A CASE

STUDY OF
PNEUMONIA
Case
A 3 year-old male, child, came into the Emergency
Room with his parents. He was admitted due to difficulty of
breathing in the last hour. 5 days prior to admission (PTA),
patient started to have fever, persistent cough with sputum
discharges, irritability and lack of appetite. Her mother is
almost in tears while answering the assessment questions of
the doctor and nurse. The father also looks anxious and keeps
on Doctor’s diagnosis is Pneumonia, bilateral.
 The child was then hooked to D5LR and his vital signs
are as follows:

• BP: 90/60 mmHg

• PR: 118 bpm
• RR: 40 cpm
• Temp: 39.3˚ C
• Sp𝑶𝟐 : 88%
• Weight: 12.5 kg.
• Height: 93 cm
Laboratory and Diagnostic Results

TESTS RESULTS

ABG pH 7.26; paO2 57; paCO2 72; HCO3 26; O2 sat 88%
CBC RBC 3.5 x 1012 /L; Hgb 11 g/dL; Hct 0.33, MCVI 71
Serology M. Pneumoniae positive
Sputum Gs/Cs Waiting for result
Chest X-Ray (CXR) (+) Infiltrates on upper right lobe and lower left lobe
Spirometry FVCI 78%

Drugs Prescribed
 Combivent 1neb q6hrs
 Cefuroxime 75mg/kg/day
 Paracetamol 1/2amp PRN for fever 38.5 and above
 Structure and Function
of the
Respiratory System
The ​respiratory system​ is the system in the human body
that enables us to breathe. It is divided into two parts:
1. Upper respiratory tract
- includes the nose, mouth, and the beginning of the trachea
(the section that takes air in and lets it out).
2. Lower respiratory tract
- includes the trachea, bronchi, broncheoli and the lungs (the
act of breathing takes place in this part of the system).
- The organs of the lower respiratory tract are located in the
chest cavity. They are delineated and protected by the ribcage, the chest
bone (sternum), and the muscles between the ribs and diaphragm.
Structure and Function of the Respiratory System
Who are mostly vulnerable to Pneumonia?
 Anyone can acquire Pneumonia but children younger than 2 years
old and people older than 65 years old are most likely to develop it.

 Certain factors can also increase your risk of pneumonia, such as:
 Having a weakened immune system.
 Being hospitalized or being on a ventilator
 Having a chronic condition including ​asthma​, chronic
obstructive pulmonary disease, structural lung disease
and ​heart disease
 Smoking
What causes the changes in the client’s vital signs?
Vital Signs
If one has pneumonia, oxygen
 BP: 90/60 mmHg
exchange decreases because the
 PR: 118 bpm infection causes the bronchi and
 RR: 40 cpm alveoli to be filled with pus or fluids
which usually results to
 Temp: 39.3˚C
cough, fever, chills and troubled
 SpO2: 88% breathing. Fever may rise as high
 Weight: 12.5kg and as dangerous as 105 degrees F,
 Height: 93 cm with profuse sweating and rapidly
increasing breathing and pulse rate.
Lips and nailbeds may have a bluish
color due to lack of oxygen in the
blood. And a patient's mental state
may be confused or delirious.
Laboratory Tests
 ABG (Arterial Blood Gases) is the test used to evaluate respiratory
diseases and conditions that affect the lungs. It helps determine the
effectiveness of oxygen therapy. The test also provides information about
the body's acid/base balance, which can reveal important clues about
lung and kidney function and the body's general metabolic state.
There are five key components to an ABG and normal values. They
include:
1. pH- 7.38-7.42
2. Partial pressure of oxygen (PaO2)- 75 to 100 mmHg
3. Partial pressure of carbon dioxide (PaCO2)- 38 to 42 mmHg
4. Bicarbonate (HCO3)- 22-28 mEq/L
5. Oxygen saturation (O2 Sat)- 94-100%
Abnormal results may be due to lung, kidney, or metabolic diseases.
Laboratory Tests
 CBC (Complete Blood Count) measures several components and
features of blood including Red blood cells, which carry oxygen;
Hemoglobin, the oxygen-carrying protein in red blood cells; Hematocrit,
the percentage of red blood cells in your blood. This test determines if
there are any increases or decreases in your blood cell counts.
Normal values:
• RBC = 3.9-5.3 x1012/L
• Hgb = 11.5–15.5 g/dL
• Hct = 0.34-0.40
• MCV1= 75-87

 Chest X-Ray is used to evaluate the lungs, heart and chest wall and
may be used to help diagnose variety of lung conditions. White spots in
the lungs (called infiltrates) can be seen in the chest x-ray result of the
3y/o.
Laboratory Tests
 Serology is a blood test that looks for antibodies in the blood. When
your doctor tests your blood, they can identify the type of antibodies and
antigens in your blood sample, and identify the type of infection that you
have.
Normal test results
• Your body produces antibodies in response to antigens. If testing
shows no antibodies, it indicates you don’t have an infection.
Abnormal test results
• Antibodies in the blood sample often mean you’ve had an immune
system response to an antigen from either current or past exposure
to a disease or foreign protein.

 Sputum Gs (gram stain)/Cs is the test that studies the bacteria or

fungi that might be growing in your lungs and causing the production of
the sputum. This can help them find the cause of your illness.
Laboratory Tests
 Spirometry is a standard test the doctors use to measure how well
your lungs are functioning. The test works by measuring airflow into and
out of your lungs. Using a spirometer, the amount of air you breathe in
and out and the speed of your breath are being recorded. This test is done
if the doctor suspects you have signs or symptoms of a chronic lung
condition.
Deviations Found

 Decreased blood pressure : 90/60 mmHg

 Increased Pulse Rate : 118 bpm
 Rapid Breathing : 40 cpm
 Increased Temperature : 39.3˚ C
 Decreased Oxygen Saturation : 88%
 Decreased Arterial Blood Gases : pH 7.26; pa𝑶𝟐 57; paC𝑶𝟐 72; HC𝑶𝟑 26; 𝑶𝟐 𝐬𝐚𝐭
88%
 Low Blood Count
 M. Pneumoniae Positive
 Infiltrates on upper right lobe and lower left lobe of the lungs
 Decreased lung functioning (Spirometry of 78%)
 Health Teaching Prior to
and/or After the tests:
Before
• Explain the procedure to the patient, with particular attention to
the associated risks and benefits.
• Describe the procedure, what part of the body will be evaluated,
whether or not the procedure is invasive, where the procedure
will take place, and who will participate in performing the study.
After
• Tell patient to report to healthcare personnel if new symptoms
develop, such as persistent or worsening of the symptoms.
 Reasons why the client had acquired
the present symptoms

a. When the inflammation occurs in the alveoli (air

sacs in the lungs) they fill it with fluid. The lungs
become less elastic and cannot take oxygen into the
blood or remove carbon dioxide from the blood as
efficiently as usual.

b. The infection that inflames your alveoli, fill it up with fluid or

pus.

c. Kids with pneumonia caused by bacteria usually become sick

fairly quickly, starting with a sudden high fever and unusually
fast breathing.
DRUG STUDY
 COMBIVENT
Mechanism of Nursing
Drug Name Indications Contraindication Side Effects Adverse Effects
Action Responsibilities
Generic Name: Therapeutic Indicated for use Contraindicated  Body aches or  Upper respiratory Monitor patient
Albuterol and Class: in patients with in patients with pain infection for signs and
Ipratropium Bronchodilators chronic Atropine allergy.  Chills  Nasopharyngitis symptoms of
obstructive  Cough  Cough, superinfection
Brand Name: Pharmacologic pulmonary Use cautiously in  Cough  Bronchitis and diarrhea and
Combivent Class: disease (COPD) patient producing  Headache treat
Respimat Anticholinergic + on a regular hypersensitive to mucus  Dyspnea appropriately.
beta-2 agonist. aerosol penicillin.  Difficulty with  Paradoxical
Route & bronchodilator breathing bronchospasm, Drug may
Dosage: who continue to Drug appears in  Ear congestion  Urianary retention increase INR and
have evidence of human milk.  Fever  Hypokalemia, risk of bleeding.
1 inhalation bronchospasm Patient should  Headache  Hypersensitivity
q.i.d; max 6 (airway consider  Loss of voice reactions, ocular Do not confuse
inh/day. narrowing) and temporarily  Runny nose effects. drug with
who require a discontinuing cephalosporin
second breastfeeding that sound alike.
bronchodilator. during treatment.
Health Teaching:
• Inform patients that Cefuroxime Axetil is a cephalosporin that can
cause allergic reactions in some individuals
• Inform patients that diarrhea is a common problem caused by
antibacterials, and it usually ends when the antibacterial is
discontinued.
• Instruct patients to swallow the tablet whole, without crushing the
tablet. Patients who cannot swallow the tablet whole should receive
the oral suspension.
• Inform patients that antibacterial drugs, including Cefuroxime Axetil,
should only be used to treat bacterial infections. They do not treat
viral infections (e.g., the common cold). When Cefuroxime Axetil is
prescribed to treat a bacterial infection, inform patients that although
it is common to feel better early in the course of therapy, the
medication should be taken exactly as directed. Skipping doses or not
completing the full course of therapy may: (1) decrease the
effectiveness of the immediate treatment, and (2) increase the
likelihood that bacteria will develop resistance and will not be
treatable by Cefuroxime Axetil or other antibacterial drugs in the
future.
 CEFUROXIME
Mechanism of Nursing
Drug Name Indications Contraindications Side Effects Adverse Effects
Action Responsibilities
Cefuroxime Contraindicated in  diarrhea  CV: phlebitis, Before giving
Generic Name:
Axetil tablets are patients  nausea thrombophlebitis drug, ask
Cefuroxime
indicated for the hypersensitive to  vomiting patient if she is
Axetil
treatment of drug or other  abdominal pain  GI: diarrhea, allergic to
adult patients cephalosporin.  headache anorexia, penicillin or
Brand Name:
and pediatric  rash vomiting cephalosporin.
Ceftin Therapeutic
patients (13 Use cautiously in  hives Obtain
Class:
years and older) patients  vaginitis and  Hematologic: specimen for
Generic Name: Antibiotics
with mild-to- hypersensitive to  mouth hemolytic culture and
Cefuroxime
moderate penicillin because ulcers. anemia, sensitivity tests
Sodium Pharmacologic
pharyngitis/ton of possibility of thrombocytopeni before giving
Class:
sillitis caused by cross-sensitivity a, transient first dose.
Brand Name: Second-
susceptible with other beta neutropenia, Absorption of
Zinacef Generation
strains of lactam antibiotics eosinophilia oral drug is
cephalosporins
Streptococcus induced.
Route & Dosage:
pyogenes.
750 mg I.V or
I.M every 12
hours
Health Teaching:
• Tell patient to take drug as prescribed, even if feeling
better
• Advise patient who has difficulty swallowing tablets to
ask prescriber for suspension
• Tell parent to shake suspension well before measuring
dose. Suspension may be stored at room temperature or
refrigerated, but must be discarded after 10 days.
• Instruct caregiver to give suspension with food
• Instruct patient to notify the provider about rash, loose
stool, diarrhea or evidence of superinfection.
• Advice patient receiving drug I.V to report discomfort at
I.V insertion site.
 PARACETAMOL
Mechanism of Nursing
Drug Name Indications Contraindications Side Effects Adverse Effect
Action Responsibilities
 Bloody or black, CNS: agitation,
tarry stools anxiety, fatigue,
Generic Name:  bloody or cloudy headache, insomnia,
Acetaminophen/ urine pyrexia
Paracetamol  fever with or CV: HTN,
without chills hypotension,
Brand Name: (not present peripheral edema, Use liquid for
Abenol, ACET, before treatment periorbital edema, children and adults
Contraindicated to
Arthritis Pain Relief, and not caused tachycardia who have difficulty
Temporary relief of patients with:
Atasol Forte, Fortolin Therapeutic Class: by the condition GI: nausea, vomiting, swallowing.
pain and discomfort Hypersensitivity,
Analgesics being treated) abdominal pain,
from headache, fever, intolerance to
Route & Dosage:  pain in the lower diarrhea, Monitor ALT, AST and
cold, flu, minor tartrazine (yellow
Pharmacological back and/or side constipation bilirubin levels in all
muscular aches, dye #5), alcohol,
Per Orem: 325- Class: (severe and/or GU: oliguria patients at baseline.
overexertion, table sugar, saccharin
650mg q4h up to a Para-aminophenol sharp) SKIN: rashes,
menstrual cramps, and contraindicated
maximum of 1 gram derivatives  pinpoint red urticarial, pruritus Monitor patient with
toothache. with allergy to
q6h. spots on the skin RESPIRATORY: a history of CV
acetaminophen
 skin rash, hives, abnormal breath disease at least
Suppositories: 650mg or itching sounds, dyspnea, monthly for HTN
q4h not to exceed 4  sore throat (not hypoxia
grams a day for up to present before
10 days. treatment and
not caused by
the condition
being treated)
Health Teaching
• Tell parents to consult prescriber before giving drug to
children younger than age of 2.
• Advice parents that drug is just for short term use; urge them
to consult prescriber if giving to children for longer than 5
days and 10 days for adults.
• Tell patient not to use for marked fever (temp higher than
103.1^o F or 39.5^o C)
• Caution patient to contact health care provider if signs and
symptoms of liver damage occur.
• Tell breastfeeding patient that drug appears in human milk in
low levels. Drug may be used safely if therapy is short-term
and doesn’t exceed recommended doses.
• Warn patient to stop drug and seek medical attention
immediately if rash or other reactions occur while using
acetaminophen.
REFERENCES:
https://www.visiblebody.com/learn/respiratory/5-functions-of-respiratory-system
https://www.mada.org.il/en/about/engineer/challenge/respiratory-system
https://www.ucsfbenioffchildrens.org/tests/003855.html
https://www.mayoclinic.org/tests-procedures/complete-blood-count/about/pac-20384919
https://www.childrensmn.org/references/lab/hematology/cbc-reference-value-table.pdf
https://www.radiologyinfo.org/en/info.cfm?pg=chestrad
https://www.healthline.com/health/serology#results
https://www.healthline.com/health/routine-sputum-culture
https://www.healthline.com/health/spirometry#graph
Woods, A et al, (2019). Nursing 2020 drug Handbook Volume 1. C&E Publishing, Inc.
Woods, A et al, (2019). Nursing 2020 drug Handbook Volume 2. C&E Publishing, Inc.
Knight, M. (2019). Drugs.com. Know more. Be sure. Retrieved from
https://www.drugs.com/mtm/cefuroxime.html
THANK YOU :)