Case Study Of Pediatric Pneumonia Philippine

INTRODUCTION

Pneumonia is an inflammation of the lungs caused by an infection. It is also called Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our health. Although pneumonia is a special concern for older adults and those with chronic illnesses, it can also strike young, healthy people as well.  It is a common illness that affects thousands of people each year in the Philippines, thus, it remains an important cause of morbidity and mortality in the country.
There are many kinds of pneumonia that range in seriousness from mild to life-threatening. In infectious pneumonia, bacteria, viruses, fungi or other organisms attack your lungs, leading to inflammation that makes it hard to breathe. Pneumonia can affect one or both lungs. In the young and healthy, early treatment with antibiotics can cure bacterial pneumonia. The drugs used to fight pneumonia are determined by the germ causing the pneumonia and the judgment of the doctor. It’s best to do everything we can to prevent pneumonia, but if one do get sick, recognizing and treating the disease early offers the best chance for a full recovery.
A case with a diagnosis of Pneumonia 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 the case is a toddler, 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.

ANATOMY AND PHYSIOLOGY

The lungs constitute the largest organ in the respiratory system. They play an important role in respiration, or the process of providing the body with oxygen and releasing carbon dioxide. The lungs expand and contract up to 20 times per minute taking in and disposing of those gases.
Air that is breathed in is filled with oxygen and goes to the trachea, which branches off into one of two bronchi. Each bronchus enters a lung. There are two lungs, one on each side of the breastbone and protected by the ribs. Each lung is made up of lobes, or sections. There are three lobes in the right lung and two lobes in the left one. The lungs are cone shaped and made of elastic, spongy tissue. Within the lungs, the bronchi branch out into minute pathways that go through the lung tissue. The pathways are called bronchioles, and they end at microscopic air sacs called alveoli. The alveoli are surrounded by capillaries and provide oxygen for the blood in these vessels. The oxygenated blood is then pumped by the heart throughout the body. The alveoli also take in carbon dioxide, which is then exhaled from the body.
Inhaling is due to contractions of the diaphragm and of muscles between the ribs. Exhaling results from relaxation of those muscles. Each lung is surrounded by a two-layered membrane, or the pleura, that under normal circumstances has a very, very small amount of fluid between the layers. The fluid allows the membranes to easily slide over each other during breathing.

PATHOPHYSIOLOGY

Pneumonia is a serious infection or inflammation of your lungs. The air sacs in the lungs fill with pus and other liquid. Oxygen has trouble reaching your blood. If there is too little oxygen in your blood, your body cells can’t work properly. Because of this and spreading infection through the body pneumonia can cause death. Pneumonia affects your lungs in two ways. Lobar pneumonia affects a section (lobe) of a lung. Bronchial pneumonia (or bronchopneumonia) affects patches throughout both lungs.

Bacteria are the most common cause of pneumonia. Of these, Streptococcus pneumoniae is the most common. Other pathogens include anaerobic bacteria, Staphylococcus aureus, Haemophilus influenzae, Chlamydia pneumoniae, C. psittaci, C. trachomatis, Moraxella (Branhamella) catarrhalis, Legionella pneumophila, Klebsiella pneumoniae, and other gram-negative bacilli. Major pulmonary pathogens in infants and children are viruses: respiratory syncytial virus, parainfluenza virus, and influenza A and B viruses. Among other agents are higher bacteria including Nocardia and Actinomyces sp; mycobacteria, including Mycobacterium tuberculosis and atypical strains; fungi, including Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Cryptococcus neoformans, Aspergillus fumigatus, and Pneumocystis carinii; and rickettsiae, primarily Coxiella burnetii (Q fever).

The usual mechanisms of spread are inhaling droplets small enough to reach the alveoli and aspirating secretions from the upper airways. Other means include hematogenous or lymphatic dissemination and direct spread from contiguous infections. Predisposing factors include upper respiratory viral infections, alcoholism, institutionalization, cigarette smoking, heart failure, chronic obstructive airway disease, age extremes, debility, immunocompromise (as in diabetes mellitus and chronic renal failure), compromised consciousness, dysphagia, and exposure to transmissible agents.

Typical symptoms include cough, fever, and sputum production, usually developing over days and sometimes accompanied by pleurisy. Physical examination may detect tachypnea and signs of consolidation, such as crackles with bronchial breath sounds. This syndrome is commonly caused by bacteria, such as S. pneumoniae and H. influenzae.

NURSING PROFILE

a.Patient’s Profile

Name: R.C.S.B.

Age: 1 yr,1 mo.

Weight:10 kgs

Religion: Roman Catholic

Mother: C.B.

Address: Valenzuela City

b.Chief Complaint: Fever

Date of Admission: 1st admission

Hospital Number: 060000086199

c.History of Present Illness

2 days PTA – (+) cough

(+) nasal congestion, watery to greenish

(+) nasal discharge

Tx: Disudrin OD

Loviscol OD

Few hrs PTA –(+) fever, Tmax= 39.3 C

(+) difficulty of breathing

(+) vomiting, 1 episode

Tx: Paracetamol

Sought consultation at ER: Rx=BPN, Salbutamol neb.

IE: T = 38.3C, CR= 122’s, RR= 30’s

(+) TPC

SCE, (-) retractions, clear BS, (-) cyanosis, (-) edema

d.Past Illness

(-) asthma

(-) allergies

e.Family History

PMHx: (+) asthma(mother)

f.Activities of Daily Living

·Sleeping mostly at night and during afternoon

·Usually wakes up early in the morning (5AM) to be milkfed.

·Eats a lot (hotdogs, chicken, crackers, any food given to her)

·Active, responsive

·BM (1-2 times a day)

·Urinates in her diaper (more than 4 times a day)

·Likes to play with those around her

g.Review of Systems

Neuromuscular: weakness of muscles

Integumentary: (-) cyanosis

Respiratory: tavhypnea; (+) DOB; (+) coarse crackles, (+) wheezes,

Digestive: food aversion, vomits ingested milk

DRUG STUDY

View NCP

NURSING ACTIONS

INDEPENDENT

  • positioning of the patient with head on mid line, with slight flexion
    rationale: to provide patent, unobstructed airway , maximum lung excursion
  • auscultating patient’s chest
    rationale: to monitor for the presence of abnormal breath sounds
  • provide chest and back clapping with vibration
    rationale: chest physiotheraphy facilitates the loosening of secretions
  • considering that the patient is an infant, and has developed a strong stranger anxiety
    as manifested by “white coat syndrome” ,  it is a nursing action to play with the patient.
    rationale: to establish rapport, and gain the patients trust

DEPENDENT

  • administer due medications as ordered by the physician, bronchodilators, anti pyretics and anti biotics
    rationale:  bronchodilators decrease airway resistance, secondary to bronchoconstriction,
    anti pyretics alleviate fever, antibiotics fight infection
  • placing patient on TPN  prn
    rationale:  to compensate for fluid and nutritional losses during vomiting

COLLABORATIVE

  • assist respiratory therapist in performing nebulization of the patient
    rationale:  nebulization is a favourable route of administering bronchodilators
    and aid in expectorating secretions, hence patient’s breathing

PHYSICIAN’S ORDER SHEET

11/19/06          

Admit patient to ROC under the service of Dr. Vitan secure consent for  admission and management, TPR every shift then record. May have diet for age with strict aspiration precaution, IVF D5 0.3NaCl 500cc to run at 62-63mgtts/min.May give paracetamol 125mg 1supp/rectum if oral paracetamol is not tolerated.

11/20/06         

For urinalysis, IVF to follow D5 0.3 NaCl 500 at SR (62-63mgtt/m Use zinacef brand of cefuroxine 750mg- given ½ vial 375mg every 8hours, nebulize    (Ventolin 1 nebule) every 6 hours, paracetamol drugs prn every 4hours (Temp 37.8).

11/21/06         

Continue cefuroxine and nebulizer every 6 hours. May not reinsert IVF, revise Cefuroxine IV to Cefuroxine 500mg via deep Intramuscular BID,continue  management.

11/22/06          

Continue management and refer.

DISCHARGE PLANNING

  • Take the entire course of any prescribed medications. After a patient’s temperature returns to normal, medication must be continued according to the doctor’s instructions, otherwise the pneumonia may recur. Relapses can be far more serious than the first attack.
  • Get plenty of rest. Adequate rest is important to maintain progress toward full recovery and to avoid relapse.
  • Drink lots of fluids, especially water. Liquids will keep patient from becoming dehydrated and help loosen mucus in the lungs.
  • Keep all of follow-up appointments. Even though the patient feels better, his lungs may still be infected. It’s important to have the doctor monitor his progress.
  • Encourage the guardians to wash patient’s hands. The hands come in daily contact with germs that can cause pneumonia. These germs enter one’s body when he touch his eyes or rub his nose. Washing hands thoroughly and often can help reduce the risk.
  • Tell guardians to avoid exposing the patient to an environment with too much pollution (e.g. smoke). Smoking damages one’s lungs’ natural defenses against respiratory infections.
  • Give supportive treatment. Proper diet and oxygen to increase oxygen in the blood when needed.
  • Protect others from infection. Try to stay away from anyone with a compromised immune system. When that isn’t possible, a person can help protect others by wearing a face mask and always coughing into a tissue.

What Do You Think?

A Case Study: Pneumonia

Muhammad Zeeshan Zafar*

Faculty of Pharmacy, University of Sargodha, Pakistan

*Corresponding Author:
Zafar MZ
Faculty of Pharmacy
University Of Sargodha
Pakistan
Tel: 03466189496
E-mail:[email protected]

Received date: July 8, 2016; Accepted date: July 29, 2016; Published date: August 4, 2016

Citation: Zafar MZ (2016) A Case Study: Pneumonia. Occup Med Health Aff 4:242. doi: 10.4172/2329-6879.1000242

Copyright: © 2016 Zafar MZ. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Pneumonia (from the Greek pneuma, “breath”) is a potentially fatal infection and inflammation of the lower respiratory tract (i.e., bronchioles and alveoli) usually caused by inhaled bacteria and viruses has both properties (Streptococcus pneumoniae, aka pneumococcus). The illness is frequently characterized by high fever, shortness of breath, rapid breathing, sharp chest pain, and a productive cough with thick phlegm. Pneumonia that develops outside the hospital setting is commonly referred to as community-acquired pneumonia. Pneumonia that develops 48 hours or later after admission to the hospital is known as nosocomial or hospital acquired pneumonia. In this case report we review the presentation and management of pneumonia involving the respiratory system. The aim of this report is to alert the clinicians to the potential diagnosis of pneumonia treatment. This is the case report of 3 months old boy with Pneumonia. He was diagnosed with pneumonia. His treatment was starting and after 7 days, he became completely recovered. For his disease diagnosis different tests are also performed.

Keywords

Community-acquired pneumonia (CAP); Pneumonia; Diagnosis; Drug uses; Doctors treatment; Respiratory disorders

Introduction

Community-acquired pneumonia (CAP) is a common and potentially serious illness that is associated with morbidity and mortality. Only half of the cases had an etiology microorganism identified.

Dozens of types of bacteria can cause pneumonia. Bacterial pneumonia is caused by an infection of the lungs and may present as a primary disease or as secondary disease in a debilitated individual or following a viral upper respiratory infection, such as influenza or the common cold.

Community-acquired pneumonia tends to be caused by different microorganisms than those infections acquired in the hospital.

Pneumonia caused by Streptococcus pneumonia remains the most common cause of all bacterial pneumonias. High-risk groups include older adults and people with a chronic illness or compromised immune system. This type of pneumonia is a common complication of chronic cardiopulmonary disease (e.g., heart failure) or an upper respiratory tract infection [1].

The knowledge of etiology of pneumonia in low and middle income countries is based on two types of studies: prospective, microbiologybased studies and vaccine trial studies, where indirect evidence of vaccine efficacy for the prevention of pneumonia can be used to estimate the disease burden of each pathogen.

Prospective studies have identified Streptococcus pneumonia as the leading cause of bacterial pneumonia among children in developing countries, responsible for 30-50% of pneumonia cases.

The second most common is Haemophilus influenza type b followed by Staphylococcus aureus and i Other bacteria are Mycoplasma pneumonia and i , causing atypical pneumonia non-typable H. influenza (NTHI) and non-typhoid Salmonella spp. Furthermore, studies of lung aspirate have identified Mycobacterium tuberculosis as an important cause of pneumonia.

Case Presentation

A 3 months old boy was brought to the DHQ hospital Gujranwala, Pakistan. He presenting complains are cough, fever, dyspnea, vomiting and diarrhea from the period of last 5 days.

He ate contaminated food and drinks few days ago so, that is the main cause of this. Before to come here they also went in Ahsan hospital Daska, Pakistan, but he did not understand a disease, he gave him Amoxicilline 125 mg/5 ml and Dimenhydrinate 12.5 mg/4 ml syrups.

After 3 days of treatment, they came into DHQ hospital Gujranwala. Other chief complaints by the patient include problem in breathing may be due to cold feeling.

His physical examination showed temperature 102°F. Respiratory rate is 28 beats/min, hear crept on auscultation, he weighed 5 kg. His caused of fever may be some cold exposure.

He was treated with Cefixime 100 mg/5 ml, Ibuprofen 100 mg/5 ml, pseudoephedrine 15 mg/5 ml and Dimenhydrinate 12.5 mg/5 ml in DHQ hospital. Doctor advised him for laboratory tests and admitted him in a Hospital.

Diagnosis

CBC (Complete blood count), CXR (Chest X-Ray), Electrolyte count tests are performed. CBC showed that his TLC Total leukocytes count) and lymphocytes concentrations had increased, neutrophils decreased.

His neutrophils concentration now 22% whose normal value is 45 to 75% and lymphocytes concentration increased whose normal value is 20 to 45% (Table 1).

TestValueUnitsExpected value
Hb%12.1g/dl14 to 24
WBC12100mm3new born5500 to 18000/cm
Platelet count616000mm3150000 to 400000
Different Leucocyte count (DLC)
Neutrophils22%45 to 75%
Lymphocytes70%20 to 45%
Eosinophils4%02 to 06%
Monocytes4%02 to 10%
RBC5.5710>12/litre3.5 to 5.5
MCV79.2F175 to 100
HCT36.2%35 to 55
MCH26.5Pg25 to 35
MCHC33.4g/dl31 to 38

Table 1: Complete blood count test.

On electrolyte counting test showed that calcium concentration decreased which is 7.8 now its normal value is 8.5 to 10.5 (Table 2).

TestValueUnitExpected value
Sodium136mEq/L135……….145
Potassium4.4mEq/L3.8………5.0
Calcium7.8mEq/L8.5……….10.5

Table 2: Electrolyte counting test.

On Chest X-Ray detected a white patch on left side upper lobe, which indicated that pneumonia is confirmed. So when the pneumonia is confirmed then Doctor started his actual treatment (Figure 1).

Treatment

His treatment include injection Cefotaxime 250 mg intravenous B.D, injection Ampicillin 125 mg intravenous after 6 hours, given Nebolization with ventoline, and Oxygen now SOS, and a Panadol drops, 10 drops. His vitals were checked.

The patient recovered slowly and after 2 days treatment Doctor again checked him and gave him another treatment claritex drops 1/2 drops and Calcium 2/2.

At the third day of his admission in hospital Doctor checked him, his physical examination showed now that temperature reached at 100°F, diarrhea and vomiting are also decreased. Doctor advised his mother to continue this medication, care and feed properly.

At the fifth day continuously five days treatment child become completely recovered and doctor discharged them at 5/10/2014.

Discussion

Community-acquired pneumonia (CAP) is a frequent cause of hospital admission and mortality in elderly patients worldwide. The clinical presentation, etiology, and outcome of community acquired pneumonia in elderly differs from that of other population [2,3].

This patient had community-acquired bacterial pneumonia on the basis of his physical examination and chest radiograph.

The most common cause of community-acquired bacterial pneumonia is Streptococcus pneumoniae . The finding of gram-positive diplococci in the blood is consistent with pneumococcal disease as well. Approximately 25 to 30% of patients with pneumococcal pneumonia will have positive blood cultures. Group A streptococcus is another possible organism because it can cause bacteremic pneumonia and can possibly appear as a gram-positive diplococcus. However, in a blood culture, group A streptococci are much more likely to be present as gram-positive cocci in chains. The two streptococci are easily distinguished by the fact that S. pneumoniae is alpha-hemolytic and bile soluble whereas group A streptococcus is beta-hemolytic and bile insoluble but bacitracin susceptible.

Determination of precise etiology of pneumonia is difficult due to the lack of sensitive and specific tests. Many clinicians treat pneumonia empirically with minimal laboratory or radiographic evaluation and thus up to 80% of non-bacterial pneumonia may be treated with antibiotics. This approach is satisfactory when clinical risk is deemed to be low [4].

Conclusion

Our main findings and conclusion were:

Community-acquired pneumonia in elderly patients is a common and serious problem encountered in clinical practice. Elderly patients with community-acquired pneumonia have different clinical presentation and higher mortality.

From this case study we conclude that main causes for pneumonia and what are these treatments.

As we read that here patient is not cured after its first treatment because disease was not identied our main purpose is to first diagnose a disease and then to start rational treatment.

Acknowledgment

I take this opportunity to express my profound gratitude and deep regards to Dr. Taha Nazir (Assistant Professor and Course Director Microbiology & Immunology, Faculty of Pharmacy, University of Sargodha)for his exemplary guidance, monitoring and constant encouragement throughout the course of this case report. Also thanks to the staff at the Pediatrics department at the DHQ hospital Gujranwala.

Recommendations

Increase caretakers' recognition of pneumonia signs through extensive health communication activities by strengthening the third component of IMCI (improving family and community practices).

Antibiotics improve outcomes in those with bacterial pneumonia. Antibiotic choice depends initially on the characteristics of the person affected, such as age, underlying health, and the location the infection was acquired.

Stay away from people who have colds, the flu, or other respiratory tract infections.

If you haven't had measles or chickenpox or if you didn't get vaccines against these diseases, avoid people who have them.

Preventive measures are under observations i.e., avoid contaminated food, drinks purified water etc.

References

  1. Schumann L (2006) Pneumonia. In: Copstead LEC, Banasik JL (eds.). Pathophysiology(3rd edn) St WHO.
  2. World Health Organization (2002) Promoting rational use of medicines: core components: WHO policy perspectives of medicines. No.5. Geneva: WHO.
  3. World Health Organization (2009) Medicines use in primary care in developing and transitional countries: Fact book summarizing results from studies reported between 1990 and 2006. Document No. WHO/EMP/MAR/2009.3. Geneva: WHO.
  4. Levinson W (2012) LANGE: Review Of Medical Microbiology and Immunology (12th edN) (Part IX brief summaries of medical important organisms).

Figure 1: Chest X-Ray: In this a white patch seen on left side upper lobe of lung which indicated pneumonia.

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