CASE PRESENTATION OF GROUP 1

+ Pneumonia is an inflammatory condition of

the lungespecially affecting the microscopic air sacs (alveoli. The disease is either an infection of one 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 a half a million of these people are admitted to a hospital for treatment. Although most of these people recover, approximately 5% will die from pneumonia. Pneumonia is the sixth leading cause of death in the United States.

+ Left Lower lobe (LLL) is a relatively common

site for consolidation. The term consolidation is 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.

+ Appearances of Lung Consolidation + Radiological appearances common

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to all lobes are: 1. Abnormal lung opacity 2. Increase in the size and number of lung markings 3. Loss of clarity of the diaphragm on the AP and/or lateral views 4. Loss of clarity of the heart border on the AP and/or lateral views 5. Loss of the normal darkening inferiorly of the thoracic vertebral bodies on the lateral view 6. Opacification of the lung behind the heart shadow or below the diaphragms

+ Risk factors + Adults age 65 or older and very young children, whose
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immune systems aren't fully developed. Patients who have Immune deficiency diseases such as HIV/AIDS and chronic illnesses such as cardiovascular disease, 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 immobilized from 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 properly cleaned and changed

+ Nursing management + Appropriate antibiotic therapy + Oxygen therapy to treat

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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

GENERAL OBJECTIVE To enhance our knowledge, skills, and attitude in properly initiating the actual duties and responsibilities of a healthcare provider by participating on national objectives of the health of our country in reducing mortality, morbidity, disability and complications of the disease. Through this presentation, we are to share to our audience the knowledge that we have gain from pneumonia also the skills required to manage the patient and the attitude that we must obtain to become an effective and efficient healthcare provider to the patient that we may encounter in the future.

SPECIFIC OBJECTIVES: + After the case presentation, we the student nurses will be able to accomplish the following: + Define pneumonia + Enumerates the different signs and symptoms 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

NAME: AGE: BIRTHDATE: BIRTHPLACE: Cagayan MARITAL STATUS: EDUCATIONAL ATTAINMENT: ADDRESS: Cagayan OCCUPATION: RELIGION: NATIONALITY: CONSULTANT: DATE OF ADMISSION: TIME ADMITTED: CHIEF COMPLAINT: ADMITTING DIAGNOSIS: FINAL DIAGNOSIS: ATTENDING PHYSICIAN:

D.Q 83 Y/O September 03, 1927 Centro 01, Lasam Widowed Elementary Level Centro 01, Lasam None Roman Catholic Filipino Dr. Jamorabon September 17, 2012 2:00 am Epigastric Pain Drug Induced Gastritis Left Basal Pneumonia Dr. Jamorabon

+ Ego Integrity vs. Despair

(Late adulthood, 65-death)

+ As we grow older and become senior citizens we tend to

slow down our productivity and explore life as a retired person. It is during this time that we contemplate our accomplishments and are able to develop integrity if we see ourselves as leading a successful life. If we see our life as unproductive, or feel that we did not accomplish our life goals, we become dissatisfied with life and develop despair, often leading to depression and hopelessness. + The final developmental task is retrospection: people look back on their lives and accomplishments. They develop feelings of contentment and integrity if they believe that they have led a happy, productive life. They may instead develop a sense of despair if they look back on a life of disappointments and unachieved goals. + This stage can occur out of the sequence when an individual feels they are near the end of their life (such as when receiving a terminal disease diagnosis). + Patient D.Q have no regrets in her life because she feels that she has been productive as a citizen and a good mother to her children as evidenced by all of her children finished their studies in college.

+ When asked if there are any disease

in the family like hypertension, cancer, diabetes, asthma, obesity, allergies, tuberculosis and mental problems, patient D.Q said that her father has hypertension and asthma. No disease mentioned on the mother side. Patient DQs said that her older brother has just recently diagnosed with lung cancer last June 2011.

+ The patient said that she already suffered from chicken pox, mumps

and measles. When asked when it occurred, she said Hindi ko na matandaan kung ilang taon ako basta bata pa ako noon. When asked if she had dengue, malaria, and diarrhea she only mentioned about chicken pox, mumps and measles. The patient also said that she was diagnosed with asthma when she was 40 years old. Buong araw kasi akong nagtrabaho sa bukid, pagkauwi ko sumakit ang dibdib ko at hindi na ako makahinga tapos dinala ako sa Lasam District Hospital. Doon sinabi ni Dr. Gonzales na may asthma daw ako, as verbalized by the patient. She also added, Prinescriban ako ng gamot, Salbutamol ata yun. The patient was asked about her childhood immunizations, she said she had BCG. When asked if she had DPT, Measles, OPV and Hepa B, she said, Hindi ko na matandaan kung ano yung iba, basta noong Grade 2 ako my tinusok sa akin sa eskwelahan, noong uso pa ang cholera. When asked about any allergies to food, animals or plants or any kind of allergens (allergy-causing substances), Sa pagkain wala naman, sa alikabok ako sensitibo, nahihirapan akong huminga o kaya inaatake ako ng asthma kapag nakakalanghap ako ng alikabok, as verbalized by the patient. When asked if she had minor/major accidents and injuries the patient verbalized, Sa awa ng Diyos, wala naman.

+ The pt first complains of epigastric pain last September 14. Nung

lingo, medyo masakit na yung tiyan ko pero hindi siya tuloy tuloy. Pasulpot sulpot lang ganon at parang iikot lang. Mga twice siguro yun, the patient stated. She also rated the pain in a scale of 3. Her daughter immediately called Dr.Jamorabon to report the symptom and the doctor ordered Omeprazole 20 mg. Binigay namin bago sya kumain tapos naging okay okay naman na sya, her daughter said. But on September 16 ( Sunday), she again experienced epigastric pain in the afternoon.This time they called Dr. Salva of Lasam District Hospital. Pumunta siya sa bahay namin para tignan si nanay, tapos tinawagan niya si Dr. Jamoorabon at inorderan siya ng ranitidine, her daughter verbalized. When pt. D.Q asked to describe the pain, Nung una, medyo kaya ko pa pero nung mga madaling araw na,hindi. Kung may mas tataas pa ng 10 sa sakit, yun yun. Tinakbo ako sa Lasam District Hospital mga alas tres ng madaling araw , the pt verbalized. The daughter said that they stop giving her Hydrocortisone . The patient was transferred to CVMC referred by Dr. Salva the next day ( monday).

Before Hospitalization
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After Hospitalization
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When asked about her perception on what is health, the patient verbalized, Hindi pagkakaroon ng anumang sakit, malinis ang pangangatawan at kumakain ng masustansyang pagkain. She added that a healthy person is malusog ang pangangatawan, hindi matamlay at parang walang sakit kung titignan. She considers health as important aspect of life, kapag may sakit ka hindi mo magagawa yung gusto mong gawin, as verbalized by her. The patient enumerated some ways on how she manages her health like doing exercise every morning, eating proper and nutritious foods and maintaining good hygiene. Every two months she goes for a check-up to monitor her health at St. Joseph Clinic, her consultant is Dr. Magnolia Reyes. When asked if what are the things she does every time she got sick, she said, Nagpapahinga lang. Umiinom din ako ng gamot. Pero pag malala na, kumukunsulta na ako sa doctor.

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 the orders of the doctors.

Before Hospitalization
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During Hospitalization
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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 per meal. 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.She doesnt have any difficulty in swallowing.

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.

Before Hospitalization
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During Hospitalization
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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 not defecating, the patient finally defecated after giving Lactulose 30ml, a laxative. The patient said matubig tsaka konti lang at kulay yellow,as verbalized by her.

Before Hospitalization
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During Hospitalization
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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, as verbalized by her.

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 also assisted on deep-breathing exercise because she said, Inuubo ako at nahihirapan akong ilabas ang plema.

Before Hospitalization
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During Hospitalization
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Patient D.Q had her telarche when she was 12 years old and menarche when she was 14 years old, regular with moderate flow, 3 days duration and consumes 5 pads per day(PADS= cut from old clothes) not fully soaked. She had her first boyfriend when she was 20 years old. Yung unang kasintahan ko siya ang napangasawa ko at nagpakasal kami noong 23 years old ako as verbalized by her. Her coitarche happened when she was 23 years old with her husband. When she reached 54, she had her menopausal period. She also said, Kontento naman ako sa pagiging babae ko kasi mas mapagmahal at malambing sila, as verbalized by the patient.

Nothing follows>>>>>>>

Before Hospitalization
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During Hospitalization
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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 paputolputol ang tulog ko. She usually sleeps in the afternoon for 1-2 hours between 24pm. 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

Before Hospitalization
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During Hospitalization
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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, as verbalized 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.

Before Hospitalization
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During Hospitalization
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Patient D.Q said that she cant read something unless she wears her eyeglasses, Nearsighted ako, 250 ang grado nung eyeglasses ko, nagsimula akong magsuot noong 45 years old ako, as verbalized by the patient. In terms of hearing, Medyo mahina na rin ang pandinig ko, kapag kinakausap nila ako kailangan lakasan nila para marinig ko, she said although she can easily comprehend on the questions asked to her. She is not wearing hearing aids. She doesnt have any problems with her sense of smell, taste and touch. Patient D.Q finished her 4th grade. Hanggang grade 4 lang ang narating ko, malayo kasi sa amin ang eskwelahan kailangan pa naming tumawid sa ilog at wala pa kaming sapin sa paa dahil mahirap lang din kami noon, as verbalized by the patient.

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 cooperative to questions and health regimen. She responds appropriately to verbal and physical stimuli and obeys simple commands.

Before Hospitalization`
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During Hospitalization
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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 communicate and 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 because they are living in other places although they were aware on her condition thus they communicate to her through the phone.

Before Hospitalization
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During Hospitalization
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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 may problema 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 when she needs something.

Before Hospitalization
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During Hospitalization
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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. She attends 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.

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 by her. 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 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. NOSE consists of the external nose and nasal cavity. External nose visible 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 tissue and skin. Nasal cavity extends from the nares to the choane, divided by nasal septum. nares external 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. choane openings into the pharynx. paranasal sinuses are air-filled spaces within bone. - open into the nasal cavity are lined with a mucous membrane. - produce mucus. pseudostratified columnar epithelial cells lined 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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PHARYNX throat -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. Oropharynx extends from the uvula to the epiglottis. - where oral cavity opens. - lined with stratified squamous epithelium, protects against abrasion. - air pass through it.
LARYNX located 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 body and carbon dioxide is breathed out. The red blood cells are responsible for picking up the oxygen in the lungs and carrying the oxygen to all the body cells that need it. The red blood cells drop off the oxygen 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 out when we exhale.

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

+ . TRACHEA + The trachea is sometimes called the windpipe. The trachea filters the

air we breathe and branches into the bronchi.

+ + 3. BRONCHI + The bronchi are two air tubes that branch off of the trachea and

carry 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 diaphragm contracts. When it contracts it flattens out and pulls downward. This movement enlarges the space that the lungs are in. This larger space pulls air into the lungs. When you breathe out, the diaphragm expands reducing the amount of space for the lungs and forcing air out. The diaphragm is the main muscle used in breathing.

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PHYSIOLOGY OF RESPIRATION

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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 ventilation this 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 respiration this is the exchange of gases or the loading of oxygen and the unloading of carbon dioxide between the pulmonary blood and alveoli. Respiratory gas transport this 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 respiration in 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 changes occurring 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. Inspiration also 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

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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.
Expiration also 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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