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INTRODUCTION
Substances other than bacteria may be aspirated into the lung, such as gastric
contents, exogenous chemical contents, or irritating gases. This type of aspiration or
ingestion may impair the lung defenses, cause inflammatory changes, and lead to
bacterial growth and a resulting pneumonia.
This inflammation causes an outpouring of fluid in the infected part of the lungs,
affecting either one or both lungs. The blood flow to the infected portion of the lung (or
lungs) decreases, meaning oxygen levels in the bloodstream can decline.
The body attempts to preserve blood flow to vital organs and decrease blood flow to
other parts of the body such as the GI tract. The effects of pneumonia are widespread
even though the infection is localized to the lung. The complications of pneumonia in the
elderly can be life-threatening, from low blood pressure and kidney failure to bacteremia,
an infection that spreads to the bloodstream.
Elderly people are more susceptible to pneumonia for several reasons. Often
they already suffer from co-morbid conditions such as heart disease, which means they
don’t tolerate infection as well as younger people. Age also causes a decrease in an
older person’s immune system response, so his defenses are weaker. Some virulent
organisms can cause infection in younger people, but the infections can be worse in
older people.
II. OBJECTIVES
General
I should be able to able to make use of the knowledge, skills, and attitude I have
built up in myself as a preparation for this clinical exposure. In the process, I should be
able to improve these three domains and motivate our patient to the road of recovery.
Specific:
Cognitive
1. Learn important information about Pneumonia; its causes, signs and
symptoms, occurrence, diagnostic tests, and treatment.
Psychomotor
1. Assess the patient’s condition in a cephalocaudal manner noting her
general physique and patterns of functioning.
Attitude
1. Interview the patient / folks in a therapeutic manner using different means
of therapeutic communication.
The lungs constitute the largest organ in the respiratory system. They play an
important role in respiration, or the process of providing the body with oxygen and
releasing carbon dioxide. The lungs expand and contract up to 20 times per minute
taking in and disposing of those gases.
Air that is breathed in is filled with oxygen and goes to the trachea, which branches off
into one of two bronchi. Each bronchus enters a lung. There are two lungs, one on each
side of the breastbone and protected by the ribs. Each lung is made up of lobes, or
sections. There are three lobes in the right lung and two lobes in the left one. The lungs
are cone shaped and made of elastic, spongy tissue. Within the lungs, the bronchi
branch out into minute pathways that go through the lung tissue. The pathways are
called bronchioles, and they end at microscopic air sacs called alveoli. The alveoli are
surrounded by capillaries and provide oxygen for the blood in these vessels. The
oxygenated blood is then pumped by the heart throughout the body. The alveoli also
take in carbon dioxide, which is then exhaled from the body.
Inhaling is due to contractions of the diaphragm and of muscles between the ribs.
Exhaling results from relaxation of those muscles. Each lung is surrounded by a two-
layered membrane, or the pleura, that under normal circumstances has a very, very
small amount of fluid between the layers. The fluid allows the membranes to easily slide
over each other during breathing.
Each alveolus has a thin membrane that allows oxygen and carbon dioxide to
pass in and out of the capillaries, the smallest of the blood vessels. When you take a
deep breath, the membrane unfolds and expands. Fresh oxygen moves into the
capillaries, and carbon dioxide passes from the capillaries into the bloodstream, where it
is carried out of the body through the lungs.
When air is inhaled through the nose or mouth, it travels down the trachea to the
bronchus, where it first enters the lung. From the bronchus, air goes through the bronchi,
into the even smaller bronchioles and lastly into the alveoli.
V. CLINICAL ASSESSMENT
A. Nursing History
1 month prior to admission, the patient is (+) to CVA but it is undiagnosed.
Mrs. E.A. is (-) to HPN and (-) DM.
1 week prior to admission, E.A. was noted to have cough associated with
fever, undocumented. So she sought consult with AP given Co.amoxiclav with
relief of symptoms.
Day of admission, folks decided to have patient admitted for general
check – up.
E. F.A. Died of
A 94 Asthma
87
58 56 40 18
67 65 60 54 52 41
Lung cancer
LEGEND:
FEMALE
MALE
DISEASED
Educational Background
Occupational Background
Religious Practices
Economic Status
A. Vital Signs
V/S taken upon admission:
T – 36.1 °C P – 89 bmp RR – 18 bmp CR – 92 bmp BP–130/90mmHg
B. Height: 152 cm
Weight: 44 kg
BMI: 19.0
Mrs. M.L is in a Normal Weight.
C. Physical Assessment
I. General Appearance: Patient is as sleep most of the time, cannot
move freely and is not responsive.
IV. Eyes: Dirty sclera, Pale conjunctiva, Presence of cataract at the left
eye.
XII. Musculoskeletal system: Unable to flex and extend both upper and
lower extremities. No tenderness or swelling on joints or bones. Good hand
grip.
D. GENERAL APPRAISAL
III. Hearing: She can’t easily responds when called and claims to hear
well.
A. Chemistry
Fluid: serum
August 24, 2009 Result Normal Values Significance of the
16:52:35 Abnormal Result
renal disease that
Creatinine 28.2 62.0 – 106.0 umol/L affects the
glomerular filtration
rate.
Potassium 3.10 3.50 – 5.10 mmol/L Within Normal
Range
Sodium 136.3 62.0 – 106.0 umol/L Starvation &
diabetic acidosis,
Dehydration
ALT 26
B. Hematology
Blood Exam Result Normal Values Significance of the
August 24, 2009 Abnormal Result
WBC 3.8 4.5 – 11.0 10^ g/L Within Normal Range
RBC 4.62 M: 4-6 – 6.2 10^ Within Normal Range
12/L
F: 4.2 – 5.4 10^
12/L
Hemoglobin 135 M: 130 – 180 g/L Within Normal Range
F: 115 – 165 g/L
Hematocrit L 0.41 M: 0.40 – 0.54 vol Within Normal Range
- fr
F: 0.37 – 0.47 vol
– fr
Mean Cell volume 90.0 78 – 79 fl Folate deficiency,
(MVC) B12 deficiency,
Hereditary
spherocytosis
Mean cell 29.1 27 – 32 pg Within Normal Range
Hemoglobin (MCH)
Mean Cell 32.5 30 – 35 g/dl Within Normal Range
haemoglobin
concentration(MCHC)
RDW 13.2 11 – 16 % Within Normal Range
Neutrophil 50.0 50-70 % Within Normal Range
Stabs 1.0 2-3
Eosinophil 11.0 0 - 3% Infection,
Inflammation,
Leukemia, Allergic
reaction
Basophil 0.0 0–1% Anaplastic anemia,
Bone marrow
depression,
Pernicious anemia,
Some infectious or
parasitic disease
Lymphocytes 29.0 20 – 45 % Within Normal Level
Monocytes 9.0 0–8% Chronic Infection
C. ABG analysis
August 24, 2009 Result Normal Values Significance of the
Abnormal Result
pH 7.45 7.35 – 7.45 Within Normal Value
PCO2 41.3 35 – 45 mmHg Within Normal Value
PO2 46.0 80 – 100 mmHg Anemia &
Obstructive
Pulmonary disease
HCO2 28.3 22 – 26 mmol/L
TCO2 66.4 Mmol/L
D. X-RAY result
Infection occurs
Vasoconstriction
Release of chemical
mediators
Increase in local
Capillary leaks
Hypoxia
ASPIRATION PNEUMONIA
XI. NURSING MANAGEMENT
A. Concept Map of Nursing Problems
S/Sx:
Tachycardia
Restlessness
Dyspnea
Hypoxia
Therapy: O2 therapy, 2
liters.
S/Sx: S/Sx:
Inability to cough effectively - Starvation
Anxiety CC: Cough - Diabetic acidosis
Dyspnea Dx: Aspiration - Dehydration
Dry cough Pneumonia
Meds & Diet: OTF (1,500
Meds: Metronidazole kilocalories / day ÷ 6
Fluimucil feedings).
Celebrex Macrobee with Iron
Activity Intolerance
S/Sx:
Lethargy
Verbal reports of weakness
Fatigue
Exhaustion
M (MEDICATION)
Instruct the folks to monitor the client’s position, she must be in moderate
high back rest and change position every two hours.
T (TREATMENT)
Give supportive treatment. Proper diet and oxygen to increase oxygen in the
blood when needed.
Treatment is one of the main factors in restoration of health and curing of the
failure in the body system. Treatments are given to the patient for a specific time
until treatment is not more needed by the patient.
Encourage the folks to wash patient’s hands. The hands come in daily
contact with germs that can cause pneumonia. These germs enter one’s body
when he touch his eyes or rub his nose. Washing hands thoroughly and often
can help reduce the risk.
Tell folks to avoid exposing the patient to an environment with too much
pollution (e.g. smoke). Smoking damages one’s lungs’ natural defenses against
respiratory infections.
Protect others from infection. Try to stay away from anyone with a
compromised immune system. When that isn’t possible, a person can help
protect others by wearing a face mask and always coughing into a tissue.
O (OUT PATIENT FOLLOW – UP)
Keep all of follow-up appointments. Even though the patient feels better,
his lungs may still be infected. It’s important to have the doctor monitor his
progress.
D (DIET)
Drink lots of fluids, especially water. Liquids will keep patient from becoming
dehydrated and help loosen mucus in the lungs.
S (SPIRITUALITY)
Advise the patient to join the church activities. Keeping faith in God and believing
in him can uplift some distress.
XIV. MY JOURNEY
Being a third year student taking up Nursing is challenging, nerve breaking, head
cracking, interesting, and exhausting. But being a Nurse is somewhat opposite, because
every single intervention you do is remarkable and very accommodating to your patient. I
am a future Nurse and I admit that I’ve been devoted in rendering care to my patient until
such time that she recovers from her illness.
Mrs E.A is an 87 years old woman. She’s from Cogon, Panitan Capiz and has
been admitted in the Immaculate Heart of Mary (IHM) last August 18, 2009 at around
3:20 pm, with the Chief Complaint of Cough & with the Diagnosis of Aspiration
Pneumonia. She has a Nasogastric Tube Feeding (NGT) and Oxygen Saturation of 2
liters.
I always check her IVF (PNSS 1L x 80 cc/hour) every hour to be sure that it is not
delayed or advanced. I follow up her IVF when it was consumed. Her vital signs are
monitored every hour and her Intake & Output is monitored Q shift. I assist her in her
OTF (1,500 kilocalories / day ÷ 6 feedings). I always see to it that her medications are
given at the right time to prevent complications. I assist her in her morning care and oral
care every morning. I also changed her linens and assist her in combing her hair.
It feels so great to know that you did something right and good to your patient.
When you will ask me, “What is good in being a nurse?” I would answer this way, being
a Nurse is AWESOME because I know that I am one of God’s instruments to save
people and help the poor in my own dearest way. I believe that being a Nurse is not
merely a job or a chosen career. It is a Responsibility, Commitment, Destiny and it’s your
Calling from up above. To tell you frankly, those are part of the things that motivates me
for doing the best that I can do as a STUDENT NURSE.
XIV.BIBLIOGRAPHY / REFERENCES