Escolar Documentos
Profissional Documentos
Cultura Documentos
Nice To Know:
Pneumonia can also be defined by how much
of the lung is involved.
In
lobar Pneumonia:
pneumonia, one section (lobe) of
Facts
about
a lung is affected.
Pneumonia is a serious illness that
affects
one out
of every (or
100 people each
In
bronchial
pneumonia
bronchopneumonia), patches throughout
both lungs are affected.
year.
There are about 30 different causes of pneumonia. However, they all fall into
one of these categories:
Nice To Know:
Although most cases of pneumonia are caused
by a viral or bacterial infection, the disease
can also be caused anything that obstructs the
bronchial tubes. Tumors, peanuts, hard
candies, or small toys in the bronchial tubes
can trap bacteria, viruses, or fungi, resulting in
pneumonia.
The incubation period last from 1-3 days with sudden onset of shaking chills,
rapidly raising fever and stabbing chest pain aggravated by coughing and
respiration.It can be transmitted through (a)Droplet infection from the
mouth and nose of an infected person via the nasopharynx intimate contact
with carrier and (b)Indirect contact by contaminated objects is possible,
Anatomy &
Physiology of the
Respiratory
System
The respiratory system is situated in
the thorax, and is responsible for
gaseous exchange between the
circulatory system and the outside
world. Air is taken in via the upper
airways (the nasal cavity, pharynx and larynx) through the lower airways
(trachea, primary bronchi and bronchial tree) and into the small bronchioles
and alveoli within the lung tissue.
The lungs are divided into lobes; The left lung is composed of the upper
lobe, the lower lobe and the lingula (a small remnant next to the apex of
the heart), the right lung is composed of the upper, the middle and the
lower lobes.
Mechanics of Breathing
To take a breath in, the external intercostal muscles contract, moving the
ribcage up and out. The diaphragm moves down at the same time, creating
negative pressure within the thorax. The lungs are held to the thoracic wall
by the pleural membranes, and so expand outwards as well. This creates
negative pressure within the lungs, and so air rushes in through the upper
and lower airways.
Expiration is mainly due to the natural elasticity of the lungs, which tend to
collapse if they are not held against the thoracic wall. This is the mechanism
behind lung collapse if there is air in the pleural
space (pneumothorax).
Physiology of Gas Exchange
Each branch of the bronchial tree eventually subdivides to form very narrow terminal bronchioles,
which terminate in the alveoli. There are many
millions of alveloi in each lung, and these are the areas responsible for
gaseous exchange, presenting a massive surface area for exchange to occur
over.
Each alveolus is very closely associated with a network of capillaries
containing deoxygenated blood from the pulmonary artery. The capillary and
alveolar walls are very thin, allowing rapid exchange of gases by passive
diffusion along concentration gradients.
CO2 moves into the alveolus as the concentration is much lower in the
alveolus than in the blood, and O2 moves out of the alveolus as the
continuous flow of blood through the capillaries prevents saturation of the
blood with O2 and allows maximal transfer across the membrane.
How do the lungs normally work?
The chest contains two lungs, one lung on the right side of the chest, the
other on the left side of the chest. Each lung is made up of sections called
lobes. The lung is soft and protected by the ribcage. The purposes of the
lungs are to bring oxygen (abbreviated O2), into the body and to remove
carbon dioxide (abbreviated CO2). Oxygen is a gas that provides us energy
while carbon dioxide is a waste product or "exhaust" of the body.
How do the lungs protect themselves?
The lungs have several ways of protecting themselves from irritants. First,
the nose acts as a filter when breathing in, preventing large particles of
pollutants from entering the lungs. If an irritant does enter the lung, it will
get stuck in a thin layer of mucus (also called sputum or phlegm) that lines
the inside of the breathing tubes. An average of 3 ounces of mucus are
secreted onto the lining of these breathing tubes every day. This mucus is
"swept up" toward the mouth by little hairs called cilia that line the breathing
tubes. Cilia move mucus from the lungs upward toward the throat to the
epiglottis. The epiglottis is the gate, which opens allowing the mucus to be
swallowed. This occurs without us even thinking about it. Spitting up sputum
is not "normal" and does not occur unless the individual has chronic
bronchitis or there is an infection, such as a chest cold, pneumonia or an
exacerbation of chronic obstructive pulmonary disease (COPD).
Another protective mechanism for the lungs is the cough. A cough, while a
common event, is also not a normal event and is the result of irritation to the
bronchial tubes. A cough can expel mucus from the lungs faster than cilia.
The last of the common methods used by the lungs to protect themselves
can also create problems. The airways in the lungs are surrounded by bands
of muscle. When the lungs are irritated, these muscle bands can tighten,
making the breathing tube narrower as the lungs try to keep the irritant out.
The rapid tightening of these muscles is called bronchospasm. Some lungs
are very sensitive to irritants. Bronchospams may cause serious problems for
people with COPD and they are often a
major problem for those with asthma,
because it is more difficult to breathe
through narrowed airways.
How does air get into the body?
To deliver oxygen to the body, air is
breathed in through the nose, mouth or
both. The nose is the preferred route
since it is a better filter than the mouth.
The nose decreases the amount of
irritants delivered to the lung, whilst also
heating and adding moisture (humidity) into the air we breathe. When large
amounts of air are needed, the nose is not the most efficient way of getting
air into the lungs and therefore mouth breathing may be used. Mouth
breathing is commonly needed when exercising.
After entering the nose or mouth, air travels down the trachea or "windpipe".
The trachea is the tube lying closest to the neck. Behind the trachea is the
esophagus or "food tube". When we inhale air moves down the trachea and
when we eat food moves down the esophagus. The path air and food take is
controlled by the epiglottis, a gate that prevents food from entering the
trachea. Occasionally, food or liquid may enter the trachea resulting in
choking and coughing spasms.
The trachea divides into one left and one right breathing tube, and these are
termed bronchi. The left bronchus leads to the left lung and the right
bronchus leads to the right lung. These breathing tubes continue to divide
into smaller and smaller tubes called bronchioles. The bronchioles end in tiny
air sacs called alveoli. Alveoli, which means "bunch of grapes" in Italian, look
like clusters of grapes attached to tiny breathing tubes. There are over 300
million alveoli in normal lungs. If the alveoli were opened and laid out flat,
they would cover the area of a doubles tennis court. Not all alveoli are in use
at one time, so that the lung has many to spare in the event of damage from
disease, infection or surgery.
Which muscles help in the breathing process?
Many different muscles are used in breathing. The largest and most efficient
muscle is the diaphragm. The diaphragm is a large muscle that lies under the
lungs and separates them from the organs below, such as the stomach,
intestines, liver, etc. As the diaphragm moves down or flattens, the ribs flare
outward, the lungs expand and air is drawn in. This process is called
inhalation or inspiration. As the diaphragm relaxes, air leaves the lungs and
they spring back to their original position. This is called exhalation or
expiration. The lungs, like balloons, require energy to blow up but no energy
is needed to get air out.
The other muscles used in breathing are located between the ribs and
certain muscles extending from the neck to the upper ribs. The diaphragm,
muscles between the ribs and one of the muscles in the neck called the
scalene muscle are involved in almost every breath we take. If we need more
help expanding our lungs, we "recruit" other muscles in the neck and
shoulders. In some conditions, such as emphysema, the diaphragm is pushed
down so that it no longer works properly. This means that the other muscles
must work extra hard because they arent as efficient as the diaphragm.
When this happens, patients may experience breathlessness or shortness of
breath.
HEMATOLOGY
PARAMETERS
WBC Count
ACTUAL
FINDINGS
19.8
UNITS
10.9/L
REFERENCE
VALUES
4-10
CLINICAL
IMPLICATIONS /
SIGNIFICANCE
HIGH
May be increased with
RBC Count
4.52
10.12/L
4.2-6.3
Hemoglobin
116
9/L
120-180
Hematocrit
0.35
2/L
0.37-0.54
Platelet Count
727
10 g/L
150-450
infections,
inflammation, cancer,
leukemia;
decreased
with some medications
(such
as
methotrexate), some
autoimmune
conditions,
some
severe
infections,
bone
marrow failure, and
congenital
marrow
aplasia
(marrow
doesn't
develop
normally
NORMAL
Decreased
with
anemia;
increased
when too many made
and with fluid loss due
to
diarrhea,
dehydration, burns
LOW
measures the amount
of
oxygen-carrying
protein in the blood.
LOW
measures the
percentage of red
blood cells in a given
volume of whole
blood.
HIGH
Decreased
or
increased
with
conditions that affect
platelet
production;
decreased
when
greater numbers used,
as
with
bleeding;
decreased with some
inherited
disorders
(such
as
WiskottAldrich,
BernardSoulier), with Systemic
lupus erythematosus,
pernicious
anemia,
hypersplenism (spleen
takes too many out of
MCV
77
f1
80-100
MCH
25.6
Pg
27-33
MCHC
332
g/L
320-360
circulation), leukemia,
and chemotherapy
Normal
a measurement of
the average size of
your RBCs. The MCV is
elevated when RBCs
are larger than normal
(macrocytic),
for
example in anemia
caused by vitamin B12
deficiency. When the
MCV
is
decreased,
RBCs are smaller than
normal (microcytic) as
is
seen
in
iron
deficiency anemia or
thalassemias
LOW
Mirrors MCV results
NORMAL
Mean corpuscular
hemoglobin
concentration (MCHC)
is a calculation of the
average concentration
of hemoglobin inside a
red cell. Decreased
MCHC
values
(hypochromia)
are
seen
in
conditions
where the hemoglobin
is abnormally diluted
inside the red cells,
such
as
in
iron
deficiency anemia and
in
thalassemia.
Increased
MCHC
values (hyperchromia)
are seen in conditions
where the hemoglobin
is
abnormally
concentrated
inside
the red cells, such as
in burn patients and
hereditary
spherocytosis,
a
relatively
rare
congenital disorder.
22.6
30-60
-Lymphocyte
(P)
Monocyte (p)
Granulocyte
(P)
7.2
3-9
70.2
20-65
RDW
14.00
13-16
LOW
may
indicate
lymphocytosis;increas
ed in convalescent
phase
after
bacterial/viral infection
NORMAL
HIGH
include
neutrophils
(bands
and
segs),
eosinophils,
and
basophils.
In
evaluating numerical
aberrations of these
cells (and of any other
leukocytes),
one
should first determine
the absolute count by
multiplying the per
cent value by the total
WBC
count.
For
instance, 2% basophils
in a WBC of 6,000/L
gives 120 basophils,
which
is
normal.
However,
2%
basophils in a WBC of
75,000/L gives 1500
basophils/L, which is
grossly abnormal and
establishes
the
diagnosis of chronic
myelogenous leukemia
over that of leukemoid
reaction with fairly
good accuracy.
NORMAL
The
red
cell
distribution width is
a
numerical
expression
which
correlates with the
degree of anisocytosis
(variation in volume of
the population of red
cells).
Some
investigators feel that
it
is
useful
in
differentiating
MPV
5.90
7.1-9.5
PDW
10.20
10-18
- Lymphocyte
(a)
- Monocyte
(a)
Granulocyte
(a)
4.40
10.9/L
1.2-3.2
NORMAL
measure
the
conformity of platelet
in
the
specimen.
Serves as a validity
check & monitors false
result.
HIGH
1.40
10.9/L
0.2-0.8
LOW
14.20
10.9/L
1.2-6.8
HIGH
CHEST X-RAY
Date taken : July 10, 2009
Examination: Chest AP
FINDINGS:
Bilateral Bronchopneumonia
Paratracheal Adenopathy
CLINICAL MANIFESTATION
SUBJECTIVE SYMPTOMS
OBJECTIVE SYMPTOMS
ACTUAL MANIFESTATION
THEORETICAL
SIGNS AND
SYMPTOMS
Dyspnea
Chest discomfort
ACTUAL
SIGNS AND
SYMPTOMS
Present
of purulent
or blood-tinged
sputum
Present
Absent
Cough productive
RATIONALE
All abnormal
formation/accumulati
on/ reaction in our
body causes
inflammatory
response, which
stimulates the nerve
fibers and produces
sensation of pain.
Mucus production is
increased, and the
leaky capillaries may
tinge the mucus with
blood. Mucus plugs
actually further
decrease the
efficiency of gas
exchange in the lung.
The alveoli fill further
Tachypnea
Tachycardia
Adventitious Sound
Breadth
* wheezes (or
rhonchi)
pitch, musical,
squealing sound
called wheezes.
* stridor
Cyanosis
Confusion
Chest indrawing
Because of
inadequate diffusion
of oxygen, gas
exchange in the
lungs, the blood
carries insufficient
amount to oxygen to
oxygenate the tissues,
organs of the body.
Organs like the brains
which when deprived
with oxygen will cause
in decrease nervous
function thus cause
confusion.
Another major sign of
severe pneumonia,
characterized when
the lower ribs goes in
when the child
breaths in too.
PATIENT DATA
Name: Patient X
Address: Ragay, Camarines Sur
Age: 2 years old
Date of Birth: April 13, 2007
Place of Birth: Ragay, Camarines Sur
Nationality: Filipino
Religion: Evangelical
Hospital Admission:
Date: July 10, 2009
Time: 4:00 P.M.
Brief History
Patient X was rushed to hospital last July 10, 2009 at 4:00 in the afternoon. Prior to
admission hospitalized he was confined first in a hospital in Ragay, Camarines sur for 4 days.
After being discharged, the patient stayed at home for almost two weeks. His parents
decided to bring him to Bicol Medical Center because of his high fever (39 C), Halak
(crackles) difficulty of breathing, cyanosis when crying and convulsion, and were
consequently admitted.
The cyanosis exhibited by the patient started when he was only 3 months old and
until now the manifestation still occurs whenever he cries. The patient had a history of blood
infection. According to his mother 3 days after his birth, he became yellowish and was
confined that early in the hospital. After being discharged, there were several recurrences of
jaundice. The diagnosis is Sepsis Neonatorum. At seven days old, the patient was operated
in the abdomen and was confined for one week at the ICU. Since then, the patient has been
undergoing monthly check-up at Tagkawayan Their preferred pediatrician there had treated
him for six consecutive months. Unfortunately, according to his parent, his condition did not
improve at all. His Halak had never been treated successfully.
TABLE OF CONTENTS
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
XI.
XII.
XIII.
XIV.
INTRODUCTION
BACKGROUND
PATIENTS DATA AND HISTORY
COURSE IN THE WARD
ANATOMY AND PHYSIOLOGY
PATHOPHYSIOLOGY
CLINICAL MANIFESTATION
PROGNOSIS
CLINICAL LABORATORY RESULTS
DIAGNOSTIC TEST
NURSING MANAGEMENT
DRUG STUDY
NURSING CARE PLAN
DISCHARGE PLAN
PATHOPHYSIOLOGY
The
invading microorganism causes symptoms, in part, by provoking an
The invading m icroorganism causes sym ptom s, in part, by provoking an
overly exuberant immune response in the lungs. The small blood vessels in
overly exuberant im m une response in the lungs. The sm allblood vessels in
the lungs (capillaries) become leaky, and protein-rich fluid seeps into the
the lungs (capillaries) becom e leaky, and protein-rich fl
uid seeps into the
alveoli. This results in a less functional area for oxygen-carbon dioxide
alveoli.
exchange. The patient becomes relatively oxygen deprived, while retaining
potentially damaging carbon dioxide. The patient breathes faster and faster,
in an effort to bring in more oxygen and blow off more carbon dioxide.
Mucus
is increased,
and
the
leaky capillaries
may
tinge the mucus
This rproduction
esults in a less
functionalar
ea f
or oxygencarbon dioxi
de exchange.
with
blood.
Mucus
plugs
actually
further
decrease
the
efficiency
gas
The patient becom es relatively oxygen deprived, w hile retaining potof
ent
ially
exchange in the lung. The alveoli fill further with fluid and debris from the
dam aging carbon dioxide. The patient breathes faster and faster, in an eff
ort
large number of white blood cells being produced to fight the infection.
to bring in m ore oxygen and blow offm ore carbon dioxide.
Consolidation, a feature of
bacterialpneum onias,
occurs w hen the alveoli,
w hich are norm ally hollow
air spaces w ithin the lung,
instead becom e solid, due
to quantities of fl
u id and
debris.
PROGNOSIS
The prognosis for pneumonia varies widely depending on the type of
infection. The recovery rate is nearly 100 percent, for example, in cases of
"walking pneumonia." By contrast, people with pneumonia caused by
Staphylococcus pneumoniae stand only a 60 percent to 70 percent chance of
survival. For the most common form of pneumonia, caused by Streptococcus
pneumoniae, the survival rate is about 95 percent.
In the United States, about one of every twenty people with pneumococcal
pneumonia die. In cases where the pneumonia progresses to blood poisoning
(bacteremia), just over 20% of sufferers die.
The death rate (or mortality) also depends on the underlying cause of the
pneumonia. Pneumonia caused by Mycoplasma, for instance, is associated
with little mortality. However, about half of the people who develop
methicillin-resistant Staphylococcus aureus (MRSA) pneumonia while on a
ventilator will die. In regions of the world without advanced health care
DIAGNOSTIC PROCEDURES
Pneumonia can usually be diagnosed on the basis of a patient's symptoms. A
doctor will also listen to the patient's chest with a stethoscope. If the lungs
are infected, they produce an unusual sound when the patient breathes in
and out. Tapping on the patient's back is also a test for pneumonia. Normally,
the tapping produces a hollow sound because the lungs are filled with air. If
pneumonia is present, however, the lungs may contain fluid. In this case, the
sound is dull thump.
Some forms of bacterial pneumonia can be diagnosed by laboratory tests. A
sample of the patient's sputum is taken. The sample is then stained with
dyes and examined under a microscope. The organisms causing the disease
can often be seen and identified.
X rays can also be used to diagnose pneumonia. Dark spots on the patient's
lungs may indicate the presence of an infection. The appearance of the spots
may give a clue to the type of infection that has occurred.
Investigations
Pneumonia as seen on chest x-ray. A: Normal chest xray. B: Abnormal chest x-ray with shadowing from
pneumonia in the right lung (white area, left side of
image).
produced when the lungs are diseased (SIADH). Specific blood serology tests
for other bacteria (Mycoplasma, Legionella and Chlamydophila) and a urine
test for Legionella antigen are available. Respiratory secretions can also be
tested for the presence of viruses such as influenza, respiratory syncytial
virus, and adenovirus. Liver function tests should be carried out to test for
damage caused by sepsis.
Combining findings
One study created a prediction rule that found the five following signs best
predicted infiltrates on the chest radiograph of 1134 patients presenting to
an emergency room:
Rales/crackles
Absence of asthma
1 findings - 5% to 9%
0 findings - 2% to 3%
Differential diagnosis
Several diseases and/or conditions can present with similar clinical features
to pneumonia and as such care must be taken in the proper diagnosis of the
disease. Chronic obstructive pulmonary disease (COPD) or asthma can
present with a polyphonic wheeze, similar to that of pneumonia. Pulmonary
edema can be mistaken for pneumonia due to its ability to show a third heart
sound and present with an abnormal ECG. Other diseases to be taken into
consideration include bronchiectasis, lung cancer and pulmonary emboli.
DISCHARGE PLAN
NURSING MANAGEMENT