Presentation on pneumonia

CASE ON PNEUMONIA

1. A CASE STUDY PRESENTATION ON PNEUMONIA Presented by-KM KUSUM 1 st YEAR P.C Bsc Nsg, MIBE

2. NAME- Master SAHITYA AGE- 2 Yrs SEX- Male DOB- 26/09/2013 DOA- 14/10/2015 DOCTOR INCHARGE- Dr. Mukesh Birla WARD- General Ward DIAGNOSIS-Pneumonia INTRODUCTION (Patient)

3. On admission master Sahitya brought with a complain of fever since 5 days, cough since 8 days, and breathlessness since 2 days. H/O Present Illness:2 years old male child was admitted in General ward with fever on and off, cough and breathing difficulty. H/O Past Illness: Had a history of viral fever with cold and cough 2 months before. Chief complains:

4. ANTENATAL- Mother attended check up regularly, no illness during pregnancy, taken 2 doses of TT. INTRANATAL- Born through NVD, conducted by skilled person at hospital, no complications, no evidence of birth injury, cried immediately after birth, baby weight was 2.6 kgs. POSTNATAL- No complication, baby was pink and active, breast feeding started after1/2 an hour, no evidence of congenital anomalies. BIRTH HISTORY

5. Taken all immunization according to the age group (BCG, DPT, MEASLES,OPV) ANTHROPROMETRY Length-75 cms Weight-11kgs Head circum-45 cms Chest circum-48 cms Mid arm circum-14 cms IMMUNIZATION

6. PHYSICAL DEVELOPMENT: Have weight 11kgs, have temporary teeth, pulse rate-110/m, Resp. rate-30. MOTOR DEVELOPMENT: A. Gross motor -steady gait, walks on heel toe, walks up and down upstairs holdings wall. B. Fine motor- picks up objects from floor, can build tower of 6-7 cubes, turn pages one at a time, drink with glass. DEVELOPMENTAL HISTORY

7. Autonomy vs. Shame and Doubt Occurs in the toddler age. (18 months-3 years). Child learns to feed themselves and do things on there own. Or they could start feeling ashamed and doubt their abilities. Questions the child's willpower. PSCHSOCIAL DEVELOPMENT

8. ANAL STAGE: According to Sigmund Freud it is the second stage of oral development that occurs between 1 ½ until 3 years of age, in which the child’s greatest pleasure involves the anus or the eliminative functions associated with it. Child is getting proper toilet training. PSCHOSEXUAL DEVELOPMENT

9. The Sensorimotor Period (0-2 yrs.) According to Jean Piagent , Infants and toddlers "think" with their eyes, ears, hands, and other sensorimotor equipment. They learn to generalize their activities to a wider range of situations and coordinate them into increasingly lengthy chains of behavior. COGNITIVE DEVELOPMENT

10. Enjoys story Knows at least 4 body parts Has a vocabulary of 300 words Refers to self by name LANGUAGE DEVELOPMENT

11. Stages of Faith- Stage 0  –  "Primal or Undifferentiated"  faith (birth to 2 years). It is characterized by an early learning of the safety of their environment (i.e. warm, safe and secure vs. hurt, neglect and abuse). If consistent nurture is experienced, one will develop a sense of trust and safety about the universe and the divine. Conversely, negative experiences will cause one to develop distrust with the universe and the divine. Transition to the next stage begins with integration of thought and languages which facilitates the use of symbols in speech and play. SPIRITUAL DEVELOPMENT

12. Nuclear family, 4 members, father, mother, elder sister. FAMILY TREE: FAMILY HISTORY:

13. S.NO DRUG FORM DOSE ROUTE TIME ACTIONS 1. ANGUMENTIN 300 mg IV TDS BACTERIOCIDAL 2. AMIKACIN 75 mg IV BD BACTERIOCIAL 3. SYP. NOBLE PLUS 4 ml PO TDS NON-OPOID ANALGESIC 4. IPRAVENT NEBS 1 ml PN QID BRONCHO DILATOR 5. VANCOMYCIN 200 mg IV BD ANTI-INFECTIVE MEDICATION

14. INVESTIGATION PATIENT’S VALUE NORMAL VALUE TLC 27.31 10^3/ microL 5-15 10^3/ microL HAEMOGLOBIN 10.9 gm/dl 11-14 gm/dl ABORH B + ve - PLATELETS 5 31 10^3/ microL 150-450 10^3/ microL URINE R/E NORMAL NORMAL SECIFIC GRAVITY 1.15 1.003-1.035 INVESTIGATIONS

15. Head to toe examinations done. Respiratory- dyspnea , nasal flaring. Rest of the findings were normal. VITAL SIGNS Temperature-100F Heart rate-122/m Respiration-36/m PHYSICAL EXAMINATIONS

16. INTRODUCTION : Pneumonia is inflammation of the lung that is most often caused by infection with bacteria, viruses , or other organisms . Occasionally, inhaled chemicals that irritate the lungs can cause pneumonia. Healthy people can usually fight off pneumonia infections. However, people who are sick, including those who are recovering from the flu (influenza) or an upper respiratory illness, have a weakened immune system. This makes it easier for bacteria to grow in their lungs. PNEUMONIA

17. ANATOMY OF LUNGS

18. Pneumonia is a breathing (respiratory) conditions in which there is an infection and inflammations of the lungs parenchyma cells. Pathologically there is consolidation of alveoli or infiltration of the interstitial tissue with inflammatory cell or both. DEFINITION

19. The World Health Organization (WHO) estimates there are 156 million cases of pneumonia each year in children younger than five years , with as many as 20 million cases severe enough to require hospital admission. INCIDENCE

20. Approximately one- half of children younger than five years of age with community-acquired pneumonia (CAP) require hospitalization. In the developed world, the annual incidence of pneumonia is estimated to be 33 per 10,000 in children younger than five years and 14.5 per 10,000 in children 0 to 16 years.

21. The mortality rate in developed countries is low (<1 per 1000 per year) . In developing countries, respiratory tract infections are not only more prevalent but more severe, accounting for more than 2 million deaths annually. Pneumonia is the number one killer of children in the WORLD. MORTALITY

22. BOOK DESCRIPTION PATIENT’S PICTURE Bacterial infections Viral or Fungal infections Aspiration pneumonia Who had a recent viral infections People with low immune system Hospital acquired pneumonia Community acquired pneumonia. Master Sahitya had recent viral infections 2 months before. CAUSES

23. PATHOPHYSIOLOGY INFECTIONS, ASPIRATIONS, LOW IMMUNITY, POLLUTANTS ETC. NEUTROPHILLIC/LYMPHOCYTIC INFILTRATIONS ACUTE/CHRONIC INFLAMMATION

24. INCREASED CAPILLARY PERMEABILITY FLUID/CELLULAR EXUDATION EDEMA OF MUCUOUS MEMBRANE HYPERSECREATION OF MUCUS PERSISTENT COUGH, STAGES OF CONGESTION IN THE ALVEOLAR SPACES WITH FLUID AND HEMORRHAGIC EXUDATES

25. PATHOPHYSIOLOGY

26. Pneumonia can affect anyone. But the two age groups at highest risk are: 1. Children who are 2 years old or younger developing 2. People who are age 65 or older Other risk factors include: Chronic disease Weakened or suppressed immune system Smoking Being hospitalized WHO ARE AT RISK?

27. BOOK’S PICTURE PATIENT’S PICTURE History taking Physical examination Chest X-ray Blood test, blood culture Sputum examination Bronchoscopy Pleural fluid culture Pulse oximetry CT-scan CBC Patient history taken Physical examination Chest X-ray Blood test DIAGNOSTIC EVALUATION

28. CHEST X-RAY SHOWING PNEUMONIA

29. 1. PHARMACOLOGICAL : The choice of an initial, empiric agent is selected according to the susceptibility and resistance patterns of the likely pathogens and experience at the institution and the selection is tempered by knowledge of the delivery of the drugs to the suspected infected sites with the lungs. Antibiotics agents Anti inflammatory therapy Anti viral Bronchodilators MANAGEMENT

30. 2. Chest physiotherapy and breathing exercise 3. Postural drainage 4. Surgical Management Drainage of plural effusion by continuous suction Reduction of pneumothorax

31. Most people with pneumonia improve after 3-5 days of antibiotics of treatments but a mild cough and fatigue can last longer up to a month. Patients who required treatment in a hospital may take longer to see improvement. pneumonia is more likely to be fatal in the elderly or those with chronic medical conditions or a weakened immune system. GENERAL PROGNOSIS

32. Pleural effusion Empyema Lung abscess Necrotizing pneumonia Airway injury Obstructive airway secreations Air leak syndrome Chronic lungs disease Sepsis COMPLICATIONS

33. NURSING DIAGNOSIS Ineffective airway clearance related to inflammation and accumulations of secretions as evidenced by cough with sputum productions. Impaired gas exchange related to alveolar capillary membrane changes as evidenced by tachycardia and restlessness. Hyperthermia related to inflammatory process as evidenced by increased body temperature. Risk for fluid volume deficit related to inadequate oral intake, fever, as evidenced by poor skin turgour. Imbalanced nutrition less than body requirement related to disease condition as evidenced by refusal of food by child. NURSING MANAGEMENT

34. 6. Sleeping pattern disturbed related to hyperthermia and cough as verbalized by mother’s concern for rest and sleep. 7. Interrupted family process related to hospitalization as evidenced by inability to fullfill daily works. 8. Knowledge deficient about the conditions, prognosis, and treatment of pneumonia as evidenced by less knowledge about pneumonia management.

35. Teach parents about signs and symptoms of pneumonia. To teach about fluid intake . To Give proper rest and sleep . To make child to sleep in head elevated at 30 degree to ease the breathing. CONTACT HEALTH CARE : IF symptoms do not get better or get worse, child have fever. Child is lethargic and weak Not taking feeds properly HEALTH EDUCATION

36. IMMIDIATE CARE: Blood in cough Tachycardia Looks very lethargic and weak Not able to breath properly Childs lips or finger nails turn black and blue

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