St.

Paul University Quezon City

(St. Paul University System) College of health Sciences A case study on

Acute Respiratory Failure

Secondary to

Community Acquired Pneumonia,

High Risk of COPD in acute exacerbation
To consider

Respiratory Encephalopathy
At Justice Jose Abad Santos By Fegarido Audrey Aaron V. BSN Level 4 Submitted to: Mrs. Karen P. Calagui, RN, MSN

I.

Introduction

Community Acquired Pneumonia This is a case of a 52 year old man, who was confined in Justice Jose Abad Santos General Hospital after experiencing an acute respiratory failure secondary to having Community Acquired Pneumonia. Pneumonia is an infection of the lung parenchyma. Community-acquired pneumonia refers to pneumonia acquired outside of hospitals or extended-care facilities. The signs and symptoms of acute pneumonia develop over hours to days, whereas the clinical presentation of chronic pneumonia often evolves over weeks to months. Despite a broad armamentarium of antimicrobials available to treat the disease, pneumonia remains the seventh leading cause of death in the United States. In 2003, the age-adjusted death rate caused by influenza and pneumonia was 20.3 per 100,000 persons. Estimates of the incidence of communityacquired pneumonia range from 4 million to 5 million cases per year, with about 25% requiring hospitalization .According to the Department of Health of the Philippines in a report back in 2005, pneumonia is in the top 3 morbidity which affected 837.4 per 100,000 which is equivalent to 652,585 of the population back in 2001. Also, in the top 3 leading cause of death, which affected 46.10 out of 100,100 which accounting for 33,709 Filipino population in the year 1998. The more dense countries are, the more likely to have a higher prevalence rate compared to less dense countries. Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. It makes it difficult to breathe. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus and Emphysema, which involves destruction of the lungs over time. Most people with COPD have a combination of both conditions. Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD. However, some people smoke for years and never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema. Other risk factors for COPD are: Exposure to certain gases or fumes in the workplace Exposure to heavy amounts of second hand smoke and pollution Frequent use of cooking fire without proper ventilation

Since the patient is a chronic smoker, and has a history of Pneumonia, learning about this case, knowing more about the history of the client would help the grasp the understanding of the complications of these diseases. Hence, studying more about this case would very beneficial for the student. II. Objectives General objective: At the end of the case study, the student involved will learn more about the disease of the patient and how it is treated. Specific Objectives: 1) Define Acute Respiratory Failure secondary to Community Acquired Pneumonia and how it affected/affects the patient. 2) Identify possible risk factors present in the clients environment and daily living 3) Recognize the normal anatomy and physiology of the respiratory system and interrelate the pathophysiology of the disease that the patient experienced. 4) Prioritize Patient problems and produce possible nursing care plan(s) on how the nursing students could render care to the patient 5) Produce a drug study to know more about the medicinal treatment of the patient 6) Create a possible discharge planning for the patient 7) Summarize the entire case and what they have learned in the conclusion III. Patients Data Name: Sex: E.Q. Female Filipino Age: 58 Single August 4, 2011 altered mental saatus

Civil Status:

Nationality:

Date of admission: Dyspnea,

Religion:

Roman Catholic

Chief complaint:

Diagnosis: Cellulitis

Acute Respiratory Failure Secondary to Community Acquired Pneumonia, High Risk Diagnosis: of COPD in acute exacerbation

History of present illness One month prior to admission, the client started to experience difficulty in breathing and shortness of breath. He would use the aid of his accessory muscles, and Pursed Lip when breathing. Normally he would self-nebulize himself with salbutamol, and also take medications at home such as antibiotics, for his cough, colds, and expectorant to normalize his condition. However, at 2:00am on the day of his admission, he started to become restless, while everyone else is asleep, he would be making noises and was doing gestures as if he was eating, drinking and smoking something but in fact he was not, he even offered his family members to eat. At 5:00 am on the day of admission, the wife became shocked when he suddenly became quiet, he was barely responsive and was just staring at the floor. When asked if they would bring him to the hospital he said, that it was up to them, and hence, they did. On the way to the hospital via jeep, he was still making gestures as if he was drinking, eating and smoking. When they arrived at Justice Jose Abad Santos for check-up, they were told that he needed to be confined

Past Health History The wife of the client said that he was diagnosed with Pneumonia back in 1999. It was treated by visiting the health centre near their home in Tondo. She said that he was able to complete the treatment regimen. The wife did not know about the patients childhood diseases and vaccination. Family History The parents of Mr. E.Q. both have a history of tuberculosis and Hypertension in which they may have died from. His Siblings also suffer from Hypertension, Asthma and tuberculosis.

The wife of Mr. E.Q. suffers from diabetes and pneumonia. Both her parents also Suffer from pneuomia and her mother suffer from diabetes. Among her siblings tuberculosis is also present.

IV. Nursing Theorist Florence Nightingales Environmental Theory Ventilation Light Nutrition

E.Q.

Cleanliness Clean Water

Efficient Drainage

Nightingale viewed the manipulation of the physical environment as a major component of nursing care. When one or more aspects of the environment are out of balance, the client must use more energy to counter the environmental stress. These stresses hinder the client to heal efficiently. These aspects of physical environment are also influenced by the social and psychological environment of the individual. Application The environment is a big factor when it comes to patients who are at high risk of respiratory disease, like for the patient in this case study. Proper ventilation of the environment and better yet, reverse isolation from infected individuals in the community is important to avoid respiratory diseases so as to promote healing. Hygiene also play a vital role in the healing process in order to eliminate the accumulation of bacteria in the body that could eventually worsen the condition of the patient.

V. Gordons Assessment VI. During Hospitalization Health Perception and Management He was able to complete his The patient would nod when his treatment according to his wife relatives chant out to get well soon after being diagnosed with CAP. and to fight. However, he would still smoke 2 packs of cigarettes a day, and his relatives said that he thinks of this as his vitamins. His wife also said that he was afraid to go to the hospital since they do not have money, no one would take care of him when hes confined and would just visit the local health centre Nutrition and Metabolism The patients favourite meal is Now he is limited to 1600kcal sugar or banana with rice and osterized feeding, which is divided biko. Would also eat vegetables into 6 equal feedings. If not when hes in the mood. present Milk would be given instead. They rarely eat meat as they cannot afford it They would eat fish at least once a week He would regularly drink water on a daily basis, roughly around 2 litters per day The patient would urinate 5 times a day, amount is not known by the clients wife but is dark yellow in color. Elimination The patient is on Foley Catheter, and is draining around 1000-2000 litters per day, dark yellow- orange in color. Since the patient had to use a urinal and bedside commode, the patient finds it difficult to urinate regularly The patient has poor nutritional status prior to confinement and now that hes confined hes given NGT as he may aspirate his food and may further aggravate his condition. Before Hospitalization Interpretation Inspite of his condition he is determined to fight off his disease and go home as soon as possible as they have financial difficulties

He would Defecate around twice Hes on diaper and no bowel a day movement is noticed during the students shift. Activity and Exercise Before his current hospitalization The patient is bed ridden, could he would sell in their sari sari only move his arms and legs at a store, and would also have side limited motion. lines when theres a festival in their municipality. He would also read the bible as they attend a couple group in their church, and also reads the news paper Sleep and Rest The wife said he never has long The patient would still wake up

Due to the fatigue and body malaise that the patient is experiencing the patient is inactive.

Due to pain and fatigue that

periods of sleep he would just sit from time to time, but usually hes the patient experience, the and, close his eyes for a 5- asleep difficulty of breathing, 15minutes then he would then accumulated secretions that again be awake and this occurs needs to be suctioned, he day and night can barely have enough sleep Coping and Stress Management He would smoke when hes As he is currently hospitalized, he They barely have money to stressed. He would also pray. is stressed and worried about the commute to the hospital His children also expressed that hospital bill payments and wants to since they live very far he would always be hot go home. away, and hes worried they tempered by his grandchildren wont be able to pay off for being their bills and no one would take care of him Cognitive and self-Perception The patient is able to read and The patient could still write when Due to his disease, client write, he finished third year high he cant verbalize his needs, and perceives himself as school. now that hes confined, he was someone weak. asked to write what he thinks of himself, and he wrote that he is a weak person. Sexual Reproductive pattern The client and his wife has not Even more that he is confined. Due to age, loss of libido been sexually active for the past There is a foley catheter inserted. may have risen, also the 5 years. The wife said that they wife is embarrassed of her stopped because of her diabetes diseases and prompted to and pneumonia. stop. Role Relationship The patient is able to fulfil his Now, he is confined and is not able Hospitalization and his role as a father and a to fulfil his roles. condition affects his role in grandfather. He would teach his the family. means of earnings to both his children and grandchildren Values and Beliefs The patient is a Roman Catholic Now, he is unable to pray . They are religious , he and his wife attend couple groups in their church and would He would always tell his children constantly pray. and grandchildren not to have girlfriend too early, also not to mingle with those who are married already.

VII. Physical Assessment Date done: Vital Signs Assessment November19, 2011 BP: 130/80 Temp:36.8rC Pulse rate: 108 Respiratory Rate: 18 Normal Findings Actual Findings Interpretation

General Appearance Eye contact Maintained, able to Facial Expression smile, and perform other facial expression as desired Only shows facial grimace when coughing or when experiencing dyspnea Blunt affect The patient would frequently have accumulated secretions and would cough or be in need of suctioning from time to time, hence disturbed sleep patterns, lethargic and He expresses the desire to just go home as said by the Cooperative, nonviolent, Conversant, Mood and Behavior able to interact well to the people around him significant others. Cooperative when asked questions and obeys commands with repetition. Responds positively with a raise of his eye brows when his relatives tells him not to give up Firm Muscle Body Built developed and strong Dressed Clothing SKIN Generalized color Texture Brown Rough and moist Possible factor was because of the poor hygiene Smooth Due to old age and heat of the hospital & diaphoresis Appropropriately Poor Muscle movements tone, slow Due to inadequate nutrition, and the energy demands of the disease to the heat of the Poor lessen economic the length status of motivates client to get well to confinement.

Topless and diaper, only Due covered by his top sheet

hospital

Turgor

Returns immediately

Skin slowly returns into its normal state

Decreasing elasticity with age

Edema

Non present

Present at the hands and feet Lesions present at both

Fluid accumulation Due to frequent IV line reinsertion secondary to infiltration or phlebitis.

Lesions

Non present

hands

Head Color and distribution according to age, Hair non-oily, absence of parasites and dandruf Black with localized distrubition of grew hair strands. Oily hair depressed to the right lower Face Symmetrical side Due to the existence of endotracheal tubing Due to progressing age

Eyes are symmetrical, the patient is able to blink but

Located symmetrically, Blinking symmetrically, 15 blinks/min Clear with tiny vessels visible

would stare for about a minute then closes it again for a long period of time. Eyes are irritated The sides of is sclera on the left eye is reddened
Pupils equally reactive to light and accommodation, pupillary size 2-3mm

Eyes
Pupils equally reactive to light and accommodation, pupillary size 2-3mm

Ears

Ears of equal size and similar appearance. Pinna aligned with the eye and has absence of

Ears of equal size and similar appearance. Pinna aligned with the eye and absence of secretions

normal

secretions Prolonged ET tubing Mouth Pinna aligned with the eye secondary to Respiratory Pinna aligned with the eye failure and due to the diet preferences of the patient Neck Neck has limited movements since he has to lean to his right as the oxygen is there where the ET tubing is attached. Redness is also seen Thorax Deep rapid respiration is noted with the aid of his accessory muscle while breathing. The area of his chest near to his neck is also reddened S1 exhibited a quick diastolic pause and followed by the systolic pause and corresponds to each carotid pulsation Ranged from 104-120 beats/min within the course of 3 days. Compensatory mechanism of the body due to the impair gas exchange in the body due to ineffective airway clearance. Client has limited neck motion The neck is irritated due to prolonged bed rest and the hot environment

Normal in size, shape and colour and can move regularly

No pain No adventitious breath sounds

heart

S1 follows the long diastolic pause and precedes the short systolic pause and corresponds to each carotid pulsation. 60-100 beats/min, Regular

Tachycardic

Abdomen Umbilicus Position Sunken, centrally located Absence of lesions 1 bowel sound heard every 5-15 second 2 bowel sound per minute is noted Gurgling sound heard upon administration of air Extremities Umbilicus Position Sunken, centrally located Absence of lesions Slow bowel movement Normal

NGT is still at the correct position

Radial and brachial pulses are strong and palpable Bilaterally symmetric and has no edema. Arms are mobile with wide range of motion. Free of lesions and have no edema. Nail beds are pink, round and immbobile Nails Capilliary refill is quick Legs are mobile with Lower wide range of motion. Free of lesions and have no edema. Glasgow Coma Scale Eye opening Verbal Motor Response Spontaneous Oriented Obeys Commands

IV site with on going PNSS 27-28gtts/min, side drip of D5W250ml+ Aminophyline and another D5W250+2 ampules of Dopamine are present at the right arm Able to raise hands upon command, and even write to answer question

upper

normal

Nail beds are slightly pale pink Quick capilliary refill noted Normal

Legs are slightly mobile with wide range of motion and weakness noted. Free of lesions and have no edema To voice none Obeys commands Total 3 1 6 10 Decreasing motility

VIII.

Anatomy and Physiology

There are two major parts of the respiratory system: the upper respiratory tract and the lower respiratory tract. The upper respiratory tract consists of the nose, sinuses, pharynx, larynx, trachea, and epiglottis. The lower respiratory tract consists of the bronchi, bronchioles and the lungs. Each lung is enveloped in its own double walled sac called the pleurae. The innerwall, the visceral pleura, adheres to the outer surface of the lung. The outer wall, the parietal pleura, is an extension of the visceral pleura that doubles back on itself at the hilum and runs along the surface of the rib cage, diaphragm and mediastinum. Both pleurae are serous membranes, which secrete a thin layer of watery pleural fluid into the pleural cavity that separates them. The major function of the respiratory system is to deliver oxygen to arterial blood and remove carbon dioxide from venous blood, a process known as gas exchange. The normal gas exchange depends on three process: 1) Ventilation is movement of gases from the atmosphere into and out of the lungs. This is accomplished through the mechanical acts of inspiration and expiration. 2) Diffusion is a movement of inhaled gases in the alveoli and across the alveolar capillary membrane 3) Perfusion is movement of oxygenated blood from the lungs to the tissues. The control of gas exchange involves neural and chemical process.The neural system, composed of three parts located in the pons, medulla and spinal cord, coordinates respiratory rhythm and regulates the depth of respirations.The chemical processes perform several vital functions such as: y regulating alveolar ventilation by maintaining normal blood gas tension

guarding against hypercapnia (excessive CO2 in the blood) as well as hypoxia (reduced tissue oxygenation caused by decreased arterial oxygen [PaO2]. An increase in arterial CO2 (PaCO2) stimulates ventilation; conversely, a decrease in PaCO2 inhibits ventilation.

helping to maintain respirations (through peripheral chemoreceptors) when hypoxia occurs.

IX. Pathophysiology

Predisposing Factor: Age: 58 Gender: Male

Precipitating Factors Sedentary Lifestyle, Smoking Environmental Condition Exposure to microorganisms

Presence of Streptococcus pneumonia, anaerobic bacteria and other gram-negative bacilli in the environment Inhalation of droplets

Trapped by the cilia and mucous in the upper respiratory airway

Aspiration of secretions into lower respiratory tract

Adhesion to the endothelial cells of the aveoli

Rapid replication of bacteria

Stimulation of the inflammatory response Fever diaphoresis Increased heart rate

Cytokines, Chemotaxins released

Increase Vascular permeability

Increase migration of red blood cells, fluid and neutrophils in the affected area

Vascular congestion persists

Extravasation of red blood cells in the alveolar spaces, and increased number of neutrophin and fibrin a fluid

White sputum production Increase mucus production Occlusion of airway passages Prolonged Venous blood entering pulmonary circulation passes through under ventilated areas Acute respiratory Failure Exudates fills the airspaces and remains

Shortness of breath

Consolidation of the alveolar parenchyma

Risk for COPD

Blood circulated poorly oxygenated

Hypoxemia Altered level of consciousness Shortness of breath Prolonged

Respiratory encephalopathy

Medical and Nursing Management Laboratory Results

Electrolytes Date: November 18, 2011 Component Sodium Result 122.1 Reference Range 135-148 mmol/L Interpretation Due to decreased sodium intake, or excessive sweating normal

Potassium

4.52

3.50-5.00 mmol/L

Chloride

82.7`

98-107 mmol/L

Dehydration may be due to excessive sweating

Clinical Date: November 12, 2011 Component Result Glucose (Fasting 7.22 Blood Sugar) Blood Urea Nitrogen 3.31 Reference Range 3.88-6.38 mmol/L Interpretation Normal Normal 2.14-7.14 mmol/L

Chemistry

Creatinine 49.8 Total Cholesterol Triglycerides Very Low Density Lipoprotein High Density Lipoprotein Low Density Lipoprotein BUA 3.37 0.61 0.61 0.81

M: 59-104 mmol/L F: 48-84 mmol.L 0-5.2 mmol/L 0-2.3 mmol/L Up to 1.05 mmol/L 0.91-1.56 mmol/L

Decreased blood flow to kidneys

Normal Normal Normal Risk for Heart Disease

3.67

M: 2.29-3.05 mmol/L F: 2.11-2.74 mmol/L M: 202.3-416.5 mmol/L F: 2.11-2.74 mmol/L M: up to 38 U/L F: 2.11-2.74 mmol/L

Risk for Heart disease

150.5

Normal High AST may be caused by Drug

Aspartate amino 39.1 transferase (AST)

Metabolism Alanine amino 18.5 transferase (ALT) M: up to 41 U/L F: up to 31 U/L Normal

Drug Study Drug Name Action Side Effects Indication Contraindicati on Nursing Consideration Monitor blood pressure, Generic Name: Dopamine Hydrochloride . effects Major produced Cardio Hypotension, beats, Vascular: To tachycardia, imbalance due to correct Pheochromocyt oma; in tachyarrhythmi MI ventricular fibrillation. Mechanical trauma, Weaning pulse, peripheral pulses, and urinary output every hour. essential from Report indicators physician suspending for the for Precise are accurate following to in use or measurements titration of dosage. promptly cardiovascular by direct action on Brand Name: Dopastat, Revimine Classifications: Autonomic alpha- and betareceptors and on specific dopaminergic in and vascular combined and effects, nervous receptors Intropin, adrenergic ectopic hemodynamic

anginal pain, palpitation, shock vasoconstriction (indicated

syndrome as

by (cardiogenic

disproportionate rise in shock), diastolic pressure), cold endotoxic extremities; frequent: widening pressure. GastroIntestinal: Nausea, vomiting CNS: Headache. Skin: Necrosis, tissue with Other: sloughing piloerection. of

less septicemia (septic Ventilation aberrant shock), open heart QRS COPD

decreasing or temporarily dose: Reduced urine flow rate in absence of hypotension; ascending dysrhythmias; disproportionate rise in tachycardia;

system agent; alpha- mesenteric and beta-adrenergic renal agonist (sympathomimetic) Dosage & route Incorporated D5W250cclevel regulated 10ugtts/min beds. Has in inotropic vasopressor

conduction, bradycardia, surgery, and CHF. complex, elevated blood

but it may also at exert effects by significant on the

diastolic pressure (marked decrease pressure); peripheral coldness, in signs pulse of ischemia complaints of

respiratory system decreasing oedema formation

extravasation, gangrene,

(pallor, cyanosis, mottling,

and function

improving

Azotemia, dilated doses).

dyspnea, pupils (high

tenderness, numbness, sensation). Monitor effectiveness or

pain, burning

respiratory muscle

therapeutic by

assessment of adequate dosage and perfusion of vital organs include loss of pallor, increase in toe

temperature, adequacy of nail bed capillary filling, and reversal of confusion or comatose state.

Drug Name

Action

Side Effects

Indication and

Contraindication Nursing Consideration Monitor for S&S of toxicity (generally related to theophylline serum levels over 20 mg/mL). Observe patients receiving parenteral drug closely for signs of hypotension, arrhythmias, and convulsions until serum theophylline stabilizes within the therapeutic range. Note: High incidence of toxicity is associated with rectal suppository use due to erratic rate of absorption. Monitor & record vital signs and I&O. A sudden, sharp, unexplained rise in heart rate may indicate toxicity. Lab tests: Monitor serum theophylline levels. Note: Older adults, acutely ill, and

Inhibits betaGeneric Name lactamase which AMINOPHYLLINE (theophylline is responsible for ethylenediamide) drug resistance. Brand names: Hence, Causing Corophyllin , wide range of Paladron , Phyllocontin, inhibition of Somophyllin, betalactamases Somophyllin-DF, Truphylline found in Classifications: Bronchodilator (respiratory smooth relaxant) Incorporated D5W250cc running 20ugtts/min in level for muscle organisms resistant penincillins cephalosporins

CNS: Nervousness, To restlessness, depression,

prevent Hypersensitivity relieve to xanthine of derivatives or to ethylenediamine component; and cardiac of arrhythmias.

symptoms bronchial muscle asthma treatment associated

insomnia, irritability, acute headache, dizziness, hyperactivity, convulsions. CV:

bronchospasm Cardiac with chronic

to arrhythmias, and tachycardia rapid hyperventilation, chest pain, severe hypotension, cardiac arrest. GI: vomiting, Nausea, anorexia, IV),

bronchitis and (with emphysema.)

patients problems,

with liver

severe

respiratory or

dysfunction,

hematemesis, diarrhea, epigastric pain

pulmonary edema are at greater risk of toxicity due to reduced drug clearance.

Drug Name Generic Name Clarithromycin Brand names: Biaxin, Biaxin XL Classifications: Macrolide antibiotic Route,frequency dosage 500 mg tab/ BID per orem

Action

Side Effects CNS:

Indication Treatment of lower respiratory infections caused by Mycoplasma pneumoniae, S. pneumoniae, H. influenzae, M.

Contraindication Contraindicated with hypersensitivity to clarithromycin,

Nursing Consideration Culture infection before therapy. Do not cut or crush, and ensure that patient does not chew ER tablets.

Inhibits protein synthesis in susceptible bacteria, causing cell death

Dizziness, headache, vertigo, somnolence, fatigue, GI:Diarrhea, abdominal pain, nausea, dyspepsia, flatulence, vomiting, melena, immune system: Superinfections, increased PT, decreased WBC

erythromycin, or any macrolide antibiotic.

Monitor taking toxicitiy with grape response. juice due to risk of

patient

for

anticipated

catarrhalis

Administer without regard to meals; administer with food if GI effects occur.

Drug Name Generic Name Salbutamol Brand names: Ventolin Proventil Volmax Classifications: Bronchodilator (respiratory smooth relaxant) Dosage,frequency and route Q4 via Nebulizer muscle

Action binds to the b2adrenergic receptors in the airway of the smooth muscle

Side Effects CNS: Nervousness Restlessness Tremor Headache Insomnia CV: Palpitations Angina Arrhythmias

Indication To and acute bronchial asthma treatment associated with

Contraindication Nursing Consideration disease Assess lung sounds, PR and BP before drug administration and during peak of a medication.

prevent Cardiac relieve including of coronary

symptoms

insufficiency,

history of stroke, Observe fore paradoxical spasm and and coronary of disease arrhythmias artery withhold medication and notify physician and if condition occurs. Administer PO medications with meals to minimize gastric irritation. Extended-release tablet should be swallowed-whole. It should not be crushed or chewed. If administering medication through inhalation, allow at least 1 minute Geriatric patients between inhalation of aerosol older for reactions may lower dosage individuals medication. Advise the patient to rinse mouth with water after each inhalation to minimize dry mouth. Inform the patient that Albuterol may cause an unusual or bad taste. adverse and require are at higher risk

Activation of the adenyl cyclase and increased levels of cyclic- 35adenosine monophosphate (cAMP). cAMP increases kinases activated Kinases inhibit the phosphorylation of myosin and decrease intracellular calcium. Decreased in intracellular calcium will result to the relaxation of the smooth muscle airways

bronchospasm cardiac chronic Hypertension Diabetes Glaucoma

bronchitis and Hyperthyroidism

Hypertension. emphysema.) GI: Nausea,

vomiting, hypokalemi hypokalemia

X. Discharge Planning Medication: Inform the client about the importance of taking antibiotic drugs at the right time as prescribed the physician as drug resistance may occur and the effectiveness of the drug can be compromised. Instruct significant others to follow prescribe frequency of nebulizing salbutamol as this may cause heart failure. Exercise: Perform Range of motion exercises to prevent muscle atrophy Treatment: Encourage following and continuing medications prescribed by the doctor and follow proper diet and exercise taking the full course medications. Health teaching: Teach Significant others about the disease process, mode of transmission and possible ways of preventing it, ex. Hand washing, Wearing masks Out-Patient: Instruct the significant others to rush to the hospital as soon as respiratory distress occurs Diet: Encourage clients to eat food rich vitamins such as green leafy vegetable and also High Protein Diet in order to help the body repair itself when physician allows it. Spiritual: Encourage the family to engage in spiritual activities together to stronger and to promote a deeper spiritual lifestyle. help keep the faith

XI. Conclusion

Based from this drug study, the student was able to know more about the complications of Community Aquired Pneumonia especially about its risks factors and its diseases process on how it affected the clients respiratory system. By learning about the disease, the student was able to create prioritized nursing care plans, how the drugs help the patients condition. Seeing the progress of this patient was a fulfilling experience for the student, and learning more about the disease would help in future encounters with the same disease and further promote care and recovery of the patients with Community Acquired Pneumonia.