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Bilatreal
Pneumonia
DONE BY: SALAMA
ALMUDHKY 0848
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OBJECTIVES:-Discuss (client back ground )
- Explain patient history and assessment
(physical & diagnostic test)-Discuss theoretical knowledge about
disease.
- Discuss collaborative management (medica, surgical ,nursing ).
- Summary.
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BACK GROUND..
Mrs. G.k is a 89 years old female. Widow, From
india ,She is a house wife & she has3 daughters
and 2 sun . she lives in Manama in small flat , with
low family income . shes not educated . She is aknown case of bilateral pneumonia with HTN 10
years on medication.
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Mrs. G.A. presented to the accident &emergency department with history ofdifficulty of breathing since two days , She hadshortness of breath, using accessory muscle inrespiration , the pulse was rapid and boundingwith fever , cough , rapid and shallow
breathing with wheezing sound and chestpain. There was no history of abdominal painor vomiting .
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PAST HISTORY
Mrs. G.A is a case of pneumonia bilateral
with HTN since 10 years, she has no allergies
or known to have any medical illness. She hasbeen hospitalized in Salmaniya Medical
Complex 3 times & the last one was in
October 2007 with the presentation of the
same problem & diagnosis. She has no
surgeries done for her.
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FAMILY HISTORY MEDICAL DISEASE LIFE STYLE
GENDER&AGE ENVIROMENTAL AGENTS SMOKING
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Physical assessmentInspection:the contour of the chest is barrelno swilling rash hair or anyskin lesion. There is no rednessor ulceration in the lung region.
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-- Auscultation:
decreased breath sounds throughout both lungfields, with crackles heard predominantly in theleft and right upper lobes, egophony present.
-- Percussion:dullness over the lung ( inflammation ofparenchyma)
-- palpation:fremitus increased. No tenderness ormasses palpable ,Mild pain on the back ( dueto reduced activity &laying over the back forlong period.)
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Diagnostic Studies..
Lap Result:Blood tests:to confirm the presence of infection and to try to identify the type of
organism causing the infection.- CBC/PC/LT: Date received: 7 may 2013Hematology :Test Result Reference RangeHemoglobin 115.0 120 -150 g/l
Hematocrit 0.33 0.37-0.45 lErythrocyte no conc 3.89 4.00-5.00 lLeucocyte DifferentialLymphocytes 0.24 0.25- 0.40Eosinophil 396.0 150-400 l
Total protein 63.6 66.00-87.00Albumin 29.2 34.00-48.00 g/lAlbumin/globulin ratio 0.85:1 1.8:1-2.3:1INTERPRETATION: The result of her CBC/PLT CT is abnormal like thehemoglobin, hematocrit and erythrocyte that are low comparing
from the baseline.
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Sputum testA sample of fluid from the lungs (sputum) is taken after a deep cough,
and analyzed to pinpoint the type of infection
- G/S: Date received: 7 may 2013
BacteriologySource ENDOTRACHEAL ASPIRATE
Gram staining epithelial cells =
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Radiographic examination:Chest X-rays, to confirm the presence of pneumonia anddetermine the extent and location of the infection.
- Chest x-ray:
Bilateral inflammation in the both lungs in the left and
right upper lobes
INTERPRETATION: that indicate inflammation is presenceand verify the diagnoses.
- If pneumonia isn't clearing as quickly as expected, thedoctor may recommend a chest CT scan to obtain a moredetailed image of the pt lungs.
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leural fluid culture
Other test not done :
Bronchoscopy
CT SCAN
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Medical Diagnosis:
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SURGICAL MANAGMENT
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- Impaired gas exchangerelated to alveolar-capillarymembrane changesinflammatory effects).
- Acute pain related toInflammation of lungparenchyma.
- activity intolerance relatedto impaired respiratoryfunction.- Risk for deficient fluidvolume related to fever andrapid respiratory rate.
NURSING DIAGNOSIS:
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NURSING INTERVENTION
Impaired gas exchangerelated to alveolar-capillarymembrane changesinflammatory effects).- Administer oxygen therapy by
appropriate means, e.g., nasal prongs,
mask, Venturi mask..
- Elevate head and encourage
frequent position changes, deep
breathing, and effective coughing
- Assess level of anxiety. Encourage
verbalization of concerns/feelings.Answer questions honestly. Visit
frequently, arrange for SO/visitors to
stay with patient as indicated.
- Monitor ABGs, pulse oximetry.
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NURSING INTERVENTION
- Administer analgesics and antitussivesas indicated.- Instruct and assist patient in chestsplinting techniques during coughingepisodes.- Provide comfort measures, e.g., backrubs, change of position, quiet music or
conversation. Encourage use ofrelaxation/breathing exercises.- Reassess and monitor vital signs.
Acute pain related to Inflammation of lungparenchyma.
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RESEARCH1
On this research they are assessing
the efficacy and safety of Chinese
medicinal herbs for Childhood
Pneumonia. They includedrandomized controlled trials . THEY
FOUND Chinese herbs may
increase total effective rate and
improve symptoms and signs.
However, large, properly
randomized, placebo-controlled,
double-blind studies are required.
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RESEARCH2
This research to determine risk factors
associated with ventilator dependence
in patients with ventilator-associatedpneumonia (VAP).
Study Design. A retrospective study
was conducted at Chang Gung
Memorial Hospital, Kaohsiung, fromJanuary 1, 2007 to January 31, 2008.
Methods. This study evaluated 163
adult patients (aged 18 years).
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The Results. Of the 163 VAPpatients in the study, 90
patients survived, yielding a
mortality rate of 44.8%.
Among the 90 surviving
patients, only 36 (40%) had
been weaned off ventilators
at the time of discharge..
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