Professional Documents
Culture Documents
INTRODUCTION
http://www.sciencedaily.com/releases/2007/06/070626123930.htm
Children suffering from pneumonia could be spared the pain of the doctor's
needle, thanks to new research funded by the British Lung Foundation.
The research involved 243 children in hospitals throughout the UK. It was led by
Terence Stephenson, Professor of Child Health, and Dr Maria Atkinson, both of The
University of Nottingham's Medical School.
The study is the first in the developed world to compare oral treatment versus
intravenous (IV) treatment for children with community-acquired pneumonia, who
are unwell enough to need admission to hospital.
Professor Stephenson said: “This is good news for children who hate injections;
good news for parents whose children will spend less time in hospital; good news for
paediatricians who hate sticking needles in children and good news for the NHS, as
fewer beds will be occupied and the treatment is cheaper.”
Dame Helena Shovelton, Chief Executive of the British Lung Foundation, said:
“Treating childhood pneumonia will be less painful and distressing for parents, for
children and for the health professionals caring for them, thanks to this research.
We are very proud to have made this breakthrough possible.”
The research project involved 243 children, enrolled over a 21-month period at
eight UK hospitals. Half were randomly assigned to receive a week of oral antibiotic
treatment and half to receive antibiotics intravenously.
Follow-up over subsequent weeks showed that both types of treatment are
effective in tackling the illness — and the former actually had a number of
advantages over the latter. Oral antibiotics are also cheaper than those given via
the IV route.
The researchers concluded: “We suggest that in countries like the UK, all but the
sickest children with community-acquired pneumonia should be treated with oral
amoxicillin initially.
http://www.sciencedaily.com/releases/2007/06/070626123930.htm
The group chose Pneumonia as their case for presentation because they want
to expand their knowledge gained in classroom lectures. This case is chosen
because it seems for them that it is just simple but when they conducted a study
about it they learned that there are so many factors that could be cause for
Pneumonia. The group would like to gain more information about the disease
condition. Other than the fact that the case is very common and it is the usual case
used by the student nurses for their case presentations the group still took part in
conducting a case study about Pneumonia because they have considered the fact
that Pneumonia according to DOH is one of the leading caused of infant mortality in
the Philippines. Interest leads the group to come up with such study as they make
every effort to expand their knowledge about pneumonia.
1. PERSONAL DATA
Baby Nicole is a 1 year and 2 months old baby girl who was born last
September 09, 2006 in Quezon City General Hospital. Because of her age, the group
decided to interview the mother of the patient. Her parents are Peyton Scott and
Lucas Scott. They are currently living in Dolores, Magalang, Pampanga. They are all
having Filipino nationality and are all followers of Born Again religion.
Baby Nicole was admitted last November 22, 2007, at around 12 noon in
Balitucan District Hospital complaining for on and off fever. And was discharge last
November 24 2007.
Brooke Davis
Haley Scott DD: Dec.26-
Nathan Scott Chris Davis 2003
BD: july-5-
BD: Nov-10-1955 DD: April-22-1992 birth
1954
Asthma Cancer complication
Jake Scott
BD: Dec.-04-2000 Nicole Scott
BD; Sept.-09-
Cerebral Palsy
2006
BPN
Birth Date: BD
Death Date: DD
Male:
Female:
Diseased:
With existing illness:
The diagram shows that Lucas Scott and Peyton Scott are the parents
of Baby Nicole. At the paternal side, Lucas’s parents or the grandparents of
Baby Nicole are both still alive. Haley Scott the grandmother of Baby Nicole is
diagnosed with asthma. At the maternal side, Peyton’s parents or Baby
Nicole’s grandparents on mother side are both already dead. Chris Davis the
grandfather of Baby Nicole died because of cancer, while Brooke Davis died
because of birth complications. The mother of Baby Nicole which is Peyton
Scott is diagnosed with asthma. Baby Nicole has one brother which is Jake
Scott. He is diagnosed with cerebral palsy.
3. PERSONAL HISTORY
Mrs. Scott told the group that she’s having a monthly check up during
her pregnancy. She delivered her 1st baby for 6 hours. And she delivered her
2nd baby which is baby Nicole for 2 hours. They are both delivered in the
hospital and they are all 9 months when they were delivered. Mrs. Scott said
that she only breastfed her children for 2 weeks after that she begins to
bottle feed them. She also stated that her children were all fully immunized.
Mrs. Scott stated that baby Nicole had mumps last September and got
tigdas hangin when she’s just about 7 months. She also had sore eyes last
October. Other than that she also had some cough and colds.
Baby Nicole was hospitalized twice already. She was first hospitalized
last November 10 2006 at Quezon City General Hospital with complain of
difficulty of breathing, cough and colds. During that hospitalization she was
diagnosed to have Pneumonia. She stayed in the hospital for 1 week. Her 2nd
hospitalization was in Balitukan District hospital last November 22 2007. She
was admitted with complains of on and off fever for 7 days and cough for 3
days.
6. PHYSICAL EXAMINATION
November 23 2007
General Condition
The patient is seen lying on bed with her mother, awake and conscious
She’s wearing comfortable and loose sando and short. The patient is slightly
irritable and looks untidy because of uncombed hair and slightly wet back.
Vital Signs:
T= 37.5°C
P= 148 bpm
R= 61 cpm
Skin and Hair
With dark brown complexion all throughout the body. Hair evenly
distributed.
Head
Hair is evenly distributed, smooth and shiny. No dandruff. Symmetrical
contours of the head. No abnormal depressions, masses, and nodules upon
palpation.
Eyes
Symmetrical eyebrow movement and evenly distributed hair.
Symmetrical eyelid movement and evenly distributed eye lashes.
Symmetrical eye movement.
No abnormal discharges. With pinkish palebral conjunctiva. With round and
black iris. With white sclera. No abnormal masses and nodules. Pupils dilate
upon introduction of light. With (+) blink reflex.
Ears
Symmetrical ear shape, non-tender, and firm. Ears line the outer
cantus of the eye. Presence of serumen in minimal amount. Intact tympanic
membrane. No abnormal masses and nodules upon palpation. Pinna recoils
after it is folded. Good sense of hearing evident by head turning upon
mentioning her name.
Nose
Presence of little amount of nasal secretion because of colds. No
abnormal masses, nodules and lesions. With good sense of smell evident by
removing the cotton ball with alcohol introduce by the student nurse.
Mouth
Symmetrical pale, lips. Presence of 8 teeth. Tongue located at the
middle. Able to move tongue. With (+) gag reflex. With good sucking reflex.
No abnormal lesion and sores.
Neck
Located on the midline. No abnormal masses, nodules and lesions.
Trachea is located at the center
Chest
Symmetrical lung expansion. With evenly distributed hair. No masses
and lesions. With abnormal breath sound (rales) on both lung fields. With
shallow, short breaths.
Heart
No unusual heart sound upon auscultation.
Abdomen
Uniform in color. Round shape of abdomen. No lesions and masses. No
tenderness upon palpation. Presence of normal bowel sound. (gurgle)
(16/min)
Upper Extremities
Able to move hands freely. Symmetrical in shape. With dirty
fingernails. No abnormal lesions and masses. Pale nailbeds.
Lower Extremities
Able to move feet freely. Symmetrical in shape. With dirty toe nails. No
masses and lesions.
7. DIAGNOSTIC AND LABORATORY PROCEDURES
Diagnosti Date ordered, Indication(s) Results Normal Analysis and
c/ Date or Purpose(s) Values (units Interpretation of
Laborator performed, used in the results
y Date results in hospital)
procedur
es
Chest X- DO: 1i1-22-07 To visualize Chest The results were
ray DP: 11-23-07 possible roentgenograms interpreted by the
DRI: 11-23-07 enlargement of reveal minimal hazy physician, the results
the heart and infiltrates on both revealed pneumonitis
assess lower lung fields. on both lung fields.
presence of Heart and great
congestion in vessels are of
the lungs. normal size and
configuration.
Hemidiaphragms
sulci and other
visualized included
chest structures are
unremarkable.
Nursing Responsibilities:
Preprocedural care:
• Orient the client about the procedure.
• Inform the client that the procedure is pain free.
• If the client is pregnant, inform her that radiation can be harmful to the fetus. If an x-ray is necessary,
precautions will be taken to minimize radiation exposure to the baby.
• Ask the client to remove some or all of their clothes and ask them to wear a gown.
• Ask them to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the x-ray
images.
• Assist the client and will position the patient with hands on hips and chest pressed the image plate. For the
second view, the patient's side is against the image plate with arms elevated.
• The patient who can’t stand may be positioned lying down on a table for chest x-rays.
• Ask the patient to hold very still and may be asked to keep from breathing for a few seconds while the x-ray
picture is taken to reduce the possibility of a blurred image.
Postprocedural care:
• Ask the client to wait until the technologist determines that the images are of high enough quality for the
radiologist to read.
Diagnostic/ Date ordered, Indication(s) or Results Normal Analysis and
Laboratory Date Purpose(s) Values (units Interpretation of
procedures performed, used in the results
Date results in hospital)
Hemoglobin It measures the total 11.2 mg % 12-16 mg % The results are slightly
amount of below normal, which
hemoglobin in the may indicate that the
blood to determine patient is at risk of
the oxygen carrying having ineffective
capacity of the blood. tissue perfusion and
Hemoglobin in lack of adequate
vertebrates oxygen.
transports oxygen
from the lungs to the
rest of the body, such
as to the muscles,
where it releases the
oxygen load. Due to
vaginal bleeding of
the patient, there is
loss of blood and
should be monitored
if she needs blood
transfusion to
Nursing Responsibilities:
Before:
• Check the doctor’s order.
• Determine the prescribed test and other restrictions prior to the test.
• Get the laboratory requisition slip.
• Explain to the patient what the procedure to be done is.
• Inform the patient that this requires a blood sample.
• Inform the patient how the procedure is performed, the equipment to be used.
During:
• Explain to the patient what test should be done.
• Prepare all the equipments to be used.
• Tell the patient when to insert the needle for her to be prepared.
• Encourage the patient to remain calm during the test.
• Assist the patient if necessary.
• Ensure a sterile blood sample from the patient.
After:
• Send the blood sample to the laboratory immediately.
• Proper documentation
III. ANATOMY AND PHYSIOLOGY
-pleural effusion
Resolution -empyema
Resolution with with
treatment treatment
(stage IV)
(Patient Centered)
Risk Factors
-second-hand
smoker
-age
-environment
-nutrition
Invasion of microorganism
Stimulate
respiratory
response
Accumulation of Release of
exudates and chemical
bacteria mediators
D5IMB 500cc DO: 11-22-07 Sterile, nonpyrogenic Indicated as a source The patient showed
DP: 11-22-07 solution for fluid and of water, electrolytes no signs of fluid
DC: ------------ electrolyte and calories, or as an overload,
replenishment and alkalinizing agent. dehydration and
caloric supply in phlebitis along the
single dose intravenous site.
containers for IV
administration
Nursing Responsibilities:
Before:
• Identify the purpose of IV therapy and to the client’s significant others.
• Before starting the IV therapy, consider duration of therapy, type of infusion, condition of veins and medical
conditions of patient to assist in choosing the IV site.
• Make sure that the equipments are sterile.
During:
• Secure the IV site with a board to prevent it from dislocation.
After:
• Regulate the IV fluid as ordered by the physician.
• After the IV therapy, identify local complications at or near the IV needle site.
• Check for signs of infiltration, phlebitis and signs of fluid overload or dehydration.
• Routinely check for the IV level to change it immediately to prevent air from entering the veins.
b. Drugs
Name of Date ordered Route or Gen. action Indications or Client response
Drugs: Date admin Function purposes to the
Generic performed dosage and Classification medication w/
Name Date frequency of Mechanism of ax actual side
Brand Name changed/D/C admin effects
Nursing Responsibilities:
Before:
• Obtain skin test before the start of the treatment.
• Determine previous hypersensitivity to the medication.
• Explain the reason for prescribing the medication, the effects and side effects of the drug to the client’s s.o.
During:
• Administer slowly over 3-5 minutes.
• Monitor site frequently for thrombophlebitis (pain, redness and swelling).
• Check the IV patency before administering the medication.
After:
• Instruct S.O. to report signs of superinfection (furry overgrowth on tongue, loose or foul- smelling stools) and
allergy.
• Instruct client’s S.O. to notify any health carte professional if fever and diarrhea develop, especially if stool
contains pus, blood or mucus
Name of Date ordered Route or Gen. action Indications or Client response
Drugs: Date admin Function purposes to the
Generic Name performed dosage and Classification medication w/
Brand Name Date frequency Mechanism of ax actual side
changed/D/C of admin effects
Generic Name: DO: 11-22-07 140 mg IV Antipyretic, nonopioid Treatment for The patient’s
Acetaminophen DP: 11-22-07 every 4 hours analgesics. Inhibits fever. temperature was
DC:----------- PRN the synthesis of maintained within
Brand name: prostaglandins that normal range.
Paracetamol may serve as
mediators of pain and
fever, primarily in the
CNS.
Nursing Responsibilities:
Before:
• Obtain culture and sensitivity test before the treatment starts.
• Obtain history of hypersensitivity to analgesics.
• Get the patients temperature before administering the medication
During:
• Check the patency of the IV.
• Administer slowly.
After:
• Obtain patients temperature.
• Instruct S.O. to report signs of superinfection (furry overgrowth on tongue, loose or foul- smelling stools) and
allergy.
• Instruct client’s S.O. to notify any health carte professional if fever and diarrhea develop, especially if stool
contains pus, blood or mucus
Name of Date ordered Route or Gen. action Indications or Client response
Drugs: Date admin Function purposes to the
Generic performed dosage and Classification medication w/
Name Date frequency of Mechanism of ax actual side
Brand Name changed/D/C admin effects
Generic Name: DO: 11-22-07 1 neb. TID Bronchodilators; binds Used as The patient
Albuterol DP: 11-22-07 to beta 2-adrenergic bronchodilator to maintained patent
DC:11-23-07 re ceptors in airway control and airway.
Brand name: smooth muscle, prevent reversible
Salbutamol leading to activation airway obstruction
of adenyl cyclase and caused by
increased levels of respiratory
cyclic-3’, 5’- conditions.
adenosine
DO: 11-23-07 1 neb every 4 monophosphate
DP: 11-23-07 hours. (cAMP). Increases in
DC:------------- cAMP activate
kinases, which inhibit
the phosphorylation
of myosin and
decrease intracellular
calcium that leads to
relaxation of smooth
muscle airways.
Nursing Responsibilities:
Before:
• Assess lung sounds before administration and during peak of medication. Note characteristics of sputum.
• Make sure that the equipments are clean before using them.
During:
• Shake inhaler well.
• Maintain a fowler’s position.
• Keep the inhaler close to the patient to make sure she inhales the medication.
After:
• Provide mouth care because nebulization can cause bad taste.
• Advise patient to rinse with water, to minimize drying of mouth.
c. Diet
Diet For Age DO: 11-22-07 Diet for age It will help The patient eats The patient’s so
DP: 11-22-07 means that the prevent crackers, and didn’t give the
DC: ------------ patient can eat aspiration. drink water. patient food that
anything that he/she can’t
he/she can tolerate.
tolerate at
his/her age.
Nursing Responsibilities:
Before:
• Explain the purpose of the diet order, the consequences of not following such diet and how it will be
implemented.
• Emphasize the food that the patient can take.
During
• Make sure that the client is taking the specified diet.
After:
• Emphasize the new preferred diet.
d. Activity/Exercise
Date ordered,
Type of Indications or Client’s response to the
Date started, General Description
exercise Purposes treatment
Date changed
Activity as DO: 11-22-07 The patient is allowed To provide sense of well The patient walks with her mom
tolerated. DP: 11-22-07 to do activities as being. And to have some in the hospital.
DC: ------------ long as he/she can exercise in other ways,
tolerate them.
Nursing Responsibilities:
• Educate patient’s SO about what activities is the patient allowed to do.
• Make sure that the patient is doing the desired exercise or activity.
• Have the patient rest after doing an activity.
• Emphasize the importance of following the activity.
B. SURGICAL MANAGEMENT
The group found no surgical treatment for pneumonia. While
searching the group have open sites that indicate that there are no surgical
treatments available for pneumonia since that this disease is curable.
C. NURSING MANAGEMENT
1. Nursing Care plan
Problem # 1: Ineffective Airway Clearance
Problem #2: Ineffective Breathing Pattern
Assessmen Nursing Scientific Objectives Nursing Rationale Expected
t Diagnosis Explanation Interventions Outcome
S =∅ Ineffective Pneumonia is an Short term: • Establish rapport • To gain trust and Short term:
airway inflammation of After 4 hours cooperation of the pt. After 4 hours of
O= pt clearance the lung of NI, pt will • Assess gen. • to provide appropriate NI, pt shall
manifested: r/t retained parenchyma be able to condition of the pt. assessment and have
>DOB pulmonary caused by various improvement management demonstrate
secretions microorganisms. of airways • monitor and record • to obtain base line data improvement
>(+) rales AEB non- An inflammatory patency AEB VS of airway
productive reaction that reduction of patency AEB
>with nasal cough occurs in the cough and • auscultate breath • to ascertain status and to reduction of
flaring secondary alveoli produces noiseless sounds and assess note progress cough and
to BPN exudates. And as breathing air movement noiseless
>with non part of breathing.
productive inflammatory • elevate pt.’s HOB • to maximize oxygen
cough reaction WBC Long term: consumption
migrate to the After 3 days
>skin warm alveoli and fill the of NI, the Long term:
• reposition pt. • prevents accumulation and
to touch normally air patient will After 3 days of
periodically pooling of secretions
containing spaces. be able to NI, the patient
>with The exudates maintain should be able
together with the patent airway • Instruct pt.’s SO to • to liquefy secretion for to maintain
shallow
migration of WBC AEB absence increase fluid intake easy expectoration patent airway
respiration
produces thick of pt’s of pt. AEB absence of
=pt may secretions that abnormal pt’s abnormal
manifest: blocks the airways respiratory • perform CPT • to loosen the secretions respiratory
>changes in does leading to manifestation manifestations
respiratory ineffective airway s that has • administer • to provide appropriate that has been
rate and clearance. been medications as treatment and to help observed and
rhythm observed and order facilitate airway patency assessed
assessed
Problem #3: Impaired Gas Exchange
• Administer
medications as • To lower body temperature
order trough pharmacologic
means.
2. Actual SOAPIE’s
S=”sinisinat pa sya” as verbalized by the mother
Hematology
Hemoglobin
Hematocrit
WBC
Lymphocytes
Platelet count
X-ray
Medical Management
IVF
D5IMB 500cc * * *
Nebulization
Salbutamol Neb * * N/A
Drugs
Cefuroxime * * *
Paracetamol * * AF
Diet
Activity as Tolerated * * *
2. Discharge Planning
The patient is actively playing with her mom. Still have cough and
slight difficulty of breathing.
S= 0
O=received pt. lying on bed on supine position, awake, with an ongoing IVF
#3 D5IMB 500cc at 450 cc level regulated at 29-30 mgtts/min infusing well
on the left arm.
>active
>Afebrile
>with normal breath sounds
>with good skin turgor
>slight DOB
>non-productive cough
Vital signs taken as follows:
T= 36.2C
P=126 bpm
R=42 cpm
A= for health maintenance and home management
I = established rapport
= assessed gen. condition of pt.
= monitored and recorded vital signs
= auscultated lung for breath sounds
= provided comfort measures
=IVF out at 12:40 pm
M= Cefixime 100mg/5ml susp. ¾ tsp BID
= SCMC syrup 1 tsp TID
= Multivitamins syrup 1 tsp OD
E= Activity as tolerated
T= To comply to treatment regimen
H= instructed pt.’s SO to increase fluid intake of the pt.
= instructed pt.’s SO to keep pt.’s back dry
= Instructed pt.’s SO to increase pt.’s intake of food rich in vit. C
= instructed pt.’s SO to perform chest and back tapping
O= Instructed pt.’s So to go back to the scheduled follow up check up
(Dec. 1 2007)
D=Diet for age
E= Goal met AEB SO’s verbalization of understanding about health teachings
given.
As we go along with our case study about BPN, I have learned so many
things about it on how to deal with it and how to handle this kind of case. It is
important to include not only the patient in the study but also the family of
the patient. Because a case study will not be completed unless the family is
not included. Bronchopneumonia is defined as a type of pneumonia that is
localized, often to the bronchioles and surrounding alveoli. It means that this
kind of disease may show any symptoms of coughing, chest pains, fever,
blood-streaked sputum, chills, and difficulty in breathing. This type of disease
may be nosocomial or community acquired. Patients who are immobile
develop retention of secretions; thus, most commonly involves the lower
lobes. If treated, recovery usually involves focal organisation of lung by
fibrosis. This type of diseases includes infants and the elderly people. BPN is
a disease that spreads from bronchioles to nearby alveoli. Now I’ve learned
the how painful the suffering of the people who are infected with this kind of
diseases. In treating this kind of disease we should always competent on
what we do especially on what we give to our patients because a single
mistake can put danger to the life of our patient. Giving medicines to our
patient can help them to recover fast and to be able to help them fight for
their disease. And also giving them nebulization can help them relieve chest
pain because too much secretion is blocking on their airway. And also we
should not always forget to put our shoes to our patients because through
this we would be able to understand them and also to gain their trust. We
should always remember that they are also humans like us, with a heart that
also needs nourishment and care from other people. Through giving
medicines regularly and also through treating them humanely our patient will
be able to recover fast and also to have a greater chance for improvement.
That’s why as a student nurse we should always practice to treat our patients
humanely no matter what race, looks and kind of person they are. So that in
the coming future hopefully if we would become a registered nurse we would
be able to remember and practice all the things that we have learned from
the past. And through this I’m sure that we would also be a successful nurse
because if you treat your patient humanely you will not only make them
happy but also God will be very proud of you.
-Adrian Guarin
VIII. BIBLIOGRAPHY
Deglin, Judith Hopfer & Vallerand, April Hazard. Davis’s Drug Guide for
Nurses(10th edition). Philadelphia, Pannsylvania. 2007
http://www.sciencedaily.com/releases/2007/06/070626123930.htm
http://www.netdoctor.co.uk/diseases/facts/pneumonia.htm
http://encarta.msn.com/encyclopedia_761577180/Respiratory_System.html
College of Nursing
A Case Study
Bronchopneumonia
Submitted by:
Dumas, Joycee
Guarin, Adrian
Serrano, Emilyn
Group 3
Submitted to:
Mr. Ercel Gamboa