Respiratory Adult Nursing
Key Takeaways
- COPD exacerbation: upright positioning, controlled oxygen, bronchodilators, monitor CO2 retention and mental status.
- Venturi masks deliver precise FiO2 for CO2 retainers; avoid uncontrolled high-flow oxygen.
- PE presents with sudden dyspnea, pleuritic pain, tachycardia—immobility is a major risk factor.
- Pneumonia care includes cultures when possible, spirometry, hydration, and oxygenation monitoring.
- Saudi dust storms and respiratory outbreaks reinforce environmental triggers and isolation precautions.
Quick Answer: SNLE respiratory items test COPD exacerbation, asthma, pneumonia, pulmonary embolism, and oxygen therapy safety—including Saudi sandstorm triggers, MERS-CoV-era respiratory precautions, and correct O2 delivery devices for hypoxemia without CO2 narcosis risk.
Respiratory Adult Nursing
Respiratory failure kills silently; SNLE rewards nurses who interpret oxygen saturation trends, breath sounds, and ABG implications quickly. Adult patients in Riyadh and Eastern Province may present with dust-related exacerbations; pilgrims may arrive with atypical infections—always apply infection control while stabilizing breathing.
Oxygen Delivery Devices
| Device | FiO2 range | Best use |
|---|---|---|
| Nasal cannula | Low (~24–44%) | Mild hypoxemia, chronic stable |
| Simple mask | ~35–50% | Moderate hypoxemia |
| Non-rebreather | ~60–90% | Acute severe hypoxemia |
| Venturi mask | Precise FiO2 | COPD with CO2 retention risk |
COPD trap: high-flow uncontrolled oxygen can suppress hypoxic drive—titrate per protocol, often Venturi 24–28% unless critically hypoxemic.
COPD Exacerbation Nursing Care
Position high Fowler's, encourage pursed-lip breathing, administer bronchodilators and steroids per order, monitor work of breathing, obtain ABG if indicated, watch for fatigue heralding respiratory failure. SNLE "first action" may be sit upright and apply controlled oxygen before antibiotics.
Asthma Acute Episode
Peak flow decrease, wheezing, accessory muscles. First-line bronchodilator (short-acting beta-agonist) per protocol; monitor for silent chest (impending failure). Status asthmaticus requires escalation—continuous nebs, magnesium, ICU.
Pneumonia
Fever, productive cough, crackles, infiltrate on imaging. Nursing: cultures before antibiotics when possible, antipyretics, hydration, incentive spirometry, turn/cough/deep breathe, monitor oxygenation. Elderly may lack fever—altered mental status may be sole sign.
Pulmonary Embolism Suspicion
Sudden dyspnea, pleuritic chest pain, tachycardia, hypoxemia, risk factors (immobility, surgery, OCP). Nurse: oxygen, vital signs, notify provider, prepare for CT angiography/anticoagulation—do not massage calf if DVT suspected.
ABG Interpretation Basics
| Pattern | pH | PaCO2 | HCO3 | Example |
|---|---|---|---|---|
| Respiratory acidosis | ↓ | ↑ | ↑ compensating | COPD retain CO2 |
| Respiratory alkalosis | ↑ | ↓ | ↓ compensating | Hyperventilation |
| Metabolic acidosis | ↓ | ↓ compensating | ↓ | DKA, sepsis |
SNLE may not require full ABG math but tests clinical pairing—rising CO2 with somnolence in COPD means ventilatory failure risk.
Chest Tubes (Conceptual)
Water seal, tidaling, absence of tidaling may mean clot or lung re-expansion; sudden sharp pain and subcutaneous emphysema—notify provider; never clamp without order except emergency transport per policy.
Saudi-Specific Notes
Sandstorm air quality worsens COPD/asthma—teach indoor refuge and adherence to controller meds. MERS-CoV and influenza seasons reinforce droplet/contact precautions on respiratory wards per MOH updates.
Worked Scenario
COPD patient SpO2 84% on room air, drowsy but arousable. Give controlled low-flow oxygen via Venturi, assess mental status trend, notify provider, prepare for possible BiPAP—not high-flow NRB indefinitely.
Traps
- Sedating anxious asthmatic with opioids prematurely
- Ambulating PE suspect before anticoagulation
- Ignoring post-op incentive spirometry teaching
Final Check
Match device to COPD versus acute hypoxemia, list three PE risk factors, and state oxygen titration goal in CO2 retainers per protocol language.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
A COPD patient with chronic CO2 retention arrives with SpO2 83% and increasing somnolence. What is the priority oxygen management approach?
Which finding cluster most strongly suggests pulmonary embolism?
After pneumothorax chest tube placement, the nurse notes continuous bubbling only in the water seal chamber during exhalation with tidaling. What is the appropriate interpretation?