ACKNOWLEDGEMENT

I would like to extend my heartfelt and sincerest gratitude to the following people who
have made this endeavor possible:
First and foremost, i lift my hands to our Lord and creator for providing us with
the physical and mental capability to accomplish the work needed to put together this
case study. For giving me the strength and perseverance to push through despite my
hectic schedules.
To the groups clinical instructor, Mr. Leo Hamed B. Fabre RN, MN for providing me
with the much needed guidance in our clinical experiences. His approachability, patience,
kindness and unwavering support have been instrumental in helping us develop into
better nurses.
To the staff of Northern Mindanao Medical Center ICU department who have been very
kind in assisting me to obtain the needed information for the completion of this case
study. Their generosity with providing us access to the charts is very much appreciated.
To our Head Nurses , Ms. Ann Baldo and Mr. Joseph Ababol for helping and guiding me
all throughout this second rotation and for their sincere support and concerns regarding
the completion of this study.

To God be the glory !

I. INTRODUCTION

Human existence is always associated with complexities. Man itself is a

structured compound. It is with system and subsystems that connect its function
to enable to breath, to move and to think.
-Tolstoy
We, as health care providers, called to the responsibility of promoting health
through providing strategic care to the patients and to be actively involved in the
development of the nursing profession. In addition to the conventional nursing
duties of observing, assessing and recording symptoms and treatments, they
also provide emotional support to patients and their families. In each patient we
care, we tend to provide quality of care as if we are taking our own family
member and at the end of the day The mantra caring is the essence of nursing
will be experienced by our families and our patients as well.
The chosen patient of my case study has a case of Acute respiratory failure
secondary to currently Acquired pneumonia high risk, Coronary Heart
disease,Cardiomegaly severe rhythm, heart failure for pulmonary congestion
secondary to hypoglycemia, diabetes mellitus type 2.

What is Acute respiratory failure? Respiratory failure is a condition in which not

enough oxygen passes from the lungs into the blood. The body's organs, such as
the heart and brain, need oxygen-rich blood to work well.
Respiratory failure also can occur if the lungs can't properly remove carbon
dioxide from the blood. Too much carbon dioxide in the blood can harm the
body's organs.

Both of these problemsa low oxygen level and a high carbon dioxide level in
the bloodcan occur at the same time.
Diseases and conditions that affect your breathing can cause respiratory failure.
Examples include COPD (chronic obstructive pulmonary disease) and spinal cord
injuries. COPD prevents enough air from flowing in and out of the airways. Spinal
cord injuries can damage the nerves that control breathing.
To understand respiratory failure, it helps to understand how the lungs work.
When you breathe, air passes through your nose and mouth into your windpipe.
The air then travels to your lungs' air sacs. These sacs are called alveoli
Small blood vessels called capillaries run through the walls of the air sacs. When
air reaches the air sacs, the oxygen in the air passes through the air sac walls
into the blood in the capillaries. At the same time, carbon dioxide moves from the
capillaries into the air sacs. This process is called gas exchange.
In respiratory failure, gas exchange is impaired.
Respiratory failure can be acute (short term) or chronic (ongoing). Acute
respiratory failure can develop quickly and may require emergency treatment.
Chronic respiratory failure develops more slowly and lasts longer.
Signs and symptoms of respiratory failure may include shortness of breath, rapid
breathing, and air hunger (feeling like you can't breathe in enough air). In severe
cases, signs and symptoms may include a bluish color on your skin, lips, and
fingernails; confusion; and sleepiness.
One of the main goals of treating respiratory failure is to get oxygen to your lungs
and other organs and remove carbon dioxide from your body. Another goal is to
treat the underlying cause of the condition.

Acute respiratory failure usually is treated in an intensive care unit. Chronic

respiratory failure can be treated at home or at a long-term care center.
Each year, 170,000 Filipinos die from cardiovascular diseases, up from 85,000
more than 20 years ago, according to a 2009 study by the Department of Health.
Thats a mortality rate way more than those caused by typhoons that hit the
country every year. Yet, like a thief in the night, cardiovascular disease quietly
sneaks into our homes and hospital beds, snuffing the life out of 19 Filipinos each
hour.
These are the deaths that do not make headlines, but diseases of the heart and
the vascular system have remained the top two causes of death in the country
since 1993.
Coronary heart disease (CHD) is a disease in which a waxy substance called
plaque builds up inside the coronary arteries. These arteries supply oxygen-rich
blood to your heart muscle. When plaque builds up in the arteries, the condition
is called atherosclerosis . The buildup of plaque occurs over many years.Over
time, plaque can harden or rupture (break open). Hardened plaque narrows the
coronary arteries and reduces the flow of oxygen-rich blood to the heart.If the
plaque ruptures, a blood clot can form on its surface. A large blood clot can
mostly or completely block blood flow through a coronary artery. Over time,
ruptured plaque also hardens and narrows the coronary arteries.
Cardiomegaly is the enlargement of the heart. Cardiomegaly is a descriptive term
that is used to refer to the physical finding of an enlarged heart and is not a
disease itself. Cardiomegaly can be caused by a number of different conditions
including diseases of the heart muscle or heart valves, high blood pressure,
arrhythmias, and pulmonary hypertension.
Hypoglycemia, also called low blood glucose or low blood sugar, occurs when
blood glucose drops below normal levels. Glucose, an important source of

energy for the body, comes from food. Carbohydrates are the main dietary
source of glucose. Rice, potatoes, bread, tortillas, cereal, milk, fruit, and sweets
are all carbohydrate-rich foods.
After a meal, glucose is absorbed into the bloodstream and carried to the body's
cells. Insulin, a hormone made by the pancreas, helps the cells use glucose for
energy. If a person takes in more glucose than the body needs at the time, the
body stores the extra glucose in the liver and muscles in a form called glycogen.
The body can use glycogen for energy between meals. Extra glucose can also be
changed to fat and stored in fat cells. Fat can also be used for energy.
When blood glucose begins to fall, glucagonanother hormone made by the
pancreassignals the liver to break down glycogen and release glucose into the
bloodstream. Blood glucose will then rise toward a normal level. In some people
with diabetes, this glucagon response to hypoglycemia is impaired and other
hormones such as epinephrine, also called adrenaline, may raise the blood
glucose level. But with diabetes treated with insulin or pills that increase insulin
production, glucose levels can't easily return to the normal range.
Hypoglycemia can happen suddenly. It is usually mild and can be treated quickly
and easily by eating or drinking a small amount of glucose-rich food. If left
untreated, hypoglycemia can get worse and cause confusion, clumsiness, or
fainting. Severe hypoglycemia can lead to seizures, coma, and even death.
In adults and children older than 10 years, hypoglycemia is uncommon except as
a side effect of diabetes treatment. Hypoglycemia can also result, however, from
other medications or diseases, hormone or enzyme deficiencies, or tumors

II. SIGNIFICANCE OF THE STUDY

Nursing Education: The significance of this study to nursing education is to

further increase and expound knowledge of the students. It also helps to make a
reliable and holistic care plans to improve the quality of life of the client. The
study hastens the opportunity for the students to apply theoretical knowledge to
actual health care settings.
Nursing Practice: This study is significant to nursing practice to further improve
the skills and ability of the nursing students and enhances students capability to
make intelligent actions and decisions in the clinical area. This study also helps
us to attain our goal which is to provide quality care to our client to improve their
quality of life.
Nursing Research: Through having this study, nursing students would be able to
apply their skills in research. Be able to apply systematic and scientific way of
solving problems and discover new ideas that would give answers to the patients
situation. It also a means of revision the kind of therapy we have and a means of
discovering a new technique or methods in dealing and caring of client with this
kind of condition.

III.OBJECTIVES OF THE STUDY

GENERAL OBJECTIVES:
To enhance skills, critical thinking and approach in the practice of nursing and be
able to create accurate knowledge on the risk factors, prognosis, nursing
managements, current trends and incidences of the disease condition that was
chosen, to come up with an inclusive presentation of the disease condition
through proper implementation of the collected information attained throughout
the nursing process.
SPECIFIC OBJECTIVES:
1. To evaluate and use parameters for assessment of a patient with the said
diagnosis
2. To comprehend the disease process with regards to Acute respiratory failure,
coronary heart disease and hypoglycemia. to know the key to a good
outcome in patients with these conditions , its significant effect on the
systemic circulation
3. Interpret the results in the laboratory and diagnostic procedures done with
the patient and the nursing responsibilities before, during and after
procedure.
4. Formulate appropriate nursing diagnosis, with patient centered nursing care
plans.

SCOPE AND LIMITATION

This case study discusses about Acute Respiratory Failure secondary to currently
Acquired Pneumonia high risk , Coronary Heart disease, Cardiomegaly Severe Rhythm,
Heart failure for Pulmonary congestion Secondary to Hypoglycemia Secondary to
Diabetes Mellitus Type 2. It includes essential concepts in relation to said condition
such as the patients profile and health history, nursing assessment and clinical
manifestation, drug study and diagnostic exams. The anatomy and physiology is
also included as well as the pathophysiology with its associated factors. The
medical and nursing management along with the discharge plan and other
relevant data are also being covered.
The scope of the plan covers during the course of duty last July 30-31, 2015 to
August 6-7, 2015. The physical assessment and nursing management cover the
above mentioned dates only cater the clients care. The information given by the
patient. Data gathering about the laboratory results and diagnostic test covers
from July 2- July 29 . This study only encompasses the health condition of a
patient with Acute Respiratory Failure secondary to currently Acquired Pneumonia high
risk , Coronary Heart disease, Cardiomegaly Severe Rhythm, Heart failure for Pulmonary
congestion Secondary to Hypoglycemia Secondary to Diabetes Mellitus Type 2.and
therefore should not be used to generalize any patient with the same condition.

OREMS THEORY OF SELF CARE DEFICIT

Orems initial definition of nursings concern included mans need for self-care
action and the provision and management of it on a continuous basis in order to sustain
life and health, recover from disease or injury, and cope with their effects

Orems general theory of self-care deficit nursing states that a self-care demand
exists when the patient of family members are not able to provide care for him/herself
and those self-care demands can be met by the nurse.

I chose Dorothea Orems theory of self-care deficit because as what I

have observed in our patient, he was unable to care for himself and was very
dependent on his wife to take care of him and on nurses to provide his day-today exercises. With the condition that he is in, self-care is impaired justifying the
need for other people to provide the care. He is on complete bed rest and
combine that with his condition, his ADL scores are limited to assist with person
on every task.