Group 3 presents

ASPERGILLOMA

INTRODUCTION
An

Aspergilloma is a fungal mass caused by a fungal infection with Aspergillus species that grows in either scarred lungs or in a pre-existing lung cavity, which may have been caused by a previous infection

Causes
The

spores of Aspergillus are readily inhaled and the disease is spread by airborne transmission. The spores are present in the atmosphere throughout the year, but at their highest concentration in the late autumn. They are also common in bedding and houses.

Signs and symptoms:

Dyspnea

Hemoptysis

- this may be infrequent and in small quantity, but can be severe and it requires urgent medical help

Diagnostic Test:
Blood

tests to detect IgG antibodies to Aspergillus (precipitins) Sputum culture Chest X-ray Chest CT Scan (may or may not be necessary depending on chest x-ray findings) Bronchoscopy/ Broncho-alveolar lavage (often with biopsy)

Complications:
Progressive

difficulty breathing Massive bleeding from the lungs Spread of the infection

SIGNIFICANCE OF THE STUDY

Aspergilloma as a case study will provide knowledge and deeper understanding . It will give opportunity for nurses to recognize and provide different nursing care for the patient . It will serve as a lead as they provide health teaching and present instructional materials focusing on the prevention of the problem

OBJECTIVES

Our

main scheme for this study could be very helpful for our patient having the disease. What we hope to achieve after this study are the following:

General Objectives

To gain knowledge about Aspergilloma and utilize nursing process with emphasis on the nursing intervention, health teachings that will address the holistic needs of patient diagnosed and receipt of treatment for the disease.

Specific Objectives

Identify the cause of the disease and how does it affect the patients health status. Identify medical intervention need to be administered to treat underlying causes of problem. Apply Nursing Care Process to the patient. To make health teaching and recommended intervention to improve health status of the patient.

THEORETICAL FRAMEWORK

Sister

Callista Roys Adaptation Theory The goal of nursing is to promote adaptation for individuals and groups in each of the four adaptive modes, thus contributing to health, quality of life, and dying with dignity.

NURSING HEALTH HISTORY

Personal Data Name: Mr. E.V.O.M Address: Quezon City Sex: Male Civil Status: Married Religion: Roman Catholic Birthday: January 25, 1954 Attending Physician: Dr. Encarnation and Dr. Ecarma Medical Diagnosis: Aspergilloma Chief Complaint: Hemoptysis

Medical History
History of Present Illness CC: Hemoptysis Diagnosed case of aspergilloma, 4 days prior to admission with hemoptysis 2 cup on day of admission recurrence of hemoptysis with 2tsp. Past Medical History Patient was diagnosed Diabetes type 2 when he was 40 years old. Had problems in his lungs at age of 45 years old and had hypertension at the age of 55. On January 2012, he was diagnosed End Stage Renal Disease (ESRD). On the month of August, he was diagnosed with having Aspergilloma.

Family Medical History The patients father has hypertension. The patients family has no history of Diabetes Mellitus. Social History The patient is a non-smoker and drinks alcoholic beverages occasionally. Go to bars every night.

GORDONS FUNCTIONAL HEALTH PATTERN

Functional Health Pattern

Before Hospitalization

During Hospitalization

Interpretation

Health Perception/ Health Management

Patient states that his health status is appropriate to his age. Patient does not take vitamins. Patient does not take OTC drugs whenever hes not feeling well. He takes a bath twice a day. Dialysis at St. Johns center twice a week.

Patient states that he is not The patient became more feeling well. focused in dealing about his condition. He adheres to the right medication prescribe by his physician. The patient knows about his condition and accepts the consequences that might happen.

Nutritional Metabolic

Good appetite Eats 4x daily or more. Usually eats salty and fried food. Drinks 8 glasses of water everyday. Drinks soft drinks most of the time.

Patient was on low salt low fat renal diet. Eats 2 or 3x a day. Usually eats vegetables, moderate fatty food but still eats salty foods. Allowed to drink 1Liter of water a day.

Patients NutritionalMetabolic pattern before hospitalization became a big contributing factor to his condition.

Patient is aware about his diet during hospitalization.

His appetite has decreased due to his condition.

Elimination

He defecates once a day Voids 4x daily

He defecates once a week. Voids 2x a day

Due to decreased fluid and food intake, elimination pattern of patient has also been affected. Due to the condition of patient, he is unable to perform his usual activities.

Activity Exercise

Patient doesnt have a routine exercise. His past time is watching television and taking care of his business.

He sleeps most of the time.

Cognitive Perceptual

When he makes a decision, he rationalized it first.

Patient is irritable and depressed.

As a result of his hospitalization, cognition and perception pattern was affected.

Sleep Rest

The patient usually sleeps early in the morning around 3am then wakes up at 9am. He usually sleeps with 2 pillows and in any position.

He sleeps most of the time due to taking sleeping pills. He is only comfortable in semifowlers position with 1 pillow and right side lying when sleeping. Sleep is disturbed due to the scheduled medications to be given and vital signs taking.

Patient cant sleep well because he cant do his preferred sleeping position and due to the interruptions of the nurses.

Self Perception / Self Concept

He is comfortable about his appearance. He is confident about his personality and body image. He has 2 children year old child He seldom communicates with his wife. Lacks attention to his children. Married for 30 years

Patient is aware of his The patient is not condition and threatened about his accepts the condition. consequences that might happen.

Role Relationship

He has a good relationship with his family even though he is in the hospital His family supports him.

His relationship with his family became better.

Sexuality Reproductive

He is satisfied about his sexuality. Patient was able to fulfill his duty as a male. He uses artificial family planning method such as using condoms.

He is not able do have coitus with his wife.

His sexual pattern is altered due to his condition.

Coping/ Stress Tolerance

The patient is stressed about his business. He copes with this kind of stress by resting, watching, going out late at night.

Patient is stressed about Patient learns other his hospital bills and coping mechanisms to manage his stress. condition. He copes with this kind of stress by taking sleeping pills. He copes with this kind of stress by conversing with his family.

Value- Belief

Patient is a Roman Catholic. He does not an active in church. Being optimistic and realistic in life is what he believes in.

Prays before meals. He still applies his principles in life on his present condition such as being positive. He goes to mass every Sunday with his family.

Patients spirituality leveled-up and he maintained believing his principles.

LABORATORY AND DIAGNOSTIC EXAMINATIONS

Laboratory Examinations Hemoglobin

Results 101g/L

Normal Values 135-160

Analysis/Interpretati on The level of hemoglobin is below normal which has abnormally concentrated inside the RBC.

Hematocrit

0.11

0.40-0.48

Decreased due to less RBC production. Normal Indicates RBCs are smaller than normal (microcytic); caused by iron deficiency anemia

Erythrocytes MCV

4.32 10^12/L 65.00

4.5-5.0 80-96

MCH

21.40 pg

27-33

Decreased due to of blood loss over time, or microcytic anemia. May be low when MCV is low; decreased MCHC values (hypochromia) are seen in conditions such as iron deficiency anemia.

MCHC

32.90 g/dL

33-36

Total WBC 7.8 10^9/L Differential Count

Neutrophils 0.83

5.0-10.0
0.55-0.65

Normal Increased due to infection.

Lymphocytes

0.08

0.25-0.40

Decreased due to infection

Monocytes

0.05

0.02-0.06

Normal

Eosinophils

0.07

0.01-0.050

Normal

STABS

0.01

0.01-0.05

Normal

Platelet Estimate

299

150-440

Normal

Laboratory examination Prothrombin (patient) Prothrombin (control)

Result 120 sec 11.3

Normal Values 10-14 sec 1.3 to 1.5 Due to warfarin therapy Increased due to blood clot

Laboratory examination Prothrombin (patient) Prothrombin (control)

Result 120 sec 11.3

Normal Values 10-14 sec 1.3 to 1.5 Due to warfarin therapy Increased due to blood clot

Test

Result

Partial thromboplastin time (patient)

37.2 sec

60 -70 sec

Considered to have little clinical relevance, but some research indicates that it might increase risk of thromboembolis m (blood clot).
Decreased due to blood's reaction to acute tissue inflammation or trauma.

Ptt (control)

28.6 sec

30 40 sec

Laboratory examinations Sodium Potassium Chloride Hemoglucotest

Result

Normal values

Analysis

138 mmol/L 5.0 mmol/L 100mmol/L 135 @5:35pm

136-145 3.5-5.1 98-107 80-120

Normal Normal Normal Increased due to hyperglycemia Due to decreased blood flow to the kidneys. Due to a serious kidney disease

Blood urea nitrogen

19

25-64

Creatinine

706

53-115

Uric Acid

154

155-428

Due to a serious kidney disease

Chest Xray +/c Aspergilloma, Left upper lobe Impression: Aspergilloma End Stage Renal Disease stage 2 with Hypertension, Nephrosclerosis and DKD Hypertensive Cardiovascular Disease (HCVD), DM TYPE 2 ECG: 1 AV block

PHYSICAL ASSESSMENT

Physical Examination Date : 08-14-2012 General: patient is conscious, irritable and uncooperative. Dry Weight: 55kg Psychological: patient can answer questions. Vital Sign: Temp: 37C P: 89beats per minute BP: 130/90mmHg R: 19breaths per minute

Body Part
Skin

Normal Findings
-Varies from light to deep brown; from from yellow to overtones to olive -Generally uniform except in areas exposed to sun

Actual Findings
-Heplock at right metacarpal lower extremities -Fistula for hemodialysis at right antecubital area -skin color is generally

Analysis/Interpretation
-Heplock and Fistula is a possible portal entry for infection -edema indication for fluid and electrolytes imbalance

ruddy pink to light pink; -edema present at

-no edema
-freckles, some birthmarks some flat and raised nevi; no abrasions or other lesions -moisture in skin folds and the axillae (varies w/ environmental

uniform.

temp. & activity)

Ears

-Color same as facial skin -Symmetrical

-Ears are equal size bilaterally, kin intact with no swelling,

Normal

-Auricle aligned with thickening, masses, outer cantus of eye, lesions, discharge or about 10 degrees from vertical -Mobile, firm, and not tender; pinna recoils after it is folded. tenderness.

Hearing Acuity

Able to hear whisper Whispered words

Normal

Eyes

-Transparent, shiny, and -There is no protrusion of -Dark circles under the eyes smooth; details of the eyeballs.

iris are visible

-patients eye bags are

-Black in color; equal in prominent size; normally 3 to 7 mm -Lid Margins are clear. in diameter; round, smooth border, iris flat and round -Pupil constricts when looking near objects -When looking straight objects in the periphery. move in union, with parallel alignment -Patient wears eyeglasses(reading glasses. He stated that he doesnt know his eyeglasses grade.) -Eye lashes are evenly distributed and turn outward. -Sclera is slightly red in color -Pupils PERRLA patients eye can move into 6 cardinal

ahead, patient can see -Extraocular movement

-Both eyes coordinates, position

Eyebrows

-symmetrically align; equal movement.

-patients eyebrows are normal in size, shape, hair

Normal

-Equally distributed;
curled slightly outward. Skin intact; no lesions, abrasions, or any abnormalities Nose -Symmetric & straight -No discharge / flaring. -Uniform color -Mucosa pink

and no any other

abnormalities present

-Nasal septum is straight and not perforated. -Airways are patent. -Symmetric, in the midline. polyps.

Normal

-Clear watery discharge. -No discharge, lesions or

Lips and Buccal Mucosa -Uniform pink color -Soft moist, smooth texture -Symmetry of contour -Ability to purse lips -Smooth, moist soft glistering and elastic texture

-Lips are pink, moist, no masses, ulcerations and fissures.

Normal

Teeth and Gums

-Smooth, white, shiny tooth enamel

-Patient is wearing dentures.

Normal

-Pink gums
-No retraction of gums

- Gums are pink, no

swelling, masses or lesions.

Tongue

-Central position -Pink color -Moves freely

-Tongue is in the midline, covered with papillae. No lesions, no tremor.

Normal

Neck

-Proportional to the size of the body and head,

ROM The chin can touch the anterior chest, the least 45 degrees from the vertical position and can rotated 90 degrees from midline to side.

Normal

symmetrical and position. head can be extended at

-Jugular veins are not

distended when the patient is sitting.

Abdomen

-Unblemished skin, uniform color scaphoid (concave) -No evidence of enlargement of liver or spleen. -must heard the peristaltic movements -not constipated or loose stool

-Patient is constipated for a week. and symmetric bilaterally, even when taking deep breath. -the umbilicus is in the midline and inverted, with no sign of discoloration, inflammation, or hernia. -asymmetrical chest expansion -crackles present upon

- defecation once a week is an indication of constipation.

-Flat rounded (convex), -The abdomen is smooth

Thorax and Lungs

-symmetrical during in inhalation and exhalation

-asymmetrical chest expansion is an indication of abnormal breathing pattern.

-normal breathing
pattern must observe -no crackles,wheezing, or any adventitious breath sounds.

auscultation

-crackle's is not a normal

sound during respiration

Upper Extremities

-Skin color varies, skin is smooth, fine hair

-Extremities are symmetrically even in

Normal

evenly distributed
-Muscles appear equal, warm and -can perform ROM without difficulties

color, warm
-can perform ROM without difficulties .

Lower Extremities

-Skin color varies, skin is

distributed, and absence of varicose veins, muscles is symmetrical, length symmetrical. -Muscles appear equal, warm and with good

-edema present at both -edema at both pedals is a

possible indication for fluid -difficulty in standing for and electrolytes imbalance a long time.

smooth, fine hair evenly pedals

muscle tone.

Neuro-logic

-Cerebral function: The patient should be alert and active, respond appropriately, and relate well to the parent and the nurse. -Sensory

-Patient is irritable and unresponsive -patients sensory functions is normal and no deviation

function:
Sensitivity to touch should be

present.

ANATOMY AND PHYSIOLOGY

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.

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).

The Physiology of Gas Exchange

Each

branch of the bronchial tree eventually sub-divides 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.

The Etiology and Pathophysiology of Aspergilloma

Introduction An aspergilloma, also known as a mycetoma or fungus ball, is a clump of fungus which exists in a body cavity such as the lung. It is associated with the Aspergillus species, but Zygomycota and Fusarium may also form similar structures.

Etiology
The most common place affected by aspergillomas is the lung. Aspergillus fumigatus, the most common species, is typically inhaled as small spores which do not affect people without underlying lung or immune system disease. However, people who have preexisting lung problems are at risk for developing aspergillomae. The fungus settles in a cavity and is able to grow free from interference because the immune system is unable to penetrate into the cavity. As the fungus multiplies, it forms a ball, which incorporates dead tissue from the surrounding lung, mucus, and other debris.

Typically, individuals who are affected by aspergillomae do not have symptoms related to the infection. People often coexist for decades with aspergillomae prior to incidental diagnosis, typically by X-ray or computed tomography.

PATHOPHYSIO LOGY

DRUG STUDY

DRUG STUDY

Mechanism of Action

Indication

Contraindication

Side Effects

Nursing Responsibilities

Drugs
Tranexamic Acid (Hemostan) Classification: - anti fibrinolytic anti fibrinolytic agent that effectively thwarts breaking of fibrin coagulate. It inhibits joining of plasminogen and plasmin to fibrin, by this means stopping haemostatic plug termination. Coronary artery bypass surgery1 g IV bolus before surgery or 30 mg/kg in aspirin treated patients; 200 mg/hr infusion during surgery. Valvular heart surgery 100 mg/kg body wt IV before surgery. Correction of congenital heart disease in childn Initial bolus 15 mg/kg body wt IV before & after surgery. Thoracic aortic surgery 1 g IV before skin incision, 400 mg infusion during surgery & 500 mg in pump priming. Placid to temperate renal injury, uneven menstrual bleeding, haematuria, past recrod of thromboembolic disease. Observe intimately in dispersed intravascular coagulation. Diarrhea, vomiting, nausea, giddiness, disturbances in color vision, thromboembolic events, hypotension. Consult a doctor in case any of these side effects become persistent and problematic. Unusual change in bleeding pattern should be immediately reported to the physician. For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be taken during the menstrual period. Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed. The medication can be taken with or without meals. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing. If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose at least 6 hours later. Do not take 2 doses at once. Inform the client that he/she should inform the physician immediately if the following severe side effects occur:

Route: IV Dosage: 500mg/IV q8h

The laxative principles of the senna plant have (Senokot) been identified Classification: Laxative as sennosides (senna Route: Oral glycosides). Dosage: 1 tab TID Enzymatic action by colonic bacteria converts the glycosides into aglycones, which induce colonic peristalsis through stimulation of the intrinsic peristaltic mechanism in the colonic wall.

Standardized senna concentrate

Relief & control of constipation in the elderly, during pregnancy & puerperium.

Patients with an acute surgical abdomen.do not use when abdominal pain, nausea, vomiting, or other symptoms of appendicitis are present, acute abdominal disease, intestinal hemorrhage, or obstruction , or persistent diarrhea.

The action of Senoko tablets and granules is virtually limited to the colon. In proper dosage, there is usually no intestinal turmoil, cramping, or gripping that occur with orindary laxatives and harsh purgatives.

-Check for Abdominal pain -Do not give if has gastric ulcer or any other complication -Check if patient has under go post surgical treatment

Lantus Classification: Insulin

Route: Subcutaneous
Dosage: 14 units

Insulin glargine is a human insulin analogue designed to have a low solubility at neutral pH. It is completely soluble at acidic pH of the Lantus injection solution (pH 4).

Treatment of adults, adolescents and children 6 years with diabetes mellitus, where treatment with insulin is required.

Hypersensitivity to insulin glargine or to any of the excipients of Lantus.

Hypoglycaemia. Severe hypoglycemic attacks, especially if recurrent, may lead to neurological damage. Prolonged or severe hypoglycemic episodes may be life-threatening.

Ensure uniform dispersion of insulin suspensions by rolling the vial gently between hands; avoid vigorous shaking. Give maintenance doses SC, rotating injection sites regularly to decrease incidence of lipodystrophy; give regular insulin IV or IM in severe ketoacidosis or diabetic coma. Monitor patients receiving insulin IV carefully; plastic IV infusion sets have been reported to remove 20% 80% of the insulin; dosage delivered to the patient will vary.

Amlodipine besylate

Inhibits the movement of (Norvasc) calcium ions across the membranes of Classification: cardiac and Calcium channelarterial muscle blocker, Antianginal cells; inhibits drug, transmembrane Antihypertensive calcium flow, Route: Oral which results in the depression of Doasge: 10mg/tab impulse formation 1 tab OD in specialized cardiac pacemaker cells, slowing of the velocity of conduction of the cardiac impulse, depression of myocardial contractility, and dilation of coronary arteries and arterioles and peripheral arterioles;

Contraindicated with allergy to amlodipine, impaired hepatic or renal function, sick sinus syndrome, Chronic stable heart block angina, alone or in (second or third combination with degree), lactation. other agents Essential hypertension, alone or in combination with otherantihypertensi ves

Angina pectoris due to coronary artery spasm (Prinzmetal's variant angina)

Dizziness, lightMonitor patient headedness, carefully (BP, headache,astheni cardiac rhythm, a,fatigue, and output) while lethargy,Peripheral adjusting drug to edema, therapeutic dose; arrhythmias,Flushin use special caution g,rash,Nausea,abd if patient has CHF. ominal discomfort Monitor BP very carefully if patient is also on nitrates. Monitor cardiac rhythm regularly during stabilization of dosage and periodically during long-term therapy. Administer drug without regard to meals.

Centrally acting Step 2 drug in Contraindicated with antiadrenergic stepped-care hypersensitivity to derivative. Stimulates approach to clonidine or any Clonidine alpha2-adrenergic treatment of adhesive layer Hydrochloride receptors in CNS to hypertension, either components of the (catapres) inhibit sympathetic alone or with diuretic transdermal system. Classification: vasomotor centers. or other cardiovascular agent; antihypertensive central-acting agents. Epidural antihypertensive; administration as analgesic adjunct therapy for severe pain. Route: Oral Dosage: 150 mg 1 tab BID

Drowsiness, sedation, Do not discontinue dizziness,headache, abruptly; discontinue fatigue that tend to therapy by reducing diminish within 46 the dosage gradually wk, dreams, over 24 days to avoid nightmares, insomnia, rebound hypertension, hallucinations, tachycardia, flushing, delirium, nervousness, nausea, vomiting, restlessness, anxiety, cardiac arrhythmias depression, retinal (hypertensive degeneration encephalopathy and death have occurred after abrupt cessation of clonidine). Do not discontinue prior to surgery; monitor BP carefully during surgery; have other BP-controlling drugs on standby. Store epidural injection at room temperature; discard any unused portions. Reevaluate therapy if clonidine tolerance occurs; giving concomitant diuretic increases the antihypertensive efficacy ofclonidine.

Nursing Care Plan

Assessment Subjective:

Diagnosis

Planning After an hour of nursing interventions, the patient will be able to expectorate secretions.

Interventions Elevate head of the bed. Keep environment allergen free. Monitor patient abdominal distension and emotional stressors that may compromise airway. Encourage deep breathing. And coughing excercises. Administer analgesics to improve cough when pain is inhibit. Observe for improvement of symptoms.

Evaluation After an hour of nursing intervention, the patient was able to expectorant secretions readily.

Ineffective airway medyo nahihirapan ako clearance huminga paminsanrelated to minsan as verbalized by excessive the patient. mucus production as manifested Objective: by: - Excessive cough. Excessive cough - Mucus secretion Mucus - Restlessness secretion Crackles - Crackles

Assessment Subjective: Isang beses lang ako sa isang lingo dumudumi as verbalized by the patient

Diagnosis Constipation related to poor eating habits as evidence by Distended Abdomen

Planning Short Term: After 1 hour of Nursing Interventions, The patient will be verbalized ways to improve bowel elimination.

Interventions -Encourage balance Fiber and Bulk in diet

Rationale

Evaluation

-Promote adequate fluid intake including high fiber fruit juices, suggest drinking warm

-To improve consistency Short Term: of stool and facilitate After 1 hour of passage through colon. Nursing Interventions, The patient verbalized ways to -To promote moist/ soft improve bowel stool elimination.

Long Term: Objective: -Facial Grimace -Irritable -Distended Abdomen

-Increase fluid intake

-To prevent Dehydration Long Term: After 1 day of nursing Interventions, the patient regained his normal pattern of functioning

After 1 day of nursing Interventions, the patient will regain normal pattern of functioning

-encourage the -To cure the clients patient to take her problem medicine prescribe by the physician

Assessment Subjective: Medyo naninibago sa paligid ko. Hindi ako sanay na mayat maya may nanggigising sa`kin para mag BP, as verbalized by the patient Objective: -Dark circles under the eyes -Restless -Irritable -Tired facial expression

Diagnosis Disturbed sleep pattern r/t therapeutic interruptions as manifested by restlessness, irritability and dark circles under the eyes

Planning After 8 hours of nursing interventions, the patient will be able to: -Achieve optimal amount of sleep as evidenced by rested appearance -Demonstrate or show of being rested by increased activity tolerance -Become more active and participative in monitoring phases Become more active and participative in monitoring phases

Interventions -Assess patients sleep patterns (changes, naps, and frequency of sleep) by means of observation of the patient while sleeping and awakening -Assess patient for irritability upon awakening -Ensure environment is quiet and has a comfortable room temperature by adjusting the fan/air conditions -Provide ritualistic procedures to clean linens and/or bath prior to bedtime -Provide back rubs, music, and other relaxation techniques -Instruct relatives to provide with comfortable bed linens and pillows

Rationale -Provide information on which to establish a plan of care for correction of sleep disturbances

Evaluation After 8 hours of nursing interventions, the patient was able to:

-Achieve optimal amount of sleep as evidenced by rested appearance -Demonstrate or show of -This ensures the being rested by increased patients degree of activity tolerance sleep pattern -Become more active and participative in -External stimuli monitoring phases interfere with going to Become more active and sleep and increase participative in monitoring awakenings phases

-Prevents disruption of established pattern and promotes comfort and relaxation before sleep

-Promotes relaxation before sleep and reduces anxiety and tension -May help to enhance the sleep patterns in terms of good and conditioned environment

Assessment Subjective: Simula nang ubuhin ako, hindi ko na magawa ang mga dating ginagawa ko, as verbalized by the patient Objective: -HR: 89 cpm -RR: 19 bpm -BP: 130/90 mmHg -ROM: RUE: 3/5 LUE: 3/5 RLE: 3/5 LLE: 3/5 -Restless -Irritable -Tired facial expression -Ambulatory with assistance

Diagnosis Activity Intolerance r/t imbalanced oxygen supply demand 2 Aspergilloma as manifested by verbal reports of weakness, fatigue and easy exhaustion

Planning After 8 hours of nursing interventions, the patient will report/demonstr ate a measurable increase in tolerance to activity with absence of dyspnea and excessive fatigue, and vital signs within patients acceptable range

Interventions -Evaluate patients response to activity. Note reports of dyspnea, increased weakness/fatigue, and changes in VS during and after activities -Provide a quiet environment and limit visitors. Encourage use of stress management and diversional activities as appropriate -Assist patient in assuming comfortable position

Rationale -Establishes patients capabilities/ needs and facilitates choice of interventions.

Evaluation After 8 hours of nursing interventions, the patient was able to report/demonstrate a measurable increase in tolerance to activity with absence of dyspnea and excessive fatigue, and vital signs within patients -Reduces stress and acceptable range excess stimulation, thus, promoting rest

-To decrease oxygen demand of the body during uncomfortable positioning; Promotion of comfort -Minimizes exhaustion and helps balance oxygen supply and demand

-Assist with self-care activities as necessary. Provide progressive increase in activities as tolerated

DISCHARGE PLANNING

Received lying on bed, awake and responsive. With vital signs of: Temperature: 37C Pulse rate: 89bpm Respiratory rate: 19bpm Blood pressure: 130/90 mmHg With a previous order of May Go Home

Medication Tranexamic Acid (Hemostan) 500 mg IV q8 Standardized senna concentrate (Senokot) 1tab PO TID Lantus sq 14 u Amlodipine besylate (Norvasc) 10mg/tab PO OD Clonidine Hydrochloride (catapres) 150mg/tab PO BID Exercise/Environment Advice patient to stay in a clean and well ventilated environment. Advice patient to maintain bed rest. Maintain a quiet, pleasant environment to promote relaxation and healing. Instruct patient to balance activities with adequate rest periods. Encourage patient to do ROM exercises.

Treatment Educate patient the importance of drug compliance. Instruct the patient to return for check-up after two weeks. Discuss to the client the complication/s of the condition because knowledge about the condition supports learning that will decrease deficit and anxiety. Health Teachings Encourage patient to have adequate rest periods. Encourage patient to do daily hygiene and to practice proper hand washing. Instruct patient to ensure safety of the incision part. Instruct patient to avoid strenuous activities.

Outpatient Orders Call or visit the attending physician if any of the following occurs: Develop fever Experienced nausea and vomiting Experienced shortness of breath Have bleeding on expectoration Diet Encourage patient to increase fluid intake. Encourage client to eat a balanced diet rich in fresh fruits and vegetables. Also, to eat foods that are rich in carbohydrates, protein and vitamins and minerals. Advice the patient to eat high-fiber foods, drink plenty of water, and if necessary, use stool softeners to avoid straining which may result to dehiscence.

Spirituality Advice patient to go to church every weekend, to uplift his spiritual health. Instruct patient to pray and seek for the Lords guidance.