106427165 39078672-case-study-pleural-effusion

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OURLADY OF FATIMA UNIVERSITY
College of Nursing
Valenzuela City
A Case Study
On
Pleural Effusion
In Partial Fulfillment
Of the course
NCM 103
Submitted to:
THFS 6:00 pm – 2:00 pm

TABLE OF CONTENTS
I. Introduction
II. Client’s Profile
III. Anatomy and Physiology
IV. Pathophysiology
V. Diagnostic Procedures and Lab Result
VI. Drug Study
VII. Nursing Care Plans
VIII. Discharge Plan
IX. Learning Insights

X. Reference
I. INTRODUCTION
Our group chose this case as interesting to us because it is a common disease
entity that is usually underestimated as a cause of mortality and morbidity to patients.
We would like to make an outlook of what this case is and gather information that can
help us learn how it occurs, manifest, develop and cause a disease.
It is our goal to identify the risk factors that affects people making them at risk for
the disease. How is the disease being treated. And by learning from the inputs we gather
from out patient.
We discuss pleural effusion as its definition as the collection of at least 10-20 mL
of fluid in the pleural space. Pleural effusion develops because of excessive filtration or
defective absorption of accumulated fluid. Pleural effusion may be a primary
manifestation or a secondary complication of many disorders. Pleural effusions are
usually classified as transudates and exudates. Diseases that affect the filtration of
pleural fluid result in transudate formation, such as in congestive heart failure and
nephritis. Transudates usually occur bilaterally because of the systemic nature of the
causative disorders. Inflammation or injury increases pleural membrane permeability to
proteins and various types of cells and leads to the formation of exudative effusion
Infectious effusions are usually unilateral. However, a recent large Turkish study
revealed bilateral effusion in 5% of 515 children.
Its frequency occurs, as in the US: American and international frequencies
are similar. The prevalence of pleural infections appears to be increasing in some
developed countries; this could be partly due to increased referral of patients with
these conditions to tertiary-care pediatric hospitals.
Nonbacterial infectious agents, such as viruses and Mycoplasma pneumoniae,
cause more pleural effusion in children than do bacterial organisms. Although
bacteria are more likely than viruses to cause effusion, viral infections in children occur

more frequently than bacterial infections, explaining the observation above. As
many as 20% of the viral infections can cause small and transient effusions that
resolve spontaneously, affects internationally and more frequently on developed nations.
Several decades ago, pleural effusion was a complication of 70% of all cases of
Staphylococcus aureus pneumonia, with positive cultures resulting from 80% of pleural-
fluid specimens. In the late 1970s, pleural effusion occurred in 75% of cases of
pneumonia secondary to Haemophilus influenzae type b. In a report by Murphy et al,
empyema complicated the course of pneumonia in 9 of 21 patients with Streptococcus
pneumoniae pneumonia. Chartrand and McCracken indicated that empyema
complicated the course of pneumonia in 57 of 79 patients with S aureus infections.
Pleural effusion occurs in 6-12% of all cases of pulmonary tuberculosis (TB) in
children. Of 175 Spanish children with pulmonary TB, 39 (22.1%) had pleural effusion.
Congenital effusions, including chylothorax, occur in 1 per 10,000-15,000 live
births annually. In a review of 74 patients with intrathoracic lymphomas, Chaignaud et al
found pleural effusions in 10 (71%) of 14 children with lymphoblastic lymphoma and in 7
(12%) of 60 children with non-Hodgkin lymphoma.
The outcome of this condition affects the morbidity and mortality of patients. Most
effusions caused by viral and mycoplasmal infections resolve spontaneously.
Empyema has a complicated course if not treated early, especially in children
younger than 2 years. Thirty years ago, the mortality rate from empyema was 100%. At
present, the mortality rate from empyema is 6-12% in infants younger than 1 year.
Malignant effusion worsens the patient's prognosis depending on the underlying
tumor. With regards to its ratio. Pleural effusions may be more common in boys than in
girls.

II. CLIENT’s PROFILES
Patient Ω is 52 years-old female, Filipino, Roman Catholic from the
province of Jasaan, Misamis Oriental. She was admitted at Northern Mindanao
Medical Center last August 17, 2010 at 3:00 PM due to shortness of breath,
Tightness of the chest, dry cough and abdominal enlargement.
Patient’s vital signs are: Blood Pressure of 130/90 mmHG, temperature of
36.7 degree Celsius, respiratory rate of 29 cpm and a heart rate of 110 bpm. At
present she weighs 58 kls.
HISTORY OF PRESENT ILLNESS
One week Prior to admission, patient submitted self for a medical check
One month prior to admission, patient Ω started having shortness of
breath. She endured that condition for a month.
up by Dr. Alejo at a polyclinic due to body malaise and was diagnosed as having
U.T.I. She was then referred to an Internal Medicine specialist, Dr. Ampong for
further assessment. Dr. Ampong Diagnosed her as having Pleural Effusion,
Massive Ascites and some abnormalities in her ovary. She was again referred to
another specialist, an OB-GYNE, Dr. Mangganges. The OB-GYNE found some
abnormal growth in her ovary and suggested her to undergo a treatment. But The
OB-GYNE refused to start the treatment unless pleurais cleared from the edema.
So, She then was admitted at the Northern Mindanao Medical Center Payward,
Annex 3 floor 2 to undergo Chest Thoracostomy for Excessive Pleural Fluid
clearance.
PRE-HOSPITALIZATION
Health Perception-health management pattern:

Patient X is a 43 years-old male that is dependent to his own decision and
care. Patient X was not active to his daily routine. During onset of coughing the
patient verbalizes, “Gasige lng kog ubo-ubo sir”. Due to his illness, he cannot
perform his daily routine that he is usually doing when he is still not sick.
Nutritional metabolic pattern: (While confined)
Patient X said he takes 1500cc of water a day, and takes 3 meals in a day
with a combination of 1-2 cups rice with different viand. He has poor appetite that
sometimes he cannot consume his meal. “Wala koy gana mo kaun sir” as
verbalized by the patient. He was ordered to have a Low-salt and Low-Fat Diet.
He is also fond of drinking alcoholic beverages for 15 years and a smoker for 10
years. He can consumed 1 pack of cigarette per day.
Elimination pattern: (while confined)
Patient X has a normal elimination pattern. He defecates one time a day
with moderate amount, soft stool, and light-brown in color. There was no problem
on his urination; he can urinate 3-5 times per day.
.
Activity exercise pattern: (while confined)
Prior to confinement, the patient was be able to do the activities of daily
living by himself not until a day prior to confinement he always ask for assistance
in doing his activities of daily living because he’s anxious he might fall down.
Patient was advice to refrain from doing strenuous activity because of his
condition. “Galisud ko ug ginhawa kung mahago ko” as verbalized by the patient.
Sleep-rest pattern: (while confined)
Patient X has a normal sleeping pattern and would sleep at most 6-8 hrs
per day, he was easily get distracted and awaken by any environmental stimuli,
especially when taking his medications. Watching TV makes him fall asleep.
Cognitive-perceptual pattern:
Patient was calm, responsive, conscious, well oriented with time and place
and with normal behavior of communication.
Role-relationship pattern: (while confined)
Patient X is married, a good provider and was happy being with his family.
He’s been wishing that everybody is well, so that it would not add to his daily
financial needs.

Sexuality and Reproductive Pattern
Patient X said that he is not so much active in his sexual patterns.
Coping-Stress Tolerance Pattern
Having this condition makes him challenge, and think that everything will
be alright, though he remains to be calm but he is a bit worried.
Value-Belief Pattern
He is a Roman Catholic and don’t believe in superstitious beliefs. He said,
“God is our savior and he is our creator, he has a plan for me”.
PHYSICAL ASSESSMENT
ASSESSMENT DATA
ASSESSMENT FINDINGS
BEFORE (SEPT 23, 09)
SKIN
Color
Temperature
Turgor
Texture
Lesion
Integrity
Others
Fair
37.1 º C
Good skin turgor
Moist skin
(-) Lesions/Rash
Intact
NAILS
Color
Texture
Shape
Others
Pinkish
Smooth
Concave
Poor capillary refill = 3 sec

HAIR
Color
Texture
Distribution
Quantity
Others
Black
Coarsely dry
Evenly distributed
Moderate
HEAD
Shape
Size
Configuration
Headache
Round
Normocephalic
Symmetrical
None
ASSESSMENT DATA
EARS
Hearing
Tinnitus
Vertigo
Earaches
Infection
DischargesS
Others
Good
None
No vertigo
No earaches
No infection
No discharges
NOSE AND SINUSES
Frequent colds
Nasal stiffness
Nose bleed
Sinus trouble
None
None
None
Sinuses are non tender
MOUTH & THROAT
Condition of teeth
Bleeding gums
Tongue
Throat
Hoarseness
Mucous membrane
Incomplete teeth
No bleeding
Tongue is at midline,
Throat Non-tender
None
Pinkish
ASSESSMENT DATA ASSESSMENT FINDING
NECK
Symmetry
Condition of trachea Thyroid
Lymph nodes
Symmetrical
in the midline
(-) nonpalpable
(-) nonpalpable

LUNG
Symmetry
Shape
Respiratory movements
# of breath
Symmetrical
A:P diameter 1:2
Asymmetrical, use of accessory muscles
26cpm
AUSCULTATION:
Character of respiration (+) rales on upper lung lields
Decrease breath sounds on left lung field
HEART AND NECK VESSELS:
Apical Pulse
Cardiac Sounds
Apical/Radial pulse data
Blood pressure
Pulse pressure
Any special procedure
Done
107 bpm
(-) murmurs
Not assessed
ASSESSMENT DATA ASSESSMENT FINDING
ABDOMEN:
Symmetry
Contour
Skin Lesion
Masses
Bowel Sounds
Tenderness
Symmetrical
Globular
none
(-) Masses
Normoactive bowel sounds
none

MUSCULOSKELETAL SYSTEM:
Posture
ROM
Muscle Strength
abnormal postures aren’t present
active-passive
4/5
HEAD AND NECK:
Facial muscle symmetry
Swelling
Scars
Discoloration
Weakness
ROM
Posterior neck cervical spine
Muscle spasm
Crepitus
Symmetrical
None
None
None
(+) Weakness
can turn head from side to side
Non-tender
(-) Spasm
(-) Crepitus heard
MOTOR SYSTEM:
Muscle tone
Ability to move extremities against gravity
Spasticity, flaccidity or rigidity, tremors, lies
Without hypertrophy or atrophy
Muscle strength is 4/5
none
MENTAL STATUS:
LOC
Long term memory
Short Term Memory
Conscious
Not assessed
III. ANATOMY AND PHYSIOLOGY

Human Respiratory System
The respiratory system consists of all the organs involved in breathing.
These include the nose, pharynx, larynx, trachea, bronchi and lungs. The
respiratory system does two very important things: it brings oxygen into our
bodies, which we need for our cells to live and function properly; and it helps us
get rid of carbon dioxide, which is a waste product of cellular function. The nose,
pharynx, larynx, trachea and bronchi all work like a system of pipes through
which the air is funneled down into our lungs. There, in very small air sacs called
alveoli, oxygen is brought into the bloodstream and carbon dioxide is pushed
from the blood out into the air. When something goes wrong with part of the
respiratory system, such as an infection like pneumonia, it makes it harder for us
to get the oxygen we need and to get rid of the waste product carbon dioxide.
Common respiratory symptoms include breathlessness, cough, and chest pain.

Nose
A nose is a protuberance in vertebrates that houses the nostrils, or nares,
which admit and expel air for respiration in conjunction with the mouth. Behind
the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air
next passes through the pharynx, shared with the digestive system, and then into
the rest of the respiratory system. In humans, the nose is located centrally on the
face; on most other mammals, it is on the upper tip of the snout.
In cetaceans, the nose has been reduced to the nostrils, which have migrated to
the top of the head, producing a more streamlined body shape and the ability to
breathe while mostly submerged. Conversely, the elephant's nose has
elaborated into a long, muscular, manipulative organ called the trunk.
Mouth
The mouth, buccal cavity, or oral cavity is the first portion of the alimentary
canal that receives food and begins digestion by mechanically breaking up the
solid food particles into smaller pieces and mixing them with saliva.[1]
The oral
mucosa is the mucous membrane epithelium lining the inside of the mouth.In
addition to its primary role as the beginning of the digestive system, in humans
the mouth also plays a significant role in communication. While primary aspects

of the voice are produced in the throat, the tongue, lips, and jaw are also needed
to produce the range of sounds included in human language. Another non-
digestive function of the mouth is its role in secondary social and/or sexual
activity, such as kissing. The physical appearance of the mouth and lips play a
part in defining sexual attractiveness.
The mouth is normally moist, and is lined with a mucous membrane. The lips
mark the transition from mucous membrane to skin, which covers most of the
body.
Pharynx
The pharynx (plural: pharynges) is the part of the neck and throat situated
immediately posterior to (behind) the mouth and nasal cavity, and cranial, or
superior, to the esophagus, larynx, and trachea. The pharynx is part of the
digestive system and respiratory system of many organisms.Because both food
and air pass through the pharynx, a flap of connective tissue called the epiglottis
closes over the trachea when food is swallowed to prevent choking or aspiration.
In humans the pharynx is important in vocalization.
Epiglottis
The epiglottis is a flap of elastic cartilage tissue covered with a mucus
membrane, attached to the root of the tongue. It projects obliquely upwards
behind the tongue and the hyoid bone. The term is, like tonsils, often incorrectly
used to refer to the uvula. The epiglottis guards the entrance of the glottis, the
opening between the vocal folds. It is normally pointed upward during breathing
with its underside functioning as part of the pharynx, but during swallowing,
elevation of the hyoid bone draws the larynx upward; as a result, the epiglottis
folds down to a more horizontal position, with its upper side functioning as part of
the pharynx. In this manner it prevents food from going into the trachea and
instead directs it to the esophagus, which is more posterior.
The epiglottis is one of nine cartilaginous structures that make up the larynx
(voice box). While breathing, it lies completely within the pharynx. When
swallowing it serves as part of the anterior of the larynx.
Larynx
The larynx (plural larynges), colloquially known as the voicebox, is an
organ in the neck of mammals involved in protection of the trachea and sound

production. The larynx houses the vocal folds, and is situated just below where
the tract of the pharynx splits into the trachea and the esophagus. Sound is
generated in the larynx, and that is where pitch and volume are manipulated. The
strength of expiration from the lungs also contributes to loudness.
Fine manipulation of the larynx is used to generate a source sound with a
particular fundamental frequency, or pitch. This source sound is altered as it
travels through the vocal tract, configured differently based on the position of the
tongue, lips, mouth, and pharynx. The process of altering a source sound as it
passes through the filter of the vocal tract creates the many different vowel and
consonant sounds of the world's languages as well as tone, certain realizations
of stress and other types of linguistic prosody. The larynx also has a similar
function as the lungs in creating pressure differences required for sound
production; a constricted larynx can be raised or lowered affecting the volume of
the oral cavity as necessary in glottalic consonants.
Trachea
The trachea, or windpipe, is a tube that connects to the pharynx or larynx,
allowing the passage of air to the lungs. It is lined with pseudostratified ciliated
columnar epithelium cells with mucosal goblet cells which produce mucus. This
mucus lines the cells of the trachea to trap inhaled foreign particles which the
cilia then waft upwards towards their larynx and then the pharynx where it can
either be swallowed into the stomach or expelled as phlegm.
Bronchi
The trachea (windpipe) divides into two main bronchi (also mainstem
bronchi), the left and the right, at the level of the sternal angle at the anatomical
point known as the carina. The right main bronchus is wider, shorter, and more
vertical than the left main bronchus. The right main bronchus subdivides into

three lobar bronchi while the left main bronchus divides into two. The lobar
bronchi divide into tertiary bronchi, also known as segmental bronchi, each of
which supplies a bronchopulmonary segment. A bronchopulmonary segment is a
division of a lung that is separated from the rest of the lung by a connective
tissue septum. This property allows a bronchopulmonary segment to be
surgically removed without affecting other segments. There are ten segments per
lung, but due to anatomic development, several segmental bronchi in the left lung
fuse, giving rise to eight. The segmental bronchi divide into many primary
bronchioles which divide into terminal bronchioles, each of which then gives rise
to several respiratory bronchioles, which go on to divide into 2 to 11 alveolar
ducts. There are 5 or 6 alveolar sacs associated with each alveolar duct. The
alveolus is the basic anatomical unit of gas exchange in the lung.
Alveoli
An alveolus (plural: alveoli, from Latin alveolus, "little cavity") is an
anatomical structure that has the form of a hollow cavity. Found in the lung, the
pulmonary alveoli are spherical outcroppings of the respiratory bronchioles and
are the primary sites of gas exchange with the blood. Alveoli are particular to
mammalian lungs. Different structures are involved in gas exchange in other
vertebrates.
Each human lung contains about 150 million alveoli. Each alveolus is wrapped in
a fine mesh of capillaries covering about 70% of its area. An adult alveolus has
an average diameter of 0.2–0.3 mm, with an increase in diameter during
inhalation.

V. DIAGNOSTIC PROCEDURE AND LABORATORY RESULT
Predisposing Factor
Age, gender
Inflammation of airways wheezing
Bronchial edema Increased mucus
secretion
Broncoconstrict
-ion
Bronchial
spasm
Worsening of obstruction
Dsypnea, cold and
clammy skin,
diaphoresis
Accumulation of fluids caused by over secretion
Multiplication of growth of organism
Inflammation in the epithelial wall
Fluid filled alveoli/lobar copartment
Rupture of inflamed endothelial cellsExcess fluid
accumulate
d in
spaceperica
rdial
Shallow
breathing,
RR
increase Mismatch of ventilation and perfusion
DyspneaMismatch of ventilation
and perfusion
Hypoxemia
Hypoxia
Pleural
effusion
Precipitating Factors:
Lifestyle, environmental

CBC
The CBC is used as a broad screening test to check for such disorders as
anemia, infection, and many other diseases. It is actually a panel of tests that
examines different parts of the blood.
September 24, 2009
Test Result Unit References
WBC 18.0 1O^3/uL 5.0-10.0
RBC 3.47 10^6/uL 4.2-5.4
HEMOGLOBIN 7.7 g/dL 12.0-16.0
HEMATOCRIT 25.6 % 37.0-47.0
MCV 73.8 fL 82.0-98.0
MCH 22.2 Pg 27.0-31.0
MCH-C 30.1 g/dL 31.5-35.0
RDW-CV 17.1 % 12.0-17.0
IMPRESSION:
Increased White Blood Cells may be with infections and inflammation. Red
Blood Cell decreased with anemia also with Hemoglobin and Hematocrit
because this mirrors RBC results. Mean Corpuscular Volume decreased with iron
deficiency and thalassemia. MCH mirrors MCV results. MCHC may be
decreased when MCV is decreased. Increased RDW indicates mixed population
of RBCs; immature RBCs tend to be larger.
Differential Count
The white blood cell differential count determines the number of each type
of white blood cell, present in the blood.
Monocyte 11.4 % 4.5-10.5
Eosinophils 0.9 % 1.0-3.0
Platelet 987 10^3/uL 1500-4000
IMPRESSION:
Monocyte levels can increase in response to infection of all kinds as well
as to inflammatory disorders. Monocyte counts are also increased in certain
malignant disorders, including leukemia. Decreased levels of eosinophils can
occur as a result of infection. Platelet decreased when greater numbers used, as
with bleeding; decreased with some inherited disorders.

September 25, 2009
Test Result Unit References
WBC 21.5 1O^3/uL 5.0-10.0
RBC 3.65 10^6/uL 4.2-5.4
HEMOGLOBIN 8.1 g/dL 12.0-16.0
HEMATOCRIT 27.1 % 37.0-47.0
MCV 74.2 fL 82.0-98.0
MCH 22.2 Pg 27.0-31.0
MCH-C 29.2 g/dL 31.5-35.0
RDW-CV 17.2 % 12.0-17.0
PDW 9.0 fL 9.0-16.0
MPV 8.7 fL 8.0-12.0
IMPRESSION:
Based on the table above it was interpreted that the significant elevation of
WBC means that an infection occurred inside the body. RBC is below normal,
which could reflect the body's inability to produce enough red cells to replenish
what, has been lost out of the blood stream. Decreased hemoglobin and
hematocrit mirrors RBC results. MCH mirrors MCV results. MCHC may be
decreased when MCV is decreased. Increased RDW indicates mixed population
of RBCs; immature RBCs tend to be larger.
Differential Count
The white blood cell differential count determines the number of each type
of white blood cell, present in the blood.
Lymphocyte 32.3 % 17.4-48.2
Neutrophil 53.5 % 43.4-76.2
Monocyte 13.0 % 4.5-10.5
Eosinophils 1.0 % 1.0-3.0
Basophils 0.2 % 0.0-2.0
Platelet 1085 10^3/uL 1500-4000
IMPRESSION:
Monocyte levels can increase in response to infection of all kinds as well
as to inflammatory disorders. Monocyte counts are also increased in certain
malignant disorders, including leukemia. On the other hand, platelet decreased
when greater numbers used, as with bleeding; decreased with some inherited
disorders.

DRUG ORDER
(Generic name, brand
name, classification,
dosage, route,
frequency)
MECHANISM OF
ACTION
INDICATIONS
CONTRAINDICATIONS ADVERSE EFFECTS OF
THE DRUG
NURSING
RESPONSIBILITIES/
PRECAUTIONS
Generic Name:
Furosemide
Brand Name:
Apo-Furosemide,
Furosemide special, Lasix
Classification:
Loop diuretic
Dosage:
1 mg/kg
Route:
IVTT
Frequency:
2 hr
Inhibits the
reabsorption of
sodium and chloride
from the ascneding
limb of the loop of
Henle, leading to a
sodium-rich diresis
 Acute
Pulmonary
edema
 Contraindicated with
allergy to furosemide,
sulfonamides; allergy
to tartrazine (in oral
solution0;
anuria,severe renal
failure; hepatic coma;
pregnancy; lactation
 Use cautiously with
Sle, gout, diabetes
mellitus.
CNS: Dizziness,
weakness,headache,
drowsiness,fatigue
CV: Orthostatic
hypotension,
thrombophlebitis
Dermatologic:
Photosensitivity,
rash,pruritus,purpura
GI: Nausea,
anorexia,vomiting, oral and
gastric irritation,
constipation,
GU: Polyuria, nocturia,
glycosuria, urinary bladder
spasm
Hematologic: Leukopenia,
anemia, thrombocytopenia,
fluid and electrolyte
imbalances, hyperglycemia
Other: Muscle cramps and
muscle spasms
 Adminiser with food
or milk to prevent GI
upset
 Reduce dosage if
given with other
antihypertensives;
readjust dosae
gradually as BP
responds
 Give early in the day
so that increased
urination will not
disturb sleep
 Avoid IV use of oral
use is at all possible
 Arrange for
potassium-rich diet
or supplemental
potassium as
needed.

DRUG ORDER
dosage, route,
frequency)
MECHANISM OF
ACTION
INDICATIONS
THE DRUG
NURSING
RESPONSIBILITIES/
PRECAUTIONS
Generic Name:
Oxacillin sodium
Brand Name:
Antibiotic;
Penicillinase-resistant
penicillin
Dosage:
600 mg
Route:
IVTT
Frequency:
q 6 hr
Bactericidal:Inhibits
cell wall synthesis of
sensitive organisms,
causing cell death.
Infections due to
penicillinase-producing
staphylococci; may be
used to initiate
treatment when a
staphylococci infection
is suspected.
 containdicated with
allergies to
penicillins,
cephalosporins, or
other allergens
renal disordes,
pregnancy, lactation
(may cause diarrhea
or candidiasis in
infants).
CNS: Lethargy,
hallucinations, seizures
GI: stomatitis, glossitis,
gastritis,nausea, vomiting,
diarrhea, abdominal pain
GU: Nephritis-oliguria,
proteinuria, hematuria,
pyuria
Hematologic: Anemia,
thrombocytopenia,
leukopenia, prolonged
bleeding time
Hypersensitivity: Rash,
fever, wheezing,
anaphylaxis
Local: Pain, phlebitis,
thrombosis at injection site
Other: Superinfections,
sodium overload leading to
CHF
 Culture infection
before treatment;
reculture if response
is not as expected
 Reconstitite for IM
use to a dilution of
250 mg/1.5 mL
using sterile water
for injection or
sodium chloride
injection. Discard
after 3 days at room
temperature or after
7 days if
refrigerated.
TP:
 You may
experiencethese
side effects: Upset
stomach, nausea,
diarrhea, (eat
frequent small
meals), mouth
ssores (perform
mouth care), pain at
the injection site

DRUG ORDER
dosage, route,
frequency)
MECHANISM OF
ACTION
INDICATIONS
THE DRUG
NURSING
RESPONSIBILITIES/
PRECAUTIONS
Generic Name:
Cefuroxime
Brand Name:
Cefuroxime sodium
(Zinacef)
Classification:
Antibiotic
Dosage:
385 mg
Route:
IVTT
Frequency:
q.8 hr
Bactericidal: Inhibits
synthesis of
bacterial cell wall,
causing cell death
 Lower
respiratory
infections
 contraindicated with
allergy to
cephalosporins or
penicillins
enal failure,
lactation,
pregnancy
CNS: Headache,
dizziness, lethargy
GI: Nausea, vomiting,
diarrhea, anorexia,
abdominal pain,
flatulence, liver toxicity
GU: Nephrotoxicity
Hematologic: Bone
marrow deppression
( decreased WBC,
decreased platelets,
decreased Hct).
Hypersensitivity: Ranging
from rash to fever to
anaphylaxis, serum
sickness reaction
Local: Pain, abscess at
injection site, phlebitis,
NR:
 Culture infection,
nd arrange for
sensitivity tests
before and during
therapy if
expected,
response is not
seen
 Give oral drug with
food to decrease
GI upset and
enhance
absorption
 Give oral drug to
children who can
swallow tablets:
crushing the drug
results in a bitter,
unpleasant taste

inflammation at IV site
ASSESSMENT DATA
(Subjective & Objective Cues) NURSING DIAGNOSIS
(Problem and Etiology)
GOALS AND
OBJECTIVES
NURSING INTERVENTIONS AND
RATIONALE
EVALUATION
Subjective:
“Ga sige rako ug ubo-ubo sir” as
verbalized by the patient.
Objective:
- (+) cough
- restlessness
- yellowish sputum
- tachycardia (PR=107
bpm)
- pale
- RR=26 cpm
Ineffective airway clearance
related to retained secretions
as manifested by persistent
coughing and yellowish
sputum.
After 8 hours of care
patient will be able to:
a. maintain airway
patency
b. expectorate/clear
secretions readily
Independent:
- Elevate head of the bed/change
position every 2 hours.
R. To take advantage of gravity
decreasing pressure on the
diaphragm.
- Encouraged deep-breathing and
coughing exercises.
R. To mobilize secretions.
- Auscultate breath sounds and
assess air movement.
R. To ascertain status and note
progress.
- Evaluate changes in sleep pattern.
goals partially met.
Patient was able to:
a. Maintain airway
patency.
b. Expectorate
clear secretions
readily as
evidenced by
less secretions
retained.

R. To assess changes.
ASSESSMENT DATA
(Subjective & Objective Cues)
NURSING DIAGNOSIS
GOALS AND
OBJECTIVES
RATIONALE
EVALUATION
Subjective:
“Galisud ko ug ginhawa kung
mahago ko” as verbalized by the
patient.
Objective:
- RR=26
- Dyspnea
- Restlessness
- Tachycardia (PR=107
bpm)
- Pale
Impaired gas exchange
related to alveolar-capillary
membrane changes.
a. Participate in
treatment regimen
b. Demonstrate
improve
ventilation.
Independent:
- Monitor vital signs and cardiac
rhythm.
R. To evaluate degree of
compromise.
- Elevate head of bed/position client
appropriately.
R. To maintain airway.
- Maintain adequate I/O.
R. For mobilization of secretions.
- Encourage frequent position
changes and deep-breathing
coughing exercises.
R. To correct/improve existing
deficiencies.
After 8 hours of duty
goals met. Patient was
able to:
a. Participate in
treatment regimen.
b. Demonstrate
improve ventilation.

Dependent:
- Administer medications as
indicated.
R. To treat underlying conditions.
ASSESSMENT DATA
GOALS AND
OBJECTIVES
RATIONALE
EVALUATION
Subjective:
“Nahihirapan akong huminga”
as verbalized by the patient.
Objective:
- RR=26 cpm
- Irritability
- Restlessness
Ineffective tissue perfusion
(cardiopulmonary) related to
impaired transportation of
the oxygen across the
alveolar and/or capillary
membrane.
Within 2-3 hours of care
a. Demonstrate
behaviors/lifestyle
changes to
improve
circulation.
b. Demonstrate
increased
perfusion as
individually
appropriate.
Independent:
-Identify changes related to systemic
or peripheral alterations in
circulation.
R. To assess contributing factors
-Determine duration of problem.
R. To note degree of impairment
-Monitor vital signs
R. To maximize tissue perfusion
-Investigate report of chest pain
R. To note degree of impairment
Dependent:
goals met. Patient
was able to:
a. Demonstrate
behaviors/lifestyle
changes to improve
circulation
b. Demonstrate
increased perfusion as
individually
appropriate.

-Administer medication as ordered
R. To maximize tissue perfusion
ASSESSMENT DATA
GOALS AND
OBJECTIVES
RATIONALE
EVALUATION
Subjective:
“Wala ko’y gana mo kaon sir” as
verbalized by the mother.
Objective:
- Poor muscle tone
- Pale
- Weakness
Imbalanced nutrition, less
than body requirement
related to illness.
patient will be able to
demonstrate progressive
good appetite.
Independent:
-Identify underlying condition
involved.
R. To assess causative factors.
-Identify clients at risk for
malnutrition.
R. to assess contributing factors.
- Discuss eating habits, including
food preferences, intolerance.
R. To appeal to clients like and
dislike.
-Assess weight, age, body build, and
strength of the client.
goals met. Patient
was able to
demonstrate
progressive good
appetite.

R. To evaluate degree of deficit.
Dependent:
-Administer pharmaceutical agents
as indicated.
R. To evaluate degree deficit.

VIII. DISCHARGE PLAN
M- Medication
• Medication includes Amikacin, Cefuroxime, Oxacilin, Furosemide. These
medicines are taken depending on severity and kind of pleural effusion.
E- E xercise
• Teaching breathing retaining exercise to increase diaphragmatic excursion
and reduce work of breathing.
• Teach relaxation techniques to reduce anxiety with dyspnea.
• Augment the patient’s ability to cough effectively by splinting the patient’s
chest manually.
T- Treatment
• Follow strict compliance to treatment regimen given to improve condition
especially medications, diet and lifestyle.
H- Health Teachings
• Keep a list of your medicines: Keep a written list of the medicines you take,
the amounts and when and why you take them. Bring the list of your medicines or
the pill bottles when you see your caregivers. Do not take any medicines, over the
counter drugs, vitamins, herbs or food supplements without first talking to
caregivers.
• To decrease your pain; when coughing, hold a pillow over your chest where
the pain is.
• Quit smoking. Do not smoke and do not allow others to smoke around you.
Smoking increases your risk of lung infections such as pneumonia. Smoking also
makes it harder for you to get better after having a lung problem. Talk to your
caregiver if you need help quitting smoking.
• Drink enough liquids and get plenty of rest. Be sure to drink enough liquids
every day. Most people should drink at least 8(oz.) Cups of water a day. This help
to keep your air passages moist and better able to get rid of germs and other
irritants. You may feel like resting more. Slowly start to do more each day. Rest
when you feel it is needed.
• Exercise your lungs. The discomfort of pleural effusion may cause you to
avoid breathing as deeply as you should. Coughing and deep breathing can help
prevent a new or worsening lung infection. Take a deep breath and hold the breath
as long as you can then push the air out of your lungs with a deep, strong cough.
Take 10 deep breaths in a row every hour that you are awake. Remember to follow
each deep breathe with a cough.
O- Out patient
• Compliance to home medication regimen.
D- Diet
• Ensure adequate protein intake such as milk, eggs, oral nutritional
supplements, chicken, and fish if other treatments not tolerated.

• Advice patient to eat small amounts of high-calorie and protein foods
frequently rather than three daily large meals.

IX. LEARNING EXPERIENCE
Caring is our major responsibility. That’s why we have to treat everyone as such,
despite the consequences we might to commit, that wouldn’t matter. We learned to always
have a presence of mind while on duty.
For all those times, time management best thump us a lot. We learned to adjust and
manage time exactly as possible because when you say you are going to do something,
you have do it right away! You don’t have to wait for the time to come when it’s too late for
you to do such actions. It would be your lose and at the end you’ll realized that you acquire
worse. Another thing is to establish a therapeutic and a trusting relationship to each patient
because that’s one of the ways a person can feel free to open lines communication. And
the best experience we had is to be in one piece, helping each other and persevering.
Regarding this case we chose, we found it out to be enjoyable. We thought we don’t
have enough time focusing on this one especially that we still have other subjects to be
tackled. Surfing the net and printing is money consuming but we still feel happy because
doing these things helps us improved our learning about the disease and makes us think of
possible task that can also be helpful to the patients
At the end, we’re still thankful because God never put us down. All these things
wouldn’t be possible if nobody helps us find ways to finish this requirement. There goes the
time we learned to value our selves, we learned how to be “flexible”, and we learn how to
adjust things somehow. It’s never easy but we have to be with our selves to make things
possible.

X. REFERENCES
BOOKS:
Doenges, M.E., Moorhouse, M.F., & Geissler, A.C, (2002). Nursing Care
Plans Guidelines for Individualizing Patient Care, (6th
ed.). Thailand
Doenges, M.E., Moorhouse, M.F., & Geissler, A.C (2006). Nurse’s pocket
Guide; Diagnoses, Prioritized Interventions, and Rationales. (10th
ed.).
Philadelphia, Pennsylvania
Smeltzer, Suzanne C., RN, Edd, FAAN, & Bare, Brenda G., RN, MSN,
(2004). Textbook of Medical-Surgical Nursing, (10th ed.), Philadelphia
Karch, Amy M. ; 2006 Lippicott’s Nursing Drug Guide, 8th edition.
Lippincott Williams & Wilkins.
Nurses’ Pocket Guide, 10th edition F.A. Davis.
Nursing Care Plans, 7th edition F.A. Davis Doeuger, Moorhouse, Murr.
Patient’s Chart
Black, Joyce M. et. al, Medical-Surgican Nursing: Clinical Management for
Positive outcome. 7th edition. Philadelphia, W.B. Saunders. 2005
Malseed, Roger T. ; Springhouse Nurses’ Drug Guide 2004, 5th edition.
Davis drug handbook, 10th
edition
Drug handbook by Saunders
INTERNET:
http://cpmcnet.columbia.edu/dept/gi/.html
http://digestive.niddk.nih.gov/ddiseases/pubs/_ez/
http://www.angelfire.com/scifi2/lnuphysiology/Blood_Physiology_1.pdf
http://www.drstandley.com/labvalues
http://www.google.com.ph/search
http://www.google.com.ph/search?anatomy&meta=
http://www.merck.com/ l

ACKNOWLEDGEMENT
In behalf of our group, we would like to thank each member
for their unending support and cooperation and for being patient in
making this case study possible.
For the sleepless nights that we have been together, that despite of each our
own differences we were able to stand united through thick and thin..
To our PCI who guides us as we go along in our duties,
Thank you Mrs Helen Yorong.
To our diligent and responsible CI,
who provides us with ample knowledge and skills to make us efficient student
nurses,
and for helping us develop the right attitude while in this rotation.
Thank You so much, Mrs. Maria Rica Adane, RN.
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