Respiratory Disorders (BAD)

What are the signs of respiratory distress?

Tachypnea, dyspnea, accessory muscle use, nasal flaring, retractions, cyanosis, decreased SpO2, altered mental status/restlessness (kids may sit in tripod position).

What respiratory rate is tachypnea in an adult?

Greater than 24 breaths per minute.

What SpO2 on room air should make the nurse think about calling the provider and getting supplemental oxygen?

88% or lower.

Who shows cyanosis faster: children or adults?

Children. They can deteriorate into respiratory failure very quickly.

What are the priority nursing actions (ABCs) for any respiratory illness?

Assess airway patency; monitor RR, effort, and SpO2; position High Fowler’s; give oxygen as prescribed; encourage cough & deep breathing when appropriate; monitor lung sounds; promote hydration if not contraindicated.

Is supplemental oxygen a drug?

Yes. Oxygen is a medical treatment that requires a provider’s order. On test questions, choose ‘apply PRESCRIBED oxygen.’

What percentage of oxygen is in room air?

About 21%.

Name the 6 warning signs of significant respiratory problems from the oxygen video.

Nasal flaring, tachypnea (>24/min), noisy breathing (wheezing, stridor, moaning), accessory muscle use, pursed-lip breathing, and Cheyne-Stokes breathing.

What is Cheyne-Stokes breathing?

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

What is pursed-lip breathing and who uses it?

Exhaling through pursed lips so exhale is about twice as long as inhale; helps empty trapped air (often COPD patients).

NCLEX priority: four clients: bronchitis wanting cough medicine, flu with body aches, pneumonia with SpO2 88%, RSV wanting water. Who first?

The pneumonia client with SpO2 of 88%. Oxygenation problems take priority (ABCs).

NCLEX priority: four clients: flu headache 5/10, pneumonia temp 100→101°F, bronchitis needing restroom help, epiglottitis with new inspiratory stridor. Who first?

The epiglottitis client with inspiratory stridor: an airway emergency.

What respiratory finding means ‘airway and oxygenation before everything else’?

Stridor, falling SpO2, altered mental status, or severe work of breathing in any respiratory patient.

What happens to gas exchange when alveoli are collapsed or filled with fluid/mucus?

O2 and CO2 can’t be exchanged; CO2 can’t be blown off, leading to respiratory acidosis, and the body isn’t oxygenated.

What is atelectasis?

Collapsed, airless alveoli (not necessarily the whole lung).

What causes atelectasis?

Airway obstruction from retained exudates and secretions.

What are the signs of atelectasis?

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

How is atelectasis prevented/managed?

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

Why are deep breathing, coughing, and the incentive spirometer so important after surgery?

Patients were breathed for in the OR; these pop the alveoli back open so gas exchange can occur.

Why does fluid in the alveoli show up white on chest x-ray?

Air lets the x-ray pass through (dark); fluid/congestion reflects the beam, showing patchy white areas.

What does the epiglottis do?

A flap that closes over the trachea when we swallow so food and fluid go to the GI tract, not the lungs.

Why are patients with dementia or neuro deficits at risk for aspiration pneumonia?

The epiglottis may not close completely, so normal oral flora can be aspirated into the lungs.

What is bronchiolitis, and what is its most common cause?

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’s the key prevention?

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

How do young children usually catch RSV?

From an older person/adult who has a mild case.

What are the manifestations of bronchiolitis/RSV?

Clear runny nose, pharyngitis, low-grade fever, cough 1–3 days in followed by wheeze, poor feeding; then respiratory distress (wheezing, crackles, rhonchi).

How is RSV identified?

Cultures of nasal secretions (also PCR/viral antigen testing).

What is the supportive treatment for bronchiolitis/RSV?

Supplemental O2 (as ordered), nasal/nasopharyngeal suctioning, hydration (oral or IV), inhaled bronchodilators, antipyretics; hospitalization for 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 dehydration.

Which RSV finding requires IMMEDIATE intervention: runny nose, mild fatigue, SpO2 86%, or temp 100.4°F?

SpO2 of 86%: significant hypoxemia.

What precautions are used for RSV?

Contact and droplet precautions, hand hygiene, cleaning frequently touched surfaces.

What is pneumonia?

Infection of the lung tissue (including the alveoli) causing inflammation and fluid accumulation in the alveoli.

How is pneumonia acquired (routes)?

Inhalation, aspiration, and hematogenous (bloodstream) spread.

What can cause pneumonia?

Bacteria (most common: Streptococcus pneumoniae), viruses, fungi (e.g., spores from dirt), mycobacterium, parasites, chemicals.

What is community-acquired pneumonia (CAP)?

Onset in the community or more than 14 days after a hospital stay.

What is hospital-acquired (nosocomial) pneumonia?

Pneumonia with onset 48+ hours after hospital admission.

What counts as health-care associated pneumonia?

Long-term care resident; IV therapy, chemo, or wound care in the past 30 days; or attending a dialysis unit.

What is ventilator-associated pneumonia (VAP)?

A type of hospital-acquired pneumonia occurring >48 hours after endotracheal intubation. Air enters without normal filtering, so meticulous care and hand hygiene are needed.

What are predisposing factors for pneumonia?

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

How does fever usually differ between bacterial and viral pneumonia?

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

What are the classic cues of pneumonia?

Cough, fever, chills, dyspnea, tachypnea/orthopnea, pleuritic chest pain, discolored sputum, adventitious breath sounds (crackles), fatigue.

What is the most characteristic assessment finding of pneumonia?

Crackles and a productive cough.

What is often the first sign of pneumonia in an older adult?

Confusion (from hypoxia). Older/debilitated patients may not show classic symptoms and may even be hypothermic instead of febrile.

What breath sounds might you hear over a lung area full of fluid in pneumonia?

Absent breath sounds, so listen to all lung fields front and back.

What are the features of streptococcal (pneumococcal) pneumonia?

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

What is relative bradycardia (pulse-temperature deficit) in viral pneumonia?

The pulse is slower than expected for the given temperature.

What diagnostic studies are done for pneumonia?

History (smoking, etc.), sputum culture, bronchoscopy, chest x-ray, labs (WBC, blood cultures, CBC, ABGs), pulse oximetry.

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

Sputum culture: obtain it BEFORE starting antibiotics, to identify the organism and choose the right antibiotic.

Why shouldn’t antibiotics be given before a sputum culture?

The infection may be viral (no antibiotics needed), or a specific bacteria needs a specific antibiotic.

When might a bronchoscopy be used for pneumonia?

When the patient can’t produce sputum; the scope can obtain cultures.

What lab finding suggests bacterial pneumonia?

Elevated WBCs.

Pneumonia patient: SpO2 88% on room air. With ordered supplemental O2, what goal was mentioned?

Raise and maintain SpO2 around 93%.

What is the nursing management of pneumonia?

Identify at-risk patients, monitor respiratory status, ensure oxygenation, upright positioning, fluids/food, rest, meds (antibiotics, analgesics, antipyretics, antivirals), promote vaccination.

How should a pneumonia patient be positioned?

Upright: never flat; at least 30 degrees, preferably High Fowler’s.

Why is hydration important in pneumonia, and how much fluid?

Fluids thin/liquefy mucus so it can be cleared; encourage 2–3 L/day unless restricted. (Use caution with dementia patients due to aspiration risk.)

How often should incentive spirometry be used in pneumonia?

Every 1–2 hours while awake. It’s the best intervention to prevent atelectasis and improve lung expansion.

Should a pneumonia patient stay on bed rest?

No. Early ambulation is encouraged so secretions can drain; turn every 2 hours if in bed.

What signs of sepsis should be monitored in pneumonia?

Hypotension, confusion, tachycardia, fever.

What is the NCLEX priority concern in pneumonia?

Hypoxemia (impaired gas exchange).

What is the nursing care for a child with pneumonia?

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

Child with pneumonia and highly anxious parents: best nursing approach?

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

What device delivers aerosolized medicine for wheezing/asthma?

A nebulizer.

List complications of pneumonia.

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

What is empyema?

A collection of pus in a body cavity, especially the pleural cavity.

What is a pneumothorax?

Air in the pleural space causing the lung to collapse.

What vaccinations prevent pneumonia, and who should get the pneumococcal vaccine?

Flu and pneumonia vaccines. Pneumococcal vaccine (PCV13/PPSV23) is recommended for adults 65+, children <2 (PCV13), and people with certain conditions or who smoke.

Pneumonia discharge teaching: which statement shows understanding?

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

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

Apply prescribed oxygen.

What is acute bronchitis?

Inflammation of the bronchi causing increased mucus production.

What causes acute bronchitis?

Usually viral (rhinovirus, influenza); can be bacterial (Strep pneumoniae, H. influenzae); may be secondary to a URI or an acute exacerbation of chronic bronchitis (AECB).

What are the signs/symptoms of acute bronchitis?

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

Are antibiotics usually needed for acute bronchitis?

No. It’s usually viral and self-limiting (can persist for weeks). Antibiotics only for high-risk patients or confirmed bacterial infection.

What is the nursing management of acute bronchitis?

Rest, fluids, anti-inflammatory meds, cough suppressants (if it disrupts sleep), humidifier, bronchodilators; prevent pneumonia.

Which bronchitis teaching statement shows understanding?

‘Increasing fluids can help thin secretions.’ (Don’t restrict fluids or avoid coughing.)

How is chronic bronchitis defined?

A COPD subtype with a chronic productive cough for at least 3 months in 2 consecutive years.

What is the NCLEX priority in bronchitis?

Airway clearance: thick secretions need hydration and clearance measures.

What is pleurisy?

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

What causes pleurisy?

Pneumonia, tuberculosis, chest trauma, pulmonary infarctions, 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 medication (NSAIDs, since it’s inflammation), position on the AFFECTED side, deep breathing and cough, splint rib cage when coughing, ambulation.

Which side should a pleurisy patient lie on?

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

What is a pleural effusion?

A collection of fluid in the pleural space.

What are the signs of a pleural effusion?

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

How is a pleural effusion managed?

Find the underlying cause, prevent re-accumulation, relieve dyspnea/discomfort; thoracentesis to remove fluid (nurse prepares the patient).

What is the most common reason for seeking healthcare among respiratory problems?

Upper respiratory infections.

What is rhinitis?

Inflammation and irritation of the mucous membranes of the nose (allergic, acute viral, or non-allergic).

How many viruses cause acute viral rhinitis, and how is it spread?

Over 200 viruses; spread by airborne droplets (coughing, sneezing).

What are the cues of rhinitis?

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

What can rhinitis lead to?

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

What is the teaching about OTC decongestant nasal sprays (e.g., Afrin)?

Limit to 3 days; overuse causes rebound congestion.

What should be used instead of petroleum jelly for a sore nose in the hospital?

K-Y (water-soluble). NO petroleum products around oxygen.

How is allergic vs. viral rhinitis managed?

Allergic: reduce allergen exposure, allergy testing (now a blood test), immunotherapy. Viral: handwashing, self-limiting with rest and fluids.

What fraction of children with allergic rhinitis have asthma?

About 1/3.

Why might infants with rhinitis need suctioning?

They are nose breathers.

What is otitis media, and what increases its risk?

Infection/blockage of the middle ear (often bacterial). Risk: smoke exposure, pacifiers, bottle feeding (especially lying flat).

What are the signs and treatment of otitis media?

Pulling at ears, drainage, pain, irritability. Treated with antibiotics; tube placement surgery for recurrent cases.

Why do children get ear infections so easily?

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

Why does repeated otitis media matter?

Frequent ear infections can cause hearing loss, so prevention teaching for parents is important.

What were the deaths from the 1918 influenza pandemic?

675,000 Americans and an estimated 50 million worldwide.

What are the two main types of flu, and which is most common/virulent?

Group A and Group B. Type A is most common and virulent and can affect animals and humans; B affects only humans.