Nursing Care of Clients Nursing Care of Clients With Altered Ventilatory With Altered Ventilatory Function Function

ST.
PAUL UNIVERSITY PHILIPPINES

TUGUEGARAO CITY, CAGAYAN 3500
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
COLLEGE OF NURSING

SECOND SEMESTER, AY 2022-2023

BACHELOR OF SCIENCE IN NURSING - LEVEL IV

NCM 118 - CARE OF CLIENTS WITH LIFE-THREATENING CONDITIONS
NURSING CARE OF CLIENTS

WITH ALTERED VENTILATORY
FUNCTION
W
ITH
PRESENTATION OUTLINE
LIF
E-
TH
NURSING CARE OF CLIENTS WITH ALTERED
RE
AT
VENTILATORY FUNCTION
EN
IN
G
A. Assessment
CO
ND
- Subjective Data
ITI
ON
- Objective Data
S
B. Nursing Diagnoses
CA
RE
C. Planning for Health Restoration and Maintenance
OF
- Client Positioning
CL
IEN
- Preventing Desaturation
TS
- Promoting Secretion Clearance
W
ITH
- Patient Education
LI
- Optimizing Oxygenation And Ventilation
- Preventing Atelectasis
EN
TA
PRESENTATION OUTLINE
ND
TR
AN
SC
NURSING CARE OF CLIENTS WITH ALTERED
UL
TU
VENTILATORY FUNCTION
RA
LN
UR
D. Implementation
SI
NG
- Medical/Surgical Management
DE
- Pharmacologic Management
CE
NT
- Complementary and Alternative Medicines
EM
- Nutritional and Diet Therapy
PL
OY
E. Client Education
M
EN
F. Evaluation
TA
ND
A ASSESSMENT

SUBJECTIVE DATA

subjective data
Important Health Information

Functional Health Patterns

Important Health Information
Past Health History
Medications
Surgery or Other Treatments

functional health patterns
Health Perception- Health Management Pattern
Nutritional Metabolic Pattern
Elimination Pattern
Activity-Exercise Pattern
Sleep-Rest Pattern
Cognitive-Perceptual Pattern
Self-Perception - Self concept Pattern
Sexuality-Reproductive Pattern
Coping-Stress Tolerance Pattern
Value-Belief Pattern
OBJECTIVE DATA
objective data
Physical Assessment
Diagnostic Assessment

physical assessment
1.Vital signs
Temperature
Pulse
Respiration
Blood Pressure
Oxygen Saturation
physical assessment
2. Four Techniques
Inspection
Palpation
Percussion
Auscultation

Diagnostic Assessment
Non-Invasive-oximetry
Invasive
-ABG -Pulmonary Angiography
-Pulmonary -Ventilation-Perfusion(V/Q) Scan
-Capillary Wedge Pressure -Capnography
-Pleural Fluid Analysis

Non-invasive-oximetry

invasive
ARTERIAL BLOOD GASES
Arterial blood is obtained through puncture of

radial or femoral artery or through arterial catheter.
It is performed to assess acid-base balance,
ventilation status, need for oxygen therapy, change
in oxygen therapy or in ventilator settings.

invasive
CAPILLARY WEDGE PRESSURE
Also called pulmonary arterial wedge pressure (PAWP),
pulmonary capillary wedge pressure (PCWP), pulmonary
artery occlusion pressure (PAOP), or cross-sectional pressure,
is the pressure measured by wedging a pulmonary artery
catheter with an inflated balloon into a small pulmonary
arterial branch. It estimates the left atrial pressure.

invasive
PLEURAL FLUID ANALYSIS
Found in the thin space between the lungs and the
tissue covering the lungs. Pleural fluid testing
involves removing a sample of this fluid so that it
can be analyzed using one or more laboratory
methods. Testing is used to diagnose the cause of
an abnormal buildup of pleural fluid, which is called
a pleural effusion.


invasive
VENTILATION
The movement of air in and out of the lungs
through a patent airway. The majority of

observations regarding ventilation focus on

the movements of the chest.

invasive
PERFUSION (V/Q SCAN)
A ventilation–perfusion (VQ) scan is a nuclear
medicine scan that uses radioactive material
(radiopharmaceutical) to examine airflow (ventilation)

and blood flow (perfusion) in the lungs. The aim of the

scan is to look for evidence of any blood clot in the
lungs, called pulmonary embolism.


invasive
CAPNOGRAPHY
Refers to the invasive measurement of the partial
pressure of carbon dioxide (CO2) in exhaled breath
expressed as the CO2 concentration over time. The
relationship of CO2 concentration to time is
graphically represented by the CO2 waveform, or
capnogram.
NURSING
B
DIAGNOSES
NURSING DIAGNOSES FOR
PATIENTS WITH
ALTERED VENTILATORY
FUNCTION
INefFECTIVE AIRWAY CLEARANCE
related to excessive tenacious
secretions
a common NANDA-I nursing diagnosis for pneumonia .This
diagnosis is related to excessive secretions and ineffective
cough or nonproductive coughing. Inflammation and
increased secretions in pneumonia make it difficult to
maintain a patent airway.

IMPAIRED GAS EXCHANGE RELATED
TO ACTIVITY INTOLERANCE
Impaired Gas Exchange is a NANDA nursing diagnosis
that is used for conditions where there is an
alteration in the balance between the exchange of
gases in the lungs.

anxiety related to
breathlessness
This nursing care plan is for patients with anxiety.
According to Nanda the definition for anxiety is the state in
which an individual or group experiences feelings of
uneasiness or apprehension and activation of the
autonomic nervous system in response to a vague,
nonspecific threat.

powerlessness related to
feelings of loss of control
This nursing care plan is for patients who are
experiencing powerlessness. According to Nanda, the
definition of powerlessness is a state in which an
individual or group perceives a lack of personal control
over certain events or situations, which affects outlook,
goals, and lifestyles.
high risk for ineffective therapeutic
regimen management related to lack
of knowledge
Perception that one's own actions will not significantly
affect an outcome; a perceived lack of control over a
current situation or immediate happening

C PLANNING

HEALTH RESTORATION AND

MANAGEMENT
PATIENT POSITIONING
What is Patient Positioning?
involves properly maintaining a patient’s neutral body
alignment by preventing hyperextension and extreme lateral
rotation to prevent complications of immobility and injury.
In most settings, proper positioning of patients provides airway

management and ventilation, maintains body alignment, and
provides physiologic safety.

PATIENT POSITIONING
Goals of Patient Positioning
The ultimate goal of proper patient positioning is to safeguard the

patient from immobility injury and physiological complications.
Specifically, patient positioning goals include:
Provide patient comfort and safety
Maintaining patient dignity and privacy
Allows maximum visibility and access

PATIENT POSITIONING
Positions to relieve breathlessness and reduce the effort of
breathing:
High Side Lying
Forward Lean Sitting w/o Pillows
Forward Lean Sitting with Pillows
Upright Sitting in the Chair
Forward Lean Standing
Standing with Back Support

PATIENT POSITIONING
ACUTE & CHRONIC OBSTRUCTIVE PULMONARY DISEASE
is a progressive disease in which
shortness of breath is a common
symptom
The tripod position helps to lower

diaphragm and open lung space
to decrease shortness of breath

PATIENT POSITIONING
ACUTE & CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Leaning forward in the tripod position takes some of
the pressure of breathing off our lungs. The effort of the
diaphragm is increased in this position, and gravity
helps the muscle to move down and increase the
space in our thoracic cavity. The thoracic cavity houses
our lungs, and the extra space around the lungs from
this position helps them expand more, releasing
carbon dioxide and increasing oxygen intake.

PATIENT POSITIONING
a blood clot that blocks and stops
PULMONARY EMBOLISM
blood flow to an artery in the lung
The Left Lateral Decubitus and

Trendelenburg position. This helps to
prevent air from traveling through
the right side of the heart into the
pulmonary arteries, leading to right
ventricular outflow obstruction (air
lock).

PATIENT POSITIONING
ACUTE RESPIRATORY DISTRESS SYNDROME
RESPIRATORY FAILURE a serious lung condition that causes low
blood oxygen. a serious condition that
makes it difficult to breathe on your own.
Hospitalized patients typically lie on

their backs, a position known as supine
while prone positioning is generally
used for patients who require a
ventilator (breathing machine)

PATIENT POSITIONING
PNEUMONIA an infection that inflames the air sacs in
one or both lungs.
Semi-upright position improves

ventilation and oxygenation in
mechanically ventilated intensive
care patients

PATIENT POSITIONING
PULMONARY HYPERTENSION
the pressure in the blood vessels leading
from the heart to the lungs is too high
Semi-upright position improves

ventilation and oxygenation in
mechanically ventilated intensive
care patients

PATIENT POSITIONING
Fowler's position is used for
patients who have difficulty
breathing because, in this position,
gravity pulls the diaphragm
downward allowing greater chest
and lung expansion

Preventing Desaturation
What is considered oxygen desaturation?
Oxygen saturation of 95 to 100 percent is usually considered

normal in healthy adults and children. Below 95 percent is
considered abnormal. If our oxygen saturation falls below 89
percent, supplemental oxygen is usually needed.

What are the causes of respiratory desaturation?
Respiratory desaturation can happen suddenly or develop over

time. Possible underlying causes of respiratory desaturation
include:
low levels of oxygen in the air
problems with our lungs’ ability to inhale air
problems with our blood’s ability to circulate to our lungs

What can you do to prevent hypoxemia?
Manage health conditions. If a patient has a health

condition that can potentially cause hypoxemia, like asthma
or sleep apnea, ensure that it’s being properly managed or
treated.
Avoid exposure to air pollution. Long-term exposure to
pollutants like secondhand smoke or chemical fumes can
harm our lungs.

What can you do to prevent hypoxemia?
Prevent infections. A variety of infections can lead to

pneumonia, which can cause hypoxemia.
Make healthy lifestyle choices. Adopting healthy lifestyle
habits can improve our health and reduce our risk of
some health conditions that can cause hypoxemia.

How is desaturation treated?
Inhaled steroids that can open up your airways to treat

asthma or other lung disease.
Medications that help to reduce excess fluid on the
lungs (diuretics).
Continuous positive airways pressure mask (CPAP) to
treat sleep apnea.

How is desaturation treated?
BiLevel positive airway pressure to treat COPD or and some kinds

of sleep apnea.
Supplemental oxygen to treat ongoing (chronic) hypoxia. An
oxygen delivery device is attached to your nose with a mask or
tubes to increase the amount of oxygen getting into your lungs
and down to your alveoli.
Mechanical ventilation in a hospital, in circumstances of severe
acute hypoxia (sudden onset).

Promoting Secretion Clearance
What are airway clearance techniques?
Airway clearance techniques (ACTs) are ways to loosen thick,
sticky mucus so it can be coughed up and cleared out of the lungs.
The term airway clearance techniques (ACTs) refers to a variety of
different strategies used to eliminate excess secretions. Their aim is
to reduce airway obstruction caused by secretions occupying the
airway lumen and so prevent respiratory tract infections, re-expand
the collapsed areas of the lung, thus improving gas exchanges and
decreasing the inflammatory response.

Though clinicians may recommend many different airway
clearance techniques, this list consists of five popular methods for
treating a variety of chronic lung conditions.
High Frequency Chest Wall Oscillation (HFCWO) Therapy

Coughing and Huffing
Oscillating Positive Expiratory Pressure (OPEP)
Manual Chest Physiotherapy (CPT)
Postural Drainage

High Frequency Chest Wall Oscillation (HFCWO) Therapy
HFCWO therapy offers an effective,
easy-to-manage (and monitor)
treatment option. Also known as a
respiratory vest or vest therapy, this
airway clearance therapy works by
delivering repeated pulses of air that
gently squeeze and release the upper
body.

COUGHING & HUFFING
This airway clearance technique is
most effective when performed
before and after your HFCWO therapy
to effectively clear mucus from the
airways. The technique is similar to
breathing on a pair of eyeglasses to
clean them. The routine takes practice
and should be repeated 2-3 times

Oscillating Positive Expiratory Pressure (OPEP)
OPEP is a hand-held device that
creates resistance and vibration to
help break down and clear mucus
from the airways and is most effective
when paired with huff cough

Manual Chest Physiotherapy (CPT)
Manual CPT is an airway clearance
technique that requires the
assistance of a caregiver or
respiratory therapist. To perform, the
patient gets in different positions
while a trained individual manually
claps on the chest wall to help clear
the lungs of mucus build up.

POSTURAL DRAINAGE
a technique that involves
laying/ sitting in certain
positions to drain secretions
from your airways using
gravity.

PATIENT EDUCATION
Encourage sustained deep breaths
techniques
1. using demonstration: highlighting slow

inhalation, holding end inspiration for a
few seconds, and passive exhalation
2. utilizing incentive spirometer
3. requiring the patient to yawn

PATIENT EDUCATION
Instruct patient to be in proper body
alignment for maximum breathing
pattern.
A sitting position permits maximum lung

excursion and chest expansion.

PATIENT EDUCATION
Educate patient about medications:
indications, dosage, frequency, and
possible side effects. Incorporate
review of the metered-dose inhaler and
nebulizer treatments, as needed.
Promotes safe and effective medication

administration.

PATIENT EDUCATION
Encourage frequent rest periods and
teach the patient to pace activity.
Extra activity can worsen shortness of

breath. Ensure the patient rests between
strenuous activities

PATIENT EDUCATION
Educate patient or significant other on
proper breathing, coughing, and
splinting methods.
These allow sufficient mobilization of

secretions.

OPTIMIZING OXYGENATION AND
VENTILATION
Recruitment Maneuvers
Recruitment maneuvers represent an attempt to open the
atelectatic distal airways and alveoli on the border of the collapsed
flooded alveoli using sustained increases in airway pressure. The
maneuver is accomplished by increasing the PEEP to 35 to 60 cm
H2O and holding that level of pressure for approximately 30 seconds.

VENTILATION
Positioning in ARDS
The prone position has been shown to improve oxygenation in some
patients with ARDS. This position is felt to be more physiologic and
results in improved secretion removal, ventilation-perfusion
matching, and better aeration of the dorsal lung units. The prone
position may also prevent the heart from collapsing the left lower
lobe and enhance the recruitment effects of PEEP by stabilizing the
more flexible ventral chest wall.
VENTILATION
Surfactant Replacement Therapy
Surfactant abnormalities may be present in patients with ARDS
related to decreased production, inactivation by alveolar proteins
and proteolytic enzymes, and dilution by the alveolar fluid.
To counter these abnormalities, surfactant replacement has been
evaluated in patients with ARDS.

VENTILATION
Enhanced Edema Clearance
Fluid in the alveolus may worsen gas exchange and pulmonary
mechanics, and increase the work of breathing.
The BALTI (Beta-Agonist Lung Injury) trial evaluated the use of
intravenous salbutamol in patients with ALI and demonstrated a
significant decrease in extravascular lung water, lower end-inspiratory
plateau pressures, and a trend toward a lower Murray Lung Injury
Score

PREVENTING ATELECTASIS
Percuss on the chest to loosen mucus plugs in the airway.
Deep breathing exercises
Remove or relieve any blockage in the airways by
bronchoscopy.
Tilt the patient so the head is lower than the chest (called
postural drainage).
Turn the patient <<<< to lie on the healthy side, allowing the
collapsed area of lung to re-expand.
Use inhaled medicines to open the airway.

D IMPLEMEN
TATION
1. Medical/Surgical
Management
DECENT EMPLOYMENT AND TRANSCULTURAL NURSING

mobilization of secretions
Airway Clearance Therapy
it uses non-invasive techniques to help mobilize and remove
secretions in order to improve Gas Exchange.
It includes:
-Chest Physiotherapy
- Postural Drainage

Chest Physiotherapy
-is an airway clearance technique that typically
involves the assistance of another individual to
manually perform chest percussion on a patient’s chest
wall.
-it involves striking the lungs manually with your hands

with a cuffed hand.

Chest Physiotherapy Indications
Cystic Fibrosis
Atelectasis
Bronchiectasis
Foreign Body Obstruction
Lung abscess
Neuromascular Diseases

Chest Physiotherapy Contra Indications
Head, neck, or spinal injury
Hemodynamic instability
Increased Intracranial pressure
Hemoptysis
Rib fractures or flail chest
Vertebral fractures
Osteoporosis

Postural Drainage
it is a form of airway clearance therapy that involves
placing the patient's body in various positions in
order to drain secretions from the long segments
into the central airway using gravity the secretions
can be removed via cuff or suctioning.

Postural Drainage
involves placing the patient in various positions to
drain secretions from specific lung segments into
the central airways. The technique uses gravity to
mobilize secretions for removal by coughing or
suctioning.

Postural Drainage Indications
Cystic Fibrosis
Atelectasis
Bronchiectasis
Foreign Body Obstruction

Postural Drainage Contra Indications
Head, neck, or spinal injury
Hemodynamic instability
Increased Intracranial pressure
Hemoptysis
Pulmonary Edema as result of CHF
Pleural Effusion
Flail Chest

Postural Drainage Positions

artificial airway management
Artificial Airway
-mechanical device used for securing unobstructed
respiration when the patient is not breathing or is
otherwise unable to maintain a clear passage, such
as during general anesthesia or respiratory arrest.

indications OF artificial
airway
To facilitate mechanical ventilation
To protect the airway, and prevent aspiration
To facilitate suctioning
To relieve upper airway obstruction

routes FOR ARTIFICIAL AIRWAYS
Oral Pharyngeal Airway – inserted into the mouth
Nasal Pharyngeal Airway – inserted into the nose

types OF PHARYNGEAL AIRWAYS
1. Oropharyngeal Airways
-Device designed for insertion along the tongue
until the teeth /or gingiva limit the insertion.
- it isused to maintain or open the airway by stopping
the tongue from covering the epiglottis. In this
position, the tongue may prevent an individual from
breathing.

Hazards of Oropharyngeal Airway
If too small, may not displace tongue or may
cause tongue to obstruct airway or may aspirated
It too large, may cause epiglottis impaction
Roof of mouth may be lacerated upon insertion
Aspiration from intact gag reflex

2. Nasopharyngeal Airway
- This is a hollow tube placed through the nose into
the nasopharynx to bypass upper airway obstruction
or to decrease trauma from nasotracheal suctioning.
-Useful for patient with a soft tissue obstruction

who have jaw injury or spasm of jaw muscles

Contraindications of Nasopharyngeal Airway
Nasal trauma
Space occupying lesion
Skull fracture
Deformities of the nose
Coagulation Disorders

types of Tracheal Airways
1. Endotracheal Tubes (nasal or oral)
- catheter that is inserted into the trachea for the
primary purpose of establishing and maintaining a
patent airway and to ensure the adequate exchange
of oxygen and carbon dioxide.

2. Nasotracheal Tube
- one of the commonest methods used to induce
anaesthesia for surgeries of the head and neck
region.
-Requires a longer and more flexible tracheal tube
-Is the route of choice in special situations such as
when the oral route is unavailable.

3. Tracheostomy Tube
- creation of an opening into the trachea through
the neck, with insertion of an indwelling tube to
facilitate passage of air or evacuation of secretions.
- prevent or treat long-term respiratory failure

Complications and Hazards of Tracheostomies
Postsurgical bleeding
Infection
Mediastinal emphysema
Pneumothorax
Subcutaneous emphysema
Stoma collapse (should not be moved or changed
first 36 hours)

4. Esophageal Obturator Airway(EOA)
- a device designed for use in the management of
cardiopulmonary arrest, obstructs the esophagus
while simultaneously ventilating the lungs.

administering oxygen therapy
Oxygen Therapy
-Oxygen therapy is a treatment that delivers extra
oxygen to the lungs when the level of oxygen in the
blood is too low.
Purpose
-increase oxygen saturation in tissues where the
saturation levels are too low due to illness or injury.

Oxygen Therapy is used to treat:
Sever respiratory distress

Severe Trauma
COPD
Pulmonary Hypertension
Acute Myocardial Infarction

Classifications of oxygen
delivery system
Low flow system
-contribute partially to inspired gas client breathes
ex: nasal cannula, simple mask, non-breather mask, partial rebreather
mask
High flow systems

-Deliver specific and constant percent of oxygen independent of
client’s breathing
Ex: Venturi mask,, trach collar, T-piece

Methods of oxygen
administration
Nasal Cannula
- Amount Delivered Fio2 (Fraction Inspired Oxygen)
Low flow- 24-44 %, 1 Lmin=24%, 2 Lmin=28%
3 Lmin=32% 4 Lmin=36% 5 Lmin=40% 6 Lmin=44%

Advantages
Client able to talk and eat with oxygen in place

Easily used in home setting
Safe and simple
Easily tolerated
Delivers low concentrations

Disadvantages
Unable to use with nasal obstruction

Drying to mucous membranes, so flow greater
than 4 L/min needs to be humidified
Can dislodge from nares easily
Causes skin irritation or breakdown over ears or at
nares
Not good for mouth breathers
Patient’s breathing pattern affects exact FIO2

MECHANICAL VENTILATION
is a medical intervention used to provide

breathing support to patients who are unable to
breathe effectively on their own.

MECHANICAL VENTILATION

two types of mechanical
ventilation
Invasive ventilation- is a tube inserted into the patient’s
airway, performed in the intensive care unit in the hospital.
Noninvasive ventilation- can be used at home by people
with respiratory difficulties.
NCM 118 - Care of Clients with Life-Threatening Conditions

two types of mechanical
ventilation
Non-invasive ventilation Invasive ventilation

indications of mechanical
ventilation
Acute respiratory failure
Impending respiratory failure
-hypoxemia
-severe respiratory acidosis
Reduce myocardia oxygen consumption
-myocardial infarction
Prevent or reverse atelectasis
Stabilize the chest wall (trauma)
Provide sedation or paralysis for a procedure
CONTRAindications of
mechanical ventilation
Pneumothorax (untreated)
Patient/Family refusal
medical futility

MEDICAL management
Monitoring: Frequent monitoring of the patient's respiratory status,
including oxygen saturation, end-tidal carbon dioxide, and ventilator
settings is essential.
Ventilator settings: The ventilator settings should be adjusted to
maintain adequate oxygenation and ventilation while minimizing the
risk of complications such as barotrauma or volutrauma.
Sedation and analgesia: Sedation and analgesia may be necessary
to help the patient tolerate mechanical ventilation and reduce the
risk of complications such as agitation or delirium

MEDICAL management
Nutritional support: Adequate nutritional support is essential to
support the patient's metabolism and promote healing.
Physical therapy: Physical therapy can help prevent muscle
weakness, improve lung function, and facilitate weaning from
mechanical ventilation
Regular follow-up: Regular follow-up appointments with the
healthcare team are essential

THORACIC SURGERY
Refers to surgical procedures performed on the chest,

including the lungs, heart, esophagus, and other structures
Have a significant impact on the respiratory system and can
lead to respiratory failure if not managed appropriately.

THORACIC SURGERY

indications of THORACIC
SURGERY
Bleeding
Hemothorax
Circulatory arrest
Lung resection
Pericardial effusion

contraindications of THORACIC
SURGERY
Inability to tolerate single-lung ventilation
Pulmonary lesion invading the mediastinum or chest wall
Large pulmonary lesions (5 cm)
Inability to achieve ipsilateral pulmonary atelectasis.

MEDICAL MANAGEMENT
Oxygen Therapy: Patients with respiratory failure require
supplemental oxygen to maintain adequate oxygenation. Oxygen
therapy is administered via nasal cannula, face mask, or non-
invasive positive pressure ventilation (NIPPV)
Bronchodilators: Bronchodilators such as albuterol and ipratropium
bromide can be used.
Steroids: Steroids are potent anti-inflammatory agents that can
reduce inflammation in the lungs and airways.

MEDICAL MANAGEMENT
Antibiotics: Patients with respiratory failure are at high risk of
developing infections.
Pain management: Thoracic surgeries can cause significant pain,
which can lead to shallow breathing and decreased lung volumes.
Nutritional Support: Adequate nutritional support is necessary to
maintain the energy required for the healing process.
Physiotherapy: Respiratory physiotherapy includes a variety of
techniques that aim to improve lung function, such as deep
breathing exercises, coughing, and postural drainage.

LUNG TRANSPLANTATION
is a surgical procedure to replace a diseased or

failing lung with a healthy lung, usually from a
deceased donor.

LUNG TRANSPLANTATION

MEDICAL MANAGEMENT
Immunosuppression: After lung transplantation, the patient will
require immunosuppressive medications to prevent rejection of the
transplanted lung.
Infection prevention and treatment: The patient is at high risk for
infections after lung transplantation, and prophylactic antibiotics and
antivirals may be necessary to prevent or treat infections.
Oxygen therapy: Oxygen therapy may be necessary to maintain
adequate oxygenation after lung transplantation

MEDICAL MANAGEMENT
Bronchodilators and steroids: Bronchodilators and steroids may be

necessary.
healthcare team are essential.

MEDICAL MANAGEMENT
Bronchodilators and steroids: Bronchodilators and steroids may be

necessary.
healthcare team are essential.

PHARMACOLOGICAL MANAGEMENT

PHARMACOLOGICAL MANAGEMENT

COMPLEMENTARY
AND ALTERNATIVE
MEDICINES
A. ECHINACEA
Echinacea
What is Echinacea?
a Native American medicinal plant named for the prickly scales
in its large conical seed head, which resembles the spines of an
angry hedgehog ( echinos is Greek for hedgehog).

There are different varieties including:

echinacea purpurea
echinacea angustifolia
echinacea pallida

Echinacea
Echinacea contains polysaccharides, glycoproteins, alkamides,
volatile oils, and flavonoids.
The chemicals contained in the root differ considerably from those

in the upper part of the plant.
roots = volatile oils (odorous compounds)
above-ground parts = polysaccharides (substances known to
trigger the activity of the immune system).

ECHINACEA befenits/uses
Boost immunity - decrease odds of cold by 58 % and reduced
length by 1.4 days
Reduce upper respiratory conditions (cytokines)
Anti-inflammatory
reduces pain
lower blood sugar- activates the PPAR-y receptor
reduce anxiety, depression, social disorders
support common skin conditions - eczema, wrinkles (hydration)
protection from cancer

ECHINACEA befenits/uses
Professional herbalists may recommend echinacea to treat
urinary tract infections, vaginal yeast (candida) infections, ear
infections (also known as otitis media), athlete's foot, sinusitis,
hay fever (also called allergic rhinitis), as well as slow-healing
wounds.

Side effects
headaches
dizziness
feeling sick
stomach ache
constipation
skin reactions (redness, itchiness and swelling) – more common
in children

dosing
Echinecea is available in many different types of products,
including supplements, liquids, creams, mouthwashes, and throat
sprays.
Doses vary widely depending on the type of product used. Speak

with a healthcare provider to find out what type of product and
dose might be best for a specific condition.

INTERACTIONS
Some of the well-known interactions include the following:
Econazole. When echinacea is used together with econazole,
recurrence rates of these infections may be reduced.
Immunosuppressants. Because echinacea can enhance
immune function, people should not use the herb with
immunosuppressive medications, especially when taken for
organ transplant.
Caffeine. Echinacea increases the amount of time caffeine
stays in the body.

patient education
For general immune system stimulation, during colds, flu,
upper respiratory tract infections, or bladder infections, take
echinacea 3 times a day until you feel better, but not for more
than 10 days.
DO NOT take echinacea on an empty stomach. Instead, take it
with food or a large glass of water.
Apply creams or ointments for slow-healing wounds as
needed.

B. GOLDENSEAL

goldenseal
Goldenseal ( Hydrastis canadensis ) is one of the most popular
herbs in the United States, often combined with echinacea and
sold to treat or prevent colds.
added to various over-the-counter remedies, such as ear drops,
feminine hygiene products, eyewash formulations, cold and flu
remedies, allergy relief products, laxatives, and digestive aids
naturally rich in a class of alkaloid compounds, with berberine,
hydrastine, and canadine being found in the highest
concentrations.

Nutrients And Chemical Constituents

Goldenseal contains the active chemical constituents isoquinoline
alkaloids: berberin and hydrastine. Other alkaloids are
canadaline, canadine (tetrahydroberberine), 1-α-hydrastine and
5-hydroxytetrahydroberberine.
Goldenseal also contains feruloyl quinic acid glucoside esers, C-

methyl flavonoids (methylluteolin methyl ethers), chlorogenic
acid, meconin, β-sitosterol glucoside, resin, starch, sugar, and
volatile oil.

Traditional Health Benefits

with other herbs such
Goldenseal is often combined as
Echinacea. It enhances the curative effects of other herbs.
Genitourinary system. Used as antimicrobial in fighting against

urinary tract infections and treating gonorrhea.
Respiratory system as it is used along with Echinacea. Treats

colds, flu, clogged noses, whopping coughs, bronchitis, sinus
problems, pneumonia and hay fever.

Traditional Health Benefits

stomach pain, peptic ulcers,
Digestive system. Treatment for
colitis, diarrhea, constipation, intestinal gas, hemorrhoids and
anorexia.
Used to treat malaria, chronic fatigue syndrome and cancer.
Benefits the membrane for its antimicrobial and anti-
inflammatory activity.
It is used as antiseptic and also used to wash eyes sores
(conjunctivitis).
used to mask a positive test for illegal drugs during drug tests.

Goldenseal Availability And Dosage

Goldenseal is available in tablets and capsules (containing the

powdered root), liquid extracts, and glycerites (low alcohol
extracts). Goldenseal is often combined with echinacea.
There is no recommended daily allowance for goldenseal

SIDE EFFECTS
Goldenseal can cause side effects such as sleeplessness,
dizziness, breast pain, increased heart rate, loss of appetite,
itching, rash, mood changes, low blood pressure or high blood
pressure, changes in menstrual cycles, diarrhea, headache and
many other side effects.
Other less common side effects of Goldenseal include Steven

Johnson syndrome, severe allergic reactions and liver damage.

WARNINGS
Pregnant or breastfeeding women should not use goldenseal.
People with high blood pressure, liver disease, or heart disease
should ask their provider before taking goldenseal.
Goldenseal can irritate the skin, mouth, throat, and vagina. It may
also cause an increased sensitivity to sunlight.
Goldenseal may interfere with some medications. If taking
prescription or over-the-counter medications, ask doctor before
taking goldenseal.

interactions
Cyclosporine : increases levels of cyclosporine in the body
Digoxin : raise blood levels of digoxin, a medication used to treat
heart conditions.
Tetracycline : One study reported that berberine may cause
tetracycline antibiotics to not work as well.
Anticoagulants (blood thinners)- Warfarin (Coumadin), Plavix
(Clopidogrel) andAspirin- Goldenseal and berberine could
increase the risk of bleeding

C. ZINC

zinc
Zinc is an essential nutrient found in a variety of plant and animal
foods, along with supplements. It plays a key role in skin health,
immune function, and cell growth and may protect against acne,
inflammation, and other conditions. and most common mineral in
the body and is found in every cell, next to iron.
has antioxidant properties which helps protect cells in the body

from damage caused by free radicals.

zinc
Zinc is an essential mineral that your body does not make on its
own. It is required for numerous processes in your body, including
1. gene expression
2. enzymatic reactions
3. immune function
4. protein synthesis
5. DNA synthesis
6. wound healing
7. growth and development

zinc
Low zinc levels are sometimes seen in the elderly, alcoholics,
people with anorexia, and people on very restricted diets
Symptoms of zinc deficiency include loss of appetite; poor growth;

weight loss; lack of taste or smell; poor wound healing; skin
problems such as acne, atopic dermatitis and psoriasis; hair loss;
lack of menstrual period; night blindness; white spots on the
fingernails; and depression.

health benefits
Boosts immune system - Zinc supplements stimulate particular
immune cells and reduce oxidative stress.
Accelerates wound healing - plays critical roles in collagen
synthesis, immune function, and inflammatory response, it is
necessary for proper healing
May reduce the risk of certain age-related diseases - may
relieve oxidative stress and improve immune response by
boosting the activity of T-cells and natural killer cells, which help
protect your body from infection

health benefits
May help treat acne - both topical and oral zinc treatments can
effectively treat acne by reducing inflammation, inhibiting the
growth of P. acnes bacteria, and suppressing oil gland activity
Decreases inflammation - Zinc decreases oxidative stress and
reduces levels of certain inflammatory proteins in your body

Food sources
Your body absorbs 20 - 40% of the zinc present in food. Zinc from
animal foods like red meat, fish, and poultry is more readily
absorbed by the body than zinc from plant foods. Zinc is best
absorbed when taken with a meal that contains protein.
The best sources of zinc are oysters (richest source), red meats,
poultry, cheese (ricotta, Swiss, gouda), shrimp, crab, and other
shellfish.

Food sources
Other good, though less easily absorbed, sources of zinc include
legumes (especially lima beans, black-eyed peas, pinto beans,
soybeans, peanuts), whole grains, miso, tofu, brewer's yeast,
cooked greens, mushrooms, green beans, tahini, and pumpkin,
and sunflower seeds.

TOXICITY
Symptoms of toxicity include:
nausea and vomiting
diarrhea
abdominal cramps and pain
headaches

DOSAGE RECOMMENDATIONS
The Recommended Dietary Allowance (RDA) is 11 mg for adult
males and 8 mg for adult females.
People who are pregnant and breastfeeding should consume
11 and 12 mg per day, respectively.

PRECAUTIONS
Take zinc with water or juice. If zinc causes stomach upset, it can
be taken with meals. Don't take zinc at the same time as iron or
calcium supplements.
Taking too much zinc can also cause deficiencies in other
nutrients and weakens immune system. If you take zinc, including
zinc in a multivitamin, you should also take copper.
Taking 100 mg of zinc daily, or taking supplemental zinc for 10
years or longer, has been linked with a doubling of the risk
developing prostate cancer in men.

interactions
Amiloride (Midamor)
Blood pressure medications, ACE Inhibitors
Antibiotics
Cisplatin (Platinol-AQ)
Deferoxamine (Desferal
Immunosuppressant medications
Penicillamine
Thiazide diuretics (water pills)

NUTRITIONAL
& DIET THERAPY
Nutritional & Diet Therapy
Nutritional and diet therapy refer to the use of food and
nutrients to prevent or treat diseases and conditions. It involves
making dietary modifications to improve the health and well-
being of individuals, and is often used in conjunction with other
forms of medical treatment.

Nutritional Therapy
Nutritional therapy focuses on the use of specific nutrients, such
as vitamins, minerals, and other dietary components, to prevent
or treat specific health conditions.

Diet Therapy
Diet therapy involves making changes to an individual's overall
dietary intake to manage or treat a medical condition. This may
involve reducing the intake of certain nutrients or increasing the
intake of others.

Both nutritional and diet therapy can be used to treat a
wide range of conditions. It is important to work with a
qualified healthcare professional to develop an
individualized plan that meets your specific nutritional
and dietary needs.

TUBE FEEDINGS
Tube feedings, also known as enteral nutrition, are a form of
nutritional therapy in which a liquid formula is given directly into
the stomach or small intestine through a tube. Tube feedings are
often used when a person is unable to eat or swallow food due to
a medical condition, such as a neurological disorder,
gastrointestinal disease, or cancer.

TUBE FEEDINGS
The formula used in tube feedings is designed to provide all
the necessary nutrients, such as carbohydrates, proteins, fats,
vitamins, and minerals, that a person needs to maintain their
health.

TUBE FEEDINGS
Tube feedings may be administered through various types of
tubes, such as nasogastric tubes, gastrotomy tubes, or
jejunostomy tubes, depending on the person's medical
condition and nutritional needs. The tube may be temporary
or permanent, depending on the underlying medical condition
and the person's response to the feedings.

FLUID THERAPY
Fluid therapy, also known as hydration therapy, is a form of
medical treatment that involves the intravenous (IV)
administration of fluids to maintain or restore the body's fluid
balance. Fluid therapy can be used to treat a wide range of
medical conditions, such as dehydration, electrolyte imbalances,
shock, and kidney disease.

FLUID THERAPY
Fluids used in fluid therapy typically contain a combination of
water, electrolytes, and sometimes other nutrients such as
glucose or amino acids. The type and amount of fluids
administered will depend on the individual's medical
condition and fluid needs.

FLUID THERAPY
Fluid therapy can be administered in various settings,
including hospitals, clinics, and at home under the guidance of
a healthcare professional. The IV fluids may be administered
through a peripheral IV line or a central line, depending on the
person's condition and the type of fluids being administered.

high chon, high-calorie supplements
High Carbon, Hydrogen, Oxygen, Nitrogen (CHON), High-Calorie
Supplements are a form of nutritional therapy that provide
additional calories and macronutrients to individuals who have
increased nutrient needs due to medical conditions. These
supplements contain a high concentration of carbohydrates,
proteins, and fats, which are the macronutrients that contain
carbon, hydrogen, oxygen, and nitrogen.

high chon, high-calorie supplements
High CHON, high-calorie supplements are intended to
supplement the individual's regular diet and are not meant to
replace whole foods. They are often recommended for
individuals who have difficulty consuming enough calories and
nutrients through regular food intake or who have increased
nutrient needs due to a medical condition.

E CLIENT
EDUCATION
CLIENT EDUCATION ON
ALTERED VENTILATORY
FUNCTION

Check your oxygen level, if directed.
Use your oxygen as directed.
Use pursed-lip breathing any time you feel short of breath.
Do not smoke.
Prevent the spread of germs.
Follow your treatment plan.
Talk to your doctor about when you can resume normal activities.
Watch for warning signs of complications if you had to use a
mechanical ventilator.

Talk to your doctor about pulmonary rehabilitation.
Limit alcohol intake.
Ask about vaccines you may need.
Prepare for emergencies.
Talk to your doctor about when you can resume normal activities.
Watch for warning signs of complications if you had to use a
mechanical ventilator.
Talk to your doctor about pulmonary rehabilitation.

F EVALUATION

INefFECTIVE AIRWAY CLEARANCE
related to excessive tenacios
secretions
Patient was able to identify/demonstrate behaviors to achieve
airway clearance.
Patient was able to display/maintain a patent airway with breath
sounds clearing; absence of dyspnea, or cyanosis, as evidenced
by keeping a patent airway and effectively clearing secretions.

IMPAIRED GAS EXCHANGE RELATED
TO ACTIVITY INTOLERANCE
Patient maintained optimal gas exchange as evidenced by usual mental status,
unlabored respirations at 12-20 per minute, oximetry results within normal
range, blood gases within normal range, and baseline HR.
Patient maintained clear lung fields and remains free of signs of respiratory
distress.
Patient verbalized understanding of oxygen and other therapeutic interventions.
Patient participated in procedures to optimize oxygenation and in management
regimen within level of capability/condition.
Patient manifested resolution or absence of symptoms of respiratory distress.

anxiety related to
breathlessness
The client was able to appear relaxed and reported anxiety is reduced to a
manageable level.
The client was able to appear to verbalize awareness of feelings and healthy
ways to deal with them.
The client was able to appear to verbalize accurate knowledge of the situation.
The client was able to appear demonstrate an appropriate range of feelings and
lessened fear.
The client was able to appear demonstrate problem-solving skills and effective
use of resources.

powerlessness related to
feelings of loss of control
The patient identified 5 factors in her life that she can control.
The patient verbalized satisfaction with the ability to control the quality of
time she has left in the present.
The patient was able to have opportunities to make decisions regarding her
treatment schedules and future treatment regimes.
The patient identified 4 factors in her life she can change to increase the
feelings of having control in her life.
The patient shared 4 areas in her life she feels she has loss the most control
in.

high risk for ineffective therapeutic
regimen management related to lack
of knowledge
Patient was able to verbalize factors contributing to current health
status/preventing improved health status
Patient adopted lifestyle changes to support health goals (example:
Patient will stop smoking by the end of the year to prevent worsening of
asthma.)
Patient was able to identify resources necessary to support health
maintenance.

Nursing Care of Clients Nursing Care of Clients With Altered Ventilatory With Altered Ventilatory Function Function

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ST.

PAUL UNIVERSITY PHILIPPINES

SECOND SEMESTER, AY 2022-2023

NCM 118 - CARE OF CLIENTS WITH LIFE-THREATENING CONDITIONS