TRACE COLLEGE

Traceville Subdivision, El Danda Street, Los Baños, Laguna

COLLEGE OF NURSING
Bachelor of Science in Nursing

In partial fulfillment of the course requirement in

Nursing Care Management 101 with RLE

NURSING CASE STUDY

Bronchopneumonia

Submitted by:

Date Submitted:

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 COLLEGE OF NURSING
Bachelor of Science in Nursing

NURSING CASE STUDY

Bronchopneumonia

After having presented, the Nursing Case Study is hereby approved by the
following

Clinical Instructor

Date Submitted:

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means. Please obtain permission from the College of Nursing – TRACE College.
 CHAPTER 1
INTRODUCTION

Last August 18, 2008, a group of students with eleven members were assigned to
Mrs. Aura Venus B. Ramos at Los Baños Doctor’s Hospital and Medical Center to complete
their affiliation and to gain lots of new knowledge, and develop their skills and passion on the
field of nursing.

Each members of the group were required to submit an individual nursing case study.
We have our orientation on the first day of duty and were told that being assigned on the
main ward we must expect that each of us will have at least 2 patients everyday.

What interests me to take Mr. RR’s case to be studied is that I handled him almost for
the whole week of my duty. I think, I already established a good nurse-patient relationship
with this patient and because of that it’ll be easier for me to ask information needed for my
case study.

Another thing is that he’s always alone in his room. Nobody among the members of
his family is there to take care of him and assist him while staying at the hospital. Through
taking him as my case study, I can have the reason to stay longer with him and take care of
him.

And lastly, it is my first time to handle a patient with bronchopneumonia. This is my

chance to gain new information related to geriatric nursing. I’m aiming to be a geriatric nurse,
hoping to be suitable and deserving to be a nurse with the specialty of taking care of elderly,
and I’m thankful that almost all my patient, even before, we’re old aged.

Bronchopneumonia is a classification of Pneumonia according to its distribution of

inflammation. Pneumonia is the leading cause of morbidity in the Philippines as of year 2004
and the 5th leading cause of mortality in the Philippines as of year 2004 among male and
female, and among all ages.

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 CHAPTER 2
OBJECTIVES

General Objectives:

My general objective is to understand what Bronchopneumonia is.

Specific Objectives:

Specifically:
1.) To know what causes to have Bronchopneumonia.
2.) To know the anatomy and physiology of the body organ involved in
Bronchopneumonia.
3.) To understand the pathophysiology of Bronchopneumonia.
4.) To relate my patient chief complaint on his condition having
Bronchopneumonia.
5.) To improve myself on formulating Nursing Care Plans.
6.) To relate the medications and medical procedures done to Mr. RR on his
condition of having Bronchopneumonia.

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 CHAPTER 3
HEALTH HISTORY
i. PATIENT’S DATA

Patient's Name: “Mr. RR” Hospital Case No.: 0441208

Address: Timugan, Los Baños, Laguna
Birth Date: 09/04/1954 Placeof Birth: San Pablo City, Laguna, Ph
Age: 54Y0M Insurance: MedoCare
Sex: Male Date & Time Admitted: 09/21/08 06:58pm
Ordinal Rank (if pedia patient): n/a Ward/Room No./Bed No.: Rm # *03
Nationality: Filipino Inclusive Date of Confinement: ---
Civil Status: Married Discaharge Date&Time: ---
Religion: Catholic Attending Physician: Dr. M, MD
Occupation: Pay Collector Educational Background: 3rd Yr Highschool

Payment Source for Discharges:

Self/Family: Employer/Union (give name):
Public Agency (give name): Others (pls. specify):
Private Insurance (pls. specify name of insurance company): MedoCare

Name of Spouse (if married): Mrs. NR Age: 50

Occupation: Teacher Educational Attainment: College Graduate

Admitted per: Ambulatory: Stretcher: Wheelchair: 

Level of Consciousness upon Admission:

Alert: Oriented: Responds to Verbal: Unresponsive:
*
Drowsy: Disoriented: Responds to Pain: Confused:
Lethargic: Asleep: Easily Aroused:

Chief Complaint/s:
Fever with chills

Impression/ Admitting Diagnosis:

T/C Bronchopneumonia

Final Diagnosis:
Community-acquired Pneumonia

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ii. PAST HEALTH HISTORY

Mr. RR verbalized that it’s been a long time since he was confined in the hospital, and
he can’ remember it. He is conscious about his health. He has no allergy to any foods or
other stuffs. He never smoked. He occasionally drinks alcoholic beverages but not to the
point that he’ll get drunk. He never had undergone any surgery.

iii. PRESENT HEALTH HISTORY

Two days prior to admission, he developed productive cough of whitish sputum

followed by low grade fever. He took Carbocisteine (Solmux) and Paracetamol (Biogesic),
but because symptoms persist, he consulted his doctor and was abruptly admitted.

iv. ADMISSION HISTORY

The patient was admitted last September 21, 2008 around 6:58 pm with the chief
complaint of fever with chills. He was admitted under the service of Dr. M, MD with the
admitting impression of “To Consider Bronchopneumonia”. Consent for admission was
secured. The doctor ordered administration of Intravenous Fluid D5LRS 1 L x 10o and to
follow with D5NM 1 L x 10o. The doctor also ordered to monitor his Vital Signs every 4o and
record it. His diet was Diet as Tolerated (DAT). The doctor also ordered for the Laboratory
Results of CBC, Urinalysis, Na, K, CXR-PA, RBS, BUN, and Crea with administration of the
following drugs: Paracetamol 500mg/tab 1 tab every 4o PRN for To > 37.8 oC, Sinecod Forte
1 tab TID, Nebulize with Venolin 1 neb TID, Levofloxacin 500mg/tab 1 tab OD am.

v. GENOGRAM

On the genogram of Mr. RR, you’ll noticed that most members of the family have
hypertension and died because of cardiac arrest. Mr. RR’s mother is the only one among the
members of the family with weak lungs, and the only disease associated with my pt’s
diagnosis – Bronchopneumonia.

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 Grandfather R Grandmother R
Grandfather N Grandmother N
♥ ♥ ♥ ♥
? ?

? ? ♥
? ♥
Grandfather R
♥
Mother R

? ♥ 

PR, ♥ SR, ♥ BR, ♥

RR, 54 (Wife) NR, 48

Legends:
? - unknown
♥ - cardiac disease MR, 18
 - deceased
- weak lungs NR, 14

- female
- male DR, 12

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 CHAPTER 4
PHYSICAL ASSESSMENT
I General Survey

Patient’s mobility was limited, with slow onset and speaks slowly. She is
conscious but looks drowsy and very weak on the first two days of my care. Dress
appropriately on the condition of her room (specifically the room temperature):
wearing sleeveless blouse and doesn’t have any unnecessary/unpleasant odor.
On the next two days of my care, the patient shows alertness on answering. But I
noticed that he’s always lonely and he verbalized boredom.

Vital Signs results are:

• Temperature: 36 oC
• Pulse Rate: 80 bmp
• Respiratory Rate: 20 cpm
• Blood Pressure: 100/70 mmHg

II Skin, Hair and Nails

The color of his hair is black. His skin is smooth, intact and warm to touch
without any rashes, bruises nor cuts. His nails are intact, cut, clean and with three
seconds capillary perfusion.

III Head, Neck and Lymph Nodes

Facial expressions show grimace. Neck and lymph nodes palpation is not
done.

IV Nose and Sinuses

No secretions in the nose noted but the patient verbalized

V Mouth and Throat

Lips look pale in color. Patient verbalized itchiness on throat and difficulty on
clearing his throat. The patient uses dentures. Teeth are clean with whitish color.

VI Eyes

Assessment not done.

VII Ears

Assessment not done.

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 VIII Respiratory System

Upon auscultation, I heard a breathe sound that sounds like scratching a

stainless steel. It is near on the sound of the breath sound “crackles”. Percussion
was not done. Use of accessory muscles while coughing was noted. The patient
verbalized that he sometimes feels difficulty on breathing.

IX Cardiovascular System

He is not hypertensive with BP of 100/70 mmHg during our shift. The patient
doesn’t feel any chest pain during my shift. Upon auscultation, Heart Rate was

X Breasts

Assessment not done.

XI Gastro-Intestinal System

Patient shows loss of appetite. He eats small amount of food. He defecated

twice during my whole week of care.

XII Urinary System

Patient’s urinated twice. Amount of urine depends on the amount of fluid intake.

XIII Reproductive System

Assessment not done.

XIV Nervous System

Assessment not done.

XV Musculoskeletal System

Patient is but shows weakness on doing activities like walking and changing
positions.

XVI Immune and Hematologic System

XVII Endocrine System

Assessment not done.

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 GORDON’S FUNCTIONAL HEALTH PATTERN

A. HEALTH PERCEPTION – HEALTH MANAGEMENT PATTERN

Whenever he is sick he buy OTC drugs, then if symptoms persists, that’s the
time he’ll go to his doctor and have check-up.

B. NUTRITIONAL – METABOLIC PATTERN

He eats whatever he wants to eat. He loves to eat fatty foods. He verbalized

that he’s not eating street foods.

C. ELIMINATION PATTERN

In the span of my whole week of care, the patient defecated twice and urinated
twice everyday. The amount of urine depends on the amount of his fluid intake.

D. ACTIVITY – EXERCISE PATTERN

Before admitted in the hospital, he works as a pay collector and his work is
associated with traveling that’s why he is at risk to develop bronchopneumonia
because of the pollution he encountered every time he travels. He verbalized that
he do not exercise.

E. SLEEP – REST PATTERN

Before admitted, he sleeps early. He verbalized that after watching news,

around 7pm and awakes early around 4am.

F. COGNITIVE – PERCEPTUAL PATTERN

The patient is conscious but shows loneliness and boredom. Coherent and
answers my questions directly.

G. SELF– PERCEPTION PATTERN/SELF – CONCEPT PATTERN

The patient is conscious but shows loneliness and boredom.

H. ROLE – RELATIONSHIP PATTERN

He verbalized that all the members of the family were close with each other.
And he’s happy with how his relationship with his family goes.

I. SEXUALLY – REPRODUCTIVE PATTERN

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 Not asked.

J. COPING STRESS TOLERANCE PATTERN

Whenever he’s bored or sad, he takes rest and sleeps. He is not that fond of
watching TV.

K. VALUES/BELIEF PATTERN

Their whole family religion is Catholic. They do not believe in hilot and faith
healers.

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 CHAPTER 5
DEFINITION OF COMPLETE MEDICAL DIAGNOSIS

Bronchopneumonia is a type of pneumonia that is characterized by an inflammation of

the lung generally associated with, and following a bout with bronchitis. This is really a
specific type of pneumonia that is localized in the bronchioles and surrounding alveoli. This
article provides a general overview of this condition, including symptoms and treatment
options for those who have been diagnosed with bronchopneumonia. The most common
pneumonia-causing bacterium in adults is Streptococcus pneumoniae (pneumococcus)

Symptoms of bronchopneumonia:
Cough with greenish or yellow mucus; Fever; chest pain; Rapid, shallow breathing;
Shortness of breath; Headache; Loss of appetite; fatigue

Treatment of bronchopneumonia:
If the cause is bacterial, the goal is to cure the infection with antibiotics. If the cause is
viral, antibiotics will NOT be effective. In some cases it is difficult to distinguish between viral
and bacterial pneumonia, so antibiotics may be prescribed. Pneumococcal vaccinations are
recommended for individuals in high-risk groups and provide up to 80 percent effectiveness
in staving off pneumococcal pneumonia. Influenza vaccinations are also frequently of use in
decreasing one’s susceptibility to pneumonia, since the flu precedes pneumonia
development in many cases.

Unlike lobar pneumonia, in which an entire section or subdivision of the lung may be
inflamed; bronchopneumonia tends to appear in patches in and around the small airways
and passages. Outward clinical symptoms will be similar to those of lobar pneumonia,
however, and can include fever, coughing, chest pain, chest congestion, chills, difficulty with
breathing and blood-streaked mucus that is coughed up. Bronchopneumonia is more
common in elderly people, and in association with other viral respiratory illnesses
(bronchitis), and as a complication of those who have asthma. Pneumonia, including
bronchopneumonia is a fairly common illness and it affects millions of people annually in the
United States. The severity of the illness will depend on the type of bacteria or infection
causing the illness, as well as the overall health of the person who has bronchopneumonia.

In order to diagnosis this illness, a doctor may take a chest X-ray, may test a sample
of the sputum, may do a CBC to get a count of the white blood cells in the blood, may take a
CAT scan, and/or may take a pleural fluid culture of the fluid surrounding the lungs.

Upon diagnosis, most people will be treated at home with antibiotics. If the patient is
suffering from dehydration or has a severe case of bronchopneumonia, he or she may be
treated in the hospital where the illness can be more closely monitored. With appropriate
treatment, most people recover fully within a couple weeks. Very infirm or elderly people who
do not get appropriate treatment can die from bronchopneumonia.

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 CHAPTER 6
ANATOMY AND PHYSIOLOGY
Lungs: The Bronchioles

The Lungs are the principal organs of respiration. Each lung is cone-shaped, with its
base resting on the diaphragm and its apex extending superiorly to a point about 2.5 cm
above the clavicle. The right lung has three lobes called the superior, middle and inferior
lobes. The left lung has two lobes called the superior and inferior lobes. The lobes of the
lungs are separated by deep, prominent fissures on the surface of the lung. Each lobe is
divided into bronchopulmonary segments separated from one another by connective tissue
septa, but these separations are not visible as surface fissures. There are nine
bronchopulmonary segments in the left lung and ten in the right lung.

The main bronchi branch many times to form the tracheobronchial tree. Each main
bronchus divides into lobar bronchi as they enter their respective lungs. The lobar
(secondary) bronchi, two in he left lung and three in the right lung, conduct air to each lobe.
The lobar bronchi in turn give rise to segmental (tertiary) bronchi, which extend to the
bronchopulmonary segments of the lungs. The bronchi continue to branch many times,
finally giving rise to bronchioles. The bronchioles also subdivide numerous times to give
rise to terminal bronchioles, which then subdivide into respiratory bronchioles. Each
respiratory bronchiole subdivides to form alveolar ducts, which are like long, branching
hallways with many open doorways. The doorways open into alveoli, which are small air

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sacs. The alveoli become so numerous that the alveolar duct wall is little more than a
succession of alveoli. The alveolar ducts end as two or three alveolar sacs, which are
chambers connected to two or more alveoli. There are about three million alveoli in the
lungs.

The bronchioles are very small airways that extend from the bronchi to the alveoli.
The bronchioles are made up of smooth muscle cells and are smaller than 1 millimeter in
diameter. The bronchioles do not have glands or cartilage. The epithelial cells of the
bronchioles are cuboidal in shape.

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 CHAPTER 7
PATHOPHYSIOLOGY
Pneumonia:
Bronchopneumonia

Predisposing Factors Precipitating Factors

Age Airborne Pathogenic
Work/Job
History of weak lungs
Without history of pneumococcal
vaccination
Without history of influenza
vaccine in previous years
History of being exposed to viral
or influenza infection
Lifestyle

Inhalation of infectious organism

Infectious organismresponse
Inflammatory penetrateofairway mucosa
the lungs

Multiplication
WBCof infectious
migrate toorganism
the area in
of the alveolar spaces
infection

Local capillary leak, edema and exudates

Fluids collect in and around alveoli

Alveolar walls thicken

Manifests ↓ gas exchange

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 RBC and fibrin also move into alveoli

Capillary leak spread of infection into the other areas of the lungs

Fibrin and edema of inflammation stiffen the lungs

Manifests ↓ vital
capacity
Alveolar collapsed
Manifests ↓ ability of lungs to
oxygenate the blood moving
through it
Exudates digested by enzymes

Action provides excellent culture media to ↑ spread of organism

Clinical Manifestation
• Fever and chills
• Plueric Chest Pain
• Shortness of breath
• Crackles and wheezes
• Cough
• Sputum production
• Rapid, shallow respirations

IF TREATED IF NOT TREATED

Diagnostic Exams:
• Chest X-ray COMPLICATIONS:
• Blood/Serologic Exam • Hypoxemia
Treatment: • Ventilatory Failure
• Antimicrobial therapy • Atelectasis
• Bronchodilators • Pleural Effusion
• Deep Breathing and • Pleurisy
Coughing Exercise • Continued infection despite of
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• Increase Fluid Intake use of antimicrobial therapy
• Absolute bedrest
 Resolution Abscess formation

GOOD PROGNOSIS

Necrosis of pulmonary tissues

Overwhelming sepsis

Death

POOR PROGNOSIS

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 CHAPTER 8
LABORATORY AND DIAGNOSTIC EXAMINATIONS

NURSING
DIAGNOSTIC
DATE ACTUAL CLINICAL SIGNIFICANCE CONSIDERATIONS
EXAMINATIONS WITH NORMAL FINDINGS
ORDERED RESULTS (RATIONALE) BEFORE AND AFTER
DEFINITIONS
THE PROCEDURES
Hemoglobin
• 13 – 18 gms
*12.8 Within normal range
*08/20/08 HEMATOLOGY/CBC –
Hematocrit
the most commonly Within normal range
performed blood test •40 - 54 vol % *40 %
which is a basic evaluation RBC Count
of the cellular components • 4.5 – 5.5 M/ml
*4.1 M/ml Anemia
1. Instruct family
of blood. WBC Count about the requirements or
• 5,000-10,000 *8,400/μl Within normal range instructions
cumm 2. Inform the
Differential WBC Count mother/family about the time
• Segmented period before the results will
be available.
Neutrophils: *85%
55 - 65% 3. Document
teachings. Include the
• Lymphocytes: 25 *15% client’s responses.
- 35%
• Monocytes:
3 - 7% *0% ---

• Eosinophils: 0 *0% ---

- 5%
• Basophils:
0 - 3% *0% ---

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12/12/2007 Urinalysis – the chemical analysis of Appearance: Urinalysis Obtaining a clean catch
urine sample • Clear Slightly turbid To measure and detect urine sample:
Color: the level of a variety of The head of the man’s
• straw/amber Yellow substances in the urine. penis or opening of
Odor : a woman’s urethra
• aromatic Not specified is cleansed, usually
Transparency: with a small pad
Slightly hazy that contains an
Specific Gravity : antiseptic
• 1.005 - 1.030 1.015
substance.
Glucose : A few drops of urine are
• negative Negative
allowed to flow into
Casts : the toilet washing
Albumin-traced;
• none out the urethra.
WBC : Urination is resumed
• 0-4 2 – 4/cast
and a sample is
RBC : collected from the
1-3
• <2 stream into a sterile
cup.
Always wash your
hands before and
after holding your
patient.

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 1. Instruct patient and
12/12/2007 BLOOD CHEMISTRY – measure the Sodium : BLOOD CHEMISTRY family about the
143 mmol/l requirements or instructions.
substances in the blood • 135 – 145 To evaluate organ
function and to help 2. Provide information
mmol/l about what the client may
diagnose and monitor feel.
various disorders. 3. Encourage
questions about dialogue
about fear and
Potassium : apprehension.
• 3.5 – 5 mmol/l
3.7 mmol/l 4. Inform the client
about the time period before
the results will be available.
5. Document
teachings. Include the
RBC : client’s responses.
• 4.2 – 5.9 M/ml 97 M/ml

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 CHAPTER 9
MEDICAL MANAGEMENT
DOCTOR’S ORDER

Sept. 21, 2008

• Pls. admit to ROC under service of Dr. M.
• Secure consent for admission
• Monitor VS q 4o & record
• Diet: DAT (Diet as Tolerated)
• IVF D5LRS 1L x 10 o
D5NM 1L x 10 o
• Dx:
CBC, Urinalysis, Na, K
CXR-PA, RBS, BUN, Crea
• Therapeutics:
Paracetamol 500mg/tab 1tab q4o PRN for T o =37.8
Sinecod Forte 1 tab TID
Nebulize with Ventolin 1 neb TID
Levofloxacin 500mg/tab, 1tab OD
• Inform AP of this admission
• Relay lab results to AP once available
• Refer accordingly
Dr. M.
Sept. 22, 2008
8:30am
• IVF to IVF: D5NM 1L x 10 o (2 cyasets)
Dr. M.
Sept. 22, 2008
4:30pm
• Klaricin 500mg OD
• For Tubex Test
• IVF TF: D5NM 1L x 10 o (2 cyasets)
Dr. M.
Sept. 22, 2008
10:15 pm
• Lasix 1 amp IV now
• Shift Flox to IV 500mg q12 ANST
• ↓ rate of IV to KVO
• Measure I&O q shift
• Refer to Dr. Romeo
Dr. M.
Sept. 23, 2008
10:35am
• Refer temp referral to Dr. Romeo

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 Dr. M.
Sept. 24, 2008
4:20am
• Start Lasix 40mg 1 tab OD – 8am
Dr. M.

MEDICAL PROCEDURES

INTRAVENOUS THERAPY

Intravenous therapy or IV therapy is the giving of liquid substances

directly into a vein. It can be intermittent or continuous; continuous administration
is called an intravenous drip. The word intravenous simply means "within a vein",
but is most commonly used to refer to IV therapy. Therapies administered
intravenously are often called specialty pharmaceuticals.

Compared with other routes of administration, the intravenous route is the

fastest way to deliver fluids and medications throughout the body. Some
medications, as well as blood transfusions and lethal injections, can only be
given intravenously.

NEBULIZATION

It is the process of using a nebulizer that changes liquid medicine into fine
droplets (in aerosol or mist form) that are inhaled through a mouthpiece or mask
Nebulizers is used to deliver bronchodilator (airway-opening) medicines such as
albuterol or ipratropium bromide. Nebulizers are hand-held machines with an
airflow meter that measures oxygen flow. These machines administer a variety of
medications. Nebulizers vaporize this mixture and deliver it as a fine mist or
steam. Nebulizers are usually used in the hospital or nursing home setting.
Disposable nebulizers are often sent home with a patient and are cleaned and
reused for a limited time.

TEPIDS SPONGE BATH

Tepid sponging is a time honored and well known method of reducing the
elevated temperature. Tepid sponging is useful as an immediate but transient
measure in bringing down the temperature and it should always be
supplemented with drugs like paracetamol for a longer antipyretic effect. A tepid
sponge bath relieves fever without cooling the body too fast. Eighty degrees
Fahrenheit is still 20oF below body temperature and yet warm enough not to
drive blood from the skin, thereby preventing the cooling from getting to the
body's core. Limbs are bathed first and then the chest, abdomen, back, and
buttocks. Tepid baths should be 80-93oF (26.7-34oC).

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 CHAPTER 10
NURSING CARE MANAGEMENT
NURSING CARE PLAN

Nursing
Assessment Objectives Interventions Rationale Evaluation
Diagnosis
Criteria for
Date/Time Ineffective airway At the end of our - Auscultate for - To identify GOAL MET:
Sept. 23, 2008 clearance related duty shift we breath sound abnormal breath
to the presence of must: sounds At the end of my
Problem #1: secretions 8o span of care:
Cough - Monitor Vital - To know the
- be able to cough Signs status or progress -Patient will
Subjective Data: out phlegm in/of the pt. maintain patent
“Inuubo parin ako effectively airway
paminsan-minsan, - Regulate IVF as - Helps to
pero hindi na tulad - maintain desired maintain hydration -Patient will be
nung mga patient’s airway and fluid status, able to
nakaraang araw. “ patency as well as to thin expectorate
as verbalized by viscous secretions sputum and cough
the patient to allow effectively

Objective Data: - Encourage - To liquefy

- productive cough patient to drink secretions
- body malaise more water
- poor appetite (should be warm)
- use of accessory
muscles while - Teach patient to - To mobilize
breathing do deep breathing secretions so that
-with yellowish exercise patient may be
sticky mucous able to more
secretions easily expectorate
-crackles breath mucous

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TRACE College.
 sound secretions

-Instruct - To monitor
patient/family to signal of
notify worsening of
nurse/physician of condition that
sputum color requires
changes, increase immediate
work of breathing, medical
or onset of chest intervention to
pain prevent further
complications

- Encourage - To promote
patient to rest wellness

- Position patient - To facilitate

to High-Fowler’s airway
Position

- Administer - To helps relief

medicines as cough
prescribed

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 Nursing
Assessment Objectives Interventions Rationale Evaluation
Diagnosis

Problem #2: Hyperthermia That within my 8o - Perform tepid  Vaporization Criteria for
Fever related to disease span of care, the sponge bath of water GOAL MET:
process as patient’s body relieves heat
Date/Time evidenced by temperature will from the At the end of my
Sept. 24, 2008 chills noted lower from 38.1 oC surface of the 8o span of care:
to 37.5oC and will skin
demonstrate - the patient’s
Subjective Data: absence of chills - Apply cold wet  To help temperature will
Pt. verbalized... compress if normalize lowers to 37.5oC
“nilalamig ako” necessary body
temperature - The patient will
manifest negative
chilling
- Remove some  To provide air
Objective Data blankets and movement, to - The patient will
- Temp: 38.1 oC clothes which augment heat verbalize comfort
- skin warm to are not loss.
touch necessary
- body malaise
- poor appetite - If patient’s skin  To stimulate
- chills noted feels cold to circulation
touch, apply
friction

- Advise to wear  To be more

loose and comfortable
comfortable
clothes

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 - Encourage  To prevent
patient to dehydration
increase fluid
intake

- Monitor  To see
Temperature effectiveness
every 15 mins of said
interventions

- Repeat TSB if  Vaporization

needed of water
relieves heat
from the
surface of the
skin

- Administer  Helps relief of

antipyrentic fever
drugs as
prescribed

- Regulate IVF  Helps

as desired maintain
hydration

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 Nursing
Assessment Objectives Interventions Rationale Evaluation
Diagnosis

Problem #5: Deficient That within my 8o - Advise patient - To divert his Criteria for
Boredom Diversional span of care, the to do leisure attention so he’ll GOAL MET:
Activity related to patient will be able activities such as not feel boredom
Date/Time boredom as to divert his reading books At the end of my
Sept. 25, 2008 evidenced by attention into and watching 8o span of care,
verbalized report something that will TV. the patient will
Subjective Data: make him feel divert his attention
Pt. verbalized... busy. - Advise family, if - To prevent and will lessen the
“Naiinip nga ako possible, to visit development of feeling of
e,” the patient or anxiety/ emotional boredom.
provide depression
someone to be
with him while
staying at the
hospital

Objective Data - Frequently visit - To ensure to the

- loneliness noted the patient patient that he can
- talkative when trust me as his
visited nurse and he’s not
- frequent change alone, also to be
in position noted able to attend
when visited immediately
- seen ambulating nursing care
inside room needed by the
- body malaise patient

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 CHAPTER 11
DRUG STUDY
A. INTRAVENOUS THERAPY

Classification/ Mechanisms Adverse Reaction/

IV fluid Indications Nursing Responsibilities
Type Of Action Side Effects

D5NM Hypertonic Normosol-M and 5% Normosol-M and Reactions which Solutions containing sodium ions
Or Solution Dextrose Injection 5% Dextrose may occur because should be used with great care, if
Normosol- (Multiple Injection provides of the solution or at all, in patients with congestive
M in 5% Electrolytes and 5% water and the technique of heart failure, severe renal
Dextrose Dextrose Injection electrolytes (with administration insufficiency and in clinical states
Type 1, USP) is dextrose as a include febrile in which there exists edema with
indicated for readily available response, infection sodium retention.
parenteral source of at the site of Solutions which contain
maintenance of carbohydrate) for injection, venous potassium should be used with
routine daily fluid maintenance of thrombosis or great care, if at all, in patients with
and electrolyte daily fluid and phlebitis extending hyperkalemia, severe renal failure
requirements with electrolyte from the site of and in conditions in which
minimal requirements, plus injection, potassium retention is present.
carbohydrate minimal extravasation and In patients with diminished renal
calories from carbohydrate hypervolemia. function, administration of
dextrose. calories. If an adverse solutions containing sodium or
Magnesium in the reactiondoes occur, potassium ions may result in
formula may help to discontinue the sodium or potassium retention.
prevent iatrogenic infusion, evaluate Solutions containing acetate
magnesium the patient, institute should be used with great care in
deficiency in appropriate patients with metabolic or
patients receiving therapeutic respiratory alkalosis, and in those
prolonged countermeasures conditions in which there is an
parenteral therapy. and save the increased level or an impaired

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 remainder of the utilization of acetate, such as
fluid for examination severe hepatic insufficiency.
if deemed Administration of this solution can
necessary. cause fluid and/or solute
overloading resulting in dilution of
serum electrolyte concentrations,
overhydration, congested states
or pulmonary edema. The risk of
dilutional states is inversely
proportional to the electrolyte
concentrations of administered
parenteral solutions. The risk of
solute overload causing
congested states with peripheral
and pulmonary edema is directly
proportional to the electrolyte
concentrations of such solutions.

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 Adverse
Classification/ Mechanisms
IV fluid Indications Reaction/ Nursing Responsibilities
Type Of Action
Side Effects

D5LRS Lactated Ringer’s Lactated Ringer’s Allergic reactions Lactated Ringer’s and 5%
Or and 5% Dextrose and 5% Dextrose or anaphylactoid Dextrose Injection, USP should
Lactated Injection, USP is Injection, USP has symptoms such be used with great care, if at all,
Ringer’s indicated as a value as a source as localized or in patients with congestive heart
Solution in source of water, of water, generalized failure, severe renal insufficiency,
5% electrolytes and electrolytes, and urticaria and and in clinical states in which
Dextrose calories or as an calories. It is pruritus; there exists edema with sodium
alkalinizing agent. capable of inducing periorbital, facial, retention.
diuresis depending and/or laryngeal Lactated Ringer’s and 5%
on the clinical edema, Dextrose Injection, USP should
condition of the coughing, be used with great care, if at all,
patient. sneezing, and/or in patients with hyperkalemia,
Lactated Ringer’s difficulty with severe renal failure, and in
and 5% Dextrose breathing have conditions in which potassium
Injection, USP been reported retention is present.
produces a during Lactated Ringer’s and 5%
metabolic administration of Dextrose Injection, USP should
alkalinizing effect. Lactated Ringer’s be used with great care in
Lactate ions are and 5% Dextrose patients with metabolic or
metabolized Injection, USP. respiratory alkalosis. The
ultimately to The reporting administration of lactate ions
carbon dioxide and frequency of should be done with great care in
water, which these signs and those conditions in which there is
requires the symptoms is an increased level or an impaired
consumption of higher in women utilization of these ions, such as
hydrogen cations. during severe hepatic insufficiency.
pregnancy. Lactated Ringer’s and 5%
Reactions which Dextrose Injection, USP should
may occur not be administered

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 because of the simultaneously with blood
solution or the through the same administration
technique of set because of the likelihood of
administration coagulation.
include febrile The intravenous administration of
response, Lactated Ringer’s and 5%
infection at the Dextrose Injection, USP can
site of injection, cause fluid and/or solute
venous overloading resulting in dilution of
thrombosis or serum electrolyte concentrations,
phlebitis overhydration, congested states,
extending from or pulmonary edema. The risk of
the site of dilutional states is inversely
injection, proportional to the electrolyte
extravasation, concentrations of the injection.
and The risk of solute overload
hypervolemia. causing congested states with
If an adverse peripheral and pulmonary edema
reaction does is directly proportional to the
occur, electrolyte concentrations of the
discontinue the injection.
infusion, evaluate In patients with diminished renal
the patient, function, administration of
institute Lactated Ringer’s and 5%
appropriate Dextrose Injection, USP may
therapeutic result in sodium or potassium
countermeasures retention.
, and save the Lactated Ringer’s and 5%
remainder of the Dextrose Injection, USP is not for
fluid for use in the treatment of lactic
examination if acidosis.
deemed
necessary.

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B. MEDICATIONS

Generic Brand Mechanisms Dose/

Classification Indication
Name Name Of Action Frequency

Paracetamol Biogesic Antipyretics Paracetamol has long

For Fever
been suspected of
having a similar
mechanism of action to
aspirin because of the
similarity in structure.
That is, it has been
PRN 1 tab q 4o
assumed that
For T o >37.8
paracetamol acts by
reducing production of
prostaglandins, which
are involved in the pain
and fever processes,
by inhibiting the
cyclooxygenase (COX)
enzyme as aspirin
does.

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 Interactions Side Effects Adverse Reactions Nursing Considerations

Do not start, stop, or change the

easy bruising/bleeding, Tell your doctor immediately if any
dosage of any medicine before
new signs of infection of the following symptoms of liver
checking with your doctor or
(e.g., fever, persistent damage have: persistent
pharmacist first. Before using
sore throat) nausea/vomiting, yellowing
this product, tell your doctor or
eyes/skin, dark urine,
pharmacist if you use any of the
stomach/abdominal pain, extreme
following products: anti-seizure
tiredness. A very serious allergic
medications (e.g., phenytoin,
reaction to this drug is rare.
carbamazepine, phenobarbital),
However, seek immediate medical
"blood thinners" (e.g., warfarin),
attention if you notice any
isoniazid, phenothiazines (e.g.,
symptoms of a serious allergic
chlorpromazine).Acetaminophen
reaction, including: rash, itching,
is an ingredient in many
swelling, severe dizziness, trouble
nonprescription products and in
breathing.If you notice other effects
some combination prescription
not listed above, contact your doctor
medications.
or pharmacist.

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 Generic Brand Mechanisms Dose/
Classification Indication
Name Name Of Action Frequency

Butamirate Sinecod Cough & Cold 1 tab TID

Acute cough of any etiology
citrate Preparations

Interactions Side Effects Adverse Reactions Nursing Considerations

Rarely, skin rash, nausea,

diarrhea or dizziness.

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 Generic Brand Mechanisms Dose/
Classification Indication
Name Name Of Action Frequency

VENTOLIN NEBULES Inhalation

Inhalation beta2-adrenergic Solution is indicated for the relief of
Ventolin 1 neb TID
Albuterol Solution bronchodilator bronchospasm. This drug relaxes
Nebule
Sulfate the smooth muscle in the lungs
and dilates airways to improve
breathing.

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 Interactions Side Effects Adverse Reactions Nursing Considerations

Cases of urticaria, Tremors, Dizziness,

angioedema, rash, Nervousness, Headache, - Tell your doctor if you have heart
bronchospasm, Sleeplessness, Gastrointestinal, disease, high blood pressure, an
- Tell your doctor of
hoarseness, Nausea, Dyspepsia , Ear, nose, overactive thyroid gland, epilepsy
all prescription and
oropharyngeal edema, and throat, Nasal congestion, or diabetes.
nonprescription
and arrhythmias Tachycardia, Hypertension, - Tell your doctor if you ever had a
drugs you may use,
(including atrial Bronchospasm, Cough, bad reaction to bitolterol,
especially of drugs
fibrillation, Bronchitis, Wheezing ephedrine, epinephrine,
used for asthma,
supraventricular metaproterenol, phenylephrine,
depression or colds;
tachycardia, phenylpropanolamine,
and beta-blockers
extrasystoles) have been pseudoephedrine, or terbutaline.
(e.g., atenolol,
reported after the use of - Many nonprescription products
propranolol).
VENTOLIN NEBULES contain these drugs (e.g., diet pills
- Do not start or stop
Inhalation Solution. and medication for colds and
any medicine
asthma), so check the labels
without doctor or
carefully.
pharmacist
- Do not take any of these
approval.
medications without consulting
your doctor (even if you never had
a problem taking them before).
- Do not allow anyone else to take
this medication.

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 Generic Brand Mechanisms Dose/
Classification Indication
Name Name Of Action Frequency

Levofloxacin Floxel Quinolones Antibacterial 500mg/tab, 1 tab Treatment of more than 18 years
OD of age with mild, moderate and
severe infection caused by
susceptible strains of
microorganisms in community-
acquired pneumonia

Side
Interactions Adverse Reactions Nursing Considerations
Effects

Antacids, metal cations Diarrhea, abdominal discomfort, nausea, anorexi, Patient should be adequately
and multivitamin vomiting, stomatitis, and heart burns; insomia, hydrated. History of convulsive
preparations containing headache and dizziness; rash, pruritis, and disease should be watched out.
zinc may interfere with aczema; muscles and joints pain; bone marrow Discontinue if CNS stimulation
absorption depression, increase liver enzymes; pain, rednes occurs. Hypersensitivity.
at injection site; phlebitis

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 Generic Brand Mechanisms Dose/
Classification Indication
Name Name Of Action Frequency

Furosemide Lasix Diuretics Lasix is a loop diuretic

(water pill) that Mild – moderate hypertension;
prevents your body 40mg 1 tab OD – renal failure
Interactions Side Effects Adverse
from absorbing too Reactions 8am Nursing Considerations
much salt, allowing the
salt to instead be
passed in your urine.
Glucocorticoids; Symptomatic hypertension; Do not use Lasix if you are unable to
laxatives; dehydration; hemoconcentration; urinate.
aminoglucosides; hypokalemia; hyponathermia; Before using this medication, tell your
NSAIDS; antidiabetics metabolic acidosis; increase doctor if you have kidney disease, liver
blood lipid levels, crea, uric acid; disease, gout, lupus, diabetes, or an
reduced glucose tolerance; allergy to sulfa drugs.
hearing disorder; tinnitus; To be sure Lasix is not causing harmful
pancreatitis; anaphylactic and effects, your blood will need to be
anaphylactoid reaction; tested on a regular basis. Your kidney
cutaenous reaction; fever; or liver function may also need to be
anemia. tested. Do not miss any scheduled
appointments.
Lasix will make you urinate more often
and you may get dehydrated easily.
Follow your doctor's instructions about
using potassium supplements or
getting enough salt and potassium in
your diet.
Avoid becoming dehydrated. Follow
your doctor's instructions about the
type and amount of liquids you should
drink while you are taking this
medication.
If you are being treated for high blood
pressure,
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Please obtain permission from theLasix
College even if –you
of Nursing
TRACE College.
feel fine. High blood pressure often has
no symptoms.
 CHAPTER 12
PROGNOSIS/EVALUATION

Criteria Poor Fair Good Justification

Duration of Illness  Duration of illness is fair because it
didn’t get worse.
Onset of Illness  Onset of illness is fair because it is
immediately attended.
Precipitating Factors  Precipitating factors were poor
because of his job. His job being a
pay collector was prone on pollution
that can make his lungs weak. Making
him at risk of developing respiratory
illnesses.
Willingness to take medicines  He is willing to take his medications
and doesn’t have any difficulty on
swallowing tablets and capsules.
Compliance to treatment  Compliance to treatment was good
regimen because he is willing to do whatever
his doctor told him so.
Age  Age as criteria is fair because he is
not too old and not too young to
develop such illness.
Environment  Environment as criteria is poor
because he is exposed on pollutions
especially hen traveling.
Family Support  Family Support as criteria is fair even
no one among the family can take
care of him while in the hospital.
Because his wife is a teacher, she is
very busy on his work but still take
some time to be with him after her
work. His children were still studying

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 and were busy.
***  - Mark of choice

Prognosis of the patient is fair. He can overcome this disease if he knows how to prevent being exposed on its predisposing factors and
prevent being sick, especially acquiring cough and colds. Family Support is also a big help for his recovery.

CHAPTER 13
DISCHARGE PLAN

MEDICATION
• Mosegor Vita 1 cap once a day for seven days – indicated to underweight due to lack of appetite associated with Vitamin B
deficiency secondary to impaired dietary intake or absorption. Adverse reactions are sedation, rarely dizziness, dry mouth,
constipation and nervousness.
• Ansimar 400mg ½ tab twice a day for seven days – indicated for respiratory disease

EXERCISE
• Be sure to get enough rest and sleep on a daily basis.
• Practice deep breathing and coughing exercise to easily excrete phlegm

TREATMENT
• Have annual influenza vaccine after discussing appropriate timing of the vaccination as recommended
• Discuss the pneumococcal vaccine with your primary health care provider, and have the vaccination as recommended
• If you do not smoke, don’t start.
• Avoid stress, fatigue, sudden changes in temperature and excessive alcohol intake, all of this lowers resistance to
pneumonia.

HYGIENE
• Take bath daily.

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 • Wear masks especially when traveling for the first week after being discharged.
• Promote frequent oral hygiene.

OUTPATIENT ORDERS/FOLLOW UPS

• Follow up check up will be on Oct. 4, 2008, 1-6pm

DIET
• Drink plenty of water (at least 8 glasses every day), especially during warm weather.
• Eat a healthy, balanced diet and take in a sufficient amount of non-alcoholic fluids each day.

BIBLIOGRAPHY

Beers, M. H., et al. The Merck Manual of Medical Information (2nd Home Ed.). NY, USA. Merck & Co., Inc. 2003

Cleveland Clinic Health System. (November 23, 2005). Home Nebulizer Therapy. Cleveland Clinic Health.
http://www.cchs.net/health/health-info/docs/0300/0352.asp?index=4297.

Comer, S. R. Delmar’s Critical Care: Nursing Care Plans (2nd edition). Singapore. Thomson Learning Asia Pte. Ltd.
2005

CWAnswer. Bronchopneumonia. CWAnswer. http://www.cwanswers.com/8921/bronchopneumonia

This is a property of College of Nursing – TRACE College. No part of this manuscript may be reproduced or transmitted in any form or by any means. Please obtain permission from the College of Nursing –
TRACE College.
 Department of Health. Health Indicators: Morbidity. (2006). Department of Health.
http://www.doh.gov.ph/kp/statistics/morbidity

Department of Health. Health Indicators: Mortality. (2006). Department of Health.

http://www.doh.gov.ph/kp/statistics/mortality

Department of Health. Pneumonia. (2006). Department of Health. http://www.doh.gov.ph/faqs/pneumonia

Doenges, M.E., et al. Nurses’ Pocket Guide (ed. 10). Philadelphia, Pennsylvania. F.A. Davis Co. 2006

Gupta, L.C.. Illustrated Nurses’ Dictionary (2nd Ed.). India. AITBS Publishers and Distributors. 2005.

RxList:The Internet Drug Index. (2008). RxList Inc. http://www.rxlist.com/script/main/hp.asp.

Seeley, R.R., et al. Essentials of Anatomy and Physiology (5th ed., international ed.). NY, USA. The McGraw-Hill
Co.,Inc. 2005

Wikipedia. (22 May 2008,). Intravenous Therapy. http://en.wikipedia.org/wiki/Intravenous_therapy

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