Pamantasan ng Lungsod ng Pasig

Alkalde Jose St., Kapasigan, Pasig City

COLLEGE OF NURSING

CASE
PRESENTATION –
PCAP B

Submitted by:
RAMOS, Mikaela C.

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TABLE OF CONTENTS
I. Demographic Data…

II. Information Source and Source of Information…

III. Chief Complaint…

IV. History of Present Illness related to admitting diagnosis…

V. Past Medical History…

VI. Physical Health Assessment…

VII. Gordons Functional Pattern…

VIII. Anatomy and Physiology…

IX. Pathophysiology…

X. Laboratory/Diagnostic Result…

XI. Drug Study…

XII. Problem List…

XIII. Nursing Care Plan…

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 Pamantasan ng Lungsod ng Pasig
Alkalde Jose St., Kapasigan, Pasig City
COLLEGE OF NURSING

CASE PRESENTATION – PCAP B

INTRODUCTION:

Community-acquired pneumonia (CAP), which refers to pneumonia that develops in

people in the community rather than in a hospital, nursing home, or assisted-living facility.
About four million cases of CAP occur each year in the United States, and approximately 20
percent of people with CAP require hospitalization.
During normal breathing, air is inhaled through the nose and mouth and travels
through the trachea (windpipe) and bronchi (airways) to smaller tubes called the bronchioles.
At the end of the bronchioles, there are small air sacs, called alveoli. Alveoli have thin, porous
walls that contain tiny blood vessels called capillaries. Your mouth and respiratory tract are
constantly exposed to micro-organisms (germs like viruses and bacteria) through the air you
breathe. However, your body's immune system, the shape of your nose and throat (which helps
trap microorganisms and tiny particles in the air, preventing them from entering the lungs),
your ability to cough, and fine hair-like structures on the bronchi called "cilia" all help to
prevent micro-organisms from causing pneumonia. The cilia help remove particles or bacteria
that enter the bronchi by moving the material up to your trachea, where it can be coughed out.
You can develop pneumonia if your body's defences are not adequate, you are exposed to a
particularly strong micro-organism, or you are exposed to a very large number of micro-
organisms.

As the micro-organisms multiply, your immune system responds by sending white

blood cells to the alveoli to help fight the infection. The infected alveoli become inflamed (filled
with white blood cells, proteins, fluid, and red blood cells). These changes lead to the symptoms
of pneumonia. Common symptoms of pneumonia include fever, chills, shortness of breath,
chest pain with breathing, a rapid heart and breathing rate, nausea, vomiting, diarrhea, and a
cough that often produces green or yellow sputum (mucus from the lungs); occasionally, the
sputum is rust colored. Most people have a fever (temperature greater than 100.5ºF or 38ºC),
although this is less common in older adults. Shaking chills (called rigors) and a change in
mental status (confusion, unclear thinking) can also occur, (File T., Ramirez J., 2019). There are
different pneumonia causing microbes, it can be viruses, bacterial or fungal. The commonly
cause of it is Streptococcus Pneumoniae. It can also be characterized by where is the infection
is, Bronchopneumonia- infection throughout the lungs involving the bronchioles and alveoli.
Atypical/ Interstitial Pneumonia-Infection outside the alveoli interstitial. Lobar Pneumonia-
Entire region is filled with fluid. Commonly caused by S. Pneumoniae. There are different stages
of pneumonia. Congestion, Red Hepatilization, Gray Hepatilization and Resolution. In

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Congestion, it is happening in the Day 1 or 2 which the blood vessels and Alveoli filled with
excess fluid. Red Hepatilization happening in day 3-4 which the exudates such as the Red Blood
Cells, Neutrophils and Fibrin starts filling the airspaces and makes them more solid.
“Hepatization” refers to lungs taking on a liver like appearance from the reddish-brown color of
exudate. Gray Hepatilization happening 5-7 days which lungs are still firm but the color has
change because Red Blood Cells in exudate are starting to break down. Resolution happening 8
(up to 3wks) which the exudate gets digested by enzymes, ingested by Macrophages or cough
up.

 Etiology
Viral - peak attack is between 2-3 y.o.
S. pneumoniae, M. pneumoniae – older than 5 y.o.
other bacterial causes: group A strep, S. pyogenes, Staph aureus, H. influenzae type B

 Clinical manifestation

Viral and bacterial pneumonias are most often preceded by several days of symptoms of
an upper respiratory tract infection, typically rhinitis and cough

Viral pneumonia, fever -temp.- is generally lower than bacterial.

 Tachypnea is the most consistent clinical manifestation Increased working breathing

accompanied by intercostal retractions, nasal flaring and use accessory muscles

 Bacterial pneumonia in older children typically begins suddenly with shaking chill
followed by high fever, cough and chest pain

 Predictors of CAP in a Patient with cough

1. ages 3-5 y.o.- tachypnea and/or chest indrawing

2. ages 5-12 y.o. – fever, tachypnea & crackles

3. > 12 y.o. fever, tachypnea, tachycardia at least 1 abnormal chest findings rhonchi,
crackles, wheezes, ↓breath sounds.

 Reliable indicators- either tachypnea and/or chest indrawing among infants and
preschool children, Tachypnea is still the best predictor

Age specific criteria for tachypnea: 2-12 mos. – 50 breaths/min.

1-5 years. – 40 breaths/min.

5 years – 30 breaths/min. Patients with CAP are 2-3 times more likely to have the
following signs and symptoms: nasal flaring, grunting, tachypnea, rales and pallor

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 Diagnosis of an adolescent suspected to have CAP: cough, tachypnea (RR .20
breaths/min.), tachycardia (HR .100bpm) fever (temp > 37.8 ºC) at least 1 abnormal
chest findings CXR with infiltrates.

 Criteria for admission is a patient who is moderate to high risk to develop pneumonia-
related mortality should be admitted. A patient who is at minimal to low risk can be
managed on OPD basis

RISK CLASSFICIATION FOR PENUMONIA- RELATED MORTALITY

VARIABLES PCAP A PCAP B PCAP C PCAP D

Minimal Risk Low Risk Moderate Risk High Risk

Co Morbid None Present Present Present

Illness

Compliant Care Yes Yes No No

Giver

Ability to ff-up Possible Possible Not Possible Not Possible

Presence of None Mild Moderate Severe

Dehydration

Ability to feed Able Able Unable Unable

Age >11mos. >11mos <11mos <11mos

Respiratory
Rate
2-12mos >50/min >50/min >60/min >70/min
1-5yrs. >40/min >40/min >50/min >50/min
>5yrs old. >30/min >30/min >35/min >35/min

Signs of
Respiratory none None Supraclavicular
Failure Intercoastal/ Intercoastal/
a. Retraction Subcoastal Subcoastal
b. Head Bobbing Present Present
c. Cyanosis Present Present
d. Grunting None Present
Signs of
Respiratory
Failure
e. Apnea None None None Present
f. Sensorium Awake Awake Irritable Lethargic/
Stuporous

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 Complications None None Present Present
Action Plan OPD OPD Admit to Admit to ICU
regular Ward

This is a case of (12 y/o) Twelve years old female who have been diagnosed with
Pediatric Community Acquired Pneumonia- B. We will study how the patient got the condition,
the condition itself, and her course in the hospital. We also aim to further understand the
treatment, manifestations, and nursing actions in patients with Pneumonia.

I. Demographic Data
Name: J.J.J.
Age: 12 y/o
Birthplace: Cainta
Birthday: December 18 2006
Civil Status: Single
Race/Nationality: Filipino
Religion: Catholic
Educational Background: Elementary Graduate
Address: Cainta, Rizal
Occupation of Parents: Auntie – Catechist / Personal Collection Direct Seller
Usual Source of Income: Allowance
Admission Diagnosis: PCAP - B
Date Admitted: 9/20/2019 / Seen: 9/21/19
Time Admitted: 2:01 AM
Height: 148 cm
Weight: 44.3 kg
BMI: 20.22 (Normal)

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 II. Information Source and Source of Information
- The information written on this paper primarily came from the patient’s chart, inside it is
the doctors order, nurses’ notes, ER notes, medications, vital signs, and Laboratory
Examinations. The client’s relative (Aunt) was interviewed to confirm the reliability of the
data indicated on the chart.

III. Chief Complaint

- The patient experienced vomiting, paleness, coughing and malaise as a chief complain
when brought to the Emergency Room.
-

IV. History of Present Illness related to admitting diagnosis

- Two weeks prior to consultation the patient experience nonproductive cough, fever, LBM,
and vomiting. 4 days prior to consult, patients still presented signs and symptoms. She
was given cefixime after having a consultation with her PMD.
-
Progress Note Doctors Order
September. 20, 2019  Please admit to Broncho Ward
o The service of Dra.
 Secure consent of admission and management
 Monitor V/S q4 + 02Sat
 Diet: DAT
 IVF: D5LR 620cc x 8 (BSA x 1500)
 Diagnostic:
o CBC PC
o PBS
o CXR APL
o BUN
o Reticulocyte Count
o UA
o FOBT
o Serum Na, K, Ca, Cl
 Therapeutics:
o Ceftazidime 1.5gm IV q8
o Paracetamol 500mg tab / 1 Tab q4, T=37.8C
o Cetirizine 10g Tab
o Vitamin C + Zinc Tab / 1 Tab OD Am
o ONS Sachet as needed
7:30 AM  Discontinue Ceftazidime
S> No vomiting recurrence  Start Clarithromycin 500mg Tab / Tab q12 for 7 days
still with cough, no fever, no  For CBC, PC, PBS (Save Smear Please)

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rashes, no joint pain and  IVF: D5LR 620cc x 8 Hours (BSA x 1500) to run for 3 cycles
swelling.  Repeat serum Na, Ca, K, Cl, post correction of Na
O> Awake, Comfortable AP,  For possible 2-D echo today
Grade 3 murmur, SCE, CMS,  Continue Medication and Management
No Retraction, Soft non  Monitor V/S q4
tender, no organomegaly,  Refer
and Pale conjunctiva.
Nasal Pallor,
CM <2 sec
No Heart Disease
Na 129
K4
Ca 7.04
Cl 98
Weight - 44.3
135 – 129 x 44.3kg x 0.6 =
159.48
44.3 x 2 = 88.6
= 24736
82.5 in 8 hours or 8.3mEq in 8
hours
PNSS 154/1000 x 95/620 (BSA
x 1500)
PE: Dynamics  For ASO quantitative
Pericardium  Start Peen G 100000 IU/ day q6
AB 5th – 6th ICS  Start Furosemide 40mg TIIV q12
+ Thrill  Start captopril 25mg / Tab q8
 Start Lanoxin 0.25mg / Tab, ½ Tab q12
 Please check serum electrolytes prior to start cardiac meds.
9/20  Start omeprazole 40mg IV now then OD in Am
1 pm  For ASO Quantitative test and serum Na, K, Ca, Cl prior starting
Referred to Cardio Cerule cardiac meds
No Hx of recent dental  Please inform the problem once with result
extraction  Therapeutics:
No sore throat for skin  Pen G 1,100,000 IU in fractional doses, give q6 (100,00
infection IU/kg/day)
A> RF in failure  Furosemide 40mg IV q12
 Captopril 30mg Tab q8
 Lanoxin 0.25mg Tab, ½ Tab q12
 Continue Medications and Management
 Monitor V/S q4 with BP
 Refer
9/20/19  IVF to ff: D5LR 620cc x 8 hours (BSA x 1500)

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7:00 pm  DFA
S> Weak Looking, Pale, (-)  Hold Cardiac Medications for now
Fever, DOB, fair oral intake,  Start calcium correction give 10 mEq’s Ca + equal amount
(+) vomiting, (-) abdominal diluent to run for 1 hour every 8 hours x 3 doses
pain  Hook to cardiac monitor while correction is on going
A> Awake, Not in  Do not push any fluids/medications on the same side of
distress, AS, pale, PC, correction
CCLADS  For repeat serum calcium post correction
Ca Correction = 44.3/3 x 2=  FU: CBC, PC, ASO Titer
29.5 – 30 mEq (max: 10  WF: Arrythmia, irregular heart rate, DOB
mEq’s)  Hold calcium correction if HR is <60 bpm
 Monitor V/S q4, q Shift
 Refer
9/21/19  WF to ff: D5LR 620cc x 8 hours (BSA x 1500)
8 AM  DFA
S> Weak Looking, (-) DOB, (-)  FR: Serum Electrolyte, Post correction (Due 12nn)
Chest Pain, Fair oral intake, (-)  Cardiac Medication
abdominal pain, (-) febrile  Monitor V/S q4, q Shift
episode  Will refer back to cardio
O> Awake, Pale lips, AS PCC,  Refer
AP (+) Normal

V. Past Medical History

- The patient’s immunization history is unknown because she’s not living with her parents,
she is living with her aunt. Past medical history is also unknown because all of her past
records is with her parents. She just experiences colds, coughs, and fever.

VI. Family History: Genogram

Male

Female

Pat Patient
*Patient not living with
her Parents.

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 VII. Physical Health Assessment
NORMAL CHART BASIS - 09/20/19 ACTUAL – 09/21/19
BP: 100/70 100/70
TEMP: 36.4 36.6
PR: 104 101
RR: 25 32
HEIGHT: 148 148
WEIGHT: 44.3 44.3

General Survey
CHART BASIS – 09/20/19 ACTUAL – 09/21/19
Level of Consciousness
Conscious
Drowsy Conscious Conscious
Stuporous
Comatose
Coherence
Coherent Coherent Coherent
Incoherent
Orientation
Oriented
Disoriented to:
N/A but obeys command Oriented
- Time
- Person
- Place
General Appearance
Signs of distress:
- Cardiorespiratory None None
- Pain
- Anxiety
Development
Endomorph
Mesomorph
Ectomorph
Endomorph
Well developed Endomorph
Fairly Developed
Fairly developed Looks according to age
Looks according to age
Poorly developed
Looks according to age
Appears older/younger
that stated age
Nutrition
Well-nourished Well-nourished Well-nourished
Obese

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 Cachexic
Emotional state
Calm
Worried Irritable Calm
Restless
Tense
Gait
Coordinated
Uncoordinated
Staggering
N/A N/A
Shuffing
Stumbing
Unable to walk alone
Walk with assistance

SKIN

CHARACTERISTICS NORMAL FINDINGS ACTUAL FINDINGS

09/21/2019
Inspection

GENERAL COLOR

Normal (+) Pallor

Pallor (-) Pallor, (-) Jaundice, (-) Redness (-) Jaundice
(-) Redness
Jaundice

Redness

MOISTURE
Moist

Dry
(-) Dryness, (-) Clammy Skin, (-) Oily Skin (+) Dryness
Wet/ Clammy

Oily

TEXTURE
Smooth

Scaly (-) Scaly Skin, (-) Rough Skin (+) Smooth Skin

Rough

Palpation
TEMPERATURE
Warm (-) Coolness (+) Coolness

Cool

TURGOR (-) Poor Skin Turgor Good Skin Turgor

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 Good

Fair

Poor

EDEMA

No Edema

Pitting
(-) Edema (-) Edema
Non-Pitting

Pedal R/L

Others

Petechiae
(-) Petechiae, (-) Ecchymosis, (-) Lesions/
(-) Petechiae, (-) Ecchymosis, (-) Lesions/ Rashes
Ecchymosis Rashes

Lesions/ Rashes

HEAD

CHARACTERISTICS NORMAL FINDINGS ACTUAL FINDINGS

09/21/2019
Inspection

SCALP
Clean
(-) Dandruff, (-) Lice, (-) Wounds, (-)
Dandruff (+) Lice
Scars, (-) Lesions
Lice

Wounds/ Scars/
Lesions

HAIR
Normal/ Even
Distribution

Fine (-) Dryness, (-) Coarseness, (-) Alopecia,

Coarse (-) Hair Thinning (+) Normal/Even distribution

Dry

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 EYES
CHARACTERISTICS NORMAL FINDINGS ACTUAL FINDINGS

09/21/2019
Inspection
Lids
Symmetrical (-) Edema/ Swelling (+) Symmetrical

Edema/ Swelling

Conjunctiva

Pinkish

Pale (-) Paleness, (-) Lesions, (-) Discharges (+) Pale

Lesions

Discharge

Cornea
Smooth

Clear

Lesions

Opacity (-) Lesions, (-) Opacity, (-) Arcus senilis

(+) Smooth
Arcus senilis pupils (+) Clear
(+) Equal
Equal (-) Unequal Diameter
Unequal

Diameter (R)
____mm

Diameter (L) ____mm

Reaction to
Accommodation
Uniform constriction (-) Unequal Constriction Uniform constriction, Brisk reaction to light
Unequal constriction

Visual Acuity
Grossly Normal
(-) Eyeglasses (+) Grossly Normal
Wears eyeglasses

13
 NOSE

CHARACTERISTICS NORMAL FINDINGS ACTUAL FINDINGS

09/21/2019
Inspection
Nasolabial
Symmetrical Symmetrical Nasolabial Fold (+) Symmetrical Nasolabial Fold
Shallow Nasolabial
Fold L/R

Mucosa
Pinkish

Pale (-) Paleness, (-) Redness on mucosa N/A

Reddish

MOUTH
CHARACTERISTICS NORMAL FINDINGS ACTUAL FINDINGS

09/21/19
Inspection
Lips
Normal

Pallor
(-) Pallor, (-) Cyanosis, (-) Dryness/ (-) Pallor, (-) Cyanosis, (+) Dryness/ Cracks, (-) Lesions,
Cyanosis Cracks, (-) Lesions, (-) Swelling (-) Swelling
Dryness/ Crack

Lesion

Swelling

Tongue
Midline

Deviation to L/R Tongue is at midline, (-) Deviation on

Atrophy either side, (-) Atrophy, (-) Tongue is at the midline.
Fasciculation, (-) Lesions
Fasciculation

Lesions

Teeth
Complete Complete set of teeth, (-) Caries, (-) (+) Missing Teeth
Dentures, (-) Braces/ Retainers (+) Caries
Missing Teeth___

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 Caries

Dentures

Braces/ Retainers

Gums
Pinkish

Pale
(-) Paleness, (-) Bleeding, (-) Tenderness (+) Paleness
Bleeding

Tenderness

Buccal Mucosa
Pinkish

Pale (-) Paleness, (-) Cyanosis, Stenson’s

(+) Paleness
Duct is visible
Cyanotic

Stenson’s Duct

PHARYNX

CHARACTERISTICS NORMAL FINDINGS ACTUAL FINDINGS

09/21/2019
Inspection
Uvula
Midline Symmetrical Nasolabial Fold Midline

Deviation to L / R

Mucosa
Pinkish

Pale (-) Paleness, (-) Redness on mucosa (+) Pale

Reddish

Tonsils
Not Inflamed
(+) Pale
Slight Inflamed (-) Paleness, (-) Redness on mucosa
(-) Inflamed

Exudate

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 LUNGS

CHARACTERISTICS NORMAL FINDINGS ACTUAL FINDINGS

09/21/2019
Inspection
Breathing Pattern
Effortless (eupnea)
(-) Hyperventilation, (-) Use of Accessory (+) Tachypnea
Hyperventilation Muscle (+) Use of Accessory Muscle

Use of Accessory
Muscle

Shape of Chest
Anterior- Posterior-
Lateral Ratio

AP_______

L________ AP: L
(-) Barrel Chest, (-) Funnel Chest, (-)
2:1
Barrel Chest Pidgeon Chest
(-) Barrel Chest, (-) Funnel Chest, (-) Pidgeon Chest

Funnel

Pigeon

Other

Chest Expansion
Symmetrical
Symmetrical Lung Expansion Symmetrical Lung Expansion
Decreased L/R

Breath Sounds
Normal

Abnormal breath
sound

Bronchovesicular

Vesicular (-) Abnormal Breath Sounds, (-) Rhonchi,

(+) Wheezes
Bronchial (-) Rales, (-) Pleural Friction

Wheezes

Ronchi

Rales

Pleural friction

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 BACK AND EXTREMITIES
CHARACTERISTICS NORMAL FINDINGS ACTUAL FINDINGS

09/21/2019
Nails and nail beds
Inspection
Normal

Redness (-) Redness, (-) Swelling, (-) Pain Pinkish

Swelling

Pain

Palpation
Normal
(-) Tenderness (-) Tenderness
Tenderness

Joints
Inspection
Normal

Redness
(-) Redness, (-) Swelling, (-) Pain (-) Redness, (-) Swelling, (-) Pain
Swelling

Pain

Arms
 IVF to ff: D5LR 620cc x 8 hours (BSA x 1500)

Summary Findings:
SKIN

- (+) Paleness
- (+) Dry Skin
- (+) Cold Temperature

HEAD

- (+) Lice

EYES

- (+) Pale Conjunctiva

MOUTH

- (+) Dry Lips

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 - (+) Missing Teeth
- (+) Carries
- (+) Paleness of Gums and Buccal Mucosa

PHARYNX

- (+) Paleness of Mucosa and Tonsils

LUNGS

- (+) Tachypnea
- (+) Use of Accessory Muscles
- (+) Wheezes

VIII. Gordon’s Functional Pattern

Gordon’s Before During Confinement Identified Nursing
Confinement Diagnosis
1. Health According to the  The patient is Ineffective Health
Perception and relative of the admitted to Maintenance
Health patient, it has been the hospital
Management easy to find ways to with a
Pattern follow things nurses diagnosis of
or doctors suggest. PCAP-B and
experiences
Cough,
Dizziness,
and she was
attached
with an IVF
D5LR 620cc x
8 hours (BSA
x 1500)

2. Nutritional and According to the During - Impaired

Metabolic relative, the patient is a hospitalization the Dentition
picky eater. She likes patient eats a variety
Pattern (ask to eat junk foods, she
about appetite doesn’t like to eat of foods, such as
for present) vegetables and fruits, banana, rice, and
and she doesn’t drink soup. She still
enough water. The experiences
patient had problems problems with
eating due to missing eating due to her
of teeth.
missing teeth and

18
 also, she vomits the
foods she is eating.
3. Elimination According to the During Readiness for
Pattern relative, the patient hospitalization the enhanced urinary
was defecating up to patient was elimination
two times a day. urinating more
According to the frequently.
patient, she urinates
3x a day.
4. Activity and According to the From admission, the - Activity
Exercise Pattern relative, the patient patient does bathe Intolerance
just watches level II with - Ineffective
television and she assistance of the Breathing
does regular relative. The patient Pattern
household chores as experiences shallow - Impaired
her exercise. breathing along with Gas
coughing and Exchange
wheezing, - Ineffective
tachycardia, Airway
paleness of the skin Clearance
and extremities.
5. Sleep and Rest According to the Now that the patient Fatigue
Pattern relative of the is confined, she
patient, she has sleeps every time, it
always enough takes about 11
sleep, sometimes hours.
more than enough.
6. Cognitive- According to the During Disturbed Sensory
Perceptual patient, she is hospitalization, the Perception; Visual
Pattern having difficulty in patient had trouble
learning new things with her vision when
particularly when it comes to looking
it’s in English. She afar.
doesn’t have any
problems regarding
her vision.
7. Self-Perception According to the During the Readiness for
and Self-Concept patient, she feels confinement, the enhanced self-
Pattern good all the time patient doesn’t have concept.
and she feels strong. any problems and
she was able to
communicate
properly.

19
 8. Role According to the During the Readiness for
Relationship relative, the patient confinement, her enhanced
Pattern is living with her, aunt comes and relationship
along with her visits her, who takes
cousin and her other care of her.
sibling.
9. Sexuality- N/A N/A N/A
Reproductive
Pattern

10. Coping Stress According to the During the Fear

Pattern patient, she doesn’t hospitalization, the
have any stressors patient is sometimes
as of the moment nervous when she is
since she is only a given medication
child. through IV.
11. Value and Belief According to the According to the Readiness for
Pattern relative of the relative of the enhanced spiritual
patient, the patient, they pray well-being
patient’s religion is that this won’t
Catholic. When happen again
stressed, she prays because they want
that the thing that her to live longer to
gives her strength be with her family.
and keeps her going
is her family.

20
 IX. Anatomy and Physiology

Pneumonia is a respiratory infection characterized by inflammation of the alveolar space

and/or the interstitial tissue of the lungs.

Pulmonary protective mechanisms (cough reflex, mucociliary clearance, alveolar macrophages)

fail → microbial infiltration of the pulmonary parenchyma cannot be prevented
Pathogen infiltrates pulmonary parenchyma → interstitial and alveolar inflammation → impaired
alveolar ventilation → Ventilation/perfusion (V/Q) mismatch with intrapulmonary shunting (right
to left) → hypoxia due to increased alveolar-arterial oxygen gradient (This effect is worsened if
the affected lung is in the dependent position since perfusion is better to the dependent lung
than the non-dependent lung)
Pattern of involvement
Lobar pneumonia: classic (typical) pneumonia of an entire lobe, primarily caused by
pneumococci
Classic disease progression in stages:
 Congestion (day 1): serous exudate in blood-rich lungs, numerous bacteria evident
 Red hepatization (days 2–3): exudate rich in fibrin and inflammatory cells with many
bacteria still visible; lungs take on a liver-like texture. Lung loses some spongy quality
 Gray hepatization (days 4–7): erythrocytes are degraded but inflammatory cells persist;
most bacteria have been destroyed by this stage. Lung is now firm

21
  Resolution (day 8 to week 4): fibrinolysis by enzymatic means and removal of the
purulent exudate via productive cough.

"Alveoli" are air sacs in your lungs that are surrounded by tiny blood vessels called capillaries.
The air sacs have thin walls that allow the exchange of gases. When blood flows through the
capillaries around the air sacs, it picks up oxygen that you have breathed in and dumps off carbon
dioxide that you then breathe out. But if you have pneumonia, your alveoli swell and fill with
inflammatory cells and fluid, containing white blood cells, red blood cells, macrophages, fibrin,
cell debris, and microorganisms. This makes you cough and makes it hard to breathe.

22
 Respiratory system
facilitates gas exchange,
oxygen in the air is inhaled
and makes its way through
the pharynx, larynx,
trachea, large upper
airways, conducting
bronchioles, respiratory
bronchioles, alveoli, and
finally capillary to be sent to the bodies tissue, then carbon dioxide makes the reverse journey to
be eventually exhaled to the world.
Active congestion of the lungs is caused by infective agents or irritating gases, liquids, and
particles. The alveolar walls and the capillaries in them become distended with blood. Passive
congestion is due either to high blood pressure in the capillaries, caused by a cardiac disorder, or
to relaxation of the blood capillaries followed by blood seepage.
Left-sided heart failure—inability of the left side of the heart to pump sufficient blood into the
general circulation—causes back pressure on the pulmonary vessels delivering oxygenated blood
to the heart. The blood pressure becomes high in the alveolar capillaries, and they begin to
distend. Eventually the pressure becomes too great, and blood escapes through the capillary wall
into the alveoli, flooding them. Mitral stenosis, narrowing of the valve between the upper and
lower chambers in the left side of the heart, causes chronic passive congestion. Iron pigment
from the blood that congests the alveoli spreads throughout the lung tissue and causes
deterioration of tissue and formation of scar tissue. The walls of the alveoli also thicken and gas
exchange is greatly impaired. The affected person shows difficulty in breathing, there is a bloody
discharge, and the skin takes on a bluish tint as the disease progresses.
Passive congestion due to relaxation of the blood vessels occurs in bedridden patients with weak
heart action. Blood accumulates in the lower part of the lungs, although there is usually enough
unaffected lung tissue for respiration. The major complication arises in mild cases of pneumonia,
when the remaining functioning tissue becomes infected.
Pulmonary edema is much the same as congestion except that the substance in the alveoli is the
watery plasma of blood, rather than whole blood, and the precipitating causes may somewhat
differ. Inflammatory edema results from influenza or bacterial pneumonia. In mechanical edema
the capillary permeability is broken down by the same type of heart disorders and irritants as in
congestion. It can occur, for unknown reasons, after reinflation of a collapsed lung. After an
operation, if too great a volume of intravenous fluids is given, the blood pressure rises and edema
ensues. Excessive irradiation and severe allergic reactions may also produce this disorder.

23
Pathophysiology

24
25
26
X. Laboratory/Diagnostic Result
Complete Blood Count
HCT L 0.27 0.38– 0.47
Hgb L 90.0 120 – 160
RBC L 3.23 4.50 – 6.00
WBC H 15.3 4.50 – 11
Platelets H 491 150 – 400

RCL
MCV 85 80 – 100
MCH 28 27.0 – 31.0
MCHC 33 31.0 – 36.0
RDW - CV L 10.9 11 – 16
RDW-SD L 33 37-54

Differential Count
Neutrophils H 0.66 0.35 – 0.65
Lymphocytes 0.26 0.25 – 0.35
Eosinophils 0.02 0.00 – 0.05
Monocytes 0.06 0.02 – 0.08

SECTION OF CLINICAL CHEMISTRY

Sodium L 131 137 – 145
Potassium 4.7 3.60 – 5
Calcium L 1.96 2.10 – 2.57
Chloride 99 96 – 107

FECALYSIS
Physical: Color Consistency
Brown Formed
NO INTESTINAL PARASITES SEEN

27
XI. Drug Study
Generic General Dosag Contraindi Side Nursing Patient
Name Indication e cation Effects Consider Teaching
ation
Cetirizine Allergic 10 mg, Hypersensi Pharyngitis Assess Avoid
Rhinitis & tablets tivity to , Dry lung task that
Antihistami Urticaria, 7 days cetirizine, mucous sounds, require
ne Renal/Hepati Hydroxyzin membrane severity alertness
c Impairment e , nausea, rhinitis, motor
vomiting, urticaria, skills until
abdominal and other drug is
pain, symptom establish
headache, s. ed
dizziness, Increase
fatigue, fluid
thickening intake.
of mucous,
drowsiness
,
photosensi
tivity,
urinary
retention.
Paracetamo Mild pain or 500mg/ Contraindic > CNS: Check IV- > Do not
l fever Tab q4 ated in Headache line exceed
patients patency recomme
hypersensit > CV: as drug is nded
ive to the dyspnea oil-based dose
drug or its > and > Report
component Hematolog irritating rash,
s, patients ic: to the unusual
with long- Hematuria vein, bleeding
term dilute or
alcohol use drug in bruising,
because sterile change in
therapeutic water for voiding
doses patient’s patterns
could comfort,
cause flush IV
hepatotoxic line
ity in these before
patients and after
administr
ation

28
Vitamin C - Dietary 1 Tab - Use of > GI: > Secure > Do not
supplement; OD sodium Nausea, doctors exceed
- Frank and AM ascorbate Vomiting, order the
subclinical in patients Heartburn, > Do recomme
scurvy; on sodium Diarrhea hand nded
- Extensive restriction; washing dose
burns, - Use of > > Assess > Take
delayed calcium Hematolog patient’s the drug
fracture or ascorbate ic: Acute condition after
wound on patient hemolytic > Give meals
healing, receiving anemia medicatio
severe febrile digitalis > CNS: n on right
or chronic Headache timing
disease > > Inform
states; Urogenital: patient
- To prevent Urethritis, about the
Vitamin C in dysuria, possible
patients with crystalluria side
poor > Others: effects of
nutritional Mild the
habits soreness, drugs.
- To acidify dizziness,
urine faintness,
- To Muscular with rapid
degeneration IV
administra
tion
Oral - Sachet This > Mild > Secure > Do not
Rehydratio Gastroesoph as product is nausea doctors exceed
n Solution ageal Reflux Neede used to and order recomme
Disease d replace vomiting > Inform nded
Zollinger- fluids and may occur. patient dose
Ellison minerals about the
Syndrome (such as possible
Duodenal sodium, side
Ulcer potassium) effects of
Helicobacter lost due to the drugs
Pylori diarrhea
Infection and
Erosive vomiting. It
Esophagitis helps
Read More prevent or
treat the
loss of too

29
 much body
water
(dehydratio
n).
Ceftazidime Treatment of 1.5 Severe Frequent Obtain Discomfo
susceptible gms IV renal discomfort CBC, rt may
infections q8 impairmen with IM Renal occur
Antibiotic due to gram- t, history of administra function with IM
negative penicillin tion, oral test, injection,
organism allergy, candidiasis question doses
including seizure , mild for should be
pseudomona disorder diarrhea, history of evenly
s and mild allergies spaced,
Enterobacteri abdominal particular continue
aceae. cramping, ly antibiotic
nausea, penicillin, therapy
joint pain monitor for full
daily length of
pattern treatmen
of bowel t
activity or
stool
consisten
cy
Dextrose -Treatment D5LR Contraindic > Itching, Do not > Do not
5% and for persons 620 ml ated in hives, administe exceed
Lactated needing extra Infusin patients swelling of r unless recomme
Ringers calories who g left taking the face, solution nded
cannot arm Amphoteri puffy eyes, is clean dose.
tolerate fluid for 8 cin, B coughing, and > Report
overload. hours mannitol, sneezing, container rash,
- Treatment Diazepam sore is edema,
of shock throat, undamag and
difficulty ed. unusual
breathing, Caution voiding
fever, and must be patterns
injection exercised
site in the
reactions administr
(infection, ation of
swelling, parentera
redness). l fluids.
Solution
containin

30
 g
dextrose
should be
used with
caution.
Omeprazole Symptomatic 40 mg Patients >CNS: Dosage > Take
gastroesopha TIV OD hypersensit Headache, adjustme the drug
geal reflux ive to the dizziness, nts may before
disease drug or its vertigo, be meals.
(GERD) component insomnia, necessar > Have
Antacid without s, anxiety, y in regular
esophageal metabolic apathy Asians medical
lesions, alkalosis and follow-up
erosive and >Dermatol patients visits
esophagitis hypocalce ogic: with
and mia, Urticaria, hepatic
accompanyin patients alopecia, impairme
g symptoms with Bartter dry skin nt; drug
caused by syndrome, increases
GERD, hypokalemi >GI: its own
maintenance a, and constipatio bioavaila
of healing respiratory n, dry bility with
erosive alkalosis, mouth, repeated
esophagitis, long-term tongue doses,
pathologic administrati atrophy, unstable
hypersecretor on of abdominal in gastric
y conditions sodium pain acid,
such as bicarbonat gastrin
Zollinger- e with >Respirato level
Elison calcium or ry: cough, increases
Syndrome, milk can epistaxis, in most
duodenal cause milk- URI patients
ulcer, alkali symptoms during the
Helicobacter syndrome >Other: first 2
back pain, weeks of
fever, therapy
decreased
bone
density
Clarithromy Renal 500 Hypersensi Diarrhea, Monitor Continue
cin impairment & mg / tivity to nausea, bowel therapy
Hepatic Tab, 1 other altered activity for full
impairment Tab antibiotics, taste, and stool length of
q12 for history of abdominal consisten treatment
Antibiotic 7 days ventricular pain, cy, fever, , doses
arrythmias, headache, vomiting, should be
including dyspepsia diarrhea, evenly
torsade’s Monitor spaced,
depointes, CBC, report

31
 history of Serum severe
cholestatic BUN, diarrhea
jaundice or Creatinin
hepatic e
impairment
prior
clarithromy
cin use.
Penicillin G Renal 1,100, Hypersensi Lethargy, Question Do not
Impairment, 000 IU tivity to any Fever, for history exceed
Antibiotic Hepatic TIV q6 of the Dizziness, of recomme
Impairment penicillin. Rash, Pain allergies, nded
Renal at Injection monitor dosage
Impairment Site CBC,
, Seizure Urinalysis
disorder, , Renal
history of Function
allergies Test
and
asthma
Furosemide Edema, heart 40 mg Anuria, Increased Monitor Expect
failure, TIV hepatic urinary the vital increased
Deuretic hypertension, q12 xerosis, frequency signs, frequency
renal hepatic or volume, especially , volume
impairment, coma, nausea, the BP of
hepatic severe dyspepsia, and Pulse urination,
impairment electrolyte abdominal for report
depletion, cramps, hypotensi palpitatio
pre diarrhea or on before n, signs
diabetes, constipatio administr of
diabetes, n, ation. electrolyt
systemic electrolyte Asses e
lupus disturbanc baseline imbalanc
erythemato e, serum e, hearing
us dizziness, electrolyt abnormali
light e ties, eat
headednes especially foods
s, for high in
headache, hyperkale potassiu
blurred mia, m such
vision, asses for as whole
paresthesi skin grains,
a, turgor, legumes,
photosensi mucous meat,
tivity membran bananas,
es for apricots,
hydration oranges,
status, juice,
observe potatoes,
for raisins,
edema

32
 Avoid
sunlight.
Captopril Hypertension 25 mg History of Pruritus, Obtain Full
, Diabetic / Tab, angioedem rash, BP therapeuti
Antihyperte nephropathy, 1 Tab a from dysgeusia immediat c effect of
prevention of q8 previous or altered ely before BP
nsive, renal failure, treatment taste, each reduction
Vasodilator renal with ACE headache, dose, if may take
impairment, inhibitors, cough, hypotensi several
hepatic concomitan insomnia, on occurs weeks,
impairment t use with dizziness, place in immediat
aliskiren in fatigue, supine ely report
patients nausea, position if swelling
with DM diarrhea, with legs of waist,
constipatio elevated. lips, or
n, dry Asses tongue,
mouth, skin for difficulty
tachycardi rash, of
a pruritus, breathing,
assist vomiting,
with diarrhea,
ambulatio excessive
n if perspirati
dizziness on,
occurs dehydrati
on
Calcium Hypocalcemi 10 ml Hypokalem Pain, rash, Assess Do not
Gluconate a tetani, IDST, ia, calcium redness, BP, take
chronic renal Equal based flushing, Cardiac within 1-2
impairment Diluent renal nausea, Rhythm, hours of
Electrolyte x1 calculi, vomiting, Renal other oral
Replenisher Hr., q8 ventricular diaphoresi Function, medicatio
x3 fibrillation, s, Serum ns, fiber
doses chronic hypotensio Magnesiu containin
renal n m, g foods
impairment Phosphat and
, e, caffeine.
Potassiu
m,
Monitor
Calcium
Digoxin Heart failure, 0.25 Ventricular Dizziness, Asses Follow up
supraventricu mg / fibrillation, Headache, Apical visits,
Antiarrhyth lar Tab, ½ renal Diarrhea, Pulse, if blood test
arrythmias, Tab impairment Rash, pulse is are an
mic renal q12 , sinus Visual <60 per important
Cardiotonic impairment, nodal Disturbanc minute, part of
hepatic disease, es withhold therapy,
impairment 2nd or 3rd drug, follow
degree Monitor guideline

33
 heart block, pulse for s to take
hyperthyroi bradycard apical
dism, ia, asses pulse and
hypothyroid for GI report
ism, Disturban pulse <60
hypokalemi ces, per
a, Neurologi minute,
hypocalce c do not
mia abnormali increase
ties or skip
doses,
report
decrease
appetite,
nausea,
vomiting,
diarrhea,
and
visual
changes.

XII. Problem Lists:

Problem Number Problem Date Identified Date Resolved
(Prioritized)
#1 (Actual) Ineffective Airway September 21 -----
Clearance 2019
#2 (Actual) Ineffective September 21 -------
Breathing Pattern 2019

#3 (Potential) Impaired Gas September 21 ------

Exchange 2019

34
 XIII- Nursing Care Plan:

ASSESSMENT: DIAGNOSIS: PLANNING: INTERVENTION: RATIONALE: EVALUATION:

Objective: -Ineffective Short Term: Short Term:
-Flat on bed Airway -After 6 hours -Establish -To build -After 6 hours of
accompanied by Clearance r/t of nursing therapeutic rapport and Nursing
the relative. accumulation interventions, communication trust. Interventions,
-Paleness of the of secretion as the patient’s with the patient. the patient’s
skin and evidenced by: respiration respiration has
extremities. a. will improve - Monitor V/s -To evaluate improved and
-Frequent dry unproductive and difficulty especially degree of difficulty of
coughing. cough of breathing respiratory rate, compromise breathing have
-Shallow b. Tachypnea will be note for any been relieved.
breathing with c. Wheezes relieved. respiratory
the use of distress. Long Term:
Lung
accessory Long Term: -After 4-5 days
congestion,
muscle. -After 4-5 -Elevate the head -To take of nursing
distention
BP- days of of the bed/ change advantage of interventions,
of blood
100/70mmhg vessels in the Nursing position every 2 gravity the patient has
HR- 32 bpm lungs and filling Interventions, hours and as decreasing able to maintain
PR- 101 cpm of the alveoli the patient needed pressure on a patent airway.
T- 36.6c with blood as a will maintain the diaphragm
-Wheezes in result of an a patent enhancing
Lower Left Lung infection, drainage of/
airway.
high blood ventilation to
field upon
pressure, or
auscultation. different lung
cardiac
segments
insufficiencies
Subjective: (i.e., inability of
“Nahihirapan din the heart to -Teach and assist -It facilitates
ako huminga” as function patient with proper maximum
verbalized by the adequately). The deep- breathing expansion of
patient. alveoli in the exercises. the lungs and
lungs are minute Demonstrate smaller
air sacs proper splinting of airways, and
where carbon
chest and effective improves the
dioxide and
coughing while in productivity of
oxygen
exchange
upright position. cough.
occurs.

RAMOS, Mikaela C. Clinical Instructor: Prof. Elena Mabini

BSN II- Watson

35