I.

INTRODUCTION

This is a case of a 42-year-old woman who was diagnosed with Community Acquired Pneumonia with effusion at the Right Lung.

Community-acquired pneumonia (CAP) is a disease in which individuals who have not recently been hospitalized develop an infection of the lungs (pneumonia). CAP is a common illness and can affect people of all ages and often causes problems like difficulty in breathing, fever, chest pains, and a cough. CAP occurs because the areas of the lung which absorb oxygen (alveoli) from the atmosphere become filled with fluid and cannot work effectively. Community acquired pneumonia occurs throughout the world and is a leading cause of illness and death. Causes of CAP include bacteria, viruses, fungi, and parasites. CAP can be diagnosed by symptoms and physical examination alone, though x-rays, examination of the sputum, and other tests are often used. Individuals with The kind of disease sometimes require treatment in a hospital and are primarily treated with antibiotic medication. Community-acquired pneumonia develops in people with limited or no contact with medical institutions or settings. The most commonly identified pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms (ie, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella sp). Symptoms and signs are fever, cough, pleuritic chest pain, dyspnea, tachypnea, and tachycardia.

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Diagnosis is based on clinical presentation and chest x-ray. Treatment is with empirically chosen antibiotics. Prognosis is excellent for relatively young or healthy patients, but much pneumonia, especially when caused by S. pneumoniae or influenza virus, are fatal in older, sicker patients. Etiology Many organisms cause community-acquired pneumonia, including bacteria, viruses, and fungi. Pathogens vary by patient age and other factors 1: Pneumonia: Community-Acquired Pneumonia in Children 2: Pneumonia: Community-Acquired Pneumonia in Adults but the relative importance of each as a cause of communityacquired pneumonia is uncertain, because most patients do not undergo thorough testing, and because even with testing, specific agents are identified in < 50% of cases. S. pneumoniae, H. influenzae, C. pneumoniae, and M. pneumoniae are the most common bacterial causes. Pneumonia caused by chlamydia and mycoplasma are often clinically indistinguishable from pneumonias with other causes. Common viral agents include respiratory syncytial virus (RSV), adenovirus, influenza viruses,

metapneumovirus, and parainfluenza viruses. Bacterial superinfection can make distinguishing viral from bacterial infection difficult. C. pneumoniae accounts for 2 to 5% of community-acquired pneumonia and is the 2nd most common cause of lung infections in healthy people aged 5 to 35 yr. C. pneumoniae is commonly responsible for outbreaks of respiratory infection within families, in college dormitories, and in military training camps. It causes a relatively benign form of pneumonia that infrequently requires hospitalization. Chlamydia psittaci pneumonia (psittacosis) is rare and occurs in patients who own or are often exposed to birds. A host of other organisms cause lung infection in immunocompetent patients, although the term community-acquired pneumonia is usually reserved for the more common bacterial and viral etiologies. Q fever, tularemia, anthrax, and plague are uncommon bacterial syndromes in which pneumonia may be a prominent feature; the latter three should raise the suspicion of bioterrorism. Adenovirus, Epstein-Barr virus, and coxsackievirus are common viruses that rarely cause pneumonia. Varicella virus and hantavirus cause lung infection as part of

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adult chickenpox and hantavirus pulmonary syndrome; a coronavirus causes severe acute respiratory syndrome. Common fungal pathogens include Histoplasma capsulatum (histoplasmosis) and Coccidioides immitis (coccidioidomycosis). (blastomycosis) and Less common fungi include

Blastomyces

dermatitidis

Paracoccidioides

braziliensis

(paracoccidioidomycosis). Pneumocystis jiroveci commonly causes pneumonia in patients who have HIV infection or are immunosuppressed. Parasites causing lung infection in developed countries include Toxocara canis or T. catis (visceral larva migrans), Dirofilaria immitis (dirofilariasis), and Paragonimus westermani (paragonimiasis). (For a discussion of pulmonary TB or of specific microorganisms, see Mycobacteria.) Symptoms include malaise, cough, dyspnea, and chest pain. Cough typically is productive in older children and adults and dry in infants, young children, and the elderly. Dyspnea usually is mild and exertional and is rarely present at rest. Chest pain is pleuritic and is adjacent to the infected area. Pneumonia may manifest as upper abdominal pain when lower lobe infection irritates the diaphragm. Symptoms become variable at the extremes of age; infection in infants may manifest as nonspecific irritability and restlessness; in the elderly, as confusion and obtundation. Signs include fever, tachypnea, tachycardia, crackles, bronchial breath sounds, egophony, and dullness to percussion. Signs of pleural effusion may also be present (see Mediastinal and Pleural Disorders: Symptoms and Signs). Nasal flaring, use of accessory muscles, and cyanosis are common in infants. Fever is frequently absent in the elderly. Symptoms and signs were previously thought to differ by type of pathogen, but presentations overlap considerably. In addition, no single symptom or sign is sensitive or specific enough to predict the organism. Symptoms are even similar for noninfective lung diseases such as pulmonary embolism, pulmonary malignancy, and other inflammatory lung diseases. Diagnosis

Chest x-ray Consideration of pulmonary embolism Sometimes identification of pathogen

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Diagnosis is suspected on the basis of clinical presentation and is confirmed by chest x-ray (see Table 3: Pneumonia: Probability of Pneumonia Given Chest X-ray Infiltrate ). The most serious condition misdiagnosed as pneumonia is pulmonary embolism, which may be more likely in patients with minimal sputum production, no accompanying URI or systemic symptoms, and risk factors for thromboembolism (see Table 1: Pulmonary Embolism (PE): Risk Factors for Deep Venous Thrombosis and Pulmonary Embolism). Chest x-ray almost always demonstrates some degree of infiltrate; rarely, an infiltrate is absent in the first 24 to 48 h of illness. In general, no specific findings distinguish one type of infection from another, although multilobar infiltrates suggest S. pneumoniae or Legionella pneumophila infection and interstitial pneumonia suggests viral or mycoplasmal etiology. Hospitalized patients should undergo WBC count and electrolytes, BUN, and creatinine testing to classify risk and hydration status. Two sets of blood cultures are often obtained to detect pneumococcal bacteremia and sepsis, because about 12% of all patients hospitalized with pneumonia have bacteremia; S. pneumoniae accounts for
2

3 of these cases. Whether the results of blood cultures alter therapy commonly enough

to warrant the expense is under study. Pulse oximetry or ABG should also be done. Pathogens: Attempts to identify a pathogen are not routinely indicated; exceptions may be made for critically ill patients, patients in whom a drug-resistant or unusual organism is suspected (eg, TB, P. jiroveci), and patients who are deteriorating or not responding to treatment within 72 h. The use of Gram stain and culture of sputum for diagnosis is of uncertain benefit, because specimens often are contaminated and because overall diagnostic yield is low. Samples can be obtained noninvasively by simple expectoration or after hypertonic saline nebulization for those unable to produce sputum. Alternatively, patients can undergo bronchoscopy or endotracheal suctioning, either of which can be easily done through an endotracheal tube in mechanically ventilated patients. Testing should include mycobacterial and fungal stains and cultures in patients whose condition is deteriorating and in those unresponsive to broad-spectrum antibiotics. Additional tests are indicated in some circumstances. Patients at risk of Legionella pneumonia (eg, patients who smoke, have chronic pulmonary disease, are > 40, receive chemotherapy, or take immunosuppressants for organ transplantation) should undergo testing for urinary Legionella antigen, which remains present long after treatment is initiated, but the test detects only L. pneumophila serogroup 1 (70% of

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cases). A 4-fold rise in antibody titers to 1:128 (or a single titer of 1:256 in a convalescent patient) is also considered diagnostic. These tests are specific (95 to 100%) but are not very sensitive (40 to 60%); thus, a positive test indicates infection, but a negative test does not exclude it. Infants and young children with possible RSV infection should undergo rapid antigen testing of specimens obtained with nasal or throat swabs. No other tests for viral pneumonias are done; viral culture and serologic tests are rarely clinically warranted. PCR testing for mycoplasma and chlamydia species, although not widely available, holds promise as a highly sensitive and specific rapid diagnostic test and is likely to play a greater role as PCR technologies are refined. Reason for choosing Pneumonia as our case This case study aims to identify patients health needs and problems in order to identify goals to promote the general health of the patient by providing proper intervention through the application of nursing process. We have chosen this case study in order to identify and determine the general health problems and needs of the patient with an admitting diagnosis of Community Acquired Pneumonia. This study also intends to help patient as well as its significant others to promote health and medical understanding of such condition through the application of the nursing theories and nursing skills. Our inadequate knowledge on Community Acquired Pneumonia motivated us to study the case suffered by most of my patients in medical ward. I wanted to have enough knowledge regarding this condition so that I could apply and handle such this kind of condition correctly.

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II. CLIENTS PROFILE

A. Socio-demographic Data Patient Y is a 42-year-old, female, single, a Roman Catholic from Lam-an, Ozamis City, Misamis Occidental. The patient was admitted for the first time at Northern Mindanao Medical Center last June 24, 2010; 3:00 pm. She arrived at the hospital, awake and conscious with chief complaints of dyspnea and persistent cough. She was then diagnosed with Community Acquired Pneumonia with Pleural Effusion. She currently weighs 41 kilograms from the previous weight of 50 kilograms and she is 53 tall. She was hospitalized last May 5, 2010 at Mayor Hilario Ramos Regional Training and Teaching Hospital due to appendicitis and undergone appendectomy. The patient usually uses over-the-counter drugs to manage health problems like fever and headache. Patient denied the use of tobacco, alcohol or illicit drug use, drinks coffee, cola or tea about 4-5 times a week and can consume 1 glass. She has no known food allergies but patient is allergic to Myrin P-forte.

B. Vital Signs The patients vital signs are so important, since it provides a baseline data in determining what are the alterations in body function. Any change from normal is considered to be an indication of the persons state of health and provides clues to the physiological functioning of the body. The patient had the following vital signs: blood pressure: 110/70 mmHg, pulse rate: 83 bpm, respiratory rate: 26 cpm, temperature: 38C.

C. History of Present Illness A month PTA, she began to have an undocumented fever, temporarily relieved by paracetamol 500 mg, associated with cough, body malaise with poor appetite. No consultation done. No medication taken. 8 days PTA, she began to have dyspnea which prompted consultation and subsequent admission at Mayor Hilario Ramos Training and Teaching hospital where she was diagnosed with Polycythemia vera and Essential thrombocytosis. She was referred to Celo Hospital because of incidence of decrease BP. She was brought to and admitted at Maria Reyna Hospital last June 6, 2010. There was onset of pleural effusion and R thoracentesis was done 3 hours after admission. 2 days later, CTT was done at R hemithorax.

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D. Health Patterns Assessment 1. Health Perception Health Management Pattern (pre-hospitalization) Patient X doesnt have regular consultations to physicians if she doesnt feel any deviation of his health status. She doesnt drink any alcoholic beverages or smoke and has no known food and drug allergies. Patient X is a worker from Misamis Occidental Hospital where she works as a secretary. She is the only person who works in the family.

2. Nutrition Patient X is not eating well and the appetite is poor. She wasnt experiencing nausea or vomiting either. She has no discomforts in terms of eating. But because of her disease condition, she was not eating well. She has rapid weight loss from 50 kg to 41 kg within a short span of time (1 month). The client has Chest Thoracostomy Tube draining well at the right mid-axillary line.

3. Elimination Pattern Mrs. X s stool as described by her everyday with no discomforts. Urinates approximately 3-4 times a daywith 100-200 cc per urination. Urine is slightly hazy in color but had no problem in control. as yellowish in color, defecates

4. Activities of daily living (Pre-hospitalization) The client is working as a secretary from one of the hospitals located at Misamis Occidental. Her duty hours is from 8 am to 5pm. She works extremely hard because her 2 sons are already in college and her husband has no work.

a. Activity-Exercise Pattern (while confined) Describe the patients functional abilities a. Feeding: dependent b. Bathing: dependent c. Toileting: dependent d. Bed mobility: dependent e. Dressing: dependent f. Grooming: dependent g. General mobility: dependent

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The patient need assistance in doing Range of Motion, thus, it requires assistance coming from the significant others and/or the attending nurse.

5. Cognitive- Perceptual Pattern The patient can understand & speak visayan, Filipino and English Patient is able to recall recent and past events and is oriented to time, person and place. He has the ability to explain things clearly and can make simple decisions. Patient can understand instructions as well as can perceive pain. Though, pain is not verbalized by the client. She takes prescribed medicines, takes vitamins daily and exercises regularly and used over-the-counter drugs as well.

6. Sleep and Rest Pattern She usually sleeps 8 hours/day. He has no history of sleep disturbances.prayers as well as singing lullaby was one of the effective methods to induce her sleeping.

7. Self Perception and Self-concept Pattern (self esteem, body image) Patient believes she ca surpass these problems that she is going through and she will go back to work so soon. She can maintain eye contact, able to talk well, speech is audible Emotional reaction to present condition: Check only: Calm: Depressed: Anxious: Angry: ____________ Fearful: Irritable: Worried: The patient was generally calm and easy to have conversation with but verbalized that she was worried and fearful because of th rcent condition that shes experiencing thus, it bothers her a lot every time there is procedure that is being performed. In addition to that, she was anxious due to financial constraints as well as she was depressed because with her condition she cannot do activities of daily living independently and worse, she cant work and provide the needs of her family since shes the only member in the family

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that has work.

8. Role and Relationship Pattern Patient verbalized having good family relationship. She has been a good mother to her sons and a good wife to his husband. She verbalized having good relationship with friends. 9. Coping Stress Tolerance Pattern Patient was calm but sometimes irritable, anxious, worried and depressed. She handles stress through sleeping.

10. Values-Belief Pattern The patient is a Roman Catholic and believes no superstitions. She together with her family attends mass every Sundays and both of the couples were active in the Couples for Christ.

E. Physical Assessment 1. Neurological Assessment

Orientation Appropriate behavior/communication Level of Consciousness Emotional State

Fully oriented Responsive and coherent Conscious Anxious (sometimes)

2. Skin

General Color Texture Turgor Temperature Moisture

Pallor rough elastic Warm Dry

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3. Head

Facial Movements Fontanels Hair Scalp

Symmetrical Closed Fine Clean

4. Eyes

Lids Preorbital Region Conjunctiva Sclera Reaction to light

Symmetrical Intact/full Pale Anicteric R- Brisk L- Brisk

Reaction to accommodation Visual Acuity Peripheral Vision

Uniform constriction / Convergence normal normal

5. Nose

Septum Mucosa Patency Gross Smell Sinuses

Midline Pinkish Both patent Normal/symmetrical Non-tender

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6. Ears

External Pinnae Tympanic Membrane Gross Hearing

Normoset; Symmetrical Intact Normal

7. Mouth

Lips Mucosa Tongue Teeth Gums

Pallor; cracked Pinkish Midline complete Pinkish

8. Neck

Trachea Thyroids Others

Midline Non-palpable Normal ROM

9. Pharynx

Uvula Tonsils Posterior Pharynx Mucosa

Midline Not Inflamed Not Inflamed Pinkish

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10. Abdomen

General Configuration Bowel Sounds Percussion

Normal Symmetrical Normoactive Tympanitic

11. Back and Extremities Range of Motion Muscle tone and strength Spine Gait Normal Fair Midline normal

12. Cardiovascular Status

Precordial Area Point of Maximal Impulse (PMI) Heart Sounds Peripheral Pulses Capillary Refill

Flat 5th ICS, midclavicular line Regular Regular 2 seconds

13. Respiratory Status

Breathing Pattern Shape of Chest Lung Expansion Vocal/Tactile Fremitus Percussion Breath Sounds Cough

Irregular AP:L:2:1 Symmetrical Symmetrical Resonant crackles Non-productive

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III. ANATOMY AND PHYSIOLOGY

The Lungs

The lungs lie within the thoracic cavity on either side of the heart. They are coneshaped, with the apex above the first rib and the base resting on the diaphragm. Each lung is divided into superior and inferior lobes by an oblique fissure. The right lung is further divided by a horizontal fissure, which creates a middle lobe. The right lung, therefore, has three lobes; the left lobe has only two. In addition to these 5 lobes, which are visible externally, each lung can be subdivided into about 10 smaller units (bronchopulmonary segments). Each segment represents the portion of the lung that is supplied by a specific tertiary bronchus. These segments are important surgically, because a diseased segment can be resected without the need to remove the entire lobe or lung. The two lungs are separated by a space (the mediastinum) where the heart, aorta, vena cava, pulmonary vessels, esophagus, part of the trachea and bronchi, and the thymus gland are located. The lungs contain gas, blood, thin alveolar walls, and support structures. The alveolar walls contain elastic and collagen fibers; these form a three-dimensional, basket-like structure that allows the lung to inflate in all directions. These fibers are capable of stretching when a pulling force is exerted on them from outside of the body or when they are inflated from within. The elastic recoil helps in return the lungs to their resting volume.

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The lung itself is covered with a membrane called the visceral (or pulmonary) pleura. The visceral pleura are adjacent to the lining of the thoracic cavity which is called the parietal pleura. Between the two membranes is a thin, serous fluid which acts as a lubricant reducing friction as the two membranes slide across one another when the lungs expand and contract with respiration. The surface tension of the pleural fluid also couples the visceral and parietal

pleura to one another, thus preventing the lungs from collapsing. Since the potential exists for a space between the two membranes, this area is called the pleural cavity or pleural space The respiratory system is situated in the thorax, and is responsible for gaseous exchange between the circulatory system and the outside world. The respiratory system is divided into two systems namely the upper respiratory system, which composed of the nasal cavity, pharynx and larnyx: and the lower respiratory system, which are the trachea, bronchus, bronchioles and the alveoli.

ORGANS OF THE RESPIRATORY SYSTEM

THE UPPER RESPIRATORY

THE LOWER RESPIRATORY

NOSE NASAL CAVITY PHARYNX

LARYNX BRONCHIAL TREE LUNGS

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UPPER RESPIRATORY TRACT

Respiration is defined in two ways. In common usage, respiration refers to the act of breathing, or inhaling and exhaling. Biologically speaking, respiration strictly means the uptake of oxygen by an organism, its use in the tissue, and the release of carbon dioxide. By either definition, respiration has two main functions: to supply the cells of the body with the oxygen neede for metabolism and to remove carbon dioxide formed a waste product from metabolism. This lesson describes the components of the upper respiratory tract. The upper respiratory tract conducts air from outside the body to the lower respiratoty tract and helps to rotect the body from irritating substances. The upper respiratory tract consists of the following stuctures: The nasal cavity, the mouth, the pharynx, the epiglottis, the larynx, and the upper trachea. The esophagus leads to the digestive tract. One of the feature of both the upper and lower respiratory tracts is the mucociliary apparatus that protects the airways from irritating substances, and is composed of the celiated cells and mucus-producing glands in the nasal epithelium. The glands produce a layer of mucus that traps unwanted particles as they are inhaled. These are swept towards the posterior pharynx, from where they are either swallowed, spat out, snezzed, or blown out. Air passes through each of the structures of the upper respiratory tract on its way to the lower respiratory tract. When a person at rest inhales, air enters via the nose and mouth. The nasal cavity filters, warms, and humidifies air. The pharynx or throat is a tube like structure that connects the back of the nasal cavity and mouth to the larynx, a passageway for air, and the esophagus, a passageway for food. The pharynx servs as a common hallway for the respitarory and digestive tracts, allowind both air and food to pass through before entering the appropriate passageways.

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The pharynx contains a specialized flap-like structure called the epiglottis that lower over the larynx to prevent the inhalation of food and liquid into the lower respiratory tract. The larynx or voice box, is a unique structure that contains the vocal cords, which are essential for human speech. Small and triangular in shape, the larynx extends from the epiglottis to the trachea.the larynx helps control movement of the epiglottis. In addition, the larynx has specialized muscular folds that close it off and also prevent food, foreighn objects, and secretions such as saliva from entering the lower respiratory tract.

Mechanism of Breathing To take a breath in, the external intercostal muscles contract, moving the ribcage up and out. The diaphragmmoves down at the same time, creating negative pressure within the thorax. The lungs are held to the thoracic wall by the plueral membranes and so expand outward as well. This creates negative pressure within the lungs, and so air rushes in through the upper and lower airways. Expirations are mainly due to the natural elasticity of the lungs, which tend to collapse if they are not held against the thoracic wall. This mechanism behind lung collapse if there is air in the pleural space (pneumothorax)

How does the respiratory system work? The respiratory system works with the body to help our body function correctly. One of the things it does is it gives our cells/blood oxygen to take to the rest of our body.

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IV. PATHOPHYSIOLOGY

PRECIPITATING FACTORS: PREDISPOSING FACTORS: Age (High Risk) (42 years old) Gender: female Exposure to crowded places Exposure to stress Lifestyle Exposure to air pollution Hospitalization Occupational status

Organisms may enter respiratory tract through inspiration, aspiration or inhalation of oral secretions

Normal pulmonary defense mechanisms (cough reflex, mucociliary transport and pulmonary macrophages) usually protects against infection. However, in susceptible host, these defenses are either suppressed or overwhelmed by the invading organism.

The invading organism multiplies and releases damaging toxins

Inflammation and edema of the lung parenchyma

Accumulation of cellular debris and exudates

Lung tissue fills with exudates and fluid changing from an airless state to consolidated state.

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Inflamed and fluid-filled alveolar sacs cannot exchange oxygen and carbon dioxide effectively

Alveolar exudates tends to consolidate, so it is increasingly difficult to expectorate

Fever Chills Malaise Pleuritic pain

Cough

Dyspnea

Rales and cracles upon auscultation

Kinin

Myocardial Depressant Factor

Clotting Cascade

Thromboxane release

Bradykinin Dysrhythmias Vasodilation Decrease Cardiac Output

Vascular Thrombi

Pulmonary Constriction

Increase Hydrostatic Pressure

Increase Lymphatic Flow Decrease BP Decrease Venous Return

Fluid transudation into alveolus

Impaired Oxygen Diffusion

Fluid fills the intestitium and alveolar spaces

Thickened alveolar membrane impairing the exchange of Oxygen and Carbon Dioxide

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Interpretation:

The defense mechanisms of the lungs lose effectiveness and allow organism to penetrate the sterile lower respiratory tract, where inflammation develops. Disruption of the mechanical defenses of cough and ciliarys motility leads to colonization of the lungs and subsequent infection. Inflamed and fluid-filled alveolar sacs cannot exchange oxygen and carbon dioxide effectively.

Systemic inflammation leads to release of cytokines and other chemical mediators. The cytokines activate alveolar macrophages and recruit neutrophils to the lungs, which in turn release leukotrienes, oxidants, platelet-activating factor, and proteases. These substances damage capillary endothelium and alveolar epithelium, disrupting the barriers between capillaries and airspaces. Edema fluid, protein, and cellular debris flood the airspaces and interstitium, causing disruption of surfactant, airspace collapse, and ventilation-perfusion mismatch leading to decreased lung expansion and eventually may lead to acute respiratory failure if ;left untreated.

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VIII. DISCHARGE PLANNING/ HEALTH TEACHINGS M-Medication to take Instruct and explain to the patient that the medication is very important to continue depending on the duration that the doctor ordered for the total recovery of the patient. E- Exercise Encourage and instruct the patient to do proper breathing exercise. T- Treatment Advice the patient to relax in order to recover in his present condition. Instruct the patient to minimize the exposure to an environment such as dusty and smoky area, which airborne micro organism is present that can be a high risk factor that may cause severity of his condition. H- Health teaching Encouraged and explain to the patient that it is important to maintain proper hygiene to prevent further infection. Instruct the patient to take a bath every day and explain that bathing early in the morning is not a factor or cause of having pneumonia. Instruct to increase fluid intake of the patient. O-Out Patient follow-up Regular consultation to the physician can be factor for recovery and to assess and monitor the patients condition D-Diet Diet as tolerated, meaning, the patient can eat everything until she can. Diet plays a big role in fast recovery so that, instruct the patient to take nutritious food such as green leafy vegetable and fruits.

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Additional Health Teaching Home Care Take your medication exactly as directed. Dont skip doses. Continue taking your antibiotics as directed until they are all goneeven if you start to feel better. This will prevent the pneumonia from coming back. Drink at least 8 glasses of water daily, unless directed otherwise. This helps to loosen and thin secretions so that you can cough them up. Use a cool-mist humidifier in your bedroom. Be sure to clean the humidifier daily. Coughing up mucus is normal. Dont use medications to suppress your cough unless your cough is dry, painful, or interferes with your sleep. You may use an expectorant if ordered by your doctor. Learn percussion and postural drainage. These are techniques that can help you cough up extra mucus. This extra mucus can trap germs in your lungs. Ask your healthcare provider for instructions. Perform these techniques 3 times a day until your lungs are clear. Warm compresses or a moist heating pad on the lowest setting can be used to relieve chest discomfort. Use several times a day for 15-20 minutes at a time. (To prevent injuring your skin, be sure the temperature of the compress or heating pad is warm, not hot.) Get plenty of rest until your fever, shortness of breath, and chest pain go away. Plan to get a flu shot every year. Ask your doctor about a pneumonia vaccination. Take the entire course of any prescribed medications. After a patients temperature returns to normal, medication must be continued according to the doctors instructions, otherwise the pneumonia may recur. Relapses can be far more serious than the first attack. Get plenty of rest. Adequate rest is important to maintain progress toward full recovery and to avoid relapse. Drink lots of fluids, especially water. Liquids will keep patient from becoming dehydrated and help loosen mucus in the lungs.

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Keep all of follow-up appointments. Even though the patient feels better, his lungs may still be infected. Its important to have the doctor monitor his progress. Encourage the guardians to wash patients hands. The hands come in daily contact with germs that can cause pneumonia. These germs enter ones body when he touch his eyes or rub his nose. Washing hands thoroughly and often can help reduce the risk. Tell guardians to avoid exposing the patient to an environment with too much pollution (e.g. smoke). Smoking damages ones lungs natural defenses against respiratory infections. Give supportive treatment. Proper diet and oxygen to increase oxygen in the blood when needed. Protect others from infection. Try to stay away from anyone with a compromised immune system. When that isnt possible, a person can help protect others by wearing a face mask and always coughing into a tissue.

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IX. RELATED LEARNING EXPERIENCE Medical ward is the ward where were assigned for, for the 4 weeks duty, we have encountered several restrain with regards to the implementation. It was not easy that we are dealing with our lives. But we did not loss hope because its our responsibility to care ant to address the patients need. Three nights of multi-tasking and time management even though we are busy in other major subject but yet we try our best to do these case study correctly and to avoid correction about this work. but then again caring patient in medical ward is hard, hard, because this is our first time to exposed in this ward with different kind of diseases that some are not easy to handle and hard also because some of significant other are uncooperative and non compliant, but at last we really succeed. It inst that smooth to establish an interacting relationship specially that most of the patients significant other institution has a low educational attainment/low class status. Therefore, we cannot expect them to fully comprehend the instruction we have imparted. However, it was a wonderful experience since we were handle different condition of the patient and we performed some procedure which weren't return demonstrate yet. Fortunately, there is our clinical instructor and our PCI who persistently supervised us and assisted us to make it through with just minimal errors. However, this our 4th time to manage group case study in different setting, adding to that is the fear of making a physiologic structure of our client with a different kind of diseases, we have learned to thorough assess our patient to comply with the indispensable. Also we have acquired ourselves with regards to establish rapport with our patient to have trusting relationship. But enjoy with other people helps you identify your strength and weakness, and it aids in modifying what is somehow negative in our attitude. Most and for all we thank to god for the guidance always and for giving wisdom and knowledge to do this case study successful.....

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X. SOURCES:

WEB:

http://nursingcrib.com/nursing-care-plan/nursing-care-plan-community-acquiredpneumonia/

http://merck-ut.merck.com/mmpe/sec05/ch052/ch052b.html

http://en.wikipedia.org/wiki/Community-acquired_pneumonia

BOOKS: Nurses Pocket Guide 11th edition (Diagnoses, Prioritized interventions, and Rationales) By: Marilyn E. Doenges Mary Frances Moorhouse Alice C. Murr

Nursing 2003 Drug Handbook 23rd edition By: Springhouse Lippincott Williams and Wilkins

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