Pneumonia

ROMERO, PAMELA
SANCHEZ, DIANE
 K.B. is a 2 year old female with a chief complaint of
cough and difficulty of breathing for one week and fever for
three days prior to admission. One week prior to admission,
K.B. had positive signs and symptoms of cough and
yellowish phlegm with fever, three days before admission.
Her mother knowing that these signs and symptoms were just
the usual cough that her daughter had, however, she noticed
Case no changes so she decided of pneumonia and because of the
severity of the condition, she was admitted. She was given
Scenario: initial medications and had her for further observations and
laboratory exams. According to her mother, she frequently
had colds which were almost every month. She said that her
daughter only had BCG vaccine. She never brought her
daughter back for other immunization. Every time her
daughter got sick, she would ask medicines from their
Barangay Health Center. Sometimes they would result using
boiled oregano leaves for her cough.
Physical Assessment
The patient is awake and sitting on bed. There is no noticeable physical
deformity or abnormalities. Her size is appropriate to her age. There is observable
difficulty of breathing and coughing. She seemed to be irritable and exhausted
from crying
VITAL SIGNS: LABORATORY EVALUATION:

T: 37.2 °C, Hematology Report

RR: 56 cpm Examination Requested: CBC
PR: 140 bpm Hemoglobin (Hgb): 128 g/L
Weight: 9.3 kgs Hematocrit (Hct) : 0.39 %
Height: 71.12 cms White Cell Count: 5.9 cells/L

Differential Count:
Segmenters: 0.64
Lymphocytes: 0.36
 Chief Complaint: Cough and difficulty of breathing for one week, fever
for three days prior to admission

History of present illness: One week prior to admission, K. B. had

Nursing positive signs and symptoms of cough and yellowish phlegm with fever,
three days before admission. Her mother knowing that these signs and
History symptoms were just the usual cough that her daughter had, however, she
noticed no changes so she decided of pneumonia and because of the
severity of the condition, she was admitted.

History of past illness: According to her mother she said that K.B only
had BCG vaccine. She never brought her daughter back for other
immunization. And she said that her daughter frequently had colds which
were almost every month.
 Introduction
Pneumonia is an inflammation of the lung parenchyma
caused by various microorganisms, including bacteria,
mycobacteria, fungi, and viruses. Pneumonias are classified
as community- acquired pneumonia (CAP), hospital-
acquired (nosocomial) pneumonia (HAP), pneumonia in
the immunocompromised host, and aspiration pneumonia.
There is overlap in how specific pneumonias are classified,
because they may occur in differing settings. Those at risk
for pneumonia often have chronic underlying disorders,
severe acute illness, a suppressed immune system from
disease or medications, immobility, and other factors that
interfere with normal lung protective mechanisms. The
elderly are also at high risk. (Brunner, 2018)
 Pneumonia accounts for 15% of all deaths of
children under 5 years old, killing 808 694
children in 2017.
 Pneumonia can be caused by viruses, bacteria, or
fungi.
 Pneumonia can be prevented by immunization,
adequate nutrition, and by addressing
environmental factors.
 Pneumonia caused by bacteria can be treated
with antibiotics, but only one third of children
with pneumonia receive the antibiotics they
need. (WHO 2019)
Pathophysiology
 Hematology Report
Examination Requested: CBC
Hemoglobin (Hgb): 128 g/dL
Hematocrit (Hct) : 0.39 %
White Cell Count: 5.9 %

Laboratory Differential Count:

Segmenters: 0.64
Lymphocytes: 0.36
and  
Physical examination. During the exam, the physician listens to

Diagnostic patient's lungs with a stethoscope to check for abnormal bubbling or

cracking sounds and rumblings (rhonchi) that signal the presence of

Procedure
thick liquid.
Chest x rays. X rays can confirm the presence of pneumonia and
determine the extent and location of the infection.
Blood and mucus tests. The patient may have a blood test to
measure the white cell and look for the presence of viruses, bacteria
or other organisms. The physician also may examine a sample of the
mucus or the blood to help identify the particular microorganisms
that’s causing the patient’s illness.
Gram’s stain and culture of the sputum for the organism causing the
symptoms
Medical Management
• Antibiotics are prescribed on the basis of Gram stain results and antibiotic guidelines (resistance patterns,
risk factors, etiology must be considered). Combination therapy may also be used.
• Supportive treatment includes hydration, antipyretics, anti- tussive medications, antihistamines, or nasal
decongestants.
• Oxygen therapy is given for hypoxemia.

• Respiratory support includes high inspiratory oxygen concentrations, endotracheal intubation, and
mechanical ventilation.
• Treatment of atelectasis, pleural effusion, shock, respiratory failure, or superinfection is instituted, if
needed.
• For groups at high risk for CAP, pneumococcal vaccination is advised.
NURSING MANAGEMENT
Nurses are expected to perform both
dependent and independent functions for the
patient to aid him or her towards the
restoration of their well-being.
NURSING ASSESSMENT
Nursing assessment is critical in detecting pneumonia. Here are
some tips for your nursing assessment for pneumonia.
 Assess respiratory symptoms. Symptoms of fever, chills, or
night sweats in a patient should be reported immediately to the
nurse as these can be signs of bacterial pneumonia.
 Assess clinical manifestations. Respiratory assessment should
further identify clinical manifestations such as pleuritic pain,
bradycardia, tachypnea, and fatigue, use of accessory muscles
for breathing, coughing, and purulent sputum.
 Physical assessment. Assess the changes in temperature and
pulse; amount, odor, and color of secretions; frequency and
severity of cough; degree of tachypnea or shortness of breath;
and changes in the chest x-ray findings.
ASSESSMEN DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
T
Subjective Data:  Ineffective airway  Within 8 hours of nursing Independent: Tachypnea, shallow respirations and asymmetric chest movement After 8 hours of nursing
clearance related to intervention the client will Assess rate/depth of respirations and chest are frequently present because of discomfort of moving chest wall intervention the client was
“Nahihirapan able to: able to
increased sputum movement. and /or fluid in lung.
siyang huminga" Maintain airway patency Maintained airway patency
production in response to        
as verbalized by respiratory infection Demonstrate reduction of Auscultate lung fields, noting areas of Decreased airflow occurs in areas consolidated with fluid. Demonstrated reduction of
congestion with breath decreased/absent airflow and adventitious Bronchial breath sounds (normal over bronchus) can also occur in congestion with breath
the mother of the sounds clear, respirations breath sounds, e.g., crackles, wheezes. consolidated area. Crackles, rhonchi, and wheezes are heard on sounds clear, respirations
patient noiseless, improve oxygen   inspiration and/or expiration in response to fluid accumulation, noiseless, improve oxygen
exchange
  thick secretions and airway spasm/obstruction. exchange
Objective Data:    
Elevate head of bed, change position Lowers diaphragm, promoting chest expansion, aeration of lungs Goal met
-The patient is frequently. segments, mobilizations and expectoration of secretions.
coughing having  
Suction as indicated, (e.g., frequent or sustain Stimulates cough or mechanically clears airway in patient who is
difficulty of cough, adventitious breath sounds, unable to do so because of ineffective cough or decreased level of
breathing, with desaturation related to airway secretions). consciousness.
few secretions in    
Force fluids to at least 3000 mL/day (unless Fluids (especially warm liquids) aid in mobilization and
her nostrils contraindicated, as in heart failure). Offer expectoration of secretions.
-With series of warm, rather than cold, fluids.
productive cough Assist with/monitor effects of nebulizer Facilitates liquefaction and removal of secretions. Postural drainage
  treatments and other respiratory may not be effective in interstitial pneumonias or those causing
physiotherapy, e.g incentive spirometer, IPPB,
-Vital Signs: percussion, postural drainage. Perform
alveolar exudate/destruction. Coordination of treatments/schedule
and oral intake reduces likelihood of vomiting with coughing
RR; 56 cpm treatments between meals and limit fluids expectorations.
PR: 140 bpm when appropriate.  
 
T: 37.2 °C,  
 
Height: 71.12 cms. Dependent:
Aids in reduction of bronchospasm and mobilization of secretions.
Administer medications as indicated:
Weight: 9.3 kgs. Analgesics are given to improve cough effort by reducing
mucolytic, expectorants, bronchodilators,
  discomfort, but should be used cautiously because they can
analgesics.
decrease cough effort/depress respiration.
Provide supplemental fluids, e.g., IV,  
humidified oxygen, and room humiliation. Fluids are required to replace losses (including insensible) and aid
  in mobilization of secretions.
GENERIC NAME MECHANISM INDICATION CONTRAINDICATION ADVERSE NURSING RESPONSIBILITY
OF ACTION EFFECT

Acetaminophen Antipyretics: Common cold Contraindicated with CNS: headache Before:

Reduces fever flu, other viral allergy to acetaminophen Advice parents or caregivers to
BRAND NAME: by acting and bacterial Use cautiously with CV: chest pain, check concentration of liquid
Tylenol, directly on the infection with impaired hepatic function dyspnea, preparation errors have resulted in
Paracetamol hypothalamic pain and fever myocardial serious liver damage.
heat regulating damage when
CLASSIFICATIO center to cause doses of Assess Fever: Note presence of
N: vasodilation and 58g/day are associated signs (diaphoresis
Antipyretics, sweating, which ingested daily tachycardia and malaise).
analgesics helps dissipate for several
heat. weeks or when Take the drug only for complains
DOSAGE, doses of 4g/day indicated: it is not an anti-
FREQUENCY, Analgesics: are ingested for inflammatory agent
ROUTE: Site and 1yr
-PO or PR mechanism of During:
-Doses may be action unclear Hematologic: Consult the physician if needed
repeated 4-5 hematuria, for children < 3yrs.; if needed for
times/day; do not anuria, longer 10 days; if continued fever
exceed five doses in neutropenia, severe or recurrent pain occur
24 hr; give PO or leukopenia,
by suppository thrombocytopen Advise mother or caregiver to
ia take medication exactly as
Age Dosage directed and not to take more than
(mg) Metabolic: the recommended amount.
0-3 40 hypoglycemia
4-11 80 Give drug with food if GI upset
12-23 120 GI: hepatic occurs.
2-3 yr. 160 failure: After:
4-5 yr. 240 Hepatotoxicity Advise parents to consult health
6-8 yr. 320 (overdose) care professional if discomfort of
9-10 yr. 400 jaundice. fever is not relieved by routine
11 yr. 480 doses of this drugs of if fever is
GU: acute renal greater than 39.5 °C
failure (high
doses/chronic Discontinue drug if
use) hypersensitivity reaction occur.

Derm: rash Report rash, bruising, yellowing

urticaria of skin or eyes, changes in
voiding patterns
 Discharge Plan (health teachings)
Take the entire course of any prescribed
medications. After a patient's
temperature returns to normal,
medication must be continued according
to the doctor's instructions, otherwise the
pneumonia may recur. Relapses can be
far more serious than the first attack.
Encourage the guardians to wash
patient's hands. The hands come in daily
contact with germs that can cause
pneumonia. These germs enter one's
body when he touch his eyes or rub his
nose. Washing hands thoroughly and
often can help reduce the risk.
Drink lots of fluids, especially water. Keep all of follow up appointments.
Get plenty of rest. Adequate rest is
Liquids will keep patient from becoming Even though the patients feel better, his
important to maintain progress toward
dehydrated and help loosen mucus in the lungs may still be infected. It's important
full recovery and to avoid relapse.
lungs. to have the doctor monitor his progress.
Protect others from infections. Try to
Tell guardians to avoid exposing the
stay away from anyone with a
patient to an environment with too much Give supportive treatment. Proper diet
compromised immune system. When
pollution (e.g. smoke). Smoking and oxygen to increase oxygen in the
that isn't possible, a person can help
damages one's lungs natural defenses blood when needed.
protect others by wearing a face mask
against respiratory infections.
and always coughing into a tissue.