Community Acquired Pneumonia Moderate Risk

A Case Presentation
Presented to the College of Nursing
St. Jude College Dasmariñas Cavite, Inc.
Dasmariñas Cavite, Philippines

In Partial Fulfilment of the

Requirements for the Subject
Medical Surgical Nursing I

Presented By:
Amador, Jhessen G.
Aquino, Jan Rosette C.
Arenas, Marjorie A.
Calaycay, Cherry Mae S.
Calinisan, Alferine Marishel C.

Presented to:
Kristelle Lynne O. Manlapas, RN
Clarissa T. Clavecilla, RN
Michelle I. Mercado, RN

BSN LEVEL III

GROUP 3-E
BATCH 2024
 TABLE OF CONTENTS

I. INTRODUCTION......................................................................................................3

II. BIOGRAPHICAL DATA...........................................................................................5

A. Genogram.....................................................................................................6

III. HISTORY OF PAST AND PRESENT ILLNESS.....................................................8

A. Past Medical History
B. Present Medical History

IV. ASSESSMENT
A. General Assessment....................................................................................9
B. Physical Assessment (Head to Toe Assessment) .....................................10
C. Gordon’s Functional Pattern of Assessment..............................................30

V. LABORATORY AND DIAGNOSTIC.....................................................................38

VI. ANATOMY AND PHYSIOLOGY..........................................................................64

VII. PATHOPHYSIOLOGY.........................................................................................76

VIII. NURSING CARE PLAN

A. Prioritization................................................................................................81
B. Nursing Care Plan......................................................................................89

X. DRUG STUDY.....................................................................................................119

XI. DISCHARGE PLAN...........................................................................................131

2
 I. INTRODUCTION

Pneumonia is still one of the leading causes of death in the Philippines.

According to preliminary data from the Philippine Statistics Authority (PSA),
pneumonia ranked sixth among the top ten causes of death in the country as of
August 2022, killing 13,536 people. According to the Department of Health's (DOH)
2021 Field Health Services Information System (FHSIS) report, pneumonia killed
over 76,000 people in the Philippines. Alarmingly, the data also showed a high
mortality rate among Filipino children.
According to the World Health Organization (WHO), 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 a
person has pneumonia, the alveoli fill with pus and fluid, making breathing difficult
and limiting oxygen intake. For different groups, the symptoms may vary. However,
the most typical signs of pneumonia are coughing (with some pneumonia you may
cough up greenish or yellow mucus, or even bloody mucus), fever, which may be
mild or high, shaking and chills, shortness of breath, nausea, vomiting, muscle and
joint pain. Additionally, especially older people, may have a headache, lack of
appetite, poor energy, lethargy, confusion, and severe or stabbing chest discomfort
that gets worse when they cough or breath deeply. Numerous infectious organisms,
such as bacteria, fungi, and viruses, can cause pneumonia. Streptococcus
pneumonia, Legionella pneumophila (Legionnaires' disease), Mycoplasma
pneumoniae, Chlamydia pneumoniae, and Haemophilus influenzae type b (Hib) are
only a few of the bacteria that can cause pneumonia.
Pneumonia can occasionally result from viruses that cause the common cold,
the flu (influenza), COVID-19, and respiratory syncytial virus (RSV). Pneumocystis
jirovecii, Coccidioides, and other fungi are uncommon causes of pneumonia.
Pneumonia can be spread through sneezing or coughing. When someone sneezes
or coughs, small droplets spread throughout the air. The infectious organism is
present in these droplets. They are then inhaled, which can lead to pneumonia in
some cases. This is especially true for people who are already sick from illnesses
such as the flu or, worse, AIDS. People with weak immune systems are less able to
resist infection. Because of this, they are more susceptible to infections from

3
microorganisms that rarely cause illness in healthy individuals. Additionally, they are
more susceptible to the common causes of pneumonia, which can affect anyone.
Furthermore, Pneumonia is one of the most common diseases in people aged
60 and up. In the Philippines, Pneumonia has been one of the leading causes of
death among older Filipinos aged 60 and up. As a result, many international and
local health societies, including the Philippine Society of Microbiology and Infectious
Diseases (PSMID), strongly advise people aged 60 and up to get the pneumococcal
vaccine to protect themselves from this serious disease (Berba, 2006). In 2011, the
Department of Health (DOH) launched a free pneumococcal vaccination program for
indigent older people in the country. Four years later, the National Policy on Health
and Wellness Program for Senior Citizens (HWPSC), which aims to prevent
functional decline and disease in old age (DOH Administrative Order No.
2015-0009), expanded this vaccination program to include all older people. Following
the Department of Health's implementation guidelines for the immunization of senior
citizens, older people can avail of the recommended doses of pneumococcal
polyvalent vaccine in public healthcare facilities.
Although pneumonia prevention and immunization are still practiced.
Pneumonia is still one of the leading causes of death in the Philippines, and this
case study aims to address this issue and broaden student nurses' understanding of
the disease by the end of it. Moreover, this case study aims to raise awareness of
the rising mortality rate from pneumonia and to support pneumonia control or
prevention for those who do not yet have the disease.

4
II. BIOGRAPHICAL DATA:

A. Patient’s Name : E.O.E

B. Address : Molino IV, Bacoor, Cavite
C. Age : 73 years old
D. Birthdate : January 27, 1949

E. Birthplace : Makati City

F. Gender : Female

G. Civil status : Married

H. Religion : Roman Catholic

I. Highest Educational Attainment: College Graduate

J. Nationality : Filipino

K. Occupation : Retired Teacher

L. Primary Informant : Patient E.O.E

M. Secondary Informant : Daughter

N. Other Sources : Patient’s Chart

O. Date and Time of Admission : December 14, 2022, at 5:05 p.m. at

DCMC

P. Chief Complaint : Difficulty of breathing, Cough

(productive; thick yellow green sputum) and colds for 2 days ,
Lack of appetite, Vomit (twice)

Q. Initial Diagnosis : Pneumonia Moderate Risk

R. Final Diagnosis : Community Acquired Pneumonia

Moderate Risk

5
A. GENOGRAM

6
 Analysis: Patient E.O.E. is a 73-year-old female, diagnosed with pneumonia. She
is the family's eldest child, as shown in the illustration above. According to her, she
had been diagnosed with bronchial asthma since she was a child, and was
diagnosed with hypertension at the age of 35. On the maternal side of the patient,
her grandmother C.E. died at the age of 80 due to an arthritis complication, and at
the age of 84, her grandfather F.E. died due to a diabetes complication. Her
mother, A.E.O., died at the age of 74 due to diabetes complications. Patient
E.O.E.'s mother has five siblings. R.E., 65, died as a result of an internal
hemorrhage; V.E.B., 72 years old; L.E., 74 years old; N.E.R., 76 years old; and
L.E., 82 years old, died due to hypertension. Moving on to the paternal side, at the
age of 85, her grandfather E.O. died due to enlargement of the heart, and she was
not able to recall the name, age, and cause of death of her grandmother. Her
father, E.O., died of a heart attack at the age of 80, and he has two siblings,
T.O.A., who died at the age of 74, also due to a heart attack, and M.O.D.R., who
died of hypertension at the age of 76. Patient E.O.E has seven siblings, J.E.L died
at the age of 59 due to thyroid cancer, B.O 64 year old died due to diabetes,
C.O.M 68 year old died due to hypertension, and E.O 57 years old, E.O 61 year
old, E.O 66 year old, and R.O 70 year old are all alive and well. Patient E.O.E. has
four children; the oldest is C.E., 44 years old alive and well, the youngest is V.E.C.,
40 years old, is a smoker. Her only daughter, M.G.E.C., 42 years old, has
hypertension, and her youngest son, R.K.E., 37 years old, is also known to have
hypertension.

7
III. HISTORY OF PAST AND PRESENT ILLNESS

A. Past Medical History

Patient E.O.E. was diagnosed with bronchial asthma at the age of 13 as she
experienced chest tightness and shortness of breath at that time. Furthermore, at the
age of 35, patient E.O.E was diagnosed with hypertension. "Dati wala akong control
sa mga kinakain ko lalo mahilig ako sa fast food noon at maaalat" says patient
E.O.E. Candesartan and Amlodipine are her maintenance medications. Patient
E.O.E. had previously undergone a hysterectomy as well as cataract removal, she
states that she still has problems in her ears as she refused to have the surgery
before. There was no report of hypertension or asthma because she continues to
take medications, but on December 14, 2022, patient E.O.E. experienced difficulty in
breathing and was taken to Dasmarinas Cavite Medical Center's Emergency Room.

B. Present Medical History

Patient E.O.E., 73, was admitted to Dasmarinas Cavite Medical Center's
Emergency Room (DCMC) at 5:05 p.m. on December 14, 2022. Patient E.O.E.'s
chief complaint before admission was that she had a cough (productive; thick
yellow-green sputum) and colds for two days, had difficulty of breathing, a lack of
appetite, and vomited twice. Blood pressure is 130/90; heart rate is 107 bpm;
respiratory rate is 24 cpm; temperature is 36.7 °C; and SPO2 is 93%. When she was
admitted, the doctor ordered PNSS for her IV fluids. She was connected to oxygen
via face mask at 5-6 lpm, and the doctor prescribed Atorvastatin 40 mg/tab, 1 tab,
and clopidogrel 75 mg/tab, 1 tab OD, and advised her to continue her maintenance
medications (Candesartan and Amlodipine). She had some laboratory tests done
while in the ER and was diagnosed with Pneumonia and tested positive for troponin
I. Her results showed decreased potassium; the doctor prescribed Kalium Durule 1
tab OD, and increased neutrophils; at 6:45 p.m., an hour after her admission, the
doctor prescribed NAC, Ceftriaxone, and Omeprazole. On December 15, 2022, the
patient appears to be having difficulty removing her phlegm; the doctor prescribes
Hydrocortisone 100 mg q8 IV for the patient's secretion; her oxygen level has
switched to 2 lpm, and the doctor suggests that she will transfer to the ward the
following morning. On December 16, 2022, the patient was noted to have improved
(no DOB, cough, or chest pain), but she was still having difficulty removing her
phlegm and the doctor ordered to switch oxygen via nasal cannula at 2-3 lpm. Her
cholesterol level had increased, according to another laboratory test. The patient is
fully vaccinated with AstraZeneca; an oropharyngeal/nasopharyngeal swab was
taken upon admission, and the patient tested negative for SARS-CoV 2.

8
IV. ASSESSMENT
A. General Assessment
Patient E.O.E. is a female who is 73 years old. The patient's blood pressure is
130/90, pulse rate is 107 beats per minute, respiration rate is 24 cycles per minute,
the temperature is 36.7 ℃, and oxygen saturation is 93%. On the left metacarpal
vein, there is an ongoing PNSS 1 L x 12 hours and oxygen via nasal cannula. The
patient was speaking to her daughter while sitting in high fowlers. The patient was
able to respond to the student nurses' questions in a way that was cooperative, clear,
and calm.

VITAL SIGNS

Blood Pressure 130/90

Pulse Rate 107 bpm

Respiratory Rate 24 cpm

Temperature 36.7℃

Spo2/Oxygen Saturation 93%

Pain assessment Provoking factor: “sumasakit ang

dibdib ko sa tuwing humihinga ako o
umuubo” as verbalized by the patient.

Radiation: under the breast bone

(sternum), it becomes more intense
during inhalation or coughing.

Severity: 7/10

1-3 = Mild, 4-6 = Moderate, 7-10 =

Severe

Time: 2 days before admission

Weight 61kg / 134.48 lbs

Height 5 feet 4 inches / 162.56cm

BMI 23.1 = normal weight

9
 B. Physical Assessment (Head to Toe Assessment)
Body Part Actual Finding Normal Finding Clinical
Examined Significance

SKIN

I: Color, uniformity, I: The skin is I: Skin color This indicates

edema, lesions slightly pale and varies from light NORMAL findings.
uniform in color, to deep brown; Skin thinning, loss of
generally, uniform elasticity, wrinkles,
thinning of the
in areas exposed and drying are all
epidermis and to sun; no edema natural physiological
wrinkles are and lesions. changes associated
noted. No edema with aging.
or lesions.
According to
P: Moisture, temp. P: Skin is dry, with P: Moisture in the Adrianne, L.
Turgor and decreased skin skin folds and in According to Helen,
hollowness turgor, elasticity, the axillae; L. (2006), aging
and subcutaneous normal range of causes the skin to
fat. The patient 36.5- 37.6; when thin, lose elasticity,
has a temperature pinched, skin and become more
of 36.7°C and is springs back to fragile. It also causes
warm to the previous state. the fatty tissue
touch. directly beneath the
skin to shrink.
Because natural oil
production declines
with age, the skin
may become drier.
Skin tags, age spots,
and wrinkles become
more common as
people get older.

A pale skin color

indicates
ABNORMAL
findings.

According to Elana
Pearl Ben-Joseph,
MD (Pediatrician;
Medical Editor at
Nemours Kids
Health), pneumonia
patients have blue or
pale skin, which
indicates that the

10
 lungs are not getting
enough oxygen or
there are insufficient
levels of oxygen in
the blood.

HAIR

I: Evenness of I: Hair is grayish I: Evenly This indicates

growth thickness, white in color, and distributed hair, NORMAL findings.
texture, oiliness, evenly distributed. thick, silky, and Pigment loss in hair
infection or There are no resilient hair; No is a normal
infestation, body signs of infection infection or physiological change
hair or infestations infestation; fine, associated with
noted. medium, or aging.
coarse texture
According to
P: Smoothness P: Hair is smooth P: Smooth hair MidlinePlus, hair
color is caused by a
pigment called
melanin, which is
produced by hair
follicles. Hair follicles
are skin structures
that produce and
grow hair. Gray hair
results from follicles
producing less
melanin as
individuals age.
Scalp hair frequently
begins graying at the
temples and
progresses to the top
of the scalp. The
color of the hair
gradually lightens,
eventually turning
white.

NAILS

I: Plate, shape, I: Nails are Convex Upon assessing the

texture, bed color, trimmed and curvature; patient's nails, the
surrounding clean. Nail beds Smooth texture; patient does have
tissues are slightly pale. Highly vascular lines on the
The nail plate and pink in light fingernails, and this
appears flat but skinned clients; indicates a NORMAL
there is dark skinned finding as it is normal
longitudinal clients may have for older adults as

11
 ridging observed. brown or black they age.
pigmentation
A certain number of
lines (vertical nail
ridges/longitudinal
ridges) are typically
found on all
fingernails due to
the basic aging
process (Lashkari,
2022).

P: Blanch test Capillary refill, 3 Prompt return of The patient’s

seconds. pink or usual fingernails upon
color (Generally doing the test were
less than 2 observed to have
seconds) delayed refill time
that indicates
ABNORMAL.
According to
Registered Nurse
RN, prolonged or
poor capillary refill
can be due to
dehydration, and
poor tissue perfusion.

HEAD

Skull and Face I: Head is round Normocephalic;

This indicates
I: Size, shape, and symmetrical symmetrical; No
NORMAL findings.
symmetry: Facial facial features are presence of
The size of the head
features: Eyes for normal, eyes have edema is normal and
edema and no signs of symmetrical; no
hollowness edema. presence of edema,
absence of nodules,
masses, and
P: Nodules, P: No nodules, No presence of depression
masses, masses, and Nodules,
Depressions depression noted Masses, and According to
depressions MedlinePlus, with
aging, the face and
neck often begin to
change in
appearance. Skin
thinning and loss of
muscular tone make
the face look flabby
or drooping. Some
persons may appear

12
 to have a double chin
due to jowls that are
drooping.

EYES AND VISION

I: Eyebrows for I: Eyebrows are Hair is evenly The following

distribution and evenly distributed distributed; skin findings are all
alignment, quality, and are aligned. is intact. NORMAL.
and movement Eyebrows, on Eyebrows are Hair is evenly
both sides, can symmetrical distributed; skin is
move up and aligned, equal intact; eyebrows are
down movement symmetrical aligned,
independently. and equal
movement.
I: Eyelashes for Eyelashes are Equally
evenness of evenly distributed, distributed; curl Eyebrow position
distribution and and direction of slightly outward was unchanged at
direction of curl. curl is outward the MC with aging,
except at maximal
eye opening and
maximal frown. No
differences in
eyebrow position
were observed
between the younger
and older groups
when eyes were
maximally closed
(Par, J., et. al.)
According to Patel,
in humans, there are
75 to 80 lashes on
the lower eyelid., and
the upper eyelid has
90 to 160 lashes.
Lash length is
variable from
individual to
individual: they do
not grow beyond a
certain length
(usually less than 12
mm) and then fall off
by themselves.

I: Eyelids for Sagging of the Approximately The findings are all

surface upper lid down 15-20 involuntary NORMAL as the
characteristics, across the eye blinks per min; patient eyelids sag
position in relation bilateral blinking; down and this aging

13
to cornea, ability to when lids open causes the muscles
blink and no visible sclera under the eyes to
frequency above cornea weaken, and the
and upper and tendons stretch. As a
lower border of result, eyelids may
cornea are begin to droop as
slightly covered; they age (Stefanacci,
Transparent R., 2022).
capillaries;
sometimes
evident; sclera
appears white
(yellowish in dark
skinned people)

I/P: lacrimal gland I/P: Lacrimal No presence of The following

sac, nasolacrimal gland sac, edema, findings are all
duct for edema, nasolacrimal tenderness/ NORMAL.
tenderness/ duct has no signs tearing No presence of
tearing of edema, tender, edema,
and tenderness/tearing.
tearing.
Aging alterations in
lacrimal gland
structure begin in
middle age in both
humans and
experimental
animals. In humans,
acinar atrophy and
fibrosis first occur in
younger patients, but
increase with age.
This is accompanied
by dilation and
increased tortuosity
of secretory ducts,
suggesting ductal
obstruction (Rocha,
E., et. al.).

I: Cornea for I: Cornea is Clear and very Upon inspecting the

clarity, texture, and translucent, sensitive cornea, the patient
sensitivity smooth, and has decreased visual
avascular. The
acuity and has
ability to focus on
nearby objects is problems focusing on
decreased. Visual nearby objects that
acuity decreased. indicate the result as

14
 NORMAL for older
patient.

According to Jensen
S., older adults have
decreased elasticity,
diminished corneal
sensitivity, and
slowed pupillary
responses.

I: Pupils for color, Pupils are black Usually color This indicates
shape, symmetry f and equally black; Rounded NORMAL findings.
size, direct and round. There is a pupil; Black in color;
consensual normal pupil Symmetrical size. rounded pupils,
reaction to light response in light. Pupils are symmetrical in size,
and equally round, reactive to light and
accommodation and reactive to accommodation
light and (ability to change
accommodation. focus).
According to
Cleveland Clinic, as
you age, the skin
below your eyes
begins to loosen and
thin out so the blood
vessels under your
skin may become
more visible. This
can darken the
appearance of your
under eyes.
Hollowed areas
called tear troughs
may develop as well.

EARS AND HEARING

I: Auricles for I: Auricles are I: Color same as The patient has a

texture, elasticity, uniform in skin facial skin; problem in ears
and areas of color; position is symmetrical; wherein she cannot
tenderness aligned to the auricle aligned hear clearly as stated
inner canthus of with the outer and act by the patient
the eyes. canthus of eyes. and this indicates
There are no NORMAL findings.
lesions and Color is same as the
tenderness. facial skin;
symmetrical; auricles

15
P: Auricles for P: Auricles are Normal voice are aligned with the
texture, elasticity, slightly elastic and tones audible: outer canthus of the
and areas of not that tender. Able to hear eyes; No lesions and
tenderness Able to hear but ticking in both tenderness.
diminished. ears.
According to Jensen
S., changes to the
inner ear can reduce
an older adult’s
ability to discriminate
sound.

NOSE AND SINUSES

I: Nose deviation I: Nose symmetric I: Symmetric and Upon assessment of

in shape size, and straight, straight; no the patient, nasal
color, flaring, uniform color. discharge or flaring is observed;
flaring; uniform
discharge. During the this indicates an
color: Mucosa is
assessment, pink; No swelling; ABNORMAL
I: Nasal mucosa nasal flaring is No presence of According to
for observed. discharge MediFind (2022),
redness, swelling, I: No redness or when the nostrils
growth or swelling widen while
discharge breathing, this is
referred to as nasal
Pa: Tenderness, Pa: No lesions, Pa: Not tender; flaring. It is frequently
masses, tenderness, and no lesions, and a sign of breathing
displacements. masses. Air is felt during
expiration difficulties. Nasal
flaring could be an
Pa: Maxillary and Pa: No Pa: No indication of
frontal sinuses for tenderness in tenderness in breathing problems.
tenderness both sinuses. both sinuses

MOUTH AND OROPHARYNX

I: Lips for I: The lips are I: Uniform pink The patient’s lips are
symmetry of symmetrical, thin, color; soft, moist, dry and slightly
contour, color, dry, and slightly smooth texture; pale.Dehydration
texture, moisture, symmetry of makes the lips more
pale.
lesion contour; ability to prone to dryness and
purse lips. causes them to lose
their natural color.
According to Dr. De
Jonge (2016), it’s
easy to get
dehydrated when

16
 people have
pneumonia because
the lungs are
inflamed.

I: Teeth for I: Dentures noted; I:White, shiny The patient's teeth

alignment, loss, no dental caries. tooth enamel; are dentures and no
dental fillings, and pink gums; a dental caries.Tooth
caries. moist, firm surfaces can become
texture to the damaged, and good
gums; no oral hygiene habits
retraction of the are critical to
gums. preventing tooth loss
and gum disease.

According to Martini,
C. (2021), teeth do
not fall out by
themselves. There
are a number of
internal and external
factors that can lead
to a loose adult tooth.
Common causes
include poor dental
health, oral trauma of
any kind, and
underlying
conditions.

I: Gums for I: Gums are not I:Central position, Upon assessment of

bleeding, color, bleeding, no pink color, the patient’s gums,
retraction, lesions, swelling and no smooth, lateral there is no bleeding,
margins;no swelling, or lesions.
swelling. lesions noted.
lesions The tongue is
aligned with the
I: Tongue for I: Tongue is :Soft palate is mouth, and the
position, color & aligned within the light pink, palates are pink in
texture; mouth, slightly dry smooth, and color. The uvula is
movable positioned in the
movement, as well
upwards. Hard middle of the mouth
as the base of the palate whitish in and is pink in color.
tongue, mouth color, with a firm Oropharynx are pink
floor and frenulum text. in color and have no
lesions, while tonsils
are pink in color and
have a normal gag
reflex. This indicates
NORMAL findings.
According to the

17
 I: Palates for I: Palates are pink :Positioned
in Cleveland Clinic, in a
color, shape, in color, have midline of soft healthy mouth, the
texture, presence normal wave like palate tissues are pink, firm,
of bony and moist. With a
structure and with
prominences. healthy mouth,
bony people's breath will
prominences. smell pleasant or
neutral and will not
I: Uvula for I: Uvula is I: Pink and have any bumps,
position & mobility positioned at the smooth posterior flaps, gaps, or rough
middle of the wall patches.
mouth when
opened; pink in
color.

I: Oropharynx for I: Pink in color, no I: Pink, and

color & texture lesions noted. smooth; no
discharge of
normal size.

I: Tonsils for color, I:Tonsils are pink I: Gag reflex is

discharge, and in color; Tonsil present
size. Test for Gag grade 1; Normal
gag reflex
Reflex

NECK

I: Abnormal I: No swelling, or I: Muscles of Upon assessment of

swelling or masses, pain equal size; head the patient, she can
masses, head noted on both centered; smooth tolerate the head
movement without
movement, and sides of the neck. coordination.
pain and there is no
muscle strength Patient can swelling, masses and
tolerate head pain on both side of
movement without the neck.This
pain. indicates NORMAL
findings.
According to
mhmedical, the neck
moves in flexion,
extension, rotation,
and lateral flexion.
Movements arise
from the interrelated
actions of the

18
 vertebrae,
intervertebral discs,
ligaments, and
muscles in the neck.
There is a wide
range of normal with
regard to the neck's
range of motion, and
age-related
degeneration may
limit movement. If the
patient is able to
complete functional
duties without pain or
discomfort, this is
likely normal.

THORAX AND LUNGS (Posterior Thorax)

Posterior Thorax I: Symmetrical I: Anteroposterior

The patient is an
I: Shape & from posterior to transverse
older adult, and her
symmetry from lateral view and diameter ratio ofposterior lateral view
posterior-lateral has outward 1:2; symmetrical shows outward
views; spinal curvature of the chest: Spine
curvature of the
alignment for thoracic vertebrae vertically aligned.
thoracic vertebrae of
deformities of the upper back the upper back
(Dowager's (Dowager's Hump). It
Hump). is a normal
physiological change
Pa: Temperature, Pa: No Pa: Warm in older adults.
bulges, tenderness on the temperature,
tenderness, and patient’s posterior absence of According to JOSPT
bulges, and
abnormal thorax noted. (2011), the most
abnormal
movements. Increased movement. common causes of
fremitus was age-related
noted upon kyphosis, or
checking the Dowager's hump,
tactile fremitus. are two common
conditions involving
bone (osteoporosis)
and muscle
(sarcopenia)
weakness.

The patient’s fremitus

increases because of

19
 the consolidation of
the mucus in the
lungs. ABNORMAL

According to Modi P.
and Tolat S. (2022),
assessment of the
lungs is made
through the intensity
of the vibrations felt
on the chest wall
(tactile fremitus)
and/or the sound
heard on the chest
wall by a stethoscope
with certain spoken
words (vocal
resonance). The
chest wall and lungs
can feel the
vibrations that the
vocal cords cause in
the tracheobronchial
tree. Causes of
increased vocal
fremitus: pneumonia,
lung abscess, and
decreased vocal
fremitus: pleural
effusion,
pneumothorax, and
emphysema

A: Breath sounds A: Bilateral A: Bronchovesi - ABNORMAL

diminished cular sounds, Upon the
vesicular breath and vesicular auscultation, there is
sounds noted. sounds.
a diminished
vesicular breath
sound.

Diminished vesicular
breath sound
indicates reduced

20
 airflow and may
indicate the bronchial
tree is obstructed by
secretions or mucus
(Sarkar, M., et. al.).

THORAX AND LUNGS (Anterior Thorax)

I: Breathing I: Patient’s I: Quiet, ABNORMAL

pattern, coastal respiratory rate is rhythmic, and Due to decreased
and costovertebral 24cpm, effortless oxygen circulation,
respirations;
angle. continuously the patient
coastal
coughing. experienced hypoxia.
Subcostal As a result, the
Retractions and oxygen demand
Chest pain noted rises, causing the
with a scale of respiratory rate to
7/10 upon increase (Bhutta, B.,
inhalation. et al.).

Pe: Symmetry of Pe: Both lungs Pe: Percussion ABNORMAL

resonance are resonant by notes resonate Dull sound signifies
percussion; left down to the sixth consolidation of the
rib at the level of lungs in the specific
mid- anterior and
the diaphragm areas mentioned.
left mid-lateral but flat over
lungs fields are. areas of heavy According to Lone,
muscles and dullness to
bone; dull on percussion indicates
areas over heart denser tissue, such
as the liver as zones of effusion
tympanic over or consolidation.
the underlying Dullness replaces
stomach resonance when fluid
or solid tissue
replaces
air-containing lung
tissues, such as
occurs with
pneumonia, pleural
effusions, or tumors.

Pa: Respiratory Pa: Tactile Pa: Full and ABNORMAL

excursion, tactile fremitus increased symmetric chest Fremitus increases
fremitus expansion during because of the
deep inspiration
consolidation of the
mucus in the lungs.

21
 This commonly
occurs as a result of
lung consolidation,
which refers to the
replacement of the
air within healthy
lung tissue with
another substance;
either inflammatory
exudate, blood, pus,
or cells (Singh, A., et.
al.).

A: Breath sounds A: Crackles heard A: Normal breath ABNORMAL

sound should be Inflammation or
heard bilaterally. infection of the small
There should be
bronchi, bronchioles,
no crackles upon
auscultation and alveoli is
commonly
associated with
crackles.

According to
healthline, these
sounds occur if the
small air sacs in the
lungs fill with fluid
and there's air
movement in the
sacs, such as when
you're breathing. The
air sacs fill with fluid
when a person has
pneumonia or heart
failure.

HEART

I: Precordium for I: Patient’s pulse I: No presence of ABNORMAL

pulsations & lifts or rate is 107 bpm. lifts or heaves The increase in heart
heaves rate is a
compensation
mechanism of the
heart in response to

22
A: Heart sounds A: Irregular A: No murmur the body functions
(S1, S2, etc.) rhythm with a sound obtaining insufficient
heart rate of 107 oxygenation.
The body's
bpm
hormones and
nervous systems try
to make up for this.
They increase blood
pressure, hold on to
salt (sodium) and
water in the body,
and increase the
heart rate. These
responses are the
body's attempt to
compensate for the
poor blood circulation
and the backup of
blood (Healthwise,
2022).

CENTRAL VESSEL

Carotid Arteries: A: Negative bruit A: No murmur This indicates

A: Bruit sound sound normal findings.

The carotid arteries

supply oxygenated
blood to the head
and neck. Because
they are the only
source of blood to
the
brain, prolonged
occlusion of these
arteries can result in
serious brain
damage (Assessing
Health, 2014).

Jugular Veins: I: Not distended/ I: Not distention This indicates

I: Distention Negative jugular NORMAL findings.
distension
The jugular veins
drain blood from the
head and neck
directly into the
superior vena cava
and right side of the
heart. The external

23
 jugular veins are
superficial and may
be visible above the
clavicle. The internal
jugular veins lie
deeper along the
carotid artery and
may transmit
pulsations onto the
skin of the neck.
Normally, external
neck veins are
distended and visible
when a person lies
down; they are flat
and not as visible
when a person
stands up, because
gravity encourages
venous drainage
(Assessing Health,
2014).

PERIPHERAL VESSELS

I: Presence or I: No visibility of I: No superficial This is indicated as

appearance of superficial veins; Veins; Good an ABNORMAL
superficial veins, Capillary refill: 3 capillary refill finding.
signs of phlebitis seconds.
According to Jensen,
*Buerger’s Test
*Capillary Refill Poor capillary refill
can be due to
dehydration, and
poor tissue perfusion

BREAST AND AXILLAE

I: Breast for size, I: Breasts are I: Slightly Breast changes are a

symmetry, contour slightly saggy and unequal in size; natural part of the
or shape, shrink. generally aging process and
discoloration, symmetric :
this indicates
retraction, Round bilaterally
hypervascularity, the same; color NORMAL findings.
swelling, edema : dark brown : Particularly during
Round, everted, menopause, changes
I: Areola for size, I: Areolas are and equal in size, in firmness or size
shape, symmetry, darker than the similar in color; are very typical.
color, surface rest of the skin. soft and smooth; Breasts can shrink
characteristics, nipples point in
masses, lesions : over time. When the
the same

24
I: Nipples for size, I: Nipples are direction estrogen levels drop,
shape, position, less erect. the breast tissue
color, discharge, changes. The
lesion
breasts may also sag
P: Lymph nodes, P: No tenderness P: No tenderness because of
breast, areola & or masses and or masses; no estrogen-related
nipples for discharge noted; nodules; no changes that cause
tenderness, skin is intact nipple discharge breasts to shrink.
masses, nodules, When breast tissue
discharge
weakens, the skin
stretches, and gravity
pulls the breasts
downward (Brennan,
D., 2021).

ABDOMEN

I: Skin integrity, I: Skin matches to I: Abdominal skin This assessment

contour & the color of the may be paler indicates NORMAL
symmetry, hernia, body than the general findings wherein the
distention (girth), skin tone patient’s body's color
movements No evidence of No evidence of matches the skin's
associated with enlargement of enlargement of color and there’s no
respiration, liver or spleen liver and spleen. evidence of
peristalsis & aortic enlargement of liver
pulsations or spleen.

According to Charles
Ferguson, the
contour should be
carefully examined
for any signs of
distention, and it
should be noted
whether any
distention is
widespread or
restricted to a
specific area of the
abdomen. The flanks
should also be
examined for any
bulging. Additionally,

25
 the skin of the
abdomen should be
carefully examined
for engorged
abdominal wall veins
and the direction of
blood flow in these
veins. In contrast to
an intra-abdominal
mass, the mass of
the abdominal wall
will become more
apparent when the
abdominal wall
musculature is
tensed. Hernias
(either umbilical,
epigastric, incisional,
or spigelian),
neoplasms (benign
and malignant),
infections, and
hematomas are the
most frequent
abdominal wall
masses. The mass
should be checked to
see if it moves with
respiration or pulses
in time with each
heartbeat.

MUSCLE

I: Size, I: Both sides of I: Equal size on Aging causes muscle

contractures, muscle are equal both sides of mass, tone, and
fasciculations, in size; No muscle strength to decline;
these are typical
tremors tremors noted.
No contractures general changes in
the elderly.
No fasciculations
According to Mount
No tremors Sinai Health System,
because of changes
P: Muscle tone P: Sagging of the P: Decreased in the muscle tissue

26
(tonicity), flaccidity skin and skin turgor, and typical aging
(skin turgor), decreased muscle elasticity changes in the
spasticity (spasm), tone noted Same strength neurological system,
smoothness of on both sides of muscles are less
movement, the body toned and less able
strength to contract. Even with
regular exercise,
muscles can lose
tone and become
inflexible with age.

NEUROLOGIC

Cranial Nerve The patient only

CN VIII: CN VIII: CN VIII: experiences difficulty
Auditory/vestibular Patient can hear hearing in the right
nerve Difficulty of ear and the rest of
hearing in the cranial nerves are
right ear functioning well.

According to the
National Institute on
Deafness and other
Communication
Disorder (2022),
age-related hearing
loss, also known as
presbycusis,
develops gradually
as a person ages.
Changes in the inner
ear and auditory
nerve, which
transmits signals
from the ear to the
brain. However, there
are other factors to
consider, such as
genes, loud noise,
and family history.

Mental Status ● The patient is conscious, GCS of 15 indicates

● Language coherent, and awake. that the patient is

27
 ● Orientation ● The patient can properly fully conscious.
● Memory formulate words and respond
● Attention to questions. According to
Span/Calcul Kathleen Gaines
● Patient is aware of place and
ation (2022), the Glasgow
time. Coma Scale can be
Consciousness used to describe a
level patient's level of
● Glasgow GCS: 15 consciousness after
Coma E–4 suffering an acute or
Scale V–5 severe brain injury.
(GCS) M–6 Patients with a GCS
score of 8 or less are
considered to have
suffered a severe
head injury. A GCS
score of 9-12 is
moderate and a GCS
of 15 means a
patient is fully
conscious.

RECTUM AND ANUS

I: Anus and I: No redness, or I: No redness, or The patient has no

surrounding tissue tenderness, skin tenderness, skin redness, tenderness,
for color, integrity, intact, wrinkles intact, wrinkles hemorrhoids,
lesions noted. No noted. No nodules or masses,
hemorrhoids hemorrhoids the skin is intact and
noted. noted. wrinkles were noted.

P: Anal sphincter P: No noted P: No nodules, According to Mark

tonicity, nodules, nodules, masses masses and Williams (2012), Pay
masses, and and tenderness. tenderness. close attention to the
tenderness rectal mucosa and
the skin's edge. Tags
that are flesh-colored
point to old, fibrosed
external
hemorrhoids.
External hemorrhoids
are indicated by the
purple vascular
structures distal to
the pectinate line.
Internal hemorrhoids
are indicated by
sensitive, purple
vascular structures
close to the pectinate

28
 line. Rectal prolapse
is indicated by a ring
of tissue that is dark
red around the anus.
The rectum's
ecchymotic ring
shows
intra-abdominal
hemorrhage. Sexual
abuse often results in
bruises. An anal
fissure is a sensitive
tear in the distal
anus. Anal fistula is
indicated by an
opening in the
perineal skin.

References:
Adrianne, L. & Helen, L.(2006). Matteson & McConnell’s Gerontological Nursing Concepts and
Practice (3rd Ed). Saunders Elsevier

Jensen, S. (2015). Nursing Health Assessment: A Best Practice Approach (3rd ed.). Wolters Kluwer

Brunner & Suddarth’s Textbook of Medical Surgical Nursing

C. Gordon’s Functional Pattern of Assessment

29
 Gordon’s Before During Analysis
Assessment Hospitalization Hospitalization

Health The patient The patient stated Before being admitted

Perception stated that that “Simula noong to the hospital, the
“Pagdating ng 7 naospital ako, hindi patient engages in
ng umaga ko na nagagawa morning exercises or
maglalakad na yung mga dati kong activities such as
ko niyan... at gawain sa bahay. walking and cleaning
mag wawalis.. Hindi ko rin their house. She
Sa tingin ko sa masyadong alam believed that by
ganun paraan ang kalagayan ko. engaging in these
nagiging healthy Ngayon, syempre, activities, her health
ako kahit paano alam ko na mga would improve.
ang katawan bawal sa akin dahil
ko..” sinabi ng doctor ko.” According to Case
Western Reserve
University (2015),
because of the effort
required to maintain a
clean and organized
home, elders tend to
feel better both
physically and
emotionally after doing
housework.

The patient was not

aware of her health
until she was admitted
to the hospital.
According to Care Inc.
(2015), one of the
reasons that affects the
health of the older
adults is the negligence
of both the patient and
her family. Because the
patient is an older adult,
she requires more
supervision and
understanding from her
family in order to be
aware of her own
health.

Nutritional The patient The patient stated Before being admitted

Metabolic stated that that to the hospital, the
Pattern “Eh kasi alam “Pagkagabi patient enjoys cooking

30
 mo kung nagtitinapay lang adobo, stewed meat,
magluto sa amin ako. Pero dapat and other fatty foods.
Adobo, nilaga. walang palaman, The patient is also
Ang nilaga pa bawal na ang aware that her eating
puro taba. Yun matatamis. habits have resulted in
ang madalas Maraming bawal high cholesterol.
naming kainin. ngayon na sinabi sa
Kung ano naka akin ang doktor, According to Serenity
hain mapipilitan tulad ng maalat o Home Care (2016), as
ka rin kumain ng mag fast food..” people get older they
mga yun. Kaya become less active,
siguro ako making it harder to burn
nagkaganito...” off more calories and
fat. This additional
weight raises the risk of
heart disease while
also putting pressure
on joints and crucial
organs

Elimination “Oo normal The patient stated Before hospitalization,

Pattern naman bago ako that the patient’s elimination
ma-hospital kasi “Nako madami na pattern was normal.
dalawang beses ako naihi mula However, the doctor
naman ako umaaga mga 5 advises total bedrest
dumumi sa isang beses siguro. while the patient is in
araw, tapos Pag-iihi ako dito o the hospital. She is
nakaihi naman pagdudumi ako sa wearing a diaper since
ako siguro mga diaper. Yung he is unable to use the
3 beses.” As kakulay niya yung restroom because of
verbalized by the dirt at matigas, mga his condition, which
patient. 2 beses din ako makes her a little
dumumi ngayong comfortable.
araw.”
According to the
American Lung
Association, in the
acute period, bed rest
is maintained to reduce
metabolic demands and
conserve energy for
healing. Activity
restrictions after that
are determined by the
individual patient's
response to activity and
the resolution of
respiratory
insufficiency.

31
Activity Exercise The patient The patient Before hospitalization,
Pattern verbalized, verbalized,’’Ngayon the patient walked
‘’Pagdating ng 7 nasa hospital, every morning for at
naglalakad na ko limitado na lang least 30 minutes. The
niyan. Pero pag galaw ko tayo - Centers for Disease
matandang tayo na lang minsan Control and Prevention
ganyan, 30 masama naman (2022) recommend that
minutes lang yung hindi dahil a 70-year-old or senior
hanggang 7:30 o nangangalay ako walk for at least 150
kaya umpisahan kapag naka higa minutes a week (for
ko ng 6:30am.” lang. Pag punta ko example, 30 minutes a
sa CR limitado din, day, 5 days a week)
dito ako naihi sa Many age-related
kama nilalagyan na health issues can be
lang ng lalagyanan avoided. Additionally, it
o kaya diaper.’’ strengthens muscles
that can continue
performing daily tasks
independently.
During hospitalization,
the patient’s activity is
limited. She was placed
on complete bed rest
without bathroom
privileges.

Sleep-Rest “Simula bata “Nagising ako ng Before hospitalization,

Pattern hanggang mga ala una ng the patient had trouble
ngayon maaga umaga kahit pilitin sleeping since she was
talaga ako ko matulog gising a child; she gets up
nagigising, ala na ko ng 2, 3, 4, 5, early in the morning
una gising na 6, kaya ginagawa and spends her time
ako tuloy tuloy ko, ala-syete pa doing housework.
na hanggang lang ng gabi Sleep patterns are
umaga pero sa nakahiga na ako frequently taught to
tanghali para makatulog children. When we
nakakatulog ako.’’ as verbalized repeat these patterns
naman ako.’’as by the patient. over many years, they
verbalized by the become habits
patient. (Medlineplus 2022).
‘’Ay oo kami
tulog pa pero ‘’Medyo hirap talaga During hospitalization,
may naririnig na sya makatulog dito she hasn’t been able to
kumakalabog sa sa hospital kasi get enough sleep,
kusina kahit ganon na which may be due to
madaling araw nakasanayan nya, her sleep habits before
pa lang at nagigising agad hospitalization, and
tinanong namin kapag may nurse sometimes her sleep is
sya dati bakit napapasok.’’ as interrupted whenever
verbalized by the

32
 ganon oras patient’s daughter. the nurse checks up on
gising na sya her. Due to some
ang sagot hospital noise, the
naman nya patient had a sleeping
naglilinis at disturbance, which can
saing na lang be a problem for her
kasi hindi na sya rest and comfortable
makatulog.’’ as environment (Park, J.,
verbalized by the 2017).
patient’s
daughter.

Cognitive The patient The patient's eyes Upon interviewing the

Perceptual verbalized are good now and client, she has so much
Pattern “Naopera na can see clearly to talk about her life
yung mata ko… without using and she seems fine as
ni lasic, operado eyeglasses. Yet her if she has no condition.
na ko sa ears are not good Our group asked her
katarata… yung as she verbalized some questions and by
salamin ko “nakakarinig ako observing, the patient’s
noong araw pero may ugong… daughter still had to
nasa 150/200 at tsaka mahina… repeat the questions or
ang pandinig ko halimbawa pagka volume up her voice
medyo parang, nag-uusap kami… because the patient
kaya pag nahihilo ako, can’t hear what we
nagsalita ako kumbaga sa hindi were saying even if we
minsan malakas balance yung tainga are close in distance to
pala kase nga ko, kaya minsan her. Based on our
minsan yung nagsasalita siya observation, sometimes
tainga ko mali… puro ako ano, naka we need to give her
dapat dito ako tatlong ulit na ako… follow up questions
ooperahan kailangan malapit because some of her
(referring to right yung kausap kong answers are not
ear) … eh may ganyan dahil hindi connected to the
nakita naman ko talaga naririnig… questions. Due to her
akong babae, at retired teacher na ear problem, she can’t
inopera yung ako nung 2019… 60 clearly hear, and this is
tainga nga pero years old.” the most common
hindi na problem in older
nakarinig, kaya people.
natakot ako…
tapos teacher According to the article
ako sa makati of Harvard Health
noon.” Publishing, as people
age, changes to the
glands inside the ear
cause the earwax to
become drier which
makes it harder for the

33
 ears to clean
themselves as
effectively as they used
to, and this will build up
inside the ear canal and
form a blockage.

Self-Perception/ Patient E.O.E is Aside from The patient is happy

Self-Concept a friendly and a attending gathering with her life and still
Pattern happy person she still managed to manages to think
and she said take care of her positively despite her
before the grandchildren as the condition. During her
pandemic she patient verbalized hospitalization, she was
joined some of “Nagluluto din ako… still able to laugh and
her friends Naghahatid at talk positively even
gathering, as nagsusundo kami though she cannot walk
she verbalized alas-kwatro.” to the restroom alone.
“Oo nagkikita
kami. Pagka According to Levy &
yung may Bavishi, elderly adults
kainan. Pero are prone to various
nung chronic diseases as
nagka-pandemic they age; however, the
, wala na. kasi impacts of diseases on
natatakot na ako health outcomes will
eh.” vary, as self-perceived
aging is an important
influential factor.

Role The patient While patient E.O.E. According to EuroMed's

Relationship verbalized “Ako is confined, her article on the Impact of
Pattern yung nag-aalaga husband and Illness on the Family,
sa mga apo ko. daughter remain by when a family member
Ako din yung her side, supporting is sick, other family
naghahatid at her by providing her members have to
nagsusundo with necessities and change their routine
kami ng asawa waiting for her to and fill in for the sick
ko tuwing recover quickly and person in some of their
alas-kwatro.” be healthy. The roles, which has an
She is a mother patient lives with her impact on their own
of 4 children. husband, children ability to play those
The patient’s and grandchildren in roles normally.
husband and their home. While
their children she is in the Patient E.O.E receives
help her. Patient hospital, she is moral and emotional
E. E she lives visited by her support from her
with her children, husband and other
husband, grandchildren, and family members by
children and other relatives. staying by the patient’s
grandchildren’s. side and taking care of

34
 her as she stays in the
hospital, which will help
her deal with her
current health
condition.

Sexually The patient She is no longer Patient E.O.E. is a 73

Reproductive verbalized that sexually active due years old woman
“...matagal na to a decrease in married. She discovers
ang huli namin interest in the that as she gets older,
pag-tatalik ng activity. her desire to have sex
asawa ko, pero is declining. She can't
minsan pag even recall when the
nanjan naman o last time was because it
gusto namin has been so long since
nakakainis rin they last engaged in the
parang ayaw activity (sex).
mona rin ganun
talaga kapag According to Kaplan
tumatanda and Berkman's (2022)
na……” study on the intimacy of
older adults, the desire
for intimacy does not
decrease with age.
However, the illnesses
and emotional
alterations that
frequently come with
aging might prevent
people from forming
and maintaining
intimate relationships. A
person's intimate
expressions can
change as they age.
Age-related changes:
Sex hormone levels
decrease, leading to
changes (such as
vaginal atrophy, and
diminished vaginal
lubrication) that make
sexual activity
uncomfortable or
difficult. Libido (sex
drive or the desire for
sex) may decrease.

Coping Stress The patient The patient stated, As we assess patient

verbalized that "...palagi ko E.O.E., we see that she

35
 “...nag-dadasal ginagawa parin ang has a lot of knowledge
ako yan ang pag-dadasal, kahit and maturity that she
ginagawa ko na nandito ako....", has gained from
kapag na-iistress indicating that experiencing the hard
ako, nothing had lessons of life. She is
nag-dadasal ako changed in the way aware that she cannot
sa bahay mayat she coped with control life on her own;
maya, gabi-gabi stress. only God can. Her faith
bago matulog, in God helps her
paggising..” overcome obstacles
and cope with stress.
One helpful way for
lowering stress, anxiety,
and depression is to
pray for patient E.O.E.
This can help to let go
of problems, give them
to God, and believe that
he will take care of you,
as she has a saying
that goes, "Let go and
let God."

Values-Belief Patient As stated by the As we assess patient

Pattern verbalized that patient, she still E.O.E., we can observe
she believed in lives by the idea how her life
many things in "huwag madaliin experiences have made
life as stated by ang mga her strong. Patient
“marami ako bagay-bagay bata E.O.E. added that her
paniniwala sa pa kayo unahin life's lessons have
buhay..tulad ng muna ang pag-aaral enabled her to mentor
huwag bago ang ibang those who are less
mag-madali sa bagay." She also experienced or in need.
bagay-bagay, expresses this belief The patient stated that
hindi kailangan to others because her beliefs were shaped
magmadali... she believes that by or resulted from her
mag tapos muna everything happens experiences and that if
kayo ng for a reason, that she could go back in
pag-aaral at everything has its time and undo the
mag-trabaho..” time, and that what mistakes she had
is yours will be made, she would not do
yours. anything.
She views aging
positively and is happy
with all of her life's
experiences. She is
satisfied with all she
has, good or bad, and
this is what makes her

36
 view life so
meaningfully.

V. LABORATORY AND DIAGNOSTIC

37
 In order to determine whether an individual has pneumonia and make a
diagnosis of the health condition of the patient the doctor will ask questions about
medical history, perform a physical examination, and order some diagnostic tests
such as Chest X-ray and other laboratory tests. It is vital for the physician to identify
pneumonia and establish the location and severity of the infection. Requesting
Chest-X-ray only cannot inform the physician what type of bacteria is causing the
pneumonia which will lead for further tests such as sputum test or blood culture.
Determining the type of pneumonia the patient has through diagnostic testing is
crucial in improving patient care by assuring that each patient receives the right
treatment.

A. Normal Chest-X-Ray

B. Chest X-Ray with Pneumonia

38
Synthesis: The two figures illustrate the difference between a chest x-ray taken on
a healthy person and one taken on a patient who has pneumonia. This type of
diagnostic test is carried out to know whether a patient has presence or absence
of lung consolidation. After the chest x-ray of patient E.O.E in a
posterior-anterior and lateral view which confirmed acute pneumonia in both
lower lobe which is the part with the infiltrate and pneumonia. Furthermore,
as depicted above the figure (B) displays a white patch on the lower and right
lung lobes, which represents the lung part that is compromised with bibasal
pneumonia. On the other hand, the figure (A) having a normal chest x-ray reveals
a clear lung field.

LABORATORY NORMAL ACTUAL INTERPRETATION

AND FINDINGS FINDINGS
DIAGNOSTICS

CLINICAL CHEMISTRY

The high-density
High-Density 0.90 – 100 1.33 lipoprotein level
Lipoprotein of the patient is
within the normal
range. According to
Koeth and Tang
(2013), HDL is a
crucial mediator in
the reverse
cholesterol transport
pathway, which
transports
cholesterol from
peripheral tissues
back to the liver for
metabolism.

39
 The LDL level
LDL <3.40 3.12 of the patient is
within the normal
range. As stated by
Aherne (2011) LDLs
are the primary
carriers of
cholesterol in blood
since their primary
function is to
distribute cholesterol
to both peripheral
and hepatic cells.

The VLDL level

VLDL ≤30 0.49 of the patient is
within the normal
range. As
mentioned by
Cleveland Clinic
(2022) VLDLs help
the body retain
energy, and control
blood pressure by
transporting
triglycerides and
cholesterol to where
it is needed in the
body.

The fasting blood

Fasting Blood 3.9 – 6.4 H 6.50 sugar of the patient
Sugar is above the normal
range. Increase in
fasting blood
glucose is an
indication that the
patient is at higher
risk of developing
diabetes
(pre-diabetes). The
condition is called
hyperglycemia or

40
 high count of fasting
blood sugar due to
lifestyle factors such
as unhealthy eating
habits despite
having
hypertension.

As indicated by
Jensen et al. (2017)
hyperglycemia is
frequent in
individuals with
community-acquired
pneumonia (CAP)
and is associated
with a higher risk of
complications. Only
patients without
diabetes that have
elevated blood
glucose have a
greater likelihood of
getting confined in
the hospital.

The condition is
CHOLESTEROL 0.00 – 5.10 H 5.39 called
hypercholesterolemi
a; patient
low-density
lipoprotein (LDL), or
bad cholesterol level
is too high due to
her underlying
condition of
hypertension and
continuous
unhealthy diet.

As eloquently stated
by the National
Health Service

41
 (2022) , having a
high cholesterol is
primarily brought on
by different factors
such as consuming
fatty foods, failing to
exercise regularly,
being overweight,
smoking, and using
alcohol. Moreover, it
can run in families.
Through eating a
well-balanced diet
and increasing
physical activity, this
can lower the
cholesterol level.

The triglycerides
Triglycerides 0.00 – 2.2 1.08 level of the
patient is within
the normal range
.According to
Medline Plus (2022),
an individual may
have high
triglyceride levels in
blood if they
consume more
calories than they
burn off, particularly
calories from
carbohydrates that
include sugary and
fatty foods.
A high blood
triglyceride level
normally does not
create any
symptoms, but it can
damage arteries and
increase risk of

42
 heart disease over
time.

LABORATORY NORMAL ACTUAL INTERPRETATION

AND FINDINGS FINDINGS
DIAGNOSTICS

CLINICAL CHEMISTRY

The BUN level

BUN 3.50 – 7.20 5.58 of the patient is
within the normal
range. This
indicates that the
patient has normal
waste product on
her blood. As stated
by Laboratory
Corporation (2017)
it is
significant to assess
kidney function
under various
conditions, to assist
in the diagnosis of
renal disease, and
to keep track of
those who have
kidney failure or
malfunction. The
BUN level is a basic
but substantial
predictor of
pneumonia severity
and death (Feng et
al., 2019). In the
current study, a
higher 30-day
mortality is linked to

43
 a higher BUN level.
Increased urea
absorption by the
kidneys as a result
of dehydration in
patients with
pneumonia
commonly leads to
elevated BUN
levels.

Elevated creatinine
Creatinine 45.000 – 84.000 H 92.69 level signifies
impaired kidney
function since the
heart might not be
able to pump
enough blood to
kidneys which leads
to reduced blood
flow to the kidneys.
As mentioned by J.
Johnson (2019) a
high amount of
creatinine in the
blood or urine may
indicate that the
kidneys are not
doing a good job of
filtering the blood.
Although high
creatinine levels do
not pose a
life-threatening
threat, it might be a
sign of a major
health problem,
such as chronic
renal disease.

44
 The sodium level
Sodium 136.00 – 149.00 136.0 of the patient is
within the normal
range. The balance
amount and
distribution of fluids
in her body. As
indicated by
Harvard T.H. Chan
School of Public
Health (2022) In
order to convey
nerve impulses,
contract and relax
muscles, and
maintain the right
ratio of water and
minerals, the
human body needs
a small amount of
sodium. If the
sodium levels are
abnormally high or
low, individuals
might be
experiencing
dehydration, kidney
issues, or another
kind of condition
(Medline Plus,
2022).

The condition is
[3] Potassium 3.80 – 5.00 L 3.60 hypokalemia, which
means that the
amount of
potassium in the
blood is lower than
normal which is
induced by the lack
of potassium in the
patient E.E diet
since she is fond of

45
 eating red meat
rather than fruits
and vegetables that
are rich in
potassium. As
eloquently stated by
Lewis (2023) blood
potassium levels
are too low in
hypokalemia. The
most common
causes of low
potassium levels
are diuretic use,
adrenal gland
problems, vomiting,
and diarrhea. A low
potassium level can
cause irregular
heart rhythms,
muscles to feel
weak, cramp,
twitch, or even
become paralyzed.

LABORATORY NORMAL ACTUAL INTERPRETATION

AND FINDINGS FINDINGS
DIAGNOSTICS

CLINICAL CHEMISTRY

Blood Uric Acid 155.00 – 357 H 416.25 The condition is

called
hyperuricemia,
which means that
elevated uric acid
levels are above the
normal range. The
uric acid is the
immune system
stimulant, urate is a

46
 potent antioxidant,
and it aids in the
maintenance of
blood pressure in a
salt-deficient
environment The
possible cause of
this is the patient
consuming food high
in fructose and red
meat. As studied by
Brennan (2021)
when the body
produces too much
uric acid or excretes
it insufficiently,
hyperuricemia can
develop. The most
prevalent cause of
hyperuricemia is an
unhealthy lifestyle,
which is primarily
due to an excessive
intake of purines,
proteins, alcohol,
and carbs in an
individual diet
(Grassi et al., 2013).

SGOT/AST 0.000 – 31.000 H 41.17 ALT level is above

the normal range
indicates that the
liver is irritated due
to the patient
medication
maintenance for
hypertension which
is Amlodipine. This
can raise the levels
of the enzyme
aspartate
aminotransferase
(AST). This implies

47
 that amlodipine
could cause
drug-induced liver is
inflamed. According
to Fletcher (2021)
AST blood tests are
typically used to
detect and evaluate
liver problems. AST
protein is primarily
found in the liver.
The physician may
request a test of the
second liver
enzyme, ALT,
concurrently to rule
out problems
affecting organs
other than the liver.
Since ALT can also
be found in the
muscles, heart,
kidneys, and brain.
If both levels are
high, it can be a sign
that the person's
liver is having
issues. If only the
AST levels are
elevated, this can
point to an issue
with another organ
or system.

SGPT/ALT 0.00 – 31.00 19.08 The ALT level of the

patient is within the
normal range. As
stated by
HexaHealth (2022)
SGPT/ALT are
liver-specific
enzymes that aid in
keeping track of liver

48
 health. It is in charge
of giving the cells in
your liver the energy
that proteins can
provide.

As a result of the
enzyme's release
into the bloodstream
as a result of liver
damage, the level of
SGPT rises.
Increased levels of
SGPT are indicative
of diseases such as
infectious
mononucleosis,
myopathy, viral
hepatitis, diabetes,
bile duct issues,
congestive heart
failure, and liver
damage.

LABORATORY NORMAL ACTUAL INTERPRETATION

AND FINDINGS FINDINGS
DIAGNOSTICS

CLINICAL MICROSCOPY

URINALYSIS

Color Clear to pale LIGHT YELLOW The color of the

yellow patient's urine is
within the normal
range. The patient's
body is well-
hydrated with the
fluids it requires. As
mentioned by

49
 Bumrungrad
International
Hospital (2020)
Regularly checking
the color of urine
could reveal health
information
regarding any
underlying condition.
The color of urine
can change
depending on a
variety of
circumstances, such
as medications,
nutrition, or medical
problems. While this
normally is not
cause for concern,
there are some
instances where it
might be a sign that
the body has
medical issues. A
person is usually
well-hydrated and
drinking enough
water if they have
pale or translucent
yellow urine
(Sissons, 2022).

Transparency Clear SLIGHTLY HAZY This signifies that

the patient’s urine
transparency is not
normal. As indicated
by Cleveland Clinic
(2021) hazy urine is
usually harmless,
however recurrent
and repetitive signs
of hazy urine may
signal an underlying

50
 medical issue. Hazy
urine is a result of
high alkalinity,
dehydration, or
infection.

Protein NEGATIVE NEGATIVE This indicates that

the patient’s urine is
normal. As
eloquently stated by
Medline Plus (2022)
Your urine may
contain protein if you
have kidney
disease. The first
symptom that kidney
disease or another
ailment has harmed
the filters in your
kidneys may be high
levels of protein in
your urine over time.
They are the two
most frequent
reasons kidneys can
be damaged due to
diabetes and
hypertension
(Cleveland Clinic,
2022).

GLUCOSE NEGATIVE NEGATIVE The hematocrit

count of the patient
is within the normal
range. A normal
blood glucose level
implies a negative
urine glucose test.

As studied by
Medline Plus (2022)
usually urine
contains little or no

51
 glucose. However, if
your blood glucose
level is too high,
your kidneys will
eliminate some of
the additional
glucose through
your urine.

pH 7.35-7.45 6.0 Decrease of pH in

function is caused
by pneumonia and
can contribute to
respiratory acidosis.
The blood and other
bodily fluids become
overly acidic as a
result of excessive
amounts of CO2
lowering the pH.

According to
Brennan (2021) the
pH, urine can be
impacted by a
number of factors
that include diet
such as wheat,
drinks, seafood,
sugary meals, and
foods high in
protein, which can
have an impact on
the urine pH test
findings.Dehydration
,acidosis, starvation,
and diarrhea are
among the
conditions that might
make the urine test
at an acidic pH level.

52
Specific Gravity 1.010-1.020 1.005 This indicates that
the urine specific
gravity is within
normal range this is
due to normal
concentration of
each chemical
component in the
urine.

As stated by
Brennan (2021) this
is an indicator of the
kidneys capacity to
regulate water
balance and
eliminate waste.
Numerous medical
diseases including
central diabetes
insipidus and
nephrogenic
diabetes insipidus,
are diagnosed with
the use of urine
specific gravity. The
body signals
excessive thirst in
both medical
conditions which
results in an
increase of frequent
urination.

WBC 2-5 6–8 Leukocytosis

pertains to the high
count of white blood
cells (WBC) due to
pneumonia infection.

As mentioned by
Watson (2019) High
amounts of

53
 leukocytes in the
urine could be a sign
of an infection or
other inflammatory
medical conditions.
WBC’s in urine are
most frequently
caused by an
infection in the
urinary tract. The
immune system
increases the
creation of these
cells if an individual
has an infection in
order to combat the
infection in the
urinary tract.

RBC 0-4 0–2 This indicates that

the RBC is within
normal count since
the patient RBC
levels in the blood
that are exceedingly
low can be
considered normal.

As indicated by Nall
(2019) urine
normally does not
include RBC’s. This
frequently indicates
a health problem,
such as an infection
or irritation of the
tissues in the urinary
system.

Epithelial Cell None MODERATE This indicates that

the epithelial cell is
not normal since
moderation could

54
 imply a medical
condition which
would lead to further
tests for a proper
diagnosis.

As eloquently stated
by Nall (2019) "few"
indicates that a
person's test results
are normal while
results of
"moderate" or
"many" could point
to a health issue.
When urinalysis
findings reveal a
moderate to high
number of epithelial
cells, it may be an
indication of some
types of cancer,
kidney problems,
liver disease, yeast
infections, or urinary
tract infections. For
a precise diagnosis,
an individual might
require further tests.

Bacteria None MODERATE This indicates that

presence of bacteria
in the urine is not
normal since
pneumonia causing
bacteria is found in
the urine.

As studied by
Goldman (2018) the
bacteria can also
travel from the lungs
through the

55
 circulation and into
the urinary system.

Amorphous Urate None FEW This indicates that

presence of
amorphous urate in
the urine is not
normal. The
reduced urine
volume combined
with frequent
consumption of
large amounts of
uric acid in meat
products are some
of the causes that
contribute to the
formation of
amorphous crystals.

According to Biron
(2017) amorphous
urates typically do
not have much of an
impact on clinical
outcomes. This
develops as a result
of a number of
circumstances
including decreased
urine volume,
changes in urine pH,
and frequently
consuming
substantial amounts
of uric acid from
eating meat or
calcium from dairy
products.

56
 LABORATORY NORMAL ACTUAL INTERPRETATION
AND FINDINGS FINDINGS
DIAGNOSTICS

IMMUNOLOGY

Troponin I <19 H.3831.20 The prognosis of

(Quantitative) POSITIVE hospitalized
pneumonia patients
with increased
troponin levels is
significantly
impacted.
Consequently,
troponin levels could
be another method
of risk assessment
for the patient
admitted to the
hospital since acute
infections such as
pneumonia put more
strain on the heart
that leads to the
elevation of
Troponin I.

As stated by Icahn
School of Medicine
at Mount Sinai
(2013) troponin
levels that even
slightly rise indicate
that the heart may
have sustained
some damage.
Troponin levels that
are extremely high
indicate the onset of
a heart attack.
Within six hours

57
 after a heart attack,
the majority of
individuals
experience elevated
troponin levels.

COVID-19 Negative NEGATIVE This indicates that

RT-PCR TEST the patient is not
infected by
COVID-19 virus
which is normal.

According to
Cleveland Clinic
(2021), PCR test for
COVID-19 is a
useful and effective
diagnostic for
diagnosing
COVID-19 is the
PCR test. A
negative test result
indicates that an
individual was most
likely not infected
with SARS-CoV-2 at
the time the samples
were taken.

LABORATORY NORMAL ACTUAL INTERPRETATION

AND FINDINGS FINDINGS
DIAGNOSTICS

HEMATOLOGY

COMPLETE BLOOD COUNT

Hemoglobin 120-160 146 It shows all of the

complete blood
counts of the patient
Hematocrit 0.37-0.43 0.43
are within the
normal range which

58
Red Blood Cell 4.0-5.4 5.19 exhibits absence of
a health problem in
the patient’s blood.
Mean Cell Volume 80-100 82.7

As indicated by File
Mean Cell 27-31 28.1 (2022) patients must
Hemoglobin have blood tests
done including a
Mean Cell 310-360 340 complete blood cell
Hemoglobin Cone count (CBC). A CBC
White Blood Cell 4.0-10.0 5.90 counts numerous
different blood cell
types, including
white blood cells
(WBC), the quantity
of which rises in
response to
bacterial infections.
One of the signs that
the patient is
suffering from
bacterial infection,
particularly
pneumonia, may be
present is an
increase in WBCs.

LABORATORY NORMAL ACTUAL INTERPRETATION

AND FINDINGS FINDINGS
DIAGNOSTICS

DIFFERENTIAL COUNT

Neutrophils 0.55-0.65 H 0.70 This condition is

called neutrophilia,
which pertains to
Lymphocytes 0.25-0.35 0.27
high count of
neutrophils in the
blood as a result of
Monocyte 0.03-0.06 L 0.02 the bacterial
infection. This is a

59
Eosinophil 0.02-0.04 L 0.01 type of white blood
cell (WBC) which
assists the immune
Platelet Count 170-400 276 system in body
defense against
infection. Direct
migration of
neutrophils to the
infection site causes
them to cluster in
large numbers and
release many
antimicrobial agents
that are intended to
contain and
eradicate the
infection (Pechous &
National Library of
Medicine, 2017).

The rest of the

differential count in
the blood is within
normal range except
in the neutrophils
count.

As eloquently stated
by File (2022) a
differential blood
count helps to know
the blood's
percentage of each
type of white blood
cell (WBC)
determined. It also
shows whether any
abnormal or
immature cells are
present.

60
 LABORATORY
NORMAL ACTUAL
AND INTERPRETATION
FINDINGS FINDINGS
DIAGNOSTICS

ARTERIAL BLOOD RESULT

pH 7.35 – 7.45 7.34 The patient has acid

base disturbances
this condition is
called
uncompensated
respiratory acidosis.
This mainly occurs
when the HCO3
value does not rise
while there is
increase with the
PaCO2 level. As a
result of the
respiratory failure,
there will be acidosis
due to inability to
remove excess
carbon dioxide from
the blood and the
lungs which leads to
quickly dropping of
pH to compensate.
The base excess of
the patient becomes
negative in
respiratory acidosis.
Respiratory acidosis
is caused by
hypoventilation
because of
decreased CO2
production.

According to
Brandon Peters, MD
(Neurologists; Sleep

61
Medicine Specialist;
Author), a mismatch
between airflow
(ventilation) and
blood flow
(perfusion) causes
dead space
ventilation. This loss
of function can lead
to respiratory
acidosis, which can
be caused by
pneumonia.
Respiratory acidosis
occurs when the
lungs are unable to
remove enough of
the carbon dioxide
(CO2) produced by
the body. Excess
CO2 lowers the pH
of your blood and
other bodily fluids,
making them acidic.

62
CULTURE SENSITIVITY TEST

Sputum culture is necessary when a patient develops pneumonia, this is the

most common test that must be conducted. A sample of bodily fluid or tissue is
added to a material that encourages microbial growth for a culture. It is used to
identify the bacteria or fungi that are affecting the airways of lungs. The sensitivity
test determines which medication will be most effective in treating the disease or
infection.

Sputum Culture

Sputum is a mucus-based material that is expelled from the respiratory

system, particularly the lungs. Sputum culture is used to examine lung related
conditions to identify what is growing in the patient’s lung. In sputum cultures, the
following are the most common pathogens used to detect bacteria like Streptococcus
pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Klebsiella
species.

Figure I. Illustrates a gram-positive bacterium colony (Streptococcus Pneumoniae)

found in the patient's Culture and Sensitivity test result.

Synthesis: Patient E.O.E. culture and sensitivity results revealed Streptococcus

Pneumoniae, a gram-positive anaerobic aerotolerant microorganism. This
indicates that the patient's disease was caused by bacterial pneumonia. This was
confirmed by the following clinical manifestations of the patient: elevated WBC,
chest x-ray revealing white patches on both lobes of the lungs (bibasal
pneumonia), productive cough and colds, difficulty breathing, chest pain, thick
yellowish sputum, and chills.

63
VI. ANATOMY AND PHYSIOLOGY

The Respiratory System exchanges these gasses between the air and the blood,
and the cardiovascular system transports them between the lungs and the body
cells. Without healthy respiratory and cardiovascular systems, the capacity to carry
out normal activity is reduced. Respiration (breathing) is necessary because all
living cells of the body require oxygen and produce carbon dioxide.

FUNCTIONS OF THE RESPIRATORY SYSTEM

1. Regulation of blood pH. The respiratory system can alter blood pH by
changing blood CO2 levels.
2. Production of chemical mediators. The lungs produce an enzyme called
angiotensin-converting enzyme (ACE), which is an important component of
blood pressure regulation
3. Voice production. Air moving past the vocal folds makes sound and speech
possible.
4. Olfaction. The sensation of smell occurs when airborne molecules are drawn
into the nasal cavity
5. Protection. The respiratory system provides protection against some
microorganisms by preventing them from entering the body and removing
them from respiratory surfaces.

UPPER RESPIRATORY TRACT

Air enters your body through your mouth or nose as you breathe. From there, it
passes via your larynx or voice box, into your trachea (windpipe), and then into your
lungs. All of these structures work together to draw in fresh air from the outside into
your body. The upper airway is crucial because breathing depends on it remaining
open at all times. Additionally, it aids in warming and moistening the air before it
enters your lungs.

64
Nose (nasus) consists of the external nose and the nasal cavity.

External nose is the visible structure that forms a prominent feature of the face. The
largest part of the external nose is composed of hyaline cartilage plates. The nasal
bones plus extensions of the frontal and maxillary bones constitute the bridge of the
nose, which is where eyeglasses would rest.

Nasal cavity is the open chamber inside the nose where air first enters the
respiratory system. It extends from the anterior structures called the nares or nostrils,
and posterior structures called choanae. The Nares are external openings of the
nasal cavity. The vestibule (entry room) is a region located just behind each naris in
the anterior part of the nasal cavity.

The vestibule is lined with stratified squamous epithelium, which is continuous with
the stratified squamous epithelium of the skin. The choanae in the posterior part of
the nasal cavity are the openings into the pharynx.

The hard palate is the anterior portion of the roof of the mouth and is formed by the
palatine process of the maxillae and the palatine bone. It is covered by a highly
vascular mucous membrane that forms the floor of the nasal cavity. It separates the
nasal cavity from the oral cavity.

The nasal septum is a partition that separates the nasal cavity's right and left
halves. The anterior part of the nasal septum is composed of cartilage, while the
posterior part consists of the vomer bone and the perpendicular plate of the ethmoid
bone.

65
Conchae (resembling a conch shell) has three bony lateral ridges known on each
side of the nasal cavity. The conchae used to be named the turbinate bones because
they act as “wind turbines,” helping the air churn through the nasal cavity.

The meatus or passageway is a tunnel where air passes through beneath each
concha. Paranasal Sinuses are air-filled spaces within bone. Nasolacrimal ducts
opening for tear drainage from the eye's surface is present in each inferior meatus.

FIVE FUNCTIONS OF THE NASAL CAVITY

1. Serves as a passageway for air.
2. Cleans the air.
3. Humidifies and warms the air.
4. Contains the olfactory epithelium.
5. Helps determine voice sound.

PHARYNX
The Pharynx (throat) is a common passageway for both the respiratory and digestive
systems. It receives air from the nasal cavity and receives air, food, and drink from
the oral cavity. The pharynx is connected to the larynx, which controls breathing, and
the esophagus, which controls digestion.

3 REGIONS OF THE PHARYNX

1. NASOPHARYNX is immediately posterior to the nasal cavity. Specifically, it is
posterior to the choanae and superior to the soft palate.
a) Soft Palate is an incomplete partition composed of muscle and connective
tissue. It separates the nasopharynx from the oropharynx. The soft palate
blocks swallowed materials away from the nasopharynx and nasal cavity
toward the back of the pharynx.
b) Uvula is the posterior extension of the soft palate
c) Pharyngeal tonsil or Adenoids helps defend the body against infection.
An enlarged pharyngeal tonsil can interfere with normal breathing and
airflow through the auditory tubes.
The nasopharynx is lined with a mucous membrane that traps debris. This
debris-laden mucus from the nasal cavity is moved through the nasopharynx and
swallowed. Any swallowed pathogens are killed by the acid in the stomach. The
nasopharynx also contains openings on each side from the auditory tubes that are
continuous with the middle ear

2. OROPHARYNX extends from the uvula to the epiglottis

A. Palatine Tonsil is located in the lateral walls near the border of the oral
cavity and the oropharynx.
B. Lingual Tonsil is located on the surface of the posterior part of the tongue.

66
 3. LARYNGOPHARYNX passes posterior to the larynx and extends from the tip
of the epiglottis to the esophagus. It is lined with moist stratified squamous
epithelium. Food and drink pass through the laryngopharynx to the
esophagus. A tiny amount of air may be swallowed with food and liquids,
despite the fact that most air flows from the laryngopharynx into the larynx.

LARYNX
Larynx (voicebox) is located in the anterior part of the laryngopharynx and extends
from the base of the tongue to the trachea. It must remain open and be strongly
constructed because it is a passageway for air between the pharynx and the trachea.
Larynx has 3 unpaired cartilages and 6 paired cartilages.

4 FUNCTIONS OF LARYNX
1. The rigid nature of the thyroid and cricoid cartilages maintains an open
passageway for air movement.
2. The larynx prevents swallowed materials from entering the lower respiratory
tract and regulates the passage of air into and out of the lower respiratory
tract.
3. The vocal folds are the primary source of sound production.
4. The pseudostratified ciliated columnar epithelium lining the larynx produces
mucus, which traps debris in air. The cilia move the mucus and debris into the
pharynx.

3 UNPAIRED CARTILAGES
1. THYROID CARTILAGE (shield; refers to the shape of the cartilage; Adam’s
apple) is the largest cartilage.
2. CRICOID CARTILAGE (ring-shaped) is the base of the larynx and most
inferior cartilage of the larynx. The other cartilages rest upon the cricoid
cartilage.
3. EPIGLOTTIS (on the glottis) is the third single cartilage and id attached to the
thyroid cartilage and projects superiorly as a free flap toward the tongue. It
consists of elastic cartilage rather than hyaline cartilage.

6 PAIRED CARTILAGES
1. ARYTENOID CARTILAGES (ladle-shaped) are located in the superior part of
cricoid cartilage.
2. CORNICULATE CARTILAGES (horn-shaped) are attached to the superior
tips of the arytenoid cartilages.
3. CUNEIFORM CARTILAGES (wedge-shaped) are in anterior to the
corniculate cartilages.
4. VESTIBULAR FOLDS (false vocal cords) are superior ligaments covered by
a mucous membrane.
5. VOCAL FOLDS (true vocal cords) are inferior ligaments covered by a mucous
membrane.

67
 6. GLOTTIS is the combination of the vocal folds and the opening between
them.
The vestibular folds and the vocal folds are lined with stratified squamous epithelium.
The remainder of the larynx is lined with pseudostratified ciliated columnar
epithelium.

TRACHEA
The Trachea (windpipe) allows air to flow into the lungs. It is a membranous tube
attached to the larynx. It is made up of smooth muscle and regular, dense connective

68
tissue. 15-20 C-shaped segments of hyaline cartilage support the anterior and
lateral sides of trachea to protect the trachea and maintain an open passageway for
air.

Trachealis muscle contains an elastic ligamentous membrane and bundles of

smooth muscle. Contraction of this smooth muscle can narrow the diameter of the
trachea, which aids in coughing. Air moves more quickly and powerfully through the
trachea when it is narrower, which aids in coughing up mucus and foreign things.

Membrane’s goblet cells produce mucus, which traps inhaled dust, bacteria, and
other foreign substances. The ciliated epithelium moves the mucus and foreign
matter into the larynx. From the larynx, the foreign matter enters the pharynx and is
swallowed. The trachea has an inside diameter of 12 mm and a length of 10–12 cm,
descending from the larynx to the level of the fifth thoracic vertebra.

MAIN BRONCHI (Primary bronchi)

Carina is a tracheal cartilage separating the openings into the main bronchi that
forms a ridge. It is an important landmark for reading x-rays. The mucous membrane
of the carina is very sensitive to mechanical stimulation. If foreign substance is
inhaled to the level of the carina, it stimulates a powerful cough reflex. Materials in
the air passageways beyond the carina do not usually stimulate a cough reflex.

Tracheobronchial Tree
It includes the trachea and the other lungs' respiratory passages. The left and right
bronchus, which are formed by the trachea's division, further split into smaller and
smaller bronchi. The tracheobronchial tree consists of several microscopic tubes
and sacs. The right main bronchus is larger in diameter and more directly in line
with the trachea than the left main bronchus. Because of this, ingested objects that
accidentally enter the lower respiratory system have a higher chance of being stuck
in the right main bronchus.

The main bronchi within each lung separate into lobar bronchi (secondary bronchi).
The left lung has two lobar bronchi, while the right lung has three lobar bronchi. The
lobar bronchi give rise to segmental bronchi (tertiary bronchi). The bronchioles are
continued branches of bronchi, which are less than 1 mm in diameter. The
bronchioles also subdivide several times to become even smaller terminal
bronchioles.

ALVEOLI
Once gas exchange between inspired air and blood is possible, the respiratory zone
begins. Alveoli (hollow cavities) are small, air-filled chambers where the air and the
blood come into close contact with each other. Terminal bronchioles divide to form
respiratory bronchioles, which have a few attached alveoli. The respiratory
bronchioles give rise to alveolar ducts, which are like long, branching hallways with

69
many open doorways. The alveolar ducts end as two or three alveolar sacs, which
are chambers connected to two or more alveoli.

RESPIRATORY MEMBRANE OF THE LUNGS

It is where the gas exchange takes place. It is formed mainly by the alveolar walls
and surrounding pulmonary capillaries. The respiratory membrane is too thin to
facilitate diffusion of gases. It consists of 6 layers:
1. A thin layer of alveolar fluid
2. The alveolar epithelium, which is a single layer of simple squamous
epithelium
3. The basement membrane of the alveolar epithelium
4. A thin interstitial space
5. The basement membrane of the capillary endothelium
6. The capillary endothelium, which is a single layer of simple squamous
epithelium

LUNGS
● Main organs of respiration. If base on volume, the lungs are the largest
organs in the body
● It is conical in shape. Its base is resting on the diaphragm and its apex
extending to a point approximately 2.5 cm superior to the clavicle.
● Hilium is a region on the media surface where main bronchus, blood vessels,
nerves, and lymphatic vessels enter or exit the lung. All these structures are
referred to as root of the lung.
● The lung lobes are separated by deep, prominent fissures on the surface of
the lung and are supplied by a lobar bronchus. The lung lobes are subdivided
into bronchopulmonary segments, each is supplied by the segmental bronchi.

70
 The bronchopulmonary segments are even further subdivided into lobules by
partial walls of connective tissue. The bronchioles supply the lobules.
● Right lung – larger and weighs an average of 620g
- Has 3 lobes
- Has 10 bronchopulmonary segments
● Left lung – weighs an average of 560g
- Has 2 lobes
- Cardiac notch – an indentation that allows the heart to lie between the
lungs
- Has 9 bronchopulmonary segments

Thoracic Wall and Muscles of Respiration

● Thoracic Wall – consists of thoracic vertebrae, ribs, costal cartilages,
sternum and associated muscles.
● Thoracic cavity – a space enclosed by the thoracic wall
● Diaphragm – partition; dome-shaped; a sheet of skeletal muscle separating
the thoracic cavity from the abdominal cavity.

71
● Ventilation is carried out by the diaphragm and other skeletal muscles
connected to the thoracic wall.
● Muscles of inspiration – the downward movement of the diaphragm during
contraction is responsible for increased thoracic volume during inspiration.
● Muscles of expiration – decrease the thoracic volume by depressing the ribs
and sternum.
● Internal intercostals and transverse thoracis – most active during
expiration
● External intercostals – most active during inspiration
● The primary function of these muscles is to stiffen the thoracic wall by
contracting at the same time. They prevent the thoracic cage from collapsing
inward during inspiration.

PLEURA
● Pleural Cavity – is formed by the pleural serous membrane that surround the
lungs and provide protection against friction
● Mediastinum – a central region that separates the two pleural cavities. It
houses the heart, trachea, esophagus and other structures such as blood
vessels and the thymus.
● Parietal pleura – covers the inner thoracic wall, superior surface of the
diaphragm and the mediastinum
● Visceral pleura – covers the surface of the lung

2 Functions of Pleural Fluid

1. It acts as a lubricant, allowing the parietal and visceral pleural membranes to
slide past each other during ventilation.
2. It causes the parietal pleura to cling to the visceral pleural around the lungs.

72
LYMPHATIC SUPPLY
2 LYMPHATIC SUPPLIES
1. Superficial lymphatic vessels - deep to the visceral pleura. They drain
lymph from the superficial lung tissue and the visceral pleura.
2. Deep lymphatic vessels - follow the bronchi. They drain lymph from the
bronchi and associated connective tissues.
***No lymphatic vessels are located in the walls of the alveoli. Both the superficial
and deep lymphatic vessels exit the lung at the hilum.
***Phagocytic cells within the lungs phagocytize carbon particles and other debris
from inspired air and move them to the lymphatic vessels. In an older person,
especially one who smokes or has lived most of his or her life in a city with air
pollution, these particles accumulate and cause the surface of the lungs to become
gray or black. In addition, cancer cells from the lungs can sometimes spread to
other parts of the body through the lymphatic vessels.

VENTILATION
Pressure Differences and Airflow
● Ventilation (breathing) is the movement of air into and out of the lungs.
● Air moves from an area of higher pressure to an area of lower pressure.

Pressure and Volume

● Pressure is inversely related to volume.

Airflow Into and Out of Alveoli

● Inspiration results when barometric air pressure is greater than intra alveolar
pressure.
● Expiration results when barometric air pressure is less than intra alveolar
pressure.

Changing Alveolar Volume

1. Lung recoil causes alveoli to collapse.

73
 ● Lung recoil results from elastic fibers and water surface tension.
● Surfactant reduces water surface tension.
2. Pleural pressure is the pressure in the pleural cavity.
● A negative pleural pressure can cause the alveoli to expand.
● Pneumothorax is an opening between the pleural cavity and the air that
causes a loss of pleural pressure.
3. Changes in thoracic volume cause changes in pleural pressure, resulting in
changes in alveolar volume, intra-alveolar pressure, and airflow.

MEASUREMENT OF LUNG FUNCTION

Compliance of the Lungs and Thorax

● Compliance is a measure of lung expansion caused by intra-alveolar
pressure.
● Reduced compliance means that it is more difficult than normal to expand
the lungs.

Pulmonary Volumes and Capacities

● Four pulmonary volumes exist: tidal volume, inspiratory reserve volume,
expiratory reserve volume, and residual volume.

74
 ● Pulmonary capacities are the sum of two or more pulmonary volumes and
include inspiratory capacity, functional residual capacity, vital capacity, and
total lung capacity.
● The forced expiratory vital capacity measures vital capacity while the
individual exhales as rapidly as possible.

Minute Volume and Alveolar Ventilation

● Minute volume is the total amount of air moved into and out of the respiratory
system per minute.
● Dead space is the part of the respiratory system where gas exchange does
not take place.
● Alveolar ventilation is how much air per minute enters the parts of the
respiratory system where gas exchange takes place.

PHYSICAL PRINCIPLES OF GAS EXCHANGE

Partial Pressure
● Partial pressure is the contribution of a gas to the total pressure of a mixture
of gases (Dalton’s law).
● Water vapor pressure is the partial pressure produced by water.
● Atmospheric air, alveolar air, and expired air have different compositions.

Diffusion of Gases Into and Out of Liquids

● The concentration of a dissolved gas in a liquid is determined by its pressure
and by its solubility coefficient (Henry’s law).

Diffusion of Gases Through the Respiratory Membrane

● The respiratory membrane is thin and has a large surface area that
facilitates gas exchange.
● The rate of diffusion of gases through the respiratory membrane depends on
its thickness, the diffusion coefficient of the gas, the surface area of the
membrane, and the partial pressure of the gases in the alveoli and the blood.

Relationship Between Alveolar Ventilation and Pulmonary Capillary Perfusion

● Increased alveolar ventilation or increased pulmonary capillary perfusion
increases gas exchange.
● The physiological shunt is the deoxygenated blood returning from the lungs.

75
VII. PATHOPHYSIOLOGY

76
77
78
79
80
VIII. NURSING CARE PLAN
A. Prioritization

Nursing Diagnoses Priority Rationale

ACTUAL PROBLEMS

Ineffective airway clearance related to 1 Based on our case study, the patient has
excessive accumulation of secretions (High Priority) pneumonia, which can cause airway
secondary to activation of goblet cells as obstruction due to increased sputum
manifested by thick yellow green sputum production, and changes in gas
and productive cough. exchange, making breathing difficult for
the patient, ranking high on the nursing
Ineffective breathing pattern related to 2 priority list.
alteration of oxygen and carbon dioxide (High Priority)
as evidenced by infiltrates seen on chest According to Maslow's hierarchy of
x-ray, presence of crackles, productive needs, the Airway, Breathing, and
cough, and thick yellow green sputum. Circulation (ABC) rule states that the
airway should be prioritized first because
Impaired gas exchange related to 3 it will provide the client with a patent
ventilation perfusion inequality as (High Priority) airway. Every part of the body needs
evidenced by verbal report of shortness oxygen to function properly. If an
of breath, and hypercapnia. individual's oxygenation fails, their overall
functioning may suffer.

Risk for aspiration related to increased 4 The patient's body produces mucus, also
production of sputum in the airway as (High Priority) known as phlegm or sputum, to protect
manifested by thick yellow green sputum sensitive tissues in the airways. Changes
production, and crackles. in the color, thickness, or quantity of
phlegm indicated a health problem, such
as a respiratory infection and lung

81
 disease.

According to Maegan Wagner (2022),

aspiration can be dangerous if it is not
promptly treated and diagnosed since it
causes choking, respiratory issues,
infections, and other problems. The first
step is prevention. The nurse should
identify risk factors before administering
medication or giving patients food, and
she should put aspiration safeguards in
place for patients who have trouble
swallowing.

Risk for infection related to inadequate 5 These patients have insufficient

primary defences as evidenced by (High Priority) protection against harmful organisms,
increased WBC and neutrophil count. thus nursing care and actions to give
further protection and infection
prevention must be planned.

According to Shelly Caruso (2021),

patients with weakened immune systems
or natural defenses are more susceptible
to infection.

Risk for fall related to impaired hearing 6 Fall puts a person at risk for serious
as evidenced by verbal reports of (High Priority) injury and reduces their ability to remain
problems in ringing sensation on ears independent.

According to the Centers for Disease

Control and Prevention (CDC), falls are

82
 the leading cause of death among adults
65 and older, causing over 34,000 deaths
for that age group.

Risk for deficient fluid volume related to 7 According to the patient's daughter, the
decreased oral intake as evidenced by (High Priority) E.O.E. seldomly drinks water and she
verbal reports of poor water intake if not has to be reminded to drink water to stay
encouraged by the relative to drink water. hydrated.

As stated by Gil Wayne (2022), fluid

volume deficit, also known as
hypovolemia, is a state or condition in
which fluid output exceeds fluid intake.
When the body loses both water and
electrolytes, this happens. Appropriate
management is critical in preventing
life-threatening hypovolemic shock. Fluid
imbalances are more common in older
patients. As a result, it is one of the
potential nursing problems to consider in
one of the nursing priorities. If it is not
treated hypovolemic shock can result in
ischemia injury to vital organs, which
could result in multi-system organ failure
and death. Thus, hydration is crucial for
the patient and must be one of the
priorities.

Risk for activity intolerance related to 8 Since the patient is in complete bed rest
impaired tissue perfusion as evidenced (High Priority) without bathroom privilege she will have
by verbal reports of weakness and to stay in her bed with the use of a
fatigue. diaper for urine elimination and stool.

83
 Recovery frequently involves a lot of bed
rest. The body quickest method of
removing particles from the lungs is
through this method.

According to Hinkle, J. L., and Cheever,

K. H. (from Brunner and Suddarth's
Textbook of Medical-Surgical Nursing).
Activity intolerance is defined as a lack of
physiological or psychological energy to
carry out necessary or desirable daily
tasks. Activity intolerance is caused by a
variety of factors, including respiratory
diseases that can cause an imbalance
between oxygen supply and demand,
such as pneumonia. That is why one of
the goals of activity intolerance is to
identify the factors that aggravate
decreased tolerance to activity and to
reduce activity intolerance in order to
conserve energy.

Risk for imbalanced nutrition: Less than 9 The patient verbalized that she lacks
body requirements related to lack of (High Priority) appetite due to her continuous coughing
appetite and taste of phlegm every time she tried
to spit it out.

According to Hinkle, J. L., and Cheever,

K. H. (from Brunner and Suddarth's
Textbook of Medical-Surgical Nursing). A
patient suffering from pneumonia may be
at risk of nutritional imbalance. Because

84
 of the odor and taste of sputum, certain
aerosol treatments, abdominal
distension, and other factors, they may
experience a lack of appetite or
nutritional imbalance. Risk for
imbalanced nutrition: less than body
requirement is a life-threatening
condition. Nutrition should always be
monitored and strictly followed; a patient
with pneumonia is at high risk for
malnutrition.

Disturbed sleeping pattern related to 10 The patient stated she cannot sleep well
exhaustion associated with interruption in (Medium Priority) due to the discomfort of a productive
usual sleep pattern as evidenced by cough.
verbal reports of discomfort, and
productive cough. According to Lee and Birring's (2010)
study, patients with coughs frequently
experience disturbed sleep, which is
often the cause of their discomfort.
Verbal complaints of feeling unwell or
restlessness, irritability, and altered
mental status may occur.

Acute pain related to inflammation of the 11 Acute pain is defined as an unpleasant

lung parenchyma as evidenced by verbal (Medium Priority) emotional and sensory experience. It is
reports of chest pain on a pain scale of most commonly connected with tissue
7/10, persistent coughing, irritability, damage in the body and may appear
increased heart rate (107 bpm) and blood gradually or suddenly.
pressure (130/90).
According to Hinkle, J. L., and Cheever,
K. H. (from Brunner and Suddarth's

85
 Textbook of Medical-Surgical Nursing). A
patient suffering from pneumonia may
experience acute pain as a result of
increased sputum production and
frequent coughing. This persistent
coughing can be painful, and common
contributing factors include inflammation
of the lung parenchyma, cellular
reactions to circulating toxins, and
persistent coughing.

Deficient knowledge related to health 12 Due to unhealthy eating habits, the

maintenance and the potential (Medium Priority) patient may aggravate the condition of
consequences of unhealthy eating habits pneumonia since she already has a
or behaviors as evidenced by verbal weakened immune system and the
reports of inability to comply with potential to delay recovery from
treatment plans, and failure to improve. respiratory infectious diseases and
develop other diseases.

According to the American Lung

Association, good health habits such as
a healthy diet, regular exercise, and so
on reduce the possibility of becoming ill
with viruses and respiratory illnesses. It
is critical to be aware of your overall
health.

Deficient knowledge related to condition 13 E.O.E. verbalized that she just has hard
and treatments as evidenced by verbal (Medium Priority) time breathing right after tasting adobo
reports of statements of misconception, meal she cooked and questioned the
requesting for information, and confusion. purpose of taking medicines. The patient
mentioned knew only little about her

86
 health condition and purpose of
medications she is taking.

According to Dorothea Orem's Self-Care

Theory, the goal of nursing was to make
the patient capable of meeting self-care
needs, a process that frequently included
patient teaching. However, many factors
influence patient education, including
age, cognitive level, developmental
stage, physical limitations, the primary
disease process and comorbidities, and
sociocultural factors. Knowledge has a
significant impact on a patient's life and
recovery. It is one of the nurses'
responsibilities to decide with the patient
what to teach, when to teach, and how to
teach certain health issues and
concerns. In patient E.O.E., providing
knowledge about her condition and
treatments as evidenced by verbal
reports of statements of misconception,
requests for information, and confusion is
one of the top but not the least followed
nursing priorities.

Readiness for Enhanced Knowledge 14 The patient expressed a desire to

related to health as evidenced by verbal (Medium Priority) improve her knowledge of health or
reports of a desire to learn. well-being, which is a good sign in the
midst of a disease or problem.

Our desire to want more, according to

87
 Annie Lennon (author; writer at medical
news today), serves an important
purpose. Our desires give us a clear idea
of what we want to achieve or if we have
a goal in mind. Our desires provide us
with hope, inspiration, and energy to
accomplish the things we really want.

Readiness for Enhanced Nutrition related 15 The patient stated a desire to improve
to health as evidenced by verbal reports (Medium Priority) and correct her eating habits. The patient
of a desire to change eating habits. is eager to change her unhealthy eating
habits because she understands the
benefits of this lifestyle change. Adopting
new, healthier habits may protect you
from serious health problems.

According to the National Institute of

Diabetes and Digestive and Kidney
Diseases. New habits, such as healthy
eating and regular physical activity, may
also help you manage your weight and
have more energy.

88
 B. Nursing Care Plan

Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

Subjective Ineffective airway Short term: Independent: Independent: Short term:

“Nahihirapan ako clearance related to After 8 hours of Goal was met, after
ng hinga, siguro excessive nursing 1. Elevated the 1. By doing this, the8 hours of nursing
dahil sa hindi ko accumulation of interventions, the head of the bed diaphragm would interventions, the
mailabas ng secretions patient will and changed be lowered, which patient was able to
maayos plema ko..” secondary to participate in positions would encourage participate in
as verbalized by activation of goblet activities/actions to frequently. chest expansion, activities/actions to
the patient. cells as manifested improve or achieve oxygenation of the improve or achieve
by thick yellow airway clearance. lung segments, airway clearance.
Objective: green sputum and mobilization, and
● Cough; productive cough. expectoration of
Thick yellow Long term: secretions. Long term:
green After 3 days of Goal was met, after
sputum nursing 2. Instructed and 2. Deep breathing 3 days of nursing
● Dyspnea interventions, the assisted in proper exercises facilitate interventions, the
● + Crackles patient will have a deep breathing the maximum patient was able to
patent airway with exercises. Proper expansion of the have a patent
clear breath chest splinting and lungs and smaller airway with clear
sounds, no effective coughing airways and breath sounds, no
dyspnea, and while upright were improve the dyspnea, and
demonstrate demonstrated. productivity of demonstrate
effective secretion Encouraged the cough. effective secretion
clearance. patient to do so - Coughing is a clearance.
regularly. reflex and a natural
self-cleaning
mechanism that

89
 assists the cilia in
maintaining patent
airways. It is the
most helpful way to
remove most
secretions.
- Splinting relieves
chest discomfort,
and an upright
position
encourages a
deeper and more
forceful cough,
making it more
effective.

3. Encouraged 3. Fluids help

adequate hydration reduce mucosal
by consuming at drying and increase
least 1 to 2 L of ciliary action to
fluid per day. move secretions.

4. Oral care was 4. After respiratory

provided at least 3 secretions have
times a day. been expectorated,
oral care cleans the
mouth.

90
Dependent: Dependent:

1. Administered 1. Aids in reduction

medication as of bronchospasm
prescribed: and mobilization of
mucolytics - secretions.
N-Acetyl Cysteine
(NAC)

2. Maintained 2. Supplemental
humidified oxygen oxygen may be
or oxygen as required to
prescribed. maintain PaO2 at
an acceptable level
or increasing the
humidity of the
inspired air will thin
secretions and aid
in their removal.

3. Performed 3. Helps improve

physiotherapy as deep breathing,
prescribed by prevent atelectasis,
doctor. helps loosen, and
mobilize secretions.

91
 Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

Subjective: Ineffective Short term: Independent: Independent: Short term:

“Medyo hirap ako breathing pattern After 8 hours of Goal was met, after
huminga” as related to nursing 1. Assessed and 1. Any change in 8 hours of nursing
verbalized by the alteration of intervention, the recorded breathing pattern intervention, the
patient. oxygen and patient will maintain respiratory rate and can help in the patient was able to
Objective: carbon dioxide as an effective depth every 3 detection of early maintain an
● ABG evidenced by breathing pattern, hours. signs of respiratory effective breathing
Analysis: infiltrates seen on as evidenced by compromise. pattern, as
Respiratory chest x-ray, relaxed breathing evidenced by
Acidosis presence of or absence of DOB. 2. Auscultated 2. To detect relaxed breathing
● Increased RR crackles, breath sounds. decreased or or absence of DOB.
- 24 cpm productive cough, adventitious breath
● Restlessness and thick yellow Long term: sounds.
● Infiltrates on green sputum. After 3 days of Long term:
Chest X-Ray nursing 3. Assisted the 3. These measures Goal was met, after
● +Crackles intervention, the patient into a encourage 3 days of nursing
● Cough;Thick patient’s respiratory comfortable maximum chest intervention, the
yellow green rate remains within position by expansion, patient’s respiratory
sputum the normal or elevating the head secretion rate was able to
● Difficulty of acceptable range. of the bed and mobilization, and remain within the
breathing encouraged ventilation normal or
frequent position improvement. acceptable range.
changes, deep
breathing, and
effective coughing.

92
Dependent: Dependent:
1. Administered 1. Supplemental
respiratory oxygen may be
medications (NAC, required to
Ceftriaxone) and maintain PaO2 at
oxygen as an acceptable level
prescribed by the and medications
doctors. relax airway
smooth muscles
and cause
bronchodilation to
widen air
passages; prevent
bacteria from
growing and
causing an
infection; will
provide relief to the
patient or help
expel it.

93
 Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

Subjective data: Impaired gas Short term: Independent: Independent: Short term:
“Ang bilis ko exchange related to After 8 hours of 1. Assessed 1. To detect any Goal was partially
mapagod at ventilation perfusion nursing respiratory status respiratory met, after 1 day of
nakakaramdam ako inequality as interventions, the including rate, problems. nursing
ng kabagalan sa pag evidenced by verbal patient will depth, oxygen interventions, the
hinga ko..” as report of shortness maintain clear saturation, ease of patient was able to
verbalized by the of breath, and lung fields and respirations, and maintain clear lung
patient. hypercapnia. remain free of auscultate breath fields and remain
signs of sounds every 2 free of signs of
Objective data: respiratory hours. respiratory distress
● ABG distress such as such as crackles
Analysis: crackles and 2. Instructed the 2. To eliminate any and dyspnea.
Respiratory dyspnea. patient on the knowledge deficit
Acidosis importance of or to correct any
pCO2: 49 oxygen therapy and misconceptions, Long term:
saO2: 90% Long term: other therapeutic and help in Goal was met, after
pH: 7.34 After 3 days of interventions for the managing the 3 days of nursing
pO2: 67 nursing management of condition. Because interventions, the
● Infiltrates on interventions, the Pneumonia. other therapeutic patient will
Chest X-Ray patient will techniques demonstrate
● + Crackles demonstrate promotes relaxation improved
● Cough;Thick improved or helps to ventilation and
yellow green ventilation and decrease adequate
sputum adequate respiratory oxygenation.
● Dyspnea oxygenation. compromise
● ↑ WBC (6-8)

94
● ↑ Neutrophil
count (H 0.70) Dependent: Dependent:
1. Administered 1. Supplemental
respiratory oxygen may be
medications (NAC, required to
Ceftriaxone) and maintain PaO2 at
oxygen as an acceptable level
prescribed by the and medications
doctors. relax airway
smooth muscles
and cause
bronchodilation to
widen air
passages; prevent
bacteria from
growing and
causing an
infection; will
provide relief to the
patient or help
expel it.

95
 Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

Subjective data: Risk for aspiration Short term: Independent: Independent: Short term:
“Pakiramdam ko related to increased After 5 hours of 1. Kept head of bed 1. Maintaining a Goal was met, after
mabubulunan ako production of nursing elevated when sitting position 5 hours of nursing
dahil sa kapal ng sputum in the intervention, the feeding and for at after meals may intervention, the
plema ko” as airway as patient will least a half hour help decrease patient was able to
verbalized by the manifested by thick understand the afterward aspiration understand the
patient. yellow green purpose of pneumonia. purpose of
sputum production, preventive preventive
and crackles. measures of measures of
Objective: aspiration 2. Provided oral 2. Oral care after aspiration.
● Productive cough; care before and eating removes
thick yellow green after meals residual food that
sputum Long term: could be Long term:
● (+) crackles After 3 days of aspirated at a Goal was met, after
nursing later time. 3 days of nursing
intervention, the intervention, the
patient will maintain 3. Supervised or 3. Supervision patient was able to
performing aid the patient with helps identify maintain
preventive oral intake abnormalities performing
measures of early and allows preventive
aspiration implementation measures of
of strategies for aspiration.
safe swallowing.
Withholding
fluids and foods
as needed
prevents
aspiration.

96
4. Advised the 4. Giving food to a
guardian of the patient that
patient that the only requires chewing
food that is allowed thoroughly can
is soft only. cause aspiration.

Dependent: Dependent:

1. Informed the 1. Early

physician instantly intervention
of noted decrease protects the
in cough/gag patient’s airway
reflexes or difficulty and prevents
in swallowing. aspiration.

2. Administered 2. Aids in reduction

medication as of bronchospasm
prescribed: and mobilization of
mucolytics - secretions.
N-Acetyl Cysteine
(NAC)

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 Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

Subjective: Risk for infection Short term: Independent: Independent: Short term:
The patient related to After 8 hours of 1. Demonstrated 1. Handwashing is Goal was met, after
verbalized “Hindi ako inadequate nursing and encouraged the single most 8 hours of nursing
pala-kain ng gulay o primary defences interventions, the good handwashing effective way to intervention, the
prutas, mahilig ako as evidenced by patient will techniques. prevent infection. patient was able to
sa karne o increased WBC participate in Effective means of participate in
matatamis. Kaya and neutrophil activities to reduce reducing spread or activities to reduce
siguro lapitin ako ng count. the risk of infection. acquisition of the risk of infection.
sakit bukod sa infection.
matanda nako…”
2. Limit visitors as 2. Reduces the
Objectives: Long term: indicated. likelihood of Long term:
● age > 60 After 2 days of exposure to other After 2 days of
● ↑ WBC (6-8) nursing infectious nursing
● ↑ Neutrophil intervention, the pathogens. intervention, the
count (H 0.70) patient will identify goal was met. As
● ↑ FBS (6.50) interventions to 3. Encouraged 3. Facilitates the evidenced by the
● ↑ Cholesterol reduce risk of the adequate rest healing process patient’s ability to
(5.39) disease. balanced with and enhances enumerate the
moderate activity. natural resistance. interventions to
Promote adequate reduce risk of the
nutritional intake. disease.

Interdependent: Interdependent:
1. Referred to a 1. Nutritional
dietitian for support may also
counselling specific help the body's
to individual dietary ability to heal and
customs. regenerate tissues.

98
 Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

Subjective: Risk for falls related Short term: Independent: Independent: Short term:
“Minsan mayroon to impaired hearing After 8 hours of 1. Assessed the 1. A patient who is Goal was met, after
yung time na as evidenced by nursing patient's unfamiliar with 8 hours of nursing
nasakit yung tenga verbal reports of interventions, the environment. the placement of interventions, the
ko tapos ayun dun problems in ringing patient risk for falls furniture in an patient and her
na ako parang sensation on ears would be lessened. area or who has family were able to
nahihilo. Ayun insufficient enumerate
vive-vertigo ako lighting in the important strategies
nahirapan ako house is more to lessened the
gumalaw likely to fall. patient’s risk from
pagganun” as falls.
verbalized by the 2. Encouraged the 2. Keeps the
patient patient's family patient from Goal was met, after
to never leave slipping or falling 8 hours of nursing
their side. out by mistake. interventions, the
Objective: patient and her
● Dizziness 3. Used side rails 3. Raising the side family made an
● Vertigo on the bed. rails decreases effort to used fall
● Loss of the risk of prevention
balance patients falling methods.
out of bed.

4. Kept the 4. Keeping the bed

patient's bed at a closer to the floor
low position. reduces the
chance of injury
and falls.

99
Long term: 5. Advised the 5. Slips and falls Long term:
After 2 days of patient to walk in can be avoided Goal was met, after
nursing non-slip footwear by using non-slip 2 days of nursing
interventions: such as shoes or footwear. interventions, the
slippers. patient and her
- The patient will be family were able to
free from the risk 6. Introduced the 6. Rearranging the discussed and
of falls. patient to their room's demonstrated
surroundings. furnishings is improve ways for
- The patient and best avoided. the patient safety
her family will put The patient and avoid falls.
in preventive should be made
measures to aware of any
improve safety potential
and avoid falls. environmental
. dangers that
might cause her
to slip or fall.

7. Ensured 7. Well-lighting in
adequate lighting the room may
in the patient's help people
room. move about
safely and avoid
obstructions.

8. Informed that the 8. Patients should

patient and refrain from
family is more carrying several
susceptible to items since they

100
 falling if they are may increase the
occupied with risk of future
anything else. falls.

9. Discussed the 9. Vitamin D

benefits of taking supplements,
vitamin D especially
supplements. among older
adults, reduce
vertigo
recurrence which
lessens the risk
of falls and injury
for older adults.

Interdependent: Interdependent:
1. Referred the 1. The patient and
patient to an ear her family should
specialist. know if she
requires medical
attention and treat
if she has any
underlying ear
condition
associated with her
impaired
imbalance. This
helps in assuring
that the patients
receive the care
she needs.

101
 Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

Subjective data: Risk for deficient Short term: Independent: Short term:
As verbalized by fluid volume related After 5 hours of 1. Observed 1. If the patient Goal was met after
the patient “Konti to decreased oral nursing and document is dehydrated, 5 hours of nursing
lang ako uminom intake as intervention, the vital signs. vital signs intervention, the
ng tubig… kung di evidenced by patient will show including patient will show
pa nila ako pipilitin verbal reports of less signs of tachycardia and less signs of
o papa alahanan poor water intake if dehydration. hypotension may dehydration.
na uminom hindi ko not encouraged by be abnormal.
pa maaalala…” as the relative to drink Long term: Long term:
verbalized by the water. After 3 days of 2. Checked for 2. The skin Goal was met, after
patient. nursing symptoms of should be 3 days of nursing
intervention, the dehydration assessed since intervention:
patient and her through skin dehydration may
family will be able turgor. cause a loss of - The patient has
to: skin elasticity. enough fluid
- The patient's volume and
exhibited no signs 3. Analyzed the 3. This is electrolyte
or symptoms of patient's history of essential to balance as shown
dehydration. fluid consumption confirm whether by urine output
- The patient and and excretion the patient is more than 30
family will know habits. under a fluid mi/hr, heart rate
preventive restraint. (HR) of 100
measures for the beats/min, and
patient to lessen 4. Offered oral 4. This normal skin
the risk of care to the encourages turgor.
dehydration. patient. drinking interest.

102
5. Encouraged 5. Considering - The patient and
the patient to the patient's her family
drink the choice when it mentioned at
recommended comes to her least 3
amount of fluids drink would make appropriate
while also her encourage coping
considering the drinking fluids. mechanisms as
patient's preferred well as methods
drinks. in improving fluid
imbalance
6. Advised the 6. Food with
patient to high fluid content
consume foods can help the
high in fluids such patient for
as watermelon or hydration.
strawberries.

7. Explained 7. This will help

the factors that them appreciate
lead to decreased the purpose and
fluid intake or fluid expected
loss. outcome of the
adherence for
deficient fluid
management.

8. Ensured 8. Accurate records

accurate intake are critical in
and output assessing the
monitoring patient’s fluid
intake.

103
Dependent: Dependent:
1. Provided 1. Dehydration can
electrolyte cause abnormal
replacement as electrolyte
ordered by the imbalances as a
physician. result the nurse
must continuously
monitor and offer
fluid replacement
as needed.

Interdependent: Interdependent:
1. Referred the 1. Referring the
patient to a home patient from
health nurse. someone who can
take care of her at
home to monitor
her health.

104
 Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

Subjective: Risk for activity Short term: Independent: Independent: Short term: Goal
“Medyo nanhihina intolerance related After 8 hours of 1. Noted client 1. Symptoms may Goal was met, after
ako nahihirapan to impaired tissue nursing reports of be a result of or 8 hours of nursing
akong gumalaw” as perfusion as interventions, the weakness, fatigue, contribute to interventions, the
verbalized by the evidenced by patient will be able pain, difficulty intolerance of patient was able to
patient. verbal reports of to do some accomplishing activity. do some self-care
weakness and self-care activities tasks. activities or
Objective: fatigue. or activities of daily activities of daily
● Weak looking living. 2. Assessed the 2. To determine living.
● Fatigue client’s ability to current status and
● Difficulty of Longterm: stand and move needs associated Longterm:
breathing After 2 days of and the degree of with participation in Goal was met, after
● ↑ RR - 24 effective nursing assistance needed/desired 2 days of effective
cpm interventions, the necessary or use of activities. nursing
● ↑ HR - 107 patient will be able equipment. interventions, the
bpm to maintain activity patient was able to
level within 3. Instructed the 3. To prevent maintain activity
capabilities as client to reduce any overexertion level within
evidenced by intense activities capabilities as
normal vital signs evidenced by
during activity, as 4. Instructed for 4. To conserve normal vital signs
well as absence of maximal activity energy and during activity, as
weakness or within the client’s promote safety well as absence of
difficulty ability. weakness or
accomplishing difficulty
tasks. accomplishing
tasks.

105
 Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

Subjective: Risk for Short term: Independent: Independent: Short term:

imbalanced
‘’Konti na lang ako nutrition: Less After 8 hours of 1. Kept the head of 1. Maintaining a Goal was met,
kumain, nawawalan than body nursing the bed elevated sitting position after 8 hours of
kasi ako ng gana requirements interventions, when feeding and after meals may nursing
kumain, sabay dahil related to lack of the patient will for at least a help decrease the intervention, the
ubo ako ng ubo para appetite understand the half-hour afterward risk of elderly patient was able to
ba naiiwan o importance of aspiration understand the
nalalasahan ko yung consuming at pneumonia in the importance of
plema ko.’ least 50% of the elderly. consuming the right
food provided. amount of food to
support adequate
Long term: 2. Assessed food
2. Providing food nutrition.
Objective: preferences and
to the patients will
After 3 days of dislikes;
promote sufficient Long term:
● Productive nursing appropriate food
intake.
cough; thick interventions, the were selected
After 3 days of
patient will be based on the
yellow-green nursing
able to patient’s condition.
intervention, the
sputum demonstrate the 3. Oral care cleans goal was met. As
selection of food 3. Provided oral
production care at least three the mouth after evidenced by the
to increase her respiratory patient’s
● Weak looking appetite. times a day.
secretions have demonstration of
been expectorated, meal selection that
and lessens the helps the patient
taste of any increase appetite.
residual sputum.

106
4.Encouraged 4. Fluid intake
adequate hydration minimize mucosal
by consuming at drying and
least 1 to 2 L of maximizes ciliary
fluid per day, if not action to move
contraindicated. secretions.

5. Provided a 5. Prevent the

covered container spread of infection
for sputum and by covering the
remove it at container, removing
frequent intervals. frequent intervals,
and the proper
disposal of sputum.

Interdependent: Interdependent:
1. Consulted a 1. A dietician is
dietician or knowledgeable
nutritionist to about the nutritional
coordinate food value of food.
recommendations
to maintain
nutrient count.
2. To increase
2. Encouraged the patient appetite
family to
accompany the
patient during
mealtime.

107
 Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

Subjective: Disturbed sleeping Short term: Independent: Short term:

“Grabe ako ay pattern related to After 8 hours of 1. Provided a quiet 1. Promotes rest Goal was met, after
nahihirapan na wala exhaustion nursing environment. and healing. 8 hours of nursing
pa ako maayos na associated with intervention, the intervention, the
tulog, inuubo ako, interruption in patient will 2. Provided comfort 2. This soothes and patient was able to
ang sakit ng dito ko usual sleep verbalize or report measures. relaxes the patient. verbalize or report
… kaya tuloy kapag pattern as relief, uninterrupted relief, uninterrupted
nag kikilos ako para evidenced by sleep pattern, and 3. Scheduled or 3. To promote rest sleep pattern, and
ba nanhihina ako..’’ verbal reports of absence of arranged the care and healing. absence of
as verbalized by the discomfort, and weakness and to provide weakness and
patient. productive cough. fatigue. uninterrupted fatigue.
sleep.
Objective: Long term: Long term:
● Discomfort After 2 days of 4. Instructed the 4. This inhibits Goal was met, after
● Productive nursing patient to limit or sleep. 2 days of nursing
cough; Thick intervention, the avoid intake of intervention, the
yellow green patient will caffeine and patient was able to
sputum demonstrate an chocolate prior to demonstrate an
● Restlessness improved rest and sleep. improved rest and
● Weakness sleep patterns. sleep patterns.
5. Instructed the 5. To avoid the
patient to avoid need for voiding
large fluid intake during the night.
before bedtime.

108
 Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

Subjective: Acute pain related Short term: Independent: Independent: Short term:
“Sumasakit ang to inflammation of After 8 hours of 1. Provided comfort 1. Goal was met after
dibdib ko sa tuwing the lung nursing measures: back Non-pharmacologic 8 hours of nursing
humihinga at parenchyma as interventions, the rubs, position al pain intervention, the
umuubo ako” as evidenced by patient willchanges, quiet management can patient was able to
verbalized by the verbal reports of verbalize relief from music, massage. lessen discomfort. verbalized relief
patient. chest pain on a pain. Encouraged the Patient involvement from pain.
pain scale of 7/10, use of relaxation in pain control
Objective: persistent Long term: and /or breathing measures Long term:
● Chest pain: coughing, irritability, After 2 days of exercises. promotes Goal was met, after
Pain Scale - increased heart nursing independence and 2 days of nursing
7/10 rate (107 bpm) and interventions, the enhances the intervention, the
● Persistent blood pressure patient will sense of patient was able
coughing; (130/90). demonstrate a well-being. demonstrate a
Thick yellow relaxed manner, relaxed manner,
green sleep/rest and 2. Determined pain 2. To assess any sleep/rest and
sputum engage in activity. characteristics such changes, character, engage in activity.
● Irritability as sharp, constant, location, and
● Increased and stabbing. intensity of pain.
heart rate:
107 bpm 3. Encouraged the 3. Fluids especially
● Increased patient to drink warm liquids aid in
BP: 130/90 warm, rather than mobilization and
cold fluids. expectoration of
secretions.

4. Demonstrated 4. Coughing is a
and helped the natural self

109
patient to perform cleaning
activity like splinting mechanism.
chest and effective Splinting reduces
coughing while in chest discomfort,
upright position. and an upright
position favors
deeper, more
forceful cough
effort.

Dependent: Dependent:
1. Administered 1. Aids in reduction
medication as of bronchospasm
prescribed: and mobilization of
mucolytics - secretions.
N-Acetyl Cysteine
(NAC)

110
 Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

Subjective: Deficient Short term: Independent: Independent: Short term:

knowledge related Goal was met,
“Eh kasi alam mo to health After 6 hours of 1. Determined the 1. Remember that after 6 hours of
kung magluto ang maintenance and nursing learner, whether respect is crucially nursing
mga tao sa bahay… the potential intervention, the the patient or the important when intervention, the
Adobo, nilaga. Ang consequences of client and her family. educating patients patient and her
nilaga pa puro taba. unhealthy eating family will be able or families that family were able to
Yun ang madalas habits or to understand have various understand the
naming kainin. behaviors as information values and beliefs importance of
Sobrang mahilig ako evidenced by regarding about health and consuming the
doon. Kaya siguro verbal reports of consuming healthy illness. healthy food to
parang nagkaroon inability to comply foods improve patient
ako ng mga sakit with treatment 2. Diet change is a health
2.Encouraged complicated
sakit na kasi plans, and failure appropriate food process that
hanggang ngayon to improve.
Long term: consumption for involves changing Long term:
kahit bawal hala
body type and patterns that have After 7 days of
sige… kain parin
ako..” After 7 days of lifestyle; a soft, been firmly nursing
nursing low-sodium, and fat established by intervention, the
Objectives: interventions, the diet culture, family, and goal was met. As
patient and her personal factors. evidenced by the
● ↑ FBS(6.50) family will be able The patient's patient and family
● ↑ Cholesterol to demonstrate a condition requires a demonstration of a
(5.39) selection of healthy soft, low-sodium, plan and meal
● Uric Acid food to improve and low-fat diet. that helps the
(416.25) health. patient to change
appetite, and
improve health.

111
3. Encouraged the 3. Memory is
patient or the inadequate for
patient’s family to quantification of
keep a daily log of intake, and a visual
food or liquid record may also
ingestion and help the patient in
caloric intake. selecting foods and
serving sizes that
are more
appropriate.

Interdependent: Interdependent:

1.Consulted a 1. Dieticians
dietician or provide specialized
nutritionist to care that takes into
improve nutrient account each
count and lifestyle patient's unique
for optimum health dietary needs and
outcomes. preferences.

2. Encouraged 2. Success rates

family, in nutrition are higher when
counseling. the family
incorporates a
healthy eating plan

112
 Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

Subjective data: Deficient Short term: Independent: Independent: Short term:

As verbalized by knowledge related After 1 hour of 1. Established 1. To gain client’s Goal was met after
the patient “Hindi to condition and nursing rapport and cooperation; the 1 hour of nursing
ko alam na may treatments as intervention, the provided a quiet patient and the intervention. The
pneumonia ako, evidenced by client and her environment. family can focus patient and her
ang alam ko lang verbal reports of family will be able and concentrate family were able to
nahirapan ako statements of to understand better or absorb determine the at
huminga at ubo ako misconception, information the information if least 1 reason
ng ubo pag tapos requesting for regarding her the environment behind her
ko mag luto nun” as information, and health condition is quiet. acquiring
verbalized by the confusion. and course of her pneumonia and the
patient. follow-through of 2. Created a 2. When educating purpose of some of
therapy instructions respectful, patients or her medication
As “..Para san ba honest, reliable, families who have regimen as
itong gamot na to?” Long term: and cooperative diverse values evidenced by they
hindi ko alam bakit After 3 days of environment. and beliefs about are already capable
may antibiotic nursing health and illness, of explaining at
(while intervention, the keep in mind that least 1 of the
administering the patient and her showing respect reason for her
medicine). family will be able is extremely getting pneumonia
to: crucial. and discuss the
Objective: - Discuss the purpose of the
● Confused reason why the 3. Determined the 3. Other patients, patient from taking
● Asking for patient have learner whether especially older antibiotics.
question pneumonia the patient or the ones, refuse to
- Enumerate the family. participate in the
purpose of each teaching process
medications the because they see
patient is taking themselves as

113
 dependent on Long term:
their caregiver. Goal was met, after
3 days of nursing
4. Identified the 4. Learning intervention. The
patient's and the demands effort. patient and her
family motivation Patients must see family were able to
and openness to a need or goal for determine the
learning. their learning. reason behind her
acquiring
5. Take into account 5. Knowledge pneumonia and the
the patient's retention will be purpose of her
preferred method facilitated by medication regimen
of learning, matching the as evidenced by
particularly if they educational they are already
have previously approach with the capable of
learned and learner's enumerating at
retained new preferred learning least 3 of the
material. style. reasons for her
getting pneumonia
6. Explained the 6. Using brief and and discuss the
reason why and simple words help purpose of her
how the patient them understand respiratory
acquired the patient's medications.
pneumonia health condition
briefly. more.

7. Discussed the 7. This would

purpose of each ensure to help
medication and them use their
time it has to be medication safely
taken. and effectively.

114
8. Used the 8. Teach-back
teach-back technique
method to the pertains to
patient and family. specified stages
performed
repeatedly to
assess the
patient's
understanding of
the discussed
material.

9. Encouraged the 9. Questions enable

patient and family clear
to ask questions if communication
they have between patients
concerns. and medical
professionals for
confirmation that
the information
has been
understood.

115
 Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

Subjective: Readiness for Short term: Independent: 1. To indicate Short term:

“Ano ba ang pwede Enhanced After 8 hours of 1. Assessed the deficient knowledge Goal was met, after
ko gawin? As Knowledge related nursing patient’s perception or misinformation. 8 hours of nursing
verbalized by the to health as interventions, the of her current interventions, the
patient. evidenced by patient will health problems. patient was able to
verbal reports of a verbalize verbalized
Objective: desire to learn. understanding of 2. Determined the 2. To develop a understanding and
● Asking information gain. motivation or plan for teaching. gained information.
questions expectations for
● Follows learning.
instructions Long Term: Long Term:
● Active After 3 days of 3. Assessed 3. To know what Goal was met, after
nursing preferred methods applicable methods 3 days of nursing
interventions, the of learning. to be used. interventions, the
patient will use the patient was able to
information to 4. Information 4. Promotes use the information
develop an about additional ongoing learning at to develop an
individual plan to learning resources own pace. individual plan to
meet health care such as books, meet health care
needs/goals. magazines, and t.v. needs/goals.
programs provided.

Interdependent: Interdependent:
1. Identified 1. Additional
available support opportunity to learn
groups. more.

116
 Nursing Nursing
Assessment Planning Rationale Evaluation
Diagnoses Interventions

“Ano ba dapat kong Readiness for Short term: Independent: Independent: Short term:
gawin… ano pa ba Enhanced Nutrition After 8 hours of 1. Assessed client’s 1. Provides Goal was me, after
ang dapat ko related to health as nursing level of opportunity to 8 hours of nursing
iwasan na evidenced by interventions, the understanding of assure accuracy interventions, the
pag-kain. Para verbal reports of a patient will proper nutrition and and completeness patient was able to
naman gumanda desire to change verbalize listed specific of knowledge. verbalized
ganda ang aking eating habits. understanding of nutrition goals. understanding of
kalusugan…” as information gain. information gain.
verbalized by the
patient. 2. Identified steps 2. Understanding
that are necessary the process
Objective: Long Term: to reach desired enhances Long Term:
● Asking After 3 days of health goals. commitment and Goal was me, after
questions nursing the likelihood of 3 days of nursing
● Follows interventions, the achieving the interventions, the
instructions patient will use the goals. patient was able to
● Active information to use the information
develop an to develop an
individual plan to 3. Accepted client’s 3. Promotes a individual plan to
meet nutritional evaluation of own sense of self meet nutritional
goals. strengths/ esteem and goals.
limitations while confidence to
working together continue efforts.
for improvement.

117
4. Acknowledged 4. Provides positive
patient’s efforts/ reinforcement
capabilities to encouraging
reinforce continued progress
movement toward toward desired
attainment of goals.
desired outcomes.

Interdependent: Interdependent:
1. Referred the 1. To provide
patient to the specialized nutrition
nutrition and management for
dietetics team. the patient.

118
 X. DRUG STUDY

SIDE EFFECTS /
MECHANISM OF NURSING
MEDICATION INDICATION CONTRAINDICATION ADVERSE
ACTION CONSIDERATION
EFFECTS

Brand Name: Hydrocortisone binds Used to treat Inactive tuberculosis Side Effects: Monitor and report signs
Solu-Cortef, to the glucocorticoid symptoms of low Herpes simplex infection Common: of thrombophlebitis,
A-Hydrocort, Alphosyl, receptor leading to corticosteroid levels of the eye headache peptic ulcer,
Aquacort, Cortef, downstream effects by replacing An infection due to a increased sweating hypersensitivity reactions
such as inhibition of steroids that are fungus trouble sleeping or anaphylaxis or skin
Cortenem
phospholipase A2, normally produced Intestinal infection caused unusual hair growth reactions.
NF-kappa B, other naturally by the by the roundworm on your face or
Generic Name: inflammatory body and by Strongyloides body Assess any muscle or
Hydrocortisone transcription factors, reducing swelling Pheochromocytoma upset stomach joint pain.
and the promotion of and redness and by A condition with low increased appetite
Classification: anti-inflammatory changing the way thyroid hormone levels nausea Assess muscle strength
Corticosteroids genes. the immune system Diabetes weight gain regularly to determine
works Insufficiency of the skin changes degree of muscle
Dosage: Therapeutic Effect: hypothalamus and (acne, rash, wasting during long- term
100mg Used for its pituitary gland dryness and use.
immunosuppressive Low amount of potassium scaliness)
and anti-inflammatory in the blood injection site Measure blood pressure
Route:
properties. Psychotic disorder reactions (tender or periodically and compare
IV Brain injury sore to touch, red it to normal values. Notify
Myasthenia gravis, a and swollen) the doctor if
Frequency: skeletal muscle disorder small skin hypertensive.
Q8 A disease with shrinking depressions
and weaker muscles (indentations) at Assess peripheral
called myopathy the injection site edema using girth
Increased pressure in the measurements, volume
eye Hypersensitivity displacement, and
Wide-angle glaucoma measurement of edema.
Clouding of the lens of Adverse effect: Report increased

119
the eye called cataracts Sodium and fluid swelling in feet and
High blood pressure retention. ankles or a sudden
Chronic heart failure Potassium and increase in body weight
An ulcer from too much calcium depletion. due to fluid retention.
stomach acid Muscle wasting,
Diverticulitis weakness, Monitor personality
osteoporosis. GI changes, including
disturbances and depression, euphoria,
bleeding. Increased restlessness,
appetite and hallucinations
delayed wound
healing. Bruising,
striae, hirsutism,
acne, flushing.
Raised intracranial
pressure,
headache,
depression,
psychosis,
menstrual
irregularities.
Hyperglycaemia,
glycosuria, DM,
obesity, increased
susceptibility for
infection.

120
 SIDE EFFECTS /
MECHANISM OF NURSING
MEDICATION INDICATION CONTRAINDICATION ADVERSE
ACTION CONSIDERATION
EFFECTS

Brand Name: Provides gradual Hypokalemia Renal insufficiency, Uncommon: Give while the patient is
Kalium Durule release of the active hyperkalemia, untreated Metabolism: standing or sitting up
ingredient over a long Prophylaxis during Addison’s disease, Hyperkalemia (never in recumbent
Generic Name: period of time. treatment with stricture of esophagus position) to prevent
saluretic diuretics, and obstructive changes Gastrointestinal: drug–induced esophagitis.
Potassium Chloride
High local especially in in the alimentary tract. Abdominal pain, Some patients find it
concentrations of the combination with diarrhea, nausea difficult to swallow the
Classification: substance in the digitalis Hypersensitivity to the large sized KCl tablet.
Electrolytic and water stomach or intestine active substance or to Rare:
balance agent any of the excipients. Gastrointestinal: Advise the patient not to
Replacement solution Therapeutic effect: Ulceration, crash or chew or suck the
Used to prevent or to perforation and tablet as this can cause
Dosage: treat low blood levels stricture/stenosis oral ulceration if dissolved
of potassium of the esophagus in the mouth.
1 tab
(hypokalemia) or small intestine Monitor I&O ratio and
Route: patterns as oliguria can
Skin: occur.
PO
Rash
Monitor and report signs
Frequency: of GI ulceration.
OD
Monitor patient closely
with cardiac monitor.
Irregular heartbeat is
usually the earliest clinical
indication of
hyperkalemia.

121
 SIDE EFFECTS
MECHANISM OF NURSING
MEDICATION INDICATION CONTRAINDICATION / ADVERSE
ACTION CONSIDERATION
EFFECTS

Brand Name: Statin medications Treatment of Active liver disease or Side Effects: Assess patient’s history of
Caduet, Lipitor, competitively inhibit several types of unexplained persistent Muscle pain or allergy to atorvastatin,
Lypqozet, Lorstat, the enzyme dyslipidemias. serum transaminase weakness fungal byproducts; active
Zarator hydroxymethylglutary elevation Headache hepatic disease, acute
l-coenzyme A Can be used as a Diarrhea serious illness,
(HMG-CoA) preventive agent for Concurrent use with Constipation pregnancy, lactation
Generic Name: Reductase, 8 which myocardial glecaprevir/pibrentasvir Stomach upset
Atorvastatin catalyzes the infarction, stroke, combination, systemic Bloating or gas in Assess for allergies to
conversion of revascularization, fusidic acid or within 7 the tummy HMG-CoA reductase
Classification: HMG-CoA to and angina days of stopping fusidic Nausea inhibitors
HMG-CoA Reductase mevalonic acid, an acid treatment, telaprevir, Signs of an
Inhibitors, early rate-limiting ciclosporin and allergic reaction Obtain baseline
Lipid-Lowering step in cholesterol tipranavir/ritonavir such as itchy skin, cholesterol, triglycerides,
Agents, Statins biosynthesis. combination. and rash and liver function tests

Dosage: Acts primarily in the ADVERSE Monitor liver function and

liver, where EFFECT: creatine kinase level
40mg
decreased hepatic Significant:
cholesterol Myalgia Assess for signs of
Route: concentrations Myositis muscle weakness or pain
PO stimulate the Myopathy
upregulation of Monitor for EKG changes
Frequency: hepatic low-density Rare:
ODHS lipoprotein (LDL) Immune-mediated Assess for changes in
receptors which necrotising concentration, alertness,
increases hepatic myopathy (IMNM) vision
uptake of LDL Interstitial lung
disease Monitor for therapeutic
Therapeutic effect: Worsen/precipitat response and other side
Used to lower lipid e myasthenia effects

122
levels and reduce the gravis
risk of cardiovascular Instruct patient not to
disease including drink it with grapefruit
myocardial infarction Fatal: juice
and stroke. Rhabdomyolysis,
heaptic failure Assess the patient's
understanding of the
Others: prescription schedule and
Diarrhea, any problems with
Constipation, compliance.
flatulence,
dyspepsia, Instruct patient not to
nausea, Malaise, chew, crush or divide the
asthenia, fatigue, atorvastatine. It can be
pyrexia, Hepatitis, taken with or without food.
Allergic reactions,
Abnormal LFT Teach the patient that
atorvastatin should be
Arthralgia, muscle taken before bed.
spasms, back
pain, joint Encourage a low-fat,
swelling, pain in low-cholesterol diet with
extremity an increase in fiber, fruits,
and vegetables. Increase
Headache, physical activity.
dizziness,
paraesthesia, Instruct patient to avoid
amnesia smoking.

Insomnia,
nightmares

Nasopharyngitis,
pharyngolaryngea

123
 l pain, epistaxis

Rash, pruritis,
urticarial, alopecia

SIDE EFFECTS
MECHANISM OF NURSING
MEDICATION INDICATION CONTRAINDICATION / ADVERSE
ACTION CONSIDERATION
EFFECTS

Brand Name: Blocks Antihyper- tensive ● Hypersensitivity Side effects: ● To prevent

Atacand vasoconstrictor and ● Pregnancy and ● Nausea orthostatic
aldosterone lactation ● Vomiting hypotension:
producing effects of ● Renal and hepatic ● Headache instruct the patient
angiotensin II at impairment ● Dizziness to move slowly
Generic Name:
receptor sites, ● Abdomina when getting up,
Candesartan including vascular l or instruct the patient
smooth muscle and stomach to get up slowly in
the adrenal glands. pain bed, turn side to
Classification: ● Arm, side, sit for a while
Angiotensin II back, or before standing,
receptor antagonist jaw pain and when getting
● Lighthead up from sitting,
edness slowly stand.
Dosage:
8mg/tab Adverse effects: ● If hypotension
● Chest occurs after a dose
pain of candesartan,
● Diarrhea place the patient in
Route: ● Skin rash, a supine position
PO dry skin with the legs
● General elevated to
feeling of manage

124
Frequency: tiredness symptomatic
OD AM or hypotension, and
weakness monitor vital signs.
● Syncope
● Dry mouth ● Monitor patients
● Ear with renal disease
congestio for adverse
n or pain reactions.
● Anemia
● Hypotensi ● To avoid any
on potential adverse
effects, check for
contraindications.

● Obtain baseline
status for weight,
vital signs, overall
skin condition, and
laboratory tests like
renal and hepatic
function tests, and
serum electrolyte
to assess patient’s
response to
therapy.

125
 SIDE EFFECTS
MECHANISM NURSING
MEDICATION INDICATION CONTRAINDICATION / ADVERSE
OF ACTION CONSIDERATION
EFFECTS

Brand Name: Inhibits the Antihypertensive ● Hypersensitivity CNS: Dizziness, Assessment:

Norvasc, Katerzia transport of ● Hepatic impairment lightheadedness, BEFORE:
calcium into ● Heart block (sick sinus headache, ● Obtain patients
Generic Name: myocardial and syndrome) asthenia, fatigue, history to allergy of
vascular smooth ● Pregnancy and lactation lethargy amlodipine.
Amlodipine
muscle cells, ● Assess vital signs
resulting in CV: Peripheral before therapy
Classification: inhibition of edema, DURING:
Calcium channel excitation-contra arrhythmias ● Monitor patient’s BP,
blockers ction coupling cardiac rhythm
and subsequent Dermatologic: ● Monitor intake and
Dosage: contraction. Flushing, rash output.
10mg/tab AFTER:
GI: Nausea, ● Monitor vital signs.
Route: abdominal ● Be alert for adverse
PO Discomfort effects.

Frequency:
OD PM

126
 SIDE EFFECTS
MECHANISM OF NURSING
MEDICATION INDICATION CONTRAINDICATION / ADVERSE
ACTION CONSIDERATION
EFFECTS

Brand Name: Binds to bacterial cell • Indicated in patient • Contraindicated with Side effects: • Assess for history of
Rocephin, Forgram, membranes, inhibits with allergy to cephalosporin Frequent: allergies, particularly
Keptrix cell wall synthesis, serious infections of or Discomfort with cephalosporins,
promoting osmotic lower penicillin and related IM penicillin.
instability. respiratory and antibiotics. administration,
Generic Name:
urinary oral candidiasis • Obtain specimen for
Ceftriaxone tract. (thrush), mild culture and sensitivity
• Patient with Acute diarrhea, mild tests before giving first
Classification: bacterial otitis media. abdominal dose.
3rd generation cramping, vaginal
cephalosporin candidiasis. • Assess oral cavity for
antibiotics white patches on
Occasional: mucous membranes,
Dosage: Nausea, serum tongue (thrush).
2g sickness–like
reaction (fever, • Monitor daily pattern of
joint pain; usually bowel activity, stool
Route:
occurs after consistency.
IV second course of
therapy and • Mild GI effects may be
Frequency: resolves after tolerable (increasing
OD drug is severity may indicate
discontinued). onset of antibiotic
associated colitis).
Rare:
Allergic reaction • Monitor I&O, renal
(rash, pruritus, function tests for
urticaria), nephrotoxicity, CBC.
thrombophlebitis
(pain, • Be alert for

127
redness,swelling superinfection: fever,
at vomiting, diarrhea,
injection site). anal/genital pruritus, oral
mucosal changes
Adverse effects: (ulceration,
Antibiotic-associa pain, erythema).
ted
colitis, other
superinfections
(abdominal
cramps,
severe watery
diarrhea, fever)
may
result from
altered
bacterial balance
in
GI tract.
Nephrotoxicity
may
occur, esp. in pts
with preexisting
renal disease. Pts
with history of
penicillin allergy
are
at increased risk
for
developing a
severe
hypersensitivity
reaction (severe
pruritus,

128
 angioedema,
bronchospasm,
anaphylaxis)

SIDE EFFECTS
MECHANISM OF NURSING
MEDICATION INDICATION CONTRAINDICATION / ADVERSE
ACTION CONSIDERATION
EFFECTS

Brand Name: Acetylcysteine's - Acetylcysteine is In patients with a prior Side effects: Assessment
NAC and Mucomyst sulfhydryl groups indicated for history of - indigestion/upset -History:
may hydrolize mucolytic therapy hypersensitivity to any of stomach Hypersensitivity to
Generic Name: disulfide bonds within and in the the ingredients. Also, in - diarrhea atropine, soybeans,
mucin, breaking management of asthmatics and patients - fatigue and peanuts (aerosol
Acetylcysteine
down the oligomers, acetaminophen with history of drowsiness preparation); acute
and making the overdose. bronchospasm - sweating bronchospasm,
Classification: mucin less viscous. - Adjunctive therapy - skin rash narrow-angle glaucoma,
mucolytic agents Acetylcysteine has in patients with prostatic hypertrophy,
also been shown to abnormal or viscid Adverse effect: bladder neck obstruction,
Dosage: reduce mucin mucous secretions in stomatitis, pregnancy, lactation
600 mg secretion in rat bronchopulmonary nausea, vomiting,
models. It is an disease, pulmonary fever, rhinorrhea, -Physical: Skin color,
antioxidant in its own complications of drowsiness, lesions, texture; T;
Route: right but is also surgery, and cystic clamminess, chest orientation, reflexes,
PO deacetylated to fibrosis. tightness and bilateral grip strength;
cysteine, which - Meconium ileus bronchoconstrictio affect; ophthalmic
participates in the n. Clinically overt examination; P, BP; R,
synthesis of the acetylcysteine adventitious sounds;
Frequency: antioxidant induced bowel sounds, normal
BID glutathione. The bronchospasm output; normal urinary
antioxidant activity occurs output, prostate
may also alter infrequently and palpation
intracellular redox unpredictably

129
reactions, decreasing even in patients Patient and Family
phosphorylation of with asthmatic Education:
EGFR and MAPK, bronchitis or - Counsel patient on
which decrease bronchitis proper inhalation
transcription of the complicating techniques, and advise
gene MUC5AC which bronchial asthma. patient not to exceed the
produces mucin. recommended dose or
frequency of inhalations.
- Instruct patient and
family/caregivers to
report other troublesome
side effects such as
severe or prolonged
drowsiness, chills, fever,
nasal inflammation, or GI
problems (nausea,
vomiting, irritation
in/around the mouth).

130
XI. DISCHARGE PLAN

Medication

● Advised the patient to continue taking Ipratropium 500 mcg as

needed only when the patient is experiencing dyspnea. Inform the
patient and relatives that nebulization should be used to administer
this medication.

Exercise

1. Tell the patient to seek assistance if she is having trouble with any of her
everyday tasks in order to reduce the danger of a fall and exhaustion.
2. Inform the patient that she should prevent as much as possible from engaging
in unrelated activities like biking, playing contact sports, etc.
3. Yoga breathing exercises will be beneficial. Exercises that improve breathing
will help you use your lung capacity more effectively.
4. Demonstrate to the patient and family on taking long, calm, deep breaths.
The mucus in your lungs can be moved by performing five to ten deep
breaths, followed by a few vigorous coughs or huffs to move the mucus.

Treatment

1. Encouraged the patient to adequate fluid intake

2. Advised the patient or the patient’s daughter to encourage her mother
to have completed the rest.
3. Advised the patient for a follow-up checkup, lab test monitoring, a
repeat chest X-ray, and a CBC (Complete Blood Count).
4. All adults 65 years of age or older should receive one final dose of
PPSV23 at 65 years or older. This dose should be given at least 1 year
after PCV13 and at least 5 years after the most recent dose of
PPSV23.
Health Teaching

1. Encourage the patient to consume at least 1-2 liters of water per day, if not
contraindicated.
2. Inform the patient and their loved ones that soft food should only be
consumed if the patient is still having trouble swallowing.
3. Advise the patient to eat more fruits and green leafy vegetables, as this will
boost the immune system's response and help the body fight infectious
diseases. Instruct the patient to limit foods high in fat and salt, such as meat
and canned foods.
4. Inform the patient and their family members about the medications the patient
is taking, as well as their dosage, frequency, route, therapeutic effects, side
effects, and precautions.
5. Remind the patient and their family members that they must follow the
discharge plan.

131
 6. Teach the patient's family members how to prevent or control the spread of
disease contamination, such as proper hand washing, the patient should have
a separate room or clean the house on a regular basis, and so on.
7. Instruct the patient to cover her nose and mouth if someone smokes near her
or to avoid areas where people smoke.
8. Instruct the patient and family members about DOH-approved herbal
medicines. Lagundi can be used as an expectorant for asthma, cough, and
fever. To make this herbal medicine, thoroughly wash the leaves before
boiling them, and then boil the leaves or other parts of it in a couple of glasses
of water for 15 minutes).
9. Encourage family members to have regular check-ups or consult physicians
to monitor the patient's condition and detect recurrences and other
complications that may arise.
10. When lying down, elevate the head of the bed and change positions
frequently to encourage lung expansion.
11. Wash your hands and stay away from crowded places.
12. Continue to be active. A morning walk improves circulation and strengthens
the tissue around your lungs.

Observe for/Anticipatory

The following are to closely monitor older adults that has pneumonia since it could
lead the patient from further complications:

● Undernourished as a result of medical issues or loss of appetite.

● Possess underlying lung conditions such as asthma.
● Recently have a viral upper respiratory infection such as influenza.

Diet

1. Advised the patient to continue Soft, Low-Salt and Low-Fat diet.

2. Encouraged small frequent meals to prevent aspiration.

Spirituality

● Advised the patient that if she has plans to attend holy mass every Sunday or
whenever she has time, she should always wear a mask and sit in an
uncrowded area.
● Support the patient until she fully recovered from the disease process by
always praying for her health and condition.

132
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