GENERAL OBJECTIVE:

To be able to acquire reliable information about Pneumonia in order for us students to become knowledgeable ;be able to demonstrate competent nursing care that will address our patient’s condition ; and to demonstrate right attitude as member of the health care team.

SPECIFIC OBJECTIVES:

To obtain pertinent information about the the patient’s demographic and socio-economic

profile.

To be well informed on the client’s history including the past and present illness.

To be familiar with the structures and normal function of the body organs involved..

To gain knowledge about the underlying causes and factors of the client’s diagnosis.

To be able to formulate and establish appropriate nursing care plan that will help improve

our client’s condition.

To be familiar with some of the client’s medications which includes both therapeutic and

the adverse effects.

As heath care providers, it is important to know and understand more about of this case for

better provision of care to clients, for more sufficient and adequate health educations/teachings

for the patient, and to protect ourselves from possible transmission of this disease while working

on clients with this case. Moreover, the importance of this study is also to continually challenge

the students to expand their scope to meet the needs of the patient with pulmonary disease. The

purpose of this paper is to enable the readers to enhance their knowledge of normal pulmonary

function and apply it to abnormal situations when assessing, applying and evaluating therapeutic

care. Patient observation and recognition of the signs and symptoms of pneumonia are the keys

to recognizing abnormal function. The ability of the clinical students to participate, recognize

and intervene to treat pneumonia may prevent or modify complications.

PATIENT’S PROFILE:

Name: John Domagas

Age: 1 y/o

Birthday: October 15, 2009

Address: Calasiao, Pangasinan

Sex: Male

Religion: Roman Catholic

Nationality: Filipino Citizen

Admitted by: Dr. Fama

Diagnosis: Pneumonia (PCAP-C)

History of Past and Present Illness:

John Domagas, a 1 year old male from Calasiao , Pangasinan was admitted at Pangasinan Provincial Hospital last January 10, 2011 @ 9:30 pm with the chief complaints of fever and cough that started 2 weeks ago.

The patient has no previous history of hospitalization and operations.

Family History:

They have a history of Hypertension, diabetes, and asthma on his mother side.

Environmental history:

They are living in a barangay. They have their own toilet and bathroom. For their garbage disposal, they usually burn them. They have lots of plants that surround their house.Patient is fond of playing outside with his cousins.

INTRODUCTION:

The inflammation of the lung parenchyma (the respiratory bronchioles and alveoli) is

known as Pneumonia. Frequently, it is described as lung parenchyma/alveolar inflammation and

abnormal alveolar filling with fluid. The alveoli are microscopic air-filled sacs in the lungs

responsible for absorbing oxygen from the atmosphere. Pneumonia can result from a variety of

causes, including infection with bacteria, viruses, fungi, or parasites, and chemical or physical

injury to the lungs.

Pneumonia often classified as community acquired, nosocomial (hospital acquired), or

opportunistic. The most common causative organism for community acquired pneumonia is

Streptococcus pneumoniae (also called pneumococcus), a gram- positive bacterium. This

organism causes 70% to 75% of all diagnosed cases of pneumonia. Mycoplasma pneumoniae,

Haemophilus influenzae, and in the influenza virus are also leading cause of community-

acquired pneumonia. Staphylococcus aureus and gram-negative bacteria such as Klebsiella

pneumoniae, Pseudomonas aeruginosa, and enteric bacilli, including Escherichia coli, are often

implicated as nosocomial causes of pneumonia. Organisms such as Pnuemonocystis carinii

generally cause infections only in immuno-compromised people (opportunistic infections).

NORMAL ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY SYSTEM:

In anatomy and physiology, the Respiratory system, is a system that delivers oxygen to

the circulatory system and transport it to all body cells. Oxygen is essential for cells, which use

this vital substance to liberate the energy needed for cellular activities. In addition to supplying

oxygen, the respiratory system aids in removing of carbon dioxide, preventing the lethal buildup

of this waste product in body tissues. Everyday without the prompt of conscious thought, the

respiratory system carries out its life-sustaining activities. If the respiratory system’s tasks are

interrupted for more than a few minutes, serious, irreversible damage to tissues occurs, followed

by the failure of all body systems, and ultimately, death.

While the intake of oxygen and removal of carbon dioxide are the primary functions of

the respiratory system, it plays other important roles in the body. The respiratory system helps

regulate the balance of acid and base in tissues, a process crucial for the normal functioning of

cells. It protects the body against disease-causing organisms and toxic substances inhaled with

air. The respiratory system also houses the cells that detect smell, and assists in the production of

sounds for speech.

The respiratory and circulatory systems work together to deliver oxygen to cells and

remove carbon dioxide in a two-phase process called respiration. The first phase of respiration

begins with breathing in, or inhalation. Inhalation brings air from outside the body into the lungs.

Oxygen in the air moves from the lungs through blood vessels to the heart, which pumps the

oxygen-rich blood to all parts of the body. Oxygen then moves from the bloodstream into cells,

which completes the first phase of respiration. In the cells, oxygen is used in a separate energy-

producing process called cellular respiration, which produces carbon dioxide as a byproduct. The

second phase of respiration begins with the movement of carbon dioxide from the cells to the

bloodstream. The bloodstream carries carbon dioxide to the heart, which pumps the carbon

dioxide-laden blood to the lungs. In the lungs, breathing out, or exhalation, removes carbon

dioxide from the body, thus completing the respiration cycle.

Structure

The organs of the respiratory system extend from the nose to the lungs and are divided

into the upper and lower respiratory tracts. The upper respiratory tract consists of the nose and

the pharynx, or throat. The lower respiratory tract includes the larynx, or voice box; the trachea,

or windpipe, which splits into two main branches called bronchi; tiny branches of the bronchi

called bronchioles; and the lungs, a pair of saclike, spongy organs. The nose, pharynx, larynx,

trachea, bronchi, and bronchioles conduct air to and from the lungs. The lungs interact with the

circulatory system to deliver oxygen and remove carbon dioxide.

A. Nasal passages

The nose is uppermost portion of the human respiratory system, and is a hollow air

passage that functions in breathing and for the sense of smell. The nasal cavity moistens and

warms incoming air, while small hairs and mucus filter out harmful particles and

microorganisms. The flow of air from outside of the body to the lungs begins with the nose,

which is divided into the left and right nasal passages. The nasal passages are lined with a

membrane composed primarily of one layer of flat, closely packed cells called epithelial cells.

Each epithelial cell is densely fringed with thousands of microscopic cilia, fingerlike extensions

of the cells. Interspersed among the epithelial cells are goblet cells, specialized cells that produce

mucus, a sticky, thick, moist fluid that coats the epithelial cells and the cilia. Numerous tiny

blood vessels called capillaries lie just under the mucous membrane, near the surface of the nasal

passages. While transporting air to the pharynx, the nasal passages play two critical roles: they

filter the air to remove potentially disease-causing particles; and they moisten and warm the air

to protect the structures in the respiratory system. Filtering prevents airborne bacteria, viruses,

other potentially disease-causing substances from entering the lungs, where they may cause

infection. Filtering also eliminates smog and dust particles, which may clog the narrow air

passages in the smallest bronchioles. Coarse hairs found just inside the nostrils of the nose trap

airborne particles as they are inhaled. The particles drop down onto the mucous membrane lining

the nasal passages. The cilia embedded in the mucous membrane wave constantly, creating a

current of mucus that propels the particles out of the nose or downward to the pharynx. In the

pharynx, the mucus is swallowed and passed to the stomach, where the particles are destroyed by

stomach acid. If more particles are in the nasal passages than the cilia can handle, the particles

build up on the mucus and irritate the membrane beneath it. This irritation triggers a reflex that

produces a sneeze to get rid of the polluted air. The nasal passages also moisten and warm air to

prevent it from damaging the delicate membranes of the lung. The mucous membranes of the

nasal passages release water vapor, which moistens the air as it passes over the membranes. As

air moves over the extensive capillaries in the nasal passages, it is warmed by the blood in the

capillaries. If the nose is blocked or “stuffy” due to a cold or allergies, a person is forced to

breath through the mouth. This can be potentially harmful to the respiratory system membranes,

since the mouth does not filter, warm, or moisten air. In addition to their role in the respiratory

system, the nasal passages house cells called olfactory receptors, which are involved in the sense

of smell. When chemicals enter the nasal passages, they contact the olfactory receptors. This

triggers the receptors to send a signal to the brain, which creates the perception of smell.

B. Pharynx

Air leaves the nasal passages and flows to the pharynx, a short, and funnel-shaped tube

about 13 cm (5 in) long that transports air to the larynx. Like the nasal passages, the pharynx is

lined with a protective mucous membrane and ciliated cells that remove impurities from the air.

In addition to serving as an air passage, the pharynx houses the tonsils, lymphatic tissues that

contain white blood cells. The white blood cells attack any disease-causing organisms that

escape the hairs, cilia, and mucus of the nasal passages and pharynx. The tonsils are strategically

located to prevent these organisms from moving further into the body. One tonsil, called the

adenoids, is found high in the rear wall of the pharynx. A pair of tonsils, the palatine tonsils, is

located at the back of the pharynx on either side of the tongue. Another pair, the lingual tonsils,

is found deep in the pharynx at the base of the tongue. In their battles with disease-causing

organisms, the tonsils sometimes become swollen with infection. When the adenoids are

swollen, they block the flow of air from the nasal passages to the pharynx, and a person must

breathe through the mouth.

C. Larynx

Air moves from the pharynx to the larynx, a structure about 5 cm (2 in) long located

approximately in the middle of the neck. Several layers of cartilage, a tough and flexible tissue,

comprise most of the larynx. A protrusion in the cartilage called the Adam’s apple sometimes

enlarges in males during puberty, creating a prominent bulge visible on the neck.

While the primary role of the larynx is to transport air to the trachea, it also serves other

functions. It plays a primary role in producing sound; it prevents food and fluid from entering the

air passage to cause choking; and its mucous membranes and cilia-bearing cells help filter air.

The cilia in the larynx waft airborne particles up toward the pharynx to be swallowed. Food and

fluids from the pharynx usually are prevented from entering the larynx by the epiglottis, a thin,

leaf like tissue. The “stem” of the leaf attaches to the front and top of the larynx. When a person

is breathing, the epiglottis is held in a vertical position, like an open trap door. When a person

swallows, however, a reflex causes the larynx and the epiglottis to move toward each other,

forming a protective seal, and food and fluids are routed to the esophagus. If a person is eating or

drinking too rapidly, or laughs while swallowing, the swallowing reflex may not work, and food

or fluid can enter the larynx. Food, fluid, or other substances in the larynx initiate a cough reflex

as the body attempts to clear the larynx of the obstruction. If the cough reflex does not work, a

person can choke; a life-threatening situation. The Heimlich maneuver is a technique used to

clear a blocked larynx (see First Aid). A surgical procedure called a tracheotomy is used to

bypass the larynx and get air to the trachea in extreme cases of choking.

D. Trachea, Bronchi, and Bronchioles

Air passes from the larynx into the trachea, a tube about 12 to 15 cm (about 5 to 6 in)

long located just below the larynx. The trachea is formed of 15 to 20 C-shaped rings of cartilage.

The sturdy cartilage rings hold the trachea open, enabling air to pass freely at all times. The open

part of the C-shaped cartilage lies at the back of the trachea, and the ends of the “C” are

connected by muscle tissue. The base of the trachea is located a little below where the neck

meets the trunk of the body. Here the trachea branches into two tubes, the left and right bronchi,

which deliver air to the left and right lungs, respectively. Within the lungs, the bronchi branch

into smaller tubes called bronchioles. The trachea, bronchi, and the first few bronchioles

contribute to the cleansing function of the respiratory system, for them, too, are lined with

mucous membranes and ciliated cells that move mucus upward to the pharynx.

E. Alveoli

In

hu

mans the lungs occupy a large portion of the chest cavity from the collarbone down to the

diaphragm. The right lung is divided into three sections, or lobes. The left lung, with a cleft to

accommodate the heart, has only two lobes. The two branches of the trachea, called bronchi,

subdivide within the lobes into smaller and smaller air vessels known as bronchioles.

Bronchioles terminate in alveoli, tiny air sacs surrounded by capillaries. When the alveoli inflate

with inhaled air, oxygen diffuses into the blood in the capillaries to be pumped by the heart to the

tissues of the body. At the same time carbon dioxide diffuses out of the blood into the lungs,

where it is exhaled. The bronchioles divide many more times in the lungs to create an

impressive tree with smaller and smaller branches, some no larger than 0.5 mm (0.02 in) in

diameter. These branches dead-end into tiny air sacs called alveoli. The alveoli deliver oxygen to

the circulatory system and remove carbon dioxide. Interspersed among the alveoli are numerous

macrophages, large white blood cells that patrol the alveoli and remove foreign substances that

have not been filtered out earlier. The macrophages are the last line of defense of the respiratory

system; their presence helps ensure that the alveoli are protected from infection so that they can

carry out their vital role. A scanning electron micrograph reveals the tiny sacs known as alveoli

within a section of human lung tissue. Human beings have a thin layer of about 700 million

alveoli within their lungs. This layer is crucial in the process called respiration, exchanging

oxygen and carbon dioxide with the surrounding blood capillaries.

The alveoli are about 150 million per lung and comprise most of the lung tissue. Alveoli

resemble tiny, collapsed balloons with thin elastic walls that expand as air flows into them and

collapse when the air is exhaled. Alveoli are arranged in grapelike clusters, and each cluster is

surrounded by a dense hairnet of tiny, thin-walled capillaries. The alveoli and capillaries are

arranged in such a way that air in the wall of the alveoli is only about 0.1 to 0.2 microns from the

blood in the capillary. Since the concentration of oxygen is much higher in the alveoli than in the

capillaries, the oxygen diffuses from the alveoli to the capillaries. The oxygen flows through the

capillaries to larger vessels, which carry the oxygenated blood to the heart, where it is pumped to

the rest of the body. Carbon dioxide that has been dumped into the bloodstream as a waste

product from cells throughout the body flows through the bloodstream to the heart, and then to

the alveolar capillaries. The concentration of carbon dioxide in the capillaries is much higher

than in the alveoli, causing carbon dioxide to diffuse into the alveoli. Exhalation forces the

carbon dioxide back through the respiratory passages and then to the outside of the body.

Regulation

As the diaphragm contracts and moves downward, the pectoralis minor and intercostal

muscles pull the rib cage outward. The chest cavity expands, and air rushes into the lungs

through the trachea to fill the resulting vacuum. When the diaphragm relaxes to its normal,

upwardly curving position, the lungs contract, and air is forced out

The flow of air in and out of the lungs is controlled by the nervous system, which ensures

that humans breathe in a regular pattern and at a regular rate. Breathing is carried out day and

night by an unconscious process. It begins with a cluster of nerve cells in the brain stem called

the respiratory center. These cells send simultaneous signals to the diaphragm and rib muscles,

the muscles involved in inhalation. The diaphragm is a large, dome-shaped muscle that lies just

under the lungs. When the diaphragm is stimulated by a nervous impulse, it flattens. The

downward movement of the diaphragm expands the volume of the cavity that contains the lungs,

the thoracic cavity. When the rib muscles are stimulated, they also contract, pulling the rib cage

up and out like the handle of a pail. This movement also expands the thoracic cavity. The

increased volume of the thoracic cavity causes air to rush into the lungs. The nervous stimulation

is brief, and when it ceases, the diaphragm and rib muscles relax and exhalation occurs. Under

normal conditions, the respiratory center emits signals 12 to 20 times a minute, causing a person

to take 12 to 20 breaths a minute. Newborns breathe at a faster rate, about 30 to 50 breaths a

minute. The rhythm set by the respiratory center can be altered by conscious control. The

breathing pattern changes when a person sings or whistles, for example. A person also can alter

the breathing pattern by holding the breath. The cerebral cortex, the part of the brain involved in

thinking, can send signals to the diaphragm and rib muscles that temporarily override the signals

from the respiratory center. The ability to hold one’s breathing has survival value. If a person

encounters noxious fumes, for example, it is possible to avoid inhaling the fumes.

A person cannot hold the breath indefinitely, however. If exhalation does not occur,

carbon dioxide accumulates in the blood, which, in turn, causes the blood to become more acidic.

Increased acidity interferes with the action of enzymes, the specialized proteins that participate in

virtually all biochemical reaction in the body. To prevent the blood from becoming too acidic,

the blood is monitored by special receptors called chemoreceptors, located in the brainstem and

in the blood vessels of the neck. If acid builds up in the blood, the chemoreceptors send nervous

signals to the respiratory center, which overrides the signals from the cerebral cortex and causes

a person to exhale and then resume breathing. These exhalations expel the carbon dioxide and

bring the blood acid level back to normal.

A person can exert some degree of control over the amount of air inhaled, with some

limitations. To prevent the lungs from bursting from overinflation, specialized cells in the lungs

called stretch receptors measure the volume of air in the lungs. When the volume reaches an

unsafe threshold, the stretch receptors send signals to the respiratory center, which shuts down

the muscles of inhalation and halts the intake of air.

PATHOPHYSIOLOGY:

Narrative

Pneumonia is an acute infection of the lungs, often caused by inhaled pnemococci of the species.

Streptococcus pneumoniae. The alveoli and bronchioles of the lungs become plugged with

fibrous exudates. Pneumonia may be caused by other bacteria, as well as viruses and also fungi.

Predisposing factors to the development of pneumonia include upper respiratory infection,

excessive alcohol ingestion, central nervous system depression, cardiac failure, COPD or chronic

obstructive pulmonary disease, have history of smoking, patient who are malnourished, elderly

and very young persons (Gulanick & Myers. 1998 p. 417). Pathogenic microorganisms can

reach the lung by several routes. The most common means of entry of pathogens into the lungs is

aspiration of oropharyngeal secretions containing microbes. Microorganisms also may be inhaled

after having been released when an infected person coughs, sneezes, or talks. Microorganisms

can also be inspired with aerosols (nebulized gas) from contaminated respiratory therapy

equipment. In illness or poor dental hygiene, normal flora of the orophaynx can become

pathogenic. Staphylococcus and gram- negative bacteria can be spread by the circulation from

systemic infection (IV) drug abusers. Upon entering, microorganisms start to attach themselves

into the mucosal surface and releases toxin which stimulates the activation of body’s defense

mechanism in the lungs. The cough reflex, mucociliary clearance, and phagocytosis by alveolar

macrophages are backed up by the body’s immune system and various components of the

inflammatory response, including the release of biochemical mediators by alveolar mast cells. In

susceptible individuals the invading pathogen multiplies, releasing damaging toxins and

stimulating full-scale inflammatory responses, both of which have damaging side effects. The

antigen- antibody reaction and the endotoxins released by some microorganisms damage

bronchial mucous membranes and alveolocapillary membranes. Inflammation and edema cause

the acini (respiratory bronchioles, alveolar ducts, and alveoli) to fill with infectious debris and

exudates. Exudate is a fluid rich in proteins (leukocyes, plasma proteins of all kinds); that

migrates out of the capillaries. Together with this exudates are fibrin, RBC, and bacteria that

cause the consolidation or solidification of the lungs. Due to the RBC in the lungs, the lungs

becomes red giving the name Red Hepatization in which hepatization is based from liver- like

feature of the lungs, Red liver-like lungs. The WBC then continues their job by infiltrating and

eliminating injurious agents and dead cells in the lungs caused by the phagocytic activity. Gray

hepatization then occurs due to the accumulation of the WBC in the lungs, deposition of fibrin (a

body protein which hardens when blood leaves its usual channels) on pleural surfaces, and

phagocytes in alveoli. Ingestion and removal of degenerated neutrophils, fibrin, and bacteria are

then secreted mechanically through hard coughing resulting to purulent, rusty-colored sputum.

Resolution then occurs when all the infectious and injurious agents are brought out of the lungs

returning lungs to its normal function. On the other hand, alveolar edema could decrease the

intrapleural pressure, elastic recoil and tidal volume; the ability to pressure and gets enough air

thus, impairing ventilation and gas exchange. Impaired ventilation then may impair lung function

which may gradually lead to lung collapse due to absence of air in the lungs, respiratory arrest,

and finally death. So, the body will try to compensate to get adequate supply of oxygen by the

form of increasing in respiration rate for the lungs to have sufficient air. There is respiratory

acidosis if there is abnormal increase of carbon dioxide in the body. On other the way, impaired

gas exchange will decrease the percentage of oxygen and carbon dioxide exchange thus,

resulting to absence of oxygen in the blood which will lead to hypoxemia, systemic hypoxia and

eventually death.

Failure to trap and expel microorganisms in the upper airway may cause the spread and invasion

of the bacteria in the other parts of the lungs especially to the lower airways. This will cause

inflammation to the mucous membranes which leads to mucous secretions as body’s mechanism

to continue trap and remove foreign bodies through mucous clearance. Due to the inflammation

and increased secretions, nasal obstruction and clogging will occur which thickens respiratory

secretions, decreased movement of the cilia and mucous clearance then results. Hard coughing is

a person’s way then to continually remove the blocking substance inside the lungs which may

sometimes lead to fatigue, weakness, loss of appetite, and weight loss due to over exertion of

breathing and accessory muscles. Decreased defense mechanism of the lungs also occurs due to

the decreased ciliary and mucous clearance increasing the risk for spread and transmission of

infection to other parts of the lungs especially in the lower airways. Microorganisms go to the

terminal part of the lungs combining to blood in the bloodstream which leads to septicemia or

infection in the blood, septic shock, and death. Infection may also spread to the other parts of the

body same way through bloodstream which will lead then multiple organ affectation that results

to multiple organ failure, and again death.

Upper panel shows a normal lung under a

microscope. The white spaces are alveoli that contain

air. Lower panel shows a lung with pneumonia under

a microscope. The alveoli are filled with inflammation

and debris.

MEDICAL DIAGNOSIS:

Pneumonia is a serious infection or inflammation of one or both lungs.

Description of Pneumonia

Pneumonia is caused by the inhalation of infected microorganisms (tiny, single-celled living organisms, such as bacteria, viruses, fungi or protozoa) spread through contact with an infected person. The microorganisms enter the body through the mouth, nose and eyes. If the body's resistance is down, the natural process of fighting off diseases is weakened and the microorganisms are free to spread into the lungs and the lungs' air sacs. The air sacs become filled with fluid and pus from the infectious agent, making it more difficult for the body to get the oxygen it needs, and the person may become sick.

Potential complications of pneumonia include pleural effusion (fluid around the lung), empyema (pus in the pleural cavity), hyponatremia (low blood sodium) and rarely, an abscess in the lung.

Causes of Pneumonia

There are over 30 different causes of pneumonia, but the most common causes are bacteria (including mycoplasma) and viruses. Corresponding to these causes are the most common types of pneumonia - bacterial pneumonia, viral pneumonia and mycoplasma pneumonia.

Bacterial pneumonia

Pneumonia-causing bacteria is present in many throats, but when the body's defenses are weakened (for example, by illness, old age, malnutrition or impaired immunity) the bacteria can multiply, working its way into the lungs, inflaming the air sacs and filling the lungs with liquid and pus. The bacteria that cause bacterial pneumonia are streptococcus pneumonia (resulting in lobar pneumonia), hemophilus influenza(resulting in bronchopneumonia), legionella pneumophilia (resulting in Legionnaires' disease) and staphylococcus aureus.

Viral pneumonia

Half of all pneumonias are believed to be caused by viruses, such as influenza (flu), adenovirus, coxsackievirus, chickenpox, measles, cytomegalovirus and respiratory syncytial virus. These viruses invade the lungs and multiply.

Mycoplasmal pneumonia (also called "walking pneumonia")

Similar to bacterial pneumonia, the mycoplasmas multiply and spread, causing infection.

Some of the other pneumonia-related disorders are aspiration pneumonia, chlamydial pneumonia, Loffler's syndrome, pneumocystis carinii pneumonia, pediatric pneumonia and necrotizing pneumonia.

Risk factors include:

65 years of age or older People in nursing homes or other chronic care facilities Male Children under the age of two People with colds or other respiratory infections People with reduced immunity People with other lung diseases, such asthma, cystic fibrosis and lung cancer People with AIDS or HIV Organ transplant recipients People who have had their spleen removed People receiving chemotherapy People who smoke

Alcoholics People with chronic health problems, such as lung disease, heart disease, kidney

disorders, sickle cell anemia or diabetes

Symptoms of Pneumonia

Symptoms vary, depending on the type of pneumoniaand the individual.

With bacterial pneumonia, the person may experience:

shaking chills chattering teeth severe chest pain cough that produces rust-colored or greenish mucus very high fever sweating rapid breathing rapid pulse rate

With viral pneumonia, the person may experience:

fever dry cough headache muscle pain and weakness

These flu-like symptoms may be followed within one or two days by:

increasing breathlessness dry cough becomes worse and produces a small amount of mucus higher fever bluish color to the lips

With mycoplasma pneumonia, the person may experience:

violent coughing attacks chills fever nausea vomiting slow heartbeat breathlessness bluish color to lips and nailbeds diarrhea rash muscle aches

Regardless of the type of pneumonia, the person may also experience the following symptoms:

a loss in appetite feeling ill clammy skin nasal flaring fatigue mental confusion joint and muscle stiffness anxiety, stress and tension abdominal pain

Diagnosis of Pneumonia

To diagnose pneumonia, the doctor begins with a medical history and physical examination. By placing a stethoscope on the chest, the doctor may be able to hear crackling sounds, coarse breathing, wheezing and/or the breathing may be faint in a particular area of the chest. Additionally, the doctor may order a chest x-ray, a sputum gram stain and a blood test. The chest x-ray may show a blotchy-white area, where fluid and pus has accumulated in the lung's air sacs. The sputum grain stain and the blood test may determine the cause and severity of the condition.

If these tests are inconclusive, the doctor may perform a procedure called a bronchoscopy. In this procedure, a flexible, thin and lit viewing tube is inserted into the nose or mouth after a local anesthetic is administered. The breathing passages can then be directly examined by the doctor and specimens from the infected part of the lung can be obtained.

TREATMENT/ MANAGEMENT FOR PNEUMONIA:

Treatment depends on the severity of symptoms and the type of organism causing the infection.

Bacterial pneumonia (caused by the streptococcus pneumonia bacteria) is often treated with penicillin, ampicillin-clavulanate (Augmentin) and erythromycin. Bacterial pneumonia (caused by the hemophilusinfluenza bacteria) is treated with antibiotics, such as cefuroxime (Ceftin), ampicillin-clavulanate (Augmentin), ofloxacin (Floxin), and trimethoprim-sulfanethoxazole (Bactrim and Septra). Bacterial pneumonia (caused by legionella pneumophilia and staphylococcus aureus bacteria) are treated with antibiotics, such as erythromycin.

Viral pneumonia does not respond to antibiotic treatment. This type of pneumonia usually resolves over time. If the lungs become infected with a secondary bacterial infection, the doctor will prescribe an appropriate antibiotic to eliminate the bacterial infection.

Mycoplasma pneumonia is often treated with antibiotics, such as erythromycin, clarithromycin (Biaxin), tetracycline or azithromycin (Zithromax).

In addition to the pharmaceutical intervention, the doctor will also recommend bedrest, plenty of fluids, therapeutic coughing, breathing exercises, proper diet, cough suppressants, pain relievers and fever reducers, such as aspirin (not for children) or acetaminophen. In severe cases, oxygen therapy and artificial ventilation may be required.

The course of pneumonia varies. Recovery time depends upon the organism involved, the general health of the person and how promptly medical attention was obtained. A majority of sufferers recover completely within a few weeks, with residual coughing persisting between six and eight weeks after the infection has gone.

Prevention of Pneumonia

Practice good hygiene. Get an influenza shot each fall. Get a pneumonococcal vaccine. People who stand to benefit most from vaccination are

those over the age 65; anyone with chronic health problems (such as diabetes, kidney disease, heart disease, etc.); anyone who has had their spleen removed; anyone living in a nursing home or chronic care facility; caregivers of the chronically ill (healthcare workers or family caregivers); children with chronic respiratory diseases (such as asthma), and anyone who has had pneumonia in the past (due to increased risk of reinfection). The pneumonococcal vaccine is 90 percent effective against the bacteria and protects against infection for five to 10 years.

Practice good preventive measures by eating a proper diet, getting regular exercise and plenty of sleep.

Do not smoke.

LABORATORY:

>No laboratory results in, still for request. (CBC,Platelet count, CXR AP-L)

DISCHARGE PLANNING:

Instruct the mother to do the following teachings to her child for continuity of care:

>Breathing warm, moist (wet) air helps loosen the sticky mucus that may make you feel like you are choking. These things may help:

Place a warm, wet washcloth loosely over your nose and mouth. Fill a humidifier with warm water and breathe in the warm mist.

>Coughing helps your lungs clear your airways. Take a couple of deep breaths 2 to 3 times every hour. Deep breaths will help open up your lungs.

>Tap your child’s back gently if there are secretions, to loosen them.

> Do not allow smoking in your home.

>Increase fluid intake(as long as your doctor says it is okay):

Drink water, juice, and weak tea. Drink at least 8to 12 cups a day.

>Get plenty of rest when you go home..

>Keep the child’s back dry always.

>Observe proper hygiene.

> feed the child with nutritious foods specially fruits that are rich in Vitamin C to enhance child’s immune system.

Medicines:

Continue medications per doctor’s order and do not use the medication for self-treating

with other health problems.

University of LuzonCollege of Nursing

Dagupan City

A Case Study of

(In partial fulfillment of the requirements in the subject NCM 102- RLE)

Submitted by:

ARGELY BERNAL (PPH/Pedia/ mtw/7-3)

Submitted to: MRS. MINERVA PAMUTAN (Clinical Instructor)