Our Lady of Fatima University
M a r u l a s , V a l e n z u e l a C i t y
NCM 101- Group 41 D Ponce, Exequiel M. Ruales, Jemmalyn B. Santiago, Sarah R. Santos, Ran Robert F. Valera, Rona M.
August 30, 2008
I. Introduction II. Objectives -General Objectives -Specific Objectives III.Nursing History IV. Physical Assessment V. Anatomy and Physiology VI. Pathophysiology VII.Nursing Care Plan VIII.Drug Study IX. Health Teachings X. Evaluation
Pneumonia is an inflammatory illness of the lung. Frequently, it is described as lung parenchyma/alveolar inflammation and abnormal alveolar filling with fluid. The alveoli are microscopic air-filled sacs in the lungs responsible for absorbing oxygen from the atmosphere. Pneumonia can result from a variety of causes, including infection with bacteria, viruses, fungi or parasites, and chemical or physical injury to the lungs. Its cause may also be officially described as idiopathic- that is unknown when infectious cause has been excluded. Typical symptoms associated with pneumonia included cough, fever, chest pain, fever, and difficulty in breathing. Diagnostic tools include x-rays and examination of the sputum treatment depends on the cause of pneumonia, bacterial pneumonia is treated with antibiotics. Pneumonia is a common illness which occurs in all age groups, and is a leading cause of death among elderly and people who are chronically and terminally ill. Vaccines to prevent certain types of pneumonia are available. The prognosis depends on the type of pneumonia, the appropriate treatment any complications and the person’s underlying health. People with infectious pneumonia often have a cough producing greenish or yellow sputum, or phlegm and a high fever that may be accompanied by shaking chills. Shortness of breath is also common, as is pleuritic chest pain, a sharp or stabbing pain, either experienced during deep breaths or coughs or worsened by it. People with pneumonia may cough up blood, experience headaches, or develop sweaty and clammy skin. Other possible symptoms are loss of appetite, fatigue, blueness of the skin, nausea, vomiting, mood swings, and joint pains or muscle aches. Less common forms of pneumonia can cause other symptoms; for instance, pneumonia caused by Legionella may cause abdominal pain and diarrhea, while pneumonia caused by tuberculosis or Pneumocystis may cause only weight loss and night sweats. In
elderly people manifestations of pneumonia may not be typical. They may develop a new or worsening confusion or may experience unsteadiness, leading to falls. Infants with pneumonia may have many of the symptoms above, but in many cases they are simply sleepy or have a decreased appetite. Symptoms of pneumonia need immediate medical evaluation. Physical examination by a health care provider may reveal fever or sometimes low body temperature, an increased respiratory rate, low blood pressure, a high heart rate, or a low oxygen saturation, which is the amount of oxygen in the blood as indicated by either pulse oximetry or blood gas analysis. People who are struggling to breathe, who are confused, or who have cyanosis (blue-tinged skin) require immediate attention. Physical of the lungs may be normal, but often shows decreased expansion of the chest on the affected side, bronchial breathing on auscultation with a stethoscope (harsher sounds from the larger airways transmitted through the inflamed and consolidated lung), and rales heard over the affected area. Percussion may be dulled over the affected lung, but increased rather than decreased vocal resonance (which distinguishes it from a pleural effusion). While these signs are relevant, they are insufficient to diagnose or rule out pneumonia; moreover, in studies it has been shown that two doctors can arrive at different findings on the same patient.
Pneumonia fills the lung's alveoli with fluid, keeping oxygen from reaching the bloodstream. The alveolus on the left is normal, while the alveolus on the right is full of fluid from pneumonia.
A: Normal chest x-ray
B: Abnormal chest x-ray with shadowing from pneumonia in the right lung
Pneumonia as seen on chest x-ray.
PERSONAL HISTORY This is a case of a fifty-three years old female patient she was born on March 16, 1955. She is a Filipino, a roman catholic and lives at # 153 Cainsin, Malolos, Bulacan. CHIEF COMPLAINT Cough and fever HISTORY OF PRESENT ILLNESS Three weeks prior to admission patient started to have cough with associated chest pain and fever persistent signs and symptoms consulted then patient was admit. PAST MEDICAL HISTORY The patient has asthma since she was 4 years old.
GENERAL APPERANCE SKIN FACE NECK LUNGS ABDOMEN EXTREMITIES
VITAL SIGNS BP- 150/80 RR- 24 cpm PR- 76 bpm T- 36.6 C
NORMAL
ABNORMAL
GENERAL OBJECTIVES The participants apply the knowledge that they learned, practice and enhance their skills, and at the same time for them to develop their attitude. The client and her family will be able to understand what pneumonia is. This case study will serve as a future reference.
SPECIFIC OBJECTIVES • Collect data for base to serve as baseline • Inform the family what is pneumonia and it’s classification • Instruct the client and her family with the importance of check-up and follow up visits taking prescribed medications on time • Demonstrate nursing measures in caring for a client with pneumonia • Evaluate the effectiveness of nursing care rendered
M E T H O D S
The patient and her significant others were informed about the importance of taking proper medications on the right dose, route, and time as prescribed by the physicians. Encouraged her significant others to provide quiet environment to promote non pharmacological pain management. Instructed her significant others how to manage the patient when in pain related to bronchial asthma. Demonstrated proper hand washing and encouraged good grooming to promote self-esteem. Emphasized the importance of attending follow up check up to monitor the status of the client. Encouraged her significant others to provide diet as ordered by physicians and explained its importance on the present situation of the patient. Instructed her significant others when at home to watch out when the patient is in pain to prevent accident that may contribute in worsening of the present situation.
After the case study the participants were able to meet this objective. This case study was able to present information regarding bronchial asthma and its mechanism.
The lung is the essential respiration organ in air-breathing animals, including most tetrapods, a few fish and a few snails. The most primitive animals with a lung are the lungfish (vertebrate) and the pulmonate snails (invertebrate). In mammals and the more complex life forms, the two lungs are located in the chest on either side of the heart. Their 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.
In humans, the trachea divides into the two main bronchi that enter 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 sacs. 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. 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 segments, then 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 one of the reasons 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 perfuse with blood for gas exchange. As oxygen requirements increase due to exercise, a greater volume of the lungs is perfuse, 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.
Our Lady of Fatima University
M a r u l a s , V a l e n z u e l a C i
t y
NCM 101- Group 41 D Ponce, Exequiel M. Ruales, Jemmalyn B. Santiago, Sarah R. Santos, Ran Robert F. Valera, Rona M.
August 30, 2008
XI. Introduction XII.Objectives -General Objectives -Specific Objectives XIII.Nursing History XIV.Physical Assessment XV. Anatomy and Physiology XVI.Pathophysiology XVII.Nursing Care Plan XVIII.Drug Study XIX.Health Teachings XX. Evaluation
Pneumonia is an inflammatory illness of the lung. Frequently, it is described as lung parenchyma/alveolar inflammation and abnormal alveolar filling with fluid. The alveoli are microscopic air-filled sacs in the lungs responsible for absorbing oxygen from the atmosphere. Pneumonia can result from a variety of causes, including infection with bacteria, viruses, fungi or parasites, and chemical or physical injury to the lungs. Its cause may also be officially described as idiopathic- that is unknown when infectious cause has been excluded. Typical symptoms associated with pneumonia included cough, fever, chest pain, fever, and difficulty in breathing. Diagnostic tools include x-rays and examination of the sputum treatment depends on the cause of pneumonia, bacterial pneumonia is treated with antibiotics. Pneumonia is a common illness which occurs in all age groups, and is a leading cause of death among elderly and people who are chronically and terminally ill. Vaccines to prevent certain types of pneumonia are available. The prognosis depends on the type of pneumonia, the appropriate treatment any complications and the person’s underlying health. People with infectious pneumonia often have a cough producing greenish or yellow sputum, or phlegm and a high fever that may be accompanied by shaking chills. Shortness of breath is also common, as is pleuritic chest pain, a sharp or stabbing pain, either experienced during deep breaths or coughs or worsened by it. People with pneumonia may cough up blood, experience headaches, or develop sweaty and clammy skin. Other possible symptoms are loss of appetite, fatigue, blueness of the skin,
nausea, vomiting, mood swings, and joint pains or muscle aches. Less common forms of pneumonia can cause other symptoms; for instance, pneumonia caused by Legionella may cause abdominal pain and diarrhea, while pneumonia caused by tuberculosis or Pneumocystis may cause only weight loss and night sweats. In elderly people manifestations of pneumonia may not be typical. They may develop a new or worsening confusion or may experience unsteadiness, leading to falls. Infants with pneumonia may have many of the symptoms above, but in many cases they are simply sleepy or have a decreased appetite. Symptoms of pneumonia need immediate medical evaluation. Physical examination by a health care provider may reveal fever or sometimes low body temperature, an increased respiratory rate, low blood pressure, a high heart rate, or a low oxygen saturation, which is the amount of oxygen in the blood as indicated by either pulse oximetry or blood gas analysis. People who are struggling to breathe, who are confused, or who have cyanosis (blue-tinged skin) require immediate attention. Physical of the lungs may be normal, but often shows decreased expansion of the chest on the affected side, bronchial breathing on auscultation with a stethoscope (harsher sounds from the larger airways transmitted through the inflamed and consolidated lung), and rales heard over the affected area. Percussion may be dulled over the affected lung, but increased rather than decreased vocal resonance (which distinguishes it from a pleural effusion). While these signs are relevant, they are insufficient to diagnose or rule out pneumonia; moreover, in studies it has been shown that two doctors can arrive at different findings on the same patient.
Pneumonia fills the lung's alveoli with fluid, keeping oxygen from reaching the bloodstream. The alveolus on the left is normal, while the alveolus on the right is full of fluid from pneumonia.
A: Normal chest x-ray
B: Abnormal chest x-ray with shadowing from pneumonia in the right lung
Pneumonia as seen on chest x-ray.
PERSONAL HISTORY This is a case of a fifty-three years old female patient she was born on March 16, 1955. She is a Filipino, a roman catholic and lives at # 153 Cainsin, Malolos, Bulacan. CHIEF COMPLAINT Cough and fever HISTORY OF PRESENT ILLNESS Three weeks prior to admission patient started to have cough with associated chest pain and fever persistent signs and symptoms consulted then patient was admit. PAST MEDICAL HISTORY The patient has asthma since she was 4 years old.
GENERAL APPERANCE SKIN FACE NECK LUNGS ABDOMEN EXTREMITIES
VITAL SIGNS BP- 150/80 RR- 24 cpm PR- 76 bpm T- 36.6 C
NORMAL
ABNORMAL
GENERAL OBJECTIVES The participants apply the knowledge that they learned, practice and enhance their skills, and at the same time for them to develop their attitude. The client and her family will be able to understand what pneumonia is. This case study will serve as a future reference.
SPECIFIC OBJECTIVES • Collect data for base to serve as baseline • Inform the family what is pneumonia and it’s classification • Instruct the client and her family with the importance of check-up and follow up visits taking prescribed medications on time • Demonstrate nursing measures in caring for a client with pneumonia • Evaluate the effectiveness of nursing care rendered
M E T H O D S
The patient and her significant others were informed about the importance of taking proper medications on the right dose, route, and time as prescribed by the physicians. Encouraged her significant others to provide quiet environment to promote non pharmacological pain management. Instructed her significant others how to manage the patient when in pain related to bronchial asthma. Demonstrated proper hand washing and encouraged good grooming to promote self-esteem. Emphasized the importance of attending follow up check up to monitor the status of the client. Encouraged her significant others to provide diet as ordered by physicians and explained its importance on the present situation of the patient. Instructed her significant others when at home to watch out when the patient is in pain to prevent accident that may contribute in worsening of the present situation.
After the case study the participants were able to meet this objective. This case study was able to present information regarding bronchial asthma and its mechanism.
The lung is the essential respiration organ in air-breathing animals, including most tetrapods, a few fish and a few snails. The most primitive animals with a lung are the lungfish (vertebrate) and the pulmonate snails (invertebrate). In mammals and the more complex life forms, the two lungs are located in the chest on either side of the heart. Their 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.
In humans, the trachea divides into the two main bronchi that enter 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 sacs. 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. 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 segments, then 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 one of the reasons 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 perfuse with blood for gas exchange. As oxygen requirements increase due to exercise, a greater volume of the lungs is perfuse, 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.