Laboratory Result November 26, 2009

Parameters Result Normal values Clinical significance

hemoglobin 139. 5 138-166g/l normal
hematocrit 0.44 0.40-0.48g/l Normal
RBC 4.73 4.2-6.5m/U Normal
White cell count 19.3 (15.8) 5-10x10g/l infection

Differential Count
basophils 0.01 0 - 0.5 normal
segmenters 0.36(.24) .55 - .65
Lymphocytes .62(.56) .2 -.6 normal
Monocytes .01 .2 - .6 normal

Platelets count 277 (133) 150-350x10g/l Aplastic or aplastic bone

marrow, leukemia, vit. B12
deficiency immiiiiune
disorder.
MVP 7.17 5.83-8.46f/L normal
RDW 11.52 11.0-14.0 f/L normal
MCV 89.81 80.97f/L Normal
MCHC 32.82 32-36% normal

Microscopic / Chemical Examinations

Routine Physical Examination

Color: straw
Turbidity: clear
CHEMICAL ANAYSIS
glucose negative Ph:8.5
Bilirubin Negative Protein: negative
Ketone Negative Urobilirubin: normal
Specifis gravity 1.015 Nitrite: negative
bood negative Leukocytes: negative
 Introduction

Pneumonia is acute inflammation of the lungs caused by infection. Initial

diagnosis is usually based on chest x-ray. Causes, symptoms, treatment, preventive
measures, and prognosis differ depending on whether the infection is bacterial, viral,
fungal, or parasitic; whether it is acquired in the community, hospital, or nursing home;
and whether it develops in a patient who is immunocompetent or immunocompromised.

An estimated 2 to 3 million people in the US develop pneumonia each year, of

whom about 45,000 die. Pneumonia is the most common fatal hospital-acquired infection
and the most common overall cause of death in developing countries.

Bacteria are the most common cause of pneumonia in adults > 30 yr, Streptococcus
pneumoniae infection being the most common pathogen across all age groups, settings,
and geographic regions. However, pathogens of every sort, from viruses to parasites,
cause pneumonia.

The airways and lungs are constantly exposed to pathogens in the external
environment; the upper airways and oropharynx in particular are colonized with so-called
normal flora rendered harmless by host defenses. Infection develops when pathogens that
are inhaled or aspirated or reach the lungs via the bloodstream or contiguous spread
overcome multiple host defenses.

Upper airway defenses include salivary IgA, proteases, and lysozymes; growth
inhibitors produced by normal flora; and fibronectin, which coats the mucosa and inhibits
adherence. Nonspecific lower airway defenses include cough, mucociliary clearance, and
airway angulation preventing infection in airspaces. Specific lower airway defenses
include various pathogen-specific immune mechanisms, including IgA and IgG
opsonization, anti-inflammatory effects of surfactant, phagocytosis by alveolar
macrophages, and T-cell–mediated immune responses. These mechanisms protect most
people against infection. But numerous conditions alter normal flora (eg, systemic illness,
undernutrition, hospital or nursing home exposure, antibiotic exposure) or impair these
defenses (eg, cigarette smoking, nasogastric or endotracheal intubation). Pathogens that
then reach airspaces can multiply and cause pneumonia.

Specific pathogens causing pneumonia cannot be found in < 50% of patients, even
with extensive diagnostic investigation. But because pathogens and outcomes tend to be
similar by setting and host risk factors, pneumonias can be categorized as
Anatomy and Physiology
 The main function of the lungs is to provide continuous gas exchange between
inspired air and the blood in the pulmonary circulation, supplying oxygen and removing
carbon dioxide, which is then cleared from the lungs by subsequent expiration. Survival
is dependent upon this process being reliable, sustained and efficient, even when
challenged by disease or an unfavourable environment. Evolutionary development has
produced many complex mechanisms to achieve this, several of which are compromised
by anaesthesia. A good understanding of respiratory physiology is therefore essential to
ensure patient safety during anaesthesia.

Anatomy
The respiratory tract extends from the mouth and nose to the alveoli. The upper
airway serves to filter airborne particles, humidify and warm the inspired gases. The
patency of the airway in the nose and oral cavity is largely maintained by the bony
skeleton, but in the pharynx is dependent upon the tone in the muscles of the tongue, soft
palate and pharyngeal walls.

Larynx

The larynx lies at the level of upper cervical vertebrae, C4-6, and its main
structural components are the thyroid and cricoid cartilages, along with the smaller
arytenoid cartilages and the epiglottis, which sit over the laryngeal inlet. A series of
ligaments and muscles link these structures, which, by a co-ordinated sequence of
actions, protect the larynx from solid or liquid material during swallowing as well as
regulating vocal cord tension for phonation (speaking). The technique of cricoid pressure
is based on the fact that the cricoid cartilage is a complete ring, which is used to compress
the oesophagus behind it against the vertebral bodies of C5-6 to prevent regurgitation of
gastric contents into the pharynx. The thyroid and cricoid cartilages are linked anteriorly
by the cricothyroid membrane, through which access to the airway can be gained in an
emergency.

Trachea and bronchi

The trachea extends from below the cricoid cartilage to the carina, the point where
the trachea divides into the left and right main bronchus, with a length of 12-15cm in an
adult and an internal diameter of 1.5-2.0cm. The carina lies at the level of T5 (5th thoracic
vertebra) at expiration and T6 in inspiration. Most of its circumference is made up of a
series of C-shaped cartilages, but the trachealis muscle, which runs vertically, forms the
posterior aspect.

When the trachea bifurcates, the right main bronchus is less sharply angled from the
trachea than the left, making aspirated material more likely to enter the right lung. In
addition, the right upper lobe bronchus arises only about 2.5cm from the carina and must
be accommodated when designing right-sided endobronchial tubes.
Lungs and pleura

The right lung is divided into 3 lobes (upper, middle and lower) whereas the left has
only 2 (upper and lower), with further division into the broncho-pulmonary segments (10
right, 9 left). In total there are up to 23 airway divisions between trachea and alveoli. The
bronchial walls contain smooth muscle and elastic tissue as well as cartilage in the larger
airways. Gas movement occurs by tidal flow in the large airways. In the small airways,
by contrast, (division 17 and smaller) it results from diffusion only.

The pleura is a double layer surrounding the lungs, the visceral pleura enveloping the
lung itself and the parietal pleura lining the thoracic cavity. Under normal circumstances
the interpleural space between these layers contains only a tiny amount of lubricating
fluid. The pleura and lungs extend from just above the clavicle down to the 8th rib
anteriorly, the 10th rib laterally and the level of T12 posteriorly.

The lungs have a double blood supply, the pulmonary circulation for gas exchange
with the alveoli and the bronchial circulation to supply the parenchyma (tissue) of the
lung itself. Most of the blood from the bronchial circulation drains into the left side of the
heart via the pulmonary veins and this deoxygenated blood makes up part of the normal
physiological shunt present in the body. The other component of physiological shunt is
from the thebesian veins, which drain some coronary blood directly into the chambers of
the heart.

The pulmonary circulation is a low-pressure (25/10mmHg), low-resistance system with a

capacity to accommodate a substantial increase in blood flowing through it without a
major increase in pressure. Vascular distension and recruitment of unperfused capillaries
achieve this. The main stimulus which produces a marked increase in pulmonary vascular
resistance is hypoxia.
Objectives
General Objectives:

To provide the students a guide line caring for persons with pneumonia using the
nursing process. To give information on the readers on the nature and extend of
Pneumonia. Lastly, to provide a general public of the new developments in nursing care
with regards to treating Pneumonia.

Specific Objectives:

At the end of this study, the student will able to:

1. Define and identify the probable causative factors of pneumonia
2. trace the anatomy and physiology
3. Assess the nursing history of the patient.
4. Identify the signs and symptoms of pneumonia.
5. Formulate the nursing care plan, to achieve the maximum wellness of the patient
as well as awareness on the part of the significant others.
6. to provide health teaching to the patient and significant others to improved the
former condition and prevent complication.
 Nursing History
Biographic Data

Baby John Timothy Angeles is a 1 month old, a Roman Catholic, residing at Sta. Cruz
Manila, His birth Day is on October 13, 2009. He was admitted on November 18, 2009 at 9
am.

Chief Complaint: DOB and Cough

History of Present illness

Two days prior to admission, patient’s mother noticed that john had a fever and cough.
Patient showed lack to interest or decrease drink of milk.

One day prior to admission, the patient fever and frequent cough, the fever is on and off in
the morning and evening.

Four hours prior to admission, the patient consulted a pediatrician. He was advised to
take erythromycin, salbutamol and piperacilin.

Two hours prior to admission, the patient complains DOB to her mother hence patient
rushed to PCMC and subsequently admitted.

PAST MEDICAL HISTORY

Allergies: non

No previous hospitalization

Immunization: BCG, DPT, hepa B.

SOCIO CULTURAL

The patient lived with her parents in a medium size of house in bambang Manila. He is
the only child; her father is a construction worker, and have own a mini grocery. She take a
regular nap in the morning and evening.
Gen. Band Classification Dosage Mechanism Indications Contraindications Side Nursing
Name Name of Action Effects Implication
salbutamol albuterol 8 mg Stimulates relief of Hypersensitivity to Fine -Assess the
beta-2 bronchospasm salbutamol, also to skeletal cardio-
receptors of in bronchial artropine and its muscle respiratory
bronchioles asthma, derivatives. Threatened tremor, function, BP,
by increasing chronic absorption during the leg heart rate,
level of bronchitis, 1st and 2nd trimester. cramps, rhythm and
cAMP which emphysema Cardiac arrhythmia palpitati breathe sound.
relaxes and other associated with on, -determine
smooth reversible, tachycardia cause by tachycar history of
muscle to obstructive digitalis intoxication. dia, previous
produce pulmonary Hypertrophic hyperten medication.
bronchodilati diseases. Also obstructive tion, -monitor for
ns. Also cause useful for cardiomyopathy or head evidence of
CNS treating tachyarrthmia. ache, allergic
stimulation, bronchospasm Thyrotoxicosis. nausea, reaction.
increase in patient with Prevention of vomitin
diuresis, co-existing premature labor g,
skeletal heart disease associated with dizzines
muscle of toxemia of pregnancy s, hyper
tremors, and hypertension. or antepartum activity,
increase hemorrhage. Lactation. insomia,
gastric acid Use with non selective hypoten
secretion. beta-blockers. sion,
Longer acting mouth
than and
isoprotenerol throat
irritation
.
Gen. name Brand Classificatio Dosage Mechanism Indication Contraindication Side Effect Nursing
Name n Of action Implication
Erythromyci 100mg/5ml Treatment of Hypersensitivity Rash, -Assess the
n infections of to erythromycin photosensitivit patient for
respiratory or any y diarrhea, previous
tract, skin macrolide nausea. sensitivity
and skin antibiotic. Pre Vomiting, reaction.
structures existing liver abdominal -Assess the
STD cause disease, pain, and patient for
by epithelial herpes vaginitis. signs and
susceptible keratitis. symptoms
organism of infection
treatment of before and
pertussis, during
diphtheria, treatment
intestinal
amebiasis
conjunctiviti
s of new
bornand
legionnaire
disease.

Evaluation
 This case study was able to improve the knowledge of the student nurses by
letting gain understanding of the nature of the disease and by letting they formulate
appropriate nursing procedures to the client. Not with standing, through their study
the student nurses were able to enhance their attitude and skills.

The whole case study was also able to adequate information regarding the disease
and may serve as a future comparison for the study related to the case.