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INTRODUCTION
Pneumonia is a general term that refers to an infection of the lungs,which can be caused by a variety of microorganisms, including
viruses,bacteria, fungi, and parasites.
Most cases of pneumonia are caused by viruses, includingadenoviruses,rhinovirus, influenza virus (flu), respiratory syncytial virus
(RSV), and parainfluenza virus (which causes croup).
Often, pneumonia begins after an upperrespiratory tract infection (an infection of the nose and throat), with symptoms of pneumo nia
beginning after 2 or 3 days of a cold or sore throat.
Signs and Symptoms
Symptoms vary depending on the age of the child and the cause of the pneumonia, but common ones include:
 fever
 chills
 cough
 nasal congestion
 unusually rapid breathing (in some cases,this is the only symptom)
 breathing with grunting or wheezing sounds
 labored breathing that makes the rib muscles retract (when muscles under the ribcage or between ribs draw inward with each
breath) and causes nasalflaring
 vomiting
 chest pain
 abdominal pain
 decreased activity

2.  loss of appetite (in older kids) or poor feeding (in infants), which may lead to dehydration
 in extreme cases,bluish or gray color of the lips and fingernails
Someone with pneumonia in the lower part of the lungs near the abdomen might have fever and abdominal pain or vomiting but no
breathing problems.
Kids with pneumonia caused by bacteria usually becomes sick fairly quickly and will have a sudden onset ofa high fever and
unusually rapid breathing.
Kids with pneumonia caused by viruses probably will have symptoms that appearmore gradually and are less severe, though
wheezing can be more common in viral pneumonia.
Some types of pneumonia cause symptoms that give important clues about which germ is causing the illness. For example, in old er
kids and adolescents,pneumonia due to Mycoplasma (also called walking pneumonia) is notorious for causing a sore throat, headache,
and rash in addition to the usual symptoms of pneumonia.
In infants, pneumonia due to chlamydia may cause conjunctivitis (pinkeye) with only mild illness and no fever. When pneumonia is
due to whooping cough (pertussis),a child may have long coughing spells, turn blue from lack of air, or make the classic "whoop"
sound when trying to take a breath.
PATIENT’S PROFILE
Name:patient X
Address: Bokawkan Rd. Baguio City
Age: 4yrs
Birthday: December 28, 2007
Sex: Male
Nationality: Filipino
Religion: Roman Catholic
Date & Time of Admission: Dec 5, 2011
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
NURSING HISTORY
PAST MEDICAL HISTORY
According to the patient’s SO, he had completed his childhood immunization. He had no allergy to foods or
medications. He experienced common diseases such as fever,cough and colds he usually took OTC drugs (Paracetamol
syrup, Neozep syrup) to manage his fever cough and colds. On June 2010 the patient was admitted at Government
Hospital due to illness.
HISTORYOF PRESENT ILLNESS
According to the SO, 3 days prior to admission the patient experienced sudden onset of squeezing pain at Para
gastric area aggravated by activity. No meds taken or consultation made. 2 days PTA the patient still has 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 BGH-MC hence he was admitted.

3. FAMILYHEALTH HISTORY
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 3rd
among 4 siblings. He lived with 7 other households’ member. His father worked as a garbage
collector and his mother is a housewife, they consume or use tap and not boiled water.
.
PATHOPHYSIOLOGY

4. PHYSICAL ASSESSMENT
Date assessed:Dec 2011
Time: 7pm

5. Initial vital signs:
T=37.9 PR=140bpm RR=25cpm
General Appearance:the patient is conscious and coherent with ongoing of
D5NM 500ml at 750cc level hook at his left arm, intact and infusing well
skin
 Skin normally dry
 Skin is moist d/t hyperthermia
 Normally warm 37.9 o C d/t hyperthermia
Hair Texture
 Smooth Rough Due to poor hygiene
Thorax and
Lungs
Auscultation
 Clear breath Sounds
 Presence of breath sound Due to congestion
Nose and
Teeth
Nares
Inspection
 Oval, symmetric and without discharge
 Oval, symmetric but with discharge Due to the presence of colds
 Teeth Inspection Firmly set, shiny Firmly set, shiny with tooth decay Due to poor hygiene
LABORATORY RESULTS
HEMATOLOGY RESULTS

6. Dec.6,2011Parameter 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
HEMATOLOGY RESULTS
Dec.6,2011Parameter 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
NCP
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

7. Subjective:
“hindi ako
makahinga ng
mabuti” as
verbalized
Objective:
•Use of
accessory
muscle.
•Dyspnea
•Fatigue.
•V/S taken as
follows: T: 37.9
PR: 140 bpm
RR:
25cpm
- ( + ) crackles
- tachypnea
- ineffective
cough
Ineffective
airway
clearance r/t
increase
pulmonary
secretion as
evidenced by
( + ) crackles,
tachypnea,
ineffective
cough
STO:
After 4 hours
of
nursing
interventions,
the
patient will
be able to
demonstrate
cooperation on
therapeutic
regimens to be
done
LTO:
After 3-4days
of
nursing
interventions,
the
patient will
display patent
airway with
breath sounds
clearing airway
and
absence of
dyspnea.
>auscultated breath
sound and assessed
air movement
>Elevated head
of the bed,
change position
frequently.
>Assist patient
with deep
breathing
exercises.
>Forced fluids to
at least 3000 ml
per day and offer
warm, rather
than cold fluids.
>Provided
supplemental
fluids.
.
>| kept the
environment
allergens free
> gave expectorant
( bronchodilator )
as
>Demonstrated
or help patient
learn to perform
activity like
splinting chest
and effective
coughing while in
upright position.
> to ascertain
status and note
progress
>Lowers
diaphragm,
promoting
chest
expansion and
expectoration
of
secretions.
>Coughing is a
natural self
cleaning
mechanism.
>Fluids
especially
warm
liquids aid in
mobilization
and
expectoration
of
secretions.
>Fluids are
required to
replace losses
and aid in
mobilization of
secretion
> To avoid
irritation of
airway
caused by
allergens.
>to mobilized
secretion
>Splinting
reduces
chest
discomfort,
and an upright
position favors
deeper,more
forceful cough
STO:
After 4 hours of
nursing
interventions,
the
patient was able
to demonstrate
cooperation on
therapeutic
regimens to be
done
LTO:
After 3-4 days
of
nursing
interventions,
the
patient was able
to display patent
airway with
breath sounds
clearing airway
and
absence of
dyspnea.

8. effort.
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective: “Mainit
siya hawakan “ as
verbalized by the
mother
Objective
 Temp
37.9ºC
 Skin warm
to touch
 Flushed
skin
 Dry mouth
Hyperthermia
r/t
inflammatory
response of the
body as
evidence
by increase in
core
temperature
After 2hours
of nursing
interventions
the
patient will
have
lowered
temperature
from
37.9-37.5 ºC
> monitored
V/S
> Performed
tepid
sponge bath
> demonstrated
proper
performance of
TSB
> instructed the
SO to keep the
patient rested
> administered
antipyretics as
ordered
> for baseline
data
> to facilitate
heat loss
through
evaporation
and
conduction
> to provide
proper
knowledge and
to empower the
SO in taking
care
of the –patient
To slow down
the
patient
metabolism
> aid in
lowering
down the
temperature
Goal met as
evidenced by
lowered
temperature
from 37.9-37.5
ºC
Assessment Diagnosis Planning Intervention Rationale Evaluation
Objectives:
>
DRUG STUDY
Name ofthe Dosage Indication Contraindication Adverse effect Nursing

9. Drug Mechanism
of action
responsibility
Generic name:
ranitidine
brand name:
Zantac
Classification:
Antacids,
Antireflux
Agents &
Antiulcerants
18 mg IV
q 8 hours
Ranitidine is
a specific,
rapidly
acting
histamine
H2-
antagonist.
It inhibits
basal and
stimulated
secretion of
gastric acid,
reducing
both the
volume and
the acid and
pepsin
content of
the
secretion.
Duodenal &
benign
gastric
ulcer
Patients known to
have
hypersensitivity
to
ranitidine or to
any component of
Zantac Injection.
> Immune System
Disorders:
(urticaria,
angioneurotic
edema, fever,
bronchospasm, and
hypotension and
chest pain
> Nervous System
Disorders:Headache
(sometimes severe),
dizziness
>Gastrointestinal
Disorders: Acute
pancreatitis,
diarrhea
> assess
patient
abdominal
pain. Not
presence of
blood in
emesis, stool
or gastric pain
> drug may be
added to total
parenteral
nutrition
Name ofthe
Drug
Dosage
Mechanism
of action
Indication Contraindication Adverse
effect
Nursing
responsibility
Salbutamol
BRAND
NAME:Ventolin
vilmax
3-12
yrs4mg tab
BID
Facilitates/
potentiates
the inhibitory
activity of
GABA at the
limbic system
and reticular
formation to
reduce
anxiety,
promote
calmness and
sleep
Reversible
airway
obstruction
including
bronchial
asthma,
chronic
brochitis
Hypersensitivity Fine tremor of
skeletal
muscle,
feeling of
tension, a
compensory
small increase
in heart rate,
headache,
muscle
cramps
> drug may be
decrese
sensitivity of
spirometry
used for
diagnosis of
asthma
>syrup may be
taken
as young as
age 2
>monitor
for evidence of
allergic rxn
Name of
the
Drug
Dosage
Mechanism
of action
Indication Contraindication Adverse effect Nursing
responsibility

10. Cefuroxime
Cefuroxime
750 mg
IV
q 6h
Cefuroxime, a
semisynyhetic,
broadspectrum”
second
generation”
cephalosporin
antibiotic,
exerts its
bactericidal
activity by
interfering with
the synthesis of
the bacterial cell
wall. It binds to
penicillinbinding
protein
3 responsible
for the
synthesis of
peptidoglycan, a
hetoropolymeric
structure that
gives the cell
wall its
mechanical
stability.
Indicated in
the
treatment of
the
following
infections
due to
cefuroximesensitive
organisms
>Lower
respiratory
tract
infections
including
pneumonia
>Urinary
tract
infection
>Skin and
skin
structure
infections
>Septicemia
>Meningitis
.Gonorrhea
Known allergy to
the cephalosporin
group of
antibiotic
CV: phlebitis,
thrombophlebitis
GI: diarrhea,
nausea,
vomiting,
anorexia
Hematologic:
hemolytic
anemia,
eosinophilia
Skin:
maculopapular
and
erythomatous
rashes,urticaria,
pain,
indurations,
sterile abscesses,
temperature
elevation
>Before
giving
drug, ask
patient if he is
allergic to
penicillin or
cephalosporin.
>Obtain
specimen for
culture and
sensitivity
tests before
giving first
dose. Therapy
may begin
while waiting
the results
>Monitor
patient for
signs and
symptoms of
super
infection
Name ofthe
Drug
Dosage
Mechanism
of action
Indication Adverse effect Nursing
responsibility
Acetaminophen
( Paracetamol)
Classification:
antipyretics,
nonopioid
analgesics
1.2 mL
q
4 hr
PRN
Inhibits the
synthesis of
prostaglandins
that may
serve as
mediators of
pain and
fever,
primarily in
the CNS
Mild pain
Fever
Hema:
hemolytic anemia,
neutropenia,
leukopenia,
pancytopenia.Hepa:
jaundice
Metabolic:
hypoGGI:
HEPATIC FAILURE,
HEPATOTOXICITY
(overdose).
GU:
renal failure (high
doses/chronic use).
Derm:
rash, urticaria.
BEFORE:
> Advise
parents or
caregivers to
check
concentrations
of liquid
preparations.
Errors have
resulted
in serious liver
damage.~
Assess
fever; note
presence of
associated
signs
(diaphoresis,
tachycardia,
and

11. malaise).
DURING:
>Adults
should not
take
acetaminophen
longer than 10
days
and children
not longer than
5 days
unless directed
by health care
professional.~
Advise mother
or
caregiver to
take
medication
exactly
as directed and
not to take
more
than the
recommended
amount.
AFTER:
>Advise
patient to
consult health
care
professional if
discomfort or
fever is not
relieved by
routine
doses of this
drug or if
fever is
greater than
39.5°C
(103°F) or
lasts longer
than 3 days.
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