We know the minimal polynomial $\sqrt{2+\sqrt{2}}$ over $\mathbb{Q}$ is $x^4-4x^2+2$ which by Eisenstein is irreducible, thus $\left|\mathbb{Q} \left[\sqrt{2+\sqrt{2}}\right]:\mathbb{Q}\right| = 4$, then by tower law $$\left|\mathbb{Q}\left[\sqrt{2+\sqrt{2}}\right]:\mathbb{Q}\right| =\left|\mathbb{Q}\left[\sqrt{2+\sqrt{2}}\right]:\mathbb{Q}[\sqrt{2}]\right| \Big|\mathbb{Q}[\sqrt 2] : \mathbb{Q}\Big|$$ which shows $\left|\left[\sqrt{2+\sqrt{2}}\right]:\mathbb{Q}[\sqrt{2}]\right| = 2$.
Is there an elemetary way of showing $$\sqrt{2+\sqrt{2}} \neq p + q\sqrt 2 \;\text{ for } p,q \in \mathbb{Q}?$$
And generally, is it true that $\sqrt{a+\sqrt{b}} \not\in \mathbb{Q}[\sqrt b]$ for (let us assume) $a\geq 0$ and $b$ is prime?
Supposing otherwise, this implies that $\sqrt{2+\sqrt{2}}=p+q\sqrt{2}$. for some $p,q\in \mathbb{Q}$. This gives:
$$2+\sqrt{2}=p^2+2pq\sqrt{2}+2q^2,$$
or,
$$\sqrt{2}=\frac{p^2+2q^2-2}{1-2pq}=\frac{a}{b},$$
where $a,b$ are integers. Note that if $1-2pq=0$, then from the above this implies that $2+\sqrt{2} = p^2+\sqrt{2}+2q^2$, or $2 = p^2+2q^2$. This implies $2|p^2$, which is ludicrous since $\sqrt{2}$ is irrational and $2q^2>0$, so $p\geq 2$.
But this is impossible, as $\sqrt{2}$ is irrational.
More generally,
$$\sqrt{b} = \frac{p^2+q^2b-a}{1-2pq}=a’/b’,$$
and again from the fact that $\sqrt{b}$ is irrational for non-square $b$, the result follows. You'll have to again double check that 1-2pq\neq 0$ by similar methods.