SAINT MICHAEL’S COLLEGE OF

LAGUNA
Old National Highway, Platero, Biñan Laguna.

School of Nursing and Midwifery

A Partial Fulfillment in Related Learning Experience III

A CASE STUDY
of
Pneumonia

Submitted by:

Angelique A. Malabo

BSN 3B

Submitted to:

Mrs. Aimee Agorilla

26July2008
 INTRODUCTION

Pneumonia is inflammation of one or both lungs. In people with

pneumonia, air sacs in the lungs fill with fluid, preventing oxygen from reaching

blood cells and nourishing the other cells of the body. Sometimes the

inflammation occurs in scattered patches in the tissue around the ends of the

bronchioles, the smallest air tubes in the lungs.

Pneumonia in children manifests different signs and symptoms such as

fever, chills, cough, unusually rapid breathing, breathing with grunting or

wheezing sounds, labored breathing that makes child’s rib muscles retract,

vomiting, chest pain, abdominal pain, decreased activity, loss of appetite, and in

extreme cases bluish or gray color of the lips and fingernails.

It is an infection that can be caused by different types of germs, including

bacteria, viruses, fungi, and parasites. Although different types of pneumonia

tend to affect children in different age groups, pneumonia is most commonly

caused by viruses. Some viruses that cause pneumonia are adenoviruses,

rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV), and

parainfluenza virus (the virus that causes croup).

The viruses and bacteria that cause pneumonia are contagious and are

usually found in fluid from the mouth or nose of an infected person. Illness can

spread when an infected person coughs or sneezes on a person, by sharing

drinking glasses and eating utensils, and when a person touches the used

tissues or handkerchiefs of an infected person.

Most cases of pneumonia can be treated without hospitalization. Typically,

oral antibiotics, rest, fluids, and home care are sufficient for complete resolution.

However, people with pneumonia who are having trouble breathing, people with

other medical problems, and the elderly may need more advanced treatment. If

the symptoms get worse, the pneumonia does not improve with home treatment,

or complications occur, the person will often have to be hospitalized.

 PATIENT’S PROFILE

Name: Ivan Dave Arenas

Address: Doña Rosa Compound Tagapo Sta. Rosa City of Laguna

Age: 2

Gender: Male

Nationality: Filipino

Religion: Roman Catholic

Birth Date: August 24, 2005

Birth Place: Sta. Rosa City

Attending Physician: Dr. Rizalina Gonzales

Admitting Physician: Dr. Irine Maroto

Date of Admission: July 16, 2008

Time of Admission: 02:08 pm

Chief Complain: Difficulty of breathing

Admission Diagnosis: Pneumonia with asthmatic component

History of Past Illness:

On February this year, the pt. was already hospitalized due to difficulty of

breathing. He was then asked to be confined in the hospital for a couple of days.

And after his breathing was back no normal, his attending physician allowed him

to go home and prescribed home medications.

History of Present Illness:

One day prior to admission on July 16, the pt. started to experience

difficulty of breathing with dry cough. Then his parents decided to bring him to

BDH where he undergone series of tests and was diagnosed of having

pneumonia with asthmatic component.

 ANATOMY ANG PHYSIOLOGY

Nasal Passages

The flow of air from outside of the body to the lungs begins with the nose, which
is divided into the left and right nasal passages. The nasal passages are lined
with a membrane composed primarily of one layer of flat, closely packed cells
called epithelial cells. Each epithelial cell is densely fringed with thousands of
microscopic cilia, fingerlike extensions of the cells. Interspersed among the
epithelial cells are goblet cells, specialized cells that produce mucus, a sticky,
thick, moist fluid that coats the epithelial cells and the cilia. Numerous tiny blood
vessels called capillaries lie just under the mucous membrane, near the surface
of the nasal passages. While transporting air to the pharynx, the nasal passages
play two critical roles: they filter the air to remove potentially disease-causing
particles; and they moisten and warm the air to protect the structures in the
respiratory system.

Filtering prevents airborne bacteria, viruses, other potentially disease-causing

substances from entering the lungs, where they may cause infection. Filtering
also eliminates smog and dust particles, which may clog the narrow air passages
in the smallest bronchioles. Coarse hairs found just inside the nostrils of the nose
trap airborne particles as they are inhaled. The particles drop down onto the
mucous membrane lining the nasal passages. The cilia embedded in the mucous
membrane wave constantly, creating a current of mucus that propels the particles
out of the nose or downward to the pharynx. In the pharynx, the mucus is
swallowed and passed to the stomach, where the particles are destroyed by
stomach acid. If more particles are in the nasal passages than the cilia can
handle, the particles build up on the mucus and irritate the membrane beneath it.
This irritation triggers a reflex that produces a sneeze to get rid of the polluted air.

The nasal passages also moisten and warm air to prevent it from damaging the
delicate membranes of the lung. The mucous membranes of the nasal passages
release water vapor, which moistens the air as it passes over the membranes. As
air moves over the extensive capillaries in the nasal passages, it is warmed by
the blood in the capillaries. If the nose is blocked or “stuffy” due to a cold or
allergies, a person is forced to breathe through the mouth. This can be potentially
harmful to the respiratory system membranes, since the mouth does not filter,
warm, or moisten air.

In addition to their role in the respiratory system, the nasal passages house cells
called olfactory receptors, which are involved in the sense of smell. When
chemicals enter the nasal passages, they contact the olfactory receptors. This
triggers the receptors to send a signal to the brain, which creates the perception
of smell.

Oral Cavity

The first space of the mouth is the mouth cavity, bounded laterally and in front by
the alveolar arches (containing the teeth), and posteriorily by the isthmus of the
fauces. The oral cavity is also known as the mouth which it swallows food and
drinks and goes down to the person's stomach.
The mouth plays an important role in speech (it is part of the vocal apparatus),
facial expression, kissing, eating, drinking (especially with a straw), and
breathing.

Pharynx

Air leaves the nasal passages and flows to the pharynx, a short, and funnel-
shaped tube about 13 cm (5 in) long that transports air to the larynx. Like the
nasal passages, the pharynx is lined with a protective mucous membrane and
ciliated cells that remove impurities from the air. In addition to serving as an air
passage, the pharynx houses the tonsils, lymphatic tissues that contain white
blood cells. The white blood cells attack any disease-causing organisms that
escape the hairs, cilia, and mucus of the nasal passages and pharynx. The
tonsils are strategically located to prevent these organisms from moving further
into the body. One tonsil, called the adenoids, is found high in the rear wall of the
pharynx. A pair of tonsils, the palatine tonsils, is located at the back of the
pharynx on either side of the tongue. Another pair, the lingual tonsils, is found
deep in the pharynx at the base of the tongue. In their battles with disease-
causing organisms, the tonsils sometimes become swollen with infection. When
the adenoids are swollen, they block the flow of air from the nasal passages to
the pharynx, and a person must breathe through the mouth.

Larynx

Air moves from the pharynx to the larynx, a structure about 5 cm (2 in) long
located approximately in the middle of the neck. Several layers of cartilage, a
tough and flexible tissue, comprise most of the larynx. A protrusion in the
cartilage called the Adam’s apple sometimes enlarges in males during puberty,
creating a prominent bulge visible on the neck.

While the primary role of the larynx is to transport air to the trachea, it also serves
other functions. It plays a primary role in producing sound; it prevents food and
fluid from entering the air passage to cause choking; and its mucous membranes
and cilia-bearing cells help filter air. The cilia in the larynx waft airborne particles
up toward the pharynx to be swallowed.

Food and fluids from the pharynx usually are prevented from entering the larynx
by the epiglottis, a thin, leaflike tissue. The “stem” of the leaf attaches to the front
and top of the larynx. When a person is breathing, the epiglottis is held in a
vertical position, like an open trap door. When a person swallows, however, a
reflex causes the larynx and the epiglottis to move toward each other, forming a
protective seal, and food and fluids are routed to the esophagus. If a person is
eating or drinking too rapidly, or laughs while swallowing, the swallowing reflex
may not work, and food or fluid can enter the larynx. Food, fluid, or other
substances in the larynx initiate a cough reflex as the body attempts to clear the
larynx of the obstruction. If the cough reflex does not work, a person can choke a
life-threatening situation. The Heimlich maneuver is a technique used to clear a
blocked larynx. A surgical procedure called a tracheotomy is used to bypass the
larynx and get air to the trachea in extreme cases of choking.

Trachea, Bronchi, and Bronchioles

Air passes from the larynx into the trachea, a tube about 12 to 15 cm (about 5 to
6 in) long located just below the larynx. The trachea is formed of 15 to 20 C-
shaped rings of cartilage. The sturdy cartilage rings hold the trachea open,
enabling air to pass freely at all times. The open part of the C-shaped cartilage
lies at the back of the trachea, and the ends of the “C” are connected by muscle
tissue.

The base of the trachea is located a little below where the neck meets the trunk
of the body. Here the trachea branches into two tubes, the left and right bronchi,
which deliver air to the left and right lungs, respectively. Within the lungs, the
bronchi branch into smaller tubes called bronchioles. The trachea, bronchi, and
the first few bronchioles contribute to the cleansing function of the respiratory
system, for they, too, are lined with mucous membranes and ciliated cells that
move mucus upward to the pharynx.

Alveoli

The bronchioles divide many more times in the lungs to create an impressive tree
with smaller and smaller branches, some no larger than 0.5 mm (0.02 in) in
diameter. These branches dead-end into tiny air sacs called alveoli. The alveoli
deliver oxygen to the circulatory system and remove carbon dioxide. Interspersed
among the alveoli are numerous macrophages, large white blood cells that patrol
the alveoli and remove foreign substances that have not been filtered out earlier.
The macrophages are the last line of defense of the respiratory system; their
presence helps ensure that the alveoli are protected from infection so that they
can carry out their vital role.
The alveoli number about 150 million per lung and comprise most of the lung
tissue. Alveoli resemble tiny, collapsed balloons with thin elastic walls that
expand as air flows into them and collapse when the air is exhaled. Alveoli are
arranged in grapelike clusters, and each cluster is surrounded by a dense hairnet
of tiny, thin-walled capillaries. The alveoli and capillaries are arranged in such a
way that air in the wall of the alveoli is only about 0.1 to 0.2 microns from the
blood in the capillary. Since the concentration of oxygen is much higher in the
alveoli than in the capillaries, the oxygen diffuses from the alveoli to the
capillaries. The oxygen flows through the capillaries to larger vessels, which
carry the oxygenated blood to the heart, where it is pumped to the rest of the
body.

Carbon dioxide that has been dumped into the bloodstream as a waste product
from cells throughout the body flows through the bloodstream to the heart, and
then to the alveolar capillaries. The concentration of carbon dioxide in the
capillaries is much higher than in the alveoli, causing carbon dioxide to diffuse
into the alveoli. Exhalation forces the carbon dioxide back through the respiratory
passages and then to the outside of the body.

Lung

It is either of a pair of elastic, spongy organs used in breathing and respiration. In

humans the lungs occupy a large portion of the chest cavity from the collarbone
down to the diaphragm, a dome-shaped sheet of muscle that walls off the chest
cavity from the abdominal cavity.

Heart

In anatomy, hollow muscular organ that pumps blood through the body. The
heart, blood, and blood vessels make up the circulatory system, which is
responsible for distributing oxygen and nutrients to the body and carrying away
carbon dioxide and other waste products. The heart is the circulatory system’s
power supply. It must beat ceaselessly because the body’s tissues—especially
the brain and the heart itself—depend on a constant supply of oxygen and
nutrients delivered by the flowing blood. If the heart stops pumping blood for
more than a few minutes, death will result.

Epiglottis

It is a thin, lidlike flap of cartilage attached to the base of the tongue of terrestrial
vertebrates. The epiglottis is normally pointed upward, but during the passage of
solids and liquids from the mouth into the esophagus, the epiglottis is folded
down over the glottis, the opening between the vocal cords, to prevent food from
passing into the trachea.
 LABORATORY AND DIAGNOSTIC EXAMINATIONS

Exam Name Result Unit Normal Value

WBC Count 11.7 x10^g/L 5.0-15.0
DIFFERENTIAL
COUNT
Segmenters 0.76 0.45-0.65
Lymphocytes 0.16 0.20-0.35
Monocytes 0.05 0.02-0.06
Eosinophils 0.03 0.02-0.04
Basophils 0.00 0.00-0.01
RBC Count 3.9 x10^12/L 0-0
Hemoglobin 114 Gm/L 120-140
Hematocrit 0.34 0.32-0.42
Platelet Count 320 x10^g/L 150-350

Implications:

WBC

Increased – infection, leukemia, tissue necrosis

Decreased – bone marrow depression, influenza, typhoid fever, measles,
infectious hepatitis, mononucleosis, rubella

Segmenters (Neutrophils)

Increased – infection, ischemic neurosis, metabolic disorders, RA, acute gout

Decreased – bone marrow depression, typhoid, hepatitis, influenza, measles,
mumps, rubella, hepatic disease, SLE, vit. B12 deficiency

Lymphocytes

Increased – TB, hepatitis, infectious mononucleosis, mumps, rubella,

thyrotoxicosis, lymphocytic leukemia

Monocytes

Increased – TB, malaria, hepatitis, SLE, RA, carcinoma, monocytic leukemia,

lymphomas

Eosinophils

Increased – asthma, hay fever, parasitic infections, chronic myelocytic leukemia,

Hodgkin’s disease, metastasis
Decreased – Cushing’s Syndrome

Basophils

Increased – chronic myelocytic leukemia, Hodgkin’s disease, ulcerative colitis

Decreased – hyperthyroidism, ovulation, pregnancy
RBC

Increased – absolute/relative polycythemia

Decreased – anemia, fluid overload of >24 hrs.

Hemoglobin

Increased – polycythemia or dehydration

Decreased – anemia, recent hemorrhage, fluid retention

Hematocrit

Increased – polycythemia, hemoconcentration

Decreased – anemia, hemodilution

Platelet Count

Increased – hemorrhage, iron deficiency anemia, inflammatory disease, primary

thrombocythemia, myeloid metaplasia, polycythemia vera, chronic myelogenous
leukemia
Decreased – aplastichypoplastic bone marrow, leukemia, vit. B12 deficiency,
immune disorders

ROENTGENOLOGICAL REPORT

Name: Ivan Dave Arenas

Address: Doña Rosa Compound Tagapo Sta. Rosa City of Laguna
Exam: Chest AP/L
CC: DOB
Referred by: Dra. Gonzales

Chest PA:
Both lung fields are clear with normal pulmonary vascular markings. The
cardiac shadow is not enlarged. The diaphragm sulvi and Sony thorax are
unremarkable.

Impression:
Normal chest findings.
 Pathophysiology

Inhalation of infectious
and irritating agents

Microbial invasion (organisms

penetrate the airway mucosa &
multiply in alveolar spaces)

Inflammation in interstitial spaces,

alveoli, and/or bronchioles

Lung become RBC and fibrin WBC migrates to the

stiff moves in alveoli area of infection

Reduced lung compliance and Capillary leaks spread the infection to Capillary leak,
vital capacity decrease other areas of the lung edema, exudates

Alveolar collapse Fluids collect in and

(atelectasis) Organisms move into Infection extends into around the alveoli
the bloodstream the pleural cavity

Ability of the lungs to oxygenate

blood decrease Sepsis Emphysema

Arterial tension falls

Excess fluid in the lungs

 Alveolar walls thicken

Gas exchange is reduced

Hypoxemia

If treated: If untreated:

Analgesics to relieve pleuratic chest

pain.
Antitussives Lung abscess Pleural effusion Meningitis Pericarditis
Bed rest
Bronchodilator therapy
Chest physiotherapy Metastatic infection Emphyema Diffuse brain Pericardial
Postural drainage such as brain abscess swelling effusion
High-calorie diet
Adequate fluid intake Death
Death Death
Humidified oxygen therapy for hypoxia
Mechanical ventilation for respiratory Death
failure

Recovery
 BIBLIOGRAPHY

• www.wikipedia.com

• http://www.medicinenet.com

• http://doh.gov.ph

• http://kidshealth.org

• Anatomy and Physiology by Gerard Tortora

• Fundamentals of Nursing

• Medical and Surgical Book

• PPD Drug Handbook

• Handbook for Nursing Diagnosis

• Nursing Care Plan Book

• Webster’s Medical Dictionary