DISCHARGE RECOMMENDATION

Medications
Instructed the client to take all the medications prescribed by the
doctor even if he feels better by following the right route, right dose
and right frequency.
Azithromycin 500mg 1tab OD
Omeprazole 40mg 1tab OD
Salbutamol NEB Q8
Environment and Exercise
Advised the client to maintain a safe, clean and comfortable
environment
Advised the client to stay in a place with good ventilation
Encouraged client to do light exercises such as walking after his
hospitalization. Physical activity releases endorphins in the body,
which are the bodys natural pain killers.
Treatment
Oral antibiotics are used to treat patients with mild to moderate
infection.
Bronchodilators such as Salbutamol helps in opening/dilating the
airway so that the patient would be able to breathe properly
Health Teaching
Advised the client practice good hygiene
Explained to the client the importance of drug compliance and that not
completing the prescribed medications can make infection come back.
It may also make a future infection harder to treat.
Out- Patient
Reminded the client to go to the OPD of Valenzuela Medical Center 1
week after date of discharge as advised by his doctor.
Diet
Increase oral fluid intake unless contraindicated
Lean Protein-Rich Foods because protein plays an important role in
tissue repair and immune function. Choose sources low in saturated
fats.
Hearty Whole Grains as whole grains provide valuable amounts of
carbohydrates as well as a host of vitamins, minerals and antioxidants.
The B-vitamins in whole grains play an important role in energy

production and body temperature control,. Grains are also a good

source of selenium, a mineral that supports immune system function.
Spiritual
Encouraged client to pray according to his beliefs. Spiritual health
depends on the clients religion.

ANATOMY & PHYSIOLOGY

Upper Respiratory Tract

The upper airways consist of the nose, the sinuses, the pharynx (throat), and
the larynx ("voice box").

NOSE AND SINUSES

The nose is the organ of smell, with receptors from cranial nerve I (olfactory)
located in the upper areas. This organ is a rigid structure that contains two
passages separated in the middle by the septum. The upper one third of the nose
is composed of bone; the lower two thirds is composed of cartilage, which allows
limited movement. The septum and interior walls of the nasal cavity are lined with
mucous membranes that have a rich blood supply. Theanterior nares (nostrils or
external openings into the nasal cavities) are lined with skin and hair follicles, which
help keep foreign particles or organisms from entering the lungs. The posterior
nares are openings from the nasal cavity into the nasopharynx.
Three bony projections (turbinates) protrude into the nasal cavities from the walls
of the internal portion of the nose. Turbinates increase the total surface area for
filtering, heating, and humidifying inspired air before it passes into the
nasopharynx. Inspired air entering the nose is first filtered by vibrissae in the nares.
Particles not filtered out in the nares are trapped in the mucous layer of the
turbinates. These particles are moved by cilia (hairlike projections) to the
oropharynx, where they are either swallowed or expectorated. Inspired air is
humidified by contact with the mucous membrane and is warmed by exposure to
heat from the vascular network.

The paranasal sinuses are air-filled cavities within the bones that surround the
nasal passages. Lined with ciliated epithelium, the purposes of the sinuses are to
provide resonance during speech and to decrease the weight of the skull.

PHARYNX
The pharynx, or throat, serves as a passageway for both the respiratory and
digestive tracts and is located behind the oral and nasal cavities. It is divided into
the nasopharynx, the oropharynx, and the laryngopharynx.
The nasopharynx is located behind the nose, above the soft palate. It contains the
adenoids and the distal opening of the eustachian tube. The adenoids(pharyngeal
tonsils) are an important defense, trapping organisms that enter the nose or mouth.
The eustachian tube connects the nasopharynx with the middle ear and opens
during swallowing to equalize pressure within the middle ear.
The oropharynx is located behind the mouth, below the nasopharynx. It extends
from the soft palate to the base of the tongue and is a shared passageway for
breathing and swallowing. The palatine tonsils (also known as faucial tonsils) are
located on the lateral borders of the oropharynx. These tonsils also guard the body
against invading organisms.
The laryngopharynx is located behind the larynx and extends from the base of the
tongue to the esophagus. The laryngopharynx is the critical dividing point where
solid foods and fluids are separated from air. At this point, the passageway divides
into the larynx and the esophagus.

LARYNX
The larynx is located above the trachea, just below the pharynx at the base of the
tongue. It is innervated by the recurrent laryngeal nerves. The larynx is composed
of several cartilages. The thyroid cartilage is the largest and is commonly referred
to as the Adam's apple. The cricoid cartilage, which contains the vocal cords, lies
below the thyroid cartilage. The cricothyroid membrane is located below the level
of the vocal cords and joins the thyroid and cricoid cartilages. This site is used in an
emergency for access to the lower airways. In this procedure, called
a cricothyroidotomy (or cricothyrotomy), an opening is made between the thyroid
and cricoid cartilage and results in a tracheostomy. The two arytenoid cartilages,
which attach at the posterior ends of the vocal cords, are used together with the
thyroid cartilage in vocal cord movement.
Inside the larynx are two pairs of vocal cords: the false vocal cords and the true
vocal
cords.
The
opening
between
the true
vocal
cords
is
the glottis. Theepiglottis is a leaf-shaped, elastic structure that is attached along
one edge to the top of the larynx. Its hinge-like action prevents food from entering
the tracheobronchial tree (aspiration) by closing over the glottis during
swallowing. The epiglottis opens during breathing and coughing.

The lower airways consist of the trachea; two mainstem bronchi; lobar, segmental,
and subsegmental bronchi; bronchioles; alveolar ducts; and alveoli.The
tracheobronchial tree is an inverted treelike structure consisting of muscular,
cartilaginous, and elastic tissues. This system of continually branching tubes, which
decrease in size from the trachea to the respiratory bronchioles, allows gases to
move to and from the pulmonary parenchyma. Gas exchange takes place in the
pulmonary parenchyma between the alveoli and the pulmonary capillaries.
Lower Respiratory Tract

TRACHEA
The trachea (windpipe) is located in front of (anterior to) the esophagus. It begins
at the lower edge of the cricoid cartilage of the larynx and extends to the level of
the fourth or fifth thoracic vertebra. The trachea branches into the right and
left mainstem bronchi at the carina.
The trachea is composed of 6 to 10 C-shaped cartilaginous rings. The open portion
of the is the back portion of the trachea and contains smooth muscle that is
shared with the esophagus. Low pressure must be maintained in endotracheal and
tracheostomy tube cuffs to avoid causing erosion of this posterior wall and to avoid

creating a tracheoesophageal fistula (abnormal connection between the trachea

and the esophagus).
MAINSTEM BRONCHI
The mainstem, or primary, bronchi begin at the carina. The bronchus is similar in
structure to the trachea. The right bronchus is slightly wider, shorter, and more
vertical than the left bronchus. Because of the more vertical line of the right
bronchus, it can be accidentally intubated when an endotracheal tube is passed.
Similarly, when a foreign object is aspirated from the throat, it most often enters the
right bronchus.

LOBAR, SEGMENTAL, AND SUBSEGMENTAL BRONCHI

The mainstem bronchi further branch into the five secondary (lobar) bronchi that
enter each of the five lobes of the lung. Each lobar bronchus is surrounded by
connective tissue, blood vessels, nerves, and lymphatics, and each branches into
segmental and subsegmental divisions. The cartilage ofthese lobar bronchi is ringlike and resists collapse. The bronchi are lined with ciliated, mucus-secreting
epithelium. The cilia propel mucus up and away from the lower airway to the
trachea, where the mucus is either expectorated or swallowed.

BRONCHIOLES
The bronchioles branch from the secondary bronchi and subdivide into smaller and
smaller tubes: the terminal and respiratory bronchioles. These terminal and respiratory tubes are less than 1 mm in diameter. They have no cartilage and therefore
depend entirely on the elastic recoil of the lung to remain open(patent). The
terminal bronchioles do not participate in gas exchange.

ALVEOLAR DUCTS AND ALVEOLI

Alveolar ducts, which resemble a bunch of grapes, branch from the respiratory
bronchioles. Alveolar sacs arise from these ducts. The alveolar sacs contain clusters
of alveoli, which are the basic units of gas exchange. A pair of healthy adult lungs
contains approximately 300 million alveoli, which are surrounded by pulmonary
capillaries. Because these small alveoli are so numerous and share common walls,
the surface area for gas exchange in the lungs is extensive. In a healthy adult, this
surface area is approximately the size of a tennis court. Acinus is a term used to indicate the structural unit consisting of a respiratory bronchiole, an alveolar duct,
and an alveolar sac.
In
the
walls
of
the
alveoli,
specific
cells (type
II
pneumocytes) secrete surfactant, a fatty protein that reduces surface tension in
the alveoli. Without sufficient surfactant, atelectasis (collapse of the alveoli)

ultimately occurs. In atelectasis, gas exchange is reduced because the alveolar

surface area isreduced.

LUNGS
The lungs are sponge-like, elastic, cone-shaped organs located in the pleural cavity
in the thorax. The apex (top) of each lung extends above the clavicle; the base
(bottom) of each lung lies just above the diaphragm (the major muscle of
inspiration). The lungs are composed of millions of alveoli and their related ducts,
bronchioles, and bronchi. The right lung, which is larger than the left, is divided into
three lobes: upper, middle, and lower. The left lung, which is somewhat narrower
than the right lung to make room for the heart, is divided into two lobes.
The hilum is the point at which the primary bronchus, pulmonary blood vessels,
nerves, and lymphatic enter each lung. Innervation of the chest wall is via the
phrenic (pleura) and intercostal (diaphragm, ribs, and muscles) nerves. Innervation
of the bronchi is via the vagus nerve.
The pleura is a continuous smooth membrane composed of two surfaces that
totally enclose the lung. The parietal pleura lines the inside of the thoracic cavity
and the upper surface of the diaphragm. The visceral pleura covers the lung
surfaces, including the major fissures between the lobes. These two surfaces are
lubricated by a thin fluid that is produced by the cells lining the pleura. This
lubrication allows the surfaces to glide smoothly and painlessly during respirations.
Blood flow through the lungs occurs via two separate systems: bronchial and
pulmonary. The bronchial system carries the blood necessary to meet the metabolic
demands of the lungs. The bronchial arteries, which arise from the thoracic aorta,
are part of the systemic circulation and do not participate in gas exchange.
The pulmonary circulation is composed of a highly vascular capillary network.
Oxygen-depleted blood travels from the right ventricle of the heart into the
pulmonary artery, which eventually branches into arterioles that form the capillary
networks. The capillaries are enmeshed around and through the alveoli, the site of
gas exchange. Freshly oxygenated blood travels from the capillaries and through
the venules to the pulmonary veins and then to the left atrium. From the left atrium,
oxygenated blood flows into the left ventricle, where it is pumped throughout the
systemic circulation.

PATHOPHYSIOLOGY

Risk Factors
Aspiration of Secretions
Containing Microbes
Failure of Defense Mechanisms
Invasion of the Lower Respiratory
Tract
Activation of B Cells
Release of Antibodies
Antigen-Antibody Reaction

Antigen Antibody
Complexes Adhere to the
Mucosal Lining of the
Lower Respiratory Tract
Mucosal Irritation

Initiation of Complement
System
(Non-Specific and Specific
Immune System)

Increased Mucus
Production

Increased Blood Flow

Accumulation of Mucus

Vasocongestion

Vasodilation

Increased Plasma
Hydrostatic Pressure
Increased Capillary
Permeability

Product
ive
Cough

Escape of
Plasma
Proteins

Escape of
RBC, Serum
and Fibrin

Edema
Narrowing
of Airway

Inspirato
ry rales

Ineffective
Airway

Increased
Respiratio
n

Asymmetr
ical Chest
Expansion

Use of
Accessory
Muscles

Exudate
Filling of the
Bronchi,
Bronchioles,
and Alveoli
Consolidat
ion of
Lung
Decreased
Lung
Inflation

Transportatio
n of
Phagocyting

Engulfing
of the
Antigen
Replication
of the
Antigen
within the
Cells
become
Infected
Detection of
the Infected
Cells by the T
Cells
Effector T
Cells Destroy
the Antigen
Regulator T
Cells
Strengthen
the
Activity
of
Altered
Effector
and
thje
Effector
Temperature
Regulator
Regulating
Cells
Mechanism
Synthesize
Fever in
the

Release of
Pyrogens