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Maricar R. Trinidad
Celine S. Udani
BSN 135 Group 139

           


   
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Pneumonia (pneumonitis) is an inflammatory process in the lung parenchyma usually with


marked increase in interstitial and alveolar fluid. Among all nosocomial infections, pneumonia is the
second most common, but has the highest mortality (Black & Hawks, 2009). Community-acquired
pneumonia (CAP) is a disease in which individuals who have not recently been hospitalized develop an
infection of the lungs (pneumonia). CAP is a common illness and can affect people of all ages (Wikipedia,
2010). In a study undertaken at the UP-PGH to determine common etiologic agents causing community-
acquired pneumonia in adults forty-eight patients (48) were recruited based on set clinical criteria.
Streptococcuspneumoniae and H. influenzae were the most common pathogens isolated. There was no
difference in the pathogensisolated from elderly and younger patients.The most common predisposing
factors for gram negative bacillary pneumonia were COPD, smoking, andthe use of steroids. There was
little difference in the clinical manifestations between the elderly and youngerindividuals except for the
decreased frequency of fever in the elderly. Anti-biotic usage greatly decreased the yield of specimens.
Both Streptococcus pneumoniae and H. influenzae, the two most predominant organisms, were
sensitive tocotrimoxazole - an inexpensive first line antibiotic. [Phil J Microbiol Infect Dis 1995; 24(2):29-
32.
This nursing process case presentation presents pneumonia of a 9-month old baby girl. We have
chosen this case to know more on how pneumonia affects a pediatric client, if there are differences in
adult and in pedia. And furthermore this is our first time to present a case of pneumonia beacause in
other clinical duties we choose more complicated case, and this time why not choose pneumonia a
disease that we are taking for granted for it was always common to patients we handle in different
areas. By this presentation gaining knowledge about this disease we can be more confident to handle
more pneumonia patients in our future nursing practice
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Name:
Address:
Age: Gender:
Religion:
Room and bed:
Chief complaint:
Attending Physician:
Physician͛s Diagnosis:

——O | OO


O 
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1.O Childhood Illness

2.O Immunizations

3.O Allergies

4.O Accidents
.

5.O Hospitalization

6.O Medications used or currently taken


Medications currently taken are ranitidine, hydrocortisone, cefuroxime
and salbutamol

7.O Foreign travel (when, length of stay)


No foreign travel yet.

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1.O Coping Patterns
2.O Interaction Patterns
3.O Cognitive Patterns
4.O Self-Concept
5.O Emotional Patterns
6.O Family Coping Patterns
O
O
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:
The World Health Organization defines psychological health as "a being of well-being in which
the individual realizes his or her own abilities, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to his or her community͟. An example of
a wellness model includes one developed by Myers, Sweeney and Witmer. It includes five life tasksͶ
essence or spirituality, work and leisure, friendship, love and self-directionͶand twelve sub tasksͶ
sense of worth, sense of control, realistic beliefs, emotional awareness and coping, problem solving and
creativity, sense of humor, nutrition, exercise, self care, stress management, gender identity, and
cultural identityͶwhich are identified as characteristics of healthy functioning and a major component
of wellness. (wikipedia.com)
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Family is the source of strength of the patient in times of crisis. They support him emotionally
and financially. All kinds of consideration are given to him by his children, especially his wife, as they
took care of him.

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1.O Cultural Patterns
2.O Significant Relationships
3.O Recreation Patterns
4.O Environment
5.O Economic


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Being a part of a regional group of culture is called a subculture. Though they are smaller group, they
possess many of the values, beliefs and customs of the larger culture but have unique characteristics.
According to studies, Filipinos hereditary diseases include diabetes mellitus, Thalassemia, and G6PD
deficiency.
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OOis in a transition of accepting the shifting of generational roles. The family
needs to maintain own and couple functioning and interests in face of physiological decline; exploration
of new and familial and social role options. They also need to support for a more central role of middle
generation. They should also make a room for the wisdom and experience for elderly people, supporting
the older generation without over functioning for them. u  
     
        
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Client has regional customs and beliefs. Hiscurrent health status has affected his daily activities.


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1.O Religious Beliefs and Practices

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Spiritual health is the connectedness with self, others, higher power, all life, nature and the
universe that transcends and empowers the self. Spiritual and religious beliefs can significantly affect
health behavior.
—  
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The patient has religious beliefs and cultural values. These beliefs are influenced by the social
environment and also health behavior.

—O OO
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General Appearance
1.O Skin color Pale Brown, light brown normal

2.O Personal Hygiene/ Clean, neat Clean, neat


Grooming No apparent breath No apparent breath normal
odor odor

3.O Nutritional Status Poor nutritional Healthy appearance Abnormal


status with body
weakness.

4.O Non-verbal Behavior cries when in pain. Appropriate to Normal


Appropriate to situation/ appropriate
situation. response 
O
A patient who appears
ill usually is ill, and
needs to be carefully
assessed via the history
and physical
examinations.
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Measurement
1.O Temperature 35.4 ʹ 37.4 C
2.O Pulse Rate 60 ʹ 100 cpm 
O
3.O Respiratory Rate 12 -20 breaths/ min Hypoxia and metabolic
4.O Blood Pressure S: 100-160 mmHg / acidosis are common
D: 60- 90 mmHg causes of tachypnea
Average: 130/80 (RR>20 breaths). The
5.O Weight increased respiratory
6.O Height rate is a compensatory
mechanism to provide
the body with more
oxygen and eliminate
excess hydrogen when
the body͛s metabolism
is increased.
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SKIN
—   O
Skin color Light brown, darker on Skin is uniform whitish Normal
Uniformity of skin color areas exposed to light. pink or brown color,
Texture With warts scattered on depending on the
the face, chest and patient͛s race. Exposure
some on the abdomen. to sunlight can results in
increased pigmentation
of sun-exposed areas.



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Skin moisture Dry. Skin is dry with Normal.
Skin temperature Bilaterally equal warm minimum perspiration.
Skin turgor temperature and Moisture varies from
nontender. one body area to
another.

Skin temperature is Normal


warm and equal
bilaterally. Nontender.

NAILS
—   O
Fingernail plate shape smooth Convex curvature; angle Normal
Fingernail and toenail Pink. of nail plate about 160
texture Blanch test return to degrees
Fingernail and toe nail normal in 1 second. Smooth texture
bed color Convex curvature; angle Highly vascular and pink
Tissue surrounding nails of nail plate about 160 on light-skinned clients;


 O degrees dark-skinned clients
Blanch test of the Smooth texture may have brown or
capillaryO Intact epidermis black pigmentation in
longitudinal streaks
Intact epidermis
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Prompt return of pink
or usual color (generally
less than 4 seconds)
SKULL AND FACE
—   O
Skull size, shape, and Patient is Rounded Normal skull and face
symmetry normocephalic, (normocephalic and features.
Facial features proportion to the body. symmetrical, with
Facial movement frontal, parietal, amd
Symmetrical and occipital prominences);
bilaterally equal in parts smooth skull contour


 Smooth, uniform
Skull nodules or masses No nodules, masses and consistency; absence of
and depressions depressions. nodules or masses
Slightly asymmetric
facial features;
palpebral fissures equal
in size; symmetric
nasolabial folds
Symmetric facial
movements.
EYES AND STRUCTURES
—   O
Cornea Has whitish halo on the Pink, transparent Normal
Iris sides of the cornea. conjunctiva. Pupils
PERRLA Pupils constrict reactive to light and
Bulbar conjunctiva bilaterally direct and accommodation.
Palpebral conjunctiva indirect response, 3cm


 O size in normal light,
Bulbar conjunctiva reactive to light and
Palpebral conjunctiva accommodation.
Iris is brown color.

He has pinkish, palpable


conjunctiva.
EARS AND HEARING
—   O
Normal voice tones Patient can hear normal Can repeat whispered Normal
tone of voice. words within 2 feet
distance.
NOSE AND SINUSES
—   O
External nose shape, Symmetrical in shape, Symmetrical in shape, Normal
size, or color and flaring same color as the face, same color as the face,
or discharge from the no discharge or nasal no discharge or nasal
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nares. flaring. flaring.

Patency of both nasal Both nares are patent Both nares are patent Normal
cavities.
Presence of redness, No swelling and redness No swelling and redness Normal
swelling, growths, and present. present.
discharge.
Masses Nasal septum at the Nasal septum at the Normal
Nasal septum middle. middle.

THORAX

Inspection Even color; regular, Even color; regular, Abnormal


even contour; even contour; 
O
respirations audible as respirations quiet, Labored breathing and
wheeze, labored, of unlabored, of even use of accessory
different depth: deeper depth, and without muscles are indicative
expiration than retractions, bulges, of increased demand
inspiration, verbalized masses, or use of for air due to narrowed
difficulty breathing, accessory muscles; airway as in asthma.
chest tightness and anteroposterior- u  
  
non-productive cough transverse diameter    
and without retractions, ratio 1:2      
bulges and masses, uses  
accessory muscles;   
anteroposterior- 
transverse diameter 
ratio 1:2 
Breathing is good when 
head of the bed is 
elevated 30-45 degrees 
or when sitting. 
Palpation Chest wall symmetrical, Chest wall symmetrical, Normal
smooth, without lumps, smooth, without lumps,
masses, tenderness, or masses, tenderness, or
crepitus; thoracic crepitus; thoracic
excursion symmetrical; excursion
tactile fremitus present. symmetrical;tactile
Resonant throughout fremitus present.
peripheral lung fields;
Percussion cardiac dullness; Resonant throughout Normal
diaphragmatic excurion peripheral lung fields;
ranges from 3 ʹ 6 cm cardiac dullness;
for each diaphragmatic excurion
hemidiaphragm, with ranges from 3 ʹ 6 cm
right side slightly higher for each
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than the left. hemidiaphragm, with
right side slightly higher
than the left.
Auscultation Vesicular sounds Abnormal
throughout peripheral Vesicular sounds 
O
lung fields; adventitious throughout peripheral Wheeze ʹhigh pitched
sounds present: wheeze lung fields; (sibilant ronchi) is
ʹhigh pitched (sibilant bronchovesicular indicative of air
ronchi); vocal sounds over the area of squeezed or
resonance absent. bifurcation, both compressed through
anteriorly and passageways narrowed
posteriorly; bronchial almost to closure by
sounds over the trachea collapsing, swelling,
anteriorly; adventitious secretions, or tumors;
sounds absent; vocal passageway walls
resonance absent. oscilate in apposition
between closed and
barely open positions;
resulting sound is
similar to a vibrating
reed.
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ABDOMEN
Skin integrity Symmetrical but No abdominal scars Normal
Contour and symmetry prominent. With present. O
Light palpation for areas tenderness, no masses, 
O
of tenderness or nodules found. 
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No pain is felt upon    
light palpation on the 4      
quadrants of the  
abdomen.   

PERINEAL
Inspection Fluid retention on both No fluid present Abnormal
testicles and the penis. 
O
Hydrocele: A hydrocele
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is a collection of fluid in
the membrane that
covers the testis or
testes. A hydrocele may
be present at birth or
develop later in life. It is
most common after age
40. Usually the cause is
unknown. However, the
condition occasionally
results from a testicular
disorder (for example,
injury, epididymitis, or
cancer).
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27 September 2010 HEMATOLOGY
Hemoglobin 143 g/L 120 ʹ 140 g/L Increased Increased
hemoglobinmay be
caused by exposure
to high altitudes,
smoking,
dehydration, or
tumor.
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Hematocrit 0.42 0.37 ʹ 0.47 Normal
WBC count 14.9 x 109 /L 5.5 ʹ 11.0 x 109 /L Increased Indicates infection
Platelet Count 266 x 109 /L 150 ʹ 250 x 109 /L Increased Functions with WBC
to fight inflammation
and promote healing
process. 

Segmenters 0.87 0.50 ʹ 0.70 Increased Neutrophils also
known as segmenters
are recruited to the
site of injury within
minutes following
trauma and are the
hallmark of acute
inflammation.

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Lymphocytes 0.08 0.20 ʹ 0.40 Decreased Decreased immune
Monocytes 0.05 0.01 ʹ 0.06 Normal response.
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27 September 2010 URINALYSIS


 
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Color YELLOW AMBER Normal
Transparency SLIGHTLY TURBID CLEAR Abnormal Turbidity may
Reaction ACIDIC ACIDIC/BASIC Normal indicate bacterial
pH 5.00 4.6 ʹ 8.0 Normal infection.
Specific gravity 1.005 1.003 to 1.030 Normal



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Albumin +++ 0 Abnormal Proteinuria- may
Sugar NEGATIVE NEGATIVE Normal indicate
Ketones NEGATIVE NEGATIVE Normal glomerulonephritis or
Blood in urine NEGATIVE NEGATIVE Normal other decline in
Urobilinogen NEGATIVE NEGATIVE Normal kidney function.
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RBC 8-10 / hpf 0 Abnormal May be renal disease
Pus MANY /hpf 0 Abnormal Indicates bacterial
Epithelial MODERATE NEGATIVE Abnormal infection.
Mucus Threads MODERATE NEGATIVE Abnormal
Bacteria MODERATE NEGATIVE Abnormal u !!"
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28 September 2010 BLOOD CHEMISTRY
Potassium 4.92 mmol/L 3.5 ʹ 5.30 mmol/L Normal
Sodium 123.8 mmol/L 135 ʹ 148 mmol/L Hyponatremia Edematous disorders
Chloride 100.1 mmol/L 100 ʹ 112 mmol/L Normal resulting in sodium
deficits: CHF, liver
cirrhosis, nephrotic
syndrome, acute and
chronic renal failure,
psychogenic
polydipsia. u
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30 September 2010 Total Calcium 1.96 mmol/L 2.2 ʹ 2.55 mmol/L Decreased Fluid and electrolyte
imbalances especially
sodium also affects
calcium
concentration.
30 September 2010 IMMUNOLOGY 100 NG/ML 0.00 ʹ 4.00 NG/ML Increased Prostate-specific
PSA antigen (PSA) is a
protein produced by
the cells of the
prostate gland. PSA is
present in small
quantities in the
serum of men with
healthy prostates, but
is often elevated in
the presence of
prostate cancer
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2 October 2010 ABG
pH 7.215 7.35 ʹ 7.45 Acidosis Respiratory acidosis
PaCO2 103.9 mmHg 35 ʹ 45 mmHg Increased uncompensated is an
PaO2 79.9 mmHg 80 ʹ 100 mmHg Decreased indication that there
HCO3 42.0 meq/L 22 ʹ 26 meq/L Increased is a problem in the
TCO2 45.2 ml/dL 15 ʹ 20 ml/dL Increased released of CO2
BE 8.0 meq/L + 2 to ʹ 2 meq/L causing it to be
O2 Sat 92.8 % 95 ʹ 100 % Abnormal contained in the
FiO2 36.0 % blood. Metabolic
acidosis also follows
due to increase in
HCO3. This causes the
O2 Saturation to
decrease.
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Salbutamol Anti-asthmatic Treatment of acute Hypersensitivity to its Small increase in heart Special precaution on patient
and COPD prep. severe asthma and in content. rate, peripheral with hyperthyroidism, CV
Q1 2.5-5 mg
routine management vasodilation, fine tremor diseases
of chronic of skeletal muscle.
bronchospasm
unresponsive to
conventional therapy.

Budesomide Anti-asthmatic Prophylaxis and Primary treatment of Neck pain, cough, resp. WOF withdrawal symptoms
and COPD prep. management of status asthmaticus or infection during transfer from systemic
Q6
asthma other acute asthma corticosteroid therapy to
where in sensitive budesomide
measures are
required

Hydrocortisone Hormones Acute adrenocortical Latent, healed and Fluid electrolyte Special precaution on patient
insufficiency active TB imbalance, dermatologic with CHF, HPN, DM

Chloramphenico Anti-infective Diseases which does History of GI symptoms Take on an empty stomach ½
l not respond to other hypersensitivity or hour before meals
standard anti- toxic reaction
microbial agent

Ampicillin Anti-infective Respiratory infections Hypersensitivity to GI disturbances Special precaution on patient


penicillin with prolonged treatment
350mg IV q6 requires renal, hepatic
function assessment.
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Risk factors: Cigarette smoking, Advanced age (74 yrs old), Hx of asthma,
Chronic disease states such as Prostate Carcinoma stage II

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most common bacterial agent

Resides in the nasopharynx

Attachment to the
Infection
Impaired surfactant respiratory epithelium
production and lung
injury and repair
Fever
Inhaled into the alveolus

јWBC,
Impaired type 1 јSegmenters
alveolar cells Infect type II alveolar cells

Impaired Pneumococci spread through the pores of Kohn


gas
exchange
Asthma
Producing inflammation and consolidation (Bronchocon
aggravates striction)
Dyspnea/
Orthopnea
Alveolar sacks cannot exchange
oxygen and carbon dioxide

Decreased Oxygen saturation in the blood Change on the level


Tachypnea
јPaCO2, mpH, mPaO2,јHCO3 of consciousness

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The patient acquired his pneumonia via the community where he is mostly exposed.
Contributing factors such as the surroundings or the environment the child lives in, her
age.

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-O Streptococcus O
pneumoniaO
O -O $   O
,O O
-O Age ʹ 9 monthsO Economic
-O Sexʹ femaleO -O The family of the
-O Nationalityʹ FilipinoO patient doesn͛t have
-O Exposed to second enough financial
hand smokeO income. Their budget is
-O History of asthma only enough for their
O daily living.
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C.O $ O&

HOST
-O Age -9 monthsO
-O Sex ʹfemaleO
Nationality ʹ FilipinoO
Exposed to second hand smoke
History of asthmaO

ENVIRONMENT
AGENT
-O Streptococcus
pneumoniaO

O 
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The patient became susceptible to pneumonia due to the following direct risk factors:
She͛s a 9-month old baby, history of asthma, and exposed to second hand smoke.
CAP is defined as pneumonia acquired outside of hospitals or long-term care facilities,
and HAP is pneumonia that develops 48 or more hours after patient admission to an
inpatient facility (e.g., hospital, long-term care facility, skilled nursing facility) or 48ʹ72
hours after patient intubation. Older adults are particularly susceptible to pneumonia
due to waning immunity and age-associated anatomical and physiological changes that
make the lungs more vulnerable to infection. Streptococcus pneumoniae is the most
common bacterial cause of pneumonia in older adults; other common causes include
Haemophilusinfluenzae, Staphylococcus aureus, Chlamydia pneumoniae, Legionella
pneumophila, and Klebsiellapneumoniae. Common viral pathogens that cause
pneumonia in older adults include influenza, parainfluenza, respiratory syncytial virus
(RSV), and possibly adenoviruses. Older adults with dysphagia often related to stroke,
dementia, and poor oral hygiene are also at risk for aspiration pneumonia, in which the
patient breathes in food, liquids, gastric contents, or exogenous chemicals, weakening
lung defenses and causing inflammatory changes that allow for bacterial overgrowth.

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  http://www.smokehelp.org/html/second_hand_smoke.html)

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Research have also linked asthma and pneumonia. Mycoplasma pneumoniae (M


pneumoniae), primarily recognised as a causative agent of community-acquired
pneumonia has recently been linked to asthma. An infection with M pneumoniae may
precede the onset of asthma or exacerbate asthma symptoms. Chronic infection with M
pneumoniae has been suspected to play a part in some patients with asthma. The role
of immunoglobulin E-related hypersensitivity and induction of T helper type 2 immune
response leading to inflammatory response in M pneumoniae-infected patients with
asthma have also been proposed. Use of macrolides in reducing asthma symptoms only
in M pneumoniae-infected patients supports the use of macrolides in patients with
asthma having M pneumoniae infection. As macrolides are both antimicrobial and anti-
inflammatory drugs, the therapeutic role of their biphasic nature in reducing asthma
symptoms needs further attention in clinical research (Nisar, N., Guleria, R., Kumar, S.,
Chand Chawla, T., &RanjanBiswas, N.,2007).

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Children are also susceptible to pneumonia especially they are exposed to second-hand
smoke. Asthma not also makes the person susceptible but it also aggravates the
condition. Being a Filipino also contributes to his susceptibility because of cultural
aspects and way of life.
Nursing interventions should not only concentrate on the airway, breathing and
circulation of the patient but also on the possibility of spreading the disease and
preventing it from happening.
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Black, J. M., & Hawks, J. H. (2009).%&'()'  (. Manila, Philippines:
Saunders Elsevier.

Buckley, L., &Schub, T. (2010). '   .


' !Retrieved from CINAHL Plus
with Full Text database.
O
Jacobson, K., Miceli, M., Tarrand, J., &Kontoyiannis, D. (2008).Legionella pneumonia in
cancer patients! , 87(3), 152-159. Retrieved from CINAHL Plus with Full
Text database.

Nisar, N., Guleria, R., Kumar, S., Chand Chawla, T., &RanjanBiswas, N.
(2007).Mycoplasma pneumoniae and its role in asthma. ('
' , 83(976), 100-104. Retrieved from CINAHL Plus with Full Text database.

Yoo, S., Cha, S., Shin, K., Lee, S., Kim, C., Park, J., et al. (2010). Bacterial pneumonia
following cytotoxic chemotherapy for lung cancer: clinical features, treatment
outcome and prognostic factors!&  +  ' 6 ' -   
42(10), 734-740. Retrieved from CINAHL Plus with Full Text database

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