suction, equipment, emergencies.

Trach — Emergency spare tubes?

Same size and one smaller, per policy.

Trach priority — Cannot pass suction catheter: action?

Suspect blockage/displacement; call airway help. Do not force catheter.

Trach — Blindly reinsert a fresh displaced trach?

No; skilled airway staff manage replacement.

Trach priority — Sudden distress: first bedside focus?

Call help and assess airway patency and breathing.

Trach priority — Suspected blockage: initial algorithm checks?

Remove cap/valve; check inner cannula and suction-catheter passage per protocol.

Trach oxygen — During airway emergency with possibly patent upper airway?

Provide oxygen to stoma and face while help follows the algorithm.

Trach reassessment — After suctioning?

Recheck air entry, SpO2, effort, secretions, and tolerance.

Trach priority — Speaking valve attached with inflated cuff?

Remove valve and obtain help; cuff must be deflated for use.

Treatment response — What supports improvement beyond SpO2?

Less effort, clearer mentation, better speech, and lower oxygen need.

Teaching — How to verify skills and fix incorrect technique?

Demonstration and teach-back; reteach and repeat if incorrect.