NORTH VALLEY COLLEGE FOUNDATION, INC.

Lanao, Kidapawan City, Province of Cotabato

Nursing Department

PEDITRIC COMMUNITY ACQUIRED

PNEUMONIA (PCAP)

An Undergraduate Case Presentation to the

Faculty of North Valley College Foundation, Inc.

In Partial Fulfillment of the Requirement for the

degree Bachelor of Science in Nursing

DAYMIEL, MART C.
DULATRE, DAPHNE O.
ESPIRITU, MARY M.
FERMOSA, MICKAELA L.
FLORES, JUSTINE M.
ISANAN, ERIKA JOY
KALIM, ARNAISA MAE M.
KAMSA, SAKINA U.
LUBALANG, JAMAYKA K.
MASUAL, IRENE H.
Bachelor of Science in Nursing 4-C

SEPTEMBER 2023
 ACKNOWLEDGMENT

Words cannot express our gratitude to our clinical instructor Mr Jay Pee Carandang
Malibiran for hir invaluable patience and feedback. We could not have undertaken this
journey without each other back, who generously provided knowledge and expertise.
Additionally, this endeavor would not have been possible without the generous support from
our very supportive parents.

We are also grateful to our friends and classmates, especially in ourselves, for their
helping hand, late-night feedback sessions, helping us throughout the journey, and moral
support. Thanks should also go to the librarians, research assistants, and study participants
of our research, who impacted and inspire us.

Finally, we would want to thank the hospital or organization for giving us the tools and
chances to participate in valuable clinical practice and education. Our preparation for this
case presentation and next clinical attempts has been greatly aided by their dedication to
healthcare quality and ongoing learning.

I
 TABLE OF CONTENT
Pages

Title Page i

Acknowledgment ii

Table of Content iii

I. INTRODUCTION 1
Background of the Study

II. OBJECTIVES 3
General Objectives

Specific Objectives

III. PATIENT’S DATA 4

IV. FAMILY BACKGROUND 6

Family Health History

Effects and Expectations of Illness to Self/Family

Clients Health History

Past Illnesses

Present Illnesses

V. DEVELOPMENT DATA 8

VI. DEFINITION OF COMPLETE DIAGNOSIS 11

VII. PHYSICAL ASSESSMENT 12

VIII. ANATOMY AND PHYSIOLOGY 16

II
IX. ETIOLOGY AND SYMPTOMATOLOGY 20

X. PATHOPHYSIOLOGY 23
Manangement
Prognosis
Findings

XI. DOCTOR’S ORDER 26

XII. DIAGNOSTIC EXAM 36

XIII. DRUG STUDY

47

XIV. SURGICAL PROCEDURE 69

XV. NURSING THEORIES 69

XVI. NURSING CARE PLAN 49

XVII. DISCHARGE PLAN 51

Medications

Exercise

Treatment

Health Education/Teaching

Out-Patient Schedule

Diet

XVIII. RECOMMENDATION 83
Community

Patients

III
 Nurses

Future Researchers

XIX. DEFINITION OF TERMS 84

XX. REFERENCES 85

IV
V
 CHAPTER I

INTRODUCTION

Background of the Study

Community-acquired pneumonia (CAP) is defined as an acute infection of
the pulmonary parenchyma in a patient who has acquired the infection in the
community, as distinguished from hospital-acquired (nosocomial) pneumonia.
CAP is a common and potentially serious illness with considerable morbidity.

The estimated worldwide incidence of community-acquired pneumonia

varies between 1.5 to 14 cases per 1000 person-years, and this is affected by
geography, season, and population characteristics. In the United States, the
annual incidence is 24.8 cases per 10,000 adults with higher rates as age
increases.

CAP is associated with significant morbidity and mortality and

considerable costs of care. In the United States, CAP is the most frequent cause
of death resulting from infectious diseases and is the eighth leading cause of
death overall. The mortality rate of patients treated on an outpatient basis is <1%;
for those who require admission to the hospital, it averages 12% but increases to
30% to 40% for those with severe CAP who require admission to the intensive
care unit (ICU). The overall rate of CAP ranges from 8 to 15 per 1000 persons
per year; the highest rates are at the extremes of age. More cases occur during
the winter months. The economic cost exceeds $17 billion a year.

In the philippines, the number of total PCAP cases which met the inclusion
and exclusion criteria were as follows: (1) 218 cases for 2017 (2) 249 cases for
2018; (3) 224 cases for 2019. Based on a national prevalence of 828 per
100,000 population7, the minimum sample size was computed at 158
cases/year.

1
 In this case scenario patient AS is a 3 years old female patient.
Patient is bottle feed baby, loves to eat junk and sweet foods. Patient is
know to have Congenital Heart Disease and Transposition of the great
arteries. Her grandmother has heart problems, her father has asthma, and
her mother has high blood. She was brought to the emergency room with
the chief complaint of cough, fever and tachypnea. Vital signs were taken:
BP 70/60 mmHg, PR 164 bpm, RR 53 bpm, body temperature of 38.0 °C.
and SpO2 of 83%. The doctor ordered for different laboratory test
Hemoglobin 236, Hematocrit 0.729, RBC 7.75, Platelet 38, and PO2 31.2.

2
 CHAPTER II

OBJECTIVES

General Objectives

The case involves a patient who is a 3-year-old femae. This study aims to
understand the causes of the patient’s different health issues and symptoms and
to provide an effective nursing care plan. This study will also discuss the
appropriate treatment and medications for the patient’s illnesses. Lastly, this
study will give other nursing students knowledge about Pediatric Community-
acquired pneumonia, and other symptoms that the patient experiences. At the
end of three days exposure, the group will be able to come up with
comprehensive study on Pediatric Community-acquired pneumonia.

Specifically, it aims to:

a. Provide an introduction consisting of the definition of the disease and a brief

overview of the patient’s condition;

b. discuss the patient’s clinical data, past health history, and developmental
data;
c. conduct a thorough physical assessment:
d. define the complete diagnosis of the Pediatric Community-acquired
pneumonia
e. review the anatomy and physiology and illustrate the pathophysiology of the
affected organs and systems in Pediatric Community-acquired pneumonia
f. identify the predisposing and precipitating factors that contribute to the onset
of the disease and state the symptomatology of the case;
g. relate a nursing theory applicable to the case;
h. formulate nursing care plan base on the priority needs of the patient
i. prepare a discharge planning using the method format.

3
 CHAPTER III

PATIENT’S DATA

PATIENT CASE PRESENTATION

A. Patient’s Profile Name: AS

Age: 3 yrs Old

Sex: Female

Nationality: Filipino

Civil Status: Single

Occupation: N/A

Religion: Roman Catholic

Educational Attainment: N/A

Ward and Room Number: Pedia Ward

Date of Admission: October 9, 2023

Date of Discharge: Still admitted

Chief of Complaint: Productive Cough, fever and tachypnea

Vital Signs During Admission:

VITAL SIGNS VALUE NORMAL INFERENCE

VALUE

ABNORMAL

Fever can lead to

4
 dehydration. Medical
help is needed if the
Temperature 38.0 Celsius 36.5 Celsius-
child refuses to drink
37.4 Celsius
or shows signs of
dehydration, such as
dry mouth and dry
lips.

Blood 70/60 mmHg systolic<90-110 DECREASE

Pressure mmHg/
diastolic<50-70
Low blood pressure is
mmHg
not always a concern,
but sometimes
hypotension can cause
dizziness and fainting
or be life-threatening.

INCREASE

Sinus tachycardia is
Pulse Rate 164 bpm 80-120
bpm usually considered a
heart rate over 120
beats per minute.
Most of the time sinus
tachycardia is not a
problem but actually a
normal physiologic
response of the body.

INCREASED
Fever can increase
respiratory rate.

Respiratory How fast they breathe

53 cpm 20-40 cpm
Rate can be a signal. If it is
a bit too quick, that

5
 can be one of the first
symptoms of a lung
infection, especially
for a baby or small
child.

Oxygen 83% Normal O2 DECREASE

Saturation saturation:
95%-100% Hypoxemia is low
oxygen levels of blood
in the body. It causes
symptoms like
headache, difficulty of
breathing, rapid heart
rate and bluish skin.

Admitting diagnosis:

1. Pediatric Community Acquired Pneumonia (PCAP)

Attending Physician: Dr. Y.

Source of Information/Informant’s: Patient Grandmother

6
 CHAPTER IV

FAMILY BACKGROUND/ HEALTH HISTORY

MATERNAL SIDE

This diagram illustrates the patient’s family members, how they are related, and
their medical history. This genogram enables the patient to see ancestral
behavioral tendencies as well as medical and psychological issues that run in
families.

Effects/Expectation of Illness to Self/Family

The patient has no knowledge about the illness and considering that she
is still 3 years old, it really affect her health especially she is still a child growing
up it became a hindrance for her to grow healthier. In the other hand, due to the
patient's illness, her family have been affected, especially with their finances. The
family only rely with her father as a laborer and also her mother having a part
time job doing laundry.

7
CLIENT HEALTH HISTORY

Past Illness/es

The patient has had a history of CHD-TGA since 9 months old. The last known
follow-up checkup was in September 2023 at OPD. She has a productive cough
and fever.

Present illness/es

Prior to hospital admission, the patient experienced fever,

productive cough, shortness of breath, and weakness. The patient was
admitted to the pediatric ward due to a fever and cough.

8
 CHAPTER V
DEVELOPMENTAL DATA
JEAN PIAGET THEORY OF DEVELOPMENTAL

Jean Piaget was a psychologist Who developed a theory of cognitive

development focused on intellectual development of children. He suggest that
children’s intelligence undergoes changes as they grow. Cognitive development
in children is not only related to acquiring knowledge, children needs to build or
develop a mental model of their surrounding world.

The pre-operational stage is a crucial period in children's cognitive development.

During this stage, children's thinking is not yet logical or concrete, and they
struggle with concepts like cause and effect. They also have difficulty
understanding other people's perspectives, which is why their thinking is
egocentric.

TASK ACHIEVED JUSTIFICATION

Pre-operational stage ✓ According to Jean
Piaget's theory of
cognitive development,
the preoperational stage
typically occurs between
the ages of 2 and 7 years
old. The patient is
developing language
skills, symbolic thinking,
and the ability to
represent objects with
words and images. When
she asked for food and
milk she uses her hands
to show what she want or
she say dede for milk and
am am for food. . The
preoperational stage is

9
 characterized by the
child's increasing ability to
use symbols and engage
in pretend play which the
patient is qualified for this
stage.

FREUD PSYCHOSOCIAL DEVELOPMENTAL THEORY

Freud's Stages of Psycho sexual Development are, like other stage theories,

completed in a predetermined sequence and can result in either successful

completion or a healthy personality or can result in failure, leading to an
unhealthy personality.

This theory is probably the best known as well as the most controversial; as
Freud believed that we develop through stages based upon a particular
erogenous zone. During each stage, an unsuccessful completion means that a
child becomes fixated on that particular erogenous zone and either over- or
under-indulges once he or she becomes an adult.

TASK ACHIEVED JUSTIFICATION

Anal stage ✓ Achieved due to the

fact that the patient
is qualified in the
age bracket in this
theory. According to
the mother, the
patient relies on

10
 diapers due to her
physical weakness
and condition
preventing her from
getting up to use the
toilet, but she
dislikes using them
and vocalizes her
discomfort with a 'uu'
sound when she
needs to eliminate."

HAVIGHURT’S DEVELOPMENTAL THEORY

Theory Havighurst's theory of development stated that change and growth are
continuous throughout the entire life, from birth through death.

Infancy and Early Childhood: This stage typically lasts from birth through age
five. In this stage, humans learn basic survival. Babies and young children find
control of their bodies, develop initial language concepts, and form friendships.

TASK ACHIEVED JUSTIFICATION

Early childhood ✓ Achieved for this stage.
As verbalized by the
Mother, patient was able
known what she wants.
she was able to do things
such as picking her
clothes after taking a
bath, and putting on her
clothes with the
assistance of the mother.

11
 CHAPTER VI

DEFINITION OF COMPLETE DIAGNOSIS

 Pediatric Community Acquired Pneumonia

Community-acquired pneumonia (CAP) is defined as an acute

infection of the pulmonary parenchyma in a patient who has acquired the
infection in the community, as distinguished from hospital-acquired
(nosocomial) pneumonia. CAP is a common and potentially serious illness
with considerable morbidity. Pediatric Community-Acquired Pneumonia
(CAP) refers to a respiratory infection that affects the lungs in children who
have not been hospitalized recently and who acquire the infection in the
community, outside of a healthcare setting. This type of pneumonia is
commonly seen in children who are otherwise healthy and is typically
caused by various infectious agents, such as bacteria, viruses, or
sometimes fungi.

Infectious Agents:
 Bacterial Causes: Streptococcus pneumoniae is one of the most common
bacterial pathogens causing pneumonia in children. Other bacteria, such as
Haemophilus influenzae and Mycoplasma pneumoniae, can also be
implicated.
 Viral Causes: Viruses, including respiratory syncytial virus (RSV), influenza,
and adenovirus, are frequent causes of pneumonia in children.
 Other Pathogens: In some cases, fungi or atypical pathogens may contribute
to pediatric CAP.

Sign and Symptoms

Common symptoms

 Fever

 Cough

12
  Respiratory distress (eg, tachypnea, nasal flaring, grunting, retractions)

 Poor feeding

 Irritability

 Less common symptoms

 Abdominal pain

 Nausea or vomiting

 Chest pain

 Headache and/or sore throat are common in children presenting with

SARS-CoV-2 infection.

 Receipt of conjugate pneumococcal vaccine decreases probability of

bacterial pneumonia.

Diagnostic Tests:

 Chest X-ray: A chest X-ray is often performed to visualize the lungs and
confirm the presence of infiltrates or consolidation, which are indicative of
pneumonia.

 Blood Tests: Complete blood count (CBC) may be conducted to assess the
white blood cell count, specifically looking for an elevated white blood cell
count, which can indicate an infection.

 Blood Cultures: In some cases, blood cultures may be obtained to identify the
specific causative organism and guide antibiotic therapy.

13
 CHAPTER VI
PHYSICAL ASSESSMENT
Personal data
Patient AS who was admitted to the hospital with chief complaints of fever, cough
and tachypnea
General survey
Physical assessment done at Davao del Sur Provincial Hospital Annex3 Pedia
Ward while patient was lying on bed and asleep. The patient was 3 years old,
Female. Received patient with heplock at her left metacarpal vein. Upon the
assessment the patient appears weak lying on bed with a GCS score of 15.
During inspection the patient is emaciated and has cyanosis, with dry lips and
there is an evidence of enlargement on the tip of her fingers and a clubbing nails
with discoloration of violet of both finger nails and foot nails. Upon auscultation it
has been heard that there was a rale sound at the base of her lungs. Patient is
wearing a diaper, minimal rashes noted around her anus.
Vital Signs

VITAL SIGNS VALUE NORMAL INFERENCE

VALUE

ABNORMAL

Fever can lead to

dehydration. Medical
help is needed if the
Temperature 38.0 Celsius 36.5 Celsius-
37.4 Celsius child refuses to drink
or shows signs of
dehydration, such as
dry mouth and dry
lips.

Blood 70/60 mmHg systolic<90-110 DECREASE

Pressure mmHg/
diastolic<50-70
Low blood pressure is
mmHg
not always a concern,
but sometimes

14
 hypotension can cause
dizziness and fainting
or be life-threatening.

INCREASE

Sinus tachycardia is
Pulse Rate 164 bpm 80-120
bpm usually considered a
heart rate over 120
beats per minute.
Most of the time sinus
tachycardia is not a
problem but actually a
normal physiologic
response of the body.

INCREASED
Fever can increase
respiratory rate.

Respiratory How fast they breathe

53 cpm 20-40 cpm
Rate can be a signal. If it is
a bit too quick, that
can be one of the first
symptoms of a lung
infection, especially
for a baby or small
child.

Oxygen 83% Normal O2 DECREASE

Saturation saturation:
95%-100% Hypoxemia is low
oxygen levels of blood
in the body. It causes
symptoms like
headache, difficulty of

15
 breathing, rapid heart
rate and bluish skin.

HEAD, EYES, and EARS

Significant Findings:
 Sunken head
 Eyes are symmetrical in line
 Dry lips
 Equal-sized ears with no discharge
Inference:
Sunken head is abnormal; a noticeably sunken fontanelle is a sign that the child
does not have enough fluid in its body.
Eyes are symmetrical in line with each other is normal.
Dry lips are a sign of dehydration.
Equal-sized ears with no discharge are normal.

INTEGUMENTARY (SKIN/NAILS)
Significant dindings:
 Cyanosis
 Clubbing nails
Inference:
Cyanosis is a bluish discoloration of the skin resulting from poor circulation or
inadequate oxygenation of the blood.
Clubbing may result from low blood-oxygen levels. The tips of the fingers enlarge
and the nails become extremely curved from front to back.

CHEST AND CVS

Significant Findings:
 Rale (fine crackles) sound

16
Inference:
These popping sounds are created when air is forced through airways that have
been narrowed by mucus, pus or other fluids. Rales are frequently associated
with inflamed or infected small bronchi, bronchioles, and alveoli.

ABDOMEN
Significant Findings:
 Essentially normal
Inference:
No abnormal signs of bulging and swelling on her abdomen.

EXTREMITIES
Significant findings:
 GCS 15
 Muscle weakness
Inference:
As the body tries to fight an infection, weakness or muscle soreness may also
occur. This is more common with pneumonia caused by virus. If pneumonia
induces a fever, chills can be a symptom of the fever. Chills happen when
muscles expand and contract.

CHAPTER VIII

ANATOMY AND PHYSIOLOGY

REPIRATORY SYSTEM

17
 The respiratory system is situated in the thorax, and is
responsible for gaseous exchange between the circulatory system and the
outside world. Air is taken in via the upper airways (the nasal cavity,
pharynx and larynx) through the lower airways (trachea,primary bronchi
and bronchial tree) and into the small bronchioles and alveoli within the
lung tissue. Move the pointer over the coloured regions of the diagram; the
names will appear at the bottom of the screen)The lungs are divided into
lobes; The left lung is composed of the upper lobe,the lower lobe and the
lingula (a small remnant next to the apex of the heart), the right lung is
composed of the upper , the middle and the lower lobes.

Anatomy of the Lung

The lungs are the major organs of the respiratory system, and are
divided into sections, or lobes. The right lung has three lobes and is
slightly larger than the left lung, which has two lobes. The lungs are
separated by the mediastinum. This area contains
the heart, trachea, esophagus, and many lymph nodes. The lungs are
covered by a protective membrane known as the pleura and are
separated from the abdominal cavity by the muscular diaphragm, with
each inhalation, air is pulled through the windpipe (trachea) and the
branching passageways of the lungs (the bronchi), filling thousands of tiny
air sacs (alveoli) at the ends of the bronchi. These sacs, which resemble

18
 bunches of grapes, are surrounded by small blood vessels
(capillaries). Oxygen passes through the thin membranes of the alveoli
and into the bloodstream. The red blood cells pick up the oxygen and
carry it to the body's organs and tissues. As the blood cells release the
oxygen they pick up carbon dioxide, a waste product of metabolism. The
carbon dioxide is then carried back to the lungs and released into the
alveoli. With each exhalation, carbon dioxide is expelled from the bronchi
out through the trachea.

Nose or Nasal Cavity

As air passes through the nasal cavities, it is warmed and humidified so that air
that reaches the lungs is warmed and moist. The Nasal airways are lined with
cilia and kept moist by mucous secretions. The combination of cilia and mucous
helps to filter out solid particles from the air a Warm and moisten the air, which
prevents damage to the delicate tissues that form the Respiratory System. The
moisture in the nose helps to heat and humidify the air, increasing the amount of
water vapor the air entering the lungs contains. This helps to keep the air
entering the nose from drying out the lungs and other parts of our respiratory
system. When air enters the respiratory system through the mouth, much less
filtering is done. It is generally better to take in air through the nose.
To review: The nose does the following:
1. Filters the air by the hairs and mucous in the nose
2. Moistens the air
3. Warms the air.

Pharynx
The pharynx is also called the throat. As we saw in the digestive system, the
epiglottis closes off the trachea when we swallow. Below the epiglottis is the
larynx or voice box. This contains 2 vocal cords, which vibrate when air passes
by them. With our tongue and lips, we convert these vibrations into speech. The
area at the top of the trachea, which contains the larynx, is called the glottis.
Trachea

19
The trachea or windpipe is made of muscle and elastic fibers with rings of
cartilage. The cartilageprevents the tubes of the trachea from collapsing. The
trachea is divided or branched into bronchi and then into smaller bronchioles.
The bronchioles branch off into alveoli.
Bronchi
Similar to the trachea with ciliated mucous membrane and hyaline cartilage. The
lower end of the trachea divides into right and left.
Bronchioles
Thinner walls of smooth muscle, lined with ciliated epithelium. Subdivision of
bronchi. In the end, the alveolar duct and cluster of alveoli. Lungs The lungs are
spongy structures where the exchange of gases takes place. Each lung is
surrounded by a pair of pleural membranes. Between the membranes is pleural
fluid, which reduces friction while breathing. The bronchi are divided into about a
million bronchioles. The ends of the bronchioles are hollow air sacs called alveoli.
There are over 700 million alveoli in the lungs. This greatly increases the surface
area through which gas exchange occurs. Surrounding the alveoli are capillaries.
The lungs give up their oxygen to the capillaries through the alveoli. Likewise,
carbon dioxide is taken from the capillaries and into the alveoli

NORMAL ANATOMY OF LUNGS

The right and left lung anatomy are similar but

asymmetrical. The right lung consists of three
lobes: the right upper lobe (RUL), the right
middle lobe (RML), and the right lower lobe
(RLL). The left lung consists of two lobes: the
left upper lobe (LUL) and the left lower lobe
(LLL). The lungs are spongy structure where the
e. The lungs are pyramid-shaped, paired organs
that are connected to the trachea by the right
and left bronchi; on the inferior surface, the

20
lungs are bordered by the diaphragm. The diaphragm is the flat, dome-shaped
muscle located at the base of the lungs and thoracic cavity. The lungs are
enclosed by the pleurae, which are attached to the mediastinum. The right lung is
shorter and wider than the left lung, and the left lung occupies a smaller volume
than the right. The cardiac notch is an indentation on the surface of the left lung,
and it allows space for the heart. The apex of the lung is the superior region,
whereas the base is the opposite region near the diaphragm. The costal surface
of the lung borders the ribs. The mediastinal surface faces the midline.

LUNGS WITH PCAP

Pneumonia is an infection that affects

one or both lungs. It causes the air
sacs, or alveoli, of the lungs to fill up
with fluid or pus. Bacteria, viruses, or
fungi
may cause pneumonia. Symptoms can
range from mild to serious and may
include a cough with or without mucus
(a slimy substance), fever, chills, and
trouble breathing. How serious your
pneumonia is depends on your age,
your overall health, and what caused
your infection.

21
 CHAPTER IX

ETIOLOGY AND SYMPTOMATOLOGY

ETIOLOGY

BASIC PRESENT/ RATIONALE ACTUAL

ETIOLOGY ABSENT

PREDIS
POSING
AGE Present The World Health ● 3 years
Organization (WHO) old
estimates there are 156
million cases of pneumonia
each year in children
younger than five years,
with as many as 20 million
cases severe enough to
require hospital admission.
In the developed world, the
annual incidence of
pneumonia is estimated to
be 33 per 10,000 in
children younger than five
years and 14.5 per 10,000
in children 0 to 16 years.
Pneumonia is considered
as the largest killer of
children.

Reference:
Tiewsoh K, Lodha R,
Pandey RM, Broor S,
Kalaivani M, Kabra SK.
http://www.uptodate.com/
contents/pneumonia-in-
children-epidemiology-
pathogenesis-etiology
Genetics/Family Present Your inherited genetic ● The patient's
History makeup predisposes you father has
to having asthma. In fact, asthma, which is
it's thought that three-fifths believed to be a

22
 of all asthma cases are risk factor why
hereditary. According to a the patient is
CDC report, if a person susceptible to
has a parent with asthma, pneumonia.
he or she is three to six
times more likely to
develop asthma than
someone who does not
have a parent with asthma.

Reference:
Awad IA, Chireau MV,
Fedder WN, Furie, KL, et
al.
http:/www.webmd.com/
asthma/guide/asthma-risk-
factor
PRECIPITATI
NG

Bacteria Present Streptococcus pneumoniae, ● Streptococcus

which initially inhabits the Pneumoniae
mucosal surfaces of the
nasopharynx in its hosts,
can migrate to the lungs,
where it causes
pneumococcal pneumonia.
This is an infection of the
lungs that leads to
inflammation of the air sacs
causing them to fill with
fluid, and making it difficult
to breathe. Individuals who
have pneumonia usually
suffer with high heart rates,
shortness of breath,
frequent coughing, and high
fevers.

The nasopharynx has been

classed as the main
reservoir of S. pneumoniae.
This is due to the
nasopharynx of hosts being

23
 colonized without any
symptoms. Following
colonization, the spreading
of the disease depends on
carriers coming into close
contact with healthy
individuals within the
community. The CDC has
declared that the main
source of S. pneumoniae
transmission is direct
contact with secretions of
the respiratory system of a
carrier

Reference:
Le Polain de Waroux et al.
Environmental Present Respiratory disease occur ● Congested
Influence as a result of interactions Community
between genotype and
environment. Environmental
influences include
allergens, irritants, smoking,
environmental tobacco
smoke (ETS), diet,
nutrients, drugs, infections
and injuries. Other diseases
are triggered mainly by
major by environmental
exposure; examples include
carbon monoxide poisoning,
acute lung injury and acute
respiratory distress
syndrome (due to severe
pneumonia or major
trauma).

Reference:
Wang C, Liu Y, Yang Q, Dai
X, Wu S, Wang W, et al.
http:/
www.erswhitebook.org/

24
 chapters/genetic-
susceptibility/
Diet Present Diet, particularly bottle ● Bottle fed
feeding, is not inherently a
direct risk factor for
Pediatric Community-
Acquired Pneumonia
(CAP). However, certain
feeding practices or dietary
factors may indirectly
contribute to an increased
risk of respiratory infections,
including pneumonia, in
children. It's essential to
note that pneumonia is
often caused by infectious
agents, such as bacteria,
viruses, or fungi, and risk
factors are typically related
to the child's overall health
and exposure to these
pathogens.

Reference:
Heidenreich PA, Trogdon
JG, Khavjou OA, et al.

25
 CHAPTER XI
DOCTOR’S ORDER

DATE DOCTOR’S ORDER RATIONALE

ORDERED

10-09-23  Please admit to  For close monitoring of the

pedia ward patient
11:00 am
 Secure consent  To have legal papers and avoid
for care any problems about the surgery
to be done
 With Heplock
 To used as medication line
 Diet with strict
aspiration,  To secure patent food way and
percussion observe if there are any problems

DIAGNOSIS

 CBC with Platelet

count
 To monitor the level of WBC RBC
 arterial blood gas and hemoglobin
analysis (ABG)
 to detect any lungs problems
 Chest X-ray PA
 It can help in detecting certain
(posteroanterior)
lung and heart problems as well
as visualizing the internal organs
of the chest which include food
 Urinalysis
pipe and diaphragm.

 to detect and manage a wide

range of disorders, such as

26
 urinary tract infections, kidney
disease and diabetes.

THERAPUTIC

 Ceftriaxone 700
mg IVTT now  The doctor ordered drugs For
medication and treatment of
 Salbutamol +
infection , breathing problems
ipratropium 1 neb
headaches, and chronic heart
q6
failure.
 Paracetamol
70mg IVTT q4
 To have baseline and record the
PRN for fever
water intake and output level of
 Lanoxin syrup 0.6 the patient
ml BID

 Monitor VS Q4,
I&O Q Shift, refer
accordingly

10-10-23  Continue meds as  To continue the medications as

order / O2 ordered
8:00 am
inhalation
 To have baseline and monitor the
 VS Q4h, I&O Q water intake and urine output and
Shift, Refer stool
accordingly

10-10-23  Continue meds as  To continue the medications as

order ordered
11:00 am
 chest  to help the client clear excessive
physiotherapy mucus secretions from the lungs
after nebulization in order to prevent complications,

27
  Watcher apprised like mucus plugs, and infections.
of patient
 To have baseline and monitor the
condition
water intake and urine output and
 VS Q4h, I&O Q stool
Shift, Refer
accordingly

10-11-23  Continue meds as  To continue the medications as

order ordered
08:00 am
 Continue  To continue giving nebulization
nebulization

10-12-23  CBC with Platelet  To monitor the level of WBC RBC

count and hemoglobin
06:00 am
 #2p Chest X-ray  It can help in detecting certain
PA lung and heart problems as well
(posteroanterior) as visualizing the internal organs
of the chest which include food
 IVF:D5 0.3 Nacl
pipe and diaphragm.
500ml @ 30cc/hr
 For replacement or maintenance
 Continue meds as
of fluid & electrolytes.
order refer
accordingly  To continue the medications as
ordered

10-13-23  IVF to follow at  For replacement or maintenance

same rate of fluid & electrolytes.
06:10 am
 Continue meds  To continue the medications as
ordered
 Refer accordingly

10-14-23  Continue meds  To continue the medications as

ordered

28
06:00 am  Refer accordingly  To Refer accordingly

10-15-23  CBC with Platelet  To monitor the level of WBC RBC

count and hemoglobin
06:00 am
 IVF to follow at  To continue the medications as
same rate ordered

 Continue meds  To Refer accordingly

 Refer accordingly

10-16-23  Continue meds  To continue the medications as

ordered
06:00 am  Refer accordingly
 To Refer accordingly

10-17-23  For repeat CBC  to look at overall health and find a

wide range of conditions,
06:30 am  IVF to follow at
including anemia, infection and
same rate
leukemia.
 Continue meds
 To continue the medications as
 Refer accordingly ordered

 To Refer accordingly

10-17-23  IVF:D5 0.3 Nacl  To reduce the rate of IVF For

500ml @ 21cc/hr replacement or maintenance of
12:32pm
fluid & electrolytes.

10-18-23 THERAPUTIC  The doctor ordered drugs For

medication and treatment of
07:00 am  clarithromycin
infection , breathing problems,
125mg 5ml BID x
pulmonary arterial hypertension,
5 days
and chronic heart failure.
 Salbutamol 2 neb

29
 q6

 Lanoxin syrup 0.6

ml BID

 sildenafil 35 mg 1
tab BID

CHAPTER XII

DIAGNOSTIC EXAM

30
 DATE TEST/ NORMAL RESULT INTERPRETATI NURSING
ORDERE PURPOSE RANGE ON MANANGEME
D NT

CBC Hemoglobi 236 high  The protocol

n •135-175 for
A complete
g/L conducting the
blood count
test should be
(CBC) is a Hematocrit
0.729 high explained to the
blood test. It's
•42.00-50.00 patient in order
used to look at
RBC for the patient
overall health
7.75 high can participate
and find a wide •4.50-
well during the
range of 5.00mmol/l
procedure
conditions,
MCV
including
•80.00- 90.8  Explain that
anemia,
100.00fL when the skin is
infection and
punctured, it
leukemia.
MCH
may cause
•27.00- 30.7 some
A complete 31.00pg/cell discomfort.
blood count
MCHC
test measures  Explain that
•320.00- fasting is not
the following: 338
360.00g/L necessary.
WBC However, fatty
•Red blood 8.10 meals may alter
•5.00-
cells, which some test
10.00x10^9/
carry oxygen results as a
L
•White blood result of
Neutrophils lipidemia.
cells, which 49.2 low
fight infection •55.00-65.00
 Apply manual
•Hemoglobin, Lymphocyt
pressure and
the oxygen- es
dressings over
carrying protein 39.9
•25.00-40.00 the puncture
in red blood
31 site on removal
cells Monocytes
8.0 of dinner.
•Hematocrit, •1.00-10.00
 DATE TEST/ NORMAL RANGE RESULT NURSING
ORDERE PURPOSES MANANGEMENT
D

Urinalysis: Color:  Explain to the patient

why the procedure
A urinalysis is a Yellow yellow
needs to be done
common test that
•Apperance: clear clear
can assess many
a•Specific  Instruct the patient to
different aspects
gravity: void directly into the
of your health
specimen bottle.
with a urine 1.00-1.035
1.015
sample.
•Ph
Healthcare
providers often 5.0-8.0  Instruct patient to
6.0
use urinalysis cover all of the
•Glucose:
Negative specimens tightly and
tests to screen
Negative
for or monitor properly identify them,
•Bilirubin: and send them to the
certain health
Negative Negative lab as soon as
conditions and to
diagnose urinary possible. A delay in
•Ketone:
tract infections. examining the
Negative Negative
specimen may cause
•Occult blood: a false result when
Negative Negative bacterial
determinations are
•Protein:
made.
Negative Negative

•Nitrite: Inform the patients and

explain the result of the

32
 Negative Negative laboratory

•Leukocytes:
 WOF any unusualities
•Esterase: Negative
NEGATIVE
 Refer to the HCP if
Urine there are any
NONE SEEN
microscopic abnormalities

•WBC: <=5
WTC/HPF NONE SEEN

•RBC: <=2
RBC/HPF 0-2

•Squamous
Epithelial:
FEW
<=5 HPF

•Bacteria:
FEW
None seen HPF

•Crystals:
NONE SEEN
None seen HPF

•Caste:
NONE SEEN
None seen HPF

•Yeast:
NONE SEEN
None seen HPF

33
 TEST RESULT REFERENCE RANGE

CLINICAL CHEMISTRY

PH 7.389 7.35 - 7.45

PCO2 38.4 35.0 - 45

mmHg
PO2 31.2
80 - 100 mmHg
HCO3 22.7
22.0 - 26.0
O2SAT 58.4
mmo/L

95-99 %

X-RAY REPORT

CHEST :HEART SIZE CANNOT BE EVALUATED DUE TO THE AP

PROJECTION. THERE ARE INFILTRATES IN BOTH LUNGS WITH AREAS OF
CONFLUENCE SULCI ARE INTACT.
IMPRESSION
> BRONCHOPNEUMONIA

34
 CHAPTER XIV

SURGICAL PROCEDURE

a medical procedure involving an incision with instruments; performed

to repair damage or arrest disease in a living body.

NO SURGICAL PROCEDURE

CHAPTER XV
NURSING THEORY

Nursing Needs Theory by Virginia Henderson

35
 The Nursing Need Theory was created by Virginia Henderson to
describe the special focus of nursing practice. The approach emphasizes
how critical it is for patients to become more independent in order to
speed up their recovery. Henderson's philosophy focuses on the
fundamental needs of people and how nurses might address them.

In this case, the theory can be used by applying one of the major
assumptions where nurses care for patients until the patient can care for
themselves once again. Since Patient AS is still a child, it is the nurse’s
responsibility to care for her when she cannot take care herself. The
fundamental rule to keep in mind is that the fact that a child patient is
entirely dependent on others to meet all of her requirements. Virginia
Henderson’s emphasis on basic human needs as the central focus of
nursing practice has led to further theory development regarding the
needs of the person and how nursing can assist in meeting those needs.

Virginia Henderson proposed that caring for the patient’s basic

human needs is essential and that nurses can help to meet those needs.
The theory covered the following four key ideas: environment, health, the
individual, and nursing. Although she does not describe the environment
specifically, she claims that it should be encouraging. Health, according to
Henderson, is a state of equilibrium in all facets of life and is closely
related to independence. According to her idea, the individual has
fundamental needs that contribute to health and must be satisfied in order
to provide the desired nursing outcomes. It's interesting to note that she
doesn't merely think of patients as those who are ill.

Additionally, according to this theory, the nurse's primary role is to

assist people who are unable to satisfy one or more of Henderson's 14
demands. The fourteen elements of the need theory are made up of these
needs. However, since the patient is in a comatose state, we can only
apply the Nursing Needs Theory’s first category which concerns the
physiological state of the patient. This includes the need to breathe

36
 normally, eat and drink adequately, eliminate body wastes, move and
stand with the desired posture, rest and sleep, dress and undress in the
desired clothes, maintain the required body temperature through clothes
adjustment or environment adjustment, cleanliness, grooming, and skin
protection, and lastly, the need to avoid dangers from the environment,
and possible injury to people around the patient. These components show
a holistic approach to nursing that covers the physiological aspect of the
patient’s needs. Although the nurse is responsible for carrying out a
doctor's therapy plan, individualized care is the product of the nurse's
innovative care planning. As long as the nurse does not diagnose,
prescribe therapy, or make a prognosis, which are tasks that belong to the
doctor, the nurse should be an autonomous practitioner with the ability to
reach independent decisions.

In conclusion, the Nursing Needs Theory is relatively simple,

logical, and applied to individuals of all ages. The patient AS who is still a
child requires extensive support and a great deal of close monitoring. The
goal of daily care is to keep patient in a comfortable position with healthy
skin, clear lungs, and enough fluid administration.

Environmental Theory by Florence Nightingale

The focus of nursing in this model is to alter the patient’s environment in

order to affect change in his or her health. The environmental factors that affect
health, as identified in the theory, are: fresh air, pure water, sufficient food
supplies, efficient drainage, cleanliness of the patient and environment, and light
(particularly direct sunlight). If any of these areas is lacking, the patient may
experience diminished health. A nurse’s role in a patient’s recovery is to alter the
environment in order to gradually create the optimal conditions for the patient’s
body to heal itself. In some cases, this would mean minimal noise and in other
cases could mean a specific diet. All of these areas can be manipulated to help
the patient meet his or her health goals and get healthy.

37
 The Environment Theory of nursing is a patient-care theory. That is, it
focuses on the care of the patient rather than the nursing process, the
relationship between patient and nurse, or the individual nurse. In this way, the
model must be adapted to fit the needs of individual patients. The environmental
factors affect different patients unique to their situations and illnesses, and the
nurse must address these factors on a case-by-case basis in order to make sure
the factors are altered in a way that best cares for an individual patient and his or
her needs.

As a nurse in terms of the fresh air and ventilation: Ensure that the
child's environment is well-ventilated, maintaining a comfortable
temperature and providing fresh air. Relating to Die of the patient:
Encourage outdoor activities and play, promoting physical activity and
exercise. Emphasize the importance of a balanced diet for overall health.
By adapting Florence Nightingale's Environmental Theory to the care of a
3-year-old patient with Pediatric CAP, healthcare providers can create an
environment that supports recovery, addresses nutritional preferences,
and promotes overall well-being. Collaborating with parents to implement
these principles can enhance the child's experience and contribute to a
positive healing environment.

Faye Glenn Abdellah: 21 Nursing Problems Theory

Faye Abdellah is well known for developing the “Twenty-One Nursing

Problems Theory” that has interrelated the concepts of health, nursing problems,
and problem-solving. She views nursing as an art and a science that molds the
attitude, intellectual competencies, and technical skills of the individual nurse into
the desire and ability to help individuals cope with their health needs, whether
they are ill or well. She used Henderson’s 14 basic human needs and nursing
research to establish the classification of nursing problems.

Virginia Henderson's 14 Basic Needs, which is often expanded to

21 Nursing Problems, provides a comprehensive framework for nursing

38
care. Adapting this theory to the case of a 3-year-old patient with Pediatric
Community-Acquired Pneumonia (CAP), who has a preference for sweets
and junk foods and was bottle-fed as a baby, can help guide nursing
interventions. As a nurse we could help the breathing problems which is
Impaired respiratory function due to pneumonia by administer prescribed
medications, monitor respiratory rate, and provide a comfortable
environment to support breathing and also in eating and drinking problems
which Inadequate nutrition and dietary habits by collaborate with a dietitian
to create a balanced diet that accommodates the child's preferences
within the constraints of the medical condition. Educate parents on healthy
food choices.

These interventions focus on addressing the specific needs of the

child with Pediatric CAP while considering their preferences for sweets
and past feeding habits. It's essential to work collaboratively with the
child's parents or caregivers to tailor interventions to the child's unique
circumstances and promote a holistic approach to care.

CHAPTER XVII

39
 DISCHARGE PLAN (M.E.T.H.O.D)
MEDICINE

MEDICATION INSTRUCTION INFERENCE

Clarithromycin Twice times a day; Antibiotic

2.5ml

Salbutamol syrup 2.5 ml three times Bronchodilator

a day

Lanoxin syrup Four times a day; Digitals therapy

60mg tablets PO

EXERCISE
 Walking
 Swimming

TREATMENT
 Ask patient to monitor their oxygen saturation levels with a pulse
oximeter

 Educate patient on warning signs that indicates they need to go back to

the hospital

 Advise patient to take medications as prescribed

HEALTH TEACHING
 Wash your hands with soap and water or alcohol-based hand sanitizers
to kill germs.
 Get plenty of physical activity and follow a healthy eating plan
 Eat smaller meals of thickened food and sleep with the head of your bed
raised up.

40
 OUTPATIENT/FOLLOW UP
1. First follow up 01/22/2024
2. Second follow up 02/22/2024
3. Third follow up 03/22/2024
DIET
 high in protein
 Nuts, peanuts, beans, white meat, and cold water fish

CHAPTER XVIII

RECOMMENDATION
Based on the outcome of this study, the following will be benefited to the
following:

Community. This study will be advantageous in the community

since it focuses on community-based interventions for Pediatric
Community-Acquired Pneumonia (CAP) prevention, management, and

41
outcomes, and contributes to evidence-based nursing practice in the
community setting.

Patient. This study can help patients with Pediatric Community-

Acquired Pneumonia (CAP) to effectively manage the condition, promote
healing, prevent recurrence, raising awareness and achieve the best
possible outcomes. It is important for them to always consult with a
qualified healthcare provider for personalized medical advice and
treatment.

Nurses. This study is very important for the nurses so that they can
provide safe, effective, and patient-centered care for patients with
Pediatric Community-Acquired Pneumonia (CAP) , promoting healing,
preventing complications, and optimizing patient outcomes. It is important
for nurses to always work within the scope of nursing practice and
collaborate closely with the healthcare team for comprehensive patient
care.

Future researcher. These can serve as a guide for the future

researchers in conducting research that advances the understanding of
Pediatric Community-Acquired Pneumonia (CAP).

CHAPTER XIX

DEFINITION OF TERMS

42
 Community-acquired pneumonia (CAP) is defined as an acute
infection of the pulmonary parenchyma in a patient who has acquired the
infection in the community, as distinguished from hospital-acquired
(nosocomial) pneumonia. CAP is a common and potentially serious illness
with considerable morbidity.

Goblet cells produce mucus which traps dust, dirt and bacteria to
prevent them entering the lungs.

Exotoxin is a toxin secreted by bacteria that can cause damage to

the host cells or disrupt normal cellular metabolism.

Streptococcus pneumoniae, or pneumococcus, is a Gram-

positive, spherical bacteria, alpha-hemolytic member of the genus
Streptococcus. cause of community-acquired pneumonia. Pneumococcal
infections are present throughout the world

Alveoli are the tiny sacs in the lungs that move oxygen and carbon
dioxide into and out of your bloodstream.

Emaciated is very thin and weak especially from lack of nutrition or

illness.

Congenital heart disease is one or more problems with the heart's

structure that exist since birth. Congenital means that you're born with the
condition.

43
 Transposition of the great arteries (TGA) is a rare heart problem
in which the two main arteries leaving the heart are reversed.

Tachypnea is rapid, shallow breathing that can affect anyone at

any age and is common among newborns and people with respiratory
conditions.

Alveolar Macrophage, Pulmonary Macrophage, (or dust cell) is a

type of macrophage, a professional phagocyte, found in the airways and
at the level of the alveoli in the lungs.

REFERENCE

44
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45