A CASE PRESENTATION ON

PNEUMONIA
(With respiratory alkalosis)

PRESENTED BY:
Camille Honeyleith L. Fernando, RN
MSN I-B

Presentation
On October 11,2015, a 29 years
old lady accompanied by her
family arrived at the Emergency
Department complaining of
difficulty of breathing. Associated
with fever, generalized body ache
& productive cough for 7 days.

EXAMINATION
Anxious, Confused
Temperature : 38.1C
Blood pressure : 130/90 mm of Hg
Pulse rate :128 bpm
Respiratory Rate : 36 per minute
Oxygen saturation of 90% room air

 Her symptoms started 7 days ago with

mild fever , cough, headache for which
she self-medicated with Biogesic and
Ambroxol tablet.
After initial improvement, she had a
worsening of symptoms starting 2 days
ago with high fever, generalized body
ache accompanied with mild difficulty
of breathing , so she decided to come
to the hospital

PAST CLINICAL HISTORY:No surgery or hospitalization ever before.

FAMILY HISTORY:- Nothing significant.

PRESENT MEDICAL HISTORY:Fever, head ache and generalized body
ache with productive cough
accompanied by difficulty of breathing
since last 7 days.

Laborator
ies

Urinalysis:
Within normal
limits

30
PaO2=7
7
HCO3=
24
pH
=7.50

Hgb14.2grms%
Hct- 41vol%

WBC12,800/cumm
Platelet213,000/cumm
Segmenters- 0.74
Lympocytes-0.26

CHEST X-RAY
REVEALED

CHEST:
There is opacity in the right lower
lobe.
Heart is not enlarged.
Diaphragm and sulci are intact.
Osseous structures are
unremarkable.
IMPRESSION:

WHAT IS THE VALUE OF CHEST X-RAY IN

PNEUMONIA???

Patter
n

Establish
Dx

Evaluation of
severityMultilobar or
bilateral,
Patchy, Pleural
Effusion

Co-existing
conditions:Bronchitis,
Bronchial
Obstruction,
Abscess

V
I
R
A
L

Pneumonia is an infammatory condition of

the Lungs,
afecting mainly the air- sacs or Alveoli

F
U
N
G
A
L

DRUGS
BACTERIAL
(Most
common)

Autoimmune
diseases

PNEUMONIA AND ITS TYPES

RISK
FACTORS

PATHOPHYSIO
LOGY

CLINICAL MANIFESTATIONS OF PNEUMONIA

Fever
Rapid or difficult breathing
Non- productive Cough
Loss of appetite
Chills
Rale/ Crackles
Wheezing
Headache
Myalgia
Running nose
Fatigue
Sharp or stabbing chest pain
which increases on breathing
Excessive sweating or clammy skin

ANTIPYRETICS
DIET

ANTIBIOTICS

STEROIDS
FLUID

THERAPY
HEMODYNAMIC

MONITORING

O2
THERAPY
REGULA
R

CHEST
PHYSIO.

INVESTIGATIONS

Relevant
Nursing
Diagnosis

Impaired
Nutritional
status R/t
disease
condition

Anxiety
R/t
Disease
condition

Impaired gas
exchange R/t
Disease process

Risk of infection R/t

disease process,

Activity
Intolerance
& Self
Care
Deficit R/T
Disease
condition

Ineffective
airway
clearance
related to
retained
secretions

NURSING CARE
PLAN

Severe
Shortness of
Breath

Tachycardia,
Tachypnoea
SPO2

IMPAIRED GAS
EXCHANGE R/T
POOR LUNG
COMPLIANCE
Propped up
position
Oxygen therapy
Nebulisation
therapy
Hemodynamic
monitoring
Mech.
Ventilation
Auscultation
Suctioning
ABG analysis
Chest Physio &
Spirometry

Restless,
Confusion

NURSING CARE
PLAN

Anxious ,
Restless

Depressed

Anxiety R/T
Fear of
Unknown
Outcome

Re-assurance
Counseling
Proper
explanation
Participation in
care

Lots of queries

NURSING CARE PLAN

Fever

Presence of
Effusion

Congested
Lung

High risk of infection

R/T
Disease condition

Proper Hand Washing

Maintained Aseptic technique
Monitored temperature
Antibiotics & Steroids given
Blood for TC, DC, ESR checked
Blood , Urine & Sputum C/S checked
High Protein diet given
Hygiene maintained

NURSING CARE PLAN

Dull & Weak

Appearance

SOB

Fatigue

Activity Intolerance
& Self Care Deficit
R/T Disease
condition

Comfortable position provided

ROM exercise provided
Sponge bath, Back care provided
Position changed
Encouraged activity as per symptom tolerance

THANK YOU FOR

LISTENING!