case study,,,,,,pneumonia

I. INTRODUCTION

Pneumonia is an inflammatory illness of the lung. Frequently, it is described

as lung parenchyma/alveolar (microscopic air-filled sacs of the lung responsible for

absorbing oxygen from the atmosphere) inflammation and (abnormal) alveolar

filling. Pneumonia can result from a variety of causes, including infection with

bacteria, viruses, fungi, or parasites, and chemical or physical injury to the lungs. Its

cause may also be officially described as idiopathic, that is unknown, when

infectious causes have been excluded.

Bronchopneumonia (Lobular pneumonia) is one of two types of bacterial

pneumonia as classified by gross anatomic distribution of consolidation

(solidification). In bacterial pneumonia, invasion of the lung parenchyma by bacteria

produces an inflammatory immune response. This response leads to a filling of the

alveolar sacs with exudate. The loss of air space and its replacement with fluid is

called consolidation. In bronchopneumonia, or lobular pneumonia, there are

multiple foci of isolated, acute consolidation, affecting one or more pulmonary

lobes.

Pneumonia is a common illness in all parts of the world. It is a major cause of

death among all age groups. In children, the majority of deaths occur in the

newborn period, with over two million deaths a year worldwide. The World Health

Organization estimates that one in three newborn infant deaths are due to

pneumonia and WHO also estimates that up to 1 million of these (vaccine

preventable) deaths are caused by the bacteria Streptococcus pneumoniae, and

90% of these deaths take place in developing countries. Mortality from pneumonia

generally decreases with age until late adulthood. Elderly individuals, however, are

at particular risk for pneumonia and associated mortality.

New Research Spares Children the Pain of the Needle

ScienceDaily (Jun. 27, 2007)

http://www.sciencedaily.com/releases/2007/06/070626123930.htm

http://en.wikipedia.org/wiki/World_Health_Organization

http://en.wikipedia.org/wiki/World_Health_Organization

http://en.wikipedia.org/wiki/Pulmonary

http://en.wikipedia.org/wiki/Idiopathic_interstitial_pneumonia

http://en.wikipedia.org/wiki/Parasite

http://en.wikipedia.org/wiki/Fungus

http://en.wikipedia.org/wiki/Virus

http://en.wikipedia.org/wiki/Bacteria

http://en.wikipedia.org/wiki/Infection

http://en.wikipedia.org/wiki/Earth's_atmosphere

http://en.wikipedia.org/wiki/Oxygen

http://en.wikipedia.org/wiki/Alveolus

http://en.wikipedia.org/wiki/Parenchyma

http://en.wikipedia.org/wiki/Lung

http://en.wikipedia.org/wiki/Illness

http://en.wikipedia.org/wiki/Inflammatory

Children suffering from pneumonia could be spared the pain of the doctor's

needle, thanks to new research funded by the British Lung Foundation.

The study, a world-first carried out by researchers at The University of

Nottingham, discovered that children given oral treatment recovered as quickly,

suffered less pain, required less oxygen therapy in hospital and were able to go

home sooner than those given injections.

Two-and-a-half million children are affected by pneumonia each year in Europe.

Until now, most children have been admitted to hospital and treated with injected

antibiotics.

The findings suggest that these injections — endured by generations of children

— may be unnecessary and could be replaced with oral doses of the medicine in the

majority of cases. The study has been published online in the medical journal

Thorax.

The research involved 243 children in hospitals throughout the UK. It was led by

Terence Stephenson, Professor of Child Health, and Dr Maria Atkinson, both of The

University of Nottingham's Medical School.

The study is the first in the developed world to compare oral treatment versus

intravenous (IV) treatment for children with community-acquired pneumonia, who

are unwell enough to need admission to hospital.

Professor Stephenson said: “This is good news for children who hate injections;

good news for parents whose children will spend less time in hospital; good news for

paediatricians who hate sticking needles in children and good news for the NHS, as

fewer beds will be occupied and the treatment is cheaper.”

Dame Helena Shovelton, Chief Executive of the British Lung Foundation, said:

“Treating childhood pneumonia will be less painful and distressing for parents, for

children and for the health professionals caring for them, thanks to this research.

We are very proud to have made this breakthrough possible.”

The research project involved 243 children, enrolled over a 21-month period at

eight UK hospitals. Half were randomly assigned to receive a week of oral antibiotic

treatment and half to receive antibiotics intravenously.

Follow-up over subsequent weeks showed that both types of treatment are

effective in tackling the illness — and the former actually had a number of

advantages over the latter. Oral antibiotics are also cheaper than those given via

the IV route.

The researchers concluded: “We suggest that in countries like the UK, all but the

sickest children with community-acquired pneumonia should be treated with oral

amoxicillin initially.


The group chose Pneumonia as their case for presentation because they want

to expand their knowledge gained in classroom lectures. This case is chosen

because it seems for them that it is just simple but when they conducted a study

about it they learned that there are so many factors that could be cause for

Pneumonia. The group would like to gain more information about the disease

condition. Other than the fact that the case is very common and it is the usual case

used by the student nurses for their case presentations the group still took part in

conducting a case study about Pneumonia because they have considered the fact

that Pneumonia according to DOH is one of the leading caused of infant mortality in

the Philippines. Interest leads the group to come up with such study as they make

every effort to expand their knowledge about pneumonia.

1. PERSONAL DATA

Baby Nicole is a 1 year and 2 months old baby girl who was born last

September 09, 2006 in Quezon City General Hospital. Because of her age, the group

decided to interview the mother of the patient. Her parents are Peyton Scott and

Lucas Scott. They are currently living in Dolores, Magalang, Pampanga. They are all

having Filipino nationality and are all followers of Born Again religion.

Baby Nicole was admitted last November 22, 2007, at around 12 noon in

Balitucan District Hospital complaining for on and off fever. And was discharge last

November 24 2007.

2. PERTINENT FAMILY HISTORY

Nathan ScottBD: Nov-10-1955

Chris DavisDD: April-22-1992

Cancer

Peyton ScottBD: Jan.-4-1977Asthma

Lucas ScottBD: April-09-1979

Jake ScottBD: Dec.-04-2000Cerebral Palsy

Nicole ScottBD; Sept.-09-2006BPN

Brooke DavisDD: Dec.26-2003birth complication

Haley ScottBD: july-5-1954Asthma

Birth Date: BD

Death Date: DD

Male:

Female:

Diseased:

With existing illness:

The diagram shows that Lucas Scott and Peyton Scott are the parents

of Baby Nicole. At the paternal side, Lucas’s parents or the grandparents of

Baby Nicole are both still alive. Haley Scott the grandmother of Baby Nicole is

diagnosed with asthma. At the maternal side, Peyton’s parents or Baby

Nicole’s grandparents on mother side are both already dead. Chris Davis the

grandfather of Baby Nicole died because of cancer, while Brooke Davis died

because of birth complications. The mother of Baby Nicole which is Peyton

Scott is diagnosed with asthma. Baby Nicole has one brother which is Jake

Scott. He is diagnosed with cerebral palsy.

Scott family is composed of 4 members. Peyton Scott gave birth to 2

children. Her first child is Jake Scott he was born last December 04 2000, at

East Avenue Medical Center via normal spontaneous delivery. After about 6

years she gave birth to her 2nd child which is Baby Nicole at Quezon City

General Hospital via normal spontaneous delivery also. She said that during

her pregnancy she’s a little bit irritable with her husband. But she has

positive attitudes with her pregnancies.

The Scott family is currently residing at Brgy. Dolores, Magalang,

Pampanga. They live in a wooden house owned by their boss. Mr. Lucas the

father of Baby Nicole works as a hollow block maker. He earns 1800/week

and works from 6am-6pm. He is a smoker; he usually smokes 5 sticks/day. He

also drinks alcoholic beverages; he usually drinks 2 bottles/week. Peyton

Scott is a house wife, she stays at home to take care of their children. She

stated that the house is in good condition but the surrounding is very dusty

because it’s near the hollow block making site.

Mrs. Scott believes to herbolarios, she usually consults herbolarios to

have hilot and tawas. She also uses herbal medicines when they caught

simple illnesses like cough or cold. The usual herbal medicines that they use

are oregano, ampalaya leaves, guava, and sambong. Mrs. Scott said that

whenever she has an emergency financial problem they usually come to their

boss to borrow some money.

3. PERSONAL HISTORY

Mrs. Scott told the group that she’s having a monthly check up during

her pregnancy. She delivered her 1st baby for 6 hours. And she delivered her

2nd baby which is baby Nicole for 2 hours. They are both delivered in the

hospital and they are all 9 months when they were delivered. Mrs. Scott said

that she only breastfed her children for 2 weeks after that she begins to

bottle feed them. She also stated that her children were all fully immunized.

Growth and Development

Erik Erickson’s Psychosocial Development

Trust Vs. Mistrust (birth to 1 year)

Characterized by taking in through all the senses, loving care of

a mothering person is essential to develop trust, must have basic needs met,

and having an attachment to primary care taker

Baby Nicole manifested this by crying when she woke up and

her mom is not around. She gained trust because her mother responded to

her eagerly whenever she’s crying and give her food whenever she’s hungry.

Sigmund Freud’s Psychosexual Development

Oral Stage (birth to 1 year)

Characterized by infant-seeking pleasure via oral activities such

as biting, sucking, chewing, and vocalizing.

Baby Nicole manifested this by putting everything that she

reaches in her mouth like IV tube, and she’s stop crying whenever she sucks

her pacifier.

Jean Piaget’s Cognitive Development

Sensorimotor (birth to 2 years)

Characterized y progression from reflex activity through simple

repetitive behaviors to imitative behaviors, information is gained through the

senses and developing motor abilities, develop a sense of cause and effect,

problem-solving is by trial and error, high level of curiosity, experimentation,

and enjoinment in novelty, begin to separate self from others, develop sense

of object permanence, begin language development.

Baby Nicole manifested this because when the group is

assessing her. She wants to get the penlight from one of the member, and

when the group member hides it, Nicole is still looking for it.

4. HISTORY OF PAST ILLNESSES

Mrs. Scott stated that baby Nicole had mumps last September and got

tigdas hangin when she’s just about 7 months. She also had sore eyes last

October. Other than that she also had some cough and colds.

5. HISTORY OF PRESENT ILLNESSES

Baby Nicole was hospitalized twice already. She was first hospitalized

last November 10 2006 at Quezon City General Hospital with complain of

difficulty of breathing, cough and colds. During that hospitalization she was

diagnosed to have Pneumonia. She stayed in the hospital for 1 week. Her 2nd

hospitalization was in Balitukan District hospital last November 22 2007. She

was admitted with complains of on and off fever for 7 days and cough for 3

days.

6. PHYSICAL EXAMINATION

Initial Assessment upon Admission (November 22 2007)

Vital signs:

T= 38 °C

P= 143 bpm

R= 49 cpm

Complain of 7 days on and off fever accompanied by cough and colds.

Fairly nourished

Fairly developed

Weight: 14 kg

(+) Rales on both lung fields

(-) Wheezes

November 23 2007

General Condition

The patient is seen lying on bed with her mother, awake and conscious

She’s wearing comfortable and loose sando and short. The patient is slightly

irritable and looks untidy because of uncombed hair and slightly wet back.

Vital Signs:

T= 37.5°C

P= 148 bpm

R= 61 cpm

Skin and Hair

With dark brown complexion all throughout the body. Hair evenly

distributed.

Head

Hair is evenly distributed, smooth and shiny. No dandruff. Symmetrical

contours of the head. No abnormal depressions, masses, and nodules upon

palpation.

Eyes

Symmetrical eyebrow movement and evenly distributed hair.

Symmetrical eyelid movement and evenly distributed eye lashes.

Symmetrical eye movement.

No abnormal discharges. With pinkish palebral conjunctiva. With round and

black iris. With white sclera. No abnormal masses and nodules. Pupils dilate

upon introduction of light. With (+) blink reflex.

Ears

Symmetrical ear shape, non-tender, and firm. Ears line the outer

cantus of the eye. Presence of serumen in minimal amount. Intact tympanic

membrane. No abnormal masses and nodules upon palpation. Pinna recoils

after it is folded. Good sense of hearing evident by head turning upon

mentioning her name.

Nose

Presence of little amount of nasal secretion because of colds. No

abnormal masses, nodules and lesions. With good sense of smell evident by

removing the cotton ball with alcohol introduce by the student nurse.

Mouth

Symmetrical pale, lips. Presence of 8 teeth. Tongue located at the

middle. Able to move tongue. With (+) gag reflex. With good sucking reflex.

No abnormal lesion and sores.

Neck

Located on the midline. No abnormal masses, nodules and lesions.

Trachea is located at the center

Chest

Symmetrical lung expansion. With evenly distributed hair. No masses

and lesions. With abnormal breath sound (rales) on both lung fields. With

shallow, short breaths.

Heart

No unusual heart sound upon auscultation.

Abdomen

Uniform in color. Round shape of abdomen. No lesions and masses. No

tenderness upon palpation. Presence of normal bowel sound. (gurgle)

(16/min)

Upper Extremities

Able to move hands freely. Symmetrical in shape. With dirty

fingernails. No abnormal lesions and masses. Pale nailbeds.

Lower Extremities

Able to move feet freely. Symmetrical in shape. With dirty toe nails. No

masses and lesions.

7. DIAGNOSTIC AND LABORATORY PROCEDURES

Diagnosti

c/

Laborator

y

procedur

es

Date ordered,

Date

performed,

Date results in

Indication(s)

or Purpose(s)

Results Normal

Values (units

used in the

hospital)

Analysis and

Interpretation of

results

Chest X-

ray

DO: 1i1-22-07

DP: 11-23-07

DRI: 11-23-07

To visualize

possible

enlargement of

the heart and

assess

presence of

congestion in

the lungs.

Chest

roentgenograms

reveal minimal hazy

infiltrates on both

lower lung fields.

Heart and great

vessels are of

normal size and

configuration.

Hemidiaphragms

sulci and other

visualized included

chest structures are

unremarkable.

The results were

interpreted by the

physician, the results

revealed pneumonitis

on both lung fields.

Nursing Responsibilities:

Preprocedural care:

Orient the client about the procedure.

Inform the client that the procedure is pain free.

If the client is pregnant, inform her that radiation can be harmful to the fetus. If an x-ray is necessary,

precautions will be taken to minimize radiation exposure to the baby.

Ask the client to remove some or all of their clothes and ask them to wear a gown.

Ask them to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the x-ray

images.

During the procedure:

Assist the client and will position the patient with hands on hips and chest pressed the image plate. For the

second view, the patient's side is against the image plate with arms elevated.

The patient who can’t stand may be positioned lying down on a table for chest x-rays.

Ask the patient to hold very still and may be asked to keep from breathing for a few seconds while the x-ray

picture is taken to reduce the possibility of a blurred image.

Postprocedural care:

Ask the client to wait until the technologist determines that the images are of high enough

quality for the radiologist to read.

Diagnostic/

Laboratory

procedures

Date ordered,

Date

performed,

Date results in

Indication(s) or

Purpose(s)

Results Normal

Values (units

used in the

hospital)

Analysis and

Interpretation of

results

Hematology

Hemoglobin

DO: 1i1-22-07

DP: 11-22-07

DRI: 11-23-07

To monitor levels of

blood components

that could be

indicative of infection

or other disease or

health conditions

It measures the total

amount of

hemoglobin in the

blood to determine

the oxygen carrying

capacity of the blood.

Hemoglobin in

vertebrates

transports oxygen

from the lungs to the

rest of the body, such

as to the muscles,

where it releases the

oxygen load. Due to

11.2 mg % 12-16 mg %

The results are slightly

below normal, which

may indicate that the

patient is at risk of

having ineffective

tissue perfusion and

lack of adequate

oxygen.

Hematocrit

vaginal bleeding of

the patient, there is

loss of blood and

should be monitored

if she needs blood

transfusion to

maintain the normal

circulation of oxygen

in blood to

supplement the body

and organs.

It measures the

percentage of RBCs in

the total blood

volume. It may also

provide idea on

patient’s fluid status.

The hematocrit is the

percent of whole

blood that is

composed of red

37 vol.% 37-47 vol.%

The results are with in

normal range that may

indicate normal RBCs in

the blood.

WBC

Lymphocytes

blood cells. The

hematocrit is a

measure of both the

number of red blood

cells and the size of

red blood cells

The total white blood

cell count is the

absolute number of

leukocytes circulating

in a cubic millimeter

of blood. It is used to

determine factor of

inflammation and also

to determine and

evaluate body’s

physiologic capacity

to resists and

overcome infection.

A variety of WBC

7,700/cu.mm

64%

10-25x10

25-40

The results are below

normal that can

indicate that the WBCs

are already worn out by

the microorganism.

The results were

elevated which may

Platelet Count

(leucocyte), present

also in the lymph

nodes, spleen,

thymus gland, gut

wall and bone

marrow. They are

involve in immunity

and can be

subdivided into B-

cells which produce

circulating antibodes

and T-cell which are

primarily responsible

for cell-mediated

immunity

A disc –shaped cell

structure, 1-2 um in

diameter, which is

present in the blood.

Assess for any risk of

bleeding and for

252/cu. Mm. 150-450/cu mm

indicate that the body

is trying to fight the

infection by producing

lymphocytes that

produces

T-cells and B-cells

which produces

antibodies and

responsible for cell

mediated immunity.

The results are within

normal range that may

indicate normal clotting

time and is safe from

bleeding.

clotting time.


Before:

Check the doctor’s order.

Determine the prescribed test and other restrictions prior to the test.

Get the laboratory requisition slip.

Explain to the patient what the procedure to be done is.

Inform the patient that this requires a blood sample.

Inform the patient how the procedure is performed, the equipment to be used.

During:

Explain to the patient what test should be done.

Prepare all the equipments to be used.

Tell the patient when to insert the needle for her to be prepared.

Encourage the patient to remain calm during the test.

Assist the patient if necessary.

Ensure a sterile blood sample from the patient.

After:

Send the blood sample to the laboratory immediately.

Proper documentation

III. ANATOMY AND PHYSIOLOGY

Respiration is necessary because all living cells of the body require

oxygen and produce carbon dioxide. The respiration system assists in gas

exchange and performs other formation as well our body needs a constant

supply of oxygen to support metabolism. The respiratory system brings

oxygen through the airways of lungs into the alveoli, where it diffuses into

the blood for transport to the tissue, this process is so vital that difficult in

breathing is expected as a threat to life in self. The respiratory system allows

oxygen from the air to enter the blood and carbon dioxide to leave the blood

and enter the air. The cardiovascular system transport oxygen from the lungs

to the cells of the body and carbon dioxide. Without healthy respiratory and

cardiovascular system, the capacity to carry out normal activity is reduced,

and without adequate respiratory and cardiovascular system friction, life

itself is possible.

Nose- The term nose refers to the visible structure that forms a prominent

feature of the face. Most of the nose is composed of cartilage, although the

bridge of the nose consists of bone the bone and cartilage and covered by

connective tissue and shin.

Nasal cavity- The nasal extends from the noses to the choane the nares or

nostrils are the external opening of the nose and the choane are the

openings to the pharynx. The nose is formed from both bone and cartilage.

The nasal bone forms the bridge and the remainder of the nose is composed

of cartilage and connective tissue. Each opening of the nose to the face leads

to the cavity. The vestibule is lined anteriorly to the skin and hair that filter

foreign objects and prevent from being inhaled. The posterior vestibule is

lined with a mucous membrane, composed of columnar epithelial cells and,

goblets cells that secrete mucous. The mucous membrane extends

throughout the airways and cilia propel mucous to the pharynx for

elimination by swallowing or coughing. The portion of mucous membrane that

is located at the top of the nasal cavity, just beneath the cribriform plate of

the ethmoid bone, is specialized epithelium; witch provides the sense of

smell.

Along the side of the vestibule are turbinate, mucous membrane covered

projections that contain a rich blood supply from the internal and external

carotid arteries. They warm and humidify inspired air.

Paranasal sinuses- open areas within the skull are named for the bones in

witch they lie: frontal, ethmoid, sphenoid and maxillary. Passageway from

paranasal sinuses drain into the nasal cavity. The nasolacrimal duct, witch

drain tears from the surface of the eyes, also drains the nasal cavity.

Pharynx- it is a funnel-shaped tube that extends from the nose to the larynx.

It is the common passageway of both the respiratory and digestive system. It

can be divided into three regions:

a. Nasopharynx- is located above the margin of the soft palate and

receives air from the nasal cavity. From the ear, the Eustachian

tubes open into the nasopharynx. The pharyngeal tonsils are

located on the posterior wall of the nasopharynx.

b. Oropharynx- serves both respiration and digestion. It receives

air from the nasopharynx and food from the oral cavity. Palatine

tonsils are located along the sides of the posterior mouth, and

the lingual tonsils are located at the base of the tongue.

c. Laryngopharynx- located below the base of the tongue, is the

most inferior portion of the pharynx. It connects to the larynx

and serves both the respiration and digestion.

Larynx- is commonly called the voice box. It connects the upper and

lower airway. It lies just anterior to the upper esophagus. Nine cartilages

form the larynx: epiglottis, thyroid, cricoid, arythenoid, corniculate,

cuneiform. The cartilage are attach to the hyoid bone above and below

the trachea by muscles and ligaments. The slit the vocal cords forms the

glottis. The epiglottis, a leaf shaped structure immediately posterior to the

base of the tongue. The thyroid cartilage protrudes in front of the larynx

forming the Adam’s apple.

Trachea- extends from the larynx to the level of the seventh thoracic

vertebrae, where it divides into two main bronchi. The point at witch the

trachea divides is called carina. The trachea is a flexible, muscular, 12cm

long air passage with C-shaped cartilaginous ring.

Lungs- it lie within the thoracic cavity on either side of the heart. They

are cone-shaped, with the apex above the first rib and the base resting on

the diaphragm. Each lung is divided into superior and inferior lobes by an

oblique fissure. The right lung is further divide by a horizontal fissure,

witch bounds a middle lobe. The right lung therefore has three lobes. The

lung contains gas, blood, and thin alveolar wall and support structure. The

alveolar walls contain elastic and collagen fibers. These fibers are capable

of stretching when the pulling force is exerted on then from outside of the

body or whey they are inflated from within.

Alveoli- the lungs parenchyma, consists of millions of alveolar units, is

the working area of the lung tissue it birth a person has approximately 24

million alveoli, by the age 8 yrs a person 300 million. The total working

alveolar surface are is the approximately 750 to 860 square feet. Oxygen

and CO2 are exchange through the respiratory membrane about 0.2 mm

thick (The average diameter of the pulmonary capillary only about 5

mins).

Thorax- provides protection for the lungs, heart and great vessels. The

outer shell of the thorax is made up of 12 pairs of ribs. The ribs connects

posterior to the transverse processes of the thoracic vertebrae of the

spine. Anteriorly, the first seven pairs of ribs are attached to the sternum

by cartilage. The 8th, 9th and 10th ribs are attached to each other by costal

cartilage. The 11th and12th ribs allow full chest expansion because they

are not attached in any way to the sternum.

Diaphragm- it is the primary muscle of breathing and serves as the lower

boundary of the thorax. The diaphragm is dome- shaped in the relaxed

position, with central muscular attachments to the xiphoid process of the

sternum and the lower rib.

IV. PATIENT AND HIS ILLNESS

A. PATHOPHYSIOLOGY

a. Schematic Diagram

(book base)

yema

(Patient Centered)

Viral infection

Inflammation of pulmonary parenchyma

Fungal infection

Engorgement with effusion of blood and serum into the alveoli

in 1 or more lobes;(stage I) lobe airless and alveoli contain fibrin, serum, RBC,

neutrophils,(stage II) lobe larger with fibrin in alveoli

and decreased cellular elements and bacteria

(stage III) Usually pneumococcal

Bronchopneumonia Interstitial pneumonia

Bacterial infection

Lobar pneumonia

Mucopurulent exudate in terminal

bronchioles. Clogging of bronchioles. Necrosis and

sloughing of bronchial mucous membranes.

Formation of peribronchial

abscesses and pneumatoceles.

Usually staphylococcal

Resolution with treatment (stage IV)

Inflammation of walls of alveoli, bronchi and bronchioles. Usually

viral and staphylococcal

Risk Factors

-second-hand

smoker

-age

-environment

-nutrition

-pleural effusion-pleurisy

-empyema

-pleural effusion-empyemaResolution

with treatment

-pneumothorax-empyema

Resolution with

treatment

b. Synthesis of the disease

b.1. Definition of the Disease

Pneumonia is a general term that refers to an infection of the

lungs, which can be caused by a variety of microorganisms, including

viruses, bacteria, fungi, and parasites.

Invasion of microorganism

Enter lower respiratory tract

Stimulate respiratory response

-cough-rales-colds

Accumulation of exudates and

bacteria

Cytokine

Release of chemical mediators

Parenchymal and Alveolar sacs tend to consolidate

stimulate

Fever

Stimulate goblets cells

Increase in temperature

Bradykinin

Narrowing of blood vessels

Histamine

Air pass trough narrowed airways

DOB

Often pneumonia begins after an upper respiratory tract

infection (an infection of the nose and throat). When this happens,

symptoms of pneumonia begin after 2 or 3 days of a cold or sore

throat.

b.2. Predisposing and Precipitating Factors

Bacteria are the most common causes of pneumonia, but these

infections can also be caused by other microbial organisms. It is often

impossible to identify the specific culprit. Many bacteria are

categorized by the staining procedure used to visualize bacteria under

a microscope. The stains determine if they are gram-negative or gram-

positive bacteria. This gives the physician an idea of the severity of the

pneumonia and how to treat it.

Gram-Positive Bacteria. These bacteria appear blue on the stain. The

following are common gram-positive bacteria:

The most common cause of pneumonia is the gram-positive bacterium

Streptococcus pneumoniae (also called S. pneumoniae or

pneumococcal pneumonia ). It was thought to cause 95% of

community-acquired bacterial infection, but research now indicates it

is far less, accounting for about half of all cases. (Some studies suggest

it may account for even fewer, 10% to 30% of cases.)

Staphylococcus aureus , the other major gram-positive bacterium

responsible for pneumonia, accounts for about 10% of bacterial cases.

It is one of the main causes of pneumonia that occurs in the hospital

(nosocomial pneumonia). It is uncommon in healthy adults but can

develop about five days after viral influenza, usually in susceptible

individuals, such as people with weakened immune systems, very

young children, hospitalized patients, and drug abusers who use

needles.

Streptococcus pyogenes or Group A Streptococcus.

Gram-Negative Bacteria. These bacteria stain pink . Gram negative bacteria

are common infectious agents in hospitalized or nursing home patients,

children with cystic fibrosis, and people with chronic lung conditions.

The most common gram-negative species causing pneumonia is

Haemophilus influenzae (generally occurring in patients with chronic

lung disease, older patients, and alcoholics).

Klebsiella pneumoniae may be responsible for pneumonia in alcoholics

and in other people who are physically debilitated.

Pseudomonas aeruginosa is a major cause of pneumonia that occurs in

the hospital (nosocomial pneumonia). It is common in pneumonia

patients with chronic or severe lung disease.

Moraxella catarrhalis is found in everyone's nasal and oral passages.

Experts have identified this bacteria as a cause of certain pneumonias,

particularly in people with lung problems, such as asthma or

emphysema.

Neisseria meningitidis is one of the most common causes of meningitis

(central nervous system infection), but the organism has been

reported in pneumonia, particularly in epidemics of military recruits.

Other gram-negative bacteria that cause pneumonia include E. coli (a

cause in newborns), Proteus (found in several damaged lung tissue),

and Enterobacter.

Bacterial pneumonias tend to be the most serious and, in adults, the

most common cause of pneumonia. The most common pneumonia-causing

bacterium in adults is Streptococcus pneumoniae (pneumococcus).

Respiratory viruses are the most common causes of pneumonia in young

children, peaking between the ages of 2 and 3. By school age, the bacterium

Mycoplasma pneumoniae becomes more common.

In some people, particularly the elderly and those who are debilitated,

bacterial pneumonia may follow influenza or even a common cold.

Many people contract pneumonia while staying in a hospital for other

conditions. This tends to be more serious because the patient's immune

system is often impaired due to the condition that initially required

treatment. In addition, there is a greater possibility of infection with bacteria

that are resistant to antibiotics.

b.3. Signs and Symptoms

Symptoms of pneumonia vary, depending on the age of the child and the

cause of the pneumonia. Some common symptoms include:

Fever- A fever occurs when the thermostat resets at a higher

temperature, primarily in response to an infection.

Chills- The "chills" that often accompany a fever are caused by the

movement of blood to the body's core, leaving the surface and

extremities cold.

Cough- this is the body’s way to expel foreign objects in our body

Unusually rapid breathing- the small blood vessels in the lungs

(capillaries) become leaky, and protein-rich fluid seeps into the alveoli.

This results in less functional area for oxygen-carbon dioxide

exchange. The patient becomes relatively oxygen deprived, while

retaining potentially damaging carbon dioxide. The patient breathes

faster and faster, in an effort to bring in more oxygen and blow off

more carbon dioxide.

Breathing with grunting or wheezing sounds-this is because of the

secretions that are present in the lungs.

Labored breathing that makes a child's rib muscles retract (when

muscles under the rib cage or between ribs draw inward with each

breath)

Vomiting –because the respiratory center and the vomiting center are

the same which is the medulla oblongata, when there is an

abnormality in breathing this may also trigger the patient to vomit.

Chest pain

Abdominal pain

Decreased activity

Loss of appetite (in older children) or poor feeding (in infants)

In extreme cases, bluish or gray color of the lips and fingernails

Health Promotion and Preventive Aspects of the Disease

There are vaccines to prevent infections by viruses or bacteria that

cause some types of pneumonia.

Children usually receive routine immunizations against Haemophilus

influenzae and pertussis (whooping cough) beginning at 2 months of

age. (The pertussis immunization is the "P" part of the routine DTaP

injection.) Vaccines are now also given against the pneumococcus organism

(PCV), a common cause of bacterial pneumonia.

Children with chronic illnesses, who are at special risk for other types

of pneumonia, may receive additional vaccines or protective immune

medication. The flu vaccine is strongly recommended for children with

chronic illnesses such as chronic heart or lung disorders or asthma, as well as

otherwise healthy children.

Because they are at higher risk for serious complications, infants who

were born prematurely may be given treatments that temporarily protect

against RSV, which can lead to pneumonia in younger children.

Doctors may give prophylactic (disease-preventing) antibiotics to

prevent pneumonia in children who have been exposed to someone with

certain types of pneumonia, such as pertussis. Children with HIV infection

may also receive prophylactic antibiotics to prevent pneumonia caused by

Pneumocystis carinii.

Antiviral medication is now available, too, and can be used to prevent some

types of viral pneumonia or to make symptoms less severe In addition;

regular tuberculosis screening is performed yearly in some high-risk areas

because early detection will prevent active tuberculosis infection including

pneumonia.

In general, pneumonia is not contagious, but the upper respiratory viruses

that lead to it are, so it is best to keep your child away from anyone

who has an upper respiratory tract infection. If someone in your home has a

respiratory infection or throat infection, keep his or her drinking glass and

eating utensils separate from those of other family members, and wash your

hands frequently, especially if you are handling used tissues or dirty

handkerchiefs.

V. THE PATIENT AND HIS CARE

A. MEDICAL MANAGEMENT

a. IVF’s, BT, NGT fee ding, Nebulization, TPN, Oxygen Therapy, etc.

Medical management/

treatment

Date ordered,Date performed,

Date changed

General Description

Indication(s) or Purpose(s)

Client response to the treatment

D5IMB 500cc DO: 11-22-07

DP: 11-22-07

DC: ------------

Sterile, nonpyrogenic

solution for fluid and

electrolyte

replenishment and

caloric supply in

single dose

containers for IV

administration

Indicated as a source

of water, electrolytes

and calories, or as an

alkalinizing agent.

The patient showed

no signs of fluid

overload,

dehydration and

phlebitis along the

intravenous site.


Before:

Identify the purpose of IV therapy and to the client’s significant others.

Before starting the IV therapy, consider duration of therapy, type of infusion, condition of veins and medical

conditions of patient to assist in choosing the IV site.

Make sure that the equipments are sterile.

During:

Secure the IV site with a board to prevent it from dislocation.

After:

Regulate the IV fluid as ordered by the physician.

After the IV therapy, identify local complications at or near the IV needle site.

Check for signs of infiltration, phlebitis and signs of fluid overload or dehydration.

Routinely check for the IV level to change it immediately to prevent air from entering the veins.

b. Drugs

Name of Drugs: Generic Name

Brand Name

Date orderedDate

performedDate

changed/D/C

Route or admin

dosage and frequency of admin

Gen. action Function

ClassificationMechanism of ax

Indications or purposes

Client response to the

medication w/ actual side

effects

Generic Name:

Cefuroxime

Sodium

Brand name:

Cefuroxime

DO: 11-22-07

DP: 11-22-07

DC:-----------

450 mg IV

every 8 hours

Anti-inffectives,

second generation

cephalosporin, bind

to bacterial cell wall

membrane, causing

cell death.

Treatment of

respiratory tract

infections.

There’s a

decrease of

microorganisms

causing the

infection evident

by not having

fever.


Before:

Obtain skin test before the start of the treatment.

Determine previous hypersensitivity to the medication.

Explain the reason for prescribing the medication, the effects and side effects of the drug to the client’s s.o.

During:

Administer slowly over 3-5 minutes.

Monitor site frequently for thrombophlebitis (pain, redness and swelling).

Check the IV patency before administering the medication.

After:

Instruct S.O. to report signs of superinfection (furry overgrowth on tongue, loose or foul- smelling stools) and

allergy.

Instruct client’s S.O. to notify any health carte professional if fever and diarrhea develop, especially if stool

contains pus, blood or mucus


Date orderedDate

performedDate

Route or admin

dosage and frequency






Brand Name changed/D/C of admin effects

Generic Name:

Acetaminophe

n

Brand name:

Paracetamol

DO: 11-22-07

DP: 11-22-07

DC:-----------

140 mg IV

every 4 hours

PRN

Antipyretic, nonopioid

analgesics. Inhibits

the synthesis of

prostaglandins that

may serve as

mediators of pain and

fever, primarily in the

CNS.

Treatment for

fever.

The patient’s

temperature was

maintained within

normal range.


Before:

Obtain culture and sensitivity test before the treatment starts.

Obtain history of hypersensitivity to analgesics.

Get the patients temperature before administering the medication

During:

Check the patency of the IV.

Administer slowly.

After:

Obtain patients temperature.

Instruct S.O. to report signs of superinfection (furry overgrowth on tongue, loose or foul- smelling stools) and

allergy.

Instruct client’s S.O. to notify any health carte professional if fever and diarrhea develop, especially if stool

contains pus, blood or mucus


Brand Name

Date orderedDate

performedDate

changed/D/C

Route or admin

dosage and frequency of admin






effects

Generic Name:

Albuterol

DO: 11-22-07

DP: 11-22-07

1 neb. TID Bronchodilators;

binds to beta 2-

Used as

bronchodilator to

The patient

maintained

Brand name:

Salbutamol

DC:11-23-07

DO: 11-23-07

DP: 11-23-07

DC:-------------

1 neb every 4

hours.

adrenergic re ceptors

in airway smooth

muscle, leading to

activation of adenyl

cyclase and

increased levels of

cyclic-3’, 5’-

adenosine

monophosphate

(cAMP). Increases in

cAMP activate

kinases, which inhibit

the phosphorylation

of myosin and

decrease intracellular

calcium that leads to

relaxation of smooth

muscle airways.

control and

prevent reversible

airway obstruction

caused by

respiratory

conditions.

patent airway.


Before:

Assess lung sounds before administration and during peak of medication. Note characteristics of sputum.

Make sure that the equipments are clean before using them.

During:

Shake inhaler well.

Maintain a fowler’s position.

Keep the inhaler close to the patient to make sure she inhales the medication.

After:

Provide mouth care because nebulization can cause bad taste.

Advise patient to rinse with water, to minimize drying of mouth.

c. Diet

Type of Diet Date orderedDate startedDate changed

General Description

Indication(s) or Purpose(s)

Specific foods taken

Client’s Response

and/or reaction to diet

Diet For Age DO: 11-22-07

DP: 11-22-07

DC: ------------

Diet for age

means that the

patient can eat

anything that

he/she can

tolerate at

his/her age.

It will help

prevent

aspiration.

The patient eats

crackers, and

drink water.

The patient’s so

didn’t give the

patient food that

he/she can’t

tolerate.


Before:

Explain the purpose of the diet order, the consequences of not following such diet and how it will be implemented.

Emphasize the food that the patient can take.

During

Make sure that the client is taking the specified diet.

After:

Emphasize the new preferred diet.

d. Activity/Exercise

Type of exercise

Date ordered, Date started, Date changed

General Description Indications or

PurposesClient’s response to the

treatment

Activity as

tolerated.

DO: 11-22-07

DP: 11-22-07

DC: ------------

The patient is allowed

to do activities as

long as he/she can

tolerate them.

To provide sense of well

being. And to have some

exercise in other ways,

The patient walks with her mom

in the hospital.


Educate patient’s SO about what activities is the patient allowed to do.

Make sure that the patient is doing the desired exercise or activity.

Have the patient rest after doing an activity.

Emphasize the importance of following the activity.

B. SURGICAL MANAGEMENT

The group found no surgical treatment for pneumonia. While

searching the group have open sites that indicate that there are no surgical

treatments available for pneumonia since that this disease is curable.

C. NURSING MANAGEMENT1. Nursing Care plan

Assessment

Nursing Diagnosis

Scientific Explanation

Objectives Nursing Interventions

Rationale Expected Outcome

S =

O= pt manifested:>DOB

>(+) rales

>with nasal flaring

>with non productive cough

>skin warm to touch

>with shallow respiration

=pt may manifest:>changes in respiratory rate and rhythm

Ineffective airway clearance r/t retained pulmonary secretions AEB non-productive cough secondary to BPN

Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms. An inflammatory reaction that occurs in the alveoli produces exudates. And as part of inflammatory reaction WBC migrate to the alveoli and fill the normally air containing spaces. The exudates together with the migration of WBC produces thick secretions that blocks the airways does leading to ineffective airway clearance.

Short term:After 4 hours of NI, pt will be able to improvement of airways patency AEB reduction of cough and noiseless breathing

Long term:After 3 days of NI, the patient will be able to maintain patent airway AEB absence of pt’s abnormal respiratory manifestations that has been observed and assessed

Establish rapport

Assess gen. condition of the pt.

monitor and record VS

auscultate breath sounds and assess air movement

elevate pt.’s HOB

reposition pt. periodically

Instruct pt.’s SO to increase fluid intake of pt.

perform CPT

administer medications as order

To gain trust and cooperation of the pt.

to provide appropriate assessment and management

to obtain base line data

to ascertain status and to note progress

to maximize oxygen consumption

prevents accumulation and pooling of secretions

to liquefy secretion for easy expectoration

to loosen the secretions

to provide appropriate treatment and to help facilitate airway patency

Short term:After 4 hours of NI, pt shall have demonstrate improvement of airway patency AEB reduction of cough and noiseless breathing.

Long term:After 3 days of NI, the patient should be able to maintain patent airway AEB absence of pt’s abnormal respiratory manifestations that has been observed and assessed

Problem # 1: Ineffective Airway Clearance

Problem #2: Ineffective Breathing Pattern

Assessment

Nursing Diagnosis




S =

O= pt manifested:> (+) rales

>non-productive cough

> abnormal respiratory depth and rate

>shallow breaths

=pt may manifest:>increased a/p diameter

>altered chest excursion

Ineffective breathing pattern r/t retained pulmonary secretions AEB abnormal respiratory rate and depth.

An inflammatory reaction can occur in the alveoli, producing an exudates. White blood cells, mostly neutrophils, also migrate into the alveoli and fill the normally air-containing spaces. Bronchospasm may also occur in patients with reactive airway disease. The secretions and bronchospasm makes the patient to have ineffective breathing pattern.

Short term:After 4 hours of NI, pt will be able to have an improvement of breathing pattern AEB normalization of respiratory rate and depth.

Long term:After 3 days of NI, the patient will be free from respiratory distress and other s/sx of hypoxia.

Establish rapport



elevate pt.’s HOB

provide adequate rest and sleep

suction secretions when necessary

administer medications as order




to promote maximum lung expansion and oxygen consumption

to reduce potential dyspnea and fatigue.

to facilitate and promote effective breathing pattern

to promote well ness through pharmacologic means.

Short term:After 4 hours of NI, shall have demonstrate improvement of breathing pattern AEB normalization or respiratory rate and depth.

Long term:After 3 days of NI, the patient should be able to maintain patent airway AEB absence of pt’s abnormal respiratory manifestations that has been observed and assessed

Problem #3: Impaired Gas Exchange

Assessment

Nursing Diagnosis




S=

O= pt manifested:> irritability

> nasal flaring

>DOB

>pale lips and nail beds

> increase respiratory distress


>(+) rales

=pt may manifest: >cyanosis

impaired gas exchange r/t altered oxygen supply DOB

Due to retained mucus secretions in the bronchi, there will be an alteration in the normal perfusion of gases in the alveoli, resulting in oxygen deficit and carbon dioxide that will therefore develop to an impairment in gas exchange.

Short term:After 4 hours of NI, pt will have an improvement of gas exchange AEB pinkish lips and nailbeds.

Long term:After 3 days of NI, pt will be able to demonstrate improvement in ventilation and presence of adequate oxygenation AEB absence of DOB.

Establish rapport



elevate pt.’s HOB

reposition pt. periodically

Instruct pt.’s SO to increase fluid intake of pt.

Provide adequate rest and sleep

administer oxygen inhalation as order

administer due medications


to provide appropriate

assessment and management


to maximize oxygen consumption

prevents accumulation and pooling of secretions

to liquefy secretion for easy expectoration

to lessen oxygen demand of the pt.

to provide oxygen supply

to promote wellness through pharmacologic means.

Short term:After 4 hours of NI, pt shall have demonstrate improvement in gas exchange AEB pinks lips and nailbeds.

Long term:After 3 days of NI, pt should be able to demonstrate improvement in ventilation and presence of adequate oxygenation AEB absence of DOB.

Problem #4: Hyperthermia

Assessment

Nursing Diagnosis




S=

O= pt manifested:>elevated temp. 38

>skin warm to touch

>irritable

> (+)rales

>Restless

Hyperthermia The set point of the hypothalamic thermostat changes suddenly from the normal level to increasing than the normal value as a result respiratory infection related to bronchopneumonia and as the body’s defense mechanism against infection

Short term:After 3hours of nursing intervention, the client will have a decrease temperature from 38C to 37C

Long Term;After 2 days of nursing intervention, the client will maintain peripheral temperature within normal range.

Establish rapport



Provide TSB

Provide adequate rest periods

Encouraged client SO to provide for adequate ventilation

Instruct client’s SO to loosen the client’s clothing and wear loose clothing

Emphasized to client’s So the need for well balanced diet

Administer medications as order




To promote heat loss by evaporation and conduction

To reduce metabolic demands

To have adequate oxygen exchange

To provide comfort

To increase body resistance and meet metabolic needs

To lower body temperature

trough pharmacologic means.

Short term:After 3 hours of nursing intervention the client shall have a decrease temperature from 38C to 37C

Long Term:After 2 days of nursing intervention, the client shall maintain peripheral temperature within normal range.

Problem #5: Sleep Pattern Disturbance

Assessment

Nursing Diagnosis




S=

O= pt manifested:>DOB

>restless

>frequent crying


Sleep pattern disturbance r/t external stimuli and DOB AEB restlessness

Pt’s suffering from pneumonia requires a comfortable position during sleeping which includes the high fowler’s position and an elevated head. Lying on flat on bed makes the pt uncomfortable and the occurrence of having DOB usually follows. However, if the pt is an infant, it would be more difficult for them to fall asleep not just because of shortness of breath but also of the pain they are experiencing. Another contributing factor is the unfamiliar environment which eventually affects the sleeping routine of the pt.

Short term: After 4 hours of NI, pt’s SO will be able to verbalize understanding o0f different sleep disturbance and will be able to demonstrate techniques to implement sleeping for the infant

Long term:After 3 days of NI, pt’s SO will be able to report improvement in pt’s sleep/rest pattern

Establish rapport



obtain feedback from the SO regarding usual bedtime routine and hours of sleep of the pt

observe parent-infant interactions provisions of emotional support

promote relaxation by providing calm and quite environment

elevate head by several degrees conducive for sleeping




to determione usual sleep pattern and comparative baseline data

lack of knowledge of infant cues and problems relationship may create tension interfering with sleep routines based on adult schedules may not meet child’s needs

hospital environment can interfere to the sleep and relaxation of the child’s mind and body

upright position facilitates adequate ventilation and provides comfort

Short term: After 4 hours of NI, pt’s SO should be to verbalize understanding o0f different sleep disturbance and will be able to demonstrate techniques to implement sleeping for the infant

Long term:After 3 days of NI, pt’s SO should be able to report improvement in pt’s sleep/rest pattern

2. Actual SOAPIE’s

S=”sinisinat pa sya” as verbalized by the mother

O= Received patient sitting on bed, awake. With an ongoing IVF # 2 D5 IMB

>skin warm to touch

>with non-productive cough

>with abnormal breath sounds(rales)

>with shallow respirations

>DOB

>SOB

Vital signs taken as follows:

T= 37.5C

P=148 bpm

R=61 cpm

A= Ineffective airway clearance r/t retained pulmonary secretions AEB non-

productive cough secondary to BPN.

P= after 2-4 hours of N.I. pt. will have an improvement of airways patency

AEB minimal cough and normalized respiratory depth and rate.

I = Established rapport

= assessed gen. condition of the pt.

=monitored and recorded vital signs

=provided AM care

=auscultated chest and back for breath sounds

=kept pt.’s back dryo

=repositioned pt. periodically

=instructed pt.’s SO to increase fluid intake of the pt.

=Instructed pt.’s SO to elevate pt.’s HOB

=instructed pt.’s SO to perform CPT

=provides restful environment

E= Goal met AEB reduction of cough and normalization of RR

VI. CLIENTS DALY PROGRESS CHART’

1. Clients Daily Progress Chart

DAYS ADMISSION11-22-07

DAY 211-23-07

DISCHARGE11-24-07

Nursing Problems

1. Ineffective Airway Clearance * * *2. Ineffective Breathing Pattern * * *3. Impaired gas Exchange *4. Hyperthermia *5.Sleep pattern disturbance * * *

Vital Signs

Temperature 38°c 37.5°c 36.2°cPulse Rate 143 bpm 148 bpm 126 bpmRespiratory Rate 49 cpm 61 cpm 42 cpm

Laboratory Procedures

HematologyHemoglobinHematocritWBC LymphocytesPlatelet count

X-rayMedical Management

IVFD5IMB 500cc * * *

Nebulization

Salbutamol Neb * * N/ADrugs

Cefuroxime * * *Paracetamol * * AF

Diet

Diet for Age * * *

Activity/exercise

Activity as Tolerated * * *

2. Discharge Planning

The patient is actively playing with her mom. Still have cough and

slight difficulty of breathing.

S= 0

O=received pt. lying on bed on supine position, awake, with an ongoing IVF

#3 D5IMB 500cc at 450 cc level regulated at 29-30 mgtts/min infusing well

on the left arm.

>active

>Afebrile

>with normal breath sounds

>with good skin turgor

>slight DOB


Vital signs taken as follows:

T= 36.2C

P=126 bpm

R=42 cpm

A= for health maintenance and home management

P= after 30 mins. To 1 hour of N.I. pt. will verbalize understanding about

health teachings given.

I = established rapport

= assessed gen. condition of pt.

= monitored and recorded vital signs

= auscultated lung for breath sounds

= provided comfort measures

=IVF out at 12:40 pm

M= Cefixime 100mg/5ml susp. ¾ tsp BID

= SCMC syrup 1 tsp TID

= Multivitamins syrup 1 tsp OD

E= Activity as tolerated

T= To comply to treatment regimen

H= instructed pt.’s SO to increase fluid intake of the pt.

= instructed pt.’s SO to keep pt.’s back dry

= Instructed pt.’s SO to increase pt.’s intake of food rich in vit. C

= instructed pt.’s SO to perform chest and back tapping

O= Instructed pt.’s So to go back to the scheduled follow up check up

(Dec. 1 2007)

D=Diet for age

E= Goal met AEB SO’s verbalization of understanding about health teachings

given.

VII. CONCLUSION AND RECOMMENDATION

Pneumonia is an acute infection of lung parenchyma including alveolar

spaces and interstitial tissue. Pneumonia is a common illness in all parts of

the world. It is a major cause of death among all age groups. In children, the

majority of deaths occur in the newborn period, with over two million deaths

a year worldwide. The World Health Organization estimates that one in three

newborn infant deaths is due to pneumonia.] Mortality from pneumonia

generally decreases with age until late adulthood. Elderly individuals,

however, are at particular risk for pneumonia and associated mortality.

Pneumonia and its management still pose a challenge not only to the

health care team involve but also the person diagnosed with this condition.

However, recent advances in our understanding of the pathophysiology,

diagnosis, and monitoring of the different kinds of pneumonia can help

physicians optimize treatment strategies. Contemporarily treatment

guidelines emphasize an aggressive approach, with the prompt and liberal

use of antibiotic medications to the microorganism producing the disease to

control the spread to other parts of the body aside from its origin. It is

increasingly recognized that successful pneumonia treatment requires a

commitment from both patient and physician. Patient education can

empower persons with pneumonia top begin guided self management and

awareness of their disease condition. Such shared responsibility will help to

ensure a favorable outcome and an enhanced quality of life.

Often pneumonia begins after an upper respiratory tract infection (an

infection of the nose and throat). When this happens, symptoms of

pneumonia begin after 2 or 3 days of a cold or sore throat. Since pneumonia

often follows ordinary respiratory infections, the most important preventive

measure is to be alert to any symptoms of respiratory trouble that linger

more than a few days. Good health habits, proper diet and hygiene, rest,

regular exercise, etc., increase resistance to all respiratory illnesses. They

also help promote fast recovery when illness does occur. Proper consultation

can aid on the early diagnosis of the disease and treatment plan for decrease

duration of having the disease.

Because pneumonia is a common complication of influenza (flu),

getting a flu shot every fall is good pneumonia prevention. Vaccines to

prevent certain types of pneumonia are available. The prognosis for an

individual depends on the type of pneumonia, the appropriate treatment, any

complications, and the person's underlying health.

Learning Derive:

In doing this case study, I have learned new things about pneumonia. I

have learned that there are different factors that can lead you to acquiring

pneumonia. And that pneumonia usually occurs to pediatric pt. because their

immune system is not yet fully developed and that they have less body

defense against bacteria that causes pneumonia. The living condition or

situation can also contribute to the occurrence of the disease. There are also

vaccines, wherein before I never thought that there are such vaccines, that

we can get to prevent pneumonia from occurring. This case study makes me

realize a lot of things. One is that, before my perception about Pneumonia is

just “sipon and ubo”, I didn’t even know then what could be the cause of

Pneumonia, but with this study I’ve learned that different microorganisms

could cause the disease. And I’ve also learned the different types of

Pneumonia. The most important thing that I’ve learned from this study is not

on the disease proper but on how to come up with a good case study. If you

want to have a good case study you should get all the needed information

you need for your case, and don’t skip any information because this could

greatly affect your study. It is also important on how you establish rapport to

your client so that they will not be hesitant to give you information about

their family. -Emilyn Serrano

As we go along with our case study about BPN, I have learned so many

things about it on how to deal with it and how to handle this kind of case. It is

important to include not only the patient in the study but also the family of

the patient. Because a case study will not be completed unless the family is

not included. Bronchopneumonia is defined as a type of pneumonia that is

localized, often to the bronchioles and surrounding alveoli. It means that this

kind of disease may show any symptoms of coughing, chest pains, fever,

blood-streaked sputum, chills, and difficulty in breathing. This type of disease

may be nosocomial or community acquired. Patients who are immobile

develop retention of secretions; thus, most commonly involves the lower

lobes. If treated, recovery usually involves focal organisation of lung by

fibrosis. This type of diseases includes infants and the elderly people. BPN is

a disease that spreads from bronchioles to nearby alveoli. Now I’ve learned

the how painful the suffering of the people who are infected with this kind of

diseases. In treating this kind of disease we should always competent on

what we do especially on what we give to our patients because a single

mistake can put danger to the life of our patient. Giving medicines to our

patient can help them to recover fast and to be able to help them fight for

their disease. And also giving them nebulization can help them relieve chest

pain because too much secretion is blocking on their airway. And also we

should not always forget to put our shoes to our patients because through

this we would be able to understand them and also to gain their trust. We

should always remember that they are also humans like us, with a heart that

also needs nourishment and care from other people. Through giving

medicines regularly and also through treating them humanely our patient will

be able to recover fast and also to have a greater chance for improvement.

That’s why as a student nurse we should always practice to treat our patients

humanely no matter what race, looks and kind of person they are. So that in

the coming future hopefully if we would become a registered nurse we would

be able to remember and practice all the things that we have learned from

the past. And through this I’m sure that we would also be a successful nurse

because if you treat your patient humanely you will not only make them

happy but also God will be very proud of you.

-Adrian Guarin

VIII. BIBLIOGRAPHY

Deglin, Judith Hopfer & Vallerand, April Hazard. Davis’s Drug Guide for

Nurses(10th edition). Philadelphia, Pannsylvania. 2007

Smeltzer, Suzanne et al. Brunner & Suddarth’s Textbook of Medical-

Surgical Nursing(11th edition).

Doenges, Marilynn E. Nurse’s Pocket Guide: Diagnoses,

Interventions and Rationales. (9th Edition). F.A. Davis Co., 2004.

Delmars’s Pediatric Nursing Care Plans.(third edition)., Karla L.

Luxner


http://www.netdoctor.co.uk/diseases/facts/pneumonia.htm

http://encarta.msn.com/encyclopedia_761577180/Respiratory_System.html

Angeles University Foundation

Angeles City

College of Nursing

http://encarta.msn.com/encyclopedia_761577180/Respiratory_System.html

http://www.netdoctor.co.uk/diseases/facts/pneumonia.htm

A Case Study

Bronchopneumonia

Submitted by:

Dumas, Joycee

Guarin, Adrian

Serrano, Emilyn

Group 3

Submitted to:

Mr. Ercel Gamboa

Documents

case study,,,,,,pneumonia