I. INTRODUCTION

A. Pneumonia is an inflammation of the lung that is most often caused by

infection with bacteria, viruses, or other organisms. Occasionally, inhaled chemicals that

irritate the lungs can cause pneumonia. Healthy people can usually fight off pneumonia

infections. However, people who are sick, including those who are recovering from the

flu (influenza) or an upper respiratory illness, have weakened immune systems that

make it easier for bacteria to grow in their lungs.

Aspiration is defined as the inhalation of either oropharyngeal or gastric contents

into the lower airways. Inhalation of these contents can lead to aspiration pneumonia.

Aspiration pneumonia results from chronic, usually unwitnessed, inhalation of small

amounts of oropharyngeal contents leading to an infectious process.

Substances other than bacteria may be aspirated into the lung, such as gastric

contents, exogenous chemical contents, or irritating gases. This type of aspiration or

ingestion may impair the lung defenses, cause inflammatory changes, and lead to

bacterial growth and a resulting pneumonia.

This inflammation causes an outpouring of fluid in the infected part of the lungs,

affecting either one or both lungs. The blood flow to the infected portion of the lung (or

lungs) decreases, meaning oxygen levels in the bloodstream can decline.

The body attempts to preserve blood flow to vital organs and decrease blood flow to

other parts of the body such as the GI tract. The effects of pneumonia are widespread

even though the infection is localized to the lung. The complications of pneumonia in the

elderly can be life-threatening, from low blood pressure and kidney failure to bacteremia,

an infection that spreads to the bloodstream.

Elderly people are more susceptible to pneumonia for several reasons. Often

they already suffer from co-morbid conditions such as heart disease, which means they

don’t tolerate infection as well as younger people. Age also causes a decrease in an

older person’s immune system response, so his defenses are weaker. Some virulent

organisms can cause infection in younger people, but the infections can be worse in

older people.

Common pathogens are Streptococcus pneumoniae. Other causes include

Haemophilus influenzae, and Streptococcus aureus.

B. (Incidence and Prevalence rate)

Incidence Rate for Pneumonia: approx 1 in 56 or 1.76% or 4.8 million people in USA

Extrapolation of Incidence Rate for Pneumonia to Countries and Regions: The

following table attempts to extrapolate the above incidence rate for Pneumonia to the

populations of various countries and regions. As discussed above, these incidence

extrapolations for Pneumonia are only estimates and may have limited relevance to the

actual incidence of Pneumonia in any region:

Country/Region Extrapolated Incidence Population Estimated Used

Pneumonia in North America (Extrapolated Statistics)

USA 5,182,154 293,655,4051

Canada 573,668 32,507,8742

Pneumonia in Europe (Extrapolated Statistics)

Austria 144,260 8,174,7622

Belgium 182,616 10,348,2762

Britain (United Kingdom) 1,063,600 60,270,708 for UK2

Czech Republic 21,991 1,0246,1782

Denmark 95,530 5,413,3922

Finland 92,020 5,214,5122

France 1,066,309 60,424,2132

Greece 187,897 10,647,5292

Germany 1,454,551 82,424,6092

Iceland 5,187 293,9662

Hungary 177,041 10,032,3752

Liechtenstein 590 33,4362

Ireland 70,051 3,969,5582

Italy 1,024,543 58,057,4772

Luxembourg 8,165 462,6902

Monaco 569 32,2702

Netherlands (Holland) 287,968 16,318,1992

Poland 681,641 38,626,3492

Portugal 185,720 10,524,1452

Spain 710,837 40,280,7802

Sweden 158,583 8,986,4002

Switzerland 131,485 7,450,8672

United Kingdom 1,063,600 60,270,7082

Wales 51,494 2,918,0002

Pneumonia in the Balkans (Extrapolated Statistics)

Albania 62,555 3,544,8082

Bosnia and Herzegovina 7,193 407,6082

Croatia 79,356 4,496,8692

Macedonia 36,001 2,040,0852

Serbia and Montenegro 191,045 10,825,9002

Pneumonia in Asia (Extrapolated Statistics)

Bangladesh 2,494,243 141,340,4762

Bhutan 38,568 2,185,5692

China 22,920,840 1,298,847,6242

East Timor 17,986 1,019,2522

Hong Kong s.a.r. 120,972 6,855,1252

India 18,795,363 1,065,070,6072

Indonesia 4,207,993 238,452,9522

Japan 2,247,052 127,333,0022

Laos 107,084 6,068,1172

Macau s.a.r. 7,857 445,2862

Malaysia 415,102 23,522,4822

Mongolia 48,552 2,751,3142

Philippines 1,521,912 86,241,6972

Papua New Guinea 95,652 5,420,2802

Vietnam 1,458,755 82,662,8002

Singapore 76,833 4,353,8932

Pakistan 2,809,347 159,196,3362

North Korea 400,545 22,697,5532

South Korea 851,184 48,233,7602

Sri Lanka 351,267 19,905,1652

Taiwan 401,467 22,749,8382

Thailand 1,144,685 64,865,5232

Pneumonia in Eastern Europe (Extrapolated Statistics)

Azerbaijan 138,853 7,868,3852

Belarus 181,950 10,310,5202

Bulgaria 132,670 7,517,9732

Estonia 23,676 1,341,6642

Georgia 82,833 4,693,8922

Kazakhstan 267,241 15,143,7042

Latvia 40,699 2,306,3062

Lithuania 63,668 3,607,8992

Romania 394,509 22,355,5512

Russia 2,540,718 143,974,0592

Slovakia 95,710 5,423,5672

Slovenia 35,496 2,011,473 2

Tajikistan 123,733 7,011,556 2

Ukraine 842,330 47,732,0792

Uzbekistan 466,066 26,410,4162

Pneumonia in Australasia and Southern Pacific (Extrapolated Statistics)

Australia 351,408 19,913,1442

New Zealand 70,479 3,993,8172

Pneumonia in the Middle East (Extrapolated Statistics)

Afghanistan 503,182 28,513,6772

Egypt 1,343,248 76,117,4212

Gaza strip 23,382 1,324,9912

Iran 1,191,233 67,503,2052

Iraq 447,788 25,374,6912

Israel 109,394 6,199,0082

Jordan 99,021 5,611,2022

Kuwait 39,839 2,257,5492

Lebanon 66,656 3,777,2182

Libya 99,380 5,631,5852

Saudi Arabia 455,222 25,795,9382

Syria 317,944 18,016,8742

Turkey 1,215,775 68,893,9182

United Arab Emirates 44,539 2,523,9152

West Bank 40,785 2,311,2042

Yemen 353,380 20,024,8672

Pneumonia in South America (Extrapolated Statistics)

Belize 4,816 272,9452

Brazil 3,248,843 184,101,1092

Chile 279,246 15,823,9572

Colombia 746,660 42,310,7752

Guatemala 252,010 14,280,5962

Mexico 1,852,228 104,959,5942

Nicaragua 94,583 5,359,7592

Paraguay 109,259 6,191,3682

Peru 486,075 27,544,3052

Puerto Rico 68,787 3,897,9602

Venezuela 441,483 25,017,3872

Pneumonia in Africa (Extrapolated Statistics)

Angola 193,739 10,978,5522

Botswana 28,927 1,639,2312

Central African Republic 66,043 3,742,4822

Chad 168,327 9,538,5442

Congo Brazzaville 52,906 2,998,0402

Congo kinshasa 1,029,124 58,317,0302

Ethiopia 1,258,880 71,336,5712

Ghana 366,300 20,757,0322

Kenya 582,037 32,982,1092

Liberia 59,834 3,390,6352

Niger 200,480 11,360,5382

Nigeria 313,241 12,5750,3562

Rwanda 145,388 8,238,6732

Senegal 191,508 10,852,1472

Sierra leone 103,833 5,883,8892

Somalia 146,551 8,304,6012

Sudan 690,849 39,148,1622

South Africa 784,384 44,448,4702

Swaziland 20,633 1,169,2412

Tanzania 636,543 36,070,7992

Uganda 465,710 26,390,2582

Zambia 194,571 11,025,6902

Zimbabwe 64,797 1,2671,8602

There are 25 million cases of pneumonia world wide are reported each year and

about 63,500 people died from the disease.

II. OBJECTIVES

General

I should be able to able to make use of the knowledge, skills, and attitude I have

built up in myself as a preparation for this clinical exposure. In the process, I should be

able to improve these three domains and motivate our patient to the road of recovery.

Specific:

Cognitive

1. Learn important information about Pneumonia; its causes, signs and

symptoms, occurrence, diagnostic tests, and treatment.

2. Know what happens to the body once this disease occurs.

3. Formulate an effective nursing care plan to relieve the problems

experienced by the patient and achieved plan goals.

4. Apply the different kinds of interventions performed.

Psychomotor

1. Assess the patient’s condition in a cephalocaudal manner noting her

general physique and patterns of functioning.

2. Perform appropriate interventions to each of the NANDA-approved

diagnoses we have formulated.

Attitude

1. Interview the patient / folks in a therapeutic manner using different means

of therapeutic communication.

2. Successfully establish trust and rapport with the patient

II. ANATOMY AND PHYSIOLOGY

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

exchange between the circulatory system and the outside world. Air is taken in via the

upper airways (the nasal cavity, pharynx and larynx) through the lower airways (trachea,

primary bronchi and bronchial tree) and into the small bronchioles and alveoli within the

lung tissue.

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.

Each alveolus has a thin membrane that allows oxygen and carbon dioxide to

pass in and out of the capillaries, the smallest of the blood vessels. When you take a

deep breath, the membrane unfolds and expands. Fresh oxygen moves into the

capillaries, and carbon dioxide passes from the capillaries into the bloodstream, where it

is carried out of the body through the lungs.

When air is inhaled through the nose or mouth, it travels down the trachea to the

bronchus, where it first enters the lung. From the bronchus, air goes through the bronchi,

into the even smaller bronchioles and lastly into the alveoli.

Pneumonia may be defined according to its location in the lung:

Lobar pneumonia occurs in one part, or lobe, of the lung.

Bronchopneumonia tends to be scattered throughout the lung.

III. VITAL INFORMATION

Name: E.A

Age: 87 years old

Sex: Female

Address: Cogon, Panitan Capiz

Civil Status: Married

Religion: Roman Catholic

Occupation: ----

Date & Time admitted: August 18, 2009 / 3:29 pm

Ward: IHM – Room 224

Chief Complaint: Cough

Impression/Admitting Diagnosis: Aspiration Pneumonia

Final Diagnosis: Aspiration Pneumonia

Attending Physician: Dr. M. Obligacion and Dr. J. Arancillo

V. CLINICAL ASSESSMENT

A. Nursing History

1 month prior to admission, the patient is (+) to CVA but it is undiagnosed.

Mrs. E.A. is (-) to HPN and (-) DM.

1 week prior to admission, E.A. was noted to have cough associated with

fever, undocumented. So she sought consult with AP given Co.amoxiclav with

relief of symptoms.

Day of admission, folks decided to have patient admitted for general

check – up.

B. Past Health Problem/Status

Mrs. E.A has no notable Illness. She sometimes experiences cough, fever

and cold. She is a Non alcoholic and Non Smoker.

C. Family History Illness

Mrs. E.A. family is (+) in Hypertension.

OBGyne HX = G10P10

VI. BRIEF SOCIAL, CULTURAL, AND RELIGIOUS BACKGROUND

Educational Background

o Mrs. E.A. is a high school graduate.

Occupational Background

o Mrs. E.A. is a housewife.

Religious Practices

o Mrs. E.A. is a Roman Catholic.

Economic Status

o Mrs. E.A. is supported by her children in her daily living.

Lung cancer

Died of Asthma

E.A87

6567 6058

5618

4154 52 40

F.A.94

LEGEND:

FEMALE

MALE

DISEASED

VII. CLINICAL INSPECTION

A. Vital Signs

V/S taken upon admission:

T – 36.1 °C P – 89 bmp RR – 18 bmp CR – 92 bmp BP–130/90mmHg

V/S taken during my care:

T – 36.5 °C P – 83 bmp RR – 21 bmp CR – 86 bmp BP – 120/80 mmHg

B. Height: 152 cm

Weight: 44 kg

BMI: 19.0

Mrs. M.L is in a Normal Weight.

C. Physical Assessment

I. General Appearance: Patient is as sleep most of the time, cannot

move freely and is not responsive.

II. Skin: Moist

Hair: There is no presence of dandruff and no presence of lice.

Nails: She had a short nails.

III. Head: normocephalic and symmetric; no lesions, lumps, tenderness.

Face: Face symmetric.

Lymphatic: no involuntary movements, symmetric facial movements.

IV. Eyes: Dirty sclera, Pale conjunctiva, Presence of cataract at the left

eye.

Ears: Auricles brown in color, symmetrical in size and position; no

lesions, tenderness, scaling, and discharge in palpation. Unable to

hear sounds distinctly.

Nose: symmetric in size and position. No lesions, tenderness, scaling,

and discharge on palpation. No nasal congestion observed.

Mouth: lips symmetrical, soft, and dry.

V. Neck and upper extremities: symmetrical, no masses or swelling.

VI. Chest, breast and axilla: symmetrical; no masses noted.

VII. Respiratory System: symmetrical chest expansion, (+) crackles both

LF, (+) rhonchi both LF.

VIII. Cardiovascular System: cardiac rate is normal and weak.

IX. Gastrointestinal system: bowel movement is regular.

X.Genitor-urinary system: she can micturate well, no pain noted.

XII. Musculoskeletal system: Unable to flex and extend both upper and

lower extremities. No tenderness or swelling on joints or bones. Good hand

grip.

D. GENERAL APPRAISAL

I. Speech: She cannot speak clearly but able to make sounds.

II. Language: Bisaya

III. Hearing: She can’t easily responds when called and claims to hear

well.

IV. Mental status: She is illogical. Cannot respond easily to verbal

command but is not experiencing any mental deficits.

V. Emotional Status: she is emotionally stable. She is currently not

grieving for anyone.

VIII. LABORATORY AND DIAGNOSTIC DATA

A. Chemistry

Fluid: serum

August 24, 2009

16:52:35

Result Normal Values Significance of the

Abnormal Result

Creatinine 28.2 62.0 – 106.0 umol/L

renal disease that

affects the

glomerular filtration

rate.

Potassium 3.10 3.50 – 5.10 mmol/L Within Normal

Range

Sodium 136.3 62.0 – 106.0 umol/L Starvation &

diabetic acidosis,

Dehydration

ALT 26

B. Hematology

Blood Exam

August 24, 2009

Result Normal Values Significance of the

Abnormal Result

WBC 3.8 4.5 – 11.0 10^ g/L Within Normal Range

RBC 4.62 M: 4-6 – 6.2 10^

12/L

F: 4.2 – 5.4 10^

12/L

Within Normal Range

Hemoglobin 135 M: 130 – 180 g/L Within Normal Range

F: 115 – 165 g/L

Hematocrit L 0.41 M: 0.40 – 0.54 vol

- fr

F: 0.37 – 0.47 vol

– fr

Within Normal Range

Mean Cell volume

(MVC)

90.0 78 – 79 fl Folate deficiency,

B12 deficiency,

Hereditary

spherocytosis

Mean cell

Hemoglobin (MCH)

29.1 27 – 32 pg Within Normal Range

Mean Cell

haemoglobin

concentration(MCHC)

32.5 30 – 35 g/dl Within Normal Range

RDW 13.2 11 – 16 % Within Normal Range

Neutrophil 50.0 50-70 % Within Normal Range

Stabs 1.0 2-3

Eosinophil 11.0 0 - 3% Infection,

Inflammation,

Leukemia, Allergic

reaction

Basophil 0.0 0 – 1 % Anaplastic anemia,

Bone marrow

depression,

Pernicious anemia,

Some infectious or

parasitic disease

Lymphocytes 29.0 20 – 45 % Within Normal Level

Monocytes 9.0 0 – 8 % Chronic Infection

C. ABG analysis

August 24, 2009 Result Normal Values Significance of the

Abnormal Result

pH 7.45 7.35 – 7.45 Within Normal Value

PCO2 41.3 35 – 45 mmHg Within Normal Value

PO2 46.0 80 – 100 mmHg Anemia &

Obstructive

Pulmonary disease

HCO2 28.3 22 – 26 mmol/L

TCO2 66.4 Mmol/L

D. X-RAY result

Bibasal pneumonia with consolidation with minimal regression in the Right.

Right upper lobe Pneumonia, no significant interval change

Atheromatons & Tortuous aorta

Bronhiectasis, both lung bases

Dextroscooliosis, thoracic spine

IX. PATHOPHYSIOLOGY

Liquid or object enters the respiratory system through inhalation of microorganism

(Infectious Process)

Infection occurs

Immune reaction follows

Under the infection and immune response inflammation process

proceeded.

Vasoconstriction

Release of chemical mediators

Vasodilatation and increase capillary permeability

Increase blood pressure then formation of heat and redness to the site

Swelling and pain emerges then led to loss of tissue functions

Increase in localCapillary leaks

Increased permeability of cell members allowing leukocytes and fibrin to

consolidate in involved areas

fibrin and leukocytes stiffen there will be a decrease in lung compliance & decrease lung vital capacity which decreases gas

exchange that leads to hypoxemia

Hypoxia

Triggers the compensatory mechanism

ASPIRATION PNEUMONIA

XI. NURSING MANAGEMENT

A. Concept Map of Nursing Problems

Impaired Gas Exchange

S/Sx: TachycardiaRestlessnessDyspneaHypoxia

Therapy: O2 therapy, 2 liters.

Activity Intolerance

S/Sx: LethargyVerbal reports of weaknessFatigueExhaustion

Meds & Therapy: ZantacRehab /

Exercise therapy.

Ineffective Airway Clearance

S/Sx: Inability to cough effectivelyAnxietyDyspneaDry cough

Meds: MetronidazoleFluimucilCelebrex

Risk for less than body requirements

S/Sx: - Starvation- Diabetic acidosis- Dehydration

Meds & Diet: OTF (1,500 kilocalories / day ÷ 6 feedings). Macrobee with Iron

CC: CoughDx: Aspiration

Pneumonia

XII. DISCHARGE PLANNING

M (MEDICATION)

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.

E (EXERCISE & ACTIVITY)

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

full recovery and to avoid relapse.

Instruct the folks to monitor the client’s position, she must be in moderate

high back rest and change position every two hours.

T (TREATMENT)

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

blood when needed.

Treatment is one of the main factors in restoration of health and curing of the

failure in the body system. Treatments are given to the patient for a specific time

until treatment is not more needed by the patient.

H (HOME TEACHING IN REACTION TO DISEASE, ETIOLOGY & HYGIENE

MEASURES)

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

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

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

can help reduce the risk.

Tell folks 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.

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.

O (OUT PATIENT FOLLOW – UP)

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.

D (DIET)

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

dehydrated and help loosen mucus in the lungs.

Controlled diets are designed to avoid excessive sodium retention.

S (SPIRITUALITY)

Advise the patient to join the church activities. Keeping faith in God and believing

in him can uplift some distress.

XIV. MY JOURNEY

Being a third year student taking up Nursing is challenging, nerve breaking, head

cracking, interesting, and exhausting. But being a Nurse is somewhat opposite, because

every single intervention you do is remarkable and very accommodating to your patient. I

am a future Nurse and I admit that I’ve been devoted in rendering care to my patient until

such time that she recovers from her illness.

Mrs E.A is an 87 years old woman. She’s from Cogon, Panitan Capiz and has

been admitted in the Immaculate Heart of Mary (IHM) last August 18, 2009 at around

3:20 pm, with the Chief Complaint of Cough & with the Diagnosis of Aspiration

Pneumonia. She has a Nasogastric Tube Feeding (NGT) and Oxygen Saturation of 2

liters.

I always check her IVF (PNSS 1L x 80 cc/hour) every hour to be sure that it is not

delayed or advanced. I follow up her IVF when it was consumed. Her vital signs are

monitored every hour and her Intake & Output is monitored Q shift. I assist her in her

OTF (1,500 kilocalories / day ÷ 6 feedings). I always see to it that her medications are

given at the right time to prevent complications. I assist her in her morning care and oral

care every morning. I also changed her linens and assist her in combing her hair.

It feels so great to know that you did something right and good to your patient.

When you will ask me, “What is good in being a nurse?” I would answer this way, being

a Nurse is AWESOME because I know that I am one of God’s instruments to save

people and help the poor in my own dearest way. I believe that being a Nurse is not

merely a job or a chosen career. It is a Responsibility, Commitment, Destiny and it’s your

Calling from up above. To tell you frankly, those are part of the things that motivates me

for doing the best that I can do as a STUDENT NURSE.

XIV.BIBLIOGRAPHY / REFERENCES

- Nursing Care Plan (Guideline for individualizing Client Care

across the life span).

- Nurse’s Pocket Guide

- Nurse’s Manual of Laboratory Tests and Diagnostic Procedures

- Fundamentals of Nursing

- 2009 Lippincott’s Drug Guide

- MIMS

- www. Yahoo.com

- www. Google.com

- www. Wekipedia.com