INSTITUTE OF NURSING

SY 2008-2009

CASE

PRESENTATION
SUBMITTED BY:

DIZON, Myline L.
LOPEZ, Ma. Cristina V.
NEUDA, Regine Paula M.
ORDIALES, Henrico Paulo M.
PANTALEON, John David C.
PAZA, Christopher George R.

BSN129/GROUP116-A

SUBMITTED TO:

PROFESSOR JOSIE ROSS SULIT,RN,MAN

 I. INTRODUCTION

PNEUMONIA
This is a case of a 59 year old man who was initially diagnosed with Community
Acquired Pneumonia.

Pneumonia is an inflammation or infection of the lungs that causes them to function

abnormally. Pneumonia can be classified as typical or atypical, although the clinical
presentations are often similar. Several symptoms commonly present in patients with pneumonia.

Community-acquired pneumonia (CAP) is defined as pneumonia not acquired in a hospital or

a long-term care facility. The most commonly identified pathogens are Streptococcus
pneumoniae, Haemophilus influenzae, and atypical organisms (ie, Chlamydia
pneumoniae,Mycoplasma pneumoniae, Legionella sp). Symptoms and signs are fever,
cough, pleuritic chest pain, dyspnea, tachypnea, and tachycardia. Diagnosis is based on clinical
presentation and chest x-ray. Treatment is with empirically chosen antibiotics. Prognosis is
excellent for relatively young or healthy patients, but many pneumonias, especially when caused
by S. pneumoniae or influenza virus, are fatal in older, sicker patients.

Source: The 2004 Philippine Health Statistics

* Percent share from total deaths, all causes, Philippines

** External Causes of Mortality

Last Update: February 11, 2008

DIABETES MILLETUS

Diabetes mellitus is a condition in which the pancreas no longer produces enough

insulin or cells stop responding to the insulin that is produced, so that glucose in the
blood cannot be absorbed into the cells of the body. Symptoms include frequent
urination, lethargy, excessive thirst, and hunger. The treatment includes changes in
diet, oral medications, and in some cases, daily injections of insulin.

Types

The most common form of diabetes is Type II, It is sometimes called age-onset or
adult-onset diabetes, and this form of diabetes occurs most often in people who are
overweight and who do not exercise. Type II is considered a milder form of diabetes
because of its slow onset (sometimes developing over the course of several years)
and because it usually can be controlled with diet and oral medication. The
consequences of uncontrolled and untreated Type II diabetes, however, are the just
as serious as those for Type I. This form is also called noninsulin-dependent
diabetes, a term that is somewhat misleading. Many people with Type II diabetes
can control the condition with diet and oral medications, however, insulin injections
are sometimes necessary if treatment with diet and oral medication is not working.

Causes / Risk Factors

The causes of diabetes mellitus are unclear; however, there seem to be both
hereditary (genetic factors passed on in families) and environmental factors
involved. Research has shown that some people who develop diabetes have
common genetic markers. In Type I diabetes, the immune system, the body’s
defense system against infection, is believed to be triggered by a virus or another
microorganism that destroys cells in the pancreas that produce insulin. In Type II
diabetes, age, obesity, and family history of diabetes play a role.

In Type II diabetes, the pancreas may produce enough insulin, however, cells have
become resistant to the insulin produced and it may not work as effectively.
Symptoms of Type II diabetes can begin so gradually that a person may not know
that he or she has it. Early signs are lethargy, extreme thirst, and frequent
urination. Other symptoms may include sudden weight loss, slow wound healing,
urinary tract infections, gum disease, or blurred vision. It is not unusual for Type II
diabetes to be detected while a patient is seeing a doctor about another health
concern that is actually being caused by the yet undiagnosed diabetes.
Individuals who are at high risk of developing Type II diabetes mellitus include
people who:

• are obese (more than 20% above their ideal body weight)
• have a relative with diabetes mellitus
• belong to a high-risk ethnic population (African-American, Native American,
Hispanic, or Native Hawaiian)
• have been diagnosed with gestational diabetes or have delivered a baby
weighing more than 9 lbs (4 kg)
• have high blood pressure (140/90 mmHg or above)
• have a high density lipoprotein cholesterol level less than or equal to 35
mg/dL and/or a triglyceride level greater than or equal to 250 mg/dL
• have had impaired glucose tolerance or impaired fasting glucose on previous
testing

Epidemiology

MORTALITY: TEN LEADING CAUSES BY SEX

Number, Rate/100,000 Population and Percent Distribution

Philippines, 2004
Source: The 2004 Philippine Health Statistics

* Percent share from total deaths, all causes, Philippines

** External Causes of Mortality

Last Update: February 11, 2008

II. GENERAL OBJECTIVE

The main objective of the group in conducting this case study is to be able
to evaluate and have a firm background on the health condition of the
patient and his needs associated to Pneumonia and Diabetes Mellitus so that
proper planning, management and intervention will be given to meet basic
needs, alleviate sufferings and prevent complications.

III. SPECIFIC OBJECTIVE

In order to meet the main objective, the group has:
• To establish rapport;
• To set our goals that will guide us through the course of the study;
• To have a background on lung cancer statistics as an introductory of
the case study;
• To be able to have a clear picture of the patient’s family background
and health history;
• To define the patient’s complete diagnosis through different sources
and references;
• To have a background on the effects of the condition on the patients
anatomy and physiology;
• To be able to establish a thorough systemic pathophysiology as the
foundation of the origin of the disease;
 • To evaluate the doctor’s order to promote health and prevent further
complications;
• To analyze recommended drugs taken by the patient through a precise
drug study;
• To formulate realistic nursing care plans;
• To establish discharge plan in promoting patient’s wellness;
• To present recommendations for patient’s fast recovery, continuity of
care and holistic self

CHAPTER I: ASSESSMENT
A. NURSING HISTORY
1. BIOGRAPHIC DATA
NAME:
AGE:
BIRTHDATE:
SEX:
ADDRESS:
ADMITTED:
TIME ADMITTED:
DATE OF DELIVERY:

2. CHIEF COMPLAINT
3. HISTORY OF PRESENT ILLNESS
4. PAST MEDICAL HISTORY
5. FAMILY HEALTH HISTORY
 6. SOCIAL HISTORY
7. REVIEW OF SYSTEM (GORDON’S FUNCTIONAL
PATTERN)
HEALTH PERCEPTION – HEALTH MANAGEMENT
According to Mr. AK health is so much important nowadays especially
he’s getting old. For him if rated 1-10 that 1 will be the worst health and 10
will be the healthier, he will rate his health as 5 because of his admission to
the hospital. He also added, but if for pain I will rate myself as 10 because I
don’t experience any pain in my body as for now. For him healthy is no
sickness as he verbalized “Yung meaning ng malusog sakin eh yung walang
sakit at hindi laging na’oospital.

He makes sure that he have routine checkups to his doctor 1x month,

and as his doctor gave him some medicine and some restrictions for food he
always follow his doctors advise to become him a healthy person. And for his
dentist he goes 3x a year to makes his teeth strong and healthy.

The client is an active smoker before when he was still at the age of
15-27y/o, he usually consume 5-8 sticks a day during that time. The client
says that he knows the bad effects of smoking in his body that’s why he
stops it. The client also drinks occasionally but with a moderate drink every
time he drinks alcohol.

According to the client their house is well ventilated as he verbalized

“Yung bahay namin my atik kaya lumalabas yung mainit na singaw ng amin
bahay. Yung atik yun yung maliit na butas sa kisame. Tapos my mga
dalawang bintana na my screen din ang aming mga kwarto. Kaya minsan
kahit nde kami mg’aircon. But their house is near with his work which is a
mechanic who fix cars and jeepneys that’s why sometimes the smoke is
going inside their house. The client also mentioned that there are some rats,
cockroaches and flies in their house and they tried to kill this by using trap
paper. Their water comes from NAWASA while the garbage collector comes
to their house 2x a week.

ANALYSIS:

At his age, it is possibly that the manifestations of genetic diseases can

be acquired. The strongest predictors positively related to health were
internal locus of control and health habits. The strongest predictors inversely
related to health were powerful, genetic predisposition, and less-than-high
school education. Although some factors not readily modifiable for middle-
aged adults were found to contribute to health status, modifiable attitudinal
and behavioral variables were also found to be important: even in cases with
high genetic predisposition to disease, good health habits appeared to make
a significant difference. (eric.ed.gov)

INTERPRETATION:

A middle adult is naturally going under general check up since this is

the stage that manifestations of symptoms from genetic diseases may occur.
For Mr. AK it’s good for him that he’s having general checkups.

NUTRITIONAL – METABOLIC PATTERN

According to the client the right nutrition is attained by eating a
proper diet and the right choice of food. He doesn’t have any dislikes on
food, he likes almost all of the foods served to him, and his only problem is
that he has food restriction that’s why he couldn’t eat his favorite foods.
Usually his wife is the one preparing the food, her wife usually prepare
dishes sinigang fish or pork, and fried foods, but he doesn’t eat a lot of fried
food sometimes he ask her wife to steam the fish instead of frying it. He
usually eats with his family, but sometimes they are not eating on the same
time because of his work. He had an allergy to a fish 15 years ago. He has
maintenance of drugs for his cholesterol and hypertension. He doesn’t have
any weight loss or gain in the past month. The client has a good appetite,
but when he is not feeling well his appetite is sometimes low. The client
knows that he needs to consume 6-8 glasses of water a day but he doesn’t
usually consume 8 glasses of water a day. He consults to a dentist trice a
year and every time that his tooth aches. He brushes his teeth three times a
day because of the stains retained when he was smoking.
January 19, 2010 January 20, 2010 January 21, 2010
BREAKFAST: BREAKFAST: BREAKFAST:
Adobong Manok Adobong pusit 1 scrambled egg
1 ½ cup rice 2 cups rice 2 pcs. of tuyo
2 (420ml) glasses of water 3 glasses of water 2 cups of rice

LUNCH: LUNCH: LUNCH:

Sayoteng ginisa Adobong pusit Daing na bangus
2 cups of rice 2 cups of rice 2 cups of rice
2 glasses of water 1 glass of water 3 glasses of water

MERYENDA: MERYENDA: MERYENDA:

5 pcs. of macaroons 3 pcs. of nilagang saging 6 pcs. of oatmeal cookies
1 pc. of apple 1 glass of pineapple juice 1 glass of pineapple juice
1 glass of water 1 glass of water

DINNER: DINNER: DINNER:

Sayoteng ginisa Nilagang baboy Adobong posit
2 cups of rice 2 cups of rice 1 ½ cup of rice
3 glasses of water 3 glasses of water 3 glasses of water
1 glass of pineapple juice

ANALYSIS:

Middle adulthood experience weight gain due to slowed metabolism. Increase

fruits, vegetables, fiber and water. Exercise does many things that dieting alone
cannot. If you just reduce your calorie intake your body is going to think it is
starving and slow down your already decreasing metabolism.

Decrease high calorie foods with no low nutritional value. Cookies and chips
are fine in moderation, but can't eat them all day long. After the high caloric
demands of a growing teenager and before aging brings on a gradual decline in the
normal physiologic functions is what like to be called as middle adulthood. This
should be a time to relax about eating. (Nutrition during Middle Adulthood
http://www.suite101.com/article.cfm/clinical_nutrition/65112#ixzz0cUVEpKTi)

INTERPRETATION:

The client weight is normal. His diet is fine but he has some food
restrictions to food. The client also is wealthy in eating of vegetables which
is good. Also, the client also has the condition of eating a balanced diet to
restore and maintain his proper health.

ELIMINATION PATTERN
 Client usually defecate once a day every morning he verbalized
“Depende sa kung gaano kadami ang kinain ko sa kung gaano kadalas akong
dumudumi”. The client experienced constipation once when he eats in a
turo-turo when he experienced constipation he ate fiber rich foods like
papaya, and pears. Client urinates 5-7 times a day; his urine is usually light
yellow in color and has an aromatic odor. The client is sometimes disturbed
at night when he is sleeping because of the urge to urinate. The client
perspires when he is working.
ANALYSIS:

The frequency of defecation is highly individual, varying from several times

per day to 2 or 3 times per week. The amount of defecated also varies for person to
person. Feces are normally brown, chiefly due to the presence of stercobilin and
urobilin, which are derived from bilirubin. Noraml feces are made of about 75%
water and 25% solid materials. They are soft but formed. (Fundamentals of Nursing
8th edition Kozier and Erb’s, p.1325).

Although people’s patterns of urination are highly individual, most people

void about 5 to 6 times a day. People usually void when they first awaken in the
morning, before they go to bed and around mealtimes. (Fundamentals of Nursing 8th
edition Kozier and Erb’s, p.1290).

INTERPRETATION:

The client defecation is good. He usually defecates once a day every

morning. But sometimes experience constipation because of what he is eating.
When it comes to urination the client urinates 5-7 times a day which is normal.

ACTIVITY EXERCISE PATTERN

Client doesn’t have a routine exercise, but in his free time he does
some walking, jogging and stretching. Usually he is working fixing cars and
when he is not doing anything he sometimes swept the floor and clean their
house. Client verbalized “satisfied naman ako sa ginagawa ko, kasi
pagpinagpapawisan ako parang exercise na din yon”. The clients spent his
night watching the news. The client experienced stress when he remember
his situation and sometimes when he cannot fix the car he uttered
“naiisteress ako pag di ko nagagwa yung sasakyan lalo na kapag nagbigay
ako ng petsa na maaayos ko pero di ko pa rin naaayos.” He usually rest at
his rocking chair when he is tired.
ANALYSIS:

In general, regular exercise is essential for maintaining mental and physical

health. Having a regular exercise helps the blood to circulate properly and prevent
any kind of cardiovascular diseases. Having leisure activities are helpful to have a
good relationship with others.
(Fundamentals of Nursing 8th edition Kozier and Erb’s, p.1113).

INTERPRETATION:

The client activity doesn’t have a regular exercise but sometimes when in his
free time he do walking and jogging which is good to our body.

SLEEP - REST PATTERN

Client A.K. sleeps usually at 8pm and wakes up at 5am, so he sleeps for 8 hours
every night. He said, “Naiistorbo ako minsan sa gabi kasi kapag naiihi ako,
magigising ako.” He said that his problem during night hours is that he is always
turning left and right every now and then while sleeping. He watches news on TV
and that is his way of getting his sleep and according to him, “Madalas akong
antukin kapag nagbabasa”. He is taking a nap for every 20 minutes whenever he is
sleepy. A.K. has no problem in the environment during his sleep. He is comfortable
and feel refreshed when he wakes up.

ANALYSIS

When men and women enter middle age, slow-wave sleep continues to
diminish. Nighttime awakenings become more frequent and last longer. Waking
after about three hours of sleep is particularly common. During menopause, many
women experience hot flashes that can interrupt sleep and lead to chronic
insomnia. Obese people are more prone to nocturnal breathing problems, which
often start during middle age. Men and women, who are physically fit sleep more
soundly as they grow older, compared with their sedentary peers.
(http://www.aarp.org/health/conditions/articles/harvard__improving-sleep-a-guide-
to-a-good-night-s-rest_2.html)

INTERPRETATION

The client sleep pattern is normal since he sleeps 8 hours every night which
is a good range of sleep and also he takes a nap of 20-30 minutes. The activities he
usually do to get his sleep is also normal for middle adult. Turning while sleeping is
normal since its purpose is to feel comfortable during the person’s sleep.

COGNITIVE – PERCEPTUAL PATTERN

The client knows how to read and write. His hearing is impaired. “Minsan kailangan
malakas talaga ang boses ng kausap ko para marinig ko ng maayos.” He was
referred to a physician but never went. He also had a check-up on his eyes since he
has also problem with his eyes. He claimed that sometimes, he forgets something
and hard to remember about it. He verbalized, “Mabilis naman akong matuto.
Kapag tinuruan ako ng isang bagay matatandaan ko agad pero minsan
makakalimutin din ako.” He also has good sense of taste and smell.

ANALYSIS:

Declines are small and gradual from early to middle adulthood: noticeable in
mid forties. Hearing loss for high-pitched sounds (presbycusis). Men have twice loss
rate as women. Vision - Ability to focus declines. Loss of near vision (presbyopia).
Decline in visual acuity-sharpness of vision. Need more brightness.
(http://blue.utb.edu/ecantu/Psyc
%202314/Feldman3Notes/MiddleAdultPhysCogFeldman3Notes.htm)

INTERPRETATION

A.K. has normal taste and smell but his memory due to his age. His eyes are
also impaired but he wears glasses to enhance his eye perception. He is a health
conscious and knows how to take care of himself.

SELF – PERCEPTION – SELF – CONCEPT PATTERN

According to the patient he describes himself as a guy who doesn’t get
mad easily. As other thought he’s always mad of his loud voice he said that
he is so kind in spite of that. As he added “Gusto ko lagi akong nasa mood
yung masaya para okay ang lahat”. Sometimes when he’s not feeling good,
he always prays to God because for him when you are with God any
problems that you encounter can easily be solved. His goal in 5 years is to
have complete health and will not be admitted again in the hospital.

ANALYSIS:

A healthy self concept enables the person to find happiness in life and
to cope with life’s disappointment and changes. (Fundamentals of Nursing by
Kozier page 648)

INTERPRETATION:

As for the client it’s good that he always making sure that he is happy
is spite of all the problems in life that he encounters.
ROLE – RELATIONSHIP PATTERN
The client lived with his wife and their two children a total of four in the
house. The client verbalized “Maaalahanin ako sa mga anak ko lalo na pag
umuuwi sila ng gabi. He is the head of the family so when there are activities
in their house he is the one who decide in the family. Usually when he has
problem in their house God is the 1st person he talked to and next is his wife.
Mr. AK has no social group in their community. But he added “Kahit
naman hindi ako kasama sa sa mga social group na yan npapaglingkuran ko
naman ang mga kapitbahay ko. At kapag my alam akong politiko sa
barangay namin na gumagawa ng mali o walang pakyalam sa bayan namin
nagagalit ako, at sinusubukan kong kausapin.
ANALYSIS:

Throughout life people undergo numerous role changes. A role is a set

of expectations about how the person occupying one position behaves. Role
performance relates what a person in a particular role does to the behaviors
expected of that role. Each person usually has several roles, such as
husband, parent, brother, son, employee, friend, nurse and church member.
Some roles are assumed for only limited periods, such as client, student and
ill person. (Fundamentals of Nursing 8th edition Kozier and Erb’s, p.1113).

INTERPRETATION:

The role of the patient is to be a father. The patient as a father and the
head of the family makes sure that their problems will solved immediately.

SEXUALITY – REPRODUCTIVE PATTERN

The client doesn’t have any difficulty expressing himself as a man
especially being a husband and father to his family. He expresses his self as
he verbalized “Kelangan my paninindigan ka at prinsipyo sa buhay”. Every
time when his wife argued he always feels guilty. They are open to each
other and obviously love each other. When asked about family planning Mr.
AK verbalized “Matanda na kami nde na naming kayang mgkaanak pa, tama
na yung mga anak ko ngun.
ANALYSIS:

Gender identity is one’s self-image as a female or male. Gender

identity is the result of a long series of development events that may or may
not conform to one’s apparent biologic sex. Once gender identity is
established, it cannot be easily changed. . (Fundamentals of Nursing 8th
edition Kozier and Erb’s,)

INTERPRETATION:
 He doesn’t have any difficulty expressing himself as a man especially
being a husband and father to his family. He is a father who love his family
so much.

COPING – STRESS TOLERANCE PATTERN

The most stressful event that Mr. AK experience is his work because he
said being a mechanic is so hard, as he added “Kapag hindi ko pa natatapos
yung trabaho ko sa dahil sa kapaguran ko, wala pa akong kita, at wala din
akong mapapakain sa pamilya ko.” He said that he handles this by praying
to God and thinking of his family because he loves his family so much.

ANALYSIS:

Stress is a condition in which the person experiences change in the

normal balanced state. Coping is described as dealing with change,
successfully or unsuccessfully. Coping strategies vary among individuals and
are often related to the individual’s perception of the stressful event. Clients
frequently identify religious practices such as prayer as important strategies
for coping with illness. (Fundamentals of Nursing 8th edition Kozier and Erb’s,)

INTERPRETATION:

For Mr. AK stress for him is normal. For him just handle your stress
properly and you will overcome it.

VALUE – BELIEF PATTERN

For the client a healthy person is the one who doesn’t get sick as for
him “Health is wealth.” According to the client a person who said to be
healthy is all in his body are normal. As he added, a person becomes healthy
because he follows proper diet and exercise. Being a Christian with him is so
important because he is close to God. He always making sure that every
week he goes to church to hear the pastor’s preaching. Because he believes
that God is the only one who will understand and help him in the life that He
gave.
ANALYSIS:

Religion is an organized system of beliefs and practices. It offers a way

of spiritual expression that provides guidance for believers in responding to
life’s questions and challenges. Prayer is a spiritual practice; for many, it is
also a religious practice.

INTERPRETATION:
Mr.AK is so active to his Religion, he believes in God a lot. He always
pray to Him and ask guidance to his everyday life.
ACTIVITIES OF DAILY LIVING
ADL Before hospitalization
1. Nutrition The client is fond of eating
vegetables, pork and meat.
He also eats fruits and
believed that it is important
to have a balanced diet.
2. Elimination Defecate once in a day and
urinate 4 to 7 in a day
depending on the amount
of water that he drink in a
day and its color is pale
yellow.
3. Exercise His engage in a walking,
jogging and stretching
when he has free time. He
do his work (mechanic) as
an exercise.
4. Hygiene Take a bath once, oral care,
change clothes every day.
5. Substance Sometimes drink liquor.
Use
6. Sleep and Have a proper and
Rest continuous sleep
7. Sexual Client is not sexually active.
Activity
During hospitalization
Less than 2gm Sodium
diet was prescribed to
the patient.
The client urinate 7x a
day and has difficulty in
defecating since he was
hospitalized.
The client doesn’t have
the opportunity to walk,
jog and work anymore
since he was
hospitalized.
Doesn’t take a bath since
admitted to the hospital
but he make sure to wipe
his body with clean towel
and doesn’t change his
clothes every day.
Can’t drink liquor
anymore
Can still sleep properly
but not continuous
because of the nurse
who gives medicine.
Client is not sexually
active at all.
 B. PHYSICAL ASSESSMENT

GENERAL SURVEY

TEMPERATURE: 36 °C

PULSE RATE: 70 bpm

REPIRATORY RATE: 19 cpm

BLOOD PRESSURE: 130/70 mmHg

Interpretation/
Body Parts Normal Findings Actual Findings
Analysis
General Appearance

Relaxed, erect Client is relaxed, Interpretation:

posture; and erectly
Normal
Clients posture, coordinated sitting on the
gait, standing, movement bed
sitting and
walking Analysis:

The older adult overall

mobility commonly
slows, and posture
tends to stoop.
(fundamentals of
Nursing by Taylor,
p426)

Signs of No distress noted. (+) Distress Interpretation:

distress, in Normal
posture or (+) Facial
facial Grimace Analysis:
expression
Pain after surgery is
common. Pain after
surgery is also normal
and to be expected.
(www.emedicinehealth.
com)
Quantity of Understands, The client speaks Interpretation:
speech quality moderate pace, clearly, in a Abnormal
exhibits thoughts moderate voice.
 association.
Analysis:

A patient who is acutely

ill may not be able to
communicate
adequately if the pain is
severe or consciously is
altered in any way.
(Fundamentals of
Nursing by Taylor, page
240)
INTEGUMENTARY

Varies from light to Skin is tan brown Interpretation:

deep brown; from in color. normal
ruddy pink; from
yellow overtones Dry skin and has Analysis:
to olive. skin folds.
Skin color and With aging, the
epidermis thins and
uniformity
elastic fibers that
provide support to the
dermis degenerate and
lead to sagging folds.
The skin of the middle
adult becomes dry.
(Assessment &
Physical Examination
by Estes p.311)

Hair Interpretation:
Varies from dark Patches of Normal
Color black to pale grayish hair.
blonde based on Analysis:
the amount of Decreased melanin
melanin present. production decreases
the melanocytes at the
hair follicle and thus
leads to graying
(Assessment & Physical
Examination by Estes
p.311)

Skin Moisture Moist Moist Interpretation:

normal
 Analysis:
In middle adult, the
skin becomes drier.
(Fundamentals of
Nursing, page 420)

Musculoskeletal system

Muscle strength Equal strength on Not equal Interpretation:

each body side strength of
muscle. His Abnormal
Kozier et al. right hand is
Fundamentals of impaired. He
Nursing 5th ed. can’t move his
1998, Addison digitalis on his
Wesley Longman, right hand.
Inc. p.541

Hearing Diminished The client stated Interpretation:

hearing acuity that his hearing
ability weakens. Normal

Analysis:

It is normal at middle
adult to diminished
hearing acuity,
especially for high-
pitched sounds.

(Fundamentals of
Nursing by Taylor, page
420)

DIAGNOSTIC PROCEDURE

Laboratory/Diagnostic Procedures
ANATOMY AND PHYSIOLOGY

The normal respiratory system can be conveniently subdivided into an upper respiratory
tract (or conducting zone) and lower respiratory tract (respiratory zone), trachea and lungs.

Air moves through the body in the following order:

• Nostrils
• Nasal cavity
• Pharynx (naso-, oro-, laryngo-)
• Larynx (voice box)
• Trachea (wind pipe)
• Thoracic cavity (chest)
• Bronchi (right and left)
• Alveoli (site of gas exchange)

Physiology of the lungs:

Ventilation of the lungs is carried out by the muscles of respiration. Ventilation occurs under the control
of the autonomic nervous system from the part of the brain stem, the medulla oblongata and the pons.
This area of the brain forms the respiration regulatory center, a series of interconnected neurons within
the lower and middle brain stem which coordinate respiratory movements.The major function of the
respiratory system is gas exchange. As gas exchange occurs, the acid-base balance of the body is
maintained as part of homeostasis. If proper ventilation is not maintained two opposing conditions could
occur: 1) respiratory acidosis, a life threatening condition, and 2) respiratory alkalosis.Upon inhalation,
gas exchange occurs at the alveoli, the tiny sacs which are the basic functional component of the lungs.
The alveolar walls are extremely thin (approx. 0.2 micrometres), and are permeable to gases. The alveoli
are lined with pulmonary capillaries, the walls of which are also thin enough to permit gas exchange. All
gases diffuse from the alveolar air to the blood in the pulmonary capillaries, as carbon dioxide diffuses in
the opposite direction, from capillary blood to alveolar air. At this point, the pulmonary blood is oxygen-
rich, and the lungs are holding carbon dioxide. Exhalation follows, thereby ridding the body of the carbon
dioxide and completing the cycle of respiration. In an average resting adult, the lungs take up about
250ml of oxygen every minute while excreting about 200ml of carbon dioxide. During an average breath,
an adult will exchange from 500 ml to 700 ml of air. This average breath capacity is called tidal volume.

In patient with pneumonia,

Pneumonia fills the
lung's alveoli with fluid,
keeping oxygen from
reaching the bloodstream.
The alveolus on the left is
normal, while the alveolus on
the right is full of fluid from
pneumonia.

Chest x-rays can reveal areas of

opacity (seen as white) which
represent consolidation. Pneumonia
is not always seen on x-rays, either
because the disease is only in its
initial stages, or because it involves a part of the lung not
easily seen by x-ray.
PATHOPHYSIOLOGY
Precipitating Factors: Predisposing Factors:
Virulent Microorganism

Streptococcus Pneumoniae

Microorganism eneters the nose( nasal passages)

Passes through the larynx, pharynx, trachea

Microorganism enters and affects both airway and lung parenchyma

Airway damage Lung invasion

Infiltration of bronchi flattening of epithelial cells

Infectious organism lodges macrophages and leukocytes

Stimulation in bronchioles necrosis of bronchial tissues mucus and phlegm production

Alveolar collapse narrowing of air passage COUGHING

Productive/non-productive

Increase pyrogen in the body DIFFICULTY OF BREATHING

FEVER

Necrosis of pulmonary tissue

Overwhelming sepsis

DEATH
Causative Agent: Host: Environment factor.
Genetic factor Man Sedentary life style

Genetic Predisposition

Destruction of alpha and

Beta cells of the pancreas

Insulin resistance

Reduced cell uptake of glucose

Hyperglycemia(chronic evalaution
In blood glucose)

Glycoprotein cell wall deposit

Diabetes mellitus

Signs and symptoms

blurring of vision

accelerated artherosclerosis

hypertension

impaired immune system

delayed wound healing

infection

severe complication- neuropathy,retinopathy

death