CASE

PRESENTATIO
N
COMMUNITY ACQUIRED
PNEUMONIA III
February 19, 2010
GROUP 93
 The Presentors
•
Bumatay, Allan
•
Corpuz, leo
•
Garcia, carla
•
Garcia, krystal
•
GOMEZ, GENELLE
•
Ibañez, Jesus D.C.III
•
ISLES, KRIS EVERT
•
Jereos, Abigail Raejoy A.
•
Lapiña, Danica M.
•
Legaspi, Rochelle Glureen B.
•
Licarte, Charlene Mae M.
•
 Introduction
• The pathogens that cause community-acquired pneumonia
(CAP) are predictable; copathogens are involved rarely, if
ever. Extrapulmonary clinical features are helpful in
distinguishing between typical and atypical causes of CAP.
Various clinical findings can also point to specific diagnoses,
such as Klebsiella pneumonia or Legionella infection. Severe
CAP suggests the presence of underlying problems in the
patient, such as cardiopulmonary dysfunction or impaired
splenic functioning. Empiric therapy should cover typical and
atypical pathogens. Oral antibiotics should be used for as
much of the treatment course as is practicable.
 Objectives
This case study significantly identifies the factors
that gave rise for our client to have the diagnosed
problem. The ff. are the identified objectives for
the case study
• To develop a comprehensive assessment of the
client.
• To establish a pathophysiology for the disease of
the client.
• To develop a nursing care plan appropriate for
the client’s diagnosed problem.
• To be able to teach the mother of the client for
proper health maintenance.
• To lessen the risk of infection and development of
complications of the client.
• To be able to provide an environment conducive
for health.
• To enhance the care that will be given for other
client’s with the same diagnosis.
BIOGRAPHIC
DATA
Name: CL
Address: Sto. Nino,Meycauayan
Bulacan
Age: 8
Marital Status: NA
Room and Bed number: Room 214-C
Chief Complaint: Fever
Diagnosis: Community Acquired
Pneumonia III
Attending Physician: Dra. Lea Dilag
Gender: Female
Reigion: Pentecostal
NURSING
HEALTH
HISTORY
PAST HEALTH
HISTORY
CL has Bronchial asthma in acute
exacerbation. It was 2004 when she
was first diagnosed with the supposed
illness. Her mother stated that she had
complete immunizations. She does not
have any allergies. When she was five
years old, CL fell-off her bicycle. Her
mother performed first aid treatment
by cleansing the wound with running
water and betadine. That wound left
her a scar on the right ankle. Other
than that, she had not encountered
PAST HEALTH
HISTORY
She had two hospital admissions prior
to her recent condition. In 2005, she
was first admitted to SCDMMC due to
Pneumonia then she was hospitalized
again last 2008 due to typhoid fever.
She is currently taking Paracetamol Jr.
for her fever with Flumuicil and
Duavent for her asthma. She does not
take any vitamin supplements. In April
2005, her family went to Hongkong for
their vacation trip and to witness the
Grand Opening of Hongkong Disney
land.
HISTORY OF
PRESENT ILLNESS
One day prior to her condition, CL
experienced low-grade fever,
productive cough with watery
nasal discharge. Due to this
instance, her mother brought her
to SCDMMC and was then
admitted with the diagnosis of
Community-Acquired Pneumonia
III.
FAMILY HISTORY

 
The client has familial history of
hypertension and asthma. CL’s mother
said that her mother-in-law has
hypertension and her father-in-law has
asthma.
GENOGRAM
JL LL LEGEND:

(73 y/o) (73 y/o) HYPERTENSION

ASTHMA

EL CL
(50 y/o) (50y/o)

JFL CL NL
(23 y/o) (8 y/o) (19 y/o)
Developme
ntal
History
Emotional Health
• The child said that her problems would only
include academic activities. She does not
want to be sick and absent because she said
she would miss school. She is active in school
activities. She belongs to a class of excellent
students. Her mother said that her teacher
does not find any particular problem with her
at all. Her greatest fear is the darkness. CL
said that she would only cry when her
brother teased her or when her parents scold
her.
Social Health
• She has a good relationship with her family. She stated
that she is bonded with her family members. She also has good
relationship with her teachers, schoolmates and playmates. She allots time
for self-enjoyment. Her hobby includes artworks. She loves to draw. She
also verbalized that she is active in school. In fact, she joins athletic
activities. Her favorite is obstacle race. When her father is available, they
would often play badminton. Computer games serve as her bonding activity
with her brothers. Walking around the school and eating are her friends’
past time. She has variety of toys to share with her playmates and cousins.
She is always provided with time to play and mingle with them.
Cognitive Patterns
• The child said that she does well in school. She excels in their
academic subjects most especially in Mathematics. She had
won in Quiz Bee last school’s fest with bronze medal. She
belongs to a class of excellent students. She is proud of her
achievements in school. She said that her parents are glad
about it. She is always present in class. She would only be
absent in times of sickness. She loves to do her homework and
likes to recite during class discussions.
Language
• She has good language skills. She speaks
Filipino fluently and is able to understand
English language. She attentively answered to
the questions presented. She would set
examples when asked to describe a situation.
She had an explorative mind. She too listened
carefully and was very eager to answer.
Self-Concept
• She has no physical defects.
• She is an active girl, very
attentive and smart. The
child verbalized, “Gusto ko
maging doktor at saka
teacher paglaki ko.”
SPIRITUAL HEALTH
Religious Beliefs and Practices
• The child belongs to Christian-
Pentecostal religion. Her mother
said that CL also does the things that people
usually do as Christians. Every Sunday they
would go to their church and attend their
mass. CL still believes in God Almighty. Her
mother stated that they just don’t believe in
spiritual images and does not worship
saints.
Moral Development

The child at
her age has a good
understanding about
the concept of good
and bad. She knows the simple bad
deeds that she has to avoid. She said
that she is being scolded by her
parents when she had done bad things
such as being naughty sometimes. She
understands that her wrong deeds
have corresponding punishments.
 •Physical Assessment
NORMS ACTUAL FINDINGS INTERPRETATION &
(Based on Fundamentals of ANALYSIS
Nursing 8th Edition, by
Kozier, et al., published by
Pearson Education Inc.,
©2008, pp. 572 – 641)

General Appearance
Posture/gait Relaxed, erect posture; Posture is slightly Physical difficulty can
Coordinated movement slouching affect the posture and
gait of a person. This
may be accompanied by
observable physical
responses. (Medical-
Surgical Nursing 8th
Edition, by Black &
Hawks, published by
Saunders Inc., ©2009, p.
613)

Personal Clean, neat The client appears

Hygiene/Grooming neat, wearing clean Normal
clothes
•Physical Assessment
Nutritional Optimal Height 127 Height: 114.3 cm Normal
status cms Range (108 - Weight: 24 kg
142 cms) BMI: 18.37
Optimal Weight 26 kg
Range (18 - 40 kg)
(http://www.medindia.
net/patients/calculator
s/ht_wt_chartResult.as
p)

Verbal Understandable, The client is able Normal

Behavior moderate pace, to understand the
exhibits though instructions and
association questions asked
 •Physical Assessment
Measurements:
Axillary= 36.5°C - 37.5°C 37.2°C Normal
(Fundamentals of Nursing, Taylor,
p526)
80-120 beats/min (Medical-Surgical 106 bpm Normal
Nursing, 5th ed., p1814)

20-25 cycles/min 28 cpm An increase in respiratory rate

is a common manifestation
experienced by clients with
pulmonary disorders. Also in
the case, the client is
experiencing difficulty breathing
because of the increased
mucus production in her nasal
area. (Medical-Surgical Nursing
8th Edition, by Black & Hawks,
published by Saunders Inc.,
©2009, p. 1526)
•Physical Assessment
BODY PARTS NORMS AND ACTUAL ANALYSIS
STANDARDS FINDING

INTEGUMENTARY

A. Skin

a. inspect for Generally uniform The client’s skin Normal

color and except in areas looks pale.
uniformity exposed to the sun; Darker areas are
areas lighter seen on skin folds
pigmentation (palm, like on the arm
lips, nail beds) in dark folds.
skinned people

b .inspect for No edema No edema Normal

presence of
edema
 •Physical Assessment
c. inspect for Freckles, birthmarks, flat The client has Normal
lesions according and raised nevi: no birthmark on the left
to location, abrasions or other lesions upper arm, about 2
distribution, color cm in size, circular in
configuration, size, shape.
shape, type or
structure

d. palpate skin Moisture in skin folds The client’s skin has Normal
moisture moisture in skin
folds.

e. palpate skin Uniform; with normal rangeThe client’s skin Normal

temperature temperature is
uniform

f. palpate for skin When pinched ,skin When pinched skin Normal
turgor springs back to previous returns back to its
state previous state
 •Physical Assessment
B. NAILS
a. inspect Convex curvature; angle Convex curvature; Normal
fingernail plate of nail pate about 160° angle is 160°
shape to
determine its
curvature and
angle

b .inspect Highly vascular and pink The fingernail and Normal

fingernail and in light-skinned clients; toenail of the client
toenail color dark-skinned clients may is pink in color.
have brown or black
pigmentation in
longitudinal streaks

c. palpate Smooth texture Smooth in texture Normal

fingernail and
toenail texture
 •Physical Assessment
d. inspect Intact epidermis Intact epidermis Normal
tissue
surrounding nail

e. perform Prompt return in pink or delayed return of Delayed return of

blanch test usual in less than 3 pink in 4 seconds. pink or usual color.
capillary refill seconds. This may indicate
circulatory
impairment in the
body.
(Fundamentals of
Nursing 8th Edition,
by Kozier, et al.,
published by
Pearson Education
Inc., ©2008, p. 584)
 •Physical Assessment
HEAD
A. SKULL rounded/normocephalic; Rounded; smooth Normal
Size, shape, smooth, uniform skull contour;
Symmetry consistency; absence of symmetrical; Absence
Nodules, masses nodules or masse of nodules or masses;
And depressions uniform consistency

B. SCALP -evenly distributed hair; White scalp; no lice, Normal

whitish color; no dandruff; nits and dandruff; no
no tenderness, nodules, lumps, gently curved;
masses and edema no nodules, masses
and edema.

C. HAIR -evenly distributed; thick The client’s hair is Normal

hair; silky, resilient hair; no thick and evenly
infection or infestation distributed.

D. FACE -Symmetric facial Facial movements is Normal

movements symmetric
 •Physical Assessment
EYES
A. EYEBROWS Hair evenly distributed, The eyebrows of Normal
Distribution, skin intact; eyebrows the client are
Alignment, skin symmetrically aligned; evenly distributed,
Quality and equal movement symmetrically
movement aligned, and equal
in movement.

B. EYELASHES Equally distributed; The client’s Normal

Evenness of curled slightly outward eyelashes are
Distribution and equally distributed
Direction of curl and curled upward
C. EYELIDS Skin intact, no discharge; The client’s eyelids Normal
Surface no discoloration; lids close
characteristics close symmetrically symmetrically.
position in
relation to the
cornea ability to
blink; frequency
of blinking
 •Physical Assessment
D. CONJUNCTIVA Transparent; capillaries Transparent, evident Normal
Bulbar conjunctiva: sometimes evident; Shiny, capillaries, shiny,
Color, texture, smooth, and pink or red smooth and pink in
Presence of lesions color
Palpebral
conjunctiva:
Color, texture,
Lesions

E. SCLERA Sclera appears Clear and white in color Normal

Color and clarity White(yellowish in dark- with visible veins.
skinned clients)
F. CORNEA Transparent, smooth, shiny, Transparent, smooth Normal
Clarity and texture details of iris are visible texture and shiny

G. IRIS Color brown, flat and round Color brown and round Normal
Shape and color in shape
H. PUPILS Black in color equal in size, Pupils are equal; round Normal
Color, shape, normally 3-7 mm in diameter, and reacts to light
and size round, smooth borders accommodation, color
black, 6 mm
•Physical Assessment
I. VISUAL Able to identify Able to identify Normal
ACUITY Near pictures; pictures
vision
Distance vision

J. LIGHT Pupil constrict when The pupil constricts Normal

REACTION looking at near object; when light is pointed
AND Illuminated pupil and dilates when
ACCOMODATI constrict and light is removed
ON Non illuminated pupil The pupil constrict
Light reaction dilates when an object is
and placed near to it and
accommodation the pupil dilate when
the object is far from
it.
•Physical Assessment
K. LACRIMAL No edema or tenderness No edema or Normal
GLAND, over lacrimal gland, no tenderness
LACRIMAL SAC, edema or tearing
AND
NASOLACRIMAL
DUCT

L. Both eyes coordinated, With parallel Normal

EXTRAOCULAR move with unison, with alignment and
MUSCLE parallel alignment coordinated visual
Alignment; field
coordination

M. VISUAL When looking straight Client can see Normal

FIELDS ahead, client can see objects in periphery
Peripheral visual objects in periphery.
fields
 •Physical Assessment
EARS
A. Auricles Symetrical; color same as Color same as facial Normal
Color, size, the facial skin; pinna skin; mobile, firm,
Position recoils after it is folded; recoils when it is
Texture, elasticity, mobile, firm and not folded
and tenderness tender.

B. External Ear Distal third contains hair The client’s external Normal
Canals follicles and glands, and ear canal has no
Cerumen, skin tha external ear canals haslesions, pus, and
Lesions, pus cerumen. blood and has
And blood presence of
cerumen.

C. Hearing Must be audible The client verbalized

In normal voice The client is able to hear that she can hear Normal
ones the ticking in both ears clearly what the Normal
Watch tick test student nurse says.
Able to hear ticking
in both ears
 •Physical Assessment
NOSE
Shapes, size, and The client’s nose is Symmetric and Normal
color symmetric and straight. The straight. Light brown
color of the nose ranges color of the nose,
from medium to light brown. uniform to the face.
Uniform to the color of the
face.

Nasal cavities: Mucosa is pink and no Discharges are seen. Discharges from the
>Redness, watery discharge and nasal cavity are often
swelling, lesions influenced by the
Growths, and increased secretion of
discharge mucus, and/or brought
about by allergic
reaction. (Fundamentals
of Nursing 8th Edition, by
Kozier, et al., published
by Pearson Education
Inc., ©2008, p. 613)
 •Physical Assessment
Nasal septum Nasal septum is in the Intact and in the Normal
midline midline
Nasal cavity Air moves freely as the client The air moves freely Air movement is
patency breathes through the nares on the left side, and restricted in one nares
obstructed on the right since the client has
side. increased mucus
production.
(Fundamentals of
Nursing 8th Edition, by
Kozier, et al., published
by Pearson Education
Inc., ©2008, p. 613)

Tenderness, No tenderness; no lesions No tenderness; no Normal

masses and lesions
displacement of
bone and cartilage

FACIAL SINUSES No tenderness No tenderness Normal

Frontal
Supraorbital ridges
Sphenoid
maxillary
 •Physical Assessment
MOUTH
A. Lips Uniform pink color; moist The client’s lip is Deviation from
Symmetry of soft, glistening and pale in color, dry normal because of
contour, color, elastic texture and chappy. It is dry, pale lips.
texture Lips should be pink, symmetrical in This may indicate
moist and smooth. contour. She has fluid intake
ability to purse lips deficiency.
and it has no (Fundamentals of
lesions. Nursing 8th Edition, by
Kozier, et al.,
published by Pearson
Education Inc.,
©2008, p. 613)

B. Buccal Uniform pink color; Moist It is smooth, soft Normal

Mucosa soft, glistening, elastic and elastic. It does
Color, moisture, and no lesions not have lesions.
texture and
lesions
 •Physical Assessment
C. Teeth 20 teeth; smooth, white, shiny yellowish, shiny tooth Dental caries is one of the
Color,number, tooth enamel. enamel problems that frequently
conditiona The teeth should be regular and affect the teeth. It is
with 6 broken upper teeth
free of cavities or have dental associated with plaque and
and 6 broken lower teeth
restorations. tartar deposits. It is common
to children since they like to
eat sweets and hard to teach
dental hygiene.
(Fundamentals of Nursing 8th
Edition, by Kozier, et al.,
published by Pearson
Education Inc., ©2008, p.
601)

D. Gums Gums should be pink and smooth Pale gums, dry when mouth breathing, the
Color, Pink gums; firm texture; moist brain thinks carbon dioxide is
condition being lost too quickly and
sensing this, will stimulate the
goblet cells to produce
mucous, slow the breathing
and cause constriction of
blood vessels.
(http://www.breathing.com/art
icles/nose-breathing.htm)
 •Physical Assessment
E. Tongue/ Floor of The tongue relaxed on the Pink color of the Dry/furry tongue may
the Mouth floor of the mouth tongue. indicate or be associated
Surface of the Smooth tongue base; Slightly rough. Semi with fluid deficiency.
tongue prominent veins. moist, move freely, (Fundamentals of Nursing
For position ,color, Smooth moves freely; no central position, 8th Edition, by Kozier, et
texture and tongue tenderness. smooth with no al., published by Pearson
movement palpable nodules. Education Inc., ©2008, p.
Nodules, lumps or Functions normally. No 603)
enlarged lymph tenderness.

F. Palates & Uvula Light pink hard palate, more Light pink, smooth (soft Normal
>Palate color, irregular texture palate)
shape, texture and The uvula is normally Lighter pink, more
body prominence centered and freely movable. irregular texture (hard
>Position of uvula palate)
and mobility The uvula is at the
center and freely
movable.

G. Oropharynx & Pink and smooth posterior Tonsils are pink and Normal
Tonsils wall symmetric in size,
Color, texture Tonsils are small, pink and Grade 1 tonsils
Tonsils color symmetric in size.
Discharge
H. Gag Reflex Present Present Normal
 •Physical Assessment
NECK AND LYMPH NODES
A. LYMPH NODES Not palpable Lightly enlarged Enlarged, palpable, possibly
Locate/palpate/ submandibular lymph tender lymph nodes are
identify lymph nodes node often associated with
and note for infection and tumors
tenderness (Fundamentals of Nursing
8th Edition, by Kozier, et al.,
published by Pearson
Education Inc., ©2008, p.
607)

B. TRACHEA Central placement in midline of Central placement in Normal

Inspect and palpate neck are equal on both sides midline of neck are equal
for placement on both sides

C. THYROID GLAND Not visible in inspection Not visible Normal

Inspect symmetry and
visible masses

Palpate for Lobes not palpable The client has no Normal

smoothness and areas palpable masses or
of enlargement, nodules.
masses or nodules.
 •Physical Assessment
POSTERIOR THORAX
Inspect the spinal Spine vertically aligned Spine vertically Normal
alignment aligned

Palpate for Skin intact; uniform Uniform temperature, Normal

temperature, temperature skin intact, chest wall
tenderness and intake, (-) tenderness
masses and masses

Auscultate the Vesicular and High-pitched breath Adventitious breath

posterior thorax bronchovesicular breath sounds, Occasional sounds heard as a
sounds crackles and result of secretions,
wheezing narrowed air passages
(Fundamentals of
Nursing 8th Edition, by
Kozier, et al., published
by Pearson Education
Inc., ©2008, p. 613)
 •Physical Assessment
ANTERIOR THORAX
The breathing pattern is effortless
respiration and quite rhythmic.
Skin intact; uniform temperature
No respiratory complaints
No tenderness and no masses
Bronchovesicular-moderate –
intensity and moderate- pitched
blowing Vesicular-soft intensity, low wheezing
pitched, gentle sishing
Difficulty of breathing Typical symptoms associated
with pneumonia include cough,
chest pain, fever, and difficulty
in breathing. Diagnostic tools
include x-rays and examination
of the sputum.
(http://en.wikipedia.org/wiki/Pne
umonia)
Uniform temperature, skin Normal
intact, chest wall intake, (-)
tenderness and masses
High-pitched breath sounds, Adventitious breath sounds
Occasional crackles and heard as a result of secretions,
narrowed air passages
(Fundamentals of Nursing 8th
Edition, by Kozier, et al.,
published by Pearson
Education Inc., ©2008, p. 613)
 •Physical Assessment
BREAST AND AXILLAE
A. Breast Rounded shape; slightly Flat, uniform in color, Normal
Size, symmetry , unequal in size; generally smooth and intact skin.
and shape symmetric
Skin uniform in color; skin
smooth and intact
B. Areola Round or oval and bilaterally Light pink, no Normal
Shape, color, the same; color varies widely tenderness, masses,
masses or lesions from light pink to dark brown; nodules, or nipple
irregular placement of discharge.
sebaceous glands on the
surface of the areola
No tenderness, masses,
nodules, or nipple discharge

C. Nipples Round, everted, and equal in Round, everted, equal Normal

Size, shape, color, size; similar in color; soft and
position, discharge , smooth; both points in same
and lesions direction
No tenderness, masses,
nodules, or nipple discharge
in size, similar in color,
both points in same
direction
 •Physical Assessment
ABDOMEN
Inspection Unblemished skin; uniform The client has Normal
Abdomen skin color; silver-white striae unblemished skin; no
(stretch marks) or surgical striae or stretch marks
scars

Abdominal contour Flat, rounded (convex), or Convex in shape Normal

and symmetry scaphoid (concave)

Vascular patterns No visible vascular pattern No visible vascular Normal

pattern
Bowel sounds, Audible bowel sounds, Audible bowel sounds, Normal
vascular sounds, absence of arterial bruits, (-) arterial bruits and
and peritoneal absence of friction rub friction rub
friction rubs

Percussion each of Tympany over the stomach Tympany and gas Normal
the four quadrants and gas-filled bowels; filled bowels; dull
dullness, especially over the abdomen
liver and spleen, or a full
bladder
 •Physical Assessment
MUSCULOSKELETAL
Muscles: Equal size on both sides of Equal size on both Normal
>Size the body; no contractures; no sides of the body; no
>Tendons for fasciculation or tremors; contractures or
contractures normally firm; smooth shortenings; no
>Fasciculation and coordinated movements; fasciculation or
tremors equal strength on each body tremors; normally firm;
>Palpate muscle side equal leg strength,
tonicity
>Muscle Strength

Bones No deformities; no tenderness No deformities; no Normal

or swelling edema or tenderness
Joints: No swelling; no tenderness, No swelling; no Normal
>Joints for swelling swelling, crepitation, or tenderness and
>Palpation for nodules; joints move smoothly nodules
tenderness
Range of motion Varies to some degree in The client’s right arm Limited range of motion in
accordance with person’s can not move well due one or more joints.
genetic makeup and degree ofto the IV site. (Fundamentals of Nursing
physical activity 8th Edition, by Kozier, et
al., published by Pearson
Education Inc., ©2008, p.
641)
 Entire Laboratory and
Diagnostic Results
GENERIC NAME DOSAGE/ CLASSIFICATI INDICATION
FREQUENC ON
Y
CONTRAINDICATION SIDE EFFECTS NURSING
RESPONSIBILITIES

1. 300 Mucolytic Treatment of respiratory infection MAO inhibitor therapy within Bronchospasm, 1. Monitor
ACETYLCYSTEINE MG(NEB) OD Agent characterized by thick and 14 days initiating therapy; angioedema, pruritus, effectiveness of
(Fluimucil) viscous hyper secretions: Acute severe HPN; severe CAD; nausea and vomiting, therapy and advent of
Bronchitis, Chronic Bronchitis and hypersensitivity to syncope, sweating, fever,allergic/adverse effect.
its exacerbation, Pulmonary Pseudoedephrine, acrivastine arthralgia, blurred vision, 2. Instruct client in
emphysema and bronchiectasis or any component; renal disturbances of liver appropriate use and
impairment function adverse effect to
report.

2. IPRATROPIUM (Neb) TID Antiasthmatic prevent wheezing, difficulty Hypersensitivity to so lecithin Headache, dizziness, Teach the client about
SALBUTAMOL and COPD breathing, chest tightness, and and other related products like cough, sinusitis, dry the medication;
(Duavent) preparation coughing in people with chronic soybean and peanuts, and to cough, dyspnea, Assess for allergy
obstructive pulmonary disease any component of Duavent, bronchitis, dry mouth, before administration
(COPD atropine and its derivatives, rash, pain, and at the peak of
Hypertophic obstructive hypersensitivity reaction administration; Check
cardiomyopathy or or evaluate the client
tachyarrhythmia after giving the
medication.

3. Paracetamol 325 mg Tab Non-opiod Acute pain treatment There are no absolute Occasional GI side effect Monitor SBS of
q4 analgesic contraindications but in patient may occur but these are hepatomegaly esp. in
with gastric ulceration relative almost invariably mild. individuals with poor
caution should be observed. nutrition; Don’t take
other medications
containing
acetaminophen
without medical
advice; Patient and
family education
• Upper Respiratory Tract
• Nose Inspiration and expiration usually
occurs through the nose. The nose has main
two functions: The cilia and hairs which line
the nasal cavities trap dust and other foreign
particles and the rich supply of blood
surrounding the cavities warms the air
before it enters the lungs.
Pharynx Allows for separation of food and
air. The epiglottis closes the trachea when
we eat and opens when we breathe.
• Lower Respiratory Tract
Larynx This structure sits on top of the trachea. Air rushing across
two ligaments causes sounds that we shape into speech. Also
called the voice box.
Trachea Also called the windpipe
• Bronchi The trachea branches into two forks each called a bronchi

Bronchioles The smaller and smaller passageways that come off

the bronchi
• Alveoli These are the small air sacs where actual gas exchange
takes place. The respiratory system's function is to allow gas
exchange through all parts of the body. The space between the
alveoli and the capillaries, the anatomy or structure of the
exchange system, and the precise physiological uses of the
exchanged gases vary depending on organism. Molecules of
oxygen and carbon dioxide are passively exchanged, by diffusion,
between the gaseous external environment and the blood. This
exchange process occurs in the alveolar region of the lungs.
• Respiratory System is made up of
different organs that work together
in the process of respiration.
• All parts of the Respiratory system
helps in the process of respiration
• Main Parts of the Respiratory System
• Nose
• Trachea
• Bronchial Tubes
• Lungs
•  
•  Other Parts:
• Pharynx
• Larynx
• Alveoli
• The Nose
• The nose has two openings called nostrils.  The air enters
the nasal passages through the nostrils. The air that you
breathe may not be fit to enter the lungs.  It must be
cleaned, warmed, and moistened before it reaches the
lungs.  The hairs in your nostrils filter the larger particles
of dust and dirt as air enters the nostrils.  The nasal
passages are lined with tiny hairs called cilia and a moist
tissue lining called mucous membrane.
•  
• The cilia filter the smaller particles of dust and dirt.
• The moist mucous membrane also catches particles of
dirt.  It also warms and moistens the incoming air. 
• The tiny blood vessel inside the nose also warm and
moisten the passing air.
• The Pharynx          
• The clean, warm, and moist air travels from
the nasal passages to the pharynx. The
pharynx is found at the back of the throat. 
• The pharynx separates into two tubes:
• Esophagus –  leading to the stomach.
• Trachea – leading to the lungs. 
• At the bottom of the pharynx is a flap of
cartilage called the epiglottis. 
• The epiglottis opens and closes the trachea. 
It prevents the food from going to the trachea
by closing it during swallowing.  Most of the
time, the epiglottis is open to allow the flow of
air in the breathing process.
• The Larynx  
• From the pharynx, the clean air moves
down to the larynx.   The Larynx is found at
the lower end of the pharynx.  It is the
enlarged upper portion of the trachea.  It is
also called the voice box.  The larynx
contains the vocal cords that vibrate when
air passes through them.  The vibration of
the vocal cords, together with the
movements of the mouth and tongue,
produces the sound of your voice.
• The Trachea or Windpipe
• The trachea, or windpipe, is a tube about 13
centimeters long.  It is the tube leading to the
lungs.  It is a tough, flexible passageway that air
can move through all the time.  The trachea lies
just in front of the esophagus at the lower part
of the larynx.

• Like the nasal passages, the inner wall of the

trachea is lined with cilia.  The cilia catch the
dust particles that reach the windpipe.  The dust
particles are then pushed out and up toward the
throat and mouth for expulsion.  This explains
why one coughs or sneezes when dirt gets into
the upper respiratory tract.  The lower end of
the trachea branches into two large tubes called
the bronchi.
• The Lungs
•             The Lungs are the main organs for breathing.  The left
bronchus leads to the left lung while the right bronchus leads to
the right lung.
•             Inside the lungs, each bronchus divides into smaller tubes
called bronchial rami.  The bronchial rami branches off further into
smaller tubes called bronchial tubes or bronchioles.  At the ends
of these bronchioles are the tiny air sacs called alveoli.
•             The bronchioles and alveoli look like the branches of a
tree.  The biggest branches are the bronchi.  Bronchi are covered
by cilia and a thin film of mucus.  Dust and pollen are trapped by
the mucus before they reach the alveoli.
•             Each of the lungs contains about 300 million alveoli.  Each
alveolus is surrounded by tiny blood vessels called capillaries. 
The exchange of oxygen and carbon dioxide during the breathing
process takes place in the capillaries of each alveolus.
•
• The Respiratory Process
•              Breathing is the process by which air is taken into the lungs
and carbon dioxide is pushed out of the lungs.
•             Breathing involves two parts.  Breathing in is called inhaling,
and breathing out is called exhaling or expiration.  When you inhale,
you fill your lungs with air.  When you exhale, you push air with more
carbon dioxide out of the lungs.
•             The lungs, being important and delicate organs, are protected
by a set of bones called the rib cage.  The rib cage forms the chest
cavity where the lungs are found.  At the lower portion of the chest
cavity is a sheet of muscles called diaphragm.  The diaphragm
separates the chest from the abdomen.  Both the rib cage and the
diaphragm are important in the breathing process.
•             When you inhale, the ribs move upward and outward while
the diaphragm moves downward.  The volume of the chest cavity
becomes larger.  The pressure inside it is lower that the air pressure
outside the body.  Air is drawn into the lungs by the atmospheric
pressure outside the body.
•             When you exhale, the opposite happens.  The ribs move
downward and inward while the diaphragm moves upward.  These
actions make the chest cavity smaller.  The pressure in the chest
cavity becomes greater than the air outside the body.  This cause the
air to rush out of the lungs and out of the body.
 Predisposing Factor:
Precipitating factors: Exposure to a carrier
Inhalation of High risk community
Streptococcal
Pneumoniae History of respiratory
illness(Asthma)
NURSING CARE
PLAN
DISCHARGE PLAN
 M EDICATIONS
• Advise client to take medicine as
prescribed by the Physician. The
following are the medications
prescribed: Acetylcysteine to liquefy
secretions, Ipratroprium salbutamol for
bronchodilation and Paracetamol Jr. to
lower body temperature. Medicines
used to treat pneumonia may include
antibiotics to make the infection be
cured
 E XERCISE
• Take adequate rest. If tolerated, do
light exercises such as walking. And
also do deep breathing and coughing.
 T REATMENT
• Medications should be taken exactly
as prescribed by a physician. If it is not
helping, call the doctor. Do not quit
taking it unless told to do so by a
doctor. Nebulization as ordered by the
doctor. Increase fluid intake to 2,500
to 3000ml per day to help liquefy
secretions incentive
 EALTH
H TEACHING
• Comply with the treatment regimen:
place the client in a comfortable
position. And ask the mother to take
care and give time to the child to take
good care for herself. Encourage deep
breathing and cough exercises.
 UTPATIENT
O DEPARTMENT
• Comply to the scheduled follow up
check up
 D IET
• Eat healthy and nutritious food. Eat
fruits rich in vitamin C or take vitamin
c to increase the resistance of the
client against infection. Increase fluid
intake if not contraindicated to the
patient.