RESPIRATORY NURSING NCM

ACUTE & CHRONIC (LECTURE) Made by DALE 112

TOPRANK REVIEW ACADEMY: ENHANCEMENT REVIEW PROGRAM

OUTLINE Pathophysiology
I. Overview Trigger exposure → inflammation → goblet cell
II. Respiratory Disorders stimulation → mucus secretion + smooth muscle
III. Signs and Symptoms of Respiratory Distress tightening → obstruction
IV. Diagnostic Procedures
Causes

I. OVERVIEW • Extrinsic (Allergic): Dust, pollen, food,

smoke, pet dander
LUNGS • Intrinsic (Non-allergic): Stress, cold air,
infection
The lungs are vital organs of the respiratory system • Mixed Type: Combination of both
located in the thoracic cavity. Their main function Clinical Manifestations
is gas exchange, where oxygen from inhaled air
diffuses into the bloodstream and carbon dioxide, • Wheezing (expiration) – hallmark sign
a waste product, is exhaled. This exchange occurs • Dyspnea (shortness of breath), tachypnea
in the alveoli, the smallest air sacs at the end of • Cough (often dry or with minimal sputum)
the bronchioles. • Hypoxia:
Early: restlessness, confusion, irritability.
II. RESPIRATORY DISORDERS Late: cyanosis, clubbing of fingers
• Hyperventilation → respiratory alkalosis
BRONCHIAL ASTHMA (early)
• Respiratory fatigue → respiratory acidosis
A chronic inflammatory disorder of the airways (late)
characterized by bronchoconstriction, increased Nursing Management
mucus production, and airway
hyperresponsiveness. • Position: High-Fowler’s or orthopneic
• Oxygen: 1–2 L/min via nasal cannula
• Call for assistance if needed

Medications

Bronchodilators:

• Beta-2 agonists (-terol): Albuterol,

Salmeterol
• Anticholinergics (-tropium): Ipratropium,
Tiotropium
• Watch out for: tachycardia, palpitations
• Methylxanthines (-phylline):
Aminophylline, Theophylline
Anti-inflammatory agents: Chronic Bronchitis:

• Corticosteroids (-one): Hydrocortisone • Airway inflammation + ↑ mucus from

(oral, IV, inhaled) goblet cell damage.
• Leukotriene Modifiers (-kast): Montelukast
Signs
Health Teaching
• “Blue bloater” – cyanosis, productive
• Allergen avoidance cough, edema.
• Use of peak flow meter
Common S/S
• Encourage breathing exercises (swimming
helps improve lung function) • Chronic cough, sputum production
• Wheezes or crackles
• Hypercapnia → respiratory acidosis
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
(COPD) Nursing Interventions

• Smoking cessation
Irreversible, progressive lung disease including
• O₂ therapy: Low-flow (1–2 L/min), Venturi
emphysema and chronic bronchitis, marked by
mask
airflow limitation and gas exchange impairment.
• Encourage pursed-lip breathing, chest
physiotherapy
• High-calorie, low-carbohydrate diet
• Monitor for cor pulmonale and respiratory
infections

PNEUMOTHORAX

Air in the pleural space causing lung collapse.

Causes

• Smoking (primary)
• Air pollutants
• Genetic (α1-antitrypsin deficiency)

Types

Emphysema:
Causes
• Air trapping due to alveolar damage
• ↓ Elastic recoil • Trauma (stab, rib fracture)
• Ruptured blebs (spontaneous)
Signs
• Medical procedure complications
• “Pink puffer” – barrel chest, dyspnea,
pursed-lip breathing
Types Variants:

• Open: air enters via chest wall opening Hemothorax: blood

• Closed: internal rupture (e.g., blebs)
Empyema/Pyothorax: pus
• Tension: trapped air increases pressure →
mediastinal shift Hydrothorax: serous fluid

Common S/S Common S/S

• Sudden chest pain • Diminished breath sounds

• Dyspnea • Dyspnea, orthopnea
• Absent breath sounds on affected side • CXR: white-out appearance
• Tracheal deviation (in tension
Management
pneumothorax)
• Thoracentesis (fluid aspiration)
Management
• Best position: Orthopneic (sitting over bed
• Chest tube insertion (closed drainage) table)
• Oxygen therapy • Treat underlying cause
• Monitor for subcutaneous emphysema, • Monitor for pneumothorax after
respiratory status thoracentesis

III. S/SX OF RESPIRATORY DISORDERS

PLEURAL EFFUSION
EARLY SIGNS OF HYPOXIA
Fluid accumulation in the pleural space.
• Restlessness
• Irritability
• Anxiety
• Tachypnea – increased respiratory rate
• Tachycardia – compensatory increase in
heart rate
• Pale skin and mucous membranes
• Altered level of consciousness (ALOC) –
mild confusion, difficulty concentrating

LATE SIGNS OF HYPOXIA

Causes

• Congestive heart failure • Cyanosis – bluish discoloration of lips, nail

• Liver/kidney disease beds, or mucosa
• Pneumonia • Clubbing of fingernails – due to chronic low
• Cancer oxygen levels
• Bradypnea – slowed respiratory rate
Types (impending failure)
Transudate (clear fluid) – due to systemic factors • Hypotension – reduced tissue perfusion
• Cardiac dysrhythmias
Exudate (protein-rich) – due to inflammation or
• Lethargy → Unresponsiveness
infection
CLINICAL MANIFESTATIONS OF RESPIRATORY IV. DIAGNOSTIC PROCEDURES
IMBALANCE
NON-INVASIVE DIAGNOSTICS
Imbalance Cause Symptoms
Chest X-Ray (CXR)
Respiratory Hyperventilation Lightheadedness, • First-line imaging tool
Alkalosis numbing, • Shows lung consolidation (e.g.,
tingling pneumonia), pneumothorax (black space),
pleural effusion (whiteout), masses
• Used for: pneumonia, pleural effusion,
Respiratory Hypoventilation Confusion,
COPD, pneumothorax
Acidosis / CO₂ buildup drowsiness,
flushed skin Pulse Oximetry (SpO₂)

• Measures oxygen saturation of

ADDITIONAL SIGNS TO OBSERVE hemoglobin
• Normal: 95–100%; COPD: acceptable 88–
• Use of accessory muscles – neck and 92%
intercostal retractions Capnography (EtCO₂)
• Tripod positioning – especially in COPD and
asthma • Monitors exhaled CO₂
• Pursed-lip breathing – compensatory in • Useful in patients under sedation or during
COPD CPR
• Paradoxical breathing – diaphragm fatigue Pulmonary Function Test (PFT) / Spirometry
• Nasal flaring – especially in children
• Evaluates lung volumes and capacities
Adventitious breath sounds: • Used in asthma and COPD for diagnosis
• Wheezes: asthma, COPD and monitoring
• Crackles (rales): fluid overload, pneumonia • Measures FEV₁ (Forced Expiratory Volume
in 1 second), FVC (Forced Vital Capacity),
Absent breath sounds: and FEV₁/FVC ratio
• Pneumothorax, severe pleural effusion Sputum Analysis

• Detects causative organisms in infections

MONITORING AND PRIORITIZATION
(e.g., pneumonia, TB)

• Vital signs: RR, HR, BP, SpO₂ Types

• Oxygen saturation: Aim for > 92% in • Gram stain and culture
general, but 88–92% in COPD • Acid-fast bacilli (AFB) test – for TB
• ABG interpretation: Crucial for determining • Cytology – for lung cancer
acid-base balance
• Level of consciousness: Early sign of Peak Expiratory Flow Rate (PEFR)
deteriorating oxygenation
• Measures how fast a person can exhale
• Helps monitor asthma control
• Personal best PEFR is used to detect
worsening
INVASIVE DIAGNOSTICS

Arterial Blood Gas (ABG)

• Determines oxygenation, ventilation, and

acid-base status.
• Key components: PaO₂, PaCO₂, pH, HCO₃.
• Example:
• ↓ PaO₂ = hypoxemia
• ↑ PaCO₂ = hypoventilation/respiratory
acidosis

Thoracentesis

• Needle aspiration of fluid from pleural

space
• Used for diagnosis and relief in pleural
effusion
• Best position: Orthopneic (sitting on the
side of the bed, leaning forward)
• Monitor for complications: pneumothorax,
bleeding

Bronchoscopy

• Direct visualization of the airway

• Purpose: biopsy, secretion removal, tumor
identification
• Pre-procedure: NPO 6–8 hrs
• Post-procedure: Assess gag reflex before
feeding

Chest CT Scan

• Detailed imaging for tumors, infections,

embolism
• Used when CXR is inconclusive

Lung Biopsy

• Invasive tissue sampling for definitive

diagnosis (e.g., malignancy)