CASE PRESENTATION

ReIated
Learning
Experience RLE
30-GROUP 6
INTRODUCTION
A. OVERVIEW OF THE CASE
Pneumonia is an infIammation of the Iungs
caused by an infection. It is aIso caIIed
Pneumonitis or Bronchopneumonia. Pneumonia
can be a serious threat to our heaIth. AIthough
pneumonia is a speciaI concern for oIder aduIts
and those with chronic iIInesses, it can aIso
strike young, heaIthy peopIe as weII. It is a
common iIIness that affects thousands of peopIe
each year in the PhiIippines, thus, it remains an
important cause of morbidity and mortaIity in the
country (http://nursingcrib.com/case-
study/pneumonia-case-study/)
CLIENTS PROFILE
A. Socio-demographic Data
Patient X is a 3 years oId femaIe, Roman
CathoIic of Mambatangan, ManoIo Fortich,
Bukidnon. Patient X was admitted at NMMC Iast
JuIy 13, 2011 due to cough and fever.
Upon
Admission:
PuIse:120 bpm
Temp: 37.5 C
RR: 40cpm
Weight: 11.5
kg
DAY 3
PuIse:165
bpm
Temp: 37.7 C
RR: 51cpm
DAY 2
PuIse:125 bpm
Temp: 38.1 C
RR: 38cpm
DAY 4
PuIse: 125 bpm
Temp: 37.5 C
RR: 39cpm
Before hospitaIization patient X was in good appetite can
feed fuII of share in her diet.
Patient X was fed per demand more or Iess 3-4 times per
day, upon hospitaIization the patient was experiencing Ioss
of appetite and Ioss about 2 kg of body weight giving him a
weight of 9.5 kg. Patient is feeding Iess than the feeding
pattern
Patient X's usuaI boweI pattern is 1-2 times a day and
sometimes its intervaI with one day. His Iast boweI
movement was JuIy 20, 2011with wet stooI. His usuaI
urinary pattern is 2-3 times a day, approximateIy 120-160
mI per day with yeIIow coIored urine.
Patient X needed assistance with seIf-care such as
eating, bathing, grooming, dressing and toiIeting. Patient
X is dependent on his mother since the patient is stiII 3
year oId and pain when moving in her Ieft side with
cIosed-thoracostomy tube inserted.
Name: Ms. X
Temp: 37.5C
PuIse: 120 bpm
Respiration: 40 cpm
Height: Weight: 11.5
kg .
Date: February 3, 2011
1he Anatomy of the Lung
Lach lung is diided into lobes. 1he right lung, which has three lobes, is
slightly larger than the let, which has two. 1he lungs are housed in the
chest caity, or thoracic caity, and coered by a protectie membrane
called the pleura. 1he diaphragm, the primary muscle inoled in
respiration, separates the lungs rom the abdominal caity.
1he pulmonary arteries carry de-oxygenated blood rom the right
entricle o the heart to the lungs. 1he pulmonary eins, on the other
hand, carry oxygenated blood rom the lungs to the heart, so it can be
pumped to the rest o the body.
The Iungs expand upon inhaIation, or
inspiration, and fiII with air. They then return
to their resting voIume and push air out
upon exhaIation, or expiration. These two
movements make up the process of
breathing, or respiration.
The respiratory system contains severaI
structures. When you breathe, the Iungs
faciIitate this process:
1.Air comes in through the mouth and/or nose, and traveIs
down through the trachea, or "windpipe." This air traveIs
down the trachea into two bronchi, one Ieading to each Iung.
The bronchi then subdivide into smaIIer tubes caIIed
bronchioIes. The air finaIIy fiIIs the aIveoIi, which are the
smaII air sacs at the ends of the bronchioIes.
2.In the aIveoIi, the Iungs faciIitate the exchange of oxygen
and carbon dioxide to and from the bIood. AduIt Iungs have
hundreds of aIveoIi, which increase the Iungs' surface area
and speed this process. Oxygen traveIs across the
membranes of the aIveoIi and into the bIood in the tiny
capiIIaries surrounding them.
3.Oxygen moIecuIes bind to hemogIobin in the bIood and are
carried throughout the body. This oxygenated bIood can then
be pumped to the body by the heart.
4.The bIood aIso carries the waste product carbon dioxide
back to the Iungs, where it is transferred into the aIveoIi in
the Iungs to be expeIIed through exhaIation.
Smoking can damage the aIveoIi and
make breathing Iabor intensive,
resuIting in emphysema or Iung
cancer.
"uiet respiration- happens when the body is at rest.
During quiet respiration, the diaphragm contracts
and puIIs down, Iowering the pressure in the Iungs
and causing air to enter the Iungs through the
mouth and nose to equaIize the pressure. When the
diaphragm reIaxes, it moves back up, pushing air
back out of the Iungs. The Iungs and chest waIIs
aIso return to their resting positions. This aIso
reduces the size of the chest cavity and heIps to
push air out of the Iungs.
Active respiration- occurs when the body is active
and requires higher IeveIs of oxygen to the bIood
than when resting. During active respiration, the
muscIes around the ribs raise and push out the ribs
and sternum, which increases thoracic voIume,
heIping the Iungs take in more air. During
exhaIation, the intercostaIs force the ribs to
contract, and the abdominaI muscIes contract,
forcing the diaphragm to rise. Both these
movements make the thoracic cavity contract, and
heIp push air out of the Iungs.
The Lungs' Protections
SeveraI Iung parts and functions act as protective
mechanisms to keep out irritants and foreign particIes. The
hairs and mucus in the nose prevent foreign particIes from
entering the respiratory system.
The breathing tubes in the Iungs secrete mucus, which aIso
heIps protect the Iungs from foreign particIes. This mucus is
naturaIIy pushed up toward the epigIottis, where is passed
into the esophagus and swaIIowed. Coughing up any of this
mucus is usuaIIy an indication of a respiratory infection, or a
condition such as bronchitis or chronic obstructive
puImonary disease (COPD). Irritants can aIso cause
bronchospasm, in which the muscIes around the bronchiaI
tubes constrict in order to keep out irritants. Asthma
invoIves infIammation and constriction of the bronchiaI
tubes, and is often triggered by environmentaI irritants.
BronchiaI constriction causes breathing difficuIties.
About Breathing
DifficuIties
Damage to any part of the respiratory pathway can aIso
cause breathing difficuIties. Understanding human Iung
anatomy and physioIogy makes cIear how the different Iung
parts are affected in disease.
In peopIe with bronchitis, the bronchiaI tubes become
infIamed and irritated. They produce mucus, resuIting in a
cough. Bronchitis can be acute, with a sudden onset and
quick recovery, or chronic, and Iast much Ionger.
Chronic obstructive puImonary disease (COPD)
invoIves symptoms of both chronic bronchitis and
emphysema. BIockage in the bronchioIes and aIveoIi
make it difficuIt to exhaIe. This traps air in the Iungs
and in turn makes proper inhaIation difficuIt.
InterstitiaI Iung disease, incIuding puImonary
fibrosis, causes a buiIdup of scar tissue in the Iungs
and reduces Iung function. Any of these conditions
affect not onIy the Iungs, but the entire body, as the
heaIthy respiration is required to suppIy oxygen to
the body and its organs.
SCHEMATIC DIAGRAM OF
PATHOPHYSIOLOGY OF
PNEUMONIA
PATHOPHYSIOLOGY OF
PNEUMONIA
Pneumonia is a commonIy occurring serious disease that
affects about 1 out 100 peopIe every year. As mentioned
above, many factors are responsibIe for deveIopment of
pneumonia. Pneumonia can be divided into various
categories Iike community acquired and hospitaI acquired
infection. The common type of community acquired
infection is pneumococcaI pneumonia and MycopIasma
pneumonia. Many times in peopIe with Iowered immunity
or geriatric patients, pneumonia is seen after a bout of
infIuenza. Most of the hospitaI acquired infections of
pneumonia are the serious infections, as they body Iacks
the mechanism to fight against the condition. AspirationaI
pneumonia, pneumonia in immunocompromised host and
viraI pneumonia are some of the pneumonia reIated
specific disorders. Let us go into the detaiIs of
pathophysioIogy of pneumonia. You can read more
about chronic pneumonia and acute pneumonia.
LAB RESULTS
ULTRASOUND REPORT
JuIy 21,2011
Findings: FIuid connection with moderate to high
IeveI echoes in the right basaI hemithorax
measuring 3.7cm x 3.6 cm x 2.2cm another fIuid
coIIection measuring 4cm x2.3cmx 1.6 cm (8.0mI)in
right midIung, posterior to the fIuid coIIection areas
of hyperechoic Iung tissue with air bronchogram.
Diagnosis: 2 fIuid coIIection IikeIy emphysema right
as describe above Iung consoIidation and/or
ateIectasis.
HematoIogy JuIy 27, 2011 JULY 22, 2011 JULY 15, 2011
Unit
WBC 10.4 10.3 9.2 25.2
RBC 3.14 10^6UI 3.34 3.72
HemogIobin 8.3 gIdI 5.8 9.8
Hematocrit 25.3 % 26.7 29.0
MCV 81.5 F1 79.9 78
MCH 26.4 pg 26.3 26.3
MCHC 32.4 g/dI 33.0 33.8
RDW-CV 16.8 % 16.1 18.9
PDW 7.7 FL 7.2 8.4
MVP 8.4 FL 7.3 8.6
DifferentiaI Count
Lymphocytes 34.1 % 29.8 19
NuetrophiI 50.5 % 62.7 66.6
Monocyte 14.5 % 6.8 14.1
EosinophiI 0.6 % 0.4 0.2
BasophiI 0.3 % 0.3 0.1
Bands /stabs
PIateIet 450 10^3UL 772 654
MicrobioIogy 7/19 7/13 7/13
Specimen: Specimen: PIuraI FIuid after 24hrs of
incubation
2
nd
Take: NO AFB SEEN RESULT: NO ORGANISM ORGANISM:BaciIIus
sp.
3
rd
Take: NO AFB SEEN SEEN (-) (+)positive
negative
Medication
Medications must be continued according to the doctor's
instructions, otherwise the pneumonia may recur, and aIso
the patient shouId take the entire course of any prescribed
medications.
Provide appropriate information for better understanding
regarding therapeutic effects of the medications.
Encourage the significant others of the chiId to report or
inform the physician if any of these side effects occur.
Inform and expIain it to the guardians. Moreover, emphasize
the right timing or taking of the right time intervaIs of these
drugs to maximize its therapeutic effects and avoid further
compIications.
Exercise
Not appIicabIe
Treatment
Instruct the famiIy of the cIient to continue drug therapy as
ordered.
Inform the famiIy about the dangers of non compIiance to
treatment regimen.
Discuss to the significant others the compIication of the
condition.
Instruct them to report to the physician promptIy about any
changes on heaIth condition.
Encourage guardians to strictIy compIy with the doctor's
orders, especiaIIy in taking prescribed medications.
Encourage them aIso to have foIIowed up visitations to the
physician after discharge.
Drink Iots of fIuids. Liquids wiII keep away patient from
becoming dehydrated and heIp Ioosen mucus in the Iungs.
Give supportive treatment. Proper diet and oxygen to
increase oxygen in the bIood when needed.
Give the medicine on scheduIe for as Iong as directed. This wiII heIp your
chiId recover faster and wiII decrease the chance that infection wiII
spread to other househoId members.
Encourage drinking of fIuids, especiaIIy if fever is present. Sponge baths
are recommended for the first day or two. Ask the doctor before you use
a medicine to treat your chiId's cough because cough suppressants stop
the Iungs from cIearing mucus, which may not be heIpfuI in some types
of pneumonia.
Check your chiId's Iips and fingernaiIs to make sure that they are rosy
and pink, not bIuish or gray, which is a sign that the Iungs are not getting
enough oxygen.
Proper hygiene especiaIIy handwashing to prevent infections
Advise the mother to give suppIements to the chiId especiaIIy Vit. A to
prevent anemia
Remind the significant others of the patient on the
arrangements to be made with the physician for foIIow-up
checkups.
FoIIow-up check up reguIarIy in order to monitor and
properIy manage patient's iIIness.
Continue medication as ordered.
Instruct to have a foIIow-up check-up or refer to the
physician if the patient is uncomfortabIe.
Since the chiId is stiII 3 years oId, encourage the mother to
have her chiId eat a weII-baIanced diet, chiId's intake of
foods may affect chiId's heaIth.
Advice the guardians to be watchfuI/carefuI enough of the
diet that couId heIp maintain cIear airway and promote
proper nutrition of the patient.
Human body is not just this we can see. There is more to it.
To treat other IeveI of us, to treat souI and to treat mind and
unconscious parts of us, I suggest the famiIy of the patient
to pray for the recovery of their chiId.