Introduction (Introduction/Definition of Disease and origin)

Pneumonia is an infection that inflames the air sacs in one or both lungs. Most pneumonia occur when a breakdown in your body's natural
defenses allows germs to invade and multiply within your lungs, the air sacs may fill with fluid or pus (purulent material), causing cough with phlegm,
fever, chills, and accompanied with difficulty of breathing. Pneumonia is sometimes caused by viral infections, including RSV (Respiratory syncytial
virus), the parainfluenza virus, adenovirus, and the flu. Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants
and young children, people older than age 65, and people with health problems or weakened immune systems. There are many types of pneumonia,
these can be bacterial, viral, mycoplasmic, and other forms of pneumonia. One of these are the bacterial type streptococcus pneumoniae. These are
lancet-shaped gram-positive facultative anaerobic bacteria with more than 100 known serotypes. S. pneumoniae is one of the common causes of middle
ear infections, meningitis or sinus infections, sepsis in children and also pneumonia in immunocompromised individuals and elderly which is also the one
responsible for Pediatric Community-Acquired Pneumonia.

PCAP is classified into four types. First is, PCAP A, which has a minimal risk, there is no dehydration, with a respiratory rate of greater than 30-
50/min. Second is, PCAP B, which has a low risk, there is mild dehydration, with a respiratory rate of greater than 30-50/min. Third is, PCAP C, which
has a moderate risk, with moderate dehydration, with a respiratory rate of greater than35-60/min. Fourth is, PCAP D, which has a high risk, with severe
dehydration with a respiratory rate of greater than 35-70/min. But in this case, the patient has a PCAP C. Community-acquired pneumonia (CAP) is one
of the classifications of pneumonia, 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 (HAP). CAP is a common and potentially serious illness, associated with considerable
morbidity and mortality, particularly in older adult patients and those with significant comorbidities.

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 Anatomy and Physiology

The lungs are the principal organs of respiration. Each lung is cone-shaped, with its base resting on the diaphragm and its apex extending superiorly
to a point about 2.5 cm above the clavicle. 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 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.
Air is inhaled through nose or mouth than passed to the trachea and then to the bronchial tree for the exchange process. Finally, the oxygenated
blood is carried back to the heart through pulmonary veins and the circulated to the entire body.
• Nose or Mouth – Air is inhaled into the body through nose or lungs.
• Trachea – Inhaled air is passed through it to bronchi. It is also a flexible tube, 10 to 12 cm (4 inches) long and 2.5 cm (1 inch) in diameter.
• Bronchi – They are tubular branches through which inhaled air is passed to lungs. It is further divided into microscopic tubular branches called
bronchioles.

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 • Alveoli – A cluster of microscopic air sacs is called Alveoli and it has many capillary veins in their walls. Gaseous exchange takes place here i.e.
oxygen from the air is absorbed into blood and carbon dioxide from blood travels to alveoli for exhalation.
• Pleura – It is a thin tissue layer that covers the lungs. It acts as a lubricant allowing Lungs to slip smoothly as they expand and

Functions
• The main function of lungs is to maintain gaseous exchange called respiration.
• Act as a blood reservoir and help the heart to function more efficiently.
• Maintains body PH balance by expelling unwanted gas (carbon dioxide) and protects the body.
• Lungs from becoming acidic.
• Immunoglobulin A is secreted within the lungs and protects it from infections.
• Cilia clears the dust particles trapped in the respiratory passage by expelling it in the form of cough or in the digestive system.
• Lungs can filter small blood clots.
Mechanics of Breathing

To outwards as well. This creates negative pressure within the lungs, and so air rushes in through
the upper and lower airways.
Expiration is mainly due to the natural elasticity of the lungs, which tend to collapse if they are not
held against the thoracic wall. This is the mechanism behind lung collapse if there is air in the
pleural space (pneumothorax).
Take a breath in, the external intercostal muscles contract, moving the ribcage up and out. The
diaphragm moves down at the same time, creating negative pressure within the thorax. The lungs
are held to the thoracic wall by the pleural membranes, and so expand

3
Physiology of Gas Exchange

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 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.

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 Nursing Assessment 1
ASSESSMENT FORM

PATIENT PROFILE

Name: Aksha Kate T. Mangumpit Age: 2 Sex: F Status: Child

Address: Sinuyak, Katipunan, Zamboanga de Norte Religion: Roman Catholic

NURSING ASSESSMENT I
A. Chief complaints:
Fever and Cough

B. Impression/ Admitting diagnosis

PCAP – C- Pediatric Community- Acquired Pneumonia
W/A

C. History of Present Illness (HPI) (location, onset, character, intensity, duration, aggravation and alleviation, associated symptoms, previous
treatment and result, social and vocational responsibilities).
4days PTA, patient manifested colds associated with cough. 3 days prior to admission condition was associated with fever given with
paracetamol and has partial relief.

5
D. History of Past illness (previous hospitalization, injuries, procedures, infectious disease, immunization/health maintenance, major illness,
allergies, medication, habits, birth and development history, nutrition – for pedia).
Patient has hospitalized due to fever and cough in the month of August. Patient has no injury, infectious disease and (-) allergies. Patient has
complete immunization.
E. Heath Habits
Frequency Amount Period

1. Tobacco X X X

2. Alcohol X X X

3. OTC drugs/non-prescription X X X
drugs

F. Family History with Genogram

6
G. Patient’s Perception of
Present Illness:
“Para sa amoa hasol jod siya, nabalaka lagi ko kay ni balik na pod iyang ubo ug hilanat” as verbalized by patient’s mother.

Hospital Environment:
“Okay ra,limpyo ra pud sya, dili ra gubot” as verbalize by patients mother.

H. Summary of Interaction
The patient can react to verbal stimulus correctly and in a meaningful way. The patient’s eyes open spontaneously. The patient’s mother was
interactive, responds well to questions and answers appropriately. The interaction was

7
 REVIEW OF SYSTEM
Name: Khrishia Gyll. E. Saldia Date: October 5, 2022
Vital Signs
Temperature: 37
Pulse: 132bpm Height:
Respiration: 30 Weight:5.8kg
Blood Pressure: Observation: Pt. appears lethargic

Pt. appears lethargic and skinny. A D5LR is attached with antibiotic Metronidazole @25gtts/cc at the right foot. The upper and lower
1. General
extremities of the patient is not proportionate to the abdomen size, it is much thinner whereas abdomen is largely distended (18 inches).

Head – round, no bumps, no tenderness, no lesions or masses, no injury. Pt. has headache.
Eyes – patient’s eyes are symmetrical in shape and iris are black.
Ears – no hearing impairment observable, there’s slight cerumen present on both side of the ears
2. HEENT
Nose – no allergies, no epistaxis. There is no nose discharge.
Throat – patient has no difficulty swallowing, no tonsil inflammation. Slight hoarseness of voice is noted. There are 6 teeth on upper and
lower mouth.

8
 Patient’s lower extremities and back is covered with birth mark that resembles a bruise. No lesions present. pt. has good skin turgor, skin is
3. Integumentary warm, and has equal hair distribution. There are no lice present in patient’s head, hair is smooth and clean. Nails are short and trimmed
cleanly.

Pt. reported no chest pain. Chest wall is symmetric and there’s equal chest expansion. Pt. has cough. RR: 47
4. Respiratory
There are no abnormal sounds heard upon auscultation.

The external chest is free of heaves, lifts and thrills. Pt. felt no tightness, no dryness, and no palpitation. Pulses are strong and palpable in
5. Cardiovascular both hands. Capillary refill <2

No loss of appetite, no weight loss, no dysphagia, no indigestion. Stool appeared normal – a semi solid brownish stool without blood. An
enlarged and globular abdomen can be observed, there’s no abdominal pain even when palpated. Abdominal circumference is 40. 64cm.
6. Digestive

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 Pt. sometimes urinates deep amber urine but also pale yellow most of the time. No nocturia, no dysuria, no hematuria. Urinated for at least
4x in the morning before 8am.
7. Excretory

Pt. has no joint pain, no swelling or edema, and no redness. Pt. has muscle weakness on her lower extremities and cannot ambulate due to
8. Musculoskeletal
the heaviness of the enlarged abdomen. Pt. can only sit up and lie down.

9. Nervous GCS 15: Pt. is conscious. There’s normal plantar reflex. Pt. appears lethargic.

10. Endocrine No weight loss and polyuria noted.

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 NURSING ASSESSMENT II
(GORDON’S 11 FUNCTIONAL PATTERN )

Name of Patient: Patient X Age:1 year and 7 mos. Sex: F

Chief Complaints: Vomiting Inclusive Dates of Care: OCT 19, 2022
Impression/Diagnosis:Acute dyspepsia with moderate dehydration Allergies: none
Date of Admission:
Diet: breastmilk
Type of Operation (if any):none

Before Clinical Appraisal

Normal Pattern
Hospitalization DAY 1 DAY 2 DAY 3 DAY 4
1. Health • Mother of the • Mother of the • Mother of the • Mother of the client • Mother of
client state client stated that client stated that stated that it is the client
Perception/Health
that health is it is very it is very very important to stated that it
management Pattern always and important to take important to take take care of our is very
will always be care of our health care of our health and we important to
her top most and we should health and we should be mindful take care of
priority. be mindful of should be of what we eat and our health
• Completed as what we eat and mindful of what what we do. and we
claimed as what we do. we eat and what • Complete as should be
stated by • Complete as we do. claimed as stated mindful of
mother claimed as stated • Complete as by the mother what we eat
• Mother of by the mother claimed as • Mother of the client and what we
client forgot if • Mother of the stated by the forgot if when was do.
when the last client forgot if mother the last time her • Complete as
time was her when was the • Mother of the child got claimed as
child got last time her child client forgot if immunix=zed. stated by the

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 immunized. got when was the • Mother of the client mother
• Mother of the immunix=zed. last time her stated that her • Mother of
client stated • Mother of the child got child has no the client
that her child client stated that immunix=zed. allergies. forgot if
has no her child has no • Mother of the • Mother of the client when was
allergies. allergies. client stated that stated that her the last time
• Mother of the • Mother of the her child has no child’s health is her child got
client stated client stated that allergies. now recovering immunix=ze
that her health her child’s health • Mother of the • Mother of the client d.
and her child’s is now recovering client stated that stated that she • Mother of
health is great • Mother of the her child’s health always includes the client
• Mother of client stated that is now vegetables and stated that
client stated she always recovering fruits when feeding her child has
that she includes • Mother of the her child in order no allergies.
always vegetables and client stated that for him to be • Mother of
includes fruits when she always healthy. the client
vegetables feeding her child includes stated that
and fruits in order for him vegetables and her child’s
when feeding to be healthy. fruits when health is
her child in • feeding her child now
order for him in order for him recovering
to be healthy to be healthy. • Mother of
• Mother of the • the client
client stated stated that
that she didn’t she always
know what the includes
exact cause of vegetables
illness of her and fruits
child is. when
feeding her
child for him
to be
healthy.

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2. Nutrition – Metabolic • Mother of the • Mother of the • Mother of the • Mother of the client • Mother of
client stated client stated that client stated that stated that it is the client
Pattern
that she let she prepares she prepares very important to stated that it
her child eat lugaw for her lugaw for her take care of our is very
cerelac. child and also child and also health and we important to
Sometimes banana. banana. should be mindful take care of
fruits and • Mother of the • Mothe of the of what we eat and our health
vegetables. client stated that client stated that what we do. and we
• Mothe of the her child does her child does • Complete as should be
client stated not want to eat not want to eat claimed as stated mindful of
that her child bread bread by the mother what we eat
does not want • Mother of the • Mother of the • Mother of the client and what we
to eat bread client stated that client stated that forgot if when was do.
• Mother of the her child’s daily her child’s daily the last time her • Complete as
client stated fluid intake is fluid intake is child got claimed as
that her child’s around 2 to 3 around 2 to 3 immunix=zed. stated by the
daily fluid glasses a day. glasses a day. • Mother of the client mother
intake is • Mother of the • Mother of the stated that her • Mother of
around 2 to 3 client stated that client stated that child has no the client
glasses a day. her child’s weight her child’s allergies. forgot if
• Weight: from decreased weight • Mother of the client when was
9kg to 8.5kg • Moderately good decreased stated that her the last time
• Moderately appetite • Moderately good child’s health is her child got
good appetite • Mother of the appetite now recovering immunix=ze
• Mother of the client stated that • Mother of the • Mother of the client d.
client stated there are no client stated that stated that she • Mother of
that there are problems in there are no always includes the client
no problems in eating and in problems in vegetables and stated that
eating and in breastfeeding her eating and in fruits when feeding her child has
breastfeeding child. breastfeeding her child in order no allergies.
her child. • Heal poorly her child. for him to be • Mother of
• Heal poorly • Upon expecting • Heal poorly healthy. the client
• No skin her child’s skin , • Upon expecting Mother of the client stated stated that

13
 problem and there is dryness her child’s skin , that she didn’t know what her child’s
no dental present there are there is dryness the exact cause of the health is
problems. no dental present there are illness of her child is. now
problem as no dental recovering
observed. problem as
observed.

3. Elimination Patient bowel pattern • Client urinates at • Client urinates at • Client urinates at • Client
is every other day, least 3x in every least 3x in every least 3x in every 8 urinates at
a. Urine (frequency, usually in the 8 hours and the 8 hours and the hours and the least 3x in
color, morning. urine color is urine color is urine color is clear. every 8
clear. clear. hours and
transparency) • Oliguria is noticed the urine
• Oliguria is • Oliguria is due to
Urinates frequently color is
b. Bowel (frequency, noticed due to noticed due to dehydration.
(8x a day). Yellowish clear.
dehydration. dehydration.
color) in color. • Client eliminates • Oliguria is
• Client eliminates • Client eliminates 2x within 8 hours
noticed due
2x within 8 hours 2x within 8 hours with no discomfort, to
Patient is satisfied in with no with no but the stool is dehydration.
her bowel regularity. discomfort but discomfort, but watery.
Yellow in color the stool is the stool is • Client
• Client urinates 2x
watery. watery. eliminates
within 8 hours with
2x within 8
• Client urinates 2x • Client urinates

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 within 8 hours 2x within 8 hours no discomfort. hours with
with no with no no
Proper hygiene is advised
discomfort. discomfort. discomfort
to counter bad odor.
but the stool
• Proper hygiene is • Proper hygiene
are watery.
advised to is advised to
counter bad counter bad • Client
odor. odor. urinates 2x
within 8
hours with
no
discomfort.
Proper hygiene is
advised to counter
bad odor.
4. Activity and Exercise • No breathing • No breathing • No breathing • No breathing
pattern problem problem problem observed. problem
Patient considered
observed. observed. observed.
running, playing, • No cough
(Oxygenation and Vital walking as activity • No cough • No cough observed. • No cough
signs) exercise. observed. observed. observed.
• No since client is
a. Respiratory rate • No since client is • No since client is lethargic. • No since
Mother of the client lethargic. lethargic. client is
Client isn’t doing any
b. Pulse rate lethargic.
stated that her child • Client isn’t doing • Client isn’t doing activities as observed
doesn’t have a any activities as any activities as because she always Client isn’t doing
c. Heart rate problem in breathing. observed observed asleep. any activities as
because she because she observed because
d. Blood pressure she always asleep.
always asleep. always asleep.
Mother of the client

15
 e. Lung sounds stated that her child
doesn’t have any
f. History of cough.
respiratory
problems Mother of the client
stated that her child
plays with her toys.

5. Cognition and Perception • In relation to • In relation to her • In relation to her • In relation to her In relation to her
Pattern- Neuro – Sensory her age, pt. age, pt. age, pt. age, pt. expresses age, pt. expresses
expresses her expresses her expresses her her stress through her stress through
a. Mental sate stress through stress through stress through crying. Whenever crying. Whenever
crying. crying. Whenever crying. she cries, her she cries, her
b. Condition of 5 sense:
Whenever she she cries, her Whenever she parent, specifically parent, specifically
(sight, hearing, smell, cries, her parent, cries, her parent, his mother, his mother, cuddles
parent, specifically his specifically his cuddles her or her or sometimes
taste, touch) specifically his mother, cuddles mother, cuddles sometimes breastfeed her
mother, her or sometimes her or breastfeed her
cuddles her or breastfeed her sometimes
sometimes breastfeed her
breastfeed her

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6. Sleep and Rest Pattern • Mother of the • Mother of the • Mother of the • Mother of
client stated that client stated that client stated the client
Patient usually sleeps
her child’s her child’s that her stated that
at 8pm and wakes up
sleeping hour is sleeping hour is child’s her child’s
at 7am.
5am and 5am and sleeping hour sleeping
Take a nap 12pm , sometimes 7pm sometimes 7pm. is 5am and hour is 5am
awake at 2pm. sometimes and
• Client is always • Client is always
7pm. sometimes
asleep and asleep and does
7pm.
does not not engage in • Client is
Mother of the client
engage in any any particular always • Client is
stated that her child’s
particular activities. asleep and always
sleeping hour is 9 pm.
activities. does not asleep and
• Mother of the engage in does not
• Mother of the client stated that
any particular engage in
Mother of the client client stated that her child always
activities. any
stated that whenever her child always wakes up at
particular
her child’s wakes up, wakes up at dawn and • Mother of the
activities.
she always plays with dawn and started to cry. client stated
her toys and walk started to cry. that her child • Mother of
around. • Mother of the always wakes the client
• Mother of the client stated that
up at dawn stated that
client stated that her child is
and started to her child
her child is always asleep
Mother of the client cry. always
always asleep and only wakes
stated that her child wakes up at
and only wakes up when eating
has no sleeping dawn and
up when eating and taking meds.
problems. started to
and taking
cry.
meds.
Mother of the client
stated that her child

17
 rest after playing with
her toys.

7. Self-Perception and Self - Considering pt.’s Considering pt.’s age, Considering pt.’s age, Considering pt.’s Considering pt.’s
Concept Pattern-Ego age, she still doesn’t she still doesn’t have she still doesn’t have age, she still doesn’t age, she still
Integrity have her own self her own self perception her own self perception have her own self doesn’t have her
perception perception own self
a. Perception of self
Crying is her coping Crying is her coping
perception
Crying is her coping mechanism, and her mechanism, and her Crying is her coping
b. Coping Mechanism mechanism, and her support mechanism is support mechanism is mechanism, and her Crying is her
support mechanism her mother at her side. her mother at her side. support mechanism coping
c. Support Mechanism is her mother at her is her mother at her mechanism, and
• There is frequent • There is frequent
side. side. her support
d. Mood / Affect mood changes. mood changes.
mechanism is her
• There is no • There is
mother at her side.
frequent mood frequent
changes. mood There is frequent
changes. mood changes.

18
8. Roles and Relationship Mother of the client • Mother of the • Mother of the • Mother of the • Mother of
Pattern stated that she lives client stated that client stated that client stated the client
together with her it is only her and it is only her and that it is only stated that it
aunt. her aunt will take her aunt will take her and her is only her
care of the child. care of the child aunt will take and her
care of the aunt will
• Mother of the • Mother of the
Mother of the client child take care of
client stated that client stated that
stated that she does the child
she lives she lives • Mother of the
not have any
together with her together with her client stated • Mother of
problems in her
aunt. aunt. that she lives the client
family.
together with stated that
• Mother of the • Mother of the her aunt. she lives
client stated that client stated that together
Mother of the client she does not she does not • Mother of the
with her
stated that she prays have any have any client stated
aunt.
whenever problems problems in her problems in her that she does
arise within her family. family. not have any • Mother of
family. problems in the client
• Mother of the • Mother of the her family. stated that
client stated that client stated that she does
she prays she prays
not have
whenever whenever
any
problems arise problems arise
problems in
within her family. within her family.
her family.
.

19
PATHOPHYSIOLOGY

20
 Summary of Laboratory and Diagnostic Procedures

HEMATOLOGY

TEST RESULT NORMAL VALUES NURSING IMPLICATION

Complete Blood Count:

Red Blood Cells 4.53 3.80-5.20 Normal
Hemoglobin 11.9 11.50-15.20 Normal
Hematocrit 36.20 35.00-46.00 Normal
White Blood Cells 7.0 3.5-10-.0 Normal
Platelet Count 192 150-400 Normal
MHC 26.4 26-34 Normal
MCV 79.9 77-97 Normal
MCHC 33.0 32-35 Normal
RDW-CV 15.60 11.0-17.0 Normal
MPV 9.40 8.00-11.00 Normal

Differential Count
Segmenters 53.4 40.0-73.0 Normal

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Lymphocytes 38.8 15.0-45.0 Normal
Monocytes 6.5 4.0-12.0 Normal
Eosinophils 0.2 0.5 – 7.0 Decrease
basophils 1.1 0.0-2.0 Normal

Summary of Intravenous Fluid

Intravenous Fluids Date/Time

Date/Time Started Drop Rate No. of Hours
& Volume Consumed

10/05/22 – 8:00 am
10/06/22 – 8:00 am
1. D5LR 35 CC/HR Not indicated in the Not indicated in the
2. D5LE WITH SOLUCET 50 CC/HR record record

22
 Summary of Medications
Date Medication Remarks
No remarks

October 2022 • Ampicillin 425mg IV q 6 hours

• Salbutamol + Ipratropium 1 ne q 8 hours
• Paracetamol 250/5 2.5ml q 4hours PRN for fever
• Zinc sulfate 2.5 ml OD

23
 Drug Study of Medications
GENERIC NAME: PARACETAMOL
BRAND NAME: TYLENOL
DRUG CLASSIFICATIONS: ANTIPYRETIC

DOSAGE, INDICATIONS MECHANISMS OF SIDE AND ADVERSE CONTRADICTIONS NURSING

FREQUENCY, ACTIONS EFFECT RESPONSIBLITIES
ROUTE
Dosage: 500 Temporary Reduces fever by • CNS: headache • Contraindicated with • Discontinue drug if
mg / tab reduction of fever, acting directly on the allergy to hypersensitivity
temporary relief of hypothalamic heat – • CV: chest pain, acetaminophen reactions occur
Frequency: dyspnea,
minor aches and regulation center to the
q4h
pains caused by cause vasodilatation myocardial • Reduces fever by • Avoid using multiple
common cold and and sweating damage when acting on preparations containing
Route: PO
influenza, doses of 5-8g/day hypertension to acetaminophen.
headache, sore are ingested daily cause vasodilatation Carefully check all OTC
throat, toothache, for several weeks and sweating
• Do not exceed the
backache, or when doses of
recommended dosage.
menstrual cramps. 4g/day are
ingested for 1yr • Reduce dosage with
hepatic impairment.
• GI: hepatic
toxicity and
failure, jaundice
• GU: acute renal
failure, renal
tubular necrosis
• Hematologic:
methemoglobine
24
 mia- cyanosis;
hemolytic
anemia-
hematuria, anuria;
neutropenia,
leukopenia,
pancytopenia,
thrombocytopenia
, hypoglycemia
• Hypersensitivity:
rash, fever

25
GENERIC NAME: SULBUTAMOL + IPRATROPIUM
BRAND NAME: DUAVENT
DRUG CLASSIFICATION: BRONCHODILATOR
DOSAGE, INDICATIONS MECHANISMS OF SIDE AND ADVERSE CONTRADICTIONS NURSING
FREQUENCY, ACTIONS EFFECT RESPONSIBLITIES
ROUTE
Dosage : 1ml Management of Ipratropium is a • Hypersensitivity • Hypersensitivity to soya •Medical background –
reversible nonselective reactions (e.g. lecithin or related food includes medical history
Frequency:
bronchospasm competitive urticaria, products e.g., soybeans and ongoing
q24h
associated with antimuscarinic agent. It angioedema, rash, or peanuts; and to any medications
Route: inhaled obstructive airway causes bronchodilation anaphylaxis, component of Duavent
•Physical - Skin color,
route by blocking the action of bronchospasm, or to atropine and its
diseases (eg, lesions, texture; T;
acetylcholine-induced oropharyngeal derivatives. Hypertrophic
bronchial orientation, reflexes,
stimulation of guanyl oedema) obstructive
asthma). bilateral grip strength;
cyclase, hence reducing cardiomyopathy or
affect; ophthalmic exam;
formation of cyclic tachyarrhythmia.
P, BP; R, adventitious
guanosine
For patients with monophosphate sounds; bowel sounds,
chronic normal output; normal
(cGMP) at
obstructive urinary output, prostate
parasympathetic site.
pulmonary palpation
disease (COPD)
•Baseline lung sounds
on a regular
Salbutamol activates
inhaled •Store below 25°C. Do
adenyl cyclase, the
bronchodilator not freeze. Protect from
enzyme that stimulates
who continue to light
the production of cyclic
have evidence
adenosine-3’, 5’-
of bronchospasm monophosphate

26
 and who (cAMP).
require a second
bronchodilator

GENERIC NAME: ZINC SULFATE

BRAND NAME: ZINCATE
CLASSIFICATION OF DRUGS: MINERAL AND ELECTROLYTE REPLACEMENTS/SUPPLEMENTS
DOSAGE, INDICATIONS MECHANISMS OF ACTIONS SIDE AND ADVERSE CONTRADICTIONS NURSING
FREQUENCY EFFECT RESPONSIBLITIES
, ROUTE
Dosage: 10 • Replacement • Zinc facilitate wound • Gastric irritation • Hypersensitivity • Monitor
mg/ml and healing, helps maintain or allergy to any progression of
• Nausea components in
supplementation normal growth, normal zinc deficiency
2 ml OD the formulation.
therapy in skin hydration and the • Vomiting symptoms during
Frequency: patients who are senses, taste and • Use cautiously therapy.
RDA at risk for zinc smell • Diarrhea in renal failure
• Encourage
recommende deficiency • Abdomen pain patient to comply
d daily
• Treatment for with the diet
allowance
ache and recommendation.
Route: IV rheumatoid
• Ask the patient to
notify any of the
healthcare team if
he feels nausea,
vomiting,
abdominal pain or

27
 tarry stools occur
• Emphasize the
importance follow
up exams

GENERIC NAME: AMPICILLIN

BRAND NAME: PENICILLIN
DRUG CLASSIFICATION: ANTIBIOTIC
DOSAGE, INDICATIONS MECHANISM OF ACTION SIDE AND ADVERSE CONTRAINDICATIONS NURSING
FREQUENCY, EFFECT RESPONSIBILTIES
ROUTE
Dosage: Treatment of Bactericidal action against CNS: lethargy, Contraindicated with check doctor’s order
infections caused by sensitive organisms; inhibits hallucinations, seizures allergies to Penicillis,
max 14 • Assess for
susceptible strains of synthesis of bacterial cell cephalosporins, or
g/day allergies to
Shigella, Salmonella, wall, causing death other allergens
Penicillins,
min 2g/day S. Typhosa, E.Coli, CV: heart failure
cephalosporins,
Haemophilus
Frequency: Q6H Influenzae, or other allergens
Proteus Interactions:
Route: IVTT (In mirabilis, Neisseria GI: glossitis, stomatitis, • Assess for renal
gonorrhoeae > drug-drug: increased
Vitro gastritis, sore mouth, disorders,
effect with probenecid;
Transcription > meningitis caused furry tongue, black lactation
increased risk of rash
and Translation) by Neisseria “hairy” tongue, nausea,
with allopurinol; • Culture infected
increased bleeding

28
meningitidis vomiting, diarrhea effect with heparin, oral area; skin color,
anticoagulants; lesion;
> prevention of
decreased adventitious
bacterial endocarditis
GU: nephritis effectiveness with sounds
following dental, oral,
tetracyclines,
or respiratory • Monitor renal
chloramphenicol,
procedures in very function tests
high-risk patients Hematologic: anemia, decreased efficacy of
thrombocytopenia hormonal
> prohylaxis in contraceptives, atenolol
caesarean section in with ampicillin
certain high-risk Hypersensitivity: rash,
patients fever, wheezing,
anaphylaxis

Local: pain, phlebitis,

thrombosis at injection
site (parenteral)

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 MEDICAL MANAGEMENT

IDEAL ACTUAL

Anti-bacterial Drugs

Salbutamol
Antibiotics Ampicillin
salbutamol
Ampicillin

Antipyretic Drugs
Paracetamol
Paracetamol Zinc sulfate
Aspirin
Naproxen

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 SURGICAL MANAGEMENT

IDEAL ACTUAL

Chest Tubes Treatment

-to drain infected plural fluid
• Antibiotics-these medication may used to treat bacterial
pneumonia
Thoracotomy
• Cough medication-this medication may be used to calm the cough
-involves incision to open the chest and view the lungs so that dead and
so that you can rest
damaged tissue can be removed
• Fever reducers/Pain reliever-you may take this for fever and
discomfort
Labectomy
-removing a part of the lung affected by pneumonia

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 NURSING MANAGEMENT

IDEAL ACTUAL

• Promote oxygenation • Monitor vital signs q2h

• Control elevated temperature • Perform hand hygiene before and after client interaction using
• Maintain nutritional and fluid intake alcohol-based product
• Provide adequate rest • Asses daily and fluid intake
• Monitor vital signs
• Provide good oral hygiene
• Prevent irritation of the lungs by smoke
and other irritants
• Avoid secondary bacterial infections

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 DISCHARGE PLAN

Patient’s Name: AKSHA KATE MANGUMPIT Date of Discharge:

Condition upon Discharge: PEDIATRIC COMMUNITY PNEUMONIA
Nature: Home per request ( ) Discharge Against Medical Advice (.)

PARACETAMOL
Indication: Antipyretic
Dosage:250/5;2.5 ml
Route:PO
Frequency: q4h

1. Medication SALBUTAMOL
Indication: Bronchodilators
Dosage:1 Tab
Route:PO
Frequency: Q8H

AMPICILLIN

33
 Indication:Penicillin
Dosage:425 mg
Route:IV
Frequency:Q6H

ZINC SULFATE
Indication: Electrocyte
Dosage:2.5 ml
Route:
Frequency: OD

2. Exercise -exercise in a regular basis can help reduce the risk of pneumonia like walking and running

3. Diet -Drinks a lot of liquid, eat healthy foods rich in protein and green leafy vegetables to promote faster recovery

-Instruct to take home medication, instruct how to take meds precise and time dose and time to be taken at
ensure efficiency to avoid overdose or under dose, emphasize importance of drugs to prevent complications
4. Health Teaching
-Importance of healthy diet
-Getting plenty of rest at night and taking nap during the day

34
5. Schedule for Next Visit -Inform to have a follow-up checkup after 1 to 2 weeks

6. Spiritual -Encourage to derived strength from God and maintain a close relationship with family and community

7. Lifestyle -Encourage to stay in calm and clean environment

8. Referral

35
 RELATED ARTICLES

Risk factors in predicting mortality among children admitted for PCAP C and D at Philippine Children's Medical Center.

By: Canonizado E. M., Mary Therese M. Leopando

A total of 472 patients were included in the study, of whom 77% had PCAP C and 23% had PCAP D. More than half in each patient group
were infants; male; and of normal nutritional status. Most common comorbidities in both groups were neurologic and cardiovascular in nature.
Leukocytosis, thrombocytosis, and anemia were the most common hematologic findings. Overall mortality rate among patients was 5.08%. On
univariate analysis, being severely underweight (cOR 8.28 [95% CI 2.52-27.23]), with history of antibiotic use (cOR 3.01 [95% CI 1.18-7.62],
neurologic comorbidities (cOR 4.04 [95% CI 1.42-11.43]), cardiac comorbidities (cOR 5.33 [95% CI 1.31-21.75]), Down syndrome (cOR 22.11 [95%
CI 2.44- 200.30]), and thrombocytopenia (cOR 22.11 [95% CI 2.44-200.30]) were associated with greater odds of mortality among PCAP-D patients.
On multivariate analysis, the odds of mortality were 5.02 (95% CI 1.05-23.96) for severely underweight patients, 4.51 (95% CI 1.13-17.95) in patients
with neurologic disease, and 73.62 (95% CI 3.63-1491.10) in patients with Down syndrome.

PREDICTIVE FACTORS OF TREATMENT FAILURE FOR PEDIATRIC COMMUNITY-ACQUIRED PNEUMONIA C AND D IN 2-TO-59 MONTHS
OF AGE

By: Charisse R. Zuniga, MD* Robert Dennis Garcia, MD* Rozaida Villon, MD*

Pneumonia is a leading cause of death accounting for 17% of all under-five deaths worldwide, or a loss of roughly 1.6 million lives. Around
90%-95% of these deaths occur in developing countries. According to the United Nations International Children’s Emergency Fund (UNICEF), data
back in September 2013 showed that majority of deaths occurred in sub-Saharan Africa and South Asia. The Institutional Review Board (I.R.B.)

36
approval was secured, the investigator conducted an information session with the medical staff of the Department of Pediatrics of the Medical Center,
where the objectives, purpose, and method of the study were discussed. Informed consent was obtained prior to enrollment. The pediatric resident
on duty recruited and screened the patients in the pediatric emergency room (E.R.) based on the inclusion criteria. The resident then classified the
patients as PCAP-C or PCAP-D. When an overlap between the two categories was seen, the presence of a minimum of two clinical variables
sufficed to classify the patient to a higher category (PCAP-D from PCAP-C). The same pediatric resident gathered information regarding patient’s
history and physical examination and laboratory results. The chest radiograph, if requested, was not used as an inclusion criterion since the
diagnosis of pneumonia was based on clinical parameters. Baseline clinical assessment and laboratory work-ups as ordered by the attending
physician were performed at the E.R. prior to the administration of the first dose of antibiotics. Clinical pneumonia was considered in patients with
cough and/or respiratory difficulty, plus any of the following predictors: tachypnea in a patient aged 3 months to 5 years, fever at any age or oxygen
saturation less than, or equal, to 92% at room air at any age in the absence of any co-existing illness (neurologic, musculoskeletal, or cardiac
condition) that may potentially affect oxygenation (PCAP guidelines, 2012). Bacterial pneumonia was considered when the patient had high-grade
fever but without wheezing for children less than 2 years old or for those more than two years old, with the following findings: alveolar consolidation
on chest x-ray, and elevated serum C-reactive protein (C.R.P.), procalcitonin and/or elevated white blood cell count. The bedside nurse recorded the
vital signs every four hours. Supportive therapy such as oxygen supplementation, antipyretics, and treatment with bronchodilators was given, as
needed. All treatment instituted as ordered by the attending physician was noted, whether they were part of the current treatment guidelines for
pneumonia or not. Any changes to the current antibiotic treatment made by the attending physician were also recorded. All patients who were
diagnosed to have clinical pneumonia were followed up in the wards or ICU where the principal investigator measured the outcomes of a 72-hour
treatment. The status of the patient was also noted on the seventh day of admission or on the day of discharge, whichever came first. The subjects’
clinical characteristics and socio-demographics were summarized in frequency tables using binary logistic regression analysis to determine
predictors of antibiotic treatment failure of PCAP-C and PCAPD. Predictors with a p-value of less than 0.05 on multivariate regression analysis were
considered as significant independent predictors of antibiotic treatment failure

37
REFERENCES

Canonizado, E. M., Leopando, M. T.,(2020) Risk factors in predicting mortality among children admitted for PCAP C and D at Phillipine Children’s
Medical Center. Risk factors in predicting mortality among children admitted for PCAP C and D at Philippine Children's Medical Center. (herdin.ph)

Deglin, J.H., Vallerand, A. H. Davis’s Drug Guide for Nurses (9th edition)

Essentials of Anatomy and Physiology,(10th Edition), Anatomy of the Respiratory System,Lungs - Anatomy of the Respiratory System
(brainkart.com)

Ramirez, J. (2022) Overview of community-acquired pneumonia in adults Overview of community-acquired pneumonia in adults - UpToDate

Yogitha, M.(2019), Human Anatomy, Lungs - Anatomy, Functions, Diseases, Diagnosis, Tips For Healthy Lungs – LeoGenic Healthcare Pvt Ltd

Zuniga, C., Garcia, R. B., Villon, R.,(2017) PREDICTIVE FACTORS OF TREATMENT FAILURE FOR PEDIATRIC COMMUNITY-ACQUIRED
PNEUMONIA C AND D IN 2-TO-59 MONTHS OF AGE, jo52_ja04.pdf (pidsphil.org)

38