INTRODUCTION

Pneumonia is a form of acute respiratory infection that affects the lungs. It is the single largest cause of death in children worldwide. Every year, it kills an estimated 1.2 million children under the age of five years, accounting for 18% of all deaths of children under five years old worldwide. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa.

Causes Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are: Streptococcus pneumoniae Haemophilus influenzae type b (Hib) respiratory syncytial virus

Transmission The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze.

Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia. The following environmental factors also increase a child's susceptibility to pneumonia: indoor air pollution caused by cooking and heating with biomass fuels (such as wood) living in crowded homes Parental smoking

Patients Profile Name: Baby B Case no: #100038 Address: National Road, Buenavista, Magdalena (24), Laguna Gender: Male Birthdate: July 10, 2012 Age: 1 y/o Birthplace: Majayjay Hospital, Laguna Nationality: Filipino Religion: Catholic Admission Date: July 17, 2013 Admission Time: 11:00 pm Admitting Physician: Dr. Guisando, M.D Chief Complaint: DOB Admitting Diagnosis: BPN Moderate

ASSESSMENT Previous admission: 1st admission Birth History: NSD, delivered by midwife Feeding History: Artificial Breast feed Immunization: Complete EPI from RHU Family History: (+) Hypertension (+) asthma (-) DM (-) Renal dse (-) seizure d/o (-) convulsion Allergy: none History of present illness: 4 days cough and colds (+)fever (+) DOB Physical Examination: Vital sign : Wt. : 7 kg CR: 110/ min RR: 50/ min (+) Rales, Cough

Nose Pharynx Esophagus Trachea or windpipe Lungs bronchioles and alveoli pleural cavity diaphragm

Diagnostics and Laboratory studies

Date : July 17, 2013 X-ray examination requested: Chest API ROENTGENOLOGICAL REPORT: Pneumonia, both lower lobes

HEMATOLOGY
Normal values

Hgb
Hct Rbc MCV

M: 130-180 g/L
40-50 % 4.0-6.2 80-100

Result 97 28% 3.58 72

MCH
MCHC RDW PLT CT

27-32 pg
32.0-36.0 11.0-16.0 350-660

27.1
37.5 13.8 402

PCT
MPV PDW WBC

0.15-0.50
6-11 fl 11-18% 4-15

.283
7 11.3 18.3

NEUTROPHILS
LYPHOCYTES MONOCYTES EOSIONPHILS

45-48
40-48 3-6 2-5

65
33 01 01

SALBUTAMOL Bronchodilators. With the fast onset of action of salbutamol, it is particularly suitable for the management and prevention of attack. Salbutamol has a duration of action of 4-6 hrs in most patients A suitable starting dose of salbutamol by wet inhalation is 2.5 mg, this may be increased to 5 mg. Treatment may be repeated 4 times daily.

CEFUROXIME Cefuroxime is indicated for the treatment of many different types of bacterial infections such as bronchitis, sinusitis, tonsillitis, ear infections, skin infections, gonorrhea, and urinary tract infections. It works by stopping the growth of bacteria. Antibiotics will not work for colds, flu, or other viral infections.

PARACETAMOL Control of pain due to headache and pain. To reduce fever in viral and bacterial infections. Relief of mild-tomoderate pain; treatment of fever.

Assessment S> hindi sya maka tulog tuwing gabe gawa ng ubo, as verbalized by the mother O> changes in behavior (irritability) >restless >difficulty of breathing

Diagnosis Disturbed sleeping pattern related to difficulty of breathing as evidenced by three or more nighttime awakenings

Planning Goal: The patient will achieve optimal amounts of sleep

Intervention

Rationale

Objective: > To be able to report > Provide a quiet improvement in environment for the sleep pattern of the child child. >Instruct to elevate head of the bed

> To promote comfort for the child

Evaluation After 8 hours the mother have reported improvement in sleep pattern for the child

> To maximize lung expansion of the child and to decrease DOB

> To give back rub, providing pillows for comfort, calming music, or reading can all help the patient relax before sleeping.

> Provide a relaxing activity before bedtime.

Assessment S>ang bilis huminga ng anak ko as verbalized by the mother O>restlessness >with nasal flaring >DOB >dyspnea >RR=56 bpm

Diagnosis Impaired gas exchange related to inflammatory process as evidenced by restlessness and productive cough

Planning Goal: To demonstrate improvement in gas exchange Objective: > To be able to demonstrate improved ventilation and to have adequate oxygenation of tissues

Intervention

Rationale

> Elevate head of bed and encourage frequent position changes

> To promote maximal inspiration, enhance expectoration of secretions in order to improve ventilation > To avoid coughing > Rest will prevent fatigue and decrease oxygen demands for metabolic demands

Evaluation Patient shall demonstrate improvement in gas exchange AEB a decrease in respiratory rate to normal

> Keep back dry > Promote adequate rest periods

> Keep environment allergen free

> To reduce irritant effects on airways

Assessment S>mahigpit ang ubo ng anak ko as verbalized by the mother. O>Restlessness >With nasal flaring >With rales on both lung fields >minimal colorless nasal secretions >irritability > productive cough

Diagnosis Ineffective airway clearance related to retained secretions as evidenced by rales on both lung fields

Planning Intervention Goal: To demonstrate improve airway clearance Objectives: > Maintain airway patency. >Elevate head of bed and encourage frequent position changes.

Rationale

Evaluation After 8 hours the patient have demonstrated improve airway clearance

> To promote maximal inspiration, enhance expectoration of secretions in order to improve ventilation

>Expectorate/ clear secretions.

>Give expectorants and bronchodilators as ordered. >Emphasized bronchial tapping after neb >Health teaching: -Keep back dry and loosen clothing

> To clear airway when secretions are blocking the airway >To loosen secretions

- To promote comfort and adequate ventilation - To further mobilize secretions

-Adequate rest periods for the child

Discharge Planning Health Teaching: Encourage to maintain cleanliness of house and surroundings Encourage to provide a well-ventilated area Encourage mother to give child a good sleeping time Reminded to have a follow up checkup after discharge Emphasize proper hygiene Kept back dry