NURS2003 Pathophysiology Case Study: Pneumonia, Symptoms and Rx

This case study delves into the pathophysiology of pneumonia, focusing on the anatomy and physiology of the respiratory system and how pneumonia disrupts its normal function. It examines the intrinsic and extrinsic causes of pneumonia, particularly in the context of a patient named Roger, whose asthma and exposure to irritants in a warehouse likely contributed to his condition. The study discusses the role of bacterial infections, immune system impairment, and inflammatory responses in the development of pneumonia, highlighting symptoms such as elevated respiratory and heart rates, malodorous sputum, and chest pain. The medications prescribed, Salbutamol and Doxycycline, are analyzed in terms of their mechanisms of action and therapeutic effects. Salbutamol provides relief from bronchospasms, while Doxycycline acts as a broad-spectrum antibiotic to combat the bacterial infection. The case study offers a comprehensive understanding of pneumonia's pathogenesis, clinical presentation, and pharmacological management.

Running head: PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
Name of the student:
Name of the university:
Author note:

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Anatomy and physiology of the system affected:
The lungs are found to be the pair of spongy as well as air-filled organs that are located
on the either side of the chest. The trachea also called the windpipe helps in conducting the
different inhaled air into the lungs through the different tubular branches which are named as the
bronchi. These tubular structures are then seen to divide into smaller as well as smaller branches
also called the bronchioles until they become microscopic (DiBardino et al., 2015). These
bronchioles are seen to end eventually in clusters of the different microscopic air sacs which are
named as alveoli. In the alveoli, the oxygen from the air is seen to be absorbed in blood. The
waste product of metabolism called the carbon dioxide is seen to travel from blood to the alveoli
where it gets exhaled. Between the alveoli, there remains a thin layer of cells called the
interstitium. This is seen to contain blood vessels and the different cells that support the alveoli.
Pathophysiology of pneumonia:
The cause of occurrence of pneumonia can be both intrinsic and extrinsic and different
types of bacterial can be noted. Extrinsic causes can be well associated with that of the causative
agents like being exposed to that of the pulmonary irritants or because of the pulmonary injuries.
Loss of the protective upper airways reflex can be considered to be one of the contributors for
aspiration of the contents from that of the upper airways of the lungs (Troy et al., 2016). There
might be various reasons for the loss that may include altered mental status because of
intoxication as well as other metabolic states and neurologic causes like endotracheal intubation
and stroke. In case of the patient named roger, it has been found that he was engaged in
transforming his warehouse into gym with one his friends. This might have exposed him to

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different dust and pollutants which might have been the main contributor to his development of
pneumonia.
Bacteria that enter in the upper respiratory tract ultimately try to reach to the lung
parenchyma. In such situation, three important factors help in determining whether the bacteria
would be able to become successful in infecting the individuals. These are the virulence of the
organisms, the condition of the local defenses as well as overall health of the patient. Studies are
of the opinion that patients only become more susceptible to the development of the disorder
when there is an overall impairment of the immune system or may be due to the dysfunction of
the different defense mechanisms because of smoking, COPD, tumor, inhaled toxins and others
(Teramoto et al., 2015).
Individuals are always seen to remain exposed to huge variety of potentially infectious
microns and in order to cope with them, the respiratory systems are seen to depend on a number
of hierarchies of the defense mechanisms. These physical mechanisms that help in preventing the
microbes from reaching the alveoli are the structure of the upper respiratory tracts, branching of
that of the bronchial tree as well as sticky mucus layer lining the airways, the hair like cilia that
properly mucus upward as well as the cough reflex. Any infectious organisms that can reach the
alveoli successfully are seen to be highly virulent as they have already evaded the physical
defense mechanism of the individuals (Mandell, 2015). In such situation, they are seen to
overwhelm the macrophages and this situation results in production of the fibrin-rich exudates.
These are seen to fill up the infected as well as neighboring alveolar spaces and this cause them
in stocking together rendering them airless. The inflammatory responses are mainly seen to
results in the proliferation of the neutrophils and this has been seen to damage the lung tissues.

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This causes fibrosis as well as pulmonary edema which also results in impairment of the lung
expansion.
Causes of Roger being affected by pneumonia:
Among asthmatic patients, it is seen that such individuals are excessively sensitive to that
of environmental stimuli or trigger like pollens, pet dander, environmental smoke, dust and even
by exercises. Such triggers are seen to irritate the airways in case of asthmatic patients but cannot
affect the airways of the normal individuals. This causes asthma attacks to the individuals where
they suffer from asthmatic conditions like tightening of the muscles around the airways. During
such asthma attacks, the lining of the airways were seen to become as swollen as well as
inflamed and for this reason, thicker mucus is formed which is more than normal (Mizgerd,
2017). Broncho-spasms, mucus production as well as inflammation results in development of
different types of symptoms in the patients like difficulty in breathing, coughing, shortness of
breath and many others. In such cases, individuals are advised to take in inhaled steroids along
with long acting beta agonists. This has been seen that the combination of both the compounds
provide a greater outcome in comparison to those who use LABA alone. These inhaled steroids
are found to increase the risk of development of pneumonia. People who have asthma and use
inhaled steroids are more prone to develop the risk of pneumonia by 83% in comparison to those
who do not use them. This is because these inhaled steroids are seen to lower down the impact of
the immune system helping individuals from getting relieved from the asthmatic symptoms. In
such situation when the immune responses are calmed down, the opportunistic pathogen of
pneumonia is seen to take the opportunity of the weakened immune system and infect the
individuals (Di Pasquele et al., 2017). Roger is similarly seen to use inhalers when he suffers
from asthmatic attacks because of his exercise. This might had made his immune system weak

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and working in the old warehouse to change it to that of the new gym had exposed him to smoke
which had resulted in development of pneumonia. He also complained of flu like systems which
might be another cause of his development of pneumatic systems.
Symptoms:
The respiratory rate of Roger was found to be quite high about 31 beats per minutes. The
normal respiration rate is about 12 to 20 beats per minute. Moreover, the heart rate of the patient
was found to be 128 beats per minute when the normal heart rate mainly stays around 100 beats
per minutes. The inflammatory responses that occur during pneumonia can lead to development
of pleural effusion. This is believed to complicate up to around 40% of the cases of pneumonia.
These changes are seen to result in reduction of the gaseous exchange (Torres et al., 2015).
Therefore, most of the vital organs are seen to become oxygen deprived and the respiratory
effort that is required with each breath would therefore be increased as the result of the
disturbance in the normal psychology. Respiratory as well as the different heart rate would
therefore be increased in response to that of the failing oxygen and increase in the carbon dioxide
levels.
Another important symptom that is found is that Roger was [producing cough that was
associated with malodorous and green sputum. The disorders like pneumonia is often found to be
associated with production of sputum that might vary in color raging from rust colored to
whitish, yellowish and even green. It has been found that the kind of micro-organism that affect
the individuals mainly govern the color of the sputum that would be produced. The formation of
sputum is actually because of the over production of the mucus which is the result of the
activated part of the immune system that helps in trapping the germs and helping to eliminate

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them (Quian et al., 2017). The green colored sputum is mainly associated with individuals who
are infected with Pseudomonas, Haemophilus, and pneumococcal species. Therefore, roger is be
believed to have been affected by these opportunistic bacteria.
Roger was also complaining of severe pain in his chest that was measured to be 2 out of
10 on the pain numerical scale. Pneumonia is mainly a form of disorder that associated with
inflammation of the lungs that is caused by infection. The pain can be attributed because of the
strain experienced by the muscles resulting from excessive coughing. This might be also because
of the inflammation in the linings of the lungs that are termed as pleurisy (Leigh & Marley,
2016).
Medications:
Salbutamol:
Sulbutamol is used to ensure symptomatic relief as well as prevention for the
bronchospasm that occur because of the bronchial asthma, reversible obstructive airways
disorders chronic bronchitis as well as chronic bronchio-pulmonary disorders. It helps in
ensuring acute prophylaxis against exercised induced bronchospasms as well (Bansal et al.,
2015). The patient named roger used to suffer from asthmatic attacks because of exercises and
hence this medications was asked to be continued.
Following inhalation, this drug helps by acting on the bronchial smooth muscles and
initially the drug is not found in the blood. However, after two to three hours, some amount of
drugs might be found in the blood and this might be because of the little portion of the dose that
get swallowed as well as absorbed in the gut. For that of intravenously administered salbutamol,
the volume of distribution that is found to be recorded is 156 +/- 38 L. The medication is not

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metabolized in the lungs. It is mainly seen to be converted in the form of 4'-o-sulphate
(salbutamol 4'-O-sulfate) ester in the liver and this had negligible pharmacologic activity. It
might also be metabolized by the process of that of oxidative deamination as well s conjugation
with the compound of glucoronide (Mathur et al., 2018). After that of oral administration,
approximately 60% is released as metabolites that usually comprise of about 58 to 785 of the
dose and is excreted through urine within 24 hours. A smaller fraction is also found to be
released through feces.
Doxycycline:
Doxycycline is seen to act as a broad spectrum antibiotic which shows lesser toxicity to that of
first generation tetracyclines and is prepared synthetically from that of oxytetracycline. They are
successfully utilized for treatment of the wide range of bacterial infections and this mainly
depends on the result of antibiotic susceptibility testing. They are used for various types of gram
positive as well as gram negative bacteria. Lodha et al. (2016) opines that respiratory tract
infections, Rocky mountain spotted fever, typhus fever and the typhus group, trachoma and
similar others can be effectively treated by the medication. They are mainly seen to apply their
bacteriostatic actions and are believed to exert different antimicrobial effects by inhibition of the
protein synthesis. They mainly help by obstructing the bacterial growth in their stationary phase
or exert anti-microbial effects on the inhibition of the protein synthesis. They show high level of
intracellular penetration capability with wide bacteriostatsitc actions on a wide range of bacteria.
They also show anti-inflammatory actions that help in managing different inflammatory
conditions (Demey et al., 2017). The patient named Roger was seen to suffer from pneumonia
and it was important to prevent the bacterial growth in the lungs and for this, the anti-biotic was
used.

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This drug is found be completely absorbed after oral administration following which it
bounds to plasma proteins by different degrees. This drug is found to be highly lipid soluble and
also display low affinity for calcium binding. This drug is also seen to diffuse immediately into
most of the tissues of the body as well as their fluids and cavities. This volume distribution is
found to be measured as 0.7 L/kg. They are seen to have been displaying than 90%. Doxycycline
is found to be mainly metabolized in the liver as well as in the gastrointestinal tract and
concentrated in bile (Spivey et al., 2017). However, major metabolic pathways of this drug are
not known in details but enzyme inducers have been found to reduce the half-life of this drug
considerably. The drug is eliminated as active and unchanged through the feces. 405 to 60% of
the drug is released through urine within 92hours whereas 30% of the drug is mainly released
through feces.
IV benzylpenicillin:
This medication is mainly a narrow spectrum antibiotic that is mainly utilized for the
treatment of different infections which are caused by different susceptible bacteria. It can be
described as the natural penicillin antibiotic and is mainly administered intravenously as well as
intramuscularly because of poor oral absorption (John et al., 2018). The patient named Roger
was suffering from pneumonia which is caused by the infection of bacteria and hence this
antibiotic was advised and this helped in reducing the further growth and reproduction of the
bacteria. The bactericidial action of the drug is to cause inhibition of the cell wall synthesis and
would be mediated though the binding of the drug to the sites of the penicillin binding sites
called PBS. It is seen to be highly stable against any type of beta-lactamases. It mainly results in
inhibition of the third and fourth stage of the bacterial cell wall synthesis and then cell lysis is

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mediated by the autolytic enzymes like that of autolysis of the bacterial cell wall and penicillin is
then seen to interfere with an autolysin inhibitor.
Once the drug is injected intravenously or intramuscularly, they are rapidly absorbed
initial levels of the drug in the blood that follows the parenteral administration is quite high but
at the same time it is transient. As the drug is susceptible for acid-catalysed hydrolysis, therefore
oral absorption only results in 15 to 30% of the absorption (Wang et al., 2018). The volume of
distribution is found to be about 0.53–0.67 L/kg in adults with that of normal renal function. It
has been found that about 16-30% of the intramuscular dose is metabolized towards penicilloic
acids. Small amounts of 6-aminopenicillanic acid can be recovered in the urine of the patients.
Only a very small part is found to hydroxylated into one or more active metabolites that get
excreted via urine. The main route of elimination is mainly by the kidneys and non-renal
clearance is mainly found to be because of hepatic metabolism as well as to a lesser extent
billiary excretion.

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Demey, L., Van Muylem, A., Michils, A., & Haccuria, A. (2017). Protective effect of salbutamol
on peripheral airway constriction induced by sputum induction in asthma patients.
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Di Pasquale, M., Aliberti, S., Azzari, C., Moriondo, M., Nieddu, F., Blasi, F., & Mantero, M.
(2017). Serotypes and antibiotic susceptibility of Streptococcus pneumoniae isolated
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