1

A Case Study on
Bacterial Pneumonia

In Partial Fulfillment of the Requirements in

RT 124: CLINICAL EDUCATION 1

GENERAL RESPIRATORY CARE ROTATION

Submitted to:
Sebastian, Aljessa RN, RTRP

Submitted by:
Aguinaldo, Precilda G.
Bermudez, Celine Mickaela A.
Carumba, Rica Hannah
Dilangalen, Alezandra
Eliseo, Jamielle F.
Labrador, Gabrielle
Salandron, Jennie Vil E.
Samad, Hanna Lalaine
Santos, Noriel AJ G.
Tabangan, Romeo

July 2021
 2

TABLE OF CONTENTS

I. Cover Page …………………………………………………………………… 1

II. Table of Contents …………………………………………………………….. 2-3
III. Introduction ……………………………………………………………………. 4
IV. Objectives
A. General Objectives …………………………………………………… 6
B. Specific Objectives …………………………………………………… 6
V. Definition of Diagnosis ……………………………………………………….. 7-8
VI. Personal data
A. Biographical Data …………………………………………………….. 9
B. Medical History ……………………………………………………….. 9
VII. Patient History
A. Past Health History …………………………………………………… 9
B. Present Health History ……………………………………………….. 9-10
C. Developmental Tasks ……………………………………………….... 10
D. Genogram and Narrative …………………………………………….. 11-12
VIII. Assessment
A. Physical Assessment
I. General Survey ………………………………………………. 13
II. Vital Signs …………………………………………………….. 13
III. Skin ……………………………………………………………. 13
IV. Head …………………………………………………………… 13
V. Eyes ………………………………………………………….... 13
VI. Nose …………………………………………………………… 13
VII. Mouth ………………………………………………………….. 14
VIII. Neck …………………………………………………………… 14
IX. Thorax and Lungs ……………………………………………. 14
X. Abdomen ……………………………………………………… 14
XI. Upper and Lower Extremities ………………………………. 14
IX. Anatomy and Physiology …………………………………………………… 15-18
 3

X. Pathophysiology
a. Factors ………………………………………………………………. 19-23
b. Diagram ……………………………………………………………… 24-29
c. Narrative ……………………………………………………………… 30
XI. Medical Management ………………………………………………………. 31-34
XII. Drug Study ……………………………………………………………………. 35-68
XIII. Respiratory Therapy Care Plan …………………………………………….. 69-71
XIV. Pulmonary Rehabilitation ……………………………………………………. 72-74
XV. Prognosis ……………………………………………………………………… 75
References ……………………………………………………………………………. 76-78
 4

INTRODUCTION

The Respiratory therapy internship is an academic undertaking which is set as

the minimum standard by the school in order to measure the RT intern’s performance
and development. It is in the fourth year of Bachelor of Science in Respiratory Therapy
program. It is an intensive practical and theoretical training in the different parts of a
clinical laboratory. According to the CHED memorandum order, this rotation is the
General Respiratory care that aims to cover topics such as humidity, oxygen, aerosol,
lung expansion, environmental therapy, cardiopulmonary rehabilitation, and record
keeping and sterilization techniques.

Pneumonia is an inflammation that causes the air sacs of one or both lungs to
become filled with fluid or pus. The infection manifests cough with phlegm or pus, fever,
chills, and difficulty breathing. It is caused by invasive microorganisms such as bacteria,
fungi, or viruses.This infection can be a life-threatening disease. For infants and young
children, 65 years old and above, and those who have weak or problems with their
immune system pose a serious effect of the infection (Mayo Foundation for Medical
Education and Research, 2021).

According to the Centers of Disease and Prevention, more children younger than
5 years old are killed by this infectious disease of the lungs called pneumonia than any
other disease such as tuberculosis, malaria, and HIV infection. In the United States,
during 2017 there were around 1.3 million people who were diagnosed with pneumonia
in an emergency department. Lower respiratory tract infections regard for more
morbidity and mortality compared to other infections. Additionally, there are more than 5
million CAP incidence in the United States per year; 80% are treated as outpatients with
less than 1% of mortality rate, whereas inpatients account for 20% with a mortality rate
of 12% to 40% ( Sattar & Sharma, 2021). On the other hand, pneumonia in the
Philippines is one of the leading causes of deaths among Filipinos. According to the
World Health Organization (WHO), 75, 970 or 12.27 % fatalities were recorded in
pneumonia deaths along with the flu. In 2016, the Philippines reported 57,809
 5

pneumonia deaths, almost 10 percent of the registered deaths during that year. Due to
pneumonia prevalence, it became the third top killer behind ischemic heart disease and
cancer (Outbreak News Today, 2017). In 2018, pneumonia caused about 56.8 thousand
deaths and was the 3rd leading cause of death among Filipino women ( Statista, 2021).

Pneumonia has been one of the major contributing factors of death around the
world. This disease is also prevalent in the Philippines which makes it become one the
top killers in the said country . In 2016, the Philippines recorded a 786,085 number of
pneumonia cases with a rate of 758 cases per 100,000 population.

The 2016 Philippine health statistics recorded 50,040 pneumonia cases in Davao
Region with a rate of 994 cases per 100,000 of the population (Epidemiology Bureau
Department of Health, n.d.). The case study is conducted in order to provide knowledge,
prevention, and management of the disease. This is beneficial in the Respiratory
therapy field and in the areas where pneumonia is more prevalent.

The case study contributes to the impact of health education on pneumonia

knowledge and awareness in Respiratory therapy education. It expands knowledge of
every RT practitioner especially with regards to management and prevention. This also
contributes to RT research since it adds several information found in this case study
that might help in developing wide arrays of treatment. And lastly, it is beneficial to RT
practice because knowledge about pneumonia helps in the application of it, specifically
the prevention, management, and treatment.
.
 6

GENERAL OBJECTIVES
At the end of our General Respiratory Care rotation, we, as BSRT 4 interns
would be able to produce a detailed case study to be utilized and be a source of
supplementary knowledge on the emergence and even management of patients with
pneumonia to be able to improve the practice of our profession.

SPECIFIC OBJECTIVES
Specifically, we intend to:
a. Exhibit an introduction that states relevant global, international, and national
topics related to the purpose of this study with regards to our focused subject,
pneumonia,
b. identify the study’s association to the RT study, research, and practice,
c. draw smart objectives as a guide in the completion of this study,
d. describe the medical diagnosis,
e. indicate the patient’s past and present medical and/or health history,
f. assess the patient in cephalocaudal manner giving emphasis to the abnormalities
observed related to their case, pneumonia,
g. review the anatomy and physiology of the affected system,
h. detect the pathophysiology of the diagnosis to be presented in a diagram with a
stated narrative,
i. list the actual and possible diagnostic tests that helped come up with the
diagnosis,
j. link the laboratory results to the patient’s condition,
k. acknowledge the importance of medical management done to the patient,
l. talk over the drugs administered to or by the patient by presenting its indications;
side and adverse effects, mode of action, and the appropriate respiratory
interventions,
m. come up with respiratory care plans considering the immediate needs of the
patient, and
n. describe the prognosis of the patient’s condition after being rendered relevant
interventions.
 7

DEFINITION OF DIAGNOSIS

The word pneumonia comes from the ancient Greek word “pneumon”, which
means “lung”, therefore, the word pneumonia becomes a disease of the lungs (Sattar &
Sharma, 2021). Pneumonia is the inflammation of the tissue in one or both lungs which
is usually caused by a bacterial infection (NHS Choices, 2019). On the other hand, this
disease is a common acute respiratory infection that damages the distal airways and
alveoli which is considered as a major health problem that is associated with high
morbidity in all age groups worldwide (Torres, A., Cilloniz, C., Niederman, M.S. et al.,
2021).
A huge variety of microbial organisms can cause pneumonia with great
geographical variations in their prevalence such as bacteria, fungi, and viruses.
Bacterial pneumonia is caused by a pathogenic infection of the lungs. The most
consistent presenting symptom of bacterial pneumonia is cough productive of sputum
(Gamache, 2021).
According to the American Lung Association, bacterial pneumonia can occur on
its own or develop after you've had a viral cold or the flu. Bacterial pneumonia often
affects just one part, or lobe, of a lung. Those at greatest risk for bacterial pneumonia
include people recovering from surgery, people with respiratory disease or viral infection
and people who have weakened immune systems. There are many types of
pneumonia, and the most common type of bacterial pneumonia is called pneumococcal
pneumonia. Pneumococcal pneumonia is caused by bacteria that live in the upper
respiratory tract. Common symptoms of pneumococcal pneumonia include high fever,
excessive sweating and shaking chills, coughing, difficulty breathing, shortness of
breath and chest pain. Certain symptoms, such as cough and fatigue, can appear
without warning and may last for weeks, or longer. If you're 65 and older, even if you're
healthy and active and take good care of yourself, you could be at increased risk for
pneumococcal pneumonia. Some risk factors, including smoking, and chronic conditions
may increase risks for pneumococcal pneumonia.
 8

Persons with pneumonia usually show respiratory and systemic symptoms, and
diagnosis is based on the clinical manifestation and radiological findings. The delayed
and insufficient antimicrobial therapy can lead to poor outcomes due to difficulty and
crucial pathogen identification. However there are new antibiotic and non-antibiotic
therapies, also fast and accurate diagnostic tests that can identify pathogens and
antibiotic resistance will improve the management of pneumonia. (Torres, A., Cilloniz,
C., Niederman, M.S. et al., 2021).
The patient has shown signs, symptoms, and factors that made her
diagnosed with bacterial pneumonia as evidenced by her answers on the patient
interview. Thus, further discussion of her situation is to be discussed in the next
chapters of this paper.
 9

PERSONAL DATA

A. Biographical Data
Name: Celia Asuncion
Age: 40 y/o
Birthday; February 20, 1981
Weight: 55 kg.
Height 150 cm.
Address: Toril Davao City

B. Medical Data
Chief Complaint: Five (5) days cough with fever, sharp pain in the chest while
coughing with shortness of breath.

PATIENT HISTORY

A. Past Health History

The patient has not recalled any childhood illnesses and remembers she
has undergone complete vaccination as a kid. She only stated that she had a
long history of hypertension. There has been no history of surgeries, injuries
and/or trauma. She has not been hospitalized except for the check up she had
three months ago for work purposes in which she had undergone common
laboratory tests, CBC and urinalysis where results showed nothing unusual.
Allergies to food, drugs, and any environment are not applicable
She has been under her maintenance drug for hypertension which is
Lozartan taken 1 tab a day for 5 years now. The patient stated that she is
relieved from symptoms of hypertension as she complies regularly to her
maintenance. She takes Berocca 1x a day as her vitamins.
B. Present Health History
The patient experienced 5 days of productive cough evidenced by green
sputum and fever evidenced by a 40°C temperature that started a day before
 10

consultation. Chest pain is described as sharp when coughing. She had difficulty
breathing and fatigue.
The patient also stated that dyspnea occurs most especially after a busy
day at work. She declared that she took OTC drugs such as Paracetamol to
suppress the fever and Solmux for the cough.

C. Developmental Tasks
a. Erik Erikson’s Stages of Psychosocial development - The patient stated
that she is 40 years old thus according to this theory, she is not under the
seventh (7th) stage of development which specifies the conflict of
Generativity vs. Stagnation. The patient is said to be a wife and a mother
of 2 children and a teacher by profession. As the definition of this stage
goes, people tend to have the sense of world contribution by serving one’s
family and/or work (Myers, 2019). Thus, the patient has elicited
generativity in this stage of development.
b. Robert J. Havighurst Developmental task theory - Havighurst asserted that
throughout one’s entire lifespan, we develop through 6 individual stages
by means of resolving a problem or performance of developmental tasks.
This theory suggests that humans are always active learners interacting in
their social environments (Torg, 2019). Some examples of these tasks
include maintaining a standard of living, performing civic and social
responsibilities, and maintaining a relationship with a spouse. With these
given tasks, the patient will be said to have completed or is living with this
stage appropriate for her age.
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GENOGRAM
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GENOGRAM NARRATIVE
The patient’s grandfather on the maternal side died at the age of 71 with no
known disease while the grandmother died at the age 65 due to hypertension. On the
other hand, the patient’s grandfather on the paternal side died at the age of 74 and the
grandmother at the age of 72 with no known disease.
The mother of the patient is at the age of 70 and is currently diagnosed with
diabetes mellitus and hypertension. The patient’s father is 71 years old and has asthma.
The patient has 2 siblings, sibling #1 is currently 50 years old with no known disease
and the sibling #2 is 36 years old with no known disease. Patient CA is 40 years old and
currently has hypertension with an admitting diagnosis of pneumonia.
 13

ASSESSMENT

A. General Survey
The patient described that she is experiencing difficulty sleeping caused by a non
stop cough. She started feeling the loss in her appetite as her fever started. Her fever
has been associated with cold sweats. She has been experiencing fatigue due to work.

B. Vital signs
Temperature: 40°C
Blood Pressure: 130/60
C. Skin
Upon inspection, rashes, lumps, and sores are not visible.
Upon palpation, there are no changes in nails and hair noted. Cold skin was
noted.
D. Head
Upon Inspection, the head is normocephalic. The scalp was dry and hair was
evenly distributed. The facial movements are symmetrical.
Upon palpation, there were no lesions and deformities noted.

E. Eyes
Upon inspection, eyes are both symmetrical. The sclera is white and clear;
conjunctiva is transparent and appears pink. Pupils are equally round and
reactive to light accommodation. Both pupils have equal size of 3mm during light
accommodation.
Upon palpation, corneal reflex is present and the cornea is transparent. There
were no lumps and lesions noted.

F. Nose
Upon inspection, the nose is in the midline and no discharges. Both nares are
patent and nasal flaring was not noted.
Upon palpation, no bone and cartilage deviation were noted.
 14

G. Mouth
Upon inspection, lips were dry.
Upon palpation, no swelling and lesions were noted.

H. Neck
Upon inspection, trachea is located midline. No accessory muscle used during
respiration and work of breathing is decreased.
Upon palpation, there was no swelling and inflammation noted. Carotid pulse is
regular, Jugular vein is not distended.

I. Thorax and Lungs

Upon inspection, there was symmetrical chest expansion. There were no lesions
and swelling noted. Patient is dyspneic.
Upon palpation, the antero-posterior diameter is in 1:2 ratio.
Upon percussion, dullness was noted.
Upon auscultation, rhonchi and wheezes are present.

J. Abdomen
Upon inspection, the abdomen was flat and brown in color.
Upon auscultation, no abnormal bowel movement sounds were noted.
Upon percussion, the abdomen is tympanic.
Upon palpation, it is soft, non-tender and no swelling was noted.

K. Upper and Lower Extremities

Upon inspection, both upper and lower extremities are brown in color and dry.
Upon palpation, the skin was cold to touch. No edema present.
 15

ANATOMY AND PHYSIOLOGY

Introduction

The Respiratory System

The respiratory system

includes tubes that remove
particles from incoming air
and transport air to and
from the lungs and the air
sacs where gases are
exchanged. Respiratory is
the entire process of gas
exchange between the
atmosphere and body
cells.

Respiratory is a biological
system for all organisms
that involve gas exchange.
Body tissues receive
oxygen by the respiratory
system and the rate of
oxygen is increased during
exercise. Organs of the Respiratory System. The organs of the respiratory system can
be divided into two groups. The upper respiratory tract includes the nose, nasal cavity,
and pharynx and the lower respiratory tract includes the larynx, trachea, bronchial tree
and lungs.

The nose, pharynx, larynx, trachea and bronchi all work like a system of pipes through
which the air is funnelled down into our lungs. There, in very small air sacs called
 16

alveoli, oxygen is brought into the bloodstream and carbon dioxide is pushed from the
blood out into the air. When something goes wrong with part of the respiratory system,
such as an infection like pneumonia, it makes it harder for us to get the oxygen we need
and to get rid of the waste product carbon dioxide. Common respiratory symptoms
include breathlessness, cough, and chest pain.

The Upper Airway and Trachea

When you breathe in, air enters your body through your nose or mouth. From there, it
travels down your throat through the larynx (or voicebox) and into the trachea (or
windpipe) before entering your lungs. All these structures act to funnel fresh air down
from the outside world into your body. The upper airway is important because it must
always stay open for you to be able to breathe. It also helps to moisten and warm the air
before it reaches your lungs.

The Lungs
 17

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.

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 vessels 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
 18

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 into your body the oxygen that you need
to live, and get rid of the waste product carbon dioxide.

The lungs are enclosed by the

pleura, a membrane that is
composed of visceral and
parietal pleural layers. The
space between these two
layers is called the pleural
cavity. They produce pleural
fluid and create cavities that
separate the major organs.
Pleural fluid is secreted by
mesothelial cells from both
pleural layers and acts to
lubricate their surfaces. This
lubrication reduces friction between the two layers to prevent trauma during breathing,
and creates surface tension that helps maintain the position of the lungs against the
thoracic wall.

Nervous Innervation

Dilation and constriction of the airway are achieved through nervous control by the
parasympathetic and sympathetic nervous systems. The parasympathetic system
causes bronchoconstriction, whereas the sympathetic nervous system stimulates
bronchodilation. Reflexes such as coughing, and the ability of the lungs to regulate
oxygen and carbon dioxide levels, also result from this autonomic nervous system
control. Sensory nerve fibers arise from the vagus nerve, and from the second to fifth
thoracic ganglia. The pulmonary plexus is a region on the lung root formed by the
entrance of the nerves at the hilum. The nerves then follow the bronchi in the lungs and
branch to innervate muscle fibers, glands, and blood vessels.
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Blood Supply

The major function of the lungs is to perform gas exchange, which requires blood from
the pulmonary circulation. This blood supply contains deoxygenated blood and travels
to the lungs where erythrocytes, also known as red blood cells, pick up oxygen to be
transported to tissues throughout the body. The pulmonary artery is an artery that arises
from the pulmonary trunk and carries deoxygenated, arterial blood to the alveoli. The
pulmonary artery branches multiple times as it follows the bronchi, and each branch
becomes progressively smaller in diameter. One arteriole and an accompanying venule
supply and drain one pulmonary lobule. As they near the alveoli, the pulmonary arteries
become the pulmonary capillary network. The pulmonary capillary network consists of
tiny vessels with very thin walls that lack smooth muscle fibers. The capillaries branch
and follow the bronchioles and structure of the alveoli. It is at this point that the capillary
wall meets the alveolar wall, creating the respiratory membrane. Once the blood is
oxygenated, it drains from the alveoli by way of multiple pulmonary veins, which exit the
lungs through the hilum
 20

PATHOPHYSIOLOGY

A. FACTORS

PREDISPOSING FACTORS

FACTORS PRESENT/ABSENT RATIONALE

Pneumonia can range in

seriousness from mild to
life-threatening. It is most
serious for infants and
young children, people
Age -
older than age 65, and
people with health
problems or weakened
immune systems.

(Mayo Clinic, 2020)

Pneumonia affects
children and families
Race -
everywhere, but is most
prevalent in South Asia
and sub-Saharan Africa.

(WHO, 2019)
 21

The incidence of
pneumonia is greater in
males than in females
but the total number of
deaths due to pneumonia
Gender -
has been higher among
females since the mid
1980s.

(Medscape, 2021)

Genetic factors can

increase the risk of
respiratory infections,
Genetic + including acute bronchitis
and pneumonia.
Repeated

respiratory infections can

be precipitated by
structural defects of the
lungs or by genetic
defects in the immune
system.

PRECIPITATING FACTORS
Being hospitalized
Chronic disease
22
(ERS, 2021)
You're at greater risk of
pneumonia if you're in a
-
hospital intensive care unit,
especially if you're on a
machine that helps you
breathe (a ventilator).
(Mayo Clinic, 2020)
You're more likely to get
pneumonia if you have
+
asthma, chronic obstructive
pulmonary disease, heart
disease or hypertension.
(Mayo Clinic, 2020)
 23

Smoking damages your

body's natural defenses
Smoking -
against the bacteria and
viruses that cause
pneumonia.

(Mayo Clinic, 2020)

People who have

HIV/AIDS, who've had an
Weakened or suppressed -
organ transplant, or who
immune system.
receive chemotherapy or
long-term steroids are at
risk.

(Mayo Clinic, 2020)

Indoor air pollution caused

by cooking and heating with
 24

Environmental factors + biomass fuels (such as

wood or dung), pollution,
living in crowded homes
and parental smoking or
exposed to second-hand
smoke can increase a
person susceptibility to
pneumonia. (Medscape,
2019)

B. DIAGRAM

PREDISPOSING FACTOR PRECIPITATING FACTOR

Age Being
Gender hospitalized
Race Smoking
Genetic Weakened
immune system
Chronic
disease
Environment
al

Entry of microorganisms to respiratory

system through inspiration/aspiration
(staphylococcus and Gram-negative
bacilli)

Activation of normal pulmonary defenses

 25

Fight bacteria or viruses from entering

the lungs and to prevent tissue damage
Ineffective immune response resulting to
overwhelming infection

Penetrate the sterile lower respiratory

tract

The organism multiplies and released

damaging toxins

Release of inflammatory mediators

Vessels to dilate, increasing the

permeability so fluid starts leaking out

 Allowing more white blood cells, proteins,

Chills &
inflammatory structures to come off to fight
Fever
against the bacteria

Inflammation
Increased mucus
production

Vasolidation Cough
Airway
and increase &
obstruction
blood flow Sputum
producti
on
 26

Alveolar
capillary
leakage

Inflamed &
fluid-filled Hyperventilation
alveolar sac

Altered gas
exchange
Dyspnea

If treated If not treated

Ventilation perfusion
mismatch

MEDICATIONS
Clarithro
mycin
PO (Adults): Pharyngitis/tonsillitis 250 mg q
12hr for 10 days
PO (Children): Most infections 15 mg/kg/day Respiratory Failure
divided q 12hr for 7-14 days

PO (Adults): Ccr <30ml/min, 250 mg 1-2

times daily, a 500 mg initial dose may be
used.

PO (Children): Ccr <30 ml/min, decrease

dose by 50% or double dosing interval.
 27

Death

BAD PROGNOSIS

 Levaquin
PO (Adults): Most infections 500-750mg q 12hr.
PO (Children 1-7 yr): Complicated urinary tract
infections 10-15 mg/kg q 12 hr (not to exceed 750
mg/dose) for 10-21 days.
IV (Adults): Most infections 400 mg q 12 hr.
Complicated urinary tract infections 400 mg q 12
hr for 7-14 days.
IV (Children 1-7 yr): Inhalation anthrax (post
exposure) 10 mg/kg q 12 hr (not to exceed 400
mg/dose) for 60 days

Penicillin G

IM, IV (Adults): Most infections 1-5 million units q

4-6 hr.

IM, IV (Children): 8333-16,667 units/kg q 4 hr;

 28

Zithromax 

Immediate release: 500 mg orally as a single

dose on day 1, followed by 250 mg orally once a
day on days 2 to 5

Extended-release: 2 g orally once as a single

dose

Parenteral: 500 mg IV once a day as a single

dose for at least 2 days, followed by 500 mg
orally to complete a 7 to 10 day course of
therapy

MEDICAL MANAGEMENT
Complete blood count
Chest X Ray
Sputum Test
 29

GOOD PROGNOSIS

LEGEND:

PRECIPITATING & PREDISPOSING

FACTORS

SIGNS & SYMPTOMS

MEDICATIONS
 30

MEDICAL MANAGEMENT
 31

C.NARRATIVE

Before a patient can develop pneumonia, it requires certain causes. The genetic
factor serves as the predisposing factor and the patient has experienced hypertension
and was exposed to second-hand smoke, and that contributes as the precipitating
factors. The microorganism gains access to the patient’s lungs through aspiration of
oropharyngeal contents, by inhalation of respiratory secretions, droplets, viruses or
bacteria. Once inhaled, the normal pulmonary defenses activate. The defense
mechanisms are associated with the cough reflex and use of mucociliary escalator,
secretory immunoglobulin A (IgA) antibodies and macrophages. These mechanisms
work to fight bacteria or viruses from entering the lungs and to prevent tissue damage.
Whether these defenses are effective or not, there are still bacteria that are hard and
dangerous that can still produce tissue damage and since the patient has an ineffective
immune response, it results in an overwhelming infection that leads to penetrate the
sterile lower respiratory tract. The organism multiplies and releases damaging toxins
and a bunch of different endotoxins can start producing tissue damage and can lead to
pneumonia. In response to tissue damage, there are chemicals that start releasing
inflammatory mediators of inflammation such as histamines, leucochenes,
prostaglandins and platelet activating factor. These mediators cause the vessels to
dilate, increasing the permeability so fluid starts leaking out and allowing more white
blood cells, proteins, inflammatory structures to come off to fight against the bacteria
and it can cause pyrexia or fever. The inflammation occurs and the patient has
experienced increased mucus production which resulted in airway constriction that
leads the patient to hyperventilate. On the other hand, vasodilation and increase of
blood flow also occurs that can result in alveolar capillary leakage and can produce
crackles. There is also an inflamed and fluid-filled alveolar sac and altered gas
exchange and the patient may experience hypoxemia. These factors decreased the
patient’s lung compliance and dyspnea or shortness of breath happened. If treated with
proper management, therapy and medications, the patient will have a good prognosis.
But if not treated it will lead to more complications like Pleural effusion, Empyema,
Pleurisy, Bacteremia, Septic shock and even death.
 32

MEDICAL MANAGEMENT

a. Diagnostic Exams and Laboratory Tests

I. Complete blood count
CBC is a group of tests that evaluate the cells that circulate in blood, including
red blood cells (RBCs), white blood cells (WBCs), and platelets (PLTs). It can
evaluate your overall health and detect a variety of diseases and conditions, such
as infections, anemia, and leukemia. This is ordered in patients who are ill/ or
have signs and symptoms that may affect blood cells.
This laboratory test is also used in patients who are ill in order to identify if the
body’s immune system is responding to an infection or not.
RT interventions: (RTs are not incharge to do this tests however, they still have
the need to educate patient about the procedure)
1. Before performing the procedure to the patient, make sure to identify and
educate the patient first about the laboratory test in order to alleviate
anxiety.
2. Explain to the patient about the possible complications such as hematoma
after taking the blood.
3. Let the patient rest after the procedure.
COMPLETE BLOOD COUNT RESULT

Test Value Units Expected Value

Hb% 12.1 g/dl 14-24

WBC 20000 mm3 5500-18000/cm

Platelet Count 61600 mm3 150000-400000

Neutrophils 90 % 45-75%

Lymphocytes 70 % 20-45%

Eosinophils 4 % 02-06%

Monocytes 4 % 02-10%

RBC 5.57 10>12/litre 3.5-5.5

 33

MCV 79.2 F1 75-100

HCT 36.2 % 35-55

MCH 26.5 Pg 25-35

MCHC 33.4 g/dl 31-38

Interpretation/narrative:
CBC showed that her TLC (Total Leukocytes count) increased 20000 mm3 with a
normal value of 5500-18000/cm and lymphocytes concentration was 70% which
exceeded the normal range of leukocytes from 20-45%. Whereas neutrophils showed a
result of 90% which exceeded the normal values of 45-75%. These results suggest that
the patient’s immune system responds to the invasive microorganism that enters in her
body as well as the infection.

II. Chest X Ray

This diagnostic test uses a very small dose of ionizing radiation to produce pictures of
the inside of the chest. It will try to look at the location and the extent of inflammation or
abnormalities in the patient’s lungs.
This is ordered by the Doctor when symptoms are connected with the problems in your
chest. Suspicious symptoms include chest pain, fever, persistent cough, and shortness
of breath.
The patient is required to undergo this kind of test in order to rule out possible problems
of the lungs.
RT interventions: (RTs are not incharge to do this tests however, they still have the
need to educate patient about the procedure)
1. Identify and educate the patient first about the diagnostic test to alleviate anxiety.
2. Instruct the patient to take off jewelry, eyeglasses, piercings, or other metals in
her body because it might prevent visualization of normal anatomy and/or
pathoses in the radiograph.
3. Instruct the patient to take clothes and replace it with a lab gown provided by the
Radtech.
 34

4. After the procedure, let the patient wait or comes back a day after the test.

CHEST XRAY result interpretation/narrative:

The chest radiograph of the patient shows white patch on the left side upper lobe of the
lung which indicated pneumonia. This result means that white patch or infiltrate is an
infection that occurs in that particular lobe.

III. Sputum Test

A bacterial sputum culture is used to detect and diagnose bacterial lower respiratory
tract infections such as bacterial pneumonia or bronchitis.
It is typically performed with a Gram stain to identify the bacteria causing a person's
infection. A sputum culture from deep respiratory secretion is analized.
RT Interventions: (RTs are not incharge to do this tests however, they still have the
need to educate patient about the procedure)
1. The RT obtains samples from patients by properly instructing them to
expectorate sputum from the inside and not saliva.
 35

2. Make sure to educate patients to take samples before eating in order to prevent
aspiration as well as making sure that the patient’s bolus does not mix with their
sputum.
3. Instruct the patient to just wait for the result after 2-3 days.
Results of sputum test: Sputum culture is positive of Streptococcus pneumoniae; the
causative agent of bacterial pneumonia. A positive result to Gram staining suggests that
bacteria is the cause of the pneumonia and not virus.

POSSIBLE TESTS:
a. Arterial Blood gases - This test uses extracted blood from an artery that
measures different parameters such as the pH, oxygen, bicarbonate, and carbon
dioxide in the blood. This test would see how the lungs function. In connection to
pneumonia, in cases where it worses, ABG could help monitor the patient
especially when in dyspneic stages to properly administer care needed.
b. CT (computed tomography) scan- This test helps evaluate the severity of lung
infection and also to look for other non-infectious causes of the disease. For
pneumonia patients, since the lungs are under infection, this test will be an
additional diagnostic test for further assessing the need for additional
interventions.
c. Bronchoscopy— This procedure includes seeing inside the lungs using a flexible
instrument with a camera on its end. For our patient’s case, this may be used
when she does not respond well to medications and treatments to see if there
are any underlying causes of the decline.
 36

DRUG STUDY 1

Brand Name:

Biaxin, Biaxin XL

Generic Name:

Clarithromycin

Classification:

Therapeutic: agents for atypical mycobacterium, anti-infectives, antiulcer agents

Pharmacology: macrolides

Pregnancy Category C

Mode of Action:

Inhibits protein synthesis at the level of the 50s bacterial ribosome.

Therapeutic Effects: Bacteriostatic action

Spectrum: Active against these gram-positive aerobic bacteria: Staphylococcus aureus,

Streptococcus pneumoniae, Streptococcus pyogenes (group A strep). Active against
these gram-negative aerobic bacteria: Haemophilus influenzae, Moraxella catarrhalis.
Also active against: Mycoplasma, Legionella, H. Pylori, M. Avium.

Dosage:

PO (Adults): Pharyngitis/tonsillitis 250 mg q 12hr for 10 days; Acute maxillary sinusitis

500 mg q 12hr for 14 days or 1000mg once daily for 14 days as XL tablets; Acute
exacerbation of chronic bronchitis 250-500 mg q 12hr for 7-14 days or 1000mg once
daily for 7 days as XL tablets; Community -Acquired pneumonia; 250 mg q 12hr for 7-14
 37

days or 1000mg once daily for 7 days as XL tablets; skin/skin structure infections 250
mg q 12hr for 7-14 days; H. Pylori 500mg 2-3 times daily with a proton pump inhibitor
(lansoprazole or omeprazole) or ranitidine with or without amoxicillin for 10-14 days;
Endocarditis prophylaxis 500 mg 1hr before procedure; MAC prophylaxis/treatment 500
mg twice daily, for active infection another antimycobacterial is required.

PO (Children): Most infections 15 mg/kg/day divided q 12hr for 7-14 days (up to 500
mg/dose for MAC). Endocarditis prophylaxis 15 mg/kg 1 hr before procedure.

Renal Impairment::

PO (Adults): Ccr <30ml/min, 250 mg 1-2 times daily, a 500 mg initial dose may be used.

PO (Children): Ccr <30 ml/min, decrease dose by 50% or double dosing interval.

Indications:

Respiratory tract infections including streptococcal pharyngitis, sinusitis, bronchitis, and

pneumonia. Treatment (with ethambutol) and prevention of disseminated
Mycobacterium avium complex (MAC). Treatment of following pediatric infections: Otitis
media, Sinusitis, Pharyngitis, Skin/skin structure infections. Part of a combination
regimen for ulcer disease due to Helicobacter pylori. Endocarditis prophylaxis.

Contraindications:

Contraindicated in: Hypersensitivity to clarithromycin, erythromycin. Or other

macrolide anti-infectives; Concurrent use of pimozide;

OB: Avoid using during pregnancy unless no alternatives are available

Lactation: Not recommended for breastfeeding women

Use cautiously in: Severe liver or renal impairment (dose adjustment required if Ccr
<30ml/min).

Side Effects/ Adverse Effects

 38

CNS: headache

Derm: pruritus, rash, Stevens-Johnson syndrome

GI: pseudomembranous colitis, abdominal pain/discomfort, abnormal taste, diarrhea,

dyspepsia, nausea

Drug Interaction:

Drug-Drug: Clarithromycin is an inhibitor of the CYP3A enzyme system. Concurrent

use with other agents metabolized by this system can increase levels and risk of
toxicity. May prolong the QT interval and increase risk of arrhythmias with pimozide;
concurrent use is contraindicated. Similar effects may occur with antiarrhythmics; ECG
should be monitored for Qtc prolongation and serum levels monitored. May increase
serum levels and the risk of toxicity from carbamazepine, some benzodiazepines
(midazolam, triazolam, alprazolam), cyclosporine, buspirone, disopyramide, ergot
alkaloids, felodipine, omeprazole, tacrolimus, digoxin or theophylline. Ritonavir
increases blood levels (decreases clarithromycin dose in patients with CC <60ml/min).
Increase levels of HMG-CoA reductase inhibitors and may increase risk of
rhabdomyolysis. May increase the effect of warfarin and sildenafil (dose reduction
may be warranted). May increase or decrease the effect of zidovudine. Blood levels
are increased by delavirdine and fluconazole. Blood levels may be decreased by
rifampin and rifabutin. Increase risk of colchicine toxicity when administered with
colchicine, especially in the elderly.

RT Management:
● Administer around the clock, without regard to meals.
Rationale: Because food shows but does not decrease the extent of absorption.
● Always check for his/her vital signs.
Rationale: In order to have the baseline data and to know if you can administer
the drug.
● RT should provide patient teaching.
 39

Rationale: Giving the patient important information about their prescription could
include things like precautions, directions, and guidelines for using it.
● Also keep an eye on the patient's gastrointestinal condition.
Rationale: Clarithromycin has adverse side effects that can affect the GI and
could manifest such as pseudomembranous colitis, abdominal pain/discomfort,
abnormal taste, diarrhea, dyspepsia, nausea.
● Instruct the patient to notify the health care professional if symptoms do not
improve within a few days.
Rationale: In order to monitor his/her mental and physical state.
● Caution patients taking zidovudine that clarithromycin and zidovudine must be
taken at least 4 hr apart.
Rationale: To help keep drug interactions and unwanted effects to a minimum.
● Assess the patient for infection at the beginning of and during therapy
Rationale: In order to determine if the patient is healthy enough to undergo
surgery and if he or she is stable.
 40

DRUG STUDY 2

Brand Name: Apo-Ciproflox, Cipro, Cipro XR,

Proquin XR, Factive, Levaquin, Novo-Levofloxacin,
Avelox, Apo-Norfloxacin, Co-Norfloxacin, Noroxin,
Novo-Norfloxacin, PMS-Norfloxacin, Riva-
Norfloxacin, Apo-Ofloxacin, Floxin

Generic Name: Fluoroquinolones, Ciprofloxacin,

Gemifloxacin, Levofloxacin, Moxifloxacin, Norfloxacin, Ofloxacin

Classification: Therapeutic: anti-infectives

Pharmacologic: fluoroquinolones

Pregnancy Category C

Mode of Action: Inhibit bacterial DNA synthesis by inhibiting DNA gyrase.

Therapeutic Effects: Death of susceptible bacteria.

Spectrum: Broad activity includes many gram-positive pathogens:

Staphylococci including methicillin-resistant Staphylococcus aureus, Staphylococcus
epidermidis, S. saprophyticus, Streptococcus pneumoniae, S. pyogenes, and Bacillus
anthracis. Gram-negative spectrum notable for activity against: Escherichia coli,
Klebsiella, Enterobacter, Salmonella, Shigella, Proteus, Providencia, Morganella
morganii, Pseudomonas aeruginosa, Serratia, Haemophilus, Acinetobacter, Neiserria
gonorrhoeae, Moraxella catarrhalis, Campylobacter. Additional spectrum includes:
Chlamydia pneumoniae, Legionella pneumoniae, and Mycoplasma pneumoniae.

Dosage:

● PO (Adults): Most infections 500-750mg q 12hr. Complicated urinary tract

infections 500mg q 12 hr for 7-14 days (immediate-release); or 1000mg q 24hr
for 7-14 days (extended-release). Uncomplicated urinary tract infections 250 mg
 41

q 12hr for 3 days (immediate-release) or 500mg q 24 hr for 3 days (extended-

release). Gonorrhea 250 mg single dose. Inhalation anthrax (post exposure) or
cutaneous anthrax 500 mg q 12hr for 60 days.
● PO (Children 1-7 yr): Complicated urinary tract infections 10-15 mg/kg q 12 hr
(not to exceed 750 mg/dose) for 10-21 days. Inhalation anthrax (post exposure)
or cutaneous anthrax 10-15 mg/kg q 12 hr (not to exceed 500 mg/dose) for 60
days.
● IV (Adults): Most infections 400 mg q 12 hr. Complicated urinary tract infections
400 mg q 12 hr for 7-14 days. Uncomplicated urinary tract infections 200 mg q 12
hr for 7-14 days. Inhalation anthrax (post exposure) 400 mg q 12 hr for 60 days.
● IV (Children 1-7 yr): Inhalation anthrax (post exposure) 10 mg/kg q 12 hr (not to
exceed 400 mg/dose) for 60 days; Complicated urinary tract infections 6-10
mg/kg q 8 hr (not to exceed 499 mg/dose) for 10-21 days.

Renal Impairment

● PO (Adults): CCr 30-50 ml/min, 250-500 mg q 12 hr; CCr 5-29ml/min, 250-500 q

18 hr (immediate release) or 500 mg q 24 hr (extended-release).
● IV (Adults): CCr 5-29 ml/min, 200-400 mg q 18-24 hr.

Gemifloxacin

PO (Adults): Acute bacterial exacerbation of chronic bronchitis 320 mg once daily for 5
days; Community-acquired pneumonia (CAP) caused by Klebsiella pneumoniae,
Moraxella catarrhalis, and multidrug resistant strains of S. pneumonia 320 mg once
daily for 7 days. Community-acquired pneumonia (CAP) caused S. pneumonia,
Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumonia, and
multidrug resistant strains of S. pneumonia 320 mg once daily for 5 days.

Renal Impairment

PO (Adult): CCr ≤ 40ml/min 160 mg once daily for 5 days.

Levofloxacin
 42

PO, IV (Adults): Most infections 250-750 mg q 24 hr; inhalation anthrax (post exposure)
500 mg once daily for 60 days.

Renal Impairment

PO, IV (Adults): Normal renal function dosing of 750 mg/day: CCr 20-49 ml/min 750 mg
q 48 hr; CCr 10-19 ml/min 750 mg initially, then 500 mg initially then 250 mg q 24 hr;
CCr 10-19 ml/min 500 mg initially then 250 mg q 48 hr. Normal renal function dosing of
250 mg/day: CCr 10-19 ml/min 250 mg q 48 hr.

Moxifloxacin

PO, IV (Adults): Bacterial sinusitis 400 mg once daily for 10 days. Community-acquired
pneumonia 400 mg once daily for 7-14 days. Acute bacterial exacerbation of chronic
bronchitis 400 mg once daily for 5 days. Complicated intra abdominal infection 400 mg
once daily for 5-14 days. Urethritis/cervicitis 300 mg q 12 hr for 7 days. Skin/skin
structure infections 400 mg/day for 7-21 days.

Norfloxacin

PO, IV (Adults): Uncomplicated urinary tract infections 400 mg q 12 hr for 3-14 days.
Complicated urinary tract infections 400 mg q 12 hr for 10-21 days. Gonorrhea 800 mg
single dose. Prostatitis 400 mg q 12 hr for 4-6 wk.

Renal Impairment

PO (Adults): CCr ≤30ml/min 400 mg once daily.

Ofloxacin

PO (Adults): Most infections 400 mg q 12 hr. Prostatitis 300 mg q 12 hr for 6 wk.

Uncomplicated urinary tract infections 200 mg q 12 hr for 3-7 days. Complicated urinary
tract infections 200 mg q 12 for 10 days. Gonorrhea 400 mg single dose.

Otic (Adults and Children ≥6 mo): Otitis externa 6 months to 13 yr 5 drops instilled into
affected ear once daily for 7 days; Otitis externa ≥13 yr 10 drops instilled into affected ear
 43

once daily for 7 days. Acute otitis media in pediatric patients 1-12 yr old with
tympanostomy tubes 5 drops instilled into affected ear twice daily for 10 days.

Chronic suppurative otitis media with perforated tympanic membranes in patients ≥12 yr
q0 drops instilled into the affected ear twice daily for 14 days.

Renal Impairment

PO, IV (Adults): CCr 20-50 ml/min 100% of the usual dose q 24 hr; CCr <20ml/min
50% of the usual dose q 24 hr.

Indications:

PO, IV: Treatment of the following bacterial infections: Urinary tract infections including
cystitis and prostatitis (ciprofloxacin, levofloxacin, norfloxacin, ofloxacin), Gonorrhea
(may not be considered first-line agents due to increasing resistance), Gynecologic
infections (ciprofloxacin, norfloxacin, ofloxacin), Respiratory tract infections including
acute sinusitis, acute exacerbations of chronic bronchitis, and pneumonia (not
norfloxacin), Skin and skin structure infections (levofloxacin, moxifloxacin, ciprofloxacin,
ofloxacin), Bone and joint infections (ciprofloxacin), Infectious diarrhea (ciprofloxacin,
moxifloxacin). Febrile neutropenia (ciprofloxacin). Post-exposure treatment of inhalation
anthrax (ciprofloxacin, levofloxacin).

Contraindications:

Contraindicated in: Hypersensitivity to flumazenil or benzodiazepines; Patients

receiving benzodiazepines for life-threatening medical problems, including status
epilepticus or increased intracranial pressure, should not be given flumazenil; Serious
cyclic antidepressant overdosage.

Use cautiously: Mixed CNS depressant overdose (effects of other agents may emerge
when benzodiazepine effect is removed); History of seizures (seizures are more likely to
occur in patients who are experiencing sedative/hypnotic withdrawal, who have recently
received repeated doses of benzodiazepines, or who have a previous history of seizure
 44

activity); Head injury (may increase intracranial pressure and risk of seizures); Severe
hepatic impairment; Pregnancy, lactation (safety not established); Pedia: children <2 yr
(safety not established).

Side Effects/Adverse Effects:

CNS: Seizures, dizziness, agitation, confusion, drowsiness, emotional lability, fatigue,

headache, sleep disorders

EENT: abnormal hearing, abnormal vision, blurred vision

CV: arrhythmias, chest pain, hypertension

GI: nausea, vomiting, hiccups

Derm: flushing, sweating

Local: pain/injection-site reactions, phlebitis

Neuro: paresthesia,

Misc: rigors, shivering

Drug Interactions:

Drug-Drug: None significant

RT Management:

● Monitor prothrombin time closely in patients receiving fluoroquinolones and

warfarin

Rationale: Due to the drug interactions and may enhance the anticoagulant
effects of warfarin.

● Administer norfloxacin and ofloxacin on an empty stomach.

 45

Rationale: Because food can interfere with absorption, this will ensure that the
tablets have a greater chance of combating the infection.

● Observe the signs and symptoms of anaphylaxis.

Rationale: In order to avoid any complications that can cause death. Always have
an epinephrine on your side.

● Advise patients to notify health care professionals immediately if they are taking
theophylline.

Rationale: Several antibiotics in the fluoroquinolone class have been shown to

interfere with theophylline metabolism.

● Instruct patients being treated for gonorrhea that partners also must be treated.

Rationale: To prevent the infection from spreading, both partners must be

treated.

● Caution patients to use sunscreen and protective clothing.

Rationale: To prevent phototoxicity reactions during and for 5 days after therapy.

● Do not forget to check for vital signs and proper hygiene.

Rationale: To know if the patients need to administer the drugs or to undergo

surgery, and to deter the spread of microorganisms.
 46

DRUG STUDY 3

Brand Name: Pfizerpen, Apo-Pen VK, Crystapen,

Novo-Pen-VK, Nu-Pen-VK, Penicillin V, Wycillin,
Bicillin L-A, Permapen.

Generic Name: Penicillin G, Penicillin V, Procaine

Penicillin G, Benzathine Penicillin G.

Classification: Therapeutic: anti-infectives

Pharmacologic: penicillins

Pregnancy Category B

Mode of Action: Bind to bacterial cell wall, resulting in cell death.

Therapeutic Effects: Bacterial action against susceptible bacteria.

Spectrum: Active against: Most gram positive organisms, including many

streptococci (Streptococcus pneumoniae, group A beta-hemolytic streptococci),
staphylococci (non-penicillinase-producing strains) and Bacillus anthracis. Some gram-
negative organisms, such as Neisseria meningitidis and Neisseria Gonorrhoeae (only
penicillin susceptible strains). Some anaerobic bacteria and spirochetes including
Borrelia burgdorferi.

Dosage:

Penicillin G (Aqueous)

IM, IV (Adults): Most infections 1-5 million units q 4-6 hr.

 47

IM, IV (Children): 8333-16,667 units/kg q 4 hr; 12,550-25,000 units/kg q 6 hr; up to

250,000 units/kg/day in divided doses, some infections may require up to 300,000
units/kg/day.

Infants >7 days): 25,000 units/kg q 8 hr; meningitis 50,000-75,000 units/kg q 6 hr.

IV (Infants <7 days): 25,000 units/kg q 12 hr; Streptococcus B meningitis 100,000-

150,000 units/kg/day in divided dose.

Penicillin V

PO (Adults and Children ≥ 12 yr): Most infections 125-500 mg q 6-8 hr. Rheumatic
fever prevention 125-250 mg q 12 hr.

PO (Children <12 yr): Lyme disease 12.5 mg/kg q 6 hr (unlabeled); prevention of

Streptococcus pneumoniae sepsis in children with sickle cell disease 125 mg twice
daily.

Benzathine Penicillin G

IM (Adults): Streptococcal infections/erysipeloid 1.2 million units single dose. Primary,

secondary, and early latent syphilis 2.4 million units single dose. Tertiary and late latent
syphilis (not neurosyphilis) 2.4 million units once weekly for 3 wk. Prevention of
rheumatic fever 1.2 million units q 3-4 wk.

IM (Children >27 kg): Streptococcal infections/erysipeloid 900,000-1.2 million units

(single dose). Primary, secondary, and early latent syphilis up to 2.4 million units single
dose. Late latent or latent syphilis of undetermined duration 50,000 units/kg weekly for 3
wk. Prevention of rheumatic fever 1.2 million units q 2-3 wk.

IM (Children <27 kg): Streptococcal infections/erysipeloid 300,000-600,000 units single

dose. Primary, secondary, and early latent syphilis up to 2.4 million units single dose.
Late latent or latent syphilis of undetermined duration 50,000 units/kg weekly for 3 wk.
Prevention of rheumatic fever 1.2 million units q 2-3 wk.
 48

Procaine Penicillin G

IM (Adults): Moderate or severe infections 600,000-1.2 million units/day as a single

dose or in 2 divided doses. Neurosyphilis 2.4 units/day with 500mg probenecid PO 4
times daily for 10-14 days.

IM (Children): Congenital syphilis 50,000 units/kg/day for 10-14 days.]

Indication: Treatment of a wide variety of infections including: Pneumococcal

pneumonia, Streptococcal pharyngitis, Syphilis, Gonorrhoea strains. Treatment of
enterococcal infections (requires the addition of an aminoglycoside). Prevention of
rheumatic fever. Should not be used as a single agent to treat anthrax.

Unlabeled uses: treatment of lyme disease. Prevention of recurrent

Streptococcus pneumoniae septicemia in children with sickle-cell disease.

Contraindication:

Contraindicated in: Previous hypersensitivity to penicillins (cross-sensitivity may exist

with cephalosporins and other beta lactams); Hypersensitivity to procaine or benzathine
(procaine and benzathine preparations only); Some products may contain tartrazine and
should be avoided in patients with known hypersensitivity.

Use cautiously in: Geri: Geriatric patients (consider decreased body mass, age-related
decrease in renal/hepatic/cardiac function, intercurrent disease and drug therapy);
Severe renal insufficiency (dose reduction recommended)

OB: Pregnancy (although safety not established, has been used

safely); Lactation (safety not established).

Side Effects/Adverse Effects:

CNS: seizures
 49

GI: diarrhea, epigastric distress, nausea, vomiting, pseudomembranous colitis

GU: interstitial nephritis

DERM: rashes, urticaria

HEMAT: eosinophilia, hemolytic anemia, leukopenia

LOCAL: pain at IM site, phlebitis at IV site

MISC: allergic reactions including anaphylaxis and serum sickness, superinfection.

Drug Interactions:

Drug-Drug: Penicillin may decrease effectiveness of oral contraceptive agents.

Probenecid decreases renal excretion and increases blood levels of penicillin (therapy
may be combined for this purpose). Neomycin may decrease absorption of penicillin V.
decrease elimination of methotrexate and increase risk of serious toxicity.

RT Management:

● Change IV sites every 48 hr.

Rationale: To reduce the risk of phlebitis and bloodstream infections.

● Obtain a history to determine previous use of and reactions to penicillin,

cephalosporins, or other beta lactam antibiotics.

Rationale: Persons with a negative history of penicillin sensitivity may still have
an allergic response.

● Monitor serum sodium concentration in patients with hypertension of CHF.

Rationale: Hypernatremia may develop after a large dose of penicillin sodium.

● Inject penicillin deep into a well-developed muscle mass at a slow, consistent

rate to prevent blockage of needle.
 50

Rationale: Due to accident injury near or into a nerve can result in severe pain
and dysfunction.

● Never give penicillin G benzathine penicillin G suspensions IV.

Rationale: It may cause embolism or toxic reactions.

● Patients with an allergy to penicillin should be instructed to always carry an

identification card with this information.

Rationale: To avoid misuse of drugs, anaphylaxis, a life-threatening illness that

affects numerous body systems, is one of the most severe reactions.
 51

DRUG STUDY 4

Brand Name: Zithromax

Generic Name: azithromycin

Classification: Macrolides

Mode of Action:

Azithromycin binds to the 23S rRNA of the bacterial 50S ribosomal subunit. It stops
bacterial protein synthesis by inhibiting the transpeptidation/translocation step of protein
synthesis and by inhibiting the assembly of the 50S ribosomal subunit.

Dosage:

Community-acquired pneumonia:

Oral: ADULT

-Immediate-release: 500 mg orally as a single dose on day 1, followed by 250 mg orally

once a day on days 2 to 5

-Extended-release: 2 g orally once as a single dose

Parenteral: 500 mg IV once a day as a single dose for at least 2 days, followed by 500
mg (immediate-release formulation) orally to complete a 7- to 10-day course of therapy.

PEDIATRIC
 52

6 months and older:

Immediate-release: 10 mg/kg (maximum: 500 mg/dose) orally on day 1, followed by 5

mg/kg (250 mg/dose) orally once a day on days 2 to 5

Extended-release:

-Patients less than 34 kg: 60 mg/kg (maximum dose: 2 g/dose) orally as a single dose

-Patients 34 kg or greater: 2 g orally as a single dose

16 years and older:

Parenteral: 500 mg IV once a day as a single dose for at least 2 days, followed by 500
mg (immediate-release formulation) orally to complete a 7- to 10-day course of therapy

Indications:

Azithromycin should be used only to treat or prevent infections that are proven or
strongly suspected to be caused by susceptible bacteria in order to prevent the
development of antimicrobial resistance and maintain the efficacy of azithromycin.

Azithromycin is indicated for the treatment of patients with mild to moderate infections
caused by susceptible strains of the microorganisms listed in the specific conditions
below. Recommended dosages, duration of therapy and considerations for various
patient populations may vary among these infections. Refer to the FDA label and
"Indications" section of this drug entry for detailed information.

Adults:

Acute bacterial exacerbations of chronic obstructive pulmonary disease due to

Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae

Acute bacterial sinusitis due to Haemophilus influenzae, Moraxella catarrhalis or

Streptococcus pneumoniae
 53

Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus

influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients
appropriate for oral therapy

Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line

therapy in individuals who cannot use first-line therapy. Uncomplicated skin and skin
structure infections due to Staphylococcus aureus, Streptococcus pyogenes, or
Streptococcus agalactiae. Abscesses usually require surgical drainage.

Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae.

Genital ulcer disease in men due to Haemophilus ducreyi (chancroid). Due to the small
number of women included in clinical trials, the efficacy of azithromycin in the treatment
of chancroid in women has not been established.

Pediatric Patients

Acute otitis media caused by Haemophilus influenzae, Moraxella catarrhalis or

Streptococcus pneumoniae

Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus

influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients
appropriate for oral therapy.

Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line

therapy in individuals who cannot use first-line therapy.

Contraindications:

Contraindicated in patients with known hypersensitivity to azithromycin, or any other

macrolide and in hepatic disease. Use caution in renal failure.

Side Effects/ Adverse Effects:

● diarrhea or loose stools,

 54

● nausea,
● abdominal pain,
● stomach upset,
● vomiting,
● constipation,
● dizziness,
● tiredness,
● headache,
● vaginal itching or discharge,
● nervousness,
● sleep problems (insomnia),
● skin rash or itching,
● ringing in the ears,
● hearing problems,
● or decreased sense of taste or smell.

Drug Interaction:

Azithromycin may interact with other medications a person is taking. For example, using
azithromycin while taking nelfinavir, which is a drug that helps treat HIV, can increase
the risk of liver abnormalities and hearing problems. Azithromycin can also increase the
effects of blood thinners such as warfarin. Other drugs that may interact with
azithromycin include:

● digoxin, a heart medication

● colchicine, a gout medication
● phenytoin, a seizure medication
● antacids that contain magnesium or aluminum

RT Management:
 55

1.) Ask your patient if they have drug allergy

Rationale: To know if they are hypersensitivity to azithromycin or any macrolide
antibiotic.

2.) Administer on an empty stomach 1 hr before or 2–3 hr after meals.

Rationale: You need to administer 1hr before or 2-3 after meals because food affects
the absorption of this drug.

3.) Prepare Zmax by adding 60 mL water to the bottle, shake well.

Rationale: To mix the medication properly.

4.) Take the full course prescribed. Do not take antacids.

Rationale: Taking antacids two hours before or two hours after you take azithromycin
can make azithromycin less effective.

5.) Tell your patient that they may experience these side effects: Stomach cramping,
discomfort, diarrhea; fatigue, headache.

6.) Report severe or watery diarrhea, severe nausea or vomiting, rash or itching, mouth
sores, vaginal sores.
 56

DRUG STUDY 5

Brand Name: Dificid

Generic Name: Fidaxomicin

Classification: Macrolide

Mode of Action:

Fidaxomicin produces its antibacterial effects by inhibiting bacterial RNA polymerase a

transcription initiation. Although fidaxomicin and rifamycins are both inhibitors of
bacterial transcription, fidaxomicin acts at an earlier step in the transcription initiation
pathway.

Dosage:

Oral

Clostridium difficile-associated diarrhoea

Adult: 200 mg bid for 10 days.

Indications:

Fidaxomicin is indicated for the treatment of Clostridioides (formerly Clostridium)

difficile-associated diarrhea in adult and pediatric patients 6 months of age and older.
Fidaxomicin should only be used in patients with proven or strongly suspected C.
difficile infection to reduce the risk of development of drug-resistant bacteria and
maximize the therapeutic effectiveness of fidaxomicin and other antimicrobial agents.

Contraindications:

Hypersensitivity.
 57

Side Effects/ Adverse Effects:

Significant: Hypersensitivity reactions (e.g. dyspnoea, pruritus, rash, angioedema of

mouth, face and throat).
Nervous: Dizziness, headache.
GI: Nausea, GI haemorrhage, abdominal pain, vomiting, abdominal distention,
tenderness, dyspepsia, dysphagia, flatulence, intestinal obstruction, megacolon,
anorexia, dysgeusia, constipation.
Hepatic: Increased ALT.
Haematologic: Anaemia, neutropenia.
Drug Interaction:
May diminish the therapeutic effect of Na picosulfate, lactobacillus and estriol. May
increase serum concentration of mizolastine. Increased plasma concentration w/ P-gp
inhibitor (e.g. ciclosporin).

RT Management:

1.) Instruct the patient to take fidaxomicin twice daily, 12 hrs. apart, as directed for the
full course of therapy, even if feeling better.
Rationale: Skipping doses or not completing a full course of therapy may decrease
effectiveness of therapy and increase risk that bacteria will develop resistance and not
be treatable in the future.

2.) Advise the patient to notify the health care professional of all Rx or OTC
medications, vitamins, or herbal products being taken and to consult with health care
professionals before taking other medications.
Rationale: Because some medicines may interfere and can cause unpleasant to the
patient and have dangerous side effects.

3.) Advise females of reproductive potential to notify health care professionals if

pregnancy is planned or suspected or if breastfeeding.
 58

Rationale: Because there are some cases that dificid can harm your baby while you are
pregnant. If you are pregnant, you and your doctor should decide together if you will
take dificid.

4.) Monitor bowel function for diarrhea, abdominal cramping, fever, and bloody stools.
May begin up to several weeks following cessation of antibiotic therapy.
Rationale: Check with your doctor immediately if the symptoms don't stop.

5.) Monitor for signs and symptoms of hypersensitivity reactions (dyspnea, pruritus,
rash, angioedema of mouth, throat, and face) periodically during therapy. Risk
increases with a macrolide allergy.
 59

DRUG STUDY 6

Brand Name: Cozaar

Generic Name: Losartan potassium

Classification: Pharmacotherapeutic: Angiotensin II Receptor

Antagonist

Clinical: Antihypertensive

Mode of Action: Blocks vasoconstrictor, aldosterone-secreting effects of angiotensin

II, inhibiting binding of angiotensin II to AT1 receptors

Indication/Dosage: Hypertension:

PO: Adults & Elderly: 50mg/day initially. May be given once or twice
daily, total dose in a day ranging from 25-100mg. Children 6-16yrs:
0.7 mg/kg once daily. Adjust dose based on BP.

Stroke Prevention (Hypertension with Left Ventricular Hypertrophy)

PO: Adults & Elderly: 50 mg/day. Maximum of 100mg/day based on

BP response. Combined with thiazide diuretic

Diabetic Nephropathy:

PO: Adults & Elderly: 50mg/day initially. May increase to

100mg/day depending on BP response.

Contraindication: Hypersensitivity to losartan. Concomitant use of aliskiren in patients

with diabetes. Pregnancy, as losartan can cause fetal injury or
mortality.
 60

Side Effects: Common: URTI. Occasional: Dizziness, diarrhea, cough. Rare:

Insomnia, dyspepsia, heartburn, back/leg pain, muscle
cramps, myalgia, nasal congestion, sinusitis, depression.

Adverse Effects: Overdosage may manifest as hypotension and tachycardia.

Bradycardia occurs less often.

Drug Interaction: NSAIDs (Ibuprofen, naproxen): may decrease effects

Potassium-sparing diuretics (spironolactone): may increase serum

potassium

Diuretics (Furosemide): may cause additive hypotension. May

increase levels of lithium.

RT Management: 1. Check doctor’s order and patient’s chat to prevent wrong

administration of medication;

2. Assess patient for contraindications and cautions to prevent

adverse effects;

3. Obtain BP and apical pulse immediately before dose to monitor

for fluctuations post-medication;

4. Question for possibility of pregnancy as it is a contraindication

and can cause harm to fetus;

5. Assess for evidence of URTI as a side effect of the medication;

6. Monitor patient’s vital signs and check for any abnormalities;

7. Obtain arterial blood for Arterial Blood Gas to monitor

oxygenation status to check for changes or improvements
 61

8. Evaluate respirations and auscultate breath sounds to check for

any hypersensitivity reactions;

9. Assess patient for any possible side effects or adverse effects for
documentation, report to attending physician if effects are present
 62

DRUG STUDY 7

Brand Name: Paracetamol

Generic Name: Acetaminophen

Classification: PHARMACOTHERAPEUTIC: Central analgesic.

CLINICAL: Non-narcotic analgesic, antipyretic

Mode of Action: Appears to inhibit prostaglandin synthesis in the CNS and, to a

lesser extent, block pain impulses through peripheral action.
Acts centrally on the hypothalamic heat-regulating center,
producing peripheral vasodilation (heat loss, skin erythema,
diaphoresis). Therapeutic Effect: Results in antipyresis.
Produces analgesic effect.

Indication/Dosage:

Note: Over-the-counter (OTC) use of acetaminophen should be

limited to 3,000 mg/day.

Analgesia and Antipyresis IV: ADULTS, ADOLESCENTS

WEIGHING 50 KG OR MORE: 1,000 mg q6h or 650 mg q4h.
Maximum single dose: 1,000 mg; maximum total daily dose: 4,000
mg. ADULTS, ADOLESCENTS WEIGHING LESS THAN 50 KG: 15
mg/kg q6h or 12.5 mg/kg q4h. Maximum single dose: 750 mg;
maximum total daily dose: 75 mg/kg/day (3,750 mg). CHILDREN
2–12 YRS: 15 mg/kg q6h or 12.5 mg/kg q4h. Maximum single
dose: 750 mg. Maximum: 75 mg/kg/day, not to exceed 3,750
mg/day. INFANTS AND CHILDREN LESS THAN 2 YRS: 7.5–15
mg/kg q6h. Maximum: 60 mg/kg/day. NEONATES: (Limited data
available) Loading dose: 20 mg/kg. PMA 37 or greater than 37 wks:
10 mg/kg/dose q6h. Maximum: 40 mg/kg/day. PMA 33–36 wks: 10
mg/kg/dose q8h. Maximum: 40 mg/kg/day. PMA 28–32 wks: 10
 63

mg/kg/dose q12h. Maximum: 22.5 mg/kg/day. PO: ADULTS,

ELDERLY, CHILDREN 13 YRS AND OLDER: (Regular Strength)
325–650 mg q4–6h. Maximum: 3,250 mg/day unless directed by
health care provider. (Extra Strength) 1000 mg q6h. Maximum:
3,000 mg/day unless directed by health care provider. CHILDREN
12 YRS AND YOUNGER: (Weight dosing preferred; if not available,
use age. Doses may be repeated q4h. Maximum: 5 doses/day.)
Age Weight (Kg) Dose 11–12 yrs 32.7–43.2 480 mg 9–10 yrs 27.3–
32.6 400 mg 6–8 yrs 21.8–27.2 320 mg 4–5 yrs 16.4–21.7 240 mg
2–3 yrs 10.9–16.3 160 mg 1–<2 yrs 8.2–10.8 120 mg 4–11 mos
5.4–8.1 80 mg 0–3 mos 2.7–5.3 40 mg NEONATES: Term: 10–15
mg/kg/dose q4–6h. Maximum: 75 mg/kg/day. GA 33–37 wks or
term less than 10 days: 10–15 mg/kg/dose q6h. Maximum: 60
mg/kg/day. GA: 28–32 wks: 10–12 mg/kg/dose q6–8h. Maximum:
40 mg/kg/day. Rectal: ADULTS: 325–650 mg q4–6h. Maximum: 4
g/24 hrs. CHILDREN: 10–20 mg/kg/dose q4–6h as needed.
Maximum: 5 doses/24 hrs. NEONATES: Term: Initially, 30
mg/kg/once, then 20 mg/kg/dose q6–8h. Maximum: 90 mg/kg/day.
GA 33–37 wks or term less than 10 days: Initially, 30 mg/kg once,
then 15 mg/kg/dose q8h. Maximum: 60 mg/kg/day. GA: 28–32 wks:
20 mg/kg/dose q12h. Maximum: 40 mg/kg/day. Dosage in Renal
Impairment Creatinine Clearance Frequency Oral 10–50 mL/min
q6h Less than 10 mL/min q8h Continuous renal replacement
therapy q6h IV 30 mL/min or less (use caution, decrease daily
dose, extend dosing interval) Dosage in Hepatic Impairment Use
with caution. IV contraindicated with severe impairment.

Contraindication: Hypersensitivity to acetaminophen. (Ofirmev): severe hepatic

impairment or severe active liver disease. Cautions:
Sensitivity to acetaminophen; severe renal impairment; alcohol
 64

dependency, hepatic impairment, or active hepatic disease;

chronic malnutrition and hypovolemia (Ofirmev); G6PD deficiency
(hemolysis may occur). Limit dose to less than 4 g/day.

Side Effects: Rare: Hypersensitivity reaction

Adverse Effects: Early Signs of Acetaminophen Toxicity: Anorexia, nausea,

diaphoresis, fatigue within first 12–24 hrs. Later Signs of
Toxicity: Vomiting, right upper quadrant tenderness, elevated
LFTs within 48–72 hrs after ingestion. Antidote: Acetylcysteine
(see Appendix J for dosage).

Drug Interaction: DRUG: Alcohol (chronic use), hepatotoxic medications (e.g.,

phenytoin), hepatic enzyme inducers (e.g., phenytoin,
rifAMPin) may increase risk of hepatotoxicity with prolonged
high dose or single toxic dose. May increase risk of bleeding with
warfarin with chronic, high-dose use. HERBAL: St. John’s wort
may decrease blood levels. FOOD: Food may decrease the
rate of absorption. LAB VALUES: May increase serum ALT, AST,
bilirubin; prothrombin levels (may indicate
hepatotoxicity).

RT Management:

● Assess for clinical improvement and relief of pain, fever

Rationale: to ensure patient wellbeing.

● Instruct patients not to exceed the maximum daily recommended

dose: 4g/day

Rationale: this is to avoid toxicity.

 65

● Consult a physician for use in children younger than 2 yrs, oral use
longer than 5 days (children) or longer than 10 days (adults), or
fever lasting longer than 3 days to prevent complications.

DRUG STUDY 8

Brand Name: Solmux

Generic Name: Carbocisteine

Classification: R05CB03 - carbocisteine; Mucolytics

Mode of Action: These medicines contain carbocisteine, a medicine that causes

phlegm to be less thick and sticky and thus easier to cough
up and expel. Carbocisteine, in an in vitro study (outside the
living organism), was shown to have significantly reduced
the ability of bacteria to adhere to human pharyngeal cells.

Indication/Dosage:Carbocisteine (Solmux) is a mucolytic agent used to relieve cough

characterized by excessive or sticky sputum or phlegm to
help treat respiratory tract disorders such as acute bronchitis.
Carbocisteine also reduces the number of
exacerbations associated with chronic obstructive
pulmonary disease (COPD) and inhibits the adherence of bacteria
and viruses to human respiratory cells. Gar1locisteine
is also used in the treatment of otitis media with effusion (glue
ear).

Contraindication: If patients are allergic to any ingredient in the products. Avoid

carbocisteine in patients with an active stomach or
intestinal ulcer.
 66

Side Effects: Common Side effects: diarrhea and feeling or being sick.
Serious side effects: in rare cases, anaphylaxis.

Adverse Effects: Nausea, stomach discomfort, diarrhea, and skin rashes are the
most common undesirable effects.Carbocisteine rarely
causes dizziness, insomnia, headache, palpitations, mild
lowering of blood glucose, dryness of mouth, abnormal heart
rhythm (atrial fibrillation), and "gassiness".

Drug Interaction: Patients should always tell their doctor if they are taking other
medicines, including herbal medicines and food
supplements.

RT Management:

● Assess breathing sound for any sign of secretion by auscultation.

● Instruct patients to drink an adequate amount of water daily.
● Give the patient the prescribed dosage of the drug.
● Inform the patient the proper dosage of drug per 8 hours.
 67

DRUG STUDY 9

Brand Name: Berocca Roche

Generic Name: Multivitamins

Classification: Drug class vitamin and mineral combinations

Mode of Action: Biotin catalyzes the action of the B and C vitamins for faster results.
Calcium is significant in the excitation mechanisms of the
nerve and muscle cells important for muscle contraction. The
effervescent form of Berocca allows the body to
quickly and completely absorb the essential vitamins and
minerals.

Indication/Dosage: Adult: 1 tablet orally once/day

10mL in 500-1000 mL NS/D5W IV

Pediatric: 3kg or greater to 11 years: 5 mL/day IV of pediatric

formulation added to TPN or 100 mL or greater of
appropriate solution

Age over 11 years: 1 tablet orally once/day or 10mL in 500-1000mL

NS/D5W IV

Contraindication: Impaired renal functions and Nephrolithiasis.

Side Effects: Constipation

Dark stools
Nausea
Vomiting
Abdominal pain
 68

Adverse Effects: Constipation, diarrhea, or upset stomach may occur. These effects
are usually temporary and may disappear as your body
adjusts to this medication. If any of these effects persist or
worsen, contact your doctor or pharmacist promptly.

Drug Interaction: If your physician has directed you to use this medication, your
doctor may already be aware of any possible drug
interactions and may be monitoring you for them. Do not start,
stop, or change the dosage of any medicine before checking with
your doctor, health care provider or pharmacist first.

Multivitamins have no listed severe interactions with other drugs.

Multivitamins have no listed serious interactions with other drugs.

Multivitamins have no listed moderate interactions with other drugs.

Multivitamins have no listed mild interactions with other drugs.

This document does not contain all possible interactions. Therefore,

before using this product, tell your doctor or pharmacist of all the
products you use. Keep a list of all your medications with you, and
share the list with your doctor and pharmacist. Check with your
physician if you have health questions or concerns.

RT Management:

● Assess patients for any kind of complication to the drug to prevent

any kind of complications.
● Instruct patients to consume prescribed amounts of drugs daily to
give substantial vitamins.
 69

● Inform patients for common complications of the drug to avoid

panic response.
● Instruct the patient to drink an adequate amount of water to keep
the patient hydrated.
 70

Respiratory Therapy Care Plan 1

Analysis: Impaired gas exchange related to inflammation secondary to bacterial

pneumonia as evidenced by tachycardia or dyspnea

RT interventions:

a. Assess respiratory rate or depth - the presence of respiratory distress may

suggest the degree of lung impairment
b. Monitor Vital signs such as heart rate - due to the existing increase in the
patient’s temperature, tachycardia may be present due to the excessive use of
oxygen in the body (hypoxemia).
c. Monitor vital signs such as temperature - having high fever is common among
patients with bacterial pneumonia and this should be monitored because this
may increase oxygen consumption and then alters oxygenation.
d. Encourage patients to have adequate bed rest - this may lessen the oxygen
demand of the body thus relieving exhaustion.
e. Position the patient on semi fowlers - a proper position to promote chest
expansion.
f. Suggest use of humidifier - Humidification may loosen secretions and improve
ventilation
g. Suggest deep breathing exercises - this action will mobilize the secretions and
improve ventilation
h. Encourage the patient to undergo Chest physiotherapy - to help loosen and
mobilizes secretions.
i. Secretions should be removed - retained secretions interfere with gas exchange
and may slow recovery.
j. Observing for signs of worsening condition - signs such as severe dyspnea and
bloody sputum - signs of worsening condition requires immediate response to
avoid worst case scenarios.
 71

Respiratory Therapy Care Plan 2

Analysis: Acute chest pain related to persistent coughing secondary to bacterial

pneumonia as evidenced by subjective statement of patient

RT interventions:

a. Assess the characteristic of the pain - the type of pain may vary from sharp,
constant, or stabbing. It may also be assessed by the location and intensity. This
assessment will suggest the onset of the complications.
b. Monitor vital signs - changes in this especially in the HR and BP is an indication
that the patient is experiencing pain.
c. Provide procedures that will promote comfort - aside from administering pain
relievers, back rubs, position changes, and breathing exercises will control the
pain.
d. Encourage oral hygiene - mouth breathing is one of the suggested breathing
exercises and this may dry out mucous membranes that will lead to more
discomfort.
e. Administer analgesics and/or antitussives - these medications may suppress
cough and thus will minimize its persistence that causes pain. Therefore, it will
improve comfort.
f. Instruct patient to support chest when coughing (chest splinting) - this will aid
support and control chest discomfort during cough.
g. Position the patient in a comfortable position - this may lessen the discomfort
brought by pain.
 72

RT Care Plan 3

Analysis: Extreme Tiredness or Fatigue secondary to bacterial pneumonia as

evidenced by subjective statement of patient

RT Interventions:

a. Assess the patient’s typical level of exercise and physical movement. - Increased
physical exertion and inadequate levels of exercise can add to fatigue.
Encourage the patient to avoid overexertion and possible exacerbation of
symptoms.
b. Position the patient on semi fowlers - The patient should assume a comfortable
position to promote rest and breathing and should change positions frequently to
enhance secretion clearance and pulmonary ventilation and perfusion.
c. Adequate hydration of 2 to 3 liters of water per day - thins and loosens
pulmonary secretions, also to avoid dehydration and help the patient to recover
more quickly
d. Promote sufficient nutritional intake. - The patient will need properly balanced
intake of fats, carbohydrates, proteins, vitamins, and minerals to provide energy
resources.
e. Evaluate the patient’s outlook for fatigue relief, eagerness to participate in
strategies to reduce fatigue, and level of family and social support. - These will
promote active participation in planning, implementing, and evaluating
therapeutic management to alleviate fatigue.
f. Instruct patient and family about the cause of pneumonia, management of
symptoms, signs, and symptoms, and the need for follow-up.
g. Instruct the patient about the factors that may have contributed to the
development of the disease.
73
 74

Discharge plan & Pulmonary Rehabilitation

Pulmonary rehabilitation is an education and exercise program designed to raise your

knowledge of your lungs and illness. You'll learn how to workout without becoming out
of breath.
Medication:
Explain to the patient or family member about the medication and instruct them to
take the drug at the right time and right dose and develop a process to guarantee that
medicines are taken. If you stop taking your medicine too soon, bacteria in your lungs
may continue to proliferate, causing pneumonia to return.
1. Clarithromycin – Clarithromycin is used to treat infections of the lungs, bronchitis
(infection of the tubes leading to the lungs), and infections of the ears, sinuses,
skin, and throat.
Community -Acquired pneumonia; 250 mg q 12hr for 7-14 days or 1000mg once daily
for 7 days as XL tablets
2. BAXDELA - a fluoroquinolone antibacterial medicine used to treat certain types
of infections caused by certain germs called bacteria in adults 18 years or older.
450 mg BAXDELA tablet orally every 12 hours. For 5 to 10 days
Exercise
The most important aspect of pulmonary rehabilitation is exercise training. It
counteracts the effects of idleness and deconditioning by reducing shortness of breath
and increasing exercise capacity. Physical restrictions, on the other hand, may limit the
sorts of exercise training that may be employed.
- Breathing exercise. You can do this by taking long slow deep breaths or blowing
through a straw into a glass of water.
- Deep breathing can also help remove mucus from your lungs: breathe deeply 5
to 10 times, then cough or puff forcefully a few times to move the mucus around.
- Emphasize physical exercise to help pulmonary system cope with disease
Therapy
- Bed rest therapy. Your body needs a lot of rest for your recovery
 75

- Hydration therapy. Fluids hydrate the body, loosen mucus in the lungs, and help
bring up phlegm. Take in lots of water.
- Oxygen therapy. Patients who are unable to breathe sufficiently on their own
might benefit from oxygen supplementation.

Hygiene
Hygiene and maintaining healthy personal habits can help you stay healthy and feel
good about yourself. Learn the personal hygiene routines you should incorporate into
your daily routine. You can also help prevent pneumonia and other respiratory infections
by following good hygiene practices.
- Wash your hands. Washing your hands before preparing or eating food, after
going to the bathroom, after coughing or sneezing, and after handling garbage, goes a
long way toward preventing the spread of bacteria and viruses.
- Make sure to clean your environment
Out Patient
- Patients must be informed about any potential warning signs or symptoms that
may occur.
- Encourage the patient or the significant other to see doctor if there is a problem
regarding with the patient’s health
- Remind the patient and the significant other to do follow up check-up and for
them to know the progress
- Do not smoke. Allowing others to smoke around you is not a good idea. Your
cough will persist longer if you smoke
Diet
- Starches and saccharine-containing foods should be avoided. The loss of fluid
induced by diarrhoea and/or perspiration is linked to an increased demand for
fluid in pneumonia.
- The carbohydrate content of whole grains such as quinoa, brown rice, oats, and
barley gives energy to the body. They include B-vitamins, which aid in the
generation of energy and the regulation of body temperature. The mineral
selenium included in these grains helps to improve the immune system.
 76

- For those suffering from pneumonia, a high-protein diet is useful. Anti-

inflammatory foods include almonds, seeds, beans, white meat, and cold-water
seafood like salmon and sardines. They also aid in the healing of damaged
tissues and the formation of new ones in the body.
- Leafy greens such as kale, lettuce, and spinach are high in nutrients that aid in
the recovery of this respiratory illness. They are high in antioxidants, which help
to protect the body from infectious pathogens.
Spiritual
- Encourage the family to pray for the patient's recovery.
- Encourage the family to continue to provide emotional support to the patient in
order to help him or her heal and establish a strong connection with God.
- Discuss with the patient about how you may assist them spiritually. Asking
patients how you might help them spiritually is one of the simplest methods to
give spiritual care, and then doing your best to fulfill that request is another.
 77

PROGNOSIS

The patient is 40 years old and sought medical attention at the Pulmonary
Department consultation room of San Pedro Hospital on July 14, 2021, 15:00. To further
assess the patient, tests were performed namely, complete blood count, chest x ray,
and sputum test.
The main goal of the respiratory therapists is to give care to the patient to
improve the cardiorespiratory state of the patient. We are tasked to help other members
of the healthcare team to give holistic attention to the patient. Continuous medication
and care is a must to improve the patient’s condition and avoid further complications.
After all the treatments aided to the patient, it is believed that she had a good
prognosis given that she is not hospitalized and is only prescribed home remedies.
 78

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