Pulmonary

Congestion
secondary to
Pneumonia
INTRODUCTION
 Life is short, health should be valued
 Globally, community-acquired pneumonia (CAP) is one of the
most important serious infectious diseases, with an increasing
incidence in many parts of the world and an increasing rate of
serious complications (Brown, 2013)
 As part of the burden of respiratory infections, CAP is well
recognized to be a leading cause of death among the infectious
diseases (Torres, 2013).
 In the Philippines, pneumonia is the third leading cause of
morbidity (2001) and mortality (1998) in Filipinos based on the
Philippine Health Statistics from the Department of Health.
 The Department of Health (DOH) reported that pneumonia has
been the No. 1 killer disease in Davao City from 2010 to 2013
with a total of 2,291 deaths out of 8,258 cases.
GENERAL OBJECTIVE
 the group aims to conduct a case study particularly on a
patient with oxygenation problems, present a thorough
study of the patient’s condition, and most especially, to
provide holistic and effective nursing care to the patient
by relating and implementing the knowledge that has
been imparted by the university.
SPECIFIC OBJECTIVES
Cognitive:

 Identify all necessary information regarding the chosen patient that is

associated to our case study;
 Distinguish the clinical significance of the diagnostic tests;
 Identify the etiology and clinical manifestations of the disease condition of the
patient;
 Review the drugs prescribed to the patient, including their actions, indications,
contraindications, side and adverse effects, and nursing responsibilities;
 Identify the nursing problems diagnosed from the patient and formulate a
nursing care plan;
 Identify the Nursing Theories according to the presented nursing problem.
 State recommendations that will be supportive for the benefit of the Patient and
family, the Nursing Education, the Nursing Practice, and the Nursing Research.
Psychomotor

 Assess the patient’s overall health condition through a Physical

Assessment;
 Demonstrate and illustrate a physical assessment cephalocaudal
 Provide basic nursing care that the patient needs
Affective

 Actively listen with respect to the accounts of the patient and

significant others;
 Show genuine and willingness in serving the patient;
 Develop a caring, non-judgmental, and therapeutic attitude
towards the patient and significant others
Insert History here
Genogram
DEVELOPMENT DATA
Definition of Diagnosis
Pulmonary Congestion Secondary to Pneumonia
PNEUMONIA
 Pneumonia is an inflammation of the lung parenchyma caused by
various microorganisms, including bacteria, mycobacteria, fungi,
and viruses. (Brunner and Sudarth, Volume 1, 12 th Edition, 2010)
 Pneumonia is an infection of lungs that is most commonly caused
by viruses or bacteria. These infections are generally spread by
direct contact with infected people. (World Health Organization,
2016)
 Pneumonia is a lung infection involving the lung alveoli (air sacs)
and can be caused by microbes, including bacteria, viruses, or
fungi. (American Thoracic Society, 2015)
Definition of Diagnosis
Pulmonary Congestion Secondary to Pneumonia

Pulmonary Congestion / Edema

 Defined as abnormal accumulation of fluid in the lung tissue, the
alveolar space, or both. It is a severe, life-threatening condition.
(Brunner & Suddarth, 12th Edition, Volume 1; 2010)
 Abnormal accumulation of fluid in the lungs. (Merriam-Webster’s
Medical Dictionary, 2016)
 Is fluid accumulation in the air spaces and parenchyma of the lungs. It
leads to impaired gas exchange and may cause respiratory failure. It is
due to either failure of the left ventricle of the heart to adequately
remove blood from the pulmonary circulation or an injury to the lung
parenchyma or vasculature of the lung. (
http://www.symcat.com/conditions/pulmonary-congestionhttp://www.sy
mcat.com/conditions/pulmonary-congestion
; Retrieved on September 9, 2018)
REVIEW OF
SYSTEMS
 General Survey
 “Wala akong masasabi na sobrang sakit na parte sa aking katawan pero nahihirapan
ako huminga at na pansin ko na madali lang ako hingalin at mapagod.”

 General Pain
 “Wala akong nararamdaman na sakit pero mabilis lang ako hingalin at mapagod.”
 Integumentary System
 “Pakiramdam ko parang ang tuyo ng kutis ko. Ang putla putla ko na rin di naman
to ganito nuon, ngayon lang nung nagkasakit ako. Sabay to siya sa pag hihingal at
ubo ko.”

 Musculoskeletal System
 “Humina katawan ko lalo na nung may lagnat ako. Madali lang rin ako mapagod.”

 Hair
 “Wala naman akong problema sa buhok ko. Natural naman na unti unting
namumuti na siya. Wala rin akong maramdaman na pagkakati ng anit.”
 Head
 “Okay lang naman ulo ko. Sakto tulog ko rito sa ospital kaya di sumasakit ulo ko.
Wala naman akong mga sakit sa ulo na nararamdaman”

 Eyes
 “Wala akong reklamo parte sa paningin ko. Di ko kailangan mag suot ng mga
salamin. Di naman rin ako nahihilo pag nag lalakad.”

 Ears
 “Wala akong problema parte sa aking mga tenga. Wala naming lulmalabas at wala
naman akong naririnig na “ringing”.”
 Nose and Sinuses
 “Wala naman akong sipon pero hinihingal talaga ako.”

 Teeth
 “Wala naman akong problema sa ngipin, di naman sumasakit at wala naman akong
sira sa ngipin.”

  Mouth and Throat

 “Grabe talaga tong ubo ko. May plema rin siya tapos nahihirapan din ako huminga.”
 “Medyo umitim na tong mga labi ko at gums ko dahil sa sobrang dalas ko
manigarilyo.”
 Neck
 “Kumakati ang aking lalamunan at Makati siya pag umuubo ako.”

 Respiratory System
 “Nahihirapan ako huminga kaya naisip naming magpa ospital. Grabe rin ang aking
ubo nun.”

 Cardiovascular System
 “Dumaan na ako ng pagka stroke noong 2013 kaya nag iingat na talaga ako ngayon.
May highblood rin ako ngayon.”
 Peripheral Vascular System
 “Okay naman ang pakiramdam ng aking mga kamay at paa di naman sila nag
mamanhid.”

 Gastrointestinal System
 “Wala naman akong problema sa aking pag babawas, di rin sumasakit ang aking
tiyan.”
 “Ang dumi ko ay soft pero di sobrang basa, brown lang rins siya hindi pula o itim.”

 Genito-urinary System
 “Wala rin akong problema sa pag iihi ko sama sa aking pag dudumi.”
PHYSICAL
ASSESSMENT
 General Assessment
 Physical assessment of Patient “Button” was done at the Davao Medical School
Foundation Ward 2A last September 4, 2018. While patient was lying down, semi-
fowler’s position in the bed, wearing loose comfortable clothing that was
appropriate for age, gender and setting. Patient appeared tired. Patient “Button”
was oriented to time, place and person. He displayed a good attention span and was
very cooperative throughout the whole physical assessment. He displayed no
involuntary movements and was logical throughout the interview. Both nonverbal
and verbal responses were appropriate. His current weight is 64kg, current height is
172 which is a BMI of 21.63 (normal). With and IV line infusing Plain Normal Saline
Solution at 60cc/hr. Patent and infusing well.
 Abnormalities: Patient appeared tired.
Vital Signs

Temperature – 38.2C

Pulse Rate – 107 bpm

Heart rate – 112 bpm

Respiratory Rate – 26 cpm

Blood Pressure – 140/90 mm Hg

Abnormalities: High Temperature, High Pulse Rate, High Heart Rate, High Respiratory Rate and High

Blood Pressure.
 Pain
 Abnormalities: No abnormalities found.

 Skin, Hair and Nails Assessment

 Abnormalities: Dry and pale skin, high temperature.

 Head and Neck Assessment

 Abnormalities: Palpable lymph nodes.

 Eye Assessment
 Abnormalities: Eyebags.
 Ear Assessment
 Abnormalities: No abnormalities noted.

 Nose and Sinuses Assessment

 Abnormalities: Nasal Flaring.

 Mouth and Throat Assessment

 Abnormalities: Dry, discolored and slightly pale lips. Discolored gums and stained
teeth. Productive cough.

 Thorax, Breast and Lungs Assessment

 Abnormalities: Bilateral crackles, high respiratory rate noted at 26 breaths per
minute. Use of accessory muscles: Shoulders. Noted wheezing.
 Heart and Neck Vessels Assessment
 Abnormalities: High heart rate: 112bpm.

 Abdomen Assessment
 Abnormalities: No abnormalities found

 Musculoskeletal System Assessment

 Abnormalities: Patient easily gets tired.

 Genito-Urinary Assessment
 Abnormalities: No abnormalities noted.
ExtremitiesAssessment
Abnormalities: No Abnormalities found.

MentalStatus
Abnormalities: No Abnormalities found.
 Upon Neurologic Assessment

 Olfactory
 Patient was able to identify the smell of the alcohol and the cologne.

 Optic
 Peripheral field intact upon confrontation

 Oculomotor
 Eyes exhibit PERRLA
 Trochlear
 Both eyes exhibit purposeful movements and as necessary

 Trigeminal
 Facial sensations are intact and can be felt equally and bilaterally. Patient can frown
and smile at will and jaw strength was equally bilateral.

 Abducens
 Both eyes show coordinated, voluntary and purposeful movement
 Facial
 Patient reported that he could taste his previous meal. Patient can frown, smile,
wink both eyes and purse lips

 Vestibulocochlear
 Patient can hear words at different distances.

 Glossopharyngeal
 Patient was able to swallow without pain and difficulty
 Vagus
 Uvula rises at the midline and patient can swallow without difficulty

 Accessory
 Patient can move neck both left and right, front and back without pain and difficulty.
Patient can shrug shoulders one by one and at the same time without difficulty.

 Hypoglossal
 Patient can protrude tongue at the midline without difficulty and can pronounce
various words properly
ETIOLOGY
 PREDISPOSING FACTORS
FACTORS PRESENCE RATIONALE JUSTIFICATION

AGE PRESENT Respiratory muscle strength decreases with Patient’s age is 64 years
age and can impair effective cough, which is old, therefore he’s more
important for airway clearance. The lung vulnerable to ventilatory
matures by age 20–25 years, and thereafter failure.
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.

Family History of PRESENT Genetic factors likely play some role in high Patient stated that his
Hypertension blood pressure, heart disease, and other father is also suffering
related conditions. However, it is also likely from hypertension.
that people with a family history of high
blood pressure share common environments
and other potential factors that increase
their risk.
 PRECIPITATING FACTORS
PNEUMONI PRESEN Bacterial or viral pneumonia infections Patient is positive of
A T are quite common; however, occasionally community acquired
become complicated as a collection of pneumonia as seen in his
fluid develops in the section of the lung chart
that is infected.

SEDENTARY PRESENT A sedentary lifestyle is a type of lifestyle with Patient have lived a
LIFE STYLE little or no physical activity. A person living a sedentary lifestyle as
sedentary lifestyle is often sitting or lying down evidenced by inactive
while engaged in an activity like reading, lifestyle such as watching T.V
socializing, watching television, playing video for hours while lying on a
games, or using a mobile phone/computer for sofa. He, also, is not into
much of the day doing any light exercises at
all.
SMOKER PRESENT Tar and smoke particulates that enter the Patient stated that he can
airways and lungs with each cigarette cause consume 1 pack of cigarettes
irritation and inflammation. Over time scar a day.
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
SYMPTOMATOLOGY
 SIGNS & PRESENCE RATIONALE JUSTIFICATION
SYMPTOMS

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

WHEEZING PRESENT Wheezing is caused by something Upon patient’s

obstructing the air channels in the lungs, inspiration, a high
and since pneumonia causes accumulation pitched, sharp sound
of mucus inside of the lung sacks then it is was heard
most probably caused by it.

FROTHY SPUTUM ABSENT Even though the fluid in pulmonary edema During exposure, the
is a transudate, there is blood in it. This is patient did not show any
substantiated by the fact that there are manifestation of having
microhemorrhages in acute lung congestion frothy sputum.
and hemosiderin laden macrophages or
'heart failure cells' in long standing
pulmonary congestion on histology.
WBC ABOVE PRESENT The WBC is expected to rise up White blood cell count
NORMAL in response to bacterial showed above normal
infection. levels: 10.67.

BILATERAL PRESENT Crackles are often associated with Based on assessment, patient
CRACKLES inflammation or infection of the manifested bilateral crackles
small bronchi, bronchioles, and on his chest and on chest X-
alveoli. Crackles that do not clear Ray, fluid build-up was
after a cough may indicate present.
pulmonary edema or fluid in the
alveoli.
PATHOPHYSIOLOGY
DOCTOR’S ORDER
Laboratory Tests
NURSING
THEORIES
Florence Nightingale’s
Environmental Theory
 Nightingale’s theory focuses on the role that the
environment plays on the patient’s overall health

 Altering the environment of the patient as much as

situation allows the group was able to prevent, suppress
or contribute to the disease and prevent accidents and
even death

 Cleanliness was a concern for the patient because since

he has an infection it is a priority to prevent progression
of the disease and prevent any further complications
Imogene King’s Goal
Attainment Theory
 Incorporate the concept of the nurse and the patient mutually in
communicating information, establishing goals and taking action
to attain a certain goal formulated by the nurse for the
achievement of optimum health of the patient

 The group had formulated a set of goals for the patient that she
should be able to attain to reach her optimum health.

 The group strategically planned and formulated specifically for

the patient for the attainment of his optimum health
Virginia Henderson’s Need
Theory
 Virginia Henderson’s Need Theory connects to the patient
in a way that most of the fourteen basic needs by
Henderson were given attention and consideration and
with this, the group was able to formulate and provide a
plan of care based on the assessed needs of the patient
Sister Callista Roy’s
Adaptation Model
 According to Sister Callista Roy's model, a person is a bio-
psycho-social being in constant interaction with a changing
environment. He or she uses innate and acquired mechanisms
to adapt

 There is a feedback cycle of input (stimuli), Throughput

(control processes), and output (behaviors or adaptive
responses)

 The group looks at our patient as a constantly adapting

individual
NURSING CARE PLANS
PROGNOSIS
  Good Fair Poor Justification

Onset of Illness       Patient Button experienced an

    episode of chest pain located on the
X   right sternal border and rated it with
a 10/10 on the pain scale. He then
decided to go to the nearest hospital
to have himself checked and then the
physician ruled him for admission for
further management.

Duration of Illness     Prior to admission, Button

  experienced chest pain for 18 hours.
  X After further assessment/diagnostic
tests Patient Button was diagnosed
with Pulmonary Congestion
secondary to Community Acquired
Pneumonia
  Good Fair Poor Justification
Precipitating       Patient is a smoker for 40 years.
Factors   X   Patient is reported to consume 1
pack of cigarettes per day. Patient
  stated that he is willing to stop
smoking for sake of his health.

Willingness to       Patient “Button” is very cooperative

take medications   and willing to comply with all the
medications and treatments that
X were prescribed by the physician,
  and that because he is aware of its
effects and how it can aid in his
recovery. Also, Button stated that he
gives importance to every word that
the physician says.
  Good Fair Poor Justification
Environmental       Button’s wife stated that their home
Factors       environment is conducive to health
  X   recovery/maintenance. She added
that their home is suitable for rest
and comfort since there are
adequate resources such as
comfortable bed and adequate food
supply.
Family Support       Button stated that his family
      especially his wife and children are
    all very supportive, he reported that
X they frequently visit in the hospital
and fully supports him physically,
financially and emotionally. He also
stated that most of the hospital bills
was taken care off by his children.
Total 0 4.6 6.4 Poor:1 X1.6 = 1.6
Fair: 1X2.3 = 2.3
Good: 4X3.0 = 12
Total: 13.5/6 = 2.65
GOOD
Range of Value:
1.0-1.6 = Poor
1.7-2.3 = Fair
2.4-3.0 = Good
Insert Discharge Plan
RECOMMENDATION
The Client and the Family

 alwayscomply with the doctor’s order to

speed up his recovery

 comply
on the medications as ordered to
manage his pain and other symptoms

 continue giving importance to his health.

The Students

 to administer medications as ordered

 togive the holistic care that the clinical

instructors have taught them

 to
come into duty stock with the knowledge
needed for the entire shift.
The School of Nursing Faculty

 continueproviding the excellent quality of

education that they have always been giving
since time immemorial

 focus on areas that need improvement

The Hospital

 continue
giving that world class care they
have been giving to patients ever since

 continueimproving its facilities for faster

recuperation of the patients
References
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https://www.verywellhealth.com/what-causes-low-hdl-cholesterol-
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https://www.healthline.com/health/eosinophil-count-absolute#pu
rpose
 High uric acid level. (2016). Retrieved from
https://www.mayoclinic.org/symptoms/high-uric-acid-level/basics
/definition/sym-20050607
 Charles Patrick Davis, P. (2018). Liver Blood Tests Abnormal
Values (High, Low, Normal) Explained. Retrieved from
https://www.medicinenet.com/liver_blood_tests/article.htm#what_
are_the_basic_functions_of_the_liver
References
 Van Leeuwen, A., & Poelhuis-Leth, D. (2014). Comprehensive Handbook
of Laboratory and Diagnostic Tests with Nursing Implications (3rd ed.).
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 (Ignatavicius, D. D., MS,RN,ANEF, & Workman, M., PhD, RN, FAAN.
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