I.

INTRODUCTION

A. Pneumonia is an 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 weakened immune systems that
make it easier for bacteria to grow in their lungs.

Aspiration is defined as the inhalation of either oropharyngeal or gastric contents

into the lower airways. Inhalation of these contents can lead to aspiration pneumonia.
Aspiration pneumonia results from chronic, usually unwitnessed, inhalation of small
amounts of oropharyngeal contents leading to an infectious process.

Substances other than bacteria may be aspirated into the lung, such as gastric
contents, exogenous chemical contents, or irritating gases. This type of aspiration or
ingestion may impair the lung defenses, cause inflammatory changes, and lead to
bacterial growth and a resulting pneumonia.

This inflammation causes an outpouring of fluid in the infected part of the lungs,
affecting either one or both lungs. The blood flow to the infected portion of the lung (or
lungs) decreases, meaning oxygen levels in the bloodstream can decline.

The body attempts to preserve blood flow to vital organs and decrease blood flow to
other parts of the body such as the GI tract. The effects of pneumonia are widespread
even though the infection is localized to the lung. The complications of pneumonia in the
elderly can be life-threatening, from low blood pressure and kidney failure to bacteremia,
an infection that spreads to the bloodstream.

Elderly people are more susceptible to pneumonia for several reasons. Often
they already suffer from co-morbid conditions such as heart disease, which means they
don’t tolerate infection as well as younger people. Age also causes a decrease in an
older person’s immune system response, so his defenses are weaker. Some virulent
organisms can cause infection in younger people, but the infections can be worse in
older people.

Common pathogens are Streptococcus pneumoniae. Other causes include

Haemophilus influenzae, and Streptococcus aureus.
 B. (Incidence and Prevalence rate)
Incidence Rate for Pneumonia: approx 1 in 56 or 1.76% or 4.8 million people in USA
Extrapolation of Incidence Rate for Pneumonia to Countries and Regions: The
following table attempts to extrapolate the above incidence rate for Pneumonia to the
populations of various countries and regions. As discussed above, these incidence
extrapolations for Pneumonia are only estimates and may have limited relevance to the
actual incidence of Pneumonia in any region:

Country/Region Extrapolated Incidence Population Estimated Used

Pneumonia in North America (Extrapolated Statistics)
USA 5,182,154 293,655,4051
Canada 573,668 32,507,8742
Pneumonia in Europe (Extrapolated Statistics)
Austria 144,260 8,174,7622
Belgium 182,616 10,348,2762
Britain (United Kingdom) 1,063,600 60,270,708 for UK2
Czech Republic 21,991 1,0246,1782
Denmark 95,530 5,413,3922
Finland 92,020 5,214,5122
France 1,066,309 60,424,2132
Greece 187,897 10,647,5292
Germany 1,454,551 82,424,6092
Iceland 5,187 293,9662
Hungary 177,041 10,032,3752
Liechtenstein 590 33,4362
Ireland 70,051 3,969,5582
Italy 1,024,543 58,057,4772
Luxembourg 8,165 462,6902
Monaco 569 32,2702
Netherlands (Holland) 287,968 16,318,1992
Poland 681,641 38,626,3492
Portugal 185,720 10,524,1452
Spain 710,837 40,280,7802
Sweden 158,583 8,986,4002
Switzerland 131,485 7,450,8672
United Kingdom 1,063,600 60,270,7082
Wales 51,494 2,918,0002
Pneumonia in the Balkans (Extrapolated Statistics)
Albania 62,555 3,544,8082
Bosnia and Herzegovina 7,193 407,6082
Croatia 79,356 4,496,8692
Macedonia 36,001 2,040,0852
Serbia and Montenegro 191,045 10,825,9002
Pneumonia in Asia (Extrapolated Statistics)
Bangladesh 2,494,243 141,340,4762
Bhutan 38,568 2,185,5692
China 22,920,840 1,298,847,6242
East Timor 17,986 1,019,2522
Hong Kong s.a.r. 120,972 6,855,1252
India 18,795,363 1,065,070,6072
Indonesia 4,207,993 238,452,9522
Japan 2,247,052 127,333,0022
Laos 107,084 6,068,1172
Macau s.a.r. 7,857 445,2862
Malaysia 415,102 23,522,4822
Mongolia 48,552 2,751,3142
Philippines 1,521,912 86,241,6972
Papua New Guinea 95,652 5,420,2802
Vietnam 1,458,755 82,662,8002
Singapore 76,833 4,353,8932
Pakistan 2,809,347 159,196,3362
North Korea 400,545 22,697,5532
South Korea 851,184 48,233,7602
Sri Lanka 351,267 19,905,1652
Taiwan 401,467 22,749,8382
Thailand 1,144,685 64,865,5232
Pneumonia in Eastern Europe (Extrapolated Statistics)
Azerbaijan 138,853 7,868,3852
Belarus 181,950 10,310,5202
Bulgaria 132,670 7,517,9732
Estonia 23,676 1,341,6642
Georgia 82,833 4,693,8922
Kazakhstan 267,241 15,143,7042
Latvia 40,699 2,306,3062
Lithuania 63,668 3,607,8992
Romania 394,509 22,355,5512
Russia 2,540,718 143,974,0592
Slovakia 95,710 5,423,5672
Slovenia 35,496 2,011,473 2
Tajikistan 123,733 7,011,556 2
Ukraine 842,330 47,732,0792
Uzbekistan 466,066 26,410,4162
Pneumonia in Australasia and Southern Pacific (Extrapolated Statistics)
Australia 351,408 19,913,1442
New Zealand 70,479 3,993,8172
Pneumonia in the Middle East (Extrapolated Statistics)
Afghanistan 503,182 28,513,6772
Egypt 1,343,248 76,117,4212
Gaza strip 23,382 1,324,9912
Iran 1,191,233 67,503,2052
Iraq 447,788 25,374,6912
Israel 109,394 6,199,0082
Jordan 99,021 5,611,2022
Kuwait 39,839 2,257,5492
Lebanon 66,656 3,777,2182
Libya 99,380 5,631,5852
Saudi Arabia 455,222 25,795,9382
Syria 317,944 18,016,8742
Turkey 1,215,775 68,893,9182
United Arab Emirates 44,539 2,523,9152
West Bank 40,785 2,311,2042
Yemen 353,380 20,024,8672
Pneumonia in South America (Extrapolated Statistics)
Belize 4,816 272,9452
Brazil 3,248,843 184,101,1092
Chile 279,246 15,823,9572
Colombia 746,660 42,310,7752
Guatemala 252,010 14,280,5962
Mexico 1,852,228 104,959,5942
Nicaragua 94,583 5,359,7592
Paraguay 109,259 6,191,3682
Peru 486,075 27,544,3052
Puerto Rico 68,787 3,897,9602
Venezuela 441,483 25,017,3872
Pneumonia in Africa (Extrapolated Statistics)
Angola 193,739 10,978,5522
Botswana 28,927 1,639,2312
Central African Republic 66,043 3,742,4822
Chad 168,327 9,538,5442
Congo Brazzaville 52,906 2,998,0402
Congo kinshasa 1,029,124 58,317,0302
Ethiopia 1,258,880 71,336,5712
Ghana 366,300 20,757,0322
Kenya 582,037 32,982,1092
Liberia 59,834 3,390,6352
Niger 200,480 11,360,5382
Nigeria 313,241 12,5750,3562
Rwanda 145,388 8,238,6732
Senegal 191,508 10,852,1472
Sierra leone 103,833 5,883,8892
Somalia 146,551 8,304,6012
Sudan 690,849 39,148,1622
South Africa 784,384 44,448,4702
Swaziland 20,633 1,169,2412
Tanzania 636,543 36,070,7992
Uganda 465,710 26,390,2582
Zambia 194,571 11,025,6902
Zimbabwe 64,797 1,2671,8602
 There are 25 million cases of pneumonia world wide are reported each year and
about 63,500 people died from the disease.

II. OBJECTIVES

General
I should be able to able to make use of the knowledge, skills, and attitude I have
built up in myself as a preparation for this clinical exposure. In the process, I should be
able to improve these three domains and motivate our patient to the road of recovery.
Specific:
Cognitive
1. Learn important information about Pneumonia; its causes, signs and
symptoms, occurrence, diagnostic tests, and treatment.

2. Know what happens to the body once this disease occurs.

3. Formulate an effective nursing care plan to relieve the problems

experienced by the patient and achieved plan goals.

4. Apply the different kinds of interventions performed.

Psychomotor
1. Assess the patient’s condition in a cephalocaudal manner noting her
general physique and patterns of functioning.

2. Perform appropriate interventions to each of the NANDA-approved

diagnoses we have formulated.

Attitude
1. Interview the patient / folks in a therapeutic manner using different means
of therapeutic communication.

2. Successfully establish trust and rapport with the patient

II. ANATOMY AND PHYSIOLOGY

 The respiratory system is situated in the thorax, and is responsible for gaseous
exchange between the circulatory system and the outside world. Air is taken in via the
upper airways (the nasal cavity, pharynx and larynx) through the lower airways (trachea,
primary bronchi and bronchial tree) and into the small bronchioles and alveoli within the
lung tissue.

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.
 Each alveolus has a thin membrane that allows oxygen and carbon dioxide to
pass in and out of the capillaries, the smallest of the blood vessels. When you take a
deep breath, the membrane unfolds and expands. Fresh oxygen moves into the
capillaries, and carbon dioxide passes from the capillaries into the bloodstream, where it
is carried out of the body through the 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.

Pneumonia may be defined according to its location in the lung:

• Lobar pneumonia occurs in one part, or lobe, of the lung.

• Bronchopneumonia tends to be scattered throughout the lung.

III. VITAL INFORMATION

 Name: E.A
Age: 87 years old
Sex: Female
Address: Cogon, Panitan Capiz
Civil Status: Married
Religion: Roman Catholic
Occupation: ----
Date & Time admitted: August 18, 2009 / 3:29 pm
Ward: IHM – Room 224
Chief Complaint: Cough
Impression/Admitting Diagnosis: Aspiration Pneumonia
Final Diagnosis: Aspiration Pneumonia
Attending Physician: Dr. M. Obligacion and Dr. J. Arancillo

V. CLINICAL ASSESSMENT

A. Nursing History
1 month prior to admission, the patient is (+) to CVA but it is undiagnosed.
Mrs. E.A. is (-) to HPN and (-) DM.
1 week prior to admission, E.A. was noted to have cough associated with
fever, undocumented. So she sought consult with AP given Co.amoxiclav with
relief of symptoms.
Day of admission, folks decided to have patient admitted for general
check – up.

B. Past Health Problem/Status

Mrs. E.A has no notable Illness. She sometimes experiences cough, fever
and cold. She is a Non alcoholic and Non Smoker.

C. Family History Illness

Mrs. E.A. family is (+) in Hypertension.
OBGyne HX = G10P10

E. F.A. Died of
A 94 Asthma
87

58 56 40 18
67 65 60 54 52 41

Lung cancer
LEGEND:

FEMALE

MALE

DISEASED

VI. BRIEF SOCIAL, CULTURAL, AND RELIGIOUS BACKGROUND

 Educational Background

o Mrs. E.A. is a high school graduate.

 Occupational Background

o Mrs. E.A. is a housewife.

 Religious Practices

o Mrs. E.A. is a Roman Catholic.

 Economic Status

o Mrs. E.A. is supported by her children in her daily living.

VII. CLINICAL INSPECTION

A. Vital Signs
V/S taken upon admission:
T – 36.1 °C P – 89 bmp RR – 18 bmp CR – 92 bmp BP–130/90mmHg

V/S taken during my care:

T – 36.5 °C P – 83 bmp RR – 21 bmp CR – 86 bmp BP – 120/80 mmHg

B. Height: 152 cm
Weight: 44 kg
BMI: 19.0
Mrs. M.L is in a Normal Weight.

C. Physical Assessment
I. General Appearance: Patient is as sleep most of the time, cannot
move freely and is not responsive.

II. Skin: Moist

Hair: There is no presence of dandruff and no presence of lice.

Nails: She had a short nails.

III. Head: normocephalic and symmetric; no lesions, lumps, tenderness.

Face: Face symmetric.

Lymphatic: no involuntary movements, symmetric facial movements.

IV. Eyes: Dirty sclera, Pale conjunctiva, Presence of cataract at the left
eye.

Ears: Auricles brown in color, symmetrical in size and position; no

lesions, tenderness, scaling, and discharge in palpation. Unable to
hear sounds distinctly.

Nose: symmetric in size and position. No lesions, tenderness, scaling,

and discharge on palpation. No nasal congestion observed.

Mouth: lips symmetrical, soft, and dry.

V. Neck and upper extremities: symmetrical, no masses or swelling.

VI. Chest, breast and axilla: symmetrical; no masses noted.

VII. Respiratory System: symmetrical chest expansion, (+) crackles both

LF, (+) rhonchi both LF.

VIII. Cardiovascular System: cardiac rate is normal and weak.

IX. Gastrointestinal system: bowel movement is regular.

 X.Genitor-urinary system: she can micturate well, no pain noted.

XII. Musculoskeletal system: Unable to flex and extend both upper and
lower extremities. No tenderness or swelling on joints or bones. Good hand
grip.

D. GENERAL APPRAISAL

I. Speech: She cannot speak clearly but able to make sounds.

II. Language: Bisaya

III. Hearing: She can’t easily responds when called and claims to hear
well.

IV. Mental status: She is illogical. Cannot respond easily to verbal

command but is not experiencing any mental deficits.

V. Emotional Status: she is emotionally stable. She is currently not

grieving for anyone.

VIII. LABORATORY AND DIAGNOSTIC DATA

A. Chemistry
Fluid: serum
August 24, 2009 Result Normal Values Significance of the
16:52:35 Abnormal Result
renal disease that
Creatinine 28.2 62.0 – 106.0 umol/L affects the
glomerular filtration
rate.
Potassium 3.10 3.50 – 5.10 mmol/L Within Normal
Range
Sodium 136.3 62.0 – 106.0 umol/L Starvation &
diabetic acidosis,
Dehydration
ALT 26

B. Hematology
Blood Exam Result Normal Values Significance of the
 August 24, 2009 Abnormal Result
WBC 3.8 4.5 – 11.0 10^ g/L Within Normal Range
RBC 4.62 M: 4-6 – 6.2 10^ Within Normal Range
12/L
F: 4.2 – 5.4 10^
12/L
Hemoglobin 135 M: 130 – 180 g/L Within Normal Range
F: 115 – 165 g/L
Hematocrit L 0.41 M: 0.40 – 0.54 vol Within Normal Range
- fr
F: 0.37 – 0.47 vol
– fr
Mean Cell volume 90.0 78 – 79 fl Folate deficiency,
(MVC) B12 deficiency,
Hereditary
spherocytosis
Mean cell 29.1 27 – 32 pg Within Normal Range
Hemoglobin (MCH)
Mean Cell 32.5 30 – 35 g/dl Within Normal Range
haemoglobin
concentration(MCHC)
RDW 13.2 11 – 16 % Within Normal Range
Neutrophil 50.0 50-70 % Within Normal Range
Stabs 1.0 2-3
Eosinophil 11.0 0 - 3% Infection,
Inflammation,
Leukemia, Allergic
reaction
Basophil 0.0 0–1% Anaplastic anemia,
Bone marrow
depression,
Pernicious anemia,
Some infectious or
parasitic disease
Lymphocytes 29.0 20 – 45 % Within Normal Level
Monocytes 9.0 0–8% Chronic Infection

C. ABG analysis
August 24, 2009 Result Normal Values Significance of the
Abnormal Result
pH 7.45 7.35 – 7.45 Within Normal Value
PCO2 41.3 35 – 45 mmHg Within Normal Value
PO2 46.0 80 – 100 mmHg Anemia &
Obstructive
Pulmonary disease
HCO2 28.3 22 – 26 mmol/L
TCO2 66.4 Mmol/L
D. X-RAY result

Bibasal pneumonia with consolidation with minimal regression in the Right.

Right upper lobe Pneumonia, no significant interval change
Atheromatons & Tortuous aorta
Bronhiectasis, both lung bases
Dextroscooliosis, thoracic spine
IX. PATHOPHYSIOLOGY

Liquid or object enters the respiratory system

through inhalation of microorganism
(Infectious Process)

Infection occurs

Immune reaction follows

Under the infection and immune

response inflammation process
proceeded.

Vasoconstriction

Release of chemical
mediators

Vasodilatation and increase

capillary permeability

Increase blood pressure then formation

of heat and redness to the site

Swelling and pain emerges then led to

loss of tissue functions

Increase in local
Capillary leaks

Increased permeability of cell members

allowing leukocytes and fibrin to
consolidate in involved areas

fibrin and leukocytes stiffen there will be a

decrease in lung compliance & decrease
lung vital capacity which decreases gas
exchange that leads to hypoxemia

Hypoxia

Triggers the compensatory

mechanism

ASPIRATION PNEUMONIA
 XI. NURSING MANAGEMENT
A. Concept Map of Nursing Problems

Impaired Gas Exchange

S/Sx:
Tachycardia
Restlessness
Dyspnea
Hypoxia

Therapy: O2 therapy, 2
liters.

Ineffective Airway Risk for less than body

Clearance requirements

S/Sx: S/Sx:
Inability to cough effectively - Starvation
Anxiety CC: Cough - Diabetic acidosis
Dyspnea Dx: Aspiration - Dehydration
Dry cough Pneumonia
Meds & Diet: OTF (1,500
Meds: Metronidazole kilocalories / day ÷ 6
Fluimucil feedings).
Celebrex Macrobee with Iron

Activity Intolerance

S/Sx:
Lethargy
Verbal reports of weakness
Fatigue
Exhaustion

Meds & Therapy: Zantac

Rehab /
Exercise therapy.
XII. DISCHARGE PLANNING

M (MEDICATION)

Take the entire course of any prescribed medications. After a patient’s

temperature returns to normal, medication must be continued according to the
doctor’s instructions, otherwise the pneumonia may recur. Relapses can be far
more serious than the first attack.

E (EXERCISE & ACTIVITY)

Get plenty of rest. Adequate rest is important to maintain progress toward

full recovery and to avoid relapse.

Instruct the folks to monitor the client’s position, she must be in moderate
high back rest and change position every two hours.

T (TREATMENT)

Give supportive treatment. Proper diet and oxygen to increase oxygen in the
blood when needed.

Treatment is one of the main factors in restoration of health and curing of the
failure in the body system. Treatments are given to the patient for a specific time
until treatment is not more needed by the patient.

H (HOME TEACHING IN REACTION TO DISEASE, ETIOLOGY & HYGIENE

MEASURES)

Encourage the folks to wash patient’s hands. The hands come in daily
contact with germs that can cause pneumonia. These germs enter one’s body
when he touch his eyes or rub his nose. Washing hands thoroughly and often
can help reduce the risk.

Tell folks to avoid exposing the patient to an environment with too much
pollution (e.g. smoke). Smoking damages one’s lungs’ natural defenses against
respiratory infections.

Protect others from infection. Try to stay away from anyone with a
compromised immune system. When that isn’t possible, a person can help
protect others by wearing a face mask and always coughing into a tissue.
O (OUT PATIENT FOLLOW – UP)

Keep all of follow-up appointments. Even though the patient feels better,
his lungs may still be infected. It’s important to have the doctor monitor his
progress.

D (DIET)

Drink lots of fluids, especially water. Liquids will keep patient from becoming
dehydrated and help loosen mucus in the lungs.

Controlled diets are designed to avoid excessive sodium retention.

S (SPIRITUALITY)
Advise the patient to join the church activities. Keeping faith in God and believing
in him can uplift some distress.

XIV. MY JOURNEY

Being a third year student taking up Nursing is challenging, nerve breaking, head
cracking, interesting, and exhausting. But being a Nurse is somewhat opposite, because
every single intervention you do is remarkable and very accommodating to your patient. I
am a future Nurse and I admit that I’ve been devoted in rendering care to my patient until
such time that she recovers from her illness.

Mrs E.A is an 87 years old woman. She’s from Cogon, Panitan Capiz and has
been admitted in the Immaculate Heart of Mary (IHM) last August 18, 2009 at around
3:20 pm, with the Chief Complaint of Cough & with the Diagnosis of Aspiration
Pneumonia. She has a Nasogastric Tube Feeding (NGT) and Oxygen Saturation of 2
liters.

I always check her IVF (PNSS 1L x 80 cc/hour) every hour to be sure that it is not
delayed or advanced. I follow up her IVF when it was consumed. Her vital signs are
monitored every hour and her Intake & Output is monitored Q shift. I assist her in her
OTF (1,500 kilocalories / day ÷ 6 feedings). I always see to it that her medications are
given at the right time to prevent complications. I assist her in her morning care and oral
care every morning. I also changed her linens and assist her in combing her hair.
It feels so great to know that you did something right and good to your patient.
When you will ask me, “What is good in being a nurse?” I would answer this way, being
a Nurse is AWESOME because I know that I am one of God’s instruments to save
people and help the poor in my own dearest way. I believe that being a Nurse is not
merely a job or a chosen career. It is a Responsibility, Commitment, Destiny and it’s your
Calling from up above. To tell you frankly, those are part of the things that motivates me
for doing the best that I can do as a STUDENT NURSE. 

XIV.BIBLIOGRAPHY / REFERENCES

- Nursing Care Plan (Guideline for individualizing Client Care

across the life span).
- Nurse’s Pocket Guide
- Nurse’s Manual of Laboratory Tests and Diagnostic Procedures
- Fundamentals of Nursing
- 2009 Lippincott’s Drug Guide
- MIMS
- www. Yahoo.com
- www. Google.com
- www. Wekipedia.com