CASE PRESENTATION

Related Learning Experience RLE 30-GROUP 6

INTRODUCTION
A. OVERVIEW OF THE CASE

Pneumonia is an inflammation of the lungs caused by an infection. It is also called Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our health. Although pneumonia is a special concern for older adults and those with chronic illnesses, it can also strike young, healthy people as well. It is a common illness that affects thousands of people each year in the Philippines, thus, it remains an important cause of morbidity and mortality in the country (http://nursingcrib.com/casestudy/pneumonia-case-study/)

CLIENTS PROFILE
A. Socio-demographic Data Patient X is a 3 years old female, Roman Catholic of Mambatangan, Manolo Fortich, Bukidnon. Patient X was admitted at NMMC last July 13, 2011 due to cough and fever.

Upon Admission: Pulse:120 bpm Temp: 37.5 C RR: 40cpm Weight: 11.5 kg

DAY 2 Pulse:125 bpm Temp: 38.1 C RR: 38cpm

DAY 3 Pulse:165 bpm Temp: 37.7 C RR: 51cpm

DAY 4 Pulse: 125 bpm Temp: 37.5 C RR: 39cpm

Before hospitalization patient X was in good appetite can feed full of share in her diet. Patient X was fed per demand more or less 3-4 times per day, upon hospitalization the patient was experiencing loss of appetite and loss about 2 kg of body weight giving him a weight of 9.5 kg. Patient is feeding less than the feeding pattern

Patient Xs usual bowel pattern is 1-2 times a day and sometimes its interval with one day. His last bowel movement was July 20, 2011with wet stool. His usual urinary pattern is 23 times a day, approximately 120-160 ml per day with yellow colored urine.

Patient X needed assistance with self-care such as eating, bathing, grooming, dressing and toileting. Patient X is dependent on his mother since the patient is still 3 year old and pain when moving in her left side with closedthoracostomy tube inserted.

Name: Ms. X

Date: February 3, 2011

Temp: 37.5C Pulse: 120 bpm Height: . Weight:

Respiration:

40 cpm

11.5 kg

The Anatomy of the Lung Each lung is divided into lobes. The right lung, which has three lobes, is slightly larger than the left, which has two. The lungs are housed in the chest cavity, or thoracic cavity, and covered by a protective membrane called the pleura. The diaphragm, the primary muscle involved in respiration, separates the lungs from the abdominal cavity. The pulmonary arteries carry de-oxygenated blood from the right ventricle of the heart to the lungs. The pulmonary veins, on the other hand, carry oxygenated blood from the lungs to the heart, so it can be pumped to the rest of the body.

The lungs expand upon inhalation, or inspiration, and fill with air. They then return to their resting volume and push air out upon exhalation, or expiration. These two movements make up the process of breathing, or respiration.

The respiratory system contains several structures. When you breathe, the lungs facilitate this process:

1.Air comes in through the mouth and/or nose, and travels down through the trachea, or "windpipe." This air travels down the trachea into two bronchi, one leading to each lung. The bronchi then subdivide into smaller tubes called bronchioles. The air finally fills the alveoli, which are the small air sacs at the ends of the bronchioles.

2.In the alveoli, the lungs facilitate the exchange of oxygen and carbon dioxide to and from the blood. Adult lungs have hundreds of alveoli, which increase the lungs' surface area and speed this process. Oxygen travels across the membranes of the alveoli and into the blood in the tiny capillaries surrounding them.

3.Oxygen molecules bind to hemoglobin in the blood and are carried throughout the body. This oxygenated blood can then be pumped to the body by the heart. 4.The blood also carries the waste product carbon dioxide back to the lungs, where it is transferred into the alveoli in the lungs to be expelled through exhalation.

Smoking can damage the alveoli and make breathing labor intensive, resulting in emphysema or lung cancer.

Quiet respiration- happens when the body is at rest. During quiet respiration, the diaphragm contracts and pulls down, lowering the pressure in the lungs and causing air to enter the lungs through the mouth and nose to equalize the pressure. When the diaphragm relaxes, it moves back up, pushing air back out of the lungs. The lungs and chest walls also return to their resting positions. This also reduces the size of the chest cavity and helps to push air out of the lungs.

Active respiration- occurs when the body is active and requires higher levels of oxygen to the blood than when resting. During active respiration, the muscles around the ribs raise and push out the ribs and sternum, which increases thoracic volume, helping the lungs take in more air. During exhalation, the intercostals force the ribs to contract, and the abdominal muscles contract, forcing the diaphragm to rise. Both these movements make the thoracic cavity contract, and help push air out of the lungs.

The Lungs' Protections

Several lung parts and functions act as protective mechanisms to keep out irritants and foreign particles. The hairs and mucus in the nose prevent foreign particles from entering the respiratory system. The breathing tubes in the lungs secrete mucus, which also helps protect the lungs from foreign particles. This mucus is naturally pushed up toward the epiglottis, where is passed into the esophagus and swallowed. Coughing up any of this mucus is usually an indication of a respiratory infection, or a condition such as bronchitis or chronic obstructive pulmonary disease (COPD). Irritants can also cause bronchospasm, in which the muscles around the bronchial tubes constrict in order to keep out irritants. Asthma involves inflammation and constriction of the bronchial tubes, and is often triggered by environmental irritants. Bronchial constriction causes breathing difficulties.

About Breathing Difficulties

*Damage to any part of the respiratory pathway can also cause breathing difficulties. Understanding human lung anatomy and physiology makes clear how the different lung parts are affected in disease. In people with bronchitis, the bronchial tubes become inflamed and irritated. They produce mucus, resulting in a cough. Bronchitis can be acute, with a sudden onset and quick recovery, or chronic, and last much longer.

*Chronic obstructive pulmonary disease (COPD) involves symptoms of both chronic bronchitis and emphysema. Blockage in the bronchioles and alveoli make it difficult to exhale. This traps air in the lungs and in turn makes proper inhalation difficult. Interstitial lung disease, including pulmonary fibrosis, causes a buildup of scar tissue in the lungs and reduces lung function. Any of these conditions affect not only the lungs, but the entire body, as the healthy respiration is required to supply oxygen to the body and its organs.

SCHEMATIC DIAGRAM OF PATHOPHYSIOLOGY OF PNEUMONIA

PATHOPHYSIOLOGY OF PNEUMONIA

Pneumonia is a commonly occurring serious disease that affects about 1 out 100 people every year. As mentioned above, many factors are responsible for development of pneumonia. Pneumonia can be divided into various categories like community acquired and hospital acquired infection. The common type of community acquired infection is pneumococcal pneumonia and Mycoplasma pneumonia. Many times in people with lowered immunity or geriatric patients, pneumonia is seen after a bout of influenza. Most of the hospital acquired infections of pneumonia are the serious infections, as they body lacks the mechanism to fight against the condition. Aspirational pneumonia, pneumonia in immunocompromised host and viral pneumonia are some of the pneumonia related specific disorders. Let us go into the details of pathophysiology of pneumonia. You can read more about chronic pneumonia and acute pneumonia.

LAB RESULTS ULTRASOUND REPORT July 21,2011 Findings: Fluid connection with moderate to high level echoes in the right basal hemithorax measuring 3.7cm x 3.6 cm x 2.2cm another fluid collection measuring 4cm x2.3cmx 1.6 cm (8.0ml)in right midlung, posterior to the fluid collection areas of hyperechoic lung tissue with air bronchogram. Diagnosis: 2 fluid collection likely emphysema right as describe above lung consolidation and/or atelectasis.

Hematology WBC RBC Hemoglobin Hematocrit MCV MCH MCHC RDW-CV PDW

July 27, 2011 Unit 10.4 10.3 3.14 10^6Ul 8.3 gldl 25.3 % 81.5 F1 26.4 pg 32.4 g/dl 16.8 % 7.7 FL FL % % %

JULY 22, 2011 9.2 3.34 5.8 26.7 79.9 26.3 33.0 16.1 7.2 7.3 29.8 62.7 6.8

JULY 15, 2011 25.2 3.72 9.8 29.0 78 26.3 33.8 18.9 8.4 8.6 19 66.6 14.1

MVP 8.4 Differential Count Lymphocytes 34.1 Nuetrophil 50.5 Monocyte 14.5

Eosinophil 0.6 % 0.4 Basophil 0.3 % 0.3 Bands /stabs Platelet 450 10^3UL 772 Microbiology 7/19 7/13 Specimen: Specimen: Plural Fluid incubation 2nd Take: NO AFB SEEN RESULT: NO ORGANISM sp. 3rd Take: NO AFB SEEN SEEN (-)

0.2 0.1 654 7/13 after 24hrs of

ORGANISM:Bacillus
(+)positive negative

Medication Medications must be continued according to the doctor's instructions, otherwise the pneumonia may recur, and also the patient should 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 child to report or inform the physician if any of these side effects occur. Inform and explain it to the guardians. Moreover, emphasize the right timing or taking of the right time intervals of these drugs to maximize its therapeutic effects and avoid further complications.

Exercise Not applicable

Treatment Instruct the family of the client to continue drug therapy as ordered.

Inform the family about the dangers of non compliance to treatment regimen.
Discuss to the significant others the complication of the condition. Instruct them to report to the physician promptly about any changes on health condition.

Encourage guardians to strictly comply with the doctor's orders, especially in taking prescribed medications.

Encourage them also to have followed up visitations to the physician after discharge. Drink lots of fluids. Liquids will keep away patient from becoming dehydrated and help loosen mucus in the lungs. Give supportive treatment. Proper diet and oxygen to increase oxygen in the blood when needed.

Give the medicine on schedule for as long as directed. This will help your child recover faster and will decrease the chance that infection will spread to other household members. Encourage drinking of fluids, especially 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 child's cough because cough suppressants stop the lungs from clearing mucus, which may not be helpful in some types of pneumonia. Check your child's lips and fingernails to make sure that they are rosy and pink, not bluish or gray, which is a sign that the lungs are not getting enough oxygen. Proper hygiene especially handwashing to prevent infections Advise the mother to give supplements to the child especially Vit. A to prevent anemia

Remind the significant others of the patient on the arrangements to be made with the physician for follow-up checkups. Follow-up check up regularly in order to monitor and properly manage patient's illness. Continue medication as ordered. Instruct to have a follow-up check-up or refer to the physician if the patient is uncomfortable.

Since the child is still 3 years old, encourage the mother to have her child eat a well-balanced diet, child's intake of foods may affect child's health. Advice the guardians to be watchful/careful enough of the diet that could help maintain clear 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 level of us, to treat soul and to treat mind and unconscious parts of us, I suggest the family of the patient to pray for the recovery of their child.