CLINICAL SUMMARY

Personal data
Name: K.S
Age: 2 month old
Sex: female
Religion: Roman Catholic
Place of Birth: Calamba, Laguna
Date Admitted: February 1, 2013
Admitting Physician: Dr.
Admitting Diagnosis: T/C Pneumonia
ASSESSMENT
Physical Assessment
General survey: Temp: 37, HR: 140, RR: 85, Patient appears conscious, hyperventilate
Skin: pale pink, warm to touch
Nose and sinuses: external structure without deformity, asymmetry or inflammation. Nares has few
secretions
Chief complaint: difficulty of breathing

Application of theory

Self-Care Deficit Theory

Definition of Nursing
The provision of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury, or coping
with their effects.
A service to people, not a derivative of medicine.
Nursing promotes the goal of patient self-care.

Orems General Theory of Nursing

(3 related theories collectively referred to as Orems General Theory of Nursing)

1. Self-care Theory: three types of self-care requisites (needs) or categories based on the concepts of:

a. SELF-CARE
- comprises those activities performed independently by an individual to promote and maintain personal well-being
throughout life.

b. SELF-CARE AGENCY
- the individuals ability to perform self-care activities. Consists of TWO agents:
b1. Self-care Agent - person who provides the self-care
b2. Dependent Care Agent - person other than the individual who provides the care (such as a parent)

c. SELF-CARE REQUISITES
- the actions or measures used to provide self-care. Consists of THREE categories:
c1. Universal - requisites/needs that are common to all individuals
c2. Developmental - needs resulting from maturation or develop due to a condition or event
c3. Health Deviation - needs resulting from illness, injury & disease or its treatment
d. THERAPEUTIC SELF-CARE DEMAND
- Therapeutic self-care demand represents the totality of action required to meet a set of self-care requirements using a
set of technologies (McLaughlin-Renpenning, & Taylor, 2002, p.175)

2. Self-Care Deficit Theory

Five Methods of Assistance
-

is the central focus of Orems Grand Theory of Nursing

explains when nursing is needed
describes and explains how people can be helped through nursing
results when the Self-care Agency (patient) cant meet her/his self-care needs or administer self-care
nursing meets these self-care needs through five methods of help

Five Methods of Nursing Help

-Acting or doing for

-Guiding
-Teaching
-Supporting
-Providing an environment to promote the patients ability to meet current or future demands

3. Nursing Systems Theory

- Describes nursing responsibilities, roles of the nurse and patient, rationales for the nurse-patient relationship, and types
of actions needed to meet the patients demands
- Refers to a series of actions a nurse takes to meet a patients self-care needs, is determined by the patients self-care
needs, is composed of THREE systems:
Wholly compensatory
Partly compensatory
Supportive-educative

Background

Pneumonia is one of the most common medical problems encountered in clinical practice and leading fatal infectious
disease worldwide. In the Philippines last 2011 based on a number of health insurance claims by Philhealth revealed as
one of the top cases acquired disease in the country.
Its also ranked as the eight leading cause of death in the US consistently accounts for the overwhelming majority death in
2006, were in 55,477 people died of pneumonia.
Pneumonia is caused by a number of infectious agents including viruses, bacteria, and fungi. The most common bacterial
pathogen, Streptococcus pneumoniae, is identified as the leading cause of community-acquired pneumonia among
children and adults.
Two causes of Pneumonia

Primary pneumonia -is caused by the patients inhaling or aspirating a pathogen.

Secondary pneumonia -ensues from lung damage caused by the spread of bacteria from an infection elsewhere in
the body. Likely causes include various infectious agents, chemical irritants (including gastric reflux/aspiration, smoke
inhalation), and radiation therapy. This plan of care deals with bacterial and viral pneumonias, e.g., pneumococcal
pneumonia, Pneumocystis carinii, Haemophilus influenzae,mycoplasma, and Gram-negative microbes.

Pneumonia can occur at any age, although it is more common in younger children. Pneumonia accounts for 13% of all
infectious illnesses in infants younger than 2 years.
Newborns with pneumonia commonly present with poor feeding and irritability, as well as tachypnea, retractions, grunting,
and hypoxemia. Infections with group BStreptococcus, Listeria monocytogenes, or gram-negative rods (eg, Escherichia
coli, Klebsiella pneumoniae) are common causes of bacterial pneumonia. Group B streptococci infections are most often
transmitted to the fetus in utero. The most commonly isolated virus is respiratory syncytial virus (RSV).
Cough is the most common symptom of pneumonia in infants, along with tachypnea, retractions, and hypoxemia. These
may be accompanied by congestion, fever, irritability, and decreased feeding. Streptococcus pneumoniae is by far the
most common bacterial pathogen in infants aged 1-3 months.
Adolescents experience similar symptoms to younger children. They may have other constitutional symptoms, such as
headache, pleuritic chest pain, and vague abdominal pain. Vomiting, diarrhea, pharyngitis, and otalgia/otitis are also

common in this age group. Mycoplasma pneumoniae is the most frequent cause of pneumonia among older children and
adolescents.

Diagnostic test

Physical exam. During the exam, the physician listens to patients lungs with a stethoscope to check for abnormal
bubbling or crackling sounds (rales) and for rumblings (rhonchi) that signal the presence of thick liquid.
Chest X-rays. X-rays can confirm the presence of pneumonia and determine the extent and location of the
infection.
Blood and mucus tests. The patient may have a blood test to measure the white cell count and look for the
presence of viruses, bacteria or other organisms. The physician also may examine a sample of the mucus or the
blood to help identify the particular microorganism that's causing the patients illness.

Anatomy & Physiology

Human Respiratory System

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
funnelled 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 voicebox) and into the trachea (or windpipe) before entering your lungs. All these structures act to funnel fresh
air down from the outside world into your body. The upper airway is important because it must always stay open for you to
be able to breathe. It also helps to moisten and warm the air before it reaches your lungs.
The Lungs
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. Travelling in the opposite direction is carbon dioxide, which
crosses from the blood in the capillaries into the air in the alveoli and is then breathed out. In this way, you bring in to your
body the oxygen that you need to live, and get rid of the waste product carbon dioxide.

Blood Supply
The lungs are very vascular organs, meaning they receive a very large blood supply. This is because the pulmonary
arteries, which supply the lungs, come directly from the right side of your heart. They carry blood which is low in oxygen
and high in carbon dioxide into your lungs so that the carbon dioxide can be blown off, and more oxygen can be absorbed
into the bloodstream. The newly oxygen-rich blood then travels back through the paired pulmonary veins into the left side
of your heart. From there, it is pumped all around your body to supply oxygen to cells and organs.

The Work of Breathing

The Pleurae
The lungs are covered by smooth membranes that we call pleurae. The pleurae have two layers, a 'visceral' layer which
sticks closely to the outside surface of your lungs, and a 'parietal' layer which lines the inside of your chest wall (ribcage).
The pleurae are important because they help you breathe in and out smoothly, without any friction. They also make sure
that when your ribcage expands on breathing in, your lungs expand as well to fill the extra space.

The Diaphragm and Intercostal Muscles

When you breathe in (inspiration), your muscles need to work to fill your lungs with air. The diaphragm, a large, sheet-like
muscle which stretches across your chest under the ribcage, does much of this work. At rest, it is shaped like a dome
curving up into your chest. When you breathe in, the diaphragm contracts and flattens out, expanding the space in your
chest and drawing air into your lungs. Other muscles, including the muscles between your ribs (the intercostal muscles)
also help by moving your ribcage in and out. Breathing out (expiration) does not normally require your muscles to work.
This is because your lungs are very elastic, and when your muscles relax at the end of inspiration your lungs simply recoil
back into their resting position, pushing the air out as they go.
The Respiratory System Through the Ages
Breathing for the Premature Baby
When a baby is born, it must convert from getting all of its oxygen through the placenta to absorbing oxygen through its
lungs. This is a complicated process, involving many changes in both air and blood pressures in the baby's lungs. For a
baby born preterm (before 37 weeks gestation), the change is even harder. This is because the baby's lungs may not yet
be mature enough to cope with the transition. The major problem with a preterm baby's lungs is a lack of something called
'surfactant'. This is a substance produced by cells in the lungs which helps keep the air sacs, or alveoli, open. Without
surfactant, the pressures in the lungs change and the smaller alveoli collapse.

This reduces the area across which oxygen and carbon dioxide can be exchanged, and not enough oxygen will be taken
in. Normally, a foetus will begin producing surfactant from around 28-32 weeks gestation. When a baby is born before or
around this age, it may not have enough surfactant to keep its lungs open. The baby may develop something called
'Neonatal Respiratory Distress Syndrome', or NRDS. Signs of NRDS include tachypnoea (very fast breathing), grunting,
and cyanosis (blueness of the lips and tongue). Sometimes NRDS can be treated by giving the baby artifically made
surfactant by a tube down into the baby's lungs.
The Respiratory System and Ageing

The normal process of ageing is associated with a number of changes in both the structure and function of the
respiratory system. These include:
Enlargement of the alveoli. The air spaces get bigger and lose their elasticity, meaning that there is less area for
gases to be exchanged across. This change is sometimes referred to as 'senile emphysema'.
The compliance (or springiness) of the chest wall decreases, so that it takes more effort to breathe in and out.
The strength of the respiratory muscles (the diaphragm and intercostal muscles) decreases. This change is closely
connected to the general health of the person.
All of these changes mean that an older person might have more difficulty coping with increased stress on their
respiratory system, such as with an infection like pneumonia, than a younger person would.

Treatments and drugs

Medication
Antibiotics are used to treat bacterial pneumonia. Other medications may help improve breathing and relieve symptoms in
bacterial and viral pneumonia. Medication options include:

Antibiotics. The decision to treat pneumonia with an antibiotic isn't always straightforward. Even with a high
likelihood of bacterial infection, it takes time to identify the bacterium involved and choose the best antibiotic to
wipe it out. Initially, the physician may prescribe a particular antibiotic based on trends in infection and antibiotic
use in the area. If tests show that the patient need a different drug or the condition doesn't improve, they may
switch to another antibiotic.
Antivirals. The physician may recommend antiviral medication for viral pneumonia. Antibiotics are not effective for
treating viral pneumonia.
Fever reducers. The patient may treat their fever with aspirin, ibuprofen, naproxen or acetaminophen. (Children
should not take aspirin.)
Cough medicine. Talk to the physician before taking cough medicine. Coughing helps loosen and get rid of extra
sputum. If the physician advises cough medicine, only take enough to calm the patients cough and get some rest.

NURSING CARE PLAN

Problem: Ineffective Airway Clearance

Cues
nahihirapan
siyang
huminga , as
verbalized by
the mother of
the patient

Diagnosis
Ineffective airway
clearance
related presence
of secretions
secondary to
pneumonia.

Goals
Short term:
After the nursing
intervention, the patient
will be able to maintain
airway patency

Nursing Intervention

Independent :
Assess rate/depth of
respirations and
chest movement.

Long term:
Objective
cues: RR: 70,
rapid, shallow
HR: 137
Temp: 36.7
The patient is
coughing,
having
difficulty of
breathing, with
few secretions
in her nostrils

Definition: The
inflammation and
increased
secretions make
it difficult to
maintain a patent
airway, which is
cause by
decrease ability
to expel the
excessive mucus
produced that will
lead to extensive
obstruction of the

After the nursing

intervention, the patient
will be able to improved
gas exchange (e.g., ABG
results)

Auscultate lung
fields, noting areas of
decreased/absent
airflow and
adventitious breath
sounds, e.g.,

Rationale

Evaluation

After the 8 hours

of shift, the
Tachypnea, shallow
patient
respirations, and
maintained
asymmetric chest
airway patency
movement are frequently with clear breath
present because of
sounds; absence
discomfort of moving
of dyspnea. ABG
chest wall and/or fluid in results returns to
lung.
normal

Decreased airflow
occurs in areas
consolidated with fluid.
Bronchial breath sounds
(normal over bronchus)
can also occur in
consolidated areas.
Crackles, rhonchi, and
wheezes are heard on

airway.

crackles, wheezes.

inspiration and/or
expiration in response to
fluid accumulation, thick
secretions, and airway
spasm/obstruction.
Lowers diaphragm,
promoting chest
expansion, aeration of
lung segments,
mobilization and
expectoration of
secretions.

Elevate head of bed,

change position
frequently.

Suction as indicated
(e.g., frequent or
sustained cough,
adventitious breath
sounds, desaturation
related to airway
secretions).

Stimulates cough or
mechanically clears
airway in patient who is
unable to do so because
of ineffective cough or
decreased level of
consciousness.
Fluids (especially warm
liquids) aid in
mobilization and
expectoration of
secretions.
Facilitates liquefaction

Force fluids to at
least 3000 mL/day
(unless
contraindicated, as in
heart failure). Offer
warm, rather than
cold, fluids.

Assist with/monitor
effects of nebulizer
treatments and other
respiratory
physiotherapy, e.g.,
incentive spirometer,
IPPB, percussion,
postural drainage.
Perform treatments
between meals and
limit fluids when
appropriate.

Administer
medications as
indicated: mucolytics,
expectorants,
bronchodilators,

and removal of
secretions. Postural
drainage may not be
effective in interstitial
pneumonias or those
causing alveolar
exudate/destruction.
Coordination of
treatments/schedules
and oral intake reduces
likelihood of vomiting
with coughing,
expectorations.

Aids in reduction of
bronchospasm and
mobilization of
secretions. Analgesics
are given to improve
cough effort by reducing
discomfort, but should
be used cautiously
because they can
decrease cough
effort/depress
respirations.
Fluids are required to

analgesics.
Provide
supplemental fluids,
e.g., IV, humidified
oxygen, and room
humidification.

replace losses (including

insensible) and aid in
mobilization of
secretions. Note: Some
studies indicate that
room humidification has
been found to provide
minimal benefit and is
thought to increase the
risk of transmitting
infection.

Problem: Risk for Infection

Cues

Diagnosis

Goals

Objective
cues;

Risk for
infection
related to
Inadequate
primary
defenses
(decreased
ciliary

After the 8
hours of shift,
the patient will
be able to
achieve timely
resolution of
current infection
without

Patient is
coughing
. Have
few
secretion

Nursing Intervention

Rationale

Independent:
Monitor vital signs
closely, especially during
initiation of therapy.

Instruct patient
concerning the

During this period of

time, potentially fatal
complications
(hypotension/shock)
may develop.
Although patient

Evaluation
After the 8 hours of shift, the patient will
achieve timely resolution of current
infection without complications.

s in her
nostrils

action,
stasis of
respiratory
secretions)

complications.

disposition of secretions
(e.g., raising and
expectorating versus
swallowing) and
reporting changes in
color, amount, odor of
secretions.
Demonstrate/encourage
good hand washing
technique.
Change position
frequently and provide
good pulmonary toilet.
Encourage adequate rest
balanced with moderate
activity. Promote
adequate nutritional
intake.
Investigate sudden
changes/deterioration in
condition, such as
increasing chest pain,
extra heart sounds,
altered sensorium,
recurring fever, changes
in sputum
characteristics.

may find
expectoration
offensive and
attempt to limit or
avoid it, it is
essential that
sputum be disposed
of in a safe manner.
Changes in
characteristics of
sputum reflect
resolution of
pneumonia or
development of
secondary infection.

Effective means of
reducing spread or
acquisition of
infection.
Promotes
expectoration,
clearing of infection.

Facilitates healing
process and
enhances natural
resistance.
Delayed recovery or
increase in severity

Collaborative:
Prepare for/assist with
diagnostic studies as
indicated.

of symptoms
suggests resistance
to antibiotics or
secondary infection.
Complications
affecting any/all
organ systems
include lung
abscess/empyema,
bacteremia,
pericarditis/endocard
itis,
meningitis/encephalit
is, and
superinfections.

Problem : Impaired Gas Exchange

Cues

nahihirapa
n siyang

Diagnosis

Impaired gas

Goals

Nursing
Intervention
Independent
:

Rationale

Evaluation

After the 8 hours of

huminga ,
as
verbalized
by the
mother of
the patient
Objective
cues: RR:
70, rapid,
shallow
HR: 137
Temp: 36.7

Objective
cues:
Patient is
coughing,
having
difficulty of
breathing
Have few
secretions
in her

exchange related to
altered delivery of
oxygen as
evidenced by
hyperventilate

After the nursing

intervention, the
patient will be able
to demonstrate
improved ventilation
and oxygenation of
tissues by ABGs as
evidenced by
absence of
symptoms of
respiratory distress.

Assess
respiratory
rate, depth,
and ease.

Observe
color of skin,
mucous
membranes,
and
nailbeds,
noting
presence of
peripheral
cyanosis
(nailbeds) or
central
cyanosis
(circumoral).

Manifestations of respiratory nursing shift, the patient

distress are dependent
is free of symptoms of
on/and indicative of the
respiratory distress
degree of lung involvement
and underlying general
health status.

Cyanosis of nailbeds may

represent vasoconstriction
or the bodys response to
fever/chills; however,
cyanosis of earlobes,
mucous membranes, and
skin around the mouth
(warm membranes) is
indicative of systemic
hypoxemia.
Restlessness, irritation,
confusion, and somnolence
may reflect hypoxemia/
decreased cerebral
oxygenation.

Tachycardia is usually
present as a result of
fever/dehydration but may

nostrils

represent a response to
hypoxemia.

Assess
mental
status

Monitor
heart
rate/rhythm.

Monitor body
temperature,
as indicated.
Assist with
comfort
measures to
reduce fever

High fever (common in

bacterial pneumonia and
influenza) greatly increases
metabolic demands and
oxygen consumption and
alters cellular oxygenation.

Prevents over exhaustion

and reduces oxygen
consumption/demands to
facilitate resolution of
infection.

and chills,
e.g.,
addition/rem
oval of
bedcovers,
comfortable
room
temperature,
tepid or cool
water
sponge bath.

Maintain
bedrest.
Encourage
use of
relaxation
techniques
and
diversional
activities.

Management

Stay rested and fit. Proper rest and moderate exercise can help keep the immune system strong.
Drink plenty of fluids, especially water. Liquids keep you from becoming dehydrated and help loosen mucus in
your lungs.
Wash your hands. Washing hands often and thoroughly can help reduce the risk. When washing isn't possible,
use an alcohol-based hand sanitizer.
Eat a healthy diet. Include plenty of fat-free dairy products, fruits, vegetables and whole grains.
Take the entire course of any prescribed medications. If the patient stop medication too soon, their lungs may
continue to harbor bacteria capable of multiplying and causing a relapse of their pneumonia. Also, bacteria begin to
develop drug resistance when they survive inadequate treatment and continue to multiply and spread.
Keep all of follow-up appointments. It's important to have the physician monitor the progress of the disease

DRUG STUDY

Name of the
Drug

Classificati
on

Indication

Mechanism
of Action

Side Effects

Contraindication

Generic name:
ampicillin

penicillins

Treatment of
respiratory
tract
infections,
UTI, Intra
abdominal,
sin and soft
tissue, bone
and joint

Ampicillin is
a b-lactam
antibiotic
with a mode
of action
similar to
benzylpenicil
lin. It enables
it to
penetrate
the outer
member of
some gramnegative
bacteria

Confusion,
dizziness,
urine
retention,
dysuria

History of allergic
reactions to any
of the penicillins,
cephalosporins

Brand name:
ampipax

Nursing
responsibilities
Assess patient
for signs and
symptoms of
infection
Assess history
of previous
sensitivity
reactions to
penicillins or
other
caphalosporins
Instruct
patient to take
all medication
prescribed for
the length of
time ordered
Instruct
patient if
diarrhea with
blood or pus
occur which
may indicate
pseudomembr
aneous colitis,
notify

physician
immediately

Generic
Name
Brand Name
Paracetamol/
Acetaminophe
n
Tylenol
Dosages:
Age
Dosa
ge
(mg)
0-3
40
mo.
4-11
80
mo.
12120
23
mo.
2-3
160
yr.
4-5
240
yr.
6-8
320
yr.
9-10
400
yr.
11
480
yr.

Classific
ation

Action

Indication

Adverse
reactions

Contraindica
tion

Nursing
Consideration

Analgesi
c

Algesics:
pain reducer

Antipyret
ic

Antipyretic:
reducer
fever by
acting
directly on
the
hypothalami
c heatregulating
center to
cause
vasodilation
and
sweating,
which helps
dissipate
heat.

Analgesicantipyretic in
patients with
aspirin allergy,
hemostatic
disturbances,
bleeding
diatheses,
upper GI
disease, gouty,
arthritis

CNS:
Headache
CV:
Chest
pain,dyspnea,
myocardialdamage
whendoses of 58
g/dayare ingested
dailyfor several
weeksor when
doses of 4g/day
are ingestedfor 1
yr
GI: Hepatictoxicity
andfailure,
jaundice
GU:
Acute
kidneyfailure,
renaltubular
necrosis
Hematologic:
Methemoglobinemi
a
cyanosis;hemolytic
anemia
hematuria,
anuria;neutropenia

Contraindicat
ed with
allergy to
acetaminophe
n

Do not exceed
the
recommended
dosage
Consult the
physician if
needed for
children < 3yr.;
if needed for
tlonger 10
days; if
continued fever
severe or
recurrent pain
occur
Avoid using
multiple
preparations
containing
acetaminophen.
Carefully check
all OTC
products
Give drug with
food. If GI upset
occurs.
Discontinue
drug if
hypersensitivity

Arthritis and
rheumatic
disorders
involving
musculoskeleta
l pain
Common cold,
flu, other viral
and bacterial
infection with
pain and fever

Use
cautiously
with impaired
hepatic
function,
chronic
alcoholism
and
pregnancy,
lactation

,leukopenia,pancyt
openia,thrombocyt
openia,hypoglyce
mia
Hypersensitivity:
Rash, fever

Generic
Name
Brand Name
Paracetamol/
Acetaminophe
n
Tylenol
Dosages:
Age
Dosa
ge
(mg)
0-3
40
mo.
4-11
80
mo.
12120
23
mo.
2-3
160
yr.
4-5
240

relations occur.

Classific
ation

Action

Indication

Adverse
reactions

Contraindica
tion

Nursing
Consideration

Analgesi
c

Algesics:
pain reducer

Antipyret
ic

Antipyretic:
reducer
fever by
acting
directly on
the
hypothalami
c heatregulating
center to
cause
vasodilation
and
sweating,
which helps
dissipate
heat.

Analgesicantipyretic in
patients with
aspirin allergy,
hemostatic
disturbances,
bleeding
diatheses,
upper GI
disease, gouty,
arthritis

CNS:
Headache
CV:
Chest
pain,dyspnea,
myocardialdamage
whendoses of 58
g/dayare ingested
dailyfor several
weeksor when
doses of 4g/day
are ingestedfor 1
yr
GI: Hepatictoxicity
andfailure,
jaundice
GU:
Acute
kidneyfailure,
renaltubular

Contraindicat
ed with
allergy to
acetaminophe
n

Do not exceed
the
recommended
dosage
Consult the
physician if
needed for
children < 3yr.;
if needed for
tlonger 10
days; if
continued fever
severe or
recurrent pain
occur
Avoid using
multiple
preparations
containing
acetaminophen.

Arthritis and
rheumatic
disorders
involving
musculoskeleta
l pain
Common cold,

Use
cautiously
with impaired
hepatic
function,
chronic
alcoholism
and
pregnancy,
lactation

yr.
6-8
yr.
9-10
yr.
11
yr.

flu, other viral

and bacterial
infection with
pain and fever

320
400
480

Pathophysiology of Pneumonia

Contributing factor
bacteria
Predisposing factor
Age

necrosis
Hematologic:
Methemoglobinemi
a
cyanosis;hemolytic
anemia
hematuria,
anuria;neutropenia
,leukopenia,pancyt
openia,thrombocyt
openia,hypoglyce
mia
Hypersensitivity:
Rash, fever

Carefully check
all OTC
products
Give drug with
food. If GI upset
occurs.
Discontinue
drug if
hypersensitivity
relations occur.

Staphylococcus pneumoniae

Organisms enter the

respiratory tract through
inspiration/ aspiration

Activation of defense
mechanism

Lose effectiveness of defense

mechanism

Penetrate the sterile lower

respiratory tract (lungs)

Penetrate the sterile lower

respiratory tract (lungs)

alveoli

multiplies

Irritation
of airway

colonization

Release damaging
toxins

Increase goblet
cell

Occlude
d the
airway

Increase mucus
production

Infection
cough
Exudates come
from bacteria
erode the lung

Dead

crackles

Inflammation

Vasodilation

hyperventilatio
n

Airway
constriction

space
Increased
respiratory

Difficulty of
breathing

Inflamed and fluid

filled alveolar sacs
Increased
blood flow
Dead space
happened

Decrease CO2
Plasma and
CHON rich fluid
leakage
Lung
Accumulation
of
consolidation
edematous fluid

Hypoxia

Impaired o2
and CO2
exchange

Ventilator
demands

Impaired O2 and
Co2 exchange

A CASE STUDY OF
PNEUMONIA

As a partial requirement in
Related Learning Experience (RLE)

Prepared and presented by:

Granada, Abigail F.
4BSN1-Group 2

Conducted at
Calamba Medical Center- Calamba, Laguna

Submitted to:
Margarita Samson RN, MAN

Abigail F. Granada, BS Nursing

c/o Romeo Banatlao
Campus Ministry Department
Colegio de San Juan de Letran Calamba
Bo. Bucal, Calamba City, Laguna 4027