MOLENO APRIL MARIEBSN II F

Case Scenario 1
Pediatric- Community Acquired Pneumonia
PCAP-C
I. Introduction

Pneumonia is a type of lung infection. It can cause breathing problems and other
symptoms. In community-acquired pneumonia (CAP), you get infected in a
community setting. It doesn’t happen in a hospital, nursing home, or other healthcare
center. Your lungs are part of your respiratory system. This system supplies fresh
oxygen to your blood and removes carbon dioxide, a waste product. When you
breathe in air through your nose and mouth, it reaches the tiny air sacs of the lung
(alveoli) through a series of tubes. From here, oxygen flows into your blood. Carbon
dioxide flows out into the alveoli. You then breathe it out.

Many germs can grow inside your body and cause disease. Specific types of germs
can cause lung infection and pneumonia when they invade. These germs can cause
your respiratory system to work poorly. For example, oxygen may not be able to get
into your blood as easily. That can cause shortness of breath. If your body can’t get
enough oxygen to survive, pneumonia may lead to death. These germs can spread
from person to person. When someone infected with one of these germs’ sneezes or
coughs, you might breathe the germs into your lungs. If your immune system doesn’t
kill the invaders, the germs might grow and cause pneumonia.

CAP can result from infection with many types of germs. These include bacteria,
viruses, fungi, or parasites. Symptoms from pneumonia can range from mild to
severe. Certain types of germs are more likely to lead to serious infection. CAP is
very common, especially during the winter months. It is more common in older
adults. But it can affect people of any age. It can be very serious. That’s often the case
in older adults or people with other health problems.

II. Objectives
At the end of this case study presentation, the students will be able to require the
proper knowledge, skills, and attitudes in providing care to the patient.
 Specific Objectives
Knowledge
 To gather data appropriate and completely.
 To analyze the collected data
 To recognize the sign and symptoms of pneumonia

Skills
 Goal oriented, monitor and check the vital signs of the
patient and monitor the
 pain using pain scale.
Attitude
 Established rapport with the patient and members of the
family.
MOLENO APRIL MARIEBSN II F

 Provide the best care for the child.

III. Nursing Health History

Biographic Data:
 Harry is a 3-year-old male, child from Arevalo I.C. Harry is only
child. They lived in a swampy, crowded area. Harry is only child.
His mother is a housewife and his father is a construction worker.

Chief Complaint:
 High grade fever and accompanied by abdominal pain 4 days prior
to admission

History of Present Illness:

Past Medical History

 N/A

Pediatric History

Lifestyle
 N/A
Social history
 Only child
Psychological data
 N/A

IV. Physical Examination

Vital signs showed a
temperature of 38.4ºC
pulse rate 138 bpm
respiratory rate of 40 breaths per minute
Oxygen saturation 94% in room air
Weight - 12.5 kg.

The Pedia Resident on Duty ordered for the following diagnostic tests:
Chest X-ray AP, CBC, Sputum culture and sensitivity, Urinalysis.

V. 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.
Macrophages, neutrophils, lymphocytes, and eosinophils carry out the immune-mediated
host defenses.
MOLENO APRIL MARIEBSN II F

Respiratory tract host defenses

To prevent and minimize injury and invasion by microorganisms and foreign
substances, various defense mechanisms have evolved, both systemically and within the
respiratory tract. Some mechanisms are nonspecific and are directed against any invasive
agent, whereas others are targeted against only microbes or substances with specific
antigenic determinants. Many of the defenses are compromised in the fetus and newborn
infant. These compromises may result in more frequent breaches and a consequent
disruption of normal lung structure and function.
Systemic host defenses
Immunologic defense mechanisms targeted against particular pathogens typically
emanate from specifically primed lymphocytes following the presentation of processed
antigens by macrophages. These mechanisms include cytotoxic, killer, suppressor, and
memory functions; systemic and secretory antibodies; and consequent cascades of
cytokines, complement, vasomotor regulatory molecules, hemostatic factors, and other
agents. Secretory antibodies are typically multimeric and contain secretory component
and J chains that render them more opsonic and more resistant to microbial proteases.

Pathogenesis
Pneumonia is characterized by inflammation of the alveoli and terminal airspaces
in response to invasion by an infectious agent introduced into the lungs through
hematogenous spread or inhalation. The inflammatory cascade triggers the leakage of
plasma and the loss of surfactant, resulting in air loss and consolidation.
MOLENO APRIL MARIEBSN II F

VI. Diagnostic and Laboratory

 Chest X-ray

-Impression: Pneumonia upper lobe of the right lung.

 Sputum Culture and Sensitivity

-Positive for Streptococcus Pneumoniae.

 CBC

 Urinalysis
MOLENO APRIL MARIEBSN II F

VII. Drug Study

Prescribed Classification Indication and Side effect or Nursing

Drug, and Contraindication Adverse responsibility
dosage, Mechanism of reaction
route, Action
frequency,
timing
Drug: Classification: Indication: Side effects: Check doctor’s
paracetamol  Nonsteroidal an allergic order 
anti- This drug is used reaction, which
Trade inflammatory to treat mild to can cause a Observe the 10
name:  drug moderate pain rash and rights of medication 
(from headaches, swelling.
Dosage: 120 menstrual periods, Assess the expected
mg Mechanism of toothaches, flushing, low actions, dose range,
Route: oral action: backaches, blood pressure side effects of the
osteoarthritis, or and a fast medication, and any
Paracetamol cold/flu aches and heartbeat – this precautions to be
has a central pains) and to can sometimes taken 
Frequency& analgesic effect reduce fever happen when
Timing: that is mediated paracetamol is Provide client
7.5 ml q4h  through given in education about
activation of Contraindication hospital into a medication
descending : vein in your
serotonergic arm. Advise the patient’s
pathways. acute liver failure. family to take the
Debate exists liver problems. Adverse medication with
about its severe renal effect:  meals for better
primary site of impairment. a low fever with absorption & to
action, which condition where nausea, reduce GI
may be the body is unable stomach pain, discomfort.
inhibition of to maintain and loss of
prostaglandin adequate blood appetite; Instruct the patient’s
(PG) synthesis flow called shock family to take
or through an dark urine, medication as
active clay-colored prescribed even after
metabolite stools; or. feeling better and not
influencing to double dose.
cannabinoid jaundice
receptors. (yellowing of
the skin or
eyes).
 MOLENO APRIL MARIEBSN II F

Prescribed Classification Indication and Side effect Nursing

Drug, and Mechanism Contraindication or Adverse responsibility
dosage, of Action reaction
route,
frequency,
timing
Drug:  Classification: Indication: Side effects: Check doctor’s
cefuroxime  cephalosporin order 
antibiotics Cefuroxime is used to Nausea,
Trade treat certain infections vomiting, Observe the 10
name:  caused by bacteria, such diarrhea, rights of
as bronchitis(infection strange taste medication 
Mechanism of of the airway tubes in the mouth,
action: leading to the lungs); or stomach Assess the
gonorrhea (a sexually pain may expected actions,
Dosage: Cefuroxime  transmitted disease); occur. Diaper dose range, side
125 mg is a bactericidal Lyme disease (an rash may effects of the
agent that acts by infection that may occur in medication, and
Route: inhibition of develop after a person is young any precautions to
 intravenous  bacterial cell wall bitten by a tick); and children. be taken 
synthesis. infections of the skin, Dizziness and
Cefuroxime has ears, sinuses, throat, drowsiness Provide client
activity in the may occur education about
Frequency presence of some Contraindication: less medication
& beta-lactamases, frequently,
Timing: both penicillinases Cefuroxime is especially Advise the
Q8h ANST and contraindicated in with higher patient’s family to
for 7 days cephalosporinases, patients with doses\ take the medication
of Gram-negative cephalosporin with meals for
and Gram-positive hypersensitivity or Adverse better absorption &
bacteria cephamycin effect: to reduce GI
hypersensitivity. discomfort.
Cefuroxime should be
used cautiously in Instruct the
patients with patient’s family to
hypersensitivity to take medication as
penicillin. The prescribed even
structural similarity after feeling better
between cefuroxime and not to double
and penicillin means dose.
that cross-reactivity can
 MOLENO APRIL MARIEBSN II F

occur.

Prescribed Classification and Indication and Side effect Nursing

Drug, dosage, Mechanism of Contraindication or responsibility
route, Action Adverse
frequency, reaction
timing
Drug:  Classification: Indication: Side Check doctor’s
Salbutamol   Albuterol effects: order 

Trade name:  headache. Observe the 10

Albuterol Salbutamol is indicated for rights of
Mechanism of (i) the symptomatic relief feeling medication 
action: and prevention of nervous,
bronchospasm due to restless, Assess the
Dosage: 0.5 Albuterol bronchial asthma, chronic excitable expected
ml plus pnss (Salbutamol) bronchitis, reversible and/or actions, dose
1ml It promotes the obstructive airway disease, shaky. range, side
production of and other chronic effects of the
Route: oxygen intracellular cyclic bronchopulmonary disorders fast, slow medication,
inhalation adenosine in which bronchospasm is a or uneven and any
monophosphate complicating factor, and/or heartbeat. precautions to
Frequency& (cAMP), which (ii) the acute prophylaxis be taken 
Timing: enhances the binding against exercise bad taste
Q6h  of intracellular in the Provide client
calcium to the cell  Contraindication: mouth. education about
membrane. This Salbutamol sulphate is   medication
action decreases the contraindicated in patients dry
calcium with hypersensitivity mouth. Advise the
concentration within (allergy) to any of the active patient’s family
cells and results in substances or the excipients. sore throat to take the
the relaxation of Salbutamol and non-selective and medication
smooth muscle and beta-blocking drugs, such as cough. with meals for
bronchodilation. propranolol, should not better
usually be prescribed inability to absorption & to
together. Caution is also sleep. reduce GI
advised in patients using discomfort.
cardiac glycosides.
 MOLENO APRIL MARIEBSN II F

Prescribed Classification Indication and Side effect or Nursing

Drug, and Contraindication Adverse reaction responsibility
dosage, Mechanism of
route, Action
frequency, 
Drug:  Classification: Indication: Side effects: Check doctor’s order 
Carbocistein  mucolytic
Carbocisteine is a Severe allergic Observe the 10 rights
Trade mucolytic agent for reactions (rash; of medication 
name:  Mechanism of the adjunctive hives; itching;
action: therapy of difficulty Assess the expected
respiratory tract breathing; actions, dose range,
Carbocisteine disorders tightness in the side effects of the
Dosage: 5ml works by characterised by chest; swelling of medication, and any
making excessive, viscous the mouth, face, precautions to be
phlegm mucus, including lips, or tongue); taken 
Route: oral (mucus) less chronic obstructive blood in the
thick and airways disease. stools; irregular Provide client
sticky, and heartbeat; education about
therefore symptoms of low medication
Frequency easier to cough blood sugar (eg,
& up. It may also Contraindication: dizziness, Advise the patient’s
Timing: have a knock- drowsiness, family to take the
TID on effect of Conditions: fainting, medication with meals
making it stomach or weakness, for better absorption
harder for intestinal ulcer. increased hunger, & to reduce GI
germs bleeding of the increased discomfort.
(bacteria) to stomach or sweating,
cause chest intestines. headache, chills Instruct the patient’s
infections pregnancy. family to take
medication as
prescribed even after
feeling better and not
to double dose.
 MOLENO APRIL MARIEBSN II F

VIII. Nursing Care Plan

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Risk related to Short  Assess the  Tachypnea, Goals met as
- Decreased Pediatric- Term: rate, shallow evidenced by:
breath sounds Community After 3 rhythm, respirations
and rales on Acquired hours of and depth and  The patient
the right upper Pneumonia nursing of asymmetric was able to
lobe. interventio respiration chest display patent
- Observed to n, the , chest movement airway with
have an Pneumonia is patient will movement are breath sounds
occasional inflammation of display , and use frequently clearing and
productive the terminal patent of present absence of
cough and with airways and airway with accessory because of dyspnea.
difficulty of alveoli caused by breath muscles. discomfort
breathing. acute infection by sounds of moving  Vitals signs
various agents. clearing and chest wall back to
Objective: Pneumonia can be absence of and/or fluid normal
Vital signs divided into three dyspnea in lung due
showed a groups: to a
 temper community compensato
ature of acquired, hospital ry response
38.4ºC or nursing home to airway
 pulse acquired(nosoco obstruction.
rate mial), and  Assess  Coughing is
138 pneumonia in an cough the most
bpm immunocomprom effectiven effective
 respirat ised person. ess and way to
ory rate productivi remove
of 40 ty secretions.
breaths Pneumonia
per may cause
minute thick and
 Oxygen tenacious
saturati secretions
on 94% to patients.
in room  Auscultate  Decreased
air lung airflow
 Weight fields, occurs in
- 12.5 noting areas with
kg. areas of consolidate
decreased d fluid.
or absent Bronchial
 MOLENO APRIL MARIEBSN II F

Patient looks airflow breath

weak and pale, and sounds can
irritable and adventitio also occur
always crying. us breath in these
Inflamed throat sounds: consolidate
noted. crackles, d areas.
wheezes. Crackles,
rhonchi,
and
wheezes are
heard on
inspiration
and/or
expiration
in response
to fluid
accumulatio
n, thick
secretions,
and airway
spasms and
obstruction.

IX. Discharge plan

Medication:
Before the patient discharge, the mother must be encouraged to follow the prescribed
medications of her child with the right dose at the right time. This could be also enhanced by
explaining to the mother the reason why the drug is given and the possible effects that my occur
it.
Exercise:
Encourage the mother let the child have frequent exercises such as walking, arm raising, to
enhance the lung function but inform the mother to avoid places that are prone to pollution, dust
and infections such as smoking places to prevent straining the child’s lung.
Teaching:
Inform the mother that the child needs to have adequate rest because it is important to maintain
progress towards full recovery. Ask the parents to have the child washed his hands frequently to
avoid further infections brought microorganism.
Diet:
Tell about the importance of eating a well-balanced diet. If asked if multivitamins can be given,
refer to the physician. Remind about the increased fluid requirements and advise foods that are
rich in natural vitamins such as fruits.
MOLENO APRIL MARIEBSN II F