My little case study and a brief discussion about Pneumonia in general. Constructive criticisms and reactions are welcomed. I'm still a nursing student, so I would like to thank you guys in advance for helping me to learn more. :)

1. PNEUMONIA Submitted To: Sir. Javier Submitted By: Mitch Angela P. Roderos BSN III-C Grp. 1 SDCA

2. GlobalSituation Pneumonia is a common illness in all parts of the world. It is a major cause of death among all age groups and is the leading cause of death in children in low income countries. In children, many of these deaths occur in the newborn period. The World Health Organization estimates that one in three newborn infant deaths are due to pneumonia.Over two million children under five die each year worldwide and it is estimated that up to 1 million of these (vaccine preventable) deaths are caused by the bacteria Streptococcus pneumoniae, and over 90% of these deaths take place in developing countries. ortality from pneumonia generally decreases with age until late adulthood with increased mortality in the elderly.

3. Local Situation Pneumonia remains in the list of the leading causes of morbidity and mortality in the Philippines. It ranked third among the causes of morbidity and fourth among the causes of death in 2000. The region with the highest reported mortality rate from pneumonia is Western Visayas (74.6 deaths per 100,000 population) followed closely by Ilocos (73.7 per 100,000) and Cagayan Valley (59.2 per 100,000) with ARMM having the lowest reported death from pneumonia at 2.5 deaths per 100,000 followed by Central Mindanao (15.6 per 100,000) and Western Mindanao (21.3 per 100,000) (PHS 2000).

4. Risk Factors Conditions that produce mucus or bronchial obstruction and interfere with normal lung drainage (eg, cancer, cigarette smoking, COPD) Immunosuppressed patients and those with a low neutrophil count (neutropenic) Smoking; cigarette smoke disrupts both mucociliary and macrophage activity Prolonged immobility and shallow breathing pattern Depressed cough reflex (due to medications, a debilitated state, or weak respiratory muscles); aspiration of foreign material into the lungs during a period of unconsciousness (head injury, anesthesia, depressed level of consciousness), or abnormal swallowing mechanism Nothing-by-mouth (NPO) status; placement of nasogastric,orogastric, or endotracheal tube Antibiotic therapy (in very ill people, the oropharynx is likely to be colonized by gram-negative bacteria) Alcohol intoxication (because alcohol suppresses the body’s reflexes, may be associated with aspiration, and decreases white cell mobilization and tracheobronchial ciliary motion) General anesthetic, sedative, or opioid preparations that promote respiratory depression, which causes a shallow breathing pattern and predisposes to the pooling of bronchial secretions and potential development of pneumonia Advanced age, because of possible depressed cough and glottic reflexes and nutritional depletion Respiratory therapy with improperly cleaned equipment

5. Pathophysiology Alteration or resistance to normal flora present in oropharynx Activation of inflammatory response in the alveloi Exudates interferes with diffusion of oxygen and carbon dioxide Lungs are not adequately ventilated because of secretions and mucosal edema that cause partial occlusion of the bronchi or alveoli, Ventilation Perfusion Mismatch on the affected area of the lung

6. Signs & Symptoms Pneumonia varies in its signs and symptoms depending on the organism and the patient’s underlying disease. shaking chills rapidly rising fever pleuritic chest pain that is aggravated by deep breathing and coughing. Tachypnea upper respiratory tract infection (nasal congestion, sore throat) mucoid or mucopurulent sputum Orthopnea increased tactile fremitus percussion dullness bronchial breath sounds, egophony, and whispered pectoriloquy cheeks are flushed and the lips and nailbeds demonstrate central cyanosis (a late sign of poor oxygenation [hypoxemia]).

7. Diagnostic Exams

10. Intravenous antibiotic and may be Immunotherapy or combination therapy.

11. Hydration (fever and tachypnea may result in insensible fluid losses)

12. Bed rest

13. Oxygen Therapy

14. Antipyretics may be used to treat headache and fever

15. Antitussive medications may be used for the associated cough.

16. Warm, moist inhalations are helpful in relieving bronchial irritation.

17. Antihistamines may provide benefit with reduced sneezing and rhinorrhea.

18. Nasal decongestants may also be used to treat symptoms and improve sleepCOMMUNITY ACQUIRED PNEUMONIA HOSPITAL ACQUIRED PNEUMONIA GENERAL

19. SurgicalManagement Endotracheal intubation Mechanical ventilation.

20. Nursing Care Plan “Masakitangkanangdibdibkopaghumihingaako” as verbalized by the patient With vital signs as follows: Temp: 36 c PR: 23 RR: 78 BP: 110/80 Afebrile With good skin turgor with anictericsclerae with pink palpebral conjunctiva with mild pain on right chest Ineffective breathing pattern related to accumulation of tracheobronchial secretions as manifested by dyspnea secondary to pneumonia

21. Nursing Care Plan To expectorate secretions Received patient on bed with ongoing IVF #3 PNSS 1 L regulated at 10 gtts/min inserted at left metacarpal vein infusing well at 800 cc level Conscious and Coherent Oriented to time, place and person Established rapport Vital Signs taken & recorded I & O monitored Instructed NPO when dyspneic Observed for any untoward reaction Chest Physiotherapy rendered such as: Pursed Lip breathing Bronchial Cupping Deep Breathing exercises Increased Oral fluid intake Provided psychological & emotional support Kept back dry Instructed proper & oral body hygiene Encouraged to perform Activities of Daily Living

22. Nursing Care Plan (+) right chest pain Afebrile With latest Vital signs Temp: 36 c PR: 81 RR: 24 BP: 120/80 With latest #3 Plain NSS level of 410 cc

23. Photo Documentation Pneumococcal pneumonia

24. Drug Study Cefuroxime AzithromycinCelecoxib Salbutamol Ranitidine

30. Learning Feedback Diary DAY 1: SEPTEMBER 19,2010 Dear Sir Regen, This was my very first duty with a shift of 10pm to 4 am at General Emilio Aguinaldo Hospital. I haven’t seen you very often that is why I am not very familiar of our clinical instructor who will be with us, which is Sir. Javier. But I have heard comments that You assign lots of tasks on students giving out a term of “nanonoxic.” In our duty, Sir thought us on how to chart with the use of SOAPIE approach, he even thought us on what to browse and pay attention to when you are asked to endorsed. The whole midnight shift was fun and tiring. We did our vital signs and met different kinds of patients. We charted and truly assessed our patients. It was very nice and a worthwhile activity. S – The skills that I have learned for this day was charting, the “WHAT to Look” in the patient’s chart and enhanced our vital signs taking. K - How to chart on legal documents with the use of SOPIE. A – Our 10-4pm shift has made us feel sleepy, but we need to be focused and alert. We have to be observant on our patient to achieve accurate assessments. MITCH ANGELA P. RODEROS BSN III-C GRP.1 SDCA We need to be snappy to get rid the feeling of drowsiness

31. Learning Feedback Diary DAY 2: SEPTEMBER 20,2010 Dear Sir Regen, For the second day of our duty, our patients are under the case of Pulmonary Diseases. We took their vital signs and did our SOAPIE charting. I have learned what is more appropriate realistic interventions on patient’s with pulmonary diseases. I hoped our shift is due on morning, so that we could even perform lots of interventions and learn more to our patient. We also took vital signs on cardiovascular department, mostly composed of geriatric patients which filled my heart with empathy, it kind of reminds me of my father. I was given a chance to perform male catheterization on the patient. S - I have learned the skill on how to catheterize, enhanced our Charting, Vital signs and Aseptic techniques K- I have learned that you have to insert the catheter swiftly to reduce the pain felt by the patient. A - I have to provide client’s privacy at all times, explain the procedure to the patient and reduce the patient’s anxiety. MITCH ANGELA P. RODEROS BSN III-C GRP.1 SDCA Nurses provides empathy, not sympathy

32. The End THANK YOU!