Case Presentation

Brgy . Santolan , Palayan City , N.E.Purok 1 5 Case Presentation by: BSN 2-0

ContentsI.Community Cases II.Urinalysis III.The infants and their Weight IV.The Adopted FamilyFamily

Nursing Care Plan

V.Learning Experiences

1

AsthmaDefinition is a chronic inflammatory disease of the airways that causes airway hyperresponsiveness, mucosal edema, and mucus production

Recurrent asthma symptoms: cough,

chest tightness, wheezing and dyspnea

It differs from other obstructive lung

diseases in that it is largely reversible, either spontaneously or with treatment. Patients with asthma may experience

symptom-free periods alternating with acute exacerbations that last from minutes to hours or days. It is the most common chronic

disease of childhood and can occur

Allergy is the strongest predisposing

factor. Chronic exposure to airway irritants or

allergens increases the risk of asthma.

Examples of allergens:

Grass TreeDust

Common triggers for asthma:

Airway irritants (e.g. air pollutants,

cold, heat, weather changes, strong odors or perfumes, smoke) Exercise Stress or emotional upset Sinusitis with post natal drip Medications Viral respiratory tract infections Gastroesophageal Reflux

Physiology/PathophysiologyPredisposing Factors: Atopy Female Gender Causal Factors: Exposure to indoor and outdoor allergens Occupational sensitizers Contributing Factors: Respiratory infections Air Pollution Active/Passive Smoking Others: cold, heat, etc.

INFLAMMATION Hyperresponsivenes s of airwaysSome Risk factors: Allergens Respiratory Infections Exercise and hyperventilation Weather change

Airflow limitation

Symptoms: Wheezing Cough Dyspnea Chest Tightness

Management

Immediate intervention is necessary, because

the continuing and progressive dyspnea leads to increased anxiety, aggravating the situation.

Pharmacologic Therapy Quick

Relief Medications for immediate treatment of asthma symptoms and exacerbations Long-acting Medications to achieve and maintain control of persistent asthma (e.g. inhalation of Corticosteroids which are the most potent and effective antiinflammatory medications currently available)

Management of Exacerbations asthma

exacerbations are best managed by early treatment and education including the use of written action plans as part of any overall effort to educate patients about selfmanagement techniques, especially those with moderate or severe persistent asthma.

Peak Flow Monitoring peak flow meters

measure the highest airflow during a forced expiration. It is recommended to be done daily for all patients with moderate to severe asthma.

Florentino Baltazar73 years old His asthma started when he was

50 years old

Management 1 tablet of

Salbutamol

everyday

2

Definition

Cataract

is a clouding that develops in the crystalline

lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light.

According to the World health Organization,

it is the leading cause of blindness in the world.

It may be partial or complete, stationary or

progressive, hard or soft.

classified by their location, e.g. posterior

(classically due to steroid use) and anterior [common (senile) cataract related to aging]

Causes of Cataract:long-term exposure to ultraviolet light

and infrared and microwave radiations secondary effects of diseases such as diabetes, hypertension and advanced age, or trauma (possibly much earlier)

usually a result of denaturation of lens

protein

Genetic factors are often a cause of

congenital cataracts and positive family history may also play a role in predisposing someone to cataracts at an earlier age, a phenomenon of "anticipation" in pre-senile cataracts

produced by eye injury or physical

trauma

Atopic or allergic conditions

Physiology/PathophysiologyCataracts can develop in one or

both eyes at any age for a variety of reasons

Visual impairment normally

progresses at the same rate in both eyes

The extent of visual impairment

depends on their size, density and location in the lens.

Three most common types of Senile (Age-related) Nuclear Cataract caused by central opacity

Cataract are defined by their location in the lens:

in the lens and has a substantial genetic component. It is accompanied by myopia (nearsightedness). Cortical Cataract involves the anterior, Posterior Subscapular Cataracts occur in

posterior or equatorial cortex of the lens.

front of the posterior capsule. Typically in younger people. Near vision is diminished and the eye is increasingly sensitive to glare from bright light.

Management No nonsurgical (medications, eyedrops, eyeglasses) treatment cures cataracts or prevents age-related cataracts.

Surgical Management Extracapsular Cataract Extraction involves smaller incisional wounds (less trauma to the eye) and maintains the posterior capsule of the lens, reducing postoperative complications, particularly aphakic retinal detachment and cystoid macular edema.

Intracapsular Cataract Extraction the entire

lens is removed and fine sutures are used to close the incision Phacoemulsification this method of

extracapsular surgery uses an ultrasonic device that liquefies the nucleus and cortex, which are then suctioned out through a tube.

Lens Replacement after removal of the

crystalline lens, the patient is referred to as aphakic (without lens). The lens, which focuses light on the retina, must be replaced for the patient to see clearly.

Toxic Anterior Segment Syndrome also

known as toxic endothelial cell destruction or sterile endophthalmitis. It is a noninfectious inflammation caused by a toxic agent after an uncomplicated and unevenful surgery.

Antonio Garcia77 years old Cataract started when he was 72

years old

Management applied treatment

for three years but stopped

3

Ulcer

Definition

These are crater-like sores (generally 1/4 inch to

3/4 inch in diameter, but sometimes 1 to 2 inches in diameter) which form in the lining of the stomach (called gastric ulcers), just below the stomach at the beginning of the small intestine in the duodenum (called duodenal ulcers) or less commonly in the esophagus (called esophageal ulcers)

In general, ulcers in the stomach and duodenum

are referred to as peptic ulcers.

Symptoms of Ulcer There may be no symptoms of ulcers or the individual may experience: A gnawing or burning pain in the abdomen between the breastbone and the navel. The pain is usually worse a couple of hours after a meal or in the middle of the night when the stomach is empty. Nausea Vomiting

Loss of appetite Loss of weight Tiredness (a symptom of a bleeding

ulcer) Weakness (a symptom of a bleeding ulcer) Blood in vomit or stool. When blood is in the stool, it appears tarry or black (symptom of a bleeding ulcer).

Physiology/Pathophysiology

Peptic Ulcers occur mainly in the

gastroduodenal mucosa

The erosion is caused by the increased

concentration or activity of acid-pepsin or by decreased resistance of mucosa A damaged mucosa cannot act as a barrier

against HCl.

The use of NSAIDs inhibits the secretion of

mucus that protects the mucosa.

Damage to the gastroiduodenal mucosa

allows for decrease resistance to bacteria, and thus infection from Helicobacter pylori may occur.

Zollinger Ellison Syndrome is suspected

when a patient has several peptic ulcers or an ulcer that is resistant

Management

Pharmacologic Therapy uses a combination

of antibiotics, proton pump inhibitors and bismuth salts that suppress or eradicate H. pylori Stress reduction and Rest Smoking Cessation Dietary Modification Surgical Management it includes vagotomy, with or without pyloroplasty and the Billroth I and II procedures Follow-up care

Antonio Garcia77 years old His ulcer began when he was

only 30 years old

Management tea from different

plant leaves and roots

4Definition

Diabetes Mellitus

is a group of metabolic disorders

characterized by elevated levels of blood glucose (hyperglycemia) resulting from defects in insulin production and secretion, decreased cellular response to insulin, or both.

It has two types:DM 1 or Insulin Dependent Diabetes

Mellitus characterized by absolute lack of insulin due to damaged pancreas, prone to develop ketosis and dependent on insulin injections DM 2 or Noninsulin Dependent DM

characterized by fasting hyperglycemia despite availability of insulin. Gestational

Diabetes develops during pregnancy. It may develop into fullblown hypothesis Juvenile Diabetes DM in people who

Physiology/Pathophysiology mellitus is characterized by peripheral insulin resistance, impaired regulation of hepatic glucose production, and declining -cell function, eventually leading to -cell failure. respond appropriately when insulin is present. Unlike type 1 diabetes mellitus, the insulin resistance is generally "post-receptor", meaning it is a problem with the cells that respond to insulin rather than a problem with production of insulin

The pathophysiology of type 2 diabetes

Insulin resistance means that body cells do not

Management

The easiest method of treating Type 2

diabetes is with diet control. Dietary regulation is set by basing the caloric intake on the patients ideal body weight, selecting adequate sources of protein and carbohydrate, while maintaining a reasonable distribution of foods. When hyperglycemia persists despite dietary changes, oral hypoglycemic agents become necessary. These agents can be prescribed in small doses, adjusting the dosage to larger levels to achieve tighter control, as necessary.

Insulin is always required for Type 1

and is an option for recalcitrant cases involving Type 2 diabetes. Conventional therapy involves the administration of an intermediateacting insulin (NPH or lente), once or twice a day, with or without small amounts of regular insulin.

Annalyn Peralta8 months pregnant

ManagementDiet Control such as smaller

amount of sugar intake (e.g. when drinking coffee), lesser rice during meals and abstinence from sweet foods.

5Definition

Pneumonia

It is an inflammation of the lung

parenchyma caused by various microorganisms, including bacteria, mycobacteria, chlamydiae, mycoplasma, fungi, parasites and viruses.

It is classified into:Community Acquired Pneumonia

occurs either in the community setting or within the first 48 hours after hospitalization. The causative agents for CAP are gram-negative rods like Pseudomonas aeruginosa Hospital Acquired Pneumonia also

known as nosocomial pneumonia, is defined as the onset of pneumonia symptoms more than 48 hours after admission in patients with no evidence of infection at the time of admission.

Pneumonia in the Immunocompromised

Host it occurs with use of corticosteroids or other immunosuppresive agents, chemotherapy, nutritional depletion, use of broad-spectrum antimicrobial agents and AIDS.

Aspiration Pneumonia refers to the

consequences resulting from entry of endogenous or exogenous substances into the lower airway.

Physiology/Pathophysiology

Pneumonia arises from normal flora present in

patients whose resistance has been altered or from aspiration of flora present in the oropharynx It may also result from bloodborne organisms

that enter the pulmonary circulation and are trapped in the pulmonary capillary bed. Inflammatory reaction can occur in the alveoli,

producing an exudate that interferes with the diffusion of oxygen and carbon dioxide.

The mixing of oxygenated and

unoxygenated or poorly oxygenated-blood eventually results in arterial hypoxemia.

If a substantial portion of one or more lobes

is involved, the disease is called lobar pneumonia.

The term bronchopneumonia is used to

describe pneumonia that is distributed in a patchy fashion, having originated in one or morelocalized areas within the bronchi and extending to the adjacent surrounding lung parenchyma.

Management

Pharmacologic Therapy includes

administration of the appropriate antibiotics as determined by the results of a Gram stain. Prompt administration of antibiotics in patient

with CAP is strongly suspected or confirmed as a key treatment measure.

For HAP patients infusion of IV antibiotics and

may be monotherapy or combination of therapy.

For pt who are at risk for Pseudomonas

infection, antipseudomonal penecillin plus an amino glycoside fever and tachypnea, give antipyretics reduced sneezing.

For viral pneumonia which is accompanied by Antihistamines may provide benefit with Nasal decongestants may also be used to treat

symptoms and improve sleep.

Bed Rest

Trixie Claire Villasan4 month-old baby Management health check-up

whenever money is available

6

Hypertension

Definition or a diastolic pressure above 90 mm Hg, based on two or more measurements.

systolic blood pressure above 140 mm Hg

Prolonged blood pressure elevation

damages vessels in target organs (heart, kidneys, brain and eyes)

Physiology/Pathophysiology

Many factors have been implicated as causes of hypertension: Increased sympathetic nervous system activity related to dysfunction of the autonomic nervous system

Increased renal reabsorption of sodium,

chloride, and water related to a genetic variation in the pathways by which the kidneys handle sodium

Increased activity of the renin-angiotensin-

aldosterone system, resulting in expansion of extracellular fluid volume and increased systemic vascular resistance

Decreased vasodilation of the arterioles

related to dysfunction of the vascular endothelium

Resistance to insulin action, which may be

a common factor linking hypertension, type 2 diabetes mellitus, hypertriglyceridemia, obesity, and glucose intolerance

Management

The goal of any treatment program is to

prevent death and complications by achieving and maintaining an arterial blood pressure below 140/90 mm Hg (130/80 mm Hg for people with diabetes mellitus or proteinuria >1 g/24 hours), whenever possible. Promote compliance by avoiding

complicated drug schedules.

Select a drug class that has the greatest

effectiveness, fewest side effects, and best chance of acceptance by patient. Two classes of drugs are available as first-line therapy: diuretics and beta-blockers.

Nonpharmacologic approaches include

weight reduction; restriction of alcohol, sodium, tobacco; regular exercise and relaxation. A DASH (Dietary Approach to Stop Hypertension) diet high in fruit and vegetables and low in dairy products has been shown to lower elevated pressures.

Villa Rosa Dela Cruz67 years old She has a medicine to maintain her blood

pressure normal

Management adequate rest, lesser stress

provoking activities, proper diet, attend health check-ups whenever money is available

Urinalysis

Summary of ResultsName of Patient 1. Annalyn Peralta 2. Chuchi Alcantara 3. Analiza Pinzon 4. Cherry Capile Test for Albumin Negative Traces of Protein Negative Negative Test for Sugar Positive Range - 0 to 1 Negative Negative Positive Range 0 to 1

The Infants

Summary of Results

To ta lN u m b e r of Children = 78

Labiano Family

Fa m i y C a se lPostpartum Psychosissometimes referred to as puerperal

psychosis or postnatal psychosis It is a term that covers a group of

mental illnesses with rapid onset of psychotic symptoms following childbirth

Postpartum Psychosis Signs

Although the onset of symptoms can occur at anytime within the first three months after giving birth, women who have postpartum psychosis usually develop symptoms within the first two to three weeks after delivery. Postpartum psychosis symptoms usually appear quite suddenly; in 80% of cases, the psychosis occurs three to 14 days after a symptom-free period.

Signs of postpartum psychosis include:

Hallucinations Delusions Illogical thoughts Insomnia Refusing to eat Extreme feelings of anxiety and agitation Periods of delirium or mania Suicidal or homicidal thoughts

Who Is At Risk?

Women with a personal history of psychosis, bipolar disorder or schizophrenia have an increased risk of developing postpartum psychosis. Likewise, women who have a family history of psychosis, bipolar disorder or schizophrenia have a greater chance of developing the disorder. Additonally, women who have had had a past incidence of postpartum psychosis are between 20% and 50% more likely of experiencing it again in a future pregnancy.

Causes of Postpartum Psychosis

Experts arent exactly sure why postpartum psychosis happens. However, they do offer a variety of explanations for the disorder, with a womans changing hormones being at the top of their list. Other possible reasons or contributing factors include a lack of social and emotional support; a low sense of self-esteem due to a womans postpartum appearance; feeling inadequate as a mother; feeling isolated and alone; having financial problems; and undergoing a major life change such as moving or starting a new job.

Treating Postpartum Psychosis

Postpartum psychosis is considered to be a mental health emergency and therefore requires immediate attention. Because women who suffer from the psychosis are not always able or willing to speak with someone about their disorder, it is sometimes necessary that their partner or another family member help them get the medical attention they need.

The condition is usually treated with medications, typically antipsychotic drugs and sometimes antidepressants and/or antianxiety drugs. If a woman is thought to pose a threat to herself or others, she will likely be hospitalized for a short time.

Many women can also benefit from psychological counseling and support group therapy. With proper care, most women are able to recover from their disorder.

Family Nursing Care PlanFamily size beyond the familys

resources Malnutrition

Health Problem

Family Nursing Goal of Care Problems Family size beyond Inability to provide After nursing the familys resources adequate nursing care intervention, the and service due to family will now be poor nurse-client able to decide interaction and properly what actions because the they are going to knowledgeable make when it comes members are always to family planning out. with a sense of responsibility.

Intervention Objectives of Care Nursing Interventions Method of Resources NurseRequired Family Broaden the knowledge of the Contact Home Visit Material

After nursing intervention, the couple: family about family planning

Discuss with the family the possible consequences if Can explain what family family planning will be planning is all about disregarded Can enumerate the ways Explain to the family the advantages and disadvantages on birth control Will select the most of each of the methods used in appropriate method for family planning Provide information about the them consultation hours

Resources: Visual Aids about Family Planning Human Resources: Time, effort and patience of the family and the nurse

Will regularly seek for medical consultation and guidance

Health Problem Malnutrition

Family Nursing Problems

Goal of Care

Inability to provide After nursing adequate nursing care to intervention, the a member suffering children will gain at from this disease least 2 kg in 4 weeks because of lack of time knowledge about the condition and insufficient resources for care (example, responsible member of the family and limited financial inc0me

Intervention Objectives of Care Nursing InterventionsWiden the familys After nursing intervention, the family: knowledge about malnutrition

Method of Resources NurseRequired Family Contact Home Visit Material

Discuss why the children are malnourished and the possible Can now plan a meal things that may happen to which contains a balance them if it continues Show a picture of the food diet and is affordable Will feed the children pyramid and enumerate the foods they can buy which are with the agreed upon quantity and quality of affordable but very nutritious Give advices about budgeting

Resources: Visual Aids about Malnutrition, Picture of the food pyramid, Human Resources: Time, effort and patience of the family and the nurse

food

Learning ExperiencesWe are so thankful that we were given the

chance to have a duty at Brgy. Santolan, Palayan, N.E. It is going to be a place that we will not forget because we met 3 Clinical Instructors who stand as our mothers and gave additional knowledge to us. Also, its unforgettable because we became friends with BSN 2-3 We experienced so many stuffs that we havent before neither in the hospital nor in any other place

Thank You !..