Grand Case Study Final

8/13/2019 Grand Case Study Final

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I. INTRODUCTION:Basically the purpose of this study is to relay a realistic information to the readers

providing complete experience based data that would hopefully assess our knowledge in research

making. In the course of making this study we strongly suggest that student nurses should begin

his/her experience from the student nurses first encounter with the patient subject to the study.

This would aid a student to deliver accurate information for his/her study. We would also like to

suggest having an intensive bed side cares for as to the role performance which is necessary

though in some settings the same observably being compromised.

Fungi, parasites, and viruses. This is the most common cause of death here in the

Philippines. In ranked third among the causes morbidity and fourth the causes of death in 2000.

There was an increase in the morbidity trend for pneumonia from 1990 to 1996. This may be due

to improved case finding and reporting with the intensification of the program to control acute

respiratory infections during this period. The morbidity trend decreased slightly from 1997 to

2000 but the number of cases remained high at 829 cases per 100,000 populations in 2000. On

the other hand, there is a decreasing trend of mortality from pneumonia in the general population

from 1990 to 2000 despite the high number of cases per year. The mortality rate from pneumonia

decreased from 64.7 deaths per 100,000 population in 1990 to 42.7 deaths per 100,000

population in 2000.

Pneumonia is the most common cause of death from infectious disease in the

United States. Together they account for nearly 60,000 deaths annually and ranked as the 8th

leading cause of death in the United States (MINING, HERON, MURPHY, et al., 2007). CAP

occurs either in the community setting or within the first 48 hours after hospitalization as

Institutionalization. The need for hospitalization for CAP depends on the severity of PHN. The

causative agents for CAP that requires hospitalization are most frequently S. Pneumoniae, H.

influenziae, Legionella, Pseudonomas aureiginosa, and other gram-negative rods. The specific

etiology agents is identified in about 50% of causes. It is estimated that more than 915, 000

episodes of CAP occur in adults 65 years old of age and older each year in the United States

(MENDELL, WUNDERINIC, ANZUETO, et. al., 2007)


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S. pneumonia (pneumococcus) is the most common cause of CAP in people younger than

60 years of age without co-morbidity and in those 60 years and older with co-morbidity.

S. pneumonia, gram-positive organism that resides naturally in Upper respiratory tract,

colonizes the upper respiratory tract and can cause disseminated. Invasive infection, PHN and

other Lower respiratory tract infection, and upper respiratory tract infection, such as otitis media

and rhinosinusitis. It may occur as a lobar or bronchopneumonic in patient of any age and mat

follow a recent respiratory illness. (M.S.N 12th

edition, Brunners and Suddarths)

(pneumococcal) pneumonia usually has a sudden onset of chills, rapidly rising fever (38.5C

to 40.5 C), and pleuritic chest pain that is aggravated by deep breathing and coughing. The

patient is severely ill, with marked tachypnea (25-45 bpm), accompanied by other signs of

respiratory distress. Signs and symptoms of pneumonia may also depend on a patients

condition. Such as the following:

People 65 years of age and older. Immunocompetent people who are at increased risk for illness and death associated with

pneumococcal disease because of chronic illness (eg, cardiovascular disease, pulmonary

disease, diabetes mellitus, chronic liver cirrhosis)

These complications are encountered chiefly in patients who have received no specific

treatment or inadequate or delayed treatment. These complications are also encountered when

the infecting organisms resistant to therapy, when a co-morbid disease complicates the

pneumonia or when the patient is immunocompromised. Patients may require endotracheal

intubations and mechanical ventilation. Heart failure, cardiac dysrhythmias, pericarditis and

myocarditis also are complications of pneumonia that may lead to shock.


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II. OBJECTIVESGENERAL OBJECTIVE:

To be knowledgeable about the nature of our Case, management and treatment to be ableto render effective nursing care to the client.

SPECIFIC OBJECTIVES:

To know the etiology, risk factors and manifestations of the disease process to determine client-based pathophysiology of undifferentiated to learn the basic principle of medical management of COPD to detect possible complications of the disease process to use the nursing process to identify nursing problems from the client and provide the

appropriate nursing care plan

to formulate health teachings for disease prevention and health maintenance


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III. THEORETICAL FRAMEWORKThe case of Mrs. C.F. is being correlated to Florence Nightingales Environmental

Theory. This theory explains that external factors influence the health of a patient. She believed

that healthy surroundings were necessary for proper nursing care. Pure air, pure water, efficient

drainage, cleanliness and light are the five essential components of environmental health. For the

attainment of these essential components, man must use their power to control and modify the

environment.

The patient describes their area as congested and houses are built right next to the other.

Their house has small space that minimizes ventilation and natural light that enters the house. Its

also located few meters away from the national road causing them to constantly inhale polluted

air from passing vehicles. They also have no electrical supply that adds up to the compensation

of proper ventilation. The patient adds that they cant maintain the cleanliness of their

surroundings because of the constant dirt coming from their neighbors. These clearly reveal that

3 of the 5 essential components are being compromised and may be one of the cause of the

patients present condition.Modification of the environment is an effective strategy on patients

treatment and rehabilitation.


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IV. NURSING HISTORY:Source of information: Patient herself, including her son, 19 years old.

A. Biographical DataPatient name : Patient C.F.

Address : Lacson St., Sampaloc Manila

Date of Birth : May 15, 1964

Birth Place : Masbate City

Age : 47 years old

Sex : Female

Occupation : labandera

Nationality : Filipino

Marital Status : Widowed

Religion : Roman Catholic

Source of health assistance: health center; Ospital ng Sampaloc

Chief Complaints: nahihirapan akong huminga, as verbalized by the patient

(Difficulty of Breathing)

B. Reason for seeking health care: Nung una po nahihirapan syanghuminga pero sabi nya ok na daw sya after 30

minutes pero isang oras pagkatapos nya maglaba, nakita ko nalang siya na nakahiga na sa

sahig at sobrang hirap nang huminga kaya dinala ko na sya dito sa Ospital. As

verbalized by her son.

Patient C.F. is a 47 years old female. Born on May 15, 1964 in Masbate City. She

is widowed with 2 children of 19 and 11 years old. She lives in Lacson St., Sampaloc

Manila.

She experienced cough and cold, fever, and body weakness most of the time and

took over the counter drugs like neozep, biogesic, mefenamic acid, strepsil and bioflu for


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medication. Or sometimes she just ignored it. If she has time, she goes to the health

center for consultation and check-up.

C. History of present illness:1 year prior to admission patient C.F claims that she is healthy. She claims that

sometimes she experienced difficulty of breathing and easy fatigability but she just

ignored it thinking that it has something to do with her whole day doing the household

chores. She just took rest and have a nap for relief.

6 months prior to admission, she experienced difficulty of breathing accompanied

with body weakness, and dizziness. She then decided to go to Ospital ng Sampaloc for

consultation and check-up. She was given nebulization. After the three doses of

nebulization, she was advised to go home after experiencing relief from her difficulty of

breathing. She was also advised to undergo Chest X-ray and CBC but unfortunately, she

didnt comply due to her reason that its just a waste of time to wait.

3 months prior to admission, still with the above symptoms, so they decided again

to Ospital ng Sampaloc for consultation and check-up. This time, she complied to

undergo Chest X-ray and CBC. Chest X-ray result reveals that she has pneumonia and

hemoglobin level slightly decreased from normal as she claims. The doctor prescribed

her ferrous sulfate once a day and unrecalled antibiotics. Due to financial constraints, she

was not able to take religiously those said medications.

3 weeks prior to admission, still with the above symptoms accompanied with

productive cough which she claims that it is greenish in color. But no consultations or

check-up done.

3 days prior to admission while doing laundry, she felt sudden difficulty of

breathing and got worse that leads her to rushed to Ospital ng Sampaloc. At the

emergency room, she was hooked with oxygen at 3 Lpm/NC and nebulization with

salbutamol. Her situation got worsen so she was then advised for admission and

confinement.


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D. Past Health History:1. Medical Historyno previous hospitalization2. Surgical Historyno surgical or operations done3. Medicationsferrous sulfate, and unrecalled antibiotics, but poor compliance4. Allergies- chemical inhalants such as zonrox, rugby, and vulcaseal. No

allergies to drugs, foods and animals.

5. Injuries and accidentsnone6. Special needsnone7.

Childhood illness and immunizationcant recall except for tetanus toxoid

E. Family Health History:Legend: asthmatic hypertensive

mother

father

brother

sister hypertensive pneumonia

patient

F. Social History:a. alcohol useshe denies that shes not drinking any alcoholicbeveragesb. drug usenonec. tobacco usenon-smokerd. sexual practicenot mentionede. travel historynonef. work environment- poor ventilationg. physical environmenttheyre living in a small space, made of light materials.


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h. home environment congested, they live in a crowded place with poor ventilationand sanitation, they have one common CR described as pail system; they dont have

electrical connection, and they dont have a conducive sleeping space using only

plastic mat; their source of water supply is NAWASA; they dont usually boil their

water prior to drinking.

i. Psychosocial environmentthey live near in a public market and accessible torecreational areas and public utility vehicles.

j. Hobbies and leisureshe plays BINGO as a form of her relaxationk.

Stressfinancial constraints is her primary reason of stress

l. Educationshe is an elementary graduate at Geronimo Elementary School.m. Economic status religion ethnic backgroundshe is a laundry woman earning P150

per day (depending to the number of costumers), but able to eat three times a day. She

is a Roman Catholic and no ethnic background affiliation.

n. Roles and relationshipshe is a mother of two, a widow for seven years, with goodpersonal relationship to her neighbors and her family. She is a law abiding citizen and

able to exercise her right to vote every election.

V. IMMUNIZATION/EXPOSURE TO COMMUNICABLE DISEASESShe doesnt recall any immunizations except for TT 1.

She recall that she experienced chicken pox

VI. ALLERGIESshe has allergy to chemicals/agents such as zonrox, rugby, andvulcaseal. No allergies to drugs, foods and animals.

VII.HOME MEDICATION/ALTERNATIVE MEDICINESshe usually takes paracetamolfor fever, mefenamic acid for headache, neozep for colds. She doesnt have history of

taking any alternative medications and she doesnt believe in herbolaryos or quack

doctors.


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VIII. PSYCHOSOCIAL HISTORYa. Alcohol useshe denies that shes not drinking any alcoholic beveragesb. Drug usec. Caffeine useshe drinks coffee 3 cups everyday, sometimes mixed with milk powder.

IX. OBSTETRICAL HISTORYMenarche13 years olds

G2P2


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X. GORDONS HEALTH PATTERN:GORDONS

FUNCTIONAL

HEALTH

PATTERN

BEFORE

HOSPITALIZATION

DURING

HOSPITALIZATION

ANALYSIS

Health Perception

Pattern

Patient C.F. described

herself sick because shefeels weak and she

doesnt know why. She

wanted to visit the centerbut she doesnt find time.

She even felt worse

during her stay in thehospital. She couldnt do

her daily routine. She

wanted to feel better andeventually healed from

her sickness and go

home to take care of her

children.

Due to knowledge

deficit because sheis an elementary

graduate.

Nutritional and

Metabolic Pattern

She eats 3 times a day.

Commonly she eats fishand vegetables. She eat

meat twice a week

because she doesnt liketoo much meat like

chicken and pork. She

could drink 2 glasses of

water about 500 to 600mldaily.

In the hospital she eat

everything they servedbut in a little amount

because she doesnt have

appetite or loss herappetite all the time. She

drinks not more than

500ml daily.

Loss of appetite is

due to decreasetaste sensation.

Elimination Pattern She doesnt have anyproblem in urinating. She

urinate 4 0r 5 times daily

without any difficultywith slightly yellowish

color. She defecates twice

daily, one in the morningand in the evening

without any difficulty

with brown color with

soft to hard consistencyor its depend on the food

she eats.

Now, she urinates 2 to 3times daily without any

difficulty with yellowish

color with a veryminimal amount. She

defecate once a day or

sometimes none with asoft consistency.

Due to decreaseamount of food

and fluids intake.

Activity-Exercise

Pattern

She could still perform

her daily living. She

clean the house, wash herclothes and her children,

cooking food, and doing

the household chores was

her way of exercising andalso stretching and

walking around the house

for 20 to 30 minutesdaily.

She couldnt do

everything that she was

doing before. She feltvery weak and couldnt

even move too much

because of the IVF and

the oxygen. Moving andtalking a little started her

to cough and start to feel

the difficulty ofbreathing.

Due to generalize

body weakness is

a sign ofpneumonia.

Sleep and RestPattern

She has the normal 6 to 8hours of sleep daily. She

sleeps 9 in the evening

and woke up 4 in the

morning. Sometime shecould still nap in the

afternoon by 2 to 4 in the

She couldnt get her 6 to8 hours sleep daily

because of her present

condition. Difficulty of

breathing made herrestless. She wanted to

sleep but she couldnt get

Restless anddifficulty of

breathing are the

sign and

symptoms ofpatient with

respiratory


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afternoon. it. problem.

Cognitive

Perceptual Pattern

She doesnt have any

problem in term of her

cognitive abilities. Shestill has a good memory.

She doesnt weareyeglasses or hearing aid.

She is always restless

and irritated because of

her present condition.

Restlessness and

irritability are sign

of pneumonia

Self Perception-

Self ConceptPattern

She doesnt always feel

fine especially when shehas coughed that last 1

week with a mild

headache every time sheexperienced it. It limits

her daily activities.

She felt very weak and

her conditions worseneveryday she stays in the

hospital. She felt scare of

the situation.

Anxiety is due to

her condition anda long stay in the

hospital.

Role-Relationship

Pattern

Shes living with his

children and has a good

relationship with them.She became more closerto them after her husband

died. She also has good

relationship with herneighbors and relatives.

She is more close to her

family now because of

her condition.

Her present

condition made

the family morecloser.

Sexual

Reproductive

Pattern

When her husband died 7

years ago she never

thought of having asecond husband and has a

sexual activity. Shededicated her life to her

children and neverthought about that.

Now, she couldnt

imagine herself with

another man except herson especially with her

present condition.

No problem on her

sexual

reproductivepattern.

Coping Stress

Tolerance

She always seeks her

siblings advice and help

every time she has

problem. She just criesand thinks of the best

way to resolve all the

stress she has when her

siblings are not availableto help her.

Praying, crying and

talking to her sibling are

her ways to lessen her

stress because of hercondition.

These are the

natural ways on

how she cope

from her stress.

Value Belief

Pattern:

She is a Roman Catholic.

She wasnt very religious

person and she doesnt

remember the last timeshe visited the church to

ask for God help.

When she recover from

her disease and discharge

from the hospital she

promise that the firstthing she will do is to

visit the Black Nazarene

in Quiapo and alwaysattend the mass every

Sunday and will devote

her life in serving Him.

Her present

condition changed

her beliefs.


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XI. PHYSICAL ASSESSMENT:General Appearance:

The patient is sitting on the bed on high back rest. She is conscious and coherent, orientedto time, place and person. She is appropriately dressed with no body odor. She hasoxygen via nasal cannula at a flow rate of 3Lpm. She has 0.9% NaCl IV fluid regulated atKVO rate at left hand (cephalic vein). She appears weak, with accompanying shortness of

breath.

Vital Signs:

BP: 100/70 Weight: 90 kg

T: 36.5 Height: 5 ft.

RR: 28PR: 90

BODY PARTS ACTUAL FINDINGS ANALYSIS NURSING

ALERT

SKULL -Rounded (normocephalic and

symmetrical, with frontal,

parietal, and occipitalprominences); smooth skull

contour

- no presence of nosules,

masses and depressions

No deviations found

HAIR - excessive dryness; sparse

dandruff visible

-evenly distributed and coversthe whole scalp

-abnormal, excessive dry

hair could indicatemalnutrition and can

attract nits.

-advise patient to

practice properhygiene to prevent

further hairproblems

SKIN -appears pale

-with even skin tone

-no lesions and abrasions noted

Cyanosis is a sign ofdecreased oxygen level in

the blood (hypoxemia) due

to increased fluid in the

pleural space

FACE -symmetric and palpebral

fissure equal in size, nasolabialfolds are symmetrical

No deviations found

EYES -pupil equally rounded reactive

to light and accommodation

-Able to follow movement -symmetrically in all direction

-white sclera

pink conjunctiva-Symmetrical eyes

-No drainage upon palpation of

the nasolacrimal duct

No deviations found


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EARS -Symmetrical

-Tympanic membrane are

pearly, grey, and translucentwith no bulging and

retraction

No deviations found

NOSE -both nares are patent-symmetric and straight

-nasal septum, intact and

midline

-no tenderness or lesions

No deviations found

MOUTH -Lips appear cyanotic,

-has 27 adult teeth, yellowish

and has halitosis

-cyanosis is an indication

of decreased oxygen level

in the body.

No deviations found

-abnormal, incompletenumber of teeth is due to

having history of poor oral

hygiene.

-most unpleasant breathknown to arise from

proteins trapped in the

mouth which areprocessed by oral bacteria.

-

-teach client about

proper oralhygiene to prevent

further oral

infections

LYMPH NODES -not palpable -no deviations

THORAX

Anterior -difficulty of breathing -abnormal labored

breathing is a commonmanifestation affecting

clients with cardiac and

pulmonary disorders. Its isrelated to obstructed

airways. It is also related

to the decreased size of thelungs due to PTB

-it is also the most

common symptom of a

pleural effusion. As theeffusion grows larger with

more fluid, the harder it is

for the lung to expand andthe more difficult it is for

the patient to breathe.

-administer

oxygen as orderedby the doctor to

support

oxygenation

-minimize

physical activityto decrease

oxygen demand


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Posterior

-medium-pitched, thudlikesound is heard on percussion

-unequal chest expansion is

observed on palpation

-has crackles sounds on the

upper and lower thorax

-spine vertically aligned

-skin intact, uniform

temperature; no tenderness;no masses

-uses accessory muscles toassist breathing

-diminished breath sounds are

auscultated at the apex of thelungs

-abnormal, dullness maycharacterize areas of

increased density such as

pleural effusion

-unequal chest expansion

is seen in patients withsevere atelectasis,

pneumonia, chest trauma,

pleural effusion or

pneumothorax.

-abnormal crackles are

audible when there is s

sudden opening of thesmall airways that contain

fluid. It is usually heardduring inspiration; may

indicate pnuemonia

No deviations found

-trapezius or shouldermuscles are used to

facilitate inspiration in

cases of acute and chronic

airway obstruction

-diminished or absent

breath sounds oftenindicate that little or no air

is moving in or out of the

lung area being

auscultated. It may alsoindicate abnormalities of

the pleural space such as

pleural effusion.

-

-changing of

positions at bedevery 30 mins will

minimize mucus

stasis for easy

expectoration.

-nebulization

must be done as

prescribed

CARDIOVASCULAR -has full and rapid pulsations; No deviations found

ABDOMEN -uniform color and has noblemish; has a concave

abdomen; symmetric colour;

-abdominal movements note

when inhaling-has no vessels visible

No deviations found


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MUSCOSKELETAL

Muscle strength

Right arm

Left arm

Right leg

Left leg

-weak muscle tone; weak

muscle strength

- +4 active motionagainst some resistance


- With IV fluids insertedspecifically at thecephalic vein



-no edema, no pain whenmoved

-nails are

-abnormal, possibly

related to the amount of

food she is eating; due to

decrease oxygen supply tothe body causing easy

fatigability.

-abnormal

-abnormal

-abnormal

-abnormal

No deviations found

-minimize

physical activity

to prevent over

fatigue

-place patients

needs within

reach to reduceexertion of energy

-raise side railes

to prevent injury


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XII. ANATOMY AND PHYSIOLOGY

THE RESPIRATORY SYSTEM

The human respiratory system consists of the lungs and tubes associated with the lungs. It

is located in thethorax or chest. The thorax is surrounded by the ribs. The diaphragm forms the

base of the thorax.

Contractions of the diaphragm and the intercostals muscle change the size of the thorax and,

thus, cause air to move in and out of the lungs.

The main job of the respiratory system is to get oxygen into the body and get waste gases

out of the body. It is the function of the respiratory system to transport gases to and from the

circulatory system.

The Nose or Nasal Cavity

As air passes through the nasal cavities it is warmed and humidified, so that air that

reaches the lungs is warmed and moist. The Nasal airways are lined with cilia and kept moist by

mucous secretions. The combination of cilia and mucous helps to filter out solid particles from

the air an Warm and moisten the air, which prevents damage to the delicate tissues that form the

Respiratory System. The moisture in the nose helps to heat and humidify the air, increasing the

amount of water vapour the air entering the lungs contains. This helps to keep the air entering the

nose from drying out the lungs and other parts of our respiratory system. When air enters the

respiratory system through the mouth, much less filtering is done. It is generally better to take in

air through the nose.

To review: he nose does the following:

1. Filters the air by the hairs and mucous in the nose

2. Moistens the air

3. Warms the air


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The Pharynx

The pharynx is also called the throat. As we saw in the digestive system,

the epiglottis closes off the tracheawhen we swallow. Below the epiglottis is the larynx or voice

box. This contains 2 vocal cords, which vibrate when air passes by them. With our tongue and

lips we convert these vibrations into speech. The area at the top of the trachea, which contains

the larynx, is called the glottis.

The Trachea

The trachea or windpipe is made of muscle and elastic fibres with rings of cartilage. The

cartilage prevents the tubes of the trachea from collapsing. The trachea is divided

or branched into bronchi and then into smallerbronchioles. The bronchioles branch off

into alveoli. The alveoli will be discussed later.


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These tubes are lined with mucous-secreting cells and tiny hairs called cilia. The mucous

traps bacteria, dust and viruses. The cilia beat and create an upward current. This moves the

mucous up and into the oesophagus. Here it goes to the stomach. When we clear our throats we

force the mucous away from our vocal cords. This is often called coughing. It is used to get rid

of irritants and excess mucous from our respiratory system.


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The Lungs

The lungs are spongy structure where the exchange of gases takes place. Each lung is surrounded

by a pair of pleural membranes. Between the membranes is pleural fluid, which reduces friction

while breathing. The bronchi are divided into about a million bronchioles. The ends of the

bronchioles are hollow air sacs called alveoli. There are over 700 million alveoli in the lungs.

This greatly increases the surface area through which gas exchange occurs. Surrounding the

alveoli are capillaries. The lungs give up their oxygen to the capillaries through the alveoli.

Likewise, carbon dioxide is taken from the capillaries and into the alveoli.


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Gas Exchange

Body cells use the inhaled oxygen gotten from the alveoli of the lungs. In turn, they

produce carbon dioxide and water, which is taken to the alveoli and then exhaled. These

exchanges occur as a result of diffusion. In each case the materials move from an area of high

concentration to an area of lower concentration.

The alveoli are well suited for the important job they have. There are about 300,000,000

alveoli per lung! That means there is a great surface area for gas exchange. Also, the walls of the

alveoli as well as the capillaries are very thin so that the gases can diffuse readily.

When the blood picks up the diffused gases the gases are carried to their destinations. Most

of the oxygen is carried by the haemoglobin in the red blood cells with only a small % dissolved

in the plasma. Carbon dioxide and water are carried in the plasma of the blood.

The following chart compares the content of air before as it is inhaled (Inspired Air) and as it is

exhaled (Expired Air).

Inspired and Expired Air Comparison

Gas + %

Inspired

Air

Expired

Air

Alteration

Nitrogen 78% 76% No real change.

Oxygen 20.8% 15.3% Reduced by about a quarter

Carbon

Dioxide

0.04% 4.2%Increased by about a hundred and

five times

Water

Vapour

1.2% 6.1% Increased about five times

Note: a lot of water is lost from the body each day due to breathing.


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The Mechanism of Breathing

Inspiration or inhalation is said to be an active process because it involves muscle

contraction. The diaphragm andintercostal muscles contract. The contracting diaphragm flattens

and stretches the elastic lungs downward. The contracting intercostals pull the ribcage up and out

causing the elastic lungs to stretch. The expanding lungs cause the air inside to expand (a gas

will always fill its container). The expansion of air causes a drop in air pressure in the lungs. The

air in the lungs is at a lower pressure than the air outside. Air flows from higher to lower pressure

so air flows into the lungs from outside.

Expiration or exhalation is said to be a passive process because it does not involve

muscle contraction. The diaphragm and the intercostal muscles relax. The deforming force on the

elastic lungs has been removed. The lungs recoil elastically reducing their volume a passive

process. The volume of air in the lungs decreases causing an increase in the air pressure. The air

in the lungs is at a higher pressure than the air outside. Air flows from higher to lower pressure

so the air flows out of the lungs. The elastic recoil of the lungs pulls up the adhering diaphragm

and drags in the adhering ribcage.

Breathing is normally under unconscious control. We dont have to think about

breathing. Exercise increases the rate of breathing. The brain detects a large increase in carbon


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dioxide and increases the rate of breathing. Now, exhalation, which is normally passive, becomes

active. Other times when we control our breathing rate is in speaking, singing, or swimming.

Breathing is always controlled by the brains detection of carbon dioxide in the blood.

When carbon dioxide is in the blood the pH of the blood is slightly lowered. The brain detects

this slight drop and sends impulses to the diaphragm and intercostal muscles. Thus, our breathing

mechanism is controlled by rising levels of carbon dioxide, not low levels of oxygen. Just as the

level of carbon dioxide controls the stomata opening in leaves it also controls our breathing.

Breathing Disorders

Asthma is a breathing disorder. Its symptoms include coughing, wheezing, tightness of

chest and breathlessness. It is caused by an allergic reaction to materials in the environment such

as pollen, cigarette smoke, house dust and pet dander. More recently scientists have found a link

between stress and anxiety with the onset of asthma.

Asthma is a chronic ailment in which inflammation of the airways, or bronchi, affects the

way air enters and leaves the lungs, thereby disrupting breathing. When allergens or irritants

come into contact with the inflamed airways, the already sensitive airways tighten and narrow,

making it difficult for the person to breathe. Progressively severe symptoms can lead to an

asthma attack. In asthma attacks, the overproduction of mucus lining the airways further narrows

the airways, limiting oxygen intake and making it more difficult to breathe.


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To prevent asthma the allergen must be identified and avoided. Also, in the case of stress,

the stress must be alleviated.

The treatment of asthma is usually by Inhalers. These devices (sometimes called 'puffers')

contain a gas that will propel the correct dose of medication when the top is pressed down. This

is inhaled into the airways. There are two basic categories of inhaler medicines that are used for

asthma: relievers - which treat the symptoms and preventers - which can prevent the symptoms.


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XIII. PATHOPHYSIOLOGY


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XIV. LABORATORY/DIAGNOSTIC EXAMINATIONS:Fuentes, Clarinda

47 yrs old

HEMATOLOGY RESULTS

January 29, 2012

Tests Normal Value Found Value Interpretation

Hemoglobin F: 12-14g/dl 10.2 Below normal: An

indication of pleural

effusion and PTB.

Hematocrit F: 0.37-0.47 0.31 Below normal: An

indication of

inadequate

hydration.

WBC count 4.8-10.8x10 8.0 Normal.

Segmenters 60-70% 77 Increased: Indicates

that the bodys

immune response is

activated and

compensating in the

body.

Lymphocytes 30-40% 23 Decreased: Indicates

that the body's

resistance to fight

infection has been


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27

substantially lost.

Monocytes 2-8%

Platelet count 130-400x10 280 Normal.

January 23, 2012




effusion and PTB..


indication of

inadequate

hydration.



that the bodys

immune response is

activated and

compensating in the

body.


that the body's

resistance to fight

infection has been


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28

substantially lost.

Monocytes 2-8%

Platelet count 130-400x10

January 9, 2012




effusion and PTB.


indication of

inadequate

hydration.



that the bodys

immune response is

activated and

compensating in the

body.


that the body's

resistance to fight

infection has been


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29

substantially lost.

Monocytes 2-8%


December 31, 2011



indication of

pleural effusion and

PTB.


indication of

inadequate

hydration.



that the bodys

immune response is

activated and

compensating in the

body.


that the body's

resistance to fight


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30

infection has been

substantially lost.

Monocytes 2-8%


December 28, 2011




effusion, PTB


indication of

inadequate

hydration.

WBC count 4.8-10.8x10 10 Normal.


that the bodys

immune response is

activated and

compensating in the

body.


that the body's

resistance to fight


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31

infection has been

substantially lost.

Monocytes 2-8%


December 30, 2011




effusion and PTB.


indication of

inadequate

hydration.


Segmenters 60-70% 66 Normal.

Lymphocytes 30-40% 34 Normal.

Monocytes 2-8%

Platelet count 130-400x10

Analysis:


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Complete blood count is the calculation of the cellular formed components of the blood.

Its major portion includes the measurement of red blood cells, white blood cells, and platelet

concentration in the blood.

Based on Mrs. C.Fs hematology test, hemoglobin as well as the hematocrit level was

below normal which merely indicates a possible iron deficiency anemia and nutritional

deficiency due to muscle waste, fatigue and having loss of appetite. An increase of segmenters

indicates that there is a presence of infection. Elevation of segmenters indicates presence of

infection; means that many band (immature) cells are present as the body fights infection. A low

lymphocyte count indicates that the bodys resistance to fight infection has been substantially

lost and one becomes more susceptible to certain types of infection.

URINALYSIS

January 3, 2012

Tests Found Value Analysis

MACROSCOPIC

Color Yellowish Normal.

Transparency Slightly turbid

MICROSCOPIC

Pus cell 5-8/hpf

Red cell 3-5/hpf

Epithelial cell Many

Mucus thread Few


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Date: 1-27-12

Specimen Pleural Fluid

Pus Cells Rare

Epithelial Cell Occasional

Results No organisms found

CHEST X-RAY

Date: 1-31-12

RIGHT CHEST:

There is pleural effusion with an approximate volume of 290cc seen in the posterior costalsulcus. No loculations seen at this time.

IMPRESSION: PROGRESSIVE PTB VS. PNEUMONIA

NURSING ANALYSIS:

Pleural effusion accumulates due to imbalance in hydrostatic or oncotic pressure.

Date: 1-30-12

Follow up when compared to the one done 1/17/12 shows no significant interval changed.


NURSING ANALYSIS:



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Date: 12-29-11

CXR PA:

There is almost complete specification of the right lung.

Reticulonodular densities seen in the left lung.

Heart size cannot be assess.

Left hemidiaphragm and sulcus intact.

Bony thorax are unremarkable.

IMPRESSION:

PTB EXTENSIVE, BILATERAL VS. MASSIVE PLEURAL EFFFUSION RIGHT.

OVER WHELMING PNUEMONIA , BILATERAL.

NURSING ANALYSIS:


CXR PA:

Follow-up new shows total specification of the right lung while the left lung showsfurther increase in infiltrates.

Date: 12-17-12

CHEST PA:

Follow up film when compared to the one done Jan. 6, 2012 shows no significant interval

changed.


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NURSING ANALYSIS:



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XVII. DISCHARGED PLANNINGDischarge Planning

Medication

Medication includes: FeSo4 500mg/ tab BID Combivent nib 1Mb q6

Ceftazidine 500mg TIV q8

Environment

Teaching breathing retaining exercise to increase diaphragmatic excursion and reducework of breathing

Teaching relaxation techniques to reduce anxiety with dyspnea Augment the patients ability to cough effectively by spiriting the patients chest

manually

Treatment/Therapy

Follow strict compliance to treatment regimen given to improve condition especiallymedications, diet, and lifestyle

Encourage significant others to assist the patient in performing of breathing exercises topromote lung expansion and clearing.

Encourage to provide adequate rest and sleep for the patient.

Health Teaching

Health teachings regarding the importance of proper hygiene and hand washing, food andwater preparation, intake of adequate vitamins especially vitamin C-rich foods to

strengthen the immune response and increasing of oral fluid intake should be conveyed.

Encourage family members to provide adequate support and care to the patient Teach relative/care provider to recognize signs and symptoms of the disease to prevent its

progression and to manage it

Recommend that they consult the physician if the patient is in a respiratory distress To decrease your pain; when coughing. Hold a pillow over your chest where pain is.


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Quit smoking. Do not smoke and do not allow others to smoke around you. Smokingincreases your risk of lung infections such as pneumonia. Smoking also makes it harder

for you to get better after having a lung problem. Talk to your care giver if you need help

in quitting smoking.

Exercise your lungs. The discomfort of pleural effusion may cause you to avoid breathingas deeply as you should. Coughing and deep breathing can help prevent a new or

worsening lun infection. Take a deep breath and hold the breath as long as you can then

push the air out of the lungs with a deep strong cough. Take 10 deep breaths in a row

every hour that you are awake. Remember to follow each deep breath with a cough.

Outpatient follow-up

Confirms and advise them to keep all scheduled physician appointment or checkup to seehow well the treatment is working. The physician might change the medications of the

patient for better treatment

Inform family that follow-up appointment provides an opportunity for the evaluation ofthe patient recuperation and identify recurrent or new care needs

Notify family that follow-up reinforces patient teaching initiated in the hospital inrecognizing and managing the different danger signs of illness

Diet/Nutrition

Diet which is prescribed should be followed. To include fruits and vegetables in the dietis significant.

Ensure adequate protein intake such as milk, eggs, oral nutritional supplements, chicken,and fish if other treatments not tolerated

Increase fluid intake; avoid drinks with caffeine and alcohol content Eat less salty, oily, spicy, and sweet foods.

Spiritual

Respect the spiritual coping of the patient during illness Encourage patients family members to seek council with their spiritual leader

Grand Case Study Final

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