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Respiratory

Respiratory System Review

Educational Use Only. This app is not intended to replace instructor guidance, institutional policies, clinical judgment, or professional medical training.

Overview

The respiratory system manages gas exchange. NCLEX emphasizes COPD, asthma, pneumonia, pulmonary embolism, and respiratory failure. Key skills include oxygen therapy, airway management, and recognizing respiratory distress.

Key Concepts

  • 1

    COPD patients are chronic CO2 retainers — oxygen must be delivered cautiously (2-4 L/min NC); high O2 can suppress hypoxic drive

  • 2

    Asthma: triad of bronchospasm, inflammation, and mucus production; triggered by allergens, exercise, infections

  • 3

    Pulmonary embolism: triad of dyspnea, chest pain, and hemoptysis; risk factors include immobility, surgery, pregnancy, oral contraceptives

  • 4

    Normal ABG values: pH 7.35-7.45, PaCO2 35-45, PaO2 80-100, HCO3 22-26, SaO2 95-100%

  • 5

    Respiratory acidosis: pH <7.35, PaCO2 >45 (hypoventilation); Respiratory alkalosis: pH >7.45, PaCO2 <35 (hyperventilation)

  • 6

    Pneumonia: bacterial (sudden onset, productive cough) vs viral (gradual, dry cough)

  • 7

    Tuberculosis: airborne precautions, negative pressure room, N95 mask, 6-month multi-drug regimen

Nursing Interventions

  • Assess respiratory rate, depth, effort, and use of accessory muscles every 1-4 hours for acute patients

  • Monitor SpO2 continuously; maintain >92% (or >88% for COPD patients per provider order)

  • Position patient in high Fowler's or semi-Fowler's to maximize lung expansion

  • Administer bronchodilators before corticosteroids for asthma (opens airways first)

  • Encourage coughing and deep breathing, incentive spirometry q1h while awake post-op

  • For COPD: pursed-lip breathing to prevent airway collapse and reduce dyspnea

  • Maintain airborne precautions for TB: private negative-pressure room, N95 mask, door closed

  • Administer oxygen as ordered; monitor for signs of oxygen toxicity with prolonged high-flow O2

Critical Red Flags

  • Respiratory rate <10 or >30 per minute

  • SpO2 <90% on room air or below prescribed target

  • Sudden onset dyspnea with pleuritic chest pain and hemoptysis — pulmonary embolism

  • Cyanosis (central or peripheral), nasal flaring, or intercostal retractions

  • Diminished or absent breath sounds on one side — pneumothorax

  • Stridor — upper airway obstruction requiring immediate intervention

Key Lab Values

ABG pH: 7.35-7.45

PaCO2: 35-45 mmHg

PaO2: 80-100 mmHg

HCO3: 22-26 mEq/L

SaO2: 95-100%

D-dimer: <0.5 mcg/mL (elevated may indicate PE or DVT)

Patient Teaching

  • Use inhalers correctly: shake, exhale fully, inhale slowly, hold breath 10 sec, wait 1 min between puffs

  • Use spacer with metered-dose inhalers for better medication delivery

  • Practice pursed-lip breathing: inhale through nose 2 sec, exhale through pursed lips 4 sec

  • Avoid smoking and secondhand smoke; get annual flu and pneumococcal vaccines

  • Recognize asthma triggers and avoid them; have an action plan for exacerbations

  • Complete full course of TB medications; do not stop even if feeling better

Educational Use Only — Not a substitute for professional training.