Pnemonia powerpoint

8/7/2019 Pnemonia powerpoint

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PNEUMONIA


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Introduction

Patients Data

Source and Reliability of Information Reason for seeking care/Chief complaint

History of present illness

Past medical history

Family history

Functional Assessment

Review of Systems

Anatomy and Physiology: Respiratory System

Pathophysiology

Laboratory Dug Study

Problem List

Nursing Care Plan

Progress Report


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INTRODUCTION

Pneumonia is a form of infection that affects

the lungs and this infection may be caused bya variety of different organisms.

Even newly born babies as young as 2 to 3

months old may develop pneumonia and this

is called INFANT PNEUMONIA.

Such pneumonia may occur due to group B

streptococcus or respiratory syncytial virus.


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Signs & Symptoms fever

chills

cough

unusually rapid breathing

breathing with grunting or wheezing sounds

labored breathing that makes a child's rib musclesretract

vomiting

chest pain

abdominal pain

decreased activity

loss of appetite (in older kids) or poor feeding (in

infants)

in extreme cases, bluish or gray color of the lips and

fingernails

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Incubation period

The incubation period for pneumoniavaries, depending on the type of virus or

bacteria causing the infection (for

instance, respiratory syncytial virus, 4 to

6 days; influenza, 18 to 72 hours).

Duration

With treatment, most types ofbacterial pneumonia can be cured within

1 to 2 weeks. Viral pneumonia may last

longer. Mycoplasmal pneumonia may

take 4 to 6 weeks to resolve completely

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PATIENTSDEMOGRAPHIC

DATA


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SOURCE & RELIABILITY OF INFORMATION

REASON FOR SEEKING CARE/CHIEFCOMPLAIN

HISTORY OF PRESENT ILLNESS

PAST MEDICAL HISTORY

FAMILY HISTORY


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Grandfather

Hypertension

Grand-

Mother

A & WA

Grand-

Mother

A & W

Grandfather

A & W

Father

A & W

Mother

A & W

Patient J. C.

PneumoniaBrother

A & W

Brother

A & W

F

A

M

I

L

Y

H

I

S

TO

R

Y


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FUNCTIONALASSESSMENT


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Health Perception/Health Maintenance

Self Esteem/Self Concept/Self

Perception

Activity/Exercise Pattern

Nutrition/Elimination Process

Sexuality/Reproductive Health

Sleep/Rest pattern

Intrapersonal relationship

Coping stress management/Tolerancepattern

Personal Habits

Environmental Hazards

F

U

N

CT

I

O

N

A

L

A

S

S

ES

S

M

E

N

T


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REVIEWOF

SYSTEM


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SYSTEMS JULY 22, 2010 JULY 24, 2010

General Status Awake, lying in bedconscious

Sleeping, lying in bed

conscious

Vital Signs

TP

R

4pm

36.9C144

41

8pm

37.0C142

57

TP

R

4pm

37.1C138

42

8pm

37.0C141

45

Integument Afebrile with temp of 36.9CWith fair skin color

With good skin turgor

No lesions present

Afebrile with temp of 36.9C

With fair skin color

With good skin turgor

No lesions present

Neurological Has social smileHas binocular vision

Flexes extremities

Has social smile

Has binocular vision

Flexes extremities


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HEENT y with slightly sunken fontanels

y no head injury

y no lesions noted on head

y has binocular vision

y ears are properly aligned

y responds when called by gazing

at the person who called

y no nasal discharges noted

y no nasal flaring noted

y With dry cough

y no head injury

y no lesions noted on head

y has binocular vision

y ears are properly aligned

y responds when called by gazing

at the person who called

y no nasal discharges noted

y no nasal flaring noted

y With dry cough

Cardiovascular y with normal heart rate of 144

bpm

y no edema noted

y with good capillary refill of 2.0

secs

y with normal heart rate of 144

bpm

y no edema noted

y with good capillary refill of 2.0

secs

Respiratory y with clear breath sounds on

both lungs upon auscultation

y shallow and rapid breathing

pattern

y with clear breath sounds on

both lungs upon auscultation

y shallow and rapid breathing

pattern


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Gastrointestinal NPO temporarily

Bowel elimination duringshift is 0

NPO temporarily

Bowel elimination duringshift is 0

Genitourinary UO during shift is 1 diaper UO during shift is 1 diaper

Musculoskeletal With active flexion of

extremities

With active flexion of

extremities


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PATHOPHYSIOLOGY


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Viruses

Bacteria

Fungi

Other parasites

Immune system

(Inflammatory response)

rapid breathing,

fever, chills

presence of mucous

secretions

y coughS/SX

Presence of

pathogens

Blood vessels within the lungs

congest

Less area for exchange of O

and CO

Protein rich fluid seeps

into the alveoli

Breathing

becomes faster

Debris also fills

the alveoli

gas exchange

Fluid continues

to fill alveoli

Debris

results from

WBC

fighting the

infection


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LABORATORY


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Procedure/Test Result Normal Values Significance Nursing Implication

Hemoglobin

83 M: 170-170

F: 120-140

Decreased Anemia, hemorrhage,

leukemia

Hematocrit 0.23 M: 0.44-0.48 Decreased Anemia, hemorhage, leukemia

RBC count 2.7 M: 4.5-5.0

F: 4.0-4.5

Decreased Anemia, hemorhage, leukemia

WBC count 10.4 5.0-10.0 Slightly increased Acute bacterial infection

Platelet count 403 150-

400/cu.mm.

Slightly increased May indicate infection

Differential countSegmenters

Lymphocytes

0.23 (.40-.60) DecreasedIt is the first defense of thebody against antigen

0.77 (.20-.40) increased

May indicate acute bacterial

infection


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DRUG STUDY


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Name of Drug Classification Dosage/Route/

Frequency

Indication/

Contraindication

Side effects Mechanism of

Action

Nursing Consideration

Generic name:

Ampicillin

Brandname:

Novamox

Date ordered:

July 19, 2010

Penicill in 100mg TIV q6 Indication:

Used to treat UTI, otitis

media, uncomplicated

CAP, Haemophilus

influenzae, salmonellosis

and Listeria meningitis.

Contraindication:

Hypersensitivity to

ampicillin, any

component of theformulation, or other

penicillins.

Most common:

Inflammation and

redness of tongue;

irritation of mouth

and throat; mild

diarrhea; nausea;

second infection;

vomiting.

Allergic:

Skin rashes, erythema

GI:

Diarrhea, abdlcramps, N&V

CNS:

Dizziness, insomnia,

fatigue

Hematologic:

Agranulocytosis,

thrombocytopenia

Renal:

Oliguria, hematuriaMiscellaneous:

Hepatotoxicity,

superinfection,

anorexia

Inhibits bacterial

cell wall synthesis

by binding to one

or more of the

penicillin binding

proteins (PBPs);

which in turn

inhibit the final

transpeptidation

step of

peptidoglycan

synthesis inbacterial cell walls,

thus inhibiting cell

wall biosynthesis.

yDuring first 30 min

of IV therapy,

monitor closely for

S&S of

hypersensitivity

reactions

y Ensure adequately

hydrated. Assess for

diarrhea and S&S of

superinfection.

y Inject slowly,

because IM and IVadministration

causes a great deal

of local irritation

y Take as directed,

finish the course of

therapy

y For oral, take with a

glass of water 1 hr

or 2 hr after mealsto minimize binding

with foods which

may cause GI upset


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Frequency

Indication/

Contraindication


Action


Generic name:

Gentamycin Sulfate

Brand name:

Garazin

Date ordered:

July 19, 2010

Aminoglycoside 20mg TIV OD Indication:

Treatment of infections in

biliary tract, skin and UTI

and immunocompromised

patients in intensive care;

brucellosis, cat scratch

disease, cystic fibrosis,

endocarditis, endomeritis,

gastroenteritis, granuloma

inguinale, listeriosis,

meningitis, otitis externa,

pelvic inflammatory disease,

peritonitis, plague,pneumonia, septicemia;

burns and ulcer; acute

pyelonephritis. Prophylaxis

of surgical infections.

Contraindication:

Hypersensitivity to

aminoglycosides. Patients

with myasthenia gravis,

Parkinsonism and conditioncharacterized by muscle

weakness. Increased risk of

ototoxicity and

nephrotoxicity at high

plasma conc. May damage

the 8th cranial nerve of fetus

in pregnant women.

General:

ototoxicity and

nephrotoxicity

Renal:

Nephrotoxicity

Nervous system:

dizziness, vertigo,

ataxia, tinnitus, and

roaring in the ears.

Musculoskeletal:

neuromuscular

blockade

Respiratory:respiratory depression

and respiratory arrest.

Hematologic:

anemia, leukopenia,

granulocytopenia,

Hepatic:

transient

hepatomegaly, and

increases in serum

transaminase, serumLDH, and bilirubin

Cardiovascular:

hypotension and

hypertension.

Gastrointestinal:

nausea, vomiting,

weight loss, decreased

appetite, increased

salivation.

Broad-spectrum

antibiotics believed

to inhibit protein

synthesis by binding

irreversibly to

ribosomes, thereby

interfering with an

initiation complex

between messenger

RNA and 30S

subunit. This leads

to prodn of non-

functional proteins;polyribosomes are

split apart and are

unable to

synthesize protein.

Usually bactericidal

due to disruption of

the bacterial

cytoplasmic

membrane

y Report S&S of

superinfection or other

adverse effects.

y Do not mix with other

drugs for parenteral

use.

y Finish the course of

therapy

y Monitor VS and I&O;

increase fluids to

prevent renal tubule

irritation

y

Monitor drug levely Assess for ototoxicity


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Frequency

Indication/

Contraindication


Action


Generic name:

Salbutamol

Neb

Brandname:

Ventolin

Date ordered:

July 19, 2010

Sympathomimetic neb + 2cc NS

q4 thru

facemask ,

shifted to:

Q6

July 21, 2010

shifted to:

Q8

July 23, 2010

Indication:

Prophylaxis and

treatment of

bronchospasm due

to reversible

obstructive airway

disease. Inhalation

solution for acute

attacks of

bronchospasm.

Prophylaxis ofexercise-induced

bronchospasm

Contraindication:

Aerosol for

prevention of

exercise-induced

bronchospasm and

tablets are notrecommended for

children less than 12

years of age. Use

during lactation.

Most common:

Headache, N&V,

palpitations/tachycardi

a, tremor,

bronchospasm

GI:

Diarrhea, dry mouth,

appetite loss

CNS:

Hyperkinesia,

Excitement, tremorRespiratory:

Cough, wheezing, dry

throat

CV:

Palpitations, BP

changes,

Hypersensitivity:

Urticaria, angioedema,

rashMiscellaneous:

Flushing, Sweating, bad

or unusual taste

Stimulates beta-

2 receptor of the

brochi, leading

to

bronchodilation.

Causes less

tachycardia and

is longer-acting

than

isoproterenol.

Has minimalbeta-1 activity.

Available as an

inhaler that

contained no

fluorocarbons.

y Take as directed. Do

not increase dosage

or take more

frequently than

prescribed

y Monitor VS; assess

CV response

y Position patient in

upright to aid in

postural drainage

y

Perform CPT topromote good

respiratory hygiene

y Review technique for

use/care of inhalers

and respiratory

equipment

y Advised parents to

increase fluid intake,

to aid in liquefyingsecretions and

removal.


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PROBLEM LIST

Rank Actual Problem Date

Identified

Date

resolved

1 Ineffective airway clearance July 22, 2010 July 22 2010

2 Altered nutrition July 22, 2010

Rank Potential Problem Date

Identified

Date

resolved

1 Regurgitation upon feeding July 22, 2010


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NURSING CARE PLAN


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Assessment Nursing

Diagnosis

Nursing Plan Nursing Intervention Rationale Expected

outcome

Subjective:

Inuubosya asverbalized by the

mother

Objective:

y RR - 57 cpm

y With dry cough

y Restless

y With clear breath

sounds on both

lung field upon

auscultation

Ineffective airway

clearance related topresence of mucus

secretions in the

tracheobroncial

tree secondary to

disease condition as

manifested by dry

cough

Short term:

at the end of theshift, the patient,

with the help of

his mother will

demonstrate

behaviors to

improve airway

clearance

Long term:

at the end of the

patients

hospitalization,

the patients

coughing will be

lessened or

expectorated

y Assess contributing

factorsy Monitor VS esp. RR

y Ausculate lungs

y Note rate and depth of

respirations and

breathing pattern

y Position head

appropriate for

age/condition

y Monitor infant/child forfeeding intolerance,

abdl distention and

emotional stressors

y Encourage mother to

perform CPT to patient

y Observe for S&S of

infection

y Keep back dry

y Maintain adequate

ventilation

y To know what might

have triggered thecondition

y To know if there is

abnormal breathing


abnormal sounds


abnormality In breathing

pattern; indicative of

respiratory distressand/or accumulation of

secretions

y To open or maintain

airway at rest in at-rest

or compromised

individual

y To maximize effort

y To help loosen

secretions

y To identify infectious

process/promote timely

intervention

y To avoid further

complication

y To help in breathing

y Mother will be

seen back-tapping the

patient


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Assessment Nursing

Diagnosis

Nursing Plan Nursing

Intervention

Rationale Expected

outcome

Subjective:

apat na araw na

syang di kumakain

as verbalized by the

mother

Objective:

y With slightly

sunken

fontanels

y Status NPO

y Restless

Altered nutrition

related to inability

to be breast-fed

secondary to


manifested by

regurgitation upon

feeding

Short term:

At the end of the

shift, the patients

mother will be able

to demonstrate

ways t o to feed

again the patient

Long term:

at the end of the

patients

hospitalization, the

patient will be back

to its normal state

before his

confinement

y Note age, body

build, strength,

activity/rest level,

etc.

y Aid in treating the

patients cough

y Teach proper

positioning upon

feeding: upright

position

y Teach importance

of breastfeeding

y Teach importance

of good hygiene

and clean

environment

y Helps determine

nutritional needs

y So that he can be

fed again without

regurgitation

y To avoid

possibility of

aspiration

y Breast milk is a

good source of

vitamins and

gives protection

to the baby

y To aid in

preventing

further infection

y Patient will be

back to its normal

state


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Assessment Nursing Diagnosis Nursing Plan Nursing Intervention Rationale Expected

outcome

Objective:

y

withregurgitation

upon feeding

y with presence of

cough

Risk for aspiration

related to presence ofcough secondary to


manifested by

regurgitation upon

feeding

Short term:

at the end of theshift, the patients

mother will be able

to demonstrate

ways to avoid

patient from

experiencing

aspiration.

Long term:

At the end of the

patients

hospitalization, the

patient will be able

to be breast-fed

again without

regurgitation

y Assess clients ability to

swallow and strength ofgag/cough reflex and

evaluate

amount/consistency of

secretions

y Advise mother to

position the patients

head upright upon

feeding

y Assist with posturaldrainage

y Auscultate lung sounds

frequently

y Determine best resting

position for infant/child

y Help to determine

presence/effectiveness of protective

mechanism

y To avoid possibility

of aspiration

y To mobilize

secretions that may

interfere with

swallowing

y To determinepresence of

secretions

y Upper airway

patency is

facilitated by

upright position and

turning to right

sided decreases

likelihood of

damage to trachea.

y The patient will be

able to be breast-fed again without

experiencing

regurgitation


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PROGRESS REPORT


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P

R

OG

R

E

S

S

R

E

P

O

R

T

When the patient was admitted, he was put into NPO because of his

regurgitation problem but then after 5 days, the doctor ordered for

liquid diet because he can now be breast-fed without regurgitating.

The patient is not seen coughing anymore.After almost 6 days of hospital confinement, the patients now

referred for discharge and may go home the following day, with take

home meds of as follows: Amoxicillin hydrate drops (Novamox) 0.6

ml TID until July 29, 2020 and Salbutamol neb (Ventolin) neb + 2ml

NSS 3x a day until July 28, 2010.

July 22, 2010

From my first day of handing patient J.C. there a good progress, his

coughing and airway is better than the day he was admitted. My

admitting VS for that day was Temp of 36.9C, HR of 144 bpm and RR

of 41 cpm. He is sleeping most of the time and when he cries

because of hunger, his mother gave him a pacifier instead of milkbecause he is NPO.

July 24, 2010

Patient J.C. has progressed well. He is no longer coughing

and is now allowed to a liquid diet. He is for referral for discharge

and may go home the following day.

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Pnemonia powerpoint