PINES CITY COLLEGES

COLLEGE OF NURSING
Magsaysay Ave. Baguio City 2600

TITLE
CASE STUDY FOR PEDIATRIC COMMUNITY ACQUIRED PNEUMONIA CATEGORY C
WITH URINARY TRACT INFECTION WITH MODERATE SIGN OF DEHYDRATION

SUBMITEED BY:
APA-AN, LEANNE TRACY K.

SUBMITTED TO:
MA’AM KARISHA ARTIGAS

DATE OF ROTATION
FEBRUARY 18-20, 2021

AREA OF ROTATION
PEDIATRIC WARD

DATE SUBMITTED
FEBRUARY 25, 2021

I. INTRODUCTION
Pediatric Community Acquired Pneumonia (PCAP) refers to pneumonia in a previously
healthy person who acquired the infection outside a hospital. PCAP is a common illness that
affects infants and children. 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 a three newborn
infant deaths are due to pneumonia. It occurs because the areas of the lung which absorb oxygen
(alveoli) from the atmosphere become filled with fluid and cannot work effectively. Pneumonia
 PINES CITY COLLEGES
COLLEGE OF NURSING
Magsaysay Ave. Baguio City 2600

can occur at any age; nevertheless, it is more common in younger children. Newborns with
pneumonia commonly present with poor feeding and irritability, as well as tachypnea, retractions,
grunting, and hypoxemia.

In very young children who appear toxic, hospitalization and intravenous antibiotics are
needed. The symptoms in outpatients who present with community-acquired pneumonia can help
determine the treatment. Knowing the age-specific causes of bacterial pneumonia will help guide
antibiotic therapy. Childhood immunization has helped decrease the incidence of invasive
Haemophilus influenzae type B infection, and the newly introduced heptavalent pneumococcal
vaccine may do the same for Streptococcus pneumoniae infections. The symptoms of pneumonia
in neonates are nonspecific and include poor feeding, hypotonic, floppiness, lethargy, apnea,
temperature elevation or depression, and hypotension. In older children, presence of respiratory
infection may be characterized by tachypnea and occasionally, hypoxia progressing to apnea and
need for ventilator support. The World Health Organization has defined clinical criteria for
making the diagnosis of pneumonia. The criteria consist of presence of a cough associated with
tachypnea.

PCAP is classified into four types. First is, PCAP A, which has a minimal risk, there is no
dehydration, with a respiratory rate of greater than 30-50/min. Second, PCAP B, which has a low
risk, there is mild dehydration, with a respiratory rate of greater than 30-50/min. Third, PCAP C
which has a moderate risk, with moderate dehydration, with a respiratory rate of greater than35-
60/min. Fourth is, PCAP D, which has a high risk, with severe dehydration, with a respiratory
rate of greater than 35-70/min. In this case, our patient has a PCAP C. Pneumonia is sometimes
caused by viral infections, including RSV, the parainfluenza virus, adenovirus, and the flu. In
addition to viruses, pneumonia can also be caused by bacteria, including S. pneumoniae, H,
influenza type b, group A streptococcus, and M. tuberculosis (TB). Some of the symptoms
of PCAP are fever, cough, tachypnea, grunting and audible wheezing, chest pain, and it is often
proceeded by upper respiratory tract infection. It can be diagnosed by chest x-ray, blood tests,
sputum culture, pulse oximetry, chest CT scan, bronchoscopy, and pleural fluid culture.

Treating pneumonia includes: appropriate diet, increase fluid intake, cool mist
humidifier, medication for cough , intravenous (IV) fluids or oral antibiotics, oxygen therapy, and
breathing treatments, as ordered by the child’s doctor. The infection can also be carried from the
lungs through the bloodstream and into the urinary tract. According to World Health
Organization (WHO), Pneumonia is the single largest infectious cause of death in children
worldwide. Pneumonia killed 808 694 children under the age of 5 in 2017, accounting for 15% of
all deaths of children under five years old. Pneumonia affects children and families everywhere,
but is most prevalent in South Asia.

II. Case Study

A. PATIENT PROFILE
a. Name: Patient X
 PINES CITY COLLEGES
COLLEGE OF NURSING
Magsaysay Ave. Baguio City 2600

b. Age: 1 month old

c. Sex: Male
d. Chief Complaint: Vomiting, Fever and Loose Bowel movement
e. Admitting diagnosis: PCAP – C, UTI WITH MODERATE SIGNS OF DEHYDRATION
f. Final Diagnosis: PCAP category C

B. HEALTH HISTORY
a. History of Past Illnesses:(Data Not Available)
b. History of Present Illnesses:
- Patient X has fever, LBM and vomiting upon admission on February 17. Upon receiving
the patient at the Pedia ward at 8:05 pm on the same day the chief complaint was
suffering from fever, loose bowel movement and vomiting. Patient X had a temperature
of 39 degree Celsius, which is above normal.
c. Family Health History: (Data Not Available)
d. Pediatric Ward History: (No Data Available)

C. DEVELOPMENTAL DATA
Basing on the hierarchy of needs by Maslow, Patient X had met one basic need called the
physiological needs. Since he is an infant, he only met physiological needs by having air, water,
food, shelter, sleep, and clothing as stated by Maslow, and those things are provided by his
parents.

D. 13 AREAS OF ASSESSMENT
1. SOCIAL STATUS
Patient X is a Filipino citizen aged 1 month old. He is born on January 5, 2020 at Kukong
Liwayway City. He stay together with his family at 10 Lower Matahimik Street, High City. Their religion
is Roman Catholic. Patient X’s mom is Nora Labin and his dad is Romeo Labin. Patient X was admitted
on February 18, 2021, 8:05pm with PCAP-C, UTI, and with moderate signs of dehydration.
Analysis: The patient is properly taken cared of, is not abandoned and is not abused.

2. MENTAL STATUS
Patient X is conscious and is very responsive to medication. He consistently identify his mother
and does not cry frequently.
Analysis: The patient has no trouble with regards to everything that’s happening around him.
3. EMOTIONAL STATUS

Patient X is responding well to his mother and breastfeeding well too. It cries when hungry and if
he excrete stool and urine.

Analysis: He is consistent with what he feels and converse it through crying and giggling.

4. SENSORY STATUS
Patient X’s skin feels warm to touch upon admission Is afebrile with temperature of 37.8
Analysis: The patient is not feverish.

5. MOTOR STATUS
Patient X comfortable with mothers’ carry, and can move freely.
Analysis: The patient has no problem wiggling around.
 PINES CITY COLLEGES
COLLEGE OF NURSING
Magsaysay Ave. Baguio City 2600

6. BODY TEMPERATURE
The table shows the body temperature of the patient within the three-day stay during the
7-3 shift.

DATE TIME TEMPERATURE

02/18/21 8 am 37.8
10 am 37.5
12 pm 37.4
2 pm 37.3
02/19/21 8 am 38.9
10 am 37.1
12 pm 39
2 pm 37.6
Analysis: The body temperature of patient X is not consistently within normal range.

7. RESPIRATORY STATUS

The table shows the respiratory rate of the patient within the three-day stay during the 7-3
shift.

DATE TIME RESPIRATORY

RATE
02/18/21 8 am 36
10 am 38
12 pm 36
2 pm 38
02/19/21 8 am 35
10 am 31
12 pm 35
2 pm 39
Analysis: The respiratory of the patient is within normal range.

8. CIRCULATORY STATUS
The table shows the pulse rate and blood pressure of the patient within the three-day stay
during the 7-3 shift.

DATE TIME PULSE RATE

02/18/21 8 am 109
10 am 112
12 pm 115
2 pm 111
02/19/21 8 am 119
10 am 109
12 pm 106
2 pm 171
Analysis: The data shows that her pulse rate is within normal ranges.

9. NUTRITIONAL STATUS
The patient was allowed to be on diet as tolerated (DAT) by physician.
Analysis: The digestive tract can handle the food well without causing any problem
10. ELIMINATION
The patient defecated for two times on day 2, urinated 3 times on the same day on the 7-3
shift.
Analysis; Patient X has a good elimination process.
 PINES CITY COLLEGES
COLLEGE OF NURSING
Magsaysay Ave. Baguio City 2600

11. REPRODUCTIVE STATUS

Patient X is a one-month-old male. It has complete descended testicles. Rugae in the
scrotum is noted.
Analysis: Patient X has normal reproductive system.

12. STATE OF PHYSICAL REST AND COMFORT

Patient X is irritable at times, interrupted sleeping time.
Analysis: Patient X is not comfortable due to his persistent cough and fever.
13. STATE OF SKIN APPENDGES
Patient X has a fair complexion, poor skin turgor, has a moderately dehydrated. Skin hair
is evenly distributed and nails are clean and well-trimmed.
Analysis: Patient X was perfectly taken cared by his Mother and well-groomed.

E. Pathophysiology
PATHOPHYSIOLOGY
PREDISPOSING FACTORS: PRECIPITATING FACTORS:
 1 month old * Environment
 Male * Exposed to infected person

Pathological entry (Inhalation) of

organism:
Bacteria or viruses

Occurrence of localized

Manifested by:
Mucus  Cough
 Fever

 Diminished production Bacteria invades alveolar cell in the

 Formation of Hyaline membrane lungs

Acute inflammatory response

Loss of effectiveness of defense

mechanism

Affects Alveoli Common Signs and

symptoms:
 PINES CITY COLLEGES
COLLEGE OF NURSING
Magsaysay Ave. Baguio City 2600

Impairing O2 and Co2 exchange

Mucus production

Airway constriction Occludes Airway

Cough

Crackles

Dyspnea
 PINES CITY COLLEGES
COLLEGE OF NURSING
Magsaysay Ave. Baguio City 2600

F. DIAGNOSTICS/LABORATORY TESTS
Methods used to determine whether the health of a person is normal are medical tests and
diagnostic procedures. For instance, to see if anything is wrong, a lab will examine a sample of your
blood, urine or body tissue.
HEMATOLOGY
Hematology is practiced by experts in the field who treat people with blood disorders varying
from anemia to blood cancer with either the diagnosis, care and proper effectiveness of patients. Blood
tests are used to confirm an infection and to try to identify the type of organism causing the infection.

Results Normal Values

Hematocrit 0.39 (Male) 0.42-0.53
(Female) 0.36-0.46
Hemoglobin 130 g/l (Male)155+/- 20g/L
(Female) 140+/- 20g/L
WBC count 13.81 x 10^9/L 5-10 x 10^9/L
Platelet count 317 x 10^9/L 150-450 x 10^9/L
Schilling’s Differential
Count
Neutrophilic Segmenters 0.86 0.43-0.76
Neutrophilic Stab 0.00-0.05
Lymphocytes 0.14 0.17-0.48
Eosinophils 0.00-0.04
Basophils 0.00-0.01
Monocytes 0.04-0.10
Atypical Cells
1.00

Indication: An elevated white blood cell (WBC) count is a characteristic finding in pneumococcal
pneumonia. Neutrophilic segmenters increase in response to bacterial infections as well as to physical or
emotional stress. There is a bacteria that invaded the respiratory status of Patient X.
URINALYSIS
Urinalysis is a urine test. For the diagnosis and treatment of a wide variety of diseases, such as
urinary tract infections, kidney failure and diabetes, urinalysis is often used. The presence, composition
and substance of urine are tested by urinalysis. Abnormal outcomes of urinalysis may point to a medical
problem. The test detects S. pneumoniae antigen in the urine of infected patients

Urine Flowcytometry Result Unit Normal Values

WBC 13.40 /uL 0.0-11.0
RBC 18.00 /uL
Epith. Cells 9.10 /uL 0.13
Cast 1.00 /uL 0-2
Bacteria 56.90 /uL 0-708
Urates/Phosphates Occasional /uL
Mucus Threads Moderate /lpf
Crystals /lpf
Physical Examination
Color Yellow
Transparency Slightly Turbid
pH Acidic
Specific gravity 1.020
Protein Trace
Glucose Negative
 PINES CITY COLLEGES
COLLEGE OF NURSING
Magsaysay Ave. Baguio City 2600

Chemical
Examination
Leukocytes esterase Negative
Nitrite Negative
Urobilinogen Negative
Blood/Hb Negative
Ketone Negative
Bilirubin Negative
Indication: High levels of WBCs in your urine also suggest that you have an infection. In this
case, the body is trying to fight off an infection somewhere in the urinary tract. Overall, the
urinalysis test was in the normal range.

G. NURSING PRIORITIZATION OF PROBLEMS

Actual Problems

Nursing Diagnosis/ Ran Justification / Rationale

Problem k
Hyperthermia 1st  This is my first prioritized nursing diagnosis for
the reason of the patient is experiencing
hyperthermia which is caused by being dehydrated
and  illness that causes general weakness or fever.
It is shown by the infants’ flushed skin and it
should require immediate attention to decrease the
patients temperature
 Second prioritized nursing diagnosis is fever
Fever 2nd because it is a sign that something out of the
ordinary is going on in your body and or the body
is infected with bacteria.

3rd  Third prioritized nursing diagnosis because patient

UTI with moderate who is remarkably dehydrated is no longer able to
Dehydration expel sweats to help cool down the body. UTI
should be treated immediately  because if it is not
treated immediately it can eventually travel
through the body, becoming very dangerous, even
deadly, it can become a kidney infection.

Cough 4th  Fourth nursing diagnosis prioritization is cough

Parents’ knowledge deficit
because it requires less immediate attention
compared to the other problems. The cough can be
treated along with fever too if the medication can
go well with other medicine.
5th  This would be my fifth prioritized problem
because according to Maslow’s Hierarchy of
needs, love and belonging needs is secondary to
safety needs. A failed display and make him feel
love can disrupt the bond between the mother and
him.

H. NURSING CARE PLAN (Written in a separated sheet)

I. DRUG STUDY
J. EVALUATION/REFFERAL ------

K. NURSING IMPLICATION
a. To Nursing Practice
 PINES CITY COLLEGES
COLLEGE OF NURSING
Magsaysay Ave. Baguio City 2600

Delivering care to a patient, a nurse should not forget to embody the nursing core values
to properly give care and need to a patient.

This is useful in the clinical settings to review specific positive outcomes of patient care. It
offers a safe way for the nurse to apply theoretical and actual knowledge to an actual or potential
patient scenario. She can employ her decision-making skills, use critical thinking to analyze the
situation, and develop cognitive reasoning abilities without harming a patient. It enables a holistic
review and the holistic nature of nursing care can be addressed properly and completely.

b. To Nursing Education

This case study will help to enhance current knowledge about the medical condition of
the patient. The case study builds on learned material that encourages students to more fully
understand the content being presented. Both nursing and health science literature discuss the
benefits of using a case study to instruct students to think critically and develop problem-solving
capabilities. Furthermore, this study can help future nurses to improve knowledge about PCAP
and improve patient care.

c. To Nursing Research

The case study contributes in the making of future research, used internationally in healthcare
studies across clinical settings, to explore systems and processes of care delivery. It serves to provide
a framework for evaluation and analysis of complex issues. Moreover, I suggest that other nursing
researchers should include other factors to widen the research study and to provide additional
information about the case.

L. References

Baer, S (2016) Community-Acquired Pneumonia (CAP). Retrieved from:

https://emedicine.medscape.com/article/234240-overview

Basilio, A (2016) PCAP C case. Retrieved from:

https://www.scribd.com/document/330798652/PCAP-C-CASE

De Jager, et al. (2012) The Neutrophil-Lymphocyte Count Ratio in Patients with Community-
Acquired Pneumonia. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462173/

Gardner, et al. (2017) White Blood Cell Counts, Alcoholism, and Cirrhosis in Pneumococcal
Pneumonia. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510456/

Luo,M (2018) The effect of Pneumonia in our body. Retrieved from:

https://www.healthline.com/health/pneumonia/effects-on-body

Male reproductive system (2020) Retrieved from:

https://my.clevelandclinic.org/health/articles/9117-male-reproductive-system
 PINES CITY COLLEGES
COLLEGE OF NURSING
Magsaysay Ave. Baguio City 2600

Marcin, J (2019) What you should know about pneumonia. Retrieved from:
https://www.medicalnewstoday.com/articles/151632
Ning and Shao (2016) Valuable hematological indicators for the diagnosis and severity
assessment of children with community-acquired pneumonia.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5134884/
Seroje, D (2013) Pediatric Community Acquired Pneumonia (PCAP). Retrieved from:
https://www.scribd.com/doc/162423816/Pediatric-Community-Acquired-Pneumonia-PCAP
Waseem, M (2020) Pediatric Pneumonia Clinical Presentation. Retrieved from:
https://emedicine.medscape.com/article/967822-clinical
Waseem, M (2020) Pediatric Pneumonia. Retrieved from:
https://emedicine.medscape.com/article/967822-overview#:~:text=Newborns%20with
%20pneumonia%20commonly%20present,common%20causes%20of%20bacterial
%20pneumonia.

White, C (2019) Everything You Need to Know About Fever. Retrieved from:
https://www.healthline.com/health/fever

Pneumonia (2020) Retrieved from: https://www.mayoclinic.org/diseases-

conditions/pneumonia/diagnosis-treatment/drc-20354210
Retrieved from:
https://www.medicinenet.com/pneumonia__quick_new_urine_test/views.htm