NUR 198 Respiratory Clinical Judgment Module

Oxygenation describes oxygen reaching the blood and tissues. Ventilation describes air movement and carbon dioxide elimination. A patient may have a ventilation problem even when oxygen saturation does not yet look severely abnormal.

Restlessness and anxiety may appear before late findings such as cyanosis or hypotension. A new change in mental status should be treated as a respiratory cue until another cause is established.

Nasal flaring, intercostal retractions, accessory muscle use, tripod positioning, limited speech, fatigue, and a change from baseline can matter more than one isolated number.

After respiratory interventions, look for improved oxygen saturation, lower work of breathing, improved mental status, more normal respiratory and heart rates, and better activity tolerance.

URI care focuses on maintaining the airway, preventing transmission, hydration, rest, communication, and symptom control. Complications in the deck include airway obstruction, hemorrhage, sepsis, dysphagia, aphonia, and other spread of infection.

Important cues include loud snoring, witnessed apnea, daytime sleepiness, morning headache, and difficulty concentrating. The course emphasizes weight loss when appropriate, smoking and alcohol cessation, avoiding sedatives, and consistent CPAP use.

The course teaches sitting upright and pinching the soft portion of the nose. Risk is higher with factors such as trauma, hypertension, thrombocytopenia, and anticoagulant use.

Persistent hoarseness, dysphagia, weight loss, and a throat mass fit the laryngeal cancer content. A new sign of obstruction changes the priority toward airway management.

After total laryngectomy, the patient breathes through the stoma. Oxygenation and ventilation must be directed to the stoma, and emergency ventilation is mouth-to-stoma rather than mouth-to-mouth.

Thick secretions, falling oxygen saturation, coarse breath sounds, or increased work of breathing should trigger assessment of tracheostomy patency and suctioning when indicated.

The course chart distinguishes low-flow nasal cannula, simple mask, Venturi mask for precise oxygen concentration, nonrebreather mask for higher concentration, and high-flow nasal cannula for high oxygen needs and respiratory distress.

Postoperative atelectasis may develop gradually with increasing dyspnea, cough, tachypnea, hypoxemia, crackles, and decreased breath sounds. Deep breathing, coughing, mobility, and adequate pain control support lung expansion.

Inflammation, edema, exudate, mucus, and consolidation interfere with gas exchange. Older adults may present with confusion from hypoxia rather than a dramatic fever or leukocytosis.

The pneumonia content includes chest x-ray, sputum culture, blood culture, CBC, and ABGs. The deck specifically notes that sputum culture is best obtained early in the morning.

The nurse verifies consent, helps position the patient, monitors vital signs and oxygenation, measures output, assesses the site, auscultates lung sounds, and watches for bleeding, infection, and pneumothorax.

The deck emphasizes negative-airflow isolation and N95 respiratory protection. PPD is a screening test for exposure, while other testing includes nucleic acid testing, serum testing, and acid-fast bacilli smear and culture.

The course lists isoniazid, rifampin, pyrazinamide, and ethambutol as a typical initial regimen and emphasizes completing therapy because drug resistance is a major concern.

Early findings include restlessness, dyspnea, tachycardia, hypertension, fatigue, and headache. Later findings include confusion, lethargy, central cyanosis, diaphoresis, and respiratory arrest.

The deck teaches securing the tube, maintaining cuff pressure at 20 to 30 mm Hg, and using the endotracheal tube for ventilation and secretion removal.

Positive end-expiratory pressure is used with mechanical ventilation to improve gas exchange and lung expansion and to reduce alveolar collapse.

Nursing goals include gas exchange, airway patency, prevention of injury and infection, communication, and mobility. The course specifically identifies barotrauma, pneumothorax, pulmonary infection, and sepsis as complications.

ARDS involves diffuse alveolar damage, noncardiogenic pulmonary edema, reduced compliance, bilateral infiltrates, and severe hypoxemia that does not respond adequately to supplemental oxygen. Management includes treating the cause, mechanical ventilation with PEEP, and prone positioning.

Rib fracture pain can limit ventilation. Flail chest causes chest-wall instability and paradoxical movement, so respiratory status takes priority.

Sudden pleuritic pain, dyspnea, tachypnea, anxiety, accessory muscle use, and diminished or absent breath sounds on one side are key cues. The deck identifies needle decompression for tension pneumothorax.

The water seal allows air to leave while preventing re-entry. Tidaling is expected. Continuous bubbling in the water-seal chamber indicates an air leak. The system stays upright and below chest level.

The deck emphasizes monitoring for kinks, occlusions, loose connections, insertion-site problems, and respiratory deterioration. If the drainage system disconnects, the course directs placing the end of the chest tube in sterile water to reestablish a water seal.

The lung cancer content emphasizes smoking exposure, late diagnosis, diagnostic imaging, bronchoscopy, thoracoscopy, biopsy, and multiple treatment approaches.

For bronchoscopy, verify consent, keep the patient NPO before the procedure, reassess respiratory status afterward, and keep the patient NPO until the gag reflex returns. After thoracoscopy, monitor for bleeding, pneumonia, and pneumothorax.

Sudden dyspnea, pleuritic chest pain, anxiety, air hunger, cough, and sometimes hemoptysis should be interpreted together with VTE risk factors such as recent orthopedic surgery, immobility, obesity, cancer, trauma, or advanced age.

The deck includes dyspnea, chronic productive cough, SpO2 commonly 88% to 92%, accessory muscle use, decreased breath sounds, barrel chest, hypoxemia, hypercarbia, and increased hematocrit from chronic low oxygenation.

High-Fowler positioning, effective coughing or suctioning, prescribed breathing treatments, prescribed oxygen, diaphragmatic breathing, and pursed-lip breathing are emphasized.

Smoking cessation, reducing secondhand smoke and occupational exposure, vaccination, medication teaching, hydration and nutrition, exercise conditioning, and complication prevention are part of the long-term plan.

The deck notes that it is commonly performed before meals and at bedtime so secretions can be mobilized and removed by coughing or suctioning.

The course emphasizes allergy, family history, smoke, irritants, GERD, environmental factors, selected medications, respiratory infection, and other triggers.

The deck includes forced vital capacity and peak expiratory flow and emphasizes using pulmonary function testing to determine dysfunction and response to therapy.

Albuterol and ipratropium are presented as quick-relief therapies. Corticosteroids, long-acting beta-2 agonists, leukotriene modifiers, and combinations are presented for longer-term control.

Respiratory muscle fatigue, increasing PaCO2, respiratory acidosis, and severe hypoxemia indicate deterioration and may require emergency intubation and mechanical ventilation.

The deck emphasizes oxygen, bronchodilators, systemic corticosteroids, IV fluids, epinephrine, and preparation for emergency intubation when the patient fails to respond.

Do not stop at naming acidosis or alkalosis. Ask whether ventilation is failing, whether CO2 is rising, whether the patient is tiring, and whether treatment is improving the trajectory.