Introduction Rheumatoid arthritis Pneumonia is an inflammation or infection of the lungs most commonly caused by a bacteria or virus.

Pneumonia can also be caused by inhaling vomit or other foreign substances. In all cases, the lungs' air sacs fill with pus , mucous, and other liquids and cannot function properly. This means oxygen cannot reach the blood and the cells of the body. Most pneumonias are caused by bacterial infections.The most common infectious cause of pneumonia in the United States is the bacteria Streptococcus pneumoniae. Bacterial pneumonia can attack anyone. The most common cause of bacterial pneumonia in adults is a bacteria called Streptococcus pneumoniae or Pneumococcus. Pneumococcal pneumonia occurs only in the lobar form. An increasing number of viruses are being identified as the cause of respiratory infection. Half of all pneumonias are believed to be of viral origin. Most viral pneumonias are patchy and the body usually fights them off without help from medications or other treatments. Pneumococcus can affect more than the lungs. The bacteria can also cause serious infections of the covering of the brain (meningitis), the bloodstream, and other parts of the body. Community-acquired pneumonia develops in people with limited or no contact with medical institutions or settings. The most commonly identified pathogens areStreptococcus pneumoniae, Haemophilus influenzae, and atypical organisms (ie, Chlamydia pneumoniae,Mycoplasma pneumoniae, Legionella sp). Symptoms and signs are fever, cough, pleuritic chest pain, dyspnea, tachypnea, and tachycardia. Diagnosis is based on clinical presentation and chest x-ray. Treatment is with empirically chosen antibiotics. Prognosis is excellent for relatively young or healthy patients, but many pneumonias, especially when caused by S. pneumoniae or influenza virus, are fatal in older, sicker patients.

Patients Profile Name: Patient X Age: 74 years old Sex: Female Status: Married Address: Gulf View Subd., Toril, Davao City

The patient is a resident of Gulf View Subd., Toril, Davao City. She is 74 years old, and married to his Husband Mr. X for forty five years. They had four children and all were professionals and married. They had seven grandchildren who live with her. At, August 19, 2012, he was admitted to Davao Doctors Hospital due to the difficulty of breathing. The use of accessory muscle was noted during inhalation.

Anatomy and Physiology of the Lungs

The Lungs
The lungs are paired, cone-shaped organs which take up most of the space in our chests, along with the heart. Their role is to take oxygen into the body, which we need for our cells to live and function properly, and to help us get rid of carbon dioxide, which is a waste product. We each have two lungs, a left lung and a right lung. These are divided up into 'lobes', or big sections of tissue separated by 'fissures' or dividers. The right lung has three lobes but the left lung has only two, because the heart takes up some of the space in the left side of our chest. The lungs can also be divided up into even smaller portions, called 'bronchopulmonary segments'.

These are pyramidal-shaped areas which are also separated from each other by membranes. There are about 10 of them in each lung. Each segment receives its own blood supply and air supply.

Air enters your lungs through a system of pipes called the bronchi. These pipes start from the bottom of the trachea as the left and right bronchi and branch many times throughout the lungs, until they eventually form little thin-walled air sacs or bubbles, known as the alveoli. The alveoli are where the important work of gas exchange takes place between the air and your blood. Covering each alveolus is a whole network of little blood vessel called capillaries, which are very small branches of the pulmonary arteries. It is important that the air in the alveoli and the blood in the capillaries are very close together, so that oxygen and carbon dioxide can move (or diffuse) between them. So, when you breathe in, air comes down the trachea and through the bronchi into the alveoli. This fresh air has lots of oxygen in it, and some of this oxygen will travel across the walls of the alveoli into your bloodstream. Travelling in the opposite direction is carbon dioxide, which crosses from the blood in the capillaries into the air in the alveoli and is then breathed out. In this way, you bring in to your body the oxygen that you need to live, and get rid of the waste product carbon dioxide.

Predisposing Factors

Precipitating Factors Pathophysiology

Age Smoker COPD Asthma

Virulent Microorganism Invasions Streptococcus Pneumoniae

Exposure to certain chemicals, pollutants, or toxic fumes.

Lifestyle

Microorganism eneters the nose( nasal passages)

Passes through the larynx, pharynx, trachea

Microorganism enters and affects both airway and lung parenchyma

Airway damage

Lung invasion

Infiltration of bronchi

flattening of epithelial cells

Infectious organism lodges

macrophages and leukocytes

Stimulation in bronchioles

necrosis of bronchial tissues

mucus and phlegm production

Alveolar collapse

narrowing of air passage

COUGHING Productive/non-productive

Increase pyrogen in the body

DIFFICULTY OF BREATHING

FEVER Necrosis of pulmonary tissue

Overwhelming sepsis

DEATH

Comprehensive Assessment

A. FAMILY BACKGROUND Mrs. Telespora has a two sons and three daughters who do not live with her, only her one nephew and two grandsons live with her. Her husband died five years ago and the only thing that she depend on is her mango farm and her pension . . B. EFFECTS/EXPECTATIONS OF ILLNESS TO FAMILY AND SELF Mrs. Telespora is suffering asthma since she was a child and the effects of this illness gives her and her family problems not only in financial aspects but it also gives a treat to the life of Mrs. Telespora. She is expecting of a recovery during the hospitalization for him to go back to their house and stay where she can rest well and so as her family.

C. HISTORY OF PAST ILLNESS The father of Mrs. Telespora has a history of asthma and high blood pressure on the mothers side has a history of diabetes mellitus and asthma. Mrs. Telespora was admitted in Davao Doctors Hospital due to difficulty of breathing and stayed in the ICU for four days.

FUNCTIONAL PATTERN

On Going Assessment Guidelines Admission August 19, 2012 I. MENTAL STATUS a. State of mental consciousness b. Orientation c. Intellectual capacity d. Vocabulary level Conscious Oriented to time, place and people. Able to answer simple questions Able to speak bisaya and tagalog language. e. Attention span f. Ability to understand ideas II. STATUS OF SPECIAL SENSES a. Auditory perception b. Visual perception c. Speech perception d. Tactile perception e. Olfactory perception f. Gustatory perception III. MOTOR ABILITY STATUS a. Current mobility Unable to walk without aid Able to hear sounds Able to see Unable to speak well Able to feel sensations Able to distinguish different odor Able to distinguish different taste Short attention span Able to understand simple instructions Day1 August 28, 2012

b. Posture c. Range of motion

Disturb body posture Able to move only upper extremities properly

d. Loss of extremities IV. BODY TEMPERATURE STATUS a. Ranges V. RESPIRATORY STATUS a. Character b. Use of respiratory aids c. Interference of respiration d. Abnormal respiratory opening VI. CIRCULATORY STATUS a. Characteristics of arterial pulse b. Apical-radial pulse c. Intravenous fluid VII. NUTRITIONAL STATUS a. Condition of buccal cavity b. Digestion of food

None

36.0 degree Celcius

Difficult O2 administration @ 2LPM Minimal Secretions/Cough Use of accessory muscle during inhalation

Regular Regular PNSS @ KVO RATE

Pale color gums Able to consume of food served (Soft Diet)

c. Weight VIII. ELIMINATION STATUS a. Bowel

80 kilo grams

Able to defecate 1x in my shift (With diaper)

b. Bladder

With diaper

c. Abnormalities IX. STATE OF SKIN AND APPENDAGES a. Skin b. Hair c. Nails

None

Noted some Evenly distributed hair with little white hair Well-trimmed/With CRT of less than 2 seconds

X. STATE OF PHYSICAL REST AND COMFORT a. Sleep/rest pattern b. Presence of pain/ discomfort c. Use of supportive aids XI. EMOTIONAL STATUS a. Emotional Reactions b. Body image c. Ability to relate to others Nursing Diagnosis Ineffective breathing pattern r/t decline in lung compliance secondary to pneumonia. Ineffective airway clearance r/t asthma. Activity intolerance r/t exhaustion associated with interruption in usual sleep pattern because of discomfort, excessive coughing, and dyspnea. Disturb due to difficulty of breathing Weak body image Able to follow simple instructions Able to sleep 3 hours in my shift Swelling is still noted on right knee None

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A. NEURO SYSTEM

D. GI SYSTEM

ANTERIOR

POSTERIOR

B. CARDIOVASCULAR SYSTEM IVF PNSS @ KVO RATE

E. REPRODUCTIVE SYSTEM

C. RESPIRATORY SYSTEM
O2 Administration of 2LPM via NC Telemetry

F. GENITOURINALYSIS SYSTEM
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Rashes

Laboratory Results

Chest X-ray Result: Impression: There are reticolunodular opacities on both lungfields with upward traction of left hilus. There are dilated thick walled bronchi noted on both lower lobes. Heart is not enlarged. Aortic knob is sclerotic other visualized structures are unremarkable. Findings are suggestive of Extensive PTB, Bilateral with cicatrical changes, left upper lobe.Bacteriologic correlation is suggested.

Clinical Chemistry Result: Sodium: 124.9 mmol/L Normal: 135.0-148mmol/L

Hematology Result: Hct: 0.29 Normal: 0.37-0.47 Normal: 5.0-10.0x10

WBC: 23.5x10 Segmenters: 0.87 Lymphocytes: 0.13

Urinalysis: Color: Light Yellow Transparency: Slightly Hazy Reaction: (pH) 6.0 Glucose: negative Specific Gravity: 1.010 Pus cells: 3-4/HPF

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Protein: +1 Crystals: A Urates: Many Cast: Fine Granular cast : 1-2/HPF

RBC: 2-3/hpf Mucus threads: few

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Drug Study
GENERIC NAME METFOR MIN BRAND NAME Glucophage, Glumetza, Fortamet, Glucophage XR CLASSIFICATION Hormones & synthetic substitutes; antidiabetic agent; biguanides MECHANISM OF ACTION Management of type 2 diabetes mellitus as monotheraph y or concomitantl y with an oral sulfonylurea or insulin. Unlabeled indication: Treatment of metabolic complications of AIDS, weight reduction, prediabetes. INDICATION Metformin is primarily suited for the treatment of subjects with non-insulindependent diabetes mellitus (type II diabetes). Compared to other antidiabetic agents, it has the advantages of lowering rather than increasing body weight, of not causing hypoglycemia, and of entailing a reduction of triglycerides and LDLcholesterol levels. Metformin is therefore recommended in single drug therapy especially for obese subjects. In the majority of the treated subjects, a lowering of blood glucose levels by at least 25% is achieved. CONTRAINDICATION Impaired renal functions and situations that could lead thereto (severe infections, surgery, intravenous pyelography). Cirrhosis of the liver, hepatitis. Alcoholism. Advanced cardiovascular or general diseases. ADVERSE REACTION Lactic acidosis occurs rarely (0.03 cases/ 1,000 patients) but s a serious, often fatal (50%) complication. Characterized by increase in blood lactate levels (more than 5 mmol/L), decrease in blood pH, electrolyte disturbances. Symptoms include unexplained hyperventilation, myalgia, malaise, and somnolence. May advance to cardiovascular collapse (shock), acute CHF, acute MI, and prerenal azotemia. DOSAGE Oral: 500mg 1 TAB PO BID NURSING RESPONSIBILITY Inform the patient of potential risks/advantages of therapy and of alternative modes of therapy. Assess Hemoglobin, hematocrit, red blood cellsm and serum creatinine prior to initiation of therapy. Monitor fasting blood glucose, hemoglobin a, and renal function. Monitor renal function test for evidence of early lactic acidosis. If patient is on oral sulfonylureas, assess for hypoglycemia. Be alert to conditions that alter glucose requirements: fever, increased activity or stress, surgical procedure.

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Drug Study
GENERIC NAME Colchicine BRAND NAME Colcrys CLASSIFICATION Antigout agents MECHANISM OF ACTION Colchicine inhibits microtubule polymerizatio n by binding to tubulin, one of the main constituents of microtubules. Availability of tubulin is essential to mitosis, and therefore colchicine effectively functions as a "mitotic poison" or spindle poison. INDICATION Colchicine is specifically indicated for treatment and relief of pain in attacks of acute gouty arthritis. It is also recommended for regular use between attacks as a prophylactic measure, and is often effective in aborting an attack when taken at the first sign of articular discomfort. CONTRAINDICATION Colchicine is contraindicated in patients with a known hypersensitivity to the drug, in those with serious gastrointestinal, renal, hepatic, or cardiac disorders, and in those with blood dyscrasias. ADVERSE REACTION Adverse reactions in decreasing order of severity are: bone marrow depression, with aplastic anemia, with agranulocytosis or with thrombocytopenia may occur in patients receiving long-term therapy. Peripheral neuritis, purpura, myopathy, loss of hair, and reversible azoospermia have also been reported. Vomiting, diarrhea, and nausea may occur with colchicine therapy, especially when maximal doses are necessary for a therapeutic effect. To avoid more serious toxicity, the drug should be discontinued when these symptoms appear, regardless of whether or not joint pain has been relieved. DOSAGE Oral: 0.5mg 1 TAB PO BID NURSING RESPONSIBILITY Assess the client taking colchicine for nausea and loose stools. Local tissue reactions can occur withinfiltration of colchicine. Treatment should be initiated at thefirst sign of an attack of gout. Factors that may produce attacksinclude a high fat diet, purine richfoods, thiazide diuretics, liver extracts,penicillin, levodopa, ethambutol. Aspirin is avoided when probenecidor sulfinpyrazone is used. Fluid intake is encouraged duringprobenecid, sulfinpyrazone, andallopurinol therapy. Notify the prescriber promptly if skinrash occurs during allopurinol.

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Nursing Care Plan

PROBLEM S: Ang akong tiil naghubag ug sakit kaayo. as verbalized by the patient. O: Vital Signs Taken: BP:150/90 Pain Scale of 6/10 Swelling on the right knee Exhibited facial grimace upon movement of the right knee. Nsg. Dx: Acute pain related to physical agent and inflammatory process as secondary to presence of arthritis. SCIENTIFIC BASIS Pain is a complex, multifaceted phenomenon. It is individual, unique experiences that may be difficult for clients to describe or explain and is often difficult for others to recognize, understand, and assess. Unrelieved acute pain leads to debilitation, diminished quality of life, and depression. Unrelieved acute postoperative pain leads to development of chronic pain syndromes and increased complications. In fact, unrelieved pain can kill. Source: Medical-Surgical Nursing, 7th ed.by Black, JoyceM. and Jane Hokanson Hawks; p. 440 GOAL OBJECTIVES At the end of my 6 hours span of care my patient will be able to: Verbalized reduction/ relief in pain in the affected area. Blood Pressure will be at normal range. Move his right knee without facial grimace. NURSING INTERVENTION Independent: Apply Cold Compress to the affected area to relieved pain. RATIONALE EVALUATION Goal partially met as evidence by: The client verbalizes the relief of pain and discomfort. States the pain is a 4 (on a scale of 010), but the blood pressure is still in 150/90.

Cold temperature can cause numbness and will follow relieved from the pain felt. Only the client can judge the level and distress of pain; pain management should be a team approach that includes the client.

Encourage verbalization of feelings about the pain

Teach the use of nonpharmacologic techniques (example relaxation,guided imagery, music therapy, distraction, and massage) before,after, and if possible during painful activities; before pain occurs orincreases; and along with other pain relief measures.

The use of noninvasive pain relief measures can increase the re- lease of endorphins and enhance the therapeutic effects of pain relief medications.

Encourage patient to do deep breathing exercise.

Deep breathing for relaxation is easy to learn and contributes to pain relief and/or

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reduction by reducing muscle tension and anxiety. Encourage mobilization of the right knee. Assist with ROM exercises. To promote circulation and prevent excessive tissue pressure. To prevent fatigue.

Encourage adequate periods of rest and sleep, including uninterrupted periods of sufficient duration, meeting comfort needs. Encourage quiet, restful atmosphere. Create a quiet, nondisruptive environment with dim lights and comfortable temperature when possible.

Comfort and a quiet atmosphere promote a relaxed feeling and permit the client to focus on the relaxation technique rather than external distraction. Necessary for treatment of the underlying cause.

Dependent: Administer medications (particularly analgesics) as prescribed. Collaborative: Obtain specimens for culture/sensitively as indicated.

Verifies presence of infection, identifies specific pathogen, and influences choice of treatment.

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Nursing Care Plan

PROBLEM S: Ang akong tiil naghubag ug sakit kaayo. as verbalized by the patient. O: Vital Signs Taken: BP:150/90 Pain Scale of 6/10 Swelling on the right knee Exhibited facial grimace upon movement of the right knee. Nsg. Dx: Impaired physical mobility r/t decreased muscle strength. SCIENTIFIC BASIS Alteration in mobility may be a temporary or more permanent problem. Most disease and rehabilitative states involve some degree of immobility (example as seen in strokes, leg fracture, trauma, morbid obesity, and multiple sclerosis). With the longer life expectancy for most Americans, the incidence of disease and disability continues to grow. And with shorter hospital stays, patients are being transferred to rehabilitation facilities or sent home for physical therapy in the home environment. Mobility is also related to body changes from aging. Loss of muscle mass, GOAL OBJECTIVES At the end of my 6 hours span of care my patient will be able to: Maintain a function of position with no presence / restrictions contractures. Maintain or increase the power and functionality of and / or compensation of the body. Demonstrate techniques / behaviors that allow doing activities. Assist with range of motion active / passive NURSING INTERVENTION Independent: Evaluation / continue monitoring the level of inflammation / pain in the joints. RATIONALE EVALUATION Goal met as evidence by: The client can move his right knee within normal ROM.

Level of activity / exercise depends on the development / resolution of the inflammatory process. Rest is recommended during the acute exacerbation phase of disease and all that important, to prevent fatigue and maintain power. Maintain / improve joint function, muscle strength and general stamina. Deep breathing for relaxation is easy to learn and contributes to pain relief and/or reduction by reducing muscle tension and anxiety.

Maintain a rest / sit if necessary scheduled events

Encourage patient to do deep breathing exercise.

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reduction in muscle strength and function, stiffer and less mobile joints, and gait changes affecting balance can significantly compromise the mobility of elderly patients. Mobility is paramount if elderly patients are to maintain any independent living. Restricted movement affects the performance of most activities of daily living (ADLs). Elderly patients are also at increased risk for the complications of immobility. Nursing goals are to maintain functional ability, prevent additional impairment of physical activity, and ensure a safe environment. Source: Medical-Surgical Nursing, 7th ed.by Black, JoyceM. and Jane Hokanson Hawks; p. 440

Instruct the patient to maintain an upright posture and sitting height, standing, and walking.

Maximize maintain joint function and mobility.

Create a quiet, nondisruptive environment with dim lights and comfortable temperature when possible.

Comfort and a quiet atmosphere promote a relaxed feeling and permit the client to focus on the relaxation technique rather than external distraction. Necessary for treatment of the underlying cause.

Dependent: Administer medications (particularly analgesics) as prescribed. Collaborative: Consult with physiotherapy.

Useful in formulating training programs / activities that are based on individual needs and in identifying tools.

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