Fichas
Chronic Asthma (Part 2)
Fichas del conjunto (20)
- 1PEF calc --- ?Age/Ht (cm)
**2.54 cm = 1 inch - 2Steps to using a PEF meter are ----- ?1. Move the indicator to the bottom if the number scale
2. Pt shd stand up
3. Pt shd take a deep breath, filling the lungs completely with air
4. Pt shd place the spirometer mouthpiece in his/her mouth and close his/her lips around it.
5. Pt shd blow out as hard and fast as he/she can in a single blow
6. Pt shd repeat steps 1 - 5 two or more times and write down the best of the three values. - 3How does a pt established a personal best PEF?1. First in the morning and late afternoon or early evening (twice daily) pt shd record PEF values for 2 - 3 weaks.
2. Pt shd record PEF 15 - 20 mins after using an inhaled short acting B2-agonist for trt of asthma snxs.
3. The personal best PEF is the highest PEF achieved when the pt's asthma is well controlled - 4Bronchodilator reversibility test involves ---- ?1. Measures the FEV1 b4 a SABA is given
2. Measures FEV1 10 - 15 minutes after SABA is given.
3. If there is at least 10% improvement in FEV1, there is an evidence of reversible airflow obstruction. Hence, it favors asthma diagnosis.
4. Alternatively, you may determine reversibility by an increase in FEV1 of at least 12% from the baseline at a follow-up appointment after starting an inhaled corticosteroid. - 5Using Spirometry to suggest an asthma diagnosis involves ----- ?1. Measure the FEV1 and FVC
2. If (FEV1/FVC) * 100% is =/> 80% in adult and 90% in children, then the pt has no flow limitation (healthy lung).
3. Any value less than the above means the pt has flow limitation. - 6How do you classify asthma severity in patient not currently taking maintenance medication? ** Include the FEV1 percentages1. Intermittent (FEV1 =/> 80%)
2. Mild persistent (FEV1 =/> 80%)
3. Moderate persistent (FEV1 60 - 79%)
4. Severe persistent (FEV1 < 60%) - 7How do you classify asthma severity in patient currently taking maintenance medication?1. Well controlled (FEV1 =/> 80%)
2. Not well controlled (FEV1 = 60 - 79%)
3. Very poorly controlled (or not controlled) (FEV1 =/< 60%) - 8Clinical Question (1): A pt w/ asthma problem uses SABA daily, claimed no interference with her daily activity. Pt is not on maintenance drug. What classification is this pt asthma?Moderate persistent
** Explanation: Pt uses SABA daily = persistent; Pt asthma has no interference w/ activities = Moderate. - 9Clinical Question (2): A pt is on SABA, claimed asthma interference w/ his daily activities. Upon checking his FEV per sec (FEV1), you discovered that his FEV1 is 75% and the pt is not on maintenance drug. How do you classify this pt's asthma?Moderate persistence
** Explanation: FEV1 60 - 79% = moderate persistence.
** Since the patient is 60 - 79%, the asthma is considered "not well controlled". - 10Clinical Question (3): A pt with asthma walks down to your pharmacy and he said, he uses SABA many times a day (more than 3 times a DAY) and LABA for maintenance. In addition, he has daily symptoms of asthma, nocturnal snxs 4 times (sometimes more) a WEEK and his asthma interferes with his daily activities. How do you classify this patient's asthma?very poorly controlled
** Explanation: 1. Look at the daytime snxs
2. Look at the night time snxs
3. Look at the interference or activity limitations
4. Read more on Table 4 - 11Clinical Question (4): A pt with asthma walks down to your pharmacy and she said, she uses SABA 3 days in one week (more than 2 times a week) but not daily, and also uses oral corticosteroid 2 or more times per year for asthma exacerbations . In addition, she has daytime symptoms of asthma 3 days per WEEK, nocturnal snxs 1 - 3 times (sometimes more) a WEEK and her asthma interferes with his daily activities. How do you classify this patient's asthma?Not well controlled
** Explanation: 1. Look at the daytime snxs
2. Look at the night time snxs
3. Look at the interference or activity limitations
4. Read more on Table 4
5. Oral corticosteroid is a rescue asthma drug (see Table 5) - 12Clinical Question (3): A pt with asthma walks down to your pharmacy and he said, he uses SABA 1 or 2 days in a week and also uses asthma maintenance drug. In addition, he has daytime symptoms of asthma of 1 - 2 days a week, nocturnal snxs 1 - 2 times a WEEK and no asthma exacerbation or interfere with his daily activities. How do you classify this patient's asthma?Well Controlled
** Explanation: 1. Look at the daytime snxs
2. Look at the night time snxs
3. Look at the interference or activity limitations
4. Read more on Table 4 - 13What is the role of asthma action plan?1. Control asthma
2. Adjust medication in response to signs of worsening asthma
3. seek medical care as appropriate - 14How do you achieve asthma action plan?1. Pt education
2. Daily management - 15What are the three asthma plans for PEF?1. Green Zone = 80 - 100% of normal predictive values or personal best
2. Yellow Zone = 50 - 79% of normal predictive values or personal best
3. Red Zone = < 50% of normal predicted values or personal best - 16Clinical Question (1): A pt on asthma medication walks down to your pharmacy with a predicted values or personal best of 80%, what action would you take?Take no action
- 17Clinical Question (1): A pt on asthma medication walks down to your pharmacy with a predicted values or personal best of 79%, what action would you take?1. Increase short acting bronchodilator or SABA use
2. Begin oral corticosteroid if no improvement (Do not discontinue SABA or SA bronchodilator) - 18Clinical Question (1): A pt on asthma medication walks down to your pharmacy with a predicted values or personal best of 50%, what action would you take?Refer the patient or contact the PCP
- 19How do you calculate PEF % predicted?[Actual measurement / Predicted value] * 100%
- 20What is the difference btw actual measurement and predicted value?1. Actual measurement = value you got when the pt blow into the meter
2. Predicted value = the pt PEF value you got from the table = it is the age/ht (cm)