TABLE OF CONTENTS

TITLE PAGE NO:

I. INTRODUCTION………………………………………………………….………….1

II. OBJECTIVES…………..…………………………………….………………………2

a. General objectives

b. Specific objectives

III. NURSING HEALTH HISTORY ………………………....………………………..3-5

IV. Physical assessment…………………………...……………………..…………6-8

V. Anatomy and Physiology …….……………….....…………………….…...…..9-13

VI. Pathophysiology, Etiology, ……………….……………………………..…...14-15

VII. Laboratory – Diagnostic result …………………………………………..…16-20

VIII. Medical management………………………………………………...……….21-25

a. Drug study

IX. Nursing care plans……………………………………………………………...26-28

X. Prognosis………………………………………………………………...…………29

XI. Discharge plan and recommendations……………………………………….30

I.INTRODUCTION

Pneumonia is an infection of the lung parenchyma. Community-acquired pneumonia

refers to pneumonia acquired outside of hospitals or extended-care facilities

CAP is a common illness in all parts of the world. It is a major cause of death among all age

groups. In children, the majority of deaths occur in the newborn period, with over two million

worldwide deaths a year. In fact, the WHO estimates that one in three newborn infant deaths

are due to pneumonia. Mortality decreases with age until late adulthood; elderly individuals are

particularly at risk for CAP and associated mortality.

Although viral pneumonias are common in school-aged children and adolescents and are

usually mild and self-limited, these pneumonias are occasionally severe and can rapidly

progress to respiratory failure, either as a primary manifestation of viral infection or as a

consequence of subsequent bacterial infection.

Despite a broad armamentarium of antimicrobials available to treat the disease,

pneumonia remains the seventh leading cause of death in the United States. In 2003, the age-

adjusted death rate caused by influenza and pneumonia was 20.3 per 100,000 persons.

Estimates of the incidence of community-acquired pneumonia range from 4 million to 5 million

cases per year, with about 25% requiring hospitalization.

The United Nations Children's Fund (UNICEF) estimates that 3 million children die worldwide

from pneumonia each year; these deaths almost exclusively occur in children with underlying

conditions, such as chronic lung disease of prematurity, congenital heart disease, and

immunosuppression. According to the WHO’s Global Burden of Disease 2000 Project, lower

respiratory infections were the second leading cause of death in children younger than 5 years

(about 2.1 million [19.6%])

It is due to the motive to learn and apply our knowledge and skills in caring the patient with

pediatric community acquired pneumonia (PCAP). This is a rare case since the patient is only

6 month old..

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II. OBJECTIVES

a. GENERAL OBJECTIVES

· After this case study, we will be able to know what are Pneumonia, how it is acquired and

prevented, its prevention and treatments of its occurrence.

b. SPECIFIC OBJECTIVES

· Define what is Pneumonia

· Trace the pathophysiology of Pneumonia

· Enumerate the difference signs and symptoms of pneumonia

· Formulate and apply nursing care plans, utilizing the nursing process

· To learn new clinical skills as well as sharpen our current clinical skills

required in the management of the patient with Pneumonia

· To develop our sense of unselfish love and empathy in rendering nursing care to our patient

so that we may able to serve future clients with higher level of holistic understanding as well as

individualized care.

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II. NURSING HEALTH HISTORY

A. BIOGRAPHIC DATA

Client MT is a 6 month old, female, was born January 28, 2010 in Biday, San

Feranando City La Union. She is the youngest daughter of Mr and Mrs NT. She is a Roman

Catholic.

She was admitted on July 31, 2010 9:40 PM at Lorma Medical Center by Dr. Rapisura,

Carie Q.,MD and Dr. Orlindo, Maria Teresa V.,MD as her attending physician.

B. CHIEF COMPLAINT

The patient was admitted due to the chief complaint of high grade fever, 38.6 C via

axilla, productive cough and difficulty of breathing.

C. HISTORY OF PRESENT ILLNESS

The present condition started 3 days prior to admission when the patient had dry cough

with associated difficulty of breathing. No other associated signs and symptoms such as

diarrhea and vomiting. No consultation done or medication taken.

2 days prior to admission, the above condition persisted associated with neither fever, still

no consultation done nor medication taken.

Few hours prior to admission, due to persistence of the above condition, she was then

brought in the institution and was then admitted on July 31, 2010 at 9:40PM with the vital signs

of T-38.6ºC, PR-135bpm, RR-68bpm, O2sat-98%, weight-6.4kg, height-58.5cm and a BMI of

18.90 kg/m2 (healthy weight) 22 as ideal with a range of 18.5-25

D. PAST MEDICAL HISTORY

The mother stated that the patient was not hospitalized nor had illnesses before. The

patient had no allergies to drugs. The mother also claimed that the patient already received her

BCG and Hepa B vaccines, 1 dose each, 1 week after her birth at the health center, and had

her vaccines in DPT and OPV with 1 dose each when she was 6th week old.

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E. PEDIA HISTORY

The patient was born to a 33 year old mother with a 38-39 weeks age of gestation via

NSD at home. The mother stated that there were no complications happened nor the mother

acquired illnesses during her pregnancy period.

F. FAMILY HEALTH HISTORY

The mother of the patient claimed that both sides of the patient has history of asthma.

And no other hereditary illnesses present such as diabetes, cancer and hypertension.

G. LIFESTYLE

In an interview, mother said that their house is a concrete bungalow, located along the

highway and near to other houses.

The patient is a pure breastfed baby, the mother verbalized that she didn't introduced

any solid foods yet. The family is using firewood in cooking their foods. While their drinking

water comes from a well which the mother boils before giving to her children. They are also

using dipper in taking a bath and flushing their toilet.

The mother also claimed that the patient's uncle who lives with the family is an active

smoker. And this can one of the precipitating factors that contributed on the patient’s case for

her lungs are still sensitive since patient is still 6 month old. Health teaching was done to the

mother by encouraging the mother to advice the uncle to minimize smoking and not to smoke

near their house.

H. SOCIAL HISTORY

The mother also claimed that, their family are active and concern citizen of the

community, they also mingles with their neighbors and always active participates in activities,

education in their community.

Just like a typical family relationships, there are some misunderstanding experienced

by the family but usually it only lasted for a day, they fix the problem in a calm manner.

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The patient's mother described their family as a traditional Filipino family, wherein they

eat together, live together and giving respect with one another.

I. HEALTH PRACTICES

When a member of the family got sick, they always consult to a medical doctor. They

don't have any private family physician. They also believe in “hilot” but they never use any

herbal medicines that were being prescribed to them, they only taking medicines which are

prescribed only by a physician.

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IV. PHYSICAL ASSESSMENT

I. GENERAL STATISTICS

A Filipino female client, conscious and with a normal body built.

A. Vital signs

RR: 60 bpm

TEMP: 36.5 ˚C

CR: 142 bpm

OXYGEN SAT: 99%

B. Height and weight:

Height – 58.5 cm

Weight- 9kg

II. HEAD AND NECK

A. Head

The head is round with no nodules or masses and depressions.

B. Eyes

The eyes are symmetrically aligned and eyebrows are evenly distributed with no discharge or

discoloration on the eyelids. Conjunctiva on both eyes is pinkish in color, and the sclera is

normal in color. The pupils are black round and equal in size and are reactive to light and

accommodation.

C. Ears

The ears are symmetrically aligned and the color is same as the facial skin, it is firm and not

tender. No serum and discharges noted.

D. Nose

The nose is symmetrically aligned with the face, no discharges, with flaring nares. It is the

same color with the face. It is not tender and no lesions present. The mucosa is pink. The

sinuses are not tender when palpated.

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E. Mouth

The lips are pinkish in color and moist. No ulcerations or lesions noted. The tongue moves

freely and not tender. The client possesses pink gums with no teeth yet.

III. INTEGUMENT:

1. Skin

The skin of the client is moist, pale and has a good skin turgor. Has a fair skin

complexion.

2. Hair and Scalp

The hair are equally distributed with a thin hair strands; well kept; no lice or dandruff

seen/noted.

3. Nails

Client’s nails are normally transparent and convex. The surrounding cuticles are intact

and without inflammations noted. Has a normal capillary refill with 1 to 2 seconds.

IV. THORAX and LUNGS

The chest contour is symmetrical, the spine is vertically aligned. The chest wall is

intact, no tenderness or no masses noted. Upon auscultation rales was being noted.

V. HEART

There is no presence of abnormal pulsations when the heart was auscultated. No

murmurs and friction rubs heard upon auscultation.

VI. BREAST

The breasts are even with the chest wall, skin is smooth and intact. Areola is round and

bilaterally the same. The nipples are round and equal in size, no discharge noted. The breast

are not tender, no masses or nodules noted.

VII. ABDOMEN

The abdomen is intact, round and with normal bowel sound heard upon auscultation.

Has a darken umbilicus. No deformities seen.

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VIII. EXTREMITIES:

On the upper extremities no deformities noted. The has a D5IMB ½ L at the left

hand. While on the lower extremities, no deformities were noted.

IX. GENITAL AND RECTAL:

Upon inspection there were no deformities, no rashes, no abnormal secretions

were present.

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IV. ANATOMY AND PHYSIOLOGY

Anatomically, the respiratory system structures are divided into:

Upper respiratory tract and Lower respiratory tract

The upper respiratory tract is located in the head and neck and consists of the:

Nose

Pharynx

Larynx

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NOSE:

Regions of the nose include the external nose and the nasal cavity. Air moves from the

nostrils to the back of the nasal cavity where it exits through the posterior nares. The function

of the nasal cavity is to clean, warm and dampen the air that enters so that it can travel

throughout the body.

REGIONS OF THE PHARYNX:

Air moves into the nasal cavity through the nostrils (nasopharynx). The oropharynx

opens into the oral cavity which encloses the lips, teeth, cheek, hard and soft palates, tongue

and tonsils. Extending from the tip of the epiglottis to the glottis and the esophagus is the

laryngopharynx and positioned in the anterior neck is the larynx.

LARYNX

The larynx is a passageway between the pharynx and the lower airway structures. It is a

short tube made up of supportive cartilage, ligaments, muscle and mucosal lining. The

supportive cartilage prevents food and drink from entering the larynx while swallowing.

The lower respiratory tract is located in the chest and makes up the:

Trachea

Bronchial tree

Lungs

Air passes from the larynx to the lungs (trachea).The trachea divides into the right and

left primary bronchi (bronchial tree) and the large pair of spongy organs (lungs) are used for

respiration.

TRACHEA:

Also known as the windpipe, the trachea is a 10-12cm tube that runs through the lower

neck and chest. The wall of the trachea is made of hyaline cartilage which enables the trachea

to stay open so that air can be conducted between the larynx and primary bronchi.

BRONCHIAL TREE

The bronchial tree consists of a primary, secondary (lobar) and tertiary bronchi

(segmental bronchi). The trachea splits into the right and left bronchi at the level of the sternal

angle. The secondary bronchi forms when the primary bronchus enters the lung; and conducts

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air directly to one of the five lobes within the lung. Tertiary bronchi derive from the secondary

bronchi and conduct air to and from the bronchial segment. There are 8 bronchial segments in

the left lung and 10 in the right lung.

LUNGS:

The lungs are paired cone-shaped organs which take-up most of the space in the chest

with the heart. Their role is to take oxygen into the body, which we need for the cells to live and

function properly, and to help us get rid of carbon dioxide, which is a waste product. There are

two division of the lungs, the left and the right lung. These are divided up into lobes or big

secretions of tissues separated by “fissures” or dividers.

The right lung has three lobes but the left lung has only two, it is because the heart takes up

some of the space in the left side of the chest. The lungs can also be divided up into even

smaller portions, called bronchopulmonary segments. These are pyramidal-shaped areas

which are also separated from each other by membranes. There are about 10 of them in each

lung. Each segment receives it's own blood supply and air supply. Air enters the lungs through

a system pipes called the bronchi. Theses pipe start from the bottom of the trachea as the left

and right bronchi and branch many times through out the lungs, until they eventually form little

thin-walled air sacs or bubbles, known as the alveoli. The alveoli are important in the gas

exchange where it takes place between the air and the blood. Covering alveolus is a whole

network of little blood vessel called capillaries, which are very small branches of the pulmonary

arteries. It is important that the air in the alveoli and the blood in the capillaries are very close

together, so that oxygen and carbon dioxide can diffuse between them.

Mechanics of Breathing

To take a breath in, the external intercostals muscles contract, moving the ribcage up

and out. The diaphragm moves down at the same time, creating negative pressure within the

thorax. The lungs are held to the thoracic wall by the pleural membranes, and so expand

outwards as well. This creates negative pressure within the lungs, and so air rushes in through

the upper and lower airways.

Expiration is mainly due to the natural elasticity of the lungs, which tend to collapse if

they are not held against the thoracic wall. This is the mechanism behind lung collapse if there

is air in the pleural space (pneumothorax).

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Physiology of Gas Exchange

Each branch of the bronchial tree eventually sub-divides to form very narrow terminal

bronchioles, which terminate in the alveoli. There are many millions of alveloi in each lung,

and these are the areas responsible for gaseous exchange, presenting a massive surface area

for exchange to occur over.

Each alveolus is very closely associated with a network of capillaries containing

deoxygenated blood from the pulmonary artery. The capillary and alveolar walls are very thin,

allowing rapid exchange of gases by passive diffusion along concentration gradients.

CO2 moves into the alveolus as the concentration is much lower in the alveolus than in

the blood, and O2 moves out of the alveolus as the continuous flow of blood through the

capillaries prevents saturation of the blood with O2 and allows maximal transfer across the

membrane.

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V. DISEASE ENTITY/ PATHOPHYSIOLOGY

Precipitating FactorENVIRONMENT

LIFESTYLE

Passes to the pharynx, larynx & trachea

Leukocytes increased

Mucus and phlegm

COUGHINGINEFFECTIVELY

Narrowing of air passage

DIFFICULTY BREATHING

Microorganisms enters the affects both the lung parenchyma

Infection lodges and stimulates in the parenchyma

Lung invasion

Lung Invasion

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Streptococcal Infection

Predisposing FactorAGE (6months old)

Enters through nose or mouth by Inhalation

Viral infections increase attachment of S. pneumoniae to the receptors on respiratory

epithelium. Once inhaled into the alveolus, pneumococci infect type II alveolar cells. They

multiply in the alveolus and invade alveolar epithelium. Pneumococci spread from alveolus

through the pores of Kohn, thereby producing inflammation and consolidation along lobar

compartments. Inflamed and fluid-filled alveolar sacs cannot exchange oxygen and carbon

dioxide effectively. Alveolar exudates tends to consolidate, so it is increasingly difficult to

expectorate. Bacterial pneumonia may be associated with significant ventilation-perfusion

mismatch as the infection grows.

Etiology :

There are many causes of Pneumonia, including bacteria, viruses, mycoplasmas, fungal

agents and protozoa. Pneumonia may also result from aspiration of food, fluids or vomitus or

from inhalation of toxic or caustic chemicals, smoke, dusts, or gasses. Pneumonia may

complicate immobility and chronic illnesses. Pneumonia often follows influenza and together

they rank as the 7th leading cause of death in the US, and are the fifth leading cause in people

older than 65.

Additional risk factors are dysphagia; exposure to air pollution; altered consciousness (from

alcoholism, drug overdose, general anesthesia ,or a seizure disorder);inhalation of noxious

substances; aspiration of food ,liquid or foreign or gastric material and residence in institutional

settings, where transmission of the disease is more likely.

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VI. DIAGNOSTIC EXAMINATION / LABORATORY RESULTS

Cotabato Regional and Medical Center

Laboratory Department

HEMATOLOGY

February 21, 2013

PARAMETERS RESULT REFERENCE

RANGE

INTERPRETATION

Hemoglobin 117 115-155 -normal

Hematocrit 0.37 0.36-0.47 -normal

White Blood Cell 18.2 4.0 – 10.0 -Increase WBC may

be due to

inflammation

MCV 82.0 85.0-95.0 Low MCV indicates

microcytic (small

average RBC size),

MCH 25.7 28.0-32.0 Low MCH indicates

low hgb content in

RBC

MCHC 314 320-350 Low-MCHC red cells

are hypochromic.

RDW-SD 43 37-46 Normal

-segmenters 0.56 0.50-0.70 Normal

-eosinophils 0.01 2..0-8.0 Decrease eosinophils

may be due to

inflammation

-basophils 0.2 0.00-0.5 Normal

-lymphocytes 23.7 19.0-48 Normal

-monocytes 7.9 3.0-9.0 normal

Platelet count 489 150-400 -high platelet count is

a reaction to

inflammation,

infection, anemia,

Neutrophils 68.1 40.0-70.0 normal

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February 27, 2013

PARAMETERS RESULT REFERENCE

RANGE

INTERPRETATION

Hemoglobin 106 115-155 -normal

Hematocrit 0.33 0.36-0.47 -normal

White Blood Cell 7.2 4.0 – 10.0 -Increase WBC may

be due to

inflammation

MCV 80.0 85.0-95.0 Low MCV indicates

microcytic (small

average RBC size),

MCH 26.0 28.0-32.0 Low MCH indicates

low hgb content in

RBC

MCHC 321 320-350 Normal.

RDW-SD 43 37-46 Normal

-lymphocytes 23.7 19.0-48 Normal

-monocytes 7.9 3.0-9.0 normal

Platelet count 507 150-400 -high platelet count is

a reaction to

inflammation,

infection, anemia,

Neutrophils 68.1 40.0-70.0 normal

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March 6, 2013

PARAMETERS RESULT REFERENCE

RANGE

INTERPRETATION

Hemoglobin 98 115-155 -normal

Hematocrit 0.31 0.36-0.47 -normal

White Blood Cell 5.2 4.0 – 10.0 -Increase WBC may

be due to

inflammation

MCV 80.0 85.0-95.0 Low MCV indicates

microcytic (small

average RBC size),

MCH 26.0 28.0-32.0 Low MCH indicates

low hgb content in

RBC

MCHC 320 320-350 Normal.

RDW-SD 43 37-46 Normal

-lymphocytes 23.7 19.0-48 Normal

-monocytes 8.0 3.0-9.0 normal

Platelet count 394 150-400 Normal

Neutrophils 68.1 40.0-70.0 normal

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Cotabato Regional and Medical Center

CHEST X-RAY

Chest x-ray including the anterior, posterior, and lateral was conducted last February

22, 2013. The result indicates hazy infiltrate on both lung fields. The heart is not enlarged. And

the diaphragm and bony thorax are intact.

The impression of the above results indicates that the patient has pneumonia.

IMPRESSION: PNEUMONIA

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