FUNDAMENTALS PULMONARY VENTILATION

OF NURSING
 First process of the respiratory system
 Accomplished thru the act of breathing:
OXYGENATION Inspiration (inhalation) - air flows into the lungs
 Expiration (exhalation) – air moves out of the
lungs
OXYGEN
FACTORS AFFECTING VENTILATION
 A clear, odorless gas that constitute 21% of the
 Clear airways
air we breathe
 An intact central nervous system (CNS) &
 Necessary for proper functioning of all living
respiratory center
cells.
 An intact thoracic cavity capable of expanding
RESPIRATION & contracting
 Adequate pulmonary compliance & recoil
 The process of gas exchange between the
individual & the environment INTRAPLEURAL PRESSURE

4 COMPONENTS OF RESPIRATION  Pressure in the pleural cavity surrounding

the lungs
VENTILATION OR BREATHING  Always slightly negative in relation to
atmospheric pressure
 The movement of air in & out of the lungs as
we inhale or exhale INTRAPULMONARY PRESSURE

ALVEOLAR-CAPILLARY GAS EXCHANGE  Pressure within the lungs

 Always equalizes with atmospheric pressure
 Involves the diffusion of oxygen & CO2
between alveoli & the pulmonary capillaries TIDAL VOLUME

TRANSPORT OF OXYGEN & CARBON DIOXIDE  The lung volume representing the normal
BETWEEN THE TISSUES & THE LUNGS volume of air displaced between normal
inhalation and exhalation when extra effort is
MOVEMENT OF OXYGEN & CARBON DIOXIDE not applied.
BETWEEN THE SYSTEMIC CAPILLARIES & THE  In a healthy, young human adult, tidal volume
TISSUES is approximately 500 ml per inspiration.

STRUCTURES OF THE RESPIRATORY SYSTEM LUNG COMPLIANCE

 The expansibility or stretchability of lung

tissue
UPPER RESPIRATORY SYSTEM
 Plays a significant role in the ease of
 Mouth, nose, pharynx and larynx ventilation

LOWER RESPIRATORY SYSTEM ATELECTASIS

 Trachea, primary bronchi and lungs  Collapse of a portion of the lung

4 RESPIRATORY PROCESSES LUNG RECOIL

PULMONARY VENTILATION  The continual tendency of the lungs to

collapse away from the chest wall

ALVEOLAR GAS EXCHANGE SURFACTANT

TRANSPORT OF OXYGEN & CARBON DIOXIDE  A lipoprotein produced by specialized

alveolar cells, acts like detergent, reducing
SYSTEMIC DIFFUSION the surface tension of alveolar fluid.

Tolentino, Mikaella Joneth | Castillon, Maria Kristelle | Sereneo, Christian | Pelaez, Danica
 ALVEOLAR GAS EXCHANGE

 The second phase of the respiratory CONDITIONS AFFECTING MOVEMENT OF AIR

process
 Breathing patterns
 The diffusion of oxygen from the alveoli &
o Refers to the rate, volume, rhythm &
into the pulmonary blood vessels
relative ease or effort of respiration
DIFFUSION  Eupnea
o Normal respiration; Quiet, rhythmic
 The movement of gases or other particles effortless
from an area of greater pressure or  Tachypnea
concentration to an area of lower pressure o Rapid respirations
or concentration  Bradypnea
TRANSPORT OF OXYGEN & CARBON DIOXIDE o Abnormally slow respiratory rate
 Apnea
 The third part of the respiratory process o Absence of breathing
 Involves the transport of respiratory gases  Hypercarbia/hypercapnia
o Increased level of carbon dioxide
Hemoglobin
 Kussmaul’s Breathing
 Oxygen-carrying red pigment o Characterized by a deep, rapid
breathing pattern. The body starts to
Oxyhemoglobin breathe faster and deeper.
 Cheyne-Stokes Respirations
 The compound of oxygen & hemoglobin
o Marked rhythmic waxing & waning of
FACTORS AFFECTING OXYGEN TRANSPORT respirations from very deep to very
shallow with short periods of apnea
1.Cardiac Output  Biot’s (cluster) respirations
2. Number of erythrocytes & blood haematocrit o shallow breaths interrupted by apnea
 Orthopnea
3. Exercise o inability to breathe easily unless in
sitting upright or standing
SYSTEMIC DIFFUSION
 Dypsnea
 The fourth process of respiration o difficulty of breathing or feeling of
 Diffusion of oxygen & CO2 between the being short of breath
capillaries & the tissues & cells CONDITIONS AFFECTING DIFFUSION
FACTORS AFFECTING RESPIRATORY
 Hypoxemia
FUNCTION
- Reduced oxygen levels in the blood
 Age  Hypoxia
 Environment - Insufficient oxygen anywhere in the body
 Lifestyle  Cyanosis
 Health Status - Bluish discoloration of the skin, nail beds &
 Medications mucous membranes due to reduced
hemoglobin-oxygen saturation
 Stress
CONDITIONS AFFECTING TRANSPORT
ALTERATIONS IN RESPIRATORY FUNCTION
 Congestive heart failure
 Conditions affecting the airway
- a chronic progressive condition that affects the
 Conditions affecting movement of air
pumping power of your heart muscle
 Conditions affecting diffusion
 Hypovolemia
 Conditions affecting Transport
- AKA volume depletion or volume contraction,
CONDITIONS AFFECTING AIRWAY - a state of abnormally low extracellular fluid in
the body.
• Upper airway obstruction of foreign object,
tongue falls back or collection of secretions ASSESSMENT

Tolentino, Mikaella Joneth | Castillon, Maria Kristelle | Sereneo, Christian | Pelaez, Danica
 Nursing History INDICATIONS
 Physical Examination
• Used after surgery especially thoracic &
 Diagnostic Studies
abdominal surgery
NURSING DIAGNOSES • To promote expansion of alveoli & prevent
or treat atelectasis
• Ineffective airway clearance
• Ineffective breathing pattern NURSING MANAGEMENT
• Impaired gas exchange
• Placing the patient in the proper position
• Activity intolerance
(sitting/semi-fowler’s)
• Anxiety
• Educating the patient on the technique
• Fatigue
using the IS
• Fear
• Setting realistic goals
• Powerlessness
• Recording the result of the therapy
• Insomnia
• Social Isolation

GOALS OF CARE PERCUSSION, VIBRATION & POSTURAL

DRAINAGE
 Maintain a patent airway
 Improve comfort & ease of breathing PERCUSSION
 Maintain or improve pulmonary ventilation &
oxygenation • AKA clapping
 Improve ability to participate in physical • Forceful striking of the skin with cupped
activities hands
 Prevent risks associated with oxygenation VIBRATION
problems
• A series of quiverings produced by hands
that are placed flat against the client’s
IMPLEMENTATION chest wall

• Promoting oxygenation POSTURAL DRAINAGE

• Deep breathing & coughing • The drainage by gravity of secretions from
• Hydration various lung segments.
• Medications
• Incentive spirometry MUCUS CLEARANCE DEVICES
• Percussion, vibration & postural drainage
• Used for clients with excessive secretions
• Mucus clearance devices
such as cystic fibrosis, COPD, &
• Oxygen therapy
bronchiectasis.
• Produces vibrations that loosen mucus
from the airway & assist its movement up
HUMIDIFIERS the airways to be expectorated
• Devices that add water vapor to inspired OXYGEN THERAPY
air
• Provide moistened air directly to the client • The administration of oxygen at a
• Prevent mucous membranes from drying & concentration greater than that found in the
becoming irritated & to loosen secretions environmental atmosphere.
for easier expectoration • Provides adequate transport of oxygen in
the blood while decreasing the work of
INCENTIVE SPIROMETERS breathing and reducing stress on the
myocardium
• Referred to as sustained maximal
• Oxygen conc. at room air is 21%
inspiration devices (SMIs)
• Measure the flow of air inhaled thru the
mouthpiece

Tolentino, Mikaella Joneth | Castillon, Maria Kristelle | Sereneo, Christian | Pelaez, Danica
 DEVICE SUGGESTED O2 % Setting
INDICATIONS
FLOW
RATE (L/min)
Trans tracheal ¼-4 60-100
HYPOXEMIA catheter
Mask, Venturi 4-6 24, 26, 28
• Decrease in the arterial oxygen tension in 6-8 30, 35, 40
the blood Mask, aerosol 8-10 30-100
HYPOXIA Tracheostomy 8-10 30-100
collar
• Decrease in oxygen supply to the tissues T-piece 8-10 30-100
or cells Face Tent 8-10 30-100
 The visible mist must be inhaled by the patient
METHODS OF OXYGEN ADMINISTRATION
INDICATIONS
(Oxygen Administration Devices)
 Difficulty in clearing respiratory secretions
Low Flow Systems
 Reduced vital capacity
• Contribute partially to the inspired gas the  Unsuccessful trials of simpler & less costly
patient breaths methods
 Diaphragmatic breathing technique prior to
LOW –FLOW SYSTEMS administration

ENDOTRACHEAL INTUBATION
DEVICE SUGGESTED O2 % Setting
FLOW • Involves passing an endotracheal tube thru
RATE (L/min) the mouth or nose into the trachea
Cannula 1-2 23-30 • Provides a patent airway when the patient
3-5 30-40 is having respiratory distress
6 42 • Method of choice in emergency care
Oropharyngeal 1-6 23-42
TRACHEOTOMY
Catheter
Mask, simple 6-8 40-60 • A surgical procedure in which an opening
Mask, partial 8-11 50-75 is made into the trachea.
breathing
Mask, non- 12 80-100 TRACHEOSTOMY
rebreathing
• The stoma that is the product of the
tracheotomy
•
High Flow Systems • May be temporary or permanent

NURSING MANAGEMENT
• Provide the total inspired air
• Reduced vital capacity • Continuous monitoring & assessment
• Unsuccessful trials of simpler & less costly • Opening kept patent by proper suctioning
methods of secretions
• Diaphragmatic breathing technique prior to • Semi-fowler’s position
administration • Paper & pencil means of communication
• HIGH-FLOW SYSTEMS

SMALL-VOLUME NEBULIZER THERAPY PERFUSION

(Mini-nebulizer)
CIRCULATORY or CARDIOVASCULAR SYSTEM
 A handheld apparatus that disperses a  Responsible for the transport of oxygen, fluids,
moisturizing agents or medication electrolytes and products of metabolism via the
 Usually air driven by means of a compressor blood to & from tissues
thru connecting tubing.

Tolentino, Mikaella Joneth | Castillon, Maria Kristelle | Sereneo, Christian | Pelaez, Danica
 PHYSIOLOGY OF THE CARDIOVASCULAR TERMS RELATED TO CARDIAC OUTPUT
SYSTEM HEART

 A hollow, cone-shaped organ about the size of

HEART RATE
a fist
 Located in the mediastinum, between the lungs  The number of times your heart beats in 1
& underlying the sternum minute.
CORONARY CIRCULATION  A normal resting heart rate for adults ranges
from 60 to 100 beats per minute. A lower
 The circulation of blood in the blood vessels heart rate at rest implies more efficient heart
that supply the heart muscle (myocardium). function and better cardiovascular fitness.
 Coronary arteries supply oxygenated blood to
PRELOAD
the heart muscle, and cardiac veins drain away
the blood once it has been deoxygenated.  The degree to which muscle fibers in the
CARDIAC CYCLE ventricles are stretch at the end of the
relaxation period (Diastole).
 The performance of the human heart from the
CONTRACTILITY
ending of one heartbeat to the beginning of the
next.  The natural ability of the cardiac muscle fibers
to shorten or contract
It consists of two periods:
AFTERLOAD
DIASTOLE
 The resistance that the ventricle must
 The heart muscle relaxes and refills with blood
overcome during systole to eject blood into
SYSTOLE circulation

 A period of robust contraction and pumping of BLOOD VESSELS

blood

CARDIAC CONDUCTION SYSTEM

ARTERIAL CIRCULATION
 The sinoatrial (SA) node fires a stimulus
 Moves blood from the heart to the tissues,
across the walls of both left & right atria
maintaining a constant flow to the capillary
causing them to contract
beds despite the intermittent pumping action of
 The stimulus arrives at the atrioventricular
the heart
(AV) node
 The stimulus is directed to follow the AV VENOUS CIRCULATION
bundle (Bundle of His)
 The stimulus now travels thru the apex of the  Returns blood from peripheral tissues to the
heart thru the Right & Left bundle branches heart without resistance
 The Purkinje fibers distribute the stimulus BLOOD PRESSURE
across both ventricles causing ventricular
contractions  The force exerted on the arterial walls by the
blood flowing within the blood vessel.
CARDIAC OUTPUT (CO)
MEAN ARTERIAL PRESSURE (MAP)
 The amount of blood pumped by the ventricles
in 1 minute.  Maintains blood flow to the tissues throughout
the cardiac cycle
Stroke volume (SV)
Cardiac Formula
 the amount of blood ejected with each
contraction  MAP=systolic blood pressure + (2 X diastolic
blood pressure) / 3
Formula
• The reference range is 70-100 mm Hg.
 CO = SV x HR (Heart rate)

Tolentino, Mikaella Joneth | Castillon, Maria Kristelle | Sereneo, Christian | Pelaez, Danica
 Altered by conditions that affect

PERIPHERAL VASCULAR RESISTANCE (PVR)  The function of the heart as a pump

 Blood flow to organs & peripheral tissues
• Impedes or opposes blood flow to the tissues
 The composition of the blood & its ability to
It is determined by: transport O2 & CO2

 The viscosity, or thickness, of the blood 3 MAJOR ALTERATIONS

 Blood vessel length
 Decreased cardiac output
 Blood vessel diameter
 Impaired tissue perfusion
BLOOD  Blood alterations

 Serves as the transport medium within the DECREASED CARDIAC OUTPUT

cardiovascular system, bringing oxygen &
nutrients from the environment to the cells.
MYOCARDIAL INFARCTION (MI)
Primary functions
 Commonly known as a heart attack
 Transporting oxygen, nutrients & hormones to
 Occurs when blood flow decreases or stops to
the cells & metabolic wastes from the cells for
a part of the heart, causing damage to the
elimination
heart muscle
 Regulating body temperature, pH, & fluid
volume HEART FAILURE
 Preventing infection & blood loss
 The heart is unable to keep up with the body’s
HEMOGLOBIN need for oxygen & nutrients to the tissues
 Major component of red blood cells IMPAIRED TISSUE PERFUSION
(erythrocytes), the predominant cell present in
the blood.
 A protein in your RBC that carries oxygen to ATHEROSCLEROSIS
the body's organs and tissues and transports
carbon dioxide from the organs and tissues  Refers to the buildup of fats, cholesterol and
back to the lungs. other substances in and on your artery walls
(plaque), which can restrict blood flow.
RISK FACTORS FOR CV DISEASE
ISCHEMIA

 A lack of blood supply due to obstructed

Traditional Risk Factors
circulation
- Non-modifiable (cannot be reduced)
 Heredity
 Age BLOOD ALTERATIONS
 Gender
- Modifiable (can be reduced)
 Elevated serum lipid level Hypertension ANEMIA
 Cigarette smoking
 Diabetes, obesity & sedentary lifestyle  A condition in which a person lacks enough
- Non-traditional risk factors Metabolic healthy red blood
syndrome (Met-S) ASSESSMENT
 C-reactive protein (CRP)
 Elevated homocysteine level  Nursing History
 Physical Examination
ALTERATIONS IN CV FUNCTION  Diagnostic Studies


Tolentino, Mikaella Joneth | Castillon, Maria Kristelle | Sereneo, Christian | Pelaez, Danica
 NURSING DIAGNOSES FUNCTIONS OF WATER

 Decreased cardiac output EXTRACELLULAR FLUID

 Risk for peripheral neurovascular dysfunction
• Maintains blood volume .Transports gases,
 Activity intolerance
nutrients and other substances to the cells
GOALS OF CARE
INTRACELLULAR FLUID
 Maintain or improve tissue perfusion
• Promotes cellular chemical function
 Maintain or restore an adequate cardiac output Maintains normal body temperature
IMPLEMENTATION Eliminates waste products from the cells

 Promoting circulation FUNCTIONS OF ELECTROLYTES

 Medications • Promote neuromuscular irritability
 Preventing venous stasis • Maintain body fluid volume and osmolality
 Cardiopulmonary resuscitation (CPR) • Distribute body water between fluid
compartments
CARDIOPULMONARY RESUSCITATION (CPR)
• Regulate acid-base balance
 A combination of oral resuscitation (mouth-to-
NORMAL VALUES
mouth breathing or use of a mask), which
supplies oxygen to the lungs, & external INTERNAL REGULATION OF BODY WATER and
cardiac massage (chest compression), which ELECTROLYTES
is intended to reestablish cardiac function &
blood circulation. SODIUM AND WATER REGULATION
 AKA basic life support (BLS)
• Thirst – major control of actual fluid intake
FLUID, ELECTROLYTES AND ACID-BASE • Kidneys – major organs controlling output
BALANCE • ADH – retains water in the renal tubules
• RAAS – aldosterone retain sodium and
water (sodium primarily determines
BODY FLUID COMPARTMENTS
osmolality (concentration) of the body
fluids)

INTRACELLULAR FLUID COMPARTMENT (ICF) POTASSIUM REGULATION

• Fluid found inside the cells • Aldosterone and hydrogen ions regulate
• It comprises 2/3 (70%) of the body fluid. potassium levels
• Aldosterone retains sodium and excretes
EXTRACELLULAR FLUID COMPARTMENT (ECF) potassium
• Alkalosis increases k excretion
• Fluid found outside the cells.
• It comprises 1/3 (30%) of the body fluid ELECTROL NORMAL VALUES
• May be interstitial fluid (in-between the YTES
cells) Intravascular fluid (plasma) SODIUM 135 – 145 mEq/L
• Transcellular fluid (digestive juices, pleural (Na)
POTASSIU 3.5 – 5 mEq/L
fluid, water in the renal tubules &CS)
M (K)
FACTORS OF BODY WATER DISTRIBUTION CALCIUM 4.5 – 5.5 mEq/L
(Ca)
• In infants, 80% of the body weight is water. PHOSPHAT 1.7 – 2.6 mEq/L
• In males, 60% of the body weight is water. E (HPO4)
Males are more muscular than females. CHLORIDE 98 – 108 mEq/L
• In females, 50% of the body weight is (Cl)
water. Females have more adipose tissue MAGNESIU 1.5 – 2.5 mEq/L
than males. M (Mg)
(hypokalemia)
• Acidosis decreases k excretion
(hyperkalemia)

Tolentino, Mikaella Joneth | Castillon, Maria Kristelle | Sereneo, Christian | Pelaez, Danica
• K is the major cation in the ICF HYPERTONIC SOLUTION
• K is necessary in the conduction of nerve
impulses and promotion of • Has HIGHER concentration than the body
• skeletal and cardiac muscle activity fluids
• Examples: D10W, D50W, D5LR, D5NM
CALCIUM REGULATION
ELECTROLYTE IMBALANCES
• Parathormone, thyrocalcitonin and Vitamin
D regulate calcium levels SODIUM IMBALANCES
• Vitamin D promotes calcium absorption
from GIT HYPONATREMIA (SODIUM DEFICIT)
• Calcium promotes neuromuscular
irritability; bone and teeth • Caused by sodium loss or water excess
• development and blood clotting
• Parathormone elevates s. Ca levels by CAUSES
withdrawing calcium from bones (bone • Diuretics
resorption) • Low Na diet
• Thyrocalcitonin lowers s. Ca levels by • Decreased aldosterone secretions
depositing Ca in the bones (bone • Edema
absorption) • Ascites
• Calcium and phosphorus have inverse • Burns
relationship • Diaphoresis

MOVEMENT OF FLUIDS HYPERNATREMIA (SODIUM EXCESS, EDEMA)

PASSIVE TRANSPORT • Sodium and water excess result to edema

CAUSES:
• Diffusion – transport of solutes from area • Hyperventilation and diarrhea
of higher concentration to lower • High sodium intake
concentration across semi-permeable • Sodium tablets
membrane • Water deprivation
• Osmosis – transport of solvent from area
of lower concentration to higher Hyponatremia vs. Hypernatremia
concentration across semi-permeable
membrane Hyponatremia
ACTIVE TRANSPORT Increases ICF volume CELLS SWELL
Hypernatremia
• Hydrostatic pressure – caused by the CELLS SHRINK
Decreases ICF volume
blood pressing against walls of blood
vessels (pushing force)
• Colloid Osmotic pressure (oncotic
pressure) – pressure needed to overcome
the pull of CHON. Pull or absorb fluid from
POTASSIUM IMBALANCES
the interstitial space
HYPOKALEMIA (POTASSIUM DEFICIT)
TYPES OF INTRAVENOUS FLUIDS

ISOTONIC SOLUTION • Characterized by decreased

neuromuscular irritability
• Everything is low and slow
• Has the same concentration as the body
fluids
CAUSES:
• Examples: D5W, NaCl 0.9% & Plain
• Decreased food and fluid intake
ringer’s lactate
(starvation)
HYPOTONIC SOLUTION • Increased loss of potassium
• Has lower concentration than the body • Shifting of K into the cells
fluids
• Example: NaCl 0.3%

Tolentino, Mikaella Joneth | Castillon, Maria Kristelle | Sereneo, Christian | Pelaez, Danica
 HYPERKALEMIA (POTASSIUM EXCESS) • Alcohol withdrawal syndromes
• Draining fistulas
• Characterized by increased neuromuscular
irritability HYPERMAGNESEMIA
• Everything is high and fast
• There is decreased acetylcholine release
CAUSES: which result to decreased neuromuscular
• Excess dietary intake of potassium-rich irritability
food • Everything is low and slow
• Excess parenteral administration of
potassium CAUSES:
• Decreased excretion of potassium • Excessive intake of magnesium-containing
• Shifting of potassium out of cells antacids
• Renal failure
CALCIUM IMBALANCES • Diabetic ketoacidosis

HYPOCALCEMIA HYPOCALCE HYPOMAGNES EVERYTHING

MIA EMIA IS HIGH AND
• Increased cell membrane permeability FAST
which results to increased neuromuscular
HYPERCALC HYPERMAGNE EVERYTHING
irritability
EMIA SEMIA IS LOW
• Everything is high and fast
AND SLOW
CAUSES:
ACID – BASE IMBALANCES
• Decreased ionized calcium
• Excess loss of calcium - Arterial Blood Gas Analysis (ABG) Normal
values
• Inadequate dietary intake of calcium-rich
food
• Decreased calcium absorption Blood pH 7.35 – 7.45
• Calcium Imbalances pO2 80 – 100 mmHg
pCO2 35 – 45 mmHg
HYPERCALCEMIA HCO3 22 – 26 mEq / L

 Decreased cell membrane permeability which INTERPRETATIONS

decreases neuromuscular irritability
 Everything is low and slow pH less than 7.35 Acidosis
pH more than 7.45 Alkalosis
CAUSES: pCO2 less than 35 Alkalosis
• Calcium loss from bones
pCO2 more than 45 Acidosis
• Excessive intake of calcium
• Hyperparathyroidism HCO3 less than 22 Acidosis
• Hypervitaminosis D HCO3 more than 26 Alkalosis
• Steriod therapy
• If pH is 7 and below or 7.8 and above,
MAGNESIUM IMBALANCES death occurs.
• If pH and pCO2 are primarily affected,
HYPOMAGNESEMIA respiratory acid-base imbalances will result
• If pH and HCO3 are primarily affected,
• Magnesium inhibits acetylcholine release metabolic acid – base imbalances will be
• In hypomagnesemia, there is increased experienced.
acetylcholine release which results to
increased neuromuscular irritability RESPIRATORY ACIDOSIS (Carbonic Acid Excess)
• Everything is high and fast
• Caused by failure of the respiratory system
CAUSES: to remove carbon dioxide from the body
• Prolonged malnutrition or starvation fluid as it is produced in the tissues
• Malabsorption syndromes
• Hypercalcemia

Tolentino, Mikaella Joneth | Castillon, Maria Kristelle | Sereneo, Christian | Pelaez, Danica
 • Disorders that lead to hypoventilation seconds (+ Allen’s test), indicating that arterial
result to retention of carbon dioxide circulation has resumed. If that does not
happen, you will need to select another site.
RESPIRATORY ALKALOSIS (CARBONIC ACID
DEFICIT) ACCESSIBLE VESSELS FOR ARTERIAL
PUNCTURE
• Caused by loss of carbon dioxide from the
lungs at a faster rate that it is produced in • Radial artery – superficial, easily
the tissues compressible and with good collaterals with
• Disorders that lead to hyperventilation ulnar artery. Ideal vessel for arterial puncture.
result to excess loss of carbon dioxide. • Brachial artery
• Femoral artery
METABOLIC ACIDOSIS (Bicarbonate Deficit) • Temporal artery
• Dorsalis pedis artery
• Results from abnormal of fixed acids or
loss of base
Assessment NUTRITION
• Headache
• Mental dullness Nutrition
• Kussmaul’s breathing  Sum of all the interactions between an
• hyperkalemia organism and the food it consumes.
 In other words, it is what a person eats and
METABOLIC ALKALOSIS (Bicarbonate Excess) how the body uses it

• Results from loss of hydrogen ions or Nutrients

addition of base to body fluids.  organic and inorganic substances found in
Assessment foods that are required for body functioning
• Hypoventilation  Balance nutrients consists of water,
• Mental confusion carbohydrates, proteins, fats, vitamins and
• Dizziness minerals
• Numbness and tingling of fingers and toes,
muscle twitching Nutritive Value
• Tetany and seizures  nutrient content of a specified amount of food

ARTERIAL BLOOD GAS ANALYSIS Water

 The body is made up of 60% water
• Commonly ordered on the client with  Body’s most basic nutrient
COPD, pulmonary edema,  Every cell requires a continuous supply of fuel.
ARD, MI or PNA.  The most important nutritional need after water
• Also used for non-emergencies such as - nutrients that provide fuel or energy.
weaning from ventilator helpful in the
 Energy providing nutrients are called
assessment of children who are acutely ill
macronutrients, which needed in large
with either pulmonary or non-pulmonary
amounts to provide energy
disorders who require an artificial airway
 Micronutrients, are required in small amounts
to metabolize the energy-providing nutrients.
ALLEN’S TEST
ESSENTIAL NUTRIENTS
• To assess adequacy of blood supply to the
client’s non-dominant hand.
Macronutrients
 Energy provider
STEPS:
 Carbohydrates
• Have client open and close fist a few times.
 Fats
• While fist is clenched, simultaneously occlude
 Proteins
both radial and ulnar arteries.
 Water
• While arteries are occluded, ask client to
Micronutrients
slowly unclench fist and relax hand. (the palm
 metabolizes energy providing nutrients
should be pale from lack of arterial blood flow)
 Vitamins and Minerals
• Then, release the pressure over the ulnar
artery. The palm should turn pink within 7 to 15
Carbohydrates

Tolentino, Mikaella Joneth | Castillon, Maria Kristelle | Sereneo, Christian | Pelaez, Danica
  composed of the elements carbon (C), Types Fatty acids
hydrogen (H) and oxygen (O) a) Saturated
 Two basic types: (1) simple, (2) complex b) Unsaturated
Cholesterol
Types Sugar, Starches, Fiber Chemical Simple, Glycerides, most
Digestion Major enzymes: ptyalin, common.
pancreatic amylase and Structure Triglycerides
disaccharides a) Unsaturated
Metabolism body breaks CHO into b) b. Saturated
glucose Digestion Digestion begins in
 continues to circulate stomach, but mainly
in the blood (maintain digested in small
blood levels) and to intestines.
provide a readily Metabolism Conversion of fat into
available source of usable energy occurs
energy through enzyme
 remainder is used as hormone sensitive lipase
energy or stored.
Storage and stored either as Micronutrients
Conversion glycogen or as fat
VITAMINS Lack of vitamins leads to
Proteins metabolic deficit
 formed in combination of amino acids
 Essential AA organic compound a. Water soluble –
 Nonessential AA Vit C and B complex;
 Complete Proteins body cannot store, thus
 Incomplete derived from daily supply
in diet and may be
Digestion from stomach to the degraded by food
small intestine processing, storage and
 breakdown of protein preparation.
(pepsin) to smaller b. Fat soluble –
units Vit A, D, E & K; body can
 pancreas secretes store but with limitation
proteolytic enzymes of Vit E and K; daily
 intestinal wall glands supply is not necessary;
secrete amino highest in fresh foods
peptidase & consumed after harvest
dipeptidase MINERALS a. Macrominerals -
- requires in daily in
 protein into smaller
found in organic amounts over 100mg.
molecules
compounds, as inorganic This includes calcium,
 AA
compounds, and phosphorus, sodium,
Metabolism Anabolism
as free ions potassium, magnesium,
Catabolism
chloride and sulfur.
Nitrogen balance
-
Storage and absorbed by active Calcium and phosphorus
Conversion transport through the make up 80% of all
small intestine into the minerals in the body
portal blood circulation b. Microminerals –
requires daily amounts
Lipids less than 100mg. This
 organic substances that are greasy and includes iron, zinc,
insoluble in water but soluble in alcohol or manganese, iodine,
ether fluoride, copper, cobalt,
 Fats – lipids that are solid in room temp chromium and selenium
 Oils – lipids that are liquid in room temp
 CHO but contains a higher proportion of Common problems
hydrogen associated with mineral

Tolentino, Mikaella Joneth | Castillon, Maria Kristelle | Sereneo, Christian | Pelaez, Danica
 nutrients are iron Religious Practice Roman Catholics,
deficiency resulting in Protestants, Islam,
anemia and osteo Orthodox Jews, etc.
porosis resulting from Lifestyle Linked to food related
loss of bone calcium. behaviors
Economics Socioeconomic status is
a factor.
Energy Balance Medications Effects of drugs on
 the relationship between the energy derived nutrition
from food and the energy used by the body Health Individual’s health status
Alcohol A small amount of
ENERGY INTAKE Caloric value alcohol is converted
Calorie directly to fat.
Carbohydrates 4 Advertising Influence on people’s
Cal/g - Small calorie (c, cal) food choices & eating
Protein 4 Cal/g - Large calorie (Calorie, patterns
Fat 9 Cal/g kilocalorie [Kcal]) Psychological Stressed, depressed,
Alcohol 7 Cal/g - Energy freed in food lonely or happy
metabolism
ENERGY OUTPUT Metabolism, all Nutritional Variations Throughout the Life Cycle
biochemical and Neonate to 1 year
physiological processes by  The neonate’s fluid and nutritional needs are
which the body grows and met by breastmilk or formula
maintains itself  The newborn is fed “on demand”.
Basic Metabolic Rate  Regurgitation or spitting up, during or after a
(BMR) feeding is a common occurrence during the
Resting energy first year
expenditure (REE)  Bottle mouth syndrome – decay of the teeth
caused by constant contact with sweet liquid
Body Weight & Body Mass Standards from the bottle
 Ideal Body Weight - optimal weight
recommended for optimal health 0-2 years Breastmilk (for 6 months
 Body Mass Index - a more reliable indicator by until 1 year)
health professionals 4-6 months Adding solid food
 Percent Body Fat 6 months Can consume solid food
 Skin fold testing more because they can sit
 Bioelectrical impedance analysis up, hold spoon and have
decreased sucking and
Measuring the BMI tongue protrusion reflex
BMI =Weight in kilograms requires iron
(height in meters) 2 supplementation to prevent
iron deficiency
Factors Affecting Nutrition anemia
cow’s milk is low in iron;
Development Rapid period of growth thus, iron fortified cereals
has increased needs for or formulas as
nutrients recommended and are
Sex Differs due to body continued until 18 months
composition & 7-11 months With the eruption of teeth,
reproductive functions the infant is ready to chew
Ethnicity and Culture Food preference differs and can experience
as such among cultural different food textures. The
backgrounds infant enjoys finger foods,
Beliefs about food Food fads that involve such as skinless fruit cut
non-traditional food into small pieces to prevent
practices are common choking, dry cereal, or
Personal Preferences Individual likes and toast.
dislikes can be related to
familiarity

Tolentino, Mikaella Joneth | Castillon, Maria Kristelle | Sereneo, Christian | Pelaez, Danica
 12 months should be fed with table 3. Consume milk, milk products, and other
food; milk intake about 20 calcium-rich food such as small fish and
oz per day shellfish, every day for healthy bones and
12-24 months weaning from breasts or teeth.
bottle to the cup 4. Eat more vegetables and fruits to get the
essential vitamins, minerals, and fiber for
Toddler Meals should be short regulation of body processes.
because of brief 5. Eat a variety of foods every day to get the
attention span and nutrients needed by the body.
environmental 6. Consume safe foods and water to prevent
distractions diarrhea and other food-and water-borne
Preschool Very active, such diseases.
requires snacks; Teach 7. Limit intake of salty, fried, fatty, and sugar-rich
to use utensils and foods to prevent cardiovascular diseases.
provide opportunity to 8. Be physically active, make healthy food
practice choices, manage stress, avoid alcoholic
School Age The goal is to allow beverage, and do not smoke to help prevent
weight to increase more lifestyle-related non-communicable disease.
slowly than height 9. Attain normal body weight through proper diet
Adolescent Teach lifelong eating and moderate physical activity to maintain
habits; Risk for eating good health and help prevent obesity.
disorder 10. Use iodized salt to prevent Iodine Deficiency
: Anorexia and Bulimia Disorders.
Young Adult Two or three liters of
fluid should be included The Food Guide Pyramid
in the daily diet  A graphic aid developed by USDA as a guide
Middle Age Adult Postmenopausal women in making daily choices
need to ingest sufficient  The food groups – grains, vegetables, fruits,
calcium and vitamin D to milk, meat and beans – are drawn from the
reduce osteoporosis. base of the pyramid to the apex. This indicates
Older Adults Requires same basic that activity, moderation, personalization,
nutrition as younger proportionality, variety and gradual
adults improvement are the keys to good nutrition.

Standards of A Healthy Diet MyPlate

Dietary Guidelines for Americans  A simple reminder on how to implement dietary
 Keep fat to 20–35% of total calories guidelines and was introduced by Michelle
Less than 7% saturated fatty acids/day Obama
Less than 300 mg cholesterol/day
 Consume less than 1,500 mg sodium/day Vegetarian Diets
 Moderate alcohol, if the individual drinks  There are two basic VD:
1. Vegan – use only plant food
 Published by USDA every 5 years
2. Those that include milk, eggs or dairy
 Shift to plant-based foods
products
 Reduce foods with added sugars, fats
 Protein found in plant food are incomplete
Exercise regularly
proteins, therefore vegetarians must eat
 Consume foods daily with vitamin D, calcium, complementary protein foods to obtain EAA
potassium, and fiber
 Important to eat wide range of foods and
maintain balance with protein, vitamin, and
2012 Nutritional Guidelines for Filipinos (NGF)
mineral supplements as needed
includes the ten nutritional and health message.
1. Consume fish, lean meat, poultry, egg, dried
Altered Nutrition
beans or nuts daily for growth and repair of
 Malnutrition – lack of appropriate food
body tissues.
substance
2. Breastfeed infants exclusively from birth up to
 Overnutrition – caloric intake in excess of
six months and then give appropriate
daily energy requirements, resulting in storage
complementary foods while continuing
breastfeeding for two years and beyond for of energy in form of adipose tissue
optimum growth and development.

Tolentino, Mikaella Joneth | Castillon, Maria Kristelle | Sereneo, Christian | Pelaez, Danica
 Undernutrition – intake of nutrients
insufficient to meet daily energy requirements Nursing Interventions
because of inadequate food intake  Maintain or restore optimal nutritional status
 Protein-calorie malnutrition – seen in  Promote healthy nutritional practices
starving children of underdeveloped countries  Prevent complications associated with
malnutrition
Anthropometric Measurements  Decrease weight or regain specified weight
 non-invasive technique that aims to quantify  Planning for home care
body composition  Provide aid with eating, purchasing food, and
1. Skinfold measurement – determine fat stores preparing meals
2. Mid-arm circumference – measure fat,  Instruct about nutrition therapy
muscle and skeleton  Assess client and family's abilities for self-care,
3. Mid-arm muscle area (MAMA) – calculated financial resources, and need for referrals
by using formula using SF and the MAC

Biochemical (Laboratory) Data

 provides objective data to the nutritional
assessment
 Serum proteins– estimate of visceral protein
stores in the body
 Urinary tests – measure of protein catabolism
and the state of nitrogen balance
 Total Lymphocyte count – results decrease
as protein depletion occurs

Clinical Data
 assessment that focuses on rapidly
proliferating tissues such as skin, hair, nails,
eyes and mucosa but also includes systematic
review comparable to any routine physical
examinations
 Calculating percentage of weight loss
 Compare height, current body weight, and
usual body weight
 IBW based on healthy people

Dietary Data
1. 24H Food recall
2. Food frequency record – checklist that
indicates how often general food groups
are eaten
3. Food diary – detailed record of
measurement amounts of all food and
fluids a client consumes usually 3-7 days
4. Diet history – extensive interview by the
dietician

Possible Nursing Diagnosis

 Imbalance nutrition: Less than body
requirements
 Obesity
 Overweight
 Readiness for Enhanced Nutrition
 Activity intolerance
 Constipation
 Chronic Low Self Esteem
 Risk for Infection
 Knowledge deficits

Tolentino, Mikaella Joneth | Castillon, Maria Kristelle | Sereneo, Christian | Pelaez, Danica