Pneumonia case study

Armed Forces of the Philippines Medical Center

Medical Intensive Care Unit

Submitted by:
Santos Llomer Ferdinand D.
Submitted to:
Professor Ephraim Mirafuentes, RN, MAN
Introduction
 Background
 Community-acquired pneumonia (CAP) is
infectious pneumonia in a person who has not recently
been hospitalized. CAP is the most common type of
pneumonia. The most common causes of CAP vary
depending on a person's age, but they include
Streptococcus pneumoniae, viruses, the atypical
bacteria, and Haemophilus influenzae. Overall,
Streptococcus pneumoniae is the most common cause
of community-acquired pneumonia worldwide. Gram-
negative bacteria cause CAP in certain at-risk
populations. CAP is the fourth most common cause of
death in the United Kingdom and the sixth in the United
States. The term "walking pneumonia" has been used
to describe a type of community-acquired pneumonia of
less severity (because of the fact that the sufferer can
continue to "walk" rather than require hospitalization).
Walking pneumonia is usually caused by the atypical
bacteria mycoplasma pneumonia.
 Pneumonia is an inflammatory illness of the lung.
Frequently, it is described as lung
parenchyma/alveolar inflammation and abnormal
alveolar filling with fluid (consolidation and
exudation). The alveoli are microscopic air-filled sacs
in the lungs responsible for absorbing oxygen.
Pneumonia can result from a variety of causes,
including infection with bacteria, viruses, fungi, or
parasites, and chemical or physical injury to the
lungs. Its cause may also be officially described as
idiopathic—that is, unknown—when infectious causes
have been excluded. Pneumonia is a common illness
which occurs in all age groups, and is a leading cause
of death among the elderly and people who are
chronically and terminally ill. Additionally, it is the
leading cause of death in children under five years
old worldwide. Vaccines to prevent certain types of
pneumonia are available. The prognosis depends on
the type of pneumonia, the appropriate treatment,
 Pneumonia can be caused by microorganisms, irritants
and unknown causes. When pneumonias are grouped
this way, infectious causes are the most common
type. The symptoms of infectious pneumonia are
caused by the invasion of the lungs by
microorganisms and by the immune system's
response to the infection. Although more than one
hundred strains of microorganism can cause
pneumonia, only a few are responsible for most
cases. The most common causes of pneumonia are
viruses and bacteria. Less common causes of
infectious pneumonia are fungi and parasites.
Pneumonia is an inflammation of the lungs caused by
an infection. It is also called Pneumonitis or
Bronchopneumonia. Pneumonia can be a serious
threat to our health. Although pneumonia is a special
concern for older adults and those with chronic
illnesses, it can also strike young, healthy people as
well.  It is a common illness that affects thousands of
people each year in the Philippines, thus, it remains
an important cause of morbidity and mortality in the
country.
 There are many kinds of pneumonia that range in
seriousness from mild to life-threatening. In infectious
pneumonia, bacteria, viruses, fungi or other
organisms attack your lungs, leading to inflammation
that makes it hard to breathe. Pneumonia can affect
one or both lungs. In the young and healthy, early
treatment with antibiotics can cure bacterial
pneumonia. The drugs used to fight pneumonia are
determined by the germ causing the pneumonia and
the judgment of the doctor. It’s best to do everything
we can to prevent pneumonia, but if one do get sick,
recognizing and treating the disease early offers the
best chance for a full recovery.
A case with a diagnosis of Pneumonia may catch
one’s attention, though the disease is just like an
ordinary cough and fever, it can lead to death
especially when no intervention or care is done. Since
the case is a toddler, an appropriate care has to be
done to make the patient’s recovery faster. Treating
patients with pneumonia is necessary to prevent its
spread to others and make them as another victim of
this illness.
 To be able for me to present this case, I
gathered the patient's medical history,
psychosocial history, the activities of daily
living before and during his hospitalization
and medical management. The anatomy and
physiology of the affected part, nursing
diagnosis and nursing management are also
discussed for better understanding of his
condition and implement a necessary action
to help the patient recover.

General Objective
At the completion of this case, student/s will be


able to:
 Determine the risk factors that precipitate the
formation of pneumonia from the patient
which can be taken through his health
history and his activities of daily living
before hospitalization.
 Formulate a nursing diagnosis regarding on his
condition.
 Formulate nursing intervention to attain a
good condition and alleviate the existing
problem.
 Promote teaching to patient’s self care to
maintain good health and wellness.
Importance of the study
 A case with a diagnosis of Pneumonia may
catch one’s attention, though the disease is
just like an ordinary cough and fever, it can
lead to death especially when no
intervention or care is done. An appropriate
care has to be done to make the patient’s
recovery faster. Treating patients with
pneumonia is necessary to prevent its
spread to others and make them as another
victim of this illness.

Database
Client profile
Name: Patient LAA
Age: 73 years old

Gender: Female

Race: Brown

Nationality: Filipino

Religion: Roman Catholic

City Address: 78 Brgy. M. Acevida, Sinoluan, Laguna

Marital Status: Widow

Occupation: Business woman

Diagnosis: CAP high risk; HCVD FC II; DM type 2

History
Chief complaint: Difficulty of breathing
History of Present

 Past Medical History
Illness
 Three days prior to  Client was diagnosed
consultation, she before at Philippine
had a productive General Hospital,
cough, moderate Laguna of
grade fever with pneumonia. Client
anorexia and was confined for 3
vomiting, but due weeks and later on
to complaint of continues the
difficulty of medicines as
breathing he was prescribed by the
admitted for further doctor.
monitoring.
 Family Medical History  Social History

 No hereditary disease  As we know client runs

can be attributed a small business as a
from her family. door-to-door sweets.
However, relatives Being a business
from his father side owner, client’s knows
like uncle and cousins
encountered illnesses how to mingle and
such as hypertension. interact with her
Other than the latter, customers. In
no hereditary consideration the
diseases from both of client’s social
his parents are within environment are also
the patient’s good with her
knowledge. relatives and
 neighbors.
Physical Assessment
Body Part Method of Assessment Actual Findings Normal Findings Interpretations

Head Inspection Hair color is gray with some Evenly distributed hair, silky Normal findings
Hair Palpation black hair. Wavy hair. and no infection.
Scalp No dandruff Smooth skull contour,
2. Skin Inspection Pallor
No lesions and masses Varies
smoothfrom light totoned
and evenly deep Pallor in elderly, skin loses
Face
Palpation Rough
palpatedtexture and dry skin, brown;
skin on from
face ruddy pink to its elasticity and wrinkles
slow skin turgor. Secondary light pink. due to decreased collagen
skin lesions noted on left Moisture in skin folds and formation. Skin is also dry
arm and masses palpated on axillae. Skin springs back to and flaky because sebaceous
different parts of his body. previous state when pinched. glands and sweat glands are
less active.
3. Eyes Inspection Pupils are brown in color, Pupil is black in color, equal Normal findings
equal pupils, pale in size, and round. External
conjunctiva eye structures should not
4. Ears Inspection Symmetrical
Grossly normal external
visualpinae, Symmetrical
manifest edema external
nor ispinae Normal findings
Palpation Symmetrical
activity Gross hearing and
sunken; Sclera andpinna
gross hearing,
recoils after itshould
is folded.
5. Nose Inspection Brown in color, no discharge Conjunctiva
Pinkish mucosa, absence be of Sense of smell is still perfect
Palpation or any lesions; white. Normal visions are for his age.
discharges
Able to breathe without 20/20.
No lesions, symmetrical
restriction in both nares. gross smelling
6. Mouth Inspection Pale lips, pinkish gums, no
Palpation abrasions, swelling and
ulceration.
7. Pharynx Inspection Midline pharynx
Palpation No tonsillitis noted
8. Neck Inspection Midline trachea
Palpation Non-palpable thyroids, no
swelling or masses,
coordinated and free range
of motion and movements,
with some difficulty or
discomfort, no nodules.
Uniform pink color lips, Normal findings
slight-pinkish gums, 32 teeth
intact, no swelling, no
Midline
abrasionspharynx
ulceration. Normal findings
Un-inflamed tonsils
Midline trachea Normal findings
Non-palpable thyroids, no
discomforts and has equal
muscle strength- free range
of motions and movements
without discomfort.
9. Chest and Lungs Inspection Irregular breathing pattern Regular breathing pattern Patient’s breathing is
Palpation auscultation (Quiet rhythmic, and altered due to his present
effortless respirations), condition
10. Heart Auscultation No visible pulsations No visible and
Vesicular pulsations, lifts Normal findings
noted. Normal Heart or heaves, S1 usually
bronchovesicular breath
Sounds (S1, S2) on four heardsounds atshould
all sites
beand
audible. Not Assessed
11. Breast and axilla Inspection Not
sitesAssessed
of pericardium sites: Breast
louder atsurface
apicalisarea,
generally
S2
even with the chest wall;
aortic, pulmonic, tricuspid, usually heard at all sites
and apical. smooth
and louderandatintact
baseskin,
of no
inflammation,
heart. no redness
and swelling.
12. Abdomen Inspection No rashes, masses and No rashes, no masses, no Normal findings
Auscultation tenderness with bowel tenderness, with bowel
Palpation sound that carry on every sound that persist for
13. Back and extremities Inspection
Percussion Equal size on both sides
tympany. Equal
every size on both sides Less movements on the
(tympany)
Palpation of the body, no of the body, no right lower extremities due
contractures, to tremors, contractures, to tremors, to age.
firm muscle tone, less firm muscle tone, smooth
movements on the right coordinated movements,
lower extremities, equal equal strength on each
strength on each body body side
side
Diagnostic studies
 Chest x-ray: Identifies structural distribution (e.g., lobar,
bronchial); may also reveal multiple abscesses/infiltrates,
empyema (staphylococcus); scattered or localized infiltration
(bacterial); or diffuse/extensive nodular infiltrates (more often
viral). In mycoplasmal pneumonia, chest x-ray may be clear.
 ABGs/pulse oximetry: Abnormalities may be present, depending
on extent of lung involvement and underlying lung disease.
 Gram stain/cultures: Sputum collection; needle aspiration of
empyema, pleural, and transtracheal or transthoracic fluids;
lung biopsies and blood cultures may be done to recover
causative organism. More than one type of organism may be
present; common bacteria include Diplococcus pneumoniae,
Staphylococcus aureus, ahemolytic streptococcus,
Haemophilus influenzae; cytomegalovirus (CMV). Note: Sputum
cultures may not identify all offending organisms. Blood
cultures may show transient bacteremia.
 CBC: Leukocytosis usually present, although a low white blood
cell (WBC) count may be present in viral infection,
immunosuppressed conditions such as AIDS, and
overwhelming bacterial pneumonia. Erythrocyte sedimentation
rate (ESR) is elevated.
 Electrolytes: Sodium and chloride levels may be low.

Anatomy and physiology
A
 respiratory
system
functions to
allow gas
exchange. The
gases that are
exchanged, the
anatomy or
structure of the
exchange
system and the
precise
physiological
uses of the
exchanged
gases vary
depending on
the organism. In
humans and
other mammals,
for example, the
anatomical
features of the
respiratory
system include
airways, lungs,
and the
respiratory
muscles.
Molecules of
oxygen and
carbon dioxide
are passively
exchanged, by
diffusion,
between the
gaseous
external
environment
and the blood.
Nose
 Air enters through two openings, the external nares or
nostrils.
 Just inside each nostril is an expanded vestibule
containing coarse hairs.
 A midsagittal nasal septum divides the nasal cavity.
 The maxillary, nasal, frontal, ethmoidand sphenoid
bones form the lateral and superior walls of the
nasal cavity.
 The hard and soft palate forms the floor of the cavity.
(The posterior part of the soft palate is the uvula)
 The external portion of the nose is composed of
cartilage that forms the bridge and the tip of the
nose.
 The superior, middle and inferior nasal cochae are bony
shelves that project from the lateral walls of the nasal
cavity.
 The spaces between the conchae are the meatuses.
pharynx
 Is a chamber shared by the digestive and
respiratory systems.
 It extends between the internal nares and the
entrances to the larynx and esophagus.
 A stratified squamous epithelium lines the
pharynx.


The throat of pharynx is divided in three



regions:
 Upper naso-pharynx

 Middle oropharynx

 Lower laryngopharynx


 THE NASOPHARYNX
 Lies superior to the soft palate
 Serves a passageway for airflow from nasal cavity
 It contains the pharyngeal tonsils (adenoids) in
posterior wall, and the opening of the eustaquian
tubes (auditory tube)


 THE OROPHARYNX
 Extends front soft palate down to the epiglottis (base
of the tongue)
 It contains the palatine and lingual tonsils.


 THE LARYNGOPHARYNX
 The narrow zone between the hyoid bone and the
entrance to the esophagus.

 THE LARYNX
 Joins the laryngopharynx with the trachea.
 It consist of cartilage
 It is called the voice box.
 The three main cartilage are: thyroid cartilage (Adams’s apple), epiglottis,
and the cricoid cartilage.
 Other cartilage is: arytenoids cartilage, corniculate cartilage and the
cuneiform cartilage.
 The epiglottis is a piece of elastic cartilages that falls over the opening
(GLOTTIS) during swallowing to prevent ingested food from entering
the respiratory tract.
 The corniculate cartilage are involve the opening and closing of the
epiglottis, and in the production of sounds
 Two pairs of folds span the glottal opening. The ventricular folds (false
vocal cords) are inelastic but the tension in the vocal cords can be
adjusted by voluntary muscle movements.
 During expiration air flowing through the larynx vibrates the vocal cords
(true vocal cords) and produces sound waves.
 Coughing and laryngeal spasms are protective reflex that protect the
glottis and trachea from objects and irritants.
  

 THE TRACHEA
 Extends from the level of the sixth cerebral vertebra, at the base of the
larynx, to the level of the fifth thoracic vertebra.
 is a tubular structure with 4.25 inch length and 1 inch in diameter.
 At its caudal limit the trachea divides to form primary bronchi.
 Lies anterior to the esophagus.
 Along the length of the trachea are 15-20 c-shapes in pieces of hyaline
cartilage (tracheal cartilages)
 The tracheal muscle holds the two sides of the c-shaped c
 Trachea is lined with pseudo stratified ciliated columnar epithelium.  
 The trachea branches within the mediastum, forming the left and right
bronchi.
 (Extra pulmonary bronchi)
 Each bronchus enters a lung at groove, The Hilus.
 Each bronchus branches into increasingly smaller passageway to conduct
air into the lungs.
 The primary bronchi branch into as many secondary bronchi
 (Intrapulmonary bronchi)
 The smallest passageway is the bronchioles.
 THE LUNGS
 is pair of cone shaped organs lining in the pleural
cavity.
 The apex is the conical top of each lung, and the broad
inferior portion is the base.
 Each lung has a hilus, a medical slits as the bronchial
tubes, vascularization, lymphatic, and nerves reach
the lungs.
 Each lining is divided into lobes by deep fissures.
 Right lungs have three lobes and left lungs have two
lobes.
 Left lung is divided by oblique fissure into superior and
inferior lobes.
 Right lung is divided into three lobes (superior, middle
and inferior)
 Superior and middle lobes are separated by a
Horizontal fissure and
 The Oblique fissure separates Inferior and Middle lobes.

 THE PLEURAL CAVITIES
 The thoracic cavity is bounded by the ribcage and the muscular
diaphragm.
 The mediastinum divides the region into TWO PLEURAL CAVITIES.
 The pleural cavity is lined with a serous membrane, THE PLEURA.
 Parietal pleura line the thoracic wall, diaphragm, and
mediastinum.
 Visceral pleura cover the surfaces of the lungs. 
 The alveolar walls are made of simple squamous pulmonary
epithelium.
 Scattered among epithelium are surfactant cells that secretes oil
coating to prevent
 The alveoli from sticking together after exhalation
 Also the alveolar walls are macrophages that phagocytes debris
or potential pathogens.
 Pulmonary capillaries cover the exterior of the alveoli.


Pathophysiology
 GORDONS 11 FUNCTIONAL PATTERN
Areas of Functional Before During Analysis Interpretation
Pattern Hospitalization Hospitalization

Health Perception – Patient LAA is an Patient LAA is now The onset of all Patient LAA cannot
Health Management active business being hospitalized pneumonias is function well with
woman who sells and consider she’s marked by any or all respect to his illness
sweet goods “ube.” not healthy anymore; of the following pneumonia evidenced
As part of her daily She was diagnosed manifestations; fever, by difficulty of
routine she vends her with Community chills, sweats, breathing and fever.
product door-to-door Acquired Pneumonia fatigue, cough, Patient also
in the community. High Risk and had sputum production undergone
She rarely visits the undergone and dyspnea. oxygenation during
barangay health confinement. She (Medical-Surgical confinement.
center for check-ups manifests fever prior Nursing Vol. 2 8th
because she thinks to her confinement Edition by Joyce
that keeping herself and difficulty of Black p.1599)
healthy will prevent breathing. She is
getting illness. expecting to recover
Whenever she has a from his present
free day patient walks condition with the
around their help and support of
community for an her family and the
exercise. health providers
attending to her
needs.
 GORDONS 11 FUNCTIONAL PATTERN
Nutritional - Patient LAA is living Patient LAA is on her “An individual health Nutritional and
Metabolic a healthy lifestyle her low sugar diet status greatly affects metabolic status of
appetite is well. She’s consisting mainly of eating habits and patient LAA has been
Elimination Bowel
fond of eating Bowel
fruits, and vegetables. Elimination is
nutritional status” Bowel
changed slightly to
Patient LAA
different types of Patient LAA important
That’s being served (Fundamentals ofbecause There was a change
her confinement and
defecates 1-2 times a defecates daily.
dishes consisting of in the hospital. Stool urinary
Nursing by Kozier to her medicalof bowel
and bowel in frequency
week without
vegetables, fishes and is brownish in color, movement
p.1178) affects elimination
condition.
experiencing
meats. She drinks normal in amount but your entire
discomfort. Stool
plenty of water is with discomfort.
and physiology. It makes
color brown and
patient takes her Bladder the body pH in
well-formed.
supplement Patient LAA urinates balance and it
Bladder
(Centrum.) 5-7 times daily eliminates body
Patient LAA usually without having toxins with it.
voids 5-7 times a day. discomfort. Urine is Urinalysis is an array
Urine is light-yellow light-yellow in color of test performed on
in color and without without any urine and one of the
any discomfort. discomfort. most common
methods of medical
diagnosis.
(Fundamentals of
Nursing by Taylor,
Lillis)
 GORDONS 11 FUNCTIONAL PATTERN
Activity-Exercise In the morning Patient LAA’s “Individuals who During patient EO’s
patient LAA walks activities in the have inactive confinement, there is
around their hospital are limited lifestyles all who are a limitation and his
Cognitive-Perceptual Patient LAAasisan
community a high Patient LAA’s
only within her room. “When a patient
faced with is There
inactivity wasofa daily
activities change
school graduate.
exercise. At her She present condition
Patient LAA is admitted to a health in cognitive
because of illness or living and a and
can read and
business, she speaks
usually affects her cognitive- agency
activity-intolerance he at
injury are orrisk
she for
is perceptual
disruption inpattern
his in
well
sells and listens
door-to-door perceptual pattern. confronted
due to her condition. many problemswith that terms
leisureofand
stimuli is
recreation
attentively.
goods. After her Her sensory stimuli that are limited
She often lies in bed can affect major body pattern. only to the
work patient LAA perception is limited
and only shifts to a different
systems” in quality environment which is
mingles with her to
chair with the help of and
her hospital room, quantity than
(Fundamentals of that within the hospital
grandchildren. and within the
her relatives to whichby
Nursing he Kozier
or she is area and patient’s
Patient LAA likes hospital
wheneverarea.
she wants accustomed.”
page 1068.) room.
watching television to sit. She talks with (Fundamentals of
shows, listening to her relatives Nursing, 5th ed. By
radio and make whenever she feels Taylor, Lillis, p.906)
conversation with her boredom and
siblings. frequently reads the
newspaper.
 GORDONS 11 FUNCTIONAL PATTERN
Sleep- Rest Patient LAA usually Patient LAA’s “Illness that causes Patient LAA’s sleep
sleeps around 11 pm. sleeping pattern is pain or distress can and rest pattern was
Self-Perception – She drinks her milk Patient’s
Patient LAA is a
disturbedLAA
due to “Events
result in or situations Due
sleep to his
changed present
when she
Self-Concept friendly and happy considers her-self may change the level condition,
before
person. And she use to sick. She nowofthinks
she goes to every 1 hour vital problems. People was admitted to is
there thea
bed; this helps her to signs to be taken. of
who are ill require hospital. Due to herof
self-concept change to the level
socialize with her
fall asleep.
friends She wakes that
in their Coldshe can’tof the
breeze overtime
more sleep illness
than and patient self other
illness and
up early in the function well as of
air-conditioning trauma
normal can
and also effect perception
normal contributingand self
factors.
neighborhood and to
morning
her clientsaround before.
in her 5 am the patient’s room the self-concept”
rhythm and concept due to her
business. Sheroutine
as her daily is a well- also adds as a factor (Fundamentals of
wakefulness is often illness on her age of
determined person and to her difficulty in
and body clock. Nursing
disturbed.by Kozier life. She now thinks
she wants to be happy sleeping. page 959 and 962.)
(Fundamentals of that her activities
and free from anxieties. Nursing by Kozier.7th now are limited.
Her family and relatives
is always there for her ed.)
to give assistance and
support. She wants to
have good health and
live her life to the
fullest.
 GORDONS 11 FUNCTIONAL PATTERN
Role-Relationship Patient LAA speaks Patient’s LAA family “When and illness Patient LAA achieves
Tagalog and clearly is with her during her occurs, roles changes her emotional and
understands English. confinement, they are for both patient and moral support from
She can express her- supportive in giving family.” her families and
Sexuality- Patient
self veryLAA
well.doesn’t
Patient Patient’s LAAneeds
the necessary sees “Sexual response
(Fundamentals of There
friends,are no changes
which will
Reproductive engage in sexuality
is a widower and herself healthy
and wishing the even- involves
Nursing by people’s
Taylor in patient sexuality
help her to cope with
activity
lives withprior
herto her though she’s
patient to not and emotional
be well page 63). and reproductive
her present condition.
husband’s
siblings. Shedeath and sexually
is also to recoveractive
soon. The psychological pattern.
age.
very active and anymore.
patient’s visited by physical and spiritual
socializes with her her friends and makeup, which plays
friends and relatives during her a significant role in
neighbors. stay in the hospital. sexual
satisfaction.”(Funda
mentals of Nursing
by Kozier page 980.
 GORDONS 11 FUNCTIONAL PATTERN
Coping – Stress- When she is anxious During her “According to The patient has outlet
Tolerance patient LAA wants to hospitalization Folkman and to let her feelings of
Values-Belief Patient
be aloneLAAand is a
haves Patient
patient’sLAA
LAAstill
copes “A person’s
Lazarus, values
coping is the Patient LAA
stress out by believes
Roman Catholic, and believe
some rest. When she by with familythat Godandwill influences belief
cognitive and that
interacting withhas
everything the a
she goes to mass
has problems she always help them.
friends with their about human needs, purpose or
behavioral effort to family and friendsa reason,
every
used toSunday with According
communicate support. to her health,
manageand illness, the
specific patient
during take her
visitation
her
and family.
share herThe family they still the practice
external andof health present
internal hours andsituation as a
the ability
patients have
problems to his a great attend mass even behaviors and
demands that are human challenge, and with
of the patient to adapt
value
family and friends. without her, praying
of sense when responses to illness.”
appraised as taxing the supports
on her of her
condition to
it
Shecomes
makesto herself
religion. for patient’s faster (Fundamentals
exceeding ththe of families,
lessen stress. accepted
she
busy like watching recovery. Nursing, the By her condition and she
resources5of Ed.
television or listening Taylor,
person.”Lillis, will seek medical
to radio. LeMone, p. 91)
(Fundamentals of assistance for check-
Nursing by Kozier ups for prevention of
page 1020.) her illness in the
future.
Drug study
Brand Name Generic Name Classification Action Patient’s Dosage Indication Adverse Reaction Nursing
Consideration

Pipracil Piperacillin Sodium Antibiotic Semisynthetic, Adults, IV – 8- Infections due to Rarely, prolonged For IV
Penicillin broad spectrum 6grams/day (125- streptococcus muscle relaxation. administration
penicillin for 200mg/kg/day) in species including reconstitute each
parenteral use. It is divided doses q 6- group A b- gram with at least
not penicillinase 8hrs. hemolyitc 5ml diluent, such as
resistant. Penetrates streptococcus and sterile or
CSF and in the S.pneumoniae bacteriostatic water
presence of for injection. Shake
inflamed meninges. until dissolved.
Inject IV slowly
over a period of 3-5
minutes to avoid
vein irritation.
Administer over 20
to 30 minutes by
intermittent IV
infusion in at least
50ml of dextrose or
saline solution.
Brand Name Generic Name Classification Action Patient’s Dosage Indication Adverse Reaction Nursing
Consideration

Amikin Amikacin Antibiotic Derived from 15mg/kg/day in Maybe use as Suppression of Add 500mg vial
Sulfate Aminoglycoside kanamycin it’s 2-3 equally initial therapy in normal flora of to 200ml of
spectrum is divided doses q8 certain situations the body which in sterile diluents
somewhat to 12 hour for 7- in the treatment turn keeps certain such as NSS of
broader than that 10 days. of known or pathogenic D5W.
of other suspected microorganisms Administer over
aminoglycosides, staphylococci that may cause 30-60minutes for
including serratia disease. kidney and liver adults. Potency is
and damage. not affected if the
Acinetobacter solution turns a
species, as well as light yellow.
certain
staphylococci and
streptococci.
Effective against
both penicillinase
and non-
penicillinase
producing
organisms.
Brand Name Generic Name Classification Action Patient’s Dosage Indication Adverse Reaction Nursing
Consideration

Z-Pak Azithromycin A macrolide 500mg as a single Those who can Give suspension
Anitibiotic antibiotic derived dose on day 1 take P.O. therapy Nausea and atleast 1 hour
Macrolide from followed by in community Vomiting, prior to or at least
erythromycin. 250mg once/daily acquired diarrhea, loose 2 hour after meal.
Acts by binding on days 2-5 for a pneumonia due to stools, abdominal Tablets maybe
to the p-site of the total dose 1.5 c. pneumonia and pain, dyspepsia, taken with or
50s ribosomal grams. s. pneumonia or gastritis, without food,
subunit and may H influenza. flatulence, although increase
inhibit RNA- melena, tolerability
dependent protein constipation, increases with
synthesis by dizziness, fatigue, food. Maybe
stimulating chest pain. taken with milk.
dissociation of
peptidyl t-RNA
from ribosomes.
Rapidly absorbs
and distributed
widely
throughout the
body.
Brand Name Generic Name Classification Action Patient’s Dosage Indication Adverse Reaction Nursing
Consideration

Parvolex Acetylcysteine Reduces the PO. 140mg initial Pulmonary Respiratory: Use nonreactive
Mucolytic viscosity of then 70mg/kg q4 complications of Increase plastic, glass or
purulent and non- hours for a total cystic fibrosis incidence of stainless steel for
purulent of 17 doses. acute broncho- bronchospasm in administration.
pulmonary pulmonary clients with Have suction
secretions and disease such as asthma. Increase available for
facilitates their bronchitis, amount of removal of
removal by pneumonia, liquefied increase
splitting disulfide tracheo- bronchial secretions.
buns. Action bronchitis. secretion, which
increases with must be removed
increasing pH. by suction if
(peak. pH7-9.) cough is
inadequate.
Brand Name Generic Name Classification Action Patient’s Dosage Indication Adverse Reaction Nursing
Consideration

Salbutamol Salbutamol Adrenergic This drug relaxes Nebule Brochodilator Dry mouth, Suction as
bronchodilators the smooth irritated throat, needed.
are medicines that muscle in the dizziness, Assess dyspnea,
are breathed in lungs and opens headache, respiratory rate.
through the airways to lightheadedness,
mouth to open up improve heartburn, loss of
the bronchial breathing. It is appetite, altered
tubes (air used to treat taste sensation,
passages) of the asthma, chronic restlessness,
lungs. bronchitis, anxiety,
emphysema and nervousness,
to prevent trembling, and
exercise-related sweating may
asthma. occur but should
subside as your
body adjusts to
the medication.
Nursing Care Plan
Ineffective airway clearance
Assessment Diagnosis Planning Intervention Rationale Evaluation

"Nahihirapan akong Ineffective airway After 8 hours of nursing Independent: After 8 hours of
huminga.” as verbalized clearance related to intervention client will Assess rate/depth of Tachypnea shallow nursing intervention
by client. increased sputum demonstrate behaviors respirations and chest respirations, and client was able to
production secondary to to achieve airway movement. asymmetric chest achieve airway
Objective: pneumonia as clearance and to display  movement are frequently clearance and
Difficulty of breathing manifested by difficulty patent airway with  present because of displayed patent
Restlessness of breathing, breath sounds clearing  discomfort of moving airway with normal
Changes in respiratory restlessness, changes in and absence of dyspnea.  chest wall and/or fluid in breath sounds and
rate respiratory rate and  the lung. absence of dyspnea.
Effective cough with effective cough with  

sputum production. sputum production.  Decreased airflow occurs

Auscultate lung fields, in areas consolidated with

noting areas of fluid.

decreased/ absent 

airflow and adventitious 

breath sounds. 

E.g.crackles, wheezes. 
 


Assessment Diagnosis Planning Intervention Rationale Evaluation

Elevate head of bed,

 Bronchial sounds
change of position (normal over bronchus)
frequently. can also occur
 consolidated areas.
 Crackles, rhonchi, and
wheezes are heard on
inspiration or expiration
in response to fluid
accumulation, thick
secretions, and airway
obstruction. Lowers the
diaphragm promoting
chest expansion,
aeration of lung
segments, mobilization
and expectoration of
lung secretions.
Assessment Diagnosis Planning Intervention Rationale Evaluation

Assist patient with

 Deep breathing

frequent deep-breathing facilitates maximum

exercises. expansion of the
lungs/smaller airways.
Coughing is natural
self-cleaning
mechanism. Assisting
the cilia to maintain
patent airways.
Splinting reduces chest
discomfort, and an
upright position favors
deeper, more forceful
cough effort,



Assessment Diagnosis Planning Intervention Rationale Evaluation

Demonstrate/help patient Stimulates cough or

learn to perform mechanically clears
activity,e.g. splinting airway in patient who is
chest and effective unable to do so because
coughing while in an of ineffective cough or
upright position. Suction decreased level of
as indicated (e.g. consciousness.
frequent or sustained 

cough, adventitious 

breath sounds, 

desaturation related to 

airway secretions.) 


Assessment Diagnosis Planning Intervention Rationale Evaluation

Force fluids to at least Fluids (especially warm

3000ml/day (unless liquids) aid in

contraindicated, as in heart mobilization and
failure.) Offer warm rather expectoration of
than cold fluids. secretions.
 

Collaborative; 

 Assist with/monitor 

effects of nebulizer 

treatments and other Facilitates liquefaction

respiratory physiotherapy. and removal of

 secretions.
Administer medications as 

in mucolytics, 

bronchodilators, Aids in reduction of

expectorants and bronchospasm and

analgesics. mobilization of
secretions.
Acute pain
Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Acute pain r/t localized After 4 hours of nursing Independent: After 4 hours of nursing
“ Masakit ang dibdib inflammation and intervention the patient Elevate head of the Lowers the diaphragm intervention patient was
ko.” as verbalized by persitent cough will display patent bed. Change in position promoting chest able to display patent
patient. airway and breath frequently. expansion and airway with breath
sounds clearing and  expectoration of sounds clearing and
Objective: absence of dyspnea.  secretions. absence dyspnea.
use of accesory muscle  

dyspnea Assist patient with deep Deep breathing

fatigue breathing exercises facilitates maximum
 expansion of the lungs
 and smaller airways.
 

Demonstrate or help Coughing is a natural



patient learn to perform self-cleaning

activity like splinting mechanism.
chest and effective
cough.



Activity intolerance
Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Activity Intolerance After 4 hours of nursing Monitor vital signs. Serves as a baseline
 After 4 hours of nursing
“Di na ko makatindig related to immobility intervention patient will  data of the patient. intervention patient
ng maayos.” as secondary to measurably increase in   participation in
verbalized by patient. pneumonia as activity tolerance. Encourage patient to To decrease patient’s
 conditioning to enhance
manifested by rest. cardiac rate. ability to perform.
Objective: irritability and facial  

Irritability grimace.  Muscles will rest to

Facial Grimace Limit movement and
 promote strength and
encourage R.O.M. joint motion.
exercises. 

 To establish goal and

 provide positive attitude
Promote wellness and towards the client.
provide emotional 

support in the process. 




Discharge Planning
REFERENCES
Medical-Surgical Nursing Clinical Management for Positive Outcomes by Joyce M. Black and


Jane Hokanson Hawks 8th Edition Volume 1 & 2

Fundamentals of Nursing The Art and Science of Nursing Care by Taylor, Lillis and LeMone 5th


Edition
Nursing 2008 Drug Handbook by Wolters Kluwer | Lipincott Williams & Wilkins


PDR Nurse’s Drug Handbook by George R. Spratto & Adrienne L. Woods



http://www.wikipedia.org/


Yahoo! Search Engine

