SURIGAO EDUCATION CENTER

College of Allied Medical Sciences

Nursing Department
Surigao City

A CASE PRESENTATION
OF
PEDIATRIC COMMINITY ACQUIRED PNEUMONIA

Prepared by:

MIRAS, JELIEZA M.
MOISES, EGIE
NIMEZ, NESS DOMINIC A.
ORTIZ, LYKA IVONE B.
PALEN, CINDY D.
PEREZ CZARINA JUBIL F.
PEÑAFLOR, RICAH A.
PITO, NEÑA FAYE
PRESILDA, ANGELA MAY F.
REYES, CHRISTINE ANN R.
TAPIA, SANITA CHANCHAY
VELARDE, DAPHNE SHANE T.

Presented to:

CARLA M. BALOSCA, RN
CHERYL P. ALVARADO, RN
LYNNCE MAE S. ESPEJON, RN
OFEL DEL ROSARIO, RN
 TABLE OF CONTENTS

 Introduction

 Review of Related Literature

 Nursing Health History

Health History
 Client’s Profile
 History of Present Illness
 Past Health History
 Childhood Illness
 Childhood Immunizations
 History of Hospitalizations
 Medical History
 Surgical History
 Accidents and Injury
 Allergies
 Family Health History
 Diet
 Sleep/ Rest Pattern
 Elimination Pattern
 Social Data
 Social Data
 Family Relationship/Friendship
 Educational History
 Occupational History
 Economic Status
 Patterns of Health Care
 Developmental Milestones
 Physical Examination
 Skin
 Hair
 Nails
 Skull and Face
 Eyes
 Ears
 Nose
 Mouth and Throat
 Neck
 Thorax and Lungs
 Breast and Axillae
 Abdomen
 Upper Extremities
 Lower Extremities
 Review of System
 Integumentary System
 Respiratory System
 Cardiovascular System
 Genitourinary System
 Gastrointestinal System
 Reproductive System
 Musculoskeletal System
 Endocrine System
 Circulatory System
 Neurologic System

 DEDICATION

We student nurses who is assigned in this particular actual medical care and assistance to
analysis, and subsequently in its final documentation, wish to confer the fruits of our mental and
physical labor, firstly to the Almighty Creator for His Holy inspiration in the preparation of this
academic endeavour;

Although it is physically tiresome yet mentally interesting, every learning process

was seriously and carefully considered in its minutes detail because such assignment involved a
patient’s full recovery from ailment to healthy human life;

This case presentation is dedicated to those who have been an integral part of our
journey. To our parent’s and guardian, who patiently extended material support and nurturing
advice that without which, everything would be impossible;

Finally, to our medical mentors, hospital staff, thank you for sharing your
knowledge and expertise. To our co- students, thank you for your support and encouragement.
To our patients, thank you for trusting us with your care. This presentation is a testament to the
hard work and dedication of our group, and we are grateful for the opportunity to share our
findings with you.
 ACKNOWLEDGEMENT

First of all, we would like to thank GOD for his guidance, gift of wisdom and strength.

We would like to express our heartily and sincere appreciation to all the persons
and agencies for their support, expertise and unending encouragement in the preparation of this
case presentation.

Special thanks to our parents for the continued financial support and unending
words of encouragements, to the family of our patient for their approval and being cooperative
and allowing us to present the medical case.

Thanks to all the clinical instructors for teaching and giving us all the detailed
information and providing us lectures properly, shared clinical expertise, made suggestion and
recommendation for the success of this CP plan and all nurses for sharing to us their thoughts
and knowledge. Your contributions are appreciated.
 INTRODUCTION

Pediatric community-acquired pneumonia (PCAP)

Pneumonia is a general term that refers to an infection of the lungs, which can be
caused by a variety of microorganisms, including viruses, bacteria, fungi, and parasites.
Pneumonia is the infection of the pulmonary tissue, including the interstitial spaces, the
alveoli, and the bronchioles. Pneumonia can be community-acquired or hospital acquired.

Community acquired pneumonia occurs either in the community setting or within the
first 48 hours after hospitalization or institutionalization.
Pneumonia is caused by a number of infectious agents, including viruses, bacteria and
fungi. The most common are: Streptococcus pneumoniae – the most common cause of
bacterial pneumonia in children; Haemophilusinfluenzae type b (Hib) – the second most
common cause of bacterial pneumonia; respiratory syncytial virus is the most common
viral cause of pneumonia.

Environmental Risk Factors include: indoor air pollution caused by cooking and
heating with biomass fuels (such as wood or dung), living in crowded homes, parental
smoking.

Signs and Symptoms vary depending on the age of the child and the cause of
the pneumonia, but common ones include: fever, chills, cough, nasal congestion,
unusually rapid breathing (in some cases, this is the only symptom), breathing with
grunting or wheezing sounds, labored breathing that makes the rib muscles retract
(when muscles under the ribcage or between ribs draw inward with each breath) and
causes nasal flaring, vomiting, chest pain, abdominal pain, loss of appetite (in older
kids) or poor feeding (in infants), which may lead to dehydration, in extreme cases,
bluish or gray color of the lips and fingernails.

Incidence:
Pneumonia is the single largest cause of death in children worldwide. Every year, it kills
an estimated 1.2 million children under the age of five years, accounting for 18% of all
deaths of children under five years old worldwide. Pneumonia affects children and
families everywhere, but is most prevalent in South Asia and sub-Saharan Africa.
 REVIEW OF RELATED LITERATURE

Community-acquired pneumonia (CAP) is a common disease in infancy, requiring

several pediatric specialties for its diagnosis and treatment. It is a potentially serious infection in
children nad often results in hospitalization. The diagnosis can be based on the history and
physical examination results in children with fever plus respiratory signs and symptoms. Chest
radiography and rapid viral testing may be helpful when the diagnosis is unclear. The most likely
etiology depends on the age of the child. Viral and Streptococcus pneumoniae infections are
most common in pre-schooled aged children, whereas Mycoplasma pneumoniae is common in
older children. Most children can be managed empirically with oral antibiotics as outpatients
without specific laboratory investigations. 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.

Causes of Pediatric Acquired Pneumonia:

Many germs can cause pneumonia. The most common are bacteria and viruses in the air
we breathe. Your body usually prevents these germs from infecting your lungs. But sometimes
these germs can overpower your immune system, even if your health is generally good.
Pneumonia is classified according to the types of germs that cause it and where you got the
infection.
Community-acquired pneumonia:
Community-acquired pneumonia is the most common type of pneumonia. It occurred
outside of hospitals or other health care facilities. It may be caused by:

 Bacteria. The most common cause of bacterial pneumonia in the U.S is Streptococcus
pneumoniae. This type of pneumonia can occur on its own or after you’ve had a cold or
the flu. It may affect one part (lobe) of the lung, a condition called lobar pneumonia.
 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. 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.

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 machine (ventilators), often used in intensive care units, are at higher risk of
this type of pneumonia.

Health care-acquired pneumonia:

 Health care-acquired pneumonia is a bacterial infection that occurs in people who live in
long-term care facilities or who receive care in outpatient clinics, including kidney
dialysis centers. Like hospital-acquired pneumonia, health care-acquired pneumonia can
be caused by bacteria that are more resistant to antibiotics.

Aspiration pneumonia:
 Aspiration pneumonia occurs when you inhaled food, drink, vomit or saliva in to 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.

Prevalence Pediatric Acquired Pneumonia:

Pneumonia remains in the list of the leading causes of morbidity and mortality in the
Philippines. It ranked third among the causes of morbidity and fourth among the causes of death
in 2000. There was an increase in the morbidity trend for pneumonia from 1990 to 1996. This
may be due to improved case finding and reporting with the intensification of the program to
control acute respiratory infections during this period. The morbidity trend decreased slightly
from 1997 to 2000 but the number of cases remained high at 829 cases per 100,000 population in
2000 up until now. The region with the highest reported mortality rate from pneumonia is
Western Visayas (74.6 deaths per 100,000 population) followed closely by Ilocos (73.7 per
100,000) and Cagayan Valley ( 59.2 per 100,000) with ARMM having the lowest reported death
from pneumonia at 2.5 deaths per 100,000 follwed by Central Mindanao (15.6 per 100,000) and
Western Mindanao ( 21. 3 per 100,000). Death rate from pneumonia among children under-five
years of age followed a downward trend since the 1980s. the death rate from pneumonia
decreased around 83.6 percent during a twenty-year period. From 401.93 per 100,000 under five
years old.

Epidemiology of Pneumonia:
Pneumonia is a common illness affecting approximately 450 million people a year and
occurring in all parts of the world. It is ma major cause of death among all age groups, and
resulting in 1.4 million deaths in 2014. Resulting in 3.0 million deaths worldwide. Pneumonia is
a type of lower respiratory tract infection, and is also the most deadly communicable disease as
of 2016. Rates are greatest in children less than five and adults older than 75 years of age. It
occurs about five times more frequently in the developing world versus the developed world.
Viral pneumonia accounts for about 200 million cases.