Respiratory Nursing for NCLEX: Assessment Techniques, Oxygen Therapy & ABG Analysis
NCLEX respiratory nursing review. Master breath sound assessment, oxygen delivery systems, ABG interpretation, and respiratory interventions.
Respiratory Nursing Assessment and Interventions for NCLEX
Respiratory assessment and intervention questions are core components of the NCLEX exam. Mastering these topics prepares you for questions about oxygen therapy, airway management, and arterial blood gas interpretation.
Respiratory Assessment
Assess respiratory rate (normal 12-20 breaths per minute in adults), depth, rhythm, and effort. Observe for accessory muscle use, nasal flaring, and retractions, which indicate respiratory distress. Auscultate breath sounds systematically, comparing bilateral sides. Normal breath sounds include vesicular (soft, over peripheral lung fields), bronchovesicular (moderate, over mainstem bronchi), and bronchial (loud, over trachea). Adventitious sounds include crackles (fluid or atelectasis), wheezes (narrowed airways), rhonchi (mucus in large airways), and stridor (upper airway obstruction, an emergency sign).
Oxygen Delivery Systems
Low-flow systems include nasal cannula (1-6 L/min, delivering 24-44% FiO2), simple face mask (5-8 L/min, 40-60% FiO2), partial rebreather mask (6-10 L/min, 60-75% FiO2), and non-rebreather mask (10-15 L/min, 80-100% FiO2). The non-rebreather delivers the highest concentration of any low-flow device. High-flow systems include the Venturi mask, which delivers precise FiO2 concentrations, making it ideal for COPD patients who require controlled oxygen to avoid suppressing their hypoxic drive. For COPD patients, maintain SpO2 at 88-92% and use low-flow oxygen (1-2 L/min).
ABG Interpretation
Normal values: pH 7.35-7.45, PaCO2 35-45 mmHg, HCO3 22-26 mEq/L, PaO2 80-100 mmHg. Step 1: Check pH (acidosis or alkalosis). Step 2: Check PaCO2 (respiratory component). Step 3: Check HCO3 (metabolic component). Step 4: Determine compensation. If pH is abnormal and only one component matches, it is uncompensated. If both components are abnormal but pH is still outside normal range, it is partially compensated. If pH is within normal range with abnormal PaCO2 and HCO3, it is fully compensated.
Priority Interventions
For respiratory distress: position the patient upright (high Fowler), administer oxygen as ordered, prepare for intubation if deteriorating, suction secretions as needed, and monitor SpO2 continuously. For asthma exacerbation, administer bronchodilators (albuterol) before corticosteroids. Study more with our clinical nursing flashcards and ABG interpretation cheat sheets.