PNEUMOTHORAX

SULTAN KUDARAT EDUCATIONAL INSTITUTIONCOLLEGE OF NURSING

TACURONG CITY

A CASE STUDY:

PNEUMOTHORAXIn partial fulfilment of the requirement in NCM 103.

Submitted by:Manguiat,Ma. Christelle Erazo,Myra Ylona Jean Hornada, Jhonna Mae Gaguil, Asheiya JaneMartinez,Shiela Mae Gante, Kristine Jill Doce,Kristine JoyHinong, Ian Mark Maulana,Zuhanie

Mata,RechelEsmail,Orfha

This paper contains all explicit and

necessary data and information with regards to a patient having Pneumothorax. Moreover, the said data information had been justified accurately through verification with the aid related literature and other sources of references.

However, the confidentiality of our patient and his loved ones is safeguarded. Hence, their privacy was secured.

GENERAL OBJECTIVES To gain knowledge, skills, understand the

disease condition and proper attitude towards the case of client having Pneumothorax, to enable us to render quality nursing care and do our role in health promotion.

SPECIFIC OBJECTIVES>Define the disease Pneumothorax.>To broaden the horizon regarding the disease

condition – its anatomy and physiology, its pathopshysiology, its treatment, as well as its nursing management.

>To render the ideal nursing care based on the client’s need and response towards interventions.

>To do health teachings not just to our client but also to the common people.

The ward exposure in Sultan Kudarat Doctors Hospital contributes a lot in developing our skills, knowledge and attitude as part of improving our nursing abilities. This serves as a challenge for our capacity to meet the needed requirements in making this case study.

A warm thank you to our Practicing Clinical Instructors (PCI) for helping us, for guiding us, for sharing your brilliant knowledge, for being sensitive and attentive to our needs for the completion of this case presentation, we really appreciate your support to us.

With great appreciation and respect, we express our thanks to the staff of Sultan Kudarat Doctors Hospital for allowing us to conduct our interview to our patient and do practice our nursing care, and for their participation to the success of this paper.

To our very supportive Clinical Instructor, Ms. Andilyn Alvarez – Gentica, RN, MAN, Ms. Nancy Aujero – Apoldo, RN and Sir. Renato Sionzon – Gleyo Jr. RN, MAN for their teachings, support and pieces of advice, we deeply appreciate your presence and guidance throughout the experience. We also recognize your help for directing us in the right path of nursing care process.

To our patient who really cooperate during our interview together with his family, thank you, for the permission to have his as our subject of case presentation. To our dear parents for your unconditional love, who have supported our financial concerns and serve as our inspiration to continue our education in spite of hardships and shorthcoming, we extend our heartily gratitude and appreciation.

Above all, to our Almighty God, Gracious and loving Father for sending us His Holy Spirit that serves as our light to have peace of mind, good health and self worth, we thank you for all these matters that drive us to the success of this case study.

Equipping oneself with knowledge about various kinds of disease is a necessity in nursing profession, as this may help enhance nurses ability to promote, restore and maintain health and even prevent occurrence of illness. Each case is unique in its own way through they all possess a particular characteristic, which is to impair a person’s health. Nurse should be knowledgeable in terms of preventing and giving proper intervention with those people who have a specific disease. And one of many different ways in giving more knowledge is through constant learning and discovery. This case study is tool in expanding knowledge about a particular disease that will help us in dealing with our future patients.

Health is the process through which the person seeks to maintain an equilibrium that promotes stability and comfort. Being unhealthy is a hindrance in people’s daily activities and it can reduce people’s happiness and contentment.

Our group was assigned in the general ward where we found this case, pneumothorax. We got interested and want to know more about this case.

A pneumothorax exist when air is another gas is introduced into the pleural space within the chest, causing the lung to collapse. It affects people at age of 50 but it can also affect younger people. It’s symptoms are sudden pain on the lungs, sudden chest pain and difficulty of breathing. The treatment for this is chest tube drainage.

Bleb- an accumulation of fluid under the skin. Bulla- a thin walled blister of the skin or mucous

membranes greater than 1cm in diameter containing clear, serous fluid.

Chest tube- a catheter inserted through the rib space, commonly used after chest surgery and lung collapse, to remove air 0r fluid.

Emphysema- an abnormal condition of the pulmonary system, characterized by over inflation and destructive changes in alveolar walls.

Pnemothorax- the presence of air in the pleural space, causing a lung collapse.

Postural drainage- the used of positioning to drain secretions from specific segments of the bronchi and the lungs into the trachea.

Case #: 104162 Name: Mr. NT Age: 70 yrs old Sex: Male Birth Date: December 19, 1939 Place of Birth: Isulan, S.K. Address: Isulan, S.K. Religion: Catholic Educational Attainment: Elementary graduate Occupation: Farmer Civil Status: Married Admitting physician: L.B. Daguio Jr. RN,RM Attending physician: Dr. Salvador Admitting diagnosis: Pneumothorax R, S/P, CTT R Chief complaints: Subcutaneous emphysema, DOB Final diagnosis: Pnaumothorax R s/to PTB3, CAP, Acute

gastritis, subcutaneous emphysema S/P CTT R

Date of admission: 08-04-10 @ 5pm Date of discharge: 08-16-10

SKPHIsulan, Sultan Kudarat

REFERRAL SLIP

Reffered to: HOC Date: 08-04-10 Patient’s Name: Tagle, Nemesio Address; Bless: Isulan Sultan Kudarat Age: 71 y.o. Sex: Male Civil Status: Married Working diagnosis: Pneumothorax R

Koch’s PneumoniaSubcutaneous emphysema

Management: CTT RCefuroxime 750mg IVTT q 8◦ x 20 dosesFluminicil 600mg ODSalbutamol nebulization q 8◦ PRN for dyspneaCaptopril 25mg 1tab PRN if BP is 160/100

Reason for referral: Amlodipine 10mg 1 tab OD

Lozartan 100mg 1 tab ODKetorolac 30mg IVTT q 8◦

Referred By: G. Montano MDAttending physician/ Resident

Noted: Isaias S. De Peralta Jr. MDChief of Hospital II

A.HISTORY OF PRESENT ILLNESS a.Usual health status

Client verbalized “ Nasudlan sang hangin ang operasyon ko. “

b.Chronologic story

Ten days prior to admission, patient experience difficulty of breathing, and consulted with Government Hospital and was diagnosed with Pneumothorax Right Chest Tube Therapy done, presented difficulty of breathing and subcutaneous emphysema and promoted transfer to other hospital.

c.Relevant Data

The usual illness that the patient’s family experienced are cough, fever, colds, stomachache and headache. They do sometimes believed that the cause of their illness was “ nabuyagan “ as what the family belief for. According to him he acquired his ulcer and gastritis to his mother and tuberculosis to his father. Some of his brothers and sisters acquired the disease of their parents. His 2 brothers died because of the cancer of the bones, while his sister died of appendicitis. His father died because of appendicitis and his mother died because of cancer of the bones.

PATERNAL MATERNAL PATIENT High blood Tuberculosis Appendicitis

Ulcer Cancer of the

bone Gastritis

Ulcer Tuberculosis Gastritis Cough Fever Stomachache Colds Headache

d.Disability assessment

According to patient everytime he experienced pain that occurred on his body he just rest and slept. Ptient was fun of drinking alcohol and smoking after work because for him it was his relaxant.

B. PAST HEALTH PROBLEM STATUS a.Childhood illness

Patient experienced stomachache and difficulty of breathing for several times. Sometimes experienced mild cough, colds, fever and headache and never been hospitalized.

b.Childhood ImmunizationNonec.AllergiesNo allergies identified

d.Medications-Tuseran and Lemon juice (cough)-Neozep (colds)-Paracetamol (fever and pain)

C.PATTERNS OF FUNCTIONINGa.Breathing patterns>Respiratory Problem:-Sometimes patient experiences difficulty of breathing>Usual Remedy-He just requested his wife to massage his back.>Manner of Breathing

Rate : 28 cpmRhythm : irregularDepth : shallowCharacter : effortless and noiseless

b.CirculationUsual blood pressure : 120/80 mmHgc.Sleeping patternsUsual bedtime : sleeps at 9pm and wakes 6amBedtime rituals : just sleep an hour after dinner and smoking.Problem regarding sleep : none

d.Drinking patterns Kinds of fluids intake:-Water ( approximately 5 glasses per day )-Coffee ( at least 2 cups per day )-Beer, Tanduay and Red horse ( 3 times a week ) e.Eating patternsBreakfast : bread, fried egg and fish, rice and 1 cup of coffeeLunch : rice, vegetable soup, dried fish and pinaksiwDinner : rice, vegetable soup, fried fish, ginataan and 1 cup of

coffee

f.Elimination patternsf.1 Bowel movements

Frequency : once a dayProblem : none

f.2 UrinationFrequency : 7 times in 24 hoursProblem : none

g.Personal hygieneg.1 Bath

Type : Full bathFrequency : 7 times in 1 week

g.2 Oral careSometimes go to dental clinic at least once year for his check-up and brush his teeth at least twice a day.

D.BRIEF SOCIAL, CULTURE AND RELIGIOUS BACKGROUND

Educational background : Elementary GraduateOccupation : FarmerReligious practices : Seldom goes to churchPerson significant to the patient : Family E.ENVIRONMENT

The house is located near the rice field and surrounded by tall grasses. There is presence of dust with unsanitary surroundings. Although they have proper garbage disposal still there is open drainage.

HEMATOLOGYDate : August 05, 2010

Physician : Dr. SalvadorRESULT NORMAL VALUES

CLINICAL SIGNIFICATION

INTERPRETATION

Hemoglobin mass concentration

178 g/L 140-170g/L high

Leukocyte # concentration

10.9x10 g/L 5.10x10 g/L high

Increased of leukocyte is due to inflammation & infection

LEUKOCYTE # FRACTION

Segmenters 0.85 0.55-0.65 highIncreased is due to infection

Lymphocytes 0.10 0.26-0.36 lowDecreased may be indicated defective lymphatic circulation

Eosinophils 0.05 0.02-0.04 high

Increased may be caused by a hyperimmune or allergic reaction

Erythrocytes Volume Fraction

0.55

HEMATOLOGY Date : August 05, 2010



INTERPRETATION


108 g/L 140-170g/L LowAnemia


8.9x10 g/L 5.10x10 g/L high








0.34

HEMATOLOGYDate : August 10, 2010



INTERPRETATION


141 g/L 140-170g/L normal


15.6x10 g/L 5.10x10 g/L high








0.44

CLINICAL LABORATORY CHEMISTRYDate : August 05, 2010

Physician : Dr. Salvador

Dr. Patrocinio N. Bella, FPSEClinical Patnologist

NORMAL VALUE

RESULT

DeterminationS.I Unit CON S.I Unit CON

Creatinine 61.8-124 0.7-1.4

124 mmole/L

1.4 mg/L

FBS4.2-6.4 75-115 8.5mmole 154mg/L

SGPTUp to 42 18m/L

CLINICAL LABORATORY CHEMISTRY Date : August 06, 2010

Physician : Dr. Salvador

Grace T. Larroza Medical Technologist

NORMAL

VALUES RESULT

Determination Method

UseS.I Unit CON S.I Unit CON

FBS

Enzymatic 4.2-6.4 75-115 8.9mmole 162.75

ROENTGENELOGIC REPOT

Date : August 04, 2010 Agency : SKDH

Diagnostic test : Chest X-rayExamination requested : Chest PA viewX-ray film # : 9517 Reading Observations :

Study taken with a thorocostomy tube inserted in the lower lateral aspect of the right hemithorax. Irregular lucencies are seen in the soft tissue overlying the chest and neck areas. This obscure the lung markings and band of lucency is noted in the lateral margin of the right hemithorax. There is hyperaeration bilaterally. The heart is not enlarged. The right costophrenic sulcus appears blunted. There is no definite fractures seen in the visualized asseous structures.

Impression/RemarksPneumohydrothoraxSubcutaneous emphysemaPulmonary hyperaerationPresence or absence of pulmonary infiltrates not ruled out

Michael Mañago, MD

ROENTGENELOGIC REPORT

Date : August 11, 2010 Agency : SKDHDiagnostic test : Chest X-rayExamination requested : Chest AP viewX-ray film # : 9517 Reading observations :

Study taken with two thoracostomy tubes inserted in the lower lateral aspect of the right hemithorax. Gas is noted in the soft tissue underlying the chest and neck areas. This obscure the lung markings. There is hyperaeration bilaterally. The heart is not enlarged. The right costophrenic sulcus is blunted.

Impression/RemarksSubcutaneous emphysemaPulmonary hyperaeration with numeral hydrothorax Michael Mañago, MD

8/4/10+Cough -Pls Admit DOB -Secure consent Subq - TPR q shift emphy -D5LR1L x 8hrs sema all -For CBC,Urinalysis,CXR over -Cefuroxime 750mg IVTT CXR+ q8hrs ANST Pneum -For reinsertion of CTT othor -Secure consent ax+ -For comanagement c Dr. Salvador -Refer accordingly :Daguio 6:25PM -Post op +Invasive -Moderate high back rest air leaks-Tramadol 200mg +

diclofinac

75mg in D5W 500cc x24hrs as SD-Cont. Meds-Refer :Daguio8/5/10

-Refer to Dr.Salvador,Pulmonogist ordered

-Cont Meds+ invasive -For insertion of posterm Subq CTT emphy -Secure consent sema -Transferred OR(DR) -Refer Dr. Acquiatan 12:00nn - ECG ordered now BP:130/ -Metronodazole 500mg IVTT 80 q 8hrs ANST -Ceftriaxone 1g IVTT Q8 ANST -D/C Cefuroxime IV -SGPT potassium repeat CBC. -O2 @ 3Lmin -Ranitidine 1g IVTT q 6hrs -Combivent 1neb q 6hrs -Relative appraise of pt. Cond. -High back rest position

8/5/10ISMN(imdur) 60mg ½ tabs OD+invasive -Post op Air leaks - DAT when awake Cutaneous -Cont IVF/Meds flaps done -Watchout for DOB -Moderate high back rest -Refer Dr.Acquiatan -Hydrocortisone 100mg IVTT q 8hrs/L 5 pm - BP q 4hrs/L PRN BP120/ -Refer 80 -D/C Ranitidine IV 9pm -MVT(Childrens

clusivol BP:120/80 syrup) 15ml OD -IVF PNSS 1L + Benotrix x 10/L

8/6/10

-Cont Meds-Increase CHON intake,3 eggs

white/meal-Refer accordingly Dr.Acob8/7/1010am -IVF PNSS 1l x 10/LBp:100/ -Cont Meds 70(-)Dyspnea5pm -Sinecod forte syrup

10ml 3x day(-)Dyspnea-Celestamine 1tab 2xday(-)Fever -IVF PNSS 1L +Benetrix

1 amp ANST x 12hrs/L -Rif,INH,Pyre 3x /day(81 tab,91

tab,10am 1 tab) -AlmagoH 10ml 4xdayA-Refer pm-CBC w/o

8/8/10-Cont Meds-IVF PNSS 1Lx10hrs3:50pm -Post insertion of CTT-Cont IVF/Meds-O2 inhalation at 4-5 Lpm-Refer5pm -Captropil 25mg 1 tab

PO Q6 PRN for BP>150/908/9/10-IVF PNSS 1Lx14hrs-Increase sinecod forte 15ml

3xday-Cont. Other medsStill c -Change packing of

woundSubq -Cont. MedsEmphy - Refer accordingly

sema4:30pm -Cont. MedsBP:140/90-IVF PNSS 1 L x 12hrsWith subq emphysema8/10/1010am -Cont MedsEdema -IVF PNSS 1Lx12hrs -Repeat CBC tomorrow am8/11/10Bp:120/80 -Cont Meds-IVF PNSS 1L x 12hrs-For repeat Chest x-Ray8/12/10-Cont.MedsBP:120/80 -IVF PNSS 1Lx12hrs

--8/12/10-Cont. Meds6pm -PNSS 1Lx12hrs

8/13/10-Cont mends10am -PNSS 1L-Hold Hydrocortisol IV-For removal of anterior CTT-Watched out for DOB-Mefenamic acid 500mg 1cap now

then q65pm -D/C Metronidazole IVWith pain@ operation site8/14/10-Cont Meds10:30pm -IVF PNSS 1Lx12hrs-For removal of posterior CTT8/15/10-Cont Meds-D/C ceftiaxone IV-Ciprobay 500mg 1 tab BID after meal

-Hold Rimstar4 temporarily-IVF PNSS 1L x 12hrs-MGH if okay c Dra.Salvador8/16/10-D/C IVF before discharge-MGHDOB -THM(pls inform Dr.Acob)(-)Fever ISMN(imdur)60mg/L ½

tab BID+pneumoth Sinecod Forte 50mg TIDOrax

Rif,INH,Pyra,Etham(Rimstar4)Subq 3 tab ODEmphysema Celestamine 1 tab O D AlmgoH 1 tab ID Ciprobay 500 1 tab

BID-To come back at Salvador Clinic @

8/18/10-Advise low salt fat diet

ANATOMY

The Respiratory System moves air into and out the lungs, which are the site of exchange of O2 and CO2 between the air and the blood

Divided into: Upper respiratory tract – consists of those parts outside the

chest cavity:the air passages of those nose, nasal cavities,pharynx,larynx,and upper alveoli.

Lung respiratory tract – consists of those parts within the chest cavity: the lower trachea and the lungs themselves,which include the brochial tubes and alveoli.

NOSE – is the only externally visible part of the respiratory system.

Functions:Provide an airway for respirationMoistens and warms entering airFilters inhaled air and cleanses it of foreign particlesServes as a resonating chamber for speechHouses the olfactory receptors

NASAL CAVITIES – within the skull;separated by the nasal

septumNasal mucosa is epithelium,with goblet cells that

produce mucusOlfactory receptors detect vaporized chemicals

that have been inhaledParanasal sinuses are air cavities in the

maxillae,frontal,sphenoid and ethmoid bone

PHARYNX- is funnel-shaped passageway that connects the nasal cavity and

mouth superiorly to the larynx and

esophagus inferiorly. -passageway for air and food

Divided into 3 regionsNasopharynx -passageway of airOropharynx-Passageway for food and airLaryngopharynx-Passageway for food and air.

Larnyx- or the voicebox,extends from the level of the 4th to the 6th cervical vertebra.

Functions:Provide an open airwayPrevents food from entering respiratory tractVoice production

TRACHEA - or the windpipe,extends from the larynx to the primary bronchi - air passagway,

filters,warms,and moistens incoming air

BRONCHIAL TREE - extends from the trachea to the alveoli,consists of right and left

primary bronchi which subdivided with the

lungs - airpassageways connecting

trachea with alveoli;moistens and warms

incoming air.

PLEURAE- serous membranes of the thoracic cavity

produce lubricating fluid and compartmentalize lungs.

Parietal pleura-lines the chest wallVisceral pleura-covers the lungsPleural cavity-the space between the 2 pleuras.

Lungs- located on either side of the heart in the chest com the cavity;extend from the diaphragm below up to the level of the clavicles

-house passageways smaller than primary

bronchi -the right lung has 3 lobes,while

the left lung has 2 lobes

- the 2 lungs are separated by a space

called mediastenum Alveoli- air filled sacs in the lungs -main sites of gas exchange

DISCUSSION OF HEALTH CONDITIONDefinition:

The presence of air in the pleural cavity caused by a breach in the pleura.

NURSING MANAGEMENT Ask patient about the onset and course of

symptoms Explain the diagnosis tests Emergency treatment of a penetrating chest

wound.Consists of applying an air tight seal immediately over the wound

Note how the paient has managed pain

PATHOPHYSIOLOGY

>Predisposing Factors:-Gender(most common in males)

>Precipitating factors-Post op complicationOf hydrothorax

The tube has been dislocated from sutures due to daily activities such as frequent moving

Caused by a small tear on the surface of the lung allowing air to enter in the pleural cavity

Causing negative pressure to decrease

With each inspiration,air moves into the pleural space & some air moves out with each exhalation causing subq

emphysema

Depending on the amount that continuous to enters initially and the amount that continuous o enter the lung is no

longer able to remain fully inflatd causing dyspnea

PNUEMOTHORAX

SIGNS & SYMPTOMSBOOK ACTUAL

Chest painCyanosisDyspneaNonproductive coughShallow respirationTachycardiaTachypneaSubq Emphysema

Chest painDyspneaShallow respirationSubq emphysemaNonproductive cough

Drug8/5/10 Action Indication Side Effects Contraindicati

onsNursing

Consideration

Generic Name:Combivent Brand Name:Albuterol SulfateDosage:1 nebuleRoute:Mouth Frequency:Every 6 hoursClassification:Antiashtmatic

Relaxes bronchial smooth muscle by stimulating beta 2 receptors.

Management of reversible bronchospasm associated with obstructive airway disease.

>Palpitations, headache, dizziness and dryness of mouth.

Contraindicated to pt. hypersensitive to drug.

>10 rights of giving medication.>Instruct the pt. that he may use tablets and aerosol together. Monitor this pt. closely for signs & symptoms of toxicity.>Warn pt. about risk of paradoxical bronchospasm and to stop drug if it occurs.

DRUG INDICATION

MECHANISM OF ACTION

CONTRAINDICATIONS

ADVERSE REACTION

NURSING RESPONSIBILITIES

BRAND NAME:ImdurGENERIC NAME:IsomononitrateCLASSIFICATION:AntianginalsDOSAGE:60 mg ½ tabROUTE:PO

Acute angina attack

To prevent situations that may cause anginal attacks

Thought to reduce cardiac O2 demand by decreasing preload and afterload.

Patients hypersensitive to nitrates and those with severe Hypotension, angle-closure glaucoma, increase ICP, shock or acute MI with low

CNS- weakness, headache, dizziness

CV- orthostatic HPN, tachycardia, palpitations, uncle edema, flusing, fainting

Know the 10 rights of patient before giving the medications

Monitor BP, intensity and duration of drug response

DRUG INDICATION

MECHANISM OF ACTION

CONTRAINDICATIONS

ADVERSE REACTIONS


BRAND NAME:CorlefGENERIC NAME:HydrocortisoneCLASSIFICATION:Hormonal drugsDOSAGE:100 mgROUTE:IVTTFREQUENCY:Every 8 Hours

Severe inflammation

Not clearly defined.

Pt. hypersensitive to drugs.

Use cautiously with patient GI ulcer, Renal disease, HPN, TB, and ocular herpes simplex.

CNS- insomnia, headache, vertigo, seizure.

CV- heart failure, HPN, edema

GI- GI irritation, nausea, vomiting

Hematologic- easy bruising

Musculoskeletal- muscle weakness

Skin- delayed wound healing

Know 10 rights of patient before giving medications

Determine whether is sensitive to other corticosteroid.

Give oral dose with food. Patient may need another drug to prevent GI irritation.

Monitor patient’s BP.

DRUG INDICATION

MECHANISM OF ACTION

CONTRAINDICATIONS

ADVERSE REACTION


FREQUENCY:BID

Drug may also increase blood flow through the collateral coronary vessels.

left ventricular filling pressure.

EEnt-SL burning

GI-nausea vomiting

Drug may cause headaches, especially at beginning of therapy. Dosage may be reduced temporarily.

Treat headache with aspirin or acetaminophen

Drug8/6/10 Action Indication Side Effects Contraindicatio

nsNursing

Consideration

Generic Name:Pharex Mefenamic AcidBrand Name:Pascual/ PharexDosage:1 cap 500mgRoute:P.O Frequency:Every 6 hoursClassification:Anti-inflammatory Analgesics

Inhibits prostaglandin synthesis by decreasing the activity of the enzyme. Cyclo-oxygenase, w/c results in decreased formation of prostaglandin precursors.

Mild to moderately and severe pain associated w/ muscular.

>GI disturbances, peptic ulceration and GI bleeding, drowsiness, dizziness, nervousness, visual disturbances, renal failure, glomerulone, phritis and papillary nicrosis.

Active ulceration of GIT inflammation.

>10 rights of giving medication.> Monitor the effectiveness of therapy on a regular basis.>Assess or teach pt. to monitor and report adverse reactions, including regular weight and assessment for edema.

Drug8/7/10 Action Indicati

on Side Effects Contraindications

Nursing Consideration

Generic Name:Celestamine EssexBrand Name:CelestamineDosage:1 tabRoute:P.O Frequency:O.DClassification:Antihistamines and Antiallergics

Blocks the effects of histamine at H1 receptor sites, has atropine-like, antipruritic, and sedative effects.

Respiratory ocular.

>CNS: drowsiness, sedation, dizziness, fatigue, headache, blurred vision, weakness of the hand.>GI: epigastric distress, anorexia, nausea, vomiting, diarrhea or constipation.>Respiratory: thickening of bronchial secretions, chest tightness, wheezing, nasal stuffiness, dry mouth, dry nose, dry throat, sore throat.

New born and premature infants. Systemic fungal infection.

>10 rights of giving medication.>Take as prescribed; avoid excessive dosage. Take w/ food if GI upset occurs.>Monitor pt. response and adjust dosage to lowest possible effective dose.

Drug Action Indication Side Effects Contraindications

Nursing Consideratio

n

Generic Name:Rimstar-4Brand Name:Sandoz Dosage:Rifampicin 150mg, INH 75mg, Pyracinamide 400mg, Ethambutol 275mgRoute:P.OFrequency:O.DClassification:Antituberculous Agents

Rifampicin and INH are both bactericidal against M. tuberculosis. Ethambutol is bacteriostatic and pyrazinamide is specific antitubercular agent.

Management for TB and certain opportunistic mycobacterial infections.

>GI : nausea, vomiting, abdominal pain, anorexia and epigastric distress.>CNS : tiredness, drowsiness, dizziness, muscular weakness, headache.>Skin : rash, urticaria.

Contraindicated to pt. hypersensitive to drug.

>10 rights of giving medication.>Instruct pt. that medication should be taken on an empty stomach (at least 1 half hour before meals). >Instruct pt. swallow drug, do not chew or crush.

DRUG8/8/10

INDICATION

MECHANISM OF ACTION

CONTRAINDICATIONS

ADVERSE REACTION


BRAND NAME:AcenormGENERIC NAME:CaptoprilCLASSIFICATION:AntihypertensivesDOSAGE:25 mg 1 tabROUTE:POFREQUENCY:Every 6 Hours

Hypertension

Inhibits ACE, Preventing conversion of Angiotensin 1 to A 2 , a potent vasoconstrictor.

Patient hypersensitive to drug or other ACE inhibitors.

CNS- dizziness, headache, fainting, fatigue

CV- tachycardia

GI- nausea, vomiting, anorexia, abdominal pain.

Respiration- dyspnea, dry, persistent nonproductive cough.

Know the 10 rights of patient before giving medications

Monitor patient’s BP and PR frequently

Drug causes the most frequent occurance of cough

DRUG INDICATION

MECHANISM OF ACTION

CONTRAINDICATIONS

ADVERSE REACTION


HOME MEDSBRAND NAME:CiprobayGENERIC NAME:CiprofloxacinCLASSIFICATION:Anti-infectivesDOSAGE:500 mg/ tabROUTE:POFREQUENCY:2x a day

Mild to moderate respiratory- infections

Inhibits bacterial DNA synthesis, Mainly by blocking DNA syrase; bactericidal

Patient’s hypersensitive to fluoro quinolones

CNS- dizziness, fatigue, headache, drowsiness

CV- chest pain , edema

GI- nausea, vomiting, diarrhea, constipation, dyspepsia, flatulence, abdominal discomfort

Know the 10 rights of patient before giving medications

Obtain specimen for C&S test before giving 1st dose. Begin therapy, awaiting results.

ASSESSMENT8/5/10

DIAGNOSIS

PLANNING

INTERVENTION

RATIONALE EVALUATION

S- “Nglisod ko ug ginhawa”O-Weak looking -Pallor -Dyspnea noted -Oscillition -With CTT attached @ R thoracic cavity -With IVF #2 of D5LR @ 30gtts/min @1000 cc @ L metacarpal vein-VS:BP 100/70mmHgRR:26cpm,PR:94bpm,BT:37C

Ineffective breathing pattern r/t decreased lung expansionDifinition:Inspiration and/or expiration that does not provide adequate ventilation

Within 8hrs of duty the pt. Will be able to establish effective respiratory pattern

Independent:-Established rapport-VS taken and recorded -Assisted on high fowlers position-Encouraged and taught on how to do deep breathing-Encouraged enough rest and sleep-Nebulization done

Dependent:Due meds Given by NOD:-Ceftiaxone 1g IV Q6Combivent 1neb Q6

-To gain trust and cooperation-To have baseline data-To maximize lung expansion-To maximize lung expansion

-To limit fatigue

-To facilitate deeper respiratory effort

-Anti-ineffective

-Bronchodilator

Goal met as evidenced by pt’s verbalization “Makaginhawa na pud ko ug tarong”BP:100/60mmHgPR:82bpmRR:21cpmBT:37C

ASSESSMENT8/6/10

DIAGNOSIS

PLANNING

INTERVENTION

RATIONALE

EVALUATION

S- “Masakit ang likod ko”as verbalized with pain rate of 4 as moderate on a 0-10 pain scaleO-Weak looking -Irritable -Pale looking -Grimaced face noted -With CTT -Oscillition BP:130/60mmHg -RR:19cpm -PR:91bpm, -BT:37C

Acute pain r/t irritation of nerve endings within pleural space y foreign subject(Chest Tube)Definition:Unpleasant sensory and emotional experience arising from actual or potential tissue damage

Within 8hrs of duty the pt will report pain is controlled with pain rate of 3 as mild from 7.

Independent:-Established rapport-VS taken and recorded-Positioned comfortably-Provided comfort measure:Back massage(effleuradge)-Encouraged adequate rest and sleepDependent:Due meds given by NOD:Mefenamic acid 500mg 1 cap

-To gain trust and cooperation-To have baseline data-To provide comfort-To provide nonpharmacological pain management.

-To prevent fatigue

-Analgesic

Goal met as evidenced by pt verbalization “Okay na ako” with pain rate of 3 as mild from pain rate of 4.BP:120/60mmHgPR:18cpmRR:89bpmBT:37.5C

ASSESMENT8/13/10

DIAGNOSIS

PLANNING INTERVENTION

RATIONALE

EVALUATION

S- “Ginaubo ko” as verbalizedO-Weak looking -Pallor -With CTT -Unproductive cough heard -BP:120/80 mmHg -PR:98bpm -RR:24cpm -BT:37C

Ineffective airway clearance r/t retained secretions Definition:Inability to clear secretions or obstructionsFrom the respiratory tract to maintain a clear airway.

Within 8hrs of duty the pt will maintain airway clearance patency and expectorate secretions freely

Independent:-Established rapport-VS taken an d recorded-Positioned comfortably-Encouraged deep breathing exercise-Advised to increase fluid intakeDependent:Due meds given by NOD:-Combivent 1neb Q6-Ceftriaxone 1g IV Q8

-To gain trust and cooperation-To have baseline data-To provide comfort-To maximize lung expansion-To liquefy secretions

-Brochodilator

Anti-ineffective

Goal partially met as evidenced by pt’s verbalization, “Usahay na lang ko mag-ubo pero dili gihapon nako mapagawas ang plema.”BP:120/60 mmHgPR:95bpmRR:26cpmBT:36.8C

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTION

RATIONALE EVALUATION

S/O-With CTT-Pallor-Weak looking

High risk for infection r/t invasive procedure(CTT)Definition:At increased risk for being invaded by pathogenic organisms.

Within 8hrs of duty the pt will identify interventions to prevent risk of infection.

Dependent:-Established rapport-Vs taken and recorded-Noted risk factors for occorence of infection(skin integrity,environment)-Taught pt and SO on proper hand washing and proper preparation of food-Advised SO to checked CT regularly

-To gain trust and cooperation-To have baseline data-To identify source of infection

-To prevent spread of microorganism

-To checked for leak and to avoid accumulation ofPathologic organism

Goal met as evidenced by SO verbalization “Amoa na jud bantayan ang tubo kag magbantay pud sa kalimpyo.”

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTION RATIONALE EVALUATION

S/O-Pale Looking-Dry lips noted-Weak looking-Crepitus all over the body noted-With CTT-BP:130/80 mmHgTemp:37CPR:82bpmRR:21 cpm

Impaired skin surgal integrity r/t surgical incision/surgeryDefinition:Altered epidermis and/or dermis (the integumentary system is the largest multifunctional organ of the body)

Within 8hrs of duty pt. Will participate in preventionMeasures and treatment program

-Established rapport-Vs taken an monitored-Increased fluid intake-Encouraged adequate rest period -Instructed to eat ntritious food(rich in CHON)-Instructed SO to assist pt in terms of personal hygiene-Used appropriate padding devices(pillows)-Encouraged earlyambulation-Advised cessation of smoking and drinking alcohol

-To gain trust and cooperation-To have baseline data-To improve skin integrit-To avoid fatigueData_to facilitate easy healing-To prevent spread of microorganisms-To reduce pressure on/inhance circulation to compromise tissues-Promotes circulation and reduces risk associated c immobility -For easy recovery ad avoid complications

Goal met as evidenced pt participated in preventive measures “Mokaon nako ug tama ug undangan na nako akong mga bisyo” as verbalized

CRITERIA UNFAVORABLE/FAVORABLE

RATIONALE

1.ON SET OF ILLNESS UNFAVORABLE 10 Days prior to admission pt.experience difficulty of breathing consult with Provincial hospital diagnosis. Pneumothorax R CTT done, presented difficulty of breathing and subcutaneous emphysema promoted transfer to other hospital.

2.PRECIPITATING FACTORS

FAVORABLE The precipitating factors of clients illness include lifestyle because of the lifestyle of the clients, his conditioned worsened.

Legend:: Favorable – 3/5,Unfavorable – 2/5

Based on the justification mentioned the prognosis of the client

is Good.

CRITERIAA UNFAVORABLE/FAVORABLE

RATIONALE

3.Complication UNFAVORABLE The complication of pneumothorax to the client is the PTB, and CAP.

4.Attitude and willingness towards medication and treatment

FAVORABLE The client willfully complied with the medication and treatment done to him.

5.Bodily responses towards therapy

FAVORABLE The client’s condition is progressing and his body is responding to medical therapy.

Medication .After the patient is discharge encouraged him to continue taking medications that was prescribed bt the physician with its proper dosage and frequency.

Environment .Advise the patient and significant other to promote desirable environment for client such as:.Maintaining proper waste disposal to prevent further accumulation of pathogens..Prevent excessive noise to promote rest and sleep.

Therapy .Stressed the need for bed rest when pain occurs. Avoid to much of exercise, it must be balanced with rest.

Health teaching.Discuss to the client the importance of taking medicines, physical activity, eating healthy foods and increase fluid intake..Avoid strenuous activities such as lifting heavy objects, prolong exercise.

.Advise the patient to do the following exercise:>Deep breathing and coughing exercise helps remove

accumulation from the pleural space, facilitate drainage, help the lung to reexpand.

>Do ROM of the affected shoulder 3x a day to maintain joint stability.

Outpatient Department.Advice the patient that he should have a follow up check up with his doctor when he is discharge to determine his health status.

Diet .Remind the patient that he should eat well balanced healthy diet to add energy and nutrients needed by the body.

Support System.Instructed the significant other to be aware of the manifestation of severe alleviation of pain. Provide information about activity limitation for client to prevent fatigue and stress.

.Advised to stressed out good hygiene to client to avoid further accumulation of pathogens that can worsen the disease condition..Discuss about the need for continuity of medication and treatment, this allows patient to comply with his medication and treatment strictly.

Nursing Implications of laboratory tests-Mary Brambilla Mcfarland/Marcia Moeller Grant

Mosby’s Pocket Dictionary of Medicine,Nursing and Allied Health 4th edition

Jaypee’s Nurses Dictionary 3rd edition MIMS 10th edition 2005 Philippine PIMS Windmanns Clinical Interpretation of

Laboratory Tests 11th edition-Roland A. Sancher &Richard A.Mcphenson

Documents

PNEUMOTHORAX