2. OBJECTIVEOFTHECASESTUDY
Able to identify the pathophysiology of pneumonia
Able to dealing patient affected by pneumonia.
Patient will return to normal activity within few days.
Understanding of effective management of pneumonia.
4. History of present Illness:
General Appearance
Patient looks well, conscious, oriented to time ,place and person. With average mood and
memory.
Chief complain (Onset, Location, Duration, Characteristics, Aggravating factors, Related
symptoms)
sudden onset left sided chest pain, cough with blood-tinged sputum and shortness of
breath, which started abruptly six hours prior to the presentation, shortness of breath
was at rest and the chest pain was associated with cough and deep breathing
Illness history upon admission in ER/OPD
Mohamed is a 39-year-old male who presents to the emergency department with a chest pain,
(worsening when breathing or coughing), and difficulty of breathing and coughing of
blood . three days ago , he complains of myalgia, fever, headache, nausea, vomiting and
diarrhea
5. Past medical and Surgical History
Diabetes: Type 1
No previous history of surgical operation and
blood transfusion. No previous hospitalization.
Social history
Married with no kids. He smokes 27 pack-year
history of smoking, marijuana use and consuming
a pint of alcohol every day, he had no history of
intravenous drug use. He lived with his girlfriend,
and denied promiscuous sexual activity or sex
with males)
6. Family History
Immunization Received
Type of Diet
Father has diabetes: Type 1, history of heart
attack; mother has hypertension.
Patient received all vaccine program of
Saudi Arabia
Historyofpresent
Normal and balance rice, meat, fruits,
vegetable .
7. Neurological system Digestivesystem
Respiratorysystem Cardiovascularsystem
01 02
Abdomen Soft, non-
distended, non-tender,
bowel sounds hyperactive
04
Tachypnea ,dullness in right
lobes ,decrease air entry ,
bronchial breathing. Wheezing
05
There is palpitation, no other
cardiovascular system
symptoms affected.
PhysicalAssessment(bybodysystem)
Lethargic, oriented to place
and person, (–) Brudzinski’s
sign, (–) Kernig’s sign
03
No cold and hot
intolerance .no
weight loss and
weight gain.
Endocrine system
8. LungFunction
The lungs’ main role is to bring in air from
the atmosphere and pass oxygen into the
bloodstream. From there, it circulates to the
rest of the body.
The diaphragm is a muscle that is domed at
the top and sits below the lungs. It powers
most of the work necessary in breathing. As
it contracts, it moves down, allowing more
space in the chest cavity and increasing the
lungs
As the diaphragm relaxes and returns to its
resting position, the lung volume decreases
because the pressure inside the chest cavity
goes up, and the lungs expel the air. The
lungs are like bellows — as they expand, they
suck in air for oxygen
9. Pneumonia: is an infection that inflames the air sacs in one or both
lungs. The air sacs may fill with fluid or pus (purulent material), causing
cough with phlegm or pus, fever, chills, and difficulty breathing. A
variety of organisms, including bacteria, viruses and fungi, can cause
pneumonia.
Pneumonia can range in seriousness from mild to life-threatening. It is
most serious for infants and young children, people older than age 65,
and people with health problems or weakened immune systems.
10. Risk factors
Pneumonia can affect anyone. But the two age groups at
highest risk are:
Children who are 2 years old or younger
People who are age 65 or older
11. Other risk factors include:
Being hospitalized.
You're at greater risk of pneumonia if
you're in a hospital intensive care
unit, especially if you're on a machine
that helps you breathe (a ventilator).
Chronic disease.
Smoking.
Smoking damages your body's
natural defenses against the
bacteria and viruses that cause
pneumonia.
Weakenedor suppressed
immune system.
You're more likely to get pneumonia
if you have asthma, chronic
obstructive pulmonary disease
(COPD) or heart disease.
People who have HIV/AIDS, who've had an
organ transplant, or who receive
chemotherapy or long-term steroids are
at risk.
12. Pathophysiology of
pneumonia
pneumonia develops as a result of inflammation
of the alveolar space, in one lung or both lungs.
The alveoli are tiny sacs in human lungs that
are filled with air. The alveoli are responsible for
gas exchange, and any kind of inflammation in
the alveolar space compromises this process.
13. Symptoms
Chest pain when you breathe or cough
Confusion or changes in mental awareness
Cough, which may produce phlegm
Fatigue
Fever, sweating and shaking chills
Nausea, vomiting or diarrhea
Shortness of breath
14. 1 2 3 4
DiagnosticStudies
Pulse oximetry
measures the oxygen level in your
blood. Pneumonia can prevent your
lungs from moving enough oxygen
into your bloodstream.
Bloodtests.
are used to confirm an infection
and to try to identify the type of
organism causing the infection.
However, precise identification
isn't always possible.
Sputum test.
A sample of fluid from your lungs
(sputum) is taken after a deep
cough and analyzed to help
pinpoint the cause of the infection.
ChestX-ray.
diagnose pneumonia and determine
the extent and location of the
infection. However, it can't tell your
doctor what kind of germ is causing
the pneumonia.
5
CT scan.
If your pneumonia isn't clearing as
quickly as expected, your doctor
may recommend a chest CT scan
to obtain a more detailed image of
your lungs.
18. Nursingcareplan
Nursing Diagnosis
Ineffective Airway Clearance rt Tracheal,
bronchial inflammation, edema formation,
increased sputum production
Nursing Gale
Patient will identify/demonstrate behaviors
to achieve airway clearance.
Patient will display/maintain a patent
airway with breath sounds clearing as
evidenced by keeping a patent airway and
effectively clearing secretions.
Nursing intervention Nursing Rational
Elevate the head of the bed
and change position
frequently.
would lower the diaphragm
and promote chest
expansion, aeration of lung
segments, mobilization, and
expectoration of secretions.
Suction as indicated:
frequent coughing,
adventitious breath sounds,
desaturation related to
airway secretions.
Stimulates cough or
mechanically clears airway
in a patient who cannot do
so because of ineffective
cough or decreased level of
consciousness.
19. Nursingcareplan
Nursing Diagnosis
Impaired Gas Exchange rt Alveolar-capillary
membrane changes (inflammatory effects),
Fluid-filled alveoli, Inflammation of airways and
alveoli
Nursing Gale
Patient will maintain optimal gas exchange.
Patient will participate in actions to maximize
oxygenation.
Nursing intervention Nursing Rational
Maintain bedrest by
planning activity and rest
periods to minimize energy
use. Encourage the use of
relaxation techniques and
diversional activities.
It prevents over exhaustion
and reduces oxygen
demands to facilitate the
resolution of infection.
Administer oxygen therapy
by appropriate means: nasal
prongs, mask, Venturi mask.
oxygen therapy is to
maintain PaO2 above 60
mmHg. Oxygen is
administered by a method
that provides appropriate
delivery within the patient’s
tolerance
20. Nursingcareplan
Nursing Diagnosis
Ineffective Breathing Pattern rt Alteration of
patient’s O2/CO2 ratio, anxiety, hypoxia,
Decreased lung expansion, inflammatory
process
Nursing Gale
Patient maintains an effective breathing
pattern, as evidenced by relaxed breathing
at normal rate and depth and absence of
dyspnea.
Patient’s respiratory rate remains within
established limits.
Nursing intervention Nursing Rational
Place patient with proper
body alignment for
maximum breathing
pattern.
sitting position permits
maximum lung excursion
and chest expansion.
Encourage diaphragmatic
breathing for patients with
chronic disease.
This method relaxes
muscles and increases the
patient’s oxygen level.
Suction secretions, as
necessary.
This is to clear the
blockage in the airway.
21. Nursingcareplan
Nursing Diagnosis
Deficient Knowledge rt Lack of exposure,
Misinterpretation of information, altered recall,
Unfamiliarity with the disease process and/or
transmission of disease
Nursing Gale
Patient and caregiver will verbalize
understanding of therapeutic regimen.
Patient will initiate necessary lifestyle
changes.
Patient will participate in treatment
program.
Nursing intervention Nursing Rational
Review the importance of
cessation of smoking.
Smoking destroys
tracheobronchial ciliary
action, irritates bronchial
mucosa, compromising the
body’s natural defense
against infection.
Stress the importance of
continuing medical follow-
up and obtaining
vaccinations as appropriate.
May prevent recurrence of
pneumonia and/or related
complications.
Encourage Pneumovax and
annual flu shots for high-
risk patients
To help prevent the
occurrence of the disease.
22. Get vaccinated. Vaccines are available to prevent some types of pneumonia and
the flu. The vaccination guidelines have changed over time so make sure to review
your vaccination status with your Doctor.
Make sure children get vaccinated. Doctors recommend a different pneumonia
vaccine for children younger than age 2 and for children ages 2 to 5 years who are
at particular risk of pneumococcal disease.
Practice good hygiene. To protect yourself against respiratory infections that
sometimes lead to pneumonia, wash your hands regularly or use an alcohol-based
hand sanitizer.
Don't smoke. Smoking damages your lungs' natural defenses against respiratory
infections.
Keep your immune system strong. Get enough sleep, exercise regularly and eat a
healthy diet.
Prevention
23. resources
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Nat Rev Dis Primers. 2021 Apr 8;7(1):25. doi: 10.1038/s41572-021-00259-0. PMID: 33833230.
Htun TP, Sun Y, Chua HL, Pang J. Clinical features for diagnosis of pneumonia among adults in primary care
setting: A systematic and meta-review. Sci Rep. 2019 May 20;9(1):7600. doi: 10.1038/s41598-019-44145-y.
PMID: 31110214; PMCID: PMC6527561.
Ortega, S. M., & Sua
́ rez, M. L. (2011). Pneumonia: Symptoms, Diagnosis and Treatment. Nova Science
Publishers, Inc.
Scott H. Podolsky. (2006). Pneumonia Before Antibiotics : Therapeutic Evolution and Evaluation in
Twentieth-Century America. Johns Hopkins University Press.
Chen, R., Shang, H., Niu, X., Huang, J., Miao, Y., Sha, Z., Qin, L., Huang, H., Peng, D., & Zhu, R. (2021).
Establishment and evaluation of an indirect ELISA for detection of antibodies to goat Klebsiella
pneumonia. BMC Veterinary Research, 17(1). https://doi-org.sdl.idm.oclc.org/10.1186/s12917-021-02820-1
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