Respiratory nursing: COPD, asthma, TB, oxygenation & ABG interpretation

Respiratory items usually give a short scenario and ask what the nurse does FIRST, which finding to report, or which position or intervention protects breathing. Because 'A' (airway) and 'B' (breathing) sit above circulation in the ABC framework, a genuine airway or oxygenation problem almost always outranks everything else on the page.

A useful mental frame for breathing scenarios:

• •Patency first — an obstructed or threatened airway (stridor, gurgling, choking, angioedema) is the top priority; positioning, suction or an emergency airway comes before anything else.
• •Then oxygenation and work of breathing — reposition upright, apply appropriate oxygen, and assess before reaching for comfort measures.
• •'Report immediately' answers win when a finding signals deterioration: falling oxygen saturation, a silent chest in asthma, rising drowsiness in a CO2 retainer, or a rising respiratory rate that then suddenly slows (a tiring patient is an ominous sign).
• •When two answers both look reasonable, choose the one that ASSESSES before it acts — unless the patient is in true respiratory failure, where acting (positioning, oxygen, calling for help) is the priority.

This note states widely accepted nursing principles. Oxygen targets, drug doses and reference ranges vary by protocol; verify local orders and current guidance before applying any figure to a real patient.

Oxygenation depends on a clear airway, adequate ventilation (air moving in and out), diffusion across the alveolar membrane, and enough haemoglobin and circulation to carry oxygen to tissues. A problem at any step shows up as hypoxaemia (low blood oxygen) and, if uncorrected, hypoxia (low tissue oxygen).

Pulse oximetry (SpO2) is the quick bedside screen, but know its limits: it can read falsely high or be unreliable with poor perfusion, cold peripheries, movement, nail polish, and — importantly — carbon monoxide poisoning, where SpO2 can look normal while the patient is dangerously hypoxic. When the picture does not fit the number, assess the patient.