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Case On Pneu
Case On Pneu
The lungs constitute the largest organ in the respiratory system. They play an important role in
respiration, or the process of providing the body with oxygen and releasing carbon dioxide. The
lungs expand and contract up to 20 times per minute taking in and disposing of those gases.
Air that is breathed in is filled with oxygen and goes to the trachea, which branches off into one
of two bronchi. Each bronchus enters a lung. There are two lungs, one on each side of the
breastbone and protected by the ribs. Each lung is made up of lobes, or sections. There are three
lobes in the right lung and two lobes in the left one. The lungs are cone shaped and made of
elastic, spongy tissue. Within the lungs, the bronchi branch out into minute pathways that go
through the lung tissue. The pathways are called bronchioles, and they end at microscopic air
sacs called alveoli. The alveoli are surrounded by capillaries and provide oxygen for the blood in
these vessels. The oxygenated blood is then pumped by the heart throughout the body. The
alveoli also take in carbon dioxide, which is then exhaled from the body.
Inhaling is due to contractions of the diaphragm and of muscles between the ribs. Exhaling
results from relaxation of those muscles. Each lung is surrounded by a two-layered membrane, or
the pleura, that under normal circumstances has a very, very small amount of fluid between the
layers. The fluid allows the membranes to easily slide over each other during breathing.
PATHOPHYSIOLOGY
Pneumonia is a serious infection or inflammation of your lungs. The air sacs in the lungs fill with
pus and other liquid. Oxygen has trouble reaching your blood. If there is too little oxygen in your
blood, your body cells can’t work properly. Because of this and spreading infection through the
body pneumonia can cause death. Pneumonia affects your lungs in two ways. Lobar pneumonia
affects a section (lobe) of a lung. Bronchial pneumonia (or bronchopneumonia) affects patches
throughout both lungs.
Bacteria are the most common cause of pneumonia. Of these, Streptococcus pneumoniae is the
most common. Other pathogens include anaerobic bacteria, Staphylococcus aureus, Haemophilus
influenzae, Chlamydia pneumoniae, C. psittaci, C. trachomatis, Moraxella (Branhamella)
catarrhalis, Legionella pneumophila, Klebsiella pneumoniae, and other gram-negative bacilli.
Major pulmonary pathogens in infants and children are viruses: respiratory syncytial virus,
parainfluenza virus, and influenza A and B viruses. Among other agents are higher bacteria
including Nocardia and Actinomyces sp; mycobacteria, including Mycobacterium tuberculosis
and atypical strains; fungi, including Histoplasma capsulatum, Coccidioides immitis,
Blastomyces dermatitidis, Cryptococcus neoformans, Aspergillus fumigatus, and Pneumocystis
carinii; and rickettsiae, primarily Coxiella burnetii (Q fever).
The usual mechanisms of spread are inhaling droplets small enough to reach the alveoli and
aspirating secretions from the upper airways. Other means include hematogenous or lymphatic
dissemination and direct spread from contiguous infections. Predisposing factors include upper
respiratory viral infections, alcoholism, institutionalization, cigarette smoking, heart failure,
chronic obstructive airway disease, age extremes, debility, immunocompromise (as in diabetes
mellitus and chronic renal failure), compromised consciousness, dysphagia, and exposure to
transmissible agents.
Typical symptoms include cough, fever, and sputum production, usually developing over days
and sometimes accompanied by pleurisy. Physical examination may detect tachypnea and signs
of consolidation, such as crackles with bronchial breath sounds. This syndrome is commonly
caused by bacteria, such as S. pneumoniae and H. influenzae.
NURSING PROFILE
a. Patient’s Profile
Name: R.C.S.B.
Age: 1 yr,1 mo.
Weight:10 kgs
Mother: C.B.
Tx: Disudrin OD
Loviscol OD
Tx: Paracetamol
(+) TPC
d. Past Illness
(-) asthma
(-) allergies
e. Family History
Active, responsive
g. Review of Systems
INDEPENDENT
positioning of the patient with head on mid line, with slight flexion
rationale: to provide patent, unobstructed airway , maximum lung excursion
auscultating patient’s chest
rationale: to monitor for the presence of abnormal breath sounds
provide chest and back clapping with vibration
rationale: chest physiotheraphy facilitates the loosening of secretions
considering that the patient is an infant, and has developed a strong stranger anxiety
as manifested by “white coat syndrome” , it is a nursing action to play with the patient.
rationale: to establish rapport, and gain the patients trust
DEPENDENT
administer due medications as ordered by the physician, bronchodilators, anti pyretics
and anti biotics
rationale: bronchodilators decrease airway resistance, secondary to bronchoconstriction,
anti pyretics alleviate fever, antibiotics fight infection
placing patient on TPN prn
rationale: to compensate for fluid and nutritional losses during vomiting
COLLABORATIVE
assist respiratory therapist in performing nebulization of the patient
rationale: nebulization is a favourable route of administering bronchodilators
and aid in expectorating secretions, hence patient’s breathing
11/19/06
Admit patient to ROC under the service of Dr. Vitan secure consent for admission and
management, TPR every shift then record. May have diet for age with strict aspiration
precaution, IVF D5 0.3NaCl 500cc to run at 62-63mgtts/min.May give paracetamol 125mg
1supp/rectum if oral paracetamol is not tolerated.
11/20/06
For urinalysis, IVF to follow D5 0.3 NaCl 500 at SR (62-63mgtt/m Use zinacef brand of
cefuroxine 750mg- given ½ vial 375mg every 8hours, nebulize (Ventolin 1 nebule) every 6
hours, paracetamol drugs prn every 4hours (Temp 37.8).
11/21/06
Continue cefuroxine and nebulizer every 6 hours. May not reinsert IVF, revise Cefuroxine IV to
Cefuroxine 500mg via deep Intramuscular BID,continue management.
11/22/06
DISCHARGE PLANNING
Take the entire course of any prescribed medications. After a patient’s temperature
returns to normal, medication must be continued according to the doctor’s
instructions, otherwise the pneumonia may recur. Relapses can be far more serious than
the first attack.
Get plenty of rest. Adequate rest is important to maintain progress toward full recovery
and to avoid relapse.
Drink lots of fluids, especially water. Liquids will keep patient from becoming
dehydrated and help loosen mucus in the lungs.
Keep all of follow-up appointments. Even though the patient feels better, his lungs may
still be infected. It’s important to have the doctor monitor his progress.
Encourage the guardians to wash patient’s hands. The hands come in daily contact
with germs that can cause pneumonia. These germs enter one’s body when he touch
his eyes or rub his nose. Washing hands thoroughly and often can help reduce the risk.
Tell guardians to avoid exposing the patient to an environment with too much
pollution (e.g. smoke). Smoking damages one’s lungs’ natural defenses against
respiratory infections.
Give supportive treatment. Proper diet and oxygen to increase oxygen in the blood
when needed.
Protect others from infection. Try to stay away from anyone with a compromised
immune system. When that isn’t possible, a person can help protect others by wearing a
face mask and always coughing into a tissue.
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