1. step 8
1.1. diagnostic decision
1.1.1. CAP with otitis media
1.2. mechanisim
1.2.1. infection of the lung by micro-organismic. ethnicity play a role
1.3. presentation
1.3.1. cough , fever tachypnea , and ear discharge for one day
1.3.2. skin lesion in the lower extremity
1.4. supporting data
1.4.1. x-ray
1.4.2. skin colture
1.4.3. hyponitremia
1.4.4. increse in WBC
1.4.5. physical examination
1.4.6. and all test results
2. step 6
2.1. vesiaulize data and theory
2.1.1. pnuemonia
2.1.2. otitis media
2.1.3. spreading of the infection
2.1.4. tachypnea
3. step 7
3.1. inquiry plan and info gathering
3.1.1. history of presenting complain
3.1.1.1. 23 month
3.1.1.2. came 2 times for the same symptoms ( cough/fever )
3.1.1.3. the symptoms began 24 hours ago
3.1.1.4. cough
3.1.1.5. tachypnea
3.1.1.6. ALL THE PROBLEMS BEGAN ONE DAY AGO
3.1.1.7. dhiarea
3.1.1.8. no vomiting
3.1.2. previous medical / surgical history
3.1.2.1. she had to previous episodes
3.1.2.1.1. 8 month
3.1.2.1.2. 12 month
3.1.2.2. bilateral tympanic membrane perforation
3.1.2.3. no chronic dieases
3.1.2.4. no previous surgery
3.1.2.5. born 3 weeks premature
3.1.2.5.1. birth wight 2.75 KG
3.1.3. drug history / allergy
3.1.3.1. no allergies
3.1.3.2. medication ( only the ones at 12 month )
3.1.4. family history
3.1.4.1. father smokes but the mother do not
3.1.4.2. 3 sibilings under the age of 10
3.1.4.3. a sungle room sheltier
3.1.5. social / occupational history
3.1.5.1. parents are unemployed ( 2 week bases salary )
3.1.5.2. diet include a lot of tea , meet ocasionally ,hot water system did not work for the 6 month.
3.1.5.3. no encom
3.1.5.4. support from relatives
3.1.6. systemic review
3.1.6.1. AT AGE OF 12 month ( 80 % averege wight of her age )
3.1.7. physical examination
3.1.7.1. vital sign
3.1.7.1.1. puls 130
3.1.7.1.2. RR 65
3.1.7.1.3. tempretor 38.5
3.1.7.2. ear
3.1.7.2.1. mucoid from nose
3.1.7.2.2. and purlent from left ear
3.1.7.2.3. mild tympanic membrane porferation ( right )
3.1.7.2.4. enlarged tonsils
3.1.7.3. chest
3.1.7.3.1. irratable and responding to her mother
3.1.7.3.2. mild chest indroeing ( respiratory muscles go in and out )
3.1.7.3.3. unwell but active
3.1.7.3.4. air entery heard
3.1.7.4. scattered skin lesions in lower limp
3.1.8. test results
3.1.8.1. X-RAY
3.1.8.2. biochemistry
3.1.8.2.1. hyponitremia
3.1.8.2.2. hemoglobin decrese
3.1.8.2.3. whit blood cells increase