Case Study

I.
Introduction Pneumonia is an illness of the lungs and respiratory system in which the alveoli (microscopic air-filled sacs of the lung responsible for absorbing oxygen from the atmosphere) become inflamed and flooded with fluid. Pneumonia can result from a variety of causes, including infection with bacteria, viruses, fungi, or parasites. Pneumonia may also occur from chemical or physical injury to the lungs. One can get pneumonia in daily life, such as at school or work. This is called community-based pneumonia. One can also get it in a hospital or nursing home. This is called hospital-based pneumonia. It may be more severe because one is already are ill. You may cough, run a fever, and have hard time breathing. For most people, pneumonia can be treated at home. It often clears up in 2 to 3 weeks. But older adults, babies, and people with other diseases can become very ill. It is one of the leading causes of death among the elderly and people who are chronically and terminally ill. People with infectious pneumonia often have a cough that produces greenish or yellow sputum and a high fever that may be accompanied by shaking chills. Shortness of breath is also common, as is pleuritic chest pain, a sharp or stabbing pain, either felt or worse during deep breaths or coughs. People with pneumonia may cough up blood, experience headaches, or develop sweaty and clammy skin. Other symptoms may include loss of appetite, fatigue, blueness of the skin, nausea, vomiting, mood swings, and joint pains or muscle aches. Less common forms of pneumonia can cause other symptoms. For instance, pneumonia caused by Legionella may cause abdominal pain and diarrhea, while pneumonia caused by tuberculosis or Pneumocystis may cause only weight loss and night sweats. In elderly people the manifestations of pneumonia may not be typical. Instead, they may develop new or worsening confusion or may experience unsteadiness leading to falls. Infants with pneumonia may have many of the symptoms above, but in many cases, they are simply sleepy or have decreased appetite.
According to the Unicef/WHO report, India, with 44 million pneumonia cases, China with 18 million cases and Nigeria and Pakistan with seven million cases top the chart. The disease causes acute infections in any part of the respiratory system from the middle ear to the nose to the lungs. Acute respiratory infection is also a serious problem in India, accounting for 14.3 per cent deaths during infancy and 15.9 per cent deaths among children aged between 1-5 years in India, claim studies undertaken by experts. It is estimated that more than 150 million cases of pneumonia occur every year among children under five in developing countries, accounting for more than 95 per cent of all new cases worldwide. Between 11 million and 20 million children with pneumonia will require hospitalization, and more than two million will die from the disease, the report warns. According to Dr. Josefina Cadorna-Carlos, associate professor at the University of the East Ramon Magsaysay Memorial Medical Center, that the characteristics of Streptococcus pneumoniae and atypical bacterial pneumonia in children may be difficult to distinguish. The question now is, how is one going to suspect atypical pneumonia? "When there is delay in resolution of symptoms, [presence of] diffuse bilateral infiltrates, and if it's refractory to standard treatment," Carlos pointed out. In the 2004 Philippine Consensus Guidelines in the Evaluation and Management of Pediatric Community Acquired Pneumonia, amoxycillin remains the drug of choice against pneumonia. and tetracyclines are the drugs useful Macrolides, against atypical quinolones, pathogens.
Clarithromycin answers the need for a better macrolide. It has 50-percent bioavailability with significantly fewer GI adverse effects, and has increased activity against H. influenzae Compared due with to the active metabolite 14hydroxyclarithromycin. clarithromycin time-dependent erythromycin,
is concentration
dependent, which provides for better
compliance at twice-daily dosing. In vitro, potency is marked by lower
minimum-inhibitory-concentration (MIC) values at 50 and 90 percent against M. pneumoniae and C. pneumoniae. Against common respiratory tract infections, clinical success is achieved with 93- to 97-percent alleviation of symptoms (Germany, Italy, 1994). The primary role of nurses is to provide care to all their patients. They play an important role for patients survival. As aspiring nurses, it is best that we are now practicing the core of nursing, which is caring. The case of Clark Kent, an eleven-month old baby boy, is common among infants these days. It is an acute pneumonia with spells of cough and fever. It is also one of the leading causes of morbidity. The researchers will expand their knowledge regarding the pathophysiology of the disease, develop their critical thinking about the essential interventions when dealing with pneumonia, and most importantly, be able to appreciate the fact that they are already handling real patients in which individuality of each persons is highly regarded. The researchers are fortunate to have the chance to apply their skills and knowledge while delivering or rendering essential health care to the patient. Given the opportunity to handle a client with the same condition in the future, the researchers can take care of the client with competence and can provide the best possible care in attaining the optimum health for their client.
OBJECTIVES A. Student-Nurse Centered After the completion of the case study, the researchers will be able to: General Objective: Gain knowledge and deeper understanding of the disease process itself, be able to provide the best nursing care for the client, and impart health teachings regarding the clients condition in maintaining an optimum level of functioning. Specific Objectives: 1. Interpret the current trends and statistics regarding the disease condition; 2. Relate the present state of the client with his personal and pertinent family history; 3. Analyze and interpret the different diagnostic and laboratory procedures, its purpose and its essential relationship to clients disease condition; 4. Identify treatment modalities and its importance like drugs, diet and exercise; 5. Identify surgical management and its purpose that is applicable with the disease condition; 6. Formulate nursing care plans based on the prioritized health needs of the client; 7. Gain knowledge on the acquisition and progression of the disease; 8. Impart knowledge on fellow students in providing care for clients with the same illness. B. Patient-Centered After the completion of the study, the patient will be able to:
General Objective: Acquire knowledge on the risk factors that have contributed to the development of the disease, gain understanding of the disease process and demonstrate compliance on the treatment management rendered by the health care team. Specific Objectives: 1. Gain knowledge about the disease; 2. Identify different interventions in his condition; 3. Gain knowledge on the importance of compliance to treatment regimen; 4. Demonstrate compliance on the treatment management; 5. Identify different measures to prevent further aggravation of condition; 6. Participate in his plan of care; and 7. Demonstrate independence on self-care and home management upon discharge and during follow-up home visits.
II. Nursing Assessment

A. Personal History
A.1.Demographic Data Clark Kent is an eleven month old baby boy and he is the youngest in his family. He was born as a Filipino citizen on July 7,2006 at their home somewhere in Magalang, Pampanga. He was admitted at a hospital in Magalang, Pampanga last June 23, 2007 with a chief complaint of cough, cyanosis, and fever. His admitting diagnosis is Pneumonia with Anemia. A.2. Socio-economic, Environmental, and Cultural Factors Baby Clark Kent in an extended type of family specifically composed of his father, mother, one sibling; also includes his grandfather, grandmother, aunties, uncles, and cousins on the maternal side. With regards to their operating cost only a total amount of P 2,000-P3,000 is spent to suffice for their daily needs for a month. His father, who is said to be a construction worker, earns about P7,000 per month. The members of the family pools together the money that they can get to supply for the monthly needs. The family is affiliated to Iglesia Ni Cristo. With regards to culture, they believe that whenever a child is sick, he should not take a bath during Fridays and Tuesdays, plus, he shouldnt cut his nails. They also embrace the healing powers of manghihilot. With regards to their resettlement area, the place is said to be clean although it is not yet developed. Also, the houses arent evenly spaced. They have poor mode of transportation, and they are remote from the market and church. Baby Clark Kents activities of daily living includes the following:
6am Baby Raven wakes up 7am 8am Breakfast
8am 10am Plays with his older sister 10am 11am Takes a bath 11:30am Lunch 12pm - 2pm Siesta for Baby Raven 2pm 4:30pm Plays again 4:30pm 5pm Snack Time 5:30pm Another bath session 6pm 6:30pm Dinner 7pm - Sleep
B. Maternal and Child Health History Obstetric History According to Martha, a 20 year old mother, she had an obstetric history of 2 gravidarum (number of pregnancy), 2 parity (number of pregnancy in which the fetus reach the age of viability whether or not the baby was born alive or not), 1 term (number of infants born at 37 weeks or after), 1 preterm ( number of infants born before 37 weeks), 0 for abortion, (number of spontaneous or induced abortion), and 2 for living children. Prenatal History According to Martha, she had her prenatal check up a month. In every pregnancy that she had, she takes ferrous sulfate capsule for her daily supplement that is taken once a day. Antepartal History
She had chicken pox during her first pregnancy. While on her second pregnancy, she had fever on the first trimester, and she had cough and cold on the second trimester for a month. She described that she had really difficulty in laboring the second baby.
Erik Eriksson (Theory of Trust and Mistrust) -1 year old An infant depends almost exclusively on parents, specially the mother, for food, sustenance and comfort. Parents are the primary representatives of society to the child. If the parents would be discharging their infant-related duties with warmth, regularity and affection, the infant will develop the feeling of trust towards the world, a trust that someone will always be around to care for ones needs. Alternatively, a sense of mistrust develops if the parents fail to The infant would be able to develop the sense of trust with his parents/ world because they are able to support the infants needs in his life. The infant was not able to develop his trust with his parents/ world because they are not able to support the infants needs in his life. In relation to Baby Clark Kents case, the researchers discovered that he could manifest a feeling of trust towards the world. This is evident in a way that his parents are providing him his basic needs such as love and safety as well as physiologic needs (food, proper home, etc.) Normal Abnormal Clients response
According to Baby Clark Kents mother, she had a history of parasitism when she was young and she has only one brother who has asthma, her father had a history of appendectomy and her mother has hypertension and cardiomegaly. Her younger sister was hospitalized due to cough and colds and was born premature while on Baby Clark Kents paternal side, his grandfather has renal failure and his grandmother suffers from diabetes mellitus and asthma that led to his father having asthma. One of Baby Clark Kents cousin on the paternal side suffers with asthma too.
Fathers Side
Grandfather Preston Burke 50 years old -Renal Failure Grandmother Cristina Yang 49 years old -Diabetes Mellitus -Asthma
Mothers Side
Grandfather Derek Shepherd 42 years old -history of appendectomy Grandmother Meredith Grey 40 years old -Hypertension -Cardiomagaly
Jonathan 28 years old -Asthma
Lionel 27 years old -history of smoking and alcoholism
Alex 21 years old -Asthma
Martha 20 years old -history of parasitism
Elizabeth 16 years old
George 10 years old -Asthma
Lois 3 years old -Asthma
Clark Kent 11 months -Fever -Cough & Cold Pneumonia Pre-mature (3 weeks)
Lana 8 years old
Lex 6 years old -Asthma
Lois 3 years old -Asthma
Clark Kent 11 months -Fever -Cough & Cold Pneumonia Pre-mature (3 weeks)
Caley 3 months hospitalize d due to cough & colds -premature (3 weeks)
E. History of Past Illness It was reported that after Baby Clark Kent was born, he had experienced difficulty of breathing which was manifested by cyanosis. Other than that, he also experienced hyperthermia, cough, colds, asthma, and lastly, jaundice. F. History of Present Illness Prior to admission to the hospital in Magalang last June 23,2007, Baby Clark Kent had experienced fever and cough.
G. Physical Examination Upon Admission (lifted from the chart): June 23, 2007 Vital Signs: T - 40C First Nurse-Patient Interaction: June 26, 2007 Vital Signs: T 38.1C, P - 150, R - 23 SKIN: Physical Assessment: no odor; pale; unblemished; goes back when pinched; with
temperature within normal limit. HAIR: thick; black in color; short; evenly distributed; no dandruff or lice upon inspection
HEAD: symmetrical & normocephalic; no mass noted upon palpation FACE: symmetric features; facial movement EYEBROWS: hair evenly distributed; skin intact; symmetrically aligned; equal movement EYELASHES: equally distributed; curled slightly upward EYELIDS: skin intact; no discharge; no discoloration; lids close symmetrically; involuntary blinks approximately 15 to 20 per minute EYES: sclera appears white no discharges noted; pale palpebral conjunctiva; no edema or tenderness over the lacrimal glands; transparent, smooth and shiny, details of iris are visible; the client blinks when cornea is touched; pupils black in color, equal in size; smooth border; iris flat and round NOSE: symmetrical in shape and size; nasal flaring and secretions noted upon inspection; uniform MOUTH: symmetric; uniform pink; moist, smooth; no lesions TONGUE: central position; pink; moist; slightly rough; thin whitish coating; no lesions EARS: symmetrical; no lesions noted upon inspection; same color as facial skin, auricle is aligned with the outer canthus of the eye; mobile; firm; non tented; pinna recoils after it is folded NAILS: short with minimal dirt; capillary refill time less than 3 seconds; convex curve; intact epidermis NECK: symmetrical; with no lesions noted upon inspection, muscles equal in size; head centered; coordinated, smooth movement with no discomfort CHEST: symmetrical expansion, LUNGS: adventitious breath sounds (rales) HEART: no pulsations heard upon auscultation; symmetric pulse volumes; full pulsations; thrusting quality; quality remains same when client breaths, turns head and changes from sitting to supine position; elastic arterial wall
ABDOMEN: symmetric contour, no evidence of enlargement of liver and spleen, symmetric movements caused by respiration, audible bowel sounds; unblemished skin; uniform color EXTREMITIES: (-) edema
Second Nurse-Patient Interaction: June 27, 2007 Vital Signs: T 37.4C, P -150 bpm , R -23cpm Physical Assessment: no odor; pale; unblemished; goes back when pinched; with
SKIN:
temperature within normal limit. HAIR: thick; black in color; short; evenly distributed; no dandruff or lice upon inspection HEAD: symmetrical & normocephalic; no mass noted upon palpation FACE: symmetric features; facial movement EYEBROWS: hair evenly distributed; skin intact; symmetrically aligned; equal movement EYELASHES: equally distributed; curled slightly upward EYELIDS: skin intact; no discharge; no discoloration; lids close symmetrically; involuntary blinks approximately 15 to 20 per minute EYES: sclera appears white no discharges noted; pale palpebral conjunctiva; no edema or tenderness over the lacrimal glands; transparent, smooth and shiny, details of iris are visible; the client blinks when cornea is touched; pupils black in color, equal in size; smooth border; iris flat and round
NOSE: symmetrical in shape and size; nasal flaring and secretions noted upon inspection; uniform MOUTH: symmetric; uniform pink; moist, smooth; no lesions TONGUE: central position; pink; moist; slightly rough; thin whitish coating; no lesions EARS: symmetrical; no lesions noted upon inspection; same color as facial skin, auricle is aligned with the outer canthus of the eye; mobile; firm; non tented; pinna recoils after it is folded NAILS: short with minimal dirt; capillary refill time less than 3 seconds; convex curve; intact epidermis NECK: symmetrical; with no lesions noted upon inspection, muscles equal in size; head centered; coordinated, smooth movement with no discomfort CHEST: symmetrical expansion, LUNGS: adventitious breath sounds (rales) HEART: no pulsations heard upon auscultation; symmetric pulse volumes; full pulsations; thrusting quality; quality remains same when client breaths, turns head and changes from sitting to supine position; elastic arterial wall ABDOMEN: symmetric contour, no evidence of enlargement of liver and spleen, symmetric movements caused by respiration, audible bowel sounds; unblemished skin; uniform color EXTREMITIES: (-) edema noted
EXTREMITIES: (-) edema noted
Reflexes
Description
Appeaance
Disappearance 9 months
Baby Clark Kent Absence of Babinski Reflex
Babinski
Toes
fan upward
whenBirth
sole of the foot is stroke.
Galant
Arching of trunk towardBirth stimulated spine. side when infant is stroke along the
Neonatal Period
Absence of Galant Reflex
Moro (startle)
Sudden midline returns
outwardBirth when
4months
Absence of Moro Reflex
extension of arms with startled by loud noise or rapid change in position.
Righting
Attempting head in position.
to an
maintainBirth upright
24 months Presence of Righting Reflex
Rooting
Turning
head
towardBirth
6 months
Absence Rooting Reflex
of
stimulated side of cheek.
Sucking
Initiation of sucking whenBirth an object is place on the mouth.
Indefinite
Presence of Sucking Reflex
Swimming
Mimicking movement
swimmingBirth when held
4 months
Absence Swimming Reflex
of
horizontally in wate.
Walking
Making movements upright with
steppingFirst when heldweeks; feetreappear
12 months Presence of Walking Reflex
touching the surface.
s at 4-5 months
H. Diagnostic and Laboratory Findings Diagnostic/ Laboratory Procedures 1. CBC or Hematology Date Ordered & Date Result(s) In
Indication(s) or Purpose(s) To determine whether specific blood levels are higher or lower than normal and can be useful in the diagnosis of such diseases as anemia, leukemia and infection. Analysis of RBCs, WBCs, PT, PTT, Erythrocyte Sedimentation Rate, Platelets,
Results (1st, 2nd) Hemoglobin is the ironcontaining oxygentransport metalloprotein in the red blood cells of the blood in vertebrates and other animals.
Normal Values
Analysis & Interpretation of Results
88
120 160
Low Hb concentration may indicate
DO: 06/23/07
H/H
g/L
anemia, recent hemorrhage or fluid retention, which can cause hemodilution.
96 mg% (12 DRI: 06/23/07 Hematocrit is the measures of the proportion of blood volume that is occupied by red blood cells. 0.29 Low Hct suggests anemia, 16 mg%)
DO: 06/26/07 31 0 DRI: 06/26/07 WBC or leukocytes are cells of the immune system which defend the body against both infectious disease and foreign materials.
0.40 0.50
hemodilution or massive blood loss.
vol% (37 47 vol%)
A low WBC count (leukopenia) 11.8 DO: 06/23/07 5.0 10 x 106/ indicates bone marrow depression, which may result from viral
infections or from toxic reactions, DRI: 06/23/07 3.6 w/cu.mm (5000 10000/ cu.mm) Differential Count Neutrophils are the most abundant type of white blood cells and form an integral part of the immune system. Normal. Neutrophils are such as those following treatment with antineoplastics, ingestion of mercury or other heavy metals or exposure to benzene or arsenicals.
DO: 06/26/07 DRI: 06/26/07
.62 .45 .65 68 % (60 70)
phagocytes, capable of ingesting microorganisms or particles. They can internalise and kill many microbes, each phagocytic event resulting in the formation of a phagosome into which reactive oxygen species and hydrolytic enzymes are secreted.
Lymphocyte is a type of white blood cell in the vertebrate immune system. By their appearance under the light
microscope, there are two broad categories of lymphocytes, namely the large granular lymphocytes and the small lymphocytes. Functionally distinct subsets of lymphocytes correlate with their DO: 06/23/07 .33 DRI: 06/23/07 % (30 40) appearance. .25 .40 Normal. Most, but not all large granular lymphocytes are more commonly known as the natural killer cells (NK cells). The small lymphocytes are the T cells and B
cells. Lymphocytes play an 91 important and integral role in the body's defenses. An increase in lymphocytes may indicate infection: tuberculosis, hepatitis, infectious mononucleosis, mumps, rubella, cytomegalovirus Thyrotoxicosis, hypoadrenalism, ulcerative colitis, immune diseases, lymphocytic leukemia
Monocyte is a leukocyte, part of the human body's immune system that protects
against bloodborne pathogens and moves quickly to sites of DO: 06/26/07 DRI: 06/26/07 infection in the tissues. .05 .02 .06 Normal. A monocyte count is part of a complete blood count and is expressed either as a ratio of monocytes to the total number of white blood cells counted, or by absolute numbers. none
Eosinophils are white blood cells of the immune
system that are responsible for combating infection by parasites in vertebrates. They also control mechanisms associated with allergy and asthma. They are granulocytes that develop in the bone DO: 06/23/07 DRI: marrow before migrating into
06/23/07
blood. none
% (0 3)
Normal. Eosinophils produce and store many secondary granule proteins prior to their exit from the bone marrow. After maturation, eosinophils circulate in blood and
01
migrate to inflammatory sites in tissues, or to sites of helminth infection in response to chemokines like CCL11 (eotaxin) and CCL5 (RANTES), and certain leukotrienes like leukotriene B4 (LTB4).
Platelets or thrombocyte s are the cell
fragments circulating in the blood that are involved in the cellular mechanisms of primary DO: 06/26/07 hemostasis leading to the formation of blood clots. DRI: 06/26/07 153 150 450 x 106/mL 150 450 x 106/mL
Normal. Normal platelet counts are not a guarantee of adequate function. In some states the platelets, while being adequate in number, are dysfunctional. For instance, aspirin irreversibly disrupts platelet function by inhibiting cyclooxygenase-1 (COX1), and hence normal hemostasis; normal platelet function may not return until the aspirin has ceased and all the affected
184
platelets have been replaced by new ones, which can take over a week. Similarly, uremia (a consequence of renal failure) leads to platelet dysfunction that may be ameliorated
by the administration of desmopressin.
NURSING RESPONSIBILITIES 1. Prior Note current drug therapy before procedure. Check the physicians order. Identify the client. Prepare the needed materials. Explain the procedure, its purpose and how it is done. Inform the patient/SO that there are no food or fluid restrictions. Inform the patient that the test may require blood specimen and might bring a little pain to the punctured site. Wash hands. 2. During Collect approximately 5 to 10 ml of venous blood in a purple top tube. Avoid hemolysis. Maintain aseptic technique.
3. After Apply pressure to the punctured site to prevent bleeding. Discuss with SO signs of inflammation of punctured site and advice to report immediately. Check the site for bleeding after procedure. Wash hands.
Date Diagnostic/ Laboratory Procedures 2. Urinalysis Ordered & Date Result(s) In DO: 06/23/0 7 DRI: 06/23/0 7 Indication(s) or Purpose(s) Results Normal Values Analysis & Interpretation of Results
Determination of urine composition and possible abnormal components (e.g. protein or glucose) or infection To screen for metabolic and kidney disorders and for urinary
Color: Yellow Transparency: Clear pH: 7.5 Specific Gravity: 1.010 Albumin: Negative Sugar: Negative Microscopic Exam Pus Cell: 0-
Color: Yellow Transparency: Clear to faintly hazy pH: 4.5 8.0 Specific Gravity: 1.003 1.030 Albumin: Negative Sugar: Negative
A normal urinalysis also does not guarantee that there is no illness. Some people will not release elevated amounts of a substance early in a disease process and some will release them sporadically during the day (which means they may be missed by a single urine sample).
tract infections
3/hpf RBC: 2-5/hpf Epithelial Cells: Rare
Pus Cell: 01/hpf RBC: < 4 cells/hpf Epithelial Cells: < 11 cells/hpf
Mild infection An elevated RBC count may indicate absolute or relative polycythemia.
NURSING RESPONSIBILITIES 1. Prior Tell the patient to avoid stress and strenuous exercise before the test. Check for drugs that influence urinalysis. Explain the procedure to the mother. 2. During Collect a random urine specimen of at least 15 ml, preferably a first-voided morning specimen. If the patient is being evaluated for renal colic, strain the specimen to catch stones or stone fragments. Refrigerate the specimen if analysis will be delayed longer than 1 hour. Maintain aseptic technique. 3. After
Send specimen to the laboratory immediately. Perform proper hand-washing. Document.
Diagnostic/ Laboratory Procedures

3. X-ray or Rontgen Rays
Date Ordered & Date Result(s) In DO: 06/25/07

DRI: 06/25/07 To identify the abnormalities of the lungs and the structures on the thorax. And also to identify the size of the heart and the abnormalities in the ribs and diaphragm.
Indication(s) or Purpose(s)
To determine pulmonary edema or congestion
Analysis & Results Normal Values Interpretation of Results Hazy infiltrates are noted on both lower lungfields
Visible in the Normal lung fields. Pneumonia, bilateral
Heart is normal in size
anterior left mediastinal cavity; appears solid because of blood contents
Diaphragm and sulci are intact Other chest structures are remarkable
NURSING RESPONSIBILITIES 1. Prior Check the doctors order. Identify the client. Describe the procedure to the patient. Determine the patients ability to inhale and hold breath. Explain to the mother that this test assesses respiratory status. Tell the mother that no fasting is required. Inform the mother that the test takes 5 to 10 minutes. Describe the test to the mother including who will perform it and when will it take place. Assist transporting the client in going to the x-ray room. Provide a gown without snaps, and ask the patient to remove all jewelry in the radiographic field. Tell him hell be asked to take a deep breath and hold it momentarily while the film is being taken, to provide a clear view of pulmonary structures. If the patient is intubated, check that no tubes have been dislodged during positioning. To avoid exposure to radiation, leave the room or the immediate area while the films are being taken. If you must stay in the area, wear a lead-lined apron. Assist and keep patient still as possible during the procedure.
2. During
3. After
Inform the mother the possible need for additional x-ray. Document.
III. Anatomy and Physiology The Respiratory System The respiratory System of the Human body is primarily for the sole purpose of facilitating respiration. This includes the exchange of gases between the environment and the lungs through the process of ventilation. Also, it provides a mechanism for the bodys exchange of oxygen and carbon dioxide in the lungs and in the blood. As the oxygen being inspired travel to the bloodstream to allow for cellular exchange, carbon dioxide, which is a waste material of a cell, is replaced by oxygen to attain maximum functioning. Other than respiration, the human bodys respiratory system is also responsible for regulation of blood pH, voice production, olfaction, and innate immunity. The respiratory system is divided into two, namely: the upper and the lower respiratory tract. Under the upper respiratory tract refers to the nose, nasal cavity, and pharynx. While the lower respiratory tract refers to the larynx, bronchi, the trachea, and the lungs; Pneumonia, a very serious disease causes inflammation in the lungs. The air sacs in the lungs fill with pus and other liquid. Oxygen has trouble reaching your blood. If there is too little oxygen in your blood, your body cells can't work properly. Because of this and spreading infection through the body pneumonia can cause death. Bronchi and Bronchial Tree In the mediastinum, at the level of the fifth thoracic vertebra, the trachea divides into the right and left primary bronchi. The bronchi branch into smaller and smaller passageways until they terminate in tiny air sacs called alveoli.
The cartilage and mucous membrane of the primary bronchi are similar to that in the trachea. As the branching continues through the bronchial tree, the amount of hyaline cartilage in the walls decreases until it is absent in the smallest bronchioles. As the cartilage decreases, the amount of smooth muscle increases. The mucous membrane also undergoes a transition from ciliated pseudostratified columnar epithelium to simple cuboidal epithelium to simple squamous epithelium. The alveolar ducts and alveoli consist primarily of simple squamous epithelium, which permits rapid diffusion of oxygen and carbon dioxide. Exchange of gases between the air in the lungs and the blood in the capillaries occurs across the walls of the alveolar ducts and alveoli. Lungs The two lungs, which contain all the components of the bronchial tree beyond the primary bronchi, occupy most of the space in the thoracic cavity. The lungs are soft and spongy because they are mostly air spaces surrounded by the alveolar cells and elastic connective tissue. They are separated from each other by the mediastinum, which contains the heart. The only point of attachment for each lung is at the hilum, or root, on the medial side. This is where the bronchi, blood vessels, lymphatics, and nerves enter the lungs. The right lung is shorter, broader, and has a greater volume than the left lung. It is divided into three lobes and each lobe is supplied by one of the secondary bronchi. The left lung is longer and narrower than the right lung. It has an indentation, called the cardiac notch, on its medial surface for the apex of the heart. The left lung has two lobes. Each lung is enclosed by a double-layered serous membrane, called the pleura. The visceral pleura is firmly attached to the surface of the lung. At the hilum, the visceral pleura is continuous with the parietal pleura that lines the wall of the thorax. The small space between the visceral and parietal pleurae
is the pleural cavity. It contains a thin film of serous fluid that is produced by the pleura. The fluid acts as a lubricant to reduce friction as the two layers slide against each other, and it helps to hold the two layers together as the lungs inflate and deflate.
A Diagram showing Trachoebronchial Tree and the Diaphragm Oxygen Transport System
the
The flow of air in and out of the lungs is controlled by the nervous system, which ensures that humans breathe in a regular pattern and at a regular rate. Breathing is carried out day and night by an unconscious process. It begins with a cluster of nerve cells in the brain stem called the respiratory center. These cells send simultaneous signals to the diaphragm and rib muscles, the muscles involved in inhalation. The diaphragm is a large, dome-shaped muscle that lies just under the lungs. When the diaphragm is stimulated by a nervous impulse, it flattens. The downward movement of the diaphragm expands the volume of the cavity that contains the lungs, the thoracic cavity. When the rib muscles are stimulated, they also contract, pulling the rib cage up and out like the handle of a pail. This movement also
expands the thoracic cavity. The increased volume of the thoracic cavity causes air to rush into the lungs. The nervous stimulation is brief, and when it ceases, the diaphragm and rib muscles relax and exhalation occurs. Under normal conditions, the respiratory center emits signals 12 to 20 times a minute, causing a person to take 12 to 20 breaths a minute. Newborns breathe at a faster rate, about 30 to 50 breaths a minute. The diaphragm works by creating a negative pressure area. When pulling downward it makes the thoracic cavity have a substantially lower internal pressure than what exists out side the cavity. Air rushes into the respisrtory system. When the diaphragm relaxes it pushes upward causing the pressure in the thoracic cavity to become greater than exists outside the cavity. Air is forced out of the respiartory system. The rhythm set by the respiratory center can be altered by conscious control. The breathing pattern changes when a person sings or whistles, for example. A person also can alter the breathing pattern by holding the breath. The cerebral cortex, the part of the brain involved in thinking, can send signals to the diaphragm and rib muscles that temporarily override the signals from the respiratory center. The ability to hold ones breath has survival value. If a person encounters noxious fumes, for example, it is possible to avoid inhaling the fumes. A person cannot hold the breath indefinitely, however. If exhalation does not occur, carbon dioxide accumulates in the blood, which, in turn, causes the blood to become more acidic. Increased acidity interferes with the action of enzymes, the specialized proteins that participate in virtually all biochemical reaction in the body. To prevent the blood from becoming too acidic, the blood is monitored by special receptors called chemoreceptors, located in the brainstem and in the blood vessels of the neck. If acid builds up in the blood, the chemoreceptors send nervous signals to the respiratory center, which overrides the signals from the cerebral cortex and causes a
person to exhale and then resume breathing. These exhalations expel the carbon dioxide and bring the blood acid level back to normal. A person can exert some degree of control over the amount of air inhaled, with some limitations. To prevent the lungs from bursting from overinflation, specialized cells in the lungs called stretch receptors measure the volume of air in the lungs. When the volume reaches an unsafe threshold, the stretch receptors send signals to the respiratory center, which shuts down the muscles of inhalation and halts the intake of air. In pulmonary circulation, deoxygenated blood returning from the organs and tissues of the body travels from the right atrium of the heart to the right ventricle. From there it is pushed through the pulmonary artery to the lung. In the lung, the pulmonary artery divides, forming the pulmonary capillary region of the lung. At this site, microscopic vessels pass adjacent to the alveoli, or air sacs of the lung, and gases are exchanged across a thin membrane: oxygen crosses the membrane into the blood while carbon dioxide leaves the blood through this same membrane. Newly oxygenated blood then flows into the pulmonary veins, where it is collected by the left atrium of the heart, a chamber that serves as collecting pool for the left ventricle. The contraction of the left ventricle sends blood into the aorta, completing the circulatory loop. On average, a single blood cell takes roughly 30 seconds to complete a full circuit through both the pulmonary and systemic circulation.
A Diagram showing both the process of Pulmonary Circulation and Systemic Circulation Gas exchange or respiration takes place at a respiratory surface - a boundary between the external environment and the interior of the body. For unicellular organisms the respiratory surface is simply the cell membrane, but for large organisms it usually is carried out in respiratory systems. In humans and other mammals, respiratory gas exchange or
ventilation is carried out by mechanisms of the lungs. The actual exchange of gases occurs in the alveoli. Convection occurs over the majority of the transport pathway. Diffusion occurs only over very short distances. The primary force applied in the respiratory tract is supplied by atmospheric pressure. Total atmospheric pressure at sea level is 760 mm Hg, with oxygen (O2) providing a partial pressure (pO2) of 160 mm Hg, 21% by volume, at the entrance of the nares, and an estimated pO2 of 100 mm Hg in the alveoli sac, pressure drop due to conduction loss as oxygen travels along the transport passageway. Atmospheric pressure decreases as altitude increases making effective breathing more difficult at higher altitudes.
Diagram
showing
gas
exchange
that
occurs only at pulmonary and systemic capillary beds near the alveoli. CO2 is a result of cellular respiration. The concentration of this gas in the breath can be measured using a capnograph. As a secondary measurement, respiration rate can be derived from a CO2 breath waveform. Trace gases present in breath at levels lower than a part per million are ammonia, acetone, isoprene. These can be measured using selected ion flow tube mass spectrometry. Blood carries oxygen, carbon dioxide and hydrogen ions between tissues and the lungs. The majority (70%) of CO2 transported in the blood is dissolved in plasma (primarily as dissolved bicarbonate; 60%). A smaller fraction (30%) is transported in red blood cells combined with the globin portion of hemoglobin as carbaminohemoglobin. Hemoglobin in the red blood cells increases the carrying capacity of oxygen hundreds of times greater than plain water. CO2 that diffuses into the blood enters red blood cells where an enzyme converts the CO2 into bicarbonate ions (HCO3-). Converting the CO2 into Bicarbonate ions increases the carrying capacity of CO2 molecules.
In addition, formation of bicarbonate ions offers the body an effective method of regulating blood pH. CO2 will react with water to produce carbonic acid. If carbonic acid were to increase (which can occur as a result of increased cellular activity) blood pH would lower which could effect enzyme activity. The fact that red blood cells convert CO2 into Bicarbonate ions, which are basic, enables the body to maintain a constant pH in the blood.
IV THE PATIENT AND HIS ILLNESS SCHEMATIC DIAGRAM OF PNEUMONIA (Book-Based) Modifiable Factors modifiable Factors -Poor Diet -Age: 11 months -Unhygienic Practices based on culture Male -Place of residence is far from market -Underdeveloped place of residence Bodys defense is lowered/ low immune system Failure of the respiratory tree to be free of infection Exposure to an environment which serves as niche for M.O. (microorganisms Acquisition of M.O.s (bacterial, viral, fungal) Inhalation of M.O.s and become lodged vomit or In naso pharyngeal secretions substances such as into the lungs PATHOGENS BEGIN TO COLONIZE Infection Starts Aspiration of foreign body, food, other irritating products (cleaners) Non-
-Sex:
Bacteria reaches Tracheomucosa bronchial Tree
Virus attacks Bronchiolar epithelial cells Mucosal Edema
Irritation to the airway and lung parenchyma Desquamation mucous
(peeling off of membrane Impairment of the mucous glands Mucociliary escalator mucus) Absence of major barrier blood/fluid) against infection Further infection inflammation with Infiltrates in the alveolar walls (no exudates) Interstitial Reaches alveoli (fills with goblet cells (produces in lungs Invasion in
Local pulmonary defenses Resists infection than normal Cough Reflex temperature
Infects alveoli the
No. of WBC in peripheral blood is higher
Triggers alveolar inflammation
Elevated
Chills
Stress in the lungs; disrupts function perfusion
Produces an area of low ventilation w/ normal
Injury reduces normal blood flow to lungs injection into
Introduction of fluids on tissues by their blood vessels (veins)
Platelets aggregate and release histamine, blood Serotonin, & bradykinins
capillaries become engorged with
Stasis (cessation of flow of blood/ body fluids) Alveolocapillary membrane breaks down Increase capillary permeability Alveoli fills with blood and exudate Atelectasis( gas exchange is not accomplished by the shrunken alveoli) Cont. Reaches Pleural surface Hypoxemia Proteins and fluids Leak out
in some areas pulmonary compliance Diminished O2 in body (cyanosis) ronchi Hypoxemia Inflammatory exudates accumulates in the Pleural surfaces Irritation and inflammation of the pleura
Decrease
Crackles and
Hypoxia in muscles and brain respiration Vascular changes in Cephalic area Headache pressure Loss of appetite Edema Body malaise
Consolidation
Friction in the pleura upon
Partial loss of lung function Oxygenation of blood is impaired
Chest pain Cont. Increase in interstitial osmotic
Decrease Brain impulses In taste buds function
Shortness of breath
Pulmonary
Heart pumps more blood (compensatory mechanism)
Decreased Blood flow and fluids in the alveoli damage Surfactant
Tachycardia more
Impairs cells ability to produce
Alveoli collapses Sufficient O2 cant cross the exchange alveolocapillary membrane CO2 is lost w/ every exhalation Atelectasis Increase in respiratory distress Impaired gas Fibrosis Hypoxemia Metabolic acidosis develops Hemorrhage Tissue necrosis Acute Respiratory Failure Edema Formation of exudates Further pulmonary
SCHEMATIC DIAGRAM OF PNEUMONIA (Client-Centered) Modifiable Factors Factors -Poor Diet months -Unhygienic Practices based on culture -Place of residence is far from market -Underdeveloped place of residence Bodys defense is lowered/ low immune system Failure of the respiratory tree to be free of infection Exposure to an environment which serves as niche for M.O. (microorganisms Acquisition of M.O.s (bacterial, viral, fungal) Inhalation of M.O.s and become lodged In naso pharyngeal secretions Non-modifiable -Age: 11 -Sex: Male
PATHOGENS BEGIN TO COLONIZE Infection Starts Bacteria reaches Tracheobronchial Tree Virus attacks Bronchiolar epithelial cells Irritation to the airway mucosa and lung parenchyma
Desquamation (peeling off of mucous membrane in lungs Invasion in mucous glands goblet cells (produces mucus) Reaches alveoli (fills with blood/fluid)
Interstitial inflammation with Infiltrates in the alveolar walls (no exudates)
Local pulmonary defenses Resists infection Cough Reflex
Infects alveoli
Triggers alveolar inflammation
Stress in the lungs; disrupts function perfusion
Produces an area of low ventilation w/ normal
Injury reduces normal blood flow to lungs into
Introduction of fluids on tissues by their injection blood vessels (veins)
Platelets aggregate and release histamine, Serotonin, & bradykinins
capillaries become engorged with blood
Stasis (cessation of flow of blood/ body fluids) Alveolocapillary membrane breaks down
Alveoli fills with blood and exudate Atelectasis( gas exchange is not accomplished by the shrunken alveoli) Reaches Pleural surface in some areas Irritation and inflammation of the pleura
Diminished O2 in body
Hypoxemia
Inflammatory exudates accumulates in the Pleural surfaces
Hypoxia in muscles and brain In taste buds function Loss of appetite
Headache Vascular changes in Cephalic area
Decrease Brain impulses Body malaise
Synthesis of the Disease (Book-Centered) Pneumonia is the inflammation of the lung parenchyma and also of the interstitium of the lungs. It is acquired either in the community, where a host is exposed to and together with lowered immune system could cause an infection, or in the hospital where immunocompromised patients such as pediatrics, and geriatrics where there is failure of the body to be free of infection. A lot of different factors may have a contribution in the development of the disease. Among the factors are, poor diet, unhygienic practices based on culture, and an underdeveloped place of residence. Also, in addition to that, the presence of non-modifiable factors such as age of the client ad the sex (e.i. to which sex is the disease condition more prominent). Baby Clark Kent is an eleven month old baby boy, living in an underdeveloped place of residence which is far from the market. They observe unhygienic practices under the influence of culture. With all these combined, the defense mechanism of the client is lowered or impaired, there is failure of e respiratory tract to be free of infection. Upon exposure to an environment that serves as a niche for microorganisms, pathogens begin to start colonizing the body when the body undergoes two processes. First, inhalation of microorganisms in which they become lodged in the nasopharyngeal secretions. Second, Aspiration of foreign body, food, vomit or other irritating substances such as cleaning products into the lungs. There are three modes in which infection may start. First, a bacterium reaches the tracheobrochial tree. By then, local pulmonary defenses resists infection as manifested in coughing. The alveoli become infected and it triggers alveolar inflammation. With this, the number of WBC in the peripheral blood is higher than normal. And so there is elevated temperature plus chills may also be seen as a form of involuntary compensatory mechanism.
When the alveoli inflames, there is a presence of stress in the lungs that disrupts respiration. Therefore normal blood flow to the lungs is reduced. So what happens is that, platelets aggregate and release histamine, serotonin and bradykinins as an inflammatory response. Alveolar capillary membrane breaks down which will eventually lead to the filling of blood and exudates in the alveoli and increase capillary permeability. In the mean time, when alveolar inflammation occurs, there is a production of an area of low ventilation with normal perfusion which means that there is an introduction of fluids on tissues by their injection into blood vessels (veins). Capillaries now becomes engorged with blood so its flow will stop, thus stasis will occur. Atelectasis impairs gas exchange because the alveoli had already been shrunken when the alveoli was filled with blood and exudates. So what happens is that there is diminished oxygen in the body, which is evident in the occurrence of cyanosis; because of this there would be hypoxemia in the entire body which leads to hypoxia in the muscles and brain. Due to this occurrence, there would be vascular changes in the cephalic area which leads to headache and loss of appetite (decrease brain impulses in taste buds), body malaise will also be experienced. Also, when alveoli fill with blood and exudates pleural surfaces are being irritated and inflamed. Production of inflammatory exudates accumulates in the pleural surfaces; this causes consolidation of exudates which leads to partial loss of lung function in which oxygenation of blood is impaired. Therefore, there will be shortness of breath. Heart pumps more blood as a compensatory mechanism which leads to tachycardia. Furthermore, inflammatory exudates cause friction in the pleura upon respiration instigates chest pain. In relation to the increase in capillary permeability, proteins and fluids leak out; this increases interstitial osmotic pressure causing pulmonary edema. Pulmonary edema is an abnormal buildup of fluid within the tissues of the lung. Fluid can build up in the lungs for many reasons. This fluid makes it difficult for the lungs to give oxygen to the blood. There will be low oxygen in
the blood and the fluid itself; this damages the surfactant. When this happens, cells ability to produce more surfactant is impaired which leads to alveoli collapses. Gas exchange is impaired and respiratory distress increases. Sufficient Oxygen cant cross the alveolocapillary membrane; CO2 is lost with every exhalation. Hypoxemia occurs and metabolic acidosis develops soon after. When this happens, the client is at risk for having Fibrosis, Atelectasis, Hemorrhage, Tissue Necrosis, formation of exudates, and further Pulmonary Edema. In relation to the onset of infection, viruses attacks bronchiolar epithelia cells causing mucosal edema which impairs the mucociliary escalator. This leads to further infection because of the absence of a major barrier. Another factor when pathogens begin to colonize is the irritation to the airway mucosa and lung parenchyma. This directs to desquamation, which is the peeling off of mucous membrane in the lungs. This leads to invasion of mucous glands and goblet cells, which produces the mucous. Then, it fills the alveoli with blood and fluid when reached, and there will be interstitial inflammation with infiltrates in the alveolar walls; there are no present exudates. Synthesis of the Disease (Client-Centered) Baby Clark Kent is an 11-month old baby boy living in an
underdeveloped residence which is far from market. His diet is poor and their family performs unhygienic practices based on their culture. All of the above mentioned factors contributed to the lowered body defense of baby Clark. He failed to have a respiratory tree that is free from infection. Upon exposure to an environment which serves as a niche for microorganisms (M.O.), baby Clark had acquired these MOs because of lowered immunity. He acquired it through inhalation in which the MOs
became lodged in the nasopharyngeal secretions. Pathogens began to colonize and infection has started. Bacteria which is the tracheobronchial tree causing coughing reflex as a defense mechanism. Baby Clark was infected with quite a number of a MOs therefore he became susceptible and the alveoli in his lungs became infected causing an inflammation. Because of the inflammation the alveoli was filled with blood and exudates. Gas exchange is compromised leading to diminished oxygen in the body. There is low oxygen in the blood which leads to hypoxia in the muscles and brain causing headache and body malaise. Plus a decrease in appetite was attributed to that cause; since there is a decrease in the nerve impulses that stimulate the tastebuds function. Because of viral attacks to the bronchiolar epithelial cells, there was an impairment of the mucocilliary escalator which adds up to further infection. In addition to the blood and exudates that had filled the alveoli, pleural surfaces had been irritated and inflamed causing an accumulation in the inflammatory exudates leading to consolidation resulting in poor oxygenation in blood. This will pilot the body to have shortness of breath, and as a compensatory mechanism, the heart pumps more blood and the outcome will be tachycardia. Lastly, due to the irritation in the airway mucosa and lung
parenchyma, interstitial inflammation with infiltrates in the alveolar walls occurs when the alveoli is filled with blood or fluid. This action is due to the invasion of M.O.s in the mucous glands which stimulates the goblet cells to produce more mucus.
Modifiable and Non-modifiable Factors
1. Poor Diet is a modifiable factor in which this is crucial in the

strengthening of the immune system of the client. Without the
sufficient intake of vitamins and minerals that are present in the diet, the defense mechanism of the body is weakened; making it susceptible to infection and invasion of possible microorganisms that are present in the environment. This can be attributed to the possibility that these microorganisms are dwelling in the environment itself. Specifically, fruits and vegetables such as oranges, apples and green leafy vegetables would be helpful in strengthening the immune system. Plus, the compliance of the mother in giving due amount of breast milk to the client, who is Baby Clark Kent.
2. Unhygienic Practices based on culture is a modifiable factor

because it may or may not be done. It was found out that during Fridays and Tuesdays Baby Clark Kent is prohibited from taking a bath whenever he is sick. It is important to take a bath everyday and if this will be continually practiced, possible microorganisms could thrive on moist environments in the body making the client susceptible for diseases.
3. Place of residence is underdeveloped is another modifiable factor

since crowdedness of the people living in a particular geographical area would facilitate direct contact mode of transmission of possible microorganisms or through droplet infection, as well. This will make the client susceptible for acquiring a disease from someone proximal to him; therefore, a disease may or may not develop depending on the distance of the client from an infected person and the virulence of the disease.
4. Place of residence is far from market is a modifiable factor; this

factor is very important because the food that are said to be essential for the strengthening of the immune system of the child is present in the market. If it will be distal to the clients place of residence, then it will be hard for the family to supply for the needs of the client in terms of food. This difficulty lessens the food that Baby Clark Kent could have eaten should they live in a close proximity to the market.
5. Age is a non-modifiable factor in which the clients immunity against

possible diseases is not that developed in comparison to adults.
6. Sex is a non-modifiable factor in which the occurrence of the said

disease in prevalent in males more it is in females. Signs and Symptoms
1. Cough an important way to keep your throat and airways clear.

However, excessive coughing may mean you have an underlying disease or disorder. Some coughs are dry, while others are considered productive; a reflex which is said to be a natural defense mechanism because of its action of expulsing bacteria out of the tracheobronchial tree. Manifestation in baby Clark: Baby Clark seldom coughs as a form of resistance to infection because the bacteria has already reached the tracheobronchial tree.
2. Cyanosis refers to a blue or purple hue to the skin. It is most easily

observed on the lips, tongue and fingernails. Cyanosis indicates there may be decreased oxygen in the bloodstream. It may suggest a problem with the lungs, but most often is a result of mixing blue and red blood due to defects of the heart or great vessels. Cyanosis is a finding based on observation, not a laboratory test. Cyanosis is usually caused by either serious lung or heart disease, or circulation problems.
3. Loss of Appetite is a result of decrease in the brain impulses that

stimulates the function of the taste buds. It is because of the vascular changes in the cephalic area. Since the alveoli where filled with fluids and exudates, gas exchange was not accomplished well; so what happened was, there was diminished Oxygen in the body, as it was manifested by the presence of cyanosis. Hypoxemia had erupted resulting to low oxygen in the brain and muscles which eventually lead to the vascular changes. Manifestation in baby Clark:
As a result of loss of appetite, baby Clark had a weight reduction as verbalized by the mother. It is because of the decrease brain impulses in taste buds function because of low oxygen in the body tissues particularly in the brain.
4. Headache is the outcome when there is low oxygen in the brain.

There are vascular changes in the cephalic area. Manifestation in baby Clark: Baby Clark had experienced headache because of the vascular changes in the cephalic area when there is low oxygen in the head. This can be attributed to the diminished oxygen in the body due to the fluid that filled the alveoli.
5. Body Malaise had resulted out of low oxygen content in the muscles.
Since the cells in the body require sufficient amount in oxygen, it cannot work properly if its level is decrease resulting to malaise.
V. THE PATIENT AND HIS CARE

A. Planning a. Nursing Care Plan
ASSESSME NT S> the S.O verbalized manguku ya ampong lalagnat O> the patient manifested >Flushed skin >skin warm to touch >with body
NURSING DIAGNOSIS Hyperther mia
SCIENTIFIC EXPLANATIO N When the causative agent enters the body and invades the respiratory system, the inflammatory process is triggered releasing platelets, WBC, RBC, which
OBJECTIVES
INTERVENTI ONS
RATIONALE
EXPECTED OUTCOME
Short term: After 6 hours of nursing interventions the patient will maintain core temperature within the normal range. Long Term: After 1 day
1.Measure temperature
1. Indicates if fever exists and its extent.
Short term: The patient shall have maintained core temperature within the normal range.
2. Assess skin temperature and color.
2. Warm, dry, flushed skin may indicate a fever.
3. Monitor WBC count.
3. Leucocytes indicate an inflammatory and infectious process Long term: The patient shall have been free of
temperature of 38.1C > with skin rashes present in the abdomen, back and face > rales on both lung field -The patient may manifest >dehydratio n >Irritability
produces exudates of fibrin, which enhances the spread of microorganis m, causing infection. In response to infection, the individual WBC release pyrogens. These pyrogens affect the body temperatureregulating mechanism in
of nursing intervention the patient will be free from hyperthermi a. 4. Encourage fluid intake orally or intravenously as ordered. 5. Measure intake and output.
presence. 4. Replaces fluid lost by insensible loss and perspiration. 5. Determine fluid balance and need to increase fluid intake. 6. Give tepid sponge bath. 6. To facilitate heat loss through evaporation. 7. Apply an 7. To facilitate
hyperthermi a.
the hypothalamus of the brain. As a consequence, heat production and conservation increase, a body temperature increases. Fever promotes activities of the immune system, such as phagocytosis,
ice bag covered with towel to the axilla and groin. 8. Administer antipyretics as ordered.
heat loss through conduction.
8. To interrupt the growth of microorganis m.
inhibits the growth of some microorganis m.
ASSESSM ENT S>
NURSING DIAGNOSIS Risk for infection (spread) related to inadequate secondary defenses(decreas e hemoglobin, hematocrit and immunosuppressi on)
SCIENTIFIC EXPLANATI ON Immunosuppression due to decrease in hemoglobin, leukopenia, and suppress inflammator y response gives a greater opportunity for pathogenic bacteria to invade and inoculate in a specific body part of
OBJECTIVES
INTERVENTI ONS
RATIONALE
EXPECTED OUTCOME
Short term: After 6 hours of nursing interventions the patients S.O will verbalize her understandin g of individual causative/risk factors and demonstrate lifestyle changes to prevent further infection. Long term:
After 1-2 days of nursing interventions the patient will be free from possible spread of
1. Monitor v/s closely, especially during initiation of therapy. 2. Instruct the S.O concerning about the disposition of secretions and report changes in color, amount and odor of secretions.
1. To know potential fatal complication that may occur. 2. To promote safety disposal of secretions and to assess for the resolution of pneumonia or development of secondary infection.
Short term:
The patients S.O shall have verbalized her understandin g of individual causative/risk factors and demonstrate lifestyle changes to prevent further infection.
O>the patient manifested >fever of 38.4C >presence of adventitiou s sounds in both lung field. >productiv e cough >skin pale in color >restlessn ess -The patient may manifest >body malaise >activity
a susceptible human body. Thus, leading to a further damage or infection.
Long term: The patient shall have been free from possible spread of
3. Encourage good hand washing techniques. 3. To reduce spread or acquisition of infection.
ASSESSME NT S> the S.O verbalized masalese neng mangan, kayamu sasanat yapa ampong sisispun. O>the patient manifested >pale palpibral conjunctiva >rales on
NURSING DIAGNOSIS Ineffective Airway Clearance related to retained secretions
SCIENTIFIC EXPLANATION When the causative agent triggers the inflammatory process of the lungs, exudates of fibrin containing fluid, polymononuclea r leucocytes and erythrocytes is produce. Furthermore, the mucous produce joins it by the goblet cells in response to the invading
OBJECTIVE S Short term: After 4-6 hours of nursing intervention s the patient will maintain airway patency. Long term: After 1-2 days of nursing intervention
INTERVENTI ONS 1. Auscultate lungs for crackles, consolidation and pleural friction rub.
RATIONALE 1. To determine the adequacy of gas exchange and extent of airways obstructed with secretions.
EXPECTED OUTCOME Short term: The patient shall have maintained airway patency.
Long term: The patient shall have expectorated secretions readily.
2. Assess characteristic s of secretions: quantity, consistency,
2. Because presence of infection is suspected when secretions
both lung fluid >restless -The patient may manifest >dyspnea >cyanosis >chest pain >headache
microorganism, this combination produce and increase in the tracheobronchial tree.
s the patient will expectorate secretions readily.
color, and odor.
are thick, yellow or rust in color and foul smelling.
3. Keep the environment allergen free according to the individual needs.
3. To prevent allergic reactions that may cause bronchial irritation.
4. Encourage the mother to increase the fluid intake of the child. 4. As to liquefy secretions so that they are easy to
expectorate. 5. Position the patient in HOB. 5. To Facilitate optimal breathing. 6. Encourage eating high caloric foods, food rich in iron like liver and dark green leafy vegetables, and foods rich in vitamin C. 6. To supplement the iron needs of the child as well as to facilitate absorption and strengthenin g his immune system.
7. Perform and instruct chestphysiotherapy after nebulization. 8. Administer meds per doctors order. 8. To facilitate fast recovery. 7. For easy secretion expulsion.
ASSESSME NT S>the S.O verbalized
NURSING DIAGNOSIS Imbalance nutrition:
SCINETIFIC EXPLANATION Many taste sensations are
OBJECTIVES Short term: After 5-6
INTERVENTIO NS 1. Monitor and record vital
RATIONALE 1. To establish baseline data.
EXPECTED OUTCOME Short term:
meyayat ya O>the patient manifested >Pale conjunctiva and mucous membranes >Sunken eyes >Lethargy -The patient may manifest >Anorexia >Malnutritio n >Gastric irritation
less than body requiremen ts related to loss of appetite.
strongly influenced by olfactory sensations. This influence can be demonstrated by comparing the taste of some food before and after pinching your nose it is easy to detect that the sense of taste is reduce will the nose is pinch. Thus having secretions in the nasal cavity will impede
hours of nursing interventions the patient will demonstrate increase appetite. Long term: After 2-3 days of nursing interventions the patient will maintain normal body weight.
sign. 2. To know the 2. Assess for patients BMI. nutritional status of the client. 3. Instruct the S.O to give food to the infant in an appetizing manner. 4. Encourage small frequent feeding. 4. To enhance intake even though appetite may be slow to return. 5. Monitor electrolyte values and 5. Poor nutritional status may 3. To boost patients appetite.
The patient shall have demonstrated an increased in appetite.
Long term: The patient shall have maintained normal body weight.
your taste buds from giving you the appetite you need. Physical illness, unfamiliar or unpalatable food, environmental and psychologic factors and physical discomfort or pain may depress the appetites of may clients.
report any abnormalities. 6. Promote adequate rest.
cause electrolyte imbalances. 6. To reduce fatigue and improve the childs ability and desire to eat.
7. Encourage the mother to give the child multivitamins. 7. To supplement the nutritional needs of the child.
ASSESSM ENT S> O> the patient manifested >restlessn ess >irritability >nasal flaring -The patient may manifest >diaphores is >tachycard ia >dyspnea
NURSING DIAGNOSI S Impaired gas exchange related to alveolar capillary membran e changes secondary to inflammat ion.
SCIENTIFIC EXPLANATI
OBJECTIVE S
INTERVENTIO NS 1. Monitor vital signs and assess patients conditions. 2.Auscultate lungs for crackles , consolidation and pleural friction rub.
RATIONALE
EXPECTED OUTCOME
ON Bronchospas Short term: m, which occurs in many pulmonary diseases, reduces the caliber of the small bronchi and may cause dyspnea, static secretions and infections. Bronchospas m can sometimes be detected by stethoscope when wheezing or diminished breath Long term: After 2-3 days of nursing intervention s the patients S.O will verbalize understandi ng of the causative factors that could aggravate the condition After 6 hours of nursing intervention s the patient will demonstrate ease in breathing.
1. To establish baseline data.
Short term: The patient shall have demonstrated ease in breathing.
2. Determine adequacy of gas exchange and detect areas of consolidation and pleural friction rub. Long term: The patients S.O will verbalized understanding of the causative factors that could aggravate the condition and appropriate factors that could help the patient relive from gas exchange impairment.
3. Assess LOC, distress and irritability. 4. Observe skin color and capillary refill.
3. This signs may indicate hypoxia. 4. Determine circulatory adequacy, which is necessary for gas
B. Implementation
B.1. Medical Management

B.1.a. IVFs and Nebulization
Medical Management/ Treatment Intravenous Fluids D5IMB 500cc 28-29 gtts/min
Date Ordered Date Performed Date Changed/DC DO: 06-23-07 DP: 06-23-07 DC: 06-26-07
General Description It is a hypertonic solution, which makes the cells shrink, composes of water and carbohydrates, as source of energy and both cations and anions.
Indication(s) or Purpose(s) It is use to supply the necessary nutrients. And this solution is given usually when serum osmolality has decreased to dangerously low levels.
Clients Response to the Treatment Client fluid loss due to insensible fluid loss was replaced and nourished.
DO: 06-26-07 D5LRS 500cc 28-29 gtts/min DP: 06-26-07 DC: 06-28-07
It is a hypertonic solution, which draws fluid out of It provides caloric nutrients, thus
Client fluid loss due to insensible fluid loss was replaced.
the intracellular and interstitial compartments into the vascular compartment, expanding vascular volume.
resembles the electrolyte composition of the normal blood serum and plasma.
Nursing Responsibilities: Prior to the procedure:

Check doctors order. Check for ordered IVF. Check for the patency of the IV tubing, cloudiness and expiration date. Explain the procedure.
During the procedure:

Clean the site of administration. Choose a vein in the distal arm. Support client hand and maintain aseptic technique.
After the procedure:
Monitor rate as ordered, flow and patency. Document the time and date.
Medical Management/ Treatment Nebulization
Date Ordered Date Performed Date Changed/DC DO: 06-23-07 DP: 06-24-07 DC: 06-28-07
General Description Adding medication or moisture to inspired air by mixing particles of various sizes with air.
Indication(s) or Purpose(s) It aids bronchial hygiene by restoring and maintaining mucous blanket continuity, hydrating dried, retained secretions, promoting expectoration of secretions. To relive bronchospasm, to provide relief to a hyperresponsive airway and to liquefy and clear tenacious secretions.
Clients Response to the Treatment The client still manifested rales even though nebulization is given. And was able to cough out secretions. On the other hand his respiratory rate decreases from 37cpm as of 06-2407 to 27cpm as of 06-28-07.

Check doctors order. Check for the amount of medication that is to be incorporate in the procedure. Explain the procedure to the patients S.O. Arranged all the material needed. Wash hand.

Hold the mouthpiece of the nebulizer upright to avoid spilling of medicines. Continue nebulization until the medication is already nebulized. Do chest physio-therapy after nebulisation. Assess the clients vital signs after nebulisation, especially the respiratory rate. Document the time of the procedure was done.
B.1.b Drugs Name of Drugs Generic Name Brand Name Date Ordered Date Taken/Given Date Changed/DC Route of Administration, Dosage and Frequency of CEPHALOSPORIN Ceftazidime DO: 06-23-07 DP: 06-23-07 DC: 06-28-07 Administration IV 300mg every 8 hours An anti-infective drug which eliminates bacteria that cause many kinds of infections, including lung, skin, bone, joint, stomach, blood, gynecological, and urinary tract infections. Nursing Responsibilities: Indication(s) and Purposes(s) Client Response to the Medication with Actual Side Effects The patient had skin rashes on his face, abdomen and back for the first 3 days of medication. The patient manifested a decrease infection as evidence by absence of fever as of 06-27-07 until discharged.
Prior to the procedure:

Check doctors order. Check patients sensitivity to penicillin and to other cephalosporins. Explain to the action of the drug.

Recompute the drug formula and inspect for the patency of the needle. Check for any resisitence. Clean the IV port with an alcohol before injecting the medication. Push the IV medication slowly as possible.

Observe for any discomfort in the IV insertion site. Tell the S.O to immediately report any signs of adverse effect. Document.
Name of Drugs Generic Name Brand Name
Date Ordered Date Taken/Given Date Changed/DC
Route of Administration, Dosage and Frequency of Administration Inhalation (nebulizer) 1 every 4 hours.
Indication(s) and Purposes(s)
Client Response to the Medication with Actual Side Effects
ALBUTEROL Salbutamol
DO: 06-23-07 DP: 06-23-07 DC: 06-28-07
Salbutamol is used in cases of bronchospasm in patients with reversible airway obstruction: mild and moderate attacks of dyspnea in patients suffering from bronchial asthma; mild and moderate bronchoobstruction in patients with chronic bronchitis and lung emphysema.
After the each medication the patient feels relief and able to expectorate secretions easily.

Check doctors order. Assess for the lung sounds, pulse and blood pressure before administration. Warn the S.O for possible paradoxical bronchospasm.

Put the medication into the inhaler and shake it well. Clear nasal passenges and throat. Place the mouthpiece well into mouth as dose from the inhaler is released, and instruct the patient to inhale
deeply. Perform chest-physio therapy.

Instruct the S.O on how to perform nebulisation. Emphasize to the S.O to take missed dose as soon as remembered, spacing remaining doses at regular Do not double the dose or increase the dose or frequency of dosage. Document.
interval.
Name of Drugs Generic Name Brand Name
Date Ordered Date Taken/Given Date Changed/DC
Route of Administration, Dosage and Frequency of Administration V 90cc every 4 hours if temperature is > 38.8 degree Celsius
Indication(s) and Purposes(s)
Client Response to the Medication with Actual Side Effects
ACETAMINOPHEN Paracetamol
DO: 06-23-07 DP: 06-23-07 DC: 06-23-07
It is a common analgesic and antipyretic drug that is used for the relief of fever, headaches, and other minor aches and pains.
The patients body temperature decreases from 40 degree Celcius to 37.5 degree Celcius.
Tempra
DO: 06-23-07 DP: 06-24-07 DC: 06-28-07 Oral (drops) 1ml or 1 tsp. every 4 hours The clients body temperature was maintained within the normal range.
Nursing Responsibilities:
Prior to the procedure:

Check doctors order. Explain the action of the drug. Assess fever note presence of associated signs like diaphoresis, tachycardia and malaise. Tell the S.O that this drug can be taken with food or an empty stomach.

IV: Clean the IV port before slowly injecting the medication. ORAL (drops): Drop medication at the side of the cheeks to prevent aspiration.

Advice the S.O to check concentrations of liquid preparations. Errors have resulted in serious liver damage. Have the S.O determine the correct formulation and dose for their child. Document.
B.1.c Diet Type of Diet Date Ordered Date Performed Date Changed/DC DO: 06-23-07 DP: 06-23-07 DC: 06-28-07 General Description Indication(s) and Purpose(s) Specific Food Taken Clients Response and/or Reaction to the Diet The client appetite was increased.
DAT REGULAR DIET DIET AS TOLERATED
Ordered when the clients appetite, ability to eat, and tolerance for certain food may change.
To increase the caloric intake of food to maintain or achieve optimal health status. This diet is indicated to ambulatory or bed patients whose conditions to not necessitate a modified diet.
Food rich in iron such as liver and dark green leafy vegetables.

Check doctors order. Advice the S.O to give the food to the patient in an appetizing manner.
Instruct the S.O to give nutritious and balance foods to the patient.

Stress the importance of compliance to the diet. If the patient loss his appetite, instruct the S.O to give food to the patient in a small frequent feeding.

Assess the patients health status. Compare previous health status from the present. Document.
B.1.d Activity Exercise Type of Exercise Date Ordered Date Performed Date Changed/DC CBR with elevated HOB DO: 06-23-07 DP: 06-23-07 DC: 06-28-07 The patient is required to stay in bed to reduce metabolic activity and to facilitate proper lung expansion for easy breathing. Bed rest- rest prevents tissue oxygen demand and enhances tissue oxygen perfusion. While elevated head of bed facilitates lung expansion to enhance breathing. General Description Indication(s) and Purpose(s) Clients Response and/or Reaction to the Activity/Exercise The client reached his optimum level of recovery.
Check doctors order. Explain the importance of complying in the said exercise. Monitor patients vital signs.

Provide a relaxing resting environment to the patient. Observe the patient for any difficulty in performing the said exercise.

Assess patient condition after the exercise. Document.
B.2 Nursing Management
Actual Nursing Care (SOAPIE) June 26, 2007 Tuesday S> O> Manguku ya ampong lalagnat as verbalized by the S.O received patient lying on bed in a supine position with mother, restless, conscious, with an IVF out of D5IMB, skin warm to touch, with skin rashes on face, abodomen and back, febrile, with productive cough, (-)DOB, pale, with rales on both lung field, with vital signs as follows T:38.1C CR:150bpm RR:29cpm A> P> I> Hyperthermia After 6 hours of nursing interventions, patients temperature will decrease from 38.1 C to 37.5 C. >Established rapport. >Monitored and recorded vital signs. >Assessed patients condition. >Provided comfort measures such as changing patients clothes. >Maintained back dry and encouraged loosen patients clothing. >Performed TSB. >Emphasized to the mother the importance of increasing the fluid intake of the child. >Encouraged the mother to give the child nutritious foods rich in iron such as liver and dark green leafy vegetables. >Instucted nebulization. >Reinfused IVF @ 9:00am and regulated. >Administered medications per doctors order. E> Goal met. As evidence by decreased patients body temperature to 37.5 C. and performed chest physiotherapy after
June 27, 2007 Wednesday S> O> Masalese ne, okay neng mangan, kayamu nengkayi sasanat yapa ampong sisispun as verbalized by the S.O received patient lying on bed in a supine position with mother, aware, conscious, with IVF of D5IMB 500cc 28-29 gtts/min @ 200cc level, infusing well at his right foot, with pale palpebral conjunctiva, with rales onboth lung field, with vital signs as follows T: 37.4 C CR:150bpm RR:23cpm A> P> I> Ineffective airway clearance related to retained secretions. After 4-6 hours of nursing interventions the patient will maintain airway patency. >Established rapport. >Monitored and recorded vital signs. >Assessed patient condition. >Maintained back dry. >Auscultated lungs for crackles, consolidation and pleural friction rub. >Assessed characteristics of secretions, quantity color consistency and odor. >Stressed the importance of increasing fluid intake. >Positioned patient in elevated HOB for optimal breathing pattern. >Encouraged the S.O to give the patient high caloric foods. >Instructed the S.O to give foods rich in Iron like liver and dark green leafy vegetables and Vitamin C. >Performed and instructed chest-physio therapy and postural drainage after nebulization. >Encourage bed rest. >Administered meds per doctors order. E> Goal met. As evidence by patients maintenance patent airway.
VI. CLIENTS DAILY PROGRESS IN THE HOSPITAL

1. Clients Daily Progress chart (from admission to discharge)
DAYS Ineffective Airway Clearnce Imbalace Nutrition: less than body requirements Risk for Infection (spread) Impaired Gas Exchange Hyperthermia
June 23, 2007
24-Jun-07
25-Jun-07
26-Jun-07
27-Jun-07
June 28. 2007
Nursing Problems * * * * * * * * * * * * * Vital Signs 37.8 C 38.4 C 101bpm 37cpm Diagnostic Exams CBC Hematocrit: 0.29 Hemoglobin: Hemoglobin : 9-6 Hematocrit: * * * * * *
T: CR: RR:
40C
38.1 C 150bpm 29cpm
37.4 C 150bpm 23cpm
37.3 C 129 27cpm
88 WBC: 11.8 Neutrophils: .62 Lymphocytes : .33 Monocytes: . 05 Platelet:153 Hazy infiltrates are noted on both lower lungfields; Heart is normal in size; Diaphrag m and sulci are intact; Other chest structures are remarkabl e Color: Yellow
31-0 WBC: 3.6 Differential count Polys: 68 Lymphocyte : 91 Eosinophil: 01 Platelet: 184
X-tray Urinalysis
Transparenc y: Clear pH: 7.5 Specific Gravity: 1.010 Albumin: Negative Sugar: Negative Microscopic Exam Pus Cell: 03/hpf RBC: 2-5/hpf Epithelial Cells: Rare Medical Management IVF D5 IMB D5 LRS Nebulization Nebulization Drugs Acetaminophen Paracetamol IV Tempra PO Albuterol * * * * * *
* *
* *
* * * * * *
Salbutamol Cephalosporin Ceftazidime Diet Diet as tolerated Exercise/Activity CBR with elevated HOB
* * * *
* * * *
* * * *
* * * *
* * * *
* * * *
VII. DISCHARGE PLANNING

A. General condition about the client upon discharge. The client achieved his optimum health status after his hospitalization. He has already adequate ventilation and oxygenation. There were no complications noted. Still, on the process of recovery. B. M> E> T> METHOD Vitamin C 1 tsp once a day Nebulization: Salbutamol once a day >Deep breathing exercise. >have adequate rest >Instruct to follow treatment regimen. >Instruct the S.O to perform chest physiotheraphy after nebulisation. >Emphasize that too much nebulization my cause paradoxymal spasm. H> >Increase fluid intake >Avoid strenuous activities >Eat high caloric foods, rich in iron and vitamin C >Maintain back dry >Warn the S.O to report any signs and symptoms of the disease condition that she had observed immediately to the physician or nurse. Like elevated temperature, diaphoresis, difficulty of breathing, persistent cough and cold or flu. >Encourage proper handwashing. >Have an adequate rest. O> D> >Instructed to come back after a week for check up. >DAT
VIII. CONCLUSION AND RECOMMENDATION
The proponents of this study conclude about the effect of low socioeconomic status and nutritional deficiency to the vulnerability of an individual against microorganisms. They are as follows:
The environment plays a vital role in the health of a person. The viruses and bacteria that cause pneumonia are contagious and are Illness can spread when an infected person coughs or sneezes on a
usually found in fluid from the mouth or nose of an infected person. person, by sharing drinking glasses and eating utensils, and when a person touches the used tissues or handkerchiefs of an infected person. Risk for infection will always be blamed to the decrease in the primary defenses as well as with the virulence of a microorganism.
The proponents of this study recommends the following: If your child's doctor has prescribed antibiotics for bacterial pneumonia, give the medicine on schedule for as long as the doctor directs. This will help your child recover faster and will decrease the chance that infection will spread to other household members. Don't force a child who's not feeling well to eat, but encourage your child to drink fluids, especially if fever is present. Ask your child's doctor before you use a medicine to treat your child's cough because cough suppressants stop the lungs from clearing mucus, which may not be helpful in some types of pneumonia. If your child has chest pain, try a heating pad or warm compress on the chest area. Take your child's temperature at least once each morning and each evening, and call the doctor if it goes above 102 degrees Fahrenheit (38.9 degrees Celsius) in an older infant or child, or above 100.4 degrees Fahrenheit (38 degrees Celsius) in an infant under 6 months of age.
Check your child's lips and fingernails to make sure that they are rosy and pink, not bluish or gray, which is a sign that your child's lungs are not getting enough oxygen.
VIII. CONCLUION AND RECOMMENDATION A. Nurse-centered The researchers were able to gain knowledge and deeper understanding of the disease process itself and impart health teachings regarding the clients condition in maintaining an optimum level of functioning. Plus, the researches were able to accomplish the following:
1. Interpret the current trends and statistics regarding the disease condition; 2. Relate the present state of the client with his personal and pertinent family history; 3. Analyze condition; 4. Identify treatment modalities and its importance like drugs, diet and exercise; 5. Identify surgical management and its purpose that is applicable with the disease condition; 6. Formulate nursing care plans based on the prioritized health needs of the client; 7. Gain knowledge on the acquisition and progression of the disease; 8. Impart knowledge on fellow students in providing care for clients with the same illness. B. Patient-Centered The proponents were able to acquire knowledge on the risk factors that have contributed to the development of the disease; also, gain understanding of the disease process and demonstrate compliance on the treatment management rendered by the health care team. and interpret the different diagnostic and laboratory procedures, its purpose and its essential relationship to clients disease
In relation to the patients condition, the proponents were also able to accomplish these tasks: 1. Gain knowledge about the disease of Baby Clark Kent; 2. Identify different interventions in his condition; 3. Gain knowledge on the importance of compliance to treatment regimen; 4. Demonstrate compliance on the treatment management; 5. Identify different measures to prevent further aggravation of condition; 6. Participate in his plan of care; and 7. Demonstrate independence on self-care and home management upon discharge and during follow-up home visits.
The proponents of this study conclude about the effect of low socio-economic status and nutritional deficiency to the vulnerability of an individual against microorganisms. They are as follows:
The environment plays a vital role in the health of a person. The viruses and bacteria that cause pneumonia are contagious and are usually found in fluid from the mouth or nose of an infected person. Illness can spread when an infected person coughs or sneezes on a person, by sharing drinking glasses and eating utensils, and when a person touches the used tissues or handkerchiefs of an infected person. Risk for infection will always be blamed to the decrease in the primary defenses as well as with the virulence of a microorganism.
The proponents of this study recommends the following: If your child's doctor has prescribed antibiotics for bacterial pneumonia, give the medicine on schedule for as long as the doctor directs. This will help your child recover faster and will decrease the chance that infection will spread to other household members.
Don't force a child who's not feeling well to eat, but encourage your child to drink fluids, especially if fever is present. Ask your child's doctor before you use a medicine to treat your child's cough because cough suppressants stop the lungs from clearing mucus, which may not be helpful in some types of pneumonia. If your child has chest pain, try a heating pad or warm compress on the chest area. Take your child's temperature at least once each morning and each evening, and call the doctor if it goes above 102 degrees Fahrenheit (38.9 degrees Celsius) in an older infant or child, or above 100.4 degrees Fahrenheit (38 degrees Celsius) in an infant under 6 months of age. Check your child's lips and fingernails to make sure that they are rosy and pink, not bluish or gray, which is a sign that your child's lungs are not getting enough oxygen.

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I.

dependent, which provides for better

compliance at twice-daily dosing. In vitro, potency is marked by lower

II. Nursing Assessment

Jonathan 28 years old -Asthma

Lionel 27 years old -history of smoking and alcoholism

Alex 21 years old -Asthma

Martha 20 years old -history of parasitism

Elizabeth 16 years old

George 10 years old -Asthma

Lois 3 years old -Asthma

Lana 8 years old

Lex 6 years old -Asthma

Lois 3 years old -Asthma

Caley 3 months hospitalize d due to cough & colds -premature (3 weeks)

EXTREMITIES: (-) edema noted

Baby Clark Kent Absence of Babinski Reflex

sole of the foot is stroke.

Absence of Galant Reflex

Sudden midline returns

Absence of Moro Reflex

extension of arms with startled by loud noise or rapid change in position.

Attempting head in position.

24 months Presence of Righting Reflex

Absence Rooting Reflex

stimulated side of cheek.

Initiation of sucking whenBirth an object is place on the mouth.

Presence of Sucking Reflex

swimmingBirth when held

Absence Swimming Reflex

Making movements upright with

steppingFirst when heldweeks; feetreappear

12 months Presence of Walking Reflex

touching the surface.

Analysis & Interpretation of Results

Low Hb concentration may indicate

anemia, recent hemorrhage or fluid retention, which can cause hemodilution.

hemodilution or massive blood loss.

vol% (37 47 vol%)

DO: 06/26/07 DRI: 06/26/07

.62 .45 .65 68 % (60 70)

Eosinophils are white blood cells of the immune

Platelets or thrombocyte s are the cell

by the administration of desmopressin.

3/hpf RBC: 2-5/hpf Epithelial Cells: Rare

Send specimen to the laboratory immediately. Perform proper hand-washing. Document.

Diagnostic/ Laboratory Procedures

Date Ordered & Date Result(s) In DO: 06/25/07

Heart is normal in size

anterior left mediastinal cavity; appears solid because of blood contents

Bacteria reaches Tracheomucosa bronchial Tree

Virus attacks Bronchiolar epithelial cells Mucosal Edema

Irritation to the airway and lung parenchyma Desquamation mucous

Infects alveoli the

No. of WBC in peripheral blood is higher

Triggers alveolar inflammation

Stress in the lungs; disrupts function perfusion

Produces an area of low ventilation w/ normal

Injury reduces normal blood flow to lungs injection into

Introduction of fluids on tissues by their blood vessels (veins)

Platelets aggregate and release histamine, blood Serotonin, & bradykinins

capillaries become engorged with

Friction in the pleura upon