CHILD HEALTH NURSING

CASE SCENERIO ON PNEUMONIA

Master Rahul aged 3 years presented to the pediatric emergency department with the chief
complains of difficulty breathing with a 103 degrees F (39.4 degrees C)and diagnosed as
pneumococcal pneumonia.

History of illness

The patient was apparently well 3 days back when he had developed a runny nose, cough,
and low grade fevers with a temperature maximum of 101 degrees F (38.3 degrees C).

Antenatal:

• No ANC visits

• No TT vaccines

• Iron and calcium taken

Perinatal history:

• Normal term, spontaneous vaginal delivery at (patient not sure of exact date)

• Baby cried at birth.

• Baby weight:-2.5 kgs

• Breast feeding at 4 hours of life.

Post natal history:

• No h/o Excessive bleeding

• No other complications

Dietary History:

Takes liquids well, but his solid intake has decreased.

Immunization history:

• Immunization as per EPI schedule with strictly all vaccines given to child.

Developmental History

• H/o normal developments

• Explore drawers, runs ups and downstairs

• Asks for food , toilets etc

*On Examination

*General condition:

Child is awake and alert, in moderate distress.

His height and weight are in the 50th percentile for his age.

Vitals

Temperature: 40 degrees C (104 degrees F)

Pulse: 130 /min

RR: 40br/m

BP: 100/70 mm/Hg

oxygen saturation: 87%

RT:

Inspection: His nasal mucosa is erythematous with yellowish discharge.

His lips and mucous membranes are dry.

Lungs: Moderate subcostal, intercostal, and supraclavicular retractions, symmetric expansion

Percussion: Dullness to percussion at the right base.

Ausculatation: Increased vocal fremitus over the right base, decreased air entry over right
lower lobe with crackles, no wheezes.

Heart: Tachycardia, regular rhythm without murmur.

CBC :

WBC - 20,000, 70% neutrophils, 11% bands, 15% lymphocytes, 3% monocytes, 1%

eosinophils.

Hemoglobin - 12.4 mg/dl

Platelet count - 280,000.

Blood culture - pneumococci +

Chest x-ray (CXR):

Right lower lobe opacity consistent with a round pneumonia (technically "air/space disease",
commonly called infiltrates by most physicians).

Management and Treatment

Supplemental oxygen 3 L/m through oxygen mask.

20 cc/kg infusion of normal saline

IV cefuroxime 195mg/BD
REQUIREMENTS:

 Kardex

 Nurses Notes

 Medicine cards if administered

 Investigation chart

 Feeding chart

 Nursing process according to NANDA diagnosis

 Immunization schedule

 Growth and Development:

 Head to foot examination

 Play therapy and play materials

Health Education
Follow –up &Medication schedule
Personal hygiene
Environmental hygiene
Immunization
Prevention of infection

KARDEX
Sn Nursing care plan
no Medication Dose Route Fre Tim
que e
ncy Time

1. Cefuroxime 195 mg IV BD 8-8  Monitor vital signs hourly. 7 am

 Assess and record respiratory rate 7: 15 am

2. 8- and depth at every 4 hours.
Acetoaminophen
8
 Place child with proper body
alignment for maximum breathing
2 pattern.

 Change position frequently.

 Maintain a clear airway by

encouraging child to mobilize
own secretions with successful
coughing.

 Observe sputum color, viscosity

and odor.

 Provide nebulisation 7:30 am

 Provide humidified oxygen @
3L /m.. 8am

 Teach and assist child with proper 10 am

deep-breathing exercises.

 Demonstrate proper splinting of

chest and effective coughing
while in upright position.
Encourage him to do so often.

 Maintain adequate hydration by

providing fluids to at least 3000
mL/day unless

 Encourage small frequent meals.

 Encourage frequent rest periods

and teach patient to pace activity.
 11 am
 Encourage use of relaxation
techniques and diversional
activities.

 Encourage parents to stay with

infant and involve the parents in
care of child.

 Encourage ambulation. 11 am

 Provide a quiet environment and 12pm

limit visitors.

 Allow expressions of concern and

opportunity to ask questions about
condition and recovery of ill
infant.

 Provide information regarding

hospital routines and modalities
of treatment.

 Review normal lung function and

pathology of condition

 Teach the importance of

continuing medical follow-up and
obtaining vaccinations as
appropriate.

Name: Master Rinku Age: 3 years

Diagnosis: Pneumonia IP No: 1234

Religion: Hindu Doctor:

TPR & BP Diet: Liquid diet

Actual problems:

Breathing difficulty
Pain

Potential Problems:

Infection

Dehydration

Loss of weight
 NURSES NOTES:

Name: Master Rahul Diagnosis: Pneumonia

Age/Sex: 3 years /Male
IP No: 1234

Nursing Interventions
Date Diet Tim
e
16/04/1 The child is awake and alert, in moderate distress. Nasal flaring with lips 7 am
9 and mucous membran dry. IV line on left hand with oxygen @ 3L /m
through oxygen mask.

7:10 am
 Vitals stable

 Weight- 10 Kgs 7: 15 am

 Assessed respiratory rate and depth at every 4 hours. 7:20 am

 Placed child in for maximum breathing pattern.

 Changed position @ 4 hourly.

 Provided nebulisation 7:30 am

 Maintained a clear airway by encouraging child to cough - thick

yellowish sputum

 Provided humidified oxygen @ 3L /m. 8am

 Taught and assisted child with proper deep-breathing exercises.

10 am
 Demonstrated proper splinting of chest and effective coughing
while in upright position.

 Maintained adequate hydration by providing fluids to at least 3000

 mL/day

 Provided warm vegetable soup 11 am

 Encouraged small frequent semi-solid meals.

 Encouraged rest periods in between the activities.

 Provided picture books. 11:30 am

 Encouraged parents to stay with infant and involve the parents in

care of child.

 Encouraged ambulation.

 Provided a quiet environment and limited visitors.

 Taught parents regarding aseptic techniques like strict 12 pm

handwashing, use of sterile equipments and strict hygiene of child.

 Allowed expressions of concern and opportunity to ask questions

about condition and recovery of ill infant.

 Provided information regarding hospital routines and modalities of

treatment.

 Taught normal lung function and pathology of condition.

 Taught the importance of continuing medical follow-up and

obtaining vaccinations as appropriate.