Republic of the Philippines

ISABELA STATE UNIVERSITY

Echague Campus
San Fabian, Echague, Isabela

A case Study of Covid 19 with underlying Pnumonia

Presented to:
Sir, Jojo Justo
May 4, 2020

Presented by:
Angelica Carl Mae P. Cauilan
Table of content

Page:

I. Overview of the study…………………………………

II. Anatomy and physiology……………………………

III. Pathophysiology……………………………………

IV. Nursing Care Plan (3)…………………………………

V. DrugStudy…………………………………
Introduction
Coronavirus disease (COVID-19) - is an infectious disease caused by a newly
discovered coronavirus.
- Most people infected with the COVID-19 virus
will experience mild to moderate respiratory
illness and recover without requiring special
treatment.  Older people, and those with
underlying medical problems.

Pneumonia -  is an infection in one or both lungs. Bacteria,

viruses, and fungi cause it.

The main types of pneumonia are:

 Bacterial pneumonia - This type is caused by various bacteria. The most

common is Streptococcus pneumoniae. It usually occurs when the body is
weakened in some way, such as by illness, poor nutrition, old age, or impaired
immunity, and the bacteria are able to work their way into the lungs. Bacterial
pneumonia can affect all ages, but you are at greater risk if you abuse alcohol,
smoke cigarettes, are debilitated, have recently had surgery, have a respiratory
disease or viral infection, or have a weakened immune system.
 Viral pneumonia - This type is caused by various viruses, including the flu
(influenza), and is responsible for about one-third of all pneumonia cases. You
may be more likely to get bacterial pneumonia if you have viral pneumonia.
 Mycoplasma pneumonia - This type has somewhat different symptoms and
physical signs and is referred to as atypical pneumonia. It is caused by the
bacterium Mycoplasma pneumoniae. It generally causes a mild, widespread
pneumonia that affects all age groups.
 Other pneumonias - There are other less common pneumonias that may be
caused by other infections including fungi.

Sign and symptoms of Pneumonia

 Bluish color to lips and fingernails
  Confused mental state or delirium, especially in older people

 Cough that produces green, yellow, or bloody mucus

 Fever

 Heavy sweating

 Loss of appetite

 Low energy and extreme tiredness

 Rapid breathing

 Rapid pulse

 Shaking chills

 Sharp or stabbing chest pain that’s worse with deep breathing or coughing

 Shortness of breath that gets worse with activity

Early symptoms of viral pneumonia are the same as those of bacterial pneumonia,
which may be followed by:

 Headache

 Increasing shortness of breath

 Muscle pain

 Weakness

 Worsening of the cough

Mycoplasma pneumonia has somewhat different symptoms, which include a severe

cough that may produce mucus.

Sign and symptoms of Covid 19

Common symptoms:
 fever.
 tiredness.
 dry cough.
 Some people may experience:
  aches and pains.
 nasal congestion.
 runny nose.
 sore throat.
 diarrhea.

CAUSES of Pneumonia

Many germs can cause pneumonia. The most common are bacteria and
viruses in the air we breathe. Your body usually prevents these germs
from infecting your lungs. But sometimes these germs can overpower
your immune system, even if your health is generally good.

Pneumonia is classified according to the types of germs that cause it

and where you got the infection.

Community-acquired pneumonia

Community-acquired pneumonia is the most common type of

pneumonia. It occurs outside of hospitals or other health care
facilities. It may be caused by:

 Bacteria. The most common cause of bacterial pneumonia in the

U.S. is Streptococcus pneumoniae. This type of pneumonia can
occur on its own or after you've had a cold or the flu. It may affect
one part (lobe) of the lung, a condition called lobar pneumonia.

 Bacteria-like organisms. Mycoplasma pneumoniae also can

cause pneumonia. It typically produces milder symptoms than do
other types of pneumonia. Walking pneumonia is an informal name
given to this type of pneumonia, which typically isn't severe
enough to require bed rest.
  Fungi. This type of pneumonia is most common in people with
chronic health problems or weakened immune systems, and in
people who have inhaled large doses of the organisms. The fungi
that cause it can be found in soil or bird droppings and vary
depending upon geographic location.

 Viruses. Some of the viruses that cause colds and the flu can
cause pneumonia. Viruses are the most common cause of
pneumonia in children younger than 5 years. Viral pneumonia is
usually mild. But in some cases it can become very serious.

Hospital-acquired pneumonia

Some people catch pneumonia during a hospital stay for another

illness. Hospital-acquired pneumonia can be serious because the
bacteria causing it may be more resistant to antibiotics and because
the people who get it are already sick. People who are on breathing
machines (ventilators), often used in intensive care units, are at higher
risk of this type of pneumonia.

Health care-acquired pneumonia

Health care-acquired pneumonia is a bacterial infection that occurs in

people who live in long-term care facilities or who receive care in
outpatient clinics, including kidney dialysis centers. Like hospital-
acquired pneumonia, health care-acquired pneumonia can be caused
by bacteria that are more resistant to antibiotics.

Aspiration pneumonia

Aspiration pneumonia occurs when you inhale food, drink, vomit or

saliva into your lungs. Aspiration is more likely if something disturbs
your normal gag reflex, such as a brain injury or swallowing problem,
or excessive use of alcohol or drugs.

Risk factors
Pneumonia can affect anyone. But the two age groups at highest risk
are:

 Children who are 2 years old or younger

 People who are age 65 or older

CAUSES of Covid 19
Infection with the new coronavirus (severe acute respiratory syndrome
coronavirus 2, or SARS-CoV-2) causes coronavirus disease 2019
(COVID-19).

The virus appears to spread easily among people, and more continues
to be discovered over time about how it spreads. Data has shown that
it spreads from person to person among those in close contact (within
about 6 feet, or 2 meters). The virus spreads by respiratory droplets
released when someone with the virus coughs, sneezes or talks. These
droplets can be inhaled or land in the mouth or nose of a person
nearby.

It can also spread if a person touches a surface with the virus on it

and then touches his or her mouth, nose or eyes.

Risk factors

Risk factors for COVID-19 appear to include:

 Recent travel from or residence in an area with ongoing community

spread of COVID-19 as determined by CDC or WHO

 Close contact with someone who has COVID-19, , such as being within

6 feet, or 2 meters, or being coughed on — which can occur when a
family member or health care worker takes care of an infected person

Complications
Although most people with COVID-19 have mild to moderate
symptoms, the disease can cause severe medical complications and
lead to death in some people. Older adults or people with existing
chronic medical conditions are at greater risk of becoming seriously ill
with COVID-19.

Complications can include:

 Pneumonia in both lungs

 Organ failure in several organs

 Respiratory failure

 Heart problems, such as heart rhythm problems and a disease of the

heart muscle that makes it hard for your heart to pump blood to the body
(cardiomyopathy)

 Acute kidney injury

 Additional viral and bacterial infection

ANATOMY AND PHYSIOLOGY

 Respiratory system
(pulmonary system) anatomy
Human Respiratory System
The respiratory system consists of all the organs involved in
breathing. These include the
nose, pharynx, larynx, trachea, bronchi and lungs. The
respiratory system does two very important things: it brings
oxygen into our bodies, which we need for our cells to live and
function properly; and it helps us get rid of carbon dioxide,
which is a waste product of cellular function. The nose,
pharynx, larynx, trachea and bronchi all work like a system of
pipes through which the air is funnelled down into our lungs.
There, in very small air sacs called alveoli, oxygen is brought
into the bloodstream and carbon dioxide is pushed from the
blood out into the air. When something goes wrong with part of
the respiratory system, such as an infection like pneumonia, it
makes it harder for us to get the oxygen we need and to get rid
of the waste product carbon dioxide. Common respiratory
symptoms include breathlessness, cough, and chest pain.

The Upper Airway and Trachea

When you breathe in, air enters your body through your nose or
mouth. From there, it travels down your throat through the
larynx (or voicebox) and into the trachea (or windpipe) before
entering your lungs. All these structures act to funnel fresh air
down from the outside world into your body. The upper
airway is important because it must always stay open for you
to be able to breathe. It also helps to moisten and warm the air
before it reaches your lungs.
The Lungs
Structure
The lungs are paired, cone-shaped organs which take up most
of the space in our chests, along with the heart. Their role is to
take oxygen into the body, which we need for our cells to live
and function properly, and to help us get rid of carbon dioxide,
which is a waste product. We each have two lungs, a left lung
and a right lung. These are divided up into ‘lobes’, or big
sections of tissue separated by ‘fissures’ or dividers. The right
lung has three lobes but the left lung has only two, because
the heart takes up some of the space in the left side of our
chest. The lungs can also be divided up into even smaller
portions, called ‘bronchopulmonary segments’.
These are pyramidal-shaped areas which are also separated
from each other by membranes. There are about 10 of them in
each lung. Each segment receives its own blood supply and air
supply.
How they work
Air enters your lungs through a system of pipes called the
bronchi. These pipes start from the bottom of the trachea as
the left and right bronchi and branch many times throughout
the lungs, until they eventually form little thin-walled air sacs
or bubbles, known as the alveoli. The alveoli are where the
important work of gas exchange takes place between the air
and your blood. Covering each alveolus is a whole network of
little blood vessel called capillaries, which are very small
branches of the pulmonary arteries. It is important that the air
in the alveoli and the blood in the capillaries are very close
together, so that oxygen and carbon dioxide can move (or
diffuse) between them. So, when you breathe in, air comes
down the trachea and through the bronchi into the alveoli. This
fresh air has lots of oxygen in it, and some of this oxygen will
travel across the walls of the alveoli into your bloodstream.
Travelling in the opposite direction is carbon dioxide, which
crosses from the blood in the capillaries into the air in the
alveoli and is then breathed out. In this way, you bring in to
your body the oxygen that you need to live, and get rid of the
waste product carbon dioxide.

How Do We Breathe?
Breathing starts when you inhale air into your nose or mouth. It travels down the back of your
throat and into your windpipe, which is divided into air passages called bronchial tubes.
For your lungs to perform their best, these airways need to be open.  They should be free
from inflammation or swelling and extra mucus.
As the bronchial tubes pass through your lungs, they
divide into smaller air passages called bronchioles.
The bronchioles end in tiny balloon-like air sacs
called alveoli. Your body has about 600 million
alveoli.
The alveoli are surrounded by a mesh of
tiny blood vessels called capillaries. Here, oxygen
from inhaled air passes into your blood.
After absorbing oxygen, blood goes to your heart.
Your heart then pumps it through your body to the
cells of your tissues and organs.
As the cells use the oxygen, they make carbon
dioxide that goes into your blood. Your blood then
carries the carbon dioxide back to your lungs, where
it’s removed from your body when you exhale.

Parts of the Respiratory System

 nasal cavity is the inside of your nose. It is lined with a mucous membrane that helps
keep your nose moist by making mucus so you won't get nosebleeds from a dry nose.
There are also little hairs that help filter the air you breathe in, blocking dirt and dust from
getting into your lungs.
 sinuses are a connected system of hollow cavities in the skull. The
largest sinus cavities are about an inch across. Others are much smaller. 
 mouth is an oval-shaped cavity inside the skull. The two main functions of
the mouth are eating and speaking.
 throat (pharynx) is a muscular tube that runs from the back of your nose down into your
neck. 
  larynx (/ˈlærɪŋks/), commonly called the voice box, is an organ in the top of the neck
involved in breathing, producing sound and protecting the trachea against food aspiration.
 trachea, colloquially called the windpipe, is a cartilaginous tube that connects the larynx
to the bronchi of the lungs, allowing the passage of air, and so is present in almost all
air-breathing animals with lungs.
 diaphragm is a thin skeletal muscle that sits at the base of the chest and separates the
abdomen from the chest.
  lungs are a pair of spongy, air-filled organs located on either side of the chest (thorax).

 Bronchi and Bronchus When a person breathes, air taken in through the nose or mouth then
goes into the trachea (windpipe). From there, it passes through the bronchial tubes, into the
lungs, and finally back out again. The bronchial tubes, which branch into
smaller tubes called bronchioles, are sometimes referred to as bronchi or airways.
 Bronchioles are air passages inside the lungs that branch off like tree limbs from the
bronchi—the two main air passages into which air flows from the trachea (windpipe)
after being inhaled through the nose or mouth.
 Alveoli are tiny air sacs in your lungs that take up the oxygen you breathe in and keep
your body going.
 Capillaries are very tiny blood vessels — so small that a single red blood cell can barely
fit through them.
Blood Supply
The lungs are very vascular organs, meaning they receive a
very large blood supply. This is because the pulmonary
arteries, which supply the lungs, come directly from the right
side of your heart. They carry blood which is low in oxygen and
high in carbon dioxide into your lungs so that the carbon
dioxide can be blown off, and more oxygen can be absorbed
into the bloodstream. The newly oxygen-rich blood then travels
back through the paired pulmonary veins into the left side of
your heart. From there, it is pumped all around your body to
supply oxygen to cells and organs.
PATHOPYSIOLOGY
Nursing Care Plan
Assessment Diagnosis Planning Intervention
Rationale Evaluation
Activity •After 4 * Evaluate*Estab- •After
Objective: Intolerance hours of patient’s Lishes 4hours
“hindi ako Related to nursing Response patient’s Of
maka tulog Exhaustion inter- To activity
capa- nursing
dahil sa Associated Vention Bilities inter-
ubo ko” With Or needs vention
Inter- •the and the
Subjective: Ruption patient facilitates patient
*Fatigue In usual will choice of adopted
*Dyspnea Sleep demon- inter- new
pattern Strate ventions infor-
Because of A *Provide a *Reduces mation
discomfort, Mea- quiet stress on how
Excessive Surable environ- and to
coughing Increase ment excess prevent
And In And limit stimu- herself
dyspnea tolerance visitors lation, for
In During promo- infec-
activity acute phase Ting rest tion
With *Elevate *These
absence Head and measures
of encourage promotes
dyspnea frequent maximal
And position inspi-
exce- changes, ration,
Ssive deep enhance
fatigue breathing Expecto-
And Ration of
effective secretion
coughing to
*Encourage improve
adequate venti-
rest balance lation.
with
moderate
activity.
Promote
adequate
nutritional
intake.
Assessment Diagnosis Planing Intervention Rationale Evaluation
*Flushed After 4 After *Establish *To gain After
skin hours of 4hours rapport trust and 4hours of
*Skin nursing of have a nursing
warm to inter- nursing nurse inter-
touch vention inter- Patient vention
*38.5C the vention relation- the patient
tem- patient the Ship tem-
perature tem- patient *Monitor *To perature
*Rales perature tem- vital sign establish shall drop
*Dehy- will drop perature every baseline from
dration from will 4hours data of 38.5C to
*Irri- 38.5C to drop the 37.2C
tability 37.5C from patient
38.5C *Provide *To
to TSB as a lower
37.5C measure patient
tem-
perature
*Instruct *To
SO to release
provide heat and
with loose to
clothing provide
comfort
*Assess *Warm,
skin dry,
temperature flushed
 And color skin may
indicated
a fever

Assessmen Diagnosis Planning Intervention Rationale

Evaluatio
t n
“apat na Diarrhea *After *Auscultat *For After 2-3
beses r/t 2-3hours e the presence hours of
napo infectiou of abdomen location nursing
syang s process nursing and inter-
dumumi” inter- charac- ventions
as ventions teristics the
verbalize the the of bowel patients
d by the patients sounds mother
mother mother *Discuss to *For the shall gain
Objective will gain the mother educationo know-
: know- the f the ledge
*Lossed ledge different patients about
bowel about causative mother diarrhea
movemen diarrhea, factors and and
t verbaliz rationale verbalized
*Abdo- e under- for under-
minal standing treatment standing
cramping of regimen of
causativ *Restrict *To allow causative
e solid food for factors of
factor intake bowelrest diarrhea
and reduce and
intestinal rationale
workload for
*Provide *To allow treatment
for foods that regimen.
changers in precipitate
dietary diarrhea
intake
*Limit *To
caffeine, prevent
high fiber gastric
foods and irritation.
fatty foods
DRUG STUDY
 Discharge planning
M-edication
• the patient is advised to follow and take the prescribe medication regimen needed for
Effective treatment and fast recovery
E-xercise
• Instruct the patient to exercise regularly like stretching
T-reatment
• Encouraged patient to have adequate rest
• Encouraged patient to drink 2-3 litters of water everyday
H-ygiene
•Educated patient about proper hygiene and its importance
• Encourage patient to practice good hygiene
O-ut patient
• Instructed the patient to have follow up check up after 7 days
• Advise to notify physician physician if there is any problem or complications arises
D-iet
• Instructe the patient to eat atleast 2 fruits and 2 vegetable
•Instruct the patient to drink plenty of water
• Advised the patient to avoid eating junk foods and refrain from drinking sodas
• Advised patient to avoid foods that are rich in fat
S-pirituity
•Encouraged patient to go to Church every Sunday
• Instructed to patient o pray for fast recovery
• Instruct the patient to have faith in God
• Advised to patient to always thanks God
Medications Dosage Route Indications Application to
the patient
Fortifier FA 125mg/tab Oral To prevent and Because the
treat iron patient had a lot
deficiency of blood loss so
anemia she needs to
regain by taking
this and she is
prone to anemia
Mefenamic acid 500mg/tab with Oral Relief of pain Because
meals during post op postpartum
and postpartum women had a
traumatic
experience and
pain during
procedure
Co-amoxiclav 625 mg/cap BID Oral Used to prevent Mother who
x 7 days an infection have been for
completion
curettage can be
at risk of getting
infection,
example: the
patient has a
poor perineal
hygiene