CASE: PNEUMONIA

GROUP D: NCM 104 RLE-CD BSN 3Y2-1

SUBMITTED TO: Gerardo Nicolas, RN, MAN

GROUP MEMBERS CONTRIBUTION

Hipple, Lesley S. Question #3: DRUG STUDY
Jagna, Ma. Christina Sirikit N. Question #2: PATHOPHYSIOLOGY
Lascañas, Miafel B. Question #4: NCP #1 (Hyperthermia)
Majan, Irica S. Question #4: NCP #2 (Ineffective airway clearance)
Mallare, Michelle Gliselle G. Question #1: ANATOMY & PHYSIOLOGY
Quiambao, Razelle F. Question #3: DRUG STUDY
Rebadavia, Shaira D. Question #5: RECOMMENDATIONS

I. ANATOMY & PHYSIOLOGY

In order to acquire knowledge regarding Community Acquired Pneumonia III, it is important to
understand the basic anatomical characteristics of the respiratory system. The respiratory
system consists of all the organs involved in breathing. These include the
nose, pharynx, larynx, trachea, bronchi and lungs. The respiratory system does five very
important things: 
(1) Oxygen supplier. The job of the respiratory system is to keep the body constantly
supplied with oxygen.
(2) Elimination. Elimination of carbon dioxide.
(3) Gas exchange. The respiratory system organs oversee the gas exchanges that occur
between the blood and the external environment.
(4) Passageway. Passageways that allow air to reach the lungs.
(5) Humidifier. Purify, humidify, and warm incoming air.
The nose, pharynx, larynx, trachea and bronchi all work like a system of pipes through which the
air is funneled down into our lungs. There, in very small air sacs called alveoli, oxygen is
brought into the bloodstream and carbon dioxide is pushed from the blood out into the air. When
something goes wrong with part of the respiratory system, such as an infection like pneumonia,
it makes it harder for us to get the oxygen we need and to get rid of the waste product carbon
dioxide. Common respiratory symptoms include breathlessness, cough, and chest pain.
ANATOMY OF THE RESPIRATORY SYSTEM:
- The respiratory system has many different parts that work together to help you breathe. Each
group of parts has many separate components.
- Your airways deliver air to your lungs. Your airways are a complicated system that includes
your:
 Mouth and nose: Openings that pull air from outside your body into your respiratory
system.
 Sinuses: Hollow areas between the bones in your head that help regulate the temperature
and humidity of the air you inhale.
 Pharynx (throat): Tube that delivers air from your mouth and nose to the trachea
(windpipe).
 Trachea: Passage connecting your throat and lungs.
 Bronchial tubes: Tubes at the bottom of your windpipe that connect into each lung.
 Lungs: Two organs that remove oxygen from the air and pass it into your blood.

- From your lungs, your bloodstream delivers oxygen to all your organs and other tissues.
- Muscles and bones help move the air you inhale into and out of your lungs. Some of the bones
and muscles in the respiratory system include your:
 Diaphragm: Muscle that helps your lungs pull in air and push it out
 Ribs: Bones that surround and protect your lungs and heart

- When you breathe out, your blood carries carbon dioxide and other waste out of the body.
Other components that work with the lungs and blood vessels include:
 Alveoli: Tiny air sacs in the lungs where the exchange of oxygen and carbon dioxide
takes place.
 Bronchioles: Small branches of the bronchial tubes that lead to the alveoli.
 Capillaries: Blood vessels in the alveoli walls that move oxygen and carbon dioxide.
 Lung lobes: Sections of the lungs – three lobes in the right lung and two in the left lung.
  Pleura: Thin sacs that surround each lung lobe and separate your lungs from the chest
wall.

- Some of the other components of your respiratory system include:

 Cilia: Tiny hairs that move in a wave-like motion to filter dust and other irritants out of
your airways.
 Epiglottis: Tissue flap at the entrance to the trachea that closes when you swallow to keep
food and liquids out of your airway.
 Larynx (voice box): Hollow organ that allows you to talk and make sounds when air
moves in and out.
 PHYSIOLOGY OF THE RESPIRATORY SYSTEM:
- The major function of the respiratory system is to supply the body with oxygen and to
dispose of carbon dioxide. To do this, at least four distinct events, collectively called

respiration, must occur.

- The diaphragm is the large dome shaped muscle that contracts and relaxes during breathing. It also
separates the chest and abdominal cavity. Muscles near our ribs also help expand our chest for
breathing.
 Respiration:
 Pulmonary ventilation. Air must move into and out of the lungs so that gasses in the
air sacs are continuously refreshed, and this process is commonly called breathing.
 External respiration. Gas exchange between the pulmonary blood and alveoli must
take place.
 Respiratory gas transport. Oxygen and carbon dioxide must be transported to and
from the lungs and tissue cells of the body via the bloodstream.
 Internal respiration. At systemic capillaries, gas exchanges must be made between the
blood and tissue cells.
 Mechanics of Breathing:
 Inspiration. Air is flowing into the lungs; chest is expanded laterally, the rib cage is
elevated, and the diaphragm is depressed and flattened; lungs are stretched to the larger
thoracic volume, causing the intrapulmonary pressure to fall and air to flow into the
lungs.
 Expiration. Air is leaving the lungs; the chest is depressed and the lateral dimension is
reduced, the rib cage is descended, and the diaphragm is elevated and dome-shaped;
lungs recoil to a smaller volume, intrapulmonary pressure rises, and air flows out of the
lung.
 Intrapulmonary volume. Intrapulmonary volume is the volume within the lungs.
 Intrapleural pressure. The normal pressure within the pleural space, the intrapleural
pressure, is always negative, and this is the major factor preventing the collapse of the
lungs.
OVERVIEW OF THE LUNGS:


Structure of the lungs:

The lungs are paired, cone-shaped organs which take up most of the space in our chests, along
with the heart. Their role is to take oxygen into the body, which we need for our cells to live and
function properly, and to help us get rid of carbon dioxide, which is a waste product. We each
have two lungs, a left lung and a right lung. These are divided up into ‘lobes’, or big sections of
tissue separated by ‘fissures’ or dividers. The right lung has three lobes but the left lung has only
two, because the heart takes up some of the space in the left side of our chest. The lungs can also
be divided up into even smaller portions, called ‘bronchopulmonary segments’.
These are pyramidal-shaped areas which are also separated from each other by membranes.
There are about 10 of them in each lung. Each segment receives its own blood supply and air
supply.

 Physiology of the lungs:

Air enters your lungs through a system of pipes called the bronchi. These pipes start from the
bottom of the trachea as the left and right bronchi and branch many times throughout the lungs,
until they eventually form little thin-walled air sacs or bubbles, known as the alveoli. The alveoli
are where the important work of gas exchange takes place between the air and your blood.
Covering each alveolus is a whole network of little blood vessel called capillaries, which are
very small branches of the pulmonary arteries. It is important that the air in the alveoli and the
blood in the capillaries are very close together, so that oxygen and carbon dioxide can move (or
diffuse) between them. So, when you breathe in, air comes down the trachea and through the
bronchi into the alveoli. This fresh air has lots of oxygen in it, and some of this oxygen will
travel across the walls of the alveoli into your bloodstream. Travelling in the opposite direction is
carbon dioxide, which crosses from the blood in the capillaries into the air in the alveoli and is
then breathed out. In this way, you bring in to your body the oxygen that you need to live, and
get rid of the waste product carbon dioxide.

II. PATHOPHYSIOLOGY
 III. DRUG STUDY

MEDICATION/ MECHANISM OF INDICATION AND POSSIBLE SIDE NURSING

CONTRAINDICATION
DRUGS ACTION RATIONALE EFFECT CONSIDERATIONS
It works by relaxing Bronchodilator for the  Hypersensitivity to  Dizziness  Teach to the patient the proper
Generic Name: and opening the air prevention and fenoterol hydrobromide  Nausea inhalation technique.
Ipratropium bromide passages to the treatment of symptoms or atropine-like  Stomach upset  Advise the patient not to exceed
+ Fenoterol lungs to make in chronic obstructive substances or to any of  Dry mouth the prescribed dose.
breathing easier airway disorders with the excipients of the  Constipation  Advise the patient to rinse their
Brand Name: reversible airflow product. mouth after each use of the
Berodual limitation such as  Hypertrophic inhaler and Keep delivery
bronchial asthma and obstructive devices always clean and dry.
Classification: especially chronic cardiomyopathy  Tell the patient that if he missed
Bronchodilator bronchitis with or  Tachyarrhythmia the dose, take missed dose as
without emphysema- soon as remembered unless it is
Dosage: to help the patient almost time for the next dose.
10gtts/ 3ml NSS breathe easily. Do not take a double dose.
 Tell the patient to take frequent
Route: drinks and the use of sugar-free
Inhalation gum can help with dry mouth.
 Advise the patient to the
Frequency: possible side effects.
q6h  Monitor Vital signs and Monitor
Intake and Output.
 Evaluate therapeutic response.

The drug may - To relieve mild to  Contraindicated in  Stomach pain and  Advise the patient to take the
Generic Name: relieve fever moderate fever- to patient hypersensitivity loss of appetite medication after meal to prevent
Paracetamol through central reduce the fever. to drug.  Allergic reaction- the stomach pain.
action in the - Paracetamol, TIV-  Use cautiously in may can cause rash  Assess the patient vital signs
Classification: hypothalamic heat- giving this patients with long-term and swelling, dark specially the temperature to
Non-opioids regulating center. medication, if the alcohol use because urine, and clay- indicate baseline data, and
analgesic and anti- patient body therapeutic doses cause colored stools monitor the drug’s
pyretic temperature is (³ hepatotoxicity effectiveness.
38.6).  Assess patient’s history and
- Paracetamol, PO- if calculate total daily dosage
the patient body accordingly. To prevent over
Dosage, temperature is (< dosage that lead to toxicity and
Route, and 38.5) liver damage.
Frequency:  Advise the patient to the
 possible side effects
1amp, TIV, PRN - if
temperature (³ 38.6)

500mg tab, PO, PRN-

if the temperature is
(< 38.5).

- Binds to bacterial - Lower respiratory  Antimicrobial  Nausea  Tell patient to report history of
Generic: cell wall tract infections: resistance, viral  Vomiting allergic reactions to penicillin
Cefuroxime membrane, Treatment of lower infection  Bad taste and cephalosporin.
causing cell respiratory tract  Hypersensitivity to  Diarrhea  Note reasons for therapy,
Brand name: deaths. infections, including cephalosporins  Unusual tiredness baseline assessments.
Zinacef pneumonia, caused  Serious hypersensitivity or fatigue  Assess for anemia, renal
- Exert bactericidal by S. pneumoniae, to penicillin.  Difficulty of dysfunction. Reduce dose with
Classification: effect by H. influenzae,
inhibiting cell  Renal failure, renal breathing impaired renal function.
Anti-infectives; Streptococcus impairment  Assess if the patient has taken
membrane  Pain at injection
second-generation pyogenes, and  Diabetes mellitus drug that may decrease the
synthesis in site
cephalosporins Escherichia coli. medication effectiveness.
susceptible
bacteria, leading - Pneumonia,  Inform patient need and
Dosage: importance of the drug to him.
750mg to cell death community-
acquired, outpatient  Inspect IV site frequently for
empiric therapy signs of phlebitis.
Frequency:
(patients with  Monitor I & O rates and
q8
comorbidities): patterns.
Oral: 500 mg twice  Ensure that patient receives full
Route of
daily as part of an course of aminoglycosides as
administration:
appropriate prescribed, divided around the
TIV
combination clock to increase effectiveness
regimen. Duration is and decrease the risk for
for a minimum of 5 development of resistant strains
days; patients of bacteria.
should be clinically  Provide safety measures to
stable with normal protect
vital signs before  The patient if CNS effects (e.g.
discontinuing confusion, disorientation,
therapy. numbness) occur.
 Educate client on drug therapy
- Uncomplicated
to promote understanding and
pneumonia
compliance.
 Instruct the patient to drink lots
 of fluids and to maintain
nutrition even though nausea
and vomiting may occur, report
difficulty breathing, severe
headache, fever, diarrhea, and
signs of infection.
 Monitor patient compliance to
drug therapy.
Inhibits the enzyme Inhibits the enzyme  Hypersensitivity to  Nausea  Check v/s
DNA gyrase DNA gyrase drug, its components, or  Headache  Closely monitor patients with
Generic: insusceptible gram- insusceptible gram- other quinolones  Diarrhea renal insufficiency.
Levofloxacin negative and gram- negative and gram-  Insomnia  Assess for severe diarrhea,
positive aerobic and positive aerobic and  Constipation which may indicate
Brand name: anaerobic bacteria, anaerobic bacteria,  Dizziness pseudomembranous colitis.
Levox interfering with interfering with  May be administered without
bacterial DNA bacterial DNA regard to meals. Products or
Classification: synthesis. synthesis.
Anti-infective; foods containing calcium,
Fluoroquinolones magnesium, aluminum, iron,
zinc should not be ingested for 4
Dosage: hr before and 2 hr after
500 mg administration.
 Watch for hypersensitivity
Frequency: reaction. Discontinue drug
1 tab OD immediately of rash or other
Route of s/sx occur.
administration:  Watch for s/sx of tendinitis or
PO tendon rupture.
 Observe patient for signs and
symptoms of anaphylaxis (rash,
pruritus, laryngeal edema,
wheezing). Discontinue drug
and notify physician or other
health care professional
immediately if these problems
occur.
 Keep epinephrine, an
antihistamine, and resuscitation
equipment close by in case of an
anaphylactic reaction.
 Monitor bowel function.
Diarrhea, abdominal cramping,
 fever, and bloody stools should
be reported to health care
professional promptly as a sign
of pseudomembranous colitis.
May begin up to several weeks
following cessation of therapy.
 Assess for rash periodically
during therapy. May cause
Stevens-Johnson syndrome.
Discontinue therapy if severe or
if accompanied with fever,
general malaise, fatigue, muscle
or joint aches, blisters, oral
lesions, conjunctivitis, hepatitis
and/or eosinophilia.

IV. NURSING CARE PLANS

NCP 1

NURSING BACKGROUND
ASSESSMENT
DIAGNOSIS KNOWLEDGE
PLANNING INTERVENTIONS RATIONALE EVALUATION
SUBJECTIVE Hyperthermi Infection After 30 1. Obtain initial vital 1. To monitor changes After 30
DATA: a related to minutes of signs and abnormalities in minutes of
Patient infection as giving vital signs nursing
complained of evidenced by Immune Response nursing interventions,
Mediators
productive body intervention, 2. Adjust and monitor 2. Room temperature the client has:
cough with temperature Patient environmental factors may be accustomed temperature of
fever above normal Leukocytes maintains like room temperature to near normal body 38 °C
range Monocytes,neutrophils, body and bed linens as temperature and
Lymphocytes,endothilium Respiratory
OBJECTIVE temperature indicated. blankets and linens
DATA: , glial cells,mesenchymal within may be adjusted as rate of 24
TEMP: 39.3 ℃ cells normal range indicated to regulate
PR: 104 of 36.5–37.5 temperature of the Pulse rate of 93
RR: 37 Pyrogenic cytokines °C patient
(+) productive IL-1, TFN, IFN
cough, greenish Gp130 receptor ligands 3. Evaporative cooling: 3. Alcohol cools the GOAL WAS
phlegm cool with a tepid bath; skin too rapidly, PARTIALLY
Hypothalamic do not use alcohol causing shivering. MET.
endothelium
Production of PGE2
Rise in cAMP (acts as 4. Modify cooling 4. Cooling too quickly
neutransmitter) measures based on the may cause
patient’s physical shivering, which
Elevated Set-Point response. increases the use of
Activation of vasomotor energy calories and
centre neurons peripheral increases the
vasoconstrictions and heat metabolic rate to
production produce heat.

FEVER 5. Educate patient and 5. Providing health

family members about teachings to the
the signs and patient and family
symptoms of aids in coping with
hyperthermia and help disease condition
in identifying factors and could help
related to occurrence prevent further
of fever; discuss complications of
importance of hyperthermia.
increased fluid intake
to avoid dehydration.

6. Give antipyretic 6. Antipyretic

medications as medications lower
prescribed. body temperature
Paracematol1 amp by blocking the
TIV for temp of ≥ synthesis of
38.6 and Paracetamol prostaglandins that
500mg tab PO for act in the
temp of 38.5 below hypothalamus.
 NCP 2: Difficulty of breathing and cough

NURSING BACKGROUND
ASSESSMENT
DIAGNOSIS KNOWLEDGE
PLANNING INTERVENTIONS RATIONALE EVALUATION
SUBJECTIVE Ineffective Bacteria (foreign After 30 1. Ensured standard 1. To promote After 45 minutes
DATA: airway pathogen) enters minutes of protocols are infection control and of nursing
clearance respiratory tract via nursing observed. prevention. interventions, the
Patient r/t excessive direct inhalation or intervention, client has:
complained of secretions indirectly through client will 2. Explained 2. To make sure
productive as evidence contact with have: necessary procedures that the client allows Respiratory rate
cough and by contaminated surface of care to the client. and understands the of 24
slight difficulty productive 1.Respiratory procedure.
of breathing cough and rate within Pulse rate of 93
Stimulates
dyspnea normal 12-20 3. Obtained vital 3. To provide
inflammatory response
OBJECTIVE 2. A pulse rate signs. baseline data for Effectively
Fluid leaks out of
DATA: within 60-100 comparison. eliminates
pulmonary capillaries
3. Have sputum
PR: 104 bpm effective 4. Positioned client 4. To provide secretions.
RR: 37 bpm Fluid enters alveoli sputum in high Fowler’s. maximum lung
(+) productive elimination expansion. Reported
cough 4. Relieved of relieved from
Fluid consolidates
(+) slight dyspnea 5. Encouraged deep 5. To improve difficulty of
inside the lungs
dyspnea breathing and lung expansion and breathing.
Affects amount of air coughing exercise 10 sputum elimination.
entering the lungs and times every hour. GOAL WAS
gas exchange PARTIALLY
6. Encouraged 6. To ensure MET.
adequate fluid intake adequate hydration,
at least 2litres daily. and to help
expectorate the
mucus
7. Instructed client
on proper disposal of 7. To prevent the
tissues and secretions. spread of the
pathogens.

8. Suctioned
secretions when 8. To effectively
necessary. eliminate secretions.

9. Provide oral care  9. To promote oral

care and clear off
any excess
secretions in the
10. Encouraged adequate mouth and throat
rest.
10. To promote
comfort for the
COLLABORATIVE: client
11.Administered O2
therapy 3L/min via nasal COLLABORATIVE:
cannula if difficulty of 11. To ensure adequate
breathing is observed. oxygen supply.

12. Administered
berodual nebulization
(10gtts in 3ml NSS) q6
hours, followed by CPT.
12. To loosen and
effectively eliminate
secretions.
 V. RECOMMENDATIONS

Medication
 Cefuroxime (Zinacef) 750 mg every 8 hours TIV
 Levofloxacin (Levox) 500 mg 1 tab OD PO
 Paracetamol 1 amp TIV for temp of equal or greater than 38.6
 Paracetamol 500mg tab PO for temp of 38.5 below
 Berodual nebulization (10gtts in 3 ml NSS) every 6 hours
 Therapeutics: IVF PNSS 1L to run for 8 hours at 31-32 gtts/min
 Bedside O2 of 3L/min via nasal cannula
 Nebulization followed by CPT

Environment/ Exercise
 Promoted privacy and a calm environment for the client.
 Ensured client maintains good hygiene and clean bed/surroundings; provided appropriate
receptacle for tissues/infectious waste.
 Ensured client’s safety, side rails up.

Treatment
 Monitor vital signs every shift and monitor for any signs of dyspnea progression.
 Monitor I and O
 Suction secretion when necessary
o Encourage patient to drink plenty of fluids unless contraindicated
o Do not suppress the urge to cough.
o Practice chest therapy (percussion, postural drainage, vibration, deep breathing)
 Emphasized importance of adherence to drug therapy to the client.
 TSB (tepid sponge bath) if fever is still present.
Health teachings
 Encourage the patient to follow the doctor's order.
 Instruct the patient to take medications on time as prescribed by the doctor.
 Be cooperative to be able to get well soon.
 Encourage patient to have deep breathing exercise and coughing reflex to promote
expectoration of sections (taught patient proper coughing etiquette and disposal of
tissues/secretions)
 Encourage the patient to have an adequate rest and sleep to increase strength and immune
system.
 Continuous observation of symptoms.
 Encourage the patient to do deep breathing and coughing exercise at least 10 times every
hour.
 Provide relaxation and diversion activities to the patient
 Involved client’s family/relative/guardian in the health teachings.

Observation/ Out-patient
 Instructed the patient to comply with his follow up check- up schedule for continued
treatment and management to prevent relapse

Diet
 Diet as tolerated (DAT) encouraged on high protein, high calories foods. (Avoid milk
products, because they stimulate mucus production)
 Encourage patient to increase fluid intake (unless contraindicated)
 Eat green leafy vegetables
 Add vitamin C rich foods to diet for boosting your immune system.
 Small frequent meals

Spiritual
 Encourage family and patient to straighten his/ her faith to God (spiritual and emotional
support)