Etal Ame Case (1)

7/27/2019 Etal Ame Case (1)

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INTRODUCTION:

Pneumonia is an inflammatory condition of the lungaffecting

primarily the microscopic air sacs known as alveoli. It is usually

caused by infection with viruses or bacteria and less commonlyother microorganisms, certain drugs and other conditions such as

autoimmune diseases. Typical symptoms include a cough, chestpain, fever, and difficulty breathing. Diagnostic tools include x-rays

and culture of the sputum. Vaccines to prevent certain types of

pneumonia are available. Treatment depends on the underlying cause.Pneumonia presumed to be bacterial is treated with antibiotics. If the

pneumonia is severe, the affected person is, in general, admitted tohospital.

People with infectious pneumonia often have a productive

cough, fever accompanied by shaking chills, shortness of breath, sharpor stabbing chest pain during deep breaths, and an

increased respiratory rate. In the elderly, confusion may be the most

prominent sign. The typical signs and symptoms in children under fiveare fever, cough, and fast or difficult breathing. [10]

Fever is not very specific, as it occurs in many other common illnesses,

and may be absent in those with severe disease or malnutrition. Inaddition, a cough is frequently absent in children less than 2 months

old. More severe signs and symptoms may include: blue-tinged skin,decreased thirst, convulsions, persistent vomiting, extremes of

temperature, or a decreased level of consciousness.Bacterial and viral cases of pneumonia usually present with similarsymptoms. Some causes are associated with classic, but non-specific,

clinical characteristics. Pneumonia caused by Legion Ella may occur

with abdominal pain, diarrhea, or confusion, while pneumonia causedby Streptococcus pneumoniae is associated with rusty colored

sputum,and pneumonia caused by Klebsiella may have bloody sputumoften described as "currant jelly. Bloody sputum (known

as hemoptysis) may also occur with tuberculosis, Gram-negative

pneumonia, and lung abscesses as well as more commonly with acute

bronchitis. Mycoplasma pneumonia may occur in associationwith swelling of the lymph nodes in the neck,joint pain, or a middleear infection. Viral pneumonia presents more commonly

with wheezing than does bacterial pneumonia.

Septic shock is a serious condition that occurs when an overwhelminginfection leads to life-threatening low blood pressure. Septic shock
http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Alveolihttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Microorganismhttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Autoimmune_diseasehttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Shortness_of_breathhttp://en.wikipedia.org/wiki/Sputumhttp://en.wikipedia.org/wiki/Vaccinehttp://en.wikipedia.org/wiki/Antibiotichttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Rigorshttp://en.wikipedia.org/wiki/Shortness_of_breathhttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Respiratory_ratehttp://en.wikipedia.org/wiki/Pneumonia#cite_note-Develop11-10http://en.wikipedia.org/wiki/Central_cyanosishttp://en.wikipedia.org/wiki/Decreased_level_of_consciousnesshttp://en.wikipedia.org/wiki/Legionellahttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Streptococcus_pneumoniaehttp://en.wikipedia.org/wiki/Klebsiellahttp://en.wikipedia.org/wiki/Hemoptysishttp://en.wikipedia.org/wiki/Tuberculosishttp://en.wikipedia.org/wiki/Acute_bronchitishttp://en.wikipedia.org/wiki/Acute_bronchitishttp://en.wikipedia.org/wiki/Cervical_lymphadenopathyhttp://en.wikipedia.org/wiki/Arthralgiahttp://en.wikipedia.org/wiki/Otitis_mediahttp://en.wikipedia.org/wiki/Otitis_mediahttp://en.wikipedia.org/wiki/Wheezinghttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Alveolihttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Microorganismhttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Autoimmune_diseasehttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Shortness_of_breathhttp://en.wikipedia.org/wiki/Sputumhttp://en.wikipedia.org/wiki/Vaccinehttp://en.wikipedia.org/wiki/Antibiotichttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Rigorshttp://en.wikipedia.org/wiki/Shortness_of_breathhttp://en.wikipedia.org/wiki/Chest_painhttp://en.wikipedia.org/wiki/Respiratory_ratehttp://en.wikipedia.org/wiki/Pneumonia#cite_note-Develop11-10http://en.wikipedia.org/wiki/Central_cyanosishttp://en.wikipedia.org/wiki/Decreased_level_of_consciousnesshttp://en.wikipedia.org/wiki/Legionellahttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Streptococcus_pneumoniaehttp://en.wikipedia.org/wiki/Klebsiellahttp://en.wikipedia.org/wiki/Hemoptysishttp://en.wikipedia.org/wiki/Tuberculosishttp://en.wikipedia.org/wiki/Acute_bronchitishttp://en.wikipedia.org/wiki/Acute_bronchitishttp://en.wikipedia.org/wiki/Cervical_lymphadenopathyhttp://en.wikipedia.org/wiki/Arthralgiahttp://en.wikipedia.org/wiki/Otitis_mediahttp://en.wikipedia.org/wiki/Otitis_mediahttp://en.wikipedia.org/wiki/Wheezing


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occurs most often in the very old and the very young. It also occurs inpeople who have other illnesses.

Any type of bacteria can cause septic shock. Fungi and (rarely) viruses

may also cause the condition. Toxins released by the bacteria or fungi

may cause tissue damage, and may lead to low blood pressure andpoor organ function. Some researchers think that blood clots in small

arteries cause the lack of blood flow and poor organ function.

The body also produces a strong inflammatory response to the toxins.This inflammation may contribute to organ damage.


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Demographic Data

Name: Patient R.H.P

Age: 41 years of age

Sex: Female

Civil Status: Single

Address: Mangyan, Sibonga, Cebu

Religion: Roman Catholic

Nationality: Filipino

Birthdate: November 11, 1971

Admitting Diagnosis:

Septic Shock secondary to PTB with pneumonia, severe anemia ofchronic disease t/c lymphatic obstruction left leg


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X-RAY REPORT

Procedure: Leg ( left) APL

Findings:

The bones are normal in density, texture and modeling. There is noevidence of fracture, bone erosion, no bone destruction.

Impression:

Normal bones of the left leg

Procedure: Chest PaFindings:

There are in homogenous and nodular densities on both lungs. There is

a homogenous density at the left paracardiac area. There is ahaziness in the right lung. Heart is normal in size and shape. The

thoracic aorta is tortous. The trachea is at the midline. Bothhemidiaphragms are sharp and distinct. The osseous tjoracic cage

showed no significant bony abnormality

Impression:Pneumonia, both lungs, suggest after 10-14 days for

comparative study

Artherosclerosis of the thoracic aorta.


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SPUTUM MICROSCOPY RESULTS

1 2 3Visal Appearance Mucoid Mucoid

Reading 0 +1

Lab Diagnosis: POSITIVE

- Specimen 2 & 3= not applicable if sputum follow-up

- Muco- purulent, blood stained, saliva, etc.


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HEMATOLOGY

Result Unit Reference

Reticulocyte Count 99 10^3/L 5-20

Peripheral Smear -

Smears show a slightly hypochromic normocytic

erythrocytes. Leukocytes are increased in number, demonstratingNeutrophilia. No immature or blast cells are seen. Platelets are

adequate in quantity with normal morphology.


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CLINICAL MICROSCOPY

URINALYSIS RESULT UNIT

Color Yellow

Transparancy Cloudy

Specific Gravity 1.030pH 6.0

Glucose neg (-)Protein +1

RBC 0-2 /hpf

WBC 3-5 /hpfCast

Hyaline Cast 2-4 /lpfFine Granular Cast 1-3 /lpf

MISCELLANEOUS STRUCTURES

Squamous E. Cells FewBacteria Mod

Mucus Threads Few


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DRUG STUDY

Generic Name: Piperacillin Sodium and Tazobactam Sodium

Brand Name: Zosyn

Classification: Antibiotic

Mechanism of

Action:

Inhibits cell-wall synthesis during bacterial

multiplication

Contraindication: Contraindicated in patients hypersensitive

to drug or other penicillins.

Use cautiously in patients with bleedingtendencies, uremia, hypokalemia, and

allergies to other drugs, especiallycephalosporins, because of possible cross-

sensitivity.

Interaction: Drug: Hormonal Contraceptives: may decrease

contraceptive effectiveness. Advise use ofanother fform of contraception during therapy.

Oral Anticoagulants: May prolong effectiveness.Monitor PT and INR closely.

Vecuronium: May prolong neuromuscular

blockade. Monitor patient closely.

Adverse and Side

effects:

CNS: headache, insomnia, fever, seizures,

agitation, anxiety, dizziness, pain

EENT: rhinitis

GI: diarrhea, constipation, nausea,

pseudomembranous, abdominal pain, dyspepsia,

stool changes, vomiting

GU: candidiasis, interstitial nephritis

HEMA: leukopenia, neutropenia,thrombocytopenia, anemia, eosinophilia


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NursingIntervention

(minimum of 5)

SKIN: pruritis, rash

OTHERS: anaphylaxis, hypersensitivity reactions,phlebitis at I.V site

Drug may alter normal colon flora. Monitorpatient for diarrhea and initiate therapeutic

measures as needed. Drug may need to be

stopped.

Because peritoneal dialysis removes 6% of

the piperacillin dose and 21% of the

tazobactam dose, and hemodialysisremoves 30% to 40% of a dose in 4 hours,

additional doses may be needed after eachdialysis period.

If large doses are given or if therapy is

prolonged, bacterial or fungalsuperinfection may occur, especially in

elderly, debilitated, or immunesuppressed

patients.

Monitor hematologic and coagulation

parameters

Drug contains 2.35 mEq sodium/ g ofpiperacillin. Monitor patients sodium intake

and electrolyte levels.

Patient Teaching Tell patient to report any adverse reaction

Tell patient to alert w health care

professionals about discomfort at the I.Vsite


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Generic Name: Acetylcysteine

Brand Name: Acetadote

Classification: Mucolytic

Mechanism ofAction:

Reduce the viscosity of pulmonary secretions bysplitting disulfide linkages between mucoprotein

molecular complexes. Also, restores liver storesof glutathione to treat acetaminophen toxicity.


to drug. Use cautiously in elderly or debilitated

patients with severe respiratoryinsufficiency. Use I.V form cautiously in

patients with asthma or a history ofbronchospasm.

Interaction: Drug: Activated charcoal: May limit

acetylcysteines effectiveness. Avoid usingactivated charcoal before or with acetylcysteine.

Activity:

Adverse and Side

effects:

CNS: abnormal thinking, fever, drowsinees, gait

disturbance

EENT: rhinorrhea, ear pain eye pain, pharyngitis,throat tightness

GI: nausea, stomatitis, vomiting


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Nursing

Intervention(minimum of 5)

SKIN: clamminess, diaphoresis, pruritis, rash,

urticaria

OTHERS: anaphylactoid reaction, angioedema,

chills

Monitor cough type and frequency

If you suspect acetaminophen overdose,

obtain baseline, AST, ALT, bilirubin, PT,

BUN, creatinine, glucose, and electrolyte

levels Facial erythema may occur within 30 to 60

minutes of start of I.V infusion and usually

revolves without stopping infusion

When acetaminophen level is below toxic

level according to nomogram, stop therapy

The vial stopper doesnt contain natural

rubber latex, dry natural rubber, or blendsof natural rubber

Patient Teaching Warn patient that drug may have a foul

taste or smell that may be distressing

For maximum effect, instruct patient to

cough to clear his airway before aerosol

administration


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Generic Name: AcetaminophenBrand Name: Acephen

Classification: Analgesic

Mechanism of

Action:

Thought to produce analgesia by inhibiting

prostaglandin and other substances that sensitizepain receptors. Drug may relieve fever through

central action in the hypothalamic heat-

regulating center


to drug

Use cautiously in patients with any type of

liver disease and in patients with long-termalcohol use because therapeutic doses

cause hepatoxicity in these patients.

Chronic alcoholics shouldnt take more than2g of acetaminophen every 24 hours

Interaction: Drug: Amphetamines, anticholinergics,

mecamylamine, procainamide, quinidine: Maydecrease renal clearance of these drugs,

increasing toxicity. Monitor patient for toxicityCyclosporine: May increase cyclosporine level,

causing nephrotoxicity and neurotoxicity. Monitor

patient for toxicityDiflunisal: May increase acetazolamide adverse

effects; may significantly decrease IOP. Usetogether cautiously

Lithium: May increase lithium excretion,

decreasing its effect. Monitor lithium levelMethenamine: May reduce methenamine effect.

Avoid using togetherPrimidone: May decrease serum and urine

primidone levels. Monitor patient closely


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Activity:

Adverse and Sideeffects:

CNS: seizures, drowsiness, paresthesia,confusion, depression, weakness, ataxia

EENT: transient myopia, hearing dysfunction,

tinnitus

GI: nausea, vomiting, anorexia, metallic taste,diarrhea, black tarry stools, constipation

GU: polyuria, hematuria, crystalluria, glycosuria,

phosphaturia, renal calculus

HEMA: aplastic anemia, leukopenia,thrombocytopenia, hemolytic anemia

SKIN: pain at injection site, stevensjohnsonsyndrome, rash, urticaria

OTHERS: sterile abscesses

NursingIntervention

Cross-sensitivity between bacterial

sulfonamides and sulfonamide- derivative

diuretics such as acetazolamide has beenreported


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(minimum of 5) Monitor fluid intake and output, glucose,

and electrolytes, especially potassium,

bicarbonate, and chloride.

Monitor elderly patients closely because

they are especially susceptible to excessive

diuresis Weigh patient daily. Rapid or excessive

fluid loss may cause weight loss and

hypotension

Monitor patient for signs of hemolytic

anemia

Patient Teaching Tell patient to take oral form with food to

minimize GI upset

Tell patient not to crush, chew, or open

capsules

Caution patient no to perform hazardousactivities if adverse CNS reaction occur

Instruct patient to avoid prolonged

exposure to sunlight because drug maycause phototoxicity

Instruct patient to notify prescriber of any

unusual bleeding, bruising, tingling, ortremors


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Generic Name: Ketorolac tromethamine

Brand Name: Toradol

Classification: NSAID

Mechanism of

Action:

May inhibit prostaglandin synthesis, to produce

anti-inflammatory, analgesic, and antipyretic

effects


to drug and in those with active peptic

ulcer disease, recent GI bleeding or

perforation, advanced renal impairment,cerebrovascular bleeding, hemorrhagic

diathesis, or incomplete hemostasis

Interaction: Drug: ACE inhibitor, angiotensin II receptorantagonists: May cause renal impairment,

particularly in volume-depleted patients. Avoidusing together in volume-depleted patients

Anticoagulants: may increase anticoagulant

levels in the blood. Use together with extremecaution and monitor patient closely

Anticonvulsants: may increase seizure activity.Use together cautiously

Antihypertensives, diuretics: may decrease

effectiveness. Monitor patient closelyLithium: may increase lithium level. Monitor

patient closely

Methotrexate: may decrease methotrexateclearance and increased toxicity. Avoid using

together

Pentoxifylline: may increase risk of bleeding


CNS: headache, dizziness, drowsiness, sedation


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EENT: inomfort, rhinalgia, rhinitis, throatirritationcreased lacrimation(nasal spray only),

nasal disc

GI: dyspepsia, GI pain, nausea, constipation,diarrhea, flatulence, peptic ulceration, stomatitis,

vomiting

GU: renal failure

HEMA: decreased platelet adhesion, prolonged

bleeding time, purpura

SKIN: diaphoresis, pruritus, rash

OTHERS: pain at injection site

NursingIntervention

(minimum of 5)

Correct hypovolemia before giving Dont give drug epidurally or intrathecally

because of alcohol content

Carefully observe patients with

coagulopathies and those takinganticoagulants

Dont give drug concomitantly with other


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forms of ketorolac or other NSAIDs

NSAIDs may mask signs and symptoms of

infection because of their antipyretic andanti-inflammatory actions

Generic Name: Salbutamol + Ipratropium

Brand Name: DuoNeb

Classification: Bronchodilator

Mechanism of

Action:

Is used to treat severe breathing trouble caused by

ongoing lung diseases (chronic obstructivepulmonary disease-COPD, which include chronic

bronchitis and emphysema). It helps to relax the

muscles around your airways so that they open upto make breathing easier. It helps to reduce

shortness of breath, wheezing, and coughing. Thismedication is a combination of 2 drugs, ipratropium

and albuterol. Albuterol is also called salbutamol in

some countries. Ipratropium is an anticholinergicbronchodilator and albuterol (salbutamol) is a beta-

agonist bronchodilator.

Contraindication:

Contraindicatedwithhypersensitivityto atropine oritsderivatives.

Interaction: Drug: Your healthcare professionals (e.g., doctor or

pharmacist) may already be aware of any possibledrug interactions and may be monitoring you for it.

Do not start, stop or change the dosage of any

medicine before checking with them first.Avoidtaking MAO inhibitors (e.g., furazolidone,

isocarboxazid, linezolid, moclobemide, phenelzine,procarbazine, rasagiline, selegiline,

tranylcypromine) within 2 weeks before, during,

and after treatment with this medication. In somecases a serious, possibly fatal drug interaction may

occur.Before using this medication, tell your doctoror pharmacist of all prescription and

nonprescription/herbal products you may use,especially of: anticholinergic drugs (e.g.,

atropine,scopolamine), certain antihistamines

(e.g., diphenhydramine, meclizine), antispasmodic
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drugs (e.g., dicyclomine, hyoscyamine), certain

anti-Parkinson's drugs (e.g., benztropine,

trihexyphenidyl), some beta-blockers (suchas propranolol), bladder control drugs

(e.g., oxybutynin, tolterodine),pramlintide,

stimulant-like drugs (e.g., ephedrine, epinephrine),tricyclicantidepressants (e.g., amitriptyline, nortriptyline), certain "water pills" (diuretics that cause

potassium loss from the body such

as furosemide,hydrochlorothiazide).Check the labelson all your medicines (e.g., cough-and-cold

products, diet aids) because they may containingredients that could increase your heart rate or

blood pressure. Ask your pharmacist about the safe

use of those products.

Adverse and

Side effects:

CNS: headache, dizziness, blurred vision

GI: nausea, diarrhea, constipation, dry mouth

CV: palpitations, chest pain

SKIN: rash

Nursing

Intervention Monitor the patients vital signs, noting

hypotension and an irregular or abnormal pulse

.Maintain a quiet, comfortable environment to

minimize anxiety and perhaps decreasepalpitations.

Teach the patient pursed-lip breathing,

diaphragmatic breathing, and chest splinting.
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Patient

Teaching Never take more than the prescribed dose. If

you suspect that you have taken, or someoneelse has taken, an overdose of this medicine, go

to the accident and emergency department ofyour local hospital at once. Take the container

with you, even if it is empty.

If you are having an operation or dental

treatment tell the person carrying out the

treatment which medicines you are taking. This medicine is for you. Never give it to

other people even if their condition appears tobe the same as yours.

Never keep out-of-date or unwanted

medicines. Take them to your local pharmacywhich will dispose of them for you.


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Generic Name: erythromycin

Brand Name: E-Mycin

Classification: MACROLIDE ANTIBIOTIC

Mechanism of

Action:More active against gram-positive organismsthan against gram-negative organisms due to

its superior penetration into gram-positive

organisms

Contraindication: Erythromycin is contraindicated in patients with

known hypersensitivity to this antibiotic.Erythromycin is contraindicated in patients taking

terfenadine, astemizole,cisapride, pimozide,ergotamine, or dihydroergotamine

Interaction: Drug:

Activity:


GI: Nausea, vomiting, abdominal cramping,diarrhea, heartburn, anorexia

SKIN: (topical use) Erythema, desquamation,burning, tenderness, dryness or oiliness, pruritus
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Nursing

Intervention

(minimum of 5)

Report onset of GI symptoms after PO

administration to physician. These are

doserelated; if symptoms persist after dosagereduction, physician may prescribe drug to

begiven with meals in spite of impaired

absorption.Observe for S&S of superinfection byovergrowth of nonsusceptible bacteria

or fungi.Emergence of resistant staphylococcal

strains is highly predictable duringprolongedtherapy.

Monitor for S&S of hepatotoxicity. PremonitoryS&S include: Abdominal pain, nausea,vomiting,

fever, leukocytosis, and eosinophilia; jaundice

may or may not be present.Symptoms may

appear a few days after initiation of drugbut usually occur after 12 wk of continuoustherapy. Symptoms are reversible with prompt

discontinuation of erythromycin.

Monitor for ototoxicity that appears to developmost frequently in patients receiving 4 g/dor

more, older adults, female patients, and patientswith kidney or liver dysfunction. It is reversible

with prompt discontinuation of drug.

Report any ototoxic effects including dizziness,vertigo, nausea, tinnitus, roaring noises, hearing

impairment

Patient Teaching Advise patient to report any adverse effect


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ANATOMY AND PHYSIOLOGY

The respiratory system

The respiratory system is composed of various structures and organs

that ensure that the body is able to maintain its internal environmentthrough the exchange of air between the lungs and the atmosphere. In

order to survive the body needs a constant supply of oxygen, which it

obtains from the air.The body also needs to dispose of carbon dioxide, made as a wasteproduct from the process of cell metabolism. The ingestion of oxygen

and the discarding of carbon dioxide, occurs through the process ofrespiration or breathing.


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Structure

The respiratory system is comprised of the:

nose

nasopharynx

mouth sinuses

larynx

trachea

bronchi

lungs

alveoli

The respiratory system contains the upper and the lower respiratorytracts. The upper respiratory tract contains the respiratory organs

located outside the chest cavity: the nose and the nasal cavities,pharynx, larynx and upper trachea.

The lower respiratory tract consists of organs located in the chest

cavity: the lower trachea, bronchi, bronchioles, alveoli and the lungs.

The lower parts of the bronchi, the bronchioles and alveoli, are alllocated in the lungs. The alveoli are the point at which gas exchange

takes place.

The pleura are a membrane that covers the lungs.

The muscles that form the chest cavity are also part of the lower

respiratory tract. The respiratory centre in the brain, which is locatedin the medulla oblongata, regulates breathing. (Herlihy et al. 2000).

Function

The function of the respiratory system is to supply oxygen and to

remove carbon dioxide from cells. Oxygen is needed by cells toproduce heat and energy. In using oxygen, the cells produce carbon

dioxide as waste.

Inhaled air is moistened and warmed as it passes through the upperrespiratory tract - the nose, the pharynx and the larynx. The clean air

passes on through the lower respiratory tract - the trachea and lungs

where the exchange of gases takes place (Sorrentino, 1997).

Respiration

Respiration involves the passage of air in and out of the lungs.

Air passes from nose to the pharynx to the larynx to the trachea to the

left and right bronchus to the bronchioles to the alveoli (where a gas


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exchange takes place and oxygen and carbon dioxide are exchanged inthe pulmonary capillaries) (Herlihy et al. 2000).

Air enters the body via the nasal passages, where it is warmed,

moistened and filtered. Air then passes down through the pharynx andinto the larynx and trachea. The air continues into the right and left

bronchi and then into the lungs. In the lungs the bronchi then branchinto smaller bronchioles, that each have air sacs called alveoli,

attached to them. The exchange of oxygen and carbon dioxide takes

place at this level, between the alveoli and the blood capillaries.Through this process oxygen enters the bloodstream and can be

transported around the body.

The circulatory system is an organ system that

permits blood and lymph circulation to transport nutrients (such

as amino acids and electrolytes), oxygen, carbondioxide, hormones, blood cells, etc. to and from cells in the body to

nourish it and help to fight diseases, stabilize bodytemperature and pH, and to maintain homeostasis.

This system may be seen strictly as a blood distribution network, but

some consider the circulatory system as composed of thecardiovascular system, which distributes blood, and the lymphatic

system,which returns excess filteredblood plasmafrom the interstitial

fluid (between cells) as lymph. While humans, as well asother vertebrates, have a closed cardiovascular system (meaning that

the blood never leaves the network ofarteries, veins and capillaries),

some invertebrate groups have an open cardiovascular system. Themore primitive, diploblastic animal phyla lack circulatory systems. Thelymphatic system, on the other hand, is an open system providing an

accessory route for excess interstitial fluid to get returned to the

blood.

Two types of fluids move through the circulatory system: blood and

lymph. Lymph is essentially recycled blood plasma after it has been

filtered from the blood cells and returned to the lymphatic system. Theblood, heart, and blood vessels form the cardiovascular (from Latin

words meaning 'heart'-'vessel') system. The lymph, lymph nodes, and

lymph vessels form thelymphatic system. The cardiovascular systemand the lymphatic system collectively make up the circulatory system.
http://en.wikipedia.org/wiki/Biological_systemhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Lymphhttp://en.wikipedia.org/wiki/Amino_acidshttp://en.wikipedia.org/wiki/Electrolyteshttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Carbon_dioxidehttp://en.wikipedia.org/wiki/Carbon_dioxidehttp://en.wikipedia.org/wiki/Hormonehttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Cells_(biology)http://en.wikipedia.org/wiki/Thermoregulationhttp://en.wikipedia.org/wiki/Thermoregulationhttp://en.wikipedia.org/wiki/PHhttp://en.wikipedia.org/wiki/Homeostasishttp://en.wikipedia.org/wiki/Lymphatic_systemhttp://en.wikipedia.org/wiki/Lymphatic_systemhttp://en.wikipedia.org/wiki/Capillary_filtrationhttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Interstitial_fluidhttp://en.wikipedia.org/wiki/Interstitial_fluidhttp://en.wikipedia.org/wiki/Lymphhttp://en.wikipedia.org/wiki/Vertebrateshttp://en.wikipedia.org/wiki/Arterieshttp://en.wikipedia.org/wiki/Veinshttp://en.wikipedia.org/wiki/Capillarieshttp://en.wikipedia.org/wiki/Invertebratehttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Blood_cellshttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Lymphatic_systemhttp://en.wikipedia.org/wiki/Biological_systemhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Lymphhttp://en.wikipedia.org/wiki/Amino_acidshttp://en.wikipedia.org/wiki/Electrolyteshttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Carbon_dioxidehttp://en.wikipedia.org/wiki/Carbon_dioxidehttp://en.wikipedia.org/wiki/Hormonehttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Cells_(biology)http://en.wikipedia.org/wiki/Thermoregulationhttp://en.wikipedia.org/wiki/Thermoregulationhttp://en.wikipedia.org/wiki/PHhttp://en.wikipedia.org/wiki/Homeostasishttp://en.wikipedia.org/wiki/Lymphatic_systemhttp://en.wikipedia.org/wiki/Lymphatic_systemhttp://en.wikipedia.org/wiki/Capillary_filtrationhttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Interstitial_fluidhttp://en.wikipedia.org/wiki/Interstitial_fluidhttp://en.wikipedia.org/wiki/Lymphhttp://en.wikipedia.org/wiki/Vertebrateshttp://en.wikipedia.org/wiki/Arterieshttp://en.wikipedia.org/wiki/Veinshttp://en.wikipedia.org/wiki/Capillarieshttp://en.wikipedia.org/wiki/Invertebratehttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Blood_cellshttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Lymphatic_system


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Systemic circulation

Systemic circulation supplies nourishment to all of the tissue located

throughout your body, with the exception of the heart and lungsbecause they have their own systems. Systemic circulation is a major

part of the overall circulatory system.

The blood vessels (arteries, veins, and capillaries) are responsible for

the delivery of oxygen and nutrients to the tissue. Oxygen-rich blood

enters the blood vessels through the heart's main artery called the

aorta. The forceful contraction of the heart's left ventricle forces the

blood into the aorta which then branches into many smaller arteries

which run throughout the body. The inside layer of an artery is very

smooth, allowing the blood to flow quickly. The outside layer of an

artery is very strong, allowing the blood to flow forcefully. The oxygen-rich blood enters the capillaries where the oxygen and nutrients are

released. The waste products are collected and the waste-rich blood

flows into the veins in order to circulate back to the heart

where pulmonary circulation will allow the exchange of gases in the

lungs.

During systemic circulation, blood passes through the kidneys. This

phase of systemic circulation is known as renal circulation. During this

phase, the kidneys filter much of the waste from the blood. Blood also

passes through the small intestine during systemic circulation. This

phase is known as portal circulation. During this phase, the blood from

the small intestine collects in the portal vein which passes through the

liver. The liver filters sugars from the blood, storing them for later.
http://www.fi.edu/learn/heart/systems/circulation.htmlhttp://www.fi.edu/learn/heart/vessels/vessels.htmlhttp://www.fi.edu/learn/heart/systems/pulmonary.htmlhttp://www.fi.edu/learn/heart/systems/circulation.htmlhttp://www.fi.edu/learn/heart/vessels/vessels.htmlhttp://www.fi.edu/learn/heart/systems/pulmonary.html


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History of Present Illness

A case of patient RHP 41 years old, female, single, from MangyanSibonga, Cebu. One year prior to admission, she has positive

symptoms of on and off cough with yellowish phlegm. Knowing thatthese signs and symptoms were just of forms of little discomforts, so

she self medicated herself with Tuseran and never seek medical

advice.

Two months prior to admission patient RHP observed that her left legis getting bigger and swelling and she has difficulty in moving her left

leg. She went to hospital XX to seek medical treatment about hercondition and the patients admitting diagnosis was Septic Shocksecondary to PTB with Pneumonia, Severe Anemia to consider

Lymphatic Obstruction left leg.


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Gordons Functional Health Pattern

A. Health Perception and health management pattern.

Patient states that having a stable life health condition would

make life easy especially when you have work to do. Patient iswell aware and informed to his present condition.

B. Nutritional and Metabolic Pattern

Patient has normal diet as tolerated, patients eats meals on timeand has biscuit for snacks, patient drinks water every after

snacks and major meals, and in time when she is feels thirsty.The total amount of fluid take orally is 600-800 daily perafternoon shift.

C. Elimination Pattern

Patient urinates with more than the minimum around per hour.Client urinates 2-4 times per shift. Patients total outcome in

urination limits from 400-600 ml per afternoon shift.

D. Activity/ Exercise Pattern

Patient was observed to have minimal activity to compensate for

her weakness. Patient well rested on bed.

E. Cognitive and Perceptual Pattern


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Patient was able to answer most of the questions thrown to herand was responding well of her knowledge gained in her

experiences. Patient educational attainment was until 4 th yearhighschool.

F. Sleep and rest Pattern

She had difficulty in sleeping during the first day of admissionbecause she is experiencing difficulty in breathing. Patient also

verbalized that the environment is not soothing for her sleeping

pattern because of its hot and noisy environment.

G. Self-Perception and Self Concept Pattern

Patient loves to have conversation and states that she finds ithard to do her daily activities or work when she feels bad.

Patient states that having a good health make you do anythingwith ease.

H. Role & Relationship Pattern

Patient is living with her family and is satisfied with therelationship of her parents and siblings, Patient is working with

minimal wage to help finance the family.

I. Sexuality and Reproductive Pattern

Patient is a lesbian and have never been experience sex with her

partner.

J. Coping Stress Pattern

To cope up with external and internal stressors. Patient will have

her rest until she will feel energized to face the real world.Patient also drink alcoholic beverages like tanduay togetherwith her friend. Patient will also watch television or play hand

games to divert her attention from stressors.

K. Value Belie Pattern


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Patient values oneself, being good to other and having positiveattitude towards life. Patient values her religion as she prays to

be spiritually free from diseases.

Physical Assessment

General Survey

Appearance: Clean

Grooming: well-groomed, dressed properly

Temperature: 37.0Weight:

Pulse Rate: 90Respiratory Rate: 28Blood Pressure: 80/60

Skin:

fair complexion

smooth

dry

skin returns after 2 seconds upon pinch

no lesions noted

Hair

Black

evenly distributed

thin and straight in texture

no lesions noted


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Nails

pinkish white

curve in shape

no tenderness noted

Eyes

symmetrical

PEERLA pupils constrict when looking at the near object and

dilate when looking at the far object pupils have direct and

consensual reaction to light

Eyelashes hair is evenly distributed

Blink reflex is present

Able to see

Nose

Symmetrical

Able to smell

No tenderness noted

Ears

Consistent with facial skin color

Able to hear

Symmetrical No tenderness noted

No lesion noted

Mouth & OropharynxLips

Pallor

No lesions

Gums

Pinkish

No lesionsTongue

Symmetrical

Moves freely

Pinkish

Respiratory


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Symmetrical

No thoracic tenderness noted

Crackles/ wheezing during expiration

Chest

Symmetrical Same as the body

Abdomen

Same as with the body

Flat

No murmur

Genitourinary tract

Able to urinate

No lesions noted

Extremities

Left dorsalis pedis ( not palpable with edema of left lower

extremity)

Documents

Etal Ame Case (1)