Nursing Care Management 101

By: BSN 3 Students

 

 Introduction
 Objectives
> General objectives
> Specific objectives
 Patient’s data
 Vital Information
 Family Background
 History of Past Illness
 History of Present Illness
 Effects & Expectations of Illness to Self & Family
 Genogram
 Growth and development
 Physical Assessment & Review Of System
 Definition Of Terms
 Textbook Discussion
a. Complete Diagnosis
b. Anatomy and Physiology
c. Etiology and Symptomatology
d. Pathophysiology
 
 Diagnostic Results
 Complete Doctor’s Order
 List Of Drug’s
 Drug Study
 Priorities Problems
 Nursing Care Plan
 Prognosis
 Bibliography
 This is a case of a 14 years old male who was
admitted at Allah Valley Medical Specialist Center
Incorporated last August 24, 2009 at 11:06 am and was
diagnosed as having Community Acquired Pneumonia under
the service and care of Dra. Luz F. Improgo.
 
Community Acquired Pneumonia refers to Pneumonia
acquired outside of hospitals or extended – care facilities.
It occurs. Either in the community setting or within first 48
hours after hospitalization. It is an illness of lung which is
caused by different organism like bacteria, viruses, and
fungi and characterized by acute inflammation of the walls
of the bronchioles. It is common in women and causes to
the 6% deaths. Streptococcus pneumonia and mycoplasma
pneumonia both are common bacterium which causes
community acquired pneumonia in adults and children.
 Bacterial pneumonias tend to be the most serious and, in
adults the most common cause of pneumonia. The most common
pneumonia – causing bacterium in adults is streptococcus
pneunoniae.
 
If the cause is bacteria, the goal is to cure the infection
with antibiotics. If the cause is virus, antibiotics will not be
effective. In some case it is difficult to distinguish between viral
and bacterial pneumonia, so antibiotics may be prescribed.
Pneumococcal vaccinations are recommended for individuals in
high – risk groups and provide up to 80% effectiveness in staying
off pneumococcal pneumonia.
 
In general pneumonia will be acquired when our immune
systems are unable to combat the virulence of the invading
organisms. Organisms from environment, invasive devices,
equipments and supplies, staff or from other people can invade
the body. All types of pneumonia can be caused by bacteria,
viruses, mycoplasma, fungi, rikettsiae, protozoa and helminthes.
 
 Non infections causes of pneumonia include inhalation of toxic
gases, chemicals, smoke and aspiration of water, food, fluid and
vomitus.
 
Pneumonia is the most common of death from infectious disease in
the United States. It is the Seventh leading cause of death.
 
Here in the Philippines, 42.8% cases of pneumonia occur each year,
and it is the fourth leading causes of death. The highest incidence
among adults more specifically in older adults, hospitalized clients
and those being mechanically ventilated. Community acquired
pneumonia is more common than mosocomial pneumonia.
 
This case study aims to provide knowledge to nurses and future
nurses about Community acquired pneumonia. Improves their skills
in saving for patients with the same illness and develop positive
attitude towards caring for patient having CAP.
 
 
 General Objectives:

After 3 – 5 hours of Case presentation,

the presenters and attendees will be able to
obtain additional knowledge regarding
community acquired pneumonia, develop
skills on the proper management or
interventions of the said illness and embrace
their attitude positively in dealing with
patients having the same condition.
 
 Specific Objectives:

This case aims to presents the following specific

objectives:

 Present the introduction completely

 Present the general and specific objectives properly
 Present the client’s profile completely
 Trace the Genogram of the patient correctly
 Discuss the physical assessment in line with the
current condition of the client
 Present the review of system of the client
comprehensively
 Identify the related developmental stages achieved
by the client correctly
 Discuss thoroughly the medical diagnosis of the client
 Define terms related to community acquired
pneumonia correctly
 Discuss the anatomy and physiology of the affected
system thoroughly
 Discuss the medical, surgical and nursing
management of community acquired pneumonia
appropriately / briefly
 Enumerate the etiology and symptomatology briefly
 Trace the pathophysiology systematically.
 Discuss the result of diagnostic laboratory procedures
done.
 Present completely the physician / doctor’s order
 Present all the drugs taken by the client and its
pharmacokinetics clearly
 Enumerate the 5 nursing diagnoses according to
priority precisely / correctly
 Present the nursing care plan comprehensively /
accurately.
 Discuss the prognosis of the client properly
 Present the bibliography completely
 Patient’s Name: Meow
 Age: 14 years old
 Birthday: September 17, 1994
 Birth Place: DCHI
 Address: Blk. 5 Lot 11 Agan Phase II Sta. Cruz Koronadal
City, South Cotabato
 Sex: Male
 Tribe: Ilonggo
 Citizenship: Filipino
 Race: Asian
 Religion: Iglesia ni Kristo
 Chief Complaint: Cough, Fever for 5 days
 Date Admitted: August 24, 2009
 Time Admitted: 11:06 Am
 Admitting Diagnosis: Community Acquired Pneumonia
 Attending Physician: Dra. Luz F. Improgo
 Reason for admission: for management
 Name of Institution: Allah Valley Medical
Specialist Center Incorporated
 Source of Medical Financing: Phil. Health
 Father’s Name: Mr. Meow
 Age: 48 years old
 Birthdate: July 31, 1961
 Occupation: Government Employee
 Mother’s Name: Mrs. Meow
 Age: 45 years old
 Birthdate: November 27, 1963
 Occupation: House Wife
 Siblings: Mee(28), Oink(25), Twit(12),
Aw(6)[Asthma]
 Source of Information
>Patient
>Patient’s Chart
>Patient’s Brother
>Patient’s Mother
 The Meow family can be considered as a
nuclear family. They live together in a concrete
two storey house that is hoisted in a private
owned lot in Agan Homes. The family’s source of
income is through Mr. Meow’s job – a government
employed worker, while Mrs. Meow is merely a
housewife, as well as the eldest child, who works
as an engineer in abroad. These resources suffice
the family’s basic needs and emergency cases
like hospitalization.
The family’s bloodline is embedded with
genetic disorders and diseases as well. Asthma is
the recessive genetic endowment whereas a
Heart disease such as cardiac arrest is a
dominant gene. Asthma causes the death of the
patient’s Grandfather on maternal side and
Cardiac arrest claims the life of the patient’s
grandparents (both).
 The family utilizes different herbal medicine
approved by DOH such as Lagundi for cough, Oregano
as anti oxidant, and Sambong to decrease uric acid.
According the Patient’s brother, the family has also
experienced common household illnesses such as
headache, body pain, cough, cold, fever, and flu.
The family also purchases over the counter
drugs to relieve themselves such as paracetamol for
headeche, mefenamic acid for body pain, and Bioflu
for colds. In addition to that, the family had also
receives series of immunization and vaccination as
follows: 1 dose of BCG, 3 doses of DPT, 3 doses of
OPV, measles’s vaccine and Hepa B vaccine.
As to religious affiliation, the family attends
church gatherings and participates in any activities
conducted. The family also has their recreational
activities tilling their vegetables bin at their
backyard, going to market and attends to their
program.
 History of past illness comprises the data of
patient’s childhood illness and medical history;
as well as ways on how these conundrums were
resolve.
Zero in to the knowledge of patient Meow,
he had already passed through the childhood
illness such as measles, mumps and chicken pox;
but by virtue of Active natural immunity and
prior vaccinations, he did not manifest the
illness ever again.
Last August, in the same year, he was
admitted at the same hospital for treatment of
Asthma attack. He was given a nebulizer with
Ventolin, a bronchodilator; at that very moment
he was relieve.
 Five days prior to admission, patient
Meow experiences cough, fever, and
difficulty in breathing with severe headache.
An hour prior to admission, Patient Meow
experiences vomiting and feels dizzy; due to
this he was admitted at once under the
supervision of Dra. Luz F. Improgo and was
diagnosed of having a Community Acquired
Pneumonia.
 To self:
Patient meow said that it is not okay for
him to experienced this kind of illness, because
it is difficult to have a severe headache and
fever. He can’t breathe well because of retain
mucus secretions. He was absent for three days
and he can’t do his daily activities.
 To family:
His parents said that it is not good for them
to bring their son in the hospital because they
are very busy in their work. His father is working
and his mother is taking good care of their
youngest sister and she can’t leave her in their
house. His mother is also afraid to bring his sister
to the hospital because she is scared that her
daughter might acquire an illness.
 To self:
Patient meow expect that after few days
of hospitalization he can already recover in
order for him to go back in school to
continue his studies.

 To family:
They expect that the patient will
recover after hospitalization in order for
them not to worry and also for them to go
back to work and do their daily routine.
Date: August 24, 2009
Time: 8:00 Pm – 3 – 11 Shifts
 
 
General:
 
Received patient lying on bed, conscious and
coherent with IVF of D5LR at the level of 900cc
infusing well, regulated at 20 gtts/min hooked at the
right metacarpal vein. Patient is weak, aware with
the surrounding and responsive, well oriented with
the people around him, can speak clearly at the stage
of early adolescent, male, Asian in race with brown
complexion of skin.
Vital Signs:

Temperature: 38.4 OC Hyperthermia

Pulse Rate: 77 beats / min
Respiratory rate: 21 cycles / min
Blood pressure: 130 / 90 mmHg

Head

 Inspection: skull is proportionally positioned,

round in shape, dandruff no noted, hairs are
fixed and equally distributed, dry and black in
color.
 Palpation: smooth and absence of mass noted
Facial

 Inspection: slightly brown in color, eyes and

nose are properly positioned, Wrinkled skin
not noted
 Palpation: skin are smooth and slightly oily

Eyes and vision

 Inspection: eyes are in bilateral position;

pupils normally are equal in size, round,
reacts to light and with accommodation.
 Palpation: Masses not noted, tearing of
lacrimal gland not noted
Ears and hearing

 Inspection: Eardrum is normally shiny,

transparent and opaque or pearly gray,
slightly concave and free of lesions, can hear
whispered words, discharges not noted.
 Palpation: tenderness not noted

Nose

 Inspection: positioned in the center of the

face , discharges noted but minimal.
 Palpation: no tenderness noted
Lips, mouth, pharynx

 Inspection: lips are dry, slightly pale in

appearance, tongue is in pinkish in color as
well as the gums, teeth are complete
without dentures present, tonsils are not
inflamed.
 Palpation: lymph nodes not noted
 
Neck

 Inspection: can move freely, can perform

range of motion easily.
 Palpation: submandibular lymph nodes
noted, jugular veins noted
Thorax and lungs

 Inspection:deepness & difficulty of breathing

noted. skin same color with the rest of the body
 Palpation: Chest wall intact, no tenderness
 Auscultation: wheezing & Crackling sound noted
in the upper & lower lobes of the lungs
 Percussion: Dullness

Abdomen

 Inspection: same color with the rest of the body,

no lesions or abrasions noted
 Auscultation: bowel sounds not noted
 Percussion: normally bulging
 Palpation: smooth and tenderness not noted
Genitals
 Inspection: Patients refuse to assess his
organs

Extremities

 Inspection: symmetrical in shape, lacerations

not noted, can performed range of motion
easily
 Palpation: tenderness not noted
Skin

 Inspection: brown complexion, lumps and

bruises not noted, vascularity generally
uniform, temperature is 38.4 OC febrile,
warm to touch with good skin turgor.
 
Nails

 Inspection: Smooth, well trimmed, capillary

refill back not less than 3 seconds.
 Date: August 24, 2009
 Time: 8:00 Pm – 3 – 11 Shift

 General: Patient verbalized that he is

suffering from fever and severe headache
with flu and cough.

 Skin, hair, nails: Patient stated that he

doesn’t have any dandruff and he cleaned
and trimmed his nails every 5 days
 Head: Patient claims that he is experiencing
headache and said that he haven’t encounter
yet head injuries.

 Eyes: Patient claims that he doesn’t have any

problems in his eyes

 Ears: Patient claims that he can hear words

clearly

 Nose: Patient claims that he had discharges

in his nose
 Mouth and throat: Patient claims mild pain in
his throat and when swallowing foods and state
that prior to admission he experience vomiting.
 
 Neck: Patient claims that he haven’t encounter
neck injuries

 Lymph nodes: Patient claims that he haven’t

experience enlargement of lymph nodes

 Respiratory: Patient claims that he has an

asthma and experiencing cough and flu for the
past 5 days already

 Cardiovascular: Patient claims of pain in the

chest when coughing.
 Gastrointestinal: Patient claims that he
experienced gastrointestinal pain before

 Endocrine: Patient devise of cold intolerance

 Reproductive: Patient claims that he is

washing his genitals after doing bathroom
necessities

 Genitourinary: Patient claims absence of

pain when voiding

 Musculoskeletal: Patient claims muscles

cramping
 Hematologic: Patient claims absence of
lumps and bruises

 Neurologic: Patient claims of headache

 Psychiatric: Patient claims of discomfort

 A respiratory system functions to allow gas
exchange. The gases that are exchanged, the
anatomy or structure of the exchange system
and the precise physiological uses of the
exchanged gases vary depending on the
organism. In humans and other mammals, for
example, the anatomical features of the
respiratory system include airways, lungs, and
the respiratory muscles. Molecules of oxygen
and carbon dioxide are passively exchanged,
by diffusion, between the gaseous external
environment and the blood. This exchange
process occurs in the alveolar region of the
lungs.
 
THE NOSE
 
 •  Air enters through two openings, the external nares
or nostrils.
 •  Just inside each nostril is an expanded vestibule
containing coarse hairs.
 •  A midsagittal nasal septum divides the nasal cavity.
 •  The maxillary, nasal, frontal, ethmoid and sphenoid
bones form the lateral and superior walls of the nasal
cavity.
 •  The hard and soft palate forms the floor of the cavity.
(the posterior part of the soft palate is the uvula)
 •  The external portion of the nose is composed of
cartilage that forms the bridge and the tip of the nose.
 •  The superior, middle and inferior nasal cochae are
bony shelves that project from the lateral walls of the
nasal cavity.
 •  The spaces between the conchae are the meatuses.
 •   Posteriorly the internal nares open into the
nasopharynx.
 THE PHARYNX

•Is a chamber shared by the digestive and

respiratory systems.
•It extends between the internal nares and the
entrances to the larynx and esophagus.
•A stratified squamous epithelium lines the
pharynx.

 The throat of pharynx is divided in three

regions:

1.Upper naso-pharynx
2.Middle oropharynx
3.Lower laryngopharynx
 THE NASOPHARYNX

•Lies superior to the soft palate

•Serves a passageway for airflow from nasal cavity
•It contains the pharyngeal tonsils ( adenoids) in
posterior wall, and the opening of the eustaquian
tubes (auditory tube)
 
 THE OROPHARYNX

 
•Extends front soft palate down to the epiglottis
(base of the tongue)
•It contains the palatine and lingual tonsils.

 THE LARYNGOPHARYNX

•The narrow zone between the hyoid bone and the

entrance to the esophagus.
 THE LARYNX

• Joins the laryngopharynx with the trachea.

• It consist of cartilage
• It is called the voice box.
• The three main cartilage are: thyroid cartilage (Adams’s apple),
epiglottis, and the cricoid cartilage.
• Other cartilage is: arytenoids cartilage, corniculate cartilage
and the cuneiform cartilage.
• The epiglottis is a piece of elastic cartilages that falls over the
opening ( GLOTTIS ) during swallowing to prevent ingested
food from entering the respiratory tract.
• The corniculate cartilage are involve the opening and closing of
the epiglottis, and in the production of sounds
• Two pairs of folds span the glottal opening. The ventricular
folds (false vocal cords) are inelastic but the tension in the
vocal cords can be adjusted by voluntary muscle movements.
• During expiration air flowing through the larynx vibrates the
vocal cords (true vocal cords) and produces sound waves.
• Coughing and laryngeal spasms are protective reflex that
protect the glottis and trachea from objects and irritants.
 
 
 THE TRACHEA
 
•   Extends from the level of the sixth cerebral vertebra, at the
base of the larynx, to the level of the fifth thoracic vertebra.
•   is a tubular structure with 4.25 inch length and 1 inch in
diameter.
•   At its caudal limit the trachea divides to form primary
bronchi.
•   Lies anterior to the esophagus.
•   Along the length of the trachea are 15-20 c-shapes in pieces
of hyaline cartilage (tracheal cartilages)
•   The tracheal muscle holds the two sides of the c-shaped c
•   Trachea is lined with pseudo stratified ciliated columnar
epithelium.  
•  The trachea branches within the mediastum, forming the left
and right bronchi.
• Each bronchus enters a lung at groove, The Hilus.
• Each bronchus branches into increasingly smaller passageway
to conduct air into the lungs.
• The primary bronchi branch into as many secondary bronchi
(Intrapulmonary bronchi)
• As there are lobes in each lung
• The smallest passageway is the bronchioles.
 
 THE LUNGS

•  Is pair of cone shaped organs lining in the pleural cavity.

•  The apex is the conical top of each lung, and the broad
inferior portion is the base.
•  Each lung has a hilus, a medical slits as the bronchial
tubes, vascularization, lymphatic, and nerves reach the
lungs.
•  Each lining is divided into lobes by deep fissures. 
• Right lungs have three lobes and left lungs have two
lobes.
• Left lung is divided by oblique fissure into superior and
inferior lobes.
• Right lung is divided into three lobes (superior, middle
and inferior)
• Superior and middle lobes are separated by a Horizontal
fissure and
• The Oblique fissure separates Inferior and Middle lobes.
 THE PLEURAL CAVITIES

• The thoracic cavity is bounded by the ribcage and the

muscular diaphragm.
• The mediastinum divides the region into TWO PLEURAL
CAVITIES.
• The pleural cavity is lined with a serous membrane, THE
PLEURA.
• Parietal pleura line the thoracic wall, diaphragm, and
mediastinum.
• Visceral pleura cover the surfaces of the lungs. 
• The alveolar walls are made of simple squamous
pulmonary epithelium.
• Scattered among epithelium are surfactant cells that
secretes oil coating to prevent
• the alveoli from sticking together after exhalation.
• Also the alveolar walls are macrophages that phagocytes
debris or potential pathogens.
• Pulmonary capillaries cover the exterior of the alveoli.
 
 Atelectasis- partial or total collapse of the
lung;a condition in which lungs of a fetus
remain unexpanded at birth.
 Inflammation- a tissue or organ reaction to
injury or irritation characterized by pain,
heat, swelling, redness, and possible loss of
function
 Pleura- a serous membrane lining the walls
of the thorax and enclosing to the pleura.
 Effusion- the escape of fluid into a cavity, as
the pleura space.
 Community Acquired Pneumonia- an illness
acquired prior the hospitalization. An
inflammation of the bronchi and lungs
caused by various types of pneumonia,
pathogenic bacteria as well as viruses,
rickettsias, and fungi.
 Lungs – one of two cone-shaped structures
which function as respiratory organs
responsible for providing oxygen for the body
and discharging waste products.
 Tracheobronchial- related to both the
bronchial and the trachea.
 Medical diagnosis:
Community Acquired Pneumonia refers to
pneumonia acquired outside of hospital or in
the community. It is an inflammation of the
walls of the smaller bronchial tubes, with
varying amounts of pulmonary consolidation
due to spread of the inflammation into
peribronchiolar alveoli and the alveolar
ducts.
Assessment Diagnosis findings:
The diagnosis of pneumonia is made by
history(particular of a recent respiratory
tract infection), physical examination, chest
x-ray studies, blood culture (bloodstream
invasion called bacteremia, occurs
frequently), and sputum examination. The
sputum sample is obtained by having the
patient.(1) Rinse the mouth with water to
minimize contamination by normal oral flora,
(2) Breath deeply several times, (3) Cough
deeply, and (4) Expectorate the raised
sputum into a sterile container.
 More invasive procedure may used to collect
specimens. Sputum may be obtained by
asotracheal or orotracheal suctioning with a
sputum trap or by fiberoptic bronchoscopy.
Bronchoscopy is often used in patients with
acute severe infection, patients with chronic
or refractory infection, or immune-
compromised when a diagnosis cannot be
made from an expectorated or induced
specimen.
 Complications:
Shock and respiratory failure
Severe complication of pneumonia include
hypotension and shock and respiratory
failure (especially with gram negative
bacterial disease especially in elderly in
elderly patients).

The complications are encountered chiefly in

patients who have received no specific
treatment or inadequate or delayed
treatment. These complication are also
encountered when the infecting organism is
resistant to therapy and when a comorbid
disease complicates the pneumonia.
 If the patient is seriously ill, aggressive therapy
may include hemodynamic and ventilator support
to combat peripheral collapse, maintain arterial
blood pressure, and provide adequate
oxygenation.

 A vasopressor agent may be administered

intravenously by continuous infusion and at a
rate adjusted in accordance with the pressure
response. Corticosteroids may be administered
parenterally to comfort shock and toxicity in
patients who are extremely ill with pneumonia
and in apparent danger of dying of the infection.
Patients may require endotracheal intubation
and mechanical ventilation. Congestive heart
failure, cardiac dysrhythmias, pericarditis, and
myocarditis also are complications of pneumonia
that may lead to shock.
 Risk Factors:
Community Acquired Pneumonia is very common illness that affects
millions of people each year here in the Philippines.

Bacterial pneumonia tend to be the most serious and the most common
cause of pneumonia in adults. The most common pneumonia causing
bacterium in adults is streptococcus pneumonia.

Respiratory viruses are the most common causes of pneumonia in young

children, peaking between the age or 2 and 3. by school age, the
bacterium mycoplasma pneumonia becomes more common.
In some people, particularly the elderly and those who are debilitated,
bacterial pneumonia may follow influenza or even a common cold.

People who have trouble swallowing are at risk of aspiration pneumonia.

In this condition, food, liquid, or saliva accidentally goes into the airways. It
is more common in people who have a stroke, parkinson’s disease, or
previous throat surgery. It is often harder to treat pneumonia in people
who are in a hospital, or a nursing facility.
The treatment of pneumonia includes
administration of the appropriate antibiotic as
determined by the result of the cram stain.
However, an etiologic agent is not identified in
50% of cap cases and empiric therapy must be
initiated. Therapy for cap is continuing to
evolve. Guidelines exist to guide antibiotic
choice, however, the resistance patterns,
prevalence antibiotic agents must all be taken
into consideration. Several organizations have
published guidelines for the medical
management of CAP.
Recommendations are classified by existing
risk factors, setting (inpatient vs. outpatient
treatment), or specific pathogens. Examples
of risk factors that may increase the risk of
infection with certain types of pathogens
appear.

Recommendations for treatments of

outpatients with CAP who have no
cardiopulmonary disease or other modifying
factors include a macrolide (erythromycin,
azithromycin, or clarithromycin, doxycycline,
or a fluroquinolone with enhanced activity
against streptococcus pneumoniae).
Erythromycin should be avoided in areas
where H. influenza and streptococcus aureus
are more prevalent. For those outpatients
who have cardiopulmonary disease or other
modifying factors, treatment should include
a beta-lactam, cefuroxine plus a macrolide
or doxycycline may also be used. There are
guidelines: treatment for individual patients
may be modified.
For treatment with CAP who are hospitalizes
and do not have cardiopulmonary disease or
modifying factors, management consists of
intravenous beta-lactam plus either an oral
macrolide or doxycycline. An intravenous
antipneumococcal fluoroquinolone may also
be used alone. For acutely ill patients
admitted to the intensive care unit,
management includes an intravenous beta-
lactam plus either an intravenous macrolide
or doxycycline or fluoroquinolone
In specific pathogens have been identified
for the CAP, more specific agents may be
utilized. Mycoplasma pneumonia is treated
with doxycline or macrolide. PCP responds
best to pentamiane and rimatitidine are
effective with influenza and have been
shown to reduce the duration of fever and
other systematic complications when
administered within 24 to 48 hours of the
onset of an uncomplicated influenza
infection.
These medications are also reducing the
duration and quantity of virus shedding in
the respiratory secretions.
They are not effective when used in
combination with influenza vaccine.
Ganciklovir is used to treat cytomegalo virus
in the non-aids patient; cytomegalovirus
immunoglobulin may also be used.
For patient at high risk for pseudomonas
infection, an anti pseudomonal penicillin
plus an animoglycoside (amikalia gentamicin)
or beta lactamase inhibitor
(ampicillin/sulbactam, tinacillin/clavulanate
may be used). Other types of combination
therapy may also be used depending upon
the individual characteristics of the patient.
Of concern is the rampant rise in
respiratory pathogens that are resistant to
available antibiotics. Examples include
vancomycin-resistant enterrococcus and
drug-resistant streptococcus pneumoniae
There are tendency for clinicians to
aggressively use antibiotics inappropriately
or to use broad-spectrum agents when
narrow-spectrum agent are more
appropriate. Mechanism to monitor and
minimize the inappropriate use of antibiotics
is in place. Educations of clinicians to use
evidence-based guidelines in the treatment
of respiratory infection are important.
Monitoring and surveillance of susceptibility
for pathogens is also important.
Therapy with parenteral agents usually is
changed to oral antimicrobial agents when
there is evidence of clinical response and the
patient is able to tolerate oral medications.
The recommended duration of treatment
for pneumococcal pneumonia is 72 hours
after the patients become afebrile. Most
other forms of pneumonia caused by
bacterial pathogens are treated for 1 to 2
weeks after the patient become aferbile. A
typical pneumonia is usually treated for 10 to
21 days.
Treatment of viral pneumonia is primarily
supportive. Antibiotics are ineffective in viral
upper respiratory infections and pneumonia
may be associated with adverse effects.
Treatment of viral infections with antibiotics
are the major reason for the over use of
these medications in the United States.
Antibiotics are indicated with viral
respiratory infection only when a secondary
bacterial pneumonia, bronchitis or sinusitis is
present. Hydration is necessary part of
therapy because fever and tachypnea may
result an insensible fluid losses. Antipyretics
may be used to treat headache and fever;
antitussive medications may be used for the
associated cough.
Warm, moist inhalations are helpful in
relieving bronchial irritation. Antihistamines
may provide benefit with reducing and
rhinorrhea. Nasal decongestants may also be
used to symptoms and improve sleep;
however, excessive use may rebound nasal
congestion. Treatment of viral pneumonia
the exception of antimicrobial therapy is the
same as that for bacterial pneumonia. The
patient is placed on bed rest until the
infection shows signs of clearing. If
hospitalized, the patient is observed
carefully until the clinical condition
improves.
If hypoxemia develops oxygen is
administered. Pulse oximetry or arterial
blood gas analysis is performed to determine
the level for oxygen and to evaluate the
effectiveness of the therapy. A concentration
of oxygen is contraindicated in patients with
CAP D because it may worsen alveolar
ventilation by decree. Aging the patient’s
ventilator drive, leading to further
respiratory compensation.
 Cough Enhancement: promotion of deep
inhalation by the client with subsequent
generation of high intrathoracic pressures
and compression of the underlying lung
parenchyma for the forceful expulsion of air.

 Assist client to a sitting position with neck

slightly flexed, shoulders relaxed, and knees
flexed.
 Encourage client to take several deep
breaths.
 Encourage client to take deep breath, hold it
for 2 seconds, and cough two or three times in
succession.
 Instruct client to inhale deeply, bend
forwarded slightly and perform three or four
huffs (against an open glottis).
 Initiate lateral chest wall rib spring
techniques during the expiration phase of the
cough maneuver, as appropriate.
 Instruct client to follow coughing with several
maximal inhalation breaths.
 Encourage use of incentive
spirometer/spirometer, as appropriate.
 Promote systematic fluid hydration, as
appropriate.
Oxygen Therapy: Administration of Oxygen and
Monitoring of its Effectiveness.

 Clear oral, nasal and tracheal secretions, as

appropriate.
 Restrict smoking.
 Maintain airway patency.
 Set up oxygenated equipment and administer
though a heated, humidified system.
 Administer supplemental oxygen as ordered.
 Monitor the oxygen liter flow.
 Monitor position of oxygen delivery device.
 Monitor position of oxygen delivery device.
 Instruct the client about importance of
leaving oxygen delivery device on.
 Periodically check oxygen delivery device to
ensure that the prescribed concentration is
being delivered.
 Monitor the effectiveness of oxygen therapy
(eg. Pulse, okimettry, ABGs) as appropriate.
 Ensure replacement of oxygen mask/cannula
whenever the device is removed.
 Monitor client’s ability to tolerate removed
of oxygen while eating.
 Change oxygen delivery device from mask to
nasal prongs during meals, as tolerated.
 Observe for signs of oxygen-induced
hypoventilation.
 Monitor for sign of oxygen toxicity and
absorption atelectasis.
 Monitor client’s anxiety related to AEED for
oxygen therapy.
 Monitor for skin breakdown from friction of
oxygen device.
 Provide for oxygen when client is
transported.
Respiratory Monitoring: collection and analysis
of client data to ensure airway patency and
adequate gas exchange.

 Monitor rate, rhythm, depth and effort of

respiration.
 Note chest movement, watching for
symmetry, use of accessory muscles, and
supraclavicular and intercostal muscle
retractions.
 Monitor breathing pattern; bradypnea,
tachypnea, hyperventilation, kussmaul
restrictions, cheyne-strokes respiration,
apneustic biot’s respiration, and ataxic
patterns.
 Palpate for equal lung expansion.
 Monitor for diaphragmatic muscle fatigue
(baradoxical motion).
 Auscultate breath sounds, noting areas of
decreased/ absent ventilation and presence
of adventitious sounds.
 Determine the need for suctioning by
ausculating for crackles and bronchi over
major airways.
 Auscultute lung sounds after treatment to
note result.
 Note changes in SaO2, SV02, end tidal CO2,
and ABG values, as approved.
 Monitor client’s to cough effectively.
 Note onset, characteristics, and duration of
cough.
 Monitor chest x-rays result/reports.
 Place the client on side, as indicated to
prevent aspiration; log roll if cervical
aspiration is suspected.
 Institute respiratory treatments (eg.
Nebulizer), as needed.
Hematology
The branch of science concerned with the
study of blood, blood forming tissues, and
disorders associated with them.

 August 24, 2009

 Hematology results
 Urinalysis
An analysis of the volume and physical,
chemical and microscopic properties of
urine.

 August 24, 2009

Computation:

GOOD > 5/8 x 100 = 62.5 %

FAIR > 3/8 x 100 = 37.5%
POOR > 0/8 x 100 = 0 %
TOTAL = 100%
 Interpretation:
The prognosis of the patient’s condition is good
because the disease is treated when it was
detected in the hospital. It is fairly good,. The
duration, hygiene, performance level.
Willingness to undergo treatment and the support
of the family are all good which contribute a lot
to the patient’s fast recovery. Onset, age and
diet are fair which also one good factor to
achieve the wellness of the patient.