Respiratory Nursing Care – Vocabulary Review

Airway Suctioning

• Timing & Rationale
  • Perform after chest physiotherapy (CPT) and bronchodilator so secretions are already mobilised.
• Preparation
  • Pre-oxygenate until SpO_2 \ge 98\% (pulse oximeter).
  • Don clean gloves; lubricate catheter.
• Insertion
  • Introduce catheter through nares, following nasal floor.
  • Do NOT occlude suction port while advancing (prevents mucosal injury & hypoxia).
• Suction/Withdrawal
  • Once in trachea, intermittently occlude port while withdrawing with gentle circular motion.
  • Duration: 5\text{–}10\,\text{s} (textbooks: up to 15\,\text{s}; never >18\,\text{s}).
  • Repeat 2–3 passes per nostril/mouth if needed.
• Post-procedure
  • Flush catheter with sterile NSS.
  • Provide oral & nasal hygiene; auscultate for clearance.
  • Ideal practice: single use; reality (resource-poor): sleeves saved & catheter washed—never store with secretions (infection risk).

Incentive Spirometry

• Indications: post-infection, thoracic injury, post-anaesthesia—to strengthen respiratory muscles & promote deep inspiration.
• Procedure
  • Verify order, upright position, explain.
  • Exhale normally → seal lips on mouthpiece → inhale slowly (sucking) raising balls/diaphragm.
  • Hold target level for a few seconds; repeat per order.
  • Clean mouthpiece; allow rest (exercise is tiring).

Peak Flow Meter (PFM)

• Purpose: Measure expiratory flow → monitor air-trapping in asthma/COPD ; estimates residual volume trends.
• Zones (set personal best = 100 %)
  • Green =80\text{–}100\%
  • Yellow =50\text{–}79\%
  • Red <49\%
• Steps
  1. Zero the pointer; upright posture.
  2. Deep nasal breath → seal lips → blow hard & fast.
  3. Repeat ×3; average = personal best.
  4. Compute %: \bigl(\frac{\text{today\'s value}}{\text{personal best}}\bigr)\times100.
• Actions
  • Green: rest & re-check later.
  • Yellow: review Rx; often increase bronchodilator puffs per MD order.
  • Red: emergency care/ER.

Oxygen Therapy in Chronic Lung Disease

• Use low-flow devices (e.g.
  nasal cannula 1–2 L min^{-1}) to avoid abolishing hypoxic drive.
• Humidification: ensure water chamber in wall/tank setup is filled.
• Provide regular nasal/oral care; observe fire safety.

Chest Tubes & Closed Drainage

• Systems
  • 1-bottle: gravity only.
  • 2-bottle: large fluid volumes or suction.
  • 3-bottle: fluid + air + suction.
• Bedside Must-haves
  • Clamp.
  • Sterile water glass (for emergency water-seal if tubing disconnects).
• Nursing Care
  • If tubing obstructed by thick secretions:
  • Encourage cough & deep breathing; never milk tubing (pressure damage).
  • Encourage position changes & ambulation (bottles below chest on wheelchair/cart).
  • Accidental pull-out: cover stoma with petroleum-gauze, tape 3 sides (one side acts as valve).
  • Removal: patient performs Valsalva manoeuvre while physician withdraws tube; apply occlusive dressing.
• Effectiveness confirmed via chest X-ray (or ultrasound for effusion).

Thoracentesis

• Needle decompression/aspiration of pleural space.
• Prevent iatrogenic pneumothorax: give antitussive 1 h pre-procedure.
• Optimal position: upright/tripod, arms on over-bed table (or reversed chair).
• Client feels pressure despite local anaesthetic.

Asthma Essentials

• Chronic airway disorder (intrinsic & extrinsic triggers) → bronchospasm, mucosal oedema, mucus.
• Clinical Features
  • Wheezes > crackles; prolonged expiration; hyper-resonance; accessory-muscle use.
• Acute Care Sequence (ER)
  1. Ascertain diagnosis & bronchodilator use.
  2. If no recent puff → administer bronchodilator before high-flow O 2 .
• Efficacy Markers
  • Expiration (\approx 2\times) inspiration.
  • ↓ Wheezes & SOB; ↑ SpO_2.
• Medication Administration
  • Metered-Dose Inhaler (MDI)
  • Test canister in water: sinks = full; 45° = half; floats = empty.
  • Exhale → mouthpiece seal → press & inhale → hold 10\,\text{s}; usually 2 puffs (upper + lower airways).
  • Turbo– & Discus inhalers: twist/trigger to load dose, same breathing steps.
  • Rinse mouth after steroid use (prevents oral thrush).
• Drug Classes: β-agonists, anticholinergics, mast-cell stabilisers, corticosteroids.
  • Check pulse; tachycardia can contraindicate next dose.

COPD (Chronic Bronchitis vs Emphysema)

• Hallmarks
  • Chronic Bronchitis: productive cough \ge 3\,\text{mo} per year; cor pulmonale → peripheral oedema.
  • Emphysema: alveolar wall destruction → air-trapping, barrel chest, weight loss.
• Nursing Care
  • Tripod posture; pursed-lip breathing.
  • O 2 1–2 L min^{-1} only.
  • ABG pattern: initial respiratory alkalosis (tachypnoea) → later acidosis (CO 2 retention).
  • Nutrition: Low-carb, high-calorie, high-protein (carbs ↑ CO 2 production).

Thoracic Trauma & Pneumothorax

• Flail chest = ≥2 adjacent ribs broken → paradoxical movement; may need mechanical ventilation.
• Tension pneumothorax: air enters pleura, cannot exit → mediastinal shift, absent sounds, tracheal deviation.
  • Percussion: early hyper-resonant → later tympanic.
  • Emergency needle decompression or chest tube.

Pulmonary Tuberculosis (TB)

• Screening: Mantoux/PPD \ge10\,\text{mm} induration @ 48\text{–}72\,\text{h}.
• Confirmation: Sputum culture (GeneXpert/gold test if available).
• Infectivity: until 3 consecutive negative smears.
• First-line Regimen ("RESPI")
  • R – Rifampicin: orange/red tears, urine.
  • E – Ethambutol: optic neuritis.
  • S – Streptomycin: ototoxicity.
  • P – Pyrazinamide: hepatotoxic, gout.
  • I – Isoniazid: neuropathy; interferes with B_6 → supplement pyridoxine.
• Teaching
  • Take meds before breakfast.
  • Side-effects → report, do not stop unless instructed.
  • Isolation in negative-pressure room; explain as protection of others (therapeutic communication).

Cystic Fibrosis (CF)

• Autosomal recessive CFTR defect → dehydrated, thick secretions in lungs, GI, reproductive tracts.
• Diagnostics: Sweat chloride test (> normal Na/Cl).
• Manifestations: productive cough, crackles, steatorrhoea, possible barrel chest.
• Management
  • CPT + postural drainage = cornerstone; effectiveness ⇒ ↓ crackles.
  • Bronchodilators; ↑ oral fluids; nebulised Dornase-α to thin mucus.

Pulmonary Embolism (PE)

• Risk Factors: immobility, obesity, trauma, ortho surgery, DVT, hypercoagulability, air/fat emboli.
• S/S: sudden dyspnoea, pleuritic pain, hypoxia, sense of impending doom.
• Priority Dx: Ineffective tissue perfusion (pulmonary).
• Immediate Care
  • High-flow O 2 .
  • IV morphine (pain & anxiety).
  • Prepare for anticoag/thrombolysis or embolectomy.
• Prevention: early ambulation, leg exercises, no crossed legs, anti-embolism stockings, prophylactic anticoagulants.

Acute Respiratory Distress Syndrome (ARDS)

• Secondary to infection, trauma, COVID, etc.
• Key Signs: retractions, central cyanosis, fine crackles, refractory hypoxia, respiratory acidosis, evolving pulmonary fibrosis.
• Management: mechanical ventilation with PEEP (Positive End-Expiratory Pressure).
  • Provide eye care (high FiO 2 dryness).
  • Suction ETT using same pre-oxygenate/intermittent technique as standard suctioning.

Pneumonia

• Typical Findings: fever, productive cough, crackles, dull percussion, asymmetric expansion, positive transmitted voice sounds.
• Care
  • Appropriate antimicrobial (bacterial/viral/fungal).
  • CPT & bronchodilators if obstructed.
  • ↑ Fluids (liquefy mucus); encourage ambulation if tolerated.

Upper Airway Disorders

Sinusitis

• Home care: saline irrigation/neti pot.
• Surgical options
  • Caldwell-Luc (via gingiva).
  • FESS (endoscopic via nasal route).

Tonsillitis / Adenoiditis

• Usually Strep; severe = "quinsy" (kissing tonsils) → airway risk.
• Tonsillectomy
  • Pre-op: check PT/PTT/platelets.
  • Post-op
  • Ice collar; cold non-citrus, non-dairy fluids, popsicles; blended diet.
  • Watch for frequent swallowing or bloody stools/vomit → bleeding.

Epiglottitis

• Rapid airway obstruction risk.
• Keep tracheostomy set & ICU monitoring available.

Laryngeal Cancer & Laryngectomy

• Risks: voice abuse (singers/teachers), smoking, asbestos.
• Treatment
  • Voice rest (no whispering—still irritates cords).
  • Surgery ± chemo/radiation.
  • Radical vs Total laryngectomy (loss of voice, smell, cough, Valsalva).
  • Rehab: artificial larynx, esophageal speech.
• Tracheostomy Care
  • Cover stoma with porous dressing (keeps insects/particulates out).
  • No swimming/tub baths; avoid aerosols & powders.

Oxygen Delivery & Safety Review

• Low O 2 for chronic retainers; humidify all flow >4 L min^{-1}.
• Keep away from flames, oils; post "No Smoking" signs.

Key Formulae & Values

• Peak-flow percentage \Bigl(\frac{\text{Current}}{\text{Personal Best}}\Bigr)\times100
• Suction duration: 5\text{–}10\,\text{s} (max 15\,\text{s}).
• Mantoux positive: \ge10\,\text{mm} induration @ 48\text{–}72\,\text{h}.
• PFM Zones: Green 80\text{–}100\%; Yellow 50\text{–}79\%; Red <49\%.

Ethical & Practical Notes

• Resource limitations may force reuse of "single-use" items (e.g.
  suction catheters). Nurses must still minimise infection risk.
• Isolation for TB is framed as protecting others, supporting patient dignity.
• Total laryngectomy patients require extensive psychosocial support due to permanent functional losses.