PNEUMONIA

CASE STUDY PRESENTATION

CASE STUDY
Situation:
Baby H, a pediatrics admitted by her mother in the
pedia ward. Her mother said that she had fever for four(4)
days with cough that doesnt comes out. She also said that
baby H has a very hard time to breath. When admitted,
initial assessment findings were: difficulty on breathing,
intercostal retraction, nasal flaring, respiratory rate is
89b/m, and cough.

CASE STUDY
Patients Profile:

Name: Baby H

Age: 1 year old

Religion: Islam

C/C: Cough, colds fever for 4 days, DOB

Medical Dx: PCAP C

CASE STUDY

LABORATORY RESULTS:
CBC
RESULT
Hbg

73

Hct

.22

WBC

10.50

Segmenters

.69

Lymphocytes

.30

Eosinophils

.01

Platelet

265

Urinalysis
RESULT
Color

Yellow

Transparency

Hazy

Reaction

pH 6.0

Specific Gravity

1.025

Sugar

(-)

Protein

(+)

Pus cells

20-35

RBC

1-2

Epithelial Cells

Few

Bacteria

Few

PNEUMONIA
o

Is an inflammation of the lung

parenchyma (the alveoli, alveolar ducts
and respiratory bronchioles) caused by
various microorganisms (bacteria,
mycobacteria, fungi, and viruses)
Pneumonitis is a more general term that
describes an inflammatory process in the
lung tissue that may predispose or place
the patient at risk for microbial invasion.

PNEUMONIA

1.

CLASSIFICATIONS

Community Acquired Pneumonia

Occurs either in the community OR within the first 48 hours after

hospitalization, depends on the severity

Causative agent: Streptococcus Pneumoniae, Haemophilus

Influenzae, Legionella, Mycoplasma Pneumoniae and other gram
negative rods, viral pneumoniae, Chlamydophilia Pneumoniae
2.

Hospital Acquired Pneumonia

a.k.a nosocomial pneumonia - onset of pneumonia symptoms

more than 48 hours after time of admission

Causative agent: Pseudomonas Aeruginosa, Staphylococcus

Aureus, Klebsiella Pneumoniae,

PNEUMONIA

3. Pneumonia in the Immunocompromised Host

4.

CLASSIFICATION

Includes Pneumocystis Jiroveci (PCP), fungal pneumonias,

and Mycobacterium Tuberculosis

Occurs with use of corticosteriods or other

immunosuppressive agents, chemotherapy, nutritional
depletion, use of broad spectrum antibiotics, acquired
immunodeficiency syndrome (AIDS), genetic immune
disorders, and long-term advanced life-support technology
(mechanical ventilation).
Aspiration Pneumonia

Refers to the pulmonary consequences from entry of the

endogenous or exogenous substances into the lower airway.

Most common form is bacterial infection from aspiration of

bacteria that normally reside in the upper airways.

PATHOPHYSIOLOGY
Microorgansim
(most common:
bacteria) enters
the lungs

Microorganism
(bacteria) invade
the spaces
between cells and
alveoli

Macrophages and
neutrophils
inactivate the
bacteria.
Neutrophils
release cytokines.

Neutrophils,
bacteria, and fluid
fill the alveoli

Causing fever,
chills, and fatigue

General
activation of the
immune system

Resulting lung
consolidation
visible in CXR

PATHOPHYSIOLOGY

NORMAL LUNG CHEST XRAY

LABORATORY
FINDINGS
CBC
NORM

RESULT

Hbg

120-150 g/L

73

Hct

0.37-0.47 g/L

.22

WBC

5-10x109 L

10.50

Segmenters

0.35-0.65

.69

Lymphocytes

0.23-0.35

.30

Eosinophils

0.01-0.06

.01

Platelet

175-350x10

265

LABORATORY
FINDINGS
Urinalysis
NORMAL

RESULT

Color

Yellow

Yellow

Transparency

Clear

Hazy

Reaction

4.5-8

pH 6.0

Specific Gravity

1.005-1.025

1.025

Sugar

(-)

(-)

Protein

(-)

(+)

Pus cells

1-2

20-35

RBC

(-)

1-2

Epithelial Cells

(-)

Few

Bacteria

(-)

Few

SIGNS AND SYMPTOMS

Dysnea

Elevated RR

High grade fever

Chills

Wheezing

NURSING MANAGEMENT

Elevate head of bed, change position frequently.

R: Doing so would lower the diaphragm and

promote chest expansion, aeration of lung
segments, mobilization and expectoration of
secretions.

Assess respiratory rate, depth, and ease.

R: Manifestations of respiratory distress are

dependent on/and indicative of the degree of lung
involvement and underlying general health status.

NURSING MANAGEMENT

Monitor heart rate and rhythm.

R: Tachycardia is usually present as a result of fever

and/or dehydration but may represent a response to
hypoxemia.

Monitor body temperature, as indicated. Assist with

comfort measures to reduce fever and chills: addition or
removal of bedcovers, comfortable room temperature,
tepid or cool water sponge bath.

R: High fever (common in bacterial pneumonia and

influenza) greatly increases metabolic demands and
oxygen consumption and alters cellular oxygenation.

NURSING MANAGEMENT

Maintain bedrest. Encourage use of relaxation

techniques and diversional activities.

R: Prevents over exhaustion and reduces oxygen

demands

Administer medications as prescribe

MEDICAL
MANAGEMENT
Paracetamol
80mg IVTT q4h for fever

Ampicillin 400mg IVTT q6h (-) ANST

Amikacin 80mg IVTT OD

Salbutamol Ipratropium neb + 2cc NSS q15mins

x2 doses then q2h

NURSING CARE PLAN

ASSESSMENT
Subjective
Cues:
As verbalized
by the S/O:
May ubo na
hindi
lumalabas.
Nahihirapan
din siyang
huminga.

Objective
Cues:
Tachypnea
(RR: 89bpm)
Nasal
flaring
Coughing
Colds
Dyspnea
Intercostal
Retraction
Fever
Temp: 38.9

NURSING
DIAGNOSIS

Ineffective
airway
clearance r/t
copious
tracheobronc
hial and
alveolar
secretions.

PLANNING
& GOALS

NURSING
INTERVENTION

Within 8
hrs. of
Nsg.
Interventi
ons the
patient
will
manifest
the signs
of
improved
airway
patency:

Increase
hydration
R: loosens
pulmonary
secretions
Humidification
R: loose
secretions
(liquefy)
Chest
physiotherapy
R: loosening and
mobilizing
secretions
O2 theraphy
R: provides
supplemental
oxygen

RR back
to normal
Absence
of nasal
flaring
Coughs
out
phlegm
Absence
of
dyspnea

EVALUATION

After 8 hrs.
of Nsg.
Intervention
s the patient
has
manifested
the signs of
improved
airway
patency:
RR back to
normal (2237 bpm)
Absence of
nasal flaring
Coughing out
phlegm
Absence of
dyspnea

NURSING CARE PLAN

ASSESSMENT

NURSING
DIAGNOSIS

Subjective
Cues:
As verbalized
by the S/O:
Nag fever
siya 4 days.
Mainit talaga
siya

Objective
Cues:
-Fever
Temperature:
38.9

Hypertherm
ia r/t
infection
process

PLANNING
AND GOAL

Within 8
hrs. of
Nsg.
Interventi
on the
patient
will
manifest
normal
body
temperat
ure.

NURSING
INTERVENTION

EVALUATIO
N

Tepid sponge
bath
R: to lower the
body temperature
Ventilate the
room from
warm to cold
air
R: to lower body
temperature
Advise the
mother/SO to
avoid letting
patient wear
thick clothes or
blankets.
Increase oral
fluid
R: to hydrate,
addresses
hyperthermia.
Prevents
dehydration
Administer
medication as
prescribed

After 8
hrs. of
Nsg.
Interventi
on the
patient
has
manifeste
d normal
body
temperat
ure.

Drugs

Generic
name:
Paracetamo
l/
acetaminop
hen
Classificatio
n:
>
antipyretic
> analgesic

Dosage

Mechanis
m of
action

Indicatio
n

contraind
ication

Nursing
responsi
bilities

18mg IVTT
q 4h for
fever.

-reduce
fever by
acting
directly on
the
hypothalam
ic heatregulator
canter to
cause
vasodilation
and
sweating,
which help
dissipate
heat.

-common
colds, flu,
other viral
and
bacterial
infections
with pain
and fever.

hypersent
ivity to
paracetamo
l.
Life
cautiosly
for pedia,
for
overdosing

Do not
exceed
recommend
ed dosage.
Do not
take for 10
days.
Advise
patient that
is not antiinflammato
ry agent.

Adverse
effect:
CNS:
headache
CU:
dyspnea
GI: jaundice

Drug

Generic
name:
Ampicilin.
Classification
:
> antibiotics
> penicilin

Dosage

400mg
IVTT q 6H
(-) ANST

Mechanis
m of
action

Indicatio
n

Contrain
dication

-bacterial
agents
sensitive
organism,
inhibit
synthesis of
bacterial
causing
death.

-treatment
of infection
caused by
heamophill
us
influenza,
gram (+)
organisms
(pneumoco
ccal, staph,
strept.)

> allergy to
penicillin,
cephalospor
in
Adverse
effects:
CNS:
seizure
GI:
stomatitis,
sore mouth,
nausea and
vomiting,
diarrhea.
Local:
parentalpain
phlebitis.

Nursing
responsibi
lities
> history of
allergies
> check IV
site or drug
reaction.

Drugs

Generic
name:
amikacin
sulfate
Brand name:
amikin
Classification
:
aminoglyco
side.

Dosage

80mg
IVTT OD

Mechanism
of action

Indicatio
n

Contraind
ication

Nursing
responsibili
ties

-initial
treatmen
t of
staph.
Infections
.
- Short
term
treatmen
t of
serious
infection
caused
by
Pseudom
onas,
E.coli,
Klebsiella
IV facts:
,
Compatible
Enteroba
to 5%
cter,
dextrose,
Serratia
lactate
spp.,
ringers soln. Acinobact

Allergy to
amino
glycosides.
Cautiousl
y use if
patient id
dehydrate
d.

Monitor
duration of
treatment
Well
hydrated
before
administerin
g med.
May
experience:
headache,
nausea and
vomiting,
dizziness,
loss of
appetite.
Asses for IV
site for
phlebitis
Monitor for
toxicity

-bactericidal
inhibit
protein
synthesis in
susceptible
strains of
gram (-)
bacterial,
and the
functional
cell
membrane
appears to
be
disrupted,
causing cell
death.

Drug

Dosage

Mechanism
of action

Indicatio
n

Contraindi
cation

Nursing
responsibi
lities

Brand
name:
salbutamol
+
Ipatropium

neb. +
2cc NSS q
15mins x2
doses then
q2H

-a beta2
adrenergic
agonist.
Activation of
beta
adrenergic
receptors
leads smooth
muscle
relaxation,
resulting in
dilation of
bronchial
passages
and
vasodilation.

-used to
control
and
prevent
symptoms
(wheezing
and
shortness
of breath)
cause by
ongoing
lung
disease

Hypersen
sitivity to
adrenergic
amines.
Hypersen
sitivity to
fluorocarbo
ns (some
inhalers)

Asses
lungs
sound,
pulse and
BP before
administeri
ng.
Monitor
pulmonary
function
test before
initiating
therapy.
Observe
paradoxical
bronchospa
sm
(wheezing).

Classificatio
n:
Bronchodi
lator
adrenergi
c

Adverse
reaction:
CNS: hyper
activity in
children.
GI: nausea
and
vomiting