Table of Contents Introduction........................................................................................................................ 2 Presentation of the Client.....................................................................................................4 List of Intervention.............................................................................................................5 Summary of Intervention.....................................................................................................5 Evaluation.............................................................................................................................6 Bibliography..........................................................................................................................

Introduction Aspiration is defined as the inhalation of either oropharyngeal or gastric contents into the lower airways; that is, the act of taking foreign material into the lungs. This can cause a number of syndromes determined by the quantity and nature of the aspirated material, the frequency of aspiration, and the host factors that predispose the patient to aspiration and modify the response. Aspiration of bacteria from oral and pharyngeal areas causes bacterial pneumonia, and aspiration of oil (eg, mineral oil or vegetable oil) causes exogenous lipoid pneumonia, a rare form of pneumonia. In addition, aspiration of a foreign body may cause an acute respiratory emergency and, in some cases, may predispose the patient to bacterial pneumonia. (http://emedicine.medscape.com/article/296198-overview) Acute respiratory failure is an emergency medical condition in which there is an extremely low oxygen content or an extremely high carbon dioxide content in an individual's blood. The lungs can become unable to replenish oxygen supplies because of an airway obstruction or the presence of excessive fluids. Acute respiratory failure is usually fatal if an individual does not receive immediate medical services. ( http:// wisegeek.com/what-is-acute-respiratory-failure.htm) Acute respiratory failure remains a major cause of morbidity and mortality in both pediatric and adult populations. The annual incidence in the United States may be as high as 150,000 cases, with mortality rates generally ranging between 50% and 70%.1 Recent studies of acute respiratory distress syndrome in children report a 60% to 75% mortality rate (Bernard GR, Artigas A, Brigham KL, et al: The American-European Consensus Conference on ARDS. Am J Respir Crit Care Med.) Cerebrovascular accident the sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to the brain. A CVA is also referred to as a stroke. Symptoms of a stroke depend on the area of the brain affected. The most common symptom is weakness or paralysis of one side of the body with partial or complete loss of voluntary movement or sensation in a leg or arm. There can be speech problems and weak face
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muscles, causing drooling. Numbness or tingling is very common. A stroke involving the base of the brain can affect balance, vision, swallowing, breathing and even unconsciousness. (http://www.medterms.com/script/main/art) Cerebral hypoxia technically means a lack of oxygen supply to the outer part of the brain, an area called the cerebral hemisphere. However, the term is more typically used to refer to a lack of oxygen supply to the entire brain. (http://health.allrefer.com/health/cerebral-hypoxia-info.html) Abdominal aortic aneurysm is a localized dilatation (ballooning) of the abdominal aorta exceeding the normal diameter by more than 50 percent, and is the most common form of aortic aneurysm. Approximately 90 percent of abdominal aortic aneurysms

occur infrarenally (below the kidneys), but they can also occur pararenally (at the level of the kidneys) or suprarenally (above the kidneys). Such aneurysms can extend to include one or both of the iliac arteries in the pelvis. (Upchurch GR, Schaub TA (2006). "Abdominal aortic aneurysm". Am Fam Physician 73 (7): 1198204.)

Client Presentation A case of S.L.B a 78 years old male patient, catholic in religion that was born on the 17th day of September 1934 with a nationality of Filipino who is currently residing at Nueva Ecija. The patient was admitted last November 24, 2012 in a selected tertiary hospital in Makati City due to Tracheostomy tube and Percutaneous Endoscopic Gastrostomy. Patient had a cardiopulmonary arrest last November 13, 2012 in previous hospital in Nueva Ecija, wherein patient was hooked to mechanical ventilator. Upon admission, the patient was able to perform chest X-ray, CBC, blood culture, serum Na, K and Creatinine, and 2Decho. The patient was diagnosed to have Acute Respiratory Failure secondary to Aspiration Pneumonia, Hypoxic Encephalopathy, Post Cardiovascular Accident, Hypertensive Cardiovascular Disease, Abdominal Aortic Aneurysm, Laryngeal Cancer (2002), Lung Cancer (2008). Upon nurse-patient interaction last November 26,2012, upon receiving patient S.L.B he was hooked to a mechanical ventilator, Endotracheal tube and Nasogastric tube was present, Central venous line and foley catheter was intact. During physical assessment the patient has a GCS of 8, sticky yellowish secretion was obtained during suctioning, bed sore is present at the sacral and contractures was present both upper and lower extremities. On November 27, 2012 the patient still obtunded, sticky yellowish secretion was present during suctioning and the doctor suggest to have a blood transfusion to avoid anemia. The patient was scheduled in the operating room for tracheostomy and PEG insertion as he received a clearance from all his doctors. On December 1, 2012 the patient increased GCS of 8 to 9, sticky whitish secretion was present both in the mouth and in the ET tube. The patient was cleared by his doctors and ready for tracheostomy and PEG insertion but the daughter refused because they decided to wait their other siblings from the other country. Upon leaving the patient, the patient has good skin turgor, no respiratory distress and falls was noted during handling the patient.

List of interventions: 1. Turning and back clapping every 2 hours 2. Wound care was done every shift 3. Suctioning before feeding and administering of medication 4. Assessed breath sounds 5. Note for any respiratory distress and use of accessory muscles 6. Due nebulizations and medications was given. 7. Talking to patient as a normal people 8. Greeting and presenting myself before nurse-patient interaction

Summary of intervention: 1. Complete Blood Count was done for monitoring 2. Blood transfusion of Packed RBC 3. Serum Na, K and Creatinine was done. 4. Arterial Blood Gas 5. Blood Culture 6. 2D echo

Evaluation: The patients vital signs are within normal range, upon interaction no respiratory distress and falls was noted. Turning and back clapping was done every 2 hours , the patient was noted to have a third degree of bed sore and still continue to administer Calmoseptine. Rhonchi was present on both lungs. Due medications given as ordered.

FORMAT Title page Introduction PART I Client presentation - Pathophysiology (client based) PART II List of problems (nursing problems) PART III- List interventions ( surgical, medical and,nursing interventions) PART IV EVALUATION BIBLIOGRAPHY Minimum of 6 pages 1. Client presentation demographic profile, assessment findings (PE, health history, laboratory, diagnostic procedures); pathophysiology 2. List of problems (physical, psychosocial and spiritual) 3. Summary of interventions (medical, surgical, independent nursing actions) 4. Evaluation (outcomes of the interventions (problems resolved and unresolved) 5. Case report (format, bibliography, English and grammar, time of submission The font and the spacing including the title page are the same format as with the case study Minimum of 6 pages Introduction is optional( 1 page only)

Bibliography Book Source: Bernard GR, Artigas A, Brigham KL, et al: The American-European Consensus Conference on ARDS. Am J Respir Crit Care Med. Upchurch GR, Schaub TA (2006). "Abdominal aortic aneurysm". Am Fam Physician 73 (7): 1198204. Internet Source: http://emedicine.medscape.com/article/296198-overview http://wisegeek.com/what-is-acute-respiratory-failure.htm http://www.medterms.com/script/main/art