bilatreal pnumonia

8/13/2019 bilatreal pnumonia

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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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bilatreal pnumonia