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GENERAL OBJECTIVE:

To be able to acquire reliable information about Pneumonia in order for us students to

become knowledgeable ;be able to demonstrate competent nursing care that will address
our patients condition ; and to demonstrate right attitude as member of the health care
team.

SPECIFIC OBJECTIVES:

To obtain pertinent information about the the patients demographic and socioeconomic profile.

To be well informed on the clients history including the past and present illness.

To be familiar with the structures and normal function of the body organs involved..

To gain knowledge about the underlying causes and factors of the clients diagnosis.

To be able to formulate and establish appropriate nursing care plan that will help
improve our clients condition.

To be familiar with some of the clients medications which includes both therapeutic
and the adverse effects.

As heath care providers, it is important to know and understand more about of this case
for better provision of care to clients, for more sufficient and adequate health
educations/teachings for the patient, and to protect ourselves from possible transmission of
this disease while working on clients with this case. Moreover, the importance of this study
is also to continually challenge the students to expand their scope to meet the needs of the
patient with pulmonary disease. The purpose of this paper is to enable the readers to
enhance their knowledge of normal pulmonary function and apply it to abnormal situations
when assessing, applying and evaluating therapeutic care. Patient observation and
recognition of the signs and symptoms of pneumonia are the keys to recognizing abnormal
function. The ability of the clinical students to participate, recognize and intervene to treat
pneumonia may prevent or modify complications.

PATIENTS PROFILE:

Name: J. D.
Age: 1 y/o
Birthday: October 15, 2009
Address: Calasiao, Pangasinan
Sex: Male
Religion: Roman Catholic
Nationality: Filipino Citizen
Attending Physician: Dr. Fama
Diagnosis: Pneumonia (PCAP-C)

History of Past and Present Illness:

John Domagas, a 1 year old male from Calasiao , Pangasinan was admitted at
Pangasinan Provincial Hospital last January 10, 2011 @ 9:30 pm with the chief complaints of
fever and cough that started 2 weeks ago.
The patient has no previous history of hospitalization and operations.

Family History:

They have a history of Hypertension, diabetes, and asthma on his mother side.

Environmental history:

They are living in a barangay. They have their own toilet and bathroom. For their garbage
disposal, they usually burn them. They have lots of plants that surround their house.
Patient is fond of playing outside with his cousins.

INTRODUCTION:

The inflammation of the lung parenchyma (the respiratory bronchioles and alveoli) is
known as Pneumonia. Frequently, it is described as lung parenchyma/alveolar inflammation
and abnormal alveolar filling with fluid. The alveoli are microscopic air-filled sacs in the lungs
responsible for absorbing oxygen from the atmosphere. Pneumonia can result from a variety
of causes, including infection with bacteria, viruses, fungi, or parasites, and chemical or
physical injury to the lungs.
Pneumonia often classified as community acquired, nosocomial (hospital acquired),
or opportunistic. The most common causative organism for community acquired pneumonia
is Streptococcus pneumoniae (also called pneumococcus), a gram- positive bacterium. This
organism causes 70% to 75% of all diagnosed cases of pneumonia. Mycoplasma
pneumoniae, Haemophilus influenzae, and in the influenza virus are also leading cause of
community-acquired pneumonia. Staphylococcus aureus and gram-negative bacteria such
as

Klebsiella

pneumoniae,

Pseudomonas

aeruginosa,

and

enteric

bacilli,

including

Escherichia coli, are often implicated as nosocomial causes of pneumonia. Organisms such
as Pnuemonocystis carinii generally cause infections only in immuno-compromised people
(opportunistic infections).

NORMAL ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY SYSTEM:

In anatomy and physiology, the Respiratory system, is a system that delivers oxygen
to the circulatory system and transport it to all body cells. Oxygen is essential for cells,
which use this vital substance to liberate the energy needed for cellular activities. In addition
to supplying oxygen, the respiratory system aids in removing of carbon dioxide, preventing
the lethal buildup of this waste product in body tissues. Everyday without the prompt of
conscious thought, the respiratory system carries out its life-sustaining activities. If the
respiratory systems tasks are interrupted for more than a few minutes, serious, irreversible
damage to tissues occurs, followed by the failure of all body systems, and ultimately, death.
While the intake of oxygen and removal of carbon dioxide are the primary functions
of the respiratory system, it plays other important roles in the body. The respiratory system
helps regulate the balance of acid and base in tissues, a process crucial for the normal
functioning of cells. It protects the body against disease-causing organisms and toxic
substances inhaled with air. The respiratory system also houses the cells that detect smell,
and assists in the production of sounds for speech.
The respiratory and circulatory systems work together to deliver oxygen to cells and
remove carbon dioxide in a two-phase process called respiration. The first phase of
respiration begins with breathing in, or inhalation. Inhalation brings air from outside the
body into the lungs. Oxygen in the air moves from the lungs through blood vessels to the
heart, which pumps the oxygen-rich blood to all parts of the body. Oxygen then moves from
the bloodstream into cells, which completes the first phase of respiration. In the cells,
oxygen is used in a separate energy-producing process called cellular respiration, which
produces carbon dioxide as a byproduct. The second phase of respiration begins with the
movement of carbon dioxide from the cells to the bloodstream. The bloodstream carries
carbon dioxide to the heart, which pumps the carbon dioxide-laden blood to the lungs. In the
lungs, breathing out, or exhalation, removes carbon dioxide from the body, thus completing
the respiration cycle.
Structure
The organs of the respiratory system extend from the nose to the lungs and are
divided into the upper and lower respiratory tracts. The upper respiratory tract consists of
the nose and the pharynx, or throat. The lower respiratory tract includes the larynx, or voice
box; the trachea, or windpipe, which splits into two main branches called bronchi; tiny
branches of the bronchi called bronchioles; and the lungs, a pair of saclike, spongy organs.
The nose, pharynx, larynx, trachea, bronchi, and bronchioles conduct air to and from the
lungs. The lungs interact with the circulatory system to deliver oxygen and remove carbon
dioxide.

A. Nasal passages

The nose is uppermost portion of the human respiratory system, and is a hollow air
passage that functions in breathing and for the sense of smell. The nasal cavity moistens

and warms incoming air, while small hairs and mucus filter out harmful particles and
microorganisms. The flow of air from outside of the body to the lungs begins with the nose,
which is divided into the left and right nasal passages. The nasal passages are lined with a
membrane composed primarily of one layer of flat, closely packed cells called epithelial
cells. Each epithelial cell is densely fringed with thousands of microscopic cilia, fingerlike
extensions of the cells. Interspersed among the epithelial cells are goblet cells, specialized
cells that produce mucus, a sticky, thick, moist fluid that coats the epithelial cells and the
cilia. Numerous tiny blood vessels called capillaries lie just under the mucous membrane,
near the surface of the nasal passages. While transporting air to the pharynx, the nasal
passages play two critical roles: they filter the air to remove potentially disease-causing
particles; and they moisten and warm the air to protect the structures in the respiratory
system. Filtering prevents airborne bacteria, viruses, other potentially disease-causing
substances from entering the lungs, where they may cause infection. Filtering also
eliminates smog and dust particles, which may clog the narrow air passages in the smallest
bronchioles. Coarse hairs found just inside the nostrils of the nose trap airborne particles as
they are inhaled. The particles drop down onto the mucous membrane lining the nasal
passages. The cilia embedded in the mucous membrane wave constantly, creating a current
of mucus that propels the particles out of the nose or downward to the pharynx. In the
pharynx, the mucus is swallowed and passed to the stomach, where the particles are
destroyed by stomach acid. If more particles are in the nasal passages than the cilia can
handle, the particles build up on the mucus and irritate the membrane beneath it. This
irritation triggers a reflex that produces a sneeze to get rid of the polluted air. The nasal
passages also moisten and warm air to prevent it from damaging the delicate membranes of
the lung. The mucous membranes of the nasal passages release water vapor, which
moistens the air as it passes over the membranes. As air moves over the extensive
capillaries in the nasal passages, it is warmed by the blood in the capillaries. If the nose is
blocked or stuffy due to a cold or allergies, a person is forced to breath through the mouth.
This can be potentially harmful to the respiratory system membranes, since the mouth does
not filter, warm, or moisten air. In addition to their role in the respiratory system, the nasal
passages house cells called olfactory receptors, which are involved in the sense of smell.
When chemicals enter the nasal passages, they contact the olfactory receptors. This triggers
the receptors to send a signal to the brain, which creates the perception of smell.

B. Pharynx
Air leaves the nasal passages and flows to the pharynx, a short, and funnel-shaped
tube about 13 cm (5 in) long that transports air to the larynx. Like the nasal passages, the
pharynx is lined with a protective mucous membrane and ciliated cells that remove
impurities from the air. In addition to serving as an air passage, the pharynx houses the
tonsils, lymphatic tissues that contain white blood cells. The white blood cells attack any
disease-causing organisms that escape the hairs, cilia, and mucus of the nasal passages and
pharynx. The tonsils are strategically located to prevent these organisms from moving
further into the body. One tonsil, called the adenoids, is found high in the rear wall of the
pharynx. A pair of tonsils, the palatine tonsils, is located at the back of the pharynx on either
side of the tongue. Another pair, the lingual tonsils, is found deep in the pharynx at the base
of the tongue. In their battles with disease-causing organisms, the tonsils sometimes
become swollen with infection. When the adenoids are swollen, they block the flow of air
from the nasal passages to the pharynx, and a person must breathe through the mouth.

C. Larynx
Air moves from the pharynx to the larynx, a structure about 5 cm (2 in) long located
approximately in the middle of the neck. Several layers of cartilage, a tough and flexible
tissue, comprise most of the larynx. A protrusion in the cartilage called the Adams apple
sometimes enlarges in males during puberty, creating a prominent bulge visible on the neck.
While the primary role of the larynx is to transport air to the trachea, it also serves
other functions. It plays a primary role in producing sound; it prevents food and fluid from
entering the air passage to cause choking; and its mucous membranes and cilia-bearing
cells help filter air. The cilia in the larynx waft airborne particles up toward the pharynx to be
swallowed. Food and fluids from the pharynx usually are prevented from entering the larynx
by the epiglottis, a thin, leaf like tissue. The stem of the leaf attaches to the front and top
of the larynx. When a person is breathing, the epiglottis is held in a vertical position, like an
open trap door. When a person swallows, however, a reflex causes the larynx and the
epiglottis to move toward each other, forming a protective seal, and food and fluids are
routed to the esophagus. If a person is eating or drinking too rapidly, or laughs while
swallowing, the swallowing reflex may not work, and food or fluid can enter the larynx. Food,
fluid, or other substances in the larynx initiate a cough reflex as the body attempts to clear
the larynx of the obstruction. If the cough reflex does not work, a person can choke; a lifethreatening situation. The Heimlich maneuver is a technique used to clear a blocked larynx
(see First Aid). A surgical procedure called a tracheotomy is used to bypass the larynx and
get air to the trachea in extreme cases of choking.

D. Trachea, Bronchi, and Bronchioles

Air passes from the larynx into the trachea, a tube about 12 to 15 cm (about 5 to 6
in) long located just below the larynx. The trachea is formed of 15 to 20 C-shaped rings of
cartilage. The sturdy cartilage rings hold the trachea open, enabling air to pass freely at all
times. The open part of the C-shaped cartilage lies at the back of the trachea, and the ends
of the C are connected by muscle tissue. The base of the trachea is located a little below
where the neck meets the trunk of the body. Here the trachea branches into two tubes, the
left and right bronchi, which deliver air to the left and right lungs, respectively. Within the
lungs, the bronchi branch into smaller tubes called bronchioles. The trachea, bronchi, and
the first few bronchioles contribute to the cleansing function of the respiratory system, for
them, too, are lined with mucous membranes and ciliated cells that move mucus upward to
the pharynx.

E. Alveoli

In humans the lungs occupy a large portion of the chest cavity from the collarbone
down to the diaphragm. The right lung is divided into three sections, or lobes. The left lung,
with a cleft to accommodate the heart, has only two lobes. The two branches of the trachea,
called bronchi, subdivide within the lobes into smaller and smaller air vessels known as
bronchioles. Bronchioles terminate in alveoli, tiny air sacs surrounded by capillaries. When
the alveoli inflate with inhaled air, oxygen diffuses into the blood in the capillaries to be
pumped by the heart to the tissues of the body. At the same time carbon dioxide diffuses out
of the blood into the lungs, where it is exhaled. The bronchioles divide many more times in
the lungs to create an impressive tree with smaller and smaller branches, some no larger
than 0.5 mm (0.02 in) in diameter. These branches dead-end into tiny air sacs called alveoli.
The alveoli deliver oxygen to the circulatory system and remove carbon dioxide.
Interspersed among the alveoli are numerous macrophages, large white blood cells that
patrol the alveoli and remove foreign substances that have not been filtered out earlier. The
macrophages are the last line of defense of the respiratory system; their presence helps
ensure that the alveoli are protected from infection so that they can carry out their vital role.
A scanning electron micrograph reveals the tiny sacs known as alveoli within a section of
human lung tissue. Human beings have a thin layer of about 700 million alveoli within their
lungs. This layer is crucial in the process called respiration, exchanging oxygen and carbon
dioxide with the surrounding blood capillaries.
The alveoli are about 150 million per lung and comprise most of the lung tissue.
Alveoli resemble tiny, collapsed balloons with thin elastic walls that expand as air flows into
them and collapse when the air is exhaled. Alveoli are arranged in grapelike clusters, and
each cluster is surrounded by a dense hairnet of tiny, thin-walled capillaries. The alveoli and
capillaries are arranged in such a way that air in the wall of the alveoli is only about 0.1 to
0.2 microns from the blood in the capillary. Since the concentration of oxygen is much higher
in the alveoli than in the capillaries, the oxygen diffuses from the alveoli to the capillaries.
The oxygen flows through the capillaries to larger vessels, which carry the oxygenated blood
to the heart, where it is pumped to the rest of the body. Carbon dioxide that has been
dumped into the bloodstream as a waste product from cells throughout the body flows
through the bloodstream to the heart, and then to the alveolar capillaries. The concentration
of carbon dioxide in the capillaries is much higher than in the alveoli, causing carbon dioxide
to diffuse into the alveoli. Exhalation forces the carbon dioxide back through the respiratory
passages and then to the outside of the body.
Regulation

As the diaphragm contracts and moves downward, the pectoralis minor and
intercostal muscles pull the rib cage outward. The chest cavity expands, and air rushes into
the lungs through the trachea to fill the resulting vacuum. When the diaphragm relaxes to its
normal, upwardly curving position, the lungs contract, and air is forced out
The flow of air in and out of the lungs is controlled by the nervous system, which
ensures that humans breathe in a regular pattern and at a regular rate. Breathing is carried
out day and night by an unconscious process. It begins with a cluster of nerve cells in the
brain stem called the respiratory center. These cells send simultaneous signals to the
diaphragm and rib muscles, the muscles involved in inhalation. The diaphragm is a large,
dome-shaped muscle that lies just under the lungs. When the diaphragm is stimulated by a
nervous impulse, it flattens. The downward movement of the diaphragm expands the
volume of the cavity that contains the lungs, the thoracic cavity. When the rib muscles are
stimulated, they also contract, pulling the rib cage up and out like the handle of a pail. This
movement also expands the thoracic cavity. The increased volume of the thoracic cavity
causes air to rush into the lungs. The nervous stimulation is brief, and when it ceases, the
diaphragm and rib muscles relax and exhalation occurs. Under normal conditions, the
respiratory center emits signals 12 to 20 times a minute, causing a person to take 12 to 20
breaths a minute. Newborns breathe at a faster rate, about 30 to 50 breaths a minute. The
rhythm set by the respiratory center can be altered by conscious control. The breathing
pattern changes when a person sings or whistles, for example. A person also can alter the
breathing pattern by holding the breath. The cerebral cortex, the part of the brain involved
in thinking, can send signals to the diaphragm and rib muscles that temporarily override the
signals from the respiratory center. The ability to hold ones breathing has survival value. If a
person encounters noxious fumes, for example, it is possible to avoid inhaling the fumes.
A person cannot hold the breath indefinitely, however. If exhalation does not occur,
carbon dioxide accumulates in the blood, which, in turn, causes the blood to become more
acidic. Increased acidity interferes with the action of enzymes, the specialized proteins that
participate in virtually all biochemical reaction in the body. To prevent the blood from
becoming too acidic, the blood is monitored by special receptors called chemoreceptors,
located in the brainstem and in the blood vessels of the neck. If acid builds up in the blood,
the chemoreceptors send nervous signals to the respiratory center, which overrides the
signals from the cerebral cortex and causes a person to exhale and then resume breathing.
These exhalations expel the carbon dioxide and bring the blood acid level back to normal.

A person can exert some degree of control over the amount of air inhaled, with some
limitations. To prevent the lungs from bursting from overinflation, specialized cells in the
lungs called stretch receptors measure the volume of air in the lungs. When the volume
reaches an unsafe threshold, the stretch receptors send signals to the respiratory center,
which shuts down the muscles of inhalation and halts the intake of air.

PATHOPHYSIOLOGY:

Narrative
Pneumonia is an acute infection of the lungs, often caused by inhaled pnemococci of the
species. Streptococcus pneumoniae. The alveoli and bronchioles of the lungs become
plugged with fibrous exudates. Pneumonia may be caused by other bacteria, as well as
viruses and also fungi. Predisposing factors to the development of pneumonia include upper
respiratory infection, excessive alcohol ingestion, central nervous system depression,
cardiac failure, COPD or chronic obstructive pulmonary disease, have history of smoking,
patient who are malnourished, elderly and very young persons (Gulanick & Myers. 1998 p.
417). Pathogenic microorganisms can reach the lung by several routes. The most common
means of entry of pathogens into the lungs is aspiration of oropharyngeal secretions
containing microbes. Microorganisms also may be inhaled after having been released when
an infected person coughs, sneezes, or talks. Microorganisms can also be inspired with
aerosols (nebulized gas) from contaminated respiratory therapy equipment. In illness or poor
dental hygiene, normal flora of the orophaynx can become pathogenic. Staphylococcus and
gram- negative bacteria can be spread by the circulation from systemic infection (IV) drug
abusers. Upon entering, microorganisms start to attach themselves into the mucosal surface
and releases toxin which stimulates the activation of bodys defense mechanism in the
lungs. The cough reflex, mucociliary clearance, and phagocytosis by alveolar macrophages
are backed up by the bodys immune system and various components of the inflammatory
response, including the release of biochemical mediators by alveolar mast cells. In
susceptible individuals the invading pathogen multiplies, releasing damaging toxins and
stimulating full-scale inflammatory responses, both of which have damaging side effects.
The antigen- antibody reaction and the endotoxins released by some microorganisms
damage bronchial mucous membranes and alveolocapillary membranes. Inflammation and
edema cause the acini (respiratory bronchioles, alveolar ducts, and alveoli) to fill with
infectious debris and exudates. Exudate is a fluid rich in proteins (leukocyes, plasma
proteins of all kinds); that migrates out of the capillaries. Together with this exudates are
fibrin, RBC, and bacteria that cause the consolidation or solidification of the lungs. Due to
the RBC in the lungs, the lungs becomes red giving the name Red Hepatization in which
hepatization is based from liver- like feature of the lungs, Red liver-like lungs. The WBC then
continues their job by infiltrating and eliminating injurious agents and dead cells in the lungs
caused by the phagocytic activity. Gray hepatization then occurs due to the accumulation of
the WBC in the lungs, deposition of fibrin (a body protein which hardens when blood leaves
its usual channels) on pleural surfaces, and phagocytes in alveoli. Ingestion and removal of
degenerated neutrophils, fibrin, and bacteria are then secreted mechanically through hard
coughing resulting to purulent, rusty-colored sputum. Resolution then occurs when all the
infectious and injurious agents are brought out of the lungs returning lungs to its normal
function. On the other hand, alveolar edema could decrease the intrapleural pressure,
elastic recoil and tidal volume; the ability to pressure and gets enough air thus, impairing
ventilation and gas exchange. Impaired ventilation then may impair lung function which may
gradually lead to lung collapse due to absence of air in the lungs, respiratory arrest, and
finally death. So, the body will try to compensate to get adequate supply of oxygen by the
form of increasing in respiration rate for the lungs to have sufficient air. There is respiratory
acidosis if there is abnormal increase of carbon dioxide in the body. On other the way,
impaired gas exchange will decrease the percentage of oxygen and carbon dioxide exchange

thus, resulting to absence of oxygen in the blood which will lead to hypoxemia, systemic
hypoxia and eventually death.
Failure to trap and expel microorganisms in the upper airway may cause the spread and
invasion of the bacteria in the other parts of the lungs especially to the lower airways. This
will cause inflammation to the mucous membranes which leads to mucous secretions as
bodys mechanism to continue trap and remove foreign bodies through mucous clearance.
Due to the inflammation and increased secretions, nasal obstruction and clogging will occur
which thickens respiratory secretions, decreased movement of the cilia and mucous
clearance then results. Hard coughing is a persons way then to continually remove the
blocking substance inside the lungs which may sometimes lead to fatigue, weakness, loss of
appetite, and weight loss due to over exertion of breathing and accessory muscles.
Decreased defense mechanism of the lungs also occurs due to the decreased ciliary and
mucous clearance increasing the risk for spread and transmission of infection to other parts
of the lungs especially in the lower airways. Microorganisms go to the terminal part of the
lungs combining to blood in the bloodstream which leads to septicemia or infection in the
blood, septic shock, and death. Infection may also spread to the other parts of the body
same way through bloodstream which will lead then
multiple organ affectation that results to multiple
organ failure, and again death.

Upper panel shows a normal lung under a microscope. The white spaces are alveoli that
contain air. Lower panel shows a lung with pneumonia under a microscope. The alveoli are
filled with inflammation and debris.

MEDICAL DIAGNOSIS:

Pneumonia is a serious infection or inflammation of one or both lungs.

Description of Pneumonia

Pneumonia is caused by the inhalation of infected microorganisms (tiny, single-celled living

organisms, such as bacteria, viruses, fungi or protozoa) spread through contact with an
infected person. The microorganisms enter the body through the mouth, nose and eyes. If
the body's resistance is down, the natural process of fighting off diseases is weakened and
the microorganisms are free to spread into the lungs and the lungs' air sacs. The air sacs
become filled with fluid and pus from the infectious agent, making it more difficult for the
body to get the oxygen it needs, and the person may become sick.
Potential complications of pneumonia include pleural effusion (fluid around the lung),
empyema (pus in the pleural cavity), hyponatremia (low blood sodium) and rarely,
an abscess in the lung.
Causes of Pneumonia

There are over 30 different causes of pneumonia, but the most common causes are bacteria
(including mycoplasma) and viruses. Corresponding to these causes are the most common
types of pneumonia - bacterial pneumonia, viral pneumonia and mycoplasma pneumonia.
Bacterial pneumonia
Pneumonia-causing bacteria is present in many throats, but when the body's defenses are
weakened (for example, by illness, old age, malnutrition or impaired immunity) the bacteria
can multiply, working its way into the lungs, inflaming the air sacs and filling the lungs with
liquid and pus. The bacteria that cause bacterial pneumonia are streptococcus pneumonia
(resulting in lobar pneumonia), hemophilus influenza(resulting in bronchopneumonia),
legionella pneumophilia (resulting in Legionnaires' disease) and staphylococcus aureus.
Viral pneumonia
Half of all pneumonias are believed to be caused by viruses, such as influenza (flu),
adenovirus, coxsackievirus, chickenpox, measles, cytomegalovirus and respiratory syncytial
virus. These viruses invade the lungs and multiply.
Mycoplasmal pneumonia (also called "walking pneumonia")
Similar to bacterial pneumonia, the mycoplasmas multiply and spread, causing infection.
Some of the other pneumonia-related disorders are aspiration pneumonia, chlamydial
pneumonia, Loffler's syndrome, pneumocystis carinii pneumonia, pediatric pneumonia and
necrotizing pneumonia.
Risk factors include:

65 years of age or older

People in nursing homes or other chronic care facilities

Male

Children under the age of two

People with colds or other respiratory infections

People with reduced immunity

People with other lung diseases, such asthma, cystic fibrosis and lung cancer

People with AIDS or HIV

Organ transplant recipients

People who have had their spleen removed

People receiving chemotherapy

People who smoke

Alcoholics

People with chronic health problems, such as lung disease, heart disease, kidney
disorders, sickle cell anemia or diabetes

Symptoms of Pneumonia

Symptoms vary, depending on the type of pneumoniaand the individual.

With bacterial pneumonia, the person may experience:

shaking

chills

chattering teeth

severe chest pain

cough that produces rust-colored or greenish mucus

very high fever

sweating

rapid breathing

rapid pulse rate

With viral pneumonia, the person may experience:

fever

dry cough

headache

muscle pain and weakness

These flu-like symptoms may be followed within one or two days by:

increasing breathlessness

dry cough becomes worse and produces a small amount of mucus

higher fever

bluish color to the lips

With mycoplasma pneumonia, the person may experience:

violent coughing attacks

chills

fever

nausea

vomiting

slow heartbeat

breathlessness

bluish color to lips and nailbeds

diarrhea

rash

muscle aches

Regardless of the type of pneumonia, the person may also experience the following
symptoms:

a loss in appetite

feeling ill

clammy skin

nasal flaring

fatigue

mental confusion

joint and muscle stiffness

anxiety, stress and tension

abdominal pain

Diagnosis of Pneumonia

To diagnose pneumonia, the doctor begins with a medical history and physical
examination. By placing a stethoscope on the chest, the doctor may be able to hear
crackling sounds, coarse breathing, wheezing and/or the breathing may be faint in a
particular area of the chest. Additionally, the doctor may order a chest x-ray, a sputum gram
stain and a blood test. The chest x-ray may show a blotchy-white area, where fluid and pus
has accumulated in the lung's air sacs. The sputum grain stain and the blood test may
determine the cause and severity of the condition.
If these tests are inconclusive, the doctor may perform a procedure called a bronchoscopy. In
this procedure, a flexible, thin and lit viewing tube is inserted into the nose or mouth after a
local anesthetic is administered. The breathing passages can then be directly examined by
the doctor and specimens from the infected part of the lung can be obtained.

TREATMENT/ MANAGEMENT FOR PNEUMONIA:

Treatment depends on the severity of symptoms and the type of organism causing the
infection.
Bacterial pneumonia (caused by the streptococcus pneumonia bacteria) is often treated with
penicillin, ampicillin-clavulanate (Augmentin) and erythromycin. Bacterial pneumonia
(caused by the hemophilusinfluenza bacteria) is treated with antibiotics, such as cefuroxime
(Ceftin), ampicillin-clavulanate (Augmentin), ofloxacin (Floxin), and trimethoprimsulfanethoxazole (Bactrim and Septra). Bacterial pneumonia (caused by legionella
pneumophilia and staphylococcus aureus bacteria) are treated with antibiotics, such as
erythromycin.
Viral pneumonia does not respond to antibiotic treatment. This type of pneumonia usually
resolves over time. If the lungs become infected with a secondary bacterial infection, the
doctor will prescribe an appropriate antibiotic to eliminate the bacterial infection.
Mycoplasma pneumonia is often treated with antibiotics,
clarithromycin (Biaxin), tetracycline or azithromycin (Zithromax).

such

as

erythromycin,

In addition to the pharmaceutical intervention, the doctor will also recommend bedrest,
plenty of fluids, therapeutic coughing, breathing exercises, proper diet, cough suppressants,
pain relievers and fever reducers, such as aspirin (not for children) or acetaminophen. In
severe cases, oxygen therapy and artificial ventilation may be required.
The course of pneumonia varies. Recovery time depends upon the organism involved, the
general health of the person and how promptly medical attention was obtained. A majority
of sufferers recover completely within a few weeks, with residual coughing persisting
between six and eight weeks after the infection has gone.
Prevention of Pneumonia

Practice good hygiene.

Get an influenza shot each fall.

Get a pneumonococcal vaccine. People who stand to benefit most from vaccination
are those over the age 65; anyone with chronic health problems (such as diabetes,
kidney disease, heart disease, etc.); anyone who has had their spleen removed;
anyone living in a nursing home or chronic care facility; caregivers of the chronically
ill (healthcare workers or family caregivers); children with chronic respiratory
diseases (such as asthma), and anyone who has had pneumonia in the past (due to
increased risk of reinfection). The pneumonococcal vaccine is 90 percent effective
against the bacteria and protects against infection for five to 10 years.

Practice good preventive measures by eating a proper diet, getting regular exercise
and plenty of sleep.

Do not smoke.

LABORATORY:

>No laboratory results in, still for request. (CBC,Platelet count, CXR AP-L)

DISCHARGE PLANNING:
Instruct the mother to do the following teachings to her child for continuity of care:
>Breathing warm, moist (wet) air helps loosen the sticky mucus that may make you feel like
you are choking. These things may help:

Place a warm, wet washcloth loosely over your nose and mouth.

Fill a humidifier with warm water and breathe in the warm mist.

>Coughing helps your lungs clear your airways. Take a couple of deep breaths 2 to 3 times
every hour. Deep breaths will help open up your lungs.
>Tap your childs back gently if there are secretions, to loosen them.
> Do not allow smoking in your home.
>Increase fluid intake(as long as your doctor says it is okay):

Drink water, juice, and weak tea.

Drink at least 8to 12 cups a day.

>Get plenty of rest when you go home..

>Keep the childs back dry always.
>Observe proper hygiene.
> feed the child with nutritious foods specially fruits that are rich in Vitamin C to enhance
childs immune system.
Medicines:
Continue medications per doctors order and do not use the medication for selftreating with other health problems.