Chronic bronchitis (“blue bloaters”):
COPD NCLEX Review – Summary
● Thickened bronchioles + excess
Definition: mucus → incomplete exhalation →
Chronic pulmonary disease causing hyperinflation.
irreversible obstruction of airflow.
● Low O2, high CO2 → cyanosis;
body increases RBC → pulmonary
hypertension → right-sided heart
Key Points: failure (edema, bloating).
● Limited airflow due to thick, swollen,
deformed bronchioles and excess Emphysema (“pink puffers”):
sputum.
● Alveoli lose elasticity → air trapped
● Inability to fully exhale due to loss of → hyperinflation → diaphragm
alveolar elasticity; air retention leads flattens → accessory muscles used.
to hyperinflation.
● Barrel chest, increased AP diameter,
● Progressive, gradual onset; often high CO2, low O2.
noticed in middle age with dyspnea,
chronic cough, and recurrent lung ● Compensates via hyperventilation →
infections. pink complexion, less cyanosis.
● “Catch-all” term for airflow-limiting
diseases causing dyspnea.
Signs & Symptoms:
Types:
● Dyspnea, extreme fatigue, poor
● Emphysema (“pink puffers”) – tolerance to activity.
hyperventilation, pink complexion.
● Weight loss (emphysema), abnormal
● Chronic bronchitis (“blue ABG (high PCO2, low PO2).
bloaters”) – cyanosis, edema,
productive cough. ● Chronic cough: productive (chronic
bronchitis), dry (emphysema).
● Accessory muscle use, abnormal
lung sounds (diminished, crackles,
Pathophysiology: wheezing).
Normal breathing: Oxygen enters alveoli ● Cyanosis in “blue bloaters,” barrel
→ gas exchange occurs → CO2 exhaled. chest in “pink puffers.”
● Tripod position during dyspnea. ● Administer prescribed
bronchodilators and respiratory
● Stimulated to breathe by low O2, not therapy.
high CO2.
● Monitor for complications
(pneumonia, heart failure).
Complications:
● Heart failure, pneumothorax, Patient Education:
pneumonia, lung cancer.
● Small, frequent high-calorie,
protein-rich meals; stay hydrated.
● Avoid sick people, irritants, extreme
Diagnosis: weather.
● Spirometry: Measures lung ● Smoking cessation and vaccination:
volumes. annual flu + Pneumovax every 5
years.
● FVC (Forced Vital Capacity): Low
→ restrictive breathing. ● Correct use of inhalers and
breathing techniques.
● FEV1 (Forced Expiratory Volume):
Low → disease severity.
Medication Regimen (Mnemonic:
Chronic Pulmonary Medications
Nursing Interventions:
Save Lungs):
● Assess lung sounds, sputum, and
1. Corticosteroids:
oxygen saturation (target 88–93%).
● Reduce inflammation and mucus;
● Administer low-flow O2 (1–2 L)
oral, IV, inhaled (Prednisone,
carefully; avoid hyperoxia.
Solu-Medrol, Pulmicort, Symbicort).
● Teach pursed-lip breathing
● Rinse mouth to prevent thrush;
(prolong exhalation) and
inhaler after bronchodilator.
diaphragmatic breathing
(strengthens diaphragm, decreases
● Side effects: hyperglycemia,
energy use).
infection risk, bone loss.
2. Methylxanthines:
● Theophylline (oral), narrow
therapeutic range 10–20 mcg/mL.
● Drug interactions: digoxin toxicity ↑,
lithium/Dilantin ↓.
3. PDE-4 Inhibitors:
● Roflumilast for chronic bronchitis;
reduces exacerbations.
● Side effects: suicidal thoughts,
weight loss.
4. Short-acting bronchodilators:
● Albuterol (beta-2 agonist), Atrovent
(anticholinergic) → emergency relief.
5. Long-acting bronchodilators:
● Salmeterol (beta-2 agonist), Spiriva
(anticholinergic) → maintenance
therapy.
● Use before corticosteroids to open
airways.
ARDS (Acute Respiratory Causes
Distress Syndrome) – Indirect Injury (systemic issue →
inflammation):
Summary
● Sepsis (most common, poor
Definition & Mechanism prognosis w/ gram-negative
bacteria)
● Type of respiratory failure caused
by damage to the ● Burns
alveolar-capillary membrane →
fluid leaks into alveoli → impaired ● Multiple blood transfusions
gas exchange.
● Pancreatitis
● Leads to: fluid-filled alveoli, collapse
(atelectasis), ↓ surfactant, ↓ lung ● Drug overdose
compliance (“stiff lungs”).
● Results in hypoxemia (low O₂) → Direct Injury (lung damage):
organ failure → high mortality if
untreated. ● Pneumonia
● Aspiration
● Inhaled toxins
Quick Facts
● Drowning
● Rapid onset
● Embolism
● Occurs as a complication in
already sick patients (e.g., sepsis,
burns, trauma).
● High mortality rate Pathophysiology Phases
● Hallmark sign: Refractory 1. Exudative Phase (≈24 hrs after
hypoxemia → O₂ remains low injury):
despite high O₂ therapy.
○ Pulmonary edema
(protein-rich fluid leaks into
alveoli → worsens fluid
draw-in).
○ Surfactant loss → alveolar ○ Refractory hypoxemia (low
collapse (atelectasis). PaO₂ despite O₂ therapy)
○ Hyaline membrane forms → ○ Respiratory alkalosis → later
↓ elasticity. respiratory acidosis
○ Ventilation-perfusion (V/Q) ○ Cyanosis, confusion/altered
mismatch → refractory mental status
hypoxemia.
○ Retractions, crackles, ↓
○ Early ABG: respiratory compliance (“stiff lungs”)
alkalosis (blowing off CO₂).
○ Chest X-ray: bilateral
2. Proliferative Phase (≈14 days): infiltrates/“white-out”
lungs
○ Repair begins, fluid
reabsorbed.
○ But lung tissue → fibrotic &
dense → ↓ compliance, Diagnosis
persistent hypoxemia.
● Pulmonary artery wedge pressure
3. Fibrotic Phase (≈3 weeks): (PAWP):
○ Severe fibrosis & scarring → ○ <18 mmHg → ARDS
major ↓ compliance, ↑ dead (non-cardiac pulmonary
space. edema)
○ Poor prognosis, chronic lung ○ 18 mmHg → cardiac cause
damage. (e.g., HF)
Signs & Symptoms
Nursing Interventions
● Early: subtle; may hear few coarse
crackles. ● Airway/Respiratory Support:
● Progression: ○ Mechanical ventilation w/
PEEP (10–20 cm H₂O) →
○ Severe dyspnea, tachypnea, keeps alveoli open, improves
tachycardia oxygenation.
○ Monitor for ↓ cardiac output Neuromuscular blocking
(high intrathoracic pressure), agents (Rocuronium,
pneumothorax, subQ Vecuronium, Atracurium,
emphysema. Cisatracurium, and
Mivacurium) - promote
○ Frequent ABG monitoring. patient ventilator synchrony
● Positioning:
○ Prone positioning →
improves V/Q mismatch, Key NCLEX Points
reduces atelectasis,
improves secretion drainage. ● Fast onset, occurs in critically ill
patients.
● Systemic Support:
● Refractory hypoxemia = classic
○ Assess perfusion: mental sign.
status, urine output, BP,
cardiac output. ● Mechanical ventilation with PEEP
+ prone positioning = cornerstone
○ Prevent complications: of treatment.
pressure injuries, DVT,
infections (esp. ● Monitor for complications:
ventilator-associated hypotension, pneumothorax,
pneumonia), stress ulcers, infection.
malnutrition.
● Medications:
Corticosteroids (↓
inflammation)
Antibiotics (treat/prevent
infection)
Inotropes (dobutamine and
milrinone) - improve heart
contraction if CO low)
Fluids (colloids/crystalloids)
as needed
GI prophylaxis (stress
ulcers)
📌 Pneumonia NCLEX Review ● Lung disease (COPD, asthma,
smoking)
– Summary
● Post-op (shallow breathing, no
Definition: cough)
● Lower respiratory tract infection
causing inflammation of alveoli
sacs → fluid, WBCs, bacteria, RBCs
fill sacs → impaired gas exchange. Pathophysiology:
● Germs enter lungs via inhalation,
aspiration, or blood.
Key Causes: ● Alveoli become inflamed + filled with
fluid, WBCs, bacteria → sacs
● Germs: cannot inflate/deflate → hypoxemia
+ respiratory acidosis.
○ Bacteria (most common;
Streptococcus pneumoniae).
ABG findings:
○ Atypical bacteria
(Mycoplasma pneumoniae → ● PO₂ < 90 mmHg
walking pneumonia).
● pH < 7.35
○ Virus (influenza, RSV in
children). ● PCO₂ > 45 mmHg
○ Fungi (rare, ● HCO₃ > 26 mEq/L (compensation by
immunocompromised kidneys)
patients).
Types:
Risk Factors:
1. Community-Acquired Pneumonia
● Prior infection (flu, cold) (CAP) – outside healthcare system.
● Weak immune system (elderly, 2. Hospital-Acquired Pneumonia
infants, HIV, immunosuppressants) (HAP) – develops 48–72 hrs after
admission, often resistant bacteria,
● Immobility (stroke, decreased common in ventilated patients.
awareness)
Nursing Interventions:
Signs & Symptoms (PNEUMONIA ● Monitor respiratory status: lung
mnemonic): sounds, RR, SpO₂ (>95%), ABGs.
● Productive cough, pleuritic chest ● Collect sputum for culture.
pain
● Suction PRN.
● Neuro changes (elderly: confusion,
fatigue, ↑RR) ● Encourage fluids (2–3 L/day unless
contraindicated).
● Elevated labs (↑WBC, ↑PCO₂ > 45
mmHg) ● Incentive spirometer, deep
breathing, coughing.
● Unusual breath sounds (crackles,
rhonchi, bronchial sounds in ● Prevent aspiration: HOB
periphery) >30°(semirecumbent), frequent
turning.
● Mild–high fever (esp. bacterial
>104°F) ● Monitor for complications (sepsis,
respiratory failure).
● O₂ saturation ↓ (<90%, needs O₂)
● Education: vaccines (Pneumovax,
● Nausea/vomiting, poor appetite flu shot), smoking cessation,
infection prevention (handwashing,
● Increased HR and RR avoid sick contacts).
● Aching, activity intolerance, SOB
Treatments:
Diagnosis: ● Oxygen therapy for hypoxemia.
● Abnormal lung sounds ● Respiratory treatments
(bronchodilators, chest percussion,
● Chest x-ray: infiltrates/ consolidation RT support).
● Sputum culture ● Antipyretics for fever, fluids for
hydration.
● Antibiotics for bacterial
pneumonia (mnemonic: Various
Medications Frequently Treat
Pneumonia Cases):
○ Vancomycin –
severe/resistant cases;
watch ototoxicity.
○ Macrolides – e.g.,
Azithromycin (Z-Pak). narrow
spectrum
○ Tetracyclines – e.g.,
Doxycycline; avoid in
pregnancy/children. (broad
spectrum)
○ Fluoroquinolones – e.g.,
Levaquin; risk C. diff, tendon
rupture, QT prolongation.
(broad spectrum)
○ Cephalosporins – e.g.,
Rocephin; caution if PCN
allergy. - great for CAP
(broad spectrum)
○ Penicillin – e.g., Penicillin G;
narrow spectrum, monitor if
patient is allergic to
cephalosporins, decreases
effectiveness of birth control
● Antivirals (e.g., Tamiflu) for viral
pneumonia.
Antibiotic teaching:
● Take full course, don’t stop early,
avoid alcohol, monitor side effects.
chest wall → collapse.
Pneumothorax –
● If pressure builds (tension
NCLEX Review pneumothorax): compresses heart
& vessels, ↓ cardiac output.
Notes
📌 Definition
● Collapse of a lung due to air in the 📌 Types of Pneumothorax
pleural space (between visceral &
● Open (“sucking chest wound”):
parietal pleura).
opening in chest wall → air moves
in/out with breathing.
● Can be partial or total, usually one
lung affected.
○ Intervention: 3-sided
occlusive dressing (allows
exhaled air out, prevents air
📌 Causes
entry).
● Closed: no outside wound; air leaks
● Spontaneous: rupture of pulmonary internally (e.g., rib fracture puncture,
bleb (esp. young, tall, thin, smokers). spontaneous).
● Trauma: blunt or penetrating chest ● Spontaneous: pulmonary bleb
injury. rupture.
● Lung disease: COPD, asthma, CF. ○ Primary: no lung disease,
young/tall/thin.
● Medical procedures: central line
insertion, mechanical ventilation ○ Secondary: with lung disease
(PEEP). (COPD, CF, asthma).
● Tension Pneumothorax: medical
emergency; one-way valve effect
📌 Pathophysiology
traps air.
○ Leads to mediastinal shift, ↓
● Normal: intrapleural space has venous return, ↓ cardiac
negative pressure → keeps lungs output.
inflated.
○ Tx: needle decompression
● With pneumothorax: air enters → ↑ followed by chest tube.
pressure → pushes lung away from
● Monitor: breath sounds, chest
📌 Signs & Symptoms (mnemonic: symmetry, VS, O₂ sat, subcutaneous
emphysema.
COLLAPSED)
● Administer O₂ as ordered.
● C: Chest pain (sudden, sharp, worse
on inspiration), Cyanosis ● Maintain chest tube system if
placed:
● O: Overt tachycardia & tachypnea
○ Water seal chamber should
● L: Low BP fluctuate with breathing.
● L: Low SpO₂ ○ Intermittent bubbling =
expected (air leaving pleural
● A: Absent breath sounds (on space).
affected side)
○ Continuous bubbling =
● P: Pushing of trachea to unaffected abnormal (air leak).
side (tension pneumo)
○ If stops fluctuating → check
● S: Subcutaneous emphysema for kinks or re-expansion.
(crackling skin), sucking sound
(open pneumo) ● Keep HOB ↑ (Fowler’s).
● E: Expansion unequal (uneven chest ● If chest tube dislodges → apply
rise) sterile dressing, notify provider.
● D: Dyspnea
👉 Quick Recall:
📌 Diagnostics ● Small pneumo → may resolve on its
own.
● Chest X-ray, ultrasound, or CT
● Large pneumo/tension pneumo →
scan.
chest tube or needle
decompression required.
● ABGs: hypoxemia, possible
respiratory acidosis.
● Watch for tracheal deviation, JVD,
hypotension, hypoxia = tension
pneumo emergency.
📌 Nursing Interventions
