Patients Profile

Name: LARIN, Alicia Aguilar

Sex: Female
Date of Birth: April 14, 1930
Age: 80 years old
Status: Widow
Religion: Roman Catholic
Address: 218 Ipil St. Amparo Village Caloocan City
Initial Diagnosis: Pneumonia community acquired-moderate risk,
HCVD with LV diastolic dysfunction
Date of Admission: October 30, 2010
Patient I.D. No.: DN09-0-9451
Registration No.: -108113
History of Present Illness
(+) cough
(+) nasal congestion, watery to greenish
(+) nasal discharge
(+) difficulty of breathing
Past Illness
(+) asthma
(-) allergies
Family History
(+) asthma (mother)

INTRODUCTION

Pneumonia is an inflammation of the lungs caused by an infection. It is also

called Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat
to our health. Although pneumonia is a special concern for older adults and
those with chronic illnesses, it can also strike young, healthy people as well.
It is a common illness 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 attack your lungs, leading to inflammation that makes it hard to
breathe. Pneumonia can affect one or both lungs. In the young and healthy,
early treatment with antibiotics can cure bacterial pneumonia. The drugs
used to fight pneumonia are determined by the germ causing the pneumonia
and the judgment of the doctor. Its best to do everything we can to prevent
pneumonia, but if one do get sick, recognizing and treating the disease early
offers the best chance for a full recovery.
A case with a diagnosis of Pneumonia may catch ones attention, though the
disease is just like an ordinary cough and fever, it can lead to death
especially when no intervention or care is done. Since the case is a toddler,
an appropriate care has to be done to make the patients recovery faster.

Treating patients with pneumonia is necessary to prevent its spread to others

and make them as another victim of this illness.
ANATOMY AND PHYSIOLOGY

The lungs constitute the largest organ in the respiratory system. They play
an important role in respiration, or the process of providing the body with
oxygen and releasing carbon dioxide. The lungs expand and contract up to
20 times per minute taking in and disposing of those gases.
Air that is breathed in is filled with oxygen and goes to the trachea, which
branches off into one of two bronchi. Each bronchus enters a lung. There are
two lungs, one on each side of the breastbone and protected by the ribs.
Each lung is made up of lobes, or sections. There are three lobes in the right
lung and two lobes in the left one. The lungs are cone shaped and made of
elastic, spongy tissue. Within the lungs, the bronchi branch out into minute
pathways that go through the lung tissue. The pathways are called
bronchioles, and they end at microscopic air sacs called alveoli. The alveoli
are surrounded by capillaries and provide oxygen for the blood in these
vessels. The oxygenated blood is then pumped by the heart throughout the
body. The alveoli also take in carbon dioxide, which is then exhaled from the
body.
Inhaling is due to contractions of the diaphragm and of muscles between the
ribs. Exhaling results from relaxation of those muscles. Each lung is

surrounded by a two-layered membrane, or the pleura, that under normal

circumstances has a very, very small amount of fluid between the layers. The
fluid allows the membranes to easily slide over each other during breathing.
PATHOPHYSIOLOGY

Pneumonia is a serious infection or inflammation of your lungs. The air sacs

in the lungs fill with pus and other liquid. Oxygen has trouble reaching your
blood. If there is too little oxygen in your blood, your body cells cant work
properly. Because of this and spreading infection through the body
pneumonia can cause death. Pneumonia affects your lungs in two ways.
Lobar pneumonia affects a section (lobe) of a lung. Bronchial pneumonia (or
bronchopneumonia) affects patches throughout both lungs.
Bacteria are the most common cause of pneumonia. Of these, Streptococcus
pneumoniae is the most common. Other pathogens include anaerobic

bacteria, Staphylococcus aureus, Haemophilus influenzae, Chlamydia

pneumoniae, C. psittaci, C. trachomatis, Moraxella (Branhamella) catarrhalis,
Legionella pneumophila, Klebsiella pneumoniae, and other gram-negative
bacilli. Major pulmonary pathogens in infants and children are viruses:
respiratory syncytial virus, parainfluenza virus, and influenza A and B
viruses. Among other agents are higher bacteria including Nocardia and
Actinomyces sp; mycobacteria, including Mycobacterium tuberculosis and
atypical strains; fungi, including Histoplasma capsulatum, Coccidioides
immitis, Blastomyces dermatitidis, Cryptococcus neoformans, Aspergillus
fumigatus, and Pneumocystis carinii; and rickettsiae, primarily Coxiella
burnetii (Q fever).
The usual mechanisms of spread are inhaling droplets small enough to reach
the alveoli and aspirating secretions from the upper airways. Other means
include hematogenous or lymphatic dissemination and direct spread from
contiguous infections. Predisposing factors include upper respiratory viral
infections, alcoholism, institutionalization, cigarette smoking, heart failure,
chronic obstructive airway disease, age extremes, debility,
immunocompromise (as in diabetes mellitus and chronic renal failure),
compromised consciousness, dysphagia, and exposure to transmissible
agents.
Typical symptoms include cough, fever, and sputum production, usually
developing over days and sometimes accompanied by pleurisy. Physical

examination may detect tachypnea and signs of consolidation, such as

crackles with bronchial breath sounds. This syndrome is commonly caused
by bacteria, such as S. pneumoniae and H. influenzae.

DISCHARGE PLANNING

Take the entire course of any prescribed medications. After a

patients temperature returns to normal, medication must be continued
according to the doctors instructions, otherwise the pneumonia may
recur. Relapses can be far more serious than the first attack.

Get plenty of rest. Adequate rest is important to maintain progress

toward full recovery and to avoid relapse.

Drink lots of fluids, especially water. Liquids will keep patient from
becoming dehydrated and help loosen mucus in the lungs.

Keep all of follow-up appointments. Even though the patient feels

better, his lungs may still be infected. Its important to have the doctor
monitor his progress.

Encourage the guardians to wash patients hands. The hands

come in daily contact with germs that can cause pneumonia. These

germs enter ones body when he touch his eyes or rub his nose.
Washing hands thoroughly and often can help reduce the risk.

Give supportive treatment. Proper diet and oxygen to increase

oxygen in the blood when needed.

Protect others from infection. Try to stay away from anyone with a
compromised immune system. When that isnt possible, a person can
help protect others by wearing a face mask and always coughing into a
tissue.

Drug Name

Dosage &
Route

Action

Indication

Adverse Effects

Contraindicatio
n

Nursing Responsibility

LOSARTAN
POTASSIUM
(lo-sar'tan)
Cozaar
Classifications
: cardiovascular
agent;
angiotensin ii
receptor
antagonist;
antihypertensive

Hypertensio
n
Adult: PO 25
50 mg in 12
divided doses
(max: 100
mg/d); start
with 25 mg/d
if volume
depleted (i.e.,
on diuretics)

Angiotensin II
receptor
(type AT1)
antagonist
acts as a
potent
vasoconstrict
or and
primary
vasoactive
hormone of
the renin
angiotensin
aldosterone
system.

Hypertension

CNS: Dizziness,
insomnia,
headache. GI:
Diarrhea,
dyspepsia.
Musculoskeleta
l: Muscle cramps,
myalgia, back or
leg pain.
Respiratory:
Nasal
congestion,
cough, upper
respiratory
infection,
sinusitis.

Hypersensitivity to
losartan, pregnancy
[category C (first
trimester), category
D (second and third
trimesters)], lactation

Assessment & Drug Effects

Monitor BP at
drug trough
(prior to a
scheduled
dose).
Monitor drug
effectiveness,
especially in
AfricanAmericans when
losartan is used
as monotherapy.

Inadequate
response may
be improved by
splitting the
daily dose into
twice-daily dose.

Lab tests:
Monitor CBC,
electrolytes,
liver & kidney
function with
long-term
therapy.

Drug Name

FUROSEMIDE
(fur-oh'se-mide)

Fumide ,
Furomide , Lasix,
Luramide

Classifications
: ELECTROLYTIC
AND WATER
BALANCE
AGENT; LOOP
DIURETIC

Dosage &
Route

Edema
Adult: PO 2080
mg in 1 or more
divided doses up
to 600 mg/d if
needed IV/IM 20
40 mg in 1 or
more divided
doses up to 600
mg/d
Child: PO 2
mg/kg, may be
increased by 12
mg/kg q68h
(max: 6
mg/kg/dose) IV/I
M 1 mg/kg, may
be increased by
1 mg/kg q2h if
needed (max:
mg/kg/dose)
Neonate: PO 14
mg/kg q12
24h IV/IM 12
mg/kg q1224h
Hypertension
Adult: PO 1040
mg b.i.d. (max:
480 mg/d)

Action

Rapid-acting
potent
sulfonamide
"loop" diuretic
and
antihypertensi
ve with
pharmacologic
effects and
uses almost
identical to
those of
ethacrynic
acid. Exact
mode of action
not clearly
defined;
decreases
renal vascular
resistance and
may increase
renal blood
flow

Indication

Treatment of
edema
associated
with CHF,
cirrhosis of
liver, and
kidney
disease,
including
nephrotic
syndrome. May
be used for
management
of
hypertension,
alone or in
combination
with other
antihypertensi
ve agents, and
for treatment
of
hypercalcemia.
Has been used
concomitantly
with mannitol
for treatment
of severe
cerebral
edema,
particularly in
meningitis.

Adverse
Effects

CV: Postural
hypotension,
dizziness with
excessive
diuresis, acute
hypotensive
episodes,
circulatory
collapse.
Metabolic:
Hypovolemia,
dehydration,
hyponatremia
hypokalemia,
hypochloremia
metabolic
alkalosis,
hypomagnesemi
a, hypocalcemia
(tetany),
hyperglycemia,
glycosuria,
elevated BUN,
hyperuricemia.
GI: Nausea,
vomiting, oral
and gastric
burning,
anorexia,
diarrhea,
constipation,
abdominal
cramping, acute
pancreatitis,
jaundice.
Urogenital:
Allergic
interstitial
nephritis,
irreversible
renal failure,
urinary
frequency.
Hematologic:
Anemia,
leukopenia,
thrombocytopen
ic purpura;
aplastic anemia,
agranulocytosis
(rare). Special
Senses: Tinnitus,

Contraindicatio
n

History of
hypersensitivity
to furosemide or
sulfonamides;
increasing
oliguria, anuria,
fluid and
electrolyte
depletion states;
hepatic coma;
pregnancy
(category C),
lactation.

Nursing
Responsibility

Assessment &
Drug Effects

Observe
patients
receiving
parenteral drug
carefully;
closely monitor
BP and vital
signs. Sudden
death from
cardiac arrest
has been
reported.
Monitor BP
during periods
of diuresis and
through period
of dosage
adjustment.

Observe
older adults
closely during
period of brisk
diuresis.
Sudden
alteration in
fluid and
electrolyte
balance may
precipitate
significant
adverse
reactions.
Report
symptoms to
physician.

Lab tests:
Obtain frequent
blood count,
serum and
urine
electrolytes,
CO2, BUN, blood
sugar, and uric
acid values
during first few
months of
therapy and
periodically
thereafter.

Monitor for
S&S of
hypokalemia.

vertigo, feeling
of fullness in
ears, hearing
loss (rarely
permanent),
blurred vision.
Skin: Pruritus,
urticaria,
exfoliative
dermatitis,
purpura,
photosensitivity,
porphyria
cutanea tarde,
necrotizing
angiitis
(vasculitis).
Body as a Whole:
Increased
perspiration;
paresthesias;
activation of
SLE, muscle
spasms,
weakness;
thrombophlebiti
s, pain at IM
injection site.

Monitor I&O
ratio and
pattern. Report
decrease or
unusual
increase in
output.
Excessive
diuresis can
result in
dehydration
and
hypovolemia,
circulatory
collapse, and
hypotension.
Weigh patient
daily under
standard
conditions.

Monitor urine
and blood
glucose & HbA1C
closely in
diabetics and
patients with
decompensated
hepatic
cirrhosis. Drug
may cause
hyperglycemia.

Intensive
Care
Unit

Josef Jay T. Chavenia

Drug Name

PHENOBARBITAL
SODIUM

Luminal Sodium

Classifications:
CENTRAL
NERVOUS SYSTEM
AGENT;
ANTICONVULSANT
; SEDATIVEHYPNOTIC;
BARBITURATE

Dosage &
Route

Anticonvulsa
nt
Adult: PO 100
300 mg/d IV/IM
200600 mg up
to 20 mg/kg
Child: PO/IV 38
mg/kg or 125
mg/m2/d
Neonate: PO/IV
34 mg/kg/d
(max: 5
mg/kg/d)
Status
Epilepticus
Adult/Child: IV
1518 mg/kg in
single or
divided doses
(max: 20
mg/kg)
Neonate: IV 15
20 mg/kg in
single or
divided doses
Sedative
Adult: PO 30
120 mg/d IV/IM
100200 mg/d
Child: PO 6
mg/kg/d or 180
mg/m2 in 3
divided
doses IV/IM 16
100 mg/d (13

Action

Indication

Long-acting
barbiturate.
Sedative and
hypnotic
effects of
barbiturates
appear to be
due primarily
to
interference
with impulse
transmission
of cerebral
cortex by
inhibition of
reticular
activating
system. CNS
depression
may range
from mild
sedation to
coma,
depending on
dosage, route
of
administratio
n, degree of
nervous
system
excitability,
and drug
tolerance.
Initially,
barbiturates
suppress REM
sleep, but
with chronic
therapy REM
sleep returns
to normal.

Long-term
managemen
t of tonicclonic
(grand mal)
seizures and
partial
seizures;
status
epilepticus,
eclampsia,
febrile
convulsions
in young
children.
Also used as
a sedative
in anxiety or
tension
states; in
pediatrics as
preoperative
and
postoperativ
e sedation
and to treat
pylorospasm
in infants.

Adverse
Effects

Body as a Whole:
Myalgia,
neuralgia, CNS
depression,
coma, and
death. CNS:
Somnolence,
nightmares,
insomnia,
"hangover,"
headache,
anxiety, thinking
abnormalities,
dizziness,
nystagmus,
irritability,
paradoxic
excitement and
exacerbation of
hyperkinetic
behavior (in
children);
confusion or
depression or
marked
excitement
(older adult or
debilitated
patients); ataxia.
CV: Bradycardia,
syncope,
hypotension. GI:
Nausea,
vomiting,
constipation,
diarrhea,
epigastric pain,
liver damage.

Contraindicatio
n

Sensitivity to
barbiturates;
manifest hepatic
or familial history
of porphyria;
severe
respiratory or
kidney disease;
history of
previous
addiction to
sedative
hypnotics;
uncontrolled
pain; pregnancy
(particularly
early pregnancy)
(category D),
lactation;
sustained
release
formulation for
children <12 y of
age.

Nursing
Responsibility

Assessment &
Drug Effects

Observe
patients
receiving large
doses closely
for at least 30
min to ensure
that sedation is
not excessive.
Keep patient
under constant
observation
when drug is
administered
IV, and record
vital signs at
least every
hour or more
often if
indicated.

Lab tests:
Obtain liver
function and
hematology
tests and
determinations
of serum folate
and vitamin D
levels during
prolonged
therapy.

Monitor
serum drug
levels. Serum
concentrations
>50 mcg/mL
may cause
coma.
Therapeutic

mg/kg)

Hematologic:
Megaloblastic
anemia,
agranulocytosis,
thrombocytopeni
a. Metabolic:
Hypocalcemia,
osteomalacia,
rickets.
Musculoskeletal:
Folic acid
deficiency,
vitamin D
deficiency.
Respiratory:
Respiratory
depression. Skin:
Mild
maculopapular,
morbilliform
rash; erythema
multiforme,
Stevens-Johnson
syndrome,
exfoliative
dermatitis (rare).
.

serum
concentrations
of 1540
mcg/mL
produce
anticonvulsant
activity in most
patients. These
values are
usually
attained after
2 or 3 wk of
therapy with a
dose of 100
200 mg/d.

Expect
barbiturates to
produce
restlessness
when given to
patients in
pain because
these drugs do
not have
analgesic
action.

Be prepared
for paradoxical
responses and
report
promptly in
older adult or
debilitated
patient and
children (i.e.,
irritability,
marked
excitement
[inappropriate
tearfulness
and aggression
in children],
depression,
and confusion).

Research Paper help

https://www.homeworkping.com/