Ward 6 Case Study
-
Upload
sioti31390 -
Category
Documents
-
view
232 -
download
0
Transcript of Ward 6 Case Study
-
8/8/2019 Ward 6 Case Study
1/57
!!"#"#
"$%!#"&%"#
%
"!'#()! "!#$#! #"
"%*#!! +*! +!$#!
#'##,"!!! #!$#*#"$
"!#!-,""%++$ $$#"#%$
#..
#!#, /'#!$##" ""#,!#
0,$1" 0#$$#$"
2#+,#$ #+#"#, 0#!$#3#,#(#
#$#-#"+,! *!#$+,&%
03#*,!+"$
#"-#" "$!
-'#""#,#4$#!'#
-
8/8/2019 Ward 6 Case Study
2/57
-
8/8/2019 Ward 6 Case Study
3/57
-
8/8/2019 Ward 6 Case Study
4/57
-
8/8/2019 Ward 6 Case Study
5/57
-
8/8/2019 Ward 6 Case Study
6/57
-
8/8/2019 Ward 6 Case Study
7/57
-
8/8/2019 Ward 6 Case Study
8/57
7$$%"',$A+#"'#!,#%"',$,#0'6*+*'&+2,)"%+"#!,#,/$$!+"'":#)"3!'#%"',$3$$H/$#$#$/#
'"#!/$#$%.!//,#;!'#,#++!
5(+%"$1:#)#!'!#,#!%+$#'$/#%$4','.1)"#3#!'!$#$#3#!,$
C"-,3!#!%+1,$%'#!#+#$!--!,##',11'$%!"#,!3"#+#!"!3,#"##4'$""!#!#!#$"#'.+#
+#"'#!#!#,3!#!%+#++#"
E&!3!"!1'!0"!1)"3!#$#!!1'!"!3,',$#!',+#"'#!@%"',$3$",!$%#!3!$%$$,#,'!!#!#',,'#"1$#/,#,#
6!$0'6*+*'&+2&0*:*0(#.
71%,#)'3,'$","#'"#$")"#$!1'!#."!1"%"'",#%",#)
51%,#)!3"/":+#!%'#!#!%""!'##4'$"!1"%"'"#$%
C1%,#)%$$/,'$"#!1%".!'$"#"#!%+#"1%"%'!$%"'"#$%
E),1$$/!31,##"'!"#!'##!3M0&1'!!)#$ 1#)##!
"/!
$3>$#3#"#!!33#!?
$"">#$#++$1+"''!#!!3,?
%#1>#,./#%#'?
!'/#"
"#$%&!
@)!3!1":+",1$$/!3"3#!','#$ #!4#$#"#$
:"'!H$
1"#-$!
,%$!$
$1#,:#-$
)#!(
$!$
-
8/8/2019 Ward 6 Case Study
9/57
-
8/8/2019 Ward 6 Case Study
10/57
-
8/8/2019 Ward 6 Case Study
11/57
!$)#/*!&!6"!!0+'.
H#+,+"',"3,/,',!/"$'$$#"'"#1",)!1'"#!'$$!,!#""/J,!,!#""/#$$$'$$"
%+1!+'#$-'$$'#$$#'$$J,!#'$$)1"'#!#""$'$$/,$'$$"+$#$4+"'!3'$$,#"'$$,!)
$#$%'##""$'$$/,$'$$"+$#$
$'$$
A1!'!+"#"$%1""%:%3!!$#$$'$$1,%,%#"#!'$##!!3,%$#'.!'$#"'"'$#!3!,$#"$"#$$%#!#!'#3$#!?
-$#&(!+2/'.
$%+,'%#!"+!
!'%!#'$!3+,#3'%
#/''/.
1"#3!13#.#"%'%1"!!#""/
+"'!"3$#%,"+!
!#$1#'"!'#3$#!
"$##!'!)$)!'#3$#!
-
8/8/2019 Ward 6 Case Study
12/57
-
8/8/2019 Ward 6 Case Study
13/57
-
8/8/2019 Ward 6 Case Study
14/57
-
8/8/2019 Ward 6 Case Study
15/57
-
8/8/2019 Ward 6 Case Study
16/57
-
8/8/2019 Ward 6 Case Study
17/57
-
8/8/2019 Ward 6 Case Study
18/57
-
8/8/2019 Ward 6 Case Study
19/57
-
8/8/2019 Ward 6 Case Study
20/57
-
8/8/2019 Ward 6 Case Study
21/57
#'+#!%#!+"1"!
,$)!##!:"#,,"5M%#"
$#+$#!,/1#!#.'#"1,/
',$"!H,##33"","/,',@%#"
$
0#"!#$#"!#$
3!
- #$4'#
- #$4+#!
- ,%+"!!4#
$$%+5
- #,#
4!#$1:%!,"!!"
4!#$"#'.!A$!3
1#'
4!"+!$!
,'./=$#2
0"+
"+$!#"%""',1$#"1"2!$%
""#3!""$+!!#!%+"'$'#!")!',:
"#%#'#!'#"#'##!##3,"
"$!3,"+$!#"%""',#
+!,"#:>+"!'1#""3#!,',
'#)%,$!3?"+,%##%
'")#$#,"3,,1',:
"#%
QK5EK76
:#!#!")#$,#,"#"+#',%
!!,$!3,'+,"!'#!3$
+#"#$$%$"#
#:?P3!/ XH$1"1"$+""N
F6K@6H3
7666X!'"#1!3C6''2CH
X5%C!$F6G"#',25H
X#1"F6G5"#',
X++$%#'$/#,&
X$!1$@63K##.@
3K+#+"#7+#+"#2MH,"3,
CE@0U!%&"',
@E@0X!'"#1!3E@''2CH#"!3
""/
X!%&""#
PC60X)P6''10$!/
76E@0X&'"#005F
X&'"#5P@#!,!'"#
@G)"%5,"
+/!"'$?>?>
F@6X$'!#-$>&1$'#!?E63K++#7
++#&+"
CC60X#"1"$#1!3,"3,7@
''#$!#/,/,7@''2CH
X&'"#005M&'"#5#
M6'+
X&'"#%5)"%5H!$C6
"#',
X5H#1"1C6"#',
E760X)#$1#!'#$#"# X!"!/
-
8/8/2019 Ward 6 Case Study
22/57
QK5PK76
"#%1,',")#$,"#"+#',%
!!,$!3,'#"!$,
!!$#"3,"!3+!
'+#"#)%/,,$"1$#.!!+5@5676,/+"3"!1,
+!!#
!&+(.*!&
-
8/8/2019 Ward 6 Case Study
23/57
0
!'"#J#%"$1"!1'!
0#!,##!!'"#+"'!1,
$'+!!13,11,!1'!
"3,#%,!1$##!1,
$!3
!'"##%"$1"#'
#'"#$!1'!#!#'!1$##!
&'"##%!'#,$%'
#!#'!#"%M0&1'!'%#!,
%#%!3!3,:%3!!
&'"#H#%!'#,$%'
#!#
&'"#H#%!'#,$%'
#!#
!'"##!''"/,!,'!!',"!'#!+"$!3
""#'"#$!1'!,,#++!
6664@66
6664@66
G
667M 6665 666E
6664766
6664566
G
7ME 67CF 6E5
E@64@Q6
CQC CPQ C5E
7C@47P@
QEE 76E FQ@
E764@C6 C6E C6M 5ME
; F6647661 A> F6M F7@
5M64CE6
+3
5MC 5PE 5PM
C764CM6
C5P CE6 CCQ
77M47F6
G
7MM 7FM 7F@
7E64EE6 @75 CE6 CCM
; 6664QQQ
1
MEQ M5M ME@
-
8/8/2019 Ward 6 Case Study
24/57
/,!,$%+,'%13,!3#$#"
:,#,)"%1,'!!
$/'$*#!!0#.
$3##!#$%)#$#"+"#"%
1!'!#!+")##"1""!!3
#'4##$#!'+"#"%"!#$#!
'#")#'$#"%1!'!#"!3"#!
""#!#!!"#$#'4##$#!'
,"1""+"#"%"#$'""#%
'##!"#$$3#1!!3
QK5EK76P560
+CPFTK#:$$#
HFF
+$'#!
!'+!##$''/,"
,#!#2#:%3!#!
&'"#5!#''"!'#"!#
$)$
&'"##5#%!'#!"#$3#
:',#!3
!$)#$#&-' #/*'&/@.
:#('.
% PC@4PE@ PC65
% C5EFH3 C56
FC76FH37M7
565E$K7MM
* 575@$KQP
4CC>R?75
$K
QQ
Q@6QQG F@
& QK5@K76
-
8/8/2019 Ward 6 Case Study
25/57
QK5@K76
F77
+CFQTK#:$$#
HM5
!$)#$#&-' #/*'&/@.
:#('.% PC@4PE@ P5@M
% C5EFH3 5FC
FC76FH37FM
565E$K7CF
* 575@$K77F
4CC>R?75
$K
47CE
Q@6QQ QQ5
+$'#!
0#"#$$%+!##$'#'/,
",#!#2#:%3!#!
3#))#$!'#'"
'#"!#$)$
&'"5!#''"!'#"!#
$)$
QK5@K76
@5@0
+CFMTK#:$$#
H@E !$)#$#&-' #/*'&/@.:#('.
% PC@4PE@ P5Q6
% C5EFH3 57F
FC76FH35E5
565E$K75@
* 575@$KQQ
4CC>R?75 47@7
$K
-
8/8/2019 Ward 6 Case Study
26/57
$K
Q@6QQG QQF
+$'#!
0#"#$$%'+!##$'#'/,
",#!#2#:%3!#!
&'"5!'#'"!'#"!#
$)$
QK5MK76
775@0
+CPMTK#:$$#
HMQ
!$)#$#&-' #/*'&/@.:#('.
% PC@4PE@ P5CC
% C5EFH3 @P6
FC76FH3756
565E$K57C
* 575@$K55Q
4CC>R?75
$K
4CP
Q@6QQG QPQ
!'+!#"+"#"%#'/,"
,#!#2#:%3!#!
3#))#$!'#'"
'#"!#$)$
QK5PK76
@56
+CPCTK#:$$#
HP5
!$)#$#&-' #/*'&/@.:#('.
% PC@4PE@ PE7C% C5EFH3 CQ@
FC 76F H3 QE M
-
8/8/2019 Ward 6 Case Study
27/57
FC76FH3QEM
565E$K5@7
* 575@$K5CP
4CC>R?75
$K
6P
Q@6QQG QF
$$%'+!##$'#$.#$/,
#2#:%3!#!
QK5FK76
Q6@
+CPF
HM@
!$)#$#&-' #/*'&/@.:#('.
% PC@4PE@ PC@6
% C5EFH3 E66
FC76FH3@P7
565E$K57M
* 575@$K56F 4CC>R?75
$K
4C5
Q@6QQG FQ
"#,%+:#
'$()'+/$!2/'.'./
0"+,##",'!'!"#!1
$'"$%#"!1",,#3!#!
#!#3!1"!#$!'"!#'4#/#"
#$#!'#!#!%,"'!!
T
)#$
QK5@K
76
QK5FK76 QKC6K7
6
'#$'
!-
7M4
@7M
E@M3
G
EC3
G
3G
-
8/8/2019 Ward 6 Case Study
28/57
3G
+# E64
@M
$K
C5
$K
H
E@
$K
CQ
$KH
7CM4
7E5$K
7EE
$K
7CE
$KH
7CQ
$K
+$'#!H%+.#$##!H%+'#$'##"
%+1#!#'4#'#$#!'
76K67K76
&/*)*+$!"*#(.+'%/*"**/2'./*&-
0"++"',%%''"1#$"1
#!',"#+%
+'!"#',#$+"#
"3#!$#I
!3"#1$""#+)'''
+)
&
&
4
0!'$$
!
0!'$$
!
763 K
4
$"2
!$!
+"1$
:#'!
@3 K
:1$
:#'!
@3 K
4
!3$%'
-
8/8/2019 Ward 6 Case Study
29/57
!#
%'!
763 K
4
#'"$
-,"
%'!
@3 K
"%,"
%'!
7@3 K
4,"
,$"#+,!
'$
C63 K
$!#
%'!
K
D 75@K
5CP@
3
K
"#'%
'$!
C63 K
#!'
%'!
C63 K
$!-$
K
+$'#!,
-
8/8/2019 Ward 6 Case Study
30/57
',$#!K",#!"#-!
#",#1#$$!,"#!3/,"+'1'
'"#$"#!'',#!>3#4
$#'##?#"$.$%#!'$!'#$11'#'%1,
#3!#3#!,$#,#!!"$#$%
,/!!"#!,#'"#,#'#,!1'!"#!0!'$$!
-,"%'!","%'!#!$!#%'!
!!0(/($'
0"+
$'$"#!!1%!3,+'1'%+1
"3#!'#!3##'"#$"1!3#$$"#!1'!#!/,!'!/,#!'
!)%'#!+")!1"#!,
+,%'#!#/,',#!'/".,
#3#!,#+#"'$#"+'1#'"#
76K7K76
>R?,'$$!4#!#+,%$'''#"
>R?#!##$'#!
!!02%*&-
0"+#.'"#!,##+"!/,!
#"#!1!/$$"')$,##',>
'+#$/,?,/!
$"+HR
'$*%,'$#!!0)'#$C#)*/*!&
0"+'"'+':#!#!1##!
+"+,"#$$#"#%1$!)#$#!3
$""
$%!"'%'!"',"'
,"$#!+.$'%/,,
+"!'1#'"'%'#!#$
'"'%#'#!,'%',-'%
#""+1"#!+,"-%#"
!'$#L#"!
-
8/8/2019 Ward 6 Case Study
31/57
-
8/8/2019 Ward 6 Case Study
32/57
-
8/8/2019 Ward 6 Case Study
33/57
-
8/8/2019 Ward 6 Case Study
34/57
-
8/8/2019 Ward 6 Case Study
35/57
-
8/8/2019 Ward 6 Case Study
36/57
-
8/8/2019 Ward 6 Case Study
37/57
-
8/8/2019 Ward 6 Case Study
38/57
PATHOPYSIOLOGY
HOST AGENT
-
8/8/2019 Ward 6 Case Study
39/57
HOST AGENT
ENVIRONMENT
4@!,$ 4#+,%$'''#"
,,$
4#$
1$"V'$!3
4H,#&H0 :+"'##)#3!
4M0&1'!'%
entry of bacteria to upper respiratory tract
X-linked gene deficiency through inhalation, aspiration or direct spread from infected sites
Defective G6PD gene Infection
^Susceptibility to hemolysis and infection subsequent inflammation occurs
Exposure to infections, severe stress, mucus secretion initiation of glottic and cough reflex nasopharyngeal defensesand foods (fava beans) (manifestation of productive cough and secretions)
oxidation of RBC effectiveness of defenses due to exhaustion of defense mechanisms
inability to generate NADPH entry of bacteria to LRT
Hemolytic Anemia tea-colored urine
drained Sept. 27,2010 Macrophages digest bacteria and Inflammation of alveolar epithelium and lung
disposal of destroyed RBC in the liver
present antigen to immune system Blockage in alveolar sac
A B C
A B C
-
8/8/2019 Ward 6 Case Study
40/57
A B C
Inc. production of bilirubin phagocyte migration to site of invasion Pooling of blood, mucus, and fluids in alveoli
Accumulation of bilirubin to diff. Destruction of bacteria and release of cytokines (auscultatory rales on both lung fields)
parts of the body and in the skin.
Bilirubin passes through Stimulates hypothalamus to body temperature
blood-brain barrier Vascular congestion alveolar edema
Fever
Subsequent Brain damage (Kernicterus)
Pulmonary Congestion
DEATH
Massive outpouring of leukocytes
accompanied by intra alveolar hemorrhage
Red Hepatization
erythrocytes neutrophils desquamated epithelial cells firbrin formation
Grey Hepatization
Blood clot formation
fibropurulent exudates RBC disintegration hemosiderin formation disrupts circulation to organs
B2
A1
-
8/8/2019 Ward 6 Case Study
41/57
A1 B2 C2
Resolution stage Systemic hypoxia pressure in the alveoli
Resorption and restoration multiple organ failure Destruction of alveolar epithelium pleural effusi
of pulmonary architecture
DEATH occlusion of bronchi and alveoli limits lung expa
Decrease of alveolar O2 tension impaired breath
Perfusion mismatch Inadequate oxyg
Venous blood enters underventilated areaand travel to the left side of the heart
poorly oxygenated
mixture of oxygenated and unoxygenated or poorly oxygenated blood
arterial hypoxemia hypercapnia
ischemia and cyanosis
Systemic Hypoxemia multiple o
-
8/8/2019 Ward 6 Case Study
42/57
!$0!&@.(&+/*!'#/,..'..)'&/
76#%0+#!,##!!11)"/,,,3,+"#"1CFT#''+#!%+"')'3,#!",!"",#
7#%0+#!,#"'""!'1'3,#!1)"/,,,3,+"#"1CFSK#:$$#/,)"%+!#
H"1#$#$#!'$H%+"!!,#$$#!M0&1'!'%
,"$+#!"!.$#)''!#!!3@$+"+/,+"#"%"$1
,"#!!3!3'!"'!1","+#"1,""1
-
8/8/2019 Ward 6 Case Study
43/57
"+!$!'$#++!3,#!
##$1$#"!3!
0"!'1'$#"'"!!"#$'#)%##',',#!'#$)!$#"+"!'17@$%$$/'"!/,"#.1$!"#!
%+!'#',%+!'/,1MF'+3"!!3+"!'1+"#'$#)'$#"#!!"'#$""#'!2#$',:+#!!,%+""!#!!,$!31$,#","#,!
'"#'.$!,$!31$+"!'1",!',+"!!!"3,$!31$
0#$!#$
"#!31!!#2#'$"!3,'"#'$!
H##!'"%!"+!$#!>'$#++!31,#!,#.!3#!$!?
4!#$1:%!,"!!"
4!#$"#'.!A$!31#'
4!"+!$!
.!/#"',
%,#$1+!++"%$/,!+!!3%+#$+#$+"#$'!;!')#!#$1:3#-#!1$$/;'
#""+!$!'$#++!3,#!
##$1$#"!3!+"!'1'$#"'"!
,+"!'1'$#"'"!!"#$'#)%##',',#!'#$)!$#"+"!'176$,'.%$$/3"!'"!!"#!
,#!!3%+!'#',%+!'/,176E'+3"!!3+"!'1+"#'$#)'$#"#!!"'#$""#'!,#","#,!+"!'1'#"'"#'.$!,$!",!',+"!!!"3,$!31$
#"#'#!0"+,"#$"'$#!+#$!#$
#'.#!:"$"#!31!!#2#'$"!3,'"#'$!
"$3'!03!"#$$%!"+!)$#!
1$:>4?!''.1$:>4?0$#!#"1$:>4?#!."1$:'"#7RR+!!"1$:"#!#$")!3
-
8/8/2019 Ward 6 Case Study
44/57
$/'$*#!!0#.
-
8/8/2019 Ward 6 Case Study
45/57
!'+!##$'#'/,",#!#2#:%3!#!
QK5@F77
0#"#$$%'+!##$'#'/,",#!#2#:%3!#!
QK5@@5@0
0#"#$$%'+!##$'#'/,",#!#2#:%3!#!QK5M
!'+!#"+"#"%#'/,",#!#2#:%3!#!
QK5P
$$%'+!##$'#$.#$/,#2#:%3!#!
QK5F
"#H%+:#
'$()'+/$!2/'.'./
-
8/8/2019 Ward 6 Case Study
46/57
#"$#!!#$1H#!!#%#!0,%$3%F,!+E66
$#'.*%'#$'#$4"3'#$"!3M,+75ME+P@
0,$++!$C7)"C5676
#5665
#!#$"#"%1'!566F
'#!!$!'#$#0,$%")'!)"%1",#"$!#")'!$!566F
"""#I,"#"&>+"C5676?./!!'%'$+#1"3"%")!'"@56761",+KK///"3"%!'%'$+#'K4K,4D4
)0,,>*!75566Q?")!'"@56761",+KK!"!3'"'K!"!34!4")/"K3M+41'!'%K
&/,!)!&>)"566Q-!)0,,!(H#$,1","!#!")!'"@56761",+KK.,#$,"3K+#"!K3!"#$K#',K3M+
'0*+#/*!&.
-
8/8/2019 Ward 6 Case Study
47/57
!'"#3#!"#.,+#!#,"3,"O#/#"1#)"11''!"#!'#!O'!"#!
#)#.'#!,"3,,1$$'"1#!"#!
&:*$!&)'&/
!'"#3.+!)"!!'$#!/$$4)!$#O'$"1"
!'"#3.+,!3!""#)!;"
!"'!$+#!#%!"%+$#'
!"'$,+#!#%#/#%1"."
!"'#),#)$%'!3#"#$.#".+$#'
$'#/)'&/
(+#$$11$$/4+#++!!)!,3,,+#!1$","3,$$,+"!'1!1'!A+"#!,#),'"!"+A+"3"
!'"#3'+$%/,#$$"#!#"""
'#/,'#+,*&-.
!"'#$/#%,#)+#!!+"+",%3!O33"!3
!"'.++#!#/#%1"#$$"3!>:1"+$$!'?
!"'"$-,1!3$1"#!#1"
!"'$/#"/,!+"+#"!31"$.
".'$:#"'*-&.#&02)%/!).
!"'#.+#!,#)','.+11$$/!33!#!%+''"
M0&1'!'%
o 1)"
o '3,!3
o "."!
o !$#"3+$!
o #3
o 0#$$"
o #+,#""#o ,"!1"#,
o $$/.!'$">;#!'?
0!!#
4#$!#++
41$!3$$
4'$#%.!
4!##$1$#"!3
41#34!#$'!1!
4;!#!'$11!
4#!:%"#!!!
4#!#$+#!
-
8/8/2019 Ward 6 Case Study
48/57
*'/
!'"#3"#1,#%)"%5,""+"#%A#!
!"'"+,#%#1""#1!3
!"'1$$/,"'!'#"1$$%11"$#$.
!"'"$-,1!3$1"#!#1"
!'"#3+"+#",#$,%11"#$+'#$$%)3#$#!1"/,!,#%#"#
%*$*/(#*/2
!'"#3#.,+#!#!!#%O,$#%1$3#!
!'"#3#',+#!+"#%)"%#%#!+#"+"+")#$!',$+'#$$%$)"+',!%'?/,!',$3"/+
-
8/8/2019 Ward 6 Case Study
49/57
#"(/#)!7;'&/!*&8?&'"L++3,
#..*6*+#/*!&
-
8/8/2019 Ward 6 Case Study
50/57
'$!%'&')7'$!)#C8A>)-#.;0$*%3D,
#..*6*+#/*!&
-
8/8/2019 Ward 6 Case Study
51/57
#..*6*+#/*!&,3,?+"#!'$#"",#!##)!3$)#$)"!-%"#,"'#"#$%'"###$$"3'"#'!!'$!3#!#+,%$#:"'
+"!1'!
-
8/8/2019 Ward 6 Case Study
52/57
($.*&-!&.*0'$#/*!&.
-
8/8/2019 Ward 6 Case Study
53/57
-
8/8/2019 Ward 6 Case Study
54/57
-
8/8/2019 Ward 6 Case Study
55/57
-
8/8/2019 Ward 6 Case Study
56/57
C#+**&720!C8>)-;0$*%':'$2,!($.#6/'$&'-#/*:'.B*&/'./
#..*6*+#/*!&
-
8/8/2019 Ward 6 Case Study
57/57
'+,#&*.)!6+/*!&!,'$$/#$$%!,%!!3!""1,+!'$$!4!!3+"!/,',!"!!,,1!#$"#!++#!+1++3$%'#!%!
/#$$#'"#)!#$$%$%/!3!3!3#')%1'$$/#$$#$%'!-%>#$%!#!"!,%"$#?/,$'$$/#$$#$%#""
&0*+#/*!&.