Case Press Group 6 Rel 30

8/3/2019 Case Press Group 6 Rel 30

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CASE PRESENTATION

Related LearningExperience RLE

30-GROUP 6


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INTRODUCTIONA. OVERVIEW OF THE CASE

Pneumonia is an inflammation of the lungs caused byan infection. It is also called Pneumonitis orBronchopneumonia. Pneumonia can be a serious

threat to our health. Although pneumonia is a specialconcern for older adults and those with chronicillnesses, it can also strike young, healthy people aswell. It is a common illness that affects thousands of

people each year in the Philippines, thus, it remainsan important cause of morbidity and mortality in thecountry (http://nursingcrib.com/case-study/pneumonia-case-study/)


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CLIENTS PROFILEA. 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 dueto cough and fever.


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Upon

Admission:Pulse:120 bpmTemp: 37.5 CRR: 40cpmWeight: 11.5 kg

DAY 3

Pulse:165 bpmTemp: 37.7 CRR: 51cpm

DAY 2

Pulse:125 bpmTemp: 38.1 CRR: 38cpm

DAY 4Pulse: 125 bpm

Temp: 37.5 CRR: 39cpm


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Before hospitalization patient X was in good appetite can feedfull of share in her diet.

Patient X was fed per demand more or less 3-4 times per day,upon hospitalization the patient was experiencing loss ofappetite and loss about 2 kg of body weight giving him a weightof 9.5 kg. Patient is feeding less than the feeding pattern


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Patient Xs usual bowel pattern is 1-2 times a day andsometimes its interval with one day. His last bowel movement

was July 20, 2011with wet stool. His usual urinary pattern is 2-3 times a day, approximately 120-160 ml per day with yellowcolored urine.


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Patient X needed assistance with self-care such as eating,bathing, grooming, dressing and toileting. Patient X isdependent on his mother since the patient is still 3 year old

and pain when moving in her left side with closed-thoracostomy tube inserted.


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Name: Ms. X

Temp: 37.5CPulse: 120 bpm

Respiration: 40 cpm

Height: Weight: 11.5 kg.

Date: February 3, 2011


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The Anatomy of the Lung

Each lung is divided into lobes. The right lung, which has three lobes, is

slightly larger than the left, which has two. The lungs are housed in the

chest cavity, or thoracic cavity, and covered by a protective membrane

called the pleura. The diaphragm, the primary muscle involved in

respiration, separates the lungs from the abdominal cavity.

The pulmonary arteries carry de-oxygenated blood from the right

ventricle of the heart to the lungs. The pulmonary veins, on the other

hand, carry oxygenated blood from the lungs to the heart, so it can bepumped to the rest of the body.


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The lungs expand upon inhalation, or

inspiration, and fill with air. They then return totheir resting volume and push air out uponexhalation, or expiration. These two movements

make up the process of breathing, or respiration.

The respiratory system contains severalstructures. When you breathe, the lungsfacilitate this process:


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1.Air comes in through the mouth and/or nose, and travels downthrough the trachea, or "windpipe." This air travels down thetrachea into two bronchi, one leading to each lung. The bronchi

then subdivide into smaller tubes called bronchioles. The air finallyfills the alveoli, which are the small air sacs at the ends of thebronchioles.

2.In the alveoli, the lungs facilitate the exchange of oxygen andcarbon dioxide to and from the blood. Adult lungs have hundredsof alveoli, which increase the lungs' surface area and speed thisprocess. Oxygen travels across the membranes of the alveoliand into the blood in the tiny capillaries surrounding them.


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3.Oxygen molecules bind to hemoglobin in the blood and arecarried throughout the body. This oxygenated blood can then bepumped to the body by the heart.

4.The blood also carries the waste product carbon dioxide back tothe lungs, where it is transferred into the alveoli in the lungs to beexpelled through exhalation.


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Smoking can damage the alveoli and

make breathing labor intensive,resulting in emphysema or lung cancer.


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Quiet respiration- happens when the body is at rest.During quiet respiration, the diaphragm contracts andpulls down, lowering the pressure in the lungs andcausing air to enter the lungs through the mouth and

nose to equalize the pressure. When the diaphragmrelaxes, it moves back up, pushing air back out of thelungs. The lungs and chest walls also return to theirresting positions. This also reduces the size of the chest

cavity and helps to push air out of the lungs.

Active respiration occ rs hen the bod is acti e and


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Active respiration- occurs when the body is active andrequires higher levels of oxygen to the blood than whenresting. During active respiration, the muscles around

the ribs raise and push out the ribs and sternum, whichincreases thoracic volume, helping the lungs take inmore air. During exhalation, the intercostals force theribs to contract, and the abdominal muscles contract,

forcing the diaphragm to rise. Both these movementsmake the thoracic cavity contract, and help push air outof the lungs.

The Lungs' Protections


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The Lungs ProtectionsSeveral lung parts and functions act as protective mechanisms tokeep out irritants and foreign particles. The hairs and mucus in

the nose prevent foreign particles from entering the respiratorysystem.The breathing tubes in the lungs secrete mucus, which also helpsprotect the lungs from foreign particles. This mucus is naturally

pushed up toward the epiglottis, where is passed into theesophagus and swallowed. Coughing up any of this mucus isusually an indication of a respiratory infection, or a condition suchas bronchitis or chronic obstructive pulmonary disease (COPD).Irritants can also cause bronchospasm, in which the muscles

around the bronchial tubes constrict in order to keep out irritants.Asthma involves inflammation and constriction of the bronchialtubes, and is often triggered by environmental irritants. Bronchialconstriction causes breathing difficulties.


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About Breathing

Difficulties


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*Damage to any part of the respiratory pathway can also causebreathing difficulties. Understanding human lung anatomy and

physiology makes clear how the different lung parts are affected indisease.In people with bronchitis, the bronchial tubes become inflamedand irritated. They produce mucus, resulting in a cough. Bronchitiscan be acute, with a sudden onset and quick recovery, or chronic,and last much longer.

*Chronic obstructive pulmonary disease (COPD)


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Chronic obstructive pulmonary disease (COPD)involves symptoms of both chronic bronchitis andemphysema. Blockage in the bronchioles and alveoli

make it difficult to exhale. This traps air in the lungs andin turn makes proper inhalation difficult.Interstitial lung disease, including pulmonary fibrosis,causes a buildup of scar tissue in the lungs and reduces

lung function. Any of these conditions affect not only thelungs, but the entire body, as the healthy respiration isrequired to supply oxygen to the body and its organs.


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SCHEMATIC DIAGRAM OF

PATHOPHYSIOLOGY OF

PNEUMONIA


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PATHOPHYSIOLOGY OFPNEUMONIA

Pneumonia is a commonly occurring serious disease that


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Pneumonia is a commonly occurring serious disease thataffects about 1 out 100 people every year. As mentionedabove, many factors are responsible for development ofpneumonia. Pneumonia can be divided into various categories

like community acquired and hospital acquired infection. Thecommon type of community acquired infection is pneumococcalpneumonia and Mycoplasma pneumonia. Many times in peoplewith lowered immunity or geriatric patients, pneumonia is seen

after a bout of influenza. Most of the hospital acquiredinfections of pneumonia are the serious infections, as they bodylacks the mechanism to fight against the condition. Aspirationalpneumonia, pneumonia in immunocompromised host and viral

pneumonia are some of the pneumonia related specificdisorders. Let us go into the details of pathophysiology ofpneumonia. You can read more about chronicpneumonia and acute pneumonia.
http://www.buzzle.com/articles/aspiration-pneumonia.htmlhttp://www.buzzle.com/articles/aspiration-pneumonia.htmlhttp://www.buzzle.com/articles/chronic-pneumonia.htmlhttp://www.buzzle.com/articles/chronic-pneumonia.htmlhttp://www.buzzle.com/articles/acute-pneumonia.htmlhttp://www.buzzle.com/articles/acute-pneumonia.htmlhttp://www.buzzle.com/articles/chronic-pneumonia.htmlhttp://www.buzzle.com/articles/chronic-pneumonia.htmlhttp://www.buzzle.com/articles/aspiration-pneumonia.htmlhttp://www.buzzle.com/articles/aspiration-pneumonia.html


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LAB RESULTS


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LAB RESULTSULTRASOUND REPORT

July 21,2011

Findings: Fluid connection with moderate to high levelechoes in the right basal hemithorax measuring 3.7cm x3.6 cm x 2.2cm another fluid collection measuring 4cmx2.3cmx 1.6 cm (8.0ml)in right midlung, posterior to the

fluid collection areas of hyperechoic lung tissue with airbronchogram.Diagnosis: 2 fluid collection likely emphysema right asdescribe above lung consolidation and/or atelectasis.


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Hematology July 27, 2011 JULY 22, 2011 JULY 15, 2011Unit

WBC 10.4 10.3 9.2 25.2RBC 3.14 10^6Ul 3.34 3.72

Hemoglobin 8.3 gldl 5.8 9.8Hematocrit 25.3 % 26.7 29.0MCV 81.5 F1 79.9 78MCH 26.4 pg 26.3 26.3MCHC 32.4 g/dl 33.0 33.8RDW-CV 16.8 % 16.1 18.9

PDW 7.7 FL 7.2 8.4MVP 8.4 FL 7.3 8.6Differential CountLymphocytes 34.1 % 29.8 19Nuetrophil 50.5 % 62.7 66.6Monocyte 14.5 % 6.8 14.1

Eosinophil 0.6 % 0.4 0.2


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pBasophil 0.3 % 0.3 0.1Bands /stabsPlatelet 450 10^3UL 772 654Microbiology 7/19 7/13 7/13

Specimen: Specimen: Plural Fluid after 24hrs ofincubation2nd Take: NO AFB SEEN RESULT: NO ORGANISM ORGANISM:Bacillussp.3rd Take: NO AFB SEEN SEEN (-) (+)positive

negative


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Medication


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Medication

Medications must be continued according to the doctor'sinstructions, otherwise the pneumonia may recur, and also the

patient should take the entire course of any prescribedmedications.

Provide appropriate information for better understanding regarding

therapeutic effects of the medications.

Encourage the significant others of the child to report or inform thephysician if any of these side effects occur. Inform and explain it tothe guardians. Moreover, emphasize the right timing or taking of

the right time intervals of these drugs to maximize its therapeuticeffects and avoid further complications.


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Exercise

Not applicable

Treatment


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Treatment

Instruct the family of the client to continue drug therapy asordered.

Inform the family about the dangers of non compliance totreatment regimen.

Discuss to the significant others the complication of the condition.

Instruct them to report to the physician promptly about anychanges on health condition.

Encourage guardians to strictly comply with the doctor's orders,especially in taking prescribed medications.

Encourage them also to have followed up visitations to the


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cou age t e a so to a e o o ed up s tat o s to t ephysician after discharge.

Drink lots of fluids. Liquids will keep away patient from becoming

dehydrated and help loosen mucus in the lungs.

Give supportive treatment. Proper diet and oxygen to increaseoxygen in the blood when needed.


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Give the medicine on schedule for as long as directed. This will help your childrecover faster and will decrease the chance that infection will spread to otherhousehold members.

Encourage drinking of fluids, especially if fever is present. Sponge baths arerecommended for the first day or two. Ask the doctor before you use a medicineto treat your child's cough because cough suppressants stop the lungs fromclearing mucus, which may not be helpful in some types of pneumonia.

Check your child's lips and fingernails to make sure that they are rosy and pink,not bluish or gray, which is a sign that the lungs are not getting enough oxygen.

Proper hygiene especially handwashing to prevent infections

Advise the mother to give supplements to the child especially Vit. A to preventanemia


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Remind the significant others of the patient on the arrangements


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g p gto be made with the physician for follow-up checkups.

Follow-up check up regularly in order to monitor and properly

manage patient's illness.

Continue medication as ordered.Instruct to have a follow-up check-up or refer to the physician if

the patient is uncomfortable.


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Since the child is still 3 years old, encourage the mother to have


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y gher child eat a well-balanced diet, child's intake of foods mayaffect child's health.

Advice the guardians to be watchful/careful enough of the diet thatcould help maintain clear airway and promote proper nutrition ofthe patient.


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Human body is not just this we can see. There is more to it. Totreat other level of us, to treat soul and to treat mind andunconscious parts of us, I suggest the family of the patient to pray

for the recovery of their child.

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