Final case study PCAP..docx

University of Perpetual Help System LagunaDr. Jose G. Tamayo Medical University

Sto. Niño, Biñan, Laguna

COLLEGE OF NURSING

Pediatric Community-Acquired Pneumonia (PCAP – C)

In Partial Fulfillment of the Requirements in NCM 107 B

A Case Presented By

Group 1 - 3/ N4X

Abellar, Justine A.

Acabado, Melanisol C.

Delfin, Gian Carlo D.

Fermindoza, Jenny Gay S.

Garcia, Leslie M.

Gutierrez, Joana G.

Olay, Nicole Neil N.

Regis, Melanie B.

Santos, Jeffrey M.

August 15, 2013

CONTENTS

I. Introduction

II. Patient’s Profile

III. Physical Assessment

IV. Anatomy and Physiology

V. Pathophysiology

VI. Medical Management

VII. Laboratory and Diagnostic Tests

VIII. Drug Study

IX. Nursing Care Plan

INTRODUCTION

I. Introduction

Pediatric community-acquired pneumonia (PCAP)

Pneumonia is a general term that refers to an infection of the lungs, which can be caused by a variety of microorganisms, including viruses, bacteria, fungi, and parasites. Pneumonia is the infection of the pulmonary tissue, including the interstitial spaces, the alveoli, and the bronchioles. Pneumonia can be community-acquired or hospital-acquired.

Community acquired pneumonia occurs either in the community setting or within the first 48 hours after hospitalization or institutionalization.

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; Haemophilusinfluenzae type b (Hib) – the second most common cause of bacterial pneumonia; respiratory syncytial virus is the most common viral cause of pneumonia.

Environmental Risk Factors include: indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung), living in crowded homes, parental smoking.

Signs and Symptoms vary depending on the age of the child and the cause of the pneumonia, but common ones include: fever, chills, cough, nasal congestion, unusually rapid breathing (in some cases, this is the only symptom), breathing with grunting or wheezing sounds, labored breathing that makes the rib muscles retract (when muscles under the ribcage or between ribs draw inward with each breath) and causes nasal flaring, vomiting, chest pain, abdominal pain, loss of appetite (in older kids) or poor feeding (in infants), which may lead to dehydration, in extreme cases, bluish or gray color of the lips and fingernails.

Incidence:

Pneumonia is the single largest cause of death in children worldwide. Every year, it kills an estimated 1.2 million children under the age of five years, accounting for 18% of all deaths of children under five years old worldwide. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa.

PATIENT’S PROFILE

Name : C.R.

Age : 2 years old 9 months

Gender : Female

Status : Child

Nationality : Filipino

Religion : Roman Catholic

B-date : November 5, 2010

B-place : Binan,Laguna

Address : Cabuyao, Laguna

Admission date and time : August 4, 2013/ 9:42am

Attending Physician : Dra. G.M.

Initial Diagnosis :

PCAP-C

Final Diagnosis :

NONE

Chief Complaint

Cough

History of present illness:

Two weeks prior to admission, patient experienced cough, productive, no fever noted, no difficulty of breathing. Patient was given Cefexime 2.5 ml and cetirizine 2.5 ml which give temporary relief. One day prior to admission suddenly experienced fever, temperature maximum of 39 degree Celsius, patient was given Paracetamol suppository which gave temporary relief, associated with appearance of petechial rashes on the periorbital area. Persistence of the symptom, prompted to have the admission.

Maternal and obstetric history:

Patient was born to a 27 years old G2P2 (2002) mother who had regular prenatal checkup and regular intake of vitamins. No history and exposure to radiation and teratogenic drugs. Patient had history of UTI during the course of pregnancy and asthma at 7 months.

Birth History:

Patient was delivered live, via Caesarian Section attended by obstetrician and pediatrician with no noted complications. Routine newborn screening was done.

Neonatal History:

Patient has no history of jaundice and cyanosis. Meconium was passed out within 24 hour of life.

Immunization History:

(+) BCG

(+) DPT 3 doses

(+) OPV 3 doses

(+) Hep B 3 doses

(+) Varicella Vaccine

(+) Pneumonia Vaccine

Past Medical History:

(+) Hospitalization = 2012 Aug ; cough, UPHS

(+) Seizure at 5 months

(+) Asthma, 2012, Montelukast and prednisone

Family History:

(+) HPN = Paternal

(+) DM = Paternal

(+) Seizure = Paternal

(+) Asthma = Both

(-) CVD

(-) PTB

Aug. 8, 2013 vital signs:

Temperature : 36.1°C

Cardiac Rate : 107 bpm

Respiratory Rate : 35cpm

Blood pressure : 90/60

Weight : 14.1kg

Physical assessment

Psychological and social examination

she is conscious and coherent

Erik Erikson Stages of psychosocial development

Early Childhood (2 to 3 years) Autonomy vs. Shame and Doubt

Toilet Training-Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt.

Freud’s Stages of Psychosexual Development

Anal Stage: Age Range 1 to 3 years old

The child begins to toilet train, which brings about the child's fascination in the erogenous zone of the anus. The erogenous zone is focused on the bowel and bladder control. Therefore, Freud believed that the libido was mainly focused on controlling the bladder and bowel movements. The anal stage coincides with the start of the child’s ability to control their anal sphincter, and therefore their ability to give or withhold gifts at will. If the children during this stage can overcome the conflict it will result in a sense of accomplishment and independence.

PHYSICAL ASSESSMENT (Cephalo-caudal)

August 8, 2013

Body Parts TechniqueNormal Findings

Actual Findings Analysis

Skin (General)

Hair and scalp

InspectionPalpation

Inspection

-light to dark brown

-no swelling

-good skin turgor

-no lesion

- hair distribution, equal.

- light to dark brown

-no swelling

- with good skin turgor.

-no lesion

-color black

- Equal and healthy hair and distribution.

Head

Neck

Inspection

Inspection

-face is symmetrical

-no lesion

-no swelling

-face is symmetrical

-no lesion

-no swellingEyes Inspection -symmetrically

align-symmetrically align

Eye brows Inspection -blinking symmetrically

-blinking symmetrically

Eye lashes Inspection -Evenly distributed

- Turned outward eyelashes; hair equally distributed-eyelashes are short

Eye lids Inspection -eye lid margins are moist

- Moist

Sclera Inspection -white in color -white in color

Pupil Inspection -equally round and reactive to light and accommodation

- Pupils equally reactive to light and accommodation.

Ears Palpation

Inspection

-equal in size

-symmetrically align-no lesion-no swelling- no discharge

-equal and symmetrical

-no lesion-no swelling- no discharge

Nose Inspection -Symmetric and straight; no discharge or flaring; Uniform color

-Symmetric and straight; no discharge or flaring; Uniform color

Lips Inspection -Pink in color, soft, moist, smooth texture, asymmetry of contour, ability to purse lips

-pink, moist and smooth in texture.-no lesion, no sores.

Buccal mucosa Inspection - Pink in color, soft, moist, smooth, glistening, and elastic texture.

- Pink color and moist.

- no lesions and sores noted

Tongue Inspection -no lesion-no swelling- moisten

-no lesion-no swelling-moist- no sores noted

Gums Inspection -pink and moist -pink and moist,- healthy gums.

Teeth Inspection -symmetrically aligned, no tooth decay

-Good set of milk teeth.

NailsCapillary refill

Inspection -Pink in color<2 secs

-Pink in color<2 secs

Upper Extremities

InspectionPalpation

-symmetrically align-no lesion-no swelling-light to dark brown in color

-symmetrically align-no lesion-no swelling-light to dark brown in color- can do active range of motion.

ANTERIOR

THORAXBreathing patterns

Inspection -Quiet, rhythmic, and effortless respirations.

-Normal breathing pattern- no chest indwelling

Anterior ThoraxAuscultation Broncho

vesicular and vesicular breath sounds.

-Normal breath sounds heard on auscultation

POSTERIOR

THORAX

Auscultation Vesicular and broncho vesicular breath sounds

Crackles on both lower lung fields

Crackles are often associated with inflammation or infection of the small bronchi, bronchioles, and alveoli.

Abdomen InspectionPalpation

-smooth to touch-no lesion-no swelling-warm to touch-round and symmetrical-abdomen rises

-smooth to touch-no lesion-no swelling-warm to touch-round and symmetrical-abdomen rises

with inspiration in synchromy with chest

with inspiration in synchromy with chest.

Lower Extremities

Inspection -bilaterally symmetrical and equal-right foot has complete fingers-skin color is as same as the other parts of the body

-bilaterally symmetrical and equal-right foot has complete fingers-skin color is as same as the other parts of the body

Posterior LowerExtremities

Inspection and palpation.

Normal skin color.

-Normal skin color

F. Functional Health Pattern Assessment

1. Health Perception-Health Management Pattern

The child’s health is fair as describe by the mother but now it’s already poor. She said that in maintaining the child’s health she provided the child with nutritious food as much as possible and giving all the needs of the child like nice dress and proper hygiene. She gave the child time to play with other kids. The child’s immunization was complete.

The child was admitted to the hospital because of cough fever for 2 weeks. The mother know the real cause of the illness because the ‘’yaya’’ has cough and cold. It began on July 22, 2010 in the child was warm to touch. Patient was given Cefexime 2.5 ml and cetirizine 2.5 ml which give temporary relief. One day prior to admission suddenly experienced fever, temperature maximum of 39 degree Celsius, patient was given Paracetamol suppository which gave temporary relief, associated with appearance of petechial rashes on the periorbital area. Persistence of the symptom, prompted to have the admission.

The child was hospitalized last August 2012 because of cough as stated by her grandmother. They expect that the child will get well soon as soon as possible so that the child will not suffer from staying in the hospital.

During her pregnancy, the mother had her complete pre-natal check-up during her pregnancy stage. She did not take any medications & no complications during pregnancy.

2. Nutritional and Metabolic Pattern

The child’s appetite is usually good but upon hospitalization the child’s appetite is poor. She doesn’t like to eat fruits and vegetables. They were not fond of going to fast food or restaurants.

3. Elimination Pattern

The child defecates once a day, usually every morning with soft, brown, formed & moderate in amount stool. She was toilet trained. The child doesn’t have any problems in his urination. He doesn’t have any trouble in his skin.

4. Sleep-Rest Pattern

The child usually sleeps 9pm & wakes at 8am. She sleeps 11 hours a day with naps. The child’s usual sleep routine was singing with his parents and listening bedtime stories. She had no usual sleep pattern problem.

5. Activity-Exercise Pattern

Walks with steady gait, runs with few falls, walks on toes, stands on one foot, jumps, kicks ball, throws ball overhand.

The child could eat using spoon and fork with assistance. She doesn’t want to be helped. The child needs help in toileting since she doesn’t know where to defecate and urinate. She defecates and urinates on their comfort room. The child needs help to dress by herself, bath and brush his teeth.

The child watches TV for more than an hour she loves to watch cartoons. She watches with his parents. She was prohibited watching action movies to avoid being violent when he grows up.

6. Cognitive-Perceptual Pattern

The child did not have any sensory perception deficits. She was 2 years old. She is a smart child

7. Self-Perception – Self-concept Pattern

The mother feels bad about her child’s illness and she was concerned about the wellness of the child. The child verbalizes that he feels restless.

8. Role Relationship Pattern

The child uses appropriate words for his age. Spoken language in their home is Tagalog and English. The child has one sibling. She was the youngest. Both the child’s parents do the decision making and in disciplining the child. There was no marital problem and violence in the family.

9. Sexuality-Reproductive Pattern

The child did not verbalize any sexual curiosity according to her mother.

10. Coping Stress Tolerance Pattern

The child needs to learn to decide for himself and if greater decisions are to be made she should ask approval from his parents. There were no losses for the past year. When the child is stress he turns to her mother. When the child was frustrated he plays with her toys. She was not afraid of her mother and always try things that she is not familiar of.

11. Value-Belief Pattern

The whole family was Roman Catholic as claimed by the mother. The mother just likes to be prayed for her child’s wellness.

ANATOMYAND

PHYSIOLOGY

Respiratory System

Nose or Nasal Cavity

As air passes through the nasal cavities it is warmed and humidified, so that air that reaches the lungs is warmed and moist. The Nasal airways are lined with cilia and kept moist by mucous secretions. The combination of cilia and mucous helps to filter out solid particles from the air a Warm and moisten the air, which prevents damage to the delicate tissues that form the Respiratory System. The moisture in the nose helps to heat and humidify the air, increasing the amount of water vapour the air entering the lungs contains. This helps to keep the air entering the nose from drying out the lungs and other parts of our respiratory system. When air enters the respiratory system through the mouth, much less filtering is done. It is generally better to take in air through the nose.

To review: The nose does the following:

1. Filters the air by the hairs and mucous in the nose

2. Moistens the air

3. Warms the air

Pharynx

The pharynx is also called the throat. As we saw in the digestive system, the epiglottis closes off the trachea when we swallow. Below the epiglottis is the larynx or voice box. This contains 2 vocal cords, which vibrate when air passes by them. With our tongue and lips we convert these vibrations intospeech. The area at the top of the trachea, which contains the larynx, is called the glottis.

Trachea

The trachea or windpipe is made of muscle and elastic fibres with rings of cartilage. The cartilage prevents the tubes of the trachea from collapsing. The trachea is divided or branched into bronchi and then into smaller bronchioles. The bronchioles branch off into alveoli.

Bronchi

Similar to trachea with ciliated mucous membrane and hyaline cartilage. Lower end of trachea divides into right and left this.

Bronchioles

Thinner walls of smooth muscle, lined with ciliated epithelium. Subdivision of bronchi.At the end, alveolar duct and cluster of alveoli.

Lungs

The lungs are spongy structure where the exchange of gases takes place. Each lung is surrounded by a pair of pleural membranes. Between the membranes is pleural fluid, which reduces friction while breathing. The bronchi are divided into about a million bronchioles. The ends of the bronchioles are hollow air sacs called alveoli. There are over 700 million alveoli in the lungs. This greatly increases the surface area through which gas exchange occurs. Surrounding the alveoli are capillaries. The lungs give up their oxygen to the capillaries through the alveoli. Likewise, carbon dioxide is taken from the capillaries and into the alveoli.

pathophysiology

MEDICAL MANAGEMENT

Time Doctors Order Rationale Nursing Consideration

August 4, 2013

- Please admit to ROC under the service of Dr. Malayan

- Please secure consent for this admission and management

- TPR q shift and record pls

- DAT

- IVF D5 0.3 NaCl 500cc x 6hrs at 20 -21 gtts/min

- Patient has a right to choose his/her medical practitioner or treatment

- An informed consent is a sign of patient participation in medical treatment in written form.

-TPR is used to create baseline parameters.

-DAT means that the patient can eat any meals as long as he/she can tolerate.

- Temporary treatment for shock if any plasma expander is unavailable and for patient having addison’s crisis. For replacement or maintenance of fluid and electrolytes.

-It is a diagnostic test

- Make sure there is a witness when patient signs an informed consent.

- Observe proper documentation.

- Carefully check for regulation to avoid fluid overload or underload.

-

Diagnostics:

a. CBC c platelet count

b. Chest X-ray AP-L

Therapeutics

- Paracetamol 150mg IV every 4 hrs for temp 38 and above.

- Paracetamol 250mg/5ml, give 4ml every 4 hrs for temp 37.8 and above

- Monitor I&O every shift

that gives information about the cells in the patient's blood.

- It is a radiograph projection of the chest used to diagnose conditions affecting the chest

- Paracetamol is an anti-pyretic and analgesic drug used to treat fever and pain.

- I &O is a parameter that checks how much fluids has been consumed or excreted in the patients body.

- Vital signs are monitored to know how the body functions proprerly.

-History taking and physical examination are important tools to know what are the etiologic factors prior

- Paracetamol is given as a PRN order if the patient really needs it.

- Always check for fluid intake including IVF consumed

- Monitor VS every 2hrs

-Do complete Hx and PE c/o PCIC/PHC

-Replace volume per volume losses with PLR

-Dr. Malayan informed with this condition

-Refer

to a disease.

mesuring the fluid and electrolytes losses by how manny times the patient vomit througt the use of cup method

- It relieves inflammation (swelling, heat, redness, and pain) and is used to treat certain forms of arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders (e.g., colitis); severe allergies; and asthma.

- It is used in inhibition of eosinophil chemotaxis

- Always double check VS readings if there is doubt.

- when doing PE it should be from head-toe.

- Rotate sites of

1:30pm

Meds:

- Start hydrocortisone 60mg/IV every 6 hrs

- Start cetrizine + phenylephrine (Alnix plus) 2.5ml BID in full stomach

- Replace losses volume per volume as ordered

- Replace patient meds:

4 mg chewable tablet or 4 mg granules orally

- For maintenance of losses in fluids and electrolytes.

- Montelukast is a leuokotreine receptor antagonist (LTRA) used for the maintenance treatment of asthma and to relieve symptoms of seasonal allergies.

-D5IMB is an IV solution that consists of 5% dextrose and water level. It is usually given to patients in hospitals that could potentially become ill through high sodium levels or low blood sugar levels.

IM repository injections to avoid local atrophy.

- This should be given after the patient has eaten.

- Assess for drug hypersensitivity.

- Carefully check for regulation to avoid fluid

3:45pm

once a day.

- IVF to follow D5IMB 500cc x 11hrs at 45cc/hr

- Hold D5IMB instead IVF to follow

D5NSS 500cc at 4cc/hr

- For repeat cbc with platelet tomorrow at 6am

- for urinalysis

- It is a diagnostic test that checks the components of your urine.

- NS1 (Nonstructural Protein 1) is a test for dengue which allows rapid detection on the first day of fever, before antibodies appear some 5 or more days later.

overload or underload.

8:46pm - for dengue NS1 to include to next blood extraction

- cut present management

August 5, 2013

- IVF for follow D5NSS 500cc at 42cc/hr

- follow up CBC with platelet result

- Dr. Malayan updated

- for repeat cbc with platelet tomorrow at 6am(8/6/13)

- Nebulize with combivent 1 neb every


- Combivent is a drug


5pm

7:45am

9am

9:45am

3:30pm

6hrs via facemask

- rounds with Dr, Malayan

- continue present management

- start cefuroxime 250mg n every 8 ANST()

- IVF to follow D5NSS 500cc at 42cc/hr

used for treating COPD through inhalation from a nebulizer.

- Cefuroxime is a parenteral second generation cephalosphorin antibiotic used to treat infection.


- Assess for drug hypersensitivity.


August 6, 2013

- Continue with present management

- for repeat cbc with platelet tomorrow at 6am

- am present management

8:30am

2:30pm

12nn - IVF to FF: D5NSS at 42cc/hr



August 7, 2013


- rounds with Dr. Malayan

- Heraclene 1mg/cap OD c/o patient meds, continue present management

- Dr. Malayan updated

- for report cbc with platelet tom at 6am (8/8/13)

-Heraclene (Dibencozide) Capsule aids optimal consumption of nutritional protein ingestion and helps in the development and restoration of body tissues and kindles in the body the desire for food.

- Advise patient to avoid products that contain caffeine.

7:50am

11:30am

August 8, 2013

- Continue present management

8:25am

1:20pm

- IVF to follow D5NSS 1 liter at 42cc/hr




LABORATORYAND

DIAGNOSTICTESTS

COMPLETE BLOOD COUNT (CBC)

The complete blood count or CBC test is used as a broad screening test to check for such disorders as anemia, infection, and many other diseases.

DATE REQUESTED: August 4, 2013

RESULT NORMAL VALUE

INTERPRETATION SIGNIFICANCE

Hemoglobin 132 110-140 NORMAL

Hematocrit .406 0.37-0.47 NORMAL

RBC count 4.70 4.00-5.50 NORMAL

WBC count 6.50 5.0-10.0 NORMAL

Neutrophils 3.44 1.63-6.96 NORMAL

Lymphocytes 2.25 1.09-2.99 NORMAL

Monocytes .739 0.240-0.790 NORMAL

Eosinophiles .005 0.00-0.5% NORMAL

Basophiles .064 0.00-0.80 NORMAL

MCV 86.3 80-98 NORMAL

MCH 28.1 26-32 NORMAL

MCHC 325 320-360 NORMAL

RDW 10.2 10.2-14.5% NORMAL

Platelet count 124 150-450 DECREASEDIndicate risk ofbleeding


RESULT NORMAL VALUE





WBC count 4.81 5.0-10.0 NORMAL




Eosinophiles 0.00 0.00-0.5% NORMAL

Basophiles .025 0.00-0.80 NORMAL



MCHC 323 320-360 NORMAL

RDW 10.3 10.2-14.5% NORMAL

Platelet count 122 150-450 DECREASEDIndicate risk of bleeding


RESULT NORMAL VALUE





WBC count 3.76 5.0-10.0 DECREASEDDecreased due to inadequate inflammatory defenses to suppress infection.



Monocytes .296 0.240-0.790

NORMAL

Eosinophiles 0.00 0.00-0.5% NORMAL

Basophiles .024 0.00-.0.80 NORMAL



MCHC 316 320-360 DECREASEDIndicate presence of anemia.

RDW 10.0 10.2-14.5%

DECREASEDIndicate presence of anemia.

Platelet count 122 150-400 DECREASEDIndicate risk of bleeding


RESULT NORMAL VALUE





WBC count 4.21 5.0-10.0 DECREASEDDecreased due to inadequate inflammatory defenses to suppress infection.

Neutrophils 1.42 1.63-6.96 DECREASEDDecreased. May indicate increase risk of infection



Eosinophiles .001 0.00-0.5% NORMAL

Basophiles .018 0.00-.080 NORMAL

MCV 26.8 80-98 DECREASEDIndicate presence of anemia


MCHC 315 320-360 DECREASEDIndicate presence of anemia

RDW 10.1 10.2-14.5% DECREASEDIndicate presence of anemia

Platelet count 176 150-400 NORMAL

CHEST X-RAY (CHEST RADIOGRAPHY)

The chest x-ray is the most commonly performed diagnostic x-ray examination. A chest x-ray makes images of the heart, lungs, airways, blood vessels and the bones of the spine and chest.


EXAMINATION DONE: Chest X –ray Posterior Anterior

Interpretation:

- The interstitial lung markings are accentuated with fine reticulation in the parihilar areas.

- The heart is not enlarged- Diaphragm and sulci are normal- Visualized bones are intact

Impression: INTERSTITIAL PNEUMONITIS CONSIDERED

URINALYSIS

The urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is ordered widely and routinely to detect any abnormalities that require follow up.


RESULT NORMAL VALUE

INTERPRETATION SINIFICANT

Color: Light Yellow Straw to Dark Yellow

NORMAL

Transparency: Slightly Hazy Clear-Hazy NORMALReaction (pH): 6.5 5-8.5 NORMALGlucose: Negative Negative NORMALProtein Negative Negative NORMALKetones: - NegativeSpecific gravity:

2.020 1.003-1.029 INCREASED Indicate presence of dehydration

Pus cells: 10-12/hpf 2-3/hpf INCREASED Indicatepresence of infection

RBC 1-2/hpf Male: 0-3/hpfFemale: 0-5/hpf

NORMAL

Epithelial Cells

Few Rare-moderate

NORMAL

DENGUE NS1 Ag Assay Test

This test is use for early diagnosis of dengue virus infection


TEST NAME RESULT

Dengue NS1AgNegative

: IgG Negative: IgM Negative

Drug study

Drug Name Mode of Action Indication Interaction Side Effect Nursing Consideration

Generic Name:Cefuroxime axetil

Brand Name:

Classification:Cephalosporin 2nd generation

250mg/

Frequency:Q8

-Second-generation cephalosporin that inhibits cell-wall synyhesis,promoting osmotic instability;usually bactericidal.

-Lower respiratory infection

Contraindication:

-Contraindicated in patients hypersensitivity to cephalosporin

-Amino glycosides-Loop diuretics-Probenecid

GI: nausea and vomiting

SKIN: rash,pruritus,urticaria

-Determine history of hypersensitivity reactions todrugs.

-Check the IV site before giving the medicartion.

-Instruct the parent or guardian of the patient toNotify the prescriber about rash or evidence of superinfection.

-Administer medication with meals to decrease GI upsetand enhance absorption.

-Advise the parent or guardian of the patient to reportloose stools or diarrhea.


Generic Name:clarithromycin

Brand Name:Klaz

Classification:

-Inhibits protein synthesis in susceptible bacteria, causing cell death.

-Bacterial infection (pneumonia)

-Alprozalam-Carbamazepine-Cyclosporine-Digoxin-Ritonavir-Thophylline

CNS:dizziness, headache, vertigo,fatigue

GI: diarrhea, abdominal pain or discomfort,nausea,vo

-Assess bowel pattern,discontinue drug if severe diarrhea occurs.

-Assess patient’s infection before therapy and regularly thereafter.


Generic Name:

+penylphrine

Brand Name: Alnix Plus

Classification:Antihistamine

2.5ml

Frequency: BID

P.O

-A long-acting nonsedating antihistamine that selective inhibits pheripera H1 receptor.

-Seasonal allergic rhinitis-Perennial allergic rhinitis,chronic urticaria

Contraindication:

-Contraindicated in patients hypersensitivity to drug.-Use cautiously in patients with renal and hepatic impairement.

- CNS depressant-Theophylline-Barbiyuates-Hypnotics-Opiod analgesics

-somnelence,headache,dizziness,fatigue.

-pharyngitis

-dry mouth,nausea,vomiting,abdominal distress.

-couhing,bronchospasm

-Assess for allergy symptoms: rhinitis, pruritus, urticaria, watering eyes, before and periodically during treatment.

-Assess respiratory status and increase in bronchial secretions, wheezing, chest tightness: provide fluids to decrease viscosity or thickness of secretion.

-Instruct the patient’s family to take 1hr before or 2 hrs after a meal to facilitate absorption.

-Advise pts family to use sugarless gum, candy, frequent zip of water of minimize dry mouth.

-Instruct pts family to inform physician if dizziness occurs or if symptoms persist.

Macrolide Antibiotic

Dosage:250mg/5ml

Frequency: BID(on full stomach)

Route: PO

Contraindication:

-Contraindicated in patients hypersensitivity to clarithromycin, erythromycin, or any macrolide antibiotic.

-Fluconazole-Warfarin

miting, pseudomembranous colitis.

SKIN: rash(pediatric)

HEMATOLOGIC: leukopenia,coagulation abnormalities.

-Take drug with food if GI effects occur.Do not drink grapefruit juice while taking this drugs.

-Shake suspension before use: do not refrigerate.

-Instruct the pts family to take all medication prescribed for the length of time ordered and to continue drug therapy as prescribed even he feels better.

-Instruct the pts family to report persistent adverse reactions.

-Advise the pts family to report diarrhea, rash or itching, mouth sores.

Drug Name Mode of Action Indication Interaction Side Effect

Generic Name:dibencozide

BrandName:Heraclene

Classification:Appetite Stimulants

Dosage:1mg

Frequency:OD

Route:

-Dibencozide increases the protein efficiency coefficient ie, the percentage of bound nitrogen for protein build-up in the body compared to ingested nitrogen with food intake.

-Premature babies, low birth weight, retarded growth, poor appetite in infants, children and adults.

Contraindication:

- Hypersensitivity to drugs or its ingredients

- GI: Constipation, Diarrhea, N/V.

CV: Tachycardia

CNS: Overstimulation, Headache, Dizziness, Insomnia

-Advise the parent of the patient to avoid products that contain caffeine.

-Report any evidence of excessive stimulation

Drug Name Mode of Action Indication Interaction

Side Effect Nursing Consideration

Generic Name:hydrocortisone sodium succinate

Brand Name:Solu-Cortef

Classification:Corticosteroids/Anti-inflammatory

Dosage:60mg

Frequency: Q 6hrs

Route: IV

-Decreases inflammation,mainly by stabilizing leukocyte lysosomalmembranes;suppresses immune response;stimulates bone marrow;and influences protein,fat,and carbohydrate metabolism.

-Severe inflammation,-Adrenal insufficiency-Shock

Contraindication:

-contraindicated in patients hypersensitivity to drug or its ingredients,in those receiving immunosuppressivedoses together with live virus vaccine,and in premature infants.

-NSAID’s-Cyclosporine-Oral anticoagulants-Pottasium-depleting drugs -Skin-test antigen

-headache-nausea/vomiting-easy bruising-carbohydrate intolerance-GI irritation-growth suspension in children,muscle weakness

-Assess the pt’s condition before starting therapy and reassess regularly.

-Tell the parents or guardian of the patient not to stop drug abruptly or without prescriber’s consent.

-Warn the parents or guardian of the patient on long-term therapy about cushing effects (moon face,buffalo hump) and need to notify prescriber about sudden weight gain or swelling,ang easy bruising.

-Monitor the patient’s weight and electrolyte level.

-Instruct the parents or guardian of the patient to take Vit.D and calcium supplement.

-Encourage the parents or guardian of the patient to deep breathing exercise.

-Teach the parents or guardian of the patient sign and symptoms of early adrenal insufficiency: fatigue,muscleweakness,jointpain,fever,anorexia,nausea,Shortness of breath,dizziness,and fainting.


Generic Name:paracetamol

Brand Name:Tempra

Classification:Analgesic/Antipyretic

Dosage: 250mg/5ml T - >37.8

Frequency:Q4

Route: PO

- Unknown. Thought to produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the CNS or other substances that sensitize pain receptors to stimulation.The drug may relieve fever through central action in the hypothalamic heat regulating center.

-Mild pain or fever

Contraindication:

-Contraindicated in patients hypersensitivity to drugs.

- Barbiturates- Carbamazepine- Hydantoins- Fifampin- Sulfinpyrazone

- hemolyticanemia- neutropenia- leukopenia- pancytopenia- jaundice- rash- urticaria

-Assess pts fever: temperature, diaphoresis.

-Give with food or milk to decrease gastric symptoms;give 30mins before or 2hrs after meals;absorption may be slowed.

- Advise the parents to do tepid sponge bath (TSB) to lower the body temperature (if the pt. is febrile 38 and above).

- Tell parents to consult prescriber before giving drug to children younger than age 2.

-Advise the parent of the patient that the drug is only for short-term used and to consult prescriber if giving to children for longer than 5 days.

-Tell parents to increase fluid intake to prevent dehydration.


Generic Name:paracetamol

Brand Name:

Classification:Analgesic/Antipyretic

Frequency:Q4/

- Unknown. Thought to produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the CNS or other substances that sensitize pain receptors to stimulation.The drug may relieve fever through central action in the hypothalamic heat regulating center.

-Mild pain or fever

Contraindication:

-Contraindicated in patients hypersensitivity to drugs.

- Barbiturates- Carbamazepine- Hydantoins- Fifampin- Sulfinpyrazone

- hemolyticanemia- neutropenia- leukopenia- pancytopenia- jaundice- rash- urticaria

-Assess pts fever: temperature, diaphoresis.

-Give with food or milk to decrease gastric symptoms;give 30mins before or 2hrs after meals;absorption may be slowed.

-Assess the IV site before giving medication.

- Advise the parents to do tepid sponge bath (TSB) to lower the body temperature (if the pt. is febrile 38 and above).

- Tell parents to consult prescriber before giving drug to children younger than age 2.

-Advise the parent of the patient that the drug is only for short-term used and to consult prescriber if giving to children for longer than 5 days.

-Tell parents to increase fluid intake to prevent dehydration.

Drug Name Mode of Action Indication Interaction Side Effect

Generic Name: montelukast sodium

Brand Name: Singulair

Classification:Bronchodilator

Dosage:4mg granules

Frequency: ODHS

Route: PO

-Selective,competiti-ve leukotriene receptor antagonistthat reduces early and late-phase bronchoconstrictionfrom antigen challenge.

-asthma-seasonal allergic rhinitis

Contraindication:

-Contraindicated in patients hypersensitivity to drug.-Use cautiously and with appropriate monitoring in patients whose dosages of systemic corticosteroids are reduced..

- Phenobarbital-Rifampin

CNS:fever,headache,dizziness,fatigue.

EENT:nasal congestion,dental pain

GI:dyspepsia,infectious gastroenteritis,abdominal pain

RESPIRATORY:cough

SKIN:rash

NursingCareplan

CUES PROBLEM SCIENTIFIC REASON

DESIRED OUTCOME

INTERVENTION/RATIONALE

EVALUATION

Objective:• Nasal Flaring

• Abnormal breath sounds. (crackles)

Productive cough (transparent)

V/S taken as follows:

RR-35

Ineffective airway clearance related to increase production of mucus secretion

Ineffective airway clearance occurs when an artificial airway is used because normal mucociliary transport mechanisms are bypassed and impaired.

Short term goal:

After 6 hours of NursingIntervention, the Patient breathes without using nasal flaring.

Long term goal:

After 3 days of nursing intervention the patient breathes normally.

Independent:• Auscultate breath sounds. Note adventitious breath sounds like wheezes, crackles and rhonchi.

Rationale:• Some degree of bronchospasm is present with obstructions in airway and may or may not be manifested in adventitious breath sounds.

• Keep environmental pollution to a minimum like dust, smoke and feather pillows, according to individual situation.

Rationale:• Precipitators of allergic type of respiratory reactions

STANDARD CRITERIA

The patient will be able to breathes without nasal flaring with RR of 35bpm to 28bpm

Outcomes partially met, the patient was able to demonstrate behavior to improved airway clearance

that can trigger or exacerbate onset of acute episode.

• Encourage or assist with abdominal or pursed lip breathing exercises.

Rationale:• Provides patient with some means to cope with or control dyspnea and reduce air tapping.

• Assist with measures to improve effectiveness of cough effort.

Rationale: Coughing is most

effective in an upright position after chest percussion.

Position appropriately and discourage use of oil-based products

around nose.

Rationale: To prevent vomiting

with aspiration into lungs.

Obtain sputum specimen, preferable

before antimicrobial therapy is initiated.

Rationale: To verify

appropriateness of therapy.

COLLABORATIVE:

Administered analgesics.

Rationale: To improve cough

when pain is inhibiting effort.


DESIRED OUTCOME


EVALUATION

Subjective:

Objective:- Patient is diagnosed with PCAP

- Vital SignRR: 35 cpmHR:142 bpmTEMP: 36.6WT: 14.1 kg-

Decreased WBC level 4.21

Risk for further infection r/t spread of pathogens secondary to identified PCAP

The patient’s immune system is not fully activated until sometime after birth. Limitation in the patient’s inflammatory response result in failure to recognize, localize, and destroy invasive bacteria thus, increasing risk for infection

Short term goal:After 8 hrs of nursing interventionthe patient will free from further infection

Long term goal: After several days of nursing intervention infection will be prevented.

INDEPENDENT1. assess TPR,

auscultate breath sounds

- Assessments provide information about the spread of infection, increased RR and HR, decreased BP are signs of sepsis. Spread of infection may cause resp. distress2. Ensure that all

people coming in contact with patient. wash their hands well before & after touching the patient.

- Hand washing prevents the spread of pathogens coming from the patient to

STANDARD CRITERIA

The patient will exhibit no signs of infection

After 8 hrs of nursing intervention the patient are Free from further infection

the caregiver and vice versa3. Ensure that all

equipment used for patient is sterile, scrupulously clean &disposable. Do not share equipment with other patient.

- this would prevent the spread of pathogens to the patient from equipment4. Place patient

in isolette/ isolation room per hospital policy

- placing the patient in an isolette allows close observation of the ill neonate & protects other patient from infection

5. maintain neutral thermal

environment- A neutral thermal

environment decreases the metabolic needs of the patient. The patient has difficulty maintaining a stable temp6. Provide

respiratory support (oxygen)

- resp. support may be needed during the acute phase of the infection to prevent additional physiological stress7. Monitor lab

results as obtained. Notify care giver/ physician of abnormal findings

- lab results provide information about the pathogen and patient’s response to illness and

treatment8. administer IV

fluids as ordered (D10IMB)

- IV fluids help maintain fluid balance9. Administer

antibiotics as ordered.

- Antibiotics act to inhibit the growth of bacteria and destruction of bacteria.


DESIRED OUTCOME


EVALUATIONSTANDARD

Subjective:

”Anim na bases na siyang nagsusuka.” As verbalized by the patient’s caregiver

Objective:

•Restlessness

•Vomiting (6x)

•Fatigue

•V/S taken as follows:

RR: 35 cpm

HR:142 bpm

TEMP: 36.6

WT: 14.1 kg

Risk for Deficient Fluid Volume may includeexcessive fluid loss (fever, profuse diaphoresis, mouth breathing/hyperventilation, vomiting)

Fluid volume deficit, or hypovolemia, occurs from a loss of body fluid or the shift of fluids into the third space, or from a reduced fluid intake. Common sources for fluid loss are the gastrointestinal tract, polyuria, and increased perspiration. Fluid volume deficit may be an acute or chronic condition managed in the hospital outpatient center, or home setting.

Short term goal:After 8 hrs of nursing interventionthe patient will demonstrate fluid balance evidenced by individually appropriate parameters, e.g., moist mucous membranes, good skin turgor, prompt capillary refill, stable vital signs.

Long term goal:After several days of nursing intervention the patient will experience fluid balance.

1. Assess vital sign changes, e.g., increased temperature/prolonged fever, tachycardia, orthostatic hypotension.

Elevated temperature/prolonged fever increases metabolic rate and fluid loss through evaporation. Orthostatic BP changes and increasing tachycardia may indicate

The client will remain show no signs and symptoms of dehydration

Subjective:

”Anim na bases na siyang nagsusuka.” As verbalized by the patient’s caregiver

Objective:

•Restlessness

•Vomiting (6x)

•Fatigue


RR: 35 cpm

HR:142 bpm

TEMP: 36.6

WT: 14.1 kg


DESIRED OUTCOME


EVALUATIONSTANDARD CRITERIA

Subjective:

Objective:

•Use of accessory muscle.

•Productive cough (transparent)

•Restlessness

•Fatigue


RR: 35 cpm

HR:142 bpm

TEMP: 36.6

Acute pain r/t localized inflammation and persistent cough.

Pneumonia is inflammation of the terminal airways and alveoli caused by acute infection by various agents. Pneumonia can be divided into three groups: community acquired, hospital or nursing home acquired(nosocomial), and pneumonia in an immune compromis

Short term goal:

After 4hrs of nursing interventionthe patient will relief of pain and demonstrate relaxed manner, resting/sleeping and engaging in activity appropriately.

Long term goal:

After several days of nursing intervention the patient will display patent airway with breath sounds clearing

INDEPENDENT

1. Elevate head of the bed, change position frequently.

Lowers diaphragm, promoting chest expansion and expectoration of secretions.

2.Assist patient with deep breathing exercises

Deep breathing facilitates maximum expansion of the lungs and smaller airways.

3. Demonstrate or help patient learn to perform activity like splinting chest

The patient will relief of pain and demonstrate relaxed manner, resting/sleeping and engaging in activity appropriately

The patient will free from pian

The patient was relief on pain and demonstrated relaxed manner, resting/sleeping and engaging in activity appropriately.

ed person. Causes include bacteria (Streptococcus, Staphylococcus

Haemophilusinfluenzae, Klebsiella,Legionella). Community Acquired Pneumonia (CAD) is a disease in which individuals who have not recently been hospitalized develop an infection of the lungs. It is an acute inflammator

and effective coughing while in upright position.

Coughing is a natural self-cleaning mechanism. Splinting reduces chest discomfort, and an upright position favors deeper, more forceful cough effort.

4. Force fluids to at least 3000 ml per day and offer warm, rather than cold fluids.

Fluids especially warm liquid said in mobilization and expectoration of

y condition that’s result from aspiration of oropharyngeal secretions or stomach contents in the lungs.

secretions

COLLABORATIVE

5. Administer medications as prescribe: mucolytics or expectorants.

Aids in reduction of bronchospasm and mobilization of secretions.

6. Provide supplemental fluids.

Fluids are required to replace losses and aid in mobilization of secretions.

Final case study PCAP..docx

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