casestudy pneumonia.docx

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Foundation University

COLLEGE of NURSING

Dumaguete City

A CASE STUDY

on

PNEUMONIA

In partial fulfillment of the requirementsin

Nursing Care Management (NCM) 10

!u"mitted to#Mrs$ Melanie Mae %$ &ustero' N M&D

!u"mitted "y#eneryl &ngelique &$ Cu"ero

Fran*es +ra*e ,$ -illegas



Table of contentsI$ Foundation University Miss' -ision' .ife /urpose

II$ Central %"2e*tive!pe*ifi* %"2e*tive 3

III$ Introdu*tion 4

I-$ Demographi* /rofile 5-$ Developmental 6as7 89-I$ &natomy and /hysiology of system:s;11

-II$ evie< of elated .iterature13-III$ Medi*al Management

&$ .a"oratory e=ams and *orrelation48,$ /athophysiology 9;C$ 6reatment modalities01D$ Drug study15

I>$ Nursing Managementa$ Nursing history8;

"$ /hysi*al assessment findings30*$ Nursing theories303d$ +ordon?s fun*tional pattern34e$ Nursing *are plans443

>$ &nnotated eadings445>I$ !ummary and Con*lusion53

>II$ ,i"liography 53

I. Foundaton Un!e"st# Mss$ %son$ Lfe Pu"&ose

Foundaton Un!e"st#



Lfe Pu"&ose

6o edu*ate and develop individuals to "e*ome produ*tive' *reative' useful and responsi"le *iti@ens of so*iety$

%son

6o "e a dynami*' progressive s*hool that *ultivates effe*tive learning' generates *reative ideas' responds to so*ietal needs and offers equal opportunity for all$ Msson

In its quest for e=*ellen*e in mind' "ody and *hara*ter and the pursuit of truth and freedom' Foundation University *ommits itself to#1$ Develop students of sound *hara*ter and "road *ultureA$ /repare students for a definite *areerA

$ Im"ue students <ith the spirit of universal "rotherhoodA and3$ &dvo*ate truth' promote 2usti*e and advan*e 7no<ledge$

II. Cent"al Ob'ect!e

&t the end of the one hour and 1 hour *ase presentation' the learners <ill "e a"le to gain 7no<ledge and "etter understanding of /neumonia' develop invalua"

nursing s7ills geared to<ards the management of patients <ith this *ondition' and demonstrate values and positive attitude in themselves and for their future patie

in relation to the disease <hi*h is the su"2e*t of this study$

S&ecfc ob'ect!e

6o summari@e the "asi* information a"out the *lient 6o identify the *lient?s psy*hoso*ial and *ognitive level of development 6o determine his overall health status 6o give a general pi*ture of the systems that are affe*ted "y the *ondition

6o outline the "asi* fa*ts pertaining to the *ondition "eing studied 6o identify the medi*al treatments <hi*h are availa"le for this *ondition 6o e=amine the nursing theory that <ould "e appropriate for appli*ation to<ards the *lient and his *ondition



6o sho< *lient?s health pattern "efore and during hospitali@ation 6o summari@e the nursing diagnoses as determined after *lient assessment 6o sum up the nursing plan of *are for the *lient

III. Int"oducton

/neumonia is an inflammatory illness of the lung$ Frequently' it is des*ri"ed as lung paren*hyma:alveolar inflammation and a"normal alveolar filling <ith flu

(*onsolidation and e=udation)$

6he alveoli are mi*ros*opi* airfilled sa*s in the lungs responsi"le for a"sor"ing o=ygen$ /neumonia *an result from a variety of *auses' in*luding infe*tion <

"a*teria' viruses' fungi' or parasites' and *hemi*al or physi*al in2ury to the lungs$ Its *ause may "e also offi*ially des*ri"e as idiopathi* that is' un7no<n <

infe*tious *auses have "een e=*luded$

6ypi*al symptoms asso*iated <ith pneumonia in*lude *ough' *hest pain' fever' and diffi*ulty in "reathing$ Diagnosti* tools in*lude =rays and e=amination of

sputum$ 6reatment depends on the *ause of pneumoniaA "a*terial pneumonia is treated <ith anti"ioti*s$

/neumonia is a *ommon illness in <hi*h o**urs in all age groups' and is a leading *ause of death among the elderly and people <ho are *hroni*ally and terminal

ill$ &dditionally' it is leading *ause of death in *hildren under five years old <orld<ide$ -a**ines to prevent *ertain types of pneumonia are availa"le$ 6he progno

depends on the type of pneumonia' the appropriate treatment' any *ompli*ations' and the person?s underlying health$



I%. De(o)"a&*c P"ofle

Na(e+ D$.$/

A)e+ years old and 4 months

Add"ess# Motong' Dumaguete City' Negros %riental

Roo( and ,ed No.+ // 3

Rel)on+ oman Catholi*

C!l status# !ingle

Se-+ Male

Educatonal attan(ent# /res*hooler

Occu&aton# !tudent

Natonalt#+ Filipino

Docto"s/ n *harge# Dr$ +

Date and T(e of Ad(sson+ Fe"ruary 05' 013 B 0335

C*ef Co(&lcatons/+ ard nonprodu*tive *ough <hi*h started 3 d

/6&

Da)nossses/+ Ineffe*tive &ir<ay Clearan*e r:t thi*7' vis*ous se*retions

C*ef Co(&lant+

ard nonprodu*tive *ough <hi*h started 3 days /6&

0sto"# of &"esent llness+

!tarted 5 days patient has intermittent high fever asso*iated <ith n

produ*tive *ough for 4 days' *olds and vomiting o**urs on*e$

Fnal da)noss+

/neumonia

Gene"al (&"esson+

6he patient loo7s <ea7 and his eyes loo7s sleepy$ /resen*e of nasal flar

<hen "reathing$ No proper hygiene' his nails are long and dirty$



%. De!elo&(ental Mlestone

T0EORIST1 MILESTONE C0ILD2S FINDINGS CORRELATION

Freud?s /sy*hoanalyti* theory

(/&..IC !6&+/

/leasure *enter around genitals

!elfmanipulation is the *hief

sour*e of pleasure• Child learns se=ual a<areness of

genital area

on*e tou*hed his genital' as a normal area of

e=ploration <as a"le to identify se=ual differen*es

patient D at age of yrs$ and 4 months had

rea*hed the phalli* stage <here he <as a"le

sho< his *uriousness on his genital part

ri*7son?s theory of /sy*hoso*ial

Development

(INI6I&6I- vs$ +UI.6)

Child learns ho< to do things ("asi*

pro"lem solving) and that doing

things is desira"le• .earning initiative is learning ho<

to do things

learns ho< to *ount and solve very simple mathemati*s'

for e=ample 11 .i7es to do things on his o<n

/atient D has rea*hed the final stage in

ri*7son?s theory of /sy*hoso*ial

Development <hi*h is initiative vs$ guiltA h

<as a"le to use his initiative "y planning

a*tivities' a**omplishing tas7s and fa*ing

*hallenges$



/iaget?s theory of Cognitive Development

(/%/&6I%N&. 6%U+6) Eoung *hildren are a"le to thin7

a"out things sym"oli*ally• Child this stage is ego*entri*

play sym"oli*ally li7e role playing or play <ith

imaginary friend una"le to see the vie<point of another' sti*7 to his o<n

vie<point

patient D had rea*hed the se*ond stage of

preoperational stage <here he <as a"le toused sym"ols' as eviden*ed "y in*rease in

a*tivities and role playing



%I. ANATOMY OF AFFECTED SYSTEM

REPIRATORY SYSTEM



P0YSIOLOGY OF AFFECTED SYSTEM

6he respiratory system is an intri*ate arrangement of spa*es and passage<ay that *ondu*t air from outside the "ody into the lungs and finally into the "lood as <

as e=pelling <aste gasses$ 6his system is responsi"le for the me*hani*al pro*ess *alled "reathing' <ith the average *hild?s "reathing 00 times per minute$

hen engage in strenuous a*tivities' the arte and dept of "reathing in*reases in order to handle the in*reased *on*entrations of *ar"on dio=ide in the "lood$ ,reath

is typi*ally an involuntary pro*ess' "ut *an "e *ons*iously stimulated or inhi"ited as in holding your "reath$

NOSTRILS1NASAL CA%ITIES

During inhalation' air enters the nostrils and passes into the nasal *avities <here foreign "odies are removed' the air heated and moisturi@ed "efore it is "roug

further into the "ody$ It is this part tha houses our sense of smell$SINUSES

6he sinuses are small *avities that are lined <ith mu*ous mem"rane <ithin the "ones of the s7ull$P0ARYN3

6he pharyn=' or throat *arries foods and liquids into the digestive tra*t and also *arries air into the respiratory tra*t$

LARYN3

6he laryn= or voi*e "o= is lo*ated "et<een the pharyn= and tra*hea$ It is the lo*ation of the &dam?s apple' <hi*h in reality is the thyroid gland and houses the vo

*ords$TRAC0EA

6he tra*hea or <indpipe is a tu"e that e=tends from the lo<er edge of the laryn= to the upper part of the *hest and *ondu*ts air "et<een the laryn= and the lungs$LUNGS

6he lungs are the organ in <hi*h the e=*hange of gasses ta7es pla*e$ 6he lungs are made up of e=tremely thin and deli*ate tissues$ &t the lungs' the "ron*

su"divides the tiny air sa*7s of the lungs *alled the alveoli$ It is at the alveoli that gasses enter and leave the "lood stream$,RONC0I

6he tra*hea divides into t<o parts *alled the "ron*hi' <hi*h enter the lungs$,RONC0IOLES



6he "ron*hi su"divide *reating a net<or7 of smaller "ran*hes' <ith the smallest one "eing the "ron*hioles$ 6here are more than one million "ron*hioles in ea*h luAL%EOLI

6he alveoli are tiny air sa*7s that are enveloped in a net<or7 of *apillaries$ It is here that the air <e "reathe is diffused into the "lood' and <aste gasses are return

for elimination$

(http#::<<<$s*ri"d$*om:do*:05853:Case!tudyof/NUM%NI&)%II. Re!e4 of Related Lte"atu"e

DEFINITION

/neumonia is an infe*tion in one or "oth of the lungs$ Many germsGsu*h as "a*teria' viruses' and fungiG*an *ause pneumonia$6he infe*tion inflames your lungs? air sa*s' <hi*h are *alled alveoli$ 6he air sa*s may fill up <ith fluid or pus' *ausing symptoms su*h as a *ough <ith phlegm

slimy su"stan*e)' fever' *hills' and trou"le "reathing$

SYMPTOMS

levated fever /rodu*tive or nonprodu*tive harsh *ough !hallo< repiraions estlessness Cyanosis Nasal flaring Diminished:adventitious "reath sounds

CAUSES

6he most *ommon *auses of pneumonia are infe*tions *aused "y#

http://www.scribd.com/doc/20627642/Case-Study-of-PNEUMONIA

http://www.nhlbi.nih.gov/health/health-topics/topics/cough/

http://www.nhlbi.nih.gov/health/health-topics/topics/cough/




• ,acte"a H the most *ommon *ause of pneumonia in adults

• %"uses H often responsi"le for pneumonia in *hildren

• M#co&las(a H organisms that have *hara*teristi*s of "a*teria and viruses that *ause milder infe*tions

• O&&o"tunstc o")ans(s H a threat to people <ith vulnera"le immune system( http#::7idshealth$s*hn$health$ns<$gov$au:fa*tsheets:pneumonia)

Most t#&es of &neu(ona a"e t"ans(tted n t*e sa(e 4a# as nfluen5a o" t*e co((on cold H "y people?s hands and "y tiny droplets from their mouths

noses$ In fa*t' the same viruses that *ause *olds and the flu *an *ause pneumonia$ If they infe*t the throat' sinuses' and upper respiratory tra*t' they *ause a *o

If they rea*h the lungs' they *ause pneumonia$,acte"a t*at l!e &e"(anentl# n (an# &eo&les2 t*"oats cause so(e of t*e (o"e se!e"e t#&es of &neu(ona $ Normally' the immune system 7eeps them

*he*7$ If someone is <ea7ened "y a throat virus' these "a*teria *an tri*7le do<n into the respiratory tra*t$ ,a*terial pneumonia is most often *aused "y

"a*teria Streptococcus ospitali (pneumo*o**us)$ Respiratory syncytial virus (!-) is the most *ommon *ause of pneumonia in infants and young *hildren

pea7s sharply around De*em"er and anuary and usually isn?t a lifethreatening disease' though some individuals *an "e seriously affe*ted$ -iruses *ause a"

half of all *ases of pneumonia$My*oplasma *auses the illness *alled J<al7ing pneumonia'K so*alled "e*ause people <ho have it are not *onfined to "ed$

fungus *alled Pneumocystis carinii is usually seen only in people <ho have &ID!$ 6his parasite is normally harmless' "ut in people <ith I- it *an *ause

aggressive and often fatal pneumonia$In addton to nfectous dseases$ &eo&le can )et &neu(ona f"o( c*e(cals t*at ente" t*e lun)s and nfla(e t*e(. &spiration pneumonia is *aused

a**identally inhaling food' vomit' or digestive a*id into the lungs$ 6he inhaled su"stan*e may "e*ome infe*ted' or it may inflame the lungs and *ause them to

<ith liquid$A &e"son 4*o *as a *)*e" "s6 of &neu(ona+

is under one year of age or over the age of 54 is a smo7er

has a *old or flu

http://kidshealth.schn.health.nsw.gov.au/fact-sheets/pneumonia






( http#::7idshealth$s*hn$health$ns<$gov$au:fa*tsheets:pneumonia /

• & *hest >ray may "e ta7en to *onfirm the diagnosis and the e=tent of the infe*tion

• ,lood tests and sputum tests may "e ta7en to find <hi*h "a*terium is *ausing the pneumonia$ 6his helps to de*ide <hi*h anti"ioti* is "est to use$ !ometimes

"a*terium that is *ausing the pneumonia is resistant to the first anti"ioti*$ & s<it*h to another anti"ioti* is sometimes needed$• !ometimes o=ygen and other supportive treatments are needed if you have severe pneumonia$ 6hose <ho "e*ome severely un<ell may need treatment in

intensive *are unit$• hen you return home' even though the infe*tion is treated' you may feel tired and un<ell for some time$

COMPLICATION

• ,uildup of fluid in the spa*e "et<een the lung and *hest <all (pleural effusion )$

• /o*7ets of pus that form in the spa*e "et<een the lung and *hest <all (empyema) or in the lung itself (lung a"s*ess)$

• &nother "a*terial lung infe*tion after a viral infe*tion (se*ondary infe*tion)$

• &nother "a*terial infe*tion' su*h as a vaginal infe*tion or infe*tions of the digestive system' "e*ause of anti"ioti* therapy (se*ondary infe*tion)$

• ,a*teria in the "loodstream ("a*teremia) or throughout the "ody (septi*emia)$

• !<elling of the *overing of the spinal *ord (meningitis) *aused "y spread of the infe*tion$

• Infe*tion of a 2oint *aused "y the spread of "a*teria through the "loodstream (septi* arthritis)$

• Infe*tion of the heart mus*le or the sa* surrounding the heart (endo*arditis or peri*arditis)$

TEST AND DIAGNOSIS


http://www.webmd.com/lung/picture-of-the-lungs


http://www.webmd.com/a-to-z-guides/bacterial-and-viral-infections

http://www.webmd.com/heartburn-gerd/your-digestive-system



http://www.webmd.com/heart/picture-of-the-heart



http://www.webmd.com/a-to-z-guides/bacterial-and-viral-infections


http://www.webmd.com/heart/picture-of-the-heart



/hysi*al e=am# Eour do*tor <ill listen to your lungs <ith a stethos*ope$ If you have pneumonia' your lungs may ma7e *ra*7ling' "u""ling' and rum"ling sou

<hen you inhale$ Eou also may "e <hee@ing' and it may "e hard to hear sounds of "reathing in some areas of your *hest$( http#::<<<$nlm$nih$gov:medlineplus:pneumonia$html )

Chest >ray (if your do*tor suspe*ts pneumonia)

!ome patients may need other tests' in*luding#

• C,C "lood test to *he*7 <hite "lood *ell *ount

• &rterial "lood gases to see if enough o=ygen is getting into your "lood from the lungs

• C6 (or C&6) s*an of the *hest to see ho< the lungs are fun*tioning

• !putum tests to loo7 for the organism (that *an dete*ted "y studying your spit) *ausing your symptoms

• /leural fluid *ulture if there is fluid in the spa*e surrounding the lungs

• /ulse o=imetry to measure ho< mu*h o=ygen is moving through your "loodstream' done "y simply atta*hing a small *lip to your finger for a "rief time

•

,ron*hos*opy' a pro*edure used to loo7 into the lungs? air<ays' <hi*h <ould "e performed if you are hospitali@ed and anti"ioti*s are not <or7ing <ell

TREATMENT AND DIAGNOSIS

6reatment for pneumonia depends on the type of pneumonia you have and ho< severe it is' and if you have other *hroni* diseases$ 6he goals of treatment are to *

the infe*tion and prevent *ompli*ations$

Most people *an "e treated at home "y follo<ing these steps#

• Drin7 plenty of fluids to help loosen se*retions and "ring up phlegm$• +et lots of rest$ ave someone else do household *hores$

http://www.nlm.nih.gov/medlineplus/pneumonia.html




• Do not ta7e *ough medi*ines <ithout first tal7ing to your do*tor$ Cough medi*ines may ma7e it harder for your "ody to *ough up the e=tra sputum

http#::<<<$nlm$nih$gov:medlineplus:pneumonia$html )• Control your fever <ith aspirin' nonsteroidal antiinflammatory drugs (N!&IDs' su*h as i"uprofen or napro=en)' or a*etaminophen$ D% N%6 give aspirin

*hildren$

If your pneumonia "e*omes so severe that you are treated in the hospital' you may re*eive fluids and anti"ioti*s in your veins' o=ygen therapy' and possi"

"reathing treatments$Eou are more li7ely to "e admitted to the hospital if you#

• ave another serious medi*al pro"lem

• ave severe symptoms

• &re una"le to *are for yourself at home' or are una"le to eat or drin7

• &re older than 54 or a young *hild

• ave "een ta7ing anti"ioti*s at home and are not getting "etter

%"al Pneu(ona

6ypi*al anti"ioti*s <ill not <or7 for viral pneumoniaA sometimes' ho<ever' your do*tor may use antiviral medi*ation$ -iral pneumonia usually improves in

<ee7s$,acte"al Pneu(ona

/atients <ith mild pneumonia <ho are other<ise healthy are sometimes treated <ith oral ma*rolide anti"ioti*s (a@ithromy*in' *larithromy*in' or erythromy*in

/atients <ith other serious illnesses' su*h as heart disease' *hroni* o"stru*tive pulmonary disease' or emphysema' 7idney disease' or dia"etes are often giv

more po<erful and:or higher dose anti"ioti*s$In addition to anti"ioti*s' treatment in*ludes# proper diet and o=ygen to in*rease o=ygen in the "lood <hen needed$ In some patients' medi*ation to ease *h

pain and to provide relief from violent *ough may "e ne*essary$

( http#::<<<$nlm$nih$gov:medlineplus:pneumonia$html )Reco!e"#







& healthy young person may lead a normal life <ithin a <ee7 of re*overy from pneumonia$ For middleaged people' it may "e <ee7s "efore they regain th

usual strength and feeling of <ell"eing$& person re*overing from my*oplasma pneumonia may "e <ea7 for an e=tended period of time$ &dequate rest is important to maintain progress to<ard

re*overy and to avoid relapse$ Don?t rush re*overyL

MEDICATION

&nti"ioti*s are usually needed to treat pneumonia in *hildren <ho are younger than 3 months or older than 4 years$ =a*tly <hi*h anti"ioti* your do

pres*ri"es <ill depend on#

your *hild?s age

ho< severe their symptoms are

<hat type of "a*teria are *ausing the infe*tion

It is important that you tell your health professional a"out all the medi*ines you or anyone in your *are is ta7ing G in*luding pres*ription' overthe*oun

and *omplementary medi*ines (her"al' ?natural?' vitamin or mineral supplements)$7,abes ,abes 8 4ee6 old o" less/

,a"ies in this age group <ill "e given anti"ioti*s (usually "en@ylpeni*illin plus gentami*in) dire*tly into a vein (intravenously) in hospital$

( http#::<<<$healthline$*om:health:pneumonia ),a"ies aged 1 <ee7 to 3 months,a"ies in this age group <ho have symptoms of pneumonia "ut no fever <ill usually "e given a@ithromy*in (ta7en "y mouthA e$g$ ithroma=) or

erythromy*in (e$g$ ry*)$,a"ies <ho have symptoms of pneumonia and a fever (a temperature of 9$4C or higher)' <ill usually "e given "en@ylpeni*illin or *efota=ime dire*tly int

vein (intravenously) in hospital$Find out ho< to treat a fever ' and read our medi*ines information a"out a@ithromy*in and erythromy*in$

http://www.nps.org.au/conditions/respiratory-problems/respiratory-tract-infections/for-individuals/conditions/pneumonia/for-individuals/medicines-and-treatments/for-children#babies

http://www.nps.org.au/conditions/respiratory-problems/respiratory-tract-infections/for-individuals/conditions/pneumonia/for-individuals/medicines-and-treatments/for-children#children_5_15

http://www.nps.org.au/conditions/respiratory-problems/respiratory-tract-infections/for-individuals/conditions/pneumonia/for-individuals/symptoms

http://www.nps.org.au/glossary/bacteria

http://www.nps.org.au/conditions/respiratory-problems/respiratory-tract-infections/for-individuals/symptoms/relieving-the-symptoms-of-a-respiratory-tract-infection/complementary-medicines


http://www.healthline.com/health/pneumonia

http://www.nps.org.au/medicines/infections-and-infestations/antibiotics/antibiotics-for-respiratory-tract-infections/for-individuals/active-ingredients/azithromycin/for-individuals/brands-of-azithromycin/zithromax-tablets

http://www.nps.org.au/medicines/infections-and-infestations/antibiotics/antibiotics-for-respiratory-tract-infections/for-individuals/active-ingredients/erythromycin/for-individuals/brands/eryc-capsules

http://www.nps.org.au/conditions/respiratory-problems/respiratory-tract-infections/for-individuals/symptoms/relieving-the-symptoms-of-a-respiratory-tract-infection/how-do-i-treat-a-fever

http://www.nps.org.au/conditions/respiratory-problems/respiratory-tract-infections/for-individuals/conditions/pneumonia/for-individuals/medicines-and-treatments/for-children#babies

http://www.nps.org.au/conditions/respiratory-problems/respiratory-tract-infections/for-individuals/conditions/pneumonia/for-individuals/medicines-and-treatments/for-children#children_5_15





http://www.nps.org.au/medicines/infections-and-infestations/antibiotics/antibiotics-for-respiratory-tract-infections/for-individuals/active-ingredients/azithromycin/for-individuals/brands-of-azithromycin/zithromax-tablets

http://www.nps.org.au/medicines/infections-and-infestations/antibiotics/antibiotics-for-respiratory-tract-infections/for-individuals/active-ingredients/erythromycin/for-individuals/brands/eryc-capsules

http://www.nps.org.au/conditions/respiratory-problems/respiratory-tract-infections/for-individuals/symptoms/relieving-the-symptoms-of-a-respiratory-tract-infection/how-do-i-treat-a-fever



7C*ld"en C*ld"en a)ed 9 (ont*s to : #ea"s/

%"al &neu(ona

hen pneumonia o**urs in *hildren in this age group it is usually *aused "y a virus (e$g$ respiratory syn*ytial virus' or flu virus)' so anti"ioti*s <on?t "e

effe*tive$ &nti"ioti*s don?t 7ill viruses$/ara*etamol or i"uprofen *an help relieve pain and fever (a temperature higher than 9$4C)$Find out ho< to relieve the symptoms of pneumonia' and read our medi*ines information on para*etamol and i"uprofen$,acte"al &neu(ona

If your *hild?s pneumonia is *aused "y "a*teria ("ased on the results of la"oratory tests)' then your do*tor <ill pres*ri"e anti"ioti*s$If your *hild?s symptoms are not severe' Oospitali@a (ta"lets' *apsules or liquidA e$g$ &mo=il) <ill usually "e pres*ri"ed$( http#::<<<$healthline$*om:health:pneumonia )

7C*ld"en a)ed : to 8: #ea"s old

/neumonia in this age group is usually *aused "y "a*teria and *an generally "e treated at home <ith anti"ioti*s$Eour do*tor <ill usually pres*ri"e Oospitali@a (ta7en "y mouth as ta"lets' *apsules or liquid)$ &mo=y*illin is effe*tive against the "a*terium ( Streptococ

pneumonia)' <hi*h is the usual *ause of pneumonia in this age group$Eour do*tor may pres*ri"e *larithromy*in or ro=ithromy*in (ta7en "y mouth)$ 6his is for treating the "a*teria Mycobacterium ospitali' <hi*h also *au

pneumonia in *hildren in this age group$If your *hild?s symptoms are severe' they *an develop other *ompli*ations and so they <ill need anti"ioti* treatment or even Oospitali@ation' <here they <

usually "e given anti"ioti*s dire*tly into a vein (intravenously)$ 6he type of anti"ioti* given to your *hild <ill depend on <hat "a*teria are thought to

*ausing the infe*tion$

If c*ld s#(&to(s *a!en2t (&"o!ed at all ; da#s afte" sta"tn) antbotc t"eat(ent$ o" t*e" s#(&to(s )et 4o"se$ see #ou" docto".( http#::<<<$healthline$*om:health:pneumonia)

http://www.nps.org.au/glossary/virus


http://www.nps.org.au/medicines/infections-and-infestations/antibiotics/antibiotics-for-respiratory-tract-infections/for-individuals/how-do-i-take-my-antibiotics/antibiotics-dont-kill-viruses


http://www.nps.org.au/conditions/respiratory-problems/respiratory-tract-infections/for-individuals/conditions/pneumonia/for-individuals/symptoms/managing-symptoms


http://www.nps.org.au/medicines/pain-relief/simple-pain-reliever-and-fever-medicines/paracetamol



http://www.nps.org.au/medicines/muscles-bones-and-joints/anti-inflammatory-medicines-nsaids/ibuprofen




http://www.nps.org.au/medicines/infections-and-infestations/antibiotics/antibiotics-for-respiratory-tract-infections/for-individuals/what-are-antibiotics-and-how-do-they-work


http://www.nps.org.au/medicines/infections-and-infestations/antibiotics/antibiotics-for-respiratory-tract-infections/for-individuals/active-ingredients/amoxycillin/for-individuals/brands-of-amoxycillin/amoxil-capsules


http://www.nps.org.au/glossary/bacteria#children









http://www.nps.org.au/medicines/infections-and-infestations/antibiotics/antibiotics-for-respiratory-tract-infections/for-individuals/what-are-antibiotics-and-how-do-they-work


http://www.nps.org.au/medicines/infections-and-infestations/antibiotics/antibiotics-for-respiratory-tract-infections/for-individuals/active-ingredients/amoxycillin/for-individuals/brands-of-amoxycillin/amoxil-capsules






%III. Medcal Mana)e(ent

&$ .a"oratory =ams and Correlation(indi*ate normal values' patient result <1=' *lini*al impli*ations)

.&,%&6%E >&M! !U.6 N%M&. -&.U! C%.&6I%N!:IM/.IC&6I%N!1$ C,C(0:5:13)

NUM%N,&!

,C+,C6M/-

$ C,C(0:8:13),Cemoglo"inemato*ritM/-

$ Urinalysis(0:5:13)Color!p$ +ravity

+lu*ose/rotein p

8$314$91$3

3$0;11$438$0

3$41$4$8$9

light yello<1$014

()

()5$0

54%-62%

0 H ;;P

1%

3$85$1 million:m*.

10$5 H 14$ g:dl

P H 3P

8$011$0 f.

35 million:mm

12-18 g/100 mL

P3P8$011$0 f.

!tra< to dar7 yello<

1$0041$04()()

N.N.

It is high "e*ause the patientQs "ody is fighting against

infe*tion$N.N.N.N.

N.N.N.N.

N.N.N.N.N.



3$ Fe*alysisColor Consisten*y

4$ Mi*ros*opi*=amination&s*aris/in <ormsoo7<orms6ri*huris6aenia

"ro<nsoft

no parasite seenno parasite seenno parasite seenno parasite seenno parasite seen

3$49

,ro<n plasti*

no parasite seenno parasite seenno parasite seenno parasite seenno parasite seen

N.N.

N.N.N.

N.N.

!pe*ial Medi*al Management ationale Correlationa) ,ed "ath

b) Mouth *are

c) -:! ta7ing

6o help lo<er "ody temperature

6o *lean the mouth of the patient and to help

redu*e the o**urren*e of dental *arries$

6o monitor the alterations of the temperature'

pulse' respiratory rate and heart rate

6he patient has on and off fever' this <ill help

to lo<er his "ody temperature$6he patient and his !$%$ *an no longer ta7e *are

of *leaning his teeth' so itQs our responsi"ility to

*lean it$!o if there are alteration that are already very

dangerous <e *an dire*tly report it to the

do*tors assigned$



,.Pat*o&*#solo)#

!I+N! B !EM/6%M!#Cough (<ith mu*usli7e' greenish' or pusli7e sputum' *hills <ith sha7ing )' fever ' easy fatigue' *hest pain (sharp or sta""ing in*reased "y d

"reathing or in*reased "y *oughing)' heada*he' loss of appetite' nausea and vomiting' general dis*omfort' uneasiness' or ill feeling (malaise)' 2o

stiffness (rare)' mus*ular stiffness (rare)' rales$&dditional symptoms that may "e asso*iated <ith this disease# shortness of "reath' *lammy s7in' nasal flaring' *oughing up "lood' ta*hypn

apnea' an=iety' stress' and tension' a"dominal pain $

http://www.sonic.net/~danslist/pathos/%5Cmhc%5Ctop%5C003072.cfm















































C. T"eat(ent (odaltes

6reatment Mode of a*tion Correlation

R!tart veno*lysis D4 0$P NaCl 400 ml 1 amp M-

(&N!6) S 15

RCefuro=ime 400 mg I-66 q 9 &N!6

R/lease ne"uli@e' 1 ne"ule ,udesonide q 9

R/ara*etamol 40 mg:.p syrup 3 ml q 3 prn for 69 and

a"ove /$%$

R/lease refer for severe dyspnea at 10#00 hr D4 0$P NaCl

400 ml

R& simple <atersolu"le sugar that minimi@es

gly*onoegenesis and promotes ana"olism in

patients <hose oral *alori* inta7e is limited$

RInhi"its *ell<all synthesis' promoting osmoti*

insta"ilityA usually "a*tri*idal$

R=hi"its potent glu*o*orti*oid a*tivity$ Drug

inhi"its mast *ells' ma*rophages' and

mediators(su*h as leu7otrienes)involved in

inflammation$ R De*reases fever "y inhi"iting the effe*ts of

pyrogens on the hypothalamus heat regulating

*enters B "y a hypothalami* a*tion leading to

s<eating B vasodilatation$

During this time the patientQs appetite is poor'

this <ill promote ana"olism$

6he has patient has an infe*tion this <ill help

7ill the "a*teria$

6his <ill help the patient "reath "etter$

6he patient has on and off fever$

6he patient has diffi*ulty "reathing aseviden*ed "y nasal flaring



R& simple <atersolu"le sugar that minimi@es

gly*onoegenesis and promotes ana"olism in

patients <hose oral *alori* inta7e is limited$

D. D"u) Stud#8. Cefu"o-(e :>> () I%TT ? @ ANST/

GENERIC NAME: cefu!"#me

BRAND NAME: e!tin" #inace!

DU+ C.&!! &ND MC&NI!M# Cefuro=ime is a semisyntheti* *ephalosporin anti"ioti*' *hemi*ally similar to peni*illin$ Cephalosporins stop

slo< the gro<th of "a*terial *ells "y preventing "a*teria from forming the *ell <all that surrounds ea*h *ell$ 6he *ell <all prote*ts "a*teria from t

e=ternal environment and 7eeps the *ontents of the *ell together$ ithout a *ell <all' "a*teria are not a"le to survive$ Cefuro=ime is effe*tive agains

<ide variety of "a*teria' su*h as Staphylococcus aureus' Streptococcus pneumoniae" $aemophilus in!luen%ae' E& coli' N& gonorrhea' and many others$ 6

FD& approved *efuro=ime in De*em"er 1;98$

DU+ IN6&C6I%N!# /ro"ene*id in*reases the *on*entration of *efuro=ime in the "lood$ Drugs that redu*e a*idity in the stoma*h (for e=amp

anta*ids' "lo*7ers' proton pump inhi"itors) may redu*e a"sorption of *efuro=ime$

http://www.medicinenet.com/e_coli__0157h7/article.htm



http://www.medicinenet.com/drug_interactions/article.htm

http://www.medicinenet.com/probenecid/article.htm

http://www.medicinenet.com/proton-pump_inhibitors/article.htm


http://www.medicinenet.com/drug_interactions/article.htm

http://www.medicinenet.com/probenecid/article.htm

http://www.medicinenet.com/proton-pump_inhibitors/article.htm



!ID FFC6!# Cefuro=ime is generally <ell tolerated' and side effe*ts are usually transient$ !ide effe*ts in*lude diarrhea' nausea' vomiting' a"dom

pain' heada*he' rash' hives' vaginitis' and mouth ul*ers$ &llergi* rea*tions' severe s7in rea*tions' anemia' and sei@ures also may o**ur$ !in*e *efuro=

is *hemi*ally related to peni*illin' patients allergi* to peni*illin may develop an allergi* rea*tion (sometimes even anaphyla=is) to *efuro=im

Cefuro=ime li7e other anti"ioti*s *an alter the *olonQs normal "a*teria' leading to overgro<th of a "a*terium *alled lostri'ium 'i!!icile$ %vergro<th

this "a*terium leads to the release of to=ins that *ontri"ute to the development of lostri'ium 'i!!icileasso*iated diarrhea' <hi*h may range in seve

from mild diarrhea to fatal pseudomem"ranous *olitis$

2$ aace&am!' 250 mg/L( *u( 4 m' + 4, ( f! .-38 a ab!e $$

+eneri* name#

T para*etamol

,rand name#

T Calpol

http://www.medicinenet.com/diarrhea/article.htm

http://www.medicinenet.com/nausea/symptoms.htm

http://www.medicinenet.com/vomiting/symptoms.htm


http://www.medicinenet.com/abdominal_pain_causes_remedies_treatment/article.htm



http://www.medicinenet.com/headache/article.htm

http://www.medicinenet.com/rash/article.htm


http://www.medicinenet.com/hives/article.htm

http://www.onhealth.com/vaginitis/article.htm

http://www.medicinenet.com/anemia/article.htm

http://www.medicinenet.com/seizure/article.htm

http://www.medicinenet.com/anaphylaxis/article.htm

http://www.medicinenet.com/clostridium_difficile_colitis/article.htm

http://www.medicinenet.com/colitis/article.htm

http://drugsfornursingstudents.blogspot.com/2009/10/paracetamol.html

http://www.medicinenet.com/diarrhea/article.htm

http://www.medicinenet.com/nausea/symptoms.htm




http://www.medicinenet.com/headache/article.htm


http://www.medicinenet.com/hives/article.htm

http://www.onhealth.com/vaginitis/article.htm

http://www.medicinenet.com/anemia/article.htm

http://www.medicinenet.com/seizure/article.htm

http://www.medicinenet.com/anaphylaxis/article.htm

http://www.medicinenet.com/clostridium_difficile_colitis/article.htm

http://www.medicinenet.com/colitis/article.htm

http://drugsfornursingstudents.blogspot.com/2009/10/paracetamol.html



Classifi*ation#

T &nalgesi*s

T Mus*le ela=ants

Dosage#

T $4ml

oute#

T /%

Frequen*y#

T q 3hrs

MC&NI!M %F &C6I%N

De*reases fever "y inhi"iting the effe*ts of pyrogens on the hypothalamus heat regulating *enters B "y a hypothalami* a*tion leading to s<eating B

vasodilatation$

elieves pain "y inhi"iting prostaglandin synthesis at the CN! "ut does not have antiinflammatory a*tion "e*ause of its minimal effe*t on peripheral

prostaglandin synthesis$

INDIC&6I%N!

elief of mildtomoderate painA treatment of fever$



C%N6&INDIC&6I%N!

Contraindi*ated to patients <ith#

V ypersensitivity

V intoleran*e to tartra@ine (yello< dye W4)' al*ohol' ta"le sugar' sa**harin

V Contraindi*ated <ith allergy to a*etaminophen

&D-! FFC6! %F 6 DU+

!timulation' dro<siness' nausea' vomiting' a"dominal pain' hepatoto=i*ity' hepati* sei@ure(overdose' enal failure(high' prolonged doses)' leu*openia'

neutropenia' hemolyti* anemia (long term use) throm"o*ytopenia' pan*ytopenia' rash' urti*aria' hypersensitivity' *yanosis' anemia' 2aundi*e' CN!'

stimulation' delirium follo<ed "y vas*ular *ollaps' *onvulsions' *oma' death$

NU!IN+ IN6-N6I%N and /C&U6I%N!

&ssess patient?s fever or pain# typeof pain' lo*ation' intensity' duration' temperature' and diaphoresis$

&ssess allergi* rea*tions# rash' urti*ariaA if these o**ur' drug may have to "e dis*ontinued$

6ea*h patient to re*ogni@e signs of *hroni* overdose# "leeding' "ruising' malaise' fever' sore throat$

6ell patient to notify pres*ri"er for pain: fever lasting for more than days$

B. 8 nebule ,udesonde ? @

GENERIC NAME: ENIE ENIN R NELI7ER - INALA.IN

U!!# ,udesonide is used to *ontrol and prevent symptoms (<hee@ing and shortness of "reath) *aused "y asthma$ 6his medi*ation "elongs to a *lasdrugs 7no<n as *orti*osteroids$ It <or7s dire*tly in the lungs to ma7e "reathing easier "y redu*ing the irritation and s<elling of the air<ays$6

http://www.medicinenet.com/budesonide/article.htm

http://www.onhealth.com/asthma/article.htm


http://www.medicinenet.com/budesonide/article.htm




medi*ation must "e used regularly to "e effe*tive$ It does not <or7 immediately and should not "e used to relieve sudden asthma atta*7s$ If an asthm

atta*7 o**urs' use your qui*7relief inhaler as pres*ri"ed$%6 6his se*tion *ontains uses of this drug that are not listed in the approved professio

la"eling for the drug "ut that may "e pres*ri"ed "y your health *are professional$ Use this drug for a *ondition that is listed in this se*tion only if it h

"een so pres*ri"ed "y your health *are professional$6his medi*ation may also "e used to treat lung diseases su*h as "ron*hitis and emphysema$

!ID FFC6!# !ee also /re*autions se*tion$Dry:irritated throat' hoarseness' voi*e *hanges' "ad taste in the mouth' runny nose' or nose"leeds m

o**ur$ If any of these effe*ts persist or <orsen' notify your do*tor or pharma*ist promptly$emem"er that your do*tor has pres*ri"ed this medi*ati

"e*ause he or she has 2udged that the "enefit to you is greater than the ris7 of side effe*ts$ Many people using this medi*ation do not have serious s

effe*ts$Infrequently' this medi*ation may *ause severe sudden <orsening of "reathing pro"lems:asthma immediately after use$ If you have sudd

<orsening of "reathing' use your qui*7relief inhaler and see7 immediate medi*al attention$,e*ause this drug <or7s "y <ea7ening the immune system

may lo<er your a"ility to fight infe*tions$ 6his may ma7e you more li7ely to get a serious (rarely fatal) infe*tion or ma7e any infe*tion you have <or

6ell your do*tor immediately if you have any signs of infe*tion (su*h as ear pain' sore throat' fever ' *hills)$ Use of this medi*ation for prolonged

repeated periods may result in oral thrush (yeast infe*tion)$ Conta*t your do*tor if you noti*e <hite pat*hes in your mouth or on your tongue$6ell yo

do*tor immediately if any of these rare "ut serious side effe*ts o**ur# unusual tiredness' vision pro"lems' easy "ruising:"leeding' puffy fa*e' unusual h

gro<th' mental:mood *hanges (su*h as depression' mood s<ings' agitation)' mus*le <ea7ness:pain' thinning s7in' slo< <ound healing$& very serio

allergi* rea*tion to this drug is rare$ o<ever' see7 immediate medi*al attention if you noti*e any symptoms of a serious allergi* rea*tion# ra

it*hing:s<elling (espe*ially of the fa*e:tongue:throat)' severe di@@iness' trou"le "reathing$6his is not a *omplete list of possi"le side effe*ts$

DU+ IN6&C6I%N!# 6he effe*ts of some drugs *an *hange if you ta7e other drugs or her"al produ*ts at the same time$ 6his *an in*rease your r

for serious side effe*ts or may *ause your medi*ations not to <or7 *orre*tly$ 6hese drug intera*tions are possi"le' "ut do not al<ays o**ur$ Eour do*tor

pharma*ist *an often prevent or manage intera*tions "y *hanging ho< you use your medi*ations or "y *lose monitoring$6o help your do*tor a

http://www.onhealth.com/emphysema/article.htm

http://www.medicinenet.com/sore_throat_pharyngitis/article.htm

http://www.medicinenet.com/aches_pain_fever/article.htm

http://www.medicinenet.com/thrush/article.htm

http://www.medicinenet.com/yeast_infection_in_women_and_men/article.htm

http://www.medicinenet.com/depression/article.htm


http://www.onhealth.com/emphysema/article.htm

http://www.medicinenet.com/sore_throat_pharyngitis/article.htm

http://www.medicinenet.com/aches_pain_fever/article.htm

http://www.medicinenet.com/thrush/article.htm

http://www.medicinenet.com/yeast_infection_in_women_and_men/article.htm

http://www.medicinenet.com/depression/article.htm




pharma*ist give you the "est *are' "e sure to tell your do*tor and pharma*ist a"out all the produ*ts you use (in*luding pres*ription drugs' nonpres*ript

drugs' and her"al produ*ts) "efore starting treatment <ith this produ*t$ hile using this produ*t' do not start' stop' or *hange the dosage of any ot

medi*ines you are using <ithout your do*torQs approval$!ome produ*ts that may intera*t <ith this drug in*lude# aldesleu7in' other drugs that <ea7en

immune system (su*h as a@athioprine' *y*losporine' *an*er *hemotherapy' natali@uma")' large doses of aspirin and aspirinli7e drugs (sali*ylat

nonsteroidal antiinflammatory drugs (N!&IDs su*h as indometha*in' i"uprofen)' mifepristone' quinolone anti"ioti*s (su*h as *iproflo=a

levoflo=a*in)' drugs that *an *ause "leeding:"ruising (in*luding X"lood thinnersX su*h as <arfarin' antiplatelet drugs su*h as *lopidogrel)$%t

medi*ations *an affe*t the removal of "udesonide from your "ody' <hi*h may affe*t ho< "udesonide <or7s$ =amples in*lude a@ole antifungals (su*h

7eto*ona@ole)' ma*rolide anti"ioti*s (su*h as erythromy*in)' rifamy*ins (su*h as rifa"utin)' !t$ ohnQs <ort' drugs used to treat sei@ures (su*h

*ar"ama@epine' phenytoin)' among others$&spirin *an in*rease the ris7 of "leeding <hen used <ith this medi*ation$ o<ever' if your do*tor has dire*

you to ta7e lo<dose aspirin for heart atta*7 or stro7e prevention (usually at dosages of 914 milligrams a day)' you should *ontinue ta7ing it unl

your do*tor instru*ts you other<ise$ &s7 your do*tor or pharma*ist for more details$6his produ*t may interfere <ith *ertain la" tests (su*h as s7in test

Ma7e sure la"oratory personnel and all your do*tors 7no< you use this drug$

I3. Nu"sn) Mana)e(ent&$ Nursing istory

1$ Chief Complaintsard nonprodu*tive *ough <hi*h started 3 days prior to admission$

$ +eneral Impression6he patient loo7s <ea7 and his eyes loo7s sleepy$ /resen*e of nasal flaring <hen "reathing$ No proper hygiene' his nails are long and di

$ istory of /resen*e Illness!tarted 5 days patient has intermittent high fever asso*iated <ith nonprodu*tive *ough for 4 days' *olds and vomiting on*e$

3$ /ast ealth istory in*luding /renatal istoryComplete prenatal history

http://www.medicinenet.com/aldesleukin/article.htm


http://www.medicinenet.com/azathioprine/article.htm

http://www.medicinenet.com/cancer/article.htm


http://www.medicinenet.com/indomethacin/article.htm

http://www.medicinenet.com/ibuprofen/article.htm


http://www.medicinenet.com/ciprofloxacin/article.htm

http://www.medicinenet.com/levofloxacin/article.htm

http://www.medicinenet.com/warfarin/article.htm

http://www.medicinenet.com/clopidogrel/article.htm

http://www.medicinenet.com/ketoconazole/article.htm

http://www.medicinenet.com/erythromycin/article.htm

http://www.medicinenet.com/st_johns_wort_hypericum_perforatum-oral/article.htm

http://www.medicinenet.com/carbamazepine/article.htm

http://www.medicinenet.com/phenytoin/article.htm

http://www.medicinenet.com/heart_attack/article.htm

http://www.medicinenet.com/stroke_prevention/article.htm


http://www.medicinenet.com/azathioprine/article.htm


http://www.medicinenet.com/indomethacin/article.htm


http://www.medicinenet.com/ciprofloxacin/article.htm

http://www.medicinenet.com/levofloxacin/article.htm

http://www.medicinenet.com/warfarin/article.htm

http://www.medicinenet.com/clopidogrel/article.htm

http://www.medicinenet.com/ketoconazole/article.htm

http://www.medicinenet.com/erythromycin/article.htm

http://www.medicinenet.com/st_johns_wort_hypericum_perforatum-oral/article.htm

http://www.medicinenet.com/carbamazepine/article.htm

http://www.medicinenet.com/phenytoin/article.htm

http://www.medicinenet.com/heart_attack/article.htm

http://www.medicinenet.com/stroke_prevention/article.htm



4$ Family istory <ith +enogram

.egends#

female

male

31 */!

#abe&#c

.N

35 */!

A 9

11 */!

A 9

3 */!

eum!#a





/resen*e of *ra*7les in "oth lungs upon aus*ultation' no use of a**essory mus*les <hen "reathing$ No tenderness up

palpation$$ Nose

/resen*e of nasal flaring <hen "reathing$

C. Nu"sn) T*eo"#

Do"ot*ea O"e(s SelfCa"e Re?ustes

6he purpose of Dorothea %rem?s !elf Care Model is to allo< individuals and their families to maintain *ontrol of their health*are$ !elf*are is ongo

throughout the *ontinuum of life and is forever evolvi

!elf*are Defi*it is the 7ey to %rem?s !elfCare Model "e*ause it identifies <hen and ho< mu*h a nurse is needed in the *are of the patient$ Nursing *arneeded if there is a pro"lem that prevents a person from rea*hing their optimal hea

%rem "elieves there are three *omponents to the !elf*are nursing model' the *ompensatory system' the partial *ompensatory system and the edu*ati

developmental system$

6he Compensatory system is <hen the nurse provides total *are for the patient$ 6his patient *annot do anything for themselves in*luding "ut not limited

a*tivities of daily living and am"ulation$ 6his patient is totally dependent of the nurse for survival' su*h as an a*ute !tro7e pati

6he se*ond of %rem?s systems is the /artial Compensatory$ 6he nurse must assist in the *are of the patient "ut the patient and family *an assist as <ell



pneumonia patient' <ho is very short of "reath' may require the nurse to monitor vital signs' o=ygen saturations' assist in &D.?s and am"ulation$ 6

patient <ill "e a"le to resume their o<n *are <hen they are "etter "ut need the assistan*e and edu*ation a nurse *an provide at this tim

6he third of %rem?s systems is the du*ativedevelopmental system$ 6he patient has primary *ontrol over their healthA the nurse assists <ith edu*ation

promoting safe health pra*ti*es$ 6he patient <ho has high *holesterol may fit into this *ategory' diet' e=er*ise regimen and medi*ation is import

edu*ation for this patient$ 6he nurse <ould tea*h the patient ho< to properly maintain good health pra*ti

estoring' promoting and maintaining health are the goals Dorothea %rem?s !elf*are Model promotes$ 6he model loo7s at the patient as a <hole and h

they intera*t <ith their environment$ !elf*are is an ever *hanging pro*ess throughout the *ontinuum of life and requires *onstant reassessme

6he advantages to Dorothea %rem?s !elfCare 6heory <hen esta"lishing a plan of *are is the *omprehensive assessment pro*ess <hi*h is used$ ve

aspe*t of the patients <ell"eing is dis*ussed' their *hara*ter traits' so*ial situation' environment' head to toe physi*al assessment using self*are requisi

"ehavioral *hara*teristi*s and past medi*al history$ %rem fo*uses on the patientA the need for nursing *are is esta"lished "y the patients self*are defi

found during the assessment pro*ess$ &lso' %rem s*ales do<n to a*tual nursing *are requirements for the patient' separate from other health*

providers' *reating autonomy for nursing as a profession$

6he disadvantage to Dorothea %rem?s !elfCare 6heory is ho< time *onsuming the pro*ess is for the nurse$ !taffing ratios don?t allo< for su*h

e=tensive initial plan of *are$ Nurses re*eive several admissions per t<elve hour shiftsA to s*rutini@e a patient this thoroughly <ould "e impossi"le

<ould ta7e several days to 7no< a patient as <ell as %rem suggests <e should and <ith the short length of stay the lu=ury of time is not ours$ 6he oth

disadvantage to %rem?s theory is *omple=ity$ er theory is very long and detailed' the <ording is diffi*ult to understand' and re*ogni@ing ho< all

*omponents fit together *an only "e a**omplished after a*tually studying her pro*ess$

C%.&6I%N#



6he patient and his signifi*ant others *an no longer or have no more time to thin7 of proper hygiene' so it is our tas7 to render *are to our pati

and help him feel *lean and *omforta"le$ In this simple <ay <e *an help the patient restore his health$

NURSING 0ISTORY

/art I$ Demographi* Information#



Name# D$ .$/$

Civil !tatus# !ingle

!e=# Male

du*ational &ttainment# /res*hooler

&ddress# Motong' Dumaguete City' Negros %riental

eligion# oman Catholi*

%**upation# !tudent

oom and ,ed No$# // 3

Do*tor(s) in *harge# Dr$ +utierre@

Nationality# Filipino

Chief Complaint(s)#ard nonprodu*tive *ough <hi*h started 3 days prior to admission

Date and 6ime of &dmission# 0:05:13 B 0335

Diagnosis(es)# Ineffe*tive &ir<ay Clearan*e r:t thi*7' vis*ous se*retionsA distur"ed sleep pattern r:t environmental *hanges' noise' dis*omfort' and fa*ility routinesA

hyperthermia r:t inflammatory response$

U!U&. /&66N INI6I&. /&66N(0:5:13) %N+%IN+&//&I!&.(0:5:13) %N+%IN+ &//&I!&.(0:8:13)

I$ &.6

C %

R*hild is very a*tive and 7eeps

i h i h i

R*hild no< is very <ea7 and

li7 li hi " d ll h

Rsought admission due to on and off fever for 5

d



/C/6I%N

&.6

M&N&+MN6

/&66N

on moving every<here in their

house

Reats vegeta"les and drin7s

mil7 to "e healthy

Rno food allergies

Rno previous hospitali@ation

R*hildQs health is good

Rusually plays <ith dust

Rno proper hygieneRtreatment or pra*ti*es are

XipahilotX' *he*7up or

medi*ation(tempra)

Rno medi*ine allergies' as

ver"ali@ed "y the mother

Rthe pro"lem <ith *aring for

her *hild is that' she is pregnant

and she is al<ays <ea7 <hi*h

is <hy she *anQt ta7e *are of her

*hild <ellRnot irrita"le

Rusually do things alone

R*hild has a *omplete prenatal

history' as ver"ali@ed "y the

mother

R7eeps on playing inside and

outside their house' as


Rhas a *omplete immuni@ation'

as ver"ali@ed "y the mother

li7es to lie on his "ed all the

time

R*hildQs first hospitali@ation

Rthe reason for hospitali@ation

is fever and *ough and e=pe*ts

his *hild to "e <ell

RCefuro=ime 400 mg I-66 q

9 &N!6 ()

R!al"utamol :1 ne" q 5R,udesonide 1 ne" q 9

R/ara*etamol 40 mg:tsp

syrup 3 ml q 3 prn for 6emp$

R9

C,C(0:5:13)

RNeutrophil 8$3

RMono*yte 14$9

R,asophile 1$3

R,C 3$0;

R+" 11$4RC6 3

RM/- 8$0

R6emp$ 5$ C:a=illa

R/ 10 "pm

R 9 *pm

Reight 13 7g

Rla*7 of hygiene' have dirty

nails

Rpulses(radial)fast and

irregular

Rrespirationsfast' presen*e of

*ra*7les in "oth lungs

Rmumata siya para muo"o' as


Rsige siya og gau"ou"o

Rpaspas iyahang ginha<a og

days

RMother des*ri"es *hildQs health as poor

R*hild sho<s interest to re*over easily and fast

RMother assumed that the *ause of *hildQs illness is

"e*ause of al<ays playing on dust and *hild loves

to <rite on his "la*7"oard using a *hal7 <hi*h the

*hild pro"a"ly inhales the parti*les

RX"efore I donQt *hange my *hildQs shirt though it is

<et <ith s<eat "ut no< IQll ma7e sure that thereQsa to<el on his "a*7'X as ver"ali@ed "y the mother

RX"efore I donQt supervise my *hild <hen <ashing

his hands <ell after this I <ill supervise him

already'X as ver"ali@ed "y the mother

Rusually after playing my *hild <ill dire*tly eat

<ithout <ashing his hand' as ver"ali@ed "y the

mother

C,C(0:5:13)

R,C 3$4R+, 1$

RC64$

R6emp$8$ C:a=illa

R/190 "pm

R 0 *pm



COLLEGE OF NURSING

Foundation UniversityDumaguete City

NU!IN+ C& /.&N

CU!:-IDNC! NU!IN+

DI&+N%!I!

%,C6I-! IN6-N6I%N! &6I%N&. -&.U&6I%N

!u"2e*tive#&s ver"ali@ed "y themother#

1$ Mumata siya usahay para muo"o$ !ige siya og gau"ou"o$ /aspas iyahang ginha<aog mura siya og galisod

%"2e*tive#1$ /resen*e of *ra*7les in

"oth lungs$ /resen*e of nasal flaring$ 9 *pm

Ineffe*tive "reathing patternr:t de*reased lunge=pansion(fluida**umulation)

&fter days of*are the pt$ <ill

"e a"le to#1$ Improve

"reathing pattern

Independent#Rmaintain positionof *omfort' usually<ith head of "edelevated$ 6urn toaffe*ted side$n*ourage *lient tosit up as mu*h as

possi"le$Rmaintain a *almattitude' assisting*lient to Xta7e*ontrolX "y usingslo<er: deeperrespirations$

R promotes ma=imalinspirationA enhan*es lunge=pansion and ventilationin unaffe*ted area$

Rassists *lient to deal <iththe physiologi* effe*ts ohypo=ia' <hi*h may "emanifested as an=iety and:or fear$

Rreports improvement in "reathing



COLLEGE OF NURSING

Foundation UniversityDumaguete City

NU!IN+ C& /.&N

CU!:-IDNC

!

NU!IN+

DI&+N%!I!

%,C6I-! IN6-N6I%N! &6I%N&. -&.U&6I%N

!u"2e*tive#&s ver"ali@ed "y themother#

1$ +ainit pud siya7aron$ ga"ali7"ali7 angiyang hilanata7ong gihi7apiyang ulo init napud

%"2e*tive#

1$ on and off fever $ temp$ 9$:a=illa$ <arm to tou*h

In*rease "odytemperature r:tinflammatoryresponse to pneumonia

&fter days of my*are the pt$ <ill "e

a"le to#a$ de*rease "odytemperature <ithinthe normal range

"$ *ough outse*retions

a1$ /rovide tepidsponge "ath

a$ /ara*etamol40nmg sp syrup3 ml q 3 prn fortemp$ R9 C

"1$ %ffer <arm'rather than *old'fluids

R 6!, <ill help in

lo<ering "ody

temperature

R De*reases fever

"y inhi"iting the

effe*ts of pyrogens

on the

hypothalamus heat

regulating *enters B "y a hypothalami*

a*tion leading to

s<eating B

vasodilatation$

R fluids' espe*ially

<arm liquids' aid in

mo"ili@ation and

e=pe*toration of

se*retions



3. Annotated Readn)s

Pneu(ona stll "es&onsble fo" one fft* of c*ld deat*s

On :t* o"ld Pneu(ona Da#$ )lobal *ealt* bodes *)*l)*t essental nte"!entons t*at 4ll *el& "educe bu"den of dsease

oint ne<s release# %' UNICF' +&-I &llian*e

() November )*(+ , -eneva . /neumonia remains the single "iggest 7iller of *hildren under 4 glo"ally' *laiming the lives of more than 1 million girls and "oys ev

year$ ,ut pneumonia deaths are preventa"le$

&s *ountries mar7 orld /neumonia Day on 1 Novem"er' %' UNICF and the +&-I &llian*e are highlighting essential a*tions that *an help end *hild deaths fr

this disease$

Jvery 0 se*onds' a *hild younger than 4 dies of pneumonia$ 6his is a great shame as <e 7no< <hat it ta7es to prevent *hildren from dying of this illness'K says

Mi*7ey Chopra' Chief of ealth' UNICF$ J6a*7ling pneumonia doesn?t ne*essarily need *ompli*ated solutions$K

Many fa*tors *ontri"ute to pneumonia' and no single intervention *an effe*tively prevent' treat and *ontrol it$ 4 simple "ut effe*tive interventions' if implemen

properly' <ill help redu*e the "urden of the disease that is responsi"le for almost onefifth of all *hild deaths around the <orld$



6hese are#

• e=*lusive "reastfeeding for 5 months and *ontinued "reastfeeding *omplemented "y nutritious solid foods up to age A

• va**ination against <hooping *ough (pertussis)' measles' $aemophilus in!luen%ae type " (i") and pneumo*o**usA

• safe drin7ing <ater' sanitation and hand<ashing fa*ilitiesA

•

improved *oo7ing stoves to redu*e indoor air pollutionA and• treatment' in*luding amo=i*illin dispersi"le ta"lets and o=ygen$

6he theme of orld /neumonia Day 01 is JInnovate to nd Child /neumoniaK$ e*ogni@ing that *hild mortality *annot "e addressed in a va*uum' "ut only throu

integrated efforts' in &pril 01' % and UNICF released an Integrated +lo"al &*tion /lan for the /revention and Control of /neumonia and Diarrhoea (+&//D)

6he +&//D presents an innovative frame<or7 "ringing together prevention' prote*tion and *ontrol of "oth pneumonia and diarrhoea H t<o of the <orld?s leading 7il

of *hildren under 4 to ma7e more effi*ient and effe*tive use of s*ar*e health resour*es$

6o mar7 4th orld /neumonia Day' Mauritania and /apua Ne< +uinea are today introdu*ing the pneumo*o**al va**ine' <hi*h prote*ts against one of the lead

*auses of pneumonia$ ith support from the +&-I &llian*e' more than 40 *ountries <ill introdu*e this va**ine "y 014$

J6he +&-I &llian*e is helping to a**elerate the fight against pneumonia "y in*reasing a**ess to pneumo*o**al va**ines' than7s to +&-I?s innovative &dvan*e Mar

Commitment (&MC)' "ut also to the 4in1 pentavalent va**ine <hi*h prote*ts against aemophilus influen@ae type "' another ma2or *ause of pneumonia'K says Dr !

,er7ley' C% of the +&-I &llian*e$



!in*e the laun*h of the +&//D 8 months ago' several *ountries have ta7en this for<ard$ For e=ample' ,angladesh and am"ia are translating the +&//D into lo*

implementation plans in some distri*ts$ /rogramme managers responsi"le for immuni@ation' *hild health' nutrition and <ater and sanitation have 2oined for*es

a**elerate progress and eliminate preventa"le deaths from pneumonia and diarrhoea$

In addition' in %*to"er 01' % pu"lished ne< te*hni*al advi*e for *ountries#

• ,ased on a revie< of the latest eviden*e' guidelines on the treatment of pneumonia <ere updated' re*ommending simpler anti"ioti* regimens$

• & hand"oo7 to guide distri*t and health fa*ility staff on ho< to introdu*e the pneumo*o**al va**ine emphasi@es using ne< va**ine introdu*tions to s*ale

a**ess to other essential interventions to prote*t' prevent and treat pneumonia' in line <ith the +&//D$

J6o a*hieve the vision and goals of the integrated plan H to end preventa"le deaths from pneumonia and diarrhoea in the ne=t generation H the *hildren of the <orld n

to see politi*al <ill' *oordinated efforts' and in*reased resour*es at the glo"al and national levels to fight these stu""orn 7illers'K says Dr li@a"eth Mason' Dire*tor

%?s Department of Maternal' Ne<"orn' Child and &doles*ent ealth

REACTION

It?s good to 7no< that there is already a va**ine for pneumonia sin*e pneumonia is the "iggest 7iller of *hildren under 4 glo"ally$ If it <ill "e implemented "y ne=t ye

the death *aused "y pneumonia <ill "e de*rease and no family <ill "e losing their *hildren anymore$



Pneu(ona Is Ne4 T*"eat to Sto"(,atte"ed P*l&&nes



By /E01$ BRADS$ER

Publishe': November ))" )*(+

6&C.%,&N' the /hilippines G 6<o <ee7s after 6yphoon aiyan devastated the east*entral /hilippines' a ne< pro"lem has emerged# pneumonia$ i@a Flores'

<aited for treatment at the astern -isayas egional Medi*al Center in 6a*lo"an$

undreds of thousands of people have lost their homes and are living under tarpaulins and in ma7eshift huts a*ross .eyte Island and near"y islands$ 6hese simp

stru*tures are proving no mat*h for torrential rain and a rapid alternation of *hilly "ree@es and s<eltering heat$

6hree /hilippines Department of ealth offi*ials said in separate intervie<s on Friday night that a*ute respiratory infe*tions' in*luding pneumonia' <ere the "igg

single pu"li* health pro"lem to emerge sin*e the typhoon$

Con*erns a"out pneumonia *ame as the National Disaster is7 edu*tion Management Coun*il' a /hilippines government agen*y' said the death toll had rea*hed 4'

"y Friday evening$ 6he agen*y uses a *onservative figure for deaths that relies on "odies "eing found and logged "y offi*ials$

&t a meeting on Friday evening' <here representatives of several do@en domesti* and foreign medi*al groups des*ri"ed the latest health *on*erns' most <ere a*u

respiratory infe*tions' said Dr$ im ,ernadas' the a*ting *hief typhoon health in*ident offi*er for .eyte Island' the island in the ar*hipelago that suffered most of t

*asualties$ e attri"uted the respiratory infe*tions to the <idespread la*7 of shelter' saying more tents <ere needed from international donors$

http://topics.nytimes.com/top/reference/timestopics/people/b/keith_bradsher/index.html

http://www.ndrrmc.gov.ph/


http://topics.nytimes.com/top/reference/timestopics/people/b/keith_bradsher/index.html





6he department plans to *ompile on !aturday detailed information on the num"er of a*ute respiratory infe*tions that have "een diagnosed and offi*ially reported to t

authorities' ealth Department offi*ials said$

Dr$ a2iv !hah' the administrator of the United !tates &gen*y for International Development' said in a telephone intervie< from ashington on Friday that the Unit

!tates government <as *on*erned a"out reports of pneumonia in typhoonaffe*ted areas$ 6he agen*y estimates that 1$1 million homes <ere damaged or destroyed "y

typhoon' and Dr$ !hah said "etter shelter' nutrition and *lean <ater <ere *ru*ial to preventing a further spread of a*ute respiratory infe*tions in the *oming months$

Dr$ !hah' a spe*ialist in internal medi*ine' said the United !tates <as donating plasti* sheeting to provide "etter prote*tion from the elements for vulnera"le families a

had donated food rations for $8 million people' in*luding highenergy "ars that may help strengthen the immune systems of *hildren <ho have not "een getting enou

to eat sin*e the storm$

Foreign medi*al teams are seeing so many *ases that some of the smaller ones from nongovernmental organi@ations are running out of anti"ioti*s and have to "orro

more from other *lini*s' usually those set up "y governments$

JIt?s the *onstant rain <hile living under a tarpaulin'K said Dr$ Ian Norton' the team leader of the National Criti*al Care and 6rauma esponse Center' an &ustra

government group "ased in Dar<in that has deployed a full field hospital here *omplete <ith operating theaters$

http://www.nationaltraumacentre.nt.gov.au/





Compounding the pro"lem is that residents from all <al7s of life G from do*tors to muni*ipal offi*ials' fishermen and manual la"orers G lost every garment th

o<ned <hen their homes <ere ripped apart "y <ind' <ater or "oth$ Donations of used *lothing from a"road have "arely started to arrive G red and <hite plasti* "ags

*lothing <ere "eing handed out Friday afternoon along 6a*lo"an?s *oastal road$

!o most people <ear the same 6shirt and shorts' often "orro<ed' for days on end$ 6hey *annot *hange <hen they get soa7ed in the rain' and the *onstant damp h

ma7es it hard to dry anything$

!helter has not "een a "ig priority for aid groups' <hi*h have fo*used on "ringing in food' <ater and medi*al supplies first$ 6he result is that almost all the tarpaul

here are s*avenged from de"ris' sometimes <ith holes or rips$ -irtually no tents have "een put up$

/ediatri* respiratory *ases that start as *oughs and *olds qui*7ly <orsen in this environment and *an easily turn into pneumonia$ JIt?s a sign of the *onditions of living

it?s raining every day'K said Dounia De7hili' the /hilippines emergen*y program dire*tor for Do*tors ithout ,orders' as she stood under an opensided shelter at

group?s *lini* here and <at*hed a *old dri@@le fall$

Do*tors ithout ,orders is "ringing in tents' she said$

%ne of the many pneumonia patients here is Yesha Magason' a yearold <ho lay shyly in her mother?s arms on a "ed at Dr$ Norton?s hospital on Friday afternoon a

"arely surviving the previous night$ er mother' o*elyn Magason' said the storm surge had destroyed their home in 6olosa' a to<n 10 miles south of 6a*lo"an$

http://www.doctorswithoutborders.org/

http://www.doctorswithoutborders.org/



6he family survived the surging <aters "y *lim"ing on the roof of their home' <ith Mrs$ Magason and her hus"and passing up ea*h of their four *hildren' ages 1 to

6hey *ounted themselves lu*7y that the sea level rose less in 6olosa' "e*oming *hestdeep in o*eanfront lo<in*ome neigh"orhoods li7e theirs' than here in 6a*lo"

<here it rea*hed 1 to 0 feet$

Yesha is asthmati*' and "egan having trou"le "reathing four days ago' her mother said$ Yesha?s *ondition deteriorated over the ne=t *ouple of day and her mother to

her to a foreign medi*al mission$

6he group re*ogni@ed pneumonia and rushed the girl on 6hursday to the &ustralian hospital' lo*ated ne=t to the 6a*lo"an airport$

Je thought she <as going to die that night' and no< she is sitting up' loo7ing around <ith her mum'K said Dr$ Norton' adding that spe*ial anti"ioti*s had "een us

"e*ause of the *ompli*ation of Yesha?s asthma$

Dr$ Frederi* u*7ert' a surgeon for International !ear*h and es*ue +ermany' a nonprofit group' said in an intervie< at the group?s *lini* in /alo' eight miles south

6a*lo"an' that <hile respiratory infe*tions <ere a pro"lem' diarrhea had proved less of one than e=pe*ted$ 6he heavy rain may have <ashed a<ay *ontaminants t

might other<ise *ause diarrhea' he said$

&mputations have also "een less *ommon here than after some other natural disasters' although a fe< are still o**urring$ Dr$ Norton said numerous *ases had "e

referred to the &ustralian hospital for possi"le amputation' "ut only t<o amputations <ere ne*essary$

REACTION

http://www.isar-germany.de/en/about-us/responsibilities/such-und-rettungs-spektrum/

http://www.isar-germany.de/en/about-us/responsibilities/such-und-rettungs-spektrum/



/neumonia *an follo< a *ommon *old$ 6he agents *ausing pneumonia are most often transmitted "y droplet spread resulting from *lose *onta*t <ith a sour*e *a

Conta*t <ith *ontaminated fomites also may "e important in the a*quisition of viral agents$ &n upper respiratory tra*t illness permits invasion of the lo<er respirato

tra*t "y "a*teria' viruses' or other pathogens that trigger the immune response and produ*e inflammation$ 6he lo<er respiratory tra*t air spa*es fill <ith <hite "lood *

(,C)' fluid' and *ellular de"ris. &nd the pathogens along <ith the *ells' fluid and de"ris *ause all the symptoms of pneumonia$

I. Su((a"# and Concluson/neumonia is an infe*tion of the lungs that is *aused "y "a*teria' viruses' fungi' or parasites$ It is *hara*teri@ed primarily "y inflammation of the alveol

the lungs or "y alveoli that are filled <ith fluid (alveoli are mi*ros*opi* sa*s in the lungs that a"sor" o=ygen)$ &t times a very serious *ondition' pneumonia *an ma7

http://www.medicalnewstoday.com/articles/248423.php

http://www.medicalnewstoday.com/articles/248423.php



person very si*7 or even *ause death$ &lthough the disease *an o**ur in young and healthy people' it is most dangerous for older adults' "a"ies' and people <ith ot

diseases or impaired immune systems$

II. ,I,LIOGRAP0Y

,oo7s#ealth &ssessment in Nursing 3th edition: anet e"er and ane Yelly

Internet#

( http#::<<<$healthline$*om:health:pneumonia)( http#::<<<$nlm$nih$gov:medlineplus:pneumonia$html )

( http#::7idshealth$s*hn$health$ns<$gov$au:fa*tsheets:pneumonia /

(http#::<<<$s*ri"d$*om:do*:05853:Case!tudyof/NUM%NI&)









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