case pres 8 th floor

8/13/2019 Case Pres 8 Th Floor

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Case Presentationof

Bronchial sthmaIn cute Exacerbation

Mapili, Anjelika Eurelle C.Sadol, Bryan C.Zamora, Miguel Rodolfo G.


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General Objectives:To fully learn and understand theunderlying processes involved in BronchialAsthma in Acute Exacerbation, itsetiological process, complications andtreatments for its prevention andtermination.


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Specific Objectives:To identify the process of BronchialAsthma in Acute Exacerbation.To enumerate the signs and symptomsof the disease.To trace the Anatomy and Physiologyof the systems involved.To trace the Pathophysiology of thedisease.To identify the different ways intreating the disease.


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Bronchial asthma is a chronic inflammatorydisease of the airways, associated withrecurrent, reversible airway obstruction withintermittent episodes of wheezing anddyspnea. Bronchial hypersensitivity is causedby various stimuli, which innervate the vagusnerve and beta adrenergic receptor cells ofthe airways, leading to bronchial smoothmuscle constriction, hyper secretion ofmucus, and mucosal edema.


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An acute asthma exacerbation occurs whenthe symptoms of asthma worsen suddenly orover a few days.An acute exacerbation indicates that yourasthma is not well controlled. Controllermedications include inhaled steroids, whichwork by decreasing the inflammatoryresponse.


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The symptoms of bronchial asthma includes:* a feeling of tightness in the chest* difficulty in breathing or shortness ofbreath* wheezing* coughingAsthma triggers may include:* Tobacco smoke* Infections such as colds, flu, or pneumonia* Allergens such as food, pollen, mold, dustmites, and pet dander* Exercise


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PatientsName: AA REYAddress: Balagtas, BulacanAge: 78 Years OldSex: FemaleCivil Status: WidowReligion: Roman CatholicBirthday: December 12,1933Room#: 802Attending Physician: Dr Joselito AtabugMedical Diagnosis: CAP-MNBAIAE

HASCVD-NIFChief complaint: Fever


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History of present illness:3 days PTA, patient complained offever maximum of 38C withproductive cough, yellowishsputum. Persistence of symptomsprompted consult hence admission.


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Past Medical History:The patient said that in her childhood she neverexperienced any major illness and was neverhospitalized before. She has a Type 2 Diabetes andHypertension, she said that sometimes she takessome medicine but she cant recall the name of thedrug because she seldom takes it because of financialproblem. She has a Asthma ever since, her daughterusually buy salbutamol ventolin for her nebulization.She also said that whenever she experienced thosecommon illnesses like fever, cough and colds, flu shejust takes Paracetamol and Neozep. The patient hascomplete vaccines. The patient has no allergies bothon food and medicines.


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Family History:Patients parents both died fromunknown cause Both parents hadHypertension and in her mother sidemost of them had history of Bronchialasthma The patients 2 sons are bothHypertensive. Some of her grandchildrenhave asthma.


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Social History:The patient is non-alcoholic beverage drinker.The patient never tried cigarettes or anytobacco products but the people around herenvironment are smokers like her 2 sons. Thepatient lives with her family and relatives in1 compound. She loves to go outside and talkto her neighbors it is a part of her dailyroutine. Their house is near from thehighway. She is exposed to the air pollutioncoming from the vehicles


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LYDIA HALL AND HER THEORYLydia Hall was born in New York City onSeptember 21, 1906.She promoted involvement of the community inhealth-care issues.She derived from her knowledge of psychiatry andnursing experiences in the Loeb Center theframework she used in formulating her theory ofnursing.The theory contains of three independent butinterconnected circles:

the core,the care andthe cure


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The core is the person or patient to whom nursingcare is directed and needed. The core has goals set byhimself and not by any other person. The corebehaved according to his feelings, and value system.The cure is the attention given to patients by themedical professionalsThe theory contains of three independent butinterconnected circlesthe core, the care and thecure.According to the theory, the core is the person orpatient to whom nursing care is directed andneeded. The core has goals set by himself and notby any other person, and that these goals need tobe achieved.The core, in addition, behaved according to hisfeelings, and value system.


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The cure, on the other hand is the attention givento patients by the medical professionals. The modelexplains that the cure circle is shared by the nursewith other health professionals. These are theinterventions or actions geared on treating or curingthe patient from whatever illness or disease he may besuffering from.It is easy to understand from the model that in allof the circles of the model, the nurse is alwayspresents the bigger role she takes belongs to the carecircle where she acts a professional in helping thepatient meet his needs and attain a sense of balance.


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Pattern ofFunctioning BeforeHospitalization DuringHospitalization Analysis/InterpretationHealth

Perception andManagement

Before hospitalization,the patient tends towalk around the houseas her exercise. Shethinks of health as animportant issue thatshould not beneglected.

During herhospitalization,patient does what sheis told to do. Shefollows what she istold in order to getbetter quicker.

Due to her old agepatient prioritized herhealth very seriously,but could not avoidhaving problems withher body.

Nutritional andmetabolicpattern

Before hospitalization,the patient eats alot of vegetables inher meals. Does notdrink or smoke. Sheavoids oily foods.

During herhospitalization,patient eats what isgiven to her. Thepatients diet is LowSalt- Low Fat diet.

The patient is carefulwith what she eatsand drinks and stayshealthy.

Eliminationpattern

Before hospitalization,the patient urinates3-4 times a day. Anddefecates twice a day.One in the morningand another beforeshe goes to sleep.

During herhospitalization,patients eliminationpattern did notchange.

Patient eliminationpattern is normal.There is no difficultyin both urinating anddefecating.

Activity and


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Activity andExercise pattern

Beforehospitalization, thepatient normallyjust walks aroundthe house, talkingto her neighboursabout the latesthappening in theirlives.

Due to beinghospitalized patientjust stays on herbed, watch tv andtalks to herrelatives.

Due to Patientsold age she doesnot do too muchexercise and usuallyjust sits around.

Sleep and Restpattern

According to thepatient she usuallysleeps around 8 or 9pm then wakes uparound 2 am.

Patient gets moresleep. According toher daughter thepatient gets moresleep because herroom is air-conditioned and it hasmore quiteenvironment.

Patient gets a lot ofsleep during her stayin the hospital.

Role andRelationshipPattern

According to herdaughter, patient isloved by everyonein the family. Sheis very close to herfamily.

Patient was beingtaken care by herfamily. Theycooperate with eachother well andenjoy each others.

Patient has a goodrelationship withher family. Theylove to laugh andjoke around andthey became closer.

Coping stress


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Coping stresspattern

According to herdaughter, whenpatient feels stressshe just talks tothe members ofthe family andthen just forgetsabout what she isstressing about.

During herhospitalization,patient seemedrelaxed. And justuses the televisionto divert herattention to thingsthat stresses her.

Patient greatlyrelies to her familyin coping stress.Usually she justtalks to them andthings get better.There is no changewhen it comes tocoping to herstressors.Cognitive and

Perceptualpattern

According to thepatients daughtershe is not hard totalk to. Sheanswers directlyand with focus.

During ourinterview thepatient was verycooperative andanswers ourquestions clearly.

Patient has a goodsense of perception.She understandsher situation andcooperates wellwith others.

Self perceptionand SelfConcept

Due to patientsold age, she feelsthat she cannot dothe things she usedto do. Such ascleaning the houseand doing chores.

Due to beinghospitalized,patient feels moreof a burden becauseshe cannot help attheir house andnow she has to betaken care of.

Patient does notfeel good aboutbeing hospitalizedbecause she feelsshe is giving herfamily moreproblems.

Sexuality and


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Sexuality andReproductivepattern

Patients menarche was at the age of 14 and was menopauseat the age of 45.

Values andBeliefs pattern

Beforehospitalization, thepatient attendsmass on Wednesdayand Sunday. Goesto church onMonday andSaturday and pray.

During herhospitalization, dueto beinghospitalized shecannot go tochurch or attendmass. But shenever fails to pray.All the time.

Patient is veryreligious andattends massregularly. There willbe no change in herstrong faith nomatter whathappens.


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Area Assessed Technique Normal Findings Findings Analysis


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Area Assessed Technique Normal Findings Findings Analysis

A. SkinColor Inspection Light brown,

tanned skin

(may vary

according to race)

Light brown skin Normal

Moisture Inspection/Palpation

Skin normally dry Skin normally dry Normal

Temperature Palpation Normally warm Normally warm Normal

Texture Palpation Smooth and soft Smooth and softslightly saggy.

Presence of

winkles.

Due to her old age.

Turgor Palpation Skin snaps back Skin snaps back Normal


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Turgor Palpation Skin snaps backimmediately

Skin snaps back

immediatelyNormal

B. SkinAppendages

Nails Inspection Transparent,smooth and convex

Transparent,

smooth and convexNormal

Nail beds Inspection Pinkish Pinkish Normal

Nail base Inspection Firm Firm Normal

Hair distribution Inspection Evenly distributed Evenly distributed Normal

Color Inspection Black to light Black with White hair due


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Color Inspection Black to light

brown

Black with

partly white.

White hair due

to her old age.

C. Upper

Extremities

Arms Palpation Warm to touch

and tenderness

Warm to touch,

no lesionsNormal

Palms and

dorsal surface

Inspection /

Palpation

Pinkish and

slightly rough

Pinkish, slightly

roughNormal

Shoulders Inspection Perform w/o anydifficulty

Can movewithout difficulty.

Normal

Elbows Inspection Perform without

any difficulty

Can bend

without difficultyNormal

Inspection


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skullInspection

Generally round Round Normal

D. Eyes

EyesInspection

Non protruding Visual acuity :20/20

Normal

Eyebrows Inspection Symmetrical insize, extension,

hair texture and

movement

Symmetrical in

size, extension,

hair texture and

movement

Normal

Eyelashes Inspection Evenly distributed Evenly distributed Normal

EyelidsInspection

Same colour as

skinSame colour as

skinNormal

Inspection


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Conjunctiva

Inspection

Transparent with

light pink color

Transparent with

light pink color

Normal

Sclera Inspection Color white Color white Normal

Ears Inspection Free of Lesions,

discharge of

inflammation

Free of Lesions,

discharge of

inflammation

Normal

Hearing acuity Inspection Client normally

hears words when

whispered.

Client normally

hears words when

whispered.

Normal

E. Nose Inspection Nose in the

midline; no

discharges; no

bone or cartilage

deviation noted.

No tenderness

noted; no signs of

any discharges

Normal

F. Neck Inspection No mass or

lumps;

symmetrical; no

No mass or

lumps;

Normal

`Inspection non-tender IF Firm; non-tender


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lymph nodes

p

PALPABLE; less

than 1cm in size.

;

and less than 1cm

in size

Normal

thyroid

Inspection

Normally non-palpable; no nodules

palpable

No nodules present Normal

G. Thorax

Lungs

Auscultation Normal lung tissue

produces resonant

sound, diaphragm

has dull sound.

Wheezing is present

when the patient is

inhaling and

exhaling.

Abnormal breath

sounds due to

bronchial asthma in

acute exacerbation.

H. Cardiovascular

Pulsation

Pulse visible; no lift

or heaves.

apical pulsations is

present

Normal

I. Abdomen Inspection

Skin colour is

uniform, no lesions;

some may havepresence of striae or

No venous

engorgement; no

tenderness noted; nomuscles guarding

Normal


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J. Lower extremities

Inspection

Equal in size; no

edema; no

crepitus

Equal in size; no

edema

Normal


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The upper respiratory tract consists of the nose,sinuses, pharynx, larynx, trachea, and epiglottis. Thelower respiratory tract consists of the bronchi,bronchioles and the lungs.The major function of the respiratory system is todeliver oxygen to arterial blood andremovecarbon dioxide from venous blood, a processknown as gas exchange.The normal gas exchange depends on three process:Ventilation-is movement of gases from theatmosphere into and out of the lungs. This isaccomplished through the mechanical acts of inspirationand expirationDiffusion-is a movement of inhaled gases in the alveoliand across the alveolar capillary membranePerfusion-is movement of oxygenated blood from thelungs to the tissues.


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Control of gas exchange - involves neural and chemicalprocessThe neural system, composed of three parts locatedin the Pons, medulla and spinalcord,coordinates respiratory rhythm and regulates thedepth of respirationsThe chemical processes perform several vital functionssuch as:regulating alveolar ventilation by maintaining normalblood gastensionguarding against hypercapnia (excessiveCO2 inthe blood) as well as hypoxia(reduced tissueoxygenation caused by decreased arterial oxygen [PaO2].An increase in arterial CO2 (PaCO2) stimulatesventilation; conversely, a decrease in PaCO2inhibitsventilation.helping to maintain respirations (throughperipheral chemoreceptor) when hypoxia occurs.


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Name: AA REY Sex: Female


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Date: 8-14-2012 Age: 78 years oldBirthday: 12-12-1933 Room : 802Requesting Doctor: Dr. Joselito AtabugLab. ID: 56096Biochem Result Normal Value Interpretation

Glucose Fasting 8.4mmol/L 3.6-6.1 It is high becausethe patient has

diabetes.

Cholesterol 4.2mmol/L Desirable -- 0-5.2Borderline -- 5.2-

6.2High -- > 6.2

Cholesterol level is

Desirable therefore it

is within the normal

range.Triglycerides 1.72mmol/L Borderline -- 1.7-

2.25High -- 5.64Very High -->5.65

Triglyceride is in the

borderline level. It is

within the normal

range.AHDL Cholesterol 1.53mmol/L 0.901.55 NormalLDL Cholesterol

2.10mmol/L

2.60-4.10

Normal

Test Result Normal Value Interpretation


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Sodium 137mmoL 136-145 Normal

Potassium 3.7mmoL 3.5-3.1 NormalChloride 99mmoL 98-107 Normal

II-Non-FastingBlood Urea

Nitrogen2.6mmol/L 2.5-6.4 Normal

Creatinine 75mol/L 53-115 NormalUric Acid 276mol/L 155-428 Normal


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R l f diff t i fl t h i l di t


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Release of different inflammatory chemical mediators.

Leukotrienes and other

inflammatory mediators.Prostaglandins Histamine, Bradykinin and

other infalammatorymediators

Release of Eosinophils

(To combat allergen)

Opening of the mucosal

intrcellular junction.

Inflammatory process

Mucus production Increase vascular

permeability

Direct stimulation of the

vagal efferent.

Mucus edema Bronchoconstriction Further Edema


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More release of other

inflammatory mediators.

Decrease of ciliary function.

Epithelial damage

Increased airway

responsiveness.

Mucus hypersecretion

Dyspnea, tachypnea and

anxiety.

Wheezing, Continuous

coughing, Feeling of

chest tightness


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Drug Dosag Mechanism of Indicatio Contraindicat Adverse Nursing


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e Action ns ions Reaction Responsibilitie

s

Generic

Name:

Hydrocortisone

Sodium

Succinate

Brand

Name:Solu-

Cortef

Generic

Name:

Cefuroxime Axetil

Brand

Name:

Zegen

100

mg

IVEvery

8

hours

1gram

IVEvery

12

hours

Hydrocortison

e Sodium

Succinate isan

adrenocortical

Steroid with

salt-retaining

properties. Itssynthetic

analog form is

mainly used

for anti-

inflammatoryeffects in

different

disorders in

many organ

systems.

-Allergic

disorder

-Collagendisease

-Disorder

of

endocrine

system-Disorder

of eye

-disorder

of

Gastrointestinal

tract

-Fungal

infections,

systemic; usenot

recommended

Unless

controlling a

drug reaction.-

Hypersensitivit

y to

Hydrocortison

e or any othercomponent of

the product.

Dermatologi

c:

Atrophiccondition of

skin,

impaired

wound

healing, sinulcer.

Endocrine

Metabolic:

Disorder of

ProteinMetabolism

-Advise patient

to avoid

vaccines duringtherapy unless

approved by a

Physician.

-This drug may

causehyperglycemia. -

-Advise patients

to report

difficulties in

glycemic control.-Instruct patients

on prolonged

therapy to report

blurred.

Drug Dosag

e

Mechanism of

Action

Indications Contraindicati

ons

Adverse

Reaction

Nursing

Responsibili


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e Action ons Reaction Responsibili

ties

Cefuroxime

Axetil is a

bactericidalsemisynthetic

cephalospori

n that binds

to essential

target

proteins,thereby,

preventing

the synthesis

of bacterial

cell walls.

-Disorder

of

Respiratory

System

-Disorder

of skin

-Bells

palsy

-Breast

Cancer

-Burn

-Cystic

Fibrosis

-Intrathecal

Administrati

on;

Serious

medical

events have

been

reported

.

Hypersensiti

vity to the

cephalospori

n group of

antibiotics.

Musculosk

eletal:

Fracture of

bone,

muscle

weakness,

Osteoporo

sis

Neurologic

:

Headache,

raised

intracranial

pressure


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Drug Dosag

e

Mechanism of

Action

Indications Contraindica

tions

Adverse

Reaction

Nursing

Responsibilities


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e Action tions Reaction Responsibilities

Generic

Name:

CefuroximeAxetil

Brand

Name:

Zegen

1

gram

IV

Every12

hours

Cefuroxime

Axetil is a

bactericidal

semisyntheticcephalospori

n that binds

to essential

target

proteins,

thereby,

preventing

the synthesis

of bacterial

cell walls.

-Acute

bacterial

exacerbat

ion of

chronic

bronchitis

-Acute

otitis

media

-

Bronchitis

, acute

Secondary

bacterial

infection

Hypersens

itivity to

the

cephalosp

orin group

of

antibiotics.

Gastrointe

stinal:

Diarrhea,

Nausea

and

Vomiting

Reproducti

ve:

Vaginitis

Dermatolo

gic:

Erythema

multiforme

Immunolo

gic:Anaphylax

is,

Hypersens

itivity

reaction

-Obtain a

careful history

before

giving/initiatin

g therapy to

determine

previous use

and reactions

to penicillin or

cephalosporin.

-This drug

may cause

diarrhea,

nausea andvomiting. The

patient should

be monitored

by his/her

watcher.

Drug Dosage Mechanism of

Indications Contraindications

AdverseReaction

NursingResponsibili


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ism of

Action

ns Reaction Responsibili

ties

-Gonorrhea,Uncomplica

ted

-Impetigo

-Tonsillitis

-Pharyngitis

-Assesspatient for

renaldysfunction andadjustaccordingly.

-Observepatient forsigns andsymptomsof

anaphylaxis (rash,pruritus,laryngealedema andwheezing)


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Drug Dosage Mechanism of

Action

Indications Contraindica

tions

Adverse

Reaction

Nursing

Responsibili


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Action tions Reaction Responsibili

ties

Generic

Name:

Salmeterol

Xinafoate

Brand

Name:

Seritide

1 Oral

Inhalatio

n

(50mcg)

BID

12 hours

Apart

Salmeterol

Xinafoate is

a long-

acting beta

(2)-

adrenergic

agonist. It

stimulates

adenylcyclase

resulting in

increased

intracellular

cyclic AMP

level whichin turns

triggers

smooth

muscles

relaxation.

-Asthma

-Chronic

Obstructiv

e

Pulmonary

Disease

-Nocturnal

Asthma

-Allergicasthma

-Cystic

fibrosis

-Use for

asthma

symptoms

without a

long-term

asthma

control

medication

.

-

Hypersens

itivity to

salmeterol

or anycomponen

t of the

product.

Musculos

keletal:

Musculosk

eletal pain

Respirato

ry:

Death

Asthma

Exacerbation of

Asthma

-This drug

may cause

dizziness,

headache,

tremors

and throat

irritation.

-Advise

patient onproper

inhalation

technique,

depending

on the

deliverydevice

used.

attack.


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Drug Dosage Mechanism ofAction


AdverseReaction

NursingResponsibili


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Action tions Reaction Responsibili

ties

Generic

Name:

Ipatropium

Br,

Salbutamo

l /

Albuterol

Sulfate

Brand

Name:

Combivent

, Ventolin

Neb

every 6

hours

-Blocks the

action of

acetylcholineat

parasympath

etic sites in

bronchial

smooth

musclecausing

bronchodilati

on

-Relief and

prevention

ofbronchosp

asm.

-Ihalation:

Treatment

of acute

attacks ofbronchopa

sm.

-

Prevention

of exercise

induced

bronchosp

asm.

-Patients

who is

allergic tothe drugs.

-Patients

with

Hypertropi

cobstructive

cardiomyo

pathy.

- Patients

having

tachyarrhy

thmia.

Musculos

keletal:

Finetremor of

skeletal

muscle.

Nervous

system:

Dizziness,Tremor,

Nervousne

ss and

insomnia.

Cardiovas

cular:

Hypertensi

on,

edema,

palpitation

s and

arrhythmia

- Advise

the patient

to rinsemouth with

water after

using the

nebulizer

to

minimizeDry mouth.


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Drug Dosage Mechanismof Action


AdverseReaction

NursingResponsibili


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of Action tions Reaction Responsibili

ties

Generic

Name:

Metformin

Hydrochlor

ide

Brand

Name:

Glumet-XR

1 tablet

500 mg

OD

Metformin

hydrochlori

de is an

oral

antihypergl

ycemic

agent. It

lowers

both basaland

postprandi

al glucose

levels in

type 2

Diabetespatients

through

several

mechanis

ms:

-Diabetes

mellitus

type 2

-diabetes

mellitus:

Prophylaxi

s

-

Gestational Diabetes

mellitus

-Polycystic

ovary

syndrome

-Weightgain,

Antipsycho

tic

therapy-

induced

-

Hypersens

itiity to

metformin.

-Metabolic

acidosis,

acute or

chronic,

includingdiabetic

ketoacidos

is

Gastroint

estinal:

Diarrhea,

flatulence,

indigestion

and

nausea

and

vomiting.Endocrine

Metabolic

:

Lactic

acidosis

Cobalamindeficiency

-Instruct

patient to

report

signs/sym

ptoms of

lactic

acidosis.

-Patientsshould

take

tablets

with meals

and

extended-release

tablets

with the

evening

meal.


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Assessment

Diagnosis Planning Intervention Rationale Evaluation


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t

Subjective:

ok naman

ako kasoinuuubo pa

rin ako at

minsan

nahihirapan

ako

huminga asverbalized

by the

patient.

Objective:

-Presence of

wheezing

sound at

auscultation

-RR of

25bpm

Ineffective

airway

clearance as

evidenced by

wheezing

breath

sounds.

After 8 hours

of effective

nursing

interventionthe patient will

maintain

patent airway

with clear

breath sound

and the patient

will

demonstrate

behaviors to

improve airway

clearance like

coughing

effectively and

expectorate

her

secretions.

Independent:

-Monitor

Vital signs.

-Auscultatebreathsounds, noteareas with

presence ofadventitiousbreathsounds.

-Adequatelyhydrate thepatient.

-For baseline

data.

-CracklesindicateAccumulation of

secretionsand inabilityto clearairways.

-Systemichydrationkeeps thesecretionmoist andeasier toexpectorate.

After 8 hoursof effectivenursing

interventionthe patienthadmaintainedpatent airwaywith clear

breath soundand thepatient haddemonstrated behaviorsthatimproved herairway. Goalwas met.

Assessment

Diagnosis Planning Intervention

Rationale Evaluation Assessment


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-Teach

and

encourage

the use ofdiaphragm

atic

breathing

and

coughing

exercises.

-If there is

no fluid

restriction,Increase

fluid intake

up to

3000ml/da

y.

-These

techniques

help to

improveventilation

and

mobilize

secretions

without

causing

breathless

ness and

fatigue.

-Hydrationhelps

viscosity of

secretions,

facilitating

expectorati

on

Assessment

Diagnosis Planning Intervention

Rationale Evaluation Assessment


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Collaborati

ve:

-Assist in

administeri

ng

nebulizer

as

indicated.

-

Administer

antibiotics

as

prescribed

.

-These

ensure

adequate

delivery of

medication

to theairway.

-Antibiotic

may be

prescribed

to treat the

infection.

Assessment

Diagnosis Planning Intervention Rationale Evaluation


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t

Subjective:

None

Objective:

-Weakness

-Immobility

Activity

Intolerance

related to

decreaseoxygenation.

After 8

hours of

effective

nursingintervention

the patient

will

participate

willingly in

necessary /

desired

activity such

as deep

breathing

exercises.

-Monitor

Vital Signs

-Note

contributingfactors for

fatigue.

-Assess

emotional or

psychologica

l factors.

-Plan care

with rest

periods.

-Assist

patient to

assume

comfortable

position.

-Providequiet

-For

Baseline

data.

-To identifyprecipitating

factor.

-Stress

depression

may

increase

effect of

illness.

-To reduce

fatigue.

-To maintain

functional

position.

-To reducestress.

After 8 hours

of effective

nursing

interventionthe patient

had

participated

willingly in

the activity

such as

deep

breathing

exercises.

Goal was

met.


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Medication Exercise Treatment Healthteaching

OPD Diet Spiritual


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g

Metformin

Hydrochlori

de 1tablet

500mg ODSeritide

1puff BID

Encoura

ge to do

exercises

dailysuch as

brisk

walking

for

30min.

Instructto do

deep

breathing

exercises

and do

chest uptapping

Combiven

t every

6hours(Ne

b)

Encourag

e oral fluid

atleast 8 to

10 glassesa day

Encourag

e pt to sit

up straight

when there

is a DOBEncourag

e to avoid

persons

with

respiratory

infectionssuch as

cold,cough

,pneumoni

a and

many

others.

Instruct

the patient

to visit the

physicianon the

scheduled

date of

visit

Provide

photocopyof all

laboratory

test taken

during

hospitaliza

tion

Low salt

Low fat

Eat high

fiber foodssuch as

fruits and

vegetables

Avoid

salty foods

such asdried fish,

canned

goods and

bagoong.

Eat fruits

with Vit Csuch as

oranges,

guava and

apple.

Encourag

e not to

lose hope

and pray toGod o a

regular

basis

asking Him

for his

constantguidance

and

blessing

continue to

have

strongfaith.


66/66

case pres 8 th floor

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