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)
1

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.

II. OBJECTIVES GENERAL OBJECTIVE: To be knowledgeable about the nature of our Case, management and treatment to be able to 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

III.

THEORETICAL FRAMEWORK The 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.

IV.

NURSING HISTORY:

Source of information: Patient herself, including her son, 19 years old. A. Biographical Data Patient name : Address : Patient C.F. Lacson St., Sampaloc Manila May 15, 1964 Masbate City 47 years old Female labandera Filipino Widowed Roman Catholic

Date of Birth : Birth Place Age Sex Occupation Nationality : : : : :

Marital Status : Religion :

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 syang huminga 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. 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 As

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.
6

D. Past Health History: 1. Medical History no previous hospitalization 2. Surgical History no surgical or operations done 3. Medications ferrous sulfate, and unrecalled antibiotics, but poor compliance 4. Allergies- chemical inhalants such as zonrox, rugby, and vulcaseal. No allergies to drugs, foods and animals. 5. Injuries and accidents none 6. Special needs none 7. Childhood illness and immunization cant recall except for tetanus toxoid

E. Family Health History: Legend: mother father brother sister patient hypertensive pneumonia asthmatic hypertensive

F. Social History: a. alcohol use she denies that shes not drinking any alcoholic beverages b. drug use none c. tobacco use non-smoker d. sexual practice not mentioned e. travel history none f. work environment- poor ventilation g. physical environment theyre living in a small space, made of light materials.
7

h. home environment congested, they live in a crowded place with poor ventilation and 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 environment they live near in a public market and accessible to recreational areas and public utility vehicles. j. Hobbies and leisure she plays BINGO as a form of her relaxation k. Stress financial constraints is her primary reason of stress l. Education she is an elementary graduate at Geronimo Elementary School. m. Economic status religion ethnic background she 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 relationship she is a mother of two, a widow for seven years, with good personal 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 DISEASES She doesnt recall any immunizations except for TT 1. She recall that she experienced chicken pox

VI. ALLERGIES she has allergy to chemicals/agents such as zonrox, rugby, and vulcaseal. No allergies to drugs, foods and animals.

VII. HOME MEDICATION/ALTERNATIVE MEDICINES she usually takes paracetamol for 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.

VIII. PSYCHOSOCIAL HISTORY a. Alcohol use she denies that shes not drinking any alcoholic beverages b. Drug use c. Caffeine use- she drinks coffee 3 cups everyday, sometimes mixed with milk powder. IX. OBSTETRICAL HISTORY Menarche 13 years olds G2P2

X.

GORDONS HEALTH PATTERN: BEFORE HOSPITALIZATION DURING HOSPITALIZATION ANALYSIS

GORDONS FUNCTIONAL HEALTH PATTERN Health Perception Pattern

Patient C.F. described herself sick because she feels weak and she doesnt know why. She wanted to visit the center but she doesnt find time.

Nutritional and Metabolic Pattern

Elimination Pattern

Activity-Exercise Pattern

Sleep and Rest Pattern

She eats 3 times a day. Commonly she eats fish and vegetables. She eat meat twice a week because she doesnt like too much meat like chicken and pork. She could drink 2 glasses of water about 500 to 600ml daily. She doesnt have any problem in urinating. She urinate 4 0r 5 times daily without any difficulty with slightly yellowish color. She defecates twice daily, one in the morning and in the evening without any difficulty with brown color with soft to hard consistency or its depend on the food she eats. She could still perform her daily living. She clean the house, wash her clothes and her children, cooking food, and doing the household chores was her way of exercising and also stretching and walking around the house for 20 to 30 minutes daily. She has the normal 6 to 8 hours of sleep daily. She sleeps 9 in the evening and woke up 4 in the morning. Sometime she could still nap in the afternoon by 2 to 4 in the

She even felt worse during her stay in the hospital. She couldnt do her daily routine. She wanted to feel better and eventually healed from her sickness and go home to take care of her children. In the hospital she eat everything they served but in a little amount because she doesnt have appetite or loss her appetite all the time. She drinks not more than 500ml daily.

Due to knowledge deficit because she is an elementary graduate.

Loss of appetite is due to decrease taste sensation.

Now, she urinates 2 to 3 times daily without any difficulty with yellowish color with a very minimal amount. She defecate once a day or sometimes none with a soft consistency.

Due to decrease amount of food and fluids intake.

She couldnt do everything that she was doing before. She felt very weak and couldnt even move too much because of the IVF and the oxygen. Moving and talking a little started her to cough and start to feel the difficulty of breathing. She couldnt get her 6 to 8 hours sleep daily because of her present condition. Difficulty of breathing made her restless. She wanted to sleep but she couldnt get

Due to generalize body weakness is a sign of pneumonia.

Restless and difficulty of breathing are the sign and symptoms of patient with respiratory
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Cognitive Perceptual Pattern

Self PerceptionSelf Concept Pattern

Role-Relationship Pattern

afternoon. She doesnt have any problem in term of her cognitive abilities. She still has a good memory. She doesnt wear eyeglasses or hearing aid. She doesnt always feel fine especially when she has coughed that last 1 week with a mild headache every time she experienced it. It limits her daily activities. Shes living with his children and has a good relationship with them. She became more closer to them after her husband died. She also has good relationship with her neighbors and relatives. When her husband died 7 years ago she never thought of having a second husband and has a sexual activity. She dedicated her life to her children and never thought about that. She always seeks her siblings advice and help every time she has problem. She just cries and thinks of the best way to resolve all the stress she has when her siblings are not available to help her. She is a Roman Catholic. She wasnt very religious person and she doesnt remember the last time she visited the church to ask for God help.

it. She is always restless and irritated because of her present condition.

problem. Restlessness and irritability are sign of pneumonia

She felt very weak and her conditions worsen everyday she stays in the hospital. She felt scare of the situation.

Anxiety is due to her condition and a long stay in the hospital.

She is more close to her family now because of her condition.

Her present condition made the family more closer.

Sexual Reproductive Pattern

Now, she couldnt imagine herself with another man except her son especially with her present condition.

No problem on her sexual reproductive pattern.

Coping Stress Tolerance

Praying, crying and talking to her sibling are her ways to lessen her stress because of her condition.

These are the natural ways on how she cope from her stress.

Value Belief Pattern:

When she recover from Her present her disease and discharge condition changed from the hospital she her beliefs. promise that the first thing she will do is to visit the Black Nazarene in Quiapo and always attend the mass every Sunday and will devote her life in serving Him.

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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, oriented to time, place and person. She is appropriately dressed with no body odor. She has oxygen via nasal cannula at a flow rate of 3Lpm. She has 0.9% NaCl IV fluid regulated at KVO rate at left hand (cephalic vein). She appears weak, with accompanying shortness of breath. Vital Signs: BP: T: RR: PR: BODY PARTS SKULL 100/70 36.5 28 90 ACTUAL FINDINGS -Rounded (normocephalic and symmetrical, with frontal, parietal, and occipital prominences); smooth skull contour - no presence of nosules, masses and depressions - excessive dryness; sparse dandruff visible Weight: 90 kg Height: 5 ft.

ANALYSIS No deviations found

NURSING ALERT

HAIR

-abnormal, excessive dry hair could indicate malnutrition and can attract nits.

-advise patient to practice proper hygiene to prevent further hair problems

SKIN

-evenly distributed and covers the whole scalp -appears pale

Cyanosis is a sign of decreased oxygen level in the blood (hypoxemia) due to increased fluid in the pleural space

FACE

-with even skin tone -no lesions and abrasions noted -symmetric and palpebral No deviations found fissure equal in size, nasolabial folds are symmetrical -pupil equally rounded reactive No deviations found 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
12

EYES

EARS

-Symmetrical -Tympanic membrane are pearly, grey, and translucent with 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,

-cyanosis is an indication of decreased oxygen level in the body. No deviations found

-has 27 adult teeth, yellowish and has halitosis

-abnormal, incomplete number of teeth is due to having history of poor oral hygiene. -most unpleasant breath known to arise from proteins trapped in the mouth which are processed by oral bacteria. LYMPH NODES -not palpable -no deviations

-teach client about proper oral hygiene to prevent further oral infections

THORAX Anterior

-difficulty of breathing

-abnormal labored breathing is a common manifestation affecting clients with cardiac and pulmonary disorders. Its is related to obstructed airways. It is also related to the decreased size of the lungs due to PTB -it is also the most common symptom of a pleural effusion. As the effusion grows larger with more fluid, the harder it is for the lung to expand and the more difficult it is for the patient to breathe.

-administer oxygen as ordered by the doctor to support oxygenation -minimize physical activity to decrease oxygen demand

13

-medium-pitched, thudlike sound is heard on percussion

-abnormal, dullness may characterize areas of increased density such as pleural effusion -unequal chest expansion is seen in patients with severe atelectasis, pneumonia, chest trauma, pleural effusion or pneumothorax.

-unequal chest expansion is observed on palpation

-changing of positions at bed every 30 mins will minimize mucus stasis for easy expectoration.

-has crackles sounds on the upper and lower thorax

-abnormal crackles are audible when there is s sudden opening of the small airways that contain fluid. It is usually heard during inspiration; may indicate pnuemonia

-nebulization must be done as prescribed

Posterior -spine vertically aligned -skin intact, uniform temperature; no tenderness; no masses -uses accessory muscles to assist breathing No deviations found

-trapezius or shoulder muscles are used to facilitate inspiration in cases of acute and chronic airway obstruction -diminished or absent breath sounds often indicate that little or no air is moving in or out of the lung area being auscultated. It may also indicate abnormalities of the pleural space such as pleural effusion. No deviations found

-diminished breath sounds are auscultated at the apex of the lungs

CARDIOVASCULAR -has full and rapid pulsations;

ABDOMEN

-uniform color and has no blemish; 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 -weak muscle tone; weak muscle strength -abnormal, possibly related to the amount of food she is eating; due to decrease oxygen supply to the body causing easy fatigability. -minimize physical activity to prevent over fatigue

Right arm

+4 active motion against some resistance

-abnormal

-place patients needs within reach to reduce exertion of energy -raise side railes to prevent injury

Left arm

+4 active motion against some resistance With IV fluids inserted specifically at the cephalic vein +4 active motion against some resistance +4 active motion against some resistance

-abnormal

Right leg

-abnormal

-abnormal

Left leg

-no edema, no pain when moved -nails are

No deviations found

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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

16

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.

17

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.

18

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.

19

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 Inspired Gas + % Air Nitrogen Oxygen Carbon 0.04% Dioxide Water 1.2% Vapour Note: a lot of water is lost from the body each day due to breathing. 6.1% Increased about five times 4.2% five times 78% 20.8% Air 76% 15.3% No real change. Reduced by about a quarter Increased by about a hundred and Expired Alteration

20

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

21

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.

22

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.

23

XIII. PATHOPHYSIOLOGY

24

25

XIV. LABORATORY/DIAGNOSTIC EXAMINATIONS: Fuentes, Clarinda 47 yrs old HEMATOLOGY RESULTS January 29, 2012 Tests Hemoglobin Normal Value F: 12-14g/dl Found Value 10.2 Interpretation 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 Segmenters 4.8-10.8x10 60-70% 8.0 77 Normal. 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

26

substantially lost. Monocytes Platelet count 2-8% 130-400x10 280 Normal.

January 23, 2012 Tests Hemoglobin Normal Value F: 12-14g/dl Found Value 11.8 Interpretation Below normal: An indication of pleural effusion and PTB.. Hematocrit F: 0.37-0.47 0.30 Below normal: An indication of inadequate hydration. WBC count Segmenters 4.8-10.8x10 60-70% 7.3 71 Normal. Increased: Indicates that the bodys immune response is activated and compensating in the body. Lymphocytes 30-40% 29 Decreased: Indicates that the body's resistance to fight infection has been

27

substantially lost. Monocytes Platelet count 2-8% 130-400x10

January 9, 2012 Tests Hemoglobin Normal Value F: 12-14g/dl Found Value 11.1 Interpretation Below normal: An indication of pleural effusion and PTB. Hematocrit F: 0.37-0.47 0.33 Below normal: An indication of inadequate hydration. WBC count Segmenters 4.8-10.8x10 60-70% 10.4 72 Normal. Increased: Indicates that the bodys immune response is activated and compensating in the body. Lymphocytes 30-40% 28 Decreased: Indicates that the body's resistance to fight infection has been

28

substantially lost. Monocytes Platelet count 2-8% 130-400x10 262 Normal.

December 31, 2011 Tests Hemoglobin Normal Value F: 12-14g/dl Found Value 10.1 Interpretation Below normal: An indication of pleural effusion and PTB. Hematocrit F: 0.37-0.47 0.30 Below normal: An indication of inadequate hydration. WBC count Segmenters 4.8-10.8x10 60-70% 8.5 76 Normal. Increased: Indicates that the bodys immune response is activated and compensating in the body. Lymphocytes 30-40% 24 Decreased: Indicates that the body's resistance to fight

29

infection has been substantially lost. Monocytes Platelet count 2-8% 130-400x10 289 Normal.

December 28, 2011 Tests Hemoglobin Normal Value F: 12-14g/dl Found Value 10.8 Interpretation Below normal: An indication of pleural effusion, PTB Hematocrit F: 0.37-0.47 0.32 Below normal: An indication of inadequate hydration. WBC count Segmenters 4.8-10.8x10 60-70% 10 78 Normal. Increased: Indicates that the bodys immune response is activated and compensating in the body. Lymphocytes 30-40% 22 Decreased: Indicates that the body's resistance to fight

30

infection has been substantially lost. Monocytes Platelet count 2-8% 130-400x10 240 Normal.

December 30, 2011 Tests Hemoglobin Normal Value F: 12-14g/dl Found Value 9.4 Interpretation Below normal: An indication of pleural effusion and PTB. Hematocrit F: 0.37-0.47 0.28 Below normal: An indication of inadequate hydration. WBC count Segmenters Lymphocytes Monocytes Platelet count 4.8-10.8x10 60-70% 30-40% 2-8% 130-400x10 8.7 66 34 Normal. Normal. Normal.

Analysis:
31

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 MACROSCOPIC Color Transparency MICROSCOPIC Pus cell Red cell Epithelial cell Mucus thread 5-8/hpf 3-5/hpf Many Few Yellowish Slightly turbid Normal. Found Value Analysis

32

December 9, 2011 Tests MACROSCOPIC Color Transparency MICROSCOPIC Pus cell Red cell Epithelial cell Mucus thread 0-2/hpf 0-2/hpf Many Few Yellowish Slightly turbid Normal. Found Value Analysis

Clinical Chemistry Date: January 3, 2012 Tests Bun Creatinine Normal Value 2.49-6.42umol/L 53.04-106.08 umol/L Sodium Potassium 135-14 umol/L 2.5-5.5 umol/L 136.5 3.69 Normal. Normal. Found Value 3.33 94.72 Analysis Normal. Normal.

Gram Stain
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Date: 1-27-12 Specimen Pus Cells Epithelial Cell Results Pleural Fluid Rare Occasional 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 costal sulcus. 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. IMPRESSION: PROGRESSIVE PTB VS. PNEUMONIA NURSING ANALYSIS: Pleural effusion accumulates due to imbalance in hydrostatic or oncotic pressure.

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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:

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

CXR PA: Follow-up new shows total specification of the right lung while the left lung shows further 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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IMPRESSION: PROGRESSIVE PTB VS. PNEUMONIA NURSING ANALYSIS: Pleural effusion accumulates due to imbalance in hydrostatic or oncotic pressure.

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XVII. DISCHARGED PLANNING Discharge 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 reduce work 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 especially medications, diet, and lifestyle Encourage significant others to assist the patient in performing of breathing exercises to promote 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 and water 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. Smoking increases 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 breathing as 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 see how 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 of the patient recuperation and identify recurrent or new care needs Notify family that follow-up reinforces patient teaching initiated in the hospital in recognizing and managing the different danger signs of illness

Diet/Nutrition Diet which is prescribed should be followed. To include fruits and vegetables in the diet is 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

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