I.

INTRODUCTION
Pneumonia is an inflammatory illness of the lung. Frequently, it is described
as lung parenchyma/alveolar (microscopic air-filled sacs of the lung responsible for
absorbing oxygen from the atmosphere) inflammation and (abnormal) alveolar
filling. Pneumonia can result from a variety of causes, including infection with
bacteria, viruses, fungi, or parasites, and chemical or physical injury to the lungs. Its
cause may also be officially described as idiopathic, that is unknown, when
infectious causes have been excluded.
Bronchopneumonia (Lobular pneumonia) is one of two types of bacterial
pneumonia

as

classified

by

gross

anatomic

distribution

of

consolidation

(solidification). In bacterial pneumonia, invasion of the lung parenchyma by bacteria

produces an inflammatory immune response. This response leads to a filling of the
alveolar sacs with exudate. The loss of air space and its replacement with fluid is
called consolidation. In bronchopneumonia, or lobular pneumonia, there are multiple
foci of isolated, acute consolidation, affecting one or more pulmonary lobes.
Pneumonia is a common illness in all parts of the world. It is a major cause of
death among all age groups. In children, the majority of deaths occur in the
newborn period, with over two million deaths a year worldwide. The World Health
Organization estimates that one in three newborn infant deaths are due to
pneumonia and WHO also estimates that up to 1 million of these (vaccine
preventable) deaths are caused by the bacteria Streptococcus pneumoniae, and
90% of these deaths take place in developing countries. Mortality from pneumonia
generally decreases with age until late adulthood. Elderly individuals, however, are
at particular risk for pneumonia and associated mortality.
New Research Spares Children the Pain of the Needle
ScienceDaily (Jun. 27, 2007)
http://www.sciencedaily.com/releases/2007/06/070626123930.htm

Children suffering from pneumonia could be spared the pain of the doctor's
needle, thanks to new research funded by the British Lung Foundation.
The study, a world-first carried out by researchers at The University of
Nottingham, discovered that children given oral treatment recovered as quickly,
suffered less pain, required less oxygen therapy in hospital and were able to go
home sooner than those given injections.
Two-and-a-half million children are affected by pneumonia each year in Europe.
Until now, most children have been admitted to hospital and treated with injected
antibiotics.
The findings suggest that these injections endured by generations of children
may be unnecessary and could be replaced with oral doses of the medicine in the
majority of cases. The study has been published online in the medical journal
Thorax.
The research involved 243 children in hospitals throughout the UK. It was led by
Terence Stephenson, Professor of Child Health, and Dr Maria Atkinson, both of The
University of Nottingham's Medical School.
The study is the first in the developed world to compare oral treatment versus
intravenous (IV) treatment for children with community-acquired pneumonia, who
are unwell enough to need admission to hospital.
Professor Stephenson said: This is good news for children who hate injections;
good news for parents whose children will spend less time in hospital; good news for
paediatricians who hate sticking needles in children and good news for the NHS, as
fewer beds will be occupied and the treatment is cheaper.
Dame Helena Shovelton, Chief Executive of the British Lung Foundation, said:
Treating childhood pneumonia will be less painful and distressing for parents, for
children and for the health professionals caring for them, thanks to this research.
We are very proud to have made this breakthrough possible.

The research project involved 243 children, enrolled over a 21-month period at
eight UK hospitals. Half were randomly assigned to receive a week of oral antibiotic
treatment and half to receive antibiotics intravenously.
Follow-up over subsequent weeks showed that both types of treatment are
effective in tackling the illness and the former actually had a number of
advantages over the latter. Oral antibiotics are also cheaper than those given via
the IV route.
The researchers concluded: We suggest that in countries like the UK, all but the
sickest children with community-acquired pneumonia should be treated with oral
amoxicillin initially.
http://www.sciencedaily.com/releases/2007/06/070626123930.htm
The group chose Pneumonia as their case for presentation because they want
to expand their knowledge gained in classroom lectures. This case is chosen
because it seems for them that it is just simple but when they conducted a study
about it they learned that there are so many factors that could be cause for
Pneumonia. The group would like to gain more information about the disease
condition. Other than the fact that the case is very common and it is the usual case
used by the student nurses for their case presentations the group still took part in
conducting a case study about Pneumonia because they have considered the fact
that Pneumonia according to DOH is one of the leading caused of infant mortality in
the Philippines. Interest leads the group to come up with such study as they make
every effort to expand their knowledge about pneumonia.

1. PERSONAL DATA

Baby Nicole is a 1 year and 2 months old baby girl who was born last
September 09, 2006 in Quezon City General Hospital. Because of her age, the group
decided to interview the mother of the patient. Her parents are Peyton Scott and
Lucas Scott. They are currently living in Dolores, Magalang, Pampanga. They are all
having Filipino nationality and are all followers of Born Again religion.
Baby Nicole was admitted last November 22, 2007, at around 12 noon in
Balitucan District Hospital complaining for on and off fever. And was discharge last
November 24 2007.
2. PERTINENT FAMILY HISTORY

Nathan Scott
BD: Nov-10-1955

Haley Scott
BD: july-51954
Asthma

Brooke Davis
DD: Dec.262003
birth
complication

Chris Davis
DD: April-22-1992
Cancer

Lucas Scott
BD: April-09-1979

Jake Scott
BD: Dec.-04-2000
Cerebral Palsy

Peyton Scott
BD: Jan.-4-1977
Asthma

Nicole Scott
BD; Sept.-092006
BPN

Birth Date: BD
Death Date: DD
Male:
Female:
Diseased:
With existing illness:
The diagram shows that Lucas Scott and Peyton Scott are the parents
of Baby Nicole. At the paternal side, Lucass parents or the grandparents of
Baby Nicole are both still alive. Haley Scott the grandmother of Baby Nicole is
diagnosed with asthma. At the maternal side, Peytons parents or Baby
Nicoles grandparents on mother side are both already dead. Chris Davis the
grandfather of Baby Nicole died because of cancer, while Brooke Davis died
because of birth complications. The mother of Baby Nicole which is Peyton
Scott is diagnosed with asthma. Baby Nicole has one brother which is Jake
Scott. He is diagnosed with cerebral palsy.
Scott family is composed of 4 members. Peyton Scott gave birth to 2
children. Her first child is Jake Scott he was born last December 04 2000, at
East Avenue Medical Center via normal spontaneous delivery. After about 6
years she gave birth to her 2nd child which is Baby Nicole at Quezon City
General Hospital via normal spontaneous delivery also. She said that during
her pregnancy shes a little bit irritable with her husband. But she has
positive attitudes with her pregnancies.
The Scott family is currently residing at Brgy. Dolores, Magalang,
Pampanga. They live in a wooden house owned by their boss. Mr. Lucas the
father of Baby Nicole works as a hollow block maker. He earns 1800/week and
works from 6am-6pm. He is a smoker; he usually smokes 5 sticks/day. He also
drinks alcoholic beverages; he usually drinks 2 bottles/week. Peyton Scott is a
house wife, she stays at home to take care of their children. She stated that
the house is in good condition but the surrounding is very dusty because its
near the hollow block making site.

Mrs. Scott believes to herbolarios, she usually consults herbolarios to

have hilot and tawas. She also uses herbal medicines when they caught
simple illnesses like cough or cold. The usual herbal medicines that they use
are oregano, ampalaya leaves, guava, and sambong. Mrs. Scott said that
whenever she has an emergency financial problem they usually come to their
boss to borrow some money.
3. PERSONAL HISTORY
Mrs. Scott told the group that shes having a monthly check up during
her pregnancy. She delivered her 1 st baby for 6 hours. And she delivered her
2nd baby which is baby Nicole for 2 hours. They are both delivered in the
hospital and they are all 9 months when they were delivered. Mrs. Scott said
that she only breastfed her children for 2 weeks after that she begins to
bottle feed them. She also stated that her children were all fully immunized.
Growth and Development
Erik Ericksons Psychosocial Development
Trust Vs. Mistrust (birth to 1 year)
Characterized by taking in through all the senses, loving care of
a mothering person is essential to develop trust, must have basic needs met,
and having an attachment to primary care taker
Baby Nicole manifested this by crying when she woke up and
her mom is not around. She gained trust because her mother responded to
her eagerly whenever shes crying and give her food whenever shes hungry.
Sigmund Freuds Psychosexual Development
Oral Stage (birth to 1 year)

Characterized by infant-seeking pleasure via oral activities such

as biting, sucking, chewing, and vocalizing.
Baby Nicole manifested this by putting everything that she
reaches in her mouth like IV tube, and shes stop crying whenever she sucks
her pacifier.
Jean Piagets Cognitive Development
Sensorimotor (birth to 2 years)
Characterized y progression from reflex activity through simple
repetitive behaviors to imitative behaviors, information is gained through the
senses and developing motor abilities, develop a sense of cause and effect,
problem-solving is by trial and error, high level of curiosity, experimentation,
and enjoinment in novelty, begin to separate self from others, develop sense
of object permanence, begin language development.
Baby Nicole manifested this because when the group is
assessing her. She wants to get the penlight from one of the member, and
when the group member hides it, Nicole is still looking for it.
4. HISTORY OF PAST ILLNESSES
Mrs. Scott stated that baby Nicole had mumps last September and got
tigdas hangin when shes just about 7 months. She also had sore eyes last
October. Other than that she also had some cough and colds.

5. HISTORY OF PRESENT ILLNESSES

Baby Nicole was hospitalized twice already. She was first hospitalized
last November 10 2006 at Quezon City General Hospital with complain of
difficulty of breathing, cough and colds. During that hospitalization she was

diagnosed to have Pneumonia. She stayed in the hospital for 1 week. Her 2 nd
hospitalization was in Balitukan District hospital last November 22 2007. She
was admitted with complains of on and off fever for 7 days and cough for 3
days.
6. PHYSICAL EXAMINATION
Initial Assessment upon Admission (November 22 2007)
Vital signs:
T= 38 C
P= 143 bpm
R= 49 cpm
Complain of 7 days on and off fever accompanied by cough and colds.
Fairly nourished
Fairly developed
Weight: 14 kg
(+) Rales on both lung fields
(-) Wheezes
November 23 2007

General Condition
The patient is seen lying on bed with her mother, awake and conscious
Shes wearing comfortable and loose sando and short. The patient is slightly
irritable and looks untidy because of uncombed hair and slightly wet back.
Vital Signs:
T= 37.5C
P= 148 bpm
R= 61 cpm
Skin and Hair

With dark brown complexion all throughout the body. Hair evenly
distributed.
Head
Hair is evenly distributed, smooth and shiny. No dandruff. Symmetrical
contours of the head. No abnormal depressions, masses, and nodules upon
palpation.
Eyes
Symmetrical

eyebrow

movement

and

evenly

distributed

hair.

Symmetrical eyelid movement and evenly distributed eye lashes.

Symmetrical eye movement.
No abnormal discharges. With pinkish palebral conjunctiva. With round and
black iris. With white sclera. No abnormal masses and nodules. Pupils dilate
upon introduction of light. With (+) blink reflex.
Ears
Symmetrical ear shape, non-tender, and firm. Ears line the outer
cantus of the eye. Presence of serumen in minimal amount. Intact tympanic
membrane. No abnormal masses and nodules upon palpation. Pinna recoils
after it is folded. Good sense of hearing evident by head turning upon
mentioning her name.
Nose
Presence of little amount of nasal secretion because of colds. No
abnormal masses, nodules and lesions. With good sense of smell evident by
removing the cotton ball with alcohol introduce by the student nurse.
Mouth
Symmetrical pale, lips. Presence of 8 teeth. Tongue located at the
middle. Able to move tongue. With (+) gag reflex. With good sucking reflex.
No abnormal lesion and sores.
Neck

Located on the midline. No abnormal masses, nodules and lesions.

Trachea is located at the center
Chest
Symmetrical lung expansion. With evenly distributed hair. No masses
and lesions. With abnormal breath sound (rales) on both lung fields. With
shallow, short breaths.
Heart
No unusual heart sound upon auscultation.
Abdomen
Uniform in color. Round shape of abdomen. No lesions and masses. No
tenderness upon palpation. Presence of normal bowel sound. (gurgle)
(16/min)
Upper Extremities
Able to move hands freely. Symmetrical in shape. With dirty fingernails.
No abnormal lesions and masses. Pale nailbeds.
Lower Extremities
Able to move feet freely. Symmetrical in shape. With dirty toe nails. No
masses and lesions.

7. DIAGNOSTIC AND LABORATORY PROCEDURES

Diagnosti

Date ordered,

Indication(s)

c/

Date

or Purpose(s)

Laborator
y
procedur
es

Results

Normal

Analysis and

Values (units

Interpretation of

performed,

used in the

results

Date results in

hospital)

Chest X-

DO: 1i1-22-07

To

visualize Chest

ray

DP: 11-23-07

possible

DRI: 11-23-07

enlargement of reveal minimal hazy

physician,

the

the heart and infiltrates

revealed

pneumonitis

assess

The

roentgenograms
on

interpreted

both

lower

lung

fields.

presence

of Heart

and

great

congestion

in vessels

the lungs.

are

normal

of

size

and

configuration.
Hemidiaphragms
sulci

and

visualized

other
included

chest structures are

unremarkable.

Nursing Responsibilities:
Preprocedural care:

Orient the client about the procedure.

Inform the client that the procedure is pain free.

results

were

by

the
results

on both lung fields.

If the client is pregnant, inform her that radiation can be harmful to the fetus. If an x-ray is necessary,
precautions will be taken to minimize radiation exposure to the baby.

Ask the client to remove some or all of their clothes and ask them to wear a gown.

Ask them to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the x-ray
images.

During the procedure:

Assist the client and will position the patient with hands on hips and chest pressed the image plate. For the
second view, the patient's side is against the image plate with arms elevated.

The patient who cant stand may be positioned lying down on a table for chest x-rays.

Ask the patient to hold very still and may be asked to keep from breathing for a few seconds while the x-ray
picture is taken to reduce the possibility of a blurred image.

Postprocedural care:

Ask the client to wait until the technologist determines that the images are of high enough quality for the
radiologist to read.

Diagnostic/

Date ordered,

Indication(s) or

Laboratory

Date

Purpose(s)

procedures

Hematology

Results

Normal

Analysis and

Values (units

Interpretation of

performed,

used in the

results

Date results in

hospital)

DO: 1i1-22-07

To monitor levels of

DP: 11-22-07

blood

DRI: 11-23-07

that

components
could

be

indicative of infection
or other disease or
health conditions
Hemoglobin

It measures the total

amount

of

hemoglobin
blood

to

in

11.2 mg %

12-16 mg %

The results are slightly

below

normal,

the

may indicate that the

determine

patient is at risk of

the oxygen carrying

having

capacity of the blood.

tissue

perfusion

Hemoglobin

lack

of

in

vertebrates
transports

which

oxygen.
oxygen

from the lungs to the

rest of the body, such

ineffective
and

adequate

as

to

the

muscles,

where it releases the

oxygen load. Due to
vaginal

bleeding

of

the patient, there is

loss

of

blood

and

should be monitored
if

she

needs

transfusion

blood
to

maintain the normal

circulation of oxygen
in

blood

to

supplement the body

Hematocrit

and organs.

37 vol.%

37-47 vol.%
The results are with in

It

measures

the

normal range that may

percentage of RBCs in

indicate normal RBCs in

the

the blood.

total

blood

volume. It may also

provide

idea

on

patients fluid status.

The hematocrit is the

percent

of

blood

that

is

of

red

composed
blood

whole

cells.

hematocrit

The
is

measure of both the

number of red blood
cells and the size of
WBC

red blood cells

7,700/cu.mm

10-25x10
The results are below

The total white blood

normal

cell

the

indicate that the WBCs

of

are already worn out by

count

absolute

is

number

leukocytes circulating
in a cubic millimeter
of blood. It is used to
determine

factor

of

inflammation and also

to

determine

evaluate
physiologic
Lymphocyte

to

resists

and
bodys

capacity
and

that

the microorganism.

can

overcome infection.

64%

25-40
The

variety

of

(leucocyte),
also

in

the

nodes,
thymus
wall

WBC

marrow.

elevated

which

lymph

is trying to fight the

spleen,

infection by producing

gut

lymphocytes

bone

involve in immunity

which

and

be

antibodies

B-

responsible

can
into

circulating

that

produces
T-cells

cells which

may

indicate that the body

They are

subdivided

were

present

gland,
and

results

produce

and

B-cells
produces
and
for

cell

mediated immunity.

antibodes

and T-cell which are

primarily
for
Platelet
Count

responsible

cell-mediated 252/cu. Mm.

150-450/cu mm

immunity
The results are within
A disc shaped cell

normal range that may

structure, 1-2 um in

indicate normal clotting

diameter,

time and is safe from

which

is

present in the blood.

Assess for any risk of
bleeding

and

clotting time.

for

bleeding.

Nursing Responsibilities:
Before:

Check the doctors order.

Determine the prescribed test and other restrictions prior to the test.

Get the laboratory requisition slip.

Explain to the patient what the procedure to be done is.

Inform the patient that this requires a blood sample.

Inform the patient how the procedure is performed, the equipment to be used.

During:

Explain to the patient what test should be done.

Prepare all the equipments to be used.

Tell the patient when to insert the needle for her to be prepared.

Encourage the patient to remain calm during the test.

Assist the patient if necessary.

Ensure a sterile blood sample from the patient.

After:

Send the blood sample to the laboratory immediately.

Proper documentation

III. ANATOMY AND PHYSIOLOGY

Respiration is necessary because all living cells of the body require
oxygen and produce carbon dioxide. The respiration system assists in gas
exchange and performs other formation as well our body needs a constant
supply of oxygen to support metabolism. The respiratory system brings
oxygen through the airways of lungs into the alveoli, where it diffuses into the
blood for transport to the tissue, this process is so vital that difficult in
breathing is expected as a threat to life in self. The respiratory system allows
oxygen from the air to enter the blood and carbon dioxide to leave the blood
and enter the air. The cardiovascular system transport oxygen from the lungs
to the cells of the body and carbon dioxide. Without healthy respiratory and
cardiovascular system, the capacity to carry out normal activity is reduced,
and without adequate respiratory and cardiovascular system friction, life
itself is possible.
Nose- The term nose refers to the visible structure that forms a prominent
feature of the face. Most of the nose is composed of cartilage, although the
bridge of the nose consists of bone the bone and cartilage and covered by
connective tissue and shin.
Nasal cavity- The nasal extends from the noses to the choane the nares or
nostrils are the external opening of the nose and the choane are the openings
to the pharynx. The nose is formed from both bone and cartilage. The nasal
bone forms the bridge and the remainder of the nose is composed of
cartilage and connective tissue. Each opening of the nose to the face leads to
the cavity. The vestibule is lined anteriorly to the skin and hair that filter
foreign objects and prevent from being inhaled. The posterior vestibule is
lined with a mucous membrane, composed of columnar epithelial cells and,
goblets

cells

that

secrete

mucous.

The

mucous

membrane

extends

throughout the airways and cilia propel mucous to the pharynx for elimination
by swallowing or coughing. The portion of mucous membrane that is located
at the top of the nasal cavity, just beneath the cribriform plate of the ethmoid
bone, is specialized epithelium; witch provides the sense of smell.

Along the side of the vestibule are turbinate, mucous membrane covered
projections that contain a rich blood supply from the internal and external
carotid arteries. They warm and humidify inspired air.
Paranasal sinuses- open areas within the skull are named for the bones in
witch they lie: frontal, ethmoid, sphenoid and maxillary. Passageway from
paranasal sinuses drain into the nasal cavity. The nasolacrimal duct, witch
drain tears from the surface of the eyes, also drains the nasal cavity.
Pharynx- it is a funnel-shaped tube that extends from the nose to the larynx.
It is the common passageway of both the respiratory and digestive system. It
can be divided into three regions:

a. Nasopharynx- is located above the margin of the soft palate and

receives air from the nasal cavity. From the ear, the Eustachian
tubes open into the nasopharynx. The pharyngeal tonsils are
located on the posterior wall of the nasopharynx.
b. Oropharynx- serves both respiration and digestion. It receives air
from the nasopharynx and food from the oral cavity. Palatine
tonsils are located along the sides of the posterior mouth, and
the lingual tonsils are located at the base of the tongue.

c. Laryngopharynx- located below the base of the tongue, is the

most inferior portion of the pharynx. It connects to the larynx
and serves both the respiration and digestion.
Larynx- is commonly called the voice box. It connects the upper and
lower airway. It lies just anterior to the upper esophagus. Nine cartilages
form the larynx: epiglottis, thyroid, cricoid, arythenoid, corniculate,
cuneiform. The cartilage are attach to the hyoid bone above and below
the trachea by muscles and ligaments. The slit the vocal cords forms the
glottis. The epiglottis, a leaf shaped structure immediately posterior to the
base of the tongue. The thyroid cartilage protrudes in front of the larynx
forming the Adams apple.
Trachea- extends from the larynx to the level of the seventh thoracic
vertebrae, where it divides into two main bronchi. The point at witch the
trachea divides is called carina. The trachea is a flexible, muscular, 12cm
long air passage with C-shaped cartilaginous ring.
Lungs- it lie within the thoracic cavity on either side of the heart. They
are cone-shaped, with the apex above the first rib and the base resting on
the diaphragm. Each lung is divided into superior and inferior lobes by an
oblique fissure. The right lung is further divide by a horizontal fissure,
witch bounds a middle lobe. The right lung therefore has three lobes. The
lung contains gas, blood, and thin alveolar wall and support structure. The
alveolar walls contain elastic and collagen fibers. These fibers are capable
of stretching when the pulling force is exerted on then from outside of the
body or whey they are inflated from within.
Alveoli- the lungs parenchyma, consists of millions of alveolar units, is
the working area of the lung tissue it birth a person has approximately 24
million alveoli, by the age 8 yrs a person 300 million. The total working
alveolar surface are is the approximately 750 to 860 square feet. Oxygen
and CO2 are exchange through the respiratory membrane about 0.2 mm
thick (The average diameter of the pulmonary capillary only about 5
mins).
Thorax- provides protection for the lungs, heart and great vessels. The
outer shell of the thorax is made up of 12 pairs of ribs. The ribs connects
posterior to the transverse processes of the thoracic vertebrae of the

spine. Anteriorly, the first seven pairs of ribs are attached to the sternum
by cartilage. The 8th, 9th and 10th ribs are attached to each other by costal
cartilage. The 11th and12th ribs allow full chest expansion because they
are not attached in any way to the sternum.
Diaphragm- it is the primary muscle of breathing and serves as the lower
boundary of the thorax. The diaphragm is dome- shaped in the relaxed
position, with central muscular attachments to the xiphoid process of the
sternum and the lower rib.

IV. PATIENT AND HIS ILLNESS

A. PATHOPHYSIOLOGY

a. Schematic Diagram
(book base)
Bacterial infection

Viral infection

Fungal infection

Inflammation of pulmonary parenchyma

Lobar pneumonia

Bronchopneumonia

Engorgement with
effusion of blood and
serum into the alveoli
in 1 or more lobes;
(stage I) lobe airless
and alveoli contain
fibrin, serum, RBC,
neutrophils,
(stage II) lobe larger
with fibrin in alveoli
and decreased cellular
elements and bacteria
(stage III) Usually
pneumococcal

Mucopurulent exudate
in terminal
bronchioles. Clogging
of bronchioles.
Necrosis and
yema
sloughing of bronchial
mucous membranes.
Formation of
peribronchial
abscesses and
pneumatoceles.
Usually
staphylococcal

-pleural effusion
-pleurisy
-empyema

Inflammation of walls
of alveoli, bronchi and
bronchioles. Usually
viral and
staphylococcal

Resolution
with
treatment

-pleural effusion
-empyema

Resolution
with
treatment

Resolution with
treatment
(stage IV)

Interstitial pneumonia

-pneumothorax
-empyema

(Patient Centered)
Risk Factors
-second-hand
smoker
-age
-environment
-nutrition

Invasion of microorganism

Enter lower respiratory tract

Stimulate
respiratory
response
Accumulation of
exudates and
bacteria

Release of
chemical
mediators

Parenchymal and Alveolar sacs

tend to consolidate

Cytokine

Bradykinin

Histamine

stimulate

Stimulate goblets
cells

Narrowing of blood
vessels

Increase in
temperature
Fever

-cough
-rales
-colds

Air pass trough

narrowed airways
DOB

b. Synthesis of the disease

b.1. Definition of the Disease
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.

Often pneumonia begins after an upper respiratory tract

infection (an infection of the nose and throat). When this happens,
symptoms of pneumonia begin after 2 or 3 days of a cold or sore
throat.
b.2. Predisposing and Precipitating Factors
Bacteria are the most common causes of pneumonia, but these
infections can also be caused by other microbial organisms. It is often
impossible

to

identify

the

specific

culprit.

Many

bacteria

are

categorized by the staining procedure used to visualize bacteria under

a microscope. The stains determine if they are gram-negative or grampositive bacteria. This gives the physician an idea of the severity of the
pneumonia

and

how

to

treat

it.

Gram-Positive Bacteria. These bacteria appear blue on the stain. The

following are common gram-positive bacteria:

The most common cause of pneumonia is the gram-positive bacterium

Streptococcus

pneumoniae

(also

called

S.

pneumoniae

or

pneumococcal pneumonia ). It was thought to cause 95% of

community-acquired bacterial infection, but research now indicates it is
far less, accounting for about half of all cases. (Some studies suggest it
may account for even fewer, 10% to 30% of cases.)

Staphylococcus aureus , the other major gram-positive bacterium

responsible for pneumonia, accounts for about 10% of bacterial cases.
It is one of the main causes of pneumonia that occurs in the hospital
(nosocomial pneumonia). It is uncommon in healthy adults but can
develop about five days after viral influenza, usually in susceptible
individuals, such as people with weakened immune systems, very
young children, hospitalized patients, and drug abusers who use
needles.

Streptococcus pyogenes or Group A Streptococcus.

Gram-Negative Bacteria. These bacteria stain pink . Gram negative bacteria

are common infectious agents in hospitalized or nursing home patients,
children with cystic fibrosis, and people with chronic lung conditions.

The most common gram-negative species causing pneumonia is

Haemophilus influenzae (generally occurring in patients with chronic
lung disease, older patients, and alcoholics).

Klebsiella pneumoniae may be responsible for pneumonia in alcoholics

and in other people who are physically debilitated.

Pseudomonas aeruginosa is a major cause of pneumonia that occurs in

the hospital (nosocomial pneumonia). It is common in pneumonia
patients with chronic or severe lung disease.

Moraxella catarrhalis is found in everyone's nasal and oral passages.

Experts have identified this bacteria as a cause of certain pneumonias,
particularly in people with lung problems, such as asthma or
emphysema.

Neisseria meningitidis is one of the most common causes of meningitis

(central nervous system infection), but the organism has been reported
in pneumonia, particularly in epidemics of military recruits.

Other gram-negative bacteria that cause pneumonia include E. coli (a

cause in newborns), Proteus (found in several damaged lung tissue),
and Enterobacter.
Bacterial pneumonias tend to be the most serious and, in adults, the

most common cause of pneumonia. The most common pneumonia-causing

bacterium in adults is Streptococcus pneumoniae (pneumococcus).
Respiratory viruses are the most common causes of pneumonia in young
children, peaking between the ages of 2 and 3. By school age, the bacterium
Mycoplasma pneumoniae becomes more common.
In some people, particularly the elderly and those who are debilitated,
bacterial pneumonia may follow influenza or even a common cold.
Many people contract pneumonia while staying in a hospital for other
conditions. This tends to be more serious because the patient's immune

system is often impaired due to the condition that initially required treatment.
In addition, there is a greater possibility of infection with bacteria that are
resistant to antibiotics.
b.3. Signs and Symptoms
Symptoms of pneumonia vary, depending on the age of the child and the
cause of the pneumonia. Some common symptoms include:

Fever- A fever occurs when the thermostat resets at a higher

temperature, primarily in response to an infection.

Chills- The "chills" that often accompany a fever are caused by the
movement of blood to the body's core, leaving the surface and
extremities cold.

Cough- this is the bodys way to expel foreign objects in our body

Unusually rapid breathing- the small blood vessels in the lungs

(capillaries) become leaky, and protein-rich fluid seeps into the alveoli.
This results in less functional area for oxygen-carbon dioxide exchange.
The patient becomes relatively oxygen deprived, while retaining
potentially damaging carbon dioxide. The patient breathes faster and
faster, in an effort to bring in more oxygen and blow off more carbon
dioxide.

Breathing with grunting or wheezing sounds-this is because of the

secretions that are present in the lungs.

Labored breathing that makes a child's rib muscles retract (when

muscles under the rib cage or between ribs draw inward with each
breath)

Vomiting because the respiratory center and the vomiting center are
the same which is the medulla oblongata, when there is an abnormality
in breathing this may also trigger the patient to vomit.

Chest pain

Abdominal pain

Decreased activity

Loss of appetite (in older children) or poor feeding (in infants)

In extreme cases, bluish or gray color of the lips and fingernails

Health Promotion and Preventive Aspects of the Disease

There are vaccines to prevent infections by viruses or bacteria that
cause some types of pneumonia.
Children usually receive routine immunizations against Haemophilus
influenzae and pertussis (whooping cough) beginning at 2 months of
age. (The pertussis immunization is the "P" part of the routine DTaP injection.)
Vaccines are now also given against the pneumococcus organism (PCV), a
common cause of bacterial pneumonia.
Children with chronic illnesses, who are at special risk for other types
of pneumonia, may receive additional vaccines or protective immune
medication. The flu vaccine is strongly recommended for children with
chronic illnesses such as chronic heart or lung disorders or asthma, as well as
otherwise healthy children.
Because they are at higher risk for serious complications, infants who
were born prematurely may be given treatments that temporarily protect
against RSV, which can lead to pneumonia in younger children.
Doctors may give prophylactic (disease-preventing) antibiotics to
prevent pneumonia in children who have been exposed to someone with
certain types of pneumonia, such as pertussis. Children with HIV infection
may also receive prophylactic antibiotics to prevent pneumonia caused by
Pneumocystis carinii.
Antiviral medication is now available, too, and can be used to prevent some
types of viral pneumonia or to make symptoms less severe In addition;
regular tuberculosis screening is performed yearly in some high-risk areas
because early detection will prevent active tuberculosis infection including
pneumonia.
In general, pneumonia is not contagious, but the upper respiratory viruses
that lead to it are, so it is best to keep your child away from anyone
who has an upper respiratory tract infection. If someone in your home has a
respiratory infection or throat infection, keep his or her drinking glass and
eating utensils separate from those of other family members, and wash your
hands frequently, especially if you are handling used tissues or dirty
handkerchiefs.

V. THE PATIENT AND HIS CARE

A. MEDICAL MANAGEMENT
a. IVFs, BT, NGT fee ding, Nebulization, TPN, Oxygen Therapy, etc.
Medical
management/
treatment

D5IMB 500cc

Date ordered,
Date performed,
Date changed

General
Description

Indication(s) or
Purpose(s)

Client response to
the treatment

DO: 11-22-07

Sterile, nonpyrogenic Indicated as a source

DP: 11-22-07

solution for fluid and

of water, electrolytes no

DC: ------------

electrolyte

and calories, or as an overload,

replenishment
caloric

supply

single
containers

in
dose

for

administration

Nursing Responsibilities:

and alkalinizing agent.

IV

The patient showed

signs

of

fluid

dehydration

and

phlebitis

the

along

intravenous site.

Before:

Identify the purpose of IV therapy and to the clients significant others.

Before starting the IV therapy, consider duration of therapy, type of infusion, condition of veins and medical
conditions of patient to assist in choosing the IV site.

Make sure that the equipments are sterile.

During:

Secure the IV site with a board to prevent it from dislocation.

After:

Regulate the IV fluid as ordered by the physician.

After the IV therapy, identify local complications at or near the IV needle site.

Check for signs of infiltration, phlebitis and signs of fluid overload or dehydration.

Routinely check for the IV level to change it immediately to prevent air from entering the veins.

b. Drugs

Name of
Drugs:
Generic
Name
Brand Name

Date ordered
Date
performed
Date
changed/D/C

Route or
admin
dosage and
frequency of
admin

Generic Name: DO: 11-22-07

450

Cefuroxime

DP: 11-22-07

every 8 hours

Sodium

DC:-----------

Brand

name:

Cefuroxime

mg

Gen. action
Function
Classification
Mechanism of ax

IV Anti-inffectives,
second

Treatment

generation respiratory

cephalosporin, bind to
bacterial
membrane,
cell death.

Indications or
purposes

cell

wall

causing

infections.

Client response
to the
medication w/
actual side
effects

of Theres

tract decrease

of

microorganisms
causing
infection
by

not

fever.

Nursing Responsibilities:

the
evident
having

Before:

Obtain skin test before the start of the treatment.

Determine previous hypersensitivity to the medication.

Explain the reason for prescribing the medication, the effects and side effects of the drug to the clients s.o.

During:

Administer slowly over 3-5 minutes.

Monitor site frequently for thrombophlebitis (pain, redness and swelling).

Check the IV patency before administering the medication.

After:

Instruct S.O. to report signs of superinfection (furry overgrowth on tongue, loose or foul- smelling stools) and
allergy.

Instruct clients S.O. to notify any health carte professional if fever and diarrhea develop, especially if stool
contains pus, blood or mucus

Name of
Drugs:
Generic Name
Brand Name

Date ordered
Date
performed
Date
changed/D/C

Route or
admin
dosage and
frequency
of admin

mg

Gen. action
Function
Classification
Mechanism of ax

Generic Name:

DO: 11-22-07

140

Acetaminophen

DP: 11-22-07

every 4 hours analgesics.

DC:-----------

PRN

IV Antipyretic, nonopioid Treatment

the

Inhibits fever.

synthesis

Brand name:

prostaglandins

Paracetamol

may

serve

of
that
as

mediators of pain and

fever, primarily in the
CNS.

Nursing Responsibilities:
Before:

Indications or
purposes

Client response
to the
medication w/
actual side
effects

for The

patients

temperature

was

maintained within
normal range.

Obtain culture and sensitivity test before the treatment starts.

Obtain history of hypersensitivity to analgesics.

Get the patients temperature before administering the medication

During:

Check the patency of the IV.

Administer slowly.

After:

Obtain patients temperature.

Instruct S.O. to report signs of superinfection (furry overgrowth on tongue, loose or foul- smelling stools) and
allergy.

Instruct clients S.O. to notify any health carte professional if fever and diarrhea develop, especially if stool
contains pus, blood or mucus

Name of
Drugs:
Generic
Name
Brand Name

Date ordered
Date
performed
Date
changed/D/C

Generic Name:

DO: 11-22-07

Albuterol

Route or
admin
dosage and
frequency of
admin

1 neb. TID

Gen. action
Function
Classification
Mechanism of ax

Indications or
purposes

Client response
to the
medication w/
actual side
effects

Bronchodilators; binds Used

as The

DP: 11-22-07

to beta 2-adrenergic bronchodilator

to maintained patent

DC:11-23-07

re ceptors in airway

Brand name:

smooth

Salbutamol

leading to activation

control

muscle, prevent reversible

airway obstruction

of adenyl cyclase and caused

increased

levels

cyclic-3,

of respiratory
5- conditions.

adenosine
DO: 11-23-07

1 neb every 4 monophosphate

DP: 11-23-07

hours.

DC:-------------

and airway.

(cAMP). Increases in
cAMP

activate

kinases, which inhibit

the

phosphorylation

of

myosin

and

decrease intracellular
calcium that leads to

by

patient

relaxation of smooth
muscle airways.

Nursing Responsibilities:
Before:

Assess lung sounds before administration and during peak of medication. Note characteristics of sputum.

Make sure that the equipments are clean before using them.

During:

Shake inhaler well.

Maintain a fowlers position.

Keep the inhaler close to the patient to make sure she inhales the medication.

After:

Provide mouth care because nebulization can cause bad taste.

Advise patient to rinse with water, to minimize drying of mouth.

c. Diet
Type of Diet

Diet For Age

Date ordered
Date started
Date changed

General
Description

Indication(s) or
Purpose(s)

Specific foods
taken

Clients
Response
and/or reaction
to diet

DO: 11-22-07

Diet for age

It will help

The patient eats

The patients so

DP: 11-22-07

means that the

prevent

crackers, and

didnt give the

DC: ------------

patient can eat

aspiration.

drink water.

patient food that

anything that

he/she cant

he/she can

tolerate.

tolerate at
his/her age.
Nursing Responsibilities:
Before:

Explain the purpose of the diet order, the consequences of not following such diet and how it will be
implemented.

Emphasize the food that the patient can take.

During

Make sure that the client is taking the specified diet.

After:

Emphasize the new preferred diet.

d. Activity/Exercise
Type of
exercise

Date ordered,
Date started,
Date changed

Indications or
Purposes

General Description

Clients response to the

treatment

Activity as DO: 11-22-07

The patient is allowed To provide sense of well

The patient walks with her mom

tolerated.

DP: 11-22-07

to

in the hospital.

DC: ------------

long as he/she can exercise in other ways,

do

activities

as

being. And to have some

tolerate them.

Nursing Responsibilities:

Educate patients SO about what activities is the patient allowed to do.

Make sure that the patient is doing the desired exercise or activity.

Have the patient rest after doing an activity.

Emphasize the importance of following the activity.

B. SURGICAL MANAGEMENT
The group found no surgical treatment for pneumonia. While
searching the group have open sites that indicate that there are no surgical
treatments available for pneumonia since that this disease is curable.

C. NURSING MANAGEMENT
1. Nursing Care plan

Assessmen
t

Nursing
Diagnosis

Scientific
Explanation

Objectives

Nursing
Interventions

Rationale

Expected
Outcome

S =
O= pt
manifested:
>DOB
>(+) rales
>with nasal
flaring
>with non
productive
cough
>skin warm
to touch
>with
shallow
respiration
=pt may
manifest:
>changes in
respiratory
rate and
rhythm

Ineffective
airway
clearance
r/t retained
pulmonary
secretions
AEB nonproductive
cough
secondary
to BPN

Pneumonia is an
inflammation
of
the
lung
parenchyma
caused by various
microorganisms.
An
inflammatory
reaction
that
occurs
in
the
alveoli
produces
exudates. And as
part
of
inflammatory
reaction
WBC
migrate
to
the
alveoli and fill the
normally
air
containing spaces.
The
exudates
together with the
migration of WBC
produces
thick
secretions
that
blocks the airways
does leading to
ineffective airway
clearance.

Problem # 1: Ineffective Airway Clearance

Problem #2: Ineffective Breathing Pattern

Short term:
After 4 hours
of NI, pt will
be able to
improvement
of airways
patency AEB
reduction of
cough and
noiseless
breathing
Long term:
After 3 days
of
NI,
the
patient
will
be able to
maintain
patent airway
AEB absence
of
pts
abnormal
respiratory
manifestation
s that has
been
observed and
assessed

Establish rapport
Assess gen.
condition of the pt.
monitor and record
VS

To gain trust and

cooperation of the pt.
to provide appropriate
assessment and
management
to obtain base line data

auscultate breath
sounds and assess
air movement

to ascertain status and to

note progress

elevate pt.s HOB

to maximize oxygen
consumption

reposition pt.
periodically

prevents accumulation and

pooling of secretions

Instruct pt.s SO to to liquefy secretion for

increase fluid intake
easy expectoration
of pt.
perform CPT

to loosen the secretions

administer
medications as
order

to provide appropriate
treatment and to help
facilitate airway patency

Short term:
After 4 hours of
NI, pt shall
have
demonstrate
improvement
of airway
patency AEB
reduction of
cough and
noiseless
breathing.

Long term:
After 3 days of
NI, the patient
should be able
to
maintain
patent airway
AEB absence of
pts abnormal
respiratory
manifestations
that has been
observed and
assessed

Assessmen
t
S=
O= pt
manifested:
> (+) rales
>nonproductive
cough
> abnormal
respiratory
depth and
rate
>shallow
breaths
=pt may
manifest:
>increased
a/p diameter

Nursing
Diagnosis
Ineffective
breathing
pattern r/t
retained
pulmonary
secretions
AEB
abnormal
respiratory
rate and
depth.

Scientific
Explanation
An
inflammatory
reaction can occur
in
the
alveoli,
producing
an
exudates.
White
blood cells, mostly
neutrophils,
also
migrate into the
alveoli and fill the
normally
aircontaining spaces.
Bronchospasm
may also occur in
patients
with
reactive
airway
disease.
The
secretions
and
bronchospasm
makes the patient
to have ineffective
breathing pattern.

>altered
chest
excursion

Problem #3: Impaired Gas Exchange

Objectives

Nursing
Interventions
Establish rapport

Short term:
After 4 hours
of NI, pt will
be able to Assess gen.
have
an condition of the pt.
improvement
of breathing
pattern AEB monitor and record
normalization
VS
of respiratory
rate
and elevate pt.s HOB
depth.
Long term:
provide adequate
After 3 days
of
NI,
the rest and sleep
patient
will
be free from suction secretions
when necessary
respiratory
distress and
other s/sx of administer
medications as
hypoxia.
order

Rationale
To gain trust and
cooperation of the pt.
to provide appropriate
assessment and
management
to obtain base line data
to promote maximum lung
expansion and oxygen
consumption
to reduce potential
dyspnea and fatigue.
to facilitate and promote
effective breathing pattern
to promote well ness
through pharmacologic
means.

Expected
Outcome
Short term:
After 4 hours of
NI, shall have
demonstrate
improvement
of
breathing
pattern
AEB
normalization
or respiratory
rate and depth.
Long term:
After 3 days of
NI, the patient
should be able
to
maintain
patent airway
AEB absence of
pts abnormal
respiratory
manifestations
that has been
observed and
assessed

Assessmen
t
S=
O= pt
manifested:
> irritability
> nasal
flaring

Nursing
Diagnosis
impaired
gas
exchange
r/t altered
oxygen
supply DOB

>DOB
>pale lips
and nail
beds
> increase
respiratory
distress
>nonproductive
cough
>(+) rales
=pt may
manifest:
>cyanosis

Problem #4: Hyperthermia

Scientific
Explanation
Due to retained
mucus secretions
in
the
bronchi,
there will be an
alteration in the
normal
perfusion
of gases in the
alveoli, resulting in
oxygen deficit and
carbon
dioxide
that will therefore
develop
to
an
impairment in gas
exchange.

Objectives

Nursing
Interventions
Establish rapport

Rationale

Short term:
After 4 hours
of NI, pt will
have
an Assess gen.
improvement
condition of the pt.
of
gas
exchange
AEB pinkish monitor and record
lips
and VS
nailbeds.

To gain trust and

cooperation of the pt.

to provide appropriate
assessment and
management

elevate pt.s HOB

Long term:
After 3 days
of NI, pt will
reposition pt.
be able to
periodically
demonstrate
improvement
in ventilation Instruct pt.s SO to
and presence increase fluid intake
of adequate of pt.
oxygenation
AEB absence Provide adequate
rest and sleep
of DOB.

to maximize oxygen
consumption

to obtain base line data

prevents accumulation and

pooling of secretions
to liquefy secretion for
easy expectoration
to lessen oxygen demand
of the pt.

administer oxygen
inhalation as order

to provide oxygen supply

administer due
medications

to promote wellness
through pharmacologic
means.

Expected
Outcome
Short term:
After 4 hours of
NI,
pt
shall
have
demonstrate
improvement in
gas exchange
AEB pinks lips
and nailbeds.
Long term:
After 3 days of
NI, pt should be
able
to
demonstrate
improvement in
ventilation and
presence
of
adequate
oxygenation
AEB absence of
DOB.

Assessme
nt
S=
O= pt
manifested
:
>elevated
temp. 38
>skin
warm to
touch
>irritable
> (+)rales

Nursing
Diagnosis
Hyperthermia

Scientific
Explanation
The set point of
the hypothalamic
thermostat
changes suddenly
from the normal
level to increasing
than the normal
value as a result
respiratory
infection related to
bronchopneumonia
and as the bodys
defense
mechanism
against infection

>Restless

Objectives

Nursing
Interventions
Establish rapport

Short term:
After 3hours
of
nursing
intervention, Assess gen.
the client will condition of the pt.
have
a
decrease
monitor and record
temperature
VS
from 38C to
37C
Provide TSB

To gain trust and

cooperation of the pt.
to provide appropriate
assessment and
management
to obtain base line data
To promote heat loss by
evaporation and
conduction
To reduce metabolic
demands

Long Term;
After 2 days
Provide adequate
of
nursing
rest periods
intervention,
the client will
Encouraged client
To have adequate oxygen
maintain
SO
to
provide
for
exchange
peripheral
adequate
temperature
within normal ventilation
Instruct clients SO To provide comfort
range.
to loosen the
clients clothing and
wear loose clothing
Emphasized to
To increase body resistance
clients So the need
and meet metabolic needs
for well balanced
diet
Administer
medications as
order

Problem #5: Sleep Pattern Disturbance

Rationale

To lower body temperature

trough pharmacologic
means.

Expected
Outcome
Short term:
After 3 hours of
nursing
intervention
the client shall
have
a
decrease
temperature
from 38C to
37C

Long Term:
After 2 days of
nursing
intervention,
the client shall
maintain
peripheral
temperature
within normal
range.

Assessme
nt
S=
O= pt
manifested
:
>DOB
>restless
>frequent
crying
>nonproductive
cough

Nursing
Diagnosis
Sleep pattern
disturbance
r/t external
stimuli and
DOB AEB
restlessness

Scientific
Explanation
Pts suffering from
pneumonia
requires
a
comfortable
position
during
sleeping
which
includes the high
fowlers
position
and an elevated
head. Lying on flat
on bed makes the
pt uncomfortable
and the occurrence
of
having
DOB
usually
follows.
However, if the pt
is an infant, it
would be more
difficult for them to
fall asleep not just
because
of
shortness
of
breath but also of
the pain they are
experiencing.
Another
contributing factor
is the unfamiliar
environment which
eventually affects
the
sleeping
routine of the pt.

Objectives
Short term:
After 4 hours
of NI, pts SO
will be able to
verbalize
understandin
g
o0f
different
sleep
disturbance
and will be
able
to
demonstrate
techniques to
implement
sleeping for
the infant

Nursing
Interventions
Establish rapport
Assess gen.
condition of the pt.

Rationale
To gain trust and
cooperation of the pt.
to provide appropriate
assessment and
management
to obtain base line data

monitor and record

VS
obtain feedback
to determione usual sleep
from the SO
pattern and comparative
regarding usual
baseline data
bedtime routine and
hours of sleep of
the pt
observe parent lack of knowledge of infant
infant interactions
cues and problems
provisions of
relationship may create
emotional support
tension interfering with
sleep routines based on
adult schedules may not
meet childs needs
promote relaxation hospital environment can
by providing calm
interfere to the sleep and
and quite
relaxation of the childs
environment
mind and body

Long term:
After 3 days
of NI, pts SO
will be able to
report
improvement
in
pts
sleep/rest
elevate head by
pattern
several degrees
conducive for
sleeping

upright position facilitates

adequate ventilation and
provides comfort

Expected
Outcome
Short term:
After 4 hours of
NI,
pts
SO
should be to
verbalize
understanding
o0f
different
sleep
disturbance
and will be able
to demonstrate
techniques to
implement
sleeping for the
infant
Long term:
After 3 days of
NI,
pts
SO
should be able
to
report
improvement in
pts sleep/rest
pattern

2. Actual SOAPIEs

S=sinisinat pa sya as verbalized by the mother

O= Received patient sitting on bed, awake. With an ongoing IVF # 2 D5 IMB
>skin warm to touch
>with non-productive cough
>with abnormal breath sounds(rales)
>with shallow respirations
>DOB
>SOB
Vital signs taken as follows:
T= 37.5C
P=148 bpm
R=61 cpm

A= Ineffective airway clearance r/t retained pulmonary secretions AEB nonproductive cough secondary to BPN.

P= after 2-4 hours of N.I. pt. will have an improvement of airways patency
AEB minimal cough and normalized respiratory depth and rate.

= Established rapport
= assessed gen. condition of the pt.
=monitored and recorded vital signs
=provided AM care
=auscultated chest and back for breath sounds
=kept pt.s back dryo
=repositioned pt. periodically
=instructed pt.s SO to increase fluid intake of the pt.
=Instructed pt.s SO to elevate pt.s HOB
=instructed pt.s SO to perform CPT
=provides restful environment

E= Goal met AEB reduction of cough and normalization of RR

VI. CLIENTS DALY PROGRESS CHART

1. Clients Daily Progress Chart
DAYS

ADMISSION
11-22-07

DAY 2
11-23-07

DISCHARGE
11-24-07

*
*

*
*
*

*
*

*
*

38c
143 bpm
49 cpm

37.5c
148 bpm
61 cpm

36.2c
126 bpm
42 cpm

Nursing Problems
1. Ineffective Airway Clearance
2. Ineffective Breathing Pattern
3. Impaired gas Exchange
4. Hyperthermia
5.Sleep pattern disturbance
Vital Signs
Temperature
Pulse Rate
Respiratory Rate
Laboratory Procedures
Hematology
Hemoglobin
Hematocrit
WBC
Lymphocytes
Platelet count
X-ray
Medical Management
IVF
D5IMB 500cc
Nebulization

Salbutamol Neb

N/A

*
*

*
*

*
AF

Drugs
Cefuroxime
Paracetamol
Diet
Diet for Age
Activity/exercise
Activity as Tolerated

2. Discharge Planning
The patient is actively playing with her mom. Still have cough and
slight difficulty of breathing.
S= 0
O=received pt. lying on bed on supine position, awake, with an ongoing IVF
#3 D5IMB 500cc at 450 cc level regulated at 29-30 mgtts/min infusing well
on the left arm.
>active
>Afebrile
>with normal breath sounds
>with good skin turgor
>slight DOB
>non-productive cough
Vital signs taken as follows:
T= 36.2C
P=126 bpm
R=42 cpm
A= for health maintenance and home management
P= after 30 mins. To 1 hour of N.I. pt. will verbalize understanding about
health teachings given.
I

= established rapport
= assessed gen. condition of pt.
= monitored and recorded vital signs
= auscultated lung for breath sounds
= provided comfort measures
=IVF out at 12:40 pm
M= Cefixime 100mg/5ml susp. tsp BID
= SCMC syrup 1 tsp TID
= Multivitamins syrup 1 tsp OD
E= Activity as tolerated

T= To comply to treatment regimen

H= instructed pt.s SO to increase fluid intake of the pt.
= instructed pt.s SO to keep pt.s back dry
= Instructed pt.s SO to increase pt.s intake of food rich in vit. C
= instructed pt.s SO to perform chest and back tapping
O= Instructed pt.s So to go back to the scheduled follow up check up
(Dec. 1 2007)
D=Diet for age
E= Goal met AEB SOs verbalization of understanding about health teachings
given.

VII. CONCLUSION AND RECOMMENDATION

Pneumonia is an acute infection of lung parenchyma including alveolar
spaces and interstitial tissue. Pneumonia is a common illness in all parts of

the world. It is a major cause of death among all age groups. In children, the
majority of deaths occur in the newborn period, with over two million deaths
a year worldwide. The World Health Organization estimates that one in three
newborn infant deaths is due to pneumonia.] Mortality from pneumonia
generally decreases with age until late adulthood. Elderly individuals,
however, are at particular risk for pneumonia and associated mortality.
Pneumonia and its management still pose a challenge not only to the
health care team involve but also the person diagnosed with this condition.
However, recent advances in our understanding of the pathophysiology,
diagnosis, and monitoring of the different kinds of pneumonia can help
physicians

optimize

treatment

strategies.

Contemporarily

treatment

guidelines emphasize an aggressive approach, with the prompt and liberal

use of antibiotic medications to the microorganism producing the disease to
control the spread to other parts of the body aside from its origin. It is
increasingly recognized that successful pneumonia treatment requires a
commitment from both patient and physician. Patient education can
empower persons with pneumonia top begin guided self management and
awareness of their disease condition. Such shared responsibility will help to
ensure a favorable outcome and an enhanced quality of life.
Often pneumonia begins after an upper respiratory tract infection (an
infection of the nose and throat). When this happens, symptoms of
pneumonia begin after 2 or 3 days of a cold or sore throat. Since pneumonia
often follows ordinary respiratory infections, the most important preventive
measure is to be alert to any symptoms of respiratory trouble that linger
more than a few days. Good health habits, proper diet and hygiene, rest,
regular exercise, etc., increase resistance to all respiratory illnesses. They
also help promote fast recovery when illness does occur. Proper consultation
can aid on the early diagnosis of the disease and treatment plan for decrease
duration of having the disease.
Because pneumonia is a common complication of influenza (flu),
getting a flu shot every fall is good pneumonia prevention. Vaccines to
prevent certain types of pneumonia are available. The prognosis for an
individual depends on the type of pneumonia, the appropriate treatment, any
complications, and the person's underlying health.

Learning Derive:
In doing this case study, I have learned new things about pneumonia. I
have learned that there are different factors that can lead you to acquiring
pneumonia. And that pneumonia usually occurs to pediatric pt. because their
immune system is not yet fully developed and that they have less body
defense against bacteria that causes pneumonia. The living condition or
situation can also contribute to the occurrence of the disease. There are also
vaccines, wherein before I never thought that there are such vaccines, that
we can get to prevent pneumonia from occurring. This case study makes me
realize a lot of things. One is that, before my perception about Pneumonia is
just sipon and ubo, I didnt even know then what could be the cause of
Pneumonia, but with this study Ive learned that different microorganisms
could cause the disease. And Ive also learned the different types of
Pneumonia. The most important thing that Ive learned from this study is not
on the disease proper but on how to come up with a good case study. If you
want to have a good case study you should get all the needed information
you need for your case, and dont skip any information because this could
greatly affect your study. It is also important on how you establish rapport to
your client so that they will not be hesitant to give you information about
their family.

-Emilyn Serrano

As we go along with our case study about BPN, I have learned so many
things about it on how to deal with it and how to handle this kind of case. It is
important to include not only the patient in the study but also the family of
the patient. Because a case study will not be completed unless the family is
not included. Bronchopneumonia is defined as a type of pneumonia that is
localized, often to the bronchioles and surrounding alveoli. It means that this
kind of disease may show any symptoms of coughing, chest pains, fever,
blood-streaked sputum, chills, and difficulty in breathing. This type of disease

may be nosocomial or community acquired. Patients who are immobile

develop retention of secretions; thus, most commonly involves the lower
lobes. If treated, recovery usually involves focal organisation of lung by
fibrosis. This type of diseases includes infants and the elderly people. BPN is
a disease that spreads from bronchioles to nearby alveoli. Now Ive learned
the how painful the suffering of the people who are infected with this kind of
diseases. In treating this kind of disease we should always competent on
what we do especially on what we give to our patients because a single
mistake can put danger to the life of our patient. Giving medicines to our
patient can help them to recover fast and to be able to help them fight for
their disease. And also giving them nebulization can help them relieve chest
pain because too much secretion is blocking on their airway. And also we
should not always forget to put our shoes to our patients because through
this we would be able to understand them and also to gain their trust. We
should always remember that they are also humans like us, with a heart that
also needs nourishment and care from other people. Through giving
medicines regularly and also through treating them humanely our patient will
be able to recover fast and also to have a greater chance for improvement.
Thats why as a student nurse we should always practice to treat our patients
humanely no matter what race, looks and kind of person they are. So that in
the coming future hopefully if we would become a registered nurse we would
be able to remember and practice all the things that we have learned from
the past. And through this Im sure that we would also be a successful nurse
because if you treat your patient humanely you will not only make them
happy but also God will be very proud of you.
-Adrian Guarin
VIII. BIBLIOGRAPHY

Deglin, Judith Hopfer & Vallerand, April Hazard. Daviss Drug Guide for
Nurses(10th edition). Philadelphia, Pannsylvania. 2007
Smeltzer, Suzanne et al. Brunner & Suddarths Textbook of MedicalSurgical Nursing(11th edition).

Doenges, Marilynn E. Nurses Pocket Guide: Diagnoses,

Interventions and Rationales. (9th Edition). F.A. Davis Co., 2004.
Delmarss Pediatric Nursing Care Plans.(third edition)., Karla L.
Luxner
http://www.sciencedaily.com/releases/2007/06/070626123930.htm

http://www.netdoctor.co.uk/diseases/facts/pneumonia.htm

http://encarta.msn.com/encyclopedia_761577180/Respiratory_System.html

Angeles University Foundation

Angeles City
College of Nursing

A Case Study

Bronchopneumonia
Submitted by:
Dumas, Joycee
Guarin, Adrian
Serrano, Emilyn

Group 3

Submitted to:
Mr. Ercel Gamboa

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