I.

Basic medical concepts

A. DEFINITION
Pneumonia is an acute inflammation of the lung parenchyma that usually originates
from an infection. (Price, 1995).
Pneumonia is inflammation of the lung parenchyma, distal to the terminal bronchioles which
includes respiratory bronchioles, alveoli, and causes lung tissue consolidation and disruption
of local gas exchange. (Zul, 2001)
Bronchopneumonia is used to describe pneumonia that has a pattern of spotting spread,
regularly in one or more localized areas within the bronchi and extends to the adjacent lung
parenchyma around it. In bronchi pneumonia, there is a consolidation of the spot area.
(Smeltzer, 2001).

B. ETIOLOGY
1. Bacteria
Bacterial pneumonia is usually found in old age. Gram positive organisms such as:
Steptococcus pneumonia, S. aerous, and streptococcus pyogenesis. Gram-negative
bacteria such as Haemophilus influenza, klebsiella pneumonia and P. aeruginosa.
2. Viruses
Caused by influenza viruses that spread through droplet transmission.
Cytomegalovirus in this case is known as a major cause of viral pneumonia.
3. Mushrooms
Fungal infections such as histoplasmosis spread through the inhalation of air
containing spores and are usually found in bird droppings, soil and compost.
4. Protozoa
Cause the occurrence of Pneumocystis carinii pneumonia (CPC). Usually infects
patients who experience immunosuppression. (Reeves, 2001).
C. PATHWAY

A.

D. CLINICAL MANIFESTATIONS
Clinical manifestations of bronchopneumonia include:
1. Difficulty and pain during breathing
a. Pleuritic pain
b. Shallow breath and snoring
c. Tachypnea
 2. Breathing sounds over the consolidated area
a. Shrink, then become lost
b. Krekels, ronki, egofoni
3. Asymmetrical chest movements
4. Shivering and fever 38.8 ° C to 41.1 ° C, delirium
5. Diaphoresis
6. Anorexia
7. Malaise
8. Thick, productive cough
a. The greenish yellow sputum then turns reddish or rusty
9. Restlessness
10. Cyanosis
a. Circumoral area
b. Basic bluish nails
11. Psychosocial problems: disorientation, anxiety, fear of death

E. SUPPORTING EXAMINATION
1. X-rays: identify structural distribution; can also express extensive abscesses /
infiltrates, empyema (stapilococcus); diffuse or localized (bacterial) infiltration; or
spread / expansion of nodular (viral) infiltrate. Chest x-ray mycoplasma pneumonia
may be clean.
2. Blood Gas Analysis (Blood Gas Analysis): abnormal may occur, depending on the
area of the lung involved and the existing lung disease.
3. Gram examination / sputum and blood cultures: taken by needle biopsy, transtracheal
aspiration, bronchoscopic fibrillation or lung opening biopsy to treat the causative
organism.
4. JDL: leukocytosis is usually present, although low white blood cells occur in viral
infections, a condition of immune pressure allows the development of bacterial
pneumonia.
5. Serological examination: viral titer or legionella, cold agglutinin.
6. LED: increase
7. Examination of pulmonary function: volume may decrease (congestion and alveolar
collapse); airway pressure may increase and complaints decrease, hypoxemia.
8. Electrolytes: sodium and chloride may be low
9. Bilirubin: may increasePercutaneous aspiration / biopsy of open lung tissue: states of
typical intranuclear and cytoplasmic involvement (CMV) (Doenges, 1999)
F. MANAGEMENT
1. Chemotherapy
The administration of chemotherapy must be based on indicative of the discovery of
germs that cause infection (sputum culture results and tests of germ sensitivity to
antibodies). If the disease is mild antibiotics are given orally, whereas if severe are
given parenterally. If there is a decrease in kidney function due to the aging process, it
must be remembered that the possibility of using certain antibiotics needs to be
adjusted by the dose (Harasawa, 1989).
2. General Medicine
a. Oxygen Therapy
b. Hydration
If mild oral hydration, but if severe hydration is done parenterally
3. Physiotherapy
Patients need bed rest and the position of the patient needs to be changed to avoid
hypographic pneumonia, weakness and pressure sores.

II. Basic Concepts of Nursing

1. Activity / rest
a. Symptoms: weakness, fatigue, insomnia
b. Signs: lethargy, decreased tolerance to activity
2. Circulation
a. Symptoms: history of chronic heart failure
b. Signs: tachycardia, silvery or pale appearance
3. Ego Integrity
a. Symptoms: many stressors, financial problems
4. Food / Liquid
a. Symptoms: loss of appetite, nausea / vomiting, history of DM
b. Signs: abdominal distension, hyperactive bowel sounds, dry skin with poor
turgor, malnutrition appearance
5. Neurosensory
a. Symptoms: frontal headache
b. Sign: mental change
6. Pain / Comfort
a. Symptoms: headache, increased chest pain and cough, myalgia, atralgia

7. Breathing
a. Symptoms: history of PPOM, cigarette smoking, tachypnea, dyspnea, shallow
breathing, use of accessory muscles, nasal dilation
b. Signs: sputum; pink, rusty or purulent
c. Percussion; deaf above the consolidated area, pleural friction friction
d. Breath sounds: decreased or absent above the area involved or bronchial
breath
e. Framitus: tactile and vocal increases with consolidation
f. Color: pale or cyanotic lips / nails
8. Security
a. Symptoms: history of immune system disorders, fever
b. Signs: sweating, repeated shivering, trembling, redness, possibly in the case of
rubella / varicella
9. Counseling
a. Symptoms: history of surgery, chronic alcohol use

10. NURSING PLAN

1) Treatment Diagnosis: Cleanliness of the airway is not effective
Can be linked to:
a) Tracheobronchial inflammation, edema formation, increased sputum
production
b) Pleuritic pain
c) Decreased energy, weakness
Results Criteria:
a) Shows the behavior of achieving airway hygiene
b) Indicates a patent airway with clear breath sounds, no dyspnea or
cyanosis
 Nursing Interventions:
a) Independent
a. Assess the frequency / depth of breathing and chest movements
b. Pulmonary auscultation, note down area / no air flow and additional
breath sounds (krakles, wheezing)
c. Help the patient to cough effectively and breathe deeply
d. Suction as indicated
e. Give a liquid of at least 2500 ml / day
b) Collaboration
Give medication as indicated.

2) Treatment Diagnosis: Damage to gas exchange

Can be linked to:
a) Alveolar membrane changes - capillary (inflammatory effect)
b) Impaired blood oxygen capacity
Results Criteria:
a) Demonstrate improved ventilation and tissue oxygenation with a Blood
Gas Analysis in the normal range and no symptoms of respiratory distress
b) Participate in actions to maximize oxygen
Nursing Interventions:
a) Assess the frequency, depth and ease of breathing
b) Monitor body temperature, as indicated. Help comfort measures to
reduce fever and chills
c) Maintain a restful sleep
d) Elevate the head and push frequently changing positions, deep
breathing and effective coughing
e) Assess anxiety level. Push to express the problem / feeling.

3) Treatment Diagnosis: Ineffective breathing pattern

Can be linked to:
a) The inflammatory process
b) Decreased pulmonary compliance
Results Criteria:
Showing normal /effective respiratory patterns with Blood Gas Analysis in the
normal range
Nursing Interventions:
a) Assess the frequency, depth of breathing and chest expansion
b) Auscultation of breath sounds
c) Observe cough patterns and secretive characters
 d) Encourage / help patients breathe deeply and exercise cough
effectively
e) Give additional oxygen

4) Diagnosis Treatment: Increased body temperature

Can be linked to: Infection process
Results Criteria:
a) The patient shows no sign of an increase in body temperature
b) Not shivering
c) Normal pulse
Nursing Interventions:
a) Body temperature observation (4 hours)
b) Monitor skin color
c) Perform cooling measures as needed
d) Give medication as indicated: antipyretic
e) Monitor blood culture and sputum culture, monitor the results every
day

5) Diagnosis Treatment: High risk of spreading infection

Can be linked to:
a) Inadequate main defense
b) Inadequate secondary defenses (presence of infection, immune
suppression)
Results Criteria:
a) Achieve time to repair repeated infections without complications
b) Identifying interventions to prevent / reduce the risk of infection
Nursing Interventions:
a) Monitor Vital Signs
b) Encourage the client to pay attention to secretion expenditure and
report changes in color number and odor of secretions
c) Change positions frequently
d) Perform preventive isolation according to the individual
e) Encourage adequate resting balance with moderate activity.
f) Give antimicrobials as indicated
6) Diagnosis Treatment: Activity intolerance
Can be linked to: Weakness, fatigue
Results Criteria:
Report / show increased tolerance to activity that can be measured by the
absence of dyspnea, excessive weakness and Vital Signs in the normal range
Nursing Interventions:
 a) Evaluate client responses to activities
b) Give a calm environment and limit visitors
c) Explain the importance of rest in the treatment plan and the need to
balance activity and rest
d) Help the patient choose a comfortable position for rest / sleep
e) Assist self-care activities as needed

7) Diagnosis Treatment: Resti nutrition is less than the body's needs

Can be linked to:
a) Increased metabolic requirements secondary to fever and the process
of infection
b) Anorexia of abdominal distension
Results Criteria:
a) Showing increased appetite
b) Stable or increased body weight
Nursing Interventions:
a) Identify factors that cause nausea or vomiting
b) Give a closed container for sputum and discard as often as possible
c) Auscultation of bowel sounds
d) Give small and frequent meals
e) Evaluate nutritional status
8) Diagnosis Treatment: Resti lacks fluid volume
Risk factor :
a) Excessive fluid loss (fever, heavy dryness, hyperventilation, vomiting)
Results Criteria:
a) Balanced liquid balance
b) Moisturized mucous membranes, normal turgor, fast capillary filling
Nursing Interventions:
a) Review changes in Vital Signs
b) Assess skin turgor, mucous membrane moisture
c) Record reports of nausea / vomiting
d) Monitor input and output, note color, urine character
e) Calculate fluid balance
f) Give medication as indicated; antipyretic, antiemetic

REFERENCES

Doenges, Marilynn (2000). Nursing Care Plan, Issue 3, Jakarta: EGC.

Lackman’s (1996). Care Principle and Practice of Medical Surgical Nursing,
Philadelphia: WB Saunders Company.
Pasiyan Rahmatullah (1999), Geriatrics: Elderly Health Sciences. Editor: R.
Boedhi Darmoso and Hadi Martono, Jakarta, FKUI Publishing Center
Reevers, Charlene J, et all (2000). Surgical Medical Nursing, Jakarta: Salemba
Medica.
Smeltzer SC, Bare B.G (2000). Surgical Medical Nursing Textbook, Volume I,
Jakarta: EGC
Suyono, (2000). Internal Medicine. Edition II, Jakarta: FKUI Publisher Center.