Michael Emory NUR 101 / MTCC PNE 2014                                                     Pneumonia       Pneumonia is a very serious infection or inflammation that can manifest one or both of your of your lungs. Many small germs, such as bacteria, viruses, and fungi, can cause pneumonia, however as I understand it, there are two main types Pneumonia; bacterial pneumonia and viral pneumonia. ("Understanding Pneumonia  N.p., n.d. Web. 12 Dec. 2013.)       Bacterial pneumonia can attack anyone from infants to the very old. People who are alcoholics, smokers, debilitated, post-operative patients, people with respiratory diseases or viral infections and people who have weakened immune systems are at greater risk. Pneumonia bacteria are present in some healthy throats. When body defenses are weakened in some way, by illness, old age, malnutrition, general debility or impaired immunity, the bacteria can multiply and cause serious damage. Usually, when a person’s resistance is lowered, bacteria work their way into the lungs and inflame the air sacs and a person’s temperature may rise to as high as 105 degrees Fahrenheit. ("Understanding Pneumonia  N.p., n.d. Web. 12 Dec. 2013.)      Another of the more common types is viral pneumonia. Half of all pneumonias are believed to be caused by viruses. More and more viruses are being identified as the cause of respiratory infection, and though most attack the upper respiratory tract, some of the organisms settle in small air sacs called alveoli and continue multiplying. As the body sends white blood cells to attack the infection, the sacs become filed with fluid and pus - causing pneumonia, especially in children. Most of these pneumonias are not serious and last a short time. Pneumonia coupled with the influenza virus may be severe and occasionally fatal. The virus invades the lungs and multiplies, but there are almost no physical signs of lung tissue becoming filled with fluid. It finds many of its victims among those who have pre-existing heart or lung disease or are pregnant. (Dasaraju, Purushothama - Web. 12 Dec. 2013.)       A pneumonia diagnosis usually begins with a physical exam and a discussion about your symptoms and medical history. A doctor may suspect pneumonia if they hear coarse breathing, wheezing, crackling sounds, or rumblings when listening to the chest through a stethoscope. Chest x-rays and blood tests may be ordered to confirm a pneumonia diagnosis. A chest x-ray can confirm pneumonia and determine its location and extent in the lungs. Blood tests measure white blood cell count to determine the severity of pneumonia and can be used to determine whether the infection is bacterial, viral, fungal, etc. An analysis of sputum also can be used to determine the organism that is causing the pneumonia. Under some circumstances a more invasive diagnostic tool is the bronchoscopy - a procedure whereby the patient is under anesthesia and a thin, flexible, and lighted tube is inserted into the nose or mouth to directly examine the infected parts of the lung. ( Medical News Today -Web. 11 Dec. 2013.)      In the United States, more than 3 million people develop pneumonia each year. Most people with pneumonia recover, but about 5% will succumb to the condition. The initial symptoms of viral pneumonia are the same as influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness. Within 12 to 36 hours, there is increasing breathlessness; the cough becomes worse and produces a small amount of mucus. There is a high fever and there may be blueness of the lips. It can have over 30 different causes this means it is affected in different parts of the body. The main parts are lungs, stomach, and the temperature of the body. If you have pneumonia then you may suffer from fever, chills, cough, rapid breathing, breathing with grunting or wheezing sounds. Some other signs may include: Labored breathing that makes a child’s rib muscles retract (when muscles under the rib cage or between ribs draw inward with each breath), vomiting, chest pain, abdominal pain, loss of appetite. In extreme cases, bluish or grey color of the lips and fingernails.( Medical News Today -Web. 11 Dec. 2013.)      Increased awareness of pneumonia and vigilance in observations and basic nursing care will help nurses to identify possible cases of pneumonia, and facilitate early intervention and better quality of care for patients. Nursing treatment for pneumonia should include oxygen therapy as an essential component of treatment for all patients with pneumonia. Its aim is to maintain their saturations above 93%. Physiotherapy is often beneficial to help teach patients how to breathe properly, control their breathing and good posture to promote good lung expansion. Deep breathing helps to open the air passages in your lungs. Coughing helps to bring up sputum (mucus) from your lungs. You can deep breathe and cough on your own, or with the help of an incentive spirometer. Any signs of dehydration and hypotension should be addressed immediately as good hydration makes it easier for patients to expectorate secretions. Nutrition should also be considered. Many patients with severe pneumonia will experience nausea and therefore have a poor appetite however; their calorific requirement is raised due to the presence of infection. An adequate calorie intake should be sought to enable the body to fight the infection. (“Pneumonia 2: Nursing Practice  Web. 13 Dec. 2013.)      If you develop pneumonia, your chances of a fast recovery are greatest under certain conditions: if you’re young, if your pneumonia is caught early, if your defenses against disease are working well, if the infection hasn’t spread, and if you’re not suffering from other illnesses. The drugs used to fight pneumonia are determined by the germ causing the pneumonia and the judgment of the doctor. After a patient’s temperature returns to normal, medication must be continued according to the doctor’s instructions, otherwise the pneumonia may recur. Relapses can be far more serious than the first attack. Besides antibiotics, patients are given supportive treatment: proper diet and oxygen to increase oxygen in the blood when needed. In some patients, medication to ease chest pain and to provide relief from violent cough may be necessary. The most common place where it occurs is the lungs or the stomach. In 1996 (latest data available), there were an estimated 4.8 million cases of pneumonia resulting in 54.6 million restricted-activity days and 31.5 million bed days. In 2000, there were approximately 1.3 million hospitalizations, 1.3 million emergency room visits, and 63,548 deaths recorded in the United States. ( Foundations of Nursing, White & Duncan, 3rd Edition. 2011.)

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"Understanding Pneumonia - American Lung Association." American Lung Association. N.p., n.d. Web. 12 Dec. 2013. .

Dasaraju, Purushothama V. Infections of the Respiratory System. U.S. National Library of Medicine, 17 Jan. 0096. Web. 12 Dec. 2013. .

Medical News Today. MediLexicon International, n.d. Web. 11 Dec. 2013. .

"Pneumonia." (Inpatient Care). N.p., n.d. Web. 13 Dec. 2013. .

 "Pneumonia 2: Effective Nursing Assessment and Management." Nursing Practice and Peer-reviewed Clinical Research for All Nurses. N.p., n.d. Web. 13 Dec. 2013. .

Brunner and Suddarth's Textbook of Medical Surgical Nursing, 12th Ed. Fundamentals of Nursing, 7th Ed. Clinical Nursing Skills Video Guide, 2nd Ed. Taylor's Clinical Nursing Skills, 3rd Ed. LWW DocuCare One Year Access North American Edition. N.p.: Lippincott Williams & Wilkins, 2013. Print.

Foundations of Nursing, White & Duncan, 3rd Edition. 2011.

Diabetes Mellitus

Michael Emory
NUR 101 / 2014
MTCC PNE
                                                     Diabetes Mellitus
     Diabetes Mellitus is caused by insufficient insulin production or lack of responsiveness to insulin, resulting in hyperglycemia, causing the glucose in the blood not to be absorbed into the cells of the body (high blood glucose levels). There are 2 primary types of diabetes mellitus, Type I (insulin-dependent or juvenile-onset), which may be caused by an autoimmune response, and type II (non-insulin-dependent or adult-onset). Diabetes insipidus is typically due to hormonal dysregulation. (Web. 02 Dec. 2013)
     The muscle cells and other tissues of the body require certain specific levels of glucose and carbohydrates to maintain their normal functions. The levels of glucose absorbed into the bloodstream by the intestines, and the method by which glucose enters the body’s cells, is controlled by the hormone, insulin. The insulin is produced in the pancreas, a gland about the size of a person’s hand that is located behind the lower part of the stomach. ( Web. 01 Dec.2013)
     Diabetes is a disease characterized by excessive urination. An interesting fact, according to The American Heritage College Dictionary; Diabetes is named for one of its symptoms. The disease was known to the Greeks as Diabetes, which was derived from the verb “diabainien”, made up of the prefix “dia” meaning across or apart and the word “bainen” which means to walkor stand. The verb “diabainien” meant “to stride, walk, or stand with legs apart. Its derivation diabetes meant one that “straddles”, which gave rise to it being used to describe a disease involving the discharge of excessive urine.
     Diabetes mellitus (DM) is a chronic metabolic disorder caused by an absolute or relative deficiency of insulin, an anabolic hormone. Insulin is produced in the pancrea sby the beta cells of the islets of Langerhans. Absence, destruction, or loss of these cells causes an absolute deficiency of insulin, leading to Type I Diabetes (insulin-dependent diabetes mellitus [IDDM]). Type I Diabetics must have daily injections of insulin to survive. There is currently no cure for Diabetes. This condition can however be managed so that patients cans live relatively normal lives. Treatment of Diabetes focuses on two goals; keeping blood glucose levels within normal range and preventing the development of long-term complications. Careful monitoring of diet, exercise, and blood glucose levels are as important as the use of insulin or oral medication in preventing complications of Diabetes. Most children with diabetes have IDDM, often referred to as juvenile diabetes, which begins most commonly in childhood and requires a lifetime dependence on exogenous insulin.( William H Lamb)
     Type II diabetes, the most common form of the disease (non–insulin-dependent diabetes Mellitus [NIDDM]), is a heterogeneous disorder, in which the pancreas still has the ability to produce insulin, but the amount is not enough for the body’s needs. Patients with NIDDM have insulin resistance and their beta cells lack the ability to overcome this resistance. The symptoms for Type II Diabetes develop gradually and include; feeling tired or ill, frequent night urination, thirst, blurred vision, possible weight loss, frequent infections, and sores that heal slowly or not at all. Although this form of diabetes previously was uncommon in children, 20% or more of new patients with diabetes in childhood and adolescence now have NIDDM, a change associated with increased rates of obesity. (Mayo Clinic Research, 3-14, 2013. Web. 12-1, 2013)
     Insulin is essential to process carbohydrate, fat, and protein. Insulin reduces blood glucose levels by allowing glucose to enter muscle cells and fat cells and by stimulating the conversion of glucose to glycogen as a carbohydrate store. Insulin also inhibits the release of stored glucose from liver glycogen and slows the breakdown of fat to triglycerides, free fatty acids, and ketones. Additionally, insulin slows the breakdown of protein for glucose production.(Martin,Terry R., 2010. Print)
     Hyperglycemia results when insulin deficiency leads to uninhibited gluconeogenesis and prevents the use and storage of circulating glucose. The kidneys cannot reabsorb the excess glucose load, causing glycosuria, osmotic diuresis, thirst, and dehydration. Increased fat and protein breakdown leads to ketone production and weight loss. Without insulin, a child with IDDM wastes away and eventually dies from diabetic ketoacidosis. Information on mortality rates is difficult to ascertain without complete national registers of childhood diabetes, although age-specific mortality probably is double that of the general population. Particularly at risk are children aged 1-4 years who may die with DKA at the time of diagnosis. Adolescents also are a high-risk group. Most deaths result from delayed diagnosis or neglected treatment and subsequent cerebral edema during treatment for DKA, although untreated hypoglycemia also causes some deaths.(Molitch, Mark E., U.S. National Library of Medicine, 17 Jan. 0090. Web.02 Dec. 2013)
     IDDM complications are comprised of 3 major categories: acute complications, long-term complications, and complications caused by associated autoimmune diseases. Acute complications reflect the difficulties of maintaining a balance between insulin therapies, dietary intake, and exercise. Acute complications include hypoglycemia, hyperglycemia, and DKA. Long-term complications arise from the damaging effects of prolonged hyperglycemia and other metabolic consequences of insulin deficiency on various tissues. While long-term complications are rare in childhood, maintaining good control of diabetes is important to prevent complications from developing in later life. The likelihood of developing complications appears to depend on the interaction of factors such as metabolic control, genetic susceptibility, lifestyle, pubertal status, and gender. Most cases of IDDM are the result of environmental factors interacting with a genetically susceptible person. This interaction leads to the development of autoimmune disease directed at the insulin-producing cells of the pancreatic islets of Langerhans. These cells are progressively destroyed, with insulin deficiency usually developing after the destruction of 90% of islet cells. (Mayo Clinic Research, 3-14, 2013. Web. 12-1, 2013)



Resources:
1) Pediatric Type 1 Diabetes Mellitus Clinical Presentation
Author: William H Lamb, MBBS, MD, FRCP(Edin), FRCP, FRCPCH; Chief Editor: Stephen Kemp, MD, PhD
2) Martin, Terry R. Hole's Human Anatomy & Physiology: Laboratory Manual, Twelfth Edition [by] David Shier, Jackie Butler, [and] Ricki Lewis. New York: McGraw-Hill Higher Education, 2010. Print.
Websites:
3) Molitch, Mark E. Diabetes Mellitus. U.S. National Library of Medicine, 17 Jan. 0090. Web. 02 Dec. 2013. .

4) Staff, Mayo Clinic. "Definition." Mayo Clinic. Mayo Foundation for Medical Education and Research, 14 Mar. 2013. Web. 01 Dec. 2013. .

5) "Diabets.org." Diabets.org. N.p., n.d. Web. 02 Dec. 2013. .

6) "Diabetes." Diabetes. N.p., n.d. Web. 01 Dec. 2013. .