Community-

Acquired
Pneumonia
BSN 4A - Group 3
Lutero, Charisse
Martinez, Faye
Mendiola, Thea Marie
Nanagad, Wrenzie
Rentoy, Jan Felix Emmanuel
 PATIENT DATA
Name: EMP
Age: 56 y/o
Gender: Female
Diagnosis: Community Acquired Pneumonia- Moderate Risk

History
Cough prior to admission, hypertensive

X-Ray
Chest x-ray PA view- left lower lobe infiltration
Impression: CAP-MR, left lower lung considered

Sputum culture and Sensitivity

Sputum culture and sensitivity positive for Streptococcus Pneumoniae

Laboratory
Serum sodium and serum potassium are decreased

Epidemiology
In the Philippines, pneumonia is the third leading cause of death
across all ages. In 2019, 2.5 million people died from pneumonia
around the world. The estimated worldwide incidence of community-
acquired pneumonia varies between 1.5 to 14 cases per 1000 person-
years, and this is affected by geography, season, and population
characteristics.

In the United States, the annual incidence is 24.8 cases per 10,000
adults with higher rates as age increases. Pneumonia is the eighth
leading cause of death and first among infectious causes of death.
The mortality rate is as high as 23% for patients admitted to the
intensive care unit.
 OBJECTIVES
General Objective
At the end of this case presentation, the audience will be educated
about Community Acquired Pneumonia- Moderate Risk and its nursing
management, and acquire the proper knowledge and attitude in
providing care to the patient.

Specific Objectives

Knowledge
1. Discuss the pathophysiology of CAP-MR.
2. Identify the predisposing and precipitating factors of the disease.
3. Recognize the signs and symptoms of the patient’s condition.

Skills
1. Document the patient’s condition, nursing interventions and
evaluations correctly.
2. Implement a nursing care plan in managing patient’s signs and
symptoms using the nursing process
3. Identify appropriate nursing diagnosis according to the needs of the
patient.

Attitude
1. Show utmost confidence in managing the patient’s bedside care.
2. Recognize the patient's needs using a holistic approach.
3. Establish rapport with the patient and members of the family.
PNEUMONIA
It is the infection of the pulmonary parenchyma or pulmonary tissue,
including the interstitial spaces, the alveoli, and the bronchioles.
It may inflame the air sacs in one or both luncgs, which may fill with fluid
or pus, causing coughing, fever, chills, and difficulty breathing.

Pneumonia can be community acquired or hospital acquired.

The edema associated with inflammation stiffens the lung, decreases
lung compliance and vital capacity, and causes hypoxemia.
Chest X-Ray film shows diffuse patches throughout the lungs or
consolidation in a lobe.
A sputum culture identifies the organism.

The white blood cells and erythrocyte sedimentation

rate are elevated.

Types of Pneumonia
Community Acquired Pneumonia acquired outside of a
Pneumonia hospital in a community setting.

Pneumonia acquired 48 hours

Hospital Acquired after being admitted and not
Pneumonia intubated at the time of
admission.

Ventilator Acquired Pneumonia acquired 48 hours

Pneumonia after endotracheal intubation.

Pneumonia acquired in the setting

Healthcare Associated of assisted-living facilities,
Pneumonia rehabilitation facilities, and other
healthcare facilities.

Pathogen
These are lancet-shaped, gram-
STREPTOCOCCUS positive, facultative anaerobic
PNEUMONIAE bacteria that causes pneumococcal
disease.
 Primary Pneumonia Etiology
Caused by the patient's inhaling or aspirating a pathogen such as bacteria or
a virus. Bacterial pneumonia, often caused by staphylococcus, streptococcus,
or klebsiella, usually occurs when the lungs' defense mechanisms are impaired by
such factors as suppressed cough reflex, decreased cilia action, decreased
activity of phagocytic cells, and the accumulation of secretions. Viral
pneumonia occurs when a virus attacks bronchiolar epithelial cells and causes
interstitial inflammation and desquamation, which eventually spread to the
alveoli.

Secondary Pneumonia

Ensues from lung damage that was caused by the spread of bacteria from an
infection elsewhere in the body or by a noxious chemical. Aspiration
pneumonia is caused by the patient's inhaling foreign matter such as food or
vomitus into the bronchi. Factors associated with aspiration pneumonia include
old age, impaired gag reflex, surgical procedures, debilitating disease, and
decreased level of consciousness.

Community-Acquired

Caused by bacteria that are divided into two groups: typical and atypical.
Organisms that cause typical pneumonia include Streptococcus pneumonia
(pneumococcus) and Haemophilus and Staphylococcus species. Organisms that
cause atypical pneumonia include Legionella, Mycoplasma, and Chlamydia
species.

Cigarette Smoking
Risk Factors
Recent viral respiratory Cerebral Palsy or Impaired
infection (common cold, consciousness (loss of brain
laryngitis, influenza) function due to dementia, stroke,
or other neurologic conditions)
Difficulty swallowing (due to
stroke, dementia, Parkinson's Other serious illnesses, such as
disease, or other neurological heart disease, liver cirrhosis, or
conditions) diabetes mellitus
Chronic lung disease (COPD,
Living in a nursing facility
bronchiectasis, cystic fibrosis)

Immune system problem Recent surgery or trauma

 Signs and Symptoms
Chills Loss of appetite and fatigue
Elevated temperature Crackles
Pleuritic Pain Percussion: dullness
Rhonchi and wheezes Auscultation: breath sounds
Cyanosis Shortness of breath
Mental status changes respiratory rate
Sputum production heart rate
Use of accessory oxygen saturation
muscles for breathing

Complications
Respiratory failure Which requires a breathing machine or
ventilator

Acute respiratory distress syndrome is a

ARDS
severe form of respiratory failure.

A condition in which there is uncontrolled

Sepsis swelling (inflammation) in the body, which
may lead to organ failure.
These are infrequent, but serious,
complications of pneumonia. They occur
Empyema or lung
when pockets of pus form inside or around
abscesses
the lung. These may sometimes need to be
drained with surgery.

Diagnostic Procedures
Sputum cultures and sensitivities reveals presence of
infecting organisms. Cultures identify organism; sensitivity
testing identifies how resistant or sensitive the bacteria
are to antibiotics. Lab results tested positive for S.
Pneumoniae
Chest x-ray reveals areas of increased density, (can be
a lung segment, lobe, one lung, or both lungs). Findings
reflect areas of infection and consolidation.
 Treatments
Antibiotics are prescribed Supportive treatment
based on Gram stain results includes hydration,
and antibiotic guidelines antipyretics, antihistamines, or
(resistance patterns, risk nasal decongestants.
factors, etiology must be
Oxygen therapy is given for
considered). Combination
hypoxemia.
therapy may be used.
Treatment of atelectasis,
Best rest is recommended
pleural effusion, shock,
until infection shows signs of
respiratory failure,
clearing.
superinfection is instituted, if
Respiratory support includes needed.
endotracheal intubation, high
inspiratory oxygen For groups of high risk for
concentrations, and community-acquired
mechanical ventilation. pneumonia, pneumococcal
vaccination is advised.

Antibiotics
Macrolides provide coverage for
INITIAL ANTIBIOTICS:
likely organisms in community-
MACROLIDES
acquired bacterial pneumonia.
erythromycin
azithromycin
roxithromycin
clarithyromycin

Penicillin G for streptococcal

OTHER ANTIBIOTICS pneumonia
Nafcillin or oxacillin for
staphylococcal pneumonia
Aminoglycoside or a
cephalosporin for klebsiella
pneumonia
Penicillin G or clindamycin for
aspiration pneumonia

Amoxicillin and clavulanate

ALTERNATIVE (Augmentin); doxycycline;
trimethoprim and
sulfamethoxazole (Bactrim DS,
Septra); levofloxacin (Levaquin)
 P
P H
A Y
T S
H I
O O
Nursing Care Plan
Drug Study
DISCHARGE PLANNING
Breathing Exercises: Teach the patient any breathing
exercises or techniques that may help with lung recovery and
to prevent complications like atelectasis or pneumonia
recurrence.
Activity and Rest: Discuss activity limitations and gradual
resumption of physical activity. Patients should avoid strenuous
activities until their healthcare provider approves.
Environmental Factors: Discuss the importance of
maintaining a clean and smoke-free home environment. Ensure
the patient avoids exposure to irritants like tobacco smoke or
pollutants that can worsen respiratory symptoms.
Support System: Assess the patient's support system at home.
Ensure they have someone who can assist with daily activities
if needed, and who can help monitor their progress and
provide emotional support.
Discharge Equipment: If the patient requires specific
equipment at home (e.g., oxygen therapy), ensure it is set up,
and the patient and their caregivers are trained on how to use
it safely.
Vaccination: Discuss the importance of vaccinations, such as
the pneumococcal vaccine and annual influenza vaccine, to
prevent future respiratory infections.
Social Services: If necessary, involve social workers or case
managers to assess the patient's social and economic situation
and provide assistance with home healthcare, insurance, or
financial issues.
DISCHARGE PLANNING
Here are the key components and considerations for discharge
planning for a patient with pneumonia:

1. Medical Stability: The patient should be medically stable

and well enough to leave the hospital. This includes
resolution of fever, improvement in breathing, and a
general sense of well-being. Medical stability is assessed
by the healthcare team.
2. Medication Management: Ensure that the patient
understands the importance of completing their antibiotic
course if bacterial pneumonia is the cause. Provide clear
instructions on medication dosage, timing, and potential
side effects. In the case of viral pneumonia, ensure the
patient knows the appropriate antiviral medications or
supportive care measures.
3. Follow-up Appointments: Schedule a follow-up
appointment with the patient's primary care physician or a
pulmonologist. The healthcare provider will evaluate the
patient's progress, order any necessary tests, and adjust
treatment as needed.
4. Symptom Management: Educate the patient about how
to manage symptoms at home, including when to seek
medical attention. Provide information on signs of
worsening pneumonia or potential complications.
5. Home Care Instructions: Offer detailed instructions for
care at home, such as the importance of rest, maintaining
hydration, and nutrition. Explain how to monitor oxygen
levels, if applicable, and how to use any prescribed
equipment, like inhalers or oxygen tanks.
6. Nutrition and Hydration: Encourage a balanced diet and
sufficient fluid intake to support recovery. Provide dietary
recommendations if the patient has specific dietary
restrictions or preferences.