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CASE PRESENTATION

Related Learning Experience RLE 30-GROUP 6

INTRODUCTION
A. OVERVIEW OF THE CASE

Pneumonia is an inflammation of the lungs caused by an infection. It is also called Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our health. Although pneumonia is a special concern for older adults and those with chronic illnesses, it can also strike young, healthy people as well. It is a common illness that affects thousands of people each year in the Philippines, thus, it remains an important cause of morbidity and mortality in the country (http://nursingcrib.com/casestudy/pneumonia-case-study/)

CLIENTS PROFILE
A. Socio-demographic Data Patient X is a 3 years old female, Roman Catholic of Mambatangan, Manolo Fortich, Bukidnon. Patient X was admitted at NMMC last July 13, 2011 due to cough and fever.

5 C RR: 40cpm Weight: 11.7 C RR: 51cpm DAY 4 Pulse: 125 bpm Temp: 37.Upon Admission: Pulse:120 bpm Temp: 37.5 C RR: 39cpm .5 kg DAY 2 Pulse:125 bpm Temp: 38.1 C RR: 38cpm DAY 3 Pulse:165 bpm Temp: 37.

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Before hospitalization patient X was in good appetite can feed full of share in her diet. upon hospitalization the patient was experiencing loss of appetite and loss about 2 kg of body weight giving him a weight of 9. Patient is feeding less than the feeding pattern . Patient X was fed per demand more or less 3-4 times per day.5 kg.

approximately 120-160 ml per day with yellow colored urine. 2011with wet stool.Patient X’s usual bowel pattern is 1-2 times a day and sometimes its interval with one day. His usual urinary pattern is 23 times a day. . His last bowel movement was July 20.

dressing and toileting. grooming. Patient X is dependent on his mother since the patient is still 3 year old and pain when moving in her left side with closedthoracostomy tube inserted. bathing. .Patient X needed assistance with self-care such as eating.

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5°C Pulse: 120 bpm Height: . 2011 Temp: 37. Weight: Respiration: 40 cpm 11.5 kg . X Date: February 3.Name: Ms.

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separates the lungs from the abdominal cavity. which has three lobes.The Anatomy of the Lung Each lung is divided into lobes. the primary muscle involved in respiration. The diaphragm. The pulmonary veins. on the other hand. The right lung. carry oxygenated blood from the lungs to the heart. so it can be pumped to the rest of the body. is slightly larger than the left. The pulmonary arteries carry de-oxygenated blood from the right ventricle of the heart to the lungs. . and covered by a protective membrane called the pleura. The lungs are housed in the chest cavity. or thoracic cavity. which has two.

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They then return to their resting volume and push air out upon exhalation. or respiration. The respiratory system contains several structures. and fill with air.The lungs expand upon inhalation. or inspiration. These two movements make up the process of breathing. or expiration. the lungs facilitate this process: . When you breathe.

The air finally fills the alveoli. Oxygen travels across the membranes of the alveoli and into the blood in the tiny capillaries surrounding them. which are the small air sacs at the ends of the bronchioles. or "windpipe. The bronchi then subdivide into smaller tubes called bronchioles. the lungs facilitate the exchange of oxygen and carbon dioxide to and from the blood. 2.Air comes in through the mouth and/or nose.In the alveoli. ." This air travels down the trachea into two bronchi.1. one leading to each lung. Adult lungs have hundreds of alveoli. and travels down through the trachea. which increase the lungs' surface area and speed this process.

3.Oxygen molecules bind to hemoglobin in the blood and are carried throughout the body. 4. where it is transferred into the alveoli in the lungs to be expelled through exhalation. . This oxygenated blood can then be pumped to the body by the heart.The blood also carries the waste product carbon dioxide back to the lungs.

resulting in emphysema or lung cancer. .Smoking can damage the alveoli and make breathing labor intensive.

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Quiet respiration. the diaphragm contracts and pulls down. pushing air back out of the lungs. The lungs and chest walls also return to their resting positions. . When the diaphragm relaxes. During quiet respiration. This also reduces the size of the chest cavity and helps to push air out of the lungs. it moves back up.happens when the body is at rest. lowering the pressure in the lungs and causing air to enter the lungs through the mouth and nose to equalize the pressure.

and help push air out of the lungs. During exhalation. .Active respiration. the muscles around the ribs raise and push out the ribs and sternum.occurs when the body is active and requires higher levels of oxygen to the blood than when resting. forcing the diaphragm to rise. the intercostals force the ribs to contract. helping the lungs take in more air. Both these movements make the thoracic cavity contract. During active respiration. which increases thoracic volume. and the abdominal muscles contract.

in which the muscles around the bronchial tubes constrict in order to keep out irritants. or a condition such as bronchitis or chronic obstructive pulmonary disease (COPD).The Lungs' Protections Several lung parts and functions act as protective mechanisms to keep out irritants and foreign particles. which also helps protect the lungs from foreign particles. Bronchial constriction causes breathing difficulties. Asthma involves inflammation and constriction of the bronchial tubes. and is often triggered by environmental irritants. The hairs and mucus in the nose prevent foreign particles from entering the respiratory system. Irritants can also cause bronchospasm. . This mucus is naturally pushed up toward the epiglottis. Coughing up any of this mucus is usually an indication of a respiratory infection. The breathing tubes in the lungs secrete mucus. where is passed into the esophagus and swallowed.

About Breathing Difficulties .

or chronic. the bronchial tubes become inflamed and irritated. . and last much longer. Bronchitis can be acute. They produce mucus. resulting in a cough. Understanding human lung anatomy and physiology makes clear how the different lung parts are affected in disease. with a sudden onset and quick recovery.*Damage to any part of the respiratory pathway can also cause breathing difficulties. In people with bronchitis.

as the healthy respiration is required to supply oxygen to the body and its organs. Blockage in the bronchioles and alveoli make it difficult to exhale. Interstitial lung disease. including pulmonary fibrosis.*Chronic obstructive pulmonary disease (COPD) involves symptoms of both chronic bronchitis and emphysema. . Any of these conditions affect not only the lungs. but the entire body. causes a buildup of scar tissue in the lungs and reduces lung function. This traps air in the lungs and in turn makes proper inhalation difficult.

SCHEMATIC DIAGRAM OF PATHOPHYSIOLOGY OF PNEUMONIA .

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PATHOPHYSIOLOGY OF PNEUMONIA .

You can read more about chronic pneumonia and acute pneumonia. many factors are responsible for development of pneumonia. as they body lacks the mechanism to fight against the condition. The common type of community acquired infection is pneumococcal pneumonia and Mycoplasma pneumonia. . Aspirational pneumonia. Most of the hospital acquired infections of pneumonia are the serious infections.Pneumonia is a commonly occurring serious disease that affects about 1 out 100 people every year. Pneumonia can be divided into various categories like community acquired and hospital acquired infection. Let us go into the details of pathophysiology of pneumonia. As mentioned above. pneumonia in immunocompromised host and viral pneumonia are some of the pneumonia related specific disorders. Many times in people with lowered immunity or geriatric patients. pneumonia is seen after a bout of influenza.

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6 cm (8.2cm another fluid collection measuring 4cm x2. Diagnosis: 2 fluid collection likely emphysema right as describe above lung consolidation and/or atelectasis.2011 Findings: Fluid connection with moderate to high level echoes in the right basal hemithorax measuring 3.6 cm x 2. posterior to the fluid collection areas of hyperechoic lung tissue with air bronchogram. .3cmx 1.0ml)in right midlung.7cm x 3.LAB RESULTS ULTRASOUND REPORT July 21.

7 FL FL % % % JULY 22.5 F1 26.3 29.2 7.8 29.1 7.72 9.3 3.6 19 66.2 3.6 14.8 % 7.4 10.7 6.8 62.1 MVP 8.7 79.0 16.8 18.3 % 81.8 26.3 33.2 3.5 .14 10^6Ul 8.3 gldl 25.5 Monocyte 14.9 8.4 pg 32.0 78 26. 2011 25.9 26.8 JULY 15.4 Differential Count Lymphocytes 34.4 8.Hematology WBC RBC Hemoglobin Hematocrit MCV MCH MCHC RDW-CV PDW July 27. 2011 9. 2011 Unit 10.34 5.3 33.4 g/dl 16.1 Nuetrophil 50.

6 % 0.4 Basophil 0.3 % 0.2 0.Eosinophil 0.1 654 7/13 after 24hrs of ORGANISM:Bacillus (+)positive negative .3 Bands /stabs Platelet 450 10^3UL 772 Microbiology 7/19 7/13 Specimen: Specimen: Plural Fluid incubation 2nd Take: NO AFB SEEN RESULT: NO ORGANISM sp. 3rd Take: NO AFB SEEN SEEN (-) 0.

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Provide appropriate information for better understanding regarding therapeutic effects of the medications. Inform and explain it to the guardians. and also the patient should take the entire course of any prescribed medications. Moreover. Encourage the significant others of the child to report or inform the physician if any of these side effects occur. emphasize the right timing or taking of the right time intervals of these drugs to maximize its therapeutic effects and avoid further complications.Medication Medications must be continued according to the doctor's instructions. . otherwise the pneumonia may recur.

Exercise Not applicable .

. Instruct them to report to the physician promptly about any changes on health condition.Treatment Instruct the family of the client to continue drug therapy as ordered. Encourage guardians to strictly comply with the doctor's orders. Discuss to the significant others the complication of the condition. Inform the family about the dangers of non compliance to treatment regimen. especially in taking prescribed medications.

Proper diet and oxygen to increase oxygen in the blood when needed. Liquids will keep away patient from becoming dehydrated and help loosen mucus in the lungs. Drink lots of fluids. Give supportive treatment.Encourage them also to have followed up visitations to the physician after discharge. .

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Give the medicine on schedule for as long as directed. which is a sign that the lungs are not getting enough oxygen. This will help your child recover faster and will decrease the chance that infection will spread to other household members. Check your child's lips and fingernails to make sure that they are rosy and pink. Sponge baths are recommended for the first day or two. A to prevent anemia . which may not be helpful in some types of pneumonia. Ask the doctor before you use a medicine to treat your child's cough because cough suppressants stop the lungs from clearing mucus. not bluish or gray. Proper hygiene especially handwashing to prevent infections Advise the mother to give supplements to the child especially Vit. Encourage drinking of fluids. especially if fever is present.

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Follow-up check up regularly in order to monitor and properly manage patient's illness. Continue medication as ordered.Remind the significant others of the patient on the arrangements to be made with the physician for follow-up checkups. Instruct to have a follow-up check-up or refer to the physician if the patient is uncomfortable. .

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Advice the guardians to be watchful/careful enough of the diet that could help maintain clear airway and promote proper nutrition of the patient.Since the child is still 3 years old. encourage the mother to have her child eat a well-balanced diet. . child's intake of foods may affect child's health.

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There is more to it. I suggest the family of the patient to pray for the recovery of their child. .Human body is not just this we can see. to treat soul and to treat mind and unconscious parts of us. To treat other level of us.

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