🫁 New Lesson 14

Respiratory Disorders

Asthma, COPD, pneumonia, oxygen devices, respiratory failure, chest tubes, and ABG links.

Overview

Respiratory questions ask two things

Can the patient move air in and out? And can the patient get oxygen into the blood? Ventilation is about CO2. Oxygenation is about O2. A patient can have trouble with one or both.

Concept	What It Means	NCLEX Clue
Ventilation	Moving CO2 out	High CO2, drowsy, headache, shallow breathing
Oxygenation	Getting O2 into blood	Low O2 sat, cyanosis, restlessness, dyspnea
Work of Breathing	How hard the patient is trying	Tripod position, accessory muscles, nasal flaring
Airway	Whether air can pass	Stridor, inability to talk, drooling = emergency

Device	Typical Use	Why It Matters
Nasal Cannula	Mild oxygen support	Easy, low-flow, common for COPD or stable hypoxia
Simple Mask	Moderate oxygen need	More support than cannula
Nonrebreather	Severe hypoxia	Used when the patient needs high oxygen quickly
Venturi Mask	Precise FiO2	Helpful when controlled oxygen is important

✅

Early hypoxia sign: restlessness and anxiety often happen before cyanosis.

⚠️

ABG link: low ventilation pushes CO2 up and causes respiratory acidosis. Fast breathing can blow CO2 off and cause respiratory alkalosis.

🚨

Airway beats everything: if the patient cannot speak, is stridorous, or is tiring out, get help fast and stay at the bedside.

Common Disorders

Disorder	Classic Findings	Priority Focus
Asthma	Wheezing, chest tightness, prolonged expiration	Open airway fast, rescue bronchodilator first, monitor for silent chest
COPD	Barrel chest, chronic cough, diminished breath sounds	Controlled oxygen, pursed-lip breathing, energy conservation
Pneumonia	Fever, crackles, cough, pleuritic pain	Airway clearance, antibiotics, fluids if appropriate, turn/cough/deep breathe
Pulmonary Embolism	Sudden dyspnea, pleuritic chest pain, tachycardia	Treat as emergency, oxygen, rapid provider response
Pulmonary Edema	Crackles, pink frothy sputum, severe dyspnea	High Fowler, oxygen, fluid-offloading meds per orders
Tuberculosis	Weight loss, night sweats, cough	Airborne precautions, negative airflow, medication adherence

🫁 Asthma vs COPD

Asthma = airway SPASM and inflammation. COPD = chronic airflow limitation and trapped air.

Asthma can become suddenly severe. COPD patients may live near baseline distress for a long time, so focus on changes from baseline.

Chest tube red flags

Sudden respiratory distress, accidental disconnection, massive drainage changes, or no expected fluctuation when it should be present all deserve immediate attention.

Pneumonia teaching

Use coughing, deep breathing, incentive spirometry, mobility, and hydration support when appropriate. These are not “extra” interventions — they are the core work.

Exam shortcut: a sudden change from the patient’s respiratory baseline matters more than chronic symptoms the patient has had for months.

Meds & Oxygen Links

Respiratory meds usually fit predictable patterns

Learn which medication opens the airway fast, which one reduces inflammation slowly, and which ones require careful oxygen or infection teaching.

⚡ Rescue

Short-Acting Bronchodilators

Examples include albuterol-type rescue inhalers.

Use for acute bronchospasm
Can cause tremor and tachycardia
If multiple inhalers are ordered, rescue bronchodilator is usually used first

ABG connectionClass notes

🧯 Inflammation Control

Corticosteroids

Reduce airway inflammation, but they are not instant rescue medications.

Monitor glucose and infection risk
Rinse mouth after inhaled steroids
Teach not to stop long-term systemic steroids abruptly

Glucose crossoverLinked notes

🫧 Airway Maintenance

Long-Acting Bronchodilators

Maintenance therapy, not first-line emergency rescue.

Teach scheduled use
Still monitor HR and tremor with some agents
Patients still need rescue medication for sudden attacks

Compare classesEmergency clues

🦠 Infection Treatment

Antibiotics & TB Meds

Used when infection is driving the respiratory problem.

Get cultures if ordered before first dose
Watch response trends: fever, sputum, oxygenation
TB medications require long adherence teaching

Precautions linkMedication-class notes

💧 Fluid Relief

Diuretics in Pulmonary Edema

These are cardiovascular meds that often show up in respiratory crises.

Better breathing should happen as fluid clears
Watch potassium and blood pressure
Daily weights and lung sounds are key response markers

Cardio crossoverElectrolyte link

🎯 Oxygen Safety

Controlled Oxygen for COPD

Do not fear oxygen, but give it thoughtfully and monitor response.

Low-flow oxygen is common for stable COPD flare patterns
Watch mental status, O2 sat, and work of breathing
The goal is safer oxygenation, not under-treating hypoxia

CO2 connectionLinked note hub

📖 Notes for Dummies

🧠 Think of lungs like balloons and straws

The lungs are balloons. The airways are straws. If the straw tightens, air cannot move well. If the balloon fills with fluid or infection, oxygen cannot cross well. That is why respiratory questions are either about moving air, getting oxygen in, or both.

🥤

Asthma: the straw suddenly squeezes. That is why the patient wheezes and needs a bronchodilator fast.

🎈

COPD: the balloon gets stretched out and air gets trapped. The patient can still look “normal for them,” so pay attention to new changes.

🫧

Pneumonia or edema: the balloon is filling with junk or fluid, so oxygen has a harder time crossing into the blood.

📝 Simple memory picture:
Can’t move air? Think airway/ventilation.
Can’t get oxygen into blood? Think oxygenation/fluid/infection.
Can’t do either? That patient can crash fast.