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

💨 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 (만성폐쇄성폐질환)
• 🌪 Asthma (천식)
• 🦠 Tuberculosis (결핵)
• 🌫 Pneumonia (폐렴) & ARDS
• 🧯 Chest Tube (흉관 배액)

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💨 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

Type	Features
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

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🌪 Asthma (천식)

Type	Reversible
Definition	Acute, 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

Class	Examples	Key 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.

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🦠 Tuberculosis (결핵)

• Airborne isolation (N95)
• Treatment 6–12 months
• Sputum negative ×3 → no longer infectious

Drug	Key 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.

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🌫 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)

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🧯 Chest Tube Management

Chamber	Normal	Abnormal / 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

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정리: 오늘의 간호사 Haley

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

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