DIPLOMA IN MEDICAL ASSISTANT

HOSPITAL PAKAR SULTANAH FATIMAH MUAR, JOHOR

CASE STUDY

Instruction to Student:

Prepare one (1) Case Study of any type of disease / condition / incident / procedure
in the clinical areas.

Objective:

Enable students to learn a disease / condition / incident / procedure selected in more

detail and appreciate the importance of learning the selected title.

STUDENT PARTICULAR:

NAME:
AINURUL FATEHAH BINTI ABDUL RAHMAN

MATRIC NUMBER:
DMA 002245
3/SEM 5
YEARS /SEMESTER:

CLINICAL PLACEMENT HOSPITAL PAKAR SULTANAH FATIMAH

AREA: MUAR, JOHOR

SUBJECT CODE : MACP : 5131 (PRAKTIS PEDIATRIKS)

EN. HJ KHALIDI BIN HUSSIN

CLINICAL INSTRUCTOR:

PNEUMONIA
TOPIC :

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 CONTENTS TASKS
NO TOPIC PAGE

PNEUMONIA
PART ONE: INTRODUCTION
1. Introduction 3
2. Problem statement 3
3. Literature Review 3
PART TWO: DISSCUSION
1. Definition 5
2. Symptoms 5
3. Cause 6
4. Risk Factors 7
5. Types of Pneumonia 8
6. Investigation 10
7. Treatment 11
8. Complication 12
9. Prevention 12
10. Referances 13

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PART ONE: INTRODUCTION
INTRODUCTION
Pneumonia is an inflamation in one or both of lungs caused by bacteria, viruses or
fungi. When there is an infection in the lungs became inflamed and the air sacs in
the lungs fill with the mucus and other fluids.
Lungs’ main job is to get oxygen into the bloodstream and remove carbon dioxide.
This happens during breathing. During breathing 12 to 20 times per minute. When
breathe in, air travels down the back of the throat and passes through voice box and
into the windpipe (trachea). Trachea splits into two air passages (bronchial tubes).
One bronchial tube leads to the left lung, the other to the right lung. For the lungs to
perform their best, the airways need to be open as breathe in and out. Swelling
(inflammation) and mucus can make it harder to move air through the airways,
making it harder to breathe. This leads to shortness of breath, difficulty breathing and
feeling more tired than normal.
Pneumonia is spread when droplets of fluid containing the pneumonia bacteria or
virus are launched in the air when someone coughs or sneezes and then inhaled by
others. You can also get pneumonia from touching an object previously touched by
the person with pneumonia (transferring the germs) or touching a tissue used by the
infected person and then touching your mouth or nose.

PROBLEM STATEMENT
Patient come to Emergency at 1.00am with chief complaint:
 Fever x 4/7 on off
 No rashes
 No mouth ulcer
 Cough x 3/7 (non-productive)
 Running nose (yellowish to clear discharge)
Investigation done, Chest X-ray and Atrial blood gas shown Bronchopneumonia.

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 LITERATURE REVIEW
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air
sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus,
fever, chills, and difficulty breathing. A variety of organisms, including bacteria,
viruses and fungi, can cause pneumonia. Pneumonia can range in seriousness from
mild to life-threatening. It is most serious for infants and young children, people older
than age 65, and people with health problems or weakened immune systems.
(Marrie TJ,2016)

Pneumonia is one of the commonest infections in children. The pathogens

responsible for pneumonias in the children are the same as in adult. Because of
associated cardiopulmonary disease and/or impaired host defences, pneumonia in
elderly patients is associated with increased mortality and morbidity compared to
younger patients. Pneumonias in the elderly may be classified, for clinical purposes,
according to their location of acquisition, community-acquired pneumonias, or
hospital-acquired pneumonias. The clinical presentation of pneumonias in the elderly
may be difficult, due to pre-existing cardiopulmonary disease that mimics
pneumonia. (Infectious Disease Division, Winthrop-University Hospital,
Mineola, 2018)

Pneumonia is an infection in one or both lungs caused by bacteria, viruses, or fungi.

The infection leads to inflammation in the air sacs of the lungs, which are called
alveoli. The alveoli fill with fluid or pus, making it difficult to breathe.Both viral and
bacterial pneumonia are contagious. This means they can spread from person to
person through inhalation of airborne droplets from a sneeze or cough. (Lauren
Castiello,2021)

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs
are made up of small sacs called alveoli, which fill with air when a healthy person
breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid,
which makes breathing painful and limits oxygen intake.
Pneumonia is the single largest infectious cause of death in children worldwide.
Pneumonia killed 740 180 children under the age of 5 in 2019, accounting for 14% of
all deaths of children under five years old but 22% of all deaths in children aged 1 to
5. Pneumonia affects children and families everywhere, but deaths are highest in
South Asia and sub-Saharan Africa. Children can be protected from pneumonia, it
can be prevented with simple interventions, and treated with low-cost, low-tech
medication and care.(world health organisation,2021)

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PART TWO: DICUSSION
1. DEFINITION
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air
sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus,
fever, chills, and difficulty breathing. A variety of organisms, including bacteria,
viruses and fungi, can cause pneumonia.

Pneumonia can range in seriousness from mild to life-threatening. It is most serious

for infants and young children, people older than age 65, and people with health
problems or weakened immune systems.

2. SYMPTOMS

The signs and symptoms of pneumonia vary from mild to severe, depending on
factors such as the type of germ causing the infection, and patient age and overall
health. Mild signs and symptoms often are similar to those of a cold or flu, but they
last longer.

Symptoms may be a bit different for each child. They may also depend on what is
causing the pneumonia. Cases of bacterial pneumonia tend to happen suddenly
with these symptoms:

 Cough that produces mucus

 Cough pain

 Vomiting or diarrhoea

 Loss of appetite

 Tiredness (fatigue)

 Fever Fast or hard breathing

 Headache

 Fussiness

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Early symptoms of viral pneumonia are the same as those of bacterial pneumonia.
But with viral pneumonia, the breathing problems happen slowly. Child may wheeze
and the cough may get worse. Viral pneumonia may make a child more at risk for
bacterial pneumonia.

3. CAUSE

Many germs can cause pneumonia. The most common are bacteria and viruses in
the air we breathe.Our body usually prevents these germs from infecting the lungs.
But sometimes these germs can overpower the immune system, even if our health is
generally good.

Pneumonia is classified according to the types of germs that cause it and where the
infection got.

I. Community-acquired pneumonia
Community-acquired pneumonia is the most common type of pneumonia. It occurs
outside of hospitals or other health care facilities. It may be caused by:

 Bacteria. The most common cause of bacterial pneumonia in the is

Streptococcus pneumoniae. This type of pneumonia can occur on its
own or after patient had a cold or the flu. It may affect one part (lobe) of
the lung, a condition called lobar pneumonia.

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  Bacteria-like organisms. Mycoplasma pneumoniae also can cause
pneumonia. It typically produces milder symptoms than do other types of
pneumonia. Walking pneumonia is an informal name given to this type of
pneumonia, which typically isn't severe enough to require bed rest.

 Fungi. This type of pneumonia is most common in people with chronic

health problems or weakened immune systems, and in people who have
inhaled large doses of the organisms. The fungi that cause it can be
found in soil or bird droppings and vary depending upon geographic
location.

 Viruses, including COVID-19. Some of the viruses that cause colds and

the flu can cause pneumonia. Viruses are the most common cause of
pneumonia in children younger than 5 years. Viral pneumonia is usually
mild. But in some cases it can become very serious. Coronavirus 2019
(COVID-19) may cause pneumonia, which can become severe.

II. Hospital-acquired pneumonia

Some people catch pneumonia during a hospital stay for another illness. Hospital-
acquired pneumonia can be serious because the bacteria causing it may be more
resistant to antibiotics and because the people who get it are already sick. People
who are on breathing machines (ventilators), often used in intensive care units, are
at higher risk of this type of pneumonia.

III. Aspiration pneumonia

Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your
lungs. Aspiration is more likely if something disturbs your normal gag reflex, such as
a brain injury or swallowing problem, or excessive use of alcohol or drugs.

4. RISK FACTORS
Pneumonia can affect anyone. But the two age groups at highest risk are:
 Children who are 2 years old or younger
 People who are age 65 or older
Other risk factors include:

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  Being hospitalized. You're at greater risk of pneumonia if you're in a hospital
intensive care unit, especially if you're on a machine that helps you breathe (a
ventilator).
 Chronic disease. You're more likely to get pneumonia if you have asthma,
chronic obstructive pulmonary disease (COPD) or heart disease.
 Smoking. Smoking damages your body's natural defenses against the
bacteria and viruses that cause pneumonia.
 Weakened or suppressed immune system. People who have HIV/AIDS,
who've had an organ transplant, or who receive chemotherapy or long-term
steroids are at risk.

5. TYPES OF PENUMONIA
Pneumonia is an inflammation of the lungs caused by bacteria, viruses, or chemical
irritants. It is a serious infection or inflammation in which the air sacs fill with pus and
other liquid.
 Lobar pneumonia. This affects one or more sections (lobes) of the lungs.
 Bronchial pneumonia (or bronchopneumonia). This affects patches
throughout both lungs.
The main types of pneumonia are:

I. Bacterial pneumonia. This is caused by various bacteria. The streptococcus

pneumoniae is the most common bacterium that causes bacterial pneumonia .

Many other bacteria may cause bacterial pneumonia including:

 Group B streptococcus
 Staphylococcus aureus
 Group A streptococcus

Bacterial pneumonia may have a quick onset and the following symptoms may
occur:

 Productive cough
 Pain in the chest
 Vomiting or diarrhea
 Decrease in appetite
 Fatigue
 Fever

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 II. Viral pneumonia. This is caused by various viruses, including the following:
 Respiratory syncytial virus, or RSV (most commonly seen in children under
age 5
 Parainfluenza virus
 Influenza virus
 Adenovirus

Early symptoms of viral pneumonia are the same as those of bacterial pneumonia.
However, with viral pneumonia, the respiratory involvement happens slowly.
Wheezing may occur and the cough may worsen. Viral pneumonias may make a
child susceptible to bacterial pneumonia.

III. Mycoplasma pneumonia. This presents somewhat different symptoms and

physical signs than other types of pneumonia. They generally cause a mild,
widespread pneumonia that affects all age groups but more commonly in
older children.
Symptoms usually do not start with a cold, and may include the following:

 Fever and cough are the first to develop

 Cough that is persistent and may last three to four weeks
 A severe cough that may produce some mucus

Other less common pneumonias may be caused by the inhaling of food, liquid,
gases or dust, or by fungi

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 6. INVESTIGATION
Start by asking about patient medical history and doing a physical exam,
including listening to the lungs with a stethoscope to check for abnormal bubbling
or crackling sounds that suggest pneumonia.
If pneumonia is suspected, doctor may recommend the following tests:
 Blood tests. Blood tests are used to confirm an infection and to try to identify
the type of organism causing the infection. However, precise identification isn't
always possible.
 Chest X-ray. This helps doctor diagnose pneumonia and determine the
extent and location of the infection. However, it can't tell what kind of germ is
causing the pneumonia.
 Pulse oximetry. This measures the oxygen level in your blood. Pneumonia
can prevent lungs from moving enough oxygen into the bloodstream.
 Sputum test. A sample of fluid from lungs (sputum) is taken after a deep
cough and analysed to help pinpoint the cause of the infection.
 CT scan. If pneumonia isn't clearing as quickly as expected, your doctor may
recommend a chest CT scan to obtain a more detailed image of lungs.
 Pleural fluid culture. A fluid sample is taken by putting a needle between
ribs from the pleural area and analysed to help determine the type of infection.

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 7. TREATMENT
Treatment for pneumonia involves curing the infection and preventing complications.
People who have community-acquired pneumonia usually can be treated at home
with medication. Although most symptoms ease in a few days or weeks, the feeling
of tiredness can persist for a month or more.
The options of treatment include:
 Antibiotics. These medicines are used to treat bacterial pneumonia. It may
take time to identify the type of bacteria causing the pneumonia and to choose
the best antibiotic to treat it. If the symptoms don't improve,doctor may
recommend a different antibiotic.
 Cough medicine. This medicine may be used to calm your cough so that
patient can rest. Because coughing helps loosen and move fluid from the
lungs, it's a good idea not to eliminate the cough completely.
 Fever reducers/pain relievers. Patient may take these as needed for fever
and discomfort. These include drugs such as aspirin, ibuprofen (Advil, Motrin
IB, others) and acetaminophen (Tylenol, others).
There are no treatments for most viral causes of pneumonia. However, if the flu virus
is thought to be the cause, antiviral drugs might be prescribed.

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 8. COMPLICATIONS
Even with treatment, some people with pneumonia, especially those in high-risk
groups, may experience complications, including:
 Bacteria in the bloodstream (bacteremia). Bacteria that enter the
bloodstream from the lungs can spread the infection to other organs,
potentially causing organ failure.
 Difficulty breathing. If pneumonia is severe or have chronic underlying lung
diseases, may have trouble breathing in enough oxygen. May need to be
hospitalized and use a breathing machine (ventilator) while lung heals.
 Fluid accumulation around the lungs (pleural effusion). Pneumonia may
cause fluid to build up in the thin space between layers of tissue that line the
lungs and chest cavity (pleura). If the fluid becomes infected, patient may
need to have it drained through a chest tube or removed with surgery.
 Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An
abscess is usually treated with antibiotics. Sometimes, surgery or drainage
with a long needle or tube placed into the abscess is needed to remove the
pus.

9. PREVENTION
To help prevent pneumonia:

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  Get vaccinated. Vaccines are available to prevent some types of pneumonia
and the flu. Talk with doctor about getting these shots. The vaccination
guidelines have changed over time so make sure to review the vaccination
status.
 Make sure children get vaccinated. Doctors recommend a different
pneumonia vaccine for children younger than age 2 and for children ages 2 to
5 years who are at particular risk of pneumococcal disease. Children who
attend a group child care center should also get the vaccine. Doctors also
recommend flu shots for children older than 6 months.
 Practice good hygiene. To protect yourself against respiratory infections that
sometimes lead to pneumonia, wash your hands regularly or use an alcohol-
based hand sanitizer.
 Don't smoke. Smoking damages your lungs' natural defenses against
respiratory infections.
 Keep your immune system strong. Get enough sleep, exercise regularly
and eat a healthy diet.

10. REFERENCES
I. Pneumonia. National Heart, Lung, and Blood Institute.
http://www.nhlbi.nih.gov/health/health-topics/topics/pnu. Accessed April 15,
2016.
II. AskMayoExpert. Community-acquired pneumonia (adult). Rochester, Minn.:
Mayo Foundation for Medical Education and Research; 2014.
III. Goldman L, et al., eds. Overview of pneumonia. In: Goldman-Cecil Medicine.
25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016.
http://www.clinicalkey.com. Accessed April 18, 2016.
IV. Schauner S, et al. Community-acquired pneumonia in children: A look at the
IDSA guidelines. Journal of Family Practice. 2013;62:9.
V. Attridge RT, et al. Health care-associated pneumonia: An evidence-based
review. American Journal of Medicine. 2011;124:689.

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