INTRODUCTION

This is a case of 16-year-old boy who was diagnosed of having a Pediatric Community Acquired
Pneumonia-Type C with Bronchial asthma.

Pneumonia is an illness of the lungs and respiratory system in which the alveoli
(microscopic air-filled sacs of the lung responsible for absorbing oxygen from the atmosphere)
become inflamed and flooded with fluid. Pneumonia can result from a variety of causes, including
infection with bacteria, viruses, fungi, or parasites. Pneumonia may also occur from chemical or
physical injury to the lungs. One can get pneumonia in daily life, such as at school or work. This
is called community-based pneumonia.

As a product of having Pneumonia client developed bronchial asthma which refers to a

medical condition which causes the airway path of the lungs to swell and narrow. Due to this
swelling, the air path produces excess mucus making it hard to breathe, which results in coughing,
short breath, and wheezing. The disease is chronic and interferes with daily working. Pneumonia
causes inflammation in the lungs, much like asthma, and in some cases, pneumonia can cause
damage to the lungs, resulting in lasting inflammation. Bronchial Asthma can be a consequence of
a severe case of pneumonia, or due to multiple cases of pneumonia, because of the amount of
inflammation accumulated in the lungs and airways.

People with infectious pneumonia often have a cough that produces greenish or yellow
sputum and a high fever that may be accompanied by shaking chills. Shortness of breath is also
common, as is pleuritic chest pain, a sharp or stabbing pain, either felt or worse during deep breaths
or coughs. People with pneumonia may cough up blood, experience headaches, or develop sweaty
and clammy skin. Other symptoms may include loss of appetite, fatigue, blueness of the skin,
nausea, vomiting, mood swings, and joint pains or muscle aches. Less common forms of
pneumonia can cause other symptoms. For instance, pneumonia caused by Legionella may cause
abdominal pain and diarrhea, while pneumonia caused by tuberculosis or Pneumocystis may cause
only weight loss and night sweats.

Pediatric Community Acquired Pneumonia (PCAP) refers to pneumonia in a previously

healthy person who acquired the infection outside a hospital. PCAP is a common illness that affects
infants and children. In children, the majority of deaths occur in the newborn period, with over
two million worldwide deaths a year. In fact, the WHO estimates that one in three newborn infant
deaths are due to pneumonia. It occurs because the areas of the lung which absorb oxygen (alveoli)
from the atmosphere become filled with fluid and cannot work effectively.

Children are very susceptible to acquire this illness especially when their immune systems
are low. They can get it anywhere like in school, for example one of the classmates has a cough.
Then in house, if there is a poor environment. Then in playground, wherein there are lots of other
children playing PCAP is classified into four types.
P-CAP (type C) WITH BRONCHIAL ASTHMA
1
 First is, PCAP A, which has a minimal risk, there is no dehydration, with a respiratory rate
of greater than 30-50/min. Second is, PCAP B, which has a low risk, there is mild dehydration,
with a respiratory rate of greater than 30- 50/min. Third is, PCAP C, which has a moderate risk,
with moderate dehydration, with a respiratory rate of greater than35-60/min. Fourth is, PCAP D,
which has a high risk, with severe dehydration, with a respiratory rate of greater than 35-70/min.
But in this case, our patient has a PCAP C. Pneumonia is sometimes caused by viral infections,
including RSV, the parainfluenza virus, adenovirus, and the flu. In addition to viruses, pneumonia
can also be caused by bacteria, including S. pneumoniae, H, influenza type b, group A
streptococcus, and M. tuberculosis (TB). Some of the symptoms of PCAP are fever, cough,
tachypnea, grunting and audible wheezing, chest pain, and it is often preceded by upper respiratory
tract infection. It can be diagnosed by chest x-ray, blood tests, sputum culture, pulse oximetry,
chest CT scan, bronchoscopy, and pleural fluid culture. The best way to prevent PCAP is to cover
mouth when coughing, practice good hygiene, and have a clean environment.

Also, childhood immunizations will help greatly in the prevention of PCAP in children.
Treating pneumonia includes appropriate diet, increase fluid intake, cool mist humidifier in the
child's room, medication for cough, intravenous (IV) fluids or oral antibiotics, oxygen therapy,
frequent suctioning of the child's nose and mouth (to help get rid of thick secretions), and breathing
treatments, as ordered by the child's doctor. In 2009. 1.1 million people in the United States were
hospitalized with pneumonia and more than 50,000 people died from the disease. Globally,
pneumonia kills more than 1.5 million children younger than 5 years of age each year. The United
Nations Children's Fund (UNICEF) estimates that 3 million children die worldwide from
pneumonia each year; these deaths almost exclusively occur in children with underlying
conditions, such as chronic lung disease of prematurity, congenital heart disease, and
immunosuppression. According to the WHO's Global Burden of Disease 2000 Project, lower
respiratory infections were the second leading cause of death in children younger than 5 years
(about 2.1 million [19.6%]

The chronology we have come from the Department of Health's Health statistics which
have been updated sometime last January 2019 and during the COVID-19 pandemic documented
that one of the leading causes of mortality in the Philippines is Pneumonia either community
acquired or hospital acquired, Pneumonia is considered the 2nd leading cause of death and the 3rd
leading cause of morbidity in children (Department of Health, 2015 Health Statistics). For the
adults, this occurs mainly as a complication of other chronic diseases like lung cancer, COPD,
tuberculosis, and other debilitating illnesses that leave them bedridden most of the time and for the
children, this remains to be a major killer. In the year 2015 it was recorded that in every 100,000
total population in the Philippines over15,822 males died this year and 16,276 for the females. In
the Philippines, there are more than 40,000 cases of PCAP annually. More than 50% are admitted
P-CAP (type C) WITH BRONCHIAL ASTHMA
2
in the hospital. In the statistics in Davao City on 2015 PCAP was rank seventh in the top 10 leading
causes of morbidity age groups in Baguio City and ranked third on top leading causes of mortality
between January and February last three year based on statistics prepared by the City Health Office
(CHO).

OBJECTIVE

GENERAL OBJECTIVE:

At the end of the study, the nursing student will able to gai the necessary knowledge
about PCAP-C or Pediatric community acquired pneumonia (type-c). They will also apply and
improve the right skills and uphold the appropriate attitude needed to render effective nursing
intervention focused entirely.

SKILLS:

1. Assess the patient thoroughly for their presenting signs and symptoms in order to develop an
appropriate plan of care for the condition's management.

2. Gather all pertinent patient information to serve as the foundation for nursing diagnosis and
the development of a nursing care plan.

3. For a more effective response to the client, perform the necessary nursing interventions with
accuracy and promptness.

4. Utilize the skills and knowledge they gained by providing health education and encouraging
patients to maintain proper health promotion.

Knowledge

1. Identify the prescribed medications and be familiar with their action, dosing, side effects and
adverse effects, contraindications, and nursing responsibilities.

2. Recognize the clinical significance of laboratory findings in monitoring and preventing further
complications in the patient by comparing results to normal values and diagnostic test results.

3. Take note of any additional management procedures or interventions that are appropriate for
the patient's condition, and understand the rationale for implementing the treatment or care.

P-CAP (type C) WITH BRONCHIAL ASTHMA

3
Attitude

1. In each procedure and intervention, incorporate the Vincentian Core Values.

2. Establish and maintain rapport with the patient in order to provide client-centered care
and to prioritize the Se's of nursing, which include compassion, competence, confidence,
conscience, and commitment. Show an alert and responsive attitude when assisting other
members of the healthcare team.
3. Display a proactive and responsive attitude in assisting other members of the healthcare
team in providing the best treatment and care for the patient's care and recovery.

Vital Information

Case Scenario

A 16-year-old male came for admission. Two weeks prior to admission patient exhibit sign
and symptoms of productive cough (with greenish secretion), difficulty of breathing, and chest
tightness. Patient opt for consultation and advised for hospital admission. During admission to ER;
upon auscultation patient shows presence of wheezing, difficulty of breathing worsens, and
cyanosis raised. Vital signs revealed: Temperature of 36 degree Celsius, BP of 110/70 mmhg,
Cardiac rate of 138 beats per minutes, and respiration rate of 45 breath per minutes.

As laboratory results follows; his X-ray results and interpretation was bilateral pneumonia,
hyperaerated lungs, and pulmonary congestion. The hematology finding remarks increased level
of white blood cells, segmenters, and decreased level of lymphocyte.

Personal Data

Name: K.V

Age: 16

Sex: Male

Citizenship: Filipino

Civil status: Single

Occupation: N/A

Religion: Roman Catholic

City Address: Lanot, Roxas City, Capiz

Clinical/Admitting Data

Date of Admission: Feb 18, 2023

P-CAP (type C) WITH BRONCHIAL ASTHMA

4
Time of Admission: 11:59 AM

Accompanied by: Mother

Chief complain: Difficulty of breathing and Cough

Working Diagnosis: PCAP-C (Pediatric community acquired pneumonia type C) and Bronchial
asthma

Hospital: St.Anthony College Hospital

Ward: Immaculate heart of Mary ward

Attending Physician: Dr. L.G

Vital Signs upon admission:

Temperature: 36 degree celsius

Heart Rate: 134/min

Respiratory Rate: 45/min

Blood pressure: 110/70 mmhg

HEALTH ASSESSMENT

A. Past Medical History

According to the past medical history, he was diagnosed with bronchial asthma. Her
mother stated that the patient always diagnosed with pneumonia when he was 1 to 3 years old
and the factors that triggers his asthma are environmental pollutants, such as cigarette smoke,
dust, and chemicals like the smell of a paint.

B. Present Medical History

A 16-year-old male came for admission. Two weeks prior to admission patient exhibit
sign and symptoms of productive cough (with greenish secretion), difficulty of breathing, and
chest tightness. Patient opt for consultation and advised for hospital admission. During
admission to ER; upon auscultation patient shows presence of wheezing, difficulty of
breathing worsens, and cyanosis raised. The patient diagnosed of PCAP-C (Pediatric
community acquired pneumonia type-c) with bronchial asthma.

P-CAP (type C) WITH BRONCHIAL ASTHMA

5
 C. Family history

There is significant history of asthmatic patient in the family of the patient including his
younger sister, grandmother and grandfather at the mother side.

D. Psychosocial History
There is no significant psychosocial history found in the patient’s chart. Patients
was unable to disclose any information regarding this topic.

Genogram

1945 - 2010 1941 - 2011 1950 - 2017 1948 - 2014

65 70 67 66

F.V C.V C.L F.L

1977 1978
46 45

E.R.V L.R.V

2001 2002 2004 2007 2017

22 21 19 16 6

A.M.V A.V E.V K.V L.V

P-CAP (type C) WITH BRONCHIAL ASTHMA

6
 Genogram Symbols

Male Female Death

Family Relationships
3

2 Hypertension / High Blood Pressure

1 A rthritis

4 Asthmatic

REVIEW OF SYSTEM

LEGENDS:
Red- Abnormal Black- Normal
Baseline Vital Signs:

TEMP 36®C

B/P 110/70

CR 138 beats/min.

P-CAP (type C) WITH BRONCHIAL ASTHMA

7
RR 45 breaths/min/

General Survey The patient complained difficulty of breathing

and coughing. His temperature was 36®C;
cardiac rate of 138 beats/min; respiratory rate
of 45 breath/min and blood pressure of 110/70
mmhg. He is cooperative and interactive with
others. Patient established good eye contact
when conversing. Speech is clear and
culturally appropriate.
SKIN Firm. Slightly bluish discoloration at the
tip of his finger
HEENT round, symmetric skull that is
(Head, eyes, ears, nose, throat) proportionate to the patient’s body with
the absence of bumps, lesions, and masses.
Neck No bumps
Breast symmetrical
Respiratory Respiratory rate of 45 breaths. Chest and
lungs: asymmetrical lung expansion
positive wheezing cough
Cardiovascular Blood pressure of 110/70 and Cardiac rate
of 138 beats per minute
Gastrointestinal No visible lesions, Intact skin, Absence of
pain or tenderness, and Absence of masse

Genitourinary Regularly urinating, Circumcised

Peripheral/vascular Capillary bed refill in 1 to 2 seconds
Musculoskeletal - Both extremities are equal in size.
- Have the same contour with
prominences of joints.
- No involuntary movements.
- No edema

Psychiatric The patient obeys the command, gives an

appropriate verbal response, and is aware
of time, person, and place. Eye opening
response and movement that is
spontaneous. There was no evidence of a
neurological deficit.
Hematologic (-) Bleeding

P-CAP (type C) WITH BRONCHIAL ASTHMA

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 DIAGNOSTIC TEST RESULTS
LEGENDS:
Red-Increased
Blue-Decreased
Black-Normal

A. Hematology
A complete blood count (CBC), also known as a complete cell count, full blood count
(FBC), or full blood exam (FBE),is a blood panel requested by a doctor or other medical
professionals that gives information about the cells in the patient's blood. A scientist or a
lab technician performs the requested testing and provides the requesting medical
professional with the results of the CBC.
Result Verified: 02-18-2023

COMPLETE BLOOD COUNT

RESULT REFERENCE VALUE
HEMATOCRIT 0.45 0.33-0.51
HEMOGLOBIN 154 120-160
RBC 5.3 4.10-5.10
WBC (H) 18.8 4.5-13.0

DIFFERENTIAL COUNT
RESULTS REFERENCE VALUE
SEGMENTERS (H) 92 34-64
BASOPHIL 0 0-1
EOSINOPHIL 0 0-3
LYMPHOCYTES (L) 4 24-45
MONOCYTES 4 3-6

INDICES
RESULTS REFERENCE VALUE
MCV 84 78-102
MCH 29 25-35
MCHC 35 32-36
RDW 12.70 11.5-14.0

PLATELETE COUNT 292 150-450

P-CAP (type C) WITH BRONCHIAL ASTHMA

9
 B. Serology
An antibody test looks for the presence of antibodies, which are specific proteins made
in response to infections. Antibodies are typically detected in the blood of people who are
tested after infection; they show an immune response to the infection.

Besults verified: 02/18/23

COVID-19 NEGATIVE ANTIGEN TEST

C. Imaging Test
EXAMINATION RESULTS IMPRESSION
CHEST PAL X-RAY ➢ The upper lobe markings
are prominent. ➢ Pulmonary
➢ Both paracardial areas and Congestion
retrocardiac area are hazy. ➢ Bilateral Pneumonia
➢ The cardiac shadow is not
enlarged
➢ The diaphragm is low set
➢ The sulci, osseous and soft
tissue structures are
unremarkable

P-CAP (type C) WITH BRONCHIAL ASTHMA

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 COURSE IN THE WARD

DATE/TIME SIDE PHYSICIAN’S FOCUS NURSING

NOTES ORDER MANAGEMENT
2/18/23 CC: Coughing ➢ Please admit to Ineffective D: Tachypneic,
and difficulty room of choice breathing tachycardiac, (+)
of breathing ➢ VS Asthma pattern cough at times.
➢ Hypoallergenic A: Due
TEMP: 36C® Diet bronchodilator
PR: 134 ➢ CBC W/APC given as ordered
beats/min ➢ CXR PAL : Nebulization
RR: 35 ➢ RAT done as ordered
breaths/min ➢ IVF: D5NM L : Due meds given
BP: 110/70 at 80 cc/hr. : maintained O2 at
mmhg ➢ Nebulize 1 neb. 9 pm
O2 sat: 95% Pulmodual : side rails up
every hour for 3 : Kept rested
DX: PCAP-C, doses then : All needs catered
Bronchial every 4 hrs : For further care
asthma treatment and monitoring
➢ Hydrocirtisome R: Endorsed to
(Hydrorex) 100 NOD.
mg IV q6 hrs.
➢ Doxopylline 1
tab q12 hrs.
give 2 tab after
nebulization.
➢ Ceterizine 10
mg (alnix) 1 tab
once a day (4
pm)
➢ Ceforoxime
750 na IV
(Zeaen) q8hrs
ANST
2/19/23 Comfortable ➢ Continue Physician D: seen and
10:15 AM diffuse with nebulization Visit examine by Dr.
wheezing fine every 40 hrs. Grino made new
crache ➢ Decreased IVF orders
LXN: PNSS to 40 cc per/hr. A: orders noted
W/ half, W/ ➢ Furosemide 20 and carried out
pulmonary g IV. due medication
congestion given monitored
for any untoward
s/sx IVF regulated
to desired rate.
R: Meds attended
for further care
and management .
2/20/23 Less cough; ➢ Nebulize to q 6 Physician D: seen and
(-)dyspnea hrs. Visit examine by Dr.
expiratory ➢ Give last dose Grino made new
wheezing of cefuroxime orders
(zegen) 500 g 1 A: orders noted
and carried out
P-CAP (type C) WITH BRONCHIAL ASTHMA
11
 tab. 1 tablet 2x due medication
a day given monitored
➢ Hydrocortisome for any untoward
IV to consult s/sx IVF regulated
then shift to to desired rate.
prednisone 20 R: Meds attended
g/ 1-tab 2x a for further care
day and management .
➢ Decreased IVF
to RUB
2/21/23 (-) ➢ IVF to consume D: (-) DOB,
4:06 PM WHEEZING then D1c Afebrile.
➢ Possible to go A: Due
home tomorrow medication given.
: IVF regulated
appropriately
: made
comfortable
: keep rested
: VIP score: 0
2/22 /23 ➢ May go home Discharge D: Seen and
11:06 AM ➢ Home meds: process examined by Dr.
1. Cipuroxine 500 Grino made
g 1 tab 2x a day orders, may go
for 7 days home
2. Doxofylline A: Orders noted
200 g 1 tab 2x a and carried out
day for 7 days bills summarized
3. Prolix 20 mg 1 : one oral
tab 2x a day for medication given
7 days : IV site checked
4. Cetirizine regularly kept
(alnix) 10 g 1 monitored
tab once a day R: VIP score – 0
(4 pm) Bills not yet
• Follow up chek settled
up on March 1,
2023 at 1 pm

P-CAP (type C) WITH BRONCHIAL ASTHMA

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 TEXTBOOK DISCUSSUION
A. Anatomy and Physiology
Pneumonia is an illness of the lungs and respiratory system in which the alveoli (microscopic
air-filled sacs of the lung responsible for absorbing oxygen from the atmosphere) become inflamed
and flooded with fluid. Pneumonia can result from a variety of causes, including infection with
bacteria, viruses, fungi, or parasites. The infection causes inflammation in the air sacs of the lungs.
This results in a buildup of fluid that makes it hard to breathe. Pneumonia may also occur from
chemical or physical injury to the lungs. One can get pneumonia in daily life, such as at school or
work. This is called community-based pneumonia.

As a product of having Pneumonia client developed bronchial asthma which refers to a medical
condition which causes the airway path of the lungs to swell and narrow. Due to this swelling, the
air path produces excess mucus making it hard to breathe, which results in coughing, short breath,
and wheezing. Pneumonia causes inflammation in the lungs, much like asthma, and in some cases,
pneumonia can cause damage to the lungs, resulting in lasting inflammation. Bronchial Asthma
can be a consequence of a severe case of pneumonia, or due to multiple cases of pneumonia,
because of the amount of inflammation accumulated in the lungs and airways.

Pneumonia may affect other system because pneumonia infection can spread from the lungs
into the bloodstream. This is a serious complication. It can reach other major organs and result in
organ damage or even death. The spread of bacteria through the blood, and the problem of airways
in the lungs that lessen the capacity to produced oxygen may result to impaired functionality of
other organ system.

Here is the major system mostly affected by the condition:

RESPIRATORY SYSTEM

Is the major organ that is responsible for gas

exchange and the one that is responsible for breathing.
Through breathing, inhalation and exhalation,
The respiratory system facilitates the exchange
of gases between the air and the blood and between the
blood and the body’s cells. The respiratory system also
helps us to smell things and create sound.
The respiratory system aids in breathing, also
called pulmonary ventilation. In pulmonary
ventilation, air is inhaled through the nasal and oral
cavities (the nose and mouth). It moves through the
pharynx, larynx, and trachea into the lungs. Then air is
exhaled, flowing back through the same pathway.
Changes to the volume and air pressure in the lungs
trigger pulmonary ventilation.
P-CAP (type C) WITH BRONCHIAL ASTHMA
13
 LUNGS Lungs is a paired organs in the thoracic cavity
in which gas exchange takes place between the air in
the alveoli and the blood in the pulmonary capillary.
A bacteria or virus enters the body through an
airway. Once the infection gets into the lungs,
inflammation causes air sacs, called alveoli, to fill up
with fluid or pus. This can lead to trouble breathing,
coughing, and coughing up yellow or brown secretion.
Breathing may feel more difficult or shallow.
You may experience chest pain when you take a deeper
breath.

ALVEOLI

Alveoli are microscopic balloon-shaped structures located at the end of the respiratory tree. They
expand during inhalation, taking in oxygen, and shrink during exhalation, expelling carbon dioxide. These
tiny air sacs are the site where gas exchange between inspired air and the blood takes place.

BRONCHI
Are the large tubes that connect to your trachea
(windpipe) and direct the air you breathe to your right and
left lungs. They are in your chest. Bronchi is the plural form
of bronchus. The left bronchus carries air to your left lung.
The right bronchus carries air to your right lung. Your
bronchi are an essential part of your respiratory system. As
you breathe and your lungs expand, your bronchi distribute
the air within your lung.

P-CAP (type C) WITH BRONCHIAL ASTHMA

14
 CIRCULATORY SYSTEM

The circulatory system (cardiovascular system) pumps

blood from the heart to the lungs to get oxygen. The heart then
sends oxygenated blood through arteries to the rest of the body.
The veins carry oxygen-poor blood back to the heart to start the
circulation process over. Your circulatory system is critical to
healthy organs, muscles and tissues.
Main function of the circulatory system is to provide
oxygen, nutrients and hormones to muscles, tissues and organs
throughout your body. Another part of the circulatory system is to
remove waste from cells and organs so your body can dispose of
it.
One of the earlier signs of pneumonia caused by bacteria is a fast
heartbeat. This may be linked to a high fever. A pneumonia
infection can spread from the lungs into the bloodstream. This is
a serious complication. It can reach other major organs and result
in organ damage or even death. The spread of bacteria through the
blood is called bacteremia. Its potentially deadly result is called
septic shock that may cause heart attack.

Heart

Heart is a muscular organ in most animals,

which pumps blood through the blood vessels of
the circulatory system. The pumped blood carries
oxygen and nutrients to the body, while carrying
metabolic waste such as carbon dioxide to the
lungs.

IMMUNE SYSTEM

The immune system is a complex network of

organs, cells and proteins that defends the body against
infection, whilst protecting the body's own cells. The
immune system keeps a record of every germ (microbe)
it has ever defeated so it can recognize and destroy the
microbe quickly if it enters the body again.

LYMPHATIC SYSTEM
The lymphatic system is part of the immune
system. It keeps body fluid levels in balance and defends
the body against infections. Lymphatic vessels, tissues,
organs, and glands work together to drain a watery fluidP-CAP (type C) WITH BRONCHIAL ASTHMA
called lymph from throughout the body. 15
 SPLEEN
The spleen has a few important functions: It fights
any invading germs in the blood (the spleen
contains infection-fighting white blood cells). It
controls the level of blood cells. The spleen
controls the level of white blood cells, red blood
cells and platelets (small cells that form blood
clots)

THYMUS GLAND

The primary function of the thymus

gland is to train special white blood cells called
T-lymphocytes or T-cells. White blood cells
(lymphocytes) travel from your bone marrow
to your thymus. The lymphocytes mature and
become specialized T-cells in your thymus.
After the T-cells have matured, they enter your
bloodstream.

Muscular system
is an organ system consisting of skeletal, smooth, and
cardiac muscle. It permits movement of the body,
maintains posture, and circulates blood throughout the
body. The muscular systems in vertebrates are
controlled through the nervous system although some
muscles (such as the cardiac muscle) can be
completely autonomous

P-CAP (type C) WITH BRONCHIAL ASTHMA

16
b. Risk factors
Modifiable:
1. Immunization
- Vitamins, immunization status, immunization response

2. Environment
- Pneumonia will trigger if the patient will not avoid second-hand smoke, air pollution, and
odor of strong chemicals.

3. Community
- Interaction to individual that are infected of Streptococcus and mycoplasma pneumoniae
(bacteria)

Non-modifiable:
1. Age
- Pneumonia occurs in every age group and every person are susceptible for the infection
of bacteria.

2. Genetics
- Being immunocompromised against the bacteria can be hereditary

P-CAP (type C) WITH BRONCHIAL ASTHMA

17
c. Pathophysiology
Pneumonia is an illness of the lungs and respiratory system in which the alveoli (microscopic
air-filled sacs of the lung responsible for absorbing oxygen from the atmosphere) become inflamed
and flooded with fluid. Pneumonia can result from a variety of causes, including infection with
bacteria, viruses, fungi, or parasites. The infection causes inflammation in the air sacs of the lungs.
This results in a buildup of fluid that makes it hard to breathe. Pneumonia may also occur from
chemical or physical injury to the lungs. One can get pneumonia in daily life, such as at school or
work. This is called community-based pneumonia. The process of this disease are in this
illustration below:

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18
P-CAP (type C) WITH BRONCHIAL ASTHMA
19
D. Clinical Manifestation
1. Textbook vs. Patient
Signs and Symptoms Associated to patient How is it manifested by the
patient:
Fever The symptoms of bacterial
pneumonia can develop
gradually or suddenly. Fever
may rise as high as 39 degrees
Celsius with profuse sweating
and rapidly increased breathing
and pulse rate. Lips and
nailbeds may have a bluish
color due to lack of oxygen in
the blood.
Cough A cough that produces greenish
yellowish due to Pneumonia
and bronchial asthma.
Rapid heartbeat Due to Pneumonia and
Bronchial asthma the stress of
being sick causes surges in
adrenaline levels, which make
the heart accelerate. Lower
oxygen levels in the blood also
make the heart beat faster
Chest pain Due to Pneumonia and
Bronchial asthma patient
experience chest pain caused
by the membranes in the lungs
filling with fluid. This creates
pain that can feel like a
heaviness or stabbing sensation
and usually worsens with
coughing, breathing or
laughing.
Dyspnea Due to the infection of
Pneumonia it inflames your
lungs' air sacs (alveoli). The air
sacs may fill up with fluid or
pus, causes dyspnea to patient.
Wheezing Due to Pneumonia and
bronchial asthma the patient
experience airway obstruction
that results wheezing.
Wheezing is commonly
experienced by people who
have Pneumonia that causes
patient with airway foreign
bodies, congestive heart failure,
airway malignancy, or any
lesion that causes narrowing of
the airways
Nasal Flaring Due to blockage of secretion in
the alveoli of the client he may
experience difficulty of
P-CAP (type C) WITH BRONCHIAL ASTHMA
20
 breathing that cause nasal
flaring. Nostrils flaring if you
have a severe infection such as
the flu. It's most commonly
seen in people with serious
respiratory conditions such as
pneumonia and bronchiolitis.
Pleural Effusion Due to the infection of
Pneumonia patient manifest A
parapneumonic effusion; is a
pleural effusion that forms in
the pleural space adjacent to a
pneumonia. When
microorganisms infect the
pleural space, a complicated
parapneumonic effusion or
empyema may result that
causes difficulty of breathing to
patient.
Muscle and joint pain Due to the effect of bacteria that
brought by Pneumonia the
patient may manifested
Infectious arthritis that
experience joint pain, soreness,
stiffness, and swelling. These
infections can enter a joint
various way: After spreading
through the bloodstream from
another part of the body, such as
the lungs
Cyanosis It is evident that the cyanosis of
pneumonia patients is due to
the incomplete saturation of
venous blood with oxygen in
the lungs, and that the various
shades of blue observed in the
distal parts are caused by an
admixture of reduced
hemoglobin and
oxyhemoglobin in the
superficial capillaries.
Chest tightness Due to pneumonia that infect
the airways of lungs client
experience Chest tightness
when they breathe or cough.
Cough, which may produce
phlegm.
Nausea and Vomiting Severe abdominal pain
sometimes occurs in people
with pneumonia in the lower
lobes of the lung. Cough, which
may be dry at first, but
eventually produces phlegm
(sputum) Night sweats. Nausea,
vomiting, and muscle aches.

P-CAP (type C) WITH BRONCHIAL ASTHMA

21
E. Diagnostic Tests

Textbook

According to Villon et. Al (2017) Pediatric Community Acquired Pneumonia (PCAP)

refers to pneumonia in a previously healthy person who acquired the infection outside a hospital.
PCAP is a common illness that affects infants and children. In children, the majority of deaths
occur in the newborn period, with over two million worldwide deaths a year. In fact, the WHO
estimates that one in three newborn infant deaths are due to pneumonia. It occurs because the areas
of the lung which absorb oxygen (alveoli) from the atmosphere become filled with fluid and cannot
work effectively. Patient with PCAP-C have a distinguishing signs and symptoms that can be
examined through physical exam.

• A chest X-ray looks for inflammation in your lungs. A chest X-ray is often used to
diagnose pneumonia.

• Blood tests, such as a complete blood count (CBC) see whether your immune system is
fighting an infection.

• Pulse oximetry measures how much oxygen is in your blood. Pneumonia can keep your
lungs from getting enough oxygen into your blood. To measure the levels, a small sensor
called a pulse oximeter is attached to your finger or ear.

If you are in the hospital, have serious symptoms, are older, or have other health problems, your
provider may do other tests to diagnose pneumonia.

➢ A blood gas test may be done if you are very sick. For this test, your provider measures
your blood oxygen levels using a blood sample from an artery, usually in your wrist. This
is called an arterial blood gas test.
➢ A sputum test, using a sample of sputum (spit) or mucus from your cough, may be used
to find out what germ is causing your pneumonia.
➢ A blood culture test can identify the germ causing your pneumonia and also show whether
a bacterial infection has spread to your blood.
➢ A polymerase chain reaction (PCR) test quickly checks your blood or sputum sample to
find the DNA of germs that cause pneumonia.

F. medical management

Textbook-based

According to Mayo clinic (2019) Treatment for PCAP-C 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.
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Specific treatments depend on the type and severity of Pneumonia. the options include:

• Antibiotics. These medicines are used to treat bacterial pneumonia. It may take time to
identify the type of bacteria causing your pneumonia and to choose the best antibiotic to
treat it. If your symptoms don't improve, your doctor may recommend a different antibiotic.

• Cough medicine. Such as bronchodilators. This medicine may be used to calm your cough
so that you can rest. Because coughing helps loosen and move fluid from your lungs, it's a
good idea not to eliminate your cough completely. In addition, you should know that very
few studies have looked at whether over-the-counter cough medicines lessen coughing
caused by pneumonia. If you want to try a cough suppressant, use the lowest dose that helps
you rest.

• Fever reducers/pain relievers. You may take these as needed for fever and discomfort.
These include drugs such as aspirin, ibuprofen (Advil, Motrin IB, others) and
acetaminophen (Tylenol, others).

Patient-Based

1. Monitoring

● Chest X-Ray - can show the structure of the heart and lung

2. Asthma/ Pneumonia therapy

• Cepoproxine belongs to the class of drugs known as quinolone antibiotics. It works by

killing bacteria or preventing their growth. However, this medicine will not work for colds,
flu, or other virus infections.
• DOXOFYLLINE relaxing the muscles in the lungs and widening the airways (bronchi).
They're often used to treat long-term conditions where the airways may become narrow
and inflamed.
• Prednisone is a synthetic corticosteroid that has potent anti-inflammatory and
immunosuppressive actions.
• Salbutamol – also a bronchodilator treats long-term conditions where the airways may
become narrow and inflamed.

G. Nursing Management

Nursing care of the child with pneumonia in the hospital is mostly supportive and will
involve routine monitoring and assessment of the child for respiratory status and oxygenation,
fluid status, and sepsis risk. The child may require supplemental oxygen and SpO2 monitoring,
depending on the severity of the illness. The nurse should assess oxygenation and for the adequacy
of air movement in lung fields, the presence of accessory muscle usage, nasal flaring, grunting,
and diminished breath sounds at each routine assessment, and more frequently if indicated. In
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addition, assessment of the child's disposition and level of activity can help the nurse determine
the child's status. Nurse should chest tube in the case of a pleural effusion or
pneumothorax. Depending on the age of the child, bronchodilator and chest physiotherapy may
be indicated. The child may be at risk for a fluid deficit if eating and drinking poorly. Nurse must
anticipate he risk for dehydration increases if the child is febrile. Careful monitoring of intake and
output can help the nurse determine the risk for a fluid deficit. Supplemental intravenous fluids
may be required. Nasogastric tube placement may be indicated to provide nutrition. Routine
monitoring for fever and risk of sepsis is required. Prompt initiation of antibiotic or antifungal
therapy is required if the etiology is bacterial or fungal. The nurse should routinely assess vital
signs with more frequent follow-up if out of range. Fever may be treated with antipyretics. If the
child is determined to be experiencing sepsis, prompt initiation of a sepsis protocol should be
initiated.

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