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NUR2571: Professional Nursing II / PN 2 Exam 2 Study Guide
Respiratory assessment
• Ventilation: movement of air in and out of the lungs
• Perfusion: oxygen carbon dioxide exchange in the alveolar capillaries
• Hyper carbic drive (normal): respiratory drive that depends on CO2 and associated
chemoreceptors
• Hypoxic drive: patients with chronic pulmonary diseases depend on O2 chemoreceptors
rather than CO2 receptors (CO2 receptors in the medulla become insensitive to high CO2
levels).
• Early Signs of respiratory distress: Changes in mental status (confusion), changes in vital
signs (increased bp & hr), Headache.
• Late signs of respiratory distress: Arrhythmias, bradycardia, hypotension, cyanosis,
coma.
Oxygen Therapy
• Nasal Cannulas: 1-6 L
• Simple face mask: 5-8 L
• Partial rebreather: 6-11 L
• Trach collar:
Obstruction during sleep
• Sleep apnea. – Obstruction in the nasopharynx or tongue. Central is the failure of the
brain to trigger respiration muscles. Mixed is combo.
• Assess for: Narrowed oropharynx, enlarged tonsils/uvula, prominent tongue, nasal
obstruction. s/s: loud snoring, snorting, periods of apnea lasting 10-60 seconds. Patient’s
may have frequent headaches, drowsiness, memory problems, personality changes,
fatigue.
*Weight loss (if contributing factor) and surgery for anatomical correction
Asthma
• Chronic inflammatory disorder characterized by episodes of airway inflammation
• Triggers: Allergenic, pharm, environment, air pollution, occupational, infectious,
exercise, other comorbidities (aging)
• Status asthmatics: a severe asthma attack that doesn’t respond to standard treatment,
it’s severe and can lead to death in minute. IV fluids, potent bronchodilators, steroids,
epi, O2 given. Prepare to intubate.
-Assessment: wheezing cough, dyspnea, chest tightness, distention of neck veins
As episode progresses and worsens, less ventilation occurs, lung sounds will diminish
and respiratory status will decline.
• Testing: PFT, measures how much you inhale and exhale and how quickly you can exhale
it. Measured at different times of the day and a greater than 20% difference from
morning to afternoon suggests asthma.
-CXR
-ABGs
• Meds: short acting (albuterol, levalbuterol) long acting (Salmeterol and Formoterol)
Chronic Obstructive Pulmonary Disease (COPD)
• s/s: barrel chest, dyspnea on exertion, cough, sputum.
• Treatment: Inhalers (bronchodilators), RT, O2- target sat 88-90%, pulse oximetry.
, 2
• COPD exacerbation: typically caused by infection or inhaled irritant, treated with
antibiotics (if infection), RT, IV steroids.
• Things to consider: administering meds that cause depression need careful assessment
or may be contraindicated depending on status of pt. Don’t give too much O2. Keep up
with ABGs. COPD pts should have annual influenza and pneumonia vaccine.
Influenza
• Highly contagious viral respiratory infection
• s/s: rapid onset of headache, muscle aches, fever, chills, fatigue, weakness, sore throat,
cough, watery nasal discharge. Flu b can also have nausea, vomiting, diarrhea.
• Treatment: Vaccine (won’t cure but can help prevent) droplet isolation
• Education: hand washing, avoid exposure to others, get annual vaccine.
Pneumonia
• Infection acute or chronic involving one or both lungs caused by virus, bacteria, fungi,
parasites, or chemical agents. (by aspirations or inhalation of foreign material)
• s/s: chest pain/ discomfort, tachypnea, hemoptysis (coughing up blood), sputum
production, crackles, fever, chills, cough.
• Immunocompromised are more susceptible.
• CAP: Community acquired, HAP: Hospital acquired after 48 hours of admission, 30 days
after discharge, VAP: ventilator acquired pneumonia.
• Young and elderly at risk
• Diagnostic tests: chest x-ray, CBC, BMP, glucose (can be high with infection because
infection feeds off glucose. The higher the harder to treat the infection), sputum culture
• Prevention is possible; teach to use incentive spirometer (always post-op) for less active
patients, hand washing and hygiene (VAP), prevention of aspiration (aspiration
precautions), pneumonia vaccine (over 65, chronic heart disease, or asthma), stop
smoking!!
• Treatment: O2 and antibiotics.
Tuberculosis
• Infection of the lungs caused by mycobacterium
• s/s: progressive fatigue, lethargy, nausea, anorexia, weight loss, low-grade fever, blood
tinged sputum, chest pain/tightness.
• Assess: history (foreign born? Recent travels? Cough?)
• Testing and diagnosis: PPD confirms latent infection 6-8 weeks after exposure. 5mm or
greater means active, latent, previous treatment, recent immunization.
CXR, CT, sputum culture, blood work.
• Treatment: Isoniazid, Rifampin, Ethambutol, Pyrazinamide.
Pulmonary Embolism
Collection of particulate matter that enters venous circulation and lodges in the pulmonary
vessels, blood clots most common.
• s/s: dyspnea, pleuritic chest pain, restlessness, cough, hemoptysis, feeling of impending
doom, tachycardia, tachypnea.
• Treatment: O2, high fowlers, cardiac monitoring, continuous pulse ox, anticoagulants
(Heparin, lovenox, Coumadin) IV heparin initially, then bridge to PO Coumadin.
NUR2571: Professional Nursing II / PN 2 Exam 2 Study Guide
Respiratory assessment
• Ventilation: movement of air in and out of the lungs
• Perfusion: oxygen carbon dioxide exchange in the alveolar capillaries
• Hyper carbic drive (normal): respiratory drive that depends on CO2 and associated
chemoreceptors
• Hypoxic drive: patients with chronic pulmonary diseases depend on O2 chemoreceptors
rather than CO2 receptors (CO2 receptors in the medulla become insensitive to high CO2
levels).
• Early Signs of respiratory distress: Changes in mental status (confusion), changes in vital
signs (increased bp & hr), Headache.
• Late signs of respiratory distress: Arrhythmias, bradycardia, hypotension, cyanosis,
coma.
Oxygen Therapy
• Nasal Cannulas: 1-6 L
• Simple face mask: 5-8 L
• Partial rebreather: 6-11 L
• Trach collar:
Obstruction during sleep
• Sleep apnea. – Obstruction in the nasopharynx or tongue. Central is the failure of the
brain to trigger respiration muscles. Mixed is combo.
• Assess for: Narrowed oropharynx, enlarged tonsils/uvula, prominent tongue, nasal
obstruction. s/s: loud snoring, snorting, periods of apnea lasting 10-60 seconds. Patient’s
may have frequent headaches, drowsiness, memory problems, personality changes,
fatigue.
*Weight loss (if contributing factor) and surgery for anatomical correction
Asthma
• Chronic inflammatory disorder characterized by episodes of airway inflammation
• Triggers: Allergenic, pharm, environment, air pollution, occupational, infectious,
exercise, other comorbidities (aging)
• Status asthmatics: a severe asthma attack that doesn’t respond to standard treatment,
it’s severe and can lead to death in minute. IV fluids, potent bronchodilators, steroids,
epi, O2 given. Prepare to intubate.
-Assessment: wheezing cough, dyspnea, chest tightness, distention of neck veins
As episode progresses and worsens, less ventilation occurs, lung sounds will diminish
and respiratory status will decline.
• Testing: PFT, measures how much you inhale and exhale and how quickly you can exhale
it. Measured at different times of the day and a greater than 20% difference from
morning to afternoon suggests asthma.
-CXR
-ABGs
• Meds: short acting (albuterol, levalbuterol) long acting (Salmeterol and Formoterol)
Chronic Obstructive Pulmonary Disease (COPD)
• s/s: barrel chest, dyspnea on exertion, cough, sputum.
• Treatment: Inhalers (bronchodilators), RT, O2- target sat 88-90%, pulse oximetry.
, 2
• COPD exacerbation: typically caused by infection or inhaled irritant, treated with
antibiotics (if infection), RT, IV steroids.
• Things to consider: administering meds that cause depression need careful assessment
or may be contraindicated depending on status of pt. Don’t give too much O2. Keep up
with ABGs. COPD pts should have annual influenza and pneumonia vaccine.
Influenza
• Highly contagious viral respiratory infection
• s/s: rapid onset of headache, muscle aches, fever, chills, fatigue, weakness, sore throat,
cough, watery nasal discharge. Flu b can also have nausea, vomiting, diarrhea.
• Treatment: Vaccine (won’t cure but can help prevent) droplet isolation
• Education: hand washing, avoid exposure to others, get annual vaccine.
Pneumonia
• Infection acute or chronic involving one or both lungs caused by virus, bacteria, fungi,
parasites, or chemical agents. (by aspirations or inhalation of foreign material)
• s/s: chest pain/ discomfort, tachypnea, hemoptysis (coughing up blood), sputum
production, crackles, fever, chills, cough.
• Immunocompromised are more susceptible.
• CAP: Community acquired, HAP: Hospital acquired after 48 hours of admission, 30 days
after discharge, VAP: ventilator acquired pneumonia.
• Young and elderly at risk
• Diagnostic tests: chest x-ray, CBC, BMP, glucose (can be high with infection because
infection feeds off glucose. The higher the harder to treat the infection), sputum culture
• Prevention is possible; teach to use incentive spirometer (always post-op) for less active
patients, hand washing and hygiene (VAP), prevention of aspiration (aspiration
precautions), pneumonia vaccine (over 65, chronic heart disease, or asthma), stop
smoking!!
• Treatment: O2 and antibiotics.
Tuberculosis
• Infection of the lungs caused by mycobacterium
• s/s: progressive fatigue, lethargy, nausea, anorexia, weight loss, low-grade fever, blood
tinged sputum, chest pain/tightness.
• Assess: history (foreign born? Recent travels? Cough?)
• Testing and diagnosis: PPD confirms latent infection 6-8 weeks after exposure. 5mm or
greater means active, latent, previous treatment, recent immunization.
CXR, CT, sputum culture, blood work.
• Treatment: Isoniazid, Rifampin, Ethambutol, Pyrazinamide.
Pulmonary Embolism
Collection of particulate matter that enters venous circulation and lodges in the pulmonary
vessels, blood clots most common.
• s/s: dyspnea, pleuritic chest pain, restlessness, cough, hemoptysis, feeling of impending
doom, tachycardia, tachypnea.
• Treatment: O2, high fowlers, cardiac monitoring, continuous pulse ox, anticoagulants
(Heparin, lovenox, Coumadin) IV heparin initially, then bridge to PO Coumadin.
