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SUBMITTED TO: Mrs. Guendelyn Feleciano

INTRODUCTION Pneumonia for infants is pneumonia that occurs in very young infants. This lung disease can develop in infants as young as 24 hours old and often occurs partially because of abnormalities in

the airways and lungs. Pneumonia is a significant cause of death in newborns/infants; in deaths that occur in the first 30 days of life, pneumonia is a contributing factor in as much as 25 percent of cases. Infants with pneumonia complicated by blood-borne infection have a mortality risk of 10 percent, and this risk triples if the infant had a low birth weight. There are several risk factors for infants with pneumonia that can be present before birth. These include maternal fever, tenderness or pain in the uterine area, urinary tract infection and tachycardia of the fetus. Signs that can be noted at or shortly after birth include preterm labor, cloudy or foulsmelling amniotic fluid and rupture of uterine membranes before labor begins. An additional risk factor is gestational maternal illness with an infectious organism known to be capable of crossing the placental barrier. Infants with pneumonia can have a number of different symptoms. These include abnormally high respiratory rate, grunting when exhaling, yellow or green airway secretions, aspiration of blood, oxygen deprivation in certain tissues and discolored skin, hair and nails. Newborns might also have fluctuating temperature, skin rash, jaundice, irregular heartbeat and a distended abdomen. Prompt diagnosis and treatment of neonatal pneumonia is crucial because of the high mortality risk associated with this disease. Pneumonia can significantly alter gas exchange in the lungs of neonates, potentially resulting in oxygen

deprivation and compromise of metabolism of all cell types in the body. Structural and immunological defense mechanisms are not fully formed in neonates, which makes it all but impossible for the newborn to fight the infection effectively. In addition, there is an increased risk that the infection might spread from the lungs to other parts of the body. The goals of treatment for infants with pneumonia are to eradicate the infectious agent and at the same time to protect the infant by providing respiratory support. There are some risks involved in treatment; however, that must be minimized to ensure the infants lungs are not permanently damaged. The main risk of antimicrobial treatment is that antimicrobial medications can temporarily worsen lung inflammation, which might increase the risk of permanent lung damage. To reduce this risk, antimicrobial medications are chosen carefully to minimize the dose required to combat the infection. Antimicrobial medications are the key to successfully treating this disease, but medication alone cannot provide the infant with adequate support. In addition to antimicrobial medication, the infant is provided with a source of oxygen to ensure that he or she is not oxygen-deprived because of reduced lung function. Neonates might also receive blood transfusions and intravenous fluids to ensure adequate nutrition and blood-oxygen capacity.

OBJECTIVES GENERAL OBJECTIVE: The researchers will be able to know what pneumonia is, causes of pneumonia, how it is acquired and prevented, its treatments and prevention of the occurrence of pneumonia.


Define what is pneumonia Trace the pathophysiology of pneumonia Enumerate the different signs and symptoms of pneumonia Formulate and apply nursing care plans utilizing the nursing process To learn new clinical skills as well as sharpen our current clinical skills required in the management of the patient with pneumonia


The name of the patient is Carmelita Isip. The patient lives at 1717 Loyola St.,Tondo, Manila. Her age is 54 years old. Her gender is female. Her birthday is on June 13, 1956. Filipino is her nationality.The information gathered are provided by the daughter who is coherent and reliable.She has a history of hospital admissions due to breast cancer. Prior to admission stated by his daughter she was experiencing cough for 3 consecutive days. According to the daughter, these symptoms occur last_______, _________, 2010. Due to this condition, her mother decided to consult him in ____________where she was nebulized with Salbutamol X3 doses and diagnosed with pneumonia. Her vital signs were, Temperature __ C, Cardiac Rate ___ bpm, Respiratory rate ___ bpm and weight is ___kg. She was referred at Gat Andress Medical hospital and admitted on November 2, 2010 at around 10:45 pm due to cough. The patients vital signs upon admission were, Temperature ____ C, Cardiac Rate ___ bpm, Respiratory rate __ bpm and weighs ___ kg. The patients daughter decided to admit her to have proper management of her condition. Her attending physician is Dr. Torres, M.D. and Dra. See, M.D.

Chief Complaint is cough for 3 days. Her admitting clerk is V. Espiritu. Monitor her vital signs every 1 hour and must be recorded. II. Present and Past Health History According to the patients chart, the patients present health history is distressed non-productive.According to the daughter of the patient, her mother has no history of injuries and accidents. There are no known allergies based on the daughters claim. Currently the client is taking Ambroxol, Cefalexin and Salbutamol.




32yrs. old

30 yrs. old

A&W Legend: Living female Living male

A&W A&W Alive & Well HD Heart Disease

Upper panel shows a normal lung under a microscope. The white spaces are alveoli that contain air. Lower panel shows a

lung with pneumonia under a microscope. The alveoli are filled with inflammation and debris. The symptoms of infectious pneumonia are caused by the invasion of the lungs by microorganisms and by the immune system's response to the infection. Although over one hundred strains of microorganism can cause pneumonia, only a few of them are responsible for most cases. The most common causes of pneumonia are viruses and bacteria. Less common causes of infectious pneumonia include fungi and parasites. Viruses Viruses must invade cells in order to reproduce. Typically, a virus reaches the lungs when airborne droplets are inhaled through the mouth and nose. Once in the lungs, the virus invades the cells lining the airways and alveoli. This invasion often leads to cell death, either when the virus directly kills the cells, or through a type of cell self-destruction called apoptosis. When the immune system responds to the viral infection, even more lung damage occurs. White blood cells, mainly lymphocytes, activate a variety of chemical cytokines which allow fluid to leak into the alveoli. This combination of cell destruction and

fluid-filled alveoli interrupts the normal transportation of oxygen into the bloodstream. In addition to damaging the lungs, many viruses affect other organs and thus can disrupt many different body functions. Viruses also can make the body more susceptible to bacterial infections; for this reason, bacterial pneumonia often complicates viral pneumonia. Viral pneumonia is commonly caused by viruses such as influenza virus, respiratory syncytial virus (RSV), adenovirus, and metapneumovirus. Herpes simplex virus is a rare cause of pneumonia except in newborns. People with immune system problems are also at risk for pneumonia caused by cytomegalovirus (CMV). Bacteria Bacteria typically enter the lung when airborne droplets are inhaled, but they can also reach the lung through the bloodstream when there is an infection in another part of the body. Many bacteria live in parts of the upper respiratory tract, such as the nose, mouth and sinuses, and can easily be inhaled into the alveoli. Once inside the alveoli, bacteria may invade the spaces between cells and between alveoli through connecting

pores. This invasion triggers the immune system to send neutrophils, which are the type of defensive white blood cell, to the lungs. The neutrophils engulf and kill the offending organisms, and they also release cytokines, causing a general activation of the immune system. This leads to the fever, chills and fatigue common in bacterial and fungal pneumonia. The neutrophils, bacteria, and fluid from surrounding blood vessels fill the alveoli and interrupt normal oxygen transportation. The bacterium Streptococcus pneumonia, a common cause of pneumonia, photographed through an electron microscope. Bacteria often travel from an infected lung into the bloodstream, causing serious or even fatal illness such as septic shock, with low blood pressure and damage to multiple part of the body including the brain, kidneys, and heart. Bacteria can also travel to the area between the lungs and the chest wall (the pleural cavity) causing a complication called an empyema. The most common causes of bacterial pneumonia are Streptococcus pneumonia, Gram-negative bacteria and atypical bacteria. The terms Gram-positive and Gramnegative refer to the bacterias color (purple or red, respectively) when stained using a process call the Gram stain.

The term atypical is used because atypical bacteria commonly affect healthier people, cause generally lea severe pneumonia, and respond to different antibiotics than other bacteria. The types of Gram-positive bacteria that cause pneumonia can be found in the nose or mouth of many healthy people. Streptococcus pneumonia, often called pneumococcus, is the most common bacterial cause of pneumonia in all age groups except newborn infants. Another important Gram-positive cause of pneumonia is Staphylococcus aureus. Gram-negative bacteria cause pneumonia less frequently than gram-positive bacteria. Some of the gram-negative bacteria that cause pneumonia include Haemophilus influenza, Klebsiella pneumonia, Escherichia coli, Pseudomonas aeruginosa and Moraxella catarrhalis. These bacteria often live in the stomach or intestines and may enter the lungs if vomit is inhaled. Atypical bacteria which cause pneumonia include Chlamydophila pneumonia, Mycoplasma pneumonia, and Legionella pneumophila.

ANATOMY The respiratory system consists of all the organs involved in breathing. These include the nose, pharynx, larynx, trachea, bronchi and lungs. The respiratory system does two very important things: it brings oxygen into our bodies, which we need for our cells to live and function properly; and it helps us get rid of carbon dioxide, which is a waste product of cellular function. The nose, pharynx, larynx, trachea and bronchi all work like a system of pipes through which the air is 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. 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 voice box) and into the trachea (or windpipe) before entering your lungs. All these structures act to funnel fresh air down from the outside world into your body. The upper airway is important because it must always stay open for you to be able to breathe. It also helps to moisten and warm the air before it reaches your lungs. The Lungs Structure The lungs are paired, cone-shaped organs which take up most of the space in our chests, along with the heart. Their role is to take oxygen into the body, which we need for our cells to live and function properly, and to help us get rid of carbon dioxide, which is a waste product. We each have two lungs, a left lung and a right lung. These are divided up into 'lobes', or big sections of tissue separated by 'fissures' or dividers. The right lung has three lobes but the left lung has only two, because the heart takes up some of the space in the left side of our chest. The lungs can also be divided up into even smaller portions, called 'bronchopulmonary segments'. These are pyramidal-shaped areas which are also separated from each other by membranes. There are about 10

of them in each lung. Each segment receives its own blood supply and air supply. How they work Air enters your lungs through a system of pipes called the bronchi. These pipes start from the bottom of the trachea as the left and right bronchi and branch many times throughout the lungs, until they eventually form little thinwalled 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. Traveling 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.

MEDICAL MANAGEMENT The goal of treatment is to cure the infection with antibiotics. If the pneumonia is caused by a virus, antibiotics will not be effective. Supportive therapy includes oxygen and respiratory treatments to remove secretions. NURSING MANAGMENT The patient will need to have breath sounds monitored q 2 to determine if pneumonia is progressing.

O2 Sats should be done regularly ( at least q4during acute phase) to make sure that patient is getting adequate perfusion. Make sure to give all scheduled antibiotics on schedule so that therapeutic ranges are maintained. Any s/s of infection must be monitored and reported to MD. Care given to patient includes nebulization. Performed tepid sponge bath.

I and O taken every shift.

Positioning the patient in Semi-Fowlers position


Hemoglobin Hematocrit WBC Count Differential Count Segmenters Lymphocytes

103 0.31

M=140-170g/L; F=120-150g/L M=0.40-0.50;


F=0.37-0.42 5-10 X 109/L

80 20 0.55-0.65 0.25-0.35

Date of the procedure: 11/06/2010 PARAMETER Hemoglobin Hematocrit ACTUAL RESULT NORMAL 108 0.32 M=0.40-0.50; VALUES M=140-170g/L; F=120-150g/L

WBC Count Differential Count Segmenters Lymphocytes


F=0.37-0.42 5-10 X 109/L

79 21 0.55-0.65 0.25-0.35

Date of the procedure: 11/04/2010 PARAMETER Hemoglobin Hematocrit WBC Count Differential Count Segmenters 88 ACTUAL RESULT NORMAL 101 0.30 M=0.40-0.50; 12.0 F=0.37-0.42 5-10 X 109/L VALUES M=140-170g/L; F=120-150g/L



0.55-0.65 0.25-0.35 Urinalysis

Color: Yellow Transparency: Clear Reaction: (pH) 6.0 Protein: negative Glucose: negative Specific Gravity: 1.010 Pus cells: 0-1/HPF RBC: 0-1/hpf Epithelial Cell:

Chest X-ray Date of the Procedure: 11/04/2010 CHEST AP/L

Streaky densities are seen in both lower lungs Heart is not enlarged Diaphragm and sulci are intact Impression: Pneumonia, Bilateral Date of the Procedure: 11/06/2010 CHEST AP/L Follow-up film shows clearing of the previously noted bilateral Pneumonia infiltrates



Instruct and explain the patients daughter that the medication is very important to continue depending on the duration that the doctor ordered for the total recovery of the patient.


Instruct the daughter to let the patient do normal activities but it should be limited to a short period of time only to prevent the occurrence of shortness of breathing.


Advice the daughter to keep patient relax in order to recover in her present condition. Instruct the daughter to minimize the patient from exposure to an open environment such as dusty and smoky area, which airborne microorganism are present that can be a high risk factor that may cause severity of his condition.


Encourage and explain to patients family that it is important to maintain proper

hygiene to prevent further infection. Instruct the patient every day and explain that bathing early in the morning is not a factor or cause of having pneumonia.


- Regular consultation to the physician can be a factor for recovery and to assess and monitor the patients condition.


Diet as tolerated.Diet plays a big role in fast recovery.


Pneumonia is a serious infection or inflammation of your lungs. The air sacs in the lungs fill with pus and other liquid. Oxygen has trouble reaching your blood. If there is too little oxygen in your blood, your body cells cant work properly. Because of this and spreading infection through the body pneumonia can cause death. Pneumonia affects your lungs in two ways. Lobar pneumonia affects a section (lobe) of a lung. Bronchial pneumonia (or bronchopneumonia) affects patches throughout both lungs. Bacteria are the most common cause of pneumonia. Of these, Streptococcus pneumoniae is the most common. Other pathogens include anaerobic bacteria, Staphylococcus aureus, Haemophilus influenzae, Chlamydia pneumoniae, C. psittaci, C. trachomatis, Moraxella (Branhamella) catarrhalis, Legionella pneumophila, Klebsiella pneumoniae, and other gramnegative bacilli. Major pulmonary pathogens in infants and children are viruses: respiratory syncytial virus, parainfluenza virus, and influenza A and B viruses. Among other agents are higher bacteria including Nocardia and

Actinomyces sp; mycobacteria, including Mycobacterium tuberculosis and atypical strains; fungi, including Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Cryptococcus neoformans, Aspergillus fumigatus, and Pneumocystis carinii; and rickettsiae, primarily Coxiella burnetii (Q fever). The usual mechanisms of spread are inhaling droplets small enough to reach the alveoli and aspirating secretions from the upper airways. Other means include hematogenous or lymphatic dissemination and direct spread from contiguous infections. Predisposing factors include upper respiratory viral infections, alcoholism, institutionalization, cigarette smoking, heart failure, chronic obstructive airway disease, age extremes, debility, immunocompromise (as in diabetes mellitus and chronic renal failure), compromised consciousness, dysphagia, and exposure to transmissible agents. Typical symptoms include cough, fever, and sputum production, usually developing over days and sometimes accompanied by pleurisy. Physical examination may detect tachypnea and signs of consolidation, such as

crackles with bronchial breath sounds. This syndrome is commonly caused by bacteria, such as S. pneumoniae and H. influenza. Drug Study Medications: Name Drug of Dosag e Freque ncy AMPICILIN 110 mg TIV q6 Antibiotic; for Diarrhea, bacterial infection caused and Gram negative; anaerobic GENTAMI 17g TIV bacteria Antibiotic; for Toxicity to the for itching, difficulty in breathing and by swallowing, mild some stomach,vomitin g,wheezing Rout Curative Effects Side Effects & e

Gram positive skin rash,upset



bacterial cause gram negative bacteria

vestibular by inner ear(OTOTOXIC ITY) Nephrotoxicity, Gentamicin toxicity Stimulation, by drowsiness, of vomiting, on abdominal pain, hepatoxicity, seizure(overdos e), and failure(high a prolonged rash, renal ,

infection that apparatus of the

PARACET 50mg AMOL q4 for 37.8


Decrease fever effects pyrogens the heat regulating centers by

inhibiting the nausea,

hypothalamic hepa

hypothalamic doses),leucope action leading nia,

to and s. GENTAMICIN- bacteriacidal

sweating hypersensitivity, cyanosis, jaundice etc..

vasodilatation anmenia,

Symptoms of gentamicin toxicity include:

Balance difficulty Bouncing, unsteady vision Physical Assessment

Date assessed: Initial Vital Signs:

November 9, 2010

Time Assessed: 3:00 P.M

Temperature: 37.8C Cardiac Rate: 80 beats per minute Respiratory Rate: 34 breaths per minute

General Appearance: The pt. is asleep, lying on bed with CTT on the right 5th ICS Normal Actual Analysis

Area Assessed

Findings SKIN color Texture Turgor Tan(Dark

Findings Tan(Dark Normal

Brown) Brown) Smooth, soft Smooth, soft Normal Skin snaps Skin snaps Normal back immediately When back immediately when pinched Evenly Normal

pinched Hair Distribution Evenly Temperature

distributed distributed Warm to Too warm Febrile touch when touched skin Dry, skin Normal are folds normally moist and Pink clear Smooth Convex and Normal Normal Normal are


Dry, folds normally moist

NAILS Color bed Texture Shape of Nail Pink clear Smooth Convex

Nail base Capillary time HAIR Color Distribution Moisture

curvature Firm refill 2-3 seconds

curvature Firm 2 sec. Black

Normal Normal Normal

Black (varies) Evenly distributed Neither excessively dry nor oily Silky, resilient Evenly distributed Neither excessively dry nor oily Silky, resilient Normal Normal Normal

Texture HEAD

Scalp symmetry Symmetrical Skull size Shape Nodules/ masses



Normocephal Normocephal Normal ic Round Absence masses ic Round of Absence masses Normal of Normal

nodules and nodules and

FACE Symmetry Facial movement Skin color EYES Eyebrows Eyelashes Symmetrical Symmetrical Symmetrical Symmetrical Normal Normal

Tan Tan Normal Symmetricall Symmetricall Normal y aligned Slightly curved y aligned Slightly curved Normal


upward upward Smooth, tan, Smooth, tan, Normal do not cover do not cover pupil as pupil as sclera, close sclera, close symmetricall symmetricall y Blinks voluntarily and Normal y Blinks voluntarily and

Ability to blink

Ocular movement

bilaterally bilaterally Eye moves Eye moves Normal freely freely

Position Size Texture


from Drawn

from Normal

lateral angel lateral angel Medium Medium Normal Mobile, firm Mobile, firm Normal and tender non- and tender Transparent light and Normal Normal Normal non-

CONJUCTIVA Color Transparent with Texture Presence lesions APPARATUS Cornea Color Texture PUPILS Color Size Shape Black Equal Round Black Equal and Round Normal Normal and Normal Black Shiny smooth Black and Shiny smooth Normal and Normal color Shiny light with color and Shiny

smooth of No lesions

smooth No lesions

constrict Symmetry Ocular NOSE Symmetry, color Mucosa color NASAL SEPTUM Nares Oval,


briskly briskly Equal in size Equal in size Normal Eyes move Eyes move Normal freely freely

Symmetrical, Symmetrical, Normal and smooth tan to Reddish pinkish and to Normal tan Reddish pinkish

shape, size and smooth



symmetrical symmetrical Nasal discharge No discharge No discharge Normal Sinuses Not tender Not tender Normal MOUTH Secretion (neutral mucus production in Mucus Abnormal due on to inflammati color) without production

Lips Color Symmetry Texture Moisture GUMS Color Moisture BUCCAL MUCOSA Color Moisture TOUNGE Color Size Symmetry Mobility UVULA

Pinkish slightly

to Pinkish slightly

to Normal

brown brown Symmetrical Symmetrical Normal Soft, moist, Soft, moist, Normal smooth Soft moist Pinkish Moist smooth and Soft moist Pinkish Moist Normal Normal and Normal

Glistening pink Moist Pinkish Medium Symmetrical Moves freely

Glistening pink Moist Pinkish Medium Symmetrical Moves freely

Normal Normal Normal Normal Normal Normal

Location Symmetry TONSILS Color Discharges NECK Position Movement Range motion HEART Heart rate


the At

the Normal Normal Normal Normal

midline Symmetrical Pinkish No discharges Head-

midline Symmetrical Pinkish No discharges Head-


centered centered Moves freely Moves not Due to age of Full range freely Full range Normal

120-160 beats minute infants Clear, without crackles for


beats Normal

per per minute

Heart sounds


Due to the presence of phlegm and

increased mucus Lung field THORAX LUNGS POSTERIOR THORAX Symmetry Symmetrical Symmetrical 54 per for Spine vertically align Skin intact Normal Normal Normal Normal & Resonant production With crackles Due to secretions

Respiratory rate 30-60 breaths minute Spinal Alignment Skin integrity ANTERIOR THORAX Breathing pattern the infant Spine vertically align Skin intact

Breathing is Breathing is Due automatic with


effort, secretions

and effortless, regular even noise breath Bronchiavesicular and

produces noise and breathing



when lungs

produces no Lung/ sounds crackles Due to the constriction of ABDOMEN Contour Flat Flat Normal Texture Smooth Smooth Normal Frequency and Audible; soft Audible; soft Normal character gurgling irregularly and from mins UPPER EXTREMITY gurgling irregularly rages 5-30 sound occur sound occur rages and 5-30 from mins the bronchus

Skin color Size (arms) Symmetry Hair distribution LOWER EXTREMITY Skin color Size (legs) Symmetry Hair distribution NEUROLOGIC AL Level consciousness TONE

Tan Equal Symmetrical Evenly distributed

Tan Equal Symmetrical Evenly distributed

Normal Normal Normal Normal

Tan Equal Symmetrical Evenly distributed Alert

Tan Equal Symmetrical Evenly distributed

Normal Normal Normal Normal

and Irritable

Due to her fever and

of responsive

IV line High pitched Low pitched Due to her sound when sound when inflammate crying crying d lungs

Assessm Diagno Inference ent Subjecti ve: pan akong sis Acute

Planning Interventi


Malnutriti After 4 nursing intervent Difficulty ion, the patient will display patent Persisitent airway cough with breath sounds PNEUMO clearing NIA and absence braething

on on Imdepend After 4 hours of te head of bed, chan ge on interventi ons, the patient was able to display patent with Eleva nursing

pain at on chest and ent cough

gours of ent

nahihira the

huminga persisit of

Objectiv e: Dyspnea Fatigue

positi airway frequ breath ently sounds Assis clearing t and patie absence

of dyspnea

nt with deep breat hing exerc ises Help patie nt to perfo rm activi ty like effect ive coug hing while in

of dyspnea

uprig ht positi on

What is ranitidine? <script type="text/javascript" charset="ISO-8859-1" src=";tra nsactionID=47040833&amp;tile=47040833&amp;site=2&amp; affiliate=38&amp;xpg=1815&amp;pos=121"></script> Ranitidine is in a group of drugs called histamine-2 blockers. Ranitidine works by reducing the amount of acid your stomach produces. Ranitidine is used to treat and prevent ulcers in the stomach and intestines. It also treats conditions in which the stomach produces too much acid, such as Zollinger-Ellison syndrome. Ranitidine also treats gastroesophageal reflux disease (GERD) and other conditions in which acid backs up from the stomach into the esophagus, causing heartburn.

Before using ranitidine Do not use this medication if you are allergic to ranitidine. Heartburn is often confused with the first symptoms of a heart attack. Seek emergency medical attention if you have chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, and a general ill feeling. Ask a doctor or pharmacist if it is safe for you to take ranitidine if you have:

kidney disease; liver disease; or porphyria.

Ranitidine side effects Stop using ranitidine and get emergency medical help if you have any of these signs of an allergic reaction to ranitidine: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking ranitidine and call your doctor at once if you have a serious side effect such as:

chest pain, fever, feeling short of breath, coughing up green or yellow mucus; easy bruising or bleeding, unusual weakness; fast or slow heart rate; problems with your vision; fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; or nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious ranitidine side effects may include:

headache (may be severe); drowsiness, dizziness; sleep problems (insomnia);

decreased sex drive, impotence, or difficulty having an orgasm; or swollen or tender breasts (in men); nausea, vomiting, stomach pain; or diarrhea or constipation.

What other drugs will affect ranitidine? Before taking ranitidine, tell your doctor if you are taking triazolam (Halcion). You may not be able to use ranitidine, or you may need dosage adjustments or special tests during treatment. There may be other drugs that can interact with ranitidine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.