INE,MUMBAI

A CASE STUDY
On

PNEUMONIA

Presented to:
MRS. GRACE MANE MADAM
HOD, Child Health Nursing
INE, Mumbai.

Presented by:
Yashoda Pawar
1st MSc Nursing.
INE Mumbai.
INSTITUTE OF NURSING EDUCATION

INDEX

CATEGORIES Page no

Introduction

Personal Data

Nursing History/Past, Present,

Family

Pearson Assessment

Diagnostics Actual and Ideal

Anatomy and Physiology

Algorithm and Explanation of

Pathophysiology

Medical and Surgical

Management

Nursing Care Plan

Promotive and Preventive

Management

Drug Study

Discharge Planning

Summary and Copy of Updates

Bibliography
 INTRODUCTION

A baby will make love stronger, days shorter, nights longer, bankroll smaller, home

happier, clothes shabbier, the past forgotten, and the future worth living for. When you

inhale you take in air with lots of oxygen, which you need to stay alive. Healthy lungs

let air pass through and speed by the alveoli, then into red blood cells. Oxygen is

delivered all over the body. But when you have pneumonia, liquid blocks the alveoli in

your lungs using liquid.

This is a case of a 4 months old baby boy who was diagnosed with pneumonia.

The baby was admitted at JJ Hospital in the morning with a chief complaints of cough

and colds for two weeks. The vital signs were initially taken and recorded and the

admitting diagnosis was pneumonia.

Pneumonia is an acute infectious disease caused by pneumococcus, associated by

general toxemia and a consolidation of one or more lobes of either one or both lungs.

It is an inflammation of the lungs caused by infectious agent in which air sacs are filled

with pus or exudates so that air is excluded and the lungs become solid. Bacteria

commonly enter the lower airway but do not cause pneumonia in the presence of

intact host defense mechanism (Smeltzer & Bare, 2005). Often pneumonia begins

after an upper respiratory tract infection (an infection of the nose and throat). The

incubation period ranges from one to three days with sudden onset of shaking chills,

rapidly rising fever and stabbing chest pains aggravated by coughing and respiration.

The disease is transmitted through droplet infection or through indirect contact.

Upon further history taking, I found out that the mother of the baby is positive

in extensive PTB and she is now on her 3rd month of anti-Koch’s treatment.
 General Objective:

With the acquired information given by the mother of the patient, I aim to

present the case of Baby Boy comprehensively and formulate a case analysis that

would provide essential knowledge and skills in delivering quality health care to

patients diagnosed with pneumonia.

Specific Objectives:

This case study on pneumonia seeks to attain the following specific objectives
Describe the common characteristics of pneumonia.
 Know the history of past and present illness of the client.
 To assess the condition of the patient through the use of PEARSON Assessment

(Psychosocial, elimination, activity and rest, safe environment, oxygenation and

nutrition).
 Relate the significance of laboratory results to client’s condition or the disease

process.
 Present the anatomy and physiology of the system involved, in relation to the

condition of the patient.

 Identify the indication, mechanism of actions, contraindications, dosages and

frequency, adverse effects, and nursing responsibilities/interventions of the

drug administered to the client.

 To present nursing care plans formulated specifically based on client’s

condition.
 Recognize the medical and surgical interventions related to the patient and

make promotive and preventive management to help the client’s condition.

 Formulate a comprehensive discharge plan realistic to the needs and

compliance of the client.

 Present updates related to client’s case and condition.
Patient’s Profile

Personal Data:

Name: Master. Arhan Akil Khan.

Age: 10 months
Sex: Male
Address: Shivaji Nagar,Mhada colony,Govandi,Mumbai,Maharashtra
Civil Status: Child
Rank in the Family: Fourth
Child Religion: Muslim

Nationality: Indian
Date and Time of Admission: 02/03/2020 at 9:45 pm.
Admitting Hospital: Sir JJ Group Of Hospital Mumbai.
Ward: Pediatric medical ward 41
Reg.No: 2812802

Chief Complaints: Cough and Colds for two (2) weeks

Previous Illness and History: (+) history of infection and diarrhea when he was 2 mos. Old
due to poor hygiene.
Physical Findings: Skin is fair in color; nails are convex, cleaned and capillary refill returns to
original color after 2 seconds when pressed; normocephalic, symmetrical
facial features. Hair is black and evenly distributed and no infestations;
scalp is free from lesions lumps or masses; pupils are equally rounded, both
reactive to light and accommodation; nose is located at midline of the face
with watery nasal discharges; ears are symmetrical and at the level of outer
canthus of the eye; lips are pinkish in color, smooth, moist and free of
lesions; tongue lies at the midline and free of lesions also; neck is
symmetrical with the head in central position; lymph nodes are not palpable;
thorax rises and falls in unison with respiratory cycle; no chest pain noted;
fast breather but no shortness of breath noted; rales noted at both lung
fields; abdomen is round and no tenderness noted upon palpation; normal
bowel sounds; extremities grossly normal with full and equal pulses.
Weight: 8 kilograms
Initial Vital Signs: Respiratory Rate: 42bpm
Heart Rate: 150cpm
Temperature: 36.2˚C
Attending Physician: Dr. S. Saliganan
Working Diagnosis: t/c Pneumonia
Final Diagnosis: Pneumonia
Condition on Discharge: Improved

Nursing History of Past and Present Illness

A. Nursing History of Past Illness

Upon interview, the mother was asked about past history of illness of her son.
She told us that her son experienced an infection and diarrhea when he was still two

months old and was admitted at the same hospital for four days. Some immunizations

were already started to boost the immune system of the baby for him to experience

no further complications. The following immunization were given to and received by

baby boy with its corresponding dates:

 BCG – Jun 28 2019

 Hep B – June 28, 2019/August 12, 2019/September 21, 2019

DPT – September 21, 2019

 Poliomyelitiis – September 21, 2010/December 6, 2019

According to the patient’s mother, the baby is not used to have a monthly check –

up. But the baby is given a multivitamins everyday. No history of allergies of any kind. I

also noted that the mother of the child is positive in extensive PTB but she’s now on

her 3rd month of anti-Koch’s treatment.

B. Nursing History of Present Illness

Prior to admission, the patient’s mother told me that baby boy was

experiencing cough and colds with watery nasal discharges accompanied with on and

off undocumented fever since 2 weeks and she observed that the baby’s chest

expansion has more effort and she think that the patient experiencing difficulty of

breathing. Prior to admission, she first brought baby boy to Sinait District Hospital for

check – up and he was given Cefixime drops to be taken for seven days. baby boy

was admitted in JJ Hospital with chief complaints of cough and colds for two weeks.

After series of examination the working diagnosis given by the physician of the child

was to consider pneumonia.

GROWTH AND DEVELOPMENT ASSESSMENT FOR INFANT

I. DEMOGRAPHIC PROFILE:

Name: Master . Arhan Akil Khan.

Age: 10 months
Sex: Male
Date of Admission: 02/03/2020.
I.P No. 2812802
Diagnosis: Pneumonia
Adress: shivaji nagar,Mhada colony,Mumbai.

II. HISTORY OF THE CHILD:

Reason for Hospitalization:

.Cough and Colds for two (2) weeks

Past History of Illness:infection and diarrhea when he was still two months
old and was admitted at the same hospital for four days.

Present Complaints:experiencing cough and colds with watery nasal

discharges accompanied with on and off undocumented fever since 2 weeks
Family History: 6 members living in the family, joint family
No history of any diseases in the family like
TB,Cancer,Hypertension,Diabetes

Socioeconomic Status: Middle class family

Birth History: Normal vaginal delivery
No history of birth complications,admission,Breast feeding was
started after 1 hour of delivery

a) Antenatal History:No history of antenatal complications

b) Intranatal History: Normal delivery without complications

c) Post-natal History: Cried well after birth,admission was not required
d) Neonatal History: History of neonatal jaundice ,Treatment was not
required for that.
Developmental History:

Age group: Infant

Biological Development:

Anthropometric Measurements

Child Value Expected Value Remark

Height : 64 cm 64-68cm Normal
Weight : 8 kg 9-11Kg
Head circumference: 40 cm 39-41cm
Mid arm circumference: 12 cm 13-15cm
Chest circumference: 37 cm 36-39cm
Abdominal circumference: 34cm 33-36cm

Vital Signs

Vital Signs Findings of Baby Expected

Temperature: 99.80 f 98.6 F
Pulse : 130bpm 115±20bpm
Respiration : 38 breaths/min 30±10 breaths/min
Blood pressure: 100/70mmhg 96/66±30/24mm of Hg.
Gross Motor Development
YES NO Comment
Fine Motor Development yes
 Desires to grasp
 Looks from the hand to the object yes
and back
 Transfers objects from one hand to yes
the other

 Explores movable parts of toy no

 Able to pit objects into a container no

B. Gross Motor Development Head

Control
 Able to lift the head and front yes
portion of the chest about 90
degrees above the table.
 Able to raise the chest and upper yes
part of the abdomen

 Can bear weight on one hand while yes

exploring with the other.
C. Rolling Over yes
 Rolls from back to side

 Roll from abdomen to back yes

 Rolls from back to abdomen yes

D. Sitting yes
 Sits with good head control with
support
 Sits alone leaving on hands for yes
support
 Sits alone without support

E. Locomotion yes
 Moves from sitting to kneeling and
standing position
 Crawls with abdomen on floor yes
 Stands holding on to furniture yes
 Takes deliberate steps no
 Creeps on hands and knees yes
 Walks with support of our hand yes

Sensory Development

YES NO Comment
1. Able to follow in range of 90 degrees yes
2. Has binocular vision yes
3. Looks at had while lifting or lying on back yes

4. Has developed color preferences no

5. Has hand to eye coordination no

6. Able to fixate on very small objects no

7. Follows rapidly moving object no

B. Hearing
1. Turns head to side when sound is made yes

2. Imitates sounds yes

3. Responds to own name yes

4. Localizes sounds yes

5. Knows several words and meaning no

Social Development:
YES NO Comment
1. Recognizes parents yes

2. Has fear of strangers yes

3. Holds arms out to be picked up yes

4. Imitates others no
5. Has definite likes and dislikes no
6. Searches for dropped objects yes
7. Has frequent mood swings no
Language Development:

YES NO Comment
1. Imitates sounds yes Normal development
2. Laughs aloud yes

3. Takes pleasure in hearing over sounds yes

4. Produces words without meaning no

Psycho-social Development:
According Erik H Erickson -------Master Arhan------ is a stage of
development called Sense of trust V/s Sense of mistrust.

Behavior Present Absent Remark

 Imitate the others Present Psychosocial
 Shows preference for toys development
 Attracts attention of others
 May object to being away
from parents.

Psycho-sexual Development:
According to Sigmund Freud, ----Master Arhan-------is in a developmental
stage called Oral.

Behavior Present Absent Remark

 Bites and sucks Present Child in oral stage
 Induce its own gender
learning roles
 Has gender oriented
response

Intellectual Development:
According Jean Piaget, -------Master Arhan----- is in Sensory Motor Stage.

YES NO Comment
A. Sensory motor phase yes Childs senses developing
1. Use of reflexes sucking and swallowing appropriately his age

B. Primary Circular Reactions yes

1. Recognizes stimulus that produce a
response
2. Engages in an activity for the pleasure yes

3. Recognizes orderly sequence of an event no

C. Secondary Circular Reactions no
1. Recognizes symbols
2. Imitates sounds yes

Spiritual Development:
According to Fowler, ---Master Arhan---------- is in primal faith.

Behavior Present Absent Remark

 Attached to parents present normal
 Has Give and Take relations

Play:
YES NO Comment
1. Plays alone yes Not socialy developed
2. Plays with toys yes

Conclusion:
Childs growth and development is normal appropriate his age but
illness may affect his development
 PEA/RSON
Approach in Need Assessment

Admission to Home Visit

November 14, 2010 (During December 7, 2010 (After the
Hospitalization) Hospitalization)
Patient Baby boy is 4
month old child, presently
residing at shivaji nagar mumbai
He is the 4th child in the family. Baby boy’s condition was
He was admitted at JJ Hospital improved after the
last hospitalization. He was awake
PSYCHOSOCIAL
M a r c h 2 / 2 0 2 0 exactly when I went to their house to
9:45with a chief complaint visit him and to check his
of cough and colds. He is condition. While I am speaking
active, conscious and playful. to his mother, he was staring
His psychosocial development at me and it seemed that he
according to Erik Erikson is was listening to what I was
 trust vs. mistrust which means saying.
to develop a sense of purpose and
the ability to initiate and direct
one’s own activities.

 Urinary output: Baby boy  Urinary output: Baby boy

changed his diaper 2 – 3 times
during the shift normally with
yellow color of urine and
aromaticodor.
 Defecated once with little
amounts during the shift with
changed his underwear 8 –
10 times a day, orange in color
and aromatic odor with 15 to
20 ml everyvoid.
 He defecates once a day only
with an amount of 50 –

ELIMINATION greenish yellow in 70 ml of stool with yellow

color and soft consistency. orange in color and soft
 (+) diaphoresis
consistency.
Baby boy sleeps with intervals “Mga 10 pm siya natutulog
of 4 to 6 hours. He had enough ading tapos maaga siya
rest and crying at times only. He nagigising. Paggising niya sa
is jolly and playful also. He madaling araw naglalaro na yan.
usually slept on supine position Pagsapit ng tanghali matutulog
and sometimes on prone position. ulit siya mga isa o dalawang
ACTIVITY AND REST
During his hospitalization, there oras.” As verbalized by the
are times that he was irritated and mother.
cannot sleep well according to
He is so jolly and gay during the
her mother.
visit and also thumb sucking and
clapping. He is very active and
playful.

He has a good skin

turgor. Soft skin and fair
complexion. No signs of skin
rashes on both upper and lower They live in a concrete
extremities. He was able to move house, with enough light and
his body in different positions good source of air.
with medium pillows around him
 Body temperature of
for safety purposes. He was in
36.8 C
a light
 SAFE and comfortable cold room. He  (-) Edema
ENVIRONMENT has no allergies on milk, food and
 No signs of skin rashes or
medicine. He had a temperature of
allergies on both upper
36.2 C.
and lower extremities.
Laboratory analysis:
 WBC:9.2x10^g/l
 Lymp%: 50.7%
 Gra.%:44.7%
 HCT: 0.387L/L
 Hgb: 139. 5 g/l
 RBC: 4.73 m/U

“Nahihirapan siya huminga “Ayos naman na ang paghinga

minsan, kasi madami yata siyang niya ngayon ading pero may
plemas na di mailabas.”As plemas pa rin kasi siya.” As
verbalized by the mother. verbalized by the mother.
 no cyanosis noted
 no cyanosis noted
 adventitious breath
 adventitious breath
sounds noted
sounds stillnoted
Upon admission (March2 /2020)
 Vital signs taken upon
 RR: 40 bpm
Home Visit:
OXYGENATION
 RR: 38 bpm
 PR: 130 cpm
 PR: 120 cpm
 T: 36.5 ˚C
 T: 37.5 ˚C
 Breathesthroughthe nose.
(March 3/2020)
 (-)DOB
3:00 pm
 Effortless inspiration
 RR: 42 bpm
 Pinkish conjunctiva
 PR: 150 cpm
 T: 36.2 ˚C  capillary refill within 2-

7:00 pm 3 seconds

 RR: 40 bpm  Afebrile

 PR: 141 cpm  Still with watery
 T: 37.8 ˚C nasal discharges.
 (-)usage of oxygen  Still with white colored
 Effortless inspiration sputum.
 Breathesthroughthe nose.
 capillary refill within 2-3
seconds
 With watery nasal
 discharges.
 Withwhitecolored sputum.
 The impression of the chest
x – ray of Baby boy was
Pneumonitis.

Baby boy is Breast fed. He

2 to 3 times breast fed within the Still, he is Breast fed. He
shift. No signs of dehydration takes his milk 5 times a day:
were noted. His weight during after .
admission was 8 kg.
Weaning food-Hospital Khichadi,

NUTRITION
 DIAGNOSTIC
PROCEDURES
C. Ideal diagnostic Procedures
Name and Purpose Normal Significant Nursing

of the procedure Values Values Implications

Hematology – grouped together  Low Hgb concentration may indicate anemia,  Levels decreased with
into profiles or panels, requiring recent hemorrhage or fluid retention causing reduced RBC production,
one requisition and a single hemodilution. Above-normal hemoglobin levels may blood loss and hemolysis.
be the result of dehydration, excess production of red
venous specimen. blood cells in the bone marrow, severe lung disease, or Hemoglobin levels peak
 138-166g/l several other conditions. around 8 a.m. and are lowest
 Hemoglobin (Hgb) • Low Hct suggests anemia, hemodilution or massive around 8 p.m. each day.
 0.380-550 l/l blood loss. The most common cause of increased
 Hematocrit (Hct) hematocrit is dehydration, and with adequate fluid  Levels may appear decreased
  4.2-6.5m/U intake, the hematocrit returns to normal. However, it when Hgb is abnormal. The
 RBC
may reflect a condition called polycythemia vera that Hgb level is usually
 4.0-12.0x10^g/l is, when a person has more than the normal number of approximately 1/3 of Hct.
 WBC
red blood cells. This can be due to a problem with the
bone marrow or, more commonly, as compensation for Living at high altitudes
 Lymphocytes  25-50%
inadequate lung function (the bone marrow manufactures causes increased hematocrit
 50-80% more red blood cells in order to carry enough oxygen values this is your body’s
 Granulocytes throughout your body). response to the decreased
• An elevated RBC count may indicate absolute relative
oxygen available at these
polycythemia. A decreased RBC may indicate Anemia;
it may be due to blood loss or lack of production of new heights.
RBC's from the bone marrow.
• Abnormal WBC differential patterns provide evidence  Levels are easily influenced
for diseases and other conditions. by fluid volume status;
• Lymphoctyes increase in numbers hypervolemia leads to lower
(lymphocytosis) in certain types of chronic hematocrit w/o actual
decreased RBC’s &
hypovolemia &
hemoconcentration reflects
higher hematocrit than

Chest X – ray:
The most commonly performed diagnostic
x – ray examination. It is done to detect
pulmonary disorders, such as pneumonia,
atelectasis, pneumothorax and others. It is
non-invasive medical test. It marks images
of the heart, lungs, airways, blood vessels
and the bones of the spine and chest.
Gram Staining Test:
A Gram stain may be performed as part of the bacterial culture when a bacterial infection is suspected. It is performed on the same sample as the culture, and the test results are
reported out promptly to help guide treatment. The most commonly performed microbiology tests used to
 A minimal increase in granulocytes with mild elevation of
 Trachea – visible midline
in the anterior mediastinal
cavity.
 Hila – (Lung Roots) –
visible above the heart,
where
pulmonary vessels,
bronchi & lymph nodes
join thelungs.
 Bronchi – usually not
visible.
 Lung fields – usually not
visible throughout,
except for blood vessels.
infections and lymphoid leukemia. They decrease in actually exists.
numbers in acute viral infections. In a disease state,
lymphocytes will become reactive. A few reactive  Primary function of
lymphs on a blood smear is normal but if many are lymphocytes is to fight
reactive then this is a significant finding that the body is
chronic bacterial infection and
responding to an infection of somesort.
acute viral infections.
total white blood cells could indicate infection. Persons
who have lower numbers of granulocytes are more likely  Granulocytes help the body
to get frequent and severe infections. fight bacterial infections.
 Deviation from midline – tension pneumothorax, In chest x – rays, waves
atelectasis, pleural effusion. penetrate the chest and cause an image to
 Accentuated shadows – pneumothorax, emphysema, form on specially sensitized film. Normal
pulmonary abscess, tumor & enlarged lymph nodes.
pulmonary tissue is radiolucent, whereas
 Visible – atelectasis.
abnormalities such as infiltrates, foreign
bodies, fluids and tumors, appear as
densities on the film.
identify the cause of an infection. Often, detecting the presence of microorganisms and determining whether an infection is caused by an organism
that is Gram-positive or Gram-negative will be sufficient to allow a doctor to prescribe treatment with an appropriate antibiotic while waiting for more specific tests, such as a culture, to
be completed. A negative Gram stain is often reported as "no organism seen." This may mean that there is no bacterial infection present or that there were not enough microorganisms
present in the sample to be seen with the stain under a microscope. Positive Gram stain results usually include a description of what was seen on the slide. This typically includes
whether the bacteria are Gram-positive (purple) or Gram-negative (pink) as well as their shape — round (cocci) or rods (bacilli).

Sputum Culture and Sensitivity Test:

A sputum culture and sensitivity test is used to determine whether the patient's sputum (pulmonary secretion) contains pathogenic bacteria or other infectious
agents. If no bacteria or fungi grow, the culture is negative. If organisms that can cause infection (pathogenic organisms) grow, the culture is positive. The type of bacterium or fungus
will be identified with a microscope or by chemical tests. It it is Normal: Sputum that has passed through the mouth normally contains several types of harmless bacteria, including some
types of strep (streptococcus) and staph (staphylococcus). The culture should not show any harmful bacteria or fungi. If Abnormal: Harmful bacteria or fungi are present. The
most common harmful bacteria in a sputum culture are those that can cause bronchitis or pneumonia (Streptococcus pneumoniae, Staphylococcus
aureus, Haemophilus influenzae, Klebsiella pneumoniae, and Chlamydophila pneumoniae) ortuberculosis (Mycobacterium tuberculosis). Mycoplasma, a
group of organisms similar to bacteria, can also cause a type of pneumonia.

Arterial Blood Gas:

Arterial Blood Gas (ABG) Analysis is used to measure the partial pressures of oxygen (PaO2), carbon dioxide (PaCO2), and the pH of an arterial blood sample. Oxygen content
(O2CT), oxygen saturation (SaO2), and bicarbonate (HCO3-) values are also measured. A blood sample for ABG analysis may be drawn by percutaneous arterial puncture from an
arterial line. The ABG analysis is mainly used to evaluate gas exchange in the lungs. It is also used to assess integrity of the ventilatory control system and to determine the acid-bas
level of the blood. The ABG analysis is also used for monitoring respiratory therapy (again by evaluating the gas exchange in the lungs).

This section is a guide to analysis of the ABG. Follow the steps as indicated in order to best interpret the results:

step 1 - examine pH step 2 - examine CO2 step 3 - examine HCO3 step 4 - check PO2 levels

if low, indicates acidosis if if high, indicates respiratory acidosis if high, indicates metabolic alkalosis if low, indicates an interference with
high, indicates alkalosis (with low pH) if low, indicates (with high pH) if low, indicates ventilation process (should evaluate the
if normal, check to see if respiratory alkalosis (with high pH) metabolic acidosis (with low patient) if normal,
borderline (may be compensation) if normal, check for compensatory pH) if normal, check indicates patient is getting enough oxygen
problem for compensatory condition
Pulse Oximetry:

Pulse oximetry is a simple non-invasive method of monitoring the percentage of haemoglobin (Hb) which is saturated with oxygen. The pulse oximeter
consists of a probe attached to the patient's finger or ear lobe which is linked to a computerized unit. The unit displays the percentage of Hb saturated with oxygen
together with an audible signal for each pulse beat, a calculated heart rate and in some models, a graphical display of the blood flow past the probe. Audible alarms
which can be programmed by the user are provided. An oximeter detects hypoxia before the patient becomes clinically cyanosed.

Thoracentesis (in case of Pleural Effusion):

Thoracentesis is a procedure to remove fluid from the space between the lungs and the chest wall called the pleural space. It is done with a needle (and
sometimes a plastic catheter) inserted through the chest wall. This pleural fluid may be sent to a lab to determine what may be causing the fluid to build up in the
pleural space.

D. Actual Diagnostic Procedure

Name and Purpose Normal Actual Nursing

of the procedure Values Values Responsibilities

Hematology – grouped together  Explain the procedure to the significant others of the patient
into profiles or panels, requiring to gain cooperation and reduces anxiety.
one requisition and a single  Ask the mother if the baby had ever felt faint, sweaty or
nauseated when having blood drawn.
venous specimen.  Ask the mother to position he baby in a supine position and
 138-166g/l  139. 5 g/l N hold him still while getting the blood sample.
 Hemoglobin (Hgb)  Assess the veins to determine the best puncture site then tie
 0.380-550 l/l  0.387L/L N the tourniquet 5cm proximal to the area.
 Hematocrit (Hct)  Clean venipuncture site with an antimicrobial swab. Wiping
 4.2-6.5m/U  4.73 m/U N in a circular motion spiraling outward.
 RBC  Collect or withdraw 5-7ml of venous blood into the syringe.
 Apply pressure to the puncture site for 2-3 minutes or until
 WBC  4.0-12.0x10^g/l  9.2x10^g/l N bleeding stops.
 Check venipuncture site to see if hematoma has developed.
 Lymphocytes  25-50%  50.7% ↑  Observe client for signs and symptoms of anemia, including
pallor, dyspnea, chest pain and fatigue.
 Granulocytes  50-80%  Refer results to Physician.
 44.7% ↓

Chest X – ray:  Trachea – visible
midline in the anterior
The most commonly performed diagnostic mediastinal cavity.
x – ray examination. It is done to detect  Hila – (Lung Roots) –
pulmonary disorders, such as pneumonia, visible above the heart,
atelectasis, pneumothorax and others. It is where
pulmonary vessels,
non-invasive medical test. It marks images bronchi & lymph nodes
of the heart, lungs, airways, blood vessels join thelungs.
and the bones of the spine and chest.  Bronchi – usually not
visible.
 Lung fields – usually
 Streaky densities in both  Explain the procedure to the significant othersof
parahilar/paracardiac areas are the patient to gain cooperation and reduces anxiety.
seen.  Instruct the mother to remove all the objectslike jewelries (if
 The thymus gland is there is) in the body of the patient because it may interfere
with x-rayimages.
visible.
 The nurse should prepare the patient before going to X-ray
 Pulmovascularity is Room.
within normal limits.  Assist the x-ray technologist in obtaining the film.
 Heart is notenlarged.  Once the patient arrives at the exam area, the patient will
 Diaphragm is normal in position undress to the waist, and wear a gown or drape as provided
and contour. by the facility.
 Both costophrenic sulci
and visualized bonesare
ANATOMY AND PHYSIOLOGY OF ORGAN INVOLVED

Respiratory system
 The respiratory system is an intricate arrangement of spaces and passageways that conduct air from outside the body into the lungs and finally into the blood
as well as expelling waste gasses. This system is responsible for the mechanical process called breathing, with the average adult breathing about 12 to 20 times per
minute.

When engaged in strenuous activities, the rate and depth of breathingincreases in order to handle the increased concentrations of carbon dioxide in the blood.
Breathing is typically an involuntary process, but can be consciously stimulated or inhibited as in holding your breath.

Nostrils/Nasal Cavities
During inhalation, air enters the nostrils and passes into the nasal cavities where foreign bodies are removed, the air is heated and
moisturized before it is brought further into the body. It is this part of the body that houses our sense of smell.

Sinuses

The sinuses are small cavities that are lined with mucous membrane within the bones of the skull.

Pharynx
The pharynx, or throat carries foods and liquids into the digestive tract and also carries air into the respiratory tract.
Larynx
The larynx or voice box is located between the pharynx and trachea. It is the location of the
Adam's apple, which in reality is the thyroid gland and houses the vocal cords.

Trachea
The trachea or windpipe is a tube that extends from the lower edge of the larynx to
the upper part of the chest and conducts air between the larynx and the lungs.

Lungs
The lungs are the organ in which the exchange of gasses takes
place. The lungs are made up of extremely thin and delicate
tissues. At the lungs, the bronchi subdivides, becoming
progressively smaller as they branch through the lung tissue,
until they reach the tiny air sacks of the lungs called the
alveoli. It is at the alveoli that gasses enter and leave the blood stream.

Bronchi
The trachea divides into two parts called the bronchi, which enter the lungs.

Bronchioles
The bronchi subdivide creating a network of smaller branches, with the
smallest one being the bronchioles. There are more than one million
bronchioles in eachlung.

Avleoli
The alveoli are tiny air sacks that are enveloped in a network of
capillaries. It is here that the air we breathe is diffused into the blood,
and waste gasses are returned forelimination.

PATHOPHYSIOLOGY

E. Algorithm
 Precipitating Factor:
Predisposing Factor: age Environment

Entry of
microorganism
to nasal passages

Invasion of the
respiratory system

Activation of Coug
Immune response
(mucus production)

Ineffective immune
response results to
overwhelming
Infection

Invading/inflammation and
edema of lung parenchyma

Accumulation of
cellular debris, fluids Rale
and exudates in the
lungs

Massive
Hazy portion of the inflammation Dyspne
chest pain (pneumonia)

airway
narrows

Deep shallow
breathing

hypoxia ↑

F. Explanation

When the immune system is healthy, it can generally ward off the entrance of entrance of

organisms or control them from multiplying and causing disease.

Pneumonia may develop even in healthy individuals, however, when the infecting organisms are

very strong. Pneumonia is an inflammatory illness of the lung. Frequently, it is described as lung

parenchyma/alveolar (microscopic air-filled sacs of the lung responsible for absorbing oxygen from

the atmosphere) inflammation and (abnormal) alveolar filling with fluid. Pneumonia can result

from a variety of causes, including infection with bacteria, viruses, fungi, or parasites, and

chemical or physical injury to the lungs. Its cause may also be officially described as idiopathic,

that is unknown, when infectious causes have been excluded. Those with weaker immune systems

like infants or children are often the ones who catch pneumonia faster, usually after a flu infection.

There will be an activation of immune response through mucus production and if it is ineffective

immune response, it will lead to overwelming infections.

As the infecting organism enters the lungs, the lung tissues usually become swollen and

inflamed, particularly the air sacs or alveoli. This is often due to the migration of white blood cells

in the area to fight off the infection. The alveoli then becomes filled with pus and fluid resulting in

the manifestations of fever, cough, breathing problems and chills. Pneumococci spread from

alveolus to alveolus, thereby producing inflammation and consolidation along lobar compartments.

The function of the lungs become affected, and oxygen exchange may be reduced and becomes

inadequate for the need of the body. The alveolar exudate tends to consolidate so it increasingly

difficult to expectorate. The accumulation of cellular debris, fluids and exudates in the lungs also

contributes to the narrowing of airways which can lead to respiratory failure. This is why

pneumonia needs to be treated promptly as severe complications can happen.

MEDICAL and SURGICAL MANAGEMENT

A. Ideal Medical and Surgical Management

Medical:

 Outpatient (if affebrile without respiratory distress)

 Consider initial parenteral antibiotic at diagnosis

• Ceftriaxone 50 mg/kg/day up to 1 gram IM x1 dose

• It is a cephalosporin/cephamycin beta-lactam
antibiotic used in the treatment of bacterial infections
caused by susceptible, usually gram-positive,
organisms.

• Start oral antibiotics

 First-line oral agents

• Amoxicillin 90 mg/kg/day PO divided q8 hours x7-10d

• Amoxicillin is used to treat infections due to

organisms that are susceptible to the effects of
amoxicillin. Common infections that amoxicillin is
used for include infections of
the middle ear, tonsils, throat,
larynx (laryngitis), bronchi (bronchitis), lungs
(pneumonia), urinary tract, and skin. It also is used
to treat gonorrhea.

 Alternative oral agents

• Amoxicillin-Clavulanic Acid (Augmentin) or

• Amoxicillin kills or stops the growth of

bacteria that cause infection. Clavulanic acid
is added to help the amoxicillin to work
better. This medicine treats many different
kinds of infections.

• Erythromycin or

• Used to treat many different types of

infections caused by bacteria.

• Clarithromycin or

• Clarithromycin is used to treat many

different types of bacterial infections
affecting the skin and respiratory system.
 d. Azithromycin

- Used to treat certain infections caused by bacteria, such as

bronchitis; pneumonia; sexually transmitted diseases (STD);
and infections of the ears, lungs, skin, and throat. It works by
stopping the growth of bacteria.

G. Inpatient (if febrile or hypoxic)

 Cefotaxime 150 mg/kg/day IV divided q6 hours or

• An antibiotic used to treat a wide variety of bacterial

infections. This medication is known as a cephalosporin
antibiotic. It works by stopping the growth of bacteria.
This antibiotic treats only bacterial infections. It will not
work for viral infections

 Cefuroxime 150 mg/kg/day IV divided q8 hoursor

• Used to treat certain infections caused by bacteria, such

as bronchitis; gonorrhea; Lyme disease; and infections
of the ears, throat, sinuses, urinary tract, and skin.

 If confirmed Pneumococcal Pneumonia

a. Ampicillin alone 200 mg/kg/day divided q8 hours

- Used for treating bacterial infections.

H. Critically ill

Option 1

 Cefotaxime 150 mg/kg/day IV divided q6 hours and

 Erythromycin 40 mg/kg/day IV divided q6hours

Option 2
  Cefuroxime 150 mg/kg/day IV divided q8 hoursand

 Cloxacillin 150-200 mg/kg/day IV divided q6 hours

- used primarily to treat infections caused by

staphylococci, streptococci, or pneumococci.

Other Medicine:
Aminoglycosides – Aminoglycosides are a group of antibiotics that are used to treat

certain bacterial infections. This group of antibiotics includes at least eight drugs: amikacin,

gentamicin, kanamycin, neomycin, netilmicin, paromomycin, streptomycin, and tobramycin. All

of these drugs havethe same basic chemical structure.

Surgery:

Although most patients with pneumonia do not require invasive therapy, patients with

abscess, empyema, or certain other complications may require such treatment.

 Thoracotomy

Thoracotomy is the standard surgery for pneumonia. It requires general anesthesia and an

incision to open the chest and view the lungs.This procedure allowsthe surgeon to remove dead or

damaged lung tissue. Insevere cases, the entire lobe of the lung can be removed. This is called

alobectomy.Remaining healthy lung tissue re-expands after surgery to make up for any removed

tissue.

 Chest Tubes

Chest tubes are used to drain infected pleural fluid. Tubes are not typically required for

pneumonia or abscesses. The tubes are insertedafter the patient is given alocal anesthetic.

Theyremain in place for two to four days, and are removed in one quick movement. It can be very

distressing, although some

patients experience no discomfort. Complications of chest tubes include infection, accidental injury

of the lung, perforation of the diaphragm, and fluid build-up within the lung if the pleural fluid is

removed too rapidly. Removing the chest tubesmay cause the lung to collapse, requiring the

reintroduction of a chest tube to inflate thelung.

 Drainage of parapneumonic effusions with or without intrapleural instillation of a

fibrinolytic agent (eg, tissue plasminogen activator [TPA]) may be indicated.

B. Actual Medical and Surgical Management

Medical:

 The medications given to my patient were:

 Ampicillin 200mg IV q 6˚ - Bactericidal activity against susceptible

organisms. Alternative to amoxicillin when unable to take medication orally. The

baby was given this type of medication to treat the disease and the fact that he

cannot take the medication orally alone.

 Paracetamol 100mg/ml drops q 4˚/PRN – Antipyretic: Reduces fever by

acting directly on the hypothalamic heat-regulating center to cause vasodilation

and sweating, which helps dissipate heat. Baby boy also experienced fever

during his hospitalization so he was given an antipyretic drug to relief the fever.

 Salbutamol ½ neb+2cc PNSS q 4˚ - Used as a quick-relief agent for acute

bronchospasm and for prevention of exercise-induced bronchospasm. It is also

given to the baby to manage of reversible airway obstruction caused by the

underlying disease.

 Cetirizine 1mg/ml/2ml OD – Symptomatic relief of allergic rhinitis like,

sneezing, runny & itchy nose, watery eyes; allergic conjunctivitis.

 Baby boy received this medication to relief his runny nose to lessen his watery nasal discharges.

 Clarithromycin 125mg/5ml/2.5ml BID – Treatment of upper respiratory infections caused by streptococcus pyogenes or S.
pneumonia.

 During the hospitalization of Baby boy, he was given an IVF of D5 IMB

½ liter to prevent dehydration and to be consumed within 12 hours and hooked at right metacarpal vein with a drop factor of 41 – 42 uggts/min.
 Vitalsigns (Temperature,Pulse, andHeartRate) were taken every shift
and recorded accordingly for comparative baseline.
 Hydration therapy to liquify mucous secretions and improve secretion
clearance.
 Bed rest to lessen fatigue and conserve energy.
 Position appropriately to prevent aspiration into lungs.
 Monitor laboratory studies; complete blood count, sputum exams and others.
 Diet: Diet for age (milk feeding).
Surgical:
There was no surgical procedure done to my patient.
 NURSING CARE PLAN

NURSING NURSING NURSING

DIAGNOSIS OBJECTIVES INTERVENTIONS
ASSESSMENT ANALYSIS RATIONALE EVALUATION

S: PROBLEM 1: Microorganism Date: 3/32020 INDEPENDENT:  helps to check for any Date: 3/3/2020
enters the airway Time: 8 :00 am obstruction or Time: 2:00 PM
“Char hapte se  P – Ineffective passages  Assess airway accumulation of fluids
Khasi our sardi breathing pattern patency. and maintain adequate
hai bukhar bhi  E - Related to retained After 4 hours of airway patency Level of
secretions in the nursing intervention,  Assessed  Provides a basis for attainment:
aata hai Nak se the patient will:
bronchi. small blood respiratory evaluating adequacy of
pani aata hai.” As  Loosen
 S – as vessels in the rate. ventilation. - Goal
verbalized by the secretions in met.
evidenced by: lungs (capillaries)
mother of the baby. the lungs.  Noted chest  Use of accessory
become leaky,  Manifest relief of muscles of respiration
O: movement; use of
 (+) productive and protein-rich (or improvement may occur in AEB:
in) feelings of accessory muscles
fluid seeps into response to
 (+) productive shortness of during respiration. After 4 hours of
 cough the alveoli ineffective
breath. nursing
cough  Feel  Assess ventilation.
 With watery rate/depth of intervention, the
comfortable.
 With watery nasal discharges. respirations and  Tachypnea, shallow patient:
results in a less  The patient’s
significant others chest movement. respirations, and
nasal discharges.  Shortness of Loosened
functional area for Monitor for signs asymmetric chest
will Relate
 Shortness of breath breath at times. oxygen-carbon of respiratory movement are secretions in
causative factors
dioxide exchange failure (e.g., frequently present the lungs.
at times.  The impression of the and ways of
preventing or cyanosis and because of discomfort
 no cyanosis chest x – ray of severe tachypnea). of moving chest wall  Manifested
managing
Baby boy ineffective and/or fluid in lung. relief of (or
patient becomes  Auscultate lung  Decreased airflow improved in)
was relatively oxygen feelings
deprived, while of shortness of
retaining breath.
potentially
damaging carbon
 noted Pneumonitis. dioxide breathing fields, noting areas occurs in areas  Felt
pattern of the of decreased/ consolidated with fluid. comfortable
 The  adventitious breath
baby. absent airflow and Bronchial breath sounds  The patient’s
sounds Mucus production adventitious breath (normal over bronchus) significant
impression of sounds; e.g., can also occur in
is increased through others related
noted
the chest x – crackles, rales, consolidated areas. causative
 With white the leaky wheezes. Crackles, rhonchi, and factors and
ray of Baby densities wheezes are heard on ways of
colored sputum.
boy was  Place patient inspiration and/or preventing or
 Restlessness/ irritable into high expiration in response managing
Pneumonitis. fowler’s to fluid accumulation, ineffective
at
position. thick secretions, and breathing
 adventitious
times.  Advise mother to airway pattern of the
breath sounds Source: do back tapping. spasm/obstruction. baby.
Scribd.com  Maintain a  Maximize lung
noted
relaxed, calm expansion and decrease
 With white and non- respiratory effort.
colored stimulating
 Helps to manually
environment.
sputum. loosen or dislodge
 Restlessness/  Documented secretions.
respiratory
irritable at  Establish optimal rest/
secretions:
sleeppattern.
times. character and
 Expectorations may
 Initial V/S amount of
be different when
sputum.
taken as secretions are very
 Assist client with thick.
follows:
frequent deep-
RR: 42 bpm  Deep breathing
breathing exercises.
Demonstrate to facilitates
PR: 150 cpm
significant
T: 36.2 ˚C
 others/ help client maximum
learn to perform expansion of the
activity; e.g., lungs/smaller airways.
splinting chest and Coughing is a natural
effective coughing
while in upright self- cleaning
position. mechanism, assisting
the cilia to maintain
patent airways.
Splinting reduces chest
discomfort, and an
upright position favors
deeper, more forceful
cough effort.

1. Facilitates liquefaction
and removal of
secretions. Postural
drainage may not be
effective in interstitial
pneumonias or those
causing alveolar
COLLABORATIVE: exudates/destructi on.
Coordination of
1. Assist with/ monitor
effects of nebulizer treatments/schedul es
treatments and and oral intake reduces
other respiratory likelihood of vomiting
physiotherapy; with coughing and
e.g., incentive
spirometer, IPPB,
percussion,
postural drainage.
 Perform expectorations.
treatments
between meals and 2. Aids in reduction of
limit fluids when bronchospasm and
appropriate. mobilization of
secretions. Analgesics
2. Administer are given to improve
medications as cough effort by
indicated:e.g. reducing discomfort.
mucolytics, But should be used
expectorants, cautiously because they
bronchodilators, can decrease cough
analgesics. effort/ depress
respirations.

 Bronchodilator

 Salbutamol
½ neb+2cc
PNSS q4˚

NURSING NURSING NURSING

DIAGNOSIS OBJECTIVES INTERVENTIONS
ASSESSMENT ANALYSIS RATIONALE EVALUATION

S: PROBLEM 2: Infectious agents Date: 3/3/2020 INDEPENDENT: Date:3/3/2020

(Pyrogens) Time: 9:30am Time: :10:30 am
“Arhan ko bhukhar P – Hyperthermia Provide tepid sponge  Enhances heat loss
hai,badan bahot tap E – Related to bath. byevaporation&
raha hai physiologic After 1 hour of conduction.
response to Monitor
 infectious stimulate comprehensive patient’s vital signs  Notes progress Level of
 process. nursing (esp. temperature). and changes of attainment:
S – as evidenced by: Monocytes condition.
Varbalized by intervention, the
 Increased Promote bed rest, - Goal met.
release temperature of encourage
body
temperature patient will relaxation skills.  Reduces body
Pyrogenic cytokines
the mother of the (37.8 C) subside: from heat production. AEB:
patient.  Restlessness/ Stimulate 37.8 C to
Wrap extremities  Tominimize After 1 hour of
O: irritable at Anterior 37.4 C. with cotton shivering. comprehensive
times. hypothalamus blankets.
nursing
Increased body
 Skin:warm to intervention, the
temperature (37.8 results in COLLABORATIVE:
touch. temperature of
C)
 (+) productive  (-) Elevated  Administer anti-  Reduces fever by patient
thermoregulatory set pyretic as ordered. acting directly on the
dehydration
point Paracetamol hypothalamic heat-
 cough subsided: from
 flushedskin 100mg IVPRN. regulating center to
leads to cause vasodilation 37.8 C to
 With watery
 Administer and sweating, which
nasal Increased Heat 37.4 C.
conservation antibiotic as helps dissipate heat.
discharges. (Vasoconstriction/b ordered.  Ampicillin is used to
ehaviour changes) Ampicilin 200mg IV treat diseases caused
 Restlessness/ Increased Heat q °6. by bacterial
production (involuntary  Monitor
irritable at muscular contractions) infections.
laboratory values
times. as obtained.  Laboratory tests may
Skin: warm to result in
(Blood CS) indicate which
touch. organism is
 (-) dehydration FEVER responsible for fever.
 flushed skin
Reference:
NursingCrib.com
 NURSING NURSING NURSING
DIAGNOSIS OBJECTIVES INTERVENTIONS
ASSESSMENT ANALYSIS RATIONALE EVALUATION

S: PROBLEM 3: Persons at risk for Date: 3/3/2020 INDEPENDENT: Date: 3/3/2020

“Baby ko bukhar aa infection are those Time: 10 am Time: 1:00 PM
raha hai sister” As P – Risk forInfection whose natural defense  Monitor vital signs  During this period of
verbalized by the [Spread] mechanisms are closely, especially time, potentially fatal
mother of the patient. After 3 hours of during initiation complications may Level of
inadequate to protect
E – related to comprehensive of therapy. develop. attainment:
them from the
O: inadequate secondary nursing interventions
inevitable injuries and
defenses (presence of and health educating  Monitor the - Goal met.
Increased body exposures that occur
existing infection, the significant others following for signs
temperature (37.8 throughout the course
immunosuppression of the patient, they of infection:
C) of living. Infections AEB:
) will:
 (+) productive cough occur when an  Elevated
organism (e.g., Identify After 3 hours of
S – as evidenced by: temperature
 With watery bacterium, virus, interventions to  Very high fever comprehensive
[not applicable:
nasal discharges. fungus, or other accompanied by nursing
presence of signs and prevent, reduce risk
parasite) invades a and spread of sweating and chills interventions and
symptoms establishes
susceptible host. If the may indicate health educating
an actual diagnosis.] secondary
host’s (patient’s) septicemia. the significant
infection.  Color of
immune system others of the
respiratory  Yellow or yellow- patient, they:
cannot combat the
invading organism secretions green sputum is
indicative of Identified
adequately, an
infection occurs. respiratory interventions to
infection. prevent, reduce
 Demonstrate/
encourage good risk and spread of
hand  Effective means of secondary
reducing, clearing of
infection.

 Promotes
 Shortness of Infections prolong washing expectoration, infection.
healing, and can result technique. clearing of
breath at
in death if untreated.  Change position infection.
times. frequently and
provide good  Reduces likelihood of
 no cyanosis noted pulmonary toilet.
exposure to other
Source: NANDA  Limit visitors as
 Restlessness/ infectious pathogens.
indicated.
irritable at
 Patients with poor
nutritional status may
be anergic, or unable to
times. muster a cellular
Skin: warm to immune response to
touch.  Assess pathogens and are
 (-) dehydration nutritional status, therefore more
flushed skin including weight, susceptible to infection.
history of weight
 The impression of loss, and serum
the chest x– ray of albumin. Antimicrobial drugs
Baby boy was include antibacterial,
Pneumonitis. antifungal, antiparasitic,
 adventitious breath and antiviral agents.
sounds noted
 With white COLLABORATIVE:
 Ampicillin is
colored sputum.
Administer or teach used to treat
use of diseases caused
by bacterial
infections.
antimicrobial
(antibiotic) drugs
as ordered.

 Ampicilin
200mg IV q °6.
  Treatment of
upper respiratory
infections caused by
streptococcus pyogenes
 Clarithromycin or S. pneumonia.
125mg/5ml/2.5 ml
BID
 PROMOTIVE AND PREVENTIVE MANAGEMENT

The following promotive and preventive managements will be imparted to mother of the baby:

 Promote adequate ventilation:

 Note color, amount, and odor of secretions.

 Tell to the mother the importance and proper way of giving expectorants as

prescribed.

 Encourage parents to maintain adequate hydration of the baby

because adequate hydration liquify viscous secretions and improve secretion

clearance.

 Teach how to use nebulization to promote mucus secretions.

 Perform mild chest physiotherapy to promote mobilization of secretions for easier expectorations.
 Instruct mother to avoid over exposure to crowded places because some people might have
existing infection and the baby may acquire it.

 Advice mother not to ignore cough and colds. Rather encourage mother to visit health centers for
the child to be examine.

 Instruct mother to elevate head of the baby when feeding to prevent aspiration.
 Teach the mother how to count the RR of the baby because RR is one of the major indicators of
complications.

 Encourage parents to maintain good personal hygiene of the baby and

even the whole member of the family, cover nose and mouth when sneezing or coughing and wash

hands after sneezing, coughing, cleaning the nose or going to the toilet.
 Ensuring that children have adequate nutrition, including exclusive

breastfeeding during the first six months of life, can help protect them from pneumonia.

 Tell to the parents the importance of having the baby vaccinated or complete the immunity.

 Viral Influenza Vaccines (Flu Shot) – Vaccines against the flu (or a

"flu shot") use inactivated (not live) viruses. They are designed to provoke

the immune system to attack antigens contained on the surface of the virus.

 Pneumococcal Vaccines – The pneumococcal vaccine protects against S.

pneumoniae bacteria, the most common cause of respiratory infections.

 DRUG STUDY

Name Dosage Mechanism Indication Contraindication Adverse Nursing

and
of Drug Frequency of Action Effects Responsibilities

I. Explain the action of

the drug to the
Respiratory tract Lethargy, watcher.
Infections caused by hallucinations, J. Before giving drug,
S. pneumoniae (for Contraindicated to seizures, dizziness, wait for the result of
merly D. patients nausea, vomiting, the skin test.
Ampicillin 200mg IV An aminopenicillin hypersensitive to gastritis, anemia,
pneumoniae). K. Confirm the
q 6˚ that inhibits cell wall drugs or other agitation, confusion, activation and
Staphylococcus
synthesis during prenicillins. stomatitis. admixture of vial
aureus(penicillina se
microorganism contents.
and nonpenicillinasepr
multiplication.
oducing), H. L. Check for leaks by
influenzae, and squeezing container
Group A beta- firmly. If leaks are
hemolytic found, discard
unit as
Streptococci.
sterility may be
impaired.

M. Give drug 1-2 hours

before or 2-3 hours
after meals.

100mg/m Decreases fever Relief of mild to Contraindicated In rare cases  Verify the
l drops by inhibitingthe moderate pain with allergy to hypersensitivity doctor’s order.
Paracetamol q 4˚/PRN effects of and treatment of acetaminophen. reactions,  Assess patient’s
pyrogens on the fever predominantly skin fever.
hypothalamic Use cautiously with allergy (itching and  Assess allergic
action leading to impaired hepatic rash), may appear. reaction.
function. Long- term treatment  Assess
sweating and with high doses may hepatotoxicity.
vasodilation. cause a toxic hepatitis  Monitor liver and
with following initial
Relieves pain by renal function
symptoms: nausea,
inhibiting the test.
vomiting, sweating,
and discomfort.  Monitor blood
prostaglandin
Occasionally a studies, especially
synthesis at the CBC and pro-time if
gastrointestinal
CNS but does not patient is on long-term
discomfort may be
have anti- seen. therapy.
inflammatory
action because of
its minimal effect
on peripheral
prostaglandin
synthesis.
Stimulates beta 2 Relief of Hypersensitivity Headache;  Determine history of
receptors of Bronchospasm in to Salbutamol, also tremor; tachycardia; previous medication.
Salbutamol ½ bronchioles by bronchial asthma toatropine and its hypertension; anxiety.  Monitor for evidence of
neb+2cc increasing levels of chronic derivatives. Rarely allergic reaction.
PNSS q camp which relaxes Bronchitis nausea,  Assess lung sounds,
4˚ smooth Emphysema pulse, and blood
muscles to and other pressure before
Produce Reversible vomiting, and administration and
Bronchodilatation. Obstructive skin rash can during peak of
Pulmonary be observed medication. Note
diseases.
 amount, color, and
character of
sputum produced.
 Monitor pulmonary
function tests before
initiating
therapy and
periodically
throughout course to
determine
effectiveness of
medication.
 Observe for
paradoxical
bronchospasm
(wheezing). If
condition occurs,
withhold medication
and
notify physician or
other healthcare
professional
immediately.

Symptomatic relief Contraindicated in Central nervous  Explain the action of

Competes with of allergic rhinitis patients system: the drug to the
Cetirizine 1mg/ml/ histamine forH1- like, sneezing, runny hypersensitive to Somnolence, watcher.
receptor sites on & itchy nose, watery fatigue, dizziness  Tell the mother that
2ml OD drug or any of its
effector cells in the eyes; allergic breast-feeding is not
conjunctivitis. components, in Gastrointestinal:
gastrointestinal recommended.
tract, blood vessels, breastfeeding Xerostomia
and respiratory tract women. Used
cautiously in
 patients with  Instruct mother to use
renal or liver a specially marked
impairment. spoon or container to
measure your
medicine.

125mg/5 Hypersensitivity to Central nervous  Tell patient’s

ml/2.5ml Exerts its clarithromycin, system: Headache significant others to
Clarithromyci
BID antibacterial action erythromycin, or take drug as prescribed
n bybinding to 50S any macrolide Gastrointestinal: even after he feels
ribosomal subunit antibiotic; use with Diarrhea, nausea, better.
resulting in inhibition pimozide, abnormal taste,  Advice mother of the
of protein synthesis. astemizole, heartburn, patient to report
cisapride, abdominal pain persistent adverse
terfenadine effect seen on the baby.
Skin: rash,  Inform mother of the
urticaria baby that drug
may be taken with or
without food.