A case Study on Severe

Pneumonia
GENERAL OBJECTIVE
After this case study, I will be able to know what Pneumonia is, causes of
Pneumonia, how it is acquired and prevented, its treatments and prevention
of the occurrence of Pneumonia
SPECIFIC OBJECTIVES
After the completion of this study, I will be able to:
o Define what is Pneumonia
o Trace the pathophysiology of Pneumonia
o Enumerate the different sign and symptoms of Pneumonia
o Identify and understand different types of medical treatment
necessary for the treatment of Pneumonia
o Formulate and apply nursing care plans utilizing the nursing process
 INTRODUCTION
Pneumonia is characterized by inflammation of the alveoli and terminal
airspaces in response to invasion by an infectious agent introduced into the
lungs through hematogenous spread or inhalation. The inflammatory cascade
triggers the leakage of plasma and the loss of surfactant, resulting in air loss
and consolidation. This is in contrast to pneumonitis, which is caused by
noninfectious agents such as radiation or chemicals.
An inhaled infectious organism must bypass the host's normal
nonimmune and immune defense mechanisms in order to cause pneumonia.
The nonimmune mechanisms include aerodynamic filtering of inhaled
particles based on size, shape, and electrostatic charges; the cough reflex;
mucociliary clearance; and several secreted substances (eg, lysozymes,
complement, defensins). Macrophages, neutrophils, lymphocytes, and
eosinophils carry out the immune-mediated host defense.
Conditions that allow pneumonia-causing infectious organisms to circumvent
the upper airway defense mechanisms include the following:
 Intubation, tracheostomy, impaired cough reflex, and aspiration:
These conditions provide infectious organisms with easier access to the
alveoli and terminal airspaces.
 Ciliary dyskinesia, bronchial obstruction, viral infection, cigarette
smoke, and certain chemical agents: These conditions create
disruption in the mucociliary blanket.
  Anatomic abnormalities (eg, sequestrations), gastric fluid aspiration or
other causes of noninfectious inflammation, altered pulmonary blood
flow, and pulmonary edema: These conditions increase the
predisposition for pneumonia.
 Immunodeficiency and immunosuppression: These conditions increase
predisposition for pneumonia.
Mortality/Morbidity
The United Nations Children's Fund (UNICEF) estimates that 3 million
children die worldwide from pneumonia each year. Although most fatalities
occur in developing countries, pneumonia remains a significant cause of
morbidity in industrialized nations.
I have chosen this case Pneumonia because it may catch one’s attention,
though the disease is just like an ordinary cough and fever, it can lead to
death especially when no intervention or care is done. Since this case is a
child, an appropriate care has to be done to make the patient’s recovery
faster. Treating patients with pneumonia is necessary to prevent its spread to
others and make them as another victim of this illness.
 PATIENT’S PROFILE
Name: J.V.
Address: 181, Ninada Street, Lltex road, Quezon City
Age: 4yrs. and 4 months
Birthday: December 28, 2004
Sex: Male
Nationality: Filipino
Religion: Roman Catholic
Date & Time of Admission: January 18, 2009 (07:00 am)
Mode of Arrival: cuddled by mother
Chief Complaint: abdominal pain, cough and colds
Source of Information: patient, & chart, SO
Admitting Diagnosis: severe Pneumonia
Final Diagnosis: severe Pneumonia
Attending Physician: Dr. Karen Lorenzo MD
 NURSING HISTORY

PAST MEDICAL HISTORY

According to the patient SO, he had completed his childhood

immunization. He had no allergy to foods or medications. He experienced
common diseases such as fever, cough and colds she usually took OTC drugs
(Paracetamol syrup, Neosep syrup) to manage his fever cough and colds.
On June 2006 the patient was admitted at Government Hospital due to ilues.

HISTORY OF PRESENT ILLNESS

According to the SO, 3 days prior to admission the patient experienced

sudden onset of squeezing pain at Para gastric area aggravated by activity.
No meds taken or consultation made.

2 days PTA the patient still have the same abdominal pain, this time
was more severe, and associated with DOB and fever of 38°C. His mother
gave him paracetamol. No consultation was made.

Few hours PTA, the patient could not any more tolerate the pain; he
was brought to EAMC hence he admitted.

FAMILY HEALTH HISTORY

 According to the patient SO, both his maternal and paternal have a
history of Cancer, PTB, and Bronchial Asthma. PTB is evident on the patient’s
grand father and uncle while cancer and bronchial asthma is evident on the
patient aunt.
Personal/ Social History
The patient is the 4th among 6 siblings. He was lived with 7 other
households’ member. His father work as a garbage collector and his mother
is a house wife they consumed or used tap not boiled water.

PATHOPHYSIOLOGY

Predisposing factor Etiology Precipitating factor

Age S. pneumoniae UPTI
Immune defenses environment
Immune defenses

Infecting organism enter in the airway

Activation of defense mechanism

Failure to penetrate the pathogen is secreted or dies

Pathogen

Pathogen reached the lungs

Pathogen multiplies in the alveoli

Inflammation irritation of airway

Exudates come from Goblet cell

Bacteria erode the lung
mucus
Dead space occluded the production
happened Air way

Cough crackles
CO2 pagocytosis

Hyperventilation
 WBC fever chill altered LOC
RR

Impaired O2 and CO2

consolidadtion exchange

Hypoxia

Trigger the kidney

Released of erythropoietin

Long bones RBC

PHYSICAL ASSESSMENT

Date assessed: May 25, 2009

Time: 10:30pm
Initial vital signs:
T=37.9 PR=140bpm RR=25cpm
General Appearance: the patient is conscious and coherent with ongoing of
D5NM 500ml at 750cc level hook at his left arm, intact and infusing well.

Area Technique Normal Actual Findings Evaluation

Assessed Findings
skin Inspection/ Skin normally Skin is moist d/t
Moisture Palpation dry hyperthermi
a
Temperature Palpation Normally warm 37.9 o C d/t
hyperthermi
a
Hair Inspection/ Smooth Rough Due t o
Texture Palpation poor
hygiene
Nose and
Teeth Inspection Oval, symmetric Oval, symmetric
Nares and without but with Due to the
discharge discharge presence of
colds
Teeth Inspection Firmly set, shiny Firmly set, shiny Due to poor
with tooth decay hygiene
Thorax and Auscultation Clear breath Presence of Due to
Lungs sounds breath sound congestion

LABORATORY RESULTS
HEMATOLOGY RESULTS
May 18, 2009
Parameter Normal Value Results Analysis
WBC 5-10 x 10 g/L 18.1 Increased due to
infection
Hgb M 140-170g/dl 165 Increased due to
infection
Hct M 39%-54% .30 Decreased
RBC 4.6- 10 g/l 10.4 Increase due t o
hypoxia
Differential Count

Lymphocytes
20%-40% .50 Increased due to
infection

PEARSON’S FUNCTIONAL HEALTH PATTERN

Date and Time of Interview: May 25, 2009 (11:00 PM)

Functional Heath Before During

Pattern hospitalization hospitalization
Psychological The patient is 4yrs and The patient looks pale
4 months old due to his current
condition.
Elimination According to the SO, According to the SO,
the patient usually void the patient void 3-4
5 to 6 times a day. He times a day. Have a
doesn’t have any 240 ml/ shift yellow
problem in voiding. amber color urine and
dark brown stool.
Rest and Sleep According to the SO, The patient can’t sleep
the patient usually well because of the
spends his time for hospital routines.
playing and sleeping.
He sleeps for about 6-8
hours at night.
Safety and Security His SO provides all the The SO together with
safety and security that his health care
he need providers make him
safe and secured.
Oxygenation The patient has The patient had
difficulty in breathing difficulty of breathing
prior to hospitalization due to his condition
Nutrition The patient usually eats The patient in on DAT.
2 -3 times a day He doesn’t have any
problem m in
 swallowing
Spirituality According to SO, The The SO prays for the
patient was baptized in sooner recovery of the
Roman Catholic. They patient
go to church every
Sunday together with
his friends, bothers and
sisters

GROWTH AND DEVELOPMENT

Age Theorist Stage of Outcome

Development
4 years and 4 Erik Erickson; Initiative vs.
>Imaginary
month sense of guilt playmates or
Psychosocial (mimics; morecompanions are
Theory purposeful &
common; holds
active in goal
conversations
setting) and shares
strong emotions
with this invisible
friend.
Boasts,
>exaggerates,
and "bends" the
truth with made-
up stories or
claims of
boldness; tests
the limits with
"bathroom" talk.
>Cooperates
with others;
participates in
group activities.
Piaget: Preoperational- >Likes stories
preconceptual about how things
Cognitive Theory (egocentric, grow and how
magical thinking; things operate.
 no cause-effect >Delights in
reasoning; uses wordplay,
symbols) creating silly
Language.
>Understands
the concepts of
"tallest,"
"biggest,"
"same," and
"more"; selects
the picture that
has the "most
houses" or the
"biggest dogs."
>Rote counts to
20 or more.

Freud: Phallic According to the

SO, The patient
Psychosexual (ego develops begins to fear
Theory objective that his father is
conscious reality; suspicious of his
Opedipus longing for his
complex - love of mother, and that
opposite-sex the father will
parent) punish him for
his desires.
Kohlberg: Preconventional According to the
Morality SO, she punished
Moral Reasoning her child if they
(based on commit mistakes.
external control;
observe
standards of
others to avoid
punishment or
receive rewards)
Assessmen Diagnosis Planning Intervention Rationale Evaluation
t
Objectives: Ineffective At the end >auscultated > to Goal met.
-(+) airway of 15 breath sound ascertain The patient
crackles clearance minutes the and assessed status and was able to
- tachypnea r/t increase patient will air movement note demonstrate
- ineffective pulmonary be able to progress behavior to
cough secretion as demonstrat maintain
evidenced e behaviors > to take clear airway.
by ( + ) to maintain >elevated the advantage
crackles, clear airway head of the of gravity
tachypnea, bed / change decreasing
ineffective position pressure
cough to the
diaphragm
and
enhancing
ventilation
>encouraged > to
deep- minimize
breathing and long effort
coughing
exercise
>instructed to >to
increased liquefy
fluid intake secretion

>| kept the > To

environment avoid
allergens free irritation
of airway
caused by
allergens.
> gave >to
expectorant mobilized
( bronchodilat secretion
or ) as
ordered

Name Dos Mecha Indica Contraindi Adverse Nursing

of the age nism tion cation effect responsi
Drug of bility
action
Generic 18 Ranitidi Duode Patients > Immune > assess
name: mg ne is a nal & known to System patient
ranitidin IV q specific, benign have Disorders: abdomin
e 8 rapidly gastric hypersensit (urticaria, al pain.
brand hour acting ulcer ivity to angioneuroti Not
name: s histami ranitidine c edema, presence
Zantac ne H2- or to any fever, of blood
Classific antago component bronchospas in
ation: nist. It of Zantac m, and emesis,
Antacids inhibits Injection. hypotension stool or
, basal and chest gastric
Antireflu and pain pain
x Agents stimula > Nervous > drug
& ted System may be
Antiulcer secretio Disorders:H added to
ants n of eadache total
gastric (sometimes parentera
acid, severe), l nutrition
reducin dizziness
g both >Gastrointe
the stinal
volume Disorders:
and the Acute
acid pancreatitis,
and diarrhea
pepsin
content
of the
secretio
n.

Name Dos Mecha Indica Contrain Adverse Nursing

of the age nism tion dication effect responsi
Drug of bility
 action
Ciproflox 250- Inhibit Infectio Severe Common:Naus >Assess
acin 500 s ns of and ea, diarrhea, pt for
BRAND mg bacteri the persistent vomiting, previous
NAME:Ci BID al DNA resp. diarrhea rashUncommo sensitivity
probay gyrase tract, during n:Anorexia, reaction>
thus middle and after headache,dizzi Assess pt
preven ear,par treatment ness, fever, GI for any
ting anasal and abdominal s/s of
replica sinuses pain, infection
tion in , eyes, before &
suscep kidneys during
tible , treatment
bacteri urinary >Assess
a trac for
adverse
reactions

Name of Dosa Mechan Indica Contraindic Advers Nursing

the Drug ge ism of tion ation e responsi
action effect bility
Salbutam 3-12 Facilitat Reversi Hypersensiti Fine > drug
ol yrs4 es/ ble vity tremor may be
BRAND mg potentia airway of decrese
NAME:Ve tab tes the obstruc skeletal sensitivity
ntolin BID inhibitor tion muscle, of
vilmax y includin feeling spirometr
activity g of y used for
of GABA bronchi tension, diagnosis
at the al a of
limbic asthma compen asthma>s
system , sory yrup may
and chronic small be taken
reticular bronchi increase as young
formatio ti in heart as age
n to rate, 2>monito
reduce headach r for
anxiety, e, evidence
promote muscle of allergic
calmnes cramps rxn
s and
sleep

Name Dosag Mechani Indica Contraindi Adverse Nursing

of the e sm of tion cation effect responsi
Drug action bility
Cefur Cefuro Cefuroxi Indicat Known CV: >Before
oxime xime me, a ed in allergy to phlebitis, giving
750 semisyny the the thrombop drug, ask
mg IV hetic, treatme cephalospo hlebitis patient if
q 6h broad- nt of rin group GI: he is
spectrum the of diarrhea, allergic
” second followin antibiotic nausea, to
generatio g vomiting, penicillin
n” infectio anorexia or
cephalosp ns due Hematolo cephalos
orin to gic: porin.
antibiotic, cefurox hemolytic >Obtain
exerts its ime- anemia, specimen
bactericid sensitiv eosinophili for
al activity e a culture
by organis Skin: and
interferin ms maculopa sensitivit
g with the >Lower pular and y tests
synthesis respirat erythomat before
of the ory ous giving
bacterial tract rashes, first
cell wall. infectio urticaria, dose.
It binds ns pain, Therapy
to includin induration may
penicillin- g s, sterile begin
binding pneum abscesses while
protein 3 onia , waiting
responsibl >Urinar temperatu the
e for the y tract re results
synthesis infectio elevation >Monitor
of n patient
peptidogl >Skin for signs
ycan, a and and
hetoropol skin symptom
ymeric structur s of
structure e super
that gives infectio infection
the cell ns
wall its >Septic
mechanic emia
al >Menin
stability. gitis
.
Gonorr
hea

Name of Dosa Mechanis Indicati Adverse Nursing

the Drug ge m of on effect responsibi
 action lity
Acetaminop 1.2 Inhibits Mild Hema: EFORE:
hen mL q the pain hemolytic > Advise
( Paraceta 4 hr synthesis Fever anemia, parents or
mol ) PRN of neutropenia, caregivers
Classificatio prostaglan leukopenia, to check
n: dins that pancytopenia.H concentrati
antipyretics may serve epa: ons of
, nonopioid as jaundice liquid
analgesics mediators Metabolic: preparation
of pain and hypoGGI: s. Errors
fever, HEPATIC have
primarily in FAILURE, resulted in
the CNS HEPATOTOXICI serious
TY (overdose). liver
GU: damage.~
renal failure Assess
(high fever; note
doses/chronic presence of
use). associated
Derm: signs
rash, urticaria. (diaphoresi
s,
tachycardia
, and
malaise).
DURING:
>Adults
should not
take
acetaminop
hen longer
than 10
days and
children not
longer than
5 days
unless
directed by
health care
professiona
l.~ Advise
mother or
caregiver to
take
medication
exactly as
directed
and not to
take more
than the
recommend
ed amount.
AFTER:
>Advise
patient to
consult
health care
professiona
l if
discomfort
or fever is
not relieved
by routine
doses of
this drug or
if fever is
greater
than
39.5°C
(103°F) or
lasts longer
than 3
days.