ILOILO DOCTORS’ COLLEGE

COLLEGE OF NURSING
West Avenue, Molo, Iloilo City

CASE NO. 1
PNEUMONIA
1. INTRODUCTION - SALMERON

2. OBJECTIVES AND PATIENT’S DATA – SANCHEZ

3. PHYSICAL ASSESSMENT – RESMUNDO

4. PAST AND PRESENT MEDICAL HISTORY – TIBAJARES

5. PATHOPHYSIOLOGY – ROBLES

6. DIAGNOSTIC AND EXAM RESULT – MAYO AND TORECHILLA

7. NURSING CARE PLAN – SORIANO AND SIMONIO

8. DRUG STUDY- SAENZ

9. DISCHARGE PLAN – SERION

10. REVIEW OF RELATED LITERATURE – SALMERON

INTRODUCTION
Pneumonia is an infection that inflames your lungs' air sacs (alveoli). The air sacs may fill up with fluid or pus, causing symptoms such as a cough, fever, chills and
trouble breathing. It can range from mild to severe, depending on the type of germ causing the infection, your age, and your overall health. Pneumonia is spread
when droplets of fluid containing the pneumonia bacteria or virus are launched in the air when someone coughs or sneezes and then inhaled by others. You can
also get pneumonia from touching an object previously touched by the person with pneumonia (transferring the germs) or touching a tissue used by the infected
person and then touching your mouth or nose.

According to World Health Organization (WHO), pneumonia is the single largest infectious cause of death in children worldwide. It killed more than 808 000
children under the age of 5 in 2017, accounting for 15% of all deaths of children under 5 year old. People at-risk for pneumonia also include adults over the age of
65 and people with pre-existing health problems.

Globally, there are over 1,400 cases of pneumonia per 100,000 children, or 1 case per 71 children every year, with the greatest incidence occurring in South Asia
(2,500 cases per 100,000 children) and West and Central Africa (1,620 cases per 100,000 children).

In 2018, pneumonia has caused approximately 56.8 thousand deaths in the Philippines. An infection in the lungs, pneumonia was the 3rd leading cause of death
among Filipino women in the same year.
OBJECTIVES
GENERAL OBJECTIVES
This case study aims to come up with thorough understanding and to gain knowledge about the nature of Pneumonia in order to prepare ourselves and be
equipped whenever we encounter the same case in the future. Also, to be able to know the strategies and skills that need to be performed in managing and
treating the said illness.
SPECIFIC OBJECTIVES
A. KNOWLEDGE
 To define what is Pneumonia.
 To determine the signs and symptoms on the current health history and other manifestation of the patient.
 To be able to describe the anatomy and pathophysiology of Pneumonia.
 To explain the importance of learning Pneumonia.
B. SKILLS
 Apply the knowledge acquired from this case scenario
 Apply both dependent and independent nursing intervention, management and treatment towards treating patients with Pneumonia.
 Record and document accurately the past and present medical history
C. ATTITUDE
 Establish rapport with patient and the members of the family
 Exhibit positive attitude in caring
 Support and respect any of the patient’s decision
 PATIENT’S DATA
I. Biographical Data
NAME: Mr. Roque
AGE: 58 years old
SEX: Male
CIVIL STATUS: Married
CHIEF COMPLAINT: HIGH GRADE FEVER AND CHILLS
ADMITTING IMPRESSION: CAP-MR, LEFT LOWER LUNG CONSIDERED

SYMPTOMS MANIFESTED
- High grade fever and chills, decreased breath sounds and with rales/crackles on the left lower lung segments upon auscultation. Occasional productive
cough with yellowish sputum; rapid and shallow breathing. He appears to look restless and pale. Swollen and inflamed throat was noted.
PHYSICAL ASSESSMENT
General Survey
 T- 38.5°C
· PR- 85bpm
· RR- 23cpm
· BP- 130/80mmHg
· O2 Saturation- 90%
· Weight- 65 kg
- Physical examination was performed with the patient in upright position. His findings revealed that there were decreased breath sounds and with rales/crackles
on the left lower lung segments upon auscultation.
- Occasional productive cough with yellowish sputum; rapid and shallow breathing.
- He appears to look restless and pale.
-Swollen and inflamed throat was noted.
-Abdomen, HEENT, skin and extremities are essentially normal.
 PAST AND PRESENT MEDICAL HISTORY
History of Present Illnesses
1 week prior to admission, the patient had cough associated with abdominal pain and has poor appetite. He took over the counter drugs to relieve his pain or
discomfort. He then sought consultation and was requested a chest x-ray. He was advised admission due to left lung infiltration.

Past Medical history

Upon review of his past medical history, it reveals that client is hypertensive. He consumes 2 sticks of cigarettes per day, has pollen allergies and frequently
suffers from rhinitis. He works in an office as a consultant and often works overtime. Due to his nature of work, he is occasionally sent by the manager as a
representative of the company to travel places for any work related activities.

PATHOPHYSIOLOGY
Anatomy & Physiology of the Respiratory System

The respiratory system is situated in the thorax, and is responsible for gaseous exchange between the circulatory system and the outside world. Air is taken in via
the upper airways (the nasal cavity, pharynx and larynx) through the lower airways (trachea, primary bronchi and bronchial tree) and into the small bronchioles and
alveoli within the lung tissue. 
The lungs are divided into lobes; The left lung is composed of the upper lobe, the lower lobe and the lingula (a small remnant next to the apex of the heart), the
right lung is composed of the upper, the middle and the lower lobes.

Etiology
Pneumonia is classified according to the types of germs that cause it and where you got the infection. Many germs can cause pneumonia. The most common are
bacteria and viruses in the air we breathe. Your body usually prevents these germs from infecting your lungs. But sometimes these germs can overpower your
immune system, even if your health is generally good.
Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals or other health care facilities. It may be caused by:

 Bacteria. The most common cause of bacterial pneumonia in the U.S. is Streptococcus pneumoniae. This type of pneumonia can occur on its own or after
you’ve had a cold or the flu. It may affect one part (lobe) of the lung, a condition called lobar pneumonia.
 Bacteria-like organisms. Mycoplasma pneumoniae also can cause pneumonia. It typically produces milder symptoms than do other types of pneumonia.
Walking pneumonia is an informal name given to this type of pneumonia, which typically isn’t severe enough to require bed rest.

 Fungi. This type of pneumonia is most common in people with chronic health problems or weakened immune systems, and in people who have inhaled
large doses of the organisms. The fungi that cause it can be found in soil or bird droppings and vary depending upon geographic location.
Disease process
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.
Pneumonia indicates an inflammatory process of the lung parenchyma caused by a microbial agent. The most common pathway for the microbial agent to reach
the alveoli is by microaspiration of oropharyngeal secretions. Once microorganisms reach the alveolar space, they cause pneumonia by overcoming the last
defense

mechanism of the lung, the alveolar macrophage. Most of the time, the alveolar macrophage phagocytizes and kills the microorganisms that reach the alveolar
space. This explains why even though the arrival of microorganisms into the alveolar space is a not-infrequent occurrence, the presence of clinical pneumonia is
infrequent.
If the alveolar macrophage is unable to control the growth of the microorganisms, then, as a final protective defense mechanism, the lungs develop a local
inflammatory response. This local inflammatory response is characterized by movement of white blood cells, lymphocytes and monocytes from the capillaries into
the alveolar space

Symptomatology
Pneumonia symptoms can vary from so mild you barely notice them, to so severe that hospitalization is required. How your body responds to pneumonia depends
on the type germ causing the infection, your age and your overall health.

The signs and symptoms of pneumonia may include:

  Cough, which may produce greenish, yellow or even bloody mucus
 Fever, sweating and shaking chills
 Shortness of breath
 Rapid, shallow breathing
 Sharp or stabbing chest pain that gets worse when you breathe deeply or cough
 Loss of appetite, low energy, and fatigue
 Nausea and vomiting, especially in small children

 Confusion, especially in older people

How Is Pneumonia Diagnosed?

Sometimes pneumonia can be difficult to diagnose because the symptoms are so variable, and are often very similar to those seen in a cold or influenza. To
diagnose pneumonia, and to try to identify the germ that is causing the illness, your doctor will ask questions about your medical history, do a physical exam, and
run some tests.

Medical history
Your doctor will ask you questions about your signs and symptoms, and how and when they began. To help figure out if your infection is caused by bacteria,
viruses or fungi, you may be asked some questions about possible exposures, such as:

 Any recent travel

 Your occupation
 Contact with animals
 Exposure to other sick people at home, work or school
 Whether you have recently had another illness
Physical exam
Your doctor will listen to your lungs with a stethoscope. If you have pneumonia, your lungs may make crackling, bubbling, and rumbling sounds when you inhale.

Diagnostic Tests

If your doctor suspects you may have pneumonia, they will probably recommend some tests to confirm the diagnosis and learn more about your infection. These
may include:

 Blood tests to confirm the infection and to try to identify the germ that is causing your illness.
 Chest X-ray to look for the location and extent of inflammation in your lungs.
 Pulse oximetry to measure the oxygen level in your blood. Pneumonia can prevent your lungs from moving enough oxygen into your bloodstream.
 Sputum test on a sample of mucus (sputum) taken after a deep cough, to look for the source of the infection.
If you are considered a high-risk patient because of your age and overall health, or if you are hospitalized, the doctors may want to do some additional tests,
including:

 CT scan of the chest to get a better view of the lungs and look for abscesses or other complications.
 Arterial blood gas test, to measure the amount of oxygen in a blood sample taken from an artery, usually in your wrist. This is more accurate than the
simpler pulse oximetry.
 Pleural fluid culture, which removes a small amount of fluid from around tissues that surround the lung, to analyze and identify bacteria causing the
pneumonia.
 Bronchoscopy, a procedure used to look into the lungs’ airways. If you are hospitalized and your treatment is not working well, doctors may want to see
whether something else is affecting your airways, such as a blockage. They may also take fluid samples or a biopsy of lung tissue.

Diagnostic Examination Results

a. Laboratory exams
Lab exam Results Normal Values Significance
Hematology:
Hemoglobin 150 140-180 The result shows that
(Hgb) the haemoglobin is
within the normal
range
WBC count 23.84 3.4-9.6 The result is indicates
that there is an
increased production
of white blood cells
RBC count 4.98 4.7 to 6.1 This shows that the
RBC is within normal
 values

Hematocrit 0.45 .40-54 The result shows that

haematocrit is within
the normal range
Platelet 200,000 150,000 and 400,000 The result show that
platelet count is
within normal range
Neutrophils 0.83 0.66- 0.70 This indicates that the
body has a high
capacity to fight
against invading
microorganism
The result indicates
Lymphocytes 0.09 that lymphocytes is
20% to 40%
relatively low

Monocytes 0.01 The result indicates

2% to 8% that monocytes is not
within the normal
range
Eosinophils Eosinophils is within
0.01 normal range
0.0% to 6.0%

Basophils 0.01 Basophils is within the

0.5% to 1% normal range
Urinalysis Color: Straw Straw-yellow Urine color is within
normal range
Transparency is not
 Transperency: Clear within the normal
Hazy range
Urine pH is within
pH: 5.0 4-6.8 normal range

Sp Gravity:
1.015 1.05-1.030 Sp Gravity is within
Albumin: normal range
Negative Negative Albumin is within
normal range
Sugar: Negative Negative Albumin is within
normal range
Sputum Culture Positive for Negative This indicates that
Streptococcus there is a presence of
pneumoniae pathogenic
microorganisms that
caused a disease
called Pneumonia.

b. X-ray results
Lab Exam Result Normal Range Interpretation
Chest X-Ray Left Lower Lobe The normal chest X- The result shows that
Infiltration Ray shows normal size the patient is
and shape of the chest diagnosed with
wall and the main Pneumonia, left lung
structures in the chest. considered
 Chest X-Ray shows Lower Left Lobe Infiltration

Chest x-ray PA view- left lower lobe infiltration

Chest x-ray: An x-ray exam will allow your doctor to see your lungs, heart and blood vessels to help determine if you have pneumonia. When interpreting
the x-ray, the radiologist will look for white spots in the lungs (called infiltrates) that identify an infection.

Chest x-ray PA view- left lower lobe infiltration

The PA view is frequently used to aid in diagnosing a range of acute and chronic conditions involving all organs of the thoracic cavity. Additionally, it serves
as the most sensitive plain radiograph for the detection of free intraperitoneal gas or pneumoperitoneum in patients with acute abdominal pain.
Sputum culture and sensitivity- positive for Streptococcus Pneumoniae
A bacterial sputum culture is used to detect and diagnose bacterial lower respiratory tract infections such as bacterial pneumonia or bronchitis. It is
typically performed with a Gram stain to identify the bacteria causing a person's infection.
 NURSING CARE PLAN
Assessment Diagnosis Objective/ Intervention Rationale Evaluation
Planning

Subjective: Ineffective Long term: - Administer - To help patients Goal is

“naga hilanat breathing after 8 oxygen who cannot breathe met as
kag pattern hours of adequately on their evidenced
nalamigan related to nursing own by:
akon bana” low o2sat intervention
as verbalized of 90% the patient - The
by his wife secondary will patient will
to establish a establish
Objective: pneumoni normal, -Assess a normal,
-Manifestation of
VS: Temp - a effective respirations: note effective
respiratory distress
38.5°C BP- respiratory quality, rate, respiratory
are dependent on/
130/80 pattern as rhythm, use of pattern as
and indicate of the
mmHg PR- evidenced accessory muscles, evidenced
Rationale: degree of lung
85bpm RR- by normal ease, and position by normal
involvement and
23cpm respiratory assumed for easy respiratory
Inspiration underlying general
O2SAT- 90% rate and breathing rate and
and health status as
oxygen oxygen
Findings: - expiration patient will adapt
saturation. saturation
decreased that does their breathing
after 8
breath not patterns to facilitate
hours
sounds and provide effective gas
with adequate Short term: exchange. - The
rales/crackle ventilation after 1 hour patient’s
s on the left of nursing respiratory
lower lung intervention rate
segments the -Teach the patient -This method remains
upon patient’s the proper deep relaxes muscles and within the
auscultation - respiratory breathing increases patient’s normal
occasional rate techniques. oxygen level. limits and
productive remains relaxed
cough with within the breathing
yellowish normal is
sputum - limits and -Maintain a clear -This facilitates obtained
rapid and relaxed airway by adequate clearance
shallow breathing is encouraging the of secretions.
breathing - obtained patient to mobilize
appears to their own secretion
look restless with successful
and pale coughing

-To verify
-Monitor pulse maintenance and
oximetry improvement of o2
sat

-risk of further
-Encourage the complications may
patient to develop a be prevented
plan for smoking
cessation
Dependent:

Azithromycin
500mg OD for 7
days.

Piperacillin +
Tazobactam 4.5G
IV 1 vial via solulet
Q8H ANST.

Losartan K
50mg/tab 1 tab OD.
Sodium ascorbate
+ zinc 500mg/10mg
tab OD after
breakfast.

Acetylcysteine
600mg 1
effervescent tablet
 to dissolve in 30ml
of water OD HS.

Oxygen Inhalation
at 2 liter/min. PAI
with Salbutamol
sulfate 1mg/ml 1
nebule TID

Assessment Diagnosis Objective/ Intervention Rationale Evaluation

Planning

Subjective: Hyperthermia Short term: Independent: Goal is met

“naga hilanat related to high After 8 hours as evidenced
kag grade fever of of nursing -Assess the by:
nalamigan 38.5 secondary interventions patient’s vital
signs at least -To assist in -Patient
akon bana” to pneumonia as the patient
every 4 hours creating an maintains a
as verbalized evidenced by will maintain accurate body
by his wife chills temperature diagnosis and temperature
within normal
Objective: monitor within the
effectiveness of
VS: Temp - range medical normal range
38.5°C BP- treatment, after 8hours
130/80 particularly the of nursing
mmHg PR- antibiotics and intervention
85bpm RR- fever reducing
23cpm drugs
O2SAT- 90%

- No signs of
Long term:
Findings: - hyperthermia
decreased After 1 hour after 1 hour
breath of nursing of
-To lower the medications
sounds and intervention
temperature and
with the patient -Provide through the treatment.
rales/crackle will no longer tepid sponge process of
s on the left Rationale: feel cold and bath conduction.
lower lung lower body
Hyperthermia is temperature
segments -Free from
elevated body to normal
upon hyperthermia
temperature due range. - Fluid loss and
auscultation -
to a break in contributes to demonstrate
occasional
thermoregulatio fever
productive normal range
n that arises
cough with - Encourage of vital signs
when a body
yellowish fluid intake
produces or
sputum - -Exposing skin
absorbs more
rapid and to room air
heat than it
shallow -Eliminate decreases
dissipates. It is a
breathing - excess warmth and
sustained core
appears to clothing increases
temperature
look restless evaporative
and pale beyond the cooling
normal variance.

- These
methods
provide for a
more gradual
- Regulate
warming of the
the
body. Rapid
environment
warming can
temperature
induce
or relocate
ventricular
the patient to
fibrillation.
Reference: a warmer
Moisture
Nurse’s Pocket setting. Keep
promotes
Guide, 10th the patient
evaporative
Edition and linens
heat loss.
dry.

Dependent:

-Paracetamol
500mg tablet, -Paracetamol,
1 tab rtc also known as
every 4 hrs acetaminophen
for 24 hours , is a
 then prn medication
used to treat
pain and fever.

- IVFof PNSS - IV fluids

1L at 80cc replenish fluid
per hour. loss

DRUG STUDY

Drug Name Classification Indications and Side Effects and Special Nursing
and Mechanism Contraindications Adverse Effects Precautions Responsibilities
of Action

Generic Classifications Indications: GI: Abdominal Don’t mix Before and during
Name: pain, parenteral long-term therapy
Antipyretic, -To relieve mild hepatotoxicity acetaminophen including parenteral
Paracetamol nonopioid to moderate (Possibly severe), with therapy, monitor liver
analgesic pain; to manage nausea, vomiting any other function test results,
moderate to medication. including AST, ALT,
Trade/ Brand severe pain with HEME: Hemolytic Diazepam and bilirubin, and
Name: adjunctive anemia (with long- chlorpromazine creatinine levels, as
opioid analgesics; term is physically ordered because
Biogesic to reduce fever use), leukopenia, incompatible acetaminophen may
neutropenia, with parenteral cause hepatotoxicity.
-To relieve mild pancytopenia, acetaminophen. Ensure that the daily
Dosage: to moderate pain thrombocytopenia dose of
Actions: from acetaminophen from
500 mg headache, muscle SKIN: Acute all
Inhibits the ache, backache, generalized sources do not exceed
enzyme minor exanthematous maximum daily limits.
Route: cyclooxygenase, arthritis, common pustulosis,
blocking cold, toothache, jaundice, pruritus, Caution patient not to
Oral prostaglandin or rash, Stevens- exceed recommended
production and menstrual Johnson dosage or take other
interfering cramps; to syndrome, toxic drugs containing
Frequency with pain reduce fever epidermal acetaminophen at the
and Timing impulse necrolysis, same time because of
generation in urticaria risk of liver damage.
Q4H for 24 the Contraindications Advise him to contact
then PRN peripheral Other: prescriber before
nervous system. Hypersensitivity Anaphylaxis, taking other
Acetaminophen to angioedema, prescription or OTC
also acts directly acetaminophen hypersensitivity products because they
on temperature- or its reaction, may contain
regulating components, hypoglycemic acetaminophen.
center in the severe hepatic coma
hypothalamus impairment, Teach patient to
by inhibiting severe active liver recognize signs of
synthesis of disease hepatotoxicity, such as
prostaglandin bleeding, easy bruising,
E2. and malaise, which
commonly
occurs with chronic
overdose.
 Monitor renal function
in patient on long term
therapy. Keep in mind
that blood or albumin
in urine may indicate
nephritis; decreased
urine output may
indicate renal failure;
and dark brown urine
may indicate presence
of the metabolite
phenacetin.

Drug Name Classification and Indications and Side Effects and Adverse Special Precautions Nursing Responsibilities
Mechanism of Action Contraindications Effects

Generic Name: Classifications Indications: CNS: Aggressiveness, Use azithromycin cautiously Tell patient to report signs
agitation, anxiety, in patients with hepatic and symptoms of allergic
Azithromycin Antibiotic To treat community- asthenia, dizziness, dysfunction not associated reaction (such as rash, itching,
acquired pneumonia fatigue, headache, with prior use of hives, chest tightness, and
caused by Chlamydophila hyperactivity, malaise, azithromycin (drug is trouble breathing)
 pneumoniae, Haemophilus nervousness, metabolized in the liver) or immediately.
Trade/ Brand Name: influenzae, Mycoplasma paresthesia, seizures, renal dysfunction (effects are
pneumoniae, or somnolence, syncope, unknown in this Warn patient that abdominal
Zithromax Streptococcus pneumoniae vertigo group). pain and loose, watery stools
may occur. If diarrhea
Actions: To treat mild to moderate CV: Arrhythmias, chest persists or becomes severe,
Dosage: acute bacterial pain, edema, elevated urge him to contact prescriber
Binds to a ribosomal exacerbations of COPD serum CK level, and replace fluids.
500 mg subunit of susceptible hypotension, palpitations,
bacteria, blocking peptide prolonged QT interval, Give azithromycin capsules 1
translocation and Contraindications torsades de pointes, hour before or 2 to 3 hours
Route: inhibiting RNA-dependent ventricular tachycardia after food. Give tablets or
protein synthesis. History of cholestatic suspension without regard to
Oral Drug concentrates in jaundice or hepatic EENT: Hearing loss, food.
phagocytes, macrophages, dysfunction associated mucocutaneous
and fibroblasts, which with prior use of candidiasis, perversion or If hepatic function is
Frequency and Timing release it slowly and may azithromycin; loss of taste or smell, impaired, monitor liver
help move it to infection hypersensitivity to tinnitus function studies closely and
OD sites. azithromycin, expect to discontinue the drug
erythromycin, ketolide ENDO: Hyperglycemia immediately if signs and
antibiotics, or other symptoms of hepatitis occur.
macrolide antibiotics GI: Abdominal pain,
anorexia, cholestatic Assess patient for bacterial or
jaundice, constipation, fungal superinfection, which
diarrhea, dyspepsia, may occur with prolonged or
elevated liver function test repeated therapy. If it occurs,
results, flatulence, hepatic expect to give another
necrosis or failure, antibiotic or antifungal.
hepatitis, nausea,
pancreatitis, Monitor bowel elimination; if
pseudomembranous needed, obtain stool culture to
colitis, vomiting rule out pseudomembranous
colitis. If it occurs, expect to
GU: Acute renal failure, stop azithromycin and give
elevated BUN and fluid, electrolytes, and
serum creatinine levels, antibiotics effective with
nephritis, vaginal Clostridium difficile.
candidiasis

HEME: Leukopenia,
neutropenia,
thrombocytopenia

MS: Arthralgia

SKIN: Erythema
multiforme,
photosensitivity, pruritus,
rash, Stevens-Johnson
syndrome, toxic epidermal
necrolysis, urticaria

Other: Allergic reaction,

anaphylaxis, angioedema,
elevated serum
phosphorus level,
hyperkalemia, infusion-
site reaction (such as pain
and redness), new or
worsening myasthenia
syndrome, superinfection
 Drug Name Classification and Mechanism Indications and Side Effects and Adverse Special Precautions Nursing Responsibilities
of Action Contraindications Effects

Generic Name: Classifications Indications: CNS: headache, insomnia, Use cautiously in patients with Before giving drug, ask the
fever, seizures, agitation, bleeding tendencies, uremia, patient about allergic reactions
Piperacillin + Tazobactam Antibiotic Moderate to severe anxiety, dizziness, pain hypokalemia, and allergies to to penicillins.
infections from piperacillin- other drugs, especially
resistant, piperacillin and CV: arrhythmia, chest pain, cephalosporins, because of Obtain specimen for culture and
Trade/ Brand Name: tazobactam- susceptible, edema, hypertension, possible cross-sensitivity sensitivity tests before giving
beta- lactamase- producing tachycardia first dose.
Tazocin, Zosyn strains of microorganisms in Drug may alter normal colon
appendicitis (complicated by EENT: rhinitis flora. Monitor patient for Reconstitute each gram with 5
rupture or abscess) and diarrhea and initiate ml of diluent, such as sterile or
Dosage: Actions: peritonitis caused by GI: diarrhea, constipation, therapeutic measures as bacteriostatic water for
Escherichia coli, Bacteroides nausea, needed. Drug may need to be injection, normal saline solution
4.5G Inhibits cell-wall synthesis fragilis, B. ovatus, B. pseudomembranous colitis, stopped. for injection, bacteriostatic
during bacterial thetaiotaomicron, B. abdominal pain, dyspepsia, normal saline solution for
multiplication vulgatus; skin and skin- stool changes, vomiting injection, D5W, dextrose 5% in
Route: structure infections caused normal saline solution for
by Staphylococcus aureus; GU:candidiasis. Interstitial injection, or dextran 6% in
Intravenous postpartum endometritis or nephritis normal saline solution for
pelvic inflammatory disease injection
caused by E. coli; moderately HEMA: leukopenia,
Frequency and Timing severe community- acquired neutropenia, Shake until dissolved
pneumonia caused by thrombocytopenia, anemia,
Q8H Haemophilus influenzae eosinophilia Further dilute to 50 to 150 ml
before infusion.
RESPI: dyspnea
Contraindications Use drug immediately after
SKIN: pruritus, rash reconstitution
Contraindicated in patients
hypersensitive to drug or Other: Anaphylaxis, Stop any primary infusion during
other penicillin hypersensitivity reactions, administration, if possible
inflammation, phlebitis at IV
 site Infuse over at least 30 minutes

Discard unused drug in single-

dose vials after 24 hours if
stored at room temperature or
48 hours if refrigerated

Change IV site every 48 hours

Dilute drug is stable in IV bags

for 24 hours at room
temperature or for 1 week
refrigerated

Monitor hematologic and

coagulation parameters.

Drug Name Classification and Mechanism Indications and Side Effects and Adverse Special Precautions Nursing Responsibilities
of Action Contraindications Effects

Generic Name: Classifications Indications: CNS: Dizziness, fatigue, Be aware that patients who Monitor blood pressure and
headache, insomnia, have severe heart failure or renal function studies to
Losartan Potassium Antihypertensive To manage hypertension malaise renal artery stenosis may evaluate drug effectiveness.
experience acute renal
To treat nephropathy in CV: Hypotension failure from losartan therapy Periodically monitor patient’s
Trade/ Brand Name: patients with type 2 diabetes because losartan inhibits the serum potassium level, as
and hypertension EENT: Nasal congestion angiotensinaldosterone appropriate, to detect
Cozaar system, on which renal hyperkalemia.
To reduce stroke risk in GI: Diarrhea, indigestion, function depends.
Actions: patients with nausea,vomiting Monitor patient for muscle pain;
Dosage: hypertension and left rarely, rhabdomyolysis develops
50mg Blocks binding of angiotensin ventricular hypertrophy HEME: Thrombocytopenia in patients taking other
II to receptor angiotensin II receptor
sites in many tissues, MS: Back pain, leg pain, blockers.
Route: including vascular muscle spasms
smooth muscle and adrenal Contraindications Instruct patient to avoid
Oral glands. Angiotensin II is a RESP: Cough, upper potassium containing
potent vasoconstrictor Concurrent aliskiren therapy respiratory tract infection salt substitutes because they
that also stimulates the (in patients may increase risk of
Frequency and Timing adrenal cortex to secrete with diabetes), SKIN: Erythroderma hyperkalemia.
aldosterone. The inhibiting hypersensitivity to losartan
OD effects of angiotensin II or its components Other: Angioedema, Advise patient to avoid
reduce blood pressure. hyperkalemia, exercising in hot weather and
hyponatremia drinking excessive amounts
of alcohol; instruct to notify
prescriber if has prolonged
diarrhea, nausea, or
vomiting.

Drug Name Classification and Mechanism Indications and Side Effects and Adverse Special Precautions Nursing Responsibilities
of Action Contraindications Effects

Generic Name: Classifications Indications: CNS: Chills, dizziness, Don’t give acetylcysteine with Because nebulization causes
drowsiness, fever, nebulization equipment if drug sticky residue
Acetylcysteine Antidote (for To liquefy abnormal, viscid, headache can contact iron, copper, or on face and in mouth, have
acetaminophen overdose), or thickened mucus rubber. Don’t give drug with patient wash
mucolytic secretions in chronic CV: Edema, hypertension, amphotericin B, ampicillin his face and rinse his mouth at
Trade/ Brand Name: pulmonary disorders hypotension, sodium, the end of
(including emphysema, tachycardia chlortetracycline, each treatment.
Acetadote, Mucomyst, Mucosil bronchitis, tuberculosis, chymotrypsin, erythromycin,
bronchiectasis, and cystic EENT: Rhinorrhea, hydrogen peroxide, iodized oil, Be aware that an open vial of
Dosage: fibrosis) and in pneumonia, stomatitis, tooth damage oxytetracycline, tetracycline, or solution may turn light purple
pulmonary complications of trypsin. but that this doesn’t alter its
600 mg thoracic or GI: Anorexia, constipation, effectiveness.
Actions: cardiovascular surgery, and hepatotoxicity,
Route: tracheostomy care nausea, vomiting Refrigerate opened vials and
Decreases viscosity of discard after 96 hours.
Inhalation pulmonary secretions To treat acetaminophen RESP: Bronchospasm, chest
by breaking disulfide links overdose tightness, Assess type, frequency, and
that bind glycoproteins in cough, hemoptysis, characteristics of patient’s
Frequency and Timing mucus. Reduces liver respiratory distress, cough. Particularly note
damage from acetaminophen Contraindications shortness of breath, stridor, sputum. If cough doesn’t clear
OD HS overdose. wheezing secretions, prepare to perform
8PM Usually, acetaminophen’s Hypersensitivity to mechanical suctioning.
toxic metabolites bind with acetylcysteine, no SKIN: Clammy skin, facial
glutathione in the liver, contraindications when used flushing, Monitor patient for tachycardia.
which detoxifies them. When as antidote pruritus, rash, urticaria
acetaminophen Warn patient about
overdose depletes Acetylcysteine should be Other: Anaphylaxis, acetylcysteine’s
glutathione stores, toxic used cautiously in patients angioedema unpleasant smell: reassure him
metabolites bind with with asthma or a history of that it subsides as treatment
protein in liver cells, bronchospasm because drug progresses.
killing them. Acetylcysteine may adversely affect
maintains or restores levels respiratory function. To decrease mucus viscosity,
of glutathione or acts as its urge patient to consume 2 to 3 L
substitute, which reduces of fluid daily unless
liver damage from contraindicated by another
acetaminophen overdose. condition.
 Drug Name Classification and Mechanism Indications and Side Effects and Adverse Special Precautions Nursing Responsibilities
of Action Contraindications Effects

Generic Name: Classifications Indications: GI: nausea, vomiting, Diabetics, patients prone to Before using this vitamin, tell
heartburn diarrhea recurrent renal calculi, those your doctor or pharmacist your
Vitamin C (ascorbic acid) + Zinc Vitamins Frank and subclinical scurvy undergoing stool occult blood medical history, especially of :
HEMA: acute hemolytic tests, and those on sodium- kidney disease (such as kidney
Extensive burns, delayed anemia restricted diets or stones), a certain enzyme
Trade/ Brand Name: Actions: fracture or wound healing, anticoagulant therapy should deficiency (G6PD deficiency)
postoperative wound CNS: headache (high doses) not take excessive doses of
Ceelin Plus In humans, an exogenous healing, severe febrile or vitamin C over an extended Before taking ascorbic acids, tell
source of ascorbic acid chronic disease states URO: urethritis, dysuria, period of time your doctor or pharmacists if
(vitamin C) is required for crystalluria you have any allergies. This
Dosage: collagen formation and tissue To acidify urine product may contain inactive
repair. It is reversibly Others: mild soreness, ingredients (such as
500mg/10mg tab oxidized to dehydroascorbic Macular degeneration dizziness, faintness with peanut/soy), which can cause
acid in the body. These two rapid IV administration allergic reactions or other
Route: forms of the vitamin are problems
believed to be important in Contraindications
Oral oxidation-reduction Inform patient about the
reactions. The vitamin is Use of sodium ascorbate in possible side effects of the drugs
involved in tyrosine patients on sodium
Frequency and Timing metabolism, conversion of restriction Instruct patient to be cautious of
folic acid, carbohydrate the contraindications of the
OD metabolism, synthesis of drugs
8 AM (after breakfast) lipids and proteins, iron
 metabolism, resistance to Do the charting or the
infections, and cellular documentation
respiration.

Drug Name Classification and Mechanism of Action Indications and Contraindications Side Effects and Adverse Effects

Generic Name: Classifications Indications: CNS: Anxiety, dizziness, drowsiness,

headache, hyperkinesia, insomnia, irritability,
Albuterol Sulfate (Salbutamol Sulfate) Bronchodilator To prevent exercise-induced asthma nervousness, tremor, vertigo, weakness

To treat bronchospasm in patients with CV: Angina; arrhythmias, including atrial

Trade/ Brand Name: reversible obstructive airway disease or fibrillation, extrasystoles, supraventricular
acute bronchospastic attack tachycardia, and tachycardia; chest pain;
Proventil hypertension; hypotension; palpitations

EENT: Altered taste, dry mouth and throat,

Dosage: Actions: Contraindications ear pain, glossitis, hoarseness, oropharyngeal
Albuterol attaches to beta2 receptors on edema, pharyngitis, rhinitis, taste perversion
bronchial cell membranes, which Hypersensitivity to albuterol or its
stimulates the intracellular enzyme adenylate components ENDO: Hyperglycemia
Route: cyclase to convert adenosine
triphosphate (ATP) to cyclic adenosine GI: Anorexia, diarrhea, dysphagia, heartburn,
1 mg/ml monophosphate (cAMP). This reaction nausea, vomiting
decreases intracellular calcium levels. It also
Frequency and Timing increases intracellular levels of cAMP, as GU: UTI
shown. Together, these effects relax bronchial
TID smooth-muscle cells and inhibit MS: Muscle cramps
histamine release.
RESP: Bronchospasm, cough, dyspnea,
paradoxical bronchospasm, pulmonary
edema
 SKIN: Diaphoresis, flushing, pallor,
pruritus, rash, urticaria

Other: Angioedema, hypokalemia,

infection, metabolic acidosis

Drug Name Classification and Indications and Side Effects and Adverse Special Precautions Nursing Responsibilities
Mechanism of Action Contraindications Effects

Generic Name: Classifications Indications: Hypotension In patients with diminished Monitor patient frequently or:
renal function, it may result
Plain NSS Isotonic intravenous Used because it has little to Febrile response to sodium retention. a. Signs of
solution no effect on the tissues and infiltration/sluggish flow
Trade/ Brand Name: make the person feel Infection at the site of Caution when used in b. Signs of phlebitis/infection
 hydrated preventing injection patients who are receiving c. Well time of catheter and
Plain NSS hypovolemic shock or corticosteroids or need to be replaced
hypotension Venous thrombosis or cortocotropin. d. Condition of catheter
phlebitis extending from dressing
Dosage: the site of injection
Actions: Contraindications Check the level of the IVF
1L at 80cc per hour Normal saline solution has Extravasation a. Correct solution,
an osmolality of Contraindicated in any medication, and volume
308mOsm/L because the situation where salt Hypervolemia b. Check and regulate the
Route: osmolality is entirely retention is undesirable drop rate
contributed by electrolytes, such as edema, heart c. Change the IVF solution if
Intravenous the solution remains within disease, cardiac needed
the ECF, does not cause decompensation and d. Check for the presence of
red blood cells to shrink or primary or secondary bubbles in the IVF tube
swell. Isotonic fluids aldosteronism. e. Do not connect flexible
expand the ECF volume, plastic containers of IV
solution in series connections.
Such use could result in air
embolism due to the residual
air being drawn from one
container before
administration of the fluid
from a secondary container is
completed.

Discharge Planning

Discharged in an improved condition. Going home medications and care given.

 1. Advise to take the following medications at the right time, right dose, right route, and right frequency.

 Paracetamol 500mg 1 tab Q8H PRN for fever

 Acetylcysteine 600mg 1 eeffervescent tablet to dissolve in 30ml of water OD at bedtime
 Azithromycin 500mg/tab for 7 days more.

2. Encourage the patient to have an adequate rest and sleep.

3. Instruct patient to elevate head of bed if difficulty of breathing occurs.

4. Encourage patient to have deep breathing exercises and coughing reflex to promote expectoration of secretions.

5. Encourage hydration in order to thin and loosen pulmonary secretions.

6. Encourage the patient to stop smoking.

7. Advise the client to have a follow-up check-up after 3 weeks in the doctor’s office.

Review of Related Literature

According to the article of Nathan, A.M., Ju The, C.S., Jabar, K.A., Teoh, B.T, Tangaperumal, A., et.al. (2020) entitled “Bacterial pneumonia and its associated
factors in children from a developing country: A prospective cohort study” states that bacteria remain an important cause of very severe pneumonia in developing
countries with one in four children admitted isolating bacteria alone. Male gender and presence of crepitation were significantly associated with bacterial aetiology.
Co-infection was associated with a higher CRP but no other parameters of severe clinical illness. The study shows three hundred patients with a mean (SD) age
of 14 (±15) months old were recruited. Significant pathogens were detected in 62% of patients (n = 186). Viruses alone were detected in 23.7% (n = 71) with
rhinovirus (31%), human metapneumovirus (HMP) [22.5%] and respiratory syncytial virus (RSV) [16.9%] being the commonest. Bacteria alone was detected in
25% (n = 75) with Haemophilus influenzae (29.3%), Staphylococcus aureus (24%) and Streptococcus pneumoniae (22.7%) being the commonest. Co-infections
were seen in 13.3% (n = 40) of patients. Male gender (AdjOR 1.84 [95% CI 1.10, 3.05]) and presence of crepitations (AdjOR 2.27 [95% CI 1.12, 4.60]) were
associated with bacterial infection. C-reactive protein (CRP) [p = 0.007]) was significantly higher in patients with co-infections but duration of hospitalization (p =
0.77) and requirement for supplemental respiratory support (p = 0.26) were not associated with co-infection.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228056