MANILA TYTANA COLLEGES

Manila Doctors College of Nursing

I. Case Abstract

Pediatric Community-acquired pneumonia (PCAP) is a lower respiratory tract infection occurring in a child who has
not resided in a hospital or health care facility in the preceding 14 days. Community-acquired pneumonia (CAP) is common in
childhood. Viruses account for most cases of PCAP during the first two years of life. After this period, bacteria such as
Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydia pneumoniae become more common. CAP symptoms are
nonspecific in younger infants, but cough and tachypnea are usually present in older children. A chest x-ray is useful for
confirming the diagnosis. Most children can be managed empirically with oral antibiotics as outpatients without specific
laboratory investigations. Those with severe infections or with persistent or worsening symptoms need more intensive
investigations and may need admission to the hospital. (Davies, 2003).

Patient Baby Boy X, a 3-year-old male, Filipino, born full-term via CS in Manila Doctors Hospital on February 1,
2018, from Sampaloc, Manila, was admitted on February 15, 2021, at 10 AM due to cough, fever, accompanied by nausea, and
vomiting, with an initial diagnosis of PCAP-C. The cough started 3 days prior to admission, followed by an on and off fever.
Nausea and vomiting followed after giving Paracetamol as a home remedy. 3 hours prior to admission, the temperature went up
to 38.8 C. AM shift’s nursing diagnosis is hyperthermia. On February 16, a lab/radiological test was done and several CBC
values were observed, such as red blood cells, white blood cells, and platelet count. A high WBC count usually indicates that
these cells are being produced in greater numbers to combat infection (Sight, 2022). A chest x-ray was also taken, and the
patient was positive for pneumonia. It's a lung infection that affects both lungs. This condition can affect more than only the
lungs; it can also affect the bronchi and the lungs' stem. This sickness causes a build-up of fluid in the lungs, making it
increasingly difficult to breathe (Brunek, 2017).

The priority for the patient is to solve the ineffective airway clearance and hyperthermia together with the risk of
activity intolerance. As a result, numerous procedures must be taken in order to properly recover the patient and avoid the risks
that must be avoided in order to provide the best possible care. Monitoring the patient's vital signs and keeping an eye out for
indicators of respiratory distress are simple actions that may help provide the patient comfort. Finally, at the time of discharge,
there are educational requirements that must be met.
II. Nursing Health History
a. Biographic Data
Patient’s Initial: Gender: Age: Date of Birth:
Patient X Male 3 years old February 1, 2018
Educational Attainment: Occupation: Place of Birth:
N/A N/A Sampaloc, Manila
Date of Admission: No. of days in hospital: Order of Admission: Source of Information:
February 15, 2021 Ongoing Carried by mother Relative

b. Chief Complaint(s)
Cough, Fever, with Nausea and Vomiting

c. Medical Diagnosis
Pediatric Community-Acquired Pneumonia C (PCAP-C)

d.History of Present Illness

3 days prior to admission, the patient starts to cough followed by an on and off fever with nausea and vomiting. Moreover,
the temperature is 38.8 ℃.
e. Past History
Born full-term via cesarean section. Second child out of three children.
f. Developmental History
Theory Age Developmental Client Interpretation
Task Description
Psychosexual 3-6 years Phallic Stage N/A The third stage of Freud’s Psychosexual Development is the
old Phallic Stage. Children at this age start to notice the differences
between males and females, they actively use words and ask
questions to gather knowledge and mix fact and fiction in a
conversation. Also, they learn about their emotions; they
understand the words cry, sad, and laugh, as well as the emotions
associated with each. (Kozier & Erb’s “Fundamentals of
Nursing,” 2014, p. 368).
Psychosocial 3-5 years Initiative vs. N/A Initiative vs. Guilt is the third stage of Erikson’s Psychosocial
old Guilt Development, The child grows assertive and conscious of their
actions during this period. If this activity is not completed
effectively, the child's self-confidence will suffer, and he or she
will experience fear. (Kozier & Erb’s “Fundamentals of
Nursing,” 2014, p. 343).
Cognitive 2-7 years Preoperational N/A During the preoperational stage in the intuitive phase, the child
old can classify, quantify, and relate objects but is unaware of the
principles behind these operations, and displays intuitive thought
processes (know something is wrong but can't explain why); is
unable to see other people's perspective, and uses a lot of words
but not in the right context. (Kozier & Erb’s “Fundamentals of
Nursing,” 2014, p. 350).
Moral 3-7 years Preconventional N/A Slowly realizing that in a moral dilemma, different persons can
old have different perspectives. The awareness emerges at this point,
and the focus is on external control. The child's moral standards
are those of others, which he or she follows to avoid punishment
or enjoy benefits. (Weber's "Health Assessment in Nursing,"
2013, p. 751).
Spiritual 4-6 years Intuitive-Project N/A In the intuitive-projective stage of spiritual development, the
old ive instruction of significant individuals, such as parents and
teachers, is the primary source. Children learn to emulate
religious conduct, such as lowering the head in prayer, even if
they don't understand what it means. It requires simple spiritual
 explanations, such as those found in picture books. At this age,
children utilize their imaginations to imagine things like angels
or the devil. (Kozier & Erb’s “Fundamentals of Nursing,” 2014,
p. 369).

g. OB/Gyne History
Menarche Age: Amount: Characteristic:
N/A N/A N/A
Duration: Associated Symptom:
N/A N/A
Obstetric History G0 T0 P0 A0 L0 M0 Type of Delivery:
N/A N/A
Complications: Exposure to Teratogenic Agents: LMP: N/A
N/A N/A EDC: N/A

II. Physical Assessment

a. General Survey:
Body Built:
Ectomorph
Signs of Distress:
Irritability, Flushed Skin
Orientation:
Time N/A Person N/A Place N/A
Quantity & Quality of Speech
Slurred but coherent
Grooming/Hygiene: Posture & Gait: Body Odor and Breath Odor:
Good grooming and Well-balanced and well-distributed No foul body and breath odor
hygiene weight
Obvious Signs of Illness(es): Cough, Fever, with Nausea and
Vomiting, irregular, shallow breaths, mouth breathing, usage of
accessory muscles for breathing, audible breath sounds within few feet
Level of Consciousness: Affect: Mood:
Alert/Awake Appropriate Appropriate
Organization of thoughts:
Conscious and Coherent

b. Anthropometric Measurement*
Height: Weight: IBW/BMI
100cm 16kg 16 kg/m2 (Normal for Pedia)
* You may provide additional measurements (i.e. tricep skin fold, abdominal girth, etc.)

For neonates:
Head Circumference: N/A Chest Circumference: N/A Abdominal Circumference: N/A

c. Vital Signs
Temperature: Pulse Rate: Respiratory Rate: Blood Pressure:
38.2 C 125 bpm 44 cpm 100/60

d. Physical Examination
Body Normal Findings (IPPA)
Part
Skin - Skin color ranges from pale
white with pink, yellow,
brown, or olive tones to dark
brown or black. No strong
odor should be evident, and
the skin should be lesion
free.
- Skin should be soft, warm,
and slightly moist, with good
turgor and without edema
Actual Findings (IPPA) Analysis & Interpretation
- Skin is hot to touch ANALYSIS:
- Flushed Skin The skin is hot to touch since there is
- Fever: 38.2 a fever. If fever occurs, the body will
- Shivering become cold and shiver. This is the
- Dry skin body's reaction to a temperature
increase. The skin's blood vessels
constrict, pushing blood from the
outer layer of the skin to the interior
of the body, where it is easier to keep
the heat in. (Fever | Coping
Physically | Cancer Research UK,
2019)
 (Weber, Kelly Health Assessment
in Nursing 5th edition) INTERPRETATION:
ABNORMAL
Hair - During the toddler years, No Significant Findings ANALYSIS:
scalp hair becomes coarser, Hair has a normal texture and
thicker, and darker, and it distribution.
loses its curl. Fine hair
appears on the distal parts of INTERPRETATION:
the upper and lower NORMAL
extremities.

(Weber, Kelly Health Assessment

in Nursing 5th edition)
Nails - Nails should be clean and
groomed. Pink undertones
should be seen.
(Weber, Kelly Health Assessment
in Nursing 5th edition)
No Significant Findings ANALYSIS:
Nails are pale in color, smooth,
shiny, firm, and clean, with no
clubbing of fingers in either hand.
(Weber & Kelly, Health
Assessment in Nursing 5th
edition, 2018).

INTERPRETATION:
NORMAL
Head & Face - Head is normocephalic and No Significant Findings ANALYSIS:
symmetric The head is normocephalic without
scalp lesions. Sensation intact over
- Full ROM up, down, and face with no facial asymmetry,
muscles of facial expression intact.
sideways is normal.
INTERPRETATION:
- The nasal bridge is low and
NORMAL
the mandible and maxilla are
small during the toddler
years, making the face
appear small in comparison
to the entire skull.

(Weber, Kelly Health Assessment

in Nursing 5th edition)
Eyes - Eyes are less spherical than No Significant Findings ANALYSIS:
adult eyes. The eyes are evenly placed and in
line with each other and equal
- Farsighted until the age of 6 palpebral fissures and none
or 7 years, when they protruding.
achieve 20/20 vision.
The eyebrows are symmetrical and
(Weber, Kelly Health Assessment in line with each other and evenly
in Nursing 5th edition) distributed.

The eyelashes are turned outward

and evenly distributed

INTERPRETATION:
NORMAL
Ears - In the external canal, there is No Significant Findings ANALYSIS:
no excessive cerumen, The earlobes are bean-shaped,
discharge, lesions, parallel, and symmetrical with no
excoriations, or foreign lesions. The ear canal has normally
body. some cerumen with no discharges or
- With normal landmarks, the lesions.
tympanic membrane is
pearly gray to pale pink. INTERPRETATION:
When a baby is weeping or NORMAL
is febrile, the tympanic
membranes redden
bilaterally.
- Positive pressure (bulb
squeezes) causes the
tympanic membrane to shift
inward, and negative
pressure causes it to move
outward (release of the
bulb).

(Weber, Kelly Health Assessment

in Nursing 5th edition)
Nose - Nose is midline in the face,
the septum is straight and the
nares patent. No discharge or
tenderness is present.
Turbinates are pink and free
of edema.
- The nasal mucosa is dark
pink, moist, and free of
exudate. The nasal septum is
intact and free of ulcers or
perforations.
- Nasal Flaring ANALYSIS:
Nasal Flaring occurs when there is
difficulty of breathing and respiratory
distress causing the nostrils to widen
while breathing. (Nasal Flaring
Information | Mount Sinai - New
York, 2020)
INTERPRETATION:
ABNORMAL

(Weber, Kelly Health Assessment

in Nursing 5th edition)
Mouth - Lips are smooth, moist, No Significant Findings ANALYSIS:
& Pharynx and without lesions or any The mouth and throat make up the
signs of swelling. Oral first part of the digestive system.
mucosa appears pink These are responsible for ingestion,
taste, preparing mastication, and
- No tooth decayed, no aiding in speech. (Weber & Kelly,
missing teeth. Appliances Health Assessment in Nursing 5th
may be present in repair edition, 2018)
work. Teeth are
pearly-white to slightly
yellowish
INTERPRETATION:
- Gums are pink, moist, and NORMAL
firm with tight margins to
the tooth. No lesions or
masses.

- Tongue should be pink,

moist, a moderate size with
papillae (little
 protuberances) present.
The dorsal surface is
smooth, shiny, pink, or
slightly pale with veins
visible and without lesions.

- Buccal mucosa is smooth,

moist, and without lesions.
Stenson’s ducts are visible
without signs of swelling.

- No unusual or foul odor is

noted.

- Uvula is fleshy, solid, and

hangs freely in the midline.
No redness. Not swollen.
Symmetric soft palate
elevation

- Tonsils may be present or

absent. Normally, pink and
symmetric.

- Throat is pink without

exudate and lesions

(Weber, Kelly Health

Assessment in Nursing 5th
edition)
Neck - The neck is symmetric and
the head is centered on the
neck. There are no bulging
masses on the neck.
- Symmetrical elevation of
the thyroid cartilage and
cricoid cartilage when the
client swallows.
No Significant Findings ANALYSIS:
The neck is capable of performing
full range of motion against
resistance. (Weber & Kelly, Health
Assessment in Nursing 5th edition,
2018)
INTERPRETATION:
NORMAL

- Neck movement is smooth

and controlled at 45°
flexion, 55° extension, 40°
lateral abduction, and 70°
rotation.

- Trachea and other

landmarks are midline.

- If the client is very thin, the

thyroid gland is palpable,
otherwise it is not. If
palpable, the thyroid gland
should be smooth, firm, and
nontender. The right lobe is
slightly bigger than the left
lobe.
 - No bruits are auscultated

- There is no swelling,
enlargement, or tenderness
in the lymph nodes

(Weber, Kelly Health Assessment

in Nursing 5th edition)
Spine - Spinous processes appear
straight. Thorax symmetric,
ribs sloping downward 45°
in relation to the spine.
- Cervical and lumbar spines
are concave; the thoracic
spine is convex
No significant Findings ANALYSIS:
The spine is straight and with no
tenderness in its processes. It can
support a wide range of full motions.
(Weber & Kelly, Health Assessment
in Nursing 5th edition, 2018)
INTERPRETATION:
NORMAL

- Spinous processes are

non-tender, firm, and
smooth. No muscle spasms.

- Full ROM against resistance

(Weber & Kelly, Health

Assessment in Nursing 5th edition,
2018)
Thorax/Lungs - Act of breathing is not using
accessory muscles
- Thoracic diameter reaches
the adult configuration (5:7)
anterior-posterior to
transverse.
- No chest retractions or
bulging (on the sternum and
ICS), the sternum is straight
and midline
- Regular respirations and
unlabored with 12-20 CPM
- Respiratory Rate: ANALYSIS:
44cpm Due to Community-Acquired
- Irregular and shallow Pneumonia, consolidation of alveolar
Breathing units of the lungs may have
- (+) Use of accessory occurred. This resulted in findings
muscle such as adventitious sounds and
- (+) Bilateral Coarse observable distress in the patient
Crackles (Kozier & Erb’s “Fundamentals of
- Diminished breath Nursing,” 2014, p. 368).
sounds (vesicular)
INTERPRETATION:
ABNORMAL

- Resonance should be heard

when percussing the lungs
for children ages 12-18

- No adventitious sounds

- Fremitus is symmetric and

are easily identified in the
upper regions of the lungs

- Symmetrical chest
expansion ranging 5-10 cm
apart
 - Breath sounds are normal
(bronchial,
bronchovesicular, and
vesicular)

- No tenderness and crepitus

when palpated

(Weber & Kelly, Health

Assessment in Nursing 5th
edition, 2018)
Cardiovascular/ - Apical pulse is located in
Heart 5th ICS, left midclavicular
line
- Heart rate is 70-130 bpm,
may have innocent murmurs
- Pulse Rate: 125 bpm ANALYSIS:
The normal heart rate of a
preschooler is within the range of
70-130 bpm. Normally, no pulsations
or vibrations are palpated in the
areas of the apex, left sternal border,
or base

- Jugular venous pulse is not (Weber & Kelly, Health Assessment

normally visible when in Nursing 5th edition, 2018)
sitting upright. When in a
INTERPRETATION:
45° position or greater, the
NORMAL
jugular vein should not be
distended, bulging, or
protruding

- No pulsations or vibrations
are palpated in the areas of
the apex, left sternal border,
or base

- No swishing or blowing
sounds auscultated on the
carotid arteries.

- Pulses are equally strong

with a rating of 2+, with no
variation in strength.

- Bulging in the 5th left MCL

may be visible if the client
is extremely thin.

- Radial and apical pulse rates

are identical

(Weber & Kelly, Health

Assessment in Nursing 5th
edition, 2018)
Breast & Axilla N/A N/A N/A

Abdomen - Abdominal skin may be No Significant Findings ANALYSIS:

fairer in color compared to
the general skin tone Small children's abdomens are
cylindrical, conspicuous when
standing, and flat when reclining.
 - No lesions or rashes on the (Weber & Kelly, Health Assessment
abdomen in Nursing 5th edition, 2018).

- Abdomen is symmetrical
INTERPRETATION:
and appears slightly NORMAL
prominent when standing
but flat when supine

- No bruits, venous hum, and

friction rub are heard in the
abdomen

- Generalized tympany is
heard throughout the whole
abdomen

- Abdomen is soft to palpated

without masses, tenderness,
and muscle guarding

- Liver is palpable at 1 to 2
cm below the right costal
margin.

- The tip of the spleen and the

right kidney may be
palpated during inspiration

(Weber, Kelly Health Assessment

in Nursing 5th edition)
Musculoskeletal - Feet and legs are
symmetrical in shape, size,
and movement
- Extremities should be warm
and capillary refill is
adequate.
No Significant Findings ANALYSIS:
The musculoskeletal system of the
body is the main framework that
allows conscious movement in
performing ADLs (Weber & Kelly,
Health Assessment in Nursing 5th
edition, 2018).

- Gait is upright and is an INTERPRETATION:

adult configuration NORMAL

- Full ROM, no swelling and

tenderness

- Muscle size and strength are

equal bilaterally

- No tenderness, swelling,
and clicking noise on the
joints

(Weber, Kelly Health Assessment

Genitals N/A N/A N/A
(Optional)
Rectum and N/A N/A N/A
Anus (Optional)
 III. Anatomy & Physiology

Larynx
The larynx is commonly called the voicebox, it is located in the anterior throat and extends from the base of the tongue to the
trachea. The three main functions of the larynx are to maintain an open airway, protect the airway during swallowing, and
produce the voice. (Vanputte, C., Regan, J., and Russo, A. Seeley’s Essentials of Anatomy and Physiology Tenth Edition, pp.
413-418).

Trachea
The trachea or windpipe allows air to flow into the lungs. It is a membranous tube attached to the larynx. It consists of
connective tissue and smooth muscle, reinforced with C-shaped pieces of hyaline cartilage. (Vanputte, C., Regan, J., and Russo,
A. Seeley’s Essentials of Anatomy and Physiology Tenth Edition, pp. 413-418).

Carina
The carina is a ridge at the base of the trachea that separates the openings of the right and left main bronchi. (Vanputte, C.,
Regan, J., and Russo, A. Seeley’s Essentials of Anatomy and Physiology Tenth Edition, pp. 413-418).

Visceral Pleura
The visceral pleura is the inner layer that covers the lungs, blood vessels, nerves, and bronchi (Vanputte, C., Regan, J., and
Russo, A. Seeley’s Essentials of Anatomy and Physiology Tenth Edition, pp. 413-418).

Parietal Pleura
The parietal pleura is the outer membrane that lines the walls of the thorax, diaphragm, and mediastinum (Vanputte, C., Regan,
J., and Russo, A. Seeley’s Essentials of Anatomy and Physiology Tenth Edition, pp. 413-418).

Pleural Cavity
The pleural cavity is between the parietal and visceral pleura. It is filled with a small volume of pleural fluid produced by the
pleural membranes. (Vanputte, C., Regan, J., and Russo, A. Seeley’s Essentials of Anatomy and Physiology Tenth Edition, pp.
413-418).

Main (primary) Bronchus

The trachea divides into the left and right bronchi. The left main bronchus is more horizontal than the right main bronchus
because it is displayed by the heart. Foreign objects that enter the trachea usually lodge in the right main bronchus, because it is
wider, shorter, and more vertical than the left main bronchus and is more in direct line with the trachea. (Vanputte, C., Regan,
J., and Russo, A. Seeley’s Essentials of Anatomy and Physiology Tenth Edition, pp. 413-418).

Lobar (secondary) bronchus

The lobar bronchi conduct air to each lung lobe. There are two lobar bronchi in the left lung and three lobar bronchi in the right
lung. (Vanputte, C., Regan, J., and Russo, A. Seeley’s Essentials of Anatomy and Physiology Tenth Edition, pp. 413-418).

Segmental (tertiary) bronchus

The segmental bronchi lead to the bronchopulmonary segments of the lungs. (Vanputte, C., Regan, J., and Russo, A. Seeley’s
Essentials of Anatomy and Physiology Tenth Edition, pp. 413-418).

Bronchiole
The bronchiole is the smallest bronchi branch. These passageways evolve into alveoli, which is the site of oxygen and carbon
dioxide exchange in the respiratory system. (Vanputte, C., Regan, J., and Russo, A. Seeley’s Essentials of Anatomy and
Physiology Tenth Edition, pp. 413-418).

Terminal bronchiole
The terminal bronchiole is the smallest conducting airway without alveoli in its walls. Terminal bronchiole branches form
respiratory bronchioles, which give rise to alveolar ducts. (Vanputte, C., Regan, J., and Russo, A. Seeley’s Essentials of
Anatomy and Physiology Tenth Edition, pp. 413-418).

Diaphragm
The diaphragm is a large dome of skeletal muscle that separates the thoracic cavity from the abdominal cavity. (Vanputte, C.,
Regan, J., and Russo, A. Seeley’s Essentials of Anatomy and Physiology Tenth Edition, pp. 413-418).

IV. Pathophysiology

Theoretical Pathophysiology
Case-based Pathophysiology
Laboratory Results

Laboratory and Date Normal Values Result Analysis & Interpretation

X-Ray No active (+) Pneumonia Chest X-ray Interpretation: Abnormal
parenchymal
infiltrates Pneumonia occurs when the air sacs on one or
both sides of the body are irritated, thus they
Lungs are clear are subsequently filled with pus and other
liquids. And as a result, inflammation occurs
Heart is not and this causes the individual to experience
enlarged difficulty breathing.

Aorta is
unremarkable
CBC WBC: 4,500 -10,000 WBC: 14000 cells WBC Interpretation: Abnormal
cells/ mm3 /mm3
The WBC Count of the patient is beyond
RBC: 4.00 - 5.50 x normal range. This indicates an infection and
10 12/L in this case, a Bacterial pneumonia

Platelet Count: RBC: Normal RBC Interpretation: Normal

150-400 X 10
9 /L Low levels are indicative of anemia or vitamin
deficiencies while High levels of RBC
Hematocrit: indicate dehydration, blood disorders, or lung
31-41% or heart disease.

Platelets: Normal Platelets Interpretation: Normal

High levels of a platelet count are attributed to

primary thrombocytosis if the etiology is
determined while secondary thrombocytosis if
the etiology is related to infection. In addition,
low levels of platelet count may need further
laboratory work but the hallmark
characteristic of those with low platelet values
is that they are prone to excessive bleeding.

Hematrocrit: Hematocrit interpretation: Abnormal

>31-41% Hematocrit levels increases in the event of
dehydration. It is also noted to be high when
there is an illness in the lungs which depletes
the oxygen levels of the body. As a
compensatory response, the body produces red
more red blood cells (RBCs) which increases
the hematocrit levels in the blood.

Fecalysis Normal Normal Fecalysis Interpretation: Normal

Fecalysis is a test performed on a stool sample

to aid in the diagnosis of digestive system
disorders such as infection (from parasites,
viruses, or bacteria), inadequate nutrient
absorption, and cancer.
Urinalysis ● Color: Yellow Normal Urinalysis Interpretation: Normal
(light/pale to
dark/deep amber) Urinalysis is used to detect infections, kidney
 disease and diabetes. Urine testing can also
● Clarity/turbidity: assist in diagnosing pneumonia caused by
Clear or cloudy Streptococcus pneumoniae and Legionella
pneumophila, two bacteria.
● pH: 4.5-8

● Specific gravity:
1.005-1.025

● Glucose: ≤130
mg/d
●
● Nitrites: Negative

● Leukocyte
esterase: Negative

● Bilirubin:
Negative

● Urobilirubin:
Small amount
(0.5-1 mg/dL)

● Protein: ≤150
mg/d

V. Drug Study

Side Effect & Nursing Considerations/

Drugs Indication Action
Adverse Effect Health Teachings
Brand Name: This drug is used to Paracetamol exhibits Side Effects: ● Advising clients to
N/A treat mild to analgesic action by ● Drowsiness refrain from consuming
moderate pain such peripheral blockage of pain ● Fatigue medications that also
Generic Name: as headaches, impulse generation. It ● Rashes contain paracetamol as
Paracetamol menstrual periods, produces antipyresis by ● itching they are considered to
toothaches, inhibiting the be contraindications.
Classification: backaches, hypothalamic Adverse effects: ● Educate the client about
Analgesic osteoarthritis, or heat-regulating center. Its ● Liver and the side effects and
cold/flu aches and weak anti-inflammatory Kidney adverse effects of
Dose: pains which aids in activity is related to the Damage paracetamol overdose.
5mL reducing fever inhibition of prostaglandin ● Abdominal ● Advise clients that they
(WebMD, 2018). synthesis in the CNS. Pain can consume
Frequency: ● Nausea paracetamol on an
q4 for ● Seizures empty stomach
temperature ● Coma
● Educate the parents
>37.8 °C ● Jaundice
about the correct
amount of paracetamol
Route:
dosage to prevent
Per Orem
overdosing.

Brand Name: Penicillin G Penicillin G exerts a Side effects: ● Monitor for signs of
N/A (penicillin G bacterial action against ● Nausea allergic reactions and
potassium), is an penicillin-susceptible ● Vomiting anaphylaxis.
Generic Name: antibiotic prescribed microorganisms during the ● Pain ● Monitor client for
Penicillin-G for the treatment of stage of active ● Swelling seizures.
bacterial infections. multiplication. It acts and/or ● Assess for any muscle
Classification: It's used for treating through the inhibition of redness in the aches and joint pains.
Penicillins pneumonia, strep biosynthesis of cell-wall injection site ● Monitor for any signs
throat, staph peptidoglycan, rendering of eosinophilia *fatigue,
Dose: infection, diphtheria, the cell wall osmotically Adverse effects: weakness, and
200,000U meningitis, unstable (NLM, 2016). ● Rashes myalgia*.
gonorrhea, and ● hives ● Monitor IV Site for
Frequency: syphilis (Gurarie, ● itching irritation, redness, and
q6hrs 2021). ● Difficulty of swelling.
breathing
Route: ● Fever
Intravenous ● Severe
Diarrhea
● Irregular
heartbeat
Brand Name: Salbutamol is Salbutamol is a
Side Effect: ● Acquire the patient's
N/A indicated for (i) the direct-acting ● Bilateral history of milk protein
symptomatic relief sympathomimetic that acts trembling in intake.
Generic Name: and prevention of on β2-receptors to relax hands ● Advise patient to take
Salbutamol bronchospasm due to bronchial smooth muscle ● Headaches the missed medication
bronchial asthma, with a less prominent effect ● Heart dose as soon as possible
Classification: chronic bronchitis, on the heart. It activates Palpitations and refrain from double
​Antiasmathic reversible adenyl cyclase, the enzyme ● Muscle dosing.
obstructive airway that stimulates the Cramps ● Store the medication
Dose: disease, and other production of cyclic away from heat and
1 nebule chronic adenosine-3', Adverse Effect: cold at standard room
bronchopulmonary 5'-monophosphate (cAMP). ● Hypokalemia temperature.
Frequency: disorders in which Increased cAMP leads to ● Myocardial ● Auscultate for
q6 bronchospasm is a activation of protein kinase Infarction wheezing and notify the
Route: complicating factor, A, which inhibits ● Paradoxical physician if there is a
Inhalation and/or (ii) the acute phosphorylation of myosin Bronchospas presence of wheezing.
prophylaxis against and lowers intracellular m
exercise-induced ionic Ca concentrations,
bronchospasm and resulting in muscle
other stimuli known relaxation.
to induce
bronchospasm
(Drugbank, 2005).
Brand Name: B. clausii is used for Bacillus clausii (Erceflora) Side effects: ● Advise the client that
Erceflora the treatment and is a preparation composed ● N/A the medication can be
prevention of gut of a suspension of Bacillus used during pregnancy
Generic Name: barrier impairment. clausii spores. These spores Adverse Effect: or breastfeeding.
Bacillus clausii This is also are part of the normal ● Urticaria ● Administer the
administered in intestinal flora and have no ● Angioedema medication orally only.
Classification: preterm neonates to pathogenic potential. ● Rash ● Educate the client that
Antidiarrheals prevent infection, Administered via the oral the medication can be
treatment of nasal route, Bacillus clausii taken with milk, orange
Dose: allergies and upper spores overcome the gastric juice, or sweetened
1 sachet respiratory infections acid barrier due to their water.
in children, and high resistance to both ● Advise client to refrain
Frequency: treatment of acute or chemical and physical from double dosing, if
TID (Thrice a chronic diarrhea, and agents and reach the they missed a dose but
day) small intestine intestinal tract intact where they should opt to take
bacterial overgrowth they are transformed into the missed dose as soon
Route: (Gabrielli et al., metabolically active as possible.
Per Orem 2009) vegetative cells. ● Educate the client about
Thoroughly the activity of the medication and
Bacillus clausii, what it does in response
administration of Bacillus to their medical
clausii contributes to the condition.
restoration of the intestinal
 bacterial flora that has been
upset by imbalances of
various origins.
Brand Name: This nutritional Zinc sulfate is a mineral Side effects: ● Advise the client to
N/A supplement is used supplement. Zinc is a ● Diarrhea refrain from eating
for the following cofactor of various ● Abdominal bran, cereals and
Generic Name: conditions including enzymes which is involved cramps drinking milk within 2
Zinc Sulfate as an adjunct in the in cell division and growth, ● Vomiting hours after intake.
management of removal of harmful free ● Educate the client to
Classification: acute diarrhea. This radicals, and normal Adverse Effect: take the medication for
Minerals & also helps in development and ● Dyspepsia at least 1 to 2 hours.
Electrolytes boosting the immune maintenance of the immune ● Nausea ● Administer the
function and helps in system (Multum, 2021). ● Gastritis medication only by
Dose: supporting optimum ● Irritability mouth.
2 mL physical growth and ● Lethargy ● Educate the client about
development ● Headache eating lean red meat,
Frequency: (MIMS, 2017). ● Dizziness seafood, peas, and
OD (Once a day) beans during the
duration of medication
Route: intake.
Per Orem ● Advise the client to take
the missed dosage as
soon as possible.

VI. List of Prioritized problems

Cues Nursing Diagnosis Rank Justification

Objectives: Ineffective Airway Clearance 1 Airway Clearance is one of the ABCs of
- Tachypnea related to bronchial inflammation life wherein it is a must to prioritized in
- Bilateral coarse crackles and exudates in the alveoli any situation. In relation to the case, there
- Diminished vesicular secondary to diagnosis of PCAP-C are evidently various signs of respiratory
breath sounds as evidenced by tachypnea, distress and ineffective breathing pattern
- Cough bilateral coarse crackles, resulting in a high risk for the patient.
- Irregular shallow breathing diminished vesicular breaths, This diagnosis is related to excessive
- Orthopnea cough, orthopnea, use of accessory secretions and makes it difficult to
-Use of accessory muscle muscles, exudate in the alveoli, and maintain a patent airway. It has a direct
-X-ray: Pneumonia mouth breathing. impact on tissue oxygenation, which
-Exudate in the alveoli requires immediate and decisive action.
-Mouth breathing
-Administration of
Salbutamol 1 neb ampule q
6 hrs
Subjective: Hyperthermia related to 2 Mild to moderate infections are frequently
- Irritable increased metabolic rate in accompanied by a low-grade fever. Fever
response to infection as evidenced happens when the body's thermostat resets
Objectives: by body temperature of 38.2C, to a higher temperature, usually as a
- Flushed skin skin warm to touch, flushed skin, response to prevent the infection from
- 38.2 Celsius tachypnea, orthopnea, and flourishing. This is ranked second since it
- Tachypnea (RR: 44 cpm) irritability. needs immediate intervention. If left
- Skin warm to touch untreated, it can lead to dangerous
- Orthopnea complications, especially in young
children, whose immune system is
compromised.
Objectives: Risk for Activity Intolerance 3 Due to the general weakness occurring
- General weakness related to general weakness which may be induced by the 3-day
- Cough vomiting in the patient, there might be a
 - Fever Risk for Activity Intolerance. Activity
- Nausea intolerance describes an individual with
- Vomiting compromised physical conditioning. This
- Oxygen Saturation Level: requires quick intervention to prevent
92% severe complications. In pediatrics, low
- (+) use of accessory activity intolerance may impede the child
muscle from normal development and increase
- Orthopnea anxiety levels.
- Moderate dehydration
related to PCAP-C
- Administration of 1 sachet
of Erceflora TID PO
(Antidiarrheal)

VII. Nursing Care Plans

NURSING
CUES RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

Objective: Ineffective Ineffective Short Term Goal: Independent: Independent: Short Term
- Tachypnea Airway Airway 1. Assess for 1. Maintaining a Goal: (Goal Met)
- Bilateral Clearance Clearance is After 30 minutes airway patency. patent airway is
coarse related to an inability to of nursing the top priority of After 30 minutes
crackles bronchial clear intervention the the patient to of nursing
- Diminished inflammation secretions or patient will be able look for in order intervention, the
vesicular and exudates obstructions to: to establish the patient was able
breaths in the alveoli from the progress of to:
- Cough secondary to respiratory - Demonstrate healing.
- Irregular diagnosis of tract to baseline vital signs - Demonstrated
shallow PCAP-C as maintain a as evidenced by a 2. Auscultate 2. As fluid and baseline vital
breathing evidenced by clear airway. normal range of lungs for the mucus build-up, signs as evidenced
- Orthopnea tachypnea, (NANDA, RR, HR, BP, and presence of abnormal breath by a normal range
- Use of bilateral 2018). oxygen saturation. normal or sounds can be of RR, HR, BP,
accessory coarse Pediatric adventitious heard. This could and oxygen
muscles crackles, pneumonia is - Show no signs of breath sounds. indicate a saturation.
- X-ray: diminished an invasion of respiratory problem with
Pneumonia vesicular the lower distress. airway clearance. - Show no signs of
- Exudate in breaths, respiratory respiratory
the alveoli cough, tract that - Practices and 3. Monitor for 3. Monitoring distress.
- Mouth orthopnea, use results in methods on how to Oxygen oxygen saturation
breathing of accessory inflammation achieve a patent Saturation level in order to - Practices and
- Administrati muscles, and injury or airway clearance. using a pulse determine the methods on how
on of exudate in the death of oximeter. effectiveness of to achieve a patent
Salbutamol alveoli, and surrounding Long Term Goal: treatment. airway clearance
1 neb mouth epithelium
ampule q 6 breathing. and alveoli. After 3 days of 4. Instruct the 4. Huff coughing Long Term Goal:
hrs This is nursing patient and the exercises help to (Goal Met)
accompanied intervention the guardian to do expel mucus out
by a patient will be able huff coughing from the lungs. After 3 days of
migration of to: exercises. nursing
inflammatory intervention the
cells to the - Maintain clear, 5. Encourage 5. Sitting allows patient was able
site of open airways as patients and the for the most lung to:
infection, evidenced by clear guardian with movement and
causing an breath sounds, proper body chest expansion. - Maintained
exudative normal rate, and alignment for clear, open
process, depth of maximum airways as
which in turn respiration. breathing evidenced by clear
impairs pattern. breath sounds,
oxygenation. - Demonstrate an normal rate, and
(Ahmad, effective breathing 6. Encourage 6. The patient's depth of
2022). The pattern as frequent rest energy is respiration.
nursing evidenced by no periods and conserved during
diagnosis can use of accessory teach the scheduled rest - Demonstrated
now be muscles for patient and the periods, which an effective
applied to the breathing. guardian to reduces the breathing pattern
patient's pace activity. number of as evidenced by
condition as it episodes of no use of
causes this to respiratory accessory muscles
narrow, distress. for breathing.
lessening the
clearance for 7. Instruct the 7. These
air. patient and the measures allow
guardian about the patient to take
pursed-lip part in the
breathing, maintenance of
abdominal their health and
breathing, and the improvement
performing of their breathing.
relaxation
techniques.

8. Instruct the 8. Properly

patient and the administering
guardian on salbutamol can
how to increase
administer medication
salbutamol efficacy and
properly reduce both dose
and side effects.

Dependent: Dependent:

1. Administer 1. Salbutamol is
Salbutamol as used to treat
prescribed by wheezing and
the physician. shortness of
breath caused by
breathing
problems.

2.Administer 2. Variety of
medications medications
such as are prepared to
antibiotics as address the
prescribed. condition and
may help to
improve the
state.

Collaborative: Collaborative:
 1. Encourage 1. Coordinating
the patient and with a respiratory
his guardian to therapist for chest
coordinate with physiotherapy
a respiratory helps eliminate
therapist for secretions,
chest decrease work of
physiotherapy. breathing,
promote the
expansion of the
lungs, and
prevent the lungs
from collapsing.

NURSING
CUES RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

Subjective: Hyperthermia According to Short-term: Independent: Independent: Short-term:

Irritable related to the definition After 3 hours of 1. Monitor the 1. Keeps track of (Goal Met)
increased of NANDA nursing vital signs, progress and
Objectives: metabolic rate (2018), intervention, the especially changes in Short-term:
- Flushed in response to Hyperthermia patient will be the health. After 3 hours of
skin infection as refers to the able to: temperature, nursing
- 38.2 evidenced by elevated core and the intervention, the
Celsius body body - Exhibit a weight of patient was able
- Tachypnea temperature of temperature normal body the patient to:
(RR: 44 38.2C, skin due to the temperature
cpm) warm to touch, ineffectiveness of 36.5 to 2. Monitor the 2. Fluid loss - Exhibit a
- Skin warm flushed skin, of 37.5 ℃ client’s through urine, normal body
to touch tachypnea, thermoregulatio - Free from intake and vomiting and temperature
- Orthopnea orthopnea, and n or as shivering; output. sweating can of 36.5 to
irritability. defensive the skin will Assess for potentiate 37.5 ℃
mechanisms of be normal in signs of fluid and - Free from
the body. In color dehydration electrolyte shivering; the
this case, the - Shows loss which skin will be
definition is normal may worsen normal in
adhering to its respiratory hyperthermia color
defensive rate of 20-34 - Shows
mechanism in cpm without 3. Adjust room 3. Adjusting the normal
order to prevent difficulty of temperature room respiratory
further breathing. and modify temperature rate of 20-34
infection. The the patient’s and modifying cpm without
normal Long-term: clothing the patient's difficulty of
response of the After 7 days of accordingly. clothing aids breathing.
body in the effective nursing in rapid
event of intervention, the cooling. Long-term:
infection is to patient will be (Goal Met)
raise its able to: 4. Reduce the 4. Cool sponge After 8 days of
temperature to body bath promotes nursing
cease - Be free from temperature heat loss intervention, the
pathogenic hyperthermia of the through patient was able
agents from and its patient by evaporation to:
having normal associated performing and - Be free from
processes, symptoms. a cool conduction. hyperthermia
which can sponge bath and its
further damage
the body on the associated
systems. This patient. symptoms.
makes the 5. Maintaining
nursing 5. Instruct the bed rest aids
diagnosis parents of in reducing
applicable to the child to metabolic
the case. maintain demands and
bed rest. oxygen
absorption.

6. Adequate fluid
6. Educate the intake
parents minimizes the
regarding risk of
the dehydration
importance and promotes
of adequate heat loss.
fluid intake.

Dependent:
Dependent: 1. Paracetamol is
1. Administer used to aid in
Parectamol fever
as reduction.
prescribed
by the
Doctor.
2. Penicillin G is
2. Administer given in order
Penicillin G to treat
as bacteria
prescribed causing
by the infections.
Doctor.

3. Correct IV
3. Ensure flow rate
correct flow protects the
rate and patient from
patency of the
the complication
prescribed of over
and infusion or
administere under infusion
d IV Fluid. that will
further delay
recovery.

Collaborative
Collaborative: 1. The
1. Carry out physician
laboratory may order
 orders for follow-up
the labs to
follow-up monitor if the
blood works illness is
and imaging progressing
procedures or regressing.

NURSING
CUES RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

Objective: Risk for Risk for activity Short Term Independent: Independent: Short Term:
- General Activity intolerance Goal: 1. Observe and 1. Sleep (Goal Met)
weakness Intolerance refers to the After 3 days of track the deprivation
- Cough related to patient’s state of nursing patient's sleep and sleep After 3 days of
- Fever general vulnerability in intervention, the patterns and issues can nursing
- Nausea weakness having patient will be sleep duration impair a intervention, the
- Vomiting insufficient able to: throughout patient's patient was able
- Oxygen energy that is - Exhibit vital the previous activity level; to:
Saturation necessary to signs within few days. these must be
Level: 92% perform desired the patient's addressed - Exhibit vital
- (+) use of daily activities acceptable before signs within
accessory (NANDA, range. successful the patient's
muscle 2018). - The patient activity acceptable
- Orthopnea Furthermore, the will achieve progression range.
- Administrati patient’s risk for an increased can occur. - The patient
on of 1 activity tolerance to will achieve
sachet of intolerance is light 2. During 2. Supplemental an increased
Erceflora caused by physical physical oxygen may tolerance to
TID PO vomiting, which activities. activity, use a be used to light physical
(Antidiarrhe leads to - Identify portable pulse assist activities.
al) generalized child-friendl oximeter to compensate - Identify
weakness. That y techniques check for for higher child-friendly
being said, the to increase oxygen oxygen techniques to
aforementioned activity desaturation. demands increase
nursing tolerance. during activity
diagnosis is - Report physical tolerance.
appropriate for positive activity. - Report
the case because verbal positive verbal
the generalized feedback on 3. Observe and 3. Close feedback on
weakness that the record how monitoring the
the patient is performance the patient will serve as a performance
experiencing can of activities. reacts to guide for the of activities.
compromise different best activity
their health and Long Term activities. progression.
further impair Goal:
their capability After 2 weeks of 4. Allow the 4. It aids in the Long Term
to perform nursing patient to development Goal:
activities of intervention the complete the of activity (Goal Met)
daily living patient will be task more tolerance.
(ADLs) able to: slowly, over a After 2 weeks of
(Elsevier, n.d). - Maintain longer period nursing
vital signs of time, with interventions, the
within the more rest or patient was able
patient's interruptions, to:
acceptable or with - Maintain
range. vital signs
- Report assistance if within the
absences of needed. patient's
fatigue or 5. Assisting the acceptable
weakness. 5. Assist with patient with range.
- Report an ADLs while ADLs allows - Report
increased avoiding for energy absences of
tolerance to patient conservation. fatigue or
perform dependency. Balance the weakness.
moderate to support; - Report an
heavy facilitating increased
physical progressive tolerance to
activities endurance will perform
(appropriate improve the moderate to
for age). patient's heavy
exercise physical
tolerance and activities
self-esteem in (appropriate
the long run. for age). .

6. Encourages
6. Encourage autonomy
physical while
activity that is remaining
appropriate realistic about
for the capabilities.
patient's
current
energy level.

7. This makes it
7. Encourage easier for the
verbalization patient to
of feelings cope.
regarding Recognize that
limitations. living with
exercise
intolerance is
demanding
both
physically and
emotionally.

8. Having
8. Educate the adequate
family on the knowledge
importance of about the
consistent condition and
implementati appropriate
on of implementatio
recovery n of activities
activities and promotes
identify and faster recovery
report any and reduces
signs of the risks of
physical falls and
exhaustion. injuries.
 Dependent:
Dependent: 1. Zinc sulfate is
1. Administer prescribed for
Zinc Sulfate the
to aid body development
weakness. and health of
body tissues.

2. Vitamins and
2. Provide minerals are
adequate known to
vitamins and restore and
minerals as supply body’s
prescribed to nutritional
optimize requirements
body energy. to function
properly.

Collaborative:
Collaborative: 1. Consultation
1. Encourage with physical
the patient therapists is
and his necessary
parents to because it
consult a allows the
physical patient to
therapist for acquire a
specialized specialized
exercises and form of care
therapies that that is centered
are tailored to on assisting
fit the them in
physical treating
characteristics conditions that
of the patient. can limit the
patient’s
ability to
perform daily
activities.

2. Consultations
2. Consultation with pediatric
with Pediatric dieticians are
Dietician for vital to
diet menu keeping the
regimen. patient’s body
supplied with
the necessary
nutrients and
vitamins for
bone and
muscle
growth,
immunity
 from diseases,
and energy to
perform
activities.

VIII. Health Teaching Plan

Topic: Prevention of Pediatric Community-Acquired Pneumonia

Goal: At the end of 45 minutes of discussion and evaluations, the patient and his parents will be able to understand and
determine the definition of pediatric community-acquired pneumonia, its signs and symptoms, risk factors, and ways to
prevent the acquisition of pediatric community-acquired pneumonia
Time Allotment: 45 minutes

Learning Objectives Learning Content Methodology Resources Method of Evaluation

● Understand A. Pediatric ● Discussion ● Powerpoint ● State what is
Pediatric Community-Ac ● Question and Presentation PCAP-C, 3
Community-Ac quired Answer ● Pamphlets signs and
quired Pneumonia ● Pictures and symptoms,
Pneumonia and ● Definition of Videos mode of
how it is Pediatric transmission,
transmitted in Community-Ac and 2 risk
communities. quired factors
● Identify Pneumonia ● Demonstrate
methods and (PCAP-C) capability and
techniques to ● Signs and willingness to
prevent the Symptoms of perform the
acquisition of PCAP-C techniques and
Pediatric ● Risk factors for methods of
Community-Ac acquiring prevention.
quired PCAP-C ● Exhibit
Pneumonia ● Mode of willingness to
● Learn the transmission of adhere to
importance of PCAP-C immunizations.
having
immunizations. B. Methods and
Techniques to
Prevent
PCAP-C
● Importance of
having a
nutrition plan
centered on
protein, whole
grains,
carbohydrates,
and vitamin C
rich food
choices.
● How hand
washing should
be properly
done and its
benefits.
● Reduction of
 household
pollution.
● Identification of
early signs and
symptoms.

C. Importance of
Immunizations
● Routinely
administration
of
pneumococcal
conjugate
vaccines.

Topic: Administration of Salbutamol

Goal: At the end of 45 minutes to 1-hour interactive interactions, the patient and his parents will be able to gain adequate
knowledge and understanding of how to administer salbutamol properly.
Time Allotment: 45 minutes- 1-hour

Learning Objectives Learning Content Methodology Resources Method of Evaluation

● Learn how to ● What safety ● Lecture and ● Pictures and After health teaching:
administer measures should Discussion Videos ● The parents will
salbutamol be taken when ● Question and ● Powerpoint be able to
properly and using Answer Presentation demonstrate the
why it is salbutamol? ● Informational proper ways to
important to be ● How long does materials like administer
discussed salbutamol take brochures and salbutamol
● State and to work? handouts about ● Be able to know
discuss the ● What to do for a the the purpose,
purpose, action, missed dose of administration action, and
and possible salbutamol? of salbutamol possible adverse
adverse effects ● What are the effects of
of salbutamol precautions of salbutamol
● Emphasize the salbutamol ● Discuss the
importance of ● What is importance and
taking salbutamol used therapeutic
salbutamol to treat? effect of
● Know the salbutamol
indications and
contraindication
s of using
salbutamol

IX. Discharge Plan

Medication ● Instruct the patient to continue taking the medications prescribed such as zinc sulfate,
paracetamol, salbutamol, penicillin-g, and erceflora in accordance with the instructions.
● Educate the patient about the indications and side effects of medication.
● Advise the patient to take the medications with the proper schedule and amount.
● Inform the patient to notify the physician of any appearance of adverse effects.
Treatment ● Instruct the patient to do breathing exercises such as:
○ Pursed lip breathing
○ Diaphragmatic breathing
○ Deep breathing
 ● Encourage the patient to do huff cough exercises in order to expel mucus out from the lungs.
● Encourage the patient to take steamy baths and use a humidifier to help open your airways
and ease your breathing.
Health Education ● Inform the patient to do plenty of rest to help in healing your body.
● Inform the parents to always keep their child with good personal hygiene to avoid adaptation
of infection.
● Encourage the patient to consume a healthy diet.
● Advice to increase the fluid and electrolyte intake accordingly.
Exercise ● No extreme activities should be initiated by the patient within the timeframe of the order.
Inappropriate exercise or activities might trigger or delay the healing process.
OPD Follow-up ● Follow-up check ups are expected to be attended 2-3 weeks after discharge from the hospital

Diet ● Inform the parents to prepare foods for their child with plenty of vegetables, fruits, whole
grains, low-fat dairy products, and lean protein.
● Drink enough fluid in order to thin the mucus in your lungs.
● Eat foods that contain more soup to help loosen the mucus in your lungs.
○ broth-based soups like chicken soup
● Monitor for any allergic reactions to food that may induce the narrowing of airways. Report
immediately to a physician.
Spiritual ● Instruct the patient to practice spiritual practices safely.
● Educate the patient that faith can contribute to effective recovery
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