UMTC PCAP - C Case Study

CASE STUDY ON PEDIATRIC COMMUNITY AQUIRED PNEUMONIA (PCAP) Submitted by: Mary Ann M. Credo Grethyl Jean Campos Daisy Ann Iñigo Rose Mae Roslinda Prescy Marey J. Lozada Jane Yamas Krisha Jane Perez Joyce Ganzon Jig Sanchez Floriza Gozon Submitted to: DENNIS TORILLO, RN, MN

I. INTRODUCTION Pneumonia is an infection of the lung parenchyma. Community-acquired pneumonia refers to pneumonia acquired outside of hospitals or extended-care facilities CAP is a common illness in all parts of the world. It is a major cause of death among all age groups. In children, the majority of deaths occur in the newborn period, with over two million worldwide deaths a year. In fact, the WHO estimates that one in three newborn infant deaths are due to pneumonia. Mortality decreases with age until late adulthood; elderly individuals are particularly at risk for CAP and associated mortality. Although viral pneumonias are common in school-aged children and adolescents and are usually mild and self-limited, these pneumonias are occasionally severe and can rapidly progress to respiratory failure, either as a primary manifestation of viral infection or as a consequence of subsequent bacterial infection. Despite a broad armamentarium of antimicrobials available to treat the disease, pneumonia remains the seventh leading cause of death in the United States. In 2003, the age-adjusted death rate caused by influenza and pneumonia was 20.3 per 100,000 persons. Estimates of the incidence of community-acquired pneumonia range from 4 million to 5 million cases per year, with about 25% requiring hospitalization. The United Nations Children's Fund (UNICEF) estimates that 3 million children die worldwide from pneumonia each year; these deaths almost exclusively occur in children with underlying conditions, such as chronic lung disease of prematurity, congenital heart disease, and immunosuppression. According to the WHO’s Global Burden of Disease 2000 Project, lower respiratory infections were the second leading cause of death in children younger than 5 years (about 2.1 million [19.6%]).

II. OBJECTIVES a. GENERAL OBJECTIVES •

After this case study, we will be able to know what are Pneumonia, how it is acquired and prevented, its prevention and treatments of its occurrence.

b. SPECIFIC OBJECTIVES •

Define what is Pneumonia

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Trace the pathophysiology of Pneumonia

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Enumerate the difference signs and symptoms of pneumonia

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Formulate and apply nursing care plans, utilizing the nursing process

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To learn new clinical skills as well as sharpen our current clinical skills required in the management of the patient with Pneumonia

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To develop our sense of unselfish love and empathy in rendering nursing care to our patient so that we may able to serve future clients with higher level of holistic understanding as well as individualized care.

III. PATIENT’S PROFILE: Name : Mondido, Princess Address: P-4 Narra St. Bermudez, Apokon Tagum City Birth date: December 7,2010 Age: 8 months Civil status: Child Mother’s name: Mondido, Maribel Oocupation: House Wife Educational attainment: High School Graduate Father’s name: Mondido, Reynaldo Occupation: Fisher Man Educational attainment: High School Graduate Religion: Roman Catholic

IV. PATIENT’S HISTORY; a. Past health history Upon interview the patient’s mother was asked about the patient’s past history of illness, she said that her daughter had cough, fever and difficulty of breathing . The patient’s immunization was not yet completed, measles vaccine was not yet given because the child is only 8 months old. The mother brought her daughter to be immunized at the health center of their barangay . No history of allergies of any kind. Never been hospitalized. According to the patient’s mother upon seeing the signs and symptoms of fever and cough, she gave her daughter paracetamol and carbocistein (loviscol). b. Present health history Prior to admission, the patient’s mother told us that baby princess was experiencing cough and fever for 3 days, she observed that the patient’s chest expansion has more effort and experiencing difficulty of breathing. The patient’s mother also told us that she thinks her child got the illness because she gives baby princess a bath early in the morning. c. Family heath history The following illnesses on their blood; asthma,hypertension,heart disease and diabetes. d. Chief complaints Cough, fever and difficulty of breathing

VI. LABORATORY – DIAGNOSTIC RESULT Date Taken: September 2,2011 HEMATOLOGY COMPONENT

NORMAL

RESULT

INTERPRETATION

VALUE Hemoglobin

Male: 140-

Mass

170g/L

Consentration

AND ANALYSIS 106g/L

NORMAL

7.3

INCREASE

Female: 120 140g/L

Erythrocytes

4.5-5.5 x 10/L

May indicate severe diarrhea and dehydration, polycythemia,acute poisoning, and pulmonary fibrosis.

Leukocytes

5.0-10.0 x

7.3

NORMAL

0.58

NORMAL

10/L Neutrophils

0.55-0.65

Lymphocytes

0.25-0.35

0.41

INCREASE

May indicate with infectious mononucleosis, viral and some bacterial infections, hepatitis

Monocytes

0.02-0.06

0.01

DECREASE May indicate with use of corticosteroids, RA, HIV infection

Trombocytes

150-400 x

333

NORMAL

Erythrocytes

Male: 0.40- 0.32

NORMAL

volume fraction

0.50

10/L

Female: 0.37-0.43

VII. ANATOMY AND PHYSIOLOGY

LUNGS: The lungs are paired cone-shaped organs which take-up most of the space in the chest with the heart. Their role is to take oxygen into the body which we need for the cells to live and function properly, and to help us get rid of carbon dioxide,

which is a waste product. There are two divisions of the l u n g s , t h e l e f t a n d t h e r i g h t l u n g . T h e s e a r e d i v i d e d u p i n t o l o b e s o r b i g secretions of tissues separated by “fissures” or dividers. The right lung has three lobes but the left lung has only two, it is because the heart takes up some of the space in the left side of the chest. The lungs can also be divided up into even smaller portions, called bronchopulmonary segments. These are pyramidal shaped areas which are also separated from each other membranes. E a c h s e g m e n t receives it's own blood supply and air supply. Air enters the lungs through a system pipes called the bronchi. Theses pipe start from the bottom of the trachea as the left and right bronchi and branch many times through out the lungs, until they eventually form little thin-walled air sacs or bubbles, known as the alveoli. The alveoli are important in the gas exchange where it takes place between the air and the blood. Covering alveolus is a whole network of little blood vessel called capillaries, which are very small branches of the pulmonary arteries. It is important that the air in the alveoli and the blood in the capillaries are very close together, so that oxygen and carbon dioxide can diffuse between them.

Physiology of Gas Exchange

Each branch of the bronchial tree eventually sub-divides to form very narrow terminal bronchioles, which terminate in the alveoli. There are many m i l l i o n s o f a l v e o l i i n e a c h l u n g , a n d t h e s e a r e t h e a r e a s r e s p o n s i b l e f o r gaseous exchange, presenting a massive surface area for exchange to occur over each alveolus is very closely associated with a network of capillaries containing deoxygenated blood from the pulmonary artery. The capillary and alveolar walls are very thin, allowing rapid exchange of gases by passive effusion along concentration gradients. Carbon dioxide moves into the alveolus as the concentration is much lower in the alveolus than in the blood and oxygen move out ot the alveolus as t h e continuous flow of blood through the capillaries prevents saturation of the blood with oxygen and allows maximal transfer across the membrane.

VIII. Pathophysiology

Viral infections increase attachment of S. pneumoniae to the receptors on respiratory epithelium. Once inhaled into the alveolus, pneumococci infect type II alveolar cells. They multiply in the alveolus and invade alveolar epithelium. Pneumococci spread from alveolus through the pores of Kohn, thereby producing inflammation and consolidation along lobar compartments. Inflamed and fluid-filled alveolar sacs cannot exchange oxygen and carbon dioxide effectively. Alveolar exudate tends to consolidate, so it is increasingly difficult to expectorae. Bacterial pneumonia may be associated with significant ventilation-perfusion mismatch as the infection grows. Etiology : There are many causes of Pneumonia, including bacteria, viruses, mycoplasmas, fungal agents and protozoa. Pneumonia may also result from aspiration of food, fluids or vomitus or from inhalation of toxic or caustic chemicals, smoke, dusts, or gasses. Pneumonia may complicate immobility and chronic illnesses. Pneumonia often follows influenza and together they rank as the 7th leadng cause of death in the US, and are the fifth leading cause in people older than 65. Major risk factors: •

Advanced age

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History of smoking

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Upper respiratory tract infection

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Tracheal intubation

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Prolonged immobility

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Immunosuppreesive therapy

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A non – functional immune system

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Malnutrition

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Dehydration

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Homelessness

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Chronic disease states ( such as diabetes, heart disease, chronic lung disease, and cancer)

Additional risk factors are dysphagia;exposure to air pollution;altered consciousness (from alcoholism,drug overdose,general anesthesia ,or a seizure disorder);inhalation of noxious substances;aspiration of food,liquid or foreign or gastric material and residence in institutional settings,where transmission of the disease is more likely. Heredo Familial History There is history of illness in the immediate family. The father of the patient has a history of asthma,in the side of his mother had a hypertension and heart disease.

XI. PROGNOSIS Individuals who are treated for PCAP outside of the hospital have a mortality rate less than 1%. Fever typically responds in the first two days of therapy and other symptoms resolve in the first week. The x-ray, however, may remain abnormal for at least a month, even when PCAP has been successfully treated. Among individuals who require hospitalization, the mortality rate averages 12% overall, but is as much as 40% in people who have bloodstream infections or require intensive care. Factors which increase mortality are the same as those which increase the need for hospitalization and are listed above. When CAP does not respond as expected, there are several possible causes. A complication of CAP may have occurred or a previously unknown health problem may be playing a role. Both situations are covered in more detail below. Additional causes include inappropriate antibiotics for the causative organism, a previously unsuspected microorganism such as tuberculosis or a condition which mimics PCAP such as Wegener's granulomatosis. Additional testing may be performed and may include additional radiologic imaging (such as a computed tomography scan or a procedure such as a bronchoscopy or lung biopsy.

XII. DISCHARGE PLAN AND RECOMMENDATION M-MEDICATION TO TAKE Instruct and explain to the patient’s mother that the medication is very important to continue depending on the duration that the doctor ordered for the total recovery of the patient. E-EXERCISE Instruct the mother to let her child play but it should be limited to a short period of time only to prevent the occurrence of shortness of breathing. T-TREATMENT Advice the mother to keep her baby relay in order to recover in this present condition, instruct the mother to minimize the patient from exposure to an open environment such as dusty and smoky area which airborne microorganisms are present that can be a high risk factor that cause severity of his condition. H-HEALTH TEACHING EncoUrage and explain to the patient’s mother that it is important to maintain proper hygiene to prevent further infection. Instruct the patient’s mother to bath the baby everyday and explain that bathing early in the morning is not the factor or cause of having pneumonia. Instruct to increase fluid intake to the patients. O-OUT PATIENT FOLLOW-UP

Regular consultation to the physician can be a factor for recovery and assess and monitor the patient’s condition. D-DIET Diet as tolerated,meaning,the patient can eat everything until he can.Diet can plays a big role in fast recovery so that,instruct the mother to give nutritious foods intended for respiratory system.

TABLE OF CONTENTS TITLE

PAGE NO:

I. Introduction………………………………………………………….1 II. OBJECTIVES…………………………………………………………2 a. General objectives b. Specific objectives III. Patient’s Profile……………………………………………………..3 IV. Patient’s History…………………………………………………….4 V. Physical assessment………………………………………………5, 6, 7 VI. Laboratory – Diagnostic result…….…………………………….8, 9 VII. Anatomy and Physiology……………………..……………...10, 11, 12

a. Lungs b. Physiology of Gas exchange VIII.

Pathophysiology, Etiology, Sympatomology……………13, 14

IX. Medical management…………………………………………….15, 16, 17

a. Drug study X. Nursing care plans………………………………………………...18, 19, 20 XI. Prognosis……………………………………………………………21 XII.

Discharge plan and recommendations…………………….22