CBE; Respiratory Conditions

What is ARDS and how does it typically occur?

Acute Respiratory Distress Syndrome — acute inflammation of the alveolar epithelium and vascular endothelium. It usually occurs as a complication of another disease or illness, not as a primary diagnosis.

What does fluid overload do in ARDS?

It disrupts surfactant production, worsening alveolar damage and contributing to pulmonary edema.

What are the risk factors for ARDS?

Smoking, alcohol use, chronic lung disease, toxic chemical inhalation, sepsis/SIRS, lung trauma, aspiration of gastric contents, anaphylaxis, lack of pulmonary blood flow.

What are the clinical manifestations of ARDS?

Tachypnea, dyspnea, retractions, crackles, restlessness.

What are the initial diagnostics for ARDS?

History & physical, ABGs, chest X-ray, blood cultures + CBC, BMP, ESR, C-reactive protein.

What diagnostics are ordered later in ARDS workup?

CT scan / MRI and bronchoscopy.

What is the most important nursing intervention to anticipate in ARDS?

Intubation — nurses must anticipate and prepare for it early.

What are all the nursing interventions for ARDS?

Anticipate intubation, apply supplemental oxygen, reposition to prone or high-Fowler's, patient education.

What is the pathophysiology of pneumonia?

Microorganisms evade the lung's defense mechanisms, triggering an inflammatory/immune response. The alveoli fill with exudate causing consolidation, affecting the bronchioles, interstitial tissue, and alveoli.

What are the three types of pneumonia?

Community-acquired, nosocomial (hospital-acquired), and aspiration pneumonia.

What are the risk factors for pneumonia?

Elderly or very young patients, smoking, immunocompromised individuals, hospitalized patients.

What are the hallmark clinical manifestations of pneumonia?

Chronic productive cough, purulent sputum, and excessive bronchial mucus — these are the key findings.

What are all the clinical manifestations of pneumonia?

Sudden fever and chills, chronic productive cough, purulent sputum, excessive bronchial mucus, wheezing and crackles, hypoxemia, hypercapnia, and cyanosis.

What are the initial diagnostics for pneumonia?

History & physical, blood work (WBC count, blood cultures), chest X-ray.

What diagnostic comes later in pneumonia workup?

CT scan.

What are the nursing interventions for pneumonia?

Oral or IV antibiotics, IV fluids, oxygen therapy.

What is the pathophysiology of chronic bronchitis?

Chronic inflammation and edema of airways leads to: hyperplasia of bronchial mucous glands (increased mucus), destruction of cilia (impaired clearance), squamous cell metaplasia (loss of airway protection), and bronchial wall thickening with fibrosis causing airflow limitation.

What is squamous cell metaplasia and why does it matter in chronic bronchitis?

Abnormal cell change in the airway lining that results in loss of normal airway protection.

What are the risk factors for chronic bronchitis?

Secondhand smoke, environmental/occupational pollution (dust and fumes), alpha-1 antitrypsin deficiency, recurrent upper and lower respiratory infections.

What genetic factor is a risk for chronic bronchitis?

Alpha-1 antitrypsin deficiency.

What are the hallmark clinical manifestations of chronic bronchitis?

Chronic productive cough and purulent sputum.

What are all the clinical manifestations of chronic bronchitis?

Chronic productive cough, purulent sputum, dyspnea on minimal exertion, prolonged expiratory phase, wheezing and crackles, hypoxemia, hypercapnia, and cyanosis.

What are the initial diagnostics for chronic bronchitis?

History & physical, ABGs (for hypoxemia/hypercapnia), chest X-ray, CBC and sputum culture.

What diagnostics come later in chronic bronchitis?

Pulmonary function tests (showing reduced FEV1 and prolonged FET) and labs for polycythemia (elevated RBC count).

What does a reduced FEV1 indicate in chronic bronchitis?

Obstructed airflow — it is a key finding on pulmonary function testing done later in the workup.

What is the most critical component of treatment for chronic bronchitis?

Smoking cessation — it is the single most important factor for successful management.

What are the initial/core treatments for chronic bronchitis?

Smoking cessation, bronchodilator therapy, steroid anti-inflammatories, immunizations, supplemental oxygen.

What are the adjunct/later treatments for chronic bronchitis?

Mucolytic agents, antibiotic therapy (only if infection is confirmed), pulmonary rehabilitation.

When should antibiotics be used in chronic bronchitis?

Only if an active infection is confirmed — not routinely.

What are the nursing interventions for chronic bronchitis?

Teach pursed-lip breathing, elevate HOB/tripod position, chest physiotherapy, oxygen therapy, hydration, smoking cessation counseling, encourage effective coughing, cough suppressants as appropriate, patient education on breathing techniques.

What breathing technique is taught to chronic bronchitis patients and why?

Pursed-lip breathing — it slows exhalation, keeps airways open longer, and reduces air trapping.

What position helps chronic bronchitis patients breathe easier?

Elevated HOB (head of bed) or tripod position.

What is the primary source of obstruction in emphysema?

Inflammation in small airways distal to the bronchi — the obstruction is non-reversible.

How does emphysema differ from chronic bronchitis in reversibility?

Emphysema is non-reversible; chronic bronchitis may have some reversible components.

What vascular changes occur in emphysema?

Simultaneous vascular changes in the lungs contribute to alveolar and capillary destruction.

What are the early signs and symptoms of emphysema?

Shortness of breath, wheezing, coughing, fatigue.

What are the late signs and symptoms of emphysema?

Barrel chest, unintentional weight loss, cyanosis, peripheral edema, altered level of consciousness (LOC).

What is barrel chest and which condition is it associated with?

A rounded, enlarged chest shape due to air trapping and hyperinflation — a late sign of emphysema.

What are the initial diagnostics for emphysema?

History & physical, labs, chest X-ray, auscultation of lungs.

What diagnostic test is done later in emphysema?

Spirometry / FEV test.

What are the initial/core treatments for emphysema?

Smoking cessation, bronchodilators, supplemental oxygen, steroids.

What are the advanced/later treatments for emphysema?

Lung volume reduction surgery and lung transplant.

What causes asthma attacks?

Exposure to triggers (smoke, dust, mold, animal hair, temperature changes, illness, exercise) causes mast cell and IgE release, leading to airway constriction and swelling.

What is the underlying mechanism of asthma?

Bronchial hyperresponsiveness, airway inflammation, bronchial constriction, and excess mucus production — a hypersensitivity/inflammatory response.

What are the clinical manifestations of asthma?

Wheezing, chest tightness, coughing, breathlessness, bronchial constriction, excess mucus.

What are the initial diagnostics for asthma?

Chest X-ray, family and health history, ABGs (blood work).

What diagnostic is used later to monitor asthma?

Peak expiratory flow rate (PEFR).

What is PEFR and when is it used?

Peak Expiratory Flow Rate — a later diagnostic tool used to monitor asthma severity and response to treatment.

What are the treatments for asthma?

Identify and control triggers, pharmacological therapy (albuterol, nebulizer), monitoring through peak flow meter, patient education.

What is the first-line pharmacological treatment for asthma?

Albuterol via nebulizer or inhaler — a bronchodilator used to relieve airway constriction.

What are the nursing interventions for asthma?

Maintain patent airway, administer medications as ordered, position patient to optimize breathing, patient education.

Which respiratory conditions are types of COPD?

Chronic bronchitis and emphysema.

What do chronic bronchitis and emphysema have in common clinically?

Both cause chronic productive cough, dyspnea, wheezing, hypoxemia, and hypercapnia. They frequently overlap.

Which conditions share purulent sputum and productive cough as hallmark findings?

Pneumonia and chronic bronchitis.

What ABG findings are common in both chronic bronchitis and ARDS?

Hypoxemia (low O2) and hypercapnia (elevated CO2).

What do ARDS, pneumonia, chronic bronchitis, and emphysema all have in common?

All involve impaired gas exchange and require oxygen therapy as part of management.

For which respiratory conditions is smoking cessation a critical treatment priority?

Chronic bronchitis and emphysema — it is the most important modifiable factor in both.

Which conditions use spirometry/pulmonary function tests later in the workup?

Chronic bronchitis (reduced FEV1, prolonged FET) and emphysema (FEV test/spirometry).

What does FEV1 stand for and what does a reduced value indicate?

Forced Expiratory Volume in 1 second — a reduced value indicates obstructed airflow, seen in COPD (chronic bronchitis and emphysema).