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Pneumonia –
Moderate Risk
Ward Nursing Training
Program
Group 1
Patricia G. Tatiana
Ricarte, Jean V.
RN Bautista,
RN
Presente
d by:
Cristine Juvy Anne L. Cindy Ruth
Gretchen E. Gubantes, M. Ypilan,
Chiew, RN RN RN
Introduction
You would think that in the
light of modern medical treatment
and wide availability of
antibiotics, pneumonia would no
longer kill us, right? Wrong! For
adults, this occur mainly as a
complication of other chronic
diseases like lung cancer, COPD,
tuberculosis, and other
debilitating illnesses that leave
them bedridden most of the time.
Community-acquired
pneumonia (CAP) is a disease
in which individuals who have
not recently been hospitalized
develop an infection of the
lungs (pneumonia). Pneumonia
is an inflammation of the lower
air passages and air sacs of the
lungs resulting from infection
of the parenchyma of the
lungs. CAP is a common illness
and can affect people of all
Community-acquired
pneumonia (CAP) remains
a major cause of death
worldwide accounting for
an estimated five (5)
million deaths per year.
In developed countries,
the antimicrobial era has
brought a 66% reduction
Studying this disease will hopefully
give us nurses, together with the rest
of the health-care team, some more
updated information regarding the
disease and its proper management,
and the different nursing
responsibilities that should be taken
into consideration when faced with
this kind of case. Also, this case study
can contribute greatly to the nursing
research by providing necessary data
that could serve as basis for future
studies. Knowledge accumulated from
the making of this study helps in the
The study is all about Patient
“Mumai”, 33-year old female
diagnosed with CAP-Moderate Risk.
Information relevant to the disease
treatment and prevention are being
tackled with complete reliable
information during the interview
phase relevant to the building of
concrete data that further
nourished the study. The group
hopes to contribute scholarly
manuscript that depicts the
“Mumai”
Age: 33 years old Sex : Female
Marital Status: Married
Height: 5’2” Weight: 68 kilos
Address: Dumalag 1, Matina Aplaya Davao
City 8000
Religion: Foursquare
Birthdate: April 26, 1977
Diagnosis: Community
Acquired Pneumonia MR
Admitting Physician: Dr. Carl
Hill N. Florida
Background of the Study
Patient Mumai is a 33-year old
female who was rushed to the
Emergency Room of Southern
Philippines Medical Center last June
24, 2010 due to onset of cough and
an on & off fever for two (2) weeks.
She also experienced back pain at
the right side. The client was initially
seen by Dr. Florida and was admitted
under his service at Medicine
Objectives
General
Objective:
This study aims to provide
the nurses, future researchers,
readers and general
audiences to understand,
learn and gain more
knowledge regarding the case
of our patient; that is CAP-MR.
Specific
Objectives: To establish rapport with the
client and her family in order to
develop therapeutic working
relationship and gain trust for
obtaining significant information;
To present the client’s personal
and clinical data;
To trace the client’s health
history (past and present) as well
as the family health history
through the use of a genogram to
relate it to the client’s present
condition;
Specific
Objectives:
To discuss the etiology and
symptomatology of the
disease process;
To present the diagnostic
examinations and their
implications;
To present the drug studies of
all the prescribed medications
with the corresponding
nursing responsibilities;
To develop appropriate
NURSING
HEALTH
HISTORY
Nursing History
History of Past
Illness
The client had completed her
immunization from 0-5 years of age.
She completed her vaccination from
tetanus toxoid and hepatitis B booster
during her adolescent years. She had
no history of serious illnesses except
for common colds, fever and cough. At
the age of 5-14 years of age, she
acquired common childhood diseases
such as measles, mumps and chicken
History of Present Illness
Fifteen (15) days prior to
admission, the client experienced
a cough and a n on & off-low
grade fever anytime of the day.
She consulted a doctor who
prescribed her Salbutamol. This
somehow gave relief on her,
however, her health condition
didn’t subside. Seven (7) days
prior to admission, then she
experienced a back pain at the
right side and, which is also
Sociocultural Background of the
Family
Patient Mumai belongs to a
Bisaya group wherein her
biological parents, Kokoy and
Kikay, raised her in the place of
Calinan. She has eight (8)
siblings and she’s the fourth
child. When she decided to get
married, she separated with her
parents and live together with
ANATOMY AND
PHYSIOLOGY
The next structure after the larynx is the
trachea which leads down to the lower respiratory
system. From the trachea are the bronchi, which
branch down to the pleural cavity, where both lungs
are located. Each lung consists of lobes separated
by deep fissures.
Click to edit Master text stylesThe right lung has three
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elastic fibers that give the
ability to handle large
changes in air volume. The
diaphragm is the muscle
that makes up the floor of
the thoracic cavity and
plays a major role in the
pressure and volume of air
moving in and out of the
PATHOPHYSIOL
OGY
narative
Inhalation of the infectious agent causes it to transverse thru the upper
respire airways. Damaging toxins are being released and are multiplied
within the system downwards causing a disease called pneumonia or the
inflammation and edema of the lungs.
At the same time, Normal defense mechanisms occur such as the cough
reflex, mucocilliary transport, pulmonary macrophage, fever,
phagocytosis and increased metabolic demands.
If left untreated, this would result to accumulation of debris, fluids and
exudates which consolidates the lung tissues, ending up in alveolar
collapse, atelectasis, respiratory distress and a possible death.
Recovery usually involves focal organization of the lung by fibrosis,
returning to normal structure and functioning by resolution through early
detection and treatment regimen compliance.
The pathophysiology
of community
acquired pneumonia
PREDISPOSING AND CAUSATIVE AND
based on the case
PRECIPITATING ETIOLOGIC
provided may be The said causative and
FACTORS: FACTORS:
predisposingly caused etiologic factors
by a high risk causing this infection
environment where are any among
the patient lives in streptococcus
and several familial pneumonia,
histories of haemophilus influenzae
respiratory illnesses. and atypical organisms
However it has most such as chlamydia,
probably been mycoplasma and
precipitated by legionella via
inhalation of any respiratory droplet
among the infectious transmission
agents causing
pneumonia.
SYMPTOMATOLO CLASSIFICATIO
GY: N:
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BLOOD CHEMISTRY
Date: June 25,2010
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URINALYSIS
Date: June 25,2010
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SPUTUM AFB
Date: June 27, 2010
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CHEST X-RAY
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NURSING
THEORIES
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Prob Scientific G Interven Ratio Evalua
lem Basis o tion nale tion
al
NURSING CARE
PLAN
Nursing Diagnosis: Ineffective Airway
Clearance related to Retained Mucus
Secretions
Nursing Diagnosis: Altered
Thermoregulation related to disease
process
Nursing Diagnosis: Fatigue related to
Sleep Deprivation
Nursing Diagnosis: Altered Tissue
Perfusion related to Impaired
Transport of Oxygen across Alveolar
Membrane
DRUG STUDY
AMPICILLIN SULBACTAM (UNASYN)
Classification: Anti-infective
Drugs/Penicillin
Dosage: 750 mg 2 vials every 8 hours
ANST
Indication: It is a combination penicillin antibiotic.
Ampicillin kills bacteria that cause infection, or stops
the growth of bacteria. Sulbactam helps the
ampicillin to work better. They fight bacteria in the
body. It is used to treat many different types of
infections caused by bacteria.
Mechanism of action: Ampicillin exerts
bactericidal action on both gram-positive and
gram-negative organisms. Its spectrum includes
gram-positive organisms e.g. S pneumoniae and
other Streptococci, L monocytogenes and gram-
negative bacteria e.g. M catarrhalis, N
gonorrhoea, N meningitidis, E coli, P mirabilis,
Salmonella, Shigella, and H influenzae.
Ampicillin exerts its action by inhibiting the
synthesis of bacterial cell wall. Sulbactam
inhibits β-lactamases and extends the spectrum
of ampicillin to include β-lactamase producing
Contraindications: Allergy to penicillins; infectious
mononucleosis
•Obtain specimen for culture and sensitivity tests before giving first dose
•Check patient’s temperature and watch for other signs and symptoms of
reaction,
such as rash, fever, or chills.
•Monitor liver function test results during therapy, especially in patients with
Classification: Non-narcotic
analgesic
Adverse Reactions:
•Hematologic: methemoglobinemia, hemolytic anemia,
drowsiness
Nursing Responsibility:
•make sure that the drug is given at the right time as ordered
•Check urine for occult blood and albumin to assess for nephritis
rapid, weak pulse; cold extremities; unexplained bleeding, bruising, sore throat,
malaise, feeling clammy or sweaty; or subnormal temperatures may also be
symptoms of chronic poisoning;
•Document presence of fever. Rate pain, noting type, onset, location, duration, &
intensity.
•Recheck temperature after 15 minutes
BUTAMIRATE CITRATE (Sinecod Forte)
Classification: Antitussive
Nursing Responsibility:
•Assess cough type and frequency
•Assess patient’s Vital Signs
prescribed
•Monitor for adverse reactions
of water
•Encourage patient to increase fluid intake
fatigue
•CV: Palpitations, chest pain
photosensitivity, vaginitis
Nursing Responsibility:
•Asses patient for infection (vital signs; appearance of wound, sputum,
urine and
•stool; WBC)
this drug
•Instruct client not to take azithromycin with food or antacids. May cause
Isotonic
Solution
Indication: Replacement &
maintenance of fluid &
electrolytes
Nursing Responsibilities:
2
DISCHARGE PLAN
M EDICATIONS
Explain to the patient an the significant others
the importance of the following:
the medications name, its action and its potential
side effects
the right time and route of administering the drug
how to manage common side effects of the drugs
Instruct the patient to take the entire course of
the prescribed medications to prevent recurrence
of the illness.
Encourage patient to watch out and report any
unusualities during taking the prescribed drugs.
E XERCISE
Encourage patient to take plenty of rest.
Adequate rest is important to maintain
progress towards full recovery.
Encourage patient to lessen doing
strenuous activity to avoid fatigue.
Encourage patient to do deep breathing
exercises.
T REATMENT