1

CHAPTER I
INTRODUCTION

As common as it may sound, pneumonia (lung inflammation caused by infection)

has affected more than 450 million people annually. It has already become a major cause

of death among all age groups resulting in 4 million deaths (7% of the worlds annual

total). Infections from pneumonia can be acquired in many different places and is

classified according to its places of acquisition, namely: community-acquired pneumonia

(acquired outside health care facilities), hospital acquired pneumonia (acquired inside the

hospital), and health care-associated pneumonia (acquired inside other health care setting

aside from the hospital. However, CAP incidences are higher in intensive care unit

admitted patients rising to 40% of incidences.

Older studies have shown that pneumonia, especially CAP, has been the major

cause of child mortality in every region of the world, which kills more children under five

than AIDS, malaria, and measles combined. But recent studies that have come into

attention, stress out that the impact of community-acquired pneumonia in the elderly

population (people above 65 years of age) is far greater than in other age groups. A study

by Janssens and Krause (2004) explicates that the yearly incidence of CAP in the elderly

has risen to four-times than that of younger populations. Furthermore, their study gives

light to the increase in frequency and severity of CAP in the elderly population. This is

largely explained by the aging of body organs (the respiratory tract, immune system, and

digestive tract in particular) and the presence of comorbidities due to age-associated

diseases. As a result of aging body organs and the presence of infection from CAP, the
 2

elderly people may be at the highest risk for sepsis (a systemic inflammatory response

syndrome), which can progress to severe sepsis (sepsis with organ failure) and then to

septic shock (severe sepsis with hypotension despite adequate fluid resuscitation).

Sepsis is a disease most often caused by other diseases, such as CAP. Among a

number of infection complications that develop from pneumonia or other diseases that

lead to death, sepsis (along with its progressions) has maintained its position as the

primary and most common cause of infection-related death. It has a global incidence of

more than 20 million case per year, with mortality due to septic shock reaching up to 50

percent even in industrialized countries. In the hospital setting, up to 70% of CAP

patients initially have sepsis or may develop sepsis during their hospital stay. In turn,

50% of sepsis cases develop from CAP. Though there is high incidence of each diseases,

there is only a number of studies relating to septic shock resulting from CAP.

This study will focus on the case of a 95 year old female patient whom we called

in the code name Lola. She was diagnosed with septic shock secondary to CAP with high

risk for hypotension and hypoxia.

 3

Objectives of the Study

After 45 minutes of case presentation, the listeners will be able to:

Knowledge

Explain the pathophysiology and etiology of Septic Shock.

Identify the basic and appropriate nursing interventions, treatment plan, and

prognosis of Septic Shock.

Identify the different assessment parameters involving the function of each

system involved.

Skills

Develop active listening skills throughout the presentation.

Interpret laboratory and diagnostic tests related to the case study.
Demonstrate proper use of terms when presenting the case.

Attitude

Exhibit mastery and tact in answering questions about the case.

Develop sympathy and willingness to care for patients with the same or

related case.
Display attentiveness when doing physical assessment to patients with the

same case.

Definition of Terms

Septic shock a potentially lethal drop in blood pressure due to the presence of bacteria

in the blood (medical-dictionary.thefreedictionary, 2016).

 4

Sepsis also called bacteremia, sepsis refers to a bacterial infection in the bloodstream or

body tissues (medical-dictionary.thefreedictionary, 2016).

Community-acquired Pneumonia acquired outside any health care facilities ((medical-

dictionary.thefreedictionary, 2016).

Hypertension an abnormally high blood pressure (Merriam-Websters 11th collegiate

Dictionary, 2015).

Hypoxia a deficiency of oxygen reaching the tissues of the body (Merriam-Websters

11th collegiate Dictionary, 2015).

Pneumonia disease of the lungs characterized especially by inflammation and

consolidation of lung tissue followed by resolution and by fever, chills, cough,

and difficulty in breathing and that is caused especially by infection (Merriam-

Websters 11th collegiate Dictionary, 2015).

Demographic Data

Name: Lola

Age: 95-year-old
 5

Gender: Female

Civil Status: Widow

Address: Purok Gumamela Tibsoc, San Enrique, Negros Occidental

Date of Birth: September 13, 1920

Place of Birth: Pontevedra

Occupation: Retired teacher

Nationality: Filipino

Religion: Roman Catholic.

Admission Date: August 14, 2016 at 9:16pm.

Medical Diagnosis: Septic shock secondary to CAP, high risk of hypertension and

hypoxia

Nursing History

History of Present Illness

 6

On August 14 of 2016, Lola was brought to the Emergency Department with the

chief complaint of a generalized body weakness due to malnutrition and dehydration as

stated by her daughter. While she was there, Lola manifest several episodes of

unmeasured loose watery stools, she was hooked to D5LR. Doctor advise admission to

the Intensive Care Unit.

On August 15, while on the ICU, the patient experienced an episode of seizure

that lasted for 30 seconds. Seizure precaution was already done before and after hand. On

August 16, the nurse noted that she was restless and irritable especially during procedures

that involved pain, like obtaining blood for laboratory test. She kept muttering

incomprehensible words and kept pulling off tubing and wirings attached to her. She was

then restrained because of these. Her Glagow Coma Scale was 10 (E2M5V3).

On August 20, the patient developed inflamed veins related to phlebitis due to

multiple insertion. But because IVTT medications needed to be given, the doctor

suggested IV cut down on left brachial vein. On August 21, repeat hemoglobin test reveal

89 g/L was noted. The doctor ordered blood transfusion and was done the following day

at 2 am.

At around 8 am of August 23, Lolas body temperature increased 39 C. It was

referred to the Resident doctor and an order of Biogesic 500mg was given. Tepid sponge

bath and continuous monitoring of her body temperature was done.

History of Past Illness

 7

At year 2000 patient was admitted to Bacolod Our Lady of Mercy Specialized

Hospital and was diagnosed of myocardial infarction. She was compliant with her take

home medications but had no regular check-up. On March 2009, Lola experienced a

tight, painful aching sensation in her chest and was admitted again to the same hospital

where she was diagnosed again diagnosed with the same diagnosis as of 2000.

On February of 2013, the patient was brought to the eye doctor with a complaint

of difficulty in her vision where she was diagnosed to have cataract. Early on 2015, she

started to gradually lose her appetite and sometimes doesnt eat. She also experienced

dizziness. Because of these, her daughter decided to bring her to a doctor. The doctor

diagnosed her with dehydration and suggested inserting nasogastric tube.

Gordons Functional Health Pattern

Source: Lolas daughter

Health Perception-Health Management

Health conscious gid akon nga mga utod. Gusto nila mapacheck-up kami permi

kay na hadlok na kmi nga galala ang sitwasyon ni nanay, pero kis-a wala na kme

gapacheck-up kay ka mahal, as reported by the patients daughter.

Nutrition-Metabolic Pattern

According to her daughter Sang una makaon pa ni mayo sin nanay, galing sang

sugod nga na stroke siya indi na siya maayo ka kaon. Lugaw lang gina pa kaon ko sa

iya. Pero sugod sang mga 2015, indi nagid sa mag kaon. Te gina pa inom ko lang siya sa
 8

syringe sang Ensur. Subng ya ga NGT na siya, te ako nalang kisa gapakaon siya sa

balay

Elimination Pattern

Sang-una, maka lakat pa siya sa banyo pero gina buligan ko sa. Pero sugod

sang na stroke na siya, ga diaper nasa, as stated by her daughter. Maka pamuson siya

isa kada duwa ka adlaw, pero maka pangihi man sa mayo.

Activity-Exercise Pattern

Gina lagaw-lagaw lang siya nakon sa guwa kisa. Pero subong daw na budlayan

nag gid siya, te ara nalang gid ni siya sa katre ga higda, as stated by daughter

Sleep-Rest Pattern

The daughter stated that Aga pa ni siya ga tulog mga 9:30 pm. Dayun kisa ga

bugtaw-bugtaw siya mga 2 am siguro. Pero aga man siya ma bugtaw. Mga 6:00 am.

Cognitive-Perceptual Pattern

Indi na maayo kabati si nanay kung may gina hambal kami. Dapat tudohon mo

gid hambal. Tapos sang bagu pa siya nag seizure, kisa lang na siya ga kumod-kumod.

Pero subong sang na admit na siya, sagay siya wakal-wakal nga indi ma intindihan, as

stated by her care taker.

Self-Perception/Self-concept Pattern

(Patient is unable to share or describe her self-perception due to her condition.)

 9

Roles-Relationship Pattern

Patay na si tatay. Pero si nanay ara gyapon sa amon. Sang una, sang kusog-

kusog pa siya, ga try man sa bulig-bulig ginagmay. Pero subong, kami naman ang

gaalaga sa iya, as shared by daughter.

Sexuality/Reproductive Pattern

(Patient is unable to describe her sexuality or reproductive pattern.)

Stress Tolerance and Coping Pattern

Si nanay gapangyawyaw gid na siya ya kung mangakig siya, as stated by the

care taker. Ga pangakig ni siya sa mga nurse kun gina hilabtan sa, as stated by her

daughter.

Values and Beliefs Pattern

Permi ni si nanay gasimba sang baskog pa siya. Galing subong, daw mabudlay

nagid siya dalon sa simbahan, amu na sa balay nalang siya, as stated by her daughter.

She added, Kapisan kag uti gid ni siya kung mag ubra siya. Gina hatagan niya gid

value time niya kag gina gamit niya gid sa maayo. Ginahambalan niya gid na kami sang

una nga palangga niya gd kami isa-isa.

 10

Family Genogram
MOTHERS SIDE FATHERS SIDE

UN UN UN UN

UW UN UN UN UN UN UN

SEPTIC SHOCK
UN UN
COL. CA 95YRS. OLD UN

SEPTIC SHOCK
MALE DECEASED - PATIENT FEMALE
95YRS. OLDDECEASED COL.CA Colon Cancer UN - unknown

1
0
 11

CHAPTER II

THE DISEASE ENTITY

Chief complaint: Body Weakness

Medical Diagnosis: Septic shock secondary to CAP, high risk of hypertension and

hypoxia

Introduction of the Disease

Recent studies stress out that the impact of community-acquired

pneumonia in the elderly population (people above 65 years of age) is far greater than in

other age groups. This is largely explained by the aging of body organs (the respiratory

tract, immune system, and digestive tract in particular) and the presence of comorbidities

due to age-associated diseases. As a result of aging body organs and the presence of

infection from CAP, the elderly people may be at the highest risk for sepsis (a systemic

inflammatory response syndrome), which can progress to severe sepsis (sepsis with organ

failure) and then to septic shock (severe sepsis with hypotension despite adequate fluid

resuscitation).

Sepsis is a disease most often caused by other diseases, such as CAP. Among a

number of infection complications that lead to death, sepsis (along with its progressions)

has maintained its position as the primary and most common cause of infection-related

death. It has a global incidence of more than 20 million cases per year, with mortality due

to septic shock reaching up to 50 percent even in industrialized countries. In the hospital

setting, up to 70% of CAP patients initially have sepsis or may develop sepsis during

their hospital stay. In turn, 50% of sepsis cases develop from CAP.
 12

Pathophysiology of the Disease

Invasion of pathogens into lungs

On NGT
Malnourishment
Pneumonia for more than a week 95 years old
Modifable Proliferation of microorganism Non-Modifable

PNEUMONIA Spread of pathogens to systemic vessels

Irritation of respiratory tract

Lung tissue injury

Blood flow to the area

Hypersecretion of mucus Invasion

Permeability Immune response

Productive Cough
Immigration of leukocytes for immune response
Activation of biochemical cytokines and mediators

BP Cardiovascular/ Circulatory
Rapid pulse
System
Cool, pale arms and legs
Pitting edema
Phlebitis
VasodilationCapillary Activation of coagulation system
permeability
Hematoma

Systemic vascular resistance

Difficulty & effortful of breathing Transfer of fluid to extravascular space
Respiratory
System

WBC
Immune System
Hyperthermia Blood pressure
Difficulty in gas exchange
Weakness Muscular System

Lethargic
Nervous System Poor tissue perfusion
SEPTIC SHOCK
Confused
Abrupt change in mental status
Seizure
 13

CHAPTER III

THE MANAGEMENT

Nursing Physical Assessment

Date: August 24, 2016

General Survey:

Lola is a 95-year-old female patient who is restrained on a moderate high back

rest position. She has on an NGT and an oxygen cannula at 2L/min. She is stuporous with

GCS 10 (E2M5V3) but restless and disoriented to time, place and person. She is attached

to a cardiac monitor and a pulse oximeter.

V/S: Temp= 37 39 C PR= 90 120 bpm RR= 16 26 cpm

BP= 50/30 120/80 mmHg O2 Sat = 97 - 99%

HEENT:

She is normocephalic with no lesions or bruises around her head. Cataract is

present in both eyes, sclera is slightly jaundice, symmetric ears, dry and cracked lips and

with no lesions, masses and tenderness.

Extremities:

She looks slightly pale with a slightly cool and dry skin. She has a senile skin

turgor and a presence of lesions on right arm and left leg is noted. She has a seven

millimetre pitting edema on the left arm which last around 2.5 minutes. She has a

capillary refill of less than three seconds. Hematoma is noted on her upper right arm
 14

extending to the chest. Motor function on upper extremities has moderate weakness, and

lower extremities are very weak.

Cardiovascular & Respiratory System:

Tachypneic with use of accessory muscle when breathing. Dull thuds are heard

when the base of the chest is percussed. When auscultated, wheezes can be heard. She

has a productive cough. She has respiratory rates between 16 to 26, throughout the shift.

Her heart rate fluctuates between 90 to 120 beats per minute and in an irregular

rhythm. Her blood pressure also fluctuates between 50/30 to 120/80 mmHg.

Excretory System

She has urinary catheter on with normal urine output throughout the shift. Her

bladder is non-palpable. She defecated only once during the shift and stool is slight wet

and mushy.
 15

Diagnostic Studies Result and Significance

Test: Complete Blood Count Tests Result Result Result Result Unit Normal Value
Specimen: Blood 8-14-16 8-19-16 8-21-16 8-22-16
%
Rationale & Significance: Hematocrit 0.39 0.30 0.27 0.33 0.37 - 0.47

Complete blood count is used to Red Blood

3.94 3.19 2.84 3.59 10^12/L 4-6
Cells
determine the current levels of blood
Hemoglobin 123 99 89 112 g/L 110 - 160
components, to review the overall White Blood
14.00 13.56 10.06 11.58 10^9/L 5 - 10
health of the patient and to diagnose Cells

a medical condition. The test result Lymphcytes 0.11 0.25 0.30 0.07 % 0.25 - 0.35
shows decreased Hct, RBC, HGB Monocytes 0.07 0.07 0.06 0.03 % 0.03 - 0.07
which indicates anemia. There is Eosinophils 0.00 0.04 0.05 0.02 % 0.01 - 0.03
also elevated WBC or leukocytosis,
Basophils 0.00 0.00 0.00 0.00 % 0 - 0.01
which is frequently a sign of an
inflammatory response and most Polys/
0.82 0.64 0.59 0.88 % 0.5 - 0.65
commonly the result of present neutrophils

infection. It also show Tests Result Result Result Result Unit Normal Value
8-14-16 8-19-16 8-21-16 8-22-16

1
5
 16

Indirect Adequate Adequate Adequate Adequate Adequate

platelet

Mean 98.50 93.40 93.30 92.50 fL 86-100

Corpuscular
Volume

Mean 31.20 31.00 31.30 31.20 pg 26-31

Corpuscular
Hemoglobin

Mean 31.20 33.20 33.60 33.70 g/L 31-37

lymphocytopenia or decreased Corpuscular
Hemoglobin
lymphocytes which indicates recent Concentration
infection and neutrophilia, increased
Red cell 15.80 14.40 14.60 15.60
polys, which also indicates bacterial Distribution
infection especially pyogenic Width-
Corpuscular
infection. Low platelet count may Volume
indicate problems in clotting or
Platelet 55.0 80.00 134.00 136.00 G/L 150-450
bleeding. High MCH levels can
indicate hypochromic anemia, which

1
6
 17

Test: Arterial blood Result

Normal
gas Parameters 8/14/1 Significance
Value
6
pH 7.37 7.35- 7.45 Low PCO2 may indicate
Test: Prothrombin Test Result Result Result Result Result Reference Value
Site: Right radial hypocapnia, A low HCO3 can
8/16/16 8/18/16 8/19/16 8/20/16 8/21/16
artery ProthrombinPCO2
21sec 24
17.6sec 35-45 16.0sec
19.0sec mmHg 13.6sec
indicate that there
11-is14
a seconds
Specimen: Blood
Time metabolic condition causing
Rationale: It measures PO2 88 80-100 the blood to be acidic,
Rationale &
the acidity (pH) and
Significance: Index 34.0% 44.5% 39.6% mmHg
51.6% Negative BE indicates base
70.8%
the levels of oxygen
Prothrombin deficit in the blood.
and
time (PT) is carbon dioxide in
a blood HCO3 13.9 21-28 mmHg
INR 1.76 1.48 1.59 1.33 1.13
the blood
test that measures from an
how
long
Test:it Serum
takes blood
artery. to test is usedResult
This
Albumin BE -9.6 Result 0--+2 Result Reference Value
clot.
TestA prothrombin
to check how well the8-14-16 8-17-16 mmol/L 8-21-16
time test can be used 2.1 2.2 2.7 3.50-5.00g/dL (L)
Specimen: Blood
lungs are able to move
toRationale
check for&
bleeding
oxygen into the blood 02Sat 96% 97%
problems.
Significance:
and remove carbon
Low albumin l
dioxide from the O2Ct 17-21 mL/dL
evels can be seen in
blood.
inflammation, shock,
and malnutrition.
They may be seen
with conditions in
which the body does 1
not properly absorb 7
and digest protein
 18

Test: BUN Result Reference Value

Specimen: Blood 8-14-16
121 7.00-20.00 mg/dl
Rationale & Significance: To assess kidney function. Increased BUN indicates
damage of the kidneys.

1
8

Test: Creatinine Result Result Result Result

Reference Value
Specimen: Blood 8-14-16 8-15-16 8-17-16 8-19-16
Rationale & Significance: To assess kidney 2.85 2.72 1.9 1.5 0.70 1.20 mg/dl

function. Increased creatinine indicates damage

of the kidneys.

Test: K (Potassium) Test Result Result

Test Reference Value
Test: Na (sodium) 8-14-16 8-19-16
Potassiu 4.2 4.0 3.50-5.10 mmol/L
Specimen: Blood
m
Rationale & Significance:
154 153.00 137.00 145.00
The test is useful in evaluating cases where kidney
Sodium mmol/L
disease, high blood pressure or heart failure is suspected
and in monitoring the effectiveness of treatment.
 19

Diagnostic: Findings:
X-ray (Chest AP) Examination shows hazy infiltrates in both lower lungs.
Diagnostic: Urinalysis Physical Microscopic Epithelial Chemical Remarks:
Date: 08-14-16 True Cardiac size is not ascertained.
Date: 08-15-16 Cells Cells 1
Specimen: Urine
AortaColor:
is Tortuous Straw Pus cells: Squamous: Protein: (-) RBC 9
Significance: OtherTransparency:
chest structures are not4-8/HPF
Hazy remarkable. Occasional Sugar: (-) Morphology:

Urinalysis is a test that evaluates a Volume: 40mL Ketones: (-) 90% Normal
Spec. Grav.:
Impression: 1.015 RBC: Blood: (+) 10% Crenated
sample of your urine. Urinalysis is used to detect and
pH reaction: 5.0
lungs15-20/HPF Amorphous
Pneumonia, both lower
assess a wide range of disorders, such as urinary tract Urates: (+)
True Cardiac size is not ascertained.
infection, kidney disease and Bacteria:
Atherosclerotic Aorta
Diagnostic: Findings: -++
diabetes. Urinalysis involves examining the
X-ray (Chest AP) Follow-up examination after 8-14-16 shows partial clearing of the hazy
appearance, concentration and content of urine.
Date: 8-19-16 infiltrates in both lower lungs.
Heart and other chest structures are almost the same.

Diagnostic: Parasitology Test Physical Remarks

Date: 8-15-16 Color: Yellowish Brown No Intestinal Parasites seen
Specimen: Stool Consistency: Soft
Significance: Parasites: (-)
Test to determine the presence of parasites in the Amoeba (-)
stool or in the intestines.
20

2
0
 21

2
Drug Studies
1
Generic Drug
Drug Drug
Name: Mechanism of Action Side/Adverse Nursing Interventions (Rationale)
Indication Contraindications
Norepinephrine Effect
Restoration Stimulates alpha- Stimulates alpha- Headache; 1. Advise patient to notify nurse if IV 22
Brand Name: of BP in receptors in arterial and receptors in arterial dizziness; site feels cool or painful.
Levophed
certain venous beds and beta 1 and venous beds tremor; 2. Instruct patient to report the
Drug Dosage: acute receptors of heart, and beta 1 receptors insomnia; following symptoms to health care
40g/OD
hypotensiv resulting in peripheral of heart, resulting anxiety. provider: dizziness, nausea, syncope,
Drug Route: e states; vasoconstriction and in peripheral Metabolic abdominal pain, chest pain or
IV adjunct in stimulation of heart rate vasoconstriction acidosis; confusion.

Drug treatment and contractility. and stimulation of hyperglycemia 3. Caution patient to avoid sudden
Classification: of cardiac Coronary vasodilation heart rate and position changes to prevent
Vasopressor
arrest and occurs secondary to contractility. orthostatic hypotension.
profound enhanced myocardial Coronary
hypotensio contractility. vasodilation occurs
n. secondary to
enhanced
myocardial
contractility.

Generic Drug
Drug Drug
Name: Mechanism of Action Side/Adverse Nursing Interventions (Rationale)
Indication Contraindications
Omeprazole Effect
Brand Name: GERD/mai Binds to an enzyme on Hypersensitivity, Dizziness, 1. Asses routinely for epigastric or
ntenance of gastric parietal cells in metabolic alkalosis, drowsiness, abdominal pain and occult blood in
Drug Dosage:
40mg/OD healing in the presence of acidic and hypocalcemia fatigue, stool, emesis, or gastric aspirate.
2. Administer on empty stomach, as
erosive gastric pH, preventing headache,
Drug Route: least 1 hr. before a meal.
esophagitis the transport of weakness,
IV 3. If administered through NGT,
hydrogen ions into the chest pain, 2
suspend with 20ml water 2
Drug gastric lumen constipation,
Classification:
Proton-pump diarrhea,
inhibitor vomiting, 2
itching, rash 3
2
3
2 2
4
 23

Nursing Care Plan

3
1
3
2
 CUES NURSING EXPECTED INTERVENTION RATIONALE Evaluation
DIAGNOSI OUTCOME
S
Subjective Fluid Volume After 8 1. Monitor vital signs 1. BP may be high because Goal partially 24
ga halabok na excess r/t hrs. of 2. Auscultate breath of excess fluid met after 8hrs
ang kamot ni sodium nursing sounds 2. For presence of crackles of nursing
nanay as retention as interventio 3. Review laboratory data and congestion interventions
verbalized by SO manifested ns the 4. Monitor I and o strictly 3. To evaluate degree of the patient still
Objective: by presence patient 5. Elevate edematous fluid and electrolyte has edema but
Edema + 4 of edema in Regain extremities, change imbalance and response fluid volume is
present on left left upper fluid position frequently to therapies stabilized, and
arm extremity balance, as 6. Apply ice compress on 4. So that adjustments can edema
evidenced edema be made in the following decreases from
by 24 hrs. intake if needed grade 4 to
decreasing 5. To reduce tissue pressure grade 3.
edema, and and risk of skin
normal breakdown
vital signs. 6. To reduce swelling

References: Doenges, M. (2015). In M. Doenges, Nurse's pocket Guide 13th Edition. C&E publishing. INC.

CUES NURSING EXPECTED INTERVENTION RATIONALE Evaluation

DIAGNOSI OUTCOME
S
Subjective: Self- care After 8hrs of 1. Determine age and 1. It affects ability of Goal met after
ndi na kaya ni deficit: nursing development issues individual to participate 8hrs of nursing
nanay mag giho, (bathing, intervention 2. Collaborate treatment of in own care intervention
nabudlayan nag toileting, the patient underlying conditions 2. To enhance clients patient is able
gid sa as dressing, can maintain 3. Perform or assist in capabilities, maximize to meet her
verbalized by SO feeding, hygiene and patients needs rehabilitation program ADL and
toileting) r/t be assisted in 4. Bathe or assist client in 3. To assist patient in ADL maintain proper
Objective: weakness, her ADL bathing, providing for 4. Type and purpose of bath hygiene 3
Immobility fatigue, (activities of any or all hygiene needs is determined by 3
Generalized daily living) as indicated individual need
weakness 5. Dress client or assist in 5. Client may need
Old age (95 yrs dressing assistance in putting on or
old) taking off items of 3
 25

Discharge Plan

Nursing Goals Nursing Action Rationale

MEDICATION After discharge patient will comply with
the medication treatment & demonstrate
understanding of the purpose of her
medication in relation to her recovery.
EXERCISE After discharge patient will improve
function as tolerated and as prescribed by
the doctor.
THERAPHY/ After discharge patient will be compliant
TREATMENT to the therapy and treatment.
HYGIENE After discharge patient will, maintain
good hygienic practice
OUT-PATIENT After discharge patient will attend follow-
up check-ups, as scheduled
DIET After discharge patient will continue to
adhere in following good nutritional
intake and as prescribed by the doctor.
Explain mechanism of action of To give more knowledge
medication and understand the
Explain side effects that the patient medications
may experience To prevent complications
Instruct SO to continue nebulization To raise awareness of
of Bacillus Clausii Erceflora, 5 mL possible side effects
Instruct SO to assist patient in To prevent possible injury
activities of daily living. and falls
Instruct SO to assist patient in
positioning, toileting, ambulating
Instruct SO how to massage the To improve health while at
patient. home.
While patient is still bed rest, instruct To prevent sores
SO to change position every 2 hours.
Instruct SO to assist patient TSB To prevent sores
Maintain proper hygiene To prevent infection caused
Maintain proper oral care by bacteria
To prevent accumulation of
secretions
Follow up check-ups as schedule Monitor recovery progress
Assist during oral tube feeding To prevent complications
feedings To have proper time
Remind proper time and amount as management for feedings
prescribed

3
7
 26

SPIRITUAL Patient and family will continue to Reinforce going to church and Strengthen coping through
believe on the power of the Almighty attending of proper meeting of SO spirituality
God as the source of life.
 27

CHAPTER IV

GENERAL EVALUATION OF THE STUDY

Implication of the Study

To Nursing Practice:

This study aims to encourage the students and practitioners in the field of nursing

to become competent and compassionate in caring for their patients resulting to the

collaboration of treatment, implementation of care, and to provide proper teachings

regarding their diseases and establishment of rapport.

To Nursing Research:

This study will give additional insights and can be used as reference for future

researches about cardiogenic shock. Through these researches, the efficiency and quality

of nursing care to patients with cardiogenic shock will be further enhanced.

To Nursing Education:

This study aims to be of help to the nursing educators and students for an in-depth

understanding of cardiogenic shock in the clinical area.

 28

Personal Reaction

To care is the heart of the nursing profession and real nurse must have a real

heart also when implementing this four-letter word. As what they say, we care from the

womb to tomb. It means we see two different meanings of tears: the tears of joy when

a new offspring was born and the tears of grief when someone will rest in their last bed.

As a nurse, it is very difficult to handle this because we have no emotional training in our

schools. We also rejoice when there is life and also grieve when someone will surrender

their last breath. As I can say, in all the experiences I have encountered in my nursing life,

being human is not a mistake and being a real nurse is a great blessing and worth

remembering to the patient. EJ Albert Guerra

In the process of completing this case study, it helped me to be effective and

productive. I will take it as my top priority to improve my future case studies and also

help in research purposes.

Another important part of my learning is unity with my team. We need to build

trust in order for us to finish our case study. Also, we learn a lot of things during our

defense proposal. We learned a lot and it was also a big help for us.

In conclusion, I can say that I am completely engaged and excited about what I

have started and look forward to learning more. Maebelle Gelbolinga

To achieve success, we have to dream. To achieve our dream, we have to do.

Doing this study is a stepping stone for us to be successful. Rene Ryan Paul K. Inapan
 29

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