NLE Respiratory Nursing — Respiratory Assessment & DiagnosticsConcept Map

Concept

Physical Assessment

Sub Concepts

• Inspection (rate, rhythm, depth, effort)
• Palpation (tactile fremitus)
• Percussion (resonance, dullness, hyperresonance)
• Auscultation (normal and adventitious breath sounds)

Relationship To Central

Foundation of respiratory evaluation using systematic examination techniques

Concept

Arterial Blood Gas (ABG) Analysis

Sub Concepts

• Normal values (pH, PaCO2, HCO3, PaO2, SaO2)
• ROME interpretation method
• Acid-base disturbances (respiratory/metabolic, acidosis/alkalosis)
• Compensation mechanisms

Relationship To Central

Primary diagnostic tool for measuring oxygenation, ventilation, and acid-base balance

Concept

Pulmonary Function Tests (PFTs)

Sub Concepts

• Obstructive disease patterns (asthma, COPD)
• Restrictive disease patterns (pulmonary fibrosis)
• FEV1/FVC ratio
• Peak expiratory flow rate (PEFR)

Relationship To Central

Objective measurement of lung function and disease classification

Concept

Chest Imaging

Sub Concepts

• Chest X-ray findings (consolidation, hyperinflation, pneumothorax)
• Equipment placement confirmation (ETT, central lines)
• Pre-imaging nursing responsibilities

Relationship To Central

Radiographic visualization of thoracic structures and pathology

Concept

Oxygen Therapy & Delivery Devices

Sub Concepts

• Low-flow systems (nasal cannula, face masks, rebreather masks)
• High-flow systems (Venturi mask)
• FiO2 ranges and clinical applications
• COPD oxygen management and hypoxic drive

Relationship To Central

Therapeutic intervention based on oxygenation status and patient needs

Concept

Pulse Oximetry (SpO2)

Sub Concepts

• Normal values (95-100%)
• Limitations and false readings
• Difference between saturation and ventilation

Relationship To Central

Non-invasive continuous monitoring of oxygen saturation

Concept

Closed Chest Drainage (Water-Seal) Systems

Sub Concepts

• Three-chamber system components (collection, water-seal, suction)
• Normal findings and troubleshooting
• Air leak detection and management
• Emergency complications (dislodgment, disconnection)

Relationship To Central

Therapeutic management of pneumothorax, pleural effusion, and hemothorax

Concept

Nursing Priorities & Safety

Sub Concepts

• Airway management hierarchy
• Positioning strategies for gas exchange
• Monitoring and trend analysis
• Prevention of complications (oxygen toxicity, tension pneumothorax)

Relationship To Central

Clinical decision-making framework aligned with RA 9173 nursing practice standards

To

Auscultation

From

Physical Assessment

Strength

strong

Relationship

Auscultation is the final and most diagnostically rich component of physical assessment; breath sounds directly indicate respiratory pathology

To

Nursing Diagnoses

From

Auscultation

Strength

strong

Relationship

Adventitious sounds (crackles, wheezes, stridor) form the basis for respiratory nursing diagnoses such as Ineffective Airway Clearance and Impaired Gas Exchange

To

Oxygen Therapy

From

Arterial Blood Gas Analysis

Strength

strong

Relationship

ABG results (particularly PaO2 and pH) directly guide oxygen delivery device selection and flow rate adjustment; ABG interpretation determines adequacy of current therapy

To

COPD Management

From

Oxygen Therapy

Strength

strong

Relationship

COPD patients require special oxygen management with Venturi mask at SpO2 target 88-92% to avoid suppressing hypoxic drive and causing CO2 retention

To

Arterial Blood Gas Analysis

From

Pulse Oximetry

Strength

moderate

Relationship

SpO2 measures saturation only; when SpO2 trends concern the nurse or with acute changes, ABG is required to assess ventilation (PaCO2) and acid-base status

To

Obstructive vs Restrictive Disease Classification

From

Pulmonary Function Tests

Strength

strong

Relationship

FEV1/FVC ratio is the gold standard for distinguishing obstructive disease (ratio <70%) from restrictive disease (normal/high ratio); determines underlying mechanism

To

Physical Assessment

From

Chest X-Ray

Strength

moderate

Relationship

Chest X-ray findings (consolidation, hyperinflation, pneumothorax) correlate with and confirm physical assessment findings (dullness, hyperresonance, absent breath sounds)

To

Pneumothorax Management

From

Chest Tube Systems

Strength

strong

Relationship

Water-seal chest tubes are the definitive treatment for pneumothorax; proper management prevents complications like tension pneumothorax and re-expansion pulmonary edema

To

Physical Assessment

From

Nursing Priorities

Strength

strong

Relationship

Continuous respiratory assessment using inspection, palpation, percussion, auscultation enables early detection of deterioration and guides intervention timing

To

Work of Breathing

From

Inspection

Strength

strong

Relationship

Assessment of accessory muscle use, retractions, nasal flaring, and tripod positioning indicates severity of respiratory distress and need for intervention escalation

To

Pleural Effusion Detection

From

Percussion

Strength

moderate

Relationship

Dullness on percussion over lung bases with blunted costophrenic angles on X-ray confirms pleural effusion; physical finding guides diagnostic imaging

To

Fluid in Alveoli

From

Crackles

Strength

strong

Relationship

Crackles are the clinical hallmark of fluid within alveoli; heard in pneumonia, pulmonary edema, and heart failure; guides nursing diagnosis and intervention

To

Airway Obstruction

From

Wheezes

Strength

strong

Relationship

Wheezes indicate narrowed airways from bronchospasm or secretions; primary findings in asthma and COPD exacerbation; guides bronchodilator therapy decisions

To

Upper Airway Emergency

From

Stridor

Strength

strong

Relationship

Stridor heard without stethoscope indicates upper airway obstruction and is a medical emergency requiring immediate airway assessment and intervention

To

Clinical Decision Making

From

ROME Method

Strength

strong

Relationship

Systematic ROME interpretation (Respiratory Opposite, Metabolic Equal) enables rapid identification of acid-base disorder type and guides targeted interventions

To

Acid-Base Severity Assessment

From

Compensation Mechanism

Strength

moderate

Relationship

Presence of compensation indicates chronic disorder; absence of compensation suggests acute condition; determines urgency of intervention

To

FiO2 Requirements

From

Oxygen Delivery Device Selection

Strength

strong

Relationship

Device choice is determined by required FiO2; low-flow systems suit stable patients; high-flow systems (Venturi, non-rebreather) suit acute hypoxemia

To

High-Flow Oxygen

From

Humidification

Strength

moderate

Relationship

Flows above 4 L/min require humidification to prevent mucosal drying, nosebleeds, and skin breakdown behind ears; standard safety practice

To

Radial Artery Safety

From

Allen Test

Strength

strong

Relationship

Allen test confirms adequate collateral circulation from ulnar artery before radial ABG draw; negative test mandates alternative site to prevent hand ischemia

To

Hematoma Prevention

From

Post-Sampling Pressure Application

Strength

strong

Relationship

Minimum 5 minutes firm direct pressure (longer if anticoagulated) prevents hematoma formation at arterial puncture site; critical patient safety measure

To

Asthma Control Assessment

From

Peak Expiratory Flow Monitoring

Strength

strong

Relationship

Traffic-light zone system (green ≥80%, yellow 50-79%, red <50% of personal best) guides patient self-management and determination of exacerbation severity

To

Chest Tube Function

From

Tidaling

Strength

strong

Relationship

Gentle tidaling (fluctuation with respiration) in water-seal chamber is normal; sudden loss may indicate lung re-expansion or obstruction; guides assessment

To

Chest Tube Troubleshooting

From

Air Leak Detection

Strength

strong

Relationship

Continuous bubbling in water-seal indicates air leak; clamp test determines if leak is patient-side or system-side; guides corrective action

To

System Function

From

Chest Tube Positioning

Strength

strong

Relationship

Drainage system must remain below chest level at all times; elevation risks backflow of drainage into pleural space and undoes therapeutic effect

To

Dislodged Tube Management

From

Emergency Dressing

Strength

strong

Relationship

Sterile occlusive dressing taped on 3 sides only (not all 4) acts as flutter valve to allow air escape while preventing re-entry; critical to prevent tension pneumothorax

To

Early Deterioration Detection

From

Monitoring Trends

Strength

strong

Relationship

Consistent observation of declining SpO2, rising respiratory rate, and rising CO2 signals muscle fatigue and impending respiratory failure; guides escalation of care

To

COPD Oxygen Management

From

Hypoxic Drive

Strength

strong

Relationship

Chronic CO2 retention in COPD creates hypoxic drive to breathe; excess oxygen suppresses this drive and causes dangerous CO2 accumulation; therefore target SpO2 88-92%