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NCLEX-RN 이것만이라도 보고 가자! : Respiratory Disorders │ Nurse Haley

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💨 Respiratory Disorders by Nurse Haley

COPD · Asthma · TB · Pneumonia · Chest Tube 간호 요약


안녕하세요! 오늘의 간호사 Haley 입니다. 오늘 준비한 내용은 NCLEX-RN를 공부하실 때 Pulmonary, Respiratory part 에서 다른 건 다 몰라도 이것만큼은..! 무조건 알아야 할 내용들을 준비했습니다. :)

📖 Table of Contents

💨 COPD (Chronic Obstructive Pulmonary Disease)

Feature Description
🫁 Definition Chronic destruction of lung tissue, irreversible airflow limitation.
가장 큰 원인: Smoking
🔬 ABG Findings Hypoxia (PaO₂ < 80), Hypercapnia (pH < 7.35, CO₂ > 45).
SPO₂ 88–93% = normal for COPD
🩸 Physical Signs Clubbing fingers (chronic hypoxia), ↑RBC (polycythemia).
❌ Anemia는 특징이 아님!

✨ Types

TypeFeatures
Emphysema (Pink Puffer) Pursed-lip breathing
Barrel chest
Tripod position
Hyperresonance on percussion
Chronic Bronchitis (Blue Bloater) Cyanosis, chronic cough & sputum, crackles, wheezing, peripheral edema (Rt HF).
🚨 Tx Priority: Hypoxia + Hypercapnia → Use BiPAP
Do not start O₂ or bronchodilators first if CO₂ retention suspected.

🍽 Diet & Nursing Care

  • Oral hygiene before meals, small frequent meals
  • High calorie, high protein, low CHO
  • Avoid gassy foods & carbonated drinks
  • Fluids 2–3L/day (avoid during meals)
  • Vaccines: Pneumococcal q5yrs, Flu yearly
  • Pursed-lip breathing (inhale 2s, exhale 4s)
  • Huff coughing: deep inhale → hold 2–3s → exhale fully → rest 5–10s

🌪 Asthma (천식)

TypeReversible
DefinitionAcute, reversible airway inflammation & constriction.

⚠️ Signs & Triggers

  • Triggers: Smoking, allergens, infection, cold air, stress, NSAIDs, β-blockers
  • Eosinophilia (알레르기 반응 시)
  • Accessory muscle use, wheezing, SOB, tight chest
  • CO₂ retention → acidosis (late)
  • Paradoxical breathing = Critical

🫁 Asthma Meds

ClassExamplesKey Points
β₂-Agonist Albuterol First-line during attack. Tachycardia & tremor expected. 2–4 puffs q20min ×3. If no improvement → notify.
Anticholinergic Ipratropium ↓ Secretions, bronchodilation.
Methylxanthine Theophylline Toxicity if >20 mg/dL → monitor HR, arrhythmia.
Inhaled Steroids Beclomethasone Rinse mouth after use; prevents oral thrush.
💡 MDI Rule: Use Albuterol → Steroid (bronchodilator first).
Rinse mouth after steroid inhaler.

🦠 Tuberculosis (결핵)

  • Airborne isolation (N95)
  • Treatment 6–12 months
  • Sputum negative ×3 → no longer infectious
DrugKey Nursing Points
Rifampin Red/orange body fluids (expected).
↓ Oral contraceptive effectiveness → use non-hormonal.
Hepatotoxic → monitor jaundice, AST/ALT.
Isoniazid (INH) ↓ Vitamin B6 → peripheral neuropathy → give Pyridoxine 25–50mg/day.
Hepatotoxic → avoid alcohol.
Ethambutol Blurred vision, color change → Report immediately.

🌫 Pneumonia & ARDS

  • Crackles, fever, WBC ↑
  • Diagnosis: sputum culture, CXR
  • Complications: pleural effusion, ARDS, septic shock
💡 Pleural Effusion Sign: Chest pain on inspiration, dyspnea, ↓ breath sounds, dull percussion.

🩺 Nursing Care

  • HOB ↑ (High Fowler’s)
  • Hydration 2–3L/day
  • ECDB, huff cough (no cough suppressants)
  • IS q1hr (incentive spirometer)
  • Position “Good lung down” for unilateral pneumonia
  • Pain control before deep breathing (avoid codeine)
  • Oral care q12hr (chlorhexidine)

🧯 Chest Tube Management

ChamberNormalAbnormal / Nursing Action
Suction control Gentle continuous bubbling Vigorous bubbling → too high suction
Water seal Tidaling with respiration, intermittent bubbling Continuous bubbling → air leak
Collection Drainage ≤100ml/hr, dark red early postop okay Bright red >100ml/hr → Notify!
🚨 If disconnection: Have pt cough & exhale → cover with 3-side dressing.
Keep at bedside: sterile connector, petroleum gauze, padded clamp.
❌ Never clamp without order!
  • Assess lung sounds q2h
  • Mark air leak site (emphysema area)
  • During removal → instruct pt to deep breath & hold

정리: 오늘의 간호사 Haley

📌 본문 내용은 오늘의 간호사 Haley의 저작물로 무단 복제·배포를 금합니다.

#NCLEX #RespiratoryNursing #COPD #Asthma #TB #Pneumonia #ChestTube #간호요약