case presentation for inp

8/3/2019 Case Presentation for INP

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INTRODUCTION

There were many factors considered in choosing the case for this case presentation. First, Iwanted to choose a case that will show the correlation of disease entities amongst each other and

showcase their relatedness to each other. Also, I have always found cardiopulmonary cases to be

very interesting due to the fact that the lungs and the heart are vital organs and are important inthe normal functioning of the body. It has always interested me how these two organs can affect

the different organs of the body once they fail. In addition, I have a soft spot for these diseases

because my grandmother died because of these diseases and my family has a history of

hypertension and with this case study, I am able to enlighten myself on the things to avoid andthe appropriate interventions needed if one of my family members or me is affected by these

diseases.

The patient was assessed on November 8, 2011 on the 18th day of hospitalization and the 5th daypost operation day. During the assessment, the patient already, had stable vital signs. The

pneumothorax was already resolved but difficulty of breathing was still pronounced.

Concepts involved in the discussion of the case include concepts in.1. Cardiology: most especially concepts in valvular diseases of the heart and heart failures.

2. Hematology: most especially concepts in triglyceride levels which may have precipitated

the case of the patient.3. Pumonology: most specifically concepts in lung problems such as pneumothorax.

4. Endocrinology: most specially concepts in diabetes mellitus.

NURSING ASSESSMENT- Patients Profile

Name: Sedi Noel Onajo

Age: 76

Birthdate: April 28, 1935Address: 3 Malaya Street, Dominican Hill, Baguio City

Occupation: Retired Company Driver

Marital Status: MarriedSpouse: Aticap Onajo

Religion: Methodist

- Admission Details

Admission Date: October 21, 2011Ward: Coronary Ward

Chief Complaint: difficulty of breathing and dyspnea

Medical diagnosis: Spontaneous pneumothorax, coronary artery disease, impaireddiastolic relaxation, left ventricular failure

- History of Present Illness: 2 weeks prior to admission, patient experienced dyspnea but

with no accompanying fever. Still, patient did not consult. 1 week prior to admission,

dyspnea persisted but was not acted upon. 1 day prior to admission, patient consulted at aprivate physician and was advised to consult to a professional. 2 hours prior to admission,

patient consulted at Saint Louis University Hospital of the Sacred Heart and was advisedadmission.

- History of Past Hospitalization: Patient has no previous hospitalizations but patient has a

know history of hypertension since 2009

- Socio-Cultural History: The patient is an Ilocano. Upon assessment, patient expressed

that he has a very strong affinity to his roots as an Ilocano and practices in marriage,

death and other occasions are done following the Ilocano practices. The patients religionis Methodist. Upon assessment, patient expressed that he is actively practicing and that he

has no religious concerns


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M/S TOOL

ACTIVITY/RESTThe patient is a retired driver and in the hospital, he was unable to participate in usual

activities. Leisure time includes watching television, chatting with wife and with friends.

The patient is not ambulatory in the hospital. Gait was not assessed. The patient is active,needing minimal help from his significant others. The muscles are flaccid and hypotonic

with strength of 4/5 in all extremities. Because of the condition, the patient experienced

weakness, breathlessness and inability to transfer. The patient, also, has feelings of

exhaustion. Patient usually has 6-8 hours of sleep with no insomnia and is rested uponawakening. The patient usually takes 1-2 naps a day lasting for 1-2 hours. Bedtime rituals

include doing hygiene needs and relaxation technique is sleep. The patient sleeps with 2

pillows and oxygen is utilized per nasal cannula at 4 LPM uses during dyspnea. Thereare no medications used affecting sleep. Patient was asked to sit up on bed to test his

response to activities. Before the activity, heart rate was 86 beats per minute, respiratory

rate was 24 cycles per minute and blood pressure was 130/80 millimeters mercury.Immediately after the activity, heart rate was 87bpm, respiratory rate was 26cpm and

blood pressure was 130/80mmHg. 5 minutes after the activity, patients heart rate was

84bmp, respiratory rate was 23cpm and blood pressure was 130/80mmHg. Pulseoximetry reading was at high 80s and low 90s. Patient was alert and active, muscle was

hypotonic and flaccid. There were no tremors noted and there were restrictions on rangeof motion in all extremities. Muscle strength was 4/5 all over. Due to this, nursing

diagnosis formulated was ACTIVITY INTOLERANCE RELATED TO DECREASEDENERGY AND WEAKNESS.

CIRCULATIONThere were no history of head injury, stroke, hemoptysis, syncope, spinal cord

injury/dysreflexia, palpitations, bleeding tendencies, varicosities, thrombophlebitis, leg

pain, and slow healing. On 2009, patient was diagnosed to have high blood pressure andthis year, patient was diagnosed with coronary artery disease, left ventricular failure and

impaired systolic relaxation. Skin assessment revealed that skin is pale, mucous

membrane is pinkish, lips are dark, sclerae are non-icteric, conjunctivae are pale, nailbedsare pale, skin is moist. Blood pressure while lying down was 130/80mmHg on the rightand left arm. Pulse pressure was 50mmHg. There were no auscultatory gaps. Pulse was

86bpm on all pulse points and are all strong +2. There were no cardiac thrills and heaves

and heart rate was 86bpm. There was arrhythmia and quality is strong. There were also,friction rubs. At the point of maximal impulse, murmurs were noted. There were no

vascular bruit and jugular vein distention. There were no adventitious breath sounds but

there was a decrease breath sounds in the right lung. Extremities are 36.2C, pale,capillary refill of 2-3 secons, no homans sign, no varicosities, no nail abnormalities, no

edema. Hair is thin. No lesions. Due to this, nursing diagnosis formulated was

IMPAIRED TISSUE PERFUSION RELATED TO DECREASED OXYGEN

CARRYING CAPACITY OF THE BLOOD.

EGO INTEGRITY

The patient is married. Patient did not express any concern. Stress factor was thehospitalization. Usual ways of handling stress includes verbalizing problems to the wife.

Patient stated that he does not get angry too much. When anxious, patient thinks.

Patient usually cries when there is grief. No other feelings such as hopelessness,helplessness and powerlessness were said. Patient is and Ilocano and religious affiliation

is Methodist. He is actively practicing the religion and usually prays. There are no

spiritual concerns and patient did not desire visits from clergies. No specifies expression


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of sense of connectedness/harmony with self and others. Patient was calm, and patient

becomes pale as a response.

ELIMINATION

Patient has regular bowel elimination which is usually characterized as semi formed andbrownish. Last bowel movement was on November 8, 2011 and was characterized as

semiformed, brownish, about 50 ml and non fowl smelling. There was no history of

bleeding, no hemorrhoids, constipation, diarrhea and bowel incontinence. Hence, there is

no use of laxatives nor enemas and suppositories. Patient usually voids once ever 3 hoursat around 100-150 ml. there were no difficulty voiding, urgency, bladder spasm,

frequency, retention and burning feeling. There was no urinary retention, history of

bladder or kidney diseases. There was diuretic use after surgery with furosemide 40 mg tablet. Abdomen was soft upon palpation, non tender, non distended, size is about 34-35

inches, bowel sounds are normoactive, no costovertebral angle tenderness, bladder is

nonpalpable and there are no hemorrhoids. There is usage of IFC afgter surgery. Noostomy devices.

FOOD/FLUIDPatient usually has 3 meals per day with 1-2 snacks eaten during the morning and late

afternoon. Patients usual food intake during breakfast is coffee and bread, lunch isusually rice and a viand and snacks are usually breads and juices. Last meal consumed

was rice and viand. Food preference is meat and there are no known food allergies. Thereare no special cultural food preparations specified. Patient consumes 80-95% of food

served and after the operation, patients appetite decreased. Usual weight was 180-190lbs

and there are no unexpected or undesired weight loss or gain. There are no nausea,vomiting, heartburn and indigestion. Gag and swallow reflex are intact, there are no facial

injury or surgery and there are no neurological deficit. Patient was diagnosed with type II

diabetes controlled with diet. There are no vitamin or food supplements. Current weightwas 187lbs, height is 57, body built is endomorph and BMI is n ormal. There is good

skin turgor, and mucous membrane is moist. There are no edema. Breath sounds are clear

except for the decreased in breath sounds at the right lung. Gums and teeth are in goodcondition, there are partial dentures and absent teeth at the molars and incisors areobserved. There is no sore mouth or tongue, tongue is midline and reddish and abdomen

has normoactive bowel sounds all over.

HYGIENE

The patient's functional level is at 3 meaning that he is dependent to the caregiver to

provide for the hygiene needs. The patient only requires human assistance provided bythe wife and nurses. He needs help in food preparation and with eating utensils and needs

help in getting supplies for hygiene, washing body parts, regulating bath water, getting in

and out alone and dressing. He also needs assistance in toileting such as getting in and

out of the commode. The patient's manner of dressing was not assessed because he was ina hospital gown. Still, patient was able to meet hygiene needs such as shampooing, oral

care, bathing, etc. Hence, there were no body odor and vermins. Diagnosis: self care

deficit related to inability to perform activities secondary to weakness.

NEUROSENSORY

The patient has no history of injury, trauma and stroke and the patient has no dizzinessand weakness. There is tingling and numbness of upper extremities. There are not seizure

episodes, hearing loss, vision changes, smell changes. There is no change in mental status

and the patient is alert and oriented. There are no delusion and hallucinations and affect iseuthymic. Speech is slightly soft and slurred but comprehensive. Recent and remote memory


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and intact. Glasgow coma scale revealed a 15/15 score. Cranial nerves are all normal and

intact. Mini mental status examination revealed a score of 23/23 since patient refused toperform some of the examination items. All deep tendon reflexes are normal scored at 2.

there are no tremors or paralysis.

PAIN/DISCOMFORT.

There was mild pain located at the right lung and precipitated by movement with an

intensity of 3, non radiating and intermittent, relieved by tramadol and relaxation. Diagnosis:

Mild pain related to ongoing inflammatory process.

RESPIRATION

there was dyspnea related to decreased capacity of the lungs to expand precipitated bytalking and movement. It is relieved by oxygen inhalation and administration of bronchodilators.

Cough was non productive. Patient was a smoker with 20 pack years. There was usage of oxygen

and medications used affecting respiration were bronchodilators and anti inflammatory drugs.Respiratory rate ranged from 24-26cpm and was shallow and assisted. Parameters include an

IRV of 600cc. 02 inhalation was per nasal cannula at 4LPM. Chest excursion was unequal and

there is decreases fremitus on the right. There was no use of accessory muscles but there wasnasal flaring and decreases lung sounds on the right. Pulse oximetry read at high 80s to low 90s.

Client was calm. NURSING DIAGNOSIS: impaired breathing pattern related to decreased lungexpansion.

SAFETY

Pertinent data about safety stated that patient has altered /suppressed immune system due

to corticosteroid therapy. There were 2 whole blood transfusion but with no reactions. Patient isalso oriented. There is an incision site at the right thoracic region connected to a thorabottle

draining to reddish, blood tinged fluid. Nursing Diagnosis: impaired skin integrity related to

tissue trauma, risk for infection related to tissue trauma.

*No significant findings concerning sexuality.

*No significant findings in social interactions*no significant findings in teaching/learning*patient was discharged after 2 days.


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LIST OF PRIORITIZED NURSING DIAGNOSES

Nursing Diagnoses Actual/Potential Overt/Covert Justification

1. Impaired breathing

pattern related to

decreased/inadequate

lung expansion

Actual Overt Latest assessment

revealed that patient is

suffering from

difficulty of breathing

with a respiratory rateranging from 24-

26cpm, has shallow

breathing, uses the

sternocleidomastoid

muscle for breathing,

with nasal flaring, on

oxygen inhalation at 4

LPM, and with

verbalization of air

hunger. The ABC's of

life states that

problems in breathing

should be prioritized.

Also, according to

Abraham Maslow,

oxygenation is an

important part of a

person's biologic

needs. Fundamentally,the chief complaint of

the patient must be

prioritized.

2. Impaired peripheral

tissue perfusion related

to inadequate

circulating oxygen and

decreased oxygen

carrying capacity ofthe blood.

Actual Overt Latest assessment

revealed that patient

has pale palpebral

conjunctivae, pale nail

beds and skin, cold

skin and obviousweakness manifested

by muscle strenght of

3/5 on lower

extremities and 4/5 in

upper extremities and

usage of soft voice.

According to the abc's

of life, circulation is


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prioritized after

breathing. Again,

abraham maslow states

that oxygenation must

be prioritized. The fact

that the patient's

problem concerns

breathing more, this

should be least

prioritized.

3. activity intolerance

related to decreased

energy secondary to

poor oxygenation

(clustered with

problem 4)

Actual Overt Because of the

decreased circulating

0xygen in the body,

there is decreased

energy due to the fact

that 02 is integral in

the kreb's cycle for atp

production. This is

least prioritized

because this can be

prevented with the

resolution of other

problems like the first

two prioritzed.

4. self care deficitrelated to inability to

perform self care

needs from decreased

energy.

Actual Overt Because the patientcannot tolerate certain

activities such as

standing up and also

due to the contraptions

attached to the patient,

the patient is unable to

perform necessary self

care needs in order to

function as a holistic

being. Also, this isleast prioritized

because it depends on

the 3rd problems in

order for this problem

to be resolved.

5. impaired skin

integrity related to

Actual Overt Because of the

surgical procedures


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tissue trauma

secondary to ctt

insertion.

performed such as the

ctt insertion and the

thoracotomy, patient's

skin integrity is

impaired. There are no

signs of infection

present hence, this is

least prioritized.

6. mild pain related to

ongoing inflammatory

process

Actual Overt Not prioritized

because the pain is

mild and tolerable

7. risk for infection

related to tissue

trauma

Potential Covert Because of the

incisions brought

about by the insertion

and open thoracotomy,

there is a greater

chance for bacterial

invasion and growth.

Still, this is a risk

problem and must be

least prioritized.

8. risk for imbalanced

nutrition, less than

body requirement

related to poor oral

intake.

Potential Covert Risk problem

9. risk for fall related

to weakness

Potential Covert Risk problem


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DRUG STUDY


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Name of Drug Indication MOA Nursing Responsibility

1. Piperacillin +

trazobactam

Prophylaxis for

respiratoryinfection

Piperacillin has an

antimicrobial activity against awide range of gm-ve

organisms including K.

pneumoniae, P.aeruginosa, Enterobacteriacea

e and against gm+ve

organisms eg E. faecalisand B. fragilis. Tazobactam isa penicillanic acid sulfone

derivative with beta-lactamase

inhibitory properties. Incombination, tazobactam

enhances the activity of

piperacillin against beta-lactamase-producing bacteria.

Give full dose of drug

Assess hematopoieticfunction periodically.

Perform periodic

electrolytedeterminations in

patients with low K

reserves. Increasedrisk of fever and rashin patients with cystic

fibrosis. Increased risk

of bleedingmanifestations.

Prolonged treatment

may increase risk ofsuperinfections.

Convulsions or

neuromuscular

excitability may occurwhen high doses are

used, especially in

renally impairedpatients. Renal

impairment.

CEFIXIME Prophylaxis for

infection

Cefixime binds to one or more

of the penicillin-binding

proteins (PBPs) which inhibitsthe final transpeptidation step

of peptidoglycan synthesis in

bacterial cell wall, thusinhibiting biosynthesis andarresting cell wall assembly

resulting in bacterial cell death

Give full dose of drug,

History of allergy to

penicillins; pregnancy,lactation; renal failure;

GI disease.

PARACETAMOL PRN for fever Paracetamol exhibits analgesic

action by peripheral blockage

of pain impulse generation. Itproduces antipyresis by

inhibiting the

hypothalamic heat-regulating

centre. Its weak anti-

inflammatory activity isrelated to inhibition of

prostaglandin synthesis in theCNS

Watch out for Nausea,

allergic reactions, skin

rashes, acute renaltubular necrosis.

Potentially

Fatal: Very rare,

blood dyscrasias (e.g.

thrombocytopenia,leucopenia,

neutropenia,agranulocytosis); liver

damage.

Give with food.

Tramadol PRN for pain Tramadol inhibits reuptake of

norepinephrine, serotonin andenhances serotonin release. It

alters perception and response

Watch out for

Sweating, dizziness,nausea, vomiting, dry

mouth, fatigue,


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to pain by binding to mu-opiate receptors in the CNS.

asthenia, somnolence,confusion,

constipation, flushing,

headache, vertigo,tachycardia,

palpitations, miosis,

insomnia, orthostatichypotension, seizures,

CNS stimulation e.g.hallucinations.Potentially

Fatal: Respiratory

depression.

Levofloxacin Prophylaxis for

infection

Levofloxacin exerts

antibacterial action by

inhibiting bacterialtopoisomerase IV and DNA

gyrase, the enzymes required

for DNA replication,

transcription repair andrecombination. It has in vitro

activity against a wide range

of gram-negative and gram-positive microorganisms


diarrhoea,

constipation,headache, insomnia,

inj site reactions (IV).

Ophthalmic: Transient

decrease in vision,ocular burning, ocular

pain or discomfort,

foreign bodysensation, headache,

fever, pharyngitis,

photophobia.Potentially

Fatal: Anaphylaxis.

Give full course ofmedications and give

with food.SALBUTAMOL For bronchospasm Salbutamol is a direct-acting

sympathomimetic with -

adrenergic activity and

selective action on2 receptors, producing

bronchodilating effects. It also

decreases uterine contractility.

Watch out for Fineskeletal muscle tremor

especially hands,

tachycardia,palpitations, muscle

cramps, headache,

paradoxicalbronchospasm,

angioedema, urticaria,

hypotension and

collapse.Potentially

Fatal: Potentially

serious hypokalaemiaafter large doses.

AMLODIPINE Hypertension Amlodipine relaxes peripheraland coronary vascular smooth

muscle. It produces coronary

vasodilation by inhibiting theentry of Ca ions into the

Headache, peripheraloedema, fatigue,

somnolence, nausea,

abdominal pain,flushing, dyspepsia,


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voltage-sensitive channels ofthe vascular smooth muscle

and myocardium during

depolarisation. It alsoincreases myocardial

O2 delivery in patients with

vasospastic angina.

palpitations, dizziness.Rarely pruritus, rash,

dyspnoea, asthenia,

muscle cramps.Potentially

Fatal: Hypotension,

bradycardia,conductive system

delay and CCF.Monitor BP 15

minutes beforeadministration and 15

minutes after

administration.

CARVEDILOL Hypertension and

Chest Pain

Carvedilol causes vasodilation

by blocking the activity of -blockers, mainly at alpha-1

receptors. It exerts

antihypertensive effect partly

by reducing total peripheralresistance and vasodilation. It

is used in patients with renal

impairment, NIDDM orIDDM

Watch out for

Bradycardia, AVblock, angina pectoris,

hypervolaemia,

leucopenia,

hypotension,peripheral oedema,

allergy, malaise, fluid

overload, melena,periodontitis,

hyperuricaemia,

hyponatraemia,increased alkaline

phosphatase,

glycosuria,prothrombin time,

SGPT and SGOTlevels, purpura,

somnolence,impotence,

albuminuria,

hypokinesia,nervousness, sleep

disorder, skin reaction,

tinnitus, dry mouth,anaemia, sweating,

fatigue, arthralgia,

aggravation, dizziness.Diarrhoea, nausea,vomiting, insomnia,

hypercholesterolaemia,

weight gain, abnormalvision, rhinitis,

pharyngitis and

hypertriglyceridaemia.

Telmisartan (Pritor) Hypertension Telmisartan is a nonpeptide

AT1 angiotensin II receptorantagonist. Exerts

Watch out for URTI,

dizziness, back pain,sinusitis, pharyngitis


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antihypertensive activity bypreventing angiotensin II from

binding to AT1receptors thus

inhibiting the vasoconstrictionand aldosterone-secreting

effects of angiotensin II.

and diarrhoea. Slightelevations in liver

enzymes.Potentially

Fatal: Rarely

angioedema, rash,

pruritus and urticariMonitor BP frequently

Zykast (Levocetirizine+ Montelukast)

Bronchospasm Levocetirizine: Levocetirizine,an active isomer of cetirizine,selectively inhibits histamine

H1-receptors. Montelukast:

Montelukast is a selectiveleukotriene receptor antagonist

that blocks the effects of

cysteinyl leukotrienes in theairways.

Watch out forAsthenia, fatigue,fever, abdominal pain,

trauma, dyspepsia,

infectiousgastroenteritis, dental

pain, dizziness,

headache, nasalcongestion, cough &

influenza.

CELECOXIB For pain

management postop

Celecoxib has COX-2 specific

inhibitory activity. It inhibitsthe conversion of arachidonic

acid to prostaglandins whilehaving no effect on the

formation of prostaglandins

that mediate the normalhomeostasis in the GI tract,

kidneys and platelets catalysed

by COX-1.

Watch out for

Abdominal pain,diarrhea, nausea,

oedema, dizziness,headache, insomnia,

upper respiratory tract

infections; rash.Potentially

Fatal: Serious skin

reactions such asexfoliative dermatitis,

Stevens-Johnson

syndrome, and toxicepidermal necrolysis.Give after meals or

with a full glass

of water or milk.

HYDROCORTISONE Prevention of

bronchialinflammation after

surgery.

Hydrocortisone is a

corticosteroid used for its anti-inflammatory and

immunosuppressive effects. Its

anti-inflammatory action is

due to the suppression of

migration ofpolymorphonuclear leukocytes

and reversal of increasedcapillary permeability. It may

also be used as replacement

therapy in adrenocorticalinsufficiency.

Do not give for a long

period of time. Watchout for signs of

infection. Watch out

for signs and

symptoms of

Cushings syndrome.Avoid crowded places

when in steroidtherapy.

MEDROL Prevention of Methylprednisolone is a Watch out for


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(methylprednisolone) bronchialinflammation

synthetic corticosteroid withmainly glucocorticoid activity

and minimal mineralocorticoid

properties. It decreasesinflammation by suppression

of migration of

polymorphonuclear leukocytesand reversal of increased

capillary permeability.

Oedema, hypertension,arrhythmia; CNS,

endocrine, metabolic

and GI effects;hirsutism, acne, skin

atrophy, bruising,

hyperpigmentation;transient leukocytosis;

arthralgia, muscleweakness,

osteoporosis, fractures,cataracts, glaucoma;

infections,

hypersensitivityreactions, avascular

necrosis, secondary

malignancy,intractable hiccups.

Avoid crowded places

Loricid (Allopurinol) Hyperuricemia(Resolved)

Allopurinol is an inhibitor ofthe enzyme xanthine oxidase

which converts hypoxanthine

to xanthine then uric acid. Thereduced production of uric

acid relieves all symptoms

associated withhyperuricaemia and gout.

Inhibition of xanthine oxidase

leads to accumulation of itssubstrates hypoxanthine and

xanthine but since their renalclearance is more than 10

times that of uric acid, there isno risk of nephrolithiasis.

Watch out for Rash;alopoecia; GI

disorders, taste

disturbances, nausea,vomiting, abdominal

pain, diarrhoea;

paraesthesia,peripheral neuropathy,

vertigo, headache,

hepatic necrosis,drowsiness, neuritis,

arthralgia;hypertension.Potentially

Fatal: Stevens-

Jonhson and/or Lyell's

Syndrome (urticaria,fever,

lymphadenopathy,

arthralgia).Occasionally,

thrombocytopaenia,

agranulocytosis andaplastic anaemia.

Elartan (Isosorbide

Mononitrate)

Chest pain Isosorbide mononitrate relaxes

vascular smooth muscles bystimulating cyclic-GMP. It

decreases left ventricular

pressure (preload) and arterialresistance (afterload).

Watch out for

Hypotension,tachycardia, flushing,

headache, dizziness,

palpitation, syncope,confusion. Nausea,

vomiting, abdominal

pain. Restlessness,weakness and vertigo.


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Dry mouth, chest pain,back pain, oedema,

fatigue, abdominal

pain, constipation,diarrhoea, dyspepsia

and flatulence.Potentially

Fatal: Severe

hypotension andcardiac failure.

SPIRIVA

(ipratropium bromide)

For

bronchoconstriction

Ipratropium bromide blocks

the action of acetylcholine at

parasympathetic sites inbronchial smooth muscle

causing bronchodilation.

Watch out for Dry

mouth, urinary

retention, buccalulceration, paralytic

ileus, headache,

nausea, constipation,paradoxical

bronchospasm,

immediate

hypersensitivityreactions (urticaria,

angioedema), acute

angle-closureglaucoma, nasal

dryness and epistaxis

(nasal spray).Potentially

Fatal: Anaphylactic

reactions, atrialfibrillation,

supraventriculartachycardia.

Ipratropium,

Salbutamol (Duaven)

For

bronchoconstriction

Salbutamol is a direct-acting

sympathomimetic with -

adrenergic activity andselective action on

2 receptors, producing

bronchodilating effects. It alsodecreases uterine contractility.

Ipratropium bromide blocks

the action of acetylcholine at

parasympathetic sites inbronchial smooth muscle

causing bronchodilation.

Zykast (theophylline)

Watch out for

Headache, pain,

influenza, chest pain,nausea. Bronchitis,

dyspnea, coughing,

pneumonia,bronchospasm,

pharyngitis, sinusitis,

rhinitis. Edema,

fatigue, Hypertension,dizziness, nervousness,

paresthesia, tremor,

dysphonia, insomnia,diarrhea, dry mouth,

dyspepsia, vomiting,

arrhythmia,palpitation,

tachycardia, arthralgia,

angina, increasedsputum, taste


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perversion andUTI/dysuria. Allergic-

type reactions

Zykast (theophylline) For bronchospasm Theophylline competitively

blocks phosphodiesterase

which increases cAMP tissueconcentrations causing

bronchodilatation, diuresis,

CNS and cardiac stimulation,and gastric acid secretion.


vomiting, abdominal

pain, diarrhoea,headache, insomnia,

dizziness, anxiety,

restlessness, tremor,palpitations.Potentially

Fatal: Convulsions,

cardiac arrhythmias,hypotension and

sudden death after too

rapid IV inj.

Diagnostic Examinations and Laboratory Results


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Diagnostic/LabExam

Result/Interpretation Indication/Significance

XRAY Both lung fields are hyperinflated withlightly flattened diaphragmatic leaflets.

An area of 810 lucency devoid of

vascular markings seen at the rightlower peripheral hemithorax. Cardiac

shadow is unenlarged with AAR right

sided CTTThere is near complete resolution ofsubcutaneous emphysema in the right

lateral chest wall

Mid to lwer reticular and hazy densitiesprobably pneumonic, minimal pleural

effusion with probably lamellar and

interlobar componentRight apical pleural reaction

PNEUMOTHORAX RIGHT

Indicated for the patient as an initialinvestigation of the pneumothorax to

assess the location, the amount and

the gravidity of the insult. Also, thisis to serve as baseline for the

assessment and evaluation of the

effectivity of the surgical, medicaland nursing procedures. This is alsoto determine if the CTT is inserted at

the correct area.

CBC Hemoglobin: 103g/L (decreased)

Erythrocyte: 0.31 (decreased)Leukocytes: 16700 mm/L (increased)

This is important as baseline before

surgery to determine the amount ofhematocrit, RBC, Hemoglobin and

WBC which are all integral in therecovery of the patient. Also, this is

significant in order to assess the

amount of oxygen being delivered tothe body as per hemoglobin count to

reveal the degree of perfusion

problems. Also, the increase inleukocytes may also indicate an

ongoing bacterial invasion from the

surgical interventions.

case presentation for inp

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