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Brgy . Santolan , Palayan City , N.E.Purok 1 5 Case Presentation by: BSN 2-0
ContentsI.Community Cases II.Urinalysis III.The infants and their Weight IV.The Adopted FamilyFamily
Nursing Care Plan
V.Learning Experiences
1
AsthmaDefinition is a chronic inflammatory disease of the airways that causes airway hyperresponsiveness, mucosal edema, and mucus production
Recurrent asthma symptoms: cough,
chest tightness, wheezing and dyspnea
It differs from other obstructive lung
diseases in that it is largely reversible, either spontaneously or with treatment. Patients with asthma may experience
symptom-free periods alternating with acute exacerbations that last from minutes to hours or days. It is the most common chronic
disease of childhood and can occur
Allergy is the strongest predisposing
factor. Chronic exposure to airway irritants or
allergens increases the risk of asthma.
Examples of allergens:
Grass TreeDust
Common triggers for asthma:
Airway irritants (e.g. air pollutants,
cold, heat, weather changes, strong odors or perfumes, smoke) Exercise Stress or emotional upset Sinusitis with post natal drip Medications Viral respiratory tract infections Gastroesophageal Reflux
Physiology/PathophysiologyPredisposing Factors: Atopy Female Gender Causal Factors: Exposure to indoor and outdoor allergens Occupational sensitizers Contributing Factors: Respiratory infections Air Pollution Active/Passive Smoking Others: cold, heat, etc.
INFLAMMATION Hyperresponsivenes s of airwaysSome Risk factors: Allergens Respiratory Infections Exercise and hyperventilation Weather change
Airflow limitation
Symptoms: Wheezing Cough Dyspnea Chest Tightness
Management
Immediate intervention is necessary, because
the continuing and progressive dyspnea leads to increased anxiety, aggravating the situation.
Pharmacologic Therapy Quick
Relief Medications for immediate treatment of asthma symptoms and exacerbations Long-acting Medications to achieve and maintain control of persistent asthma (e.g. inhalation of Corticosteroids which are the most potent and effective antiinflammatory medications currently available)
Management of Exacerbations asthma
exacerbations are best managed by early treatment and education including the use of written action plans as part of any overall effort to educate patients about selfmanagement techniques, especially those with moderate or severe persistent asthma.
Peak Flow Monitoring peak flow meters
measure the highest airflow during a forced expiration. It is recommended to be done daily for all patients with moderate to severe asthma.
Florentino Baltazar73 years old His asthma started when he was
50 years old
Management 1 tablet of
Salbutamol
everyday
2
Definition
Cataract
is a clouding that develops in the crystalline
lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light.
According to the World health Organization,
it is the leading cause of blindness in the world.
It may be partial or complete, stationary or
progressive, hard or soft.
classified by their location, e.g. posterior
(classically due to steroid use) and anterior [common (senile) cataract related to aging]
Causes of Cataract:long-term exposure to ultraviolet light
and infrared and microwave radiations secondary effects of diseases such as diabetes, hypertension and advanced age, or trauma (possibly much earlier)
usually a result of denaturation of lens
protein
Genetic factors are often a cause of
congenital cataracts and positive family history may also play a role in predisposing someone to cataracts at an earlier age, a phenomenon of "anticipation" in pre-senile cataracts
produced by eye injury or physical
trauma
Atopic or allergic conditions
Physiology/PathophysiologyCataracts can develop in one or
both eyes at any age for a variety of reasons
Visual impairment normally
progresses at the same rate in both eyes
The extent of visual impairment
depends on their size, density and location in the lens.
Three most common types of Senile (Age-related) Nuclear Cataract caused by central opacity
Cataract are defined by their location in the lens:
in the lens and has a substantial genetic component. It is accompanied by myopia (nearsightedness). Cortical Cataract involves the anterior, Posterior Subscapular Cataracts occur in
posterior or equatorial cortex of the lens.
front of the posterior capsule. Typically in younger people. Near vision is diminished and the eye is increasingly sensitive to glare from bright light.
Management No nonsurgical (medications, eyedrops, eyeglasses) treatment cures cataracts or prevents age-related cataracts.
Surgical Management Extracapsular Cataract Extraction involves smaller incisional wounds (less trauma to the eye) and maintains the posterior capsule of the lens, reducing postoperative complications, particularly aphakic retinal detachment and cystoid macular edema.
Intracapsular Cataract Extraction the entire
lens is removed and fine sutures are used to close the incision Phacoemulsification this method of
extracapsular surgery uses an ultrasonic device that liquefies the nucleus and cortex, which are then suctioned out through a tube.
Lens Replacement after removal of the
crystalline lens, the patient is referred to as aphakic (without lens). The lens, which focuses light on the retina, must be replaced for the patient to see clearly.
Toxic Anterior Segment Syndrome also
known as toxic endothelial cell destruction or sterile endophthalmitis. It is a noninfectious inflammation caused by a toxic agent after an uncomplicated and unevenful surgery.
Antonio Garcia77 years old Cataract started when he was 72
years old
Management applied treatment
for three years but stopped
3
Ulcer
Definition
These are crater-like sores (generally 1/4 inch to
3/4 inch in diameter, but sometimes 1 to 2 inches in diameter) which form in the lining of the stomach (called gastric ulcers), just below the stomach at the beginning of the small intestine in the duodenum (called duodenal ulcers) or less commonly in the esophagus (called esophageal ulcers)
In general, ulcers in the stomach and duodenum
are referred to as peptic ulcers.
Symptoms of Ulcer There may be no symptoms of ulcers or the individual may experience: A gnawing or burning pain in the abdomen between the breastbone and the navel. The pain is usually worse a couple of hours after a meal or in the middle of the night when the stomach is empty. Nausea Vomiting
Loss of appetite Loss of weight Tiredness (a symptom of a bleeding
ulcer) Weakness (a symptom of a bleeding ulcer) Blood in vomit or stool. When blood is in the stool, it appears tarry or black (symptom of a bleeding ulcer).
Physiology/Pathophysiology
Peptic Ulcers occur mainly in the
gastroduodenal mucosa
The erosion is caused by the increased
concentration or activity of acid-pepsin or by decreased resistance of mucosa A damaged mucosa cannot act as a barrier
against HCl.
The use of NSAIDs inhibits the secretion of
mucus that protects the mucosa.
Damage to the gastroiduodenal mucosa
allows for decrease resistance to bacteria, and thus infection from Helicobacter pylori may occur.
Zollinger Ellison Syndrome is suspected
when a patient has several peptic ulcers or an ulcer that is resistant
Management
Pharmacologic Therapy uses a combination
of antibiotics, proton pump inhibitors and bismuth salts that suppress or eradicate H. pylori Stress reduction and Rest Smoking Cessation Dietary Modification Surgical Management it includes vagotomy, with or without pyloroplasty and the Billroth I and II procedures Follow-up care
Antonio Garcia77 years old His ulcer began when he was
only 30 years old
Management tea from different
plant leaves and roots
4Definition
Diabetes Mellitus
is a group of metabolic disorders
characterized by elevated levels of blood glucose (hyperglycemia) resulting from defects in insulin production and secretion, decreased cellular response to insulin, or both.
It has two types:DM 1 or Insulin Dependent Diabetes
Mellitus characterized by absolute lack of insulin due to damaged pancreas, prone to develop ketosis and dependent on insulin injections DM 2 or Noninsulin Dependent DM
characterized by fasting hyperglycemia despite availability of insulin. Gestational
Diabetes develops during pregnancy. It may develop into fullblown hypothesis Juvenile Diabetes DM in people who
Physiology/Pathophysiology mellitus is characterized by peripheral insulin resistance, impaired regulation of hepatic glucose production, and declining -cell function, eventually leading to -cell failure. respond appropriately when insulin is present. Unlike type 1 diabetes mellitus, the insulin resistance is generally "post-receptor", meaning it is a problem with the cells that respond to insulin rather than a problem with production of insulin
The pathophysiology of type 2 diabetes
Insulin resistance means that body cells do not
Management
The easiest method of treating Type 2
diabetes is with diet control. Dietary regulation is set by basing the caloric intake on the patients ideal body weight, selecting adequate sources of protein and carbohydrate, while maintaining a reasonable distribution of foods. When hyperglycemia persists despite dietary changes, oral hypoglycemic agents become necessary. These agents can be prescribed in small doses, adjusting the dosage to larger levels to achieve tighter control, as necessary.
Insulin is always required for Type 1
and is an option for recalcitrant cases involving Type 2 diabetes. Conventional therapy involves the administration of an intermediateacting insulin (NPH or lente), once or twice a day, with or without small amounts of regular insulin.
Annalyn Peralta8 months pregnant
ManagementDiet Control such as smaller
amount of sugar intake (e.g. when drinking coffee), lesser rice during meals and abstinence from sweet foods.
5Definition
Pneumonia
It is an inflammation of the lung
parenchyma caused by various microorganisms, including bacteria, mycobacteria, chlamydiae, mycoplasma, fungi, parasites and viruses.
It is classified into:Community Acquired Pneumonia
occurs either in the community setting or within the first 48 hours after hospitalization. The causative agents for CAP are gram-negative rods like Pseudomonas aeruginosa Hospital Acquired Pneumonia also
known as nosocomial pneumonia, is defined as the onset of pneumonia symptoms more than 48 hours after admission in patients with no evidence of infection at the time of admission.
Pneumonia in the Immunocompromised
Host it occurs with use of corticosteroids or other immunosuppresive agents, chemotherapy, nutritional depletion, use of broad-spectrum antimicrobial agents and AIDS.
Aspiration Pneumonia refers to the
consequences resulting from entry of endogenous or exogenous substances into the lower airway.
Physiology/Pathophysiology
Pneumonia arises from normal flora present in
patients whose resistance has been altered or from aspiration of flora present in the oropharynx It may also result from bloodborne organisms
that enter the pulmonary circulation and are trapped in the pulmonary capillary bed. Inflammatory reaction can occur in the alveoli,
producing an exudate that interferes with the diffusion of oxygen and carbon dioxide.
The mixing of oxygenated and
unoxygenated or poorly oxygenated-blood eventually results in arterial hypoxemia.
If a substantial portion of one or more lobes
is involved, the disease is called lobar pneumonia.
The term bronchopneumonia is used to
describe pneumonia that is distributed in a patchy fashion, having originated in one or morelocalized areas within the bronchi and extending to the adjacent surrounding lung parenchyma.
Management
Pharmacologic Therapy includes
administration of the appropriate antibiotics as determined by the results of a Gram stain. Prompt administration of antibiotics in patient
with CAP is strongly suspected or confirmed as a key treatment measure.
For HAP patients infusion of IV antibiotics and
may be monotherapy or combination of therapy.
For pt who are at risk for Pseudomonas
infection, antipseudomonal penecillin plus an amino glycoside fever and tachypnea, give antipyretics reduced sneezing.
For viral pneumonia which is accompanied by Antihistamines may provide benefit with Nasal decongestants may also be used to treat
symptoms and improve sleep.
Bed Rest
Trixie Claire Villasan4 month-old baby Management health check-up
whenever money is available
6
Hypertension
Definition or a diastolic pressure above 90 mm Hg, based on two or more measurements.
systolic blood pressure above 140 mm Hg
Prolonged blood pressure elevation
damages vessels in target organs (heart, kidneys, brain and eyes)
Physiology/Pathophysiology
Many factors have been implicated as causes of hypertension: Increased sympathetic nervous system activity related to dysfunction of the autonomic nervous system
Increased renal reabsorption of sodium,
chloride, and water related to a genetic variation in the pathways by which the kidneys handle sodium
Increased activity of the renin-angiotensin-
aldosterone system, resulting in expansion of extracellular fluid volume and increased systemic vascular resistance
Decreased vasodilation of the arterioles
related to dysfunction of the vascular endothelium
Resistance to insulin action, which may be
a common factor linking hypertension, type 2 diabetes mellitus, hypertriglyceridemia, obesity, and glucose intolerance
Management
The goal of any treatment program is to
prevent death and complications by achieving and maintaining an arterial blood pressure below 140/90 mm Hg (130/80 mm Hg for people with diabetes mellitus or proteinuria >1 g/24 hours), whenever possible. Promote compliance by avoiding
complicated drug schedules.
Select a drug class that has the greatest
effectiveness, fewest side effects, and best chance of acceptance by patient. Two classes of drugs are available as first-line therapy: diuretics and beta-blockers.
Nonpharmacologic approaches include
weight reduction; restriction of alcohol, sodium, tobacco; regular exercise and relaxation. A DASH (Dietary Approach to Stop Hypertension) diet high in fruit and vegetables and low in dairy products has been shown to lower elevated pressures.
Villa Rosa Dela Cruz67 years old She has a medicine to maintain her blood
pressure normal
Management adequate rest, lesser stress
provoking activities, proper diet, attend health check-ups whenever money is available
Urinalysis
Summary of ResultsName of Patient 1. Annalyn Peralta 2. Chuchi Alcantara 3. Analiza Pinzon 4. Cherry Capile Test for Albumin Negative Traces of Protein Negative Negative Test for Sugar Positive Range - 0 to 1 Negative Negative Positive Range 0 to 1
The Infants
Summary of Results
To ta lN u m b e r of Children = 78
Labiano Family
Fa m i y C a se lPostpartum Psychosissometimes referred to as puerperal
psychosis or postnatal psychosis It is a term that covers a group of
mental illnesses with rapid onset of psychotic symptoms following childbirth
Postpartum Psychosis Signs
Although the onset of symptoms can occur at anytime within the first three months after giving birth, women who have postpartum psychosis usually develop symptoms within the first two to three weeks after delivery. Postpartum psychosis symptoms usually appear quite suddenly; in 80% of cases, the psychosis occurs three to 14 days after a symptom-free period.
Signs of postpartum psychosis include:
Hallucinations Delusions Illogical thoughts Insomnia Refusing to eat Extreme feelings of anxiety and agitation Periods of delirium or mania Suicidal or homicidal thoughts
Who Is At Risk?
Women with a personal history of psychosis, bipolar disorder or schizophrenia have an increased risk of developing postpartum psychosis. Likewise, women who have a family history of psychosis, bipolar disorder or schizophrenia have a greater chance of developing the disorder. Additonally, women who have had had a past incidence of postpartum psychosis are between 20% and 50% more likely of experiencing it again in a future pregnancy.
Causes of Postpartum Psychosis
Experts arent exactly sure why postpartum psychosis happens. However, they do offer a variety of explanations for the disorder, with a womans changing hormones being at the top of their list. Other possible reasons or contributing factors include a lack of social and emotional support; a low sense of self-esteem due to a womans postpartum appearance; feeling inadequate as a mother; feeling isolated and alone; having financial problems; and undergoing a major life change such as moving or starting a new job.
Treating Postpartum Psychosis
Postpartum psychosis is considered to be a mental health emergency and therefore requires immediate attention. Because women who suffer from the psychosis are not always able or willing to speak with someone about their disorder, it is sometimes necessary that their partner or another family member help them get the medical attention they need.
The condition is usually treated with medications, typically antipsychotic drugs and sometimes antidepressants and/or antianxiety drugs. If a woman is thought to pose a threat to herself or others, she will likely be hospitalized for a short time.
Many women can also benefit from psychological counseling and support group therapy. With proper care, most women are able to recover from their disorder.
Family Nursing Care PlanFamily size beyond the familys
resources Malnutrition
Health Problem
Family Nursing Goal of Care Problems Family size beyond Inability to provide After nursing the familys resources adequate nursing care intervention, the and service due to family will now be poor nurse-client able to decide interaction and properly what actions because the they are going to knowledgeable make when it comes members are always to family planning out. with a sense of responsibility.
Intervention Objectives of Care Nursing Interventions Method of Resources NurseRequired Family Broaden the knowledge of the Contact Home Visit Material
After nursing intervention, the couple: family about family planning
Discuss with the family the possible consequences if Can explain what family family planning will be planning is all about disregarded Can enumerate the ways Explain to the family the advantages and disadvantages on birth control Will select the most of each of the methods used in appropriate method for family planning Provide information about the them consultation hours
Resources: Visual Aids about Family Planning Human Resources: Time, effort and patience of the family and the nurse
Will regularly seek for medical consultation and guidance
Health Problem Malnutrition
Family Nursing Problems
Goal of Care
Inability to provide After nursing adequate nursing care to intervention, the a member suffering children will gain at from this disease least 2 kg in 4 weeks because of lack of time knowledge about the condition and insufficient resources for care (example, responsible member of the family and limited financial inc0me
Intervention Objectives of Care Nursing InterventionsWiden the familys After nursing intervention, the family: knowledge about malnutrition
Method of Resources NurseRequired Family Contact Home Visit Material
Discuss why the children are malnourished and the possible Can now plan a meal things that may happen to which contains a balance them if it continues Show a picture of the food diet and is affordable Will feed the children pyramid and enumerate the foods they can buy which are with the agreed upon quantity and quality of affordable but very nutritious Give advices about budgeting
Resources: Visual Aids about Malnutrition, Picture of the food pyramid, Human Resources: Time, effort and patience of the family and the nurse
food
Learning ExperiencesWe are so thankful that we were given the
chance to have a duty at Brgy. Santolan, Palayan, N.E. It is going to be a place that we will not forget because we met 3 Clinical Instructors who stand as our mothers and gave additional knowledge to us. Also, its unforgettable because we became friends with BSN 2-3 We experienced so many stuffs that we havent before neither in the hospital nor in any other place
Thank You !..