11 Months Old Male with Pneumonia

A CASE OF AN 11 MONTHS
OLD MALE WITH

PNUEMONIA
Submitted by: Group 2AN5
Sagario, Cheriella Marie B.
Sapihi, Norris M.
Sariola, Vanessa Elaine C.
Simacon, Adron John A.
Valles, Geraldine S.
RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

o Introduction
• The body’s organ systems put in a collaborative work to make sure that the
body functions properly. Lungs, being the primary organ for gas exchange,
if damaged or in distress may cause other systems of the body to also
malfunction. There are numerous types of respiratory diseases to look out
for and one of this is pneumonia.
• The lungs, according to Seeley (2002), are the primary or principal organs used for
respiration. They are a pair of spongy, air-filled organs located on either side of the
chest. These lungs have small air sacs which are called alveoli and this is where
exchange of gases specifically occurs or happens. As stated by the World Health
organization, when these small air sacs are filled with pus and fluid, breathing
becomes painful and the oxygen intake becomes limited. This disease is called
pneumonia, a form of acute respiratory infection. Pneumonia is an inﬂammation of
the lung parenchyma that is caused by a microbial agent (Brunner,2004). Bacteria,
according to Brunner (2004), commonly enter the lower airway but do not cause
pneumonia in the presence of an intact host defense mechanism. Pneumonia is
usually caused by various microorganisms such as bacteria, mycobacteria,
chlamydiae, mycoplasma, fungi, parasites, and viruses.

• Pneumonia is the single largest infectious cause of death in children
worldwide as per the World Health Organization. In 2015, it killed 920,136
children under the age of 5, accounting for 16% of all deaths of children under
five years old. Meanwhile, it was stated in one article published by the
Department of Health that there have been a total of 550 Pneumonia cases
reported in the Philippines from January-June 2018 which shows an 8%
increase of pneumonia cases compared to 2017 with 509 cases. Pneumonia
kills 2 children under 5 every minute, accounting for 16% of all deaths of
children under 5 globally according to a recent report by Save the Children
and that the issue is particularly prominent in Africa (Saraki, 2017). In sub-
Saharan Africa, the estimated proportion of death in children aged below 5
years attributed to pneumonia is 17-26% (Onyango et al, 2012). According to
Onyango (2012) also, Kenya is currently ranked among the 15 countries with
the highest estimated number of deaths due to clinical pneumonia, the
mortality rate being 50.3 per 10,000 under fives per year. Pneumonia is the
second leading cause of death among children under the age of five years
and causes 16% of deaths in the age group. According to the same article
written by Onyango (2012), Kenya had 6,185,800 children under the age of
five years, 111,000 of them are estimated to have died, 16% of them died of
pneumonia.

• The group selected this case because they want to learn
more about how to manage this kind of disease and to
deepen their understanding about pneumonia. The group
also wants to provide awareness and instill knowledge
about the said disease to readers. The group believes that
they can be better nurses and will be able to cater better
care to patients when they complete the study and be
able to identify the etiology, signs and symptoms, risk
factors, complications, prevention of the disease and the
pathophysiology of the disease. The case study will also
help the students enhance their communicating skills,
data gathering skills, and critical thinking skills by
challenging their intellectual capacity in terms of
questioning how the disease was acquired and how to
properly manage it.

General Objectives
• The main objective of this case study is to improve the
student’s intellectual capacity and critical thinking with
regards to analyzing a certain case and coming up with a
well-formulated and patient based care plan. By studying
this case, students will be able to identify the etiology,
signs and symptoms, predisposing factors, risks, and the
pathophysiology of the disorder. This will also allow the
student’s to improve their case analyzing skills and will
help them improve how they present a case.

Specific Objectives
• The students aim to meet all of the following objectives:
Knowledge:
• Enhance knowledge about chosen case which is
Pneumonia
• Have a better understanding of what causes the disease
• Explain how the disease was acquired and explain the
pathophysiology in a manner that readers will be able to
understand
• Be more knowledgeable about how to manage the
disease, the signs and symptoms, and what complications
to watch out for

Skills:
• Improve data gathering skills
• Improve communication skills by interviewing patient
• Establish a SMART nursing care plan that is appropriate
for the patient
Attitude
• Work as a team and share knowledge to each and
everyone in a clear and concise manner
• Set aside differences to come up with a good care plan for
the patient
• Improve patience in gathering the information needed for
the case study
• Partake actively in the group discussions to solidify
information written about the disease.

o Nursing History: Biographical Data
• Name: Patient X
• Birthdate: Feb.17, 2018
• Age: 11 months old
• Gender: Male
• Civil Status: Single
• Nationality: Filipino
• Religion: Roman Catholic
• Date of Admission: Feb. 12, 2019
• Date of Interview: Feb. 14, 2019
• Mode of admission: Ambulatory
• Hospital: Ospital ng Makati
• Chief Complaint: Difficulty of breathing
• Diagnosis: Pneumonia
History of Present Illness
• Patient’s SO stated during the interview that patient’s cough,
which is stated as “matigas na ubo”, began on February 9, 2019
(Saturday). The patient was then brought by his mother to the
hospital for a check-up on February 10, 2019 (Sunday) and the
patient’s SO stated that the patient was diagnosed with mild
pneumonia but the doctor just prescribed them with an antibiotic,
which the patient’s SO cannot recall the name of, and sent them
home afterwards. On Monday (February 11,2019), the patient’s
SO verbalized that the patient seemed to not have any
improvement so she decided to bring the patient to the hospital for
another check-up. A blood sample was taken from the patient and
an X-ray was also done. The doctor decided to send them home
again but when the doctor saw that the patient is having a difficulty
in breathing, the patient was then admitted. Upon admission, the
patient was hooked to an IV and was given an antibiotic.
Past Medical History
• Patient has not experienced any severe illness or disease
except from cough and cold for the past six months
according to the patient’s SO.

Social History
• Patient is fond of watching TV shows and also plays with
their neighbors according to the patient’s SO. The patient
is usually fed with boiled vegetables as his lunch or
dinner. The patient has no noted allergies to food and
drugs

Family History
• The patient lives with his mother, father, and her sister.
The SO also stated that since she has work, the
grandmother is usually the one who takes care of the
patient. The patient’s father, mother, and sister is all alive
and well.

Genogram

o Gordon’s Functional Health Pattern
FUCNTIONAL HEALTH PRIOR TO DURING HOSPITALIZATION ANALYSIS AND
PATTERN HOSPITALIZATION INTERPRETATION
I. Health Perception And According to the mother, patient According to the mother, during Breathing comes naturally and
Health Management often experience cough, colds, hospitalization his son is effortlessly to everyone. When
Pattern and flu. It was Saturday (Feb. experiencing difficulty in problem concerning the airway
9,2019) when the patient started breathing and received oxygen happens, coughing takes place, which
having cough. The mother stated via nasal cannula. Patient still is the main mechanism for clearing it.
that her son's cough was hard experiencing coughs (foamy However, coughing may not always
and difficult that it causes him to white mucus), colds (clear nasal be easy to everyone especially to
cry. On Sunday morning (Feb. discharge) and flu as well. those patients with incisions, trauma,
10,2019) she brought the patient respiratory muscle fatigue, or
to Ospital ng Makati for a check- neuromuscular weakness.
up and the patient was diagnosed
with mild pneumonia as per the x- https://nurseslabs.com/ineffective-
ray result. Right after that, the airway-clearance/
patient was prescribed with an
antibiotic, which the mother  Ineffective airway clearance
cannot recall the name of. The related to retained secretions
mother observed her son's
condition on Monday but nothing Nursing Diagnoses, Definitions and
has changed on his condition and Classifications 2015-2017, 10th
patient is having difficulty in Edition
breathing. She brought the
patient back to Ospital ng Makati
for another check up on Tuesday
(Feb. 12, 2019)

The state in which the rate, depth,
timing, and rhythm, or the pattern of
breathing is altered. When the breathing
pattern is ineffective, the body is most
likely not getting enough oxygen to the
cells. Respiratory failure may be
correlated with variations in respiratory
rate, abdominal and thoracic pattern.

https://nurseslabs.com/ineffective-
breathing-pattern/
 Ineffective breathing pattern

related to decreased lung expansion
due to air or fluid accumulation

Nursing Care Plans: Guidelines for
Individualizing Client Care Across the
Life Span, 8th Edition
II. Nutritional And Metabolic According to the mother, the According to the mother, the patient Decreased appetite and it's resulting
Pattern patient was not able to eat plenty doesn’t want to eat since Tuesday weight loss is common with many life-
of foods but make sure to eat 3 (February 12, 2019) and stop taking threatening illnesses and it’s a symptom
times in a day. He only eats soup his own vitamins since the day that that some patients report just as
and rice by having the amount of the patient was admitted. distressing, if not more so than pain.
3 tbsp per day and formula milk
 Imbalanced nutrition less than
with the amount of 4 oz in every
body requirement related to
2-3 hours. The mother stated, inadequate food intake
Prior to hospitalization his son
refused to drink milk because he Nursing Care Plans: Guidelines for
vomits it after. As per the mother Individualizing Client Care Across the
his son decreased weight as his Life Span, 8th Edition
son’s teeth grows. Her son take
vitamin/supplements such as
“sulfate”. Patient has good
appetite as per the mother.
Patient has no allergies to
drugs/foods and doesn’t have any
skin problems.
III. Elimination Pattern According to the Mother, According to the mother, patient Constipation is a common condition
patient was able to defecates 2 was not able to eliminate body that affects people of all ages. It can
times a day and his stool is waste due to his nutritional mean that you're not passing stools
watery and formed with pattern. Her son was still able to regularly or you're unable to
greenish color. Her son was urinate 5 times in a day as completely empty your bowel
able to urinate for 5 times per evidenced by 5 times of replacing
https://www.nhsinform.scot/illnesses-
day as evidenced by 5 times of diapher and its color is light
and-conditions/stomach-liver-and-
replacing of diaper and its yellow with no foul odor. gastrointestinal-tract/constipation
color is light yellow with no
foul odor and perspires a lot  Constipation r/t insufficient
with no foul odor. fluid intake

Nursing Diagnoses, Definitions and
Classifications 2015-2017, 10th
Edition
IV. Activity And Exercise According to mother, his son can According to the mother since the Activity Intolerance is typically
Pattern play a lot and was able to watch patient was hospitalized, he can’t caused by feelings of generalized
cartoons and spend lots of his play anymore but is able to watch weakness that are the result of an
time. cartoons using cellphone by the help acute or chronic illness. Common
of his mom/S.O conditions that result in activity
Level of Daily Activities:
intolerance include anemia, obesity,
 Getting up from bed - 0 Level of Daily Activities
 Sitting on his/her own - 0  Getting up from bed - II malnourishment, diabetes, heart
 Eating- II  Sitting on his/her own – II problems, and as a side effect of
 Taking a bath- 0  Eating- II certain medications.
 Elimination - 0  Taking a bath- II
(Defecation/Urination) - 0  Elimination – 0 http://www.fergon.com/causes-
 Change of clothes- II (Defecation/Urination) - II coping-activity-intolerance/
 Hygiene and grooming- II  Change of clothes- II
 Movement- 0  Hygiene and grooming- II
 Movement- I  Activity intolerance related
Level 0: Full self-care imbalanced between oxygen
Level I: Requires assistance of Level 0: Full self-care
demand
equipment or device Level I: Requires assistance of
Level II: Requires assistance or equipment or device
supervision from another person Level II: Requires assistance or Nurse’s Pocket Guide Diagnoses,
supervision from another person Prioritized Interventions, and
Level III: Requires assistance or Rationales 10th Edition by Marilyn E.
supervision from another person or Doenges, Francis Moorehouse and
device Alice C.Murr

V. Cognitive-Perceptual According to the mother her According to the mother her son Patient doesn’t encounter any
Pattern son can hear clearly and don’t can still hear clearly and has no changes towards to his optic nerves
have any problems with his problem in vision. He can still and auditory
vision. He can learn easily by learn easily.
demonstration.
NORMAL
VI. Sleep-Rest Pattern According to mother the patient According to the mother, his son Time- limited interruptions of sleep
has a good sleeping pattern but doesn’t have a good sleeping amount and quality due to external
wasn’t sure of number of hours pattern. As he experienced factors.
his son spends in sleeping disturbance in his atmosphere.
because she’s not with his son http://healthysleep.med.
from time to time due to her work. harvard.edu/healthy/
science/how/external-factors

 Disturbed sleep pattern

Nurse's Pocket Guide by Marilyn E.
Doenges, Francis Moorehouse and Alice
C.Mur

VII. Self-Perception-Self- According to the mother, her son According to the mother, patient Patient doesn’t show any signs of
Concept Pattern is a jolly and melodious child and stays the same but shows irritable abnormality in his neurological system
used to play a lot but has a bad attitude due to his condition
temper. Whenever her baby is
crying, she initiates to lift and
carry her son for him to stop from NORMAL
crying.
VIII. Role-Relationship According to the mother, patient According to the mother, their only Patient doesn’t show any changes
Pattern is living with her together with his problem is his son because his not in that bothers his family towards his
papa and his sibling a normal state of well being. relationship towards to his family
NORMAL
IX. Sexuality-Reproductive According to the mother, According to the mother, Patient does not show any
Pattern patient doesn’t have any marks patient doesn’t have any presence of abnormalities to his
of abnormalities in genitals. abnormal signs to his genitals. sexuality.
NORMAL

X. Coping Stress Tolerance
Pattern
N/A N/A N/A
XI. Value-Belief Pattern
N/A N/A N/A

o Review of Systems
SYSTEM SUBJECTIVE CUES INTERPRETATION ANALYSIS
Neurological System “ hindi siya ganung makatulog Time- limited interruptions of Disturbed sleep pattern r/t
” as verbalized by the patients sleep amount and quality due to environmental barrier
S.O external factors.

Reference: Reference:
http://healthysleep.med. Doenges, Moorhouse and Murr
harvard.edu/healthy/ Nurse’s Pocket Guide 10th Edition
science/how/external-factors
Respiratory System “nahihirapan siyang huminga Breathing comes naturally and Ineffective airway clearance
dahil sa sipon at ubo niya” as effortlessly to everyone. But there are related to retained secretions
verbalized by the patients S.O some who are incapable of keeping
their airways clear and their lungs Reference:
healthy. Maintaining a patent airway
Nursing Diagnoses, Definitions and
has always been vital to life. When
problem concerning the airway Classifications 2015-2017, 10th
happens, coughing takes place, Edition
which is the main mechanism for
clearing it. However, coughing may
not always be easy to everyone
especially to those patients with
incisions, trauma, respiratory muscle
fatigue, or neuromuscular weakness.

Reference:
https://nurseslabs.com/ineffective-
airway-clearance/

“nahihirapan siyang The state in which the rate, depth, timing, and Ineffective breathing pattern
huminga dahil sa sipon at rhythm, or the pattern of breathing is altered. related to decreased lung
ubo niya” as verbalized by When the breathing pattern is ineffective, the expansion due to air or fluid
the patient’s S.O body is most likely not getting enough oxygen accumulation
to the cells. Respiratory failure may be
correlated with variations in respiratory rate, Reference:
abdominal and thoracic pattern. Nursing Care Plans: Guidelines
for Individualizing Client Care
Reference: Across the Life Span, 8th Edition
https://nurseslabs.com/ineffective-breathing-
pattern/
“nahihirapan siyang Gas is exchanged between the alveoli and the Reference:
huminga dahil sa sipon at pulmonary capillaries via diffusion. Diffusion of Nursing Diagnoses, Definitions and
ubo niya” as verbalized by oxygen and carbon dioxide occurs passively, Classifications 2015-2017, 10th
the patient’s S.O according to their concentration differences across Edition
the alveolar-capillary barrier. These concentration
differences must be maintained by ventilation (air
flow) of the alveoli and perfusion (blood flow) of the
pulmonary capillaries.

Reference:
https://nurseslabs.com/impaired-gas-exchange/
Digestive System “ayaw niya pang dumede Intake of nutrients insufficient to meet daily Imbalanced nutrition less than body
simula nung isang araw pa” requirements because of inadequate food intake or requirement related to inadequate
as verbalized by the patients improper digestion and absorption of food. An food intake
S.O inadequate food intake may be caused by the
inability to acquire or prepare food, inadequate Reference:
knowledge about essential nutrients and a balanced Nursing Care Plans: Guidelines for
diet, discomfort during or after eating, dysphagia, Individualizing Client Care Across
anorexia, nausea, or vomiting. the Life Span, 8th Edition

Reference:
http://nsc-ultimatex.blogspot.com/
2010/11/imbalanced-nutrition-less-than-body.html
“hindi pa siya nakakatae Constipation is a common Constipation r/t insufficient
simula nung naadmit siya” condition that affects people fluid intake
as verbalized by the patients of all ages. It can mean that
S.O you're not passing stools Reference:
regularly or you're unable to Nurse’s Pocket Guide
completely empty your Diagnoses, Prioritized
bowel Interventions, and
Rationales by Doenges 10
Referece: edition
https://www.nhsinform.s
cot/illnesses-and-
conditions/stomach-liver-
and-gastrointestinal-
tract/constipation
Muscular System “ hindi siya ganung

makagalaw dahil hirap din
An individual has insufficient
physiological or psychological
Activity intolerance r/t
imbalanced between oxygen
siyang huminnga ” as energy to endure or complete demand
verbalized by the patients S.O necessary or desired daily
activities Reference:
Reference: Doenges, Moorhouse and
https://www.nursetheory Murr Nurse’s Pocket Guide
.com/activity-intolerance/ 10th Edition

General Survey
• During our interview, February 12, 2019 (WEDNESDAY) 11:00
am, Patient received in a sitting position while carrying by his
mother. Patient have IV contraption in his right hand.
• The Initial vital signs were taken as follows:
• Temperature: 36.8 °C
• Pulse Rate: 129 bpm
• Respiratory Rate: 65 cpm
• O2 Saturation: 91 %
• Height: 29.3” Weight: 9 kg BMI: 16.25

o Physical Assessment

o Course in the Ward

DATE AND TIME DOCTORS ORDER NURSING RESPONSIBILITIES PATIENTS EVALUATION
February 12,
2019 • Hooked L D5LMS 1000ml to run for • Make sure to check IV if regulated properly • Patient has no complaint
0300H 24 hours. and monitor IV site for signs of swelling. regarding the IV infusion.

• Diagnosis: CBC PC, CXR • Explain to the patient and patient’s family • The patient and client’s family
what the purpose of these procedures is. understood the needed
Ensure appropriate and proper collection of laboratory procedure and

specimen cooperated with the healthcare
provider
Medications:

• Penicillin G 250000 uts • Assess the 14 rights of giving medications.
Review of medications. Monitor the • The patient received the
condition of patient for any adverse effects medication on time no adverse
of the medications administered. reactions noted.

• Paracetamol 100mg TIV every 4 • Assess the 14 rights of giving medications.

hours for temp >37.8˚C Review of medications. Monitor the • The patient received the


• Salbutamol every 4 hours • Assess the 14 rights of giving medications.
Review of medications. Monitor the • The patient received the


• Monitor vital sign every 4 hours • Strictly monitor the vital signs of the patient
for any signs of abnormalities • The patient cooperated with the
healthcare provider in getting his
1705H vital signs.
• Transfer to Ward 4 • Secure consent for admission. Make sure

that the patient will admitted in the said ward The patient is comfortable in the
ward.

Receiving Notes:
February 13,
2019  Patient was seen and examined.  Ensure to document the findings, onset and  The patient and SO cooperate
0300H time. with the examination done.

 History and PE done  Ensure to document the findings, onset and  Patient’s SO clearly discussed
time. the history of the patient and

cooperated with the health

provider in getting physical
exam to the patient.

 Continue present medication.  Continue monitor the patient’s condition.  The patient received the
medication on time no adverse
reactions noted.

 For referral to optha  Secure consent from patient’s guardian and  The patient’s SO understood
the date of the referral for ophtha. the needs of the patient to be
reffered to ophtha.

 Monitor Vital Sign every 4 hours  Strictly monitor the vital signs of the  The patient cooperated with
and record. patient for any signs of abnormalities the healthcare provider in
getting his vital signs.

 Monitor input and output and record  Strictly monitor input and output of the  The SO cooperated with the
patient for any signs of abnormalities healthcare provider in getting
his input and output.

 Continue erythromycin ointment,  Check doctors order and number of drops  Patient and SO cooperated
apply 7x a day on both eyes to be administer. with the procedure.

 Infuse Intravenous fluids and D50  Make sure to check IV if regulated  Patient has no complaint
NaCl 600cc to run for 6 hours. properly and monitor IV site for signs of regarding the IV infusion.
swelling,


1600H  Penicillin G 500000 TIV every • Assess the 14 rights of giving  The client received the
6 hours. medications. Review of medication on time no
medications. Monitor the adverse reactions noted.
condition of patient for any
adverse effects of the medications
administered. Make sure to check
IV if regulated properly and
monitor IV site for signs of
swelling.

 Administer O2 via inhalation  Ensure the correct amount of  The patient received the
6Lpm oxygen to be infused to patient right amount of oxygen.
and position the client in a
semi fowler or fowler’s
position.

 Administer Ceterizine  Assess the 14 rights of giving  The patient received
5mg/5ml/2.5ml once a day at medications. Review of medication on time with no
night. medications. Monitor the adverse reaction noted.
condition of patient for any
adverse effects of the
medications administered


February 14, • For trial feeding with strict • Strictly monitor the feeding and • Patient has been feed
2019 aspiration advised the SO to call nurse if there without experiencing
0200H is any problem with the patient aspiration.

during feeding.

• IVF to follow: D5LMB 1000ml • Make sure to check IV if regulated • Patient has no complaint
to run for 24 hours properly and monitor IV site for signs regarding the IV infusion
of swelling

o Laboratory and Diagnostics
Patient Name: C
Hospital Number: 03817015
Type: In-patient – Department of GYNE – GYNECOLOGY
WARD
Age: 32 years old
Requesting Physician:
Sex: F
Routine Order Date: June 12, 2018 7:32:13 PM
Result Date: June 12, 2018 10:17:22 PM

o Differential Diagnostics
Signs & Symptoms Pneumonia Chronic obstructive Pulmonary Embolism Lung Cancer
pulmonary disease
(COPD)
Shortness of breath / / / /
Fatigue / / / /
Cough / / / /
Nausea/Vomiting / x x x
Tachypnea / / / /
Chest Pain / / / /
Myalgia / x x /
Shaking chills / / x x
Rhonchi/rales / / / x

• Pneumonia is an infection in one or both lungs. It can be caused by bacteria, viruses, or fungi.
Pneumonia causes inflammation in the air sacs in your lungs, which are called alveoli. The alveoli fill
with fluid or pus, making it difficult to breathe.Pneumonia is the most common cause of death from
infectious diseases in the United States. It is the seventh leading cause
• of death in the United States for all ages and both genders, resulting in almost 70,000 deaths per
year. In persons 65 years of age and older, it is the fifth leading cause of death (National Center for
Health Statistics, 2016; Minino & Smith, 2017).
• Chronic Obstructive Pulmonary Disease (COPD) is a lung disease characterized by chronic

obstruction of lung airflow that interferes with normal breathing and is not fully reversible. It is an
umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis,
and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness.
COPD is not simply a "smoker's cough" but an under-diagnosed, life-threatening lung disease.
• Lung cancer, also known as lung carcinoma, is a malignant lung tumor characterized by
uncontrolled cell growth in tissues of the lung. This growth can spread beyond the lung by the
process of metastasis into nearby tissue or other parts of the body. Most cancers that start in the
lung, known as primary lung cancers, are carcinomas. The two main types are small-cell lung
carcinoma (SCLC) and non-small-cell lung carcinoma (NSCLC). The vast majority (85%) of cases of
lung cancer are due to long-term tobacco smoking. About 10–15% of cases occur in people who
have never smoked. These cases are often caused by a combination of genetic factors and
exposure to radon gas, asbestos, second-hand smoke, or other forms of air pollution.

• Reference: Brunners and Suddarths Textbook Medical Surgical Nursing 10th Edition, Vol.1

o Anatomy and Physiology
• The respiratory system is situated in the thorax, and is responsible

for gaseous exchange between the circulatory system and the
outside world. Air is taken in via the upper airways (the nasal cavity,
pharynx and larynx) through the lower airways (trachea,primary
bronchi and bronchial tree) and into the small bronchioles and
alveoli within the lung tissue.
• The lungs are divided into lobes; The left lung is composed of the
upper lobe, the lower lobe and the lingula (a small remnant next to
the apex of the heart), the right lung is composed of the upper, the
middle and the lower lobes.
Mechanics of Breathing
• To take a breath in, the external intercostal muscles contract, moving the ribcage up and out. The
diaphragm moves down at the same time, creating negative pressure within the thorax. The lungs
are held to the thoracic wall by the pleural membranes, and so expand outwards as well. This
creates negative pressure within the lungs, and so air rushes in through the upper and lower
airways.
• Expiration is mainly due to the natural elasticity of the lungs, which tend to collapse if they are not
held against the thoracic wall. This is the mechanism behind lung collapse if there is air in the
pleural space ( pneumothorax).
Physiology of Gas Exchange

• Each branch of the bronchial tree eventually sub-divides to form very narrow terminal
bronchioles, which terminate in the alveoli. There are millions of alveloi in each lung, and these
are the areas responsible for gaseous exchange, presenting a massive surface area for
exchange to occur over.
• Each alveolus is very closely associated with a network of capillaries containing deoxygenated
blood from the pulmonary artery. The capillary and alveolar walls are very thin, allowing rapid
exchange of gases by passive diffusion along concentration gradients.
• CO2 moves into the alveolus as the concentration is much lower in the alveolus than in the blood,
and O2 moves out of the alveolus as the continuous flow of blood through the capillaries prevents
saturation of the blood with O2 and allows maximal transfer across the membrane.

Significant Parts and organs involved:
• The nose consists of the visible external nose and the internal nasal cavity. The nasal septum
divides the nasal cavity into right and left sides. Air enters two openings, the external nares
(nostrils; singular, naris), and passes into vestibule and through passages called meatuses. The
bony walls of the meatuses, called concha, are formed by facial bones (the inferior nasal concha
and the ethmoid bone). From the meatuses, air then funnels into two (left and right) internal
nares. Hair, mucus, blood capillaries, and cilia that line the nasal cavity filter, moisten, warm, and
eliminate debris from the passing air.
• The pharynx (throat) consists of the following three regions, listed in order through which
incoming air passes
• The nasopharynx receives the incoming air from the two internal nares. The two auditory tubes
that equalize air pressure in the middle ear also enter here. The pharyngeal tonsil (adenoid) lies
at the back of the nasopharynx.
• The oropharyrnx receives air from the nasopharynx and food from the oral cavity. The palatine
and lingual tonsils are located here.
• The laryngopharynx passes food to the esophagus and air to the larynx.
• The larynx receives air from the laryngopharynx. It consists of several pieces of cartilage that are
joined by membranes and ligaments.
• The epiglottis, the first piece of cartilage of the larynx, is a flexible flap covers the glottis, the
upper region of the larynx, during swallowing toprevent the entrance of food.

• The thyroid cartilage protects the front of the larynx. A forward projection of this cartilage appears
as the Adam's apple (anatomically known as the laryngeal prominence).
• The paired arytenoid cartilages in the rear are horizontally attached to thethyroid cartilage in the
front by folds of mucous membranes. The upper vestibular folds (false vocal cords) contain
muscle fibers that bring the folds together and allow the breath to be held during periods of
muscular pressure on the thoracic cavity (straining while defecating or lifting a heavy object, for
example). The lower vocal folds (true vocal cords) contain elastic ligaments that vibrate when
skeletal muscles move them into the path of outgoing air. Various sounds, including speech, are
produced in this manner.
• The cricoid cartilage, the paired cuneiform cartilages, and the paired corniculate cartilages are the
remaining cartilages supporting the larynx.
•
• The trachea (windpipe) is a flexible tube, 10 to 12 cm (4 inches) long and 2.5 cm (1 inch) in
diameter.
• The mucosa is the inner layer of the trachea. It contains mucus-producing goblet cells and
pseudostratified ciliated epithelium. The movement of the cilia sweeps debris away from the lungs
toward the pharynx.
• The submucosa is a layer of areolar connective tissue that surrounds the mucosa.
• Hyaline cartilage forms 16 to 20 C-shaped rings that wrap around the submucosa. The rigid rings
prevent the trachea from collapsing during inspiration.
• The adventitia is the outermost layer of the trachea. It consists of areolar connective tissue.

• The primary bronchi are two tubes that branch from the
trachea to the left and right lungs.
• Inside the lungs, each primary bronchus divides repeatedly into
branches of smaller diameters, forming secondary (lobar)
bronchi, tertiary (segmental) bronchi, and numerous orders of
bronchioles (1 mm or less in diameter), including terminal
bronchioles (0.5 mm in diameter) and microscopic respiratory
bronchioles. The wall of the primary bronchi is constructed like
the trachea, but as the branches of the tree get smaller, the
cartilaginous rings and the mucosa are replaced by smooth
muscle.
• Alveolar ducts are the final branches of the bronchial tree.
Each alveolar duct has enlarged, bubble like swellings along its
length. Each swelling is called an alveolus. Some adjacent
alveoli are connected by alveolar pores.

The respiratory membrane consists of the alveolar and capillary walls. Gas
exchange occurs across this membrane. Characteristics of this membrane follow:
• Type I cells are thin, squamous epithelial cells that constitute the primary cell
type of the alveolar wall. Oxygen diffusion occurs across these cells.
• Type II cells are cuboidal epithelial cells that are interspersed among the type I
cells. Type II cells secrete pulmonary surfactant (a phospholipid bound to a
protein) that reduces the surface tension of the moisture that covers the alveolar
walls. A reduction in surface tension permits oxygen to diffuse more easily into
the moisture. A lower surface tension also prevents the moisture on opposite
walls of an alveolus or alveolar duct from cohering and causing the minute
airway to collapse.
• Alveolar macrophage cells (dust cells) wander among the other cells of the
alveolar wall, removing debris and microorganisms.
• A thin epithelial basement membrane forms the outer layer of the alveolar wall.
• A dense network of capillaries surrounds each alveolus. The capillary walls
consist of endothelial cells surrounded by a thin basement membrane. The
basement membranes of the alveolus and the capillary are often so close that
they fuse.

o Pathophysiology

o Medical Management

NURSING PRIORITIZATION

• 1. Ineffective airway clearance related to retained secretions

• 2. Ineffective breathing pattern related to decreased lung expansion
due to air of fluid accumulation

• 3. Impaired gas exchange related to tissue perfusion as evidenced by
91% O2 Sat

• 4. Imbalanced nutrition less than body requirement related to
inadequate food intake

• 5. Disturbed sleep pattern related to environmental barrier

o Nursing Management

o Discharge Plan
• Instruct and explain to the patient that the prescribed medications are very important to
MEDICATION be sustained at home until the duration of physician’s order for the patient’s optimum
recovery.
• Orient the patient about the drug prescribed, the name of drugs, their actions, exact
dosage, and route of administration, the frequency and when the drugs should be taken.
• Encourage to report immediately if any unusual observations occurred when taking the
drugs.
• Instruct the patient to avoid all other medications including OTC (over the counter) and
complementary drugs without checking their prescriber first.
• Inform the client regarding the following medications:

• Paracetamol 500mg/tab for fever
• Salbutamol 5mg, four times a day
EXERCISE • Lessen extraneous activity or what patient is only can tolerate
• Instruct the patient to comply with the physician’s order.

TREATMENT • Fill a humidifier with warm water and have your child breathe in the warm mist.

• Educate the patient about the importance of each drugs taking by the
HEALTH client.
• Inform the patient about the side effects as well the adverse effects
TEACHING that are expected with the prescribed drugs.
• Instruct the mother to clear her child’s nose mucus to clear the
airway
• Instruct the mother to always elevate the child’s head for effective
breathing
• Instruct the mother to bottle feed or breastfeed the child smaller
amounts more often because they may become tired easily when
feeding.
• Instruct the mother to give her child liquids as directed. Liquids help
her child to loosen mucus and keeps him or her from becoming
dehydrated
OUT PATIENT  Instruct the patient to continue follow up check up to the physician.

DIET
• Drink plenty of pure filtered water
• Give patient veggie soups, miso soup, preferably soaked nuts
and seeds, organic, free-range meats, poultry, and fish.
• Avoid eating foods that you are allergic or sensitive to
• Avoid sugar and sugar products, including an excess of sweet
fruits
• Offer breast milk or formula if your child is younger than 12
months.
SPIRITUALITY  Encourage to continue to pray in God.
 Encourage to continue to seek God’s guidance and enlightenment.
 Encourage to keep faith in God and not give up easily when hard times come.

ONE DAY MEAL PLAN MORNING SNACK: Soft fruit
BREAKFAST: Formula Milk like chopped banana
Formula milk Total banana Total
Calories 43 kcal 43 kcal Calories 105 kcal 105 kcal
Total Fats 2.2g 2.2g Total Fats 0.4g 0.4g
Sodium 12mg 12mg Sodium 1.2mg 1.2mg
Potassium 46mg 46mg Potassium 422mg 422mg
Carbohydrates 4.7g 4.7g Carbohydrates 27g 27g
Protein 0.9g 0.9g Protein 1.3g 1.3g
Vitamin A 2.6% 2.6% Vitamin A 1.5% 1.5%
Vitamin C 8.6% 8.6% Vitamin C 17% 17%
Calcium 2.6% 2.6% Calcium 0.5% 0.5%
Iron 4.3% 4.3% Iron 1.7% 1.7%
Servings 1 cup Servings 1 ripe banana

LUNCH: Cereals with milk
SNACKS: Formula milk
Cereal Formula milk Total Formula milk Total
Calories 105 kcal 43 kcal 148 kcal
Calories 43 kcal 43 kcal

Total Fats 0.4g 2.2g 2.6g
Total Fats 2.2g 2.2g

Sodium 139mg 12mg 151mg
Sodium 12mg 12mg
Potassium 179mg 46mg 225mg
Potassium 46mg 46mg
Carbohydrates 21g 4.7g 25.7g
Carbohydrates 4.7g 4.7g
Protein 3.4g 0.9g 4.3g
Vitamin A 18% 2.6% 20.6% Protein 0.9g 0.9g
Vitamin A 2.6% 2.6%

Vitamin C 10% 8.6% 18.6%
Vitamin C 8.6% 8.6%
Calcium 8.6% 2.6% 11.2%
Calcium 2.6% 2.6%
Iron 52% 4.3% 56.3%
Iron 4.3% 4.3%
Servings 1 cup 1 cup
Servings 1 cup

DINNER: Cereals with formula milk
Cereal Formula Total
milk
Calories 105 kcal 43 kcal 148 kcal
Total Fats 0.4g 2.2g 2.6g
Sodium 139mg 12mg 151mg
Potassium 179mg 46mg 225mg
Carbohydra 21g 4.7g 25.7g

tes
Protein 3.4g 0.9g 4.3g
Vitamin A 18% 2.6% 20.6%
Vitamin C 10% 8.6% 18.6%
Calcium 8.6% 2.6% 11.2%
Iron 52% 4.3% 56.3%
Servings 1 cup 1 cup

TOTAL NUTRIENT INTAKE IN ONE DAY:
Total Total
Calories 487 kcal Calories 720 kcal
Total Fats 10g Total Fats 30-40 g
Sodium 327.2mg Sodium 200mg
Potassium 964mg Potassium 700mg
Carbohydrates 87.8g Carbohydrates 45-62g
Protein 11.7g Protein 17g
Vitamin A 47.9% Vitamin A 400μg
Vitamin C 71.4% Vitamin C 40mg
Calcium 28.1% Calcium 400mg
Iron 151% Iron 10mg

o Evaluation
• The objectives of this case study were met. During the course of making the case study
the students were able to gain knowledge and experience from it which plays a huge
role in molding competitive and passionate nurses in the near future. This case study
allowed each member to deepen their knowledge about pneumonia. The disease have
been defined and explained in a clear and concise manner. The etiology, risk factors,
complications, predisposing factors, signs and symptoms have been identified and
explained in a comprehensive manner. The group was able to gather the needed
information and was able to formulate an appropriate care plan. Their communication
skills and critical thinking were also improved in the course of making the case study.
They were also able to set aside personal differences to work together as a team. Each
member was able to take part in the making of the said case study.
• The purpose of the case study which is to learn from and also to impart knowledge and
to raise awareness about pneumonia has been clearly emphasized by the students.
The group was able to provide awareness and instill knowledge about the said disease
to readers by conducting the study. A well –formulated and patient based care plan
has been made and the students were able to gain experience, skills and knowledge
vital for their nursing career

11 Months Old Male with Pneumonia

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11 Months Old Male with Pneumonia

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A CASE OF AN 11 MONTHS

OLD MALE WITH

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

 Ineffective breathing pattern

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

XI. Value-Belief Pattern

N/A N/A N/A

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

Muscular System “ hindi siya ganung

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

• Transfer to Ward 4 • Secure consent for admission. Make sure

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

• Chronic Obstructive Pulmonary Disease (COPD) is a lung disease characterized by chronic

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

• The respiratory system is situated in the thorax, and is responsible

Physiology of Gas Exchange

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

• Inform the client regarding the following medications:

EXERCISE • Lessen extraneous activity or what patient is only can tolerate

• Instruct the patient to comply with the physician’s order.

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

SPIRITUALITY  Encourage to continue to pray in God.

 Encourage to continue to seek God’s guidance and enlightenment.

RESILIENCE COMPETENCE CREATIVITY SOCIAL RESPONSIBILITY

Calories 43 kcal 43 kcal Calories 105 kcal 105 kcal

Total Fats 2.2g 2.2g Total Fats 0.4g 0.4g

Sodium 12mg 12mg Sodium 1.2mg 1.2mg

Potassium 46mg 46mg Potassium 422mg 422mg

Carbohydrates 4.7g 4.7g Carbohydrates 27g 27g

Protein 0.9g 0.9g Protein 1.3g 1.3g

Vitamin A 2.6% 2.6% Vitamin A 1.5% 1.5%

Vitamin C 8.6% 8.6% Vitamin C 17% 17%

Calcium 2.6% 2.6% Calcium 0.5% 0.5%

Iron 4.3% 4.3% Iron 1.7% 1.7%