CAPITOL UNIVERSITY

College of Nursing

A Case Study

Presented

In Partial Fulfillment of the

Requirement for the Subject

Related Learning Experience 9

By:

Lumbay, Jane Frances

Madroño, Froilan Marie
Maglangit, Anthony
Melecio, Lloyd Bryan
Merina, Jo Ann
Monteroyo, Joseph
Monteroyo, Marelou
Montes, Jerico Clodualdo
Nacua, Lovely
Naduma, Mark Jameson
Navaro, Christine
Nazareno, Maricel

Submitted to:
Ms. Syvel Jane Mata-Caharian, RN
Clinical Instructor

July 15, 2010

Introduction
 COMMUNITY ACQUIRED PNEUMONIA

Pneumonia is an infection of the lung parenchyma, usually caused by infection.

Bacteria, viruses, fungi or parasites can cause pneumonia. Community-acquired
pneumonia refers to pneumonia acquired outside of hospitals or extended-care
facilities. It can range in seriousness from mild to life-threatening. Pneumonia often is a
complication of another condition, such as the flu. Antibiotics can treat most common
forms of bacterial pneumonias, but antibiotic-resistant strains are a growing problem.
The best approach is to try to prevent infection Pneumonia is a particular concern if
you’re older than 65 or have a chronic illness or impaired immune system. It can also
occur in young, healthy people.

Community acquired pneumonia continuous to be a common and serious illness

both in developed and developing countries in spite of the advent of new and
sophisticated diagnostic techniques, potent antimicrobials and effective vaccines. It
remains an important cause of morbidity and mortality for both non-hospitalized adults.
In the Philippines, it is the fourth leading cause of morbidity and the second leading
cause of death. AMONG other diseases, pneumonia reportedly ranked first in the Top
10 causes of death in 80 barangays of Cagayan de Oro, based on the 2009 records of
the City Health Office.

One important aspect in the management of community acquired pneumonia is

the decision to hospitalize a patient. It perhaps the single most important decision
during the entire course of the illness. However, in patient care does not only entail
extra cost, but also, it theoretically increases the risk of iatrogenic complications
associated with hospitalization.

The group chose this case because of its complexity, in order to identify
and determine the general health problems and needs of the patient. Since the group
was able to render 3 days of care over the span of two weeks from June 2, 2010 two
days prior to client’s admission at Capitol University Medical City until July 10, 2010; the
group was able to monitor and participate actively in the management of the disease
process.

As nurses our main goal is health promotion and maintenance by preventative

measures through health education. As student nurses we can contribute to the field of
nursing by empowering our fellow students with knowledge on how to manage a case
like pneumonia. By sharing our knowledge we hope to help improve the quality of
nursing care rendered by Capitolians that will bring pride to our university.

The following are the specific objectives of this study:

• To raise the level of awareness of the patient and the family regarding the health
problems that are present.
 • To provide information about pneumonia specifically the disease process and the
identification of its danger manifestation.

• To motivate the patient and family to continue the health care provided by the
health workers in Capitol University Medical Center and most especially by the
students and Clinical Instructor of Capitol University.

• And lastly, to help the lower year level in the nursing department to be more
knowledgeable in making and conducting a case presentation in the higher
years.

This case presentation would also try to develop the critical analysis of each case
presenter in order to come up with a very good output and a team effort.

NURSING THEORY

This case presentation is based on Florence Nightingale’s

Environmental Theory. We have chosen this theory as our guide in caring for our patient
with CAP because as what we have noticed environmental factors have a big impact
with the cause and the possible prevention of the said disease condition. Nightingale’s

theory focuses on changing and manipulating the environment in order to

put the patient in the best possible conditions for nature to act. She has

also Identified 5 environmental factors namely fresh air, pure water,

efficient drainage, cleanliness/sanitation and light/direct sunlight. And she considered a
clean, well-ventilated, quiet environment is very essential for recovery. Applying this
theory to care of our patient will be much helpful in a way that patient will be free of the
risk and avoid things that could worsen his situation.

The factors that Florence Nightingale emphasized should come together in order
for the care to be effective, deficiencies in these 5 factors produce illness or lack of
health. That is where the family members and significant others come into participate in
providing this type of care for the patient to help her improve her condition and be free
of the symptoms of CAP.

CLIENT’S PROFILE

Patient X is a 79-year-old female, married and presently residing at Valencia,

Bukidnon. She was baptized under Roman Catholic faith.
Patient X was diabetic. She had history of hypertension and diabetes, no known
food and drug allergies, non-asthmatic, non-smoker and non-alcoholic beverage
drinker. The patient had a family history of hypertension from his both parents.
A. Vital Signs
Upon assessment, the following data was obtained from the Patient X: Blood
pressure= 130/80 mmHg; Axillary temperature= 39.7oC; Pulse rate = 100 beats per
minute; Respiratory rate= 34 cycles per minute.

B. Chief Complaints
The patient had cough and cold.

C. Health- Illness History

Three hours prior to admission patient developed increased sleeping time
and snoring-vomiting. Patient X is positive for diabetes mellitus, had a fever, had a
yellow sputum, and positive for hypertension.

D. Previous Hospitalization/Surgeries

E. Things done to manage health

Patient was kept watched and monitored. She frequently consults their
barangay health center workers. She had her maintenance drugs as prescribed by her
physician.

F. Statement of Patient General Appearance

Patient X had a senile skin turgor with fair and some white thin spots which were
evenly distributed. Nail beds were pallor, short and in convex curvature shape.

G. Nutritional and Metabolic Pattern

Patient X was on Osteorized Feeding. Daily fluid consumption was inadequate;
about a 230 cc was consumed during 8 hours of duty.

H. Elimination Pattern
Catheter in placed with yellowish urine attached to Urobag drain at 200cc.

I. Activity and Exercise Pattern

Prior to hospitalization, Patient X usually spent her time watching television. She
doesn’t have a regular schedule for exercise.

J. Cognitive-Perceptual Pattern
Upon assessment during the first week (July 2-3, 2010), Patient X was lethargic,
eye movement responsive to speech stimuli.
K. Sleep-Rest Pattern
Prior to admission the patient often slept at 10pm and usually woke up at 5am in
the morning. Usually the patient sleeps for 7 to 8 hours.

Physical Assessment
Baseline Data Assessment Findings Validation
Area of Assessment

I. SKIN
color Pale Inspection
temperature Warm (39.7°C) Palpation
turgor Senile skin turgor
Texture no lesions noted
lesions Rough skin integrity
integrity
II. NAILS
color pallor Inspection
texture dry Palpation
shape convex

III. HAIR
color White with some black hair Inspection
texture dry hair
distribution fine distributed
quantity thick

IV. HEAD
shape rounded Inspection
size normocephalic Palpation
configuration good configuration
headaches (+) headaches
head injury no head injury

V. EYES
Lids Symmetrical Inspection
Periorboital region Sunken Palpation
Conjunctiva Pale
Sclera Anicteric
Pupils Equal in size 2mm
>Reaction to light Brisk
>Reaction to Uniform
Accommodation Constriction/convergence
Visual Acuity Nearsighted
Peripheral Vision Decreased

VI. EARS
External Pinnae Normoset Inspection
External Canal No discharges Palpation
Groos Hearing Normal
Tympanic Membrane Intact

VII. NOSE AND SINUSES

Mucosa Pinkish Inspection
Septum Midline Palpation
Patency Patent
Discharge No discharges
VIII. MOUTH AND THROAT
lips Inspection
teeth Pallor
mucosa Caries
gums Pallor
tongue Pinkish
Midline
IX. NECK
Trachea Midline Inspection
Thyroid Non-palpable Palpation
X. respiratory status
Breathing pattern Irregular (34 RR) Inspection
Shape of chest Flat Palpation
Lung expansion Symmetrical Percussion
Vocal/Tactile Fremitus Symmetrical Auscultation
Percussion Resonant
Breath sounds Crackles at right chest
Productive cough but
Cough cannot expectorate
Yellowish colored

Sputum

XI.CARDIOVASCULAR
STATUS
Preorbital Area Flat Inspection
Apical Rate 100 bpm Palpation
Heart Sound Irregular Auscultation
Peripheral Pulse Strong
Capillary Refill 2 sec.

XII.BREAST & AXILLARY

symmetry
contour equal Inspection
skin lesions good contour Palpation
consistency no lesions
lymph nodes good consistency
engorgement no lymph nodes
no enlargement
XIII. ABDOMEN
General Superficial viens Inspection
Configuration Symmetrical Auscultation
Bowel Sound Hypo Active Palpation
Percussion Tympanitic Percussion
Palpation Muscle Guarding
XVI. MUSCULOSKELETAL
Inspection
spine
posture midline Inspection
gait: UA Palpation
scars coordinated
No scar seen
ROM
flexion
extension Passive
abduction Passive
Rotation Passive
Upper Extremities Passive
Edema noted
Palpation
Tenderness
no tenderness
NEURO
SYSTEM
1. Cranial
Nerves
olfactory
optic cant distinguish odor Inspection
oculomot
or cant identify color
trochlear spontaneous
trigemina can move eyes side by
l
can sense pain
facial
acoustic can smile
glossopharyngeal
can hear
vagus
cant distinguish taste
accessory cant shrug shoulder
hypoglos can curved tongue
sal

2. Sensory system
light
touch able to sense touch Palpatation
vibration can feel vibration
pain can feel pain

Motor System
muscle tone Weak muscle tone Inspection
ability to move Inability to move Palpation
extremities against Immobilize
gravity
spasticity, flaccidity or no tremors & rigidity
rigidity, tremors Passive ROM in both upper &
extremities lower extremities

flexion
abduction Passive
adduction Passive
2. Head and Neck Passive
Inspection
facial muscle symmetry:
swelling: symmetrical facial muscles
scars: no swelling noted Inspection
discoloration: no scar seen
no discoloration
ROM
flexion
Extension Passive
4. Cerebral Function Passive
muscle coordination,
rhythm, & regularity of good muscle coordination,
gait rhythm & regular gait
posture UA Inspection
balance UA Palpation
nystagmus & slow No nystagmus noted
dysrrhytmic speech can balance well
Slurred speech
5. Deep tendon reflex Grade as 1 Percussion
(Grade 0-4)
6. Brain stem integrity
oculocephalic reflex
(doll’s eye phenomenon) responsive Inspection
oculovestibular reflex present
7. Mental status
LOC, Grade w/ GCS
Orientation
8. Speech & Language Lethargic, GCS 11 Interview
Listen to speech to UA
detect dysphasia,
dysarthria or dysphonia
Can’t speak

NURSING SYSTEM REVIEW CHART

 Neurologic System
Can’t distinguish
Can’t identify clor

Skin
Pallor
Warm: 39.7
Dry
Respiratory System
RR= 34 cpm
Crackles at right chest
Yellow sputum
Productive cough

Eyes
nerasighted
decreased visual acuity Musculoskeletal System
Weak muscle tone
Inability to move

Gastrointestinal System
Mouth Hypoactive
Pale Muscle Guarding
Unable to speak
Slurred speech

ANATOMY AND PHYSIOLOGY

The Lungs

Front view of heart and lungs.

(Pulmones)

The lungs are the essential organs of respiration; they are two in number, placed one on
either side within the thorax, and separated from each other by the heart and other contents of
the mediastinum (Fig. 970). The substance of the lung is of a light, porous, spongy texture; it
floats in water, and crepitates when handled, owing to the presence of air in the alveoli; it is
also highly elastic; hence the retracted state of these organs when they are removed from the
closed cavity of the thorax. The surface is smooth, shining, and marked out into numerous
polyhedral areas, indicating the lobules of the organ: each of these areas is crossed by
numerous lighter lines.

At birth the lungs are pinkish white in color; in adult life the color is a dark slaty gray,
mottled in patches; and as age advances, this mottling assumes a black color. The coloring
matter consists of granules of a carbonaceous substance deposited in the areolar tissue near
the surface of the organ. It increases in quantity as age advances, and is more abundant in
males than in females. As a rule, the posterior border of the lung is darker than the anterior.
The right lung usually weighs about 625 gm., the left 567 gm., but much variation is met
with according to the amount of blood or serous fluid they may contain. The lungs are
heavier in the male than in the female, their proportion to the body being, in the former, as 1
to 37, in the latter as 1 to 43.
Each lung is conical in shape, and presents for examination
an apex, a base, threeborders, and two surfaces.
The apex (apex pulmonis) is rounded, and extends into the root of the neck, reaching from
2.5 to 4 cm. above the level of the sternal end of the first rib. A sulcus produced by the
subclavian artery as it curves in front of the pleura runs upward and lateralward immediately
below the apex.
The base (basis pulmonis) is broad, concave, and rests upon the convex surface of the
diaphragm, which separates the right lung from the right lobe of the liver, and the left lung
from the left lobe of the liver, the stomach, and the spleen. Since the diaphragm extends
higher on the right than on the left side, the concavity on the base of the right lung is deeper
than that on the left. Laterally and behind, the base is bounded by a thin, sharp margin which
projects for some distance into the phrenicocostal sinus of the pleura, between the lower ribs
and the costal attachment of the diaphragm. The base of the lung descends during inspiration
and ascends during expiration.

Pulmonary vessels, seen in a dorsal view of the heart and lungs. The lungs have been pulled
away from the median line, and a part of the right lung has been cut away to display the air-
ducts and bloodvessels. (Testut.)

Surfaces.—The costal surface (facies costalis; external or thoracic surface) is smooth,

convex, of considerable extent, and corresponds to the form of the cavity of the chest, being
deeper behind than in front. It is in contact with the costal pleura, and presents, in specimens
which have been hardened in situ, slight grooves corresponding with the overlying ribs.
The mediastinal surface (facies mediastinalis; inner surface) is in contact with the
mediastinal pleura. It presents a deep concavity, the cardiac impression, which
accommodates the pericardium; this is larger and deeper on the left than on the right lung, on
account of the heart projecting farther to the left than to the right side of the median plane.
Above and behind this concavity is a triangular depression named thehilum, where the
structures which form the root of the lung enter and leave the viscus. These structures are
invested by pleura, which, below the hilus and behind the pericardial impression, forms the
pulmonary ligament. On the right lung (Fig. 972), immediately above the hilus, is an arched
furrow which accommodates the azygos vein; while running upward, and then arching
lateralward some little distance below the apex, is a wide groove for the superior vena cava
and right innominate vein; behind this, and nearer the apex, is a furrow for the innominate
artery. Behind the hilus and the attachment of the pulmonary ligament is a vertical groove for
the esophagus; this groove becomes less distinct below, owing to the inclination of the lower
part of the esophagus to the left of the middle line. In front and to the right of the lower part
of the esophageal groove is a deep concavity for the extrapericardiac portion of the thoracic
part of the inferior vena cava. On the left lung (Fig. 973), immediately above the hilus, is a
well-marked curved furrow produced by the aortic arch, and running upward from this
toward the apex is a groove accommodating the left subclavian artery; a slight impression in
front of the latter and close to the margin of the lung lodges the left innominate vein. Behind
the hilus and pulmonary ligament is a vertical furrow produced by the descending aorta, and
in front of this, near the base of the lung, the lower part of the esophagus causes a shallow
impression.

Mediastinal surface of right lung.

Borders.—The inferior border (margo inferior) is thin and sharp where it separates the base
from the costal surface and extends into the phrenicocostal sinus; medially where it divides
the base from the mediastinal surface it is blunt and rounded.
The posterior border (margo posterior) is broad and rounded, and is received into the deep
concavity on either side of the vertebral column. It is much longer than the anterior border,
and projects, below, into the phrenicocostal sinus.
The anterior border (margo anterior) is thin and sharp, and overlaps the front of the
pericardium. The anterior border of the right lung is almost vertical, and projects into the
costomediastinal sinus; that of the left presents, below, an angular notch, thecardiac notch, in
which the pericardium is exposed. Opposite this notch the anterior margin of the left lung is
situated some little distance lateral to the line of reflection of the corresponding part of the
pleura.
 Mediastinal surface of left lung.

Fissures and Lobes of the Lungs.—The left lung is divided into two lobes, an upper and a
lower, by an interlobular fissure, which extends from the costal to the mediastinal surface of
the lung both above and below the hilus. As seen on the surface, this fissure begins on the
mediastinal surface of the lung at the upper and posterior part of the hilus, and runs backward
and upward to the posterior border, which it crosses at a point about 6 cm. below the apex. It
then extends downward and forward over the costal surface, and reaches the lower border a
little behind its anterior extremity, and its further course can be followed upward and
backward across the mediastinal surface as far as the lower part of the hilus. The superior
lobe lies above and in front of this fissure, and includes the apex, the anterior border, and a
considerable part of the costal surface and the greater part of the mediastinal surface of the
lung. The inferior lobe, the larger of the two, is situated below and behind the fissure, and
comprises almost the whole of the base, a large portion of the costal surface, and the greater
part of the posterior border.
The right lung is divided into three lobes, superior, middle, and inferior, by two interlobular
fissures. One of these separates the inferior from the middle and superior lobes, and
corresponds closely with the fissure in the left lung. Its direction is, however, more vertical,
and it cuts the lower border about 7.5 cm. behind its anterior extremity. The other fissure
separates the superior from the middle lobe. It begins in the previous fissure near the
posterior border of the lung, and, running horizontally forward, cuts the anterior border on a
level with the sternal end of the fourth costal cartilage; on the mediastinal surface it may be
traced backward to the hilus. The middle lobe, the smallest lobe of the right lung, is wedge-
shaped, and includes the lower part of the anterior border and the anterior part of the base of
the lung.
The right lung, although shorter by 2.5 cm. than the left, in consequence of the diaphragm
rising higher on the right side to accommodate the liver, is broader, owing to the inclination
of the heart to the left side; its total capacity is greater and it weighs more than the left lung.

The Root of the Lung (radix pulmonis).—A little above the middle of the mediastinal
surface of each lung, and nearer its posterior than its anterior border, is its root, by which the
lung is connected to the heart and the trachea. The root is formed by the bronchus, the
pulmonary artery, the pulmonary veins, the bronchial arteries and veins, the pulmonary
plexuses of nerves, lymphatic vessels, bronchial lymph glands, and areolar tissue, all of
which are enclosed by a reflection of the pleura. The root of the right lung lies behind the
superior vena cava and part of the right atrium, and below the azygos vein. That of the left
lung passes beneath the aortic arch and in front of the descending aorta; the phrenic nerve, the
pericardiacophrenic artery and vein, and the anterior pulmonary plexus, lie in front of each,
and the vagus and posterior pulmonary plexus behind each; below each is the pulmonary
ligament.
The chief structures composing the root of each lung are arranged in a similar manner from
before backward on both sides, viz., the upper of the two pulmonary veins in front; the
pulmonary artery in the middle; and the bronchus, together with the bronchial vessels,
behind. From above downward, on the two sides, their arrangement differs, thus:
On the right side their position is—eparterial bronchus, pulmonary artery, hyparterial
bronchus, pulmonary veins, but on the left side their position is—pulmonary artery, bronchus,
pulmonary veins. The lower of the two pulmonary veins, is situated below the bronchus, at
the apex or lowest part of the hilus (Figs. 972, 973).

Divisions of the Bronchi.—Just as the lungs differ from each other in the number of their
lobes, so the bronchi differ in their mode of subdivision.
The right bronchus gives off, about 2.5 cm. from the bifurcation of the trachea, a branch
for the superior lobe. This branch arises above the level of the pulmonary artery, and is
therefore named the eparterial bronchus. All the other divisions of the main stem come off
below the pulmonary artery, and consequently are termed hyparterial bronchi. The first of
these is distributed to the middle lobe, and the main tube then passes downward and
backward into the inferior lobe, giving off in its course a series of large ventral and small
dorsal branches. The ventral and dorsal branches arise alternately, and are usually eight in
number—four of each kind. The branch to the middle lobe is regarded as the first of the
ventral series.
The left bronchus passes below the level of the pulmonary artery before it divides, and
hence all its branches are hyparterial; it may therefore be looked upon asequivalent to that
portion of the right bronchus which lies on the distal side of its eparterial branch. The first
branch of the left bronchus arises about 5 cm. from the bifurcation of the trachea, and is
distributed to the superior lobe. The main stem then enters the inferior lobe, where it divides
into ventral and dorsal branches similar to those in the right lung. The branch to the superior
lobe of the left lung is regarded as the first of the ventral series.

Structure.—The lungs are composed of an external serous coat, a subserous areolar tissue
and the pulmonary substance or parenchyma.
The serous coat is the pulmonary pleura (page 1090); it is thin, transparent, and invests the
entire organ as far as the root.
The subserous areolar tissue contains a large proportion of elastic fibers; it invests the
entire surface of the lung, and extends inward between the lobules.
The parenchyma is composed of secondary lobules which, although closely connected
together by an interlobular areolar tissue, are quite distinct from one another, and may be
teased asunder without much difficulty in the fetus. The secondary lobules vary in size; those
on the surface are large, of pyramidal form, the base turned toward the surface; those in the
interior smaller, and of various forms. Each secondary lobule is composed of several primary
lobules, the anatomical units of the lung. The primary lobule consists of an alveolar duct, the
air spaces connected with it and their bloodvessels, lymphatics and nerves.
The intrapulmonary bronchi divide and subdivide throughout the entire organ, the
smallest subdivisions constituting the lobular bronchioles. The larger divisions consist of: (1)
an outer coat of fibrous tissue in which are found at intervals irregular plates of hyaline
cartilage, most developed at the points of division; (2) internal to the fibrous coat, a layer of
circularly disposed smooth muscle fibers, the bronchial muscle; and (3) most internally, the
mucous membrane, lined by columnar ciliated epithelium resting on a basement membrane.
The corium of the mucous membrane contains numerous elastic fibers running longitudinally,
and a certain amount of lymphoid tissue; it also contains the ducts of mucous glands, the
acini of which lie in the fibrous coat. Thelobular bronchioles differ from the larger tubes in
containing no cartilage and in the fact that the ciliated epithelial cells are cubical in shape.
The lobular bronchioles are about 0.2 mm. in diameter.
Part of a secondary lobule from the depth of a human lung, showing parts of several primary
lobules. 1, bronchiole; 2, respiratory bronchiole; 3, alveolar duct; 4, atria; 5, alveolar sac; 6,
alveolus or air cell: m, smooth muscle; a, branch pulmonary artery; v, branch pulmonary
vein; s, septum between secondary lobules. Camera drawing of one 50 μ section. X 20
diameters. (Miller.)

Each bronchiole divides into two or more respiratory bronchioles, with scattered alveoli,
and each of these again divides into several alveolar ducts, with a greater number of alveoli
connected with them. Each alveolar duct is connected with a variable number of irregularly
spherical spaces, which also possess alveoli, the atria. With each atrium a variable number
(2–5) of alveolar sacs are connected which bear on all parts of their circumference alveoli or
air sacs. (Miller.)
The alveoli are lined by a delicate layer of simple squamous epithelium, the cells of which
are united at their edges by cement substance. Between the squames are here and there
smaller, polygonal, nucleated cells. Outside the epithelial lining is a little delicate connective
tissue containing numerous elastic fibers and a close net-work of blood capillaries, and
forming a common wall to adjacent alveoli.
Schematic longitudinal section of a primary lobule of the lung (anatomical unit);r.
b., respiratory bronchiole; al. d., alveolar duct; at., atria; a. s., alveolar sac; a, alveolus or air
cell; p. a.: pulmonary artery: p. v., pulmonary vein; l., lymphatic; l. n., lymph node. (Miller.)

FIG. 976– Sectionof lung of pig embryo, 13 cm. long, showing the glandular character of the
developing alveoli (J. M. Flint.) X 70. a. Interstitial connective tissue. b. A bronchial
tube. c. An Alveolus. l. lymphatic clefts. q. Pleura.

The fetal lung resembles a gland in that the alveoli have a small lumen and are lined by
cubical epithelium (Fig. 976). After the first respiration the alveoli become distended, and the
epithelium takes on the characters described above.

Vessels and Nerves.—The pulmonary artery conveys the venous blood to the lungs; it
divides into branches which accompany the bronchial tubes and end in a dense capillary net-
work in the walls of the alveoli. In the lung the branches of the pulmonary artery are usually
above and in front of a bronchial tube, the vein below.
The pulmonary capillaries form plexuses which lie immediately beneath the lining
epithelium, in the walls and septa of the alveoli and of the infundibula. In the septa between
the alveoli the capillary net-work forms a single layer. The capillaries form a very minute net-
work, the meshes of which are smaller than the vessels themselves; their walls are also
exceedingly thin. The arteries of neighboring lobules are independent of each other, but the
veins freely anastomose.
The pulmonary veins commence in the pulmonary capillaries, the radicles coalescing into
larger branches which run through the substance of the lung, independently of the pulmonary
arteries and bronchi. After freely communicating with other branches they form large vessels,
which ultimately come into relation with the arteries and bronchial tubes, and accompany
them to the hilus of the organ. Finally they open into the left atrium of the heart, conveying
oxygenated blood to be distributed to all parts of the body by the aorta.
The bronchial arteries supply blood for the nutrition of the lung; they are derived from the
thoracic aorta or from the upper aortic intercostal arteries, and, accompanying the bronchial
tubes, are distributed to the bronchial glands and upon the walls of the larger bronchial tubes
and pulmonary vessels. Those supplying the bronchial tubes form a capillary plexus in the
muscular coat, from which branches are given off to form a second plexus in the mucous
coat; this plexus communicates with small venous trunks that empty into the pulmonary
veins. Others are distributed in the interlobular areolar tissue, and end partly in the deep,
partly in the superficial, bronchial veins. Lastly, some ramify upon the surface of the lung,
beneath the pleura, where they form a capillary network.
The bronchial vein is formed at the root of the lung, receiving superficial and deep veins
corresponding to branches of the bronchial artery. It does not, however, receive all the blood
supplied by the artery, as some of it passes into the pulmonary veins. It ends on the right side
in the azygos vein, and on the left side in the highest intercostal or in the accessory
hemiazygos vein.

Nerves.—The lungs are supplied from the anterior and posterior pulmonary plexuses, formed
chiefly by branches from the sympathetic and vagus. The filaments from these plexuses
accompany the bronchial tubes, supplying efferent fibers to the bronchial muscle and afferent
fibers to the bronchial mucous membrane and probably to the alveoli of the lung. Small
ganglia are found upon these nerves.

DIAGNOSTIC TEST AND

LABORATORY RESULTS
 Urinalysis
(July , 2010)
Color Yellow

Transparency Hazy

Reaction 6.0

Specific Gravity 1.030

Sugar trace

Protein (-)

Pus cells 15-20 cells/HPF

RBC 0-3 cells/HPF

Squamous Epithelial Cells Few

Bacteria Rare

Interpretation:

HEMATOLOGY
Test Reference Unit Result Interpretation
Value

Complete Blood Count

Hemoglobin 11.7 – 14.5 g/dL 14.0
Hematocrit 34.1-44.3 % 42.0
WBC 5,000- x10^d/L 9,000
10,000
Segmenters 45-70 84.0
Lymphocytes 18-45 % 14.0
Monocytes 4-8 % 2.0
Eusinophil 2-3 % 2 2
Platelet 174,000- x10^g/L 194,000
390,000
RBC 4.2-5.4 x10^12/L 4.75
MCV 80-96 fL 87.2
MCH 27-31 Pg 27.9
MCHC 32-36 g/dL 32.9
Interpretation:

Hemoglucotest

Date Result
mEq/dL
mEq/dL
mEq/dL
mEq/dl

mEq/dL
 Nursing Interpretation:
Patient Y has diabetes mellitus II. Monitoring blood glucose to ensure that the blood glucose level is
within normal range.

Chest X-Ray
(July 5, 2010)

Follow up exam relative to 6/30 shows:

Film taken with suboptimal respiratory effort.
There is interval decrease in the reticular densities seen in the right paracardiac area.
Both costrophrenic sulci are now Blunted. (Minimal pleural effusion vs. pleural
thickening).
No other remarkable interval findings.

(July 30, 2010)

Follow up exam relative to 6/7/2010 shows:

Film taken with poor inspiratory effort.

Reticular densities are seen in the right paracardiac area. (Pneumonitis vs confluent
bronchovascular markings).
There is no significant interval change in the granuloma formation in the right upper lung
field.
Same degree of cardiomegaly.
Both costrophrenic sulci and hemidiaphragms are intact.
No other remarkable interval findings.

DISCHARGE PLANNING

Medications
Compliance to the medication regimen:
• Azithromycin antibiotic 500mg 1tab PO OD
• Iosartan antihypertensive 100mg 1tab PO OD
• Dexofyline bronchodilator 400mg PO OD
• Hydrocortisone corticosteroid 100mg IVTT q6
• Sultamicillin antibiotic 750mg 1tav PO BID
• Acetylcysteine mocolytic 100mg 1tab PO OD
• Hydrixyzine anxiolytic antihistamine
• Salbutamol bronchodilator q6
 • Senna concentration laxative 2tabs PO HS

Economy
• Encourage active participation of the patient significant others in the
program including self-monitoring of vital signs and diet for increase
compliance.

To promote more understanding about the need for monitoring the

condition of the patient and proper food should be taken.

Treatment

• Encourage relaxation techniques and exercise.

To decrease tension level

• Compliance to medications

To aid in the successful recovery

• Give supportive treatment. Proper diet and oxygen to increase

oxygen in the blood when needed.

• Drink lots of fluids, especially water. Liquids will keep patient from
becoming dehydrated and help loosen mucus in the lungs.

Health teachings

• Give both the patient and the caregiver verbal and written instructions
about home medications.
• Encourage patients feeling with regards to allowances and limitations with
respect to home chores, recreation and activities.
• Encourage physical mobility.
• Maintain peaceful environment to promote comfort and fastest recovery

Out-patient

• Follow up visits to physician were encourage to significant others for

further evaluation with regards to the condition of the patient.

To ensure complete recovery and prevent further complications

Diet
• Inform that the one prescribed by the physician for underlying condition
should be followed and should not be omitted.
• Emphasis on the intended diet with low salt, low fat, low sugar and low
protein should be maintained.
 • Maintain hydration.

Spiritual

• Advice patient to ask god’s guidance and supervision all through his life
and entrust everything to him. Prayer is the best weapon to all difficulties
no matter what it is. God is always there all the time.

Related Learning Experience

With our 3 weeks exposure at Capitol University Medical City Station 4, we say
that it is one of our very unforgettable experienced because we have learned a lot with
regards to caring for our patient and dealing with people. It was not that busy because
our clinical instructor thought us to managed our time well and always be ready with the
people that we are going to encounter.

As a group, we have learned that working as a team has indeed made our duty a lot
easier and well-managed. We also have learned that having a peaceful and united
group could indeed produce a better quality of work.
One interesting woman on this rotation was our Clinical Instructor for he was the one
who work hard to make our rotation possible, enjoyable and very exciting. Shared a lot
of experiences and most of all the knowledge and the lessons she learned as a nurse.
Being in this rotation is really a one of a kind experience.