CHAPTER 1

INTRODUCTION

Pneumonia can be generally defined as inflammation of the lung parenchyma;

pneumonia is characterized by consolidation of the affected part and a filling of the
alveolar air spaces with exudate, inflammatory cells, and fibrin. Most cases of
pneumonia are due to infection by bacteria or viruses, although they may also be due to
the inhalation of chemicals, trauma to the chest wall, or other infectious agents such as
rickettsiae, fungi, and yeasts. Pneumonia can be spread in a number of ways. The
viruses and bacteria that are commonly found in a child's nose or throat, can infect the
lungs if they are inhaled. They may also spread via air-borne droplets from a cough or
sneeze. In addition, pneumonia may spread through blood, especially during and shortly
after birth. More research needs to be done on the different pathogens causing
pneumonia and the ways they are transmitted, as this has critical importance for
treatment and prevention.

Pneumonia is the single largest cause of death in children worldwide. Every year,
it kills an estimated 1.8 million children under the age of five years, accounting for 20%
of all deaths of children under five years old worldwide. There are some 155 million
cases of childhood pneumonia every year in the world. Pneumonia affects children and
families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. It can
be prevented with simple interventions, and treated with low-cost, low-tech medication
and care. A WHO Child Health Epidemiology Reference Group publication cited the
incidence of community-acquired pneumonia among children younger than 5 years in
developed countries as approximately 0.026 episodes per child-year. This equates to an
annual incidence of 150.7 million new cases, of which 11-20 million (7-13%) are severe
enough to require hospital admission. Ninety-five percent of all episodes of clinical
pneumonia in young children worldwide occur in developing countries. Pneumonia is
the top one killer in the world for children.

In the Philippines' Top Ten Causes of Mortality pneumonia is rank as number

five. This recent study is according to Department of Health and it concludes that most
physicians do not adhere to the local guidelines in treating community-acquired
pneumonia. Also, there's the other form of more fatal pneumonia --- the hospital-
acquired type. This is the pneumonia you get when your length of stay in the hospital is
long, and the antibiotics used to treat are the higher generations.Among other diseases,
pneumonia reportedly ranked first in the Top 10 causes of death in 182 barangays of
Davao city based on the 2009 records of the City Health Office there were 531 deaths
due to pneumonia . and it was recorede in the city health office. Community-acquired
pneumonia develops in people with limited or no contact with medical institutions or
settings. The most commonly identified pathogens are Streptococcus pneumoniae,
Haemophilus influenzae, and atypical organisms (ie, Chlamydia pneumoniae,
Mycoplasma pneumoniae, Legionella sp). Symptoms and signs are fever, cough,
pleuritic chest pain, dyspnea, tachypnea, and tachycardia. Diagnosis is based on
clinical presentation and chest x-ray. Treatment is with empirically chosen antibiotics.

Our patient is baby X he is 8 months old admitted to Pediatric Intensive Care Unit
of Davao Doctors Hospital last April 12,2010 due to fever and cough under the service
of Dr. R Bernardo.
General objectives:

At the end of 3 days exposure to PICU, the group 17 of Davao Doctors College will be
able to know and to understand the case pneumonia with consolidation to give proper
nursing care management to the patient.

Specific Objectives:

1. To know the background of the study based on the patient case

2. To gather significant data to have proper assessment to the patient

3. To present anatomy and physiology

4. To trace the pathophysiology of an underlying disease

5. To give nursing intervention to the patient

6. To give health teachings to parents regarding the case of the patient

 CHAPTER II

PATIENT’S PROFILE

A. Personal Profile

Patient’s name: Baby X

Age: 8 months old

Sex: Male

Nationality: Filipino

Religion: Born Again

Occupation: Child

Civil Status: Child

Date of Admission: April 12, 2010

Attending Physician: Dr. R. Bernardo

Discharge Diagnosis: Pneumonia with consolidation related to down syndrome

B. Medical History

Baby X was diagnosed upon birth with Down Syndrome. After 3 days he suffered
from abdominal pain and was admitted to Butuan Doctors Hospital and diagnosed with
Perforated anus.Baby X then undergone Colostomy that serves his fecal drainage. On
the succeeding month ,patient was then advice to have regular check ups to monitor
his surgical operation and cardiac status. Baby X was then recommended to undergo
CT scan and then diagnose with patent ductus arteriosus

C.Present Illness
 Five days prior to admission (PTA), Mrs. XY noticed that her baby experienced
irritability. After two days baby x suffered from fever and cough. The family then
decided to bring him to Davao. The day they arrived in Davao they immediately bring
him to a doctor for consultation and medical advice . The pediatritian then
recommended the family to admit baby x as soon as possible .One day prior to
admission baby x was severely manifested productive cough and fever that may lead to
respiratory distress .

D. Comprehensive Assessment

1.Family background

Baby X, 8 month old, the fourth offspring of Mr. XY and Mrs. XX. His mother has
a history of hypertension and diagnosed with cardiac problem. His father has a diabetes
mellitus type II . On his paternal side, the brother of his grandfather was also diagnosed
having down syndrome. The patient is a menopausal baby with the age of his mother
45 .His family is just owning a sari-sari store that just enough to supply their daily living
and need. They live in Brgy. Ampayon where near in Agusan river and describes as a
squatter area.

2. Effects / Expectations of Illness to Family and Self:

Baby X, was admitted for 17 days now in the hospital. Significant others
stressed out problems especially the mother of the patient who cannot afford to take
care of baby x because she’s emotionally depressed. Also one thing that his father
concern is their financial expenses and demands to hospital bills. The whole family is
very worried about his present condition. Even though they know that his condition is
complicated, they still hope for his recovery. They want baby x to be discharged from
the hospital as soon as possible this is because it has been a long time that they've
staying there. This situation had led his family members to become more conscious of
there health. They've learned that no matter how wealthy or poor you are, you can
never escape to any forms of illnesses.
 GUIDELINES Normal of an 8-month DAY 1 DAY 2 DAY 3
old baby (April 26, 2010) (April 27, 2010) (April 28, 2010)
I. Mental Status
a. State of mental The patient is The patient is conscious The patient is conscious The patient is conscious
consciousness conscious and alert. but lethargic. but lethargic. but lethargic.

b. Orientation Able to recognize one Not able to recognize Not able to recognize Not able to recognize
person (mother) even his mother. even his mother. even his mother.
c. Intellectual capacity Learns to initiates, The patient is able to The patient is able to The patient is able to
recognize, and repeat anticipate familiar anticipate familiar events anticipate familiar events
pleasurable events like when he like when he sees his like when he sees his
experiences from sees his nurse holding nurse holding the nurse holding the
environment. Memory the prepared milk for prepared milk for prepared milk for feeding.
traces are present, feeding. feeding.
infant anticipates
familiar events.
d. Vocabulary level Patient is able to utter Patient was not able to Patient was not able to Patient was not able to
the word “da-da” or utter the word “da-da” or utter the word “da-da” or utter the word “da-da” or
“ma-ma”. “ma-ma”. Patient is “ma-ma”. Patient is “ma-ma”. Patient is
attached to attached to attached to oropharyngeal
oropharyngeal tube. oropharyngeal tube. tube.
e. Attention span The patient has a short The patient has short The patient has a short The patient has a short
attention span attention span with 30 – attention span, with 20- attention span, with 30-60
60seconds 45 seconds seconds concentration
concentration. concentration
f. Ability to understand The patient is able to The patient was able to The patient was able to The patient was able to
understand object recognize the asepto recognize the asepto recognize the asepto
permanence. syringe as his milk syringe as his milk syringe as his milk
feeding container. feeding container. feeding container.
II. Status of Special
Senses
a. Auditory perception The patient have The patient is able to The patient is able to The patient is able to
progressed to being recognize sounds when recognize sounds when recognize sounds when
able to locate sounds he hears someone he hears someone he hears someone calling
made above them. calling his nickname, calling his nickname, his nickname, “Gummy”
“Gummy” and flexing “Gummy” and flexing his and flexing his arms and
his arms and legs as a arms and legs as a legs as a respond.
respond. respond.
b. Visual perception The patient is able to The patient is able to The patient is able to The patient is able to see
see near objects, see near objects, see near objects, without near objects, interpret the
without the use of any without the use of any the use of any aid when visual stimuli when the
aid. aid when his bright the bright red face towel bright red face towel was
orange toy was shown was shown to him before shown to him before
 to him. wiping his saliva. wiping his saliva.

c. Speech perception The patient is able to The patient was The patient was The patient was attached
speak one to two attached to attached to to pharyngeal tube.
syllable clearly. Says oropharyngeal tube. oropharyngeal tube.
first word (da-da or
ma-ma)
d. Tactile perception The patient is sensitive The patient is able to The patient is able to The patient is able to feel
to pain, heat and feel pain when skin feel pain when skin wetness of his diaper and
touch. testing is done. testing is done. Grimace becomes irritable.
face was noted upon
injecting his forearm.
e. Olfactory perception The patient can The patient is able to The patient is able to The patient is able to
identify different odors smell the cologne of the smell the cologne of the smell the cologne of the
such as peasant and student nurse when he student nurse when he student nurse when he
unpleasant to smell. entered the room. entered the room. entered the room. Jerking
Jerking of his legs was Jerking of his legs was of his legs was noted.
noted. noted.
III. Motor Ability
a. Current mobility The patient can freely The patient can't move The patient can't move The patient can't move
move both upper and freely, with weak freely, with weak freely, with weak
lower extremities and movement and movement and movement and restrained
was able to ambulate restrained both upper restrained both upper both upper and lower
without assistance. and lower extremities. and lower extremities. extremities.

b. Posture The patient can sit The patient is in The patient is in The patient is in complete
securely without complete bed rest, complete bed rest, bed rest, positioned in
support. positioned in high back positioned in high back high back rest.
rest. rest.
c. Range of motion The patient is able to The patient is able to The patient is able to flex The patient is able to flex
flex and extend both flex and extend both and extend both upper and extend both upper
upper and lower upper and lower and lower extremities but and lower extremities but
extremities extremities but with with weak movements. with weak movements.
weak movements.
d. Muscle and nervous The patient has The patient has a weak The patient has a weak The patient has a weak
status moderate to strong muscular movements. muscular movements. muscular movements
muscular movements.

e. Loss of extremities The patient has The patient has The patient has The patient has complete
complete extremities. complete extremities. complete extremities. extremities.

IV. Body Temperature

Status
a. Ranges Tympanic temperature Tympanic temperature Tympanic temperature Tympanic temperature
ranges from 37 – 37. 5 ranges from 37.5 -38 ranges from 37.5-38.3 ranges from 36.8-37.9
degrees centigrade degrees centigrade. degrees centigrade. degrees centigrade. (April
(April 26, 2010-12noon) (April 27, 2010-10am) 28, 2010-10am)
V. Respiratory Status
a. Characteristics The patient has The patient has The patient has The patient has
respiratory rate range respiratory rate range respiratory rate range of respiratory rate range of
of 30-60 cpm, with of 37-40 cpm, with 63-80cpm, with equal 31-48 cpm, with equal
equal depth of equal depth of depth of respiration depth of respiration
respiration respiration

b. Use of respiratory The patient has no The patient has 2 liters With oxygen inhalation The patient has 2 liters
aids oxygen inhalation, per minute oxygen of 2 liters per minute via per minute oxygen
tracheostomy tube or inhalation via nasal nasal cannula and inhalation via nasal
endotracheal tube cannula and oropharyngeal tube cannula and oro
oropharyngeal tube attached to mechanical pharyngeal tube attached
attached to mechanical ventilator to mechanical ventilator
ventilator
c. Interference with The patient has clear The patient has The patient has crackles The patient has crackles
respiration breath sounds on both crackles and wheezing and wheezing breath and wheezing breath
lungs, without breath sounds on both sounds on both lungs sounds on both lungs
tracheobronchial lungs fields, with fields, with fields, with
secretions. tracheobronchial se tracheobronchial se tracheobronchial se
cretions upon cretions upon cretions upon
auscultation. auscultation. auscultation.

d. Abnormal respiratory The patient has no The patient has no The patient has no The patient has no
opening abnormal respiratory abnormal respiratory abnormal respiratory abnormal respiratory
opening. opening but is attached opening but is attached opening but is attached to
to orpharyngeal tube. to oropharyngeal tube. oropharyngeal tube.
VI. Circulatory Status
a. Characteristics of The patient has full, The patient has weak The patient has weak The patient has weak
arterial pulse bounding and palpable pulse, hardly palpable; pulse, hardly palpable, pulse, hardly palpable,
pulse, with a range of with a range of120-143 with a range of 140-164 with a range of 120-140
100 to 120 beats per beats per minute. beats per minute. beats per minute.
minute, with rhythmic
beats.
b. Apical-radial pulse The patient has a The patient has weak The patient has weak The patient has weak
strong, fast apical- pulse, difficult to pulse, difficult to palpate, pulse, difficult to palpate,
radial pulse and can palpate, with a range of with a range of 140 to with a range of 120 to 140
 be heard between 100 120 to 143 beats per 164 beats per minute. beats per minute.
to 120 beats per minute.
minute.
c. Intravenous fluids The patient has no IV The patient has an The patient has an The patient has an
infusion intravenous infusion at intravenous infusion at intravenous infusion at the
the right metatarsal the right metatarsal area. right metatarsal area.
area. (D5 IMB 500 cubic (D5IMB 500 cubic (D5IMB 500 cubic
centimeters @ 20 cubic centimeters @ 20 cubic centimeters @ 20 cubic
centimeters per minute) centimeters per minute) centimeters per minute)
d. Others none none none None
VII. Nutritional Status
a. Condition of the The patient has pinkish The patient has pale The patient has pale The patient has pale
buccal cavity buccal cavity, intact buccal cavity with buccal cavity with buccal cavity with minimal
gums and has no minimal lesion on lower- minimal lesion on lower- lesion on lower-left gum.
lesions. left gum. left gum.
b. Digestion of food The patient has The patient has The patient has appetite, The patient has appetite,
appetite, able to appetite, able to able to consume whole able to consume whole
consume whole consume milk feeding. amount milk feeding amount milk feeding
amount of milk feeding (33 cubic centimeters) served. (33 cubic served. (33 cubic
served. centimeters) centimeters)

c. Weight 7.1 kilograms to 10.9 5.8 kilograms 5.8 kilograms 5.8 kilograms
kilograms
VIII. Elimination
Status
a. Bowel The patient is able to Patient with colostomy, Patient with colostomy, Patient with colostomy,
defecate regularly at with soft, formed stool, with soft, formed stool, with soft, formed stool,
least once a day. and yellow in color. and yellow in color. and yellow in color.
b. Bladder The patient is able to The patient is able to The patient is able to The patient is able to
urinate freely, with urinate freely with urine urinate freely with urine urinate freely with urine
urine output of output of 2.34cc/kg/hour output of 1.75cc/kg/hour output of 2.05cc/kg/hour
0.5cc/kg/hour. for 8 hours with diaper. for 8 hours with diaper. for 8 hours with diaper.
c. Abnormalities NONE The patient has The patient has The patient has increased
increased urine output. increased urine output. urine output. (of
(of 2.34cc/kg/hour ) (of 2.34cc/kg/hour ) 2.34cc/kg/hour )

IX. State of Skin And

Appendages
a. Skin The patient has intact The patient has pale, The patient has pale, . The patient has pale,
and fair skin, with even cold and dry skin, poor cold and dry skin, poor cold and dry skin, poor
distribution of skin turgor, with bruises skin turgor, with skin turgor, with
temperature, with good skin noted on both punctured skin noted on punctured skin noted on
skin turgor. upper extremities. both upper extremities. both upper extremities.
b. Hair The patient has fine, The patient has fine hair The patient has fine The patient has fine
strong and silky hair, with even distribution. hair, with even hair, with even
 with even distribution. distribution. distribution.
c. Nails The patient has clean The patient has well The patient has well The patient has well
and trimmed neatly, trimmed nails and with trimmed nails and with trimmed nails and with
with pink nail beds. pale nail beds. pale nail beds. pale nail beds.
X. State of Physical
Rest and Comfort
a. Sleep/rest pattern The patient is able to The patient is able to The patient is able to The patient is able to
sleep 16 and 18 sleep 12-14 hours a sleep 12-14 hours a day sleep 12-14 hours a day
hours a day with day related to medical related to medical and related to medical and
resting time in the and nursing procedures. nursing procedures. nursing procedures
middle of the day
b. Presence of The patient is The patient is The patient is The patient is
pain/discomfort comfortable. uncomfortable and in uncomfortable and in uncomfortable and in
pain . pain. pain.
c. Use of supportive No use of supportive No use of supportive No use of supportive No use of supportive aids
aids aids. aids. aids.

XI. Emotional Status

a. Emotional reaction The patient is able to The patient is irritable The patient is irritable The patient is irritable
react appropriately to but with happy but with happy but with happy
situations, with happy disposition. disposition. disposition.
 disposition.
b. Body image The patient has a high N/A N/A N/A
self-esteem and is
confident with his body
structures.
c. Ability to relate to The patient is N/A N/A N/A
others cooperative, with less
interaction to people
around him.

E. Diagnosis/ Impression

Pneumonia with consiladation related to down syndrome.

Laboratory Exams

CHEST PA PEDIA (4/17/2010)

A comparison with radiograph dated (4/15/2010) discloses progression of the

lesions in both lungs, more on the right. Right lateral Cp sinus is blunted while the left is

sharp. Heart is within normal size. ET tube is noted with its tip 1cm above the carina.

Chest leads are in place.

IMPRESSION:

PROGRESSIVE PNEUMONIA with CONSOLIDATION

CHEST PA PEDIA (4/19/2010)

A comparison with the radiograph dated (4/17/2010) discloses progression of the

lesion in both lungs, more on the right. Right lateral CP sinus remains blunted. The left

lateral costophrenic sinus is sharp. Heart is within normal limit size. ET tube is noted

with its tip 0.6cm above the carina. Chest leads are in place.

IMPRESSION:

PROGRESSIVE PNEUMONIA with CONSOLIDATION

CHEST PA PEDIA (4/21/2010)

A comparison with the radiograph dated (4/19/2010) discloses no significant

interval changes of the lesions in both lungs. Both lateral CP sinuses are now blunted.

ET tube is noted with its tip 1cm above the carina. Chest leads are in place.

IMPRESSION:

PLEURAL FLUID/REACTION, BILATERAL

ECHOCARDIOGRAPHY AND COLOR FLOW DOPPLER

Congenital Heart Disease

• Patent Ductus Arteriosus, measuring 0.73cm x 0.67cm with systolic-diastolic

Doppler signals and maximum gradient of 28mmHg

• Intact interatrial and interventricular septum

• Tricuspid regurgitation mild with tricuspid regurgitation jet of 32mmHg

• Left atrial enlargement (normal value: 1.1 to 1.85cm)

• Biventricular enlargement

• Good left ventricular systolic function

• Dilated main pulmonary artery segment

• Left sided aortic arch

• No vegetation, no pericardial effusion

 CHAPTER III

Anatomy and Physiology

Respiratory System

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

The lungs are paired, cone-shaped organs which take up most of the space in
our chests, along with the heart. Their role is to take oxygen into the body, which we
need for our cells to live and function properly, and to help us get rid of carbon dioxide,
which is a waste product. We each have two lungs, a left lung and a right lung. These
are divided up into 'lobes', or big sections of tissue separated by 'fissures' or dividers.
The right lung has three lobes but the left lung has only two, because the heart takes up
some of the space in the left side of our chest. The lungs can also be divided up into
even smaller portions, called 'bronchopulmonary segments'.
 These are pyramidal-shaped areas which are also separated from each other by
membranes. There are about 10 of them in each lung. Each segment receives its own
blood supply and air supply.

These are pyramidal-shaped areas which are also separated from each other by
membranes. There are about 10 of them in each lung. Each segment receives its own
blood supply and air supply.

Air enters your lungs through a system of pipes called the bronchi. These pipes

start from the bottom of the trachea as the left and right bronchi and branch many times

throughout the lungs, until they eventually form little thin-walled air sacs or bubbles,

known as the alveoli. The alveoli are where the important work of gas exchange takes

place between the air and your blood. Covering each alveolus is a whole network of

little blood vessel called capillaries, which are very small branches of the pulmonary
arteries. It is important that the air in the alveoli and the blood in the capillaries are very

close together, so that oxygen and carbon dioxide can move (or diffuse) between them.

So, when you breathe in, air comes down the trachea and through the bronchi into the

alveoli. This fresh air has lots of oxygen in it, and some of this oxygen will travel across

the walls of the alveoli into your bloodstream. Travelling in the opposite direction is

carbon dioxide, which crosses from the blood in the capillaries into the air in the alveoli

and is then breathed out. In this way, you bring in to your body the oxygen that you

need to live, and get rid of the waste product carbon dioxide.

The lungs are very vascular organs, meaning they receive a very large blood

supply. This is because the pulmonary arteries, which supply the lungs, come directly

from the right side of your heart. They carry blood which is low in oxygen and high in

carbon dioxide into your lungs so that the carbon dioxide can be blown off, and more

oxygen can be absorbed into the bloodstream. The newly oxygen-rich blood then

travels back through the paired pulmonary veins into the left side of your heart. From

there, it is pumped all around your body to supply oxygen to cells and organs.
 CHAPTER IV

Pathophysiology

Predisposing Factors: Patient exposed to Precipitating

environment Factors:
Environment
Bacteria , viruses,
Age

Down syndrome Invading microorganism

(impaired cellular
( Staphylococcus
immunity)
pneumoniae) bacteria

Enters the respiratory

tract

Goes to Alveoli
and multiplies

Triggers
pulmonary
inflammation

Fluid exudates Signs & Symptoms

accumulate in the
(+) crackles, respiratory
distress, using of accessory
Pneumonia with muscles in breathing,
consolidation cyanotic, fever, cough
 Baby X was an 8 months old baby with down syndrome. 5 days prior to

admission, the patient manifested irritability. 2 days after the patient experienced fever

and cough. When Baby X was admitted to davao, they were advised to admit their son

in Davao Doctors Hospital. After days of several diagnostic tests conducted to Baby X,

he was diagnosed to have Pneumonia with Consolidation.

The patient lived near agusan river at Brgy. Amparo, and described as a

squatters area. The environment of Baby X is not clean making him susceptible for

acquiring a disease. Baby X also has a Down Syndrome, this syndrome has a

characteristic of immunodeficiency. As patient was exposed to his environment, a

certain bacteria enters the respiratory tract of the patient which is the Staphylococcus

pneumoniae, this bacteria will lie in the alveolar sacs in the lungs. The bacteria will

multiply and triggers pulmonary inflammation. Making the sacs swell, filled with fluid

exudates. In this stage, crackles can be heard upon auscultation, using of accessory

muscles in breathing can be observed, cyanosis, fever as a sign of infection, and cough.

Consolidation of the lungs may occur if there is excessive accumulation of fluid

exudates in the patients lungs.

 CHAPTER V

COURSE IN THE WARD/TREATMENT/ INTERVENTIONS

A. Medical

A.1 Doctor’s Order

 Date/Time Order

April 12, 2010

• Start D5IMB 500 cc @ 20cc/hr
(admitting orders)
• Lab CBC

• For chest X-ray PA

8:30am
• FBS serum creatinine

April 13, 2010 • Lipid monitoring

• FF-up CBC
11:45am
• For U/A now
• Give Paracetamol 1.2 ml syrup PRN fever

• Administer 1 neb salbutamol now

April 14 ,2010 • For echo cardiogram
10:20am

April 15, 2010 • For ABG

9:30am • administer OGT feeding with 32cc if residual is

more than 13cc

April 16, 2010 • Please suction secretions on mouth and ET tube

Qhourly
10:20am
• Give Captopril 25mg/tab BID, dissolved in 10ml
water give 1.2 ml/OGT

• Give Flurosemide lasix 6mg IVTT BID

• 1 neb salbutamol

• Please admionister patient o2 2lpm via nasal

canula
 DRUG STUDY

B.Pharmacological

Generic name Brand Classificatio Mechanism of Indication Contraindication Adverse Dosage Nursing

name n Action Reaction Responsibilities

Clarithromycin Biaxin Anti Binds to the 50s Acute >used cautiously CNS- 125mg/ > Check VS for

Invectives subunit of worsening of in patients with Headache 5ml the patient

bacterial chronic hepatic or renal GI- 2.5 ml >Side Rails Up

ribosome, bronchitis impairment. Diarrhea, per >check for

blocking protein caused by >Contraindicated Nausea, OGT adverse

synthesis , S.Pneumoniae in patients vomiting, BID reaction

bacteriostatic or and hypertensive to abdominal

bactericidal, community clarithromycin, pain.

depends on acquired erythromycin, or

concentration pneumonia other macrolides

caused by or the drugs that

S.Pneumoniae prolong or

and interval or
 M.pneumonia caused cardiac

e arythmias.

Generic name Brand Classification Mechanism Indication Contraindication Adverse Dosage Nursing

name of Action Reaction Responsibilities

Digoxin Elixer Cardiovascula Inhibits Heart failure, Contraindicated CNS- 0.5ml >Report if

r system drugs sodium- paroxysmal in patients to fatigue, per pulse if less

potassium supraventricu drug and in muscle OGT than 60

activated lar those with weakness, Q12 beats/min.

adenosine tachycardia, digitalis induced dizziness, >side rails up

triphosphata atrial toxicity, headache >check for

se, fibrillation and ventricular CV- adverse

promoting flutter fibrillation or arrhythmia reactions

movement of ventricular s >VS checked

calcium from tachycardia GI- and monitor

 extracellular unless caused anorexia,

cytoplasm by heart failure N/V,

and diarrhea

strengthen

myocardial

contraction

Generic Brand Classification Mechanism of Indication Contraindication Adverse Dosage Nursing

name name Action Reaction Responsibilities

Captopril Capoten Anti- Inhibits ACE, For the Contraindicated CNS- 25mg/ >VS check and
 hypertensives preventing treatment of to patient Dizziness tab monitored

conversion or hypertension hypertensive to CV- BID, >Side rails up

angiotensin I to , capoten is drug or other Tachycardi dissolv >Not and

angiotensin II, effective ACE inhibitor a e in assess for

a potent alone and in Respi- 10ml adverse

vasoconstrictor combination dyspnea water reaction

with other give

antihyperten 1.2ml/

sive agents OGT

especially

thiazide-

type

diuretics

Generic Brand Classification Mechanism Indication Contraindication Adverse Dosage Nursing

name name of Action Reaction Responsibilities

Salbutamol Aerovent Bronchodilators Relaxes To prevent or >Contraindicate Respi- 1 neb. >side rails up

bronchial, heat d to patient tachycardi Q2 >check

uterine and bronchospas hypersensitive a, respiratory rate

vascular m in patient to drugs or its palpitation, of the patient

smooth with ingredient. bronchosp >note and

muscle by reversible >use asm, assess for

stimulating obstructure continuously in wheezing,d adverse

beta 2 airway patient with yspnea reaction

receptors disease cardiovascular >VS check

disorder.
Generic Brand Classification Mechanism Indication Contraindication Adverse Dosage Nursing

name name of Action Reaction Responsibilities

Bactroban Mupirocin Anti Absorption: Cream for Hypersensitivity Bactroban Apply 3x a >avoid contacts

bacterial systemic typical to bactroban or cream is day for up the eyes

absorption treatment other ointment generally to 10 days >check for

of mupirocin of containing well or the possible

secondaril polyethylene tolerated response sensitization

y infected glycol or any of reaction or

traumatic its constituents several local

lessions irritation
Generic Brand Classification Mechanism of Indication Contraindication Adverse Dosage Nursing

name name action effect responsibilities

Paracetamol Tempra Analgesics Decrease For the Allergic to the Skin 10ml >monitor Vital

Forte fever by relief of medicine, renal rashes, and signs

(1 to 2
inhibiting the headache, or hepatic other especially
tsp.)
effects of colds, disease, allergic temperature of

pyrogen on minor cardiovascular reactions the patient

the aches and or hematological

>Monitor
hypothalamus pains, and disorders
allergic
heat reduce of
reactions
fever
Generic Brand Classification Mechanism Indication Contraindication Adverse Dosage Nursing

name name of Action Reaction Responsibilities

Bactroban Mupiroah Antibacterial Absorption: Cream for Hypersensitivity Bactroban Apply >avoid contacts

systemic typical to bactroban or cream is 3x a the eyes

absorption of treatment of other ointment generally day for >check for

mupiroah secondarily containing well up to possible

infected polyethylene tolerated 10 days sensitization

traumatic glycol or any of or the reaction or

lessions its constituents respons several local

e irritation

Generic Brand Classification Mechanism of Indication Contraindication Adverse Dosage Nursing

name name action effect responsibilities

Paracetamol Tempre Analgesics Decrease For the relief Allergic to the Skin 10ml >monitor Vital
Forte fever by of headache, medicine, renal rashes, signs especially

inhibiting the colds, minor or and other temperature of

(1 to 2
effects of aches and heapaticdisease, allergic the patient
tspn)
pyrogen on pains, and cardiovascular or reactions
>Monitor
the reduce of hematological
allergic
hypothalamus fever disorders
reactions
heat
 CHAPTER VI

DISCHARGE PLANNING

Basic health teaching is the greatest need of a patient after admission. The nurse
should clearly teach the patient and family on how to comply with medications and other
regimen to facilitate improvement of the patient health status thus providing also
continuity of care to the patient.

M – Medication

• Informed the patient and the family about the medication prescribed by the
physician including the purpose, dose, schedule and the side effect of the drugs.

• Instructed the patient and the family that the compliance of the regimen is really
needed and may discontinue if ordered by the physician.

• Encouraged the patient and the family to report any unusualities regarding the
administration of drugs.

E – Exercise

• Informed the patient’s family to provide a moderate exercise for the patient to
promote physiological well-being, reducing the risk and strengthening the
immune system.

• Encouraged family of the patient to have a deep breathing exercise.

• Light exercise on both arms and legs to promote circulation in the heart.

T – Treatment

• Encouraged the family of the patient to keep follow-up appointment.

• Medications are recommended for this aim to improve patient’s health status.
This promotes healing and reduces pain and discomfort. Medication must be
 continued according to the doctor’s instructions, otherwise the pneumonia may
recur. Relapses can be far more serious than the first attack.

• Nutritional management-nutrition, proper diet according to patient’s age.

• Health teachings to the family to facilitate awareness an knowledge to the patient

regarding his illness.

H – Hygiene

• Encouraged the family to have a proper hand washing with soap and water
before and after feeding the patient and whenever the patient spends time
around people with cold or other illness.

• Encouraged patient’s family to brush bath the patient properly.

• Encouraged patient’s family to keep hands away from patient’s nose and mouth.

• Educate the patient’s family properly initiate the regular hygiene with assistance
as necessary.

O – Outpatient order

• Encouraged patient’s family to keep the patient stay indoors with the doors and
windows closed if air pollution levels are high.

• Encouraged patient’s family to keep the patient away from smoke.

• Encouraged patient’s family to provide the patient enough sleep and rest
everyday.

• Encouraged the significant other to monitor the temperature of the patient.

• Provided patient’s family information regarding his condition and instruct to follow
why the doctor instructed.

D – Diet
 • Encouraged patient to eat healthy and well-balanced diet.

• Provided all the essential food constitutes (vitamins and minerals).

• Patient must maintain the reasonable weight.

• Instructed the patient’s family to feed the patient nutritious food such as fruits and
vegetables and in strict diabetic diet low salt and low fat diet.

• Increased oral fluid intake.

S – Spiritual

• Encourage patient and the family to maintain realistic hope over the course of the
illness.

• Encourage the patient and the family to take time to be introspective in the
search for peace and harmony.

• Help patient’s family obtain spiritual help.

• Encourage patient’s family to pray everyday and ask for God’s guidance and
strength in order to lighten up his feelings towards his condition.

CHAPTER VII

BIBLIOGRAPHY

Books:
Adelle Piliterri, Maternal and Child Health Nursing, volume 2, 11th edition.

Amy M. Karch, Lippincott’s Nursing Drug Guide, 2008

Brunner and Suddarths, 2008, Medical Surgical Nursing, volume 1 and 2, 11th edition.

Bullock and Henze, Focus on Pathophysiology.

Deogenes et. Al.,Nurse’s Pocket Guide

MIMS annual full prescribing information, 18th edition, 2007

Website:

www.virtualmedicine.com

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