ASSIGNMENT OF PEDIATRIC HEALTH NURSING
SUBMITTED TO : MA’M SAMAWIA
SUBMITTED BY : ATIQA NOREEN
ROLL NO : 18-BSN-10
TOPIC : PNEUMONIA
CASE STUDY ON PNEUMONIA
On admission Mr. Muneer brought with a complain of fever since 5
days, cough since 8 days, and breathlessness since 2 days. H/O Present
Illness:2 years old male child was admitted in General ward with fever
on and off, cough and breathing difficulty. H/O Past Illness: Had a
history of viral fever with cold and cough 2 months before.
DEMOGRAPHIC HISTORY
NAME- Muneer
AGE- 2 years
SEX- Male
DOB- 26/09/2013
DOA- 14/10/2015
DOCTOR INCHARGE- Dr. Salman
WARD- General Ward
DIAGNOSIS-Pneumonia
ANTENATAL- Mother attended check up regularly, no illness during
pregnancy, taken 2 doses of TT.
INTRANATAL- Born through NVD, conducted by skilled person at
hospital, no complications, no evidence of birth injury, cried
immediately after birth, baby weight was 2.6 kg.
POSTNATAL- No complication, baby was pink and active, breast
feeding started after1/2 an hour, no evidence of congenital anomalies.
IMMUNIZATION :Taken all immunization according to the age group
(BCG, DPT, MEASLES,OPV)
ANTHROPROMETRY Length-75 cm Weight-11kgs Head circum-45 cm
Chest circum-48 cm Mid arm circum-14 cm
PHYSICAL DEVELOPMENT: Have weight 11kgs, have temporary teeth,
pulse rate-110/m, Resp. rate-30.
MOTOR DEVELOPMENT:
A. Gross motor-steady gait, walks on heel toe, walks up and down
upstairs holdings wall.
B. Fine motor- picks up objects from floor, can build tower of 6-7 cubes,
turn pages one at a time, drink with glass.
ERIKSON STAGE OF DEVELOPMENT : Autonomy vs. Shame and Doubt
Occurs in the toddler age. (18 months-3 years).
Child learns to feed themselves and do things on there own.
Or they could start feeling ashamed and doubt their abilities.
Questions the child's willpower.
FREUD STAGE OF DEVELOPMENT :ANAL STAGE: According to Sigmund
Freud it is the second stage of oral development that occurs between 1
½ until 3 years of age, in which the child’s greatest pleasure involves
the anus or the eliminative functions associated with it. Child is getting
proper toilet training.
JEAN PAIGET STAGE OF DEVELOPMENT: The Sensorimotor Period (0-2
yrs.) According to Jean Piaget , Infants and toddlers "think" with their
eyes, ears, hands, and other sensorimotor equipment. They learn to
generalize their activities to a wider range of situations and coordinate
them into increasingly lengthy chains of behavior.
If consistent nurture is experienced, one will develop a sense of trust
and safety about the universe and the divine. Conversely, negative
experiences will cause one to develop distrust with the universe and
the divine. Transition to the next stage begins with integration of
thought and languages which facilitates the use of symbols in speech
and play.
FAMILY TREE: Nuclear family, 4 members, father, mother, elder sister.
DRUG FORM 1. ANGUMENTIN 300 mg IV TDS BACTERIOCIDAL 2.
AMIKACIN 75 mg IV BD BACTERIOCIAL 3. SYP. NOBLE PLUS 4 ml PO TDS
NON-OPOID ANALGESIC 4. IPRAVENT NEBS 1 ml PN QID BRONCHO
DILATOR 5. VANCOMYCIN 200 mg IV BD ANTI-INFECTIVE
INVESTIGATION PATIENT’S LAB VALUES
• TLC 27.31 10^3/microL 5-15 10^3/microL • HAEMOGLOBIN 10.9
gm/dl 11-14 gm/dl • ABORH B +ve - • PLATELETS 531 10^3/microL 150-
450 10^3/microL • URINE R/E NORMAL • SECIFIC GRAVITY 1.15 1.003-
1.035
HEAD TO TOE EXAMINATION
Respiratory-dyspnea, nasal flaring.
Rest of the findings were normal.
VITAL SIGNS 1. Temperature-100F 2. Heart rate-122/m 3. Respiration-
36/m
INTRODUCTION: Pneumonia is inflammation of the lung that is most
often caused by infection with bacteria, viruses, or other organisms.
Occasionally, inhaled chemicals that irritate the lungs can cause
pneumonia. Healthy people can usually fight off pneumonia infections.
However, people who are sick, including those who are recovering from
the flu (influenza) or an upper respiratory illness, have a weakened
immune system. This makes it easier for bacteria to grow in their lungs.
The World Health Organization (WHO) 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.
Approximately one-half of children younger than five years of age with
community- acquired pneumonia (CAP) require hospitalization.
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.
The mortality rate in developed countries is low (<1 per 1000 per year).
In developing countries, respiratory tract infections are not only more
prevalent but more severe, accounting for more than 2 million deaths
annually.
Pneumonia is the number one killer of children in the WORLD.
BOOK DESCRIPTION PATIENT’S PICTURE 1. Bacterial infections 2. Viral
or Fungal infections 3. Aspiration pneumonia 4. Who had a recent viral
infections 5. People with low immune system 6. Hospital acquired
pneumonia 7. Community acquired pneumonia. Mr. Muneer had recent
viral infections 2 months before.
INFECTIONS, ASPIRATIONS, LOW IMMUNITY, POLLUTANTS ETC.
NEUTROPHILLIC/LYMPHOCYTIC INFILTRATIONS ACUTE/CHRONIC
INFLAMMATION
INCREASED CAPILLARY PERMEABILITY FLUID/CELLULAR EXUDATION
EDEMA OF MUCUOUS MEMBRANE HYPERSECREATION OF MUCUS
PERSISTENT COUGH, STAGES OF CONGESTION IN THE ALVEOLAR
SPACES WITH FLUID AND HEMORRHAGIC EXUDATES
BOOK’S PICTURE PATIENT’S PICTURE 1. History taking 2. Physical
examination 3. Chest X-ray 4. Blood test, blood culture 5. Sputum
examination 6. Bronchoscopy 7. Pleural fluid culture 8. Pulse oximetry
9. CT-scan 10.CBC 1. Patient history taken 2. Physical examination 3.
Chest X-ray 4. Blood test
PHARMACOLOGICAL MANAGEMENT : The choice of an initial, empiric
agent is selected according to the susceptibility and resistance patterns
of the likely pathogens and experience at the institution and the
selection is tempered by knowledge of the delivery of the drugs to the
suspected infected sites with the lungs. 1. Antibiotics agents 2. Anti
inflammatory therapy 3. Anti viral 4. Bronchodilators
CHEST PHYSIOTHERAPY 1. Postural drainage 2. Surgical Management
3.Drainage of plural effusion by continuous suction Reduction of
pneumothorax
NURSING DIAGNOSIS
1. Ineffective airway clearance related to inflammation and
accumulations of secretions as evidenced by cough with sputum
productions.
2. Impaired gas exchange related to alveolar capillary membrane
changes as evidenced by tachycardia and restlessness.
3. Hyperthermia related to inflammatory process as evidenced by
increased body temperature.
4. Risk for fluid volume deficit related to inadequate oral intake, fever,
as evidenced by poor skin turgor.
5. Imbalanced nutrition less than body requirement related to disease
condition as evidenced by refusal of food by child.
PLANNING :
To Teach parents about signs and symptoms of pneumonia.
To teach about fluid intake.
To Give proper rest and sleep.
To make child to sleep in head elevated at 30 degree to ease the
breathing.
NURSING INTERVENTIONS :
Use humidified oxygen or humidifier at the bedside.
Monitor serial chest x-rays, ABGs, pulse oximetry readings.
Assist with bronchoscopy and/or thoracentesis, if indicated.
Anticipate the need for supplemental oxygen or intubation if the
patient’s condition deteriorates.
Suction as indicated: frequent coughing, adventitious breath
sounds, desaturation related to airway secretions.
Maintain adequate hydration by forcing fluids to at least 3000
mL/day unless contraindicated (e.g., heart failure).
Offer warm, rather than cold, fluids.
Teach and assist the patient with proper deep-breathing
exercises. Demonstrate proper splinting of the chest and effective
coughing while in an upright position. Encourage patient to do so
often.
Elevate the head of the bed, change position frequently.
EVALUATION :
Parents learned about sign and symptoms of pneumonia
Client learn about adequate fluid intake
Client is able to cope up with the situation
