Case Scenario 1

Pediatric-community
Acquired pneumonia
P-CAP

BLESSIE PASAPORTE
ISABELLE PARCON

Clinical Instructor ; Marjory Ann Gorriceta

 INTRODUCTION
PEDIATRICIAN- a pediatrician is a doctor who focuses on the health of the infants,
children, adolescents and young adults. Pediatric care starts at birth and last through a
child’s 12st birthday or longer pediatrician prevent, detect and manage physical,
behavioral and developmental issues that affect the children.
COMMUNITY ACQUIRED PNEUMONIA – community acquired pneumonia is lung
infection that develops in people outside a hospital. Many bacteria, viruses and fungi can
cause pneumonia. The most common symptoms of pneumonia is a caught that produces
sputum, but chest pain, chills, fever, and shortness of breath are also common.
BROCHIAL BREATH- bronchial breath sounds are loud, harsh breathing sounds with a
midrange pitch. Doctors usually associate them sounds with exhalation, as their
expiratory length is longer than their inspiratory length.
ANTIDIURITIC HORMONE- antidiuretic hormone or vasopressin is a hormone
synthesized from the AVP gene as the peptide prohormone in neurons in the
hypothalamus and in converted to AVP.
ULTRASOUND- an ultrasound is an imaging test that uses sound waves to create a
picture of organs, tissues, and other structures inside the body.
X-RAY- x-ray is a quick, painless test that produces images of the structures inside your
body-particularly your bones.
PLUERAL EFFUSION- pleural effusion or ‘water on the lungs’ is the build-up of
excess fluid between the layers of the pleura outside the lungs. The pleural are thin
membranes that line the lungs and the inside of the chest cavity and act to lubricate and
facilitate breathing.
 OBJECTIVES
General objectives
At the end of this case presentation, the audience will be educated about Pediatric
community acquired pneumonia (PCAP) and its nursing management, and acquire the
proper knowledge, skills and attitude in providing care to the patient.

Specific objectives
Knowledge
1.recognize the characteristics of the term pediatric community acquired pneumonia
(PCAP)
2.identify the national health goals related to patient that nurses can be instrumental in
helping the nation to achieve.
3.identify areas related to care of children with respiratory disorders that could benefit
from additional nursing research.
Skills
1. to improve my critical thinking to analyze ways that the care can be more family
centered.
2. to enhance my capability in assessing a woman and her family for psychologic and
physiological changes following birth.
3. to improve my nursing skills or ability to do nursing care plan and plan nursing care
such as measures to aid uterine involution or encourage bonding.
Attitude
1.establish rapport with the Parents and members of the family
2. improve my self confidence in facing and interviewing the parents
3. to have more effective and reliable ways in gaining my clients trust
 NURSING HEALTH HISTORY

A. BIOGRAPHIC DATE

Patients name Harry

Address
Age 3 years old
Sex Female
Marital status single
Occupation n/a
Religion n/a
Source of information mother
Attending physician with physician
Date of admission February 04, 2022
Time of admission 8am
Chief complain Presented with a four day history of fever, feeling
generally unwell and abdominal pain.
Admitting impression PCAP-C

B. CHIEF CMPLAIN

Chief complain Presented with a four-day history of fever,

feeling generally unwell and abdominal pain.
C. HISTORY OF PRESENT ILLNESS

History of present illness Presented with a four-day history of fever,

feeling generally unwell and abdominal pain.
Poor appetite, consumed approximately 100ml
of lugaw and 4oz millk formula 2x a day.
D.PAST MEDICAL HISTORY
(-) chicken
(-) history of admission
(-) history of any respiratory illness
(-) TB
(-) heart disease
(-) DM
(-) HPN
E. FAMILY HISTORY
(-) Asthma
(-) hypertension
(-) mental illness
(-) cancer
 PHYSICAL EXAMINATION

According to Harry’s results, the right upper lobe showed reduced breath sounds and rales. On occasion, a
strong cough was reported, as well as breathing difficulties. Patients were described as weak and pale,
uncomfortable, and crying a lot. The presence of an inflamed throat noted. PCAP-C detected .

PATHOPHYSIOLOGY

An inhaled infectious organism must bypass the host’s normal nonimmune and immune defense
mechanisms in order to cause pneumonia. The nonimmune mechanisms include aerodynamic filtering of
inhaled particles based on size, shape, and electrostatic charges; the cough reflex; mucociliary clearance;
and several secreted substances (eg, lysozymes, complement, defensins). Macrophages, neutrophils,
lymphocytes, and eosinophils carry out the immune-mediated host defenses.
 Anatomy and physiology

What is respiration? Respiration is the act of

breathing in and breathing out. When you inhale,
you take in oxygen. When you exhale, you Hi
off carbon dioxide.

What makes up the respiratory system?

 Nose
 Mouth
 Throat (pharynx)
 Voice box (larynx)
 Windpipe (trachea)
 Airways (bronchi)
 Lungs

The upper respiratory tract includes the

following:

 Nose
 Nasal cavity
 Sinuses

The lower respiratory tract includes the following:

 Voice box (larynx)

 Windpipe (trachea)
 Lungs
 Airways (bronchi and bronchioles)
 Air sacs (alveoli)

To do the lungs work?

The lungs take in oxygen. The body's cells need oxygen to live and carry out their normal functions. They
also get rid of carbon dioxide, a waste product of the cells.
The lungs are a pair of cone-shaped organs made up of spongy, pinkish-gray tissue. They take up most of
the space in the chest, or the thorax (the part of the body between the base of the neck and diaphragm).
The lungs are covered in a membrane called the pleura. They are separated from each other by the
mediastinum. This area contains the following:

 Heart and its large vessels

 Windpipe (trachea)
 Esophagus
 Thymus gland
 Lymph nodes

The right lung has 3 lobes. The left lung has 2 lobes. When you breathe, the air:

 Enters the body through the nose or the mouth.

 Travels down the throat through the larynx (voice box) and trachea (windpipe).

Diagnostic and Laboratory

A chest x-ray, pneumonia in the upper lobe of the right lung, and a positive sputum culture and sensitivity
test for Streptococcus Pneumoniae were one of Harry’s results. Eosinophils and erythrocytes are also
within normal limits
CBC RESULT
 RESULT Normal value

Hemoglobin 110 140-180

Erythrocytes, volfr. 0.43 0.40-0.54

Erythrocytes, numc. 4.56 4.6- 6,2x10

Leukocytes, numc 15 4,5-11,0x10

Leukocytes, type,numc

Band neutrophils 0.10 0,02-0,05

Eosinophils 0.6

Segmenter Neutrophils 0.8 0,5-0,7

Basinophilis 0,01-0.04

Lymphocytes 0.35 0.22-0.40

Monocytes 0.09 0.03-0.08

REMARKS PLATELET
ADEQUATE

URINALYSIS

DRUG STUDY
PARACETAMOL
Drug data Classificatio Indication and Side Special Nursing
n and contraindicati effects or precautio responsibiliti
 mechanism on adverse n es
of action effect
reaction
Generic Classificatio Indication: Adverse Paracetam >check
name: n: Paracetamol is effect ol may doctors order
paracetam antipyretic a mild reaction: also cause >administer
ol analgesic and nausea, allergic the right drug
antipyretic and vomiting, reactions. in the right
is constipatio Symptoms dose and
recommended n, of drug route at the
Trade for the allergy right time
name: treatment of include >assess
dymadon, Mechanism most painful swollen allergy to any
Panadol, of action: and febrile face, ingredients
panama, paracetamol conditions like difficulty >observe 10
etc. reduces headache, sore in rights in
fever by throat, breathing, giving
affecting an backache, itchy skin medication.
area of brain migraine. rashes
Dosage:5 that over the
ml regulates the body.
body Contraindicatio
temperature. n: person with
Paracetamol caloric
Route: relieving undernutrition,
oral mild to acute liver
moderate failure, liver
pain and problem, severe
reduces renal
Frequency fever. impairment,
: q4h acute
inflammation
of the liver due
Timing: to hepatitis C
8-12-4 virus.

DRUG STUDY
CEFUROXIME
Drug Classificatio Indication and Side Special Nursing
data n and contraindication effects precautio responsibiliti
mechanism or n es
of action adverse
effect
reactio
n
Generic Classificatio Indication: Nausea, Cefuroxi >check
name: n: Susceptible mild to vomitin me may doctors order
cefuroxi cephalospori moderate g, cause >administer
me ne antibiotics infections diarrhea diarrhea, the right drug
including , strange and in in the right
pharyngitis/tonsillit taste in some dose and
is, acute maxillary the cases it route at the
Trade sinusitis, chronic mouth, can be right time
name: bronchitis, acute or severe. Do >assess
ceftin otitis media, UTIs. stomach not take allergy to any
Mechanism pain any ingredients
of action: may medicine >observe 10
cefuroxime occur. to treat rights in
Dosage: is a diarrhea giving
400mg bactericidal without medication.
agent that checking
acts by with your
inhabitation Contraindication: doctor.
Route: IV of bacterial Cefuroxime is
cell wall contraindicated in
synthesis. patients with
cephalosporin
Frequenc hypersensitivity or
y: q8h cephamycin
sensitivity.

Timing:
10days

DRUG STUDY
 AZITHROMYCIN
Drug data Classificati Indication Side effects Special Nursing
on and and or adverse precaution responsibilit
mechanism contraindicati effect ies
of action on reaction
Generic Classificati Indication: Stomach Azithromy >check
name: on: Azithromycin upset, cin may doctors order
azithromyci macrolide is used to treat diarrhea/loo cause >administer
ne antibiotics many different se tools, diarrhea, the right drug
types of nausea, and in in the right
infections vomiting, some cases dose and
Trade caused by and it can be route at the
name: bacteria, such abdominal severe. Do right time
zithromax as respiratory pain may not take >assess
infections, occur. any allergy to
Mechanism skin medicine to any
Dosage: of action: it infections, ear treat ingredients
5ml works by infection, diarrhea >observe 10
3ml for killing STD. without rights in
5mg/kg bacteria or checking giving
body preventing with your medication.
weight their Contraindicati doctor.
growth. on:
azithromycin
Route: oral is
contraindicate
d to patient
with diarrhea,
Frequency: low amount of
magnesium
and potassium
Timing: 2- in the blood,
5days slow
heartbeat.

DRUG STUDY
 CARBOCISTEIN (LOVISCOL)
Drug data ClassificatiIndication Side effects Special Nursing
on and and or adverse precaution responsibilit
mechanis contraindicat effect ies
m of action ion reaction
Generic ClassificatiIndication: Nausea, Taking of >check
name: on: Carbocisteine headache, multiple doctors order
carbocistein mucolytics (loviscol) is gastric antitussive >administer
e used as discomfort, agents with the right
adjunctive diarrhea, carbocistei drug in the
therapy for gastrointesti ne is not right dose
chronic nal recommend and route at
Trade name: disorders of bleeding, er. the right
loviscol the respiratory skin rash. time
Mechanism tract >assess
of action: associated allergy to
carbocistei with excessive any
Dosage:5ml n works by or viscous ingredients
making mucus, such >observe 10
phlegm less as chronic rights in
sticky. bronchitis, giving
Route: oral chronic medication.
obstructive
pulmonary
disease.
Frequency:T
ID Contraindicati
on:
carbocistein
Timing: 8- loviscol are
12-8 contraindicate
d in patients
with active
peptic ulcer.

DRUG STUDY
 SALBUTAMOL NEBULE
Drug Classificatio Indication Side effects or Special Nursing
data n and and adverse effect precauti responsibilit
mechanism contraindicat reaction on ies
of action ion
Generic Classificatio Indication: Chestpain, fast Salbutam >check
name: n: Salbutamol heart rate, ol nebule doctors order
albuterol bronchodilat nebule used to shakiness,heada must >administer
ors treat wheezing che, dizziness, only be the right
and shortness sore throat. used by drug in the
of breath inhalatio right dose
Trade caused by n, to be and route at
name: breathing breathed the right
Proventil problems such in time
, asthma. through >assess
Ventolin Mechanism the allergy to
of action: mouth, any
salbutamol and must ingredients
relaxes the Contraindicati not be >observe 10
Dosage: smooth on: injected rights in
2.5ml muscles of contraindicate or giving
all airways, d in patients swallowe medication.
from the with high d.
trachea to blood pressure
Route: the terminal during
inhaler bronchioles. pregnancy,
uterine
infection,
miscarriage,
Frequenc heart disease,
y: and
hypersensitivit
y.
Timing:

DRUG STUDY
 PLANE NORMAL SALINE SOLUTION
Drug data Classificati Indication Side effects Special Nursing
on and and or adverse precaution responsibili
mechanis contraindicat effect ties
m of ion reaction
action
Generic Classificati Indication: Adverse Do not use >check
name: on: Hypothermia, effect: in larger or doctors
crystalloid shock, infection at smaller order
fluid maintenance the site of amounts or >administer
Trade fluid, injection, more often the right
name: dehydration thrombophleb than drug in the
Mechanism itis. recommen right dose
of action: ded follow and route at
sodium doctor’s the right
Dosage:2.5 chloride is instruction time
ml source of >assess
water and allergy to
electrolytes any
. It is Contraindicati ingredients
Route: IV capable of on: >observe 10
inducing contraindicate rights in
diuresis d in any giving
depending situation medication.
Frequency: on the where salt
q6h clinical retention is
condition undesirable
of patient.it such as
Timing: is a edema, heart
crystalloid disease
given cardiac
intravenous decompensati
ly in case on and
of shock, primary
dehydratio aldosteronism
n, and ..
diarrhea.
 DRUG STUDY
D5LR
Drug Classificati Indication Side effects Special Nursing
data on and and or adverse precaution responsibiliti
mechanism contraindicati effect es
of action on reaction
Generic Classificatio Indication: Itching, Do not use >check
name: n: D5LR is hives, in larger or doctors order
lactated indicated as a swelling, smaller >administer
ringer’s source of puffy eyes, amounts or the right drug
in 5% water, coughing, more often in the right
dextrose electrolytes, sneezing,fev than dose and
and calories or er and recommend route at the
as an injection ed follow right time
Mechanism alkalinizing site doctor’s >assess
Trade of action: agent. reaction. instruction allergy to any
name: hypertonic ingredients
lactated solutions are >observe 10
ringer’s those that Contraindicati rights in
in 5% have an on: D5LR is giving
dextrose effective contraindicated medication.
osmolarity in severe
greater than metabolic
the body acidosis or
fluids. This alkalosis and
pulls the in severe liver
Dosage: fluid into disease or
500cc/hr the vascular anoxic states
by osmosis which affect
resulting in lactate
Route: an increase metabolism.
IV volume.

Frequenc
y:
500cc/hr
Timing:

NURSING CARE PLAN

DEFINING DIAGNOSI OUTCOM NURSING RATIONA EVALUATI
CHARACTERIS S ES INTERVENTION LE ON
TIC
SUBJECTIVE: Risk for LONG INDEPENDENT: Client has
“wala sya gana deficient TERM: >encourage fluid. >nutrition- been relief
mag kaon kag fluid volume After a Find out child enriched from
dede, kag taas iya related to week client nutrition enriched drinks and discomfort
hilanat” as fever, and a will beverages shakes can caused by
verbalized by the rapid maintain references and also help nausea and
mother respiratory proper fluid supply. restore dizziness.
rate. volume and >take and record proper
adequate respiratory rate nutrition. Client is fully
Objectives: nutrition. qhr/q2h until below >this date aware about
T – 38.4’C 40bpm. will help her condition
PR – 138bmp RATIONAL >give paracetamol, detect an
RR – 40bpm E: nausea is 5ml q4h PRN increase in
Weight – 12.5kgs. a subjective SHORT respiratory
unpleasant TERM: DEPENDENT: rate.
sensation in After an > paracetamol, 5ml >paracetam
the throat or hour q4h PRN ol will help
abdomen respiratory >cefuroxime400mg reduce fever
mat lead to rate and q8h ANST and make
the urge. temperature >oxygen inhalation child more
Dizziness will at 1l. comfortable
cause of decrease. . >salbutamol nebule .
hormonal 2.5 ml
changes and >PNSS 1ml q6h
increasing >carbocistein(lovisc
blood ol) 5ml TID
volume. >D5LR 500CC at
60cc per hr solu-set.

NURSING CARE PLAN

Defining Nursing Outcome Nursing Rationale Evaluation
Characteristi Diagnosis Identificatio Intervention
cs n
SUBJECTIVE: Risk for SHORT TERM INDEPENDE Milk products Goals have
Imbalanced After 1 hour of NT may increase been met
The mother Nutrition: Less nursing Consider sputum patient
verbalized Than Body intervention limiting the production. demonstrates
that her son Requirements patient will use of milk increased
has poor show products. Bowel sounds appetite
appetite, increased may be
consumed appetite Auscultate for diminished if
approximatel bowel sounds. the infectious
y 100ml of Observe for process is
Patient abdominal severe.
“lugaw” and maintains/rega distension. Abdominal
4 oz of milk ins desired distension may
formula two body weight. occur due to
times per air swallowing Patient has
day. or reflect the achieve airway
influence of clearance.
OBJECTIVE: bacterial toxins
Restless on the After nursing
during the LONG TERM gastrointestina intervention
examination, Ineffective l (GI) tract. the desired
Temperature Airway Patient will Doing so outcome has
: 38.4ºC Clearance identify/demon Elevate the would lower been met and
Pulse rate: related to strate head of the the diaphragm goals has been
138 bpm pneumonia behaviors to bed, change and promote met
Respiratory achieve airway position chest
rate: 40 clearance. frequently. expansion,
breaths per aeration of
minute Patient will Dependent: lung
display/maintai > paracetamol, segments,
Decreased n patent 5ml q4h PRN mobilization,
breath airway with >cefuroxime4 and
sounds over breath sounds 00mg q8h expectoration
affected lung clearing; ANST of secretions.
areas, absence of >oxygen
Cough. dyspnea, inhalation at
cyanosis, as 1l.
evidenced by >salbutamol
keeping a
nebule 2.5 ml
patent airway
>PNSS 1ml
and effectively
q6h
clearing
secretions.
>carbocistein(l
oviscol) 5ml
TID
>D5LR
500CC at 60cc
per hr solu-set.
 DISCHARGE PLAN AND HEALTH TEACHING
The mother was instructed to observe signs and symptoms of complication and has to visit the clinic
right away.
The mother was instructed about the proper administration, potential side effects of oral antibiotics
and symptoms to report.
The mother was told that stick compliance follow up check-up was important to check the latest chest
x-ray result or physical examination findings.