Respiratory Disorders
COPD vs Asthma comparison, pneumonia types, TB management, chest tube care, and oxygen delivery devices with flow rates.
COPD vs Asthma
| Feature | COPD | Asthma |
|---|---|---|
| Onset | Gradual, age > 40 | Usually childhood/early adulthood |
| Cause | Smoking (#1), alpha-1 antitrypsin deficiency | Allergens, exercise, cold air, stress |
| Pathophysiology | Chronic bronchitis (blue bloater): excessive mucus, productive cough. Emphysema (pink puffer): alveolar destruction, air trapping | Reversible bronchospasm, inflammation, mucus plugging |
| Symptoms | Progressive dyspnea, chronic cough, barrel chest (emphysema), prolonged expiration | Episodic wheezing, dyspnea, chest tightness, cough (especially at night) |
| Reversibility | Not fully reversible | Reversible with treatment |
| O2 Therapy | Low flow (1–2 L/min) — hypoxic drive; high O2 can suppress respiratory drive | As needed during exacerbation |
| Treatment | Bronchodilators, inhaled corticosteroids, smoking cessation, pulmonary rehab, O2 therapy | Rescue inhaler (SABA), controller (ICS), avoid triggers, peak flow monitoring |
Inhaler Teaching
- Use bronchodilator (SABA) before corticosteroid inhaler (opens airways first)
- Wait 1–2 minutes between puffs
- Rinse mouth after corticosteroid inhaler to prevent oral candidiasis (thrush)
- Use spacer with MDI for better drug delivery
Pneumonia
| Type | Key Features |
|---|---|
| Community-Acquired (CAP) | Most common. S. pneumoniae #1 cause. Fever, productive cough, pleuritic chest pain, crackles. Treat with antibiotics (macrolide or fluoroquinolone) |
| Hospital-Acquired (HAP) | Occurs ≥ 48 hrs after admission. Often resistant organisms (MRSA, Pseudomonas). Broader antibiotics needed |
| Aspiration | Risk: stroke, dysphagia, sedation, NG tubes. Prevent: HOB ≥ 30°, swallow evaluation, oral care |
| Pneumocystis (PJP) | Immunocompromised (HIV/AIDS, CD4 < 200). Treat with TMP-SMX. Prophylaxis when CD4 < 200 |
Tuberculosis (TB)
Key Points
- Airborne precautions (N95 respirator, negative pressure room)
- Symptoms: persistent cough > 3 weeks, night sweats, weight loss, hemoptysis, low-grade fever
- Diagnosis: PPD/Mantoux test (read in 48–72 hrs), QuantiFERON blood test, sputum for AFB (3 consecutive morning specimens), CXR
- PPD positive: ≥ 5 mm (immunocompromised/HIV, close contacts), ≥ 10 mm (high-risk groups), ≥ 15 mm (low-risk)
- Treatment: RIPE
- Rifampin (red-orange body fluids; reduces effectiveness of oral contraceptives)
- Isoniazid (INH) (monitor liver function; give with pyridoxine/vitamin B6 to prevent peripheral neuropathy)
- Pyrazinamide (hepatotoxic; monitor uric acid)
- Ethambutol (monitor vision — optic neuritis)
- Treatment duration: 6–9 months minimum; directly observed therapy (DOT) recommended
- Patient is non-infectious after 2–3 weeks of medication with negative sputum cultures
Chest Tubes
| Indication | Placement |
|---|---|
| Pneumothorax (air) | 2nd intercostal space, midclavicular line (air rises) |
| Hemothorax/Pleural effusion (fluid) | 5th–6th intercostal space, midaxillary line (fluid settles) |
Chest Tube Nursing Care
- Keep drainage system below the level of the chest at all times
- Tidaling (water fluctuation) in the water seal chamber is normal (stops when lung re-expands)
- Continuous bubbling in water seal = air leak (check connections)
- Gentle bubbling in suction control chamber is expected
- Never clamp a chest tube (risk of tension pneumothorax) unless briefly to locate a leak
- If disconnected: place tubing end in sterile water (water seal)
- If pulled out: cover site with petroleum gauze dressing taped on 3 sides
- Monitor and document drainage (color, amount); notify if > 70 mL/hr (hemorrhage)
Oxygen Delivery Devices
| Device | Flow Rate (L/min) | FiO2 Delivered | Notes |
|---|---|---|---|
| Nasal Cannula | 1 – 6 | 24% – 44% | Most common; comfortable; patient can eat/talk. Each L adds ~4% FiO2 |
| Simple Face Mask | 5 – 8 | 40% – 60% | Minimum 5 L/min to prevent CO2 rebreathing. Remove to eat |
| Non-Rebreather Mask | 10 – 15 | 80% – 95% | Highest FiO2 without intubation. Reservoir bag must stay inflated (≥ 2/3 full) |
| Venturi Mask | 4 – 12 | 24% – 50% | Most precise FiO2; ideal for COPD patients. Color-coded adapters |
| Partial Rebreather | 6 – 15 | 60% – 75% | Reservoir bag allows rebreathing of first 1/3 exhaled air (high O2 content) |
| High-Flow Nasal Cannula | Up to 60 | Up to 100% | Heated, humidified; provides some PEEP effect |