St.

Paul University Philippines

Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

A CASE STUDY ON
COMMUNITY-ACQUIRED
PNEUMONIA
(MODERATE RISK)

AREA: INTENSIVE CARE UNIT

Submitted by:

Sheryl Ann P. de Leon

BSN A4 – A2

Submitted to:

Ms. Joyce M. Taguna, RN

 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

TABLE OF CONTENTS

I. INTRODUCTION..............................................................................................................................................

II. DIAGNOSIS AND ASSESSMENT HISTORY................................................................................................

III. PHYSICAL ASSESSMENT AND OTHER VITAL ASSESSMENT..............................................................

IV. CONCEPT MAP OF CONDITIONS OF ILLNESS.........................................................................................

V. PATHOPHYSIOLOGY ...................................................................................................................................

VI. LABORATORY AND DIAGNOSTIC TESTS.................................................................................................

VII. DRUG STUDY..................................................................................................................................................

VIII. NURSING CARE PLAN...................................................................................................................................

IX. REFERENCES...................................................................................................................................................
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

I. INTRODUCTION

Pneumonia is a leading cause of hospitalization and death among elderly adults. It is an infection
that affects one or both lungs. It causes the air sacs, or alveoli, of the lungs to fill up with fluid or pus.
Bacteria, viruses, or fungi may cause pneumonia. The lungs are made up of small sacs called alveoli,
which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are
filled with pus and fluid, which makes breathing painful and limits oxygen intake. These infections are
generally spread by direct contact with infected people (World Health Organization). For elderly
individuals, factors such as weakened or suppressed immunity, comorbidities, diminished cough reflex,
and poor functional status contribute to the increased incidence of pneumonia compared with that of
younger adults.

Symptoms can range from mild to serious and may include a cough with or without mucus (a
slimy substance), fever, chills, and trouble breathing (National Heart, Lung, and Blood Institute, 2022).
One or more of the following tests may be ordered to evaluate for pneumonia:

● Chest x-ray: An x-ray exam will allow the doctor to see the lungs, heart and blood vessels to help
determine pneumonia. When interpreting the x-ray, the radiologist will look for white spots in the
lungs (called infiltrates) that identify an infection. This exam will also help determine any
complications related to pneumonia such as abscesses or pleural effusions (fluid surrounding the
lungs).
● CT of the lungs: A CT scan of the chest may be done to see finer details within the lungs and
detect pneumonia that may be more difficult to see on a plain x-ray. A CT scan also shows the
airway (trachea and bronchi) in great detail and can help determine if pneumonia may be related
to a problem within the airway. A CT scan can also show complications of pneumonia, abscesses
or pleural effusions and enlarged lymph nodes.
● Ultrasound of the chest: Ultrasound may be used if fluid surrounding the lungs is suspected. An
ultrasound exam will help determine how much fluid is present and can aid in determining the
cause of the fluid.
● Needle biopsy of the lung: The doctor may request a biopsy of the lung(s) to determine the cause
of pneumonia. This procedure involves removing several small samples from the lung(s) and
examining them. Biopsies of the lung can be done using x-ray, CT, ultrasound and/or MRI.
The following image-guided treatments may be used for pneumonia:
● Thoracentesis: Fluid may be taken from the chest cavity and studied to help doctors determine
which germ is causing the illness. X-ray, CT and/or ultrasound may be used during thoracentesis.
The fluid removed during this procedure may also help provide symptom relief.
● Chest tube placement: During this procedure, also known as thoracostomy, a thin plastic tube is
inserted into the pleural space (the area between the chest wall and lungs. The tube can help
remove excess fluid or air. The procedure is performed under the guidance of CT or ultrasound.
● Image-guided abscess drainage: Image-guidance helps direct placement of a needle into the
abscess cavity and can aid during insertion of a drainage tube. If an abscess has formed in the
lungs, it may be drained by inserting a small drainage tube (catheter). Image guidance, including
fluoroscopy, x-ray, ultrasound or CT, is used.
Pneumonia is typically categorized based on where it is acquired.
● Community-acquired pneumonia (CAP) occurs outside of healthcare settings and is often
contracted through inhalation or aspiration of bacteria like Streptococcus pneumoniae. It can
affect anyone, leading to symptoms such as shortness of breath, fever, chest pain, and cough.
● Nosocomial pneumonia is acquired within a hospital setting and includes both hospital-acquired
pneumonia (HAP) and ventilator-associated pneumonia (VAP).
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

■ HAP develops 48 hours or more after hospital admission.

■ VAP occurs after 48 hours of mechanical ventilation. These types of pneumonia
are often more severe due to the presence of more aggressive pathogens like
Klebsiella Pneumoniae and the vulnerable state of hospitalized patients (Pahal P,
Rajasurya V, Sharma S., 2023).
Mild CAP - Patients who are otherwise healthy and have normal vital signs (apart
from fever) can often be treated at home.
Moderate CAP - Patients with more significant symptoms or changes in oxygen
levels typically need hospital care.
Severe CAP - Patients with severe symptoms, such as respiratory failure or sepsis,
may require ICU admission. Early identification of severe cases and prompt
treatment in the ICU can improve outcomes.

According to the World Health Organization, pneumonia killed more than 808 000 children under
the age of 5 in 2017, accounting for 15% of all deaths of children under 5 years. People at-risk for
pneumonia also include adults over the age of 65 and people with preexisting health problems.

The number of deaths among those aged 70 and older increased — from around 600,000 in 1990
to over 1 million in 2019. This is largely because of a growing and aging population. The death rate from
pneumonia in this age group fell slightly. The risk factors for developing pneumonia in people aged 70
and older are similar to the risk factors that lead to pneumonia in children. Outdoor air pollution — small
particulate matter air pollution — is a major risk factor for dying from pneumonia, as you can see in the
chart. In addition, smoking and exposure to secondhand smoke are also important risk factors (Dadonaite
B., Roser M. 2024).

Findings suggest that the number of hospital admissions among individuals aged ≥65 years in
industrialized countries was comparable to the number of admissions in developing countries (ie, 3.1
million and 3.7 million, respectively). This may be partially explained by the high proportion of older
adults and low thresholds for hospital admission in industrialized countries and poor care-seeking
behavior in developing countries (Global and Regional Burden of Hospital Admissions for Pneumonia in
Older Adults: A Systematic Review and Meta-Analysis, 2020).

In the study “Etiology and epidemiology of community-acquired pneumonia in adults requiring

hospital admission: A prospective study in rural Central Philippines”,clinical factors and bacterial and
viral pathogens were identified among hospitalized adult patients with CAP in a rural area in Central
Philippines. The results showed that the majority of CAP patients were younger than 50 years of age. H.
influenzae, K. pneumoniae, S. pneumoniae, and M. tuberculosis were the most commonly identified
bacteria, while influenza virus, rhinovirus, and respiratory syncytial virus were the most commonly
detected viruses. The proportion of clinical CAP patients who died during hospitalization was as high as
13%, which indicates that pneumonia is an important cause of mortality in the country. It was observed
that patients who died of pneumonia were most likely drowsy on admission and had an SpO2 of <90%.
According to the Philippine Statistics Authority, pneumonia is the leading cause of death. 66.68
out of 100,000 people in region 2 (Cagayan Valley) died due to this infection in 2015. Cagayan Valley in
2021 had 6,981 cases and 1,608 deaths caused by Acute Lower Respiratory Tract Infection &
Pneumonia. In 2022, there was a rise in the number of cases with a number of 11,518. However, the
number of deaths is not yet available for 2022.
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

II. DIAGNOSIS AND ASSESSMENT HISTORY

Personal and Demographic Data

Client’s Initial A.R

Age 75 y/o

Sex Male

Address Sta. Margarita, Baggao,

Cagayan

Date of Birth October 23, 1949

Religion Roman Catholic

Nationality Filipino

Civil Status Married

Occupation Farmer

Attending Physician Dr. L. Vea-Francisco

Body Mass Index (BMI) Height: 170 cm

Weight: 75 kg
BMI: 26 (Overweight)

Chief Complaint
Patient A.R was admitted to CUDMC on the 5th of February 2025. Patient A.R have Cough: Left Sided Body
Weakness.

History of Present Illness

The patient, a 75-year-old male, was in his usual state of health until January 9, 2025, when he
experienced sudden-onset slurred speech. No other neurological deficits or associated symptoms were
noted at the time. No immediate medical consultation was sought. On January 18, 2025, the patient
developed left-sided body weakness, which progressively worsened. He was taken for consultation at
PMA and was noted to have generalized body weakness and pallor. Upon assessment in Baggao, his vital
signs revealed:

• Oxygen saturation (SpO₂): 88% on room air

• Blood pressure (BP): 180/120 mmHg (hypertensive crisis)

The presence of neurological symptoms, pallor, and hypoxia raised concerns for a possible stroke or
other neurological event, warranting further evaluation and management.

Past medical history

III. The patient has a history of hypertension, as indicated by the use of nicardipine, a calcium
channel blocker prescribed for blood pressure management. The patient has also used a nebulizer,
suggesting a possible underlying respiratory condition such as asthma or chronic obstructive
pulmonary disease (COPD). Additionally, the patient was given cefuroxime (Ceflu), an antibiotic
that may have been prescribed for a recent or ongoing bacterial infection. There are no reported
allergies for the patient.
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

III. PHYSICAL ASSESSMENT AND OTHER VITAL ASSESSMENT (PATIENT

CENTERED)

AREA ASSESSED TECHNIQUE NORMAL ACTUAL FINDING INTERPRETATION

FINDINGS

Skin Color, Inspection, Evenly colored skin The skin is brown ABNORMAL
texture, Palpation tone without unusual complexion and is warm
temperat discoloration seen; touch. Blisters on right These signs indicate
ure Smooth with no arm, right thigh and in skin integrity
presence of lesion, both ankles noted. Grade compromise likely due
the skin is warm, and 2 pressure ulcer on the to immobility, pressure,
it immediately recoil buttocks are also seen. or infection, requiring
prompt assessment,
wound care, and
preventive measures.

Neck Inspection There is no There is a tracheostomy ABNORMAL

abnormal swelling on the patient neck.
or masses found. The tracheostomy
presence indicates a
severe underlying
respiratory issue or a
need for assisted
breathing.

ABNORMAL
Tone Percussion Resonance is the Dullness to percussion
percussion tone Dull percussive
elicited over normal sounds are indicative
lung tissue. of abnormal lung
Percussion elicits density including
flat tones over the pneumonia
scapula.

ABNORMAL
Diaphrag Percussion Excursion is should Weak diaphragmatic Diaphragmatic
matic be equal bilaterally excursion weakness is caused by
excursio and measure 3-5 inflammatory factors
n cm and infectious factors
such as pneumonia
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
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SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

Adventiti Auscultation No adventitious Crackles heard on both ABNORMAL

ous sound such as sides of the lungs
Sounds crackle or wheezes Pneumonia often leads
are auscultated to inflammation and
fluid accumulation
(such as pus or serous
fluid) in the alveoli
and bronchi. When air
passes through these
fluid-filled or
inflamed areas, it
creates crackling
sounds.

Hands Size, Inspection and Hands and feet are The hands and feet are ABNORMAL
and feet shape, Palpation symmetric, symmetric. Blisters on
symmetr nontender, and the ankle are noted. The findings show
y, without nodules, no Edema on the left and blisters on the ankle,
swelling, swelling, right hand and feet are possibly due to
and deformities. noted.
friction, pressure, or
color.
infection. Symmetric
hands and feet
suggest no deformity
or trauma. Edema in
both hands and feet
indicates fluid
retention, potentially
from heart failure,
kidney disease, or
venous
insufficiency.

Neurolog GCS Inspection The patient GCS GCS 8 ABNORMAL

ical score score is 15
The patient is awake, A GCS of 8
withdraws to pain, and indicates severe
has no verbal response impairment of
due to the presence of consciousness.
an NGT.

IV. CONCEPT MAP OF CONDITIONS OF ILLNESS

Anatomy and Physiology of the Lungs

The lungs are vital organs in the respiratory system,
responsible for oxygenating blood and removing carbon
dioxide from the body.

Upper Respiratory Tract

A. Nasal Cavity: The nasal cavity serves as the entry
point for inhaled air. It cleanses the air by trapping
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

dust, debris, and pathogens in mucus. Simultaneously, it warms and humidifies the air to protect
the delicate tissues in the lower respiratory tract.
B. Pharynx (Throat): Acting as a shared passageway for both the respiratory and digestive systems,
the pharynx ensures air moves from the nasal cavity or mouth to the windpipe. It also plays a
critical role in swallowing, directing food toward the esophagus.
C. Larynx (Voice Box): The larynx produces sound through vocal cord vibrations and prevents food
from entering the trachea by coordinating with the epiglottis. This mechanism ensures safe
separation between the respiratory and digestive pathways.
Lower Respiratory Tract
1. Trachea (Windpipe): The trachea is a sturdy tube lined with ciliated cells and mucus to filter and
transport air to the lungs. Its cartilage rings maintain its structure, ensuring unobstructed airflow.
2. Primary Bronchi: At the carina, the trachea splits into the right and left primary bronchi, which
enter each lung through the hilum. These large airways deliver air to the lungs for further
distribution.
3. Bronchioles: The primary bronchi subdivide into smaller bronchi, eventually forming
bronchioles. These tiny branches ensure even distribution of air within the lungs and regulate
airflow resistance.
4. Alveoli: At the end of the bronchioles are alveoli, microscopic air sacs surrounded by a dense
network of capillaries. This is the site of gas exchange, where oxygen enters the blood, and
carbon dioxide is expelled.

Physiology of Gas Exchange

● Oxygen-rich air enters the upper respiratory tract (nose, nasal cavities, larynx) and moves through
the trachea, which divides into the right and left primary bronchi at the carina.
● The primary bronchi and blood vessels from the heart (pulmonary artery and vein) enter the lungs
at the hilum.
● The bronchi divide into smaller airways, including secondary (lobar) and tertiary (segmental)
bronchi, leading to bronchioles, alveolar ducts, and alveolar sacs where gas exchange occurs.
● The diaphragm facilitates breathing by contracting downward to create negative pressure,
drawing air into the lungs, and relaxing to expel air.
● The alveolar sacs contain capillaries that support gas exchange. The pulmonary artery delivers
deoxygenated blood to the lungs for oxygenation, while the pulmonary vein carries oxygenated
blood back to the heart.
● Oxygen crosses the thin membrane of alveolar capillaries to bind to red blood cells, while carbon
dioxide, a metabolic waste product, moves from the blood into the lungs to be exhaled.

V. PATHOPHYSIOLOGY
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

VI. LABORATORY AND DIAGNOSTIC TESTS

Test Name Result Unit Normal Range Interpretation

ARTERIAL BLOOD GAS

pH 7.42 7.35-7.45 NORMAL

pCO2 33.4 35-45 ABNORMAL

Low PaCO2 indicates
respiratory alkalosis due to
hyperventilation.

HCO3 20 22-26 ABNORMAL

Low HCO3 suggests the
presence of metabolic
acidosis due to inadequate
blood flow to organs,
which causes buildup of
metabolic acids.

tCO2 24 22-27 NORMAL

SO2 98 95-100 NORMAL

VII. DRUG STUDY

Generic Name: Twynsta
Drug Classification: Combination drug (Calcium channel blocker and Angiotensin II receptor
antagonist)
A calcium channel blocker that works by relaxing the blood vessels, reducing the workload on the heart,
and improving blood flow while angiotensin II receptor antagonist (ARB) blocks the action of angiotensin
II, a hormone that causes blood vessels to constrict, helping to relax blood vessels and lower blood
pressure.

Dose Frequency and route of administration (Doctor’s order)

Route: Oral
Dosage: 40/5 mg/tab 1 tab
Frequency: OD
Indication/s for administering medication to the patient
 Hypertension
 Chronic Stable Angina
 Prevention of Stroke
 Heart Failure
Contraindication
 Hypersensitivity to amlodipine, telmisartan, or any component of the drug
 Severe Hepatic Impairment
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

Side effects of the medications Adverse effects of the medication

● Dizziness  Hypotension
● Headache  Hyperkalemia
● Nausea  Angioedema
 Renal dysfunction
● Fatigue
● Edema

Nursing responsibilities you have to consider when administering the medication:

 Monitor blood pressure regularly to assess the effectiveness of the medication.

 Assess for signs of fluid retention (edema), especially in the legs and feet.
 Check renal and hepatic function through blood tests (e.g., creatinine, liver enzymes).
 Educate the patient about the potential side effects, especially dizziness, and advise them to rise
slowly from sitting or lying positions.
 Monitor potassium levels to detect hyperkalemia, and avoid concurrent use of potassium-sparing
diuretics.

Generic Name
Ketoanalogue
Drug Classification
Amino Acid Supplement/Nutritional Supplement
Drug Action/s

Ketoanalogues are synthetic compounds that resemble amino acids. These are used to provide essential
amino acids while minimizing the production of nitrogenous waste products, such as urea, in patients with
chronic kidney disease (CKD). This helps reduce the burden on the kidneys by decreasing the accumulation
of toxic waste, improving protein metabolism without further stressing kidney function.

Dose Frequency and route of administration (Doctor’s order)

Route: PO

Dosage: 600 mg/tab

Frequency: OD
Indication/s for administering medication to the patient
 Chronic Kidney Disease
 Protein Energy Wasting
 Preventive therapy for patients at risk of kidney failure.
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

Contraindication
● Severe liver dysfunction or hepatic failure.
● Hypersensitivity to any of the ingredients in the ketoanalogue product.

Side effects of the medications Adverse effects of the medication

 Gastrointestinal discomfort
 Diarrhea ● Hyperkalemia
 Anorexia ● Hypercalcemia
 Headache ● Renal Impairment
● Metabolic Acidosis

Nursing responsibilities you have to consider when administering the medication

● Monitor kidney function closely through regular blood tests (e.g., creatinine, BUN) to assess renal
status.
● Monitor electrolyte levels, especially potassium and calcium, to detect any imbalances.
● Assess for gastrointestinal symptoms (nausea, diarrhea), which may affect patient compliance.
● Educate the patient on dietary modifications and adherence to the prescribed dosage.
● Monitor for allergic reactions (skin rash, swelling) and report any signs of hypersensitivity
immediately.

Generic Name
Febuxostat
Drug Classification
● Xanthine oxidase inhibitor
● Antigout Agentst

Drug Action/s
Febuxostat works by inhibiting xanthine oxidase, an enzyme involved in the production of uric acid. By
reducing the production of uric acid, it helps prevent the formation of urate crystals, which cause gout and
hyperuricemia. This lowers serum uric acid levels and helps to prevent gout attacks and related
complications.
Dose Frequency and route of administration (Doctor’s order)

Route: PO

Dosage: 40 mg/tab

Frequency: OD
Indication/s for administering medication to the patient
 Chronic Gout
 Hyperuricemia
 Gout attack prevention
Contraindication
● Hypersensitivity to febuxostat or any of its components.
● Concomitant use with azathioprine or mercaptopurine, due to increased risk of severe toxicity.
● Severe liver disease (e.g., cirrhosis or hepatic failure).
● History of cardiovascular disease (use cautiously, especially in patients with a history of stroke or
heart failure).
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

Side effects of the medications Adverse effects of the medication

● Cardiovascular events, including heart
● Headache attack, stroke, and angina (use
● Nausea cautiously in patients with
● Diarrhea cardiovascular disease).
● Liver Enzyme abnormalities ● Hepatotoxicity
● Rash ● Kidney Problem

Nursing responsibilities you have to consider when administering the medication

● Monitor uric acid levels regularly to assess the effectiveness of the drug and adjust dosage as
needed.
● Monitor liver function through blood tests (ALT, AST) before and during treatment.
● Assess for signs of gout flare-ups during initiation of therapy, and provide appropriate anti-
inflammatory management.
● Educate patients on the importance of staying hydrated to prevent kidney stones and other renal
complications.
● Monitor for cardiovascular events (chest pain, shortness of breath) and immediately report if any
symptoms occur.

Generic Name
Ferrous Sulfate + Folic Acid
Drug Classification

 Hematinic
 Iron supplement
 Vitamin (B9) supplement

Drug Action/s

Ferrous Sulfate replenishes iron stores, needed for hemoglobin production and oxygen transport in
red blood cells white Folic Acid (FA) is essential for DNA synthesis, red blood cell formation,
and tissue growth. Together, they help prevent and treat anemia, especially iron-deficiency and
megaloblastic anemia.
Dose Frequency and route of administration (Doctor’s order)

Route: PO

Dosage: Tab

Frequency: BID
Indication/s for administering medication to the patient
 Iron-deficiency Anemia
 Nutritional supplementation

Contraindication
● Hemochromatosis or iron overload conditions
● Hypersensitivity to iron or folic acid
● Hemolytic anemia (iron may not be helpful)
● Pernicious anemia (needs vitamin B12, not folic acid alone)
● Active peptic ulcer disease
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

Side effects of the medications Adverse effects of the medication

● Iron toxicity
● Constipation ● Severe GI irritation or bleeding
● Nausea ● Masking of vit. B12 deficiency
● Dark colored stool symptoms
● Stomach Cramps ● Liver damage

Nursing responsibilities you have to consider when administering the medication

● Monitor hemoglobin, hematocrit, and iron levels regularly.
● Administer before meals for better absorption, or with food if GI upset occurs.
● Educate patient that dark stools are normal with iron supplements.
● Advise on high-fiber diet to reduce constipation.
● Avoid giving with antacids or dairy, which reduce iron absorption.

Drug Name
Ismodin
Drug Classification

 Anti-angina
 Nitrate Vasodilator

Drug Action/s

Ismodin (Isosorbide Mononitrate) is a long-acting nitrate that works by relaxing and dilating
blood vessels, particularly the coronary arteries. This improves blood and oxygen flow to the
heart, reduces myocardial oxygen demand, and helps relieve chest pain (angina).
Dose Frequency and route of administration (Doctor’s order)

Route: PO

Dosage: 60mg/tab

Frequency: OD
Indication/s for administering medication to the patient
 Prevention of angina pectoris (chest pain due to coronary artery disease)
 Chronic stable angina
 Ischemic heart disease
 Congestive heart failure (as adjunct therapy)
 Post-myocardial infarction support
Contraindication

● Hypersensitivity to nitrates or any component of the drug

● Severe hypotension
● Use with phosphodiesterase inhibitors (e.g., sildenafil/Viagra) due to risk of profound hypotension
● Acute myocardial infarction with low filling pressures
● Increased intracranial pressure or head trauma
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

Side effects of the medications Adverse effects of the medication

● Severe hypotension
● Headache ● Reflex tachycardia
● Nausea ● Syncope (fainting)
● Dizziness ● Allergic skin reactions
● Flushing ● Worsening of angina if abruptly
● Fatigue discontinued

Nursing responsibilities you have to consider when administering the medication

 Monitor blood pressure and heart rate before and after administration.
 Assess for chest pain relief and document onset, duration, and intensity.
 Instruct the patient not to stop the medication abruptly to avoid rebound angina.
 Educate the patient about orthostatic precautions to avoid falls due to dizziness.
 Ensure proper dosing schedule (allow a nitrate-free interval to prevent tolerance).

Drug Name
K-Lyte (Potassium Chloride)
Drug Classification

 Electrolyte supplement
 Mineral replacement

Drug Action/s
K-Lyte replaces potassium, an essential electrolyte involved in nerve conduction, muscle contraction, and
acid-base balance. It works by correcting hypokalemia (low potassium levels) and maintaining normal
cardiac and neuromuscular function.
Dose Frequency and route of administration (Doctor’s order)

Route: PO

Dosage: 1 tab

Frequency: TID
Indication/s for administering medication to the patient

 Hypokalemia (low serum potassium)

 Potassium loss due to diuretics (e.g., furosemide)
 Chronic diarrhea or vomiting
 Metabolic alkalosis and acidosi
 Prevention of potassium deficiency in patients on long-term medications that deplete
potassium

Contraindication

 Hyperkalemia (high potassium levels

 Severe renal impairment (risk of potassium retention)
 Untreated Addison’s disease
 Dehydration or acute acidosis
 Use of potassium-sparing diuretics (e.g., spironolactone) without monitoring

Side effects of the medications Adverse effects of the medication

 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
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SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
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● Nausea and vomitting

● Diarrhea  Hyperkalemia (manifesting as
● Flatulence muscle weakness, arrhythmias)
● Abdominal discomfort  Cardiac arrest (in severe overdose)
 GI ulceration or bleeding
 Intestinal obstruction or perforation
(rare, with tablets)
 Electrolyte imbalance

Nursing responsibilities you have to consider when administering the medication

 Monitor serum potassium levels regularly.

 Assess renal function (BUN, creatinine) before and during therapy.
 Administer with food or full glass of water to reduce GI irritation.
 Teach patient signs of hyperkalemia, like muscle weakness or palpitations.
 Avoid salt substitutes that contain potassium unless prescribed.

Drug Name
Ceftazidime
Drug Classification
 Antibiotic
 Third-generation cephalosporin

Drug Action/s

Ceftazidime works by inhibiting bacterial cell wall synthesis, leading to cell lysis and death. It is
bactericidal and effective against gram-negative organisms, including Pseudomonas aeruginosa.
Dose Frequency and route of administration (Doctor’s order)

Route: IV

Dosage: 1g

Frequency: q8
Indication/s for administering medication to the patient

 Respiratory tract infections (e.g., pneumonia)

 Urinary tract infections (UTIs)
 Skin and soft tissue infections
 Septicemia
 Infections caused by Pseudomonas aeruginosa

Contraindication

 Hypersensitivity to ceftazidime or other cephalosporins

 History of severe allergic reaction to penicillins (due to cross-sensitivity)
 Renal impairment without dose adjustment
 Caution in patients with gastrointestinal disease, especially coliti

Side effects of the medications Adverse effects of the medication

 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025

 Injection site pain or inflammation  Anaphylaxis

 Rash  Clostridioides difficile–associated
 Nausea diarrhea (CDAD)
 Headache  Seizures (especially in renal
 Diarrhea impairment)
 Neutropenia or thrombocytopenia
 Elevated liver enzymes

Nursing responsibilities you have to consider when administering the medication

 Assess for signs of infection (fever, WBC count) before and during therapy.
 Monitor renal function (especially in elderly and those with kidney disease).
 Observe for allergic reactions, especially after first doses.
 Monitor bowel function; report diarrhea immediately (risk of CDAD).
 Ensure correct reconstitution and administration, and rotate injection sites if IM.
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500
Tel: 078-396-1987 to 1997
Fax: 078-846-4305
[Link]
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
College of Nursing
First Semester, AY 2024-2025