CONCEPT MAP FOR INDIVIDUAL CASE PRESENTATION (ICU CASE)

Predisposing Factors Precipitating Factors

TUBERCULOSIS is an infectious  Pathogen (Mycobacterium Inhalation of droplet infection with  Living in community setting**
disease that primarily affects tuberculosis) Mycobacterium tuberculosis  Skipping vaccinations**
the lungs and can invade other  Weak immune system
body systems as well. This Bypasses goblet cells of
eventually causes a disease upper respiratory tract
such as it overwhelms the
human body’s immune system.
Bacilli are deposited in the lungs
PNEUMONIA is an acute
infection of the lung Immune system response
parenchyma that commonly
impairs gas exchange. This may Macrophage engulf bacilli
result from inhalation of a
pathogen that nay be viral, Bacilli replicates inside
bacterial, fungal, or protozoal.
Local Inflammatory response Systemic inflammatory response
MENINGITIS is the Inflammatory cells work to contain
inflammation of the meninges the infection forming granulomas
Disruption of hypothalamus
of the brain and spinal cord Fluid build-up Accumulation of
Caseous Necrosis thermoregulation
that results to viral or bacterial bacteria,
infection. inflammatory
CO2 & O2 mediators, Local progression Fever
PROGNOSIS: The majority of exchange necrotic tissues
patients with a diagnosis of TB
Chest APL -12/04/2022
have a good outcome due to Chest APL -12/03/2022 Irritation and WBC:
Pneumonia
effective treatment. Without Pneumonia in both attempted airway 12/14/2022- 18.94x10^9 /L
treatment, mortality rate for inner lung zone clearance 01/05/2023-14.11x10^9/L
tuberculosis is more than 50%.
Pipericillin 100mg OD-  Cough
STATISTICS: In 2021, an Suctioning Paracetamol 1.35mL IV PRN
antibiotic  crackles
estimated 10.6 million fell ill for fever
with TB worldwide. 6 million
men, 3.4 million women, and Ciprofloxacin 190mg IVTT
1.2 children. It is the leading q12hr-antibacterial
cause of death and second
leading infectious killer after
COVID-19. Gentamicin 47.5mg IVTT
q8hr- antibiotic

Salbutamol Nebulization
2ml q6hr-bronchodilator
 CLIENT’S PROFILE INTUBATED size 6.5, lip Tracheostomy size 6 Hematogenous dissemination
level 17 (12/10/2022) attached to mechanical
NAME: “Nikz J. Minaji” ventilator with setting:
FiO2-30%, PS-4, PEEP-3, Invasion of CNS
AGE: 12 years old
Attached to T-piece with VSensi 3.0
GENDER: Female
O2 support 5L/m
ADDRESS: Olingan, Zamboanga del Crossing blood brain barrier
Norte
Multiplies in subarachnoid space
HRZE 3tab OD AC-
History of Present Illness atituberculotics
Inflammatory response: cytokine release
 3 weeks prior to admission, onset of
fever and cough is noted.  Orange urine Ceftriaxone 100mg
 1 day prior to admission, episodes of  Hyponatremia OD -antibiotic Tuberculosis Meningitis Compression
seizure and altered sensorium is noted  Hypokalemia of the cortex
 hypocalcemia Ampicillin 85mg 1tab
CT Scan 11-24-2022
BID -antibacterial Mild cerebral and brainstem edema
Abnormal
Na: 128.6mEq/L -12/19/22
Dexamethasone 0.15 neural activity
129.6 mEq/L – 1/3/23
K: 2.08 mEq/L – 12/19/22 Ml BID IVTT - Adhesion formation
3.95 mEq/L – 1-3-23 Corticosteroid
Ca: 8.65md/dL 12-1922  Seizure
8.01 mg/dL – 1-3-23 Obstruction of CSF Flow  Jerking
 Chewing the
tongue
NaCl 1 tab BID Hydrocephalus CT Scan 11-24-2022
Mild Hydrocephalus

CaC03 500mg/tab Pregabalin 75 mg ½ tab

Meningeal ICP
1tab BID Acetazolamide 250mg/tab 1 q 12 hrs
Irritation
tab BID diuretics and carbonic
KCl 2tabs BID anhydrase inhibitors
Mannitol 50 cc IV Phenobarbital /tab
Pressure on OD - Diuretics 1tab - anticonvulsants
the brainstem

VP Shunt Baclofen 10mg/tab 1

Mental  Nuchal rigidity (12/10/2022) tab 12hrs, skeletal
 Nausea and muscle relaxant
deterioration
vomiting
Packed RBC:
Dizepam 500mg IVTT
 Lethargy Omeprazole 40 mg 12/12/2022
TID – anticonvulsants/
 LOC slow IVT OD- 12/13/2022
antianxiety
 GCS: 8, E-2, V-1, antiulcer 12/15/2022
M-5
Keppra 500mg/tab
Nasogastric tube q12hrs every 12hrs -
12/03/2022 anticonvulsants
 INEFFECTIVE AIRWAY RISK FOR IMPAIRED SKIN
CLEARANCE RELATED TO INTEGRITY RELATED TO
RETAINED SECRETIONS PROLONGED BED REST
• Advise to have adequate
• Encourage the
rest periods
implementation of a turning
• Perform suctioning and
schedule, restricting time in
keep the machine functional
one position to 2 hours or less,
at all times
if the patient is restricted to
• Turn to sides at regular
bed.
intervals
• Communicate with a
• Administer oxygen at 2-
dietician as appropriate.
5L/min as ordered
• Monitor skin condition
• Assess vital signs
• Use pillows or foam wedges
• Administered Salbutamol
to keep bony prominences
as ordered
from direct contact with each
other. Keep pillows under the
heels to raise off bed.
ACUTE PAIN RELATED TO
NUCHAL RIGIDITY MUSCLE
ACHES IMMOBILITY
EXTERNAL STIMULI
SECONDARY TO INFECTIOUS
PROCESS
• Assess the patients comfort
level with non-
pharmacological methods of
pain relief
• Reassess pain level after 30
minutes of interventions
• Use relaxation and
breathing exercises and/or
music therapy
• Promote periods of rest for
the patient
• Administer muscle relaxant
as ordered
RISK FOR ASPIRATION
RELATED TO NASOGASTRIC
TUBE INSERTION
• Auscultate bowel sounds to
assess for gastrointestinal
motility
• Observe for food particles
in secretions in patients with
tracheostomies
• Keep suction machine
available when feeding high
risk patients. If aspiration
does occur suction
immediately
• Keep head of bed elevated
when feeding and for at least
half hour afterward
HYPERTHERMIA RELATED TO
BACTERIAL INFECTION AS
MANIFESTED BY FLUSHED SKIN
AND WARM TO TOUCH WITH A
TEMPERATURE OF 37.8C
• Monitor vital signs
• Provide tepid sponge bath. Do
not use alcohol.
• Remove excess clothing and
covers
• Promote a well ventilated area to
patient.as ordered
• Administer antipyretic
medications as ordered

Doenges, M., Moorhouse, M., & Murr, A. (2019). Nurses Pocket Guide Diagnoses, Prioritized Interventions, and Rationales. 15th Edition. F.A. Davis Company.Philadelphia.

Hinkle, Janice L. and Cheever, Kerry H. (2019). Brunner and Suddarth’s Textbook of Medical Surgical Nursing 14th edition. Lippincott Williams & Wilkins.

Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/

 Doenges, M., Moorhouse, M., & Murr, A. (2019). Nurses Pocket Guide Diagnoses, Prioritized Interventions, and Rationales. 15th

Edition. F.A. Davis Company.Philadelphia.

Hinkle, Janice L. and Cheever, Kerry H. (2019). Brunner and Suddarth’s Textbook of Medical Surgical Nursing 14th edition.

Lippincott Williams & Wilkins. CONCEPT MAP FOR INDIVIDUAL CASE PRESENTATION (ICU CASE)

Predisposing Factors Precipitating Factors

Inhalation of droplet infection with
Mycobacterium tuberculosis

Bypasses goblet cells of

upper respiratory tract

Bacilli are deposited in the lungs

Immune system response

Macrophage engulf bacilli

Bacilli replicates inside

Local Inflammatory response Systemic inflammatory response
Inflammatory cells work to contain
the infection forming granulomas
Disruption of hypothalamus
Fluid build-up Accumulation of thermoregulation
bacteria, Caseous Necrosis
inflammatory
CO2 & O2 mediators, WBC:
Local progression Fever
exchange necrotic tissues 12/14/2022- 18.94x10^9 /L
01/05/2023-14.11x10^9/L
Chest APL -12/04/2022
Chest APL -12/03/2022 Irritation and
CLIENT’S PROFILE Pneumonia
Pneumonia in both attempted Paracetamol 1.35mL
inner lung zone airway clearance IV PRN for fever
NAME: “Nikz J. Minaji”
AGE: 12 years old
GENDER: Female Pipericillin 100mg OD-  Cough
 crackles Suctioning
ADDRESS: Olingan, Zamboanga del antibiotic
Norte

Ciprofloxacin 190mg
IVTT q12hr-antibacterial