Respiratory Nursing Review Notes

Normal Physiologic Ranges

  • Oxygen saturation (SpO₂)

    • Normal: ≥95%\ge 95\%
    • Concerning: < 95\%
    • Markedly dangerous/"not good": < 90\% (instructor also used 65%65\% as an extreme red flag in conversation)

  • Arterial-blood-gas (ABG) cheat-sheet (memorise; paper will NOT be provided in exam)

    • pH: 7.35–7.457.35\text{–}7.45
    • PaCO₂: 35–45  mmHg35\text{–}45\;\text{mmHg}
    • HCO₃⁻: 22–26  mEq L−122\text{–}26\;\text{mEq\,L}^{-1}
    • Interpretation steps ("ROME" still applies)
    1. Look at pH (acid / base?)
    2. Match PaCO₂ or HCO₃⁻ to pH (respiratory vs metabolic)
    3. Determine compensation if asked (this exam reportedly focuses on simple identification, not compensation)

Pneumothorax (Closed, Open & Tension)

  • Definition: air in the pleural space, not "air in the lungs" per se → lung collapse.
  • Key signs
    • Dyspnoea & shallow breathing
    • ↓ SpO₂ (may hover ~93%93\% or lower)
    • Chest pain, unequal chest expansion, possible tracheal deviation (with tension type)
  • Open pneumothorax (“sucking chest wound”)
    • Results from open chest wall injury; air moves freely in/out with respiration.
    • Nursing priorities: apply occlusive dressing taped on three sides, prepare for chest tube.
  • Tension pneumothorax
    • Air enters pleural space and cannot escape ➔ ↑ intrathoracic pressure ➔ mediastinal shift ➔ life-threatening.
    • Expect distended neck veins, hypotension, severe dyspnoea, tracheal deviation to opposite side.

Chest Tubes & Drainage System

  • Three chambers
    1. Collection – receives fluid/blood; mark level & colour.
    2. Water seal – one-way valve; tidalling (rise/fall with breathing) is NORMAL; continuous bubbling → air leak.
    3. Suction control – gentle bubbling if wet suction; dry systems use regulator dial.
  • Nursing checks
    • Ensure tubing is not kinked, clamped or disconnected.
    • Keep system below chest, water seal intact, monitor bubbling pattern.
    • Document output, fluctuations, patient respiratory status.

Asthma

  • Classic triad: wheezing, dyspnoea, cough with mucus production.
  • Patho: airway hyper-responsiveness → bronchoconstriction + inflammation + mucus.
  • Nursing/management themes likely tested
    • Use of bronchodilators (short-acting β₂-agonists first), corticosteroids, peak-flow monitoring.

COPD & Emphysema

  • Emphysema = destruction of alveolar walls ➔ ↓ surface area for gas exchange.
  • Primary risk factor: smoking (other: occupational exposures, air pollution).
  • Characteristic manifestations: barrel chest, pursed-lip breathing, dyspnoea on exertion.

Obstructive Sleep Apnoea (OSA)

  • Repeated upper-airway collapse during sleep.
  • Manifestations to memorise
    • Loud snoring, witnessed apnoeic episodes, daytime sleepiness, morning headache, irritability.
  • Complications: hypertension, arrhythmias, ↑ MVC risk.

Thoracentesis

  • Bedside invasive removal of pleural fluid/air.
  • Position: patient sits on edge of bed, leans forward over bedside table, arms supported, feet on stool.
  • Monitor post-procedure for pneumothorax, bleeding.

Pneumonia & Pleurisy

  • Pneumonia focused data collection
    • Fever, productive cough, pleuritic chest pain, crackles, ↑ WBC, CXR infiltrates.
  • Pleurisy = inflammation of pleura causing sharp, stabbing pain with inspiration.
    • Teaching: splint chest with pillow, deep-breathing exercises, pain control, report ↑ SOB.

Chest Trauma – Flail Chest

  • ≥2 fractures in ≥3 adjacent ribs ➔ free-floating segment.
  • Expectations
    • Paradoxical chest movement (flail segment in during inspiration, out during expiration)
    • Severe pain, impaired ventilation, possible underlying contusion.
  • Priorities: oxygen, pain control, possible intubation, stabilise segment.

Pulmonary Embolism (PE)

  • Priority nursing interventions
    • Rapid assessment, oxygen administration.
    • Prepare/administer anticoagulants (e.g., heparin) and/or thrombolytics per orders.
    • Positioning: high-Fowler’s to facilitate ventilation.

Bronchoscopy

  • Endoscopic exam of bronchi; may be diagnostic or therapeutic.
  • Pre-procedure: NPO, consent, remove dentures.
  • Post-procedure:
    • Keep NPO until gag reflex returns.
    • Monitor for laryngeal oedema, bleeding, pneumothorax.

Airway Clearance & Postural Drainage

  • For respiratory infection with excess secretions → utilise postural drainage aided by gravity.
    • Various positions (head-down, side-lying, prone) held 3–15 min each.
    • Combine with percussion/vibration and coughing.

Tuberculosis Screening & Medications

  • Tuberculin Skin Test (TST / PPD) – screens for TB exposure; read induration at 48–72 h.
  • Rifampin patient teaching
    • Turns urine, tears, saliva orange-red; harmless but can stain contact lenses.
    • Advise: use glasses instead of contacts, maintain good hydration, expect colour change.

Common Lifestyle Risk Factors (Respiratory Focus)

  • Smoking – primary for COPD, emphysema, lung cancer.
  • Alcohol & poor hygiene – may predispose to aspiration pneumonia.

Quick Reference Values & Red Flags

  • SpO₂ normal ≥95%\ge 95\% ; immediate concern < 90\% ; critical < 85\%.
  • Continuous bubbling in water-seal chamber = air leak → locate source.
  • Expected fluctuation/tidalling with inspiration/expiration in water seal = normal.
  • ABG mnemonics: "ROME" (Respiratory Opposite, Metabolic Equal).

Examination Tips from Instructor

  • Expect
    • “Select-all-that-apply” items on chest tubes, asthma, sleep apnoea.
    • Basic ABG category questions (no complex compensation scenarios).
    • Scenario recognition (e.g., open pneumothorax vs tension).
  • Paper ABG grids will not be provided – memorise normal values or draw from memory.
  • Prioritise safety checks (tubing, dressing integrity, patient positioning).
  • Use understanding of what is normal vs abnormal in oxygenation & drainage systems to choose correct answers.