DR. YANGA’S COLLEGES, INC.

College of Health Sciences

BS Nursing Program

CASE STUDY IN A PATIENT

WITH COMMUNITY-
ACQUIRED PNEUMONIA WITH
MODERATE RISK

Submitted by:
Natricia D. Trondillo

December 2023
I. INTRODUCTION
Community-acquired pneumonia (CAP) is a type of pneumonia that was obtained
anywhere but a hospital or a healthcare facility.

An increasing number of viruses are being identified as the cause of respiratory

infection. Half of all pneumonias are believed to be of viral origin. Most viral pneumonias are
patchy and the body usually fights them off without help from medications or other treatments.
A bacterial, viral, or fungal infection can result in pneumonia, which is an inflammation and fluid
buildup in the lungs. The lobar form is called Pneumococcal pneumonia.

Fever, pleuritic chest discomfort, dyspnea, tachypnea, tachycardia, and cough that
produces green, yellow, or red mucus are among the indications and symptoms. Pneumonia is
often caused by pneumococcal illness, COVID-19, and the flu. The etiology and severity of
pneumonia determine the course of treatment. The most common infectious cause of
pneumonia in the United States is the bacteria Streptococcus pneumoniae.

Bacterial pneumonia can attack anyone. The most common cause of bacterial
pneumonia in adults is a bacteria called Streptococcus pneumoniae or Pneumococcus.

Pneumococcus is not limited to pulmonary disease. Serious infections of the circulation,

other body parts, and the coating of the brain (meningitis) can also be brought on by the
bacterium.

Community-acquired pneumonia develops in people with limited or no contact with medical

institutions or settings. Haemophilus influenza, Streptococcus pneumoniae, and atypical
organisms (such as Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella sp.) are
the most often detected pathogens. The clinical presentation and chest x-ray are used to make
the diagnosis. Antibiotics selected empirically are used as treatment. For patients who are
relatively young or healthy, the prognosis is excellent; nonetheless, many pneumonias,
particularly those caused by Streptococcus pneumoniae in older, sicker people, influenza viruses
or pneumoniae can be lethal.
II. OBJECTIVES
General Objective

This case study aims to successfully implement the nursing process in combination with
the necessary skills, knowledge, and attitude to build an effective management for a patient
with Community Acquired Pneumonia to attain optimum level of health. Its goal is to apply the
learnings gathered through this study in an actual clinical situation and develop. This will lead to
the development enhancement of the knowledge and learnings, characteristics essential to be a
competent nurse in the future.

Specific Objective (student-centered)

At the end of the case study, the student nurse would be able to:

Knowledge

 Distinguish measures that should be taken while taking the patient into consideration

 Analyze the patient’s condition through data that have been collected

 Identify possible causes of the disease

Skills

 Apply necessary interventions that would address with patients’ condition

 Examine the patient's condition to notice any additional problems

 Construct measures that should be taken to help patients’ condition

 Demonstrate actions that will be given to the patient

Attitude

 Consider the patient’s condition

 Develop rapport with the patient and family

 Demonstrate a willingness to assist them

Specific Objective (patient-centered)

At the end of the case study, the patient would be able to:

Knowledge

 Observe what can be learned through health providers

  Review health teaching that has been discussed

Skills

 Demonstrate health education provided by the health care provider

 Apply preventive measure to prevent recurrence of the disease

 Perform self-management capabilities to help prevent the condition from worsening.

Attitude

 Demonstrate a willingness to collaborate with the healthcare provider

 Recognize the importance of participative to attain good health

 Improve self for independence toward self-care.

III. ANATOMIC AND PHYSIOLOGY OVERVIEW

The Lungs

The lungs are paired, cone-shaped organs which take up most of the space in our chests, along
with the heart. Their role is to take oxygen into the body, which we need for our cells to live and
function properly, and to help us get rid of carbon dioxide, which is a waste product. We each
have two lungs, a left lung and a right lung. These are divided up into 'lobes', or big sections of
tissue separated by 'fissures' or dividers. The right lung has three lobes but the left lung has only
two, because the heart takes up some of the space in the left side of our chest. The lungs can
also be divided up into even smaller portions, called 'bronchopulmonary segments'.
These are pyramidal-shaped areas which are also separated from each other by membranes.
There are about 10 of them in each lung. Each segment receives its own blood supply and air
supply.

Air enters your lungs through a system of pipes called the bronchi. These pipes start from the
bottom of the trachea as the left and right bronchi and branch many times throughout the
lungs, until they eventually form little thin-walled air sacs or bubbles, known as the alveoli. The
alveoli are where the important work of gas exchange takes place between the air and your
blood. Covering each alveolus is a whole network of little blood vessel called capillaries, which
are very small branches of the pulmonary arteries. It is important that the air in the alveoli and
the blood in the capillaries are very close together, so that oxygen and carbon dioxide can move
(or diffuse) between them. So, when you breathe in, air comes down the trachea and through
the bronchi into the alveoli. This fresh air has lots of oxygen in it, and some of this oxygen will
travel across the walls of the alveoli into your bloodstream. Travelling in the opposite direction
is carbon dioxide, which crosses from the blood in the capillaries into the air in the alveoli and is
then breathed out. In this way, you bring in to your body the oxygen that you need to live, and
get rid of the waste product carbon dioxide.
IV. PATHOPHYSIOLOGY
V.NURSING HISTORY
PERSONAL DATA

Patient’s name is T.D. is a 64-year-old Asian woman, married and a Filipino Roman Catholic
residing in Blk 5 Lot 21 Northville 4C Lambakin Marialao, Bulacan. She was admitted for the first
time at The Lord’s Hospital, Meycauayan, Bulacan at 11:37 am on September 12, 2023 with the
chief complaint of difficulty of breathing, fever, and 1 week of experiencing a purulent-
productive cough.

PRESENT HEALTH HISTORY

5 days prior to admission, the patient had positive signs and symptoms of cough and
yellowish phlegm. Knowing that these signs and symptoms were just forms of little discomforts,
she self-medicated with paracetamol.

3 days PTA, she noticed no changes thus she took Symdex-d oral.

24 hours PTA, she then experienced difficulty breathing so she sought medical
consultation.

1 hour PTA, she still experiencing difficulty of breathing

PAST HEALTH HISTORY

The patient has never had any serious diseases. She has only had coughs and colds that
lasted about a week. She received her first and second vaccines for COVID- 19 in 2021, as well as
her first booster shot in 2022. The patient also doesn’t have any allergy to any foods and drugs.

FAMILY HISTORY
SOCIO AND ECONOMICS

T.D. gets up early every morning to prepare breakfast for her Grandchildren. She then
helped them to get ready and walked them to school as they were near to it. She also
participates in and helps with church activities. Then does her laundry, water her garden and
cleans the house. She occasionally smokes whenever she feels stressed.

T.D. is married with 3 children. She works in the barangay as an active barangay council
member. She does not disclose her official income per month but aside from her income her
husband who is a factory worker also earns money to help support their family’s daily expenses.
Phil's health and other medical insurance cover her as well.
NUTRITION AND METABOLIC

Patient T.D. states that she enjoys cooking and eating. She stated that she’s the one who
prepares food in their home. She also mentioned that she loves vegetables, especially eggplant,
moringa or “malunggay” and chinese cabbage or “pechay”. As she has a garden that is full of
those vegetables.

1st DAY 2nd DAY

7am 4 pieces of bread (pandesal) 1 scrambled egg

1 cup of coffee
3 pieces of bread (pandesal)
1 cup of coffee

11am 1 cup of rice 1 cup of Rice

Sinigang na isda Adobong sitaw
1 banana 1 banana
1 glass of water 2 glasses of water

3pm 1 sandwich with ham and cheese 1 sandwich with cheese

1 glass of water 1 glass of water

7pm Tinolang manok 1 cup of rice

1 banana Nilagang baboy
2 glasses of water 1 banana
1 glass of water

Elimination Pattern

The patient's urination pattern is approximately 155 mL per hour and is about 7-9 times a day
and is amber in color. In terms of defecation the patient defecates once every morning and
sometimes bid. Her stool is firm and is easy to pass.

Home and Environment

T.D. lives with her husband and accompanied by their daughter and her family. Their house is
bungalow type which was made of cement and bricks. It has one kitchen, three bedrooms, one
bathroom, one comfort room and a living room. Their house is located at Blk 5 Lot 21 Northville
4C Lambakin Marilao, Bulacan. Their water is supplied by nawasa , their drinking water comes
from a refillable gallon which they buy in the store and their electrical power is provided by
Meralco. Their toilet is level 2 that facilitates the water carriage type with water seal and flush
type with septic vault or tank disposal. Their drainage system is a closed drainage. Garbage
collection in the subdivision happens every Thursday morning.

VI. PHYSICAL ASSESSMENT

GENERAL SURVEY

Received patient from the ER via wheelchair with chief complaint of cough and fever. The
patient has + cough, + fever, + body malaise. With an ongoing IVF PNSS 1L x 10 hours @ 500 cc
infusing level.

With a vital sign of:

Vital Signs (12pm) Normal Range Interpretation

Blood Pressure 110/70 pt blood pressure is in

normal range
Systolic= 90 - 120 mmHg

Diastolic= 60 – 80 mmHg

Respiratory rate 26 12-20bpm The patient has

tachypnea

Temperature 37.3 36.4 - 37.4C The patient’s

temperature is slightly
elevated

Pulse 91 60- 100beats/min The pulse is in normal

range

02sat 95% 95 - 100% The 02sat is in the

base of normal range

REVIEW OF SYSTEMS
PARTS METHOD NORMAL ACTUAL FINDINGS CLINICAL
FINDINGS SIGNIFICANCE
Respiratory Inspection Effortless DAY 1 Narrowed airway due
System inspiratory -RR is elevated to excess mucous
expansion -DOB production as
and -RR: 26 evidenced by DOB and
increase RR. After few
expiratory
days of medication
contraction DAY 2
the patient’s
-RR is still elevated
breathing is effortless
Normal -still has uneasiness and her RR return to
Range: 12- when breathing normall
20bpm -RR: 22-23

DAY 3
-RR is still slightly
elevated
-sometimes has
uneasiness when
breathing
-RR: 20-22

DAY 4
-RR normalized
-Smooth when breathing
without any exertion in
breathing
-RR: 21

VII. COURSE IN THE WARD

Day 1

A 64-year-old female was received in the ER at exactly 11:23am last September 12, 2023,
accompanied by her daughter, with a chief complaint of cough and fever. She was admitted
under the service of Dr. Jan Enrique Puentespina and following orders were given. Diet as
tolerated with strict aspiration precaution, temperature, pulse rate, respiratory rate, i and o
must be reported every shift. The physician ordered an IVF of PNSS 1l x10 hours. At 12:20pm,
patient was moved to the ward via wheelchair with ongoing IVF #1 PNSS 1l x 10 hours at 500
level. All vital signs were taken and recorded and all needs were attended. At 6pm, I & O were
taken and recorded. Patient was endorsed at 7pm to the next attending nurse. At 8pm, vital
signs were taken and recorded. At 12:45am, Piperacillin and Tazobactam initial dose was given.
At 4am,IVF #2 of PNSS 1L x 10hrs was hooked. At 6pm, I and O was taken and recorded

Day 2

Patient td was received at 7am with cough but no fever. Patient was with ongoing IVF #2 PNSS 1l
x 10 hrs @ 550cc level infusing well. She was still on diet as tolerated with strict aspiration
precaution. Dr. Ordered for urinalysis. At 8am, patient was NPO from 8am to 2pm for
ultrasound. Dr. Ordered WAB ultrasound and sputum GS/CS. At 6pm, results of ultrasound were
received and recorded. Patient was endorsed to the attending next nurse. Patient was with
ongoing IVF #3 of PNSS 1l x 10 hours at 800cc level and a low salt-low fat diet.

Day 3

Dr. Jan Puentespina seen and examined patient td at 1:45am and ordered to increase n-
acetylcysteine to 2x a day. At 7am, patient was still with IVF #3 of PNSS 1L x 10 hours at 300cc
level and infusing well. Patient was still on diet as tolerated with strict aspiration precaution. At
8am, urinalysis results were received and recorded. At 3pm, patient was seen and examined by
Dr. Jan Puentespina and ordered CBC, serum NA and K at 8am. At 5:40pm, IVF #4 of PNSS 1L x10
hours was hooked. At 6pm, all vital signs, and I and O were taken and recorded and all needs
were attended then endorsed.

Day 4

Patient was seen asleep at 3am. At 4am, vital signs were taken and recorded. At 6am, i and o
were taken and recorded and updated the attending physician. Patient was endorsed to the
attending next nurse with ongoing IVF #4 PNSS 1L x 10 hrs at 400cc level. At 9:25 am, results of
CBC, NA and K were reported to the attending physician. At 2:30pm, patient was seen and
examined by Dr. Jan Puentespina with orders of repeat serum potassium tomorrow at 10am. At
3pm, patient was hooked with IVF #5 of PNSS 1L x 10hrs. At 6pm, i&o were taken and recorded,
all meds are given and all needs were attended. Patient was endorsed at 7pm to the next
attending nurse. Patient was with ongoing IVF #5 PNSS 1L x 10 hrs @ 650cc level infusing well.
Day 5

At 12:00am, vital signs were taken and recorded. Patient was seen asleep at 3am. At 5:10am,
patient consumed IVF #5 and IVF #6 of PNSS 1L x 10 hours was hooked attending physician was
updated. At 7am, patient was endorsed and was received - with ongoing ivf #6 PNSS 1L x 10 hrs
@ 950cc level infusing well. Patient was still on diet as tolerated and morning care was done.
Patient was given breakfast at 8am and ate it regularly. At 10am, serum potassium was done
and relayed the result to AP. At 2:29pm, Dr. Jan Puentespina seen and examined patient td and
order of discharge was made. The medications were obtained in the pharmacy and billing was
settled. At 5:30pm, patient td went home.

VIII. DIAGNOSTICS/ LABORATORIES

ECG Result:
Impression: Normal Sinus Rhythm

Ultrasound Result:
Impression: Fatty liver changes. Normal ultrasound of the Gallbladder, Pancreas,
Spleen, Aorta, Kidneys, Urinary Bladder and the Uterus. Patient has negative Adnexae

Radiographic Result:
Impression: Consider Bronchiopnuemonic

SARS-CoV-2 Antigen Testing Result:

Result: Negative

Clinical Chemistry Result:

Result Normal Values

Potassium: 2.52 mmol/l Normal: 3.50-5.30 mmol/l

Sodium: 140.8 Normal: 135.00-145.00 mmol/l

Hematology Result:

Result

Hemoglobin: 126 Normal: 125 - 160 g/L

Hematocrit: 0.38 Normal: 0.38 - 0.50

Leukocyte: 10.7 Normal: 5-10 x 10^9/L

Neutrophile: 0.76 Normal: 0.40 - 0.60

Lymphocyte: 0.24 Normal: 0.20 - 0.40

Urinalysis:
Color: Yellow

Transparency: Clear

Reaction: (pH) 5.0

Protein: NEGATIVE

Glucose: NEGATIVE

Specific Gravity: 1.010

Pus cells: 3-4/HPF

RBC: 2-3/hpf
 Crystals: A Urates: Many

Mucus threads: few

Cast: Fine Granular cast: 1-2/HPF

IX. DRUG STUDY

DRUG MECHANISM INDICATION CONTRAINDICATI ADVERSE NSG RESPO

OF ACTION ON EFFETCS
Generic Name: It is a para- - Relieve mild or Severe hepatic - Tachycardia. BASELINE ASS.
Paracetamol aminophenol moderate pain, impairment or active liver
derivative that such as disease (IV). - Nausea, Assessing for
vomiting adverse effects,
Brand Name: exhibits analgesic, headaches,
- antipyretic actions toothache or such as
- redness of hematologic
and weak anti- sprains, and rectal mucus
Classification: inflammatory reduce fevers reactions, fecal
Analgesics and membranes occult blood, or
activity. caused by
antipyretics - Insomnia nephritis.
illnesses such as
Analgesic effect may colds and flu.
Dosage: 500mg be associated with - Anxiety INTER/EVAL
the inhibition of Administering the
Frequency: - Dyspnea
prostaglandin medication as
q4 for temp ≥
synthesis in the CNS - bronchospasm prescribed and at
37.8C and to a lesser appropriate
extent, by peripheral intervals.
Route: Oral blockage of pain-
Date Ordered: impulse generation. Monitoring vital
Sept 12, 2023 signs, pain levels,
It produces fever reduction,
antipyresis by and liver and renal
inhibiting the functions.
hypothalamic heat-
regulating center. PT/ FAM

Educating patients
or parents about
the correct dose,
duration, and
precautions of
paracetamol use.

Providing non-
pharmacological
methods for pain
and fever
management,
such as cold
compresses or
rest.
DRUG MECHANISM INDICATION CONTRAINDICATI ADVERSE NSG RESPO
OF ACTION ON EFFETCS
Generic Name: It is an anti- - Acute Asthma - Hypersensitivity to drugs - Congestive BASELINE ASS.
Hydrocortisone inflammatory heart failure
- Adrenocortical - Systemic fungal infections Monitoring the
adrenocortical
Brand Name: steroid. Insufficiency - Hypertension patient's response
- - Neonates or premature to the medication,
It is short acting - Tendonitis observing for any
infants - Hypokalemia
Classification: glucocorticoid with - Small Joint adverse reactions
Anaphylaxis mineralocorticoid Arthritis for Local - Patient with TB infection - Cardiac or side effects,
activities. Infiltration. enlargement and assessing for
Dosage: - Patient with measles or improvement in
100mg - Juvenile Idiopathic varicella exposure - Hypocalcemic the patient's
Arthritis alkalosis condition.
Frequency: - Immunosuppressed
q8 hours - Inflammation - Muscle INTER/EVAL
Route: IV weakness
- Replacement Administering
Date Ordered: Therapy - Abdominal hydrocortisone as
Sept 12, 2023 distention prescribed by the
healthcare
- Peptic ulcer provider, ensuring
with possible accurate dosage,
perforation timing, and route
and of administration.
hemorrhage
Accurate and
timely
documentation of
medication
administration,
patient response,
vital signs, and
any pertinent
information
related to
hydrocortisone
therapy in the
patient's medical
records.

PT/ FAM

Providing patient
education about
the medication,
including its
purpose, dosage
regimen, potential
side effects, and
the importance of
compliance with
the prescribed
treatment plan.

Advocating for the

patient's needs,
addressing
concerns, and
ensuring they
receive
comprehensive
care while on
hydrocortisone
therapy
DRUG MECHANISM INDICATION CONTRAINDICATI ADVERSE NSG RESPO
OF ACTION ON EFFETCS
Generic Name: Piperacillin works by - treat bacterial - Patients with a history of - Rash BASELINE ASS.
Piperacillin and killing the bacteria infections in many allergic reactions to any of
- Itching Conducting
Tazobactam and preventing their different parts of the penicillins,
growth the body cephalosporins, or beta- assessments to
- Hives monitor the
Brand Name: lactamase inhibitors.
- Tazobactam works by - Community- patient's response
- difficulty
preventing bacteria acquired to treatment,
breathing or
Classification: from destroying pneumonia in including
swallowing
Antibiotics and piperacillin. adults evaluating the
beta-lactamase - wheezing resolution of the
inhibitors - Skin and skin infection, tracking
structure - severe changes in
infections in diarrhea
Dosage: symptoms, and
4.5mg adults noting any adverse
- hemophagoc
- Female pelvic reactions.
Frequency: ytic
q8 hours infections in lymphohistio INTER/EVAL
adults cytosis
Route: Oral Monitoring vital
signs and
Date Ordered: laboratory
Sept 12, 2023 parameters (such
as complete blood
count or renal
function) may also
be necessary.

Encouraging
adequate fluid
intake unless
contraindicated, as
some antibiotics
may require
increased
hydration to
support kidney
function and
prevent
complications.

PT/ FAM

Providing
information to the
patient about the
purpose of the
medication, the
importance of
completing the full
course of
treatment,
potential side
effects, and any
specific
instructions or
precautions to
follow while taking
piperacillin/tazoba
ctam
DRUG MECHANISM INDICATION CONTRAINDICATI ADVERSE NSG RESPO
OF ACTION ON EFFETCS
Generic Name: decreases viscosity of - For cough and - Allergy to acetylcysteine - Shock BASELINE ASS.
N- secretions and is other lung
- Children under age of 2 - Fluid Assessing the
Acetylcysteine used as a mucolytic conditions(
agent in eyes and in bronchitis, accumulation patient's response
Brand Name: bronchial nebulizing emphysema, in the skin and to NAC treatment
- solutions mucoviscidosis, mucous involves observing
membranes for symptom
Classification: pneumonia, and
It also increases bronchiectasis) improvement or
mucolytic oxygen delivery to resolution of
agents tissues, increases - flu, dry eye, and acetaminophen
mitochondrial ATP many other overdose-related
Dosage: production, and conditions concerns.
alters the
600 mg INTER/EVAL
microvascular tone
dissolved in ½
to increase the blood Administering NAC
glass of water
flow and oxygen as prescribed,
Frequency: delivery to the liver ensuring accurate
2 times a day and other vital dosage, timing, and
organs. appropriate route
Route: Oral
of administration
Date Ordered: (oral or
Sept 12, 2023 intravenous).

Monitoring the
patient for any
adverse reactions
or side effects
related to NAC,
such as nausea,
vomiting, or
allergic reactions.

PT/ FAM

Emphasizing the
importance of
regular follow-up
appointments or
monitoring tests to
assess the
effectiveness of
NAC therapy and
ensure proper
management of
the underlying
condition.

Providing guidance
on how to take
NAC, whether
orally or
intravenously,
including details on
dosing schedule,
duration, and any
special instructions
related to taking
the medication
 X. NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Ineffective Short term Independent: 1.Tachypnea, Goal half

airway goal: shallow respiration
“nahihirapan 1. Assessed met.
clearance are usually present.
ako huminga related to After 3-4 rate/depth of
After 4 hours
at grabe ang hours of respiration and 2. Lowers
increase of nursing
ubo ko” as mucus intervention, chest movement. diaphragm,
intervention,
verbalized by production patient will promoting chest
2. Elevated head of patient
the patient expectorate expansion,
bed and changed expectorated
secretions mobilization and
Objective: position frequently. secretion and
effectively expectoration of
RR decrease
*RR- 26 and RR will 3. Assisted patient secretion.
to normal as
continue to with frequent deep 3. Deep breathing evidenced by
*Dyspnea be normal breathing exercises. facilitates maximum absence of
within the
*productive expansion of the dyspnea.
range of 16- 4. Encouraged
cough increase in fluid lungs and smaller
20 breaths
per minute. intake. airways.
*Use of
accessory 4.Fluids aid in
Long term Collaborative:
muscle mobilization and
goal:
5. Administered expectorations of
After 3 days mucolytics as secretions
of indicated.
intervention, 5. Aids in
patient will 6. Provided mobilization of
supplemental fluids. secretion.
maintain
patent airway (IVF: PNSS) 6. Fluids are
as evidenced required to replace
by normal 7. Monitored chest insensible loss and
RR. X-ray, ABG and aids in mobilization
pulse oximetry of secretions.
results.
7. Follows progress
and effects of
disease process.
 XI. HEALTH TEACHING

Medication- - Educate about the importance of strict compliance to medication.

- Educate the family and the patient about the side effects, mechanism of actions and
contraindications of each medication
- Inform the patient to contact the healthcare provider if adverse effects occur
- Educate the patient not to take other medications without consulting a physician.

Environment- - Explain the importance of having a clean surroundings.

Treatment- - Remind the patient to make sure to return on the date of follow-up visits.
Hygiene- - Explain the effects of unsanitary living to health.
Outpatient- - Strictly follow the doctor’s order and advise
Diet- - Increase clear liquids and water intake to help thin the mucus in the lungs
- Eat protein rich foods to help build new tissues in the body

Safety/Sexual/Spiritual- - Advice the patient to stop smoking

- Use facemask when going to places with interactions to many people

XII. EVALUATION
After providing interventions that directly addresses the patient's needs and offer
health education on how to prevent and manage the disease, i was able to meet the specific
goals for this study. The reader should benefit from this by learning how to deal with a patient
who has experienced community- acquired pneumonia with warning signs and may use this
knowledge to create or make a better nursing intervention.
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Piperacillin and tazobactam: package insert. (n.d.). Drugs.com.

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Pneumonia: Causes, symptoms, diagnosis & treatment. Cleveland Clinic. (n.d.).

https://my.clevelandclinic.org/health/diseases/4471-pneumonia#symptoms-and-causes

Team, C. B. M. (n.d.). Paracetamol: Indication, dosage, side effect, precaution | MIMS

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https://www.mims.com/PHILIPPINES/DRUG/INFO/PARACETAMOL?MTYPE=GENERIC

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