Rise and fall of chest

spO2

SOB

Sp02

RR

Measured by SpO2 + RR

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.

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

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

• 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 

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

  
  

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.

• 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)

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.

Respiratory rate

respiratory rate

equal rise and fall

use of accessory muscles

SPo2

breath sounds

Stridor

Crackles

Saturation

Equal rise and fall of chest

Use of accessory muscles

Pulmonary odema?

Wheezing, stridor

Listen - Sounds of breathing, Asculation.

Feel - Palpation, Percussion.

Work of breathing

Shortness of breath

SpO2 between the flags

Respiratory distress

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.

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).

ROME