ARELLANO UNIVERSITY

COLLEGE OF NURSING

COURSE AUDIT 1

CASE ANALYSIS

1ST SEMESTER, AY `2020 - 2021

NCM 100

CASE ANALYSIS

NAME: DE LEON, CHARISSA M. BRANCH: LEGARDA

Case # 1
Mrs. Salonga, 75, was admitted to the hospital due to severe case of pneumonia. Her condition rapidly
deteriorated despite of aggressive antibiotic therapy and she died unexpectedly after 3 days stay in the
hospital. Mrs. Salonga’s eldest daughter cannot believe that his mother is dead, he had difficulty attending
the funeral, has been unable to sleep or eat and can’t concentrate at work. The middle son lived near his
mother’s house and he arranged for the funeral. He was the one who cared for his mother when she was
sick. He misses his mother and cries from time to time but has managed to come to work the following after
the funeral. The youngest son did not cry at the funeral, is very distant and had a little to say to his brothers
and relatives. He is back at work but feels very tired and apathetic.

1. From the data above, Identify and explain the phase of bereavement being experienced by each of the
surviving children.
1. Immediate shock – As soon as the death occurs, and over the following hours and days, you may
be in a state of shocked disbelief. Alternatively, instead of immediate shock, you may be rather
calm and detached. Either reaction is natural and understandable.
2. Unable to accept – At this stage, you may think that the person you have lost is still physically
with you. You are unable to accept the loss, and at some level are denying that the death has
occurred.
3. Depression – No matter how many people are around you, or how much support you receive, you
will have small moments or even long periods of time when you feel lost, alone and confused.
This could span across many many months. You may question your own faith, your faith in God,
faith in other people, and even faith in yourself. You may lose interest in everything and may want
to shut yourself off from the world. You may question whether even your own life is worth living.
This may be a very heavy and lonely time. Even this phase passes.
4. Renewal – Eventually, as the pain eases, you find yourself being able to think about the person
you have lost, without feeling sad. This is a chance to recommence life with a renewed sense of
strength and focus. You could continue with old interests, or you could take up new pursuits.

2. What are the things that may have affected how each of the siblings reacted to the death of their mother?

3. Explain each of the following:

a. Rigor Mortis – stiffness afterdeath, (rigidity/spasm of muscles)
b. Algor Mortis – body temperature after death (cold)
c. Livor Mortis – discoloration after death (bluish-red discoloration of the skin and organs)

4. Having the diagnosis of Pneumonia, identify the significant palliative need that she might have had.
 Focus should be on goals of care and symptom management!
• Rest
• Oral hydration (helps to loosen mucus)
• IV fluids (if indicated and congruent with treatment preferences and goals of care)
• Oxygen for hypoxemia (base on symptom relief and not pulse oximetry at EoL)
• Antitussives for cough
• Morphine, antianxiety meds for dyspnea
• Anticholinergics (scopolamine, atropine) for excess secretions
--Select agents based on the balance of benefits vs. undesirable effects (e.g.:
Guafenesin may worsen nausea; scopolamine dries/thickens secretions and causes
Dry mouth & sedation which may not be desirable to patient)
• Provide emotional support to resident and family

5. What cues, other than physical signs, might have given evidence that she is already dying, even though her
death is unexpected?
Dyspnea (shortness of breath; air hunger)
2. Respiratory congestion
3. Agitated delirium
4. Pain (eg. pleuritic pain, discomfort from immobility, or pain due to pre-existing conditions
such as arthritis or malignancy)
5. Supporting and addressing concerns of families – such as decreased intake of food/fluids,
concerns about medications such as opioids, need for sedation in terminal delirium, rapid
deterioration

Case # 2 (Make a Concept Map)

Mr. Jose is a 25 year old , call center agent who was admitted to the hospital with elevated temperature,
fatigue, rapid labored breathing and moderately dehydrated. The nursing history reveals that he has a bad
cold that have been lasting for a few weeks already. She smoked one pack of cigarettes per day since she was
18 year old. CXR show right lobar infiltration confirming pneumonia.
Physical Examination Data:
Temp: 39.8oC
Pulse : 68 bpm
Respiration Rate : 28/min
BP : 120/80
With pale skin, uses accessory muscle, inspiratory crackles with diminished breath sounds @
right lung and expectorating thick yellow sputum.

Pneumonia is an inflammation of the lung parenchyma that is caused by microbial agent. Pneumonitis is a
more general term that describes an inflammatory process in the lung tissue that may predispose a patient to
or place a patient at risk for microbial invasion

PATHOPHYSIOLOGY

Bacteria enters
Bacteria invades The macrophages
the lungs
the space & neutrophils in
(throat/nose,
between cells activates the
airborne, droplet,
and alveoli bacteria
blood)

Resulting in the Causes general

 The neutrophils,
bacteria and fluid
fills the alveoli

Nursing Diagnosis:

• Ineffective airway clearance

• Activity intolerance related to impaired respiratory function

• Risk for deficient fluid volume

Interventioons:

• Promote fluid intake

• Maintain nutrition

• Promote rest and conserving energy

• Encourage smoking cessation