CASE ON PNEUMONIA

1. Presented by-KM KUSUM
1st YEAR P.C Bsc Nsg, MIBE

2.  NAME- Master SAHITYA
 AGE- 2 Yrs
 SEX- Male
 DOB- 26/09/2013
 DOA- 14/10/2015
 DOCTOR INCHARGE- Dr. Mukesh Birla
 WARD- General Ward
 DIAGNOSIS-Pneumonia

3. On admission master Sahitya brought with a
complain of fever since 5 days, cough since 8
days, and breathlessness since 2 days.
H/O Present Illness:2 years old male child
was admitted in General ward with fever on
and off, cough and breathing difficulty.
H/O Past Illness: Had a history of viral
fever with cold and cough 2 months before.

4.  ANTENATAL- Mother attended check up
regularly, no illness during pregnancy, taken
2 doses of TT.
 INTRANATAL- Born through NVD, conducted
by skilled person at hospital, no
complications, no evidence of birth injury,
cried immediately after birth, baby weight
was 2.6 kgs.
 POSTNATAL- No complication, baby was pink
and active, breast feeding started after1/2 an
hour, no evidence of congenital anomalies.

5.  Taken all immunization according to the age
group (BCG, DPT, MEASLES,OPV)
ANTHROPROMETRY
Length-75 cms
Weight-11kgs
Head circum-45 cms
Chest circum-48 cms
Mid arm circum-14 cms

6.  PHYSICAL DEVELOPMENT: Have weight 11kgs, have
temporary teeth, pulse rate-110/m, Resp. rate-30.
 MOTOR DEVELOPMENT:
 A. Gross motor-steady gait, walks on heel toe,
walks up and down upstairs holdings wall.
 B. Fine motor- picks up objects from floor, can
build tower of 6-7 cubes, turn pages one at a time,
drink with glass.

7.  Autonomy vs. Shame and Doubt
 Occurs in the toddler age. (18 months-3
years).
 Child learns to feed themselves and do things
on there own.
 Or they could start feeling ashamed and
doubt their abilities.
 Questions the child's willpower.

8.  ANAL STAGE: According to Sigmund Freud it
is the second stage of oral development
that occurs between 1 ½ until 3 years of
age, in which the child’s greatest pleasure
involves the anus or the eliminative
functions associated with it.
 Child is getting proper toilet training.

9.  The Sensorimotor Period (0-2 yrs.)
 According to Jean Piagent , Infants and
toddlers "think" with their eyes, ears, hands,
and other sensorimotor equipment.
 They learn to generalize their activities to a
wider range of situations and coordinate
them into increasingly lengthy chains of
behavior.

10.  Enjoys story
 Knows at least 4 body parts
 Has a vocabulary of 300 words
 Refers to self by name

11.  Stages of Faith-Stage 0 – "Primal or
Undifferentiated" faith (birth to 2 years).
 It is characterized by an early learning of the safety
of their environment (i.e. warm, safe and secure vs.
hurt, neglect and abuse). If consistent nurture is
experienced, one will develop a sense of trust and
safety about the universe and the divine.
Conversely, negative experiences will cause one to
develop distrust with the universe and the divine.
Transition to the next stage begins with integration
of thought and languages which facilitates the use
of symbols in speech and play.

12. Nuclear family, 4 members, father, mother, elder
sister.
FAMILY TREE:

13. S.NO DRUG FORM DOSE ROUTE TIME ACTIONS
1. ANGUMENTIN 300
mg
IV TDS BACTERIOCIDAL
2. AMIKACIN 75 mg IV BD BACTERIOCIAL
3. SYP. NOBLE
PLUS
4 ml PO TDS NON-OPOID
ANALGESIC
4. IPRAVENT NEBS 1 ml PN QID BRONCHO
DILATOR
5. VANCOMYCIN 200
mg
IV BD ANTI-INFECTIVE

14. INVESTIGATION PATIENT’S VALUE NORMAL VALUE
• TLC 27.31 10^3/microL 5-15 10^3/microL
• HAEMOGLOBIN 10.9 gm/dl 11-14 gm/dl
• ABORH B +ve -
• PLATELETS 531 10^3/microL 150-450
10^3/microL
• URINE R/E NORMAL NORMAL
• SECIFIC GRAVITY 1.15 1.003-1.035

15.  Head to toe examinations done.
 Respiratory-dyspnea, nasal flaring.
 Rest of the findings were normal.
VITAL SIGNS
1. Temperature-100F
2. Heart rate-122/m
3. Respiration-36/m

16.  INTRODUCTION: Pneumonia is
inflammation of the lung that is most often
caused by infection with bacteria, viruses,
or other organisms. Occasionally, inhaled
chemicals that irritate the lungs can cause
pneumonia. Healthy people can usually
fight off pneumonia infections. However,
people who are sick, including those who
are recovering from the flu (influenza) or
an upper respiratory illness, have a
weakened immune system. This makes it
easier for bacteria to grow in their lungs.

18. Pneumonia is a breathing (respiratory)
conditions in which there is an
infection and inflammations of the
lungs parenchyma cells.
Pathologically there is consolidation of
alveoli or infiltration of the interstitial
tissue with inflammatory cell or both.

19.  The World Health Organization
(WHO) estimates there are 156
million cases of pneumonia
each year in children younger
than five years, with as many
as 20 million cases severe
enough to require hospital
admission.

20.  Approximately one-half of children younger
than five years of age with community-
acquired pneumonia (CAP) require
hospitalization.
 In the developed world, the annual incidence
of pneumonia is estimated to be 33 per
10,000 in children younger than five years
and 14.5 per 10,000 in children 0 to 16
years.

21.  The mortality rate in developed countries is
low (<1 per 1000 per year). In developing
countries, respiratory tract infections are not
only more prevalent but more severe,
accounting for more than 2 million deaths
annually.
 Pneumonia is the number one killer of
children in the WORLD.

22. BOOK DESCRIPTION PATIENT’S PICTURE
1. Bacterial infections
2. Viral or Fungal
infections
3. Aspiration pneumonia
4. Who had a recent viral
infections
5. People with low
immune system
6. Hospital acquired
pneumonia
7. Community acquired
pneumonia.
Master Sahitya had recent viral
infections 2 months before.

23. INFECTIONS, ASPIRATIONS, LOW
IMMUNITY, POLLUTANTS ETC.
NEUTROPHILLIC/LYMPHOCYTIC
INFILTRATIONS
ACUTE/CHRONIC INFLAMMATION

24. INCREASED CAPILLARY PERMEABILITY
FLUID/CELLULAR EXUDATION
EDEMA OF MUCUOUS MEMBRANE
HYPERSECREATION OF MUCUS
PERSISTENT COUGH, STAGES OF CONGESTION
IN THE ALVEOLAR SPACES WITH FLUID AND
HEMORRHAGIC EXUDATES

26.  Pneumonia can affect anyone. But the two age
groups at highest risk are:
1. Children who are 2 years old or younger
developing
2. People who are age 65 or older
 Other risk factors include:
 Chronic disease
 Weakened or suppressed immune system
 Smoking
 Being hospitalized

27. BOOK’S PICTURE PATIENT’S PICTURE
1. History taking
2. Physical examination
3. Chest X-ray
4. Blood test, blood
culture
5. Sputum examination
6. Bronchoscopy
7. Pleural fluid culture
8. Pulse oximetry
9. CT-scan
10.CBC
1. Patient history taken
2. Physical examination
3. Chest X-ray
4. Blood test

29. 1. PHARMACOLOGICAL: The choice of an
initial, empiric agent is selected according to the
susceptibility and resistance patterns of the likely
pathogens and experience at the institution and the
selection is tempered by knowledge of the delivery of
the drugs to the suspected infected sites with the
lungs.
1. Antibiotics agents
2. Anti inflammatory therapy
3. Anti viral
4. Bronchodilators

30. 2. Chest physiotherapy and breathing exercise
3. Postural drainage
4. Surgical Management
Drainage of plural effusion by continuous
suction
Reduction of pneumothorax

31. Most people with pneumonia improve after
3-5 days of antibiotics of treatments but a
mild cough and fatigue can last longer up to
a month.
Patients who required treatment in a hospital
may take longer to see improvement.
pneumonia is more likely to be fatal in the
elderly or those with chronic medical
conditions or a weakened immune system.

32.  Pleural effusion
 Empyema
 Lung abscess
 Necrotizing pneumonia
 Airway injury
 Obstructive airway secreations
 Air leak syndrome
 Chronic lungs disease
 Sepsis

33. NURSING DIAGNOSIS
1. Ineffective airway clearance related to
inflammation and accumulations of secretions as
evidenced by cough with sputum productions.
2. Impaired gas exchange related to alveolar
capillary membrane changes as evidenced by
tachycardia and restlessness.
3. Hyperthermia related to inflammatory process as
evidenced by increased body temperature.
4. Risk for fluid volume deficit related to inadequate
oral intake, fever, as evidenced by poor skin
turgour.
5. Imbalanced nutrition less than body requirement
related to disease condition as evidenced by
refusal of food by child.

34. 6. Sleeping pattern disturbed related to
hyperthermia and cough as verbalized by mother’s
concern for rest and sleep.
7. Interrupted family process related to
hospitalization as evidenced by inability to fullfill
daily works.
8. Knowledge deficient about the conditions,
prognosis, and treatment of pneumonia as
evidenced by less knowledge about pneumonia
management.

35.  Teach parents about signs and symptoms of
pneumonia.
 To teach about fluid intake.
 To Give proper rest and sleep.
 To make child to sleep in head elevated at 30
degree to ease the breathing.
 CONTACT HEALTH CARE:
 IF symptoms do not get better or get worse, child
have fever.
 Child is lethargic and weak
 Not taking feeds properly

36.  IMMIDIATE CARE:
 Blood in cough
 Tachycardia
 Looks very lethargic and weak
 Not able to breath properly
 Childs lips or finger nails turn black and blue

37. WATCH
VIDEO IN
3D!