CamaristaColeen Mae - PNEUMONIA (Case Study 1)

ILOILO DOCTOR’S COLLEGE
BACHELOR OF SCIENCE IN NURSING

West Avenue Timawa, Molo, Iloilo City
NCM 112 (RLE)

CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND
ELECTROLYTES, INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC
RESPONSE, CELLULAR ABERRATIONS, ACUTE AND CHRONIC
Case Scenario 1
Pneumonia
A Case Study Presented to the Department of Nursing of Iloilo Doctor’s College
PRESENTED TO: MRS.

Arvi Tenderly V. Melliza, RN, M.A.N.
(NCM 112 RLE & SKILLS CLINICAL INSTRUCTOR)
PRESENTED BY:
Abenido, Mary Claire Cartera, Riza June
Alayon, Hannah Marie Claro, Meryll Joy
Anatan, Raenacet Catubay, Jade B.
Camariosa, Shelynar
Feliciano, Dee D Rhae
Camarista, Coleen Mae C.
(BSN III-G GROUP 1)
SEPTEMBER 4, 2021

TABLE OF CONTENTS
I...............................................................................INTRODUCTION
A. Objectives:
1. General Objective
2. Specific objectives (KSA) format
II. . .....................................................NURSING HEALTH HISTORY
III . ..........................................................PHYSICAL EXAMINATION
IV........................................ANATOMY AND PATHOPHYSIOLOGY
V..........................DIAGNOSIS AND LABORATORY PROCEDURE
VI. ....................................................................NURSING PROCESS
VII. ..........................................................................DRUG STUDY
VIII. .............................DISCHARGE PLAN/HEALTH TEACHING
IX.. ...............................................................ARTICLE/JOURNAL
I. INTRODUCTION
Pneumonia is an inflammation of the lung parenchyma that is caused by a
microbial agent. Pneumonitis is a more general term that describes an inflammatory process in
the lung tissue that may predisposes a patient to or places a patient at risk for microbial
invasion. Pneumonia is the most common cause of death from infectious diseases in the United
States. It is the seventh leading cause of death in the United States for all ages and both
genders, resulting almost 70,000 deaths per year. In persons age 65 years and older, it is the
fifth leading cause of death (National Center for Health Statistics). It is treated extensively on
both an inpatient and outpatient basis. Bacteria will commonly enter the lower airway but do
not cause pneumonia in the presence of intact defense mechanism. When pneumonia does
occur, it is caused by various microorganisms, including bacteria, mycobacterium, Chlamydia,
mycoplasma, fungi, parasites, and viruses. Classically, pneumonia has been categorized into one
of four categories: bacterial or typical, atypical, aerobic/cavitary, and opportunistic.
Pneumonia can be classified into four types: community-acquired pneumonia (CAP), health
care–associated pneumonia (HCAP), hospital acquired pneumonia (HAP), and VAP (American
Thoracic Society & Infectious Diseases Society of America, 2005; File, 2016). HCAP was added as
a category in 2005 to identify patients at increased risk for multidrug resistant (MDR) pathogens
versus community-acquired pathogens (File, 2016). Community-acquired pneumonia (CAP)
occurs either in the community setting or within the first 48 hours after hospitalization. Hospital
Acquired pneumonia (HAP) also known as nasocomial pneumonia is defined as the onset of
pneumonia symptoms more than 48 hours after admission in patients with no evidence of
infection at the time of admission. Ventilator Associated Pneumonia (VAP) individual connected
to ventilator, microbes can move from endotracheal lube directly unto the lung. Aspiration
Pneumonia gastric secretion, fluid food, tube feedings into airways. Lobar Pneumonia complete
consolidation of whole lobe of the lung. Broncho Pneumonia infection can be throughout the
lung involving the bronchioles as well as the alveoli.
Classifications and Definitions of Pneumonias

Community-acquired pneumonia (CAP): Pneumonia occurring in the community or
≤48 hours after hospital admission or institutionalization of patients who do not meet the
criteria for health care–associated pneumonia (HCAP)
Health care–associated pneumonia (HCAP): Pneumonia occurring in a

nonhospitalized patient with extensive health care contact with one or more of the following:
 Hospitalization for ≥2 days in an acute care facility within 90 days of infection
 Residence in a nursing home or long-term care facility
 Antibiotic therapy, chemotherapy, or wound care within 30 days of current infection
 Hemodialysis treatment at a hospital or clinic
 Home infusion therapy or home wound care
 Family member with infection due to multidrug-resistant bacteria
Hospital-acquired pneumonia (HAP): Pneumonia occurring ≥48 hours after hospital

admission that did not appear to be incubating at the time of admission
Ventilator-associated pneumonia (VAP): A type of HAP that develops ≥48 hours after
endotracheal tube intubation.
OBJECTIVES
A. General Objectives
This study aims to convey familiarity and to provide an effective nursing
care to a patient diagnosed with Pneumonia through understanding the patient history,
disease process and management.
B. Specific Objectives
A. Knowledge
• Define the meaning of Pneumonia
• Know the pathophysiological basis of the Pneumonia
• Determine signs and symptoms and risk factors/causes of Pneumonia
• Determine appropriate nursing care management for client with Pneumonia
• Formulate plan of care for clients with Pneumonia
• Provide accurate information about the topic
B. Skills
• Assess a woman who is experiencing a Pneumonia
• Apply different assessment techniques to determine the patients need
• Evaluate the plan of care needed
• Formulate nursing diagnoses that address the needs of the client experiencing
Pneumonia
• Collaborate with health team member in planning and performing client care
• Document expected outcomes for effectiveness and achievement of care.
C. Attitude
• Build rapport with the client to build trust.
• Respect client decision (race, culture, values and beliefs)
• Maintain confidentiality regarding patient records/information
• Explain the importance of follow up check-up.
• Establish therapeutic relationship with client and family
• Acknowledge client needs using holistic approach

• Display confidence in providing nursing care to the client.
• Develop teamwork and collaboration to the health care team member
II. NURSING HEALTH HISTORY
a. Biographical Data
Name: Mr. Roque
Age: 58 years old
Sex: Male
Civil Status: Married
b. Chief Complaint
 high grade fever and chills and difficulty of breathing.
c. Past Medical History

 Past medical history reveals he is hypertensive.
 Has pollen allergies and frequently suffers from rhinitis.
d. Present Illness History

 1 week prior to admission the patient had cough associated with back pain
and has poor appetite.
e. Lifestyle
 He has been a smoker since he was in high school at an early age of 18
years old. Consumes 2 sticks of cigarettes per day.
 He works in an office as a consultant and often works overtime. Due to his
nature of work, he is occasionally sent by the manager as a representative
of the company to travel places for any work related activities.
III. PHYSICAL EXAMINATION
A. General Survey
Clinical assessment revealed the following information:
● Pulse - 85 bpm
● Temperature - 38.5ºC
● BP - 130/80 mmHg
● Respiratory Rate - 28 cpm
● O2 Saturation 90% on room air
● Weight - 65 kg
● Decreased breath sounds and with rales/crackles on the left lower lung
segments upon auscultation.
● Occasional productive cough with yellow sputum, rapid and shallow
breathing.
● Patient looks restless and pale.
● Patient has inflamed throat.
Chief complaints
● He reported that he has a high grade fever, chills and difficulty in breathing.
B. Overall Assessment (from head to extremeties)

1. General Appearance: Patient is weak
a) Nourishment- Well
b) Body build- Thin

c) Health- Disturbed
d) Activity- Dull
2. Skin: Patient is pale. No lesions found.
3. Hair: Hair is black in color and medium in course.
4. Nails: Capillary refill test is less than 3 seconds. Nails are short and clean.
5. Skull, Head and Face:
a) Shape of skull- Normal
b) Scalp- Clean
c) Face- No any evidence of infection and facial features are
symmetrical
6. Eyes:
a) Vision- Normal
b) Discharge- No any discharge from eye
c) Lesions- No any lesion
7. Ears:
a) External ear- Normal in size annd shape
b) Hearing- Normal
c) Discharge- No any discharge
8. Nose: Nose is symmetrical in shape.
a) External nose- No any deformity
b) Nostrils- No discharges found.
9. Mouth and Pharynx:
a) Odour- No foul smell
b) Mucus membrane- Soft and pink

10.Throat: Patient’s throat is inflamed.
11.Neck: Neck muscles are equal in size. No lesions found.
a) Lymph nodes- Not palpable
b) Thyroid gland- Not enlarged
c) Range of motion- Normal
12. Back: No any lordosis, kyphosis or scoliosis is present
13. UPPER EXTREMITIES: Patient’s upper limbs, shoulders and arms were
symmetrical. No deformities and swelling noted. No tenderness on the
bones of the wrists and fingers. No structural deviations
14. Lower Extremities: No any limp. Movements are normal. No varicose.
IV. ANATOMY AND PHYSIOLOGY

Anatomy
Upper Respiratory Tract
Upper airway structures consist of the nose; paranasal sinuses; pharynx, tonsils, and
adenoids; larynx; and trachea.
Nose
The nose serves as a passageway for air to pass to and from the lungs. It filters impurities and
humidifies and warms the air as it is inhaled. The nose is composed of an external and an
internal portion.
Paranasal Sinuses
The paranasal sinuses include four pairs of bony cavities that are lined with nasal mucosa and
ciliated pseudostratified columnar epithelium. These air spaces are connected by a series of
ducts that drain into the nasal cavity. The sinuses are named by their location: frontal, ethmoid,
sphenoid, and maxillary. A prominent function of the sinuses is to serve as a resonating
chamber in speech. The sinuses are a common site of infection.
Pharynx, Tonsils, and Adenoids

The pharynx, or throat, is a tubelike structure that connects the nasal and oral cavities to the
larynx. It is divided into three regions: nasal, oral, and laryngeal. The nasopharynx is located
posterior to the nose and above the soft palate. The oropharynx houses the faucial, or palatine,
tonsils. The laryngopharynx extends from the hyoid bone to the cricoid cartilage. The epiglottis
forms the entrance to the larynx.
Larynx
The larynx, or voice box, is a cartilaginous epithelium-lined organ that connects the pharynx and
the trachea and consists of the following:
 Epiglottis: a valve flap of cartilage that covers the opening to the larynx during
swallowing
 Glottis: the opening between the vocal cords in the larynx
 Thyroid cartilage: the largest of the cartilage structures; part of it forms the Adam’s
apple
 Cricoid cartilage: the only complete cartilaginous ring in the larynx (located below the
thyroid cartilage)
 Arytenoid cartilages: used in vocal cord movement with the thyroid cartilage
 Vocal cords: ligaments controlled by muscular movements that produce sounds; located
in the lumen of the larynx
Trachea
The trachea, or windpipe, is composed of smooth muscle with C-shaped rings of
cartilage at regular intervals. The cartilaginous rings are incomplete on the posterior surface
and give firmness to the wall of the trachea, preventing it from collapsing. The trachea serves as
the passage between the larynx and the right and left main stem bronchi, which enter the lungs
through an opening called the hilus.
Lower Respiratory Tract

The lower respiratory tract consists of the lungs, which contain the bronchial and alveolar
structures needed for gas exchange.
Lungs
The lungs are paired elastic structures enclosed in the thoracic cage, which is an airtight
chamber with distensible walls. Each lung is divided into lobes. The right lung has upper,
middle, and lower lobes, whereas the left lung consists of upper and lower lobes. Each lobe is
further subdivided into two to five segments separated by fissures, which are extensions of the
pleura
Pleura
The lungs and wall of the thoracic cavity are lined with a serous membrane called the
pleura. The visceral pleura covers the lungs; the parietal pleura lines the thoracic cavity, lateral
wall of the mediastinum, diaphragm, and inner aspects of the ribs.
Mediastinum
The mediastinum is in the middle of the thorax, between the pleural sacs that contain
the two lungs. It extends from the sternum to the vertebral column and contains all of the
thoracic tissue outside the lungs (heart, thymus, the aorta and vena cava, and esophagus).
Bronchi and Bronchioles

There are several divisions of the bronchi within each lobe of the lung. First are the lobar
bronchi (three in the right lung and two in the left lung). Lobar bronchi divide into segmental
bronchi (10 on the right and 8 on the left); these structures facilitate effective postural drainage
in the patient. Segmental bronchi then divide into subsegmental bronchi.
Alveoli
The lung is made up of about 300 million alveoli, constituting a total surface area between 50
and 100 m2 (Porth, 2015). There are three types of alveolar cells. Type I and type II cells make
up the alveolar epithelium. Type I cells account for 95% of the alveolar surface area and serve
as a barrier between the air and the alveolar surface; type II cells account for only 5% of this
area but are responsible for producing type I cells and surfactant.
Pathophysiology
Normally, the upper airway prevents potentially infectious particles from reaching the
sterile lower respiratory tract. Pneumonia arises from normal flora present in patients whose
resistance has been altered or from aspiration of flora present in the oropharynx; patients often
have an acute or chronic underlying disease that impairs host defences. Pneumonia may also
result from blood borne organisms that enter the pulmonary circulation and are trapped in the
pulmonary capillary bed. Pneumonia affects both ventilation and diffusion. An inflammatory
reaction can occur in the alveoli, producing an exudate that interferes with the diffusion of
oxygen and carbon dioxide. White blood cells, mostly neutrophils, also migrate into the alveoli
and fill the normally air-filled spaces. Areas of the lung are not adequately ventilated because of
secretions and mucosal edema that cause partial occlusion of the bronchi or alveoli, with a
resultant decrease in alveolar oxygen tension. Bronchospasm may also occur in patients with
reactive airway disease. Because of hypoventilation, a ventilation–perfusion (V./Q.) mismatch
occurs in the affected area of the lung. Venous blood entering the pulmonary circulation passes
through the under ventilated area and travels to the left side of the heart poorly oxygenated.
The mixing of oxygenated and unoxygenated or poorly oxygenated blood eventually results in
arterial hypoxemia.
If a substantial portion of one or more lobes is involved, the disease is referred to as

lobar pneumonia. The term bronchopneumonia is used to describe pneumonia that is
distributed in a patchy fashion, having originated in one or more localized areas within the
bronchi and extending to the adjacent surrounding lung parenchyma. Bronchopneumonia is
more common than lobar pneumonia.
Diagram of Pneumonia
PRE-FACTOR: CIPITATING
PREDISPOSING FACTOR:
Age: 58 years old Etiology: Work related stress

Smoker
Streptococcus
Hypertension
Pneumoniae
Allergies
Infectious agent foreign substance, blood

borne organisms that enter the blood
circulation of aspiration of gastric content
Cause inflammation of pulmonary tissue affecting both ventilation and

diffusion
Edema of alveolar Alveolar fill with

membrane occurs exudate from
inflammation
Causing occlusion of Interferes with

alveoli resulting in diffusion of oxygen
decrease alveolar and carbon dioxide
oxygen tension
Signs & Symptoms

manifested by the pt:
Signs & Symptoms:
Hypoxia occur with
Fever and Chills
 Sweating retention ofcarbon
Difficulty of breathing
 breath dioxide, shortness of
 Decreased breath
 Productive cough breath, fatigue,
sounds with
 Crackling sounds crackles in lungs or
rales/crackles on left
on affected area decrease breath
lower lung
 Hemoptysis sounds.
 OccasionalProductive
 Tachypnea
cough with yellowish
sputum
 Rapid and shallow
breathing
 Swollen and inflamed
throat
V. LABORATORY AND DIAGNOSIS

DIAGNOSTIC EXAMINATION RESULTS
Laboratory Normal
Results Significance
Test Values
Normal: Normal results (This test may also be
4.5–5.9 × 106 cells/mm3
used to help diagnose and/or monitor a number of
RBC 4.98 (men) 4.1–5.1 × 106
diseases that affect the production or lifespan of
cells/mm3 (women)
red blood cells.)
Normal results (Hemoglobin is a protein in your

14–18 g/dL (men) 12–16
Hemoglobin 150g/dl red blood cells that carries oxygen from your
g/dL (women)
lungs to the rest of your body.)
Normal Results (A hematocrit test measures how
much of your blood is made up of red blood cells.
42%–50% (men) 36%–45%
Hematocrit 0.45%
(women)
Red blood cells contain a protein called
hemoglobin that carries oxygen from your lungs
to the rest of your body. )
Normal results (To screen for or diagnose various
Platelet counts 200,000/L 150,000 – 450,000 microliter diseases and conditions that can cause problems
with blood clot formation)
Abnormal: WBC is high related to bacterial
infection.
WBC 23.84 4.5–11.0 × 103 cells/mm3
Normal results (Neutrophils are a type of white

1.70-7.00 x 109
Neutrophils 0.83 blood cell that helps heal damaged tissues and
/L
resolve infections. )
Abnormal: Results is low related to possible
0.90-2.90 x 109
Lymphocytes 0.09 infection.
/L
Abnormal: Results is slightly low related to

Monocytes 0.01 0.30-0.90 x 109 /L
restless and pale. Also, elevated temperature.
Eosinophils 0.01 0.05-0.50 x 109 /L Abnormal: Results is low related to infection
Abnormal: Results is normal (Doctors may order

0.00-0.30 x 109 basophil level tests to help diagnose certain health
Basophils 0.1
/L problems)
Lab EXAM RESULTS NORMAL VALUES SIGNIFICANCE

Urinalysis Color: Straw Color: Yellow Results is normal (Normal urine is clear and a light or
(light/pale to straw yellow color, and any change in the color or
dark/deep amber) clarity of your urine can indicate a possible health
issue such as a urinary tract infection (UTI))
Transparency: Hazy Transparency: Clear Results is not normal. (Certain conditions can cause
or cloudy. excess protein or crystalline substances in the urine,
causing it to persistently appear cloudy or foamy.
Infections anywhere in the urinary tract (UTIs),)
Ph: 5.0 Ph: 4.5-8 Results is normal (Normal urine pH is slightly acidic)
Sp Gravity: 1.015 Sp Gravity: 1.005- Results is normal (A very high specific gravity means
1.025 very concentrated urine, which may be caused by
not drinking enough fluid, loss of too much fluid
(excessive vomiting, sweating, or diarrhea), or
substances (such as sugar or protein) in the urine.)
Albumin: Negative Albumin: A healthy kidney
doesn't let albumin pass from the urine.
Albumin: Negative Albumin: A healthy kidney doesn't let albumin pass from the
blood into the urine. A damaged kidney lets some
albumin pass into the urine.
sugar: Negative Sugar: A positive urine glucose test would indicate that the
blood glucose level is very high, and a negative urine
glucose test could mean that the level is low,
normal, or slightly elevated
V. DIAGNOSTIC EXAMINATION RESULTS
X-RAY Chest X-ray PA view- X-ray: An x-ray exam will allow your doctor Results is not normal related
left lower lobe to see your lungs, heart and blood vessels to infection evidence by
infiltration to help determine if you have pneumonia. infiltration.
When interpreting the x-ray, the
radiologist will look for white spots in the
lungs (called infiltrates) that identify an
infection.
SPUTUM POSITIVE : A sputum culture is a test to find germs Results is not normal related
CULTURE STREPTOCOCCUS (such as bacteria or a fungus) that can to infection evidenced by a
PNEUMONIAE cause an infection. A sample of sputum is positive sputum culture.
added to a substance that promotes the
growth of germs. If no germs grow, the
culture is negative. If germs that can cause
infection grow, the culture is positive.
VI. Nursing Care Plan
DEFINING
NURSING NURSING
CHARACTERISTIC PLANNING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION
S
Subjective: Ineffective Short Term: Independent: After 1 week of

Chief complaint airway After 24 hours - monitor - To have a nursing
of high grade clearance of nursing respiratory baseline intervention,
fever and chills related to intervention status, vital data patient will be
and difficulty of copious the patient will signs, able to
breathing tracheobronc be able to breath demonstrate
hial improved sound and improved airway
“Hindi ako ka secretions as airway patency skin color patency, as
ginhawa” evidenced by and adequate evidenced by
difficulty in oxygen, rest to - Encourage - To improve adequate
breathing conserve coughing airway patency, oxygenation by
Objective: energy, and deep the nurse pulse oximetry
- BP - Rationale: maintenance of breathing encourages the or arterial blood
Inability to proper fluid exercises patient to gas analysis,
130/80mmHg
clear volume, . perform an normal
- PR: 85 bpm secretions or maintenance of effective, temperature,
obstructions adequate directed cough, normal breath
- RR: 28 cpm
from the nutrition which includes sounds, and
- Temp: 38.5ºC respiratory correct effective
tract to Long Term: positioning, a coughing
- Oxygen maintain a After one week deep inspiratory
saturation: clear airway. of nursing maneuver,
90% intervention glottis closure,
the patient will contraction of
be able to the expiratory
understand of muscles against
the treatment the closed
protocol and
glottis, sudden
preventive
glottic opening,
measures, and
absence of and an explosive
complications. expiration.
- Position - to promote
client in lung expansion
semi-fowler’s
position
- Promoting
rest and - to decrease
conserving
oxygen need
energy
- Practice hand
washing and
proper - to prevent
disposal of spread of
secretion
infection
- Encourage
fluid up to 3
liters a day - increased
unless respiratory rate
contraindicat leads to an
ed increase in
insensible fluid
loss during
exhalation and
can lead to
dehydration.
VII. DRUG STUDY

Name of Classification Indication and Side effects or Special Precautions Nursing Responsibilities
Drug and Mechanism Contraindication Adverse
of Action Reactions
Classification: Indications Adverse  Dialyzable drug:  Drugs can be used

Anti- Reaction: No alone or with other
Generic  Neuropathy
Hypertensive  Overdose S&S: anti-hypertensives.
Name: with patients  CNS:
Hypotension,  If antihypertensive
Losartan with type 2 Headache,
tachycardia, effect is inadequate
Potassium diabetes dizziness,
Mechanism of bradycardia using once-daily
syncope,
Action: does, a b.i.d.
insomnia
 Especially tell regimen using the
Brand Name: Inhibits  To reduce risk  CV: edema,
inform the doctor same or increased
vasoconstrictive of stroke in chest pain
Cozaar if patient is taking total daily dose
and patients with  EENT: nasal
of the following: may give a more
aldosterone- hypertension congestion,
 potassium satisfactory
secreting action and left sinusitis,
Dosage: supplements response
of angiotensin II ventricular pharyngitis,
50mg  salt substitutes  Monitor patient’s
by blocking hypertrophy sinus disorder
containing BP closely to
angiotensin II  Dermatologic:
Contraindications: potassium evaluate
receptor on the Rash,
Route: PO  other medicines effectiveness of
surface of  Contraindicate pruritus,
that may increase therapy.
vascular smooth d with alopecia, dry
serum potassium  When used alone,
muscle and patients skin
 water pills drugs has less of an
Frequency: other tissue cells hypertensive  GI: diarrhea,
(diuretics) effect on BP in
OD drugs abdominal
 lithium (a black patients than
pain, nausea,
medicine used to in patients of other
constipation,
treat a certain races.
 dyspepsia
Concomitant kind of  Monitor patients
use with  Musculoskele depression) who are also taking
aliskiren is tal: muscle  medicines used to diuretics for
contraindicate cramps, treat pain and symptomatic
d in diabetic myalgia, back arthritis, called hypotension.
or leg pain.
patients non-steroidal  Regularly assess
 Respiratory: anti-inflammatory patient’s renal
cough, URI drugs (NSAIDs), function (via
 Use cautiously including COX-2 creatinine and BUN
in patients inhibitors levels).
with impaired  other medicines  Patients with
renal or to reduce blood severe HF whose
hepatic pressure renal function
function depends on the
angiotensin-
aldosterone system
may develop acute
renal failure during

therapy. Closely
monitor patient’s
BP renal function,
and potassium
levels, especially
during first few
weeks of therapy
and after dosage –
adjustments.
Name of Drug Classification and Indication and Side effects or Special Precautions Nursing
Mechanism of Contraindication Adverse Reactions Responsibilities
Action
Classification: Indications Adverse Reaction:  Dialyzable drug:  Monitor patient

Antibiotics unknown for
Generic Acute bacterial  CNS:
 Serious cases of superinfection.
Name: worsening of Headache,
allergic reactions, Drug may cause
Azithromycin COPD caused dizziness,
Mechanism of including overgrowth of
by fatigue,
Action: angioedema, nonsusceptible
Haemophilus somnolence
anaphylaxis, bacteria or fungi
Brand Name: Binds to the 50S influenza or  CV:
Steven-Johnson  If patient vomits
subunit of bacterial Streptococcus palpitations,
syndrome, toxic within 60
AzaSite, pneumonia; chest pain
ribosomes blocking epidermal minutes of taking
Zithromax, uncomplicate  EENT: eye
protein synthesis; necrolysis, and Zmax, notify
Zmax d skin and irritation
bacteriostatic or DRESS syndrome prescriber;
bactericidal, skin-structure  Dermatologic: have been additional or
depending on infections Rash, pruritus, reported, some different therapy
Dosage: concentration. caused by photosensitivit with fatalities. may be needed.
500mg Staphylococc y reactions,  Don’t use oral  Monitor patient
us aureus, pain at drug in patients for CDAD, which
Streptococcus injection site with pneumonia may range in
Route: PO pyogenes, or  GI: diarrhea, or those with severity from
Streptococcus anorexia, moderate to mild diarrhea to
agalactiae; abdominal severe illness or fatal colitis.
second line pain, nausea,
Frequency: risk factors  Monitor patient
therapy for vomiting,
OD  Use cautiously in for allergic and
pharyngitis or pseudomembr
(8: 00 P.M.) tonsillitis anous colitis, patients with skin reaction.

for 7 days caused by S. dyspepsia, impaired hepatic Discontinue drug
pyogenes. flatulence, function or if reaction
Community- melena myasthenia occurs.
acquired  Hepatic: gravis  Monitor patient
pneumonia cholestatic  Use cautiously in for jaundice,
caused by jaundice patients at hepatotoxicity,
Chlamydophil increased risk for and hepatitis
a pneumonia, torsades de  Exacerbation and
H. influenza, pointes and fatal new onset of
Mycoplasma arrhythmias, myasthenia
pneumonia, including those gravis have
S. with known occurred with
pneumonia, prolonged QT azithromycin use.
Legionella interval,  Consider full risk
pneumophila, bradyarrhythmias profile when
M. , uncompensated choosing
catarrhalis, or HF, uncorrected appropriate
S. aureus. hypokalemia or, antibiotic
To prevent hypomagnesemia therapy.
disseminated Alternative
Mycobacteriu macrolide or
m avium fluoroquinolone
complex in class drugs also
patients with have the
advanced HIV potential to
infection. cause QT interval
Pelvic prolongation and
inflammatory other significant
disease adverse effects.
caused by C.
trachomatis,
N. gonorrhea,
or
Mycoplasma
hominis in
patients who
need initial
I.V. therapy.
Contraindication
s:
 Contraindica
ted with
patients
hypersensiti
ve to
azithromycin
,
erythromyci
n, or other
macrolide or
ketolide
antibiotics
and in those
with history
of
cholestatic
jaundice or
hepatic
dysfunction
from prior
use of
azithromycin
.
 Concomitant
use with
aliskiren is
contraindica
ted in
diabetic
patients
 Use
cautiously in
patients with
impaired
renal or
hepatic
function
Action
Classification: Indications Adverse Reaction:  Dialyzable drug: Drug may cause CDAD
Antibiotics yes ranging in severity
Generic  Moderate to  CNS:
 Use cautiously in from mild diarrhea to
Name: severe Headache,
patients with fatal colitis. Monitor
Piperacillin + infections insomnia,
Mechanism of bleeding patients for diarrhea
Tazobactam from fever, seizures,
Action: tendencies, and initiate
piperacillin- agitation, therapeutic measures
uremia,
Inhibits cell wall resistant, anxiety, as needed. Drug may
hypokalemia, and
Brand Name: synthesis during piperacillin- dizziness need to be stopped.
allergies to other
bacterial tazobactam  CV: arrhythmia,
drugs
Zosyn susceptible, chest pain, Serious skin reactions
multiplication  Overdose S&S:
beta- edema, HTN, can occur. If rash
Neuromuscular
lactamase- tachycardia develops, monitor
hyperexcitability,
Dosage: producing  EENT: rhinitis patient closely and
seizures.
strains of  Dermatologic: discontinue if lesion
4.5G IV 1 vial microorganis progresses.
Rash, pruritus
via solulet m in  GI: diarrhea,
If large doses are given
appendicitis constipation,
or if therapy is
and abdominal
Route: I.V. prolonged, bacterial or
peritonitis pain, nausea,
fungal, superinfection
caused by E. vomiting,
may occur, especially
coli, B. pseudomembr
in elderly, debilitated,
Frequency: fragilis, B. anous colitis,
or immunosuppressed
Q8H ovatus, B. dyspepsia, oral
patients.
vulgatus; candidiasis,
(every 8 skin and stool changes Monitor hematologic
hours) skin-  GU: and coagulation
structure candidiasis, parameters.
infections interstitial
caused by S. nephritis Patients with cystic
aureus;  Hematologic: fibrosis may have a
postpartum leukopenia, higher rate of fever
endometritis neutroprenia, and rash. Monitor
or pelvis thrombocytope these patients closely.
inflammator nia, anemia, Don’t confuse Zosyn
y disease eosinophilia. with Zofran or Zyvox.
caused by E.  Respiratory:
coli; dyspnea
moderately
severe CAP
caused by H.
influenza
 Moderate to
severe
nosocomial
pneumonia
caused by
piperacillin-
resistant,
piperacillin-
tazobactam
susceptible,
beta-
lactamase-
producing
strains of S.
aureus or by
piperacillin-
tazobactam
susceptible
Acinetobact
er
baumannii,
H. influenza,
K.
pneumonia
and P.
aeruginosa
Contraindication
s:
Contraindicated
in patients
hypersensitive to
drug, other
penicillins,
cephalorins, or
beta-lactamase
inhibitors.
Action
Classification: Indications Adverse Reaction: Use cautiously in  Drug may

Bronchodilators patients with CV decrease
Generic To prevent or  CNS: tremor,
disorder, sensitivity of
Name: treat nervousness,
hyperthyroidism, spirometry used
bronchospasm in headache,
Salbutamol Mechanism of or diabetes for diagnosis of
patients with hyperactivity,
Sulfate Action: mellitus and in asthma
reversible dizziness,
those who are  Syrup contains no
Relaxes bronchial, obstructive insomnia,
unusually alcohol or sugar
uterine, and airway disease. weakness CNS
responsive to and may be taken
Brand Name: stimulation,
vascular smooth adrenergics by children as
To prevent
muscle by malaise
Ventolin, exercise-induces young as age 2
stimulating beta2  CV:
Proventil, bronchospasm Use extended-  In children, syrup
receptors. tachycardia,
AccuNeb release tablets may rarely cause
Contraindication palpiatations,
cautiously in erythema
s: HTN, edema,
patients with GI multiforme or
chest pain,
Dosage: narrowing. Steven-Johnson
 Contraindica lymphoadenop
1mg/ml 1 syndrome.
ted in ahty
nebule Dialyzable drug:  Monitor patient
patients  EENT:
unknown for effectiveness.
hypersensiti conjunctivitis,
ve to drug or Using drug alone
otitis media,
Route: PO its Exaggeration of may not be
dry and
ingredients adverse adequate to
irritated nose
reactions, control asthma in
and throat
seizures, angina, some patients.
Frequency: (with inhaled
hypotension, Long term control
TID (3 x a day) form), nasal
HTN, medication may
congestion,
tachycardia, be needed.
epistaxis,
arrhythmias,  Drug may cause
hoarseness,
nervousness, paradoxical
pharyngitis,
headache, bronchospasm.
rhinitis
tremor, dry Monitor patient
 GI: nausea,
mouth, closely;
vomiting,
palpitations, discontinue drug
heartburn,
nausea, fatigue immediately and
anorexia,
use alternative
altered taste,
therapy if
increased
paradoxical
appetite
bronchospasm
 GU: UTI
occurs.
 Metabolic: Bronchospasm
hypokalemia with inhaled
 Musculoskelet formulations
al: muscle frequently occurs
cramps, back with the first use
pain. of new canister or
 Respiratory: vial.
bronchospasm,  Patient may use
cough, tablets and
wheezing, aerosol together.
dyspnea, Monitor these
bronchitis, patients closely
increased for signs and
sputum symptoms of
toxicity.
 Don’t confuse
albuterol with
atenolol or
Albutein.
Name of Classification and Indication and Side effects or Special Precautions Nursing Responsibilities
Drug Mechanism of Contraindication Adverse Reactions
Action
Classification: Indications Adverse Reaction:  Drug can cause  Use caution when
Analgesics acute liver prescribing,
Generic Mild pain or fever  CNS: agitation,
failure, which preparing, and
Name: Mild to moderate anxiety, fatigue,
may require a administering I.V
pain; mild to headache,
Paracetamol Mechanism of liver transplant acetaminophen to
moderate pain insomnia,
Action: or cause death. avoid dosing errors
with pyrexia
Most cases of leading to accidental
Thought to adjunctive  CV: HTN, liver injury are overdose and death.
Brand opioid hypotension,
produce analgesia associated with Be careful not to
Name: analgesics; peripheral
by inhibiting drug doses confuse in
prostaglandin and fever edema, exceeding 4,000 milliGRAMS and dose
Biogesic,
Tylenol, other substances Maximum daily periorbital mg/day and in milliLITERS. Be sure
that sensitize pain dose includes edema, often involve to base dose on
Abenol
receptors. Drug all routes of tachycardia more than one weight for patients
may relieve fever administration  GI: nausea, acetaminophen- weighing less than 50
through central and all vomiting, containing kg, to properly
Dosage: 500
action in the acetaminophe heartburn, product program infusion
mg 1 tab
hypothalamic heat- n-containing abdominal pain, pump, and to ensure
regulating center. products, diarrhea,  May cause that total daily dose
including constipation serious, of acetaminophen
Route: P.O. combination  GU: oliguria potentially fatal from all sources
products  Hematologic: skin reactions. doesn’t exceed
hemolytic  Use cautiously in maximum daily limit.
Contraindications
Frequency: anemia,  Consider reducing
: patients with any
Q8H PRN leukopenia, total daily dose and
type of liver
(every 8  Contraindicat neutropenia, disease, G6PD increasing dosing
ed with pancytopenia, deficiency, intervals in patients
hours; when
patient anemia chronic with hepatic or renal
necessary)
hypersensitiv  Hepatic: malnutrition, impairment.
e to drug. I.V. jaundice severe  Many OTC and
form is  Metabolic: hypovolemia, or prescription products
contraindicat hypoalbuminem severe renal contain
ed in patients ia, impairment. acetaminophen; be
with severe hypoglycemia, aware of this when
hepatic hypokalemia,  Use cautiously in calculating total daily
impairment hypervolemia, patients with dose.
or severe hypomagnesemi long term alcohol
active liver a, use because of
disease. hypophosohate therapeutic
mia doses causes
 Musculoskeletal hepatotoxicity in
: muscle cramps these patients
 Respiratory:
abnormal
breath sounds,
dyspnea,
hypoxia,
atelectasis,
pleural effusion,
pulmonary
edema, stridor
 Skin: rash,
uticaria;
infusion-site
pain, pruritus
VIII. DISHARGE PLAN

Medication
 Instruct the client to follow and take medication prescribed by the physician.
 Explain to the client the nature of the drug so as the prescription.
Treatment
 Your provider may prescribe antibiotics for you. These are medicines that kill the germs that
cause pneumonia. Antibiotics help most people with pneumonia get better. DO NOT miss any
doses. Take the medicine until it is gone, even if you start to feel better.
 DO NOT take cough or cold medicines unless your doctor says it is OK. Coughing helps your body
get rid of mucus from your lungs.
 Your provider will tell you if it is OK to use acetaminophen (Tylenol) or ibuprofen (Advil or
Motrin) for fever or pain. If these medicines are OK to use, your provider will tell you how much
to take and how often to take them.
Health teaching
Knowledge of illness
 Patient is able to identify and understand the illness.
Self-care
Breathing warm, moist air helps loosen the sticky mucus that may make you feel like you are choking.
Other things that may also help include:
 Placing a warm, wet washcloth loosely near your nose and mouth.
 Filling a humidifier with warm water and breathing in the warm mist.
 Coughing helps clear your airways. Take a couple of deep breaths, 2 to 3 times every hour. Deep
breaths help open up your lungs.
While lying down, tap your chest gently a few times a day. This helps bring up mucus from the lungs.
If you smoke, now is the time to quit. DO NOT allow smoking in your home.
Drink plenty of liquids, as long as your provider says it is OK.
 Drink water, juice, or weak tea.

 Drink at least 6 to 10 cups (1.5 to 2.5 liters) a day.
 DO NOT drink alcohol.
Get plenty of rest when you go home. If you have trouble sleeping at night, take naps during the day.
IX. ARTICLES
ETIOLOGY OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS: A SYSTEMATIC REVIEW
Abstract
Background
The etiology of community-acquired pneumonia (CAP) has evolved since the beginning of the
antibiotic era. Recent guidelines encourage immediate empiric antibiotic treatment once a
diagnosis of CAP is made. Concerns about treatment recommendations, on the one hand, and
antibiotic stewardship, on the other, motivated this review of the medical literature on the
etiology of CAP.
Methods
We conducted a systematic review of English-language literature on the etiology of CAP using
methods defined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines. We searched PubMed using a combination of the keywords ‘pneumonia’,
‘CAP’, ‘etiology’, ‘microbiology’, ‘bacteriology’, and ‘pathogen’. We examined articles on
antibiotics that were develop to treat pneumonia. We reviewed all ‘related articles’ as well as
studies referenced by those that came up in the search. After we excluded articles that did not
give sufficient microbiological data or failed to meet other predetermined criteria, 146 studies
remained. Data were stratified into diagnostic categories according to the microbiologic studies
that were done; results are presented as the percentage in each category of all cases in which
an etiology was established.
Results
Streptococcus pneumoniae remains the most common cause of CAP although declining in
incidence; this decline has been greater in the US than elsewhere. Haemophilus influenzae is
the second most common cause of CAP, followed by Staphylococcus aureus and Gram negative
bacilli. The incidence of all bacteria as causes of CAP has declined because, with routine use of
PCR for viruses, the denominator, cases with an established etiology, has increased. Viruses
were reported on average in about 10% of cases, but recent PCR-based studies identified a
respiratory virus in about 30% of cases of CAP, with substantial rates of viral/bacterial
coinfection.
Conclusion
The results of this study justify current guidelines for initial empiric treatment of CAP. With
pneumococcus and Haemophilus continuing to predominate, efforts at antibiotic stewardship
might be enhanced by greater attention to the routine use of sputum Gram stain and culture.
Because viral/bacterial coinfection is relatively common, the identification of a virus by PCR
does not, by itself, allow for discontinuation of the antibiotic therapy.

CamaristaColeen Mae - PNEUMONIA (Case Study 1)

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CamaristaColeen Mae - PNEUMONIA (Case Study 1)

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ILOILO DOCTOR’S COLLEGE

BACHELOR OF SCIENCE IN NURSING

NCM 112 (RLE)

A Case Study Presented to the Department of Nursing of Iloilo Doctor’s College

PRESENTED TO: MRS.

(BSN III-G GROUP 1)

BACHELOR OF SCIENCE IN NURSING

ILOILO DOCTOR’S COLLEGE

III . ..........................................................PHYSICAL EXAMINATION

IV........................................ANATOMY AND PATHOPHYSIOLOGY

V..........................DIAGNOSIS AND LABORATORY PROCEDURE

VI. ....................................................................NURSING PROCESS

VII. ..........................................................................DRUG STUDY

VIII. .............................DISCHARGE PLAN/HEALTH TEACHING

Classifications and Definitions of Pneumonias

Health care–associated pneumonia (HCAP): Pneumonia occurring in a

Hospital-acquired pneumonia (HAP): Pneumonia occurring ≥48 hours after hospital

• Acknowledge client needs using holistic approach

II. NURSING HEALTH HISTORY

Name: Mr. Roque

Age: 58 years old

Civil Status: Married

c. Past Medical History

d. Present Illness History

III. PHYSICAL EXAMINATION

B. Overall Assessment (from head to extremeties)

b) Body build- Thin

b) Mucus membrane- Soft and pink

IV. ANATOMY AND PHYSIOLOGY

Pharynx, Tonsils, and Adenoids

Lower Respiratory Tract

Bronchi and Bronchioles

If a substantial portion of one or more lobes is involved, the disease is referred to as

Age: 58 years old Etiology: Work related stress

Infectious agent foreign substance, blood

Cause inflammation of pulmonary tissue affecting both ventilation and

Edema of alveolar Alveolar fill with

Causing occlusion of Interferes with

Signs & Symptoms

V. LABORATORY AND DIAGNOSIS

Normal results (Hemoglobin is a protein in your

Normal results (Neutrophils are a type of white

Abnormal: Results is slightly low related to

Abnormal: Results is normal (Doctors may order

Lab EXAM RESULTS NORMAL VALUES SIGNIFICANCE

V. DIAGNOSTIC EXAMINATION RESULTS

VI. Nursing Care Plan

Subjective: Ineffective Short Term: Independent: After 1 week of

VII. DRUG STUDY

Classification: Indications Adverse  Dialyzable drug:  Drugs can be used

renal failure during

Classification: Indications Adverse Reaction:  Dialyzable drug:  Monitor patient

(8: 00 P.M.) tonsillitis anous colitis, patients with skin reaction.

Classification: Indications Adverse Reaction: Use cautiously in  Drug may

VIII. DISHARGE PLAN

 Patient is able to identify and understand the illness.

Drink plenty of liquids, as long as your provider says it is OK.

 Drink water, juice, or weak tea.

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