Exam 1 semester 2

Pneumonia

Infection/inflammation of the lung tissue causing alveoli to fill with fluid or pus.

• S/S: Fever, chills, productive cough, crackles, dyspnea, pleuritic chest pain, low SpO₂.

• Diagnostics: Chest X-ray, sputum culture, CBC.

• Nursing: Assess respiratory status, give oxygen as ordered, encourage coughing/deep breathing and incentive spirometry, fluids if appropriate, ambulation.

• Treatment: Antibiotics for bacterial pneumonia.

• Remember: Older adults may present with confusion rather than a high fever.

Asthma

Chronic inflammatory airway disorder with reversible bronchoconstriction.

• S/S: Wheezing, coughing, chest tightness, dyspnea.

• Rescue medication: Albuterol.

• Long-term control commonly includes inhaled corticosteroids.

• Avoid known triggers.

• Emergency sign: Severe difficulty breathing or a silent chest can indicate very little air movement.

COPD

Chronic airflow limitation commonly involving emphysema and/or chronic bronchitis.

• S/S: Chronic cough, dyspnea, decreased exercise tolerance.

• Smoking is a major risk factor.

• Nursing: Position upright, administer prescribed oxygen/medications, encourage pursed-lip breathing and energy conservation.

• Teaching: Smoking cessation is one of the most important interventions.

Atelectasis

Partial or complete collapse of alveoli, commonly after surgery.

• S/S: Dyspnea, tachypnea, decreased breath sounds, low SpO₂.

• Prevention/treatment: Incentive spirometer, coughing/deep breathing, turning, early ambulation and pain control.

• Remember: Postoperative immobility and shallow breathing increase risk.

Emphysema

Destruction of alveolar walls causes loss of elastic recoil and air trapping.

• S/S: Progressive dyspnea, prolonged expiration, decreased breath sounds, barrel chest.

• Encourage pursed-lip breathing.

• Smoking cessation is essential.

• Small frequent meals may decrease fatigue while eating.

Lung Cancer

Malignant growth of abnormal cells in lung tissue.

• Major risk: Smoking/tobacco exposure.

• S/S: Persistent/change in cough, hemoptysis, chest pain, dyspnea, unexplained weight loss, recurrent respiratory infections.

• Diagnosis may involve CT, bronchoscopy and biopsy.

• Treatment: Surgery, radiation, systemic therapies depending on type/stage.

Respiratory Acidosis

Hypoventilation → CO₂ retention → decreased pH.

• ABG: pH ↓, PaCO₂ ↑.

• Causes: COPD exacerbation, respiratory depression, airway obstruction and other causes of inadequate ventilation.

• Treatment focuses on improving ventilation and correcting the cause.

• Remember: CO₂ acts like an acid.

Epistaxis

• Sit upright.

• Lean FORWARD.

• Pinch the soft part of the nose continuously for about 10–15 minutes.

• Do NOT tilt the head backward.

• Seek care for severe or persistent bleeding.

Acute Rhinitis

 Acute inflammation of the nasal mucosa, commonly from a viral infection.

• S/S: Runny/stuffy nose, sneezing, sore throat, malaise.

• Treatment is generally supportive: fluids, rest, symptom relief.

• Antibiotics do not treat viral rhinitis.

Streptococcal Pharyngitis

Bacterial throat infection caused by group A Streptococcus.

• S/S: Sore throat, fever, painful swallowing, erythematous throat/tonsils.

• Confirm with testing as appropriate.

• Antibiotics are used when indicated.

• Teaching: Complete the entire antibiotic course.

• Untreated infection can lead to complications such as rheumatic fever.

Acute Bronchitis

Acute inflammation of the bronchi, usually viral.

• Main symptom: Cough, sometimes with sputum.

• May have wheezing, fatigue or chest discomfort.

• Treatment is usually supportive.

• Encourage fluids if not contraindicated and avoidance of smoking/irritants

Tuberculosis (TB)

Infection caused by Mycobacterium tuberculosis.

• Spread through airborne transmission.

• S/S: Persistent cough, night sweats, fever, fatigue, weight loss, sometimes hemoptysis.

• Active/suspected pulmonary TB requires airborne precautions.

• Use a negative-pressure room when available and appropriate respiratory protection.

• Treatment requires multiple medications for months.

Rifampin

Medication commonly used as part of TB treatment.

• Can turn urine, sweat, saliva and tears orange/red-orange.

• Can stain soft contact lenses.

• Monitor for liver toxicity as ordered.

• Report jaundice, severe fatigue or other signs of liver injury.

• Has many drug interactions, so medication review is important.

Pleurisy

Inflammation of the pleura surrounding the lungs.

• Classic symptom: Sharp chest pain that worsens with deep breathing or coughing.

• May hear a pleural friction rub.

• Treatment targets the underlying cause and pain/inflammation.

• Positioning for comfort may help.

Thoracentesis

Procedure in which a needle/catheter removes fluid or air from the pleural space.

• Common positioning: Sitting upright and leaning forward when tolerated.

• Instruct patient to remain still and follow breathing instructions.

• Monitor respiratory status and puncture site afterward.

• Watch for pneumothorax: Sudden dyspnea, chest pain, decreased breath sounds, falling SpO₂.

Water-Seal Drainage System

• Keep drainage unit below chest level and upright.

• Water-seal chamber prevents air from returning to the pleural space.

• Tidaling may occur with respirations.

• Continuous bubbling in the water-seal chamber can indicate an air leak.

• Do not routinely clamp the chest tube.

Acute Pulmonary Edema

Rapid accumulation of fluid in the lungs.

• S/S: Severe dyspnea, crackles, hypoxemia, anxiety; pink frothy sputum may occur.

• Priority: Airway and breathing.

• Position upright/high Fowler’s.

• Administer oxygen/ventilatory support and prescribed medications.

• Requires rapid intervention.

Obstructive Sleep Apnea (OSA)

Repeated upper-airway obstruction during sleep.

• S/S: Loud snoring, witnessed apnea, daytime sleepiness, morning headaches.

• Common treatment: CPAP.

• Weight reduction can help when appropriate.

• Avoid alcohol and sedatives near bedtime unless specifically prescribed/cleared because they can worsen obstruction.

Upper Airway Obstruction

• Stridor is an important warning sign.

• Difficulty breathing

• Retractions/accessory muscle use

• Cyanosis or altered mental status may occur with worsening hypoxia.

• Priority: Maintain/open the airway and obtain emergency assistance.

Cancer of the Larynx

• Persistent hoarseness/voice change

• Sore throat

• Dysphagia

• Neck mass

• Smoking and heavy alcohol use increase risk.

• Treatment can include surgery, radiation and/or systemic therapy depending on disease.

Laryngectomy

 The patient’s airway is through a permanent neck stoma.

• Maintain stoma/airway patency.

• Humidification and suctioning may be required.

• Use alternative communication methods.

• Important: After a total laryngectomy, oxygen and rescue breathing must be provided through the stoma, not the mouth/nose.

Pharyngitis

Inflammation of the pharynx caused by viral or bacterial infection.

• S/S: Sore throat, painful swallowing, erythema, possible fever.

• Viral infections usually receive supportive care.

• Confirm/treat streptococcal infection appropriately.

• Encourage fluids and comfort measures if appropriate.

COVID-19

 Respiratory illness caused by SARS-CoV-2.

• Symptoms can include fever, cough, sore throat, fatigue and dyspnea.

• Severity ranges from mild illness to severe pneumonia/respiratory failure.

• Monitor respiratory status and oxygenation in symptomatic patients.

• Follow current facility infection-control precautions.

Medication Administration

Verify the correct patient, medication, dose, route, time and documentation, along with other rights required by your program/facility.

• Check allergies.

• Perform necessary assessments.

• Know why the medication is being given.

• Evaluate the patient’s response.

• Never administer a medication you cannot safely verify.

Bronchoscopy

Procedure used to visualize the airways.

• Before: Usually NPO as ordered; obtain baseline assessment and verify preparation/consent according to role/facility policy.

• After: Monitor airway, breathing, SpO₂ and vital signs.

• Keep NPO until the gag/swallow reflex returns after topical anesthesia/sedation as appropriate.

• Watch for respiratory distress or significant bleeding.

Albuterol

Short-acting beta₂ agonist (SABA) used as a rescue bronchodilator.

• Relaxes bronchial smooth muscle.

• Used for acute bronchospasm.

• Side effects: Tremor, tachycardia/palpitations, nervousness.

• If using a bronchodilator and inhaled corticosteroid together, the bronchodilator is generally used first as directed.

Chest Tubes

• Keep drainage system below chest level.

• Maintain tubing without dependent loops/kinks.

• Assess respiratory status and insertion site.

• Monitor drainage.

• Check the drainage system as ordered.

• Do not routinely strip, milk or clamp the tube unless specifically indicated/ordered by policy.

Chest Tube Dislodgement

This is an emergency.

• Stay with the patient and assess airway/breathing.

• Call for assistance/notify provider or rapid response as appropriate.

• Apply the facility-recommended sterile occlusive dressing; many nursing protocols use petroleum gauze while emergency management is initiated.

• Monitor closely for respiratory distress/tension pneumothorax.

• Follow facility policy because exact dressing technique can vary.

Chest Tube Education

• Do not pull, kink or lie on the tubing.

• Keep drainage system below chest level.

• Avoid manipulating/clamping the tubing.

• Perform coughing/deep breathing and incentive spirometry as instructed.

• Report sudden chest pain, dyspnea or difficulty breathing immediately.

Acute Respiratory Distress Syndrome (ARDS)

Severe inflammatory lung injury causing increased alveolar-capillary permeability and noncardiogenic pulmonary edema with severe hypoxemia.

• S/S: Severe dyspnea, tachypnea, crackles, hypoxemia.

• Hypoxemia can be difficult to correct.

• Often requires mechanical ventilation with PEEP and treatment of the underlying cause.

• Common triggers include sepsis, pneumonia, aspiration and major trauma.

Chronic Bronchitis

COPD phenotype characterized by chronic productive cough; classic clinical definition is productive cough for at least 3 months in each of 2 consecutive years after excluding other causes.

• Increased mucus production

• Chronic cough

• Wheezing/dyspnea

• Recurrent respiratory infections may occur.

• Smoking cessation is crucial.

Rib Fracture

• Assess respiratory status.

• Provide adequate pain control so the patient can breathe deeply.

• Encourage coughing/deep breathing and incentive spirometry when appropriate.

• Watch for complications such as pneumothorax, hemothorax and atelectasis.

• Avoid restrictive chest binding.

Pulmonary Embolism (PE)

 Blockage of a pulmonary artery, most commonly from a thrombus that originated in the deep veins.

• Sudden dyspnea

• Pleuritic chest pain

• Tachypnea/tachycardia

• Hypoxemia

• Anxiety/restlessness; hemoptysis may occur.

• Priority: Support airway/breathing, oxygen as indicated, rapid medical evaluation/treatment.

• Anticoagulation is commonly used when appropriate

Prednisone

• Class: Corticosteroid (glucocorticoid)

• Action: Decreases inflammation and suppresses the immune response.

• Respiratory uses: Asthma and COPD exacerbations; other inflammatory conditions.

• Side effects: ↑ blood glucose, ↑ appetite/weight gain, fluid retention, mood changes, GI irritation, and increased risk of infection.

• Give with food to decrease stomach irritation.

• Monitor blood glucose and signs of infection.

• Teaching: Do NOT stop suddenly after prolonged/high-dose therapy—prednisone may need to be tapered.

• Remember: Prednisone helps control inflammation; it is NOT a rescue medication for an acute asthma attack.

First action with respiratory issues

Oxygen

Hypoventilation

CO2 high

Hyperventilation

CO2 Low

BMP

Determines electrolytes

Normal RBC

4-6 million

Normal Hemoglobin level

12-16,000

Anemia

lack of blood

Inhaler meter dose

wash mouth out after use

Pleurisy

Splint chest when breathing

Diphenhydramine (Benadryl)

• Class: First-generation antihistamine

• Used for: Allergic symptoms

• Side effects: Drowsiness, dry mouth, blurred vision, urinary retention

• Use caution with driving and other CNS depressants

• Older adults are particularly susceptible to anticholinergic adverse effects

• Remember: Benadryl = sedation + drying

Benzonatate (Tessalon)

• Class: Antitussive

• Used for: Cough suppression

• Teaching: Swallow capsules WHOLE

• DO NOT chew, crush, dissolve, or suck

• Chewing can numb the mouth/throat and create a choking/aspiration risk

• Keep securely away from children; overdose can be dangerous

• Remember: Tessalon = swallow WHOLE

Dextromethorphan (Delsym/Robitussin DM)

• Class: Antitussive

• Action: Suppresses the cough reflex

• Used for: Dry/nonproductive cough

• Can cause dizziness or drowsiness

• Check for important drug interactions, especially with certain serotonergic medications/MAOIs

• Remember: Antitussive = suppresses coughing

Guaifenesin (Mucinex)

• Class: Expectorant

• Action: Helps thin/loosen respiratory secretions, making them easier to cough up

• Used for: Chest congestion

• Encourage adequate fluids if not contraindicated

• Remember: Guaifenesin = get mucus OUT

Methylprednisolone (Solu-Medrol)

• Class: Corticosteroid

• Used for: Severe airway inflammation, including asthma/COPD exacerbations

• Action: Decreases inflammation

• Side effects: ↑ blood glucose, infection risk, GI irritation, mood changes

• Monitor blood glucose and signs of infection

• Remember: Steroid = decreases inflammation