Question

CLINICAL SCENARIO

NURSING HEALTH HISTORY

A. Patient’s Profile

Name: JFK

Birthday: August 23, 1982

Age: 38 years old

Sex: Male

Nationality:Filipino

Religion:Roman Catholic

Marital Status:Married

Address: Pampanga

Date of Admission: September 02, 2020

Time of Admission: 2:30PM

Chief Complaint: productive cough with fever with slight difficulty of breathing

Final Diagnosis: Moderate Risk Community Acquired Pneumonia (CAP III)

History of Present Illness :

Patient came to the hospital complaining of productive cough, fever and slight difficulty of breathing. Client is having persistent productive cough with greenish phlegm and has had fever with 39.3 celcius for temperature when admitted. The client is ambulatory, coherent and v/s results showed an elevated RR of 37 cpm, pulse rate of 104. On DAT was prescribed, has a standing order of TSB for fever. WBC count is within range, CXR results showing consolidation and sputum culture and sensitivity shows S. pneumoniae with a medical diagnosis of CAP III.

Past Medical History :

Cough and fever has been noted to have onset 4 days prior to admission. Client has history of pneumonia and was admitted to the hospital when he was in high school. Client has suffered asthmatic attack when he was 3 years old and was admitted to the hospital and was given Ventolin for treatment but has no record of any onset after that.Immunizations were completed when he was one year old.Latest medicines prescribed are Cefuroxime, Albuterol, Montelukast, and Naproxen. The patient never undergone any type of surgery. He has no known allergy to food and medication.Family History(+) Hypertension-father(+) Diabetes Mellitus-father(-) Cancer(+) PTB-mother

Personal and Social History : Patient is a tricycle driver and a very joker person, he mingles with his co-tricycle drivers, friends, and neighbors. Patient is non-smoker, non-drinker and no history of taking illicit drugs. He prefers to eat rice, fish and vegetables, but sometimes eat in a sari-sari store. He enjoys talking to commuters and taking care of his children when his day-off, his leisure time is watching TV with his family. If the patient has free time from driving, he likes going to mall with hisfamily every Sunday after church. He is a sweet and loving husband to his wife and children.

Admission Order Medication: Cefuroxime (Zinacef) 750 mg every 8 hours TIV Levofloxacin (Levox) 500 mg 1 tab OD PO Paracematol1 amp TIV for temp of equal or greater than 38.6 and paracetamol 500mg tab PO for temp of 38.5 below Berodual nebulization (10gtts in 3 ml NSS) every 6 hour

Therapeutics: IVF PNSS 1L to run for 8 hours at 31-21 gtts per min at left arm

Bedside O2 of 3L/min via nasal cannula

Nebulization followed by CPT

Bedside Care: Vital signs every shift and watch out for any signs of dyspnea progression, bed rest, I and O monitoring, suction secretions when necessary, provide comfort, morning care done, side rails up for safety, assess every now and then and relayed any abnormal symptoms and complications

COURSE TASKS:

1. Make an Anatomy and Physiology of Community Acquired Pneumonia III.

2.Conceptualize the pathophysiological alterations distinct to the case.

✓Establish the pathophysiological triad of Host –Agent –Environment specific to the case.

✓Trace the pathophysiological changes and highlight problems that are experienced by the client.

✓Connect the pertinent nursing care and medical –surgical management to the various signs and symptoms presented by the client.

Answer 1

1. Pneumonia is a type of lung infection. It can cause breathing problems and other symptoms. In community-acquired pneumonia (CAP), you get infected in a community setting. It doesn’t happen in a hospital, nursing home, or other healthcare center. Community-acquired pneumonia is defined as pneumonia that is acquired outside the hospital.

Many germs can grow inside your body and cause disease. Specific types of germs can cause lung infection and pneumonia when they invade. These germs can cause your respiratory system to work poorly. That can cause shortness of breath. If your body can’t get enough oxygen to survive, pneumonia may lead to death.

These germs can spread from person to person. When someone infected with one of these germs sneezes or coughs, you might breathe the germs into your lungs. If your immune system doesn’t kill the invaders, the germs might grow and cause pneumonia.

CAP can result from infection with many types of germs. These include bacteria, viruses, fungi, or parasites. Symptoms from pneumonia can range from mild to severe. Certain types of germs are more likely to lead to serious infection.

CAP is very common, especially during the winter months. It is more common in older adults. But it can affect people of any age. It can be very serious. That’s often the case in older adults or people with other health problems.

2. Pathophysiology with agent host environments involvement

Pneumonia indicates an inflammatory process of the lung parenchyma caused by a microbial agent. The most common pathway for the microbial agent to reach the alveoli is by microaspiration of oropharyngeal secretions. Once microorganisms reach the alveolar space, they cause pneumonia by overcoming the last defense mechanism of the lung, the alveolar macrophage. Most of the time, the alveolar macrophage phagocytizes and kills the microorganisms that reach the alveolar space. This explains why even though the arrival of microorganisms into the alveolar space is a not-infrequent occurrence, the presence of clinical pneumonia is infrequent.

If the alveolar macrophage is unable to control the growth of the microorganisms, then, as a final protective defense mechanism, the lungs develop a local inflammatory response. This local inflammatory response is characterized by movement of white blood cells, lymphocytes and monocytes from the capillaries into the alveolar space.

The recruitment of phagocytic cells to the alveolar space is primarily mediated by tumor necrosis factor (TNF) and interleukin-l (IL-I) produced by the alveolar macrophages. In addition to TNF and IL-I, other important locally produced cytokines include IL-6, IL-10, IL-12, monocyte chemotaxin protein-l and granulocyte colony-stimulating factor (1). Once these cytokines reach the systemic circulation, they also produce a systemic inflammatory response. The local and systemic inflammatory response is responsible for the majority of the signs, symptoms ( cough, sputum production, shortness of breath, pleuritic chest pain, fever, chills. Tachycardia, tachypnea, rales, and signs of consolidation on physical examination) , and laboratory abnormalities that characterize the community-acquired pneumonia a (CAP) syndrome.

Nursing care according symptoms:-

▪Deep breathing exercises facilitates maximum expansion of the lungs and smaller airways, and improves the productivity of cough.
▪Coughing is a reflex and a natural self-cleaning mechanism that assists the cilia to maintain patent airways. It is the most helpful way to remove most secretions.
▪Splinting reduces chest discomfort and an upright position favors deeper and more forceful cough effort making it more effective.
▪Promoting good fluid intake through the use of intravenous fluids will help promote release of secretions.
▪Humidified oxygen therapy could also be helpful.

Medical treatment:-

Empiric therapy with macrolides, fluoroquinolones, or doxycycline. Patients who are hospitalized should be switched from parenteral antibiotics to oral antibiotics after their symptoms improve, they are afebrile, and they are able to tolerate oral medications.