MedSurg Exam 1: Respiratory and Cardiovascular

Blood Vessels of the Heart

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Aorta: Carries oxygenated blood from the left ventricle to the body1.

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Superior/Inferior Vena Cava: Carries deoxygenated blood from the upper and lower body to the right atrium1.

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Pulmonary Artery: Carries deoxygenated blood from the right ventricle to the lungs1.

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Pulmonary Veins: Carries oxygenated blood from the lungs to the left atrium1.

Chambers of the Heart

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Atria: Thin-walled, act as a reservoir for blood1.

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Ventricles: Thick-walled, responsible for pumping blood1.

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Right Side of Heart: Pumps blood from the body to the lungs1.

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Left Side of Heart: Pumps blood from the lungs to the body2.

Lining of the Heart

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Pericardium: Tough sac surrounding the heart2. Contains serous fluid for lubrication during contraction2.

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Epicardium: Outer protective layer of the heart muscle2.

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Myocardium: Muscular layer of the heart responsible for contractions2.

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Endocardium: Inner lining of the heart, protects the muscle and structures3.

Coronary Arteries

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Left Anterior Descending (LAD) Artery: Feeds the left ventricle. A clot here can be fatal3.

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Plaque Buildup: Caused by fatty foods, leads to cholesterol deposits and plaque, potentially causing clots and loss of artery elasticity3.

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Cardiac Catheterization: Procedure to open blocked vessels and restore blood flow3.

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Ischemia: Lack of oxygen, causes pain4.

Cardiac Cycle

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Systole: Ventricles contract, aortic and pulmonic valves open, ventricles empty4.

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Diastole: Ventricles relax, atria contract, tricuspid and mitral valves open, ventricles fill4.

Areas for Cardiac Auscultation

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Aortic (A): 2nd ICS to the right of the sternum. S2 ("dub") is heard here4.

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Pulmonic (P): 2nd ICS to the left of the sternum. S2 ("dub") is heard here4.

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Erb's Point: 3rd ICS to the left of the sternum5.

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Tricuspid (T): 5th ICS to the left of the sternum. S1 ("lub") is heard here4....

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Mitral (M): 5th ICS at the midclavicular line. S1 ("lub") is heard here5.

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S1: First heart sound, "lub", caused by mitral and tricuspid valves closing5.

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S2: Second heart sound, "dub", caused by aortic and pulmonic valves closing4....

Additional Heart Sounds

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S3 (Ventricular Gallop): Heard after S2 when the mitral valve opens, during passive filling of the left ventricle. "Lub dub DUB". Can be normal in children and young adults, but may indicate Congestive Heart Failure (CHF)5....

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S4: Heard during atrial contraction just before S1. "LUB lub dub". Rarely normal, indicates poor ventricular compliance, resistance to blood flow (e.g., hypertension), and is an important sign of diastolic heart failure or active ischemia7.

Stroke Volume

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Definition: Amount of blood ejected with each heartbeat8.

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Preload: Degree of stretch of cardiac muscle fibers at the end of diastole (ventricular filling). Reduced by decreased blood return and diuretics8.

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Afterload: Resistance to ejection of blood from the ventricle. Reduced by antihypertensives8.... Systemic vascular resistance is the afterload for the left ventricle8.

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Contractility: Ability of cardiac muscle to shorten in response to an electrical impulse. Increased by digoxin and dopamine9. Decreased contractility leads to decreased stroke volume10.

Cardiac Output (CO)

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Definition: Amount of blood pumped by the ventricle in liters per minute11.

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Formula: CO = Stroke Volume (SV) x Heart Rate (HR)11.

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Normal Range: 4-6 L/min11.

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Indicator of CO: Blood Pressure (BP)11. A drop in BP often indicates a drop in CO12.

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Body's Response to Low CO/BP: Increase Heart Rate (HR) via the autonomic nervous system and catecholamine release12.

Laboratory Tests (Cardiovascular)

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C-Reactive Protein: Used as a predictor of cardiovascular risk13.

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Lipid Profile: Measures cholesterol, lipid, and triglyceride levels. Requires a 12-hour fast13....

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Troponin Levels: Biomarker released by the heart when injured or infarcted (dead). Most accurate biomarker for MI. Elevated levels indicate heart damage14.... Remains elevated for up to 10 days14. The higher the troponin, the worse the MI15.

Diagnostic Tests for Cardiovascular Disease

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12-Lead ECG: Determines the location of the MI15. Shows electrical activity of the heart17. ST elevation indicates MI, ST depression indicates ischemia/angina18.

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Echocardiogram: Shows the motion and structure of the heart, including ventricular contraction and valve function15. Can identify heart failure (enlarged left ventricle)15. Measures ejection fraction19.

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Transesophageal Echocardiogram (TEE): Provides better pictures of the heart from behind the esophagus. Requires patient to be NPO for 6 hours. Monitor VS and O2 sat. Watch for oversedation and gag reflex after the procedure due to throat numbing20. Risk of bleeding or perforation21.

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Electrophysiology Studies (EPS): Used for patients with arrhythmias. Catheter is inserted through the groin to induce and study arrhythmias, which can then be treated with electricity21.

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Cardiac Catheterization: Involves injecting contrast into the vascular system to take pictures of the heart and blood vessels. Evaluates coronary artery patency21.... Catheter typically fed through the femoral artery. Risk of bleeding and clot formation at the insertion site22. Patient must be NPO 8-12 hours before22. Monitor for bleeding, hematoma, and peripheral pulses post-procedure23.

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Angiography: Type of cardiac catheterization to visualize blockages in blood vessels22. Balloon can be used to open the artery24.

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Percutaneous Coronary Intervention (PCI): Includes cardiac catheterization, angioplasty, and PTCA. Stents are often placed during angiography to prevent artery collapse24. Percutaneous means through the skin24.

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Cardiac Stress Testing: Exercise stress test or pharmacologic stress test to monitor heart function under stress17.

Hemodynamic Monitoring

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Used for unstable post-heart surgery patients to detect rapid changes and prevent complications24.

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Arterial Pressure Monitoring (A-line): Provides continuous blood pressure reading, typically via the radial artery25.... Requires a pressurized IV bag with heparin to prevent clotting. Transducer converts pressure waves to numbers26....

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Central Venous Pressure (CVP) Monitoring: Measures pressure in the vena cava, used as an estimate of preload25.... A rising CVP may indicate fluid overload, requiring diuretics25.

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Swan Ganz Catheter (Pulmonary Artery Pressure): Measures pressures inside the pulmonary artery and cardiac output26.... Threaded into the pulmonary artery. Can indicate problems with heart function26.

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Phlebostatic Axis: Transducer for pressure monitoring must be at this level for accurate BP readings: fourth intercostal space, midaxillary line (level of the right atrium)27. Adjust transducer position with patient position changes29.

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Hemodynamic Monitor Display: Top line is EKG (HR), second is pulse ox, third is arterial line (BP), fourth is pulmonary artery pressure, fifth may be CO2 monitor (if on ventilator)30.

Possible Complications of Pulmonary Artery Catheter

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Increased risk of infections31.

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Thrombosis and emboli31. Air embolism can occur if balloon ruptures31.

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Catheter wedges permanently: Emergency, notify MD immediately, can cause pulmonary infarct31.

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Balloon doesn't deflate32.

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Ventricular irritation: Can cause arrhythmias32.

Cardiac Hemodynamics

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Ejection Fraction (EF): Percentage of end diastolic volume ejected with each heartbeat (left ventricle). Normal is 60-70%32. Decreased EF indicates reduced pumping ability33....

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Contractility: Decreased by hypoxemia, acidosis, and some medications (e.g., Lopressor/beta-blockers)33. Can be intentionally decreased to slow heart rate33.

Nursing History Pertinent to Cardiovascular Exam

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Employment, stress, smoking (carbon monoxide reduces oxygen availability, nicotine constricts vessels), ETOH use (poor nutrition), exercise (promotes collateral circulation), nutritional status (protein, iron, vitamin C needed), cholesterol control, hypertension management, drug use (damages heart)35....

Risk Factors for Coronary Artery Disease (CAD)

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Modifiable: Hyperlipidemia, hypertension, smoking, diabetes, obesity, sedentary lifestyle36....

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Non-modifiable: Family history, elderly age, male gender, race (African American > Caucasian)36....

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Major Modifiable Risk Factors: Cholesterol abnormalities, tobacco use, HTN, and diabetes38.

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Elevated LDL: Primary target for cholesterol-lowering medication37....

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Metabolic Syndrome: Increased risk of CAD (apple shape, HTN, high cholesterol, prediabetes)37....

Hyperlipidemia

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LDL ("Bad" Cholesterol): Want it to be low (below 200)38. Medications usually given at night38....

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HDL ("Good" Cholesterol): Want it to be high39.

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High LDL and low HDL increase CAD risk39.

Chief Complaint (Cardiovascular)

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Chest pain, fatigue, leg pain/cramps, SOB, peripheral edema, weight gain, palpitations, irregular heartbeat, dizziness, syncope, changes in LOC39.

Cardiac Enzymes Indicative of Heart Damage

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Creatinine kinase (CK), CK-MB isoenzyme, myoglobin, troponin, LDL16.... Troponin is the most specific and lasts up to 10 days16.

Angina vs. MI

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Angina: Chest pain, relieved with nitroglycerin, pain usually <15 minutes, can be triggered by exertion/anxiety, ST depression may be present16....

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MI: Chest pain, not relieved with nitroglycerin, pain lasts >20 minutes, can occur at rest or in the morning, ST elevation may be present16....

Angina Pectoris

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Paroxysmal pain or pressure in the anterior chest due to insufficient coronary blood flow42.... Myocardial oxygen demand exceeds supply42.

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Nursing Assessment: Tightness, choking, heavy sensation, radiating pain, anxiety, dyspnea, SOB, dizziness, nausea, vomiting44....

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Unstable Angina: Increased frequency and severity, not relieved by rest or NTG, requires medical intervention43....

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Stable Angina: Chest pain relieved by rest or nitroglycerin43....

Angina Pectoris Treatment

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Decrease myocardial oxygen demand and increase oxygen supply47.... Medications (nitroglycerin), rest, oxygen, risk factor control, reperfusion therapy, EKG47....

Angina Pectoris Medications

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Nitroglycerin: Dilates blood vessels, increases blood flow, can cause headaches47....

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Antiplatelet/Anticoagulation: Aspirin, heparin, clopidogrel, glycoprotein inhibitors47....

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Beta-adrenergic blocking agents48....

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Calcium channel blocking agents49....

Nursing Intervention - Chest Pain (Angina)

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Stop activity, rest in semi-Fowler's position, assess patient (VS, pain, resp distress), administer oxygen (2L), get ECG, administer nitroglycerin (up to 3 doses)49....

Nursing Intervention: Patient Teaching (Angina)

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Carry nitroglycerin, balance activity/rest, follow exercise regimen, avoid extreme temperatures, use emotional support, avoid OTC meds that increase HR/BP, stop tobacco, low fat/salt/high fiber diet, follow up with HCP, report increased S&S, maintain normal BP/BG52....

Acute Coronary Syndrome (ACS) and Myocardial Infarction (MI)

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Emergency situation involving ischemia and potential infarction (death) of heart tissue18....

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Effects on ECG: Ischemia (flipped T wave, ST depression), Injury (ST segment abnormalities), Infarction (ST elevation, pathological Q wave)18....

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MONA (Initial MI Treatment): Morphine, Oxygen, Nitroglycerin, Aspirin48.... Oxygen should always be given first45.

Nursing Process: ACS/MI - Assessment

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Sudden, continuous chest pain despite rest/meds, SOB, indigestion, nausea, anxiety, cool/pale skin, increased HR/RR, ECG changes, abnormal lab studies (cardiac enzymes)41....

Collaborative Problems (ACS)

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Acute pulmonary edema, heart failure, cardiogenic shock, arrhythmias, cardiac arrest, pericardial effusion, cardiac tamponade50....

Nursing Process: ACS/MI - Planning

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Relief of pain and ischemic signs, increase perfusion, prevent myocardial damage, maintain respiratory function and tissue perfusion, reduce anxiety, promote self-care, early recognition of complications55....

Nursing Management: ACS/MI

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Oxygen and medication therapy, frequent VS, physical rest with HOB elevated, pain relief, monitor I&O and tissue perfusion, frequent position changes, report changes in condition, evaluate interventions56....

Coronary Artery Bypass Grafts (CABG)

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Healthy blood vessels from another part of the body bypass blocked coronary arteries to restore blood flow59....

Cardiopulmonary Bypass System

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Used during CABG to oxygenate and circulate blood while the heart is stopped for surgery59....

Valvular Disorders

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Regurgitation (Insufficiency): Valve doesn't close properly, causing blood backflow. Common in mitral and aortic valves61....

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Valve Prolapse: Stretching of an atrioventricular valve into the atrium during systole. Common in young women (mitral valve prolapse)61....

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Stenosis: Valve doesn't open completely, reducing blood flow. Common in aortic valve due to calcium deposits with age61....

Nursing Management: Valvular Heart Disorders

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Monitor for complications (heart failure, dysrhythmias, valve stretching), patient education, monitor VS (↓CO, ↓BP, ↑HR), consistent medication schedule, daily weights, plan activity with rest, sleep with HOB elevated64....

Trans-Aortic Valve Replacement (TAVR)

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Minimally invasive procedure for elderly patients with aortic stenosis who are not candidates for open surgery. A new valve is inserted through the femoral artery65.... Monitor pedal pulses and for bleeding/clots65....

Nursing Management: Valvuloplasty, Valve Replacement, and TAVR

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Monitor for heart failure and emboli, check pulses and VS frequently, assess heart sounds every 4 hours. Focus on hemodynamic stability and recovery from anesthesia66.... Patient education on anticoagulation, prevention of infective endocarditis, follow-up, and repeat echocardiograms69.

Cardiomyopathy

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Disease of the heart muscle that impairs effective pumping, leading to decreased CO, heart failure, sudden death, or dysrhythmias69.... Can be caused by viruses69.

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Types:

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Restrictive: Stiff ventricles resist filling ("Rock hard")72....

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Hypertrophic: Enlarged and thickened muscle, reduces ventricular volume72.... Can cause sudden death in young people74.

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Dilated: Thin and stretched muscle, enlarged chambers ("Saggy sock")75.

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Arrhythmogenic: Genetic, primarily affects right ventricle, can cause sudden death72.

Nursing Process: Cardiomyopathy Assessment

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History (predisposing factors, family history), chest pain, diet review (sodium reduction), psychosocial history, physical assessment (VS, pulse pressure, pulsus paradoxus, weight changes, murmurs, S3/S4, lung sounds, JVD, edema)76....

Cardiomyopathy Treatment

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No cure, aims to reduce symptoms. Medications (beta-blockers, anticoagulants, diuretics), implanted devices (pacemakers, AICDs), surgery (muscle removal), heart transplant (rare)78....

Pericardial Effusion and Cardiac Tamponade

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Pericardial Effusion: Fluid accumulation in the pericardial sac79.

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Cardiac Tamponade: Restriction of heart function due to fluid compressing the heart, leading to decreased venous return and CO79.... Cardinal signs: falling systolic BP, narrowing pulse pressure, rising venous pressure, distant heart sounds81.

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Medical Management: Pericardiocentesis (needle aspiration of fluid), pericardiotomy (surgical drainage)81....

Atherosclerosis and Arteriosclerosis

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Atherosclerosis: Buildup of plaque (lipids, fibrous tissue, calcium) within arterial walls, leading to blockages82....

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Arteriosclerosis: Hardening of the arteries, loss of elasticity82.... Both can lead to ischemia, pain, and poor perfusion85.

Types of Infectious Diseases of the Heart

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Rheumatic endocarditis, infective endocarditis, pericarditis, myocarditis80....

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Rheumatic Endocarditis: From rheumatic fever due to untreated Group A strep80....

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Infective Endocarditis: Infection of the inner lining of the heart, requires IV antibiotics for 6-8 weeks. Risk factors include prosthetic valves, structural defects, IV drug abuse80....

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Pericarditis: Inflammation of the pericardium, can lead to effusion and tamponade80....

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Myocarditis: Inflammation of the myocardium, usually viral, can lead to cardiomyopathy and heart failure80....

Clinical Manifestations: Infectious Diseases of the Heart

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Fever, new heart murmur (endocarditis), friction rub (pericarditis), Osler nodes/Janeway lesions/splinter hemorrhages (rheumatic), cardiomegaly, heart failure, tachycardia, fatigue, dyspnea, syncope, palpitations, chest pain (myocarditis)87.

Heart Infection Diagnostic Tools

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Blood cultures, echocardiogram, CBC, rheumatoid factor, ESR, CRP, urinalysis, ECG, cardiac cath, CMR imaging, TEE, CT scan88.

Heart Infection Prevention

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Antibiotic prophylaxis before certain procedures, ongoing oral hygiene, avoid IUDs in female patients, meticulous care of catheters, remove catheters ASAP, immunizations88.

Complications from Heart Disease: Heart Failure

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Impairment of ventricle's ability to fill or eject blood, leading to insufficient blood to meet metabolic demands71.... Can be systolic or diastolic dysfunction, causing pulmonary or systemic congestion89.

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Left-Sided Heart Failure (LUNGS): Fluid backs up into the lungs due to ineffective left ventricle pumping. Symptoms: dyspnea, orthopnea, fatigue, S3 heart sound, pulmonary congestion (crackles), cough, frothy sputum, AMS, oliguria, nocturia71....

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Right-Sided Heart Failure (BODY): Fluid backs up in the body due to ineffective right ventricle pumping (often caused by pulmonary problems). Symptoms: JVD, dependent peripheral edema, ascites, weight gain91....

Medications Used to Treat Heart Failure

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Diuretics (e.g., Lasix): Decrease fluid volume (preload), monitor electrolytes (especially potassium)93....

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Digitalis (Digoxin): Improves contractility, monitor for toxicity (low HR <60)94....

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ACE Inhibitors: Vasodilation, decrease afterload, monitor BP, potassium, renal function, cough51....

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Angiotensin II Receptor Blockers (ARBs): Alternative to ACE inhibitors51....

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Beta-blockers: Used in addition to ACE inhibitors51....

Pulmonary Edema

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Fluid backs up into pulmonary circulation due to left ventricular failure, causing hypoxemia93....

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Clinical Manifestations: Restlessness, anxiety, tachypnea, dyspnea, cool/clammy skin, cyanosis, weak/rapid pulse, cough, lung congestion (moist, noisy respirations), frothy/blood-tinged sputum, decreased LOC98....

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Nursing Interventions (Emergency): Position upright with legs dangling, psychological support, monitor medications/I&O, non-rebreather mask, call rapid response/code99....

Complications from Heart Disease: Electrolytes

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Sodium (Na): Normal 135-145. Water follows sodium, so sodium restriction is important in HF100.... Diuretics block sodium reuptake in kidneys102.

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Potassium (K): Normal 3.5-5.3. Essential for heart's electrical activity. Low potassium (hypokalemia) can cause arrhythmias. Lasix is potassium-wasting95....

Fluid Volume Deficit (Hypovolemia)

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Loss of extracellular fluid exceeds intake. Risk factors include diabetes insipidus, adrenal insufficiency, diuretics, hemorrhage, vomiting, diarrhea102....

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Manifestations: Weight loss, decreased skin turgor, low/concentrated urine output, orthostatic hypotension, increased HR, increased temp, thirst, weakness103. Elevated BUN, increased hematocrit104.

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Medical Management: Provide fluids (oral or IV - isotonic solutions like 0.9NS, D5W, LR)104.

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Nursing Management: I&O, daily weight, VS, monitor skin/tongue turgor, urine output, mental status, minimize fluid loss, oral care, administer fluids104....

Fluid Volume Excess (Hypervolemia)

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Fluid overload or diminished homeostatic mechanisms (e.g., heart failure, kidney failure)105.

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Manifestations: Edema, distended neck veins, crackles, tachycardia, increased BP/pulse pressure/CVP, weight gain, increased urine output, SOB, wheezing105....

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Medical Management: Treat cause, fluid/sodium restriction, diuretics (monitor potassium)106.

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Nursing Management: I&O, daily weights, assess lung sounds/edema, monitor diuretic response, promote fluid/sodium restriction adherence, monitor sodium intake, promote rest, semi-Fowler's position106....

Sudden Cardiac Death or Cardiac Arrest

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Emergency management: CPR (CAB if no pulse, ABC if pulse present)107.... Check carotid pulse in adults, brachial in babies107. Defibrillation for VT/VF107.

Pulmonary Embolism (PE)

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Obstruction of pulmonary artery by thrombus from venous system or right heart108.... Risk factors: recent surgery, immobility, oral hormone use, hypertension, heart disease, obesity110.

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Symptoms: Pleuritic chest pain, cough, dyspnea, hemoptysis (late), tachypnea, tachycardia, crackles, decreased O2 sat, restlessness, leg pain, EKG changes110....

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Lab Tests: Chest X-ray, D-dimer, echocardiogram, pulmonary angiography, lung scan111....

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Interventions: IV anticoagulants (Heparin), warfarin, IVC filter, embolectomy, thrombolytic therapy, pneumatic sleeves, early ambulation, compression stockings112....

Atelectasis

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Collapse of alveoli, leading to impaired gas exchange and hypoxemia114.... Risk factors: post-op, immobility115....

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Symptoms: Increased work of breathing, low O2 sat, increased HR/RR, cough, low-grade fever (acute), dyspnea, sputum production (chronic)114....

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Nursing Interventions: Frequent turning, early mobilization, incentive spirometer, deep breathing/coughing, secretion management, ICOUGH (incentive spirometer, cough/deep breath, oral care, understanding, get out of bed, HOB elevation)116.... Lay patient on unaffected side118.

Chest Trauma

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Pneumothorax: Air in the pleural space, causing lung collapse119.... Can be spontaneous or traumatic119.... Tension pneumothorax is life-threatening119.... Treatment: chest tube120.

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Hemothorax: Blood in the pleural space120.... Treatment: chest tube lower in the lung121.

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Subcutaneous Emphysema: Air leaks into skin tissue, causing crepitus120.

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Flail Chest: Multiple rib fractures causing paradoxical chest movement120.

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Pulmonary Contusion: Bruising of the lung tissue120.

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Chest Tubes: Used to remove air and fluid from the pleural space and re-expand the lung120.... Drainage system should be upright and below the patient's chest122. Water seal prevents air reentry121. Tidaling (movement with breathing) is good, bubbling (air leak) is bad123.

COPD (Chronic Obstructive Pulmonary Disease)

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Progressive airflow obstruction due to abnormal inflammatory response to noxious particles/gases (e.g., smoking)124.... Chronic inflammation damages lung tissue, narrows airways, and decreases elasticity124....

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Risk Factors: Smoking, older adults, pollution, occupational exposure, genetic abnormalities124....

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3 Primary Symptoms: Chronic cough, sputum production, dyspnea124....

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Assessment/Diagnosis: Health history, spirometry, chest X-ray, pulmonary function tests, arterial blood gas (respiratory acidosis)126.... Barrel chest (1:1 ratio)129.... Tripod position125.

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Complications: Pneumonia, chronic atelectasis, pneumothorax, respiratory insufficiency/failure, cor pulmonale (right-sided heart failure)126.

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Medical Management: Smoking cessation, reduce risk factors, supplemental O2 (use cautiously, low flow), vaccinations, pulmonary rehabilitation, manage exacerbations126....

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Medications: Bronchodilators (MDIs), corticosteroids, antibiotics (for infections, get sputum culture first), mucolytics, antitussives127....

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Nursing Management: Assess patient, improve activity tolerance, MDI education, evaluate irritant exposure, achieve airway clearance, improve breathing patterns, promote oxygenation (spirometry, postural drainage, chest percussion, breathing exercises), administer medications127.... Give protein shakes and smaller frequent meals131. CPAP may be used131.

Chronic Bronchitis

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Cough and sputum production for at least 3 months in each of 2 consecutive years129.... Bronchial walls thicken/inflame, airways narrow129.... Wheezing and crackles may be present134.

Emphysema

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Destruction of alveolar walls leading to trapped air and decreased lung surface area, causing shortness of breath129.... Hyperinflation (barrel chest)129. Increased pulmonary artery pressure can lead to right-sided heart failure135.

Bronchiectasis

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Chronic, irreversible dilation of bronchi and bronchioles135. Chronic cough, purulent sputum, clubbing of fingers. Treatment: postural drainage, smoking cessation, bronchodilators, mucolytics135.

Asthma

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Chronic inflammatory disease causing hyperresponsiveness, mucosal edema, and mucus production, leading to cough, wheezing, chest tightness136. Allergy is a major trigger136.

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Quick Relief Medications: Beta2 agonists (albuterol), anticholinergics (ipratropium), corticosteroids (prednisone), magnesium IV136. Administer bronchodilator before anti-inflammatory137.

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Long-Acting Medications: Corticosteroids (methylprednisolone), leukotriene inhibitors (montelukast)118.

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Nursing Interventions: Identify/avoid triggers, peak flow monitoring, pulmonary function tests, ICOUGH118.

Overall Respiratory Drugs

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Bronchodilators: Decrease bronchospasms and irritation133.

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Short-acting beta2 agonists (albuterol): Rapid relief, side effects: tremors/tachycardia133.

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Cholinergic antagonists (ipratropium): Increase bronchodilation, decrease secretions, watch HR, dry mouth, side effects: headache, blurred vision, palpitations (toxicity)133.

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Methylxanthines (theophylline): Requires close monitoring of blood levels, side effects: tachycardia, N/V133.

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Long-acting beta2 agonists (salmeterol): Asthma attack prevention138.

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Anti-Inflammatories: Decrease airway inflammation138.

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Glucocorticosteroids (fluticasone, prednisone): Monitor for immunosuppression, fluid retention, hyperglycemia, hypokalemia, weight gain, oral lesions, poor wound healing. Report black tarry stools, take with food and fluids138.

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Leukotriene antagonists (montelukast)138.

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Mast cell stabilizers (cromolyn)138.

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Monoclonal antibodies (omalizumab): Risk of anaphylaxis138.

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Mucolytic Agents: Acetylcysteine, dornase alfa (nebulizer), guaifenesin (oral)137.

Pulmonary Tuberculosis

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Infectious disease affecting lung parenchyma, airborne precaution139. Risk factors: overcrowding, immunocompromised139.

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Signs/Symptoms: Low-grade fever, night sweats, fatigue, weight loss, cough, hemoptysis140.

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Diagnostic Findings: Positive tuberculin skin test, blood test, sputum culture for acid-fast bacilli (AFB)140.

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Medical Management: Anti-TB agents for 6-12 months (INH, Rifampin - causes orange urine)140.

Pneumonia

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Inflammation of the lung caused by bacteria, fungi, viruses140. Types: community-acquired (CAP), healthcare-associated (HCAP), hospital-acquired (HAP), ventilator-associated (VAP)141. Risk factors