A.

Synthesis of the disease

1) Definition of the disease (Book-based)

Pneumonia is an inflammatory condition of the interstitial lung tissue in which fluid and
blood cells escape into the alveoli. More than 3 million people in the United States are
diagnosed each year with pneumonia. The disease process begins with an infection in the
alveolar spaces. As the organism multiplies, the alveolar spaces fill with fluid, white blood cells,
and cellular debris from phagocytosis of the infectious agent. The infection spreads from the
alveolus and can involve the distal airways (bronchopneumonia), part of a lobe (lobular
pneumonia), or an entire lung (lobar pneumonia).
The inflammatory process causes the lung tissue to stiffen, thus resulting in a decrease
in the work of breathing. The fluid-filled alveoli cause a physiological shunt, and venous blood
passes unventilated portions of lung tissue and returns to the left atrium unoxygenated. As the
arterial oxygen tension falls, the patient begins to exhibit the signs and symptoms of hypoxemia.
In addition to hypoxemia, pneumonia can lead to respiratory failure and septic shock. Infection
may spread via the bloodstream and cause endocarditis, pericarditis, meningitis, or bacteremia.
Diagnostic test performed to diagnose pneumonia include X-ray, sputum exam and
culture, complete blood count (CBC’s), Arterial blood gas (ABG), bronchoscopy and pulse
oximetry. Chest X-rays disclose infiltrates, confirming the diagnosis. Sputum specimen for Gram
stain and culture and sensitivity tests shows acute inflammatory cells. White blood cell count
indicates leukocytosis in bacterial pneumonia and a normal or low count in viral or mycoplasmal
pneumonia. Blood cultures reflect bacteremia and help to determine the causative organism.
Arterial blood gas (ABG) levels vary depending on the severity of pneumonia and underlying
lung state. Bronchoscopy or transtracheal aspiration allows the collection of material for
culture. Pleural fluid culture may also be obtained. Pulse oximetry may show a reduced level of
arterial oxygen saturation.
Treatment for pneumonia is antimicrobial therapy based on the causative agent.
Therapy should be reevaluated early in the course of treatment. Supportive measures include
humidified oxygen therapy for hypoxia, bronchodilator therapy, antitussives, mechanical
ventilation for respiratory failure, a high-calorie diet and adequate fluid intake, bed rest, and an
analgesic to relieve pleuritic chest pain. A patient with severe pneumonia or mechanical
ventilation may need positive end expiratory pressure to maintain adequate oxygenation.
 Without proper treatment, pneumonia can lead to life-threatening complications such
as septic shock, hypoxemia, and respiratory failure. The infection can also spread within the
patient’s lungs, causing empyema or lung abscess. It also may spread by way of the blood
stream or by cross-contamination to other parts of the body, causing bacteremia, endocarditis,
pericarditis, or meningitis (Kumar, et al., 2005).

2) Modifiable/ Non-modifiable Factors (Book based)

NON-MODIFIABLE FACTORS

AGE
Too young and too old have an increased risk to have infections like pneumonia due to
not fully developed immune response and degenerative effects respectively.

GENETIC CONSIDERATIONS
Heritable immune responses could be protective or increase susceptibility (Kumar, et al.,
2005).

MODIFIABLE FACTORS

COMMON COLDS AND OTHER VIRAL INFECTIONS/ INFLUENZA

Common cold is a general term for coryza or inflammation of the respiratory mucous
membranes from the nasal mucosa to the nasal sinuses, throat, larynx, trachea and bronchi
(Kumar, et al., 2005). Influenza is an acute contagious respiratory infection marked by fevers,
chills, muscle aches, headache, prostration, runny nose, watering eyes, cough, and sore throat
caused by either influenza A, B or C (Kumar, et al., 2005). These conditions could lead to
secondary bacterial infection like pneumonia.

ABDOMINAL SURGERY
This deals with the manual and operative procedures form correction of deformities and
defects, repair of injuries, and diagnosis and cure of certain diseases in the abdominal region
 (Kumar, et al., 2005). If an individual undergone an abdominal surgery, he/she will have
difficulty in coughing out secretions due to the presence of incision site making secretions
immobile and being retained in the lungs.

IMMUNOSUPPRESSIVE THERAPY
Is the treatment with drugs such as cyclosporine or mycophenolate that impairs
immune responses such as in Pneumocystis carinii (Kumar, et al., 2005). This would lower down
an individual’s immune response to certain bacteria and/or viruses making him or her
susceptible to infection.

MALNUTRITION
These are any disease-promoting condition resulting from either an inadequate or
excessive exposure to nutrients caused by inadequate calorie consumption, intake of essential
micronutrients, improper absorption and distribution of foods within the body, overeating and
intoxication by nutrient excess (Kumar, et al., 2005). This would lower down an individual’s
immune response to certain bacteria and/or viruses making him or her susceptible to infection.

ASPIRATION
Drawing in foreign bodies via the nose, throat or lungs on inspiration such as vomitus.

CIGARETTE SMOKING
Smoking interferes with many of the body’s natural defenses against pneumonia just
such us of that cilliary function which helps sweep away mucus and other bacteria in the
respiratory tract.

3) Signs and Symptoms with Rationale (Book-based)

FATIGUE
Frequent periods of dyspnea, which causes a person to have aversion to food, and the
infection, which causes an increase in the basal metabolic rate in order to sustain the
immunologic resistance, increases the demand for oxygen, which would be inadequate for a
person who has impaired gas exchange due to excessive lung consolidation of exudates in the
lung alveoli, impairing gas exchange (Black, et al., 2009).
CYANOSIS
Cyanosis is a blue, gray, slate or dark purple discoloration of the skin or mucous
membranes caused by deoxygenated or reduced hemoglobin in the blood due to impaired gas
exchange brought by the consolidation of the lungs (Black, et al., 2009).

TACHYPNEA
Tachypnea is an abnormally fast respiration brought about by increase in body
temperature and to compensate for low oxygen concentrations. Any inflammatory response
such as fever increases respiration to meet the increase in metabolic requirement to elicit
inflammation or to increase cellular resistance to an infection in cases such as pneumonia.
Prolonged congestion of exudates in the parenchyma may interfere with the gas exchange
causing metabolic acidosis which the body compensates by increasing respiration (Berman, et
al., 2007)

PLEURITIC CHEST PAIN

Acute pain related to inflammatory or irritation of the parietal pleura when
fibrinosuppurative pleuritis is present, occurring during the early stages of consolidation that
extends to the surface pleural tissues (Kumar, et al., 2005).

COUGH
A forceful, sometimes violent expiratory effort preceded by a preliminary inspiration.
Pulmonary cough is often deep and may be hacking and irritating in the early stages of lung
infections; in later stages, it is frequent and productive (Venes, 2009).

NASAL SECRETIONS, SPUTUM PRODUCTION

Mucus expelled from the lung by coughing which may contain a variety of materials
from the respiratory tract, including in some instance cellular debris, mucus, blood, pus, caseous
material, and/ or microorganisms. Creamy yellow sputum suggests staphylococcal pneumonia,
green sputum suggests Pseudomonas organisms and currant jelly-like sputum indicates
Klebsiella (clear sputum means no infective causes) (Venes, 2009).
 HEMOPTYSIS
Hemoptysis is the expectoration of blood that arises from the larynx, trachea, bronchi,
or lungs. This symptom may occur during the last stage of pneumonia, resolution, in which
enzymes are produced in the alveoli to dissolve consolidated exudates (Venes, 2009).

ABNORMAL BREATH SOUNDS

Breath sounds due to a disease process altering the airway or airflow dynamics.
Alterations in breath sounds may be due to vibration of solid structures, airflow through
narrowed airways, and abrupt changes in airway pressure. The following are common
adventitious sounds found in pneumonia cases:

CRACKLES/RALES
A discontinuous adventitious lung sound heard on auscultation of the chest, produced
by air passing over retained airway secretions or the sudden opening of collapsed airways, heard
on inspiration or expiration

RHONCHUS
A low-pitched wheezing, snoring or squeaking sound heard during auscultation of the
chest of a person with partial airway obstruction caused by occlusion of respiratory passage by
mucus or other secretions in the airway (Venes, 2009).

HYPERTHERMIA
Hyperthermia or fever is an abnormal elevation in temperature above the usual range,
usually one to four degrees Celsius. Fever caused by infection is brought about by the release of
cytokines such as IL-1, interleukin 1, and TNF, tumor necrotizing factor, (called endogenous
pyrogens) by stimulated leukocytes that helps produce prostaglandins that act upon the
hypothalamus to reset the temperature set point at a higher level (Kumar, et al., 2005).

4.) Health Promotion and Preventive Aspects of the Disease

Several ways to prevent infectious Pneumonia like cessation of smoking, it is important since it
will not only help to limit lung damage but also because cigarette smoking interferes with many of the
body’s natural defenses against pneumonia.
 Vaccination is also important in preventing pneumonia in children and adults. Vaccinations
against Haemophilus Influenzae and Streptococcus pneumoniae in the first year of life have greatly
reduced their role in pneumonia in children. These would also decreased incidence of these against
infections in adults because adults may acquire infections from children. Flu vaccine prevents
pneumonia and other problems cause by the influenza virus. Furthermore, health care workers, nursing
home residents and pregnant women should receive the vaccine. A repeat vaccination may also be
required after five to ten years, the vaccines that confers immunity against pneumococus. It is also given
to people who most at risk like those the age of 65 with chronic heart, lung and liver disease.
Aside from vaccines, deep-breathing exercise may also help in preventing pneumonia especially
if you are in the hospital—for example, while recovering from surgery. Drinking plenty of fluids does not
suppress, because retained secretions interfere with gas exchange and may slow recovery. Increase oral
fluid intake at least 2-3 L/day because adequate hydration thins and loosens pulmonary secretions.
Humidification may be used to loosen secretions and improve ventilation.
Lastly the best solution to prevent infections is proper hand washing and sanitation. Always
wash your hands frequently can prevent the spread of viral respiratory illness, taking vitamins especially
vitamin C will also be helpful in reducing the risk for having CAP. Avoiding stress, avoid over exertion and
possible exacerbation of symptoms.
The solution to the problem is preventing the infections rather than curing them. As the saying
goes “PREVENTION IS BETTER THAN CURE”, these preventive measures includes avoid uncooked or
unwashed fruits and vegetables in areas when sanitation is poor, good personal hygiene, wear
protective clothing and use insect repellent are some of the ways to prevent pneumonia.
B. Synthesis of the disease

1) Definition of the disease (Client-Centered)

Pneumonia is an inflammatory condition of the interstitial lung tissue in which fluid and
blood cells escape into the alveoli. The disease process begins with an infection in the alveolar
spaces. As the organism multiplies, the alveolar spaces fill with fluid, white blood cells, and
cellular debris from phagocytosis of the infectious agent. The infection spreads from the
alveolus and can involve the distal airways (bronchopneumonia), part of a lobe (lobular
pneumonia), or an entire lung (lobar pneumonia).
The inflammatory process causes the lung tissue to stiffen, thus resulting in a decrease
in the work of breathing. The fluid-filled alveoli cause a physiological shunt, and venous blood
passes unventilated portions of lung tissue and returns to the left atrium unoxygenated. As the
arterial oxygen tension falls, the patient begins to exhibit the signs and symptoms of hypoxemia.
In addition to hypoxemia, pneumonia can lead to respiratory failure and septic shock. Infection
may spread via the bloodstream and cause endocarditis, pericarditis, meningitis, or bacteremia.

2) Modifiable/ Non-modifiable Factors (Client-Centered)

NON-MODIFIABLE FACTORS

AGE
The patient has reached the age of 79. With his condition and age, his immune
response is not fully functional due to degenerative effects. His susceptibility to
pneumonia is significantly increased inability to fully respond to the stimuli that causes
the effects of pneumonia.

MODIFIABLE FACTORS

COMMON COLDS AND OTHER VIRAL INFECTIONS/ INFLUENZA

Common cold is a general term for coryza or inflammation of the respiratory mucous
membranes from the nasal mucosa to the nasal sinuses, throat, larynx, trachea and bronchi
(Kumar, et al., 2005). Influenza is an acute contagious respiratory infection marked by fevers,
 chills, muscle aches, headache, prostration, runny nose, watering eyes, cough, and sore throat
caused by either influenza A, B or C (Kumar, et al., 2005). These conditions could lead to
secondary bacterial infection like pneumonia due to the spread of bacteria from upper to lower
respiratory tract. The patient was noted to have productive cough 1 week prior to admission.

CIGARETTE SMOKING
Smoking interferes with many of the body’s natural defenses against pneumonia just
such us of that cilliary function which helps sweep away mucus and other bacteria in the
respiratory tract.

3) Signs and Symptoms with Rationale (Client-Centered)

FATIGUE AND DIFFICULTY OF BREATHING.

Frequent periods of dyspnea, which causes a person to have aversion to food, and the
infection, which causes an increase in the basal metabolic rate in order to sustain the
immunologic resistance, increases the demand for oxygen, which would be inadequate for a
person who has impaired gas exchange due to excessive lung consolidation of exudates in the
lung alveoli, impairing gas exchange (Black, et al., 2009). The patient’s chief complaint was
difficulty of breathing.

TACHYPNEA
Tachypnea is an abnormally fast respiration brought about by increase in body
temperature and to compensate for low oxygen concentrations. Any inflammatory response
such as fever increases respiration to meet the increase in metabolic requirement to elicit
inflammation or to increase cellular resistance to an infection in cases such as pneumonia.
Prolonged congestion of exudates in the parenchyma may interfere with the gas exchange
causing metabolic acidosis which the body compensates by increasing respiration (Berman, et
al., 2007). Upon admission, patient respiratory rate is 24 cpm.

COUGH
A forceful, sometimes violent expiratory effort preceded by a preliminary inspiration.
Pulmonary cough is often deep and may be hacking and irritating in the early stages of lung
infections; in later stages, it is frequent and productive (Venes, 2009). The patient has
productive cough 1 week prior to admission.

NASAL SECRETIONS, SPUTUM PRODUCTION

Mucus expelled from the lung by coughing which may contain a variety of materials
from the respiratory tract, including in some instance cellular debris, mucus, blood, pus, caseous
material, and/ or microorganisms. The patient has productive cough 1 week prior to admission.

ABNORMAL BREATH SOUNDS

Breath sounds due to a disease process altering the airway or airflow dynamics.
Alterations in breath sounds may be due to vibration of solid structures, airflow through
narrowed airways, and abrupt changes in airway pressure. The following are common
adventitious sounds found in pneumonia cases:

CRACKLES/RALES
A discontinuous adventitious lung sound heard on auscultation of the chest, produced
by air passing over retained airway secretions or the sudden opening of collapsed airways, heard
on inspiration or expiration. Rales was present on the patient’s both lung fields upon
auscultation.

RHONCHUS
A low-pitched wheezing, snoring or squeaking sound heard during auscultation of the
chest of a person with partial airway obstruction caused by occlusion of respiratory passage by
mucus or other secretions in the airway (Venes, 2009).

HYPERTHERMIA
Hyperthermia or fever is an abnormal elevation in temperature above the usual range,
usually one to four degrees Celsius. Fever caused by infection is brought about by the release of
cytokines such as IL-1, interleukin 1, and TNF, tumor necrotizing factor, (called endogenous
pyrogens) by stimulated leukocytes that helps produce prostaglandins that act upon the
 hypothalamus to reset the temperature set point at a higher level (Kumar, et al., 2005). The
patient experienced an on and off fever I day prior to admission.

4.) Health Promotion and Preventive Aspects of the Disease

Several ways to prevent infectious Pneumonia like cessation of smoking, it is important since it
will not only help to limit lung damage but also because cigarette smoking interferes with many of the
body’s natural defenses against pneumonia.
Vaccination is also important in preventing pneumonia in children and adults. Vaccinations
against Haemophilus Influenzae and Streptococcus pneumoniae in the first year of life have greatly
reduced their role in pneumonia in children. These would also decreased incidence of these against
infections in adults because adults may acquire infections from children. Flu vaccine prevents
pneumonia and other problems cause by the influenza virus. Furthermore, health care workers, nursing
home residents and pregnant women should receive the vaccine. A repeat vaccination may also be
required after five to ten years, the vaccines that confers immunity against pneumococus. It is also given
to people who most at risk like those the age of 65 with chronic heart, lung and liver disease.
Aside from vaccines, deep-breathing exercise may also help in preventing pneumonia especially
if you are in the hospital—for example, while recovering from surgery. Drinking plenty of fluids does not
suppress, because retained secretions interfere with gas exchange and may slow recovery. Increase oral
fluid intake at least 2-3 L/day because adequate hydration thins and loosens pulmonary secretions.
Humidification may be used to loosen secretions and improve ventilation.
Lastly the best solution to prevent infections is proper hand washing and sanitation. Always
wash your hands frequently can prevent the spread of viral respiratory illness, taking vitamins especially
vitamin C will also be helpful in reducing the risk for having CAP. Avoiding stress, avoid over exertion and
possible exacerbation of symptoms.
The solution to the problem is preventing the infections rather than curing them. As the saying
goes “PREVENTION IS BETTER THAN CURE”, these preventive measures includes avoid uncooked or
unwashed fruits and vegetables in areas when sanitation is poor, good personal hygiene, wear
protective clothing and use insect repellent are some of the ways to prevent pneumonia.