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Republic of the Philippines

Province of Agusan del Norte

JABONGA MUNICIPAL HOSPITAL


Purok 1, Mayugda, Poblacion, Jabonga, Agusan del Norte 8607

CLINICAL PRACTICE GUIDELINES:


COMMUNITY ACQUIRED PNEUMONIA Moderate Risk
(2016 Revision)
ER LEVEL

Initial
Assessme
nt

Consult

1. History:
Pediatric or adult
age group
Intermittent
fever
Productive /
nonproductive
cough
Acute or chronic
cough
Generalized body
malaise
Appetite changes
Chest tightness /
chest pain
Dehydration
Comorbid
conditions
2. Physical examination
Vital signs
Presence of
abnormal breath
sounds
1. Refer to physician-onduty
2. Risk stratification by
physician-on-duty
(based on CAP
Guidelines 2016
Update)
Low-risk CAP
manage as OPD
Moderate-risk
CAP for
admission
High-risk CAP

WARD LEVEL
Physical assessment upon
receiving patient at the
ward:
Vital signs to include
O2 saturation
Symptoms improved
compared to arrival at ER:
Y _____ N _____
Is patient stable:
Y _____ N _____

Refer to physician-on-duty
for new or persisting
complaints

Republic of the Philippines


Province of Agusan del Norte

JABONGA MUNICIPAL HOSPITAL


Purok 1, Mayugda, Poblacion, Jabonga, Agusan del Norte 8607
for referral to
higher
institutions

Diagnosti
cs
Interventi
ons

IVF /
Medicatio
ns

Health
teachings

CBC
Chest xray (PA / AP /
Lateral)
Moderate-high back
rest as needed
Place on NPO if visibly
dyspneic
O2 inhalation for
patients with O2
saturation < 95%
Nebulization with
bronchodilator as per
order
Start IVF as ordered
Start IV antibiotics as
per CAP Guidelines
2016 / PCAP CPG 2012
and note time of
administration
Diet as ordered

Inform patient/
significant others of
treatment plan and

Possible gram staining


if still with no
improvement after 72
hours
Safety measures as
per standard

Continuation of
antibiotic therapy
Step-up antibiotics if
there is no
improvement in vital
signs after 72 hours,
and patient should be
reassessed for
possible resistance to
the antibiotics or the
presence of other
pathogens such as M.
tuberculosis, viruses,
parasites or fungi
Maintain O2 inhalation
for patients with O2
saturation < 95%
Nebulization with
bronchodilator as per
order
Patients started on
parenteral antibiotics
can be switched to
oral therapy once
the patient is
clinically improving,
hemodynamically
stable, and has a
functioning GI tract.

Republic of the Philippines


Province of Agusan del Norte

JABONGA MUNICIPAL HOSPITAL


Purok 1, Mayugda, Poblacion, Jabonga, Agusan del Norte 8607

Discharge
Planning
and
Follow-up

Outcomes

Home
Care
Teaching

Authored by:

interventions
Provide psychological
support
One adult watcher for
the patient at ALL
times
Disposition:
Admitted to Room _____
Treated and Referred
Y _____ N _____
DOA / ER death
Y _____ N _____
Clinically stable
Y _____ N _____
HR ______
RR ______
BP _______
Temp _____
O2 sat _____
Received 1st dose of
antibiotic at ER
Y _____ N _____
Monitored intake and output
Y _____ N _____

Disposition:
Admitted to Room _____
Treated and Referred
Y _____ N _____
DOA / ER death
Y _____ N _____
Clinically stable
Y _____ N _____
HR ______
RR ______
BP _______
Temp _____
O2 sat _____
Received 1st dose of
antibiotic at ER
Y _____ N _____
Monitored intake and output
Y _____ N _____
Follow prescribed
medications and
complete medication
regimen
Limit activity, advise
adequate rest
Increase oral fluid
intake
Follow-up at OPD after
one week or earlier for
any recurrence of
symptoms

Republic of the Philippines


Province of Agusan del Norte

JABONGA MUNICIPAL HOSPITAL


Purok 1, Mayugda, Poblacion, Jabonga, Agusan del Norte 8607

HEDY SUICO GALELA, MD


Medical Officer IV OIC/COH
Copyright 2016