PNEUMONIA

A Case Study

Presented to

Sophia Nicole Ugto, RN

Clinical Instructor

In Partial Fulfillment

Of the Requirements for the

Care of Clients with problems in oxygenation, fluid & electrolyte, infectious, inflammatory and

immunologic response, cellular aberration, acute and chronic I RLE

by

Group IV

2024

i
 I

INTRODUCTION

DEFINITION

According to the World Health Organization (WHO), Pneumonia is a form of acute

respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli,

which fill with air when a healthy person breathes. When an individual has pneumonia, the

alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.

CASE REPORT

Mrs R. is a 73 y/o female and has been feeling increasingly unwell for the past week.

What started as a mild cough has escalated into severe chest pain and difficulty breathing. She

also has a high fever and has become very fatigued, often unable to get out of bed. Concerned,

she was taken to the hospital. Upon arrival, Mrs. R is immediately admitted to the emergency

room. The doctors conducted a thorough examination and diagnosed her with pneumonia. They

note the following clinical manifestations: Cough: has become persistent and productive, with

yellowish-green mucus. Vital Signs: She has a high-grade fever, reaching up to 102°F (38.9°C),

which hasn't responded well to over-the-counter medications. She also exhibits an elevated pulse

rate of 109 bpm and a respiratory rate of 27 cpm with a low oxygen saturation pulse showing

88% in pulse oximeter. Pleuritic Chest Pain: She complains of sharp chest pain, particularly

when breathing deeply or coughing. Shortness of Breath: Mrs. Thompson is noticeably

struggling to breathe, with rapid, shallow breaths. Fatigue and Lethargy: She appears extremely

tired and weak, unable to perform even basic daily activities. Laboratory Results: It revealed an

1
elevated CO2, and an elevated WBC of 12000/mm3. Due to her age and underlying health

conditions, including mild heart disease and diabetes, the medical team decides to closely

monitor her for any complications.

II

DISEASE PROCESS

PATHOPHYSIOLOGY

Infection. Pneumonia is usually caused by bacteria, viruses, and fungi. These pathogens

enter the lungs through inhalation or aspiration of contaminated substances.

Inflammatory Response. The presence of these pathogens triggers an immune response

in the lungs. Leukocytes called neutrophils migrate directly to the site of infection to combat the

invading microorganisms.

Alveolar Consolidation. As the infection progresses, the air sacs (alveoli) in the affected

area become filled with fluid, pus, and cellular debris. This leads to consolidation, where the

normally air-filled alveoli become solid and unable to function effectively in gas exchange.

Impaired Gas Exchange. The accumulation of fluid and inflammatory cells in the

alveoli interferes with the exchange of oxygen and carbon dioxide. This can result in symptoms

such as difficulty breathing, coughing, and decreased oxygen levels in the blood.

Risk Factors. Infants, elderly, and immunocompromised persons are at higher risk for

acquiring pneumonia due to their depressed or weak immune systems and high susceptibility due

to other conditions which include cardiopulmonary diseases and/or diabetes.

2
CLINICAL MANIFESTATIONS

Pneumonia may exhibit… The patient exhibit

Altered Mental Status; Restlessness, ✔

Agitation, Confusion, Lethargy especially in
elderly patient

Fever (>100.4 F/ 38C) ✔

Productive cough “yellow sputum” ✔

Fine or Course Crackles ✔

Dyspnea “Shortness of Breath ✔

Pleuritic Chest Pain ✔

Oxygen Saturation less than 90% ✔

Nausea and Vomiting

Elevated lab results; CO2, WBC ✔

Increased RR, HR ✔

Fatigue ✔

Cyanosis

DIAGNOSTIC PROCEDURES

Clinical Evaluation:

Medical History. The physician will ask about symptoms such as cough, fever, chest

pain, and difficulty breathing. They will also inquire about recent respiratory infections, travel

history, and exposure to sick individuals.

Physical Examination. The healthcare provider will listen to the lungs using a

stethoscope to check for abnormal breath sounds such as crackles or decreased breath sounds,

which can indicate areas of consolidation or fluid in the lungs.

3
· Imaging Studies:

Chest X-ray. This is often the first-line imaging study used to diagnose pneumonia. It

can reveal areas of consolidation or opacity in the lungs, which are indicative of infection. Chest

X-rays can help differentiate between bacterial and viral pneumonia and assess the extent and

location of lung involvement.

CT Scan. In some cases, when the diagnosis is unclear from a chest X-ray or if

complications are suspected, a CT scan of the chest may be performed. CT scans provide more

detailed images and can detect smaller areas of infection or complications such as lung

abscesses.

· Laboratory Tests:

Sputum Culture and Gram Stain. Patient is producing sputum, a sample may be

collected and sent to a laboratory for culture and sensitivity testing.

Blood Tests. A complete blood count (CBC) and a basic metabolic panel (BMP) may be

done to assess white blood cell count, inflammatory markers, and electrolyte levels. These tests

can provide information about the severity of infection and help monitor response to treatment.

· Other Tests:

Bronchoscopy. In some cases, especially when the diagnosis is uncertain or if there are

complications, a bronchoscopy may be performed to obtain samples for culture and to visualize

the airways.

4
COMPLICATIONS

In severe cases, pneumonia can lead to sepsis, where the infection spreads throughout the

body via the bloodstream. Other acute and/or chronic complications include emphysema, lung

abscesses, acute respiratory distress syndrome, pleural effusion, and damage to the kidney,

heart, and liver.

III

NURSING MANAGEMENT

Independent Nursing Intervention

Vital signs. Assess respiratory rate, depth,and ease. Monitor body temperature, heart rate

and rhythm, and oxygen saturation using pulse oximetry.

Skin color. Observe color of skin, mucous membranes, and nailbeds, noting presence of

peripheral cyanosis, or central cyanosis.

Mental status. Assess mental status, noting presence of restlessness, irritation, and

confusion.

Comfort Measures. Assist the patient with comfort measures to reduce fever and chills,

such as addition or removal of bedcovers, comfortable room temperature, and tepid sponge bath.

Bedrest. Maintain bedrest, promote use of relaxation techniques and diversional

activities to prevent exhaustion and reduce oxygen consumption and demands to facilitate

resolution of infection.

Positioning. Assist the patient to assume upright semi-fowlers/high-fowler's position and

encourage frequent position changes, if able, in addition to deep breathing, and effective

coughing for maximal inspiration and improve ventilation.

5
 Hydration. Provide adequate fluid intake to maintain fluid balance in the body which can

foster quick recovery and decrease risk of complications, if the patient does not have renal

failure.

Visitors. Arrange and limit the visit with significant others only, as indicated to reduce

exposure to other infectious pathogens.

Dependent Nursing Intervention

Doctor’s order. Administer medications as ordered by the physician in reducing the

signs and symptoms of the disease process.

Collaborative Nursing Intervention

Medical Technologist. Collaborate with the medical technologist to monitor CBC,noting

the level of WBC and identify any improvement of disease process.

Respiratory Therapist. Collaborate with the respiratory therapist to monitor ABGs

level, to identify problems such as ventilatory failure, and progress and improvement of disease

process.

Educative Nursing Intervention

Spirometry. Demonstrate the use of an incentive spirometer, noting the importance of it

to improve lung function.

Verbalization. Advice the patient to verbalize concerns and feelings and answer the

questions honestly to promote reassurance and sense of security.

6
 Rest. Educate the patient and their family in the importance of rest in treatment plan and

necessity for balancing activities with rest.

Medications. Educate the patient and their family regarding the disease and the

importance of adherence to medications as ordered.

IV

MEDICAL MANAGEMENT

· Antibiotic Therapy:

Empirical Treatment: Antibiotics are typically started empirically based on the likely

causative organism and severity of illness. Community-acquired pneumonia (CAP), is usually

treated with ceftriaxone and azithromycin. Hospital-acquired pneumonia (HAP) on the other

hand, is treated with broad spectrum antibiotics like vancomycin.

Targeted Treatment: Once microbiological testing identifies the specific pathogen and

its antibiotic susceptibility, the antibiotic regimen may be adjusted to target the identified

organism effectively.

· Supportive Care:

Oxygen Therapy. Patients with pneumonia may require supplemental oxygen to

maintain adequate oxygenation, especially if there is respiratory distress or low oxygen levels.

Pain Management. Analgesics may be prescribed to alleviate chest pain associated with

pneumonia.

7
· Respiratory Support:

Ventilatory Support. In severe cases of pneumonia, particularly in patients with

respiratory failure, mechanical ventilation may be necessary to support breathing until the

infection resolves and lung function improves.

GROUP MEMBERS

1. GALZOTE, Roemelyn

2. GONDAYAO, Franz Ronniell M.

3. JACOB, Jamille Anne

4. LOYOLA, Nicka Eriel