LICEO DE CAGAYAN UNIVERSITY

COLLEGE OF NURSING

NCM501202

RELATED LEARNING EXPERIENCE

CARE STUDY TOPIC

SUBMITTED BY

SANRIA O> LUGTU

RLE GROUP

CLUSTER I-A11

TERM

FINAL

SUBMITTED TO

MS. MAYLINDA B. ORO, RN

September 29, 2008

INTRODUCTION

This is a case study

of an 11month old client

admitted at Polymedic

General Hospital with a chief

complaint of cough and

fever for 2 weeks and

diagnosed with Acute

Bronchitis. Bronchitis means

that the tubes that carry air

to the lungs (the bronchial

tubes) are inflamed and

irritated. When this happens,

the tubes swell and produce

mucus. This makes you

cough. Acute bronchitis is

usually caused by viruses or

bacteria and may last

several days or weeks. Acute bronchitis is characterized by cough and sputum

(phlegm) production and symptoms related to the obstruction of the airways by

the inflamed airways and the phlegm, such as shortness of breath and wheezing.

Acute bronchitis symptoms usually start 3 or 4 days after an upper respiratory

tract infection. Most people get better in 2 to 3 weeks. But some people continue

to have a cough for more than 4 weeks. Infants with bronchitis may have many of

the symptoms above, but in many cases they are simply sleepy or have a

decreased appetite.

B. OBJECTIVE OF THE STUDY

This study aims to convey the patient and significant others with

information about the disease process, medication, treatment, diet and its

course of medical and nursing intervention.

To assess patient thoroughly, identify health problems, plan care,

application of plan activities and evaluate its effect to the patient.

To present the case study to the group members and clinical

instructor and evaluate and learn the outcome of the study to the patient

and to the student.

To understand the course and essence of the chosen care study

and add up additional knowledge and understanding in the Nursing

profession.

C. SCOPE AND LIMITATIONS

This study in general with limited background and skills of students

to care of the patient and problem identified carry through the process of

referral to the clinical instructor, staff nurses, and doctor’s during the 2

days duty in the Pedia Ward. Interventions were rendered gradually

depending on the objective assessment of the student. The following

information only involves the exact words and answers supported by the

client.

II. HEALTH HISTORY

A. Patient’s Profile

Name: Rossel E. Pabre a.k.a REP

Age: 11 months old

Sex: female

Birth date: October 24, 2007

Birth place: Cagayan de Oro City

Name of Father: Rey Pabre

Name of Mother: Roseville Pabre

Civil status: Child

Nationality: Filipino

Informant: Roseville (mother)

Religion: Roman Catholic

Address: Talakag, Bukidnun

Allergy: No known allergy to food and drugs

CLINICAL PROFILE

Date of admission: September 15, 2008

Time of admission: 12:10 PM

Attending physician: Dr. N. Lim, M.D.

Chief Complaint: Cough, fever,

Admitting diagnosis: acute bronchitis

Diet: Diet as tolerated for age

Vital Signs upon admission:

T: 39.5 0 C

RR: 58 cpm

PR: 145 bpm

B. Patient’s Health History

Rossel E. Pabre, an 11 months old child was born on Cotober 24,

2007. She is the only child of Mr. and Mrs. Pabre. The family is now

currently residing at Talakag, Bukidnun. REP and family had no history of

asthma, pneumonia or any respiratory problem.

C. History of Present Illness

A case of Seanford Luke Montecillo, male, 4 years old experienced

cough and fever. Two weeks prior to admission onset of having fever and

cough. Consulted to a physician and was given salbutamol and

paracetamol. 1 day prior to admission noted with poor appetite due to poor

appetite and vomiting. She was brought to the emergency room last

September 15, 2008 at 12:10 pm. Vital signs taken Temp.- 39.5 0 C, RR-

58 cpm, AP- 145 bpm. She was then transferred at Pedia Ward 7 th floor

PGH.

II. DEVELOPMENTAL HISTORY

Sigmund Freud: Psychosexual Theory

Psychoanalytic theories of human development began in the 1900's with

the work of Sigmund Freud. More modern theories of development have now

replaced those of Freud. Yet it is still important to be familiar with the basics of

Freud's work, as many modern views of human development still have their roots

in Freudian theory.

Freud developed a general theory of psychological development from

infancy to adulthood. He believed that the mind of an infant consists only of

primitive drives and instincts, such as the need for food and physical comfort,

which he called the "id."

The Oral Stage: Birth to 18 Months

Anyone familiar with very young babies and children knows that they are

focused on their mouths. A baby's first nourishment is received through suckling,

and the sucking instinct is usually strong, even in newborns. Freud theorised that

an infant's oral focus brought not only nourishment, but pleasure.

REP belongs to this stage in which she enjoys sucking and later biting

anything that touches the erogenous zone of the lips and mouth. Some infants

enjoy this oral activity more than others, while some maybe satisfied by sucking

at the breast or bottle, other require pacifiers, toys or other objects that can be

orally manipulated.

Erik Erikson: Psychosocial Theory

Erikson's greatest innovation was to postulate not five stages of

development, as Sigmund Freud had done with his psychosexual stages, but

eight. Erik Erikson believed that every human being goes through a certain

number of stages to reach his or her full development, theorizing eight stages,

that a human being goes through from birth to death. REP belongs to Trust vs.

Mistrust stage.

Infancy: Birth to 18 Months

Ego Development Outcome: Trust vs. Mistrust

Basic strength: Drive and Hope

Erikson also referred to infancy as the Oral Sensory Stage (as anyone

might who watches a baby put everything in her mouth) where the major

emphasis is on the mother's positive and loving care for the child, with a big

emphasis on visual contact and touch. If we pass successfully through this period

of life, we will learn to trust that life is basically okay and have basic confidence

in the future. If we fail to experience trust and are constantly frustrated because

our needs are not met, we may end up with a deep-seated feeling of

worthlessness and a mistrust of the world in general.

Robert Havighurst: Developmental Task Theory

Robert Havighurst believed that learning is basic to life and that people

continue learn throughout life. He described growth and development as

occurring during six stages, each associated with six to ten tasks to be learned.

Successful achievement of these tasks leads to success and happiness with later

tasks, while failure leads to unhappiness in the individual, and difficulty with later

tasks. REP belongs to this stage.

Developmental Tasks of Infancy and Early Childhood:

Learning to walk.

Learning to take solid foods

Learning to talk

Learning to control the elimination of body wastes

Learning sex differences and sexual modesty

Forming concepts and learning language to describe social and physical

reality.

Getting ready to read

Jean Piaget: Cognitive Theory

Swiss biologist and psychologist Jean Piaget (1896-1980) is

renowned for constructing a highly influential model of child development

and learning. Piaget's theory is based on the idea that the developing child

builds cognitive structures--in other words, mental "maps," schemes, or

networked concepts for understanding and responding to physical

experiences within his or her environment. Piaget further attested that a

child's cognitive structure increases in sophistication with development,

moving from a few innate reflexes such as crying and sucking to highly

complex mental activities.

Sensorimotor stage (birth - 2 years old)—REP belongs to this

stage-- for the child, through physical interaction with his or her

environment, builds a set of concepts about reality and how it works. This

is the stage where a child does not know that physical objects remain in

existence even when out of sight (object permanence).

IV. MEDICAL MANAGEMENT

DOCTOR’S Order

Date Order Rationale

September 15,

2008

Please admit under the

service of Dr. Lim

TPR q 4 hours

Labs: CBC

Urinalysis

IVF D5 0.3% NaCl 500 @ 40

cc/hr.

MEDS:

1. Paracetamol drops 1.1ml q

4hrs. PRN for Temp.

>37.70C

2. Cefuroxime (zinacef) 200mg

IVT q 80 (ANST -)

To render proper

medical

management.

To monitor vital

signs and note any

discrepancies.

For laboratory analysis

Saline lock; for emergency IVTT drugs used

To lower fever.

Bactericidal inhibits

synthesis of

bacterial cell wall,

causing cell death.

To meet nutritional

DAT for age

Refer accordingly

needs.

To monitor

unusualities.

September 16,

2008

12:oo midnight

Paracetamol suppository

125mg

#2 D5 0.3% NaCl 500 @ 40

cc/hr.

Salbutamol (ventolin) neb i q

6°

Chest X-Ray today

To reduce fever and

infection.

To prevent

dehydration

Treatment for cough

as bronchodilator

For assessment of

the lungs or affected

part(s)

DIAGNOSTIC EXAM

The following are the laboratory exams as ordered by the patient’s attending physician.

HEMATOLOGY (Sept. 15, 2008)

RESULT NORMALHematocrit 32.6 vol. % 30-40 %Hemoglobin 11.5 11.7-14 g/dlWBC 10.34 5,000-10,000/cc.mmMCHC 35.3 32-36 %Monocytes 11.2 2-8 %Basophils 1.2 0.5- 1 %

Clinical Implication:---Low Hb concentration may indicate anemia, recent hemorrhage, or fluid

retention, which can cause hemodilution.---Low HCT suggests anemia, hemodilution or massive blood loss

---An elevated WBC count commonly signals infection---Increase monocytes count suggest infection

URINALYSIS (Sept. 15, 2008)

Color Yellow

Transparency clear

Odor Aromatic

Protein Negative

Glucose Negative

Cast None

Bacteria Not seen

V. ANATOMY, PHYSIOLOGY AND PATHOPHYSIOLOGY

Every time a breath is taken in, the air (20% oxygen) passes through the

nose or mouth and then past the larynx or voice box into the windpipe (trachea)

which is about 12.5 cm long. At its lower end the windpipe divides into two main

tubes called bronchi.

The main air passage in each lung (the bronchus) divides into

successively smaller branches which carry inhaled air to all parts of the lung.

Each small branch terminates by forming a cluster of very tiny air sacs (the

alveoli). A fine network of blood vessels covers the surface of every air sac

thereby permitting gas exchange by diffusion. Oxygen from the inspired air

passes through the thin tissues to combine with the haemoglobin of the red blood

cells. Waste gases, mainly carbon-dioxide, pass from blood into the air sacs and

are expelled on breathing out.

Each lung is covered by a lubricated lining called the pleura. The inner

side of the chest wall is also covered by a similar lining. These two layers of

pleura are in contact and slide smoothly over one another during breathing.

The act of breathing is mainly due to the diaphragm moving up and down.

The diaphragm is a large dome-shaped muscle which separates the chest from

the abdominal cavity. When the diaphragm muscle contracts, its dome becomes

flattened and draws down the lungs, causing air to enter them; when it relaxes

the lungs become smaller and the air in them is expelled. The muscles of the

abdomen also help in breathing. When they tighten up, they press the abdominal

contents up against the diaphragm and help in expelling air from the lungs; when

they relax, they assist the diaphragm in drawing down the lungs as breathing in

takes place.

The normal rate of breathing at rest is 16–18 times a minute. This rate

increases considerably with exertion and also with certain diseases, especially

those affecting the heart and lungs.

PATHOPHYSIOLOGY

Impaired muscilliary defenses of the lung

Increase susceptibility to infection

Mucus production is greater

Bronchial walls become thickened and inflamed

VI. NURSING ASSESSMENT (System Review Chart)EENT:[ ] Impaired vision [ ] blind[ ] pain redden [ ] drainage[ ] gums [ ] hard of hearing [ ] deaf

burning [ ] edema [ ] lesion teeth

[ ] assess eyes ears nose[ ] throat for abnormality [x] no problem

RESP:[ ] Asymmetric [ x ] tachypnea [ ] barrel chest[ ] apnea [ ] rales [ ] cough[ ] bradypnea [ ] shallow [ ] rhonchi[ ] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ x ] wheezing[ ] pain [ ] cyanotic[ ] assess resp. rate, rhythm, depth, pattern, breath sounds, comfort [ ] no problem

CARDIOVASCULAR:

Obstruct airways, especially during

expiration

Airways collapse

Air is trapped in the distal alveolar ventilation

Abnormal ventilation

Fall in PaO2 Increase levels of PaCO2

Body compensates for hypoxemia

Polycythemia occurs

Productive

Skin warm to

With ongoing D5 .3NaCl 500cc @ 40 cc/hr

[ ] arrhythmia [ ] tachycardia [ ]numbness[ ] diminished pulses [ ] edema [ ] fatigue[ ] irregular [ ] bradycardia [ ] murmur[ ] tingling [ ] absent pulses [ ] pain[ ] Assess heart sounds, rate rhythm, pulse, blood pressure, circ., fluid retention, comfort [ x ] no problem

GASTROINTESTINAL TRACT:[ ] obese [ ] distention [ ] mass[ ] dysphagia [ ] rigidity [ ] pain[ ] assess abdomen, bowel habits, swallowing[ ] bowel sounds, comfort [ x ] no problem

GENITO – URINARY AND GYNE[ ] pain [ ] oliguria [ ] color [ ] vaginal bleeding[ ] hematuria [ ] discharge [ ] nocturia[x ] assess urine frequency, control, color, odor, comfort[ ] gyne bleeding [ ] discharge [ x ] no problem

NEURO:[ ] paralysis [ ] stuporus [ ] unsteady [ ] seizure[ ] lethargic [ ] comatose [ ] vertigo [ ] treamors[ ] confused [ ] vision [ ] grip[ x ] assess motor, function, sensation, LOC, strength[ ] grip, gait, coordination, speech [ x ] no problem

MUSCULOSKELETAL and SKIN:[ ] appliance [ ] stiffness [ ] itching [ ] petechie[ ] hot [ ] drainage [ ] prosthesis [ ] swelling[ ] lesion [ ] poor turgor [ ] cool [ ] flushed[ ] atrophy [ ] pain [ ] ecchymosis [ ]

[x] no problem

SUBJECTIVE OBJECTIVE

Communication: Comments: “Wala man problema __ hearing loss sa iya pandungog __visual changes panlantaw”as verba_x_denied lized by pt’s mother

__glasses __languages__contact lens __hearing aide

Pupil size: 3mm __speech difficultiesReaction Pupil equally round reactive to light and accomodation

Oxygenation: Comments: “ga ubo2x man japon __dyspnea siya pero usahay na-__smoking history lang” as verba None lized by pt’s mother_x cough __sputum __denied

Resp. __regular x irregularRR: 58cpm

Describe: abnormal and assymmetrical chest expansion

Body malaise

SUBJECTIVE OBJECTIVE

Circulation: Comments: “Wala man problema__chest pain sa iya paa og dughan” __leg pain as verbalized by the pt’s__numbness of mother extremities _ x denied

Heart rhythm __regular x _irregularAnkle edema: No edema seenPulse Car + rad + DP + fem +R: Pulse are palpable L: Pulse are palpable

Nutrition:Diet: Diet as tolerated for age_x_recent change Comments: “dili siya gakaon_x_swallowing difficulty og inom pud sa tambal”as __denied verbalized by pt’s mother

__ dentures _ x _ none

Full partial with patientUpper ___ ___ ___Lower ___ ___ ___

Elimination: Usual bowel pattern urinary frequency__once daily __ 7 times per day_____constipation __urgencyremedy __dysuria watery __hematuriaDate of last BM __ incontinenceSept. 16, 2008 __ foley in place _ denied

Comments: Bowel sounds: Bowel sounds are audible normoactive Abdominal distention present__yes_x_no Urine (color, odor, Consistency) yellow in Color

Mgt. Of health & illness:__alcohol _x_denied(amount, frequency)N/A_____________________________________

__ SBE last pap smear N/A__________________ LMP: N/A________________________________

Briefly describe the patient's ability to follow treatments (diet, meds, etc.) for chronic health problems The patient has difficulty in taking the medications.

SUBJECTIVE OBJECTIVES

Skin Integrity:__dry Comments: “init japon siya__itching kay di man gakawala iyang__ other hilanat.” As verbalized by x denied pt’s mother

_x_dry __cold __pale__flushed _x_warm __moist__cyanoticrashes,ulcers,decubitus (decribe size,location, drainage) there were no presence of rash

SUBJECTIVE OBJECTIVES

Activity/safety:__convulsion Comments:”sige man siya pa __dizziness kugos. Kung ibutang x limited motion mohilak” as verbalized by theof joints pt’s mother ability to__ambulate__bathe self__other x denied

LOC and orientation: patient is conscious Gait: __walker __cane __other__steady _x_unsteady__sensory and motor losses in face or extremities__ROM limitation: patient has limited range of motion

Comfort/sleep/awake:__pain (location, Comments: “ dali raman siya __nocturia makatulog.”as verbalized sleep difficulties by the pt’s mother x denied

__facial grimaces__guarding__other signs of pain: crying __siderail release form signed ( 60+ years) no side rails _

Coping:Occupation: N/AMembers of household: _5 – (father, mother, grandparents and the patient. Most supportive person: _Roseville (mother)

Observed non-verbal behavior : ______irritability_______________________The person and his phone number that can be reached any time none

SPECIAL PATIENT INFORMATION (USE LEAD PENCIL) 7.6 kg daily weight __________ PT/OT_________________________BP q shift __________ Irradiation__________Neuro vs _normal___ Urine test ______________________CVP/SG reading_______ __________ 24 hour urine collection

Date ordered Diagnostic/lab exams date done9/15/08 Hematology 9/15/08 9/15/08 Urinalysis 9/15/08

Date ordered I.V/ blood Date disc. 9/15/08 D5 0.3% NaCl 9/15/08 9/16/08 D5 0.3% NaCl 9/16/08

VII. IDEAL NURSING MANAGEMENT

Diagnosis #1:

Ineffective Airway Clearance may be related to thickened mucus

secretions as evidenced by tachypnea, productive cough and shallow

respiration

Interventions:

a. Assess rate and depth of respirations and chest movement

b. Auscultate lung field, noting areas of decreased/absent airflow and

adventitious breath sound, eg. Wheezes, crackles

c. Elevate head of bed, change position frequently

d. Assist with nebulizer treatments

e. Administer medications as prescribed

Rationale:

a. Tachypnea, shallow respirations and unsymmetric chest movement are

frequently present because of discomfort of moving chest wall and/or fluid

in lung.

b. Decreased airflow occurs in areas consolidated with fluid. Crackles,

rhonchi, and wheezes are heard on inspiration and/or expiration in

response to fluid accumulation, thick secretions and airway

spasm/obstruction.

c. Lowers diagphragm, promoting chest expansion, aeration of lung

segments, mobilization and expectoration of secretions.

d. Facilitates liquefication and removal of secretions

e. Aids in reduction of bronchospasm as well as mobilization of secretions.

IDEAL NURSING MANAGEMENT

Diagnosis #2:

Impaired Gas Exchange related to cough and fever as evidenced by

changes in rate and depth of respiration

Intervention:

a. Assess respiratory rate, depth and ease; use of accessory muscles

b. Monitor body temperature

c. Addition/removal of bedcovers, comfortable room temperature,

tepid/cool water sponges

d. Maintain bedrest

e. Elevate head and encourage frequent position changes

Rationale:

a. Manifestations are dependent on degree of lung involvement and

underlying pulmonary/general health status

b. High fever greatly increases metabolic demands and oxygen

consumption

c. Promotes a level of wellness; aids in faster recovery

d. Prevents over exhaustion and reduces oxygen consumption/demands

e. These measures promote maximal inspiration

IDEAL NURSING MANAGEMENT

Diagnosis #3:

Activity intolerance related to decreased pO2 and body malaise

Intervention:

a. Obtain subjective data from the patient regarding normal activities prior

to onset of acute episodes of asthma and current activity status

b. Have patient use oxygen immediately prior to activity in the acute setting

c. Monitor vital signs and oxygen saturation before and after activity

d. Assist with activities as needed

e. Pace activities and encourage periods of rest and activity during the day

Rationale:

a. Helps to determine the effect asthma has had on the patient’sity to be

active and allows for a better plan for future activity regimen.

b. Improves oxygenation and provides for oxygen reserves to be used with

increased demand.

c. Use the results to indicate when activity may be increased or decreased.

d. Conserves energy and reduces oxygen demand.

e. Conserves oxygen.

IX. ACTUAL NURSING MANAGEMENT

S “dili pa gakawala iyang ubo” as verbalized by the mother

Otachypnea, productive cough, and shallow respiration

AIneffective Airway Clearance may be related to thickened mucus secretions as evidenced by tachypnea, productive cough and shallow respiration.

P

At the end of 30 mins, client will be able to demonstrate reduction of congestion with breath sounds clear.

I

a. Assessed rate and depth of respirations and chest

movement

b. Auscultate lung field, noting areas of decreased/absent

airflow and adventitious breath sound, eg. Wheezes,

crackles

c. Elevated head of bed, change position frequently

d. Assisted with nebulizer treatments

e. Administered medications as prescribed

E

At the end of 8 hours, clients’ breath sound was clear and

was able to expectorate mucous.

S “galisod siya usahay og ginhawa mao nang d nko ehigda sa

higdaanan.” as verbalized by the pt’s mother

Otachycardia, cough, and pallor skin, shallow respiration

A

Impaired Gas Exchange related to cough and fever as

evidenced by changes in rate and depth of respiration

P

At the end of 30 mins, client will be able to display improved

breathing pattern

I

a. Elevated head using pillows

b. Changed position frequently

c. Administered medications as prescribed (eg. Brochodilators, expectorants)

d. Encouraged adequate rest

E

At the end of 30 mins, client is able to demonstrate improved

ventilation and oxygenation.

S “galuya pa siya, d pareho sauna nga magdula-dula” as verbalized by

the pt’s mother

O Wheezing during activities Gasp for breath during activities

A

Activity intolerance related to decreased pO2

P

At the end of 30 mins, client is able to perform activities of daily living without wheezing or shortness of breath.

I

a. Obtained subjective data from the patient regarding normal

activities prior to onset of acute episodes of asthma and current

activity status

b. Has patient use oxygen immediately prior to activity in the

acute setting

c. Monitored vital signs and oxygen saturation before and after

activity

d. Assisted with activities as needed

e. Paced activities and encourage periods of rest and activity during the day

E

At the end of 8 hours, client is able to state that he is

comfortable with activity performance.

X. EVALUATION/IMPLICATION

The mainstay of nursing and medical treatment with the patient

having with such condition is to help the patient to cope, alleviate distress,

prevent further complications and help the patient to recover as well as to

encourage the patient and the significant others to participate in the

therapy. From the initiation of nursing and medical interventions the client

showed some signs of recuperation and gradually showed signs of

progress. This was evidence form the complete bed rest up to the

condition she was given the chance to ambulate gradually as tolerated.

From this, my goal was achieved as evidenced by the desire of the

patient to go back to his normal daily routine and from the progress of the

patient. The client’s mother was cooperative enough to stay at the hospital

premises and never refuses to go home until the child is not stable.

XI. REFERRALS

The patient significant other is advice to take his home medication

and after 1 week the physician note that any improvement in the clients

condition and be back for follow up check up.

XII. BIBLIOGRAPHY

Kozier, Erb, Blais, Wilkinson. Fundamentals of Nursing (7 th Edition). Philippines: Addison Wesley Longman Inc.1998.

Pillitteri, Adelle. Maternal and Child Health Nursing (3 rd Edition). Philippines: Lippincott, Williams & Wilkins, Inc. 1999.

Doenges, Marilyn et.al. Nursing Care Plans: Guidelines for Planning Patient Care 2 nd Ed.

DRUG STUDY

Generic Name of

ordered drug

Salbutamol Sulfate

Brand Name Ventolin

Date Ordered September 16, 2008

Classification Bronchodilator

Dose/Frequency/Route 1 neb/ q6h / steam inhalation

Mechanism of Action Relaxes bronchial smooth muscle by acting on beta2-

adrenergic receptors; improves ventilation

Specific Indication Bronchospam in patient’s with reversible obstructive

airway disease

Contraindication To patient’s hypersensitive to the drug and its

components

Side Effects/Toxic

Effects

Tremor; palpitations; tachycardia; nausea and

vomiting; irritation

Nursing Precaution Perform chest tapping every after nebulization

Generic Name of

ordered drug

Paracetamol syrup

Brand Name

Date Ordered Two weeks PTA admission

Classification Non-opioid analgesic;antipyretic

Dose/Frequency/Route 5ml q 4 hours Per Orem

Mechanism of Action Produces analgesic effect by blocking pain impulses,

by inhibiting prostaglandins or pain receptors

sensitizers; may relieve fever by acting in hypothalamic

heat regulating center

Specific Indication For mild pain and fever

Contraindication To patient’s going long-term therapy for chronic

noncongestive angle-closure glaucoma; hyponatremia;

hypokalemia; hepatic impairment; adrenal gland

failure’ hypechloremic acidosis

Side Effects/Toxic

Effects

Confusion; anorexia; aplastic anemia; rash; renal

calculi

Nursing Precaution Report signs of F/E imbalance

Generic Name of

ordered drug

Cefuroxime Sodium

Brand Name Zinacef

Date Ordered September 15, 2008

Classification Antibiotic

Dose/Frequency/Route 200mg IVT q 8 hours (ANST -)

Mechanism of Action Bactericidal: inhibits the synthesis of bacterial cell wal

causing cell death

Specific Indication Lower respiratory infections caused by s. pnuemoniae

Contraindication Contraindicated with allergy to cephalosporins

Side Effects/Toxic

Effects

Tremor; palpitations; tachycardia; nausea and vomiting;

irritation

Nursing Precaution Take full course of therapy even if you are feeling better.