CHAPTER

INTRODUCTION

1.1. Background
Currently, many new diseases of the respiratory tract and causes vary, there are
caused by viruses, bacteria, and so forth. With this phenomenon should be of concern
to us all. One of the diseases of the respiratory tract is pneumonia. Pneumonia disease
most often affects older people (seniors) and those with chronic diseases as a result of
damage to the immune system (immune), but pneumonia also can attack the ablebodied young people. Currently the world's disease Pneumonia has been reported to
be among the major disease of childhood and is a serious disease that meragut the
lives of thousands of older people each year. (Jeremy, et al, 2007, p 76-78)
Pneumonia disease prevention the focus of the program P2ISPA (Communicable
Disease Acute Respiratory Infection). The program is underway to terms Pneumonia
known to the public, to facilitate outreach activities and disseminate information
about pneumonia prevention. P2ISPA program classifies people into 2 age groups:
Age under 2 months (Serious and Not Pneumonia Pneumonia) Age 2 months to less
than 5 years (2 months - Pneumonia, Pneumonia Pneumonia weight and not).
Classification of Non-pneumonia include cough five groups of people who do not
show symptoms of increased frequency of breath and did not show any withdrawal of
the chest wall into the bottom. ARI pneumonia beyond include: cough-cold normal
(common cold), pharyngitis, tonsillitis and otitis. Pharyngitis, tonsillitis and otitis,
excluding

diseases

covered

in

this

program.

Pneumonia is a health problem in the world because of the high death rate, not only
in developing countries but also in developed countries like the U.S., Canada and
European countries. In the U.S. for example, there are two million to three million
cases of pneumonia per year with the average number of deaths of 45,000 people (SA
Price, 2005, p 804-814)

In Indonesia, pneumonia is the third cause of death after cardiovascular and

tuberculosis. Low socioeconomic factors increases the mortality rate. Pneumonia
symptoms are fever, shortness of breath, rapid breathing and pulse, greenish sputum
or like rubber, and the results of X-ray showed density in the lungs
Density occurs because the lungs filled with inflammatory cells and fluid that is a
reaction of the body to shut down Luman. But consequently, impaired lung function,
patients have difficulty breathing, because it left no room for oxygen. Pneumonia in
the community generally, caused by bacteria, viruses or mycoplasmas (intermediate
form between bacteria and viruses). The bacterium Streptococcus pneumoniae is a
common, Staphylococcus aureus, Klebsiella Sp, Pseudomonas sp, viruses such as
influenza virus (Jeremy, et al, 2007, p 76-78).
1.2. Destination
1.2.1. General Purpose
To learn about the nursing care to clients with pneumonia.

1.2.2. Special Purpose

1. To know the basic theoretical concepts pneumonia .
2. To know the basic concepts of nursing care to clients with pneumonia, which
includes assessment, nursing diagnosis, and intervention .
3. To determine nursing care to clients with pneumonia, which includes
ppengkajian, nursing diagnoses, interventions, implementsi, and evaluation.
1.3. Benefit
1. Expected that this paper may add to the knowledge and skills of the group in
providing nursing care to clients with pneumonia.
2. Enhance knowledge and insight for the reader.
3. As a source of reference for the reader about Pneumonia.

CHAPTER

II

LITERATURE REVIEW
2.1. Basic Concepts Theory Pneumonia
2.1.1. Definition
Pneumonia is an acute respiratory infection on the bottom of the lung parenchyma.
According to anatomical, pneumonia in children can be divided into lobar
pneumonia, pneumonia and bronchopneumonia interstiasialis (Arif Mansjoer, 2001, p
446).
Pneumonia is an inflammatory process of the lung parenchyma is usually caused by
infectious agents. Pneumonia is an infectious disease that often results in death.
Pneumonia caused by radiation therapy, chemicals and aspirations. Pneumonia can
accompany radiation radiation therapy for breast and lung cancer, usually six weeks
or more after treatment is completed. Pneoumalitiis chemical or pneumonia occurring
after becoming kerosene or gas inhalation irritant. If a portion of a lobe or substasial
famous with this disease called lobar pneumonia (Jeremy, et al, 2007, p 76-78).
Pneumonia is an acute inflammation of the lung parenchyma that usually comes from
an infection. (S. A. FRICE. 2005, p 804)
2.1.2. Classification
Three classifications of pneumonia.
1. Based on the clinical and epidemiological:
a. Pneumonia local community (community-acquired pneumonia).
b. Nosocomial pneumonia, (hospital-acquired pneumonia /

nosocomial

pneumonia).
c. Aspiration pneumonia.
d. Pneumonia in immunocompromised patients.(Jeremy, et al, 2007, p 76-78)

2. Based causing bacteria:

a. Pneumonia Bacteria / typical.

Can occur at any age. Bacterial pneumonia is often termed pneumonia germs.
The types of pneumonia can affect anyone, from infants to those who have
elderly. The alcoholics, mentally retarded patients, postoperative patients,
people suffering from other respiratory diseases or viral infections are those
which have a low immune system and become very susceptible to the disease.
At the time of the body's defenses decreased, for example due to illness, old
age, and malnutrition, pneumonia bacteria will quickly multiply and damage
the lungs. If there is an infection, some tissue from the lung lobe, or entire
lobe, even most of the five lobes of the lung (three in the right lung and two in
the left lung) become filled with liquid. Of lung tissue, the infection spreads
quickly throughout the body via the blood circulation. Pneumococcal bacteria
are bacteria that are the most common cause of bacterial pneumonia as such.
Usually the symptoms of bacterial pneumonia was preceded by a mild
respiratory infection a week earlier. For example, due to a viral infection
(influenza). Viral infections of the respiratory tract can lead to pneumonia
caused by mucus (fluid / mucus) containing pneumococci can be sucked into
the

lungs

(Soeparman,

et

al,

1998,

697).

Some bacteria have a tendency to attack someone who is sensitive, such as

Klebsiella in patients with alcoholism, staphyllococcus in patients after
influenza infection. Atypical pneumonia. Caused by mycoplasma, legionella,
and chalamydia (Soeparman, et al, 1998, p 697).
b. Due to viral pneumonia.
The main cause of viral pneumonia are influenza virus (distinguished by the
bacteria Haemophilus influenza is not the cause of influenza disease, but can
cause pneumonia as well). Symptoms Early symptoms of pneumonia caused
by viruses like influenza symptoms, such as fever, dry cough, headache,
muscle pain, and weakness. Within 12 to 36 hours the patient became
congested, coughing worse, and a little slimy. There is a high heat with
membirunya lips. Type of pneumonia that can be boarded with pneumonia
due to bacterial infection. It's called bacterial superinfection. One sign of

bacterial superinfection occurs is thick mucus discharge and green or dark red
(SA Price, 2005, p 804-814)
3.Based on the predilection of infection:
a. Lobar pneumonia, pneumonia that occurs in one lobe (large branches of the
bronchial tree) either right or left.
b. pneumonia bronchopneumonia.
Pneumonia is an infection characterized patches on various parts of the lung.
Can be right or left caused by viruses or bacteria, and often occurs in infants
or the elderly. In patients with pneumonia, lung air bag filled with pus and
other fluids. Thus, the function of the lungs, which absorb the clean air
(oxygen) and release the dirty air to be disrupted. As a result, the body suffers
from a lack of oxygen to all its consequences, for example, be more easily
infected by other bacteria (super infection) and so on. If this is the case, of
course the added difficulty healing. The cause disease in a wide range of
conditions and thus had an infection that can occur throughout the body. (S.
A. Price, 2005, p 804-814)
2.1.3. Etiology
The cause of pneumonia is Streptococcus pneumoniae and Haemophilus
influenzae. In infants and young children found Staphylococcus aureus as a cause
of severe pneumonia, and very profesif with high mortality. (Arif Mansjoer, et al,
p 466)
1. Bacteria: stapilokokus, streplokokus, aeruginosa, eneterobacter
2. Virus: influenza virus, adenovirus
3. Micoplasma pneumonia
2.1.4. Pathophysiology
Most of pneumonia acquired through aspiration of infective particles. There are
several mechanisms that normally protect the lungs from infection. Infectious
particles filtered in the nose, or trapped and cleared by mucus and ciliated
epithelium in the airways. When a particle can reach the lungs, the particles will
5

be dealing with alveolar macrophages, and also with systemic immune

mechanisms, and humoral. Baby in the first months of life has also acquired
maternal antibodies that can passively protect from pneumococcal and other
infectious organisms.
Changes to this protective mechanism may cause the child susceptible to
pneumonia, for example in congenital anatomical abnormalities, congenital or
acquired immune deficiency, or a neurological disorder that facilitate child has
aspirations and changes in the quality of mucus secretion or airway epithelium. In
children without these predisposing factors, infectious particles can reach the
lungs through the changes in the anatomical and physiological defenses are
normal. It most often occurs as a result of the virus in the upper respiratory tract.
The virus can spread to the lower respiratory tract and cause viral pneumonia.
Alternatively, the virus caused damage to the normal defense mechanisms can
lead

to

bacterial

pathogens

infect

the

lower

respiratory

tract.

This bacterium is an organism which can normally colonizes the upper respiratory
tract or the bacteria are transmitted from one person to another through airborne
droplet spread. Sometimes bacterial and viral pneumonia (eg varisella, measles,
rubella, CMV, Epstein-Barr virus, herpes simplex virus) can occur through either
hematogenous spread from a localized source or bacteremia / viremia generalized.
After reaching the lung parenchyma, the bacteria causing an acute inflammatory
response that includes fluid exudation, fibrin deposits, and infiltration of
polymorphonuclear leukocytes in alveolar macrophages followed infitrasi.
Exudative fluid in the alveoli causing typical lobar consolidation on chest X-ray.
Viruses, mycoplasma, and chlamydia cause inflammation with a predominance of
mononuclear infiltrates in the submucosal and interstitial structure. This causes
the release of epithelial cells into the airway, as occurs in bronchiolitis (SA Price,
2005, p 804-814).

2.1.6. Clinical Manifestations

In general can be divided into:
a. Non-specific manifestations of infection and toxicity include fever (39.5 C
to 40.5 C). , Headache, irritable, agitated, malaise, lack of appetite
gastrointestinal complaints.
b. Common symptoms of lower respiratory tract such as cough, takipnuea (2545 times / min), expectorated sputum, nostril breath, shortness of breath,
water hinger, moaning, cyanosis. Older children with pneumonia would prefer
to lie on the affected side with knees bent because of chest pain.
c. Signs of pneumonia in the form of retraction (withdrawal down into the chest
wall while breathing along with increased respiratory rate), percussion
dullness, fremitus weak, decreased breath sounds, and crackles.
d. Signs of pleural effusion or empyema, a motion lag in the execution chest
effusion, percussion dullness, fremitus weak, decreased breath sounds, breath
sounds on the right above the tubular fluid, friction rup, chest pain due to
irritation of the pleura (pain are reduced when the effusion increased and
changed become dull pain), stiffness sit / meningimus (menigen irritation
without inflammation) when Enhancing upper lobe pleural irritation,
abdominal pain (sometimes occurs when irritation of the diaphragm in the
right lower lobe pneumonia).
e. In neonates and young infants are not always obvious signs of pneumonia.
Pleural effusion in infants will cause dullness percussion.
f. Signs of extrapulmonary infection. (Arif Mansjoer, et al, 2001, p 466)

2.1.7. Examination Support

1. Rays X: identify the structural distribution (eg, lobar, bronchial); can also
declare abscess) wide / infiltration, empyema (stapilococcos), diffuse or
localized infiltration (bacterial), or deployment / expansion of infiltrating
nodules (often viral). In mycoplasma pneumonia, chest x-ray may be clean.

2. GDA / pulse oksimetris: abnormal may occur, depending on the extent of lung
involved and the existing lung disease.
3. Examination grams / culture, sputum and blood: to be taken biosi needle
aspiration transtrakea, bronkoskofi fiberobtik or pulmonary opening biosi to
overcome penyebeb organisms. More than one organis there: bekteri
common diplococcos include pneumonia, stapilococcos, Aures A.-hemolik
strepcoccos, hemophlus influenza: CMV. Note: exit sekutum can not identify
all the organisms present. Blood cultures may indicate bacteremia semtara
4. JDL: leokositosis usually exist, although low white blood cells occurs in viral
infections, immune stress conditions such as AIDS, enabling the development
of bacterial pneumonia.
5. Serologic tests: eg, viral titer or legionella, cold agglutinins. assist in
differentiating the diagnosis of specific organisms.
6. Examination of lung function: the volume may decrease (congestion and
alveolar collapse); airway pressure may be increased and complaints. Seepage
may occur (hypoxemia)
7. Electrolytes: Sodium and Chloride may be low
8. Bilirubin: Perhaps increased.
9. Percutaneous aspiration / biopsy of lung tissue open: to declare the network
and the typical intra-nuclear cytoplasmic involvement (CMP; kareteristik
engineered cells (rubella).(Marlyn E. Dongoes, 1999 ASKEP, Page 164-174)

2.1.8. Management
1. Oxygen 1-2 L / min
2. IVFD (Intra Venous Fluid Drug) / (drug administration through intravenous)
dextrose 10%: 0.9% NaCl = 3: 1, + KCL 10 mEq / 500 ml of fluid. The
amount of fluid according to body weight, temperature rise, and hydration
3.

status.
If shortness is not too great, it can begin with a gradual entral food through a

nasogastric tube with feding drip.

4. If excessive mucus secretion can be administered with normal saline and
inhaled beta-agonists to improve transpormukosilier.
8

5. Correction balance disorders acid - base and electrolyte.

6. Antibiotics
appropriate
culture
results
For the base case of pneumonia local community:
Ampicillin 100 mg / kg / day in 4 days giving
Kloramfenicol 75 mg / kg / day

in

or

provide:

days

giving

For the base case of pneumonia hospital:

Sevotaksim 100 mg / kg / day in 2 feedings
Amikasim 10-15 mg / kg / day in 2 feedings. (Arif Mansjoer, et al, 2001, p
468)
2.1.9. Complications of Pneumonia
Skin abscesses, soft tissue abscess, otitis media, sinus sitis, pururental meningitis,
pericarditis and epiglottis kaang H. influenzae infection was found in type B (Arif
Mansjoer, 2001 It 467)

2.1.10. Prevention and risk factors

By having knowledge of the factors and situation generally be redispredisposisi
individuals to pnumonia will help to identify patients at risk psien-against
pneumonia. Preventive measures provide anticipatory care and preventive care is
an important action (Suzanne C. Smeltzer, et al, p 573).
1. Any condition that produces mucus or bronchial obstruction and interfere with
normal

draniase

chronic

pulmonary

(PPOM)

increases

patient's

susceptibility to pneumonia. Preventive action: tingkankan pengaluaran

coughing and secretion.
2. Patients and their immunosuppressive neutrofi with a low number
(neutropeni) are those noisy. Preventive action: doing special precautions
against infection.

3. Individuals who smoke noisy, smoke because they disrupt both mukosiliari
and macrophage activity. Preventive Tindaka: ajurkan individuals to quit
smoking.
4. Every patient who diperbolehakan passively lying in bed in a long time that
are relatively immobile and shallow breathing at risk of bronchopneumonia.
Done had preventive: frequently change positions.
5. Individuals who are depressed cough reflex (because of medication, or the
circumstances that weaken the weak respiratory muscles), has been aspiring
for foreign objects into the lungs over a period of unconscious (head injury,
anesthesia), or have their swallowing mechanism is abnormal who almost
certainly

suffered

bronchopneumonia.

Preventive

action:

penghisan

tracheobronchial, often changing positions, policies in delivering drugs that

increase the risk of aspiration and physical terafi chest.
6. All patients treated with regimens NPO (fasting) or those who received
antibiotics had increased pharyngeal colonization of organisms and risky.
Preventive action: tingakan regular oral hygiene.
7. Individuals who experience frequent intoxication are particularly susceptible
to pneumonia, because alcohol suppress the body's reflexes, mobolisasi white
blood cells and ciliary movement trakeaobronkial. Preventive action: Bikan
thrust to the individual to reduce the input of alcohol.
8. Individuals who receive sedatives or opioids may experience breathing,
trigger ynga collection and subsequent secretion of bronchial pneumonia.
Preventive action: observation fekuensi and into the respiratory breathing
before giving. If looks respiratory depression, tunds drug delivery and report
the problem.
9. Patients who are not aware or have poor swallowing reflex cough and go
round them at risk for pneumonoia due to accumulation seksesi or aspiration.
Preventive measures: frequent.
10. Individuals elderly, especially those who are vulnerable because of reflection
pneumonia cough. Seharusnyadapat paskaoperatif pneumonia are estimated to
occur in the elderly. Tndakan preventive: mobolisasi frequently, and coughing
and breathing exercises efekif

10

11. Each person meneriama pernasapan therapy treatment may develop

pneumonia if equipment is not cleaned them properly tersebit. Preventive
action: pastiakn that the equipment has been in bersikan breathing properly.
(Suzanne C. Smeltzer, et al, p 573)

REFERENCES
Arief Mansjoer. , 2001. Capita Selecta Medicine Volume 1. EGC: Jakarta.
Brenda G Bare, Suzan C. Smeltzer Medical Surgical Nursing 8th Edition, Vol. 1,
EGC,

Jakarta.

Doenges, Marilynn, E. et al. , 1999. Plans Nursing 3rd Edition. EGC, Jakarta
Jeremy, et al. , 2005. Respiratory System at a Glance, 2nd Edition. Grants: Jakarta

Sylvia Anderson Price, Milson Covraine McCarty. , 2005. Pathophysiology

Volume

2,

Issue

4.

EGC:

Jakarta.

11

Soeparman, et al. , 1998. Internal medicine in volume II. Faculty of medicine:

Jakarta

12