Respiratory Assessment and Common Medications

When assessing COPD patients, look for key physical signs including barrel chest, shortness of breath, lung crackling, and clubbed fingers. These indicators help identify respiratory compromise early.

Understanding medications is crucial for respiratory patients. Lasix is a loop diuretic that removes excess fluid but can drop blood pressure and potassium levels. Metoprolol, a beta-blocker that should never be crushed, treats high blood pressure, chest pain, heart failure, and reduces post-heart attack mortality risk. Erythromycin fights bacterial infections, while Prednisone reduces inflammation as a corticosteroid.

Respiratory function involves three key processes: ventilation (breathing air in and out, affected in COPD), transport (moving oxygen from lungs to cells and CO2 back, affected in CHF), and perfusion (passing through barriers, affected in pneumonia).

💡 Remember: COPD patients like those with emphysema have destructed, enlarged air spaces causing shortness of breath, wheezing, and chronic cough. Treatments include self-care strategies, bronchodilators, albuterol inhalers, and prednisone.

Pneumonia and Oxygen Administration

Pneumonia inflames the air sacs in one or both lungs, which may fill with fluid. Look for classic symptoms: cough with rusty-colored phlegm, fever, chills, and difficulty breathing. Treatment depends on whether it's bacterial (requiring antibiotics) or viral, with vaccines playing a preventive role.

When administering breathing treatments, always auscultate the lungs before and after nebulizer treatments $which typically last 8-10 minutes$ to evaluate effectiveness. Don't forget oral care afterward to maintain hygiene.

Oxygen administration methods vary in their delivery capabilities:

• Nasal cannula: Delivers 24-44% FiO2 at 1-6L per minute
• Reservoir nasal cannula: Delivers 24-60% FiO2 at 1-15L per minute
• Venturi mask: Delivers 24-60% FiO2 at 4-12L per minute

When dealing with hypervolemia (fluid overload) caused by liver disease, kidney problems, CHF, or COPD, watch for symptoms like nausea, headache, and confusion. Treatment focuses on diuretics and addressing the underlying cause. Daily weight monitoring is essential to track fluid status.

💡 Critical point: Normal pulse oxygen should be 95-100%, but 92% is acceptable for COPD patients due to their altered respiratory physiology.

COPD Assessment and Medication Review

COPD assessment requires identifying characteristic physical signs: barrel chest, shortness of breath, lung crackling, and clubbed fingers. These indicators help track disease progression and response to treatment.

Common medications for respiratory and cardiac conditions include:

• Lasix: A loop diuretic that removes excess fluid while lowering blood pressure and potassium
• Metoprolol: A beta-blocker for high blood pressure, chest pain, and heart failure that must never be crushed
• Erythromycin: An antibiotic for bacterial infections
• Prednisone: A corticosteroid that reduces inflammation in conditions like COPD

Understanding respiratory physiology is essential. Ventilation involves the movement of air in and out of lungs (affected in COPD). Transport moves oxygen from alveoli to cells and carbon dioxide back (affected in CHF). Perfusion involves passing through barriers (affected in pneumonia).

Emphysema, a type of COPD, causes destruction and enlargement of air spaces. Symptoms include shortness of breath, wheezing, and chronic cough, treated with self-care, bronchodilators, albuterol inhalers, and prednisone.

💡 Remember: When administering respiratory medications, always assess lung sounds before and after treatment to evaluate effectiveness.

Pneumonia and Fluid Imbalances

Pneumonia is characterized by inflamed air sacs that may fill with fluid. Watch for its distinctive symptoms: cough with rusty-colored sputum, fever, chills, and difficulty breathing. Treatment varies between bacterial pneumonia (requiring antibiotics) and viral pneumonia, with vaccines serving as important preventive measures.

When administering nebulizer treatments $lasting 8-10 minutes$, always auscultate the lungs before and after to verify effectiveness, and provide oral care afterward. This assessment is crucial for documenting treatment response.

Different oxygen delivery systems provide varying concentrations:

• Nasal cannula: 24-44% FiO2 at 1-6L/min
• Reservoir nasal cannula: 24-60% FiO2 at 1-15L/min
• Venturi mask: 24-60% FiO2 at 4-12L/min

Hypervolemia (fluid overload) can result from various conditions including liver disease, kidney problems, CHF, and COPD. Symptoms include nausea, headache, confusion, and if untreated, hyponatremia leading to unconsciousness. Treatment focuses on diuretics and addressing the underlying cause.

💡 Clinical tip: Daily weight measurements are the most accurate way to monitor fluid status in patients with hypervolemia. A sudden weight gain often indicates fluid retention before other symptoms appear.

Fluid Imbalances: Hypovolemia and Interventions

Nursing interventions for hypervolemia (fluid overload) include monitoring intake and output, positioning to facilitate fluid drainage, encouraging a low-sodium diet, and administering diuretics. These strategies help reduce excess fluid and prevent complications.

Hypovolemia (dehydration) can result from fever, excessive exercise, vomiting, diarrhea, increased urination, or significant skin injuries. Key assessment findings include poor skin turgor, dry mouth, flat neck veins, confusion, decreased blood pressure, increased heart rate, and dark, concentrated urine.

Treatment for severe hypovolemia centers on fluid resuscitation to restore peripheral perfusion. As a nurse, your interventions should include:

• Monitoring vital signs, behavior, and output
• Thorough patient assessment
• Notifying the physician of changes
• Elevating legs to improve circulation
• Encouraging fluid intake
• Administering medications as prescribed

When managing any fluid imbalance, follow these essential steps: listen to the lungs first, check IVs, monitor weight, and track intake and output carefully. These assessments provide crucial data about the patient's fluid status.

💡 Critical nursing action: If urine output falls below normal $30mL/hour$, contact the physician immediately. For example, if a patient produces only 100mL in 6 hours instead of the expected 180mL, this requires prompt medical intervention.

Electrolyte Imbalances: Potassium

Monitoring intake and output is critical for patients with fluid imbalances. The normal urine output is 30mL per hour, and significant deviations require physician notification. For example, if a patient produces only 100mL in 6 hours (instead of the expected 180mL), you must contact the doctor immediately.

Potassium imbalances can be life-threatening and require careful monitoring. The normal range is 3.5-5 mEq/L. Hyperkalemia $>5.0 mEq/L$ can result from acute kidney failure, chronic kidney disease, severe injuries, burns, or excessive potassium supplementation. Symptoms include muscle fatigue, weakness, arrhythmias, irritability, paralysis, nausea, and can lead to death if untreated.

Hypokalemia $<3.5 mEq/L$ may be caused by diarrhea, excessive alcohol or laxative use, excessive sweating, or diuretics. Patients typically experience weakness, fatigue, abdominal distention, muscle cramps, constipation, and arrhythmias.

Dietary management is crucial for renal patients on low potassium diets, requiring avoidance of potatoes, oranges, bananas, leafy greens, apples, and avocados. Always report low potassium levels before administering Lasix, as this diuretic further depletes potassium.

💡 Critical safety note: Always check potassium levels before giving diuretics like Lasix. Administering diuretics to patients with already low potassium can precipitate dangerous cardiac arrhythmias.

Electrolyte Imbalances: Sodium

Sodium balance is crucial for proper cellular function, with a normal range of 135-145 mEq/L. Hypernatremia $sodium >145 mEq/L$ can result from excessive salt intake, rapid saline infusions, or consumption of high-sodium foods like processed, frozen, or canned items. Look for key symptoms including dry mucous membranes, low urinary output, firm tissue turgor, restlessness, confusion, and flushed skin.

Hyponatremia $sodium <135 mEq/L$ may be caused by inadequate sodium intake, fluid losses from vomiting, diarrhea, GI drainage, diaphoresis, burns, or small bowel obstruction. Patients typically present with headache, irritability, muscle weakness, fatigue, postural hypotension, and nausea/vomiting.

Magnesium imbalances also impact patient health, with a normal range of 1.5-2.5 mEq/L. Hypermagnesemia $>2.5 mEq/L$ can occur with renal failure, diabetic ketoacidosis with severe water loss, or excessive antacid use. Watch for symptoms like increased body heat and thirst, which can progress to respiratory depression, coma, or death if untreated.

💡 Clinical connection: Sodium and fluid balance are closely related. Hyponatremia often accompanies fluid overload (dilutional hyponatremia), while hypernatremia frequently occurs with dehydration (concentrational hypernatremia).

Electrolyte Imbalances: Magnesium and Calcium

Hypomagnesemia $magnesium <1.5 mEq/L$ can result from decreased intake, impaired GI absorption, alcoholism, or diarrhea. Watch for symptoms including anorexia, agitation, confusion, dysphagia, nausea, hyperactive deep tendon reflexes, and seizures requiring precautions. Cardiac dysrhythmias may also develop.

Calcium balance is essential for nerve and muscle function, with a normal range of 8-10 mg/dL. Hypercalcemia $>10 mg/dL$ can be caused by immobilization, metastatic bone cancer, multiple myeloma, excessive calcium supplements, antacids, or increased parathyroid hormone. Symptoms include anorexia, nausea, confusion, renal calculi, decreased deep tendon reflexes, lethargy, coma, and decreased muscle tone.

Hypocalcemia $<8 mg/dL$ may result from alcoholism, vitamin D deficiency, chronic renal failure, malabsorption, severe diarrhea, diuretics, or severe burns. Patients typically present with anxiety, osteoporosis, muscle spasms, tetany, nausea, hyperactive deep tendon reflexes, and cardiac dysrhythmias.

Two specific tests help identify hypocalcemia: Chvostek's sign (facial muscle twitching when tapping over the facial nerve) and Trousseau's sign $carpopedal spasm when a blood pressure cuff is inflated above systolic pressure for 3+ minutes$.

💡 Assessment tip: To properly assess for Trousseau's sign, inflate the BP cuff above the patient's systolic pressure and leave it in place for 3 minutes. A positive sign (indicating hypocalcemia) occurs when the patient develops carpopedal spasm - a contraction of fingers and wrist.

Acid-Base Balance and Assessment Tools

Normal urine output is 15 mL per kidney per hour, totaling approximately 30 mL/hour or 200 mL per 8 hours. This is an important baseline for assessing kidney function and fluid balance.

The Glasgow Coma Scale is an essential assessment tool that evaluates eye opening, verbal response, and motor response. Scores range from 3-15, with 15 representing the best response, 8 or less indicating a comatose patient, and 3 signifying total unresponsiveness.

Acid-base imbalances fall into four main categories:

• Respiratory acidosis (lungs)
• Respiratory alkalosis (lungs)
• Metabolic acidosis (kidneys)
• Metabolic alkalosis (kidneys)

Understanding normal ranges is crucial for interpreting arterial blood gas (ABG) values:

• Normal pH: 7.35-7.45
• Normal PaCO2: 35-45 mmHg
• Normal HCO3: 22-26 mEq/L

Deviations from these ranges help identify specific acid-base disorders. For respiratory acidosis, the pH is below 7.35 with a PaCO2 above 45. In respiratory alkalosis, the pH is above 7.45 with a PaCO2 below 35. Metabolic acidosis shows a pH below 7.35 with HCO3 below 22, while metabolic alkalosis presents with a pH above 7.45 and HCO3 above 26.

💡 ABG interpretation tip: Use the "ROME" mnemonic to understand compensation patterns: Respiratory imbalances show Opposite changes in pH and PCO2, while Metabolic imbalances show Equal changes in pH and HCO3.

Acid-Base Interpretation and Respiratory Disorders

ABG (Arterial Blood Gas) analysis is crucial for assessing acid-base balance. Normal values are: pH 7.35-7.45, PaCO2 35-45 mmHg, and HCO3 22-26 mEq/L. When interpreting ABGs, first determine if values are high, low, or normal, then identify if two values move in the same or opposite directions $SAME = metabolic, OPPOSITE = respiratory$.

Respiratory acidosis (pH <7.35, PaCO2 >45) results from hypoventilation due to sedative overdose, aspiration, atelectasis, pneumothorax, or emphysema. Symptoms include muscle weakness, unconsciousness, convulsions, headache, drowsiness, palpitations, dizziness, and potentially ventricular fibrillation.

Treatment for respiratory acidosis targets the underlying condition using:

• Bronchodilators
• Corticosteroids for airway obstruction
• Antibiotics for infections
• Diuretics
• Non-invasive ventilation (CPAP or BiPAP)
• Oxygen therapy if blood oxygen is low

Respiratory alkalosis (pH >7.45, PaCO2 <35) can be caused by anxiety, fever, hypoxemia, pulmonary emboli, mechanical ventilators, or continuous suction. Symptoms include lightheadedness, numbness, tingling, sweating, nausea, vomiting, and palpitations.

💡 Clinical application: When a patient is hyperventilating (respiratory alkalosis), having them breathe into a paper bag or using a rebreather mask can help increase CO2 levels. Anti-anxiety medication, inhalers, and relaxation techniques may also be beneficial depending on the cause.