INTRODUCTION Breathing is the greatest pleasure in life. ~Giovanni Papini Breath is sometimes used as a metaphor for life itself because it takes
in the oxygen needed by the body and the carbon dioxide out of the body. It is one of the human person’s vital functions to maintain and sustain life. One of the most common illness that disrupts the normal breathing pattern of a person is Pneumonia. Pneumonia is an infection and inflammation of the alveoli in the lungs that is usually caused by infection with bacteria, viruses, fungi or other organisms. Pneumonia is a particular concern for older adults and people with chronic illnesses or impaired immune systems, but it can also strike young, healthy people. Pneumonia may be of bacterial in origin (pneumococcal, streptococcal, staphylococcal, or chlamydial) or viral in origin, such as respiratory synctial virus (RSV). (http://mayoclinic.com; August 27, 2008; 6:45pm ) Worldwide, Pneumonia is the 7th leading cause of death in 1999 and 2000 according to CDC. In the United States, the incidence extrapolations of pneumonia is 4,800,000 per year, 400,000 per month, 92,307 per week, 13,150 per day, 547 per hour, 9 per minute, 0 per second. In the Philippines, Pneumonia is the 5th cause of mortality according to the 2003 Philippine Health Statistics with a rate of 15,831 for males and 16, 224 for females or 32, 055 per 100, 000 population. ( http://doh.gov.ph; August 28, 2008; 8:30pm) A study suggests that antipsychotic drugs increase the risks of developing pneumonia in the elderly. Elderly patients who use antipsychotic drugs have a 60 percent increased risk of developing pneumonia compared to non-users. This risk is highest in the first week following prescription and decreases gradually thereafter. Antipsychotic drugs are frequently used in elderly patients for the treatment of psychosis and behavioral problems
associated with dementia and delirium. This study is the first to show that the development of pneumonia is associated with antipsychotic drug use. (www.sciencedaily.com; Apr. 16, 2008) Researchers at Children's Hospital of Pittsburgh of UPMC have identified a key protein target that may be a crucial factor in the development of a vaccine to prevent and new therapies to treat pneumonia, the leading killer of children worldwide. Identified for the first time is the importance of a protein known as interleukin 22 (IL-22) in the immune response to a strain of bacterial pneumonia. In the laboratory, the researchers were able to effectively treat mice with pneumonia by using purified IL-22. IL-22 and interleukin 17A (IL-17A) are produced by a recently discovered lineage of cells known as T Helper Type 17 (Th17). Children's researchers found evidence that the Th17 cell lineage and its cytokines IL-22 and IL-17A have evolved to promote host defense against certain infections in the lung caused by extracellular pathogens. (www.sciencedaily.com; February 12, 2008) Much of the learning of student nurses is derived from the exposure in the hospital setting. Reinforcement in the actual setting is important for learning to be truly effective. As student nurses, it is important that the care provided bring satisfaction to patients. To be able to provide outmost care, knowledge about the disease condition must be well founded. It is one of the objectives of the group to be familiar with the common disease conditions that may be encountered in the hospital setting. Knowing that Pneumonia is one of the common cases evident in the area, which is Medical – Surgical, the group decided to make this as their topic for case study.
II. NURSING ASSESSMENT A. Personal History To secure confidentiality, the patient would be referred as “Monia” throughout the study. Monia is the primary source of information. Monia is a 31 year old married Filipina who lives in a barrio in San Vicente, Magalang Pampanga. She was born on August 2, 1974. She is the 2 nd among five siblings. Monia was admitted on August 12, 2008 at 12:05 pm in a district hospital in Magalang with complaints of fever, chills and cough. The admitting diagnosis is Community Acquired Pneumonia and was discharged on August 16, 2008 with a final diagnosis of CAP. Monia lives in a barrio which has limited accessibility to the hospital. She and her family earn a living by planting different plant crops like camote. Her activities of daily living include cooking, cleaning the house, doing the laundry, taking good care of her five children and helping her husband in planting and selling crops. Monia was not able to finish her schooling due to the location of their place. She was only able to reach grade six because the school in their barrio only offers elementary schooling and her family cannot send her to high school due to financial constraints. Monia and her family are devoted Missionaries. At present, they live in a house which has concrete walls, sawali for the roof and a flooring which is still not cemented. She describes her community as a peaceful one and her neighbors are hospitable. One of the cultural practices done in their community is the practice of using herbal plants like bayabas, bawang, ginger and ampalaya for medicines.
B. Pertinent Family Health-Illness History Paternal Side Maternal Side
Lolo 89 y/o
† Lolo Ulcer 1996
† Lola Stroke 2002
MONIA 34y/o CAP
which she said gave her the difficulty of breathing. D. Monia is supposed to go with her husband to sell their root crops but her body malaise prevented her from doing so. she had “tigdas” or measles which her mother treated with some herbal plants. History of Present Illness On July 29.4 lbs to 118. she experienced fever. She only experienced cough. At first. which was the cause of death of her grandfather. 2008. which led to lost of weight of 6. She also had chickenpox when she was 25 years old. Her fever had became recurrent and caused her to have difficulty sleeping at night. History of Past Illness When Monia was 3 years old. She also lost her appetite. and stroke. Monia has no history of pneumonia on both maternal and paternal sides. On her paternal side. She also had cough. Monia did not experience any major illness in the past and was never hospitalized before. During these situations. The following day. colds and fever occasionally especially during cold weather. Monia stated that her grandparents are still living and has no known illness. she only self-medicates and uses herbal plants like oregano and takes drugs like Biogesic and Neozep. She felt that there is mucus in her throat but she cannot cough it out.8 lbs).
C. Monia thought that it is just a usual fever which she got possibly because of the prevalence of fever and cough in their barrio. Her condition prevented her from doing her usual chores of helping in the planting and selling of their root crops and taking good care of her five children. which caused the death of her grandmother last 2002 both on the mother side. which subsides after sweating.6 pounds (from 125. But after two weeks of having fever.Explanation: The illnesses present in the in the family tree of Monia are ulcer. she decided to ask her husband to bring her to the district hospital which she had not thought before because of the
awake and conscious. in high fowlers position. While on their way to the hospital. productive 2 days prior to admission – fever on and off low appetite (+) body weakness few hours prior to admission – (+) chills and fever
Date: August 12.50C/axilla (+) body weakness (+) cough. Monia was admitted with an admitting diagnosis of Community Acquired Pneumonia and was discharged after 5 days on August 16. So on August 12.
E. her husband had to carry her because she cannot walk properly due to body malaise and high fever. 2008. nonproductive First Student Nurse-Patient Interaction (August 12. 2008) General Survey: Received patient wearing a white colored shirt and blue jogging pants. Physical Examination 2 weeks prior to admission – (+) fever 1 week prior to admission – (+) cough..
. with an IVF of #1 D5NM 1L regulated at 30 to 31 gtts/min. at 550 cc level infusing well on the right hand.distance of their house to the said medical institution and also because of financial constraints. 2006 (Admission) – Lifted from the Chart pink palpebral conjunctiva anecteric sclerae adynamic pericardium (-) murmurs flabby abdomen (+) chills and fever with temperature of 40. 2008 with a final diagnosis of Pneumonia.
80C/axilla Pulse rate – 86 bpm Respiratory rate – 34bpm Blood pressure – 110/70 mmHg Skin:
Brown in color. no lesions and air moves with slight difficulty as the client breaths through the nares because of presence of nasal secretions.Signs and symptoms include (+) nonproductive cough.
Ear: Color of the auricles same as the facial skin. No infestation or infection noted. no discharges noted.
Mouth: (+) Mild drying of lips and oral mucosa
Skull: Rounded. Palpebral conjunctiva is pink in color. uniform in color. eyelids have no discharge. febrile.
periphery. Symmetrical and aligned with outer canthus of eye.
Nose: Centrally located. no discoloration and lids close symmetrically. Face: symmetrical facial feature and symmetric facial movements.
Hair and Scalp: Black in color. pinna recoils after it is folded. firm and not tender. Vital Signs: Temperature – 37. slightly thick.
Eyes: Eyebrows and eyelashes evenly distributed. mobile.
Illuminated pupil constricts while non-illuminated dilates. smooth skull contour and no masses or nodules noted. no altered pigmentation. no edema or swelling upon palpation. silky and
resilient and hair equally distributed on scalp area. not tender. (+) difficulty of breathing.
No tenderness and masses on the chest skin. walks unaided and maintains balance.Neck:
Head is centered. Flabby. good capillary refill. no murmurs.
Second Student Nurse-Patient Interaction (August 13. at 650 cc level infusing well on the right hand. with an IVF of #3 D5NM 1L regulated at 30 to 31 gtts/min. no pain when palpated. no tenderness or swelling. (+) Fast shallow breathing. in right side-lying position.
(+) Rales heard upon auscultation. head movement is coordinated with no discomfort. has upright posture and steady gait. Vital Signs: Temperature – 380C/axilla Pulse rate – 81 bpm Respiratory rate – 26 bpm Blood pressure – 120/70 mmHg
. sleeping. no deformities.
Intact toenail beds. Normal rhythm and rate noted upon auscultation. No swelling and masses noted and no enlargement of lymph nodes upon palpation. 2008) General Survey: Received patient wearing yellow colored shirt and brown shorts. Intact nail beds. skin intact and uniform temperature.
. Symmetrical and aligned with outer canthus of eye. firm and not tender.
No tenderness and masses on the chest skin. uniform in color. No infestation or infection noted. head movement is coordinated with no discomfort. no edema or swelling upon palpation.
Mouth: (+) Mild drying of lips and oral mucosa
Head is centered.
periphery. No swelling and masses noted and no enlargement of lymph nodes upon palpation. mobile. smooth skull contour and no masses or nodules noted. eyelids have no discharge.
Illuminated pupil constricts while non-illuminated dilates. skin intact and uniform temperature. not tender. Palpebral conjunctiva is pink in color.
Nose: Centrally located.
Eyes: Eyebrows and eyelashes evenly distributed.
Skull: Rounded. Face: symmetrical facial feature and symmetric facial movements. no lesions and air moves with slight difficulty as the client breaths through the nares because of presence of nasal secretions. no discoloration and lids close symmetrically.
Hair and Scalp: Black in color.Skin:
Brown in color. silky and
resilient and hair equally distributed on scalp area. pinna recoils after it is folded. (+) Fast shallow breathing. no discharges noted.
Ear: Color of the auricles same as the facial skin. no altered pigmentation.
(+) Rales heard upon auscultation. no tenderness or swelling. Flabby. Intact nail beds. good capillary refill. no pain when palpated.
Intact toenail beds.
. has upright posture and steady gait. no deformities. Normal rhythm and rate noted upon auscultation. no murmurs. walks unaided and maintains balance.
It indicates insufficient blood volume composed of RBCs and an abnormal status of patient’s hydration due to the excessive sweating experienced by
Date Ordered: 08/12/08 Date Results In: 08/12/08
This is to measure the percentage of the patient’s red blood cells in the total volume of blood. It aids in the diagnosis of any abnormal status of patient’s hydration. and oxygen carrying capacity of the blood.2 mg%
Normal Values Male: 13.F.5 – 18 Female: 12-16
Analysis and Interpretation of Results Less than normal.
Results 10.0 vol. Less than normal. producing exudates that interfere with the diffusion of oxygen and carbon dioxide.
33. Diagnostic and Laboratory Procedures Diagnostic/ Date Ordered Indications Laboratory Date Results Or Procedures In Purposes Hemoglobin Date Ordered: To evaluate the 08/12/08 hemoglobin Date Results In: content. the iron 08/12/08 status. %
Male: 40-54 Female: 37-47
. The Oxygen carrying capacity of the blood is inadequate due to the inflammatory reaction that occurs in the alveoli.
Date Ordered: 08/12/08 Date Results In: 08/12/08
280/cu. Increase in value can be a result of body’s response to infection.
Adult: 150 . Adult: 5-10 x 103 There is presence of inflammation or infection due to the invasion of microorganisms in the lungs. Decreased capability of carrying out the activities of the immune system or there is a decreased ability to produce
Date Ordered: 08/12/08 Date Results In: 08/12/08 Date Ordered: 08/12/08 Date Results In: 08/12/08
. mm. mm.750/cu.the patient after each onset of fever. WBC Count Date Ordered: 08/12/08 Date Results In: 08/12/08 To determine infection or inflammation and also to determine and evaluate the body’s physiologic capacity to resist and overcome infection To determine the number of platelets in the patient's blood and to assist in the diagnosis of bleeding disorders To determine infection or inflammation To determine viral infection or inflammation 10.450
Value is within normal range which could indicate that the patient does not have bleeding disorders.
and or swelling maybe experienced at the site. discomfort. Be sure the patient remains still upon insertion of needle. Inform that there will be a discomfort from needle puncture and pressure from the tourniquet. Apply pressure to the punctured site. During: 1. Inform the SO that the test requires blood sample. 2. 3. Explain that some bruising. Inform the SO that there is no food/fluid restriction needed. 3. Send the specimen to the laboratory. tell who will do the test and when. moist compress. Observe the venipuncture site for bleeding. 4. Support the patient’s arm upon insertion of the needle.antibodies. 2.
. Explain the procedure to the SO and the purpose of the procedure. Instruct to apply warm. Nursing Responsibilities: Before 1. 4. 2. After: 1.
Diaphragms. Right Lower Lung
Values Clear lung fields
Interpretation of Results With continuous formation of exudates. In chest x-ray. consolidated parts become dense and
. the lung should appear as black because the lung is not dense and it permits the passage of xrays. the involved lobe undergoes Consolidation of the tissue caused by filling w/ exudates. Impression: Pneumonitis. But in lungs w/ pneumonia. The heart is normal in size and configuration. costophrenic angles & visualized bones are intact.Laboratory Procedures Chest X-Ray
Date Results In Date Ordered: 08/12/08 Date Results In: 08/12/08
Or Purposes This is done to obtain or detect pulmonary diseases and the status of respiratory problems or trauma There are hazy infiltrates in the Right lower lung zone.
Ask the patient to remove her clothes and put on a hospital gown. Nursing Responsibilities: Before:
1. 2. Inform the patient that there are no foods or fluid restriction. 5. Remove all jewelries and metal objects from the area to the image.
3. Position the patient for specific views needed.appear as white areas on the chest x-ray film. Ensure that the patient will remain motionless during the imaging. Explain the procedure to the patient. Ensure the patient’s safety at all times. 2.
During: 1. Assist the patient in dismounting from the radiography table and getting dressed. 3. Assist the patient. its purpose and how it is done. After: 1.
Air al so enter through the MOUTH (oral cavity). The SINUSES (frontal. The NOSE (nasal cavity) is the preferred entrance for outside air into the respiratory system. The hairs that line the wall are part of the air-cleaning system. especially in people who have a mouth-breathing habit or whose nasal passages may be temporarily obstructed. The functions they serve include helping to regulate the temperature and humidity of air breathed in. and sphenoidal) are hollow spaces in the bones of the head. 2. 3. as well as to lighten the bone structure of the head and to give resonance to the voice. maxillary. as by a cold or during heavy exercise.
. ANATOMY AND PHYSIOLOGY
ANATOMY 1. Small openings connect them to the nose.III.
8. 10. The VOICE BOX (larynx) contains the vocal chords. 11. The RIBS are bones supporting and protecting the chest cavity. 7. 6. The THROAT (pharynx) collects incoming air from the nose and mouth and passes it downward to the windpipe (trachea). closing when anything is swallowed that should go into the esophagus and stomach. helping the lungs to expand and contract. including germs. they may be removed. The ESOPHAGUS is the passage leading from the mouth and throat to the stomach. The WINDPIPE (trachea) is the passage leading from the throat (pharynx) to the lungs. The lymph system. The EPIGLOTTIS is a flap of tissue that guards the entrance to the windpipe (trachea). and producing cells (lymphocytes) to fight them. 5.
. They move to a limited degree. 12. This system helps to resist body infection by filtering out foreign matter. 9. consisting of nodes (knots of cells) and connecting vessels. The TONSILS are lymph nodes in the wall of the throat (pharynx) that often become infected.4. carries fluid throughout the body. The ADENOIDS are lymph tissue at the top of the throat. It is the place where moving air being breathed in and out creates voice sounds. When they enlarge and interfere with breathing. They are part of the germ-fighting system of the body. The LYMPH NODES of the lungs are found against the walls of the bronchial tubes and windpipe.
17. 18. 20. or sections. 16. The smallest subdivisions of the bronchial tubes are called BRONCHIOLES. The CAPILLARIES are blood vessels that are imbedded in the walls of the alveoli. clear your throat or swallow. actually one continuous one folded on itself. The right lung is divided into three LOBES. in turn. The PLEURA are the two membranes. brought to them by the PULMONARY ARTERY and taken away by the PULMONARY VEIN. By moving downward. The ALVEOLI are the very small air sacs that are the destination of air breathed in.
. sneeze. Each lobe is like a balloon filled with sponge-like tissue.13. which subdivide into each lobe of the lungs. The DIAPHRAGM is the strong wall of muscle that separates the chest cavity from the abdominal cavity.a branch of the bronchial tube. that surround each lobe of the lungs and separate the lungs from the chest wall. These. and other unwanted matte that has invaded the lungs. subdivide further. germs. This motion carried MUCUS (sticky phlegm or liquid) upward and out into the throat. The left lung is divided into two LOBES. 15. The bronchial tubes are lines with CILIA (like very small hairs) that have a wave-like motion. Air moves in and out through one opening -. Blood passes through the capillaries. one for each lung. 19. it creates suction in the chest to draw in air and expand the lungs. at the end of which are the air sacs or alveoli (plural of alveolus). You get rid of this matter when you cough. The windpipe divides into the two main BRONCHIAL TUBES. 14. where it is either coughed up or swallowed. The mucus catches and holds much of the dust.
the concentration (or pressure) of O2 in the alveoli must be kept at a higher level than in the blood & the concentration (or pressure) of CO2 in the alveoli must be kept at a lower lever than in the blood. We do this. of course. Breathing is an active process .While in the capillaries the blood gives off carbon dioxide through the capillary wall into the alveoli and takes up oxygen from the air in the alveoli. by breathing . Diffusion requires a concentration gradient.continuously bringing fresh air (with lots of O2 & little CO2) into the lungs & the alveoli. The primary muscles of respiration include the external intercostal muscles (located between the ribs) and the diaphragm (a sheet of muscle located between the thoracic & abdominal cavities).requiring the contraction of skeletal muscles.
Physiology The exchange of gases (O2 & CO2) between the alveoli & the blood occurs by simple diffusion: O2 diffusing from the alveoli into the blood & CO2 from the blood into the alveoli.
and this attraction creates a force called surface tension. surface
. are more attracted to each other than to air. As a result. air leaves the lungs.to-back dimension of thoracic cavity > lowers air pressure in lungs > air moves into lungs
Contraction of diaphragm > diaphragm moves downward > increases vertical dimension of thoracic cavity > lowers air pressure in lungs > air moves into lungs:
relaxation of external intercostal muscles & diaphragm > return of diaphragm. which is what happens when we exhale & our alveoli become smaller (like air leaving a balloon). the lungs expand. Water molecules. air moves from an area of higher pressure (the air) to an area of lower pressure (our lungs & alveoli). This surface tension increases as water molecules come closer together. the respiration muscles relax & lung volume descreases. & sternum to resting position > restores thoracic cavity to preinspiratory volume > increases pressure in lungs > air is exhaled
Intra-alveolar pressure during inspiration & expiration As the external intercostals & diaphragm contract. Potentially. The walls of alveoli are coated with a thin film of water & this creates a potential problem. During expiration. including those on the alveolar walls.The external intercostals plus the diaphragm contract to bring about inspiration:
Contraction of external intercostal muscles > elevation of ribs & sternum > increased front. The expansion of the lungs causes the pressure in the lungs (and alveoli) to become slightly negative relative to atmospheric pressure. As a result. This causes pressure in the lungs (and alveoli) to become slight positive relative to atmospheric pressure. ribs.
Both of these would represent serious problems: if alveoli collapsed they'd contain no air & no oxygen to diffuse into the blood &.
. our alveoli do not collapse & inhalation is relatively easy because the lungs produce a substance called surfactant that reduces surface tension. inhalation would be very. Fortunately. The air we breath is a mixture of gasses: primarily nitrogen. & carbon dioxide.tension could cause alveoli to collapse and. in addition. Pulmonary Surfactant
Surfactant decreases surface tension which:
increases pulmonary compliance (reducing the effort needed to expand the lungs) reduces tendency for alveoli to collapse
Exchange of gases:
exchange of O2 & CO2 between external environment & the cells of the body efficient because alveoli and capillaries have very thin walls & are very abundant (your lungs have about 300 million alveoli with a total surface area of about 75 square meters)
Internal respiration . if 're-expansion' was more difficult. oxygen.intracellular use of O2 to make ATP occurs by simple diffusion along partial pressure gradients
it's the individual pressure exerted independently by a particular gas within a mixture of gasses. oxygen. So. & carbon dioxide move about & collide with the walls of the balloon). the air you blow into a balloon creates pressure that causes the balloon to expand (& this pressure is generated as all the molecules of nitrogen. very difficult if not impossible. would make it more difficult to 're-expand' the alveoli (when you inhaled).
in part to oxygen. therefore.g.located in aorta & carotid arteries (peripheral chemoreceptors) & in the medulla (central chemoreceptors) Chemoreceptors (stimulated more by increased CO2 levels than by decreased O2 levels) > stimulate Rhythmicity Area > Result = increased rate of respiration
. while that generated by carbon dioxide is the 'partial pressure' of carbon dioxide. Factors involved in increasing respiratory rate
Chemoreceptors . A gas's partial pressure. That part of the total pressure generated by oxygen is the 'partial pressure' of oxygen.However.. in the blood or alveoli). is a measure of how much of that gas is present (e. & in part to carbon dioxide. the total pressure generated by the air is due in part to nitrogen.
CAP can be diagnosed by symptoms and physical examination alone. examination of the sputum and other tests are often used. CAP is a common illness and can affect people of all ages. their immune system is not yet well developed making them susceptible in acquiring pneumonia. 2. and parasites.IV. CAP often causes problems like breathing. CAP occurs throughout the world and is a leading cause of illness and death. though x-rays. viruses. fungi. Non-modifiable and Modifiable Factors Non-modifiable Factors: >Age Pneumonia is more common among infants. and the elderly. Causes of CAP include bacteria. mucus accumulates within the respiratory passageways. Individuals with CAP sometimes require treatment in a hospital. In children. young children. CAP is primarily treated with antibiotic medication. THE PATIENT’S ILLNESS (Book-Based) Synthesis of the Disease Community Acquired Pneumonia 1. chest pains and a cough.
. CAP occurs because the areas of the lung which absorb oxygen (alveoli) from the atmosphere become filled with fluid and cannot work effectively. With age. This leads to increase susceptibility of the elderly to respiratory infections such as pneumonia. Some forms of CAP can be prevented by vaccination. Definition of the disease Community-acquired pneumonia (CAP) is a disease in which individuals who have not recently been hospitalized develop an infection of the lungs (Pneumonia). The mucus-cilia escalator is less able to move the mucus because it becomes more viscous and the number of cilia as well as their rate of movement decreases. fever.
Monia is exposed to smoke because of her husband who is a smoker. The body increases its temperature in order to kill the microbes. Signs and Symptoms >Fever and chills An increase in body temperature accompanied by chills is due to the invasion of microorganisms in the lungs that causes inflammation. 2008 to August 14. she is exposed to second hand smoking due to her husband who is a smoker. In the case of the patient.>Genetic Factors A number of genetic disorders can predispose a person to pneumonia. >Alcohol and Drug Abuse Alcohol and drug abuse makes a person more susceptible to pneumonia.
>Pleuritic chest pain
. 3. Also. and Kartagener’s syndrome. Modifiable Factors: >Smoking and second-hand smoking People who smoke have a much higher risk of developing pneumonia. such as: Sickle cell anemia. cystic fibrosis. 2008. >Crowded Living Conditions The risk of pneumonia is increased among people living in crowded conditions just like the area where the patient is exposed. Monia experienced recurrent fever and chills from July 30. >Environmental Factors Occupation exposure to toxic chemical fumes and smoke can weaken the lung’s defenses making a person susceptible in acquiring pneumonia. those who regularly exposed to second-hand smoking are at risk for pneumonia.
>Fatigue Accumulation of lactic acid in tissues and muscles due to poor oxygen perfusion brought about by impaired gas exchange in the lungs. Prevention and Health Promotion Immunization against influenza and increasingly resistant pneumococci can play a critical role in the prevention of pneumonia. 2008 to August 15. >Headache Impairment of oxygen and carbon dioxide exchange results in a decrease in oxygenation in the brain that causes headache. The patient experienced fatigue from July 29.
4.This is due to the constant irritation of the pleural membrane brought about by inflammation. 2008 to August 14. which stimulates the release of prostaglandin (pain mediator) that acts on the pain receptors that causes pain. The patient experienced dyspnea from July 30. 2008. >Cough and sputum production There is an increase production of mucus due to the constant inflammation of the epithelial lining of the bronchi and alveoli. 2008. >Dyspnea Difficulty in breathing is due to inflamed and fluid filled alveolar sacs cannot exchange oxygen and carbon dioxide effectively. particularly in
. Coughing is the body’s mechanism to get rid of microorganisms and excess mucus. >Hemoptysis Forceful coughing brought about by constant irritation of the respiratory tract and consolidated alveolar exudates. damage the capillaries in the lungs causing the production of blood-tinge sputum. The patient experienced cough from July 30. 2008 to August 15. 2008.
one should live a healthy lifestyle. Stopping smoking is the best way to prevent pneumonia. Oseltamivir or zanamivir can be given to prevent influenza in household contacts of people who have influenza and in people with heart or lung disorders who have not been vaccinated because these people would be at risk of severe pneumonia if they developed influenza. and adapting a regular exercise regimen are indeed a great help in minimizing the incidence of pneumonia. Consequently.lungusa. wearing of PPE’s (such as mask) for persons who are exposed in smoke and other chemicals. hemoglobinopathies. Elimination of smoking habits. Some pneumonia can be prevented by vaccination. Also. The influenza vaccine is formulated and administered annually. and patients with chronic metabolic diseases (including diabetes mellitus).immunocompromised and older adults. or immunosuppression.com/health/pneumonia) (http://www. patients who have chronic heart or lung disorders. (http://mayoclinic.org/site)
. it is recommended that the vaccine be offered to persons aged > 50 years. residents of chronic-care facilities. alcohol and drug abuse. renal dysfunction. to prevent the development of pneumonia.
3. THE PATIENT AND HIS CARE A.V. Sodium Bisulfate 30mg. Nursing Responsibilities: Before: 1. Acquaint the SO and patient with the requirements needed for IV infusion. Indications Or Purposes Multiple electrolyte maintenance solution for use in routine daily IV therapy.C: 08/15/08 General Description It is a hypertonic solution and it contains Dextrose 5 gm NaCl 234mg. Verify the doctor’s order. It is given to Monia in amount sufficient to meet her ordinary daily water needs. Potassium Acetate 128mg. Obtain necessary materials. Explain the procedure to the patient. MEDICAL MANAGEMENT a. It is also a route of administration of her IV medicines.P: 08/12/08 D. Client’s Response to Treatment Monia’s hydration status was maintained and there were no signs and symptoms of hypersensitivity.
2. IVF Medical Management/ Treatment D5NM 1L x 30 to 31 gtts/min Date Ordered Date Performed Date Changed D.O: 08/12/08 D.
swelling and tenderness. 2. Practice aseptic technique. 5.During 1. Drugs Name of Drugs: Date Ordered Date Route of Administration Indications Or Specific Foods taken Client’s Response to
. Monitor IVF flow and patient’s response. Check if the IVF is infusing well. Record all procedure done.
b. 3. Adjust rate of flow of fluids appropriate to patient’s needs as prescribed. Monitor patient for evidence of local IV complications such as pain. 2. 4. After 1. 3. Check for patency of tubing as well as infiltrations. Check for the presence of air in the tubing. Check IV level. 4.
Monia was relieved from productive cough which can be a sign that the bacteria that invades the lungs was inhibited. Dosage and Frequency of Administration 200 mg IV q 12 hours
the Meds with Actual Side Effects The patient did not show any allergic reactions.It works by stopping the growth of bacteria which invades the lungs causing pneumonia.Generic Name Brand Name Generic Name: Cefuroxime Brand Name: Ceftin
Performed Date Changed Date Ordered: August 12. fish. . water.
Rice. 2008 Dates Taken: August 12-14.
Cephalosporin antibiotics. banana.
Nursing Responsibilities: Before: 1. 2008
. Explain the action of the drug to the client
. After taking the drug for 3 days. meat. vegetable.
dosage and route of the drug. 3. Check doctor’s order for the time. Slowly push the medication to avoid irritation of the IV line. Observe sterile technique 3. During: 1.2. Observe for signs and symptoms of adverse or allergic reactions
Name of Drugs: Generic Name Brand Name
Date Ordered Date Performed Date Changed
Route of Administration . After: 1. Obtain specimen for culture and sensitivity test. Document the action done 3. Educate client about the possible side effects 2. Re-check doctor’s order 2. Dosage and Frequency of
Indications Or Purposes
Specific Foods taken
Client’s Response to the Meds with Actual Side
. Perform skin testing before administration 4.
This is indicated for mild pain and fever experienced by the patient. 2008. The patient’s recurrent fever decreased from 40. 2008 Date Changed: August 13.
Date Ordered: August 13.Generic Name: Paracetamol IV Acetylcysteine Brand Name: Parvolex. 2008 Date Taken: August 12.50C to 37. Lysox
Date Ordered: August 12.
This is indicated for mild pain
The patient responded
. The drug may relieve fever through central action in the hypothalamic heat regulatory center. 2008 (shifted to tab)
Administration 300 mg IV
Analgesic and Antipyretic.
Generic Name: Paracetamol.80C to 37.20C on August 12.
Effects The patient responded positively to the medication. Thought to produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the CNS or other substances that sensitize pain receptors to stimulation. Analgesic and Antipyretic.
2008 and from 380C to 36. Tempra
2008 Dates Taken: August 13-14. The patient’s recurrent fever decreased from 380C to 37.
Nursing Responsibilities: Before:
Thought to produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the CNS or other substances that sensitize pain receptors to stimulation. 2008. Obey the 10 rights of giving medications
positively to the medication. The drug may relieve fever through central action in the hypothalamic heat regulatory center
and fever experienced by the patient.90C on August 14.Acetaminophen Brand Name: Tylenol.30C on August 13.
abdominal pain. Administer right dose
1. Dosage and Frequency of Administration
Indications Or Purposes
Specific Foods taken
Client’s Response to the Meds with Actual Side Effects
. Record all procedures done and time of drug administration 3. drowsiness. Check for the presence of adverse reactions such as vomiting. rash and
2. Monitor temperature q 15 minutes after administration
Name of Drugs: Generic Name Brand Name
Date Ordered Date Performed Date Changed
Route of Administration . Warn the patient or SO that high doses or unsupervised long term use can cause liver damage
1. Observe proper sterile technique 3. Check the physician’s order on the patient’s chart 3. Follow standard precautions during administration of the medication 2.2. Identify the patient 4.
against influenza-virus proliferation in the airway was investigated in mice.Generic Name: Ambroxol Brand Name: Seropram
Date Ordered: August 12.
. . After taking the drug for 4 days. 2008 Date Taken: August 12-15. the patient was relieved from dyspnea and her respiratory rate decreases from 34bpm upon admission to 26 bpm on August 13 to 24 bpm on August 14 to 21 bpm on August 15 and 19 bpm upon discharge.Which has antioxidant properties and stimulates the release of pulmonary surfactant.
Patient responded well to treatment without signs of adverse reactions or complications such as superinfection.
It is administered for the breakdown of acid mucopolysaccharide fibers and to make the sputum thinner and less viscous and therefore more easily removed by coughing. 2008
A mucolytic agent.
Identify the patient. meat.P: 08/12/08 General Description Regular diet based of the 4 basic food groups as long Indications or Purposes For patients whose condition does not necessitate a Specific food taken Fish. fruits. Check for the presence of adverse reaction such as nausea and vomiting and mild gastric irritation. Caution to patient that the drug could cause gastric ulceration.
c. Observe proper sterile technique. 4.
1. Strictly follow aseptic technique in preparation of IV medication
1. Diet Date Ordered Type of diet Date Performed Date Change D. Check the physician’s order on the patient’s chart
3.Nursing Responsibilities: Before:
1. and water. 2.O: 08/12/08 D. Client’s Response and or Reaction to the Diet The patient was able tolerate the diet as the patient did not
. Record all procedures done and time of drug administration. Make sure that the patient is not pregnant which is one of the contraindications of the drug. 2. vegetables.
5. Obey the 10 rights of giving medications 2. bread.
Instruct strict compliance on the diet program given. There is a boost in the patient’s energy level and nourishment is increased as evidenced by patient’s ability to perform her self-care needs and absence of body malaise and fatigue upon discharge.as the patient can tolerate it. 3.
developed any allergies. 4. Explain the diet or type of diet to patient 2. Give small frequent feeding.
Nursing Responsibilities: Before: 1. Feed patient in upright-position to prevent aspiration.
to facilitate fast recovery and avoid complications.d. Rest Client’s Response and or Reaction to the Exercise The patient was able to take adequate amount of rest and sleep as evidenced by absence of body malaise. fatigue and
. Activity/Exercise Date Ordered Type of Exercise Bed Rest Date Performed Date Change Date Ordered: 08/12/08 General Description A type of activity wherein the patient is in supine position with his body lying flat on bed with the head raised using Indications or Purposes This is indicated to reduce the patient’s oxygen demand.
decreases the body’s metabolic rate. Check for the doctor’s order 2.
Nursing Responsibilities: 1. Assist the patient in position changes to prevent bed sore formation
Date Ordered Type of Exercise Deep Breathing Exercise Date Performed Date Change Date Ordered: 08/12/08
General Description Designed to improve the
Indications or Purposes To promote oxygenation and
Client’s Response and or Reaction to the Exercise Monia was able to demonstrate Deep
.pillows as support to the head. Ensure safety precautions by instructing SO not to leave patient alone at the bed since side rails are not present or by putting pillows at the side of the patient to prevent the patient from falling 4. Explain to the SO the type of activity needed by the patient and why it is necessary 3. Stretch bed linens 5.
normalization of respiratory rate from 34bpm upon admission to 26 bpm on August 13 to 24 bpm on August 14 to 21 bpm on August 15 and 19 bpm upon discharge.
decrease the work of breathing. have the patient assume a comfortable position and looses constrictive clothing. 2. Tell patient to practice this three to four times for her to rest. 3. Explain the reason and rationale and aims of bed rest. and improve the gas exchange and oxygenation
prevent respiratory complications.
. Instruct the patient to place hands below the anterior costal margin and ask the patient to breathe slowly and deep through the nose. increase of excursion of the diaphragm.
Breathing Exercise/DBE and had relief of her difficulty of breathing as evidenced by normalization of respiratory rate of 34bpm upon admission to 26 bpm on August 13 to 24 bpm on August 14 to 21 bpm on August 15 and 19 bpm upon discharge
Nursing Responsibilities: 1. For DBE. Have patient keep shoulder related and upper chest quite allowing the abdomen to rise.efficiency of ventilation.
Nursing Care Plan Problem # 1: Ineffective Airway Clearance r/t Retained Secretions AEB Ineffective or Absent Sputum Assessment Nursing Diagnosis Subjective Cues >Ø Objective Cues Patient manifested: > pursed lip breathing > increased respiratory rate (34 bpm on August 12. It affects both ventilation and diffusion.2. encourage deep breathing and coughing exercises. Long Term: > patient shall have demonstrated absence of congestion Rationale Expected Outcome Short Term: > patient shall have demonstrated behaviors to improve airway such as deep breathing and coughing
. to maximize respiratory effort.provided TSB 1. elevate head of bed and change position every 2 hours. establish rapport 2. to enhance drainage and ventilation to different lung segments. Areas of the lungs are not adequately ventilated because of Long Term: > After 1 to 3 days of NI. to gain cooperation 2. patient will demonstrate behaviors to improve airway such as deep breathing and coughing Planning Nursing Intervention s 1. 4. monitor vital signs 3. NURSING MANAGEMENT 1. patient will Short Term: > After 4 hours of NI. to obtain baseline data 3. 5. 4. 2008) >nonproductive Ineffective Airway Clearance r/t Retained Secretions AEB Ineffective or Absent Sputum Scientific Explanation Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms including bacteria and viruses.
6. administer meds as ordered. to lessen fever. nonproductive cough which indicates retained secretions.
9. encourage warm versus cold liquids 8. ineffective airway clearance occurs.
the patient properly hydrated 11. 2008) Patient may manifest: > difficulty of breathing > altered chest excursion > use of accessory muscles to breathe > nasal flaring
secretions. encourage increase fluid intake 7. to comply with the
. to help liquefy secretions 8. high RR which indicates the mechanism of the body to gain oxygen and fever which occurs
demonstrate absence of congestion with breath sounds clear and improved oxygen exchange. If a patient is unable to clear secretions from the respiratory tract. to prevent or lessen fatigue 10. demonstrate pursed lip and diaphragmatic breathing 9. regulate IVF as ordered
5.cough > rales heard upon auscultation > irritability > restlessness >hyperthermi a (380C/axilla on August 12. encourage opportunities for rest 10. to help liquefy secretions 7. The signs and symptoms include (+) DOB due to the presence of secretions. to improve airway
with breath sounds clear and improved oxygen exchange. to keep
therapeutic regimen.> pale conjuctiva and mucous membranes > cyanosis
because of the presence of microbes in the body. It acts as the body’s defense mechanism.
Assess patient’s condition 1. Perform (CPT) Chest Physiotherap 4. the patient will manifest improved breathing pattern thru proper positioning of the patient 3. Provides comparative baseline Planning Nursing Intervention s 1. 3. To facilitate proper breathing pattern and promote physiologic ease of maximal inspiration Long Term: >Patient shall have displayed improved condition as evidence by diminished 2. Monitor vital signs 2.Problem # 2: Ineffective Breathing Pattern r/t Presence of secretions secondary to Pneumonia Assessme nt Subjective Cues >Ø Objective Cues Patient manifested : > pursed lip breathing > increased respiratory rate (34 bpm on August 12. 2008) >nonproductive Nursing Diagnosis Ineffective Breathing Pattern r/t Presence of secretions secondary to Pneumonia Scientific Explanation Inspiration and/or expiration that do not provide adequate ventilation are termed as having an ineffective breathing pattern. To prevent exacerbation of 4. In patients with pneumonia. patient will display improved condition as 5. Air Long Term: >After 5 days of NPI. To determine proper plan of action and interventions to provide Rationale Expected Outcome Short Term: >Patient shall have manifested improved breathing pattern thru proper positioning of the patient
. Keep back dry Short Term: >After 2 hours of NPI. inflamed and fluid-filled alveolar sacs cannot exchange oxygen and carbon-dioxide effectively. Position patient on high back rest or elevate Head of Bed.
Encourage increase fluid intake
cough 5. To mobilize secretions 6.cough Patient may manifest: > difficulty of breathing > altered chest excursion > use of accessory muscles to breathe > nasal flaring > pale conjuctiva and mucous membranes
filled lungs are being covered with mucus secretions causing the air flow to be blocked. To facilitate effective breathing pattern 9.
evidence by diminished rales on Lung fields upon auscultation and improved respirations. Encourage adequate rest periods between activities 8.
7. To limit fatigue which would increase oxygen demand 8. For pharmacological management
. Administer medications as ordered
hydration 7. Assist client to learn breathing exercises 9. To facilitate
rales on Lung fields upon auscultation and improved respirations. therefore difficulty of breathing may appear and to compensate.
y 6. the patient will exert effort to breath rapidly causing more carbon dioxide to be inhaled than oxygen leading cyanotic manifestations.
small frequent 4. Pyrogens affect the body temperatureregulating mechanism in the hypothalamus of the brain. To promote adequate nutritional Planning Short Term: >After 3-4 hours of NPI.Problem # 3: Hyperthermia Assessme nt Subjective Cues >Ø Objective Cues Patient manifested : > pursed lip breathing > increased respiratory rate (34 bpm on August 12. heat Long Term: >After 5 days of NPI. Establish rapport Rationale 1. carbohydrates and vitamin C. patient will be able to maintain body temperature within normal range 3. Pyrogens are chemicals that stimulate fever production. To gain patient’s confidence and cooperation in treatment regimen Expected Outcome Short Term: Patient shall have been able to maintain body temperature within normal range
. 2008) Nursing Diagnosis Hyperthermi a Scientific Explanation Pyrogens are released in the inflammation process. Explain diet modifications such as: increase protein. Monitor vital signs Nursing Interventions 1. Provides comparative baseline 2. To determine what information to provide to SO Long Term: Patient shall have been free from development of possible complication s 2. patient will be free from development of possible complication 4. As a consequence. Ascertain understanding of individual nutritional needs 3.
including socialization when possible 6. Promote pleasant/relaxin g environment. Evaporation is decreased by environmental factors of humidity and high ambient temperature as well as body factors 7. avoidance of solid foods that may lead to indigestion 5.>nonproductive cough Patient may manifest: > difficulty of breathing > altered chest excursion > use of accessory muscles to breathe > nasal flaring > pale conjuctiva and mucous membrane s
production and conservation increase. Note presence and absence of sweating as body attempts to increase heat loss by evaporation.
feedings. To lower body temperature 8. To promote rest which decreases the metabolic demand 6. Fever promotes the activities of the immune system. and body temperature increases. such as phagocytosis. and inhibits the growth of some microorganism s. fever is concomitant especially when it has become systemic. To facilitate hydration status
. In the presence of infection. conduction and diffusion
Promote surface cooling by tepid sponge baths 8.7. Administer medications as ordered
9. For pharmacological management
. Discuss importance of adequate fluid intake 9.
Problem # 4: Risk for infection r/t to inadequate primary and secondary defenses Assessme nt S> O O> Pt. >encourage proper hand washing techniques by all caregivers between therapies/ clients > reduces risk of cross contamination Long Term: After 3 days of NI. Scientific Explanation Pneumonia involves the inflammation of the lung parenchyma which eventually leads to decreased cilliary action and may further lead to stasis of respiratory Patient may manifest: secretions the client is at risk for spread of Long Term: After 3 days of NI the patient will achieve timely >provide for isolation as Objectives Short Term: After 4-6 of NI the patient will be able to prevent/ reduce risks of spread of infection. manifeste d: >hyperthe rmia >nonproductive cough >dyspnea Nursing Diagnosis Risk for infection r/t to inadequate primary and secondary defenses. patient shall have prevented/ reduced risks of spread of infection.
. patient shall have achieved timely >monitor and recorded V/S > a first line defense against nosocomial infections >serve as baseline data Nursing Interventions >establish rapport Rationale >for patient cooperation Expected Outcomes Short Term: After 4-6 of NI.
Resolution of current infection. The secondary defense mechanism of the immune system is also inadequate since the client is suffering from a deceased hemoglobin level.
the immune system
>To liquefy >encourage increase of fluid intake >To comply >administer/mon itor medication regimen with the therapeutic regimen secretion and to avoid stasis
. C such as oranges.> irritability > restlessne ss
infection since the continuous production of mucous secretions is a perfect breeding place for microorganism.
>encourage intake of foods rich in Vit.
indicated >change position every 2 hours
> to facilitate secretion movement and drainage >to help boost
resolution of current infection without complications .
The emotions & physiological arousal Long Term: After 3 days of NI. pt. will engage in satisfying activities within personal limitations such as chatting with SO Provide am and pm care To validate reality of environment al deprivation Long Term: After 3 days of NI. pt.21 bpm B.Problem #5: Deficient diversional activity r/t long term hospitalization AEB client’s statement of boredom & inability to perform ADL Assessment S> “maynip na ku” O> pt. of N.P. Any life change that requires numerous readjustments can be perceived as stressful.83 bpm R. To provide comfort Monitor and record VS To establish therapeutic relationship Nursing Interventions Establish rapport To have baseline data Rationale To gain trust Expected Outcome Short Term: After 4 hr. pt. shall have recognized Acknowledge reality of the situation & feelings of pt. of N.110/70 Nursing Diagnosis Deficient diversional activity r/t long term hospitalizatio statement of boredom & inability to perform ADL Scientific Explanation Prolong hospitalizatio n may cause boredom especially for is use to doing chores or ADLs.I. pt. will recognize own psychologica Note impact of illness on life style by comparing with precious/norma Planning Short Term: After 4 hr.I. shall have engaged in satisfying activities within personal limitations such as chatting with SO
n AEB client’s a person who
.37 OC P. manifest: Weakness Irritability Decrease performan ce Restlessne ss Boredom With VS as follow: T.
may manifest: Hostility Withdrawa l Crying Flat affect Lack of interest in eating
created by stressful situation are highly uncomfortabl e& discomfort motivates the individuals to do something to alleviate it. is not alone
To prevent fatigue and for the pt.mmHg Pt. to gain maximum strength
. adequate rest periods
To lessen boredom
own psychological response & initiate appropriate
To provide comfort and to ensure that the pt. within the whole process of the situation Encourage the SO to provide the pt.
l response & initiate appropriate coping actions
l activity level Encourage diversional activity like talking to SO and reading newspaper Encourage the SO to be with the pt.
2. Actual SOAPIEs August 12, 2008 S> “maskup ku salu” O> Received patient on high fowler’s position with an IVF of #1 D5NM 1L regulated at 30 to 31 gtts/min at 550cc level; signs and symptoms include: (+)DOB, (+)nonproductive cough; with vital signs taken and recorded as follows: T- 37.80C/axilla, PR- 86 bpm, RR – 34 bpm, BP – 110/70mmHg A>Ineffective Airway Clearance related to Retained Secretions AEB Ineffective or Absent Sputum. P> After 4 hours of NI, patient will demonstrate behaviors to improve airway such as deep breathing and coughing. I> establish rapport >monitor vital signs >elevate head of bed and change position every 2 hours. >encourage deep breathing and coughing exercises. >provided TSB >encourage increase fluid intake > encourage warm versus cold liquids >demonstrate pursed lip and diaphragmatic breathing >encourage opportunities for rest > regulate IVF as ordered >administer meds as ordered E> Goal met AEB patient’s ability to demonstrate behaviors to improve airway such as deep breathing and coughing.
August 13, 2008 S>ø
O>Received patient in right side-lying position, sleeping; with an IVF of #3 D5NM 1L regulated at 30 to 31 gtts/min at 650cc level; infusing well on the right hand; with Hemoglobin of 10.2mg%; hematocrit – 33.0 vol%, segmenters – 87%, lymphocytes – 13% as of 08/12/08; with vital signs taken and recorded as follows: T - 380C/axilla, PR- 81 bpm, RR – 19 bpm, BP – 120/70mmHg. A> Risk for Infection related to Inadequate Secondary Defenses (decresed Hgb, Hct and Lymphocytes level) P> After 2hours of NI, patient will identify interventions to prevent or reduce risk for infection. I> established rapport >monitored and recorded vital signs >encouraged deep breathing exercises >maintained adequate hydration >emphasized necessity of taking medications (antibiotic) >encouraged increase intake of Vitamin C rich foods >encouraged increase fluid intake >provided adequate rest periods >due meds given >needs attended >referred accordingly E> Goal met AEB patient’s ability to identify interventions to prevent or reduce risk for infection.
VI. CLIENT’S DAILY PROGRESS IN THE HOSPITAL 1. Client’s Daily Progress Chart Days Admission August 13 August 14 August 15 Discharge August 16 August 12 Nursing Problems Ineffective
Airway Clearance r/t Retained Secretions AEB Ineffective or Absent Sputum Ineffective Breathing Pattern r/t Presence of secretions secondary to Pneumonia Hyperthermia Deficient diversional activity r/t long term hospitalization AEB client’s statement of boredom & inability to perform ADL Risk for infection r/t to inadequate primary and secondary defenses.
5 – 18 Female: 12-16
40.90C 81bpm 19bpm 120/70mmH g
C 88bpm 34bpm
.Vital Signs Temperature Pulse Rate Respiratory Rate Blood Pressure Diagnostic and Labora tory Proced ures Hemoglobin Male: 13.50 C
37.80C 90bpm 21bpm 110/80mmH g
380C 81bpm 26bpm 120/70mmH g
380C 83bpm 24bpm 110/70mmH g
0% vol. 87% 13%
10.Hematocrit Male: 40-54 Female: 37-47 WBC Count Adult: 5-10 x 103 Platelet Count Adult: 150 .450 Segmenters 50-70% Lymphocytes 25-40% Chest X-Ray Medical Manag ement D5NM 1L x 30 to 31gtts/ min Drugs Ambroxol Paracetamol IV Cefuroxime Paracetamol tab Diet DAT Exercise Bed Rest Deep Breathing
33.750/cu. General Condition Upon Discharge
. mm. mm. DISCHARGE PLANNING a.
METHOD M> Ø E> Encouraged to perform deep breathing and coughing exercises.Patient was not seen upon discharge on August 16. CONCLUSION Learning is not attained by chance. eggs and beans. > Encouraged patient to Include vitamin C in diet such as orange juice. 2008 at 9:00 in the morning. it must be sought for with ardor and attended to with diligence.
. 2008) at the OPD Department D> Encouraged patient to eat foods rich in protein such as meats. prevent patient from engaging in strenuous activity or those that may cause fatigue. calamansi and mangoes > Encouraged increase fluid intake
VIII. b. T> Ø H> Instructed patient to wear loose clothes to prevent excessive sweating > Imposed proper hand washing before and after eating > Instructed patient to do chest tapping and postural drainage to mobilize secretions >Encouraged patient to eat foods rich in Vitamin C >Encouraged patient to increase fluid intake >Encouraged patient to always keep the back dry > Encouraged patient to have adequate rest periods between activities O> Advised patient to come back 1 week after discharge (August 23.
. Brisk walking and other aerobic exercises should be practiced to help increase the lung capacity and breathing exercises which is the taking of slow. There is so much to learn – learning that is very much important to be able to accomplish responsibilities and in one way or another. encourage one to be committed in his chosen profession. Proper hand washing should also be practiced especially before eating and after using the bathroom. Rod. There are preventive measures which the group recommends to lessen the occurrence of pneumonia. The group also learned that pneumonia can be a complication of other respiratory diseases like tuberculosis. The pursuit for knowledge is every person’s responsibility. which is a very prevalent disease in Philippines justified by the statistics conducted by different organizations. With the completion of this case study. well-founded background knowledge is essential so as to be able to render quality care to every patient. As student nurses. may also be helpful. The primary prevention is being vaccinated with pneumococcal vaccine although this vaccine does not offer absolute protection especially to people with low immunity. A daily diet that includes foods rich in antioxidants. Early detection and prompt management may drastically lessen the severity of the disease condition. New York. the group has learned a lot about Pneumonia. relaxed breaths and exhalation through pursed lips. such as freshdark-colored fruits and vegetables and other nutrients help boost a person’s immune system. Al. It is an illness that could be prevented if precautionary measures are practiced. BIBLIOGRAPHY Seeley.-Abigail AdamsKnowledge is not achieved by a mere snap of the fingers. a person should avoid smoking. et. Essentials of Anatomy and Physiology. McGraw-Hill Companies. 6th ed. IX. Lastly. Inc.
X. Louis. 2003.htm http://doh.live. Lippincott Williams and Wilkins Nurse’s quick check diagnostic tests. Missouri.eku.htm
http://www. Anatomy and Physiology.com/cypress/ivtherapy.htm http://www. Dr. Sara (2004).ht http://www. Hand Book of Diseases 3rd Edition Professional guide to diagnostic tests.html
http://mayoclinic.lungusa.com/p/pneumonia/prevalence.htm http://search.com/results.com/results.htm http://search. 5th ed. St. Joyce.ph/data_stat/html/mortality.com/cypress/ivtherapy.childbirths. Kevin T.wddty.diagnosis.com/03363800369751974858/alternative-treatments-forpneumonia. Black.org/site/pp.gov.live.com/releases/2008/02/080213090516.aspx? q=decreased+hemoglobin+and+hematocrit&FORM=AWRE2 http://www.sciencedaily.edu/ritchisong/RITCHISO/301notes6.•
Patton.aspx? q=decreased+hemoglobin+and+hematocrit&FORM=AWRE2 http://www. Lippincott and Wilkins http://www. and Hawk Jane Hokanson (2005) Medical-Surgical Nursing Yuan.childbirths.asp?c=dvLUK9O0E&b=22576 http://people. APPENDICES Appendix A
10. signs and abnormal clinical. NEC 8. Vascular System Diseases 3.725 14.3
5.83 1 18.74 0 12.404 26.6 8. Pneumonia 6.5 22. all causes.298 48.966 41.1 13.771 33.Ten Leading Causes of Mortality by Sex Number. 2007 Appendix B Antipsychotic Drugs Increase Risk Of Developing Pneumonia In Elderly.224 32.6
period Source: The 2003 Philippine Health Statistics * percent share from total deaths. Study Suggests
Cause 1.868 64.4
5. 2003 Femal e Both Sexes Number Rate Percent* 17.99
29.055 39.823 7. all forms 7. Rate/100. Tuberculosis. Chronic lower respiratory diseases 9.05 4 20.664 39.000 Population & Percentage Philippines. Diabetes Mellitus 10.5 8. Philippines Last Update: January 11. Accidents 5.67 7 29. Heart Diseases 2.1 9.9 8.907 18. Certain conditions originating in the perinatal
Male 38.019 67.5 6.1 6.6 3.3 8 6. Malignant Neoplasm 4.9 16.196 17. Symptoms.373 14.905 23.63 4 27.397 5.8 3.72 0 15.363 26.122 17.623 21.814 51.0 18.696 83.5 8.4
4.36 7 10.246 33. laboratory findings.
for residents of nursing homes who receive antipsychotic therapy. 2008) — Elderly patients who use antipsychotic drugs have a 60 percent increased risk of developing pneumonia compared to non-users. authors of the study. They caution that “all antipsychotic drugs may be associated with pneumonia in elderly patients. these drugs are frequently used for this purpose.” In nursing homes. up to 40 percent of residents may be prescribed antipsychotics. Need to cite this story in your essay. “The risk of developing pneumonia is not associated with long-term use. according to the study. This study is the first to show that the development of pneumonia is associated with antipsychotic drug use. In the last few years it has become clear that the use of antipsychotic drugs in elderly patients is also associated with an increased risk of death and morbidity. or report? Use one of the following formats:
. Rob van Marum and Wilma Knol. It has been suggested that.
Adapted from materials provided by Wiley-Blackwell. 16.” say Drs. but is the highest shortly after starting the drug. paper.ScienceDaily (Apr. Antipsychotic drugs are frequently used in elderly patients for the treatment of psychosis and behavioral problems associated with dementia and delirium. more than half are prescribed for inappropriate reasons. This study is published in Journal of the American Geriatrics Society. Although literature shows limited efficacy and effectiveness for antipsychotic drug use in the treatment of behavioral problems in dementia patients. The underlying mechanism for the association remains unclear. The authors stress that clinicians may need to monitor patients for sedation after initiation of antipsychotic medication and that a careful weighing of the possible risks is recommended before starting antipsychotic treatment in elderly people. This risk is highest in the first week following prescription and decreases gradually thereafter.
Research led by Jay K. 2008) — Researchers at Children's Hospital of Pittsburgh of UPMC have identified a key protein target that may be a crucial factor in the development of a vaccine to prevent and new therapies to treat pneumonia.APA
MLA Wiley-Blackwell (2008.sciencedaily. 2008. Antipsychotic Drugs Increase Risk Of Developing Pneumonia In Elderly. Kolls. Jerne Professor of Pediatrics and Immunology at the University of Pittsburgh School of Medicine. As acute respiratory infections are the no.com /releases/2008/04/080415111640. 1 killer of children in the world. the leading killer of children worldwide. Retrieved August 28.htm
Possible Target For Prevention And Treatment Of Pneumonia Identified ScienceDaily (Feb. ScienceDaily. Kolls. more effective treatments is critical. identified for the first time the importance of a protein known as interleukin 22 (IL-22) in the immune response to a strain of bacterial pneumonia. April 16). 12. "Our results
. chief of the Division of Pediatric Pulmonary Medicine. Study Suggests." said Dr. the researchers were able to effectively treat mice with pneumonia by using purified IL-22. In the laboratory. "Currently there is no vaccine that covers all kinds of pneumonia and antibiotic treatment is sometimes limited by antibiotic resistance. Allergy and Immunology at Children's. from http://www. the Neils K. progress in the development of novel vaccines or new. MD.
they can more efficiently treat bacterial pneumonia.more than 2 million children each year.
. tumor necrosis factor.
Adapted from materials provided by Children's Hospital of Pittsburgh. lung immunology. pneumocytis carinii pneumonia. This is an important discovery because the Children's research team proposes that by stimulating the Th17 arm of the immune system. Additional research interests of Dr. a service of AAAS." Pneumonia causes almost one in five deaths in children under age 5 worldwide -.more than AIDS and malaria combined. Dr.raise the possibility of developing new protein-based therapies using IL-22 to limit or prevent pneumonia. Children's researchers found evidence that the Th17 cell lineage and its cytokines IL-22 and IL-17A have evolved to promote host defense against certain infections in the lung caused by extracellular pathogens. polymerase chain reaction and molecular biology. It kills more children than any other disease -. via EurekAlert!. IL-22 and interleukin 17A (IL-17A) are produced by a recently discovered lineage of cells known as T Helper Type 17 (Th17). ethanol. Kolls' laboratory investigates mechanisms of lung host defenses in normal and immunocompromised hosts as well as lung immunology in disease such as cystic fibrosis and asthma. Kolls include gene therapy. Furthermore. according to the World Health Organization.thus raising the potential to target this pathway in diseases of chronic inflammation such as rheumatoid arthritis or inflammatory bowel disease without increasing susceptibility to these intracellaulr pathogens. lung host defenses. the researchers propose that Th17 is a less critical pathway for intracellular bacteria such as those that cause listeria and tuberculosis -. gene expression. Results of the study are published in the February online issue of Nature Medicine.
com /releases/2008/02/080211111323. CAP is primarily treated with antibiotic medication. CAP is a common illness and can affect people of all ages. ScienceDaily. Individuals with CAP sometimes require treatment in a hospital. Some forms of CAP can be prevented by vaccination CAUSES Typical Bacterial Pathogens in CAP (approximately 85%)
. though x-rays.sciencedaily. CAP occurs because the areas of the lung which absorb oxygen (alveoli) from the atmosphere become filled with fluid and cannot work effectively. CAP can be diagnosed by symptoms and physical examination alone. chest pains. fungi.Need to cite this story in your essay.htm
Appendix C Community-acquired pneumonia
Community-acquired pneumonia (CAP) is a disease in which individuals who have not recently been hospitalized develop an infection of the lungs (pneumonia). Possible Target For Prevention And Treatment Of Pneumonia Identified. Retrieved August 28. Causes of CAP include bacteria. fever. CAP occurs throughout the world and is a leading cause of illness and death. examination of the sputum. viruses. and parasites. from http://www. or report? Use one of the following formats: APA
MLA Children's Hospital of Pittsburgh (2008. February 12). and other tests are often used. 2008. CAP often causes problems like breathing. and a cough. paper.
Only in patients with cystic fibrosis or bronchiectasis Nonpulmonary Pathogens in Pneumonia Nonaeruginosa pseudomonads Stenotrophomonas (Xanthomonas) maltophilia Citrobacter freundii Burkholderia (Pseudomonas) cepacia Citrobacter koseri Enterobacter species Flavobacterium species Enterobacter cloacae Flavobacterium meningisepticum Enterobacter agglomerans Enterococcus species Symptoms
.Postviral influenza setting Pseudomonas aeruginosa .Streptococcus pneumoniae Penicillin-sensitive S pneumoniae Penicillin-resistant S pneumoniae H influenzae Ampicillin-sensitive H influenzae Ampicillin-resistant H influenzae Moraxella catarrhalis (all strains penicillin resistant) Atypical Respiratory Pathogens in CAP (approximately 15%) Legionella species Mycoplasma species C pneumoniae Rare Bacterial Pathogens in CAP Klebsiella pneumoniae .Only in those with chronic alcoholism Staphylococcus aureus .
shallow breathing that is often painful
Less common symptoms include:
• • • • • • • • • •
the coughing up of blood (hemoptysis) headaches (including migraine headaches) loss of appetite excessive fatigue blueness of the skin (cyanosis) nausea vomiting diarrhea joint pain (arthralgia) muscle aches (myalgia)
. and uncontrollable shaking sharp or stabbing chest pain rapid.Symptoms of CAP commonly include:
• • •
problems breathing coughing that produces greenish or yellow sputum a high fever that may be accompanied with sweating. chills.