Pneumonia |1

Capitol Medical Center Colleges, Inc.

#4 Sto. Domingo Avenue, Quezon City

College of Nursing

A Case Analysis of Pneumonia

In Partial Fulfillment of the Requirements in

Related Learning Experiences of

Nursing Care Management 102

Submitted by:

Level II Group 4 Members:

Misador, Grace

Navarro, Simon

Nery, Francis

Palisoc, Marili

Petrache, Joseph

Poot, Marlen

Punzalan, Archimedes

Ramos, Diane

Submitted to:

Dr. Sherwin Buluran, RN, RMT, MAN, Ph.D

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OBJECTIVES OF STUDY

Our main scheme for this study could be very helpful for everyone potentially at

risk to have the disease. What we hope to achieve after this study are the following:

 To be able to identify and analyze etiology of the underlying cause of the

disease.

 To be able to give relation between another theoretical framework and the

chosen diagnosis; which is Pneumonia.

 To discuss Anatomy and Physiology of the of the related disease

 To tackle and give classification of drugs being taken by the patient.

 To establish essential nursing intervention to be implemented for the patients

wellness and recovery.

INTRODUCTION

Background of the Study

The group chose Pneumonia as our case to be study out of curiosity. This is our

first time to encounter this kind of case and because of that; our group was interested in

it. We are willing to do this case to challenge our mind in analyzing the problem and to

enhance our hidden knowledge, and also to gain new experiences which would bring

new learning for the member of the group.

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Significance of the Study

The relevance of this study is for the concluding of the prearranged diagnosis.

Likewise, it would be a big help in identifying the primary needs for its wellness and

recovery. By identifying such needs and health problems, the group will capable of

formulating individualized nursing interventions for the patient that would suffice to the

client’s needs. Effective management of the problems identified will help the patient to

recover faster and maintain a holistic sense of wellness within the hospital.

This case study would also provide the group with enough knowledge, skills and

attitude on how to manage future patients with the same or similar condition.

Overview of the Disease

Pneumonia is an inflammatory condition of the lungs caused by an infection. It is usually

occurs at a rate of 2 to 4 children in 100. Between 5 and 10 million people get

pneumonia in the United States each year, and more than 1 million people are

hospitalized due to the condition. As a result, pneumonia is the fourth most frequent

cause of hospitalizations. Although the majority of pneumonias respond well to

treatment, the infection kills 40,000 - 70,000 people each year. Men with community-

acquired pneumonia tend to fare worse than women. Men are 30% more likely than

women to die from the condition, even if the severity of the illness is the same.

Researchers say there may be some genetic reason for the disparity.

It may be of bacterial origin (pneumococcal, streptococcal, staphylococcal, or

Chlamydia) or viral in origin, such as RSV (respiratory syncytial virus). Aspiration of lipid

or hydrocarbon substances also causes pneumonia. These disease is commonly

divided into two types: hospital acquired (pneumococcal or streptococcal pneumonia)

 Pneumonia |4

and community acquired (Chlamydia, viral pneumonias). It occurs most often in late

winter and early spring.

Classification of Pneumonia:

• Hospital-acquired pneumonia, also called nosocomial pneumonia, is pneumonia

acquired during or after hospitalization for another illness or procedure with onset

at least 72 hrs after admission. The causes, microbiology, treatment and

prognosis are different from those of community-acquired pneumonia.

• Community-acquired pneumonia (CAP) is infectious pneumonia in a person who

has not recently been hospitalized. CAP is the most common type of pneumonia.

The most common causes of CAP vary depending on a person's age, but they

include Streptococcus pneumoniae, viruses, the atypical bacteria, and

Haemophilus influenzae. Overall, Streptococcus pneumoniae is the most

common cause of community-acquired pneumonia worldwide. Gram-negative

bacteria cause CAP in certain at-risk populations.

There are also types of Community-acquired pneumonia:

• Pneumococcal Pneumonia is generally abrupt and follows an upper respiratory

tract infection. With this, children may have blood-tinged sputum as exudative

serum and red blood cells invade the alveoli.

• Chlamydial Pneumonia is most often seen in newborns up to 12 weeks of age

because the chlamydial organism is contracted from the mother’s vagina

during birth. Laboratory assessment will show an elevated level of

 Pneumonia |5

immuunoglobulin IgG and IgM antibodies, peripheral eosinophilia and a

specific antibody to Chlamydia Trachomatis.

• Viral Pneumonia caused by the viruses of upper respiratory tract infection:

RSVs, myxoviruses or adenoviruses.

• Mycoplasma Pneumonia are similar to yet larger than viruses. Mycoplasmal

pneumonia occurs more frequently in older children (over 5 years) and more

often during the winter.

In making diagnosis of pneumonia begins with taking a thorough medical history,

including symptoms, smoking history, and exposure to infections and lung irritants. A

physical examination is also performed and includes listening with a stethoscope to the

sounds that lungs make during respiration. Lung sounds that may point to a diagnosis of

pneumonia include a bubbling or crackling sound and decreased lung sounds. A

physician or nurse practitioner will also tap on the chest with the fingers to listen for

certain sounds that may also point to a diagnosis of pneumonia.

Diagnostic testing generally includes a chest X-ray. Depending on a person's

condition and medical history, testing may also include lung function tests, such as a

spirometry, which measures how much air is moved in and out of the lungs during

breathing. A CT scan of the chest can help to evaluate such factors as the presence of

other lung conditions, including COPD and congestive heart failure.

A sample of phlegm that is coughed up from the lungs may be tested for the

presence of bacteria or other pathogens. The treatment for pneumonia involves a

multifaceted approach. Treatment plans vary depending on the cause, the severity of

the symptoms, the presence of complications, general health, and an individual's

medical history. One goal of treatment of pneumonia is to control symptoms, such as

 Pneumonia |6

fever, cough, and shortness of breath, until a child recovers. Another goal is to minimize

the development of serious complications, such as severe shortness of breath and

hypoxia. With treatment, generally healthy children and adults can often recover from

bacterial pnemonia or viral pneumonia.

NURSING HEALTH HISTORY

Patient’s Profile

With abundance of dignity and respect, we have decided to protect the client’s

identification and call her Patient 801 instead. All the information below are based from

statement of the patients’ family.

Patient 801, a 1 year old female, born on the 28th of August 2009 born at

Greenhills San Juan and now residing at Quezon City.

During her first few months, she was breastfed every hour and as time passes by the

frequency was decreased to 2-3 hours. After 1 year of breastfeeding, her parents

decided to switch to milk formula like Bona and Promil to support her increasing

nutritional needs.

Past Health History

Upon the interview, the patient’s mother was asked about the past health history

of patient 801 and she told us that her daughter had fever and cough for a couple of

days and OTC medication was provided. During her first 14 months, all vaccines under

the Expanded Program Immunization were given to her and were brought by their
 Pneumonia |7

Community Health Center. As for now, she had already completed her EPI vaccines.

When she was 10 months old, she was diagnosed with Bronchoasthma.

C.C.:

“She has a high fever for almost a week associated with cough and colds” as

verbalized by her mother.

Present Health History

6 days PTA, patient was noted to have fever 38C. pt was given paracetamol. 4

days PTA, patient was brought to a private MD where in Erythromycin was given. 2

days PTA, pt was now afrebile but still have an acute cough and colds. On the day of

admission, the pt. had a fever 38C.

Family Health History

Patient 801 father who resides in Quezon together with her Family doesn’t have

any history of other diseases aside from chicken fox and measles which were treated by

medications prescribed by their physician. Similarly, they have also stated that the

family is not sports-inclined and has not practiced much of their active lifestyle. Usually

they spend their time at work and at home watching television and movies and enjoy

occasional drinking.

On the other hand, her mother who grew up in Quezon City had a history of

Hypertension. Certain supplement which helps boosting up her immune system is

 Pneumonia |8

taken daily together with her healthy lifestyle consisted of regular exercise and a good

balanced diet.

THEORETICAL FRAMEWORKS

Self-Care Deficit Nursing Theory of Dorothea Orem

Orem developed the Self-Care Deficit Theory of Nursing, which is composed of

three interrelated theories: (1) the theory of Self-Care, (2) the theory of Self-Care Deficit,
and (3) the theory of Nursing System.

Theory of Self-Care

Self-care is the performance or practice of activities that individuals initiate and

perform on their own behalf to maintain life, health, and well-being.

Self-care agency is a human ability which is “the ability for engaging in self
care.”

Therapeutic self-care demand “totality of self-care actions to be performed for

some
duration in order to meet self care requisites by using various methods and related sets
of operations and actions.”

Three Categories of Self-Care Requisites

Universal self-care requisites- are associated with life processes, maintenance

of the integrity of human structure and functioning, and with general being.

Developmental self-care requisites- are associated with the developmental

processes; derived from a condition or associated with an event (e.g. adjusting to a new
job).

Health Deviation self-care requisites- Required in conditions of illness, injury,

or disease; includes seeking medical assistance, learning to live with effects of
condition, etc.

Theory of Self-Care Deficit

Self-care deficit is the basic element of Orem’s general theory of nursing

because it delineates when nursing is needed. Nursing is required when adults are
incapable of or limited in their ability to provide continuous effective self-care.
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Five methods of helping

1.Acting for or doing for another

2.Guiding and directing
3.Providing physical or psychological support
4.Providing and maintaining an environment that supports personal
development
5. Teaching
Conceptual Framework

Self -care

C.F.
Self care Agency Self-care demands
C.F.

Deficit

C.F.
Nursing Agency

Theory of Nursing System

1. Wholly Compensatory Nursing System

2. Partly Compensatory Nursing System
3. Supportive-Educative System
The wholly compensatory nursing system is selected when the patient cannot or
should not perform any self-care actions. The partly compensatory nursing system is
selected when the patient can perform some, but not all, self-care actions. The
supportive-educative nursing system is selected when the patient can and should
perform all self-care actions.

Basic Nursing System

Wholly Compensatory System

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Accomplishes patient’s therapeutic self-care Patie

nt
Nurs Compensates for patient’s inability to engage in self-
actio
e care
n
actio
Supports and protects patient

Partly Compensatory System

Performs some self-care measures for patient

Compensates for self-care limitations of patient

Nurs Assist patient as required
e
actio

Performs some self-care measures

Regulates self-care agency Patie

nt
Accepts care and assistance from nurse actio

Supportive-Educative System

Accomplishes self-care
Patie
nt
Nurs actio
Regulates the exercise and development of self-care
e agency
actio

In relation to the patient;

In the case of the patient wherein she manifested pneumonia and the fact that
she is only 1 year old, Orem’s self-care deficit theory is one of the theories that are
suitable to the patient. Since the patient is too young and doesn’t know anything yet,
she needs the help of her parents and other health care providers. The parents and the
health care providers should be involved in doing the 5 helping methods which are;
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1. Acting for or doing for another

In this method, we can help the patient in taking her medications.

2. Guiding and Directing

Guide and direct her parents and other health team members to provide
comfort measures such as maintaining a hygienic environment.

3. Providing Physical or Psychological Support

Provide physical and psychological support by attending accordingly to the
patient whenever she needs something physically and/or emotionally.

4. Providing and maintaining an environment that supports personal development

Guide the parents of the child for proper hygiene. Cleanliness must start in
their house for her to recuperate continuously. Proper ventilation must be applied
for her to breathe fresh air that is very essential. Adequate light is also needed
because the light has tangible effects upon the human body. Sufficient warmth,
the patient should not be too warm or too cold for this interacts with the
environment. Controlling the noise can help through the client’s healing process.
Unnecessary noises should be eliminated because it’s irritating to the patient.

5. Teaching
Health teachings such as: increase oral fluid intake, adequate intake of
nutritious foods, and emphasize the importance of proper hygiene to promote
optimum wellness.

If the patient is ready for discharge, it is our part to act as an educator. To

educate our client in maintaining her health one’s the client is discharged.
The nursing system that can be applied based on Orem’s Theory is supportive-
educative. We should refer the patient to her attending physician for the follow-up check
up, prescribed diet and take home medications. We are also responsible to teach the
significant others on the prevention of re-occurrence of pneumonia, advice to increase
the immune system of the child by taking vitamin supplements, explaining foods that are
rich in vitamin C and proper intake of take home medications so that the health
continuum of the client is moving forward further to wellness.

GORDON’S PATTERN OF FUNCTIONING

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Pattern of Normal Before During Analysis /

Functioning Hospitalization Hospitalization Interpretation
Findings
Health Regular The client‘s The client’s The client
Perception – exercise, mother health is good manages her
Health regular check- verbalized that the fever health well,
Management ups, regular she experienced resided, but she she informed
Pattern maintenance cough and experienced the nurse
visit for fever. difficulty in whenever she
screening expectorating feels
examination. She had a cough. The something
regular check- mother informed wrong, and it
ups with her the nurse on really helps
pediatrician duty if her the medical
temperature staffs to treat
increased. her.
Nutritional - Eat 3 meals per The was fed 8- She’s on DFA The client’s
Metabolic day, need 10 bottles of (Diet for age). appetite
Pattern protein rich food milk amounting She had an on- decreased due
and breakfast to up to 2500 Kcal going IV fluid. to her
sustain the per day and She lost her condition.
prolonged drink up to 4 appetite and
physical and glasses of water was only
mental effort. per day. consuming 4-5
Drink 6-8 bottles of milk
glasses of per day
water.

Elimination The client’s The client The Clients

Pattern usual defecating defecated once defecating
pattern is 1 – 2 a day and pattern
times a day and voided 2-3 times decreased due
voiding pattern a day. to her
3 – 4 times a decreased oral
day. fluid intake
and physical
activity.
Activity- Moves freely, The client The client was The client
Exercise easily, usually stays at not allowed to must have
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Pattern rhythmically, home while mobilize as enough rest so

and purposely in being watched much due to the she’s not
the by her guardian. fact that her IV allowed her
environment. She plays with was inserted at usual
her toys and her lower activities.
interacts with extremities. She
the people was usually
around her carried around
surroundings. by her guardian.
Sleep-Rest Most healthy The client During There is a
Pattern child needs 8 to sleeps when hospitalization, change in
12 hours of she felt tired or the client’s sleeping
sleep. full. She was mother stated pattern due to
given time for her baby lacked nursing rounds
afternoon naps sleep due to her and
and put to bed cough and the environment.
around 9pm. change in
environment.
She was only
able to sleep for
5 hours the
most.
Cognitive- Alert, oriental in The Client is in The client Having an
Perceptual time, place, her showed no intact cognition
Pattern person, developmental change in her and perception
understand age. She patterns, she could help the
verbal and watches TV, still did the client in
written words. and plays with same activities participating in
books and toys. while being health related
hospitalized activities that
could enhance
his condition.
Role- Family roles, She is the The client is Her roles did
Relationship work roles, youngest of the visited and not changed,
Pattern student roles 2 children, she taken care of by she is still the
and social roles. stays at home her relatives dependent
with her mother, most especially person that is
or other by her mother. still being
guardians that taken care of.
are available
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Sexuality – Sexual activity Client is raised There is no There is no

Reproductive is common. as a normal change in change in her
Establishes own baby girl, she is sexual patterns sexual lifestyle
lifestyle and provided with and values.
values. feminine toys
and clothed as a
young lady.

Self- Establishing As being the The family Nothing

Perception – priority of youngest participated in changed with
Self-Concept needs, member of the accompanying the clients
Pattern recognizing both family, the her so she can perception and
self and others. family views her maintain the self-concept
as their baby same pattern
and every perception
member of the
family perceives
her as well
Coping and Maintaining The client has a In relation to the The client is
Stress social status history of fear past encounters working on
Tolerance and standard of when being with the patient, overcoming
living. hospitalized due the client is still her fear and
to her prior scared of stress factors
admission. She interacting with when being
is scared of any the health team hospitalized.
health team member, which
members that created stress
are wearing and discomfort
white. for her. Her
family provided
her with toys
that resemble
medical
equipment to
help her deal
with her fear
and stress
Values and New found The client is It was difficult to Nothing
Beliefs appreciation for raised as a show her that changed with
the pas; Catholic girl. she will be okay, the family’s
 P n e u m o n i a | 15

increased They hope to but their beliefs methods, she

respect for inner provide her with still have not is still taught
voice. the proper changed, they the same
values and want to provide values and
beliefs so she her with the best hope that she
can grow up to and hopefully picks op on
be a proper and help her turn the values that
good citizen into a wonderful her parents
person. have showed
her

PHYSICAL ASSESSMENT

Physical examination follows a methodical head to toe format in the

Cephalocaudal assessment. This is done systematically using the techniques of

inspection, palpation, percussion and auscultation with the use of materials and

investments such as the penlight, thermometer, tape measure and stethoscope and

also the senses.

During the procedure, we made every effort to recognize and respect the patient’s

feelings as well as to provide comfort measures and follow appropriate safety

precautions.
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Vital signs:

Temperature: 36.0 C Weight: 22 lbs.

Respiratory rate: 31 cpm Height: 30 in.

Pulse rate: 120 bpm

General Appearance and Mental Status: She wears printed pajama, stripes shirt and

pink jacket with a pony tail. She has IV line on her right foot covered with a diaper. She

is sitting on her mother’s lap because she finds it comfortable according to her mom.

She takes a bath 5 days before she was admitted and there is the presence of curiosity.

Body Part Techniques Normal Findings Actual Findings Interpretation

used
A.HEAD
Skull • I Proportional to the Rounded Normal
nspec body size of the
tion body, round with Hair is black
• P prominence in the
alpati frontal area Evenly
on anteriorly and the distributed hair
occipital area
posteriorly Thick and slight
symmetrical in all curly hair
planes gently
curve. No
infestation/lice
and dandruff
Scalp Inspection White clean, free White, free from Theres is slighty
Palpation from masses, masses and presence of
lumps, scars, nits lumps. Slighty seborrhea
seborrhea, and presence
lesion seborrhea
Hair Inspection Black evenly Slightly She has an oily
Palpation distributed and presence of hair with slighty
 P n e u m o n i a | 17

covers the whole oiliness, thin, presence of lice

scalp, thick, shiny, black hair and in other part.
free from split evenly
ends distributed and
covers the whole
scalp with no
presence of split
ends.
There is slighty
presence of lice
in other part.
Face Inspection Oblong or oval or Round shape of She has a mole
Palpation square or heart- face and has a under her left
shaped, mole under her eye
symmetrical facial left eye
expression that is
dependent on the
mood or true
feelings smooth
and free from
wrinkles, in
involuntary muscle
movement
Eyes and Inspection Parallel and Parallel and Normal
Eyebrows evenly placed evenly placed
symmetrical. Non- symmetrically.
protruding with Both eyes are
scant amount of black and clear.
secretion. Both
eyes black and
clear
Eye lashes Inspection Black evenly Long and black She has a longa
distributed and evenly nd beautiful
turned outward distributed eyelashes.
Eye lids Inspection Upper lids cover a Covers a small Normal
small portion of portion of the iris
the iris and the and the cornea
cornea and the and the sclera
sclera when the when the eyes
eyes are closed are closed the
the lids meet lids meet
completely. completely
Symmetrical color
is the same the
surrounding skin.
Sclera Inspection White and clear White and clear. Normal
No presence of
dark spot.
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Iris and Pupil Inspection Proportional to the Dark brown color Normal
size of the eye and both
round. symmetrical.
Black/brown and Constricting
symmetrical. effect when
Constrict with there is
increasing light increasing light
and and
accommodation accommodation
when the light when the light
closely constrict closely constricts
the size of the the size of the
pupil it get smaller pupil it gets
than the normal smaller than the
size normal size.
Ears Inspection Parallel Bean-shaped, Normal
symmetrically symmetrically
proportion to the proportion to the
size of the head. size of head. In
Bean-shaped, line with the
helix is in line with outer canthus of
the outer canthus the eye and
of the eye, skin is same color.
the same color as
the surrounding
area, clean
Ear canal Inspection Pinkish clean with Presence of Normal
scant amount of cilia, slightly
cerumen and a pinkish and
few cilia. scant amount of
cerumen.
Hearing acuity Senses Able to hear Able to hear Normal
whisper spoken 2 whisper
feet away.
Nose Inspection Midline, Midline, Presence of
symmetrical and symmetrical and small amount of
patent patent. Same mucus
color and tender.
Presence of
small amount fo
mucus.
Mouth Inspection Pinkish Outer lips is pink Lips os slightly
symmetrical Lip color dried
margin well
defined, smooth Symmetry of
and moist contour

Lips is slightly
 P n e u m o n i a | 19

dried
Gums Inspection Pinkish. Smooth. Pink color, Normal
No swelling no smooth and no
retraction, no swelling.
discharge
Teeth Inspection 32 permanent Yellowish teeth She has no
teeth aligned free with no dental false teeth and
from caries or carries. 32 slightly
feeling. Permanent teeth presence of
No halitosis are aligned. halitosis.
Slightly
presence of
halitosis.
Tongue Inspection Large medium red Medium sized She has
Palpation or pink slightly white color on medium white
rough on top top and freely color tongue
smooth along the movable. and freely
lateral margins, movable.
moist, shiny, and
free movable
Frenulum Inspection Midline. Straight. Midline, straight Normal
and moist and moist
Cheeks Inspection Pinkish, smooth Pinkish, smooth Normal
Palpation and moist and moist
Soft palate Inspection Pinkish, smooth, Pinkish, smooth, Normal
Palpation and moist and moist
Voice Senses No hoarseness Partial Partial
and well modulate modulated. modulated and
Difficulty to she can’t
pronounce pronounce word
words clearly
Neck Inspection Proportional to the Proportion and Normal
Palpation size of the body symmetrical to
and head, the head and
symmetrical and body. Freely
position movable without
difficulty.
Thorax & Inspection The chest is The chest is Presence of
Lungs Palpation symmetrical and symmetrical, no occasional
Auscultation the chest is twice lamps and wheezing sound
as wide as deep. masses.
Bronchial sounds Vibrations are
are hallowing high prominent and
pitched whistling occasional
sounds. wheezing sound.
Heart Inspection Pulsation visible Cardiac rate Normal
Palpation and palpable range from 120
Auscultation Cardiac rate range bpm. Pulsation
 P n e u m o n i a | 20

from 82 beats visible and

per/minute palpable.
Positive for two
heart sound
Breast/Chest Inspection Female: variable Warm to touch Normal
Palpation in size depending and smooth.
on body builds in Color of the skin
obese, large and is same with the
pendulous. abdomen. No
Slender- thin and lumps and
small. In young masses.
client – firms,
Elastic in
consistence.
Cone-shaped,
symmetrical skin
surface smooth.
In older women,
breast sag, nipples
lower, stringy and
nodular.
Warm to touch
and smooth
Abdomen Inspection Skin is Skin is Presence of
Palpation unblemished, no unblemished, no mole on right
Auscultation scar, color is scar and lesions. side of the
Percussion uniform or Color is uniform, abdomen,
scaphoid, symmetrical borborygmy,
symmetrical movement due distention.
movement caused to respiration.
by respiration. The Umbilicus is flat,
umbilicus is flat or no bulging,
concave. Color is masses.
the same as the Presence of
surrounding skin. bowel sounds
and distention.
She has a mole
on her right side
Arm Inspection Skin color varies Same color with She has 2 mole
Palpation Symmetrical fine the body. on her left arm.
evenly distributed Symmetrical and
presence/absence moves freely.
of visible veins. Absence of scar.
Warm dry and Warm and
elastic no areas of tender. She has
tenderness. a 2 mole on her
left arm.
Hands and Inspection Palm pinkish warm Small, soft and Normal
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Palm Palpation pinkish palm. No

presence of
callus. Presence
of 5 fingers on
each hand.
Nails Inspection Nails are Nails are Normal
Palpation transparent transparent and
smooth and smooth. No
convex with pink presence of nail
nail beds and polish. Pinkish
white translucent white translucent
As pressure tips. When
applied to the nail pressured is
bed, appears applied the color
white or balance is white and
and pink color when released it
returns returns to normal
immediately as color.
pressure is
released.
Shoulder, Inspection Perform on ease Moves freely Normal
Arms, Elbows, Palpation without difficulty.
Hand and Uniform color.
wrists
Legs Inspection skin is smooth fine Skin color is Normal
Palpation hair evenly uniform.
distributed Symmetrical and
absence of muscles are
varicose vein tender and
muscle warm. No
symmetrical length presence of
Muscle appear edema. Moves
equal warm and freely without
with good muscle difficulty.
tone.
Ankles, toes Inspection Five toes in each Pinkish white Normal
and nails Palpation foot sole and color of nails
dorsal surface is with translucent
smooth with pink tips. No
nailbeds and white presence of nail
translucent tips. polish. Five toes
Range of motion in each foot.
Moves freely
without any
discomforts.
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ANATOMY AND PHYSIOLOGY

Functions of the Respiratory System:

Respiration is necessary because all living cells of the body require oxygen and
produce carbon dioxide. The respiratory system assists in gas exchange and performs
other functions as well:

1. Gas exchange. The respiratory system allows oxygen from the air to enter the
blood and carbon dioxide to leave the blood and enter the air. The cardiovascular
system transports oxygen from the lungs to the cells of the body to the lungs.
Thus, the respiratory and cardiovascular system work together to supply oxygen
to all cells and remove carbon dioxide.
2. Regulation of blood pH. The respiratory system can alter blood pH by changing
blood carbon dioxide levels.
3. Voice production. Air movement past the vocal folds make sound and speech
possible.
4. Olfaction. The sensation of smell occurs when airborne molecules are drawn into
the nasal cavity.
5. Protection. The respiratory system provides protection against some
microorganism by preventing their entry into the body and by removing them
from respiratory surfaces.

Gross Anatomy:

1. Nose
The nose is a prominent feature of the face composed mostly of cartilage, except for the
bridge which is a bone. Externally, it is covered with the skin containing large
sebaceous glands and small hairs.
 P n e u m o n i a | 23

2. Nasal cavity
A cavity that extends from the nares to the choanae, it is lined mostly by
pseudostratified columnar epithelium with cillia and goblet cells. It serves to humidify
and filter the air coming int the body, and to produce thick mucus that traps dust,
microorganisms, and foreign bodies carried by the air flowing in.

• Nares- the external openings into the nasal cavity, which are lined by stratified
squamous epithelium with coarse hairs that trap large particles of dust. The flow of air
from the atmosphere begins its journey into the body through the nares.

• Choanae- the opening at the posterior end of the nasal cavity leading to the pharynx.

• Nasal septum- a partition dividing the nasal cavity into the right and left cavities.

3. Pharynx
The pharynx is a funnel-shaped passageway that connects the respiratory and digestive
system. It houses the tonsils, which are lymphatic tissues that attack any disease-
causing organisms that escapes the hairs, cilia, and mucus of the nasal cavity. The
pharynx consist of three regions:

• Nasopharynx- which extends from the choanae to the level of the uvula. This is where
the auditory tubes open into the pharynx, and where the pharyngeal tonsils are located.

• Oropharynx- which extends from the uvula to the epiglottis and is lined by stratified
squamous epithelium since food, drink, and air all pass through this region. This is also
where the palatine and lingual tonsils are located.

• Laryngopharynx- which passes posterior to the larynx and extends from the tip of the
epiglottis to the esophagus and is lined by stratified squamous epithelium.

4. Trachea
 P n e u m o n i a | 24

Commonly called the “windpipe”, the trachea is a tube that stretches from the inferior
end of the larynx, then projects through the mediastenum and divides into the right and

left primary bronchi at the level just above the heart .

5. Bronchi
A passage of airway in the respiratory tract that conducts air into the lungs. The
bronchus branches into smaller tubes, which in turn become bronchioles.

6.Lungs

In humans, the trachea divides into the two main bronchi that enter the roots of the
lungs. The bronchi continue to divide within the lung, and after multiple divisions, give
rise to bronchioles. The bronchial tree continues branching until it reaches the level of
terminal bronchioles, which lead to alveolar sacs. Alveolar sacs are made up of clusters
of alveoli, like individual grapes within a bunch. The individual alveoli are tightly
wrapped in blood vessels and it is here that gas exchange actually occurs.
Deoxygenated blood from the heart is pumped through the pulmonary artery to the
lungs, where oxygen diffuses into blood and is exchanged for carbon dioxide in
the hemoglobin of the erythrocytes. The oxygen-rich blood returns to the heart via the
pulmonary veins to be pumped back into systemic circulation.
Human lungs are located in two cavities on either side of the heart. Though similar in
appearance, the two are not identical. Both are separated into lobes by fissures, with
three lobes on the right and two on the left. The lobes are further divided into segments
and then into lobules, hexagonal divisions of the lungs that are the smallest subdivision
 P n e u m o n i a | 25

visible to the naked eye. The connective tissue that divides lobules is often blackened in
smokers. The medial border of the right lung is nearly vertical, while the left lung
contains a cardiac notch. The cardiac notch is a concave impression molded to
accommodate the shape of the heart.

Air flow into the Alveoli:

The volume and pressure changes responsible for one cycle of the inspiration and
expiration can be described as follows:
1. At the end of expiration, the alveolar pressure, which is the air pressure within
the alveoli, is equal to atmospheric pressure, which is the air pressure outside
the body. There is no movement of air into or out of the lungs because alveolar
pressure and atmospheric pressure are equal.
2. During inspiration, contraction of the muscles of inspiration increases the volume
of the thoracic cavity. The increased thoracic volume causes the lungs to expand,
resulting in an increase in alveolar volume. As the alveolar volume increases,
alveolar pressure becomes less than the atmospheric pressure, and air flows
from outside the body through the repiratory passage to the alveoli.
3. At the end of inspiration, the thorax and alveoli stop expanding. When the
alveolar pressure and atmospheric pressure become equal, airflow stops.
 P n e u m o n i a | 26

4. During expiration, the thoracic volume decreases, producing a decrease in

alveolar volume. Consequently, alveolar pressure increases above the air
pressure outside the body, and air flows from the alveoli through the respiratory
passages to the outside.
As expiration ends, the decrease in the thoracic volume stops and the process repeats.
 P n e u m o n i a | 27

PATHOPHYSIOLOGY

Contributing Factor Inhalation of infectious and

Bacteria Predisposing Factor
irritating agents 1 y/o
Viruses
Mycoplasma
Other Pathogens 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 vital Capillary leaks spread the infection to other Capillary leak, edema,
capacity decrease areas of the lung exudates

Alveolar collapse Fluids collect in and

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

Ability of the lungs to oxygenate

blood decrease Sepsis Emphysema

Arterial tension falls

Alveolar walls thicken
Excess fluid in the lungs
 P n e u m o n i a | 28

Gas exchange is reduced

Hypoxemia

If treated: If untreated:

 Analgesics to relieve pleuratic chest pain.

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

Recovery
 P n e u m o n i a | 29

LABORATORY AND DIAGNOSTIC EXAMINATIONS

Test Normal values Results Interpretation

Total WBC 5 – 10 x 109/L 9.9 x 109/L Normal
Segmenters 0.55-0.65 0.31 Normal
Lymphocytes 0.25 – 0.40 0.64 Increased - TB, hepatitis,
infectious mononucleosis,
mumps, rubella,
thyrotoxicosis, lymphocytic
leukemia
Monocytes 0.02 – 0.06 0.04 Increased - TB, malaria,
hepatitis, SLE, RA,
carcinoma, monocytic
leukemia,
lymphomas
RBC Count M: 3.5-5.5 x 1012/L 5.0 1012/L Normal
F: 4.3 -5.9 1012/L
Hemoglobin M: 135 – 160 g/L 123 Normal
F: 120 – 150 g/L
Hematocrit M: 0.40 -0.48 0.38 Normal
F: 0.37 – 0.45
Platelet CT 150 – 130 x 109/L 464 x 109/L Normal

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
 P n e u m o n i a | 30

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
 P n e u m o n i a | 31

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

trombocythemia, myeloid metaplasia, polycythemia vera, chronic myelogenous

leukemia

Decreased – aplastichypoplastic bone marrow, leukemia, vit. B12 deficiency, immune

disorders

ROENTGENOLOGICAL EXAMINATION

Examination:

Chest AP/LAT

Roentgenological Findings:

Streaky densities are noted in both perihilar regions with confluent infiltrates in the left.

Some tracheobronchial lymph nodes are enlarged

Heart is not enlarged

Pulmonary vascularity is within normal limits

Diaphragm and costophrenic sulci are intact

Impression:

Bilateral pneumonia w/ lymphadenopathy

 P n e u m o n i a | 32

DEVELOPMENTAL MILESTONE CHART

Child's Age Normal Findings Actual Findings

1 month • Lifts head when lying on Positive reflex
tummy movements
• Responds to sound Brings hands to face
• Stares at faces Lifts head briefly
• Follows objects briefly with Stares at faces
eyes
• Vocalizes: oohs and aahs
• Can see black-and-white
patterns
2 months • Vocalizes: gurgles and coos Lifts head
• Follows objects across field Hands in fist
of vision Smiles
• Notices his hands “Ah” & “Ooh” sounds
• Holds head up for short
periods
• Smiles, laughs
• Holds head at 45-degree
angle
• Makes smoother
movements
3 months • Recognizes your face and Cries to communicate
scent hunger, fear,
• Holds head steady discomfort
• Visually tracks moving Anticipates being lifted
objects Turns toward colors
• Squeals, gurgles, coos
• Blows bubbles
• Recognizes your voice
• Does mini-pushup
4 months • Smiles, laughs Turns prone to supine
• Can bear weight on legs Supports upper body
• Coos when you talk to him with arms in prone
• Can grasp a toy Holds head erect
• Rolls over, from tummy to Makes consonant
back sounds
Laughs
5 months • Distinguishes between bold Turns supine to prone
colors Plays with toes
• Plays with his hands and Bears partial weight on
feet feet when held upright
• Recognizes own name
• Turns toward new sounds
• Rolls over in both directions

6 months • Turns toward sounds and Reaches/grasps objects
voices
• Imitates sounds
• Rolls over in both directions
• Is ready for solid foods
• Sits without support
• Mouths objects
• Passes objects from hand to
hand
7 months • Sits without support
• Drags objects toward herself
• Lunges forward or starts
crawling
• Jabbers or combines
syllables
• Starts to experience
stranger anxiety
8 months • Says "mama" and "dada" to
both parents
• Passes objects from hand to
hand Tracks moving object
• Stands while holding onto
something
• Crawls
• Points at objects Explores with hands &
• Searches for hidden objects
9 months • Stands while holding onto
something
• Jabbers or combines
syllables
• Understands object Cruises along furniture
permanence
• Cruises while holding onto
furniture
• Drinks from a sip cup
• Eats with fingers
• Bangs objects together
10 months • Waves goodbye
• Picks things up with pincer
grasp
• Crawls well, with belly off the
ground
• Says "mama" and "dada" to
the correct parent
• Indicates wants with
gestures
P n e u m o n i a | 33
Helps hold bottle
Moves toys between
hands
Pulls up to sit
Sits with UE support
Rolls over
Bounces in standing
Opens mouth for
spoon
Babbles
Laughs
Smiles in mirror
First tooth
Fear of strangers
Responds to
expressions
Says tata & mama
Pulls to stand
Sits without support
mouth
Raking grasp
Drinks from cup
Attempts to feed self
Looks for hidden
object
Well-developed craw
Pulls self to standing
Use pincer to grasp
objects
 P n e u m o n i a | 34

11 months • Says "mama" and "dada" to Knows familiar faces

the correct parent Plays “peak-a-boo”
• Plays patty-cake and peek- Cries when parent
a-boo Leaves
• Stands alone for a couple of
seconds
• Cruises
• Understands "no" and
simple instructions
• Puts objects into a container
12 months • Imitates others' activities Drinks well from cup
• Indicates wants with Apprehensive with
gestures strangers
• Takes a few steps Cries when parent
• Says one word besides leaves
"mama" and "dada" Says “dada” &
“mama”
Responds to music
with motion
13 months • Uses two words skillfully Walks alone or 1 hand
• Bends over and picks up an held
object Falls frequently when
• Enjoys gazing at his walking
reflection Points with 1 finger
• Holds out arm or leg to help Pulls off socks
you dress him Crawl forward on belly
Creeps on hand/knees
Assumes quadruped
14 months • Eats with fingers Responds to simple
• Empties containers of instructions. Uses trial-
contents and-error to learn about
• Imitates others objects
• Toddles well Demonstrate affection.
• Initiates games Participate in nursery
• Points to one body part rhymes
when asked
• Responds to instructions
15 months • Plays with ball Turns pages in a book
• Uses three words regularly Carries a doll
• Walks backward Stacks 2 blocks
• Scribbles with a crayon Scribbles with crayons
• Runs Runs clumsily
• Adopts "no" as his favorite Jumps in plac
word
 P n e u m o n i a | 35

16 months • Turns the pages of a book Looks for hidden

• Has temper tantrums when objects
frustrated Follows 1-step
• Becomes attached to a soft directions
toy or other object 8–10 word vocabulary
• Discovers the joy of climbing Scribbles with crayons
• Stacks three blocks Runs clumsily
• Uses spoon or fork Jumps in place
• Learns the correct way to Points/asks for things
use common objects
17 months • Uses six words regularly Helps with dressing
• Enjoys pretend games Indicates soiled or
• Likes riding toys wet paints
• Feeds doll Emotionally dependent
• Speaks more clearly on familiar adult
• Throws a ball underhand Likes to play a lot
Very curious.
18 months • Will "read" board books on Drinks without spilling
his own Picks up toy without
• Scribbles well falling over
• Strings two words together Shows preference for
in phrases one hand
• Brushes teeth with help Gets up/down stairs
• Stacks four blocks holding onto rail
19 months • Uses a spoon and fork Enjoys simple picture
• Runs books
• Throws a ball underhand Explores environment
• Enjoys helping around the Knows the names of
house parts of his body
• Understands as many as
200 words
• Recognizes when something
is wrong
 P n e u m o n i a | 36

DRUG STUDY

Generic Name Brand Dosage Mechanism Indication Contraindications Adverse Nursing

Name Reaction Responsibility
Cefuroxime Ceftin 125 mg/5ml Inhibits bacterial Treat Hypersensitivity to Diarrhea Assess for allergy
cell wall synthesis susceptible Cefuroxime or Nausea/Vomitti
Classification: by binding 1 or infections of related to ng Monitor I/O
Antibiotic more of the the URTI/LRTI component of Abdominal pain
penicillin binding Gonorrhea formula or other Pseudomembra Report onset of
proteins which in Otitis Media cephalosporins nous colitis loose stools
turn inhibit the Sinusitis Rashes
final Other skin Thrombocythop
transpeptidation infections enia
step of
peptidoglycan
synthesis
Paracetamol Tempra 2.5 ml Inhibits Normalize the Ulceration or Shock Assess for allergy
prostaglandin body chronic Anaphylactic
Classification: synthesis that temperature inflammation of reaction Reasses the pt’s
Antipyretic possesses anti- GIT, and Decreases in vital signs
inflammatory, anti hypersensitivity to serum
pyretic and the drugs potassium
analgesic effect. levels
Salbutamol Ventolin Inhalation: Activate of beta 2- Treat severe Hypersentivity to Tachycardia Assess allergy
0.25mg/kg adrenergic breathing soy lecithin or foods Stomach upset Assess breath
Classification: receptors on problems related products Dry mouth sounds
Bronchodilator airway smooth Flusing
muscle leads to Dizziness Monitor the
relaxation of Cough characteristics
bronchioles and Nasal stiffiness and frequency of
bronchodilation sputum
production
 P n e u m o n i a | 37

NURSING CARE PLAN

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Ineffective airway Short term: Independent: Patient

“Nahihirapan syang clearance related After 8 hours of Monitor breath Indicative of maintained
huminga” as verbalized to accumulation nursing sounds by respiratory airway patency
by the mother of secretion as intervention auscultations distress and had
evidenced by patient will be successfully
Objective: coughing. able to maintain Evaluate clients demonstrated
• Adventitious airway patency gag/cough reflex To determine reductions of
breath sounds and swallowing ability to protect secretions with
(crackles & ability own airway breath sounds
wheeze) clear
• RR: 28 – 34 Elevate head of To take
cpm bed/change position advantage of
• Restlessness Long term: every 2 hours and gravity
• wide-eyed After 2 days of PRN decreasing
• ineffective nursing pressure on the
cough intervention the Encourage deep diaphragm
patient will breathing exercises
demonstrate Maximize effort
reduction of Increase fluid intake
secretions with at least
breath sounds Hydration may
clear Dependent: help secretions
Administer
medication as
prescribed by the
Physician Helps clear
Administer secretions and
Nebulization as mobilize
ordered
 P n e u m o n i a | 38

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Hyperthermia Short term: Independent: Enhances heat Patient had

“Nilalagnat po ang related to viral After 30 minutes Provide Tepid loss by conduction successfully
anak ko” as infection as of Nursing Sponge bath and evaporation. decreased his
verbalized by the manifested by Intervention, temperature from
mother increase body patients’ Assess fluid loss Increase 38.3 to 37.5 C
temperature temperature will and facilitate oral metabolic rate and
Objective: above normal decrease from intake diaphoresis
• T: 38.3 C range of 36.5 to 38.3 C to 37.5 C
• RR: 28 37.5 Promote bed rest
bpm Reduces body
• Skin Warm heat production
to touch Monitor vital signs
• Dry To note changes
mucous that can affect the
membrane patients’ condition
Dependent:
Administer
Long term: Antipyretic Reduces fever Patient had
After 2 hours of medications as successfully
nursing ordered by maintained normal
intervention, physician body temperature
patient will of 37.5 C
maintain normal Maintain IV fluids
body temperature ordered by Prevents
ranges from 36.5 physician dehydration
to 37.5 C
 P n e u m o n i a | 39

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Constipation Short term: Independent: Patient

“Ilang araw na syang related to decrease After 8 hours of Review daily To evaluate verbalized that
hindi nadudumi” as motility of nursing dietary regimen, whether the she has no
verbalized by the
mother Gastrointestinal intervention, noting if the diet is patient has problem in
Tract as patient will be deficient in fiber. deficient fiber defecating
Objectives: manifested by able to establish intake anymore and
• Borborygmy altered bowel normal pattern of Note activity level she also
• Distended sound bowel functioning and exercise It may affect demonstrated
abdomen pattern. elimination lifestyle change.
• Severe flatus
Long term: patterns
After 1 day of
Nursing Encourage To promote
interventions, increase fluid intake passage of soft
patient will be including high fiber, stool
able to fruit juices; suggest
demonstrate drinking warm,
behaviors or stimulating fluids
change of such as pineapple
lifestyle changes juice, warm water.
to prevent
recurrence of Encourage the To promote
problem patient exercises peristalsis
that may improve
abdominal muscle
tone.
 P n e u m o n i a | 40

Increase intake of To improve

fibers in diet like consistency of
fruits, vegetables stool
and wheat

Discuss rationale To maintain

for and encourage normal bowel
continuation of movements
successful
interventions.

Dependent:
Administer stool To passage of
softerner or mild stool
stimulants as
prescribed by the
Physiccian
 P n e u m o n i a | 41

Assessment Diagnosis Planning Intervention Rationale Evaluation

Objective: Risk for injury Mother will be Mother was Prevent from Patient had
• Physical (fall) encourage to encourage to injury successfully
unsecure side keep an eye on keep an eye on displayed
rails the baby’s the baby by appropriate
• Due to the movement making sure baby range of feelings
change of side is not left alone in and lessened
of bed Baby will be free bed fear and
• Insomnia from injury demonstrated
leading to Baby was understanding
moving from will make sure monitored through use of
one side of the side rails are in regularly to make effective coping
bed to the other proper position sure she was free behaviors and
from injury resources

Side rails was

checked and
make sure it was
raised up to
prevent fall

Stress
importance of
monitoring
condition/risk that
may contribute to
occurrence of
falls
 P n e u m o n i a | 42

DISCHARGE PLANNING

Medication

Cefuroxime 250mg 15ml, 3ml 2x a day until March 8, 2011

Salbutamol Nebulization 2ml 3x day

Exercise

Parents were advised to conserve the child’s strength. Encourage to turn and reposition

the child’s frequently to avoid pooling of secretions. Chest physiotherapy was taught to

parent (by clapping the back of the baby) to encourage the movement of mucus and

prevent obstructions.

Treatment

Parent was taught on how to administer the medications to the child as noted above

and also to give the right dose at the right time. Encourage to note the day of the

medication and when it supposed to be stopped.

Health Teaching

Parents were advised to care for the child and also make sure the child is well covered

and not exposed to the electric fun and air condition for a long period of time.

Encourage also to increase the fluid intake of the child because the child feels weak in

sucking or to request for water so given enough water to the child achieves a good oral

intake. Encourage to make sure that the environment is free from pollution and other

allergens. Daily cleaning in the room and the surroundings was advised, proper hand

washing by parent was encouraged to prevent infections.

 P n e u m o n i a | 43

Outpatient

Note the time and date of follow up on Friday March 11, 2011

Diet

Parents were advised encourage on frequent small feeding and food served should

contain all the six essential food nutrient carbohydrates, proteins, fat, vitamins and

minerals. Encourage to increase the fluid intake too as well. Avoid junk foods and

chocolates that may stimulate cough.

Spiritual

Maintain patients’ good relationship to God and encourage to ask help and guidance in

every circumstances occurred.