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PNEUMONIA

Maricar R. TrinidadCeline S. Udani

BSN 135 Group 139

Introduction

Pneumonia (pneumonitis) is an inflammatory process in the lung parenchyma usually with

marked increase in interstitial and alveolar fluid. Among all nosocomial infections, pneumonia is the

second most common, but has the highest mortality (Black & Hawks, 2009). Community-acquired

pneumonia (CAP) is a disease in which individuals who have not recently been hospitalized develop an

infection of the lungs (pneumonia). CAP is a common illness and can affect people of all ages (Wikipedia,

2010). In a study undertaken at the UP-PGH to determine common etiologic agents causing community-

acquired pneumonia in adults forty-eight patients (48) were recruited based on set clinical criteria.

Streptococcus pneumoniae and H. influenzae were the most common pathogens isolated. There was no

difference in the pathogens isolated from elderly and younger patients. The most common predisposing

factors for gram negative bacillary pneumonia were COPD, smoking, and the use of steroids. There was

little difference in the clinical manifestations between the elderly and younger individuals except for the

decreased frequency of fever in the elderly. Anti-biotic usage greatly decreased the yield of specimens.

Both Streptococcus pneumoniae and H. influenzae, the two most predominant organisms, were

sensitive to cotrimoxazole - an inexpensive first line antibiotic. [Phil J Microbiol Infect Dis 1995; 24(2):29-

32.

This nursing process case presentation presents pneumonia of a 9-month old baby girl. We have

chosen this case to know more on how pneumonia affects a pediatric client, if there are differences in

adult and in pedia. And furthermore this is our first time to present a case of pneumonia beacause in

other clinical duties we choose more complicated case, and this time why not choose pneumonia a

disease that we are taking for granted for it was always common to patients we handle in different

areas. By this presentation gaining knowledge about this disease we can be more confident to handle

more pneumonia patients in our future nursing practice

I. Biographic DataName: Address: Age: Gender: Religion:Room and bed:Chief complaint: Attending Physician:Physician’s Diagnosis:

II. Nursing HistoryA. Past Health History

1. Childhood Illness

2. Immunizations

3. Allergies

4. Accidents.

5. Hospitalization

6. Medications used or currently takenMedications currently taken are ranitidine, hydrocortisone, cefuroxime

and salbutamol

7. Foreign travel (when, length of stay)No foreign travel yet.

B. History of Present Illness

C. Family History

III. Patterns of FunctioningA. Psychological Health

1. Coping Patterns2. Interaction Patterns3. Cognitive Patterns4. Self-Concept5. Emotional Patterns6. Family Coping Patterns

Analysis:The World Health Organization defines psychological health as "a being of well-being in which

the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. An example of a wellness model includes one developed by Myers, Sweeney and Witmer. It includes five life tasks—essence or spirituality, work and leisure, friendship, love and self-direction—and twelve sub tasks—sense of worth, sense of control, realistic beliefs, emotional awareness and coping, problem solving and creativity, sense of humor, nutrition, exercise, self care, stress management, gender identity, and cultural identity—which are identified as characteristics of healthy functioning and a major component of wellness. (wikipedia.com)

Interpretation:Family is the source of strength of the patient in times of crisis. They support him emotionally

and financially. All kinds of consideration are given to him by his children, especially his wife, as they took care of him.

B. Socio-Cultural Patterns1. Cultural Patterns2. Significant Relationships3. Recreation Patterns4. Environment5. Economic

Analysis:Respect and interest in cultural background will provide a strong basis for communication.

Being a part of a regional group of culture is called a subculture. Though they are smaller group, they possess many of the values, beliefs and customs of the larger culture but have unique characteristics. According to studies, Filipinos hereditary diseases include diabetes mellitus, Thalassemia, and G6PD deficiency.

Families in later life is in a transition of accepting the shifting of generational roles. The family needs to maintain own and couple functioning and interests in face of physiological decline; exploration of new and familial and social role options. They also need to support for a more central role of middle generation. They should also make a room for the wisdom and experience for elderly people, supporting the older generation without over functioning for them. (Ref: Health Assessment and Physical Examination 2nd edition 2002 by Mary Ellen Zator Estes)

Interpretation: Client has regional customs and beliefs. His current health status has affected his daily activities.

C. Spiritual Patterns1. Religious Beliefs and Practices

Analysis:Spiritual health is the connectedness with self, others, higher power, all life, nature and the

universe that transcends and empowers the self. Spiritual and religious beliefs can significantly affect health behavior.

Interpretation:The patient has religious beliefs and cultural values. These beliefs are influenced by the social

environment and also health behavior.

IV. Activities of Daily Living

V. Physical Assessment

Actual Findings Norms Analysis

General Appearance1. Skin color

2. Personal Hygiene/ Grooming

3. Nutritional Status

4. Non-verbal Behavior

Pale

Clean, neatNo apparent breath odor

Poor nutritional status with body weakness.

cries when in pain. Appropriate to situation.

Brown, light brown

Clean, neatNo apparent breath odor

Healthy appearance

Appropriate to situation/ appropriate response

normal

normal

Abnormal

Normal

Analysis:A patient who appears ill usually is ill, and needs to be carefully assessed via the history and physical examinations.(Ref: Health Assessment and Physical Examination 2nd edition 2002 by Mary Ellen Zator Estes)

Measurement1. Temperature2. Pulse Rate3. Respiratory Rate4. Blood Pressure

35.4 – 37.4 C60 – 100 cpm12 -20 breaths/ minS: 100-160 mmHg /

Analysis:Hypoxia and metabolic acidosis are common causes of tachypnea

5. Weight6. Height

D: 60- 90 mmHgAverage: 130/80

(RR>20 breaths). The increased respiratory rate is a compensatory mechanism to provide the body with more oxygen and eliminate excess hydrogen when the body’s metabolism is increased.(Ref: Health Assessment and Physical Examination 2nd edition 2002 by Mary Ellen Zator Estes)

Body Part(Technique used)

Actual Findings Norms Analysis

SKINInspectionSkin colorUniformity of skin colorTexture

PalpationSkin moistureSkin temperatureSkin turgor

Light brown, darker on areas exposed to light. With warts scattered on the face, chest and some on the abdomen.

Dry.Bilaterally equal warm temperature and nontender.

Skin is uniform whitish pink or brown color, depending on the patient’s race. Exposure to sunlight can results in increased pigmentation of sun-exposed areas.

Skin is dry with minimum perspiration. Moisture varies from one body area to another.

Skin temperature is warm and equal bilaterally. Nontender.

Normal

Normal.

Normal

NAILSInspectionFingernail plate shapeFingernail and toenail texture

smoothPink.Blanch test return to

Convex curvature; angle of nail plate about 160 degrees

Normal

Body Part(Technique used)

Actual Findings Norms Analysis

Fingernail and toe nail bed colorTissue surrounding nailsPalpationBlanch test of the capillary

normal in 1 second.Convex curvature; angle of nail plate about 160 degreesSmooth textureIntact epidermis

Smooth textureHighly vascular and pink on light-skinned clients; dark-skinned clients may have brown or black pigmentation in longitudinal streaksIntact epidermisPrompt return of pink or usual color (generally less than 4 seconds)

SKULL AND FACEInspectionSkull size, shape, and symmetryFacial featuresFacial movement

PalpationSkull nodules or masses and depressions

Patient is normocephalic, proportion to the body.

Symmetrical and bilaterally equal in parts

No nodules, masses and depressions.

Rounded (normocephalic and symmetrical, with frontal, parietal, amd occipital prominences); smooth skull contourSmooth, uniform consistency; absence of nodules or massesSlightly asymmetric facial features; palpebral fissures equal in size; symmetric nasolabial foldsSymmetric facial movements.

Normal skull and face features.

EYES AND STRUCTURESInspectionCorneaIrisPERRLABulbar conjunctivaPalpebral conjunctivaPalpationBulbar conjunctivaPalpebral conjunctiva

Has whitish halo on the sides of the cornea.Pupils constrict bilaterally direct and indirect response, 3cm size in normal light, reactive to light and accommodation.Iris is brown color.

He has pinkish,

Pink, transparent conjunctiva. Pupils reactive to light and accommodation.

Normal

Body Part(Technique used)

Actual Findings Norms Analysis

palpable conjunctiva.

EARS AND HEARINGInspectionNormal voice tones Patient can hear

normal tone of voice.Can repeat whispered words within 2 feet distance.

Normal

NOSE AND SINUSESInspectionExternal nose shape, size, or color and flaring or discharge from the nares.

Patency of both nasal cavities.Presence of redness, swelling, growths, and discharge.MassesNasal septum

Symmetrical in shape, same color as the face, no discharge or nasal flaring.

Both nares are patent

No swelling and redness present.

Nasal septum at the middle.

Symmetrical in shape, same color as the face, no discharge or nasal flaring.

Both nares are patent

No swelling and redness present.

Nasal septum at the middle.

Normal

Normal

Normal

Normal

THORAX

Inspection Even color; regular, even contour; respirations audible as wheeze, labored, of different depth: deeper expiration than inspiration, verbalized difficulty breathing, chest tightness and non-productive cough and without retractions, bulges and masses, uses accessory muscles; anteroposterior-transverse diameter ratio 1:2Breathing is good when head of the bed is

Even color; regular, even contour; respirations quiet, unlabored, of even depth, and without retractions, bulges, masses, or use of accessory muscles; anteroposterior-transverse diameter ratio 1:2

AbnormalAnalysis:Labored breathing and use of accessory muscles are indicative of increased demand for air due to narrowed airway as in asthma.(Ref: Health Assessment and Physical Examination 2nd edition 2002 by Mary Ellen Zator Estes)

Body Part(Technique used)

Actual Findings Norms Analysis

Palpation

Percussion

Auscultation

elevated 30-45 degrees or when sitting.Chest wall symmetrical, smooth, without lumps, masses, tenderness, or crepitus; thoracic excursion symmetrical; tactile fremitus present.Resonant throughout peripheral lung fields; cardiac dullness; diaphragmatic excurionranges from 3 – 6 cm for each hemidiaphragm, with right side slightly higher than the left.

Vesicular sounds throughout peripheral lung fields; adventitious sounds present: wheeze –high pitched (sibilant ronchi); vocal resonance absent.

Chest wall symmetrical, smooth, without lumps, masses, tenderness, or crepitus; thoracic excursion symmetrical; tactile fremitus present.

Resonant throughout peripheral lung fields; cardiac dullness; diaphragmatic excurionranges from 3 – 6 cm for each hemidiaphragm, with right side slightly higher than the left.

Vesicular sounds throughout peripheral lung fields; bronchovesicular sounds over the area of bifurcation, both anteriorly and posteriorly; bronchial sounds over the trachea anteriorly; adventitious sounds absent; vocal resonance absent.

Normal

Normal

AbnormalAnalysis:Wheeze –high pitched (sibilant ronchi) is indicative of air squeezed or compressed through passageways narrowed almost to closure by collapsing, swelling, secretions, or tumors; passageway walls oscilate in apposition between closed and barely open positions; resulting sound is similar to a vibrating reed.

(Ref:

Black, J. M., & Hawks, J. H. (2008). Medical-Surgical Nursing (8th ed.). Philippines: Saunders Elsevier.)

Body Part(Technique used)

Actual Findings Norms Analysis

ABDOMENSkin integrityContour and symmetryLight palpation for areas of tenderness

Symmetrical but prominent. With tenderness, no masses, or nodules found.

No pain is felt upon light palpation on the 4 quadrants of the abdomen.

No abdominal scars present.

Normal

Analysis:

(Ref: Health Assessment and Physical Examination 2nd edition 2002 by Mary Ellen Zator Estes)

PERINEALInspection Fluid retention on both

testicles and the penis.No fluid present Abnormal

Analysis:Hydrocele: A hydrocele is a collection of fluid in the membrane that covers the testis or testes. A hydrocele may be present at birth or develop later in life. It is most common after age 40. Usually the cause is unknown. However, the condition occasionally results from a testicular disorder (for example, injury, epididymitis, or cancer).

(Ref: Lui, P. D. (2008, October). Swelling in the Scrotum. Retrieved October 8, 2010, from The Merck Manuals Online Medical Library: http://merck.com/mmhe/sec21/ch238/ch238m.html)

Body Part(Technique used)

Actual Findings Norms Analysis

VI. Laboratory and Diagnostic Examinations Results

Date Procedure Result Norms Interpretation Analysis27 September 2010 HEMATOLOGY

Hemoglobin

HematocritWBC countPlatelet Count

Segmenters

143 g/L

0.4214.9 x 109 /L266 x 109 /L

0.87

120 – 140 g/L

0.37 – 0.475.5 – 11.0 x 109 /L150 – 250 x 109 /L

0.50 – 0.70

Increased

NormalIncreasedIncreased

Increased

Increased hemoglobin may be caused by exposure to high altitudes, smoking, dehydration, or tumor.(Ref: Wikipedia. (2008, December 1). Hemoglobin. Retrieved October 8, 2010, from Wikipedia website: http://en.wikipedia.org/wiki/Hemoglobin)

Indicates infectionFunctions with WBC to fight inflammation and promote healing process.

Neutrophils also known as segmenters are recruited to the site of injury within minutes following trauma and are the hallmark of acute inflammation.

Date Procedure Result Norms Interpretation AnalysisLymphocytesMonocytes

0.080.05

0.20 – 0.400.01 – 0.06

DecreasedNormal

Decreased immune response.(Ref: Corwin, E. J. (2008). Handbook of Pathophysiology. Manila, Philippines: Lippincott Williams & Wilkins.

27 September 2010 URINALYSISPhysical characteristics:ColorTransparencyReactionpHSpecific gravity

Chemical tests:AlbuminSugarKetonesBlood in urineUrobilinogen

Cells:RBCPusEpithelialMucus ThreadsBacteria

YELLOWSLIGHTLY TURBIDACIDIC5.001.005

+++NEGATIVENEGATIVENEGATIVENEGATIVE

8-10 / hpfMANY /hpfMODERATEMODERATEMODERATE

AMBERCLEARACIDIC/BASIC4.6 – 8.01.003 to 1.030

0NEGATIVENEGATIVENEGATIVENEGATIVE

00NEGATIVENEGATIVENEGATIVE

NormalAbnormalNormalNormalNormal

AbnormalNormalNormalNormalNormal

AbnormalAbnormalAbnormalAbnormalAbnormal

Turbidity may indicate bacterial infection.

Proteinuria- may indicate glomerulonephritis or other decline in kidney function.

May be renal diseaseIndicates bacterial infection.

(ref: Black, J. M., & Hawks, J. H. (2009). Medical- Surgical

Date Procedure Result Norms Interpretation AnalysisNursing.

28 September 2010 BLOOD CHEMISTRYPotassiumSodiumChloride

4.92 mmol/L123.8 mmol/L100.1 mmol/L

3.5 – 5.30 mmol/L135 – 148 mmol/L100 – 112 mmol/L

NormalHyponatremiaNormal

Edematous disorders resulting in sodium deficits: CHF, liver cirrhosis, nephrotic syndrome, acute and chronic renal failure, psychogenic polydipsia. (ref: Black, J. M., & Hawks, J. H. (2009). Medical- Surgical Nursing.)

30 September 2010 Total Calcium 1.96 mmol/L 2.2 – 2.55 mmol/L Decreased Fluid and electrolyte imbalances especially sodium also affects calcium concentration.

30 September 2010 IMMUNOLOGYPSA

100 NG/ML 0.00 – 4.00 NG/ML Increased Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. PSA is present in small quantities in the serum of men with healthy prostates, but is often elevated in the presence of prostate cancer(ref: Black, J. M., &

Date Procedure Result Norms Interpretation AnalysisHawks, J. H. (2009). Medical- Surgical Nursing.)

2 October 2010 ABGpHPaCO2

PaO2

HCO3

TCO2

BEO2 SatFiO2

7.215103.9 mmHg79.9 mmHg42.0 meq/L45.2 ml/dL8.0 meq/L92.8 %36.0 %

7.35 – 7.4535 – 45 mmHg80 – 100 mmHg22 – 26 meq/L15 – 20 ml/dL+ 2 to – 2 meq/L95 – 100 %

AcidosisIncreasedDecreasedIncreasedIncreased

Abnormal

Respiratory acidosis uncompensated is an indication that there is a problem in the released of CO2

causing it to be contained in the blood. Metabolic acidosis also follows due to increase in HCO3. This causes the O2 Saturation to decrease.(ref: Black, J. M., & Hawks, J. H. (2009). Medical- Surgical Nursing.)

VII. Medications, IV Infusions, Blood Transfusion, Treatment GivenGENERIC/ BRAND NAME

CLASSIFICATION INDICATION CONTRAINDICATION ADVERSE EFFECTS NSG. RESPONSIBILITIES

Salbutamol

Q1 2.5-5 mg

Anti-asthmatic and COPD prep.

Treatment of acute severe asthma and in routine management of chronic bronchospasm

Hypersensitivity to its content.

Small increase in heart rate, peripheral vasodilation, fine tremor of skeletal muscle.

Special precaution on patient with hyperthyroidism, CV diseases

unresponsive to conventional therapy.

Budesomide

Q6

Anti-asthmatic and COPD prep.

Prophylaxis and management of asthma

Primary treatment of status asthmaticus or other acute asthma where in sensitive measures are required

Neck pain, cough, resp. infection

WOF withdrawal symptoms during transfer from systemic corticosteroid therapy to budesomide

Hydrocortisone Hormones Acute adrenocortical insufficiency

Latent, healed and active TB

Fluid electrolyte imbalance, dermatologic

Special precaution on patient with CHF, HPN, DM

Chloramphenicol

Anti-infective Diseases which does not respond to other standard anti-microbial agent

History of hypersensitivity or toxic reaction

GI symptoms Take on an empty stomach ½ hour before meals

Ampicillin

350mg IV q6

Anti-infective Respiratory infections Hypersensitivity to penicillin

GI disturbances Special precaution on patient with prolonged treatment requires renal, hepatic function assessment.

VII. Anatomy and Physiology

ANATOMY AND PHYSIOLOGY OF THE LUNGS

The lung is the essential respiration organ in air-breathing vertebrates, the most primitive being the lungfish. Its principal function is to transport oxygen from the atmosphere into the bloodstream, and to release carbon dioxide from the bloodstream into the atmosphere. This exchange of gases is accomplished in the mosaic of specialized cells that form millions of tiny, exceptionally thin-walled air sacs called alveoli. The lungs also have non respiratory functions.

RESPIRATORY FUNCTIONS

Energy production from aerobic respiration requires oxygen and glucose and produces

carbon dioxide as a waste product, creating a need for an efficient means of oxygen delivery to

cells and excretion of carbon dioxide from cells. In small organisms, such as single-celled

bacteria, this process of gas exchange can take place entirely by simple diffusion. In larger

organisms, this is not possible; only a small proportion of cells are close enough to the surface

for oxygen from the atmosphere to enter them through diffusion. Two major adaptations made it

possible for organisms to attain great multicellularity: an efficient circulatory system that

conveyed gases to and from the deepest tissues in the body, and a large, internalized respiratory

system that centralized the task of obtaining oxygen from the atmosphere and bringing it into the

body, whence it could rapidly be distributed to all the circulatory system.

In air-breathing vertebrates, respiration occurs in a series of steps. Air is brought into the

animal via the airways — in reptiles, birds and mammals this often consists of the nose; the

pharynx; the larynx; the trachea (also called the windpipe); the bronchi and bronchioles; and the

terminal branches of the respiratory tree. The lungs of mammals are a rich lattice of alveoli,

which provide an enormous surface area for gas exchange. A network of fine capillaries allows

transport of blood over the surface of alveoli. Oxygen from the air inside the alveoli diffuses into

the bloodstream, and carbon dioxide diffuses from the blood to the alveoli, both across thin

alveolar membranes.

The drawing and expulsion of air is driven by muscular action; in early tetrapods, air was

driven into the lungs by the pharyngeal muscles, whereas in reptiles, birds and mammals a more

complicated musculoskeletal system is used. In the mammal, a large muscle, the diaphragm (in

addition to the internal intercostal muscles), drive ventilation by periodically altering the intra-

thoracic volume and pressure; by increasing volume and thus decreasing pressure, air flows into

the airways down a pressure gradient, and by reducing volume and increasing pressure, the

reverse occurs. During normal breathing, expiration is passive and no muscles are contracted (the

diaphragm relaxes).

Another name for this inspiration and expulsion of air is ventilation. Vital capacity is the

maximum volume of air that a person can exhale after maximum inhalation. A person's vital

capacity can be measured by a spirometer (spirometry). In combination with other physiological

measurements, the vital capacity can help make a diagnosis of underlying lung disease.

ANATOMY

In human, the trachea divides into the two main bronchi that enters the roots of the lungs.

The bronchi continue to divide within the lung, and after multiple divisions, give rise to

bronchioles. The bronchial tree continues branching until it reaches the level of terminal

bronchioles, which lead to alveolar sacks. Alveolar sacs are made up of clusters of alveoli, like

individual grapes within a bunch. The individual alveoli are tightly wrapped in blood vessels,

and it is here that gas exchange actually occurs. Deoxygenated blood from the heart is pumped

through the pulmonary artery to the lungs, where oxygen diffuses into blood and is exchanged

for carbon dioxide in the hemoglobin of the erythrocytes. The oxygen-rich blood returns to the

heart via the pulmonary veins to be pumped back into systemic circulation.

1:Trachea 2:Pulmonary artery 3:Pulmonary vein 4:Alveolar duct 5:Alveoli 6:Cardiac notch

7:Bronchioles 8:Tertiary bronchi 9:Secondary bronchi 10:Primary bronchi 11:Larynx

Human lungs are located in two cavities on either side of the heart. Though similar in

appearance, the two are not identical. Both are separated into lobes, with three lobes on the right

and two on the left. The lobes are further divided into lobules, hexagonal divisions of the lungs

that are the smallest subdivision visible to the naked eye. The connective tissue that divides

lobules is often blackened in smokers and city dwellers. The medial border of the right lung is

nearly vertical, while the left lung contains a cardiac notch. The cardiac notch is a concave

impression molded to accommodate the shape of the heart. Lungs are to a certain extent

'overbuilt' and have a tremendous reserve volume as compared to the oxygen exchange

requirements when at rest. This is the reason that individuals can smoke for years without having

a noticeable decrease in lung function while still or moving slowly; in situations like these only a

small portion of the lungs are actually perfused with blood for gas exchange. As oxygen

requirements increase due to exercise, a greater volume of the lungs is perfused, allowing the

body to match its CO2/O2 exchange requirements.

The environment of the lung is very moist, which makes it hospitable for bacteria. Many

respiratory illnesses are the result of bacterial or viral infection of the lungs.

Risk factors: Cigarette smoking, Advanced age (74 yrs old), Hx of asthma, Chronic disease states such as Prostate Carcinoma stage II

Streptococcus pneumoniae, most common bacterial agent

Resides in the nasopharynx

Attachment to the respiratory epithelium

Inhaled into the alveolus

Infect type II alveolar cells

Pneumococci spread through the pores of Kohn

Producing inflammation and consolidation

Alveolar sacks cannot exchange oxygen and carbon dioxide

Decreased Oxygen saturation in the blood↑PaCO2, pH, PaO2,↑HCO3

Infection

Fever

↑WBC, ↑Segmenters

Impaired surfactant production and lung injury and repair

Impaired type 1 alveolar cells

Impaired gas exchange

Dyspnea/ Orthopnea

Asthma(Bronchocon

striction)aggravates

Change on the level of consciousness

Tachypnea

VIII. Pathophysiology

HOSTAge -9 monthsSex –femaleNationality – FilipinoExposed to second hand smokeHistory of asthma

AGENTStreptococcus pneumonia

ENVIRONMENT

IX. Ecologic Model

A. HypothesisThe patient acquired his pneumonia via the community where he is mostly exposed. Contributing factors such as the surroundings or the environment the child lives in, her age.

B. Predisposing Factors

1. Agent- Streptococcus

pneumonia

2. Host- Age – 9 months- Sex – female- Nationality – Filipino- Exposed to second

hand smoke.- History of asthma

3. Environment

Economic- The family of the

patient doesn’t have enough financial income. Their budget is only enough for their daily living.

C. Ecologic Model

D. Analysis The patient became susceptible to pneumonia due to the following direct risk factors:She’s a 9-month old baby, history of asthma, and exposed to second hand smoke.

CAP is defined as pneumonia acquired outside of hospitals or long-term care facilities, and HAP is pneumonia that develops 48 or more hours after patient admission to an inpatient facility (e.g., hospital, long-term care facility, skilled nursing facility) or 48–72 hours after patient intubation. Older adults are particularly susceptible to pneumonia due to waning immunity and age-associated anatomical and physiological changes that make the lungs more vulnerable to infection. Streptococcus pneumoniae is the most common bacterial cause of pneumonia in older adults; other common causes include Haemophilus influenzae, Staphylococcus aureus, Chlamydia pneumoniae, Legionella pneumophila, and Klebsiella pneumoniae. Common viral pathogens that cause pneumonia in older adults include influenza, parainfluenza, respiratory syncytial virus (RSV), and possibly adenoviruses. Older adults with dysphagia often related to stroke, dementia, and poor oral hygiene are also at risk for aspiration pneumonia, in which the patient breathes in food, liquids, gastric contents, or exogenous chemicals, weakening lung defenses and causing inflammatory changes that allow for bacterial overgrowth.

Secondhand Smoke especially hurts Children! (http://www.smokehelp.org/html/second_hand_smoke.html)

Children who breathe Secondhand Smoke are more likely to suffer from pneumonia, bronchitis, and other lung diseases.

Children who breathe Secondhand Smoke have more inner infections Children who breathe Secondhand Smoke are more likely to develop asthma Children who have asthma and who breathe Secondhand Smoke have more

asthma attacks There are an estimated 150,000 to 300,000 case every year of infections, such as

bronchitis and pneumonia in infants and children under 18 months of  age who breathe Secondhand Smoke.  These result in 7,500 to 15,000 hospitalizations.

Research have also linked asthma and pneumonia. Mycoplasma pneumoniae (M pneumoniae), primarily recognised as a causative agent of community-acquired pneumonia has recently been linked to asthma. An infection with M pneumoniae may precede the onset of asthma or exacerbate asthma symptoms. Chronic infection with M pneumoniae has been suspected to play a part in some patients with asthma. The role of immunoglobulin E-related hypersensitivity and induction of T helper type 2 immune response leading to inflammatory response in M pneumoniae-infected patients with asthma have also been proposed. Use of macrolides in reducing asthma symptoms only in M pneumoniae-infected patients supports the use of macrolides in patients with asthma having M pneumoniae infection. As macrolides are both antimicrobial and anti-inflammatory drugs, the therapeutic role of their biphasic nature in reducing asthma symptoms needs further attention in clinical research (Nisar, N., Guleria, R., Kumar, S., Chand Chawla, T., & Ranjan Biswas, N.,2007).

E. Conclusion and RecommendationsChildren are also susceptible to pneumonia especially they are exposed to second-hand smoke. Asthma not also makes the person susceptible but it also aggravates the condition. Being a Filipino also contributes to his susceptibility because of cultural aspects and way of life.

Nursing interventions should not only concentrate on the airway, breathing and circulation of the patient but also on the possibility of spreading the disease and preventing it from happening.

References:Black, J. M., & Hawks, J. H. (2009). Medical- Surgical Nursing. Manila, Philippines:

Saunders Elsevier.

Buckley, L., & Schub, T. (2010). Pneumonia in Older Adults. Retrieved from CINAHL Plus with Full Text database.

Jacobson, K., Miceli, M., Tarrand, J., & Kontoyiannis, D. (2008). Legionella pneumonia in cancer patients. Medicine, 87(3), 152-159. Retrieved from CINAHL Plus with Full Text database.

Nisar, N., Guleria, R., Kumar, S., Chand Chawla, T., & Ranjan Biswas, N. (2007). Mycoplasma pneumoniae and its role in asthma. Postgraduate Medical Journal, 83(976), 100-104. Retrieved from CINAHL Plus with Full Text database.

Yoo, S., Cha, S., Shin, K., Lee, S., Kim, C., Park, J., et al. (2010). Bacterial pneumonia following cytotoxic chemotherapy for lung cancer: clinical features, treatment outcome and prognostic factors. Scandinavian Journal of Infectious Diseases, 42(10), 734-740. Retrieved from CINAHL Plus with Full Text database

X. Prioritized List of Nursing Problems

XI. Nursing Care Plan