PEDIATRIC COMMUNITY-ACQUIRED PNEUMONIA-C

A Case Study presented to the faculty of Bachelor of Science in Nursing

of Saint Mary’s College of Tagum, Inc.

Presented to:

Lhevinne P. Genetializa, RN

In Partial Fulfillment of the requirements of Related Learning Experiences,

(NCM 107) of Bachelor of Science in Nursing of
Saint Mary’s College of Tagum, Inc.

By:

Iris Jane N. Montenegro

Princess Norbenita E. Morcellos
Yuka Padilla

BSN II
 August 2019

ACKNOWLEDGEMENT

We, the researcher, want to express our sincere gratitude to the following that

never ceased in helping us for the fulfillment of this Case Study:

 To our Triune God, who is always by our side, giving his unconditional

love, enlightenment and guidance as we made this study.

 To Ma’am Josefina S. Balote, RN, MN, Dean of the College and the Head of

the Nursing Program, for approving and allowing us to conduct the study.

 To Ma’am Lhevinne P. Genetializa, RN our Clinical Instructor on this

concept who helped in conducting the study for the study’s improvement.

 To our parents, who showed endless support and made us be inspired and

motivated throughout the making of this study.

Thank you and May God continue to guide us. To God be the Glory.
 The Researchers

ABSTRACT

This case study aims to provide the students and readers with nursing research

related and nursing practice related further understanding about Pediatric Community-

Acquired Pneumonia-C. Viruses account for most cases of PCAP during the first two

years of life. After this period, bacteria such as Streptococcus pneumoniae, Mycoplasma

pneumoniae and Chlamydia pneumoniae become more frequent. The symptoms are

nonspecific in younger infants, but cough and tachypnea are usually present in older

children.

In order to collect data, the students used interview and patient need assessment

tool as well as gathering relevant information in the patient’s chart. It also includes the

laboratory and diagnostic results to gather more accurate data. Pediatric Community-

Acquired Pneumonia is a lower respiratory tract infection occurring in a child who has

not resided in a hospital or health care facility. Symptoms are present in about 75% of

affected children. This may include fever, cyanosis and signs of respiratory distress:

tachypnea, cough, nasal flaring, rales and decreased in breath sounds. Often it gets worse

throughout the day and improves when lying down.

 TABLE OF CONTENTS

PAGE

TITLE PAGE i

ACKNOWLEDGEMENT ii

ABSTRACT iii

TABLE OF CONTENTS iv

CHAPTERS

1 INTRODUCTION

Background of the Study

Purpose of the Study

Theoretical Lens

Definition of Terms

Limitations and Delimitations

2 REVIEW OF RELATED LITERATURE

Journal Reading

Symptomatology

Etiology

Pathophysiology

Detailed Drug Study

3 METHODOLOGY

Study Design

PNA

Laboratory Results

Nursing Care Plan

Drug Study

4 RESULTS AND FINDINGS

5 CONCLUSION

6 RECOMMENDATIONS

REFERENCES

CURRICULUM VITAE
 LIST OF TABLES

TABLES PAGE

1 Symptomatology

2 Detailed Drug Study

3 Study Design

4 NCP

LIST OF FIGURES

DIAGRAM

1 Pathophysiology
 Chapter 1

INTRODUCTION

Background of the Study

A Pediatric Community-Acquired Pneumonia-C varies between different sources;

on a pathological level, pneumonia is c parenchyma example is the lower respiratory tract

(LRT) infection by microorganisms. PCAP is defined clinically as “the presence of signs

and symptoms of pneumonia in a previously healthy child due to an infection which has

been acquired outside hospital.

It is a potentially serious infection in children and often results in hospitalization.

The diagnosis can be based on the history and physical examination results in children

with fever plus respiratory signs and symptoms. Chest radiography and rapid viral

testing may be helpful when the diagnosis is unclear. The most likely etiology depends

on the age of the child. Viral and Streptococcus pneumoniae infections are most common in

preschool-aged children, whereas Mycoplasma pneumoniae is common in older children.

The decision to treat with antibiotics is challenging, especially with the increasing

prevalence of viral and bacterial coinfections. Immunization with the 13-valent

pneumococcal conjugate vaccine is important in reducing the severity of childhood

pneumococcal infections.
 For children aged three months to five years, S pneumoniae has been the most

frequent bacterial organism. Penicillin and first- and second-generation cephalosporins

remain effective, even in children with pneumonia due to penicillin-resistant S

pneumoniae (35,36). For this reason, ampicillin is the drug of choice, but some experts

recommend increasing the dose to ensure adequate serum and lung levels. Macrolides

should also be added for empiric treatment in this age group to cover M

pneumoniae and C pneumoniae, particularly in those who are outpatients. Randomized

clinical trials comparing erythromycin with either clarithromycin or azithromycin have

shown the newer agents to be equally effective, but with many fewer side effects.

Globally, Pediatric Community Acquired Pneumonia is the leading cause of death

in children aged < 5 years. In the United States, there are an estimated 1.5 million

cases and 150,000 hospitalizations annually for pneumonia. Community-acquired

pneumonia (CAP) is defined as “the presence of signs and symptoms of pneumonia in a

previously healthy child caused by an infection that has been acquired outside of the

hospital.

Nationally, The Philippines is one of the 15 countries that together account for 75

percent of childhood pneumonia cases,” World Health Organization (WHO) reports. “In

children under five years, pneumonia is the leading cause of mortality.” Pneumonia is an

infection that inflames the air sacs in one or both lungs (doctors call these “alveoli”). “The

lung is a large organ, and it’s a vital organ,” explains Dr. Gerard Criner, chairman and

professor of thoracic medicine and surgery at Temple University School of Medicine in

Philadelphia. “If it gets infected and it comprises the primary function to support
ventilation, that’s a big contributor to morbidity and mortality.” Pneumonia happens

when the air sacs are filled with fluid or pus so much so that a person will have a hard

time breathing in enough oxygen to reach the bloodstream. “Pneumonia tends to be more

serious for children under the age of five, adults over the age of 65, people with certain

conditions such as heart failure, diabetes or chronic obstructive pulmonary disease, or

people who have weak immune systems due to HIV/AIDS, chemotherapy [a treatment

for cancer], or organ or blood and marrow stem cell transplant procedures.”

Locally, here in Tagum City, Pediatric Community Acquired Pneumonia account

for 46% on the census of sixth of August 2019. It was common during our clinical

exposure, which is the seven-three am shift.

Purpose of the Study

The purpose of this study is to broaden our knowledge as a student nurse for

Pediatric Community Acquired Pneumonia by obtaining sufficient information, which

could serve as a guide for us to enhance our skills and attitudes in the application of

nursing process and management of Pediatric Nursing care for Pediatric Community

Acquired Pneumonia patient.

Specific Objective

 To know the client’s personal data, family profile, past health history, current

health history, and physical assessment.

 To review the pathophysiology of the children’s respiratory system.

 To formulate the detailed drug study.

  To develop an effective nursing care plan in which the client may benefit.

Theoretical Lens

This case study is anchored on the theory of “Comfort Theory” by Katharine

Kolcaba because it is correlated with the patient's case. It focuses on the means of comfort

of the patient, which is relief, ease and transcendence during and after childbirth.

It is also based on the "Need Theory" by Virginia Henderson since it emphasized

the importance of patient's independence which the mother should gain with regards to

taking care of her child.

Definition of Terms

We, the researchers define important terms for the clarity and easy understanding

of the study.

Pediatric. Is the specialty of medical science concerned with the physical, mental, and

social health of children from birth to young adulthood. Pediatric care encompasses a

broad spectrum of health services ranging from preventive health care to the diagnosis

and treatment of acute and chronic diseases.

Community. Is a group of living things sharing the same environment. They usually have

shared interests. In human communities, people have some of the same beliefs and needs,

and this affects the identity of the group and the people in it.

Pneumonia. Is a lung inflammation caused by bacterial or viral infection, in which the

air sacs fill with pus and may become solid.

Limitation and Delimitation of the Study

This case study will be delimited to the assessment of the patient in the Pediatric

ward Nursing for Pediatric Community Acquired Pneumonia as well as the formulated

nursing care plan that was provided to the patient who was admitted at Bishop Joseph

Regan Memorial Hospital. Through the head-to-toe assessment, interview and the

perceptions of the professional healthcare providers therefore, having the accurate data

gather of the development and manifestation of the community acquired pneumonia is

essential to support this case study.

 Chapter 2

Review of Related Literature and Studies

In this chapter, we, the researchers present the review of related literatures and

studies which helped them understand and comprehend more about Pediatric

Community Acquired Nursing.

A Pediatric Community-Acquired Pneumonia-C varies between different sources;

on a pathological level, pneumonia is considered infection of the lung parenchyma

example is the lower respiratory tract (LRT) infection by microorganisms. PCAP is

defined clinically as “the presence of signs and symptoms of pneumonia in a previously

healthy child due to an infection which has been acquired outside hospital.

It is an infection of the alveolar or gas-exchanging portions of the lung.

Community-acquired pneumonia (CAP) accounts for approximately 4 million cases and

1 million hospitalizations per year. It is the sixth leading cause of death, particularly

among children. The incidence of pneumonia caused by atypical or opportunistic

infections is increasing. Patients with health care–associated pneumonia are at risk for

infection with resistant organisms.

Pneumonia can range in seriousness from mild to life-threatening. Viruses are the

most common causes of pneumonia in the first two years of life, accounting for up to 90%

of pneumonias. The most commonly implicated viruses are respiratory virus,

parainfluenza virus types 1, 2, and 3, influenza virus types A and B, adenovirus,

rhinoviruses, and less commonly, herpes simplex virus and enteroviruses. With

increasing age, the incidence of pneumonia decreases, but bacterial pathogens

including Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydia

pneumoniae become more frequent.

Journal Reading

Pediatric Community Acquired Pneumonia

Pneumonia is an inflammation in one or both lungs that is almost always caused

by a viral or bacterial infection. The inflammation interferes with the body’s ability to

deliver oxygen and remove carbon dioxide from the blood. A person is more likely to get

pneumonia as a child, known as pediatric pneumonia, than they are as an adult.

Symptoms of pediatric pneumonia depend on the cause of the infection and

several other factors, including the age and general health of the child. Rapid breathing,

a high temperature and coughing are three of the most common signs of the condition.

Pneumonia in newborns and very young children is more likely to be caused by a viral,

rather than a bacterial infection. Potential viral causes for pneumonia include respiratory

syncytial virus or influenza infection. Bacterial infections become more common in

school-aged children and young adolescents. The most common bacterial cause for

pneumonia is a type of bacterium known as streptococcus pneumoniae, but there are

several other bacterial infections that can also cause pneumonia.

 Diagnosis is generally based on a physical exam and several other tests, which

may include blood tests and an X-ray. The prognosis for pediatric pneumonia is generally

good. A bacterial infection can often be treated with antibiotics, such as amoxicillin. Viral

pneumonia usually resolves on its own without the need for medication. However,

parents and guardians should be vigilant, as the condition is often hard to spot in

children. Most deaths from pediatric pneumonia occur due to underlying health

conditions, such as heart disease. Vaccination against bacterial infection is the best way

of preventing the spread of pediatric pneumonia. Children aged over six months old may

also benefit from the influenza vaccine.

Symptoms

Symptoms of pediatric pneumonia depend on several factors, particularly the age

of the affected child, and whether the cause of the infection is bacterial or viral.

Symptoms in newborns

Newborns and babies under a month old are the only age group that rarely cough as

a direct consequence of pneumonia. The most common symptoms are irritability and not

feeding properly. A child of this age may also display:

 Abnormally fast breathing

 Shortness of breath

 Grunting sounds

Symptoms in babies over a month old

Once a baby is over a month old, then the most noticeable symptom of pneumonia is

likely to be coughing. All of the symptoms that affect newborns will possibly be present
too, although grunting becomes less common as the baby grows older. Other pneumonia

symptoms observed in babies of this age include:

 Congestion, the feeling that the chest is full or clogged

 Wheezing or heavy breathing

 Fever, particularly during pneumonia caused by bacterial infection

Toddlers and preschoolers

Fever and cough are the most common symptoms for children over a year old. Other

typical symptoms include:

 Abnormally rapid breathing

 Congestion

 Vomiting, particularly following coughing

Older children

Fever and coughing remain the most common signs of pneumonia in children of

school age. They might also complain of the following symptoms:

 Chest pain

 Tiredness

 Vague stomach pain

Other possible symptoms of pneumonia at this age include:

 Vomiting

 Diarrhea

 Sore throat

Causes of pediatric pneumonia

 Pneumonia is an inflammation of the air sacs, also known as the alveoli, in the

lungs, usually caused by infection that causes them to fill with fluid or pus.

This inflammation interferes with the lungs’ ability to breathe and properly supply

oxygen to the body, causing many of the symptoms described above.

Pneumonia is almost always caused by bacteria or a virus. In children below school age,

viral infection is the most common cause. School-aged children and young adolescents

are more likely to develop a bacterial infection.

Treatment

Treatment of pediatric pneumonia depends on the child’s age and health, as well

as the cause of the infection. In most cases, particularly with school-age children,

pneumonia can be treated or managed at home. Children with bacterial infections will

generally be given antibiotics, whereas viral infections usually resolve themselves

without the need for additional medication.

Sometimes a child may need to be hospitalized for treatment. The decision whether to

hospitalize is typically based on factors such as:

 The child’s breathing ability

 The age of the child

 The risk of complications due to the type of pneumonia or any underlying health

conditions the child may have

 The level of oxygen in the blood

 The presence of any unusual symptoms, such as altered mental states

Hospitalization will usually involve giving the affected child supplemental oxygen,

monitoring their condition and treatment with antibiotics. Any complications may also

need to be addressed.

Summary:

Pediatric Community Acquired Pneumonia is the most common type of

pneumonia. It occurs outside of hospitals or other health care facilities. It may be caused

by: Bacteria. Streptococcus pneumoniae. This type of pneumonia can occur on its own or

after you've had a cold or the flu. It may affect one part (lobe) of the lung, a condition

called lobar pneumonia. Bacteria-like organisms. Mycoplasma pneumoniae also can

cause pneumonia. It typically produces milder symptoms than do other types of

pneumonia. Walking pneumonia is an informal name given to this type of pneumonia,

which typically isn't severe enough to require bed rest. Fungi. This type of pneumonia is

most common in people with chronic health problems or weakened immune systems,

and in people who have inhaled large doses of the organisms. The fungi that cause it can

be found in soil or bird droppings and vary depending upon geographic location.

Viruses. Some of the viruses that cause colds and the flu can cause pneumonia. Viruses

are the most common cause of pneumonia in children younger than 5 years. Viral

pneumonia is usually mild. But in some cases, it can become very serious.

Symptoms in newborns and babies under a month old are the only age group that

rarely cough as a direct consequence of pneumonia. The most common symptoms are

irritability and not feeding properly. Symptoms in babies over a month old is coughing.
 Other pneumonia symptoms observed in babies of this age include: Congestion,

the feeling that the chest is full or clogged, Wheezing or heavy breathing and fever. In

Toddlers and preschoolers, Fever and cough are the most common symptoms. Other

symptoms include: Abnormally rapid breathing, Congestion and Vomiting. And the

symptoms in older children are fever and coughing. They might also complain of the

following symptoms: Chest pain, Tiredness, and Vague stomach pain. The treatment of

pneumonia can be managed at home. Children with bacterial infections will generally be

given antibiotics, whereas viral infections usually resolve themselves without the need

for additional medication.

Reflection:

This kind of disease can be a serious type. Community Acquired Pneumonia is a

lung infection caused by bacteria, viruses, or fungi. It occurs in healthy children who have

not recently been in the hospital or other health care facility. The child usually gets

Community Acquired Pneumonia in the bacteria and viruses living in the nose, sinuses,

or mouth and it may spread to the lungs. Also, the child may breathe some of these germs

directly into the lungs. And the child breathes in food, liquids, or vomit from the mouth

into her lungs. There are risk factors that increase a child's chance of getting CAP include:

Being younger than 6 months of age, being born prematurely, nervous system problems,

such as seizures or cerebral palsy, and heart or lung disease present at birth also weak

immune system due to HIV/AIDS. If we know children who has this kind of disease, we

have to instill information to the mother that if symptoms persist, they do have to consult
a doctor. Mild pneumonia can usually be treated at home with rest, antibiotics and by

drinking plenty of fluids. However, severe cases may need hospital.

Symptomatology

The listed terms below, is the set of symptoms characterize by a medical condition

called Pediatric Community Acquired Pneumonia as exhibited by our patient.

Symptoms Actual Justification

Observation

Cough A rapid expulsion of air from the

lungs, typically in order to clear

the lung airways of fluids, mucus,

or other material. It can be a

productive or nonproductive

cough. A productive cough is

when you have a cough that

produces mucus or phlegm.

While, nonproductive cough is

also known as a dry cough,

doesn't produce phlegm or

mucus.
Tachypnea The respiratory rate (RR) in

breaths/minute >60 in infants 0–

2 months of age, >50 in infants 2

to 12 months, >30 in children 1 to

5 years, and >20 in children >5

years of age.

Retractions Are due to reduced air pressure

inside your chest. This can

happen if the upper airway

(trachea) or small airways of the

lungs (bronchioles) become

partially blocked. As a result, the

intercostal muscles are sucked

inward, between the ribs, when

you breathe.

Hypoxemia Hypoxia is a condition or state in

which the supply of oxygen is

insufficient for normal life

functions; hypoxemia is a

condition or state where there is a

 low arterial oxygen supply –these

terms are used interchangeably

Dehydration Happens when your body doesn't

X have as much water as it needs.

Without enough, your body can't

function properly.

Etiology

The causation for the formation of Pediatric Community Acquired Pneumonia

disease as a subject of investigation are as shown in the table below with its implication

for the development of such disease.

Predisposing Etiologic Factor

The identified etiologies below are factors or conditions that render an individual

vulnerable to develop a disease called Pediatric Community Acquired Pneumonia.

Etiology Actual Implication

Observation
Age Pneumonia in children can be

caused by viruses or bacteria.

Because of the infection, the small

airways in the lungs become swollen

and make more mucus (sticky fluid).

The mucus blocks the airways and

reduces the amount of oxygen that is

able to get into the body.

Malnutrition Malnutrition refers to deficiencies,

excesses or imbalances in a person’s

intake of energy and/or nutrients.

The term malnutrition covers 2

broad groups of conditions. One is

‘undernutrition’—which includes

stunting (low height for age),

wasting (low weight for height),

underweight (low weight for age)

and micronutrient deficiencies or

insufficiencies (a lack of important

vitamins and minerals). The other is

overweight, obesity and diet-related

 noncommunicable diseases (such as

heart disease, stroke, diabetes and

cancer

Indoor Air Pollution Indoor pollution sources that release

gases or particles into the air are the

primary cause of indoor air quality

problems. Inadequate ventilation

can increase indoor pollutant levels

by not bringing in enough outdoor

air to dilute emissions from indoor

sources and by not carrying indoor

air pollutants out of the area.

Precipitating Etiologic Factor

The following etiologies below are factors that cause or trigger the onset of a

disease, Pediatric Community Acquired Pneumonia.

 Etiology Actual Implication

Observation

Parental Smoking The most coherent and consistent

evidence of adverse health effects

from parental smoking comes from

21 studies of lower respiratory

illnesses, such as bronchitis,

bronchiolitis or pneumonia in

infancy and early childhood.

Zinc Deficiency Severe zinc deficiency has

been associated with stunting of

growth, impaired immunity, skin

disorders, learning disabilities and

anorexia. Diarrhoeal disorders and

acute lower respiratory tract

infections,

especially pneumonia are the two

most common causes of infant and

child death

Pathophysiology
Written

Pneumonia means that there is an infection and inflammation in the lungs. Step 1

is that there is an invasion of pathogen. This invasion can either be a bacterium, a virus

or a fungus. Or otherwise, it can also be an invasion of a chemical that causes irritation to

the lungs. Step 2 is the inflammatory response is triggered. When this happens the blood,

vessels dilate, and the blood vessel walls separate and become leaky which leads us to

step 3 which we call “Capillary leak”. The blood vessels dilate and become leaky so that

all the white blood cells can move out from the blood vessels and go into the lungs into

battle to fight off the invading pathogens. Step 4, edema and exudate is created for this is

caused when all those white blood cells fight off the pathogens that have invaded the

lungs. This causes a lot of exudate build up inside the lungs – all those dead pathogens.

Step 5 is the reduced gas exchange. We know that the lungs are responsible for getting

oxygen into the blood and removing carbon dioxide from the blood. But, from all this

fluid build-up inside the lungs, it can’t get oxygen or get rid of carbon dioxide as well as

it should. This can lead to respiratory acidosis because of too much carbon dioxide build

up in the body – which causes the blood to become acidic.

Diagram

Predisposing Factor
Precipitating Factor
 Age
 Parental Smoking
 Malnutrition
 Zinc Deficiency
 Indoor Air Pollution

Invasion of pathogen

Inflammatory response
is triggered
 Capillary leak

Edema and exudate are

created

Chapter 3
Impaired gas exchange
METHODOLOGY

Study Design

Qualitative Research is exploratory research. It is used to gain an understanding

of the underlying reasons, opinions, and motivations. It provides insights into the study

or helps to develop ideas or hypotheses for potential quantitative research. It is also used

to uncover trends in thought and opinions, and dive deeper into the problem. Qualitative

data collection methods vary using unstructured or semi- structured techniques. Some

common methods include focus groups (group discussion), individual interviews, and

participation/observations. The sample size is typically small, and respondents are

selected to fulfil a given quota.

The data that we collected in this quantitative study consist lot of ways, such as

interview, patient assessment needs, IPPA, and we also get data through our patient’s

medical record. We also process to involved and investigate a phenomenon or issue that
has occurred in the past. Such studies most often involve secondary data collection, based

upon data available from previous studies.

Nurse, Patient Interaction

NURSE PATIENT

“Maayong buntag ma’am! Unsa gani “Shierra Maine A. Hugue ma’am”

pangalan og apilyedo sa atong baby ma’am?”

“Ma’am, ako diay si Princess po ma’am, “Aw, okay ra kaayo ma’am.”

student nurse gikan sa smc, ako diay mag

monitor sa imong baby karon ma’am gikan alas

7 sa buntag hangtod alas 3 sa hapon, okay ra

sa imuha ma’am?”

“Kamusta naman imohang baby ma’am? “Kuan maám, naglisod siya og ginhawa.”

Unsa man imuhang na observe na gibati niya

ma’am?
 “Ahh sige maám, mao diay naay oxygen nga “Oo ma’am. Sige ma’am Salamat kayo.”

naka attached sa imuhang baby maám. Atoa

lang nang e’monitor ma’am.”

“Sige ma’am kuhaan nako og vital signs “Okay ma’am.”

imuhang baby.”

“Ma’am, okay raba sa imuha na interviewhon “Okay raman ma’am,about asa man pud na

tika ma’am?” ma’am?”

“Kanang, naa lang koy mga ipangutana bahin “Ayy sige ma’am.”

sa history sa imuhang baby ma’am og uban

pa.”

“Sige ma’am, mo balik lang ko ma’am ha.” “Okay ma’am, salamat.”

PATIENT NEED ASSESSMENT

Name: Shierra Maine A. Hugue Age: 1yr old&10mos Sex: Female Status: Dependent

Admission Date/Time: August 5, 2019 / 07:59AM

Arrived on unit via: Wheelchair Stretcher Ambulatory

From: Purok-6 Poblacion, New Corella, Davao del Norte via own car

Accompanied by: Mother and Father

Admitting Medical Diagnosis: Prdiatric Community-Acquired Pneumonia

Clients Perception of Reason for Admission: “Naglisod og ginhawa akong baby

ma’am.” as verbalized by the mother.

Admitting weight: 4.6kg Height: 2’8’’ V/S: T-36.8 ºC BP-90/60 RR-33cpm CR-134bpm

Source Providing Information: Patient Others: Mother

How has the problem been managed at home: “Pagkabalo namo nga naglisod og

ginhawa among baby ma’am amoa sa siyang gi obserbahan niya ning taas naman iyang

kalintura, mao to amoang gidala diri sa hospital.” as verbalized by the mother.

IMMUNIZATIONS/VACCINATIONS

Completed

ALLERGIES AND REACTIONS

Drugs: No known drug allergies
Foods: No known food allergies
Signs & Symptoms: Not known; never has allergic reactions

Blood Reaction: Yes No Dyes/Shellfish: Yes No

Blood Type: Type O

MEDICATIONS

Current Meds Dosage/Frequency Time given

1. Ceftriaxone 1g IVTT OD ANST 6AM/6PM

2. Salbutamol + 1 neb q 6hrs with 1 ml NSS

12MN-6AM-12NN-6PM
Ipratropium x 3 doses

3. Cetirizine syrup 2.5ml OD 6AM/6PM

4. Budesonide 1 neb q 12hrs

 5. Paracetamol 250mg 3ml q 4hrs PRN

MEDICAL HISTORY:

No Major Problems: None

Cardiac - None
Hypertension/ Hypotension- None
Diabetes- None
Cancer- None
Respiratory – URTI, Asthma
Gastro- None
Arthritis- None
Stroke- None
Seizures- None
Glaucoma- None

SURGICAL HISTORY: None

PSYCHOLOGICAL HISTORY

Recent Stress: None

Coping Mechanism: None
Support System: None
Calm: Yes No
Anxious: Yes No
Tobacco Use: Yes No
Alcohol Use: Yes No
Drug Use: Yes No
NEURO VITAL SIGNS

PUPIL GAUGE (mm)

1 2 3 4 5 6 7 8 9
B – Brisk F – Fixed S – Sluggish

HAND GRIP S-Strong M-Moderate

LEG MOVEMENT W-Weak A- Absent

P SIZE LEFT
U
P RIGHT
I
L REACTION LEFT

RIGHT

M HANDGRIP LEFT
O
T RIGHT
O
LEG MOVEMENT LEFT
R

RIGHT

L EYEOPENING SPONTANEOUS
E
 V TO SPEECH
E
TO PAIN
L
NONE
O
BEST ORIENTED
F
VERBAL CONFUSED
C
RESPONSE INAPPROPRIATE
O
N INCOMPREHENSIVE
S
C NONE
I
O BEST OBEYING
U MOTOR LOCALIZING
S
N RESPONSE WITHDRAWAL
E FLEXING
S
S EXTENDING

NO RESPONSE

RESPIRATION
TEMPERATURE
ICP
TOTAL

OTHER ASSESSMENTS:

MUSCULOSKELETAL
Contractures Joint Swelling Pain

Other: ______________________

B. EENT: No head and scalp lesions, No eye and ear discharge; pinkish palpebral
conjunctivae; anicteric sclerae; (+) Alar flaring

Assistive Devices: (crutches, walker, cane, hearing aid, eyeglasses, etc.):

None
Diagnostic/Laboratory Results:(otoscopy, ophthalmoscopy, visual acuity test, etc.):
None

OXYGENATION STATUS
Circulation V/S: PR: 92bpm CR: 134bpm BP: 90/60mmHg

MAP: CVP: O2: 97% Capillary Refill: <2 seconds

Skin character and color: No jaundice; full pulses; capillary refill <2 seconds

Cardiac Status: Sound: Regular cardiac rhythm

Character: Adynamic precordium, no heaves and thrills, no murmurs

Cardiac pain: None

Diagnostic/Laboratory Results: None

AIRWAY
Rhythm: Even: Uneven: Shallow:

Cheyne-stroke: Other: Adventitious Breath Sounds (rales)

Rate: (eupnea, tachycardia, bradycardia, bradypnea, etc.)

Tachypnea

Volume: (hyperventilation, hyperpnea, hypopnea, etc.)

None

Others: (e.g. abdominal, accessory muscles, nostrils status):

Globular, normoactive bowel sounds; no splenomegaly, no hepatomegaly; soft;

tympanitic; no tenderness

Breath Sounds: (stridor, rhonchi, wheezing, crackles): Rales

Cough: None Nonproductive Productive

Secretions: (characteristics) None

Life supporting devices: (e.g. O2, tracheostomy, suction apparatus) 02 inhalation @

2.4L via nasal canula
Diagnostic/Laboratory Results: (e.g. ABG, Chest X-Ray, hematology, etc.)

HEMATOLOGY

Examination Results Normal Examination Results Normal Values

Values
Hemoglobin 103 120.00- Reticylocyte 0.50-1.50%
conc. 150.00g/L count

Erythrocyte no. 4.56 4.00- Bld type

conc 4.50x10^12L

Leucocyte no. 11.55 5.00-10.00x RH

conc 10^g/L

Segmenters 0.61 0.40-0.60 Malaria

Lymphocytes 0.36 0.25-0.40 Bleeding 1.00-3.00mn

Time

Monocytes 0.02 0.01-0.12 Clotting 3.00-6.00mn

Time

Eosinophils 0.01 0.01-0.05 Erythrocyte 0.0-20.00mm/hr

Sed. Rate

Basophils 0.00-0.05 MCV 67 80.00-99.00fl

 Stabs 0.00-0.05 MCH 22 27.00-31.00pg

Atypical cells MCHC 33 30.00-36.00g/dl

Thrombocyte 242.0 150.00-

count 440.00x10^g/L

Hematocrit 0.31 0.36-0.45

TEMPERATURE MAINTENANCE
Temperature: 36.8˚C

Skin character: No jaundice, full pulses; capillary refill < 2 seconds

Other observation: None

NUTRITIONAL/FLUIDS
General Appearance: Well Nourish Emaciated Others

Appetite: Good Fair Poor

Description:

Diet: Diet for Age Meal Pattern: 3x a day

Food Self Assist Total Feed

Height: 2’8’’ Weight: 4.6 kg BMI: Underweight

Prescribed Diet: DFA

Skin character: No jaundice, full pulses, capillary refill <2 seconds

Intake (IVF, Fluid/Water): IV Fluid, Water and Milk

Oral Mucosa: (Description) Pinkish in Color

Other Assessment (e,g. dental health, tonsils, palate, hair and scalp):

With incomplete teeth noted, tonsil is not swollen, pin in color, palates are pink and free
from exudates; scalp free from lesions; hair is free from lice with dark brown color
noted.
Bowel sounds: (Description) Globular, Normoactive sounds

Last Bowel Movement: Frequency: twice

Amount: 300cc with urine

Character: greenish in color

Diagnostic/Laboratory Results: (SE, Occult Blood, Endoscopy, etc.) None

Urine: Last voided: Twice in a diaper

Normal Anuria Dysuria Incontinence Frequency

Amount: 300cc with stool

Character: Yellowish

Normal Pattern: Twice/thrice a day

Diagnostic/Laboratory Results: (UA, IVP, USD, etc.)

None

REST SLEEP
Bedtime: 9:00 PM

Sleep pattern: 6;00AM

Amount of Sleep: able to sleep 8-9 hours of sleep

Problems: None

Other observations: None

PAIN AVOIDANCE
Rate Pain: None Time Started: None

Bedtime: None Location: None

Frequency: None Character: None

Behavior: Restless: None

Facial expression: None

Irritable: None
 Diaphoretic: None

Other observation: None

STIMULATION-ACTIVITY
Work: N/A

Recreation/Pastime: Playing games in the cellphone

Hobbies/Vices: Playing barbie dolls

SELF CARE
Needs Assistance with: Ambulating Elimination

Hygiene Dressing

Meals

Other Observations: The patient hair is messy.

LOVE-BELONG NEED
Children (living with): None

Husband (living with): None

Extended (living with): Mother and Father

SELF-ESTEEM NEED (Achievements, Awards, Travels etc.)

N/A

SELF-ACTUALIZATION NEED (Civic activities, organizations, social projects, etc.)

N/A

Assessed by Princess Norbenita E. Morcellos

Clinical Instructor: Mrs. Lhevinne P. Genetializa, RN

 List of Drugs

1. Ceftriaxone 1g IVTT OD ANST

2. Salbutamol + Ipratropium 1 neb q 6hrs with 1 ml NSS x 3doses

3. Cetirizine syrup 2.5ml OD

4. Budesonide 1 neb q 12hrs

5. Paracetamol 250mg 3ml q 4hrs PRN

 Chapter 4

RESULTS AND FINDINGS

This includes the result and findings from the diagnostic and laboratory tests taken

from the client, the interpretation of each result, the normal values and justification of

each laboratory result.

Hematology

Test Results Normal Interpretation Justification

Values

Hemoglobin 103 120.00- Low a low hemoglobin count is

conc. 150.00g/L
only slightly lower than

normal and doesn't affect

how you feel. If it gets more

severe and causes

 symptoms, your low

hemoglobin count may

indicate you have anemia.

Erythrocyte no. 4.56 4.00- High Medical conditions that can

conc 4.50x10^12L
cause an increase in red

blood cells include: Heart

failure, causing low blood

oxygen levels.

Leucocyte no. 11.55 5.00-10.00x High A high lymphocyte

conc 10^g/L
count may occur when there

is a viral or bacterial

infection.

Segmenters 0.61 0.40-0.60 High This is a sign that your body

has an infection.

Neutrophilia can point to a

number of underlying

conditions and factors,

including: infection, most

likely bacterial.

Lymphocytes 0.36 0.25-0.40 Normal A high level

of lymphocytes may be an
 indication of lymphocytosis,

which is associated with

inflammatory bowel

disease. Lymphocyte counts

above the normal range can

be a harmless and

temporary situation due to

the body's normal response

to an infection or

inflammatory condition.

Monocytes 0.02 0.01-0.12 Normal are a type of white blood cell

that fight certain infections

and help other white blood

cells remove dead or

damaged tissues, destroy

cancer cells.

Eosinophils 0.01 0.01-0.05 Normal are a type of disease-

fighting white blood cell.

This condition most often

indicates a parasitic
 infection, an allergic

reaction or cancer.

Basophils - 0.00-0.05 - account for less than three

percent of your white blood

cells.

Stabs - 0.00-0.05 - indicating an infection in

progress.

Atypical cells - - - The presence of atypical

cells is sometimes referred

to as "dysplasia." Many

factors can make normal

cells appear atypical,

including inflammation and

infection.

Thrombocyte 242.0 150.00- Normal They help form blood clots

count 440.00x10^g/L
to slow or stop bleeding and

to help wounds heal.

Having too many or too

few thrombocytes or having

platelets that don't work as

 they should can cause

problems.

Hematocrit 0.31 0.36-0.45 Low A low hematocrit means the

percentage of red blood cells

is below the lower limits of

normal for that person's age,

sex, or specific condition.

Chapter 5

CONCLUSION

Our patient Shierra Maine A. Hugue who has a Community Acquired Pneumonia

which is the lower respiratory tract (LRT) infection by microorganisms. It is the cause of

morbidity and mortality among children throughout the world. Our client was admitted

August 5, 2019 @ 07:59AM. With a history of present illness: 2 weeks PTA, had sudden

onset of cough and colds. Developed on and off fever associated with dyspnea and

tachypnea.

The bacteria Streptococcus pneumoniae, Haemophilus influenzae type b and

respiratory syncytial virus are the most common causes of pneumonia in children. There

are vaccines available for some organisms, but they are underutilized and/or still in

development. Children with bacterial infections will generally be given antibiotics,

whereas viral infections usually resolve themselves without the need for additional
medication. Sometimes a child may need to be hospitalized for treatment which was

experienced by our patient. The decision whether to hospitalize is typically based on

factors such as: The child’s breathing ability, the age of the child, the risk of complications

due to the type of pneumonia or any underlying health conditions the child may have

like asthma in which my patient had a history. Also, the level of oxygen in the blood.

Chapter 6

RECOMMENDATION

Pediatric Community Acquired Pneumonia is a common serious illness that is

associated with considerable costs, morbidity, and mortality. And so it is our prime duty

to give care, comfort, knowledge and do our best to ease the pain that our patient is

experiencing.

Viruses account for most cases of PCAP during the first two years of life. After this

period, bacteria such as Streptococcus pneumoniae, Mycoplasma pneumoniae and Chlamydia

pneumoniae become more frequent. The symptoms are nonspecific in younger infants, but

cough and tachypnea are usually present in older children.

Internet References:

https://www.medicinenet.com/

https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-

20354204

https://www.slideshare.net/crisbertc/pediatric-community-acquired-pneumonia

https://emedicine.medscape.com/article/234240-overview

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5824044/

https://www.msdmanuals.com/professional/pulmonary-

disorders/pneumonia/community-acquired-

pneumonia#targetText=Community%2Dacquired%20pneumonia%20is%20defined,Leg

ionella%20species)%2C%20and%20viruses.
 CURRICULUM VITAE

Name: Iris Jane N. Montenegro

Address: San Miguel Tagum City
Mobile Number: 09203222524
Email: irismontenegro@gmail.com

PERSONAL CIRCUMSTANCES

Age: 20
Sex: Female
Date of Birth: June 14, 1999
Place of Birth: Sugbongcoggon, Misamis Occidental
Height: 4’11
Weight: 48kg
Nationality: Filipino
Religion: Roman Catholic

EDUCATIONAL BACKGROUND
Elementary Education
School: Sto. Nino College of Science and Technology Inc.
Address: Bonifacio Street, Tagum City

Year Graduated: 2011-2012

Secondary Education
(Junior Highschool) (Senior Highschool)
School: SNCST School: Tagum Doctors College Inc.
Address: Bonifacio Street, Tagum City Address: Tagum City
Year Graduated: 2015-2016 Year Graduated: 2017-2018

Tertiary Education
School: Saint Mary’s College of Tagum
Address: National Highway Tagum City

CURRICULUM VITAE

Name: Princess Norbenita E. Morcellos

Address: North Eagle 1 Visayan Village Tagum City
Mobile Number: 09650650802
Email: princess_norbenita@yahoo.com

PERSONAL CIRCUMSTANCES

Age: 19
Sex: Female
Date of Birth: February 14, 2000
Place of Birth: Davao Regional Medical Center Tagum City
Height: 5’3’’
Weight: 48kg
Nationality: Filipino
Religion: Roman Catholic
EDUCATIONAL BACKGROUND

Elementary Education
School: Magugpo Pilot Imelda Elementary School
Address: Sobrecarey Street Tagum City
Year Graduated: 2011-2012

Secondary Education
(Junior Highschool)
School: Arriesgado College Foundation Inc.
Address: National Highway Tagum City
Year Graduated: 2015-2016
(Senior Highschool)
School: UM Tagum College
Address: Arellano St. Tagum City
Year Graduated: 2017-2018

Tertiary Education
School: Saint Mary’s Colllege of Tagum Inc.
Address: National Highway Tagum City

CURRICULUM VITAE

Name: Yuka Padilla

Name: Yuka Padilla

Address: Apokon Tagum City
Mobile Number:09357417891
Email: yuka.padilla@yahoo.com

PERSONAL CIRCUMSTANCES

Age: 19
Sex: Female
Date of Birth: January 29, 2000
Place of Birth: Tagum City
Height: 5’0’
Weight: 47.2kg
Nationality: Filipino
Religion: Roman Catholic

EDUCATIONAL BACKGROUND

Elementary Education
School: Davao Christian
Address: Davao City
Year Graduated: 2011-2012

Secondary Education
(Junior Highschool) (Senior Highschool)
School: TCNHS School: SMCT
Address: Visayan Village TC Address: National Highway TC
Year Graduated: 2015-2016 Year Graduated: 2017-2018

Tertiary Education
School: Saint Mary’s College of Tagum
Address: National Highway Tagum City