Health seminar presentation of Adult Health Nursing students in Hospital

1. NURSING PROCESS:
CASE STUDY ON ASPIRATION PNEUMONIA
BY MITIKU TEKA (AHN)

2. OUT LINE
Overview about aspiration Pneumonia
Nursing Process Using Gordon Functional Health Pattern on Patient
with aspiration Pneumonia: Case Study

3. I. INTRODUCTION
Aspiration Pneumonia (AP):
Definition:
 Is bronchopneumonia that develops due to the entrance of foreign
materials into the bronchial tree, usually oral or gastric contents
(including food, saliva, or nasal secretions).
Chemical pneumonitis can develop based on;
the acidity of the aspirate
 bacterial pathogens may add to the inflammation.

4. INTRODUCTION…
Causes:
Failure of the natural defense mechanisms increases the risk of aspiration;
Closure of the glottis
Cough reflex
This incompetent swallowing mechanism, occurs in neurological disease or
injury including;
multiple sclerosis (Disorder in which the body’s immune system attacks
the protective covering of the nerve cells in the brain, optic nerve …)
CVA (stroke)
Alzheimer’s disease
intoxication

5. CAUSATIVE BACTERIA OF ASPIRATION PNEUMONIA
Aspiration pneumonia is found in;
Community-acquired pneumonia (CAP),
 Health Care-Associated Pneumonia (HCAP),
hospital-acquired pneumonia (HAP).
Oral micro flora is usually the causative bacteria of pneumonia, and
anaerobes are primarily the causative bacteria of aspiration pneumonia.

6. Causative organism…
Gram-negative anaerobes and aerobes were common in the aspiration
pneumonia of HAP.
Gram negative rods and methicillin-resistant Staphylococcus aurous
(MRSA) are often associated with aspiration pneumonia in elderly patients
in CAP, and HAP.
 Prevalent aerobes include;
 Streptococcus pneumoniae,
Staphylococcus aureus,
Pseudomonas aeruginosa, and
enteric gram-negative rods.

7. Risk Factors
Age,
Poor dental hygiene,
Diabetes,
 Severe dementia,
Malnutrition,
Use of antipsychotic drugs,
 Proton pump inhibitors, and ACEIs.
Reduced functional status,
Prolonged hospitalization, or
surgical procedures,
Impaired consciousness,
Chronic swallowing disorders,
mechanical airway intervention,
 Immune-compromised,
History of smoking, antibiotic
therapy,
 Reduced pulmonary clearance and
obstruction of the airways.

8. INTRODUCTION…
INCIDENCE OF AP IN ELDER PEOPLE:
According to WHO data published in May 2014;
 Pneumonia Deaths reached 9.95% of total deaths.
The age adjusted Death Rate is 90.40 per 100,000 of population.
90% of invasive pneumococcal disease cases are in adults.
Pneumonia is the leading cause of death in older than 65 years of age.
The risk of developing AP increases;
 with age and
presence of underlying.
Dysphagia is the major risk which often found in older people.

9. Therapeutic Strategy for Aspiration Pneumonia
For the treatment of AP, two different approaches are necessary;
1. Proper antibiotic treatment strategies
2. therapy for the dysphagia
1. Proper antibiotic treatment strategies:
Antibiotics that are effective against indigenous oral bacteria and
anaerobic bacteria are given priority when selecting antibiotics to treat
patients with aspiration pneumonia because;
there is greater involvement by indigenous oral bacteria and anaerobic
bacteria in patients with aspiration pneumonia than in pneumonia
patients with no risk of aspiration.

10. Treatment of AP…
Therapy options include beta-lactamase-inhibitor-containing;
 penicillin,
carbapenem antibiotics, in combination with macrolides.
2. therapy for the dysphagia: While the pneumonia can be cured by antibiotics,
the dysphagia of the patients does not improve by the agents.
swallowing rehabilitation
Mouth care
Positioning to head-up by 30 degrees to reduce the gastric regurgitation
For the prevention of AP, the interesting pharmacologic approaches are
introduced.

11. Prevention of AP
For the prevention of AP, the interesting pharmacologic approaches are
introduced;
ACEIs and cilostazol:
Both agents increase substance P levels in airways and plasma
Improve swallowing and cough reflexes.
Vaccination;
pneumococcal polysaccharide vaccine (PPV)
 influenza vaccine

12. NURSING PROCESS
FOR PATIENT WITH AP

13. I attempted to do Nursing process on the 64-years-old male patient who
currently admitted at the ICU Ward of WURH due to Aspiration
Pneumonia.
He has history of heavy alcohol drinker and smoker.
In August 2015 E.C, he had developed stroke which left him bedridden
and made him Immuno-compromised and inevitably led to swallowing
dysfunction and reduced functional status.
NURSING PROCESS ON REAL PATIENT WITH AP

14. II. DEMOGRAPHIC PROFILE
Name: Abdisa Geleta
Age: 64years old
Gender: Male
Birthdate: October 07, 1952
Ethnicity: Oromo
Address: Gutu Gida Woreda
Religion: Protestant
Marital Status: Married
Educational Status: Illiterate
Work: Farmer
Admission Date and Time:
17/03/2016 E,C @ 3:00 AM LT
Attending Physician: __.
Final Diagnosis: Aspiration
Pneumonia

15. III. CHIEF COMPLAINT:
Cough with mucopurulent yellowish secretion accompanied with febrile
episodes of 38.6 d/c
presence of crackles noted upon auscultation of 2 days duration.

16. Two days prior to admission, patient had an episode of vomiting of
previously ingested food, non-projectile, non-bilious, and amounting to ¼ cup.
No interventions were done. A few hours after, he had an episode of
undocumented high grade fever, which was managed with 2 tablets of
Paracetamol which provided relief.
One day prior to admission, patient was noted to vomit almost every two
hours, consisting of previously ingested food and associated with epigastric
pain 9/10 pain scale, characterized as feeling of having hyperacidity, with no
associated symptoms of fever.
IV.HISTORY OF PRESENT ILLNESS (HPI)

17. HPI…
Persistence of acid symptoms prompted the patient to seek consult,
hence, admission to WURH for the third time.
On the day of admission, patient had epigastric pain and nausea.
Upon Laboratory Results, SPO2 was 80% which indicates
desaturation, and upon respiratory assessment, tactile fremitus was
felt upon palpation which indicates an increase in sputum production.

18. V. PAST MEDICAL HISTORY:
Around May 2014 E.C, patient was diagnosed with Hypertension but it was
controlled with an anti-hypertensive drug, Losartan (50mg OD).
He started choking water after his stroke last August 2015.
Patient had a stroke of the right middle cerebral artery which led him to
have left hemiparesis.
A right MCA stroke also affects the Oropharyngeal phase of swallowing
which is why the patient could have these choking episodes and aspiration
pneumonia.

19. PAST MH…
This could prove that the patient could have problems with swallowing such as
functional dysphagia.
After the stroke, he became bed ridden for almost 5 months.
Five months prior to admission, patient was previously admitted at Nekemte
Specialized Hospital for treatment as aspiration pneumonia and was sent
home with NGT.
No interventions were done after implementing NGT.
One month prior to admission, he removed it and insisted to be fed per Orem.
Aspiration episodes were noted. Management was not effective.

20. VI.FAMILY HISTORY:
His father died with HTN and no other any medical condition in his family.
VII.SOCIAL HISTORY:
He is friendly and is a natural joker.
He loves to drink alcoholic drinks and eats row meat twice a week with his
friends.
He is a responsible and a good provider to his family.
He has excellent relationship and has no conflict with his wife, children, siblings
& with other people.
Despite having a debilitating illness for 5 months, his family especially his wife
and children constantly care and assist him in his activities of daily living.

21. VIII. DEVELOPMENTAL HISTORY:
According to Erik Erikson’s theory of Psychosocial Development(1936), the
patient is currently in the stage of Ego Integrity vs. Despair.
At this stage people are faced with a crisis that acts as a twinning point in
development(human infants & older people highly dependent on their care
givers for food, shelter, & protection).
He is in the stage of Despair (abdii kutannaa).
Despite being happy and a natural joker, being bedridden for almost
5months took a turn and he became the main priority of the family.
He cannot perform his duties and activities as the head of the family
because of his situation.

22. IX. ACTIVITIES OF DAILY LIVING (ADL):
The patient requires full and complete assistance in his ADL’s due to
hemiparesis on his body’s left side due to stroke he experienced during
August 2015 and he is completely bedridden.

23. X. GORDON’S FUNCTIONAL HEALTH
PATTERN AND PHYSICAL ASSESSMENT

24. HEALTH PATTERN
1. HEALTH PERCEPTION- HEALTH MANAGEMENT PATTERN:
Before Hospitalization:
Patient had a stroke of the right MCA which led him to have left
hemiparesis.
Patient pulled his NGT ( as verbalized by the patient spouse).

25. 1. HEALTH PERCEPTION…
During Hospitalization:
 Currently confined at ICU.
 He is Bedridden, expresses self by nodding or shaking, slight & dirty
fingernails.
 Heart: -S1 and S2 present and no murmur, rub or gallop
 BP: 140/80mmHg
 Temp: 36.3C
 RR: 24bpm
 PR: 110 bpm
 SPO2: 80%

26. 2. NUTRITION- METABOLIC PATTERN:
Before Hospitalization:
 After he removed his NGT, he eats light meals three times a day and
has trouble swallowing water (as verbalized by the patient spouse).
During Hospitalization:
 Patient is on NGT, and being fed 6x a day.
 lips are not dry
 buccal mucosa seen to be moist
 no lesions on tongue

27.  lots of missing teeth
 weak
 dysphagia
 choking, vomiting, drooling, diminished gag reflex
 2000 kcal per day
-333 for 6 feedings
2. NUTRITION/METABOLIC PATERN…
During Hospitalization…

28. 3. ELIMINATION PATTERN:
Before Hospitalization:
 Patient voids 3-4 times a day and remove bowel every morning through the adult
diaper (as verbalized by the patient spouse).
 No burning sensation/pain felt during urination and defecating (as verbalized by
the patient spouse).
During Hospitalization:
 abdomen is tender and symmetrical
 normoactive bowel sounds in all quadrant
 no pain and no masses upon palpation.
 Urine is yellowish and odorless, and stool is brown.
o Intake: 750 ml
o Output: 500 ml

29. 4. ACTIVITY- EXERCISE PATTERN:
Before Hospitalization:
 Patient is bedridden for almost 5 Months (as verbalized by the patient spouse).
 Patient is assist by his family for movement
During Hospitalization:
 He is bed ridden
 requires help for exercises from family and or staff to help maintain
mobility.
 Uses 2 pillows to support head, and 1 on each upper and lower limb.

30. 4.ACTIVITY- EXERCISE PATTERN…
During Hospitalization…
 crackles heard (during inspiration) upon auscultation
 cough noted
 excessive sputum
 restlessness
 nasal flaring.

31. 5. SEXUALITY- REPRODUCTIVE PATTERN: N/A
6.SLEEP- REST PATTERN:
Before Hospitalization:
 Can sleep for 7-9 hours per night
 But he uses “local areke” as medication to promote sleep
During Hospitalization:
 Interrupted sleep due to hospitalizations.
 decreased ability to function.
 patient appear not well rested, irritable.

32. 7.SENSORY- COGNITIVE- PERCEPTUAL PATTERN:
During Hospitalization:
 Reduced ability to feel touch, pain, temprature
 Reduced ability to recognize objects
 No hearing, visual, and smell impairments was noticed.
 no eye glasses.
8.ROLE RELATIONSHIP PATTERN:
Before Hospitalization:
 He is married and lives with immediate family
 he had difficulty talking to his family after he developed the stroke
During Hospitalization:
 Confined
 inability to speak, difficulty forming sentences or words

33. 9. SELF-PERCEPTION-SELF CONCEPT PATTERN:
Before Hospitalization:
 Un able to support the family after he develop the stroke
 he feels depressed and anxious
During Hospitalization:
 Slightly anxious because he has limitations now and is depressed,
 He confused,
 He has poor eye contact
 He disturbed

34. 10. COPING-STRESS TOLERANCE PATTERN:
Before Hospitalization:
 Copes up with problems by talking about it with the family and finds
ways to resolve it together before developing the stroke.
 Drinks alcohol when under pressure to forget all problems.
During Hospitalization:
 Laughs and smiles about it, but there’s a slight misguided pattern.
 Thrilled(suddenly excite),
 smiley face noted
 difficulty focusing

35. 11. VALUE-BELIEF PATTERN
Before Hospitalization:
 He is Protestant and have strong faith in God
 Prays at home
During Hospitalization:
 Was not able to go to church because of hospitalization but his family
members pray for him every time
 Presence of religious materials (Bible ) around him

36. XI. LABORATORY FINDINGS
1. COMPLETE BLOOD COUNT (CBC)
Tests Actual Finding Normal Range Interpretation Nursing Responsibilities
Hgb 9 gm/dl 13.8-17.2 gm/dl Blood is unable to fully
oxygenize in the lungs
due to the narrowing of
arteries.
 Assess for signs of
pallor, tachycardia, and
fatigue.
 Collaborate with
nutritionist with regards
to what diet must the
patient follow
Hematocrit
38% 40-54%
RBC 4.2 4.5-5.5 x 10*12/L Indicate arterial
hypoxemia
 Assess for signs of
pallor.
 IV fluid as ordered
ESR 15.5 mm/hr 11-15 mm/hr Indicate medical
condition causing
inflammation
 Identify the cause
WBC 13,000/ McL 4500-11,000 /McL Presence of infection  Identify the cause &
treat immediately

37. XI. LABORATORY FINDINGS
1. COMPLETE BLOOD COUNT (CBC)…
Tests Actual Finding Normal Range Interpretation Nursing Responsibilities
Neutrophils 90 37-72 Increase in WBC
indicates infection thus
neutrophil predominance
indicates bacterial
infection.
 Assess for hyperthermia
 Provide antibiotic as
ordered
 Educate on proper diet
and things to avoid.
 Collaborate with IM to
determine effectiveness
of antibiotic
Lymphocytes 9 20-50 Decrease (lymphopenia)
which indicates infection
 Identify the cause &
treat immediately
Monocytes 1 0-14 Normal
Eosinophils 0 0-6 Normal
Basophils 0 0-1 Normal
Platelet 346 150-440 Normal

38. 2.ELECTROLYTES
Test Actual Findings Normal Range Interpretation Nursing
Responsibilities
Creatinine 0.8 mg/dL 0.7-1.3mg/dL Normal
 An increase in
count indicates
possible renal
problem.
1.Assess for signs
of edema
2.Assess for signs
of dyspnea
2.IVF as ordered
Na 138 mEq/L 135-145 mEq/L Normal
K 3.8mEq/L 3.5-5.5 mEq/L Normal
Urea Nitrogen 6.5 mg/dL 5-20 mgldL Normal

39. Test Actual Findings Normal Range Interpretation Nursing
Responsibilities
PH 7.48 7.35-7.45  Slight increase
shows compensated
metabolic alkalosis
because of previous
episodes of vomiting.
 Collaborate with
nutrionist
 Collaborate with
pulmonologist
Hco3
26.5 mEq/L 22-26
Pco2 36 35-45 Normal
PO2 69 75-100 mmhg
 A decrease in count
shows that the lungs
aren’t capable
enough of bringing
oxygen from the
atmosphere to the
bloodstream
 Prepare O2 as
needed.
O2 Sat 80% 94%-100% Is indication of
hypoxemia
 treat underlying
cause
 Prepare oxygen
3.ARTERIAL BLOOD GASES

40. SUMMARY OF SUBJECTIVE AND OBJECTIVE DATA
Subjective Data:
Trouble swallowing (dysphagia)
Chocking
Vomiting
Weakness
Drooling
Shortness of breathing
Productive cough
Objective Data:
hemiparesis
Dirty finger nails
Diminished gag reflex
Tender abdomen
Immobility
Crackles
Restlessness
Nasal flaring
 Anxiety
Peri-orbital edema
Inability to speak/Difficulty
forming sentence or words
Confusion

41. Objective Data…
Vital Sign:
Axillary temprature= 37.8 d/c
Pulse rate= 110/min.
RR=24/min.
SpO2= 80%
Blood Pressure: 140/80 mmhg
Weight= 55kg
Height=170 Cm
BMI= 19 kg/m2

42. NURSING PROBLEM INDEX LIST/DIAGNOSIS
Proble
m No. Nursing Diagnosis
Date
Resolved
1
Ineffective airway clearance r/t excessive sputum production as
manifested by crackles heard upon auscultation
Date: 18/3/016
Time: 3:00 AM LT
2 Impaired gas exchange r/to fluid & mucus in the alveoli as evidenced
by dyspnea
Date: 18/3/016
Time: 5:00 AM LT
3 Impaired swallowing r/t decreased gag reflex.
Date: 20/3/016
Time: 3:00 AM LT
4 Readiness for enhanced urinary and bowel elimination.
Date: 18/3/016
Time: 3 AM LT
5 Disturbed sleep pattern r/t interruptions Date: 19/3/016
Time: 8:00 AM LT
6. Readiness for enhanced comfort. Date: 18/3/016
Time: 8:30 AM LT
7 Risk for infection r/to invasive procedures; suctioning Date: 18-21/3/016
Time: 3-9:00 AM LT

43. NURSING CARE PLAN
Date &
Time
Prioritized Problem Goal Expected Outcomes
Date:
18/3/016
Time:
3:00
AM
LT
1.
Ineffective
airway
clearance
r/t
excessive
sputum
production
as
manifested
by
crackles
heard
upon
auscultation
 Effectively clear
secretion
 Maintain oxygen
saturation levels
above 90%
 Increased ease of
breathing
 Improved lung sound
 Patient Perform
deep breathing &
coughing exercises
independently
 Patient will maintain a patent air
way clearance
 Patient will demonstrate
appropriate air way clearance
techniques
 Patient will maintain optimal gas
exchange
 Patient will display improvement in
airway clearance as evidenced by
clear breath sounds & an even &
and unlabored respiratory rate.

44. NURSING CARE PLAN
Date &
Time
Prioritized
Problem
Goal Expected Outcomes
Date:
18/3/016
Time:
5:00
AM
LT
2.
Impaired
gas
exchange
r/to
fluid
&
mucus
in
the
lungs
as
evidence
by
dyspnea
 The patient maintains optimal
gas exchange as evidenced by
respiration at 12-20/minutes
 Oximetry results with in normal
range
 The patient will demonstrate improved
gas exchange as evidenced by oxygen
saturation >90%
 Patient will demonstrate appropriate
actions to promote ventilation &
oxygenation
 The patient maintains clear lung fields
& remains free of sign of respiratory
distress
Date:
20/3/016
Time:
3:00
AM
LT
3.
Impaired
swallowing
r/t
decreased
gag
reflex.
 Identifying the cause
 Adequate feeding of the patient
with NGT
 Patient will take bed rest with
eliminating environmental stimuli (TV,
Radio)
 Oral should be free from bad odor &
infection
 Care giver should know how to feed at
home
 Doctor should consulted for bed side
evaluation with in 72 hours to identify
whether he has had CVA

45. NURSING CARE PLAN
Date &
Time
Prioritized
Problem
Goal Expected Outcomes
Date:
18/3/016
Time:
3
AM
LT
4.
Readiness
for
enhanced
urinary
and
bowel
elimination.
 The patient participates in
a daily bowel program until
a bowel pattern develops
 The patient evacuates a
soft, formed stool
 maintain balanced fluid
balance
 Prevent bladder distension
 Minimize urinary leakage
 The patient verbalizes feelings
of self-control regarding bowel
movements
 The patient verbalizes ways how
to keep bowel movements
regular by naming what foods to
eat & how much fluids to intake
Date:
18/3/016
Time:
8:30
AM
LT
5.
Readiness
for
enhanced
comfort.
 Patient will appear calm &
relaxed with in normal
limits
 Before discharge the patient
will be able to verbalizes
sense of comfort &
demonstrate behaviors of
optimal level of ease

46. NURSING CARE PLAN
Date &
Time
Prioritized
Problem
Goal Expected Outcomes
Date:
19/3/016
Time:
8:00
AM
LT
6.
Disturbed
sleep
pattern
r/t
interruptions
 After 24 hours of
interventions, patient will be
able to achieve optimal
amount of sleep as evidenced
by rested appearance &
improvement in sleep
pattern.
 The patient will have an
improved sleep experience .
 The patient will understand the
proper use of sleep aids or
other medications.
Date:
18-21/3/016
Time:
3-9:00
AM
LT
7.
Risk
for
infection
r/to
invasive
procedures;
suctioning
 The patient will remain free
of infection as evidenced by
normal vital signs & absence
of infection symptoms
 The care giver (relatives )
will demonstrate meticulous
hand washing techniques.
 The patient is free of infection
as evidenced by vital signs with
in normal range & lack of
evidence of infection such as
swelling , redness, & purulent
drainage from non intact areas
fo skin.
 The patient will free of bed
sore on the prominent area

47. IMPLIMENTATION
Date
Identified
and Time
Problems Implementations
Date:
18/3/016
Time:
3:00
AM
LT
1. Ineffective airway
clearance r/t excessive
sputum production as
manifested by crackles
heard upon auscultation
 airway is cleared by suctioning
 Nebulizer is administered to loosen secretion in
the lungs & make it easier to cough up.
 Patient positioned every 2 hours to promote lung
expansion
 4ml Oxygen is administered using nasal cannula
 breathing exercise is practiced
 3L of fluid is given through NGT daily
 Hydrocortisone 200mg IV is given in BID
Date:
18/3/016
Time:
5:00
AM
LT
2. Impaired gas exchange
r/to fluid & mucus in the
lungs as evidence by
dyspnea
 Rest & limiting exertion is encouraged
 4ML oxygen is administered to support
oxygenation & to maintain Spo2 levels.
 Midazolam 70Mcg/kg IV infusion for sedation

48. IMPLIMENTATION
Date
Identified
and Time
Identified Problem Implementations
Date:
20/3/016
Time:
3:00
AM
LT
3. Impaired swallowing r/t
decreased gag reflex.
 Bed rest with eliminating environmental stimuli (TV,
Radio)
 Oral care is provided
 Doctor consulted for bed side evaluation (the patient
seen by Doctor with in 72 hours and evaluated as he has
had a CVA).
 Patient fed with NGT 2000ml daily
 Education is given for care giver on home feeding
practice
Date:
18/3/016
Time:
3
AM
LT
4. Readiness for enhanced
urinary and bowel elimination.
 Urinary catheter is inserted & managed
 Care giver is educated to promote healthy elimination, &
preventing complications
Date:
19/3/016
Time:
8:00
AM
LT
5. Disturbed sleep pattern r/t
interruptions
 bed bath & back care is performed to initiate sleep.
 Sedative injection is given
 The care giver is educated on the proper food & fluid
intake such as avoiding heavy meals, alcohol, caffeine or
smoking before bed time

49. IMPLIMENTATION
Date
Identified
and Time
Problem No Implementations
Date:
18/3/016
Time:
8:30
AM
LT
6. Readiness for enhanced
comfort.
 We showed kindness to the patient & relatives
 Physical cause of discomfort such as pain, nausea, medical
equipment such as IV line, & catheter were assessed.
 Tramadol is given to relief pain
 Metoclopramide is given to relief N &V
 Positioned Q 2 hours
 Bed bath & back care is provided
Date:
18-21/3/016
Time:
3-9:00
AM
LT
7. Risk for infection r/to
invasive procedures;
suctioning
 Hand washing is performed & aseptic techniques provided .
 Vancomycin 1gm IV BID + Piperacillin 4.5 gm IV in QID is
administered
 Fluids 3L per day is given to prevent dehydration
 Skin integrity is promoted with Q 2hours of positioning.
 Visitors were limited
 Health education were given for care giver on signs &
symptoms of infection.

50. EVALUATION
1. The patient maintained optimal respiratory & cardiovascular functions as evidenced by
stable vital signs and the absence of complications related to impaired respiratory
functions.
 Vital sign:
RR=18
Spo2=98%
PR=70//minutes
T=36.8 d/c
BP= 115/80
 NB: the patient is still on tracheostomy but breath spontaneously without
MV or oxygen cylinder
So, our goal is met

51. EVALUATION…
2. Impaired gag reflex is not improved as evidenced by touching the back of
the patient’s throat with a tongue blade/cotton swab.
The patient may cough or initiate swallowing as a positive response
Do not provide any thing by mouth & continue with NGT feeding
Farther evaluation is needed
So, our goal not meet
3. The patient can’t urinate & eliminate stool by him self because of he is
still partially conscious.
Our goal is not met and the patient need re assessment & further
evaluation

52. EVALUATION…
4. The patient can’t urinate & eliminate stool by him self because of
he is still partially conscious.
Our goal is not met and the patient need re assessment & further
evaluation
5. patient able to achieve optimal amount of sleep as evidenced by
rested appearance & improvement in sleep pattern with in 24 hours
of interventions.
Our goal is met.

53. EVALUATION…
6. Patient appears calm & relaxed with vital signs with in normal limits.
But un able to verbalizes sense of comfort.
So the goal is partially met, because he can’t express about his
physical, emotional, social, & spiritual challenges he encounters

54. EVALUATION…
7. The patient is free of infection as evidenced by vital signs with in normal
range & lack of evidence of infection such as swelling , redness, & purulent
drainage from non intact areas fo skin.
The patient is free of bed sore on the prominent area
The goal is met
Finally, he is referred to Tikur Anbessa Hospital for further evaluation and
better improvement.

55. REFERENCE
Teramoto, S. (2019). Clinical Significance of Aspiration
Pneumonia and Diffuse Aspiration Bronchiolitis in the Elderly.
Retrieved from https://www.omicsgroup.org/journals/clinical-
significance-of-aspiration-pneumonia-and-diffuse-aspiration-
bronchiolitis-in-the-elderly-2167-7182.1000142.php?aid=22336

56. THANK YOU!