ETIOLOGY

Predisposing Factor

Factors Presence Rationale Justification

Age Present Respiratory muscle strength decreases with age and can Patient’s age is 64 and therefore

impair effective cough, which is important for airway he’s more vulnerable to

clearance. The lung matures by age 20–25 years, and ventilatory failure.

thereafter aging is associated with progressive decline

in lung function. The alveolar dead space increases with

age, affecting arterial oxygen without impairing the

carbon dioxide elimination. The airways receptors

undergo functional changes with age and are less likely

to respond to drugs used in younger counterparts to

treat the same disorders. Older adults have decreased

sensation of dyspnea and diminished ventilatory

response to hypoxia and hypercapnia, making them

more vulnerable to ventilatory failure during high

 demand states

European Respiratory Society/European Lung

Foundation. Major respiratory diseases: pneumonia. In:

Loddenkemper R, Gibson GJ, Sibille Y, eds. European

Lung White Book. The First Comprehensive Survey on

Respiratory Health in Europe. Sheffield, European

Respiratory Society Journals, 2003; pp. 55–64

Family Present Genetic factors likely play some role in high blood Patient stated that his father is also

History of pressure, heart disease, and other related conditions. suffering from hypertension

Hypertension However, it is also likely that people with a family

history of high blood pressure share common

environments and other potential factors that increase

their risk.

The risk for high blood pressure can increase even more

when heredity combines with unhealthy lifestyle

choices, such as smoking cigarettes and eating an

unhealthy diet.

Kearney PM, Whelton M, Reynolds K, Whelton PK,

He J. Worldwide prevalence of hypertension: A

systematic review. J Hypertens. 2004;22:11–9

Precipitating Factor

Pneumonia Present Bacterial or viral pneumonia infections are Patient is positive of community

quite common; however, occasionally acquired pneumonia as seen in his

become complicated as a collection of fluid chart .

develops in the section of the lung that is

infected.

(Ignatavicius, D. D., MS,RN,ANEF, &

Workman, M., PhD, RN, FAAN. (2016).

Medical-Surgical)

Sedentary Life Present A sedentary lifestyle is a type of lifestyle with Patient have lived a sedentary

Style little or no physical activity. A person living lifestyle as evidenced by inactive

a sedentary lifestyle is often sitting or lying lifestyle such as staying long hours

down while engaged in an activity like of watching T.V while lying on a

reading, socializing, watching television, sofa. He also ignores morning

playing video games, or using a mobile jogging and other such exercises.

phone/computer for much of the day. A

 sedentary lifestyle can potentially contribute

to ill health and many preventable causes of

death.

(https://en.wikipedia.org/wiki/Sedentary_life

style. Retrieved on July 12, 2018)

Smoker Present Tar and smoke particulates that enter the Patient stated that he can consume

airways and lungs with each cigarette cause 1 pack of cigarette a day.

irritation and inflammation. Over time scar

tissue replaces lung tissue as the body

attempts to repair itself from repeated damage

and protect itself from further damage. This

scar tissue gradually destroys the alveoli and

bronchioles, the lung’s smallest structures,

and eventually becomes pervasive within the

lungs.

Fromer L, Cooper C. A review of the gold

guidelines for the diagnosis and treatment of

patients with COPD. Int J Clin Pract 2008;

62: 1219–1236
 SYMPTOMATOLOGY

Signs and Presence Rationale Justification

Symptoms
Dyspnea Present Due to the increased volume in the Upon physical assessment, the patient cannot breath
body, there will be shifting of fluids. fast enough or deeply enough.
The fluid will be accumulated in the air
spaces and parenchyma of the lungs and
leads to impaired respiratory gas
exchange and may cause dyspnea.

Churchill, E. D., & Cope, O. (1929). The

rapid shallow breathing resulting from
pulmonary congestion and
edema. Journal of Experimental
Medicine, 49(4), 531-537.
Wheezing Present Wheezing is caused by something Upon patient’s inspiration, a high pitched, sharp sound
like a whistle was heard
obstructing the air channels in the lungs,

and since pneumonia causes

accumulation of mucus inside of the

lung sacks then it is most probably

caused by it, think of it in comparison to

the balloon, when you are letting the air

escape out of the balloon while

obstructing or narrowing the exit, you

can hear the sound that if the pitch and

colour of that same sound changed a

little bit, it would sound like wheezing,

or it can be caused by the mucus hanging

inside some part of the lungs and near

the entrance/exit of the air flow, and that

can cause you to want to cough all the

time or to have a feeling like you can not

cough it out even though it is just there

at the "edge" of the lungs.

 (Ignatavicius, D. D., MS,RN,ANEF, &
Workman, M., PhD, RN, FAAN.
(2016). Medical-Surgical)
Frothy Sputum Absent Even though the fluid in pulmonary During exposure, the patient don’t show any
edema is a transudate, there is blood in manifestation of having cough.
it. This is substantiated by the fact that
there are microhemorrhages in acute
lung congestion and hemosiderin laden
macrophages or 'heart failure cells' in
long standing pulmonary congestion on
histology. These signify that RBCs have
escaped the vasculature to enter the
tissue (and failed to get back to the
blood), while the macrophages have
consumed them later on. Since the blood
loss isn't very high, the color is pink
rather than red as seen in hemoptysis.
The reason for this is likely due to the
significant differences in hydrostatic
and oncotic pressures when compared
with the rest of the body. In the Lung,
 one edge of the capillary is up against a
single, extremely thin alveolar cell that
provides very little pressure to
counterbalance the increased forces
present in pulmonary edema. Without
this inward pressure to stabilize the
capillary wall, you end up with a
situation in which small ruptures occur
at weak points in the AC membrane,
unlike elsewhere in the body where
pressures are more equalized and
change is an osmotic process rather than
one of cellular disruption.

ICU Resus Committee. (2013).

Prolonged Ventilator Weaning Protocol,
Policies and Procedures, Southlake
Regional Health Centre.
WBC above The WBC is expected to rise up in White blood cell count showed above normal levels:
10.67.
normal level response to bacterial infection.

Bilateral Present Crackles are caused by explosive Based on assessment, patient manifested bilateral
Crackles opening of small airways and are crackles on his chest and on chest X-Ray, fluid build-
discontinuous, nonmusical, and brief. up was present.
Crackles are much more common
during the inspiratory than the
expiratory phase of breathing, but they
may be heard during the expiratory
phase. Crackles are often associated
with inflammation or infection of the
small bronchi, bronchioles, and alveoli.
Crackles that do not clear after a cough
may indicate pulmonary edema or fluid
in the alveoli.

Wilkins RL, Stoller JK, Kacmarek RM

(2009) Egan’s Fundamentals of
Respiratory Care. (9thed.). St. Louis,
MI: Elsevier.