Pediatric Community

Acquired Pneumonia
(PCAP)

Case Study
Group Members:
Chybel Mende
Gerlie Jane Padernal
Ariane Pama
Jasmine Rosana Paras
Pheobe Praise Perito
Andrew Joseph Perez
Isabelle Marie Puig
Signet Mozart Vencer
Phoebe Jones Yap
 Objectives of the Study
After the case presentation student nurses will be able to obtain
the knowledge to enhance skills and to develop the attitude
towards caring for the patient with a diagnosis of Pediatric
Community Acquired Pneumonia or PCAP.
Specific Objectives:
Knowledge -
1. Explain the pathophysiology of Pediatric Community Acquired
Pneumonia.
2. To identify the main cause of the disease.
3. Increase the knowledge about the disease and how the said
disease disrupts the normal functioning of the body.
4. Identify the signs and symptoms of the disease manifested by
the patient.
5. Discuss the specific treatments for Pediatric Community
Acquired Pneumonia
Skills -
Carry out independent nursing interventions being done to the
client appropriately with care.
Provide appropriate health teaching to patients and folks with
Pediatric Community acquired Pneumonia or PCAP.
Administer properly and accurately the prescribed medications
and to be able to identify its action and drug information.

Attitude -
To be a spiritual vessel and instrumenting in caring for out patient
with Pediatric Community Acquired Pneumonia or PCAP.
 Patient Profile
• Name: S.C.B • Chief Complaint: Fever/
productive cough for two
• Age: 9 years old weeks

• Gender: Female • Diagnosis: Pneumonia

• Address: Brgy. Mambawi • Date Of Admission:1-21-

Alimodian 18/ 1:55am

• Civil Status: S

• Religion: Roman Catholic

 Health History
Present Health History

The night before admission, the patient complains about

difficulty in breathing and a hard cough. As verbalized by the
mother, the patient was crying because of her shallow breathing
and hard cough.

Past Health History

As observed it was verbalized by the folks that the patient had

a good appetite, was hyperactive and had enough sleep.
Prenatal Status

• The pregnancy spaced/gap is 1 year

• It was not planned

• She has not experienced any complication during pregnancy

• The couple had a positive attitude towards the pregnancy

• She hasn’t taken any medication prescribed during the

pregnancy

• She did not smoke, drink alcohol, or use street drugs during the
pregnancy

• She did not have any x-rays during the pregnancy

Labor and Delivery 11:35PM.

• Gravida 10 Para 6 • Weight birth is 2.7kg.

APGAR Score is 8,10
• The duration of the
pregnancy was 9 months Postnatal Status

• She gave birth at Western • No problems in the nursery

Visayas Medical Center
• They stayed in the hospital
• The type of delivery is for 2 days
NSVD, and she was in
labor for more than 24hrs. • The baby was bottle-fed
She gave birth at exactly
Childhood Illnesses Operations or Hospitalizations

• There were no childhood • Her first hospitalization was at

illnesses other than asthma age 4. It is her 4th
hospitalization caused by the
Serious Accidents or Injuries asthma

• There were no serious Immunizations

accidents or injuries in her
childhood • Completely immunized

Serious or Chronic Illness Allergies

• There were no serious or • She is allergic to seafood,

chronic illness from her eggs, meat, and chicken
childhood
Physical Examination
Vital Signs color with the skin.
T: 36.8 P: 82 R: 20 BP: 90/60 Eyes
Over - All Appearance •Eyes are symmetrical; dark brown.
•Clean and well groomed. •Vision is not impaired.
•Posture and gait aligned. •Pupils are perrla = eyes are equally
•No signs of body odour. round and reactive to light.
Head Ears
•Head has no contusions or protrusions. •Ears are symmetrical bilaterally with
•Hair is medium in length, black, and is no masses or lesions.
evenly distributed. •No unnatural discharge.
Skin •Hearing is not impaired.
•Skin is dark brown. Nose
•No scars or bruises •Nose is symmetrical with no masses,
•No rashes or blemishes lesions or signs of tenderness.
Face •Nostrils are clear during breathing test.
•Face is symmetrical with uniform
Physical Examination Cont.
Mouth Upper Extremities
• Lips are light red; with slight cracks; may • Skin color is uniform; no rashes, lesions,
be due to dehydration. or scars.
• Teeth show slight staining; uniform in size • Brachial and Radial artery are strong and
with 3 teeth missing. even on both extremities.
• Health Promotion: Advise daily dental • Capillary refill test completed with no
care abnormal findings.
• Buccal Mucosa show no signs of Axilla
discoloration or lesions. • Clean with no rashes.
• Tonsils show no sign of inflammation. • Skin is tugor. (sign of non-apparent
• Tongue exhibits white staining; may be dehydration)
due to denydration Anterior Chest
• Patient Drinks 1 Liter of water daily. • No rashes or bruises
Neck • Apical pulse auscultated with no abnormal
• Neck is symmetrical with no masses or findings.
lesions. • Anterior chest rises and falls normally.
• No sign of tenderness.
• No bruits detected during palpation of
carotid arteries.
Physical Examination Cont.

Posterior Chest Feet

•Posterior chest is symmetrical; •Feet have signs of scarring
no masses, rashes, or lesions. •Due to mosquito bites and
Abdomen scratching.
•Auscultated for peristalsis with •Feet have no masses or lesions.
no abnormal findings. •Capillary refill test completed
•Palpated for tenderness with no with no abnormal findings.
abnormal findings. Patterns of Elimination
•Patient has no masses or •Passing of Stool : Once a day
protrusions. •Normal, Solid, Brown
Legs •Passing of Urine : 5-6 times a
•Legs are fair in skin color. day
•Popliteal, Femoral, and Dorsal •Light Yellow, No Foul Odor,
Pedis pulse are strong and even. No painful urination
 Review Of Systems
I. Respiratory System
• Has a history of asthma and bronchitis.
• There was a difficulty of breathing accompanied by
chest pain.
• There was a wheezing or noisy breathing upon
auscultating the lungs.
• Shortness of breath is noted.
• Has productive cough. Yellow-ish in color.
• No hemoptysis is noted.
• Last chest x-ray was done on January 21, 2018
II. Cardiovascular System

• Complained of palpitations from time to time.

• There was no edema.

• Orthopnea is noted.

• There was no history of heart murmur and high blood pressure.

• No record of ECG or other cardiovascular tests.

III. Peripheral Nervous System

• There is no visible varicose veins or other complications.

• Did not complain of any intermittent claudication.

• No visible ulcer or thrombophlebitis in the platelets.

• There is discoloration in the hands or feet.

• Experienced coldness but no numbness, swelling and

tingling sensation.
IV. Gastrointestinal System

• Appetite is good and can eat anything that is given to her.

• There is no food intolerance.

• Has not experienced any abdominal pain.

• Has no history of any abdominal diseases.

• Bowel movement 1 X a day.

• There are no abdominal problems.

V. Urinary System

• Normal frequency, urgency of urination.

• There is no dysuria, polyuria, or oliguria.

• No history of UTI.

• There is no signs of abnormally colored urine.

VI. Female Genitalia

• Have not started menarche yet.

• No complications within this system.

VII. Musculoskeletal System

• There is no deformity in all the outer extremities.

• All complete ten fingernails and 10 toenails.

• There is no difficulty in moving or doing outdoor activities.

• Able to do anything age appropriate for her.

• No pain, cramps, weakness in the muscles.

• No problems with coordinated activities or any musculoskeletal

related problems.

• Very active at school can play volleyball.

VIII. Neurologic System

• There is no history of seizure, convulsions, or any neurologic problems.

• There is no change in mental status.
• No problems in motor function and sensory function.

IX. Hematologic System

• There is no excessive bruising, lymph node swelling, and tendency

bleeding of skin or mucous membrane.

• No visible petechia.
• No history of blood transfusion.
• No exposure to radiations and toxic agents.
X. Endocrine System

• Doesn’t have diabetes or diabetic symptoms.

• No history of thyroid disease or any other endocrine

system diseases.
 Laboratories and
Diagnostic Test
Hematology

CBC is processed to see if the patients immune system is actively fighting an infection.

Results: Normal Values:

Hemoglobin Mass Concentration 123 gms/li F- 120 - 150 gms/li

M- 130 - 170 gms/li

Erythrocyte Volume Fraction 0.36 li/li F- 0.37 - 0.45 li/li

M- .40 - 0.50 li/li

Erythrocyte Number Concentration 4.08 x10/li F- 4.0 - 5.0 x10/li

M- 4.5 - 5.0 x10/li

 Hematology

Results: Normal Values:

Leukocyte Type Number Fraction

Neutrophils Number Fraction 0.88 : 1 .60 - .70 : 1

Segmenters 0.88 : 1 .60 - .70 : 1
Eosonophil 0.02 : 1 .02 - .03 : 1
Lymphocyte 0.10 : 1 Adult: .18 - .30 : 1
Infant: .22 - .40 : 1

Reticulocyte Number Fraction 368 x10/L 5 – 15 x10/L

Thrombocyte Number Fraction(rees ecken) 368 x10/L 150 – 450 x10/L

Urinalysis
By capitalizing on the concentration of shed antigen from a variety of pathogens in the kidneys for excretion
in the urine, urinary antigen testing can be used to obtain rapid test results related to respiratory infection.
Color Straw
Transparency Hazy
Rxn Acidic
Sp. Gn 1.010
Protein Trace
Sugar Negative
Rbc 0.2 hpf
Pus cells 4.8 HPF with med. AMPI
Slight elevation of Pus cells indicates the possibility of a UTI.
Amorphous Urates Many
Squarnous Epithelial Cells Few
Mucous threads Many
 Fecalysis
A stool analysis is done in order to diagnose certain conditions affecting the tract.

Results:

Occult blood No intestinal parasites seen on smear

Chest PAL
A chest X-ray is ordered to see your lungs, heart and blood vessels to help determine if you have
pneumonia. The radiologist will look for white spots in the lungs that identify an infection.

Results:

There are hazy densities at the Paracardiac, Perihilar and retrocardiac areas.
Hazy densities indicate liquid within the lungs.
The trachea is at midline.
The cardial silhoutte is not enlarged.
The Castophrenic sulci are intact.
The hemidiaphgrams are smooth.
The rest of the findings are unremarkable.

Impression:
BronchoPneumonia
The impression indicates Pediatric Community Aquired Pnemonia.
Medications
Generic name: Ampicillin Sulbactam
Brand Name: Unasyn
Dosage: 500mg I.V Q6H for 4 days
Classification: Antibiotics
Action: Inhibits cell-wall synthesis during bacterial multiplication
Indications: Intra-abdominal, gynaecological, and skin-structure infections
caused by susceptible strains.
Contraindication: Hypersensitivities to penicillins, multiple allergens,
those with mononucleosis and those with history of cholestatic jaundiced
or hepatic dysfunction.
Adverse Reactions:
CV: Thrombophlebitis
GI: Diarrhea
Patient Teaching: Tell patient to report rash, fever, or chills. A rash is the
most common allergic reaction. Warn patient that I.M. injection may cause
pain at injection site.
Nursing Responsibility: Watch for signs and symptoms of
hypersensitivity, monitor CDAD and LFT results.
Generic name: Acetaminophen
Brand Name: Tylenol
Dosage: 250ml 1tsp q6h
Classification: Analgesics
Action: Thought to produce analgesia by inhibiting prostaglandins and other
substances that sensitive pain receptors. Drug may relieve fever through central
action in hypothalamic heart regulating center.
Indications: Mild pain or fever.
Contraindication: Patients hypersensitive to the drug, or with current or history of
liver disease.
Adverse Reactions:
CNS: Agitation, anxiety, fatigue, and headache.
CV: Hypertension, hypotension, edema, and tachycardia.
GI: Nausea, vomiting, abdominal pain, and diarrhea.
Hematologic: Leukopenia, pancytopenia, and anemia.
Musculoskeletal: Muscle Spasms
Respiratory: Dyspnea and hypoxia.
Skin: Rash
Patient Teaching: Advise that the drug is for short term use only and to not use for
temperature higher than 39.5 degrees Celsius.
Nursing Responsibility: Use caution when administering I.V to avoid dosing errors.
Generic name: Albuterol Sulfate
Brand Name: Salbutamol
Dosage: 1 neb q8h
Classification: Bronchodilators
Action: Relaxes bronchial, uterine, and vascular
smooth muscle by stimulating beta2 receptors.
Indications: To prevent or treat bronchospasm in
patients with reversible obstructive airway disease.
Contraindication: Use cautiously in patients with CV
disorders (coronary insufficientiency and
hypertension), hyperthyroidism, or diabetes.
Adverse Reactions:
CNS: Tremor, nervousness, headache, hyperactivity, insomnia,
dizziness, weakness, CNS stimulation, malaise.
CV: Tachycardia, palpitations, hypertension, chest pain,
lymphadenopathy.
EENT: Conjunctivitis, otitis media, dry and irritated nose and throat
nasal congestion, epistaxisis, hoarseness, pharyngitis, rhinitis.
GI: Nausea, vomiting, heartburn, anorexia, altered taste, increased
appetite.
GU: UTI
Metabolic: Hypokalemia
Patient Teaching: Teach patient to perform oral inhalation correctly,
to wash aerosol inhaler in water, to not eat or place any powder
inhaler in water, and to not use more than prescribed.
Nursing Responsibility: Monitor patient for effectiveness, if drug
causes paradoxical bronchospasm, discontinue drug immediately.
Generic name: Cetirizine
Brand Name: Zyrtec
Dosage: 10 g 1 tab OD
Classification: Antihistamines
Action: Compete with histamine receptor sites and preventing
access to subsequent activity of histamine.
Indications: Motion sickness, nausea and vomiting, allergic
rhinitis, and sedation.
Contraindication: Safe use hasn’t been established in pregnant
women.
Adverse Reactions: May cause drowsiness and impaired
motor function.
Patient Teaching: Advise patient to not operate heavy
machinery and to avoid alcoholic beverages.
Nursing Responsibility: Monitor patient for adverse or severe
reactions to the medication.
Generic name: Hydrocortisone
Brand Name: Colocort
Dosage: 200 g
Classification: Corticosteroids
Action: Decreases inflammation, mainly by stabilizing
leukocyte lysosomal membranes.
Indications: Respiratory Diseases such as Loeffler
syndrome, beryllium’s, pulmonary TB, and aspiration
pneumonitis.
Contraindication: Patients with systemic fungal
infections, GI ulcer, renal disease, hypertension,
osteoporosisosis, diabetes myelitis, seizures, and
psychotic tendencies.
Adverse Reactions:
CNS: Euphoria, insomnia, psychotic behaviour.
CV: Hypertension, parenthesis, seizures
EENT: Cataracts, glaucoma
GI: GI irritation, nausea, and vomiting
GU: Menstrual irregularities
Hematologic: Easy bruising
Metabolic: Hypokalemia and hyperglycemia
Skin: Delayed wound healing, acne, skin eruptions.
Musculoskeletal: Growth suppression in children, muscle
weakness, and osteoporosis.
Patient Teaching: Teach patient to take oral form with food. Warn
patient about easy bruising. Caution patient to avoid exposure to
infections such as chickenpox or measles.
Nursing Responsibility: Monitor patients weight, BP, and electrolyte
levels. Inspect patients skin for petechiae and watch for signs of
depression.
 Pathogenesis of Pediatric
Community Acquired Pneumonia

• Pneumonia arises from normal flora present in patients

whose resistance has been altered or from aspiration of
flora present in the oropharynx.

• An inflammatory reaction may occur in the alveoli,

producing exudates that interferes with the diffusion of
oxygen and carbon dioxide.

• White blood cells also migrate into the alveoli and fill the
normally air-filled spaces.
• Due to secretions and mucosal edema, there are areas of
the lung that are not adequately ventilated and cause
partial occlusion of the alveoli or bronchi.

• Hypoventilation may follow, causing ventilation-perfusion

mismatch.

• Venous blood entering the pulmonary circulation passes

through the under ventilated areas and travels to the left
side of the deoxygenated heart.

• The mixing of the oxygenated and poorly oxygenated

blood can result to arterial hypoxemia.
• Inflammation of the pulmonary parenchyma as response
to the offending organism.

• The organism to penetrate the sterile lower respiratory

tract thru inhalation where inflammation develops.

• Disruption of the mechanical defenses of cough and ciliary

motility leads to colonization and subsequent infections

• Inflamed and fluid filled alveolar sacs cannot exchange

CO2 and O2 effectively resulting to hypoxemia.
 SIGNS AND SYMPTOMS
• FEVER
• COUGH
• SHORTNESS OF BREATH
• SWEATING SHAKING CHILLS
• INCREASED WBC COUNT
• CHEST PAIN FLUCTUATES WITH BREATHING
(PLEURISY)
• HEADACHE
• MUSCLE PAIN
• FATIGUE
SCHEMATIC DIAGRAM OF PNEUMONIA
PREDISPOSING FACTORS: PRECIPITATING FACTORS:
• AGE – PEOPLE WHO WERE INDUCED IN BOTH • LIFESTYLE
ENDS OF THE AGE CONTINUUM ARE HIGHLY • PRESENT HEALTH CONDITION
SUSCEPTIBLE TI THE DIESEASE
• ENVIRONMENT

EXPOSURE TO PATHOGEN OR
SOURCE OF INFECTION

INVASION OF MICROORGANISM INTO THE LUNGS

VIA ORIFICES WHICH CONNECT TO THE URT

PROLIFERATION OF MICROORGANISM

INFLAMMATION PROCESS:
TISSUE INJURY CAUSE BY BIOLOGIC AGENTS IRRITATION OF RESPIRATORY TRACT

VASODILATION (INCREASED BLOOD FLOW TO THE AREA HYPER
 RESPIRATORY RESPIRATORY
SCRETION INSUFFICIENCY
INCREASED PERMEABILITY (PROTEIN RICH EXUDATE CONGESTION
OF MUCUS
CONTAINING IMMUNOGLOBULES AND COMPLEMENT
MOVES INTO THE INJURED AREA

EMIGRATION OF LEUKOCYTES

CHEMOTAXIS INCREASED NUMBER OF LEUKOCYTES

PHAGOCYTOSIS
 Nursing Diagnosis
Identified
1. Ineffective Airway Clearance related to viscous mucous and
retained secretions as manifested by the following signs and
symptoms.

• Productive Cough

• Restlessness

• Dyspnea

2. Impaired Gas Exchange

3. Deficient knowledge related to PCAP.

 NURSING CARE PROCESS
CUES NURSING OUTCOME NURSING RATIONALE EVALUATION DISCHARGE
DIAGNOSIS CRITERIA INTERVENTIONS PLANNING

SUBJECTIVE: ➢ INEFFECTIVE ➢ UP TO 30 MINUTES INDEPENDENT: M – ENCOURAGE

➢ MONITOR BODY ➢ BASELINE DATA
“NA BUDLAYAN AIRWAY
CLEARANCE
OR 1 HOUR OF
NURSING TEMPERATURE, AND MONITOR
➢ MET; STRICT COMPLIANCE
WITH THEIR
SIYA MAG RELATED TO INTERVENTIONS ASSESS CHANGES RESPIRATORY MEDICATION; EXPLAIN
GINHAWA KAG VISCOUS THE PATIENT WILL RESPIRATORY RATE, RATE IMPORTANCE OF
GINA UBO” AS MUCOUS AND BE ABLE TO DEPTH, AND EASE. NORMAL, ACTION, DOSAGE, AND
RETAINED MAINTAIN AIRWAY ➢ ELEVATE HEAD OF ADVERSE EFFECT
VERBALIZED BY SECRETIONS PATENCY AS THE BED AND ➢ FACILITATE LUNG RELIEF OF E- MAINTAIN A FREE,
MOTHER EVIDENCE BY RELIEF CHANGE POSITION EXPANSION, REST, DYSPNEA AS QUEIT, CLEAN
OF DYSPNEA AND FREQUENTLY AND BREATHING VERBALIZED ENVIRONMENT
ABILITY TO COUGH ➢ SMALL FREQUENT T- ANTIBIOTICS,
MUCOUS FEEDINGS ➢ IMPROVE DIET
BY MOTHER CONTINUE NEB AS
OBJECTIVE: SECRETIONS ➢ INCREASE FLUID ➢ MET; ORDERED, AND PAIN
➢ PRODUCTIVE INTAKE UNLESS ➢ LIQUIFY PRODUCTIVE RELIEVER,
COUGH CONTRAINDICATED SECRETIONS TO COUGH PARACETAMOL
➢ RESTLESSNESS MAKE IT EASIER TO
ACHIEVED
H - TEACH DEEP
➢ DYSPNEA EXPECTORATE BREATHING FACILITATE
➢ MET; PATIENT SECRETIONS, ADVISE
➢ X-RAY (+) PCAP- PATIENT TO AVOID
MR ABLE TO
CROWDED PLACES
➢ CBC (INC WBC EXPECTORATE O – GET VACCINATED
COUNT) SECRETIONS FOR PNEUMONIA,
➢ SPUTUM DEPENDENT: KEEP AWAY FROM
➢ ADMINISTER THOSE WHO ARE SICK,
AMPICILLIN ➢ TO REDUCE ADVISE TO CONSULT
➢ ADMINISTER PAI AS BRONCHOSPASM PHYSICIAN WHEN
INDICATED AND MOBILIZE SYMPTOMS COME
SECRETIONS. BACK
D – INCREASE FLUID
INTAKE, HIGH CALORIE
AND HIGH PROTEIN
S – INSTRUCT THE FOLK
TO HAVE A FOLLOW UP
CHECK UP AFTER
DISCHARGE