Nursing Care of Severe Leptospirosis with Ventilator–Associated Pneumonia (VAP) : Case study 2 case

Abstract

Background : SevereLeptospirosis isone of illness that impact on human life. Signs and symptom of Leptospirosis patient will start with jaundice, bleeding in eyes and internal organs, splenohepatomegaly, kidney failure, meningitis,and heart failure. Furthermore, hypoxia reveal in respiratory system. Consequently, patient need ventilator extensively, then, Ventilator-Associated Pneumonia (VAP) is a severe complication eventually. As a result, length of stay, cost, and mortality rate will be increasing.

Objective : To study nursing care of Severe Leptospirosis with Ventilator-Associated Pneumonia (VAP).

Methods : The research aimed to compare the study of two cases of severe Leptospirosis with VAP that was hospitalized at Medical Intensive Care Unit, Mahasarakham Hospital from July-September 2018. The research instrument consisted of the data record,interview and observation. The analysis focused on to compare health pattern, pathology, sign and symptom, treatment, problem and nursing diagnosis, nursing care in crisis period, continuum care period, and discard plan.

Result : To compare two cases of severe Leptospirosis with VAP.
Case 1 : A female 70 –year-old, was brought to hospital with chief complaints as four days fever with chillness, melena, pale, and dizzy. She needed ventilator for 44 days. Diagnosis: Weil syndrome, acute respiratory failure, adrenal insufficiency, septic shock, acute thrombocytopenia, UGIB, DIC, VAP, DM type 2, and hypertension.
Case 2 : A male 26 –year-old, was also brought to hospital with chief complaints as fever, distension about three days, jaundice (yellow eyes and body), fatigue, and headache. He was on respirator for 14 days. Diagnosis: acute respiratory failure, septic shock, acute renal failure, thrombocytopenia, hepatic
jaundice, alveolar hemorrhage, and VAP.

Conclusion : The study found that severe leptospirosis needed ventilator for a long time in order to maintain ventilation and perfusion sufficiently, until be off the crisis period and return to normal, or complications become minimized. Thus, health care team has to aware about VAP prevention guideline accurately and continuously, in order to decrease cost, length of stay, and safe from complications, then, the patient will be able to live as normal.