Community Acquired Pneumonia: Pathophysiology, Assessment, and Management

Running head: COMMUNITY ACQUIRED PNEUMONIA 1
COMMUNITY ACQUIRED PNEUMONIA
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COMMUNITY ACQUIRED PNEUMONIA 2
Introduction
The essay will focus the case scenario of John Jenkins, 72 years with Community
Acquired Pneumonia (CAP) resulting in complains of shortness of breath. He also presents
with lethargy, inability to walk, history of gastro-esophageal reflex disease, and inability to
eat and drink for two days. On examination, he has a productive cough associated with green
sputum and central cyanosis. Additionally, he is tachypneic with 28 breaths per minute, SP02
of 91%, tachycardic, heart rate -115 beats per minute and high temperatures of 38.2 degrees
Celsius. On auscultation, the patient has crackles on the left lower and middle lung lobe. With
regard to this, the paper will provide a primary survey assessment for identification of the
relevant data and discuss the underlying pathophysiology behind the disruptions of the body
in pneumonia resulting in the abnormal findings on assessment. Lastly, the paper will discuss
the nursing management of the patient prioritizing the first five nursing interventions that will
be appropriate for Mr. John.
Primary Survey Assessment
The patient had a set of vital signs which included blood pressure, temperature, pulse,
respiratory rate, and pulse oximetry. In the outpatient emergency department, the physician
examined the patient using the “ABCs” approach. Since the patient was acutely ill, he needed
the peripheral access, supplemental oxygen, and monitoring. Based on the condition of our
patient, we required a non-rebreather for oxygenation, endotracheal intubation, and non-
invasive ventilation since he had respiratory distress. In the primary survey assessment, we
systematically examined the patient using the “ABCDE” approach (Kram, DiBartolo,
Hinderer, & Jones, 2015).

COMMUNITY ACQUIRED PNEUMONIA 3
Before the assessment of the patient, the first step was to ensure our personal safety by
wearing protective garments such as gloves and apron. The patient was generally examined to
find out whether he was appearing unwell.
Airway: The patient’s airway was evaluated for obstruction, edema and strider. In our
evaluation of the patient, we repositioned and placed him on non-rebreather for
preoxygenation. We also implemented airway adjuncts and maneuvers including head tilt,
jaw thrust, chin lift, and insertion of nasal trumpet. Untreated obstruction of the airway may
lead to hypoxia and increased risk of damage of multiple body organs including heart,
kidneys, and brain, and other complications such as cardiac arrest or death (Kram et al.,
2015).
To rule out signs of airway obstruction, we considered various signs abdominal
movements and paradoxical chest and use of accessory muscles during respiration. Central
cyanosis is one of the late signs of airway obstruction. In complete obstruction of the airway,
there are no breath sounds. Partial obstruction results in diminished and noisy entry of air
(Kram et al., 2015). If airway obstruction is not treated may lead to hypoxemia thus
increasing the risks of injury to the heart, brain, and kidneys. In accordance with the case
study, the patient had an oxygen saturation of 91 % which was low compared to a reference
of more than 95 %. In a hypoxic patient, the expected range of SPO2 is 85-94%.
Breathing:
Abnormal Finding 1: Respiration rate of 28 breaths/minute: The patient was assessed the
patient for adequate ventilation. In the assessment, we looked for increased breathing work,
signs of respiratory distress like retractions and tripoding. We assessed for tachypnea and
discovered that he was tachypneic with a respiration rate of 28 breaths per minute. This rate
of respiration was quite high for the patient when compared to a reference range of 12-20

COMMUNITY ACQUIRED PNEUMONIA 4
breaths per minute in an adult. Our assessment was important since impending or imminent
respiratory failure may need Potentially Rapid Sequence Intubation (RSI) and Endotracheal
Intubation (Pinto & Biancofiore, 2016).
In the assessment of breathing, we used the three senses of looking, listening, and feeling to
identify the general signs of respiratory distress such as central cyanosis, sweating, and
abdominal breathing. We counted the respiratory rate and recorded in one minute. Increased
respiratory rate is one of the markers of illness and indicates the possibility of sudden
deterioration of the patient. We assessed the patient’s depth and pattern of respiration and
bilateral chest expansion. While assessing the patient, any chest deformities were noted while
observing the distention of Jugular Vein Pulse (JVP). We noted the presence and patency of
the chest drains and abdominal distention which limits diaphragmatic movement and may
worsen the patient’s respiratory problem (Jain et al., 2015).
Auscultation was used to listen to the breath sounds of the patient since a rattling airway may
be an indication of secretions in the airway which is commonly caused by patient’s inability
to cough sufficiently. According to the case study, on auscultation, the patient has crackles on
the left lower and middle lobe of the lung which was abnormal since no sounds should be
heard. On chest auscultation, the bronchial breathing is an indication of lung consolidation
with a patent airway while reduced or absent sounds indicate long consolidation,
pneumothorax, and pleural fluid which are associated with complete airway obstruction
(Pinto & Biancofiore, 2016).
Percussion was done on the patient’s chest to identify hyper-resonance which suggests
pneumothorax, or dullness which shows pleural fluid or consolidation. We checked the
patient’s suprasternal notch for the position of trachea since a deviation to the left or rights is
an indication of mediastinal shift which is usually attributed to lung fibrosis, pneumothorax,