Bilatreal Pneumonia

DONE BY: SALAMA ALMUDHKY 0848

OBJECTIVES:

-Discuss (client back ground ) - Explain patient history and assessment (physical & diagnostic test) -Discuss theoretical knowledge about disease. - Discuss collaborative management (medical , surgical ,nursing ). - Summary.

BACK GROUND..

Mrs. G.k is a 89 years old female. Widow, From india ,She is a house wife & she has3 daughters and 2 sun . she lives in Manama in small flat , with low family income . shes not educated . She is a known case of bilateral pneumonia with HTN 10 years on medication.

Mrs. G.A. presented to the accident & emergency department with history of difficulty of breathing since two days , She had shortness of breath, using accessory muscle in respiration , the pulse was rapid and bounding with fever , cough , rapid and shallow breathing with wheezing sound and chest pain. There was no history of abdominal pain or vomiting .

Palliative:

Provoking:

Quality:

Region

Radiation:

Scale:

PQRST

PAST HISTORY
Mrs. G.A is a case of pneumonia bilateral with HTN since 10 years, she has no allergies or known to have any medical illness. She has been hospitalized in Salmaniya Medical Complex 3 times & the last one was in October 2007 with the presentation of the same problem & diagnosis. She has no surgeries done for her.

FAMILY HISTORY

MEDICAL DISEASE

LIFE STYLE

GENDER&AGE

ENVIROMENTAL AGENTS

SMOKING

RISK FACTORS

..

Physical assessment :
Inspection: the contour of the chest is barrel , no swilling , rash, hair, or any skin lesion. There is no redness or ulceration in the lung region.

-- Auscultation:
decreased breath sounds throughout both lung fields, with crackles heard predominantly in the left and right upper lobes, egophony present. -- Percussion: dullness over the lung ( inflammation of parenchyma)

-- palpation:

fremitus increased. No tenderness or masses palpable ,Mild pain on the back ( due to reduced activity &laying over the back for long period.)

Diagnostic Studies..
Lap Result: Blood tests: to confirm the presence of infection and to try to identify the type of organism causing the infection. - CBC/PC/LT: Date received: 7 may 2013 Hematology : Test Result Reference Range Hemoglobin 115.0 120 -150 g/l Hematocrit 0.33 0.37-0.45 l Erythrocyte no conc 3.89 4.00-5.00 l Leucocyte Differential Lymphocytes 0.24 0.25- 0.40 Eosinophil 396.0 150-400 l Total protein 63.6 66.00-87.00 Albumin 29.2 34.00-48.00 g/l Albumin/globulin ratio 0.85:1 1.8:1-2.3:1 INTERPRETATION: The result of her CBC/PLT CT is abnormal like the hemoglobin, hematocrit and erythrocyte that are low comparing from the baseline.

Sputum test.
A sample of fluid from the lungs (sputum) is taken after a deep cough, and analyzed to pinpoint the type of infection

- G/S: Bacteriology Source Gram staining Final report Source

Date received: 7 may 2013

ENDOTRACHEAL ASPIRATE epithelial cells =<10 /lpf absence of any microorganism no growth after 48 hrs, of incubation endotracheal aspirate

INTERPRETATION: the result shows that there are no bacterial infection after the incubation.

Radiographic examination:
Chest X-rays, to confirm the presence of pneumonia and determine the extent and location of the infection. - Chest x-ray: Bilateral inflammation in the both lungs in the left and right upper lobes INTERPRETATION: that indicate inflammation is presence and verify the diagnoses. - If pneumonia isn't clearing as quickly as expected, the doctor may recommend a chest CT scan to obtain a more detailed image of the pt lungs.

Other test not done :

CT SCAN

Pleural fluid culture Bronchoscopy

Medical Diagnosis:

INCIDENCE,,

- in Bahrain :
it accounts for almost 173 non Bahraini and 160 bahraini death per year 2011. - 6th lead of death in Bahrain.

- World wide:
- most common cause of death from infectious disease in USA. - it account for almost 66,000 death per year. - its 7 th leading cause of death in USA.

MEDICAL MANAGMENT.. - patient on NGT tube , iVF NS on flow 250 /24 hr , V/S must be checked Q4hr , oral care (tds) , on CBD , catheter care (tds) , pressure care (tds) , on oxegyn N/C .

Tenormin

Heparin

Coversyl

Piperacillin

Ventolin

SURGICAL MANAGMENT

- Impaired gas exchange related to alveolar-capillary membrane changes (inflammatory effects). NURSING DIAGNOSIS: - Acute pain related to Inflammation of lung parenchyma. - activity intolerance related to impaired respiratory function. - Risk for deficient fluid volume related to fever and rapid respiratory rate.

NURSING INTERVENTION
Impaired gas exchange related to alveolar-capillary membrane changes (inflammatory effects).
- Administer oxygen therapy by appropriate means, e.g., nasal prongs, mask, Venturi mask.. - Elevate head and encourage frequent position changes, deep breathing, and effective coughing - Assess level of anxiety. Encourage verbalization of concerns/feelings. Answer questions honestly. Visit frequently, arrange for SO/visitors to stay with patient as indicated.

- Monitor ABGs, pulse oximetry.

NURSING INTERVENTION
Acute pain related to Inflammation of lung parenchyma.
- Administer analgesics and antitussives as indicated.
- Instruct and assist patient in chest splinting techniques during coughing episodes. Provide comfort measures, e.g., back rubs, change of position, quiet music or conversation. Encourage use of relaxation/breathing exercises.

- Reassess and monitor vital signs.

RESEARCH 1
On this research they are assessing the efficacy and safety of Chinese medicinal herbs for Childhood Pneumonia. They included randomized controlled trials . THEY FOUND Chinese herbs may increase total effective rate and improve symptoms and signs. However, large, properly randomized, placebo-controlled, double-blind studies are required.

RESEARCH 2
This research to determine risk factors associated with ventilator dependence in patients with ventilator-associated pneumonia (VAP). Study Design. A retrospective study was conducted at Chang Gung Memorial Hospital, Kaohsiung, from January 1, 2007 to January 31, 2008. Methods. This study evaluated 163 adult patients (aged 18 years).

The Results. Of the 163 VAP patients in the study, 90 patients survived, yielding a mortality rate of 44.8%. Among the 90 surviving patients, only 36 (40%) had been weaned off ventilators at the time of discharge..