OBSTRUCTIVE JAUNDICE

---------------------

A Related Learning Experience Research Work

Presented to Ms. Virginia Bellena, RN,MN

---------------------

In Partial Fulfilment of the Requirements in BSN 3

Related Learning Experience (RLE)

By
Nikka Vanessa Maghuyop
Hosanna Gabrielle Abella
Monna Llee Dimaranan
Jefte James Salubre
Karyl Saavedra

June 2014

ACKNOWLEDGEMENT

We have taken efforts in this project. However, it would not have been
possible without the kind support and help of many individuals. We would like to
extend our sincere thanks to all of them. Despite all the hardships encountered
on making this case presentation, we are thankful that we were able to make it
through.
We are highly indebted to our clinical instructor Ms. Josefina S. Balote,
RN, MN for her guidance and constant supervision as well as for her support in
completing our case.
We would also like to express our gratitude towards our parents and the
staff of Bishop Joseph Regan Memorial Hospital for their kind co-operation and
encouragement which helped us in completion of this case.
Our thanks and appreciations also go to our colleagues in developing the
case and people who have willingly helped us out with their abilities. But above
all we would like to give our greatest appreciation to our Almighty Father for
guiding and protecting us always on our journey of making this case study.

Chapter 1

INTRODUCTION
Background of the Study
General Objectives
This study aims to understand the nature of Choledocholithiasis and the
appropriate Nursing Interventions.
Specifically this study seeks answers to the following questions:
1.

What

are

the

etiology,

signs/symptoms,

and

pathophysiology

of

Choledocholithiasis?
2.

What is the most suitable Nursing Care Plan for the patient with

Choledocholithiais?
3. What are the Nursing Responsibilities towards the Medical Management of the
patient with Choledocholithiasis?
Related Articles
Maslow's Hierarchy
PHYSIOLOGICAL NEEDS

Oxygenation
-The addition of oxygen to any system, including the human body
- refers to the process of enhancing oxygen transport throughout
the body.
Farlex. (2014). www.medicaldictionary.thefreedictionary.com. Retrieved
from 07/01/14/http://medical-dictionary.
thefreedictionary
.com/
oxygenation

Temperature Maintenance

-The level of heat produced and sustained by the body processes.

Variations and changes in body temperature are major indicators of
disease and other abnormalities. Heat is generated within the body
through metabolism of nutrients and lost from the body surface
through radiation, convection and evaporation of perspiration.
Farlex. (2014). www.medicaldictionary.thefreedictionary.com. Retrieved
from

07/01/14/

http://medical-

dictionary.thefreedictionary.com/body+temperature
Gordon's Functional Health Pattern
Assessment is focused on the activities of daily requiring energy
expenditure, including self-care activities, exercise and leisure activities. The
status of major body systems involved with activity and exercise is evaluated,
including the respiratory, cardiovascular and musculoskeletal. Koshar, Jeanette.
(2013). www.sonoma.edu. retrieved from 7/8/2014. http:// www.sonoma. edu/
users/ k/ koshar/ n340/N 345_Gordon_FHP.html
I. ASSESSMENT
A. Biographical Data
Name: Yeso109

Age: 34 years old

Status: Married

Religion: Roman Catholic

Ethnic Group: Leyteo

Height: 57 ft

Weight: 61kg

Birthday: October 18, 1979

Place of Birth: Dagami, Leyte

Address: Purok Malipayon, mMendoza Highway, King-king Pantukan Comaval
Province
Occupation: PUJ driver
Attending Physician: Dr. Francis P. Maranyan

B. Chief Complaint
Jaundice. Sakit akong tiyan, Maglisod ko ug ginhawa as verbalized.
C. History of Present Illness
Was known asthmatic . Her house is located in the middle of the rice fields
in which she is exposed to smoke and chemicals.
D. Past Medical History
She experienced measles, mumps, chickenpox in her younger years. She
was diagnosed for pulmonary tuberculosis last 2012.
E. Personal, Family and Socio-economic History

Personal History
Watashi108 is 87 years old, living with her 7 th child in Purok 7,
Siocon, Compostela, Comval Province. She was a farmer in her younger
years. She has 7 siblings; 4 boys and 3 girls. She finished her elementary
and high school years in Compostela, Comval Province. Watashi108
married her husband at the age of 23 and blessed with 8 children. She
was exposed to smoke and chemicals from their rice fields.
Figure 1 below shows the genogram of the respondent of this
study. It shows the three generations of the family tree. Furthermore, it
shows the hereditary diseases.

Socio-economic History
Monthly Income
Php 9,000.00

Family History

MOTHER- deceased

FATHER- deceased

ASTHMATIC

HYPERTENSIVE, DM

HUSBAND -deceased

WATASHI108
87y/o
1st child 64y/o
ASTHMATIC
th

5 child- 56y/o

DM
2nd child- 62y/o

3rd child- 60 y/o

DM

HYPERTENSIVE
th

6 child- 54y/o

th

7 child- 52y/o

DECEASED

HYPERTENSIVE
Figure 1. Genogram
of the patient's family ASTHMATIC

F. Patient Need Assessment

Oxygenation - "Maglisod ko ug ginahaw", Sakit akong dughan"

4th child- 58y/o

------8th child- 45y/o
HYPERTENSIVE

"Sakit akong likod", "Magsige ko ug ubo" ; tacypnea (28cpm);

excessive use of accessory muscles upon breathing.
Temperature Maintenance- "Bugnaw akong paminaw, Sakit akong ulo,
Temp: 37.8 C; warm to touch; flushed skin noted
Activity - exercise pattern- "hangakon ko mag sige ug lihok"
PHYSICAL ASSESSMENT
a) General Survey
06/24/14 8:45am
Received sitting on bed, responsive but cannot clearly hear; well-combed
hair; hair is evenly distributed; with white hairs; no head and scalp lesions; pale
conjunctivae; flaring of nostrils noted; pale lips; use of accessory muscles when
breathing noted; rales @ right lower lung noted upon auscultation; with positive
fremitus; with poor tunned skin turgor; nails are trimmed; with edematous hand
(both); with weak handgrip; lower extremities can be flexed; finger toes are
untrimmed; with #2 PNSS 1L @ 80cc per hour infusing well and it's desired rate
@ left hand @ the level of 1000cc; with O 2 inhalation @ 2-4 Lpm via nasal
cannula.
b.) 9:10 am
Vital signs checked, monitored and recorded
Temperature: 36.8 C

Blood Pressure: 120/80 mmHg

Pulse rate: 92 bpm

Respiratory Rate: 31 cpm

Capillary refill: 2 seconds

c.) Nutritional Status

on diet as tolerated.
Table 1 shows the changes of the BMI from visiting the physician to
admission.
BMI Upon Visiting the physician

BMI Upon Admission

(Friday- June 20,2014)

(Monday- June 23,2014)

Weight: 42kg

Height: 1.47m

BMI :19.4kg/m2

Weight: 39kg

Height: 1.47m

BMI:18kg/m2

Table 1 BMI of the patient

d.) Neurologic Status
coherent, responsive, well-oriented and has a good memory.
e.) Integumentary System
Dry skin, no jaundice noted and has a capillary refill of 2 sec.
f.) HEENT
Head: No lesions on the head and scalp observed
Eyes: pale conjunctivae, sclera is white without lesions and no eye
discharges.
Ears: No ear discharges
Nose: Flaring of the nostrils noted.
Sinuses: no presence of pain and tenderness.
Neck: no swelling of lymph nodes, use of accessory muscles noted when
breathing.
Throat: Tonsils is in Grade 2 (between pillars and uvula)

g.) Respiratory System

Positive rales noted, symmetrical chest expansion and has retraction.
h.)Cardiovascular System
No murmurs, has regular cardiac rate and rhythm.
i.) Gastrointestinal System
-Defecated once a day with brownish, intact and with minimal amount.
-Urinated 3-4 times a day with dark-yellow in color, with minimal amount.
j.) Musculoskeletal System
Upper and lower extremities can be flexed.
k.) Genito-urinary System
No kidney punch sign.
l.) Abdomen
No tenderness on the abdomen upon palpation.
II. COURSE IN THE WARD
Table 2.1-2.5 below illustrates the condition of the respondent from
admission to discharge.
Date
Shift

Nurses

Nurses

rationale

Assessment intervention

Medical

rationale

Managmen
t

June 23, Received

2014
311

Place

on to collect

For

To test if

urinalysis

there is a

from ER per bed

non-

wheelchair;

contaminated and sputum presence

awake; with

comfortably;

of

IVF of

#1 Provided

PNSS 1L @ with
120 cc/hr @ specimen
left

hand bottle and

infusing
well;

sputum

Seen cups

and

instructed

examined

accordingly;

by

Dr. Carried out;

Prudencio

Prescribed;

with orders;

Monitored
continuously

4pm
BP- 120/70
mmHg
Temp- 36.2
C
RR- 20 cpm
PR- 69bmp
8pm
BP-

90/60

mmHg
Temp- 36.6
C
RR-24 cpm
PR-84 bmp

specimen

AFB

bacteria.

O2 Sat- 97%

Table 2.2
Date
Shift

Nurses

Nurses

rationale

Assessment intervention
June
2014
117

24,

Received Vital
on

Managment

signs For

bed; checked and baseline

awake and recorded;

data. To

responsive;

provide

with

Rest

O2 promotion;

inhalation

Placed

nasal

comfortably

cannula;

and provide

with IVF of with

#1

restful

PNSS environment

@120 cc/hr, .
infusing
well.
12mn
BP-120/80
mmHg
Temp-37.3

patent

on airway.

@ 4lpm via bed

Medical

Rationale

C
RR- 28cpm
PR-88 bpm

Table 2.3
Date
Shift

Nurses

Nurses

rationale

Assessmen

intervention

Medical
Managment

t
June
2014
73

24, Received
on

IVF

site For

bed; checked

baseline

awake and and

data,

responsive;

regulated;

ensure

on

Vital

moderate

checked

high
rest

Signs proper that

only proper

back and

amount of

with recorded;

ongoing IVF Watch

IVF

intact.

cc/hr unusualities;
with

due

meds given
by
8am

was

for induced.

#2 PNSS @ any
120

to

;needs

attended to;

rationale

BP-120/80
mmHg
Temp- 36.8
C
RR- 31cpm
PR-92 bpm

12nn
BP- 120/80
mmHg
Temp- 37.1
C
RR- 26cpm
PR- 89 bmp

Table 2.4
Date
Shift

Nurses

Nurses

rationale

Assessmen

intervention

2014
311

24, Received
on

rationale

Managmen

t
June

Medical

Followed up; For

bed, with

due baseline

awake and meds given; data.

For

Foley To closely

Catheter
To inserted

responsive;

IVF checked provide

and

on

and

attached to

patent

motor
urine
output.

the

moderate
high

regulated;

back Vital

Signs

rest; with O2 monitored

inhalation

and

with 4 Lpm recorded;

via

nasal Placed

cannula;

comfortably

with IVF of on

bed;

#2 PNSS @ Appraised
80

cc/hr patient

and

infusing

significant

well.;

others;

Refused

Continuously

ICU

assessed

admission

and

with

sign monitored;

due

to Watched

financial
concern;
Referred to
Dr. Pono as
ordered

4pm
BP- 140/90
mmHg
Temp- 37.1
C

and cared.

airway.

urobag

as

ordered ;
Seen

and

examined
by

Dr.

Prudencio
with orders,
for

ICU

admission
as ordered

RR- 25 cpm
PR-88 bpm

8pm
BP- 140/90
mmHg
Temp- 36.5
C
RR- 28cpm
PR-98bmp
O2 Sat- 98%

10pm
BP160/100
mmHg
Temp- 36.9
C
RR- 26cpm
PR- 86bpm
Table 2.5
Date
Shift

Nurses
Assessmen

Nurses

rationale

Medical

rationale

t
June
2014
117

25, Seen

intervention
and Vital

monitored

signs For

checked and baseline

by Dr. Pono recorded;

with orders;

12mn
BP-110/80
mmHg

data.

Provided

airway

urobag with

with

rest;

Carried

out

properly;
Need

assessed

and
monitored;
Followed up
continuously
meds

and pending
labs; Watch-

Temp- 36.2
C

To inserted
attached to

with

Bp- 110/80

motor the

patent

Continuousl

1am

Catheter

cared;

O2 Sat- 95%

To closely

and

attended to;

PR- 81bpm

Foley

watched and provide

Temp-36.2

RR- 25cpm

Managment

out for any

unusualities;
available
due

meds

RR- 26 cpm

given;

Left

PR- 98bpm

on

bed

resting

with

O2 Sat- 97% IVF

consent

urine
output.

4am
BP-110/80
mmHg
Temp- 37.3
C
RR- 26 cpm
PR- 98 bpm
O2

Sat-

97%

5am
BP- 120/80
mmHg
Temp- 38.5
C
RR- 28 cpm
PR-

123

bpm
O2 Sat- 92
%

6am
BP- 120/80

mmHg
Temp- 37.9
C
RR- 30 cpm
PR-

130

bmp
O2 Sat- 93%

III. LABORATORY AND DIAGNOSTIC EXAMINATION

Table 3.1-3.3 presents the results of the different diagnostic examinations
of the respondent.
Hematology

Examination

Results

Normal

Interpretation/ Implication

values
Hemoglobin

113

120.00-

a low hemoglobin count is referred

150.00 g/L

to as anemia.
deficient oxygenation.
Mayo

Clinic

Mayoclinic.org

Staff

(2010).

.Retrieved

form

6/28/14.
http://www.mayoclinic.org/sympto
ms/lowhemoglobin/basics/definition/sym20050760
Hematocrit

0.34

0.36-0.45

low hematocrit is anemia. Causes

of low hematocrit, or anemia,
include: Bleeding (ulcers, trauma,
colon cancer, internal bleeding),
Destruction of red blood cells
(sickle

cell

anemia,

enlarged

spleen), Decreased production of

red blood cells (bone marrow
supression,

cancer,

drugs),

Nutritional problems (low iron, B

12,

folate

Overhydration

and

malnutrition),
(polydypsia,

intravenous overhydration).
(Davis, Patrick Charles (2014).
Emedicine health.com. Retrieved
from

6/28/14.

www.emedicinehealth.com/hemato
crit_blood_test/page4_em.htm)

Leucocytes

4.6

5.00-

A low WBC count is often linked to

no. Concentra-

10.00x10^q/

problems with the bone marrow

tion

and the inability to make enough

white

blood

cells. Autoimmune

diseases that attack your white

Table 3.2 Urinalysis

Examination

Result

Normal

Implication

Values
Color

Dark
Yellow

Light
Yellow to

Dark yellow urine

Darker urine is usually a sign that

Amber

you're not drinking enough fluid.

"Your

body

needs

certain

amount of fluid to function, so the

body will hold on to fluid and the
urine will become very strong and
concentrated.
Jeannings, Charles

E.,

MD.

(2014). Retrieved from 06/28/14.

www.webmd.com.
(http://www.webmd.com/urinaryincontinence-oab/features/thetruth-about-urine)

Sugar

Negative

Albumin

Positive

Negative

Normal

Positive Albumin
Moderately increased albumin
levels found in both initial and
repeat urine tests indicate that a
person is likely to be in an early
phase

of

developing

kidney

disease. Very high levels are an

indication that kidney disease is
present in a more severe form.
Undetectable

levels

are

an

indication that kidney function is

normal.
Lab Test Online (2014). Retrieved
from

6/28/2014.

(http://labtestsonline.org/understa
nding/analytes/microalbumin/tab/t
est/)

Reaction
SP-Gravity

5.0
1.030

5-8.5

Normal

1.005-

Normal

1.030
Epithelial Cells

0-4 pvf

Normal

M. Threads

None

Normal

Pus Cells

1-3 lpf

0-4 pvf

Normal

Bacteria

Moderate

None

Presence of Bacteria
Bacteriuria is defined as the
presence of bacteria in the urine;
however, because the specimen
can

be

contaminated

with

periurethra flora during collection,

infection is confirmed by counting
the

number

of

bacteria.

Significant bacteriuria is defined

as the presence of more than 105
organisms per ml of urine.
(http://www.nursingtimes.net/unde
rstanding-urinetesting/204042.article)

Crystals

No
abnormal

Normal

crystal
present
Cast

Coarse

0-2 hyaline Significant renal disease. However,

granular

granular casts may be present in the

cast

urine for a short time following

strenuous exercise. Granular cast

Few

that contain fine granules may

appear grey or pale yellow in color.
Granular casts that contain larger
coarse granular are darker. These
casts often appear black because of
the density of the granules.
Integrated Publishing Inc. (2014).
www. tpub.com. Retrieved from
06/28/14.
http://www.medical.tpub.com/14295/c
ss/14295_300.htm

Table 3.3 Chest X-ray

Examination

Result

Normal

Implication

values
Chest X-ray

Heart is

Chest X-rays can be used to

normal in

determine if infection is present

size, Right

in your lungs. However, chest

Lung shows

X-rays wont show your type of

infiltrations in

pneumonia. Blood tests can

the Lower

provide a better picture of the

Lobe, Left

type of pneumonia. Also, blood

lung is clear.

tests are necessary to see if the

infection is in your bloodstream.

Pneumonia is an infection that
inflames the air sacs in one or
both lungs. The air sacs may fill
with fluid or pus, causing cough
with phlegm or pus, fever, chills
and difficulty breathing. A
variety of organisms, including
bacteria, viruses and fungi, can
cause pneumonia.
Mayo Clinic staff. (2014).
www.mayoclinic.org. Retrieved
from 6/28/14
http://www.mayoclinic.org/disea
sesconditions/pneumonia/basics/de
finition/con-20020032

IV. REVIEW OF ANATOMY AND PHYSIOLOGY

The lungs consists of right and left sides.
The right lung has three lobes: Upper lobe, Middle lobe, Lower lobe
The left lung has two lobes: Upper lobe and Lower lobe

Figure 1.1 Normal lungs

The heart sits in the mid chest extending into the left side.
Starting from the trachea (windpipe), two large tubes known as bronchi (airways)
separate and distribute air to the left and right sides of the lungs.
Bronchi gradually form more generations, like a tree branch, and become smaller
and smaller. As they spread to the ends of the lungs they eventually form a
grape-like structure known as the alveoli.

Figure 1.2 Trachea to alveoli

The diaphragm is the large dome shaped muscle that contracts and relax during
breathing. It also separate the chest and abdominal cavity. Muscle near our ribs
also help expand our chest for breathing.

Figure 1.3 Normal Breathing Pattern

Oxygen is inhaled and released from the lungs to the blood.
-Air reaches the alveoli (air sacs) where oxygen then moves from the air sacs
into the capillaries through their thin walls.
-Capillaries are tiny blood vessels that carry oxygenated blood to the blood
stream that supplies our body.
Carbon Dioxide is released from the blood to the lungs and exhaled. Carbon
Dioxide moves from capillaries (tiny blood vessels) into the alveoli. Too much
carbon dioxide in the blood results from hypoventilation (too little breathing). Too
little carbon dioxide in the blood results from hyperventilation (too much or rapid

breathing).

Figure 1.4 Blood Circulation

Tiny hairs, called cilia, line the bronchi. Cilia moves back and forth in an ongoing
motion-like a wave. Mucus is carried on top of cilia. This is the first of defense of
infection by moving foreign objects, like bacteria or viruses, out of the lungs.

Figure 1.5 Cilia

The pleura is a thin balloon-like structure, like saran wrap, that surrounds the
lungs and allows them to moved smoothly as we breath in and out.
There are two types of pleura in our chest: Visceral pleura (covers the lungs) and
Parietal pleura (covers the chest wall)

Figure 1.6 Visceral and Parietal Pleura

Between the visceral and parietal pleura exists the pleural space which contain
small amount of fluid. This fluid is moved in and out of the lungs through the
lymphatic system that exists between the lungs and the rest of the body. The
lymphatic system is a series of blood vessels, that move fluids through our
bodies to help get rid of foreign objects, like bacteria, viruses or asbestos fibers.

Figure 1.7 Upper part of the body

The interstitium refers to the tissue network that surrounds the air sacs (alveoli).
It includes a web-like network of strong structural fibers that prevent the alveoli
from being over stretched.

Figure 1.8 Collagen fibers and Alveoli

Parenchyma is the main part of an organ that contains the functions cells. The
word parenchyma can be used in reference to any organ. The lung parenchyma
is used to describe the respiratory bronchioles (smallest bronchi) and alveoli,
where carbon dioxide and oxygen are exchanged.
(CARD.

(2013).

www.akaction.org.

Retrieved

from

July

8,2014.

http://www.akaction.org/wpcontent/uploads/2013/07/Lung_Anatomy_Physiology.
pdf)

V. SYMPTOMATOLOGY
Table 4 shows the Signs and Symptoms of Community Acquired
Pneumonia III.

SYMPTOMA-

ACTUAL

TOLOGY

SYMPTOMS

Shortness
Breath

of Present

IMPLICATION

It can be a caused by problems with the

lungs or the heart, or by a low blood
count. Common cause of shortness of
breath

includes

respiratory

tract

infections, such as pneumonia.

Schwartzstein,

Richard

M.

(2014).

www.uptodate.com. Retrieved from June

29,2014.
www.uptodate.com/contents/shortnessof-breath-dyspnea-beyond-the-basics?
source=outline_link&view=text&anchor=
H2#H2
Cough

Present

Cough

is

pneumonia.
inflammation

common
It

is

and

symptom

in

caused

by

the

irritation

of

the

passages in the lungs, which is sensed

by small nerve endings which trigger the
cough.

Bregman,

Zachary,

MD.

(2014).

www.zocdoc.com. Retrieved from June

28, 2014.
www.zocdoc.com/answers/4571/whydoes-pneumonia-cause-coughing
Chills

Present

Chills

(shivering) may

occur

at

the

beginning of an infection and are usually

associated with a fever. Chills are
caused by rapid muscle contraction and
relaxation. They are the body's way
of producing heat when it feels cold.
Chills often predict the coming of a fever

or an increase in the body's core

temperature.

MedlinePlus. (2014). www.nlm.nih.gov.

Retrieved from 06/28/14
http://www.nlm.nih.gov/medlineplus/ency/
article/003091.htm
Rales

Present

Occurs

when

inspiration

negative

causes

pressure

airways

of
that

previously collapsed to "pop" open. Once

open, there is a sudden equalisation of
pressures

on

either

side

of

the

obstruction, resulting in vibrations of the

airway wall, giving the characteristics
sound.

Inkling

System

Inc.

(2014)

www.inkling.com. Retrieved from June

29,2014.
www.inkling.com/read/dennismechanismclinical-signs-1st/chapter2/crackles-rales
Retraction

Present

Inadequate oxygen can cause a person

to work harder to breathe, requiring the
use of accessory muscles. Using these
muscles indicates a potential injury or
disease process that is affecting a

persons ability to breathe.

Brannagan,

Meg.

www.livestrong.com.

(2013).

Retrieved

from

June 29, 2014

http://www.livestrong.com/article/195127the-use-of-accessory-muscles-withbreathing/
Fever

Present

An elevated body temperature (fever) is one

of the ways our immune system attempts to

(38.5 C)

combat an infection. Usually the rise in body

temperature helps the individual resolve an
infection. However, sometimes it may rise
too high, in which case the fever can be
serious and lead to complications.

MNT,

Inc.

(2013).

www.medicalnewstoday.com. retrieved from

06/29/14
http://www.medicalnewstoday.com/articles/1
68266.php

Wheezing Sound

Present

Wheezing is defined as a high-pitched

whistling

sound

that

occurs

with

breathing. Wheezing can occur both with

breathing in (inspiratory wheezing) and
with breathing out (expiratory wheezing),
though it is more common with breathing
out.

Eldridge,

Lynn

MD,.

www.lungcancer.about.com.

(2014).
Retrieved

from

6/29/14

http://lungcancer.about.com/od/symptom
s/a/Wheezing.htm
Rapid Heartbeat
(130 bpm)

Present

Irregular heart rhythm, usually more than

100 beats per minute and as many as
400 beats per minute. At these elevated
rates, the heart is not able to efficiently
pump oxygen-rich blood to your body.
Medtronic,

Inc.

www.medtronic.com.

(2014).

Retrieved

from

06/29/14
http://www.medtronic.com/patients/tachy
cardia/
Cyanosis

is the abnormal blue discoloration of the

skin and mucous membranes, caused by
an

increase

in

the

deoxygenated

haemoglobin level to above 5 g/dL.

Patients with anaemia do not develop
cyanosis until the oxygen saturation
(SaO2) has fallen to lower levels than for
patients with normal haemoglobin levels,
and patients with polycythaemia develop
cyanosis at higher oxygen saturation
levels.

Patient.co.uk. (2014). www.patient.co.uk.

Retrieved

from

06/29/14.

http://www.patient.co.uk/doctor/Cyanosis.
htm
Apnea

Sleep apnea occurs when a senior's

airway becomes constricted or blocked
as they are sleeping. Apneas, or pauses
in breathing, can happen multiple times
during the night and can cause severe
disruptions of an elderly person's sleep
cycle. Discover the common causes and
treatment options for sleep apnea in the
elderly.
Aging

Care

Inc.

www.agingcare.com.

(2014).

Retrieved

from

06/29/14.
http://www.agingcare.com/sleep-apneain-elderly
Table 4
VI. ETIOLOGY
Table 5 shows the Etiology of Community Acquired Pneumonia III.
ETIOLOGY

ACTUAL

IMPLICATION

SYMPTOMS
Age
(87
older)

The increased frequency and severity of

years

and

Present

pneumonia

in

the

elderly

is

largely

explained by the ageing of organ systems

(in particular the respiratory tract, immune
system,

and

digestive

tract)

presence of comorbidities due to

and

the

age-associated diseases.

Krause, Karl-Heinz and Janssens, JeanPaul.

(2014).

www.pneumonologia.gr.

Retrieved from June 29,2014

http://www.pneumonologia.gr/articlefiles/pne
umonia_in_the_elderly.pdf
Streptococcus
Pneumoniae

Is the common
Present

cause of CAP in people

younger than 60 years of age without co

morbidity and in 60 years and older with co
morbidity;

an

organism

that

resides

naturally in the upper respiratory tract,

colonizes the upper respiratory tract and
cause disseminated invasive infections,
pneumonia

and

other

respiratory tract

infection.

Smelter, Suzanne., Baire,Brenda., Hinkle,

Janice., Cheever, Kerry. (2008). "Textbook
of Medical-Surgical Nursing" page 555.
Lippinott-Raven

Publishers.

Philadephia.

Twelfth Edition
Smoke

Present

Being exposed to smoke i.e., car exhaust,

cigarette

smoke.

(http://www.nhs.uk/Conditions/Bronchiolitis/
Pages/Causes.aspx)
Cold
Temperature

Present

Winter weather and cold temperatures can

dry out the air, and when you breath that air,

it dries out your lungs and throat.

(http://www.nhs.uk/Conditions/Bronchiolitis/Pag
es/Causes.aspx)

Airborne

Present

Diseases

Airborne

diseases

are

caused

by

pathogenic microbes small enough to be

discharged from an infected person via

(droplets)

coughing, sneezing, laughing and close

personal contact or aerosolization of the
microbe. The discharged microbes remain
suspended in the air on dust particles,
respiratory and water droplets. Illness is
caused when the microbe is inhaled or
contacts

mucus

membranes

or

when

secretions remaining on a surface are

touched.

Maine Department of Health and Human

service. (2014). www.maine.gov. Retrieved
from

06/29/2014

http://www.maine.gov/dhhs/mecdc/infectiou
s-disease/epi/airborne/
History

of Present

Inhaled

corticosteroids

(ICS)

are

the

respiratory illness

mainstay of asthma treatment. Studies in

(asthma

chronic

PTB)

and

obstructive

pulmonary

disease

reported increased rates of pneumonia with

ICS. Concerns exist about an increased
pneumonia risk in patients with asthma
taking

ICS.

http://www.atsjournals.org/doi/full/10.1164/rc

cm.201005-0694OC#.U7WNQfmSwYM
Table 5

VII. PATHOPHYSIOLOGY

Pneumonia is an infection in the lower respiratory tract that causes to

inflammation of the lung parenchyma leading to a situation in which the alveoli,
especially in the lobes, interstitial tissue, and bronchioles become edematous
and filled with fluid.
Pneumonia begins with aspiration of organisms, either from the air when
someone coughs or sneezes or via oropharyngeal secretions, into the lower
respiratory tract. If the pathogen that enters the lungs overwhelms the alveolar
macrophages the immune system is activated, leading to invasion of lung tissue
by macrophages and other inflammatory mediators. This inflammatory process
leads to decreased lung ventilation of the affected areas due to cellular infiltration
and congestion. The filling of the alveoli with exudates or consolidation causes
them to collapse. The resulting pneumonia can cause acute hypoxemia, which
exacerbates such conditions as pulmonary hypertension and dilates the right
ventricle, leading to cor pulmonale (Huether & McCance, 2008).

Diagram 2 illustrates the Pathophysiology of Community Acquired Pneumonia III.

Predisposing Factors:

Precipitating Factors:

(a) Age (87y/o)

(a) Streptococcus Pneumoniae

(b) History of respiratory illness

(asthma)
(c) Airborne Diseases (droplets)
(b) Smoke

Causative Agent enters

Defense mechanism is activated

(cough reflex, mucocilliary transport and pulmonary
macrophages)

Defense mechanism is suppressed

by invading agent.
Invading organisms starts to multiply and
release damage toxins.

S/S
Fever, Cough,
Chills


Inflammation and edema of the lungs
parenchyma
S/S: Dsypnea,
Accumulation of cellular debris exudates within the lungs
Retraction,
Wheezing, Rales

Fluid exudate fills the lungs.

CAP III
Bad

Nursing
Good Mgt:

Prognosis

Without Medical or
Nursing
Intervention
It will complicate to:
Abscess
Bacteriuria

Infection can spread

throughout the body.
DEATH

Medical
Management:

Diagnostic
Exams:

Anti-asthmatic

CHEST X-RAY,
BLOOD
CHEMISTRY,
ABG, URINE
ANALYSIS

Anti-infective
Antibiotic
Cephalosporins

Antihistamines
Antipyretics or
Analgesics
Bronchodilator

Mucolytic

Monitor the RR,

depth and chest
movement
Positioning the
client to a
MHBR
Provide health
teaching to the
significant
others
Instruct the
client to
increase Oral
Fluid Intake
frequently to
liquefy mucous.
Encourage
client to take
some rest to
reduce O2
demand
Provide
information
about the
disease,
process, and
treatment
Back tapping
Deep breathing
and coughing
exercise
Evaluate the

CONVALESCENSE

REHABILITATION
Oxygen Therapy
Diagram 2
Prognosis:
Community-acquired pneumonia (CAP) is the most common cause of
death due to infection in industrial nations and the most common cause of death
in low-income countries. Although it can cause disease at any age, it primarily
affects the elderly (65 years of age). CAP is primarily caused by bacteria, but
can be due to a wide range of microbial pathogens.
Bestpractice.bmj

Retrieved

6/29/2014.

http://bestpractice.bmj.com/best-

practice/monograph/165/follow-up/prognosis.html
Figure 2 Lungs with Community Acquired Pneumonia III

VIII. NURSING CARE PLAN

Table 6.1-6.3 shows the plan of care.
#1NCP

DATE

ASSESS-

&

MENT

SHIFT

NEEDS

DIAGNOSIS

PLANNING

INTERVENTION

EVALUATION

06-24- Subjective:

Physio-

Ineffective

Within 8 hours

INDEPENDENT

2014

logical

airway

of providing

1. Monitored VS

clearance r/t

nursing care,

accordingly

viscous

patient will be

(R)it allows to

secretions in

able to

identify early

-Respiratory rate of

the

maintain

problems and

29cpm

tracheobron

airway patency take measures to

-Coughed out 50cc

chial tree

AEB:

prevent them

of phlegm

from becoming

-demonstrated

a. Respiratory

serious.

behaviors to

a."Sakit akong

73

dughan"

8:00a

b. "Sakit

akong likod"

(Oxygen

c. "Magsige

ation)

ko ug ubo"

Needs

Objective:
a. with

2:45pm
GOAL partially met

gurgling and

Pathogens

rate will

2. Instructed to

improve airway

loud sound of

invades the

decrease to

increase OFI at

patency

normal values

least 2000mL/day

(16-20cpm)

Within cardiac

noted upon

Irritates the

b. Expel at

tolerance.

auscultation

bronchi

least minimal

(R) Hydration can

amount of

help prevent

mucus

accumulation of

cough
b. Fine Rales

c. minimal
secretion of

lungs

Produces

rusty pink

purulent

secretions

viscous

mucous

mucous

c.

secretions,

d. flaring of

secretion

Demonstrate

liquefaction of

behaviors to

pulmonary

nostrils
e. dyspnea

Obstruct the

improve airway secretion and

f. use of

conducting

patency such

improve secretion

accesory

zone

as deep

clearance.

muscles

breathing

3. Instructed

exercise and

Maintain High

airway

coughing

back rest.

clearance

exercise

(R) this method

g. tachypnea
( 31cpm)
h. Capillary
refill

Ineffective

help maintain

(2 sec)

adequate lung
Reference:

expansion thus

Brunner and

preventing build

Suddarth's

up of secretions

Medical

and atelectasis

Surgical

4. Taught and

textbook.

demonstrated

Williams and

deep breathing

Wilkins. 12th

exercises.

edition. Vol.

(R) to keep

1, p. 554 -

airway clear of

555

secretion
5.Monitored VS
accordingly
(R) to prevent
complications,
tachycardia and
.

hypertension may
be related to
increased work of
breathing. fever
may develop in
response to
retained
secretions/atelect
asis
DEPENDENT:
1.Administered
medication such
as expectorant,
bronchodilator

and mucolytic
agents as
indicated
(R) To reduce
airway edema,
and mobilize
secretions.
2. Administered
O2 inhalation 24Lpm via nasal
cannula as
indicated.
(R)Provide
adequate
transport of O2 in
the blood while
decreasing the
work of
breathing.
Reference:
Doenges,
Marilynn E.,
Moorhouse, Mary
Frances., Murr,
Alice C., (2013).
"Nurse's Pocket
Guide", iGroup
Press Co., Ltd.
Bankok,
Thailand.
Thirteen Edition.

#2NCP
Table 6.2

DATE &

ASSESSMENT

Needs

DIAGNOSIS

PLANNING

INTERVENTION

EVALUATION

SHIFT
06-25-

Subjective:

Activity -

activity

Within 8

INDEPENDENT:

2:30pm

2014

a. "hangakon ko

exercise

intolerance

hours of

1. assess cardio

-Ate 8 tbsp of

mag sige ug

pattern

r/t

providing

pulmonary

food at lunch.

imbalance

nursing

response to

oxygen

care, patient physical activity

Objective:

supply and

will be able

R- dramatic

a. On CBR w/o

demand

to perform

changes in HR

necessary

and rhythm

73
9:00 am

lihok"

brp
b. FBC w/

Causative

activities

progressively

urobag attached

agents

with

worsening fatigue

b. dyspnea

invades the

assistance

2. encourage to

c. use of

respiratory

such as

increase food

accesory

system

providing

intake

hygiene,

R- adequate

eating

energy reserves

muscle
d. pale oral
mucosa
e. flaring of
nostrils

Irritates the
bronchi

are required for

acivity

Goblet cells

VS:

produces

3.Encouraged

RR - 28cpm

excessive

small frequent

Bp - 100/70

mucous

feeding with

PR - 118bpm

snacks daily.

Temp - 37.6

Blocks the

(R) Eating small

airway

frequent meals

Cap refill - 2sec


Less
oxygen

helps you to get

more of the
nutrients your

suppy to the

body needs.

cells of the

4.Changing

body

positions often

R - distributes

Activity

work to different

intolerance

muscles to avoid
fatigue
5. placing things
within reach that
are needed.
R -lesser activity

Reference:

decrease oxygen

http://nurses

demannd

labs.com/ac

6. educate

tivity-

patient the

intolerance-

importance of

nursing-

limiting activities

diagnosis/

R - to encourage
patient to help
herself
7. raise the side
rails
R - to prevent
from falling
DEPENDENT
1. Administered
O2 inhalation 2-

4Lpm via nasal

cannula as
indicated.
(R)Provide
adequate
transport of O2 in
the body.
Reference:
Doenges,
Marilynn E.,
Moorhouse, Mary
Frances., Murr,
Alice C., (2013).
"Nurse's Pocket
Guide", iGroup
Press Co., Ltd.
Bankok,
Thailand.
Thirteen Edition.

#3NCP
Table 6.3

DATE

ASSESSMENT

NEEDS

DIAGNOSIS

PLANNING

INTERVENTION

EVALUATION

Ineffective

Within 8

INDEPENDENT:

thermo

hours of

1. Monitored VS

regulation r/t

providing

accordingly

-Temperature

nursing

(R)it allows to

decreased to

care, patient

identify early

36.88C

will be

problems and

- Wala na

eliminate

take measures to

nagsakit akong

present

prevent them

ulo as

body

signs and

from becoming

verbalized

symptoms

serious.

of

2.Encouraged to

&
SHIFT
06-24-

Subjective:

Physiological

2014

a. Bugnaw

Needs

73

akong paminaw

(Temperature

8:00a

b. Sakit akong

Maintenance) illness

ulo
Bacteria or
Objective:
a. flushed skin
b. warm to
touch
c. shivering

viruses
invades the

Body

d. Temp: 37.8 C

produces

hyperthermi

increase OFI

E. RR - 31cpm

chemical

a AEB:

(R) Drinking

(pyrogens) as
defense

water during a
a.

fever keeps you

mechanism

Temperatur

hydrated which

e decrease

promotes healthy

to normal

bowel

range

functioning;

(36.5C-

prevents dry skin,

37.5C)

and dilutes and

b. Absence

washes the virus

Stimulate
hypothalamu

Increase

2:45pm

body

of headache

or bacteria out of

temperature

c. Free form

the body.

shivering

3. Promote

hyperthermia

surface cooling
by means of

REFERENC

tepid sponge

E:

bath.

http://www.bri

(R) To decrease

tannica.com/

Temperature by

EBchecked/t

means through

opic/205674/f

evaporation and

ever, The

conduction.

Editor of

4. Wrap

Encyclopaedi

extremities with

a Britannica,

cotton blankets.

2014

(R) To minimize
shivering
5.Maintain bed
rest.
(R)To reduce
metabolic
demands and
oxygen
consumption
DEPENDENT
1. Administered
antipyretics drugs
as prescribed by
the physician
(R) antipyretics
works to lower

the temperature,
resulting in a
reduction in fever.
2.Administer
replacement
fluids and
electrolytes
(R) To support
circulating
volume and
tissue perfusion.
Reference:
Doenges,
Marilynn E.,
Moorhouse, Mary
Frances., Murr,
Alice C., (2013).
"Nurse's Pocket
Guide", iGroup
Press Co., Ltd.
Bankok,
Thailand.
Thirteen Edition.

IX. PHARMACOLOGICAL MANAGAEMENT

Table 7.1-7.9 shows the list of medications

Generic

Brand

Classi-

Adverse

Name

Name

fication

Indications

Reaction

CNS: headache,

A nitro-

Monitor liver

Contra-

seizure, fever,

imidazole

function test

indicated with

take ER tablets

vertigo,

derivative

results

hyper-

from at least 1

dizziness,

that

carefully in

sensitivity to

hour before or 2

confusion,

disrupts

elderly

drug or other

hours after meals

depression,

bacterial

patients.

ritroimidazole

but to take all

To prevent
infection in
contaminated or
potentially
contaminated
colorectal
surgery.

weakness,

and

Give oral forn

derivatives

other oral forms

insomnia,

protozoal

with meals.

and in women

with food to

peripheral

DNA,

Observe

in first

minimize GI

neuropathy.

inhibiting

patient for

trimester of

CV: edema,

nucleic

edema,

pregnancy.

flushing,

acid

especially if

Are cautiously

thrombophlebitis

synthesis.

hes receiving

in patients

after infusion

cortico-

with health of

EENT: rhinitis,

steroids:

blood

sinusitis,

Flagyl IV RTU

dyscrasia,

MOA

Nsg

Contra-

Patients

Consideration

indications

Teaching
Instruct patient to

upset.
Inform patient of
need for sexual
partners to be
treated
simultaneously to
avoid re-infection.
Instruct patient

pharyngitis

may cause

CNS disorder,

GI: nausea,

sodium

or retinal or

abdominal

retention.

visual field

cramping or

Record

changes.

pain, stomatitis,

number and

epigastric

character of

distress,

stools when

vomiting,

drug is used

anorexia,

to treat

diarrhea,

amebiasis.

constipation, dry

Give drug

mouth

only after

Skin: rash

Trichomonas
vaginalis

about proper
hygiene.
Tell patient to
avoid alcohol and
alcohol containing
drugs during and
for at least 3 days
after treatment
course.
Tell patient he may
experience a
metallic taste and
have dark or redbrown urine.
Tell patient to

infection is

report to

confirmed by

prescribes

wet smear or

symptoms of

culture or

candidal growth,

Entameba

dry neurologic

histolytica is

symptoms

identified.

(seizures,

Sexual

peripheral

partner of

neuropathy)

patients being
treated for T.
vaginalis
infection,
even if
asymptomatic
, must also be
treated to
avoid reinfection.

Generic

Brand

Classi-

Name

Name

fication

Indications

Adverse
Reaction

MOA

Nsg

Contra-

Patients

Conside-

indications

Teaching

ration

C
I
P
R
O
F
L
O
X
A
C
I
N

A
N
T
I
I
N
F
E
C
T
I
V
E
S

CNS:
seizure,
confusion,
depression,
dizziness,

An antiinfectives
that
inhibites
the
enzyme
DNA

Obtain

Contra-

specimen for

indicated in

drug as prescribe

culture and

patients

even after he feels

sensitivity

sensitive to

tests before

antibacterial.

giving first

Use cautiously

dose. Begin

in patients with

drow-

gyrase in

therapy,

CNS

siness,

susceptibl

awaiting

disorders,

fstigue,

e bacteria,

results.

such as severe

hallucina-

interfering

Monito

cerebral

patients

arteriosclerosis

bacterial

intake and

or seizures.

cell

output and

Drugs may

tion,
headache
,
insomnia,

with

replication. observe

Tell patient to take

better.
Advise patient to
drink plenty of
fluids to reduce
risk of urine
crystals.
Advise patient not
to crush, split or
chew the
extended-release
tablets.
Warn patient to

cause CNS

avoid hazardous

light-

patient for

stimulation.

tasks that require

headed-

signs for

Drug is

alertness, such as

ness,par-

cystalluria.

associated

driving, until

ethesia,

Pregnant

with increased

effects of drug are

restlessn

women and

risk of adverse

ess,

immune-

reactions

known.
Instruct patient to

tremor

compromised

involving

avoid caffeine

CV: chest

patients

joints, tendons

while taking drug

pain,

should

and

because of

edema,

receive the

surrounding

potential for

thrombo-

usual doses

tissues in

increased caffeine

phlebitis,

and regimens

children

GI;

for anthrax.

younger than

pseudo-

Follow

18.

membra-

current CDC

nous

recommendat

colitis,

ions for

diarrhea,

anthrax.

nausea,

Steroids may

abdo-

be used as

minal

adjunctive

pain or

therapy for

dis-

anthrax

comfort,

patients with

consti-

severe

pation,

edema and

dy-

for

effects.
Advise patient trhat
hypersensitivity
reactions may
occur even after
first dose. If a rash
or other allergic
reaction occurs,
tell him to stop
drug immediately
and notify
prescriber.
Tell patient that
tendon rupture
can occur with
drug and to notify

spepsia,

meningitis.

prescriber if he

flatu-

experiences pain

lence,

or inflammation.
Tell patient to avoid

oral
candidiasis
vomiting.
GU:
crytalluria
,
interstitial
nephritis.
Hema:
leukopenia,
neutronpenia,
thrombocytopenia
, eosinophilia,

excessive sunlight
during therapy.

Musculoskeletal:
aching,
arthralgia,
arthropat
hy, joint
inflammation,
joint or
back pain
joint
stiffness,
neck
pain,
tendon
rupture.
Skin:
rash,
StevensJohnson
syndrome

, toxic
epidermal
necrolysis
, burning
erythema,
exfoliative
dermatitis
,
photosen
sitivity,
pruritus.
Others:
hypersensitivity
reactions

Generic

Brand

Classi-

Name

Name

fication

C
C
E
P

Indications

Adverse
Reaction

Treatment of
infections of
lower resp.
tract, skin &
skin
structures;
treatment for
uncomplicated
gonorrhea,
utitis media,
pharyngitis &
tonsillitis
caused by
susceptiuble
stains of
specific microorganism.

MOA

Nsg

Contra-

Patients

Conside

Indications

Teaching

GI:
nausea,
vomiting,
diarrhea,
abdominal
pain
CNS:
headache,
dizziness
Skin: temp.

Second

ration
Before giving

generatio

drugs, ask pt.

indicated with

patient to

n of

If he/ she is

allergy to

take course

cephalosp

allergic to

cephalos-

of theraphy

orin that

penicillin/

porins or

even if

inhibits

cephalos-

penicillin.

feeling

cell wall

porin

elevation

promoting

Give oral

osmotic

drug with

instability;

food to

usually

decrease GI

bactericid

upset

synthesis

Contra-

Instruct

better.
Advise

al

patient to
swallow
tablets
whole; do
not crush
them.

Tablet may

be crused if

necessary/

patient who

Instruct
patient to
take the

cant swallow

P
O

Have vitamin

K available

increase for

hypothermia

drug with
food.
Report
severe
diarrhea
with blood,
pus, or
mucus;
rash;
difficulty
breathing;un
usuak
tiredness;
fatigue;
unusual
bleedin or
bruising;
usual itching
or irritation.

Generic

Brand

Classi-

Name

Name

fication

Indications

Adverse
Reaction

MOA

Nsg

Contra-

Patients

Conside-.rati

indications

Teaching

Relief of

CNS:

on
Antagonizes -Assess

allergic

dizziness,

the effects

symptoms

drowsiness, of

symptoms

cetirizine,

take

caused by

fatigue

histamines

(rhinitis,

hydroxizine or

medications

histamines

EENT:

at H1

conjunctivitis any

release

pharyngitis

receptor

, hives)

component.

including:

GI: dry

sites; does

-Asssess

LACTATION:

seasonal and

mouth

not bind to

ung sounds

excreted in

perennial

or iactive

and

breast milk;

allergic

histamines.

character of

not

rhinitis,

Decreased

bronchial

recommende

chronic

symptoms

secretions

d for use.

urticaria.

of histamine

-Maintain

excess

fluid intake

(sneezing,

of 1500-

occular

2000mL/day

tearing,

to decrease

redness,

viscosity of

Hypersen-

-Instruct

allergy

sitivity to

patient to

as
indicated.
-May cause
dizziness
and
drowsiness.
Caution
patient to
avoid
driving or
other
activities
requiring
alertness.

pruritus)

secretions.

-Advise
patient to
avoid taking
alcohol.
-Advise
patient to
have a good
oral
hygiene.
- Patient
should
notify
dentist if dry
mouth
persists.

Generic

Brand

Classi-

Name

Name

fication

Indications

Adverse
Reaction

MOA

Nsg

Contra-

Patients

Conside-.rati

indications

Teaching

Mild fever or

GI: Hepatic

Inhibits the

on
-Assess

pain

Failure,

synthesis

overall

Hepatoto-

of

health status hypersen-

take

xicity

prostaglan

and alcohol

sitivity

medication

(overdose)

dins that

usage

products

exactly as

GU: renal

may serve

before

containing

detected

failure (high

as

administe-

alcohol,

and not to

doses/

mediators

ring

aspartame,

take more

chronic use)

of pain and

acetominop

saccharin,

than the

Derm: rash,

fever,

hen.

sugar or

recommend

urticaria

primarily in

-Assess

tartrazine

the CNS.

amount,

should be

Or

Has no

frequency

avoided in

significant

and type of

patients who

anti-

drugs taken

have

inflammato

in patients

hypersensitivit

ry

self-

y or

properties

medicating

intolerance to

Contraindicat
ed in previous

-Advise
patient to

ed amount.
-Advise
patient to
avoid
alcohol (3 or
more
glasses may
increase the

or GI

specifically

these

toxicity.

with OTC

compound.

Therapeuti

drugs

Use

c effect:

-For pain,

continuously

Analgesia,

assess type,

in hepatic

Antipyresis

location and

disease/ renal

intensity

disease;

prior to and

chronic

30-60min

alcohol use/

following

abuse;

administratio malnutrition
n.
-For fever,
assess
fever, note
presence of
associated
signs
(diaphoresis
, tachycardia
and

risk of liver
damage)
-Advise
patient to
check labels
on all OTC
products.
-Advise
patient to
consult
health care
professional
s if
discomfort
or fever is
not relieved
by routine
doses.

malaise)
-If overdose
occurs,
acetylcystei
ne
(acetadole)
is the
antidote.

Generic

Brand

Classi-

Name

Name

fication

Indications

Adverse
Reaction

MOA

Nsg

Contra-

Patients

Conside-.rati

indications

Teaching

This

Fine tremor

maximize

on
- check the

combination

of skeletal

the

heart rate

ed in patients

take this

medication

muscle,

response

before and

with a history

drug exactly

contains beta-

palpitations,

to

after the

of

as

adrenergic

headache,

treatment

treatment

hypersensitivit

prescribed.

(sympathomi

dizziness,

in patients

metic) and

nervousness

with

anticholinergic , dryness of

chronic

bronchodilator

mouth,

obstructive

, prescribed

throat

pulmonary

for chronic

irritation,

disease

obstructive

urinary

(COPD) by

pulmonary

retention

reducing

disease

bronchosp

(COPD). It

asm

relaxes airway

through

muscles that

two

result in easy

distinctly

Contraindicat

Instruct to

Instruct
patient to
take with
meals if GI
upset
oocurs.
Advice
patient to
frequently
follow- up
visits to
health care

breathing.

different

provider are

mechanism

needed to

s,

monitor

anticholiner

drug

gic

response

(parasymp

and adhust

atholytic)

dosage.

and
sympatho
mimetic.
Simultaneo
us
administrati
on of both
an
anticholiner
gic
(ipratropiu
m bromide)
and a
beta2-

sympatho
mimetic
(albuterol
sulfate) is
designed
to benefit
the patient
by
producing
a greater
bronchodil
ator effect
than when
either drug
is utilized
alone at its
recommen
ded
dosage.

Generic

Brand

Classi-

Name

Name

fication

Indications

Adverse
Reaction

MOA

Nsg

Contra-

Patients

Conside-.rati

indications

Teaching

on

Acute

sweating,

Erdosteine

This drug

Hepatic

Advice patient

bronchitis,

vertigo and

contains

can be

cirrhosis &

to report any

chronic

flushing

two

taken with or cystathionine-

bronchitis &

sulfhydryl

without food

synthetase

its

groups,

For the

anzyme

Advice to take

exacerbations

which are

reason that

deficiency.

medication on

. Respiratory

freed after

of a

phenyketonuri

time and as

disorders

metabolic

probable

prescribed

characterised

transformat intrusion of

by abnormal

ion in the

erdosteine

bronchial

liver. The

metabolites

secretions &

liberated

with the

impaired

sulfhydryl

methionine

mucus

groups

metabolism,

transport

break the

erdosteine is

disulphide

no

bonds,

recommend

which hold

ed in

the

subjects

glycoprotei

experiencing

n fibres of

hepatic

unusuallities

mucus

cirrhosis and

together.

insufficiency

This makes of the

the

cystathionin

bronchial

e synthetase

secretions

enzyme.

more fluid

Ectrin

and

Suspension

enhances

is also

elimination. contraindicat
ed for
Phenylketon
uria,
because of
existence of
aspartame.

Generic

Brand

Classi-

Name

Name

fication

Indications

Adverse
Reaction

MOA

Nsg

Contra-

Patients

Conside-.rati

indications

Teaching

Bronchial

Nausea,

Adrenergic

on
-Use with

asthma &

vomiting,

bronchodil

caution in

Hypotension

patient to

ppulmonary

apigastric

ators

patients with

Lactation

report any

disease with

pain,

and phosp

hypoxemia,

spastic

irritability,

hodiestera

hyperthyroid

bronchial

insomenia,

se

ism, liver

component

tachycardia,

inhibitors

disease,

tachypnea

renal

disease, in

those with

history of

peptic ulcer

and in

elderly.

Acute MI

Advice

unusualities
Advice
patient to
take drug as
prescribed

Generic

Brand

Classi-

Name

Name

fication

Indications

Adverse
Reaction

MOA

Nsg

Contra-

Patients

Conside-.rati

indications

Teaching

on

Treatment of

Rash, fever,

Piperacillin -Do not

Hypersensitivi

infections in

diarrhea,

, an

infuse with

ty to

the lower

nausea,

extended-

PLR

penicillins,

respiratory

constipation,

spectrum

-use

tract

vomiting,

penicillin,

immediately

abdominal

exerts its

after

pain

antimicrobi

constitution

al action in

growing

and

dividing

bacteria by

interfering

with

septum

formation

and cell

wall

synthesis

of

susceptible

bacteria.

Tazobacta
m,irreversi
bly
inactivates
many
plasmidmediated
and some
chromoso
memediated
lactamases
.

Generic

Brand

Classi-

Name

Name

fication

Indications

Adverse
Reaction

MOA

Nsg

Contra-

Patients

Conside-.rati

indications

Teaching

on
M

Management

Edema,

selective,

Safe

Hypersensitivi

of chronic

agitation &

high

with/without

ty to drug

patient to

asthma &

restlessness

affinity,

food

composition

report any

prophylaxis

competitive

unusualities

for exercise-

leukotriene

specially

induced

receptor

hypersensiti

asthma

antagonist

vity

specifically

the

cysteinyl

leukotriene

(cyst-LT1)

receptor. It
suppresses
both early
and late
bronchoco
nstrictor

Advice

Advice
patient to
take drug as
prescribed

responses
to inhaled
antigens or
irritants.

Table 7.9

X. EVALUATION OF THE OBJECTIVE OF THE STUDY

Goal met based on the data presented, we were able to:

Defined and understand Community Acquired Pneumonia

Established trusting relationship to our patient, family and significant others
Gathered information about patients personal background, family background,

socio-economic background and medical history.

Identified the systems involve in the health problem of the patient
Discussed the anatomy and physiology of the affected system
Discussed the symptomatology and etiology of the problem
Analyzed the results of laboratory examinations
Formulated and applied effective nursing interventions
Discussed the medication taken by the patient

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