BRONCHO

PNEUMONI
A
INTRODUCTION
Pneumonia is an infection of the lungs. When a person has pneumonia, lung tissue
can fill with pus and other fluid, which makes it difficult for oxygen in the lung's air sacs
to reach the bloodstream. With pneumonia, a person may have difficulty breathing and
have a cough and fever. Sometimes a person may have chest or abdominal pain and
vomiting, too.
Pneumonia is commonly caused by viruses, such as the influenza virus (flu and
adenovirus. !ther viruses, such as respiratory syncytial virus ("S#, are common
causes of pneumonia in young children and infants. $acteria such as Streptococcus
pneumoniae can cause pneumonia, too. People with bacterial pneumonia are usually
sicker than those with viral pneumonia, but can be effectively treated with antibiotic
medications.
%ou may have heard the terms &double pneumonia& or &walking pneumonia.&
Double pneumonia simply means that the infection is in both lungs. 't's common for
pneumonia to affect both lungs, so don't worry if your doctor says this is what you have
( it doesn't mean you're twice as sick.
Walking pneumonia refers to pneumonia that is mild enough that you may not
even know you have it. Walking pneumonia, which has also been called atypical
pneumonia because it's different from the typical bacterial pneumonia, is common in
teens and is often caused by a tiny microorganism known as Mycoplasma pneumoniae.
)ike the typical bacterial pneumonia, walking pneumonia can also be treated with
antibiotics.
*here are many symptoms of pneumonia, and some of them, like a cough or a
sore throat, are associated with many other common infections. !ften, people get
pneumonia after they've had an upper respiratory tract infection like a cold.
Symptoms of pneumonia can include+
fever
chills
cough
unusually rapid breathing
whee,ing
difficulty breathing
chest or abdominal pain
loss of appetite
exhaustion
vomiting
*he symptoms of pneumonia vary from person to person, and few people get all of them.
When pneumonia is caused by bacteria, the person tends to become sick -uickly
and develops a high fever and has difficulty breathing. When it's caused by a virus,
symptoms generally appear more gradually and may be less severe.
*he routine vaccinations that most people receive as kids help prevent certain
types of pneumonia and other infections. 'f you have a chronic illness, such as sickle cell
disease, you may have received additional vaccinations and disease.preventing antibiotics
to help prevent pneumonia and other infections caused by bacteria. People who have
diseases that affect their immune system (like diabetes, /'# infection, or cancer, are 01
or older, or are in other high.risk groups should receive a pneumococcal vaccination.
People with immune system problems may also receive antibiotics to prevent
pneumonia that may be caused by organisms they are especially susceptible to. 'n some
cases, antiviral medication may be used to prevent viral pneumonia or to lessen its
effects.
'nfluen,a vaccination is also recommended since pneumonia often occurs as a
complication of the flu. $ecause pneumonia is often caused by contagious germs, a good
way to prevent pneumonia is to keep your distance from anyone you know who has
pneumonia or other respiratory infections. 2se separate drinking glasses and eating
utensils, wash your hands fre-uently with warm, soapy water, and avoid touching used
tissues and paper towels. %ou can also stay strong and help avoid some of the illnesses
that may lead to pneumonia by eating as healthily as possible, getting plenty of rest, and
avoiding smoking.
*he length of time between exposure and feeling sick depends on many factors,
particularly the type of pneumonia a person has. With influen,a pneumonia, for example,
someone may become sick in as few as 34 hours or as long as 5 days after exposure to the
flu virus. $ut with walking pneumonia, a person may not have symptoms until 4 to 5
weeks after becoming infected.
6ost types of pneumonia resolve within a week or two, although a cough may
linger for several weeks more. 'n severe cases, it may take longer to completely recover.
'f a doctor suspects pneumonia, he or she will perform a physical exam and may
order a chest 7.ray and blood tests. People who have bacterial or atypical pneumonia will
probably be given antibiotics to take at home. 8 doctor will also recommend that a
person gets lots of rest and drinks plenty of fluids.
Some people with pneumonia need to be hospitali,ed to get better ( usually babies
and young children and people older than 01. /owever, hospital care may be need for a
teen who+
already has immune system problems
is dangerously dehydrated or is vomiting a lot and can't keep fluids and medicine
down
has had pneumonia fre-uently
has skin that's blue or pale in color, which reflects a lack of oxygen
8ntiviral medications approved for adults and teens can reduce the severity of flu
infections if taken in the first 3 to 4 days after symptoms begin. 'f you have been exposed
to influen,a and you begin to develop symptoms of pneumonia, call a doctor.
%ou may feel better in a room with a humidifier, which increases the moisture in the
air and soothes irritated lungs. 6ake sure you drink plenty of fluids, especially if you
have a fever. 'f you have a fever, ask the doctor whether you can take over.the.counter
medicine such as acetaminophen or ibuprofen to bring it down. $ut don't take any
medicine without checking first with your doctor ( a cough suppressant, for example,
may not allow your lungs to clear themselves of mucus.
8nd finally, be sure to rest. *his is a good time to sleep, watch *#, read, and lay low.
'f you treat your body right, it will repair itself and you'll be back to normal in no time.
PATIENTS PROFILE
Patients Name: ABCD
Age: 72 y/o
Gender: Male
Cii! Stat"s: Married
Address: Tuao, Cagayan
Date #$ Birt%: March 20, 1935
P!a&e #$ Birt%: Tuao, Cagayan
Re!igi#n: Roman Caholic
Nati#na!it': !ili"ino
Dia!e&t: #locano, Tagalog, #a$e%
Date #$ Admitti#n: &o'em(er 09, 2007
Attending P%'si&ian: Dr) *+,
C%ie$ C#m(!aints: Di--iculy o- Breahing
Fina! Diagn#sis: Broncho"neumonia
NURSING HISTOR) OF ILLNESS
HISTOR) OF PRESENT ILLNESS
8ccording to the patient9s daughter, last :ovember ;0, 4;;< early in the
morning, his father was sweeping their front yard as his form of exercise until
later that day he experienced uneasiness and episodes of dyspnea. 8fter three
(5 days they decided to bring him to the hospital and prior to his admission,
the patient had productive cough and has experienced dyspnea. *he patient
also had epigastric pain.
PAST HEALTH HISTOR)
8ccording to the patient9s daughter, his father was previously hospitali,ed due
to hypertension and asthma. She included further that his father had started his
asthma attacks when he was still 1; years old. 8ccording the patient, he has
completed his immuni,ations and has no allergies on foods or drugs. 8lso
according to him, he wasn9t taking any vitamin supplements but he was
planning to ask his physician to prescribe him some.
FAMIL) HEALTH HISTOR)
8ccording to the patient9s daughter and wife, they have a family history of
pneumonia and asthma. *hey also have known history of hypertension. :o
other hereditary disease such as diabetes was evident on their family
according to them.
GORDONS ** FUNCTIONAL HEALTH PATTERNS
Hea!t% Per&e(ti#n+Hea!t% Management Pattern
$efore /ospitali,ation, =hito perceives health as being free from any illness.
/e says that he feels healthy when he is able to perform his duties. $ut due to
his old age and health condition, he was no longer allowed by his children to
work. $ut because he is not used to do nothing at all, he prefers to help on the
household chores instead of sitting all day long. 8nd by able to help his
family do the chores, he still feels well despite of his health condition. /e isn9t
also taking any vitamin or food supplements.
>uring his hospitali,ation, =hito still perceives health as being free from
illness and now he also considers health as wealth. /e says that health should
not be taken for granted since it could even mean his life. /e said that this is
the worst hospitali,ation he has ever had so he swears to give more attention
to his health now. /e even is planning to consult his physician for some
vitamins to help him become more healthy and to protect him from ac-uiring
other illness.
N"triti#na!+Meta,#!i& Pattern
$efore =hito9s hospitali,ation, he takes his meals the usual three times a day.
$ut according to her daughter he is eating only small amounts. /e prefers
vegetables more then meat. /e drinks 0.< glasses of water a day. 't was
suspected by her daughter that before he was brought to that hospital, his
epigastric pain was due to the meals he skipped during those days.
>uring his hospitali,ation, =hito doesn9t still have the appetite to eat. /e eats
but still in small amounts. /is fluid intake has decreased to 1.0 glasses of
water a day. :ow that he was hospitali,ed, he prefers warm versus cold fluids.
/e also added that he wants to consult his physician on what supplement
should he take to increase his appetite.
E!iminati#n Pattern
$efore hospitali,ation, =hito defecates normally everyday. /e has the
normal solid to semi.solid stool consistency and is usually light brown to dark
brown in color. /e also said that he usually voids 1.0 times a day with light
yellow and aromatic odor urine. /e said that he don9t have any difficulty in
defecating and urinating.
>uring his hospitali,ation, =hito voids typically 3.4 times during my shift
with darker colored urine than the usual color of his urine but still with the

same odor. /e didn9t eliminate during my shift but according to his daughter,
he is somewhat constipated because he now defecates every other day unlike
before that he defecate everyday.
A&tiit'+E-er&ise Pattern
$efore hospitali,ation, =hito considers helping in the household chores as his
only form of exercise like sweeping their yard though it wasn9t allowed by his
children. /e has no other forms of exercise since it was contraindicated by his
health condition.
>uring his hospitali,ation, =hito has no exercise at all because of his
condition. /e has to rest most of the time.
S!ee(+Rest Pattern

$efore =hito9s /ospitali,ation, he has the normal 0.? hours sleep. 8ccording
to his daughter, he usually sleeps at <+;;.?+;; in the evening and wakes up at
@+;;.1+;; in the morning. /e has his daily naps for 4.5 hours. 8s his forms of
rest he watches the television, chats with his family or neighbors, or takes his
nap.
>uring his hospitali,ation, =hito doesn9t have the ade-uate time of sleep. /e
is much disturbed with the nurses giving medications and when they are
obtaining vital signs. $ut he has the ade-uate rest since he does noting in the
hospital.
C#gnitie+Per&e(t"a! Pattern
$efore hospitali,ation, =hito is normal in terms of his cognitive abilities. /e
has good memory and reasoning skills. /e can easily comprehend on the
-uestions ' ask him. 'n terms of his perceptual pattern, =hito has no problems
with his senses except that their functions are -uite diminished which is
normal due to his old age.
>uring his hospitali,ation, =hito was normal as before in his cognitive and
perceptual pattern. /e is still that good as he comprehend with my -uestions.
/e can also easily remember things that '9m asking him. /e also shared to me
some of his experiences and is very enthusiastic during our conversations.
sSe!$+(er&e(ti#n . Se!$+&#n&e(t Pattern
=hito perceives himself as a good person. With his age, he has now
achieved his self.actuali,ation and gained self.respect. /e sees himself an
elder that gives advices to other people based on his own experiences.
R#!e+Re!ati#ns%i( Pattern
$efore his hospitali,ation, =hito has a close relationship with his family
though some of children don9t already live with them they still find time to
communicate and see each other. /e is a father of nine children. /e does
not have his Aob already so he relies on his children for supports. 6ost of the
time he turns to his family for emotional supports.
>uring his hospitali,ation, his relationship with his family hasn9t changed.
!ne of her daughter and her wife were the ones accompanying him in the
hospital. /is family was his main source of strength.
Se-"a!it'+Re(r#d"&tie Pattern
=hito was no longer active in his sexual pattern due to his age. /e said that
he was already too old for that, by the way he already have nine children.
C#(ing+Stress T#!eran&e Pattern

$efore his hospitali,ation, =hito according to his duaghter is individualistic
in terms of her emotions. /e doesn9t usually share his problems with his
family. 8ccording to his daughter he always tries to keep his emotions or
problems by himself. /is daughter even shared that he always tries to hide
when he is feeling ill or unhealthy.
>uring his hospitali,ation, =hito9s confidant was his wife and daughter. /e
expresses all his discomforts to them.
/a!"e+Be!ie$ Pattern
=hito is a "oman =atholic devotee. /e said that he go to mass every Sunday
with his wife and some of his children since some of his children live in
other places. /e believes that Bod helps him in times of trials and sufferings
and that /e will not abandon him. /e trusts his life to him /is daughter
confessed that they do believe in -uack doctors sometimes when the health
practitioners weren9t able to cure the illness but they do consult the health
practitioners first.
PH)SICAL ASSESSMENT
Beneral 8ppearance+ neat and relaxed

'nitial #ital Signs+ $PC 33;D<;, *C50.E
o
=, ""C41 cpm, P"C?@ bpm,
AREA
ASSESSED
TECHNIQUES
USED
NORMAL
FINDINGS
ACTUAL
FINDINGS
ANALYSIS
SKIN
=olor 'nspection )ight to deep brown *an :ormal
*exture Palpation Smooth and flexible
but not uniform
throughout the
body+ palms and
soles are thicker
Smooth :ormal
*urgor *est Pinching :ormally the skin
snaps back
immediately to its
resting position
after pinching
When pinched,
skin snap back to
its previous state
for some
seconds.
>ue to old
age
/air >istribution 'nspection Fvenly distributed
hair.
Fvenly
distributed
:ormal
*emperature 'nspection 50.1
o
= G 5<.1
o
= Warm :ormal
6oisture PalpationH
'nspection
Skin is normally
dryH skin fold are
normally moist.
>ry :ormal
NAILS
=olor of :ail bed 'nspection Pink with
translucent tip.
Pink :ormal
*exture Palpation Smooth texture Smooth :ormal
Shape 'nspection =onvex curvatureH
angle between nail
and nail bed is
about 30; degrees.
=onvex with
30;.degree angle
:ormal
=apillary refill Palpation Prompt return to
pink within 4.5
seconds when put
under pressure
"eturned to pink
after 4 seconds
when put under
pressure
:ormal
HAIR
=olor 'nspection 8ccording to race
($lack.Iilipinos
$lack :ormal
>istribution 'nspection Fvenly distributed
and pliant.
Fvenly
distributed
:ormal
*exture PalpationH
'nspection
Silky, resilient hair. Silky and
resilient
:ormal
!iliness Palpation :either excessively Slightly oily :ormal
dry nor oily.
HEAD
Symmetry Palpation Symmetrical Symmetrical :ormal
Shape 'nspection "ounded "ounded :ormal
*exture Palpation Smooth skull
contour
Smooth without
nodules
:ormal
FACE
Symmetry 'nspection Symmetrical Symmetrical :ormal
Skin =olor 'nspection 6ay vary according
to raceH without
lesionsDabrasions
*anned with birth
mark on the left
cheek
:ormal
EYES
EYEBROWS
Position 8lignment 'nspection Symmetrically
aligned
Symmetrically
aligned.
:ormal
/air >istribution 'nspection Fvenly distributed Fvenly
distributed
:ormal
EYELASHES
/air >istribution 'nspection Fvenly distributed Fvenly
distributed
:ormal
=url 'nspection =urved outward =urved outward :ormal
EYELIDS
Skin Juality 'nspection Smooth and has the
same color of the
skin.
Smooth and same
color with the
skin
:ormal
*exture 'nspection Smooth, absence of
lesions
Smooth without
lesions
:ormal
Position 'nspection *he lids do not
cover the pupil and
sclera, and cannot
be seen above the
iris. *he lids close
to the eyeball.
'n normal
position.
:ormal
CONJUNCTIVA
=olor 'nspection *ransparent with
light pink color
Pink :ormal
*exture 'nspection 6oist, absence of
lesions
6oist and no
lesions
:ormal
PUPILS
=olor 'nspection #ary according to
race.
$lack :ormal
Shape 'nspection :ormally round,
small, regular and
e-uali,ed. >iameter
of 5 G < mm
"ound :ormal
Symmetry 'nspection Symmetrical Symmetrical :ormal
"eaction to light 'nspection 'lluminated pupil >irect and :ormal
constricts (direct
responseH :on.
illuminated pupil
dilates (consensual
response
consensual
responseH
PF"")8 (pupils
e-ually round
and react to light
and
accommodation
EARS
Position of the
8uricles
'nspection )ine drawn from
lateral angle of the
eye to point to
where top part of
the auricle Aoins
head is hori,ontal.
)ine drawn from
lateral angle of
the eye to point
to where top part
of the auricle
Aoins head is
hori,ontal.
:ormal
Symmetry 'nspection Symmetrical Symmetrical :ormal
Si,e 'nspection $oth auricles must
have the same si,e.
/ave the same
si,e.
:ormal
Shape 'nspection $oth auricles must
have the same
shape.
F-ual shape :ormal
*exture 'nspection Smooth without
lesions and lumps.
Smooth :ormal
Flasticity 'nspection 6obile, firm and
not tender, pinna
recoils after it is
folded.
6obile and firm
(recoils easily.
:ormal
NOSE
Symmetry 'nspection Symmetrical and
straight.
Symmetrical and
straight.
:ormal
:asal Septum 'nspection :o evidence of
lesions, normally in
midline.
)ocated in
midline.
:ormal
:ares 'nspection Symmetrical si,e of
opening.
Symmetrical si,e
of opening
:ormal
:asal >ischarge 'nspection :o discharge :o discharge :ormal
LIPS
6oisture 'nspection 6oist 6oist :ormal
GUMS & TEETH
=olor 'nspection Slightly slipped
pink color.
Pink :ormal
6oisture 'nspection 6oist 6oist :ormal
*eeth 'nspection Iirmly set, shiny,
without cavities
With tooth
cavities
>ue to age
factor.
NECK
Position 'nspection :eck is normally
located centrally in
the shoulder.
/ead centered. :ormal
Symmetry 'nspection Symmetrical Symmetrical :ormal
THORAX
Posterior Shape
and =onfiguration
'nspection *he chest should be
normally having a
greater diameter
than the front to
back diameter.
/ave a greater
diameter than the
front and back.
:ormal
Skin =olor 'nspection #ariation depends
on race.
Same as the
normal skin color
(tan
:ormal
*exture 'nspection Smooth Smooth :ormal
Position of Scapula 'nspection =losely attached to
chest wall.
=losely attached
to chest wall.
:ormal
Symmetry of =hest
Fxpansion
Palpation =hest is symmetric =hest is
symmetric
:ormal
ANTERIOR
THORAX
Shape and
=onfiguration
'nspection 6ust be
symmetrical.
Symmetrical. :ormal
Position of
Sternum
'nspection )ocated centrally in
the thorax between
the ribs.
)ocated centrally
in the thorax.
:ormal
Shape of "ibs 'nspection *he ribs slope
across and down.
Slope across and
down.
:ormal
2se of 8ccessory
6uscles
'nspection 6oves little with
normal passive
breathing.
With active
breathing.
>ue to the
ineffective
gas
exchange.
POSTERIOR
THORAX
Skin color 'nspection Same color with
other body parts.
Same color with
other body parts
(tan.
:ormal
)ung breath
sounds
8uscultation #esicular G soft,
bree,y, low pitch
sound. 5; G ?;cpm
(newborn
8dventitious
breath sounds
(crackles.
>ue to the
excessive
mucus
secretions.
ABDOMEN
Skin =olor 'nspection Same color as the
rest of the body. :o
lesions
Same color as the
rest of the body
:ormal
Symmetry 'nspection Symmetrical Symmetrical :ormal
=ontour 'nspection "ounded contour "ounded contour :ormal
EXTREMITIES:
Symmetry 'nspection :o lesions and same
skin color with the
rest of the body.
:o lesions with
the same skin
color to the rest
of the body.
:ormal
"!6 'nspection Iull mobility of
each AointH
movement is
deliberate, smooth,
and coordinated.
Iull mobility of
each Aoint.
:ormal
LABORATOR) RESULTS
HEMATOLOGY REPORT
Norm! V!"#$ E%m&'(&o'
r#$"!($
A'!)$&$
WBC 1.3; x 3;K ED) 3;.@ x 3;K ED)
'ncreased due to the
body9s attempt to
fight the infection
RBC
H*+ 6 35.;.3?.; gDdl 34.0 gDdl >ecreased due to the
obstructive
pulmonary disease
I 34.;.30.; gDdl
H(, 6 5E.;.1@.; L 5E L :ormal
I 5<.;.@?.; L
D&--#r#'(&!
Co"'(
S#*m#'(#r$
;.0;.;.<; ;.E1 'ncreased due to the
body9s attempt to
fight the infection

L)m./o,)(#$ ;.4;.;.5; ;.55
'ncreased due to the
body9s attempt to
fight the infection
BLOOD CHEMISTRY REPORT
Norm! V!"#$ E%m&'(&o' R#$"!($
Cr#(&'&'# 6. 01.34; 14.?4
I. 1;.3;;
So0&"m 351.311 mmolD) 34?.4 mmolD)
Po($$&"m 5.0. 1.1 mmolD) 5.4? mmolD)
CHEST X1RAY1APL VIEWS
1 *he lungs are hyperlucent
1 *here are fibroha,y densities in the right upper lung field and
confluent fine reticuloha,y densities in both lower lung fields. *here is a
thin.walled tubular lucency in the peripheral aspect of the left upper lung
field.
1 *he trachea is slightly shifted to the right
1 *he heart is not enlarged transversely
1 *he aortic knob is calcified
1 *he hemi.diaphragms are flattened and tented
1 *he castrophrenic sulci are shallow
1 *he rest of the visuali,ed soft and osseous structures are
unremarkable
IMPPRESSION
1 P*$, $ilateral, with $lebD $ulla formation in the left.
1 Pulmonary Fmphysema
1 $ibasal Pneumonia
1 8therosclerotic aorta
1 Pleurodiaphragmatic reaction, bilateral
1 Suggest follow up
ANATOM) AND PH)SIOLOG) OF
THE RESPIRATOR) S)STEM
Respiratory System, in anatomy and physiology, are organs that deliver
oxygen to the circulatory system for transport to all body cells. !xygen is essential for
cells, which use this vital substance to liberate the energy needed for cellular activities. 'n
addition to supplying oxygen, the respiratory system aids in removing of carbon dioxide,
preventing the lethal buildup of this waste product in body tissues. >ay.in and day.out,
without the prompt of conscious thought, the respiratory system carries out its life.
sustaining activities. 'f the respiratory system9s tasks are interrupted for more than a few
minutes, serious, irreversible damage to tissues occurs, followed by the failure of all body
systems, and ultimately, death.
While the intake of oxygen and removal of carbon dioxide are the primary
functions of the respiratory system, it plays other important roles in the body. *he
respiratory system helps regulate the balance of acid and base in tissues, a process crucial
for the normal functioning of cells. 't protects the body against disease.causing organisms
and toxic substances inhaled with air. *he respiratory system also houses the cells that
detect smell, and assists in the production of sounds for speech.
*he respiratory and circulatory systems work together to deliver oxygen to cells
and remove carbon dioxide in a two.phase process called respiration. *he first phase of
respiration begins with breathing in, or inhalation. 'nhalation brings air from outside the
body into the lungs. !xygen in the air moves from the lungs through blood vessels to the
heart, which pumps the oxygen.rich blood to all parts of the body. !xygen then moves
from the bloodstream into cells, which completes the first phase of respiration. 'n the
cells, oxygen is used in a separate energy.producing process called cellular respiration,
which produces carbon dioxide as a byproduct. *he second phase of respiration begins
with the movement of carbon dioxide from the cells to the bloodstream. *he bloodstream
carries carbon dioxide to the heart, which pumps the carbon dioxide.laden blood to the
lungs. 'n the lungs, breathing out, or exhalation, removes carbon dioxide from the body,
thus completing the respiration cycle.
Structures:
The Nasal Passages:
*he flow of air from outside of the body to the lungs begins with the nose, which
is divided into the left and right nasal passages. *he nasal passages are lined with a
membrane composed primarily of one layer of flat, closely packed cells called epithelial
cells. Fach epithelial cell is densely fringed with thousands of microscopic cilia,
fingerlike extensions of the cells. 'nterspersed among the epithelial cells are goblet cells,
speciali,ed cells that produce mucus, a sticky, thick, moist fluid that coats the epithelial
cells and the cilia. :umerous tiny blood vessels called capillaries lie Aust under the
mucous membrane, near the surface of the nasal passages. While transporting air to the
pharynx, the nasal passages play two critical roles+ they filter the air to remove
potentially disease.causing particlesH and they moisten and warm the air to protect the
structures in the respiratory system.
Iiltering prevents airborne bacteria, viruses, other potentially disease.causing
substances from entering the lungs, where they may cause infection. Iiltering also
eliminates smog and dust particles, which may clog the narrow air passages in the
smallest bronchioles. =oarse hairs found Aust inside the nostrils of the nose trap airborne
particles as they are inhaled. *he particles drop down onto the mucous membrane lining
the nasal passages. *he cilia embedded in the mucous membrane wave constantly,
creating a current of mucus that propels the particles out of the nose or downward to the
pharynx. 'n the pharynx, the mucus is swallowed and passed to the stomach, where the
particles are destroyed by stomach acid. 'f more particles are in the nasal passages than
the cilia can handle, the particles build up on the mucus and irritate the membrane
beneath it. *his irritation triggers a reflex that produces a snee,e to get rid of the polluted
air.
*he nasal passages also moisten and warm air to prevent it from damaging the
delicate membranes of the lung. *he mucous membranes of the nasal passages release
water vapor, which moistens the air as it passes over the membranes. 8s air moves over
the extensive capillaries in the nasal passages, it is warmed by the blood in the capillaries.
'f the nose is blocked or MstuffyN due to a cold or allergies, a person is forced to breathe
through the mouth. *his can be potentially harmful to the respiratory system membranes,
since the mouth does not filter, warm, or moisten air.
'n addition to their role in the respiratory system, the nasal passages house cells
called olfactory receptors, which are involved in the sense of smell. When chemicals
enter the nasal passages, they contact the olfactory receptors. *his triggers the receptors
to send a signal to the brain, which creates the perception of smell.
Pharynx:
8ir leaves the nasal passages and flows to the pharynx, a short, funnel.shaped
tube about 35 cm (1 in long that transports air to the larynx. )ike the nasal passages, the
pharynx is lined with a protective mucous membrane and ciliated cells that remove
impurities from the air. 'n addition to serving as an air passage, the pharynx houses the
tonsils, lymphatic tissues that contain white blood cells. *he white blood cells attack any
disease.causing organisms that escape the hairs, cilia, and mucus of the nasal passages
and pharynx. *he tonsils are strategically located to prevent these organisms from
moving further into the body. !ne tonsil, called the adenoids, is found high in the rear
wall of the pharynx. 8 pair of tonsils, the palatine tonsils, is located at the back of the
pharynx on either side of the tongue. 8nother pair, the lingual tonsils, is found deep in
the pharynx at the base of the tongue. 'n their battles with disease.causing organisms, the
tonsils sometimes become swollen with infection. When the adenoids are swollen, they
block the flow of air from the nasal passages to the pharynx, and a person must breathe
through the mouth.
Larynx:
8ir moves from the pharynx to the larynx, a structure about 1 cm (4 in long
located approximately in the middle of the neck. Several layers of cartilage, a tough and
flexible tissue, comprise most of the larynx. 8 protrusion in the cartilage called the
8dam9s apple sometimes enlarges in males during puberty, creating a prominent bulge
visible on the neck.
While the primary role of the larynx is to transport air to the trachea, it also serves
other functions. 't plays a primary role in producing soundH it prevents food and fluid
from entering the air passage to cause chokingH and its mucous membranes and cilia.
bearing cells help filter air. *he cilia in the larynx waft airborne particles up toward the
pharynx to be swallowed.
Iood and fluids from the pharynx usually are prevented from entering the larynx
by the epiglottis, a thin, leaf.like tissue. *he MstemN of the leaf attaches to the front and
top of the larynx. When a person is breathing, the epiglottis is held in a vertical position,
like an open trap door. When a person swallows, however, a reflex causes the larynx and
the epiglottis to move toward each other, forming a protective seal, and food and fluids
are routed to the esophagus. 'f a person is eating or drinking too rapidly, or laughs while
swallowing, the swallowing reflex may not work, and food or fluid can enter the larynx.
Iood, fluid, or other substances in the larynx initiate a cough reflex as the body attempts
to clear the larynx of the obstruction. 'f the cough reflex does not work, a person can
choke, a life.threatening situation. *he /eimlich maneuver is a techni-ue used to clear a
blocked larynx (see Iirst 8id. 8 surgical procedure called a tracheotomy is used to
bypass the larynx and get air to the trachea in extreme cases of choking.
Trachea, Bronchi, and Bronchioles:
8ir passes from the larynx into the trachea, a tube about 34 to 31 cm (about 1 to 0
in long located Aust below the larynx. *he trachea is formed of 31 to 4; =.shaped rings
of cartilage. *he sturdy cartilage rings hold the trachea open, enabling air to pass freely at
all times. *he open part of the =.shaped cartilage lies at the back of the trachea, and the
ends of the M=N are connected by muscle tissue.
*he base of the trachea is located a little below where the neck meets the trunk of
the body. /ere the trachea branches into two tubes, the left and right bronchi, which
deliver air to the left and right lungs, respectively. Within the lungs, the bronchi branch
into smaller tubes called bronchioles. *he trachea, bronchi, and the first few bronchioles
contribute to the cleansing function of the respiratory system, for they, too, are lined with
mucous membranes and ciliated cells that move mucus upward to the pharynx.
Alveoli:
*he bronchioles divide many more times in the lungs to create an impressive tree
with smaller and smaller branches, some no larger than ;.1 mm (;.;4 in in diameter.
*hese branches dead.end into tiny air sacs called alveoli. *he alveoli deliver oxygen to
the circulatory system and remove carbon dioxide. 'nterspersed among the alveoli are
numerous macrophages, large white blood cells that patrol the alveoli and remove foreign
substances that have not been filtered out earlier. *he macrophages are the last line of
defense of the respiratory systemH their presence helps ensure that the alveoli are
protected from infection so that they can carry out their vital role.
*he alveoli number about 31; million per lung and comprise most of the lung
tissue. 8lveoli resemble tiny, collapsed balloons with thin elastic walls that expand as air
flows into them and collapse when the air is exhaled. 8lveoli are arranged in grapelike
clusters, and each cluster is surrounded by a dense hairnet of tiny, thin.walled capillaries.
*he alveoli and capillaries are arranged in such a way that air in the wall of the alveoli is
only about ;.3 to ;.4 microns from the blood in the capillary. Since the concentration of
oxygen is much higher in the alveoli than in the capillaries, the oxygen diffuses from the
alveoli to the capillaries. *he oxygen flows through the capillaries to larger vessels,
which carry the oxygenated blood to the heart, where it is pumped to the rest of the body.
=arbon dioxide that has been dumped into the bloodstream as a waste product
from cells throughout the body flows through the bloodstream to the heart, and then to
the alveolar capillaries. *he concentration of carbon dioxide in the capillaries is much
higher than in the alveoli, causing carbon dioxide to diffuse into the alveoli. Fxhalation
forces the carbon dioxide back through the respiratory passages and then to the outside of
the body.
Regulation:
*he flow of air in and out of the lungs is controlled by the nervous system, which
ensures that humans breathe in a regular pattern and at a regular rate. $reathing is carried
out day and night by an unconscious process. 't begins with a cluster of nerve cells in the
brain stem called the respiratory center. *hese cells send simultaneous signals to the
diaphragm and rib muscles, the muscles involved in inhalation. *he diaphragm is a large,
dome.shaped muscle that lies Aust under the lungs. When the diaphragm is stimulated by
a nervous impulse, it flattens. *he downward movement of the diaphragm expands the
volume of the cavity that contains the lungs, the thoracic cavity. When the rib muscles
are stimulated, they also contract, pulling the rib cage up and out like the handle of a pail.
*his movement also expands the thoracic cavity. *he increased volume of the thoracic
cavity causes air to rush into the lungs. *he nervous stimulation is brief, and when it
ceases, the diaphragm and rib muscles relax and exhalation occurs. 2nder normal
conditions, the respiratory center emits signals 34 to 4; times a minute, causing a person
to take 34 to 4; breaths a minute. :ewborns breathe at a faster rate, about 5; to 1;
breaths a minute.
*he rhythm set by the respiratory center can be altered by conscious control. *he
breathing pattern changes when a person sings or whistles, for example. 8 person also
can alter the breathing pattern by holding the breath. *he cerebral cortex, the part of the
brain involved in thinking, can send signals to the diaphragm and rib muscles that
temporarily override the signals from the respiratory center. *he ability to hold one9s
breath has survival value. 'f a person encounters noxious fumes, for example, it is
possible to avoid inhaling the fumes.
8 person cannot hold the breath indefinitely, however. 'f exhalation does not
occur, carbon dioxide accumulates in the blood, which, in turn, causes the blood to
become more acidic. 'ncreased acidity interferes with the action of en,ymes, the
speciali,ed proteins that participate in virtually all biochemical reaction in the body. *o
prevent the blood from becoming too acidic, the blood is monitored by special receptors
called chemoreceptors, located in the brainstem and in the blood vessels of the neck. 'f
acid builds up in the blood, the chemoreceptors send nervous signals to the respiratory
center, which overrides the signals from the cerebral cortex and causes a person to exhale
and then resume breathing. *hese exhalations expel the carbon dioxide and bring the
blood acid level back to normal.
8 person can exert some degree of control over the amount of air inhaled, with
some limitations. *o prevent the lungs from bursting from overinflation, speciali,ed cells
in the lungs called stretch receptors measure the volume of air in the lungs. When the
volume reaches an unsafe threshold, the stretch receptors send signals to the respiratory
center, which shuts down the muscles of inhalation and halts the intake of air.
PATHOPH)SIOLOG)
Pr#,&.&((&'* F,(or E(&o!o*&, A*#'( Pr#0&$.o$&'* F,(or
. Air /olluion . /nuemococcal /neumonia . &uriion
. #nhalaion or a%"iraion . 0a"hylococcal "neumonia . Age
o- no1iou% %u(%ance% 20) aureu%3 . 4eaher
. 0re"ococcal "neumonia immune
de-iciency
20) "rogenie%3
A%"iraion o- organi%m
Muli"licaion o- organi%m $ihin ,,,Relea%e o- (acerial endoo1in
!luid and lo(e%
,,, De-en%e mechani%m
(ecome
,,, incom"een or
o'er$helmed


5u"ouring #n-lammaory Re%"on%e Alered con%ciou%ne%%
&euro"hil% accumulae Allo$% a%"iraion o-
and migrae ino al'eoli oro"haryngeal racheal
#nu(aion%
Aracion o- Relea%e o- in-lammaory Accumulaion o-
&euro"hil% mediaor% -i(rou% e1udae%, red De"re%%ion o- Cough re-le1 6"igloal re-le1
Blood cell% and (aceria (y "a%%e% he u""er air$ay%
!ilraion and humidicaion o- air
Red he"ai7aion and con%olaion o-
8ung "arenchyma
Tachycardia
2 &'

(#m.#r("r#
9ray he"ai7aion and de"o%iion o-
!i(rin on "leural %ur-ace% :""er re%"iraory rac in-ecion 0ha;ing chill%
Tachy"nea
DYSPNEA
Che% "ain
COUGH
Cold%
BRONCHOPNEUMONIA
)eukocytes
'nfiltration
NURSING CARE PLANS
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
S"+3#,(&4# D(:
<#nuu(o %iya a hinde
niya maila(a% ang
"lema,= a%
'er(ali7ed (y he
05)
O+3#,(&4# D(:
/roduci'e
cough
2>3 crac;le%
u"on
au%culaion
RR? 25 c"m
I'#--#,(&4#
&r5)
,!#r',#
r#!(#0 (o
$#,r#(&o'$
&' (/#
+ro',/&
A he end o- he
%hi-, he ") $ill (e
a(le o mainain
air$ay "aency,
e1"ecorae or clear
%ecreion% readily
and %a(ili7ed '/%)
A%%e%%ed he
"aien@% re%"iraory
"aern
#n%ruced 05 o
gi'e adeAuae -luid
ina;e o he "aien
6ncouraged 05
o gi'e $arm 'er%u%
cold liAuid% a%
a""ro"riae
#n%ruced 05 o
le he "aien
e1"ecorae
%ecreion%
/ro'ide%
(a%eline daa o
gauge he e--icacy
o- nur%ing
iner'enion)
To "re'en
dehydraion and o
hel" loo%en he
%ecreion%
4arm $aer
le%%en% he
occurrence or
aggra'aion o-
coughing
To "re'en
accumulaion o-
%"uum in he
racheo(ronchial
ree hu% "re'en%
-urher o(%rucion
9oal me) A he
end o- he %hi-, he
"aien $a% a(le o
e1"ecorae %ome
%ecreion% and
$a% %a(le $ih her
'ial %ign%B RR? 23
c"m
S"+3#,(&4# D(:
/ro'ided
o""oruniie% -or
%lee" and re%
"eriod%
Re"o%iioned
clien a% o-en)
Admini%ered
medicaion% a%
ordered)
A%%e%%ed and
recorded 'ial
%ign%)
5(%er'ed -or
%ign% o-
re%"iraory
0lee" and
re% $ill "re'en
-luid lo%% -rom oo
much e1erion
e1acer(aed (y
increa%e $or; o-
(reahing
To allo$ lung%
o (e -ully
'enilaed,
mo(ili7e%
%ecreion%)
To rea
underlying cau%e)
!or Ba%eline
daa)
To "re'en -urher
aggra'aion o-
he condiion
<Cindi da$
%iya
ma;ahinga ng
malu$ang= a%
'er(ali7ed (y
he 05)
O+#,(&4# D(:
#ncrea%ed
RR? 25 c"m
/roduci'e
cough
2>3 crac;le%
u"on
au%culaion
O+3#,(&4# D(:
Decrea%ed
immuniy
Im.&r#0
*$
#%,/'*#0
r#!(#0 (o
&r
(r..&'*6
A he end o- he
%hi- he "aien
%hould ha'e
im"ro'ed ga%
e1changed
mani-e%ed (y
le%%ened mucu% and
decrea%ed RR)
A he end o- 30
di%re%%
/laced "aien
in %emiD-o$ler%
"o%iion)
#ncrea%ed -luid
ina;e)
Mainained calm
en'ironmen
$hile dealing
$ih "aien)
Admini%ered
medicaion% a%
indicaed)
&oed ri%;
-acor% -or he
occurrence o-
in-ecion)
5(%er'ed -or
locali7ed %ing%
-or in-ecion a
!or ma1imum
lung e1"an%ion o
-aciliae "ro"er
(reahing)
To loo%en
%ecreion%)
To a'oid
an1iey ha may
-urher increa%e
o1ygen need%/
con%um"ion
To rea
underlying
condiion)
#deni-ying he
"o%%i(le
cau%ai'e
-acor% hel"%
"re'en/conro
l he
occurrence o-
in-ecion)
Ei%i(le %ing%
o- in-ecion
ena(le he
9oal me a%
e'idenced (y
decrea%ed RR?23
and le%%ened
%ecreion%)
Ri%; -or
-urher
na%ocomial
in-ecion%
minue%, he "aien
ogeher $ih he 05
$ill (e a(le oF
a) Eer(ali7e
under%andin
g o-
indi'idual
cau%ai'e/ri%
; -acor2%3
() #deni-y
iner'enion%
o
"re'en/redu
ce ri%; o-
in-ecion
in%erion %ie%)
A%%e%%ed %;in
condiion%
around in%erion
%ie% o- "in%,
$ire%, and
ong%, noing
in-lammaion
and drainage)
0re%%ed "ro"er
hand $a%hing
echniAue% (y
all caregi'er%
and 05 o- he
"aien)
#n%ruced
clien/05 in
echniAue% o
"roec he
inegriy o- he
%;in)
managemen
o- more
%e'ere
in-ecion%)
The %;in i%
our "rimary
de-en%e
again%
in-eciou%
di%ea%e%)
Cand $a%hing
echniAue i% a
-ir%Dline
de-en%e
again%
no%ocomial
in-ecion%)
Care -or he
%;in inegriy
"re'en% he
occurrence o-
in-ecion)
DRUG STUD)
HYDROCORTISONE
Br'0 'm#: F!m&'*o H)0ro,or(&$o'# So0&"m S",,&'(#
C!$$&-&,(&o': G!",o,or(&,o&0
A,(&o': Regulae he mea(olic "ah$ay% in'ol'ing "roein, car(ohydrae and -a)
Co'(r&'0&,(&o'$: 8aen, healed and aci'e TB, her"e% %im"le1, chronic
ne"hrii%, acue "%ycho%i%, Cu%hing@% %yndrome, "e"ic ulcer and "redi%"o%iion
o hrom(o"hle(ii%)
I'0&,(&o'$: Acue adrenocoricoid in%u--iciency, (ilaeral adrenalecomy, %e'ere
%hoc;, acue hy"er%en%ii'iy reacion%, o'er$helming reacion% $ih %e'ere
o1iciy, 086 in rela"%e, a%"iraion "neumonii%, and oher condiion% reAuiring
he mea(olic and aniDin-lammaory acion% o- hydrocori%one)
A04#r$# #--#,($F !luid elecrolye, mu%culo%;eleal, 9#, dermaologic,
neurological, endocrine, o"hh, mea(olic di%ur(ance%)
N"r$&'* R#$.o'$&+&!&(&#$:
1) A -reAuen iner'al%, reduce he do%e gradually o deermine i- %ym"om%
o- he di%ea%e can (e e--eci'ely conrolled (y %maller drug do%e)
2) 8ocal admini%raion o- corico%eroid% i% "re-erred o'er he %y%emic
hera"y o minimi7e %y%emic %ide e--ec%)
3) :%e he lo$e% e--eci'e do%e in children and monior rouinely o a'oid
reduced rae o- gro$h)
G) Documen indicaion% -or hera"y, y"e, on%e, and characeri%ic% o-
%ym"om%)
5) &oe underlying cau%eF adrenal or nonDadrenal di%order%)
H) Chec; -or any allergic reacion% o corico%eroid% or arra7ine)
LEARNING FEEDBAC0 DIAR)
&ameF Bienelen R) Con%anino DaeF &o'em(er 0ID10, 15D1H, 2007
R86 9rou"F R86 27 C#F M%) Ma) Con%olacion !ahardo, R)&)
AreaF 0/C, !loor 1
5(Jeci'e%F
A he end o- our clinical duy, # $ill (e a(le oF
13 Accu%om my%el- more o he ho%"ial %eing and rouine)
23 Carry ou he %;ill% # learned -rom he academe)
33 5'er"o$er my di--idence and in%ecuriie% $hen dealing $ih "aien%)
G3 #m"ro'e my communicaion %;ill% o$ard% dealing $ih di--eren "aien%)
53 61"and my ;no$ledge a(ou nur%ing aci'iie%, iner'enion% and drug
"re"araion and admini%raion)
H3 #m"ro'e my %;ill% in rendering care o my "aien%)
5ne %eme%er $a% done and one more, he %chool year i% o'er)
Thi% %econd %eme%er i% anoher o""oruniy o im"ro'e he %;ill $e ;no$
in nur%ing iner'enion% and o gain more ;no$ledge o- oher nur%ing
iner'enion%) 5ur e'ery duy mean% he %ho$ca%e o- our %;ill%) 4e ha'e
o (e aler all he ime o mee he need% o- our "aien%)
Thi% i% my -ir% roaion -or he %econd %eme%er) Though i $a%
anoher adJu%men, %ince #@m ino a ne$ grou" and no o menion $e@re
ino a /M %hi-, e'eryhing $en %o %moohly) My grou" mae% are -un o
(e $ih $hich ;ee" me -rom -eeling %lee"y) 6'en our clinical in%rucor
$a% indeed a grea hel" %ince %he allo$% u% o re% once in a $hile)
# $a%n@ really my -ir% ime o ha'e my duy in 0/C, !loor 1B i $a%
my hird ime any$ay, hough no in he %ame %hi-) Bu i $a% indeed my
-ir% ime o ha'e a duy on a /M %hi-) The %eing ha%n@ change hough
here i% a lile (i change in he rouine %ince i i% ime -or he "aien% o
ha'e heir re%%) 4e ha'e o do a lo o- e1cu%e -or he di%ur(ance $e
cau%e during heir %lee"%) # $a% a nice e1"erience (y he $ay (ecau%e #
$a% a(le o ry he /M %hi-)
Thi% roaion ha% done a lo o me) # ha'e learned %ome %;ill% and #
$a% a(le o im"ro'e in he %;ill% # already ;ne$) 4ih hi% roaion, #
e1"erienced o (ecome a eam leader) #@'e e1"erienced o (e a
medicaion nur%e during he -ir% %eme%er (u no a eam leader %o i $a%
anoher challenge o me) # $a% a -un e1"erience hough here ha'e no
much o (e done %ince i $a% my ime o (ecome he eam leader $hen
hey didn@ allo$ u% %uden nur%e% o admini%er #E medicaion%) There no
much o (e done (y a eam leader com"ared o (ecoming a (ed%ide
nur%e) #@% Ju% your duy o remind he (ed%ide nur%e% a(ou he
medicaion% hey ha'e o admini%er on a %"eci-ic ime and o ma;e %ure
ha all he medicaion% $ere a'aila(le in "aien@% medicaion ray) And
al%o a he end o- he %hi-, i i% al%o your duy o com"ile all he lae% 'ial
%ign% a;en (y he (ed%ide nur%e% -or he endor%emen) Com"ared o
a;ing 'ial %ign% e'ery 2 or G hour% (y a (ed%ide nur%e, here@% nohing
much o do -or a eam leader e1ce" o ry hel"ing he (ed%ide nur%e%
$hile $aiing -or he ime o "re"are and gi'e he medicaion%)
6'ery roaion i% an o""oruniy o im"ro'e and gain more %;ill%)
And in e'eryday o- our duy, i i% a chance -or u%, nur%e%, o hel" our
"aien% heal ino a healhy indi'idual)