powerpoint case

7/29/2019 Powerpoint Case

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+ Pneumonia is an inflammatory condition ofthe lungespecially affecting the microscopic airsacs (alveoli. The disease is either an infection ofone or both lungs which is usually caused by

bacteria, viruses, or fungi.+ Currently, over 3 million people develop

pneumonia each year in the United States. Over ahalf a million of these people are admitted to a

hospital for treatment. Although most of thesepeople recover, approximately 5% will die frompneumonia. Pneumonia is the sixth leading causeof death in the United States.
http://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Alveolihttp://en.wikipedia.org/wiki/Alveolihttp://en.wikipedia.org/wiki/Alveolihttp://en.wikipedia.org/wiki/Alveolihttp://en.wikipedia.org/wiki/Alveolihttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Inflammation


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+ Left Lower lobe (LLL) is a relatively common

site for consolidation. The term consolidationis usually referring to a long airspace replaced

by a fluid. The term consolidation does not

imply any particular etiology or pathology.

Acute pneumonia is the most common cause

of consolidation. Other causes include chronic

pneumonia, pulmonary edema and neoplasm.


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+ Appearances of Lung Consolidation

+ Radiological appearances common

to all lobes are:+ 1. Abnormal lung opacity

+ 2. Increase in the size and number oflung markings

+

3. Loss of clarity of the diaphragm onthe AP and/or lateral views

+ 4. Loss of clarity of the heart borderon the AP and/or lateral views

+ 5. Loss of the normal darkeninginferiorly of the thoracic vertebralbodies on the lateral view

+ 6. Opacification of the lung behindthe heart shadow or below the

diaphragms


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+ Risk factors

+ Adults age 65 or older and very young children, whoseimmune systems aren't fully developed.

+ Patients who have Immune deficiency diseases such asHIV/AIDS and chronic illnesses such as cardiovasculardisease, emphysema and diabetes.

+ Patients who Smoke, or drink alcohol.

+ People who have mechanical ventilation.+ Exposure to certain chemicals or pollutants.

+ People whove had surgery or who are immobilizedfrom a traumatic injury.


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+ Signs and Symptoms

+ Cough

+ Fever

+ Chest pain+ Colds or Flu

+ Chills

+ Sweating

+ shortness of breath+ Headache

+ muscle pain

+ fatigue

+

+ Diagnostics

+ Chest X-rays

+ Blood tests

+ Sputum Culture


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+ Prevention

+ Proper diet

+ Practice proper hygiene

+ Adequate rest

+ Regular exercise

+ Increase Fluid intake

+ Dont smoke+ In the hospital:

+ Strict medical asepsis

+ Adherence to universal precautions

+ Respiratory therapy equipment be properlycleaned and changed


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+ Nursing management

+ Appropriate antibiotic therapy

+ Oxygen therapy to treat

hypoxemia

+ Analgesics to relieve chest pain

+ Anti-pyretic to decrease

temperature+ Chest physiotherapy

+ Activity should be restricted and

rest should be encouraged+ Fluid intake of at least 3 liters

per day

+

Assume semi-fowlers position


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GENERAL OBJECTIVE

To enhance our knowledge, skills, andattitude in properly initiating the actualduties and responsibilities of a healthcareprovider by participating on nationalobjectives of the health of our country inreducing mortality, morbidity, disability and

complications of the disease.Through this presentation, we are to

share to our audience the knowledge thatwe have gain from pneumonia also the skillsrequired to manage the patient and theattitude that we must obtain to become aneffective and efficient healthcare provider tothe patient that we may encounter in thefuture.


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SPECIFIC OBJECTIVES:

+ After the case presentation, we the studentnurses will be able to accomplish the

following:+ Define pneumonia

+ Enumerates the different signs andsymptoms present in the disease

+ Trace and explain the pathophysiology of

the disease+ Enumerate the different drugs given to the

patient with pneumonia

+ Diagnostic procedure of the disease

+ Treatment of the disease

+ Explain the diet of the patient

+ The anatomy and physiology of the disease


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NAME: D.Q

AGE: 83 Y/O

BIRTHDATE: September 03, 1927

BIRTHPLACE: Centro 01, Lasam

CagayanMARITAL STATUS: Widowed

EDUCATIONAL ATTAINMENT: Elementary Level

ADDRESS: Centro 01, LasamCagayan

OCCUPATION: None

RELIGION: Roman Catholic

NATIONALITY: Filipino

CONSULTANT: Dr. Jamorabon

DATE OF ADMISSION: September 17, 2012

TIME ADMITTED: 2:00 am

CHIEF COMPLAINT: Epigastric PainADMITTING DIAGNOSIS: Drug Induced Gastritis

FINAL DIAGNOSIS: Left Basal Pneumonia

ATTENDING PHYSICIAN: Dr. Jamorabon


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+ Ego Integrity vs. Despair

(Late adulthood, 65-death)


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+ As we grow older and become senior citizens we tend toslow down our productivity and explore life as a retiredperson. It is during this time that we contemplate ouraccomplishments and are able to develop integrity if we see

ourselves as leading a successful life. If we see our life asunproductive, or feel that we did not accomplish our lifegoals, we become dissatisfied with life and develop despair,often leading to depression and hopelessness.

+ The final developmental task is retrospection: people lookback on their lives and accomplishments. They developfeelings of contentment and integrity if they believe thatthey have led a happy, productive life. They may insteaddevelop a sense of despair if they look back on a life ofdisappointments and unachieved goals.

+ This stage can occur out of the sequence when an individualfeels they are near the end of their life (such as whenreceiving a terminal disease diagnosis).

+ Patient D.Q have no regrets in her life because she feels thatshe has been productive as a citizen and a good mother toher children as evidenced by all of her children finished theirstudies in college.
http://en.wikipedia.org/wiki/Ego_integrityhttp://en.wikipedia.org/wiki/Ego_integrityhttp://en.wikipedia.org/wiki/Despairhttp://en.wikipedia.org/wiki/Despairhttp://en.wikipedia.org/wiki/Despairhttp://en.wikipedia.org/wiki/Ego_integrity


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+ When asked if there are any diseasein the family like hypertension,cancer, diabetes, asthma, obesity,allergies, tuberculosis and mentalproblems, patient D.Q said that herfather has hypertension and asthma.No disease mentioned on the motherside. Patient DQs said that her older

brother has just recently diagnosedwith lung cancer last June 2011.


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+ The patient said that she already suffered from chicken pox, mumpsand measles. When asked when it occurred, she said Hindi ko na

matandaan kung ilang taon ako basta bata pa ako noon. Whenasked if she had dengue, malaria, and diarrhea she only mentionedabout chicken pox, mumps and measles. The patient also said thatshe was diagnosed with asthma when she was 40 years old. Buongaraw kasi akong nagtrabaho sa bukid, pagkauwi ko sumakit angdibdib ko at hindi na ako makahinga tapos dinala ako sa LasamDistrict Hospital. Doon sinabi ni Dr. Gonzales na may asthma dawako, as verbalized by the patient. She also added, Prinescriban akong gamot, Salbutamol ata yun. The patient was asked about herchildhood immunizations, she said she had BCG. When asked if shehad DPT, Measles, OPV and Hepa B, she said, Hindi ko namatandaan kung ano yung iba, basta noong Grade 2 ako my tinusoksa akin sa eskwelahan, noong uso pa ang cholera. When asked

about any allergies to food, animals or plants or any kind ofallergens (allergy-causing substances), Sa pagkain wala naman, saalikabok ako sensitibo, nahihirapan akong huminga o kaya inaatakeako ng asthma kapag nakakalanghap ako ng alikabok, as verbalizedby the patient. When asked if she had minor/major accidents andinjuries the patient verbalized, Sa awa ng Diyos, wala naman.

+


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+ The pt first complains of epigastric pain last September 14. Nunglingo, medyo masakit na yung tiyan ko pero hindi siya tuloy tuloy.

Pasulpot sulpot lang ganon at parang iikot lang. Mga twice siguroyun, the patient stated. She also rated the pain in a scale of 3. Herdaughter immediately called Dr.Jamorabon to report the symptomand the doctor ordered Omeprazole 20 mg. Binigay namin bagosya kumain tapos naging okay okay naman na sya, her daughtersaid. But on September 16 ( Sunday), she again experienced

epigastric pain in the afternoon.This time they called Dr. Salva ofLasam District Hospital. Pumunta siya sa bahay namin para tignansi nanay, tapos tinawagan niya si Dr. Jamoorabon at inorderan siyang ranitidine, her daughter verbalized. When pt. D.Q asked todescribe the pain, Nung una, medyo kaya ko pa pero nung mgamadaling araw na,hindi. Kung may mas tataas pa ng 10 sa sakit, yun

yun. Tinakbo ako sa Lasam District Hospital mga alas tres ngmadaling araw , the pt verbalized. The daughter said that they stopgiving her Hydrocortisone . The patient was transferred to CVMCreferred by Dr. Salva the next day ( monday).


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Before Hospitalization+ When asked about her perception on what is

health, the patient verbalized, Hindipagkakaroon ng anumang sakit, malinis angpangangatawan at kumakain ng masustansyangpagkain. She added that a healthy person ismalusog ang pangangatawan, hindi matamlay atparang walang sakit kung titignan. Sheconsiders health as important aspect of life,kapag may sakit ka hindi mo magagawa yunggusto mong gawin, as verbalized by her. Thepatient enumerated some ways on how shemanages her health like doing exercise everymorning, eating proper and nutritious foods andmaintaining good hygiene. Every two monthsshe goes for a check-up to monitor her health atSt. Joseph Clinic, her consultant is Dr. Magnolia

Reyes. When asked if what are the things shedoes every time she got sick, she said,Nagpapahinga lang. Umiinom din ako nggamot. Pero pag malala na, kumukunsulta na akosa doctor.

After Hospitalization

+ Patient D.Q still perceives health as being free

from illness and now she also considers health as

wealth. She added, Ang kalusugan ay hindi

dapat pabayaan. The patient said that shes

monitoring her health properly by following theorders of the doctors.


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Before Hospitalization+ The patient said that she practices regular meals

(3x a day) with snacks like mango, papaya and

fruit juices in between. Patient D.Q loves to eat

sinigang na baboy at isda and vegetables like

okra, ampalaya, sitaw, kalabasa at talbos ng

kamote. She usually eats one cup of rice permeal. She also said she has no allergies. She

drinks 8-10 glasses of water a day preferably

lukewarm. She also drinks 1 cup of milk

(Anlene) every morning. The patient doesnt

drink coffee. She also started taking vitamin

(Appevit), an appetite stimulant, every morning

after breakfast last August. When asked why,

she said Hindi kasi ako masyadong

nakakakain.Shedoesnt have any difficulty in

swallowing.

During Hospitalization

+ Patient D.Q is on NPO except medications for

the first to second day of confinement. On the

third day of hospitalization, the doctor ordered

for a soft diet last September 19, the doctor

ordered to limit intake of oral fluid to 1L a day.


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Before Hospitalization+ Patient D.Q urinates 5-6 times a day. She also

added that the urine measures approximately

100-120 ml per urination. She described her

urine as light yellow in color. She defecates

twice a week. Binigyan ako ng fiber medicine(Psyllium Powder 4.5g). Prescribed sa akin ni

Dr. Salva noong August para makatae ako.

Iniinom ko iyon tuwing umaga. She described

her stool as soft and yellow brown in color.

Hindi naman matubig, she added. Pain is not

being experienced during elimination. According

to her she doesnt use diuretics and laxatives.


+ Patient D.Q urinates three to four times a day.

She also added that the urine measures

approximately 100-120 ml per urination; its

color is light yellow. She didnt experienced

difficulty in urinating. After three days of notdefecating, the patient finally defecated after

giving Lactulose 30ml, a laxative. The patient

said matubig tsaka konti lang at kulay

yellow,as verbalized by her.


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Before Hospitalization

+ Patient D.Q verbalized, Hindi ako

mapakali pag wala akong ginagawa. The

patient said that she considered watering

the plants and sweeping as her exercise.

Kapag tapos ko ng gawin yun, nanonood

na ako ng TV o kaya nakikinig ako ng

radio, she added. According to her, she

also joins novena in their place every day.

When asked if she easily gets tired while

doing those activities, she said Hindi

masyado, nakasanayan ko na eh, asverbalized by her.

During Hospitalization+ Patient D.Q spends her time resting

throughout the day. Sometimes, she is

listening to the radio and communicates to

her SOs. She goes out of the bed when she

urinates but with assistance. She was alsoassisted on deep-breathing exercise because

she said, Inuubo ako at nahihirapan akong

ilabas ang plema.


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Before Hospitalization+ Patient D.Q had her telarche when she was

12 years old and menarche when she was14 years old, regular with moderate flow, 3days duration and consumes 5 pads per

day(PADS= cut from old clothes) not fullysoaked. She had her first boyfriend whenshe was 20 years old. Yung unangkasintahan ko siya ang napangasawa ko atnagpakasal kami noong 23 years old akoas verbalized by her. Her coitarchehappened when she was 23 years old withher husband. When she reached 54, shehad her menopausal period. She also said,Kontento naman ako sa pagiging babaeko kasi mas mapagmahal at malambingsila, as verbalized by the patient.


+ Nothing follows>>>>>>>


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+ The patient verbalized that she sleeps 7-8

hours a day. She usually sleeps at around 8

or 9PM and wakes up at 4:30 AM, neither

bothered nor disturbed. She added,

Nakakatulog naman ako kaagad. Tahimik

naman kasi sa amin kaya hindi paputol-

putol ang tulog ko. She usually sleeps in

the afternoon for 1-2 hours between 2-

4pm. She doesnt have any rituals prior to

sleeping. Also, she doesn't take any

sleeping pills.


+ Patient D.Q sleep pattern during day 1 to

day 3 was disturbed; Nagigising ako

kapag may magbibigay ng gamot at

magBBP pero nakakatulog naman ako ulit

pagkatapos, as verbalized by her. Then

last February 1, the doctor ordered: No BP

taking from 10pm to 4am. But the patient

complained, Pero pag minsan hindi ako

makatulog kasi maingay yung mga bisita

ng katabi ko. She said she spends most of

her time resting and sleeping


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+ According to patient D.Q, she is

understanding, good and loving person.

She doesnt get angry easily. Hindi ako

mabilis magalit, mahaba ang pasyensya

ko, as verbalized by her. She is also fond

of socializing with other people,

Gustung-gusto kong makipag-usap sa

mga tao lalo na sa mga kasama kong

matatanda rin. She is also a good mother

to her children, Kapag may problema ang

mga anak ko tinutulungan ko sila, asverbalized by her. When asked for further

description about herself, she no longer

adds anything.


+ When asked about any changes in her

self-outlook, Wala namang nagbago

ganun pa rin naman ako, she said.


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+ Patient D.Q said that she cant readsomething unless she wears her eyeglasses,Nearsighted ako, 250 ang grado nungeyeglasses ko, nagsimula akong magsuot

noong 45 years old ako, as verbalized by thepatient. In terms of hearing, Medyo mahinana rin ang pandinig ko, kapag kinakausap nilaako kailangan lakasan nila para marinig ko,she said although she can easily comprehendon the questions asked to her. She is notwearing hearing aids. She doesnt have anyproblems with her sense of smell, taste andtouch. Patient D.Q finished her 4th grade.

Hanggang grade 4 lang ang narating ko,malayo kasi sa amin ang eskwelahankailangan pa naming tumawid sa ilog at walapa kaming sapin sa paa dahil mahirap langdin kami noon, as verbalized by the patient.

During Hospitalization+ The patient said that she is aware of what's

happening to her. She is also able to identify

people around her, the date and also the place

where she is. Nothing has changed to her

senses. She is also responsive and cooperativeto questions and health regimen. She

responds appropriately to verbal and physical

stimuli and obeys simple commands.


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Before Hospitalization`+ Patient D.Q was the second eldest among 9

siblings. She is a mother of seven children. She

has a close relationship with her family though

some of her children dont already live with her

but she said they still find time to communicateand see each other. Her husband died nine years

ago because of hypertension. She does not work

on field already so she relies on her children for

financial support. Most of the time, she turns to

her family for emotional supports. Ang kasama

ko sa bahay ay yung ikaapat na anak ko. Dalawa

lang kami sa bahay kasi wala naman siyang

asawa, as verbalized by the patient.


+ Patient D.Q relationship with her family hasnt

changed. Patient D.Q was visited by her children

fifth and sixth children in the hospital but her

fourth daughter was always with her every day.

Her other children didnt visit her yet becausethey are living in other places although they

were aware on her condition thus they

communicate to her through the phone.


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+ According to patient D.Q, when she has a

problem she shares it to her daughter because

she can easily recover from it through this

way. Her family was her main source of

strength. She also prays to God, Kapag mayproblema ako, nagdadasal ako ng taimtim

tapos gumagaan na ang loob ko, she said.


+ Patient D.Q being hospitalized gets stressed

thinking about her condition. She usually sleeps

to relieve her stress. Most of the time she

communicates with her daughter expressing her

discomforts or to the student nurses/RNs whenshe needs something.


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Before Hospitalization+ Patient D.Q is a Roman Catholic and believes in

the Supreme Being who watches over us. She

added, Ang Diyos ang pinakamabuti,

mapagmahal, matulungin, hindi niya tayo

pinapabayaan at sobrang mahal niya tayo. Sheattends mass every Sunday with her daughter.

Palagi ako sa simbahan lalo kapag may

novena, she said. Patient EV also said Matindi

ang pananalig at paniniwala ko sa Diyos. She

prays the rosary before going to bed. She also

believes in atang if there are occasions such as

birthday, All Souls Day, Christmas and the like.

During Hospitalization+ When asked about any changes in her faith,

patient D.Q said, Sa ngayon mas tumindi pa

ang pananampalataya ko sa Diyos. Ipinagdadasal

ko na sana gumaling na ako kaagad para

makalabas na ako sa hospital, as verbalized byher. She always prays for their safety.


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+ Consists of the external nose, the nasal cavity, the pharynx, the larynx, the trachea, the bronchi and the


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lungs.

+ The primary function of the respiratory system is to supply the blood with oxygen in order for the blood to

deliver oxygen to all parts of the body. The respiratory system does this through breathing. When we

breathe, we inhale oxygen and exhale carbon dioxide. This exchange of gases is the respiratory system's

means of getting oxygen to the blood.

+

+ I. UPPER RESPIRATORY TRACT

+ external nose, nasal cavity, pharynx and associated structures.

+

+ NOSEconsists of the external nose and nasal cavity.

+

+ External nosevisible structure that forms a prominent feature of the face.

+ - composed of hyaline cartilage and bone in bridge of the external nose that covered by connective tissueand skin.

+ Nasal cavityextends from the nares to the choane, divided by nasal septum.

+

+ naresexternal openings of the nose which air enters into nasal cavity.

+ - inside it is epithelial lining that composed of stratified squamous epithelium. containing coarse hairs that

traps some of the large particles of dust suspended in the air.

+ choaneopenings into the pharynx.

+ paranasal sinusesare air-filled spaces within bone.

+ - open into the nasal cavity are lined with a mucous membrane.

+ - produce mucus.

+ pseudostratified columnar epithelial cellslined the rest of nasal cavity.

+ - it contains cilia and many mucus-producing goblet cells and it traps debris in the air.

+ cilia- sweep the mucus posteriorly to the pharynx where it is swallowed.


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+ PHARYNXthroat

+ -common passageway of both the respiratory and digestive systems.

+ - receives air from the nasal cavity and leads to the rest of respiratory system.

+ - divided into 3 regions: the nasopharynx, oropharynx and laryngolarynx.

+ Nasopharynx- superior part, located posterior to the choane and superior to the soft palate,which is an incomplete muscle and connective tissue partition separating the nasopharynx

from the oropharynx.

+ - lined with pseudostratified ciliated columnar epithelium.

+ -its posterior part contains the pharyngeal tonsil which aids in defending the body

against infection.

+ Oropharynxextends from the uvula to the epiglottis.

+ - where oral cavity opens.

+ - lined with stratified squamous epithelium, protects against abrasion.

+ - air pass through it.

+ LARYNXlocated in the anterior throat; continuous superiorly with the pharynx and inferiorly

with the trachea.

+ - consist of an outer casing of 9 cartilages that are connected to one another by muscles and

ligaments.


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+ II. LOWER RESPIRATORY TRACT

+ 1 .LUNGS

+ The lungs are the main organs of the respiratory system. In the lungs oxygen is taken into the bodyand carbon dioxide is breathed out. The red blood cells are responsible for picking up the oxygen inthe lungs and carrying the oxygen to all the body cells that need it. The red blood cells drop off theoxygen to the body cells, then pick up the carbon dioxide which is a waste gas product produced by

our cells. The red blood cells transport the carbon dioxide back to the lungs and we breathe it outwhen we exhale.

+

+ The left lower lobe is similar in structure to the right lower lobe except that it has twosegments combined- because the anterior and medial basal segments .share a commonbronchial supply, these two segments are characteristically combined, forming an anteriormedial basal segment.


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+ . TRACHEA

+ The trachea is sometimes called the windpipe. The trachea filters theair we breathe and branches into the bronchi.

+ + 3. BRONCHI

+ The bronchi are two air tubes that branch off of the trachea andcarry air directly into the lungs.

+

+ 4. DIAPHRAGM+ Breathing starts with a dome-shaped muscle at the bottom of the

lungs called the diaphragm. When you breathe in, the diaphragmcontracts. When it contracts it flattens out and pulls downward. Thismovement enlarges the space that the lungs are in. This larger spacepulls air into the lungs. When you breathe out, the diaphragmexpands reducing the amount of space for the lungs and forcing airout. The diaphragm is the main muscle used in breathing.


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+ PHYSIOLOGY OF RESPIRATION

+

+ The respiratory primarily supplies oxygen to the body and disposes of carbon dioxide through exhalation. Four events

chronologically occur, for respiration to take place.

+ Pulmonary ventilationthis process is commonly termed as breathing. With pulmonary ventilation, air must move out into

and out of the lungs so that the alveoli of the lungs are continuously drained and filled with air.

+

External respirationthis is the exchange of gases or the loading of oxygen and the unloading of carbon dioxide between thepulmonary blood and alveoli.

+ Respiratory gas transportthis is the process where the oxygen and carbon dioxide is transported to the and from the lungs

and tissue cells of the body through the bloodstream.

+ Internal respirationin internal respiration the exchange of gases is taking place between the blood and tissue cells.

+

+ Mechanics of Breathing

+

+ Breathing, also called pulmonary ventilation is a mechanical process that completely depends on the volume changesoccurring in the thoracic cavity. Thus, a when volume changes pressure also changes, and this would lead to the flow of gases

equalizing with the pressure.

+

+ Inspirationalso called inhalation. This is the act of allowing air to enter the body. Air is flowing into the lungs with this

process. Inspiratory muscles are involved with inspiration which includes:

+ The diaphragm

+ External intercostals

+

+ These muscles contract when air is flowing in and thoracic cavity increases. When the diaphragm contracts it slides inferiorly

and is depressed. As a result the thoracic cavity increases. The contraction of the external intercostals muscles lifts the rib

cage and thrusts the sternum forward. This increases the anteroposterior and lateral dimensions of the thorax.

+

+ Expirationalso called expiration. It the process of breathing out air as it leaves the lungs. This process causes the gases to

flow out to equalize the pressure inside and outside the lungs. Under normal circumstances, the process of expiration is

effortless.

+


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