BAIAE

Bronchial Asthma in acute exacerbation

CAP
Community Acquired Pneumonia
Ineffective airway clearance rtd to increased sputum production as
evidenced by cough.
Risk for indection related todepressed immune system.
generic Name: Lagundi
Indication: It is used for the relief of cough due to common colds and flu. It
also used in the treatment of bronchospasm in acute bronchial asthma,
chronic bronchitis & other bronchopulmonary disorder. It is also prescribed
for the relief of reversible, mild to moderate bronchospasm
(prophylactic/maintenance medication) in adults & children w/ obstructive
airway disease.
ASCOF Lagundi - medicine for cough and asthma: a pure Filipino product
As interest in phytomedicines continues to grow, both patients and physicians alike are
searching for new products that are as reliable as traditional alternatives, based on their
quality, safety, and efficacy.
In the Philippines, the leading proponent of phytomedicines is backed by a company
with 63 years of experience in the field of pharmaceuticals, the Pascual Laboratories,
Inc. who introduced to the country an organic and all-natural cough and asthma remedy,
ASCOF Lagundi, derived from the lagundi plant (Vitex negundo L.) and now available in
syrup, tablet, and capsule forms.
Raw Material

Lagundi (Vitex negundo L.) leaves is the main component of the ASCOF Lagundi cough
and asthma medicine. It is a large native shrub that grows in the Philippines. Lagundi
has been traditionally used as herbal medicine by Philippine folks. Filipino mothers
would boil freshly-picked green leaves and strain them to produce an herbal tea, which

is then given to an ailing member of the family. The efficacy of Lagundi has also been
verified by the Philippine Department of Health and other Philippine based scientists
which concentrated on its use to ease respiratory complaints.
Lagundi is generally used for the treatment of coughs, asthma symptoms, and other
respiratory problems. It is also known for its analgesic effect that helps alleviate pain
and discomfort. Other traditional benefits that are derived from the use of Lagundi are
as follows:

relief of asthma & pharyngitis

recommended relief of rheumatism, dyspepsia, boils, diarrhea
treatment of cough, colds, fever and flu and other bronchopulmonary disorders
alleviate symptoms of chicken pox
removal of worms, and boils
History, Manufacturing and Marketing
During World War II, the country was devastated and, as a result, many Filipinos fell ill
and were badly in need of medicine. It was sometime in 1946 that the husband-and-wife
team of Isosceles and Leonora Pascual, who both graduated from the University of the
Philippines with degrees in Chemistry, put up Pascual Laboratories in a single-room
facility in their home on Balut, Tondo. Together, they developed products to treat
tuberculosis and vitamin deficiencytwo of the most pressing health concerns back
thenin order to help thousands of people all over the country.
Eight years later, they produced antibiotics, as well as cardiovascular medicines. At
about the same time, Pascuallab changed from a single proprietorship to a corporation,
and strategic partnerships were formed with foreign-based principals. In the 1970s the
manufacturing plant moved from Tondo to Bulacan and its head office was established
in Edsa, where the marketing and distribution of products were devolved to Pharex.
Through the years, the effectiveness of Lagundi was proven through intensive studies in
modern medicine led by the Department of Science and Technology (DOST).
Recognizing the efficacy of Lagundi as a natural remedy for cough and asthma, Pascual
Laboratories (PascualLab), in collaboration with the National Integrated Research
Program of Medicinal Plants (NIRPROMP) introduced ASCOF Lagundi as the first
herbal medicine in the country in 1996. Licensed by the Philippine Council for Health
Research and Development (PCHRD) and DOST.
This became the companys major thrust. A major reorganization happened at Pascual,
wherein Metro Drug was assigned as product distributor, Pharex was appointed to
market the Pascuallab generic products, and the Consumer Products Division was

established. ASCOF Lagundi is currently the most successful phytomedicine (or plantbased therapeutic product) in the Philippines.

The initial production of ASCOF Lagundi that began over a decade ago was done
through a technology transfer from the DOST and NIRPROMP. This made it possible for
PascualLab to manufacture quality medicine from organic lagundi leaves. ASCOF
Lagundi is currently the most successful phytomedicine (or plant-based therapeutic
product) in the Philippines. Syrups, capsules, and tablets are available in drugstores
nationwide.
Product Description and Indication

ASCOF Lagundi tablet and syrup is the only extensively researched and clinically
proven natural medicine for cough and asthma in the Philippines. ASCOF Lagundi is
natural.
Made from 100% Lagundi leaves which were nurtured organically in a qualitycertified farm untainted by synthetic chemical fertilizers and pesticides.
ASCOF Lagundi is safe.

No side effects were reported in the clinical trials for the syrup.

No known contraindications.

No risk of overdose.

ASCOF Lagundi is clinically-proven effective. ASCOF Lagundi relieves cough through a

"three way alis-ubo action":
Bronchodilating effect (lumuluwag)

Mucolytic (natutunaw)

Anti-histaminic / Cough Relief (gumiginhawa)

And since it is natural, you won't experience the harmful side effects of common
chemical cough and asthma drugs.
It is used for the relief of cough due to common colds and flu. It also used in the
treatment of bronchospasm in acute bronchial asthma, chronic bronchitis & other
bronchopulmonary disorder. It is also prescribed for the relief of reversible, mild to
moderate bronchospasm (prophylactic/maintenance medication) in adults & children w/
obstructive airway disease.
Current Thrust

Today, the company is into backward integration through the planting, harvesting and
processing of herbal medicines in its certified organic farm in Nueva Ecija. PascualLab
is the only local pharmaceutical company in the country today with an advanced herbal
research facility that is tasked to study and develop technology for phytomedicines,
thereby opening up a world of possibilities in the future of healthcare. "With our secondgeneration technology, our production process is more efficient and more standardized,
ensuring that ASCOFs phytoactive contents are consistent in every batch that is
produced. It is now the second-largest Filipino pharmaceutical company that has been
providing employment to families, and has broken into the Top 10 of the largest
pharmaceutical companies operating in the Philippines based on a pharmaceutical and
health-care report during the first and second quarters of 2009.
PascualLab takes quality care to the next level by developing more advanced
production technologies for ASCOF. Its Herbal R&D and Product & Process
Development team collaborates with independent medical and research institutions and
consultants both here and abroad, to continuously improve its products. PascualLab is
committed to intensify its researches on lagundi, and is set to launch new product
innovations within the year.

GENERIC NAME: IPRATROPIUM/ALBUTEROL (SALBUTAMOL) SOLUTION INHALATION (ip-ruh-TROW-pee-um/al-BYOU-ter-ohl)

BRAND NAME(S): DuoNeb
Medication Uses | How To Use | Side Effects | Precautions | Drug
Interactions | Overdose | Notes |Missed Dose | Storage
USES: This medication is used to treat severe breathing trouble caused by ongoing
lung diseases (chronic obstructive pulmonary disease-COPD, which include chronic
bronchitis and emphysema). It helps to relax the muscles around your airways so that
they open up to make breathing easier. It helps to reduce shortness of breath,
wheezing, and coughing. This medication is a combination of 2 drugs, ipratropium
and albuterol. Albuterol is also called salbutamol in some countries. Ipratropium is an
anticholinergic bronchodilator and albuterol (salbutamol) is a beta-agonist
bronchodilator.
HOW TO USE: Read the Patient Information Leaflet provided by your pharmacist
before you start using this medication and each time you get a refill. This medication is
used with a special machine called a nebulizer. Consult your healthcare professional for
how to properly use the nebulizer and read the manufacturer's instructions. If you have
any questions, consult your doctor or pharmacist.This medication does not require any
mixing before use. Inhale this medication into your lungs using the nebulizer and
mouthpiece/face mask, usually 4 times a day or as directed by your doctor.Avoid getting
any medication into your eyes. It may help to close your eyes during use. This will
reduce the risk of temporary blurred vision, other vision changes, eye pain, and
worsening of narrow-angle glaucoma. If you do get some medication into your eyes,
rinse them with water and call your doctor promptly if symptoms persist.Each treatment
should last about 5-15 minutes. Rinse your mouth after treatment to prevent dry
mouth and throat irritation. To prevent infections, clean the nebulizer according to the
manufacturer's directions.Use this medication exactly as prescribed. Remember to use
it at the same times each day. Do not increase your dose or use it more often than
prescribed because serious side effects may occur. Dosage is based on your medical
condition and response to therapy.Inform your doctor if your symptoms do not improve
or if they worsen. Consult your doctor about what you should do in case this medication
stops working well, or if you have worsening shortness of breath/cough, increased
sputum, or worsening peak flow meter readings.
SIDE EFFECTS: Nausea, diarrhea, constipation, blurred vision, dizziness,headache,
nervousness, dry mouth, dry/sore throat, or voice changes may occur. If any of these
effects persist or worsen, notify your doctor or pharmacist promptly.Remember that your
doctor has prescribed this medication because he or she has judged that the benefit to
you is greater than the risk of side effects. Many people using this medication do not

have serious side effects.Tell your doctor immediately if any of these unlikely but serious
side effects occur: muscle cramps, vision changes, eye pain, trouble urinating,
fast/pounding/irregular heartbeat.Seek immediate medical attention if any of these rare
but very serious side effects occur: chest pain.Rarely, this medication has caused
severe (possibly fatal), sudden worsening of breathing problems (paradoxical
bronchospasm). Seek immediate medical attention if you experience increased
wheezing/trouble breathing.A very serious allergic reaction to this drug is unlikely, but
seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction
may include: rash, itching/swelling (especially of the face/tongue/throat), severe
dizziness, trouble breathing.This is not a complete list of possible side effects. If you
notice other effects not listed above, contact your doctor or pharmacist.In the US -Call
your doctor for medical advice about side effects. You may report side effects to FDA at
1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You
may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking ipratropium/albuterol (salbutamol), tell your doctor or
pharmacist if you are allergic to it; or to atropine or other belladonna-type drugs; or if
you have any other allergies.Before using this medication, tell your doctor or pharmacist
your medical history, especially of: heart problems (e.g., irregular heartbeat, heart
failure), high blood pressure, seizures, overactive thyroid (hyperthyroidism), low
potassiumblood levels, diabetes, problems urinating, enlarged prostate, glaucoma
(narrow-angle type).This drug may make you dizzy or cause blurred vision. Do not
drive, use machinery, or do any activity that requires alertness or clear vision until you
are sure you can perform such activities safely. Limit alcoholic beverages.Before having
surgery, tell your doctor or dentist that you are using this medication.This medication
should be used only when clearly needed during pregnancy. Discuss the risks and
benefits with your doctor.It is not known whether this drug passes into breast milk.
Because of the potential risk to the infant, breast-feeding while using this drug is not
recommended. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Your healthcare professionals (e.g., doctor or pharmacist) may
already be aware of any possible drug interactions and may be monitoring you for it. Do
not start, stop or change the dosage of any medicine before checking with them
first.Avoid taking MAO inhibitors (e.g., furazolidone, isocarboxazid, linezolid,
moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) within 2
weeks before, during, and after treatment with this medication. In some cases a serious,
possibly fatal drug interaction may occur.Before using this medication, tell your doctor or
pharmacist of all prescription and nonprescription/herbal products you may use,
especially of: anticholinergic drugs (e.g., atropine,scopolamine), certain antihistamines
(e.g., diphenhydramine, meclizine), antispasmodic drugs (e.g., dicyclomine,
hyoscyamine), certain anti-Parkinson's drugs (e.g., benztropine, trihexyphenidyl), some
beta-blockers (such as propranolol), bladder control drugs
(e.g., oxybutynin, tolterodine),pramlintide, stimulant-like drugs (e.g., ephedrine,

epinephrine), tricyclicantidepressants (e.g., amitriptyline, nortriptyline), certain "water

pills" (diuretics that cause potassium loss from the body such
as furosemide,hydrochlorothiazide).Check the labels on all your medicines (e.g., coughand-cold products, diet aids) because they may contain ingredients that could increase
your heart rate or blood pressure. Ask your pharmacist about the safe use of those
products.This document does not contain all possible interactions. Therefore, before
using this product, tell your doctor or pharmacist of all the products you use. Keep a list
of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If overdose is suspected, contact your local poison control center or
emergency room immediately. US residents can call the US national poison hotline at 1800-222-1222. Canadian residents should call their local poison control center directly.
Symptoms of overdose may include: very fast or irregular heartbeat, unusual dizziness,
seizures, chest pain.
NOTES: Do not share this medication with others.Laboratory and/or medical tests (e.g.,
lung function tests) may be performed periodically to monitor your progress or check for
side effects. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the
time of the next dose, skip the missed dose and resume your usual dosing schedule. Do
not double the dose to catch up.
STORAGE: Store U.S. product between 36-86 degrees F (2-30 degrees C) in the foil
pouch or carton away from light and moisture. Do not store in the bathroom.Store
Canadian product at room temperature between 59-77 degrees F (15-25 degrees C)
away from light and moisture. Do not store in the bathroom.Keep all medicines away
from children and pets.Do not flush medications down the toilet or pour them into a
drain unless instructed to do so. Properly discard this product when it is expired or no
longer needed. Consult your pharmacist or local waste disposal company for more
details about how to safely discard your product.MEDICAL ALERT: Your condition can
cause complications in a medical emergency. For enrollment information call MedicAlert
at 1-800-854-1166 (USA) or 1-800-668-1507 (Canada).

Generic Name: Albuterol

Brand Name: Salbutamol, Proventil, Ventolin, Accuneb, airet, Novo-Salbutamol,
Proventil HFA, Gen-salbutamol, Ventodisk, Ventolin HFA, Volmax, VoSpira ER
Classification: Bronchodilator (therapeutic); adrenergics (pharmacologic)
Indications
1.
To control and prevent reversible airway obstruction caused by asthma or chronic
obstructive pulmonary disorder (COPD)

2.
Quick relief for bronchospasm
3.
For the prevention of exercise-induced bronchospasm
4.
Long-term control agent for patients with chronic or persistent bronchospasm
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.
1.
First, it binds to the beta2-adrenergic receptors in the airway of the smooth
muscle which then leads to the activation of the adenyl cyclase and increased levels
of cyclic- 35-adenosine monophosphate (cAMP).
2.
When cAMP increases, kinases are activated.
3.
Kinases inhibit the phosphorylation of myosin and decrease intracellular calcium.
4.
Decreased in intracellular calcium will result to the relaxation of the smooth
muscle airways.
Contraindications
1.
Hypersensitivity to adrenergic amines
2.
Hypersensitivity to fluorocarbons
Precaution
1.
Cardiac disease including coronary insufficiency, a history of stroke, coronary
artery diseaseand cardiac arrhythmias
2.
Hypertension
3.
Hyperthyroidism
4.
Diabetes
5.
Glaucoma
6.
Geriatric patients older individuals are at higher risk for adverse reactions and
may require lower dosage
7.
Pregnancy especially near term
8.
Lactation
9.
Children less than 2 years of age because safety of its use has not been
established
10.
Excess inhaler use which may lead to tolerance and paradoxical bronchospasm
Side Effects and Adverse Reactions
1.
Nervousness
2.
Restlessness
3.
Tremor
4.
Headache
5.
Insomnia
6.
Chest pain
7.
Palpitations
8.
Angina
9.
Arrhythmias
10.
Hypertension
11.
Nausea and vomiting
12.
Hyperglycemia
13.
Hypokalemia

Route and Dosage

PO (Adults and Children more than 12 years): 2-4 mg 3-4 times a day or 4-8 mg of
extended dose tablets twice a day.
PO (Geriatric Patients): initial dose should not exceed 2 mg 3-4 times a day and may be
increased carefully up to 32 mg/day
PO (Children 6-12 years old): 2 mg 3-4 times a day or 4 mg as extended-release tablets
twice a day; may be carefully increased as needed but not to exceed 24 mg/day
PO (Children 2-6 years old): 0.1 mg/kg 3 times a day
Inhalation (Adults and children more than 4 years of age): 2 inhalations every 4-6 hours
Inhalation (Children 2-12 years old): 0.1-0.15 mg/kg/dose 3-4 times a day
Nursing Interventions
1.
Assess lung sounds, PR and BP before drug administration and during peak of
medication.
2.
Observe fore paradoxical spasm and withhold medication and notify physician if
condition occurs.
3.
Administer PO medications with meals to minimize gastric irritation.
4.
Extended-release tablet should be swallowed-whole. It should not be crushed or
chewed.
5.
If administering medication through inhalation, allow at least 1 minute between
inhalation of aerosol medication.
6.
Advise the patient to rinse mouth with water after each inhalation to minimize dry
mouth.
7.
Inform the patient that Albuterol may cause an unusual or bad taste.

DRUG STUDY
D R U G
N A M E A C T I O N
/
C L A S S I F
I C A T I O N I N D I C A T I O N C O N T R A I N
D I C A T I O N N U R S I N G
R E S P O N S I
B I L I T Y Trade name : SalbutamolNebGeneric name: AlbuterolSulfateDosage: 1
TabFrequency: q4 hoursIn low doses, acts relativelyselectively at beta 2 adrenergic
receptors tocause bronchodilation andvasodilation; at higherdoses, beta 2 selectivity
islost, and the drug acts atbeta 2 receptors to causetypical sympathomimeticcardiac
effect.Antasthmatic

Relief and prevention of brochospasm in patientswith reversibleobstructive airwaydisease.

Inhalation: treatment of acute attacks of brochospasm.

Prevention of exercise-induced brochospasm.

Unlabeled use: adjunct intreating serioushyperkalemia in dialysispatients; seems to

lowerpotassium concentrationwhen inhaled by patientson hemodialysis.

Contraindicated withhypersensitivity toalbuterol;tachyarrhythmias,tachycardia cause

bydigitalis intoxication.


Use cautiously withdiabetes mellitus;hyperthyroidism, historyof seizure disorders.

Observe 10 rights ingiving medications.

Use minimal doses forminimal periods; drugtolerance can occur withprolonged used.

Maintain a adrenergicblocker ( cardioselectivebeta blocker, such asatenolol, should be

usewith respiratorydistress ) on standby incase cardiac arrhythmiasoccur.

Subjective:
Inuubo ako atnahihirapanakongmakahinga.Masnakakahingaako ng maayoskapag
ganitongmay Oxygen.Kapag wala, anghirap talagahuminga at sakamatanda na
rinako.
Objective:
RestlessnessNasal flaringCrackles hearduponauscultation onboth lung filedOxygen
vianasal cannulaImpaired gasexchangerelated toinflammatoryprocess in
thelungparenchymaand alveoli asmanifested byrestlessness.Community-acquired
pneumonia (CAP) isa disease inwhich individualswho have notrecently
beenhospitalizeddevelopan infection of the lungs (pneumonia).CAP is a
commonillness and canaffect people of all ages. CAPoften causesproblems
likedifficulty inbreathing,fever, chestpains, and acough. CAPoccurs becausethe
areas of thelung whichabsorb oxygen(alveoli) from theatmospherebecome
filledwith fluid andcannot work
Goal:
After 8 hours of nursingintervention, theclient will be able toestablish a normaland
effectiverespiratory pattern.
Objectives:Independent
1. After 30 minutesof intervention, theclient would be ableto have normalbreath
respirationand breath soundswithin 20 minutes.2. After 30 minutesof
nursingintervention, theclient would be ableto have easierbreathing.
Independent
1.Monitorrespiration andbreath sounds2. Place the client inhigh
fowlersposition.Tachypnea, stridor,crackles orwheezes areindicative
torepiratory distressand/oraccumulation of fluid
(Nurse's Pocket Guide by Doengeset al pp.78)
Positioning theclient in highfowler's positionpromote lungexpansion.
(Fundamentals of Nursing by Kozier

After 8 hours of nursingintervention, theclient was able toestablish a normaland

effectiverespiratorypattern.
NURSING DIAGNOSIS Ineffective Airway Clearance related to presence of Secretions
secondary to Community acquired pneumonia

Pneumonia (NCP)Nursing Care Plan-Risk for Infection

Posted on April 13, 2012 by RNspeak in Nursing Care Plan with 3 Comments

Pneumonia is one of the most common medical problems

encountered in clinical practice and leading fatal infectious disease worldwide. In the Philippines last 2011 based on a
number of health insurance claims by Philhealth revealed as one of the top cases acquired disease in the country.
Its also ranked as the eight leading cause of death in the US consistently accounts for the overwhelming majority
death in 2006, were in 55,477 people died of pneumonia.
Pneumonia is caused by a number of infectious agents including viruses, bacteria, and fungi. The most common
bacterial pathogen, Streptococcus pneumoniae, is identified as the leading cause of community-acquired pneumonia
among children and adults.

Two causes of Pneumonia

Primary pneumonia -is caused by the patients inhaling or aspirating a pathogen.

Secondary pneumonia -ensues from lung damage caused by the spread of bacteria from an infection
elsewhere in the body. Likely causes include various infectious agents, chemical irritants (including gastric
reflux/aspiration, smoke inhalation), and radiation therapy. This plan of care deals with bacterial and viral
pneumonias, e.g., pneumococcal pneumonia, Pneumocystis carinii, Haemophilus influenzae, mycoplasma, and
Gram-negative microbes.

Nursing Priorities

Maintain/improve respiratory function.

Prevent complications.
Support recuperative process.
Provide information about disease process/prognosis and treatment.

Discharge Goals

Ventilation and oxygenation adequate for individual needs.

Complications prevented/minimized.
Disease process/prognosis and therapeutic regimen understood.

Lifestyle changes identified/initiated to prevent recurrence.

Plan in place to meet needs after discharge.

Nursing Diagnosis:Risk for Infection

Risk factors may include

Inadequate primary defenses (decreased ciliary action, stasis of respiratory secretions)

Inadequate secondary defenses (presence of existing infection, immunosuppression), chronic disease,
malnutrition

Possibly evidenced by
[Not applicable; presence of signs and symptoms establishes an actual diagnosis.]
Desired outcomes

Achieve timely resolution of current infection without complications.

Knowledge: Infection Control
Identify interventions to prevent/reduce risk/spread of/secondary infection.
Nursing actions

Rationale

Monitor vital signs closely, especially during

initiation of therapy.

During this period of time, potentially fatal

complications (hypotension/shock) may
develop.

Instruct patient concerning the disposition

of secretions (e.g., raising and
expectorating versus swallowing) and
reporting changes in color, amount, odor of
secretions.

Although patient may find expectoration

offensive and attempt to limit or avoid it, it is
essential that sputum be disposed of in a
safe manner. Changes in characteristics of
sputum reflect resolution of pneumonia or
development of secondary infection.

Demonstrate/encourage good handwashing

technique.

Effective means of reducing spread or

acquisition of infection.

Change position frequently and provide

good pulmonary toilet.

Promotes expectoration, clearing of infection.

Limit visitors as indicated.

Reduces likelihood of exposure to other

infectious pathogens.

Institute isolation precautions as

individually appropriate.

Dependent on type of infection, response to

antibiotics, patients general health, and
development of complications, isolation

techniques may be desired to prevent

spread/protect patient from other infectious
processes.

Encourage adequate rest balanced with

moderate activity. Promote adequate
nutritional intake.

Facilitates healing process and enhances

natural resistance.

Monitor effectiveness of antimicrobial

therapy.

Signs of improvement in condition should

occur within 2448 hr.

Investigate sudden changes/deterioration in

condition, such as increasing chest pain,
extra heart sounds, altered sensorium,
recurring fever, changes in sputum
characteristics.

Delayed recovery or increase in severity of

symptoms suggests resistance to antibiotics
or secondary infection. Complications
affecting any/all organ systems include lung
abscess/empyema, bacteremia,
pericarditis/endocarditis,
meningitis/encephalitis, and superinfections.

Administer antimicrobials as indicated by

results of sputum/blood cultures: e.g.,
penicillins: erythromycin (E-Mycin),
tetracycline (Achromycin), doxycycline
hyclate (Vibramycin), amikacin (Amikin);
cephalosporins: ceftriaxone (Rocephin);
amantadine (Symmetrel); sparfloxacin
(Zagam); macrolide derivatives, e.g,
azithromycin (Zithromax).

These drugs are used to combat most of the

microbial pneumonias. Combinations of
antiviral and antifungal agents may be used
when the pneumonia is a result of mixed
organisms. Note:Vancomycin and thirdgeneration cephalosporins are the treatment
of choice for penicillin-resistant streptococcal
pneumonia

Definition
Contents [hide]

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1 Definition
2 Nursing Priorities
3 Discharge Goals
4 Diagnostic Studies
5 Nursing Care plans
5.1 Ineffective Airway Clearance
5.2 Impaired Gas Exchange
5.3 Risk for Deficient Fluid Volume
5.4 Imbalanced Nutrition
5.5 Acute Pain

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5.6 Activity Intolerance

5.7 Risk for Infection
5.8 Deficient Knowledge

Pneumonia is an inflammation of the lung parenchyma, associated with alveolar edema and
congestion that impair gas exchange.

Nursing Priorities
1.

Maintain/improve respiratory function.

2.

Prevent complications.

3.

Support recuperative process.

4.

Provide information about disease process, prognosis and treatment.

Discharge Goals
1.

Ventilation and oxygenation adequate for individual needs.

2.

Complications prevented/minimized.

3.

Disease process/prognosis and therapeutic regimen understood.

4.

Lifestyle changes identified/initiated to prevent recurrence.

5.

Plan in place to meet needs after discharge.

Diagnostic Studies

Chest x-ray: Identifies structural distribution (e.g., lobar, bronchial); may also reveal multiple
abscesses/infiltrates, empyema (staphylococcus); scattered or localized infiltration (bacterial); or

diffuse/extensive nodular infiltrates (more often viral). In mycoplasmal pneumonia, chest x-ray
may be clear.
Fiberoptic bronchoscopy: May be both diagnostic (qualitative cultures) and therapeutic (re-

expansion of lung segment).

ABGs/pulse oximetry: Abnormalities may be present, depending on extent of lung

involvement and underlying lung disease.

Gram stain/cultures: Sputum collection; needle aspiration of empyema, pleural, and
transtracheal or transthoracic fluids; lung biopsies and blood cultures may be done to recover
causative organism. More than one type of organism may be present; common bacteria include
Diplococcus pneumoniae, Staphylococcus aureus, a-hemolytic streptococcus, Haemophilus
influenzae; cytomegalovirus (CMV). Note: Sputum cultures may not identify all offending
organisms. Blood cultures may show transient bacteremia.

CBC: Leukocytosis usually present, although a low white blood cell (WBC) count may be
present in viral infection, immunosuppressed conditions such as AIDS, and overwhelming

bacterial pneumonia. Erythrocyte sedimentation rate (ESR) is elevated.

Serologic studies, e.g., viral or Legionella titers, cold agglutinins: Assist in differential

diagnosis of specific organism.

Pulmonary function studies: Volumes may be decreased (congestion and alveolar

collapse); airway pressure may be increased and compliance decreased. Shunting is present
(hypoxemia).
Electrolytes: Sodium and chloride levels may be low.

Bilirubin: May be increased.

Percutaneous aspiration/open biopsy of lung tissues: May reveal typical intranuclear
and cytoplasmic inclusions (CMV), characteristic giant cells (rubeola).

Nursing Care plans

Below are 8 Nursing Care Plans (NCP) for Pneumonia.

Ineffective Airway Clearance

Nursing Diagnosis: Airway Clearance, ineffective

May be related to

Tracheal bronchial inflammation, edema formation, increased sputum production

Pleuritic pain

Decreased energy, fatigue

Possibly evidenced by

Changes in rate, depth of respirations

Abnormal breath sounds, use of accessory muscles

Dyspnea, cyanosis

Cough, effective or ineffective; with/without sputum production

Desired Outcomes

Identify/demonstrate behaviors to achieve airway clearance.

Display patent airway with breath sounds clearing; absence of dyspnea, cyanosis.

Nursing Interventions

Rationale

Assess rate/depth of respirations and chest

Tachypnea, shallow respirations, and asymmetric chest

movement.

movement are frequently present because of discomfort

of moving chest wall and/or fluid in lung.

Auscultate lung fields, noting areas of

Decreased airflow occurs in areas consolidated with

decreased/absent airflow and adventitious breath

fluid. Bronchial breath sounds (normal over bronchus)

sounds, e.g., crackles, wheezes.

can also occur in consolidated areas. Crackles, rhonchi,

and wheezes are heard on inspiration and/or expiration
in response to fluid accumulation, thick secretions, and
airway spasm/obstruction.

Elevate head of bed, change position frequently.

Lowers diaphragm, promoting chest expansion, aeration

of lung segments, mobilization and expectoration of
secretions.

Assist patient with frequent deep-breathing

Deep breathing facilitates maximum expansion of the

exercises. Demonstrate/help patient learn to perform

lungs/smaller airways. Coughing is a natural self-

activity, e.g., splinting chest and effective coughing

cleaning mechanism, assisting the cilia to maintain

while in upright position.

patent airways. Splinting reduces chest discomfort, and

an upright position favors deeper, more forceful cough
effort.

Suction as indicated (e.g., frequent or sustained

Stimulates cough or mechanically clears airway in

cough, adventitious breath sounds, desaturation

patient who is unable to do so because of ineffective

related to airway secretions).

cough or decreased level of consciousness.

Force fluids to at least 3000 mL/day (unless

Fluids (especially warm liquids) aid in mobilization and

contraindicated, as in heart failure). Offer warm,

expectoration of secretions.

rather than cold, fluids.

Assist with/monitor effects of nebulizer treatments

Facilitates liquefaction and removal of secretions.

and other respiratory physiotherapy, e.g., incentive

Postural drainage may not be effective in interstitial

spirometer, IPPB, percussion, postural drainage.

pneumonias or those causing alveolar

Perform treatments between meals and limit fluids

exudate/destruction. Coordination of

when appropriate.

treatments/schedules and oral intake reduces likelihood

of vomiting with coughing, expectorations.

Administer medications as indicated: mucolytics,

Aids in reduction of bronchospasm and mobilization of

expectorants, bronchodilators, analgesics.

secretions. Analgesics are given to improve cough effort

by reducing discomfort, but should be used cautiously
because they can decrease cough effort/depress
respirations.

Provide supplemental fluids, e.g., IV, humidified

Fluids are required to replace losses (including

oxygen, and room humidification.

insensible) and aid in mobilization of secretions. Note:

Some studies indicate that room humidification has been
found to provide minimal benefit and is thought to
increase the risk of transmitting infection.

Monitor serial chest x-rays, ABGs, pulse oximetry

Follows progress and effects of disease

readings.

process/therapeutic regimen, and facilitates necessary

alterations in therapy.

Assist with bronchoscopy/thoracentesis, if indicated.

Occasionally needed to remove mucous plugs, drain

purulent secretions, and/or prevent atelectasis.

Impaired Gas Exchange

Nursing Diagnosis: Gas Exchange, impaired

May be related to

Alveolar-capillary membrane changes (inflammatory effects)

Altered oxygen-carrying capacity of blood/release at cellular level (fever, shifting

oxyhemoglobin curve)

Altered delivery of oxygen (hypoventilation)

Possibly evidenced by

Dyspnea, cyanosis

Tachycardia

Restlessness/changes in mentation

Hypoxia

Desired Outcomes

Demonstrate improved ventilation and oxygenation of tissues by ABGs within patients

acceptable range and absence of symptoms of respiratory distress.

Participate in actions to maximize oxygenation.

Nursing Interventions

Rationale

Assess respiratory rate, depth, and ease.

Manifestations of respiratory distress are dependent on/and

indicative of the degree of lung involvement and underlying
general health status.

Observe color of skin, mucous membranes,

Cyanosis of nailbeds may represent vasoconstriction or the

and nailbeds, noting presence of peripheral

bodys response to fever/chills; however, cyanosis of earlobes,

cyanosis (nailbeds) or central cyanosis

mucous membranes, and skin around the mouth (warm

(circumoral).

membranes) is indicative of systemic hypoxemia.

Assess mental status.

Restlessness, irritation, confusion, and somnolence may

reflect hypoxemia/ decreased cerebral oxygenation.

Monitor heart rate/rhythm.

Tachycardia is usually present as a result of fever/dehydration

but may represent a response to hypoxemia.

Monitor body temperature, as indicated. Assist

High fever (common in bacterial pneumonia and influenza)

with comfort measures to reduce fever and

greatly increases metabolic demands and oxygen

chills, e.g., addition/removal of bedcovers,

consumption and alters cellular oxygenation.

comfortable room temperature, tepid or cool

water sponge bath.
Maintain bedrest. Encourage use of relaxation

Prevents overexhaustion and reduces oxygen

techniques and diversional activities.

consumption/demands to facilitate resolution of infection.

Elevate head and encourage frequent position

These measures promote maximal inspiration, enhance

changes, deep breathing, and effective

expectoration of secretions to improve ventilation.

coughing.
Assess level of anxiety. Encourage

Anxiety is a manifestation of psychological concerns and

verbalization of concerns/feelings. Answer

physiological responses to hypoxia. Providing reassurance

questions honestly. Visit frequently, arrange for

and enhancing sense of security can reduce the psychological

SO/visitors to stay with patient as indicated.

component, thereby decreasing oxygen demand and adverse

physiological responses.

Observe for deterioration in condition, noting

Shock and pulmonary edema are the most common causes of

hypotension, copious amounts of pink/bloody

death in pneumonia and require immediate medical

sputum, pallor, cyanosis, change in level of

intervention.

consciousness, severe dyspnea, restlessness.

Monitor ABGs, pulse oximetry.

Follows progress of disease process and facilitates alterations

in pulmonary therapy.

Administer oxygen therapy by appropriate

The purpose of oxygen therapy is to maintain Pao2 above 60

means, e.g., nasal prongs, mask, Venturi mask.

mm Hg. Oxygen is administered by the method that provides

appropriate delivery within the patients tolerance.

Risk for Deficient Fluid Volume

Nursing Diagnosis: Risk for Deficient Fluid Volume

Risk factors may include

Excessive fluid loss (fever, profuse diaphoresis, mouth breathing/hyperventilation, vomiting)

Decreased oral intake

Desired Outcomes

Demonstrate fluid balance evidenced by individually appropriate parameters, e.g., moist

mucous membranes, good skin turgor, prompt capillary refill, stable vital signs.
Nursing Interventions

Rationale

Assess vital sign changes, e.g., increased

Elevated temperature/prolonged fever increases metabolic

temperature/prolonged fever, tachycardia,

rate and fluid loss through evaporation. Orthostatic BP

orthostatic hypotension.

changes and increasing tachycardia may indicate systemic

fluid deficit.

Assess skin turgor, moisture of mucous

Indirect indicators of adequacy of fluid volume, although

membranes (lips, tongue).

oral mucous membranes may be dry because of mouth

breathing and supplemental oxygen.

Note reports of nausea/vomiting.

Presence of these symptoms reduces oral intake.

Monitor intake and output (I&O), noting color,

Provides information about adequacy of fluid volume and

character of urine. Calculate fluid balance. Be

replacement needs.

aware of insensible losses. Weigh as indicated.

Force fluids to at least 3000 mL/day or as

Meets basic fluid needs, reducing risk of dehydration

individually appropriate.
Administer medications as indicated, e.g.,

Useful in reducing fluid losses.

antipyretics, antiemetics.
Provide supplemental IV fluids as necessary.

In presence of reduced intake/excessive loss, use of

parenteral route may correct/prevent deficiency.

Administer medications as indicated, e.g.,

Useful in reducing fluid losses.

antipyretics, antiemetics.
Provide supplemental IV fluids as necessary.

In presence of reduced intake/excessive loss, use of

parenteral route may correct/prevent deficiency.

Imbalanced Nutrition
Nursing Diagnosis: Risk for Imbalanced Nutrition Less Than Body Requirements

Risk factors may include

Increased metabolic needs secondary to fever and infectious process

Anorexia associated with bacterial toxins, the odor and taste of sputum, and certain aerosol
treatments

Abdominal distension/gas associated with swallowing air during dyspneic episodes

Desired Outcomes

Demonstrate increased appetite.

Maintain/regain desired body weight.

Nursing Interventions

Rationale

Identify factors that are contributing to

Choice of interventions depends on the underlying cause

nausea/vomiting, e.g., copious sputum, aerosol

of the problem.

treatments, severe dyspnea, pain.

Provide covered container for sputum and remove

Eliminates noxious sights, tastes, smells from the patient

at frequent intervals. Assist with/encourage oral

environment and can reduce nausea.

hygiene after emesis, after aerosol and postural

drainage treatments, and before meals.
Schedule respiratory treatments at least 1 hr

Reduces effects of nausea associated with these

before meals.

treatments.

Auscultate for bowel sounds. Observe/palpate for

Bowel sounds may be diminished/absent if the infectious

abdominal distension.

process is severe/prolonged. Abdominal distension may

occur as a result of air swallowing or reflect the influence of
bacterial toxins on the gastrointestinal (GI) tract.

Provide small, frequent meals, including dry foods

These measures may enhance intake even though

(toast, crackers) and/or foods that are appealing to

appetite may be slow to return.

patient.
Evaluate general nutritional state, obtain baseline

Presence of chronic conditions (e.g., COPD or alcoholism)

weight.

or financial limitations can contribute to malnutrition,

lowered resistance to infection, and/or delayed response to
therapy.

Acute Pain
Nursing Diagnosis: Pain, acute

May be related to

Inflammation of lung parenchyma

Cellular reactions to circulating toxins

Persistent coughing

Possibly evidenced by

Reports of pleuritic chest pain, headache, muscle/joint pain

Guarding of affected area

Distraction behaviors, restlessness

Desired Outcomes

Verbalize relief/control of pain.

Demonstrate relaxed manner, resting/sleeping and engaging in activity appropriately.

Nursing Interventions

Rationale

Determine pain characteristics, e.g., sharp,

Chest pain, usually present to some degree with pneumonia,

constant, stabbing. Investigate changes in

may also herald the onset of complications of pneumonia, such

character/location/intensity of pain.

as pericarditis and endocarditis.

Monitor vital signs.

Changes in heart rate or BP may indicate that patient is

experiencing pain, especially when other reasons for changes
in vital signs have been ruled out.

Provide comfort measures, e.g., back rubs,

Nonanalgesic measures administered with a gentle touch can

change of position, quiet music or

lessen discomfort and augment therapeutic effects of

conversation. Encourage use of

analgesics. Patient involvement in pain control measures

relaxation/breathing exercises.

promotes independence and enhances sense of well-being.

Offer frequent oral hygiene.

Mouth breathing and oxygen therapy can irritate and dry out
mucous membranes, potentiating general discomfort.

Instruct and assist patient in chest splinting

Aids in control of chest discomfort while enhancing

techniques during coughing episodes.

effectiveness of cough effort.

Administer analgesics and antitussives as

These medications may be used to suppress

indicated.

nonproductive/paroxysmal cough or reduce excess mucus,

thereby enhancing general comfort/rest.

Activity Intolerance
Nursing Diagnosis: Activity intolerance

May be related to

Imbalance between oxygen supply and demand

General weakness

Exhaustion associated with interruption in usual sleep pattern because of discomfort,

excessive coughing, and dyspnea

Possibly evidenced by

Verbal reports of weakness, fatigue, exhaustion

Exertional dyspnea, tachypnea

Tachycardia in response to activity

Development/worsening of pallor/cyanosis

Desired Outcomes

Report/demonstrate a measurable increase in tolerance to activity with absence of dyspnea

and excessive fatigue, and vital signs within patients acceptable range.
Nursing Interventions

Rationale

Evaluate patients response to activity. Note

Establishes patients capabilities/needs and facilitates choice

reports of dyspnea, increased

of interventions.

weakness/fatigue, and changes in vital signs

during and after activities.
Provide a quiet environment and limit visitors

Reduces stress and excess stimulation, promoting rest

during acute phase as indicated. Encourage

use of stress management and diversional
activities as appropriate.
Explain importance of rest in treatment plan

Bedrest is maintained during acute phase to decrease

and necessity for balancing activities with rest.

metabolic demands, thus conserving energy for healing. Activity

restrictions thereafter are determined by individual patient
response to activity and resolution of respiratory insufficiency.

Assist patient to assume comfortable position

Patient may be comfortable with head of bed elevated,

for rest/sleep.

sleeping in a chair, or leaning forward on overbed table with

pillow support.

Assist with self-care activities as necessary.

Minimizes exhaustion and helps balance oxygen supply and

Provide for progressive increase in activities

demand.

during recovery phase. and demand.

Risk for Infection

Nursing Diagnosis: Risk for [Spread] of Infection

Risk factors may include

Inadequate primary defenses (decreased ciliary action, stasis of respiratory secretions)

Inadequate secondary defenses (presence of existing infection, immunosuppression),

chronic disease, malnutrition

Desired Outcomes

Achieve timely resolution of current infection without complications.

Identify interventions to prevent/reduce risk/spread of/secondary infection.

Nursing Interventions

Rationale

Monitor vital signs closely, especially during

During this period of time, potentially fatal complications

initiation of therapy.

(hypotension/shock) may develop.

Instruct patient concerning the disposition of

Although patient may find expectoration offensive and attempt

secretions (e.g., raising and expectorating

to limit or avoid it, it is essential that sputum be disposed of in

versus swallowing) and reporting changes in

a safe manner. Changes in characteristics of sputum reflect

color, amount, odor of secretions.

resolution of pneumonia or development of secondary

infection.

Demonstrate/encourage good handwashing

Effective means of reducing spread or acquisition of infection.

technique.
Change position frequently and provide good

Promotes expectoration, clearing of infection.

pulmonary toilet.
Limit visitors as indicated.

Reduces likelihood of exposure to other infectious pathogens.

Institute isolation precautions as individually

Dependent on type of infection, response to antibiotics,

appropriate.

patients general health, and development of complications,

isolation techniques may be desired to prevent spread/protect
patient from other infectious processes.

Encourage adequate rest balanced with

Facilitates healing process and enhances natural resistance.

moderate activity. Promote adequate nutritional

intake.
Monitor effectiveness of antimicrobial therapy.

Signs of improvement in condition should occur within 2448

hr.

Investigate sudden changes/deterioration in

Delayed recovery or increase in severity of symptoms

condition, such as increasing chest pain, extra

suggests resistance to antibiotics or secondary infection.

heart sounds, altered sensorium, recurring

Complications affecting any/all organ systems include lung

fever, changes in sputum characteristics.

abscess/empyema, bacteremia, pericarditis/endocarditis,

meningitis/encephalitis, and superinfections.

Prepare for/assist with diagnostic studies as

Fiberoptic bronchoscopy (FOB) may be done in patients who

indicated.

do not respond rapidly (within 13 days) to antimicrobial

therapy to clarify diagnosis and therapy needs.

Deficient Knowledge
Nursing Diagnosis: Deficient Knowledge regarding condition, treatment, self-care, and discharge
needs

May be related to

Lack of exposure

Misinterpretation of information

Altered recall

Possibly evidenced by

Requests for information; statement of misconception

Failure to improve/recurrence

Desired Outcomes

Verbalize understanding of condition, disease process, and prognosis.

Verbalize understanding of therapeutic regimen.

Initiate necessary lifestyle changes.

Participate in treatment program.

Nursing Interventions

Rationale

Review normal lung function, pathology of

Promotes understanding of current situation and

condition.

importance of cooperating with treatment regimen.

Discuss debilitating aspects of disease, length of

Information can enhance coping and help reduce anxiety

convalescence, and recovery expectations. Identify

and excessive concern. Respiratory symptoms may be

self-care and homemaker needs/resources.

slow to resolve, and fatigue and weakness can persist for

an extended period. These factors may be associated with
depression and the need for various forms of support and
assistance.

Provide information in written and verbal form.

Fatigue and depression can affect ability to assimilate

information/follow medical regimen.

Stress importance of continuing effective

During initial 68 wk after discharge, patient is at greatest

coughing/deep-breathing exercises.

risk for recurrence of pneumonia.

Emphasize necessity for continuing antibiotic

Early discontinuation of antibiotics may result in failure to

therapy for prescribed period.

completely resolve infectious process

Review importance of cessation of smoking.

Smoking destroys tracheobronchial ciliary action, irritates

bronchial mucosa, and inhibits alveolar macrophages,
compromising bodys natural defense against infection.

Outline steps to enhance general health and well-

Increases natural defenses/immunity, limits exposure to

being, e.g., balanced rest and activity, well-rounded

pathogens.

diet, avoidance of crowds during cold/flu season and

persons with URIs.
Stress importance of continuing medical follow-up

May prevent recurrence of pneumonia and/or related

and obtaining vaccinations/immunizations as

complications.

appropriate.
Identify signs/symptoms requiring notification of

Prompt evaluation and timely intervention may

healthcare provider, e.g., increasing dyspnea, chest

pain, prolonged fatigue, weight loss, fever/chills,
persistence of productive cough, changes in
mentation.

prevent/minimize complications.