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Pneumonia Case Study

BY ADMIN DECEMBER 15, 2007


INTRODUCTION
Pneumonia is an inflammation of the lungs caused by an infection. It is also called
Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our
health. Although pneumonia is a special concern for older adults and those with
chronic illnesses, it can also strike young, healthy people as well. It is a common
illness that affects thousands of people each year in the Philippines, thus, it
remains an important cause of morbidity and mortality in the country.
There are many kinds of pneumonia that range in seriousness from mild to life-
threatening. In infectious pneumonia, bacteria, viruses, fungi or other organisms
attack your lungs, leading to inflammation that makes it hard to breathe.
Pneumonia can affect one or both lungs. In the young and healthy, early
treatment with antibiotics can cure bacterial pneumonia. The drugs used to fight
pneumonia are determined by the germ causing the pneumonia and the
judgment of the doctor. Its best to do everything we can to prevent pneumonia,
but if one do get sick, recognizing and treating the disease early offers the best
chance for a full recovery.
A case with a diagnosis of Pneumonia may catch ones attention, though the
disease is just like an ordinary cough and fever, it can lead to death especially
when no intervention or care is done. Since the case is a toddler, an appropriate
care has to be done to make the patients recovery faster. Treating patients with
pneumonia is necessary to prevent its spread to others and make them as
another victim of this illness.

ANATOMY AND PHYSIOLOGY


The lungs constitute the largest organ in the respiratory system. They play an
important role in respiration, or the process of providing the body with oxygen
and releasing carbon dioxide. The lungs expand and contract up to 20 times per
minute taking in and disposing of those gases.
Air that is breathed in is filled with oxygen and goes to the trachea, which
branches off into one of two bronchi. Each bronchus enters a lung. There are two
lungs, one on each side of the breastbone and protected by the ribs. Each lung is
made up of lobes, or sections. There are three lobes in the right lung and two
lobes in the left one. The lungs are cone shaped and made of elastic, spongy
tissue. Within the lungs, the bronchi branch out into minute pathways that go
through the lung tissue. The pathways are called bronchioles, and they end at
microscopic air sacs called alveoli. The alveoli are surrounded by capillaries and
provide oxygen for the blood in these vessels. The oxygenated blood is then
pumped by the heart throughout the body. The alveoli also take in carbon
dioxide, which is then exhaled from the body.
Inhaling is due to contractions of the diaphragm and of muscles between the ribs.
Exhaling results from relaxation of those muscles. Each lung is surrounded by a
two-layered membrane, or the pleura, that under normal circumstances has a
very, very small amount of fluid between the layers. The fluid allows the
membranes to easily slide over each other during breathing.

PATHOPHYSIOLOGY

Pneumonia is a serious infection or inflammation of your lungs. The air sacs in


the lungs fill with pus and other liquid. Oxygen has trouble reaching your blood.
If there is too little oxygen in your blood, your body cells cant work properly.
Because of this and spreading infection through the body pneumonia can cause
death. Pneumonia affects your lungs in two ways. Lobar pneumonia affects a
section (lobe) of a lung. Bronchial pneumonia (or bronchopneumonia) affects
patches throughout both lungs.
Bacteria are the most common cause of pneumonia. Of these, Streptococcus
pneumoniae is the most common. Other pathogens include anaerobic bacteria,
Staphylococcus aureus, Haemophilus influenzae, Chlamydia pneumoniae, C.
psittaci, C. trachomatis, Moraxella (Branhamella) catarrhalis, Legionella
pneumophila, Klebsiella pneumoniae, and other gram-negative bacilli. Major
pulmonary pathogens in infants and children are viruses: respiratory syncytial
virus, parainfluenza virus, and influenza A and B viruses. Among other agents are
higher bacteria including Nocardia and Actinomyces sp; mycobacteria, including
Mycobacterium tuberculosis and atypical strains; fungi, including Histoplasma
capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Cryptococcus
neoformans, Aspergillus fumigatus, and Pneumocystis carinii; and rickettsiae,
primarily Coxiella burnetii (Q fever).

The usual mechanisms of spread are inhaling droplets small enough to reach the
alveoli and aspirating secretions from the upper airways. Other means include
hematogenous or lymphatic dissemination and direct spread from contiguous
infections. Predisposing factors include upper respiratory viral infections,
alcoholism, institutionalization, cigarette smoking, heart failure, chronic
obstructive airway disease, age extremes, debility, immunocompromise (as in
diabetes mellitus and chronic renal failure), compromised consciousness,
dysphagia, and exposure to transmissible agents.

Typical symptoms include cough, fever, and sputum production, usually


developing over days and sometimes accompanied by pleurisy. Physical
examination may detect tachypnea and signs of consolidation, such as crackles
with bronchial breath sounds. This syndrome is commonly caused by bacteria,
such as S. pneumoniae and H. influenzae.

NURSING PROFILE
a. Patients Profile
Name: R.C.S.B.
Age: 1 yr,1 mo.
Weight:10 kgs
Religion: Roman Catholic
Mother: C.B.
Address: Valenzuela City
b. Chief Complaint: Fever
Date of Admission: 1st admission
Hospital Number: 060000086199
c. History of Present Illness
2 days PTA (+) cough
(+) nasal congestion, watery to greenish
(+) nasal discharge
Tx: Disudrin OD
Loviscol OD
Few hrs PTA (+) fever, Tmax= 39.3 C
(+) difficulty of breathing
(+) vomiting, 1 episode
Tx: Paracetamol
Sought consultation at ER: Rx=BPN, Salbutamol neb.
IE: T = 38.3C, CR= 122s, RR= 30s
(+) TPC
SCE, (-) retractions, clear BS, (-) cyanosis, (-) edema
d. Past Illness
(-) asthma
(-) allergies

e. Family History
PMHx: (+) asthma (mother)

f. Activities of Daily Living


Sleeping mostly at night and during afternoon
Usually wakes up early in the morning (5AM) to be milkfed.
Eats a lot (hotdogs, chicken, crackers, any food given to her)
Active, responsive
BM (1-2 times a day)
Urinates in her diaper (more than 4 times a day)
Likes to play with those around her
g. Review of Systems
Neuromuscular: weakness of muscles
Integumentary: (-) cyanosis
Respiratory: tavhypnea; (+) DOB; (+) coarse crackles, (+) wheezes,
Digestive: food aversion, vomits ingested milk

DRUG STUDY
View NCP
NURSING ACTIONS
INDEPENDENT
positioning of the patient with head on mid line, with slight flexion
rationale: to provide patent, unobstructed airway , maximum lung excursion
auscultating patients chest
rationale: to monitor for the presence of abnormal breath sounds
provide chest and back clapping with vibration
rationale: chest physiotheraphy facilitates the loosening of secretions
considering that the patient is an infant, and has developed a strong stranger
anxiety
as manifested by white coat syndrome , it is a nursing action to play with
the patient.
rationale: to establish rapport, and gain the patients trust
DEPENDENT

administer due medications as ordered by the physician, bronchodilators,


anti pyretics and anti biotics
rationale: bronchodilators decrease airway resistance, secondary to
bronchoconstriction,
anti pyretics alleviate fever, antibiotics fight infection
placing patient on TPN prn
rationale: to compensate for fluid and nutritional losses during vomiting
COLLABORATIVE

assist respiratory therapist in performing nebulization of the patient


rationale: nebulization is a favourable route of administering
bronchodilators
and aid in expectorating secretions, hence patients breathing
PHYSICIANS ORDER SHEET
11/19/06

Admit patient to ROC under the service of Dr. Vitan secure consent for admission
and management, TPR every shift then record. May have diet for age with strict
aspiration precaution, IVF D5 0.3NaCl 500cc to run at 62-63mgtts/min.May give
paracetamol 125mg 1supp/rectum if oral paracetamol is not tolerated.

11/20/06
For urinalysis, IVF to follow D5 0.3 NaCl 500 at SR (62-63mgtt/m Use zinacef brand
of cefuroxine 750mg- given vial 375mg every 8hours, nebulize (Ventolin 1
nebule) every 6 hours, paracetamol drugs prn every 4hours (Temp 37.8).

11/21/06

Continue cefuroxine and nebulizer every 6 hours. May not reinsert IVF, revise
Cefuroxine IV to Cefuroxine 500mg via deep Intramuscular
BID,continue management.

11/22/06

Continue management and refer.

DISCHARGE PLANNING
Take the entire course of any prescribed medications. After a patients
temperature returns to normal, medication must be continued according to
the doctors instructions, otherwise the pneumonia may recur. Relapses can
be far more serious than the first attack.
Get plenty of rest. Adequate rest is important to maintain progress toward
full recovery and to avoid relapse.
Drink lots of fluids, especially water. Liquids will keep patient from
becoming dehydrated and help loosen mucus in the lungs.
Keep all of follow-up appointments. Even though the patient feels better,
his lungs may still be infected. Its important to have the doctor monitor his
progress.
Encourage the guardians to wash patients hands. The hands come in
daily contact with germs that can cause pneumonia. These germs enter ones
body when he touch his eyes or rub his nose. Washing hands thoroughly and
often can help reduce the risk.
Tell guardians to avoid exposing the patient to an environment with too
much pollution (e.g. smoke). Smoking damages ones lungs natural
defenses against respiratory infections.
Give supportive treatment. Proper diet and oxygen to increase oxygen in
the blood when needed.
Protect others from infection. Try to stay away from anyone with a
compromised immune system. When that isnt possible, a person can help
protect others by wearing a face mask and always coughing into a tissue.

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