pelvic fracture ( case presentation)

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Name: H.K.A.G.Age/Sex: 8 year old/MaleAddress: Gonzaga St.Pavia,IloiloReligion: Roman Catholic

Nationality: FilipinoDate of Birth: April 5, 2001Birth of place: Molo, Iloilo CityInformant: E.H Relationship: Mother



ASSESSMENT



A. Chief complaint: Loss of ConsciousenessB. History:

a. history of present illness

Two weeks prior to admission. Patient was notedto have intermittent fever, low moderately gradefever of 38-39 degree Celsius, no other associated signand symptoms noted. Negative cough,negative lossof appetite, positive vomiting

One week prior to admission, there is persistenceof fever they sought consult and was givenIbuprofen(Dolan) 2.5ml every 6 hours,and was noted togive temporary relief.

On the day of admission, there is still persistenceof fever they sought consult and was given advise foradmission.

b. Past medical HistoryNegative previous hospitalizationPositive bronchial asthma- given Co-amoxiclav

(3 weeks prior to admission) patient 4 months.



C. Physical ExaminationGeneral Assessment

Skin -Brown Complexion, varies from light to deep brown,generally uniform, no edema, no abrasion, no lesion,excessive moisture, localized hyperthermia, when pinchedskins goes back to previous state

Level of Consciousness -conscious, oriented, responseimmediately.

Body Built -weight: 11kilogram, height-90cm

Mental-Emotional status - stressful , irritable, emotional Speech -unclear, still not able to speak fluently Body Movement -Move in full range of motion Hygiene and Grooming - good body hygiene.

Specific Assessment:

Head -Elongated head symmetrical Eyes -Eyebrows hair are evenly distributed, with equal

movement. Eyelashes are equally distributed ,curledslightly outward ,Eyelids skin is intact with discharges,sclera appears yellowish, pupils are black, equal in sizenormally 3-7mm diameter, round



Ears- color same as facial skin, symmetrical, contains hair follicles,dry cerumen, tympanic pearly gray color ,semi transparent,normal tone audible, able to hear in both ears, sound isheard in

both ears. Nose -Symmetric and straight with discharges, uniform in color,

not tender, no lesion, air movement is restricted in one or bothnares, clear watery discharges.

Mouth - Uniform pink color, soft, moist smooth texture, symmetryof contour, with 6 baby teeth, pink gums, no retraction,pink tongue ,moist, slightly rough smooth, no lesion, no tenderness

Neck- Muscles equal in size, lead centered, coordinated smoothmovements, with no discomfort, no enlargement of lymph nodes,palpable lymph nodes.

Chest- flat, symmetrical, crackles heard upon auscultation Abdomen -unblemished skin, uniform color, symmetric contour,

flat rounded, soft, no tenderness noted, umbilicus iscentrally locatedBack- Spinal cord are aligned, no lesion, notenderness

Upper extremities- with full range of motion, with swelling at theright metacarpal, uniform skin color, warm to touchtemperature 39.4 degrees Celsius per axilla.

Lower extremities- With full range of motion, no edema,

uniform skin color no tenderness. Genito-anal area - able to void 30cc/hr, rashes noted between



PATHOPHYSIOLOGY



Modifiable Nonmodifiable

environment age

nature genderBACTERIA

AIRBORNE DROPLETS

NOSE, MOUTH, SINUSES

PASSES THROUGH THE BLOODSTREAM

LUNGS

ACUTE INFLAMMATION OF THE WALLS OF BRONCHIOLES

INVADES THE SPACES BETWEEN CELLSAND ALVEOLI THROUGH CONNECTING PORES

TRIGGERS IMMNUE SYSTEM TO SEND NEUTROPHILS ENGULF AND KILL THE OFFENDING ORGANISM ANDRELEASE CYTOKINASE

LEADS TO FEVER CHILLS AN D FATIGUE

BACTERIA AND FLUID SURROUNDING THE BLOOD VESSEL FILLS THE ALVEOLI AND INTERRUPT THE OXYGEN TRANSPORTATION



LABORATORIES



January 9,2009

Myoblast 0% WBC: 25.8x10 9/L

Promyelocytes 0% Hemoglobin 7.2gms/dL

Myelocytes 0% Hematocrit 24.0vol%Platelets 392x10 9/L

Neutrophils 0%

Eosinophils 0%

Basophils 0%

Metamyelocytes MCV-720MCH-230a

MCHC-29

Neutrophilic 0%

Eosinophilic 0%

Basophilic 0%

Neutrophils 78%

Stabs (2)S

Segments (76)S

Eosinophils 5%

Basophils 0%

Monocytes 3%

Lymphocytes 14%

Total 100%



RBC- gnerally micicyrocytic-hyprochonic, mild anistosis, nopolychnesia, no fragments, no nombrlast.WBC- invased with predominances of neutrophils , no toxic granules,lymphocytes, eosinophils slightly increased, no evidence of leukemia.PLATELETS- adequate and of normal morphology

Remarks:Microcyte, hypochronic anemia, moderate leukocytes withneutrophilic and mild eosinophilia normal platelet number



January 10,a2009 Time released:

Bloodtype: A+Rb

Serial No. 807603

Volume: 196 cc

Saline Phase: Albumin Phase: Anti-human globulin:



HEMATOLOGY



RESULT NORMAL VALUE INDICATION

Hemoglobin 109g/L 135-180g/l Decrease of hemoglobin leads tosymptoms of anemia. A conditionin which your body is not gettingenough oxygen, causing fatigueand weakness

Erythrocyte, volfr o.3L/L 0.40-0.54l/l Decrease amount may indicatehemorrhage and blood diseasesinvolving red blood cell

Erythrocyte,numc 4.70x 10 12/L 4.6-6.2x10 12/l NORMAL

SegmentorNeutophils

0.87 0.05-0.7 Increase may indicate bacterialinfection or Drug Infection

Lymphocyte o.10 o.22-0.40 A decreased lymphocyte count of less than 500 places a patient atvery high risk of infection,particularly viral infections and

anemia.

Eosinophils 0.01 0,01-0.04 NORMAL

Monocytes 0.00 0.03-0.08 Decreased by viral or fungalinfection

Basophils 0.00 0.00-0.001 Normal.

Total 1.00



January 9, 2009 Time extracted:5:15 PM Time released: 6:45PM


Hemoglobin 67g/l 135-180g/l Decrease of hemoglobinleads to symptoms of anemia. A condition in

which your body is notgetting enough oxygen,causing fatigue andweakness.Erythrocyte,(Fe)E 9.23l/l 0.40-0.54l/l Decrease amount mayindicate hemorrhageand blood diseasesinvolving red blood cell

Erythrocyte,numc 2.97x10 12/l 4.6-6.2x10 12/l Decrease may lead tohemorrhage. Severe bloodloss may cause anemia.

SegmentorNeutophils

0.87 0.05-0.7 Increase may indicatebacterialinfection.“Leukocytosis”increase leukocyte/WBC.

Lymphocyte 0.12 o.22-0.40 A decreased lymphocyte

count of less than 500places a patient at veryhigh risk of infection,particularly viral infectionsand anemia.

Eosinopshils 0.01 0,01-0.04 Normal.

Monocytes o.00 0.03-0.08 Decreased by viral orfungal

Basophils 0.00 0.00-0.001 Normal.1.00




Hemoglobin 126g/L 135-180g/l Decrease of hemoglobin leadsto symptoms of anemia. Acondition in which your body is

not getting enough oxygen,causing fatigue and weakness.

Erythrocyte, volfr 0.37l/l 0.40-0.54l/l Decrease amount may indicatehemorrhageand blood diseases involvingred blood cell

Erythrocyte,numc 3.90x 10 12/L 4.6-6.2x10 12/l Decrease amount may lead tohemorrhage. Severe blood lossmay cause anemia

SegmentorNeutophils

0.83 0.05-0.7 Increase may indicate bacterialinfection or Drug Infection

Lymphocyte o.09 o.22-0.40 A decreased lymphocyte countof less than 500 places apatient at very high risk of infection, particularly viralinfections and anemia.

Eosinophils 0.00 0,01-0.04 Decreases in the eosinophilcount maybe seen when apatient is receiving in acorticosteroid drug.Monocytes 0.00 0.03-0.08 Decreased by viral or fungalinfection

Basophils 0.00 0.00-0.001 Normal.

Total

Thrombocytes

1.00

300x10 9/1 150-450x10 9/1 Normal.



RESULT NORMALVALUE

INDICATION

Hemoglobin 107g/L 135-180g/l Decrease of hemoglobin leads tosymptoms of anemia. A condition inwhich your body is not getting enoughoxygen, causing fatigue andweakness.

Erythrocyte, volfr 0.31l/l 0.40-0.54l/l Decrease amount may indicatehemorrhageand blood diseases involving redblood cellErythrocyte,numc

Leukocyte, numc

Band Neutrophils

3.28x 10 12/L

12.70x10 9/1

0.01

4.6-6.2x10 12/l

4.5-11x10 9/1

o.o2-0.05

Decrease amount may lead tohemorrhage. Severe blood loss maycause anemia.

Increase may indicate bacterialinfection or sepsis, viral, fungal orparasitic infection. “Leukocytosis”increase leukocyte or WBC.

Increase may indicate acutebacterial infection. It may increasedue to inflammatory processes.Segmentor

Neutrophils0.55 0.05-0.7 Normal.

Lymphocyte o.42 o.22-0.40 Increase may indicate erythematous.

Lymphocytes increase in many viralinfections with tuberculosis.

Eosinophils 0.001 0,01-0.04 Normal.

sBasophils 0.00 0.00-0.001 Normal.

TotalThrombocytes

____ 1.00566x10 9/1 150-450x10

9/1Normal.



DRUG STUDY

P ib d Cl ifi ti I di ti d Sid ff t S i l N i



PrescribedDrug(Dosage,Route,Frequency,Timing)T

Classificationand Mechanismof Action

Indication andContraindication

Side effects orAdverseReactions

SpecialPrecautions

NursingResponsibility

Mupirocin

Frequency:BID

Timing:11 6

Brand Name:

Foskin Ointment

Classification:Dermatologicals

Mechanism of Action:Binds to bacterialisoleucyl transferRNA synthetase,which results toninhibition of bacterial protein

synthesis.

Indication: Topical treatment

of impetigo,folliculitis,ecthyma, infecteddermatoses,infectedabrasions, insectbites, minorwounds andburns. Prophylaxis

to preventbacterialcontamination of small cuts andwounds abrasions,incisions, andother cleanlesions.

Contraindications:Hypersensitivity.Not for opthalmicuse.

Localizedburning,stinging, anditching.

In case of sensitivity orchemicalirritation,discontinue useand instituteappropriatealternativetherapy.Prolonged usemay result in

over growth of non susceptibleorganisms,including fungi.Avoid contactwith eyes.

Check doctor’sorder.

Observe tenrights in givingmedication.

Assess forallergic reaction:burning,stinging,

swelling,redness.

Monitor forpossible inducedadversereactions:

Topical:headache, rash,

abdominal pain,burning,stinging, itching,erythema,swelling,dermatitis,increasedexudates.

Prescribed Classification Indication and Side effects or Special Nursing







SpecialPrecautions


Meropenem

Dosage: 450mgRoute:IVTT

Frequency:Q8H

Timing:14 12

Classification:Anti-infectives

Mechanism of Action:Bactericidal, itinterferes withbacterial cell wallreplication of susceptibleorganisms at

readilypenetrates thecell wall of mostgram negativeand grampositive bacteriato reachpenicillin-bindingprotein targetswhere it inhibitscell wallsynthesis torender the cellwall osmoticallyunstable.

Indication: Treatment of

infections causedor multiplesusceptiblebacteriasensitive tomeropenem.Pneumoniaincludinghospital

acquired,septicemia,nuetropenia,intra-abdominalinfections,meningitis,urinary tract,gynecological,and skin and softtissue infections.

Imflammation: Trombophlebitis

and pain at thesite of injection.Rash, pruritus,urticaria.Abdominal pain,nausea andvomiting ,diarrhea,headache,

paresthesia, oralcandidiasis.

History of Gastrointestinal

complaints,particularlycolitis.

Check doctorsorders

Observe 10rights in givingmedication.

Assess patientfor previoussensitivityreaction to

carbapenemantibiotics,penicillins,cephalosporinsv,and other beta-lactants.








SpecialPrecautions


DephyhyndraminHcl

Dosage:3 ml/5ml

Frequency:Q8h

Timing:8 4 12

Brand name:Benadryl Elixeror syrup

Classification:Anti-allergics

Mechanism of Action:Acts on bloodvessels, GI,respiratorysystem byantagonizing theeffects of histamine for H1-

receptor site;decreasesallergic responseby blockinghistamine;causes heartrate,vasodilation,secretions

Indication:It used forsymptomatic relief of allergic

reactionsincluding urticaria,and angiodema,

rhinitis, andconjunctivitis, andin pruritic skindisorders.

Contraindication:Hypersensitivity toantihistamines.

Orthostatichypotension;palpitations;bradycardia;tachycardia;extra systoles;faintness;.Drowsiness;sedation;dizziness;disturbedcoordination.

Nasal stuffiness;dry mouth; sorethroat. Epigastricdistress; nausea;vomiting;constipation;change in bowelhabits.

May causedrowsiness anddulling of mentalalertness.



Assessrespiratorystatus: raterhythm, andincreased in

bronchialsecretions,wheezing, andchesttightness:provide fluids 2liter per day todecreasesecretion

thickness.

Assess thedegree of itching, skinrash, andinflammation.

Assess nausea,vomiting,








SpecialPrecautions


Ampicillin

Dosage:330mg

Route:IVTT

Frequency:Q8h

Timing:8 4 12

Brand name:Ampicin

Classification:Anti-infectives

Mechanism of Action:Interferes withcell wallsynthesis of susceptibleorganism,preventingbacterialmultiplication, italso renders tocell wallosmoticallyunstable andburst due toosmoticpressure.Deactivated bybetalactamase,an enzymeproduced byresistantbacteria.

Indication: Treatment of

respiratory tractand soft tissueinfections,bacterialmeningitis,septicimia andgonococcalinfections causedby susceptiblemicroorganism.

Contraindication:Hypersensitivityto penicillin,cephalosporin'sor emipenem .

Thrombophlebitisat injection site,

dizziness, fatigue,insomnia,reversiblehyperactivity,neurotoxicity(lethargyneuromuscular,irritability,hallucinations,convulsions,seizures),urticaria.

Use cautiouslyin

cephalosporin-sensitivepatient becauseof possiblecross-allergenity.Super infection:may result inovergrowth of no susceptiblebacterial orfungalorganism.

Check doctor’sorders.





PrescribedDrug(Dosage,Route,Frequency,Timing)tee




SpecialPrecautions


Ibupropen

Dosage:

100mg/5ml

Frequency:Q6H RTC12 6 12 6

Brand name:Dolan

Classification:Analgesics

Mechanism of Action:Inhibition of prostaglandinsynthesis bydecreasingenzyme neededfor biosynthesis;decreased pain

andinflammation,reduction of fever.

Indication:Reduction of fever.

Contraindication:Hypersensitivityto Ibuprofen.

Allergic reaction,redness andswelling at the

painful area. GIdisturbancesincludingdyspepsia,nausea,heartburn,anorexia,diarrhea,constipation,

flatulence,bloating,epigastric, andabdominal pain.Renal, hepatic,CNS, otic, andocular,dermatologiceffects, and fluidretention,increased bloodpressure,hypotension,cerebrovascularaccident andpalpitations.

Hypersensitivity.Severe allergicreaction. Do not

use more than 3days.



Monitor patienttemperature,note signsassociated withfever(diaphosis,

malaise, andtachycardia)t

Assess forallergicreactions: rash,urticaria: if theseoccur drug mayhave to bediscontinued.

Check input andoutput ratio:decreasingoutput mayindicate renalfailure if patientis long-termtherapy.








SpecialPrecautions


Ceelin

Dosage:2.5ml

Route:Oral

Frequency:OD

Timing:8

Brand Name:Ascorbic acid

Classification:Dietary/Nutritional Preparations

MechanismAction:Needed forwound healing,collagensynthesis,antioxidant,carbohydratemetabolism,protein, lipidsynthesis,prevention of infection.

Indication:Enhance body”snatural immunesystem function.

Faintness,dizziness,diarrhea,heartburn,nausea,vomiting, acidurine, oxaluria,renal calculi,discomfort atinjection site.

The risk categorywill be C only if used in dosagesabove RDA.

Phynelketonurics- this productcontainphenylalanine asone of themetabolites of aspartame.

Check doctor'sorder.


Assess forVitamin Cdeficiencybefore, during,and aftertreatment:scurvy(gingivitis,bleeding gums,loose teeth):poor bonedevelopment.

Monitor output-input ratio:polyuria.








SpecialPrecautions


Clarithromycin

Dosage:125mg/5ml

Route:Oral

Frequency:BID

Timing:8 6

Classification:MiscellaneousAnti-infectives.

Mechanism of Action:A microlideantibiotic that isderivative of erythromycin.Binds to the 50Ssubmit of bacterialribosome,blocking proteinsynthesis.Bacteriostatic of bactericidal,depending on

concentration.

Indication:Indicated for thetreatment of mild to moderateinfections causeby susceptiblestrains of thedesignatedmicroorganisms.

Contraindication:Contraindicatedin patient withhypersensitivityto erythromycinor othermacrolides.

Commonreactions are initalics; life –threateningreactions are inbold italics.Headache.Diarrhea,nausea,abnormal taste,dyspepsia,abdominal painor discomfort.

Obtain specimenfor culture andsensitivity testbefore first dose.

Therapy maybegin pendingtest results.

Drug may betaken withoutregard to meals.


Observe tenrights in givingmedications.

Tell patient totake allmedicationprescribed, evenafter even hefeels better.



Prescribed Drug Classification and Indication and Side effects or Special Nursing



g(Dosage, Route,Frequency,Timing)tee

Mechanism of Action

contraindication AdverseReactions

pprecaution

gResponsibility

Albuterol

Dosage:I nebule

Frequency:Q8H

Timing:8 4 12

Brand name:Salbutamol

Classificationbronchodilator

Mechanism of action:relaxes bronchial

and uterine smoothmuscle by actingon beta 2adrenergicreceptors

Indication:Prevention and

treatment of bronchospasm inpatients withreversibleobstructive airwaydisease

Contraindication:Hypertonic saline

will provoke coughin some patients. Itis “harsh” on theairways and maytrigger severebronchospasm. Itwill not be used inpatient with knownairway

hypersensitivity.patients whoexperience severebronchospasmafter a sputuminduction may becandidate.

Headache,dizziness, light

headedness,insomnia, tremor ornervousness,sweating, nausea,vomiting or dirrheaor dry mouth

Use cautiously incardiovascular

disorder, includingcoronaryinsuffiency andhypertension, inhyperthyroidism ordiabetes mellitusand in patients whoare usuallyresponsive to

adrenergics

Check Doctorsorder

Observe 10 rightsin givingmedication

Warn patient aboutthe possibility of paradoxicalbronchospasm,discontinue if this

occurs

Teach patient howto perform oralinhalation correctly




(Dosage, Route,Frequency,Timing)tee

Mechanism of Action


precaution Responsibility

Ceftazidine

Dosage:330mg

Route:IVTT

Frequency:Q8H

Timing:8 4 12

Brand name:Ziptrigen/Fortum

Classification:Cephalosporins

Mechanism of action:Inhibits cell wallsynthesis,promoting osmoticinstability, usuallybactericidal

Indication: Treatment of the

serious infection of the lowerrespiratory andurinary tract,gynecologicinfections,bactenemia,septicemia,intraabdominal infection

Contraindication:Hypersensitiv toothercephalosporons

Headaches,dizziness, dyspnea,elevatedtemperature

Use cautiously topatients withhistory of sensitivity topenicillin

Check Doctorsorderobserve 10 rightsin givingmedicationwith large doses or

prolonged therapy,monitor forinfection especiallyin high riskpatients.




(Dosage, Route,Frequency,Timing)tee or200mm

Mechanism of Action


precaution Responsibility

Paracetamol

Dosage:11o mg

Route:IVTT

Frequency:Q4H

Classification:

Analgesics

Mechanism of action:Decrease fever byinhbiting theeffects of pyrogenon thehypothalamic heat

regulating centerand byhypothalamicaction leading tosweating andvasodilation

Indication:

Treatment for fever

Contraindication:hypersensitivity

Stimulation,

drowsiness,nausea, vomiting,abdominal pain,hepatoxocity,hepaticseizure(overdose),renal failure

The toxic dose of

paracetamol ishighly variable. Inadults, single dosesabove 10 grams or200mg/kg of bodyweight, which everis lower, hve areasonavlelikelihood of

causing toxicity.

Checks Doctors

Order

Observe 10t rightsin givingmedication

Assess patients forfrver, temperature,diaphoresis

Assess allergicreactions: rash,uticaraia, if theseoccurs drug mayhave to bedicontinued

Assess for chronic

poisoning, rapidweak pulse,dyspnea, cold andclammyextremities, rreportimmediately todescriber



NURSING CARE PLAN



Definingcharacteristic

Diagnosis Goals of Care Intervention Rationale Evaluation

“masakit nagid nga indiko maagwantahanang lowerportion sangakon hawak”asverbalized.

OBJECTIVE:FacialgrimacenotedIncreasebloody show7 cm cervicaldilatationupon internalexaminationby physicianon duty.BP: 130/90

Lumbo sacralpain related tolabor.

RATIONALE:As cervicaldilatationincreases, thepressure of thefetal head onthe pelvic areadoes it causespain.

GENERALOBJECTIVES:

After 4 hoursof interventionclient: would haveless discomfortduring the firststage of labor.SPECIFICOBJECTIVES:

After 2 hours of intervention client:may verbalize lessdiscomfort,diminished facialgrimace, able todivert attention

INDEPENDENT:• Assist clientto her mostcomfortableposition.• Encourageverbalizationof feelings• provideemotional andspiritualsupport.

Divertingattention of awoman who is inlabor pain is themost effectiveway to lessenpain since we allknow that theincrease of cervicaldilatation alsoincreases thepressure of fetalhead to pelvicarea whichcauses pain.

Goals fully met, afterthe delivery of fetalhead and later thedelivery of the fetuspain is absolutelyrelieved as evidence bypatient verbalizes “bawdaw na haw-asan manako kag nag mag.anakon pamatyag. “BP: 180/20Pain scale of 3 out of 10.

Defining Diagnosis Goals of Care Intervention Rationale Evaluation



characteristic

January 12,2009Subjective:“Laka langgid siyamag-ubo”asverbalizedby themother

Objective:OccasionalcoughnotedRespirationrate: 48breathsper minuteBreathing:abnormalrate with

wheezingsounduponauscultationIrritabilityrestlessness

Ineffective airwayclearance related toretained mucus secretion

Rationale: Pathogenicorganism such as bacteriaenters the body throughdifferent portals. Thisinvades specific parts inthe body where infectionoccurs as an einflammation response.White blood cells assecondary defense actupon it by engulfing thisorganism through theprocess of phagocytosiscausing cell death thenmucus secretion areproduced. Increase inamount blocks airwaypassages which make

breathing patternineffective.

References1.Nurses Pocket GiudeDiagnosis, Prioriizeinterventions andRationales by Marilyn E.Doenges, Mary Frances

Moorhouse, Alice C. Murr2.Medical-Surgical

General:after 2

weeks of nursinginterventions,the patientwill be able tomaintainairwaypatency.

Specific:

After 8 hoursof nursinginterventionsthe patientwill be ableto:1.Expectoratethe mucussecretions

2.Improvebreathingpattern3.Demonstrate thebehaviors toimprove clearairway4.Able to rest

and sleep

Independent:Asses forcharacteristicof cough

to elevatehead usingpillows

To increaseoral fluidintake

Chest tappingdone afternebulization

Observe forsigns andsymptoms of infection

Dependent:Pulmo AidInhalationgiven asordered,Salbutamol 1Nebule Q8H

To assess changesand note possiblecomplications

To maintainadequate airwaypatency

To help liquefysecretions

To help loosensecretions intocentral airways

To identify infectionprocess andpromote timelyintervention

To reducebronchospasm,

opening tight orcongested airwaysand facilitatingventilation. It alsodilate bronchiolesand improvebreathing.

Occasionalcough still noted

Patient was ableto improvebreathingPatient able todrink plenty of fluids

Able spit outwhitish phlegm.Approximatelyteaspoon per dayNo possibleinfection noted

Demonstrate

improve airway.Able to rest andsleep afternebulization.

Definingh t i ti

Diagnosis Goals of Care Intervention Rationale Evaluation



characteristic

anuary 12,2009Subjected:“Ginahilant namansiya” as verbalizedby the mother.

Objecive:Temperature -39.4degrees CelsiusRespiration rate: 48breaths per minuteSkin warm to touchCardiac rate: 150beats per minute

Body temperatureelevated abovenormal range relatedto lung infection

Rationale:

Pathogens mayenter the bodythrough respiratorytract. This is inhaledby a susceptible hostthat localize in thelungs or distributedvia lymphatic systemor bloodstream. A

leukocyte,particularly isresponsible forengulfing, killing anddisposing theinvading organism inthe process of phagocytosis.phagocytic pyrogens

released endogenouspyrogens that causethe hypothalamus toincrease bodytemperatureRefernce:Medical SurgicalNursing byIgnativicius and

Workman

General:after 2 weeks

of nursingintervention thepatient will beable to maintain

bodytemperaturewithin normalrange

Specific:after 8 hours

of nursingintervention the

patient will beable to:1.Lower bodytemperature as37 degreesCelsius2.Respiratoryrate in the rangeof 30-40 breaths

per minute3.Able to rest andsleep

Independent:Continuous spongebathing wasperformed

Increased oral fluid

intake

Provided adequaterest and sleep

Monitored rate andcardiac rate

Dependent:PRN medicationwas given:Paracetamol drops(Tempra) 1.2 mlQ4H as needed forfever

Administeredreplacement of fluids andelectrolytes

To increase heatloss by evaporationand conduction

To replace fluid

lose and preventdehydration

To reducemetabolic rate andoxygenconsumption

To note thechanges whether

there isimprovement ornothing

Decreases fever byinhibiting theeffects of pyrogenon the

hypothalamic heatregulating center.Also byhypothalamicaction leading tosweating andvasodilation

To supportcirculating volume

and tissueperfusion

Decreased bodytemperature from39.4 to 37. 4degrees CelsiusPatient was able to

drink fluidapproximately1000ml per dayAble to rest andsleep

Respiration rate of 36 breath s per

minute and cardiac

rate of 130 beatsper minute

Body temperaturewas decreased to37.4 degreesCelsius andsweating noted

Intravenous Fluidwas infusing



DISCHARGE PLAN



General Objective:

To enable the folks to provide continuity of care athome with the absence of health workers and to educatethem for further clients health management. Specific Objective:

1) To teach the mother the knowledge about thedisease.

2) To give information on how to prevent thereoccurrence of the present condition.

3) Give instruction on how to manage fever at home.



Knowledge about the Disease

Fever is the elevation of the temperature above normal due to a disturbance of the heartregulating center. It is an indication of a pathological process within the body. The onset of fever

maybe accompanied by a subjective sense of malaise, fatigue, loss of appetite, headache andgeneralized and pains of mild degree. Of the onset is rapid, the symptoms includes chills,occasional nausea and vomiting and mental changes ranging from mild confusion to delirium.The patient usually feel cold even if his temperature is above normal fever is classified intothree, intermittent, remittent and relapsing. Intermittent fever is one which the temperature fallsto normal and rises within 24 hours while later manifest a variation of 1 or 2 degrees but doesnot reach the normal within 24 hours, while relapsing fever occurs when there are alternating

periods of 1 or several days of normal and elevated temperature.

Personal Hygiene

When there is a fever the mouth becomes very dry and a source of discomfort to the

patient with fever. We will tell the folks to clean and rinsed with a mild antiseptic solution every2 hours. Vaseline, or cold cream maybe applied to the lips to prevent cracking. It is also to

prevent the development of herpes and other viral disease. Frequent bathing is also advised because of the increase perspiration and to minimize the spread of microorganisms. Advice folksto take care of the skin by daily use of soap and water.



Activities of Daily Living

After the temperature return to normal the patient should remain in bed for atleast 24hours. This is to protect the heart from exertion at the time when it is fired.

Medication and Treatment

If the patient is experiencing chills, advise mother to cover him with warm blanket. If thetemperature is very high sponging the surface of the body with a cold solution of 35% alcohol inwater or may apply ice bags to the head or axillae. Room should be kept cool and ventilated.Hydrotherapy is also recommended.

Medications

Paracetamol (Dolan) 10 ml for fever

Clarithromycin (Klaricid) 125 mg/5 ml 3.5ml twice a day for 7 days (8am-6pm)C

Cititrizine (Zytec) oral suspension, 1ml twice a day to consume stocks (8am-6pm)C

Follow-up Visit

Remind mother to their follow-up check-up as indicated by the doctor on January 27,2009 and advise her to report any untoward signs and symptoms even before the date schedules.

pelvic fracture ( case presentation)

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