I.

OBJECTIVE

A. General Objective

After 30 minutes of health teaching, the client will be able to gain knowledge
about the risk and cause of having a Community Acquired Pneumonia (CAP)

B. Specific Objective

After 30 minutes of health teaching, the patient may be able to:

KNOWLEDGE

1. Know the definition, signs and symptoms of Community Acquired Pneumonia

(CAP)

2. Understand the disease process and its causes

3. Identify the disease related of having a Community Acquired Pneumonia

(CAP)

SKILLS

1. Identify the preventive measure that may lessen the progress of the disease

2. Do proper nursing care interventions for the disease

3. Be able to identify the different drugs to manage the disease

ATTITUDE

1. To gain sense of awareness regarding the preventive measure so they can

develop routine execution to reduce or if possible to eradicate their problem

2. Have positive outlook towards the possible outcome of health maintenance

and personal development.

II. READINESS TO LEARN

 Since the patient recognize the situation as a problem, they are ready to
learn methods of preventing such as worsen.

III. CAPABILITIES TO LEARN

The patient has a Community Acquired Pneumonia (CAP), he is capable of

learning some preventive measures that may prevent his body from having a more
complication related to his disease. Sepsis can occur when microorganisms enter
the blood stream and the immune system responds, Respiratory failure because
CAP affects the lungs, often individuals with CAP have difficulty breathing. If enough
of the lung is involved, it may not be possible for a person to breathe enough to live
without support.

IV. METHODOLOGY

The method used in delivering health teaching was through visual aids and in
a discussion form for better understanding of the patient. The medium used will be
tagalog for better interpretation and understanding. At the end of health teaching
the presenters will determine the pathophysiology of having CAP and some
intervention that may prevent further progression of the condition ask the patient if
they have any question or clarification regarding the discussion.

V.INTRODUCTION

COMMUNITY-ACQUIRED PNEUMONIA (CAP) is infectious pneumonia in a

person who has not recently been hospitalized. CAP is the most common type of
pneumonia. The most common causes of CAP vary depending on a person's age,
but they include Streptococcus pneumoniae, viruses, the atypical bacteria,
and Haemophilus influenzae. Overall, Streptococcus pneumoniae is the most
common cause of community-acquired pneumonia worldwide. Gram-negative
bacteria cause CAP in certain at-risk populations. CAP is the fourth most common
cause of death in the United Kingdom and the sixth in the United States. The term
"walking pneumonia" has been used to describe a type of community-acquired
pneumonia of less severity (because the sufferer can continue to "walk" rather than
require hospitalization).Walking pneumonia is usually caused by the atypical
bacterium, Mycoplasma pneumoniae.

Morbidity and Mortality

Patients with severe CAP invariably have severe cardiopulmonary disease or

diminished or absent splenic function.

Sex

A considerably higher proportion of males are attacked than females, due to

mode of lifestyle that is the hazards of outdoor exposure to which men are
subjected more of the woman.

Incidence

CAP is commonly in elderly adults, with an incidence rate in the United States
of 280 cases per 10,000 individuals older than 65 year old.

Causative Agents

 Streptococcus Pneumoniae- most common

 Viruses
 Atypical bacteria
 Haemophilus influenza
 Gram- Negative Bacteria

Incubation Period

1-3 days with sudden onset of shaking, chills, fever, chest pain.

Mode of Transmission

 Droplet
  Indirect
 Direct

Symptoms commonly include:

 problems breathing
 coughing that produces greenish or yellow sputum
 a high fever that may be accompanied with sweating, chills,
and uncontrollable shaking
 sharp or stabbing chest pain
 rapid, shallow breathing that is often painful

Less common symptoms include:

 the coughing up of blood (hemoptysis)

 headaches (including migraine headaches)
 loss of appetite
 excessive fatigue
 blueness of the skin (cyanosis)
 nausea
 vomiting
 diarrhea
 joint pain (arthralgia)
 muscle aches (myalgia)

The manifestations of pneumonia, like those for many conditions, might not be
typical in older people. They might instead experience:

 new or worsening confusion

 hypothermia
 falls*

Additional symptoms for infants could include:

  being overly sleepy
 yellowing of the skin (jaundice)
 difficulties feeding

*Dangerous if causative agent reaches the blood.

4- Stages:

1. Lung engorgement
2. Red hepatisation- rusty sputum
3. Gray Hepatisation- prune juice sputum
4. Resolution

Complication

1. Pleurisy- inflammation of pleural space, edema in the lungs.

2. Emphysema- over distension of aleveolarism
3. Pleural effusion
4. Myocarditis
5. Endocarditis
6. Otitis media due to Eustachian tube

Risk Factors

• Problems in immune system

• Recent trauma or surgery
• Impaired consciousness
• Living in the nursing facility
• Other serious health conditions like liver cirrhosis, diabetes mellitus or heart
disease
• Cerebral palsy
 • Chronic lung diseases like cystic fibrosis, bronchiectasis or COPD
• Difficulty in swallowing
• Recent viral respiratory infections, such as influenza, laryngitis, common cold
• Cigarette smoking

VI. ANATOMY AND PHYSIOLOGY

The lungs constitute the largest organ in the respiratory system. They play an
important role in respiration, or the process of providing the body with oxygen and
releasing carbon dioxide. The lungs expand and contract up to 20 times per minute
taking in and disposing of those gases.
Air that is breathed in is filled with oxygen and goes to the trachea, which branches
off into one of two bronchi. Each bronchus enters a lung. There are two lungs, one
on each side of the breastbone and protected by the ribs. Each lung is made up of
lobes, or sections. There are three lobes in the right lung and two lobes in the left
one. The lungs are cone shaped and made of elastic, spongy tissue. Within the
lungs, the bronchi branch out into minute pathways that go through the lung tissue.
The pathways are called bronchioles, and they end at microscopic air sacs called
alveoli. The alveoli are surrounded by capillaries and provide oxygen for the blood in
these vessels. The oxygenated blood is then pumped by the heart throughout the
body. The alveoli also take in carbon dioxide, which is then exhaled from the body.
Inhaling is due to contractions of the diaphragm and of muscles between the ribs.
Exhaling results from relaxation of those muscles. Each lung is surrounded by a two-
layered membrane, or the pleura, that under normal circumstances has a very, very
small amount of fluid between the layers. The fluid allows the membranes to easily
slide over each other during breathing.

VII. PATHOPHYSIOLOGY

Entry of
Microorganism
To nasal

Passages
Invasion of the
Respiratory
System

Activation of
Immune Cough
Response

Ineffective
Immune
Response results
To
Overwhelming

Invading lung
Parenchyma

Release of
Endotoxins and
Exotoxins
 Continuous
Mucus
Production

Massive
Inflammation
Hazy portion (PNEUMONIA) Dyspnea
Of the Chest

Altered gas
Exchange

Consolidation

VIII. DIAGNOSTIC EXAMINATION

• Pleural fluid culture- Pleural fluid culture is a test that looks at a sample of
fluid from the space around the lungs to find and identify disease-causing
microorganisms.

• Gram’s stain and sputum culture - laboratory test that uses a series of
stains to check for bacteria in sputum sample. Sputum is the mucous
material that comes up from your air passages when you cough very deeply.
The Gram stain method is one of the most commonly used techniques for the
rapid diagnosis of bacterial infections, including bacterial pneumonia.

• Computed Tomography scan- help diagnose the cause of clinical signs or

symptoms of disease of the chest, such as cough, shortness of breath, chest
pain, or fever.
• Chest X-ray - typically the first imaging test used to help diagnose
symptoms such as: shortness of breath, bad or persistent cough, chest pain
or injury,fever.
 • Arterial blood gas - measures the acidity (pH) and the levels of oxygen
and carbon dioxide in the blood from an artery. This test is used to check how
well your lungs are able to move oxygen into the blood and remove carbon
dioxide from the blood.
• Complete blood count - gives important information about the kinds and
numbers of cells in the blood, especially red blood cells, white blood cells ,
and platelets. A CBC helps your health professional check any symptoms,
such as weakness, fatigue, or bruising, you may have. A CBC also helps him
or her diagnose conditions, such as anemia, infection, and many other
disorders.

IX. NURSING INTERVENTION

1. Instruct the patient to have complete bed rest. To decrease oxygen

demand.
2. Encourage nutrition rich in protein. To prevent body weakness. To keep
tissues healthy.
3. Pain relief- high back rest or orthopneic. Lowers the diaphragm and
provides for maximal thoracic expansion.
4. Monitor intake and output. For excretions of toxins and for avoidance of
serious complications due to medications.
5. Tepid sponge bath for fever. To decrease above normal body
temperature.
6. Frequent turning from side to side. To prevent bed sores. To improve
circulation and prevent possible complications.
7. Nose to mouth pursed lip breathing. Helps prevent early airway collapse.
8. Increase fluid intake. For rehydration.

X. DISCHARGE PLAN
 Health teaching is one of the most important parts of the nursing
responsibilities. Before discharging, a nurse must be able to explain the following
health teachings according to the patient’s relative level of understanding.

Objectives:

• To obtain wellness for the client.

• To promote comfort and rest.
• To promote and maintain activity.
• To promote adequate nutrition.
• To prevent possible complications.

1. Abstain from drinking alcohol and quit smoking. If smoke or drink alcohol
excessively, stop doing so. To reduce the stress that will affect the body
system especially the lungs and heart.
2. Emphasize to the family thorough and frequent cleansing of mouth and the
patient should also have an adequate oral hygiene. To prevent
contamination and remove the food residue.
3. Turn to side frequently. To improve circulation and prevent possible
complications.
4. If bed ridden, be meticulous about a skin care. To monitor if there is a
signs of sores.
5. Ask a health professionals on how to clean, dress, and bandage pressure
sores properly. To be aware of it.
6. Alert a doctor or nurse immediately, if you notice signs of infection. To have
a further assessment and intervention.
7. Encourage a balanced diet with extra protein. To keep tissues healthy.
8. Explain the importance of keeping all follow-up appointments. To ensure
disease cure.
9. Teach the importance of completing the prescribed medication regimen as
ordered. For fast healing.
10. Instruct patient and their relative to report any manifestation immediately to
the physician such as increasing shortness of breathing, difficulty of
breathing, sleepiness or confusion. To have a further assessment and
intervention.