Case Study - Pneumonia Final

8/12/2019 Case Study - Pneumonia Final

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BRONCHO

PNEUMONIA


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INTRODUCTION

Pneumonia is an infection of the lungs. When a person has pneumonia, lung tissue

can fill with pus and other fluid, which makes it difficult for oxygen in the lung's air sacsto reach the bloodstream. With pneumonia, a person may have difficulty breathing and

have a cough and fever. Sometimes a person may have chest or abdominal pain and

vomiting, too.

Pneumonia is commonly caused by viruses, such as the influenza virus(flu and

adenovirus. !ther viruses, such as respiratory syncytial virus ("S#, are commoncauses of pneumonia in young children and infants. $acteria such as Streptococcus

pneumoniaecan cause pneumonia, too. People with bacterial pneumonia are usuallysicker than those with viral pneumonia, but can be effectively treated with antibiotic

medications.

%ou may have heard the terms &double pneumonia& or &walking pneumonia.&

Double pneumoniasimply means that the infection is in both lungs. t's common forpneumonia to affect both lungs, so don't worry if your doctor says this is what you have

it doesn't mean you're twice as sick.

Walking pneumoniarefers to pneumonia that is mild enough that you may noteven know you have it. Walking pneumonia, which has also been called atypicalpneumonia because it's different from the typical bacterial pneumonia, is common in

teens and is often caused by a tiny microorganism known as Mycoplasma pneumoniae.

)ike the typical bacterial pneumonia, walking pneumonia can also be treated withantibiotics.

*here are many symptoms of pneumonia, and some of them, like a cough or a

sore throat, are associated with many other common infections. !ften, people get

pneumonia after they've had an upper respiratory tract infection like a cold.

Symptoms of pneumonia can include+

fever

chills

cough

unusually rapid breathing

wheeing

difficulty breathing


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chest or abdominal pain

loss of appetite

exhaustion

vomiting

*he symptoms of pneumonia vary from person to person, and few people get all of them.

When pneumonia is caused by bacteria, the person tends to become sick -uicklyand develops a high fever and has difficulty breathing. When it's caused by a virus,

symptoms generally appear more gradually and may be less severe.

*he routine vaccinations that most people receive as kids help prevent certain

types of pneumonia and other infections. f you have a chronic illness, such as sickle celldisease, you may have received additional vaccinations and diseasepreventing antibiotics

to help prevent pneumonia and other infections caused by bacteria. People who have

diseases that affect their immune system (like diabetes, /# infection, or cancer, are 01or older, or are in other highrisk groups should receive a pneumococcal vaccination.

People with immune system problems may also receive antibiotics to prevent

pneumonia that may be caused by organisms they are especially susceptible to. n some

cases, antiviral medication may be used to prevent viral pneumonia or to lessen itseffects.

nfluena vaccination is also recommended since pneumonia often occurs as a

complication of the flu. $ecause pneumonia is often caused by contagious germs, a good

way to prevent pneumonia is to keep your distance from anyone you know who haspneumonia or other respiratory infections. 2se separate drinking glasses and eating

utensils, wash your hands fre-uently with warm, soapy water, and avoid touching used

tissues and paper towels. %ou can also stay strong and help avoid some of the illnessesthat may lead to pneumonia by eating as healthily as possible, getting plenty of rest, and

avoiding smoking.

*he length of time between exposure and feeling sick depends on many factors,

particularly the type of pneumonia a person has. With influena pneumonia, for example,someone may become sick in as few as 34 hours or as long as 5 days after exposure to the

flu virus. $ut with walking pneumonia, a person may not have symptoms until 4 to 5

weeks after becoming infected.

6ost types of pneumonia resolve within a week or two, although a cough maylinger for several weeks more. n severe cases, it may take longer to completely recover.

f a doctor suspects pneumonia, he or she will perform a physical exam and may

order a chest 7ray and blood tests. People who have bacterial or atypical pneumonia will

probably be given antibiotics to take at home. 8 doctor will also recommend that aperson gets lots of rest and drinks plenty of fluids.


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PATIENTS PROFILE

Patients Name:ABCD

Age:72 y/o

Gender: Male

Cii! Stat"s:Married

Address:Tuao, Cagayan

Date #$ Birt%:March 20, 1935

P!a&e #$ Birt%: Tuao, Cagayan

Re!igi#n:Roman Caholic

Nati#na!it':!ili"ino

Dia!e&t:#locano, Tagalog, #a$e%

Date #$ Admitti#n: &o'em(er 09, 2007

Attending P%'si&ian:Dr) *+

C%ie$ C#m(!aints:Di--iculy o- Breahing

Fina! Diagn#sis:Broncho"neumonia


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NURSING HISTOR) OF ILLNESS

HISTOR) OF PRESENT ILLNESS

8ccording to the patient9s daughter, last :ovember ;0, 4;;< early in the

morning, his father was sweeping their front yard as his form of exercise until

later that day he experienced uneasiness and episodes of dyspnea. 8fter three(5 days they decided to bring him to the hospital and prior to his admission,

the patient had productive cough and has experienced dyspnea. *he patient

also had epigastric pain.

PAST HEALTH HISTOR)

8ccording to the patient9s daughter, his father was previously hospitalied due

to hypertension and asthma. She included further that his father had started hisasthma attacks when he was still 1; years old. 8ccording the patient, he has

completed his immuniations and has no allergies on foods or drugs. 8lso

according to him, he wasn9t taking any vitamin supplements but he wasplanning to ask his physician to prescribe him some.

FAMIL) HEALTH HISTOR)

8ccording to the patient9s daughter and wife, they have a family history of

pneumonia and asthma. *hey also have known history of hypertension. :o

other hereditary disease such as diabetes was evident on their familyaccording to them.


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GORDONS ** FUNCTIONAL HEALTH PATTERNS

Hea!t% Per&e(ti#n+Hea!t% Management Pattern

$efore /ospitaliation, =hito perceives health as being free from any illness.

/e says that he feels healthy when he is able to perform his duties. $ut due to

his old age and health condition, he was no longer allowed by his children towork. $ut because he is not used to do nothing at all, he prefers to help on thehousehold chores instead of sitting all day long. 8nd by able to help his

family do the chores, he still feels well despite of his health condition. /e isn9t

also taking any vitamin or food supplements.

>uring his hospitaliation, =hito still perceives health as being free from

illness and now he also considers health as wealth. /e says that health shouldnot be taken for granted since it could even mean his life. /e said that this is

the worst hospitaliation he has ever had so he swears to give more attention

to his health now. /e even is planning to consult his physician for some

vitamins to help him become more healthy and to protect him from ac-uiringother illness.

N"triti#na!+Meta,#!i& Pattern

$efore =hito9s hospitaliation, he takes his meals the usual three times a day.$ut according to her daughter he is eating only small amounts. /e prefers

vegetables more then meat. /e drinks 0< glasses of water a day. t was

suspected by her daughter that before he was brought to that hospital, his

epigastric pain was due to the meals he skipped during those days.

>uring his hospitaliation, =hito doesn9t still have the appetite to eat. /e eats

but still in small amounts. /is fluid intake has decreased to 10 glasses ofwater a day. :ow that he was hospitalied, he prefers warm versus cold fluids.

/e also added that he wants to consult his physician on what supplement

should he take to increase his appetite.

E!iminati#n Pattern

$efore hospitaliation, =hito defecates normally everyday. /e has the

normal solid to semisolid stool consistency and is usually light brown to dark

brown in color. /e also said that he usually voids 10 times a day with lightyellow and aromatic odor urine. /e said that he don9t have any difficulty in

defecating and urinating.

>uring his hospitaliation, =hito voids typically 34 times during my shift

with darker colored urine than the usual color of his urine but still with the


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same odor. /e didn9t eliminate during my shift but according to his daughter,he is somewhat constipated because he now defecates every other day unlike

before that he defecate everyday.

A&tiit'+E-er&ise Pattern

$efore hospitaliation, =hito considers helping in the household chores as hisonly form of exercise like sweeping their yard though it wasn9t allowed by his

children. /e has no other forms of exercise since it was contraindicated by his

health condition.

>uring his hospitaliation, =hito has no exercise at all because of his

condition. /e has to rest most of the time.

S!ee(+Rest Pattern

$efore =hito9s /ospitaliation, he has the normal 0? hours sleep. 8ccording

to his daughter, he usually sleeps at uring his hospitaliation, =hito doesn9t have the ade-uate time of sleep. /e

is much disturbed with the nurses giving medications and when they are

obtaining vital signs. $ut he has the ade-uate rest since he does noting in thehospital.

C#gnitie+Per&e(t"a! Pattern

$efore hospitaliation, =hito is normal in terms of his cognitive abilities. /e

has good memory and reasoning skills. /e can easily comprehend on the-uestions ask him. n terms of his perceptual pattern, =hito has no problems

with his senses except that their functions are -uite diminished which is

normal due to his old age.

>uring his hospitaliation, =hito was normal as before in his cognitive and

perceptual pattern. /e is still that good as he comprehend with my -uestions./e can also easily remember things that 9m asking him. /e also shared to me

some of his experiences and is very enthusiastic during our conversations.


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sSe!$+(er&e(ti#n . Se!$+n&e(t Pattern

=hito perceives himself as a good person. With his age, he has now

achieved his selfactualiation and gained selfrespect. /e sees himself an

elder that gives advices to other people based on his own experiences.

R#!e+Re!ati#ns%i( Pattern

$efore his hospitaliation, =hito has a close relationship with his family

though some of children don9t already live with them they still find time tocommunicate and see each other. /e is a father of nine children. /e does

not have his Aob already so he relies on his children for supports. 6ost of the

time he turns to his family for emotional supports.

>uring his hospitaliation, his relationship with his family hasn9t changed.

!ne of her daughter and her wife were the ones accompanying him in the

hospital. /is family was his main source of strength.

Se-"a!it'+Re(r#d"&tie Pattern

=hito was no longer active in his sexual pattern due to his age. /e said that

he was already too old for that, by the way he already have nine children.

C#(ing+Stress T#!eran&e Pattern

$efore his hospitaliation, =hito according to his duaghter is individualisticin terms of her emotions. /e doesn9t usually share his problems with hisfamily. 8ccording to his daughter he always tries to keep his emotions or

problems by himself. /is daughter even shared that he always tries to hide

when he is feeling ill or unhealthy.

>uring his hospitaliation, =hito9s confidant was his wife and daughter. /e

expresses all his discomforts to them.

/a!"e+Be!ie$ Pattern

=hito is a "oman =atholic devotee. /e said that he go to mass every Sunday

with his wife and some of his children since some of his children live in

other places. /e believes that Bod helps him in times of trials and sufferingsand that /e will not abandon him. /e trusts his life to him /is daughter

confessed that they do believe in -uack doctors sometimes when the health

practitioners weren9t able to cure the illness but they do consult the healthpractitioners first.


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PH)SICAL ASSESSMENT

Beneral 8ppearance+ neat and relaxed

nitial #ital Signs+ $PC 33;Distribution nspection Fvenly distributed

and pliant.

Fvenly

distributed

:ormal

*exture PalpationH

nspection

Silky, resilient hair. Silky and

resilient

:ormal

!iliness Palpation :either excessively Slightly oily :ormal


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dry nor oily.

HEAD

Symmetry Palpation Symmetrical Symmetrical :ormal

Shape nspection "ounded "ounded :ormal

*exture Palpation Smooth skullcontour

Smooth withoutnodules

:ormal

FACESymmetry nspection Symmetrical Symmetrical :ormal

Skin =olor nspection 6ay vary accordingto raceH without

lesionsDabrasions

*anned with birthmark on the left

cheek

:ormal

EYES

EYEBROWS

Position 8lignment nspection Symmetrically

aligned

Symmetrically

aligned.

:ormal

/air >istribution nspection Fvenly distributed Fvenly

distributed

:ormal

EYELASHES/air >istribution nspection Fvenly distributed Fvenly

distributed:ormal

=url nspection =urved outward =urved outward :ormal

EYELIDS

Skin Juality nspection Smooth and has the

same color of the

skin.

Smooth and same

color with the

skin

:ormal

*exture nspection Smooth, absence of

lesions

Smooth without

lesions

:ormal

Position nspection *he lids do not

cover the pupil andsclera, and cannotbe seen above the

iris. *he lids close

to the eyeball.

n normal

position.

:ormal

CONJUNCTIVA

=olor nspection *ransparent withlight pink color

Pink :ormal

*exture nspection 6oist, absence oflesions

6oist and nolesions

:ormal

PUPILS

=olor nspection #ary according torace.

$lack :ormal

Shape nspection :ormally round,

small, regular and

e-ualied. >iameterof 5 G < mm

"ound :ormal

Symmetry nspection Symmetrical Symmetrical :ormal

"eaction to light nspection lluminated pupil >irect and :ormal


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constricts (direct

responseH :on

illuminated pupildilates (consensual

response

consensual

responseH

PF"")8 (pupilse-ually round

and react to light

andaccommodation

EARS

Position of the

8uricles

nspection )ine drawn from

lateral angle of the

eye to point towhere top part of

the auricle Aoins

head is horiontal.

)ine drawn from

lateral angle of

the eye to pointto where top part

of the auricle

Aoins head ishoriontal.

:ormal


Sie nspection $oth auricles must

have the same sie.

/ave the same

sie.

:ormal

Shape nspection $oth auricles must

have the same

shape.

F-ual shape :ormal

*exture nspection Smooth without

lesions and lumps.

Smooth :ormal

Flasticity nspection 6obile, firm and

not tender, pinnarecoils after it is

folded.

6obile and firm

(recoils easily.

:ormal

NOSESymmetry nspection Symmetrical andstraight.

Symmetrical andstraight.

:ormal

:asal Septum nspection :o evidence oflesions, normally in

midline.

)ocated inmidline.

:ormal

:ares nspection Symmetrical sie of

opening.

Symmetrical sie

of opening

:ormal

:asal >ischarge nspection :o discharge :o discharge :ormal

LIPS

6oisture nspection 6oist 6oist :ormal

GUMS & TEETH=olor nspection Slightly slipped

pink color.

Pink :ormal

6oisture nspection 6oist 6oist :ormal

*eeth nspection Iirmly set, shiny,

without cavities

With tooth

cavities

>ue to age

factor.

NECK


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Position nspection :eck is normally

located centrally in

the shoulder.

/ead centered. :ormal


THORAX

Posterior Shapeand =onfiguration

nspection *he chest should benormally having a

greater diameter

than the front to

back diameter.

/ave a greaterdiameter than the

front and back.

:ormal

Skin =olor nspection #ariation depends

on race.

Same as the

normal skin color(tan

:ormal

*exture nspection Smooth Smooth :ormal

Position of Scapula nspection =losely attached to

chest wall.

=losely attached

to chest wall.

:ormal

Symmetry of =hest

Fxpansion

Palpation =hest is symmetric =hest is

symmetric

:ormal

ANTERIORTHORAX

Shape and

=onfiguration

nspection 6ust be

symmetrical.

Symmetrical. :ormal

Position of

Sternum

nspection )ocated centrally in

the thorax between

the ribs.

)ocated centrally

in the thorax.

:ormal

Shape of "ibs nspection *he ribs slope

across and down.

Slope across and

down.

:ormal

2se of 8ccessory

6uscles

nspection 6oves little with

normal passivebreathing.

With active

breathing.

>ue to the

ineffectivegasexchange.

POSTERIORTHORAX

Skin color nspection Same color withother body parts.

Same color withother body parts

(tan.

:ormal

)ung breathsounds

8uscultation #esicular G soft,breey, low pitch

sound. 5; G ?;cpm

(newborn

8dventitiousbreath sounds

(crackles.

>ue to theexcessive

mucus

secretions.ABDOMEN

Skin =olor nspection Same color as the

rest of the body. :o

lesions

Same color as the

rest of the body

:ormal


=ontour nspection "ounded contour "ounded contour :ormal

EXTREMITIES:


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Symmetry nspection :o lesions and same

skin color with the

rest of the body.

:o lesions with

the same skin

color to the restof the body.

:ormal

"!6 nspection Iull mobility ofeach AointH

movement is

deliberate, smooth,and coordinated.

Iull mobility ofeach Aoint.

:ormal


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LABORATOR) RESULTS

HEMATOLOGY REPORT

Norm! V!"#$ E%m'(o'r#$"!($

A'!)$$

WBC 13; x 3;K ED) 3;.@ x 3;K ED)ncreased due to the

body9s attempt to

fight the infection

RBC

H*+ 6 35.;3?.; gDdl 34.0 gDdl >ecreased due to theobstructive

pulmonary disease

I 34.;30.; gDdl

H(, 6 5E.;1@.; L 5E L :ormalI 5


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CHEST X1RAY1APL VIEWS

1 *he lungs are hyperlucent1 *here are fibrohay densities in the right upper lung field and

confluent fine reticulohay densities in both lower lung fields. *here is athinwalled tubular lucency in the peripheral aspect of the left upper lung

field.

1 *he trachea is slightly shifted to the right1 *he heart is not enlarged transversely1 *he aortic knob is calcified1 *he hemidiaphragms are flattened and tented1 *he castrophrenic sulci are shallow1 *he rest of the visualied soft and osseous structures are

unremarkable

IMPPRESSION

1 P*$, $ilateral, with $lebD $ulla formation in the left.1 Pulmonary Fmphysema1 $ibasal Pneumonia1 8therosclerotic aorta1 Pleurodiaphragmatic reaction, bilateral1 Suggest follow up


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ANATOM) AND PH)SIOLOG) OF

THE RESPIRATOR) S)STEM

Respiratory System, in anatomy and physiology, are organs that deliveroxygen to the circulatory system for transport to all body cells. !xygen is essential forcells, which use this vital substance to liberate the energy needed for cellular activities. n

addition to supplying oxygen, the respiratory system aids in removing of carbon dioxide,preventing the lethal buildup of this waste product in body tissues. >ayin and dayout,

without the prompt of conscious thought, the respiratory system carries out its life

sustaining activities. f the respiratory system9s tasks are interrupted for more than a few

minutes, serious, irreversible damage to tissues occurs, followed by the failure of all bodysystems, and ultimately, death.

While the intake of oxygen and removal of carbon dioxide are the primary

functions of the respiratory system, it plays other important roles in the body. *herespiratory system helps regulate the balance of acid and base in tissues, a process crucialfor the normal functioning of cells. t protects the body against diseasecausing organisms

and toxic substances inhaled with air. *he respiratory system also houses the cells that

detect smell, and assists in the production of sounds for speech.

*he respiratory and circulatory systems work together to deliver oxygen to cells

and remove carbon dioxide in a twophase process called respiration. *he first phase of

respiration begins with breathing in, or inhalation. nhalation brings air from outside the

body into the lungs. !xygen in the air moves from the lungs through blood vessels to theheart, which pumps the oxygenrich blood to all parts of the body. !xygen then moves

from the bloodstream into cells, which completes the first phase of respiration. n thecells, oxygen is used in a separate energyproducing process called cellular respiration,which produces carbon dioxide as a byproduct. *he second phase of respiration begins

with the movement of carbon dioxide from the cells to the bloodstream. *he bloodstream

carries carbon dioxide to the heart, which pumps the carbon dioxideladen blood to thelungs. n the lungs, breathing out, or exhalation, removes carbon dioxide from the body,

thus completing the respiration cycle.

Structures:

The Nasal Passages:

*he flow of air from outside of the body to the lungs begins with the nose, whichis divided into the left and right nasal passages. *he nasal passages are lined with a

membrane composed primarily of one layer of flat, closely packed cells called epithelial

cells. Fach epithelial cell is densely fringed with thousands of microscopic cilia,fingerlike extensions of the cells. nterspersed among the epithelial cells are goblet cells,


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specialied cells that produce mucus, a sticky, thick, moist fluid that coats the epithelialcells and the cilia. :umerous tiny blood vessels called capillaries lie Aust under the

mucous membrane, near the surface of the nasal passages. While transporting air to the

pharynx, the nasal passages play two critical roles+ they filter the air to removepotentially diseasecausing particlesH and they moisten and warm the air to protect the

structures in the respiratory system.

Iiltering prevents airborne bacteria, viruses, other potentially diseasecausing

substances from entering the lungs, where they may cause infection. Iiltering alsoeliminates smog and dust particles, which may clog the narrow air passages in the

smallest bronchioles. =oarse hairs found Aust inside the nostrils of the nose trap airborne

particles as they are inhaled. *he particles drop down onto the mucous membrane liningthe nasal passages. *he cilia embedded in the mucous membrane wave constantly,

creating a current of mucus that propels the particles out of the nose or downward to the

pharynx. n the pharynx, the mucus is swallowed and passed to the stomach, where theparticles are destroyed by stomach acid. f more particles are in the nasal passages than

the cilia can handle, the particles build up on the mucus and irritate the membrane

beneath it. *his irritation triggers a reflex that produces a sneee to get rid of the polluted

air.

*he nasal passages also moisten and warm air to prevent it from damaging the

delicate membranes of the lung. *he mucous membranes of the nasal passages release

water vapor, which moistens the air as it passes over the membranes. 8s air moves overthe extensive capillaries in the nasal passages, it is warmed by the blood in the capillaries.

f the nose is blocked or MstuffyN due to a cold or allergies, a person is forced to breathe

through the mouth. *his can be potentially harmful to the respiratory system membranes,

since the mouth does not filter, warm, or moisten air.

n addition to their role in the respiratory system, the nasal passages house cells

called olfactory receptors, which are involved in the sense of smell. When chemicalsenter the nasal passages, they contact the olfactory receptors. *his triggers the receptors

to send a signal to the brain, which creates the perception of smell.

Pharynx:

8ir leaves the nasal passages and flows to the pharynx, a short, funnelshaped

tube about 35 cm (1 in long that transports air to the larynx. )ike the nasal passages, the

pharynx is lined with a protective mucous membrane and ciliated cells that removeimpurities from the air. n addition to serving as an air passage, the pharynx houses the

tonsils, lymphatic tissues that contain white blood cells. *he white blood cells attack any

diseasecausing organisms that escape the hairs, cilia, and mucus of the nasal passagesand pharynx. *he tonsils are strategically located to prevent these organisms from

moving further into the body. !ne tonsil, called the adenoids, is found high in the rear

wall of the pharynx. 8 pair of tonsils, the palatine tonsils, is located at the back of the

pharynx on either side of the tongue. 8nother pair, the lingual tonsils, is found deep inthe pharynx at the base of the tongue. n their battles with diseasecausing organisms, the

tonsils sometimes become swollen with infection. When the adenoids are swollen, they


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block the flow of air from the nasal passages to the pharynx, and a person must breathethrough the mouth.

Larynx:

8ir moves from the pharynx to the larynx, a structure about 1 cm (4 in long

located approximately in the middle of the neck. Several layers of cartilage, a tough and

flexible tissue, comprise most of the larynx. 8 protrusion in the cartilage called the

8dam9s apple sometimes enlarges in males during puberty, creating a prominent bulgevisible on the neck.

While the primary role of the larynx is to transport air to the trachea, it also serves

other functions. t plays a primary role in producing soundH it prevents food and fluid

from entering the air passage to cause chokingH and its mucous membranes and ciliabearing cells help filter air. *he cilia in the larynx waft airborne particles up toward the

pharynx to be swallowed.

Iood and fluids from the pharynx usually are prevented from entering the larynxby the epiglottis, a thin, leaflike tissue. *he MstemN of the leaf attaches to the front and

top of the larynx. When a person is breathing, the epiglottis is held in a vertical position,

like an open trap door. When a person swallows, however, a reflex causes the larynx and

the epiglottis to move toward each other, forming a protective seal, and food and fluidsare routed to the esophagus. f a person is eating or drinking too rapidly, or laughs while

swallowing, the swallowing reflex may not work, and food or fluid can enter the larynx.

Iood, fluid, or other substances in the larynx initiate a cough reflex as the body attemptsto clear the larynx of the obstruction. f the cough reflex does not work, a person can

choke, a lifethreatening situation. *he /eimlich maneuver is a techni-ue used to clear a

blocked larynx (seeIirst 8id. 8 surgical procedure called a tracheotomy is used tobypass the larynx and get air to the trachea in extreme cases of choking.

Trachea, Bronchi, and Bronchioles:

8ir passes from the larynx into the trachea, a tube about 34 to 31 cm (about 1 to 0

in long located Aust below the larynx. *he trachea is formed of 31 to 4; =shaped rings

of cartilage. *he sturdy cartilage rings hold the trachea open, enabling air to pass freely atall times. *he open part of the =shaped cartilage lies at the back of the trachea, and the

ends of the M=N are connected by muscle tissue.

*he base of the trachea is located a little below where the neck meets the trunk of

the body. /ere the trachea branches into two tubes, the left and right bronchi, which

deliver air to the left and right lungs, respectively. Within the lungs, the bronchi branchinto smaller tubes called bronchioles. *he trachea, bronchi, and the first few bronchioles

contribute to the cleansing function of the respiratory system, for they, too, are lined withmucous membranes and ciliated cells that move mucus upward to the pharynx.

Alveoli:


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*he bronchioles divide many more times in the lungs to create an impressive treewith smaller and smaller branches, some no larger than ;.1 mm (;.;4 in in diameter.

*hese branches deadend into tiny air sacs called alveoli. *he alveoli deliver oxygen to

the circulatory system and remove carbon dioxide. nterspersed among the alveoli arenumerous macrophages, large white blood cells that patrol the alveoli and remove foreign

substances that have not been filtered out earlier. *he macrophages are the last line of

defense of the respiratory systemH their presence helps ensure that the alveoli areprotected from infection so that they can carry out their vital role.

*he alveoli number about 31; million per lung and comprise most of the lung

tissue. 8lveoli resemble tiny, collapsed balloons with thin elastic walls that expand as air

flows into them and collapse when the air is exhaled. 8lveoli are arranged in grapelikeclusters, and each cluster is surrounded by a dense hairnet of tiny, thinwalled capillaries.

*he alveoli and capillaries are arranged in such a way that air in the wall of the alveoli is

only about ;.3 to ;.4 microns from the blood in the capillary. Since the concentration ofoxygen is much higher in the alveoli than in the capillaries, the oxygen diffuses from the

alveoli to the capillaries. *he oxygen flows through the capillaries to larger vessels,

which carry the oxygenated blood to the heart, where it is pumped to the rest of the body.

=arbon dioxide that has been dumped into the bloodstream as a waste productfrom cells throughout the body flows through the bloodstream to the heart, and then to

the alveolar capillaries. *he concentration of carbon dioxide in the capillaries is much

higher than in the alveoli, causing carbon dioxide to diffuse into the alveoli. Fxhalationforces the carbon dioxide back through the respiratory passages and then to the outside of

the body.

Regulation:

*he flow of air in and out of the lungs is controlled by the nervous system, which

ensures that humans breathe in a regular pattern and at a regular rate. $reathing is carriedout day and night by an unconscious process. t begins with a cluster of nerve cells in the

brain stem called the respiratory center. *hese cells send simultaneous signals to the

diaphragm and rib muscles, the muscles involved in inhalation. *he diaphragm is a large,domeshaped muscle that lies Aust under the lungs. When the diaphragm is stimulated by

a nervous impulse, it flattens. *he downward movement of the diaphragm expands the

volume of the cavity that contains the lungs, the thoracic cavity. When the rib musclesare stimulated, they also contract, pulling the rib cage up and out like the handle of a pail.

*his movement also expands the thoracic cavity. *he increased volume of the thoracic

cavity causes air to rush into the lungs. *he nervous stimulation is brief, and when it

ceases, the diaphragm and rib muscles relax and exhalation occurs. 2nder normal

conditions, the respiratory center emits signals 34 to 4; times a minute, causing a personto take 34 to 4; breaths a minute. :ewborns breathe at a faster rate, about 5; to 1;

breaths a minute.

*he rhythm set by the respiratory center can be altered by conscious control. *hebreathing pattern changes when a person sings or whistles, for example. 8 person also

can alter the breathing pattern by holding the breath. *he cerebral cortex, the part of the

brain involved in thinking, can send signals to the diaphragm and rib muscles that


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temporarily override the signals from the respiratory center. *he ability to hold one9sbreath has survival value. f a person encounters noxious fumes, for example, it is

possible to avoid inhaling the fumes.

8 person cannot hold the breath indefinitely, however. f exhalation does notoccur, carbon dioxide accumulates in the blood, which, in turn, causes the blood to

become more acidic. ncreased acidity interferes with the action of enymes, the

specialied proteins that participate in virtually all biochemical reaction in the body. *o

prevent the blood from becoming too acidic, the blood is monitored by special receptorscalled chemoreceptors, located in the brainstem and in the blood vessels of the neck. f

acid builds up in the blood, the chemoreceptors send nervous signals to the respiratory

center, which overrides the signals from the cerebral cortex and causes a person to exhaleand then resume breathing. *hese exhalations expel the carbon dioxide and bring the

blood acid level back to normal.

8 person can exert some degree of control over the amount of air inhaled, with

some limitations. *o prevent the lungs from bursting from overinflation, specialied cellsin the lungs called stretch receptors measure the volume of air in the lungs. When the

volume reaches an unsafe threshold, the stretch receptors send signals to the respiratory

center, which shuts down the muscles of inhalation and halts the intake of air.


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PATHOPH)SIOLOG)

Pr#,.(('* F,(or E(o!o*, A*#'( Pr#0$.o$'* F,(or . Air olluion . nuemococcal neumonia . &uriion . #nhalaion or a%"iraion . a"hylococcal "neumonia . Age o- noiou% %u(%ance% ) aureu% . 4eaher . re"ococcal "neumonia immune

de-iciency ) "rogenie%

A%"iraion o- organi%m

Muli"licaion o- organi%m $ihin ,,,Relea%e o- (acerial endooin !luid and lo(e%

,,, De-en%e mechani%m(ecome

,,, incom"een oro'er$helmed

u"ouring #n-lammaory Re%"on%e Alered con%ciou%ne%%

&euro"hil% accumulae Allo$% a%"iraion o- and migrae ino al'eoli oro"haryngeal racheal

#nu(aion%


23/31

Aracion o- Relea%e o- in-lammaory Accumulaion o-&euro"hil% mediaor% -i(rou% eudae%, red De"re%%ion o- Cough re-le 6"igloal re-le

Blood cell% and (aceria (y "a%%e% he u""er air$ay%

!ilraion and humidicaion o- airRed he"aiaion and con%olaion o-

8ung "arenchymaTachycardia

2 '

(#m.#r("r#ray he"aiaion and de"o%iion o-

!i(rin on "leural %ur-ace% :""er re%"iraory rac in-ecion ha;ing chill%

Tachy"nea

DYSPNEA

Che% "ain

COUGH

Cold%

BRONCHOPNEUMONIA

)eukocytes

nfiltration


24/31

NURSING CARE PLANS

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATIONS"+3#,(4# D(:


25/31

S"+3#,(4# D(:

ro'ided

o""oruniie% -or%lee" and re%"eriod%

Re"o%iioned

clien a% o-en)

Admini%ered

medicaion% a%ordered)

A%%e%%ed and

recorded 'ial%ign%)

(%er'ed -or

%ign% o-re%"iraory

lee" and

re% $ill "re'en-luid lo%% -rom oomuch eerioneacer(aed (yincrea%e $or; o-(reahing

To allo$ lung%

o (e -ully'enilaed,mo(ilie%%ecreion%)

To rea

underlying cau%e)

!or Ba%eline

daa)

To "re'en -urher

aggra'aion o-he condiion


26/31

crac;le%

u"onau%culaion

O+3#,(4# D(:

Decrea%ed

immuniy

Im.r#0*$

#%,/'*#0r#!(#0 (o

r(r..'*6

A he end o- he%hi- he "aien%hould ha'eim"ro'ed ga%echangedmani-e%ed (yle%%ened mucu% anddecrea%ed RR)

A he end o- 30

di%re%%

laced "aien

in %emi-o$ler%"o%iion)

#ncrea%ed -luid

ina;e)

Mainained calm

en'ironmen$hile dealing$ih "aien)

Admini%ered

medicaion% a%indicaed)

&oed ri%;

-acor% -or heoccurrence o-in-ecion)

(%er'ed -or

localied %ing%-or in-ecion a

!or maimum

lung e"an%ion o-aciliae "ro"er(reahing)

To loo%en

%ecreion%)

To a'oid

aniey ha may-urher increa%eoygen need%/con%um"ion

To rea

underlyingcondiion)

#deni-ying he

"o%%i(lecau%ai'e

-acor% hel"%"re'en/conrol heoccurrence o-in-ecion)

Ei%i(le %ing%

o- in-ecionena(le he

oal me e'idenced decrea%ed RR?and le%%en%ecreion%)


27/31

Ri%; -or-urherna%ocomialin-ecion%

minue%, he "aienogeher $ih he $ill (e a(le oF

a) Eer(alieunder%anding o-indi'idualcau%ai'e/ri%; -acor%

() #deni-yiner'enion%o"re'en/reduce ri%; o-in-ecion

in%erion %ie%)

A%%e%%ed %;in

condiion%around in%erion

%ie% o- "in%,$ire%, andong%, noingin-lammaionand drainage)

re%%ed "ro"er

hand $a%hingechniue% (yall caregi'er%and o- he"aien)

#n%ruced

clien/ inechniue% o"roec heinegriy o- he%;in)

managemeno- more%e'erein-ecion%)

The %;in i%

our "rimaryde-en%e

again%in-eciou%di%ea%e%)

and $a%hing

echniue i% a-ir%linede-en%eagain%no%ocomialin-ecion%)

Care -or he

%;in inegriy"re'en% heoccurrence o-in-ecion)


28/31


29/31

DRUG STUD)

HYDROCORTISONE

Br'0 'm#: F!m'*o H)0ro,or($o'# So0"m S",,'(#

C!$$-,(o': G!",o,or(,o0

A,(o': Regulae he mea(olic "ah$ay% in'ol'ing "roein, car(ohydrae and -a)

Co'(r'0,(o'$:8aen, healed and aci'e TB, her"e% %im"le, chronicne"hrii%, acue "%ycho%i%, Cu%hing@% %yndrome, "e"ic ulcer and "redi%"o%iiono hrom(o"hle(ii%)

I'0,(o'$:Acue adrenocoricoid in%u--iciency, (ilaeral adrenalecomy, %e'ere

%hoc;, acue hy"er%en%ii'iy reacion%, o'er$helming reacion% $ih %e'ereoiciy, 86 in rela"%e, a%"iraion "neumonii%, and oher condiion% reuiringhe mea(olic and aniin-lammaory acion% o- hydrocori%one)

A04#r$# #--#,($F !luid elecrolye, mu%culo%;eleal, #, dermaologic,neurological, endocrine, o"hh, mea(olic di%ur(ance%)

N"r$'* R#$.o'$+!(#$:1) A -reuen iner'al%, reduce he do%e gradually o deermine i- %ym"om%

o- he di%ea%e can (e e--eci'ely conrolled (y %maller drug do%e)2) 8ocal admini%raion o- corico%eroid% i% "re-erred o'er he %y%emic

hera"y o minimie %y%emic %ide e--ec%)3) :%e he lo$e% e--eci'e do%e in children and monior rouinely o a'oid

reduced rae o- gro$h)G) Documen indicaion% -or hera"y, y"e, on%e, and characeri%ic% o-

%ym"om%)5) &oe underlying cau%eF adrenal or nonadrenal di%order%)H) Chec; -or any allergic reacion% o corico%eroid% or arraine)


30/31

LEARNING FEEDBAC0 DIAR)

&ameF Bienelen R) Con%anino DaeF &o'em(er 0I10, 151H, 2007

R86 rou"F R86 27 C#F M%) Ma) Con%olacion !ahardo, R)&)

AreaF , !loor 1

(Jeci'e%F

A he end o- our clinical duy, # $ill (e a(le oF

1 Accu%om my%el- more o he ho%"ial %eing and rouine)

2 Carry ou he %;ill% # learned -rom he academe)

3 'er"o$er my di--idence and in%ecuriie% $hen dealing $ih "aien%)

G #m"ro'e my communicaion %;ill% o$ard% dealing $ih di--eren "aien%)5 6"and my ;no$ledge a(ou nur%ing aci'iie%, iner'enion% and drug

"re"araion and admini%raion)

H #m"ro'e my %;ill% in rendering care o my "aien%)

ne %eme%er $a% done and one more, he %chool year i% o'er)Thi% %econd %eme%er i% anoher o""oruniy o im"ro'e he %;ill $e ;no$in nur%ing iner'enion% and o gain more ;no$ledge o- oher nur%inginer'enion%) ur e'ery duy mean% he %ho$ca%e o- our %;ill%) 4e ha'e

o (e aler all he ime o mee he need% o- our "aien%)Thi% i% my -ir% roaion -or he %econd %eme%er) Though i $a%anoher adJu%men, %ince #@m ino a ne$ grou" and no o menion $e@reino a M %hi-, e'eryhing $en %o %moohly) My grou" mae% are -un o(e $ih $hich ;ee" me -rom -eeling %lee"y) 6'en our clinical in%rucor$a% indeed a grea hel" %ince %he allo$% u% o re% once in a $hile)

# $a%n@ really my -ir% ime o ha'e my duy in , !loor 1 i $a%my hird ime any$ay, hough no in he %ame %hi-) Bu i $a% indeed my-ir% ime o ha'e a duy on a M %hi-) The %eing ha%n@ change houghhere i% a lile (i change in he rouine %ince i i% ime -or he "aien% oha'e heir re%%) 4e ha'e o do a lo o- ecu%e -or he di%ur(ance $e

cau%e during heir %lee"%) # $a% a nice e"erience (y he $ay (ecau%e #$a% a(le o ry he M %hi-)Thi% roaion ha% done a lo o me) # ha'e learned %ome %;ill% and #

$a% a(le o im"ro'e in he %;ill% # already ;ne$) 4ih hi% roaion, #e"erienced o (ecome a eam leader) #@'e e"erienced o (e amedicaion nur%e during he -ir% %eme%er (u no a eam leader %o i $a%anoher challenge o me) # $a% a -un e"erience hough here ha'e nomuch o (e done %ince i $a% my ime o (ecome he eam leader $hen


31/31

hey didn@ allo$ u% %uden nur%e% o admini%er #E medicaion%) There nomuch o (e done (y a eam leader com"ared o (ecoming a (ed%idenur%e) #@% Ju% your duy o remind he (ed%ide nur%e% a(ou hemedicaion% hey ha'e o admini%er on a %"eci-ic ime and o ma;e %ureha all he medicaion% $ere a'aila(le in "aien@% medicaion ray) And

al%o a he end o- he %hi-, i i% al%o your duy o com"ile all he lae% 'ial%ign% a;en (y he (ed%ide nur%e% -or he endor%emen) Com"ared oa;ing 'ial %ign% e'ery 2 or G hour% (y a (ed%ide nur%e, here@% nohingmuch o do -or a eam leader ece" o ry hel"ing he (ed%ide nur%e%$hile $aiing -or he ime o "re"are and gi'e he medicaion%)

6'ery roaion i% an o""oruniy o im"ro'e and gain more %;ill%)And in e'eryday o- our duy, i i% a chance -or u%, nur%e%, o hel" our"aien% heal ino a healhy indi'idual)

Case Study - Pneumonia Final

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