OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF NURSING
Valenzuela City

Pneumonia
Submitted By:
Melissa D.G. David
BSN 4Y2-1D

OBJECTIVES

Define what is pneumonia

Recognize the contributing risk factors associated in the development
of pneumonia
Enumerate the different signs and symptoms
Explain the diagnostic procedures done and how it is performed
Apply appropriate nursing care plans utilizing nursing process
Learn the appropriate management and rehabilitation factors that
optimize the health
To know the Etiology, Signs and Symptoms, Incubation Period, Mode of
transmission, Pathophysiology

Identify and understand different types of medical treatment

Formulate and apply nursing care plan utilizing nursing process

I.

INTRODUCTION
Pneumonia is inflammation or SWELLING in the Lungs in which the
air sacs fill with pus and other fluids, making it difficult for oxygen to
reach the blood. Pneumonia can be typical or atypical, or may be
classified as hospital-acquired, community-acquired, or aspiration. Typical
pneumonia is most commonly caused by Streptococcus pneumoniae, also
known as pneumococcal pneumonia. Atypical pneumonia can be caused
by viruses, fungi, bacteria, or chemicals (such as when stomach contents
are inhaled into the lungs). The inflammatory cascade triggers the
leakage of plasma and the loss of surfactant, resulting in air loss and
consolidation. This is in contrast to pneumonitis, which is caused by noninfectious agents such as radiation or chemicals. An inhaled infectious
organism must bypass the host's normal nonimmune and immune
defense mechanisms in order to cause pneumonia. The nonimmune
mechanisms include aerodynamic filtering of inhaled particles based on
size, shape, and electrostatic charges; the cough reflex; mucociliary
clearance; and several secreted substances. Macrophages, neutrophils,
lymphocytes, and eosinophils carry out the immune-mediated host
defense.
A case with a diagnosis of Pneumonia may catch ones attention,
though the disease is just like an ordinary cough and fever, it can lead to
death especially when no intervention or care is done. Since the case is a
toddler, an appropriate care has to be done to make the patients
recovery faster. Treating patients with pneumonia is necessary to prevent
its spread to others and make them as another victim of this illness.
Causes
Bacteria are the most common cause of pneumonia. Of these,
Streptococcus pneumoniae is the most common. Other pathogens include
anaerobic bacteria, Staphylococcus aureus, Haemophilus influenzae,
Chlamydia pneumoniae, C. psittaci, C. trachomatis, Moraxella
(Branhamella)
catarrhalis,
Legionella
pneumophila,
Klebsiella
pneumoniae, and other gram-negative bacilli.
Among other agents are higher bacteria including Nocardia and
Actinomyces sp; mycobacteria, including Mycobacterium tuberculosis and
atypical strains; fungi, including Histoplasma capsulatum, Coccidioides
immitis, Blastomyces dermatitidis, Cryptococcus neoformans, Aspergillus
fumigatus, and Pneumocystis carinii; and rickettsiae, primarily Coxiella
burnetii (Q fever).
Types
Pneumonia is classified according to the types of germs that cause
it, and where you acquired the infection.

Community-acquired pneumonia
-is the most common type of pneumonia. It occurs outside of hospitals
and other health care facilities.

Hospital-acquired pneumonia
-is a bacterial infection that occurs in people 48 hours or more after
being hospitalized for another condition. Hospital-acquired pneumonia
can be serious because the bacteria causing it may be more resistant
to antibiotics. People who are on a breathing machine (ventilator),
often used in intensive care units, are at higher risk of this type of
pneumonia.

Health care-acquired pneumonia

-is a bacterial infection that occurs in people who are living in longterm care facilities or have been treated in outpatient clinics, including
kidney dialysis centers. Like hospital-acquired pneumonia, health careacquired pneumonia can be caused by bacteria more resistant to
antibiotics.

Aspiration pneumonia
-occurs when you inhale food, drink, vomit or saliva into your lungs.
This aspiration may happen if something disturbs your normal gag
reflex, such as a brain injury, swallowing problem, or excessive use of
alcohol or drugs.

Risk Factors
No one is immune to pneumonia, but there are certain factors that can
raise your risks:

Previous stroke or problems swallowing: People who have had a stroke,

have problems swallowing, or are bedridden can easily develop
pneumonia.
Age: Infants from birth to age two are at risk for pneumonia, as are
individuals age 65 or older.
Weakened immune system: This includes people who take medications
(steroid drugs and anti-cancer drugs) that weaken the immune system
and people with HIV, AIDS, or cancer.
Drug abuse: This includes excessive alcohol consumption and smoking.
Certain medical conditions: Asthma, cystic fibrosis, diabetes, and heart
failure raise your risks for pneumonia.

Signs and Symptoms

Viral pneumonia tends to develop slowly over a number of days,
whereas bacterial pneumonia usually develops quickly, often over a day.

Most people who develop pneumonia initially have a viral infection

such as a cold or flu, which produces symptoms such as headache,
muscle aches and fever. If pneumonia develops, symptoms commonly
include:

Fever with chills

Tachypnea
Cough
Pleuritic chest pain
Sputum production, hemoptysis
Dyspnea, shortness of breath
Headache and easy fatigability
Crackling breath sounds
Increased tactile fremitus

It is also possible for the skin, lips, and nail beds to become
dusky or bluish. This is a sign that the lungs are unable to deliver
enough oxygen to the body. If this occurs it is vital to seek medical
assistance straight away.

HEALTH HISTORY
A. General Data
Name: S.Ss
Age: 63 y/o
Gender: Female
Religion: Catholic
Citizenship: Filipino
Address: Valenzuela City
B. Chief Complaint: DOB
C. History of Present Illness:
-1 week PTC the patient has productive cough yellowish without fever,
vomiting, and dizziness. Consulted at FUMC and started meds.
Past Medical History: (-) Asthma, (+) HPN
D. Physical Assessment:

-The patient is conscious and coherent, she (+) of distress.

-(+) 10 X 10 mass at the back, (+) AS, (+) PPC
-(+) flabby, soft nont ender bowel sounds
-Vital Signs: T > 35.8C, PR > 60, RR > 27
E. Impression: CAP/ HCVD

II.

ANATOMY AND PHYSIOLOGY

The lungs constitute the largest organ in the respiratory system.

They play an important role in respiration, or the process of providing
the body with oxygen and releasing carbon dioxide. The lungs expand
and contract up to 20 times per minute taking in and disposing of
those gases.
Air that is breathed in is filled with oxygen and goes to the
trachea, which branches off into one of two bronchi. Each bronchus
enters a lung. There are two lungs, one on each side of the breastbone
and protected by the ribs. Each lung is made up of lobes, or sections.
There are three lobes in the right lung and two lobes in the left one.
The lungs are cone shaped and made of elastic, spongy tissue. Within
the lungs, the bronchi branch out into minute pathways that go
through the lung tissue. The pathways are called bronchioles, and they
end at microscopic air sacs called alveoli. The alveoli are surrounded
by capillaries and provide oxygen for the blood in these vessels. The
oxygenated blood is then pumped by the heart throughout the body.
The alveoli also take in carbon dioxide, which is then exhaled from the
body.
Inhaling is due to contractions of the diaphragm and of muscles
between the ribs. Exhaling results from relaxation of those muscles.
Each lung is surrounded by a two-layered membrane, or the pleura,
that under normal circumstances has a very, very small amount of fluid
between the layers. The fluid allows the membranes to easily slide
over each other during breathing.

III.

PATHOPHYSIOLOGY

IV.
V.

Microorganisms, chemical irritants, aspiration

VI.

VII.
Inflammatory response fever, chills
VIII.

IX.
Exudate formation cough, rales, dyspnea
X.

XI.
Capillary permeability
XII.

XIII.
Fluid in interstitial compartment
XIV.

XV.
Consolidation
XVI.

XVII.
Hypoxemia Fatigue
XVIII.

XIX.
Pleurisy Chest pain
XX.

XXI.
Pleural Effusion/Shock and Respiratory failure
XXII.
XXIII.

XXIV.
XXV.
XXVI.
XXVII.
XXVIII.
XXIX.
XXX.
XXXI.
XXXII.
Pneum
onia is a serious infection or inflammation of the lungs. The air sacs in
the lungs fill with pus and other liquid. Oxygen has difficulty reaching
the blood. If there is too little oxygen in the blood, the body cells cant
work properly. Because of this and spreading infection through the
body, pneumonia can cause death. Pneumonia affects the lungs in two
ways: Lobar pneumonia affects a section (lobe) of a lung and Bronchial
pneumonia (or bronchopneumonia) affects patches throughout both
lungs.
XXXIII.
The usual mechanisms of spread are inhaling droplets
small enough to reach the alveoli and aspirating secretions from the
upper airways. Other means include hematogenous or lymphatic
dissemination and direct spread from contiguous infections.
Predisposing factors include upper respiratory viral infections,
alcoholism, institutionalization, cigarette smoking, heart failure, chronic
obstructive
airway
disease,
age
extremes,
debility,
immunocompromise (as in diabetes mellitus and chronic renal failure),
compromised consciousness, dysphagia, and exposure to transmissible
agents.

XXXIV.

DRUG STUDY

XXXV.

Generic/ XXXVI.
Drug XXXVII.
Brand
Class
Name
XLI.
albuterol XLIV.
BronchoXLV.
XLII.
dilator
XLIII.
Salbutam
ol,
Proventil,
Ventolin

L.

Heraclen
e
LI.
LII.

LIII.

group of
vitamin
B12
(cyanoco
balamin
and
analogue
s)

LIV.

Indication
XXXVIII.

To control XLVI.
and prevent
reversible
airway
obstruction;
Quick relief
for
bronchospa
sm

It also may
be used for
treating
tuberculosis
and
additional
persistent
diseases,
recuperatin
g from
severe
surgery or
infection
and
defective
nutrition in

LV.

Action XXXIX.

It relieves XLVII.
nasal
congestio
n and
reversible
bronchos
pasm by
relaxing
the
smooth
muscles
of the
bronchiol
es.
Amplifies
LVI.
the
protein
"effective
ness
coefficien
t" for
example,
the
proportio
n of
"bound
nitrogen"
for
protein
fabricatio

Adverse
Effect

XL.
Nursing
Considerations

Nausea and XLVIII.

vomiting,
restless-ness,
nervous-ness,
HPN,
arrhythmia
XLIX.

Nausea,
vomiting,
diarrhea,
acidity,
headache,
stomach
upset and
other GI
disorders

LVII.

- Assess lung sounds,

PR and BP before drug
administration and
during peak of
medication.
- Administer PO
medications with
meals to minimize
gastric irritation

During treatment
should regularly
monitor the blood
picture and
coagulation

elderly
patients

LVIII.

Dipenhyd
ramine

LIX.

Antihista
mine

LX.

LXIV.

Amlodipi
ne

LXV.

Calcium
channel
blockers

LXVI.

Treatment
of
hypersensiti
vity
reactions

LXI.

Alone or LXVII.
with other
agents in
the
manageme
nt of
hypertensio
n, angina
pectoris
and
vasospastic
angina

n in the
system
evaluated
to
"consume
d
nitrogen"
with food
ingestion
Hypersen
sitivity to
antihista
mines

Hypersen
sitivity.
Blood
pressure
less than
90
mmHg.

LXII.

Drowsiness

LXVIII.

Systemic
vasodilation
resulting in
the
decreased
blood
pressure.

LXIII.

Drug causes
drowsiness. Avoid
activities requiring
mental alertness

LXIX.

Monitor blood
pressure and pulse
before therapy, during
dose titration, and
periodically during
therapy.

LXX.

Ketoanal LXXI.
ogue

LXXVI.

Mecobala
LXXVII.
min

Suppleme LXXII.
nt

Therapy of LXXIII.
damages
due to
faulty or
deficient
protein
metabolism
in chronic
renal
insufficienc
y in
connection
with limited
protein food
of 23%
g4day 5for
adults
Suppleme LXXVIII.
Plays an LXXIX.
nt
important
role in
transmethyl
ation as a
coenzyme
in the
synthesis of
methionine
from
homocystei
ne

HypercalcLXXIV.
emia and
disturbed
amino
acid
metabolis
m

Absorption in LXXV.
the
gastrointestin
al tract

Administer with food

to prevent GI upset

Treatmen LXXX.
t for
periphera
l
neuropat
hies
induced
by
various
factors. It
acts to
repair
damaged
nerve
tissue,
improve
sensory
disturban

Anorexia,nau LXXXI.
sea,
vomitingand
diarrhea

In IM administration,
care should be
exercised by following
the instructions as
follows to avoid
adverse effects on
tissues or nerves:
Repeated injection at
the same site should
be avoided

ces and
dyskinesi
a

LXXXII.

LXXXVIII.

Levopron LXXXIII.
Cough LXXXIV.
t
suppressa
nts

SymptomatiLXXXV.
c treatment
of cough
<24mth.

Patients LXXXVI.
GI effects,LXXXVII.
w/excessi
Exhaustion,
ve
Faintness,
discharge
Somnolence,
of mucus,
Clouding of
w/limited
Consciousnes
mucocilia
s, Numbness,
ry
Dizziness,
function,
Headache,
severe
Palpitations.
liver
dysfuncti
on.

Should be taken on an
empty stomach (Take
between meals.)

LXXXIX.

NCP

XC.
XCI.
XCVII.

XCVIII.
XCIX.
C.
CI.

CII.

CIII.

CIV.

Asse XCII.
ssme
nt
Subj CVII.
ectiv
e:
Nahi
hirap
an
ako
humi
nga
dahil
sa
plem
a na
di ko
mala
bas
Obje
ctive
:
*DO
B
*Wh
eeze
s,
*Cra
ckles
*Prod
uctiv
e
coug
h
*Pale
in
appe
aran
ce
*O2S
AT

Diag XCIII.
nosis

Plan XCIV.
ning

Ineff CVIII.
ectiv
e
airw
ay
clear
ance
r/t
sput
um
prod
uctio
n as
mani
feste
d by
whee
zes
and
crack
les
on
both
lung
fields
w/
an rr
of
22bp
m

After CIX.
30
mins
of
nursi
ng
inter
venti CX.
ons CXI.
airwa CXII.
y
CXIII.
pate CXIV.
ncy
will
be
main
taine
d,
secre
tions
will
be
CXV.
read CXVI.
y/
expe
ctora
ted

CXVII.
CXVIII.

CXIX.

Inter XCV.
venti
on
*PlacCXXII.
e in
semi
fowle
rs
positi
on

*not
e CXXIII.
amoCXXIV.
unt,
color
,
odor
of
secreCXXV.
tionCXXVI.
CXXVII.
*Mon
itor
pulse
oxim
etry,
abg
resul
ts
*Aus
culta
CXXVIII.
te CXXIX.
breat
h
soun
ds

RatioXCVI.
nale
*ToCXXXII.
prom
ote
oxyg
enati
on
via
maxi
mum
chest
expa
nsion
*May
be a
resul
t of
infec
tion
*To
mea
sure
the
oxyg
en
level
of
the
patie
nt
*to
chec
k for
pres
ence
of

Eval
uatio
n
After
30
mins
of
nursi
ng
inter
venti
ons
airwa
y
pate
ncy
was
main
taine
d,
secre
tions
was
expe
ctora
ted

CV.
CVI.

CXXXIII.
CXXXIV.

85%
*Rr:
22bp
m

CXX.
CXXI.

*enc
oura
ge
deep
breat
CXXX.
hingCXXXI.
exerc
ise

whee
zes
and
crack
les
*to
prom
ote
prop
er
lung
expa
nsion

CXXXV.

DISCHARGE PLANNING:

CXXXVI.

Medication
Encouraged the patient to continue medication at home as prescribed
by the physician
Do not administer any other drug with without the physicians
prescription.

CXXXVII.

Exercise
Explain and encouraged the patient the significance of regular exercise
like walking and stretching.
Instruct the patient to practice deep breathing exercise.
Encouraged the patient to have an adequate sleep and rest every day.

CXXXVIII.

Treatment
Instruct the patient to comply with her medication treatment.
Instruct patient to seek medical help if any reporting signs of difficulty
of breathing

CXXXIX.

Health Education
Emphasize the proper nutrition as indicated by the attending physician
How to assess for weight gain/loss and increased abdominal girth
Avoidance of smoking

CXL.

Spiritual
Encouraged

the patient to attend Sunday mass regularly and

encouraged to pray for the safe and wellness of their health.