TASK 1. MY PLAN FOR YOU!

Instructions: Craft at least two Nursing Care Plan based on the Nursing Diagnoses listed below. Follow the standard format set by the College.
(see rubrics for scoring)
 Ineffective Airway Clearance related to Excessive and Tenacious secretions
 Impaired Gas Exchange related to Activity Intolerance
 Anxiety related to Breathlessness
 Powerlessness related to feelings of loss of control
 High risk for Ineffective Therapeutic Regimen Management related to lack of Knowledge

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Impaired Gas Short term: Assess the physical activity Provides baseline Short term:
“ Kapag nag Exchange related to After 12 hours of level and mobility of the information for After 12 hours of nursing
tatrabaho po ako sa Activity Intolerance nursing intervention, patient.Pulse, blood press formulating nursing goals intervention, the patient
gawaing bahay as evidence by the patient will be ure and respiration's. during goal setting. will able to Maintains
mabilis po akong Inability to begin or able to Maintains activity level within
hinihingal at perform activity activity level within Assess the patient’s Adequate energy capabilities
nahihirapan din po capabilities nutritional status. reserves are needed
ako makatulog” as during activity. Long term:
verbalized by the Long term: Assess respiratory rate, Goal met.
client. After a day of nursing depth, and effort, Rapid and shallow After a day of nursing
intervention, the including the use of breathing patterns and intervention, the patient
Objective: patient will be able to accessory muscles, nasal hypoventilation affect gas will able to demonstrate
 Dizziness. demonstrate and flaring, and abnormal exchange. and verbalize and uses
 Dysrhythmia. verbalize and uses breathing patterns. energy-conservation
 Fatigue. energy-conservation techniques.
 Generalized techniques. Observe for signs and Increased dead space and
Weakness. symptoms of pulmonary reflex bronchoconstriction
 Nausea infarction: bronchial in areas adjacent to the
 pain increased breath sounds, infarct result to hypoxia
during or after consolidation, cough, feve (ventilation without
activity r, hemoptysis, pleural perfusion).
 shortness of effusion, pleuritic pain,
breath during or and pleural friction rub.
after activity BP, HR, and respiratory
Monitor for alteration in rate all increase with initial
BP and HR. hypoxia and hypercapnia. 

Consider the patient’s Certain conditions affect

nutritional status. lung expansion. 

Determine the patient’s Fatigue can limit the

daily routine and over-the- patient’s ability to perform
counter medication. needed activity.

Assess emotional Depression over

response to limitations in the inability to perform
physical activity. activities can be a source
of stress and frustration

Auscultate chest Basic indicators of

respiration's, noting respiratory effort.
character of breath
sounds (Quality, rate,
depth and breathing.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Data: Ineffective Airway Short term: Short term:
“Madalas po Clearance related to After 8 hours of Assess airway for Maintaining the airway is After 8 hours of
nahihirapan po Excessive and nursing intervention, patency. always the first priority nursing intervention,
akong huminga” as Tenacious secretions the patient will be the patient will able to
verbalized by the as evidence by able to recognize the Assess cough for Consider possible causes for recognize the
patient. Abnormal arterial significance of effectiveness and ineffective cough: respiratory significance of changes
blood gasses. changes in sputum to productivity. muscle fatigue, severe in sputum to include
include color, bronchospasm, thick color, character,
Objective Data: character, amount, tenacious secretions, and amount, and odor.
-Chronic cough and odor. others.
- Abnormal breath
sounds (crackles, Monitor arterial blood Increasing PaCO2 and Long term:
rhonchi, wheezes) Long term: gases (ABGs). decreasing PaO2 are signs of Partially goal met
-Dyspnea After a day of nursing respiratory failure. After a day of nursing
- Large amount of intervention, the intervention, the
secretions patient will be able to Assess for pain. Postoperative pain can result patient will able to
-Shortness of breath demonstrate in shallow breathing and an demonstrate increased
- Excessive sputum increased air ineffective cough. air exchange and
exchange and maintain clear airway.
maintain clear Assist patient in To improve productivity of the
airway. performing coughing and cough.
breathing manoeuvre s.

Demonstrate and teach So patient will understand the

coughing, deep rationale and appropriate
breathing, and splinting techniques to keep the airway
techniques. clear of secretions.

Perform nasotracheal This position allows the

suctioning as necessary, trachea to close and
especially if cough is esophagus to open, makes
ineffective. swallowing easier and reduces
the risk of aspiration.
Assist the patient to a To promote clearance of
sitting position with head airway secretions and may
slightly flexed, shoulders reduce airway resistance.
relaxed, and knees
flexed.

Give medications as A variety of medications are

prescribed, such as prepared to manage specific
antibiotics, mucolytic problems. Most promote
agents, bronchodilators, clearance of airway secretions
expectorants, noting and may reduce airway
effectiveness and side resistance.
effects

Coordinate with a Chest physiotherapy includes

respiratory therapist for the techniques of postural
chest physiotherapy and drainage and chest percussion
nebulizer management to mobilize secretions from
as indicated.  smaller airways that cannot be
eliminated by means of
coughing or suctioning.
TASK 2. CRITICAL THINKING QUESTIONS
Instructions: Instructions: Briefly answer the questions. At a minimum, you must cite the
journal, textbook, article, and other reading materials. Make sure to cite any references
you use. Use APA style (7th edition) for proper citation format for your references. (see
rubrics for scoring).

1. Discuss the following complementary and alternative medicines for pharmacologic

management for altered ventilatory function?

a. Echinacea
is a genus of herbaceous flowering plants in the daisy family. It has ten species, which
are commonly called coneflowers. They’re linked to many health benefits, such as
reduced inflammation, improved immunity and lower blood sugar levels.

b. Goldenseal
is a popular natural treatment for upper respiratory tract infections, including the
common cold.

 Goldenseal is often combined with echinacea in over-the-counter herbal cold and

flu remedies.

c. Zinc
is considered an essential nutrient, meaning that your body can’t produce or store it.

2. Discuss the following Respiratory Pandemics (overview, clinical manifestation,

pathophysiology, medical/nursing management)?

a. Pandemic Flu b. SARS c. MERS d. 2009 H1N1 e. Avian Flu f. COVID-19

 Pandemic Flu
Overview Etiology Clinical Manifestation Pathophysiology Medical/Nursing
Management
● Pandemic flu - virulent ● Highly communicable ● Fever, chills, headaches ● Virus invades the
human flu that causes a disease characterized by ● Cough epithelium of the Medical:
global outbreak, or abrupt onset with fever ● Sore throat respiratory tract, causing  Vaccine
pandemic, of serious illness which last 1 to 6 days ● Runny or stuffy nose inflammation and  Surveillance
– Because there is little desquamation.
natural immunity, the Causative agent Treatment 
disease can spread easily ● Influenza virus A,B, C ● After attaching to the host ● Prevention with annual
from person to person cell, viral ribonucleic acid influenza vaccination 
– Currently there is no Mode of transmission: enters the cell and uses host ● Fluid and electrolyte
pandemic flu ● By direct contact, through components to replicate its replacements 
● Seasonal (or common) flu droplet infection, or by genetic material and ● Oxygen and assisted
- a respiratory illness that articles freshly soiled with protein, which are then ventilation, if indicated
can be transmitted person to discharge of nose and throat assembled into new virus ● Droplet precautions 
person – Most people have of infected person, airborne particles.  ● Venous thromboembolism
some immunity, and a (VTE) prophylaxis, if
vaccine is available ● Newly produced viruses hospitalized
burst forth to invade other
Risk Factors healthy cells.
●Weakened immune system
● Age (very young or elderly) ● Viral invasion destroys
● Occupation: Health care or host cells, impairing
day-care worker  respiratory defenses
● Chronic illness  (especially the mucociliary
● Pregnancy  transport system) and
● Living in close quarters predisposing the patient to
with many people  secondary bacterial
● Absence of influenza infection.
vaccine
● Caring for or living with a
person with influenza
 Severe Acute Respiratory Syndrome (SARS)
Overview Etiology Clinical Manifestation Pathophysiology Medical/Nursing
Management
Severe acute respiratory ●The SARS-associated  High fever ● Infected person coughs or ● Monitor respiratory status,
syndrome (SARS) is a viral coronavirus is transmitted  Muscle ache sneezes, the droplets are including vital signs, breath
respiratory illness caused by via respiratory droplets  Dry cough spread to a nearby contact. sounds, spo2, and skin colour at
a coronavirus. when an infected person  Shortness of breath ● A small number of least every 4 hours.
coughs or sneezes.  Diarrhea individuals with SARS who ● Monitor cough and sputum
● The droplets may be  Nausea,vomiting are very sick can be very (amount, color, consistency and
possible odor)
deposited on the mucous  Dizziness infectious when they
● Monitor ABG results, reporting
membranes (mouth, nose,  Runny nose develop SARS symptoms.
increasing hypoxemia and other
eyes) of a nearby person.  Sore throat ● SARS becomes infectious
abnormal results to the
● It can be spread when only after the infected physician.
touches a surface or object Diagnostic test person develops symptoms, ● Administer medication as
contaminated by the ● History (first thing to-do) first of which is usually the ordered and monitor their
droplet & then touches the ● Chest x-ray or chest CT scan sudden onset of high fever. effects.
mucous membrane. ● Complete blood count (CBC) ● A person is not infectious
● Antibody tests for SARS during the incubation period Medication
Incubation period: ● Direct isolation of SARS virus which is about 3 to 7 ● Antibiotics to treat bacteria
Incubation periods have ● Rapid polymerase chain that cause pneumonia
varied depending upon the reaction (PCR) test for SARS ● Antiviral medicines
site of the outbreak (2–16 ● High doses of steroids to
days, 2–11 days, 3–10 days) reduce swelling in the lungs
● Oxygen or mechanical
(105)
ventilation – to support the
breathing
● Chest physiotherapy

Health education
● Reducing contact with people
who have SARS - until at least 14
days after their fever and other
symptoms are gone.
● Wash hands or clean with an
alcohol based instant hand
sanitizer especially after
touching surfaces.
● Cover the mouth and nose
when sneeze or cough. Droplets
that are released when a person
sneezes or coughs are infectious.
● Use surgical mask and glove.
● Do not share food, drink, or
utensils.
● Clean commonly touched
surfaces with an EPA approved
disinfectant.
● Avoid mass gatherings and
activities.
● Avoid touching the face in
general.
● Check body temperature at
least twice a day.
● Avoid travel to places where
there is an uncontrolled SARS
outbreak.
 MERS
Overview Clinical Manifestation Pathophysiology Medical/Nursing Management
● Another example of a disease that ● Patients with MERS typically report  MERS-CoV establish infection ● There is no specific treatment
could cause a pandemic.  respiratory symptoms  in monocyte for MERS. 
● MERS is caused by a “novel” or new ● Symptoms may be mild or progress  Derived macrophages (MDMs) ● Supportive care is used to
virus from the large family of rapidly to multi-system organ failure, and macrophages. manage and prevent
coronaviruses.  sepsis, and death   The virus induces the release complications. 
● Viruses from this family cause many ● With severe distress, arterial blood gas of proinflammatory cytokines, ● The patient may need
respiratory illnesses such as the analysis is performed to determine the leading to severe mechanical ventilation and
common cold.  need for oxygen therapy and possible inflammation. fluids. 
● They also can cause critical infections ventilation support.   MERS-CoV infected Vascular ● If kidney function is severely
such as severe acute respiratory ● Cough  endothelial cells located in the reduced, dialysis is performed.
syndrome (SARS).  ●Shortness of breath  pulmonary interstitium and ● Hemorrhage from
● MERS was first identified in Saudi ● Fever  infection may occur.  disseminated intravascular
Arabia and has now been reported in ● Pneumonia   Lymphopenia noted in most coagulation is managed with
26 countries.  ●GI problems, such as diarrhea patients infected with MERS- blood products. 
● Although most of human cases of CoV ● “Convalescent serum,” which
MERS-CoV infections have been  Due to cytokine-induced is the serum taken from a
attributed to human-to-human immune cell sequestration patient who has recovered from
infections in health care settings,  Release and induction of the disease, is a potential
current scientific evidence suggests monocyte chemotactic treatment but requires that the
that dromedary camels are a major protein-1 (MCP-1) and patient have the same blood
reservoir host for MERS-CoV and an interferon-gamma-inducible type as the convalescent
animal source of MERS infection in protein-10 (IP-10), which patient. 
humans.(WHO)  suppresses the proliferation of ● Patients being treated for
● The most recent outbreak started in human myeloid progenitor MERS must be maintained in
2015 in the South Korea  cells. Contact and Airborne
● Only two cases of MERS have been Precautions (CDC, 2015g).
confirmed in North America, and both
patients were health care workers who
lived in Saudi Arabia and traveled to
North America (WHO,2015b)
 2009 H1N1
Overview Clinical Manifestation Pathophysiology Medical/Nursing Management
● Also known as swine flu  ● Cough   Influenza virus ● The antiviral drugs oseltamivir
● Mutated and became highly ● Fever   Enters the body (Tamiflu) and zanamivir (Relenza)
infectious to humans  ● Sore throat   Enters cell in the respiratory should be widely distributed. 
● These drugs may reduce the
● Most recently it caused a pandemic ● Shortness of breath  tract severity of the infection and the
in 2009, spreading to 215 countries  ● ● Pneumonia   Replicates inside cell mortality rate.
In the United States, the number of ● Diarrhea   Leaves host cell in search for ● Infected patients must be cared for
people infected during the pandemic ● Vomiting  another in strict isolation. 
was estimated at 61 million with more ● Abdominal pain   Most cell die ● Ask any patient with these
than 12,000 deaths (CDC, 2015e)  ● Bleeding from the nose and gums symptoms if he or she has recently
(within the past 10 days) traveled to
● A vaccine was developed in 2009 and
areas of the world affected by H5N1.
was administered separately from the ● These precautions remain until the
seasonal influenza vaccine  diagnosis of H5N1 is ruled out or the
● Now the seasonal vaccine contains threat of contagion is over.
the H1N1 antigen  ● No effective treatment for this
● A new avian virus is the H5N1 strain, infection currently exists.
known as “avian influenza” or “bird Interventions are supportive to allow
the patient's own immune system to
flu.” 
fight the infection. 
● This virus has infected millions of ● Oxygen is given when hypoxia,
birds, especially in Asia, and now has breathlessness, or a sudden change
started to spread by human to human in cognition is present.
contact  ● Respiratory treatments to dilate
● Another avian strain, H7N9, has the bronchioles and move
appeared in China, resulting in several respiratory secretions are used.
● If hypoxemia is not improved with
deaths. This virus seems to be able to
oxygen therapy, intubation and
spread from person to person in mechanical ventilation may be
limited situations. Travelers have needed.
brought the virus outside of China, but ● Antibiotics are used to treat a
there are no cases originating outside bacterial pneumonia that may occur
of that country (CDC, 2015e). with H5N1 
● Patient with H5N1 may have
severe diarrhea and need fluid
therapy.
 Avian Flu
Overview Clinical Manifestation Pathophysiology Medical/Nursing Management
Avian Flu- A highly contagious viral  Headache Influenza can be transmitted
disease with up to 100 percent  Sore throat through small or large particle  Assess respiratory status for
mortality in domestic fowl. Caused by  Shortness of breath aerosols or through contact with rate, depth, ease, use of
influenza A virus sub-types H5 and H7.  Cough contaminated surfaces. accessory muscles, and
All types of birds are susceptible to the  Fever work of breathing
virus, but outbreaks occur most often If not neutralized by mucosal  Administer oxygen as
in chickens and turkeys. The infection DIAGNOSTIC TEST antibodies, virus attacks ordered.
may be brought by migratory wild Nasal swab Samples of fluids from your respiratory tract epithelium.  Position patient in high
birds which can carry the virus, but nose or throat can be tested for evidence Fowler’s or semi-Fowler’s
show no signs of disease. Humans are of bird flu virus. These samples must be Infection of respiratory tract position, if possible.
only rarely affected. Also known as taken within the first few days after epithelial cells leads to cellular
fowl plague, avian flu, and bird flu. symptoms appear. dysfunction, viral replication, and
TREATMENT
Chest x-ray X-rays may be useful in release of viral progeny. Amantadine and Rimantadine
assessing the condition of your lungs, (Flumadine)
MODE OF TRANSMISSION which can help determine the proper Release of inflammatory mediators ● 100mg BD
through direct contact with an infected diagnosis and the best treatment options contributes to systemic ● To treat influenza virus
bird’s saliva, nasal secretions, and for your signs and symptoms. manifestations of disease. infection
excreta or through contact with ● Oseltamivir (Tamiflu)
contaminated surfaces (such as cages) ● 75mg BD
or materials (such as water or feed) ● Blocks the actions of influenza
virus types A and B in body
● Zanamivir (Relenza)
● 10mg (2 inhalations) BD
● Antiviral medicine that blocks
the actions of viruses in your
body

HEALTH EDUCATION
● Avoid contact with live poultry
and birds, especially for
children.
● Avoid crowded areas and stay
in places with good ventilation.
● Wash hands thoroughly with
soap and water after handling
live poultry and birds, and after
coughing and sneezing.
● Build up a strong immunity
system in your body. Start by
having a regular exercise regime
and a well-balanced diet that
includes two servings of
vegetables and two servings of
fruits daily. Make sure to get
adequate rest, reduce your
stress levels and do not smoke.
 COVID-19
Overview Clinical Manifestation Pathophysiology Medical/Nursing Management
● Also named as Severe Acute  ● Coronaviruses are common in ● There is no specific antiviral
Respiratory Syndrome Coronavirus 2 ● The symptoms of COVID-19 infection many different species of animals, medication yet is recommended for
(SARS-CoV-2)  appear after an incubation period of including bats, camels, cats, and COVID-19 infection, and no current
● Identified as the cause of an approximately 5.2 days.  cattle.  vaccine to prevent it. 
outbreak first discovered at a local ● The period from the onset of COVID-19 ● Most coronaviruses infect ● Hand hygiene. Wash hands often
seafood /wild animal market in symptoms to death ranged from 6 to 41 animals, but not people; in the with soap and water for at least 20
seconds; if water and soap are not
Wuhan, China.  days with a median of 14 days . This future, one or more of these other
available, use an alcohol-based
● An outbreak of pneumonia of period is dependent on the age of the coronaviruses could potentially
hand sanitizer. 
unknown etiology in Wuhan City was patient and status of the patient's evolve and spread to humans, as
● Keep hands off your face. Avoid
initially reported to WHO on immune system. It was shorter among has happened in the past (zoonotic touching the eyes, nose, and
December 31, 2019.  patients > 70-years old compared with transmission).  mouth with unwashed hands.
● The COVID-19 has been declared by those under the age of 70. ● Evidence indicates the new virus ● Maintain social distancing. Avoid
the World Health Organization (WHO) COVID-19 is spread via the route of close contact with people at least 3
as a pandemic where it is reported Stages of illness: human-to-human transmission feet (1 meter) who are sick, and
that around 5,000,000 people are because there are infections of stay at home when you are sick. 
affected in more than 200 countries 1. Replicative stage – Viral replication people who did not visit Wuhan ● Proper cough and sneeze
around the world. occurs over a period of several days.  but had close contact with family etiquette. Cover your cough or
● An innate immune response occurs, members who had visited Wuhan sneeze with a tissue, then throw
High risk group  but this response fails to contain the and got infected. the tissue in the trash. 
● Age above 60 years old  virus.  ● Supportive care. People infected
●Smoker  ● Relatively mild symptoms may occur with COVID-19 should receive
supportive care to help relieve
● Cardiovascular disease  due to direct viral cytopathic effect and
symptoms. 
● Diabetes  innate immune responses.
● Severe cases. For severe cases,
● Hypertension 
treatment should include care to
● Immune deficiency 2. Adaptive immunity stage – An support vital organ functions. 
adaptive immune response eventually is Antiviral Treatment - there is no
initiated  clinical evidence for effective
● This leads to falling titres of virus. antiviral drugs, currently the
However, it may also increase levels of antiviral strategies based on the
inflammatory cytokines and lead to tissue characteristics of SAR-CoV-2 are
damage – causing clinical deterioration.  adopted according to Protocols for
● This progression may explain the Diagnosis.
clinical phenomenon wherein patients
are relatively okay for several days, but
then suddenly deteriorate when they Treatment of COVID-19 
enter the adaptive immunity stage ● Usage of Glucocorticoids -
appropriate and short-term use of
corticosteroids to inhibit cytokine
cascade and to prevent disease
progression should be considered
for patients with severe COVID-19
● Oxygen Therapy for hypoxemia
● Use of Antibiotics to Prevent
Secondary Infection - The options
of antibiotics include quinolones,
the second or third generation
cephalothins, lactamase inhibitor
compounds, 
● Balance of Intestinal
Microecology and Nutritional
Support 
● Convalescent Plasma Therapy
3. You are caring for a patient who has been mechanically ventilated for 2 weeks.
Physically, the patient meets all the criteria to begin weaning from mechanical
ventilation. What parameters should the nurse monitor to assess tolerance of
weaning?

Weaning Parameters Reference range

Respiratory Rate <35 breaths per minute

Heart rate between 50 and 130 bpm and within ±

20% of pre-trial HR

Systolic Blood Pressure (SBP) between 90-170 mmHg and within ± 20%
of pre-trial SBP
Exhaled TV ≥ 5 cc/ kg IBW ( ≈ 300 – 400 ml )

SpO2 ≥ 92 %
Patient showing no diaphoresis, paradoxical respiration, retractions, nasal flaring,
agitation, or complaining of SOB, or use of accessory muscles
Serial assessment of tolerance are made 5,15,30,60,and 120 minutes after the initial
setting and and any subsequent ventilator setting change