89430161 case-study

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Republic of The Philippines
University of Northern Philippines
Tamag, Vigan City
College of Nursing
PNEUMONIA
In partial fulfillment of the requirements in
Nursing Care Management
(RLE)
Presented to:

Ms. Joanne Jaramillo
Clinical Instructor
Presented by:
Chezka Marie Palola
BSN III Bromeliads
July 27, 2011
TABLE OF CONTENTS
I. Introduction
a. Disease Process
b. History of Past Illness
c. History of Present Illness
II. Objectives
a. Student centered
b. Patient Centered
III. Patient’s Profile
IV. System by system Assessment
V. Diagnostic
a. Ideal
b. Actual
VI. Anatomy of the Organ Involved
VII. Pathophysiology/ Algorithm
VIII. Medical Management
a. Ideal
b. Actual

IX. Nursing Care Plan
X. Drug Study
XI. Discharge Plan
XII. Updates
XIII. Consent Form

I. INTRODUCTION
A. Pneumonia is 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 a
weakened immune system. This makes it easier for bacteria to grow in their
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.
Disease Process Leading to Pneumonia
Pneumonia-causing agents reach the lungs through different routes:
 In most cases, a person breathes in the infectious organism, which then
travels through the airways to the lungs.
 Sometimes, the normally harmless bacteria in the mouth, or on items placed
in the mouth, can enter the lungs. This usually happens if the body's "gag
reflex," an extreme throat contraction that keeps substances out of the
lungs, is not working properly.
 Infections can spread through the bloodstream from other organs to the
lungs.
However, in normal situations, the airways protect the lungs from substances that
can cause infection.
 The nose filters out large particles.
 If smaller particles pass through, sensors along the airway prompt a cough or
sneeze. This forces many particles back out of the body.
 Tiny particles that reach the small tubes in the lungs (bronchioles) are
trapped in a thick, sticky substance called mucus. The mucus and particles are
pushed up and out of the lungs by tiny hair-like cells called cilia, which beat
like a drum. This action is called the "mucociliary escalator."
 If bacteria or other infectious organisms manage to avoid the airway's
defenses, the body's immune system attacks them. Large white blood cells
called macrophages destroy the foreign particles.
Signs and Symptoms
 Have a high fever
 Have shaking chills
 Have a cough with phlegm (a slimy substance), which doesn't improve or
worsens
 Develop shortness of breath with normal daily activities

 Have chest pain when you breathe or cough
 Feel suddenly worse after a cold or the flu
People who have pneumonia may have other symptoms, including nausea (feeling
sick to the stomach), vomiting, and diarrhea.
Symptoms may vary in certain populations. Newborns and infants may not show
any signs of the infection. Or, they may vomit, have a fever and cough, or
appear restless, sick, or tired and without energy.
Older adults and people who have serious illnesses or weak immune systems may
have fewer and milder symptoms. They may even have a lower than normal
temperature. If they already have a lung disease, it may get worse. Older adults
who have pneumonia sometimes have sudden changes in mental awareness.
Complications of Pneumonia
 Bacteremia (bak-ter-E-me-ah). This serious complication occurs if the
infection moves into your bloodstream. From there, it can quickly spread
to other organs, including your brain.
 Lung abscesses. An abscess occurs if pus forms in a cavity in the lung. An
abscess usually is treated with antibiotics. Sometimes surgery or drainage
with a needle is needed to remove the pus.
 Pleural effusion. Pneumonia may cause fluid to build up in the pleural
space. This is a very thin space between two layers of tissue that line the
lungs and the chest cavity. Pneumonia can cause the fluid to become
infected—a condition called empyema (em-pi-E-ma). If this happens, you
may need to have the fluid drained through a chest tube or removed with
surgery.
Management:
The treatment of pneumonia includes appropriate administration of the appropriate
antibiotic.
Management of Community Acquired Pneumonia includes blood cultures performed
quickly for identification of the casual pathogen and prompt administration of
antibiotics. Inpatients should be switched from intravenous to oral therapy when they
are hemodynamically stable, are improving clinically, are able to take medications/fluid by
mouth and have a normally functioning gastrointestinal tract. Hydration is necessary
part of therapy, because fever and tachypnea may result in insensible fluid losses.
Antipyretic may be used to treat headache and fever; antitussive medications may be
used for the associated cough. Warm, moist inhalations are helpful in relieving bronchial
irritation. Antihistamine may provide benefit with reducing sneezing and rhinorrhea.
Position patient with head on mid line, with slight flexion to provide patent,
unobstructed, airway, maximum lung excursion. Auscultate patient’s chest to monitor
for the presence of abnormal breath sounds. Provide chest and back clapping with
vibrationbecause chest physiotherapy facilitates the loosening of secretions. Bed rest is
also included for the management of pneumonia.

B. History Of Past Illness:
Patient X has been hospitalized last May 2011, because he underwent surgery
due to the replacement of his left pelvis at Gabriela Silang General Hospital.
He had been hospitalized also at the same institution last June 1, 2011 and
has been diagnosed with Pneumonia. The patient has no history of asthma,
diabetes mellitus or hypertension. He has no allergies to any foods or
medications. The patient had a fracture on his spinal bone and had worn a
brace before to support and correct the injury. He has been a bed ridden
patient after his surgery last May 2011. He has also an arthritis and
osteoporosis as stated by his wife.
C. History of Present Illness
3 weeks prior to admission, the pt. was hospitalized with the same
diagnosis. He had difficulty of breathing, pallor on nail beds, incoherent and
has an slurred speech. During inspiration, using of accessory muscle was noted.
He was admitted on June 21, 2011. He was examined by Dr. Tobias and
ordered to undergo different laboratory examinations related to his
conditions. At present, the pt. is bed ridden, has an activity intolerance r/t
general body weakness. He has been oxygenated via nasal cannula regulated at
1-2L/min. He is recovering and responding well to nursing care.

II. PATIENT’S PROFILE
Name: Patient X
Age: 72 years old
Date of Birth: July 7, 1938
Gender: Male
Address: Padu Grande, Sto. Domingo, Ilocos Sur
Civil status: Married
Nationality: Filipino
Religion: Roman Catholic
Date of Admission: June 6, 2011
Time of Admission: 7:00 pm
Room: Medical Room
Date of Discharge: June 27, 2011
Admitting Physician: Dr. Tobias
Attending Physician:Dra. Guerrero
Final Diagnosis: Pneumonia
Admitting Agency:Magsingal District Hospital

III. OBJECTIVES
Student-centered:
 To define what is pneumonia
 To trace the pathophysiology of pneumonia
 To enumerate the different signs and symptoms of pneumonia
 To formulate and apply nursing care plans utilizing the nursing process
 To learn clinical skills and sharpen our current skills required in the
management of the patient with pneumonia
 To develop our unselfish love and empathy in rendering nursing care to our
patient
Patient – centered:
 To assist patient with proper nutrition providing information about a
healthy lifestyle
 To provide information about Pneumonia and other underlying illness
 To improve the family coping process that plays an important role in the
patient’s recovery
 To impart a health teachings, the prevention and treatment
 To encourage patient to avoid factors that can aggravate the disease and
maintain a healthy habits
 To provide nursing care about the disease, Pneumonia
 To impart knowledge related to patient’s disease
 To be able for patient to have self-conceptualization
 To determine the physiological needs necessary for the patient during the
disease process

V. SYSTEM BY SYSTEM ASSESSEMENT
1. Psychological Status
The patient is Mr. Castro Taasan Alcantara,72 year old, male. Born on
July 7,1938 residing in a bungalow house located at Padu Grande, Sto.Domingo,
Ilocos Sur. Baptized as a Roman Catholic. He is living in their house together
with her wife and 2 children. He had 7 children. Almost all of them are
professional now and do have a job. He was a radio commentator for how many
years and had been work also as an planner in Provincial Capitol. He was also a
farmer, because they own a little farm in their place. He also work as a
fisherman. He was a persevering and hardworking father to his family.
He loves to travel and work for his family. He always do everything for his
family in order for them to have a good life.
2.Mental and Emotional Status
The patient is conscious and incoherent. He had a slurred speech. He is
oriented that he was in the hospital accompanied by his wife and son. He has a
bit of dementia due to old age.
He can still comprehend a bit of some conversation. An example of which
is that he smiles at his wife’s joke or when I give jokes to him.
He is sometimes irritable when he wants to urinate. He always play on
the sensitive part of his body. Most of the time, he is so silent, thinking so
deeply.
He is not taking any drugs that can affect his consciousness aside from
side effects of drug he is taking like headache. He was been hospitalized 3 weeks
PTA with the same diagnosis and due to difficulty of breathing.
3. Environmental Status
The patient is 72 year old and is awake. He cannot ambulate because he
undergone surgery, replacement of Left pelvic replacement last May 2011.He is
fragile and generally appears weak. He is confined at Magsingal District Hospital
in Medical Room which is well ventilated and well conducive for recovery. His
room is a conducive place for healing process because everything is accessible, his
bed is near to the comfort room, he has a urinal basin at the side of his bed
every time he wants to void. He has a wall fan that makes the room well
ventilated.
There is a ready Oxygen Tank and nasal cannula for him to used when he
feels difficulty of breathing. His room is near the nurse station so that if they
need a help the nurse would immediately guide them.
The patient cannot hear clearly and sees well. He has a slurred speech.

4. Sensory Status
The patient’s eyes are equally round and reactive to light and
accommodation. Both pupils dilate to its normal size of 3mm. He cannot read
without an eyeglasses and cannot see clearly due to aging.
He is able to distinguish voice but in a louder sound. He has a poor
appetite. He only eat a cup of oatmeal, which means he cannot tolerate nor has
a good taste to other foods. He has a dry mucosa and cracking lips and some
decayed teeth.
He speaks slowly and slurring. He has also an osteoporosis and has a
fracture on his spinal bone.
5. Motor Status
The patient is a bed ridden because of the replacement of his left pelvis.
He cannot ambulate and had a difficulty in moving from side to side. He is weak
and unable to get up by him alone. He has poor muscle strength. He cannot flex
his legs but he can twist his hands.
He had a past injury on his spinal bone. He had used a supportive device
that helped treat the fracture on his spinal bone.
6. Nutritional Status
The patient is about 5’2” tall and weighs around 55kgs, appears weak and
fragile.
He has a poor appetite. Only eats a one cup of oatmeal and drinks at least 3
glasses of water every day.
He has no religious food restriction when it comes to intake of foods. He
has no allergies to food or medication. He has a dry oral mucosa and cracking
lips. The patient is conscious and able to swallow. Has an insufficient intake and
output required for his body’s nutrition.
Has an IVF of D5lR regulated to 41-42 drops per minute.
7. Elimination Status
The patient urinates at least thrice with a small amount for an 8 hour
shift. He also has the feeling to urinate but every time her wife give the urinal
basin, there’s no urine accumulating the basin.
His bowel movement is not regular, it’s not daily as said by his wife. He
has a urinal basin on his bedside ready to use when he wants to void.
8. Fluid and Electrolyte
The patient has an intake of 200-250 mL of fluids per shift. He only
drinks water. His output ranges from 200 per shift. He received D5LR 1000cc
regulated to 41-42 drops per minute.
He ask water from his wife when he is thirsty. He has a poor hydration
status manifested by dry oral mucosa. Capillary refill is 1-2 sec. and skin is warm
to touch.

9. Circulatory Status
The patient was diagnosed with Pneumonia and has a chest x-ray findings
of cardiomegaly and atheromatous aorta.
He has a pulse rate of 94 bpm.He has a respiration rate of 26 cpm. His
blood pressure is 130/80 mmHg, stable until end of the shift.
10. Temperature status
The patient wears a sando and boxer shorts. His temperature is 36 degree
Celsius. His skin is warm to touch. His room is well ventilated.
11. Respiratory Status
The patient was admitted due to difficulty of breathing. During
inspiration, using of accessory muscle was noted. The pt.’s nail beds are pallor
and have a slurred speech. He has been oxygenated via nasal cannula regulated at
1-2L/min.
Due to activity intolerance because the pt. was bed ridden; he had further
complications of a cardiomegaly and atheromatous aorta. The blood circulation
has not been working well to his body.
12. Integumentary Status
The patient skin is fair in color and already has wrinkles due to aging. He
has a muscle wasting due to old age. He has a good skin turgor and is warm to
touch. There are scars present on the different site in his body. He has a bald
hair. Clubbing of fingers noted at times.
He has a poor hydration manifested by dry oral mucosa and cracking lips.
He has a dry skin at his back due to prolonged bed ridden.
13. Comfort and Rest Status
The patient sleeps often times and sleeps about 8-10 hours. No
medications altering his comfort. No pain noted during the shift. A discomfort is
felt by the patient every time he urinates. He appears weak and emaciated.

V. DIAGNOSTICS
A. Ideal
 Chest X-ray
How the Test is Performed: The test is performed in a hospital radiology
department or in the health care provider's office by an x-ray technician. Two
views are usually taken: one in which the x-rays pass through the chest from
the back (posterior-anterior view), and one in which the x-rays pass through the
chest from one side to the other (lateralview). You stand in front of the
machine and must hold your breath when the x-ray is taken.
How to Prepare for the Test: Inform the health care provider if you are
pregnant.. You must wear a hospital gown and remove all jewelry.
Why the Test is Performed: if you have any of the following symptoms:
 A persistent cough
 Chest injury
 Chest pain
 Coughing up blood
 Difficulty breathing
What Abnormal Results Mean; Abnormal results may be due to may things,
including the following.
In the lungs:
 Collapsed lung
 Collection of fluid around the lung
 Lung cancer
 Lung tumor
 Malformation of the blood vessels
 Pneumonia
 Scarring of lung tissue
 Tuberculosis
In the heart:
 Problems with the size or shape of the heart determined
 Problems with the position and shape of the large arteries
In the bones:
 Fractures of ribs and spine
 Osteoporosis

 Blood Culture
How is it used?:Blood cultures are used to detect the presence
of bacteria or yeasts in the blood, to identify the microorganism(s) present, and
to guide treatment. Two or more blood cultures are typically ordered and
collected as consecutive samples. Often, acomplete blood count (CBC) is ordered
along with or prior to the blood culture to determine whether the person has
an increased number of white blood cells, indicating a potential infection.
A doctor may order blood cultures when a person is having symptoms of sepsis.
A person with sepsis may have:
 Chills, fever Nausea
 Rapid breathing, rapid heartbeat Confusion
 Decreased urine output
What does the test result mean?:If blood cultures are positive, it most likely
means that the tested person has a bacterial or yeast bloodstream infection
that needs to be treated immediately, usually in a hospital. Sepsis can be life-
threatening, especially in immunocompromised patients.
 Complete Blood Count
A complete blood count (CBC) is a series of tests used to evaluate the
composition and concentration of the cellular components of blood.
It measures the following:
 The number of red blood cells (RBCs)
 The number of white blood cells (WBCs)
 The total amount of hemoglobin in the blood
 The fraction of the blood composed of red blood cells (hematocrit)
The platelet count is also usually included in the CBC.
Purpose:
 as a preoperative test to ensure both adequate oxygen carrying capacity and
hemostasis
 to identify persons who may have an infection
 to diagnose anemia
 to identify acute and chronic illness, bleeding tendencies, and white blood cell
disorders such as leukemia
 to monitor treatment for anemia and other blood diseases
 to determine the effects of chemotherapy and radiation therapy on blood cell
production
Hemoglobin 140 – 170 g/L
Hematocrit 0.40 – 0.54
WBC 4.1 – 10.9 x103
/uL
Platelet Count 150,000 – 450,000/cmm
RBC F: 4.2 – 5.4 miilion/ uL M:4.6 –
6.4 mil/uL

b. Actual
Complete Blood Count: June 26, 2011
Blood Components Normal Values Interpretation
Hemoglobin 120 140 -170g/L NORMAL
Hematocrit 0.40 0.40 – 0.54 NORMAL
Complete Blood Count: June 22, 2011
Blood Components Normal Values Interpretation
Hemoglobin: 76 140 – 170 g/L Low level of hgb indicates
anemia
Hematocrit: 0.24 0.40 – 0. 54 Decreased in hgb level
WBC: 10.1 4.1 – 10.9 x103
/uL NORMAL
Neutrophils: 0.82 0.45 – 0.73 Slightly elevated: due to
acute infection in LRT
c/b streptococcus
pneumoniae and bone
marrow suppression d/t
elevated hgb level
Lymphocytes: 0.18 0.20 – 0.40 Decreased due to
Increased neutrophils
Chest X-ray
Impression:
Cardiomegaly
Atheromatous Aorta
Osteoporosis

VI. ANATOMY OF THE SYSTEM INVOLVED
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.
Complications of Pneumonia
 Bacteremia (bak-ter-E-me-ah). This serious complication occurs if the infection
moves into your bloodstream. From there, it can quickly spread to other organs,
including your brain.
 Lung abscesses. An abscess occurs if pus forms in a cavity in the lung. An abscess
usually is treated with antibiotics. Sometimes surgery or drainage with a needle
is needed to remove the pus.
 Pleural effusion. Pneumonia may cause fluid to build up in the pleural space. This
is a very thin space between two layers of tissue that line the lungs and the
chest cavity. Pneumonia can cause the fluid to become infected—a condition
called empyema (em-pi-E-ma). If this happens, you may need to have the fluid
drained through a chest tube or removed with surgery.

VII. Pathophysiology/ Algorithm
Causes/Risk Factor
(Bacteria)
Inhalation of droplets
Aspirate secretions
from upper airways
Inflammatory reaction
Produces Exudates
Difficulty of Breathing
Interferes diffusion of
02 & CO2
Tachypnea
Ineffective airway
clearance
Hematogenous or
lymphatic dissemination
Bone marrow suppression
Decreased leukocytes
Increased hemoglobin level
Increased neutrophils
Fatigue/ Generalize Body
Malaise
Decreased hematocrit
level
Filled normally air – filled
space
Neutrophils migrate
Reach to the alveoli
Hypoventilation
Enlargement of the
heart/ Cardiomegaly
Increased blood supply
Increased Oxygen demand
Increased heart workload
Venous blood passes to
underventilated area
Travels to Left ventricle
Activity Intolerance
Mucosal Edema
Decreased Alveolar
Oxygen tension
Partial Occlusion of
bronchi or alveoli
Atheromatous aorta

VIII. Management
A. Ideal
The treatment of pneumonia includes appropriate administration of the
appropriate antibiotic.
Management of Community Acquired Pneumonia includes blood cultures
performed quickly for identification of the casual pathogen and prompt
administration of antibiotics. Inpatients should be switched from intravenous to
oral therapy when they are hemodynamically stable, are improving clinically, are
able to take medications/fluid by mouth and have a normally functioning
gastrointestinal tract. Hydration is necessary part of therapy, because fever and
tachypnea may result in insensible fluid losses. Antipyretic may be used to treat
headache and fever; antitussive medications may be used for the associated
cough. Warm, moist inhalations are helpful in relieving bronchial irritation.
Antihistamine may provide benefit with reducing sneezing and rhinorrhea.
Position patient with head on mid line, with slight flexion to provide patent,
unobstructed, airway, maximum lung excursion. Auscultate patient’s chest to
monitor for the presence of abnormal breath sounds. Provide chest and back
clapping with vibrationbecause chestphysiotherapy facilitates the loosening of
secretions. Bed rest is also included for the management of pneumonia.
B. Actual
The patient was admitted to Magsingal District Hospital, in room of
choice for 1 week. He underwent different laboratory examinations such as
Complete Blood Count and Chest X-ray to assess the underlying disease of
the patient and monitor his status. He is a complete bed rest and needs had
been attended. He received an oxygenation via nasal cannula regulated at 2-3
L/min.
The patient received medications as a medical treatment: Salbutamol +
GR, Ceftriaxone, Ranitidine, Amino Acid, Chlorphenamine and Salbutamol neb.

XI. Discharge Plan
Medications  Salbutamol + GF I cap thrice a day
for 5 days
 Cefaclor 500mg thrice a day for 1
month
 Multivitamins + Amino Acid once a
day
 Omeprazole 20 mg once a day for 2
weeks
Exercise  Promote adequate rest
 Turn pt. from side to side every 2
hours to prevent bedsores.
 Promote adequate sleep without
disturbances
 Assist pt. in passive ROM like
flexing or extending knees and hands
Treatment  Drink plenty of fluids
 Do not suppress a cough. Take
expectorants
 Take analgesics if pain occurs like
aspirin
 Practice chest therapy
Health Teachings  Instruct pt. to increased OFI as
tolerated
 Instruct pt. to elevate head of bed
id difficulty of breathing occurs.
 Encourage pt. to eat foods rich in
Iron to compensate low level of
hemoglobin
 Instruct pt. to take medications as
prescribed by the doctor
 Encourage pt. to have Deep
Breathing Exercise & Coughing reflex
to promote expectoration of
secretions
 Encourage pt. to have an adequate
rest and sleep
 Instruct pt.’s SO to turn him from
side to side to prevent bed sores.
OPD(Out – patient) The pt. was advised to have a follow up
check up on July 27, 2011 as ordered by
his attending physician, Dra. Guerrero.
Diet  Stay hydrated by increasing OFI at
least 1L/ day as tolerated
 Eat foods rich in Iron
 Eat leafy vegetables
 Add Vitamin C rich foods in diet for
better Immune System

XII. Updates
Updated Quality Data - Pneumonia
Pneumonia is an infection in one or both lungs caused by bacteria. Every
year there are approximately 3 million cases of pneumonia in the USA, and over
500,000 of these cases are admitted to hospitals. Every year 5% will die,
causing pneumonia to be the 6th leading cause of death in the USA.The goal of
treating pneumonia is to ensure patients with the diagnosis are receiving the
most appropriate antibiotics, at the earliest possible stage. Another goal is
prevention; by making sure individuals over 65years of age receive the pneumonia
vaccine.
PNEUMONIA VACCINATION GIVEN
This is a measure that shows how well the hospital has documented that
pneumonia patients over the age of 65years have been screened for or asked if
they wish vaccination.
Scientific literature has shown that people over the age of 65 years of age are
more at risk for pneumonia.
SMOKING CESSATION ADVICE/COUNSELING
This measure shows how well a hospital documents the education given to heart
attack patients regarding smoking cessation.
Smoking is known to cause damage to the heart, the lungs and the circulatory
system. Smoking makes heart disease worse.
INITIAL ANTIBIOTIC WITHIN 6 HOURS
This is the measure that shows the percentage of pneumonia patients who were
given an appropriate antibiotic within 6 hour of arriving at the hospital.
Patients who receive appropriate antibiotics within 6 hours of their arrival at
the hospital has been shown to be very effective in treating community acquired
pneumonia.
ANTIBIOTIC SELECTION FOR PATIENTS IN THE INTENSIVE CARE UNIT
This is the measure that shows the percentage of community acquired pneumonia
patients admitted to the intensive care unit who were given appropriate
antibiotics within 24 hours of their hospital admission.
Patients who receive appropriate antibiotics within 24 hours of their hospital
admission has been shown to be very effective in treating community acquired
pneumonia.
ANTIBIOTIC SELECTION FOR NON INTENSIVE CARE UNIT PATIENTS
This is the measure that shows the percentage of community acquired pneumonia
patients admitted to the hospital who were given appropriate antibiotics within
24 hours of their admission.Patients who receive appropriate antibiotics within
24 hours of their hospital admission has been shown to be very effective in
treating community acquired pneumonia.

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