DR. YANGA’S COLLEGES, INC.

(Formerly Dr. Yanga’s Francisco Balagtas Colleges)

Wakas, Bocaue, Bulacan

COLLEGE OF HEALTH SCIENCES

NURSING ● MIDWIFERY ● CAREGIVING NC II

This is a Case Study of a Patient with Pediatric community-acquired pneumonia (PCAP)-B

In partial fulfillment of the requirements in NCM 109

Related Learning Experience

Submitted by:

Calibjo, Justine Kimberly P.

BSN-2D

Submitted to:

CHS Faculty
 I. INTRODUCTION
According to World Health Organization (2022) , Pneumonia is a form of acute respiratory infection
that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person
breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful
and limits oxygen intake. Pneumonia is the single largest infectious cause of death in children worldwide.
Pneumonia killed 740 180 children under the age of 5 in 2019, accounting for 14% of all deaths of children under 5
years old but 22% of all deaths in children aged 1 to 5 years who considered as pediatric.

On the other hand pneumonia has four types. In the Study of News Medical Life Science 2021 ,The first
type of Pneumonia is Community-acquired pneumonia is an infection that is acquired outside of the
healthcare system, including hospitals, nursing homes, outpatient clinics, or any other healthcare facility. Also it
is the most common type of pneumonia and generally presents as an acute infection, with symptoms appearing
over the course of hours or days. Hospital-acquired pneumonia (HAP) is a lung infection that is obtained
during a hospital stay. This form of pneumonia can be serious because oftentimes the patient, by nature of being
in the hospital in the first place, is in an immune-weakened state due to illness or traumatic injury. Ventilator-
associated pneumonia (VAP) is a lung infection that develops in a person who is on a ventilator. (Center for
Disease Control and Prevention 2021). Aspiration pneumonia occurs when food or liquid is breathed into the
airways or lungs, instead of being swallowed. (Penn Medicine 2022).

Nevertheless, to determine if the client is a candidate for Pneumonia, he or she must have these signs and
symptoms. This symptom includes Cough, which may produce greenish, yellow or even bloody mucus, Fever,
sweating and shaking chills, Shortness of breath, Rapid or shallow breathing, Sharp or stabbing chest pain that
gets worse when they breathe deeply or cough, diarrhea, Loss of appetite, fatigue, Nausea and vomiting,
especially in small children and Confusion especially in older people. (American Lung Association 2022).

Additionally for the risk factors of Pneumonia which they are belong to increase the chance of developing this
condition those who is at high-risk group are adults older than age 65, Children younger than age 5 with signs and
symptoms, People with an underlying health condition or weakened immune system and People receiving
chemotherapy or taking medication that suppresses the immune system. (Mayo Clinic 2020). Also, World Health
Organization (2022) emphasized the following environmental factors also increase a child's susceptibility to
pneumonia such as indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung),
living in crowded homes and parental smoking. While Pneumonia is caused by several infectious agents, including
viruses, bacteria and fungi. The most common are the following are Streptococcus pneumoniae is the most
common cause of bacterial pneumonia in children which causative agent of Community-acquired pneumonia,
Haemophilus influenzae type b (Hib) is the second most common cause of bacterial pneumonia, Respiratory
syncytial virus is the most common viral cause of pneumonia and In infants infected with HIV,
Pneumocystis jiroveci is one of the most common causes of pneumonia, responsible for at least one quarter of
all pneumonia deaths in HIV-infected infants.

American Lung Association (2022) stated that to diagnose pneumonia, and to try to identify the germ
that is causing the illness it can be done by medical history, do a physical exam, and run some tests. In Medical
History client may be asked some questions about possible exposures any recent trave, occupation, contact with
animals, exposure to other sick people at home, work or school and recently had another illness. In the other
hand they can perform the Physical Exam through assessment of auscultation in lungs using stethoscope and
usually if the client has pneumonia the lungs may make crackling, bubbling, and rumbling sounds when they
inhale. While if the doctor suspect that client has pneumonia, they will probably recommend some tests to
confirm the diagnosis and learn more about infection these may include Blood tests to confirm the infection and
to try to identify the causative agent, Chest X-ray to look for the location and extent of inflammation in lungs,
Pulse oximetry to measure the oxygen level in blood, and Sputum test on a sample of mucus (sputum) taken
after a deep cough, to look for the source of the infection.

To conclude Treatment for pneumonia involves curing the infection and preventing complications. Client
who has Pediatric community-acquired pneumonia (PCAP) usually can be treated at home with medication
such as give appropriate diet, increased fluid, cool mist humidifier in child's room, acetaminophen (for fever and
discomfort), and medication for cough. While for pediatric patient who experience severe breathing problems
the treatment in hospitalization specifically the nursing management are administer intravenous (IV) if unable to
drink well or oral antibiotics if physician order, administer oxygen therapy if prescribed, Perform nasotracheal
suctioning if the client is unable to clear secretions, administer breathing treatments as ordered by physician,
monitor respiratory status, position client in semi-Fowler position to facilitate breathing and lung expansion.
monitor pulse oximetry, and monitor and record color, consistency, and amount of sputum,
 II. Objective
A. General Objectives
This case study aims to be a guide in characterizing and understanding Pediatric community-
acquired pneumonia (PCAP). It also targets to apply the learning's through this study in real life
circumstances and clinical situations, and to cultivate the qualities needed to be as killed and
knowledgeable nurse in the future.
B. Specific
Objectives Student-centered
At the end of the study, the student nurse will be able to:
Knowledge:
• Scrutinize the case of the client through systematic readings and research.
• Distinguish necessary interventions that address the problem associated with Pediatric community-
acquired pneumonia (PCAP).
• Define the characteristics of the Pneumonia such as the types, risk factors and management.
Skills
• Develop nursing interventions in response to the issues during the assessment.
• Utilize needed interventions that directly address to client’s requirement needed in clinical situations.
• Apply effective communication skills to encourage and build continuous interaction and
interdependence to reach optimal care.
Attitude
• Establish a therapeutic relationship and develop strong rapport with the client and family.
• Strengthen understanding and empathy while providing care to client.
• The nurse will be able to develop confidence through client’s interaction.

Patient-centered
At the end of the study, the client will be able to:
Knowledge
• The mother of the client will define the characteristics of Pediatric community-acquired
pneumonia (PCAP).
• The mother of the client will identify the risk factors of (PCAP).
• The mother will recognize the changes of the client’s condition.
• The mother of the client will understand the knowledge in administering the medication.
• The mother of the client will evaluate the state of health of the client at home
Skills
• The mother will identify the interventions for (PCAP) of the client.
• The mother will distinguish the need for healthy lifestyle to improve condition.
• The mother will perceive that providing healthy foods to client will boost the immune system.
• The mother of the client will show compliance to continue interventions and health teachings provided.
Attitude
• The mother will express awareness on the needs and condition of client status.
• The mother of the client will show encouragement and willingness to learn.
• The mother will express her understanding to condition of the client.
• The mother will demonstrate willingness to learn for management of (PCAP).
• The client will participate in doing management for (PCAP).
• The client actively participates in doing management.
 III. ANATOMY AND PHYSIOLOGY

The lungs are the major organs of the respiratory system, and are divided into sections, or lobes. The human
lungs are a pair of large, spongy organs optimized for gas exchange between our blood and the air. Our bodies
require oxygen in order to survive. The lungs provide us with that vital oxygen while also removing carbon dioxide
before it can reach hazardous levels. The lungs occupy the entire thoracic cavity except for the most central area, the
mediastinum, which houses the heart, the great blood vessels, bronchi, esophagus, and other organs. The anatomy of
lungs are consist of the following : The apex of lungs is narrow, superior portion of each lung, the apex, is just deep
to the clavicle. While the base is broad lung area resting on the diaphragm. Each lung is divided into lobes by
fissures; the left lung has two lobes, and the right lung has three. The pleura are double-layered serous membranes
that surround each lung. Attached to the wall of the thoracic cavity, the parietal pleura forms the outer layer of the
membrane. The visceral pleura forms the inner layer of the membrane covering the outside surface of the lungs.
Between the parietal and visceral pleura is the pleural cavity, which creates a hollow space for the lungs to expand
into during inhalation. Serous fluid secreted by the pleural membranes lubricates the inside of the pleural cavity to
prevent irritation to the lungs during breathing. The lungs are held tightly to the thorax wall, and the pleural space is
more of a potential space than an actual one. As the primary bronchi enter the lungs, they branch off into smaller
secondary bronchi that carry air to each lobe of the lung. Thus, the right bronchus branches off into 3 secondary
bronchi while the left lung branches off into 2 secondary bronchi. The secondary bronchi further branch into many
smaller tertiary bronchi within each lobe. The secondary and tertiary bronchi improve the efficiency of the lungs by
distributing air evenly within each lobe of the lungs. Bronchioles differ from bronchi both in size (they are smaller)
and in the composition of their walls. While bronchi have hyaline cartilage rings in their walls, bronchioles are made
of elastin fibers and smooth muscle tissue. The tissue of the bronchiole walls allows the diameter of bronchioles to
change to a significant degree.
When the body requires greater volumes of air entering the lungs, such as during exercise, the bronchioles dilate to
permit greater airflow. In response to dust or other environmental pollutants, the bronchioles can constrict to prevent
the pollution of the lungs. The bronchioles further branch off into many tiny terminal bronchioles. Terminal
bronchioles are the smallest air tubes in the lungs and terminate at the alveoli of the lungs. Like bronchioles, the
terminal bronchioles are elastic, capable of dilating or contracting to control airflow into the alveoli. Alveoli are the
functional units of the lungs that permit gas exchange between the air in the lungs and the blood in the capillaries of
the lungs. Alveoli are found in small clusters called alveolar sacs at the end of the terminal bronchiole. The walls of
the alveolus are lined with simple squamous epithelial cells known as alveolar cells. A thin layer of connective tissue
underlies and supports the alveolar cells. Capillaries surround the connective tissue on the outer border of the
alveolus. Alveolar fluid is extremely important to lung function, as it is a surfactant that moistens the alveoli, helps
maintain the elasticity of the lungs, and prevents the thin alveolar walls from collapsing. Macrophages in the alveoli
keep the lungs clean and free of infections by capturing and phagocytizing pathogens and other foreign matter that
enter the alveoli along with inhaled air. The physiology
of Lungs are the following : Related to pulmonary ventilation the lungs receive air from the external
environment through the process of negative pressure breathing. Negative pressure breathing requires a pressure
differential between the air inside the alveoli and atmospheric air. The total air volume of the lungs is about 4 to
6 liters and varies with a person’s size, age, gender, and respiratory health. External respiration is the process of
exchanging oxygen and carbon dioxide between the air inside the alveoli and the blood in the capillaries of the
lungs. While Breathing is controlled by the brain and may be controlled both consciously and unconsciously.
 IV. PATHOPHYSIOLOGY
RISK FACTORS
RISK FACTORS
Non-Modifiable
Modifiable
(Age,Asthma History, history of
(Weak Immune system, Cigarette
pneumonia, male gender and
smoking,Underlying Health Conditions
white race)
,and Environmental Factors)

Entrance of bacteria in airway

(Streptococcus pneumonia, Haemophilus influenza and Staphylococcus

Material propelled into alveolar system

Adherence to alveolar macrophages exposure of cell

wall component (bacterial invasion to lungs)

Acute inflammatory response

Loss of effectiveness of defense mechanism’s

WBC

Fever Diarrhea Vomiting

 Penetrate the sterile lower respiratory tract (lungs)

Affects alveoli

Multiplication

Irritation of airways

Goblet cells

Occludes the airway

Impairing 02 and CO2

exchange

Airways constriction

Occludes the airway

Mucus production

Productive
Dyspnea Crackles Rales Wheezes
Cough

Pediatric community-acquired pneumonia (PCAP)-B

 V. NURSING HISTORY

Personal Data
P.J. is a 1-year-old Filipino boy, currently residing at 213 Requino Street,
Saluysoy,Meycuayan,Bulacan. He’s also the first child of his parents. He was admitted to the emergency
room and ward of The Lord’s Hospital located in Meycuayan on March 29, 2023, at 1:37 in the
morning, together with his mother.
The Chief Complaint of a Client: ‘P.J has productive cough, a fever for 3 days for maximum of
38 degree Celsius and experience a shortness of breath due to nose flaring and accessory muscle use’’ as
verbalize and observed by the mother of client.
Present Health History
On the fourth day prior to admission, P.J. had diarrhea due to four consecutive bowel movement
s and vomiting, as stated by his mother. On the third day, P.J. has an onset fever of 38 degrees Celsius
and a productive cough, and his mother gives him over-the-counter medication such as antipyretic syrup.
But his diarrhea and vomiting stopped. On the second day, P.J. has these same symptoms, such as fever
and a productive cough, and his mother continues the intervention she had on the third day. However,
his mother noticed P.J. has no appetite, is unable to sleep, shows difficulty breathing due to the use of
accessory muscles, and has a flaring nose. As well, P.J.’s mother evaluates that the productive cough is
still present and are getting worse, which leads her to become worried and decide to admit P.J. to the
emergency room of the hospital.
Past Health History
• P.J. has had normal growth and development from the infant stage up until this current time. P.J. had
received a complete set of immunizations that were given to him from the time he was a newborn baby
up until now. Based on P.J.’s mother, he already experienced having a mild fever, cough, and cold,
which was treated immediately with usual home remedies because it was not severe and could be
managed through over-the-counter medication. However, recently, upon his first hospitalization, the
physician diagnosed him with bronchial asthma and Pediatric community-acquired pneumonia (PCAP).
.
Family health History

Social and Economic History

PJ loves playing and dancing. Every day, he usually plays with his cousins outside of their
house. Then, after playing, P.J. usually has a nap to take some rest after playing outside. P.J. enjoys watching
cartoons on YouTube on his tablet. He is also accompanied by his grandmother since both of his parents are
working.
The family’s main source of income is the wages of his father, who works as a manufacturer. Then,
P.J.’s mother, who is a sales manager, helped provide for their needs. P.J. and his parents are members of
PhilHealth. Their financial support is only enough each day to pay for the rent, bills, food, and other necessary
needs.

Nutrition and Metabolic Pattern

P.J. loves crackers and hotdogs. His mother said that he still drinks milk throughout the day. His mother
also reported that P.J consumes half a cup of rice a day. P.J does like to eat vegetables and fruits. He also
consumes chocolates, crackers, and biscuits. P.J. weighs 9.5 kg. His 48-hour recall is as follows:
 1st Day 2nd Day

8 am - Breakfast ➢ Crackers ➢ Sopas

➢ Milk ➢ Milk

12 pm - Lunch ➢ Sauce of Chicken Adobo ➢ Chicken Tinola w/ rice

w/ Small Amount of Rice ➢ Milk

4 pm - Snack ➢ Biscuit ➢ Biscuit

➢ Milk

7 pm - Dinner ➢ Sauce of Chicken Adobo ➢ Sinigang Pork w/ rice

w/ Small Amount of Rice

Elimination Pattern

P.J urinates frequently, every 2-3 hours, and the urine amount is 200 cc, which is light yellow in
color. On the other hand, in terms of bowel movements, He defecates once a day, either every morning or
every evening. The characteristics of the stool are brown, firm, and soft.

Home and Environment

P.J.’s family lives in an apartment along the highway. The house is made of mixed materials. Though
the outside of the house is made out of concrete, most of the interior and the second floor are made out of wood.
The houses in their community are very close to each other. Their water facility belongs to level 2, where they
have their own water connection. There are two faucets in total in their home. On the other hand, the drainage
system of the C.E. family is level 2. They have their own toilet facilities, which are closed system.
 VI. PHYSICAL ASSESSMENT
a. General Survey
The client appears to be awake, alert and good cry when he arrived. The client’s weight was 9.5 kg
with the height of 76 cm. Vital Signs upon admission are as follows:

Pulse Rate: 90 bpm

Respiratory Rate: 26
Temperature: 37 C
Oxygen Saturation: 95

b. Review of System/PE

PARTS METHOD NORMAL ACTUAL ACTUAL CLINICAL

FINDINGS FINDINGS FINDINGS SIGNIFICANCE
DAY 1 DAY 2
DATE DATE
3-29-2023 3-29-2023
Hair Inspect and The Hair color P.J has hair evenly P.J has hair evenly The client has a
palpate for and
distributed over the distributed over the normal finding
hair color and distribution
texture. consistent scalp with short scalp with short hair. because hair
Inspect and with no
hair. He has no He has no presence of patterns is
palpate for dryness or
hair oiliness and presence of infestations such consistent without
distribution. no lesions
infestations such pediculosis. He has patches of hair or
present.
Inspect and pediculosis. He has no palpable masses. hair loss.
palpate for
lesions and no palpable masses.
other issues
Face and Observe the The Face is P.J has symmetric P.J has symmetric Overall, His face
Neck
face for symmetry and face and his facial face and his facial and neck have no
shape. No presence expression is expression is accurate any manifestation
of pallor. The accurate in in situation. There is of significant
Inspect for neck is situation. There is no presence of pallor findings and the
Symmetry of straight. no presence of in his face. Based on assessment in
Face. And no pallor in his face. palpation he doesn’t actual findings are
visible mass Based on palpation feel any tenderness within normal.
or lumps. he doesn’t feel any and there is no
 Neck Symmetrical tenderness and presence of enlarged
inspected for Also, No there is no presence lymph nodes, thyroid
position jugular of enlarged lymph enlargement, lumps,
symmetry venous nodes, thyroid and masses.
distension enlargement,
The trachea is lumps, and masses.
palpable
Eyes and Inspect the The eyes are P.J has no presence P.J has no presence Overall, His Eyes
Ear
eyelids for evenly placed of any pallor on of any pallor on both and Ear has no any
position and and in line both eyes of eyes of conjunctiva. manifestation of
symmetry. with each conjunctiva. His His both eyes are significant findings
other. both eyes are equal equal symmetry and and the assessment
Inspect for There is no symmetry and alignment. P.J ears in actual findings
the shape protruding. alignment. P.J ears have even color and are within normal.
and color And has an have even color and size. He also has no
of the ears. equal size. He also has no presence of drainage,
palpebral presence of or lesions,
Inspect for fissure. drainage, or lesions, inflammation
discharge. inflammation (edema) or infection;
(edema) or nodules, lesions, or
Inspect the infection; nodules, tenderness in ears.
pinna and lesions, or
the tenderness in ears.
mastoid.

Palpate for
the lymph
at the back
of the ear
Mouth Inspect for The oral P.J has oral P.J has oral structures The assessment of
Symmetry, structures structures wherein wherein there is no hydration in mouth
surface such as no there is no presence presence of tartar and is moist in actual
abnormalities, presence of of tartar and white white color of teeth. findings are within
tartar in teeth color of teeth. The The outside and normal.
 color, and and normal outside and inside inside of mouth was
edema hydration of mouth was moist.
level. moist.
Skin and Inspect Nails The skin P.J has no presence P.J has no presence Overall, the
Nails for smooth, coloration of pallor in skin. of pallor in skin. assessment in
firm, colour, should have There is no There is no presence actual findings on
and presence no presence of presence of skin of skin lesions. His skin color and nails
of clubbing. cyanosis, lesions. His nails nails are normally are within normal.
pallor, are normally convex and the
Palpate Skin jaundice, and convex and the cuticle is pink and
for Capillary erythema. cuticle is pink and intact. Also, his nails
refill within 2 Inspection of intact. Also, his are firm and smooth
seconds. skin lesions nails are firm and and capillary refill is,
such as smooth and less than 3 seconds.
Inspect Skin bruises, capillary refill is,
color for scratches, less than 3 seconds.
ethnicity cuts, insect
without bites, and
lesions or wounds is not
rashes. present. s.
Nails are
Inspect Skin normally
for warm and convex and
dry with no the cuticle is
edema. pink and
intact. Nails
Palpate Skin are firm and
for normal smooth and
turgor with no capillary refill
tenting. should be
brisk, less
than 3
seconds
Cardiova Inspect the Pulsation of During inspection Still During Overall, his
scular chest wall and the apical there is no lift or inspection there is no cardiovascular has
epigastrium impulse heaves while in lift or heaves while in no any
then observe maybe visible. auscultation P.J has auscultation P.J has a manifestation of
for pulsation There should a normal heart rate normal heart rate and significant findings
and heaves or be no lift or and rhythm. There rhythm. There is also and the assessment
lifts. heaves. is also no presence no presence of bruit in actual findings
No, palpable of bruit sound. sound. During are within normal
Palpate the pulsation over During Palpation Palpation there is no
entire the aortic, there is no presence presence of thrills.
precordium is pulmonic, and of thrills.
methodically mitral valves.
using the No abnormal
palms and the heart sounds
fingers, are heard
beginning at
the apex,
moving to the
left sternal
border, and
then to the
base of the
heart.

Auscultate the
Heart using
Anatomic
areas.
Lungs Inspect for the During P.J during On the second day The client has
observation of Inspection the assessment in P.J during assessment Abnormal findings
level of work of inspection there is a in inspection he is since there is a
consciousness breathing presence of labored already breathing labored breathing
, breathing effortless breathing with use effortless without while using
rate, pattern of accessory muscle using accessory accessory muscle
and effort, , regular use and nose is muscle and nasal and nasal flaring, as
skin color, breathing flaring while flaring. Also, in well as the
chest pattern palpating there is palpation still there is presence of
configuration, , respiratory no pain or no pain or tenderness, adventitious sound
and symmetry rate within tenderness, and no and no palpable such as wheezes,
of expansion. normal range palpable masses, or masses, or lumps. crackles or rales.
for age, chest lumps. Lastly Lastly during
Palpate for expansion during auscultation auscultation there is
pain or symmetrical, there is presence of still presence of
tenderness, absence of Adventitious lung Adventitious lung
Skin cyanosis or sounds, such as sounds, such as
temperature pallor, crackles/rales and crackles or rales.
or masses. absence of wheezing,
accessory
Auscultate for muscle use,
Bronchovesic retractions,
ular and and/or nasal
vesicular in flaring and
appropriate anteroposterio
areas and for r: transverse
adventitious diameter ratio
lung sounds. 1:2.
During
palpitation
there should
No pain or
tenderness
with
palpation.
Skin warm
and dry; no
crepitus or
masses.
During
Auscultation
 the
bronchovesicu
lar and
vesicular
sounds heard
over
appropriate
areas and has
an absence of
adventitious
lung sounds.

Abdomen Inspect for Inspection of P.J has abdomen P.J still has abdomen Overall, his
skin integrity, the abdomen with evenly with evenly rounded abdomen has no
contour, should be rounded or or symmetric, any manifestation
distension, evenly symmetric, without without visible of significant
visible rounded or visible peristalsis peristalsis during findings and the
peristalsis and symmetric, during inspection. inspection. His all assessment in
,pulsations. without His all four four quadrants of the actual findings are
visible quadrants of the abdomen have a within normal.
Auscultate for peristalsis. abdomen have a bowel sounds every 2
bowel sounds Auscultation bowel sounds every to 5 seconds and no
(borborygmi). of all four 2 to 5 seconds and presence of bruit
quadrants of no presence of bruit during auscultation.
Palpation for the abdomen during auscultation. Also there has no
tenderness. for bowel Also there has no presence of pain or
sounds and no presence of pain or discomfort during
presence of discomfort during palpation.
bruit. palpation.
Palpating in
light and deep
technique
which has no
presence of
pain or
discomfort.
Extremiti Inspection During P.J has an equal P.J still has an equal Overall, his
es Observe for Inspection size of both size of both extremities has no
size, contour, there should extremities, no extremities, no any manifestation
bilateral be equal in involuntary involuntary of significant
symmetry, size those movements, no movements, no findings and the
and both edema, and color is edema, and color is assessment in
involuntary extremities, even based on even based on actual findings are
movement. No inspection. While inspection. While within normal.
involuntary during palpation the during palpation the
Palpation for movements, temperature is temperature is warm
evenness of And have the warm and even. and even.
temperature. same contour
. with
prominences
of joints.
While in
palpation
there should
no pain and
temperature is
even.
 VII. COURSE IN THE WARD

The client was admitted on March 29, 2023, at 1:37 in the morning, together with his mother. Also with
the following vital signs: PR: 90 bpm, RR: 26 bpm Temp: 37 02:96. Upon physical assessment through
auscultation of the lungs, there are signs of mild to upper bilateral crackles, rales, and wheezes, and in the test of
hematology, the leukocyte and lymphocyte counts are increasing within the normal range. A chest x-ray (AP)
shows the inner lungs to be hazy, with ill-defined opacities on the tracheobronchial regions and an impression of
perihilar pneumonia and hilar lymphadenopathies, which were later diagnosed by the physician with pediatric
community-acquired pneumonia (PCAP)-B secondary to bronchial asthma. While admitted to the ward
for Day 1, P.J. was awake and very active, had a productive cough, wheezes, afebrile, and difficulty breathing,
and the physician ordered to monitor vital signs, diet as tolerated with strict aspiration precautions, and
administer medication of Azithromycin 200 mg once a day, Salbutamol + Ipratropium nebulized every 6 hours,
Paracetamol 100 mg as needed for fever, and Prednisolone 20 mg/5 ml PO once a day. Nursing management
was applied, such as taking vital signs and collecting urine specimens for urinalysis at 2:40 a.m. On the same
day, from morning to evening, the same nursing management is applied, such as vital signs taken and recorded
every 4 hours, morning care rendered, monitoring urine output, administering medication, and IVF as ordered,
but unfortunately, during the afternoon, the IVF dislodged three times again, and his mother refused to have
reinsertion and urinalysis done. In the evening, the patient is still afebrile. On the other hand, for Day 2 in ward ,
P.J. was awake and conscious in bed, has a good appetite, a productive cough that is on and off, is afebrile, has
no presence of difficulty breathing, is still without IVF, is still on a diet with strict aspiration precautions, does
not experience diarrhea or vomiting, and has urine output every 2 hours. While in the morning and afternoon,
the same nursing management is applied, such as vital signs taken and recorded, morning care rendered,
monitoring urine output, and administering medication, but later in the afternoon, the physician has a discharge
order together with a continuous medication order. Furthermore, the physician instructed P.J.'s mother to return
to the hospital for a follow-up checkup on April 4.
 VIII. DIAGNOSTICS/LABORATORIES (TABLE)
LABORATORY TEST; Hematology

Date: 3-29-2023

PARAMETERS NORMAL VALUE RESULT REMARKS CLINICAL

SIGNIFICANCE
Leukocytes 5-10 0.20-0.40 9.8 INCREASED Increase in number signifies
Lymphocyte 0.54 presence of bacterial
infection that indicator
pneumonia is present.
PLATELETS 150-350
211 NORMAL
ERYTHROCYTES 4.5-5.5

4.8 NORMAL
HEMOGLOBIN 125-160
139 NORMAL
HEMATOCRIT 0.38-0.50 0.41 NORMAL

This laboratory result from the client shows that the red blood cells, platelets, and hematocrit are within the
normal range. However, the white blood cells, specifically leukocytes, of the client are above the normal range
because the body is releasing more of these cells to fight bacterial infections. For confirmation that the client is
releasing and fighting infection, she might have an indicator of Pediatric community-acquired pneumonia
(PCAP), which was stated in the case study.
LABORATORY TEST; URINALYSIS
Date: 3-29-2023
ROUTINE RESULT
COLOR YELLOW
TRANSPARENCY CLEAR
REACTION 6.5
SPECIFIC GRAVITY 1.010
PROTEIN NEGATIVE
SUGAR NEGATIVE
 MICROSCOPIC
PUSS CELLS 0-2/HPF
RBC 0-2/HPF
EPITHELIAL CELLS RARE
BACTERIA RARE
This laboratory result from the client shows that the result of urinalysis is within the normal.
LABORATORY TEST; Chest x-ray (AP)
The inner lungs are hazy. The diaphragm, costophrenic sulci and chest
bones are intact.
There are ill-defined opacities on the tracheobronchial An impression of perihilar pneumonia
regions.
The heart is not enlarged An impression of hilar lymphadenopathies.

A chest x-ray (AP) shows the inner lungs to be hazy, with ill-defined opacities on the tracheobronchial
regions and an impression of perihilar pneumonia and hilar lymphadenopathies.
Generic Name Mechanism of Action Indication Contraindication Adverse Effect Nursing Management

Salbutamol + Azithromycin Azithromycin Person with ➢ Diarrhea 1.The nurse must

Ipratropium binds to the 23S rRNA of should be used only low amount of ➢ Loose educate the mother of client
Azithoromycin the bacterial 50S to treat or prevent magnesium in the about taking of Antibiotic that
ribosomal subunit. It infections that are blood. Person with she must continue to take it
Duavent stool
stops bacterial protein proven or strongly low amount of until the prescribe time even
synthesis by inhibiting suspected to be potassium in the though he or
Zithromax ➢ Abdominal
the transpeptidation caused by blood. Person with she feels well.
n/translocation step of susceptible bacteria myasthenia
Macrolide Pain
protein synthesis and by in order to prevent gravis, a 2.Educate the client about the
➢ Nausea
inhibiting the assembly of the development skeletal right dose, right time to
Antibiotics
the50S Ribosomal antimicrobial muscle administer and right
Subunit This results in resistance and disorder. route of the drug.
PO 200mg
the controlfor bacterial maintain the
Once a day for
ribosomes, is consistent efficacy of 3. To avoid
five days
with their broad‐spectrum azithromycin.caused overdose the nurse
antibacterial activities by susceptible responsibility is to
strains of the monitor giving of
Microorganism dosage of the acquires an
adverse effect
Generic Name Mechanism of Action Indication Contraindication Adverse Effect Nursing Management

Salbutamol + Ipratropium is a Management of Hypersensitivity to Significant: Assess the following:

Ipratropium nonselective competitive reversible soya lecithin or
Brand Name antimuscarinic agent. bronchospasm related food Hypersensitivity 1.Medical background
It causes bronchodilation associated with products e.g. reactions (e.g- -includes medical history and
Duavent by blocking the action of obstructive airway soybeans or peanuts; .urticaria, ongoing medications.
acetylcholine-induced diseases and to any angioedema, rash,
Classification stimulation of guanyl (e.g-. bronchial component of anaphylaxis, Physical Skin color, lesions,
cyclase, hence reducing asthma). Duaventor to bronchospasm texture; Orientation, reflexes,
Adrenergic formation of cyclic For patients with atropine and its oropharyngeal bilateral grip strength; affect;
Anticholinergic guanosine chronic obstructive derivatives. oedema) paradoxical ophthalmic exam; P, BP;
(Bronchodilato monophosphate(cGMP) pulmonary disease Hypertrophic bronchospasm, Adventitious sounds; bowel
r) at parasympathetic site. (COPD) on a regular obstructive ocular complications sounds, normal output; normal

Actual Dosage inhaled cardiomyopathy or (e.g Mydriasis, urinary output, prostate

Salbutamol activates bronchodilator who tachyarrhythmia. blurred vision, palpation.

Nebulise every adenyl cyclase, the continue to have narrow-angle

6 hours enzyme that stimulates evidence of broncho glaucoma, eye pain). Baseline lung sounds
the production of cyclic spasm and who serious
adenosine-3', 5'- require a second hypokalemia, 2.Store below 25°C. Don't
monophosphate(cAMP). bronchodilator. gastrointestinal freeze. Protect from light.
Increased cAMP leads to motility
activation of protein disturbances, rapidly 3. Ensure adequate hydration.
kinase A, which inhibits worsening dyspneic control environmental
phosphorylation of changes, lactic temperature to
myosin and lowers acidosis, urinary
intracellular ionic Ca retention. Rarely 4.Teach the client's mother
concentrations, resulting myocardial about proper use of inhaler.
in smooth muscle ischemia.
relaxation.
 Generic Mechanism of Indication Contraindication Adverse Effect Nursing Management
Name Action
Prednisolone Prednisone is -Hypercalcemia Hypersensitivity to Insomnia, 1 Perform History Taking
biologically inert and associated with soya lecithin or nervousness, increased about the ff Infections;renal ör
Brand Name
converted to the cancer. related food appetite,indigestion, liver disease,hypothyroidism,
predominantly products e.g. dizziness/lightheadedn ulcerative colitis with
Delsatone
prednisolone in the -Short-term soybeans or peanuts; ess, headache, impending
liver. It decreases management of and to any hirsutism, perforation,diverticulitis, active
Classification
inflammation by various component of hypopigmentation, or latent peptic ulcer,
suppression of inflammatory and Duaventor to diabetes mellitus, inflammatory bowel
Cortecosteroid
migration of allergic disorders, atropine and its glucose intolerance, disease, CHF, hypertension,
(intermediate
polymorphonuclear such as derivatives. hyperglycemia, thromboembolic disorders,
acting)
leukocytes and reversal rheumatoid Hypertrophic arthralgia, cataracts, osteoporosis,seizure
Glucocorticoid,
of increased capillary arthritis, collagen obstructive glaucoma. epistaxis, disorders,diabetes mellitus;
Hormone
permeability; suppresses diseases (cs. SLE), cardiomyopathy or diaphoresis,Cushing's hepatic disease,lactation.
the immune system by dermatologic tachyarrhythmia. syndrome,edema,
Actual Dosage
reducing activity and diseases (çB. fractures, 2.Administer once-a-day doses
vol of the lymphatic pemphigus), status hallucinations, before 9AM to mimic normal
PO 2.5 ml OD
system;suppresses asthmaticus, and hypertension, muscle- peak corticosteroid blood
for five days
adrenal function at high autoimmune wasting, osteoporosis, levels.
doses. Indications and disorders. pancreatitis, pituitary-
dosage are same as adrenal axis 3.Educate the mother of
those for prednisolone.. -Hematologic suppression, seizures. client to Do not stop
disorders taking the drug without
Thrombocytopenia consulting your health care
purpura, provider; take oncedaily doses
Gathroblastepcnla at about 9 AM.
-Gathroblastepcnla
Ulcerative colitis,
acute exacerbations of
MS and palliation in
some leukemias and
lymphomas and
palliation in some
leukemias and
lymphomas
 Generic Mechanism of Indication Contraindication Adverse Effect Nursing Management
Name Action
Paracetamol Paracetamol. Called Paracetamol is It is contraindicated -CNS: Headache 1.The nurse must check the
N-acetyl para- Analgesic- antipyretic with allergy to history about Allergy to
Brand Name
aminophenol (APAP) or in patients with aspirin acetaminophen. It -CV: Chest pain, acetaminophen, impaired
paracetamol, is one of allergy, hemostatic should be Use dyspnea, myocardial hepatic function, chronic
Tempra
the most widely used disturbances, bleeding cautiously with damage when doses of alcoholism, pregnancy,
over-the- diatheses, upper GI impaired hepatic 5-8 g/day are ingested lactation
Classification
counter analgesic and disease, gouty function, chronic daily for several
antipyretic agents. [ï] arthritis. Also used for alcoholism, weeks or when doses 2.The nurse must Give drug
Antipyretic,
Although its exact Common cold, flu. pregnancy, lactation. of 4 g/day are ingested with food if GI upset occurs.
Analgesic
mechanism of other viral and for 1yr
(nonopioid)
action remains unclear, bacterial infections -GI: Hepatic toxicity 3. The nurse must discontinue
Actual Dosage
it is historically with pain and fever and failure, jaundice drug if hypersensitivity
categorized along reactions occur.
PO 1.5ml PRN
with NSAIDs -GU: Acute kidney
because it inhibits failure, renal tubular 4.The nurse must educate the
the necrosis client's mother to do not
cyclooxygenase (COX) exceed recommended dose; do
pathways Like NSAIDs, -Hematologic: not take for longer than 10
acetaminophen has Methemoglobinemia days.
analgesic and cyanosis; hemolytie
antipyretic anemia—hematuria 5. The nurse must educate the
properties. anura, neutropenia, client's mother to take the
However, studies have leukopenia drug only for complaints
shown that pancytopenia indicated; it is not an
acetaminophen lacks thrombocytopenia, antiinflammatory agent.
peripheral anti- hypoglycemia
inflammatory
properties. -Hypersensitivity
Acetaminóphen may Rash, fever
inhibit the COX
pathway in the central
nervous system but not
peripheral tissues.
 Generic Mechanism of Indication Contraindication Adverse Effect Nursing Management
Name Action
Cetirizine Potent histamine(H1) It use as a .It is contraindicated -CNS: Somnolence, 1.The nurse must check the
receptor antagonist; Management of with allergy to any sedation history about Allergy to any
Brand Name
inhibits histamine seasonal and perennial antihistamines, -CV:Palpitation, antihistamines,
release and eosinophil allergic rhinitis Also hydroxyzine. Also edema hydroxyzine;narrow-angle
Zyrtec
chemotaxis during for Treatment of Use cautiously with -GI: Nausea, diarrhea, glaucoma, stenosing peptic
inflammation, leading to chronic, idiopathic narrow-angle abdominal pain, ulcer, symptomatic prostatic
Classification
reduced swelling and urticaria serve as a glaucoma stenosing constipation hypertrophy, asthmatic attack,
decreased inflammatory Treatment of year- peptic ulcer, -Respiratory: bladder neck obstruction,
Antihistamine
response round allergic rhinitis symptomatic Bronchospasm pyloroduodenal obstruction;
and chronic prostatic pharyngitis lactation.
Actual Dosage
idiopathies urticaria in hypertrophy, -Other: Fever, 2. The nurse must Give
infants > 6 mo. asthmatic attack. photosensitivity, rash, without regard to meals.
DROPS 1ml
Bladder neck myalgia, arthralgia, 3. The nurse must provide
PO @HS
obstruction angioedema syrup form or chewable tablets
pyloroduodenal for pediatric use if needed.
obstruction (avoid 4.The nurse must arrange for
use or use with use of humidifier if thickening
caution as condition of secretions, nasal dryness
may be exacerbated adequate intake of fluids.
by drug effects); become bothersome; encourage
lactation 5. The nurse must educate the
client's mother about
possibility to experience these
side effects: Dizziness,
sedation, drowsiness
thickening of bronchial
secretions, dryness of nasal
mucosa (humidifier may help).
X. NURSING CARE PLAN
NCP #1
NCP #2
NCP#3
NCP#4
 XI. HEALTH TEACHING
MEDICATION • Educate the mother of the client about importance of strict
compliance to medications.
• Educate the mother to strictly follow the prescribe day of start and
end of the antibiotics.
• Educate the mother about the right time, right dose and right route
of the antibiotics.
• Educate the mother about the side effects and adverse effect of the
drug.
• Educate the mother to not give the client any medications without
consulting a physician.
ENVIRONMEN • Educate the family of the client about risk factors of Pediatric
T community-acquired pneumonia (PCAP).
• Instruct the family members or the guardian of the client to at least
limit the exposure in public areas.
• Instruct the family member or the guardian of the client to ensures
good ventilation.
• Instruct the family member to maintain a clean environment around
their house.
TREATMENT • Instruct the mother to ensures return on the date of follow up visit.
HYGIENE • Educate the family member as well as the child the importance of
handwashing after going outside or before eating.
• Educate the family members as well as the child that when sneezing
or coughing make sure to cover it.
OUT PATIENT • Educate the mother to monitor the cough and breathing pattern of
the child.
• Instruct the mother to immediately report, if there are no changes in
the condition of the child.
DIET • Instruct the mother to prepare foods like fruits, vegetables, whole
grain and protein to strengthen the immune system.
• Educate the mother to prepare a complete meal.
• . Educate the mother that client should continue drink a lot of water.
 SAFETY/SPIRIT • Instruct the mother to keep out of reach the toys that will be harmful
UAL/SEXUAL and can cause choking or aspiration.

XII. EVALUATION

This study provided knowledge on characterizing and understanding pediatric community acquired
pneumonia (PCAP). On the other hand, at this end of the study, the nurse's specific objectives in terms of
knowledge, skill, and attitude were accomplished. The student nurse distinguished the intervention and the
characteristics of PCAP. The nurse also applied effective communication skills to encourage and build
continuous interaction and interdependence in reaching optimal care. Also developed and strengthened
confidence and understanding while providing care and interaction to the client and family members. In addition,
the client’s specific objectives in terms of knowledge, skills, and attitude were also met. The mother of the client
distinguished the interventions and characteristics of pediatric community-acquired pneumonia (PCAP). The
client showed willingness and active participation in the intervention and assessment. Furthermore, the mother
demonstrated compliance with the continuing health education provided. To sum up, the objectives of the study
were attained, and the needed management f or the client was provided.

To sum up, this study can apply to Florence Nightingale's Environmental Theory, in which the
client's environment is a risk factor to his current condition. In this case, the client’s environment was one of the
risk factors since their house is surrounded by many people and along a highway that has air pollution, dust,
chemicals, toxic fumes, or pathogens that can cause a specific disease that contribute to the risk of having an
infection in the lungs. Therefore, education about the importance of having a clean environment and providing a
healthy environment can lead to healing and healthy well-being.
XIII -DOCUMENTATION WITH CONSENT OF THE MOTHER OF CLIENT
XIV-BIBLOGRAPHY

(Center for Disease Control and Prevention 2021). Retrieved from:https://www.cdc.gov/hai/vap/vap.html

(Penn Medicine 2022). Retrieved from: https://www.pennmedicine.org/for-patients-and-visitors/patien t-

information/conditions-treated-a-to-z/aspiration-pneumonia

News Medical Life Science 2021 Retrieved from: https://www.news-medical.net/health/Pneumonia -

Classification.aspx (Mayo Clinic 2020) Retrieved from:https://my.clevelandclinic.org/health/diseases/4471 -
pneumonia

RN PEDIA (2020) Retrieved from: https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-

notes/pneumonia/

World Health Organization (2022) Retrieved from: https://www.who.int/news-room/fact-

sheets/detail/pneumonia