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. Its 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 ones 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
patients 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 cant 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. Patients 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= 122s, RR= 30s
(+) 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 patients 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 patients breathing
PHYSICIANS 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 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 patients temperature returns to normal, medication must be
continued according to the doctors 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. Its important to have
the doctor monitor his progress.
Encourage the guardians to wash patients hands.The
hands come in daily contact with germs that can cause pneumonia.
These germs enter ones 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 ones 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 isnt possible, a
person can help protect others by wearing a face mask and always
coughing into a tissue.