PEDIATRIC COMMUNITY ACQUIRED PNEUMONIA

A Case Study Presented To

The Faculty of the College of Nursing
LORMA COLLEGES
City of San Fernando, La Union

In Partial Fulfillment
of the Requirements for
Microbiology Laboratory

By:
Adamu, Silas
Carillo, Kendrick
Cavaneyro, Metchelyn
De Vera, Helen
Ede, Rachael
Ukatta, Emilia Onyinyechi
Tanaka, Joanna

Submitted To:
Mrs. Surat, Araceli F., MAN
Clinical Instructor

December 2018
 I. INTRODUCTION

This is a case study of a nine-year old child who was diagnosed with Pediatric Community-
Acquired Pneumonia at Lorma Medical Center.
Community-acquired pneumonia (CAP) refers to pneumonia (any of several lung diseases)
contracted by a person with little contact with the healthcare system. CAP is common, affecting
people of all ages, and its symptoms occur as a result of oxygen-absorbing areas of the lung
(alveoli) filling with fluid. This inhibits lung function, causing dyspnea, fever, chest pains and
cough.
CAP, the most common type of pneumonia, is a leading cause of illness and death
worldwide. Its causes include bacteria, viruses, fungi and parasites. CAP is diagnosed by
assessing symptoms, making a physical examination and on x-ray. Other tests, such as sputum
examination, supplement chest x-rays. Patients with CAP sometimes require hospitalization, and
it is treated primarily with antibiotics, antipyretics and cough medicine. Some forms of CAP can
be prevented by vaccination and by abstaining from tobacco products.
A child dies from pneumonia every 20 seconds; worldwide, the disease is responsible for
almost one in six deaths in children under the age of five. In 2015, approximately 920,000
children died from pneumonia – that’s more than 2,500 children per day. In the Philippines, it is
one of the 15 countries that together account for 75% of childhood pneumonia cases worldwide.
In children aged under 5 years, pneumonia is the leading cause of mortality with a mortality rate
of 920,136 population recorded in 2015.
Over 100 microorganisms can cause CAP, with most cases caused by Streptococcus
pneumoniae. Certain groups of people are more susceptible to CAP-causing pathogens; for
example, infants, adults with chronic conditions (such as chronic obstructive pulmonary disease),
senior citizens, alcoholics and others with compromised immune systems are more likely to
develop CAP from Haemophilus influenzae or Pneumocystis jirovecii. A definitive cause is
identified in only half the cases.
II. OBJECTIVES

PATIENT/FAMILY CENTERED OBJECTIVES

During the interval of patients' management in the hospital, the family involved will
be able to;

1. Have a proper understanding about the disease process.

2. Be able to recognize the signs and symptoms of PCAP.
3. Know the measure taken to prevent the occurrence or progressiveness of
disease process.
4. Understand the level of the disease prognosis.
5. Recognize the importance of prompt hospital visit following these signs.
6. Keep to follow-up dates.
7. Adhere to discharge advice and health preventive measures.

STUDENT CENTERED OBJECTIVE

Within the period of management of the patient, student will;

1. Be able to know the definition of PCAP

2. Understand the signs and symptoms that accompany the disease.
3. Trace the pathophysiology of PCAP.
4. Enumerate the different sign and symptoms of PCAP.
5. Identify and understand different types of medical treatment necessary for the
treatment of PCAP.
6. Formulate and apply nursing care plans utilizing the nursing process.
 III. PATIENT’S PROFILE

Patient’s name is C.J.C, Male and is nine (9) years of age. Patient is currently residing in San
Gabriel, La Union which is one hour and thirty-two minutes away from San Fernando, La Union.
Patient’s birthday is February 24, 2009 and his birthplace is in La Union. His religious
affiliation as well as his family is Roman Catholic.
Patient was born to a 33-year-old mother of two. His mother is a housekeeper and his father
is an office worker.
He lives in a bungalow house with no nearby factories and environmental toxicants noted.
Patient has no history of asthma nor family history known.
Furthermore, patient has no known food and drug allergy noted. Patient's immunization is
completed for his age as well.
At the age of seven (7), the patient suffered from cough, fever, swollen tonsils and difficulty
in swallowing. As the symptoms persist, he was brought to Lorma Medical Center last August
21, 2016 for a medical check-up where he was diagnosed of non-exudative Acute
Tonsillopharyngitis.
One week prior to admission, he had sudden onset of cough with whitish-yellow sputum with
colds and loss of appetite.
One day prior to admission, patient had the same signs and symptoms with onset of on and
off fever, 38°C, headache and dizziness.
Few hours prior to his admission, patient manifested similar signs and symptoms with
vomiting.
Patient was discharged last October 17, 2018 with improvements of breathing with no
productive cough present.
PHYSICAL EXAMINATION

Performed last October 15, 2018

General: Patient is a nine-year-old male, Filipino, with normal body build and has no obvious
deformities. During admission, patient often shows signs of malaise with persistent cough with
mucus. He appears to have a normal growth development and is aware of his surroundings.
Eyes: Conjunctivae and lids normal, pupils equal, round, reactive to light and, accommodation,
no a/v nicking, hemorrhages, or exudates, normal visual acuity.
ENNT: External ears normal, no lesions or deformities; external nose normal, no lesions or
deformities, nasal mucosa, septum, and turbinate normal; good dentition and does not wear
dentures; tongue normal; neck is supple, no masses, trachea midline; no thyroid nodules, masses,
tenderness, or enlargement.
Respiratory: Symmetrical chest wall expansion, (+) intercostal retractions, (-) lagging, harsh
breathing sounds, (+) crackles on both lung fields, (-) wheezes A/dynamic precordium, PMI at
5th ICS, Normal rate and rhythm, (-) murmur.
Cardiovascular: S1, S2, normal rhythm, no murmur, rub, or gallop; no thrill or palpable murmurs
on palpation.
Abdomen: Soft, non-tender, non-distended
Lymph Nodes: No cervical, clavicular, or posterior auricular lymphadenopathy.
Skin: No rash, lesions, ulcerations, subcutaneous nodules or induration.
Musculoskeletal: Normal alignment, mobility and no deformity of head and neck, spine, ribs,
pelvis; normal ROM; no clubbing, cyanosis, petechiae, or nodes of digits and nails.
 IV. DIAGNOSTIC TEST
LAB NORMAL RESULT CLINICAL
VALUES SIGNIFICANCE
EOSINOPHILS 0-2.0 0.06 INDICATION OF
INFECTION/ILLNESS
HEMATOCRIT 0.30-0.40 0.38 NORMAL

HEMOGLOBIN 120-150 129 NORMAL

LYMPHOCYTES 0.20-0.40 0.09 INDICATION OF

INFECTION/ILLNESS
MONOCYTES 0-0.8 0.05 NORMAL

PLATELET COUNT 150-350 212 NORMAL

SEGMENTERS 45%-70% 0.80 INDICATION OF

INFECTION/ILLNESS
WBC 5.0-10.0 5.77 NORMAL

The eosinophil count measures the amount of eosinophils in your blood. They’re a kind of white
blood cell that helps fight disease. The exact role of eosinophils in your body isn't clear, but they're
usually associated with allergic diseases and certain infections in high levels.
Lymphocytes are an important part of the immune system. They help fight off diseases, so it is
normal to see a temporary rise in the number of lymphocytes after an infection.
The segmenters include an increased need for neutrophils, as with an acute bacterial infection,
will cause an increase in both the total number of mature neutrophils and the less mature bands
or stabs to respond to the infection.
A hematocrit test is a type of blood test. Your blood is made up of red blood cells, white blood
cells, and platelets. These cells and platelets are suspended in a liquid called plasma. A
hematocrit test measures how much of your blood is made up of red blood cells. Red blood cells
contain a protein called hemoglobin that carries oxygen from your lungs to the rest of your body.
Hematocrit levels that are too high or too low can indicate a blood disorder, dehydration, or other
medical conditions.
 PATHOPHYSIOLOGY
PRECIPITATING ORGANISMS (STAPHYLOCOCCUS PREDISPOSING
FACTOR AND GRAM-NEGATIVE BACILLI) FACTOR
MAY ENTER THE RESPIRATORY
-CAUSATIVE
TRACT OR ASPIRATION OF ORAL
ORGANISMS
-AGE SECRETIONS
INCLUDE BACTERIA,
-GENDER (MALE) FUNGI, VIRUSES
AND PROTOZOAN
-GENETICS NORMAL PULMONARY DEFENSE MECHANISMS
(COUGH REFLEX, MUCOCILIARY TRANSPORT, -PREVIOUS
PULMONARY MACROPHAGUS) USUALLY HOSPITAL
PROTECT AGAINST INFECTION. HOWEVER, IN ADMISSION
SUSCEPTIBLE HOSTS, THESE DEFENSES ARE -SMOKING
EITHER SUPPRESSED OR OVERWHELMED BY THE
INVADING MICROORGANISM.

LUNG TISSUE FILLS WITH EXUDATES AND FLUID,

CHANGING FROM AN AIRLESS STATE TO A
CONSOLIDATED STATE.

IN VIRAL PNEUMONIA, THE CILIATED CELLS INFLAMMATION

THE INVADING ORGANISM
BECOME MULTIPLIES AND
DAMAGED. AND EDEMA OF
RELEASES DAMAGING TOXINS THE LUNG
PARENCHYMA;
SEVERITY OF SYMPTOMS DEPENDS ON THE THIS RESULTS IN
EXTENT OF PNEUMONIA PRESENT (E.G. ACCUMULATION
PARTIAL LOBE, FULL LOBE OR DIFFUSE) OF CELLULAR
DEBRIS AND
EXUDATES.

SYMPTOMS INCLUDE:

(As seen on patient)

 MALAISE
 CRACKLES ON
AUSCULTATION
 PLEURITIC COUGH
VII. EVALUATION

The overall process of making a case study is indeed enriching and useful for us,
student nurses. The obtaining of information of the patient during our exposure in the
clinical area helped us build our communication skills and establish rapport not only
with our patient but also his family members as well.

In addition, the physical assessment we have performed to the client helped us

competently use our skills and practice the art of Nursing care through the following
nursing interventions we were able to formulate. With the interview and assessment
that we were able to gather, we were also able to understand the factors that may
contribute to the client’s health such as the environment.

Making a case study can be time consuming, energy draining and brain busting but
we would conclude that the stress is worth it. The knowledge and experience we
gained is worth the stress because we have learned time management which is very
essential in Nursing.

The patient that we presented for our case study was discharged last October 17,
2018. On the day of discharge, he was more comfortable than during his admission.
His final diagnosis is Pediatric Community-Acquired Pneumonia (PCAP) with
moderate risk. He was prescribed with clarithromycin, 125 mg/5ml-8ml two times
(2x) a day for seven (7) days. He was also advised to return for check-up after 5 days.
On that return for check-up, Dra. G.A.M. noted that patient has no productive cough
anymore and has no difficulty of breathing. Patient manifested full energy as well as
having no adventitious sounds in the lungs noted.

Finally, this case study helped us realize our own strengths and make utmost use of
these strengths in working as a team. It helped us appreciate one another’s efforts and
enhanced our ability to understand more of the concepts of our subject, Microbiology,
particularly with the understanding of pathogenic microorganisms. With this, our
awareness of such microorganisms raised, and we can use our knowledge in giving
proper Nursing diagnosis and interventions in the future as well as to make ourselves
tool in raising awareness and disseminating information to clients.