:Introduction

A.K 46 year old , Male pt. Religion:muslim from Nablus, weight

,90kg height 180cm, Patient smokes heavily
Upon entering the emergency room (ER) 8/8/2016 he was
suffering from High fever chills , headaches , loss of appetite , pain
, tachycardia . tachypnea . hypotinesion chest pain
A.K was transferred via stretcher to the Male medical ward as a
case of chest infiction with Ischemic heart disease ( IHD )
for further medical management after Taken v/s BP 109/66 HR:82
Temp:39 axillary respiratory rate :21 spo2 :90 and doing CBC.
BUN .CREATININ ).electrolyte(Na.K.Cl) CK(MB) , ECG. chest XRay to assess the lungs, and physical assessment that was
performed by the ward nurse. That no he had a past medical
history with any disease . the cardiac problem was controlled by
applying the physician orders. elevating his O 2 intake decreasing
temp and relieve pain by giving pt 2g morphen . Diagnostic tests
sent to lab

pathophysiology of chest infiction

Chest infections are common, especially after
.a cold or flu during autumn and winter
Although most are mild and get better on their own, some can be
.serious or even life-threatening

Signs and symptoms of a chest infection

:The main symptoms of a chest infection can include
a persistent cough
coughing up yellow or green phlegm (thick mucus),
or coughing up blood
breathlessness or rapid and shallow breathing
wheezing

a high temperature (fever)

a rapid heartbeat
chest pain or tightness

 feeling confused and disorientated

You may also experience more general symptoms of an infection,
such as a headache, fatigue, sweating, loss of appetite, or joint
.and muscle pain
?What causes chest infections
A chest infection is an infection of the lungs or airways. The main
.types of chest infection are bronchitis and pneumonia
Most bronchitis cases are caused by viruses, whereas most
.pneumonia cases are due to bacteria

These infections are usually spread when an infected person

coughs or sneezes. This launches tiny droplets of fluid containing
the virus or bacteria into the air, where they can be breathed in by
.others
The infections can also be spread to others if you cough or sneeze
onto your hand, an object or a surface, and someone else shakes
your hand or touches those surfaces before touching their mouth
.or nose
Certain groups of people have a higher risk of developing serious
:chest infections, such as
babies and very young children
children with developmental problems
people who are very overweight
elderly people
pregnant women
people who smoke
people with long-term health conditions, such
as asthma, heart disease, diabetes, kidney disease, cystic
fibrosis or chronic obstructive pulmonary disease (COPD)

 people with a weakened immune system this could be due

to a recent illness, a transplant, high-dose
steroids, chemotherapy or a health condition, such as an
undiagnosed HIV infection
Neurovascular:
alert and conscious for the time, place and person. He had no problems
with his neurovascular system, he had response to verbal and physical
stimuli and to sounds. He had a great flexion, extension bilateral.
complaining of headache scaled 6/10, related to ISCHEMIC HEART
DISEASE and chest infiction, and giving him antibiotic
(ROCEPHIN) and relieve pain by giving pt 2g morphen medication
as ordered by the physician. He was advised to stay in bed, resting
without any exercises or efforts and without any noises.
Cardiovascular:
A.K., has iregular heart rate of (50-70) beats/min related to hypotension .
bradycardia and chest infection. Sinus bradycardia rhythm that control by
rest and geven concor5 , normal range between 60-100 betas /min.
Palpable radial and pedal pulse. Dorsal pulse was palpable clearly in. The
capillary refill time was less than two seconds in all extremities which
indicate good peripheral tissue perfusion. No edema was noticed in all
extremities.
Her blood pressure ran between 100/65-120/75 mmgh. By auscultation
had normal S1 and S2, was heard clearly.
Respiratory:
chest without scars or redness , respiratory rate was 21 breath
per min, normal range (12-20)it is abnormal related chest
infiction. His Spo2 was 90% after receives oxygen by nasal cannula

2 liters/min to help him enhance his respiratory system and get

more oxygen to the body, normal range (95-100%).. My first
concern is the difficulty of breathing and kill the pain while
breathing , pt. is a heavy smoker but since he was admitted to the
hospital he started to decrease the number of cigarettes he smokes
per day. Bilateral lung sounds were course and diminished at the
bases, Both of his lungs were auscultated, Crackles were heard
related to chest infiction and advised to decrease the exercise and
activity , and drink of fluid, and respiratory status monitored every
2 hours, examined an increase in respiratory status and abnormal
breath sounds , give the comfortable position that allows the
patient to breath , find comfortable environment so that patients
can sleep in peace, the patient at semi-Fowler , intravenous
antibiotics were was started at the first day of admission to include
Roecphine (3th generation cephalosporin). The patients respiration
were 21 per minute at any time in the day. Encouragement use of
spirometr was used to support loosening and expulsion of
secretions . after give the pt o2 and improve position respiratory
rate achived

Gastrointestinal: (10 points)

Abdomen soft, symmetric without scars or distended or redness when
inspection..when auscalate no chrips and normal bowel sound, without
tenderness and He havent pain in deep and light palpate when palpation,
.pt said he dont have constipation, or diarrhea

Urinary: (10 Points)

A.K was voiding normally the whole time in a urinal, spontaneously

without assistance. The urine is yellow in color, clear in appearance, no

evidence was seen in urine analysis revealing signs of infection. The
urine appearance for A.K. pH is normal acidic. Protein, glucose, ketones
and billirubin were negative results. Which is normal. creatinine was 1.1
mg/dL (0.6-1.2),. the Patient urine output was 70ml/hr totaling of
1440ml/24hrs. No any mass around the kidney when assessed indicating
proper functioning, . Her required fluid intake should be 1500-2500
mls/24hrs according to her weight. A.K. urine output was around
70ml/hr., reflecting the healthy functioning of kidneys. The patient intake
and output ratio was (I : 1500 and O:1400 ) was nearly equals, that
reflects no fluids are remains in the interstitial spaces in his body.

In addition, , Upon palpation, no enlargement found around both

.kidneys or gallbladder or any masses
Musculoskeletal: (10 Points)
The pt. can walk on his feet, he has no problem walking so he needed no
assistance to perform his daily activities. But if this walking goes so far
he gets very tired, difficult breathing and unable to continue his walking.
So, he was advised to maintain the bed and get rest to minimize body
efforts that can affect his respiratory could move all of his extremities at
.all direction
Skin: (10 Points)
The skin is neither dry nor moisture but in between, in normal range to

her age. The skin doesn't contain a lot of hair(not hairy). Also there is no
signs for edema. The color of the skin ruddy pink/light pink, which means
the skin is not cyanosed or yellowish or having erythema.

Hematology: (10 points)

CBC or complete blood count was done on admission, the findings as
:follows
Wbc 8800 normal (5-10) but neutrophils is 88 normal range 35-70 and
this ratio related to infiction
Rbc 4.53
Plt 100
Hgb

normal (4.6-6.1)
normal

100-450

normal 13.5-17.5

RBS=135 normal less than 140

ESR =7 normal ( Age/2 +-10)
CRP=100 normal less than 5 the ratio is high related to infection
CK(MB)=1.45 normal=1.39-6.22
Cre=1.2 normal=0.6-1.2
Na 137 normal 135-135 / k=4.2 normal=3.5-5.1 cl=105 normal=98107 mg=2.1 normal =1.6-3.00
NOT:All finding test indicate to infection
Medication

ues
treatment of moderate pain

Said effect

Rout

sores, ulcers,
or white spots on
the lips or in the
mouth

sudden
decrease in the
amount of urine

unusual
bleeding or
bruising

used to treat high

cholesterol muscle pain or

;weakness

used for treating and

Oraly

40mg

Atorv

Oraly

5mg

Co

100mg

Hydroco

2ml

Ra

anxiety

blurred vision

decrease in the
amount of urine

PERF

bradycardia, sleep
disorders,
restlessness

management of mild
to moderate
hypertension and
.angina pectoris
reduces the swelling

doas
100mg

;liver disease
kidney
;disease

IV

oraly

dizziness
headache (may

Oraly

preventing ulcers

be severe);

drowsiness,
dizziness;

sleep problems
(insomnia);

treat pain, and reduce

fever or inflammation ad asthma or

antiplatelet

100mg

Aspirin

Powder
dissolve with
10ml N/S

IV

Ro
(ceftri

;seasonal allergies
stomac
;h ulcers

;liver disease

To reduce the development

of drug-resistant bacteria

Oraly

kidney
;disease

a bleeding or
blood clotting
;disorder

ver, chills, swollen glands,

rash or itching, joint pain, or
;general ill feeling

Endocrine: (10 points)

40year old. He had no family history endocrine development difficulties.
The pancreas, the adrenal gland and the thyroid gland are normal without
any enlargement and no pain the pt. His eyes were assessed and that
indicated no problem in his spleen or in his liver.
psychological/social: (10 Points)
Psychosocial support include emotional support that is
decreased the anxiety and promote rest and control the
number of cigarette smoked per day, comfort. And to takes all the
drugs as A doctor order And to eat diet dont contain any
fat improve breathing pattern by do breathing exercise we

explain and relax the patient don't worry or afraid from

this disease because we can treat it ,pt Communicates
well with others
Pain: (10 Points)
Patient complaining of chest pain related chest infiction. When I asked
his to choose a number out of 10 that describes his pain he said:" 6 this
chest pain is so strong ". but we tray to relieve pain by rest and mediction

Reference: (5 Points)
1. Kozier, B., Erb, G., Berman, A. and Snyder, Sh. (2014).
Fundamental of nursing concepts, process and practice. (9th ed),
Upper Saddle River, NewJersy, Pearson education, Inc.
2. Taylor, c., Lillis,C&LeMone P.(2011) Fundamentals of Nursing:
The Art & Science of Nursing Care (7th . ed.). Philadelphia:
Lippincott.
3. Mayo Clinic staff (2015, March 14) Diseases and Conditions
Pneumonia from: www..mayoclinic.org/diseasesconditions/pneumonia/basics/symptoms/con-20020032.
4. Patient's file. and Interview with the patient on November 2nd for
about 15 minutes asking about his illness