Respiratory Disorders

Where does gas exchange (O2 and CO2) take place in the lungs?

In the alveoli (air sacs).

What happens when alveoli collapse or fill with fluid/mucus and can’t exchange gas?

CO2 can’t be blown off and oxygen doesn’t get to the blood → respiratory acidosis (respiratory depression).

What is atelectasis?

Collapsed, airless ALVEOLI (not the whole lung collapsing).

What causes atelectasis?

Airway obstruction from retained exudates and secretions. Common in bedridden patients and after abdominal or thoracic surgery.

What are the cues (manifestations) of atelectasis?

Dyspnea and/or tachypnea, mild–moderate hypoxemia, cough, sputum production, decreased breath sounds.

How is atelectasis managed and prevented?

Deep breathing and coughing, incentive spirometry, frequent turning, early mobilization, directed cough or suctioning.

Why must post-op patients deep breathe, cough, and use the incentive spirometer?

They were breathed for in the OR; these actions pop the alveoli back open so gas exchange can occur (prevents atelectasis/pneumonia).

Atelectasis vs. pneumothorax: what’s the difference?

Atelectasis = collapsed alveoli. Pneumothorax (‘collapsed lung’) = air in the pleural space pressing on the lung.

What does the epiglottis do, and why does it matter in dementia/neuro deficits?

It’s the flap that closes over the trachea when swallowing. If it doesn’t close completely, the patient can aspirate normal flora → aspiration pneumonia.

What SpO2 on room air should make the nurse think ‘call the provider/supplemental oxygen’?

88% or lower on room air.

What percentage of oxygen is room air?

About 21%.

Is supplemental oxygen a drug?

Yes. It is considered a drug and must be ORDERED by a healthcare provider.

A test question asks what to do for a hypoxic patient. Which oxygen wording should you pick?

‘Apply PRESCRIBED oxygen.’ Nurses don’t apply oxygen without an order.

What are 6 signs of significant respiratory problems every nurse should recognize?

Nasal flaring, tachypnea (RR >24 in adults), noisy breathing (wheezing, stridor, moaning), accessory muscle use, pursed-lip breathing, Cheyne-Stokes breathing.

What is pursed-lip breathing, and who does it?

Exhaling through pursed lips (longer exhale) to empty trapped air; often seen in severe COPD patients.

What is Cheyne-Stokes breathing?

Periods of apnea (up to 30 seconds) alternating with rapid breathing; an ominous sign.

What does a child in respiratory distress look like?

Tachypnea, high heart rate, tripod position, retractions, nasal flaring, grunting, cyanosis (blue lips), anxiety. Children turn cyanotic faster than adults.

What respiratory rate in a child indicates distress (per slide notes)?

Respiratory rate >60 (tachypnea).

In a tachypneic infant/child, does a slowing respiratory rate always mean improvement?

No. It can mean the child is tiring/exhausted, a sign of impending respiratory arrest.

Which position helps COPD patients breathe best?

Sitting up, leaning over the bedside table (tripod-like).

What is bronchiolitis, and what usually causes it?

Acute inflammation of the bronchioles and small bronchi; most commonly caused by RSV (respiratory syncytial virus).

How long can RSV live on surfaces, and what is the key prevention?

Up to 6 hours on surfaces. Frequent hand washing (and wiping down hard surfaces).

How do infants usually catch RSV?

From an older person/adult who has a mild upper respiratory infection.

What are the cues of bronchiolitis/RSV?

Starts with clear runny nose, pharyngitis, low-grade fever; cough 1–3 days in, then wheeze; poor feeding. Can progress to respiratory distress (wheezing, crackles, rhonchi).

How is RSV diagnosed?

Clinical presentation plus culture of secretions.

What is the supportive treatment for bronchiolitis/RSV?

Supplemental O2 (ordered), nasal/nasopharyngeal suctioning, hydration (oral or IV), inhaled bronchodilators, antipyretics. Hospitalize severe cases.

What is the nursing management for bronchiolitis/RSV?

Assess respiratory status frequently, auscultate all lung fields, apnea/O2 sat monitoring, watch for respiratory distress, assess for dehydration.

Are antibiotics used for RSV bronchiolitis?

Usually not; it’s viral.

What is pneumonia?

Infection of the lung including the alveoli; an inflammatory response causes airway edema and fluid fills the alveoli, reducing gas exchange.

What can cause pneumonia?

Bacteria, viruses, fungi (e.g., spores from dirt), mycobacterium, parasites, chemicals.

What are the three ways pneumonia is acquired?

Inhalation (microbes from the air), aspiration (normal flora from nose/mouth/stomach), and hematogenous (spread from an infection elsewhere in the body).

What is aspiration pneumonia?

Pneumonia from aspirating normal flora from the mouth/stomach into the lungs; risk with decreased LOC, dementia, difficulty swallowing, NG tubes, weak gag/cough.

What is community-acquired pneumonia (CAP)?

Onset in the community (or >14 days after a hospital stay); often follows a flu or cold.

What is hospital-acquired (nosocomial) pneumonia?

Pneumonia that develops 48+ hours after hospital admission. Includes ventilator-associated and healthcare-associated pneumonia.

What qualifies as healthcare-associated pneumonia?

Long-term care residents; patients who received IV therapy, chemo, or wound care in the past 30 days; or attended a dialysis unit.

What is ventilator-associated pneumonia (VAP)?

Hospital-acquired pneumonia >48 hours after endotracheal intubation; air enters the lungs without normal filtering. Needs meticulous care and hand hygiene.

How do nurses prevent spreading pneumonia in the hospital?

Gel hands before and after entering every room; meticulous ventilator care. (Soap and water for C. diff.)

Which organism causes a community acquired pneumonia (CAP) that frequently affects older adults with comorbidities like COPD?

Haemophilus influenzae (Hib).

What are predisposing factors for pneumonia?

Age, air pollution, smoke exposure, altered consciousness, prolonged bed rest, general anesthesia, chronic disease, malnutrition, secondary infection (URI), being immunocompromised.

What are the classic cues of pneumonia?

Cough, fever, chills, dyspnea, tachypnea/orthopnea, pleuritic chest pain, discolored sputum, adventitious breath sounds, fatigue, anorexia, headache, myalgia.

What is often the FIRST sign of pneumonia in older adults?

Confusion (from hypoxia), sometimes before a fever spikes. Older patients may not have classic symptoms.

Fever pattern: bacterial vs. viral pneumonia?

Bacterial: temperature spikes. Viral: usually low-grade (around 100–100.1).

What is the hallmark of streptococcal pneumonia?

Sudden onset of chills, rapidly rising fever, and pleuritic chest pain aggravated by deep breathing and coughing.

What vital sign finding is associated with viral pneumonia?

Relative bradycardia (pulse-temp deficit): pulse is slower than expected for the temperature.

What breath sounds may be heard over a lung area with pneumonia?

Absent breath sounds where alveoli are filled with fluid, or crackles. Auscultate all lung fields front and back.

How does pneumonia look on a chest x-ray, and why?

White/patchy areas (infiltrates/consolidation): fluid reflects the x-ray beam; air lets it pass through (dark).

What is the MOST important diagnostic test to obtain for pneumonia, and when?

Sputum culture, ideally upon admission and BEFORE antibiotics are started.

Why get a sputum culture before giving antibiotics?

To identify whether it’s viral or bacterial and which organism, so the correct antibiotic is given (viral may not need antibiotics).

What diagnostic studies are done for pneumonia?

History (smoking, LTC, recent URI), sputum culture, bronchoscopy (if no sputum), chest x-ray, labs (WBC, blood cultures, CBC, ABGs), pulse oximetry.

A pneumonia patient’s SpO2 is 88% on room air. With prescribed oxygen, what goal SpO2 was mentioned?

Raise it to about 93% and maintain it.

What are the nursing interventions for pneumonia?

Identify at-risk patients, monitor respiratory status, ensure oxygenation, upright positioning (HOB ≥30°, never flat), fluids/nutrition, rest, meds as ordered, promote vaccination.

Why is hydration so important in pneumonia?

Fluids liquefy/thin the mucus so it can move out of the alveoli and be coughed up.

What caution applies to giving fluids to a pneumonia patient with dementia?

The epiglottis may not close properly, risking aspiration. Be very careful with oral fluids.

Why should pneumonia patients be up and moving?

Movement helps secretions drain; lying in bed worsens pooling of secretions.

What medications are used for pneumonia?

Antibiotics (if bacterial), analgesics, antipyretics (e.g., Tylenol), and antivirals (especially for at-risk patients like COPD).

What is the nursing care for a child with pneumonia?

Assess respiratory status and VS (at least q4h), monitor for distress, elevate HOB, change position (q2h), humidified oxygen, antipyretics/antibiotics as prescribed, quiet diversional activities.

Why avoid placing an infant with pneumonia in an infant seat?

It puts pressure on the diaphragm, decreasing lung expansion.

How is humidified oxygen often given to children?

Oxygen tent (humidified) or a nebulizer mask.

What are complications of pneumonia?

Atelectasis, pleurisy, pleural effusion, bacteremia, pneumothorax, meningitis, acute respiratory failure, sepsis/shock, delayed resolution, lung abscess, empyema.

Define bacteremia, sepsis, and empyema.

Bacteremia: infection in the blood. Sepsis: systemic infection that can lead to septic shock/MODS. Empyema: pus collected in a body cavity, especially the pleural cavity.

Who should get the pneumococcal (pneumonia) vaccine?

Adults 65+ (and younger people with certain conditions/smokers); PCV13 for all children under 2. PPSV23 covers more strains.

A 74-year-old recovering from pneumonia: which discharge statement shows understanding of prevention?

‘I need to get the flu and pneumonia vaccines as recommended.’

A 72-year-old with pneumonia: RR 30, SpO2 88% on RA, using accessory muscles. Priority action?

Apply PRESCRIBED oxygen.

A 4-year-old with pneumonia; parents are very anxious. Best nursing approach?

Allow the parents to remain with the child as much as possible.

What is acute bronchitis?

Inflammation of the bronchi; usually VIRAL (rhinovirus, influenza), sometimes bacterial (Strep pneumoniae, H. influenzae); often secondary to a URI.

Is acute bronchitis usually self-limiting?

Yes. Usually viral and self-limiting; antibiotics aren’t needed unless complications develop. The cough can persist for weeks.

What are the signs and symptoms of acute bronchitis?

Cough, sputum, fever, rhonchi or crackles or inspiratory/expiratory wheezes (or normal), shortness of breath.

Does fluid collect in the alveoli in bronchitis like in pneumonia?

No. Bronchitis is inflammation of the bronchial tubes, so the chest x-ray is usually clear.

What is the nursing management of acute bronchitis?

Rest, fluids, anti-inflammatory meds, cough suppressants (only if cough disturbs sleep), humidifier, bronchodilators; limited antibiotics (high-risk or confirmed bacterial). Goal: symptom relief and prevent pneumonia.

Why limit cough suppressants in bronchitis?

We want the patient to cough up secretions; use them only if the cough keeps the patient from sleeping.

What is pleurisy?

Inflammation of the pleura (lining between the lung and chest wall).

What causes pleurisy?

Pneumonia, tuberculosis, chest trauma, pulmonary infarctions, and neoplasms (cancer).

What are the cues of pleurisy?

Abrupt, sharp pain that worsens with inspiration; difficulty breathing; shallow, rapid respirations; pleural friction rub (‘squeaky door’ sound).

What is the nursing management of pleurisy?

Treat the underlying cause, pain meds (NSAIDs), position on the AFFECTED side, deep breathing and coughing, splint the rib cage when coughing, ambulation.

Which side should a patient with pleurisy lie on?

The affected side (e.g., left-sided pleurisy → lie on the left side).

Why are NSAIDs helpful for pleurisy pain?

Pleurisy is inflammation, and NSAIDs are anti-inflammatory.

What is a pleural effusion?

A collection of fluid in the pleural space that can limit lung expansion.

What are the manifestations of pleural effusion?

Severity depends on size: dyspnea, difficulty lying flat, cough, decreased/absent breath sounds, decreased fremitus, dull/flat sound on percussion.

How is a pleural effusion managed?

Find the underlying cause, prevent fluid re-accumulation, relieve discomfort/dyspnea; thoracentesis to remove fluid (a medical procedure that removes excess fluid (pleural effusion) or air from the space between the lungs and the chest wall)

What is the most common reason people seek healthcare?

Upper respiratory disorders/infections.

Why does early detection of URI symptoms matter?

Appropriate early intervention can prevent complications like pneumonia.

What should be included in assessment for an upper respiratory infection?

Health history, allergies, inspection of nose/neck/throat, and PALPATION OF NECK LYMPH NODES.

What is rhinitis?

Inflammation and irritation of the mucous membranes of the nose.

What are the types of rhinitis?

Allergic (intermittent vs. persistent), acute viral rhinitis (common cold; over 200 viruses, spread by airborne droplets), and non-allergic rhinitis.

What are the cues of rhinitis?

Runny nose (rhinorrhea), nasal discharge/itching, sneezing, cough, congestion, itchy watery eyes, malaise, headache. USUALLY no fever or only slight.

Can nasal discharge color tell you if rhinitis is bacterial?

Not reliably; testing is needed to tell bacterial from viral.

What can rhinitis lead to?

Sinusitis, ear infections (otitis media), and bronchitis.

How long can OTC decongestant nasal sprays (Afrin) be used, and why?

No more than 3 days; overuse causes rebound congestion.

How is allergic rhinitis managed?

Reduce exposure to allergens, allergy testing (now available as a blood test), immunotherapy (allergy shots).

How is viral rhinitis managed?

Prevention with handwashing, avoid crowds; self-limiting (rest & fluids); patient education.

What fraction of children with allergic rhinitis have asthma?

About 1/3.

Why might infants and young children with rhinitis need suctioning?

They are nose breathers.

What is otitis media?

Infection or blockage of the middle ear, often bacterial; a complication of rhinitis in children.

Why do children get more ear infections than adults?

Their Eustachian tubes are short and horizontal, so respiratory infections drain into the ear.

What are risk factors for otitis media?

Smoke exposure, pacifiers, bottle feeding (lying flat while feeding).

What are the signs of otitis media?

Pulling at ears, drainage, pain, irritability.

How is recurrent otitis media treated, and why does prevention matter?

Antibiotics; ear tube placement if recurrent. Repeated infections can cause hearing loss, so educate on prevention.

Name the key pediatric respiratory differences.

Shorter distance between structures (infection moves down fast), smaller lower airways, nose breathers, intercostal muscles not developed (diaphragm main muscle → retractions), irregular respirations, alveoli not fully developed until age 8, horizontal Eustachian tubes.

What are pediatric respiratory nursing considerations?

Manage fever, promote rest and comfort, ease respiratory effort, control infection, promote hydration and nutrition (popsicles), provide family support and teaching.

Why is fever in an infant younger than 28 days emergent?

Their immune system is severely immature; requires a full septic workup.