RESPIRATORY – MED-SURG SYSTEMS
SURVIVAL NOTES
(Adult Health / Med-Surg – Exam/NCLEX Focused)
1. Big-Picture Respiratory Overview
• Job: gas exchange – bring in O₂, blow off CO₂.
• High-yield priorities:
o Airway patency (A of ABCs).
o Breathing quality (rate, depth, pattern).
o Gas exchange (O₂ sat, ABGs, mental status).
• Most test questions boil down to:
o “Is the airway open?”
o “Is the patient moving air?”
o “Is oxygenation/perfusion adequate?”
2. Asthma vs COPD (Very Testable)
2.1 Must-Know Overview
• Asthma:
o Reversible airway obstruction (bronchoconstriction + inflammation).
o Usually episodic, often triggered (allergens, exercise, cold air, infections).
• COPD (emphysema + chronic bronchitis):
o Not fully reversible, progressive.
o Linked to long-term irritant exposure (smoking, pollution, occupational dusts).
2.2 Quick Compare Table
Feature Asthma COPD
Onset Often childhood/young adult Mid–late adulthood
Reversibility Reversible with bronchodilators/steroids Partially reversible
Sputum May be minimal Often chronic productive cough
Main problem Bronchospasm + inflammation Air trapping + loss of elasticity
Key teaching Trigger avoidance, inhaler technique Smoking cessation, energy conservation
3. Asthma
3.1 Classic Assessment Findings
, • Wheezing (especially on expiration), cough.
• Chest tightness, SOB, prolonged expiration.
• Use of accessory muscles, retractions in severe cases.
• ↓ peak flow.
Red flags (status asthmaticus):
• Silent chest (no air movement).
• Extreme SOB, unable to speak full sentences.
• Cyanosis, ↓ O₂ sat, anxiety, restlessness.
• May progress to respiratory failure.
3.2 Diagnostics
• Peak expiratory flow rate (PEFR):
o Green: 80–100% of personal best, good control.
o Yellow: 50–80% → caution, adjust meds.
o Red: <50% → emergency.
• Pulmonary function tests (PFTs), ABGs if severe.
3.3 Medications – High-Yield
Type Example Key Points
SABA (short-acting beta₂) Albuterol Rescue inhaler, quick relief; tremor, tachy
ICS (inhaled corticosteroid) Fluticasone, budesonide Daily control, rinse mouth after use
LABA (long-acting beta₂) Salmeterol Maintenance, never for acute attack
Combo ICS/LABA Fluticasone/salmeterol For moderate–severe persistent asthma
Anticholinergic (short) Ipratropium Sometimes added in acute exacerbation
Nursing teaching:
• Always use SABA (rescue) for acute symptoms.
• ICS: rinse mouth to prevent thrush.
• Know asthma action plan (green/yellow/red zones).
• Avoid triggers: smoke, irritants, cold air, some meds (e.g., NSAIDs if sensitive).
4. COPD (Chronic Obstructive Pulmonary Disease)
4.1 Must-Know Overview
• Umbrella term: emphysema + chronic bronchitis.
• Air trapping → barrel chest, CO₂ retention, chronic hypoxemia.
• Often from smoking (huge exam point).
SURVIVAL NOTES
(Adult Health / Med-Surg – Exam/NCLEX Focused)
1. Big-Picture Respiratory Overview
• Job: gas exchange – bring in O₂, blow off CO₂.
• High-yield priorities:
o Airway patency (A of ABCs).
o Breathing quality (rate, depth, pattern).
o Gas exchange (O₂ sat, ABGs, mental status).
• Most test questions boil down to:
o “Is the airway open?”
o “Is the patient moving air?”
o “Is oxygenation/perfusion adequate?”
2. Asthma vs COPD (Very Testable)
2.1 Must-Know Overview
• Asthma:
o Reversible airway obstruction (bronchoconstriction + inflammation).
o Usually episodic, often triggered (allergens, exercise, cold air, infections).
• COPD (emphysema + chronic bronchitis):
o Not fully reversible, progressive.
o Linked to long-term irritant exposure (smoking, pollution, occupational dusts).
2.2 Quick Compare Table
Feature Asthma COPD
Onset Often childhood/young adult Mid–late adulthood
Reversibility Reversible with bronchodilators/steroids Partially reversible
Sputum May be minimal Often chronic productive cough
Main problem Bronchospasm + inflammation Air trapping + loss of elasticity
Key teaching Trigger avoidance, inhaler technique Smoking cessation, energy conservation
3. Asthma
3.1 Classic Assessment Findings
, • Wheezing (especially on expiration), cough.
• Chest tightness, SOB, prolonged expiration.
• Use of accessory muscles, retractions in severe cases.
• ↓ peak flow.
Red flags (status asthmaticus):
• Silent chest (no air movement).
• Extreme SOB, unable to speak full sentences.
• Cyanosis, ↓ O₂ sat, anxiety, restlessness.
• May progress to respiratory failure.
3.2 Diagnostics
• Peak expiratory flow rate (PEFR):
o Green: 80–100% of personal best, good control.
o Yellow: 50–80% → caution, adjust meds.
o Red: <50% → emergency.
• Pulmonary function tests (PFTs), ABGs if severe.
3.3 Medications – High-Yield
Type Example Key Points
SABA (short-acting beta₂) Albuterol Rescue inhaler, quick relief; tremor, tachy
ICS (inhaled corticosteroid) Fluticasone, budesonide Daily control, rinse mouth after use
LABA (long-acting beta₂) Salmeterol Maintenance, never for acute attack
Combo ICS/LABA Fluticasone/salmeterol For moderate–severe persistent asthma
Anticholinergic (short) Ipratropium Sometimes added in acute exacerbation
Nursing teaching:
• Always use SABA (rescue) for acute symptoms.
• ICS: rinse mouth to prevent thrush.
• Know asthma action plan (green/yellow/red zones).
• Avoid triggers: smoke, irritants, cold air, some meds (e.g., NSAIDs if sensitive).
4. COPD (Chronic Obstructive Pulmonary Disease)
4.1 Must-Know Overview
• Umbrella term: emphysema + chronic bronchitis.
• Air trapping → barrel chest, CO₂ retention, chronic hypoxemia.
• Often from smoking (huge exam point).
