PATIENT MRS.

F:
PNEUMONIA
Loraine Mae L. Robillos
Katrina May B. Mataro
Nejie Zarrah S. Diaz

I.INTRODUCTION
Pneumonia is an inflammation of the lungs caused by an infection.
It is also called Pneumonitis or Bronchopneumonia. Pneumonia can
be a serious threat to our health. Although pneumonia is a special
concern for older adults and those with chronic illnesses, it can also
strike young, healthy people as well. It is a common illness that
affects thousands of people each year in the Philippines, thus, it
remains an important cause of morbidity and mortality in the country.
There are many kinds of pneumonia that range in seriousness
from mild to life-threatening. In infectious pneumonia, bacteria,
viruses, fungi or other organisms attack your lungs, leading to
inflammation that makes it hard to breathe. Its best to do everything
we can to prevent pneumonia, but if one do get sick, recognizing and
treating the disease early offers the best chance for a full recovery.

Globally, Pneumonia is the single largest infectious cause of death in children

worldwide. Pneumonia killed an estimated 922 000 children under the age of 5 in
2015, accounting for 15% of all deaths of children under five years old. Pneumonia
affects children and families everywhere, but is most prevalent in South Asia and
sub-Saharan Africa. Children can be protected from pneumonia, it can be prevented
with simple interventions, and treated with low-cost, low-tech medication and care.
(http://www.who.int/mediacentre/factsheets/fs331/en/) Retrieved January 9, 2016
Nationally, the latest data from the Department of Health (DOH) show that
pneumonia has consistently figured in the top five leading causes of mortality
among adultsan average ranking of fourth in the past 10 years. In the Lung
Center of the Philippines (LCP) alone, 2013 medical records show 849 in-patients,
65 years old and above were diagnosed with pneumonia. The sad part is nobody
seems
to
take
notice.
(http://www.mb.com.ph/when-it-becomes-difficult-tobreathe/#dHjf785H5bZV3DJV.99) Retrieved January 9, 2016

Locally, The Department of Health (DOH) reported that pneumonia has been
the No. 1 killer disease in Davao City from 2010 to 2013 with a total of 2,291
deaths out of 8,258 cases.Mary Divine Hilario, officer-in-charge of
theDOHsHealth Advocacy and Promotion Cluster, told Edge Davao that
pneumonia is caused by liquid or pus in the air sacs of the lung, which
interferes with the lungs ability to transfer oxygen to the blood. in-patients,
65 years old and above were diagnosed with pneumonia. The sad part is
nobody seems to take notice. http://www.mb.com.ph/when-it-becomesdifficult-to-breathe/#dHjf785H5bZV3DJV.99 Retrieved January 9, 2016
A case with a diagnosis of Pneumonia may catch ones attention, though the
disease is just like an ordinary cough and fever, it can lead to death
especially when no intervention or care is done. Since the case is a elderly,
an appropriate care has to be done to make the patients recovery faster.
Treating patients with pneumonia is necessary to prevent its spread to others
and make them as another victim of this illness.

OBJECTIVES
This case study determines the effect and appropriate nursing care plans for clients with Pneumonia in
the hospital and in the community as well.
Specifically,

this sought the following questions

What are the signs and symptoms of Pneumonia in terms of:
1, 1. Inspection;
2.2. Palpation;
3.3. Percussion; and
1.4. Auscultation?
2.

What are the secondary data about Pneumonia?

3. What are the etiologies of Pneumonia?
4. What is the pathophysiology or Pneumonia?
5. What are the effective nursing care plans for Pneumonia?

I . Assessment
A.

Patients Profile

Name:

Mrs. F

Birthdate:
Weight:

Age: 60 years old Status: Married

July 02, 1954 Ethnic Group: BisayaReligion: Roman Catholic

68 kg Height: 50

Occupation:

House Keeper Address: Purok 4-A Gemini Village, Apokon, Tagum City,
Davao del Norte

Admission

Date/ Time: 01/05/16

Attending

Physician: Dr. Cyrus A. Asis

B.

Chief Complaint

2 days prior to the admission of Mrs. F in the hospital she had experienced fever
headache and body weakness. Lain na jud ako paminaw sa akong lawas, init akong
paminaw unya sigeg labad akong ulo, maong nag pa admit nalang jud ko diri sa hospital,
as verbalized by Mrs. F.

Admitting

Medical Diagnosis: Influenza, Diabetes Mellitus II, Essential Hypertension

C.

History of Present illness

According to Mrs. F prior to experiencing fever she was very

exhausted after cooking for the New Years Eve. After cooking she
immediately went to her room and take a rest. She also said that
after the New Years Eve she felt more tired .Also she added she is
coughing hardly sometimes. 5 years ago she was diagnosed with
Hypertension 1 and 2 years ago she was diagnosed with Diabetes
Mellitus II
On January 05, 2016. Mrs. F accompanied by her husband went to
Bishop Joseph Regan Memorial Hospital for admission because of
fever and was considered as Influenza, Diabetes Mellitus II, Essential
Hypertension.
Mrs. F wants to seek immediate care from the health care providers.

D. Past Medical History

Mrs. F said that she had vaccination when she was still a child but
she cannot remember the appropriate time and date when it was
given and if she completed it. She had history of Hypertension and
Diabetes Mellitus. She had her previous delivery of her only child. On
1983 she delivered her daughter through Normal vaginal delivery.
Personal

Mrs. F said that she eats minimal amount per meal after she was diagnosed
with DM II and Hypertension, She eats vegetables such as bitter gourd and
she measures her rice intake. Her hobbies are cooking and gardening and she
also loves to do brisk walking at the botanical park every afternoon with his
husband. She had an intimate relationship with her family members especially
with her husband and daughter. They had a strong family bond. They
support, trust, respect and love each other. According to her she has no vices,
she doesnt smoke nor drink alcoholic drinks.

Family History
Smoker

() Fathers side
Alcohol Drinker
() Fathers side
Asthma
(x)
Hypertension
() Both side
DM
() Mothers side
Malignancy
(X)
Tuberculosis
() Fathers side
Anemia
(X)
Socio-Economic

History

Mrs. F is a housewife and her husband is a teacher and earns enough

income to support their basic needs.

E. Vital Signs Monitoring

January05,2016

January 06,2016

8 am

12pm

8 am

12pm

Temp (C)

38

37.5

36.5

36.7

BP (mmhg)

140/80

120/80

120/80

110/80

RR (cpm)

21

20

20

20

PR (bpm)

90

86

82

84

(Table 1.0 illustrates the vital signs monitoring during the 2 days shift in the hospital.)

PHYSICAL ASSESSEMENT

General Survey

11/24/15 7:45 a.m.

Received lying on bed, awake, conscious, responsive & coherent. Able to recognize
date and time and awareness of the place where she is confined; with # 1 PNSS 1L
@ 120 cc/hour @ the level of 980 cc, hooked @ left metacarpal vein. With the
following vital signs: T: 38 degree Celsius; BP: 140/80 mmhg; PR: 90; RR: 21. With
weak appearance, flushed skin and very warm to touch, with pinkish conjunctiva
and without lesions noted. No ear discharges, No nose discharges, Flaring of nostrils
not noted, sinuses is tender with no pain. With dry and pale lips without lesions. No
swelling of lymph nodes noted upon palpation. With symmetrical chest expansion.
Fremitus noted. Adventitious sounds heard upon auscultation of both lung fields;
soft and tender abdomen noted. With dry, rough brown skin and is very warm to
touch; no skin discoloration noted; upper and lower extremities can be flexed. Mrs.
F is able to answer and respond to the questions being asked to her. She is aware of
what is happening on the environment where she is in. She is also responsive to the
procedures being done towards her by the healthcare providers.

Integumentary System
Mrs. F has dry, rough and brown skin with elastic skin turgor less than 2 seconds. Flushing of skin on face
and neck noted due to fever. Skin is very warm to touch. . No abrasions and jaundice on skin noted. Cuts
or wounds on skin are not noted.
HEENT
Head
Head is norm cephalic. Can be flexed or rotated from side to side. Can lift head fully. Hair is black with
minimal white hair and short, thin and evenly distributed. No dandruffs, head and scalp lesions noted.
Eyes
Eyes are symmetrical, black in color and round in shape. Lesions not noted. Eyebrows and eyelashes are
distributed equally. Sclera is pinkish to pale in color.Thesclera'sofbotheyesareclear and
equallyround.Pupils are reactivetolight accommodation. No eye discharges noted
Ears
Ears are symmetrical. Discharges, lesions or wounds on ears not noted. No hearing problems noted.
Nose
No flaring of nostrils observed. Nose is in the midline between the eyes. No pain felt on both sinuses and
is tender to touch.
Throat
Gums are in good condition. Tongue midline and mobile with visible papillae. Tongue is pinkish in color.
Swelling or lesions not noted. Tonsils are not inflamed. Pinkish hard and soft palate. Lips are dry. Dry
mucous membrane noted. Oral mucosa are pinkish in color slightly dry. Symmetrical and pale lips noted.

 Pulmonary

System

With minimal crackles at lung fields; Symmetrical chest expansion; No

retraction. Regular breathing Pattern, adventitious sounds heard upon
auscultation.
Capillary

refill

Capillary refill returns less than two seconds.

Cardiovascular

system

Adynamic pericardium. Regular Rhythm. S1 and S2 heard upon auscultation

with Lubb-dubb sound. No murmurs heard upon auscultation. Heart
problems and chest pain not noted.
Gastrointestinal

system

Skin tone of the abdomen is similar to the rest of the body. Abdomen is soft
and tender. Lesions or abrasions not noted. Palpable mass not noted.

Nutrition and Fluids

Mrs. F is on Diabetic Diet as prescribed by the physician. Below are the data of Mrs. Fs fluid intake
upon our 2 days shift in the hospital.

Date

Water Intake

IVF Intake

January 05, 2016

570 cc

850 cc

January 06, 2016

680 cc

830 cc

Table 1.2 shows the fluid intake during the 2 days shift in the hospital

 Prescribed

Diet

Mrs. F is on Diabetic diet as prescribed by the physician.

Food

consumed

Mrs. F is able to consume the meals provided by the hospital which

includes 1 cup of rice, bitter gourd with egg and banana.
Eating

pattern

Mrs. F eats 3 times of meal per day and 2 times of snacks per day.
Additional

Intake

# 2 PLR 1 L @ the rate of 120 cc/ hr. (1st day) & # 3 D5LR @ 120
cc/hr. (2nd day)

Elimination

During the whole shifts Mrs. Y was able to defecate once with brown semi-formed
stool.

Last Bowel Movement:

January 06, 2016

Normal Pattern:

Urination

Mrs. F defecates every other day as her normal pattern of defecation.

Date

Output (cc)

January 05,2016

740 cc

January 06,2016

890 cc

Table 1.3 shows the urine output of the patient during the two days shift.

Mrs. F urinates frequently during the 2 days of shift. She was encouraged to increase her fluid intake
to be able to support hydration and to enhance her tissue perfusion.

 Musculoskeletal

System

Symmetrical development and structure of muscle and bones noted. Able to mobilize upper and
lower extremities. With good posture. No deformities or lesions noted upon inspection.
Genito-urinary

System

No kidney punch sign noted. Painful urination with burning sensation noted. Able to void with
large quantity of urine with clear output.
Reproductive
Gravida-1,

Parity-1 Menarche: 16 years old, at menopausal age

Neurological

Status

Mrs. F was awake, coherent and responsive to verbal, and non-verbal stimuli. She was able to
comprehend questions being asked to her. No neurologic deficits. No visual and auditory
hallucinations noted.
Rest/

Sleep

Mrs. F can wake up as early as 4:00 a.m. and sleeps as early as 7 p.m. at night, and she also
added that she cant sleep sometimes.

 Safety-Security

Need

Mrs. F was awake when she was received in his bed, fully conscious,
responsive and coherent. She is able to respond to stimuli and she is living
with her husband and 2 children living with them. According to Abraham
Maslows Hierarchy of Basic Needs, on safety and security need are needs
that about keeping us safe from harm. To Mrs. F since she is always in their
house she feels safe on her environment, she has a stable family and
economic status.
Self

Esteem-Self Actualization

The self-esteem need is already achieved by Mrs.F She had selfconfidence in doing her tasks as a wife. She really felt valued and respected
by the people around her. On the side of self-actualization need. She has
also achieved it through recognizing her potentials, skills, and abilities upon
dealing with different circumstances of life.

II. LABORATORY AND

DIAGNOSTIC
EXAMINATION

Date: January 5, 2016

CHEST PA

Chest save for Poor Inspiratory Effort

CHEST LATERAL ONLY

Chest Lateral: Patchy Infiltrates Are Noted in the Visualized Lower
Lobes. Upper Lobes Are Clear. Hili are Normal

IMPRESSION: SUGGESTIVE OF BASAL PNEUMONIA


BLOOD CHEMISTRY

Examinati
on
Creatinine

Result
65.61
umol/L

Normal
Values
45-84 umol/L

1.
2.
3.
4.
5.
6.
7.
8.
9.

1.
2.
3.
4.
5.

Implication
Increased creatinine:
impaired renal function
chronic nephritis
obstruction of urinary tract
muscle disease such as
gigantism, acromegaly
congestive heart failure
shock
dehydration
rhabdomyolysis
hyperthyroidism
Decreased creatinine:
small stature
decreased muscle mass
advanced and severe liver
disease
inadequate dietary protein
pregnancy
http://nursingcrib.com/medic
al-laboratory-diagnostictest/serum-creatininenormal-values/ Retrieved:
January 9, 2016

Nursing Implication
1. Correlate the elevated
creatinine levels to clinical
problems. Low levels indicates
small muscle mass which is
mostly found in amputees and
in clients with muscle disease.
Check the urine output in 24
hours. Renal insufficiency may
happen when urine output is
lessthan 600ml for 24 hours.
If creatinine are increased,
most likely there is kidney
disease.
http://nursingcrib.com/medicallaboratory-diagnostictest/serum-creatinine-normal-

Examinatio Result Normal

n
Values
Hemoglobi
127
120n
180
g/dL

Hematocrit

0.38

0.360.45

HEMATOLOGY
Implication

Normal
Hemoglobin is the protein molecule in red blood cells that
carries oxygen from the lungs to the body's tissues and
returns carbon dioxide from the tissues back to the lungs.
Hemoglobin is made up of four protein molecules (globulin
chains) that are connected together. The normal adult
hemoglobin (Hbg) molecule contains two alpha-globulin
chains and two beta-globulin chains. In fetuses and infants,
beta chains are not common and the hemoglobin molecule
is made up of two alpha chains and two gamma chains.
http://www.medicinenet.com/hemoglobin/article.htm
Retrieved: January 9, 2016

Normal
The hematocrit measures the volume of red blood cells
compared to the total blood volume (red blood cells and
plasma). The normal hematocrit; for women it is 36 to 48%.
This value can be determined directly by microhematocrit
centrifugation or calculated indirectly.
http://www.ncbi.nlm.nih.gov/books/NBK259/ Retrieved: January
9,2016

Nursing
Implication
Advised
patient to eat
nutritious
foods such as
fruits and
vegetables.

Instructed for
adequate
hydration by
increasing oral
fluid intake to
neutralize the
rbc and plasma
volume.

Leukocyte No.
Concentration

Segmenters

Lymphocytes

Monocytes
Thrombocytes

9.4

0.77

0.16

0.07

5.00-10.00 x
10^g/L

0.40-0.60

0.25-0.40

0.01-0.12

266.0

150.00-440.00
x 10^ g/L

Normal
Encouraged to eat
As we all know, WBC's are our body's first line of defense
foods riched in protein
against invading bacteria and most other harmful
for cell production.
organisms. This test (WBC), measures the total number of

all types of WBC's. Further examination of the different

types and numbers of cells present, could tell much about

the state of the body's defense system. WBC count will

normally vary as much as 2,000 on any given day.

https://www.nurseslearning.com/courses/nrp/labtest/course/

section3/c1.htm Retrieved: January 9, 2016

High

Increased by:

Infection; gonorrhea, osteomyelitis, otitis media,

chickenpox, herpes, others

Ischemic necrosis due to MI, burns, carcinoma

Metabolic Disorders; diabetic acidosis, eclampsia, uremia,

Instructed to increase
thyrotoxicosis
oral fluid intake.
Stress Response; due to acute hemorrhage, surgery,

emotional distress, others

Inflammatory disease; rheumatic fever, acute gout,

vasculitis, myositis

https://www.nurseslearning.com/courses/nrp/labtest/cours
Encouraged to eat
e/section3/c1.htm Retrieved: January 9, 2016
Low
nutritious foods such
Decreased by:
as fruits and
Severe debilitating illness; congestive heart failure, renal

vegetables.
failure, advanced tuberculosis
Others;
Defective lymphatic circulation, high levels of

Normal
adrenal Corticosteriods,
https://www.nurseslearning.com/courses/nrp/labtest/course/
section3/c1.htm Retrieved: January 9, 2016
Normal

Result

Color

Yellow

Albumin Negative

Normal
Values
Color

Yellow
(light/pale
to
dark/deep
amber)

None

URINALYSIS

Implication
Turbidity and other terms are used to characterize the
appearance of a urine specimen. Urine may contain red or
white blood cells, bacteria, fat, or chyle and may reflect renal or
urinary tract infection.
Some drugs can change the color of the urine. Normal urine
color is a light yellow to a dark amber color. Inflammation may
also cloud the urine as well as other pathological conditions
can. Dorban can color the urine red; phenolphthalein can color
it red; pyridium can color the urine dark orange. Of course, the
patient should be "warned" of these changes. Hospitalization is
stressful enough without the added shock of unexpected
orange
urine.http://www.nurseslearning.com/courses/nrp/labtest/course
/section5/c1.html Retrieved : January 9, 2016

Nursing Implication

-Monitor
urine
color
changes,
monitor
the
voiding pattern, input and
output every 8 hours and
monitor the results of
urinalysis
repeated.
To
identify the indications of
progress or deviations from
expected results
-Note the location, time
intensity scale (1-10) pain.
To help evaluate the place
of obstruction and cause
pain.

Trace albumin means that you have some protein in your urine.
This is something that we test for because it is considered
abnormal to have protein in the urine. Trace simply means that
the amount of albumin (which is the protein that the test looks
for) is quite low and just above the upper limit of detection
ability. Having trace albumin in your urine means that your
kidneys are abnormally spilling a tiny amount of protein into the
urine
from
the
blood.https://www.zocdoc.com/answers/21263/my-albumin-istrace-what-is-the-means-of-itRetrived: January 9, 2016

Reaction
Sugar
Specific
Gravity

6.5
Trace
1.015

Epithelial Cells Few

Normal

5-8.5
Normal

Negative
1.005-1.025 Specific Gravity will increase with the amount of dissolved particles
(concentrated) in it. Specific gravity will decrease when the water
content is high and the dissolved particles are low (less concentrated).
Low specific gravity (<1.005) is characteristic of diabetes insipidus,
nephrogenic
diabetes
insipidus,
acute
tubular
necrosis,
or
pyelonephritis. Fixed specific gravity, in which values remain 1.010
regardless of fluid intake, occurs in chronic glomerulonephritis with
severe renal damage. High specific gravity (>1.035) occurs in nephrotic
syndrome, dehydration, acute glomerulonephritis, heart failure, liver
failure,
or
shock.http://www.nurseslearning.com/courses/nrp/labtest/course/section
5/c1.html Retrieved: January 9, 2016
Few
Normally in men and women, a few epithelial cells from the bladder
(transitional epithelial cells) or from the external urethra (squamous
epithelial cells) can be found in the urine sediment. Cells from the
kidney (kidney cells) are less common. In urinary tract conditions such
as infections, inflammation, and malignancies, more epithelial cells are
present. Determining the kinds of cells present helps the health care
provider pinpoint where the condition is located. For example, a bladder
infection may result in large numbers of transitional epithelial cells in
urine sediment. Epithelial cells are usually reported as "few,"
"moderate,"
or
"many"
present
per
low
power
field
(LPF).https://labtestsonline.org/understanding/analytes/urinalysis/uiexams/start/2Retrieved: January 9, 2016

Pus Cells

0-1

0-4 pvf

Presences of pus cells in the

urine indicates an inflammation
of the urinary tract. The
commonest cause of this is
infection.
However,
stones,
tumours, nephritis can all
produce pus cells in the urine.

Monitor vital signs.

to
assess
the
condition
and
prevent
complications
Increased
water
intake.
to
help
flushes toxins in
the body
http://www.ncpnan
da.top/2013/02/urin
ary-tract-infectionuti-4-nursing.html
Date
Retrieved:
January 9, 2016

VI.
PATHOPHYSIOLOG
Y

A. Written Pathophysiology
The predisposing factors is age and precipitating factors are virus, bacteria, and fungi. Exposure or
Inhalation of pathogens through the nasopharynx or oropharynx the proliferation of microorganism
.Microorganisms are usually trapped in the mucous-producing cells and cilia that line the upper airway.
Factors that can impair the lungs' first line of defense include suppressed cough reflex, decreased ciliary
action, decreased activity of phagocytic cells, and the accumulation of secretions. If the microorganism gets
past the upper airways line of defense, the next line of defense is the airway epithelial cells which contain
alveolar macrophages. Alveolar macrophages release cytokines and cause widespread inflammation in the
lungs in an attempt to activate the immune response. The products of inflammation (inflammatory
mediators, immune complexes) can injured the lung tissue and cause vasodilation which is also caused of
increased permeability the terminal bronchioles to fill with infectious debris and exudates this also will lead
to hyper secretion of mucus, respiratory congestion, and respiratory insufficiency. Some microorganisms also
release toxins or the chemotaxis which can cause further damage to the alveolar walls or phagocytosis.
Accumulation of exudates can leads to alveolar edema. The signs and symptoms are Fever, Cough, and
Shortness of breath, Sweating, Shaking chills, Increased WBC count, Chest pain, Headache, Muscle pain,
Fatigue and the pneumonias most common treatment is the antibiotic to fight the bacteria. If this condition
is not treated there will be fluid accumulation in the lungs, abscess around the affected areas, Bacteremia ,
or worst is death but if this is treated the patient will be relieved from the condition and relieved from fever,
cough, muscle pain and fatigue.

NURSING CARE
PLAN

IX. DISCHARGE
PLAN

Areas

Medication

Exercise

Treatment

Objective

100 % compliance
home medicines

Activities
1. Encourage the client to take the medicine at
the right time, right dose, right amount, and
to
right frequency and take note the side effects
of the medicine.
2. Instruct patient to notify physician if there is
any abnormalities after taking the medicine.
3. Instruct patient not to buy any drugs that is
not prescribed by the physician.

1. Avoid strenuous activities

2. Encourage patient to do activities of

daily
To stabilize the condition
living.
of the patient
3. 3. Encourage client to have adequate rest
periods between activities.

1. Explain the purpose of the medication that is

prescribed by the physician.

Understanding
the 2. Inform the significance of the treatment and
recommended treatment
inform significant others that they should be
or
lessen
underlying
involved in the treatment of the client.
illness.


Health teachings

Out - patient

Diet

To prevent the risk of any

complications that may lead
to death.

1. Instruct the client to have proper hygiene.

. Instruct about proper personal hygiene
. Instruct client to always wipe from the front to the
back after using the bathroom.
. Never wipe twice with the same tissue. Any wiping
motion that starts nearer to the rectum and then
approaches
the
bladder-opening
area
moves
potentially pathogenic bacteria closer to the bladder.
1. Stress the necessity of hand washing before and after
doing any interventions for the patient to prevent
cross contamination.
2. Instruct the patient to avoid smoking and drinking
alcoholic beverages.
3. Take special precautions after sexual activity; such
activity may also increase risk because it can introduce
bacteria into the bladder area.

1. Continue the medicines that prescribed by the physician.

To maintain quality health and 2. Have a follow up visit to the physician for further orders.
independence towards self care.

1. .Emphasize intake of nutritious food more specifically

vegetables and fruits.

Less intake of carbohydrates and 2. .Increase fluid intake.
sugar
3. Observe proper handling of foods.
4. Advise the patient and significant others to have increase
intake of protein as prescribed by the physician.

VIII. PHARMACOLOGICAL
MANAGEMENT

A. Doctors Order
Drug Name

Dosage

Route

Frequency or
Timing

1.Norten

5mg

P.O

OD

2. Paracetamol

500 mg/ 1 tab

P.O

Q4 X4 Doses

3. Celecoxib

200 mg/ 1 cap

P.O

BID PRN

4. Diamicron

60 mg/ 1 tab

P.O

OD

5. Erdosteine

300 mg/ 1 cap

P.O

BID

Drug

Classific

ation
Generic Anti- Hyp
ertensive
Name:
Norten s

MIMS
Class:AC
E
Inhibitors
/Direct
Renin
Inhibitors

Mechanism of Action
Angiotensin-converting
enzyme (ACE) inhibitor,
antihypertensive.
Pharmacology:Pharmacod
ynamics: Imidapril is an
ester prodrug which is
hydrolyzed after absorption
to imidaprilat, the active
metabolite. Imidaprilat has
potent angiotensinconverting enzyme (ACE)
inhibitory effects, 1.2 and
2.6 times that of
enalaprilat and captopril,
respectively.
Imidapril's hypotensive
effect is mainly due to ACE
inhibition and the
consequent reduction in
angiotensin II, resulting in
dilatation of peripheral
vessels and reduction in
vascular resistance. The
hypotensive effect of
imidapril is comparable to
enalapril and 5-10 times
more potent than that of
captopril.

Indication

Contraindi

cation
Essential (mild Contraindic
to moderate) & ated in
severe HTN.
patients
Heart failure.
with
Proteinuria.
narrowing
Diabetic
of blood
nephropathy.
vessels,
obstruction
in blood
flow,
ascites,
and
hypersensit
ivity.

Adverse Effects
Most Common- Dizziness,
headache, fatigue, tingling,
impotence and sleep
disturbances.

Nursing Responsibilities

Before:
Check doctors order
Perform handwashing
Introduce drug to the
patient and educate her
Gastrointestinal- Mouth
about its purpose and
ulcers, inflammation of
importance
Assess for hepatic and
pancreas, and taste
disturbances.
renal impairment, lactation,
pregnancy
Respiratory- Dry cough and Assess skin status, renal
other upper respiratory tract
function tests, culture of
symptoms.
affected area, sensitivity
tests
Skin- Rash, angioedema,
During:
photosensitivity, hair loss and Administer the right drug at
mood disturbances.
the right dose
Do not mix ceftriaxone with
Genitourinary- Kidney
any other antimuicrobial
impairment, blood disorders
drug
Discontinue if
and protein in urine.
hypersensitivity occurs
Heart- Chest pain,
After:
Report severe diarrhea,
palpitations and fast heart
rate.
difficulty breathing, unusual
tiredness or fatigue, pain at
Musculoskeletal- Muscle
injection site
cramps.

Drug
Generic
Name:
Paraceta
mol
Brand
Name:
Alvedon

Classifi
cation
Analgesi
c;
Antipyre
tic

Mechanism
of Action
Reduces fever
by acting
directly on the
hypothalamic
heatregulating
center to
cause
vasodilation
and sweating,
which helps
dissipate heat

Indication

Contraind
ication
Temporary reduction Use
of fever, temporary cautiously
relief of minor aches with
and pains caused by impaired
common cold and
hepatic
influenza,
function,
headache, sore
chronic
throat,
alcoholism,
tootache,backache, pregnancy,
menstrual cramps
lactation

Adverse
Nursing
Effects
Responsibilities
CNS: headache Do not exceed
CV:
the
Chest pain,
recommended
dyspnea
dosage.
Reduce dosage
GI: hepatic
toxicity and
with hepatic
failure, jaundice
impairment.
Give drug with
GU:
Acute renal
food if GI upset
failure, renal
occurs
tubular necrosis
Hematologic:
Hematuria,
anuria,
neutropenia,
leucopenia,
pancytopenia
Hypersitivity:
Rash, fever

Drug

Classific
ation
Generic Nonopioi
Name: d
Celeco analgesi
xib
c
Brand
Name:
Celebre
x

Mechanism of
Action
Analgesic and
antiinflammatory
activities related
to inhibition of
the COX-2
enzyme, which is
activated in
inflammation to
cause the signs
and symptoms
associated with
inflammation

Indication

Contraindicatio
n
General:
Allergies to
-Acute & long-term
sulphonamides,
treatment of signs and celecoxib,
symptoms of
NSAIDs or
rheumatoid arthritis & aspirin,
osteoarthritis.
significant renal
-Management of acute impairment,
pain.
pregnancy

Adverse
Effects
CNS:
headache,
dizziness,
somnolence,
insomnia,
fatigue,
tiredness,
tinnitus
CV: MI, CVA
Dermatologic:
Rash, pruritus,
swelling,
stomatitis
GI:
Nausea,
abdominal
pain,
dyspepsia,
flatulence, GI
bleeding
Hematologic:
leucopenia,
neutropenia,
eosionphilia,
bone marrow
depression

Nursing Responsibilities
Before:
Check the doctors order
Handwashing
Explain the importance and purpose of the
drug to patient
Assess skin color and lesions, reflexes,
sensations, edema, serum electrolytes
During:
Administer right drug; receck the label
Administer drug with food or after meals
Take note for side effects
After:
Document and record
Provide positioning and environmental
control to reduce pain
Provide warmth, positioning and rest to
reduce inflammation
Monitor patients V/S

Drug Classifi
Mechanism of
Indication
Contraindication
Adverse Effects
cation
Action
Gene
Oral Gliclazide is a blood Diamicron MR This medication must not
Medicines and their
ric
Antiglucose-lowering isused in the
be used in the following
possible side effects
Nam Diabetic
agent. Non-insulin
treatment of cases:-if you are allergic
can affect individual
e:
agent
dependent
type II(nonto gliclazide-if you have people indifferent ways.
Diam
diabetes(NIDDM) is
insulin
diabetes requiring The following are some
icron
due to a decreased dependent)dia treatment with insulin,-in of the side effects that
Bran
sensitivity of the
betes that
case of diabetes
are known to be
d
body cells to insulin,
cannot be
complicated by ketosis
associated withthis
Nam
but the pancreas still
controlled
and acidosis, diabetic medicine. Just because
e:
has the ability to with diet and
precoma-if you suffer
aside effect is stated
produce insulin.
exercise
from severe liver or
here does not mean
Gliclazide stimulates
kidney disease.-in case of
that all people using
the islet cells of the
porphyria:
this medicine will
pancreas to secrete
accumulation ofpigments experience that or any
insulin, and also
(porphyria) in the body-if
side effect.
increases their
you are presently Disturbances ofthe gut
sensitivity to their
taking a treatment with
such as diarrhea,
normal stimulus,
miconazole (see
constipation
glucose. These
interactions with other
,indigestion, nausea,
effects restore
medications)-if you are vomiting or abdominal
the(first-phase)
breast-feeding pain. Temporary visual
insulinsecretion that
disturbances
has become
diminished in NIDDM
patients. Gliclazide
also has effects
outside the
pancreas, where it
improves insulinstimulated usage

Nursing Responsibilities
Take this medication by mouth as
prescribed usually 30 minutes before
mealsnand at bedtime
Monitor for persistence of nausea and
vomiting to evaluate the
Effectiveness of the drug
Monitor for signs of abdominal
discomfort such as epigastric pain or
abdominal fullness.
Monitor vital signs to determine signs
of dehydration.
Perform oral care
Tell patient that she may get dizzy or
drowsy with this drug, tell the patient
not to sit or stand quickly.

Drug

Classificati Mechanism of Action

on

Generic
Mucolytic
Name:
agent
Erdostein
e

Erdosteine contains two

sulfhydryl groups, which are
freed aftermetabolic
transformation inthe liver.
The liberated sulfhydryl
groups breakthe disulphide
bonds, which hold the
glycoprotein fibers ofmucus
together. This makes the
bronchial secretions more
fluid and enhances
elimination.
Absorption:
Rapid absorption after
oraladmin.
Distribution:
Proteinbinding: 64.5%.
Metabolism:
Undergoes1st-pass
metabolism to form an active
metabolite, N-thiodiglycolylhomocysteine.
Excretion:
Elimination half-life: About
1.46 hr(erdosteine), and

Indicatio
n

As
mucolytic
in the
treatment
ofrespirat
ory tract
disorders
and
productiv
e cough.

Contraindication

Active peptic ulcer.

Erdosteine is
contraindicated
inpatients suffering
from hepatic cirrhosis
and deficiency of
thecystathioninesynthetase
enzyme.Phenylketonuria,
due to the presence
ofaspartame, only for
thepowder for
suspension.

Adverse
Effects

Nursing Responsibilities

Epigastralgia
,nausea,
vomiting,
loose stools,
spasmodic
colitis,

headache

The product contains

sucrose. Keep this into
consideration in case
of diabetes orlowcalorie diets
This drug can be
taken with or
without food
For the reason that
of a probable
intrusion of
erdosteine
metabolites with the
methionine
metabolism,
erdosteine is no
recommended in
subjects
experiencing
hepatic cirrhosis and
insufficiency of the
cystathionine
synthetase enzyme.
Ectrin Suspension is
also contraindicated

IX. SYNTHESES OF
CLIENTS CONDITION FROM
ADMISSION TO PRESENT

A. Conclusion
Therefore, our client suffered from Pneumonia because of the factors contributed to the
development of the disease.
While assessing the patient, it was observed that she seems to be weak but can tolerate
the condition she is experiencing and feeling. The family supports, as well as the significant
others, physically, mentally, emotionally, spiritually and financially as they provided the
client her medications needed and other laboratory and diagnostic examinations essential
that is needed to be able to find treatment to her illness. Our client needs also assistance
and guidance from both her family and the health care providers to be able for her to
surpass and cope up with the illness that she is experiencing. Providing health teachings is
an important role of the nurse to aid the patient to alleviate the suffering that would serve
as the patients guide. Educating the patient to always promote healthy lifestyle by proper
hygiene, exercise, eating nutritious foods, in-take of appropriate medications prescribed by
the physician and regular check-up to be able to monitor her health condition. These are
essential components to be able to keep the patient improve her health and be free from
illness and to be physically, mentally, emotionally and spiritually fit. This will serve as her
guide and bases to attain proper care to herself and to pay attention, understand and
emphasize on the appropriate lifestyle actions that she must do and follow to achieve
optimum level of wellness.

B. Patients Prognosis
CRITERIA

Duration of Illness

POOR

FAIR

GOOD

JUSTIFICATION

We rated good since her condition started after new

years eve and she was admitted due to fever.

Starting from the day she was admitted her
condition became good.

Onset of Illness

The onset of illness happened after new years eve

and she was admitted last January 5, 2016 and the
present condition was getting better. She has
gained improvements upon the course of treatment.

Age

The patient age belongs to late adulthood which the

recovery process is fair. She is aware and her family
for the drugs she takes.

Willingness

to

take

medication

The patient has the willingness to take all medications

after the explanation of the purpose and the nature of
the medicine and was able to buy new ordered drugs

Lifestyle

because of enough financial capacity.

We rated good because the patient has

willingness to

recover. She also doesnt drink alcoholic drinks and she isnt a
smoker which is good for her condition. She is willing to follow
the doctor order regarding her condition for her to recovery
Family Support

quickly.
The family of the patient is very supportive. They provide the
needs of the patient accordingly. They do their best to give
adequate financial support to the patient. Efficient emotional,
moral and spiritual support also is being given to the patient.
The family shows cooperation and coordination with the
health care providers such as their willingness to follow the
treatment regimen for the patient through encouraging and

COMPUTATION:
POOR

1X0=0

FAIR

2X1=2

GOOD

3X 5 = 15

0+ 2 + 15= 17 / 6 = 2.8 ;

Good Prognosis

C. Recommendations
It is very essential that we should take care of ourselves so that we could take care of others
too. A person should have also basic knowledge in order to protect themselves from illnesses,
should have appropriate healthy lifestyle changes that includes adequate nutrition, neat and
clean environment, and free from stress. This would be a great help to have a positive
outcome of a therapeutic effect in the patients condition.

To the patient

Instruct the patient, husband and significant others to follow the medical regimen.
Follow physicians orders with regards to prescribe diet to know what foods should be or should
not be eaten.
Maintain proper hygiene all the time to avoid the invasion of pathogens in the body.
Adequate rest and sleep to have balance time and adequate energy in doing tasks and duties.
Strict compliance to the medical treatment and medical check-up to ;
Follow-up with appointment with the physician to know how the condition improves.
Promote healthy lifestyle by eating nutritious foods especially protein-rich foods and Vitamin-C
rich foods that are essential to have a healthy immune system.

To the family
Recommend immediate family members to give and sustain enough support, care, love and understanding to the
patients condition to be able to help the patient in recovering..
Instruct the family members to assist the patients situation for the patient to have extra guidance on the righteous
thing that she must do to gain improvements in her condition..
Encourage the patient to maintain to eat nutritious foods that are vital to promote a healthy body system and avoid
illness..
Motivate the patient more by giving words of encouragement with regards to her condition that would help increase
his self-esteem and self-actualization to herself that he would attain recovery.

To the Future Researchers

With this we recommend the future researchers to incorporate more efforts and adequate time in searching steps and
ways to aid and assist in helping the client of the same health status not just for wisdom and knowledge purposes
but also to realize the true essence and meaning of nursing which is the ART of care which implies passion,
dedication, diligence, hard work, intelligence and a sense of fulfilling responsibilities. Furthermore, it is of such a great
significance to have an absolute assessment of the client to be able to come up with an effective and appropriate
nursing care plan. Appropriate instructions and health teachings must be elaborated accordingly with client
experiencing the same situation. Case studies are one of the method of the nursing curriculum to enhance the skills,
abilities and the knowledge of the student nurses. Thus, we must be able to provide our strong efforts in order for us
not only to gain lessons or learnings from this but for us to be able to understand the nature of the patients condition
and the disease. This will enhance our competency in terms of providing quality care towards our clients.

EVALUATION OF THE OBJECTIVES OF THE STUDY

After a step-by-step review on related topics on this case study, we are
hereby presenting our evaluation with relation to our specific objectives
that we have affirmed at the start of this case study. That Pneumonia is an
inflammation of the lungs caused by an infection. That indeed, people
should not take pneumonia as an easy case, many people died from it due
to its complications.
We were able to identify the signs and symptoms manifested by our
patient through the IPPA technique: inspection, palpation, percussion and
auscultation. We were also able to identify the causes of why a person has
Pneumonia, there are many etiologies such as; bacteria, virus, fungi and the
environment. Thats why almost all can acquire pneumonia since one of the
causes is our environment.

This case study will not only help us in completing such requirements
but it has also help us in evaluating ourselves with our capacity to do
such research. It has also help us in formulating interventions and health
teachings to our client to improve her health status. We were able to use
the nursing process as a framework for the care of my patient and for
goal attainment and that is to prevent and manage potential
complications.
We therefore conclude that case studies is very important in the
course of nursing, because such case study we will be able to gain
satisfactory knowledge accordingly. These will serve as our guide and also
from the main sources of the informations being presented through the
study.