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Respiratory Rate

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RR, patent, maintaining breaths on own, rise and fall of chest, SpO2

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oxygen spo2

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Respiratory rate

Rise and fall of chest

spO2

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Sounds, rate, abnormalities

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respiratory rate

Rise and fall of the chest

Breathing sounds

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Air goes to your lungs, gas exchange occurs, CO2 leaves O2 enters.

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Ensuring that the lungs are functioning correctly they are equal and you can see they are rising and falling. Ensuring that breathing sounds are quiet and not a wheeze, crackle etc.

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WOB

SOB

Sp02

RR

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Rise/fall of chest

Measured by SpO2 + RR

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RR

Look listen feel

Equal rise and fall of chest

Breathing sounds (e.g wheeze)

Sp02 levels

Well perfused

Cap refill

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Breathing includes:-

1. Respiratory rate

2. Sound of it like is it normal or has wheezing

3. It also includes to check the saturation rate

4. It helps to the exchange of gases in the lungs.

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Work of breathing - laboured or un laboured

If pt is receiving oxygen - delivery of oxygen (nasal prongs etc)

Sp02 and RR

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Is there difficulty breathing?

Can they talk in full sentences?

Are they using accessory muscles to breathe?

Review respiratory rate and oxygen saturation

Perform respiratory assessment

Administer oxygen if indicated

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assessing someone’s airway

Sp02

respiratory rate

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Respiratory rate + SpO2 measures

SOB can have early and warning signs of deterioration

ABGs - acidosis/alkalosis, resp/metabolic, partial/full/no compensation

Conditions that affect B - COPD, Pulmonary Oedema, Pulmonary embolism

V/Q mismatch can be brought back by pulmonary bronchi construction + vasoconstriction

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B/Breathing is an involuntary action, that our bodies can control to a certain extent. To give our body oxygen and rid it of carbon dioxide.

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What i know:

Whilst experiencing breathlessness, RR and HR will increase whilst spo2 will decreases due to a decrease in oxygen and an increase in O2 concentration.

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Acute inflammation of the lung tissue

Caused by an infectious agent including bacteria, viruses, fungi and parasites

Community acquired pneumonia (CAP): the acute infection of lung tissue in a patient who has acquired it from the community or within 48 hours of the hospital admission

Hospital acquired pneumonia (HAP): the acute infection of lung tissue in a non-intubated patient that develops after 48 hours of hospitalisation

Ventilated associated pneumonia (VAP): a type of nosocomial infection of lung tissue that usually develops 48 hours or longer after intubation for mechanical ventilation

Pathophysiological changes associated with pneumonia are:

Alveolar macrophages ingest bacteria and produce purulent sputum

Homeostatic mechanisms to kill the foreign agents leads to a local host inflammatory response

Includes an alveolar-capillary leak

The purulent sputum and alveolar-capillary leak reduces the diffusion of oxygen leading to hypoxaemia

In early pneumonia individuals will have a type 1 respiratory failure because of impaired diffusion due to secretions in the alveoli and inflammation of the lung parenchyma

However, unless the person receives timely treatment and respiratory support, this will inevitably lead to type 2 as the person becomes exhausted by the increased work of breathing

Key investigations:

> sputum culture

> chest XRay

> ABG

> bronchoscopy

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What is COPD?

Chronic obstructive pulmonary disease is a condition involving constriction of the airways. It’s is Type 2 respiratory failure.

SYMPTOMS

SOB

cyanosis

chest pain

tiredness

increased phlegm

Oedema of legs and ankles

Rapid heart rate

Confusion and disorientation

CAUSES

smoking

Long term exposure to irritants

Genetics

Frequent respiratory infections in childhood

NURSING INTERVENTIONS

Providing education eg learning how to use an inhaler

Bronchodilator

Corticosteroids

Oxygen therapy

Supine position

Exercise

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Asthma is caused by inflammation in the airways, which can be triggered by a number of factors: allergies, infections, environmental factors (smoking), physical activity, medications, emotional distress, family history.

Symptoms

Wheezing

Coughing

SOB

Increased mucous production

Chest tightness

Asthma symptoms can vary from person to person. Some people have infrequent asthma attacks, while others have symptoms all the time.

Nursing interventions

1. Call for assistance

2. Positioning, sit the patient upright

3. Check spO2 and RR

4. Respiratory assessment — look, listen, fell

5. Applying nurse-initiated oxygen or mechanical ventilation depending on presentation

6. Use relievers

7. Manage airway

8. Complete full set of vital observations.

Person-Centred Care

• prioritise the needs and preferences of the person

• actively involve them in decision making regarding their asthma treatment plan

• identify triggers specific to them

• provide education to empower self-management of their condition

• foster a collaborative partnership

• regular monitoring and follow-up

• address psychosocial factors.

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Causes

COPD usually stays the same in terms of the ‘normal’ for that person but in exacerbation it deteriorates more

Normally caused by viral infection in the lungs or airway, past history

An acute - triggered by infection

An exacerbation - bronchitis - bacteria, viruses, or environmental pollutants

SHORT TERM - environmental (smoking, air pollutants)

Cardiovascular diseases

Seasonal factors

Malnutrition

Signs and Symptoms

ACUTE and CHRONIC :

SOB

Quantity and color of phlegm

Fatigue

Fever

Sleep issues

Anxiety

Treatment

Home inhalers

Steroids

Antibiotics

Aims to control the swelling and contraction in your airways

Airway construction is treated with bronchodilator’s by inhaler or nebulizer

Home oxygen therapy and regular medication

Increase in mechanical ventilation (BIPAP)

Surgery

Diagnostic

Hypoxia

SOB

Rapid shallow breathing

Wheezing (audible sounds)

No tests of the blood, sputum, or chest x-ray that have been found to diagnose an exacerbation.

Spirometry (to measure lung volume)

You (empower the pt)

ABG

Long term interventions/education

Discourage smoking

Educate on bad air pollutants that could cause the exacerbation

Proper inhaler technique

Recognizing early signs of worsening symptoms

Regular exercise

Pulmonary rehabilitation

Maintains a healthy lifestyle

Oxygen therapy

Introduce the idea of advance care planning

Inform family, with permission from the pt

Get the family involved (as long as pt gives permission)

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ABG

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Arterial blood gases

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What an ABG is and how to read it

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About ABGs and exacerbation of COPD. Learned type 1 and type 2 respiratory failure

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I learned so much about the breathing so much and also ABG was interesting.

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How to check ABG

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I learned the 2 different typesof respiratory failure, ABD and VBG etc.

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I learnt about how to analyse ABG and Dx the cause

I also learnt about respiratory types and difference between both

I know how to tackle situation when I’ll meet with respiratory failure at workklace.

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Learning about the difference between ABGs and VBGs

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I learnt about pulmonary embolism and all the different types of respiratory failure.

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Look, listen, feel

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It is important and can be one of the first indicators that something is going wrong in the body

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Equal rise and fall of the chest

Respiratory rate

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Respiratory rate, increase wob, SOB, inspiration and expiration sounds, accessory muscles, ability to talk- full or short sentences, tenderness to the chest

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Looking at the rise and fall of the chest, if they using accessory muscles to breathe, respiratory rate, breathing sounds, percussion

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look, listen and feel

respiratory rate

equal rise and fall

use of accessory muscles

SPo2

breath sounds

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Wheeze

Stridor

Crackles

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Respiratory rate

Saturation

Equal rise and fall of chest

Use of accessory muscles

Pulmonary odema?

Wheezing, stridor

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Look - work of breathing, Use of Accessory muscles, Resp Rate, SpO2.

Listen - Sounds of breathing, Asculation.

Feel - Palpation, Percussion.

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For breathing, we look for Respiratory rate (RR)

Work of breathing

Shortness of breath

SpO2 between the flags

Respiratory distress

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Definition: Pneumonia is an infection that inflames the air sacs (alveoli) in one or both lungs, which may fill with fluid or pus.

Causes: Can be caused by bacteria, viruses, fungi, or inhaling foreign substances.

Common bacterial cause: Streptococcus pneumoniae

Common viral cause: Influenza, RSV, or COVID-19

Risk Factors:

Age (children and elderly)

Smoking

Chronic illnesses (e.g., COPD, diabetes)

Weak immune system

Hospitalization (especially if on a ventilator)

Symptoms

Cough (with or without mucus)

Shortness of breath

Chest pain (worsens with deep breathing or coughing)

Fever, chills

Fatigue

Rapid breathing or increased heart rate

Confusion (especially in older adults)

Diagnosis

Physical Exam: Listen for abnormal lung sounds (crackles, wheezing)

Chest X-ray: To confirm presence of infection

Blood tests: To identify bacteria or viruses

Sputum Culture: To pinpoint the cause

Interventions

Antibiotics: For bacterial pneumonia, antibiotics (e.g., amoxicillin, azithromycin).

Start broad-spectrum, then tailor based on culture results.

Antivirals: If viral cause (e.g., oseltamivir for influenza).

Oxygen Therapy: For patients with low oxygen levels.

Fluid Management: Hydration to help loosen mucus and prevent dehydration.

Pain Management: Analgesics for chest pain.

Encourage Deep Breathing and Coughing: To clear airways and reduce atelectasis.

Vaccinations: Pneumococcal vaccine, flu vaccine to prevent future infections.

Postural Drainage: To help remove mucus from the lungs.

Monitoring and Support: Monitor vitals, oxygen levels, and response to treatment.

Prevention

Vaccination: Pneumococcal vaccine, flu shots.

Hand Hygiene: To reduce the spread of pathogens.

Quit Smoking: Reduces the risk of respiratory infections.

Avoid Exposure: Avoid close contact with sick individuals.

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what is PE?

PE (pulmonary embolism) is a blood clot that develops in a blood vessel anywhere in the body, travels to an artery in the lung and suddenly forms a blockage of the artery.

PE can reduce amount of oxygen getting into your body. Lack of oxygen can damage lungs and other organs.

Symptoms:

breathlessness

Chest pain

High HR

High RR

Cough, coughing up blood

Fainting or dizziness

Other symptoms may include:

swelling or pain in calf

Back pain

Clammy skin

Fever and sweating

Lightheaded

Risk factors:

Fracture of lower limb

Hospitalization for heart failure or atrial fibrillation/flutter within the previous 3 months

Hip or knee replacement

Major trauma

History of previous venous thromboembolism

Central venous lines

Chemotherapy

Congestive heart failure or respiratory failure

Hormone replacement therapy

Category:

There are two types:

1. Thrombotic

2. Non-thrombotic : Fat, Air, Tumor, Amniotic fluid

Treatment:

-Anticoagulants

priority

Prevent the clot from becoming larger, prevent new blood clots from forming, and prevent long term complications

nursing interventions

monitor vital signs

monitor pulse oximetry for hypoxia

administer oxygen therapy (reduces PA pressure and reverse hypoxic pulmonary vasoconstriction)

Keep the bed slightly elevated

maintaining airways clearance and breathing pattern

administer medications (anticoagulant medication)

provide individual education (educate signs of PE e.g chest pain with difficulty breathing, a rapid heart rate, or lightheadedness)

provide anti-embolism(TED) stockings (helps reduce the risk of PE by administering pressure on the lower part of the legs and feet)

Clinical Evaluation

Looking at the rise and fall of the chest, asking if there is any pain when breathing.

If there is pain when breathing in it could be a symptom of PE

A D-dimer is a blood test that detects clot formation.

ECG

Respiratory assessment, SOB, WOB, and Auscultation, there would be a  crackle or wheeze

RR of over 20 and tachycardia, Hypotension

Person-Centred Approach to PE Care

1. Holistic Assessment & Communication

Actively listen to patient concerns and explain PE in simple terms.

Consider cultural beliefs and individual health literacy.

2. Shared Decision-Making

Involve the patient in treatment choices (e.g., anticoagulation options).

Address concerns about medication side effects and lifestyle impact.

3. Emotional & Psychological Support

Acknowledge anxiety and provide reassurance.

Offer mental health support if needed.

4. Individualized Discharge Planning & Education

Teach DVT prevention (staying active, hydration, compression stockings).

Educate on medication adherence and warning signs of complications.

5. Long-Term Support & Follow-Up

Regular monitoring (INR for Warfarin, renal tests for DOACs).

Encourage lifestyle changes (e.g., smoking cessation, weight management).

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Type 1 and type 2 respiratory failure

ROME

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Respiratory distress type of respiratory failure

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When to switch to high flow

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I learned about ABG interpretation