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COLLEGE OF HEALTH
A case Study on
Severe Pneumonia
GENERAL OBJECTIVE
After this case study, I will be able to know what Pneumonia is, causes of
Pneumonia, how it is acquired and prevented, its treatments and prevention
of the occurrence of Pneumonia
SPECIFIC OBJECTIVES
After the completion of this study, I will be able to:
o Define what is Pneumonia
o Trace the pathophysiology of Pneumonia
o Enumerate the different sign and symptoms of Pneumonia
o Identify and understand different types of medical treatment
necessary for the treatment of Pneumonia
o Formulate and apply nursing care plans utilizing the nursing process
INTRODUCTION
Pneumonia is characterized by inflammation of the alveoli and terminal
airspaces in response to invasion by an infectious agent introduced into the
lungs through hematogenous spread or inhalation. The inflammatory cascade
triggers the leakage of plasma and the loss of surfactant, resulting in air loss
and consolidation. This is in contrast to pneumonitis, which is caused by
noninfectious agents such as radiation or chemicals.
An inhaled infectious organism must bypass the host's normal
nonimmune and immune defense mechanisms in order to cause pneumonia.
The nonimmune mechanisms include aerodynamic filtering of inhaled
particles based on size, shape, and electrostatic charges; the cough reflex;
mucociliary clearance; and several secreted substances (eg, lysozymes,
complement, defensins). Macrophages, neutrophils, lymphocytes, and
eosinophils carry out the immune-mediated host defense.
Conditions that allow pneumonia-causing infectious organisms to circumvent
the upper airway defense mechanisms include the following:
• Intubation, tracheostomy, impaired cough reflex, and aspiration: These
conditions provide infectious organisms with easier access to the
alveoli and terminal airspaces.
• Ciliary dyskinesia, bronchial obstruction, viral infection, cigarette
smoke, and certain chemical agents: These conditions create
disruption in the mucociliary blanket.
• Anatomic abnormalities (eg, sequestrations), gastric fluid aspiration or
other causes of noninfectious inflammation, altered pulmonary blood
flow, and pulmonary edema: These conditions increase the
predisposition for pneumonia.
• Immunodeficiency and immunosuppression: These conditions increase
predisposition for pneumonia.
Mortality/Morbidity
The United Nations Children's Fund (UNICEF) estimates that 3 million
children die worldwide from pneumonia each year. Although most fatalities
occur in developing countries, pneumonia remains a significant cause of
morbidity in industrialized nations.
I have chosen this case Pneumonia because it may catch one’s attention,
though the disease is just like an ordinary cough and fever, it can lead to
death especially when no intervention or care is done. Since this case is a
child, an appropriate care has to be done to make the patient’s recovery
faster. Treating patients with pneumonia is necessary to prevent its spread to
others and make them as another victim of this illness.
PATIENT’S PROFILE
Name: J.V.
Address: 181, Ninada Street, Lltex road, Quezon City
Age: 4yrs. and 4 months
Birthday: December 28, 2004
Sex: Male
Nationality: Filipino
Religion: Roman Catholic
Date & Time of Admission: January 18, 2009 (07:00 am)
Mode of Arrival: cuddled by mother
Chief Complaint: abdominal pain, cough and colds
Source of Information: patient, & chart, SO
Admitting Diagnosis: severe Pneumonia
Final Diagnosis: severe Pneumonia
Attending Physician: Dr. Karen Lorenzo MD
NURSING HISTORY
2 days PTA the patient still have the same abdominal pain, this time
was more severe, and associated with DOB and fever of 38°C. His mother
gave him paracetamol. No consultation was made.
Few hours PTA, the patient could not any more tolerate the pain; he
was brought to EAMC hence he admitted.
According to the patient SO, both his maternal and paternal have a
history of Cancer, PTB, and Bronchial Asthma. PTB is evident on the patient’s
grand father and uncle while cancer and bronchial asthma is evident on the
patient aunt.
Personal/ Social History
The patient is the 4th among 6 siblings. He was lived with 7 other
households’ member. His father work as a garbage collector and his mother
is a house wife they consumed or used tap not boiled water.
PATHOPHYSIOLOGY
Cough crackles
CO2 pagocytosis
Hyperventilation
WBC fever chill altered LOC
RR
Hypoxia
Released of erythropoietin
PHYSICAL ASSESSMENT
LABORATORY RESULTS
HEMATOLOGY RESULTS
May 18, 2009
Parameter Normal Value Results Analysis
WBC 5-10 x 10 g/L 18.1 Increased due to
infection
Hgb M 140-170g/dl 165 Increased due to
infection
Hct M 39%-54% .30 Decreased
RBC 4.6- 10 g/l 10.4 Increase due t o
hypoxia
Differential Count
Lymphocytes
20%-40% .50 Increased due to
infection
Specific objectives:
At the end of our 4 days clinical duty, I will be able to:
- Carryout skills I learned from school
- improve my skills regarding patient care
- establish rapport with my patient as well as health team in the EAMC
Insight:
Experience comprises knowledge of or skill in or observation of some thing
or some event gained through involvement in or exposure to that thing or
event.
Experience also is in deed the best teacher. I admit I really did learn a lot of
skills and knowledge inside the school but learning through my experience in
the actual hospital setting is really different. Gaining knowledge and skills in
my actual duty is more different and effective. I have developed a more
organized way of dealing with people that I never had before. Greatly I have
many educational experiences throughout the duration of our duty. One of
this was monitoring the I & O of my 3 patients. I also have been opened to
the different needs of my patients that would sure benefit me in rendering a
more quality care.
For all this learning experience, I appreciated and love more my future
profession. I have been realized that the greatest help we could offer to our
patient is giving them attentions and best quality of health service. I also
thank my CI because of assistance and learning he shared. It’s great under
your supervision…. GOD BLESSES!!!!!!