Comprehensive Part2

LEGEND:

- Patient’s Father and Mother

- Patient’s Siblings

- Patient

- Direct Relationship

SOURCES OF DATA

Primary: Patient’s profile and Patient itself

Secondary: Patient’s wife

Psychosocial-Economic Health History:

Patient “TB” is born on November 23 1966 via normal delivery assisted by a trained birth attendant. Patient “TB” had his Elementary years at Burauen South Central School and had her Secondary education at Burauen Comprehensive National High School. She wasn’t able to study in College because in the first place he’s not interested and also they don’t have the money that will suffice for his education. So at age of 22 he got married to Mrs. “TB” and have 3 children, to cater all their needs he need to work as a butcher in a Slaughter House in Burauen. He have been into that work for 13 years up to this moment. “Kun diri ini na akun trabaho diri ko mapapakaun tak pamilya.” He verbalized. They are living in a Barangay 15 kilometers away from the proper, but when the time he started to experienced intermittent cough, he migrated to the house of his mother located at Brgy. San Ramon, for the reason that they are near to a copra house or “Landahan” filled with smoke. Their house in Brgy. Malibog have 2 rooms, 3 windows, 2 doors and constructed with a semi-concrete house. They also have electric and water connection of their own. He is also a good Father to all of his children, “Waray ako makaiskwela han college asya balit naniniguro ako pagtrinabaho para maihatag man la ha ira hin it maupay na hiagi kumpara an akun guin-again.” He verbalized. His salary is just enough to sustain their need for food, clothing and education. (He’s salary wasn’t divulge because he is ashamed)

Commonly if they have an extra food they usually kept it on their own refrigerator and dispose their garbage by means of composting and digging. They have their own compost pit 5 meters away from their house. They also have their comfort room inside of their house. They also have a motorcycle that serve as their means of transportation and also has a cellular phone used for communication to one of their family member that is far away from them. He is also a good neighbor and relatives as evidenced by the person who visited him during his hospitalization. Usually if their family faced problems he always tries to solve it right away. And as a head of the family he is also assigned for every decision making but also involving his wife.

According to him, he is a smoker since he was 15 years old and also a drinker. In a day he consumed 10 sticks of Fortune but when he started to experienced cough he little by little have a cessation in smoking and only consumes 2 sticks per day. During drinking session especially on their leisure time in the slaughter house, he can consume ½ galloon of Tuba. “It akon mga kaupod ha karneruhan mga naniggarilyo man gihapon, mga ka-edad ko gad la hira sanglit paman bisan guin-hihinukab nasigarilyo la gihapon.” He stated. “Diri man gihapon ako maaram kon hi ako la ba it may kondisyon na sugad hini kay it akon mga katrabaho baga okay man hira, mga guin-iinubo pero ambot ngahaw kun mayda dugo it era pag-kukughad.” He added

SOURCES OF DATA

Primary: Patient’s profile and Patient itself

Secondary: Patient’s wife

C O U R S E in the W A R D A case of Patient TB a male, 47years old, a Roman Catholic and is currently residing at San Ramon St., Burauen, Leyte and was admitted on August 29, 2013 at around 07:25P.M. Per wheelchair demand assisted by wife. Patient was awake and responsive with chief complaints of productive cough with blood streaked sputum noted and febrile. With an initial vital signs of:

BLOOD PRESSURE: 120/80mmHg PR: 89bpm RR: 28cpm TEMP: 38.3˚C.

He was given Paracetamol 500mg. for every temperature >37.8˚C by the ER Nurse. Informed consent signed by patient’s wife and secured. He was examined by Dr. “C” and ordered CBC, BT, and Sputum examination at their RHU, TPR recording every shift. But due to the hospital protocol about collecting specimens they are only from 09:00am up to 03:00pm, so the blood to be withdrawn were collected the day after. Venoclysis started, PLR 1L regulated at 20gtts/min. the patient was placed on diet as tolerated and watched for any hemoptysis episode records its volume and characteristic of the blood. Medications were also ordered as to: Tranexamic Acid 500mg P.O. every 8 hours (12mn-8am-4pm), and Sinecod Forte 20mg TID (1pm-9pm-5am) and Vitamin B complex 1capsule once a day (7am).

At around 08:10pm the patient was endorsed to the ward per wheelchair and confined at Isolation Ward Station C. He was placed comfortably and ample rest stressed to the patient. The S.O. was instructed to watch for hemoptysis episode and watch the characteristics and amount of the blood. Due med. were given (Tanexamic 1st dose) and latest BP was 110/80mmHg.

On his first day of confinement: (August 30, 2013)

07:00am-3:00pm SHIFT

At around 07:10am (FIRST DAY OF DUTY) routine rounds done. Patient “TB” received awake with ongoing IVF of PLR 1L and regulated 20gtts/min. The patient was seen and examined by Dr. “C” with orders to continue medications and IVF to follow same fluid and same rate. Upon auscultation crackles noted at the LUL and labored breathing noted, thus proper breathing exercise rendered to the patient. The patient felt comforted and relieved. The patient is still for CBC, BT and Sputum examination. At around 10:00am the medical technologist collects the specimen for laboratory work-ups. Due meds are given. At around 2:30pm the result of his laboratory was endorsed to the Nurse-on-Duty, revealing the laboratory result varying for high and low values. Cough with blood streaked sputum at around 10cc were noted. Patient kept rested and made comfortable. On our first day of duty to this patient, the student nurse assigned to this patient rendered routine morning care. Patient placed on semi-fowlers position to provide total lung expansion,

stressed complete bed rest. Health teachings imparted with emphasis on: proper hygiene, increasing oral fluid intake but also monitoring his intake and output and also importance of adequate nutrition. V/S was in normal range and body weakness still noted.

03:00pm-11:00pm SHIFT

The patient is awake conscious and coherent. Patient was with cough and blood streaked sputum at around 5cc level. Health teachings were imparted as to total bed rest, Monitoring Fluid intake and Proper Hygiene. Due meds are given. There were no complaints rendered by the patient. V/S was all in normal range.

11:00pm-07:00am SHIFT

The patient is still with cough and blood streaked sputum. Headache were the only complaints rendered by the patient. Patient stressed to have bed rest and report adequately to the nurse station if the pain intensity got worsen. There were no special orders and endorsement done. Due meds are given and V/S was in normal range.

On his second of confinement: (August 31, 2013)

07:00am-03:00pm SHIFT

On August 31, 2013 at around 10:00am patient was seen and examined by Dr. “S” with orders made and carried out. The doctor ordered to continue medications and PLR 1L ,regulation was change from 20 gtts/min to 25gtts/min. patient still had some episodes of hemoptysis but not as intense as what he experienced from the previous days, body weakness also less felt by the patient. Due meds are given and patient was encouraged to have an ample rest and eat nutritious food as to quality and quantity (e.g. Iron-riched food such as green leafy vegetables and glandular organs). Still for Sputum examination in their RHU.

03:00pm-11:00pm and 11:00pm-07:00am SHIFT

At exactly 03:20pm above IVF of the patient is infiltrated and kept on KSS. Around 04:10pm IVF reinserted by the nurse-on-duty and regulated at around 25gtts/min. At around 11:20, received patient asleep and above IV is intact and infusing well at the right metacarpal vein of the patient. There was no further unusualities rendered by the patient. Due medications are given and V/S was in normal range.

On his third of confinement: (September 01, 2013)

07:00am-03:00pm SHIFT

At exactly 06:00am the doctor ordered to continue medications and still for sputum examination. Patient still with cough and blood tinged sputum at around 12cc level. Health teachings imparted with emphasis on oral hygiene, strict bed rest and adequate nutrition. Due medications are given and V/S was in normal range.

03:00pm-11:00pm and 11:00pm-07:00am SHIFT

At exactly 08:30pm after the rounds of the staff the patient is febrile 38.3˚c and was given Paracetamol 500mg 1tab. Continuous TSB rendered and made comfortable. At exactly 10:00pm his latest temperature is 37.2˚c. Crackles heard upon auscultation. Health teachings imparted with emphasis on increasing fluid intake and adequate nutrition. Exactly at around 03:00am patient had a fever for the second time but this time accompanied with difficulty of breathing with respiratory rate of 32cpm. Complaints rendered by the patient were referred by the nurse-on-duty. The Doctor ordered oxygen inhalation 2-3L minute and was carried out. Patient was on oxygen inhalation and was given Paracetamol 500mg with aspiration precaution. Due medication was given and V/S with in normal range. Latest temperature 36.6˚c and continuous TSB done.

On his forth of confinement: (August 02, 2013)

07:00am-03:00pm SHIFT

At exactly 07:45am the doctor ordered PLR 1L and was regulated 25gtts/min. patient reported less cough and negative hemoptysis. Body weakness also less felt as claimed by the patient. His wife went to RHU to get a vial for sputum exam at around 09:45am and was collected and transported back at around 01:00pm. The staff in the RHU told his wife to go back after 2 days. Health teaching imparted, due medications given and V/S within normal range.

03:00pm-11:00pm and 11:00pm-07:00am SHIFT

At around 04:00pm the Doctor ordered to terminate IV and discontinued Tranexamic acid. Negative hemoptysis noted but still with occasional cough. No unusualities noted. Due meds are given and V/S within normal range.

On his fifth day of confinement: (August 02, 2013)

07:00am-03:00pm SHIFT

At around 08:10am the Doctor ordered may go home and with home medications as to: Vitamin B complex 1capsule for 30 days and Sinecod Forte 2g three times a day after meal for 30 days. Discharged slip prepared by the patient and patient wife was

advised for clearance. At around 11:45am the patient SO surrendered their linens and cleared the clearance. 12:15 the patient went home in an improve condition per wheelchair demand accompanied by his wife.

G O R D O N’ S 11 T Y P O L O G Y

F U N C T I O N A L H E A L T H P A T T E R N

DATE TAKEN: August 30, 2013 at exactly 08:15amGeneral survey: Patient DHF 47 years old male, is fully developed, appears normal on his chronological age, is conscious, coherent and has an ongoing IVF of LRS 1 liter, regulated at 20 gtts/min infusing well at left metacarpal vein. Body weakness and dizziness, cough with hemoptysis and difficulty of breathing are the complaints available to the patient.

Vital signs upon (receiving):BLOOD PRESSURE: 110/70mmHg PR: 83bpm RR: 26cpm TEMP: 37.3˚C

1. HEALTH PERCEPTION–HEALTH MANAGEMENT PATTERN

Kun pa pagrate ka hiton imo panlawas yana ngan han hadi nga kun diin 1 iton pinakahamubo ngan 10 iton pinakahitaas pira man iton imo pag-abat hiton imo panlawas?

Past: “Han hadi han waray pa ak sakit 8 kay waray pa man ak inaabat na dire maupay”

Present: “Yana mga 6 kay damu naman tak inaabat na di maupay, maluya tak lawas may-ada pa ak ubo, danay liwat kinukuri-an ak paghinga ngan waray ak gana pagkaon tungod nga tak nararasahan it akun plema”

Para ha imo ano ka importante iton maupay na panlawas?

Past& Present: “Iton ba nga waray sakit ha lawas ngan maupay it pinanmamati.”

Gin aanu mo man para mamintinar iton maupay na imo panlawas?

Past: “Pirme la nakaun hin maupay.”

Present: “Yana baga nakaun nala ako, nanlilimugmog la ako para diri mapait tak panrasa.”

Sugad hin may-ada kaba sakit napakadto kaba dayun ha ospital?

Past: “Danay guin-papabay-an ko kun kaya ko pa.”

Present: “Han pagka-yana di ko naman kaya tak inaabat asya nagpa-ospital nala ako dayon.”

Ano iton imo mga burahaton na para ha imo makakabulig hin maupay na panlawas?

Past: “Nakaon la hin maupay ngan nag-eehersisyo”

Present: “Yana baga dire na ako nag-eehersisyo kay aanhi laak higdaan usa pa diri na gihap ako nasigarilyo pero guin bibiling-biling ko la gihap pero bawal man dinhi.”

Ha pagkayana ano man iton imo gin-aabat?

Present: “Maluya ha lawas, mayda ko ubo ngan waray gana pagkaon .”

Ano man iton imo ekspektasyon dinhi ha ospital ngan iton mga nurses?

Past&Present: “Han nakadto ako ha balay guin-huhuna ko na mas matatambal ako kun makanhi ako ha ospital.”

Nagkamay-ada kana ba iba na sakit na gin dara kana gihap ha ospital?

Past&Present: “Waray, syahan ko nga na-admit nganhi.”

Kumpleto ba imo bakuna?

Present: “Dire ako nakahinumdum kun natagan ba ako hito nga bakuna kay tak nanay man la ito it maaram.”

May-ada kaba allergy ha pagkaon ngan medisina?

Past& Present: “Ha akun pakakahinumdum baga waray man.”

May-ada ka ba Philhealth or insurances?Present: “May-ada Philhealth”

May-ada ka ba namana na sakit ha iyo pamilya?Present: “Waray man”

2. NUTRITIONAL-METABOLIC PATTERN

Ano an imo guin-kaon ngan guin-inom han sakob han 24 oras?

DINNER BREAKFAST LUNCH

Fish Bread 1 glass of water

Lugaw 1 glass of water Banana

1 glass of water

Dire ka ba mapili hin pagkaon?Past: “Naka-on man aku hin bisan ano”Present: “Yana tag-gurudti na la tak guin-kakaon, kaurugan ngani lugaw la

pero di ko ngan ito nauubos nga rasyon”

Ano it imo paborito nga pagkaon?Past: “Mahilig ako hin karne ngan isda.”Present: “Waray man kay di man ak guin-gaganahan pagkakaon yana.”

May-ada ka ba guin-iinum na vitamins?Past&Present: “Waray kay namamahalan kasi ako ito.”

Ano man it imo normal na timbang?Past: “Ha ak bana-bana 60kg”Present: “Gumasa man ako, 57kg nala ak yana dida han akun ka-admit”

Hin-o man iton napalit hit iyo guin-kaka-on?Past:”Danay ako, danay tak asawa, depende la kun hin-o it waray salang”Present: “Adi man ak naadmit, ha rasyon la”

Hin-o man it ka-urog nga nagluluto hit iyo pagkaon?Past: “Danay ako, pero kaurugan tak asawa.”Present: “Ospital syempre.”

May-ada ba panahon na guin-kukuri-an ka pagkaon?Past: “Di man ak guin-kukuri-an hadto pagkaon”Present:”Yana di gud ak nakaon hin maupay, kay plema la tak nararasahan.”

Nakakapira ka kaon ha usa ka-adlaw?Past: “Ada kay nakakatulo.”Present:”Yana depende nala, kumaon man ako tag-usa o duha nala ka kutsara.”

3. ELIMINATION PATTERN

Kada ano ka man nauro? Ano nga oras? Malagay ba o medyo bug-os?Past: “Kada adlaw man ak nakauro hadto ngan bug-os an ak baya.”Present: “Depende la, danay naka-uro yana na adlaw, danay liwat waray.”

Nagkamay-ada ka na ba panahon na kinuri’an ka pag-uro?Past: “Hadi waray man, pero kun guinkukuri-an ak nainum la ako hin tubig”Present: “Dire man ak guin-kukuri-an pag-uuro”

Nakapira ka man ihi ha usa ka adlaw?Past: “Han una, nakadamo ako iihi.”Present: “Depende kun damo tak iniinum damo gihap tak ihi.”

Nagka-mayda ka na ba problema hiton imo pag-ihi?Past: “Iday han baga burubata pa ako waray ako pagproblema pag-ihi”Present: “Yana tak pag-ihi nadepende hiton akon iniinom.”

4. ACTIVITY/EXERCISE PATTERN

Ano iton imo adlaw-adlaw na guin-hihimo na nakakabulig hiton imo pagehersisyo?Past: “Adto man ako ha karneruhan sanglit amo nala gihap ito it nakakabulig haak pag-aalsa naman baga damo la, diri man gihap ako naklingkod didto.”Present: “Dire na ko nakakapagehersisiyo kay pirmi nala ak naghihinigda.”

Kun waray ka guin-bubuhat ano man iton imo guin-hihimo para masalang ka?Past: “Pagkatapos ko ha karneruhan, nagpipinatukar na la ako ha balay”Present: “Baga turu-tagilid la danay namat unat-unat.”

Dire ka man danay guin-kukuri-an paghinga?Past: “Dire ako han una guin-kukuri-an paghinga dati.”Present: “ Kun nahigda ako baga ako hin nalulumos sanglit tag-duha tak ulunan.”

Dire ka ba kapuyon?Past: “Dire hiara man na baga damo buruhaton.”Present: “ Han yana baga hin kapuyon na lugod ako”

5. SLEEP-REST PATTERN

Ano it imo oras nga igkakaturog? Anu liwat tim oras nga igmarata?Past: “Han una nakaturog na ako mga alas 8 pala tpos timprano pa tak

igmarata mga alas 3 pala”Present: “Guin-kukuri-an ako pagkaturog sanglit hiton aga danay

nagkikinaturog nala ako.”

May-ada ka ba guin-tutumar para makakaturog?Past&Present: “Baga waray man.”

Nakakatutrog kaba hit udto?Past: “Usahay la, dipende la kun waray mga buruhaton, pero usahay napahuwayay gad man.”Present: “O okay diri man gud ako usahay nangangaturog it gab-i. Sige man la akun mata-mata waray duru-diretso na katurog.”

6. COGNITIVE-PERCEPTUAL PATTERN

Para ha imo madali ka la ba mahibaro?Past&Present: “Oo madali lugud ako mahibaro pero kun paeskwelahun ako diri ngahaw ako.”

Ano na grado nim natapos?Present: “Highschool la.”

Maupay ba it imo pagdara hit imo mga kasangkayan?Past&Present: “Oo basta maupay liwat ha akon para waray problema.”

Kun may-ada ka problema guin-aano mo man pagsulbar?Past&Present: “Ay, nag-iistorya gad kami tak asawa hasta paman yana kun mayda kami problema pirmi kami ito nagsasabot tak asawa kun ano it maupay na buruhaton.”

May-ada ba panahon na nakaabat ka hin malipong iton imo ulo?Past: “Waray man.”Present: “Oo kun maiha na ako naghihinigda.”

7. SELF-PERCEPTION/SELF-CONCEPT PATTERN

Hin-o man ha imo pamilya iton imo kusog? Imo kaluyahan?Past&Present: “It akun mga anak waray na iba pa.”

Ano it imo pagkita ha imo lawas?Past: “Ok man la kay waray man ako hadto inaabat.”Present: “ Yana baga dire maupay kay nasakit ako.”

Ano liwat it nagpapahalipay ha imo?

Past&Present: “Kinahanglan may-ada pagkaon, medisina, kwarta ngan tak pamilya.”

Ha imo pagkita ano it nakakabulig hit imo madagmit na pag-upay?Past&Present: “Nakakabulig ha akon iton akon mga anak pagfinance, pero

una an Ginoo”

8. ROLE RELATIONSHIP PATTERN

Maupay ba it imo relasyon ha imo pamilya?Past&Present: “Ha, oo naman pero diri hipa-urusahan may mga problema gihap.”

Hin-o iton imo pinaka-guindada-upan ha imo pamilya?Present: “Mga anak ko, mahal ko silang lahat pero labaw gad gihapon it akun asawa kay amo it mas makakaintindi.”

Hin-o iton imo pinaka-importante nga tawo ha imo kinabuhi?Present: “Amo la gihapon akon mga anak ngan akon asawa.”

Napartisipar ka ba ha simbahan?Past: “Usahay nasimba la kami kada Dominggo pero diri gud man pirmanente.”Present: “Ha yana dire na gud kay aadi la gihap ako ospital.”

9. SEXUALITY-REPRODUCTIVE PATTERN

Guin-planohan ba niyo kun pira it iyo magiging anak.?Present: “Oo, tanan man it hira.”

Nagamit ba kamo hin mga kontraseptibo?Past: “Oo, nagamit ako withdrawal la, per akun padis nag pipills hiya diri paman hiya layget.”Present: “Diri na.”

Nakikipaghilawas la ba gihap kamo it imo asawa?Past: “Ay oo, pero baga tikalagas naman liwat kami.”Present: “Badaw ngahaw kay-aanhi man kami ha ospital, balitaw baga husto na ito dagko naman gihap tam anak.

10. COPING-STRESS TOLERANCE PATTERN

Kun na-istress ka, guin-aano mo man paglibang iton imo kalugaringion?Past: “Nakaon ak kun na-stress ak”Present: “Pinabay-an ko nala usa pa problema la ito, mas dako ako ha iya.”

May-ada na ba namatay ha iyo pamilya?Past&Present: “Oo may-ada pero maiha na nga panahon.”

Ano an pinaka-istressful nga panhinabo han imo kinabuhi?Present: “Siguro an ka-admit k okay baga makapoy man it naghihinigdaun la.”

Guin-ano mo man para makalimtan an adto na panhinabo?Present: “Guin-kakarawat nala, usa para man gihap ini tak kaupayan”

11. VALUE-BELIEF PATTERN

Kun may-ada ka ba sakit nangaro ka ba hin bulig hit ginoo?Past&Present: “Oo gad kay hiya la it labi na mag-garahum ngan parag-boot.”

Nasimba ka ba kada dominggo?Past: “Oo, kami tak pamilya kada kulop usahay hira la liwat kun diri damo tak trabahuon.”

Present: “Diri na gud aadi man la ako ospital, siguro pagmakagawas ako manimba kami, pagpasalamat nala gihapon.

Nadaop kaba hit mga tambalan?Past: “Baga dipindi la ada kun baga nabuyagan ngan nadaot amo la siguro it akun sakit diri man ada ini guin-daot la o diri ngani guin-darahugan.”Present: “Diri kay usa pa waray man ito kasiguruhan, maupay ospital kay na

momonitor ka, ugaring la kay naghihinigda la pirmi nganhi.

R E V I E W O F S Y S T E M S

A N A T O M Y and P H Y S I O L O G Y

Function:

The respiratory system is the group of tissues and organs in your body that enable you to breathe. This system includes your airways, your lungs and the blood vessels and muscles attached to them that work together so you can breathe. The respiratory system's

primary function is to supply oxygen to all the parts of your body. It accomplishes this through breathing: inhaling oxygen-rich air and exhaling air filled with carbon dioxide, which is a waste gas.

Main Parts of the Respiratory System and their Function:

The nostrils: Nostrils are involved in air intake, i.e. they bring air into the nose, where air is warmed and humidified. The tiny hairs called cilia filters out dust and other particles present in the air and protects the nasal passage and other regions of the respiratory tract.

Trachea: The trachea is also known as windpipe. The trachea filters the air we inhale and branches into the bronchi.

Bronchi: The bronchi are the two air tubes that branch off of from the trachea and carry atmospheric air directly into the lungs.

Lungs: The main organ of the respiratory system is lungs. Lungs are the site in body where oxygen is taken into and carbon dioxide is expelled out. The red blood cells present in the blood picks up the oxygen in the lungs and carry and distribute the oxygen to all body cells that need it. The red blood cells donate the oxygen to the cells and picks up the carbon dioxide produced by the cells.

Alveolus: Alveolus is the tiny sac like structure present in the lungs which the gaseous exchange takes place.

Diaphragm: Breathing begins with a dome-shaped muscle located at the bottom of the lungs which is known as diaphragm. When we breathe in the diaphragm contracts and flatten out and pull downward. Due to this movement the space in the lungs increases and pulls air into the lungs. When we breathe out, the diaphragm expands and reduces the amount of space for the lungs and forces air out.

The respiratory system is made up of airways (your nose, mouth, voice box, windpipe and bronchial tubes) and the lungs and the muscles and blood vessels connected to them.

Gas Exchange:

This is how the respiratory system works: First you breathe air in through your nose and mouth, which wet and warm the air so it won't irritate your lungs. Then the air travels through your voice box, down your windpipe and then though two bronchii (bronchial tubes) into your lungs. Cilia (tiny mucous-covered hairs) in your airways entrap foreign particles and germs to filter the air that you breathe. You then cough or sneeze the particles out of your body. The diaphragm, abdominal muscles and other muscles help your lungs expand and contract so you can inhale and exhale. When you inhale, the air goes through the bronchii in your lungs to blood vessels that connect to veins and arteries. These veins and arteries carry the blood throughout your body. When you exhale, the carbon dioxide goes out the same way, exiting your body through your nose and mouth. If you can't breathe or can't breathe well, not only will your body not receive enough oxygen to keep it running, but it will also be poisoned by the carbon dioxide that is building up in your blood and has nowhere to go. Both oxygen and carbon dioxide are transported around the body in the blood – through arteries, veins and capillaries. They bind to hemoglobin in red blood cells although this is more effective with oxygen. Carbon dioxide also dissolves in the plasma or combines with water to form bicarbonate ions. The main respiratory surfaces in humans are the alveoli. Alveoli are small air sacs branching off from the bronchioles in the lungs. They are one-cell thick and provide a moist and extremely large surface area for gas exchange to occur. Capillaries carrying deoxygenated blood from the pulmonary artery run across the alveoli - they are also extremely thin so the total distance gases must diffuse across is only around 2-cells thick.

Inhaled oxygen is able to diffuse into the capillaries from the alveoli, while carbon dioxide from the blood diffuses in the opposite direction into the alveoli. The waste carbon dioxide can then be exhaled out of the body. Continuous blood flow in the capillaries as well as constant breathing maintains a steep concentration gradient.

Physiology in Mammals

Ventilation

In respiratory physiology, ventilation (or ventilation rate) is the rate at which gas enters or leaves the lung. It is categorized under the following definitions:

Measurement Equation Description

Minute ventilation

tidal volume * respiratory rate

the total volume of gas entering the lungs per minute.

Alveolar ventilation

(tidal volume – dead space) * respiratory rate

the volume of gas per unit time that reaches the alveoli, the respiratory portions of the lungs where gas exchange occurs.

Dead space ventilation

dead space * respiratory rate

the volume of gas per unit time that does not reach these respiratory portions, but instead remains in the airways (trachea, bronchi, etc.).

Ventilation occurs under the control of the autonomic nervous system from parts of the brain stem, the medulla oblongata and the pons. This area of the brain forms the respiration regulatory center, a series of interconnected brain cells within the lower and middle brain stem which coordinate respiratory movements.

The breathing rate increases with the concentration of carbon dioxide in the blood, which is detected by peripheral chemoreceptors in the aorta and carotid artery and central chemoreceptors in the medulla. Exercise also increases respiratory rate, due to the action of proprioceptors, the increase in body temperature, the release of epinephrine, and motor impulses originating from the brain. In addition, it can increase due to increased inflation in the lungs, which is detected by stretch receptors.

Inhalation Inhalation is initiated by the diaphragm and supported by the external intercostal muscles. Normal resting respirations are 10 to 18 breaths per minute, with a time period of 2 seconds. During vigorous inhalation (at rates exceeding 35 breaths per minute), or in approaching respiratory failure, accessory muscles of respiration are recruited for support. These consist of sternocleidomastoid,platysma, and the scalene muscles of the neck. Pectoral muscles and latissimus dorsi are also accessory muscles.Under normal conditions, the diaphragm is the primary driver of inhalation. When the diaphragm contracts, the ribcage expands and the contents of the abdomen are moved downward. This results in a larger thoracic volume and negative pressure (with respect to atmospheric pressure) inside the thorax. As the pressure in the chest falls, air moves into the conducting zone. Here, the air is filtered, warmed, and humidified as it flows to the lungs. During forced inhalation, as when taking a deep breath, the external intercostal muscles and accessory muscles aid in further expanding the thoracic cavity. During inhalation the diaphragm contracts.

Exhalation Exhalation is generally a passive process; however, active or forced exhalation is achieved by the abdominal and the internal intercostal muscles. During this process air is forced or exhaled out. The lungs have a natural elasticity: as they recoil from the stretch of inhalation, air flows back out until the pressures in the chest and the atmosphere reach equilibrium. During forced exhalation, as when blowing out a candle, expiratory muscles including the abdominal muscles and internal intercostal muscles, generate abdominal and thoracic pressure, which forces air out of the lungs.

Gas exchange

This image explains that before carbon dioxide can diffuse out of the blood into the alveoli, it must first be released from its bicarbonate ion form. For this to occur, bicarbonate ions must combine with hydrogen ions to form carbonic acid.

The major function of the respiratory system is gas exchange between the external environment and an organism's circulatory system. In humans and other mammals, this exchange facilitates oxygenation of the blood with a concomitant removal of carbon dioxide and other gaseous metabolic wastes from the circulation. As gas exchange occurs, the acid-base balance of the body is maintained as part of homeostasis. If proper ventilation is not maintained, two opposing conditions could occur: respiratory acidosis, a life threatening condition, and respiratory alkalosis. Upon inhalation, gas exchange occurs at the alveoli, the tiny sacs which are the basic functional component of the lungs. The alveolar walls are extremely thin (approx. 0.2 micrometres). These walls are composed of a single layer of epithelial cells (type I and type II epithelial cells) close to the pulmonary capillaries which are composed of a single layer of endothelial cells. The close proximity of these two cell types allows permeability to gases and, hence, gas exchange. This whole mechanism of gas exchange is carried by the simple phenomenon of pressure difference. When the air pressure is high inside the lungs, the air from lungs flow out. When the air pressure is low inside, then air flows into the lungs.

Immune functions Airway epithelial cells can secrete a variety of molecules that aid in the defense of lungs. Secretory immunoglobulins (IgA), collectins (including Surfactant A and D), defensins and other peptides and proteases, reactive oxygen species, and reactive nitrogen species are all generated by airway epithelial cells. These secretions can act directly as antimicrobials to help keep the airway free of infection. Airway epithelial cells also secrete a variety of chemokines and cytokines that recruit the traditional immune cells and others to site of infections. Most of the respiratory system is lined with mucous membranes that contain mucosal-associated lymphoid tissue, which produceswhite blood cells such as lymphocytes.

Metabolic and endocrine functions of the lungs In addition to their functions in gas exchange, the lungs have a number of metabolic functions. They manufacture surfactant for local use, as noted above. They also contain a fibrinolytic system that lyses clots in the pulmonary vessels. They release a variety of substances that enter the systemic arterial blood and they remove other substances from the systemic venous blood that reach them via the pulmonary artery. Prostaglandins are removed from the circulation, but they are also synthesized in the lungs and released into the blood when lung tissue is stretched. The lungs also activate one hormone; the physiologically inactive decapeptide angiotensin I is converted to the pressor, aldosterone-stimulating octapeptide angiotensin II in the pulmonary circulation. The reaction occurs in other tissues as well, but it is particularly prominent in the lungs. Large amounts of the angiotensin-converting enzyme responsible for this activation are located on the surface of the endothelial cells of the pulmonary capillaries. The converting enzyme also inactivates bradykinin. Circulation time through the pulmonary capillaries is less than one second, yet 70% of the angiotensin I reaching the lungs is converted to angiotensin II in a single trip through the capillaries. Four other peptidases have been identified on the surface of the pulmonary endothelial cells.

L A B O R A T O R Y E X A M I N A T I O N

DIAGNOSTIC EXAM: CBC, BT DATE ORDERED: August 29, 2013

PATIENT’S NAME: Pt. “PTB” REQUESTING PHYSICIAN: Dr. C

HEMATOLOGY

TEST RESULT NORMAL VALUES IMPLICATION

HEMATOCRIT 0.31 0.36-0.47 Decreased, the value of hematocrit is dependent upon the number of RBC; if Hematocrit is abnormal RBC is abnormal as well, hemorrhage can be a reason of decrease hematocrit because both plasma and RBC have been lost in equal proportion.

WBC COUNT 10.80X10 9/L 4.5-10X 9/L Increased, caused by a proportional increase in leukocytes of all types. When this

does occur, it is usually a result of hemoconcentration. Depends on the severity of infection, patient’s resistance, patient’s age, marrow efficiency and reserve.

BLOOD TYPE “O”

DIFFERENTIAL COUNT:

NEUTROPHILS 0.66 0.50-0.75 Normal

LYMPHOCYTES .29 0.20-0.35 Normal

EOSINOPHILS .05 0.03-0.05 Normal

DIAGNOSTIC EXAM: Radiology DATE TAKEN: August 27, 2013

PATIENT’S NAME: Pt. “PTB” REQUESTING PHYSICIAN: Dr. S

CHEST X-Ray PA VIEW

FINDINGS:

Fibrohazed infiltrates are noted at the right upper lobe.

Trachea air column at midline.

The heart shadow is not enlarged.

Sorrounding soft tissues and osseous structures are not unusual.

IMPRESSION:

1. PTB MODERATELY ADVANCE

INTRAVENOUS STUDY

IV Solution

Contains Mechanism of Action

Contraindication

Side Effects

Nursing Responsibilities

Plain Lactated Rangers Solution (PLR) @

20 gtts/min

in the left metacarpal vein.

130 mEq of Sodium ion

109 mEq of Chloride ion

28 mEq of Lactate

4 mEq of Potassium ion

3 mEq of Calcium ion

Isotonic solution. When administered intravenously, these solutions provide sources of water and electrolytes.

Their electrolyte content resembles that of the principal ionic constituents of normal plasma and the solutions therefore are suitable for parenteral replacement

No known contraindications.

Use precaution with CHF, renal insuifeciency, edema state with sodium retention, hyperkalemia, metabolic or respiratory alcalosis.

Do not administer simultaneously with blood through same administration set

Phlebitis on the IV site, fever, severe venous thrombosis and hypervolemia.

*NOTE: before use, perform the following check:

Inspect each container.

Read the level of the IV solution.

Insure solution is the one ordered and is with expiration date to know if it is still usable.

Inspect container carefully the solution in good light for any signs of cloudiness, haze, or particulate

of extracellular losses of fluid and electrolytes. Potassium plays an important role in electrolyte balance. Normally about 80 to 90% of the potassium intake is excreted in the urine: the reminder in the stool and to a small extent, in the perspiration. The kidney does not conserve potassium well so that during fasting or in patient on a potassium-free diet, potassium loss from the body continues resulting in potassium depletion.

The lactate ion is in equilibrium

because of the likelihood of couagulation.

matter.

Any container which is suspect to be unsterile should not be used.

Use only if solution is clear and with the manufacturers’ information is intact.

Monitor patient frequently for:

a. Signs of infiltration-sluggish flows.

b. Signs of phlebitis and infection.

c. Condition of catheter dressing.

Check for the level of IV if it is consuming.

Check and regulate the drop rate.

Change the IVF solution if needed. Then check for the correct

with pirovate and has alcalizing effect resulting from simultaneous removal by the liver and lactate and hydrogen ions. In the liver, lactate is metabolize to glycogen which is ultimately converted to carbon dioxide and water by oxidation.

solution, medications, and volume when changing.

Monitor intake and output