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Nursing Field Notes / Respiratory · Oxygenation & Airway IV · Fundamentals of Nursing
🫁 RESPIRATORY + LABS SET NG-092 ABG · The Method NG-138 ABG · Compensation Practice NG-173 ABG · Answer Key NG-132 Anatomy of Breathing NG-170 Key Terms & Lung Sounds

Key Terms & Lung Sounds 🩺

The vocabulary, the patterns, the map of where to listen — and what every sound means

NG-170 RESPIRATORY · ASSESSMENT ADHD-friendly visual edition

This is the reference page for respiratory assessment: every “-pnea” word, every breathing pattern drawn as a trace, a numbered map of where to put the stethoscope on the front and on the back, and each abnormal sound with what it sounds like, when in the breath you hear it, what makes it and what you do. The lobes, the pleura and the alveolus are drawn on NG-004 · Anatomy of the Lungs; the mechanics of the breath itself are on NG-132 · Anatomy of Breathing.

📄 Simple Nursing original — opens in Drive →

🚨 STRIDOR = EMERGENCYHarsh, high-pitched, heard without a stethoscope, usually on breathing IN. Upper airway obstruction. Get help now.
🩺 IN-TERCOSTAL = IN BETWEENListen in the spaces between the ribs, on bare skin, with the diaphragm of the stethoscope, side to side.
🔊 THE FOURCrackles = wet · Wheeze = tight · Rhonchi = gunk · Rub = grating. Vesicular is the normal one.
📈 RATEAdult: <12 = bradypnea · >20 = tachypnea. Kussmaul = deep + fast = the body is too ACIDIC.
📖

PART 1 · THE VOCABULARY

SAY IT PROPERLY

Learn the word endings and most of the list learns itself.

⭐ Crack the word endings first

-pneabreathing
-oxiaoxygen
-emiain the blood
-capniacarbon dioxide
tachy-fast
brady-slow
hypo-too little
hyper-too much
a-absent / none
ortho-upright
dys-difficult
-ptysisspitting up

“Tachypnea” = fast + breathing. “Hypoxemia” = too little + oxygen + in the blood.

🧠 Build the word, don't memorize it. Prefix + root + ending.

🌬️ The “-pnea” family — conditions affecting the movement of air

  • Eupnea — normal, quiet, effortless breathing.
  • Dyspnea — difficulty breathing. It is a symptom the patient reports, not something you measure. D = Difficult, D = Dyspnea.
  • Tachypnea — breathing too fast, over 20/min in an adult.
  • Bradypnea — breathing too slow, under 12/min.
  • Apnea — no breathing at all. Example: sleep apnea, a serious sleep disorder in which breathing repeatedly stops and starts.
  • Orthopnea — difficulty breathing while lying down. Example: heart failure — fluid backs up into the body and lungs, making it very difficult to breathe at night.
🧠 Tachy clothes = too much going on. Brady Bunch = slower times. And HF = Heart Failure = Heavy Fluid in the lungs and body.

🚨 Orthopnea — and how to measure it

Answer first: ask how many pillows they sleep on.

  • “Two-pillow orthopnea” means they need two pillows to breathe comfortably at night. If that number has gone up, their heart failure has got worse.
  • Paroxysmal nocturnal dyspnea (PND) is the dramatic version: waking suddenly a couple of hours into sleep, gasping, and having to sit up or stand.
  • Why it happens: lying flat lets fluid pooled in the legs redistribute into the chest, and the abdomen presses up on the diaphragm.
  • The nursing answer is the same either way: sit them up.
🧠 “How many pillows?” is a heart-failure question disguised as small talk.

🩸 Hypoxemia vs hypoxia — and the words that travel with them

HYPOXEMIA vs HYPOXIA — not the same word Magnified · left = the problem is in the BLOOD · right = the problem is at the CELL HYPOXEMIA low oxygen IN THE BLOOD red blood cells · green dots = oxygen molecules few green dots — the blood ITSELF is short of oxygen measured by PaO₂ 80–100 mmHg · SaO₂ 95–100% The lung failed to load oxygen onto the blood. CAUSES • pneumonia, pulmonary edema, ARDS • pulmonary embolism, atelectasis • COPD and other chronic lung disease • low inspired oxygen — altitude, smoke • hypoventilation of any cause HYPOXIA not enough oxygen AT THE CELLS red blood cells · green dots = oxygen molecules the blood may look FULL of oxygen — and the cell is still starved starved cell — gray mitochondria no single number measures it — you assess the PATIENT The oxygen never reached the cell, or the cell cannot use it. CAUSES (the blood gas can look NORMAL) • severe anemia — too few carriers • shock / low cardiac output — no delivery • carbon monoxide poisoning — seats taken • cyanide poisoning — the cell can’t use it • local ischemia — the vessel is blocked 🚨 RECOGNIZING IT — the signs come in this order EARLY Restlessness · anxiety · agitation · “something is wrong” THEN Tachypnoea · tachycardia · rising blood pressure · confusion LATE Cyanosis · bradycardia · falling blood pressure · loss of consciousness 🧠 “-emia is in the blood. Hypoxia is in the cells.” Restlessness is the EARLIEST sign — the brain complains long before the lips turn blue. Cyanosis is a LATE sign, and in anemia it may never appear at all.

Hypoxemia is a blood problem you can measure. Hypoxia is a tissue problem you have to assess. Restlessness comes first; cyanosis comes far too late.

🧠 “-emia is in the blood. Hypoxia is in the cells.”

📖 The rest of the vocabulary you will be examined on

HypoxemiaLow oxygen in the blood — PaO₂ / SaO₂ measure it.
HypoxiaNot enough oxygen at the tissues. Can occur with a normal PaO₂.
HypercapniaHigh CO₂ in the blood. Causes drowsiness, headache, flushing.
AtelectasisCollapse of alveoli — no gas exchange in the collapsed part. Very common post-op; prevented by deep breathing.
HemoptysisCoughing up blood from the lungs — bright red and frothy. Distinguish from hematemesis (vomited blood, dark, with food).
CyanosisBluish skin from poorly oxygenated blood. Central (lips, tongue) is the serious one; a LATE sign.
HyperventilationBreathing beyond what the body needs — CO₂ falls, and respiratory alkalosis follows.
HypoventilationNot moving enough air — CO₂ rises, and respiratory acidosis follows.
SputumWhat comes up from the lungs. Describe amount, color, consistency, odor and whether there is blood.
Pleuritic painSharp chest pain that is worse on breathing in. Think pleura — pleurisy, pneumonia, pulmonary embolism.
🧠 Hemoptysis = coughed and frothy. Hematemesis = vomited and dark.

⚠️ Describing sputum — it changes the diagnosis

  • Clear / white — often normal or viral.
  • Yellow or green — suggests infection.
  • Rust-colored — classically described in pneumococcal pneumonia.
  • Pink and frothy — flash pulmonary edema. This is an emergency.
  • Frank blood (hemoptysis) — report it, quantify it, and stay with the patient.
  • Thick, tenacious sputum in cystic fibrosis — “serious mucus all over the body”.
🧠 Pink and frothy = fluid, not infection. Sit them up and call.
📈

PART 2 · BREATHING PATTERNS

SEE THE SHAPE

A pattern is a diagnosis you can make from the end of the bed, before you touch anything.

📈 Every pattern, drawn on the same axis

BREATHING PATTERNS — the traces, side by side Respirograms · every trace is on the same time axis, so you can compare shape, depth and spacing UP on the trace = breathing IN · DOWN = breathing OUT · a flat line = no airflow EUPNEA normal quiet breathing 12–20 / min in a resting adult the baseline every other pattern is compared with TACHYPNEA breathing too FAST over 20 / min fever, pain, anxiety, hypoxia, sepsis, acidosis · “tachy clothes = too much going on” BRADYPNEA breathing too SLOW under 12 / min opioids and sedatives, raised intracranial pressure · “Brady Bunch = slower times” APNEA NO breathing pauses with no airflow at all sleep apnea — breathing repeatedly stops and starts; also seen at the end of life KUSSMAUL deep AND fast deep, rapid, sighing breaths the body is too ACIDIC and is blowing off CO₂ · classic in diabetic ketoacidosis CHEYNE-STOKES very deep → very shallow → pause a repeating crescendo–decrescendo cycle seen in heart failure, brain injury and commonly in the final hours of life (NOT the “death rattle”) BIOT’S / ataxic irregular, no pattern at all clusters of breaths with random pauses damage to the medulla — brainstem injury or stroke

Compare the height (depth), the spacing (rate) and the gaps (pauses). That is all a breathing pattern is.

🧠 Depth · spacing · pauses. Three things to look at, seven patterns to name.

🚨 Kussmaul respirations — deep and fast

A deep, rapid breathing pattern seen typically when the body is too acidic. The body is trying to breathe off all that CO₂.

  • Classic in diabetic ketoacidosis. May be accompanied by a fruity, acetone breath.
  • It is compensation, not the problem — the lungs are rescuing a metabolic acidosis.
  • Never sedate it or try to slow it down. Treat the acidosis.
  • Expect the ABG to show a metabolic acidosis with a falling PaCO₂.
SEE ALSO How that gas reads, step by step, on NG-092 ABG Answers.
🧠 Kussmaul = the lungs shouting at an acid problem. Deep, fast, purposeful.

⚠️ Cheyne-Stokes — the end-of-life breathing pattern

Very deep to very shallow breathing, in a repeating cycle with pauses. Most commonly seen before death, and also in advanced heart failure and brain injury.

  • The cycle: shallow → deeper → deepest → shallower → apnea → and round again.
  • Distinguish it from Biot's / ataxic breathing, which is completely irregular with no crescendo pattern and points to medullary damage.
  • Do not call this the “death rattle”. That term means something else entirely — the wet, gurgling sound of secretions pooling in the upper airway of a dying patient who can no longer swallow or cough. Cheyne-Stokes is a pattern of breathing; the death rattle is a sound.
  • At the end of life, the priority is comfort and family support, not correction. Explain what the family is seeing — it is frightening if nobody has told them.
🧠 Cheyne-Stokes has a shape. Biot's has no shape at all.

🔢 Counting a respiratory rate properly

1
Do not announce it. People change their breathing the moment they know you are watching. Count while you appear to take the pulse.
2
Count a full 60 seconds, especially if the pattern is irregular.
3
Record rate, depth, rhythm and effort — a rate alone is nearly useless.
4
Compare with their previous readings. A jump from 14 to 22 matters even though 22 is “only just” abnormal.
🧠 The respiratory rate is the most sensitive — and most commonly faked — vital sign.
🩺

PART 3 · WHERE TO LISTEN

THE MAP

Anterior — front, on the chest. Posterior — back, and it mostly assesses the LOWER lobes.

🩺 Anterior auscultation — the front

ANTERIOR AUSCULTATION — front of the chest Anterior view · numbers = the order to listen in · always compare LEFT with RIGHT at the same level bronchovesicular sounds are normal here 1 2 3 4 5 6 7 8 9 10 anterior chest · bare skin, diaphragm of the stethoscope THE ORDER — one commonly taught sequence (follow your own school’s if it differs) 1 · 2 above the clavicles — the lung apices 3 · 4 2nd intercostal space, midclavicular line 5 · 6 4th intercostal space 7 · 8 6th intercostal space 9 · 10 laterally, under the arm — mid-axillary line KEY 3 a place to put the stethoscope · the number is the ORDER the zig-zag route — side to side, never down one lung where BRONCHOVESICULAR sounds are normal TECHNIQUE — in order Position the client UPRIGHT — high Fowler’s. Point the DIAPHRAGM (the big flat part of the stethoscope) downward and press it firmly. Place it in the INTERCOSTAL SPACES — the part in between the ribs. Ribs block sound; gaps don’t. Have them breathe through the MOUTH, slowly and deeply. Listen to a full breath in AND out at each spot. Compare SIDE TO SIDE, apex to base — you are comparing, not touring. ❌ NEVER Listen through a gown or clothing — it manufactures fake crackles. Listen down one whole lung and then the other. You will miss the difference you were looking for. 🧠 “IN-tercostal = IN between” Sit up · big side of the stethoscope · in between the ribs · bare skin · compare side to side. Anterior listening mostly reaches the UPPER and MIDDLE lobes — the bases live on the back.

Position the client upright in high Fowler's, point the diaphragm — the big part of the stethoscope — downward, and place it in the intercostal spaces, the part in between the ribs.

🧠 Sit up · big side · in between the ribs · compare side to side.

🩺 Posterior auscultation — the back

POSTERIOR AUSCULTATION — the back Posterior view · this is where you assess the LOWER lobes — most of the lung mass is behind you 1 2 3 4 5 6 7 8 9 10 posterior chest · scapulae shown in outline THE ORDER — one commonly taught sequence (follow your own school’s if it differs) 1 · 2 above the scapulae — the lung apices 3 · 4 between the spine and the scapula, upper 5 · 6 between the spine and the scapula, lower 7 · 8 BELOW the scapulae — over the lung bases 9 · 10 laterally, over the bases ⭐ WHY THE BACK MATTERS MOST Most of the lung mass sits POSTERIORLY, so the back is where you assess the LOWER lobes. Fluid obeys gravity: pulmonary edema, effusions, atelectasis and early pneumonia show up at the BASES first — and the bases are on the back. WHAT YOU SHOULD HEAR WHERE VESICULAR soft, low-pitched, breezy — longer on the way IN over most of the peripheral lung fields · THE NORMAL SOUND BRONCHOVESICULAR medium pitch, equal in and out around the upper sternum and between the scapulae BRONCHIAL / TRACHEAL loud, high-pitched, hollow directly over the trachea only ⚠️ TRAP Hearing a loud, hollow BRONCHIAL sound out in the peripheral fields is ABNORMAL — dense, consolidated tissue (pneumonia) transmits it there. 🧠 “LISTEN LOW, LISTEN LAST” If you only get to listen in one place on a breathless patient, make it the BASES — posteriorly, comparing left with right. That is where the answer usually is. Absent sounds anywhere = escalate now.

The back is where you assess the lower lobes, because most of the lung mass sits behind — and it is where fluid and collapse settle first.

🧠 If you only get one look, listen to the BASES, posteriorly, both sides.

✅ Normal breath sounds — the KAPLAN question

Q: What are normal breath sounds?
A: Vesicular breath sounds — soft and low-pitched breezy sounds heard over most of the peripheral lung fields.

SoundWhere it is NORMAL
Vesicular — soft, low-pitched, breezymost of the peripheral lung fields
Bronchovesicular — medium pitch, equal in and out around the upper sternum and between the scapulae
Bronchial / tracheal — loud, high-pitched, hollowdirectly over the trachea

Trap: a bronchial sound heard out in the periphery is abnormal — dense, consolidated tissue (like pneumonia) transmits it there.

🧠 Vesicular = a breeze through leaves. Loud and hollow far out means something solid.

🥁 The other two hands-on techniques

Percussion (tapping the chest wall) and palpation (feeling it) are done alongside listening.

  • Resonant — the normal note over air-filled lung.
  • Dull — something solid or fluid underneath: consolidation (pneumonia), pleural effusion, a mass.
  • Hyperresonant — too much air: pneumothorax, or the air trapping of emphysema.
  • Tactile fremitus — the buzz you feel with the palms while the client says “ninety-nine”. Increased over consolidation (solid transmits vibration well), decreased or absent over an effusion or a pneumothorax (air and fluid do not).
  • Always compare side to side here too.
🧠 Solid transmits · air and fluid muffle. That one sentence explains percussion and fremitus.

🚨 What must be escalated straight away

  • Absent or dramatically reduced sounds over a lung field — pneumothorax, large effusion, complete collapse, or a mainstem intubation.
  • Stridor — upper airway obstruction.
  • New silence in a wheezing asthmatic — not improvement; too little air is moving to make a sound.
  • Pink frothy sputum with crackles throughout — flash pulmonary edema.
  • A new unilateral finding of any kind. Sudden asymmetry is always a red flag.
🧠 Silence is not calm. It usually means nothing is moving.
🔊

PART 4 · THE ADVENTITIOUS SOUNDS

WHAT IT MEANS

“Adventitious” just means added — a sound that should not be there. Six of them, and each one tells you where the problem is.

🔊 Every abnormal sound — shape, timing, cause, catch

ADVENTITIOUS SOUNDS — the shape AND the timing Waveforms drawn on one breath · the left half of every trace is INSPIRATION, the right half is EXPIRATION INSPIRATION EXPIRATION FINE CRACKLES (rales) SOUND discontinuous · fine popping, like rubbing hair between your fingers, or Velcro WHEN: END of inspiration · at the BASES WHY: fluid in the small airways and alveoli, or collapsed alveoli popping open SEEN IN: pulmonary edema / heart failure · pneumonia · fibrosis · atelectasis does NOT clear with a cough COARSE CRACKLES (coarse rales) SOUND discontinuous · louder, wetter, bubbling or gurgling WHEN: early inspiration AND expiration WHY: secretions sitting in the larger airways SEEN IN: bronchitis · severe pneumonia · a patient who cannot clear secretions may improve after a good cough or suctioning WHEEZES (sibilant) SOUND continuous · high-pitched, musical, whistling WHEN: mostly EXPIRATION (may be both) WHY: air squeezing through NARROWED small airways SEEN IN: asthma · COPD · bronchospasm · anaphylaxis a silent chest in a known asthmatic is worse, not better RHONCHI (sonorous wheezes) SOUND continuous · low-pitched, snoring or rumbling WHEN: mostly EXPIRATION · over the larger airways WHY: thick secretions or mucus in the LARGE airways SEEN IN: bronchitis · pneumonia · cystic fibrosis · a poor cough often CLEARS or changes after coughing STRIDOR SOUND continuous · harsh, high-pitched crowing — audible WITHOUT a stethoscope WHEN: usually INSPIRATION · loudest over the NECK WHY: obstruction of the UPPER airway — larynx or trachea SEEN IN: croup · epiglottitis · foreign body · anaphylaxis · post-extubation swelling 🚨 EMERGENCY — get help immediately, do not leave the patient PLEURAL FRICTION RUB SOUND creaking, grating — like leather or walking on fresh snow WHEN: BOTH inspiration and expiration · one localized spot WHY: inflamed pleural surfaces grinding instead of gliding SEEN IN: pleurisy · pneumonia · pulmonary embolism · after chest surgery does NOT clear with a cough · usually PAINFUL on breathing in

Two questions name almost every sound: is it continuous or crackly? and when in the breath do you hear it?

🧠 Crackles = wet · Wheeze = tight · Rhonchi = gunk · Stridor = STOP · Rub = grating.

🫁 Where in the airway each sound is actually made

WHERE EACH SOUND IS MADE Cutaway of the airway, throat to alveolus · the number of each sound marks the structure that makes it 1 STRIDOR narrowed LARYNX / TRACHEA — upper airway 2 RHONCHI thick mucus in the LARGE bronchi 3 WHEEZES squeezed, narrowed SMALL bronchioles 4 CRACKLES fluid in — or collapse of — the ALVEOLI 5 PLEURAL FRICTION RUB inflamed PLEURAL layers grinding 🧠 BIG PIPE, LOW NOTE · SMALL PIPE, HIGH NOTE Rhonchi are low and rumbling because the airway is wide. Wheezes are high and whistling because the airway is tiny. coronal cutaway · pleural layers shown in teal around the lung

Big pipe → low note. Small pipe → high note. Fluid → crackling. Rubbing surfaces → grating. The anatomy predicts the sound.

🧠 The higher up the airway, the more dangerous the sound. Stridor is the highest and the worst.

🦠 The mucus diseases — why some patients drown in secretions

  • Cystic fibrosis — “serious mucus all over the body”. Thick, sticky secretions that block airways and trap infection. These clients need daily airway clearance, not occasional.
  • Chronic bronchitis — hypersecretion plus damaged cilia, so the mucus is made faster than it can be cleared.
  • Anyone who cannot cough effectively — post-operative pain, weakness, sedation, a neurological problem, or simply age.
  • The result is the same in all of them: rhonchi and coarse crackles, air trapping behind the plugs, atelectasis, and then infection.
🧠 Thin it · move it · cough it. Hydration, positioning, then a taught cough.

⭐ The two questions that sort every sound

If it is…and you hear it…it is probably…think
crackly, discontinuousat the END of inspiration, at the basesFine crackles fluid or collapse — heart failure, pneumonia, atelectasis
crackly, wet, bubblingthrough both phasesCoarse crackles secretions they cannot clear
continuous, high, musicalmostly on the way OUTWheeze narrowed small airways — asthma, COPD
continuous, low, snoringmostly on the way OUT, and it clears with a coughRhonchi mucus in the big airways
harsh, crowing, no stethoscope neededon the way IN, over the neckStridor 🚨 upper airway obstruction — emergency
creaking, grating, painfulboth phases, one spot, no change with coughPleural rub inflamed pleura — pleurisy, PE, pneumonia

“Does it clear with a cough?” separates rhonchi (yes) from crackles and a rub (no).

🧠 Ask them to cough, then listen again. It is a free diagnostic test.
✅

PART 5 · WHAT YOU ACTUALLY DO

FROM SOUND TO ACTION

Treatment guidelines, positioning, and how to move secretions that a patient cannot shift alone.

🛋️ Position first — it is free, immediate and effective

POSITION IS A RESPIRATORY INTERVENTION Side view · why lying flat makes breathing worse, and what to do about it ① LYING FLAT supine — flat on the bed abdomen + fluid push UP into the chest Abdominal contents press UP on the diaphragm. Fluid redistributes from the legs into the chest. The lung bases cannot expand. This is why ORTHOPNEA happens: breathlessness that eases as soon as they sit up. WORST position for a breathless patient ② HIGH FOWLER’S sitting upright, back supported diaphragm free to move DOWN Sitting up at roughly 60–90°. Gravity pulls the abdominal contents DOWN. The diaphragm can descend fully. The lung bases expand and secretions drain. The default for anyone short of breath. FIRST thing to do — always ③ ORTHOPNEIC / TRIPOD over-bed table sitting up, leaning forward on the arms diaphragm free to move DOWN Sitting up and leaning FORWARD, arms supported on an over-bed table or on the knees. Fixing the shoulder girdle lets the accessory muscles pull on the ribs instead of the arms. Patients adopt it instinctively — believe them. A patient who chooses this is IN DISTRESS

Lying flat lets fluid and abdominal contents crowd the chest. Sitting up reverses both. Leaning forward on the arms lets the accessory muscles help.

🧠 Before you reach for anything, sit them up.

🤲 Chest physiotherapy — percussion, vibration and postural drainage

CHEST PHYSIOTHERAPY — the three techniques It loosens secretions and moves them into the CENTRAL airways, where a cough or suction can remove them ① PERCUSSION chest wall + lung cupped hand Cup the hand — do not slap with a flat palm. Rhythmic clapping over the affected lobe, over a thin layer of clothing, never on bare skin and never over the spine, sternum or kidneys. The vibration shakes mucus off the airway wall. ② VIBRATION chest wall + lung shake — only on the way OUT Flat hands on the chest wall, one over the other. Tense the arms and shake gently — ONLY as the client breathes OUT. Have the client COUGH after each vibration. Gentler than percussion; often better tolerated. ③ POSTURAL DRAINAGE mucus drains DOWNHILL head LOWER than the chest (as ordered) Position so the affected segment is UPPERMOST, and gravity drains it toward the big airways. Stay in each position 10–15 minutes to allow time for percussion, vibration and drainage. Stop for any dizziness, pain or breathlessness. ⏰ TIMING — get this right or they will vomit • 1 hour BEFORE meals, or 2 hours AFTER them. • Bronchodilators / nebulizers come FIRST — 30 minutes to 1 hour BEFORE the treatment. Open the airway, then clear it. “Bronchodilators before everything else.” • Perform the actions as the client EXHALES. • Have the client COUGH after each vibration. • Stay in each position 10–15 minutes. • Afterwards: oral care, and document what came up — amount, color, consistency, and how they tolerated it. 🚨 CONTRAINDICATIONS — do NOT percuss • Pregnant clients • Injury to the ribs, chest or head — including raised intracranial pressure • Recent abdominal surgery • Pulmonary embolism — a clot in the lungs • Osteoporosis — brittle bones Always check the order and your facility policy. When in doubt, use gentler measures: hydration, humidification, ambulation, position changes and effective coughing.

It loosens respiratory secretions and moves them into the central airways, where coughing or suctioning can remove them.

🧠 Bronchodilator first, then loosen, then cough, then mouth care. In that order.

🩺 Basic treatment guidelines — primary, secondary, tertiary

  • PRIMARY (prevent it): screening — subjective and objective data; lung sound assessment; health education about lifestyle, habits and vices.
  • SECONDARY (catch and treat it early): post-operative incentive spirometry; oxygen therapy; improve hydration to thin the secretions; humidification; mobilize secretions — mucolytics such as acetylcysteine, ambulation and position changes, chest physiotherapy.
  • TERTIARY (limit the damage): client education and lifestyle modification; smoking cessation.
🧠 Prevent · catch early · limit the damage. Every respiratory plan fits one of the three.

✅ Moving secretions — the whole toolkit, cheapest first

  • Hydration — the simplest mucolytic there is (unless they are fluid-restricted).
  • Humidification — dry oxygen thickens secretions and dries the airway.
  • Ambulation and position changes — movement mobilizes mucus better than almost anything.
  • Effective coughing — teach it: sit upright, lean slightly forward, take two deep breaths, then a third, and cough on the way out while splinting any incision with a pillow.
  • Incentive spirometry — slow deep inhalation, hold, relax. Ten times an hour while awake is a common instruction; follow the order.
  • Mucolytics — for example acetylcysteine, as prescribed.
  • Chest physiotherapy and, last, suctioning.
🧠 Water, movement, and a good cough beat a suction catheter almost every time.

🚭 Smoking cessation — the tertiary-prevention headline

  • It is the single most effective thing a respiratory patient can do, at any age and at any stage of disease.
  • Ciliary function begins to recover within months, so cough and secretion clearance improve even in long-standing disease.
  • Ask about it every admission, briefly and without judgment, and offer referral to a cessation service.
  • Nicotine replacement and prescribed medications are options — follow the local pathway.
  • Relapse is normal. Most people need several attempts; frame it as practice, not failure.
🧠 Ask · advise · refer. Three steps, thirty seconds, huge effect.

🗣️ Documenting and reporting a lung sound

Say four things, in this order: what · where · when in the breath · what you did.

Weak: “Chest sounds bad.”
Strong: “Fine crackles in both lower lobes posteriorly, at the end of inspiration, that did not clear with coughing. New since this morning. She's on 2 liters nasal cannula, sats 92%, respiratory rate 24 and she's using her neck muscles. I've sat her fully upright and I'm calling you now.”

🧠 What · where · when · what you did. Four beats, every time.

🎯 Cover & check — ten questions

Q1 · Define dyspnea, orthopnea and apnea. Dyspnea = difficulty breathing. Orthopnea = difficulty breathing while lying down (classic in heart failure). Apnea = no breathing at all (as in sleep apnea).
Q2 · What rate counts as tachypnea, and what as bradypnea, in an adult? Tachypnea = over 20 breaths per minute. Bradypnea = under 12.
Q3 · Describe Kussmaul respirations and say when you'd expect them. Deep, rapid breathing that appears when the body is too acidic — the lungs are blowing off CO₂. Classic in diabetic ketoacidosis.
Q4 · What is the difference between hypoxemia and hypoxia? Hypoxemia = low oxygen in the blood (measured by PaO₂ and SaO₂). Hypoxia = not enough oxygen reaching the tissues — it can happen with a normal PaO₂, as in severe anemia, shock or carbon monoxide poisoning.
Q5 · Where do you place the stethoscope, and which part do you use? In the intercostal spaces — the part in between the ribs — using the diaphragm (the big flat part), on bare skin, with the client sitting upright in high Fowler's.
Q6 · What are normal breath sounds, and where are they heard? Vesicular breath sounds — soft and low-pitched breezy sounds heard over most of the peripheral lung fields.
Q7 · Which adventitious sound is an emergency, and why? Stridor. It means the upper airway is obstructing. It is harsh, high-pitched, usually heard on inspiration and audible without a stethoscope. Get help immediately and stay with the patient.
Q8 · Which sound typically clears or changes after a cough? Rhonchi — because the mucus causing them sits in the large airways. Crackles and a pleural friction rub do not clear with coughing.
Q9 · Name five contraindications to chest percussion. Pregnancy; injury to the ribs, chest or head (including raised intracranial pressure); recent abdominal surgery; pulmonary embolism; and osteoporosis.
Q10 · When should chest physiotherapy be scheduled? 1 hour before meals or 2 hours after them, and 30 minutes to 1 hour after a bronchodilator or nebulizer — bronchodilators come before everything else. Perform the actions as the client exhales, have them cough after each vibration, and stay in each position 10–15 minutes.
🚨 STRIDOR = GET HELPHarsh, crowing, on the way IN, audible across the room. Upper airway obstruction. Do not leave the patient.
🩺 IN-TERCOSTAL = IN BETWEENUpright · diaphragm of the stethoscope · bare skin · in the spaces · compare side to side, never tour one lung.
🔊 SORT THE SOUNDSCrackles = wet · Wheeze = tight · Rhonchi = gunk (clears with a cough) · Rub = grating and painful.
📈 THE NUMBERS<12 bradypnea · >20 tachypnea · Kussmaul = deep + fast = acidosis · Cheyne-Stokes = deep→shallow→pause.
😰 RESTLESSNESS FIRSTThe earliest sign of hypoxia is restlessness and anxiety. Cyanosis is a LATE sign — do not wait for it.
🤲 PHYSIO ORDERBronchodilator first · 1 hr before or 2 hrs after meals · act on the exhale · cough after each vibration · 10–15 min per position.