MEDSURG WEEK 5

Which findings mean the patient may be failing?

Altered LOC + exhaustion + ↑ oxygen need + hypotension + silent/absent breath sounds.

Why is mental status a priority respiratory assessment?

Restlessness/confusion = early hypoxemia; drowsiness = CO₂ retention or respiratory fatigue.

Why can a lower respiratory rate be dangerous?

RR dropping + drowsiness/weak effort = exhaustion

What should the nurse ask before choosing an answer?

What will kill this patient first? What can I reverse now?

What should happen after every intervention?

Reassess breathing effort + SpO₂ + mental status + BP.

Oxygen-Delivery Devices

When is a nasal cannula used?

Stable patient with mild hypoxemia; provides low-flow oxygen.

When is a Venturi mask used?

When a precise FiO₂ is needed, especially for COPD.

When is a nonrebreather mask used?

Severe hypoxemia or emergency while preparing further support.

What must the nurse check with a nonrebreather?

Reservoir bag stays partially inflated + mask seals well + oxygen flow is adequate.

What should the nurse do if the nonrebreather bag collapses?

Increase oxygen flow + check tubing/mask.

What does high-flow nasal oxygen provide?

Higher flow + humidification + more reliable oxygen delivery.

Who can use CPAP/BiPAP?

Alert/cooperative patient who can protect the airway and clear secretions.

When is CPAP/BiPAP unsafe?

Vomiting + excessive secretions + inability to protect airway + severe instability.

When is intubation needed?

Refractory hypoxemia + worsening acidosis + exhaustion + inability to protect airway.

Oxygen-device recall?

Cannula = mild; Venturi = precise; Nonrebreather = severe.

Postoperative Atelectasis

What is atelectasis?

Collapsed alveoli → ↓ lung expansion → ↓ oxygenation.

Why does surgery cause atelectasis?

Pain + sedation + immobility → shallow breathing/weak cough → alveoli collapse.

What findings suggest postoperative atelectasis?

↓ SpO₂ + tachypnea + diminished bases/fine crackles + shallow breathing.

A postoperative patient refuses to cough because of pain. What is the priority?

Give prescribed analgesic → splint incision → deep breathe/cough.

What prevents atelectasis?

Incentive spirometry + early ambulation + turning + deep breathing/coughing.

Why is pain control important?

Less pain → deeper breaths + stronger cough → better lung expansion.

How does incentive spirometry help?

Slow, deep inhalation reopens collapsed alveoli.

What complication can atelectasis cause?

Retained secretions → pneumonia or respiratory failure.

How does the nurse know interventions worked?

↑ SpO₂ + improved basilar sounds + easier breathing.

Postoperative complication chain?

Surgery → pain/shallow breaths → atelectasis → retained secretions → pneumonia.

Atelectasis prevention mnemonic?

“DICE” = Deep breathe/cough, Incentive spirometer, Change position, Early ambulation.

Pneumonia and Hospital Prevention

What happens in pneumonia?

Infection fills alveoli with fluid/inflammatory material → impaired oxygen exchange.

What is hospital-acquired pneumonia (HAP)?

Pneumonia beginning ≥48 hours after admission.

How may pneumonia appear in an older adult?

New confusion + weakness + functional decline, sometimes without high fever.

What should the nurse assess in pneumonia?

RR/effort + SpO₂/oxygen need + mental status + BP + breath sounds + sputum.

What are priority pneumonia interventions?

Oxygen + prescribed antibiotics + mobility + hydration + airway clearance.

When should cultures be collected?

Before antibiotics when ordered—but do not delay emergency treatment.

Which pneumonia patient needs immediate escalation?

Patient with ↑ RR + falling SpO₂ despite oxygen + confusion + hypotension.

Why is a rising oxygen need dangerous?

It shows worsening gas exchange despite treatment.

What are serious pneumonia complications?

Sepsis + acute respiratory failure + pleural infection + ARDS.

How should a hospital reduce pneumonia rates?

Early mobility + oral care + aspiration precautions + coughing/deep breathing—not blanket antibiotics.

Why does immobility increase pneumonia risk?

↓ lung expansion + retained secretions → bacterial growth.

Pneumothorax

What is a pneumothorax?

Air enters pleural space → lung cannot fully expand.

What findings suggest pneumothorax?

Sudden unilateral chest pain + dyspnea + decreased/absent breath sounds on one side.

What causes tension pneumothorax?

Trapped pleural air increases pressure → lung collapse + ↓ venous return → obstructive shock.

What findings suggest tension pneumothorax?

Severe distress + unilateral absent sounds + tachycardia + hypotension ± JVD.

What separates simple from tension pneumothorax?

Tension pneumothorax causes shock/hypotension.

Is tracheal deviation an early sign?

No—it is a late sign; do not wait for it.

A patient develops absent right breath sounds and BP 76/44 after central-line placement. What is the priority?

Suspect tension pneumothorax → oxygen + emergency response + prepare decompression/chest tube.

Should an unstable patient wait for imaging?

No—tension pneumothorax is treated from the clinical pattern.

Collapse comparison?

Atelectasis = gradual/postoperative; pneumothorax = sudden/unilateral.

Chest-Tube Safety

Where should the chest drainage system stay?

Upright + below chest level.

What does new continuous bubbling in the water-seal chamber mean?

Air leak.

What is the first action for continuous bubbling?

Assess the patient → then trace tubing and connections.

What does tidaling mean?

Pressure changes occur with breathing; this may be expected.

Why can sudden loss of tidaling be dangerous?

If the patient worsens, the tube may be obstructed.

Should a chest tube be routinely clamped or stripped?

No—this can trap air or create harmful pressure.

Chest-tube mnemonic?

“BKN” = Below chest

COPD Pathophysiology and Findings

What is COPD?

Persistent airflow obstruction → difficult exhalation + air trapping.

What happens in chronic bronchitis?

Airway inflammation + excess mucus → narrowed airways + productive cough.

What happens in emphysema?

Alveolar destruction + loss of elastic recoil → air trapping + ↓ gas-exchange area.

Why is expiration prolonged in COPD?

Small airways narrow/collapse during exhalation → air cannot fully escape.

COPD pathophysiology chain?

Narrowed airways/lost recoil → difficult exhalation → air trapping → hyperinflation → impaired gas exchange.

What are expected baseline COPD findings?

Exertional dyspnea + chronic cough ± sputum + prolonged expiration + ↓ activity tolerance.

What findings suggest COPD exacerbation?

↑ dyspnea + ↑ sputum amount/purulence + new oxygen need + fever/confusion + ↓ activity.

What commonly worsens COPD?

Infection + smoke/irritants + missed medications + poor inhaler technique.

What complications can mimic a COPD exacerbation?

Pneumonia + pneumothorax + pulmonary embolism + heart failure + dysrhythmia.

What confirms persistent COPD obstruction?

Post-bronchodilator FEV₁/FVC <0.70.

COPD Priorities and Treatment

A COPD patient has RR 28

SpO₂ 86%

What are immediate COPD-exacerbation interventions?

Sit upright + controlled oxygen + short-acting bronchodilator + prescribed steroid ± antibiotic.

What is the foundation of COPD medication treatment?

Bronchodilators.

When are antibiotics used during COPD exacerbation?

When bacterial infection is suspected

How does pursed-lip breathing help?

Keeps small airways open longer → releases trapped air.

How is pursed-lip breathing performed?

Inhale through nose → exhale slowly through pursed lips longer than inhalation.

Should oxygen be withheld from a severely hypoxemic COPD patient?

No—treat hypoxemia while monitoring ventilation.

What SpO₂ range is often ordered for patients at risk for hypercapnic failure?

88%–92%

A COPD patient reaches the SpO₂ target but becomes drowsy. What is the concern?

CO₂ retention and worsening ventilation.

What should the nurse assess when a COPD patient becomes drowsy?

Mental status + work of breathing + ABG/PaCO₂.

When may BiPAP be used in COPD?

Acute hypercapnic respiratory failure when the patient can protect the airway.

When may COPD require intubation?

Exhaustion + worsening acidosis + refractory hypoxemia + inability to protect airway.

COPD Prevention and Teaching

What slows COPD progression the most in a patient who smokes?

Smoking cessation.

What nonmedication treatments improve COPD?

Vaccines + pulmonary rehabilitation + activity + nutrition + energy conservation.

What should be checked before deciding COPD medications are ineffective?

Adherence + correct inhaler technique.

What should COPD discharge teaching include?

Rescue vs maintenance medications + inhaler technique + oxygen safety + early exacerbation signs.

Which changes should a COPD patient report early?

↑ dyspnea + sputum amount/color change + fever + reduced activity tolerance.

Asthma Pathophysiology and Control

What happens during asthma?

Bronchospasm + airway swelling + mucus → narrowed airways.

What commonly triggers asthma?

Infection + allergens + smoke + exercise + cold air + some medications.

What shows controlled asthma?

Few daytime symptoms + no night waking + normal activity + little reliever use.

What shows uncontrolled asthma?

Frequent symptoms + night waking + activity limits + frequent reliever use.

What does frequent rescue-inhaler use mean?

Poor control + increased risk for a severe attack.

Why are inhaled corticosteroids used?

↓ airway inflammation → ↓ future attacks.

Can LABA be used alone for asthma?

No—LABA must be combined with an inhaled corticosteroid.

Should controller medication stop when symptoms improve?

No—continue it to prevent inflammation and attacks.

Acute Asthma Attack

What findings show a severe asthma attack?

Cannot speak full sentences + accessory muscles + low SpO₂/peak flow + poor air movement.