case presentation community acquired pneumonia iii
TRANSCRIPT
CASE CASE PRESENTATIOPRESENTATIO
NNCOMMUNITY ACQUIRED COMMUNITY ACQUIRED
PNEUMONIA IIIPNEUMONIA IIIFebruary 19, 2010February 19, 2010
GROUP 93GROUP 93SUBMITTED TO: SUBMITTED TO: MR. OLIVER MR. OLIVER
A.SANIDAD R.N.A.SANIDAD R.N.
• The PresentorsThe Presentors• Bumatay, AllanBumatay, Allan• Corpuz, leoCorpuz, leo• Garcia, carlaGarcia, carla• Garcia, krystalGarcia, krystal• GOMEZ, GENELLEGOMEZ, GENELLE• Ibañez, Jesus D.C.IIIIbañez, Jesus D.C.III• ISLES, KRIS EVERTISLES, KRIS EVERT• Jereos, Abigail Raejoy A.Jereos, Abigail Raejoy A.• Lapiña, Danica M.Lapiña, Danica M.• Legaspi, Rochelle Glureen B.Legaspi, Rochelle Glureen B.• Licarte, Charlene Mae M.Licarte, Charlene Mae M.
Introduction• The pathogens that cause community-acquired
pneumonia (CAP) are predictable; copathogens are involved rarely, if ever. Extrapulmonary clinical features are helpful in distinguishing between typical and atypical causes of CAP. Various clinical findings can also point to specific diagnoses, such as Klebsiella pneumonia or Legionella infection. Severe CAP suggests the presence of underlying problems in the patient, such as cardiopulmonary dysfunction or impaired splenic functioning. Empiric therapy should cover typical and atypical pathogens. Oral antibiotics should be used for as much of the treatment course as is practicable.
ObjectivesThis case study significantly identifies the factors that gave rise for our client to have the diagnosed problem. The ff. are the identified objectives for the case study
• To develop a comprehensive assessment of the client.• To establish a pathophysiology for the disease of the
client.• To develop a nursing care plan appropriate for the
client’s diagnosed problem.• To be able to teach the mother of the client for proper
health maintenance.• To lessen the risk of infection and development of
complications of the client.• To be able to provide an environment conducive for
health.• To enhance the care that will be given for other client’s
with the same diagnosis.
BIOGRAPHIC DATAName: CLAddress: Sto. Nino,Meycauayan BulacanAge: 8Marital Status: NARoom and Bed number: Room 214-CChief Complaint: FeverDiagnosis: Community Acquired Pneumonia IIIAttending Physician: Dra. Lea DilagGender: FemaleReigion: PentecostalBirthday: March 27, 2010
Name: CLAddress: Sto. Nino,Meycauayan BulacanAge: 8Marital Status: NARoom and Bed number: Room 214-CChief Complaint: FeverDiagnosis: Community Acquired Pneumonia IIIAttending Physician: Dra. Lea DilagGender: FemaleReigion: PentecostalBirthday: March 27, 2010
NURSING HEALTH HISTORY
PAST HEALTH HISTORY
CL has Bronchial asthma in acute exacerbation. It was 2004 when she was first diagnosed with the supposed illness. Her mother stated that she had complete immunizations. She does not have any allergies. When she was five years old, CL fell-off her bicycle. Her mother performed first aid treatment by cleansing the wound with running water and betadine. That wound left her a scar on the right ankle. Other than that, she had not encountered any accidents.
CL has Bronchial asthma in acute exacerbation. It was 2004 when she was first diagnosed with the supposed illness. Her mother stated that she had complete immunizations. She does not have any allergies. When she was five years old, CL fell-off her bicycle. Her mother performed first aid treatment by cleansing the wound with running water and betadine. That wound left her a scar on the right ankle. Other than that, she had not encountered any accidents.
PAST HEALTH HISTORY
She had two hospital admissions prior to her recent condition. In 2005, she was first admitted to SCDMMC due to Pneumonia then she was hospitalized again last 2008 due to typhoid fever. She is currently taking Paracetamol Jr. for her fever with Flumuicil and Duavent for her asthma. She does not take any vitamin supplements. In April 2005, her family went to Hongkong for their vacation trip and to witness the Grand Opening of Hongkong Disney land.
She had two hospital admissions prior to her recent condition. In 2005, she was first admitted to SCDMMC due to Pneumonia then she was hospitalized again last 2008 due to typhoid fever. She is currently taking Paracetamol Jr. for her fever with Flumuicil and Duavent for her asthma. She does not take any vitamin supplements. In April 2005, her family went to Hongkong for their vacation trip and to witness the Grand Opening of Hongkong Disney land.
HISTORY OF PRESENT ILLNESS
One day prior to her condition, CL experienced low-grade fever, productive cough with watery nasal discharge. Due to this instance, her mother brought her to SCDMMC and was then admitted with the diagnosis of Community-Acquired Pneumonia III.
One day prior to her condition, CL experienced low-grade fever, productive cough with watery nasal discharge. Due to this instance, her mother brought her to SCDMMC and was then admitted with the diagnosis of Community-Acquired Pneumonia III.
FAMILY HISTORY
The client has familial history of hypertension and asthma. CL’s mother said that her mother-in-law has hypertension and her father-in-law has asthma.
The client has familial history of hypertension and asthma. CL’s mother said that her mother-in-law has hypertension and her father-in-law has asthma.
LL
(73 y/o)LL
(73 y/o)
JL
(73 y/o)JL
(73 y/o)
EL
(50 y/o)EL
(50 y/o)
CL
(50y/o)CL
(50y/o)
JFL
(23 y/o)JFL
(23 y/o)
CL
(8 y/o)CL
(8 y/o)
NL
(19 y/o)NL
(19 y/o)
LEGEND:
HYPERTENSION
ASTHMA
GENOGRAM
Developmental History
• The child said that her problems would only include academic activities. She does not want to be sick and absent because she said she would miss school. She is active in school activities. She belongs to a class of excellent students. Her mother said that her teacher does not find any particular problem with her at all. Her greatest fear is the darkness. CL said that she would only cry when her brother teased her or when her parents scold her.
Emotional Health
Social Health • She has a good relationship with her family. She
stated that she is bonded with her family members. She also has good relationship with her teachers, schoolmates and playmates. She allots time for self-enjoyment. Her hobby includes artworks. She loves to draw. She also verbalized that she is active in school. In fact, she joins athletic activities. Her favorite is obstacle race. When her father is available, they would often play badminton. Computer games serve as her bonding activity with her brothers. Walking around the school and eating are her friends’ past time. She has variety of toys to share with her playmates and cousins. She is always provided with time to play and mingle with them.
Cognitive Patterns• The child said that she does well in school. She excels
in their academic subjects most especially in Mathematics. She had won in Quiz Bee last school’s fest with bronze medal. She belongs to a class of excellent students. She is proud of her achievements in school. She said that her parents are glad about it. She is always present in class. She would only be absent in times of sickness. She loves to do her homework and likes to recite during class discussions.
Language• She has good language skills. She speaks
Filipino fluently and is able to understand English language. She attentively answered to the questions presented. She would set examples when asked to describe a situation. She had an explorative mind. She too listened carefully and was very eager to answer.
Self-Concept• She has no physical defects. • She is an active girl, very attentive and
smart. The child verbalized, “Gusto ko maging doktor at saka teacher paglaki ko.”
Religious Beliefs and Practices• The child belongs to Christian-
Pentecostal religion. Her mothersaid that CL also does the things that people usually do as Christians. Every Sunday they would go to their church and attend their mass. CL still believes in God Almighty. Her mother stated that they just don’t believe in spiritual images and does not worship saints.
SPIRITUAL HEALTH
Moral Development
The child at her age has a good understanding about the concept of good and bad. She knows the simple bad deeds that she has to avoid. She said that she is being scolded by her parents when she had done bad things such as being naughty sometimes. She understands that her wrong deeds have corresponding punishments.
•Physical Assessment
NORMS(Based on Fundamentals of Nursing 8th Edition, by Kozier, et al., published by Pearson Education Inc., ©2008, pp. 572 – 641)
ACTUAL FINDINGSINTERPRETATION &
ANALYSIS
General Appearance
Posture/gait Relaxed, erect posture;Coordinated movement
Posture is slightly slouching
Physical difficulty can affect the posture and gait of a person. This may be accompanied by observable physical responses. (Medical-Surgical Nursing 8th Edition, by Black & Hawks, published by Saunders Inc., ©2009, p. 613)
Personal Hygiene/Grooming
Clean, neat The client appears neat, wearing clean clothes
Normal
•Physical Assessment
Nutritional status
Optimal Height 127 cms Range (108 - 142 cms) Optimal Weight 26 kg Range (18 - 40 kg)(http://www.medindia.net/patients/calculators/ht_wt_chartResult.asp)
Height: 114.3 cmWeight: 24 kgBMI: 18.37
Normal
Verbal Behavior
Understandable, moderate pace, exhibits though association
The client is able to understand the instructions and questions asked
Normal
•Physical AssessmentMeasurements: Axillary= 36.5°C - 37.5°C (Fundamentals of Nursing, Taylor, p526)
37.2°C Normal
80-120 beats/min (Medical-Surgical Nursing, 5th ed., p1814)
106 bpm Normal
20-25 cycles/min 28 cpm An increase in respiratory rate is a common manifestation experienced by clients with
pulmonary disorders. Also in the case, the client is experiencing difficulty
breathing because of the increased mucus production in her nasal area. (Medical-Surgical Nursing 8th Edition,
by Black & Hawks, published by Saunders Inc., ©2009, p.
1526)
•Physical AssessmentBODY PARTS NORMS AND
STANDARDSACTUAL FINDING
ANALYSIS
INTEGUMENTARY
A. Skin
a. inspect for color and uniformity
Generally uniform except in areas exposed to the sun; areas lighter pigmentation (palm, lips, nail beds) in dark skinned people
The client’s skin looks pale. Darker areas are seen on skin folds like on the arm folds.
Normal
b .inspect for presence of edema
No edema No edema Normal
•Physical Assessment
c. inspect for lesions according to location, distribution, color configuration, size, shape, type or structure
Freckles, birthmarks, flat and raised nevi: no abrasions or other lesions
The client has birthmark on the left upper arm, about 2 cm in size, circular in shape.
Normal
d. palpate skin moisture
Moisture in skin folds The client’s skin has moisture in skin folds.
Normal
e. palpate skin temperature
Uniform; with normal range
The client’s skin temperature is uniform
Normal
f. palpate for skin turgor
When pinched ,skin springs back to previous state
When pinched skin returns back to its previous state
Normal
•Physical AssessmentB. NAILS
a. inspect fingernail plate shape to determine its curvature and angle
Convex curvature; angle of nail pate about 160°
Convex curvature; angle is 160°
Normal
b .inspect fingernail and toenail color
Highly vascular and pink in light-skinned clients; dark-skinned clients may have brown or black pigmentation in longitudinal streaks
The fingernail and toenail of the client is pink in color.
Normal
c. palpate fingernail and toenail texture
Smooth texture Smooth in texture Normal
•Physical Assessment d. inspect tissue surrounding nail
Intact epidermis Intact epidermis Normal
e. perform blanch test capillary refill
Prompt return in pink or usual in less than 3 seconds.
delayed return of pink in 4 seconds.
Delayed return of pink or usual color. This may indicate
circulatory impairment in the
body. (Fundamentals of
Nursing 8th Edition, by Kozier, et al.,
published by Pearson Education Inc., ©2008, p. 584)
•Physical AssessmentHEAD
A. SKULLSize, shape,SymmetryNodules, massesAnd depressions
rounded/normocephalic; smooth, uniform consistency; absence of nodules or masse
Rounded; smooth skull contour; symmetrical; Absence of nodules or masses; uniform consistency
Normal
B. SCALP -evenly distributed hair; whitish color; no dandruff; no tenderness, nodules, masses and edema
White scalp; no lice, nits and dandruff; no lumps, gently curved; no nodules, masses and edema.
Normal
C. HAIR -evenly distributed; thick hair; silky, resilient hair; no infection or infestation
The client’s hair is thick and evenly distributed.
Normal
D. FACE -Symmetric facial movements
Facial movements is symmetric
Normal
•Physical Assessment
EYES
A. EYEBROWSDistribution, Alignment, skin Quality and movement
Hair evenly distributed, skin intact; eyebrows symmetrically aligned; equal movement
The eyebrows of the client are evenly distributed, symmetrically aligned, and equal in movement.
Normal
B. EYELASHESEvenness ofDistribution andDirection of curl
Equally distributed; curled slightly outward
The client’s eyelashes are equally distributed and curled upward
Normal
C. EYELIDSSurface characteristics position in relation to the cornea ability to blink; frequency of blinking
Skin intact, no discharge; no discoloration; lids close symmetrically
The client’s eyelids close symmetrically.
Normal
•Physical AssessmentD. CONJUNCTIVABulbar conjunctiva:Color, texture, Presence of lesionsPalpebral conjunctiva:Color, texture, Lesions
Transparent; capillaries sometimes evident; Shiny, smooth, and pink or red
Transparent, evident capillaries, shiny, smooth and pink in color
Normal
E. SCLERAColor and clarity
Sclera appears White(yellowish in dark-skinned clients)
Clear and white in color with visible veins.
Normal
F. CORNEAClarity and texture
Transparent, smooth, shiny, details of iris are visible
Transparent, smooth texture and shiny
Normal
G. IRISShape and color
Color brown, flat and round Color brown and round in shape
Normal
H. PUPILSColor, shape,and size
Black in color equal in size, normally 3-7 mm in diameter, round, smooth borders
Pupils are equal; round and reacts to light accommodation, color black, 6 mm
Normal
•Physical AssessmentI. VISUAL ACUITY Near visionDistance vision
Able to identify pictures;
Able to identify pictures
Normal
J. LIGHT REACTION AND ACCOMODATIONLight reaction andaccommodation
Pupil constrict when looking at near object; Illuminated pupil constrict andNon illuminated pupil dilates
The pupil constricts when light is pointed and dilates when light is removedThe pupil constrict when an object is placed near to it and the pupil dilate when the object is far from it.
Normal
•Physical Assessment
K. LACRIMAL GLAND, LACRIMAL SAC, AND NASOLACRIMAL DUCT
No edema or tenderness over lacrimal gland, no edema or tearing
No edema or tenderness
Normal
L. EXTRAOCULAR MUSCLEAlignment;coordination
Both eyes coordinated, move with unison, with parallel alignment
With parallel alignment and coordinated visual field
Normal
M. VISUAL FIELDSPeripheral visualfields
When looking straight ahead, client can see objects in periphery.
Client can see objects in periphery
Normal
•Physical AssessmentEARS
A. AuriclesColor, size, PositionTexture, elasticity,and tenderness
Symetrical; color same as the facial skin; pinna recoils after it is folded; mobile, firm and not tender.
Color same as facial skin; mobile, firm, recoils when it is folded
Normal
B. External Ear CanalsCerumen, skinLesions, pusAnd blood
Distal third contains hair follicles and glands, and tha external ear canals has cerumen.
The client’s external ear canal has no lesions, pus, and blood and has presence of cerumen.
Normal
C. Hearing In normal voice onesWatch tick test
Must be audibleThe client is able to hear the ticking in both ears
The client verbalized that she can hear clearly what the student nurse says.Able to hear ticking in both ears
NormalNormal
•Physical Assessment
NOSE
Shapes, size, and color
The client’s nose is symmetric and straight. The color of the nose ranges from medium to light brown. Uniform to the color of the face.
Symmetric and straight. Light brown color of the nose, uniform to the face.
Normal
Nasal cavities:>Redness, swelling,Growths, and discharge
Mucosa is pink and no watery discharge and lesions
Discharges are seen.
Discharges from the nasal cavity are often
influenced by the increased secretion of mucus, and/or brought
about by allergic reaction.
(Fundamentals of Nursing 8th Edition, by
Kozier, et al., published by Pearson Education Inc., ©2008, p. 613)
•Physical Assessment
Nasal septum Nasal septum is in the midline
Intact and in the midline
Normal
Nasal cavity patency
Air moves freely as the client breathes through the nares
The air moves freely on the left side, and obstructed on the right side.
Air movement is restricted in one nares
since the client has increased mucus
production. (Fundamentals of
Nursing 8th Edition, by Kozier, et al., published by Pearson Education Inc., ©2008, p. 613)
Tenderness, masses and displacement of bone and cartilage
No tenderness; no lesions No tenderness; no lesions
Normal
FACIAL SINUSESFrontalSupraorbital ridgesSphenoidmaxillary
No tenderness No tenderness Normal
•Physical Assessment
MOUTH
A. LipsSymmetry of contour, color, texture
Uniform pink color; moist soft, glistening and elastic texture Lips should be pink, moist and smooth.
The client’s lip is pale in color, dry and chappy. It is symmetrical in contour. She has ability to purse lips and it has no lesions.
Deviation from normal because of dry, pale lips.This may indicate fluid intake deficiency. (Fundamentals of Nursing 8th Edition, by Kozier, et al., published by Pearson Education Inc., ©2008, p. 613)
B. Buccal MucosaColor, moisture, texture and lesions
Uniform pink color; Moist soft, glistening, elastic and no lesions
It is smooth, soft and elastic. It does not have lesions.
Normal
•Physical Assessment
C. TeethColor,number,conditiona
20 teeth; smooth, white, shiny tooth enamel.The teeth should be regular and free of cavities or have dental restorations.
yellowish, shiny tooth enamel
with 6 broken upper teeth and 6 broken lower teeth
Dental caries is one of the problems that frequently affect the teeth. It is associated with plaque and tartar deposits. It is common to children since they like to eat sweets and hard to teach dental hygiene. (Fundamentals of Nursing 8th Edition, by Kozier, et al., published by Pearson Education Inc., ©2008, p. 601)
D. GumsColor, condition
Gums should be pink and smoothPink gums; firm texture; moist
Pale gums, dry when mouth breathing, the brain thinks carbon dioxide is being lost too quickly and sensing this, will stimulate the goblet cells to produce mucous, slow the breathing and cause constriction of
blood vessels.(http://www.breathing.com/articles/nose-breathing.htm)
•Physical AssessmentE. Tongue/ Floor of the MouthSurface of the tongueFor position ,color, texture and tongue movementNodules, lumps or enlarged lymph
The tongue relaxed on the floor of the mouthSmooth tongue base; prominent veins. Smooth moves freely; no tenderness.
Pink color of the tongue. Slightly rough. Semi moist, move freely, central position, smooth with no palpable nodules. Functions normally. No tenderness.
Dry/furry tongue may indicate or be
associated with fluid deficiency.
(Fundamentals of Nursing 8th Edition, by
Kozier, et al., published by Pearson Education Inc., ©2008, p. 603)
F. Palates & Uvula>Palate color, shape, texture and body prominence>Position of uvula and mobility
Light pink hard palate, more irregular texture The uvula is normally centered and freely movable.
Light pink, smooth (soft palate)Lighter pink, more irregular texture (hard palate)The uvula is at the center and freely movable.
Normal
G. Oropharynx & TonsilsColor, textureTonsils colorDischarge
Pink and smooth posterior wall Tonsils are small, pink and symmetric in size.
Tonsils are pink and symmetric in size, Grade 1 tonsils
Normal
H. Gag Reflex Present Present Normal
•Physical AssessmentNECK AND LYMPH NODESA. LYMPH NODESLocate/palpate/ identify lymph nodes and note for tenderness
Not palpable Lightly enlarged submandibular lymph node
Enlarged, palpable, possibly tender lymph
nodes are often associated with infection
and tumors(Fundamentals of Nursing 8th Edition, by Kozier, et
al., published by Pearson Education Inc., ©2008, p.
607)B. TRACHEAInspect and palpate for placement
Central placement in midline of neck are equal on both sides
Central placement in midline of neck are equal on both sides
Normal
C. THYROID GLANDInspect symmetry and visible masses
Not visible in inspection Not visible Normal
Palpate for smoothness and areas of enlargement, masses or nodules.
Lobes not palpable The client has no palpable masses or nodules.
Normal
•Physical Assessment
POSTERIOR THORAX
Inspect the spinal alignment
Spine vertically aligned Spine vertically aligned
Normal
Palpate for temperature, tenderness and masses
Skin intact; uniform temperature
Uniform temperature, skin intact, chest wall intake, (-) tenderness and masses
Normal
Auscultate the posterior thorax
Vesicular and bronchovesicular breath sounds
High-pitched breath sounds, Occasional crackles and wheezing
Adventitious breath sounds heard as a result of secretions,
narrowed air passages (Fundamentals of
Nursing 8th Edition, by Kozier, et al.,
published by Pearson Education Inc., ©2008,
p. 613)
•Physical AssessmentANTERIOR THORAXThe breathing pattern is effortless respiration and quite rhythmic.
Difficulty of breathing Typical symptoms associated with pneumonia include
cough, chest pain, fever, and difficulty in breathing.
Diagnostic tools include x-rays and examination of the
sputum.(http://en.wikipedia.org/wiki/
Pneumonia)
Skin intact; uniform temperatureNo respiratory complaintsNo tenderness and no masses
Uniform temperature, skin intact, chest wall intake, (-) tenderness and masses
Normal
Bronchovesicular-moderate –intensity and moderate- pitched blowing Vesicular-soft intensity, low pitched, gentle sishing
High-pitched breath sounds, Occasional crackles and wheezing
Adventitious breath sounds heard as a result of
secretions, narrowed air passages (Fundamentals of
Nursing 8th Edition, by Kozier, et al., published by Pearson
Education Inc., ©2008, p. 613)
•Physical AssessmentBREAST AND AXILLAEA. BreastSize, symmetry ,and shape
Rounded shape; slightly unequal in size; generally symmetricSkin uniform in color; skin smooth and intact
Flat, uniform in color, smooth and intact skin.
Normal
B. AreolaShape, color, masses or lesions
Round or oval and bilaterally the same; color varies widely from light pink to dark brown; irregular placement of sebaceous glands on the surface of the areolaNo tenderness, masses, nodules, or nipple discharge
Light pink, no tenderness, masses, nodules, or nipple discharge.
Normal
C. NipplesSize, shape, color, position, discharge , and lesions
Round, everted, and equal in size; similar in color; soft and smooth; both points in same directionNo tenderness, masses, nodules, or nipple discharge
Round, everted, equal in size, similar in color, both points in same direction
Normal
•Physical AssessmentABDOMEN
InspectionAbdomen skin
Unblemished skin; uniform color; silver-white striae (stretch marks) or surgical scars
The client has unblemished skin; no striae or stretch marks
Normal
Abdominal contour and symmetry
Flat, rounded (convex), or scaphoid (concave)
Convex in shape Normal
Vascular patterns No visible vascular pattern No visible vascular pattern
Normal
Bowel sounds, vascular sounds, and peritoneal friction rubs
Audible bowel sounds, absence of arterial bruits, absence of friction rub
Audible bowel sounds, (-) arterial bruits and friction rub
Normal
Percussion each of the four quadrants
Tympany over the stomach and gas-filled bowels; dullness, especially over the liver and spleen, or a full bladder
Tympany and gas filled bowels; dull abdomen
Normal
•Physical AssessmentMUSCULOSKELETALMuscles:>Size>Tendons for contractures>Fasciculation and tremors>Palpate muscle tonicity>Muscle Strength
Equal size on both sides of the body; no contractures; no fasciculation or tremors; normally firm; smooth coordinated movements; equal strength on each body side
Equal size on both sides of the body; no contractures or shortenings; no fasciculation or tremors; normally firm; equal leg strength,
Normal
Bones No deformities; no tenderness or swelling
No deformities; no edema or tenderness
Normal
Joints:>Joints for swelling>Palpation for tenderness
No swelling; no tenderness, swelling, crepitation, or nodules; joints move smoothly
No swelling; no tenderness and nodules
Normal
Range of motion Varies to some degree in accordance with person’s genetic makeup and degree of physical activity
The client’s right arm can not move well due to the IV site.
Limited range of motion in one or more joints.
(Fundamentals of Nursing 8th Edition, by
Kozier, et al., published by Pearson Education Inc., ©2008, p. 641)
Entire Laboratory and Diagnostic ResultsGENERIC NAMEGENERIC NAME DOSAGE/DOSAGE/
FREQUENCFREQUENC
YY
CLASSIFICACLASSIFICA
TIONTIONINDICATIONINDICATION CONTRAINDICATIONCONTRAINDICATION SIDE EFFECTSSIDE EFFECTS NURSING NURSING
RESPONSIBILITIESRESPONSIBILITIES
1. ACETYLCYSTEINE (Fluimucil)
300 MG(NEB) OD
Mucolytic Agent
Treatment of respiratory infection characterized by thick and viscous hyper secretions: Acute Bronchitis, Chronic Bronchitis and its exacerbation, Pulmonary emphysema and bronchiectasis
MAO inhibitor therapy within 14 days initiating therapy; severe HPN; severe CAD; hypersensitivity to Pseudoedephrine, acrivastine or any component; renal impairment
Bronchospasm, angioedema, pruritus, nausea and vomiting, syncope, sweating, fever, arthralgia, blurred vision, disturbances of liver function
1. Monitor effectiveness of therapy and advent of allergic/adverse effect.2. Instruct client in appropriate use and adverse effect to report.
2. IPRATROPIUM SALBUTAMOL (Duavent)
(Neb) TID Antiasthmatic and COPD preparation
prevent wheezing, difficulty breathing, chest tightness, and coughing in people with chronic obstructive pulmonary disease (COPD
Hypersensitivity to so lecithin and other related products like soybean and peanuts, and to any component of Duavent, atropine and its derivatives, Hypertophic obstructive cardiomyopathy or tachyarrhythmia
Headache, dizziness, cough, sinusitis, dry cough, dyspnea, bronchitis, dry mouth, rash, pain, hypersensitivity reaction
Teach the client about the medication; Assess for allergy before administration and at the peak of administration; Check or evaluate the client after giving the medication.
3. Paracetamol 325 mg Tab q4
Non-opiod analgesic
Acute pain treatment There are no absolute contraindications but in patient with gastric ulceration relative caution should be observed.
Occasional GI side effect may occur but these are almost invariably mild.
Monitor SBS of hepatomegaly esp. in individuals with poor nutrition; Don’t take other medications containing acetaminophen without medical advice; Patient and family education
• Upper Respiratory Tract• Nose Inspiration and expiration usually
occurs through the nose. The nose has main two functions: The cilia and hairs which line the nasal cavities trap dust and other foreign particles and the rich supply of blood surrounding the cavities warms the air before it enters the lungs. Pharynx Allows for separation of food and air. The epiglottis closes the trachea when we eat and opens when we breathe.
• Lower Respiratory Tract Larynx This structure sits on top of the trachea. Air rushing across two ligaments causes sounds that we shape into speech. Also called the voice box. Trachea Also called the windpipe
• Bronchi The trachea branches into two forks each called a bronchi Bronchioles The smaller and smaller passageways that come off the bronchi
• Alveoli These are the small air sacs where actual gas exchange takes place. The respiratory system's function is to allow gas exchange through all parts of the body. The space between the alveoli and the capillaries, the anatomy or structure of the exchange system, and the precise physiological uses of the exchanged gases vary depending on organism. Molecules of oxygen and carbon dioxide are passively exchanged, by diffusion, between the gaseous external environment and the blood. This exchange process occurs in the alveolar region of the lungs.
• Respiratory System is made up of different organs that work together in the process of respiration.
• All parts of the Respiratory system helps in the process of respiration
• Main Parts of the Respiratory System• Nose• Trachea• Bronchial Tubes• Lungs• • Other Parts:• Pharynx• Larynx• Alveoli
• The Nose• The nose has two openings called nostrils. The air enters
the nasal passages through the nostrils. The air that you breathe may not be fit to enter the lungs. It must be cleaned, warmed, and moistened before it reaches the lungs. The hairs in your nostrils filter the larger particles of dust and dirt as air enters the nostrils. The nasal passages are lined with tiny hairs called cilia and a moist tissue lining called mucous membrane.
• • The cilia filter the smaller particles of dust and dirt. • The moist mucous membrane also catches particles of
dirt. It also warms and moistens the incoming air. • The tiny blood vessel inside the nose also warm and
moisten the passing air.
• The Pharynx • The clean, warm, and moist air travels from
the nasal passages to the pharynx. The pharynx is found at the back of the throat.
• The pharynx separates into two tubes:• Esophagus – leading to the stomach.• Trachea – leading to the lungs. • At the bottom of the pharynx is a flap of
cartilage called the epiglottis. • The epiglottis opens and closes the trachea. It
prevents the food from going to the trachea by closing it during swallowing. Most of the time, the epiglottis is open to allow the flow of air in the breathing process.
• The Larynx • From the pharynx, the clean air moves
down to the larynx. The Larynx is found at the lower end of the pharynx. It is the enlarged upper portion of the trachea. It is also called the voice box. The larynx contains the vocal cords that vibrate when air passes through them. The vibration of the vocal cords, together with the movements of the mouth and tongue, produces the sound of your voice.
• The Trachea or Windpipe• The trachea, or windpipe, is a tube about 13
centimeters long. It is the tube leading to the lungs. It is a tough, flexible passageway that air can move through all the time. The trachea lies just in front of the esophagus at the lower part of the larynx.
• Like the nasal passages, the inner wall of the trachea is lined with cilia. The cilia catch the dust particles that reach the windpipe. The dust particles are then pushed out and up toward the throat and mouth for expulsion. This explains why one coughs or sneezes when dirt gets into the upper respiratory tract. The lower end of the trachea branches into two large tubes called the bronchi.
• The Lungs • The Lungs are the main organs for breathing. The left
bronchus leads to the left lung while the right bronchus leads to the right lung.
• Inside the lungs, each bronchus divides into smaller tubes called bronchial rami. The bronchial rami branches off further into smaller tubes called bronchial tubes or bronchioles. At the ends of these bronchioles are the tiny air sacs called alveoli.
• The bronchioles and alveoli look like the branches of a tree. The biggest branches are the bronchi. Bronchi are covered by cilia and a thin film of mucus. Dust and pollen are trapped by the mucus before they reach the alveoli.
• Each of the lungs contains about 300 million alveoli. Each alveolus is surrounded by tiny blood vessels called capillaries. The exchange of oxygen and carbon dioxide during the breathing process takes place in the capillaries of each alveolus.
•
• The Respiratory Process• Breathing is the process by which air is taken into the lungs and
carbon dioxide is pushed out of the lungs.• Breathing involves two parts. Breathing in is called inhaling, and
breathing out is called exhaling or expiration. When you inhale, you fill your lungs with air. When you exhale, you push air with more carbon dioxide out of the lungs.
• The lungs, being important and delicate organs, are protected by a set of bones called the rib cage. The rib cage forms the chest cavity where the lungs are found. At the lower portion of the chest cavity is a sheet of muscles called diaphragm. The diaphragm separates the chest from the abdomen. Both the rib cage and the diaphragm are important in the breathing process.
• When you inhale, the ribs move upward and outward while the diaphragm moves downward. The volume of the chest cavity becomes larger. The pressure inside it is lower that the air pressure outside the body. Air is drawn into the lungs by the atmospheric pressure outside the body.
• When you exhale, the opposite happens. The ribs move downward and inward while the diaphragm moves upward. These actions make the chest cavity smaller. The pressure in the chest cavity becomes greater than the air outside the body. This cause the air to rush out of the lungs and out of the body.
Precipitating factors:Inhalation of Streptococcal Pneumoniae
Predisposing Factor:Exposure to a carrier
High risk community
History of respiratory illness(Asthma)
NURSING CARE PLAN
DISCHARGE PLAN
EDICATIONS• Advise client to take medicine as prescribed by
the Physician. The following are the medications prescribed: Acetylcysteine to liquefy secretions, Ipratroprium salbutamol for bronchodilation and Paracetamol Jr. to lower body temperature. Medicines used to treat pneumonia may include antibiotics to make the infection be cured
M
XERCISE• Take adequate rest. If tolerated, do light
exercises such as walking. And also do deep breathing and coughing.
E
REATMENT• Medications should be taken exactly as
prescribed by a physician. If it is not helping, call the doctor. Do not quit taking it unless told to do so by a doctor. Nebulization as ordered by the doctor. Increase fluid intake to 2,500 to 3000ml per day to help liquefy secretions incentive
T
EALTH TEACHING• Comply with the treatment regimen: place the
client in a comfortable position. And ask the mother to take care and give time to the child to take good care for herself. Encourage deep breathing and cough exercises.
H
UTPATIENT DEPARTMENT
• Comply to the scheduled follow up check up
O
IET• Eat healthy and nutritious food. Eat fruits rich in
vitamin C or take vitamin c to increase the resistance of the client against infection. Increase fluid intake if not contraindicated to the patient.
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