Introduction

Acute respiratory failure occurs when fluid builds up in the air sacs in your lungs. When that happens,
your lungs can’t release oxygen into your blood. In turn, your organs can’t get enough oxygen-rich blood to
function. You can also develop acute respiratory failure if your lungs can’t remove carbon dioxide from your
blood.

Respiratory failure happens when the capillaries, or tiny blood vessels, surrounding your air sacs can’t
properly exchange carbon dioxide for oxygen. The condition can be acute or chronic. With acute respiratory
failure, you experience immediate symptoms from not having enough oxygen in your body

Incidence ranges for acute respiratory failure in adults were reported and found to be 77.6-88.6 cases/
100,000 population per year. Mortality rates of approximately 40% were reported for patients with acute
respiratory failure, and similar or slightly lower rates for those with acute lung injury and acute respiratory
distress syndrome

Signs and symptoms

The symptoms of acute respiratory failure depend on its underlying cause and the levels of carbon dioxide
and oxygen in your blood.

People with a high carbon dioxide level may experience:

 rapid breathing
 confusion

People with low oxygen levels may experience:

 an inability to breathe
 bluish coloration in the skin, fingertips, or lips

People with acute failure of the lungs and low oxygen levels may experience:

 restlessness
 anxiety
 sleepiness
 loss of consciousness
 rapid and shallow breathing
 racing heart
 irregular heartbeats (arrhythmias)
 profuse sweating
Introduction

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or
pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of
organisms, including bacteria, viruses and fungi, can cause pneumonia.

Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young
children, people older than age 65, and people with health problems or weakened immune systems.

According to the latest WHO data published in 2017 Influenza and Pneumonia Deaths in Philippines
reached 75,970 or 12.27% of total deaths. The age adjusted Death Rate is 115.96 per 100,000 of
population ranks Philippines #24 in the world. Review other causes of death by clicking the links below or
choose the full health profile.

Causes:

Pneumonia is usually caused due to an infection with a bacteria, virus, fungi or parasite. In adults it is
mostly caused by bacteria whereas in children and infants it is commonly due to viruses. Physical or
chemical injury to the lungs can also result in the condition. Individuals who smoke, who are hospitalized
and have long-term illness such as asthma, heart disease, cancer, HIV/AIDS, lung diseases or diabetes are
at a higher risk of developing pneumonia. Hospital-acquired pneumonia is also common.

Signs and symptoms of pneumonia may include:

 Chest pain when you breathe or cough

 Confusion or changes in mental awareness (in adults age 65 and older)
 Cough, which may produce phlegm
 Fatigue
 Fever, sweating and shaking chills
 Lower than normal body temperature (in adults older than age 65 and people with weak immune
systems)
 Nausea, vomiting or diarrhea
 Shortness of breath

TYPE OF ACQUIRED PNEUMONIA

Community-Acquired Pneumonia (CAP)
 Occurs in community & during < 48 hours of hospitalization.
 Is the most common type of pneumonia.

Hospital-Acquired Pneumonia (HAP)

 Pneumonia occurring 48 hours or more during a hospital stay for another illness. Higher risk client
on a mechanical ventilator eg. Ventilator-associated pneumonia (VAP).

Aspiration Pneumonia
 Due to inhale foreign body, food, drink, vomit, or saliva from your mouth into lungs that occur in
condition of poor gag reflex eg. Brain injury, dysphagia, or excessive use of alcohol or drugs.

Atypical Pneumonia
 Is most commonly caused by mycoplasma. Legionnaires’ disease or chlamydia and usually
appears in children and young adults

Hypostatic pneumonia
 Results from the collection of fluid in the dorsal region of the lungs and occurs especially in those
(as the bedridden or elderly, etc).
Anatomy and Physiology

Respiratory System
The cells of the human body require a constant stream of oxygen to stay alive. The respiratory system
provides oxygen to the body’s cells while removing carbon dioxide, a waste product that can be lethal if
allowed to accumulate. There are 3 major parts of the respiratory system: the airway, the lungs, and the
muscles of respiration. The airway, which includes the nose, mouth, pharynx, larynx, trachea, bronchi, and
bronchioles, carries air between the lungs and the body’s exterior. The lungs as the functional units of the
respiratory system by passing oxygen into the body and carbon dioxide out of the body. Finally, the
muscles of respiration, including the diaphragm and intercostal muscles, work together to act as a pump,
pushing air into and out of the lungs during breathing.

Physiology of Respiratory System

Pulmonary Ventilation
Pulmonary ventilation is the process of moving air into and out of the lungs to facilitate gas exchange. The
respiratory system uses both a negative pressure system and the contraction of muscles to achieve
pulmonary ventilation.

External Respiration
External respiration is the exchange of gases between the air filling the alveoli and the blood in the
capillaries surrounding the walls of the alveoli. Air entering the lungs from the atmosphere has a higher
partial pressure of oxygen and a lower partial pressure of carbon dioxide than does the blood in the
capillaries.

Internal Respiration
Internal respiration is the exchange of gases between the blood in capillaries and the tissues of the body.
Capillary blood has a higher partial pressure of oxygen and a lower partial pressure of carbon dioxide than
the tissues through which it passes. The difference in partial pressures leads to the diffusion of gases along
their pressure gradients from high to low pressure through the endothelium lining of the capillaries. The net
result of internal respiration is the diffusion of oxygen into the tissues and the diffusion of carbon dioxide
into the blood.

Transportation of Gases
The 2 major respiratory gases, oxygen and carbon dioxide, are transported through the body in the blood.
Blood plasma has the ability to transport some dissolved oxygen and carbon dioxide, but most of the gases
transported in the blood are bonded to transport molecules. Hemoglobin is an important transport molecule
found in red blood cells that carries almost 99% of the oxygen in the blood. Hemoglobin can also carry a
small amount of carbon dioxide from the tissues back to the lungs.

Homeostatic Control of Respiration

Under normal resting conditions, the body maintains a quiet breathing rate and depth called eupnea.
Eupnea is maintained until the body’s demand for oxygen and production of carbon dioxide rises due to
greater exertion. Autonomic chemoreceptors in the body monitor the partial pressures of oxygen and
carbon dioxide in the blood and send signals to the respiratory center of the brain stem. The respiratory
center then adjusts the rate and depth of breathing to return the blood to its normal levels of gas partial
pressures.

Respiratory Epithelium
The respiratory epitheliums is a tissue that lines the the respiratory system. serves as a protective barrier
and also provides moisture,
Ciliated cells (column-shaped and have cilia on there edges)
 Are found along the trachea and bronchi. Cilia move in a rhythmic motion that helps to keep the
airway clean
Basal cells (small and cuboidal)
 Able to differentiate into other cell type upon injury of the airway in order to restore the epithelial
cell layer
Goblet cells (columnar wine goblet)
 Secret mucous in order to trap debris and pathogens.

The Urinary system, also known as the renal system, produces stores and eliminates urine, the fluid
waste excreted by the kidneys. The kidneys make urine by filtering wastes and extra water from blood.
Urine travels from the kidneys through two thin tubes called ureters and fills the bladder. When the bladder
is full, a person urinates through the urethra to eliminate the waste.

 The kidneys are a pair of bean-shaped organs found along the posterior wall of the abdominal
cavity. The left kidney is located slightly higher than the right kidney because the right side of the
liver is much larger than the left side. The kidneys, unlike the other organs of the abdominal cavity,
are located posterior to the peritoneum and touch the muscles of the back. The kidneys are
 surrounded by a layer of adipose that holds them in place and protects them from physical
damage. The kidneys filter metabolic wastes, excess ions, and chemicals from the blood to form
urine. Some parts of the kidney includes: Adrenal Gland, Renal artery, Renal Vein, Renal Columns,
Renal Capsule, Renal Cortex, Renal Medulla, Renal Pyramid, Renal Papilla, Minor and Major
Calyx, and Renal Pelvis.

Functions of the Kidney:

 A – Acid Base Balance  B – Blood Pressure Control

 W – Water Removal  E – Electrolyte Balance
 E – Erythropoesis  D – Vitamin D Activation
 T – Toxin Removal (Urea, uric
acid, NH4 (ammonia), and creatinine.
Sometimes excess sodium and ions)

Nephrons

A nephron is the basic unit of structure in the kidney. A nephron is used separate to water, ions and small molecules
from the blood, filter out wastes and toxins, and return needed molecules to the blood. The nephron functions
through ultrafiltration. Ultrafiltration occurs when blood pressure forces water and other small molecules through tiny
gaps in capillary walls. This substance, lacking the blood cells and large molecules in the bloodstream, is known as
an ultrafiltrate. The ultrafiltrate travels through the various loops of the nephron, where water and important
molecules are removed, and into a collecting duct which drains into the bladder.
The cardiovascular system

The cardiovascular system is one of the major body systems. It transports oxygen, carbon dioxide, waste
products, nutrients and hormones to and from various parts of the body.

Circulatory Loops

• Pulmonary circulation transports deoxygenated blood from the right side of the heart to the lungs,
where the blood picks up oxygen and returns to the left side of the heart. The pumping chambers
of the heart that support the pulmonary circulation loop are the right atrium and right ventricle.

• Systemic circulation carries highly oxygenated blood from the left side of the heart to all of the
tissues of the body (with the exception of the heart and lungs). Systemic circulation removes
wastes from body tissues and returns deoxygenated blood to the right side of the heart.

The heart wall is made of 3 layers:

• Epicardium- The outermost layer of the heart wall, encases, protects and secures the heart.

• Myocardium- The muscular middle layer of the heart wall that contains the cardiac muscle tissue.
responsible for contracting and pumping blood throughout your body.

• Endocardium. The simple squamous endothelium layer that lines the inside of the heart, makes
direct contact with the blood pumping through the heart chambers.

Blood vessels

• Arteries: are tubes that carry oxygenated blood (high in oxygen) away from the heart.

• Veins: are tubes that carry deoxygenated blood (low in oxygen) from the cells back to the heart
where it is pumped to the lungs so that the blood can pick up more oxygen

• Capillaries: these are small, thin blood vessels that connect the arteries and the veins.
PERSONAL DATA

Name: ZLV
Age: 85 years old
Gender: Female
Birth Date: 12/15/1932
Birth Place: Manila, Philippines
Marital Status: Widow(er)
Nationality: Filipino
Religion: Catholic
Educational Attainment: ---
Occupation: none
Ward/Room 6D/692
Admission Date and Time: September 3. 2018
Date Handled: September 7-8, 2018
Admission No.: 33694
Admitting Physician: Dr. Ricardo L. Dy
Admitting Diagnosis: ARF, CAP HR
Chief Complaint: Difficulty of Breathing

HEALTH HISTORY

Past Health History

The patient has history of hypertension for more than 10 years and has history of diabetes mellitus for
more than 10 years. Had undergone S/P Bypass Surgery. Doesn't have any allergies on foods and
medications.

Present Health History

2 months prior to admission, the patient noticed a mass on the anterior right side of the neck. Hard,
estimated to about 1cm × 1cm in size, movable and moves upon swallowing. The patient sought consult to
a local hospital and was given unrecalled medications.

During the enterim, the patient noticed that the mass is enlarging, sought consult a private physician and
advised for surgery but patient opted not to go through surgery until one week prior to consult. the patient
had occasional symptoms of difficulty of breathing associated with chest pain and abdominal pain.No
consult taken, no medication done.

16 hours prior to consult, still with above symptoms, now associated with productive cough, due to
persistence of the above symptoms, the patient sough consult.

Family History

Patient maternal and paternal side has no history of hypertension, diabetes mellitus and other diseases.

Lifestyle Health and Health Practices

The patient was a previous smoker and doesn’t recall how many packs per week he used to smoke and
since when he started and stopped. Also doesn’t drink alcoholic beverages.
Review of Systems Date assessed: Sept. 7,2018

SYSTEM STUDENT NURSE PATIENT/RELATIVE

INTEGUMENTARY “maam gaano na po katagal yung
parang pamumula sa balat ni lola?”
CARDIOVASCULAR “pag natutulog po si lola sa anong
pwesto po sya gusto?
“mula kahapon lang, nkq restraints kase
sya…”
“ayaw nya kase ng nka tubo kaya
hinahatak nya…”
“yung medyo nakataas yung likod
nya…”

RESPIRATORY “nakakaranas po ba syang hirap sa “minsan kapag ubo sya ng ubo…”

pag hinga?”

GASTROINTESTINAL “tuwing kailan po dumudumi si lola?” “araw-araw naman…”

GENITOURINARY “gaano na po katagal syang naka “simula nung na admit kami dto… para
catheter?” din di na sya patayo tayo…”
MUSCULOSKELETAL “gaano po kalayo ang nalalakad nya? “ doon. Lang din malapit sa bahay
namin… di naman sya lumalayo lalo na
kung walang kasama… kase mabilis na
din sya mapagod.. “

NEUROLOGIC “Napapansin nyo si lola na balisa?” “minsan mas gusto lang nya na tahimik
pero nasa tabi lang nya ako… at tska
pag may doctor gusto nya lagi ko hawak
kamay nya…
Physical Assessment Date assessed: Sept. 7,2018
Appearance: The physical assessment was conducted at Metropolitan Medical Center the client was
awake on bed in semi fowlers position with a Foley catheter to urine bag.

Vital Signs: BP – 120/80mmHg; T – 36.8 C; PR – 81 bpm; RR – 25 cpm; O2 - 90%

BODY PARTS TECHNIQUE NORMAL ACTUAL ANALYSIS

USED FINDINGS FINDINGS
Skin Inspection Whitish pink or brown in color, Reddened areas Abnormal
dark skin tone depending on on the forearm Redness on the
patient’s race; no evidence of skin of the client
discoloration. results from the
No lesions except for prior restraints.
birthmarks or nevi.
Palpation Pinched-up skin returns to its No edema Normal
original position immediately. present.
Dry with minimum =T – 36.8 C
perspiration; smooth, even
and firm; no edema present.

Hair Inspection Color varies from dark black to Black to grayish Normal due to
pale; evenly distributed; no in color aging process.
lesions in scalp; thin, coarse,
straight, thick or curly hair.
Palpation Oily hair Abnormal
Due to lack in
personal hygiene
Nails Inspection Pink to brown cast, flat and Pink to brown Normal
slightly rounded. cast

Palpation 2-3 seconds capillary refill; Capillary refill Abnormal

smooth within 4 Due to decrease
seconds and oxygen in the
90% O2 blood
saturation
Head Inspection Normocephalic and Normocephalic & Normal
symmetrical symmetrical

Palpation Nontender,
smooth, nontender without without masses
masses.
Face Inspection Facial features should be Face is Normal
symmetrical; shape can be symmetrical
round, oval or slightly squared; Noinvoluntary
no involuntary movements; no movements,
edema and disproportion. edema and
disproportion

Neck Inspection Symmetrical neck muscles; able to perform Normal

head in full ROM without ROM without
discomfort assistance

Palpation No palpable masses or No palpable Normal

enlargement of lymph nodes lymph nodes
and thyroid glands.
Eyes Inspection Eyes are aligned; no Eyes are aligned
involuntary movement of either no involuntary Normal
eyes movement. Bothe
Both eyes move smoothly and eyes move
symmetrically in each 6 smoothly. No
cardinal sides drooping infection
No drooping, infections or or tumor.
tumors
Pink and moist conjunctiva
Pupil – deep black; round, and
equal in diameter.
Ears Inspection The patient has no hearing No hearing Normal
difficulty difficulty
Nose Inspection Symmetrical in the midline of Symmetrical no Normal
the face; no lesion, swelling, lesion, swelling,
bleeding and
bleeding and masses
masses.
Mouth Inspection Lips – pink and moist with no Pink, no lesions Normal
evidence of lesions or
inflammation
Tongue – midline in the
mouth; pink, moist and rough; Dry lips Normal
no lesions and swelling.
Gums – pale red; no swelling
or bleeding.
Chest & Inspection No accessory muscles are Symmetrical
Thoracic used in normal breathing Chest Expansion Normal
Symmetrical Chest Expansion No retractions
No retractions

(+) bilateral
Auscultation Vesicular Breath Sounds crackles Abnormal
No Crackles on both lungs Due to increase
mucus
production and
productive cough

Inspection/ Flat or rounded; birth marks Normal

Normalbdomen Palpation/ Symmetrical bilaterally; stretch marks due to post
Auscultation No discoloration linea nigra on delivery
hypogastric and
symphisis pubis
Upper Inspection Able to perform full ROM Able to perform Normal
Extremities No lesion, swelling or full ROM. No
inflammation lesion, swelling or
inflammation.
Lower Inspection Able to perform full ROM Able to perform Normal
Extremities No lesion, swelling or full ROM. No
inflammation lesion, swelling or
inflammation.
BLOOD CHEMISTRY

DEFINITION: This is to measure levels of important electrolytes and other chemicals.

NURSING RESPONSIBILITY

PRE-PROCEDURE:

 Explain procedure to the patient

POST PROCEDURE:

 Send the specimen in the laboratory

Patient Name: ZLV Room: 692

Sex: F Reffering Physician: Dr. Dy, Ricardo
Age: 62 Years old Date Released: September 6. 2018/ 1833H

TEST SI UNIT CONVENTIONAL UNIT

RESULT REFERENCE RESULT REFERENCE
Creatinine 2.62 0..50-0.90mg/dL 232.20mmol/L 44-80
Sodium 136 mmol/L 4.1 mmol/L 4.1 mmol/L 136 - 144
Potassium
3.8 mmol/L 140 mmol/L 140 mmol/L 3.6 – 5.1
BUN 29.49mg/dL 8-26 10.5mmol/L 2.9-9.3
ANALYSIS:

Increased level of BUN and CREATININE indicate that there is obstruction or malfunction of the kidneys.

COMPLETE BLOOD COUNT

DEFINITION: Used to evaluate your overall health and detect a wide range of disorder.Measures several
components and features of your blood.The calculation of cellular formed elements of blood in the health
status

NURSING RESPONSIBILITY:

PRE POCEDURE:

 Explain the test procedure.explain that slight discomfort may be felt when the skin is punctured
 Encourage to avoid stress if possible because altered physiologic status influences and changes
normal hematologic values
 Apply manual pressure and dressings over puncture site on removal

POST PROCEDURE:

 Check the laboratory results and report any abnormal results

 Instruct to resume normal activities and diet
Patient Name: ZLV Room: 692

Sex: F Reffering Physician: Dr. Dy, Ricardo

Age: 85 Years old Date Released: September 6 2018

EXAM RESULTS UNIT

REFERENCE RANGES
UNIT
White blood cells 15.8(H) 10^9/L 4.0- 10.0
Red blood cells 4.39 10^12/L 4.5- 6.2
Hematocrit 0.39 g/L 0.40-0.50
Hemoglobin 129 g/L 130- 180
MCV 90.9 fL 82- 98
MCH 29.4 % 28- 33
MCHC 324 g/L 320-360
Platelet count 209 10^9/L 150- 400

ANALYSIS:

Increased level of White blood cells indicate the presence of infection.

TOTAL SERUM PROTEIN TEST

DEFINITION: Used to measure the total protein in the blood.

NURSING RESPONSIBILITY:

PRE POCEDURE:

 Explain the test procedure. Explain that slight discomfort may be felt when the skin is punctured
 Apply manual pressure and dressings over puncture site on removal

POST PROCEDURE:

 Check the laboratory results and report any abnormal results

 Instruct to resume normal activities and diet

TEST CONVENTIONAL UNIT SI UNIT

RESULT REFERENCE RESULT REFERENCE
TOTAL 7.10gm/dL 6.5 - 8.1 71g/L 65-81
PROTEIN
ALBUMIN 4.30g/dL 3.5 - 5.0 43g/L 35-50
GLOBULIN 2.80g/dL 1.5 – 3.5 28g/L 15-35
A/G RATIO 1.54(H) 1.54(H)

ANALYSIS: High A/G Ratio suggests underproduction of immunoglobulin.

CKMB

DEFINITION: To monitor myocardial infarction and some disorders of the musculoskeletal system

NURSING RESPONSIBILITY:

PRE POCEDURE:

 Explain the test procedure.explain that slight discomfort may be felt when the skin is punctured
 Apply manual pressure and dressings over puncture site on removal

POST PROCEDURE:

 Check the laboratory results and report any abnormal results

 Instruct to resume normal activities and diet

TEST CONVENTIONAL UNIT SI UNIT

RESULT REFERENCE RESULT REFERENCE
CKMB 173(H) U/L 0-24 U/L 173(H) U/L 0-24 U/L

ANALYSIS: It indicates that the heart had been damaged and has a formation of scar.
CHEST X-RAY
Definition: an imaging test that uses small amounts of radiation to produce pictures of the organs, tissues,
and bones of the body. When focused on the chest, it can help spot abnormalities or diseases of the
airways, blood vessels, bones, heart, and lungs.

NURSING RESPONSIBILITY:

PRE POCEDURE

 Explain the test procedure .

 Keep the time they are exposed to X-rays as short as possible
 Use protective lead shielding while inside the X-ray theatre if they cannot leave, by standing behind
a lead screen or wearing a lead apron
 Explain to the patient that he/she have to remove all the metal accessories in his/her body.

POST PROCEDURE:

 Check the laboratory results and report any abnormal results

Date: 9-3-2018

FINDINGS:
The lungs now appear congested with re-development of the edema particularly in the lung bases, To rule
out bi-basal pneumonia.

The heart is magnified but appears to be enlarged with stable appearing configuration.

Atherosclerotic aorta is shown tortuous and calcified, as before.

Left costophrenic sulcus appear shallow, consider minimal pleural effusion or thickening.

Thoracic osteophytosis is again noted.

NGT is removed. Sternotomy wires and surgical clips are again noted.

No other significant interval findings.

ECG

DEFINITION: is the test for recording the electrical activity of the heart over a period of time
using electrodes placed over the skin.

NURSING RESPONSIBILITY:

PRE-PROCEDURE:

 Obtain a list of current meds and the time of their administration.

 Teach methods to relieve anxiety and remain relaxed.
 Encourage to remove all the metals in their body.
 Provide privacy.

POST PROCEDURE:

 Wipe the Lubricant used in their body.

Findings:
Sinus Rhythm
Non-specific intraventricular conduction delay
Non-specific ST T wave changes.

Analysis: Normal

TROPONIN I

Definition: To measure the levels of the troponin T/I proteins in the blood. To check if there’s a damage in
the heart.

NURSING RESPONSIBILITY:

PRE-PROCEDURE:

 Explain the test procedure .explain that slight discomfort may be felt when the skin is punctured.

POST PROCEDURE:

 Check the laboratory results and report any abnormal results

Findings:

Result Normal Value

0.04ng/mL 0.0 – 0.02 ng/mL

Analysis: It indicates that the patient had experienced heart attack.

ABG

Definition: is used to measure the levels of oxygen and carbon dioxide in your body.

NURSING RESPONSIBILITY

PRE-PROCEDURE:

 Explain the test procedure

 explain that slight discomfort may be felt when the skin is punctured

POST-PROCEDURE:

 Check the laboratory results and report any abnormal results

 Apply manual pressure and dressings over puncture site on removal

TEST RESULT REFERENCE

PH 7.435 7.35-7.45
PCO2 40.1 35-45
PO2 73.3 80-100
HCO3 26.3 22-26
BE 2.0 +/- 2
O2SAT 95.2% 97-100%

Analysis:
It signifies that the patient experiencing hypoxemia.
URINALYSIS

DEFINITION: An examination of the urine to determine the general health of the body and, specifically,
kidney function, usually including measurement of pH, tests for protein, glucose, ketones, and blood, and
microscopic evaluation of sediment obtained by centrifugation.

PRE PROCEDURE:

 Explain Procedure to the patient

 Instruct patient to void directly into a clean clear dry container

POST PROCEDURE:

 Send specimen to laboratory

MICROSCOPIC RESULT REFERENCE

Color Yellow Light Yellow to Amber
Transparency Turbid Clear

Reaction 6.0 5-6

Specific Gravity 1.013 1.005-1.035
CHEMICAL TEST
Protein +2 <30mg/dl
Sugar NEGATIVE NEGATIVE
Ketone NEGATIVE NEGATIVE
Urobilinogen NORMAL NEGATIVE
Bilirubin NEGATIVE NEGATIVE
Nitrate NEGATIVE NEGATIVE
Erythrocytes +1 0-4
Leukocytes +1 NEGATIVE
MICROSCOPIC
RBC 4-6(H) 0-2
Pus cell 6-8 0-82
Epithelial cell FEW NONE
Mucus Threads NONE NONE
Bacteria MODERATE NONE
Renal cell NONE NONE
OTHERS
Yeast CELL FEW NONE
Crystals NONE NONE
CAST
Fine granular NONE NONE
Coarse granular NONE NONE
Hyaline 0-2 NONE

Analysis: Turbid urine may indicate bacteria. +2 in protein may indicate kidney damage. Leukocytes may
indicate decrease of function of the kidney to filter. RBC in the urine may indicates acute renal failure.
Bacteria in the urine may indicate infection and inflammation.
Medical Management

The management of pneumonia centers is a step-by-step process that zeroes on the treatment of
the infection through identification of the causative agent.

 Blood culture. Blood culture is performed for identification of the causal pathogen and prompt
administration of antibiotics in patients in whom CAP is strongly suspected.
 Administration of macrolides. Macrolides are recommended for people with drug-resistant S.
pneumoniae.
 Hydration is an important part of the regimen because fever and tachypnea may result in insensible
fluid losses.
 Administration of antipyretics. Antipyretics are used to treat fever and headache.
 Administration of antitussives. Antitussives are used for treatment of the associated cough.
 Bed rest. Complete rest is prescribed until signs of infection are diminished.
 Oxygen administration. Oxygen can be given if hypoxemia develops.
 Pulse oximetry. Pulse oximetry is used to determine the need for oxygen and to evaluate the
effectiveness of the therapy.
 Aggressive respiratory measures. Other measures include administration of high concentrations of
oxygen, endotracheal intubation, and mechanical ventilation.

Nursing Management

Nurses are expected to perform both dependent and independent functions for the patient to aid him or her
towards the restoration of their well-being.

 Nursing Assessment
 Nursing assessment is critical in detecting pneumonia.
 Assess respiratory symptoms. Symptoms of fever, chills, or night sweats in a patient should be
reported immediately to the nurse as these can be signs of bacterial pneumonia.
 Assess clinical manifestations. Respiratory assessment should further identify clinical
manifestations such as pleuritic pain, bradycardia, tachypnea, and fatigue, use of accessory
muscles for breathing, coughing, and purulent sputum.
 Physical assessment. Assess the changes in temperature and pulse; amount, odor, and color of
secretions; frequency and severity of cough; degree of tachypnea or shortness of breath; and
changes in the chest x-ray findings.
 Assessment in elderly patients. Assess elderly patients for altered mental status, dehydration,
unusual behavior, excessive fatigue, and concomitant heart failure.
DRUG STUDY
Name of Drug Route/Dosage & Therapeutic use Action Contraindication Adverse Effects Nursing Considerations
Frequency
Generic Name: Route: Treat Works by blocking Active bleeding ( peptic  Purpura on the skin  Should be given with
Clopidogrel Oral Route new/worsening platelets from ulcer and intracranial or in the mouth food
chest pain. And to sticking together and hemorrhage  Yellowing of skin(  Assess for s/s of
Brand Name: Dosage: keep blood vessels prevents them from jaundice) bleeding
Plavix 75mg tab open and prevent forming harmful  Tiredness  Avoid straining at
blood clots after clots.  Pale looking skin stool to avoid rectal
Classification: Frequency: certain procedure.  Fever bleeding
Antiplatelet OD  Fast heart  Observe
rate/SOB toxicity(tinnitus)
Generic Name: Route: Use to fight Exert bactericidal Penicillin or other Beta  Swelling
Cefepime IV infusion or IM bacterial infection in activity by interfering lactam allergy  Redness
injection the body. Stopping with bacterial cell  Pain on injection
Brand Name: the growth of wall synthesis and site
Maxipime Dosage: bacteria. inhibiting cross-
500mg ,1g,2g after linking of the
Classification: reconstitution peptidoglycan. Also
Cephalosporin thought to play a role
Antibiotic Frequency: in the activation of
bacterical cell
autolysins which may
contribute to
bacterial cell lysis.
Name of Drug Route/Dosage & Therapeutic use Action Contraindication Adverse Effects Nursing Considerations
Frequency
Generic Name: Route: Used to treat fluid Works by blocking  Sulfonamide  Diarrhea  Monitor for fluid intake by
Furosemide IV retention (edema) the absorption of Na hypersensitivity  Constipation measuring intake, output
in people with & Cl , water from the  Diabetes  Numbness or and daily weight.
Brand Name: Dosage: CHF(congestive filtered fluid in the mellitus tingling  Determine possible drug
Lasix 40mg heart disease), liver kidney tubules,  Acid base  Headache, allergies of patient.
Classification: disease, or a kidney causing a profound imbalances dizziness  Obtain complete hx esp.
Loop Diuretics Frequency: Stat order disorder such as increase in the  Thiazide diuretic  Blurred vision electrolyte balance and
Nephrotic output of urine hypersensitivity.  Hypersensitivity renal function
syndrome. Also (diuresis). The onset  Hyperuricemia  Monitor V/S with baseline
used to treat of action after oral values esp.BP
 ototoxicity
hypertension. administration is  Monitor laboratory values
within one hour, and specially potassium and
the diuresis lasts sodium levels, BUN,
about 6-8H Serum Uric acid.
 Monitor hearing and vision
(because some loop
diuretics are ototoxic &
thiazide diuretic produce
visual change by
increasing digoxin level)
 Assess pt. for skin rash.
Name of Drug Route/Dosage & Therapeutic use Action Contraindication Adverse Effects Nursing
Frequency Considerations
Generic Name: Route: Used to treat high ARBs, bind to the Contraindicated to • dizziness  monitor BP after
Telmisartan Oral blood pressure angiotensin II type 1 patient with such • lightheadedness, initial dose
(hypertension). (AT1) receptors with hypersensitivity. Eg:  Monitor dialysis
Brand Name: Dosage: Lowering high blood high affinity, causing anaphylaxis or • blurred vision,
patients closely
Micardis 40 mg/d pressure helps inhibition of the action angioedema • back pain(body for orthostatic
prevent strokes, of angiotensin II on adjusts to the hypotension.
Classification: Frequency: heart attacks, and vascular smooth medication)  Periodic Hgb,
Angiotensin II receptor OD kidney problems. muscle, ultimately Other SE: creatinine
Antagonist leading to a reduction clearance, liver
stuffy nose,
in arterial blood enzymes.
pressure. sinus pain,
 Monitor
cough,stomach pain concomitant
digoxin levels
throughout
therapy.