Respiratory Conditions - NCLEX-PN

After the catarrhal stage, an individual with pertussis will progress into the paroxysmal stage. It's during this stage that they will experience uncontrollable fits of 5-15 forceful coughs, followed by a "whoop" or gasp as they struggle to inhale. The force of these coughs can be such that they can result in vomiting, epistaxis, subconjunctival hemorrhage, or even broken ribs.

Chronic asthma can result in a situation referred to as "airway remodeling," typified by the following changes: increased airway vascularity, epithelial desquamation, deposition of subepithelial collagen, and hypertrophy and hyperplasia of mucus glands and of the underlying muscle layer.

Destruction of alveolar septa and pulmonary capillaries is a common finding in emphysema and does not present in asthma.

Incidence of asthma is lower in populations exposed to an abundance of microbes from a young age. The "hygiene hypothesis" suggests that early immune stimulation by multiple forms of infectious agents may push a Th1 phenotype, reducing the Th2 (allergic) response.

The most commonly reported triggers for asthma attacks are cold air, emotional stress or excitement, infection, irritants such as pollen or dust mites, and exercise. Other triggers may include lying down, exposure to cigarette smoke, or acid reflux.

Isoniazid is a bactericidal drug that is given for tuberculosis that has several adverse effects including peripheral neuropathy. This drug is usually administered in conjunction to other antitubercular drugs. Pyridoxine (vitamin B6) is recommended to be taken in conjunction with isoniazid to prevent neurotoxicity.

Isoniazid is relatively inexpensive and may be taken orally or intravenously. It is not necessary to be taken under direct observation, and is usually dosed according to type of disease (active versus latent). The typical duration of administration is roughly 26 weeks. Color blindness is not associated with isoniazid treatment.

Antibiotics have been shown to have very little effectiveness in treating a pertussis infection older than four weeks. Because of this, treatment with antibiotics to individuals that have been symptomatic for longer than four weeks is not generally recommended.

The oxygen concentration should be the lowest possible, due to the risk of oxygen toxicity seen in clients with FIO2 (fraction of inspired oxygen) levels exceeding 60% for more than 48 hours.

The correct placement of tubing includes directing a tube apically to remove air from the pleural space, and to direct the tube that will drain fluids in an inferior and posterior orientation.

Albuterol is a beta adrenergic agonist. It helps to open up the airways during an asthma exacerbation by activating the beta adrenergic receptors, part of the sympathetic nervous system. Side effects include increased heart rate.

COPD is a chronic lung condition marked by air trapping. Patients with COPD are instructed to sit in the "tripod" position to help them exhale air. Patients sit and lean forward to help maximize air exiting from the lungs.

The inspiratory reserve volume for the average adult is roughly 3100mL. It is tested using pulmonary function tests. The inspiratory reserve volume is the amount of air able to be inhaled after a regular inhalation. This is in contrast to the expiratory reserve volume, which is the amount of air that can be exhaled after a regular exhalation.

Asthma is treated with albuterol. This drug is a beta-2 agonist, which works to relax smooth muscle in the lungs, and open up the airways. A consequence of this drug is the beta-2 effects on the heart. Beta-2 on the heart causes an increase in heart rate (tachycardia) and is a common side effect seen in the treatment of asthmatics.

The correct answer is "Asthma." This answer is correct because asthma is an inflammatory airway condition that is characteristically improved symptomatically and quantitatively (in terms of pulmonary function tests, including FEV1 readings) with bronchodilator administration (e.g. albuterol, the beta-2 adrenergic agonist administered in this patient). In this patient who presented for evaluation of wheezing, a characteristic symptom of asthma, his substantial response to bronchodilator administration makes the likelihood of an asthma diagnosis very high.

Chronic Obstructive Pulmonary Disease (COPD) is an obstructive physiology of the airways often due to chronic tobacco smoking. While bronchodilators may be of some clinical value in these patients, their FEV1 readings characteristically do not correct after bronchodilator administration, as this is a major method in which COPD can be distinguished from asthma and other inflammatory airway conditions.

Sarcoidosis, lung cancer, and throat cancer symptoms would not necessarily improve with bronchodilator administration, nor would pulmonary function test readings in patients with these conditions.

The correct answer is "continuous positive airway pressure mask (CPAP)." This is the correct answer as a CPAP mask helps to force airway into the lungs that is otherwise obstructed by the patient's oropharyngeal anatomy at standard breathing pressures due to obstructive sleep apnea. When wearing a CPAP mask (typically when sleeping), snoring is reduced, and oxygenation is improved, allowing patients to have a more restful sleep and feel less fatigued the following day.

While medications like metoprolol, insulin, and metformin may be beneficial to the patient in treating his conditions co-morbid to obstructive sleep apnea, they do not have a direct effect on treating his sleep apnea or the resultant fatigue.

Tamsulosin is an alpha-adrenergic blocker and can be used to treat benign prostatic hyperplasia among other conditions, but not obstructive sleep apnea.

The priority for this client is to ensure a patent airway by placing him the Fowler's or semi upright seated position. Giving oxygen is warranted but will be given after the client is positioned correctly. ABG's would be helpful in this situation but it not the priority. Auscultation of breath sounds and assessment of mental status are not indicated.

Whooping cough, a condition that results in severe paroxysmal coughing fits followed by a long wheezing inspiratory gasp (the "whoop") is caused by the bacteria B ordetella pertussis. _Haemophilus influenza_e and Klebsiella pneumoniae both commonly cause pneumonia, and RSV is a virus that is frequently implicated in lower respiratory infections of infants and children.

The incubation period for pertussis, also known as the catarrhal stage, can last as little as 4 days or as long as 42 days, but a typical period is 1-3 weeks. During this stage the disease looks like a regular upper respiratory infection, with sneezing, mild cough, and runny nose. The infected individual is highly infectious at this time, with bacteria spread by airborne droplets after sneezing or cough.

The correct answer is "Sarcoidosis." Sarcoidosis is the correct answer as this inflammatory condition is frequently found in African-American women in their 40's who present with fatigue and shortness of breath among other symptoms, who also have erythema nodosum on the lower extremities, and have bilateral hilar infiltrates on chest x-ray. This constellation of findings is highly suggestive of sarcoidosis. Sarcoidosis results in the formation of numerous non-necrotizing granulomas, most commonly found in the lungs, that can play a role in the symptoms experienced by these patients. Other findings suggestive of sarcoidosis include elevated serum calcium levels with normal serum PTH levels.

Tuberculosis can present in a similar manner to sarcoidosis, however given the patient's suburban living environment, lack of a travel history, and lack of healthcare exposure, the likelihood of being exposed to tuberculosis is very low, making sarcoidosis a more likely etiology.

While lung cancer can present as shortness of breath with hilar infiltration in chest x-ray, in a relatively young otherwise healthy patient who also has erythema nodosum and in whom the hilar infiltrates are bilateral, sarcoidosis would be a more likely etiology.

The patient does not have any findings consistent with meningitis (leg rash in meningitis is petechial, not erythema nodosum) or pharyngitis.

Due to their susceptibility to suffocation, infants are more at risk of mortality than older children, pregnant women, or the elderly during pertussis infection. Mortality in infants with this condition can be as high as 2%. There is also an increase in infant co-moridities such as pneumonia, encephalopathy, seizures, and failure to thrive.