Neonatal

Pneumonia

Prepared By: Hannah Faye U. Asinas

BSN 2101
18-53972
Demographic Pages:

Name: Patient X

Age: 19 days old

Birthdate: February 21, 2020

Address: Paharang Silangan , Batangas

Chief Complain: Cough

Actual Diagnosis: Neonatal Pneumonia; to consider Neonatal Sepsis. Newborn Full Term to a 24 year old
G1P1(1001) BW 2225g AGA Good Cry

I. Introduction:

Pneumonia is the most common invasive bacterial infection after primary sepsis. An early-
onset pneumonia is part of generalized sepsis that first manifests at or within hours of birth. On the
other hand, a late-onset pneumonia usually occurs after 7 days of age which most commonly is in
neonatal ICUs among infants who require prolonged endotracheal intubation because of lung disease.

A neonatal pneumonia is a lung infection of a newborn. The onset of it may be within hours of
birth and part of a generalized sepsis syndrome or after 7 days and confined to the lungs. It is caused
by a serious respiratory infectious disease caused by a variety of microorganisms, usually
Streptococcus pneumonia.. Abnormalities of airway patency as well as alveolar ventilation and
perfusion occur frequently due to various mechanisms. Consequently, there has been alterations in
gas exchange and dependednt cellular metabolism in the tissues and organs of the neonate.

Patients who acquire such disease experience difficulty in breathing, chills, cough, chest pain
and fever. Symptoms may be less specific , most especially on babies, and may not show clear signs
of a chest infection. Commonly they will have a fever, appear unwell and become lethargic.Also, they
may also have noisy or rattly breathing and have difficulty on feeding.

As such, the doctor will take a medical history and will be conducting a physical examination.
In that, the doctor will listen to the chest of the neonate for crackling sounds, wheezing and reduced
breath sounds that may indicate pneumonia. If it turns out positive, the hospital will be giving
antibiotics, oxygen therapy, intravenous fluids and physiotherapy.

Prevention of this disease to a neonate may include breastfeeding the baby to help boost his
immune system. Also, ensure a smoke-free environment and keep it well ventilated. At the same
time, vaccinations against pneumococcal disease should be given to prevent the risk of acquiring
such disease.
I. Patient History:

Past health history

Patient X does not have any past medical history.

Family health history

Patient X has a family history of asthma and hypertension on the maternal side

Social history:
The patient lives with her mother and father. The patient’s mother and father are involved
with the care and financial support during her stay in the hospital.

Personal history:

Patient X has been exposed to her father who was smoking.

Nutrition

Patient X is in the support of her mother’s breastfeeding

III. Physical Assessment

SYSTEM FINDINGS
General Survey Conscious and Coherent

Skin Pinkish

HEENT Flat:anterior fontanel

Neck Supple

Chest and Lungs SCE, shallow subcostal retractions , harsh breath sounds

Heart AP, NRRR

Abdomen Soft, nondistended abdomen

Rectum and
Grossly Female
Genitalia

Neurologic
GCS 15
Examination
Vital signs (as of March 9, 2020)

8:00 AM 10:00 AM
Temp 36.8 °C 36.8 °C
PR 111bpm 115 bpm
RR 58 cpm 57 cpm

Vital signs (as of March 11, 2020)

8:00 AM 10:00 AM
Temp 36.2 °C 36.5 °C
PR 120bpm 115 bpm
RR 40 cpm 38 cpm

IV. Anatomy and Physiology

PARTS OF THE RESPIRATORY SYSTEM

Respiratory Tract

Respiration is the act of breathing in and breathing out. When you inhale, you take in oxygen.
When you exhale, you give off carbon dioxide.
STRUCTURE

The respiratory system is made up of the organs involved in the

interchanges of gases. It consists of the nose , mouth, throat (pharynx), voice box (larynx), windpipe
(trachea), airways (bronchi) and lungs. The upper respiratory tract includes the nose, nasal cavity and
sinuses. The lower respiratory tract includes the voice box (larynx), windpipe (trachea), lungs,
airways (bronchi and bronchioles) and air sacs (alveoli).

DEVELOPMENT

The lungs take in oxygen. The body's cells need oxygen to live and carry out their normal
functions. Also, they get rid of carbon dioxide which is a waste product of the cells.

The lungs are a pair of cone-shaped organs made up of spongy, pinkish-gray tissue. They take
up most of the space in the chest, or the thorax (the part of the body between the base of the neck and
diaphragm). The lungs are covered in a membrane called the pleura. They are separated from each
other by the mediastinum. The right lung has 3 lobes while the left lung has 2 lobes. When you
breathe, the air enters the body through the nose or the mouth. It travels down the throat through the
larynx (voice box) and trachea (windpipe) and goes into the lungs through tubes called main-stem
bronchi. One main-stem bronchus leads to the right lung and one to the left lung. In the lungs, the
main-stem bronchi divide into smaller bronchi. Then the bronchi divide into even smaller tubes called
bronchioles which end in tiny air sacs called alveoli

V. Pathophysiology

Neonatal pneumonia is lung infection in a neonate. Onset may be within hours of birth and
part of a generalized sepsis syndrome or after 7 days and confined to the lungs. Signs may be
limited to respiratory distress or progress to shock and death. Diagnosis is by clinical and
laboratory evaluation for sepsis.
 NEONATAL PNEUMONIA

Due to the etiological factors

If a mother has a bloodstream infection

Defenses are limited in fetuses

Can readily cross the placental barrier

Dissemination off illness may result

Before birth or readily after birth

Pneumonia is already established at birth

Interstitial
Renal
Infection
Ascending
tubules
reaches
abscesses
infection
are damaged
pelvis
present
of the
andby
in
the
Urinary
parenchyma
exudates
kidney
Tract
VI. Laboratory and Diagnostic Examination
SEROLOGY

November 18, 2019

Hematology Result Unit Range

ERYTHROCYTES 3.95 10^12L 4.2-5.4
Hemoglobin 136 g/l 120-140
Hematocrit 0.402 0.38-0.47
LEUKOCYTES 10.23 10^9L 4.5-11
Neutrophils 0.185 % 0.37-0.72
Lymphocytes 0.644 % 0.20-0.50
Monocytes 0.132 % 0.0-0.14
Eosinophils 0.033 % 0.0-0.06
Basophils 0.006 % 0.0-0.01
THROMBOCYTE 432 10^9L 150-400
MCH 34.4 pg 27.0-31.0
MCV 101.8 fL 80.0-96.0
RDW-CV 16.6 % 11.5-14. 5
MCHC 0.34 0.32-0.36
MPV 11.0 RNF
RH Type Positive

SEROLOGY

March 9, 2020

SEROLOGY RESULT REFERENCE

C.R.P 0.5 Below 1mg/dl

VII. Drug Study
DRUG Action/ Indication Adverse effect Nursing Action
Classification

Generic Name: Ampicillin acts as is a CNS: Fever: Perform

an enzyme prescription fever, tepid sponge
Ampicillin irreversible penicillin-type dizziness, bath to the
Brand Names: inhibitor of the antibiotic used headache, patient to lower
enzyme to treat many fatigue, temperature.
Ampi, Omnipen, transpeptidase, different types seizure
Penglobe, Principen which is needed of infections Dizziness:
by bacteria to caused by GI: Allow the patient
Therapeutic gastritis, to sit down or lie
make the cell bacteria, such
Classification: diarrhea, still.
well. It inhibits as ear
the third and final infections, nausea,
Penicillins Headache:
stage of bacterial bladder vomiting,
abdominal pain Provide
Pregnancy Risk: cell wall synthesis infections, analgesics as
in binary fission, pneumonia, GU: ordered.
Pregnancy
which ultimately gonorrhea, and hematuria,
Category B
leads to cell lysis; E. coli or vaginitis, Fatigue:
Stock preparation: therefore, salmonella nephropathy Emphasize the
ampicillin is infection. importance of
Capsules: usually DERM: frequent rest
bacteriolytic. flushing, periods.
- 250mg, 500mg
urticaria,
rash Seizure: Clear
Oral Suspension:
the area around
-125mg/5ml, RESPIRATOR the patient and
250mg/5ml Y: turn her gently
wheezing, onto one side.
Powder for Injection: dyspnea,
hypoxia, Gastritis:
-125mg, 250mg, Advise patient to
500mg, 1g, 2g, 10g apnea
discontinue the
use of NSAIDs
drugs and
alcohol.

Diarrhea:
Encourage
increase oral
intake of fluids
containing
electrolytes.

Nausea:
Eliminate strong
odors from the
surrounding
Vomiting:
Encourage client
to eat frequent
small meals.

Abdominal
Pain:
Give analgesic as
prescribed by the
physician.

Hematuria:
Clean the
perineal area and
keep it dry and
clean.

Vaginitis:
Administer
antiviral,
antifungal, and
antibiotic
medication as
prescribed.

Nephropathy:
Advise the
patient to control
the blood
pressure by
taking
antihypertensive
medications as
ordered.

Flushing:
Reduce patient
exposure to
sunlight and cold
temperatures.

Urticaria:
Advise to cut the
nails and avoid
scratching the
affected area.

Rash:
Apply
hydrocortisone
cream or
 ointment as
ordered.

Wheezing:
Position the
patient in an
upright position.

Dyspnea: Assist
the patient with
proper body
alignment for
maximum
breathing
pattern.

Hypoxia:
Administer
oxygen as
needed.

Apnea:
Encourage
sustained deep
breaths.

Generic Name: Inhibit protein Serious CNS: Vertigo:

synthesis is by Infection vertigo, Advice patient to
Gentamicin binding directly drowsiness, move slowly.
to the 30s Endocarditis headache,
Brand Names:
ribosomes Drowsiness:
Staphylococcu GI:
Garamycin subunit; s Infection loss of appetite, Headache:
bactericida.
Cidomycin nausea, Provide
G.I Infection
vomiting, analgesics as
Septopal ordered.
RESPIRATOR
Stock preparation:
Y: Loss of
Injectable Solution: shortness of appetite:
10mg/ml breath, Encourage to
40mg/ml exercise lightly
EENT: beore meals to
photosensitivity, stimulate
hearing loss, appetite.
DERM:
Nausea:
skin redness,
Encourage to eat
allergic reaction,
small, frequent
itching
meals.
Vomiting:
Encourage oral
rehydration
solution (ORS)

Shortness of
breath: Provide
respiratory
medications and
oxygen as per
ordered.

Photosensitivity
: Administer
topical
corticosteroid s
and cool
compresses as
prescribed.

Hearing Loss:
Speak clearly
and slowly
without shouting
or exaggerating
mouth
movements.

Skin redness:
Apply cold
compress on the
affected area.

Allergic
Reaction:
Administer
antihistamine as
ordered by the
physician.

Itching: Apply
moisturizers or
cortisone cream
and avoid
scratching the
area.
IX. Prognosis
Upon checking on my patient, I found out that she was already in a good condition. The vital
signs were all normalized. At the same time she has a good sucking reflex and was able to breastfeed
properly. Also, there are no signs of pain or discomfort. Lastly, she was able to breathe properly and
has no signs of cough.

X. Discharge Planning
M= Medication

 Instruct the parent to strictly adhere to the medication precautions, routine and order,
including time and period of ingestion as prescribed by the physician.

E- Environment

 Maintain environment conducive to rest and sleep by eliminating stress contributing factors
including offensive noises and odors.

 Provide well-ventilated room with enough sunlight to facilitate fast health recovery.

 Instruct the client on ways on how to maintain the cleanliness in the environment.

T-Treatment

 Provide breastfeed and intiate bedrest.

 Carry the child and avoid stress related factors and report signs and symptoms of severe
cough, fever and difficulty in breathing

H- Hygiene

 Promote habitual hygiene to child because it helps to maintain the wellness like always
performing cord care and bath.

O- Outpatient

 Involve the participation of family in continuous planning of care at home such as reminding
and informing the significant others with regards to follow-up checkup.

 Educate and emphasize the importance of follow-up checkups to the parent.

 Instruct the parent to seek or return upon expertise of any sign and symptoms of severe cough,
fever and difficulry in breathing.
D- Diet

 Provide breastfreeding every 2 hours.

XI. Proposed Outcome and Recommendation

The patient’s vital signs will be able to normalize until discharge. At the same time , the value
of erythrocytes, thrombocytes, as well as the results in c.r.p in serology will at least be close to the
normal range. Moreover, the patient will not exhibit cough and discomfort. After discharge, I
encourage the parent to continue breastfeeding and follow the medication that will be prescribed by
the physician . Lastly, will advise the parent to give proper cord care and bath to the patient.
XII. References

 https://www.msdmanuals.com/profesionals/pediatrics/infection--in-neonates-/neonatal-
pneumonia

 https://www.webmd.com/asthma/guide/hypoxia-hypoxemia

 https://www.drugstudy.com

 https://www.emedicine.edscape.com/