.

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

This is a case study of 24 yrars old man with the diagnosis of lobar pneumonia who walked into the
hospital ; Adeoyo maternity teaching hospital, via casualty department accompanied by his parents on
account of general weakness of the body, cough which started 4 to 5 days ago . He was then admitted
into the casualty male ward, accompanied by the nurse on duty at the casualty department and assisted
by a student nurse. On assessment, patient was mild pale, nil pedal edema but weak and restless. He
was reviewed by the doctor and diagnosed of lobar pneumonia. The vital signs on admission read thus;
temperature : 36.7c, pulse :85b/m, respiration : 28c/m, Blood pressure : 100/60mmhg

He was made comfortable at the male ward by the nurse on duty.

Lobar pneumonia is a form of pneumonia characterized by inflammatory exudate within the intra-
alveolar space resulting in consolidation that affects a large and continuous area of the lobe of a lung.
Reference: E., Weinberger, Steven (2019). Principles of pulmonary medicine. Cockrill, Barbara A.,,
Mandel, Jess,, Preceded by : Weinberger, Steven E. (Seventy ed.). Philadelphia, PA. ISBN
9780323523738. OCLC 1020498796.

Pneumonia is a leading cause of death and hospitalization, costing health care systems billions of dollars
and an estimated 600,000 adult deaths worldwide each year. Pneumococcal disease is caused by the
bacterium Streptococcus pneumoniae and the term describes a group of illnesses, including invasive
infections, such as bacteremia/sepsis and meningitis, as well as pneumonia and upper respiratory tract
infections. Although all age groups may be affected, the highest rate of pneumococcal disease occurs in
young children and older adults. In addition, persons suffering from a wide range of chronic conditions
(eg, diabetes, cardiovascular disease) and immune deficiencies are at increased risk.

Pneumonia is an acute infection of the lungs that produces coughing, fever, chills, muscle aches, and
difficulty breathing in those who suffer from it.

The pneumonic infection has been noted throughout human history, with mentions of the disease
appearing during early Greek civilization. However, despite our long history with the disease, pneumonia
remains a serious medical concern throughout the global community today, with millions of cases of
pneumonia-related hospitalizations and deaths worldwide.

Each year, over 1.5 million children die of pneumonia, mostly within developing nations. Increasing our
understanding of both the primary causative agent, lobar pneumonia, and how we as a society have
handled the management and treatment of pneumonia on a global scale may help us to increase access
and efficiency of treatment options and to someday severely reduce the detrimental effects of the
disease.

1.2 Reasons for choosing this patient

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 The reasons for choosing this patient are to:

1. know basically the reason why lobar pneumonia leads to the Signs and symptoms
presented by the patient

2. To promotes the health status of the patient

3. see improvement in the patient after my nursing care at the need of the treatment.

4. To assess the causes of lobar pneumonia

5. ensure proper follow up in managing the patient

1.3 Objectives of the study

The objectives of the care study are to:

1. Acquire more knowledge about the cause, treatment, and prevention of lobar
pneumonia

2. To maintain a good nurse patient relationship

3. Determine adequate and effective care to the patient

4. Identify the measures taken in control of lobar pneumonia

5. Enlighten and health educates patient family on the disease condition.

1.4 Philosophy of care study

My main perspective is studying the patient, knowing the basic fact about the patient,
to have a better understanding about the nature of the illness, to have a better understanding
about the reoccurrence symptoms of lobar pneumonia, and to care for the patient till he
restore back to health state of health

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 CHAPTER TWO

INTRODUCTION

According to WHO, Lobar pneumonia is a form of pneumonia characterized by inflammatory

exudate within the intra-alveolar space resulting in consolidation that affects a large and
continuous area of the lobe of a lung.

according to Kumar V, Abbas A, Fausto N. Robbins and Cotran pathologic basis of the disease. 9.
Philadelphia: Elsevier Saunders; 2020. [Google Scholar]

Pneumonia remains one of the most frequent death causes worldwide. Among the etiological
factors S. pneumoniae-causing lobar pneumonia plays a leading role. According to current
textbook knowledge at least three sequential stages of lobar pneumonia are distinguished:
congestion, red hepatization and gray hepatization. However, there are no detailed data
supporting this stage concept. There are also controversial views on its etiology. In this study,
the lung changes in lobar pneumonia were related to the cause and duration of the disease. In
addition, the complications of the disease were evaluated.

Lobar pneumonia was analyzed in 252 post mortem cases examined in a large hospital in
Irkutsk. The pathology, etiology of pneumonia, course of disease and cause of death were
recorded and correlated to its clinical course and duration. In the second part of the study, the
results in 95 patients were analyzed in detail and related to PCR findings.

Most patients were adult men of low social status who showed signs of severe alcoholism.
Lobar pneumonia was observed in 85% of the patients, while the remaining patients showed
sublobar (“lobular”, focal) lung involvement. Histologically, three patterns of inflammation were
observed, which in most patients occurred concurrently in different parts of the involved lobe:
“congestion”, characterized by serous exudation with multiple cocci (41% of cases), “red
hepatization” (41% of cases) and “gray hepatization” (100% of cases). The latter pattern was
subdivided into three subgroups according to the ratio of fibrin—neutrophils and the presence
of macrophages. The mean number of different histological patterns observed per patient was
3.8. There was no correlation between the inflammatory patterns and the duration of the
disease. In 23% of the patients, the cause of death was of pulmonary origin, while the
remaining patients died of extrapulmonary complications (i.e. acute heart failure 26%, acute
vascular insufficiency 15% purulent meningitis 11–24.3%. In 29/95 patients (20 with lobar and 9
with focal pneumonia) pneumococcal etiology of pneumonia was established by PCR.

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Lobar pneumonia is a distinct clinico-pathological entity caused by S. pneumoniae,
demonstrated by PCR testing and/or cytological examinations. Bacteriologic studies frequently
give falsenegative results. Lobar pneumonia is characterized by three main histopathological
patterns (congestion or microbeous edema, and red and gray hepatization) which usually occur
side by side and not in chronological order.

2.1 Definition of the disease condition

Lobar pneumonia is a type of pneumonia characterized by the infection and inflammation of

one or more lobes of the lung.

2.2 Causes of lobar pneumonia

1. Bacteria

2. Viruses

3. Fungi

BACTERIAL PNEUMONIA

This is caused by various bacteria. The streptococcus pneumoniae is the most common
bacterium that causes bacterial pneumonia.

Many other bacteria may cause bacterial pneumonia including:

Group B streptococcus

Staphylococcus aureus

Group A streptococcus

Bacterial pneumonia may have a quick onset and the following symptoms may occur:

Productive cough

Pain in the chest

Vomiting or diarrhea

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Decrease in appetite

Fatigue

2.3 predisposing factors of lobar pneumonia

1. Older adults

2. Alcoholism

3. People with weakened immune system or other health conditions ..

4. Infants.

5. Babies who were born prematurely or have other health conditions.

2.4 Types of lobar pneumonia

2.4.1 Upper lobe L.pneumonia