jacky
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Chapter 12
Health Teachings
Primary
1. Avoid over crowded environment.
2. Encourage patient to avoid smoking.
3. Encourage patient to eat nutritious foods.
4. Tell patient to cover nose and mouth when coughing or sneezing.
5. Stress out proper hand washing techniques to reduce risk of contamination.
6. Tell patient to maintain proper hygiene.
Secondary
1. Tell to have vaccination against flu influenza and pneumonia.
2. Encourage to have regular oxygen supplementation and pulmonary
rehabilitation.
3. Have surgical removal of the portion of the affected area.
Tertiary
1. Tell to continue medication as ordered by the physician.
2. Educate the patient about the signs and symptoms of PTB.
3. Emphasize the importance of regular follow-up examinations.
4. Instruct patient to report immediately the side effects of the medicines taken
to the physician.
Chapter 13
Discharge Plan
Medications
• Inform the patient, as well as the significant other, to take the prescribed drugs as ordered.
• Tell the patient as well as the significant other, not to skip a drug intend for a particular time of the day to maintain its therapeutic level.
• Educate about the adverse effects of drug for them to know when to seek medical interventions.
Exercise
• Encourage patient to go outside of their house early in the morning to breathe some fresh air and expose her to ample amounts of sunlight. If cannot tolerate independent ambulation, ask for help.
• Teach patient to do purse-lip breathing exercise.
• Tell patient, as well as the significant other to avoid the patient from doing strenuous activities.
Treatment
• Inform the significant other about the schedule of her medications so that the patient will not forget to take her medications on a particular time.
• Encourage patient to have adequate rest and sleep.
• Encourage to comply strictly with the treatment regimen.
• Discuss the importance of having continuity of care after hospitalization based on the condition of the patient.
Hygiene
• Advice the patient to perform hand washing frequently.
• Tell to have good personal hygiene by taking a bath daily and regular changing of clothes.
• Tell patient to cover nose and mouth when coughing.
• Encourage to have a regular bowel movement daily.
Out-patient
• Encourage to comply with follow-up check-ups schedule after discharge from the hospital.
• Encourage to carry out any pending laboratory and diagnostic exams after discharge. If any.
Diet
• Encourage patient to have adequate fluid intake if tolerated.
• If on bed rest, instruct the significant other to position the patient in moderate high back rest.
• Encourage patient to have 3 basic food groups present per meal to supply the body’s demand for essential nutrients.
• Encourage to take vitamin/food supplements to maintain the body’s nutrients at a normal level.
CHAPTER 14
Prognosis
Actual
Criteria
Good
Fair
Poor
Justification
Duration
/
10 months PTA patient was diagnosed with PTB, went to a 6 months antibiotic therapy but was unsuccessful. PT suffered from productive cough with shortness of breath 2 days prior to admission; it was rated poor since the 6 months therapeutic regimen was unsuccessful.
Onset of Illness
/
Rated poor due to the fact that he once had an antibiotic therapy which eventually failed.
Compliance to Medication
/
The patient shows the willingness to comply with prescribed medication as needed for faster recovery but the family does have lack of funds
Family Support
/
The patient’s family shows their good support and concern to the patient.
Environment
/
This criterion was rated fair since the patient’s place is fairly accessible to health care workers and volunteers
Precipitating Factors
/
The patient had a past history of smoking and a present age of 62. Other than that, the patient has had recurring coughs and do have past history of PTB.
Measure General Prognosis Computation
1) Poor 1 1 x 3 = 3
2) Fair 2 2 x 2 = 4
3) Good 3 3 x 1 = 3
Total: 10/ 6 = 1.6
Interpretation Scale
Poor – 1.0 to 1.5
Fair – 1.6 to 2.3
Good – 2.4 to 3.0
Base on our assessment and justifications, we were able to come up with a fair prognosis. Sorting out the criteria, duration of illness is rated poor; onset of illness was rated poor; compliance to medication was good; family support was fair, environment was rated fair and precipitating factors was rated poor.
labs
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Laboratory Results
ABG Result
Result
Normal Value
Significance
pH
7.497 H
7.35-7.45 mmHg
Indicates if patient’s blood is alkalemic or acidotic
pCO2
39.8
35-45 mmHg
Indicates hyperventilation or underventialation which can contribute to the blood’s acidit
pO2
77.6
80-100 mmHg
Indicates wheter the patien is respiring properly or is hypoxemic
HCO3
30.1
22.0-27.0 mmoL/L
Indicates wheter a metabolic problem is present
BE (ecf)
6.9
(-2)-(-12) mmoL/L
The base excess is used for the assessment of the metabolic component of acid-base disorders, and indicates whether the patient has metabolic acidosis or metabolic alkalosis; a negative base excess indicates that the patient has metabolic acidosis, a positive base excess indicates that the patient has metabolic alkalosis
O2 sat
96.9
80-100 %
This is the sum of oxygen dissolved in plasma and chemically bound to hemoglobin
Ct CO2
31.4 H
23-30
Indicates the amount of CO2 in the blood
Clinical Microscopy - Urinalysis
A. Physical examination
color- dark yellow
appearance- slightly cloudy
reaction- 6.0
specific gravity- 1.025
B. Chemical examination
albumin- negative
sugar- negative
C. Microscopic examination
epithelial cells
pus cells- 1-2/hpf
RBC- 0.1/hpf
Sputum Examination
November 22, 2010
Specimen
1
2
3
Visual appearance
Blood-stained
Blood-stained
Blood-stained
Reading
0
0
0
Lab Dx
Negative
Negative
Negative
Impression:
Presence of fungus
November 22, 2010
Hematology test
CbC + Plt
Result
Unit
Reference Ranges
Significance
Hemoglobin
L 117.0
g/L
135-175
The oxygen-carrying pigment in the blood, the predominant protein in the red blood cells
Hematocrit
L 0.34
0.40-52
Measures the volume of RBC over whole blood
RBC count
4.21
*107 6/uL
4.20-6.10
A count of the actual number of red blood cells per volume of blood
WBC count
H 18.25
*107 3/uL
5.0-10.0
Determines the number of cells that protects the body from the diseases agents and other foreign substances in the bloodstream
Differential count
Neutrophil
H 77
55-75
Determines presence of bacterial infection or presence of aplastic anemia
Lymphocytes
L 6
20-35
Determines presence sepsis; alteration may also result from medications (chemotherapy)
Monocytes
8
2-10
Identifies if infection is caused by harmful toxins, bacteria, parasites and viruses and detects chronic inflammatory disease
Eosinophil
H 9
1-8
Determines if the infection is caused by parasites or if an allergic reaction is present
Platelet count
206
x1073/uL
150-400
Determines the number of platelet that is essential for blood clotting
MCH
27.8
Pg
25.70-82-20
Reflects the average hemoglobin concentration within red blood cells
MCHC
34.4
g/dl
32.30-36.50
Measures the relative volume of hemoglobin in the average red blood cell-that is, what portion of each red blood cell is hemoglobin
MCV
80.8
Fl
79.00-92.20
MCV refers to the relative volume of each red blood cell or its average size, MCV helps determine the size oxygen-carrying capacity of individual red blood cells
November 18,2010
CBC
Result
Unit
Reference
Significance
WBC count
H 21.53
x1073/uL
5.0-10.0
Determines the number of cells that protects the body from the diseases agents and other foreign substances in the bloodstream
Hemoglobin
L 131.0
g/L
135-175
The oxygen-carrying pigment in the blood, the predominant protein in the red blood cells
Hematocrit
L 0.37
0.40-0.52
Measures the volume of RBC over whole blood
RBC count
4.57
x1076/uL
4.20-6.10
A count of the actual number of red blood cells per volume of blood
Differential Count
Neutrophil
H 76
55-75
Determines presence of bacterial infection or presence of aplastic anemia
Lymphocyte
L 9
20-35
Determines presence sepsis; alteration may also result from medications (chemotherapy)
Monocytes
7
2-10
Identifies if infection is caused by harmful toxins, bacteria, parasites and viruses and detects chronic inflammatory disease
Eosinophil
8
1-8
Determines if the infection is caused by parasites or if an allergic reaction is present
Platelet count
223
x1073/uL
150-400
Determines the number of platelet that is essential for blood clotting
MCV
80.5
Fl
79.00-92.20
MCV refers to the relative volume of each red blood cell or its average size, MCV helps determine the size oxygen-carrying capacity of individual red blood cells
MCH
28.7
Pg
25.70-32.30
Reflects the average hemoglobin concentration within red blood cells
MCHC
35.6
g/dl
32.30-36.50
Measures the relative volume of hemoglobin in the average red blood cell-that is, what portion of each red blood cell is hemoglobin
Chemistry
Result
Unit
Reference
Significance
Potassium
L 2.94
Mmol/L
3.5-5.5 (11/25/10)
Major cation (positive ion) inside animal cells, and it is thus important in maintaining fluid and electrolyte balance in the body
Potassium
L 2.70
Mmol/L
3.5-5.5 (11/22/10)
Major cation (positive ion) inside animal cells, and it is thus important in maintaining fluid and electrolyte balance in the body
November 18,2010
Blood Type (ABO +Rh)
Blood Type A
Blood Type Rh Positive
Chemistry
Potassium
L .29
Mmol/L
3.5-5.5
Major cation (positive ion) inside animal cells, and it is thus important in maintaining fluid and electrolyte balance in the body
Sodium
136.30
Mmol/L
136.0-155.0
Necessary for regulation of blood and body fluids, transmission of nerve impulses, heart activity, and certain metabolic functions
Creatinine
88.10
Umol/L
53-115.-00
Levels in blood and urine may be used to calculate the creatinine clearance (CrCl), which reflects the glomerular filtration rate (GFR)
nsg theory
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CHAPTER 1
Introduction
“Breathe. Let go. And remind yourself that this very moment is the only one you know you have for sure”
-Oprah Winfrey
By the time a man was conceived, he learned to inhale and exhale innately before anyone could ever teach him how to.
Truly breathing is a fundamental drive to sustain life. It is as necessary as any function of the body like the brain and the heart do. In fact, without the air one breathes through the organs called lungs, neither of the other organs could do its job.
However, what if instead of perpetuating life, breathing then becomes the reason for life to curtail? Would you still care to breathe?
With every progress towards industrialization the environment responds by regressing. As it is so evident nowadays, the rise of infrastructures like factories and the development of technology like the creation of vehicles have started the fall of man. Industrialization has become one of the media that disposes the people of a developing country in acquiring certain types of diseases.
During the group’s rotation at the Southern Philippines Medical Center (SPMC), they came across with this elderly patient aliased as “Mr. Firefly.” He was admitted with complaints of cough for more than two months and was put in Room 12 together with other patients.
This case was taken by the group not because it’s a rare case- for it is not. This case was taken because the group wants to extend their knowledge in dealing with cases which needs precaution. Also, the group wants to dig deeper about how cases like this is managed and how caare should be rendered to promote health as best as possible.
CHAPTER 9
NURSING THEORY
Environmental Theory by Florence Nightingale
“Environmental Theory” stresses the nurse’s role to place the client in the best position for nature to act upon him, thus encouraging healing.
Nightingale viewed the manipulation of the physical environment as a major component of nursing care. She identified ventilation and warmth, light, noise, variety, bed and bedding, cleanliness of the rooms and walls, and nutrition as major areas of the environment the nurse could control. When one or more aspects of the environment are out of balance, the client must use increased energy to counter the environmental stress. These stresses drain the client of energy needed for healing. These aspects of physical environment are also influenced by the social and psychological environment of the individual.
I as a student nurse and part of the medical field, has the role of providing nursing care with the help of the institutions and personnel involve to cure the illness and lower down the factors causing the patient’s disease with the help of Nightingale’s Environmental Theory.
Science of Unitary Human Beings by Martha Rogers
According To Martha Rogers, the human individual is constantly interacting with the environment in an open system. It affects each other interpreted in an energy field. When there is a change in the environment the individual should adapt to the changes to maintain balance and homeostasis. The environment consists of many things that might influence to the human beings and these matters are known to humans. Helices and resonance should be in harmony with the matters affecting the open system such as environment’s manner and human’s health.
In the case of our patient, she got her illness from the environment where she constantly interacts with. Pulmonary tuberculosis cases can be found in their place. The community was already aware of the rAisk that they have the disease if precautionary measures are failed to be done.
Community services should be strengthened particularly in disseminating information about pulmonary tuberculosis and regular community assessment to know what the community needs. The Department of Health is providing free medications for parasitic infections particularly in areas where cases are common. The patient, her family and the community might have failed in keeping and identifying the patient’s health problem that led to her present situation now.
The theory has taught us that we need to be aware with our environment because human beings and the environment is an open system which continually affects each other and health will be affected. Nursing care is crucial in keeping the harmony of the system.
