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CASE STUDY
ON PEDIATRIC
COMMUNITY AQUIRED
PNEUMONIA

2. (PCAP)
Submitted by:
Neri, Tiffany Julia B.
Submitted to:
Mrs. Denise Katherine A. Amora

3. I. INTRODUCTION
Pneumonia is an infection of the lung parenchyma.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 different types of
pneumonia one is community-acquired pneumonia whichrefers to pneumonia acquired
outside of hospitals or extended-care facilities. The agents that most frequently cause CAP
are: S.Pneumoniae, H. Influenzae, Legionella, Pseudomonas aeruginosa, and other gram-
negative rods. PCAP or pediatric community acquired pneumonia is a type of community
acquired pneumonia that occurs in children.
CAP is a common illness in all parts of the world. It is a major cause of death
among all age groups. In children, the majority of deaths occur in the newborn period, with
over two million worldwide deaths a year. In fact, the WHO estimates that one in three
newborn infant deaths are due to pneumonia. Mortality decreases with age until late
adulthood; elderly individuals are particularly at risk for CAP and associated
mortality.Despite a broad armamentarium of antimicrobials available to treat the disease,
pneumonia remains the seventh leading cause of death in the United States. In 2003, the
age-adjusted death rate caused by influenza and pneumonia was 20.3 per 100,000
persons. Estimates of the incidence of community-acquired pneumonia range from 4 million
to 5 million cases per year, with about 25% requiring hospitalization.
The United Nations Children's Fund (UNICEF) estimates that 3 million children die
worldwide from pneumonia each year; these deaths almost exclusively occur in children

4. with underlying conditions, such as chronic lung disease of prematurity, congenital heart
disease, and immunosuppression. According to the WHO’s Global Burden of Disease 2000
Project, lower respiratory infections were the second leading cause of death in children
younger than 5 years (about 2.1 million [19.6%]).
My patient is a toddler, the one year old EuanJames suffered cough and on and off
fever 5 days prior to admission, the child was then admitted with chief complaints of fever,
cough and coryza. Upon admission the child was weak due to high fever. During my two
days observation, I noticed that the cough was unproductive and crackles were heard on
the right upper lung. However there is no difficulty in breathing. The x-ray result then
showed that the patient has pneumonia, specifically pediatric community acquired
pneumonia.
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.

5. II.ASSESSMENT
Name: Banaban, Euan James Date and Time admitted: 7-30-12/1:17pm
Age: 1yr old Chief Complaints: fever, cough, coryza
Sex: Male Diet: DAT
Religion: Protestant Attending Physician: Dr. Lilia Cacho
Impression on Diagnosis: PCAP
Birth History
The child was born last October 10, 2010 weighing 6.5lbs. in a normal spontaneous
vaginal delivery in a cephalic presentation assisted by a midwife at SM Lao Memorial
Hospital. According to the mother, she had no difficulty of delivering the baby. The baby
had a loud cry and he was able to position from supine to prone position.
Family History
There are five members in the family; my patient is the youngest among the three children
1st child-6years old 2nd child- 4years old
His mother is a plain housewife and his father is a chef in one of the ships abroad. Both
parents has no hereditary diseases.
History of Present Illness
Five days prior to admission he had already suffered from cough and on and off fever.
The child was then admitted yesterday with chief complaints of fever, cough and coryza.
Upon admission the child was weak due to high fever and so he was cuddled by his

6. mother. He had dry lips and tongue with whitish lesion in the buccal mucosa as observed
by the doctor.
History of Past Illness
It is his second time in the hospital, the first one was last year October 9, 2011,he was
admitted for the same diagnosis, pneumonia. At home he would experience minor illness
like cough or fever and would treat it with paracetamol and Solmux.
NORMAL ACTUAL
Physical
Steady growth in height and weight steady growth in height and weight
Average weight: 10.9kg 10.5kg
Has complete body parts has complete body parts
Motor
Gross:
Runs fairly well he can walk without assistance
he can run
Fine:
Tries to feed self he feeds himself with a biscuit
Language
Uses Da-da and Mama correctly he can say ate, mama, papa and he
Has 4 to 6 word vocabulary calls his sister “lala” he has his
Indicated wants by pulling, pointing own word like “meme” for milk
Or appropriate verbalization and he can say “ inum”

7. Sensory/Cognitive
Can hear, see, and feel, identifies tastehe can hear, see, feel, he knows what
taste is pleasing and what is not like when
I give medication.
Socialization
Likes to tell others what to do he was asking me to get the chocolate and
Negativistic, stubborn would not stop until he gets it
Engages in pretend play
May bite, slap or hit he hit me
Wants own way in everything
Affectionate he likes to play with his brother and sister
Pattern of Functioning
Respiratory
His respiratory rate is within the normal range (+) crackles heard on right upper lung
8am-29 cpm 12nn-33cpm he is unable to cough out secretions
Circulatory
His pulse rate is within the normal range capillary refill- 2 seconds
8am-130 bpm 12nn- 130bpm there is no discolored parts of the body
No swollen edematous area
no parts of the body colder or warmer than adjacent parts

8. Sleeping Habit
Prior to admission, he usually sleeps at 7pm and wakes up at 5:30am and sleeps again at
9am, he does not sleep in the afternoon. Upon admission he slept at 9pm,wakes up at
6am,during this period of sleep he tends to wake up from time to time due to the humid
environment and also the cough interferes with rest.
Eating Habit
He eats 3 times a day. He eats “lugaw” and usually drinks milk three times a day,6 oz.
He also eats rice with viand seldomly but his meal is usually milk. During his stay in the
hospital he eats less because of his oral sores.
Elimination Habit
He does bedwetting and so a diaper was used. He would usually urinate five times a day
and defecate once, usually in the afternoon, During my shift he haven’t defecated yet, he
excreted 200 cc of urine, it is light yellow in color.
Personal Hygiene
He takes a bath every day, his nails were trimmed, hair is fixed, no unpleasant odor can
be observed. In his hospital stay, his mother would change him new clothing .Children
doesn’t have a care in the world so they tend to soil their shirts. During my shift he was
eating, his shirt was soiled and so we had to change new clothing

9. Pain and Discomfort
He experienced discomfort and pain because of his oral sores.
Allergy
He has no known allergy, his mother suspected that he has allergies since there is some
rashes on his skin, it was itchy, it was not discovered whether it is caused from an allergic
reaction or because of bacteria.
Immunization
Early Childhood care and Development Card
10-13-10 BCG
11-10-10 Hep 1
12-10-10 DPT, OPV
2-9-11 OPV2, HB2
2-23-11 DPT2
3-9-11 OPV3
3-9-11 HB3
6-1-11 DPT3
7-13-11 Measles

10. III.LABORATORYRESULTS
CHEST AP
Findings:
Accentuated bronchovascular markings with interstitial haziness at both lung fields
Cardiac shadow is within normal size and configuration
Tracheal shadow in midline
Bone and other chest structures are unremarkable
Impression:
Pneumonia
URINALYSIS REPORT
Macroscopic Chemical
Color: pale yellow Protein: Negative
Transparency: clear Glucose: Negative
PH-6.0Microscopic
Sp Gr: 1.015 WBC: 1-2/HPF
Epithelial cells: Rare
HEMATOLOGY REPORT
RBC: M-4.6-6.2x10^12/L 4.28 Hematocrit :M-0.40-0.54 O.34
Hemoglobin:M-13.5-18.0g/dl 11.4 WBC- 4.50-10.0x 10^9/L 11.33
Differential Count
Lymphocyte:0.20-0.40 0.53 Segmenters: 0.50-0.70 0.42

11. Eosinophil: 0.01- 0.04 0.01 Monocyte: 0.03- 0.08 0.04
IV.ANATOMY AND PHYSIOLOGY
LUNGS:
The lungs are paired cone-shaped organs which take-up most of the space in the
chest with the heart. Their role is to take oxygen into the body which we need for the cells
to live and function properly, and to help us get rid of carbon dioxide, which is a waste
product. There are two divisions of the lungs, the left and the right lung. These are divided
up into lobes or big secretions of tissues separated by “fissures” or dividers. The right lung
has three lobes but the left lung has only two, it is because the heart takes up some of the

12. space in the left side of the chest. The lungs can also be divided up into even smaller
portions, called bronchopulmonary segments. These are pyramidal shaped areas which are
also separated from each other membranes. Each segment receives its own blood supply
and air supply. Air enters the lungs through a system pipes called the bronchi. Theses pipe
start from the bottom of the trachea as the left and right bronchi and branch many times
throughout the lungs, until they eventually form little thin-walled air sacs or bubbles, known
as the alveoli. The alveoli are important in the gas exchange where it takes place between
the air and the blood. Covering alveolus is a whole network of little blood vessel called
capillaries, which are very small branches of the pulmonary arteries. It is important that the
air in the alveoli and the blood in the capillaries are very close together, so that oxygen and
carbon dioxide can diffuse between them.

14. VI.MEDICAL MANAGEMENT
Doctor’s Order
7-30-12 1:17pm >pls admit under Dr.Cacho
>TPR every 4 hours
>Lab: CBC,U/A,CXR-AP View
>D5 0.3 % NaCl 500 cc @ 50 cc/hr
>Meds:
paracetamol 100mg/ml 1.2ml every 4 hours PRN
for fever
>Nebulize with salbutamol 1 neb every 8 hours
> I and O every shift
> Inform AP
> Refer accordingly
7-30-12 > cefuroxime 375mg IV every 8 hours ANST
>IVF TF:D5 0.3 % NaCl 500 cc @ 50 cc/hr
7-31-12
>Revised Nebulization with one salbutamol nebule every
6 hours
>cetirizine gtts 1ml O.D h.s

15. >Ceelingtts 1ml O.D
>Refer accordingly
>Daktarin oral solution apply to affected area 2x daily
>use Daktarin oral gel instead of Daktarin oral solution
8-1-12
>azithromycin 200mg/ 5ml 2.5 ml O.D
> D5 1MB 500cc @ 50 cc/hr
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