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INTRODUCTION
This is a case of a 74 year old woman who was diagnosed with
Community Acquired Pneumonia.
Pneumococcus can affect more than the lungs. The bacteria can also cause
serious infections of the covering of the brain (meningitis), the bloodstream, and
other parts of the body.
Sex: Female
General Data:
Time Assessed:
Vital Signs:
Temperature: 35.7 C
General appearance:
The lungs are paired, cone-shaped organs which take up most of the space in
our chests, along with the heart. Their role is to take oxygen into the body, which
we need for our cells to live and function properly, and to help us get rid of
carbon dioxide, which is a waste product. We each have two lungs, a left lung
and a right lung. These are divided up into 'lobes', or big sections of tissue
separated by 'fissures' or dividers. The right lung has three lobes but the left lung
has only two, because the heart takes up some of the space in the left side of our
chest. The lungs can also be divided up into even smaller portions, called
'bronchopulmonary segments'.
These are pyramidal-shaped areas which are also separated from each other by
membranes. There are about 10 of them in each lung. Each segment receives its
own blood supply and air supply.
Air enters your lungs through a system of pipes called the bronchi. These pipes
start from the bottom of the trachea as the left and right bronchi and branch many
times throughout the lungs, until they eventually form little thin-walled air sacs or
bubbles, known as the alveoli. The alveoli are where the important work of gas
exchange takes place between the air and your blood. Covering each alveolus is
a whole network of little blood vessel called capillaries, which are very small
branches of the pulmonary arteries. It is important that the air in the alveoli and
the blood in the capillaries are very close together, so that oxygen and carbon
dioxide can move (or diffuse) between them. So, when you breathe in, air comes
down the trachea and through the bronchi into the alveoli. This fresh air has lots
of oxygen in it, and some of this oxygen will travel across the walls of the alveoli
into your bloodstream. Travelling in the opposite direction is carbon dioxide,
which crosses from the blood in the capillaries into the air in the alveoli and is
then breathed out. In this way, you bring in to your body the oxygen that you
need to live, and get rid of the waste product carbon dioxide.
VI. PATHOPHYSIOLOGY
Virulent Microorganism
Streptococcus Pneumoniae
Productive/non-productive
FEVER
Overwhelming sepsis
DEATH
VII. Medical Management
Hematology Result:
Hct: 0.29 Normal: 0.37-0.47
Segmenters: 0.87
Lymphocytes: 0.13
Urinalysis:
Color: Light Yellow
Protein: +1
Glucose: negative
RBC: 2-3/hpf
Crystals: A Urates: Many
Pharmacokinetics:
Metabolism: Hepatic; half life 80-120min.
Distribution: Crosses Placenta; enters breast milk
Excretion: Urine
Indications:
Replacement therapy in adrenal cortical insufficiency
Hypercalcemia; associated with cancer
Short term inflammatory disorders
Contraindications:
Infections, especially tuberculosis, fungal infections, amoebiasis,
hepatitis B, liver disease, liver cirrhosis, active or latent peptic ulcer.
Adverse Reaction:
Vertigo, headache, hypotension, shock, thin, fragile skin, petechiae,
amenorrhea, muscle weakness.
Nursing Considerations:
1. Give daily before 9AM to mimic normal peak diurnal corticosteroid
levels and minimize HPA suppression.
Dosage:
Pharmacokinetics:
Metabolism: Hepatic; half life 6.25 hr
Excretion: Urine (30%)
Indications:
Mucolytic Adjuvant therapy for abnormal, viscid, or inspissated mucus
secretion in acute and chronic bronchopulmonary disease
(pneumonia,asthma,TB).
Contraindications:
Contraindicated with hypersensitivity to acetylcysteine; use caution
and discontinue if bronchospasm occurs.
Adverse Reaction:
Nausea, rhinorrhea, bronchospasm especially in asthmatics,
stomatitis,and urticaria.
Nursing Considerations:
1. dilute with normal saline solution or sterile water for injection.
REASON
Subjective: Ineffective Increased Short term Independent: Goal half
airway mucus goal: met.
“nagrereklamo clearance production is 1.Assessed 1.Tachypnea,
nga yang si related to often caused After 3-4 hours rate/depth of shallow After 4 hours of
nanay na increase by an of intervention, respiration and respiration are nursing
nahihirapan mucus underlying patient will chest movement. usually intervention,
siya huminga, production illness. If expectorate present. patient
dami din kasi mucus is the secretions expectorated
plema eh” as effectively and 2.Lowers
most 2.Elevated head diaphragm, secretion and
verbalized by prevalent RR will of bed and RR decreased
relative. decrease from promoting
symptom, it is changed position chest from 26/min to
usually 26 to normal frequently. 22/min.
Objective: range of 16- expansion,
caused by mobilization
*RR- 26 something 20/min.
and
simple like expectoration
allergies or of secretion.
the common Long term
*Dyspnea cold. Other goal:
illnesses that
*(+)non- result in After 3 days of
productive excessive intervention,
cough mucus patient will
production maintain 3.Deep
*Use of patent airway
accessory include breathing
as evidenced 3.Assisted patient facilitates
muscle pneumonia,
by normal RR. with frequent maximum
flu and
deep breathing expansion of
bronchitis
exercises. the lungs and
smaller
airways.
4.Fluids aid in
4. Encouraged mobilization
increase in fluid and
intake. expectorations
of secretions
Collaborative:
5.Aids in
5.Administered mobilization of
mucolytics as secretion.
indicated.
(Fluimucil)
6.Fluids are
required to
6.Provided replace
supplemental insensible loss
fluids. and aids in
(IVF: PNSS) mobilization of
secretions.
7.Follows
progress and
effects of
7.Monitored
disease
chest Xray, ABG
process.
and pulse
oximetry results.