ILOILO DOCTORS’ COLLEGE

COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

NCM 112 RLE

CARE OF CLIENT WITH ALTERATIONS IN OXYGENATION
RELATED LEARNING EXPERIENCE

A CASE STUDY ON:

PNEUMONIA

PRESENTED BY
JOEGIE ANNE T. ARIO
BSN III – A

COURSE INSTRUCTOR
MRS. MARY ANNE JANALA
 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

I. INTRODUCTION AND OBJECTIVES

a. Introduction

PNEUMONIA

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up
of small sacs called alveoli, which fill with air when a healthy person breathes. When an
individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful
and limits oxygen intake. Pneumonia is the single largest infectious cause of death in children
worldwide. Pneumonia killed 808 694 children under the age of 5 in 2017, accounting for 15% of
all deaths of children under five years old. Pneumonia affects children and families everywhere,
but is most prevalent in South Asia and sub-Saharan Africa. Children can be protected from
pneumonia, it can be prevented with simple interventions, and treated with low-cost, low-tech
medication and care.

Causes

Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The
most common are:

 Streptococcus pneumoniae – the most common cause of bacterial pneumonia in children;

 Haemophilus influenzae type b (Hib) – the second most common cause of bacterial
pneumonia;
 respiratory syncytial virus is the most common viral cause of pneumonia;
 in infants infected with HIV, Pneumocystis jiroveci is one of the most common causes of
pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected
infants.

Transmission

Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found
in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-
borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood,
especially during and shortly after birth. More research needs to be done on the different
pathogens causing pneumonia and the ways they are transmitted, as this is of critical importance
for treatment and prevention.

Presenting features

The presenting features of viral and bacterial pneumonia are similar. However, the symptoms of
viral pneumonia may be more numerous than the symptoms of bacterial pneumonia. In children
under 5 years of age, who have cough and/or difficult breathing, with or without fever,
pneumonia is diagnosed by the presence of either fast breathing or lower chest wall in drawing
 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

where their chest moves in or retracts during inhalation (in a healthy person, the chest expands
during inhalation). Wheezing is more common in viral infections.

Very severely ill infants may be unable to feed or drink and may also experience
unconsciousness, hypothermia and convulsions.

Risk factors

While most healthy children can fight the infection with their natural defences, children whose
immune systems are compromised are at higher risk of developing pneumonia. A child's immune
system may be weakened by malnutrition or undernourishment, especially in infants who are not
exclusively breastfed. Preexisting illnesses, such as symptomatic HIV infections and measles,
also increase a child's risk of contracting pneumonia.

The following environmental factors also increase a child's susceptibility to pneumonia:

 indoor air pollution caused by cooking and heating with biomass fuels (such as wood or
dung)
 living in crowded homes
 parental smoking.

Treatment

Pneumonia should be treated with antibiotics. The antibiotic of choice is amoxicillin disperse
tablets. Most cases of pneumonia require oral antibiotics, which are often prescribed at a health
centre. These cases can also be diagnosed and treated with inexpensive oral antibiotics at the
community level by trained community health workers. Hospitalization is recommended only for
severe cases of pneumonia.

Prevention

Preventing pneumonia in children is an essential component of a strategy to reduce child

mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is
the most effective way to prevent pneumonia.

Adequate nutrition is key to improving children's natural defence, starting with exclusive
breastfeeding for the first 6 months of life. In addition to being effective in preventing
pneumonia, it also helps to reduce the length of the illness if a child does become ill.

Addressing environmental factors such as indoor air pollution (by providing affordable clean
indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the
number of children who fall ill with pneumonia. In children infected with HIV, the antibiotic
cotrimoxazole is given daily to decrease the risk of contracting pneumonia.
 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

a. Objectives

General Objectives: At the end of this case study, student will be able to apply proper
knowledge, skills and attitude in providing care on patient with given illness.

Specific Objectives:

Knowledge

 Identify the etiology of Pneumonia.

 Give proper treatment and management options available for patient.
 Evaluate the outcome criteria for the achievement and effectiveness of care.
 Discuss inter-professional team strategies for improving care coordination and
communication to advance health care and improve outcomes for patients with pneumonia.

Skills

 Develop the skills in identifying the exact nursing diagnosis of the patient to provide
adequate nursing care to patients. In order help, alleviate their suffering with proper health
care and health teaching.
 Formulate proper nursing care plan.
 Implement appropriate nursing interventions.

Attitude

 Establish the rapport with the patient with the client and members of the family.
 Show out most confidence in managing the client care.
 Recognize client’s needs using holistic approach.
 Develop sense of gratitude towards the patient.

II. PATIENT’S DATA

Client’s Name: Mr. Roque

Age: 58 years old
Sex: Male
Marital Status: Married
Occupation: Office Consultant
Source of Information: Wife
Attending Physician: Resident on Duty
Admitting Impression: Left lung field infiltration
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COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

Physical Assessment:
Vital signs:
 Temperature: 38.5ºC
 Pulse rate: 85 bpm  Blood pressure: 130/80mmHg
 Respiratory rate: 28 cycles/min  Oxygen saturation: 90% room air

Weight: 65 kg
Physical Examination:
General Appearance  Restless and pale
 Swollen and inflamed throat noted
 Occasional productive cough with yellowish sputum;
III.
rapid and shallow breathing.

Skin  Good skin turgor

Lungs  Decreased breath sounds and with rales/crackles on the

left lower lung segments upon auscultation.

Abdomen  No scars or lesions noted

Upper And Lower Extremeties  Both extremities are equal in size.

 No edema.
 Can carry out complete range of motion
PAST AND PRESENT MEDICAL HISTORY

Chief Complaint:

 high-grade fever and chills and difficulty of breathing

History of Present Illness

 1 week prior to admission the patient had cough associated with back pain and has poor
appetite

 took over the counter drugs to relieve his pain/discomfort

 sought consult and was requested a chest x-ray

 advised admission due to left lung field infiltration

 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

Past Medical History

 Hypertensive

 He has been a smoker since he was in high school at an early age of 18 years old.

 Consumes 2 sticks of cigarettes per day.

 Has pollen allergies and frequently suffers from rhinitis.

 He works in an office as a consultant and often works overtime, due to his nature of work, he
is occasionally sent by the manager as a representative of the company to travel places for
any work-related activities.

Family Health History

 No family health history

Personal and Socioeconomic History

 Occupation: Consultant

IV. PATHOPHYSIOLOGY

Anatomy of the Lungs

The lungs are a pair of spongy, air-filled

organs located on either side of the chest
(thorax). The trachea (windpipe)
conducts inhaled air into the lungs
through its tubular branches, called
bronchi. The bronchi then divide into
smaller and smaller branches
(bronchioles), finally becoming
microscopic.

The bronchioles eventually end in

clusters of microscopic air sacs called
alveoli. In the alveoli, oxygen from the
air is absorbed into the blood. 
 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

Carbon dioxide, a waste product of metabolism, travels from the blood to the alveoli, where it can be
exhaled. Between the alveoli is a thin layer of cells called the interstitium, which contains blood
vessels and cells that help support the alveoli.

The lungs are covered by a thin tissue layer called the pleura. The same kind of thin tissue lines the
inside of the chest cavity -- also called pleura. A thin layer of fluid acts as a lubricant allowing the
lungs to slip smoothly as they expand and contract with each breath.

Disease Process

Symptomatology
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COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

V. DIAGNOSTIC EXAMINATION RESULTS

a. Laboratory Exams

Lab exam Results Normal Values Significance

WBC count 23.84 Elevated white blood cell
4,500 to 11,000 (WBC) count is a
Urine Test Results Normal
cells/mm³ Values Significance
characteristic finding in
Urinalysis Color: Straw; pneumococcal
Straw-colored and hazy
Color: Pale yellow pneumonia.
urine means An increased
Transparency:
production of white
drinking sufficient fluid,blood
Hazy Turbidity or cells tourine
abnormal fight color
an infection.
may
transparency: Clear
RBC count 4.98 Male adult: 4.5 – 6.2 Normal
be caused by infection,
million/mm3 million/mm3 ;
Female adult: 4.5 – 5.0 disease, medicines, or
million/mm3 food you eat.
pH
Hemoglobin 5.0
150g/L 4.5 to 7.8
Male: 14-16.5 g/dL; Normal
Normal
Specific Gravity 1.015 1.016 to 1.022
Female: 12-15 g/dL or Normal
Albumin Negative Negative
Male: 130-180 g/L Negative test result
Female: 115-165 g/L means that there is no
Hematocrit 0.45 or 45% Male: 42 – 52%; detectable amount
Normalof
Female: 35 – 47% protein in the urine at the
Platelet 200,000 150,000 to 400,000 time of testing.
Normal
Sugar Negative
cells/mm³ Negative
cells/mm³ Negative urine glucose
Neutrophils 0.83 or 83% 55 – 70% or 1,800 to test may be the
Having a high result of
percentage
7,800 cells/mm³ a normal blood glucose
of neutrophils in your
level.
blood is called
neutrophilia, this is a sign
that your body has an
infection.
Lymphocytes 0.09 or 9% 20 – 40% or 1,000 to Lymphopenia, occurs
4,800 cells/mm³ when your lymphocyte
count in your
bloodstream is lower than
normal. Severe or chronic
low counts can indicate a
possible infection.
Monocytes 0.01 or 1% 2 – 8% or 0.0 to 800 It is considered normal,
cells/mm³ because
the normal absolute 
monocytes range is
between 1 and 10% of the
body's white blood cells.
Eosinophils 0.01 or 1% 1 – 4% or 0.0 to 450 Normal
cells/mm³
Basophils 0.1 or 1% 0–2% or 0.0 to 200 Normal
cells/mm³

Impression: CAP-MR, (community-acquired pneumonia-moderate risk)

 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

left lower lung considered

b. X-ray Results

Chest x-ray PA view:

 The posteroanterior (PA) chest view examines the lungs,

bony thoracic cavity, mediastinum and great vessels.

Result: Left lower lobe infiltration

Sputum culture and sensitivity:

 Bacterial sputum cultures are used to detect and diagnose
bacterial illnesses of the lower respiratory tract, such as
pneumonia.
 To identify the bacteria that is causing a person's infection, it is
usually done with a Gram stain.

Result: Positive for Streptococcus Pneumoniae

VI. NURSING CARE PLAN

Defining Nursing Outcome Nursing Rationale Evaluation

Characteristics Diagnosis Identification Interventions

Subjective: Ineffective Long term: Independent: Goals met.

airway Patient exhibits
clearance After 1 week of Monitor rate, Provides basis a normal and
“Difficulty of related to thick nursing rhythm, depth, for evaluating effective
breathing” sputum interventions, and effort of adequacy of respiratory
secondary to the patient will respirations ventilation. pattern as
pneumonia as be able to evidence by:
evidenced by maintain airway Note chest Presence of
adventitious patency by movements, nasal flaring Respirations
Objective: breath sounds showing: watch for and use of within range.
● temperature and thick symmetry, use accessory
yellow sputum. Normal breath of accessory muscles of No sense of
of 38.5ºC sounds when muscles and respirations signs and
Rationale: auscultated supraclavicular may occur in symptoms of
and intercostal response to cyanosis
● Pulse rate 85 A state in which Respiratory rate muscle ineffective
bpm an individual's of 16- 20 BPM retractions. ventilation. Normal ABG
inhalation and and O2
or exhalation Not using saturation
● Respiratory pattern does not accessory levels.
enable adequate muscles when Elevate the To take
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COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

rate of 28 cpm pulmonary breathing. head of the bed/ advantage of

inflation or change position gravity,
emptying. every 2h. And decreasing
● Blood Short term: prn. pressure on the
After 8 hours of diaphragm and
pressure of
nursing enhancing the
130/80mmHg interventions, drainage of
the patient will ventilation to
be able to different lung
● Oxygen expectorate/ segments.
clear secretion
saturation
readily.
90% in room Promote Adequate fluid
systemic fluid intake
air.
hydration, as enhances
appropriate liquefaction of
pulmonary
● Weight -65
secretions and
kg. facilitates
expectoration
of mucks.
● Decreased
breath sounds.
Dependent:

Administered Bronchodilator
● Rales/
medications as s aid in
crackles ordered: reduction of
antibiotics, bronchospasm.
sound on the
mucolytics, Mucolytics
left lower expectorants and
and expectorants
lung upon
bronchodilators mobilize
auscultation. . secretions.
Antibiotic
therapy is
● Occasional prescribed for
pneumonia( ex
productive
cept lipid and
cough with viral
pneumonia).
yellowish
sputum.

● Rapid and
Administer Supplemental
shallow
supplemental oxygen aids in
breathing oxygen via face ventilation and
mask as minimize the
ordered. risk for
● Restless and pneumonia
pale
Collaborative:

Monitored Serial
serial x rays, diagnostic
 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

ABGSs and studies follow

pulse oximeter the progress
readings. and effects of
disease
process
therapeutic
regimen and
facilitate
necessary
alterations in
therapy.

Defining Nursing Outcome Nursing Rationale Evaluation

Characteristics Diagnosis Identification Interventions
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COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

Subjective: Hyperthermia Long term: Independent: Goals met.

“High-grade fever related to illness
and chills” (Pneumonia) After 8hrs of Monitor vital To know the After 8hrs of
nursing signs changes if the nursing
intervention, the vital sign intervention,
Objective: Rationale: patient lower or the patient
Objective: maintains body higher. maintains body
● temperature Low-grade fever temperature Adjust and temperature
caused by below 39.C. monitor below 39.C.
of 38.5ºC
environmental To regulate the
infection Short term: factors like temperature of
room the patient. After 2hrs of
● Pulse rate 85
After 2hrs of temperature nursing
bpm nursing and bed linens intervention,
intervention, the as indicated. the patient
patient maintains BP
● Respiratory maintains BP and HR within
and HR within normal limits.
rate of 28
normal limits. Monitor intake Helps ensure
cpm and output. that the patient
has a proper
intake of fluids
● Blood and nutrients.
pressure of
130/80mmHg

● Oxygen Dependent:
saturation
90% in room Monitor To ensure
air. laboratory safety and
studies, effective
Administer medication
● Warm to medications, therapy.
touch fluids and
electrolytes,
and oxygen as
ordered by the
physician

VII. DRUG STUDY

DRUG CLASSIFICATION INDICATION SIDE EFFECTS OR SPECIAL NURSING

NAME AND AND ADVERSE PRECAUTIONS CONSIDERATIONS
MECHANISM OF CONTRAINDI REACTIONS
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COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

ACTION CATION

Generic Classification: Indications:  Minimal GI  Patient  Check if the patient

Name: Non-narcotic  Mild to upset. with is not taking any
Paracetam Analgesic, moderate  Methemoglo known other medication
ol Antipyretic pain. binemia G6PD containing
Brand Mechanism of
 Pyrexia  Hemolytic deficiency, paracetamol.
Name: Action:  Post- Anemia alcohol  For children who
Biogesic, Paracetamol vaccinati  Neutropenia dependenc may refuse the
Tempra, exhibits analgesic on fever  Thrombocyt e, chronic medicine, advise
Panadol, action by peripheral from two openia malnutritio the parent to try
Tylenol blockage of pain months  Pancytopeni n or using a medicine
impulse generation. of age. a dehydratio syringe to squirt the
Dosage: It produces  Leukopenia n, weight liquid slowly into
500mg/tab antipyresis by
Contraindicati  Urticaria <50 kg; the side of child’s
inhibiting the
Route: hypothalamic heat- ons:  CNS severe mouth.
Oral regulating centre. Its  Renal stimulation hypovolae  Evaluate
weak anti- Insufficie  Hypoglycem mia (IV). therapeutic use.
Frequency: inflammatory ncy ic coma Renal and  If symptoms
Q4h for activity is related to  Anemia  Jaundice hepatic persists for more
24hrs then inhibition of  Glissitis impairmen than 3 days, pt.
prn for prostaglandin  Drowsiness t. should consult the
fever synthesis in the  Liver  Children. physician.
CNS.
Damage Pregnancy  Paracetamol can be
and taken on an empty
lactation. stomach.
 Tell the mother to
keep the medicine
well out of the
reach of children.

DRUG CLASSIFICATIO INDICATION SIDE EFFECTS OR SPECIAL NURSING

NAME N AND AND ADVERSE PRECAUTION CONSIDERATIONS
MECHANISM OF CONTRAINDIC REACTIONS S
ACTION ATION    
   
   
 
 
Generic Classification: Indications:  CNS:  Don’t use  Monitor pt. for
Name: Antibiotics  Acute fatigue, oral drug superinfection. Drug
Azithromy bacterial somnolence, in may cause
cin Mechanism of worsening dizziness patients overgrowth of
Action:
Brand Binds to the 23S
of COPD  CV: chest with nonsusceptible
Name: rRNA of the caused by pain, pneumoni bacteria or fungi.
AzaSite, bacterial 50S Haemophil palpitations a or in  If pts. Vomits within
Zithromax ribosomal subunit. us  EENT: eye those 60mins. of taking
, Zmax It stops bacterial influenza, irritation with Zmax, notify
protein synthesis Moraxella  GI: moderate prescriber;
Dosage: by inhibiting the catarrhalis, abdominal to severe additional or
500mg transpeptidation/tra or pain, illness or different therapy
nslocation step of
Streptococ anorexia, risk may be needed.
Route: protein synthesis
Oral and by inhibiting cus diarrhea, factors.  Monitor pt. for
the assembly of the pneumonia nausea,  Use CDAD, w/c may
Frequency: 50S ribosomal e; vomiting, cautiousl range in severity
OD for subunit uncomplic pseudomemb y in from mild diarrhea
7days ated skin ranous patients to fatal colitis.
and skin- colitis, with  Monitor pt. for
structure dyspepsia, impaired allergic and skin
infections flatulence, hepatic reactions. D/c drug if
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COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

caused by melena function reactions occur.

staphyloco  GU: or  Monitor pt. for
ccus candidiasis, myasthen jaundice,
aureus, nephritis, ia gravis. hepatotoxicity, and
streoptoco vaginitis  Drug is hepatitis.
ccus  Hepatic: not  Advise pt. to avoid
pyogenes, cholestatic indicated excessive sunlight
or jaundice for and to wear
streptococ  Skin: phrophyl protective clothing
cus photosensitiv axis of and use sunscreen
agalactiae; ity reactions, bronchiol when outside.
secondline rash, pain at itis  Instruct parents and
therapy for injection obliterans caregivers to contact
pharyngiti site, pruritus syndrome prescriber if
s or  Other: in vomiting or
tonsillitis angioedema patients irritability with
caused by undergoi feeding occurs
S.pyogene ng during or after used
s hematopo in neonates.
 CAP ietic stem
caused by cell
Chamydop transplant
hila ation
pneumonia (HSCT).
e, H.
influenza,
mycoplas
ma
pneumonia
e, s.
pneumonia
e,
Legionella
pneumoph
ila, M.
catarrhalis,
or
S.aureus.
 Single
dose
treatment
for mild to
moderate
acute
bacterial
sinusitis.
 Chancroid
 Nongonoc
occal
urethritis
or
cervicitis
caused by
chlamydia
trachomati
s.
 Pelvic
inflammat
ory
disease
 Otitis
media;
pharyngiti
s;
tonsillitis;
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bacterial
conjunctiv
itis.

Contraindicatio
ns:
 Hypersens
itivity

DRUG CLASSIFICA INDICATION SIDE EFFECTS OR SPECIAL NURSING

NAME TION AND AND ADVERSE PRECAUTION CONSIDERATIONS
MECHANIS CONTRAINDICATIO REACTIONS S
M OF N    
ACTION    
   
 
 
Generic Classification Indication:  CNS: fatigue,  Advise  Can be used alone or
Name: : Hypertension; headache, patients with other
Losartan Antihypertens Hypertensive Patients asthenia, receiving antihypertensive.
K ives With Left Ventricular
insomina, COZAAR
Hypertrophy;
Brand Mechanism Nephropathy In Type 2 dizziness not to use  If antihypertensive
Name: of Action: Diabetic Patients potassium effect is inadequate
Cozaar Inhibits  CV: chest suppleme using once-daily
vasoconstricti Contraindication pain, edema nts or salt doses, a bid regimen
Dosage: ve and substitutes using the same or
50mg/tab aldosterone containing
 Hypersensitivity  EENT: nasal increased total daily
secreting potassium
Route: action of congestion, dose may give a more
without satisfactory response.
Oral angiostenin II  Concomitant use sinusitis,
by blocking
consulting
with aliskiren in pharyngitis,
Frequency angiostenin II their
diabetic patients. sinus disorder  Monitor pts. BP
: receptor on healthcare
closely to evaluate
OD the surface of provider.
effectiveness of
vascular  Impaired renal or  GI:
smooth abdominal therapy.
hepatic function.  Advise
muscle and pain,
female
other tissue diarrhea,  Monitor pts. who are
cells. patients of
nausea, also taking diuretics
childbeari
dyspepsia for symptomatic
ng age
hypotension.
about the
 Musculoskele consequen
tal: muscle ces of  Tell pt. to avoid salt
cramps, exposure substitutes, w/c can
myalgia, back to cause high K level in
or leg pain COZAAR pts. taking losartan.
during
 GU: UTI pregnancy  Advise pt. not to
. Discuss breastfeed while
 Hepatic: treatment taking drug.
cholestatic options
jaundice with
women
planning
to become
pregnant.
Tell
patients to
report
pregnanci
es to their
physicians
as soon as
possible
 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City
5000 Philippines

DRUG CLASSIFICATION INDICATION SIDE EFFECTS SPECIAL NURSING

NAME AND MECHANISM AND OR ADVERSE PRECAUTION CONSIDERATIONS
OF CONTRAINDI REACTIONS S
ACTION CATION    
   
   
 
 
Generic Classification: Indication:  Vitamin C:  Ask a  High doses of
Name: Vitamins with This nutritional Vitamin C is doctor vitamin C are not
Sodium minerals supplement is usually well before use recommended during
Ascorbat for the
tolerated. if the pregnancy.
e + Zinc Mechanism of treatment and
Action: prevention of However, patient is
Brand Vitamin C and zinc vitamin C and nausea, on a  Take large doses of
Name: together help the zinc vomiting, sodium vitamin C in divided
ImmunPr body's natural defense deficiencies. heartburn, restricted amounts because the
o against damaging free abdominal diet. Each body uses only what
radicals (antioxidant Contraindicati cramps, tablet is needed at a
Dosage: effect) and help boost on fatigue, contains
500m/10 immune function. Free particular time and
flushing, 65 mg of excretes the rest in
mgtab radicals are highly
reactive and unstable  Hypersen insomnia, and sodium urine.
Route: chemicals generated sitivity sleepiness (as
Oral during normal body have been sodium
 Note: Vitamin C
activities that require reported with ascorbate)
increases the
Frequency oxygen (e.g., high doses of .
: respiration, digestion, absorption of iron
vitamin C,
OD after blood circulation, when taken at the
particularly  Do not
breakfast immune system same time as iron-
ascorbic acid take more
response, increased rich foods.
(i.e., 1 g or than the
physical activity, etc.)
and after exposure to more daily). recommen
 Do not breast feed
UV light, cigarette ded dose.
while taking this drug
smoke and various  Zinc:
pollutants. One major without consulting
Gastrointestin  Consult a
effect of zinc is on the physician.
al side effects physician
ability of cells to
such as if any
properly replicate their
DNA, which is nausea and adverse
required for cells to vomiting are effects
multiply. Hence, zinc seen with occurs.
is needed for normal doses of
growth, cell renewal elemental
and cell repair. zinc greater
Vitamin C and zinc than 40 mg.
also function as
cofactors of enzymes
involved in collagen
formation and
synthesis. Collagen
provides strength and
elasticity to the skin
and helps promote
faster wound healing.

DRUG CLASSIFICATION INDICATIO SIDE EFFECTS OR SPECIAL NURSING

NAME AND MECHANISM N ADVERSE PRECAUTION CONSIDERATIONS
OF AND REACTIONS S
ACTION CONTRAIN    
DICATION    
   
 
 
Generic Classification: Indication:  Bronchospasm  Not for  High doses of
Name: N-acetylcysteine,  Adjuv injection. vitamin C are not
Acetylcys Mucomyst recommended during
teine
ant  Disagreeable
pregnancy.
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West Avenue, Molo, Iloilo City
5000 Philippines

Mechanism of thera
Brand Action: py for odor  Continued  Take large doses of
Name: action
patien nebulizati vitamin C in divided
N- A number of possible
acetylcyst mechanisms for the ts  Drowsiness on of amounts because the
eine, mucolytic activity of with acetylcyst body uses only what
Mucomys acetylcysteine have abnor eine is needed at a
 Fever
t been proposed. mal, solution particular time and
Acetylcysteine's viscid, (n-acetyl- excretes the rest in
Dosage: sulfhydryl groups may  Coughing up l-cysteine) urine.
600mg hydrolize disulfide
or
blood with a dry
bonds within mucin, inspis
Route: breaking down the sated gas will  Note: Vitamin C
Oral oligomers, and making muco  Increased result in increases the
the mucin less viscous. volume of an absorption of iron
us
Frequency 11,16 Acetylcysteine bronchial increased when taken at the
secre
: has also been shown to secretions concentrat same time as iron-
OD HS reduce mucin secretion tions
ion of the rich foods.
in rat models. 11 It is in drug in
an antioxidant in its such  Irritation of
tracheal or the
own right but is also condi  Do not breast feed
bronchial tract nebulizer
deacetylated to tions while taking this drug
cysteine, which because of
as: without consulting
participates in the evaporatio
 Chron  Nausea n of the
physician.
synthesis of the
antioxidant ic solvent.
glutathione. 11 The bronc  Runny or stuffy Extreme
antioxidant activity hopul nose concentrat
may also alter mona ion may
intracellular redox impede
reactions, decreasing ry  Swelling and
phosphorylation of diseas sores inside the nebulizati
EGFR and MAPK, e mouth on and
which decrease (chron efficient
transcription of the ic  Vomiting delivery
gene MUC5AC which of the
emph
produces mucin. drug.
ysema  Clamminess Dilution
,
of the
emph  Wheezing nebulizing
ysema solution
with with
 Shortness of
bronc appropriat
breath
hitis, e amounts
chroni of Sterile
 Chest tightness
c Water for
asthm Injection,
atic  Bronchoconstri USP, as
bronc ction concentrat
hitis, ion
tuberc  Bleeding occurs,
ulosis, will
bronc obviate
hiecta this
problem.
sis
and
prima
ry
amylo
idosis
of the
lung)

Contraindic
ation
 Acute
Asthm
a
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5000 Philippines

DRUG CLASSIFICATIO INDICATION SIDE EFFECTS OR SPECIAL NURSING

NAME N AND AND ADVERSE PRECAUTION CONSIDERATIONS
MECHANISM OF CONTRAINDI REACTIONS S
ACTION CATION    
   
   
 
 
Generic Classification: Indication:  CNS:  Kidney  Always wash hands
Name:  ZOSYN SEIZURES failure; thoroughly and
Piperacill is a (HIGHER pregnancy disinfect equipment
in and Mechanism of combinati DOSES), (category (whirlpools,
Tazobact Action:
am Piperacillin: Binds
on confusion, B), electrotherapeutic
to bacterial cell product dizziness, lactation. devices, treatment
Brand wall membrane, consistin headache, Safety and tables, and so forth)
Name: causing cell death. g of a insomnia, efficacy in to help prevent the
Zosyn Spectrum is penicillin lethargy. children spread of infection.
extended compared -class <12 y are Use universal
Dosage: with other antibacter not precautions or
4.5g 1 penicillins.  GI:
ial, PSEUDOMEM establishe isolation procedures
vial Tazobactam:
piperacill BRANOUS d. as indicated for
Inhibits
Route: betalactamase, an in, and a COLITIS, specific patients.
IV enzyme that can beta- diarrhea,
destroy penicillins. lactamase constipation,  Instruct patient to
Frequency inhibitor, drug-induced notify physician
: tazobacta hepatitis, immediately if signs
Q8h m,
ANST
nausea, of the following
indicated vomiting. occur: superinfection
for the
treatment
of  GU: interstitial  Obtain history of
patients nephritis. Derm: hypersensitivity to
with rashes (↑ in penicillins,
moderate cystic fibrosis cephalosporins, or
to severe patients), other drugs prior to
infections urticaria. administration.
caused by
susceptibl  Hemat:  Lab tests: C&S prior
e isolates bleeding, to first dose of the
of the leukopenia, drug; start drug
designate neutropenia, pending results.
d bacteria thrombocytopen Monitor hematologic
in the ia. status with prolonged
condition therapy (Hct and
s listed  Local: pain, Hgb, CBC with
below. phlebitis at IV differential and
site. platelet count).
Contraindicati
ons:  Misc:  Monitor patient
 Hypersen Hypersensitivit carefully during the
sitivity to y Reactions, first 30 min after
piperacill Including initiation of the
in, Anaphylaxis infusion for signs of
tazobacta and Serum hypersensitivity.
m, Sickness, Fever
penicillin (↑ in Cystic
s, Fibrosis
cephalosp Patients),
orins, or Superinfection.
beta-
lactamase
inhibitors
such as
clavulani
c acid
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and
sulbacta
m.

DRUG CLASSIFICATIO INDICATION SIDE EFFECTS OR SPECIAL NURSING

NAME N AND AND ADVERSE PRECAUTION CONSIDERATIONS
MECHANISM OF CONTRAINDI REACTIONS S
ACTION CATION    
   
   
 
 
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Generic Classification: Indication: CNS: Restlessness,  Cardiac  Check and verify

Name: Bronchodilator;  Salbutam apprehension, anxiety, disease with doctor’s order
Salbutam Adrenergics ol is fear, CNS stimulation, including and Kardex.
ol indicated vertigo, headache,
coronary
Mechanism of weakness, tremors,
for (i) the insufficien
Brandna Action: drowsiness,insomnia ,  Observe rights in
symptom cy, a
me: It relieves nasal hyperactivity, malaise medication
Airomir, congestion and atic relief CV: Cardiac history of administration such
Combive reversible and arrhythmias, stroke, as giving the right
nt, bronchospasm by preventio palpitations, coronary drug to the right
Proair, relaxing the n of tachycardia,chest pain, artery patient using the right
Proventil, smooth muscles of bronchos hypertension disease
Ventolin, the bronchioles. EENT: dry and route and at the right
pasm due and
Xopenex The relief from irritated nose and time.
to cardiac
nasal congestion throat with inhaled
bronchial arrhythmi
Dosage: and bronchospasm form, nasal  Assess lung sounds,
1mg/ml 1 is made possible asthma, congestion, epistaxis, as
chronic PR and BP before
neb by the following hoarseness
bronchitis drug administration
mechanism that Dermatologic:  Hypertens
Route: takes place when , Sweating, pallor, and during peak of
ion medication.
Inhalatio Salbutamol is reversible flushing
n/Oral administered. obstructiv GI: Nausea, vomiting,
e airway heartburn, unusual or  Hyperthyr  Warn patient about
Frequenc disease, bad taste in the mouth oidism risk of paradoxical
y: Metabolic:
and other bronchospasm and to
TID hypokalemia
chronic Musculoskeletal:  Diabetes stop drug
bronchop muscle cramps immediately if it
ulmonary Respiratory:  Glaucoma occurs.
disorders Respiratory
in which difficulties, pulmonary
edema, coughing,  Geriatric
bronchos
bronchospasm, patients
pasm is a
paradoxical airway
complicat
resistance with  Pregnancy
ing repeated, excessive
factor, especially
use of inhalation
and/or preparations, near term
(ii) the increased sputum
acute production, dyspnea  Lactation
prophyla bronchitis
xis  Children
against less than 2
exercise- years of
induced age
bronchos because
pasm and safety of
other its use has
stimuli not been
known to establishe
induce d
bronchos
pasm.
 Excess
Contraindication inhaler
s: use which
Hypersensitivity may lead
 Hyperten to
sion tolerance
 Hyperthy and
roidism paradoxic
 Pregnanc al
y bronchosp
especially asm
near term
 Lactation
 Glaucom
a
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VIII. DISCHARGE PLANNING

WHAT YOU NEED TO KNOW:

Pneumonia is an infection in your lungs caused
by bacteria, viruses, fungi, or parasites. You can
become infected if you come in contact with
someone who is sick. You can get pneumonia if
you recently had surgery or needed a ventilator
to help you breathe. Pneumonia can also be
caused by accidentally inhaling saliva or small
pieces of food. Pneumonia may cause mild
symptoms, or it can be severe and life-
threatening.

DISCHARGE INSTRUCTIONS:

Seek care immediately if:

 You cough up blood.
 Your heart beats more than 100 beats in 1 minute.
 You are very tired, confused, and cannot think clearly.
 You have chest pain or trouble breathing.
 Your lips or fingernails turn gray or blue.

Call your doctor if:

 Your symptoms are the same or get worse 48 hours after you start antibiotics.
 Your fever is not below 99°F (37.2°C) 48 hours after you start antibiotics.
 You have a fever higher than 101°F (38.3°C).
 You cannot eat, or you have loss of appetite, nausea, or are vomiting.
 You have questions or concerns about your condition or care.

Medicines:
You may need any of the following:

 Antibiotics treat pneumonia caused by bacteria.

 Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how
much to take and how often to take it. Follow directions. Read the labels of all other
medicines you are using to see if they also contain acetaminophen, or ask your doctor or
pharmacist. Acetaminophen can cause liver damage if not taken correctly. Do not use more
than 4 grams (4,000 milligrams) total of acetaminophen in one day.
 NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is
available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney
problems in certain people. If you take blood thinner medicine, always ask your healthcare
provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
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 Take your medicine as directed. Contact your healthcare provider if you think your
medicine is not helping or if you have side effects. Tell him or her if you are allergic to any
medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts,
and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry
your medicine list with you in case of an emergency.

Follow up with your doctor as directed:

You will need to return for more tests. Write down your questions so you remember to ask them
during your visits.

Manage your symptoms:

 Rest as needed. Rest often throughout the day. Alternate times of activity with times of rest.
 Drink liquids as directed. Ask how much liquid to drink each day and which liquids are
best for you. Liquids help thin your mucus, which may make it easier for you to cough it up.
 Do not smoke. Avoid secondhand smoke. Smoking increases your risk for pneumonia.
Smoking also makes it harder for you to get better after you have had pneumonia. Ask your
healthcare provider for information if you need help to quit smoking.
 Limit alcohol. Women should limit alcohol to 1 drink a day. Men should limit alcohol to 2
drinks a day. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of
liquor.
 Use a cool mist humidifier. A humidifier will help increase air moisture in your home. This
may make it easier for you to breathe and help decrease your cough.
 Keep your head elevated. You may be able to breathe better if you lie down with the head
of your bed up.

Prevent pneumonia:
 Wash your hands often. Use soap and water every time you wash your hands. Rub your
soapy hands together, lacing your fingers. Use the fingers of one hand to scrub under the
nails of the other hand. Wash for at least 20 seconds. Rinse with warm, running water for
several seconds. Then dry your hands with a clean towel or paper towel. Use hand sanitizer
that contains alcohol if soap and water are not available. Do not touch your eyes, nose, or
mouth without washing your hands first.

 Cover a sneeze or cough. Use a tissue that covers

your mouth and nose. Throw the tissue away in a
trash can right away. Use the bend of your arm if a
tissue is not available. Wash your hands well with
soap and water or use a hand sanitizer. Do not
stand close to anyone who is sneezing or coughing.
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 Stay away from others until you are well. Do not go to work or other activities. Wait until
your symptoms are gone or your healthcare provider says it is okay to return.
 Ask about vaccines you may need. You may need a vaccine to help prevent pneumonia.
Get an influenza (flu) vaccine every year as soon as recommended, usually in September or
October. Flu viruses change, so it is important to get a yearly flu vaccine.

IX. REVIEW OF RELATED LITERATURE

Pneumonia in the Elderly

B. A. Cunha Infectious Disease Division, Winthrop-University Hospital, Mineola, New York and
State University of New York School of Medicine, Stony Brook, New York, USA

Pneumonia is one of the commonest infections in elderly patients. The pathogens responsible for
pneumonias in the elderly are the same as in younger adults. Because of associated
cardiopulmonary disease and/or impaired host defenses, pneumonia in elderly patients is
associated with increased mortality and morbidity compared to younger patients. The clinical
importance of pneumonias in the elderly relates to age-dependent and pathologic changes in the
immune system as well as the lungs. Pneumonias in the elderly may be classified, for clinical
purposes, according to their location of acquisition, i.e. community-acquired pneumonias, nursing
home-acquired pneumonias, or hospital-acquired pneumonias. The clinical presentation of
pneumonias in the elderly may be difficult, due to pre-existing cardiopulmonary disease that
mimics pneumonia. This review discusses the diagnostic and therapeutic approaches to elderly
patients with pneumonia.

Cunha B. A. (2001). Pneumonia in the elderly. Clinical microbiology and infection : the official
publication of the European Society of Clinical Microbiology and Infectious Diseases, 7(11),
581–588. https://doi.org/10.1046/j.1198-743x.2001.00328.x

Questions: 
1. List the possible complications that may arise if the condition is left untreated and
briefly describe each.

Complications of pneumonia

Complications of pneumonia are more common in young children, the elderly and those with
preexisting health conditions, such as diabetes.
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Possible complications of pneumonia include:

 pleurisy – where the thin linings between your lungs and ribcage (pleura) become
inflamed, which can lead to respiratory failure
 a lung abscess – a rare complication that's mostly seen in people with a serious pre-
existing illness or a history of severe alcohol misuse.
 bacteremia – can lead to septic shock which is a reaction to the infection in your blood
and it can cause your blood pressure to drop to a dangerous level
 blood poisoning (sepsis) – also a rare but serious complication

2. Differentiate the Hospital Acquired Pneumonia and Community Acquired Pneumonia.

- Hospital-acquired pneumonia (HAP), or nosocomial pneumonia, is a lower respiratory infection

that was not incubating at the time of hospital admission and that presents clinically 2 or more
days after hospitalization. Pneumonia that presents sooner should be regarded as community
acquired pneumonia, defined as an acute infection of the pulmonary parenchyma in a patient who
has acquired the infection in the community as distinguished from hospital-acquired (nosocomial)
pneumonia (HAP).

3. What is reverse isolation, quarantine and isolation.

 Reverse isolation are procedures designed to protect a patient from infectious organisms

carried by staff, patients or other patients. It is for protecting the patient whose resistance is
low from acquiring an infection.
 Quarantine separates and restricts the movement of people who were exposed to a
contagious disease to see if they become sick.
 Isolation separates sick people with a contagious disease from people who are not sick.

4. Differentiate bronchopneumonia and covid 19.

Bronchopneumonia, also known as lobular pneumonia, is the most common type

of pneumonia, caused by bacteria. It is a type of pneumonia that causes inflammation in the
alveoli.

COVID-19, the disease the novel coronavirus causes, can spread to the lungs, causing
pneumonia.
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5. What are the different microorganisms that cause pneumonia?

Viruses, bacteria, and fungi can all cause pneumonia. In the United States, common causes of
viral pneumonia are influenza, respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus
that causes COVID-19). A common cause of bacterial pneumonia is Streptococcus pneumoniae
(pneumococcus).

Bacterial pneumonia

● Most commonly caused by Streptococcus pneumoniae

● Can also be caused by Mycoplasma pneumoniae, a bacterium that causes a milder form
of pneumonia
● Can also be caused by Chlamydophila pneumoniae, which also causes milder pneumonia
● More rarely caused by Legionella pneumophila, also known as Legionnaires’ Disease,
caused by exposure to contaminated water

Viral pneumonia

● Not as serious as bacterial pneumonia, but can be severe in pregnant women and people
with existing heart and lung disease
● In adults, viral pneumonia is usually caused by the influenza virus
● In children, viral pneumonia is usually caused by a respiratory syncytial virus (RSV)

Fungal pneumonia

● Most common in people with chronic health problems or weakened immune systems,
such as occurs with HIV/AIDS.
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● Also occurs in people who are exposed to large amounts of fungi in contaminated soil or
bird droppings

Parasitic pneumonia

● A rare cause of pneumonia almost always occurs in people with compromised immune
systems
● Parasites get into the body through the skin or by being swallowed and travel to the lungs