BRONCHOPNEUMONIA

In Partial fulfillment of the Academic Requirements

Related Learning Experience

-Jz
 DEDICATION
The student nurses who are members of working group assigned in this
particular actual medical care and assistance to analysis, and subsequently in its
final documentation, wish to confer the fruits of their mental and physical labor,
firstly to the Almighty Creator for His Holy inspiration in the preparation of this
academic endeavor;
Although physically tiresome yet mentally interesting, every learning
process was seriously and carefully considered in its minutest detail because such
assignment involved a patient’s full recovery from ailment to healthy human life;
Secondly we wish to dedicate our accomplishment to each and every
lovable parent’s and guardian of the student nurses, who patiently extended
material support and nurturing advice that without which, everything would be
impossible finish;
Finally, to our medical mentors, hospital staff, and co-students of this
academic level the flying colors of recognition and excellence shall be due to
them, for their daily professional lecture cognizant of their erudition, coupled
with happy gestures of camaraderie and friendship in the work assignment.
This is the teamwork-result of unity from many minds rolled up into one
reading materials that shall serve as a future reference of similar application.
 ACKNOWLEDGEMENT
First of all, the presenters would like to thank GOD for his guidance, gift
of wisdom and strength.
We would like to express our heartily and sincere appreciation to all the
persons and agencies for their support, expertise and unending
encouragement in the preparation of this case presentation.
Special Thanks to our parents for the continued financial support and
unending words of encouragements, to our group mates for being
cooperative from the beginning up to the end of making this case
presentation plan, to the family of our patient for their approval and being
cooperative and allowing us to present the medical case.
Thanks to all the clinical instructors for teaching and giving us all the
detailed information and providing us lectures properly, shared clinical
expertise, made suggestion and recommendation for the success of this CP
plan and all nurses for sharing to us their thoughts and knowledge. Your
contributions are appreciated.
 INTRODUCTION
Within our duty in Surigao Medical Center, I received patient Y was diagnosed with an Acute
Bronchopneumonia. He`s 12 years old, Grade 7 student at Saint Paul University Surigao. He is Roman Catholic and
he was born in P-2 STO. NINO, BASILISA. Confidently answer questions. Relating the stated documentation from the
chart, patient Y is suitable case to be studied.
Pneumonia is an inflammation of the lungs caused by an infection. It is called Pneumonitis or
Bronchopneumonia. Pneumonia can be a serious threat to our health. Although is a special concern for the older
adults and those with chronic illnesses.
It can also strike young and healthy people as well. It is a common that affects thousands of people each
year in the Philippines, thus, it remains an important cause of morbidity and mortality in the country. There are
many kinds of pneumonia that range in seriousness from mild to life-threatening.
In infectious pneumonia, bacteria, viruses, fungi, or other organisms that attack the lungs, leading the
inflammation that makes it hard for an individual to breathe. Pneumonia can affect one or both lungs. In young
and healthy individual early treatment with antibiotics can cure bacterial pneumonia.
A drugs used to fight pneumonia are determined by the germ causing pneumonia and the doctors findings.
It is best to do everything we can to prevent pneumonia, but if one gets sick, recognizing and treating the disease
early offers to the best chance for a full recovery.
It is also known as pneumonia. Streptococcus pneumoniae (pneumococcus) and Mycoplasma pneumonia
both are common bacterium that causes bronchopneumonia in the adults and children. Acute inflammation of
the walls of the smaller bronchial tubes, with varying amounts of pulmonary consolidation due to spread of
inflammation into peribronchiolar alveoli and the alveolar ducts, may become confluent or may be hemorrhagic.
In Philippines, the case of pneumonia is one of leading cause of mortality and morbidity among Filipinos, 75-
85% of the population acquired the disease and the one affected the disease are those who are in low income
status and below poverty line individual. (www.DOH.org/pneumonia).
I choose this case because we want to know more about Bronchopneumonia the causes, signs and
symptoms, complications and to have further knowledge of how to treat and prevent this kind of disease.
 REVIEW OF RELATED LITERATURE
Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are
made up of small sacs called alveoli, which fill with air when a healthy person breathes. When
an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing
painful and limits oxygen intake.
Pneumonia is the single largest infectious cause of death in children worldwide. Pneumonia
killed 920 136 children under the age of 5 in 2015, accounting for 16% of all deaths of children
under five years old. Pneumonia affects children and families everywhere, but is most
prevalent in South Asia and sub-Saharan Africa. Children can be protected from pneumonia,
it can be prevented with simple interventions, and treated with low-cost, low-tech
medication and care.
Causes
Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi.
The most common are:
•Streptococcus pneumoniae – the most common cause of bacterial pneumonia in children;
•Haemophilus influenzae type b (Hib) – the second most common cause of bacterial
pneumonia;
•respiratory syncytial virus is the most common viral cause of pneumonia;
•in infants infected with HIV, Pneumocystis jiroveci is one of the most common causes of
pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected
infants.
Transmission
Pneumonia can be spread in a number of ways. The viruses and
bacteria that are commonly found in a child's nose or throat, can infect the
lungs if they are inhaled. They may also spread via air-borne droplets from a
cough or sneeze. In addition, pneumonia may spread through blood,
especially during and shortly after birth. More research needs to be done on
the different pathogens causing pneumonia and the ways they are
transmitted, as this is of critical importance for treatment and prevention.
Presenting features
The presenting features of viral and bacterial pneumonia are similar.
However, the symptoms of viral pneumonia may be more numerous than the
symptoms of bacterial pneumonia. In children under 5 years of age, who have
cough and/or difficult breathing, with or without fever, pneumonia is
diagnosed by the presence of either fast breathing or lower chest wall
indrawing where their chest moves in or retracts during inhalation (in a healthy
person, the chest expands during inhalation). Wheezing is more common in
viral infections.
Very severely ill infants may be unable to feed or drink and may also
experience unconsciousness, hypothermia and convulsions.
Risk factors
While most healthy children can fight the infection with their natural defenses,
children whose immune systems are compromised are at higher risk of
developing pneumonia. A child's immune system may be weakened by
malnutrition or undernourishment, especially in infants who are not exclusively
breastfed.
Pre-existing illnesses, such as symptomatic HIV infections and measles, also
increase a child's risk of contracting pneumonia.
The following environmental factors also increase a child's susceptibility to
pneumonia:
•indoor air pollution caused by cooking and heating with biomass fuels (such
as wood or dung)
•living in crowded homes
•parental smoking.
Treatment
Pneumonia should be treated with antibiotics. The antibiotic of choice is
amoxicillin dispersible tablets. Most cases of pneumonia require oral antibiotics, which
are often prescribed at a health Centre. These cases can also be diagnosed and treated
with inexpensive oral antibiotics at the community level by trained community health
workers. Hospitalization is recommended only for severe cases of pneumonia.
Prevention
Preventing pneumonia in children is an essential component of a strategy to
reduce child mortality. Immunization against Hib, pneumococcus, measles and
whooping cough (pertussis) is the most effective way to prevent pneumonia.
Adequate nutrition is key to improving children's natural defenses, starting with
exclusive breastfeeding for the first 6 months of life. In addition to being effective in
preventing pneumonia, it also helps to reduce the length of the illness if a child does
become ill.
Addressing environmental factors such as indoor air pollution (by providing
affordable clean indoor stoves, for example) and encouraging good hygiene in
crowded homes also reduces the number of children who fall ill with pneumonia.
In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the
risk of contracting pneumonia.
Economic costs
The cost of antibiotic treatment for all children with pneumonia in 66 of the countdown
to 2015 countries for maternal, newborn and child survival is estimated at around US$ 109
million per year. The price includes the antibiotics and diagnostics for pneumonia
management.
WHO response
The WHO and UNICEF integrated Global action plan for pneumonia and diarrhea
(GAPPD) aims to accelerate pneumonia control with a combination of interventions to
protect, prevent, and treat pneumonia in children with actions to:
•protect children from pneumonia including promoting exclusive breastfeeding and
adequate complementary feeding;
•prevent pneumonia with vaccinations, hand washing with soap, reducing household air
pollution, HIV prevention and cotrimoxazole prophylaxis for HIV-infected and exposed
children;
•treat pneumonia focusing on making sure that every sick child has access to the right kind
of care -- either from a community-based health worker, or in a health facility if the disease is
severe -- and can get the antibiotics and oxygen they need to get well;
A number of countries including Bangladesh, India, Kenya, Uganda and Zambia have
developed district, state and national plans to intensify actions for the control of pneumonia
and diarrhea. Many more have integrated diarrhea and pneumonia specific action into their
national child health and child survival strategies. For many countries the post Millennium
Development Goal agenda has explicitly included ending preventable diarrhea and
pneumonia deaths as a priority action.
 NURSING HEALTH HISTORY
Biographic Data:
Hospital : Surigao Medical Center
Case No. : 113409
Ward : PR 27
Name of Patient : Patient Y
Age : 14 years old
Sex : Male
Civil Status : Teenager
Address : Purok-7 Barangay San Juan, Surigao City
Occupation : Not applicable
Date of Birth : 05/02/06
Religion : ROMAN CATHOLIC
Height : 4’9
Weight : 46kg
Admission Data:
Mode of Transmission : Ambulatory
Date and Time of Admission : 02/28/29
Vital Signs upon admission
•Heart Rate : 100 bmp
•Respiratory Rate : 22 cpm
•Blood Pressure : 80/60 mmhg
•Body Temperature : 39 degrees Celsius

Admitting Physician : Mary grace Lim, MD

Attending Physician : Linda C. Chua, MD
Chief Compliant : Cough and Fever
Impression : Dengue Fever
Final Diagnosis : Acute Bronchopneumonia
 HISTORY OF PRESENT ILLNESS
Four days prior to admission which was February 24, 2018 Patient Y was
experienced a high fever and cough associated with colds. Her mother given
him medication which is Biogesic and Salbutamol offering no relief. Last of
February 28, 2018, patient started to have fever at 9:00 am. Parents decided
to consult thus prompted the admission of the child at 10:26 am.
PAST HEALTH HISTORY
I- Childhood Illness
Patient was experienced chickenpox and mumps at age of 10, and measles at age four. His parents brought him
to the health center when those illness occurs.

II – Childhood Immunization
Patient is completed of his immunization during his neonatal stage according to the mother.
HISTORY OF HOSPITALIZATION
III- Medical History
No known previous hospitalization as stated by the patient.

IV – Surgical History

Patient stated that he did not undergo any surgical procedures.

V- Accidents and Injuries

Patient verbalized that he had no history of any type of accidents, but minimal injuries like wound from a knife was
experienced by him that do not took a longer period of time for healing.
VI-Allergies
Patient has no known allergies to food and drugs as he claimed.

VII- Family Health History

According to the patient’s mother. She had a family history of hypertension and asthma while her husband
had also family history of hypertension.

VIII- Personal Habits

Patients usual habits is eating, watching television, listening to music in YouTube and playing computer
games.

IX – Diet/Nutritional Pattern
Patient eats three meals in a day. His usual meal consists of 2 cups of rice, meats and also he like to eats
frozen foods such as hotdogs and longganiza He never eat vegetables and sometimes takes his snacks usually
bread, biscuits and soft drinks such as coke and Pepsi. He has no known food allergies.
At the hospital, his usual meal consists of 2 cups of rice, fish and meat, with vegetables and also drinks 2
glasses of water(300ml/glass) during hospital stay.

XI- Sleep/Rest pattern

He has no problem in sleeping. He usually sleeps at 8pm and wakes up at 8am during and after hospital stay.
He means of relaxation is through watching T.V, and surfing to the internet and having nap time during
afternoon.
X-Elimination Pattern

Before and during hospitalization, patient usually defecates once a day and
urinates 3 times a day. He stated that his urine is yellow color. Stool is soft to
touch and color brown as verbalized by him.

SOCIAL DATA

XI-Family Relationship/Friendship

Patient has a good relationship with his family, relatives and classmates. His
family has been so supportive all throughout this time when he needs them.
XII- Educational History

Patient is currently Grade 7 student at Saint Paul University Surigao according

to the patient he has no difficulty in learning the subjects such as mathematics
and English.

XII- Economic Status

According to the patient mother they have no problem in paying medical

bills. They have also Philhealth Insurance. as stated by the patient’s mother.

Patterns of Health Care

According to the patient’s mother she will bring her children to the doctor
once they have illnesses such as fever and cough because she afraid what
might happen. As stated by patient mother.
Psychological Data

Patient is worried about his present illness because he had a lot of

absences in school. He worried because he is very behind in classes.
 REVIEW OF SYSTEM
INTEGUMENTARY SYSTEM
•No history of skin infection as claimed
•Brown skin complexion
•Patient has intact skin with good skin turgor
•Skin is warm to touch
•Patient has no lesion

RESPIRATORY SYSTEM
•Respiratory rate is 24cpm
•Complaints of weaknesses on simple activity.
•With history of pneumonia
•Crackle sounds noted upon auscultation

CARDIOVASCULAR SYSTEM
•Patient’s pulse rate is 73 beat per minute
•Patient has no complaints regarding his cardiovascular system

GENITOURINARY SYSTEM
•Urinates 4 times a day as claimed by the patient.
•Color of the urine is light yellow.
•Urine transparency is clear
•Few bacteria in urinalysis.
GASTROINTESTINAL SYSTEM
•With no complaints of constipation as stated by the patient.
•Patient has no abnormality in defecating
•No abnormal bowel sounds, as claimed
•No history of hemorrhoids and rectal bleeding.
REPRODUCTIVE SYSTEM
•No history of STD.
MUSCULOSKELETAL SYSTEM
•With complaints of weakness.
•No history of fracture or any injury
ENDOCRINE SYSTEM
•No mass noted.
• No thyroid problem
CIRCULATORY SYSTEM
• With no history of painful tonsils.
•With no history of having nodules on the neck
• No history of bleeding problems
NEUROLOGIC SYSTEM
•Patient is conscious to time, place and people
 PHYSICAL ASSESSMENT
Physical Assessment done on March 05, 2018

Patient is lying on bed while playing with his phone. He appears weak,
frequent coughing; he looks tired but still interactive and cooperative in my
interview and examination. He had an intravenous IVF on his left arm. Bottle (3)
500 ml D5LR at 10-15 macro drops/minute. Vital signs are; Temperature is 36.2
°C, respiratory rate is 24cpm, pulse rate is 80bpm.
Skin
Inspection
•Has a brown complexion
•Has closed intact skin
•No lesions
Palpation
•Skin is warm to touch
•Normal skin turgor
Hair
Inspection
•Color of hair is black
•No infestation of parasites
Nails
Inspection
•Pinkish nail bed
•Nails has the shape of convex curve
Palpation
• capillary refill returns within 1 seconds
Skull and face
Inspection
•Facial skin uniform in color
•Normal facial movement
•No lesions
•Skull shape is round and symmetric

Eyes
Inspection
•Both eyes were symmetrical
•Eyelashes equally distributed, curled slightly outward
•Pupils are equally rounded
•The pupil was brown in color with white conjunctiva
•Blinking reflex was normal and functional
•Peripheral reflexes are normal and functional
•Patient is farsighted
•Patient is using reading glasses
Ears
Inspection
•Auricles same color as facial skin, symmetrical and are aligned with outer
canthus of eye
•Pinna recoils after it is folded
•No cerumen
•Able to hear spoken words clearly
•No discharges
Nose
Inspection
•Has the same color as facial skin
•Not tender, no lesion
•No discharges
•Straight and symmetrical
•Able to identify odors like alcohol and cologne.
Mouth and throat
Inspection
•Lips is pinkish
•Lips are symmetrical
•Tongue is pink in color
•Tongue moves freely
•Gums is light pink in color
•Uvula is position in the midline of soft palate

Neck
Inspection
• Neck positioned at the midline
•Brown in color
Palpation
•Without tenderness and reflexes easily
•No masses
Thorax and Lungs
Inspection
•Chest movement is apparent during inhaling and exhaling
Palpation
•No pain when palpated
Auscultation
•Crackles are noted upon inspiration

Breast and Axillae

Inspection
•Skin uniform in color
•Nipples at the same level
•Breast is even with the chest wall
Abdomen
Inspection
•Symmetrical contour and uniform in color
•No rashes or lesions
Auscultation
•Bowel sounds are normal (within 5-30 gurgles/minute)
Upper Extremities
Inspection
•Both arms are symmetry
•No scars noted
Lower Extremities
Inspection
•Both legs are symmetry
•No scars noted
 CLINICAL LABORATORIES
February 28, 2018
HEMATOLOGY
Significance
HEMATOLOGY Result Reference Unit

Hemoglobin 11.7 10-13 g/dL

Normal
Normal
Hematocrit 33.0 31-40 %

Normal
RBC 4.33 4-5 X10^12/L

MCV 76.1 71-90 fL Normal

MCH 27.8 24-33 Pg Normal

MCHC 35.6 32-37 g/dL Normal

RDW 17.4 12-16 Normal

Normal
Platelet count 155 150-400 X10^9/L

WBC 15.3 4-12 X10^9/L Acute infection

Acute infection
Neutrophils 71.92 45-70 %

Monocytes 9.5 3-11 % Normal

Normal
Lymphocytes 24.7 15-43 %

Normal
Eosinophils 4.6 1-8 %
 February 28, 2018
URINALYSIS

Urinalysis Result Normal Value Significance

COLOR LIGHT YELLOW Amber Normal

TRANSPARENCY CLEAR Clear Normal

PROTEIN NEGATIVE Normal

PH 6.5 4.5 - 8.0 Normal

SPECIFIC GRAVITY 1.010 1.005- 1.035 Normal

GLUCOSE NEGATVE 0-0.8mmol/L Normal

EPITHELIAL CELLS FEW Clear Urinary tract infection

BACTERIA FEW Clear Urinary tract infection

ANATOMY AND PHYSIOLOGY
• The organs of the respiratory system include the nose, pharynx, larynx,
trachea, bronchi, and their smaller branches, and the lungs, which contain
the alveoli.
• The Nose
• The nose is the only externally visible part of the respiratory system.
• Nostrils. During breathing, air enters the nose by passing through the nostrils,
or nares.
• Nasal cavity. The interior of the nose consists of the nasal cavity, divided by a
midline nasal septum.
• Olfactory receptors. The olfactory receptors for the sense of smell are
located in the mucosa in the slitlike superior part of the nasal cavity, just
beneath the ethmoid bone.
• Respiratory mucosa. The rest of the mucosal lining, the nasal cavity called
the respiratory mucosa, rests on a rich network of thin-walled veins that
warms the air as it flows past.
• Mucus. In addition, the sticky mucus produced by the mucosa’s glands
moistens the air and traps incoming bacteria and other foreign debris, and
lysozyme enzymes in the mucus destroy bacteria chemically.
• Ciliated cells. The ciliated cells of the nasal mucosa create a gentle current
that moves the sheet of contaminated mucus posteriorly toward the throat,
where it is swallowed and digested by stomach juices.
• Conchae. The lateral walls of the nasal cavity are uneven owing to three
mucosa-covered projections, or lobes called conchae, which greatly
increase the surface area of the mucosa exposed to the air, and also
increase the air turbulence in the nasal cavity.
• Palate. The nasal cavity is separated from the oral cavity below by a
partition, the palate; anteriorly, where the palate is supported by bone, is the
hard palate; the unsupported posterior part is the soft palate.
• Paranasal sinuses. The nasal cavity is surrounded by a ring of paranasal
sinuses located in the frontal, sphenoid, ethmoid, and maxillary bones; theses
sinuses lighten the skull, and they act as a resonance chamber for speech.
• Pharynx
• Size. The pharynx is a muscular passageway about 13 cm (5 inches) long that
vaguely resembles a short length of red garden hose.
• Function. Commonly called the throat, the pharynx serves as a common
passageway for food and air.
• Portions of the pharynx. Air enters the superior portion, the nasopharynx, from
the nasal cavity and then descends through the oropharynx and
laryngopharynx to enter the larynx below.
• Pharyngotympanic tube. The pharyngotympanic tubes, which drain the
middle ear open into the nasopharynx.
• Pharyngeal tonsil. The pharyngeal tonsil, often called adenoid is located high
in the nasopharynx.
• Palatine tonsils. The palatine tonsils are in the oropharynx at the end of the
soft palate.
• Lingual tonsils. The lingual tonsils lie at the base of the tongue.
• Larynx
• The larynx or voice box routes air and food into the proper channels and
plays a role in speech.
• Structure. Located inferior to the pharynx, it is formed by eight rigid hyaline
cartilages and a spoon-shaped flap of elastic cartilage, the epiglottis.
• Thyroid cartilage. The largest of the hyaline cartilages is the shield-shaped
thyroid cartilage, which protrudes anteriorly and is commonly called Adam’s
apple.
• Epiglottis. Sometimes referred to as the “guardian of the airways”, the
epiglottis protects the superior opening of the larynx.
• Vocal folds. Part of the mucous membrane of the larynx forms a pair of folds,
called the vocal folds, or true vocal cords, which vibrate with expelled air
and allows us to speak.
• Glottis. The slitlike passageway between the vocal folds is the glottis.
• Trachea
• Length. Air entering the trachea or windpipe from the larynx travels down its
length (10 to 12 cm or about 4 inches) to the level of the fifth thoracic
vertebra, which is approximately midchest.
• Structure. The trachea is fairly rigid because its walls are reinforced with C-
shaped rings of hyaline cartilage; the open parts of the rings abut the
esophagus and allow it to expand anteriorly when we swallow a large piece
of food, while the solid portions support the trachea walls and keep it patent,
or open, in spite of the pressure changes that occur during breathing.
• Cilia. The trachea is lined with ciliated mucosa that beat continuously and in
a direction opposite to that of the incoming air as they propel mucus,
loaded with dust particles and other debris away from the lungs to the
throat, where it can be swallowed or spat out.
• Main Bronchi
• Structure. The right and left main (primary) bronchi are formed by the division
of the trachea.
• Location. Each main bronchus runs obliquely before it plunges into the
medial depression of the lung on its own side.
• Size. The right main bronchus is wider, shorter, and straighter than the left.
• Lungs
• Location. The lungs occupy the entire thoracic cavity except for the most
central area, the mediastinum, which houses the heart, the great blood
vessels, bronchi, esophagus, and other organs.
• Apex. The narrow, superior portion of each lung, the apex, is just deep to the
clavicle.
• Base. The broad lung area resting on the diaphragm is the base.
• Division. Each lung is divided into lobes by fissures; the left lung has two lobes,
and the right lung has three.
• Pleura. The surface of each lung is covered with a visceral serosa called the
pulmonary, or visceral pleura and the walls of the thoracic cavity are lined by the
parietal pleura.
• Pleural fluid. The pleural membranes produce pleural fluid, a slippery serous secretion
which allows the lungs to glide easily over the thorax wall during breathing
movements and causes the two pleural layers to cling together.
• Pleural space. The lungs are held tightly to the thorax wall, and the pleural space is
more of a potential space than an actual one.
• Bronchioles. The smallest of the conducting passageways are the bronchioles.
• Alveoli. The terminal bronchioles lead to the respiratory zone structures, even smaller
conduits that eventually terminate in alveoli, or air sacs.
• Respiratory zone. The respiratory zone, which includes the respiratory bronchioles,
alveolar ducts, alveolar sacs, and alveoli, is the only site of gas exchange.
• Conducting zone structures. All other respiratory passages are conducting zone
structures that serve as conduits to and from the respiratory zone.
• Stroma. The balance of the lung tissue, its stroma, is mainly elastic connective tissue
that allows the lungs to recoil passively as we exhale.
• The Respiratory Membrane
• Wall structure. The walls of the alveoli are composed largely of a single, thin
layer of squamous epithelial cells.
• Alveolar pores. Alveolar pores connecting neighboring air sacs and provide
alternative routes for air to reach alveoli whose feeder bronchioles have
been clogged by mucus or otherwise blocked.
• Respiratory membrane. Together, the alveolar and capillary walls, their fused
basement membranes, and occasional elastic fibers construct the
respiratory membrane (air-blood barrier), which has gas (air) flowing past on
one side and blood flowing past on the other.
• Alveolar macrophages. Remarkably efficient alveolar macrophages
sometimes called “dust cells”, wander in and out of the alveoli picking up
bacteria, carbon particles, and other debris.
• Cuboidal cells. Also scattered amid the epithelial cells that form most of the
alveolar walls are chunky cuboidal cells, which produce a lipid (fat)
molecule called surfactant, which coats the gas-exposed alveolar surfaces
and is very important in lung function.
• Physiology of the Respiratory System
• The major function of the respiratory system is to supply the body with
oxygen and to dispose of carbon dioxide. To do this, at least four distinct
events, collectively called respiration, must occur.
• Respiration
• Pulmonary ventilation. Air must move into and out of the lungs so that gasses
in the air sacs are continuously refreshed, and this process is commonly
called breathing.
• External respiration. Gas exchange between the pulmonary blood and
alveoli must take place.
• Respiratory gas transport. Oxygen and carbon dioxide must be transported
to and from the lungs and tissue cells of the body via the bloodstream.
• Internal respiration. At systemic capillaries, gas exchanges must be made
between the blood and tissue cells.
• Mechanics of Breathing
• Rule. Volume changes lead to pressure changes, which lead to the flow of
gasses to equalize pressure.
• Inspiration. Air is flowing into the lungs; chest is expanded laterally, the rib
cage is elevated, and the diaphragm is depressed and flattened; lungs are
stretched to the larger thoracic volume, causing the intrapulmonary pressure
to fall and air to flow into the lungs.
• Expiration. Air is leaving the lungs; the chest is depressed and the lateral
dimension is reduced, the rib cage is descended, and the diaphragm is
elevated and dome-shaped; lungs recoil to a smaller volume,
intrapulmonary pressure rises, and air flows out of the lung.
• Intrapulmonary volume. Intrapulmonary volume is the volume within the
lungs.
• Intrapleural pressure. The normal pressure within the pleural space, the
intrapleural pressure, is always negative, and this is the major factor
preventing the collapse of the lungs.
• Nonrespiratory air movements. Nonrespiratory movements are a result of
reflex activity, but some may be produced voluntarily such as cough,
sneeze, crying, laughing, hiccups, and yawn.
• Respiratory Volumes and Capacities
• Tidal volume. Normal quiet breathing moves approximately 500 ml of air into and out of the
lungs with each breath.
• Inspiratory reserve volume. The amount of air that can be taken in forcibly over the tidal
volume is the inspiratory reserve volume, which is normally between 2100 ml to 3200 ml.
• Expiratory reserve volume. The amount of air that can be forcibly exhaled after a tidal
expiration, the expiratory reserve volume, is approximately 1200 ml.
• Residual volume. Even after the most strenuous expiration, about 1200 ml of air still remains in
the lungs and it cannot be voluntarily expelled; this is called residual volume, and it is
important because it allows gas exchange to go on continuously even between breaths and
helps to keep the alveoli inflated.
• Vital capacity. The total amount of exchangeable air is typically around 4800 ml in healthy
young men, and this respiratory capacity is the vital capacity, which is the sum of the tidal
volume, inspiratory reserve volume, and the expiratory reserve volume.
• Dead space volume. Much of the air that enters the respiratory tract remains in the
conducting zone passageways and never reaches the alveoli; this is called the dead space
volume and during a normal tidal breath, it amounts to about 150 ml.
• Functional volume. The functional volume, which is the air that actually reaches the
respiratory zone and contributes to gas exchange, is about 350 ml.
• Spirometer. Respiratory capacities are measured with a spirometer, wherein as a person
breathes, the volumes of air exhaled can be read on an indicator, which shows the changes
in air volume inside the apparatus.
• Respiratory Sounds
• Bronchial sounds. Bronchial sounds are produced by air rushing through the
large respiratory passageways (trachea and bronchi).
• Vesicular breathing sounds. Vesicular breathing sounds occur as air fills the
alveoli, and they are soft and resemble a muffled breeze.
• External Respiration, Gas Transport, and Internal Respiration
• External respiration. External respiration or pulmonary gas exchange involves
the oxygen being loaded and carbon dioxide being unloaded from the
blood.
• Internal respiration. In internal respiration or systemic capillary gas exchange,
oxygen is unloaded and carbon dioxide is loaded into the blood.
• Gas transport. Oxygen is transported in the blood in two ways: most attaches
to hemoglobin molecules inside the RBCs to form oxyhemoglobin, or a very
small amount of oxygen is carried dissolved in the plasma; while carbon
dioxide is transported in plasma as bicarbonate ion, or a smaller amount
(between 20 to 30 percent of the transported carbon dioxide) is carried
inside the RBCs bound to hemoglobin.
• Control of Respiration
• Neural Regulation
• Phrenic and intercostal nerves. These two nerves regulate the activity of the
respiratory muscles, the diaphragm, and external intercostals.
• Medulla and pons. Neural centers that control respiratory rhythm and depth
are located mainly in the medulla and pons; the medulla, which sets the
basic rhythm of breathing, contains a pacemaker, or self-exciting inspiratory
center, and an expiratory center that inhibits the pacemaker in a rhythmic
way; pons centers appear to smooth out the basic rhythm of inspiration and
expiration set by the medulla.
• Eupnea. The normal respiratory rate is referred to as eupnea, and it is
maintained at a rate of 12 to 15 respirations/minute.
• Hyperpnea. During exercise, we breathe more vigorously and deeply
because the brain centers send more impulses to the respiratory muscles,
and this respiratory pattern is called hyperpnea.
• Non-neural Factors Influencing Respiratory Rate and Depth
• Physical factors. Although the medulla’s respiratory centers set the basic rhythm of
breathing, there is no question that physical factors such as talking, coughing, and
exercising can modify both the rate and depth of breathing, as well as an increased
body temperature, which increases the rate of breathing.
• Volition (conscious control). Voluntary control of breathing is limited, and the respiratory
centers will simply ignore messages from the cortex (our wishes) when the oxygen supply
in the blood is getting low or blood pH is falling.
• Emotional factors. Emotional factors also modify the rate and depth of breathing
through reflexes initiated by emotional stimuli acting through centers in the
hypothalamus.
• Chemical factors. The most important factors that modify respiratory rate and depth are
chemical- the levels of carbon dioxide and oxygen in the blood; increased levels of
carbon dioxide and decreased blood pH are the most important stimuli leading to an
increase in the rate and depth of breathing, while a decrease in oxygen levels become
important stimuli when the levels are dangerously low.
• Hyperventilation. Hyperventilation blows off more carbon dioxide and decreases the
amount of carbonic acid, which returns blood pH to normal range when carbon dioxide
or other sources of acids begin to accumulate in the blood.
• Hypoventilation. Hypoventilation or extremely slow or shallow breathing allows carbon
dioxide to accumulate in the blood and brings blood pH back into normal range when
blood starts to become slightly alkaline.
PATHOPHYSIOLOGY
• DRUG STUDY 1
• Generic Name: Ceftriaxone
Brand Name: Geotrax
Classifications: anti-infective; antibiotic; third-generation cephalosporin
• Dosage: 850 mg IV Q12hrs
• Actions
Semisynthetic third generation cephalosporin antibiotic. Preferentially binds to one or more of the penicillin-binding
proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial cell wall
synthesis, thus killing the bacterium.
• Indications:
Infections caused by susceptible organisms in lower respiratory tract, skin and skin structures, urinary tract, bones and
joints; also intra-abdominal infections, pelvic inflammatory disease, uncomplicated gonorrhea, meningitis, and surgical
prophylaxis.
• Contraindications
Hypersensitivity to cephalosporins and related antibiotics; pregnancy (category B).
• Adverse Effects
Body Whole: Pruritus, fever, chills, pain, induration at IM injection site; phlebitis (IV site).
GI: Diarrhea, abdominal cramps, pseudomembranous colitis, biliary sludge.
Urogenital: Genital pruritus; moniliasis.
• Nursing implications
• Determine history of hypersensitivity reactions to cephalosporins and penicillins and history of other allergies, particularly
to drugs, before therapy is initiated.
• Inspect injection sites for induration and inflammation. Rotate sites. Note IV injection sites for signs of phlebitis (redness,
swelling, pain).
• Monitor for manifestations of hypersensitivity. Report their appearance promptly and discontinue drug.
• Watch for and report signs: petechiae, ecchymotic areas, epistaxis, or any unexplained bleeding. Ceftriaxone appears
to alter vitamin K-producing gut bacteria; therefore, hypoprothrombinemic bleeding may occur.
• Check for fever if diarrhea occurs: Report both promptly. The incidence of antibiotic-produced pseudomembranous
colitis is higher than with most cephalosporins. Most vulnerable patients: chronically ill or debilitated older adult patients
undergoing abdominal surgery.
• DRUG STUDY 2
• Generic Name: Albuterol
• Brand Name: Salbutamol
• Classification: Bronchodilator
• Dosage: 2 inhalations Q6hrs
• Mechanism of Action
• It relieves nasal congestion and reversible bronchospasm by relaxing the smooth muscles of the bronchioles. The relief from nasal congestion and
bronchospasm is made possible by the following mechanism that takes place when Salbutamol is administered.
• Indications
• To control and prevent reversible airway obstruction caused by asthma or chronic obstructive pulmonary disorder (COPD)
• Quick relief for bronchospasm
• For the prevention of exercise-induced bronchospasm
• Long-term control agent for patients with chronic or persistent bronchospasm
• Contraindications
• Hypersensitivity to adrenergic amines
• Hypersensitivity to fluorocarbons
• Side Effects and Adverse Reactions
• CNS: Nervousness, Restlessness, Tremor, Headache, Insomnia
• Cardiovascular: Chest pain, Palpitations, Angina, Arrhythmias, Hypertension
• GIT: Nausea and vomiting
• Nursing implications
• Assess lung sounds, PR and BP before drug administration and during peak of medication.
• Observe fore paradoxical spasm and withhold medication and notify physician if condition occurs.
• If administering medication through inhalation, allow at least 1 minute between inhalation of aerosol medication.
• Advise the patient to rinse mouth with water after each inhalation to minimize dry mouth.
• Inform the patient that Albuterol may cause an unusual or bad taste.
• DRUG STUDY 3
• Generic Name: Paracetamol
Brand Name: Biogesic
Classification: Antipyretic
• Dosage: 1 tab 500 mg, PO, Q12 hrs.
• Actions:
• Decreases fever by a hypothalamic effect leading to sweating and vasodilation
• Inhibits pyrogen effect on the hypothalamic-heat-regulating centers
• Inhibits CNS prostaglandin synthesis with minimal effects on peripheral prostaglandin synthesis
• Indications:
• Control of pain due to headache, earache, dysmenorrhea, arthralgia, myalgia, musculoskeletal pain, arthritis, immunizations, teething,
tonsillectomy
• Reduce fever in viral and bacterial infections
• As a substitute for aspirin in upper GI disease, bleeding disorders clients in anticoagulant therapy and gouty arthritis
• Contraindications:
• Renal Insufficiency
• Anemia
• Side-Effects:
• GIT: Minimal GI upset, Nausea, Vomiting, Liver Damage
• Hematologic: Hemolytic Anemia, Leukopenia
• CNS: CNS stimulation, Drowsiness
• Nursing Considerations:
• Do not take for >5days for pain in children, 10 days for pain in adults, or more than 3 days for fever in adults.
• Extended-Release tablets are not to be chewed.
• Monitor CBC, liver and renal functions.
• Assess for fecal occult blood and nephritis.
• Avoid using OTC drugs with Acetaminophen.
• Take with food or milk to minimize GI upset.
• DRUG STUDY 4
• Generic Name: Omeprazole
Brand Name: Prilosec
Classifications: Proton pump inhibitor
Dosage: 20 mg, IV, BID
• Actions:
An antisecretory compound that is a gastric acid pump inhibitor. Suppresses gastric acid
secretion by inhibiting the H+, K+-ATPase enzyme system [the acid (proton H+) pump] in the
parietal cells.
• Indications:
Duodenal and gastric ulcer. Gastroesophageal reflux disease including severe erosive
esophagitis (4 to 8 wk treatment). Long-term treatment of pathologic hypersecretory
conditions such as Zollinger-Ellison syndrome, multiple endocrine adenomas, and systemic
mastocytosis. In combination with clarithromycin to treat duodenal ulcers associated with
Helicobacter pylori.
• Contraindications:
Long-term use for gastroesophageal reflux disease, duodenal ulcers; lactation.
• Adverse effects:
CNS: Headache, dizziness, fatigue.
GI: Diarrhea, abdominal pain, nausea, mild transient increases in liver function tests.
Urogenital: Hematuria, proteinuria.
Skin: Rash.
• Nursing implications.
• Report any changes in urinary elimination such as pain or discomfort associated with urination,
or blood in urine.
• Report severe diarrhea; drug may need to be discontinued.
• DRUG STUDY 5
• Generic Name: Amikacin
Brand Name: Amikin
Route / Dosage: IM, IV (Neonates): Loading dose –10 mg/kg;Maintenance dose—7.5 mg/kg q 12 hrs.
• Classification: Anti - Infective
• Actions:
• Inhibits protein synthesis in bacteria at level of 30S ribosome.
Indication:
• Treatment of serious gram-negative bacillary infections and infections caused by staphylococci when penicillins
or other less toxic drugs are contraindicated.
• Contraindications
• Hypersensitivity to aminoglycosides. Most parenteral products contain bisulfides and should be avoided in
patients with known tolerance. Products containing benzyl alcohol should be avoided in neonates.
• Side / Adverse Effects
• CNS: ataxia, vertigo.
• EENT: ototoxicity (vestibular and cochlear).
• GU: nephrotoxicity, hypomagnesemia.
• MS: muscle paralysis (high parenteral doses).
• Neuro: increase neuromuscular blockade
• Nursing Responsibilities
• Assess patient for signs and symptoms of infection prior to and throughout therapy.
• Instruct patient to continue taking medication around the clock until finished completely, even if feeling better.
• Keep patient hydrated during therapy.
• Instruct patient to report signs of hypersensitivity.
 NURSING CARE PLAN 1
ASSESSMENT:
Subjective Data:
“Medyo gahi pa ako ubo sir” as verbalized by the patient.
Objective Data:

 Productive cough
 Body malaise
 Use of accessory muscle while breathing
 Crackles breath sound
 With yellowish sticky mucous
Vital Signs:

 T- 38 degree Celsius
 PR- 85 bmp
 RR- 26 cpm
DIAGNOSIS:
Ineffective airway clearance related to the presence of
secretions
PLANNING:
After 8 hours of nursing interventions the patient will
be able to cough out phlegm effectively and maintain airway
patency.
INTERVENTIONS:
Independent:

 Auscultate for breath sound

R: To identify abnormal breath sounds
 Monitor Vital signs
R: To know the status or progress of the patient.
 Regulate IVF as desire rate
R: helps to maintain hydration and fluid status, as well
as to thin viscous secretions to allow.
 Encourage patient to drink more water
R: To liquefy secretions
 Teach patient to do deep breathing exercise
R: To mobilize secretions so that patient may be able to
mare easily expectorate mucous.
 Encourage patient to rest
R: To promote wellness
 Position patient to High Fowler’s Position
R: To facilitate airway
Dependent:

 Administer Bronchodilator medication such as Salbutamol as

prescribed.
R: To helps relief cough
EVALUATION:
After 8 hours of giving nursing interventions the
patient was able to expectorate sputum and cough effectively and
maintain patent airway.
 NURSING CARE PLAN 2
ASSESSMENT:
Subjective:
“Kainit sa ako lawas og tag tig-naw ko” as verbalized
by the patient.
Objective:

 Skin warm to touch

 Body malaise
 Poor appetite
 Chills noted
 Irritability
Vital signs:
 T- 39 degree Celsius
 PR- 85 bmp
 RR- 25 cpm
DIAGNOSIS:
Hyperthermia related to disease process as evidenced by
chills noted
PLANNING:
After 8 hours of giving nursing interventions the
patient body temperature will lower from 39 degrees Celsius to
37.5 degrees Celsius and will demonstrate absence of chills.
INTERVENTIONS:
Independent:

 Perform tepid sponge bath

R: Vaporization of water relieves heat from the surface
of the skin
 Apply cold wet compress if necessary
R: To help normalize body temperature
 Remove some blankets and clothes which are not necessary
R: To provide air movement to augment heat loss.
 If patient’s skin feels cold to touch, apply friction
R: To stimulate circulation
 Advise to wear loose and comfortable clothes
R: To be more comfortable
 Encourage patient to increase fluid intake
R: To prevent dehydration
 Monitor Temperature every 15 minutes
R: To see effectiveness of interventions
 Repeat TSB if necessary
R: Vaporization of water relieves heat from the surface
of the skin
 Regulate IVF at desired rate
R: Helps maintain hydration
Dependent:

 Administer antipyretic drugs such as paracetamol as

prescribed.
R: Helps relief of fever
EVALUATION:
After 8 hours of nursing interventions the patient
temperature was lower s to 37.5 degrees Celsius and manifest
negative chilling
 NURSING CARE PLAN 3

ASSESSMENT:

Subjective data: “sakit ako tilaok sige ubo” as verbalized by

the patient.

Objective data:

 Irritability
 Facial grimace upon coughing
 Pain scale is 5 out of 10
 Body malaise
 Use of accessory muscle
 Dyspnea
 Fatigue
Vital signs:
 T- 37 Degree Celsius
 PR- 80 bpm
 RR- 24 cpm

DIAGNOSIS:

Acute pain related to localized inflammation and persistent

cough.

PLANNING:

After 4 hours of nursing intervention the patient will display

patent airway with breath sounds clearing and absence of dyspnea.
INTERVENTIONS:

Independent:

 Elevate head of the bed, change position frequently.

R: Lowers diaphragm, promoting chest expansion and
expectoration of secretions.
 Assist patient with deep breathing exercises.
R: Deep breathing facilitates maximum expansion of the lungs
and smaller airways.
 Demonstrate or help patient learn to perform activity like
splinting chest and effective coughing while in upright
position.
R: Coughing is a natural self-cleaning mechanism. Splinting
reduces chest discomfort, and an upright position favors
deeper, more forceful cough effort.
 Force fluids to at least 3000 ml per day and offer warm,
rather than cold fluids.
R: Fluids especially warm liquids aid in mobilization and
expectoration of secretions.

Dependent:

 Administer Analgesic/antipyretic medication such as

Paracetamol biogesic as prescribed.
R: Aids in reduction of bronchospasm and mobilization of
secretions.
Discharge plan
Upon discharge from the hospital, the patient and his significant others will be given home
care instructions containing in the following:
MEDICATIONS  Advice patient to take his medications on time as per advice by the physician.

ENVIRONMENTAL CONSIDERATION  Advised patient or SO by providing quiet environment, and avoiding stressful Situation.
 Advice patient to avoid heavy playing.
 Advice the patient to avoid from dust and other smoky areas (smokes from cigarettes and
cars).

TREATMENT  Instructed patient to follow proper instructions medications prescribed by the physician.
 Drink at least 8-10 glasses a day
 Eat more fruits and vegetables to facilitate easy bowel movement.
 Remind the patient’s SO the importance of the following recommendations to prevent
further complications and keeping follow- up appointments from monitoring of risk factors.
 Advice the patient and SO, the importance of following treatment regimen to facilitate the
healing process.
 Advice patient to increase fluid intake.

HEALTH TEACHING  Encourage personal hygiene regularly

 Drink at least 8-10 glasses of water a day.
 Eat more fruits and vegetables to facilitate easy bowel movement.
 Advice the patient to eat a variety of healthy foods.
 Advice patient to take vitamins
 Instructed patient to follow proper instructions medications prescribed by the physician.
OUT-PATIENT CHECK-UP  Instructed patient to follow scheduled check up
 Instructed patient to seek medical attention when adverse reactions
and sign and symptom occurs.

DIET  Advised the patient’s SO to let the patient eat nutritious food like fruits,
vegetables and green leafy.

SPIRITUAL  Encourage patient to be more faithful and have trust in God

 Encourage SO to pray for the patient’s early recovery
 IVF
BOTTLE DATE AUDITIVE SOLUTION VOLUME Drop Rate
(gtts/min)

1 2/28/18 D5LR 1L 10gtts/min

2 3/1/18 D5NM 1L 10gtts/min

3 3/2/18 D5LR 1L 10gtts/min

 VITAL SIGNS
BLOOD PRESSURE PULSE RATE RESPIRATORY RATE TEMPERATURE SPO
TIME/DATE (mm/hg) (bpm) (cpm) (°C) (%)

2/28/18

10:26 am 80/60 100 22 39 98%

12nn 90/70 90 22 38.5 99%
4pm 90/70 84 25 37.4 98%
8pm 90/70 84 26 36.2 98%
12nn - 86 23 36.6 98%
4am - 87 22 36.2 99%
3/1/18

8am - 90 23 36 -
12nn - 86 24 36.4 -
4pm - 87 22 36.7 -
8pm - 84 24 36 98%
12nn - 84 25 36.2 98%
4am - 84 25 36.5 98%
• Definition of terms

• Pneumonia- Pneumonia is an infection in one or both lungs. It can be caused by bacteria, viruses,
or fungi. Bacterial pneumonia is the most common type in adults. Pneumonia causes inflammation
in the air sacs in your lungs, which are called alveoli. The alveoli fill with fluid or pus, making it
difficult to breathe.
• Streptococcus pneumonia- Streptococcus pneumoniae, or pneumococcus, is a Gram-positive,
alpha-hemolytic or beta-hemolytic, facultative anaerobic member of the genus Streptococcus.
They are usually found in pairs and do not form spores and are non-motile.
• Pharynx- Pharynx is the 4-5 inches long semicircular fibromuscular tube, commonly referred to as
the throat [1] that connects the nasal cavity to the larynx, and the oral cavity to the esophagus
• Larynx- The larynx is a tough, flexible segment of the respiratory tract connecting the pharynx to the
trachea in the neck. It plays a vital role in the respiratory tract by allowing air to pass through it
while keeping food and drink from blocking the airway. The larynx is also the body’s “voice box” as
it contains the vocal folds that produce the sounds of speech and singing.
• Trachea- The trachea, commonly known as the windpipe, is a tube about 4 inches long and less
than an inch in diameter in most people. The trachea begins just under the larynx (voice box) and
runs down behind the breastbone (sternum). The trachea then divides into two smaller tubes called
bronchi: one bronchus for each lung.
• Epiglottis- a flap of cartilage at the root of the tongue, which is depressed during swallowing to
cover the opening of the windpipe.
• Cilia- A cilium is an organelle found in eukaryotic cells. Cilia are slender protuberances that project
from the much larger cell body
• Lungs- each of the pair of organs situated within the rib cage, consisting of elastic sacs with
branching passages into which air is drawn, so that oxygen can pass into the blood and
carbon dioxide be removed. Lungs are characteristic of vertebrates other than fish, though
similar structures are present in some other animal groups.
• Pleura- The pleura include two thin layers of tissue that protect and cushion the lungs. The
inner layer (visceral pleura) wraps around the lungs and is stuck so tightly to the lungs that it
cannot be peeled off.
• Alveoli- Alveoli are tiny sacs within our lungs that allow oxygen and carbon dioxide to move
between the lungs and bloodstream.
• Macrophages- a large phagocytic cell found in stationary form in the tissues or as a mobile
white blood cell, especially at sites of infection.
• Hyperpnea- Hyperpnea or hyperpnoea is increased depth and rate of breathing.
• Eupnea- eupnea or eupnoea is normal, good, unlabored breathing, sometimes known as
quiet breathing or resting respiratory rate. In eupnea, expiration employs only the elastic
recoil of the lungs.
• Hyperventilation- Hyperventilation blows off more carbon dioxide and decreases the
amount of carbonic acid, which returns blood pH to normal range when carbon dioxide or
other sources of acids begin to accumulate in the blood.
• Hypoventilation- Hypoventilation or extremely slow or shallow breathing allows carbon
dioxide to accumulate in the blood and brings blood pH back into normal range when
blood starts to become slightly alkaline.
Genogram

Men

Women

Alive
References

BOOKS

BLACKWELL’S Dictionary of Nursing, 2002

BRUNNER AND SUDDARTH’S Medical-Surgical Nursing, authored by:

Smeltzer, Bare, Hinkle, and Cheever, 12th edition, 2010

MIMS Philippines, 140th edition, 2014

MOSBY’S Manaual of Diagnostic and Laboratory Tests, Third edition,

2006

MOSBY’S Medical-Surgical Nursing, authored by: Lewis, Heitkemper,

Dirksen, O’Brien, Giddens, Bucher, 6th edition 2004

INTERNET

https://nurseslabs.com/respiratory-system/

http://www.who.int/mediacentre/factsheets/fs331/en/

https://www.healthline.com/health/pneumonia
THANK YOU GOD BLESS!!!!!!