CHAPTER ONE

ASSESSMENT OF PATIENT/FAMILY

Assessment is a crucial component of the nursing process, serving as the foundation for identifying

a patient's needs, concerns, and health status. A comprehensive and systematic assessment

provides nurses with essential information to develop effective care plans and interventions

tailored to the individual patient. Assessment has different phases and here's a detailed overview

of the assessment phase in the nursing process:

Gathering Data: The assessment process begins with gathering data through various means,

including patient interviews, physical , reviewing medical records, and obtaining

information from the patient's family or caregivers. Nurses also use tools such as observation, vital

sign measurements, and diagnostic tests to collect objective data.

Subjective vs. Objective Data: During the assessment, nurses distinguish between subjective data

(symptoms reported by the patient, such as pain or nausea) and objective data (measurable and

observable signs, such as elevated blood pressure or skin rash). Both types of data are essential for

gaining a holistic understanding of the patient's condition.

Health History: Nurses conduct a thorough health history interview to collect information about

the patient's past and current health status, including medical conditions, medications, allergies,

lifestyle habits, and family medical history. This information provides valuable context for

understanding the patient's overall health.

Physical Examination: A systematic physical examination is performed to assess the patient's

overall health, focusing on different body systems, such as the cardiovascular, respiratory,

gastrointestinal, and neurological systems. Through palpation, auscultation, percussion, and

observation, nurses gather objective data to identify any abnormalities or changes in the patient's
physical condition.

Psychosocial Assessment: In addition to physical health, nurses assess the patient's psychological

and social well-being. This includes evaluating the patient's mental health status, emotional

responses, coping mechanisms, support systems, and any social determinants of health that may

impact the patient's well-being.

Cultural Considerations: Nurses consider the patient's cultural background, beliefs, and values

when conducting assessments to ensure that care is provided in a culturally sensitive and respectful

manner.

Documentation: Accurate and detailed documentation of assessment findings is critical. Nurses

record all relevant data, including the patient's complaints, physical assessment findings, vital

signs, and other pertinent information in the patient's medical record. Clear and thorough

documentation helps healthcare providers understand the patient's condition and plan appropriate

care.

Ongoing Assessment: Assessment is an ongoing process in nursing care. As the patient's condition

changes, nurses continuously monitor and reassess the patient's status to identify any new issues,

complications, or improvements. Ongoing assessment ensures that care plans remain responsive

to the patient's evolving needs.

In summary, the assessment phase of the nursing process involves gathering comprehensive data

through interviews, physical examinations, and health history reviews. This data collection helps

nurses understand the patient's physical, psychological, and social well-being, providing the

necessary information to develop personalized care plans and interventions. Regular reassessment

ensures that care remains tailored to the patient's changing needs and conditions.
PATIENT’S PARTICULARS/BIOGRAPHICAL DATA

A sixty-three-year old Madam S.D is a Ghanaian and hails from Nandom in the Upper West. She

was born on 14th November, 1961 as the second born among her four female siblings to the Madam

T.M. and the late Mr. T.M. She weighs 68kg and 172cm tall with no physical impairment. She

speaks English, Twi and Dagate. Madam S.D attended vocational school where she learnt how to

sew. She is married with three children, two girls and a boy and they are all residing in their own

house at Pantang in the Greater Accra region with house number of F/Z543. Her house is built

with block and cement which is well painted in cream color. She is a devoted Christian and

fellowships with the catholic church at Adenta. She was admitted at the female medical ward room

E7 of the Ga East Municipal Hospital on the 12th January, 2024 at 8.00am with the folder number

0202732.

Family’s medical and socio-economic history

During interaction with Madam S.D., she mentioned that there are no hereditary diseases in her

family. She is only aware of the mother who once was diagnosed of hypertension which was

pregnancy induced but later resolved after delivery. She explained they also experience some

minor ailments such as headache, fever, stomach ache, sore in the mouth, dizziness and abdominal

pain where they seek treatment from hospitals and sometimes treat with drugs bought from the

pharmacy shops. Her father the late Mr. T. M. died of old age but was diagnosed of hypertension

at the time of ill health in the hospital, but none of her siblings have such disease.

Madam S.D. is a trader in sewing and she uses that to support the husband and the children. Her

husband Mr. J.D. who is the bread winner of the family is a mechanic which he also uses in taking
the of the family. Due to the old age of her mother, she resides with her in her husband’s home so

that she can attend to her health needs. Apart from sewing, she has opened a drinking bar in front

of her house to boost up her income and strengthen her finances. Two of her children have

completed the university and have started working with the government, one being in a military

and the other a teacher. Both support her and the husband in terms of financial difficulties.

Socially, she gets on well with all his family members, neighbors and the community members at

large. Each member of the family is a beneficiary of the National Health Insurance Scheme and

seeks medical assistance from the nearest hospital wherever they find themselves within the

country. This helps her to take care of her hospital bills.

Madam S.D. lives in her husband’s apartment with her family and a child. The house is built with

block and cement, roofed painted in cream color. She encourages hygiene and for that matter, her

house is always kept clean.

Patient’s developmental history

Mr. S.D was born on 14th November, 1961 through vaginal delivery at the hospital in Jerapa

without any complication. She went through the normal stages of development: she sat down by

the age of five months and started crawling by the age of seven month. By age one she started

walking and could mention few words like papa, mama among others. She was breastfed until the

age of two and a half years but started her feed after six months. she said, she does not know her

immunization status, but she has the mark of Bacillus Calmette-Guerin (BCG) on her right deltoid

muscle which shows evidence of immunization against the six-killer disease. Her mother told her

that she liked koko very much when she was weaned off the breast milk. She also said during her

primary level education, she always run away from school just to come home and breastfeed.
She started her elementary school at age six in 1967 at Nandom and completed middle school at

the age of seventeen in Nandom. She could not continue her education to the secondary level

because of financial problems at home and hence, she went into trade till age twenty- seven where

came to Accra to learn apprenticeship job as a seamstress in 1987 for three years. Thus, in 1990

she became a seamstress and this is what she does for a living. She got married to Mr. J. D. the

same year she graduated as a seamstress and was blessed with three children

Patients lifestyle and hobbies.

Madam S.D. was interactive and humble as observed during my interaction with her. She wakes

up at about 5.00am, maintains her oral hygiene with toothpaste and brush and empties her bowel.

He then proceeds to prepare her children for school when they were young by preparing their

breakfast, bathing them and dressing them up for school. After sending the kids to school, she then

takes her bath and take her breakfast too before heading to her shop. She usually prefers waakye

in the morning. In the shop, she tidies up the place with her apprentices, have morning devotion

with them before starting the day’s work. She said she usually takes her lunch at 1 pm and then

closes early as a married woman to prepare supper for the family. One of her favorite movies she

liked watching in the evening is Hollywood movies specifically, Nigerian movies. Her favorite

meal is fufu with palm soup and she mostly prepare that at least four times within the week for the

family as they also like fufu. Pineapple and banana are the fruits she enjoys taking, mostly in the

afternoon.

Because she was trained by the parents who were farmers, she and the husband did some backyard

garden where she mostly spends her free time working there. One amazing thing that entertain her

mostly is Nigerian movies and football. When asked why football, she confirmed it was because

of her husband, as he liked football, so she turned to like it too and for that matter she never misses
football games on their television. She occasionally attends funerals, weddings, family parties and

other social gatherings on Saturdays. On Sundays, she goes to church in the morning around

7:00am and closes around 12pm at Saint Michael Catholic Church. She spends the rest of Sunday

with her family at home.

Patient past medical history

According to Madam S.D., she sometimes suffers from malaria and other minor ailment such as

common cold, cough general body pains but is normally treated with over the counter drugs and

if severe, goes to the hospital. Upon interaction she revealed to me that she wears glasses and

about 6 years ago visited the eye clinic and was given a lens.

Patient present medical history

According to client, she was well until the 11th of January, 2024, around 12:00am when she

suddenly started experiencing dyspnea, cough, headache and fever. According to her, she

sometimes does experience some cough with phlegm and chest pain which she usually takes some

cough suppressant before this present symptom she experienced. She explained that when the

problem started, she feels severe pain in the chest when coughing and mostly expectorate brownish

colored phlegm. She was given some analgesic to relief her of pain by her husband. She was rushed

to the Ga East Municipal Hospital at about 2:00am when condition was worsening. She was

received at the medical emergency center. She was assessed by the night doctor with the help of

the night nurses on duty. She was later admitted into the female medical ward room E7.

Admission of patient

S.D. was admitted to the female medical ward room E 7 of the Ga East Municipal Hospital by Dr.

Yorke at 8:00am on the 12th of January, 2024 with the diagnosis of right lobar pneumonia. She

was brought into the ward in a wheelchair by a nurse and her relatives. They were welcomed on
arrival and given a seat at the nurses’ station. Patient was immediately reassured to allay fear and

anxiety. S.D. was received into the ward and oriented to the ward, toilet and bathroom. The patient

was also made comfortable in an already made bed. Her vital signs on arrival were

Temperature 38.6 degree Celsius

Pulse 120 beats per minute

Respiration 40 breaths per minute

Blood Pressure 164/93mmHg

Weight on admission was 53kg

Sp02 89%

S.D. and her parents were later introduced to the ward nurses and other patients on the ward.

Visiting hours, time to serve meals, medications and doctors’ rounds were explained to them.

Client was encouraged to ask any questions bothering her. I then introduced myself as a student

nurse from Krachi Nurses And Midwifery Training School and I was interested in her condition

because many are the times I have heard of this condition but haven’t really understood its

pathophysiology so I wanted to take the chance to become familiar with the condition and know it

better. Relatives were asked to say their goodbyes and left the patient to rest. The following

medications were prescribed:

Tablet Azithromycin 500 mg daily for three days

Intravenous paracetamol, 500mg 8 hourly for 24 hours

Tab. Spironolactone 25mg daily for 30 days

intravenous Furosemide 40mg bd x72hours

Intravenous Amoxiclav 1.2 g 8 hourly for 48 hours

Tablet Azithromycin 500mg 6hourly for 7 days

All these were recorded into the drug administration charts.

Vital sings checked on admission and medications prescribed by the doctor were recorded into the

various charts and signed. Patient’s name and diagnosis were also entered into the admission and

discharge book and also in the daily ward state.

Lab Investigations/Tests

Patient’s concept of her illness

S.D. does not associate the cause of her condition to anything or anyone. Even though patient is

scared she believes that through expert medical and nursing care she was going to be well and

discharged

Literature Review on the disease condition

Definition of Pneumonia

Pneumonia is an inflammation of the lung parenchyma normally caused by infection, usually viral

or bacterial. It is associated with a marked increase in intestinal and alveolar fluid. As a result of

infection, the alveolar becomes filled with serous fluid and becomes inflamed. (Michael L, 2011).

In the case of right lobar pneumonia, the infection is confined to one of the lobes in the right side

of the lung with the same causative organism.

According to a conversation with AI chat assistant on the 7th February, 2024, pneumonia is an

inflammatory condition of the lungs that can be caused by various infectious agents, including

bacteria, viruses and fungi characterized by the presence of lung consolidation which is a filling

of the alveoli with fluid and inflammatory cells leading to the presence of symptoms such as cough,

fever, difficulty breathing and chest pain ranging from mild to severe and can be life-threatening.
Incidence

According to (Robbins, 2015), this condition is most common during the harmattan season when

the upper respiratory tract infection is most frequent. It occurs in both sexes and all age groups but

it is higher in children and elderly during cold seasons. It is highest in the low socio-economic

groups, place and also higher in overcrowded area (Marrie, Evaluation of pneumococcal

infections, 2012). People who smoke cigarette are highly affected and 90% of cigarette smokers

die as a result of pneumonia every year. It can be community acquired or hospital acquired

(nosocomial). (Marrie, Evaluation of pneumococcal infections, 2012).

According to Ruuskanenm O et al, pneumonia is a common respiratory infection affecting

approximately 450 million people a year and occurring in all part of the world. It is a common

major cause of death among all age groups, resulting in 1.4 million deaths in 2010 (7% of the

world’s yearly total) and 3.0 million deaths in 2016 (the 4th leading cause of death in the world) ,

(Ruuskanen O, Larti E. et al, April 2011)

In 2008, pneumonia occurred in approximately 156 million children (151 million in the developing

world and 5 million in the developed world. (Ruuskanen O, Lahti E, Jennings LC, Murdoch DR

(April 2011)). It caused 1.6 million deaths or 28–34% of all deaths in those under five years of

age of which 95% occurred in the developing world. (Singh V, Aneja S (March 2011). "Pneumonia

- management in the developing world". Paediatric Respiratory Reviews. 12 (1): 52–9). However,

in recent years due to improvements in prevention and treatment of pneumonia, the number of

cases in children under the age of five has decreased from 178 million in 2000 to 138 million in

2015, and mortality rates decreasing from 1.7 million in 2000 to 921,000 in 2015 worldwide.

(“Pneumonia”. www.who.int. Retrieved 7/02/2024). Out of all deaths of children age five and
under in 2017, pneumonia was the cause of 15%, killing more children than any other infectious

disease. ("pneumonia”. www.who.int. Retrieved 11/02/2024).

In Africa, the second highest incidence rate of pneumonia of children under five years old at 0.33

episodes per child per year. (WHO Epidemiology and etiology of childhood pneumonia. WHO. Archived

from the original on August 30, 2008. Retrieved on 11/02/2024). In 2015, pneumonia was responsible for

the deaths of 473,000 African children under the age of five years old. (” child health. WHO | Regional

Office for Africa. Retrieved 11/02/2024). In Sub-Saharan Africa, there is an estimated four million cases

and 200,000 deaths in adult populations per year. (Zar HJ, Madhi SA, Aston SJ, Gordon SB (November

2013).

Aetiology/Causes
Bacteria, such as mycoplasma pneumonia, haemophilus influenza
Viral, for example, rhinovirus
Fungal, for example, pneumocystis jirovecii, cryptococcus species, etc.
Risk factors
Chronic disease example asthma, chronic obstructive pulmonary disease (COPD)
Smoking
Weakened or suppressed immune system
Age

Bacteria

The most common type of bacterial pneumonia is called pneumococcal pneumonia and this is

caused by the streptococcus pneumoniae germ that normally lives in the respiratory tract. Bacterial

pneumonia can occur on its own or develop after you’ve had a viral cold or flu (Medizin, 2018).

Bacteria pneumonia often affects just one part or lobe of a lung. When this happens it is called
lobar pneumonia. Those at risk for bacteria pneumonia include people recovering from surgery,

people with respiratory disease and people with weakened immune systems. ( Moreno, 2013)

Some types of bacteria caused what is known as atypical pneumonia such as:

1. Chlamydophila pneumonia which commonly causes upper respiratory infections but can also

result in a mild pneumonia. (Goldman, 2016)

2. Legionella pneumophila causes a dangerous form of pneumonia called legionnaire’s disease.

Legionella is not passed from person to person. An outbreak of this disease has been linked to

exposure to contaminated water from cooling towers and whirlpool spas (Ardanuy, 2011).

3. Mycoplasma pneumonia is a tiny wide spread of a bacterium that usually infects people younger

than 40 years old. And especially those living and working in crowded places. It is often mild and

goes undetected and is sometimes referred to as walking pneumonia (Barson, 2016).They are

called atypical because pneumonia is caused by other organisms

Virus

Viruses that infect the upper respiratory tract may also cause pneumonia. The most common cause

of viral pneumonia is influenza virus. It is the most common cause of viral pneumonia in young

children (Rochester, 2014). Most viral pneumonia is not serious and does not last longer than the

bacterial pneumonia. With the influenza virus, the virus invades the lungs and multiples; however,

there are almost no physical signs of lung tissue becoming filled with fluid. This pneumonia is

most serious in people who have pre-existing heart or lung disease and pregnant women (Chang,

2016).

Fungi

Fungal pneumonia is most common in people with chronic health problems or weakened immune

systems and also in people who are exposed to large doses of certain fungi from contaminated soil
or bird droppings (Hunter, 2012). A serious fungal infection Pneumocystis pneumonia caused by

Pneumocystis jirovecii. And this occurs in people who have weak immune systems due to

HIV/AIDS or the long term use of drugs that suppress their immune system such as those used to

treat cancer (Dockrell, 2012).

Pathophysiology

The pathophysiology of pneumonia is based on four characteristic stages in the disease process.

This includes congestion, red hepatization, gray hepatization and resolution.

Congestion
This stage occurs within the first 24 hours of contracting pneumonia. After the pneumococcus
organism reach the alveoli there is an outpouring of fluid into the alveoli. The organisms multiply
in the serous fluid, and the infection is spread. The pneumococci damage host by their
overwhelming growth and by interfering with the lung function.

Red Hepatization
This stage occurs two to three days after congestion. There is massive dilation of capillaries and
alveoli are filled with organisms, neutrophils, red blood cells (RBCs) and fibrins. The lungs appear
red and granular, similar to the liver which is why the process is called hepatization.
This stage occurs two to three days after congestion. At this point, the lungs will be red, firm, and
airless with a resemblance to the liver. Alveolar capillaries will be engorged with blood and
vascular congestion will persist. During the red hepatization stage, the alveoli will contain many
erythrocytes, neutrophils, desquamated epithelial cells, and fibrin.

Grey Hepatization
This stage will occur two to three days after red hepatization and is an avascular stage. The lungs
will appear to be a grayish brown or yellow color because of the disintegration of red cells. Blood
flow decreases and leukocytes and fibrin consolidate in the affected part of the lung.

Resolution
Complete resolution, and healing occurs when there is no complication. The exudate experiences
progressive enzymatic digestion. This will produce debris that is eventually reabsorbed, ingested
by macrophages, coughed up, or reorganized by fibroblasts. The normal lung tissue is restored and
the person’s gas-exchange ability returns to normal.

Types

Pneumonia can be classified clinically into two different categories. These include community-

acquired pneumonia and hospital-acquired pneumonia.

Community acquired pneumonia (CAP)

Community acquired pneumonia is defined as a lower respiratory tract infection of the lung

parenchyma with onset in the community or during the first two days of hospitalization. Causative

organisms in CAP include: streptococcus pneumoniae, mycoplasma pneumoniae, haemophilus

influenzae, respiratory viruses, and fungi.

Hospital-acquired pneumonia (HAP)

Hospital-acquired pneumonia is pneumonia occurring 48hours or longer after hospital admission

and not incubating at the time of hospitalization. Organisms responsible for this type of pneumonia

include pseudomonas aeruginosa, Enterobacter, Escherichia coli, proteus, staphylococcus aureus

and streptococcus pneumoniae.

Other types of pneumonia include:

Fungal pneumonia: this is usually caused by fungi

Aspiration pneumonia: this refers to sequelae occurring from abnormal entry of secretions or

substances into the lower airway. It usually follows aspiration of materials from the mouth. Some

of these materials include food, water, vomitus or toxic fluid. Unconscious clients mostly

experience this type of pneumonia.

Opportunistic pneumonia: clients with altered immune responses are at a higher risk of to

respiratory infections. Individuals at risk include: those who have severe protein-calorie

malnutrition, those with immune deficiencies, those who have received transplants and are being

treated immunosuppressive drugs, those who are being treated with chemotherapy and

corticosteroids and radiation therapy.

Clinical Features

1. sudden chills, rapidly rising fever (38.50C to 40.50C).

2. pleuritic chest pain, aggravated by respiration and coughing

3. severely ill patient has marked tachypnea (25 to 45 breath /minutes) and dyspnea;

orthopnea when not propped up

4. pulse is rapid and bounding; may increase 10 beat/min per degree of temperature elevation

(Celsius).

5. A relative bradycardia for the amount of fever suggest viral infection or mycoplasma or

legionella species infection.

6. Sputum purulent, rusty, blood-tinged, viscous or green depending on the etiologic agent

7. Severe pneumonia suggests flushed cheeks, lips and nail beds demonstrating central

cyanosis.

Complications

1. Empyema: this is accumulation of purulent exudate in the pleural cavity. It is relatively

infrequent but requires antibiotic therapy and drainage of the exudate by chest tube or open surgical

drainage.

2. Pleural effusion:

3. Lung cancer
4. Endocarditis: this can develop when the organism attacks the endocardium and the valves of the

heart.

5. Pneumothorax

6. lung abscess: this is usually not a common complication and is caused by staphylococcus aureus

and gram-negative pneumonias.

7. meningitis

8. Bacteremia

9. pleurisy

10. Atelectasis

Diagnostic Investigations

1. Chest x-ray will disclose infiltrates in the chest

2. Sputum for gram stain and culture and sensitivity test

3. Arterial blood gas level; it varies depending on the sensitivity of the pneumonia and the

underlying lung state.

4. Bronchoscopy

5. Transtracheal aspiration allows the collection of material for culture and sensitivity

6. History from the patient.

7. Thoracentesis

Specific medical treatment

The specific medical treatment for pneumonia can vary depending on the cause of the infection,

the severity of the illness and the individual patient factors.

1. Antibiotics: if the pneumonia is caused by bacteria, antibiotics are typically prescribed to

target the specific type of bacteria responsible for the infection. The choice of antibiotic will
 depend on factors such as the severity of the pneumonia, the patient’s medical history and

local resistance pattern.

2. Antiviral medications: if the pneumonia is caused by virus, antiviral medications may be

prescribed. In case of viral pneumonia, the specific antiviral drug will depend on the type of

virus causing the infection.

3. Oxygen therapy: patients with severe pneumonia or those experiencing difficulty breathing

may require supplemental oxygen to ensure that their body is receiving enough oxygen.

4. Supportive care: this may include measures such as pain management, fever reduction and

ensuring adequate hydration and nutrition.

5. Hospitalization: in more severe cases of pneumonia, hospitalization may be necessary to

provide close monitoring and intravenous administration of medications and fluids.

Specific surgical treatment

1. Thoracotomy: this is done to drain abscess and remove infected tissue from the lung

2. Thoracentesis or chest intubation

Nursing Management

1. Assessment

• Assess for fever, chills, night sweats, pleuritic-type pain, fatigue, tachypnea, use of

accessory muscles, bradycardia or relative bradycardia, coughing and purulent

sputum, and auscultate breath sound for consolidation.

• note changes in temperature, pulse, amount, odor and color of secretion, and breath

sound.
 • Assess frequency and severity of cough

• Assess degree of tachypnea or shortness of breath

• Assess changes in chest x-ray findings

• Assess for complications, including continuing or recurring fever, failure to

resolve, atelectasis, pleural effusion, cardiac complications and superinfection.

2. Reassure patient and her family

Reassure patient and family on her condition to relief fear and anxiety, by doing so, she can trust

you on the nursing care.

3. Rest and sleep.

- Rest and relax for full recovery.

- Ensure a peaceful and quiet environment to promote sleep.

- Nurse patient in a well-ventilated and a clean environment.

- Patient should be in a comfortable position to ensure a good respiratory pattern and nurse patient

until the patient’s temperature drops to normal, particularly during respiratory distress.

4. Observation

Vital signs should be checked four hourly, pulse, respiration, temperature and blood pressure

recorded, and deviations reported. Sometimes vital signs should be checked frequently as

condition worsens. Intake and output is observed for improvement in the condition.

- Observe patient, respiratory pattern.

- Observe sputum for any abnormalities.

5. Fluid and Diet

Patients should be given easily digestible foods to minimize the operation of internal organs in

order to use more oxygen for metabolism.

▪ More protein, vitamins, and carbohydrates should be given to the patient to help fight infection

and improve tissue repair.

▪ There should be enough fruit and roughage to prevent constipation.

▪ The intake of fluid should be sufficient to prevent dehydration and to liquefy bronchial

secretions for easy expectoration.

▪ Food should be served in bits.

6. Personal Hygiene.

Ensure mouth care at least twice a day to promote appetite, prevent bad breath and fight dryness

or lip cracking and to prevent mouth infection.

▪ The lips should be kept soft with vaseline.

▪ Ensure bathing twice daily to promote circulation and to induce sleep.

▪ Provide sputum container with cover and disinfectant. Encourage rinsing of the mouth after

coughing up sputum.

6. Psychotherapy

Patient normally reacts with anxiety if there is respiratory distress. They should therefore be

allowed to express their fear and anxiety and the nurse should explain to them the treatment

regimen. Explain the cause, signs and symptoms and the preventive measures of the disease

condition to patient and family and allow asking any questions for clarification.

Reassurance must be done in order to encourage the patient about her condition been resolved.
7. Elimination

Ensure fluid intake of about 3-4 litres a day as well as adequate intake of roughages and fruits to

promote bowel movement.

8. Health Education

▪ Teach patient coughing and deep breathing exercises

▪ Educate patient on the cause, signs and symptoms and prevention of the disease

▪ Patient should be taught on the need of follow up care

▪ Educate patient to avoid dusty and dry environment

Validation of Data

This is the process of determining the accuracy of data collected and this helps to ensure that the

information collected is complete and correct. In view of the facts collected from madam S.D. and

her relatives, the clinical characteristics shown by client were true lobar pneumonia signs and

symptoms as confirmed by the literature review of the condition. I also visited my client’s home

to acquire information from the family members and inhabitants of the house and found out that

the information collected from the mother and medical records confirmed the information obtained

from the mother and patient herself. The staff and the medical officers in the ward also confirmed

the information obtained from my client. Moreover, information from the literature review

confirmed the data gathered. I can therefore conclude that the data collected is free form errors and

misinterpretation hence suitable for the study. Also, the doctor’s physical examination, the

laboratory investigation and all results help confirm that’s madam S.D. was suffering from lobar

pneumonia to free her from some sort of misinterpretations.