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University of La Salette College of Nursing Santiago City Philippines

Bronchopnuemonia
Lucas Paguila Medical Clinic Hospital August 07, 2012 Prepared by: BSN-3A Bracket C Charlene Mae Caluya Timothy John Caras Quennie Joy Carlos Nikka Castroverde Lerma Eliza Crabajal Angelica Duque Romeo Rey Opido RM, RN, MSN Clinical Instructor

Introduction
Bronchopneumonia is an illness of lung, which is caused by different organism like bacteria, viruses, and fungi and characterized by acute inflammation of the walls of the bronchioles. It is also known as pneumonia. It is common in women and causes to the 6% deaths. Streptococcus pneumoniae (pneumococcus) and Mycoplasma pneumonia both are the common bacterium, which causes bronchopneumonia in the adults and children. CAUSES Bacteria Virus Bacterial pneumonias tend to be the most serious and, in adults, the most common cause of pneumonia. The most common pneumonia-causing bacterium in adults is Streptococcus pneumonia (pneumococcus). RISK FACTOR Elderly Hospitalization Immobilization Immune Deficiency Long Term Illness Smoking SYMPTOMS Cough with greenish or yellow mucus Fever Chest pain Rapid, shallow breathing Shortness of breath Headache Loss of appetite Fatigue TREATMENT Hospitalization Intravenous Antibiotic Therapy Oxygen Therapy Rest If the cause is bacterial, the goal is to cure the infection with antibiotics. If the cause is viral, antibiotics will NOT be effective. In some cases it is difficult to distinguish between viral and bacterial pneumonia, so antibiotics may be prescribed. Pneumococcal vaccinations are recommended for individuals in high-risk groups and provide up to 80 percent effectiveness in staving off pneumococcal pneumonia. Influenza vaccinations are also frequently of use in decreasing ones susceptibility to pneumonia, since the flu precedes pneumonia development in many cases.

COMPLICATIONS Emphysema is a condition in which pus and fluid from infected tissue collects in a body cavity. the name comes from the Greek word empyein meaning pus-producing (suppurate). Pleurisy is an inflammation of the membrane that surrounds and protects the lungs (the pleura). Inflammation occurs when an infection or damaging agent irritates the pleural surface.

Lung abscess is an acute or chronic infection of the lung, marked by a localized collection of pus, inflammation, and destruction of tissue. Lung abscess is the end result of a number of different disease processes ranging from fungal and bacterial infections to cancer.

DIAGNOSTIC TEST 1. ABG is a test done to measure how much oxygen and carbon dioxide is in your blood. It also looks at the acidity (pH) of the blood. Usually, blood gases look at blood from an artery. In rarer cases, blood from a vein may be used. 2. CBC Complete blood count (CBC) test measures the following: The number of red blood cells (RBCs) The number of white blood cells (WBCs) The total amount of hemoglobin in the blood The fraction of the blood composed of red blood cells (hematocrit) The mean corpuscular volume (MCV) -- the size of the red blood cells CBC also includes information about the red blood cells that is calculated from the other measurements: MCH (mean corpuscular hemoglobin) MCHC (mean corpuscular hemoglobin concentration) The platelet count is also usually included in the CBC 3. Chest X ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm. 4. Pleural fluid culture is a test that looks at a sample of fluid from the space around the lungs to find and identify disease-causing organisms. 5. History and Physical Examination 6. CT of Chest 7. Pleural fluid gram stain 8. Sputum gram stain 9. Sputum Smear Examination PREVENTION Pneumococcal Vaccine The pneumococcal polysaccharide vaccine helps protect against severe infections due to the bacteria Streptococcus pneumoniae. This bacterium frequently causes meningitis and pneumonia in older adults and those with chronic illnesses. The vaccine has not been shown to prevent uncomplicated pneumonia. Smoking Cessation Hand washing

Anatomy and Physiology


Respiratory System: - Consists of the external nose, the nasal cavity, the Pharynx, the Larynx, the Trachea, the Bronchi and the Lungs. Function: Gas exchange Filters inspired air Voice production Olfaction Regulate blood pH Upper Respiratory Tract: (Nose-Larynx) Nose -the external opening of the Respiratory System -Consist of External nares /nostrils and Nasal Cavities RESPONSIBILITY: -Rich supply of capillaries warm the inspired air -Olfactory mucosa -Respiratory Mucosa -Lysozyme kills bacteria and Lymphocyte -LGA antibodies that protect against Bacteria -Provides an airway for respiration -Moisten and warms entering air -Filters and clean inspired air -Resonating chamber for speech -Detects odors in the air stream *Paranasal Sinuses -Four bones of the skull contain paired air spaces: Frontal, Ethmoid, Sphenoidal, and Maxillary RESPONSIBILITY: -Decrease Skull bone weight -Warm, moisten and filter incoming air -Add resonance to the voice -Communicate with the nasal cavity *Pharynx (Throat) -Common passageway of both the respiratory and digestive systems. -Common Pathway for both air and food. -Walls are lined by a mucosa and contain skeletal muscles that primarily used for swallowing -Flexible lateral walls are distensible in order to forced swallowed food to the esophagus - With three adjoining regions: a. nasopharynx (superior most region of the pharynx) b. oropharynx (the middle pharyngeal region) c. laryngopharynx (inferior narrowed region) *Larynx (Voice Box) -Is short, somewhat cylindrical airway ends in the trachea -Prevents swallowed materials from entering the lower respiratory Tract - Conduct air into the Lower Respiratory Tract produces Sounds.

-Supported by a framework of nine pieces of cartilage (Three individual pieces and three cartilage pairs ) that area held in place by ligaments and muscles *Trachea (Wind pipe) -Is a membranous tube consists of connective tissue and smooth Muscle, Reinforced with 16-20 C shaped pieces of cartilage -Adult: about 1.4-1.6 cm in diameter and about 10-11 cm long. *Bronchi -The trachea divides the left and right main (primary) bronchi each of which connects to the lung. -The left main bronchus is more horizontal than the right main bronchus because it displaced by the Heart. Foreign objects that enter the trachea usually logged in the right main Bronchus; because it is more it is more vertical than the left main Bronchus and therefore more indirect line with the trachea. The trachea is lined with psuedostratified ciliated columnar epithelium and are supported by C shaped pieces of cartilage. *Lungs -Are the principal organs of respiration. -Each lung is cone shaped, with its base resting on the diaphragm and its apex extending superiorly to a point about 2.5 centimeters above the clavicle. -The lung has three lobes: the superior, middle and inferior lobe. -Includes the Bronchioles, and the alveoli.

Demographic Data
Name: Pt. Honey Pooh Gender: Female Age: 4 y/o Birthdate: December 20, 2007 Birthplace: Ipil, Echague Isabela Address: Paddad, Alicia, Isabela Religion: Roman Catholic Nationality: Filipino Ethnicity: Ilocano Admission Date: July 31, 2012 Time: 4:30 pm Attending Physician: Dra. Paguila Chief Complaint: cough for 3 days, dyspnea, and fever for 1 day Initial Vital Signs: Temp: 38. 9 C PR: 148bpm RR: 48 cpm

Nursing History
History of Present Illness According to the patient's mother, the patient was hospitalized at Lucas-Paguila with a diagnosis of bronchopneumonia on June 26, 2012. Three days prior to admission, the patient experienced cough & dyspnea. On July 31, 2012 the patient had a fever in the morning so they admitted her at Lucas-Paguila Medical hospital at 4:40PM. History of Past Illness According to the patients mother, this is the 4th time that her daughter has been admitted to the hospital. The first time that the patient was admitted to the hospital was at the age of 9 months; the patient had a chief complaint of cough and fever. At the age of 1 year and 2 months, the patient was admitted to Lucas-Paguila due to loose bowel movement. She has completed all her vaccines. The patient has no known food allergies. Family Health History The patient has a family health history of asthma, diabetes mellitus, and hypertension.

Gordon's Functional Health Pattern


Health perception - Health Management Pattern Nutritional - Metabolic pattern PRIOR TO ADMISSION According to the mother, the patient has a healthy body. According to the patients mother, the patient eats three times a day. She eats fatty foods but also eats vegetables and fruits like squash and apple. She drinks 1 glass of water a day and 5-10 7-ounce bottles of milk a day. She also drinks soft drinks. According to the patients mother, the patient defecates daily every noon. The patient urinates 4-5 times a day. According to the patients mother, the patient wakes up at 6:00AM every weekday, and then takes a bath before eating. Her mother brings her at school at 8:00AM, and then picks her up at 10:30AM. After school, she watches TV, takes a nap at 12:30PM 3:00PM, and plays with her cousins. The patient usually sleeps at 8:30PM - 9:00PM. She takes a nap between the hours of 12:30PM3:00PM. The patient is a K-2 pupil at Alicia East District. The patient is able to read and write The patient is unaware of her condition but the mother assures to the patient that she will be good. The patient is the only daughter. The father left the mother while the patient was still in the womb. The mother describes her daughter as loving. DURING ADMISSION The child is unaware of her condition. During admission, the patient does not eat regularly. She only drinks 1/2 glass of water in the morning. During one shift, the patient consumed 1 1/2 bottles of milk.

Elimination Pattern

Activity - Exercise Pattern

The patient did not defecate since the first day of her admission. During the shift, the patient urinated twice. The patient was dependent on her mother for her activities of daily living.

Sleep - Rest pattern

The patient would have a disturbed sleep pattern through the night and also throughout the day. The patient was listening to the conversation between the nurse and mother. The patient would not respond to the questions being asked by the student nurse. The patient and the mother would play games with each other and talk to each other.

Cognitive - Perceptual Pattern Self-Perception SelfConcept Pattern

Role Relationship Pattern

Sexuality Reproductive Pattern

Coping Stress Tolerance Pattern

Value - Belief Pattern

According to the mother, the patient has a close relationship with the mother. The mother would help solve all the problems that the patient may have. The patient is a Roman Catholic. She was baptized at Our Lady of Atochia Church when she was a year old. According to the mother, the patient and mother prays together every day.

The relationship between the mother and the patient is still strong. The patient talks with the mother for any needs. The mother and patient prays together.

1st Physical Assessment Date: August 01, 2012 Time: 1:00PM Vital Signs: Temp: 38. 9 C PR: 148 bpm RR: 48 cpm General Appearance: Received patient lying on bed with an ongoing D5 .03 NaCl 500ml regulated at 30ugtts/min hooked at right arm, patent and infusing well. Mood: responsive, alert, awake Behavior: acting with appropriate behavior

Physical Assessment
AREA ASSESSED
1. SKIN COLOR TEXTURE INSPECTION INSPECTION AND PALPATION PALPATION PALPATION Smooth TURGOR PALPATION Snacks back to previous state <2 seconds 2. HAIR DISTRIBUTION TEXTURE COLOR 3. NAILS COLOR OF THE NAIL BED INSPECTION Pink and Transparent 1-2 seconds Convex NORMAL INSPECTION INSPECTION INSPECTION Evenly distributed Silky Black NORMAL NORMAL NORMAL Light brown skin color Smooth NORMAL NORMAL

METHODS

FINDINGS INTERPRETATION

TEMPERATURE MOISTURE

Normally warm

NORMAL NORMAL NORMAL

CAPILLARY REFILL TIME SHAPE 4. EYES/EYEBROW SHAPE SYMMETRY MOVEMENT ABILITY TO BLINK

PALPATION PALPATION

NORMAL NORMAL

INSPECTION INSPECTION INSPECTION INSPECTION

Round Equal in size Symmetrical in movement (+) Blink reflex

NORMAL NORMAL NORMAL NORMAL

5. CONJUCTIVA

COLOR PUPIL (PERRLA)

INSPECTION INSPECTION

Pink red

NORMAL NORMAL

Responds to pen light 6. EXTERNAL AUDITORY CANAL HEARING INSPECTION Hearing equally in both ears NORMAL

7. NOSE SYMMETRY COLOR INSPECTION INSPECTION Symmetrical Same color as the face NORMAL NORMAL

8. LIPS AND MOUTH SYMMETRY COLOR MOISTURE 9. NECK APPEARANCE 10. THORAX CHEST CONTOUR CHEST WALL BREATHING PATTERN INSPECTION INSPECTION Symmetrical NORMAL NORMAL NORMAL d/t compensatory mechanism to increase O2 d/t loose mucus secretions in larger airways INSPECTION No distention NORMAL INSPECTION INSPECTION INSPECTION Symmetrical Pink Moist NORMAL NORMAL NORMAL

BREATH SOUNDS

Full chest expansion Regular INSPECTION Deep and rapid AUSCULTATION (+) Rhonchi on right lower lobe

11. ABDOMEN GENERAL CONTOUR INSPECTION PALPATION (-) Distention (-) Tenderness NORMAL NORMAL

12. UPPER EXTREMITIES SYMMETRY ROM INSPECTION INSPECTION Symmetrical (+) Full range of motion NORMAL NORMAL

13. LOWER EXTREMITIES SIZE SYMMETRY ROM INSPECTION INSPECTION INSPECTION Equal in size Symmetrical (+) Full range of motion NORMAL NORMAL NORMAL

Laboratory Results
Date: August 31,2012, 12:05pm CBC RBC Hct Hgb WBC DIFFERENTIAL Lymphocytes Monocytes BLOOD INDICES MCV (mean cell volume) MCH (mean corpuscular hemoglobin) MCHC (Mean Cell Hemoglobin Concentration) RESULTS 4.43 0.35 128 10.9 0.24 0.06 79.5 28.9 36.4 NORMAL 4-6 0.4-0.54 130-180 5-10 0.25-.35 0.03-0.14 86-110 26-38 31-37 INTERPRETATION NORMAL NORMAL NORMAL NORMAL NORMAL

NORMAL NORMAL

Pathophysiology
Predisposing Factors - Age - Sex Etiologic Agent - Streptococcus pneumonia - Staphylococcus aureus - Escherichia coli -Mycoplasma pneumonia Precipitating Factors - immunocompromise - underlying lung disease - alcoholism - malnutrition - altered consciousness

Aspiration of microorganism

Adherence to alveolar macrophages; exposure of cell wall components

Inflammatory response: attraction of neutrophils; release of inflammatory mediators; accumulation of fibrinous exudate, red blood cells, and bacteria

Red hepatization and consolidation of lung parenchyma

Leukocyte infiltration (neutrophils and macrophages)

Gray hepatization and deposition of fibrin on pleural surfaces; phagocytosis in alveoli

Resolution of infection; macrophages in alveoli ingest and remove degenerated neutrophils, fibrin, and bacteria

Further complications such as emphysema, pleurisy, lung abscess, or cancer of lungs if left untreated

Pathophysiology
Aspiration of oropharyngeal secretions is the most common route of lower respiratory tract infection; thus the nasopharynx and oropharynx constitute the first line of defense for most infectious agents. Another route of infection is through the inhalation of microorganisms that have been released into the air when an infected individual coughs, sneezes, or talks, or form aerosolized water, such as that from contaminated respiratory therapy equipment. In healthy individuals, pathogens that reach the lungs are expelled or held in check by mechanisms of selfdefense (First line: Physical, Mechanical, and Biochemical Barriers, Second line: Inflammatory Response, Immunity, cough reflex, mucociliary clearance). If a microorganism gets past the upper airway defense mechanisms, the next line of defense is the alveolar macrophage. This phagocyte is capable of removing most infectious agents without setting off significant inflammatory or immune responses. However, if the microorganism is virulent or present in large enough numbers, it can overwhelm the alveolar macrophage and result in a full-scale activation of the bodys defense mechanism, including the release of multiple inflammatory mediators, cellular infiltration, and immune activation. These inflammatory mediators and immune complexes can damage bronchial mucous membranes and alveolocapillary membranes, causing the acini (cluster of cells that resembles a many-lobed "berry"; the berry-shaped termination of an exocrine gland, where the secretion is produced, is acinar in form, as is the alveolar sac containing multiple alveoli in the lungs) and terminal bronchioles to fill with infectious debris and exudate. In addition, some microorganisms release toxins from their cell walls that can cause further lung damage. The accumulation of exudate in the acinus leads to dyspnea and to V/Q mismatching and hypoxemia. The immune response includes complement activation and the production of antibodies, which are crucial for opsonizing the encapsulated bacterium. Inflammatory cytokines and cells are released that cause alveolar edema. Edema creates a medium for the multiplication of bacteria and aids in the spread of infection into adjacent portions of the lung. The involved lobe undergoes consolidation (solidification of the tissue caused by filling with exudate). A stage of red hepatization follows in which alveoli fill with blood cells, fibrin, edematous fluid, and pneumococci, giving lung tissue a red appearance. This passes into the stage of gray hepatization, in which affected tissues become gray because of fibrin and leukocytes (neutrophils) in the consolidated alveoli, where phagocytosis is taking place. With resolution, increasing numbers of macrophages appear in the alveolar spaces, the neutrophils degenerate, and the fibrin threads and remaining bacteria are digested by macrophages and removed by lymphatic vessels. Rapid lysis of pneumococcal bacteria (as occurs with antibiotic treatment) results in the release of intracellular bacterial proteins that can be toxic. The best known of these proteins is pneumolysin, which is cytotoxic to virtually every cell in the lung and is partially responsible for the worsening in clinical symptoms sometimes seen in individuals immediately after they begin antibiotic treatment.

Course in the Ward


Date July 31, 2012 4:35pm Doctors Order Admit to ROC V/S q 4 For CBC D5 0.3 NaCl 500 ml at 30 ggts/min Paracetamol 120 mg q 4h for T- 38 C Hydrocortisone 25 mg IV q 8 Aerosol with salbutamol Cefuroxime 250mg IV q 6 ANST Oxygen at 2-36 for dyspnea Refer for any signs and symptoms

Nursing Care Plan


Date: August 01, 2012 ASSESSMENT Subjective: none Objective: Restlessness Productive cough (+) Rhonchi on right lower lobe Temp: 38. 9 C PR: 148 bpm RR: 48 cpm DIAGNOSIS Risk for ineffective airway clearance r/t accumulation of tracheobronchial secretions PLANNING After 3-4 hours of nursing intervention, the patient will be able to maintain patent airway clearance AEB reduction of congestion with breath sounds clear INTERVENTION Monitor V/s Elevate HOB and encourage frequent positioning Auscultate breath sounds and assess air movement Keep back dry and loosen clothing and teach deep breathing and coughing exercises Instruct the mother to increase fluid intake Provide adequate rest periods Give bronchodilators as ordered Administer oxygen therapy and other medications as ordered RATIONALE For baseline data Ventilation to different lung segment To ascertain status and note progress EVALUATION After 3-4 hours of nursing intervention, the patient maintained a patent airway AEB a reduction of congestion with clear breath sounds.

To promote comfort and adequate GOAL MET ventilation and promote pulmonary hygiene To liquefy secretions Rest will prevent fatigue and decrease oxygen demands To clear airway when secretions are blocking the airway To increase oxygen saturation

Date: August 01, 2012 ASSESSMENT Subjective: none Objective: Restlessness (+) Rhonchi on right lower lobe Temp: 38. 9 C PR: 148 bpm RR: 48 cpm DIAGNOSIS Risk for impaired Gas Exchange r/t inflammation of airways and accumulation of sputum affecting O2 and O2 transport PLANNING After 4-5 hours of nursing intervention, the patient will demonstrate improvement in gas exchange AEB a decrease in respiratory rate to normal (22-34 cpm) INTERVENTION Monitor V/S Observe color of skin, mucous and nail beds Elevate HOB and encourage frequent position changes Encourage deep breathing and coughing exercises Keep back dry and loosen clothing Provide adequate rest periods RATIONALE For baseline data To note in any changes of the status of your gas exchange To facilitate the diaphragm To promote good pulmonary hygiene To promote comfort and adequate ventilation Rest will prevent fatigue and decrease oxygen demands for metabolic demands To liquefy secretions To increase oxygen saturation EVALUATION After 4-5 hours of nursing intervention, the patients respiratory rate decreased to 42 cpm GOAL NOT MET

Instruct mother to increase fluid intake of the child Administer oxygen therapy as ordered

Date: August 01, 2012 ASSESSMENT Subjective: none Objective: Warm to touch Body weakness Lack of appetite V/S: Temp: 38. 9 C PR: 148 bpm RR: 48 cpm DIAGNOSIS Hyperthermia r/t inflammatory process PLANNING After 30 minutes to 1 hour of nursing intervention, the temperature of the pt. will decrease from 38.9C to at least 37.5C INTERVENTION Establish rapport Monitor V/s Perform TSB RATIONALE To gain trust For baseline data TSB promotes heat loss through evaporation and conduction To provide comfort and prevent chills To support circulating volume and tissue perfusion To promote patients safety and to avoid chills To reduce metabolic demands and oxygen consumption To decrease circulating pyrogens EVALUATION After 30 minutes to 1 hour nursing intervention, the temperature decreased from 38.9 C to 37.8 C GOAL PARTIALLY MET

Promote surface cooling by means of undressing Encourage fluid intake Maintain patent airway and provide blanket Maintain bed rest and adequate rest periods Administer antipyretics as ordered

Date: August 01, 2012 ASSESSMENT Subjective: Objective: (+) Rhonchi in right lower lobe Productive cough Restlessness Cough Tachypnea V/S: Temp: 38. 9 C PR: 148 bpm RR: 48 cpm DIAGNOSIS Risk for infection r/t suppressed inflammatory response PLANNING At the end of the shift, the patient will be free from possible spread of infection. INTERVENTION Monitor V/S Encourage the mother to perform good hand-washing techniques Encourage adequate rest periods Stress the importance of increasing the childs nutritional intake Instruct mother to provide good hygiene for the child Instruct mother to provide adequate safe drinking milk/water for the child Instruct mother to keep the child warm and to provide a blanket RATIONALE To establish baseline data To reduce spread or acquisition of infection To enhance fast recovery and regain strength Good nutrition intake can strengthen the bodys immune system To prevent entry of microbes To prevent GI disturbance EVALUATION At the end of the shift, the patient has been free from possible spread of infection. GOAL MET.

To avoid chills and to prevent the child from having a fever

Date: August 01, 2012 ASSESSMENT Subjective: Objective: Lack of appetite Lack of interest to food offered DIAGNOSIS PLANNING Risk for imbalanced At the end of the nutrition r/t decrease shift, the patient nutrient absorption will consume at least 65% of the food offered INTERVENTION Monitor vital signs Assess for difficulty of swallowing and the ability to swallow Encourage family members to prepare food of patients preferences- develop meal plan with the patient Ask the mother to join the child during meal time Instruct client to avoid caffeinated beverages Promote adequate and timely fluid intake by limiting fluids 30 minutes prior to meal Encourage small but frequent feedings RATIONALE To have baseline data Can be factors that can affect ingestion and causative of altered nutrition To maintain adequate caloric intake EVALUATION The patient only ate 50% of foods offered. GOAL NOT MET.

To meet the nutritional needs of the client It stimulates gastric motility To reduce possibility of early satiety May reduce fatigue and thus enhance intake while preventing gastric distention This reduces the stress on the gastrointestinal tract

Instruct the client to eat a bland diet, low in roughage, avoiding hot, spicy, or very acidic foods

Drug Study
DRUG NAME ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NSG. CONSIDERATION Before - Assess for contraindications. - Assess body weight, skin color, V/S, urinalysis, serum electrolytes, X-rays, CBC. - Arrange for increased dosage when patient is subject to unusual stress. - Do not give live vaccines with immunosuppressive doses of hydrocortisone. - Observe the 15 rights of drug administration. During - Give daily before 9am to mimic normal peak diurnal corticosteroid levels. - Space multiple doses evenly throughout the day. - Use minimal doses for minimal duration to minimize adverse effects.

Generic Name: Hydrocortisone

Enters target cells and binds to cytoplasmic receptor; initiates many complex reactions that are Classification: Adrenal Cortical steroid responsible for its antiinflammatory, Corticosteroid immunosuppressive Glucocorticoid (glucocorticoid), and saltretaining Therapeutic Class: (mineralocorticoid) Hormone actions. Some actions maybe undesirable, depending on drug use

-Replacement therapy in adrenal cortical insufficiency -Allergic states Severe or incapacitating allergic conditions -Hematologic disorders -Ulcerative colitis

- Allergy to any component of the drug -Fungal infections -Amebiasis -Hepatitis B -Vaccinia or varicella -Antibiotic -Resistant infections -Immunosuppression

CNS: Vertigo, headache, paresthesias, insomnia, seizures, psychosis CV: Hypotension, shock, HPN and heart failure secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias Dermatologic: Thin, fragile skin, petechiae, ecchymosis, purpura, striae, subcutaneous fat atrophy EENT: Cataracts, glaucoma, increased IOP Endocrine: Amenorrhea, irregular mens, growth retardation, decreased carbohydrate tolerance and DM, cushingoid state, HPA suppression systemic,

hyperglycemia GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite and weight gain Hematologic: Na and fluid retention, hypocalcemia, increased blood sugar, increased serum cholesterol, decreased T3 and T4 levels Hypersensitivity: Anaphylactoid or hypersensitivity reactions Musculoskeletal: Muscle weakness, steroid myopathy and loss of muscle mass, osteoporosis, spontaneous fractures Other: Immunosuppression, aggravation or masking of infections, impaired wound healing

- Do not give IM injections if patient has thrombocytopenic purpura. - Taper doses when discontinuing high-dose or long-term therapy. After - Monitor client for at least 30minutes. - Educate client on the side effects of the medication and what to expect. - Instruct client to report pain at injection site. - Instruct client to take drug exactly as prescribed. - Dispose of used materials properly. - Document that drug has been given

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NSG. CONSIDERATION Assessment: History: hepatic and renal impairment, lactation, pregnancy. Physical: Skin Status, culture of affected area. Oral Drug: Give oral drug with food to decrease GI upset and enhance absorption. Discontinue if hypersensitivity occurred. Parenteral Drug: Report severe diarrhea, difficulty of breathing, unusual tiredness or fatigue, pain at injection site

Generic Name: Cefuroxime Classification: antibiotic Cephalosporin Dosage: 250 mg PO bid Route: oral

Bactericidal: inhibits synthesis of bacterial cell wall, causing cell death.

Acute bacterial maxillary Contraindicated with sinusitis caused by allergy to cephalosporins streptococcus pyrogens. and penicillins. Lower respiratory infections caused by streptococcus pneumonia, H. influenza

CNS: headache, dizziness, lethargy, paresthiasis. GI: nausea and Use cautiously with renal vomiting, diarrhea, failure, lactation, anorexia, abdominal pregnancy pain, flatulence. HEMATOLOGIC: bone marrow depression (WBC, decreased platelets, decrease hematocrit.) HYPERSENSITIVITY: Ranging rush to fever to anaphylaxis: serum sickness reaction.

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NSG. CONSIDERATION * Drug may decrease sensitivity of spirometry used for diagnosis of asthma. * When switching from regular to extended-release tablets, keep in mind that a regular 2 mg tablet every 6 hours is equivalent to an extendedrelease 4 mg tablet every 12 hours. * Syrup may e taken by children as young as age 2; it contains no alcohol or sugar. * Rarely, erythema multiforme or Stevens-Johnson Syndrome has been linked to use of syrup in children.

Generic Name: Salbutamol Sulfate Albuterol Sulfate Brand Name: AccuNeb, Airomir, Proventil, Proventil HFA, Proventil Repetabs, Ventolin, Ventolin HFA, Ventolin Obstetric Injection, Ventolin Rotacaps, Volmax, VoSpire ER Available Forms: Capsules for inhalation: 200 mcg Injection: 1 mg / ml Solution for inhalation: 0.083%, 0.5%, 0.63 mg / ml, 1.25 mg / 3 ml Syrup: 2 mg / 5 ml Tablets: 2 mg, 4 mg Tablets (extendedrelease): 4 mg, 8 mg

Relaxes bronchial, uterine, and vascular smooth muscle by stimulating beta2 receptors.

* To prevent or treat bronchospasm in patients with reversible obstructive airway disease * To prevent exerciseinduced bronchospasm * Acute asthma * Symptom relief during maintenance therapy of asthma and other conditions with reversible or irreversible airways obstruction (including COPD and bronchitis)

* Contraindicated in . CNS: tremor, patients hypersensitive to nervousness, dizziness, insomnia, headache, drug or its ingredients. hyperactivity, weakness, CNS stimulation, * Use with caution in malaise patients with CV disorders (including coronary insufficiency CV: tachycardia, and hypertension), palpitations, hyperthyroidism, hypertension diabetes mellitus, and those who are unusually EENT: dry and irritated responsive to nose and throat with adrenergics inhaled form, nasal congestion, epistaxis, * Use extended-release hoarseness tablets cautiously in patients with GI GI: heartburn, nausea, narrowing. vomiting, anorexia, altered taste, increased appetite

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NSG. CONSIDERATION If sensitivity reaction occurs, discontinue use of paracetamol If pain persist more than 10 days and arthritic and rheumatic condition affecting children, immediately consult physician.

Generic Name: Paracetamol Brand Name: Classification: Analgesic, Anti pyretics Dose: 1amp Frequency: for PRN meds q 4-6 hours Route: oral

Indicated in conditions like Ear pain, Headache, Malaise, Migraine, mild to moderate pain, Pain, Post-vaccine reaction, Short bowel syndrome, Toothache.

Paracetamol exhibits analgesic action by peripheral blockage pain impulse generation. It produces antipyresis by inhibiting the hypothalamic heatregulating center. Its weak anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the CNS

Contraindicated in conditions like hypersensitivity

Nausea, allergic reaction, skin rashes, acute renal tubular, necrosis. Potentially fatal: Liver damage

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