CASE PRESENTATION ON

COMMUNITY ACQUIRED
PNEUMONIA

SUBMITTED TO :- SUBMITTED BY :-

BABY SHARMA

NPCC 1ST YEAR

Dr. D Y Patil college of Dr. D Y Patil college Of

nursing pimpri pune-18 nursing pimpri pune-1
HISTORY COLLECTION

IDENTIFICATION DATA:

Name: Mr. Kisan Dyaneshwar Durafe

Age: - 55 years

Sex: - Male

Occupation- Farmer

Date of admission:-15 / 04 / 2024

Address: AT post kusur, tal junner, district Pune

Diagnosis: Community Associated pneumonia

CHIEF COMPLAINTS: Patient is admitted with the chief complaints of:

-Cough with expectorant since 2 – 3 days

-Breathlessness since 2 – 3 days

MEDICAL HISTORY

Present Medical History:

Patients has chills and fever since 7 days

Today patient is having difficulty in breathing.

Past Medical History:

No History of Diabetes mellitus

No history of Hypertension

SURGICAL HISTORY:

Present Surgical History: Patient has not undergone any surgery.

Past surgical History: Patient did not undergone any past surgical history

FAMILY HISTORY:

Type of family: Nuclear Family.

Family Tree:

Female/ 50yrs MALE/ 55yrs

Male/28yrs Male/24yr Female/20yr

Family Illness History:

No History of CAP

No History of Tuberculosis

No History of Diabetes Mellitus

FAMILY COMPOSITION:

SR. Name of Age/sex Relation Occupation Health

NO family with status status
members patient
1. Mr. Kisan 55yr/ M Self Farmer CAP
2. Mrs. Laxmi 50yr/ F Wife House wife Healthy
3. Mr.Lakhan 28yr/ M Son Engineer Healthy
4. Mr. Pravin 24yr/ M Son Student Healthy
5. Miss. Preeti 20 yr/ F Daughter Student Healthy

SOCIOECONOMIC STATUS

Patient belongs to middle class family patients work as a farmer .

Has own house with adequate supply of water and electricity .

PERSONAL HISTORY

Diet-soft diet

Number of meals per day: loss of appetite

Food allergies, food preferences: soft diet. No food allergies.

Bowel & Bladder habit- regular

Sleep pattern: disturbed due to hospitalization and disease.

Smoking: non-smoker

Alcohol Consumption: non-alcoholic

Tobacco chewing: since 20 years

HISTORY OF ANY HEREDITARY DISEASE: No history

ANY TRADITIONAL PRACTICES FOLLOWED IN THE FAMILY:

No any traditional practices followed in the family.

PHYSICAL EXAMINATION

General appearance:

Level Of Consciousness:-Conscious

Orientation:-To Place/Person/Time

Activity:-Dull

Body Built:-Moderate

Anthropometric measurement:

Height-162 cm

Weight-56kg

BMI – 21.3

Vital signs:

Temperature:-98.6°F

Pulse: 76 beats/minute

Respiration: 28 breaths/minute

Blood pressure:160/60 mm of Hg
 A. Head and Face:

Hair:-Equally Distributed/Baldhead

Colour of Hair:-Gray

Scalp:-Clean No Dandruff

Pediculosis:-Present

Face:-Symmetrical

Facial Pufliness:-Present

B. Eyes:

Eye Brows:-Equally Distributed

Eye Lid/Lashes:-Symmetrical

Eye Ball:- Redness/Swelling/Discharge/Lesions –Nil

Conjunctiva:-Colour/Swelling/Lesions – Nil

Sclera:-White

Cornea:-Regular

Iris:-Flat

Eye Discharge:-Absent

Use of Glasses:-No

C. Ears:

Redness:-Absent

Discharge:-Absent
Cerumen:-Absent

Lesions:-Absent

Foreign Body:-Absent

Use of Hearing Aids:-No

Tympanic membrane: no perforations, lesions and bulging.

Hearing acuity: medium.

D. Nose:

External nares: no crusts or discharges.

Patency: Patent

Olfactory Sense: Present

Nasal Septum:-Deviated Central

Nasal Polyps: Absent

Nasal Discharge:-Absent

E. Mouth:

Number of Teeth:28

Dentures:-Present

Dental Carries:-Present

Odour of Mouth:-Foul Smell

Gums:-Pale Colour

Palates and Uvula: visible

Tonsillar area: no inflammation

Hygiene: hygienic
 F. Lips:

Crack/Healthy

Cleft Lips:-Unilateral

Stomatitis:-Absent

G. Neck:

Muscles: normal range of motion.

Trachea: no abnormalities

Thyroid: no thyroid enlargement.

Nodes: no lymph node enlargement.

Vein distension: no distension

H. Thorax :

Chest shape: normal

Respiratory Rate: 26 breaths per minute

Type of Respiration: tachypnea

Thoracic Expansion: symmetrical

Palpation: ribs are palpable and normal

Percussion : resonant sounds

 I. Nervous system:

Language: clear and understandable

Mental status: sound mental health

Orientation: well oriented

Memory Attention span: long term memory

Level of Consciousness (GCS) :15

Cranial Nerves; normal function

Deep Tendon Reflex: present

Gross and Fine motor function of UE and LE: normal

Sensory function- normal

Light touch: sensible to light touch

Pain: sensitive to pain

Temperature: normal body temperature

Position: normal

J. Respiratory system

Respiratory Rate:-26 breaths per minute

Inspect the Chest :

Thoracic Cage-Shape: Normal

Configuration:-Normal

Breathing pattern : irregular

Skin Colour and Condition:-Normal

Chest Expansion:-Symmetric
Percussion

Lung Field:-Clear

Resonance:-Hyper Resonance

Diaphragmatic Excursion: Dull

Auscultation

Breathing Sound:- Broncho Vesicular

Adventitious Sound:-Crackles

Respiratory Pattern: Tachypnea

K. Cardiovascular system:

Pulse:-76 beats/min

Heart Sound:-S1, S2 Heard

Abnormal Heart Sound:-S3 or S4 Absent

Murmurs: Absent

Carotid Pulse Rate-74/min

Blood Pressure-160/86 mmHg

L. Central and peripheral lymphatic system

Inspect and Palpate the Leg:-

Cyanosis/Bilateral Edema/-nil

Carotid arteries: palpable

Peripheral pulses: palpable

Radial: palpable

Femoral: palpable

Popliteal: palpable

Posterior Tibial Pulse:- palpable

Dorsalis Pedis Pulse:- palpable

Edema:-Present

Type of Edema:-Pretibial Generalize

Lymph Edema:-Present

Varicose Veins: Absent

Venous Ulcer:-Absent

Capillary Refill: 3seconds

M. Digestive system

Abdominal Girth: 62

Inspection

Size:-Flat Rounded

Symmetry:-No Bulges Masses or Hernia

Scar:-Absent

Lesions:-Absent

Redness:-Absent

Palpation
Tenderness:-Absent

Fluid Collection:-Absent

Mass/Soft :- soft

Percussion

nil

No Gas/Fluid Collection

Auscultation

Bowel Sound:- Normal

N. Musculoskeletal system:

Gait : No significant spinal abnormalities and gait disturbances

Upper Extremities: Normal

Lower extremities: Swelling present

Muscle strength: No muscle weakness

Range of Motion: Normal

Spine: Absence of lordosis, kyphosis or scoliosis

Joint Swelling/Pain/Other- Absent

Weakness/Paralysis/Contracture :weakness present

O. Genito urinary system:

Frequency of Urination:-5 to 6 times a day

Colour of the urine: pale yellowish coloured

Normal/Anuria/Hematuria/Dysuria/Incontinence/Any Other:- not present

Catheter Present:-Yes

P. Integumentory system:

Skin Colour Normal Brown

Dermatitis- No

Allergies- No

Cause-Nil

Reaction-NII

Lesions/Abrasions-No

Tenderness / Redness-No

Surgical scar Secretion- No

Q. Mental status:-

Memory Good Knowledge: Good

Thinking: Good

Judgement: Good

Insight : Yes

R. Neurological assessment: (Level of consciousness)

GCS (Glasgow coma scale)

 Content Normal score Patient score
Eye opening response
Spontaneous 4 4
To Voice 3
To pain 2
No response 1
Best motor response
Obeys verbal command 6 6
Localize pain 5
Flexion 4
Flexion abnormal 3
Extension abnormal 2
No response 1
Best verbal response
Oriented to place & person 5 5
Conversation with confused 4
Inappropriate words 3
Incomprehensive Sounds 2
No response 1
TOTAL 15 15

Notes:

Record if eyes closed by swelling – C

Record if Endotracheal tube in place – E

Record if Tracheostomy tube is placed – T

 S. Motor function:

Reflexes

Sr. No. NAME OF THE REFLEX REMARK

1 Biceps Normal
2 Triceps Normal
3 Patellar Normal
4 Achilles Normal
5 Plantar Normal
6 Gluteal Normal

T. Cranial nerve function:-

Sr.No Name of the cranial nerve Functions Remarks

1 Olfactory Identify familiar Normal
odour
2 Optic Check the visual Normal
acuity and field
Check the pupilary
reflex Extra ocular
muscle movement
3 Oculomotor Extra ocular muscle Normal
movement.
4 Trochlear Extra ocular Normal
muscle movement.
Normal
5 Trigeminal Clench teeth Normal
6 Abducens Extra ocular muscle Normal
 movement to
right and left side
7 Facial Smile Puff cheeks Normal
identify tasks
8 Acaustic Hearing acuity Normal
9 Glossopharyngeal Gag reflex Normal
10 Vagus Swallowing Normal
11 Spinal Accessory Turn head Normal
Shrug shoulders
again resistance
12 Hypoglossal Protrude tongue Normal
Wiggle tongue from
side to side

FINAL IMPRESSION: All the cranial nerves function are normal.

Diagnostic Test Results and Significance

Diagnostic Indication or RESULTS Normal Values Analysis and

and Purposes Interpretation
Laboratory
Procedure

Radiology Radiography or Nodule-haze Normal lung. The result shows

Chest (PA) x-ray yields densities are Fields, cardiac that patient are
 information evident in the size, mediastinal congruent to the
about the right lung with structures, diagnosis of
pulmonary. traction of the thoracic size, pneumonia
Cardiac and trachea ribs and
skeletal systems. rightwards and diaphragm
right hemi
Monitor diaphragm
resolution, upwards. The
progression or right apical
maintenance of pleuralis
the disease thickened. Hazy
Evaluate known densities are like
or suspected wise seen in the
pulmonary left Jun lungs
disorders and base. Heart is not
cardiovascular enlarged body
disorders. thorax is
unremarkable.

Coplete Blood
Count

Hematocrit Measures the 45 40-54 The result shows that

concentration of the hematocrit is
WBC within the within the normal
blood volume. It suggesting that has
is used to aid less chance
diagriosis developing
abnormal states
 of dehydration, hemmorhage.
polycythemia
and anemia
Hemoglobin This test 145 140-180 The result shows that
evaluates. Blood the haemoglobin is
loss, within normal range.
erythropoietin IT suggests that
ability, anemia there is enough
and response to number of
therapy, It is an circulating
important hemoglobin thus no
component of deprivation of
RBC that carries oxygen supply
oxygen and CO2 different organs to
to and from the the body
tissues
Serve as a buffer
to maintain acid
and base balance
in the
extracellular
fluid..

White blood Cell Test used to 5.9 5-10*10 g\L Within Normal range
Count (WBC) detect Infection
or inflammation
to evaluate
effectiveness of
antibiotic
prescribed.
Red Blood Cell Has a principal 4.99 4.5-6.3 Within normal range
(RBC) means of
delivery of
oxygen to the
body tissues via
the blood
Platelet Count Platelet has 233 150-400 Within normal range
essential
function in
coagulation,
homeostasis and
blood thrombus
formation

Confirm low
platelet count
which can be
associated with
bleeding

Lymphocytes Lymphocytes 0.38 0.10-0.48 Within normal range

play a major role
in body's natural
defense system

Monitor the
response on
reaction to the
drugs of the
 patient
Segmenters A type of 0.62 0.66-0.70 This indicates that
neutrophil, Its the body is has low
primary function capacity to fight
is in against Invading
phagocytosis. microorganisms,
RBC Measures blood 118 118-140 Within normal range
glucose
regardless of
when you last
eat.
Blood Chemistry The result is higher
Creatinine Ordered to Traditional SI than the normal
patient to 1.7 0.4-1.7 range which
diagnose 150.3 35-124 indicates. decreased
function of the
impaired renal kidney.
function.

Cholesterol To test the total 130.0 150-250 Within normal range

amount of fatty 3.4 3.4-6.48
substance in the
blood

Helps in building
up cells and
produce
hormones
Urinalysis Is used for basic Color : Yellow Light Yellow Within normal range
screening to deep amber
purposes. It is a
 group of test that
evaluate the Transparency : Clear
kidney's ability Clear
to selectively
excrete and Ph: 6.0 4-6.8
reabsorb
substances while
maintaining Sp gravity: 1.05-1.030
water balance. 1.015

Monitor fluid Albumin: Trace Negative

Imbalance
Microscopic
Monitor finding : Normal/Trace
response to the Pus cells :0.1HPF
drug therapy and 0-3
evaluate
undesired react
was to drug that
may Impair renal
function

Ordered to
determine
whether the
urine contains
substances
indicate

Sputum AFB This test is used Negative Negative This indicates that
 to identify there is absence of
pathogenic pathogenic
organisms to microorganisms that
determine can cause diseases
whether such as PTB.
malignant cells
are present

MEDICAL MANAGEMENT

a. Intravenous Fluids

Medical General Description Indications or purpose Client

Management/Treatm response to
ent treatment

IVF: Plain Normal PNSS is under Used as a vehicle for The patient
Saline Solution 1L x isotonic solution. administration of complied with
31.32 gtts/min Where they have the drugs the doctors
same concentration of order.
solutes (osmolarity as
blood plasma). This
prevents Sudden shift
of fluids &
electrolytes in the
 body. This solution
contains 154 mEq/L
of Na and Cl. It
expands plasma and
Interstitial volume
and does not enter the
cells,

5% Dextrose and Source of water, The patient

Lactated Ringer’s electrolytes and complied with
calories or as an the doctors
alkalinizing agent order
D5NM 1L x 31-32 Hypertonic solution To prevent electrolyte The patient
gtts/min that has osmolarity Imbalance and serve complied with
higher than serum as a route for the doctors
osmolarity, when a administration for IV order
patient receives a medication: Absorbs
hypertonic IV fluid in the Interstitial
solution, serum cell: replacement of
osmolarity initially fluid, sodium,
increasing fluid to Be chloride and calories
pulled from the
Interstitial and
intracellular
compartment into the
blood vessels.

Oxygen Therapy Oxygen occurs in For patients The patient is

Oxygen Therapy at 3-4 atmosphere air in experiencing dyspnea relieved from
Ipm via nasal canula approximately 20- or difficulty of dyspnea and
 21% concentration, It breathing decreased
is a colorless, tasteless patients
gas which is essential respiration
for maintaining life, it rate.
must be continually
supplied to body cells,
since it is stored in
any parts of the body.
All body cells require
oxygen in order to
function and supply
the body with oxygen
is fundamental to life

Nebulization: A method of Bronchodilatio and The patient

administering effective mucous complied with
Combivent medication through expectoration the doctor's
the use of aerosol mist order and was
Neb q 6 relieved from
dyspnea.

.
Name of drugs, Route of General action Indications Client’s response
generic name, administration, and mechanism purpose to the meds with
Brand name dosage and of action actual S/E
frequency of
administration

Generic name: IV, 750mg TID General action: Lower Patient complied
Cefuroxime q3 (-)ANST respiratory tract woth the doctors
Brand name: Antiinfective Infections due to order and there
Zinacef Mechanism of s.pneumoniae are no
action: undesirable
effect
Binds to experienced by
bacterial cell the patient
wall membrane
causing cell
death.

Neb. (inhalation) General action: Patient complied

96 Cholinergic with the doctors
blocking drug order and was
And relieved of
sympathomimeti dyspnea.
c
Mechanism of

Action:
Ipratropium is an
anticholinergic
drug that acts to
 Inhibit the effect
of acetylcholine
following vagal
nerve
stimulation, This
results in
bronchodilation
which is
primarily a local,
site specific
effect. Albuterol
is a beta 2
adrenergic
agonist that also
causes
Bronchodilation.

Treatment of
COPD in those
who are on
regular aerosol.
Bronchodilator
therapy and who
require a second
bronchodilator.

Loperamide PO, 1 tab for Mechanism of

Hydrochlorid loose stool action: Patient complied
E Brand with the doctor’s
 Anti- diarrheal Slows intestinal order and was
Name: Imodium motility by relieved from
acting on the diarrhea.
nerve endings
and/or
intraneural
ganglia
embedded in the
intestinal wall.
The prolonged
retention of the
feces in the
intestine results
in reducing the
volume of the
stools,
increasing
viscosity and
decreasing fluid
and electrolyte
loss.

General action:

Symptomatic
relief of acute
non-specific
diarrhea
associated with
inflammatory
bowel disease.
Butamirate PO, 1 tab TID General action: Patient complied
citrate with the doctor’s
Cough order and was
Brand name: Suppresants relieved from
Sinecod forte cough.
Mechanism of
action:

Butamirate
citrate belongs to
the anti cough

Medicines of
central action.

Sinecod exerts
expectorant,
moderate

Bronchodilation
and
inflammatory
action. It also
increases the
spirometery
indexes and
blood
oxygenation
Carbocistein E PO, 500mg/cap General action: Acute and
Brand TID Mucolytics chronic Patient complied
disorders of with the doctor’s
Name: Mechanism of respiratory tract order and his
Abluent action: associated with secretions
excessive partially loosen
Its major action mucous
is on

The metabolism
of mucus
producing cells.
It reduces or
prevents
bronchial
inflammation
and bronchospas
m.

Furosemide IV, 20mg now, General action: For acute Patient complied
then q12 with bp Loop diuretic pulmonary with the doctor’s
Brand name: precaution edema. order.
Lasix Mechanism of
action:

Inhibits the
readsorption of
sadium and
chloride from
 the loop Henle
and distal renal
tubule.Increa

Ses renal
excretion of
water.

Sodium,
chloride,
magnesium,
hydrogen and
calcium.
Effectiveness
persists in
impaired renal
function.

Azithromycin PO, 500mg tab, General action: For pneumonia Patient complied
1 tab OD x 3 and lower with the doctor's
Brand name: days Antibiotic, respiratory tract order.
Zithromax macrolide infections.

Mechanism of
action:

A macrolide
derived from
erythromycin
Acts by binding
to the p site of
 the 50 s
ribosomal
subunit and may
inhibit RNA
dependent
protein synthesis
by stimulating
the dissociation
of peptidyl t-
RNA from
ribosomes.

INTRODUCTION

Pneumonia is an infection of the lower respiratory tract caused by bacteria, viruses, fungi,
protozoa, or parasites. It is the eighth leading cause of death in the United States. The
incidence and mortality of pneumonia are highest in the elderly. Risk factors for pneumonia
include advanced age ,immune compromise, underlying lung disease, alcoholism, altered
consciousness, smoking, endotracheal intubation, malnutrition, and immobilization. The
causative microorganisms influence the symptoms and signs with which the patient presents,
how the pneumonia should be treated and the prognosis. Pneumonias can be classified into
several ways. Pathologists originally classified them according to the anatomic changes that
 were found in the lungs during autopsies. As more became known about the microorganisms
causing pneumonia, a microbiologic classification arose, and with the advent of x-rays,
radiological classification. Another important system of classification is the combined clinical
classification, which combines factors such as age, risk factors for certain microorganism, the
presence of underlying lung disease and underlying systemic disease, and whether the person
has recently been hospitalized. The combined clinical classification, now the most commonly
used classification scheme, attempt to identify the person’s risk factors when he orshe first
comes to medical attention. The advantage of this classification scheme over previous
systems is that it can help guide the selection of appropriate initial treatments even before the
microbiologic cause of pneumonia is known. There are two broad categories of pneumonia in
this scheme: community-acquired pneumonia and hospital-acquired pneumonia. A recently
introduced type of healthcare-associated pneumonia lies between this two categories.

DEFINITION
Pneumonia is the inflammation of the lung parenchyma caused by infection. The inflammation is
triggered by many infectious organisms and irritating agent. Due to inflammation process, fluid
accumulates in the lungs hindering gaseous exchange. Community- acquired pneumonia refers to
pneumonia acquired outside of hospitals or extended-care facilities. (ignatavicius and workman
2010).

The Philippines ranks among the top 10 countries with the most recorded pneumonia cases.
About 9,000 Filipino children die from the disease every year. In 2007, there were 605,471
reported pneumonia cases. Children and babies who develop pneumonia often do not have any
 specific signs of a chest infection but develop a fever, appear quite ill, and can become lethargic.
Elderly people may also have few symptoms with pneumonia

Globally, every year, it kills an estimated 1.4 million children under the age of five years,
accounting for 18% of all deaths of children under five years old and elderly worldwide.
Pneumonia affects children and families everywhere, but is most prevalent in South Asia and
sub-Saharan Africa. Ignatavicius and Workmann stated that in the United States 2 to 5 million
cases of pneumonia occur each year and it’s the seventh leading cause of death. The highest
incidence among adult occur in older adult, nursing homes resident, hospitalized patent and those
being mechanically ventilated (p659). The Centers for Diseases Control and Prevention (CDC)
estimate that pneumococcus is the most common community-acquired pneumonia.

I. TYPES OF PNEUNONΙΑ

A. ACCODING TO SETTING OF ACQUISITION

a. Community-acquired pneumonia
Community-acquired pneumonia (CAP) occurs either in the community setting or within first 48
hour of hospitalization or institutionalization. Hospitalization of this condition depends on the
severity of pneumonia. Most people get CAP by breathing in germs (especially while sleeping)
that live in the mouth, nose, or throat. CAP is the most common type of pneumonia. Most cases
occur during the winter.

b. Hospital-Acquired Pneumonia
This is a type of pneumonia is acquired during hospital stay for another illness. It’s also known
as nosocomial pneumonia. Patients are at higher risk of getting HAP if they’re on a ventilator (a
machine that helps you breathe). The onset of this pneumonia symptoms starts more than 48
hours of hospitalization. HAP tends to be more severe compared to CAP because of existing
infections. Also, hospitals tend to have more germs that are resistant to antibiotics (medicines
used to treat pneumonia).
c. Ventilator-associated pneumonia
This type affect patients are intubated and mechanically ventilated. The endotracheal tube keeps
the glottis open, so secretion can be aspired into the lungs. (Williams and hopper 2007)

B. ACCORDING TO CAUSATIVE AGENT

a. Aspiration Pneumonia.
This refers to the consequences resulting from entry of endogenous or exogenous substances
gaining access to the lower airways. The most common cause is infection from aspirated bacteria
that normally resides at upper respiratory airways. (Williams & Wilkins, 2010). It can occur in
community or hospital. The most common bacteria are Streptococcus pneumonia, hemophilia
influenza, and staphylococcus aureus. Other causes may include, gastric content. Chemical or
irritating gases inhale food, drink, vomit, or saliva from your mouth into your lungs. This may
happen if something disturbs your normal gag reflex, such as a brain injury, swallowing problem,
or excessive use of alcohol or drugs.

b. Bacterial pneumonia:
This type of pneumonia is caused by different types of bacteria. The most pneumonia inducing
bacterium is Streptococcus pneumoniae. This pneumonia types generally affects people who
have weakened immune system for reasons like old age, illness, malnutrition etc,

c. Viral pneumonia:
This Type of pneumonia can be caused by different types of viruses. The most common forms of
viruses causing viral pneumonia are flu virus, para influenza virus, herpes simplex virus,
rhinovirus, adenovirus, Hantavirus, cytomegalovirus and respiratory syncytial virus.

d.Fungal pneumonia:
This is rare types of pneumonia. The fungus causing this type of pneumonia is Pneumocystis
carinii. It’s common among people with weak immune system or immunosuppressed. Often
pneumocystis carinii pneumonia is described as a complication experienced by patients with
diseases that weaken the immune system such as AIDS, Cancer etc.
 e. Hypostatic pneumonia
This type is related to patients who hypoventilate because of bed rest, immobility or shallow
respiration. Secretions pools in dependent areas of the lungs and can lead to inflammation and
infection.

f. Chemical pneumonia
Inhalation of toxic chemicals can cause inflammation and tissue damage, which will lead to
chemical pneumonia.

g. Atypical Pneumonia (Walking Pneumonia)

This refers to pneumonia that is mild enough so that you are not bedridden. The condition can be
treated without hospitalization. It is caused by mycoplasma pneumonia Legionella pneumophila,
mycoplasma pneumonia, and Chlamydophila pneumoniaelt is known as atypical because its
presentation and its course significantly differ from other bacterial pneumonia.

C. ACCORDING TO THE PART IT AFFECT

a. Lobar pneumonia
As the name suggest, this types affect one or more lobes of the lungs. It can be anywhere in the
lobe and may include both lobes.

b. Bronchopneumonia or lobular pneumonia

This type affects the epithelial cells of distal airways and alveoli part of the lungs causing
consolidations thereby decreasing gaseous exchange.

c. Interstitial pneumonia
This type is characterized by progressive scarring of both lungs.

ANATOMY AND PHYSIOLOGY

The respiratory system functions to deliver the oxygen to the blood -- the transport medium of
the cardiovascular system and to remove oxygen from the blood. The actual exchange of oxygen
and carbon dioxide occurs in the lungs.

The respiratory centers in the brain stem (pons and medulla) control respiration's rhythm, rate,
and depth. Primary controlling factors include 1) the concentration of carbon dioxide in the
blood (high CO2 concentrations initiate deeper, more rapid breathing) and 2) air pressure within
lung tissue. Expansion of the lungs stimulates nerve receptors (vagus nerve X) to signal the brain
to "turn off" inspiration. When the lungs collapse, the receptors give the "turn on" signal, termed
the Hering-Breuer inspiratory reflex. Other regulators are: 3) an increase in blood pressure,
which slows down respiration; 4) a drop in blood acidity, which stimulates respiration; and 5) a
sudden drop in blood pressure, which increases the rate and depth of respiration. Voluntary
controls "holding one's breath" can also affect respiration, but not indefinitely. Carbon dioxide
build-up soon forces an automatic start-up.tract includes the nose (nasal cavity, sinuses), mouth,
larynx, and trachea (windpipe). The lower respiratory tract includes the lungs, bronchi, and
alveoli.
The two lungs, one on the right and one on the left, are the body's major respiratory organs.
Each lung is divided into upper and lower lobes, although the upper lobe of the right lung
contains a third subdivision known as the right middle lobe. The right lung is larger and
heavier than the left lung, which is somewhat smaller in size because of the predominately
left- side position of the heart.

A clear, thin, shiny coating the pleura envelopes the lungs. The inner, visceral layer of the
pleura attaches to the lungs; the outer, parietal layer attaches to the chest wall (thorax).
Pleural fluid holds both layers in place, in a manner similar to two microscope slides that
are wet and stuck together. The lungs are separated from each other by the mediastinum, an
area that contains the heart and its large vessels, the trachea (windpipe), esophagus,
thymus, and lymph nodes. The diaphragm, the muscle that contracts and relaxes in
breathing, separates the thoracic cavity from the abdominal cavity.

The chart of the respiratory system shows the intricate structures needed for breathing.
Breathing is the process by which oxygen 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 body. At the same
time the blood gives up waste matter (carbon dioxide), which is carried out of the lungs
when air is breathed out.

1. The SINUSES (frontal, maxillary, and sphenoidal) are hollow spaces in the bones of the
head. Small openings connect them to the nose. The functions they serve include helping to
regulate the temperature and humidity of air breathed in, as well as to lighten the bone
structure of the head and to give resonance to the voice.

2. The NOSE (nasal cavity) is the preferred entrance for outside air into the respiratory
system. The hairs that line the wall are part of the air-cleaning system.

3. Air also enter through the MOUTH (oral cavity), especially in people who have a
mouth-breathing habit or whose nasal passages may be temporarily obstructed, as by a cold
or during heavy exercise.

4. The ADENOIDS are lymph tissue at the top of the throat. When they enlarge and
interfere with breathing, they may be removed. The lymph system, consisting of nodes
(knots of cells) and connecting vessels, carries fluid throughout the body. This system
helps to resist body infection by filtering out foreign matter, including germs, and
producing cells (lymphocytes) to fight them.

5. The TONSILS are lymph nodes in the wall of the throat (pharynx) that often become
infected. They are part of the germ-fighting system of the body.

6. The THROAT (pharynx) collects incoming air from the nose and mouth and passes it
downward to the windpipe (trachea).

7. The EPIGLOTTIS is a flap of tissue that guards the entrance to the windpipe (trachea),
closing when anything is swallowed that should go into the esophagus and stomach.
8. The VOICE BOX (larynx) contains the vocal chords. It is the place where moving air
being breathed in and out creates voice sounds.

9. The ESOPHAGUS is the passage leading from the mouth and throat to the stomach.

10. The WINDPIPE (trachea) is the passage leading from the throat (pharynx) to the lungs.

11. The LYMPH NODES of the lungs are found against the walls of the bronchial tubes
and windpipe.

12. The RIBS are bones supporting and protecting the chest cavity. They move to a limited
degree, helping the lungs to expand and contract.

13. The windpipe divides into the two main BRONCHIAL TUBES, one for each lung,
which subdivide into each lobe of the lungs. These, in turn, subdivide further.

14. The right lung is divided into three LOBES, or sections. Each lobe is like a balloon
filled with sponge-like tissue. Air moves in and out through one opening a branch of the
bronchial tube.

15. The left lung is divided into two LOBES.

16. The PLEURA 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.

17. The bronchial tubes are lines with CILIA (like very small hairs) that have a wave-like
motion. This motion carried MUCUS (sticky phlegm or liquid) upward and out into the
throat, where it is either coughed up or swallowed. The mucus catches and holds much of
the dust, germs, and other unwanted matte that has invaded the lungs. You get rid of this
matter when you cough, sneeze, clear your throat or swallow.
18. The DIAPHRAGM 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
expand the lungs.

19. The smallest subdivisions of the bronchial tubes are called BRONCHIOLES, at the end
of which are the air sacs or alveoli (plural of alveolus).

20. The ALVEOLI are the very small air sacs that are the destination of air breathed in.

CAPILLARIES are blood vessels that are imbedded in the walls of the alveoli. Blood
passes through the capillaries, brought to them by the PULMONARY ARTERY and taken
away by the PULMONARY VEIN. While in the capillaries the blood gives off carbon
dioxide through the capillary wall into the alveoli and takes up oxygen from the air in the
alveoli..

AIR DISTRIBUTION

On inspiration, air enters the body through the nose and the mouth. Nasal hairs and mucosa
(mucus) filter out dust particles and bacteria and warm and moisten the air. Less warming,
filtering, and humidification occur when air is inspired through the mouth.

Air travels down the throat, or pharynx, where two openings exist, one into the esophagus
for passage of food, and the other alveoli that gas exchange occurs. Tiny blood vessels,
capillaries, surround each of the alveoli. On inspiration, the concentration of dissolved
oxygen is greater in the alveoli than in the capillaries. Oxygen, therefore, diffuses across
the alveolar walls into the blood plasma. In the reverse process, carbon dioxide
concentration is greater in the blood than the alveoli, so it passes from the blood into the
alveoli and is ultimately breathed out.
As oxygen diffuses into the plasma, hemoglobin in the red blood cell picks up the oxygen,
permitting more to flow into the plasma. The oxygen- carrying capacity of hemoglobin
allows the blood to carry over 70 times more oxygen than if the oxygen were simply
dissolved in the plasma alone. Therefore, the total oxygen uptake depends on: 1) the
difference in oxygen concentration between the blood and alveoli, 2) the healthy
functioning of the alveoli, and 3) the rate of respiration.

PULMONARY CIRCULATION

The pulmonary circulatory circuit describes the process whereby oxygen and carbon
dioxide are delivered to and from the lungs. Oxygen-poor blood travels to the right atrium
via the inferior and superior vena cavae, then to the right ventricle. The right ventricle
subsequently pumps the blood into the pulmonary artery, which branches to the right and
left lungs. The pulmonary arteries subdivide until reaching the arteriole, then capillary
levels. After gas exchange, the capillaries recombine to form venules and veins. Ultimately
two right and two left pulmonary veins carry oxygen-rich blood to the heart for
distribution, via the aorta/systemic circuit, to the rest of the body.
LUNG VOLUMES/ CAPACITIES

The air that the lungs can hold can be divided into smaller designations called "volumes."
The amount of air a person breathes in and out at rest is called the Tidal Volume (Vt about
500ml). During such breathing, a person could actually take in more air or blow more out.
The additional amount a person could inhale, such as during maximum physical activity, is
called the Inspiratory Reserve Volume (IRV 3,000 ml). The additional amount a person
could exhale is called the Expiratory Reserve Volume (ERV 1,000 ml). The Residual
Volume (RV) is the amount of air that stays in the lung even after maximum
expiration .Breathing is an active process requiring the contraction of skeletal muscles. The
primary muscles of respiration include the external intercostal muscles (located between
the ribs) and the diaphragm (a sheet of muscle located between the thoracic & abdominal
cavities).The external intercostals plus the diaphragm contract to bring about inspiration:
Contraction of external intercostal muscles elevation of ribs & sternum increased front-to-
back dimension of thoracic cavity > lowers air pressure in lungs > air moves into lungs

Contraction of diaphragm diaphragm moves downward > increases vertical dimension of

thoracic cavity > lowers air pressure in lungs > air moves into lungs:

Predisposing and Precipitating Factors Predisposing/Non-modifiable factors

a. Age
Most common in people younger than 60 years of age without comorbidity and in those 60
years and older among at risk factors for the development of CAP

b. Race
African American has higher rates of Community Acquired pneumonia than among whites.

c. Gender
CAP is most common among men than in women due to their lifestyle such as smoking
and drinking.

d. Seasonality
It is most prevalent during winter and spring, where Upper Respiratory Tract infections are
frequent.

e. Medical History and Treatments

Those people who have illness such as diabetes, HIV infection, Bronchielectasis,
Neutropenia, COPD and other factors involving microorganisms.

Precipitating / Modifiable Factors

a. Lifestyle
CAP can occur with people who are smoking, 2 hand smokers and alcohol abuse

b. Occupation

People who are expose in microorganisms especially in the community. Laboratories,

Veterinarians clinics and other institution involving microorganisms.

c. Hygiene
Those that have a poor hygiene, improper hand washing, perineal care, and preparing
foods.

d. Poor Immune System

CAP could be common in children as well as n adults if they have poor immune system
or didn't acquire vaccination. malnutrition. can also contribute to poor immune.

3. SIGNS AND SYMPTOMS

a. Pleuritic Chest pain that is aggravated by deep breathing and coughing Indicates of
having pleural inflammation arising from parietal pleura, which is richly supplied by
sensory nerve endings
b. Rapid Rising Fever (38.5 to 40.5 °c)
Cause by release of endogenous pyrogens that reset the hypothalamus thermostat

c. Sudden onset of chills

Due to invasion of microorganisms causing inflammatory process

d. Tachypnea, rapid pulse and bounding.

Due to the interference in oxygen and carbon dioxide exchange that caused hypoxemia

h. Bacteremia
The invasion of microorganisms in the body

i. Cough
Brings up a greenish and yellowish mucous due to the bacterial invasion

4. Health Promotion and Prevention aspects of disease

Several ways to prevent infectious Community- Acquired Pneumonia like smoking, it
is important since it will not only helps to limit lung damage but also because cigarette
smoking interferes with many of the bodies natural defenses against pneumonia.
Vaccination is also important in preventing pneumonia in children and adults.
Vaccination against Haemophilus Influenzae and Streptococcus pneumoniae in the first
year of life have greatly reduced their role in pneumonia in children. These would also
decreased incidence of these against infections in adults because adults may. acquire
infections from children. Flu vaccine prevents pneumonia and other problems cause by
the influenza virus. Furthermore, health care workers, nursing home residents and
pregnant women should receive the vaccine. A repeat vaccination may also be required
after five to ten years, the vaccines that confers immunity against pneumococus. It is
also given to people who most at risk like those the age of 65 with chronic heart, lung
and liver disease.
Aside from vaccines, deep-breathing exercise may also help in preventing pneumonia
especially if you are in the hospital-for example, while recovering from surgery.
Drinking plenty of fluids does not suppress, because retained secretions interfere with
gas exchange and may slow recovery. Hydration of 2-3 L/day because adequate
hydration thins and loosens pulmonary secretions. Humidification may be used to
loosen secretions and improve ventilation.

Lastly the best solution to prevent infections is proper hand washing and sanitation.
Always wash your hands frequently can prevent the spread of viral respiratory illness,
taking vitamins especially vitamin C will also be helpful in reducing the risk for having
CAP. Avoiding stress, avoid over exertion and possible exacerbation of symptoms.

The solution to the problem is preventing the infections rather than curing them. As the
saying goes "PREVENTION IS BETTER THAN CURE", these preventive measures
includes avoid uncooked or unwashed fruits and vegetables in areas when sanitation is
poor, good personal hygiene, wee protective clothing and use insect repellent are some
of the ways to prevent pneumonia.
 SIGN AND SYMPTOMS :-

BOOK PICTURE PATIENT PICTURE

 Fever - often high grade  Fever
 Chills and sweats
 Cough, with phlegm (sputum) that can be  Cough, with phlegm (sputum)
yellow, green, or bloody
 Shortness of breath or difficulty breathing
 Shortness of breath or difficulty breathing
 Chest pain, particularly when breathing
 Chest pain, particularly when breathing
deeply or coughing
deeply or coughing
 Rapid heartbeat (tachycardia)
 Rapid heartbeat (tachycardia)
 Rapid breathing (tachypnea)
 Rapid breathing (tachypnea)
 Confusion or changes in mental
awareness, particularly in older adults
 Fatigue and weakness
 Loss of appetite
 Loss of appetite
 Muscle aches and joint pain
 Headache
 Headache
 Bluish tint to the lips or nails (cyanosis)
in severe cases
 NURSING PROOCESS

Nursing diagnosis:

 Ineffective Airway Clearance related to increased sputum production as evidenced by

audible rhonchi, productive cough, and difficulty expectorating sputum.
 Impaired Gas Exchange related to alveolar-capillary membrane changes as evidenced by
altered arterial blood gases, hypoxemia, and cyanosis.
 Ineffective Breathing Pattern related to respiratory distress as evidenced by use of
accessory muscles, tachypnea, and abnormal breath sounds.
 Acute Pain related to pleural irritation as evidenced by sharp chest pain that worsens with
deep breathing and coughing.
 Activity Intolerance related to decreased oxygenation and general weakness as evidenced
by fatigue, dyspnea on minimal exertion, and reluctance to engage in physical activities.
 Hyperthermia (related to inflammatory process as evidenced by elevated body
temperature, chills, and diaphoresis).
 Imbalanced Nutrition: Less Than Body Requirements related to increased metabolic
demand and decreased oral intake as evidenced by weight loss, muscle weakness, and
reported lack of appetite.

NURSING CARE PLAN

ASSESSMENT NURSING GOAL INTERVENTION IMPLEMENTATION RATION

DIAGNOSIS
SUBJECTIVE Ineffective Improve Position the patient in Fowler's position To p
DATA : Airway airway semi-Fowler's position position given to lung exp
Patient reports Clearance clearance. patient. and fa
increased sputum related to Enhance easier
production. increased respiratory breathing
Patient complains sputum function.
of difficulty production as Prevent Encourage and assist To m
Encouraged and
breathing. Patient evidenced by respiratory with deep breathing and
assisted with deep
reports feelings of audible rhonchi, complication. exercises and expector
breathing exercises and
chest congestion. productive coughing techniques sputum.
coughing techniques
Objective Data: cough, and Administer prescribed To help
Administered
Audible crackles difficulty bronchodilators and airways
prescribed
or wheezes upon expectorating expectorants as facilitate
bronchodilators and
auscultation. sputum. ordered. removal
expectorants as
Increased secretion
ordered.
respiratory rate.
Increased cough Provide adequate
Provided adequate To help
frequency hydration. secretion
hydration.
make co
more eff

Encourage ambulation
Encouraged ambulation To p
and activity as
and activity as tolerated airway
tolerated
clearance
prevent
complica
such
atelectas

ASSESSMENT NURSING GOAL INTERVENTION IMPLEMENTATION RATION

DIAGNOSIS
SUBJECTIVE Impaired Gas Improve gas Assess and monitor
DATA : Exchange exchange. respiratory status
Patient reports related to Increase closely, including
shortness of alveolar- oxygen respiratory rate, depth,
breath. Patient capillary saturation and effort.
complains of membrane levels.
To op
feeling weak or changes as Decrease Position the patient in
lung exp
fatigued. evidenced by respiratory high Fowler's position
and facil
Objective Data: altered arterial distress. or semi-Fowler's
Decreased oxygen blood gases, position to optimize
saturation levels. hypoxemia. lung expansion and
Abnormal breath facilitate breathing.
sounds such as
wheezing or Administer
crackles. supplemental oxygen
therapy as prescribed
to improve
oxygenation and
relieve respiratory
distress.

Encourage and assist

with deep breathing
exercises to improve
lung ventilation and
oxygenation.

Provide reassurance
and emotional support
to help reduce anxiety
and promote
relaxation, which can
 improve breathing
patterns.

Administer prescribed
bronchodilators or
other respiratory
medications to help
relieve bronchospasm
and facilitate airway
clearance.

ASSESSMENT NURSING GOAL INTERVENTION IMPLEMENTATION RATION

DIAGNOSIS
Subjective Acute Improve Assess and document
Data:Patient Pain related to comfort and the characteristics of

reports sharp or pleural irritation relaxation.En the pain, including

as evidenced by
stabbing chest hance coping location, intensity,
sharp chest
pain.Pain worsens mechanisms. quality, and
pain that worsens
with deep aggravating or
with deep
breathing or alleviating
breathing and
coughing.Patient coughing.
factors.Administer
may rate pain analgesic medications
intensity on a as prescribed, such as
scale from 0 to nonsteroidal anti-
10.Objective inflammatory drugs
Data:Guarding or (NSAIDs) or opioid
splinting of the analgesics, to relieve
chest wall.Facial pain.Apply cold or
grimacing or heat therapy to the
vocalization affected area as
indicative of ordered to help reduce
pain.Elevated inflammation and
heart rate and provide comfort.Teach
blood and assist the patient
pressure.Restlessn with relaxation
ess or agitation. techniques such as
deep breathing
exercises, guided
imagery, or
progressive muscle
relaxation.Position the
patient in a
comfortable position,
such as semi-Fowler's
position, to reduce
pressure on the chest
wall and improve
breathing
comfort.Encourage
and assist with
coughing and deep
breathing exercises to
prevent complications
such as atelectasis
while minimizing
pain.Provide
emotional support and
reassurance to help the
patient cope with pain
and anxiety associated
with pleural
 irritation.Monitor vital
signs and pain
intensity regularly,
and adjust
interventions as
needed based on the
patient's
response.Collaborate
with the healthcare
team to address
underlying causes of
pleural irritation and
implement appropriate
treatment measures.

ASSESSMENT NURSING GOAL INTERVENTION IMPLEMENTATION RATION

DIAGNOSIS
Subjective  Ineffecti Improve Position the patient in
Data:Patient ve airway semi-Fowler's position
reports increased Breathin clearance.En to promote lung
sputum g Pattern hance expansion and
production.Patient related to respiratory facilitate easier
complains of respirato function.Prev breathing.Encourage
difficulty ry ent and assist with deep
breathing.Patient distress respiratory breathing exercises
reports feelings of as complication and coughing
chest evidence s techniques to mobilize
congestion.Object d by use and expectorate
ive Data:Audible of sputum.Administer
crackles or accessor prescribed
wheezes upon y bronchodilators and
auscultation.Incre muscles, expectorants as
ased respiratory tachypne ordered to help dilate
rate.Increased a, and airways and facilitate
cough frequency. abnorma the removal of
l breath secretions.Provide
sounds. adequate hydration to
help liquefy secretions
and make coughing
more
effective.Monitor
respiratory status
closely, including
oxygen saturation
levels, breath sounds,
and respiratory
rate.Encourage
ambulation and
activity as tolerated to
promote airway
clearance and prevent
complications such as
atelectasis.Educate the
patient and family
about the importance
of proper breathing
techniques, the use of
prescribed
medications, and signs
of worsening
respiratory status.
ASSESSMENT NURSING GOAL INTERVENTION IMPLEMENTATION RATION
DIAGNOSIS
Subjective  Activity Improve Assess and monitor
Data:Patient reports Intoleranc activity vital signs, including
feeling tired or e related tolerance.Enh oxygen saturation
weak during to
ance levels and respiratory
physical decreased
oxygenation rate, before, during,
activity.Patient may oxygenati
during and after
describe difficulty on and
activity.Incre activity.Encourage
breathing or general w
shortness of breath eakness a
ase and assist with gradual

with s independence progressive exercise,

exertion.Patient evidenced in activities starting with activities
expresses by of daily of daily living and
frustration or fear fatigue, d living. gradually increasing
related to limited yspnea on intensity as
activity minimal tolerated.Monitor
tolerance.Objective exertion,
oxygen saturation
Data:Decreased and
levels using pulse
oxygen saturation reluctance
oximetry during
levels during to engage
activity, and provide
activity.Increased in
respiratory rate or physical supplemental oxygen

effort with activities. therapy as prescribed

exertion.Fatigue or to maintain adequate
exhaustion during oxygenation.Schedule
or after activity. rest periods as needed
during activities to
prevent excessive
fatigue and promote
recovery.Teach and
assist the patient with
energy conservation
techniques, such as
pacing activities and
prioritizing tasks, to
minimize exertion and
conserve
energy.Collaborate
with physical and
occupational
therapists to develop
an individualized
exercise and activity
plan tailored to the
patient's abilities and
limitations.Provide
emotional support and
encouragement to help
the patient cope with
feelings of frustration
or fear related to
decreased activity
tolerance.Monitor for
signs of oxygen
desaturation or
respiratory distress
during activity, and
adjust interventions
accordingly
 PROGNOSIS REPORT

Day 1-2:Initiation of antibiotic therapy based on severity and suspected pathogens. Monitoring
of vital signs, oxygen saturation levels, and respiratory status every 4-6 hours. Administration of
supplemental oxygen therapy if needed to maintain adequate oxygenation. Assessment for signs
of clinical improvement or deterioration, such as resolution of fever, improvement in respiratory
rate, and decreased chest pain.

Day 3-4:Continued antibiotic therapy as prescribed, with consideration for adjusting treatment
based on culture results if available .Monitoring for complications such as pleural effusion or
respiratory failure. Evaluation of response to treatment, including resolution of symptoms and
improvement in radiographic findings. Assessment for any development of antibiotic-associated
complications such as Clostridium difficile infection.

Day 5-6:Reassessment of clinical status and response to treatment. Consideration for switching
to oral antibiotics if the patient shows significant improvement and is clinically stable. Continued
monitoring for signs of clinical deterioration or relapse, especially in high-risk patients such as
the elderly or those with comorbidities. Education of the patient and family regarding the
importance of completing the full course of antibiotics and signs of worsening symptoms that
require prompt medical attention.

Day 7: Evaluation of overall clinical improvement and readiness for discharge. Discontinuation
of supplemental oxygen therapy if the patient's oxygen saturation levels remain within normal
range. Arrangement for follow-up appointments for further assessment and monitoring of
recovery progress. Education of the patient and family regarding strategies for preventing future
episodes of pneumonia, including vaccination and smoking cessation if applicable. Provision of
discharge instructions, including medication management, activity recommendations, and signs
of complications to watch for post-discharge.

Overall Prognosis:The prognosis for CAP patients is generally good with appropriate and timely
treatment. Most patients show significant improvement within the first few days of treatment.
However, close monitoring is essential to detect any complications or treatment failures
promptly. Follow-up care is crucial to ensure complete resolution of infection and prevent
recurrence

DISCHARGE PLANNING

Medication Management: Provide detailed instructions on the prescribed antibiotics, including

dosage, frequency, and duration of treatment. Educate the patient and family on the importance of
completing the full course of antibiotics even if symptoms improve. Review any additional medications
prescribed for symptom management or comorbid conditions. Arrange for prescription refills and provide
information on how to obtain them

Symptom Monitoring: Instruct the patient and family on signs and symptoms of worsening
pneumonia, such as increasing shortness of breath, persistent fever, chest pain, or coughing up blood.
Provide guidance on when to seek medical attention if these symptoms occur, including contact
information for emergency services or the primary care provider.

Follow-up Appointments: Schedule a follow-up appointment with the primary care provider or
pulmonologist for further evaluation and monitoring of recovery progress. Ensure the patient understands
the importance of attending follow-up appointments for ongoing assessment and management of
pneumonia.

Activity Recommendations: Advise the patient to gradually increase activity levels as tolerated,
starting with light activities and gradually progressing to normal daily activities. Provide guidance on
avoiding strenuous activities or heavy lifting until fully recovered. Emphasize the importance of rest and
adequate sleep for optimal recovery.

Nutrition and Hydration: Encourage the patient to maintain a balanced diet rich in fruits, vegetables,
lean proteins, and whole grains to support recovery .Provide guidance on increasing fluid intake,
especially water, to prevent dehydration and help loosen mucus secretions.

Respiratory Care: Educate the patient on the importance of practicing good respiratory hygiene,
including covering the mouth and nose when coughing or sneezing and disposing of tissues properly.

Provide information on techniques for clearing mucus from the airways, such as coughing and deep
breathing exercises.
Home Environment: Assess the patient's home environment for potential hazards or barriers to
recovery, such as exposure to smoke or pollutants. Provide recommendations for creating a clean and
smoke-free environment conducive to respiratory health.

Support Services: Discuss available support services and resources, such as home health care,
respiratory therapy, or community support groups, to assist with recovery and management of chronic
conditions .Provide contact information for local support services and organizations that may be
beneficial to the patient and family.

Emergency Preparedness: Review emergency preparedness measures with the patient and family,
including when and how to access emergency medical services if needed. Ensure the patient has access to
a reliable means of communication in case of emergencies.

Patient Education: Provide written discharge instructions summarizing key points discussed during the
discharge planning process. Address any questions or concerns the patient and family may have about
managing pneumonia at home. Encourage the patient to take an active role in their recovery and to
communicate any changes in symptoms or concerns to their healthcare provider promptly.

EVALUATION OF CARE

The care provided for the community-acquired pneumonia (CAP) patient involved a comprehensive
approach aimed at addressing the underlying infection, optimizing respiratory function, and promoting
recovery. Through diligent assessment, timely intervention, and ongoing evaluation, the healthcare team
worked collaboratively to ensure the patient received appropriate treatment and support throughout their
hospitalization and transition to home care.

The evaluation of care highlighted the successful management of the patient's pneumonia, as evidenced
by clinical improvement, resolution of symptoms, and normalization of vital signs and laboratory
findings. Additionally, efforts to educate the patient and family on infection prevention, medication
management, and self-care strategies contributed to empowering them to actively participate in their
recovery process.

Overall, the care provided was effective in achieving the desired outcomes of improving the patient's
health status, enhancing their quality of life, and minimizing the risk of complications. Moving forward,
continued vigilance and follow-up care will be essential to ensure ongoing recovery and prevent
recurrence of pneumonia. By maintaining open communication, collaborating with the patient and family,
and adapting care strategies as needed, the healthcare team remains committed to supporting the patient's
long-term well-being.

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Deluane and Landner et al: FUNDAMENTALS OF NURSING: Standards and Practice, 3rd edition,
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Giddens and Langford et al: MOSBY'S NURSING PDQ, Elsevier PTE LTD Health Science Asia, 2004

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