Pneumonia

1
INTRODUCTION
A. OVERVIEW
Pneumonia is an inflammation of the pulmonary parenchyma, is common in
childhood, occurring more frequently in infancy and early childhood. It is also called
Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our health.
Clinically, pneumonia may occur either as a primary disease or as a complication of
another illness.
Pneumonia is treatable and preventable. However, delays in recognizing
pneumonia and accessing appropriate care, as well as missed opportunities for
immunization, contribute to pneumonia mortality.
Major risk factors for developing pneumonia are:
A weakened immune system due to malnutrition or undernourishment
(especially in infants not exclusively breastfed)

Environmental factors including indoor air pollution (cooking/heating with
wood, dung, or other biomass fuels), living in crowded houses and parental
smoking
2
INTRODUCTION
TRANSMISSION
Pneumonia can be spread by:
Inhalation of viruses and bacteria that are commonly found in a childs nose or
throat
Inhalation of contaminated airborne droplets from someone elses cough or
sneeze
Bloodstream infections
In newborns, contact with organisms in the birth canal or contaminated
substances contacted during delivery
GENERAL SIGNS AND SYMPTOMS
Fever
Cough: unproductive to productive with whitish sputum
Breath sounds: rhonchi or fine crackles
Chest pain
Nasal flaring
Pallor to cyanosis (depends on severity)
PREVENTION AND CONTROL
Public health interventions to prevent pneumonia include:
Immunization against pathogens that directly cause pneumonia (S. pneumonia
and H. influenza type b) and pathogens that lead to pneumonia as
complication of the infection (e.g. measles and pertussis)

The most important available vaccines to prevent pneumonia are
pneumococcal conjugate vaccine, Hib vaccine, measles and pertussis
vaccine
3
INTRODUCTION
Adequate nutrition to improve natural defense and strength of respiratory
muscles (which aid in clearance of secretions)

Exclusive breastfeeding for the first six months of life
Zinc supplementation
In children infected with HIV, the antibiotic cotrimoxazole is given daily to
decrease the risk of contracting pneumonia
Reference: Marilyn J. Hockenberry and David WilsonWongs Nursing Care of Infants
and Children 10th edition (2015)
Reference:WHO surveillance contact: haiyanops@wpro.who.int)
Reference:http://www.wpro.who.int/philippines/typhoon_haiyan/media/Pneumonia.pd
f?ua=)
B. STATISTICAL DATA
Local
According to the latest WHO data published in may 2014 Influenza and Pneumonia
Deaths in Philippines reached 51,889 or 9.95% of total deaths. The age adjusted
Death Rate is 90.40 per 100,000 of population ranks Philippines #46 in the world.
4
INTRODUCTION
International
Pneumonia remains the leading infectious cause of death among children under five,
killing 2,500 children a day. Pneumonia accounted for 15 per cent of all under-five
deaths and killed 920,000 children in 2015. Most of its victims were less than 2 years
old.
C. SCOPE AND LIMITATION
The patient was confined on October 10, 2016. On the 3 rd day of
confinement, it was Thursday, October 13, 2016. The student nurses handled the
patient at 6-2 shift with an IVF of D5 0.3 Na Cl 500 cc, 35 drops per minute inserted
to right cephalic vein, with productive cough.
The coverage of the duty was Nurse Patient Interaction/Interview, Head
to Toe Physical assessment, IV regulation, monitoring and recording vital signs,
monitoring of intake and output, drug administration by oral route, studying IV
medication in Pediatric Ward at Laguna Provincial Hospital, San Pablo City, under
Mrs. Minerva Granada R.N., M.A.N.
After the patients confinement, the group decided to conduct a home visit
for further assessment and to observe the patients progress at November 17, 2016 in
Purok 5 San Antonio San Pablo City, Laguna. During the duty and home visit, the
students doesnt encounter any problems in gathering data and information about the
patient since they had explained to the parents of the patient the purpose and motives
very well and as a result, they had willingly participated all throughout the interview.
D. BACKGROUND OF THE STUDY

5
INTRODUCTION
In their case pneumonia, this is related to their subject/course. Nursing Care
Management 101.They want to implement and apply all the learnings and skills which
they acquired in their lectures taught by their clinical instructors. The student nurses
chose Pneumonia in a 1 year old, because it focuses on the disease of the child. Also
to enhance their critical thinking in analyzing their case and their decision making
skills on what proper nursingintervention they should implement. Lastly, to have
additional information about the case and to further understand the normal
physiology, disease process, clinical manifestation, nursing intervention, prevention
and control.
The following are the objectives of this case study:
General Objective:
At the end of the case study, the Level II nursing students will be able to understand
and gain knowledge about patient diagnosed with Pneumonia Moderate Risk.
Specific Objectives:
As supported by the main objective, the level 2 student nurses will be able to:
1. Utilize the nursing process in the case of the patient
Thoroughly assess the patient about her health condition through interacting
with the parents, physical examination and interpretation
Identify actual and risk nursing diagnosis
Plan appropriate nursing intervention with patient and family for identified
nursing diagnosis
Implement plan of care with the patient and family
Evaluate the progress of the patients condition and outcomes of care
2. Ensure a well organized and accurate documentation system.

6
INTRODUCTION
3. Relate with patient and his family and the health team appropriately.
Hospital No.: 192733
Patients Name: Baby CB
Address: Purok V, San Antonio II, San Pablo City, Laguna
Gender: Female
7
INTRODUCTION
Birthday: June 27, 2015
Age: 1 year old
Birthplace: Tiaong, Quezon
Nationality: Filipino
Civil Status: Child
Religion: Roman Catholic
Allergies: No known allergies
Admitting Time: 5:30 pm
Admitting Date: October 27, 2016
Admitting Diagnosis: Pneumonia, Moderate Risk
Final Diagnosis: Pneumonia, Moderate Risk
Admitting Physician: Lynn B. Quainzon, M.D.
Chief Complaint: Shortness of breath, Difficulty of Breathing,
Cough & Cold

8
PATIENTS HISTORY
A. Present History
According to the patients mother baby CB was still experiencing fever,
cough, and colds since October 9, 2016, she observed that the chest expansion has
more effort, abdominal distention, and she thinks that the patient has Difficulty of
Breathing. She said that, hindi siya makatulog tapos iyak ng iyak, tapos hindi rin siya
makaiyak ng tuloy tuloy kasi nakikita mo na nahihirapan siyang huminga at merong
parang plema dun sa dumi niya.
The mother also verbalized that she thinks patient CB acquired this illness
from her grandmother and she also thinks that infants and toddlers are prone to
acquire harmful microorganisms from environment.
Ang tagal na nung sakit niya, nakaka-ilang lingo naring nakakalipas, kasi
nung una, lagnat at sipon lang, tapos hanggang sa dalhin ko sya sa mga lola niya,
lalong lumala tapos napadala na sa ospital pagka-isang lingo, kaso masyadong mahal
doon sa ospital nayun, kaya umuwi na kami, tapos hanggang sa nahirapan na talaga
siya huminga, dinala ko nalang siya sa District Hospital.
The mother gave ASCOF Lagundi 1/2 tsp two times a day since the illness
perceived on the night of October 8, 2016.
On October 9, 2016, the day before baby CB admitted to San Pablo District
Hospital, baby CB had fever, cough, and cold that lasted until the day after the student
nurses duty that was on October 13, 2016. On the night where the illness perceived,
the mother also gave Neozep Forte 2 mL for every 6 hours. At October 10, 2016,
exactly 5:30, the client was admitted in the Pediatric Ward with Chief Complaints of
Difficulty of Breathing accompanied with Fever, Cough and Cold. Patient CB was
diagnosed with Pneumonia, Moderate Risk.

9
PATIENTS HISTORY
The client had Intravenous Fluid (D50.3NaCl) 500 mL, 35 micro drops per
minute that was run for eight hours. Intravenous fluid is necessary to supply fluid,
especially toddlers, because they tire so easily with sucking and the patient cannot
achieve a good oral intake.
Since the client had difficulty of breathing, the doctor ordered the mother
under Nothing per Orem the day she was admitted. As a relief for breathing, the
patient had oxygen inhalator via oxygen mask as needed until the day of the students
duty that was on October 13, 2016.
On the morning of students duty, client had temperature of 38.7C that was
why the doctor ordered Paracetamol through IV for faster effects to the patient. The
patient had prescription of several drugs such as: Salbutamol (1 neb, q4), Ceftriaxone
(200 mg, TIV, q12), Amikacin (64 mg, IV, q12), Immunozinc drop (1.0 mL, OD),
Neozep (1 mL, q6), Cetirizine [Allerkid drops] (1.0 mL, BID), and Forgam (200 mg,
TIV, q12)
The client also needs rest to prevent exhaustion. She needs to conserve
strength at the same time, the student turned and repositioned her frequently to avoid
pooling of secretions.
During the time of our duty, the assigned student nurse had taken the vital
signs of patient CB, with temperature of 38.6C, pulse rate of 133 bpm, and
respiratory rate of 52 cpm.

10
PATIENTS HISTORY
B. Past History
IMMUNIZATION RECORD
VACCINES DOSE ADMINISTERED DATE

BCG (0.5 ml: intradermal) At birth June 27, 2015
Pentavalent[Diphtheria, 1st dose September 7, 2015
Pertussis, Hepatitis B, 2nd dose October 5, 2015
HaemophilusInfluenzae 3rd dose November 3, 2015
type B, Tetanus] (0.5 ml:
intramuscular)
OPV (2 drops depending on 1st dose August 14, 2015
the manufacturers 2nd dose September 11, 2015
institutions: oral) 3rd dose October 11, 2015

Measles with Vitamin A 9 months March 27, 2016
(0.5 ml: subcutaneous)
The patient is currently one year old. She was born in a health center at
Tiaong, Quezon and her mother claimed that her daughter was her 9 th child and that
her child failed to cry after the delivery and several minutes passed before she
stimulated to cry.
But after what happened, the mother perceived that her daughter was normal
like her other children after she gave birth to them.
On, September 20, 2016, one week prior to admission to San Pablo Colleges
Medical Center, the patient was experiencing cough and cold, then she was sent to her
maternal parents house to take care of CB because her mother was busy with work
and her other children. The mother of the patient didnt take heed that her mother or
the grandmother of the patient has also pneumonia.

11
PATIENTS HISTORY
This last September 27, 2016 the patient has complaints of 1 week cough, cold
and fever and has been hospitalized in San Pablo Colleges Medical Center in San
Pablo City, Laguna and was diagnosed with Community Acquired Pneumonia
Moderate Risk. CB stayed for almost 7 days in the pedia ward.
CB was given Cefuroxime (Kefox) 250 mg TIV q 8, to treat severe or
complicated infections in the alveoli, Paracetamol 80 mg TIV q 4, to lower down
temperature, Paracetamol drops 0.8 ml q 4, to lower down temperature, for acute
cough of any etiology, Salbutamol (Ventolin) expectorant syrup 5 ml TID, for
respiratory disorders complicated by excessive secretion of tenacious mucus,
Combivent Nebulization using 1 neb BID, management of reversible bronchospasm
associated with obstructive airway diseases in patients who require more than a single
bronchodilator when she was still admitted in SPCMC.
On October 4, 2016, a week after, the patients mother requested for Home
Against Medical Advice due to lack of financial resources. The mother insisted that
her child was already cured.
C. Family History
Legend:
Deceased
Patient
Male
A&W Alive & Well

12
PATIENTS HISTORY
Female
Narrative:
One of the patients family has Pneumonia, which is her grandmother and
Asthma, which is her uncle in the Maternal Side.
PATERNAL SIDE MATERNAL SIDE

Heart Attack
A&W Pneumonia
68 y/o HTN
67 y/o
76 y/o
69 y/o
13
PATIENTS HISTORY
Grandfather Grandmother
Grandfather Grandmother
A&W A&W A&W HTN A&W Asthma
48 y/o 43 y/o 36 y/o 30 y/o 39 y/o 26 y/o
Father
Daughter Daughter Son Mother Son
PATIENT
D. Developmental History
SIGMUND FREUDS PSYCHOSEXUAL DEVELOPMENT
Oral Stage (0-18 months)

14
PATIENTS HISTORY
In the first stage of personality development the libido is centered in a baby's
mouth. It gets much satisfaction from putting all sorts of things in its mouth to satisfy
the libido, and thus its id demands. Which at this stage in life are oral, or mouth
orientated, such as sucking, biting, and breastfeeding.
According to clients mother, she didnt breastfeed CB since the day she was
born. She also said that this child is very fond of having a pacifier in his mouth most
of the time. She easily gets irritated every time her pacifier was being removed from
her. Even when she is sleeping, she will get awake and cry when she doesnt have to
suck into. Sometimes when doesnt have her pacifier, she instead sucks her own
thumb just to satisfy her oral needs.
In terms of handling different things, she always put directly in her mouth,
every object that her hands w they think has the possibility to harm the baby. All their
attention and eyes were focused on their son to avoid any unexpected accidents and
also to secure the safety of the child.
E. Psychological
ERIK ERIKSONS PSYCHOSOCIAL DEVELOPMENT
Toddler (Autonomy VS Shame & Doubt)

15
PATIENTS HISTORY
Existential Question: "Can I do things myself or am I reliant on the help of others?"
According to the mother, the patient starts to be picky on food. Patient CB
have favorite toy preferences such as dolls and magic wands.
But the mother said that her daughter still doesnt know how to control her
bladder, she still pees on bed in the middle of the night.
F. Sociocultural
The patients mother is also manghihilot, so the patient surely consults with
the mother and the mother is also the primary health provider of the patient.
G. Spiritual
Patient CBs religion is Roman Catholic. The patient goes to church with her
family every Sunday.
H. Nutrition
Menu Approximate size per

serving
Breakfast
Rice or substitute Porridge cup

Drinks Formulated milk glass of water
Lunch
Rice or substitute Junk foods with rice 1 pack and cup

Drinks Tap water glass of water
Dinner
Rice or substitute Junk foods with rice 1 pack and cup

Drinks Formulated milk glass of water
16
PATIENTS HISTORY
I. Elimination
Before Hospitalization During Hospitalization After Hospitalization

Urination: The clients Urination: The clients Urination:The clients
mother estimated six to mother estimated 2 to 4 mother estimated six to
eight times of usual times of usual changing eight times of usual
changing her childs diaper her childs diaper after changing her childs diaper
after urination, it is not urination, its not as damp after urination, it is not
fully soaked but of its as the urination before her fully loaded but of its
space are occupied. She hospitalization. space are occupied. She
described it as light yellow described it as light yellow
in color and amber urine. in color and amber urine.

Defecation: the mother Defecation: When the Defecation: the mother
verbalized that her child client was admitted to the verbalized that her child
usually eliminates his stool hospital during his first eliminates her stool 2-3
2-3 times a day before the day, she does not eliminate times. She describes it as
hospitalization. She stool. During her second yellow in color, slightly
describes it as yellow in 24 hours, it is recorded soft and semi-solid in
color, slightly soft and that he eliminates her stool texture.
semi-solid in texture. 2 times a day, the stool
According to becomes dark yellow in
Fundamentals of Nursing color and it has evident
7th Edition by Kozier, black pigmentation. It is
characteristics of normal slightly moist and solid in
infants stool is yellow in texture.
color, formed, soft,
semisolid and moist.

17
PATIENTS HISTORY
Infants pass stool
frequently, often after
feeding because the
intestine is immature,
water is not well absorbed
and stool is soft, liquid,
and frequent. And after
solid food are introduced,
the stool become less
frequent and firmer.
There are no evident signs
of discomforts in
eliminating stool. It is
noticeable that the patient
has no problems regarding
with his elimination before
the admission. Pero
napansin ko simula ng
magkaubo siya, may
kasama nang plema at may
bula sa dumi niya, as
verbalized by the mother.
The client told that phlegm
is present in the stool since
October 9, 2016.
18
PATIENTS HISTORY
J. Exercise
The mother stated that patient CB considered her playtime as an exercise
because when patient CB plays, it requires all the body parts to move.
K. Hygiene
Before Hospitalization
The guardian is bathing the patient once a day in the morning. Everyday her
guardian brushes her teeth twice, in the morning and in the evening. Parents barely
wash her hands. Parents are the one who spoon feeding the patient. The parents also
barely wash hands.
During Hospitalization
The guardian provides sponge bath for the patient. The guardian provides oral
care for the patient once a day. The guardian still barely wash hands. The guardian is
the one who spoon feeding the patient.
After Hospitalization
The guardian is bathing the patient once a day. The guardian provides oral care
for the patient 2 times a day. The guardian learns from the nurse to wash hands all the
time with anti-bacterial soap.
J. Sleep & Rest
Before Hospitalization During Hospitalization After Hospitalization

paputol putol ang tulog According to the mother, The mother said that after
niya, nagigising siya kasi patient was able to sleep at the hospitalization, the
19
PATIENTS HISTORY
nahihirapan siyang 7:30 in the evening and patient can sleep well
huminga, kita mo naman wake up at 1 in the again. Approximately 7-8
yun na nahihirapan siya morning because of hot hours of sleep. Because the
tapos iiyak siya, tapos environment that made her patient before she got
kapag tinatanong ko kung uncomfortable, but ableto sleep, she was really a
ano masakit, hinahawakan go back in sleep at 2:30am sleepy head.
niya dibdib niya as and wake up at 6 in the
verbalized by the mother morning.
of the patient.
Area Method Findings Interpretation
Body Inspection Light Build NORMAL

Built
Has small joint
Has lean muscle

Hair Inspection Hair is black, NORMAL
thin and equally
distributed
With oily hair
Face Inspection No signs of NORMAL

facial edema
Skin Inspection Color is brown According to Weber & Kelley Health
Pale in Assessment in Nursing 5th Edition (2013)
appearance Paleness in patient with pneumonia is
caused by reduced blood flow or a
Excessive decreased number of red blood cells. The
sweating patients lab also result with low
hemoglobin, which also indicates
No signs of infection.
Lesions Reference: Weber& Kelley Health
Assessment in Nursing 5th Edition (2013)
Areas Method page 249 Assessment of the Skin
Findings
20
PATIENTS HISTORY
Interpretation
Sweating is the bodys attempt to cool
itself in response to the temperature
elevation, and the patient might
experience chills and shaking as a result
of the process.
Reference: Weber& Kelley Health
page 251 Assessment of the Skin
Palpation Skin is soft and Warm to touch because of the bodys
smooth compensation to the bacteria. The
When pinched, patients body temperature was 38.6 C.
skin back to Inflammatory reaction occurs in the
previous state alveoli and then the white blood cells
(elastic) migrates and accumulates in the alveoli.
No signs of WBC and macrophages will release
edema while pyrogen (a substance, typically produced
palpating by a bacterium, which produces fever
Warm to touch when introduced or released into the
blood.) And then it will circulates in the
blood. Then it will stimulates
Areas Method Findings Interpretation

the hypothalamus to reset at high level
and heat production mechanisms will be
activated and it can results to fever, chills
and increased heart rate.
Reference: Weber & Kelley Health
page 253 Assessing the Skin
www.healthline .com temperature _blood
circulation
Nails Inspection Nail surface is NORMAL
slightly curved
No clubbed
fingers
Palpation Capillary The patients lab also results with Low
refillof more Hematocrit it is becauseof
than 3seconds theinflammation of the alveoli that leads
With slightly to inadequate oxygen to the blood,
pale nail beds mucous secretion blocks the alveoli to
Smooth and firm circulatethe blood. Resulting in signs of
oxygen deprivation,Reduced oxygen levels
in the blood may produce a blue
21
PATIENTS HISTORY
appearance of the nail beds or lips

(cyanosis).
page 257 Assessing the
Nailswww.pediatricnursing.net
Areas Methods Findings Interpretation
Eyes Inspection Eyelashes and It is because of insufficient oxyhemoglobin

eyebrows is in the blood.The patients lab results with
equally Low Hematocrit it is becauseof
distributed theinflammation of the alveoli that leads
to inadequate oxygen to the blood,
With pale mucous secretion blocks the alveoli to
conjunctiva circulatethe blood. Resulting in signs of
oxygen deprivation,Reduced oxygen levels
Sclera appears in the blood may produce a blue
whitish in color appearance of the conjunctiva.
Pupil Equally Assessment in Nursing 5th Edition (2013)
Round page 257 Assessing the
Reactive to Eyeswww.pediatricnursing.net
Light and
Accommodation
Palpation No signs of NORMAL

tenderness
when palpating
Ears Inspection Symmetrical, NORMAL

auricle aligns
with the corner
of each eye
No presence of
discharge or
redness
Color is
consistent with
facial color
No presence of
Cerumen
Can react
tosound
Palpation No NORMAL
tendernessand
22
PATIENTS HISTORY
nodules
Nose and Inspection With clear Because of the first line of defense, foreign
Sinuses And watery nasal material which is the streptococcus
Palpation discharge pneumoniae, there will be sneezing reflex
and cough.

Nasal septum is Reference: Weber & Kelley Nursing
intact and on Assessment 5th Edition (2013) Assessing the
midline Nose page 360
Nasal mucosa is
dark pink and
moist
Mouth Inspection Lip color is light NORMAL
pink
Moist and
pinkish mucus
membrane
Can able to
move the
tongue in all
direction
Uvula is at the
midline
No presence of
Areas Methods inflammation Interpretation
in oral mucosa
Findings
23
PATIENTS HISTORY
Palpation With dry lips Causes of chapping and cracking in the

corners of the lips is due to an underlying
bacterial infection, which is the
streptococcus pneumoniae. Dry lips also
cause by vitamin deficiencies such as iron,
and dehydration because of the
insufficient fluid intake of the patient,
which leaves the body ripe for infection.
Reference: Live Strong (2015)
Retrieved From
http://www.healthline.com/health/pneumoni
a
Tongue is pink NORMAL

in color moist
and smooth with
no palpable
lesions
Neck Inspection Head is centered NORMAL
and trachea is
midline
No abnormal
movements
No swelling
and no venous
Areas Method distention Interpretation
Findings
Palpation No palpable NORMAL
mass, lymph
nodes and
thyroid gland
enlargement
24
PATIENTS HISTORY
Thorax Inspection Labored The patient cannot breathe normally due

and respiration to accumulation of exudates in the alveoli,
Lungs Excessive use of which the alveoli is responsible for the
accessory transportation of oxygen and carbon
muscles when dioxide.
breathing Reference: Weber & Kelley Health
With Head to toe Assessment page 645
difficultyof Pneumonia causes inflammation in
breathing when patients lungs air sacs, or alveoli. The
lying down RR alveoli fill with fluid or pus, making it
of 45 cycles per difficult to breathe.
minute
Reference: Live Strong (2015)
Retrieved From
http://www.healthline.com/health/pneumoni
a
Percussion With Dullness According to Weber & Kelley Health
on the left Assessment in Nursing 5th Edition (2013)
lower lobe areas of dullness over lung tissue is
associated with consolidation of lung
Areas Method Findings tissue or a mass.
Interpretation
page 369 Assessing Thorax and Lungs
Auscultation Crackles (rales) According to Weber & Kelley Health

sounds in left Assessment in Nursing 5th Edition
lower lobe (2013)Because there is accumulation of
Breath sounds fluid in the alveoli.
may seem Reference: Weber & Kelley Health
louder and Assessment in Nursing 5th Edition (2013)
harsher in thin page 369 Assessing Thorax and Lungs
chest wall
Heart Auscultation With Cardiac According to Weber & Kelley Health

Rate of Assessment in Nursing 5th Edition due to
133 bpm, the stimulation of the hypothalamus to
irregular, reset at high level activation of heat
bounding with production mechanism such as increased
no extra heart heart rate.
sounds Reference: Weber & Kelley Health
page 169 Assessing the Heart
25
PATIENTS HISTORY
Abdomen Inspection With slightly NORMAL. It is generally normal for

distended toddlers to have potbellies. By the time
abdomen children reach school age, the potbelly
will most often disappear and their
bodies seems more proportionate
Assessment in Nursing 5th Edition
Areas Method Findings (2013) page Assessing the Abdomen
Interpretation
Auscultation Bowel sound NORMAL
Heard
With gurgling
sounds
No bruits heard
Percussion With tympanic NORMAL
Palpation Tenderness in NORMAL
the left lower
quadrant,
specifically
there is
tenderness on
the descending
colon.
Muscle Inspection Equal NORMAL

and Bilaterally
Palpation
No coordination
of movement
No pain, heat,
swelling or
nodules are
noted
Extremities Inspection Has no signs of NORMAL
lesions
Areas Method Findings Interpretation
26
PATIENTS HISTORY
Hands are NORMAL

symmetric, non-
tender and
without nodules
Feet and legs

are symmetric
in size, shape
and movement
No deformity
Palpation No masses NORMAL
Warm to touch
Neurological Reflexes(acc The patient can NORMAL

ording to do blink,
age) swallowing, and
-Blink plantar grasp
Reflex reflex
-Swallowing
Reflex
-Plantar
Grasp Reflex
.
27
ANATOMY AND PHYSIOLOGY
Function of the Respiratory System
Oversees gas exchanges (oxygen and carbon dioxide) between the blood and external
environment
Exchange of gasses takes place within the lungs in the alveoli(only site of gas
exchange, other structures passageways
Passageways to the lungs purify, warm, and humidify the incoming air
28
Shares responsibility with cardiovascular system
The Upper Respiratory Tract consists of:
External Nose
Nasal Cavity
Pharynx (throat)
The Lower Respiratory Tract consists of:
Larynx
Trachea
Bronchi
Lungs
29
Gas Exchange
Gas crosses the respiratory membrane by diffusion
1. Oxygen enters the blood
2. Carbon dioxide enters the alveoli
Macrophages add protection
Surfactant coats gas-exposed alveolar surfaces
Pulmonary ventilation moving air in and out of the lungs
External respiration gas exchange between pulmonary blood and alveoli
Respiratory gas transport transport of oxygen and carbon dioxide via the
bloodstream
30
Internal respiration gas exchange between blood and tissue cells in systemic
capillaries
31
Inspiration
Diaphragm and intercostal muscles contract
The size of the thoracic cavity increases
External air is pulled into the lungs due to an increase in intrapulmonary volume
Exhalation
Largely a passive process which depends on natural lung elasticity
As muscles relax, air is pushed out of the lungs
Forced expiration can occur mostly by contracting internal intercostal muscles to
depress the rib cage

32
External Respiration
Oxygen movement into the blood
1. The alveoli always has more oxygen than the blood
2. Oxygen moves by diffusion towards the area of lower concentration
3. Pulmonary capillary blood gains oxygen
Carbon dioxide movement out of the blood
1. Blood returning from tissues has higher concentrations of carbon dioxide than
air in the alveoli
2. Pulmonary capillary blood gives up carbon dioxide
Blood leaving the lungs is oxygen-rich and carbon dioxide-poor
Gas Transport in the Blood
Oxygen transport in the blood
1. Inside red blood cells attached to hemoglobin (oxyhemoglobin [HbO2])
2. A small amount is carried dissolved in the plasma
Carbon dioxide transport in the blood
1. Most is transported in the plasma as bicarbonate ion (HCO3)
2. A small amount is carried inside red blood cells on hemoglobin, but at
different binding sites than those of oxygen
Internal Respiration
33
Exchange of gases between blood and body cells
An opposite reaction to what occurs in the lungs
1. Carbon dioxide diffuses out of tissue to blood
2. Oxygen diffuses from blood into tissue

34
External Respiration, Gas Transport, and Internal Respiration Summary

35
Neural Regulation of Respiration
Activity of respiratory muscles is transmitted to the brain by the phrenic and
intercostal nerves
Neural centers that control rate and depth are located in the medulla
The pons appears to smooth out respiratory rate
Normal respiratory rate (eupnea) is 1215 respirations per minute

36
Hypernia is increased respiratory rate often due to extra oxygen needs

Precipitating Factors: Causative Agent S.
Exposure to some chemical/s or pollutant/s Pneumoniae 37
PATHOPHYSIOLOGY (open burning of neighbors)
Exposure to fathers smoke Predisposing
Immune suppressed due to poor eating Factors:
Failure of First Line of Defense
habits Age (<5 years old)
( Cough and Sneezing Reflex)
Acquired from the
grandmother, who
also have
Microbes multiply in trachea Pneumonia
Ciliary Action Overwhelmed
Failure of Second Line Defense

( Ciliary Action)
Microbes reach alveoli
WBC migrate & accumulate In

the alveoli Inflammatory reaction occurs in alveoli
Release of chemical mediators such as

Neutrophils, RBCs & WBC & macrophage histamine, cytokines, and Vasodilation
Red Hepatization fibrin accumulate in release pyrogen prostaglandins
alveolar exudate
Capillary Permeability Blood flow

Forms a solid mass in Pyrogen circulates
Consolidation the lobe in the blood
Accumulation of fluid in alveoli RALES
Consolidation exudate Stimulation of
undergoes enzymatic hypothalamus to
Gray Hepatization digestion reset at high level Alveolar Edema
(Purulent fluid)
B C A
B C A
38
PATHOPHYSIOLOGY
Inflammatory exudate is Activation of heat

absorbed/expectorated production mechanisms
Pleural Flow of air in Inadequate
Effusion the alveolus is ventilation of
occurs blocked the lungs
Allows Expectoration
CHILLS FEVER HR
Infection of Impaired gas Alveolar
the pleural exchanged oxygen
PRODUCTIVE COUGH
membrane tension
WITH RUSTY SPUTUM
Local irritation of O2 in the blood Ventilation-

nerve endings perfusion
during coughing and mismatch
deep breathing
O2supply in DEAD SPACE

tissues
PLEURITIC CHEST
PAIN
o2supply in Stimulation of o2supply in

muscles carotid & aortic brain
chemoreceptors
Anaerobic HEAD ACHE

respiration Stimulation of the
respiratory Center
Production of
lactic acid Increased RR
MUSCLE PAIN
39
DIAGNOSTIC PROCEDURES
HEMATOLOGY (COMPLETE BLOOD COUNT)
Date: 10-11-2016
Test Result Normal Range Interpretation Implication

Hemoglobin 98 115-148 LOW In the hospital, a drop
in hemoglobin could be
due to multiple blood
draws, and or
administration
of intravenous fluids.
Infection can suppress
the bone marrow that
produces Red Blood
Cells, older blood cells
die earlier
SOURCE:
https://www.healthtap.c
om/user_questions/208
57-why-does-
pneumonia-decrease-
hemoglobin-levels
Hematocrit (%) 32.5 38-44 LOW Low HCT is cause of
inflammation of the
alveoli that leads to
inadequate oxygen to
the blood.
The infection to the
lungs that block the
blood vessels to
circulate.
www.pediatricnursing.
net
RBC (x1012/L) 4.58 3.8-5.4 NORMAL
WBC (x109/L) 13.3 4-15 NORMAL
DIFFERENTIAL COUNT
Segmented 72.4 45-55 HIGH Neutrophil are the
Neutrophils (%) primary white blood
cells that respond to
bacterial infection.It is
increased to
phagocytize the
bacteria that are present
in the body of patient
which causes an
infection. The body
40
uses it to fight
infections.
(Reference:Nader D
Nader, MD, PhD,
FCCP.,Neutrophilia.,
Retrieved from
:http://emedicine.medsc
ape.com/article/208576
-overview)
Lymphocytes (%) 22.1 38-45 LOW In bacterial

infections, when the
bone marrow needs to
mount a large response
to bacteria then it will
produce more
neutrophils and less
lymphocytes. This
lower lymphocyte
proportion may reflect
a normal total
lymphocyte count
during bacterial
infection (Streptococcal
Pneumonia).
Retrieved from
:http://emedicine.medsc
ape.com/article/208576
-overview23)
Monocytes (%) 5.5 3-6 NORMAL

Eusinophils (%) - - - -
Platelet count 358,000 250,00-510,000 NORMAL
PCT (x1014L) 0.234 0.15-.050 NORMAL
MPV (fL) 7.4 6-11 NORMAL
PDW (%) 17.1 11.18 NORMAL
MCV (Fl) 71 80-100 LOW The sudden low
amount of haemoglobin
affect the MCV
through the suppressing
the bone marrow from
the infection.
http://www.medfriendly
.com/mean-
corpuscular-
volume.html
MCH (pg) 21.3 27-32 LOW The sudden low
affect the MCH
41

the infection.
.com/mean-
corpuscular-
volume.html
MCHC (g/L) 301 320-360 LOW The sudden low
affect the MCHC
the infection.
.com/mean-
corpuscular-
volume.html
RDW-CV - 11.0-16.0 - -.
RDW-SD - 37-54 - -
URINALYSIS
Date: 10-14-16
Test Result Normal Interpretation Implication

Range
MACROSCOPIC
Color Yellow Normal
Transparency slightly Turbid Normal
Specific 1.010 1.005 Normal
Gravity 1.030
Albumin Negative Negative Negative
Sugar Negative Negative Negative
Ketone Negative Negative Negative
Bilirubin Negative Negative Negative
Urobilinogen Negative Negative Negative
Nitrite Negative Negative Negative
Blood Negative Negative Negative
Leukocytes Negative Negative Negative
Ascorbic Acid Negative Negative Negative
MICROSCOPIC
Pus Cells 0-4/hpf Normal
Red Blood 0-4/hpf Normal
42
Cells
Bacteria Few Bacteria in urine can
suggest infection due
to vascular
permeability
SOURCE:
www..ncbi.nlm.nih.gov
Epithelial - - - -
Cells
Crystals AMORPHOUS
PHOSPHATES
CastS - - - -
Others - - - -
43
Radiologic Findings
10-12-16
Left retrocardiac streaky infiltarates are appreciated
The heart is not enlarge
No hilar fullness
Diaphragm and sulci are intact
The included osseous structures are unremarkable
IMPRESSION
- PNEUMONIC INFILTRATION, LEFT LOWER LOBE
IMPLICATION
A lower lobe infiltrate is a medical situation where an X -Ray of the lungs shows a gray
shadow on the left lobe is a build up bacterial infection that you can see to the x- ray result.
Source: www.reference.com
44
DATE DOCTORS INTERPRETATION
ORDER
DAY ONE @ To PH.
October 11, 2016 Hospital policy designates the exact
procedure that should be followed
when admitting the patient to the
holding area or opening room suite.
Admission will help to monitor the
clients condition. The admitting
procedure is continued with
reassessment of the patient and
allowanced of time for last minutes
question. (references: medical-
surgical nursing 5th edition by Lewis,
Heitkemper and Dirksen Chapter 17,
pages 380)
Secure
consent Before undergoing any invasive
procedure, the patient or the ptaients
legal surgogatemus receive sufficient
information on which to make an
informed health care decision.
(wongs Nursing Care of Infants and
children 1st Philippine edition

45
Hockenberry/ Wilson volume 2)
TPR q4 &
The vital signs are body temperature,
record
pulse respiration and blood pressure,
which should be look at in total, are
checked to monitor he function of the
body which may alter the normal
function of the body, (references:
fundamental of Nursing 8th edition
of 2008 Volume 1 by Berman Saysler,
Kozier and erb Chapter 4 Legal
aspects of Nursing page 39.)
NPO
NPO status is used to help prevent
temporarily
aspiration pneumonia
(https;//bellinosc.com/2014/09/09me
dical-terminology-deciphered-npo)
TVF:
D5 0.3 Nacl is a hypertonic saline
D5 0.3 Nacl solution that are used in critical care
500cc x 35 settings Inhalation of hypertonic

46
gtts/minutes saline has also been shown to help in
other respiratory problem.For
replacement or maintenance of fluid
and electrolytes.(reference:
http://www.answer.com/Q.
PHARMACY)
LABS:
CBC is a battery of screening test that
CBC with typically includes haemoglobin (hgb);
OPC haematocrit (Hct); red blood test (RBC)
count, morphology, indices, and
distribution width index; platelet count
and size; white blood test(WBC) count
and differential. Provides baseline data
about the hematologic system and yields
to information related to oxygenation
and infection. (refence: nursing care
plan 8th edition page 134)
X-ray are form electromagnetic radiation
CXR AP (like light). They are higher energy,
however, and can penetrate the body to

47
form an image on firm. Structures that
are dense (such as bone) will appear
white air will be black , and other
structures will be shades of gray
depending on density. X-rays can
provide information about obstructions.
An x-ray is nearly always taken to
MEDS: confirm a diagnosis of pneumonia.
We hypothesize that hydrocortisone
Hydrocortiso infusion in pneumonia attenuates
ne 60mg TIV systemic inflammation and leads to
LD 43mg earlier resolution of pneumonia and
MD q6 reduction in sepsis-related complication.
Cortisone are potent anti-inflammation
agents that have a wide range of effects
on immunological processes and have
found use in a broad spectrum of
diseases (references: jones and Bartlett
nurses drug hand book 2015
(hydrocortisone page 256 and
https://www.ncbi.nlm.gov)
Appears to inhibit prostaglandin

48
synthesis in the CNS and, to a lesser
extent, block pain in pulses through
Paracetamol peripheral action. A CNS centrally on
85mg TIV hypothalamic, heat- regulating
q4 for T centre, producing peripheral vaso
37.8C dilation (heat loss/ skin erythema,
diaphoresis) (reference: drug
handbook)
Stimulates beta-2 receptors of
bronchioles by increasing level of
cAMP which relaxes smooth muscle
Nebulizer to produce bronchodilatation. Also
with 1nebule cause CNS simulation, increased
salbutamol gastric acid secretion. Longer acting
15 mins X 3 the isoproterenol (reference: PPDs
doses then nursing drug guide 2007 edition).
Q4
Oxygen is a drug, so medication
administration criteria are followed
in additional steps unique to oxygen
therapy. Client unable to maintain
PO2 and O2 saturation levels on

O2 inhalation
room air are candidates for oxygen
via NC @ 5
therapy. An adequate airway is
49
LMP essential to effectiveness of the
treatment. It is best to treat the
hypoxia with the lowest oxygen dose
possible.((foundation of basic
nursing second edition, lois white)
Refer Antibiotics are used to manage
accordingly infection. As a result of frequent
respiratory infections requiring
Add: repeated antibiotic therapy , Sputum
cultures and sensitivity testing are
Antibiotic to conducted to help ensure that
ff- netrieval appropriate antibiotics are used.
of IV meds (Pediatric Nursing care for children
given @SPC and their families second edition)
med. centre
last Sept.r 27
to Oct. 4
admission To treat infection. Interferes with
confinement bacterial cell wall synthesis by

50
inhibiting crosslinking pf
peptidoglycan strands. Peptidoglycan
makes the cell membrane rigid and
Day two Stat protective. Without it bacterial cell
October 12 2016 ceftriaxone ruptured and die. (reference: Jones

12 noon
(for gram) and Barlett Nursing Drug handbook
200 mg TIV 2015 (ceftriaxone page 223)
Q12
Binds to bacterial ribosomal subunit
to cause misreading of genetic code
which leads to inaccurate peptide
sequence of protein synthesis and
bacterial death. (references: PPDS
Amikacin Nursing Drug Guide 2007 edition)
64mg q12
TIV ANST Ionosol MB and 5% Dextrose
(-) injection (multiple Electrolytes and
5% Dextrose Injection type 1, USP)
is a sterile, nonpyrogenic solution
designed for intravenous
TF:: D5 IMB administration. The solution is
5oo ml X SR formulated to provide fluid and
electrolytes for treatment of
dehydration and acidosis.

51
(https://dailymed.nlm.nih.gov/
Ionosol MB and 5% Dextrose
injection (multiple Electrolytes and
Day three 5% Dextrose Injection type 1, USP)
Ocober 13 2016 designed for intravenous

8:55 am
TF: D5 IMB administration. The solution is
500 KVO formulated to provide fluid and
dehydration and acidosis. An order
indicating that the patency of an
intubated vessel be maintained so
that subsequent intravenous solution
or medication can be
administered(https://dailymed.nlm.ni
h.gov/, http://medical-
dictionary.thefreeditionary.com/kvo
For supportive drug; supports body
function until other treatments or the
bodys treatments or body response
can take over. Because medication is
a substance administered for the
diagnosis, cure treatment or relief of
symptoms. (fundamental of Nursing

52
Continue 8th edition)
medication/
Nebulizer Zinc is a vital nutrient needed by
human body, it is touted to help with
immunity to colds and flu.
(http://www.medschat.com/yopics/im
muzinc-action)
Immuzincgtts
1,0 ml O.D
This test can identify some bacteria
that cause pneumonia.
(https://www.m.webmd.com/a-to-z-
Day four guides/tc/pneumonia-exam-and-test)
October 14 2016 This test can identify some bacteria

8:50 am
Urinalysis that cause pneumonia.
stat. (https://www.m.webmd.com/a-to-z-
guides/tc/pneumonia-exam-and-test)

53
For stat. u/a is a sterile, nonpyrogenic solution
as ordered designed for intravenous
administration. The solution is
formulated to provide fluid and
TF: D5 IMB dehydration and acidosis. An order
X kvo indicating that the patency of an
8th edition)
54
Continue
meds.
Day five administration. The solution is
October 15 2016 formulated to provide fluid and
D5 IMB 500 indicating that the patency of an
X KVO intubated vessel be maintained so

55
8th edition)
Continue
meds. Analgesic-antipyretic. It has
analgesic, antipyretic and weak anti-
inflammation action. The mechanism
of action is associated with inhibition
of progstaglandin synthesis, the
predominant influence on the
thermoregulation centre in the
hypothalamus , enhances heat
transfer.(https://www.ndrugs.com/?
Give Neozep s=neozep%20forte)
q6
Stimulates beta-2 receptors of
bronchioles by increasing level of
cAMP which relaxes smooth muscle
to produce bronchodilatation. Also
cause CNS simulation, increased
gastric acid secretion. Longer acting
the isoproterenol (reference: PPDs
nursing drug guide 2007 edition).

56
Continue
salbutamol
Refer Ionosol MB and 5% Dextrose
Day six designed for intravenous
October 16 2016 administration. The solution is
D5 IMB 1L (https://dailymed.nlm.nih.gov/
X Q8 For supportive drug; supports body

57
8th edition)
Cont. meds
TF: D5 IMB
500 ml X
KVO Chest physical therapy uses a
technique called percussion to loosen
mucus so the patient can get it out by
coughing.to avoid injury, the
technique is done with a cupped
hand, never flat hand. People often

58
think that they must hit he chest wall
and shakes the mucus loose.
(https:www.verywell.com/how-to-do-
chest-physical-herapy-child-under-
Chest five-998313)
clapping

Day seven
October 17 2016
9:00 am 8th edition)

Continue
medciation

59
TF: D5 IMB that subsequent intravenous solution
X decrease or medication can be
KVO administered(https://dailymed.nlm.ni
dictionary.thefreeditionary.com/kvo)
A nebulizer is a device that is used to
aerosolize medications into a mist for
delivery into the lungs. Medication
that is inhaled in the form of small
droplets is absorbed immediately into
the mucosa and bloodstream and is
available to the body within minutes.
This method of medication delivery
is one of the fastest noninvasive
methods of medication deliverys
(foundation of basic nursing second
edition, lois white)
Decreased
nebulizerq8
infusion in pneumonia attenuates

60
systemic inflammation and leads to
earlier resolution of pneumonia and
reduction in sepsis-related complication.
on immunological processes and have
Day eight found use in a broad spectrum of
0ctober 18 2016 diseases ( references: jones and Bartlett
nurses drug hand book 2015
https://www.ncbi.nlm.gov
D/C
hydrocortiso
ne
that is inhaled in the form of small
droplets is absorbed immediately into
Day nine This method of medication delivery
October 19 2016 is one of the fastest noninvasive

61
Increase
nebulizer q4 Ionosol MB and 5% Dextrose
TF: D5 IMB
500 ml x kvo

62
8th edition)
Continue that is inhaled in the form of small
meds. droplets is absorbed immediately into
Day 10 methods of medication deliverys
October 20 2016 (foundation of basic nursing second


Cont meds/
nebs q4

63
\ administered(https://dailymed.nlm.ni
TF:D5 IMB dictionary.thefreeditionary.com/kvo
X KVO
8th edition)
infusion in pneumonia attenuates
systemic inflammation and leads to
earlier resolution of pneumonia and
reduction in sepsis-related complication.

64
Continue on immunological processes and have
meds. found use in a broad spectrum of
Day eleven diseases ( references: jones and Bartlett
October 21 2016 nurses drug hand book 2015

8:25 am
Resume
hydrocortiso A nebulizer is a device that is used to
ne- increase aerosolize medications into a mist for
85mg delivery into the lungs. Medication
intiallythen that is inhaled in the form of small
43mg q6 hrs. droplets is absorbed immediately into
Cont.
Montelukast is a leukotriene receptor
nebulizer q4
antagonist used as an alternative to anti-
65
inflammatory medication in the
management and chronic treatment of
asthma and exercise induced
bronchospasm (EIB)
(https://www.drugbank.ca/drugs/DB004
71)
Montelukast can take over. Because medication is
sodium 4mg- a substance administered for the
1 tablet + OD diagnosis, cure treatment or relief of
6pm symptoms. (fundamental of Nursing
posturized 8th edition)
and mix with
milk
Cetirizine, a human metabolite of
hydroxyzine, is an antihistamine; its
principal effects are mediated via
Continue selective inhibition of peripheral H1
medication receptors.
66
Cetirizine symptoms. (fundamental of Nursing
(allerkidgtts) 8th edition)
1.0 ml BID
(6am-6pm)
Ionosol MB and 5% Dextrose injection
(multiple Electrolytes and 5% Dextrose
Day twelve Continue Injection type 1, USP) is a sterile,
October 22 2016 meds. nonpyrogenic solution designed for
intravenous administration. The solution
is formulated to provide fluid and
electrolytes for treatment of dehydration
and acidosis. An order indicating that the
patency of an intubated vessel be
maintained so that subsequent
intravenous solution or medication can
be
TF: D5 IMB administered(https://dailymed.nlm.nih.g
500ml x 8hrs ov/, http://medical-
dictionary.thefreeditionary.com/kvo)
67
8th edition)
Day thirteen Continue can take over. Because medication is
October 23 2016 meds. a substance administered for the
8th edition)
Ionosol MB and 5% Dextrose injection
(multiple Electrolytes and 5% Dextrose
Day fourteen Injection type 1, USP) is a sterile,
October 24 2016 Continue nonpyrogenic solution designed for
meds. intravenous administration. The solution

68
is formulated to provide fluid and
electrolytes for treatment of dehydration
and acidosis. An order indicating that the
patency of an intubated vessel be
maintained so that subsequent
intravenous solution or medication can
be
TF: D5 IMB administered(https://dailymed.nlm.nih.g
500ml x ov/, http://medical-
KVO dictionary.thefreeditionary.com/kvo
Discharge planning is the process of
preparing a client to receive one level of
care for another within or outside of the
current health care agency; usually refers
to the client leaving hospital for home
(fundamentals of Nursing 8th edition
May go 2008 by bermansynder, koziernderb
home Chapter 7 community based nursing and
care continuity page 113)
Outpatient department of a hospital.
It is the section of the hospital where

69
Day fifthteen patients are provided medical
October 25 2016 consultation and other allied
services.Outpatient care includes
services provided without actually
admitting the client to health care
facility.
OPD 8 hours
my after 1wk
70
Name Dosage Indication Mode of action Adverse effect Nursing

of Drug Contraindication responsibilitie
neric name: 60 mg IV Indication: Binds to intracellular CNS: Fatigue, Monitor for

drocortisone 43 mg IV To treat severe glucocorticoid receptors and insomnia, body possible drug adv
q6 inflammation. suppresses inflammatory malaise. effects.
nd name: and immune responses by:
tef Contraindication: Inhibiting neutrophil and CV: arrhythmia, heart Monitor weight,
Hypersensitivity to monocyte accumulation at failure, edema. input-output ratio
ssification: hydro cortisone or its inflammation site and urine output
i- inflammatory components, recent suppressing their ENDO: Adrenal
live-virus vaccination, phagocytic and bactericidal insufficiency, growth Assess for edem
dered at: systemic fungal activity suppression in children
11-17/16 infection Assess carefully
21-24/16 GI: increased appetite, signs of infection
nausea, vomiting, especially fever an
ute: rectalabnormalities WBC count becau
avenous such as bleeding, the dug masks
blistering, burning, infection signs an
set: itching or pain symptoms
id
HEME: Easy bruising, Check nasal
k: leukocytosis passages for chan
known in mucus (nasal)
SKIN: Skin eruptions,
ration:Unknown altered skin Be alert to signs
pigmentation,rash, hypocalcaemia
scarring.
References:
PPDS. Nursing Drug Guide, Philippines copyright 2007 by Malan press, INC p. 540
Nurses Drug Handbook by Jones & Bartlett Learning copyright 2011 10th edition, p. 507-509
Name Dosage Indication Mode of action Adverse effect Nursin

f Drug Contraindication responsibi
71
name: 85 mg IV q4 for > Indication: Decreases fever by GI: Nausea, Assess patien
mol 37.8 To reduce fever acting directly on the hepatotoxicity,
hypothalamic heat vomiting. Assess allerg
ame: Contraindication: regulating center to reactions; rash
Hypersensitivity; cause sweating and HEME: Hemolytic urticarial; if th
intolerance to tartrazine, vasodilation which help anemia, leukopenia, occur, drug ma
ation: table sugar, saccharin. to dissipate heat. neutropenia, to be discontin
etic pancytopenia.
Assess
at: SKIN: Pruritus hepatotoxicity:
rash, urticarial urine, clay-col
jaundice, blisters stools, yellowi
skin and sclera
ous
Check input a
output ratio; de
output may ind
renal failure
Assess for ch
poisoning: rap
pulse; dyspnea
clammy extrem
report immedia
prescriber.
References: Nurses Drug Handbook by Jones & Bartlett Learning copyright 2011 10 th edition, p. 23-
25; PPDS. Nursing Drug Guide, Philippines copyright 2007 by Malan press, INC p. 32-33
Dosage Indication Mode of action Adverse effect Nursing resp

g Contraindication
64 mg IV Indication: Binds to negatively CNS: Tremor, Expect to obtain

q 12 Treatment of infections charged sites on drowsiness, vertigo. culture and sensit
caused by susceptible strains bacterias outer cell before therapy be
of microorganisms, membrane, disrupting EENT: Tinnitus
especially gram-negative cell integrity. Also binds Assess patient fo
bacteria to bacterial ribosomal GI: Nausea, vomiting. symptoms of infe
subunits and inhibits characteristics of
Contraindication: protein synthesis. Both GU: Dysuria, azotemia, sputum, urine, sto
Hypersensitivity to amikacin actions lead to cell oliguria. Obtain baseline in
or other aminoglycosides death. before and during
MS: Acute muscle
paralysis; muscle fatigue Assess for allerg
and weakness. rash, urticarial, pr
RESP: Apnea Monitor for sign

ototoxicity: vertig
vomiting.
Assess bowel pa
of dehydration: if
occurs, drug shou
72
discontinued.
Monitor for blee

gums, ecchymosi
Assess for overg

infection: fever, m
rash, diarrhea, ch
sputum
Reference: PPDS. Nursing Drug Guide, Philippines copyright 2007 by Malan press, INC p. 75-76
Name Dosage Indication Mode of action Adverse ef

of Drug Contraindication
Generic Name: 200 mg TIV Indication: Interferes with bacterial CNS: Chills,
Ceftriaxone q 12 To treat infections of the cell wall synthesis by reversible
lower respiratory inhibiting cross-linking of hyperactivity,
Brand name: infections. peptidoglycan strands. seizures, fever
Forgram Peptidoglycan makes the
Contraindication: cell membrane rigid and EENT: stomat
Classification: Contraindicated to protective. Without it, glossitis
3rd generation patient with bacterial cells rupture and
cephalosporin hypersensitivity to die CV: Edema
cephalosporin and
Ordered at: penicillin. GU: Elevated
10/12/16 level, renal fail
Route: GI: Diarrhea,

Intravenous vomiting.
Onset: HEME: Aplas

Immediate anemia, hemol
anemia, hemor
Peak: unusual bleedi
Infusions end
RESP: Allergi
pneumonitis, d
SKIN: Allergi
dermatitis, rash
urticarial.
References: PPDSNursing Drug Guide, Philippines copyright 2007 by Malan press, INC p. 107-108
Nurses Drug Handbook by Jones & Bartlett Learning copyright 2011 10th edition p. 208-
73

of Drug Contraindication responsibilit
ic name: 4mg 1tab Indication: Antagonizes receptors for CNS: asthenia, Monitor patient
lukast 6pm mix Treatment of exercise cysteinylleukotrienes, fatigue, fever, adverse reactions
with ml induced produced by arachidonic acid insomnia, as cardiac and
d name: bronchoconstriction in metabolism and released from restlessness, tremor. pulmonary condi
air pediatric patients. mast cells, eosinophils and in patient, notify
other cells. When CV: Palpitations prescriber if suc
fication: Contraindication: cysteinylleukotrienes bind to reactions occur
triene receptor Hypersensitivity to any receptors in bronchial airways, EENT: Nasal
nist components acute they increase endothelial congestion, Assess patients
asthma attacks status membrane permeability, which pharyngitis, underlying condi
ed at: asthmaticus. lead to airway edema, smooth- sinusitis. before therapy an
16 muscle contraction, and altered regularly thereaf
activity of cells in asthmas GI: hepatotoxicity, monitor drug
: Oral inflammatory process, indigestion. effectiveness.
montelukast blocks these
: 24 hrs. effects. GU:Pyuria Assess respirati
auscultate bilater
24 hrs. RESP: Cough, lung fields: rate a
upper respiratory rhythm
ion: 24hrs. tract infection
SKIN: Pruritus, Assess for aller

rash reactions: rash,
urticarial and pru
References: Nurses Drug Handbook by Jones & Bartlett Learning copyright 2011 10 th edition p. 696-
698PPDSNursing Drug Guide, Philippines copyright 2007 by Malan press, INC p. 604-605
74

of Drug Contraindication responsibilities
eric Name: 1.0 mL BID Indication: Competes with CNS: fever, Assess for allergy
rizine (6am-6pm) To treat histamine for H1 insomnia, fatigue. symptoms: rhinitis,
hypersensitivity. Receptor sites on pruritus, urticarial,
nd name: effector cells in GI CV: edema, watering eyes, befo
rkid Contraindication: tract, blood vessels, palpitation, and periodically du
Hypersensitivity to respiratory tract. tachycardia treatment
ssification: cetirizine or to any of its
histamine ingredients or EENT: Dry mouth. Assess respiratory
hydroxyzine, Severe status and increase
ered at: renal insufficiency. GI: Nausea, bronchial secretions
1/16 vomiting, increase wheezing.
appetite
te:
GU: urinary
retention.
et:
60 mins. RESP: Cough
k: SKIN:
Fixed drug eruption,
rash, pruritus
ation:
o 24 hrs.
References:
PPDS. Nursing Drug Guide, Philippines copyright 2007 by Malan press, INC p. 43-44
75

of Drug Contraindication responsibilitie
eric Name: 1 neb. q 15 Indication: Albuterol attaches to CNS:Insomnia, Assess cardio-

utamol minutes x To prevent exercise- beta2 receptors on tremor, vertigo, respiratory functio
3doses q 4 induced asthma bronchial cell membranes, weakness. heart rate and rhyt
nd Name: which stimulates the and breath sounds
terol Contraindication: intracellular enzyme CV:
Hypersensitivity to adenylatecyclase to arrhythmias, Monitor serum
sification: albuterol or its convert adenosine tachycardia, potassium level
chodilator components triphosphate to cydic Palpitations. because albuterol
adenosine cause transient
ered at: monophosphate. This EENT: Dry throat and hypokalemia.
1/16 reaction decreases mouth, rhinitis
7/16 intracellulaqrr calcium Monitor for evid
levels. It also increases ENDO: of allergic reaction
te: intracellular levels of Hyperglycemia and paradoxical
ule cAMP, as shown, bronchospasm.
together; these effects GI: Diarrhea, nausea,
et: relax bronchial smooth- vomiting
mins muscle cells and inhibit
histamine release. GU: UTI
k:
hrs MS: Muscle cramps
ation: RESP: Cough,

hrs pulmonary edema
SKIN: Pallor,
flushing, rash
References: Nurses Drug Handbook by Jones & Bartlett Learning copyright 2011 10 th edition p. 37-
38 PPDSNursing Drug Guide, Philippines copyright 2007 by Malan press, INC p. 606
1. Ineffective Airway Clearance related to Increased Sputum Product
2. Impaired Gas Exchange related to Alveolar Capillary Membrane Cha
3. Deficient Fluid Volume related to Inadequate Fluid Intake

76
4. Imbalance Nutrition less than Body Requirements related inability to ingest food due to
5. Activity Intolerance related to impaired respiratory function
Problem Prioritization
1. Ineffective airway clearance related to Tracheal bronchial Inflammation, Edema
Formation, increased Sputum Production secondary to Pneumonia
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIO

Ineffective airway Short term: Independent:
Nahihirapang clearance related to
huminga ang Tracheal bronchial After 2 hours To assess patients To k
aking anak dahil inflammation, of nursing condition. determi
sa dami ng edema formation intervention, patient
plema as increased sputum the patients
verbalized by production will be able to
the mother of secondary to expectorate Monitor the
the patient. pneumonia and improve respiration and establis
difficulty of temperature and data
Objectives: breathing will record vital signs NANDA
be relieved. every 2 hours. edition
With crackles
sound on left Long Term: Auscultate lung To asce
lower lobe of field, noting areas of current
the lungs of the Within 2 weeks decrease absent of of treatm
patient. of giving air flow and crackles clearing
nursing breathe sound. (Refere
With productive intervention NANDA
cough. With and medical edition
thick and rusty management
sputum. patient will be Assist the patient to To take
(approximately able to relieved elevated head of the of grav
1/2 teaspoon) tracheal bed, or in fowlers decreas
inflammation position, also assist pressur
Presence of and edema the patient to change diaphra
clear watery formation, position for every 2 enhanc
discharge from increased hours. drainag
sputum ventilat
77
her nose production to ( Refere

maintain patent NANDA
vital signs airway. edition
especially RR
52 resp/min Collaborative: Mainta
hydratio
With oxygen Administer regulate wash aw
inhalation via IVF D5 IBM 500 (Refere
nasal cannula. ml. KVO ordered NANDA
5Lpm edition
To relax
respirat
emascu
airway
Administer Hydro
mobiliz
cortisone 43mg. IV
secretio
q6 as ordered.
(Refere
NANDA
edition
Anti-
inflamm
medica
normal
respons
Administer (Refere
Amikacin 64 mg IV handbo
q 8 as ordered
it work
inhibiti
produc
bacteria
which c
bacteria
death
(Refere
handbo
pg.1522
Bronch
selectiv
B2agon
providi
Acting
Bronch
with a f
Nebulize 1 nebule (within
q15 minute q 4 in rever
78
airway
Obst
(Ref
Drug
hand
pg.2
Precipit
allergic
respirat
reaction
With oxygen trigger
inhalation via nasal acute ep
cannula 5Lpm (Refere
A 13th e
pg.88)
To mini
dust, sm
Instruct the mother feather,
to keep the accordi
environment individu
Allergen free. situatio
79
2. Impaired Gas Exchange related to Alveolar Capillary Membrane changes
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONA
Subjective:
Nahihirapan Impaired Gas After 4 hours of
huminga ang aking Exchange related nursing Monitor vital sign all vital signs are
anak dahil sa to Alveolar Intervention, the cardiac rhythm and by changes of ox
sipon As capillary patient will assess patients (Reference :NAN
verbalize by the membrane demonstrate condition. edition pg. 423)
mother of the changes improved
patient. ventilation, and
adequate
Objectives: oxygenation by Auscultate lungs for In this nursing di
decrease crackles, ventilator effort i
Restless symptoms of consolidation and insufficient amou
respiratory pleura friction rub. dioxide. Abnorm
Irritability distress sounds are indica
numerous proble
Capillary refill (Reference: NAN
of more than 3 edition pg. 423)
seconds
Provide insight i
abnormal skin of breathing and
Observe skin color alveolar ventilati
color (pale) and capillary refill (Reference: NAN
edition pg. 422)
Vital sign
Temperature:
38.6C Pulse: Help limit oxyg
133 bpm consumption.(Re
NANDA 13th ed
Encourage the
Resp. Rate: 52 424)
mother of the patient
cpm to take adequate rest
and activities to
within client
tolerance
Encourage the Elevation or upri

mother of the patient facilitates respira
to elevate the head of function by grav
bed and position the (Reference: NAN
client appropriately. edition pg. 423)
Promote optimal
Instruct the mother to expansion , mob
perform chest secretion and ox
physiotherapy after diffusion do back
nebulization.
80
(Reference NAND
Collaborative: edition pg. 424)
Administer oxygen
as ordered.
Improve Gas exc
decrease work
of breathing(Refe
DA 13th edition
81
3. Deficient fluid volume related to inadequate fluid intake
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATION
Subjective: Short Term:

Laging uhaw ang Deficient Urge the patient to Oral fluid rep
aking anak as fluid After 4 hours drink prescribed indicated for
verbalized by the volume of amount of fluid. deficit and is
mother related to intervention, effective meth
inadequate the patient will replacement t
Objectives: fluid intake. maintain fluid (Reference: N
volume at a edition pg.410
weak functional
in appearance level, with a Signs of dehy
urinary output also detected
Dry lips of more than Assess skin turgor skin. (Referen
30 ml/hour, and oral mucous 13th edition pg
Urinary output stable vital membranes for signs
of only 2 signs, of dehydration.
diapers resolution of
(approximatel alveolar edema A normal urin
y10 ml/hr for considered no
Assess color and than 30ml/ho
2 consecutive amount of urine.
hours) used on Concentrated
Report urine output fluid deficit.(r
October 12, less than 30 ml/hr for
2016. NANDA 13th e
2 consecutive hours. pg.412)
Most fluid co
body through
water in food
Monitor fluid status
formed by ox
in relation to dietary
foods. Verifyi
intake.
patient is on a
restraint is ne
(Reference :N
edition pg,134
For rehydrati
and help wash
to reduce airw
and mobilize
Administer fluids
(reference: NA
and electrolytes as
edition pg. 88
indicated (D5IMB x
500cc to run for 8
Anti-inflamm
82
Administer inflammation
Hydrocortisone 43 to lessen the e
mg IV q6 as ordered
(reference: dru
pg 1522)
83
4. Imbalance Nutrition less than Body Requirement related to Inability to Ingest Food
due to Difficulty of Breathing

Subjective: Imbalance nutrition After 4 hours of
Walang ganang less than body intervention, Instruct the mother to All fa
kumain at uminom requirement related demonstrate how to can af
ng gatas ang aking to inability to ingest the patient will chew swallow and ingest
anak as verbalize food due to show signs of taste foods. digest
by the mother of the difficulty of increase appetite nutrie
patient. breathing (Refer
NAND
Editio
Objectives:
Weak in
appearance instruct mother to To rep
provide a high nutrie
Had only 2 calorie, high protein high c
crackers in diet consisting of high p
the shift. soft , easy -to -eat diet).
foods.( high calorie (Refer
Body weight protein e.gchicken, NAND
9.5 chocolate, soy milk, Editio
kilograms. egg, cheese )
(normal11.2
kg. For 1 yr 5
months)
Prevent Unpleasant To pro
odor. good.
(Refer
NAND
editio
To av
Instruct the Mother spread
of patient on good micro
oral hygiene before (Refer
and after feedings. NAND
editio
84
85
5. Activity Intolerance related to Impaired Respiratory Function
Subjective: Activity After 4 hours of Evaluate patients Estab

ang tamlay ng intolerance intervention, response to activity. patien
anak ko, di sya
related to The patient will capab
impaired participate needs
tulad ng dati respiratory facilit
willingly in
yung masigla function desired of int
as verbalized by activities (Refer
the mother of The patient will NAND
the patient. show editio
measurable Semi-
increase in Instruct the mother to positi
Objective:
activity give a comfortable pleasa
Weak in will f
tolerance position for patient.
appearance circul
The patient will
Pale demonstrate a andCO
decrease in (Refer
Vitals signs: physiologic NAND
signs of editio
P = 133 bpm intolerance, vital Fa
signs within he
R = 52 cpm pro
acceptable Instruct the mother to
range. encourage the patient en
to have adequate rest na
balanced with res
moderate activity. pro
And Promote en
adequate nutritional 13
intake. pg
Helps
minim
Advise the mother to frustr
provide positive chann
atmosphere, while (refer
acknowledging the NAND
difficulty of the editio
situation for the
client.
86
RECOMMENDATION
To our co-student:
This study will help you to fully understand how pneumonia III high risks occurs,
what are the symptoms and management to be given to patient with his type ofdisease. You
will also learn how risk factors such as people living or traveling to tropical areas. This will
serve s your guide in presenting case presentations in your future career.
To faulty members:
This study will help you to recall all your knowledge and refreshes your idea about
pneumonia III risk factor. This may be helpful in teaching lessons of the faculty members
especially those who handle third year nursing students. We hope that this would be a great
help to all of you.
To our beloved readers:
To our beloved readers who are curious about pneumonia III risk factor. This will be
very helpful to you because all the contents of this study were focused on the said disease.
Diet medication and other health management to prevent occurrence of the disease are also
included.
87
SUMMARY OF DISCHARGE
Medication
No medication
Exercise
No exercise
Treatment
No treatment
Health Teaching
Instruct the mother to provide warm water rather than cold water.
Rationale: To soften the childs mucus that clog in his/her nose and throat.
Instructthe mother to give foods that are easy to digest such as fruits like orange,
banana and grapes. Vegetables like mash potato and puree squash.
Rationale: To provide an array of essential vitamins, minerals and antioxidants.
Instructthe mother to let the child rest and sleep as much as possible.
Rationale: To conserve the energy and to help your childs body to heal.
Instructthe mother to take child's temperature at least once each morning and once
each evening.
Rationale: To have an accurate measurement whether your child is high in fever.
Instruct the mother to not let anyone smoke around your child.
Rationale: To prevent child from coughing and breathing worse that is cause by
smoke.
88
Instruct the mother to wash her hands and her child's hands often.
Rationale: To prevent the spread of infection.
Instruct the mother to not let her child share personal items with others.
Rationale: To prevent the spread of infection through personal items.
Instruct the mother of the child to keep his head elevated to breathe better.
Rationale: To provide a clear passage for the child to breathe.
Instructthe mother to offer the child high-calorie food and drinks such as whole milk
and juice.
Rationale: To supply the essential nutrients which is common found in milk and dairy
products.
Out-Patient Department
Follow - up consultation for 1 week
Spiritual
Encourage the mother to maintain her spiritual needs and advise to never lose hope in
any obstacle that she may encounter.
Source:
Electronics .
https://www.drugs.com/cg/pneumonia-in-children-discharge-care.html
http://www.livestrong.com/article/544124-diet-for-children-with-pneumonia/6
89
90
BIBLIOGRAPHY
Wongs Nursing Care of Infants and Children 1st Philippine edition Hockenberry/wilson
WHO surveillance contact: haiyanops@wpro.who.int
http://www.wpro.who.int/philippines/typhoon_haiyan/media/Pneumonia.pdf?ua=1
(references: medical-surgical nursing 5th edition by Lewis, Heitkemper and Dirksen Chapter
17, pages 380)
(wongs Nursing Care of Infants and children 1st Philippine edition Hockenberry/ Wilson
volume 2)
(references: BunnerndSuddarths Textbook of Medica-Surgica Nursing 13th edition by Jance
L. Hinkle and Kerry H. Cheever Chapter 5 page 67)
(https;//bellinosc.com/2014/09/09medical-terminology-deciphered-npo)
(reference: http://www.answer.com/Q. PHARMACY)
(refence: nursing care plan 8th edition page 134)
( references: jones and Bartlett nurses drug hand book 2015 (hydrocortisone page 256
andhttps://www.ncbi.nlm.gov)
(reference: drug handbook)
(reference: PPDs nursing drug guide 2007 edition).
Pediatric Nursing care for children and their families second edition)
(reference: Jones and Barlett Nursing Drug handbook 2015 (ceftriaxone page 223)
(references: PPDS Nursing Drug Guide 2007 edition)
91
BIBLIOGRAPHY
(https://dailymed.nlm.nih.gov/, http://medical-dictionary.thefreeditionary.com/kvo
(fundamental of Nursing 8th edition)
(http://www.medschat.com/yopics/immuzinc-action
(reference: atdove.org https://www.atdove /article/urine-output)
( references: Kozier and kerbs fundamental of nursing 9th edition units)
(https://www.ndrugs.com/?s=neozep%20forte)
(reference: PPDs nursing drug guide 2007 edition).
(https:www.verywell.com/how-to-do-chest-physical-herapy-child-under-five-998313)
(https://dailymed.nlm.nih.gov/, http://medical-dictionary.thefreeditionary.com/kvo)
(foundation of basic nursing second edition, lois white)

92
BIBLIOGRAPHY
https://dailymed.nlm.nih.gov/, http://medical-dictionary.thefreeditionary.com/kvo
( references: jones and Bartlett nurses drug hand book 2015 (hydrocortisone page 256 and
(https://www.drugbank.ca/drugs/DB00471)
(fundamentals of Nursing 8th edition 2008 by bermansynder, koziernderb Chapter community
based nursing and care continuity page 113)
According to Webber & Kelley Health Assessment in Nursing 3th Edition
According to Weber & Kelley Health Assessment in Nursing 3th Edition
https://www.healthtap.com/user_questions/20857-why-does-pneumonia-decrease-
hemoglobin-levels
(Reference:Nader D Nader, MD, PhD, FCCP.,Neutrophilia.,
Retrieved from :http://emedicine.medscape.com/article/208576-overview)
:http://emedicine.medscape.com/article/208576-overview23)
93
BIBLIOGRAPHY
https://www.healthtap.com/user_questions/1013250
https://en.wikipedia.org/wiki/Pulmonary
http://umm.edu/health/medical/reports/articles/pneumonia
SOURCE Nursing Care Plan 8th edition page.132
https://www.drugs.com/cg/pneumonia-in-children-discharge-care.html
http://www.livestrong.com/article/544124-diet-for-children-with-pneumonia/6

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1

Pneumonia is an inflammation of the pulmonary parenchyma, is common in

Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our health.

Clinically, pneumonia may occur either as a primary disease or as a complication of

Pneumonia is treatable and preventable. However, delays in recognizing

pneumonia and accessing appropriate care, as well as missed opportunities for

immunization, contribute to pneumonia mortality.

Major risk factors for developing pneumonia are:

A weakened immune system due to malnutrition or undernourishment

(especially in infants not exclusively breastfed)

Pneumonia can be spread by:

substances contacted during delivery

GENERAL SIGNS AND SYMPTOMS

PREVENTION AND CONTROL

Public health interventions to prevent pneumonia include:

Immunization against pathogens that directly cause pneumonia (S. pneumonia

and H. influenza type b) and pathogens that lead to pneumonia as

complication of the infection (e.g. measles and pertussis)

pneumococcal conjugate vaccine, Hib vaccine, measles and pertussis

Adequate nutrition to improve natural defense and strength of respiratory

muscles (which aid in clearance of secretions)

decrease the risk of contracting pneumonia

Reference: Marilyn J. Hockenberry and David WilsonWongs Nursing Care of Infants

and Children 10th edition (2015)

Reference:WHO surveillance contact: haiyanops@wpro.who.int)

C. SCOPE AND LIMITATION

The patient was confined on October 10, 2016. On the 3 rd day of

to right cephalic vein, with productive cough.

The coverage of the duty was Nurse Patient Interaction/Interview, Head

to Toe Physical assessment, IV regulation, monitoring and recording vital signs,

monitoring of intake and output, drug administration by oral route, studying IV

Mrs. Minerva Granada R.N., M.A.N.

D. BACKGROUND OF THE STUDY

In their case pneumonia, this is related to their subject/course. Nursing Care

skills on what proper nursingintervention they should implement. Lastly, to have

physiology, disease process, clinical manifestation, nursing intervention, prevention

The following are the objectives of this case study:

1. Utilize the nursing process in the case of the patient

with the parents, physical examination and interpretation

Identify actual and risk nursing diagnosis

Implement plan of care with the patient and family

Evaluate the progress of the patients condition and outcomes of care

2. Ensure a well organized and accurate documentation system.

Hospital No.: 192733

Patients Name: Baby CB

Address: Purok V, San Antonio II, San Pablo City, Laguna

Birthday: June 27, 2015

Age: 1 year old

Birthplace: Tiaong, Quezon

Civil Status: Child

Religion: Roman Catholic

Allergies: No known allergies

Admitting Time: 5:30 pm

Admitting Date: October 27, 2016

Admitting Diagnosis: Pneumonia, Moderate Risk

Final Diagnosis: Pneumonia, Moderate Risk

Admitting Physician: Lynn B. Quainzon, M.D.

Chief Complaint: Shortness of breath, Difficulty of Breathing,

Cough & Cold

According to the patients mother baby CB was still experiencing fever,

makaiyak ng tuloy tuloy kasi nakikita mo na nahihirapan siyang huminga at merong

parang plema dun sa dumi niya.

acquire harmful microorganisms from environment.

siya huminga, dinala ko nalang siya sa District Hospital.