© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR Chapter SALE OR DISTRIBUTION 3 NOT FOR SALE OR DISTRIBUTION Common© Jones Respiratory & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC DisordersNOT FOR in SALE Primary OR DISTRIBUTION Care NOT FOR SALE OR DISTRIBUTION Joanne L. Thanavaro © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE Chapter OR DISTRIBUTION Outline NOT FOR SALE OR DISTRIBUTION Case 1 - Influenza D. Guidelines to direct care: Global Initiative for Asthma 2015 and National Heart Lung and Blood Institute (NHLBI) Guide- A. History and Physical© Exam Jones & Bartlett Learning, LLClines for the Diagnosis and Management© Jones of & Asthma Bartlett (EPR-3) Learning, LLC B. Recommended Lab/DiagnosticsNOT FOR SALE OR DISTRIBUTIONE. Treatment Plan NOT FOR SALE OR DISTRIBUTION C. Pathophysiology D. Guidelines to direct care: Prevention and control of seasonal Case 4 - Chronic Obstructive Pulmonary influenza with vaccines: recommendation of the Advisory Disease (COPD) Committee on Immunization Practices (ACIP) © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC E. Treatment Plan A. History and Physical Exam NOT FOR SALE OR DISTRIBUTION B. RecommendedNOT FORabs/Diagnostics SALE OR DISTRIBUTION Case 2 - Acute Bronchitis C. Pathophysiology D. Guidelines to direct care: Global Initiative for Chronic A. History and Physical Exam Obstructive Lung Disease (2015) B. © Jones & Bartlett Recommended Learning, Labs/Diagnostics LLC © JonesE. Treatment & Bartlett Plan Learning, LLC NOT FOR C.SALE Pathophysiology OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION D. Guidelines to direct care: Chronic Cough Due to Acute Case 5 - Community-Acquired Pneumonia (CAP) Bronchitis: American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines A. History and Physical Exam E. Treatment Plan © Jones & Bartlett Learning, LLCB. Recommended Labs/Diagnostics© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONC. Pathophysiology NOT FOR SALE OR DISTRIBUTION Case 3 - Asthma D. Guidelines to direct care: Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines A. History and Physical Exam on the Management of Community-Acquired Pneumonia B. Recommended Labs/Diagnostics in Adults C. Pathophysiology© Jones & Bartlett Learning, LLC E. Treatment© JonesPlan & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 33 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 9781284065800_CH03_033_048.indd 33 DESIGN SERVICES OF 13/01/16 2:18 PM # 159813 Cust: JBL Au: Thanavaro Pg. No. 33 K S4CARLISLE Title: Clinical Decision Making for Adult-Gerontology Primary Care Nurse Practitioners, 1e Short / Normal Publishing Services 34 CHAPTER 3 | Common Respiratory Disorders in Primary Care © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Learning Objectives Using a case-based approach, the learner will be able to: 3. State pathophysiology of common pulmonary disorders. 1. Identify key history and physical examination parameters for 4. Document a clear, concise SOAP note for patients with com- © Jones & Bartlett Learning, LLCmon pulmonary disorders. © Jones & Bartlett Learning, LLC common pulmonaryNOT disorders FOR seen SALE in primary OR care DISTRIBUTION includ- NOT FOR SALE OR DISTRIBUTION ing influenza, acute bronchitis, asthma, COPD, and CAP. 5. Identify relevant education and counseling strategies for pa- 2. Summarize recommended laboratory and diagnostic studies tients with common pulmonary disorders. indicated for the evaluation of common pulmonary disorders 6. Develop a treatment plan for common pulmonary disorders seen in primary care. utilizing current evidence-based guidelines. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Case 1 © Jones &Mrs. Bartlett Cleaver is aLearning, 48-year-old female LLC who comes to the office accom©- JonesRunny & noseBartlett Learning, LLC NOT FORpanied SALE by her OR husband. DISTRIBUTION She’s complaining of fatigue, fever, and chillsNOT FORNasal congestionSALE OR DISTRIBUTION for the last 2 days. She recently returned home from California where Muscle or body aches she was taking care of her three grandchildren for the last 3 weeks. She Headaches reports that the kids all had “colds” but got better without treatment. Her past medical history (PMH) is remarkable for idiopathic cardio- Fatigue myopathy, diabetes mellitus© type Jones 2, and &hypertension. Bartlett She Learning, is a non- LLCVomiting and diarrhea (more common© Jones in children) & Bartlett Learning, LLC smoker and nondrinker. She has not been able to exercise since she NOT FOR SALE OR DISTRIBUTIONPhysical Exam NOT FOR SALE OR DISTRIBUTION returned home because of her extreme tiredness. Her medications include: carvedilol 6.25 BID, lisinopril 20 mg, and aldactone 25 mg For patients with comorbid conditions, be sure to evaluate for any daily. She planned to get her influenza vaccine sometime next week. worsening of underlying conditions. In this patient, it is important not only to rule out pneumonia but also to evaluate for heart fail- Physical Exam © Jones & Bartlett Learning, LLC ure and uncontrolled© Jones diabetes. & Bartlett Learning, LLC Vital Signs: Blood pressure (BP) 126/76, heart rate (HR) 65, NOT FOR SALE OR DISTRIBUTION RoutineNOT Labs/Diagnostics FOR SALE OR DISTRIBUTION respiratory rate (RR) 12, temperature (T) 99.8. General (GEN): No acute distress Ñ The Centers for Disease Control and Prevention (CDC), Eyes, ears, nose, and throat (EENT): Pharyngeal redness without exu- World Health organization (WHO), and Infectious Disease dates. Tympanic membranes (TMs) without bulging or fluid lines Society of America recommend that healthcare providers di- © Jones & Bartlett Learning, LLC © Jonesagnose & Bartlett influenza clinically.Learning, LLC Heart: S1 and S2 regular rate and rhythm (RRR) with pansystolic NOT FOR SALEmurmur OR along DISTRIBUTION the left sternal border NOT FORÑ Testing SALE is recommended OR DISTRIBUTION for: Ñ Hospitalized patients with influenza-like illnesses Lungs: Clear to auscultation Ñ Patients who died of an influenza-like illness (to clarify Abdomen: Soft, nontender with good bowel sounds etiology) What additional assessments/diagnostics do you need? Ñ Patients for whom decisions about infection control and What is the differential© diagnoses Jones list?& Bartlett Learning, LLC treatment of close contacts© isJones a concern &1–3 Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION What is your working diagnosis? Ñ Sensitivities of rapid diagnostic tests are approximately 50–70% when compared with viral culture or reverse tran- Additional Assessments/Diagnostics scription polymerase chain reaction (RT-PCR); specifici- Needed ties of rapid diagnostic tests for influenza are appropriately © Jones & Bartlett Learning, LLC 90–95%.© Jones & Bartlett Learning, LLC ReviewNOT FOR of Systems SALE (ROS)OR DISTRIBUTION Ñ False-positiveNOT (andFOR true-negative) SALE OR results DISTRIBUTION occur more fre- Ask about common signs and symptoms of influenza, including: quently when disease prevalence in the community is low, usually at the beginning and end of the flu season. Fever/chills Ñ False-negative (and true-positive) results occur more fre- Cough quently when disease prevalence is high in the community, © Jones &Sore Bartlett throat Learning, LLC © Joneswhich & Bartlett is usually at Learning, the height of the LLC flu season.4 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 9781284065800_CH03_033_048.indd 34 DESIGN SERVICES OF 13/01/16 2:18 PM # 159813 Cust: JBL Au: Thanavaro Pg. No. 34 K S4CARLISLE Title: Clinical Decision Making for Adult-Gerontology Primary Care Nurse Practitioners, 1e Short / Normal Publishing Services Case 1 35 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEDifferential OR DISTRIBUTION Diagnoses List NOT FORÑ CanSALE lessen OR symptoms DISTRIBUTION and reduce duration of symptoms by 1–2 days Upper respiratory tract infection Ñ Can prevent serious flu-related complications for people Influenza with high-risk health conditions Working Diagnosis—Influenza Ñ Side effects include nausea, vomiting, diarrhea, dizziness, © Jones & Bartlett Learning, LLC cough, and headache6 © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Pathophysiology Nonpharmacologic Influenza is a contagious respiratory illness caused by the in- Ñ Drink plenty of liquidschoose water, juice, and warm fluenza viruses that infect the nose, throat, and lungs. Viruses soups to prevent dehydration. Drink enough liquid so that spread mainly by droplets when people cough, sneeze, or talk. your urine is pale yellow or clear. Contagiousness© Jones of &influenza Bartlett occurs Learning, 1 day before LLC symptoms to © Jones & Bartlett Learning, LLC Ñ 5–7 daysNOT after FOR illness. SALE These viruses OR DISTRIBUTION are unpredictable, and their Rest. NOT FOR SALE OR DISTRIBUTION severity can vary widely from season to season. Older