INTRODUCTION

Pneumonia is an inflammation of the lungs caused by an infection. It is also called

Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our health.
Although pneumonia is a special concern for older adults and those with chronic
illnesses, it can also strike young, healthy people as well. It is a common illness that
affects thousands of people each year in the Philippines, thus, it remains an important
cause of morbidity and mortality in the country.
There are many kinds of pneumonia that range in seriousness from mild to life-
threatening. In infectious pneumonia, bacteria, viruses, fungi or other organisms attack
your lungs, leading to inflammation that makes it hard to breathe. Pneumonia can affect
one or both lungs. In the young and healthy, early treatment with antibiotics can cure
bacterial pneumonia. The drugs used to fight pneumonia are determined by the germ
causing the pneumonia and the judgment of the doctor. It’s best to do everything we can
to prevent pneumonia, but if one do get sick, recognizing and treating the disease early
offers the best chance for a full recovery.
A case with a diagnosis of Pneumonia may catch one’s attention, though the disease is
just like an ordinary cough and fever, it can lead to death especially when no intervention
or care is done. Since the case is a toddler, an appropriate care has to be done to make the
patient’s recovery faster. Treating patients with pneumonia is necessary to prevent its
spread to others and make them as another victim of this illness.

ANATOMY AND PHYSIOLOGY

The lungs constitute the largest organ in the respiratory system. They play an important
role in respiration, or the process of providing the body with oxygen and releasing carbon
dioxide. The lungs expand and contract up to 20 times per minute taking in and disposing
of those gases.
Air that is breathed in is filled with oxygen and goes to the trachea, which branches off
into one of two bronchi. Each bronchus enters a lung. There are two lungs, one on each
side of the breastbone and protected by the ribs. Each lung is made up of lobes, or
sections. There are three lobes in the right lung and two lobes in the left one. The lungs
are cone shaped and made of elastic, spongy tissue. Within the lungs, the bronchi branch
out into minute pathways that go through the lung tissue. The pathways are called
bronchioles, and they end at microscopic air sacs called alveoli. The alveoli are
surrounded by capillaries and provide oxygen for the blood in these vessels. The
oxygenated blood is then pumped by the heart throughout the body. The alveoli also take
in carbon dioxide, which is then exhaled from the body.
Inhaling is due to contractions of the diaphragm and of muscles between the ribs.
Exhaling results from relaxation of those muscles. Each lung is surrounded by a two-
layered membrane, or the pleura, that under normal circumstances has a very, very small
amount of fluid between the layers. The fluid allows the membranes to easily slide over
each other during breathing.
PATHOPHYSIOLOGY

Pneumonia is a serious infection or inflammation of your lungs. The air sacs in the lungs
fill with pus and other liquid. Oxygen has trouble reaching your blood. If there is too little
oxygen in your blood, your body cells can’t work properly. Because of this and spreading
infection through the body pneumonia can cause death. Pneumonia affects your lungs in
two ways. Lobar pneumonia affects a section (lobe) of a lung. Bronchial pneumonia (or
bronchopneumonia) affects patches throughout both lungs.

Bacteria are the most common cause of pneumonia. Of these, Streptococcus pneumoniae
is the most common. Other pathogens include anaerobic bacteria, Staphylococcus aureus,
Haemophilus influenzae, Chlamydia pneumoniae, C. psittaci, C. trachomatis, Moraxella
(Branhamella) catarrhalis, Legionella pneumophila, Klebsiella pneumoniae, and other
gram-negative bacilli. Major pulmonary pathogens in infants and children are viruses:
respiratory syncytial virus, parainfluenza virus, and influenza A and B viruses. Among
other agents are higher bacteria including Nocardia and Actinomyces sp; mycobacteria,
including Mycobacterium tuberculosis and atypical strains; fungi, including Histoplasma
capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Cryptococcus neoformans,
Aspergillus fumigatus, and Pneumocystis carinii; and rickettsiae, primarily Coxiella
burnetii (Q fever).

The usual mechanisms of spread are inhaling droplets small enough to reach the alveoli
and aspirating secretions from the upper airways. Other means include hematogenous or
lymphatic dissemination and direct spread from contiguous infections. Predisposing
factors include upper respiratory viral infections, alcoholism, institutionalization,
cigarette smoking, heart failure, chronic obstructive airway disease, age extremes,
debility, immunocompromise (as in diabetes mellitus and chronic renal failure),
compromised consciousness, dysphagia, and exposure to transmissible agents.
Typical symptoms include cough, fever, and sputum production, usually developing over
days and sometimes accompanied by pleurisy. Physical examination may detect
tachypnea and signs of consolidation, such as crackles with bronchial breath sounds. This
syndrome is commonly caused by bacteria, such as S. pneumoniae and H. influenzae.

NURSING PROFILE

a. Patient’s Profile

Name: R.C.S.B.

Age: 1 yr,1 mo.

Weight:10 kgs

Religion: Roman Catholic

Mother: C.B.

Address: Valenzuela City

b. Chief Complaint: Fever

Date of Admission: 1st admission

Hospital Number: 060000086199

c. History of Present Illness

2 days PTA – (+) cough

(+) nasal congestion, watery to greenish

(+) nasal discharge

Tx: Disudrin OD

Loviscol OD

Few hrs PTA - (+) fever, Tmax= 39.3 C

(+) difficulty of breathing

(+) vomiting, 1 episode

Tx: Paracetamol
 Sought consultation at ER: Rx=BPN, Salbutamol neb.

IE: T = 38.3C, CR= 122’s, RR= 30’s

(+) TPC

SCE, (-) retractions, clear BS, (-) cyanosis, (-) edema

d. Past Illness

(-) asthma

(-) allergies

e. Family History

PMHx: (+) asthma (mother)

f. Activities of Daily Living

• Sleeping mostly at night and during afternoon

• Usually wakes up early in the morning (5AM) to be milkfed.

• Eats a lot (hotdogs, chicken, crackers, any food given to her)

• Active, responsive

• BM (1-2 times a day)

• Urinates in her diaper (more than 4 times a day)

• Likes to play with those around her

g. Review of Systems

Neuromuscular: weakness of muscles

Integumentary: (-) cyanosis

Respiratory: tavhypnea; (+) DOB; (+) coarse crackles, (+) wheezes,

Digestive: food aversion, vomits ingested milk

DRUG STUDY

View NCP

NURSING ACTIONS

INDEPENDENT

• positioning of the patient with head on mid line, with slight flexion
rationale: to provide patent, unobstructed airway , maximum lung excursion
• auscultating patient’s chest
rationale: to monitor for the presence of abnormal breath sounds
• provide chest and back clapping with vibration
rationale: chest physiotheraphy facilitates the loosening of secretions
 • considering that the patient is an infant, and has developed a strong stranger
anxiety
as manifested by “white coat syndrome” , it is a nursing action to play with the
patient.
rationale: to establish rapport, and gain the patients trust

DEPENDENT

• administer due medications as ordered by the physician, bronchodilators, anti

pyretics and anti biotics
rationale: bronchodilators decrease airway resistance, secondary to
bronchoconstriction,
anti pyretics alleviate fever, antibiotics fight infection
• placing patient on TPN prn
rationale: to compensate for fluid and nutritional losses during vomiting

COLLABORATIVE

• assist respiratory therapist in performing nebulization of the patient

rationale: nebulization is a favourable route of administering bronchodilators
and aid in expectorating secretions, hence patient’s breathing

PHYSICIAN’S ORDER SHEET

11/19/06

Admit patient to ROC under the service of Dr. Vitan secure consent for admission and
management, TPR every shift then record. May have diet for age with strict aspiration
precaution, IVF D5 0.3NaCl 500cc to run at 62-63mgtts/min.May give paracetamol
125mg 1supp/rectum if oral paracetamol is not tolerated.

11/20/06

For urinalysis, IVF to follow D5 0.3 NaCl 500 at SR (62-63mgtt/m Use zinacef brand of
cefuroxine 750mg- given ½ vial 375mg every 8hours, nebulize (Ventolin 1 nebule)
every 6 hours, paracetamol drugs prn every 4hours (Temp 37.8).

11/21/06

Continue cefuroxine and nebulizer every 6 hours. May not reinsert IVF, revise
Cefuroxine IV to Cefuroxine 500mg via deep Intramuscular BID,continue management.

11/22/06

Continue management and refer.

DISCHARGE PLANNING

• Take the entire course of any prescribed medications. After a patient’s

temperature returns to normal, medication must be continued according to the
doctor’s instructions, otherwise the pneumonia may recur. Relapses can be far
more serious than the first attack.
• Get plenty of rest. Adequate rest is important to maintain progress toward full
recovery and to avoid relapse.
• Drink lots of fluids, especially water. Liquids will keep patient from becoming
dehydrated and help loosen mucus in the lungs.
• Keep all of follow-up appointments. Even though the patient feels better, his
lungs may still be infected. It’s important to have the doctor monitor his progress.
• Encourage the guardians to wash patient’s hands. The hands come in daily
contact with germs that can cause pneumonia. These germs enter one’s body when
he touch his eyes or rub his nose. Washing hands thoroughly and often can help
reduce the risk.
• Tell guardians to avoid exposing the patient to an environment with too
much pollution (e.g. smoke). Smoking damages one’s lungs’ natural defenses
against respiratory infections.
• Give supportive treatment. Proper diet and oxygen to increase oxygen in the
blood when needed.
• Protect others from infection. Try to stay away from anyone with a
compromised immune system. When that isn’t possible, a person can help protect
others by wearing a face mask and always coughing into a tissue.