Final for Printing(CAP HR, PTB FA) Respi Case

8/10/2019 Final for Printing(CAP HR, PTB FA) Respi Case

1/78


2/78


3/78

$'e res.iratory systemis com(osed o# t'e u((er and lo9er res(iratory tracts. $oget'er,

t'e t9o tracts are res(onsible #or ventilation=mo?ement o# air in and out o# t'e air9ays>. $'e

u((er res(iratory tract, can accom(lis' gas e:c'ange. Gas e:c'ange in?ol?es

deli?ering o:ygen to t'e tissues t'roug' t'e bloodstream and e:(elling 9aste gases, suc' as

carbon dio:ide, during e:(iration. $'e res(iratory system 9or


4/78

$'us, t'e air #inally reac'ing t'e lungs 'as many #e?er irritants =suc' as dust or bacteria> t'an

9'en it entered t'e system, and it is 9arm and dam(.

0rgans of the Res.iratory System

7..er Res.iratory ract

!3 Nose

$'e nose is t'e only e:ternally ?isible (art o# t'e res(iratory system. During breat'ing,

air enters t'e nose by (assing t'roug' t'e nostrils, or nares. $'e interior o# t'e nose consists o#

t'e nasal ca?ity, di?ided by a midline nasal se(tum. $'e ol#actory rece(tors #or t'e sense o#

smell are located in t'e mucosa in t'e slitli &n

addition, t'e stic


5/78

e:(osed to t'e air. $'e conc'ae also increase t'e air turbulence in t'e nasal ca?ity. As t'e air

s9irls t'roug' t'e t9ists and turns, in'aled (articles are de#lected onto t'e mucus/coated

sur#aces, 9'ere t'ey are tra((ed and (re?ented #rom reac'ing t'e lungs.

23 Pharyn8

$'e ('aryn: is a muscular (assage9ay about -7cm =5 inc'es> long t'at ?aguely

resembles a s'ort lengt' o# red garden 'ose. Commonly called t'e t'roat, t'e ('aryn: ser?es as

a common (assage9ay o# #ood and air. &t is continuous 9it' t'e nasal ca?ity anteriorly ?ia t'e

(osterior nasal a(erture.

Air enters t'e su(erior (ortion, t'e naso('aryn:, #rom t'e nasal ca?ity and t'en descends

t'roug' t'e oro('aryn: and laryngo('aryn: to enter t'e laryn: belo9. Food enters t'e mout'

and t'en tra?els along 9it' air t'roug' t'e oro('aryn: and laryngo('aryn:. +ut instead o#

entering t'e laryn:, #ood is directed into t'e eso('agus (osteriorly.

Clusters o# lym('atic tissue called tonsils are also #ound in t'e ('aryn:. $'e ('aryngeal

tonsil, o#ten called adenoid, is located 'ig' in t'e naso('aryn:. $'e (alatine tonsils are in t'e

oro('aryn: at t'e end o# t'e so#t (alate, as are t'e lingual tonsils, 9'ic' lie at t'e base o# t'e

tongue.

#3 Laryn8

$'e laryn: or ?oice bo: routes air and #ood into t'e (ro(er c'annels and (lays a role in

s(eec'. 0ocated in#erior to t'e ('aryn:, it is #ormed by eig't rigid 'yaline cartilages and a

s(oon/s'a(ed #la( o# elastic cartilage, t'e e(iglottis. $'e largest o# t'e 'yaline cartilages is t'e

s'ield/s'a(ed t'yroid cartilage, 9'ic' (rotrudes anteriorly and is commonly called t'e Adams

a((le. $'e e(iglottis (rotects t'e su(erior o(ening o# t'e laryn:. 'en 9e are not s9allo9ing,

t'e e(iglottis does not restrict t'e (assage o# air into t'e lo9er res(iratory (assages. 'en 9e

s9allo9 #ood or #luids, t'e laryn: is (ulled u(9ard and t'e e(iglottis ti(s, #orming a lid o?er t'e

o(ening o# t'e laryn:. anyt'ing ot'er t'an air enters t'e laryn:, a coug' re#le: is triggered to

e:(el t'e substance and (re?ent it #rom continuing into t'e lungs.


6/78

*art o# t'e mucous membrane o# t'e laryn: #orms a (air o# #olds, called t'e ?ocal #olds,

or true ?ocal cords, 9'ic' ?ibrate 9it' e:(elled air. $'is ability o# t'e ?ocal #olds to ?ibrate

allo9s us to s(ea bronc'i are #ormed by t'e di?ision o# t'e trac'ea. ac'

main bronc'us runs obliquely be#ore it (lunges into t'e medial de(ression ='ilum> o# t'e lung on

its o9n side. $'e rig't main bronc'us is 9ider, s'orter, and straig'ter t'an t'e le#t.

Consequently, it is t'e more common site #or an in'aled #oreign obBect to become lodged. +y t'e

time incoming air reac'es t'e bronc'i, it is 9arm, cleansed o# most im(urities, and 9ell

'umidi#ied. $'e smaller subdi?isions o# t'e main bronc'i 9it'in t'e lungs are direct routes to

t'e air sacs.


7/78

23 Lungs

$'e lungs occu(y t'e entire t'oracic ca?ity e:ce(t #or t'e most central area, t'e

mediastinum, 9'ic' 'ouses t'e 'eart, t'e great blood ?essels, bronc'i, eso('agus and ot'er

organs. $'e narro9 su(erior (otion o# eac' lung, t'e a(e:, is Bust dee( to t'e cla?icle. $'e

broad lung area resting on t'e dia('ragm is t'e base. ac' lung is di?ided into lobes by #issures

t'e le#t lung 'as t9o lobes, and t'e rig't lung 'as t'ree, because t'e 'eart ta bet9een t'em. During breat'ing, air comes do9n t'e trac'ea and t'roug' t'e bronc'i

into t'e al?eoli. $'is #res' air 'as lots o# o:ygen in it, and some o# t'is o:ygen 9ill tra?el across

t'e 9alls o# t'e al?eoli into t'e bloodstream. $ra?elling in t'e o((osite direction is carbon


8/78

dio:ide , 9'ic' crosses #rom t'e blood in t'e ca(illaries into t'e air in t'e al?eoli and t'en

breat'ed out.

Consequently, t'e lungs are mostly air s(aces. $'e balance o# t'e lung tissue, its stroma,

is mainly elastic connecti?e tissue t'at allo9s t'e lungs to recoil (assi?ely as 9e e:'ale. $'us, in

s(ite o# t'eir relati?ely large size, t'e lungs 9eig' only about 2 E (ounds, and t'ey are so#t and

s(ongy.

#3 Dia.hragm

&t is res(onsible #or 5 o# air in t'e lungs t'e 25 contribute to t'e intercostal muscle.

&t is a large dome s molecule called sur#actant, 9'ic' coats

t'e gas/e:(osed al?eolar sur#aces and is ?ery im(ortant in lung #unction.


9/78


10/78

(roduces a (artial ?acuum. Air continues to mo?e into t'e lungs until t'e intra(ulmonary

(ressure equals atmos('eric (ressure.

23 48.iration

:(iration =e:'alation> in 'ealt'y (eo(le is largely a (assi?e (rocess t'at de(ends more

on t'e natural elasticity o# t'e lungs t'an on muscle contraction. As t'e ins(iratory muscles rela:

and resume t'eir initial resting lengt', t'e rib cage descends and t'e lungs recoil. $'us, bot' t'e

t'oracic and intra(ulmonary ?olumes decrease. As t'e intra(ulmonary ?olume decreases, t'e

gases inside t'e lungs are #orced more closely toget'er, and t'e intra(ulmonary (ressure rises to

a (oint 'ig'er t'an atmos('eric (ressure. $'is causes t'e gas to #lo9 out to equalize t'e (ressure

inside and outside t'e lungs. Under normal circumstances, e:(iration is e##ortless, but i# t'e

res(iratory (assage9ays are narro9ed by s(asms o# t'e bronc'ioles =as in ast'ma> or clogged

9it' mucus o# #luid =as in c'ronic bronc'itis or (neumonia>, e:(iration becomes an acti?e

(rocess. &n suc' cases o# #orced e:(iration, t'e intercostal muscles are acti?ated to 'el( de(ress

t'e rib cage, and t'e abdominal muscles contract and 'el( to #orce air #rom t'e lungs by

squeezing t'e abdominal organs u(9ard against t'e dia('ragm.

$'e normal (ressure 9it'in t'e (leural s(ace, t'e intra(leural (ressure, is al9ays

negati?e, and t'is is t'e maBor #actor (re?enting colla(se o# t'e lungs. #or any reason t'e

intra(leural (ressure becomes equal to t'e atmos('eric (ressure, t'e lungs immediately recoil

com(letely and colla(se.

Res.iratory Sounds

As air #lo9s into and out o# t'e res(iratory tree, it (roduces t9o recognizable sounds t'at

can be (ic. Vesicular breathing soundsoccur as air

#ills t'e al?eoli. $'e ?esicular sounds are so#t and resemble a mu##led breeze.

Decreased res(iratory tissue, mucus, or (us can (roduce abnormal sounds suc' as

crackles=a bubbling sound> and wheezing=a 9'istling sound>.


11/78

48ternal Res.iration( -as rans.ort( and Internal Res.iration

External respiration is t'e actual c'ange o# gases bet9een t'e al?eoli and t'e blood

=(ulmonary gas e:c'ange>, and internal respiration is t'e gas e:c'ange (rocess t'at occurs

bet9een t'e systemic ca(illaries and t'e tissue cells. All gas e:c'anges are made according to

t'e la9s o# di##usion t'at is, mo?ement occurs to9ard t'e area o# lo9er concentration o# t'e

di##using substance.

48ternal Res.iration

During e:ternal res(iration, dar< red blood #lo9ing t'roug' t'e (ulmonary circuit is

trans#ormed into t'e scarlet ri?er t'at is returned to t'e 'eart #or distribution to t'e systematic

circuit. Alt'oug' t'is color c'ange is due to o:ygen (ic


12/78

1:ygen is trans(orted in t'e blood in t9o 9ays. !ost attac'es to 'emogloblin molecules

inside t'e R+Cs to #orm oxyhemoglobin %b12. A ?ery small amount o# o:ygen is carried

dissol?ed in t'e (lasma.

!ost carbon dio:ide is trans(orted in (lasma as t'e bicarbonate ion =%C17/>, 9'ic'

(lays a ?ery im(ortant role in t'e blood bu##er system. A smaller amount =bet9een 2 and 7

(ercent o# t'e trans(orted C12> is carried inside t'e R+Cs bound to 'aemoglobin. Carbon

dio:ide carried inside t'e R+Cs binds to 'emoglobin at a di##erent site t'an o:ygen does, and so

it does not inter#ere in any 9ay 9it' o:ygen trans(ort. +e#ore carbon dio:ide can di##use out o#

t'e blood into t'e al?eoli, it must #irst be released #rom its bicarbonate ion #orm. For t'is to

occur, bicarbonate ions must enter t'e red blood cells 9'ere t'ey combine 9it' 'ydrogen ions to

#orm carbonic acid. Carbonic acid quic is a?ailable to s(eed u( t'is

reaction. $'en t'e bicarbonate ions di##use out into (lasma, 9'ere t'ey are trans(orted. At t'e

same time, o:ygen is released #rom 'emoglobin, and t'e o:ygen di##uses quic


13/78

23 R4$DIN-S

Pneumonia


14/78

*neumonia is an in#lammation o# t'e lung in 9'ic' some or all o# t'e al?eoli, interstitial

tissue, and bronc'ioles become edematous and #illed #luid or blood cells as a result o# in#ection

or irritation by c'emical agents. *roli#eration o# in#ecting (at'ogens can lead to a ?ariety o#

(at'ologic and clinical #eatures, de(ending on 'ost resistance and ?irulence o# t'e organisms.

$'e immunocom(romised, 'os(italized, ?ery young, and ?ery old are at greatest ris< #or serious

lo9er res(iratory tract in#ections.

Community $cquired Pneumonia

$'e term community/acquired (neumonia is used to describe in#ections #rom organisms

#ound in t'e community rat'er t'an in t'e 'os(ital or nursing 'ome. &t is de#ined as an in#ection

t'at begins outside t'e 'os(ital or is diagnosed 9it'in 84 'ours a#ter admission to t'e 'os(ital in

a (erson 9'o 'as not resided in a long term #acility #or -8 days or more be#ore admission.

Community/acquired (neumonia may be #urt'er categorized according to ris< o# mortality and

need #or 'os(italization based on age, (resence o# coe:isting disease, and se?erity o# illness as

determined by ('ysical e:amination, laboratory, and radiologic #indings.

y.es of Pneumonia

+acterial .neumonia

*eo(le o# all ages are susce(tible to bacterial (neumonia, but debilitated or (ost/o(erati?e

(eo(le, alco'olics, and (eo(le 9it' reduced immunity are most ?ulnerable. *neumococcus

="tre(tococcus (neumoniae> is t'e organism t'at causes about o# all bacterial (neumonias,

and is one ty(e o# (neumonia #or 9'ic' t'ere is a ?accine. *neumococcal (neumonia o#ten

#ollo9s a ?iral in#ection suc' as a cold or #lu t'at 'as 9ea


15/78

Viruses cause about 'al# o# all (neumonias. Alt'oug' most ?iruses sim(ly cause a cold or

#lu, ot'ers can cause (neumonia, es(ecially in c'ildren. Viral (neumonias are common in in#ants

and young c'ildren but rare in adults. Antibiotics, 9'ic' are e##ecti?e against bacteria but not

?iruses, are not 'el(#ul #or t'is ty(e o# (neumonia. !ost ?iral (neumonias are s'ort/li?ed and go

a9ay on t'eir o9n, but a small (ercentage can be se?ere or e?en #atal. *eo(le 9it' decreased

immune systems are susce(tible to (neumonias caused by cytomegalo?irus =C!V> and ot'er

'er(es ?iruses, as 9ell as rubeola and adeno?irus. Res(iratory syncytial ?irus =R"V> and (ara/

in#luenza ?iruses are t'e most common ?iral causes o# (neumonia in in#ants and c'ildren. Viral

(neumonias can also lead to secondary bacterial in#ections.

yco.lasma .neumonia

!yco(lasma is t'e tiniest li?ing organism and is t'e most common cause o# (neumonia

in (eo(le age 5 to 75. &t is res(onsible #or u( to 5 o# adult (neumonias and an e?en 'ig'er

(ercentage o# (neumonias in sc'ool/age c'ildren. !yco(lasma (neumonia =sometimes re#erred

to as Laty(icalL or L9al most o#ten occurs in t'e s(ring and tends to s(read

t'roug' con#ined grou(s, suc' as students, military (ersonnel, and #amilies. Alt'oug' it can be

se?ere, myco(lasma (neumonia is usually mild, e?en 9'en le#t untreated. %o9e?er, some (eo(le

e:(erience long/lasting 9ea


16/78

may return later. 0egionnaireKs disease accounts #or - to 4 o# all (neumonias and is most

common among middle/aged and older (eo(le. $'e organisms t'at cause t'e (neumonia

=0egionella s(ecies> li?e in 9ater, and outbrea is t'e most common cause o# CA* in (eo(le younger

t'an M years o# age 9it'out comorbidity and in t'ose M years and older 9it' comorbidity. ".

(neumoniae, a gram/(ositi?e organism t'at resides naturally in t'e u((er res(iratory tract,

colonizes u((er res(iratory tract and can cause disseminated in?asi?e in#ections, (neumonia and

ot'er lo9er res(iratory tract in#ections, and u((er res(iratory tract in#ections, suc' as otitis

media and r'inosinusitis. &t may occur as lobar or bronc'o(neumonic #orm in (atients o# any

age and may #ollo9 a recent res(iratory illness.

%3 influen


17/78

Smo&ing/ men and 9omen 9'o smo alco'ol and drug use or abuse is closely associated 9it' t'e

de?elo(ment o# (neumonia. First, alco'ol acts as a sedati?e and diminis'es t'e re#le:es

t'at trigger coug'ing and sneezing. Alco'ol also inter#eres 9it' 9'ite blood cells t'at

destroy bacteria and ot'er microbes.

$ge > (eo(le younger t'an - year or older t'an M5 are more li


18/78

also se?eral di##erent systems o# classi#ying CA* based on #actors suc' as age.

According to t'e guidelines de?elo(ed by t'e American $'oracic "ociety, (ersons

younger t'an M years o# age, 9'o are 9it'out comorbidity and 9'o can be treated on an

out(atient basis are (ersons 9'erein t'e in#ecting organisms can remain con#ined to t'e

lungs or t'ey can cause bacteremia or se(sis.

*neumonia is most li


19/78

$'e smallest air9ays in your lungs terminate in tiny air sacs called al?eoli, 9'ere blood

cells e:c'ange carbon dio:ide #or o:ygen. &n CA*, al?eoli contain bacteria t'at may enter t'e

bloodstream during gas e:c'ange. &n#ection t'en s(reads t'roug' t'e bloodstream, (otentially

causing s'oc< and #ailure o# multi(le organs.

Se.tic shoc&

Unc'ec

e?aluated #rom around t'e 9orld 9ere t'e #ollo9ing )ort' America =22>, uro(e =24>, 0atin

America =2->, and Asia6A#rica =2>.


20/78

&n Asian studies in 9'ic' t'e *'ili((ines contributed 5.4 o# t'e (atients, t'e incidence

o# aty(ical (at'ogens among 355 cases o# CA* =out(atient and in(atient> 9as 25.2. !i:ed

in#ection 9as #ound in -.2. Anot'er study s'o9ed an o?erall (re?alence o# 27.5 in Asian

countries.

$'e *'ili((ine (re?alence data o# aty(ical (at'ogens is 87 in 'os(italized (atients

=in(atient>. $'ey occurred eit'er as sole (at'ogens in -- or as (art o# mi:ed in#ection =72>.

anagements

$'e treatment o# (neumonia includes administration o# t'e a((ro(riate antibiotic as

determined by t'e results o# a Gram stain.

!anagement o# CA* includes blood cultures (er#ormed quic in (atients in

9'om CA* is strongly sus(ected.

&n t'e out(atient setting, em(irical treatment o# CA* is o#ten used, t'at is, treatment

based on t'e clinicians estimation o# li is recommended.

For out(atients 9it' CA* 9'o 'a?e cardio(ulmonary disease or ot'er modi#ying #actors,

treatment s'ould include a res(iratory #luoroquinolone =mo:i#lo:acin, gemi#lo:a:in or

le?o#lo:acin> or a beta/lactam agent =ce#(odo:ime or ce#uro:ime> (lus a macrolide.

$9o ?accines are a?ailable to (re?ent (neumococcal disease t'e (neumococcal

conBugate ?accine =*CV-7> and t'e (neumococcal (olysacc'aride ?accine =**V27

*neumo?a:>. $'e (neumococcal conBugate ?accine is (art o# t'e routine in#ant

immunization sc'edule in t'e U.". and is recommended #or all c'ildren P 2 years o# age

and c'ildren 2/8 years o# age 9'o 'a?e certain medical conditions. $'e (neumococcal

(olysacc'aride ?accine is recommended #or adults at increased ris< #or de?elo(ing

(neumococcal (neumonia.


21/78

Antibiotics o#ten used in t'e treatment o# t'is ty(e o# (neumonia include

(enicillin, amo:icillin and cla?ulanic acid =Augmentin, Augmentin XR>, and macrolide

antibiotics including eryt'romycin =/!ycin, ryc, ry/$ab, *C, *ediazole,

&losone>, azit'romycin =Qit'roma:, Q/!a:>, and clarit'romycin =+ia:in>. *enicillin 9as

#ormerly t'e antibiotic o# c'oice in treating t'is in#ection.

Pulmonary u*erculosis

$uberculosis =$+> is an in#ectious disease t'at (rimarily a##ects t'e lung (arenc'yma and

mar


22/78

&n#ants 'a?enKt yet de?elo(ed strong enoug' immune systems to 9ard o## toug' bacterial

in#ections li


23/78

$'is could be anyone 9'o li?es 9it' or 9or

Coug'ing u( blood

:cessi?e s9eating, es(ecially at nig't

Fatigue

0o9/grade #e?er

Unintentional 9eig't loss

1t'er sym(toms t'at may occur 9it' t'is disease

+reat'ing di##iculty

C'est (ain

'eezing

Crac


24/78

Com.lications

it'out treatment, tuberculosis can be #atal. Untreated acti?e disease ty(ically a##ects your

lungs, but it can s(read to ot'er (arts o# t'e body t'roug' your bloodstream. :am(les include

+ones

"(inal (ain and Boint destruction may result #rom $+ t'at in#ects your bones. &n many

cases, t'e ribs are a##ected.

+rain

$uberculosis in your brain can cause meningitis, a sometimes #atal s9elling o# t'e

membranes t'at co?er your brain and s(inal cord.

Liver or &idneys

;our li?er and


25/78

Alt'oug' curable, an a?erage o# 5 Fili(inos die e?eryday because o# $+ and is identi#ied

as among t'e leading causes o# mortality in t'e country.

Dr. nrique "anc'o, 'ead o# t'e Communicable Disease Center #or %ealt' De?elo(ment/

Central Visayas, said t'at t'ree out o# -, Fili(inos are in#ected 9it' tuberculosis.

anagement

*ulmonary $+ is treated (rimarily 9it' antituberculosis agents #or M -2 mont's. A

(rolonged treatment duration is necessary to ensure eradication o# t'e organisms and to

(re?ent rela(se.

&n current $+ t'era(y, #our #irst/line medications are used, &)%, ri#am(in =Ri#adin>,

(yrazinamide, and et'ambutol =!yambutol>. Combination medications, suc' as &)% and

ri#am(in =Ri#amate> or &)%, (yrazinamide =*QA>, and ri#am(in =Ri#ater> and medications

administered t9ice a 9ee< are a?ailable to 'el( im(ro?e (atient ad'erence.

Ca(reomycin =Ca(astat>, et'ionamide =$recator>, (ara/aminosalicylate sodium, and

cycloserine ="eromycin> are second/line medications.

Recommended treatment guidelines #or ne9ly diagnosed case o# (ulmonary $+ 'a?e t9o

(arts an initial treatment ('ase and a continuation ('ase. $'e initial ('ase consists o# a

multi(le/medication regimen o# &)%, ri#am(in, (yrazinamide, and et'ambutol. $'is

initial intensi?e/treatment regimen is administered daily #or 4 9ee is usually administered 9it' &)% to (re?ent &)%/associated

(eri('eral neuro(at'y.


26/78


27/78

$*aton -raduate of

Christ

N Lacu*(

+atac(

Ilocos

Norte

Jonnel Abaton ! 27 " "on College

Under/

graduate

)one C'urc'

o# C'rist

+rgy. -/)

0acub,

+atac,

&locos

)orte

!rs. *erlita Abaton, 54 years old, is li?ing 9it' 'er youngest c'ild, Jonnel Abaton, and

'er 'usband, Ale:is Abaton "r. $'ere#ore t'ey are considered as a nuclear ty(e o# #amily. $'e

said #amily is considered as (atrilocal. $'ey li?e in +arangay -/) 0acub, +atac, &locos )orte.

$'e #amily o# !rs. *erlita Abaton is an egalitarian because s'e and 'er 'usband bot'

discuss and sol?e t'eir (roblems. And 9'en it comes to t'e budget o# t'e #amily, !rs. *erlita

Abaton is t'e one 9'o decides in t'is matter. Regularly, !r. Ale:is Abaton "r. earns money #or

t'eir #amily3Ale:is Abaton, "r. 9or


28/78

5. "a?ings 25 *'( 7,2

0$L !""B Ph. !#("""

According to !rs. *erlita Abaton, t'e #amily does not buy mineral 9ater #or drin


29/78

$3 Family %ealth %istory

%er grand(arents on bot' side already (assed a9ay but s'e doesnt

and neoze( =5mg #or adults>. $'ey use o?er/t'e/counter drugs suc' as (aracetamol and

biogesic 8 times a day #or 7 days to manage #e?er and 'eadac'eand also t'ey manage #e?er by

using HguyabanuI and HatsueteI lea?es by (lacing it at t'eir bac< and remo?e it until t'e lea?es


30/78

9ill get dry. For stomac'ac'e, t'ey usually drin< boiled gua?a lea?es glass to relie?e t'eir

(ain.

$'ey 'a?e also e:(erienced c'ild'ood illnesses suc' as c'ic


31/78

ta


32/78

c'urc'mates obser?ed t'at 'er condition 9orsened so 'er c'urc'mate Dr. Cocsontal


33/78

According to ric


34/78

+3 R0+4R %$;I-%7RS D4;4L0P4N$L $S@S %40R6

%a?ig'urst belie?es t'at learning is essential to li#e and t'at (eo(le continue to learn

t'roug'out li#e. %e describes gro9t' and de?elo(ment as occurring during si: stages, eac'

associated 9it' #rom si: to ten tas


35/78

T !rs Abatons leisure time is to clean t'eir 'ouse, se9ing clot'es, c'at 9it' t'eir neig'bor

and 9atc'ing 'er #a?orite $V s'o9. "'e s(ends time reading 'er bible in t'eir 'ouse.

5. Relate to s(ouse on a more intense basis/A$$A&)D

!rs. Abaton 9as able to ac'ie?e t'is tas< by s'aring t'eir (roblems 9it' 'er 'usband and

sol?ing it 9it'out arguing.

M3 Acce(t and adBust to ('ysiological c'anges o# middle age/A$$A&)D

"'e is able to adBust and acce(t to t'e ('ysiological c'anges t'at s'e undergoes. "'e said

t'at s'e acce(ts t'e c'anges in 'er body as s'e gets old. "'e added, Hnaubra< met amin nga


36/78

(ieces o# #is'=Galunggong>,

- E cu( o# rice and - banana.

For 'er snac< in t'e

a#ternoon s'e usually eats

biscuits at around 7(m. "'e

eats 'er dinner at around

47(m, eating t'e same

#ood eaten during 'er lunc'.

47(m, s'e eats t'e same

#ood eaten during 'er lunc'.

(ieces o# (andesal and - egg

=%ard +oil>. For 'er lunc' at

-2nn 9it' - cu( o# rice, E

cu( o# inabra9 and 'al# slice

bangus. "'e eats 'er dinner

at , s'e eats t'e ration

gi?en by t'e 'os(ital sta##s.

$N$L6SIS,

$'ere is a c'ange in t'e eating (attern be#ore 'os(italization and during 'os(italizationbecause 'er a((etite decreased due to 'er illness. $'ere 9as also a slig't c'ange regarding on t'e

time t'e (atient ta. %er total #luid

inta and s'e

drin. %er total

#luid inta and s'e

drin. %er total

#luid inta


37/78

$'ere is an alteration in t'e drin


38/78

$'ere is no signi#icant c'ange in t'e bo9el elimination o# !rs. Abaton, 'o9e?er, t'ere is

a c'ange in t'e color in t'e bo9el o# !rs. Abaton because o# t'e Ri#am(icin s'e 9as ta


39/78

+4F0R4 ILLN4SS+4F0R4

%0SPI$LIE$I0N

D7RIN-

%0SPI$LIE$I0N

!rs. Abaton ta


40/78

$'ere is an alteration in t'e ('ysical acti?ity o# *erlita as com(ared to be#ore illness

because s'e 9as 'os(italized and t'at s'e easily gets tired o# doing 'er daily routines due to 'er

sic


41/78

in t'eir community. "'e also

attends outreac' (rograms o#

t'eir c'urc'.

(atients inside t'e 9ard. During

t'e inter?ie9 o# t'e student

nurses, s'e ne?er 'esitated to

ans9er t'e questions being as


42/78

(rays be#ore going to slee(. "'e

stands #irm in #ait' des(ite trials

and di##iculties in li#e. "'e

attends #ello9s'i( in t'eir

c'urc' e?ery "unday.

al9ays reads t'e bible and (rays

to God to (ro?ide 'er needs and

as


43/78

RR, 28 b(m

%eight, 5I2

Weight, 84

Unable to read com(uterized 9ords 9it' a #ont size o# -2 at a distance o# - #oot

but s'es able to read 9it' 'er reading glasses.

AR"

Color is t'e same 9it' #acial s


44/78


45/78

"ymmetrical mo?ement during res(iration

+o9el sounds (resent e?ery 5/-26min and occurs 5/- seconds

With a scar *elo: her um*ilicus( 9 inches in length

5. U**R X$R!&$&"

"


46/78

1n t'e #irst day o# a((raisal, !rs. Abaton 9as seen lying on bed. "'e 9as 9earing 9'ite

s'irt and gray colored leggings. "'e 'as an &VF o# *)"" at 5 cc le?el regulated to 7

gtts6min.

1n t'is day, s'e 9as 9ea< and uncon?ersant and 'ad a com(laint o# 'eadac'e. 'eezing

u(on auscultation at t'e lo9er lobe o# 'er le#t lung is still (resent. %er coug' is dee( and

un(roducti?e. "'e 9as seen and e:amined by Dr. $omas and ne9 orders 9ere made suc' as

continue medicine, &VF to #ollo9 D5)"" - 0Y28 'ours and #acilitate s(utum collection, nebulize

(atient 9it' *)"" 2cc (rior to collection. "'e urinated 4 times and de#ecated once on t'is day.

At 4 (m, !rs. Abaton 9as #ebrile 9it' a tem(erature o# 7.3 C. At - (m o# t'e same date, Dr.

+igornia ordered *aracetamol 7 mg &V. $'en 'er V6" 9as ta


47/78

s(utum collection #or AF" and &VF D5)"" -0:-2 'ours. "'e urinated 4 times and de#ecated

once during t'e day.

#3 $ugust 21( 2"!2 5 # P

;ital Signs

+P, -264 --6 mm%g

em., 7.7 7M.4 C

PR, 45 42 b(m

RR, 22 2 b(m

1n t'e t'ird day o# a((raisal, !rs. Abaton 9as sitting on bed, #air in a((earance and

con?ersant. "'e 'as an &VF o# D5)"" to WV1 at 3 cc le?el. "'e 'as still t'e com(laint o#

un(roducti?e coug'. %e 9as seen and e:amined by Dr. $omas 9it' ne9 order made and carried

out suc' as re(eat C'est X/ray *A. "'e urinated 3 times and de#ecated once during t'e day.

3 DI$-N0SIC PR0C4D7R4S

C0PL44 +L00D C07N 'C+C)

$'e com(lete blood count or C+C test is used as a broad screening test to c'ec< #or suc'

disorders suc' as anaemia, in#ection and many ot'er diseases. $'e com(lete blood count test is

(er#ormed by obtaining a #e9 millilitres =one to t9o teas(oons> o# blood sam(le directly #rom

t'e (atient. &t can be done in many settings including t'e doctors o##ice, laboratories, and

'os(itals. $'e s


48/78

area o# cleansed s


49/78

stimulating #actors are named #or t'e cell (o(ulation t'ey stimulate. +lood trans(orts 9'ite blood

cells to sites o# in#ection. 'ite blood cells may t'en lea?e t'e bloodstream.

Segmenters ? $'ese are t'e most common o# t'e +Cs and ser?e as t'e (rimary de#ense against

in#ection. $'e ty(ical res(onse to in#ection or serious inBury is an increased (roduction o#

neutro('ils.

Neutro.hils? $'ey are a (art o# +C, 9'ic' is t'e #irst one to launc' at t'e site o# tissue inBury.

)eutro('ils are t'e #irst ty(e o# immune cell to res(ond to and arri?e at t'e site o# in#ection,

o#ten 9it'in an 'our. )eutro('ils 9ill res(ond to in#ection inside t'e body, but also on t'e

sur#ace, as in t'e case o# gastric mucosal erosion.

Lym.hocytes? are usually only slig'ty larger t'an red blood cells. A ty(ical lym('ocyte 'as a

large, round nucleus surrounded by a t'in rim o# cyto(lasm. $'ese cells account #or 25/75 o#

circulating leu. osino('ils ma


50/78

+lood 7rea Nitrogen '+7N) > a serum test t'at measures t'e amount o# nitrogenous urea, t'e

end (roduct o# (rotein metabolism.

Creatinine > a test measures t'e amount o# creatinine in t'e serum. Creatinine is an end (roduct

o# (rotein and muscle metabolism.

Sodium > maintains (lasma and interstitial osmolarity res(onsible #or generation and

transmission o# action (otential. &t is res(onsible also #or t'e acid/base balance.

Potassium > it is #or intracellular osmolarity and #or maintaining electrical membrane

e:citability.

Pur.ose,$o identi#y t'e (resence o# in#ection and to determine 9'et'er t'e (atient 'as enoug'

de#ense mec'anism in #ig'ting t'e illness and done to monitor t'e condition and6or e##ecti?e o#

treatment a#ter a diagnosis is establis'ed.

!3 $ugust !G( 2"!2

0rdered *y, Dr. $omas

est Result Reference Ranges Inter.retation

%ematology

C+C

%emoglo*in L /G3"" g60 -27/-57 D4CR4$S4D

%ematocrit L "32G .75/.88 D4CR4$S4D

R+C L #3" -Y-260 8.5/5.- D4CR4$S4D

ean Cell ;olume L 1/3!" #0 4/- D4CR4$S4D

!C%C concentration 7-.- g6d0 7-/75 )1R!A0

W+C % !#3"G -Y360 8.5/--. INCR4$S4D

Di##erential Count

"egmenters

.M7 .5/. )1R!A0

Lym.hocytes L "3!1 .2/.8 D4CR4$S4D

onocytes % "3!! .2/.4 INCR4$S4D

4osino.hils % "3"/ .-/.8 INCR4$S4D

+aso('ils .- ./.- )1R!A0

Platelet Count % 1!" -Y360 -5/85 INCR4$S4D


51/78


52/78

C'emistry

+lood Urea )itrogen 2.M3 !mol60 -/./4.7 )1R!A0

Creatinine M8.5M Umol60 88.2/-5.7 )1R!A0

$N$L6SIS,

$'ere is an increase in t'e (latelet count due to t'e (resence o# in#ection and

in#lammation at t'e (leura o# t'e lungs. $'e increase o# monocytes indicates t'e (resence o# a

bacterial in#ectious (rocess. %o9e?er, a lo9 lym('ocyte count indicates still t'e (rolonged

illness occurred to !rs. Abaton.

#3 $ugust 2( 2"!2

est Result Reference Ranges Inter.retation

%ematology

C+C

%emoglobin -2M.g60 -27/-57 )1R!A0

%ematocrit .8 .75/.88 )1R!A0

R+C 8.43-Y-260 8.5/5.- )1R!A0

!ean Cell Volume 4.4#0 4/- )1R!A0!C%C concentration 7-.3 g6d0 7-/75 )1R!A0

W+C % !A3#9 -Y360 8.5/--. INCR4$S4D

Di##erential Count

"egmenters

. .5/. )1R!A0

Lym.hocytes L "3!" .2/.8 D4CR4$S4D

onocytes % "3!2 .2/.4 INCR4$S4D

$N$L6SIS,

$'e increase in +C indicates in#ection and in#lammatory (rocess 9'ile t'e increase in

monocytes also indicates t'e (resence o# a bacterial in#ectious (rocess. %o9e?er, a lo9

lym('ocyte count indicates t'at !rs. Abaton e:(erienced (rolonged illness.


53/78

Nursing Res.onsi*ilities Rationale

-. :(lain (rocedure to t'e (atient.

2.For9ard laboratory request to laboratory

7. Follo9 u( laboratory results

8. U(on arri?al o# t'e result, re#er it to t'e

('ysician and t'en attac' it to t'e clients

c'art.

5. Re#er accordingly signi#icant results

/to gain coo(eration

/#or (ro(er consideration o# s(eci#ic (rocedure

/to


54/78

Con#luent 'aziness bases

%eart is not enlarged

*ulmonary ?ascularities are 9it'in normal

Visualized osseous structures are unremar


55/78

$N$L6SIS,

$'ere is a tuberculous t'at in#iltrates on bot' lungs 9'ic' means t'at t'ere is irritation

and in#lammation on 'er lungs 9'ic' causes 'er to coug' as t'e de#ense mec'anism o# t'e body.


-. C'ec< i# t'e laboratory request 9as

a((ro(riately #illed u( and (ro(erly

#or9arded to t'e laboratory.

$o ma


56/78

I3 4DIC$L $N$-44N

$3 DI4 %4R$P6

D$ 'Diet as olerated)

Date of ordered, 4/-3/-2

0rdered *y, Dr. Arnul#u $omas

Indication, $'is is a #ood (re(aration 9'ic' (ro?ides adequate nutrients, carbo'ydrates,

(roteins, #ats, ?itamins and minerals in t'eir normal (ro(ortion.

Pur.ose, $'is is indicated to our client to (ro?ide good and adequate nutrition #or t'e client to

gain strengt' and to 'a?e greater resistance against in#ection.

N7RSIN- R4SP0NSI+ILII4S R$I0N$L4

-. C'ec< t'e doctors order #or t'e

c'ec< o# diet.

2. $ranscribe in t'e diet t'at t'e client

is already DA$.

7. &nstruct t'e son or relati?e as 9ell

as t'e client t'at 'e is in so#t diet

and t'e im(ortance o# t'e diet.

8. *ro?ide meals or #ood in an

attracti?e manner.

5. *romote (ersonal 'ygiene and

$o a?oid error

$o in#orm t'e dietician t'at t'e client is

already on DA$.

$o gain com(liance.

$o en'ance a((etite.


57/78

en?ironmental sanitation.

M. &nstruct client to eat #oods ric' in

carbo'ydrates li


58/78

8. Assess t'e site #requently #or t'e

(resence o# redness, s9elling and

(ain, blanc'ing o# t'e s


59/78

!easurement and recording o# all #luid inta


60/78


61/78


-. )oti#y t'e blood ban< t'at a

trans#usion 9ill occur

2. :(lain t'e (rocedure #or gi?ing

blood trans#usion

7. Assist in obtaining t'e s(ecimen and

ma


62/78

43 N4+7LIE$I0N

&t is t'e (rocess o# using a nebulizer 9'ic' is an in'aler de?ice used to treat

ast'ma and allergies. $'e in'aler aerosolizes medication to 'el( reduce in#lammation and

dilate air (assages. $'e treatments are used as a (re?entati?e measure against acute

allergic reactions or as a treatment during ast'ma attac


63/78

II3 DR7- S7D6

DR7- S7D6 J!

Date ordered, 4/2M/-2

0rdering .hysician, Dr. +igornia

-eneric name, *aracetamol

+rand name, Ae


64/78


65/78

&soniazid may in'ibit cell 9all biosynt'esis by inter#ering 9it' li(id and D)A synt'esis,

bactericidal.

*yrazinamide bacteriostatic against mycobacterium tubecolosis, mec'anism o# action un

t'ambutol %Cl gi?en to t'e client #or t'e treatment o# bot' smear (ositi?e (ulmonary and e:tra

(ulmonary $+

Side effect, Ri#am(icin diarr'ea, nausea and ?omiting, 'eadac'e, dro9siness, anore:ia, sore

mout', #lus'ing

&soniazid C)" (eri('eral neuro(at'y, seizures, to:ic ence('alo(at'y

G& nausea and ?omiting, e(igastric distress, bilirubinemia,

%ematologic a(lastic anemia, t'rombocyto(enia, 'y(erglycemia, metabolic

acidosis,

%y(ersensiti?ity s


66/78


67/78

Ri#am(icin.

M. ducate (atient t'at 9'en s'e

e:(eriences gastric irritation, s'e

s'ould ta


68/78

2. &nstruct t'e (atient about t'e 9ater

needed 9'en dissol?ing.

7. &nstruct t'e (atient to mi: drug

(ro(erly.

8. &nstruct (atient to increase oral #luid

inta


69/78

Dosage and frequency, - mg6 5 mg6 -5 mcg 1D

Route, oral

echanism of action, 'el( maintain 'ealt'y ner?ous system and blood cell #ormation.

Desired effect, Vit +- +M +-2 9as gi?en to our (atient to increase 'is energy.

Side effect, %eadac'e, blac< stools, abdominal (ain, consti(ation, nausea and ?omiting,

dizziness.

$dverse effect, "9elling o# t'e #ace or tongue, di##iculty o# breat'ing, tig'tness in t'e c'est and

discoloration o# t'e s


70/78

-eneric name, Ce#tria:one "odium

+rand name, %a:on

Classification, Antibacterial

Dosage and frequency, 2 g6 1D

Route, &V

echanism of action, t'e bacteriacidal acti?ity o# ce#tria:one results #rom in'ibition o# t'e cell

9all synt'esis. &t 'as a 'ig' degree o# stability in t'e (resence o# beta/lactamase, bot'

(enicillinase and ce('alos(orinase o# gram/negati?e and gram/(ositi?e.

Desired effect, t'is drug 9as gi?en to t'e (atient #or t'e resolution o# signs and sym(toms o#

in#ection, negati?e culture re(orts.

Side effect,

0ocal reaction (ain, induration or tenderness at t'e site o# inBection

%y(ersensiti?ity ras', (ruritis, #e?er, c'ills

%ematologic eosino('illia, t'rombocytosis, leu


71/78

$dverse effect,(ain, duration at t'e site o# inBection ras', eosino('ilia, t'rombocytosis and

leu


72/78

Desired effect, t'is drug 9as gi?en to t'e client #or restoration o# s


73/78

7. &n#orm (atient (ossible e##ects o#

t'e drug.

8. *ro?ide sa#ety en?ironment suc' as

raise side rails.

5. Do re?erse isolation.

$o decrease (ossibility o# accident during

seizures.

$o (re?ent acquiring ot'er

illness6com(lication.

DR7- S7D6 J

Date ordered, 4/2-/-2

0rdering .hysician, Dr. Arnul#u $omas

-eneric name, Am(icillin sodium Z "ulbactam sodium

+rand name, "ulbacin

Classification, Antibacterial

Dosage and frequency, -.5 g e?ery 4 'ours

Route, &V

echanism of action, in'ibits cell 9all synt'esis during bacterial multi(lication.

Desired e##ect t'is drug 9as gi?en to t'e client #or t'e resolution o# in#ection and sym(tomatic

im(ro?ement.

Side effect,

G& diarr'ea, nausea, (seudomembrane colitis

%ematologic agranulocytosis, leu


74/78


-. C'ec< #or sensiti?ity o# t'e drug

=A)"$>

2. Veri#y doctors order.

7. Ad?ise (atient to re(ort any

discom#ort a#ter in#using.

8. &ns(ect ?ial.

5. A#ter reconstitution solution s'ould

stand.

M. !onitor #or signs and sym(toms o#

'y(ersensiti?ity reaction.

. atc' #or bleeding tendency.

C'ec< #or any reaction

$o (re?ent errors

$o (re?ent t'e occurrence o# ot'er in#ection

and to


75/78

Route,)ebule in'alation

echanism of action, in'ibit ?agally mediated re#le:es by antagonizing acetylc'oline at

muscarinic rece(tor or bronc'ial smoot' muscles.

Desired effect, to im(ro?e air9ay e:c'ange and breat'ing (atterns, decrease 9'eezing and

dys(nea.

Side effect,

C)" dizziness, 'eadac'e,

CV c'est (ain, (al(itations

G& G& distress

!uscos


76/78

nebulization. $o c'ec< i# t'e client is doing t'e (ro(er

9ay o# nebulization.

DR7- S7D6 J/

Date ordered, 4/-3/-2

0rdering .hysician, Dr. Arnul#u $omas

-eneric name, Azit'romycin

+rand name, Qit'roma:

Classification, antibiotic, mac?olide

Dosage and frequency, 5 mg $&D

Route, oral

echanism of action, binds to t'e "1" subunit o# bacterial ribosome, bloc


77/78

$dverse effect, )ausea, abdominal discom#ort, ?omiting, #latulence, diarr'ea and loose stool,

%earing im(airment, interstitial ne('ritis, acute renal #ailure, abdominal li?er #unction, dizziness,

con?ulsions, 'eadac'e, somnolence, reduced lym('ocyte count, increase eosino('il count,

reduced blood bicarbonate


-. Do sensiti?ity test be#ore gi?ing t'e

#irst dose.

2. $ell (atient to ta


78/78

III3 -4N4R$L 4;$L7$I0N

!rs. *erlita, 54 years old #rom +rgy. -/) 0acub, +atac, &locos )orte 9as admitted at

!ariano !arcos !edical %os(ital and !edical Center on August -3, 2-2 5 57 *! by Dr.

Cocson6Dr. $omas 9it' a diagnosis o# +ronc'ial Ast'ma 9it' Acute :acerbation, Community

Acquired *neumonia $6C *$+. "'e 9as attended by Dr. Cocson6Dr. $omas 9'o immediately

(er#ormed se?eral tests to 'er condition. "'e 9as subBected to se?eral laboratory tests suc' as

C+C and c'est :/ray 9'erein t'e #irst diagnosis 9as con#irmed.

$'e #ollo9ing managements 9ere medications li, *ulmonary

$uberculosis Far Ad?ance =FA>. %ome meds 9ere (rescribed and #ollo9/u( consultations 9ere

ad?ised and sc'eduled.

Documents

Final for Printing(CAP HR, PTB FA) Respi Case