Alfredo Salenga, a 51-year-old male, presented with difficulty breathing and weakness. Two possible diagnoses were discussed: aspiration pneumonia and acute respiratory distress syndrome. For aspiration pneumonia, the medical management includes hospitalization, antibiotics, oxygen administration, and respiratory measures. For ARDS, ventilator support, prone positioning, sedation, and fluid management are part of the treatment. The nursing care plan assesses for ineffective airway clearance and includes monitoring vital signs, administering oxygen, suctioning, and observing the patient. Intubation, mechanical ventilation, and suctioning are procedures that may be required to treat the patient's condition.

1. ALFREDO’S
CASE
PRESENTATION
Presented by:
Hussam, Jhenalyn
Iribani, Fatima Yazhra
Jaalain, Carol
Jamal, Falnaiza
Laja, Zorina

2. PATIENT’S PROFILE:
NAME: Alfredo Salenga
AGE: 51 years old
SEX: Male
Subjective cues:
“lalagyan ng tubo, nahihirapan huminga”
“… gatas at lugaw-lugaw ang pinakain”
As stated by the wife of the patien
Objective cues:
• Weakness
• Dyspnea
• Wheezy breathing sound (possible)
bradycardia (possible)
• Choking (possible)
• Mucous secretions (possible)

3. 2 POSSIBLE CASE ILLNESS
ASPIRATION PNEUMONIA
ACUTE RESPIRATORY STRESS
SYNDROME (ARDS)

4. PRESENTED BY: Jamal, Falnaiza
● ASPIRATION PNEUMONIA
CLINICAL
MANIFESTATIONS
• Shortness of breath
• Nasal flaring
• Difficulty of breathing
• Fatigue

5. PATHOPHYSIOLOGY

6. MEDICAL
MANAGEMENT:
• Hospitalization
• Administration of antibiotic
medication
• Blood culture
• oxygen administration
• Pulse oximetry
• Aggressive respiratory
measures
NURSING
MANAGEMENT:
• Assist patient with deep
breathing exercise
• Elevate patient head of
the bed
• Administer medication as
prescribed
• encouraged bed rest
• monitor vital signs

7. PRESENTED BY: Laja, Zorina
• ACUTE RESPIRATORY DITRESS
SYNDROME (ARDS)
CLINICAL MANIFESTATIONS
• Severe shortness of breath
• Labored and unusually rapid
breathing
• Low blood pressure
• Confusion and extreme
tiredness

8. PATHOPHYSIOLOGY
ARDS, fluid from the smallest blood
vessels in the lungs starts to leak into
the alveoli—the tiny air sacs where
oxygen exchange takes place. The
lungs become smaller and stiffer and it
becomes hard to breath. The amount
of oxygen in the blood falls. This is
called hypoxemia. The body becomes
starved for oxygen.

9. MEDICAL
MANAGEMENT:
• Ventilator support
• Prone positioning
• Sedation and medications to
prevent movement
• Fluid management
• Extracorporeal membrane
oxygenation (ECMO)
NURSING
MANAGEMENT:
• Monitor vital signs
• Manage nutrition
• Treating the underlying cause or
injury
• Improve oxygenation with
mechanical ventilation
• Suction oral cavity
• Give antibiotics as prescribed
• Observe for barotrauma
• Monitor blood chemistry and fluid
levels

10. Presented by: Iribani, Fatima Yazhra
NURSING CARE
PLAN

11. ASSESSMENT: NURSING DIAGNOSIS GOAL/ PLAN OF CARE
Subjective cues:
“lalagyan ng tubo,
nahihirapan huminga”
As stated by the wife of the
patien
Objective cues:
• Weakness
• Dyspnea
Ineffective Airway
Clearance related to
foreign bodies in the
airway as evidenced by
dyspnea
At the end of nursing
intervention:
• Patient will maintain patent
airway with breath sounds
clear.

12. INTERVENTIONS: RATIONALE: EXPECTED
OUTCOME
EVALUATION
• Assess if the airway is patent.
• If the patient is unable to move,
elevate the head of the bed at
least 30 degrees at all times.
• Note the patient’s oxygen
saturation
• Assess for adventitious sounds;
crackles, wheezing, rhonchi
• Assess the skin color and mucus
membrane
• Assess the level of consciousness
• The highest priority is the patency of the
airway.
• Keeping the chest in upright position helps
with lung expansion and reduces aspiration of
secretions.
• Oxygenation should be maintained at 90%. If
the patient cannot keep up above 90%,
supplemental oxygen might be required.
• Note the pitch, intensity, and duration during
the assessment. These sounds can occur
during inspiration and/or expiration.
• Pallor and cyanosis may be indicators for
deficient gas exchange and perfusion.
• Lack of adequate oxygenation to the brain can
cause restlessness and confusion. Prolonged
cerebral hypoxia can cause lethargy and
somnolence.

13. INTERVENTIONS: RATIONALE: EXPECTED
OUTCOME
EVALUATION
• Monitor Blood pressure, heart
rate, and temperature.
Dependent:
• Administer supplemental oxygen
as ordered.
• Administer medications as ordered.
Collaborative:
• Collaborate with respiratory
therapists.
• Hypotension and tachycardia might be related
to increased work of breathing, leading to
increased respiratory distress and hypoxia. An
elevated temperature can occur as a
response to infectious or inflammatory
process.
• Adequate oxygenation facilitates gas
exchange and perfusion.
• Bronchodilators, expectorants, antibiotics,
diuretics and steroids. All these medications
either treat inflammatory or infectious
processes or help improve breathing by
reducing airway resistance.
• The patient might benefit specialized
treatment plans such as chest physiotherapy
or scheduled nebulizer treatment.

14. Presented by: Hussam, Jhenalyn
PROCEDURES

15. PRESENTED BY: Hussam, Jhenalyn
INTUBATION is the process of
inserting a tube, called endotracheal
tube (ET), through the mouth and
then into the airway. This is done so
that the patient can be placed on a
ventilator to assist with breathing
during anaesthesia, sedation, or
severe illness.

16. A mechanical ventilator is a machine
that helps a patient breathe (ventilate)
when they are having surgery or cannot
breathe on their own due to a critical
illness.
WHY DO WE USE MECHANICAL VENTILATOR – it is used to
decrease the work of breathing until patient improves
enough to no longer need it.

17. SUNCTIONING is the procedure which a catheter is inserted
into the breathing tube to help remove secretions (mucus).

18. DRUG STUDY
Presented by: Jaalain, Carol

19. Drug name Dosage Mechanism of
action
Indications Contraindications Nursing
responsibilities
Generic Name:
Albuterol
Brand name:
proventil
Class:
Beta2 Adrenergic
agonists
2 mg and 4 mg tab
2mg/5ml syrup
Duration: according
to clinIcal response
Produce
bronchodilators by
stimulating the
production of cyclic
adenosine
monophospate
(cAMP).
Treatments of
persistent asthma
not controlled by
inhaled
Corticosteroids.
Administer with
caution to patients
with diabetes
mellitus,
hyperthyroidism,
arrhythmia, angina,
and hypertension.
May cause:
headache, tremor,
tachycardia,
hypokalaemia, and
hyperglycaemia.
Monitor
combinations with:
furosemide,
hydrochlorothiazide,
Corticosteroids,
xanthines.
Assess BP, pulse,
respiration, lung
sounds and
character of
secretions before
and throughout
therapy.
Patients with a
history of
cardiovascular
problems should be
monitored for ECG
changes and chest
pain.

20. Drug name Dosage Mechanism of
action
Indications Contraindications Nursing
responsibilities
Generic Name:
Budesonide
Class:
Corticosteroids
Route:
Capsule
Oral (inhaler)
1 or 2 times daily.
5-10 mins.
Budesonide is a
potent topical anti-
inflammatory agent.
It binds and
activates
glucocorticoid
receptors (GR) in
the effector cell.
For asthma
maintenance
treatment.
For the
management of
symptoms of
seasonal allergies
and perennial
allergies, including
allergic rhinitis.
For mild to
moderate Crohn's
disease involving
the ileum and/or
ascending colon.
Contraindicated as
the primary
treatment of status
asthmaticus or
other acute
episodes of asthma
where intensive
measures are
required.
Hypersensitivity to
budesonide or any
of the ingredients of
the preparation,
compromised liver
function and acute
pulmonary
tuberculosis are
contraindicated.
Assessment
History: Untreated
local nasal
infections, nasal
trauma, septal
ulcers, recent nasal
surgery, lactation
Physical: BP, P,
auscultation; R,
adventitious
sounds;
examination of
nares

21. Drug name Dosage Mechanism of action Indications Contraindications
Generic Name:
Epinephrine
Brand name:
adrenalin
Class:
Sympathomimetic
decongestant
IM
Child under 6 yrs: 0.15
ml
6-12 yrs: 0.3 ml
Over 12 yrs and adult:
0.5 ml
IV (1mg/ml)
add 1 mg EPN to 9ml
of 0.9% sodium
chloride to obtain a 0.1
mg/ml solution
Child: 0.1 ml several
time
Adult: 1 to 2 ml every 1
to 2 mins.
Through its action on
alpha-1 receptors,
epinephrine induces
increased vascular
smooth muscle
contraction, pupillary
dilator muscle
contraction, and
intestinal sphincter
muscle contraction.
Severe anaphylactic
reaction
Cardiopulmonary arrest
Administer with caution
to patients with
hypertension, angina,
ischemic heart disease,
hyperthyroidism and to
elderly patients.
Do not exceed
indicated dose.
Pregnancy and breast-
feeding: no
Contraindications

22. Nursing responsibilities
• Never interrupt an intravenous infusion of medication to administer an IVPB or other medication.
• Extravasation of epinephrine may cause tissue necrosis to skin.
• Monitor BP, pulse, respirations, and urinary output and observe patient closely following IV
administration. Epinephrine may widen pulse pressure.
• If disturbances in cardiac rhythm occur, withhold epinephrine and notify physician immediately.
• Keep physician informed of any changes in intake-output ratio.
• Use cardiac monitor with patients receiving epinephrine IV. Have full crash cart immediately
available.
• Check BP repeatedly when epinephrine is administered IV during first 5 min, then q3–5min until
stabilized.
• Advise patient to report to physician if symptoms are not relieved in 20 min or if they become worse
following inhalation.
• Advise patient to report bronchial irritation, nervousness, or sleeplessness.
• Dosage should be reduced.
• Monitor blood glucose & HbA1c for loss of glycemic control if diabetic

23. https://rnlessons.com/ineffective-airway-clearance-nursing-diagnosis-care-
plan/
https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-
notes/budesonide/
https://www.rxlist.com/consumer_albuterol_ventolin_hfa/drugs-condition.htm
https://www.mayoclinic.org/drugs-supplements/budesonide-inhalation-
route/description/drg-20071233
Nanda 9th edition pages 122-124
REFERENCES: