Introduction to Critical Care Nursing pRELIM – September 5, 2023

University of Cebu – Banilad Campus, College of Nursing ncm 118 – Emergency nursing
Clinical instructor: Mr. fervi b. Kwek, lpt, mn, rn Lyndee May Carnacer, sn

PWhat is Critical? Goals

• Crucial, Crisis, Emergency Serious
• To promote optimal delivery of safe and quality care to the
• Requiring immediate action, Thorough and constant
critically ill patients and their families.
observation
• To care for the critically ill patients with a holistic approach
• Total dependent
(considering patients biological, psychological, cultural and
spiritual dimensions regardless of diagnosis and clinical setting.
What is Critical Care?
• To use relevant and up-to-date knowledge, caring attitude and
Critical Care is a term used to describe as the care of
clinical skills, supported by appropriate technology for the
patients who are extremely ill and whose clinical condition is unstable
prevention, early detection and treatment of complications to
or potentially unstable.
facilitate recovery.

HISTORICAL BACKGROUND Members of critical care

FLORENCE NIGHTINGALE Critically Ill Client

− Recognized the need to consider the severity of illness in o high risk for actual or potential life- threatening health
bed allocation of patients and placed the seriously ill problems
patients near the nurses' station. o One who is ill
o requires more intensive and careful nursing care
World War II
Critical Care Nurse
− Shock wards established for resuscitation
− Transfusion practices in early stages o A licensed professional nurse who is trained and qualified
− In 1923, John Hopkins University Hospital developed a to practice critical care nursing.
special care unit for neurosurgical patients o Provide direct one on one care
− As surgical techniques advanced it became necessary that o Responsible for making life-and death decision
post operative patient required careful monitoring and this o At high risk of injury or illness from possible exposure to
came about the recovery room. infections
o Good communication skill
Polio Epidemic o Requires extensive knowledge and a continual desire to
learn
• 1950's: use of mechanical ventilation ("iron lung") for
treatment of polio CRITICAL CARE UNIT
• Development of respiratory intensive care units and general
ICU's developed for sick and postoperative patients ▪ It is defined as the unit in which comprehensive care of a
critically ill patient is carried out
SEVEN C's OF CRITICAL CARE ▪ Specialize in monitoring and treating patients who need 24-
hour care
1. Compassion (empathy, concern) ▪ It entails readily available and accessible emergency
2. Communication (with patient and family) equipment, sufficient supplies and effective support system
3. Consideration (to patients, relatives and colleagues) and to ensure quality patient care as well as staff safety and
avoidance of Conflict productivity.
4. Comfort (prevention of suffering) ▪ It is the home of an organization
5. Carefulness (avoidance of injury)
6. Consistency THE INTENSIVE CARE TEAM
7. Closure (ethics and withdrawal of care)
→ Doctor
Critical caPre Nursing → Nurses
→ Therapists
→ The care of seriously ill clients from point of injury or illness → Nutritionists
until discharge from intensive care → Chaplains
→ It refers to the delivery of comprehensive, specialized and → Other support staff
individualized nursing care services to critically ill patients with
life threatening conditions or injuries and their families. ❖ builds an environment for healing or dying
Introduction to Critical Care Nursing pRELIM – September 5, 2023
University of Cebu – Banilad Campus, College of Nursing ncm 118 – Emergency nursing
Clinical instructor: Mr. fervi b. Kwek, lpt, mn, rn Lyndee May Carnacer, sn

ICU BED A. Post Graduate Courses

B. Certification Course
• ICU Bed (7function) with electrically operated back rest tilting
0-80°, knee rest tilting 0-35°, Trendelenburg tilting 0-20°, ✓ Advanced Cardiac Life Support
Reverse Trendelenburg tilting 0-20°, mattress vase tilting to the ✓ Pediatric Advanced Cardiac Life Support
left up to 40°, tilting to the right up to 40°. ✓ Newborn Resuscitation
• All functions controlled with Power Device. Four easy lifting ✓ Continuous Renal Replacement Certification
guardrails (2 on each side), which are safe and reliable, and can ✓ Advanced Intravenous therapy
be fixed upward or downward. ✓ Stroke Nursing
• Easy to operate built-in Control Panel on both sides of guard
rails. CLASSIFICATION OF CRITICAL CARE
• Footstep Control Panel under the bed frame. Removable &
Interchangeable high quality engineering plastic head panel LEVEL 1
and foot panel. Head panel and foot panel equipped with safety → Provides monitoring, observation and short-term
lock and roller bumpers. ventilation.
• Provision for I.V. Rod on both sides of the bed. → Nurse patient ratio is 1:3 and the medical staff are not
present in the unit all the time.
CRITICAL CARE NURSES ASSOCIATIONS → At risk of deteriorating, support from critical care team

American Association of Critical-Care Nurses LEVEL 2

(AACN) → Provides observation, monitoring and long-term ventilation
• Founded 1969 with resident doctors.
• It offered educational / professional support → The nurse- patient ratio is 1:2
• Certification, Scholarships → Junior medical staff is available in the unit all the time and
• Largest professional specialty nursing organization consultant medical staff is available if needed.
• Research, Publishes journals → More observation or intervention, single failing organ or
• Provides standards of practice post operative care

Critical Care Nurses Association of the Philippines, Inc. LEVEL 3

(CCNAPI)
• Founded in 1977
• There is no specialization certification course to become a
critical care nurse specialist in the Philippines.
• Although RA 9173 allows for the development of the
Comprehensive Nursing Specialty program through
existing
• programs by CCNAPI, DOH and other institutions that
provide certificate of training.
• A critical care nurse is a registered nurse who is a nursing
degree holder, should have more than 3 years of
uninterrupted practice experience in the critical field.
• A nurse who has attained advanced education and expertise
in caring patients with critical problems.
TRAINING OF NURSES FOR CRITICAL CARE SERVICES
• The institution/ hospital should provide training
opportunities to ensure staff competencies.
• New recruits to the critical care units shall attend an
orientation program and be given opportunities to work
under senior staff supervision.
• Critical Care Nurses Association of the Philippines, Inc.
recommends that all practicing CCN shall continuously
update their knowledge, skills and behavior through active
participation in Critical Care Nursing Education.
→ Provides all aspects of intensive care including invasive
hemodynamic monitoring and dialysis.
→ Nurse patient ratio is 1:1.
→ advanced respirator support or basic respiratory support,
multi-organ failure
ORGANIZATIONAL MODELS FOR ICU
A. Open Model
− This model allows many different members of the medical
staff to manage patients in the ICU.
− In this type, physicians admit, treat and discharge without
consultation or communication with a Critical Care
Specialist (intensivist).
B. Closed Model
− This model is limited to ICU-certified physicians
managing the care of all patients.
− In this type, the admission, discharge and referral policies
are under the control of intensivists (a medical practitioner
who specializes in the care of critically ill patients)
C. Hybrid Model
− This model combines aspects of open and closed models
by staffing the ICU with an attending physician and/or
team to work in tandem with primary physicians
Introduction to Critical Care Nursing pRELIM – September 5, 2023
University of Cebu – Banilad Campus, College of Nursing ncm 118 – Emergency nursing
Clinical instructor: Mr. fervi b. Kwek, lpt, mn, rn Lyndee May Carnacer, sn

Admission Criteria in ICU/ ICU TRIAGE TYPES OF ICU

A. Prioritization Model General

→ This system defines those that will benefit most from − Medical Intensive Care Unit (MICU)
the ICU (Priority 1) to those that will not benefit at all − Surgical Intensive Care Unit
(Priority 4) from ICU admission. − Medical Surgical Intensive Care Unit (MSICU)

B. Diagnosis Model Specialized

→ This model uses specific conditions or diseases to − Neonatal Intensive Care Unit (NICU)
determine appropriateness of ICU admission. − Special Care Nursery (SCN)
(described in critically ill patient) − Pediatric Intensive Care Unit (PICU)
− Coronary Care Unit (CCU)
C. Objectives Parameters Model − Neuro Surgery Intensive Care Unit (NSICU)
→ This model uses vital sign ranges, physical findings, − Burn Intensive Care Unit (BICU)
diagnostic and laboratory findings. − Trauma Intensive Care Unit
Prioritization Model DOCUMENTATION

PRIORITY 1 Clinical documentation in a patient's record includes any and all

▪ These are critically ill, unstable patients in need of intensive documentation that relates to the care of the patient during the
treatment and monitoring that cannot be provided outside patient's stay or encounter.
of the ICU.
▪ Treatments include ventilator support, continuous In the Inpatient setting, some of the important pieces of the
vasoactive drug infusions. patent's clinical documentation include:
▪ Examples of these patients may include post-operative or
acute respiratory failure patients requiring mechanical a. Patient History & Physical examination
ventilatory support and shock or hemodynamically b. Progress Notes
unstable patients receiving invasive monitoring and/or c. Orders
vasoactive drugs. d. Procedures Reports
e. Anesthesia Reports
Priority 2
f. Pathology Reports
▪ These patients require intensive monitoring and may
g. Radiology/Nuclear Medicine Reports
potentially need immediate intervention.
h. Cardiology Reports
▪ Examples include patients with chronic comorbid
i. Consultation Reports
conditions who develop acute severe medical or surgical
j. Notes Provided by Nursing Staff
illness.
k. Discharge Summary
Priority 3
The move toward Electronic Medical Records (EMRS) and
▪ These unstable patients are critically ill but have a reduced
Critical Care Information Systems (CCIS) Or also known as the
likelihood of recovery because of underlying disease or
Electronic Health Record (EHR) is an electronic version of a patients
nature of their acute illness.
medical history, progress notes, medications, vital signs,
▪ Examples include patients with metastatic malignancy
immunizations, laboratory data and radiology reports.
complicated by infection, cardiac tamponade, or airway
obstruction
Priority 4
▪ These are patients who are generally not appropriate for
ICU admission.
▪ Admission of these patients should be on an individual
basis, under unusual circumstances and at the discretion of
the ICU Director.
RESPONSES TO ALTERED VENTILATORY Function pRELIM – September 11, 2023
University of Cebu – Banilad Campus, College of Nursing ncm 118 – Emergency nursing
Clinical instructor: Mr. fervi b. Kwek, lpt, mn, rn Lyndee May Carnacer, sn

Plan of care  Wheezing

• asthma, allergies, or an infection
A. Assessment  Grating sound
• Pleural friction
1.
Subjective Data → History • pleural surfaces rub together and
2.
Objective Data → Physical Assessment, suggests pneumonia
Diagnostic Studies → In infants and newborn:
B. Nursing Diagnosis o Check for flaring nostrils
C. Planning o Look for retractions or bulging of the muscles
1. Planning for Health Promotion between the ribs
2. Planning for Health Restoration and
Maintenance B. DIAGNOSTIC ASSESSMENT
D. Implementation
1. Independent Nursing Care NON-INVASIVE
• Physiologic Care Psychosocial Care
1. Oximetry
• Spiritual Care
− is a test used to measure the oxygen level
2. Interdependent Care
(oxygen saturation) of the blood.
• Pharmacological Therapeutics
− It is an easy, painless measure of how well
• Complementary & Alternative Therapies
oxygen is being sent to parts of your body
• Nutritional & Diet Therapy
furthest from your heart, such as the arms and
• Surgical Intervention
legs.
• Immunologic Therapy
E. Client Education
2. Capnography
F. Evaluation of the Outcome of Care
− non-invasive measurement during inspiration
G. Reporting & Documentation of Care
and expiration of the partial pressure of CO2
from the airway.
ASSESSMENT − provides physiologic information on
ventilation, perfusion, and metabolism,
SUBJECTIVE DATA
which is important for airway management.
→ begin with detailed patient history
INVASIVE
→ previous respiratory illnesses or cardiovascular
health. 1. ABG (Arterial Blood Gas)
→ vaccine history − test that requires a sample from an artery in
o Flu shot (every year) your body to measure the levels of oxygen and
o Pneumococcal vaccine (every 5 years) carbon dioxide in your blood.
→ If patient is in respiratory distress, ask what − The test also checks the balance of acids and
preceded the emergency bases, known as the pH balance, in your blood.
→ Determine if patient has special needs that might − used to find out how well your lungs are able
affect assessment to move oxygen into the blood and remove
carbon dioxide from the blood.
OBJECTIVE DATA
2. Pleural Fluid Analysis
A. Physical Assessment − examines a sample of fluid that has collected
in the pleural space (Thoracentesis).
→ Check the RR, PR, BP
• space between the lining of the outside of
→ Shape of the patient's chest the lungs (pleura) and the wall of the
→ SOB and watch for signs of labored breathing chest.
→ Assess oxygen saturation
o < 90% → Need O2 3. Pulmonary Angiography
− see how blood flows through the lung.
→ Auscultate breath sounds for abnormal breathing − Angiography is an imaging test that uses x-
 Crackling, popping, or bubbling sounds rays and a special dye to see inside the
• pneumonia or pulmonary edema arteries.
− Skin test before giving dye.
RESPONSES TO ALTERED VENTILATORY Function pRELIM – September 11, 2023
University of Cebu – Banilad Campus, College of Nursing ncm 118 – Emergency nursing
Clinical instructor: Mr. fervi b. Kwek, lpt, mn, rn Lyndee May Carnacer, sn

4. Ventilatory-Perfusion (V/Q) Scan IMPLEMENTATION

− see how well air moves and blood flows
through the lungs. MEDICAL/SURGICAL MANAGEMENT
− done to detect a pulmonary embolus (blood
clot in the lungs) A. Mobilization of Secretions
• Exploring Embolus − frequent repositioning
• Tambay Thrombus − deep breathing and coughing exercises
− The perfusion scan measures the blood − chest physiotherapy and postural drainage
supply through the lungs. − oral and parenteral hydration
− Ventilation (V) refers to − supplemental humidification
flow of AIR into and out of the alveoli
− Perfusion (Q) refers to the B. Artificial Airway Management
flow of BLOOD to alveolar capillaries. − mechanical device used for securing
unobstructed respiration when the patient is
NURSING DIAGNOSIS not breathing or is otherwise unable to
maintain a clear passage
• Ineffective Airway Clearance related to Excessive and − The different types of medical devices used to
Tenacious Secretions maintain or open an individual's airway include
• Impaired Gas Exchange related to Activity Intolerance the:
• Anxiety related to Breathlessness
• Powerlessness related to feelings of loss of control
1. Oropharyngeal airway (OPA)
• High Risk for Ineffective Therapeutic Regimen Management
related to lack of knowledge 2. Nasopharyngeal airway (NPA)
3. Endotracheal airway (ETA)
PLANNING
C. Administering Oxygen Therapy
1. Client Positioning − provides you with supplemental, or extra,
− Maximizes breathing oxygen.
− Encourage secretions (phlegm) to move up from D. Mechanical Ventilation
the bases of the lungs up into the larger airways − form of life support
so they can be coughed out. − A mechanical ventilator is a machine that takes
2. Promoting Secretion Clearance over the work of breathing when a person is not
− Chest physiotherapy able to breathe enough on their own.
3. Preventing Desaturation
− also called a ventilator, respirator, or breathing
− A drop in blood oxygen levels
machine.
− Check tubes of O2 if kinked
4. Patient Education
THORACIC SURGERIES
− deep breathing exercises
− increase fluid intake → wt (kg) x 0.05mL Thoracic surgery refers to operations on organs in the
− Flu/ Pneumonia/ Covid 19 vaccination chest, including the heart, lungs and esophagus.
5. Optimizing Oxygenation and Ventilation
− process of moving air in and out of the lungs.
A. Thoracotomy Procedures
− most important effect is the removal of carbon
− is a surgical procedure in which a cut is made
dioxide (CO2) from the body
between the ribs to see and reach the lungs or
6. Preventing Atelectasis
other organs in the chest or thorax.
− Atelectasis → happens when lung sacs (alveoli)
can't inflate properly − performed on the right or left side of the chest.
− Postural Drainage An incision on the front of the chest through
− Incentive Spirometry (measures the breath the breastbone but is rare.
volume)
• Measured column B. Wedge Resection
→ total volume exhaled during the first − Removes the tumor and tissue surrounding the
second, in liters. cancer
→ Males aged 20-60 range from 4.5 to
3.5 liters,
→ Females aged 20-60 range from 3.25
to 2.5 liters.
RESPONSES TO ALTERED VENTILATORY Function
University of Cebu – Banilad Campus, College of Nursing
Clinical instructor: Mr. fervi b. Kwek, lpt, mn, rn
C. Anatomical Segmental Resection
− Removes the tumor, blood vessels, lymphatic
drainage, and lung segment where tumor is
located
D. Lobectomy
− Removes entire lob of lung, including lymph
nodes
E. Pneumonectomy
− Removes whole lung with lymph nodes
F. Pleurectomy Decortication
− Removing the inner lining of the chest cavity
G. Video-assisted thoracic surgery (VATS)
− During this operation, the surgeon inserts a
long, thin tube with an attached camera
through a small incision in the chest.
− instrument is called a thoracoscope.
− Special instruments also are inserted through
small incisions in the chest. The surgeon
operates while watching the video from the
thoracoscope on high-resolution monitors in
the operating room.
H. Robotic thoracic surgery
− allows the surgeon to view the surgical site via
a camera inserted in the chest.
− surgeon operates at a console, using controls
that translate the surgeon's hand, wrist and
finger movements into movements of the
instruments inserted in the chest.
I. Lung Transplantation
− replace a diseased or failing lung with a healthy
lung, usually from a deceased donor.
− A living donor can only donate one lung lobe.
PHARMACOLOGIC MANAGEMENT
1. Bronchodilators
− a type of medication that make breathing easier
by relaxing the muscles in the lungs and
widening the airways (bronchi).
− used to treat long-term conditions where the
airways may become narrow and inflamed, such
as: asthma, a common lung condition caused by
inflammation of the airways.
→ Epinephrine
o Relax muscles around airways so that
they open up and you can breathe more
easily
pRELIM – September 11, 2023
ncm 118 – Emergency nursing
Lyndee May Carnacer, sn
→ Salbutamol (Ventolin)
o Relax muscles in airways and increase
air flow to the lungs
2. Corticosteroids
− mainly used to reduce inflammation and
suppress the immune system.
− used to treat conditions such as: asthma.
allergic rhinitis or hay fever.
− Inflammation of the inner lining of the
bronchial tubes in the lung is the major cause
of asthma symptoms.
− Regular daily use of inhaled corticosteroids is
very effective for preventing asthma symptoms
and flare-ups.
3. Antihistamine
− drugs that can relieve allergy symptoms such
as runny nose, sneezing, and congestion.
4. Corticosteroids
− drug or chemical agent which is used to
stimulate the respiratory system or restore
the normal respiration when our lungs are
unable to eliminate sufficient amount of carbon
dioxide and unable to take sufficient amount of
oxygen molecule.
5. Pulmonary Surfactants
− is essential for life as it lines the alveoli to
lower surface tension, thereby preventing
atelectasis during breathing.
6. Antivirals
− medications that help body fight off harmful
viruses. The drugs can ease symptoms and
shorten the length of a viral infection.
− Antiviral drugs are also preventive. They can
protect you from getting viral infections or
spreading a virus to others.
RESPONSES TO ALTERED VENTILATORY Function pRELIM – September 11, 2023
University of Cebu – Banilad Campus, College of Nursing ncm 118 – Emergency nursing
Clinical instructor: Mr. fervi b. Kwek, lpt, mn, rn Lyndee May Carnacer, sn

COMPLEMENTARY THERAPIES

1. Natural Products
− herbs, vitamins, minerals, probiotics, usually
sold as dietary supplements

2. Mind and body therapies

− Yoga
− Chiropractic
− meditation and massage therapy
− acupuncture
− tai chi
− healing touch
− prayer
− hypnotherapy
− Relaxation techniques.
 Breathing exercises appear to be safe for
people with COPD.
 Yoga breathing, pursed lip breathing and
diaphragmatic breathing have been shown
to improve.

3. Acupressure point
− can help relieve shortness of breath in some
people with COPD. Acupressure can improve
lung function, some markers of inflammation
and/or symptom control in people with asthma

ALTERNATIVE MEDICINE

1. Echinacea
− a dietary supplement for the common cold and
other infections,
− preparations have been promoted for topical
use (application to the skin) for wounds and
skin problems.

2. Ginseng
− has been shown to possess anti-oxidative and
anti-inflammatory properties. It enhances cell-
mediated immunity associated with healing and
tissue repair, and also reduces the symptoms of
respiratory tract infections

3. Zinc
− is used since ancient times to help heal wounds
and plays an important role in the immune
system
 NCM 118 – EMERGENCY NURSING 1st SEMESTER - PRELIMS
UNIVERSITY OF CEBU – BANILAD CAMPUS, COLLEGE OF NURSING S.Y. 2023 - 2024
CLINICAL INSTRUCTOR: MR. FERVI B. KWEK, MAN, RN, LPT TRANSES BY: MARIE JOY B. LABUS, SN

ALTERATION IN VENTILATION
Symptoms
DISEASES OF THE RESPIRATORY SYSTEM
✓ Frequent coughing or wheezing
 Chronic Obstructive Pulmonary Disease
✓ Excess phlegm, mucus, or sputum production
- Types: Emphysema/Bronchitis
✓ Shortness of breath
 Acute Respiratory Distress Syndrome
 Pulmonary Embolism
✓ Trouble taking a deep breath

 Respiratory Failure Complications

 Pneumonia
 Pulmonary Hypertension • Activity limitations like difficulty walking or climbing stairs
 Pneumothorax • Unable to work
• Need special equipment like portable oxygen tanks
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) • Not engage in social activities (like eating out, going to places of
worship, going to group events, or getting together with friends
❖ refers to a group of diseases that cause airflow blockage and
or neighbors)
breathing-related problems.
• Increased confusion or memory loss
❖ It includes: EMPHYSEMA & BRONCHITIS
• Have other chronic diseases like arthritis, congestive heart
failure, diabetes, coronary heart disease, stroke, or asthma
• Have depression or other mental or emotional conditions like
anxiety

Interventions (for patients with lung problems)

Risk Factors
✓ Smoking
→ The risk for all types of smokers increases with the
number of years and amount of tobacco smoked.
✓ Age
→ Although the lung damage that occurs in emphysema
develops gradually, most people with tobacco-related
emphysema begin to experience symptoms of the
disease between the ages of 40 and 60.
✓ Exposure to secondhand smoke, also known as passive
smoking
→ smoke that you inhale from someone else's cigarette,
pipe or cigar
✓ Occupational exposure to fumes or dust
→ if you breathe fumes from certain chemicals or dust
from grain, cotton, wood or mining products in the
workplace
✓ Exposure to indoor and outdoor pollution
→ breathing indoor pollutants, such as fumes from heating
fuel, as well as outdoor pollutants — car exhaust, for
instance — increases your risk of emphysema
Firsthand Smoke inhaled by a smoker
Secondhand exhaled by a smoker or released from the end of
Smoke a burning cigarette
toxic residue that sticks to surfaces and dust
Thirdhand Smoke
after the smoke clears
1. Tube feedings
2. Fluid Therapy
- replacement of water and electrolyte deficits, known as
rehydration phase; and
3. High CHON, High Calorie Supplements
- Protein is also a critical part of the processes that fuel your
energy and carry oxygen throughout your body in your
blood. It also helps make antibodies that fight off infections
and illnesses and helps keep cells healthy and create new
ones.
- The high-calorie diet is a type of diet in which it is comprised
of food high in protein, carbohydrate, fat, vitamins and
minerals
TWO TYPES OF COPD
EMPHYSEMA
→ is a lung condition that causes shortness of breath.
→ the air sacs in the lungs (alveoli) are damaged, the inner walls of
the air sacs weaken and ruptured — creating larger air spaces
instead of many small ones. This reduces the surface area of the
lungs and, in turn, the amount of oxygen that reaches your
bloodstream.
→ When you exhale, the damaged alveoli don't work properly and
old air becomes trapped, leaving no room for fresh, oxygen-rich
air to enter.
Symptoms
✓ You can have emphysema for many years without noticing any
signs or symptoms
✓ The main symptom of emphysema is shortness of breath, which
usually begins gradually
✓ Emphysema eventually causes shortness of breath even
while you're at rest.
 NCM 118 – EMERGENCY NURSING 1st SEMESTER - PRELIMS
UNIVERSITY OF CEBU – BANILAD CAMPUS, COLLEGE OF NURSING S.Y. 2023 - 2024
CLINICAL INSTRUCTOR: MR. FERVI B. KWEK, MAN, RN, LPT TRANSES BY: MARIE JOY B. LABUS, SN

Causes
Causes
❖ Chronic bronchitis causes include:
❖ Long-term exposure to airborne irritants, including: - Breathing in air pollution (chemical fumes or dust, over
- Cigarette/Tobacco smoke time)
- Marijuana smoke - Smoking or breathing in secondhand smoke for a long time

- Air pollution ❖ You have a higher chance of getting either kind of bronchitis if:
- Chemical fumes and dust ✓ You smoke
✓ You have asthma and allergies
Prevention ✓ You have a weaker immune system

❖ To prevent emphysema: • Call your doctor if your cough:

→ Don't smoke  Brings up blood or mucus that thickens or darkens
→ Avoid breathing secondhand smoke  Keeps you awake at night
→ Wear a mask to protect your lungs if you work with  Lasts more than 3 weeks
chemical fumes or dust  Causes chest pain
 Has a barking sound and makes it hard to speak
BRONCHITIS  Comes along with unexplained weight loss
 A foul-tasting fluid in your mouth
→ is when the tubes that carry air to your lungs, called the
 Fever over 38 degrees Celsius
bronchial tubes, get inflamed and swollen. You end up with a
 Wheezing or shortness of breath
nagging cough and mucus.

Two types:

a) Acute bronchitis
- This is more common
- Symptoms last a few weeks, but it doesn’t usually cause
problems past that time
b) Chronic bronchitis
- This one is more serious
- It keeps coming back or doesn’t go away Diagnostic Tests

Symptoms (acute and chronic bronchitis) ✓ Pulse Oximetry

- Check the oxygen levels in your blood
✓ Chest congestion, when your chest feels full or clogged ✓ Lung function test
✓ A cough that may bring up mucus that’s clear, white, yellow, or - Incentive Spirometry, Pulmonary function test
green
✓ Chest X-ray
✓ Shortness of breath
- Produces images of your lungs, and reveals fluid in or
✓ Wheezing or a whistling sound when you breathe
around your lungs or air surrounding a lung
- Wheezing may occur during breathing out (expiration) or
breathing in (inspiration) ✓ Blood tests
✓ Body aches and chills - These can identify signs of infection or measure the
✓ Low grade fever amount of carbon dioxide and oxygen in your blood (ABG)
✓ Runny, stuffy nose
✓ Sputum Test/Culture
✓ Sore throat
- Helps diagnose infections of the lungs or airways (nasal
swab could also be done)

Interventions

✓ Drink a lot of water

→ 8 to 12 glasses a day helps thin out your mucus and makes
it easier to cough it up.
✓ Get plenty of rest
✓ Take over-the-counter pain relievers
→ You can use acetaminophen to treat both pain and fever.
✓ Use a humidifier or steam inhalation
✓ Take over-the-counter cough medicines
→ Expectorants/ Mucolytics to loosen your mucus so it's
easier to cough up.
 NCM 118 – EMERGENCY NURSING
UNIVERSITY OF CEBU – BANILAD CAMPUS, COLLEGE OF NURSING
CLINICAL INSTRUCTOR: MR. FERVI B. KWEK, MAN, RN, LPT
Treatments
✓ Quit smoking
- For people who smoke, the most important part of
treatment is smoking cessation
✓ Avoid tobacco smoke and other air pollutants at home and at
work
✓ Take medication
- Symptoms such as coughing or wheezing can be treated
with medication.
✓ Ask your doctor about pulmonary rehabilitation
- Programs may include plans that teach people how to
breathe better and conserve their energy, as well as
provide advice on food and exercise.
✓ Avoid lung infections
- Respiratory infections should be treated with antibiotics, if
appropriate.
✓ Use supplemental oxygen
- Some people may need to use a portable oxygen tank if
their blood oxygen levels are low
✓ Medications like antibiotics, anti-inflammatory,
and bronchodilators to open your airways
✓ Oxygen therapy so you can breathe better
✓ Pulmonary rehab, an exercise program that can help you
breathe more easily and exercise more
Prevention
• Stay away from cigarette smoke.
• Get the flu vaccine since you can get bronchitis from the flu
virus.
• Make sure your pertussis vaccine (DPT) is up to date
• Wash your hands often.
• Wear a mask when you’re around things such as paint fumes
etc.
ACUTE RESPIRATORY DISTRESS SYNDROME
❖ occurs when fluid builds up in the tiny, elastic air sacs (alveoli)
in your lungs
❖ the fluid keeps your lungs from filling with enough air, which
means less oxygen reaches your bloodstream. This deprives
your organs of the oxygen they need to function
Symptoms
✓ Smoking
✓ Severe shortness of breath
✓ Labored and unusually rapid breathing
✓ Low blood pressure
✓ Confusion and extreme tiredness
Note:
• Respiratory distress syndrome (RDS) occurs in babies born early
(premature) whose lungs are not fully developed. The earlier the
infant is born, the more likely it is for them to have RDS and need
1st SEMESTER - PRELIMS
S.Y. 2023 - 2024
TRANSES BY: MARIE JOY B. LABUS, SN
extra oxygen and help breathing. RDS is caused by the baby not
having enough surfactant in the lungs.
• Acute respiratory distress syndrome (ARDS) is frequently
complicated by pulmonary hypertension causing right ventricular
(RV) failure (1). Symptoms are determined by low cardiac
output and/or systemic venous congestion. Low cardiac output can
result in organ failure and hemodynamic collapse.
Causes
❖ Sepsis
- A serious and widespread infection of the bloodstream
❖ Inhalation of harmful substances
- Breathing high concentrations of smoke or chemical fumes
❖ Severe pneumonia
- Affect all five lobes of the lungs
❖ Head, chest or other major injury
- Accidents, such as falls or car crashes, can directly damage
the lungs or the portion of the brain that controls breathing
❖ Coronavirus disease 2019 (COVID-19)
- People who have severe COVID-19 may develop ARDS
Complications
❖ Blood clots
- Lying still in a hospital bed for a long-time form clots in your
leg, a portion of it can break off and travel to one or both of
your lungs (pulmonary embolism) — where it blocks blood
flow.
❖ Collapsed lung (pneumothorax)
❖ Infections
- Because the ventilator is attached directly to a tube inserted
in your windpipe, this makes it much easier for
microorganisms to infect your lungs
❖ Scarring (pulmonary fibrosis)
- Scarring and thickening of the tissue between the air sacs
can occur within a few weeks stiffens your lungs, making it
even more difficult for oxygen to flow from the air sacs into
your bloodstream.
PULMONARY FIBROSIS
❖ A lung disease in which the tissue around the air sacs of the lungs
— known as alveoli — becomes damaged, thickened, and
scarred.
Causes
❖ Exposure to toxins like asbestos, coal dust or silica (including
workers in the coal mining and sandblasting industry)
❖ Certain medications (amiodarone, bleomycin, nitrofurantoin, to
name a few) list pulmonary fibrosis as a side-effect
 NCM 118 – EMERGENCY NURSING 1st SEMESTER - PRELIMS
UNIVERSITY OF CEBU – BANILAD CAMPUS, COLLEGE OF NURSING S.Y. 2023 - 2024
CLINICAL INSTRUCTOR: MR. FERVI B. KWEK, MAN, RN, LPT TRANSES BY: MARIE JOY B. LABUS, SN

→ The pain is often sharp and felt when you breathe in

deeply, often stopping you from being able to take a deep
breath
→ It can also be felt when you cough, bend or stoop
❖ Cough
→ The cough may produce bloody or blood-streaked sputum
✓ Rapid or irregular heartbeat
✓ Lightheadedness or dizziness
✓ Excessive sweating
✓ Fever
PULMONARY EMBOLISM
✓ Leg pain or swelling, or both,
❖ A blockage in one of the pulmonary arteries in your lungs. usually in the calf caused by a
❖ In most cases, it is caused by blood clots that travel to the lungs deep vein thrombosis
from deep veins in the legs or, rarely, from veins in other parts ✓ Clammy or discolored skin
of the body (deep vein thrombosis) (cyanosis)

❖ the clots block blood flow to the lungs, pulmonary embolism

Preventive Measures
can be life-threatening

Causes ❖ Blood thinners (anticoagulants)

→ These medications are often given to people at risk of clots
❖ A blood clot, gets wedged into an artery in your lungs before and after an operation, heart attack, stroke or
complications of
❖ Fat from the marrow of a broken long bone
cancer
❖ Part of a tumor
❖ Compression stockings
❖ Air bubbles → Compression stockings
❖ Prolonged immobility steadily squeeze your
• Bed rest legs, helping your veins
→ Being confined to bed for an extended period after and leg muscles move
surgery, a heart attack, leg fracture, trauma or any blood more efficiently.
serious illness makes you more vulnerable to blood ✓ Leg elevation
clots → Elevating your legs when possible and during the night
• Long trips ✓ Physical activity
→ Sitting in a cramped position during lengthy plane or → Moving as soon as possible after surgery can help prevent
car trips slows blood flow in the legs, which pulmonary embolism and hasten recovery overall
contributes to the formation of clots ✓ Pneumatic compression
→ uses thigh-high or calf-high cuffs that automatically inflate
Risk Factors
with air and deflate every few minutes to massage and
squeeze the veins in your legs and improve blood flow
❖ Smoking
→ Applied for 30-60 mins. 2x/ day at a pressure of 30-50 mm
❖ Being overweight Hg
→ Excess weight increases the risk of blood clots
Other Preventive Measures
❖ Supplemental estrogen
→ The estrogen in birth control pills and in hormone
✓ Drink plenty of fluids
replacement therapy can increase clotting factors in
→ Water is the best liquid for preventing dehydration, which
your blood, especially if you smoke or are overweight
can contribute to the development of blood clots
❖ Pregnancy → Avoid alcohol, which contributes to fluid loss
→ The weight of the baby pressing on veins in the pelvis can
✓ Take a break from sitting
slow blood return from the legs. Clots are more likely to
→ Move around the airplane cabin once an hour or so
form when blood slows or pools
→ If you're driving, stop every so often and walk around the
car a couple of times
Signs and Symptoms
→ Do a few deep knee bends

❖ Shortness of breath ✓ Fidget in your seat

→ This symptom typically appears suddenly and always → Flex your ankles every 15 to 30 minutes
gets worse with exertion
✓ Wear support stockings
❖ Chest pain → Your doctor may recommend these to help promote
→ You may feel like you're having a heart attack circulation and fluid movement in your legs
 NCM 118 – EMERGENCY NURSING 1st SEMESTER - PRELIMS
UNIVERSITY OF CEBU – BANILAD CAMPUS, COLLEGE OF NURSING S.Y. 2023 - 2024
CLINICAL INSTRUCTOR: MR. FERVI B. KWEK, MAN, RN, LPT TRANSES BY: MARIE JOY B. LABUS, SN

RESPIRATORY FAILURE (RF) Other Treatment

❖ Respiratory failure is a condition in which your lungs have a ❖ Antibiotics

hard time loading your blood with oxygen or removing carbon ❖ Drugs to break up blood clots
dioxide ❖ Inhaled medicines to open airways
❖ It can leave you with low oxygen, high carbon dioxide, or both ❖ Chest tube to drain blood or extra air in cases of injury

TWO TYPES OF RF
a) Hypoxemic or type 1 respiratory failure
- Not having enough oxygen into your blood
b) Hypercapnic, hypercarbic, or type 2 respiratory failure
- having too much carbon dioxide in the blood
PNEUMONIA
❖ An infection that inflames the air sacs in one or both lungs.
❖ The air sacs may fill with fluid or pus (purulent material), causing
cough with phlegm or pus, fever, chills, and difficulty breathing.

Symptoms Cause

✓ Bluish color of fingernails, lips, and skin – low oxygen ❖ A variety of organisms, including bacteria, viruses and fungi
(cyanosis)
✓ Confusion Symptoms
✓ Rapid breathing or extremely slow breathing
✓ Shortness of breath ✓ Chest pain when you breathe or cough
✓ Sleepiness or passing out

✓ Cough, which may produce phlegm

Causes
❖ An injury to your chest or ribs
❖ A drug or alcohol overdose, which can harm your brain and
breathing
❖ Lung damage from breathing in fumes or smoke
❖ Lung disease or infection
❖ Muscle and nerve damage from conditions like amyotrophic
lateral sclerosis (ALS), spinal cord injuries, and stroke,
✓ Fatigue
✓ Fever, sweating and shaking chills
✓ Lower than normal body temperature (in adults older than age
65 and people with weak immune systems)
- It is possible for a person to have pneumonia without a fever.
However, this appears to be more likely in older adults, infants, and
those with weakened immune systems. Instead, these groups may
experience a lower-than-normal body temperature

Scoliosis or other spine problems, which can affect bone’s ✓ Nausea, vomiting or diarrhea
structure and muscles involved in breathing ✓ Shortness of breath
❖ Blood clot

High-risk Groups
Risk Factors
Adults older than age 65
Have long-term respiratory problems like COPD or asthma
Children younger than age 2 with signs and symptoms
Smoke
People with an underlying health condition or weakened immune
Drinking alcohol
system
Have a family history of respiratory problems
People receiving chemotherapy or taking medication that
Diagnostic Procedures suppresses the immune system

❖ Pulse oximetry TWO TYPES OF PNEUMONIA

❖ Arterial blood gas test COMMUNITY-ACQUIRED PNEUMONIA
❖ Chest X-ray
❖ It occurs outside of hospitals or other health care facilities

Treatment
Causative Factor

❖ Oxygen therapy
❖ Bacteria
❖ Ventilator
→ Streptococcus pneumoniae
❖ Tracheostomy
→ This type of pneumonia can occur on its own or after
→ This is surgery in which your doctor makes an opening in
you've had a cold or the flu
your neck and windpipe to put in a small tube
→ It's called a trach tube and can make breathing easier ❖ Bacteria-like organisms
→ Mycoplasma pneumoniae also can cause pneumonia
→ It typically produces milder symptoms than do other types
 NCM 118 – EMERGENCY NURSING
UNIVERSITY OF CEBU – BANILAD CAMPUS, COLLEGE OF NURSING
CLINICAL INSTRUCTOR: MR. FERVI B. KWEK, MAN, RN, LPT
of pneumonia
❖ Fungi
→ People who have inhaled large doses of the organisms
→ The fungi that cause it can be found in soil or bird
droppings
❖ Viruses, including COVID-19
→ Some of the viruses that cause colds and the flu can
cause pneumonia
→ Viruses are the most common cause of pneumonia in
children younger than 5 years
HOSPITAL-ACQUIRED PNEUMONIA
❖ Some people catch pneumonia during a hospital stay for
another illness
❖ can be serious because the bacteria causing it may be more
resistant to antibiotics and because the people who get it are
already sick
HEALTH CARE-ACQUIRED PNEUMONIA
❖ A bacterial infection that occurs in people who live in long-term
care facilities or who receive care in outpatient clinics, including
kidney dialysis centers.
❖ Like hospital-acquired pneumonia, health care-acquired
pneumonia can be caused by bacteria that are more resistant
to antibiotics
ASPIRATION PNEUMONIA
❖ occurs when you inhale food, drink, vomit or saliva into your
lungs
High-risk Groups
Children who are 2 years old or younger
People who are age 65 or older
Other Risk Factors
• Being hospitalized
- You're at greater risk of pneumonia if you're in a hospital
intensive care unit, especially if you're on a machine that
helps you breathe (a ventilator).
• Chronic disease
- You're more likely to get pneumonia if you have asthma,
chronic obstructive pulmonary disease (COPD) or heart
disease.
- Chronic heart failure may increase risk of pneumonia
due to alveoli flooding and reduced microbial clearance
• Smoking
- Smoking damages your body's natural defenses against
the bacteria and viruses that cause pneumonia.
• Weakened or suppressed immune system
- People who have HIV/AIDS, who've had an organ
transplant, or who receive chemotherapy or long-term
steroids are at risk
1st SEMESTER - PRELIMS
S.Y. 2023 - 2024
TRANSES BY: MARIE JOY B. LABUS, SN
Prevention
✓ Get vaccinated
✓ Make sure children get vaccinated
✓ Practice good hygiene
→ Wash your hands regularly or use an alcohol-based hand
sanitizer
✓ Don't smoke
→ Smoking damages your lungs' natural defenses against
respiratory infections
✓ Keep your immune system strong
→ Get enough sleep, exercise regularly and eat a healthy diet
PULMONARY HYPERTENSION
❖ A type of high blood pressure that affects the arteries in the
lungs and the right side of the heart
❖ The arteries constrict and force your system to work harder for
the blood to flow through the vessels
Symptoms
✓ Shortness of breath (dyspnea), initially while exercising and
eventually while at rest
✓ Blue lips and skin (cyanosis)
✓ Increase pulse or pounding heartbeat (palpitations)
✓ Fatigue
✓ Dizziness or Fainting spells (syncope)
✓ Chest pressure or pain
CLASSIFICATION OF PULMONARY HYPERTENSION
Group 1: Pulmonary Arterial Hypertension (PAH)
❖ A chronic disease that makes the artery walls of the lungs
thicken which prevents blood from circulating properly
3 Types of PAH:
a) Idiopathic arterial hypertension (unknown cause)
b) Heritable –a form of PAH that can be passed from parents to
children, genetically related
c) Drug and Toxin-induced type –the disease can be caused by
drug and toxin abuse or diseases like HIV, Lupus, Congenital
Heart Disease, Chronic Liver disease
Group 2: Pulmonary Hypertension Due To Left-Sided Heart Disease
❖ This type of PH is having problems with the left side of the heart
❖ Caused by numerous heart disorders like:
→ Left ventricular diastolic dysfunction
→ Coronary artery disease
→ High blood pressure
→ Heart valve disease
→ Damaged to heart muscle
 NCM 118 – EMERGENCY NURSING 1st SEMESTER - PRELIMS
UNIVERSITY OF CEBU – BANILAD CAMPUS, COLLEGE OF NURSING S.Y. 2023 - 2024
CLINICAL INSTRUCTOR: MR. FERVI B. KWEK, MAN, RN, LPT TRANSES BY: MARIE JOY B. LABUS, SN

❖ Mechanical ventilation
Group 3: Pulmonary Hypertension Due To Lung Disease and/or
- A severe type of pneumothorax can occur in people who
Hypoxemia
need mechanical assistance to breathe
❖ Patients falling under this group will have pulmonary - The ventilator can create an imbalance of air pressure
hypertension developed as secondary disease after suffering within the chest. The lung may collapse completely
from Hypoxia, COPD, Interstitial Lung Disease, or any other Symptoms
lung disease which causes blood vessels to tighten and blood
oxygen to drop ✓ Sudden chest pain
✓ Shortness of breath
Group 4: Chronic Thromboembolic Pulmonary Hypertension
Types
❖ This type of pulmonary hypertension would be caused by old,
organized blood clots in the lungs that physically block the flow
❖ Open pneumothorax
of the blood through the pulmonary arteries
→ occurs when a chest wound allows the air to rush and in
Group 5: Pulmonary hypertension triggered by other health and collapse the lungs
conditions ❖ Closed pneumothorax
→ happens if the chest wall gets punctured, a bronchus gets
❖ Combines all other causes that are not defined in the previous
ruptured or the esophagus gets perforated resulting in air
groups
leaking into the pleural space around the lungs and
❖ All causes like hematological and metabolic disorders, various
causing a collapse
blood diseases, and system disorders will fall under this group
❖ Tension pneumothorax
Prevention → can prove fatal if not treated as a medical emergency
→ happens when the lungs continue to leak air into the chest
✓ No smoking cavity and compress not only the lungs but the vessels and
✓ Get enough sleep at night blood around the heart as well
✓ Manage your blood pressure
Symptoms:
✓ Exercise regularly
✓ Maintain a healthy weight → Sharp, stabbing chest pain that worsens when trying to
breath in
→ Shortness of breath
PNEUMOTHORAX → Bluish skin caused by a lack of oxygen
→ Fatigue
❖ A collection of air
outside the lung but → Rapid breathing and heartbeat
within → A dry, hacking cough
the pleural cavity Risk Factors
❖ Occurs when air leaks
into the space ✓ Smoking
between your lung → The risk increases with the length of time and the number
and chest wall of cigarettes smoked, even without emphysema
(parietal and visceral ✓ Previous pneumothorax
pleura). This air → Anyone who has had one pneumothorax is at increased
pushes on the outside of your lung and makes it collapse risk of another
❖ Can be a complete lung collapse or a collapse of only a portion
of the lung Treatment

Causes ❖ Observation
→ for a small pneumothorax
❖ Chest injury
- Any blunt or penetrating injury to your chest can cause ❖ Needle aspiration
lung collapse ❖ Chest tube insertion (CTT)
❖ Lung disease ❖ Video-assisted thoracoscopic surgery (VATS)
- Damaged lung tissue is more likely to collapse → Surgery is performed using a small optic fiber camera.
❖ Ruptured air blisters Leaking blebs are identified and closed off
- Small air blisters (blebs) can develop on the top of the ❖ Supplemental oxygen therapy
lungs → to speed air reabsorption and lung expansion and rest to
- These air blisters sometimes burst — allowing air to leak make a full recovery
into the space that surrounds the lungs → for a small pneumothorax
QUIZ 2 KWEK
KWEK PRELIM
 All of t
he abo
ve?

Pulse O
ximetry

Arterial

Eupnea
dimin
ished
brea
th so
unds

Promo
te carb
on dio
xide e
limina
tion
 Bacteria
l infectio
n

Pleural Fluid Analysis

Re
fra
cto
ry
hyp
oxe
mia
Pneumo
nia

Hospital-
acquired pn
eumonia

Health-care
Acquired Pn
eumonia
Hy
pe
r ca
pn
ic
PRELIM GROUP 1 QUIZ
PRELIM GROUP 2 QUIZ
PRELIM GROUP 3 QUIZ