pneumonia case presentation (1)
TRANSCRIPT
NursingProcessDiabetesNeuroAssessmentPhysicalAssessmentParesthesiaHeadacheIsACommonlyOccurringCondition that can be caused by intraCranial or extracranial problems, serious NursingProcessDiabetesNeuroAssessmentPhysicalAssessmentParesthesiaHeadacheIsACommonlyOccurringCondition that can be caused by intraCranial or extracranial problems, serious NursingProcessDiabetesNeuroAssessmentPhysicalAssessmentParesthesiaHeadacheIsACommonlyOccurringCondition that can be caused by intraCranial or extracranial problems, serious NursingProcessDiabetesNeuroAssessmentPhysicalAssessmentParesthesiaHea
PNEUMONIA
Maricar R. TrinidadCeline S. Udani
BSN 135 Group 139
Introduction
Pneumonia (pneumonitis) is an inflammatory process in the lung parenchyma usually with
marked increase in interstitial and alveolar fluid. Among all nosocomial infections, pneumonia is the
second most common, but has the highest mortality (Black & Hawks, 2009). Community-acquired
pneumonia (CAP) is a disease in which individuals who have not recently been hospitalized develop an
infection of the lungs (pneumonia). CAP is a common illness and can affect people of all ages (Wikipedia,
2010). In a study undertaken at the UP-PGH to determine common etiologic agents causing community-
acquired pneumonia in adults forty-eight patients (48) were recruited based on set clinical criteria.
Streptococcus pneumoniae and H. influenzae were the most common pathogens isolated. There was no
difference in the pathogens isolated from elderly and younger patients. The most common predisposing
factors for gram negative bacillary pneumonia were COPD, smoking, and the use of steroids. There was
little difference in the clinical manifestations between the elderly and younger individuals except for the
decreased frequency of fever in the elderly. Anti-biotic usage greatly decreased the yield of specimens.
Both Streptococcus pneumoniae and H. influenzae, the two most predominant organisms, were
sensitive to cotrimoxazole - an inexpensive first line antibiotic. [Phil J Microbiol Infect Dis 1995; 24(2):29-
32.
This nursing process case presentation presents pneumonia of a 9-month old baby girl. We have
chosen this case to know more on how pneumonia affects a pediatric client, if there are differences in
adult and in pedia. And furthermore this is our first time to present a case of pneumonia beacause in
other clinical duties we choose more complicated case, and this time why not choose pneumonia a
disease that we are taking for granted for it was always common to patients we handle in different
areas. By this presentation gaining knowledge about this disease we can be more confident to handle
more pneumonia patients in our future nursing practice
I. Biographic DataName: Address: Age: Gender: Religion:Room and bed:Chief complaint: Attending Physician:Physician’s Diagnosis:
II. Nursing HistoryA. Past Health History
1. Childhood Illness
2. Immunizations
3. Allergies
4. Accidents.
5. Hospitalization
6. Medications used or currently takenMedications currently taken are ranitidine, hydrocortisone, cefuroxime
and salbutamol
7. Foreign travel (when, length of stay)No foreign travel yet.
B. History of Present Illness
C. Family History
III. Patterns of FunctioningA. Psychological Health
1. Coping Patterns2. Interaction Patterns3. Cognitive Patterns4. Self-Concept5. Emotional Patterns6. Family Coping Patterns
Analysis:The World Health Organization defines psychological health as "a being of well-being in which
the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. An example of a wellness model includes one developed by Myers, Sweeney and Witmer. It includes five life tasks—essence or spirituality, work and leisure, friendship, love and self-direction—and twelve sub tasks—sense of worth, sense of control, realistic beliefs, emotional awareness and coping, problem solving and creativity, sense of humor, nutrition, exercise, self care, stress management, gender identity, and cultural identity—which are identified as characteristics of healthy functioning and a major component of wellness. (wikipedia.com)
Interpretation:Family is the source of strength of the patient in times of crisis. They support him emotionally
and financially. All kinds of consideration are given to him by his children, especially his wife, as they took care of him.
B. Socio-Cultural Patterns1. Cultural Patterns2. Significant Relationships3. Recreation Patterns4. Environment5. Economic
Analysis:Respect and interest in cultural background will provide a strong basis for communication.
Being a part of a regional group of culture is called a subculture. Though they are smaller group, they possess many of the values, beliefs and customs of the larger culture but have unique characteristics. According to studies, Filipinos hereditary diseases include diabetes mellitus, Thalassemia, and G6PD deficiency.
Families in later life is in a transition of accepting the shifting of generational roles. The family needs to maintain own and couple functioning and interests in face of physiological decline; exploration of new and familial and social role options. They also need to support for a more central role of middle generation. They should also make a room for the wisdom and experience for elderly people, supporting the older generation without over functioning for them. (Ref: Health Assessment and Physical Examination 2nd edition 2002 by Mary Ellen Zator Estes)
Interpretation: Client has regional customs and beliefs. His current health status has affected his daily activities.
C. Spiritual Patterns1. Religious Beliefs and Practices
Analysis:Spiritual health is the connectedness with self, others, higher power, all life, nature and the
universe that transcends and empowers the self. Spiritual and religious beliefs can significantly affect health behavior.
Interpretation:The patient has religious beliefs and cultural values. These beliefs are influenced by the social
environment and also health behavior.
IV. Activities of Daily Living
V. Physical Assessment
Actual Findings Norms Analysis
General Appearance1. Skin color
2. Personal Hygiene/ Grooming
3. Nutritional Status
4. Non-verbal Behavior
Pale
Clean, neatNo apparent breath odor
Poor nutritional status with body weakness.
cries when in pain. Appropriate to situation.
Brown, light brown
Clean, neatNo apparent breath odor
Healthy appearance
Appropriate to situation/ appropriate response
normal
normal
Abnormal
Normal
Analysis:A patient who appears ill usually is ill, and needs to be carefully assessed via the history and physical examinations.(Ref: Health Assessment and Physical Examination 2nd edition 2002 by Mary Ellen Zator Estes)
Measurement1. Temperature2. Pulse Rate3. Respiratory Rate4. Blood Pressure
35.4 – 37.4 C60 – 100 cpm12 -20 breaths/ minS: 100-160 mmHg /
Analysis:Hypoxia and metabolic acidosis are common causes of tachypnea
5. Weight6. Height
D: 60- 90 mmHgAverage: 130/80
(RR>20 breaths). The increased respiratory rate is a compensatory mechanism to provide the body with more oxygen and eliminate excess hydrogen when the body’s metabolism is increased.(Ref: Health Assessment and Physical Examination 2nd edition 2002 by Mary Ellen Zator Estes)
Body Part(Technique used)
Actual Findings Norms Analysis
SKINInspectionSkin colorUniformity of skin colorTexture
PalpationSkin moistureSkin temperatureSkin turgor
Light brown, darker on areas exposed to light. With warts scattered on the face, chest and some on the abdomen.
Dry.Bilaterally equal warm temperature and nontender.
Skin is uniform whitish pink or brown color, depending on the patient’s race. Exposure to sunlight can results in increased pigmentation of sun-exposed areas.
Skin is dry with minimum perspiration. Moisture varies from one body area to another.
Skin temperature is warm and equal bilaterally. Nontender.
Normal
Normal.
Normal
NAILSInspectionFingernail plate shapeFingernail and toenail texture
smoothPink.Blanch test return to
Convex curvature; angle of nail plate about 160 degrees
Normal
Body Part(Technique used)
Actual Findings Norms Analysis
Fingernail and toe nail bed colorTissue surrounding nailsPalpationBlanch test of the capillary
normal in 1 second.Convex curvature; angle of nail plate about 160 degreesSmooth textureIntact epidermis
Smooth textureHighly vascular and pink on light-skinned clients; dark-skinned clients may have brown or black pigmentation in longitudinal streaksIntact epidermisPrompt return of pink or usual color (generally less than 4 seconds)
SKULL AND FACEInspectionSkull size, shape, and symmetryFacial featuresFacial movement
PalpationSkull nodules or masses and depressions
Patient is normocephalic, proportion to the body.
Symmetrical and bilaterally equal in parts
No nodules, masses and depressions.
Rounded (normocephalic and symmetrical, with frontal, parietal, amd occipital prominences); smooth skull contourSmooth, uniform consistency; absence of nodules or massesSlightly asymmetric facial features; palpebral fissures equal in size; symmetric nasolabial foldsSymmetric facial movements.
Normal skull and face features.
EYES AND STRUCTURESInspectionCorneaIrisPERRLABulbar conjunctivaPalpebral conjunctivaPalpationBulbar conjunctivaPalpebral conjunctiva
Has whitish halo on the sides of the cornea.Pupils constrict bilaterally direct and indirect response, 3cm size in normal light, reactive to light and accommodation.Iris is brown color.
He has pinkish,
Pink, transparent conjunctiva. Pupils reactive to light and accommodation.
Normal
Body Part(Technique used)
Actual Findings Norms Analysis
palpable conjunctiva.
EARS AND HEARINGInspectionNormal voice tones Patient can hear
normal tone of voice.Can repeat whispered words within 2 feet distance.
Normal
NOSE AND SINUSESInspectionExternal nose shape, size, or color and flaring or discharge from the nares.
Patency of both nasal cavities.Presence of redness, swelling, growths, and discharge.MassesNasal septum
Symmetrical in shape, same color as the face, no discharge or nasal flaring.
Both nares are patent
No swelling and redness present.
Nasal septum at the middle.
Symmetrical in shape, same color as the face, no discharge or nasal flaring.
Both nares are patent
No swelling and redness present.
Nasal septum at the middle.
Normal
Normal
Normal
Normal
THORAX
Inspection Even color; regular, even contour; respirations audible as wheeze, labored, of different depth: deeper expiration than inspiration, verbalized difficulty breathing, chest tightness and non-productive cough and without retractions, bulges and masses, uses accessory muscles; anteroposterior-transverse diameter ratio 1:2Breathing is good when head of the bed is
Even color; regular, even contour; respirations quiet, unlabored, of even depth, and without retractions, bulges, masses, or use of accessory muscles; anteroposterior-transverse diameter ratio 1:2
AbnormalAnalysis:Labored breathing and use of accessory muscles are indicative of increased demand for air due to narrowed airway as in asthma.(Ref: Health Assessment and Physical Examination 2nd edition 2002 by Mary Ellen Zator Estes)
Body Part(Technique used)
Actual Findings Norms Analysis
Palpation
Percussion
Auscultation
elevated 30-45 degrees or when sitting.Chest wall symmetrical, smooth, without lumps, masses, tenderness, or crepitus; thoracic excursion symmetrical; tactile fremitus present.Resonant throughout peripheral lung fields; cardiac dullness; diaphragmatic excurionranges from 3 – 6 cm for each hemidiaphragm, with right side slightly higher than the left.
Vesicular sounds throughout peripheral lung fields; adventitious sounds present: wheeze –high pitched (sibilant ronchi); vocal resonance absent.
Chest wall symmetrical, smooth, without lumps, masses, tenderness, or crepitus; thoracic excursion symmetrical; tactile fremitus present.
Resonant throughout peripheral lung fields; cardiac dullness; diaphragmatic excurionranges from 3 – 6 cm for each hemidiaphragm, with right side slightly higher than the left.
Vesicular sounds throughout peripheral lung fields; bronchovesicular sounds over the area of bifurcation, both anteriorly and posteriorly; bronchial sounds over the trachea anteriorly; adventitious sounds absent; vocal resonance absent.
Normal
Normal
AbnormalAnalysis:Wheeze –high pitched (sibilant ronchi) is indicative of air squeezed or compressed through passageways narrowed almost to closure by collapsing, swelling, secretions, or tumors; passageway walls oscilate in apposition between closed and barely open positions; resulting sound is similar to a vibrating reed.
(Ref:
Black, J. M., & Hawks, J. H. (2008). Medical-Surgical Nursing (8th ed.). Philippines: Saunders Elsevier.)
Body Part(Technique used)
Actual Findings Norms Analysis
ABDOMENSkin integrityContour and symmetryLight palpation for areas of tenderness
Symmetrical but prominent. With tenderness, no masses, or nodules found.
No pain is felt upon light palpation on the 4 quadrants of the abdomen.
No abdominal scars present.
Normal
Analysis:
(Ref: Health Assessment and Physical Examination 2nd edition 2002 by Mary Ellen Zator Estes)
PERINEALInspection Fluid retention on both
testicles and the penis.No fluid present Abnormal
Analysis:Hydrocele: A hydrocele is a collection of fluid in the membrane that covers the testis or testes. A hydrocele may be present at birth or develop later in life. It is most common after age 40. Usually the cause is unknown. However, the condition occasionally results from a testicular disorder (for example, injury, epididymitis, or cancer).
(Ref: Lui, P. D. (2008, October). Swelling in the Scrotum. Retrieved October 8, 2010, from The Merck Manuals Online Medical Library: http://merck.com/mmhe/sec21/ch238/ch238m.html)
Body Part(Technique used)
Actual Findings Norms Analysis
VI. Laboratory and Diagnostic Examinations Results
Date Procedure Result Norms Interpretation Analysis27 September 2010 HEMATOLOGY
Hemoglobin
HematocritWBC countPlatelet Count
Segmenters
143 g/L
0.4214.9 x 109 /L266 x 109 /L
0.87
120 – 140 g/L
0.37 – 0.475.5 – 11.0 x 109 /L150 – 250 x 109 /L
0.50 – 0.70
Increased
NormalIncreasedIncreased
Increased
Increased hemoglobin may be caused by exposure to high altitudes, smoking, dehydration, or tumor.(Ref: Wikipedia. (2008, December 1). Hemoglobin. Retrieved October 8, 2010, from Wikipedia website: http://en.wikipedia.org/wiki/Hemoglobin)
Indicates infectionFunctions with WBC to fight inflammation and promote healing process.
Neutrophils also known as segmenters are recruited to the site of injury within minutes following trauma and are the hallmark of acute inflammation.
Date Procedure Result Norms Interpretation AnalysisLymphocytesMonocytes
0.080.05
0.20 – 0.400.01 – 0.06
DecreasedNormal
Decreased immune response.(Ref: Corwin, E. J. (2008). Handbook of Pathophysiology. Manila, Philippines: Lippincott Williams & Wilkins.
27 September 2010 URINALYSISPhysical characteristics:ColorTransparencyReactionpHSpecific gravity
Chemical tests:AlbuminSugarKetonesBlood in urineUrobilinogen
Cells:RBCPusEpithelialMucus ThreadsBacteria
YELLOWSLIGHTLY TURBIDACIDIC5.001.005
+++NEGATIVENEGATIVENEGATIVENEGATIVE
8-10 / hpfMANY /hpfMODERATEMODERATEMODERATE
AMBERCLEARACIDIC/BASIC4.6 – 8.01.003 to 1.030
0NEGATIVENEGATIVENEGATIVENEGATIVE
00NEGATIVENEGATIVENEGATIVE
NormalAbnormalNormalNormalNormal
AbnormalNormalNormalNormalNormal
AbnormalAbnormalAbnormalAbnormalAbnormal
Turbidity may indicate bacterial infection.
Proteinuria- may indicate glomerulonephritis or other decline in kidney function.
May be renal diseaseIndicates bacterial infection.
(ref: Black, J. M., & Hawks, J. H. (2009). Medical- Surgical
Date Procedure Result Norms Interpretation AnalysisNursing.
28 September 2010 BLOOD CHEMISTRYPotassiumSodiumChloride
4.92 mmol/L123.8 mmol/L100.1 mmol/L
3.5 – 5.30 mmol/L135 – 148 mmol/L100 – 112 mmol/L
NormalHyponatremiaNormal
Edematous disorders resulting in sodium deficits: CHF, liver cirrhosis, nephrotic syndrome, acute and chronic renal failure, psychogenic polydipsia. (ref: Black, J. M., & Hawks, J. H. (2009). Medical- Surgical Nursing.)
30 September 2010 Total Calcium 1.96 mmol/L 2.2 – 2.55 mmol/L Decreased Fluid and electrolyte imbalances especially sodium also affects calcium concentration.
30 September 2010 IMMUNOLOGYPSA
100 NG/ML 0.00 – 4.00 NG/ML Increased Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. PSA is present in small quantities in the serum of men with healthy prostates, but is often elevated in the presence of prostate cancer(ref: Black, J. M., &
Date Procedure Result Norms Interpretation AnalysisHawks, J. H. (2009). Medical- Surgical Nursing.)
2 October 2010 ABGpHPaCO2
PaO2
HCO3
TCO2
BEO2 SatFiO2
7.215103.9 mmHg79.9 mmHg42.0 meq/L45.2 ml/dL8.0 meq/L92.8 %36.0 %
7.35 – 7.4535 – 45 mmHg80 – 100 mmHg22 – 26 meq/L15 – 20 ml/dL+ 2 to – 2 meq/L95 – 100 %
AcidosisIncreasedDecreasedIncreasedIncreased
Abnormal
Respiratory acidosis uncompensated is an indication that there is a problem in the released of CO2
causing it to be contained in the blood. Metabolic acidosis also follows due to increase in HCO3. This causes the O2 Saturation to decrease.(ref: Black, J. M., & Hawks, J. H. (2009). Medical- Surgical Nursing.)
VII. Medications, IV Infusions, Blood Transfusion, Treatment GivenGENERIC/ BRAND NAME
CLASSIFICATION INDICATION CONTRAINDICATION ADVERSE EFFECTS NSG. RESPONSIBILITIES
Salbutamol
Q1 2.5-5 mg
Anti-asthmatic and COPD prep.
Treatment of acute severe asthma and in routine management of chronic bronchospasm
Hypersensitivity to its content.
Small increase in heart rate, peripheral vasodilation, fine tremor of skeletal muscle.
Special precaution on patient with hyperthyroidism, CV diseases
unresponsive to conventional therapy.
Budesomide
Q6
Anti-asthmatic and COPD prep.
Prophylaxis and management of asthma
Primary treatment of status asthmaticus or other acute asthma where in sensitive measures are required
Neck pain, cough, resp. infection
WOF withdrawal symptoms during transfer from systemic corticosteroid therapy to budesomide
Hydrocortisone Hormones Acute adrenocortical insufficiency
Latent, healed and active TB
Fluid electrolyte imbalance, dermatologic
Special precaution on patient with CHF, HPN, DM
Chloramphenicol
Anti-infective Diseases which does not respond to other standard anti-microbial agent
History of hypersensitivity or toxic reaction
GI symptoms Take on an empty stomach ½ hour before meals
Ampicillin
350mg IV q6
Anti-infective Respiratory infections Hypersensitivity to penicillin
GI disturbances Special precaution on patient with prolonged treatment requires renal, hepatic function assessment.
VII. Anatomy and Physiology
ANATOMY AND PHYSIOLOGY OF THE LUNGS
The lung is the essential respiration organ in air-breathing vertebrates, the most primitive being the lungfish. Its principal function is to transport oxygen from the atmosphere into the bloodstream, and to release carbon dioxide from the bloodstream into the atmosphere. This exchange of gases is accomplished in the mosaic of specialized cells that form millions of tiny, exceptionally thin-walled air sacs called alveoli. The lungs also have non respiratory functions.
RESPIRATORY FUNCTIONS
Energy production from aerobic respiration requires oxygen and glucose and produces
carbon dioxide as a waste product, creating a need for an efficient means of oxygen delivery to
cells and excretion of carbon dioxide from cells. In small organisms, such as single-celled
bacteria, this process of gas exchange can take place entirely by simple diffusion. In larger
organisms, this is not possible; only a small proportion of cells are close enough to the surface
for oxygen from the atmosphere to enter them through diffusion. Two major adaptations made it
possible for organisms to attain great multicellularity: an efficient circulatory system that
conveyed gases to and from the deepest tissues in the body, and a large, internalized respiratory
system that centralized the task of obtaining oxygen from the atmosphere and bringing it into the
body, whence it could rapidly be distributed to all the circulatory system.
In air-breathing vertebrates, respiration occurs in a series of steps. Air is brought into the
animal via the airways — in reptiles, birds and mammals this often consists of the nose; the
pharynx; the larynx; the trachea (also called the windpipe); the bronchi and bronchioles; and the
terminal branches of the respiratory tree. The lungs of mammals are a rich lattice of alveoli,
which provide an enormous surface area for gas exchange. A network of fine capillaries allows
transport of blood over the surface of alveoli. Oxygen from the air inside the alveoli diffuses into
the bloodstream, and carbon dioxide diffuses from the blood to the alveoli, both across thin
alveolar membranes.
The drawing and expulsion of air is driven by muscular action; in early tetrapods, air was
driven into the lungs by the pharyngeal muscles, whereas in reptiles, birds and mammals a more
complicated musculoskeletal system is used. In the mammal, a large muscle, the diaphragm (in
addition to the internal intercostal muscles), drive ventilation by periodically altering the intra-
thoracic volume and pressure; by increasing volume and thus decreasing pressure, air flows into
the airways down a pressure gradient, and by reducing volume and increasing pressure, the
reverse occurs. During normal breathing, expiration is passive and no muscles are contracted (the
diaphragm relaxes).
Another name for this inspiration and expulsion of air is ventilation. Vital capacity is the
maximum volume of air that a person can exhale after maximum inhalation. A person's vital
capacity can be measured by a spirometer (spirometry). In combination with other physiological
measurements, the vital capacity can help make a diagnosis of underlying lung disease.
ANATOMY
In human, the trachea divides into the two main bronchi that enters the roots of the lungs.
The bronchi continue to divide within the lung, and after multiple divisions, give rise to
bronchioles. The bronchial tree continues branching until it reaches the level of terminal
bronchioles, which lead to alveolar sacks. Alveolar sacs are made up of clusters of alveoli, like
individual grapes within a bunch. The individual alveoli are tightly wrapped in blood vessels,
and it is here that gas exchange actually occurs. Deoxygenated blood from the heart is pumped
through the pulmonary artery to the lungs, where oxygen diffuses into blood and is exchanged
for carbon dioxide in the hemoglobin of the erythrocytes. The oxygen-rich blood returns to the
heart via the pulmonary veins to be pumped back into systemic circulation.
1:Trachea 2:Pulmonary artery 3:Pulmonary vein 4:Alveolar duct 5:Alveoli 6:Cardiac notch
7:Bronchioles 8:Tertiary bronchi 9:Secondary bronchi 10:Primary bronchi 11:Larynx
Human lungs are located in two cavities on either side of the heart. Though similar in
appearance, the two are not identical. Both are separated into lobes, with three lobes on the right
and two on the left. The lobes are further divided into lobules, hexagonal divisions of the lungs
that are the smallest subdivision visible to the naked eye. The connective tissue that divides
lobules is often blackened in smokers and city dwellers. The medial border of the right lung is
nearly vertical, while the left lung contains a cardiac notch. The cardiac notch is a concave
impression molded to accommodate the shape of the heart. Lungs are to a certain extent
'overbuilt' and have a tremendous reserve volume as compared to the oxygen exchange
requirements when at rest. This is the reason that individuals can smoke for years without having
a noticeable decrease in lung function while still or moving slowly; in situations like these only a
small portion of the lungs are actually perfused with blood for gas exchange. As oxygen
requirements increase due to exercise, a greater volume of the lungs is perfused, allowing the
body to match its CO2/O2 exchange requirements.
The environment of the lung is very moist, which makes it hospitable for bacteria. Many
respiratory illnesses are the result of bacterial or viral infection of the lungs.
Risk factors: Cigarette smoking, Advanced age (74 yrs old), Hx of asthma, Chronic disease states such as Prostate Carcinoma stage II
Streptococcus pneumoniae, most common bacterial agent
Resides in the nasopharynx
Attachment to the respiratory epithelium
Inhaled into the alveolus
Infect type II alveolar cells
Pneumococci spread through the pores of Kohn
Producing inflammation and consolidation
Alveolar sacks cannot exchange oxygen and carbon dioxide
Decreased Oxygen saturation in the blood↑PaCO2, pH, PaO2,↑HCO3
Infection
Fever
↑WBC, ↑Segmenters
Impaired surfactant production and lung injury and repair
Impaired type 1 alveolar cells
Impaired gas exchange
Dyspnea/ Orthopnea
Asthma(Bronchocon
striction)aggravates
Change on the level of consciousness
Tachypnea
VIII. Pathophysiology
HOSTAge -9 monthsSex –femaleNationality – FilipinoExposed to second hand smokeHistory of asthma
AGENTStreptococcus pneumonia
ENVIRONMENT
IX. Ecologic Model
A. HypothesisThe patient acquired his pneumonia via the community where he is mostly exposed. Contributing factors such as the surroundings or the environment the child lives in, her age.
B. Predisposing Factors
1. Agent- Streptococcus
pneumonia
2. Host- Age – 9 months- Sex – female- Nationality – Filipino- Exposed to second
hand smoke.- History of asthma
3. Environment
Economic- The family of the
patient doesn’t have enough financial income. Their budget is only enough for their daily living.
C. Ecologic Model
D. Analysis The patient became susceptible to pneumonia due to the following direct risk factors:She’s a 9-month old baby, history of asthma, and exposed to second hand smoke.
CAP is defined as pneumonia acquired outside of hospitals or long-term care facilities, and HAP is pneumonia that develops 48 or more hours after patient admission to an inpatient facility (e.g., hospital, long-term care facility, skilled nursing facility) or 48–72 hours after patient intubation. Older adults are particularly susceptible to pneumonia due to waning immunity and age-associated anatomical and physiological changes that make the lungs more vulnerable to infection. Streptococcus pneumoniae is the most common bacterial cause of pneumonia in older adults; other common causes include Haemophilus influenzae, Staphylococcus aureus, Chlamydia pneumoniae, Legionella pneumophila, and Klebsiella pneumoniae. Common viral pathogens that cause pneumonia in older adults include influenza, parainfluenza, respiratory syncytial virus (RSV), and possibly adenoviruses. Older adults with dysphagia often related to stroke, dementia, and poor oral hygiene are also at risk for aspiration pneumonia, in which the patient breathes in food, liquids, gastric contents, or exogenous chemicals, weakening lung defenses and causing inflammatory changes that allow for bacterial overgrowth.
Secondhand Smoke especially hurts Children! (http://www.smokehelp.org/html/second_hand_smoke.html)
Children who breathe Secondhand Smoke are more likely to suffer from pneumonia, bronchitis, and other lung diseases.
Children who breathe Secondhand Smoke have more inner infections Children who breathe Secondhand Smoke are more likely to develop asthma Children who have asthma and who breathe Secondhand Smoke have more
asthma attacks There are an estimated 150,000 to 300,000 case every year of infections, such as
bronchitis and pneumonia in infants and children under 18 months of age who breathe Secondhand Smoke. These result in 7,500 to 15,000 hospitalizations.
Research have also linked asthma and pneumonia. Mycoplasma pneumoniae (M pneumoniae), primarily recognised as a causative agent of community-acquired pneumonia has recently been linked to asthma. An infection with M pneumoniae may precede the onset of asthma or exacerbate asthma symptoms. Chronic infection with M pneumoniae has been suspected to play a part in some patients with asthma. The role of immunoglobulin E-related hypersensitivity and induction of T helper type 2 immune response leading to inflammatory response in M pneumoniae-infected patients with asthma have also been proposed. Use of macrolides in reducing asthma symptoms only in M pneumoniae-infected patients supports the use of macrolides in patients with asthma having M pneumoniae infection. As macrolides are both antimicrobial and anti-inflammatory drugs, the therapeutic role of their biphasic nature in reducing asthma symptoms needs further attention in clinical research (Nisar, N., Guleria, R., Kumar, S., Chand Chawla, T., & Ranjan Biswas, N.,2007).
E. Conclusion and RecommendationsChildren are also susceptible to pneumonia especially they are exposed to second-hand smoke. Asthma not also makes the person susceptible but it also aggravates the condition. Being a Filipino also contributes to his susceptibility because of cultural aspects and way of life.
Nursing interventions should not only concentrate on the airway, breathing and circulation of the patient but also on the possibility of spreading the disease and preventing it from happening.
References:Black, J. M., & Hawks, J. H. (2009). Medical- Surgical Nursing. Manila, Philippines:
Saunders Elsevier.
Buckley, L., & Schub, T. (2010). Pneumonia in Older Adults. Retrieved from CINAHL Plus with Full Text database.
Jacobson, K., Miceli, M., Tarrand, J., & Kontoyiannis, D. (2008). Legionella pneumonia in cancer patients. Medicine, 87(3), 152-159. Retrieved from CINAHL Plus with Full Text database.
Nisar, N., Guleria, R., Kumar, S., Chand Chawla, T., & Ranjan Biswas, N. (2007). Mycoplasma pneumoniae and its role in asthma. Postgraduate Medical Journal, 83(976), 100-104. Retrieved from CINAHL Plus with Full Text database.
Yoo, S., Cha, S., Shin, K., Lee, S., Kim, C., Park, J., et al. (2010). Bacterial pneumonia following cytotoxic chemotherapy for lung cancer: clinical features, treatment outcome and prognostic factors. Scandinavian Journal of Infectious Diseases, 42(10), 734-740. Retrieved from CINAHL Plus with Full Text database
X. Prioritized List of Nursing Problems
XI. Nursing Care Plan