Abstract

TITLE: Insights on a case of Pediatric Community Acquired Pneumonia Type C

AUTHOR INFORMATION:

Sachi Sujit E. Arora

Abriel Bernabe
Ryan Jake A. Cajigan
Lydia Conrad
Shyrlyn Mae Ngayos
Raquel B. Piluden
Majid Rahhal
Katryn Hazel Saltat
Braille Sawi

BACKGROUND: This case is noteworthy since it is a highly preventable disease if we are just
aware of the prevention methods, especially if we are exposed to people infected with this
disease. Aside from that early detection and seeking early medical assistance will help to
lessen the complications.

Why should we care? We care for the reason that we want to prevent the occurrence or
acquiring this disease. We want to increase the knowledge and awareness of each one
about the disease.

CASE DESCRIPTION: We are going to present the case of a 3 months’ old female who is
diagnosed with Community Acquired Pneumonia Type C which is a common disease
among infants. A patient with present illness which is difficulty of breathing and productive
cough as the chief complaint, as evidence by fast and deep breathing and cyanosis of the
lips. Diagnostic procedures including clinical and laboratory examinations such as X-ray,
Blood chemistry, and CBC revealed that the patient has PCAP-C.

CONCLUSION:

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 I. Introduction

This is a case of 2-month-old baby boy who was diagnosed of having a Pediatric
Community Acquired Pneumonia-Type C.

Pediatric Community Acquired Pneumonia (PCAP) refers to pneumonia in a

previously healthy person who acquired the infection outside a hospital. PCAP is a
common illness that affects infants and children.

In children, the majority of deaths occur in the newborn period, with over two million
worldwide deaths a year. In fact, the WHO estimates that one in a three newborn infant
deaths is due to pneumonia. It occurs because the areas of the lung which absorb
oxygen (alveoli) from the atmosphere become filled with fluid and cannot work
effectively. Children are very susceptible to acquire this illness especially when
their immune systems are low. They can get it anywhere like in school, malls or even
play grounds.

PCAP is classified into four types. First is, PCAP A, which has a minimal risk, there is no
dehydration, with a respiratory rate of greater than 30-50/min. Second is, PCAP B, which
has a low risk, there is mild dehydration, with a respiratory rate of greater than 30-
50/min. Third is, PCAP C, which has a moderate risk, with moderate dehydration, with a
respiratory rate of greater than35-60/min. Fourth is, PCAP D, which has a high risk, with
severe dehydration, with a respiratory rate of greater than 35-70/min. But in this case,
our patient has a PCAP C. Pneumonia is sometimes caused by viral infections, including
RSV, the parainfluenza virus, adenovirus, and the flu. In addition to viruses, pneumonia
can also be caused by bacteria, including S. pneumoniae, H, influenza type b, group A
streptococcus, and M. tuberculosis (TB). Some of the symptoms of PCAP are fever,
cough, tachypnea, grunting and audible wheezing, chest pain, and it is often
preceded by upper respiratory tract infection. It can be diagnosed by chest x-ray,
blood tests, sputum culture, pulse oximetry, chest CT scan, bronchoscopy, and pleural
fluid culture. The best way to prevent PCAP is to cover mouth when coughing, practice
good hygiene, and have a clean environment.

Also, childhood immunizations will help greatly in the prevention of PCAP in

children. Treating pneumonia includes appropriate diet, increase fluid intake, cool mist
humidifier in the child’s room, medication for cough, intravenous(IV) fluids or oral
antibiotics, oxygen therapy, frequent suctioning of the child’s nose and mouth (to help
get rid of thick secretions), and breathing treatments, as ordered by the child’s doctor.

In 2009, 1.1 million people in the United States were hospitalized with pneumonia
and more than 50,000 people died from the disease. Globally, pneumonia kills more
than 1.5 million children younger than 5 years of age each year.

The United Nations Children's Fund (UNICEF) estimates that 3 million children die
worldwide from pneumonia each year; these deaths almost exclusively occur in
children with underlying conditions, such as chronic lung disease of prematurity,
congenital heart disease, and immunosuppression. According to the WHO’s Global
Burden of Disease2000 Project, lower respiratory infections were the second leading
cause of death in children younger than 5 years (about 2.1 million [19.6%]).

The chronology we have come from the Department of Health’s Health statistics
which have been updated sometime last January 2014, documented that one of the
leading causes of mortality in the Philippines is Pneumonia either community acquired
or hospital acquired, Pneumonia is considered the 3rd leading cause of death and the
4th leading cause of morbidity in children (Department of Health, 2015 Health Statistics).
For the adults, this occurs mainly as a complication of other chronic diseases like lung
cancer, COPD, tuberculosis, and other debilitating illnesses that leave them bedridden

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most of the time and for the children, this remains to be a major killer. In the year 2004 it
was recorded that in every 100,000 total population in the Philippines over15,822 males
died this year and 16,276 for the females. In the Philippines, there are more than 40,000
cases of PCAP annually. More than 50% are admitted in the hospital. In the statistics in
Davao City on 2015 PCAP was rank seventh in the top 10 leading causes of morbidity
age groups in Baguio City and ranked third on top leading causes of mortality between
January and February last three year based on statistics prepared by the City Health
Office (CHO).

The group chose the case of PCAP C which is Pediatrics Community Acquired
Pneumonia C primarily because of having a prior knowledge on this type of pediatric
illness, thus requires applying this knowledge in the actual setting. This would serve as a
good avenue for the group to develop skills in relation to the facts and information that
have already learned in the university. As student nurses and future registered
nurses, the proponents want to understand and appreciate more on what is happening
to a patient with PCAP C, being one of the most common illnesses affecting children,
the group is in a pursuit for knowledge to be able to impart it to others. Through this, the
group is hoping that we will be able to find the right plan of care and interventions, not
forgetting the patient’s rights as a person. All in all, these will help them become
efficient and effective nurses in the future.

I. Statement of Objectives

A. General Objectives

This case study will help student nurses in understanding the disease process of a client
with Community-Acquired Pneumonia Type C. It also aids in identifying the primary
needs and further health problems related to this issue, which can support the
formulation of an individualized nursing care plan. Effective management of the
identified problem will help the patient recover faster and maintain a holistic sense of
wellness.

B. Specific Objectives

Specifically, this case analysis aims to:

1. Define Pediatric Community Acquired Pneumonia-Type C.

2. Illustrate the pathophysiology of admitting diagnosis of the client

3. Describe and identify the common signs and symptoms of Pediatric Community
Acquired Pneumonia-Type C.

4. Identify the risk factors of Pediatric Community Acquired Pneumonia-Type C.

5. Formulate appropriate nursing care plans suited for the client based on the
assessment findings

6. Identify care measures to be given to the patient and family to promote continuity of
care and independence after discharge.

7. Interpret laboratory and diagnostic tests

II. Patient’s Profile

Name : Patient X
Gender : Male
Age : 2 months old
Birth Date : November 21, 2017
Nationality : Filipino
Ethnic Background : Pangasinense

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Religion : Roman Catholic
Date and Time of Admission : February 2, 2018 at 6:00 pm
Admission Diagnosis : Pediatric Community Acquired Pneumonia-
Type C.
Final/ Principal Diagnosis : Pediatric Community Acquired Pneumonia-
Type C.
Place of Admission : Baguio General Hospital & Medical Center
Date of rotation : February 8-10 2018 (7-3 shift)

IV. Chief Complaint

Patient X, aged 2 months old was admitted to BGHMC due to productive

coughing, vomiting, elevated body temperature and general weakness.

V. History of Present Illness

Four weeks prior to admission onset of cough and colds with associated
undocumented. Consult was done with a private physician wherein he was prescribed
with Amoxicillin and Ambroxol which afforded temporary relief of symptoms.

Two weeks prior to admission recurrence of cough and colds with associated
undocumented fever. Consult was done with a private physician and was prescribed
with Cefuroxime affording relief symptoms.

Three days prior to admission recurrence of cough, productive with greenish

blood tinged sputum and colds with associated puss-tissue vomiting this prompt consult
at the ER of BGHMC hence, admission.

VI. Past Medical History

The patient was hospitalized 7 days after his birth due to MSAF. No significant
illness in the past aside from unproductive coughing. No history of allergies. No current
medication taken. No need for maintenance medications and no past injury or
accident.

Vll. Family Health History

The family has no significant illness aside from having fever, cough and colds
during the mother’s childhood years. Other than that, no other diseases are currently
experienced by any member of the family. He said that there is no familial history of
Cardiovascular Disease, Diabetes or Hypertension.

VIII. Developmental History

Patient X is the only child, he is 2 months old and the physical growth is normal.
According to Erik Erikson's Developmental Theory; he is under Trust vs. Mistrust, the
important event in this stage is feeding. According to Erikson, the infant will develop a
sense of trust only if the parent or caregiver is irresponsive and consistent with the basic
needs being meet. The need for care and food must be met with comforting regularity.
The infant must first form a trusting relationship with the parent otherwise a sense of mistrust
will develop.

IX. Social and Environmental History

The patient displays irritability whenever other people try to approach him or take is
vital signs.

Patient X is living at Nangalisan, Tuba, Benguet together with his parent. They own
their own house; it is made of concrete and is a Bungalow type with two bedrooms. Their
house is surrounded with neighbors and few plants can be seen. His father is a security
guard in Baguio City and his mother is a house keeper.The family is practicing Roman
Catholic.

The patient is in the Pediatric ward and the room is not well ventilated and lighted.
On his left side is a table where his needs are readily accessible. Cleaners and garbage
collectors clean around once during the 8 hours shift.
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X. Lifestyle and Health Practices

Patient X’s mother stated that she stopped giving her breast milk to the patient
when she found out that she is suffering from mastitis, she believed that puss will come
out of her breast so she had decided to stop breast feeding. The patient consumes 3-4
bottles of milk a day prior to hospitalization.

XI. Health Assessment

A. General Survey

He was received awake, lying on bed with ongoing IVF of D5IMB 500ccx24 hours
infusing well on his right hand. Slightly irritable on the first day, guarding behavior and
grimace noted, crackles noted upon chest auscultation. Nasal flaring noted and
accessory muscles has been used every time the patient breathes.

B. Head to Toe

Head The head is rounded; Normocephalic and symmetrical skull,

there are no nodules or masses and depressions when
palpated.

Eyes Eyebrow hairs are evenly distributed. Eyebrows are

symmetrically aligned and showed equal movement during
change of facial expression. Eyelashes appeared to be
equally distributed and curled slightly outward. The sclera
appeared white, the palpebral conjunctiva appeared shiny,
smooth and pink, and cornea is transparent, smooth, and
shiny. Pupils are black in color and equal in size.

Ears Ears are symmetrical and in line with the outer canthus of the
eyes. The auricles are symmetrical and have the same color
with the facial skin. During palpation for the texture, the
auricles are mobile, firm and not tender. No nodules, swelling
or tenderness in the mastoid area.

Nose & Sinuses The nose appeared symmetric, straight and uniform in color.
There was presence of nasal flaring. When lightly palpated,
there were no tenderness and lesions.

Mouth The lips are uniformly pink; symmetric and a little bit dry in
texture. Tongue is centrally positioned and pink in color. Tonsils
are bilaterally present and not inflamed. Uvula is located
midline.

Neck Neck muscles are equal in size. Patient shows coordinated,

smooth head movement without discomfort. Lymph nodes are

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 not palpable. Trachea is placed in the midline. The thyroid
glands ascend during swallowing but are not visible.

Chest Chest is significantly bigger than the head circumference.

Breathing pattern is higher than normal. Crackles are heard
upon auscultation. Chest indrawing noted. Increased use of
chest muscles are observed during respiration, that are
indicative of difficulty in breathing.

Breast Negative of mastitis. Skin color is similar to the rest of the body.
Nipples are symmetrical and pink in color. There are no visible
pulsations on the aortic and pulmonic areas. There is no
presence of heaves of lifts.

Abdomen The abdomen of the client has an unblemished skin and is

uniform in color. Has a symmetric contour. Substernal
retraction, an inward movement of the abdomen was
observed during respiration.

Genitals No signs of urinary distention.

Musculoskeletal Normal muscular strength of 5/5 on extremities. The muscles

are not palpable with the absence of tremors. They are
normally firm and showed smooth, coordinated movements.
There are no presence of bone deformities, tenderness and
swelling.

Integumentary The patient has pallor and jaundice cyanosis. No presence of

any foul odor. Rashes are seen around the diaper area. Has a
poor skin turgor of <2 seconds and skin’s temperature is warm
to touch.

C. 13 Areas of Assessment

1. Psychosocial Status
Patient X is 2 months old, boy, born on November 21, 2017, and is currently
residing at Nangalisan, Tuba, Benguet together with his parent. He has no sibling.
According to Erick Erikson, Psychosocial Theory the patient was under “Trust vs.
Mistrust”, which means the patients daily activities and future behavior will
depend on how he is treated by his parents.

2. Mental and Emotional Status

Patient X was received awake cuddled by mother on their bed. During
interview of the parents, he would play with his parents, whoever is available.
According to Jean Piaget, Cognitive Theory, he is under Sensorimotor Stage,

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 during this period the patient is discovering relationship between their body and
their environment. Patient relies on touching, sucking and seeing, using their
senses to learn things.

3. Environmental Status
Patient X is living at Nangalisan, Tuba, Benguet together with his parent.
They own their own house; it is made of concrete and is a Bungalow type with
two bedrooms. Their house is surrounded with neighbors and few plants can be
seen. During hospitalization, the patient was admitted at Baguio General
Hospital at the Pediatrics Ward. He sleeps in a single bed together with his
parents, as observed during our rotations; the bed is near the door, near a
window over-looking the hallway, and near the window that provides air for
ventilation. No necessary odor noted.

4. Sensory Status
a. Visual: Patients eye are assessed using a penlight. Pupils are reactive to light
and accommodation, the color of the iris is brown and pupils are equally
rounded, sclera is white, eyes are symmetrical. Eyebrows are symmetrically
aligned, and showed equal movement during change of facial expression,
no presence of discharge on eyelids noted. Pupils constrict and dilate in
response to light.
b. Auditory: Patients ears are symmetrical and proportional to the size of his
head. No deformities as observed and no tenderness upon palpation .
c. Olfactory Status: Nose is located at the midline, symmetrical and proportional
to the face. No lesions and tenderness upon palpation noted. There is a
presence of nasal flaring .
d. Gustatory Status: Lips are uniformly pink; symmetric and have a dry texture.
There are no discoloration of the enamels, pinkish in color of the gums,
tongue is centrally positioned.

5. Motor Status
Patient X is a 2 months old baby boy, who still cannot walk, but is
observed to have a normal body coordination. He is being carried by his parents
interchangeably during rotation when letting him sleep or giving formula milk.

6. Nutritional Status
According to patient’s mother, Patient X used to be breastfeed for 1
month, but the mother developed puss around her areola that’s why they
resulted on bottle feeding using formula milk. So, prior to admission and during
hospitalization and rotation, patient is receiving formula milk for breakfast, lunch,
dinner and anytime as needed.

7. Elimination Status

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 Prior to admission, patient X defecates 2-4 times a day. During
hospitalization and during our rotation, patient defecates approximately 6 times,
that is weighed as 600mL with a characteristic of yellowish, foul-smelling and
watery stool.

8. Fluid and Electrolytes Status

During rotation, patient is seen drinking formula milk only. And not
receiving any IV medication.

9. Circulatory Status
Normal cardiac rate for an infant is 120-160bpm, patients cardiac rate
ranges from 145-160bpm which is within normal rate. Normal Oxygen Saturation is
95%-100%, Patients oxygen saturation ranges from 88%-97% which indicates
moderate hypoxia (86%-90%) and mild hypoxia (91%-94%), during our rotation,
patient receives oxygen via nebulizer.
February 8, Cardiac Rate Findings O2 Saturation Findings
2018
8am 160 bpm Normal 92% Abnormal

10am 150 bpm Normal 93% Abnormal

2pm 159 bpm Normal 94% Abnormal

February 9,
2018
8am 150 bpm Normal 88 Abnormal

10am 159 bpm Normal 88 Abnormal

2pm 148 bpm Normal 90 Abnormal

February 10,
2018
8am 130 bpm Normal 99 Normal

10am 145 bpm Normal 94 Abnormal

2pm 147 bpm Normal 97 Normal

10. Temperature Status

Normal body temperature ranges from 36.5- 37.5 degrees Celsius, Patient X’s
temperature ranges within 37.4 to 39 degrees Celsius therefore the patient is
febrile. The skin was warm to touch and flushed.

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 February Findings February Findings February Findings
8, 2018 9, 2018 10, 2018
8am 37.4 Normal 38.4 Abnormal 39 Abnormal

10am 37.2 Normal 37 Normal 38.3 Abnormal

2pm 38.5 Abnormal 37.4 Normal 38 Abnormal

11. Respiratory Status

Normal bpm for an infant is 40-60. Patient’s bpm during our rotation ranges from
65-70 which is an abnormal range and is indicative for pneumonia. Breathing
was rapid and shallow, from the stomach instead of the chest. Crackles were
heard upon auscultation.

February Findings February Findings February Findings

8, 2018 9, 2018 10, 2018
8am 70 bpm Abnormal 65 bpm Abnormal 70 bpm Abnormal

10am 65 bpm Abnormal 65 bpm Abnormal 68 bpm Abnormal

2pm 65 bpm Abnormal 65 bpm Abnormal 68 bpm Abnormal

12. Integumentary Status

Patient has brown complexion, pallor and jaundice cyanosis is observed. Hair is
black, dry and sparse and rashes are seen along inguinal area.

13. Rest and Comfort

During rotation, he sleeps for approximately 5-6 hours, due to irritation from the
skin rash around the diaper area and was often awaken by noise coming from
other patients cry, noise from the hallway, vital sign checking, and noise from
visitors. Weakness and lack of energy is observed.

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Page | 10
Diagnostic Description of the Procedure Purposes of the Procedure Date of the Test Normal Actual Implication
Procedure Procedure findings findings

CBC A complete blood count (CBC) is (CBC) blood test is used to 02-02-2018 Hemoglobin 110-160 g/L 112 Normal
a blood test done to check the evaluate overall health
levels of cells in the blood. It and detect a wide range Hematocrit 0.37-0.54 L/L 0.34 Normal
includes numbers and measures of disorders, including
WBC 5.0-10.0 19.64 White blood
of red blood cells, white blood anemia, infection and cell count
cells, and platelets. A CBC may leukemia. higher than
be done for many reasons, and is
A complete blood count the normal
a good tool for understanding range
symptoms as well as trying to test measures several
components and features indicates the
figure out a disease. presence of
of your blood, including:
an infection.
- Red blood cells, which
REFERENCE: carry oxygen DIFFERENTIAL
COUNT
Pediatric Community Acquired - White blood cells, which
Pneumonia (PCAP) | Lung | fight infection
Neutrophil: 50-70 % 28 Decreased
Pneumonia
-Hemoglobin, the oxygen- neutrophil
https://www.scribd.com/doc/971 carrying protein in red than the
56139/PCAP-Guideline blood cells normal
range
- Hematocrit, the indicates a
proportion of red blood sign of
cells to the fluid bacteria
component, or plasma, in
your blood Lymphocytes: 20-40 % 58 Increased
lymphocytes
than the
normal
Page | 11
 range
indicates
bacteria

Monocytes : 0 – 10 % 10 Normal

Eosinophil: 0–7% 4 Decreased

eosinophil
than the
normal
range
indicates
bacteria

Basophil : 0 -01 % 0.00 Normal

RBC Count 4.04-5.48 4.12 Normal

10^12/L

Platelet Count 150-400 10^ 594 Platelet

9/L count higher
than the
normal
normal
range
indicates the
presense of
infection

RBC INDICES

MCV: 80-100FL 83.00 Normal

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 MCH: 27-31pg 27.20 Normal

MCHC 310-360 g/L 327g/L Normal

RDW-CV 11-16 % 14.20 Normal

RDW-SD 35-56 fL 42.60 Normal

Diagnostic Description of the Purposes of the Date of the Normal Finding Actual Finding Implication
Procedure Procedure Procedure Procedure

Chest X-RAY (AP-L) An X-ray is an Your doctor may 02-02-18 The image on chest X-ray film •Confluent
imaging test that order a chest X- is in shades of black and reticular
uses small ray if they suspect white, similar to a negative of PNEUMONIA,
amounts of that your a regular photograph. The and nodular BOTH
radiation to symptoms have a shadows on a chest X-ray test opacities are seen UPPER LOBES
produce pictures connection to depend on the degree of in
of the organs, problems in your absorbed radiation by the
tissues, and chest. Suspicious particular organ based on its both lungs,
bones of the symptoms may composition. Bony structures
retrocardiac and
body. When include: absorb the most radiation
focused on the and appear white on the film.

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chest, it can help Hollow structures containing hilar areas.
spot mostly air, such the lungs,
 chest pain
abnormalities or normally appear dark. In a
 fever
diseases of the normal chest X-ray, the chest •Heart is normal in
 persistent
airways, blood cough cavity is outlined on each
vessels, bones,  shortness of side by the white bony size and
heart, and lungs. breath structures that represent the
These symptoms Configuration.
Chest X-rays can ribs of the chest wall. On the
also determine if could be the result top portion of the chest is the
you have fluid in of the following neck and the collar bones
your lungs, or fluid conditions, which (clavicles). On the bottom, •Pulmonary
or air surrounding a chest X-ray can the chest cavity is bordered vascular
your lungs. detect: by the diaphragm under
markings are within
which is the abdominal
cavity. On either side of the normal.
Your doctor  broken ribs chest wall, the bones of the
could order a  emphysem shoulders and arms are easily
a (a long- recognizable.
chest X-ray for a •The
term,
variety of progressive
reasons, including hemidiaphragms
lung
to assess injuries condition Inside the chest cavity, the
and costophrenic
resulting from an that causes vertebral column can be
accident or to breathing seen down the middle of the sulci are intact.
monitor the difficulties) chest, splitting it nearly in
 heart failure
progression of a equal halves. On each side of
 lung
disease, such as cancer the midline, the dark
•Visualized osseous
cystic fibrosis. You  pneumonia appearing lung fields are
might also need  pneumotho seen. The white shadow of structures are
a chest X-ray if rax (a the heart is in the middle of
you go to the collection the field, atop the diaphragm unremarkable.
emergency room of air in the and more to the left side. The
space
with chest pain or trachea (wind pipe), aorta
between
Page | 14
if you’ve been your lungs (main blood vessel exiting the
involved in an and your heart), and the esophagus
accident that chest wall) descend down the middle,
included force to overlapping the vertebral
your chest area. column.

REFERENCE:

Pediatric
Community
Acquired
Pneumonia
(PCAP) | Lung |
Pneumonia

https://www.scrib
d.com/doc/9715
6139/PCAP-
Guideline

Page | 15
XIV. Treatment

A. Drugs

DRUG INDICATION CONTRAINDICATION MODE OF SIDE EFFECT NURSING INTERVENTION

ACTION

BRAND NAME: Ceftriaxone  Susceptible  Contraindicat Inhibits cell-wall  CNS: Before:

bacterial ed in patients synthesis, Dizziness, Dx:
septicemia, hypersensitive promoting fever,
acute to drug or headache.  observe the 10 Rs of
GENERIC NAME: Rocephin osmotic drug administration.
bacterial other  GI:
otitis media, cephalospori instability; diarrhea,  assessed for history of
lower ns. usually dysgeusia, allergies, hepatic and
respiratory bactericidal. nausea, CV conditions
CLASSIFICATION: third-  assessed for skin color
tract. vomiting.
generation cephalosporin  Use cautiously  SKIN: pain, and lesions, reflexes,
in patients rash, and ophthalmic and
with history of Hinders or kills tenderness audiometric evaluation,
sensitivity to susceptible at injection peripheral sensation,
DOSAGE: 125mg penicillin bacteria. site. edema, CBC, serum
ROUTE: IV electrolytes.

Tx:

 obtained baseline
assessment
 rehydrated client
 assissted client to a
comfortable position

Edx:

Page | 16
 advised client to report
any signs of
hypersensitivity reactions

DURING:

Dx:

 administered drug with

food or after meals if GI
upset occurs
 assessed client for skin
rash

Tx:

 assisted the client on

taking the drug
 provided comfort
measures such as
elevating the feet.
 enhanced release of
tension so that client will
be relaxed

Edx:

 Instructed client to
avoid aspirin and other
NSAIDs during therapy.

AFTER

Dx:

 assessed for adverse

effects of the drug
given.
Page | 17
  assessed pain if
lessened.

Tx:

 provided further comfort

measures environmental
control.
 ensured safety

Edx:

 instructed to report signs

of adverse effects.

 advised mother to
breastfeed client per
demand.

BRAND NAME: Acetadote  Loosen  Contraindicat Increases  EENT: -Assess patient's respiratory
thick mucus ed in patients respiratory hemoptysis secretions before and often
in hypersensitive tract fluids to , during therapy.
individuals to drug. rhinorrhea.
GENERIC NAME: help liquefy
with cystic  GI: nausea, -Be alert for adverse reactions
Acetylcysteine fibrosis or tenacious stomatitis, and drug interactions.
chronic  Use cautiously secretions. vomiting.
obstructive in debilitated -Assess patients and family
pulmonary patients with
CLASSIFICATION: amino knowledge of drug therapy.
disease. severe
acid (L-cysteine) respiratory Thins
insufficiency. respiratory
secretions and
reverse toxic
DOSAGE:
effects of
½ 1 ampule acetaminophe
n

Page | 18
ROUTE:

Oral

BRAND NAME:  To prevent  Contraindicat Chemical  May - obtain baseline assessment

exercise- ed in patients effect: decrease of patient respiratory status
Salbutamol sulfate induced hypersensitive potassium and assess patient often
Relaxes
broncho- to druge or its level
bronchial and during therapy
spasm components.
 To prevent uterine smooth
GENERIC NAME: or treat muscle by
bronchosp  Use cauiously acting on -assess patient and family
Albuterol in patients
asm in beta2- knowledge of drug therapy
patients with cv
adrenergic
with disorders
hyperthyroidis receptors
CLASSIFICATION: reversible
obstructive m or diabetes
Adrenergic airway mellitus and in
disease. those
Therapeutic
unusually
responsive to forms:
DOSAGE: adrenergics.
Improves
1ml ventilation

ROUTE: nebulizer

Page | 19
  Uncomplic  Contraindicat Chemical None reported -Obtain complete medical
ated acute ed in patient effect: history before starting therapy
BRAND NAME: illness from hypersensitive
influenza in to the drug or Inhibits the -assess renal function before
Oseltamivir phosphate patient who any of its enzyme giving drug as directed
have been components neuraminidese
symptomati - assess patinet and family
in influenza
c for 2 days knowledge of drug therapy
GENERIC NAME: virus particles.
or less
Oseltamivir phosphate

Therapeutic
effect:
CLASSIFICATION:
Lessens the
Neuraminidase inhibitor
symptoms of
influenza

DOSAGE: 30mg

ROUTE: Oral

Page | 20
BRAND NAME: piperacillin Combination  Piperacillin Piperacillin kills  Nausea, -Obtain complete medical
tazobactam product consisting and bacteria by constipatio history before starting therapy
of a penicillin-class tazobactam inhibiting the n, diarrhea,
for injection is headache, -assess renal function before
antibacterial, synthesis of
contraindicat or trouble giving drug as directed
GENERIC NAME: piperacillin, and a ed in patients bacterial cell sleeping
piperacillin tazobactam β-lactamase with a history walls. It binds may - assess patinet and family
inhibitor, of allergic preferentially occur. If knowledge of drug therapy
tazobactam, reactions to to specific any of
indicated for the any of the penicillin- these
CLASSIFICATION: penicillins, effects last
treatment of binding
cephalospori or get
β-lactamase inhibitor patients with proteins (PBPs)
ns, or β- worse, tell
moderate to lactamase located inside your
severe infections inhibitors. bacterial cell doctor or
caused by walls. pharmacist
DOSAGE:
susceptible promptly.
50mg isolates of the
designated
bacteria in the
conditions listed
ROUTE: IV
below.

Page | 21
XV. Nursing Care Management

A. Prioritizations

1. Fever related to invasion of pathogen as evidenced by elevated body

temperature and flushed skin.
2. Ineffective Airway Clearance as evidenced by productive coughing
3. Ineffective Breathing Pattern as evidenced by fast shallow breathing
4. Risk for Aspiration
5. Risk for Imbalanced Nutrition: Less than body requirements

Basis of prioritization

1. Increased body
temperature above
normal range as Using the nursing theory of Maslow’s
evidenced by hierarchy of needs we chose fever
elevated body on the top of our prioritization due
temperature and to patient’s temperature as 39
flushed skin. degrees due to the infection of
Pneumonia causing virus. If the fever
got any worse it can cause brain
damage and other complications.

2. Ineffective Airway
Clearance as
evidenced by
productive Ineffective Airway Clearance is
coughing second on the list; According to
Maslow's Hierarchy of Needs,
physiologic needs are always first.
Maintaining a patent airway has
always been vital to life. When
problem concerning the airway
happens, coughing takes place,
which is the main mechanism for
clearing it.

3. Ineffective
Breathing Pattern as According to the theory of Virginia
evidenced by fast Henderson, breathing normally is
shallow breathing one of the sub-concepts to mean
balance in all realms of human life.
It is our third on the prioritization
because having a clear and
effective airway is vital in patient

Page | 22
 care and to prevent risks associated
with oxygenation problems such as
skin and tissue breakdown

Risk for aspiration is our fourth of the

4. Risk for Aspiration prioritization due to it only being a
risk. Feeding an infant with
compromised respiratory system
may need an extra precaution to
aspiration. It may lead to death
when neglected.

Risk for Imbalanced Nutrition: Less

than body requirements is our last of
the prioritization due to increased
body temperature to fight the
pathogen, the body also needs an
5. Risk for Imbalanced
Nutrition: Less than increased in metabolic needs. The
body requirements patient may not be able to meet
the sufficient metabolic needs to
require for faster recovery because
of his condition.

Page | 23
 XIII. Pathophysiology

Predisposing factors Precipitating factor

y
 Age: 2 months old  Environment (Having relatives
 Weather with cough and colds)

Aspiration of Microorganisms

Passes to the upper respiratory tract

Failure of defense mechanisms

Invasion of Lower Respiratory Tract

Activation of B cells

Release of Antibodies

Antigen-Antibody Reaction

Antigen-antibody complexes adhere to Initiation of Immune System

the mucosal lining of the Lower
Respiratory Tract Vasodilation

Mucosal irritation Increased Blood Flow

Increased Mucus Production Vasocongestion

Accumulation of Mucus Increased Plasma Hydrostatic Pressure

Increased Capillary Permeability

Productive Cough

Page | 24
 Escape of Plasma Escape of RBC, Serum Transportation of
proteins and Fibrin Phagocytic Cells

Engulfing of Antigen
Edema Exudate Formation

Filling of the Replication of Antigen

Narrowing of
Bronchi, within the cells
Airway
Bronchioles and
Alveoli
Cells become infected

Detection of Infected
cells by the T cells

Crackles
Use of Effector T cells destroy
Accessory the Antigen
Tachypnea
Muscle

Regulator T cells
Asymmetrical
strengthen the activity
Chest Expansion
of Effector T cells

Reticular and Effector and Regulator

Nodular Opacities on Cells Synthesize and
both lungs Release Cytokines

Ineffective Airway Clearance Release of IL-17

Decreased lung
inflation
Altered Temperature
Regulating Mechanism
in the Hypothalamus

Ineffective Breathing Pattern Increased Body

Temperature

Increased metabolic
needs

Risk for Aspiration

Risk for Imbalanced

Nutrition: Less Than
Body Requirements

Page | 25
B. B. Nursing Care Plans

Actual Problem #1 Increased body temperature above normal range

ASSESSMENT EXPLANATION OF THE PROBLEM GOALS AND NURSING INTERVENTION RATIONALE EVALUATION
OBJECTIVES

Subjective:  Hypothalamus is the STO: Dx: Dx: STO: GOAL MET

thermoregulation center of
“Ang init init ng Within 1hr of  Administered  To reduce body Within 1hr of
human body
katawan niya” nursing care, the medications as temperature. nursing care, the
 Presence of infection
as verbalized  Trigger the fever called temperature of ordered. temperature of
by the mother. pyrogen the patient will the patient
 Causing heat-creating effect, decrease.  To evaluate effects decreased to 38
increase heat conservation  Monitored of elevated body degree Celsius.
Objective: and production resulting laboratory studies. temperature.
increase body temperature. LTO:
Elevated body LTO: GOAL MET
temperature of SOURCE: Within 8hrs of
 Identified underlying  To assess causative
39 degree nursing care the Within 8hrs of
Celsius Nursing Source Center; Fever patient will cause factors. nursing care the
(November 27, 2010) Retrieved maintain core patient
Tx:
from:nsc- temperature maintained core
ultimatex.blogspot.com/2010/11/ncp- within normal Tx:  Heat loss by temperature
-Flushed skin.
fever-click-here.html range. evaporation and within normal
 Tepid sponge bath
conduction. range.

 Ice packs, especially  Areas of high blood

in groin and axillae
flow.
 To monitor progress.

Page | 26
Nursing  Monitored
Diagnosis: temperature every
30 minutes.
Increase body
temperature
above normal  To prevent
range RT Edx:
dehydration.
immune  Discussed
response to importance of
bacteria adequate fluid
intake
 To decrease body
temperature to
normal range.
 Demonstrated and
instructed patients
to do tepid sponge
bath.  Heat loss by
radiation and
conduction.
 Encouraged to
promote surface
cooling by means of
undressing

Page | 27
Actual Problem #2: Ineffective Airway Clearance

ASSESSMENT EXPLANATION OF GOALS AND NURSING INTERVENTION RATIONALE EVALUATION

THE PROBLEM OBJECTIVES

Subjective: Inability to clear STO: Dx: Dx: STO:

secretions or
“ganun padin obstructions from Within 8 hours of nursing  Assessed Respiratory  To determine early The goal is partially met
siya madami interventions the status warning signs of After performing
the respiratory tract
padin plema” patient will be able to impending effective nursing
to maintain a clear respiratory
As verbalized by maintain patent airway,  Observed breath intervention, the patient
airway difficulties.
the mother. discomfort upon sounds was able to maintain
 To check for any
coughing and deep  Monitored Vital signs patent airway,
distress and
inhalation will be accumulation of discomfort upon
SOURCE:
Objective: relieved, and will secretions. coughing and deep
Nurse’s Pocket demonstrate behaviors Tx: inhalation will be
 Course to improve airway relieved, and will
Guide: Diagnoses,  To have baseline
crackles, clearance.  Assisted in Nebulization data and to demonstrate behaviors
Prioritized
 Nasal to improve airway
interventions, and determine
flaring appropriate goals
Rationales clearance.
 Dyspnea

Page | 28
  Use of Doenges et al 12th LTO: Tx:
accessor edition
y muscle Within 3 days of nursing  A nebulizer is a LTO:
noted interventions the breathing
 Oxygen patient will be free from machine used to The goal is unmet after
in use via adventitious sounds treat lung performing effective
mask.  Demonstrated nursing intervention; the
and will not manifest bronchial tapping conditions such as
any signs or symptoms asthma, cystic patient has not been
during coughing free from adventitious
of respiratory distress. episodes. fibrosis, and other
respiratory sounds.
illnesses.

Nursing  Administered  Tapping the back

Diagnosis: prescribed to clear chest
medications. congestion is
Ineffective called chest
airway physical therapy
clearance RT Edx: and can assist in
related to loosening mucus
presence of so that your body
secretions.  Reiterated importance can expel it
of hand hygiene to the through coughing.
mother.

 Prescribed
 Emphasized medication such
Importance of as bronchodilators
aspiration precaution helps in aiding
during feeding effective airway
clearance.

Page | 29
 Instructed mother to Edx:
continue feeding per
demand
 First line of
defense, an
important measure
to prevent spread
of pathogens.

 Aspiration
precautions are
interventions to
reduce the risk of
aspiration of food,
liquids, and/or
secretions during
the swallowing
process.

 Increases fluid
volume and also
washes down
secretions that
causes problem.

Page | 30
Actual Problem #3: Ineffective breathing pattern

ASSESSMENT EXPLANATION OF THE GOALS AND OBJECTIVES NURSING INTERVENTION RATIONALE EVALUATION
PROBLEM

Subjective: Ineffective Breathing Pattern STO: Dx: Dx: STO: PARTIALLY MET
is defined as inspiration
“mabilis padin and/or expiration that do not Within 4 hours:  Auscultated  This is to detect Goal is partially met
ang paghinga provide adequate breath sounds at decreased or as evidenced by the
nya ilang araw ventilation. least every 4 adventitious breath patient’s presence of
ng ganito” as hours. sounds.

Page | 31
verbalized by A dyspneic person often The patient will show  These may be crackles. With an RR
the mother. appears anxious and may improvement in indicative of a of 58 bpm
 Observed cause for the
experience shortness of breathing pattern.
-Fast breathing presence of alteration in LTO: NOT MET
breath, a feeling of being
noted RR> 68 sputum for breathing pattern.
unable to get enough air. LTO:
bpm amount, color, Goal not met as
Dyspnea have many causes,  To have baseline evidenced by
Within 3 days: consistency.
Nursing most of which stem from data and to presence of crackles,
Diagnosis: cardiac and respiratory The patient will show determine nasal flaring and
 Monitored Vital appropriate goals
disorders. It is a subjective improvement in dyspnea.
Ineffective signs
feeling as it cannot be breathing pattern.
breathing directly observed but is Tx:
pattern reported by the client.
Tx:  For management of
SOURCE: underlying
 Administered pulmonary
(Kozier,Vol. 2, 7Ed., p. 1346) oxygen at lowest condition,
concentration respiratory distress or
indicated and cyanosis.
prescribed
respiratory
medications
 Pulse oximetry is a
helpful tool to
 Utilized pulse
detect alterations in
oximetry to
oxygenation initially;
check oxygen
but, for CO2 levels,
saturation and
end tidal CO2
pulse rate.
monitoring or arterial
blood gases (ABGs)
would require being
obtained.

Page | 32
  Demonstrated  Tapping the back to
bronchial clear chest
tapping during congestion is called
coughing chest physical
episodes. therapy and can
assist in loosening
mucus so that your
body can expel it
through coughing.

Edx:

Edx:  Presence may

trigger allergic
 Educated response that may
mother to keep cause further
the environment increase in mucus
allergen free( secretion.
smoke and dust)
 To provide relief of
 Encouraged causative factors.
position of
comfort.  To prevent bacterial
growth and
 Emphasized contamination.
importance of
hand hygiene.

Potential Problem #1: Risk for aspiration RT ineffective airway clearance

Page | 33
 ASSESSMENT EXPLANATION OF GOALS AND NURSING RATIONALE EVALUATION
THE PROBLEM OBJECTIVES INTERVENTION

.Objective: STO: Dx: STO:

 Appears The risk factors that After 8 hours of nursing  Assessed  Manifestation of Goal met, within 8 hours of
weak better predicted interventions, the client Respiratory respiratory distress is nursing intervention the
and the phenomena will be able to maintain depth and ease dependent on client will be able to
restless
under study airway patency, clear indicative of the maintain airway patency,
 Appears
tachypne include: Impaired breath sound degree of lung clear breath sound
ic or decreased gag involvement and
LTO: LTO:
 With reflex; Dysphagia; underlying general
changes and Impaired After 3 days of nursing status Goal met, within 3 days of
in rate, physical mobility. intervention the client nursing intervention the
rhythm Additionally, the  Due to the virtue of
and will be able to: client was able to:
patients with the gravity, the secretions
depth of  Positioned will pool down at the
diagnosis Risk for  Maintain airway  Maintain airway
breathing patient on semi base of the lungs
 With aspiration were at clearance/pate clearance/patency
fowlers preventing the
positive an increased risk of ncy  Maintain proper fluid
clogging of sputum in
wheezes developing  Maintain proper the lining of the airway volume
on the respiratory fluid volume  Clear secretion
lungs aspiration  Clear secretion  For possible readily
 With thermoregulatory side
readily
positive  Reviewed
effects.
productiv client’s
e cough medications.
Tx:
Tx:

 Monitored Vital  To evaluate degree of

signs specially compromise
respiratory rate

Page | 34
 SOURCE:  Assisted with  Humidity helps reduce
nebulizer viscosity of secretions,
Nurse’s Pocket
treatments. facilitating
Guide: Diagnoses, expectoration, and
Nursing Prioritized
Diagnosis: may reduce formation
interventions, and
of thick mucus plug
Risk for Rationales
aspiration RT Doenges et al 12th
ineffective edition  Monitored and  To reduce the effect
airway maintain on body alteration.
clearance comfortable
ambient
environment as
indicated.

Edx:
 To treat underlying
 Encourage
conditions and
adequate rest
mobilize secretions
and limit
activities to
within client
tolerance

 Increase fluid intake

 Instructed the
mother to
continue  Proper positioning can
feeding aid on swallowing and
decrease the risk for
aspiration with eating.

Page | 35
  Educated on
proper
positioning

Potential Problem #2: Risk for imbalanced nutrition

ASSESSMENT EXPLANATION OF THE PROBLEM GOALS AND NURSING INTERVENTION RATIONALE EVALUATION
OBJECTIVES

Objective: STO: Dx: STO:

 Intravenous
-limited Imbalanced nutrition less than Body After 8 hours of  Assessed the fluids may be Goal met, within
movement Requirements related to inability ingest or nursing level of needed to 8 hours of
digest food or to absorb nutrients because of interventions hydration, note meet nursing
biologic, psychologic , or economic factors client will fontanelle, skin increased interventions
-limited verbalize turgor, urine demand, but client will be
movement understanding specific gravity, must be able to verbalize
Risk for imbalanced nutrition: less than body of causative the condition of carefully understanding
requirement related to restriction of residue- factors and the mucous handled to of causative
containing foods necessary membranes, avoid fluid factors and
- Weak
interventions to weight overload. necessary
appearance
promote fluctuations. interventions to
optimum promote
nutrition optimum
 Assessed  Determine the
SOURCE: nutrition.
maturity reflex, appropriate
Page | 36
-loss of Thomas G. Boyce, MD, Overview of LTO : with regard to method of LTO:
appetite Gastroenteritis (N.D) feeding (eg, feeding for
After 3 days of Goal met, within
Retrieved from: sucking, infants
-Weight loss http://www.msdmanuals.com/home/digestive- nursing swallowing, and 3 days of nursing
disorders/gastroenteritis/overview-of- intervention the cough). interventions
client will the client had
gastroenteritis
demonstrate demonstrated
Retrieved when: Oct. 25, 2017  The first infant
progressive progressive
 Auscultated feeding stable
weight gain weight gain
presence of has peristaltic
toward goal. toward goal
bowel sounds, can begin 6-12
assess physical hours after
status and birth. If there is
respiratory status respiratory
distress,
Nursing parenteral
Diagnosis: fluids
indicated, and
Risk for oral fluid had
imbalanced to be
nutrition postponed
Tx:
Tx:
 Administered
medication  Gastric fullness
between meals reduces
and minimize appetite and
fluid intake with food ingestion.
meals except
fluid has
nutritional intake.

 Lowers
discomfort

Page | 37
  Gave frequent related with
mouth care, vomiting.
noting secretion Clean mouth
precaution. can improve
appetite.
 The patient
 Observed for encountering
physical signs of nutritional
poor nutritional deficiencies
intake may resemble
to be sluggish
and fatigued;
decreased
attention span,
pale and dry
skin

Edx:

 To promote
wellness.

 Promoted
adequate fluid
intake. Limit
Edx: fluids 1hr

 To promote
comfort and
 Emphasized
encourage
importance of
Page | 38
 well-balance, good eating
nutrition intake. habit

 Promoted
adequate fluid
intake. Limit fluids
1hr

 Promoted
pleasant
relieving
environment

Page | 39
C. Discharge Plan

Criteria Health Teaching

1. Prevent the spread of  Advised to Wash hands often. Use soap and
PCAP-C water.

 Advised to always cover mouth when

coughing.

 Educated about vaccines available in the

health centers to prevent Pneumonia such as
Pneumococcal Vaccine.
2.Medications  Advised to take the medications prescribed
by the doctor right away and for the full
amount of days prescribed.

 Emphasized importance of bronchial tapping

 Instructed on dose, frequency and time of

administration of medication.

3. Home Management  Instructed proper bottle cleaning and

sterilization

 Educated mother about second hand

smoking and avoidance of being surrounded
to crowded places

 Emphasized importance of ventilation and

clean environment

4.Others Follow up care:

Instructed to come back on the same institution for

follow up checkup as ordered at the OPD

Instructed the patient to immediately return to

hospital OPD if patient experience:

 Progression of PCAP C
 You have a fever
 Your symptoms do not go away, or they get
worse, even after you take medicine.
 Weakness
 lips or fingernails turn gray or blue.

Page | 40
XVI. Conclusion and Recommendation

Conclusion

Illnesses caused by type C pneumoniae can cause a prolonged cough,

bronchitis, and pneumonia as well as a sore throat, laryngitis, ear infections, and sinusitis.
They usually start gradually with a sore throat that is followed by a cough about a week
or more lately. The cough may last for 2 to 6 weeks. In some cases, the infant may get
bronchitis or a mild case of pneumonia. Type C pneumoniae can be passed from
person to person directly through coughs or sneezes and indirectly from germs on
hands or other objects. Recovery from a type C pneumoniae respiratory infection may
be slow. The pediatrician can prescribe antibiotics to clear up the infection and help
the infant get better faster. To prevent the chances of getting a type C pneumoniae
infection, you should practice good hygiene, including frequent hand washing.

In conclusion Group C was able to construct a complete Case presentation on

Pediatric Community acquired pneumonia type C. Since our patient is still a child, the
significant other "mother" was interviewed intensively for 3 days and we were able to
assess his wellbeing as a whole and find out his life style. We were able to obtain all of
his secondary data through his mother and his chart. This group was able to work
together in the time we had in order to make a full comprehensive case presentation;
we used every resource that we were able to acquire to put this write up in its complete
form.

Recommendation

Recommendations are one of the most important things for of any nurse to
patient relationship. We do this in order to improve the life of the patient. Furthermore,
we do this to put them back in the right path of recovery.

First, we provided emotional support to patient X and to his parents. When we

first met him, he was febrile and generally weak. But we were able to help him out and
let him be comfortable. We also assessed his parent’s knowledge in retaining about
feeding so that we can provide him with nutritional heath teaching and proper
cleaning of bottles since the patient is bottle fed. We also encouraged his parents
about proper bottle feeding in order to facilitate faster healing and importance of
compliance to treatment regimen.

XVII. References:

Erik Erikson’s Stages of Development – Stages 3 and 4 (2012, December 10) Retrieved
from: https://www.psychologynoteshq.com/eriksonstagesofdevelopment3-4/
Page | 41
Nursing Source Center; Fever (November 27, 2010) Retrieved from: https://www.nsc-
ultimatex.blogspot.com/2010/11/ncp-fever-click-here.html

Nursing Source Center; Imbalanced Nutrition: Less than body requirements (November
26, 2010) Retrieved from: https://www.nsc-
ultimatex.blogspot.com/2010/11/imbalanced-nutrition-less-than-body.html

Gil Wayne, RN; Nurseslabs; Hyperthermia (November 7, 2016) Retrieved from:

https://nurseslabs.com/hyperthermia

Retrieved when: October 25, 2017

T Heather Herdman; North American Nursing Diagnosis Association. NANDA 12th Edition

Page | 42