N1060 Exam 4

Pneumonia

Caused by bacteria, viruses, or fungi infecting the lungs, leading to inflammation and fluid buildup in the alveoli.

Fowler's Position for Dyspnea

45-90 degrees; to maximize lung expansion, reduce pressure on the diaphragm, and ease breathing.

Retractions

Sign of respiratory distress; the patient is using extra muscles to breathe; chest muscles pull in between the ribs or around the neck.

Crackles (Rales)

Popping sounds; caused by fluid in alveoli (pneumonia, heart failure).

Wheezes

High-pitched, musical sounds; caused by narrowed airways (asthma, COPD).

Rhonchi

Low-pitched, snoring sounds; caused by mucus in larger airways (bronchitis).

Stridor

Harsh, high-pitched sound on inspiration; caused by upper airway obstruction (croup, foreign body).

Pleural Friction Rub

Grating or squeaking sound; caused by inflamed pleural layers rubbing together (pleuritis, pneumonia).

Diminished or Absent Breath Sounds

Poor air movement (pneumothorax, pleural effusion).

Tachypnea

Rapid, shallow breathing; associated with fever, anxiety, pneumonia, pulmonary embolism.

Bradypnea

Abnormally slow breathing; associated with drug overdose, brain injury, increased intracranial pressure.

Cheyne-Stokes Respiration

Cycles of deep breathing followed by periods of apnea; associated with heart failure, stroke, end of life breathing.

Kussmaul Respirations

Deep, labored breathing; associated with diabetic ketoacidosis (DKA), metabolic acidosis.

Vesicular Breath Sounds

Soft, low-pitched; heard over most of the lungs; normal airflow in smaller airways and alveoli; inspiration is longer than expiration.

Bronchial Breath Sounds

Loud, high-pitched; heard over the trachea; normal over the upper airway, not the lungs; expiration is longer and louder.

Bronchovesicular Breath Sounds

Medium-pitched; heard over the main bronchi; normal airflow in larger airways; equal inspiration and expiration.

High Fowler’s Position

Sitting upright at 90 degrees; maximizes lung expansion and reduces pressure on the diaphragm.

Tripod Position

Sitting and leaning forward with arms resting on a table or knees; uses accessory muscles to improve airflow and reduce work of breathing.

Forward-Leaning with Pillow Support

Sitting while leaning over a pillow on a table; opens the chest and helps exhale trapped air more easily.

Signs and Symptoms of Atelectasis

Diminished breath sounds, low oxygen levels, shortness of breath, increased respiratory rate; most common after surgery, prolonged bed rest, or shallow breathing.

Priority Goal for Nurses Caring for Patients with Pneumonia

Maintain adequate oxygenation (SpO2 > 90%) and clear airways.

Signs and Symptoms of Chronic Obstructive Pulmonary Disease (COPD)

Chronic cough, excess mucus, shortness of breath, wheezing, fatigue, barrel chest in advanced stages.

Common Signs and Symptoms of Emphysema

Shortness of breath, barrel chest, pursed-lip breathing, minimal cough, little sputum, use of accessory muscles.

Signs and Symptoms of Cor Pulmonale

Peripheral edema, jugular vein distention (JVD), fatigue, enlarged liver (hepatomegaly), cyanosis.

Pulmonary Rehabilitation

A program of exercise, education, and support for patients with chronic lung disease; prescribed for moderate to severe COPD or after frequent exacerbations.

Diaphragmatic Breathing

Uses diaphragm to improve lung expansion.

Pursed-Lip Breathing

Slows exhalation to prevent air trapping.

Optimal Pulse-Ox Range for a Patient with COPD

88%-92% (to avoid suppressing respiratory drive).

Postural Drainage Position

Uses gravity to drain secretions from specific lung segments; patient is placed with the targeted lung segment higher than the airway; used for excess mucus, pneumonia, or chronic lung disease.

Controlled Coughing

Sit upright, inhale deeply, hold breath 2-3 seconds, cough twice sharply; purpose is to clear secretions and improve airway clearance.

Signs and Symptoms of Pulmonary Embolism

Sudden chest pain, shortness of breath, rapid heart rate, low O2 saturation, anxiety or restlessness.

How Cor Pulmonale Begins as a Respiratory Disease and Ends Up Being a Cardiovascular Problem

Starts with chronic lung disease (like COPD) causing low oxygen, leads to pulmonary hypertension, strains the right side of the heart, eventually causing right-sided heart failure.

Primary Nursing Goal for a Patient with COPD

Promote effective gas exchange and prevent complications.

Kussmaul Breathing

Deep, rapid breathing (seen in diabetic ketoacidosis).

Cheyne-Stokes Breathing

Cycles of deep breathing followed by apnea (seen in heart failure, near death).

Biot’s Breathing

Irregular breathing with periods of apnea (seen with brain injury).

Tonsillitis Clinical Manifestations

Sore throat, red swollen tonsils, difficulty swallowing, fever, swollen lymph nodes

Tonsillitis Therapeutic Interventions

Rest, fluids, analgesics, antibiotics, tonsillectomy

Pre-op cares for tonsillectomy

NPO before surgery, explain procedure, review pain management and bleeding signs

Post-op cares for tonsillectomy

Monitor for bleeding, soft cool foods, avoid straws, keep hydrated, administer pain meds

Hemorrhage sign after tonsillectomy

Frequent swallowing, vomiting blood, bright red bleeding from mouth

Croup Clinical Manifestations

Barky cough, inspiratory stridor, hoarseness, low-grade fever, respiratory distress

Croup Therapeutic Interventions

Cool mist, keep child calm, corticosteroids, nebulized epinephrine

Key Symptom of Epiglottitis (in addition to croup symptoms)

Drooling due to difficulty swallowing

Epiglottitis Therapeutic Interventions

Emergency airway management, Do NOT examine throat, IV antibiotics and corticosteroids, keep the child calm

Bronchiolitis (RSV) Clinical Manifestations

Wheezing, cough, nasal congestion, retractions, tachypnea, poor feeding, apnea in infants

Bronchiolitis (RSV) Therapeutic Interventions

Hydration, nasal suctioning, antipyretics, maintain airway and oxygenation, monitor for worsening distress

Prioritized Intervention for Bronchiolitis (RSV)

Maintain airway and oxygenation

Preventing Spread of Respiratory Viruses

Frequent handwashing, avoid sick contacts, clean toys, keep infants away from crowded places, avoid smoke

Cystic Fibrosis Clinical Manifestations

Persistent cough with thick mucus, recurrent lung infections, poor weight gain, greasy stools, salty skin, clubbing

Earliest Sign of Cystic Fibrosis in Newborns

Meconium ileus

Cystic Fibrosis Respiratory Therapeutic Interventions

Chest physiotherapy, bronchodilators, mucolytics, inhaled antibiotics, oxygen therapy

Cystic Fibrosis Nutritional Therapeutic Interventions

High-calorie, high-protein diet, pancreatic enzymes, fat-soluble vitamin supplements

Cystic Fibrosis Infection Prevention Therapeutic Interventions

Regular handwashing, routine immunizations, avoid sick people, prophylactic antibiotics

Cystic Fibrosis Psychological Therapeutic Interventions

Support groups, counseling, school accommodations

Cystic Fibrosis Other Therapeutic Interventions

Monitor for complications, lung transplant evaluation

Asthma Clinical Manifestations

Wheezing, coughing, shortness of breath, chest tightness

Asthma Exacerbation Triggers

Allergens, cold air, smoke, exercise, respiratory infections, strong odors, stress

Peak Flow Meter

Measures how well air moves out of the lungs. Used to monitor asthma control and detect early signs of exacerbation

Asthma Rescue Medications

Short-acting bronchodilators (albuterol)

Asthma Controller Medications

Inhaled corticosteroids, long-acting bronchodilators

Asthma Patient and Family Education

Recognize early signs, use meds properly, have an asthma action plan, use peak flow meter at home, avoid triggers