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I. INTRODUCTION

This is a case of a 42-year-old woman who was diagnosed with Community

Acquired Pneumonia with effusion at the Right Lung.

Community-acquired pneumonia (CAP) is a disease in which individuals who

have not recently been hospitalized develop an infection of the lungs (pneumonia). CAP

is a common illness and can affect people of all ages and often causes problems like

difficulty in breathing, fever, chest pains, and a cough. CAP occurs because the areas

of the lung which absorb oxygen (alveoli) from the atmosphere become filled with fluid

and cannot work effectively.

Community acquired pneumonia occurs throughout the world and is a leading

cause of illness and death. Causes of CAP include bacteria, viruses, fungi, and

parasites. CAP can be diagnosed by symptoms and physical examination alone, though

x-rays, examination of the sputum, and other tests are often used. Individuals with The

kind of disease sometimes require treatment in a hospital and are primarily treated with

antibiotic medication.

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

with medical institutions or settings. The most commonly identified pathogens are

Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms (ie,

Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella sp). Symptoms and

signs are fever, cough, pleuritic chest pain, dyspnea, tachypnea, and tachycardia.

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Diagnosis is based on clinical presentation and chest x-ray. Treatment is with

empirically chosen antibiotics. Prognosis is excellent for relatively young or healthy

patients, but much pneumonia, especially when caused by S. pneumoniae or influenza

virus, are fatal in older, sicker patients.

Etiology

Many organisms cause community-acquired pneumonia, including bacteria,

viruses, and fungi. Pathogens vary by patient age and other factors 1: Pneumonia:

Community-Acquired Pneumonia in Children 2: Pneumonia: Community-Acquired

Pneumonia in Adults but the relative importance of each as a cause of community-

acquired pneumonia is uncertain, because most patients do not undergo thorough

testing, and because even with testing, specific agents are identified in < 50% of cases.

S. pneumoniae, H. influenzae, C. pneumoniae, and M. pneumoniae are the most

common bacterial causes. Pneumonia caused by chlamydia and mycoplasma are often

clinically indistinguishable from pneumonias with other causes. Common viral agents

include respiratory syncytial virus (RSV), adenovirus, influenza viruses,

metapneumovirus, and parainfluenza viruses. Bacterial superinfection can make

distinguishing viral from bacterial infection difficult.

C. pneumoniae accounts for 2 to 5% of community-acquired pneumonia and is

the 2nd most common cause of lung infections in healthy people aged 5 to 35 yr. C.

pneumoniae is commonly responsible for outbreaks of respiratory infection within

families, in college dormitories, and in military training camps. It causes a relatively

benign form of pneumonia that infrequently requires hospitalization. Chlamydia psittaci

pneumonia (psittacosis) is rare and occurs in patients who own or are often exposed to

birds.

A host of other organisms cause lung infection in immunocompetent patients,

although the term community-acquired pneumonia is usually reserved for the more

common bacterial and viral etiologies.

Q fever, tularemia, anthrax, and plague are uncommon bacterial syndromes in

which pneumonia may be a prominent feature; the latter three should raise the

suspicion of bioterrorism.

Adenovirus, Epstein-Barr virus, and coxsackievirus are common viruses that

rarely cause pneumonia. Varicella virus and hantavirus cause lung infection as part of

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adult chickenpox and hantavirus pulmonary syndrome; a coronavirus causes severe

acute respiratory syndrome.

Common fungal pathogens include Histoplasma capsulatum (histoplasmosis)

and Coccidioides immitis (coccidioidomycosis). Less common fungi include

Blastomyces dermatitidis (blastomycosis) and Paracoccidioides braziliensis

(paracoccidioidomycosis). Pneumocystis jiroveci commonly causes pneumonia in

patients who have HIV infection or are immunosuppressed.

Parasites causing lung infection in developed countries include Toxocara canis

or T. catis (visceral larva migrans), Dirofilaria immitis (dirofilariasis), and Paragonimus

westermani (paragonimiasis). (For a discussion of pulmonary TB or of specific

microorganisms, see Mycobacteria.)

Symptoms include malaise, cough, dyspnea, and chest pain. Cough typically is

productive in older children and adults and dry in infants, young children, and the

elderly. Dyspnea usually is mild and exertional and is rarely present at rest. Chest pain

is pleuritic and is adjacent to the infected area. Pneumonia may manifest as upper

abdominal pain when lower lobe infection irritates the diaphragm. Symptoms become

variable at the extremes of age; infection in infants may manifest as nonspecific

irritability and restlessness; in the elderly, as confusion and obtundation.

Signs include fever, tachypnea, tachycardia, crackles, bronchial breath sounds,

egophony, and dullness to percussion. Signs of pleural effusion may also be present

(see Mediastinal and Pleural Disorders: Symptoms and Signs). Nasal flaring, use of

accessory muscles, and cyanosis are common in infants. Fever is frequently absent in

the elderly.

Symptoms and signs were previously thought to differ by type of pathogen, but

presentations overlap considerably. In addition, no single symptom or sign is sensitive

or specific enough to predict the organism. Symptoms are even similar for noninfective

lung diseases such as pulmonary embolism, pulmonary malignancy, and other

inflammatory lung diseases.

Diagnosis

Chest x-ray

Consideration of pulmonary embolism

Sometimes identification of pathogen

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Diagnosis is suspected on the basis of clinical presentation and is confirmed by

chest x-ray (see Table 3: Pneumonia: Probability of Pneumonia Given Chest X-ray

Infiltrate ). The most serious condition misdiagnosed as pneumonia is pulmonary

embolism, which may be more likely in patients with minimal sputum production, no

accompanying URI or systemic symptoms, and risk factors for thromboembolism (see

Table 1: Pulmonary Embolism (PE): Risk Factors for Deep Venous Thrombosis and

Pulmonary Embolism).

Chest x-ray almost always demonstrates some degree of infiltrate; rarely, an

infiltrate is absent in the first 24 to 48 h of illness. In general, no specific findings

distinguish one type of infection from another, although multilobar infiltrates suggest S.

pneumoniae or Legionella pneumophila infection and interstitial pneumonia suggests

viral or mycoplasmal etiology.

Hospitalized patients should undergo WBC count and electrolytes, BUN, and

creatinine testing to classify risk and hydration status. Two sets of blood cultures are

often obtained to detect pneumococcal bacteremia and sepsis, because about 12% of

all patients hospitalized with pneumonia have bacteremia; S. pneumoniae accounts for 2⁄3 of these cases. Whether the results of blood cultures alter therapy commonly enough

to warrant the expense is under study. Pulse oximetry or ABG should also be done.

Pathogens: Attempts to identify a pathogen are not routinely indicated;

exceptions may be made for critically ill patients, patients in whom a drug-resistant or

unusual organism is suspected (eg, TB, P. jiroveci), and patients who are deteriorating

or not responding to treatment within 72 h.

The use of Gram stain and culture of sputum for diagnosis is of uncertain benefit,

because specimens often are contaminated and because overall diagnostic yield is low.

Samples can be obtained noninvasively by simple expectoration or after hypertonic

saline nebulization for those unable to produce sputum. Alternatively, patients can

undergo bronchoscopy or endotracheal suctioning, either of which can be easily done

through an endotracheal tube in mechanically ventilated patients. Testing should

include mycobacterial and fungal stains and cultures in patients whose condition is

deteriorating and in those unresponsive to broad-spectrum antibiotics.

Additional tests are indicated in some circumstances. Patients at risk of

Legionella pneumonia (eg, patients who smoke, have chronic pulmonary disease, are >

40, receive chemotherapy, or take immunosuppressants for organ transplantation)

should undergo testing for urinary Legionella antigen, which remains present long after

treatment is initiated, but the test detects only L. pneumophila serogroup 1 (70% of

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cases). A 4-fold rise in antibody titers to ≥ 1:128 (or a single titer of ≥ 1:256 in a

convalescent patient) is also considered diagnostic. These tests are specific (95 to

100%) but are not very sensitive (40 to 60%); thus, a positive test indicates infection,

but a negative test does not exclude it.

Infants and young children with possible RSV infection should undergo rapid

antigen testing of specimens obtained with nasal or throat swabs. No other tests for viral

pneumonias are done; viral culture and serologic tests are rarely clinically warranted.

PCR testing for mycoplasma and chlamydia species, although not widely available,

holds promise as a highly sensitive and specific rapid diagnostic test and is likely to play

a greater role as PCR technologies are refined.

Reason for choosing Pneumonia as our case

This case study aims to identify patient’s health needs and problems in order to

identify goals to promote the general health of the patient by providing proper

intervention through the application of nursing process.

We have chosen this case study in order to identify and determine the general

health problems and needs of the patient with an admitting diagnosis of Community

Acquired Pneumonia. This study also intends to help patient as well as its significant

others to promote health and medical understanding of such condition through the

application of the nursing theories and nursing skills.

Our inadequate knowledge on Community Acquired Pneumonia motivated us to

study the case suffered by most of my patients in medical ward. I wanted to have

enough knowledge regarding this condition so that I could apply and handle such this

kind of condition correctly.

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II. CLIENT’S PROFILE

A. Socio-demographic Data

Patient Y is a 42-year-old, female, single, a Roman Catholic from Lam-an, Ozamis

City, Misamis Occidental. The patient was admitted for the first time at Northern

Mindanao Medical Center last June 24, 2010; 3:00 pm. She arrived at the hospital,

awake and conscious with chief complaints of dyspnea and persistent cough. She was

then diagnosed with Community Acquired Pneumonia with Pleural Effusion. She

currently weighs 41 kilograms from the previous weight of 50 kilograms and she is 5’3

tall. She was hospitalized last May 5, 2010 at Mayor Hilario Ramos Regional Training

and Teaching Hospital due to appendicitis and undergone appendectomy.

The patient usually uses over-the-counter drugs to manage health problems like

fever and headache. Patient denied the use of tobacco, alcohol or illicit drug use, drinks

coffee, cola or tea about 4-5 times a week and can consume 1½ glass. She has no

known food allergies but patient is allergic to Myrin P-forte.

B. Vital Signs

The patient’s vital signs are so important, since it provides a baseline data in

determining what are the alterations in body function. Any change from normal is

considered to be an indication of the person’s state of health and provides clues to the

physiological functioning of the body.

The patient had the following vital signs: blood pressure: 110/70 mmHg, pulse

rate: 83 bpm, respiratory rate: 26 cpm, temperature: 38ºC.

C. History of Present Illness

A month PTA, she began to have an undocumented fever, temporarily relieved

by paracetamol 500 mg, associated with cough, body malaise with poor appetite. No

consultation done. No medication taken. 8 days PTA, she began to have dyspnea which

prompted consultation and subsequent admission at Mayor Hilario Ramos Training and

Teaching hospital where she was diagnosed with Polycythemia vera and Essential

thrombocytosis. She was referred to Celo Hospital because of incidence of decrease

BP.

She was brought to and admitted at Maria Reyna Hospital last June 6, 2010.

There was onset of pleural effusion and R thoracentesis was done 3 hours after

admission. 2 days later, CTT was done at R hemithorax.

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D. Health Patterns Assessment

1. Health Perception – Health Management Pattern (pre-hospitalization)

Patient X doesn’t have regular consultations to physicians if she doesn’t

feel any deviation of his health status. She doesn’t drink any alcoholic

beverages or smoke and has no known food and drug allergies. Patient X is a

worker from Misamis Occidental Hospital where she works as a secretary.

She is the only person who works in the family.

2. Nutrition

Patient X is not eating well and the appetite is poor. She wasn’t

experiencing nausea or vomiting either. She has no discomforts in terms of

eating. But because of her disease condition, she was not eating well. She

has rapid weight loss from 50 kg to 41 kg within a short span of time (1

month). The client has Chest Thoracostomy Tube draining well at the right

mid-axillary line.

3. Elimination Pattern

Mrs. X ‘s stool as described by her as yellowish in color, defecates

everyday with no discomforts.

Urinates approximately 3-4 times a daywith 100-200 cc per urination.

Urine is slightly hazy in color but had no problem in control.

4. Activities of daily living (Pre-hospitalization)

The client is working as a secretary from one of the hospitals located at

Misamis Occidental. Her duty hours is from 8 am to 5pm. She works

extremely hard because her 2 sons are already in college and her husband

has no work.

a. Activity-Exercise Pattern (while confined)

Describe the patient’s functional abilities

a. Feeding: dependent

b. Bathing: dependent

c. Toileting: dependent

d. Bed mobility: dependent

e. Dressing: dependent

f. Grooming: dependent

g. General mobility: dependent

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The patient need assistance in doing Range of Motion, thus, it

requires assistance coming from the significant others and/or the attending

nurse.

5. Cognitive- Perceptual Pattern

The patient can understand & speak visayan, Filipino and English

Patient is able to recall recent and past events and is oriented to time, person

and place. He has the ability to explain things clearly and can make simple

decisions. Patient can understand instructions as well as can perceive pain.

Though, pain is not verbalized by the client. She takes prescribed medicines,

takes vitamins daily and exercises regularly and used over-the-counter drugs

as well.

6. Sleep and Rest Pattern

She usually sleeps 8 hours/day. He has no history of sleep

disturbances.prayers as well as singing lullaby was one of the effective

methods to induce her sleeping.

7. Self Perception and Self-concept Pattern (self esteem, body image)

Patient believes she ca surpass these problems that she is going through

and she will go back to work so soon. She can maintain eye contact, able to

talk well, speech is audible

Emotional reaction to present condition: Check only:

Calm: √

Depressed: √

Anxious: √

Angry: ____________

Fearful: √

Irritable: √

Worried: √

The patient was generally calm and easy to have conversation with but

verbalized that she was worried and fearful because of th rcent condition that

she’s experiencing thus, it bothers her a lot every time there is procedure that

is being performed. In addition to that, she was anxious due to financial

constraints as well as she was depressed because with her condition she

cannot do activities of daily living independently and worse, she can’t work

and provide the needs of her family since she’s the only member in the family

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that has work.

8. Role and Relationship Pattern

Patient verbalized having good family relationship. She has been a

good mother to her sons and a good wife to his husband. She verbalized

having good relationship with friends.

9. Coping –Stress Tolerance Pattern

Patient was calm but sometimes irritable, anxious, worried and depressed.

She handles stress through sleeping.

10.Values-Belief Pattern

The patient is a Roman Catholic and believes no superstitions. She

together with her family attends mass every Sundays and both of the couples

were active in the Couples for Christ.

E. Physical Assessment

1. Neurological Assessment

Orientation Fully oriented

Appropriate behavior/communication Responsive and coherent

Level of Consciousness Conscious

Emotional State Anxious (sometimes)

2. Skin

General Color Pallor

Texture rough

Turgor elastic

Temperature Warm

Moisture Dry

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3. Head

Facial Movements Symmetrical

Fontanels Closed

Hair Fine

Scalp Clean

4. Eyes

Lids Symmetrical

Preorbital Region Intact/full

Conjunctiva Pale

Sclera Anicteric

Reaction to light R- Brisk

L- Brisk

Reaction to accommodation Uniform constriction / Convergence

Visual Acuity normal

Peripheral Vision normal

5. Nose

Septum Midline

Mucosa Pinkish

Patency Both patent

Gross Smell Normal/symmetrical

Sinuses Non-tender

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6. Ears

External Pinnae Normoset; Symmetrical

Tympanic Membrane Intact

Gross Hearing Normal

7. Mouth

Lips Pallor; cracked

Mucosa Pinkish

Tongue Midline

Teeth complete

Gums Pinkish

8. Neck

Trachea Midline

Thyroids Non-palpable

Others Normal ROM

9. Pharynx

Uvula Midline

Tonsils Not Inflamed

Posterior Pharynx Not Inflamed

Mucosa Pinkish

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10.Abdomen

General Normal

Configuration Symmetrical

Bowel Sounds Normoactive

Percussion Tympanitic

11.Back and Extremities

Range of Motion Normal

Muscle tone and strength Fair

Spine Midline

Gait normal

12.Cardiovascular Status

Precordial Area Flat

Point of Maximal Impulse (PMI) 5th ICS, midclavicular line

Heart Sounds Regular

Peripheral Pulses Regular

Capillary Refill 2 seconds

13.Respiratory Status

Breathing Pattern Irregular

Shape of Chest AP:L:2:1

Lung Expansion Symmetrical

Vocal/Tactile Fremitus Symmetrical

Percussion Resonant

Breath Sounds crackles

Cough Non-productive

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III. ANATOMY AND PHYSIOLOGY

The Lungs

The lungs lie within the thoracic cavity on either side of the heart. They are cone-

shaped, with the apex above the first rib and the base resting on the diaphragm. Each

lung is divided into superior and inferior lobes by an oblique fissure. The right lung is

further divided by a horizontal fissure, which creates a middle lobe. The right lung,

therefore, has three lobes; the left lobe has only two. In addition to these 5 lobes, which

are visible externally, each lung can be subdivided into about 10 smaller units

(bronchopulmonary segments). Each segment represents the portion of the lung that is

supplied by a specific tertiary bronchus. These segments are important surgically,

because a diseased segment can be resected without the need to remove the entire

lobe or lung. The two lungs are separated by a space (the mediastinum) where the

heart, aorta, vena cava, pulmonary vessels, esophagus, part of the trachea and bronchi,

and the thymus gland are located.

The lungs contain gas, blood, thin alveolar walls, and support structures. The

alveolar walls contain elastic and collagen fibers; these form a three-dimensional,

basket-like structure that allows the lung to inflate in all directions. These fibers are

capable of stretching when a pulling force is exerted on them from outside of the body

or when they are inflated from within. The elastic recoil helps in return the lungs to their

resting volume.

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The lung itself is covered with a membrane called the visceral (or pulmonary)

pleura. The visceral pleura are adjacent to the lining of the thoracic cavity which is

called the parietal pleura. Between the two membranes is a thin, serous fluid which acts

as a lubricant – reducing friction as the two membranes slide across one another when

the lungs expand and contract with respiration. The surface tension of the pleural fluid

also couples the visceral and parietal

pleura to one another, thus preventing the lungs from collapsing. Since the potential

exists for a space between the two membranes, this area is called the

pleural cavity or pleural space

The respiratory system is situated in the thorax, and is responsible for gaseous

exchange between the circulatory system and the outside world. The respiratory system

is divided into two systems namely the upper respiratory system, which composed of

the nasal cavity, pharynx and larnyx: and the lower respiratory system, which are the

trachea, bronchus, bronchioles and the alveoli.

ORGANS OF THE RESPIRATORY SYSTEM

THE LOWER RESPIRATORYTHE UPPER RESPIRATORY

NOSENASAL CAVITYPHARYNX

LARYNXBRONCHIAL TREELUNGS

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UPPER RESPIRATORY TRACT

Respiration is defined in two ways. In common usage, respiration refers to the

act of breathing, or inhaling and exhaling. Biologically speaking, respiration strictly

means the uptake of oxygen by an organism, its use in the tissue, and the release of

carbon dioxide. By either definition, respiration has two main functions: to supply the

cells of the body with the oxygen neede for metabolism and to remove carbon dioxide

formed a waste product from metabolism. This lesson describes the components of the

upper respiratory tract.

The upper respiratory tract conducts air from outside the body to the lower

respiratoty tract and helps to rotect the body from irritating substances. The upper

respiratory tract consists of the following stuctures:

The nasal cavity, the mouth, the pharynx, the epiglottis, the larynx, and the upper

trachea. The esophagus leads to the digestive tract.

One of the feature of both the upper and lower respiratory tracts is the

mucociliary apparatus that protects the airways from irritating substances, and is

composed of the celiated cells and mucus-producing glands in the nasal epithelium.

The glands produce a layer of mucus that traps unwanted particles as they are inhaled.

These are swept towards the posterior pharynx, from where they are either swallowed,

spat out, snezzed, or blown out.

Air passes through each of the structures of the upper respiratory tract on its way

to the lower respiratory tract. When a person at rest inhales, air enters via the nose and

mouth. The nasal cavity filters, warms, and humidifies air. The pharynx or throat is a

tube like structure that connects the back of the nasal cavity and mouth to the larynx, a

passageway for air, and the esophagus, a passageway for food. The pharynx servs as

a common hallway for the respitarory and digestive tracts, allowind both air and food to

pass through before entering the appropriate passageways.

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The pharynx contains a specialized flap-like structure called the epiglottis that

lower over the larynx to prevent the inhalation of food and liquid into the lower

respiratory tract.

The larynx or voice box, is a unique structure that contains the vocal cords, which

are essential for human speech. Small and triangular in shape, the larynx extends from

the epiglottis to the trachea.the larynx helps control movement of the epiglottis. In

addition, the larynx has specialized muscular folds that close it off and also prevent

food, foreighn objects, and secretions such as saliva from entering the lower respiratory

tract.

Mechanism of Breathing

To take a breath in, the external intercostal muscles contract, moving the ribcage

up and out. The diaphragmmoves down at the same time, creating negative pressure

within the thorax. The lungs are held to the thoracic wall by the plueral membranes and

so expand outward as well. This creates negative pressure within the lungs, and so air

rushes in through the upper and lower airways.

Expirations are mainly due to the natural elasticity of the lungs, which tend to

collapse if they are not held against the thoracic wall. This mechanism behind lung

collapse if there is air in the pleural space (pneumothorax)

How does the respiratory system work?

The respiratory system works with the body to help our body function correctly. One of

the things it does is it gives our cells/blood oxygen to take to the rest of our body.

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IV. PATHOPHYSIOLOGY

PREDISPOSING FACTORS:

Age (High Risk)(42 years old) Gender: female

PR ECIPITATING FACTORS:

Exposure to crowded placesExposure to stressLifestyleExposure to air pollutionHospitalizationOccupational status

Organisms may enter respiratory tract through inspiration, aspiration or inhalation

of oral secretions

Normal pulmonary defense mechanisms (cough reflex, mucociliary transport and

pulmonary macrophages) usually protects against infection. However, in susceptible

host, these defenses are either suppressed or overwhelmed by the invading organism.

Inflammation and edema of the lung parenchyma

Accumulation of cellular debris and exudates

The invading organism multiplies and releases damaging toxins

Lung tissue fills with exudates and fluid changing from an airless state to consolidated

state.

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Inflamed and fluid-filled alveolar sacs cannot exchange oxygen and

carbon dioxide effectively

Alveolar exudates tends to consolidate, so it is increasingly

difficult to expectorate

Kinin

Bradykinin

Vasodilation

Myocardial Depressan

t Factor

Clotting Cascade

Thromboxane release

Vascular Thrombi

Pulmonary Constriction

Increase Hydrostatic

Pressure

Increase Lymphatic

Flow

Fluid transudation into alveolus

Thickened alveolar

membrane impairing the exchange of Oxygen and

Carbon Dioxide

Fluid fills the intestitium

and alveolar spaces

Impaired Oxygen Diffusion

Decrease Cardiac Output

Dysrhythmias

Decrease Venous

Decrease BP

Fever

ChillsMalaise

Cough Pleuritic pain

Dyspnea Rales and cracles upon auscultation

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Interpretation:

The defense mechanisms of the lungs lose effectiveness and allow organism to

penetrate the sterile lower respiratory tract, where inflammation develops. Disruption of

the mechanical defenses of cough and ciliary’s motility leads to colonization of the lungs

and subsequent infection. Inflamed and fluid-filled alveolar sacs cannot exchange

oxygen and carbon dioxide effectively.

Systemic inflammation leads to release of cytokines and other chemical

mediators. The cytokines activate alveolar macrophages and recruit neutrophils to the

lungs, which in turn release leukotrienes, oxidants, platelet-activating factor, and

proteases. These substances damage capillary endothelium and alveolar epithelium,

disrupting the barriers between capillaries and airspaces. Edema fluid, protein, and

cellular debris flood the airspaces and interstitium, causing disruption of surfactant,

airspace collapse, and ventilation-perfusion mismatch leading to decreased lung

expansion and eventually may lead to acute respiratory failure if ;left untreated.

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VIII. DISCHARGE PLANNING/ HEALTH TEACHINGS

M-Medication to take

               Instruct and explain to the patient that the medication is very important to

continue depending on the duration that the doctor ordered for the total recovery of the

patient.

E- Exercise

               Encourage and instruct the patient to do proper breathing exercise.

T- Treatment

               Advice the patient to relax in order to recover in his present condition.  Instruct

the patient to minimize the exposure to an environment such as dusty and smoky area,

which airborne micro organism is present that can be a high risk factor that may cause

severity of his condition.

H- Health teaching

               Encouraged and explain to the patient that it is important to maintain proper

hygiene to prevent further infection. Instruct the patient to take a bath every day and

explain that bathing early in the morning is not a factor or cause of having pneumonia.

Instruct to increase fluid intake of the patient.

O-Out Patient follow-up

               Regular consultation to the physician can be factor for recovery and to assess

and monitor the patient’s condition

D-Diet

               Diet as tolerated, meaning, the patient can eat everything until she can. Diet

plays a big role in fast recovery so that, instruct the patient to take nutritious food such

as green leafy vegetable and fruits.

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Additional Health Teaching

Home Care

Take your medication exactly as directed. Don’t skip doses. Continue taking your

antibiotics as directed until they are all gone—even if you start to feel better. This

will prevent the pneumonia from coming back.

Drink at least 8 glasses of water daily, unless directed otherwise. This helps to

loosen and thin secretions so that you can cough them up.

Use a cool-mist humidifier in your bedroom. Be sure to clean the humidifier daily.

Coughing up mucus is normal. Don’t use medications to suppress your cough

unless your cough is dry, painful, or interferes with your sleep. You may use an

expectorant if ordered by your doctor.

Learn percussion and postural drainage. These are techniques that can help you

cough up extra mucus. This extra mucus can trap germs in your lungs. Ask your

healthcare provider for instructions. Perform these techniques 3 times a day until

your lungs are clear.

Warm compresses or a moist heating pad on the lowest setting can be used to

relieve chest discomfort. Use several times a day for 15-20 minutes at a time. (To

prevent injuring your skin, be sure the temperature of the compress or heating

pad is warm, not hot.)

Get plenty of rest until your fever, shortness of breath, and chest pain go away.

Plan to get a flu shot every year.

Ask your doctor about a pneumonia vaccination.

Take the entire course of any prescribed medications. After a patient’s

temperature returns to normal, medication must be continued according to the

doctor’s instructions, otherwise the pneumonia may recur. Relapses can be far

more serious than the first attack.

Get plenty of rest. Adequate rest is important to maintain progress toward full

recovery and to avoid relapse.

Drink lots of fluids, especially water. Liquids will keep patient from

becoming dehydrated and help loosen mucus in the lungs.

Keep all of follow-up appointments. Even though the patient feels better, his

lungs may still be infected. It’s important to have the doctor monitor his

progress.

Encourage the guardians to wash patient’s hands. The hands come in

daily contact with germs that can cause pneumonia. These germs enter one’s

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body when he touch his eyes or rub his nose. Washing hands thoroughly and

often can help reduce the risk.

Tell guardians to avoid exposing the patient to an environment with too

much pollution (e.g. smoke). Smoking damages one’s lungs’ natural

defenses against respiratory infections.

Give supportive treatment. Proper diet and oxygen to increase oxygen in the

blood when needed.

Protect others from infection. Try to stay away from anyone with a

compromised immune system. When that isn’t possible, a person can help

protect others by wearing a face mask and always coughing into a tissue.

IX. RELATED LEARNING EXPERIENCE

        Medical ward is the ward where were assigned for, for the 4 weeks duty, we have

encountered several restrain with regards to the implementation. It was not easy that we

are dealing with our lives. But we did not loss hope because it’s our responsibility to

care ant to address the patients need.

P A T H O P H Y S I O L O G Y

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          Three nights of multi-tasking and time management even though we are busy in

other major subject but yet we try our best to do these case study correctly and to avoid

correction about this work. but then again caring patient in medical ward is hard, hard,

because this is our first time to exposed in this ward with different kind of diseases that

some are not easy to handle and hard also because some of significant other are

uncooperative and non compliant, but at last we really succeed. It inst that smooth to

establish an interacting relationship specially that most of the patients significant other

institution has a low educational attainment/low class status. Therefore, we cannot

expect them to fully comprehend the instruction we have imparted. However, it was a

wonderful experience since we were handle different condition of the patient and we

performed some procedure which weren't return demonstrate yet. Fortunately, there is

our clinical instructor and our PCI who persistently supervised us and assisted us to

make it through with just minimal errors.

       However, this our 4th time to manage group case study in different setting, adding to

that is the fear of making a physiologic structure of our client with a different kind of

diseases, we have learned to thorough assess  our patient to comply with the

indispensable. Also we have acquired ourselves with regards to establish rapport with

our patient to have trusting relationship. But enjoy with other people  helps you identify

your strength and weakness, and it aids in modifying what is somehow negative in our

attitude. Most and for all we thank to god for the guidance always and for giving wisdom

and knowledge to do this case study successful.....         

X. SOURCES:

WEB:

http://nursingcrib.com/nursing-care-plan/nursing-care-plan-community-acquired-

pneumonia/

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http://merck-ut.merck.com/mmpe/sec05/ch052/ch052b.html

http://en.wikipedia.org/wiki/Community-acquired_pneumonia

BOOKS:

Nurse’s Pocket Guide 11th edition (Diagnoses, Prioritized interventions, and

Rationales)

By:

Marilyn E. Doenges

Mary Frances Moorhouse

Alice C. Murr

Nursing 2003 Drug Handbook 23rd edition

By: Springhouse Lippincott Williams and Wilkins