CASE STUDY

( PNEUMONIA )

SUBMITTED BY:

Group 1 A3D

SUBMITTED TO:Mrs. Guendelyn Feleciano

INTRODUCTION

Pneumonia for infants is pneumonia that occurs in very young infants. This lung disease can develop in infants as young as 24 hours old and often occurs partially because of abnormalities in

the airways and lungs. Pneumonia is a significant cause of death in newborns/infants; in deaths that occur in the first 30 days of life, pneumonia is a contributing factor in as much as 25 percent of cases. Infants with pneumonia complicated by blood-borne infection have a mortality risk of 10 percent, and this risk triples if the infant had a low birth weight.

There are several risk factors for infants with pneumonia that can be present before birth. These include maternal fever, tenderness or pain in the uterine area, urinary tract infection and tachycardia of the fetus. Signs that can be noted at or shortly after birth include preterm labor, cloudy or foul-smelling amniotic fluid and rupture of uterine membranes before labor begins. An additional risk factor is gestational maternal illness with an infectious organism known to be capable of crossing the placental barrier.

Infants with pneumonia can have a number of different symptoms. These include abnormally high respiratory rate, grunting when exhaling, yellow or green airway secretions, aspiration of blood, oxygen deprivation in certain tissues and discolored skin, hair and nails. Newborns might also have fluctuating temperature, skin rash, jaundice, irregular heartbeat and a distended abdomen.

Prompt diagnosis and treatment of neonatal pneumonia is crucial because of the high mortality risk associated with this disease. Pneumonia can significantly alter gas exchange in the lungs of neonates, potentially resulting in oxygen

deprivation and compromise of metabolism of all cell types in the body. Structural and immunological defense mechanisms are not fully formed in neonates, which makes it all but impossible for the newborn to fight the infection effectively. In addition, there is an increased risk that the infection might spread from the lungs to other parts of the body.

The goals of treatment for infants with pneumonia are to eradicate the infectious agent and at the same time to protect the infant by providing respiratory support. There are some risks involved in treatment; however, that must be minimized to ensure the infant’s lungs are not permanently damaged. The main risk of antimicrobial treatment is that antimicrobial medications can temporarily worsen lung inflammation, which might increase the risk of permanent lung damage. To reduce this risk, antimicrobial medications are chosen carefully to minimize the dose required to combat the infection.

Antimicrobial medications are the key to successfully treating this disease, but medication alone cannot provide the infant with adequate support. In addition to antimicrobial medication, the infant is provided with a source of oxygen to ensure that he or she is not oxygen-deprived because of reduced lung function. Neonates might also receive blood transfusions and intravenous fluids to ensure adequate nutrition and blood-oxygen capacity.

OBJECTIVES

GENERAL OBJECTIVE:

The researchers will be able to know what pneumonia is, causes of pneumonia, how it is acquired and prevented, its treatments and prevention of the occurrence of pneumonia.

SPECIFIC OBJECTIVE:

Define what is pneumonia Trace the pathophysiology of pneumonia Enumerate the different signs and symptoms of

pneumonia Formulate and apply nursing care plans utilizing the

nursing process To learn new clinical skills as well as sharpen our

current clinical skills required in the management of the patient with pneumonia

ASSESSMENT FINDINGS

I. Demographic Data

The name of the patient is Carmelita Isip. The patient

lives at 1717 Loyola St.,Tondo, Manila. Her age is 54 years

old. Her gender is female. Her birthday is on June 13, 1956.

Filipino is her nationality.The information gathered are

provided by the daughter who is coherent and reliable.She has

a history of hospital admissions due to breast cancer. Prior to

admission stated by his daughter she was experiencing cough

for 3 consecutive days. According to the daughter, these

symptoms occur last_______, _________, 2010. Due to this

condition, her mother decided to consult him in

____________where she was nebulized with Salbutamol

X3 doses and diagnosed with pneumonia. Her vital signs

were, Temperature – __ 8 C, Cardiac Rate – ___ bpm,

Respiratory rate – ___ bpm and weight is ___kg. She was

referred at Gat Andress Medical hospital and admitted on

November 2, 2010 at around 10:45 pm due to cough. The

patient’s vital signs upon admission were, Temperature –

____ 8C, Cardiac Rate – ___ bpm, Respiratory rate – __

bpm and weighs ___ kg. The patient’s daughter decided to

admit her to have proper management of her condition. Her

attending physician is Dr. Torres, M.D. and Dra. See, M.D.

Chief Complaint is cough for 3 days. Her admitting clerk is

V. Espiritu. Monitor her vital signs every 1 hour and must be

recorded.

II. Present and Past Health History

According to the patient’s chart, the patient’s present

health history is distressed non-productive.According to the

daughter of the patient, her mother has no history of injuries

and accidents. There are no known allergies based on the

daughter’s claim. Currently the client is taking Ambroxol,

Cefalexin and Salbutamol.

III. Family History

ISIP FAMILY

FATHER

MOTHER

A&W HD

32yrs. old

30 yrs. old

A&W A&W

Legend:

Living female A&W – Alive & Well

Living male HD – Heart Disease

http://en.wikipedia.org/wiki/Image:Pneumonia_alveolus.jpg

Upper panel shows a normal lung under a microscope. The

white spaces are alveoli that contain air. Lower panel shows a

lung with pneumonia under a microscope. The alveoli are filled

with inflammation and debris.

The symptoms of infectious pneumonia are caused by the

invasion of the lungs by microorganisms and by the immune

system's response to the infection. Although over one hundred

strains of microorganism can cause pneumonia, only a few of

them are responsible for most cases. The most common causes

of pneumonia are viruses and bacteria. Less common causes of

infectious pneumonia include fungi and parasites.

Viruses

Viruses must invade cells in order to reproduce. Typically,

a virus reaches the lungs when airborne droplets are inhaled

through the mouth and nose. Once in the lungs, the virus invades

the cells lining the airways and alveoli. This invasion often leads

to cell death, either when the virus directly kills the cells, or

through a type of cell self-destruction called apoptosis. When

the immune system responds to the viral infection, even more

lung damage occurs. White blood cells, mainly lymphocytes,

activate a variety of chemical cytokines which allow fluid to

leak into the alveoli. This combination of cell destruction and

fluid-filled alveoli interrupts the normal transportation of

oxygen into the bloodstream.

In addition to damaging the lungs, many viruses affect

other organs and thus can disrupt many different body functions.

Viruses also can make the body more susceptible to bacterial

infections; for this reason, bacterial pneumonia often

complicates viral pneumonia.

Viral pneumonia is commonly caused by viruses such as

influenza virus, respiratory syncytial virus (RSV), adenovirus,

and metapneumovirus. Herpes simplex virus is a rare cause of

pneumonia except in newborns. People with immune system

problems are also at risk for pneumonia caused by

cytomegalovirus (CMV).

Bacteria

Bacteria typically enter the lung when airborne droplets are

inhaled, but they can also reach the lung through the

bloodstream when there is an infection in another part of the

body. Many bacteria live in parts of the upper respiratory tract,

such as the nose, mouth and sinuses, and can easily be inhaled

into the alveoli. Once inside the alveoli, bacteria may invade the

spaces between cells and between alveoli through connecting

pores. This invasion triggers the immune system to send

neutrophils, which are the type of defensive white blood cell, to

the lungs. The neutrophils engulf and kill the offending

organisms, and they also release cytokines, causing a general

activation of the immune system. This leads to the fever, chills

and fatigue common in bacterial and fungal pneumonia. The

neutrophils, bacteria, and fluid from surrounding blood vessels

fill the alveoli and interrupt normal oxygen transportation. The

bacterium Streptococcus pneumonia, a common cause of

pneumonia, photographed through an electron microscope.

Bacteria often travel from an infected lung into the bloodstream,

causing serious or even fatal illness such as septic shock, with

low blood pressure and damage to multiple part of the body

including the brain, kidneys, and heart. Bacteria can also travel

to the area between the lungs and the chest wall (the pleural

cavity) causing a complication called an empyema.

The most common causes of bacterial pneumonia are

Streptococcus pneumonia, Gram-negative bacteria and

“atypical” bacteria. The terms “Gram-positive” and “Gram-

negative” refer to the bacteria’s color (purple or red,

respectively) when stained using a process call the Gram stain.

The term “atypical” is used because atypical bacteria commonly

affect healthier people, cause generally lea severe pneumonia,

and respond to different antibiotics than other bacteria. The

types of Gram-positive bacteria that cause pneumonia can be

found in the nose or mouth of many healthy people.

Streptococcus pneumonia, often called “pneumococcus”, is the

most common bacterial cause of pneumonia in all age groups

except newborn infants. Another important Gram-positive cause

of pneumonia is Staphylococcus aureus. Gram-negative bacteria

cause pneumonia less frequently than gram-positive bacteria.

Some of the gram-negative bacteria that cause pneumonia

include Haemophilus influenza, Klebsiella pneumonia,

Escherichia coli, Pseudomonas aeruginosa and Moraxella

catarrhalis. These bacteria often live in the stomach or intestines

and may enter the lungs if vomit is inhaled. “Atypical” bacteria

which cause pneumonia include Chlamydophila pneumonia,

Mycoplasma pneumonia, and Legionella pneumophila.

ANATOMY

The respiratory system consists of all the organs

involved in breathing. These include the nose, pharynx,

larynx, trachea, bronchi and lungs. The respiratory system

does two very important things: it brings oxygen into our

bodies, which we need for our cells to live and function

properly; and it helps us get rid of carbon dioxide, which is a

waste product of cellular function. The nose, pharynx, larynx,

trachea and bronchi all work like a system of pipes through

which the air is funneled down into our lungs. There, in very

small air sacs called alveoli, oxygen is brought into the

bloodstream and carbon dioxide is pushed from the blood out

into the air. When something goes wrong with part of the

respiratory system, such as an infection like pneumonia, it

makes it harder for us to get the oxygen we need and to get rid

of the waste product carbon dioxide. Common respiratory

symptoms include breathlessness, cough, and chest pain.

The Upper Airway and Trachea

When you breathe in, air enters your body through your

nose or mouth. From there, it travels down your throat

through the larynx (or voice box) 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

Structure

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.

How they work

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. Traveling 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.

MEDICAL MANAGEMENT

The goal of treatment is to cure the infection with

antibiotics. If the pneumonia is caused by a virus, antibiotics

will not be effective. Supportive therapy includes oxygen and

respiratory treatments to remove secretions.

NURSING MANAGMENT

The patient will need to have breath sounds monitored q

2 to determine if pneumonia is progressing.

O2 Sats should be done regularly ( at least q4during acute

phase) to make sure that patient is getting adequate

perfusion.

Make sure to give all scheduled antibiotics on schedule so

that therapeutic ranges are maintained.

Any s/s of infection must be monitored and reported to

MD.

Care given to patient includes nebulization.

Performed tepid sponge bath.

I and O taken every shift.

Positioning the patient in Semi-Fowler’s position

LABORATORY AND DIAGNOSTIC PROCEDURE

HEMATOLOGY REPORT

Examination Request: CBC

Date of the procedure: 11/04/2010

PARAMETER ACTUAL RESULT NORMAL

VALUES

Hemoglobin

Hematocrit

WBC Count

Differential Count

Segmenters

Lymphocytes

103

0.31

11.6

80

20

M=140-170g/L;

F=120-150g/L

M=0.40-0.50;

F=0.37-0.42

5-10 X 109/L

0.55-0.65

0.25-0.35

Date of the procedure: 11/06/2010

PARAMETER ACTUAL RESULT NORMAL

VALUES

Hemoglobin 108 M=140-170g/L;

F=120-150g/L

Hematocrit

WBC Count

Differential Count

Segmenters

Lymphocytes

0.32

14.8

79

21

M=0.40-0.50;

F=0.37-0.42

5-10 X 109/L

0.55-0.65

0.25-0.35

Date of the procedure: 11/04/2010

PARAMETER ACTUAL RESULT NORMAL

VALUES

Hemoglobin

Hematocrit

WBC Count

101

0.30

12.0

M=140-170g/L;

F=120-150g/L

M=0.40-0.50;

F=0.37-0.42

5-10 X 109/L

Differential Count

Segmenters

Lymphocytes

88

18

0.55-0.65

0.25-0.35

Urinalysis

Color: Yellow

Transparency: Clear

Reaction: (pH) 6.0

Protein: negative

Glucose: negative

Specific Gravity: 1.010

Pus cells: 0-1/HPF

RBC: 0-1/hpf

Epithelial Cell:

Chest X-ray

Date of the Procedure: 11/04/2010

CHEST AP/L

Streaky densities are seen in both lower lungs

Heart is not enlarged

Diaphragm and sulci are intact

Impression: Pneumonia, Bilateral

Date of the Procedure: 11/06/2010

CHEST AP/L

Follow-up film shows clearing of the previously noted bilateral

Pneumonia infiltrates

DISCHARGE PLAN

M – MEDICATION TO TAKE

- Instruct and explain the patient’s daughter that the medication is very important to continue depending on the duration that the doctor ordered for the total recovery of the patient.

E – EXERCISE

- Instruct the daughter to let the patient do normal activities but it should be limited to a short period

of time only to prevent the occurrence of shortness of breathing.

T – TREATMENT

- Advice the daughter to keep patient relax in order to recover in her present condition. Instruct the daughter to minimize the patient from exposure to an open environment such as dusty and smoky area, which airborne microorganism are present that can be a high risk factor that may cause severity of his condition.

H – HEALTH TEACHING

- Encourage and explain to patient’s family that it is important to maintain proper hygiene to prevent further infection. Instruct the patient every day and explain that bathing early in the morning is not a factor or cause of having pneumonia.

O – OUT PATIENT

- Regular consultation to the physician can be a factor for recovery and to assess and monitor the patient’s condition.

D – DIET

- Diet as tolerated.Diet plays a big role in fast recovery.

Etiology

Pneumonia is a serious infection or inflammation of

your lungs. The air sacs in the lungs fill with pus and other

liquid. Oxygen has trouble reaching your blood. If there is

too little oxygen in your blood, your body cells can’t work

properly. Because of this and spreading infection through

the body pneumonia can cause death. Pneumonia affects

your lungs in two ways. Lobar pneumonia affects a section

(lobe) of a lung. Bronchial pneumonia (or

bronchopneumonia) affects patches throughout both

lungs.

Bacteria are the most common cause of pneumonia.

Of these, Streptococcus pneumoniae is the most common.

Other pathogens include anaerobic bacteria,

Staphylococcus aureus, Haemophilus influenzae,

Chlamydia pneumoniae, C. psittaci, C. trachomatis,

Moraxella (Branhamella) catarrhalis, Legionella

pneumophila, Klebsiella pneumoniae, and other gram-

negative bacilli. Major pulmonary pathogens in infants and

children are viruses: respiratory syncytial virus,

parainfluenza virus, and influenza A and B viruses. Among

other agents are higher bacteria including Nocardia and

Actinomyces sp; mycobacteria, including Mycobacterium

tuberculosis and atypical strains; fungi, including

Histoplasma capsulatum, Coccidioides immitis,

Blastomyces dermatitidis, Cryptococcus neoformans,

Aspergillus fumigatus, and Pneumocystis carinii; and

rickettsiae, primarily Coxiella burnetii (Q fever).

The usual mechanisms of spread are inhaling

droplets small enough to reach the alveoli and aspirating

secretions from the upper airways. Other means include

hematogenous or lymphatic dissemination and direct

spread from contiguous infections. Predisposing factors

include upper respiratory viral infections, alcoholism,

institutionalization, cigarette smoking, heart failure, chronic

obstructive airway disease, age extremes, debility,

immunocompromise (as in diabetes mellitus and chronic

renal failure), compromised consciousness, dysphagia,

and exposure to transmissible agents.

Typical symptoms include cough, fever, and sputum

production, usually developing over days and sometimes

accompanied by pleurisy. Physical examination may

detect tachypnea and signs of consolidation, such as

crackles with bronchial breath sounds. This syndrome is

commonly caused by bacteria, such as S. pneumoniae

and H. influenza.

Drug Study

Medications:

Name of

Drug

Dosag

e &

Freque

Rout

e

Curative

Effects

Side Effects

ncy

AMPICILIN 110 mg

q6

TIV Antibiotic; for

bacterial

infection

caused by

Gram positive

and some

Gram

negative; for

anaerobic

bacteria

Diarrhea,

itching, difficulty

in breathing and

swallowing,

mild skin

rash,upset

stomach,vomiti

ng,wheezing

GENTAMI

CIN

17g

q24

TIV Antibiotic; for

bacterial

infection that

cause by

gram

negative

bacteria

Toxicity to the

vestibular

apparatus of

the inner

ear(OTOTOXIC

ITY) ,

Nephrotoxicity,

Gentamicin

toxicity

PARACET 50mg TIV Decrease Stimulation,

AMOL q4 for

37.8⁰

fever by

inhibiting the

effects of

pyrogens on

the

hypothalamic

heat

regulating

centers and

by a

hypothalamic

action leading

to sweating

and

vasodilatation

s.

drowsiness,

nausea,

vomiting,

abdominal pain,

hepatoxicity,

hepa

seizure(overdos

e), renal

failure(high

prolonged

doses),leucope

nia, rash,

hypersensitivity,

cyanosis,

anmenia,

jaundice etc..

GENTAMICIN- bacteriacidal

Symptoms of gentamicin toxicity include:

Balance difficulty

Bouncing, unsteady vision

Physical Assessment

Date assessed: November 9, 2010

Time Assessed: 3:00 P.M

Initial Vital Signs:

Temperature: 37.8C

Cardiac Rate: 80 beats per minute

Respiratory Rate: 34 breaths per minute

General Appearance: The pt. is asleep, lying on bed

with CTT on the right 5th ICS

Area Assessed Normal

Findings

Actual

Findings

Analysis

SKIN

color Tan(Dark

Brown)

Tan(Dark

Brown)

Normal

Texture Smooth, soft Smooth, soft Normal

Turgor Skin snaps

back

immediately

When

pinched

Skin snaps

back

immediately

when

pinched

Normal

Hair Distribution Evenly

distributed

Evenly

distributed

Normal

Temperature Warm to

touch

Too warm

when

touched

Febrile

Moisture Dry, skin

folds are

normally

moist

Dry, skin

folds are

normally

moist

Normal

NAILS

Color of Nail

bed

Pink and

clear

Pink and

clear

Normal

Texture Smooth Smooth Normal

Shape Convex

curvature

Convex

curvature

Normal

Nail base Firm Firm Normal

Capillary refill

time

2-3 seconds 2 sec. Normal

HAIR

Color Black

(varies)

Black Normal

Distribution Evenly

distributed

Evenly

distributed

Normal

Moisture Neither

excessively

dry nor oily

Neither

excessively

dry nor oily

Normal

Texture Silky,

resilient

Silky,

resilient

Normal

HEAD

Scalp symmetry Symmetrical Symmetrical Normal

Skull size Normocephal

ic

Normocephal

ic

Normal

Shape Round Round Normal

Nodules/ Absence of Absence of Normal

masses nodules and

masses

nodules and

masses

FACE

Symmetry Symmetrical Symmetrical Normal

Facial

movement

Symmetrical Symmetrical Normal

Skin color Tan Tan Normal

EYES

Eyebrows

Symmetricall

y aligned

Symmetricall

y aligned

Normal

Eyelashes Slightly

curved

upward

Slightly

curved

upward

Normal

Eyelids Smooth, tan,

do not cover

pupil as

sclera, close

symmetricall

y

Smooth, tan,

do not cover

pupil as

sclera, close

symmetricall

y

Normal

Ability to blink Blinks

voluntarily

Blinks

voluntarily

Normal

and

bilaterally

and

bilaterally

Ocular

movement

Eye moves

freely

Eye moves

freely

Normal

Position Drawn from

lateral angel

Drawn from

lateral angel

Normal

Size Medium Medium Normal

Texture Mobile, firm

and non-

tender

Mobile, firm

and non-

tender

Normal

CONJUCTIVA

Color Transparent

with light

color

Transparent

with light

color

Normal

Texture Shiny and

smooth

Shiny and

smooth

Normal

Presence of

lesions

No lesions No lesions Normal

APPARATUS

Cornea

Color Black Black Normal

Texture Shiny and

smooth

Shiny and

smooth

Normal

PUPILS

Color Black Black Normal

Size Equal Equal Normal

Shape Round and

constrict

briskly

Round and

constrict

briskly

Normal

Symmetry Equal in size Equal in size Normal

Ocular Eyes move

freely

Eyes move

freely

Normal

NOSE

Symmetry,

shape, size and

color

Symmetrical,

smooth and

tan

Symmetrical,

smooth and

tan

Normal

Mucosa color Reddish to

pinkish

Reddish to

pinkish

Normal

NASAL

SEPTUM

Nares

Oval,

symmetrical

Oval,

symmetrical

Normal

Nasal discharge No discharge No discharge Normal

Sinuses Not tender Not tender Normal

MOUTH

Secretion (neutral in

color) without

mucus

production

Mucus

production

Abnormal

due to

inflammati

on

Lips

Color

Pinkish to

slightly

brown

Pinkish to

slightly

brown

Normal

Symmetry Symmetrical Symmetrical Normal

Texture Soft, moist,

smooth

Soft, moist,

smooth

Normal

Moisture Soft and

moist

Soft and

moist

Normal

GUMS

Color Pinkish Pinkish Normal

Moisture Moist Moist Normal

BUCCAL

MUCOSA

Color Glistening

pink

Glistening

pink

Normal

Moisture Moist Moist Normal

TOUNGE

Color Pinkish Pinkish Normal

Size Medium Medium Normal

Symmetry Symmetrical Symmetrical Normal

Mobility Moves freely Moves freely Normal

UVULA

Location At the

midline

At the

midline

Normal

Symmetry Symmetrical Symmetrical Normal

TONSILS

Color Pinkish Pinkish Normal

Discharges No No Normal

discharges discharges

NECK

Position Head-

centered

Head-

centered

Normal

Movement Moves freely Moves not

freely

Due to age

Range of

motion

Full range Full range Normal

HEART

Heart rate 120-160

beats per

minute for

infants

130 beats

per minute

Normal

Heart sounds Clear,

without

crackles

Crackling Due to the

presence

of phlegm

and

increased

mucus

production

Lung field Resonant With crackles Due to

secretions

THORAX &

LUNGS

POSTERIOR

THORAX

Symmetry Symmetrical Symmetrical Normal

Respiratory rate 30-60

breaths per

minute for

the infant

54 Normal

Spinal

Alignment

Spine

vertically

align

Spine

vertically

align

Normal

Skin integrity Skin intact Skin intact Normal

ANTERIOR

THORAX

Breathing

pattern

Breathing is

automatic

and

effortless,

Breathing is

with effort,

produces

noise when

Due to

secretions

in the

regular and

even and

produces no

noise

breathing lungs

Lung/ breath

sounds

Bronchia-

vesicular

crackles Due to the

constriction

of the

bronchus

ABDOMEN

Contour Flat Flat Normal

Texture Smooth Smooth Normal

Frequency and

character

Audible; soft

gurgling

sound occur

irregularly

and rages

from 5-30

mins

Audible; soft

gurgling

sound occur

irregularly

and rages

from 5-30

mins

Normal

UPPER

EXTREMITY

Skin color Tan Tan Normal

Size (arms) Equal Equal Normal

Symmetry Symmetrical Symmetrical Normal

Hair distribution Evenly

distributed

Evenly

distributed

Normal

LOWER

EXTREMITY

Skin color Tan Tan Normal

Size (legs) Equal Equal Normal

Symmetry Symmetrical Symmetrical Normal

Hair distribution Evenly

distributed

Evenly

distributed

Normal

NEUROLOGIC

AL

Level of

consciousness

Alert and

responsive

Irritable Due to her

fever and

IV line

TONE High pitched

sound when

crying

Low pitched

sound when

crying

Due to her

inflammate

d lungs

Assessm

ent

Diagno

sis

Inference Planning Interventi

on

Evalauati

on

Subjecti

ve:

“nahihira

pan

akong

huminga

”

Objectiv

e:

Dyspnea

Acute

pain at

the

chest

and

persisit

ent

cough

Malnutriti

on

Difficulty

of

braething

Persisitent

cough

After 4

gours of

nursing

intervent

ion, the

patient

will

display

patent

airway

with

breath

sounds

Imdepend

ent

Eleva

te

head

of

bed,

chan

ge

positi

on

frequ

ently

After 4

hours of

nursing

interventi

ons, the

patient

was able

to display

patent

airway

with

breath

sounds

Fatigue

PNEUMO

NIA

clearing

and

absence

of

dyspnea

Assis

t

patie

nt

with

deep

breat

hing

exerc

ises

Help

patie

nt to

perfo

rm

activi

ty

like

effect

ive

coug

clearing

and

absence

of

dyspnea

hing

while

in

uprig

ht

positi

on

What is ranitidine?

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Ranitidine is in a group of drugs called histamine-2 blockers. Ranitidine works by reducing the amount of acid your stomach produces.

Ranitidine is used to treat and prevent ulcers in the stomach and intestines. It also treats conditions in which the stomach produces too much acid, such as Zollinger-Ellison syndrome. Ranitidine also treats gastroesophageal reflux disease (GERD) and other conditions in which acid backs up from the stomach into the esophagus, causing heartburn.

Before using ranitidine

Do not use this medication if you are allergic to ranitidine.

Heartburn is often confused with the first symptoms of a heart attack. Seek emergency medical attention if you have chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, and a general ill feeling.

Ask a doctor or pharmacist if it is safe for you to take ranitidine if you have:

kidney disease; liver disease; or

porphyria.

Ranitidine side effects

Stop using ranitidine and get emergency medical help if you have any of these signs of an allergic reaction to ranitidine: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking ranitidine and call your doctor at once if you have a serious side effect such as:

chest pain, fever, feeling short of breath, coughing up green or yellow mucus;

easy bruising or bleeding, unusual weakness;

fast or slow heart rate;

problems with your vision;

fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; or

nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious ranitidine side effects may include:

headache (may be severe); drowsiness, dizziness;

sleep problems (insomnia);

decreased sex drive, impotence, or difficulty having an orgasm; or

swollen or tender breasts (in men);

nausea, vomiting, stomach pain; or

diarrhea or constipation.

What other drugs will affect ranitidine?

Before taking ranitidine, tell your doctor if you are taking triazolam (Halcion). You may not be able to use ranitidine, or you may need dosage adjustments or special tests during treatment.

There may be other drugs that can interact with ranitidine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.