Signs and symptoms

Symptoms of CAP commonly include:

• problems breathing
• coughing that produces greenish or yellow sputum
• a high fever that may be accompanied with sweating, chills, and uncontrollable shaking
• sharp or stabbing chest pain
• rapid, shallow breathing that is often painful
Less common symptoms include:
• the coughing up of blood (hemoptysis)
• headaches (including migraine headaches)
• loss of appetite
• excessive fatigue
• blueness of the skin (cyanosis)
• nausea
• vomiting
• diarrhea
• joint pain (arthralgia)
• muscle aches (myalgia)
The manifestations of pneumonia, like those for many conditions, might not be typical in older people.
They might instead experience:
• new or worsening confusion
• hypothermia
• falls*
Additional symptoms for infants could include:
• being overly sleepy
• yellowing of the skin (jaundice)
• difficulties feeding[2]

Adults
The full spectrum of microorganisms is responsible for CAP in adults. Several important groups of
organisms are more common among people with certain risk factors. Identifying people at risk for these
organisms is important for appropriate treatment.
• Viruses
Viruses cause 20% of CAP cases. The most common viruses are influenza, parainfluenza,
respiratory syncytial virus, metapneumovirus, and adenovirus. Less common viruses causing
significant illness include chicken pox, SARS, avian flu, and hantavirus.[6]

• Atypical organisms
The most common bacterial causes of pneumonia are the so-called atypical bacteria Mycoplasma
pneumoniae and Chlamydophila pneumoniae. Legionella pneumophila is considered atypical but
 is less common. Atypical organisms are more difficult to grow, respond to different antibiotics,
and were discovered more recently than the typical bacteria discovered in the early twentieth
century.

• Streptococcus pneumoniae
Streptococcus pneumoniae is a common bacterial cause of CAP (most common cause in UK).
Prior to the development of antibiotics and vaccination, it was a leading cause of death.
Traditionally highly sensitive to penicillin, during the 1970s resistance to multiple antibiotics
began to develop. Current strains of "drug resistant Streptococcus pneumoniae" or DRSP are
common, accounting for twenty percent of all Streptococcus pneumoniae infections. Adults with
risk factors for DRSP including being older than 65, having exposure to children in day care,
having alcoholism or other severe underlying disease, or recent treatment with antibiotics should
initially be treated with antibiotics effective against DRSP.[7]

• Hemophilus influenzae
Hemophilus influenzae is another common bacterial cause of CAP. First discovered in 1892, it
was initially believed to be the cause of influenza because it commonly causes CAP in people
who have suffered recent lung damage from viral pneumonia.

• Enteric Gram negative bacteria

The enteric Gram negative bacteria such as Escherichia coli and Klebsiella pneumoniae are a
group of bacteria that typically live in the human intestines. Adults with risk factors for infection
including residence in a nursing home, serious heart and lung disease, and recent antibiotic use
should initially be treated with antibiotics effective against Enteric Gram negative bacteria.

• Pseudomonas aeruginosa
Pseudomonas aeruginosa is an uncommon cause of CAP but is a particularly difficult bacteria to
treat. Individuals who are malnourished, have a lung disease called bronchiectasis, are on
corticosteroids, or have recently had strong antibiotics for a week or more should initially be
treated with antibiotics effective against Pseudomonas aeruginosa

Risk factors
Some people have an underlying problem which increases their risk of getting an infection. Some
important situations are covered below:
Obstruction

When part of the airway (bronchi) leading to the alveoli is obstructed, the lung is not able to clear fluid
when it accumulates. This can lead to infection of the fluid resulting in CAP. One cause of obstruction,
especially in young children, is inhalation of a foreign object such as a marble or toy. The object is
lodged in the small airways and pneumonia can form in the trapped areas of lung. Another cause of
obstruction is lung cancer, which can grow into the airways block the flow of air.
Lung disease

People with underlying lung disease are more likely to develop CAP. Diseases such as emphysema or
habits such as smoking result in more frequent and more severe bouts of CAP. In children, recurrent
episodes of CAP may be the first clue to diseases such as cystic fibrosis or pulmonary sequestration.
Immune problems

People who have immune system problems are more likely to get CAP. People who have AIDS are
much more likely to develop CAP. Other immune problems range from severe immune deficiencies of
childhood such as Wiskott-Aldrich syndrome to less severe deficiencies such as common variable
immunodeficienc
VI. DRUG STUDY
1. Clindamycin 300 mg
a. Phamacologic class:
Lincosamide
b. Therapeutic class:
Anti – infective

To reduce development of bacterial resistance and maintain drug efficacy, use only to prevent and treat
infections that are proven and
strongly suspected to be caused by bacteria.
•
Diarrhea, colitis, and pseudomembranous colitis may first appear up to the end of clindamycin therapy.
c. Actions:
•
Inhibits protein synthesis in susceptible bacteria at level of 50S ribosomes, thereby inhibiting peptide
bond formation and causing cell
death.

d. Off-label uses:

• Bacterial vaginosis (phosphate)

• Chlamydia trachomatis infection in females.
• CNS toxoplasmosis in AIDS patients
• Pneumocystis jiroveci pneumonia
• Rosacea (lotion)

e. Contraindication:

• Hypersensitivity to drug or lincomycin

f. Precautions:
• Renal or hepatic impairment
• Known alcohol intolerance
• Pregnant patient
• Neonates
g. Adverse reaction:
• diarrhea that is watery or bloody;
• fever, chills, body aches, flu symptoms;
• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing
of the skin or eyes);
• urinating less than usual or not at all; or
• fever, sore throat, and headache with a severe blistering, peeling, and red skin rash.

h. Nursing responsibilities:
• In patients with renal insufficiency, assess creatinine level before giving first dose and at least once a
week during prolonged therapy.
Monitor drug blood closely.
• Watch for s/s of serious adverse reactions, including GI problems, jaundice, and hypersensitivity
reactions.

2. N – Acetylcystein 600 mg
a. Phamacologic class:Ant idot e;
b. Therapeutic class:mucolytic
• Decrease viscosity of secretions;
• Promoting secretions removal thru vomiting

c. Actions:
• Treatment of acute chronic bronchopulmonary disease

d. Contraindication:
• cautioned for patients with asthma
• hypersensitivity to drugs (except w/ antidotal use.)

e. Precautions:
• Renal or hepatic disease
• Elderly patients

f. Adverse reaction:
• Flushing, fever, stomatitis, nausea, vomiting, rhinorrhoea, bronchospasm, anaphylactoid reactions,
rashes. Rarely, blurred vision,
bradycardia, syncope, thrombocytopenia, convulsions.
Potentially Fatal: Rarely, respiratory or cardiac arrest.
g. Nursing responsibilities:
• Monitor respiration, cough, and character of secretions
• Instruct the patient to report worsening cough and other respiratory symptoms.
• Advise patient to mix oral form with juice or cola to mask bad taste and odor.

3. Sodium Chloride (NaCl) Tab

a. Phamacologic class: Electrolyte supplement

b. Therapeutic class:Sodium replacement

c. Actions:
• Replaces deficiencies of sodium and chloride and maintains these electrolytes at adequate level.
d. Contraindication:
• Normal or elevated electrolyte levels (with 3% and 5% NaCl
• Fluid retention

e. Precautions:
• Renal impairment
• Heart failure
• Edema
• Sodium retention
• Surgical patients

f. Adverse reaction:
• Fluid and electrolyte disturbances
• Aggravation of existing metabolic acidosis
• Pulmonary edema
• Local tenderness

g. Nursing responsibilities:
• Monitor electrolyte leve
Watch for s/s of pulmonary edema or worsening heart failure
• Carefully monitor v/s, fluid balance, weight, and cardiovascular status
• Instruct patient to report DOB, pain, tenderness, and swelling at injection site
Waves and intervals

A typical ECG tracing of a normal heartbeat (or cardiac cycle) consists of a P wave, a QRS complex
and a T wave.[23] A small U wave is normally visible in 50 to 75% of ECGs. The baseline voltage of
the electrocardiogram is known as the isoelectric line. Typically the isoelectric line is measured as the
portion of the tracing following the T wave and preceding the next P wave.
P wave
(electrocardiograp
hy)
During normal atrial
depolarization, the main
electrical vector is directed
from the SA node towards
the AV node, and spreads
from the right atrium to the
left atrium. This turns into
the P wave on the ECG.
QRS complex
The QRS complex is a
recording of a single
heartbeat on the ECG that
corresponds to the
depolarization of the right
and left ventricles.
PR interval
The PR interval is measured
from the beginning of the P
wave to the beginning of
the QRS complex.
It is usually
120 to 200 ms
long.
ST segment
The ST segment connects
the QRS complex and the T
wave.
It has a
duration of
0.08 to 0.12
sec (80 to 120
ms).
T wave
The T wave represents the
repolarization (or recovery)
of the ventricles. The
interval from the beginning
of the QRS complex to the
apex of the T wave is
referred to as theabs olute
refractory period. The last
half of the T wave is
referred to as therela tive
refractory period(or
vulnerable period).
QT interval
The QT interval is measured
from the beginning of the
QRS complex to the end of
the T wave.
Normal values
for the QT
interval are
between 0.30
and 0.44
seconds.[citation
needed]
U wave
The U wave is not always seen. It is typically small, and, by definition, follows the T wave.
The four deflections were originally named ABCDE but renamed PQRST
after correction for artifacts introduced by early amplifiers.
Community-acquired pneumonia(CAP) is a disease in which individuals
who have not recently been hospitalized develop an infection of the lungs
(pneumonia ). CAP is a common illness and can affect people of all ages. CAP
often causes problems like difficulty in breathing , fever, chest pains , and a cough. CAP occurs
because the areas of the lung which absorb oxygen
(alveoli) from the atmosphere become filled with fluid and cannot work effectively.
CAP occurs throughout the world and is a leading cause of illness and death.
Causes of CAP include bacteria , viruses, fungi , and parasites. CAP can be diagnosed by symptoms
and physical examination alone, though x-rays , examination of the sputum , and other tests are often
used. Individuals with
CAP sometimes require treatment in a hospital. CAP is primarily treated with
antibiotic medication. Some forms of CAP can be prevented by vaccination.
Symptoms
Symptoms of CAP commonly include:
• problems breathing
• coughing that produces greenish or yellow sputum
• a high fever that may be accompanied with
sweating, chills, and uncontrollable shaking
• sharp or stabbing chest pain
• rapid, shallow breathing that is often painful
Less common symptoms include:
• the coughing up of blood (hemoptysis)
• headaches (including migraine headaches)
• loss of appetite
• excessive fatigue
• blueness of the skin (cyanosis)
• nausea

Electrocardiography (ECGor EKG) is a transthoracic interpretation of the

electrical activity of the heart over time captured and externally recorded by
skin electrodes.[1 ] It is a noninvasive recording produced by an
electrocardiographic device. The etymology of the word is derived from
electro, because it is related to electrical activity, cardio, Greek for heart, and
graph, a Greek root meaning "to write".
Electrical impulses in the heart originate in the sinoatrial node and travel
through the intrinsic conducting system to the heart muscle .The impulses
stimulate the myocardial muscle fibres to contract and thus induce systole.
The electrical waves can be measured at selectively placed electrodes
(electrical contacts) on the skin. Electrodes on different sides of the heart
measure the activity of different parts of the heart muscle. An ECG displays
the voltage between pairs of these electrodes, and the muscle activity that they
measure, from different directions, also understood as vectors. This display
indicates the overall rhythm of the heart and weaknesses in different parts of
the heart muscle. It is the best way to measure and diagnose abnormal rhythms
of the heart,[2] particularly abnormal rhythms caused by damage to the
conductive tissue that carries electrical signals, or abnormal rhythms caused
by levels of dissolved salts (electrolytes), such as potassium, that are too high
or low.[3] In myocardial infarction (MI), the ECG can identify damaged heart
muscle. But it can only identify damage to muscle in certain areas, so it can't
rule out damage in other areas.[4] The ECG cannot reliably measure the
pumping ability of the heart; for which ultrasound-based (echocardiography)
or nuclear medicine tests are used.

the P wave on the ECG.

QRS complex

The QRS complex is are according of a single heartbeat on the ECG that corresponds to the
depolarization of the right hand left ventricles.
PR interval
The PR interval is measured from the beginning of the Pwave to the beginning ofthe QRS complex.
It is usually 120 to 200 mslong.
ST segment
The ST segment connects the QRS complex and the T wave.
It has a duration of 0.08 to 0.12 sec (80 to 120ms).
T wave
The T wave represents the re polarization (or recovery) of the ventricles. The interval from the
beginning of the QRS complex to the apex of the T wave is referred to as the absolute refractory
period. The last half of the T wave is referred to as the relative refractory period(or vulnerable period).

QT interval
The QT interval is measured from the beginning of the QRS complex to the end of the T wave.
Normal values
for the QT
interval are between 0.30 and 0.44 seconds.[citation needed]
U wave
The U wave is not always seen. It is typically small, and, by definition, follows the T wave.