final n jud

8/19/2019 final n jud

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General Objective:

We the group 6-B develop this case study to help us enhance our knowledge about the

disease process and also to manage the treatment of the disease

!pecific Objectives

"his case study significantly identifies the factors that gave rise for our client to have the

diagnosed problem "he following are the identified objectives for the case study

• "o develop a comprehensive assessment of the client•

"o establish a #athophysiology for the disease of the client• "o develop a nursing care plant appropriate for the client$s diagnosed problem• "o be able to teach the significant others of the client for proper health

maintenance• "o lessen the risk of infection and development of complications of the client• "o be able to provide an environment conducive for health• "o enhance the care that will be given for other client$s with the same diagnosis

%ntroduction

1



#neumonia is an infection of the lower respiratory tract caused by bacteria&

viruses& fungi& proto'oa& or parasites %t is the eighth leading cause of death in the

(nited !tates "he incidence and mortality of pneumonia are highest in the elderly )isk

factors for pneumonia include advanced age& immunocompromise& underlying lung

disease& alcoholism& altered consciousness& smoking& endotracheal intubation&

malnutrition& and immobili'ation "he causative microorganisms influence the symptoms

and signs with which the patient presents& how the pneumonia should be treated and

the prognosis

*ommunity-ac+uired pneumonia develops in people with limited or no contact

with medical institutions or settings *,# tends to be caused by differentmicroorganisms than those infections ac+uired in the hospitals "he characteristics of

the individual are important in determining which etiologic microorganism is likely or

e.ample& immunocompromised persons tend to be susceptible to opportunistic

infections that are uncommon in normal adults %n general& nosocomial infections and

those affecting immunocompromised individuals have higher mortality rate community-

ac+uired pneumonias

"he most common community-ac+uired pneumonia is caused by !treptococcus

pneumoniae& which has a relatively low mortality rate& although it is higher in the elderly

/ycoplasma pneumoniae is a common cause of pneumonia in young people especially

those living in group housing such as dormitories and army barracks %nfluen'a is the

most common viral community-ac+uired pneumonia in adults 0egionella species& which

also cause *,#& can contaminate cooling systems and water supplies leading to

outbreaks of disease !igns and symptoms of *,# are fever& cough& dyspnea&

tachypnea and tachycardia 1iagnosis is based on clinical presentation and chest .-ray

"reatment is with empirically chosen antibiotics #rognosis is e.cellent for relatively

young and healthy patients& but many pneumonias& especially when caused by

!treptococcus pneumoniae and influen'a virus& are fatal in older& sicker patients

2



,ccording to the World 2ealth )eport by the World 2ealth Organi'ation& lower

respiratory infections& which include community-ac+uired pneumonia& ranks ninth

among the leading causes of mortality on individuals aging 34 to 45 worldwide and

ranks fourth on individuals aging 6 and over& and that it is the leading killer of children

worldwide

*,# is one of the most common entities seen in ilipino adults %t is the most

common infectious disease prompting hospitali'ation and the first and fifth leading

cause of morbidity and mortality in the #hilippines& respectively

#neumonia was the top common disease in all ages groups in the 36 health

districts of 1avao *ity between 7anuary and ebruary this year based on statisticsprepared by the *2O 8city health office9 #neumonia ranked first among the top three

common diseases in 33 districts& with 3& ;< cases in ,gdao districts as the highest "he

World 2ealth Organi'ation has stated that pneumonia is among the leading causes of

death in children under five years old "here were 6&==4 cases of community ac+uired

pneumonia 8*,#9 in the 36 health districts from 7anuary to 1ecember ; 33

8www.edgedavao.net 9

or our client /r > who is = years old and a lawyer ,t his young age of 36 he

started smoking and drinking alcoholic beverages 2e can consume half pack of

cigarettes a day On the day of his confinement he already develops some signs and

symptoms of the disease but did not mind it until it got more complicated

1efinition of "erms

3

http://www.edgedavao.net/




• *ommunity ,c+uired #neumonia ? a long term treatment and it is ac+uired

outside the hospitals• %mmunocompromised ? having the immune system impaired or weakened 8 as

by drugs or illness 9• Goblet *ells ? %s a glandular& modified simple columnar epithelial cell whose

function is to secrete gel-forming mucins& the major components of mucus• /ucociliary clearance ? mucus ciliary clearance also referred to as mucociliary

apparatus or mucus ciliary clearance 8//*9 derived from mucus& cilia 8cilia of

the tracheal surface epithelium in the respiratory tract9 and clearance describe

the cell clearing mechanism of bronchi• Bradykinin ? %s an inflammatory mediator %t is a peptide that causes blood

vessels to dilate 8enlarge9& and therefore cause blood pressure to fall• 0eukotriene ? ,re family of eicosanoid inflammatory mediators produce in

leukocytes by the o.ygenation of arachidonic acid by the en'yme arachidonate

4- lipo.ygenase• "hermoregulatory center ? 2ypothalamos & is the ability of an organism to keep

its body temperature within certain boundaries& even when the surrounding

temperature is very different

Comprehensive Assessment

PATIENTS PROFILE

4



@ame: /r >

,ge:

!e.: /ale

,ddress:

Birthday:

Birthplace:

*ivil status: /arried

)eligion:

@ationality: ilipino

,dmission date: 1ec 3& ; 3;

,dmission "ime: 3:4; #/

,ttending physician: 1r ,dmitting physician: 1r

*hief *omplaint: *ough and ever

1iagnosis: *,# ruled out "BA #arotitis

I. Physical Examination

A. INTEG !ENTAR"

5



#hysical .am indings

S#IN

*olor: #atient has dark skin comple.ionA no discoloration

"e.ture: 2as smooth skin but his palm of his hands is rough as well as his soles in

the feet

"urgor: 2as good skin turgor as we pinched his skin is goes back immediately in

place

!calingA @o scales noted

2air distribution: "hin& short& black hair

%nfestation: @o infestation noted

*omments: @o abnormalities noted upon assessing the skinSTO!A CDE @ot ,pplicable

C E clean& dry C E redness C E chronic redness C E drainage C E chronic drainage C E

prolapsed

FINGERNAILS $ TOENAILS

CDE color& shape& cleanliness good CDE no problems deviations assessed

C E irregularities in surface: @o irregularities in surface

C E inflammation of the nails: @o inflammation around the nailsC E fungal problem: @o fungal problem

%. &EA' AN' NEC#


&EA' $ NEC#

2ead motion: ,ble to moveD fle. head without difficulty

C E asymmetric head position: !ymmetric head position

CDE shrugs shoulder C E unable to support head midline F erect C E dull& puffy& yellow

skin

C E periorbital edema C E lymph node enlargement C E thyroid enlargement

C E tracheal displacement

*omments: @o problem noted during assessment of the head and neck

6



NOSE $ SIN SES

C E nasal drainage C E inflamed C E tender C E polypsDlesions C E edema

C E altered nasal mucosa

C E absence of frontal sinus glow C E right nostril occluded C E left nostril occlude

*omments: @o pain or lesion noted

!O T& $ P&AR"N(

C E altered oral mucosa membrane: @o altered oral mucous found

C E inflammation: @o inflammation noted

C E hoarseness C E bru.ism 8grinds teeth9 CDE loose teeth C E decay C E halitosis C Ee.cessive salivation

CDE lips dry& cracked C E lip fissures CE lip bleeding C E gums inflamed C E gums bleed C E

gum retraction C E thick tongue C E tongue dry& cracked C E tongue fissures C E tongue

bleeds

%nspected the following CDE inner oral mucosa CDE buccal mucosa CDE floor of mouth CDE

tongue CDE hard palate CDE soft palate1eviations: has normal color of the tongue as noted

C E lesions& vesicles: no lesions and vesicles noted

C E gag refle. absent C E gag refle. hyperactive C E poor denture fit or not using C E

chewing problem C E missing teeth

*omments: /r > has no lesions found of the any said inspected areas @ormal

findings upon assessment on gag refle.

C. E"ES $ EARS


E"ES

7



isual acuity: *an see objects in a distance

isual fieldsD peripheral: *an see objects on the peripheral sides

ye tracking presents: CDE up CDE down CDE CDE right CDE left

CDE corneal light refle. aligned C E light refle. misaligned C E nystagamus

.ternal eye structures: e.ternal eye structures is round and symmetrical

@o lesions& edema noted

,bnormalities: @o abnormalities noted

Blink refle.: 2as normal blink refle. ,ble to blink without difficulty

#upil F iris direct light response: #upil and iris respond to the direct light

#upil F iris consensual light response: #upil constrict on light

EARS.ternal ear structure: "he ear structure are symmetry in shape ar lobes are bean

shaped& parallel and symmetrical

.ternal ear structure abnormalities: @o abnormalities noted

*omments: @o abnormalities noted upon assessing the ears "here is no pain nor

tenderness upon touching the auricles @o discharges or lesions noted in the ear

canal

'. CAR'IOP L!ONAR"

2 ,)" F ,!*(0,)

,uscultated heart sounds:

,pical pulse: <5 bpm

7ugular venous distention C E present C E absent capillary refill C E H3 second CDE

;seconds CDE #/% palpable- 4 th intercostals space to medial to left midclavicular line

C E #/% not palpable

C E edema: @o edema noted

Blood pressure: 3; D< mm2g

#eripheral pulses: <I bpm

*omments: *lient$s heart sound characteristics is regular and strong in rhythm

8



@ipple deviations: C E retractions C E discharge C E bleeding C E nodules C E edema C E

ulcerations

*omments: @o abnormalities noted upon assessing the breast of the client

G. ! SC LOS#ELETAL

C E gait abnormalities: @o gait abnormalities

C E posture abnormalities: @o posture abnormalities

C E impaired weight bearing stance: @o impaired weight bearing stance

C E bilateral symmetry: @o bilateral symmetry

C E asymmetry: @o asymmetry noted

C E bilateral alignment: @o bilateral alignment noted

*omments: @o decrease of )O/ noted& no tenderness and misalignment noted ,llthings are normal

&. NE ROLOGIC S"STE!

CDE alert CDE aware of environment C E impaired consciousness C E Glasgow coma scale

score:

CDE changed level of consciousness C E unchanged level of consciousness

CDE able to communicate CDE vocali'es sounds C E limited verbali'ation C E non-verbal C Echanged in communication pattern

C E unchanged communication pattern

*omments: "he client is responsive he was able to interact and sociali'e with other

people

CRANIAL NER,E *CN+ F NCTION

*@ %- Olfactory CDE intact C E impaired C E unknown

*@ %- "rigeminal CDE intact C E impaired

*@ %%- acial CDE intact C E impaired

*@ %%%- ,coustic CDE intact C E impaired

*@ %>- Glossopharyngeal CDE intact C E impaired

*@ >- agus CDE intact C E impaired

10



*@ >%- !pinal accessory CDE intact C E impaired

*@ >%%- 2ypoglossal CDE intact C E impaired

SENSOR" F NCTION

"ouch CDE intact C E impaired

#ain CDE intact C E impaired

REFLE(ES

#atellar refle.: C E no response C E 3K low

CDE ;K normal& visible muscle twitch and e.tension of lower leg

,@,"O/L ,@1 #2L!%O0OGL

)espiratory !ystem

11



the chest wall 8thora.9 #leural fluid holds both layers in place& in a manner similar to

two microscope slides that are wet and stuck together "he lungs are separated from

each other by the mediastinum& an area that contains the heart and its large vessels&

the trachea 8windpipe9& esophagus& thymus& and lymph nodes "he diaphragm& the

muscle that contracts and rela.es in breathing& separates the thoracic cavity from the

abdominal cavity

"he chart of the respiratory system shows the intricate structures needed for

breathing Breathing is the process by which o.ygen in the air is brought into the lungs

and into close contact with the blood& which absorbs it and carries it to all parts of the

13



< "he O%* BO> 8laryn.9 contains the vocal chords %t is the place where moving air

being breathed in and out creates voice sounds

5 "he !O#2,G(! is the passage leading from the mouth and throat to the stomach

3 "he W%@1#%# 8trachea9 is the passage leading from the throat 8pharyn.9 to the

lungs

33 "he 0L/#2 @O1 ! of the lungs are found against the walls of the bronchial tubes

and windpipe

3; "he )%B! are bones supporting and protecting the chest cavity "hey move to alimited degree& helping the lungs to e.pand and contract

3= "he windpipe divides into the two main B)O@*2%,0 "(B !& one for each lung&

which subdivide into each lobe of the lungs "hese& in turn& subdivide further

3 "he right lung is divided into three 0OB !& or sections ach lobe is like a balloon

filled with sponge-like tissue ,ir moves in and out through one opening -- a branch of the bronchial tube

34 "he left lung is divided into two 0OB !

36 "he #0 (), are the two membranes& actually one continuous one folded on itself&

that surround each lobe of the lungs and separate the lungs from the chest wall

3I "he bronchial tubes are lines with *%0%, 8like very small hairs9 that have a wave-like

motion "his motion carried /(*(! 8sticky phlegm or li+uid9 upward and out into the

throat& where it is either coughed up or swallowed "he mucus catches and holds much

of the dust& germs& and other unwanted matte that has invaded the lungs Lou get rid of

this matter when you cough& snee'e& clear your throat or swallow

15



3< "he 1%,#2),G/ is the strong wall of muscle that separates the chest cavity from

the abdominal cavity By moving downward& it creates suction in the chest to draw in air

and e.pand the lungs

35 "he smallest subdivisions of the bronchial tubes are called B)O@*2%O0 !& at the

end of which are the air sacs or alveoli 8plural of alveolus9

; "he ,0 O0% are the very small air sacs that are the destination of air breathed in

"he *,#%00,)% ! are blood vessels that are imbedded in the walls of the alveoli

Blood passes through the capillaries& brought to them by the #(0/O@,)L ,)" )L

and taken away by the #(0/O@,)L %@ While in the capillaries the blood gives off carbon dio.ide through the capillary wall into the alveoli and takes up o.ygen from the

air in the alveoli

16



#athophysiology of *ommunity-,c+uired #neumonia

%nhalation of microorganisms

%nvasion of foreign bodies in the ()"

,ctivation of the upper airway defense mechanism& cough refle.&

mucociliary clearance and nasopharyngeal defense

#athogens begin to coloni'e

#athogens enter the lower

1amage occurs to mucous membrane

,ctivation of the inflammatory process&

released of chemical mediators

17

#redisposing actors:• 0ifestyle such as:

- smoking- alcoholic

• @ature of his work• .posure to

bacteria agents

#recipitating actors:• ,ge above 4 for

ilipinos



2istamine Bradykinin #rostaglandin 0eukotriene %ncrease in

ascular

!timulates goblet cells !timulate muscle spasm *hemota.is #ermeability

to increase mucus that contributes to

production bronchoconstriction /igration of WB* to 0eaking of fluids and fluid

the site of injury shifting resulting to

,ccumulation of mucus @arrowing of airway accumulation of fluid in

secretions in the airway )elease of pyrogens the alveolar sacs

contributing to the

narrowing of airway !timulates the thermoregulatory "his accumulation of fluids

center of the body to reset impairs gas e.change

body temperature resulting to ventilation-

*rackles #roductive 1yspnea @asal flaring perfusion mismatch

ever

"achypnea #allor *hest #ain

/alaise

18



@arrative #athophysiology

*ommunity ,c+uired #neumonia mostly caused by aging especially 4 above for

ilipinos& also lifestyle those who are smokers and alcoholic can easily get this type of

disease %t will start with inhalation of the microorganism which is staphylococcus

pneumonea through airbore or droplet& then once it will invade our body it will activate

our 3 st line of defense which are the refle.es such as the cough refle.& nasopharyngeal

defense& mucociliary clearance& also the snee'ing %t will stay longer in our upper

respiratory system and start to coloni'e& slowly pathogens will enter now the lower

respiratory system which are the lungs& bronchi and aveoli %t will start damaging the

mucous membrane Once that happened our body will now release some chemical

mediators to stop the disease such as histamine which will stimulate the goblet cells toincrease mucus production& bradykinin which wil cause muscle spasm that contributes

to have bronchoconstriction& prostaglandin will cause chemota.is or migration of white

blood cells to fight of bacteria inside our body& and leukotriene which will cause increase

of vascular permeability %f the disease is not treated well it will cause more damage and

will result to have a fever& tachypnea& pallor& chest pain& dyspnea& and also body

malaise Good prognosis with right treatment will cure the patient Bad prognosis can

lead to meningitis or death

19



Co-rse in the ar/

1octor$s Order @otes

ID6D34 8<:; pm9

- 2istory of on and off cough

whitish phlegm

- 8-9 2#@ & 8-9 1/& 8K9 B,& 8K9

,llergies: @!,%1!

- 2*0 #)* ? 8K9 left pre auricular

pain 8K9 fever

- 3 d #", ? right submandibulararea

- , !& ##*

8K9 tender lymphocecyoclay

!ubmandibular auricular

area

- give paracetamol torplanadine

8 norgesic forte tab 9 3 tab

- facilitate labs and relay

%nitial *>) receiving cDo /#G

8-9 whee'ing

6: #/"emp ? =< <

#) ? <3 - #lease admit under the service of 1r Lbiernas

)) ? ;3

/eds: 39 ,mpicillin !ulbactam 8silgram9

3 4 g +< ,@!" !tart ,!,#

;9 Orofar gargle "%1

=9 2ydrocortisone 3 g +< %

9 ,lloprinol = g 3 tab O1

49 #aracetamol 4 g 3 tab for #)@ for fever

% #@!! 3 0 3 ccDhr

% and O + shift

20



B# ? 3; D<

2t ? 36= cm

Wt ? 6I 5 kg

IDID34 8 6pm 9

- awake& comfortable - @oted pulmonites ? will relay to 2#

- dyspnea - 1ecreased hydrocortisone to +3; 2

- chest pain - 2old ##"& ()%*& ,0" and crea

- hemophysis - acilitate , B >;

- clear B!

- !table !

-8-9 ever

21



0aboratory results

.amination )esult (nit )ange 2igh

D0ow )emarks

2emoglobin 3=I gD0 3 -3I5 0

2ematocrit = - 6

)ed Blood *ell 6 P3 <3;D0 4-6

White Blood *ell 6 P3 <5D0 4 ? 3

#latelet *ount ;4= P3 <5D0 3 -

@uetrophils I4 64 ? 64 2

0ymphocyte 6 =4 ? 4 0

/onocyte < 6 ? 3;

osinophil 3 ; ? 0

Basophil - ;

,bsolute @eutrophil < P3 4<D0 3 < ? I <

,bsolute lymphocyte 3 ;< P3 45D0 3 ? <

,bsolute /onocyte 6 P3 45D0 ? <

,bsolute osinophill < P3 45D0 ? 4

,bsolute Basophil P3 45D0 ? ;/* 5; 3 P3D0 < - 5I

/*2 ;5 6 Ppg ;I ? =3 ;

/*2* =;3 =3< - =4

)1W 3= 33 4 ? 3 4



1rug !tudy

1rug @ame /echanism of

,ction

%ndication *ontraindicatio

n

,dverse

)eactions

1osage @ursing

%ntervention

)ationale

Generic

@ame: ,mpicillin

!odium

Brand @ame:

!ulbactam

!odium

*lassification:

,minopenicillin

!ulbactam

inhibitsplasmid-

mediated beta-

lactamase

en'ymes

commonly

found in

microorganism

s resistant to

ampicillin

"reatment of

skin and skinstructure& intra

abdominal& and

gynaecologic

infection caused

by susceptible

microorganisms

2ypersensitivity

to penicillins

)ash

8 less than;Q 9A

erythema

multiforme&

e.foliative

dermatitis&

urticaria

,ctual:

3 4 gram+< % ""

,@!" 8-9

• ,sk

patient ifallergic to

penicillin

• ducate

client on

the side

effects of

the

medication and

what to

e.pect

• "o

preventany

allergic

reaction• "o avoid

an.ious

reaction

of the

patient



1rug @ame /echanism

of ,ction


n

,dverse

)eactions

1osage @ursing

%ntervention

)ationale

Generic

@ame:

Ben'o.onium*l&0idocaine

2*l

Brand @ame:

Orofar - 0

*lassification:

,ntiinfective

and antiseptic

%nfections in

the mouth and

throate.amples:

pharyngitis or

laryngitis& sore

throat with

colds&

aphthous

ulcers&

stomatitis&

gingivitis

,djuvant in

tonsillitis

1ental pla+ue

%solated

cases of

skin rashAoccasional

and

transient

cases of

mild local

irritation

,ctual:

gargle 3o'

"%1

• ,ssess

patient for

signs andsymptoms

of mouth

and the

throat• ,ssess for

allergic

reaction:

skin rash• %ntstruct

patient tosip water

after

taking the

gargle

• "o obtain

baseline

informatin during

treatment

• "o give

immediat

action

• "o

decreasedry mouth



1rug @ame /echanism

of ,ction


n

,dverse

)eactions

1osage @ursing

%ntervention

)ationale

Generic

@ame:

2ydrocortison

e

Brand @ame:

*ortef& !olu-

*ortef&

2ydrocortone&

*ortenema

*lassification:

,drenal

cortical steriod

nters

target cells

and bids to

cytoplasmicreceptorA

initiates

many

comple.

reactions

that are

responsible

for its anti-

inflammator

y

immunosup

presive

8glucocortic

oid9& and

salt

retaining

-replacement

therapy in

adrenal

cortical

-allergic states

?severe or

incapacitating

allergic

conditions

-hematologic

disorders

-ulcerative

colitis

-allergy to any

component of

the drug

-fungal

infections

-amebiasis

-hepatitis B

-vaccinia or

varicella

-antibiotic-

resistant

infections

-

immunosuppres

*@!:

vertigo&

headache&

paresthesias&

insomnia&

sei'ures&

psychosis&

* :

hypotensio

n& shock&

2#@ and

heart

failure

secondary

to fluid

retention&

thromboe

mbolism&

,ctual:

3 mg %

J<

-assess for

contraindication

-give daily before

5am to mimicdiurnal

corticosteroid

levels

-space multiple

doses evenly

throughout the

day

-use minimal

doses for

minimal duration

to minimi'e

adverse effects

-do not give %/

• "o obtain

baseline

informati

n duringtreatment

• "o give

immediat

action



8mineralocor

ticoid9

actions

!ome

actions may

be

undesirable

depending

on drug use

sion thromboph

lebitis& fat

embolism&

cardiac&

arrhythmia

1ermatolo

gic:

"hin&

fragile

skin&

petechiae&

ecchymos

es&

purpura&

striae&subcutane

ous fat

atrophy

@":

*ataracts&

injections if

patient has

thrombocytopeni

c purpura

-"aper doses

when

discontinuing

high-dose or long

term therapy

-monitor client for

atleast = mins

-educate client

on the sideeffects of the

medication and

what to e.pect

-instruct client to

report pain at



glaucoma&

increased

%O#

ndocrine:

amenorrhe

a& irregular

mens&

growth

retardation

&

decreased

carbohydr

ate

tolerance

and 1/&cushingoid

state& 2#,

suppressio

n

systemic&

hyperglyce

injection site

-%nstruct client to

take drug e.actly

as prescribed



mia

G%: peptic

or

esophage

al ulcer&

pancreatiti

s&

abdominal

distention&

nausea&

vomiting&

increased

appetite

and weight

gain

2ematolog

ic: @a and

fluid

retention&

hypocalce

mia&



increased

blood

sugar&

increased

serum

cholesterol

&

decreased

"= and "

levels

2ypersens

itivity:

anaphylact

oid or

hypersensi

tivityreactions

/usculosk

eletal:

muscle

weakness&

steroid



myopathy

and loss of

muscle

mass&

osteoporo

sis&

spontaneo

us

fractures

Other:

immunosu

ppresion&

aggravatio

n or

masking of

infections&impaired

wound

healing

@ursing *are #lan

,ssessment @ursing

1iagnosis

!cientific

.planation

#lanning @ursing

%ntervention

)ationale valuation



!ubjective:

Rdili mo

gawas

akong

plema

masking

unsaon

nako ug

uboS as

verbali'ed

by the

patient

Objective:

%nitial !:

#)T<Ibpm)) T

;4cpm

Hwith rales

on both lung

lobes upon

%neffective

,irway

*learance

related to

retained

secretions in

the bronchi

and lung

inflammation

leading to

accumulatio

n of mucous

in the alveoli

*ommunity-

,c+uired

#neumonia is the

inflammation of

the lung

parenchyma

when the

offending

organism reaches

the alveoli via

droplets or saliva

in which goblet

cells produces an

outpouring fluid

into the alveoli"he organisms

multiply in the

serous fluid and

the infection is

spread "he

organisms

!hort

"erm :,fter 4

hours of

@ursing

%nterventions

& the patient

will

e.pectorate

mucous as

evidenced

by

productive

cough&

effective

coughingand

breathing

e.ercise

H ,ssess

respiratory status:

breath sounds&

respiratory rate&

o.ygen

saturation& note

abnormalities

such as dyspnea&

presence of

cyanosis& use of

accessory

muscles& flaring of

nostrils

H ,ssess an.ietyand reassure

patient with

presence

H ,bnormal breathing

patterns may signal

worsening of

condition: flaring of

nostrils indicate a

significant decline in

respiratory status:

assessment

establishes baseline

and monitor

response to

interventions

H Being unstable tobreath causes

an.iety and fear: the

patient needs a

calming presence:

an.iety increases the

demand for o.ygen

!hort "erm :

"he patient

was able to

e.pectorate

mucous as

evidenced

by

productive

cough

effective

coughing

and

breathing

e.ercise



chest

auscultation

H shortness

of breath

H with non-

productive

cough

H

)estlessnes

s

damage the host

by their

overwhelming

growth and

interference with

lung function

leading to

massive

accumulation of

mucus 1isruption

of the mechanical

defenses of

cough and ciliary

motility leads to

the coloni'ation of

the lungs andaccumulation of

secretions in the

alveoli and

bronchi leading to

ineffective airway

clearance as

H #lace patient in

high fowler$s

position and

support with

overbed table as

needed

H ncourage

e.pectoration of

secretions and

assess the

viscosity amount

and color of

secretions

H ,ssist the

patient with

coughing and

H /a.imi'e chest

e.cursion and

subse+uent

movement of air

H "hickened

secretions of *ap re

more likely to

occlude the airway:

making this

observation would

allow for

implementation ifmeasures to thin and

loosen the secretions

H /obili'es

secretions and

prevent atelectasis



evidence by non-

productive cough

etc alveolar

e.udates tend to

consolidate&

increasingly

difficult to

e.pectorate

deep breathing

H %ncrease fluid

intake

H #rovide for

periods of rest

and activity&

assisting with

devices as

needed

H levate head of

bedD change ofposition every ;

hours

H ,ssists with

li+uefying secretions

and enhancing ability

to clear airways

H 1ecrease demand

for o.ygen

H "o maintain an

open airway and totake advantage of

gravity decreasing

pressure on the

diaphragm and

enhancing drainage

of secretions



H ,ssist

respiratory

therapist U the

administration of

nebuli'er

H stablish

intravenous

access as

ordered

H ,ssess arterial

blood gases

8,BG9

H"his causes

bronchiodilation to

ease breathing

H nsures a route for

rapid- acting

medications

H,BG provide data

for treatment

regarding the lungs$

ability to o.ygenatetissues

,ssessment @ursing

1iagnosis

!cientific

.planation

#lanning @ursing

%ntervention

)ationale valuation



!ubjective:

Rkapoy man

maglakaw-

lakaw maa$m

dali ra ko

hangakonS

as verbali'ed

by the

patient

Objective:

%nitial !

#)T<Ibpm

)) T ;4cpm

H easy

fatigability

H non-

productive

,ctivity

%ntolerance

related to

increased

o.ygen

demand

with activity

and hypo.ia

8lack of

o.ygen

supply w

"he onset of

pneumonia is

generally marked

by fever&

dyspnea& and

shortness of

breath and easy

fatigability that

may lead to

inability to

perform activities

of daily living

1ue to the

accumulation of thick tenacious

mucous in the

alveoli altering

gas e.change

8 o.ygen and

carbon dio.ide9

!hort "erm :

,fter hours

of @ursing

%nterventions

& the patient

is able to

perform

activities of

daily living

without

shortness of

breath such

as doing

personalhygiene& etc

H Obtain

subjective data

from patient

regarding normal

activities prior to

onset of

pneumoniaA

monitor for fatigue

and e.haustion

H )educe level of

activity as

re+uired in

response to

o.ygen need ofthe body

H ,ssist with

activities as

needed

H2elps to determine

the effects of

pneumonia on the

patient$s ability to be

active

H%f increased

physical activity

causes shortness of

breath& activity

should be reduceduntil o.ygenation is

ade+uate

H *onserves energy

and reduces o.ygen

demand patients with

!hort "erm :

"he patient

was able to

perform

activities of

daily living

without

fatigue such

as doing

personal

hygiene&

etc



cough

Hshortness

of breath

during

activities

H%nability to

perform

physical

activities

Hphysical

e.haustion

phy

between the

alveoli ,nd

H#ace activities

and encourage

periods of rest

and activity during

the day

H /onitor ! and

o.ygen saturation

before and after

activity

H Gradually

increase activity

as tolerated and

share guidelines

pneumonia lack

enough o.ygen

reserves to perform

activities

independently

H%t conserves energy

H (se the result to

indicate when the

activity may be

increased ordecreased

H ,ctivities should be

increased gradually&

as tolerated& to avoid

over ta.ing the



for progression

with patient

H 1iscuss with

the patients

activities that

would be

appropriate once

at home that

would be within

the patient$s

activity tolerance

H %nform the

patient to stop

any activity thatproduces

shortness of

breath

H ncourage

intake of foods

patient

H #hysical activity

increases endurance

and staminaA

following pneumonia&

return to normal

activity may take

time

H "his indicate

intolerance to activity

and the level ofactivity should be

evaluated

H %ron has a role in

o.ygen transport and



high in iron and

good source of

energy such as

lean meat&

legumes which

are rich in protein

H ,ssist patient to

learn and

demonstrate

appropriate safety

measures

increases energy

level

H"o prevent injuries

,ssessment @ursing

1iagnosis

!cientific

.planation

#lanning @ursing

%ntervention

)ationale valuation



!ubjective:

Rusahay naga

lisod kog

hinga kanang

mo grabe

akong uboS

as verbali'e

by the patient

Objective :

%nitial !:

#)T <Ibpm

))T ;4cpm

Hdifficulty of

breathing

Huse of

supraclavicul

ar muscles

for respiration

%neffective

breathing

pattern

related to

thick

tenacious

secretions

in the

bronchi

due to

inflammati

on of lung

tissue

*ommunity-

,c+uired is a

disease process

involving

inflammation of

lung tissue %t

typically results

when

microorganisams

enter the normally

sterile lungs from

the nasopharyn.

and produces

inflammation of

the lungparenchyma

Because of the

inflammation of

the alveoli are

filed with fluid and

mucus and

!hort "erm :

,fter hours

of @ursing

%nterventions

& the patient

shall have a

normal

respiratory

rate& rhythm&

depth and

reports a

shortness of

breath as

evidence bydecrease

)) from ;4

cpm to 36-

; cpm

H ,ssess

respiratory

system by noting

respiratory rate&

depth chest

e.pansion& breath

sounds& arterial

blood gases& etc

H ,ssist #atient

in assuming a

high- fowler$s

position or

position of choicesuch as leaning

forward or over

bed table

H %ncrease oral

fluids to ; -

H ,ny of this

abnormalities would

indicate the studies

of the respiratory

system and

progression of

diseaseA also

establishes a

baseline comparison

Hma.imi'es thoracic

cavity space&

decreases pressure

from diaphragm and

abdominal organsand facilitates use of

accessory muscles

Hhelp to improve

hydration status and

decrease secretions

!hort "erm :

"he patient

has normal

respiratory

rate&

rhythm&

depth of

breathing

and relief

from

shortness of

breath as

evidence by

decreased)) from ;4

cpm to 36-

; cpm



as well as

shoulder

muscles

H U non-

productive

cough

H with

presence of

rales on both

lung lobe

upon chest

auscultation

#atient may

manifest the

following :

o.ygen and

carbon dio.ide

e.change cannot

take place at a

alveolar capillary

cellular

membrane level

due to blood flow

decreases

8deceased

perfusion of blood

in the lungs9and

leukocytes and

fibrin consolidate

in the affected

part of the lungdue to a

decreased blood

flow there is a

decreased supply

of o.ygen to other

tissues leading to

= mlDday as

tolerated

H #rovide chest

physiotherapy&

bronchial tapping&

vibration& etc

H,ssist with

activities of daily

living as re+uired

H "each patient

how to decrease

shorthness of

breath by

restructuring

activities

H mobili'es thick

secretions& and

facilitates clearing of

lung fields

Hpatient with

pneumonia may lack

sufficient o.ygen

reserves to perform

activitesA even eating

may cause severe

dyspnea

H Vnowing how to

control shortness of

breath will help cope

and have optimal

functioning



Hsevere

dyspnea

H,bnormal

blood gases

H abnormal

inspiratory

orDand

e.piratory

ration

H pursed lip

breathing

H altered

chest

e.cursion

Hhypo.ia

8*onfusion&

ineffective

breathing pattern H"each

pulmonary

hygieneA

prevention of

spread of

infection

H,dminister

bronchodilators

and e.pectorants

H ,dministerantibiotics as

ordered

H #reventing spread

of infection and

subse+uent

hospitali'ation

H nhances

e.pectoration of

secretions of

previously ineffective

cough

H2elps to prevent oreradicate infections

to reduce secretions

and to end to

inflammation



restlessness&

decreased

vital capacity9



'ISC&ARGE PLAN

/H #atient will continue its ordered medication by the physician

H 1eep Breathing .ercises

H *oughing .ercises

H 0imit activities and have rest periods

"H *ontinue medications as order

2H ncourage d to keep environment allergen free

H ncouraged warm versus cold li+uids as appropriate

H #rovided information about the necessity of raising and e.pectorating

secretions versus swallowing them

H ncouraged to have rest periods and limit activities to level of respiratory

toleranceH ncouraged to have a monthly check-up

H ncouraged to stop smoking

H 1emonstrated pursed lip or diaphragmatic breathing techni+ues

H discussed rationale for and encourage continuation of successful

interventions

OH ,dvised patient to have a ollow-up check-up after one week

1H %ncreased oral fluid intake H 2igh calorie& high protein diet of soft foods

T Goal /et , B patient verbali'ed understanding of the health teachings give



CONCL SION

*ommunity- ,c+uired #neumonia is one of the most common infectious diseases

addressed by clinician$s cause of morbidity and mortality worldwide

%n the case of /r >& the disease was caused primarily by personal and

environmental factors such as cigarette smoking& alcohol& job e.posure to pathogens&

and other factors "his lead to the development of the disease and lack of action on the

part of the caretakers /r > manifested difficulty of breathing& non productive cough&

and rales on both lung fields

"hrough these manifestations different laboratory and diagnostic procedures thatwould confirm and support the admitting diagnosis were performed 1ifferent results

have been taken out such as to consider illness such as #"B& ,G and ,telectasis

which have been ruled out and the hospital final diagnosis was *ommunity- ,c+uired

#neumonia

"he result played an essential part on the part of the patient !ince the family has

no information about the signs and symptoms of the disease they will now be aware onthose things in order to prevent this illness

Lears have passed and still these diseases are present especially with

developing countries "he solution is simple but needs great discipline to make it

concrete , clean surrounding will definitely boost our chances of invading such disease

condition

We the group 6-B strongly recommends that further studies are to be done to

clear out other vague information and misconceptions regarding this disease



RECO!!EN'ATIONS

To the comm-nity0

"he community should be more oriented to this kind of condition and also for the

safety of community to know what are the proper management and how to care patients

with this type of condition

To the 1amily0

or his family members& they should be more aware on their environment "his

should be an e.perience for them to not disregard any early signs and symptoms of a

disease especially pneumonia

To the st-/ents0

or the students who are more knowledgeable about community ac+uiredpneumonia& they should give more information and health teachings to the patients who

e.periencing such condition

To the client0

/r > should continue his medication to prevent any multi-resistant disease ,lso

accept if there is any changes on his lifestyle such as withdrawal of his smoking and

drinking alcoholic beverages



%I%LIOGRAP&"

%OO# SO RCES0

!melt'er& et al /edical-!urgical @ursing: 33 th dition 0ippincott Williams and Wilkins

; 33

1eglin2opfer& alierant& @a'orel 1avis$ 1rug Guide for @urses: 3 th dition , 1avis

*ompany& #hiladelphia ; 5

1oenges& et al @urses #ocket Guide: 1iagnosis& #rioriti'ed %nteractions and

)ationales: 33 th dition , 1avis *ompany& #hiladelphia

/c*ance& et al #athophysiology: "he Biologic Basis for 1isease ,dul and *hildren: 4 th

dition ; 3

!chilling& et al @ursing #rocess ,pproach "o .cellent *are: 4 th dition 0ippincott

Williams and Wilkins ; 33

ONLINE SO RCES0

http:DDwww medscape comDviewarticleD I4;3<

http:DDwww emedicine comD/ 1topic=36; htm

http:DDwww utmedicalcenter orgDencyclopediaD3D 3 4 htm

http:DDwww mims comD

http:DDwww doh gov phDdata statDhtmlDmortality htm

http:DDwww wrongdiagnosis comDpDpneumoniaDprevalenve htmtypes

http:DDwww lungusa orgDsiteDc dv0(V5 Db ;;4I6DV I D2uman )espiratory !ystem

htm

http:DDwww edgedavao net

http://www/


http://www/




TA%LE OF CONTENTS

Objectives

%ntroduction

1efinition of term

*omprehensive ,ssessment

#hysical .amination

,natomy and #hysiology

#athophysiology schematic

#athophysiology narrative

*ourse in the ward

0aboratory

1rug study@ursing care plan

1ischarge plan

*onclusion

)ecommendation

BibliographyXXXXXXXXXXXXXXX XXXXXXXXXX 6

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