SARS powerpoint

7/27/2019 SARS powerpoint

1/44

CAP-MRCommunityAcquired

Pneumonia Moderate Risk

Prepared by:

Sheena Marie Germinal


2/44


3/44

General objectives:

Within 6 days of related learning experience,I will be able to apply my knowledge, skillsand attitude regarding the concept cellular

aberrations.

Specific objectives:Within 8 hours of exposure I will be able to:


4/44

Knowledge

1.) Identify the different illness in the area ofexposure in order to give appropriate nursinginterventions.

2.) Provide information about the medications ofthe client.3.) State the exact rationale for every nursingintervention.

4.) Formulate a comprehensive nursing care plan.5.) Provide appropriate health teaching for myclient.


5/44

Skills

1.) Organize data properly to ensure a systematicdata collection.2.) Gather relevant data needed in formulating theplan of care.

3.) Construct a data analysis using initial data base.4.) Develop teaching plan to achieve wellnesspromotion.5.) List down important information and answersgiven by client which is necessary in planning aneffective nursing care.


6/44

Attitude

1.) Display a good role model to my fellow classmatesto the folks and my client.2.) Follow consciously all rules and regulation of thehospital.

3.) Show respect to the staff, clinical instructor andmy fellow classmates.4.) Seek clinical instructors guide before renderingany procedure.5.) Display Augustinian values at all times especiallyhonesty in doing any procedures and telling thetruth.


7/44

Prepared By:Frestine Joanne Ibon


8/44

I. Vital Information

Name: J.LAddress: Poblacion Ilawod Lambunao, IloiloBirth Date: April 2, 1982

Gender: FemaleMarital Status: MarriedReligion: Roman CatholicDate and Time of Admission: October 1, 2013 @ 5 a.m.Physician: Dr. S.

Chief complaint: Cough and Difficulty of BreathingAdmitting Diagnosis: CAP, MR


9/44

II. History of Present Illness

Two months prior to admission the client

experienced exertional dyspnea but she did not made

any intervention to this. Then two weeks prior to

admission she is experiencing non productive cough andincreased severity of exertional dyspnea. The following

day client went on a hilot nearby and was advised to

take some herbal plants. Thereafter, when she noticed

that her cough is not minimizing she decided to go to

WVSUMC and admitted in San Vicente Ferrer Ward andundergone different tests like CBC, platelet, protime, 12-

L ECG, Blodd typing, Urinalysis, creatinine, S. K+ and Na+,

and CT Scan.


10/44

III. Past Medical History

J.L. has no history of hospitalization. Received a

complete immunizations. She have not committed any

childhood accidents. She also had no food, drug, and

environmental allergies. She had suffered fromchildhood illnesses such as fever and runny nose that

would last at least three days as far as she could

remember. She takes over the counter drugs such as 1

tab of biogesic to relieve the pain and discomfort and

herbal medicines such as lapunaya that her motherwould use to hampol. She takes 1tab of Enervon every

day before hours of sleep as his vitamin supplement.


11/44

Disease Paternal Maternal

Asthma x

Hypertension x DM

Cancer x x


12/44

V. Socioeconomic Status

J.L is a highschool physics Teacher, married with a college Rizal teacher

with 3 children aging 6 months, 2 and 3 years. The number of their family

members who are living in their house is 6 which includes her mother who took

care of their children when they are at work.

The family earns Php 10,000.00and above monthly. They live in a bungalow stylehouse, semi-concrete, with galvanized roof. There are two rooms, a kitchen and a

comfort room separated from their house. They store foods in their refrigerator.

They get water from the their own deep well and buys mineral water as their

source of drinking. They sometimes celebrate fiesta in accordance to their

budget. They always go to church every Sunday and sometimes participate in

their barangay activities. He claims to have a mutual relationship with his

neighbors because some of them were his childhood friends and he also claimed

that he has a good and happy life with his family.


13/44

VI. Activities of Daily Living

A. Nutrition

Client eats three times a day with no difficulty. At Breakfast, she usually

drinks a cup of coffee while she dips 3-5 pieces of hot pandesal. During lunch, she

prefers to eat vegetables and fish, sometimes meat and chicken if available with 3-4

cups of rice per meal. By the time supper arrives, she eats canned goods and steamedvegetables like okra together with a cup of rice. He drinks 10-12 glasses of water a

day.

B. Elimination

She urinates 3-7 times a day, her urine is pale straw and the amount of her

urine depends on how much he usually takes. She defecates thrice a week, usually7am in the morning. Her stools are brown and well-formed as he claimed. She has no

difficulty or pain felt upon urination and defecation.


14/44

C. Rest and SleepClient sleeps after dinner at around 9pm and wakes up at 4am with a

single pillow he usually puts under his head and in a side lying position while

sleeping. When she cant sleep he watches television or listening to radio or drinking

3-4 glasses of fermented coconut chucks.

D. Activity and ExerciseShe refers doing household chores and school works as her exercise. When

she hears a pop music over the radio, he would tend to sway his hips and stretch his

arms and dance to the beat of the tune, that is if shes inside of their house.


15/44

Drug

Study


16/44

CLASSIFICATION ACTION CONTRA

-INDICATIONS

PRECAUTIONS SIDE EFFECTS NURSING

RESPONSIBILITY

Corticosteroid enters target cells andbindsto cytoplasmic

receptor;initiates

many

complexreactions that

are responsiblefor

its anti-

inflammatory,immuno

suppressive(glucocorti

coid), and salt-

retaining

(mineralocorticoid)acti

ons. Some actions

maybe undesirable,

dependingon drug

use.

Allergy to

anycomponent of

the drug- Fungal

infections-

Amebiasis- Hepatitis

B- Vaccinia or

varicella- Antibiotic-

resistantinfections-

Immunosuppression

kidney disease- Liver

disease- Cirrhosis-

Hypothyroidism-

Ulcerative colitis

withimpending

perforation-

Diverticulitis- Recent

GI surgery- Active or

latent pepticulcer -

Inflammatory

boweldisease-

Hypertension- Heart

failure-

Thromboembolicten

dencies-

Osteoporosis-

Convulsivedisorders-

Metastatic

carcinoma- Diabetes

mellitus- TB-

Lactation

Vertigo,

headache,paresthesi

as,

insomnia,seizures,

psychosis

- Give daily before

9am to mimicnormal

peak

diurnal corticosteroi

dlevels.- Space

multiple doses

evenlythroughout

the day.- Use

minimal doses for

minimalduration to

minimize adverse

effects.- Do not give

IM injections if

patienthas

thrombocytopenic

purpura.- Taper

doses whendiscontinuinghigh-

dose or long-term

therapy

Generic Name: Hydrocortisone

Brand Name: Hydrocortone


17/44


-INDICATIONS


RESPONSIBILITY

Treatment ofhospitalized infantsand young children

with severelower respiratory tra

ct infections dueto respiratory

syncytial virus.

act as an analogue ofthese cellularmetabolites

contraindicated inindividuals who

have shownhypersensitivity to

the drug or itscomponents, and inwomen who are or

may becomepregnant duringexposure to the

drug

USE OF AEROSOLIZEDVIRAZOLE IN PATIENTS

REQUIRINGMECHANICALVENTILATOR

ASSISTANCE SHOULDBE UNDERTAKEN ONLY

BY PHYSICIANS ANDSUPPORT STAFF

FAMILIAR WITH THESPECIFIC VENTILATORBEING USED AND THIS

MODE OFADMINISTRATION OF

THE DRUG. STRICTATTENTION MUST BE

PAID TO PROCEDURESTHAT HAVE BEEN

SHOWN TO MINIMIZETHE ACCUMULATION

OF DRUG PRECIPITATE,WHICH CAN RESULT IN

MECHANICALVENTILATOR

DYSFUNCTION ANDASSOCIATEDINCREASED

PULMONARYPRESSURES

fever, chills, bodyaches, flu

symptoms;severe pain in upperstomach spreading

to your back,nausea and

vomiting, fast heartrate;

stabbing chest pain,wheezing,

hallucinations,thoughts of suicidechest pain or heavy

feeling, painspreading to the

arm or shoulder,nausea,dark colored urine,

easy bruising orbleeding, confusion,

or unusualweakness.

Observe 10 Rs.Take this

medication bymouth, usuallytwice daily with

food for 24 to 48weeks or as

directed by yourdoctor. Swallowthis medicationwhole. Do notcrush, break or

chew the tablet.The dosage and

length of treatmentis based on your

age, weight,medical condition,and response to

therapy.

Generic Name: Ribavirin

Brand Name: Virazole

AVAILABLE FORMS & Dosage: Tablets, 400 mg PO qAM, 600mg PO qPM


18/44


-INDICATIONS


RESPONSIBILITY

Antiviral,neuraminidase

inhibitor

Severely inhibitsinfluenza virus

neuraminidase, byblocking the actionsof this enzyme there

is decreased viralrelease from infected

cells, increasedformation of viralaggregates, and

decreased spread ofvirus.

treatment ofuncomplicated

acute illness due toinfluenza virus (a or

b) in adults andchildren who havebeen symptomaticfor 2 days or less.

Prevention ofnaturally occurringinfluenza A and B inadults and children

in close contactwith the flu.

Allergy to anycomponent of drug.Use cautiously with

pregnancy,lactation, asthma,

COPD

nausea, vomiting,diarrhea;

dizziness, headache;nosebleed;

eye redness ordiscomfort;

sleep problems(insomnia); orcough or other

respiratorysymptoms

Instruct your clientnot take Tamiflu ifyou are allergic to

the main ingredient,oseltamivir

phosphate, or toany other

ingredients ofTamiflu.

Report severediarrhea, severe

nausea, worseningof respiratory

symptoms

Generic Name: Oseltamivir

Brand Name: Tamiflu

AVAILABLE FORMS & Dosage: Oral suspension 12.5 mL. Capsule of 75 mg


19/44


-INDICATIONS


RESPONSIBILITY

Protease Inhibitors Exhibits antiviralactivity, inhibits HIV

protease activity,

leading to the

decrease of HIV

particles, inhibits

metabolism of

lopinavir, allowing for

increased plasma

levels of lopinavir

patients withpreviously

demonstratedclinically significant

hypersensitivity(e.g., toxicepidermal

necrolysis, Stevens-Johnson syndrome,

erythemamultiforme) to anyof its ingredients,including ritonavir

KALETRA is an HIV-1protease inhibitor

indicated incombination with

other antiretroviralagents for the

treatment of HIV-1infection in adults

and pediatricpatients

Pancreatitis,Hepatotoxicity,

Diarrhea, nauseaand vomiting,

abdominal pain,flatulence, insomnia

Instruct client toeat before takingthe oral solution

of medicationIn tablets, May

be taken with orwithout food,

swallowed wholeand not chewed,

broken, orcrushed

Generic Name: Lopinavir / Ritonavir

Brand Name: Oseltamivir


20/44

Laboratory

ResultsPrepared By:Ma. Theresa Abanilla


21/44

Pyuria- containing pus

Blood Typing: O, Rh +

Composition Results Normal Values Significance

Physical Properties

Protime: Normal

Urinalysis

Color

Transparency

Reaction (ph)STGR

Pale Straw

Hazy

6.01.010

Straw/Amber

Clear

4.5-7.81.001-1.035

Normal

Pyuria, Pacleriuria

Phosphate in

Urine

Normal

Normal

Date: October 1, 2013

Time: 5:00 PM


22/44

Chemical Test

Sugar

Albumin

Negative

Negative

Negative

Negative

Normal

Normal

Microscopic Findings:

Pus cells

RBC

Amorphous Urates

Squamous Epithelial

cells

0-2/hpf

4-5/hpf

Occasional

few

3-6/hpf

0-3/hpf

None

15-20/hpf

May indicate

infection

a disease

condition is often

present. One of themost common causesof RBC's in the urine, is

infection or

inflammation of the

urinary tract itself (i.e.,

cystitis).

can be caused by

gout

Normal


23/44

Hematology


Hemoglobin

HematocritRBC

WBC

Platelet Count

134 g/L

0.40 L/L4.67 10^g/L

11.21 10^g/L

427 10^ g/L

120-160 g/L

0.37-0.47 g/L4.2-5.4 10^g/L

4.5-11 10^ g/L

150-450 10^g/L

Normal

Normal

Normal

Normal

Normal

Afebrile


O2 Saturation

INR

95%

1.02

95-99%

2.0-3.0

Normal

blood clots more

quickly than

desired

Chest: CT Scan

Limit oral fluid intake to Liter per day

Maintain to high back rest

IVF to KVO


24/44


25/44

MEDICAL & SURGICAL

INTERVENTIONS


26/44

MEDICAL interventions

Ventilation with low tidal volumes (6 mL/kg of ideal body weight) in patients

requiring mechanical ventilation secondary to bilateral pneumonia or acute

respiratory distress syndrome (ARDS)

High doses of steroids to reduce swelling in the lungs.

Administer Antiviral, Antibiotic or Steroidal medications with proper

prescription from physician.

Endotracheal Tube

Pharmacological


27/44

Monitor Vital Signs.

An IV route is established to provide an accessible means for emergency

drug therapy.

Suctioning and bronchial hygiene Pulmonary toilet may include active

suction of secretions, chest physiotherapy, positioning to promote dependent

drainage, and incentive spirometry to enhance elimination of purulent sputum

and to avoid atelectasis.


28/44

MEDICAL interventions

Position the patient to semi- or high-fowlers position to minimize risk

of aspiration.

Be sure that all members of your household are washing their hands

frequently with soap and hot water or using an alcohol-based hand rub.

Wear disposable gloves if you will have direct contact with body fluids

of a person with SARS. However, wearing gloves is not a substitute for

good hand hygiene. After contact with body fluids of a person with SARS,

remove the gloves, throw them out, and wash your hands. Do not wash

or reuse the gloves.

Non-Pharmacological


29/44

Encourage the person with SARS to cover his or her mouth and nose with a

tissue when coughing or sneezing. If possible, the infected person should wear a

surgical mask during close contact with other people in the home. If the personwith SARS cannot wear a surgical mask, other members of the household should

wear one when they are in the room with that person.

Do not use silverware, towels, bedding, clothing, or other items that havebeen used by the person with SARS until these items have been washed with

soap and hot water.

Clean surfaces in the infected person's room and bathroom fixtures used by

this person daily with a household disinfectant used according to the

manufacturer's instructions. When cleaning, wear disposable gloves and dispose

of them after use. Household utility gloves may also be used.


30/44

Limit the number of people in the household to those who are essential for

patient support. Other household members should either be relocated or

minimize their contact with the infected person in the home. This is particularlyimportant for people at risk of serious complications of SARS (e.g., persons with

underlying heart or lung disease, diabetes mellitus, older age).

Unexposed people who do not have an essential need to be in the homeshould not visit.

For 10 days after your last exposure to the person with SARS, keep a vigilant

watch for signs of fever (i.e., measure your temperature twice daily), respiratory

symptoms, and other early SARS symptoms. If you do not have any of these

symptoms, you do not need to limit your activities outside the home. You may go

to work, school, out-of-home childcare, church, or activities in other public areas.


31/44

Follow any other instructions provided by local health authorities.

If you start feeling sick, especially if you develop a fever, respiratory

symptoms, or other early symptoms of SARS, contact your healthcare provider

immediately, and tell the healthcare provider that you have had close contact

with a SARS patient.


32/44

surgical intervention

Endotracheal insertion

Endotracheal intubation is a medical procedure in

which a tube is placed into the windpipe (trachea),through the mouth or the nose. In most emergencysituations it is placed through the mouth.


33/44

Endotracheal intubation is done

to:

Open the airway to give oxygen, medication,or anesthesia

Remove blockages from the airway

Allow the doctor to get a better view of theupper airway

Protect the lungs in certain patients


34/44

Patient position

The patient should be aligned without lateral deviation ofthe head or neck.

The head should be extended on the neck with a pillow

under the occiput. If cervical spine trauma is suspected,have an assistant provide in-line immobilization.

The neck should be flexed to approximately 15 degrees onthe chest.

Try to keep the external auditory meatus and sternalnotch in same horizontal plane (except infants or whencervical spine injury is present or suspected).


35/44

Nursing

Diagnosis


36/44

As evidenced by: GOAL INTERVENTION EVALUATION

Subjective:

-I cant breath wellbecause of my chestpain, as verbalized by

the patient.Objective:

-Difficulty of breathing- Shortness of breath

- Altered breath depth

- Timing ratio; prolonged

expiration phases

- Altered chest excursion

- Nasal flaring

- Grunting

v/s

TEMP: 35.7 C

BP: 120/80 mmHg

RR: 23 cpmPR: 110 bpm

After 4 hours of nursing

intervention, the patient

will able to do coping

mechanisms to improve

his breathing pattern

After 4 hours of nursing

intervention, the patient

did the coping

mechanisms to improve

his breathing pattern

Auscultate chest; to

evaluate pressure and

character of breath

sounds

- Administer oxygen at

lowest concentration

indicated and prescribed

repiratory medicationfor

management of

underlying pulmonary

condition



37/44

y

-Evaluate HOB or have

client sit up in chair, as

appropriate to promote

physiologic ease of

maximal inspiration

- Encourage

slower/deeper

respirations, use purse

lip technique, to assist

client in taking control of

the situation

- Monitor pulse oximetry,

as indicated to verify

maintenance in oxygen

saturation

- Maintain calm attitude

while dealing with the

client to limit level of

anxiety


38/44


Subjective:

- Questioning members

of the Heath Care Team.

- lack of questionsabout SARS- verbalizing inaccurate

information

Objective:

- unaware of proper

prevention methods- denial need to learn

After 2 hours, thepxatient will be able toverbalize the diseaseprocess, transmission,

treatment, andcomplications of SARS.

1.) Provide informationabout diseasetransmission.

2.) Provide informationabout diseaseprocess/complications.

3.) Provide informationon treatments.

4.) Provide informationon general protectionfrom SARS.

After 2 hours of nursingintervention, the patientwill be able to verbalizethe disease process,

transmission,treatment, andcomplications of SARS.


39/44


Subjective:

- general feeling of

discomfort

- body aches- headache- exposure to persons

with SARS

Objective:

- Temperature >38oC

for 2-7 days- Chills- Diarrhea- Non-productive

cough 2-7 days- hypoxia- positive diagnostic

test

After 8 hours of nursingintervention, the patientwill be able to maintainnormal body

temperature of 36-35oCAnd reduce therespiratory symptoms.

INDEPENDENT:1.) Monitor lung soundsand cough

2.) MonitorTemperature

3.) Monitor oxygensaturation

4.) Maintain respiratorycirculation:

keep tissues on thebedside dispose secretionsproperly

have the patientcover mouth when

Patient exhibits absenceof fever and absence ofrespiratory symptoms.Risk of spread of

infections is reduced.The goal was partiallymet.


40/44


have the patientcover mouth whensneezing or coughing use masks

have anyone enteringthe patients room wear

a mask keep door closed allthe time and placerespiratory isolation

sign visible assist visitors tofollow appropriateisolation techniques

5.) teach the patient towash hands after

coughing


41/44


6.) use appropriatetherapy to decreasetemperature

7.) encourage thepatient to cough unlessthe cough isnonproductive

8.) for patients withreduced energy, paceactivities

9.) provide a high-protein , high calorie,increase fluid diet insmall frequent servings.


42/44


DEPENDENT:

1.) Administer antiviralmedications as ordered.

COLLABORATIVE:1.) Consult a respiratorytherapist for chestphysiotherapy andnebulizer treatments

2.) Collect and monitordiagnostic results


43/44

ovel Corona virus Well-Adapted

to Humans, Susceptible to

ImmunotherapyFeb. 19, 2013 The new coronavirus that has emerged

in the Middle East is well-adapted to infecting humans

but could potentially be treated with immunotherapy,

according to a study to be published on February 19

in mBio, the online open-access journal of the

American Society for Microbiology. The study indicates

that the virus HCoV-EMC can penetrate the lining of thepassageways in the lung and evade the innate immune

system as easily as a cold virus can, signs that HCoV-EMC

is well-equipped for infecting human cells. The study

also reveals that the virus is susceptible to treatment

with interferons, components of the immune system

that have been used successfully to treat other viraldiseases, opening a possible mode of treatment in the

event of a large-scale outbreak.

American Society for Microbiology (2013, February 19).

Novel coronavirus well-adapted to humans, susceptible

to immunotherapy.ScienceDaily. Retrieved August 7,

2013, from http://www.sciencedaily.com-

/releases/2013/02/130219091010.htm


44/44

Documents

SARS powerpoint