Clinical Scenario: Pediatric Pneumonia Assessment Case Study

This case study presents a clinical scenario involving Jasper, a four-year-old child exhibiting symptoms of respiratory distress due to bacterial pneumonia. The assessment includes monitoring vital signs such as respiratory rate, heart rate, and temperature, which are significantly elevated. The case study delves into the pathophysiology of pneumonia, highlighting common causative agents like Streptococcus pneumoniae and the impact of environmental factors. Diagnostic measures such as chest radiographs and blood tests are discussed, along with treatment strategies focusing on antibiotics like amoxicillin and supportive care to ease breathing difficulties. The study emphasizes the importance of proper positioning and monitoring of oxygen saturation to manage the child's condition effectively.

CLINICAL SCENARIOS 1
Clinical Assessment of a Child with Pneumonia
By; Student’s Name
Student ID
Code + Course Name
Professor’s Name
University’s Name
City, State
Date

CLINICAL SCENARIOS 2
Assessment
Respiratory problems are very common among children and the symptoms are unique
to the age bracket. The respiratory distress in children arises as the infant’s lungs develop and
adapt to the environment. The child should be carefully assessed for an obstruction in the
airway, the breathing rate and heart rate.
The nurse should look at the symmetry of the child’s chest expansion. The nurse will
look for the presence lip cyanosis. Since the child is trying very hard to breathe, he will use
his accessory muscles while breathing. The nurse should also look at central trachea for an
unequal pressure within the chest cavity. During the assessment, nurses should check if the
airway is patent, if there is a foreign body in the airway and if the child is drooling. The
child’s normal conditions should be noted first before the abnormal changes are monitored
(Gallacher, et al., 2016). This helps in planning for the child’s medication.
The nurse should use the butterfly procedure to find the specific symmetry of the
chest expansion during the assessment. The nurse will then try to find out if there is presence
of any subcutaneous emphysema by checking if there is any tenderness around.
The nurse should then listen carefully for a wheezing or gasping sound. Children
trivet whenever they have a difficulty in breathing therefore the nurse should leave the child
if he/she decides to extend the neck (Abbie, 2015). The extension of the neck opens the
child’s airway.
The immediate examinations in the assessment of a child with respiratory distress
should be oximetry of the pulse, a radiograph of the chest and blood tests (Arterial blood gas,
the blood culture and a full blood count). A chest radiograph is predominantly useful for
finding out the core cause. It is also very necessary to monitor the RR and oxygen saturation.
Normal oximetry pulse of a child less than 5 years should be 95 – 100%.Lower airway
infections are prevalent among children with consistent respiratory problems (Proesmans,
2016). Systematic clinical evaluation of the child is the most imperative aspect of perfectly
diagnosing the core respiratory condition.
Jasper is breathing very hard and has a breathing rate of 48 breaths per minute,
temperature of 39.1 degrees Celsius; his heart rate is 142 beats per minute and a blood
pressure of 95/60 mmHg. Jasper has had rhinorrhoea, low grade fever and cough in the past
four days. Jasper’s blood pressure is normal; however, the temperature exceeds the normal
range of 36.5 – 37 degrees Celsius; the heart rate exceeds the normal range of 60 – 110; and
the respiratory rate exceeds the range of 20-25 in a four year old child (Kliegman & Stanton,

CLINICAL SCENARIOS 3
2016). Jasper’s condition has been determined to be moderate respiratory distress caused by a
bacterial pneumonia.
A child with breathing complications displays definitive vital signs of breathing
distress irrespective of the basic cause. These consist of tachypnoea (a respiratory rate greater
than the normal range) as witnessed in Jasper, tachycardia (a heart rate greater than the
normal range), cough and in Jasper’s case high temperature.
For a child suffering from bacterial pneumonia, the nurse should ensure that the child
is positioned in a way that helps in breathing. This can be done by elevating the child’s head.
The child’s oxygen saturation should also be closely monitored since it was initially beyond
the normal range. The most common oral antibiotic prescribed by doctors is amoxicillin.
Children may possibly require up to 14 days of oral antibiotics and a day or two of rest at
home for a bacterial case of walking pneumonia (Chase et al., 2017). For walking pneumonia
to clear up totally, it could take 4-6 weeks. The child’s recovery can also be boosted by being
allowed sufficient downtime, sleep and lots of water to stay hydrated.
Discussion
Jasper is suffering from respiratory distress caused by a bacterial pneumonia. He
should be put in a certain position in order to be able to breathe well or rather he should be
comfortable in the position he is in. Being a child, Jasper might not be able to respond to
some of the nurse’s questions therefore the parent will be responsible for the responses
(Smith, et al., 2015). However, the nurse can ask some simple questions about the child’s
physical condition directly from the child. The child definitely cannot give an account of his
condition therefore a chest radiograph is necessary. The bacterial pneumonia causing
respiratory distress in Jasper is the reason why he has a high temperature of 39.1 degrees
Celsius, a cough and rhinorrhoea. The respiratory rate is high since Jasper is gasping for
breath and breathing quickly thus prompting the increase in heart rate as well. Antibiotics
such as amoxicillin or penicillin should be administered after a systematic examination
depending on the severity of the situation (Grimwood, et al., 2016).
Pathophysiology
Pneumonia is a major cause of ill health and death of children globally. Pneumonia
relies on the biological principle that parenchymal lung infection results in tachypnea;
therefore any tachypnea ultimately indicates that there is a parenchymal disease including
pneumonia (Proesmans, 2016). Most cases of childhood pneumonia acquired from the
environment are attributed to a few micro–organisms, typically bacteria. A shift from
bacterial to viral prevalence has been witnessed recently due to poor hygiene, poor sanitation

CLINICAL SCENARIOS 4
and infection control and lack of vaccination policies. Bacteria such as Streptococcus aureus,
Streptococcus pneumonia and Haemophilus influenza and some viruses like Respiratory
Syncytial Virus and Influenza virus are the major causes of pneumonia acquired from the
environment in children (Catia, et al., 2016). Pneumonia acquired from hospitals is majorly
caused by Pseudomonas aeruginosa, Acinetobacter baumannii, Haemophilus influenza and
Enterobacteriaceae.
Bacterial pneumonia can affect a part of or the entire lung thereby making it difficult
for the body to get oxygen in the blood. The most common symptoms in children are fast
breathing, fever, breathing complications and loss of appetite as witnessed in Jasper. The
bacteria get into the lungs or respiratory tract then multiply thereby causing several
respiratory conditions. Children such as Jasper are at a high risk of suffering from bacterial
pneumonia. The possible lifestyle cause of the condition in Jasper could be because he was
exposed to a polluted environment (Abbie, 2015). Bacterial pneumonia causes complications
such as organ failure, due to bacterial infection, difficulty in breathing, pleural gush, fluid
build-up in the lungs, lung swelling and cavity in the lung. At the time of admission into the
emergency department, Jasper had difficulty in breathing which became worse over time.
Bacterial pneumonia can be diagnosed by checking for abnormal sounds in the chest
that point to a hefty discharge of mucus, taking a sample of the blood to determine if the
blood count is high thus signifying an infection, examining the blood culture since it helps in
determining if the bacteria have spread to the circulation as well as helps in identifying the
bacteria that might have caused the infection, checking a sample of the mucus in order to
identify the specific bacteria that could have caused the infection and conducting X-rays or
chest radiographs to check for the existence and severity of the infection (Chase, et al., 2017).

CLINICAL SCENARIOS 5
References
Abbie, 2015. Ausmed. [Online]
Available at: http://www.ausmed.con/articles.paediatric-respiratory-assessment/
[Accessed 29 September 2018].
Chase, C., Leonard, M. & Gotter, A., 2017. Bacterial Pneumonia: Symptoms, Treatment and
Prevention, California: Healthline Media.
Cilloniz, Catia; Loeches, Ignacio Martin; Vidal, Carolina Garcia; Jose, Alicia San; Torres,
Antoni 2016. Microbial Etiology of Pneumonia: Epidemiology, Diagnosis and Resistance
Patterns. International Journal of Molecular Sciences, 17(12). 10.3390/ijms17122120
Gallacher, D. J., Hart, K. & Kotecha, S., 2016. Common respiratory conditions of the
newborn. The Respiratory Professional's Source for Continuing Medical Education, 12(1),
pp. 30-42. 10.1183/20734735.000716
Grimwood, Keith; Fong, Siew M.; Ooi, Mong H.; Nathan, Anna M.; Chang, Anne B. 2016.
Antibiotics in childhood pneumonia: how long is long enough?. BMC, 8(6).
https://doi.org/10.1186/s41479-016-0006-x
Kliegman, R. M. & Stanton, B., 2016. Nelson Textbook of Pediatrics. 2nd ed. Wisconsin:
Elsevier Health Sciences.
Proesmans, M., 2016. Respiratory illness in children with disability: a serious problem?. The
Respiratory Professional's Source for Continuing Medical Education, 12(4).
10.1183/20734735.017416
Smith, Rita Mangione; Zhou, Chuan; Robinson, Jeffrey D.; Taylor, James A.; Elliott, Marc
N.; Heritage, John 2015. Communication Practices and Antibiotic Use for Acute Respiratory
Tract Infections in Children. Annals of Family Medicine, 13(3), pp. 221-227.
10.1370/afm.1785