Case Scenario 1

Pediatric-Community Acquired Pneumonia

PCAP-C

INTRODUCTION
Community-acquired pneumonia (CAP) is a common and potentially serious illness that is
associated with morbidity and mortality. Only half of the cases had an etiology microorganism
identified.

Dozens of types of bacteria can cause pneumonia. Bacterial pneumonia is caused by an

infection of the lungs and may present as a primary disease or as secondary disease in a debilitated
individual or following a viral upper respiratory infection, such as influenza or the common cold.

Community-acquired pneumonia tends to be caused by different microorganisms than those

infections acquired in the hospital.

Pneumonia caused by Streptococcus pneumonia remains the most common cause of all

bacterial pneumonias. High-risk groups include older adults and people with a chronic illness or
compromised immune system. This type of pneumonia is a common complication of
chronic cardiopulmonary disease (e.g., heart failure) or an upper respiratory tract infection.

The knowledge of etiology of pneumonia in low and middle income countries is based on two
types of studies: prospective, microbiologybased studies and vaccine trial studies, where indirect
evidence of vaccine efficacy for the prevention of pneumonia can be used to estimate the disease
burden of each pathogen.

Prospective studies have identified Streptococcus pneumonia as the leading cause of bacterial

pneumonia among children in developing countries, responsible for 30-50% of pneumonia cases.

The second most common is Haemophilus influenza type b followed by Staphylococcus

aureus and i Other bacteria are Mycoplasma pneumonia and i , causing atypical pneumonia non-
typable H. influenza (NTHI) and non-typhoid Salmonella spp. Furthermore, studies of lung aspirate
have identified Mycobacterium tuberculosis as an important cause of pneumonia.

OBJECTIVES
At the end of this case presentation the students will be able to require the proper knowledge, skills
and attitude in providing for a patient with pneumonia.

1.) Specific Objectives

a.) Knowledge
• Understand the signs and symptoms of Pneumonia.
• Discuss the underlying classifications about Pneumonia.
 • Discuss proper health education and health promotion.
b.) Skills
• Implement a nursing care plan in managing patient’s signs and symptoms using
nursing process.
• Improve the child’s health and well-being through education and care.
• Document the patient’s condition and information correctly.
c.) Attitude
• Established rapport with the patient and members of the family.
•Recognize patient’s needs using holistic approach.
• Provide the best care for the child.

NURSING HEALTH HISTORY

BIOGRAPHIC DATA:

Patient’s name is Harry, a 3 year old male, child from Arevalo I.C. Harry is only child. His mother is a
housewife and his father is a construction worker.

CHIEF COMPLAINT:

High grade fever and abdominal pain 4 days prior to admission.

HISTORY OF PRESENT ILLNESS:

Came to the ER, arm bourn by mother for high grade fever and abdominal pain. Impression: PCAP- C

PAST HEALTH HISTORY:

N/A

PHYSICAL EXAMINATION:

Vital signs showed a

Temperature of 38.4ºC, pulse rate 138 bpm, respiratory rate of 40 breaths per minute,

Oxygen saturation 94% in room air. Weight – 12.5 kg.

The Pedia Resident on Duty ordered for the following diagnostic tests: Chest X-ray AP,

CBC, Sputum culture and sensitivity, Urinalysis.

ANATOMY AND PHYSIOLOGY:

 The lungs are the major organs of the respiratory system, and are divided into sections, or lobes.
The right lung has three lobes and is slightly larger than the left lung, which has two lobes.

The lungs are separated by the mediastinum. This area contains the heart, trachea, esophagus, and
many lymph nodes. The lungs are covered by a protective membrane known as the pleura and are
separated from the abdominal cavity by the muscular diaphragm.

With each inhalation, air is pulled through the windpipe (trachea) and the branching passageways
of the lungs (the bronchi), filling thousands of tiny air sacs (alveoli) at the ends of the bronchi. These
sacs, which resemble bunches of grapes, are surrounded by small blood vessels (capillaries). Oxygen
passes through the thin membranes of the alveoli and into the bloodstream. The red blood cells pick up
the oxygen and carry it to the body’s organs and tissues. As the blood cells release the oxygen they pick
up carbon dioxide, a waste product of metabolism. The carbon dioxide is then carried back to the lungs
and released into the alveoli. With each exhalation, carbon dioxide is expelled from the bronchi out
through the trachea.

Pneumonia: Infection in one or both lungs. Bacteria, especially Streptococcus pneumoniae, are the most
common cause.

Laboratory and Diagnostic

Chest X-ray

-Impression: Pneumonia upper lobe of the right lung.

Sputum Culture and Sensitivity

-Positive for Streptococcus Pneumoniae.

CBC
Urinalysis

DRUG STUDY

Prescribed Drug, Classification Indication and Side effect or Nursing

dosage, route, and Mechanism Contraindication Adverse reaction responsibility
frequency, of Action
timing

Drug: Classification: Indication: Side effects: Check doctor’s

paracetamol Nonsteroidal an allergic order
anti- This drug is used reaction, which
Trade name: inflammatory to treat mild to can cause a
drug moderate pain rash and Observe the 10
(from headaches, swelling. rights of
Dosage: 120 mg
Mechanism of menstrual medication
Route: oral flushing, low
action: periods,
blood pressure
toothaches,
and a fast Assess the
Frequency& Paracetamol backaches,
heartbeat – this expected
Timing: has a central osteoarthritis, or can sometimes
analgesic effect cold/flu aches and actions, dose
7.5 ml q4h happen when
that is pains) and to range, side
paracetamol is
mediated reduce fever effects of the
given in
through hospital into a medication, and
activation of vein in your any precautions
 descending arm. to be taken
serotonergic Contraindication:
pathways. Adverse effect:
Debate exists acute liver failure. low fever with Provide client
about its liver problems. nausea, education about
primary site of severe renal stomach pain, medication
impairment. a and loss of
action, which
condition where appetite;
may be
inhibition of the body is unable Advise the
dark urine, clay- patient’s family
prostaglandin to maintain
colored stools;
(PG) synthesis adequate blood to take the
or.
or through an flow called shock medication with
active meals for better
jaundice
metabolite (yellowing of absorption & to
influencing the skin or reduce GI
cannabinoid eyes). discomfort.
receptors.
Instruct the
patient’s family
to take
medication as
prescribed even
after feeling
better and not to
double dose.

Prescribed Classification Indication and Side effect or Nursing

Drug, dosage, and Mechanism Contraindication Adverse reaction responsibility
route, of Action
frequency,
timing
Drug: Classification: Indication: Side effects: Check doctor’s
cefuroxime cephalosporin order
antibiotics Cefuroxime is used Nausea,
Trade name: to treat certain vomiting,
infections caused by diarrhea, strange Observe the 10
 Mechanism of bacteria, such as taste in the rights of
action: bronchitis(infection mouth, or medication
Dosage: of the airway tubes stomach pain
125 mg Cefuroxime leading to the lungs); may occur.
is a bactericidal gonorrhea (a Diaper rash may Assess the
Route: agent that acts sexually transmitted occur in young expected actions,
intravenous by inhibition of disease); Lyme dose range, side
children.
bacterial cell disease (an infection effects of the
Dizziness and
wall synthesis. that may develop medication, and
drowsiness may
Frequency& Cefuroxime has after a person is any precautions to
occur less
Timing: activity in the bitten by a tick); and be taken
Q8h ANST for 7 presence of infections of the frequently,
days some beta- skin, ears, sinuses, especially with
lactamases, both throat, higher doses\ Provide client
penicillinases education about
and Adverse effect: medication
cephalosporinas
es, of Gram- Contraindication:
negative and Advise the
Gram-positive Cefuroxime is patient’s family to
bacteria contraindicated in take the
patients with medication with
cephalosporin meals for better
hypersensitivity or absorption & to
cephamycin reduce GI
hypersensitivity. discomfort.
Cefuroxime should
be used cautiously in
patients with Instruct the
hypersensitivity to patient’s family to
penicillin. The take medication as
structural similarity prescribed even
between cefuroxime after feeling better
and penicillin means and not to double
that cross-reactivity dose.
can occur.
Prescribed Drug, Classification Indication and Side effect or Nursing
dosage, route, and Contraindication Adverse reaction responsibility
frequency, Mechanism of
timing Action

Drug: Classification: Indication: Side effects: Check doctor’s

Salbutamol Albuterol order
headache.
Trade name: Salbutamol is
Mechanism of indicated for (i) the feeling nervous, Observe the 10
Albuterol
action: symptomatic relief restless, rights of
and prevention of excitable and/or medication
Albuterol shaky.
Dosage: 0.5 ml bronchospasm due
(Salbutamol) to bronchial asthma,
plus pnss 1ml fast, slow or
It promotes the chronic bronchitis, Assess the
uneven
production of reversible expected actions,
Route: oxygen heartbeat.
intracellular obstructive airway dose range, side
inhalation
cyclic disease, and other bad taste in the effects of the
adenosine chronic mouth. medication, and
Frequency&
monophosphat bronchopulmonary any precautions to
Timing:
e (cAMP), disorders in which dry mouth. be taken
Q6h
which enhances bronchospasm is a
the binding of complicating factor, sore throat and
intracellular and/or (ii) the acute cough. Provide client
calcium to the prophylaxis against education about
cell membrane. inability to sleep.
exercise medication
This action
decreases the Contraindication:
calcium Salbutamol sulphate Advise the
concentration is contraindicated in patient’s family to
within cells and patients with take the
results in the hypersensitivity medication with
relaxation of (allergy) to any of meals for better
smooth muscle the active absorption & to
and substances or the reduce GI
bronchodilation excipients. discomfort.
. Salbutamol and non-
selective beta-
blocking drugs, such Instruct the
as propranolol, patient’s family to
should not usually be take medication as
prescribed together. prescribed even
Caution is also after feeling better
advised in patients and not to double
 using cardiac dose.
glycosides.

Assess lung
sounds, PR and BP
before drug
administration and
during peak of
medication.

Observe fore
paradoxical spasm
and withhold
medication and
notify physician if
condition occurs.

Administer PO
medications with
meals to minimize
gastric irritation.

Prescribed Drug, Classification Indication and Side effect or Nursing

dosage, route, and Contraindication Adverse reaction responsibility
frequency, Mechanism of
Action

Drug: Classification: Indication: Side effects: Check doctor’s

Carbocistein mucolytic order
Carbocisteine is a Severe allergic
Trade name: Mechanism of mucolytic agent for reactions (rash;
action: the adjunctive hives; itching; Observe the 10
therapy of difficulty rights of
Dosage: 5ml Carbocisteine respiratory tract breathing; medication
works by disorders tightness in the
Route: oral making phlegm characterised by chest; swelling of
(mucus) less excessive, viscous the mouth, face, Assess the
thick and sticky, mucus, including lips, or tongue); expected actions,
Frequency& and therefore chronic obstructive blood in the dose range, side
Timing: easier to cough airways disease. stools; irregular effects of the
TID up. It may also heartbeat; medication, and
have a knock- symptoms of low any precautions to
on effect of Contraindication: blood sugar (eg, be taken
making it dizziness,
harder for Conditions: stomach drowsiness,
germs or intestinal ulcer. fainting, Provide client
(bacteria) to bleeding of the weakness, education about
cause chest stomach or increased medication
infections intestines. hunger,
pregnancy. increased
sweating, Advise the
headache, chills patient’s family to
take the
medication with
meals for better
absorption & to
reduce GI
discomfort.

Instruct the
patient’s family to
take medication as
prescribed even
after feeling better
and not to double
dose.

Assess the patient

for any history of
hypersensitivity or
allergy to
Carbocisteine. 2.
Special
precautions: GI
bleeding,
pregnancy
3. Special
precaution: history
of gastric or
duodenal ulcer &
GI bleeding.
Pregnancy &
lactation.
4. Use with
 caution in patients
with a history of
gastric or
duodenal ulcer
and
gastrointestinal
bleeding since
mucolytics may
disrupt the gastric
mucosal barrier..

NURSING CARE PLAN

Assessment Diagnosis Objective Intervention Rationale Evaluation
Subjective: PCAP: Short Term: Independent: - Tachypnea, Goals met as
Abdominal pediatric The client or the - Assess the shallow evidenced by:
pain as community patient will rate, rhythm,
acquired
respirations
identify what is and depth of
verbalized and Termination of
pneumonia. PCAP or
by mother. pediatric
respiration, high fever and
asymmetric
Pale, community- chest abdominal
Rationale: chest
movement,
irritability Viruses are acquired and use of movement pain.
and always the most pneumonia. accessory are frequently
crying. frequent muscles. present Treatments
Reduce fever
cause of and abdominal because of and
Objectives: pneumonia in pain. -Monitor vital medications
discomfort of
Vital Signs preschool- signs including given were
systolic and moving chest
T-38.4°C aged children; administered.
diastolic blood wall and/or
PR-138 bpm Streptococcus
RR-40 cpm pneumoniae pressure, pulse fluid in lung Pale, irritability
BP- is the most Long Term: and heart rate. due to a and crying
Oxygen Terminate fever compensator
common were
saturation: and abdominal - Observe the y response to
bacterial terminated.
94% pain. sputum color,
pathogen. airway
Mycoplasma Further viscosity, and obstruction.
pneumoniae evaluation will odor. Report Altered
and be obtained. changes. breathing
Chlamydia
pattern may
pneumoniae Dependent: occur
often are the -D5LR at 500cc
together with
etiologic per hour.
agents in
use of
children. accessory
-Administer
medications as muscles to
ordered such as increase chest
paracetamol, excursion to
cefuroxime, facilitate
salbutamol and effective
carbocistein. breathing.

-Increased
heart rate, low
blood pressure,
cyanosis,
delayed
capillary refill
indicate
hypovolemia
and impending
shock.
Decrease fluid
volume of 30-
50% will reflect
in changes in
the blood
pressure.

- Changes in
sputum
characteristic
s may indicate
infection.
Sputum that
is discolored,
tenacious, or
has an odor
may increase
airway
resistance
and may
warrant
further
intervention.

-Potassium
Chloride in
Lactated
Ringer's and
5% Dextrose
Injection, USP
is a sterile,
nonpyrogenic
solution for
fluid and
electrolyte
replenishment
and caloric
supply in a
 single dose
container for
intravenous
administration.
It contains no
antimicrobial
agents.

-reduces fever ,
infection, the
symptomatic
relief and
prevention of
bronchospasm
due to
bronchial
asthma and for
mucolytic
agents.
DISCHARGE PLAN OR HEALTH TEACHING PLAN.

Complications of PCAP, the mother will be able to enumerate at least most of the risk factors
and complications.

.After discussing the different treatments, diet, and management, the mother will be able to
apply this management to her child for health promotions.

Environment Complications: - Empyema - Pleural effusions – Pleurisy

Healthy diet: - Encouraged increased oral fluid intake - Eat green leafy vegetables such as
“malunggay”, “kangkong”, and “petchay - Small feedings only to avoid choking or aspiration

Treatments: - Do not let anyone smoke around your child - Let the child rest and sleep as much
as possible - Get your child vaccinated - Prevent the spread of germs through proper
handwashing