Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City

COLLEGE OF NURSING

A CASE STUDY
On

PNEUMONIA
In Partial fulfillment
of the Requirements in
NCM 103
(Related Learning Experience)

Suero General Hospital

Presented to:
Krishna Bautista, RN
Clinical Instructor
Presented by:
Gaile Ann P. Momblanco
BSN III-Mulberry

January 2011
Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City

COLLEGE OF NURSING
GRADING SHEET
CATEGORIES
Introduction
Personal Data
Nursing History/Past, Present,
Family
Pearson Assessment
Diagnostics Actual and Ideal
Anatomy and Physiology
Algorithm and Explanation of
Pathophysiology
Medical and Surgical
Management
Nursing Care Plan
Promotive and Preventive
Management
Drug Study
Discharge Planning
Summary and Copy of Updates
Bibliography
Appendix A and B (Consent and
Documentation)
Organization and Punctuality

PERCENTAGE

TOTAL

C.I. REMARKS

KRISHNA BAUTISTA,RN
Clinical Instructor

ACTUAL GRADE

TABLE OF CONTENTS
CATEGORIES
Introduction
General Objectives
Specific Objectives
Personal Data
Nursing History of:
Past Illness
Present Illness
PEARSON Assessment
Diagnostics:
IDEAL
ACTUAL
Anatomy and Physiology
Algorithm and Explanation of
Pathophysiology
Medical and Surgical Management:
IDEAL
ACTUAL
Nursing
Care Plan
Promotive and Preventive
Managements
Drug Study
Discharge
Planning
Summary and Copy
of Updates
Bibliography
Appendix A
(CONSENT)
Appendix B
(DOCUMENTATION)

INTRODUCTION

PAGE NUMBER

A baby will make love stronger, days shorter, nights longer, bankroll smaller,
home happier, clothes shabbier, the past forgotten, and the future worth living for.
When you inhale you take in air with lots of oxygen, which you need to stay alive.
Healthy lungs let air pass through and speed by the alveoli, then into red blood cells.
Oxygen is delivered all over the body. But when you have pneumonia, liquid blocks the
alveoli in your lungs using liquid.
This is a case of a 4 months old baby boy residing at Margaay, Cabugaoa, Ilocos
Sur who was diagnosed with pneumonia last November 15, 2010. The baby was
admitted at Suero General Hospital on November 12, 2010 at 8:25 in the morning with
a chief complaints of cough and colds for two weeks. The vital signs were initially
taken and recorded and the admitting diagnosis was pneumonia.
Pneumonia is an acute infectious disease caused by pneumococcus, associated by
general toxemia and a consolidation of one or more lobes of either one or both lungs.
It is an inflammation of the lungs caused by infectious agent in which air sacs are filled
with pus or exudates so that air is excluded and the lungs become solid. Bacteria
commonly enter the lower airway but do not cause pneumonia in the presence of
intact host defense mechanism (Smeltzer & Bare, 2005). Often pneumonia begins
after an upper respiratory tract infection (an infection of the nose and throat). The
incubation period ranges from one to three days with sudden onset of shaking chills,
rapidly rising fever and stabbing chest pains aggravated by coughing and respiration.
The disease is transmitted through droplet infection or through indirect contact.
Upon further history taking, I found out that the mother of the baby is positive
in extensive PTB and she is now on her 3 rd month of anti-Kochs treatment.
General Objective:
With the acquired information given by the mother of the patient, I aim to
present the case of Baby Boy comprehensively and formulate a case analysis that
would provide essential knowledge and skills in delivering quality health care to
patients diagnosed with pneumonia.
Specific Objectives:
This case study on pneumonia seeks to attain the following specific objectives:

 Describe the common characteristics of pneumonia.

Know the history of past and present illness of the client.
To assess the condition of the patient through the use of PEARSON Assessment
(Psychosocial, elimination, activity and rest, safe environment, oxygenation and
nutrition).
Relate the significance of laboratory results to clients condition or the disease
process.
Present the anatomy and physiology of the system involved, in relation to the
condition of the patient.
Identify the indication, mechanism of actions, contraindications, dosages and
frequency, adverse effects, and nursing responsibilities/interventions of the
drug administered to the client.
To present nursing care plans formulated specifically based on clients
condition.
Recognize the medical and surgical interventions related to the patient and
make promotive and preventive management to help the clients condition.
Formulate a comprehensive discharge plan realistic to the needs and
compliance of the client.
Present updates related to clients case and condition.

Patients Profile
Personal Data:
Name: Jayson Factor Dela Cruz
Age: 4 months old
Sex: Male
Address: Margaay, Cabugao, Ilocos Sur
Civil Status: Child
Rank in the Family: Fourth Child
Religion: Iglesia ng Diyos
Birthday: June 28, 2010
Nationality: Filipino
Name of Significant others: Zenaida Factor Dela Cruz (Mother)
Date and Time of Admission: November 12, 2010/8:25am
Admitting Hospital: Suero General Hospital

Ward: Sto. Nio

Clinical Record:
Chief Complaints: Cough and Colds for two (2) weeks
Previous Illness and History: (+) history of infection and diarrhea when he was 2 mos. Old
due to poor hygiene.
Physical Findings: Skin is fair in color; nails are convex, cleaned and capillary refill returns to
original color after 2 seconds when pressed; normocephalic, symmetrical
facial features. Hair is black and evenly distributed and no infestations;
scalp is free from lesions lumps or masses; pupils are equally rounded, both
reactive to light and accommodation; nose is located at midline of the face
with watery nasal discharges; ears are symmetrical and at the level of outer
canthus of the eye; lips are pinkish in color, smooth, moist and free of
lesions; tongue lies at the midline and free of lesions also; neck is
symmetrical with the head in central position; lymph nodes are not
palpable; thorax rises and falls in unison with respiratory cycle; no chest
pain noted; fast breather but no shortness of breath noted; rales noted at
both lung fields; abdomen is round and no tenderness noted upon palpation;
normal bowel sounds; extremities grossly normal with full and equal pulses.
Weight: 8 kilograms
Initial Vital Signs: Respiratory Rate: 42bpm
Heart Rate: 150cpm
Temperature: 36.2 C
Attending Physician: Dr. S. Saliganan
Working Diagnosis: t/c Pneumonia
Final Diagnosis: Pneumonia
Condition on Discharge: Improved

Nursing History of Past and Present Illness

A. Nursing History of Past Illness

Upon interview, the mother was asked about past history of illness of her
son. She told us that her son experienced an infection and diarrhea when he was
still two months old and was admitted at the same hospital for four days. Some
immunizations were already started to boost the immune system of the baby for
him to experience no further complications. The following immunization were
given to and received by baby boy with its corresponding dates:
BCG June 28, 2010
Hep B June 28, 2010/August 12, 2010/September 21, 2010

 DPT September 21, 2010

Poliomyelitiis September 21, 2010/December 6, 2010
According to the patients mother, the baby is not used to have a monthly
check up. But the baby is given a multivitamins everyday. No history of allergies
of any kind. I also noted that the mother of the child is positive in extensive PTB
but shes now on her 3rd month of anti-Kochs treatment.
B. Nursing History of Present Illness
Prior to admission, the patients mother told me that baby boy was
experiencing cough and colds with watery nasal discharges accompanied with on
and off undocumented fever since October 29, 2010 and she observed that the
babys chest expansion has more effort and she think that the patient
experiencing difficulty of breathing. Prior to admission, she first brought baby boy
to Sinait District Hospital for check up and he was given Cefixime drops to be
taken for seven days. November 12, 2010 at 8:25 in the morning, baby boy was
admitted in St. Nio ward at Suero General Hospital with chief complaints of cough
and colds for two weeks. After series of examination the working diagnosis given
by the physician of the child was to consider pneumonia.

PEA/RSON
Approach in Need Assessment

Admission to

Home Visit

November 14, 2010

December 7, 2010

(During Hospitalization)
Patient Baby boy is 4
month

old

child,

(After the Hospitalization)

presently

residing at Margaay, Cabugao,

Ilocos Sur. He is the 4th child in

PSYCHOSOCIAL

Baby boys condition was

the family. He was admitted at

improved

Suero

last

hospitalization. He was awake

November 12, 2010 exactly

when I went to their house to

8:25 am with a chief complaint

visit him and to check his

General

Hospital

after

the

of cough and colds. He is condition. While I am speaking

active, conscious and playful. to his mother, he was staring
His psychosocial development at me and it seemed that he
according to Erik Erikson is

was listening to what I was

trust vs. mistrust which means

saying.

to develop a sense of purpose

and the ability to initiate and
direct ones own activities.

Urinary output: Baby boy Urinary output: Baby boy

changed his diaper 2 3

changed his underwear 8

times

10 times a day, orange in

during

the

shift

normally with yellow color

color

and

aromatic

odor

of urine and aromatic odor.

with 15 to 20 ml every void.
Defecated once with little He defecates once a day

ELIMINATION

amounts during the shift

only with an amount of 50

with

70 ml of stool with yellow

greenish

yellow

in

color and soft consistency.

(+) diaphoresis

ACTIVITY AND REST

orange in color and soft

Baby boy sleeps with intervals

consistency.
Mga 10 pm siya natutulog

of 4 to 6 hours. He had enough

ading

rest and crying at times only.

nagigising. Paggising niya sa

He is jolly and playful also. He

madaling araw naglalaro na

usually

slept

yan.

position

and

prone

on

supine

sometimes

position.

During

he

was

irritated

Pagsapit

maaga

ng

siya

tanghali

on

matutulog ulit siya mga isa o

his

dalawang oras. As verbalized

hospitalization, there are times

that

tapos

and

cannot sleep well according to

her mother.

by the mother.
He is so jolly and gay during
the

visit

and

also

thumb

sucking and clapping. He is

very active and playful.

He
turgor.

has
Soft

good

skin

and

fair

skin

complexion. No signs of skin

rashes

on

both

upper

and

They live in a concrete

lower extremities. He was able house, with enough light and

to move his body in different
positions with medium pillows
around

him

for

safety

purposes. He was in a light

good source of air.

Body
36.8 C

temperature

of

SAFE

and comfortable cold room. He

ENVIRONMENT

has no allergies on milk, food

and

medicine.

He

had

(-) Edema
No signs of skin rashes
or

temperature of 36.2 C.

allergies

upper

on

both

and

lower

extremities.

Laboratory analysis:
WBC: 9.2x10^g/l
Lymp%: 50.7%
Gra.%: 44.7%
HCT: 0.387L/L
Hgb: 139. 5 g/l
RBC: 4.73 m/U
Nahihirapan

siya

minsan,

madami

siyang

kasi

huminga Ayos naman na ang paghinga

plemas

yata niya ngayon ading pero may

na

di plemas pa rin kasi siya. As

mailabas.As verbalized by the

mother.
no cyanosis noted
adventitious

breath

sounds noted
Upon

OXYGENATION

admission

(November

12, 2010)

RR: 40 bpm

PR: 120 cpm

T: 37.5 C

PR: 150 cpm

T: 36.2 C

breath

sounds still noted

Vital signs taken upon
Home Visit:

RR: 38 bpm

PR: 130 cpm

T: 36.5 C

Effortless inspiration
Pinkish conjunctiva
capillary refill within 2-3

7:00 pm

seconds

RR: 40 bpm

PR: 141 cpm

T: 37.8 C

Afebrile
Still
Still

Effortless inspiration

with

sputum.

Breathes through the nose.

capillary refill within 2-3
seconds
watery

with

watery

nasal

discharges.

(-)usage of oxygen

With

adventitious

(-)DOB

3:00 pm
RR: 42 bpm

no cyanosis noted

Breathes through the nose.

(November 14, 2010)

verbalized by the mother.

nasal

white

colored

discharges.
With white colored sputum.
The impression of the chest
x ray of Baby boy was
Pneumonitis.
Okay naman ang paggatas
niya ading. Hindi naman siya
nawalan ng gana na uminom
ng gatas. As claimed by the
mother.

Magana pa rin naman siya sa

pag-inom
ading.

He consumed 4 to 6 oz within
shift.

No

signs

of

dehydration were noted. He

had D5 IMB liter, regulated

NUTRITION

to

41

connected

42
@

uggts/min
his

right

metacarpal vein. His weight

during admission was 8 kg.
Diet:

As

gatas

claimed

niya

by

the

bottle

fed

mother.

Baby boy is bottle fed.

the

ng

Milk

Bonakid)

feeding

(Milk:

Still,

he

is

because his mother stopped

breastfeeding him. He takes
his milk 5 times a day: after
bath, 4 oz; lunch 5 oz; 3 pm
4 oz; 9 pm 6 oz; and 5 am 5
oz.
Diet:

Milk

Bonakid)

feeding

(Milk:

DIAGNOSTIC PROCEDURES
A. Ideal diagnostic Procedures
Name and Purpose

Normal

Significant

Nursing

of the procedure

Values

Values

Implications

Hematology grouped together

into profiles or panels, requiring
one requisition and a single
venous specimen.

Hemoglobin (Hgb)

138-166g/l

Hematocrit (Hct)

0.380-550 l/l

RBC

4.2-6.5m/U

WBC

4.0-12.0x10^g/l

Lymphocytes

25-50%

Granulocytes

50-80%

Low Hgb concentration may indicate anemia,

recent hemorrhage or fluid retention causing
hemodilution.
Above-normal
hemoglobin
levels
may
be
the
result
of
dehydration, excess production of red blood
cells in the bone marrow, severe lung
disease, or several other conditions.
Low Hct suggests anemia, hemodilution or
massive blood loss. The most common cause
of increased hematocrit is dehydration, and
with adequate fluid intake, the hematocrit
returns to normal. However, it may reflect a
condition called polycythemia vera that is,
when a person has more than the normal
number of red blood cells. This can be due to
a problem with the bone marrow or, more
commonly, as compensation for inadequate
lung
function
(the
bone
marrow
manufactures more red blood cells in order
to carry enough oxygen throughout your
body).
An elevated RBC count may indicate
absolute relative polycythemia. A decreased
RBC may indicate Anemia; it may be due to
blood loss or lack of production of new RBC's
from the bone marrow.
Abnormal WBC differential patterns provide
evidence for diseases and other conditions.
Lymphoctyes
increase
in
numbers
(lymphocytosis) in certain types of chronic

Levels
decreased
with
reduced
RBC
production,
blood loss and hemolysis.
Hemoglobin
levels
peak
around 8 a.m. and are lowest
around 8 p.m. each day.
Levels may appear decreased
when Hgb is abnormal. The
Hgb
level
is
usually
approximately 1/3 of Hct.
Living
at
high
altitudes
causes increased hematocrit
values this is your bodys
response to the decreased
oxygen available at these
heights.
Levels are easily influenced
by
fluid
volume
status;
hypervolemia leads to lower
hematocrit
w/o
actual
decreased
RBCs
&
hypovolemia
&
hemoconcentration
reflects
higher
hematocrit
than

infections and lymphoid leukemia. They

decrease in numbers in acute viral infections.
In a disease state, lymphocytes will become
reactive. A few reactive lymphs on a blood
smear is normal but if many are reactive
then this is a significant finding that the body
is responding to an infection of some sort.
A minimal increase in granulocytes with mild
elevation of total white blood cells could
indicate infection. Persons who have lower
numbers of granulocytes are more likely to
get frequent and severe infections.

Chest X ray:
The most commonly performed
diagnostic x ray examination. It
is done to detect pulmonary
disorders, such as pneumonia,
atelectasis, pneumothorax and
others. It is non-invasive medical
test. It marks images of the heart,
lungs, airways, blood vessels and
the bones of the spine and chest.

Trachea

visible
midline
in
the
anterior mediastinal
cavity.
Hila (Lung Roots)
visible above the
heart,
where
pulmonary vessels,
bronchi
&
lymph
nodes join the lungs.
Bronchi usually not
visible.
Lung
fields

usually not visible

throughout, except
for blood vessels.

Deviation
from
midline

tension
pneumothorax, atelectasis, pleural effusion.
Accentuated shadows pneumothorax,
emphysema, pulmonary abscess, tumor &
enlarged lymph nodes.
Visible atelectasis.

actually exists.
Primary
function
of
lymphocytes
is
to
fight
chronic bacterial infection and
acute viral infections.
Granulocytes help the body
fight bacterial infections.

In chest x rays, waves

penetrate the chest and cause
an image to form on specially
sensitized
film.
Normal
pulmonary tissue is radiolucent,
whereas abnormalities such as
infiltrates, foreign bodies, fluids
and tumors, appear as densities
on the film.

Gram Staining Test:

A Gram stain may be performed as part of the bacterial culture when a bacterial infection is suspected. It is performed on the same sample
as the culture, and the test results are reported out promptly to help guide treatment. The most commonly performed microbiology tests used to

identify the cause of an infection. Often, detecting the presence of microorganisms and determining whether an infection is caused by an organism
that is Gram-positive or Gram-negative will be sufficient to allow a doctor to prescribe treatment with an appropriate antibiotic while waiting for
more specific tests, such as a culture, to be completed. A negative Gram stain is often reported as "no organism seen." This may mean that
there is no bacterial infection present or that there were not enough microorganisms present in the sample to be seen with the stain under a
microscope. Positive Gram stain results usually include a description of what was seen on the slide. This typically includes whether the bacteria
are Gram-positive (purple) or Gram-negative (pink) as well as their shape round (cocci) or rods (bacilli).
Sputum Culture and Sensitivity Test:
A sputum culture and
sensitivity test
is
used
to
determine
whether
the
patient's sputum (pulmonary secretion)
contains pathogenic bacteria or other infectious agents. If no bacteria or fungi grow, the culture is negative. If organisms that can cause
infection (pathogenic organisms) grow, the culture is positive. The type of bacterium or fungus will be identified with a microscope or by
chemical tests. It it is Normal: Sputum that has passed through the mouth normally contains several types of harmless bacteria, including some
types of strep (streptococcus) and staph (staphylococcus). The culture should not show any harmful bacteria or fungi. If Abnormal: Harmful
bacteria
or
fungi
are
present.
The
most
common
harmful
bacteria
in
a
sputum
culture
are
those
that
can
cause bronchitis or pneumonia (Streptococcus
pneumoniae, Staphylococcus
aureus, Haemophilus
influenzae, Klebsiella
pneumoniae,
and Chlamydophila pneumoniae) ortuberculosis (Mycobacterium tuberculosis). Mycoplasma, a group of organisms similar to bacteria, can also
cause a type of pneumonia.
Arterial Blood Gas:
Arterial Blood Gas (ABG) Analysis is used to measure the partial pressures of oxygen (PaO2), carbon dioxide (PaCO2), and the pH of an
arterial blood sample. Oxygen content (O2CT), oxygen saturation (SaO2), and bicarbonate (HCO3-) values are also measured. A blood sample for
ABG analysis may be drawn by percutaneous arterial puncture from an arterial line. The ABG analysis is mainly used to evaluate gas exchange in
the lungs. It is also used to assess integrity of the ventilatory control system and to determine the acid-bas level of the blood. The ABG analysis is
also used for monitoring respiratory therapy (again by evaluating the gas exchange in the lungs).
This section is a guide to analysis of the ABG. Follow the steps as indicated in order to best interpret the results:
step 1 - examine pH
step 2 - examine CO2
step 3 - examine HCO3
step 4 - check PO2 levels
if
low,
indicates
acidosis
if high, indicates alkalosis
if normal, check to see if
borderline (may be compensation)

if high, indicates respiratory

acidosis
(with
low
pH)
if
low,
indicates
respiratory
alkalosis
(with
high
pH)
if normal, check for compensatory
problem

if
high,
indicates
metabolic
alkalosis
(with
high
pH)
if low, indicates metabolic acidosis
(with
low
pH)
if normal, check for compensatory
condition

if low, indicates an interference

with ventilation process (should
evaluate
the
patient)
if normal, indicates patient is
getting enough oxygen

Pulse Oximetry:
Pulse oximetry is a simple non-invasive method of monitoring the percentage of haemoglobin (Hb) which is saturated with oxygen. The
pulse oximeter consists of a probe attached to the patient's finger or ear lobe which is linked to a computerized unit. The unit displays the
percentage of Hb saturated with oxygen together with an audible signal for each pulse beat, a calculated heart rate and in some models, a
graphical display of the blood flow past the probe. Audible alarms which can be programmed by the user are provided. An oximeter detects
hypoxia before the patient becomes clinically cyanosed.

Thoracentesis (in case of Pleural Effusion):

Thoracentesis is a procedure to remove fluid from the space between the lungs and the chest wall called the pleural space. It is done with
a needle (and sometimes a plastic catheter) inserted through the chest wall. This pleural fluid may be sent to a lab to determine what may be
causing the fluid to build up in the pleural space.

B. Actual Diagnostic Procedure

Name and Purpose

Normal

Actual

Nursing

of the procedure

Values

Values

Responsibilities

Hematology grouped together

into profiles or panels, requiring
one requisition and a single
venous specimen.
Hemoglobin (Hgb)

138-166g/l

139. 5 g/l

Hematocrit (Hct)

0.380-550 l/l

0.387L/L

RBC

4.2-6.5m/U

4.73 m/U

WBC

4.0-12.0x10^g/l

9.2x10^g/l

Lymphocytes

25-50%

50.7%

Granulocytes

50-80%

44.7%

Chest X ray:
The most commonly performed
diagnostic x ray examination. It
is done to detect pulmonary
disorders, such as pneumonia,
atelectasis, pneumothorax and
others. It is non-invasive medical
test. It marks images of the heart,
lungs, airways, blood vessels and
the bones of the spine and chest.

Trachea

visible
midline
in
the
anterior mediastinal
cavity.
Hila (Lung Roots)
visible above the
heart,
where
pulmonary vessels,
bronchi
&
lymph
nodes join the lungs.
Bronchi usually not
visible.
Lung fields usually

Streaky densities in both

parahilar/paracardiac
areas are seen.
The thymus gland is
visible.
Pulmovascularity
is
within normal limits.
Heart is not enlarged.
Diaphragm is normal in
position and contour.
Both costophrenic sulci
and visualized bones are

Explain the procedure to the significant others of

the patient to gain cooperation and reduces
anxiety.
Ask the mother if the baby had ever felt faint,
sweaty or nauseated when having blood drawn.
Ask the mother to position he baby in a supine
position and hold him still while getting the
blood sample.
Assess the veins to determine the best puncture
site then tie the tourniquet 5cm proximal to the
area.
Clean venipuncture site with an antimicrobial
swab. Wiping in a circular motion spiraling
outward.
Collect or withdraw 5-7ml of venous blood into
the syringe.
Apply pressure to the puncture site for 2-3
minutes or until bleeding stops.
Check venipuncture site to see if hematoma has
developed.
Observe client for signs and symptoms of
anemia, including pallor, dyspnea, chest pain
and fatigue.
Refer results to Physician.
Explain the procedure to the significant others of
the patient to gain cooperation and reduces
anxiety.
Instruct the mother to remove all the objects like
jewelries (if there is) in the body of the patient
because it may interfere with x-ray images.
The nurse should prepare the patient before
going to X-ray Room.
Assist the x-ray technologist in obtaining the
film.
Once the patient arrives at the exam area, the
patient will undress to the waist, and wear a
gown or drape as provided by the facility.

not
visible
throughout, except
for blood vessels.

intact.
Impression:
Pneumonitis

Refer results to Physician.

ANATOMY AND PHYSIOLOGY OF ORGAN INVOLVED

Respiratory system

The respiratory system is an intricate arrangement of spaces and passageways

that conduct air from outside the body into the lungs and finally into the blood as well
as expelling waste gasses. This system is responsible for the mechanical process
called breathing, with the average adult breathing about 12 to 20 times per minute.
When engaged in strenuous activities, the rate and depth of breathing increases
in order to handle the increased concentrations of carbon dioxide in the blood.
Breathing is typically an involuntary process, but can be consciously stimulated or
inhibited as in holding your breath.

Nostrils/Nasal Cavities
During inhalation, air enters the nostrils and passes into the
nasal cavities where foreign bodies are removed, the air is
heated and moisturized before it is brought further into the
body. It is this part of the body that houses our sense of smell.

Sinuses
The sinuses are small cavities that are lined with mucous
membrane within the bones of the skull.

Pharynx
The pharynx, or throat carries foods and liquids into the digestive
tract and also carries air into the respiratory tract.

Larynx
The larynx or voice box is located between the pharynx and trachea. It is the location
of the Adam's apple, which in reality is the thyroid gland and houses the vocal cords.

Trachea
The trachea or windpipe is a tube that extends from the lower edge of the
larynx to the upper part of the chest and conducts air between the larynx
and the lungs.

Lungs
The lungs are
place.
The
tissues. At the
progressively
until
they
alveoli. It is at
stream.

the organ in which the exchange of gasses takes

lungs are made up of extremely thin and delicate
lungs,
the
bronchi
subdivides,
becoming
smaller as they branch through the lung tissue,
reach the tiny air sacks of the lungs called the
the alveoli that gasses enter and leave the blood

Bronchi
The trachea divides into two parts called the bronchi, which enter the lungs.

Bronchioles
The bronchi subdivide creating a network of smaller branches,
with the smallest one being the bronchioles. There are more
than one million bronchioles in each lung.

Avleoli
The alveoli are tiny air sacks that are enveloped in a network of
capillaries. It is here that the air we breathe is diffused into the
blood, and waste gasses are returned for elimination.

PATHOPHYSIOLOGY
A. Algorithm

Precipitating Factor:
Environment

Predisposing Factor: age

Entry of
microorganism
to nasal passages

Invasion of the
respiratory system

Activation of
Immune response
(mucus
production)

Coug
h

Ineffective
immune response
results to
overwhelming
Infection
Invading/inflammation
and edema of lung
parenchyma

Accumulation of
cellular debris,
fluids and exudates
in the lungs
Hazy portion of
the chest pain

Massive
inflammation
(pneumonia)

Rale

Dyspne
a

airway
narrows

Deep shallow
breathing

hypoxia

B. Explanation
When the immune system is healthy, it can generally ward off the entrance of
entrance of organisms or control them from multiplying and causing disease.

Pneumonia may develop even in healthy individuals, however, when the infecting
organisms are very strong. Pneumonia is an inflammatory illness of the lung.
Frequently, it is described as lung parenchyma/alveolar (microscopic air-filled sacs of
the lung responsible for absorbing oxygen from the atmosphere) inflammation and
(abnormal) alveolar filling with fluid. Pneumonia can result from a variety of causes,
including infection with bacteria, viruses, fungi, or parasites, and chemical or physical
injury to the lungs. Its cause may also be officially described as idiopathic, that is
unknown, when infectious causes have been excluded. Those with weaker immune
systems like infants or children are often the ones who catch pneumonia faster,
usually after a flu infection. There will be an activation of immune response through
mucus production and if it is ineffective immune response, it will lead to overwelming
infections.
As the infecting organism enters the lungs, the lung tissues usually become
swollen and inflamed, particularly the air sacs or alveoli. This is often due to the
migration of white blood cells in the area to fight off the infection. The alveoli then
becomes filled with pus and fluid resulting in the manifestations of fever, cough,
breathing problems and chills. Pneumococci spread from alveolus to alveolus, thereby
producing inflammation and consolidation along lobar compartments. The function of
the lungs become affected, and oxygen exchange may be reduced and becomes
inadequate for the need of the body. The alveolar exudate tends to consolidate so it
increasingly difficult to expectorate. The accumulation of cellular debris, fluids and
exudates in the lungs also contributes to the narrowing of airways which can lead to
respiratory failure. This is why pneumonia needs to be treated promptly as severe
complications can happen.

MEDICAL and SURGICAL MANAGEMENT

A. Ideal Medical and Surgical Management
Medical:

Outpatient (if affebrile without respiratory distress)

1. Consider initial parenteral antibiotic at diagnosis

a. Ceftriaxone 50 mg/kg/day up to 1 gram IM x1 dose
-

It is a cephalosporin/cephamycin beta-lactam antibiotic

used in the treatment of bacterial infections caused by
susceptible, usually gram-positive, organisms.

b. Start oral antibiotics

2. First-line oral agents
a. Amoxicillin 90 mg/kg/day PO divided q8 hours x7-10d
-

Amoxicillin is used to treat infections due to organisms

that are susceptible to the effects of amoxicillin.
Common infections that amoxicillin is used for include
infections

of

throat, larynx (laryngitis),

the middle
bronchi

ear, tonsils,

(bronchitis),

lungs

(pneumonia), urinary tract, and skin. It also is used to

treat gonorrhea.
2. Alternative oral agents
a. Amoxicillin-Clavulanic Acid (Augmentin) or
-

Amoxicillin kills or stops the growth of bacteria

that cause infection. Clavulanic acid is added to
help the amoxicillin to work better. This medicine
treats many different kinds of infections.

b. Erythromycin or
-

Used to treat many different types of infections

caused by bacteria.

c. Clarithromycin or
-

Clarithromycin is used to treat many different

types of bacterial infections affecting the skin
and respiratory system.

d. Azithromycin
-

Used

to treat

certain infections

caused by

bacteria, such as bronchitis; pneumonia; sexually

transmitted diseases (STD); and infections of the
ears, lungs, skin, and throat. It works by stopping
the growth of bacteria.
Inpatient (if febrile or hypoxic)
1. Cefotaxime 150 mg/kg/day IV divided q6 hours or
-

An antibiotic used to treat a wide variety of

bacterial infections. This medication is known as
a cephalosporin antibiotic. It works by stopping
the growth of bacteria. This antibiotic treats only
bacterial infections. It will not work for viral
infections

2. Cefuroxime 150 mg/kg/day IV divided q8 hours or

-

Used

to treat

certain infections

caused by

bacteria, such as bronchitis; gonorrhea; Lyme

disease; and infections of the ears, throat,
sinuses, urinary tract, and skin.
3. If confirmed Pneumococcal Pneumonia
a. Ampicillin alone 200 mg/kg/day divided q8 hours
-

Used for treating bacterial infections.

Critically ill
Option 1
a) Cefotaxime 150 mg/kg/day IV divided q6 hours and
b) Erythromycin 40 mg/kg/day IV divided q6 hours
Option 2

a) Cefuroxime 150 mg/kg/day IV divided q8 hours and

b) Cloxacillin 150-200 mg/kg/day IV divided q6 hours
-

used primarily to treat infections caused by

staphylococci, streptococci, or pneumococci.

Other Medicine:
Aminoglycosides Aminoglycosides are a group of antibiotics that are
used to treat certain bacterial infections. This group of antibiotics includes at
least eight drugs: amikacin, gentamicin, kanamycin, neomycin, netilmicin,
paromomycin, streptomycin, and tobramycin. All of these drugs have the same
basic chemical structure.
Surgery:
Although most patients with pneumonia do not require invasive therapy,
patients with abscess, empyema, or certain other complications may require
such treatment.
Thoracotomy
Thoracotomy is the standard surgery for pneumonia. It requires general
anesthesia and an incision to open the chest and view the lungs.This procedure
allowsthe surgeon to remove dead or damaged lung tissue. Insevere cases, the
entire lobe of the lung can be removed. This is called alobectomy.Remaining
healthy lung tissue re-expands after surgery to make up for any removed
tissue.
Chest Tubes
Chest tubes are used to drain infected pleural fluid. Tubes are not
typically required for pneumonia or abscesses. The tubes are insertedafter the
patient is given alocal anesthetic. Theyremain in place for two to four days, and
are removed in one quick movement. It can be very distressing, although some

patients experience no discomfort. Complications of chest tubes include

infection, accidental injury of the lung, perforation of the diaphragm, and fluid
build-up within the lung if the pleural fluid is removed too rapidly. Removing
the chest tubesmay cause the lung to collapse, requiring the reintroduction of
a chest tube to inflate the lung.
Drainage of parapneumonic effusions with or without intrapleural
instillation of a fibrinolytic agent (eg, tissue plasminogen activator [TPA]) may
be indicated.

B. Actual Medical and Surgical Management

Medical:

The medications given to my patient were:

Ampicillin

200mg IV q 6 -

Bactericidal activity against

susceptible organisms. Alternative to amoxicillin when unable to

take medication orally. The baby was given this type of medication
to treat the disease and the fact that he cannot take the
medication orally alone.
Paracetamol 100mg/ml drops q 4/PRN Antipyretic: Reduces
fever by acting directly on the hypothalamic heat-regulating center
to cause vasodilation and sweating, which helps dissipate heat.
Baby boy also experienced fever during his hospitalization so he
was given an antipyretic drug to relief the fever.
Salbutamol neb+2cc PNSS q 4 - Used as a quick-relief agent
for acute bronchospasm and for prevention of exercise-induced
bronchospasm. It is also given to the baby to manage of reversible
airway obstruction caused by the underlying disease.
Cetirizine 1mg/ml/2ml OD Symptomatic relief of allergic rhinitis
like, sneezing, runny & itchy nose, watery eyes; allergic conjunctivitis.

Baby boy received this medication to relief his runny nose to lessen his
watery nasal discharges.

Clarithromycin 125mg/5ml/2.5ml BID Treatment of upper

respiratory infections caused by streptococcus pyogenes or S.
pneumonia.

During the hospitalization of Baby boy, he was given an IVF of D5 IMB

liter to prevent dehydration and to be consumed within 12 hours and
hooked at right metacarpal vein with a drop factor of 41 42 uggts/min.

Vital signs (Temperature, Pulse, and Heart Rate) were taken every shift
and recorded accordingly for comparative baseline.

Hydration therapy to liquify mucous secretions and improve secretion

clearance.

Bed rest to lessen fatigue and conserve energy.

Diet: Diet for age (milk feeding).

Position appropriately to prevent aspiration into lungs.

Monitor laboratory studies; complete blood count, sputum exams and

others.

Surgical:
There was no surgical procedure done to my patient.

NURSING CARE PLAN

NURSING
DIAGNOSIS

ASSESSMENT
S:

ANALYSIS

PROBLEM 1:

Nahihiraoan
siyang huminga
ading dahil
madami siyang
plemas na hindi
mailabas. As
verbalized by the
mother of the
baby.
O:

P Ineffective
breathing
pattern
E - Related to
retained
secretions in the
bronchi.
S as
evidenced by:
(+) productive

(+) productive
cough
With

Shortness

of

breath

at

no cyanosis

nasal
Shortness

discharges.

times.

watery

discharges.

nasal

small blood
vessels in the
lungs (capillaries)
become leaky,
and protein-rich
fluid seeps into
the alveoli

cough
With

watery

Microorganism
enters the airway
passages

of

breath at times.
The

impression

of the chest x
ray of Baby boy
was

results in a less
functional area for
oxygen-carbon
dioxide exchange
patient becomes
relatively oxygen
deprived, while
retaining
potentially
damaging carbon

NURSING
OBJECTIVES

NURSING
INTERVENTIONS

Date: November
14, 2010
Time: 3 :00 PM

INDEPENDENT:

After 4 hours of
nursing
intervention, the
patient will:
Loosen
secretions in
the lungs.
Manifest relief
of (or
improvement
in) feelings of
shortness of
breath.
Feel
comfortable.
The patients
significant
others will
Relate
causative
factors and
ways of
preventing or
managing
ineffective

b) Assessed
respiratory
rate.

a) Assess airway
patency.

c) Noted chest
movement; use
of accessory
muscles during
respiration.
d) Assess
rate/depth of
respirations
and chest
movement.
Monitor for
signs of
respiratory
failure (e.g.,
cyanosis and
severe
tachypnea).
e) Auscultate lung

RATIONALE

EVALUATION

a) helps to check for

any obstruction or
accumulation of
fluids and maintain
adequate airway
patency
b) Provides a basis for
evaluating
adequacy of
ventilation.

Date:
November 14,
2010
Time: 7 :00 PM

c) Use of accessory
muscles of
respiration may
occur in response
to ineffective
ventilation.
d) Tachypnea, shallow
respirations, and
asymmetric chest
movement are
frequently present
because of
discomfort of
moving chest wall
and/or fluid in
lung.
e) Decreased airflow

Level of
attainment:
-

Goal
met.

AEB:
After 4 hours of
nursing
intervention,
the patient:
Loosened
secretions in
the lungs.

Manifested
relief of (or
improved
in) feelings
of shortness
of breath.

noted

Pneumonitis.
adventitious

The
impression of

breath

the chest x

noted

ray

dioxide

of

boy

Baby
was

Pneumonitis.
breath sounds
noted
white

colored
sputum.
Restlessness/
irritable

at

times.
Initial

V/S

taken

as

follows:
RR: 42 bpm
PR: 150 cpm
T: 36.2 C

white

colored sputum.

Mucus production
is increased
through the leaky
densities

fields, noting
areas of
decreased/
absent airflow
and
adventitious
breath sounds;
e.g., crackles,
rales, wheezes.

Restlessness/
irritable

adventitious

With

With

sounds

breathing
pattern of the
baby.

times.

at
Source:
Scribd.com

f) Place patient
into high
fowlers
position.
g) Advise mother
to do back
tapping.
h) Maintain a
relaxed, calm
and nonstimulating
environment.
i) Documented
respiratory
secretions:
character and
amount of
sputum.
j) Assist client
with frequent
deep-breathing
exercises.
Demonstrate to
significant

occurs in areas
consolidated with
fluid. Bronchial
breath sounds
(normal over
bronchus) can also
occur in
consolidated areas.
Crackles, rhonchi,
and wheezes are
heard on
inspiration and/or
expiration in
response to fluid
accumulation,
thick secretions,
and airway
spasm/obstruction.
f) Maximize lung
expansion and
decrease
respiratory effort.
g) Helps to manually
loosen or dislodge
secretions.
h) Establish optimal
rest/ sleep pattern.
i) Expectorations
may be different
when secretions
are very thick.
j) Deep breathing
facilitates

Felt
comfortable
The
patients
significant
others
related
causative
factors and
ways of
preventing
or
managing
ineffective
breathing
pattern of
the baby.

others/ help
client learn to
perform
activity; e.g.,
splinting chest
and effective
coughing while
in upright
position.

COLLABORATIVE:
1. Assist with/
monitor effects
of nebulizer
treatments and
other
respiratory
physiotherapy;
e.g., incentive
spirometer,
IPPB,
percussion,
postural
drainage.

maximum
expansion of the
lungs/smaller
airways. Coughing
is a natural selfcleaning
mechanism,
assisting the cilia
to maintain patent
airways. Splinting
reduces chest
discomfort, and an
upright position
favors deeper,
more forceful
cough effort.
1. Facilitates
liquefaction and
removal of
secretions.
Postural drainage
may not be
effective in
interstitial
pneumonias or
those causing
alveolar
exudates/destructi
on. Coordination of
treatments/schedul
es and oral intake
reduces likelihood
of vomiting with
coughing and

Perform
treatments
between meals
and limit fluids
when
appropriate.
2. Administer
medications as
indicated:e.g.
mucolytics,
expectorants,
bronchodilators,
analgesics.

expectorations.
2. Aids in reduction of
bronchospasm and
mobilization of
secretions.
Analgesics are
given to improve
cough effort by
reducing
discomfort. But
should be used
cautiously because
they can decrease
cough effort/
depress
respirations.
Bronchodilator

Salbutamol
neb+2cc
PNSS q4

ASSESSMENT

NURSING
DIAGNOSIS

S:

PROBLEM 2:

Nilagnat
siya
noong kadarating
naming ditto sa
hospital
at

P Hyperthermia
E Related to
physiologic
response to

ANALYSIS
Infectious agents
(Pyrogens)

NURSING
OBJECTIVES
Date: November
14, 2010
Time: 7 :00 PM
After 1 hour of

NURSING
INTERVENTIONS

RATIONALE

INDEPENDENT:
Provide tepid
sponge bath.
Monitor

Enhances heat
loss by evaporation &
conduction.

EVALUATION
Date:
November 14,
2010
Time: 8 :00 PM

umabot ito ng 38
C tapos ngayon
ulit
nilagnat
nanaman
siya.
As verbalized by
the mother of the
patient.
O:
Increased body
temperature
(37.8 C)
(+) productive
cough
With

infectious
process.
S as evidenced
by:
Increased
body
temperature
(37.8 C)
Restlessness/
irritable

at

times.
Skin: warm
to touch.
(-)
dehydration

watery

nasal
discharges.
Restlessness/
irritable

at

times.
Skin: warm to
touch.
(-) dehydration
flushed skin

flushed skin

stimulate
Monocytes
release
Pyrogenic cytokines
Stimulate
Anterior
hypothalamus
results in
Elevated
thermoregulatory
set point
leads to
Increased Heat
conservation
(Vasoconstriction/b
ehaviour changes)
Increased Heat
production
(involuntary
muscular
contractions)
result in
FEVER
Reference:
NursingCrib.com

comprehensive
nursing
intervention, the
temperature of
patient will
subside: from
37.8 C to
37.4 C.

patients vital
signs (esp.
temperature).
Promote bed
rest, encourage
relaxation skills.
Wrap
extremities with
cotton blankets.
COLLABORATIVE:
Administer antipyretic as
ordered.
Paracetamol
100mg IV PRN.
Administer
antibiotic as
ordered.
Ampicilin 200mg
IV q 6.
Monitor
laboratory
values as
obtained.
(Blood CS)

Notes progress
and changes of
condition.

Level of
attainment:
-

Reduces body
heat production.

To minimize
shivering.

Reduces fever by
acting directly on
the hypothalamic
heat-regulating
center to cause
vasodilation and
sweating, which
helps dissipate
heat.
Ampicillin is used
to treat diseases
caused by
bacterial
infections.
Laboratory tests
may indicate
which organism is
responsible for
fever.

Goal met.
AEB:

After 1 hour of
comprehensive
nursing
intervention,
the
temperature of
patient
subsided: from
37.8 C to
37.4 C.

ASSESSMENT

NURSING
DIAGNOSIS

S:

PROBLEM 3:

Nagkaimpeksyon
na
siya
noong
dalawang buwan
palang siya kaya
natatakot pa rin
kami ngayon baka
mas malala pang
impeksyon
ang
dumapo
sakanya.
As
verbalized by the
mother
of
the
patient.

P Risk for Infection

[Spread]

O:
Increased body
temperature
(37.8 C)
(+) productive
cough
With

watery

nasal
discharges.

E related to
inadequate
secondary defenses
(presence of
existing infection,
immunosuppression
)
S as evidenced
by:
[not applicable:
presence of signs
and symptoms
establishes an
actual diagnosis.]

ANALYSIS
Persons at risk for
infection are
those whose
natural defense
mechanisms are
inadequate to
protect them from
the inevitable
injuries and
exposures that
occur throughout
the course of
living. Infections
occur when an
organism (e.g.,
bacterium, virus,
fungus, or other
parasite) invades
a susceptible
host. If the hosts
(patients)
immune system
cannot combat
the invading
organism
adequately, an
infection occurs.

NURSING
OBJECTIVES
Date: November
14, 2010
Time: 3 :00 PM
After 3 hours of
comprehensive
nursing
interventions and
health educating
the significant
others of the
patient, they will:
Identify
interventions to
prevent, reduce
risk and spread
of secondary
infection.

NURSING
INTERVENTIONS

RATIONALE

INDEPENDENT:
Monitor vital
signs closely,
especially
during
initiation of
therapy.
Monitor the
following for
signs of
infection:
Elevated
temperature

Color of
respiratory
secretions

Demonstrate/
encourage
good hand

During this period

of time, potentially
fatal complications
may develop.

EVALUATION
Date:
November 14,
2010
Time: 6 :00 PM
Level of
attainment:
-

Goal met.
AEB:

Very high fever

accompanied by
sweating and
chills may indicate
septicemia.
Yellow or yellowgreen sputum is
indicative of
respiratory
infection.
Effective means of
reducing, clearing
of infection.
Promotes

After 3 hours of
comprehensive
nursing
interventions
and health
educating the
significant
others of the
patient, they:
Identified
interventions
to prevent,
reduce risk and
spread of
secondary

 Shortness

of

breath

at

times.

Infections prolong
healing, and can
result in death if
untreated.

no cyanosis
noted

Source: NANDA

Restlessness/
irritable

at

washing
technique.
Change
position
frequently and
provide good
pulmonary
toilet.
Limit visitors as
indicated.

times.
Skin: warm to
touch.
(-) dehydration
flushed skin
The impression
of the chest x
ray of Baby
boy was
Pneumonitis.
adventitious
breath sounds
noted
With white
colored
sputum.

Assess
nutritional
status,
including
weight, history
of weight loss,
and serum
albumin.

COLLABORATIVE:
Administer or
teach use of
antimicrobial
(antibiotic) drugs
as ordered.
Ampicilin
200mg IV q 6.

expectoration,
clearing of
infection.
Reduces likelihood
of exposure to
other infectious
pathogens.
Patients with poor
nutritional status
may be anergic, or
unable to muster a
cellular immune
response to
pathogens and are
therefore more
susceptible to
infection.
Antimicrobial drugs
include antibacterial,
antifungal,
antiparasitic, and
antiviral agents.
Ampicillin is
used to treat
diseases
caused by
bacterial
infections.

infection.

 Clarithromycin
125mg/5ml/2.5
ml BID

Treatment
of
upper respiratory
infections caused
by streptococcus
pyogenes or S.
pneumonia.

PROMOTIVE AND PREVENTIVE MANAGEMENT

The following promotive and preventive managements will be imparted to
mother of the baby:

Promote adequate ventilation:

Note color, amount, and odor of secretions.
Tell to the mother the importance and proper way of giving
expectorants as prescribed.
Encourage parents to maintain adequate hydration of the baby
because adequate hydration liquify viscous secretions and improve
secretion clearance.

Teach how to use nebulization to promote mucus secretions.

Perform mild chest physiotherapy to promote mobilization of secretions
for easier expectorations.

Instruct mother to avoid over exposure to crowded places because some

people might have existing infection and the baby may acquire it.

Advice mother not to ignore cough and colds. Rather encourage mother
to visit health centers for the child to be examine.

Instruct

mother to elevate head of the baby when feeding to prevent

aspiration.

Teach the mother how to count the RR of the baby because RR is one of
the major indicators of complications.

Encourage parents to maintain good personal hygiene of the baby and

even the whole member of the family, cover nose and mouth when
sneezing or coughing and wash hands after sneezing, coughing, cleaning
the nose or going to the toilet.

 Ensuring

that children have adequate nutrition, including exclusive

breastfeeding during the first six months of life, can help protect them
from pneumonia.

Tell

to the parents the importance of having the baby vaccinated or

complete the immunity.

Viral Influenza Vaccines (Flu Shot) Vaccines against the flu

(or a "flu shot") use inactivated (not live) viruses. They are
designed to provoke the immune system to attack antigens
contained on the surface of the virus.
Pneumococcal Vaccines The pneumococcal vaccine protects

against S. pneumoniae bacteria, the most common cause of

respiratory infections.

DRUG STUDY
Name
of Drug

Dosage
and
Frequency

Mechanism

Indication

Contraindication

of Action

Adverse

Nursing

Effects

Responsibilities

Ampicillin

200mg IV
q 6

100mg/m
l drops

An aminopenicillin
that inhibits cell
wall synthesis
during
microorganism
multiplication.

Decreases fever
by inhibiting the

Respiratory tract
Infections caused
by S.
pneumoniae (for
merly D.
pneumoniae).
Staphylococcus
aureus (penicillina
se and
nonpenicillinasepr
oducing), H.
influenzae, and
Group A betahemolytic
Streptococci.

Relief of mild to
moderate pain

Contraindicated
to patients
hypersensitive to
drugs or other
prenicillins.

Contraindicated
with allergy to

Lethargy,
hallucinations,

seizures, dizziness,
nausea, vomiting,
gastritis, anemia,
agitation,
confusion,
stomatitis.

In rare cases
hypersensitivity

Explain the action

of the drug to the
watcher.
Before giving drug,
wait for the result
of the skin test.
Confirm
the
activation
and
admixture of vial
contents.

Check for leaks by

squeezing
container firmly. If
leaks are found,
discard
unit
as
sterility may be
impaired.

Give
drug
1-2
hours before or 2-3
hours after meals.

Verify
the
doctors order.

Paracetamol

q 4/PRN

effects of
pyrogens on the
hypothalamic
action leading to
sweating and
vasodilation.

and treatment of
fever

acetaminophen.
Use cautiously
with impaired
hepatic function.

Relieves pain by
inhibiting the
prostaglandin
synthesis at the
CNS but does not
have antiinflammatory
action because of
its minimal effect
on peripheral
prostaglandin
synthesis.

Salbutamol

neb+2cc
PNSS q
4

Stimulates beta 2
receptors of
bronchioles by
increasing levels
of camp which
relaxes smooth
muscles to
Produce
Bronchodilatation.

Relief of
Bronchospasm
in bronchial
asthma chronic
Bronchitis
Emphysema
and other
Reversible
Obstructive
Pulmonary
diseases.

Hypersensitivity
to Salbutamol,
also to atropine
and its
derivatives.

reactions,
predominantly
skin allergy
(itching and rash),
may appear. Longterm treatment
with high doses
may cause a toxic
hepatitis with
following initial
symptoms:
nausea, vomiting,
sweating, and
discomfort.
Occasionally a
gastrointestinal
discomfort may be
seen.

Headache;
tremor;
tachycardia;
hypertension;
anxiety.
Rarely
nausea,
vomiting, and
skin rash can
be observed

Assess patients
fever.
Assess
allergic
reaction.
Assess
hepatotoxicity.
Monitor liver and
renal
function
test.
Monitor
blood
studies, especially
CBC and pro-time
if patient is on
long-term therapy.

Determine history of
previous
medication.
Monitor for evidence
of allergic reaction.
Assess lung sounds,
pulse, and blood
pressure
before
administration and
during
peak
of
medication. Note

amount, color, and

character
of
sputum produced.
Monitor pulmonary
function
tests
before
initiating
therapy
and
periodically
throughout course
to
determine
effectiveness
of
medication.
Observe
for
paradoxical
bronchospasm
(wheezing).
If
condition
occurs,
withhold
medication
and
notify physician or
other health care
professional
immediately.

Cetirizine

1mg/ml/
2ml OD

Competes with
histamine for H1receptor sites on
effector cells in
the
gastrointestinal
tract, blood
vessels, and
respiratory tract

Symptomatic
relief of allergic
rhinitis like,
sneezing, runny &
itchy nose, watery
eyes; allergic
conjunctivitis.

Contraindicated
in patients
hypersensitive to
drug or any of its
components, in
breastfeeding
women. Used
cautiously in

Central nervous
system:
Somnolence,
fatigue, dizziness
Gastrointestinal:
Xerostomia

Explain the action

of the drug to the
watcher.
Tell the mother
that breast-feeding
is
not
recommended.

patients with
renal or liver
impairment.

Clarithromyci
n

125mg/5
ml/2.5ml
BID

Exerts its
antibacterial
action by binding
to 50S ribosomal
subunit resulting
in inhibition of
protein synthesis.

Hypersensitivity
to clarithromycin,
erythromycin, or
any macrolide
antibiotic; use
with pimozide,
astemizole,
cisapride,
terfenadine

Central nervous
system: Headache
Gastrointestinal:
Diarrhea, nausea,
abnormal taste,
heartburn,
abdominal pain

Instruct mother to
use a specially
marked spoon or
container
to
measure
your
medicine.

Tell
patients
significant others
to take drug as
prescribed
even
after
he
feels
better.
Advice mother of
the
patient
to
report
persistent
adverse
effect
seen on the baby.
Inform mother of
the baby that drug
may be taken with
or without food.

Skin: rash,
urticaria