I. INTRODUCTION

Bronchopneumonia is a type ofpneumonia which results when

haematogeneous dissemination of organisms to the lung or colonization of

airways with subsequent aspiration is responsible forpulmonary infection.

As opposed to other acute bacterial or lobar pneumonias which begin in

alveoli, bronchopneumonia originates in small bronchioles. Typical

bacteria causing this form of infection include Staphylococcus aureus and

Gram-negative organisms such as Pseudomonas aeruginosa. These

organisms disseminate through the bloodstream and colonize

thebronchial or bronchiolar epithelium, but then quickly cause acute

inflammatory responses which extend outside the airway into adjacent

alveoli. The initial inflammatory response consists largely of

polymorphonuclear leukocytes which limit the extent of infection to the

peribronchiolar region. Since multiple sites are involved simultaneously a

scattered appearance of heterogeneous opacities is the usual pattern

observed on chest films (Fig.1). Eventually more and more alveoli are

affected and ultimately a homogeneous opacification simulating lobar

pneumonia may be observed. Nevertheless, because there is greater

airway involvement with bronchopneumonia, air bronchograms are

infrequent and atelectasis is more common. Peribronchial interstitial

thickening may also be seen early in the course of infection. Necrosis and

cavitation are more frequent in this type of pneumonia.Pneumatocoe les

are occasionally noted.

Clinically, patients present with fever and productive cough similar to

other bacterial infections although physical findings typical of

denseconsolidation such as bronchophony and whispering pectoriloquy

are not heard. Treatment with a variety of antibiotics usually results in

rapid clinical and radiographic resolution.

II. OBJECTIVE

General Objectives:

My general objective is to understand what Bronchopneumonia is.

Specific Objectives:

Specifically:

1.) To know what causes to have Bronchopneumonia.

2.) To know the anatomy and physiology of the body organ involved in

Bronchopneumonia.

3.) To understand the pathophysiology of Bronchopneumonia.

4.) To relate my patient chief complaint on his condition having

Bronchopneumonia.

5.) To improve myself on formulating Nursing Care Plans.

6.) To relate the medications and medical procedures done to Mr. RR on

his condition of having Bronchopneumonia.

III. HEALTH HISTORY

PATIENT’S PROFILE

Name: XY

Address: Macabalan, Lapasan Cagayan de Oro City

Civil Status: Child

Sex: Male

Age: 10 years old

Birth Date: April 8, 2000

Date Admitted: August 9, 2010

Time of Admission: 11:30 A.M

Place of Admission: NMMC

Blood Pressure: Not assesed

Respiratory Rate: 29 cpm

Pulse Rate: 116 bpm

Temperature: 37.8

Attending Physician: Dr. Macarayan

PAST HEALTH HISTORY

Mr. XY verbalized that it’s been a long time since he was confined

in the hospital, and he can’ remember it. He is conscious about his health.

He has no allergy to any foods or other stuffs He never had undergone

any surgery.

PRESENT HEALTH HISTORY

Two days prior to admission, he developed productive cough of

whitish sputum followed by low grade fever. Her mother gave him

Carbocisteine (Solmux) and Paracetamol (Biogesic),but because

symptoms persist, they consulted the doctor and was abruptly admitted.

IV. PHYSICAL ASSESSMENT

NURSING SYSTEM REVIEW CHART

Name: XYDate: Vital Signs:Pulse: BP: Temp: Height: Weight:

EENT [] impaired vision [] blind[] pain reddened [] drainage [] gums [] hard of hearing [] deaf [] burning [] edema [] lesion teeth

fever[] asses eyes, ears, nose

rashes[] throat for abnormality [X] no problemRESPIRATION

[] asymmetric [] tachypnea [] barrel chest [] apnea [] rales [X] cough [] bradypnea [] shallow [] rhonchi [] sputum [] diminished [] dyspnea [] orthopnea [] labored [] wheezing[] pain [] cyanotic[] assess resp rate, rhythm, depth, pattern[] breath sounds, comfort []no problem GASTRO INTESTINAL TRACT[] obese [] distention [] mass [] dysphagia [] rigidly [] pain [] asses abdomen, bowel habits, swallowing [] bowel sounds, comfort [X]no problemGENITO-URINARY and GYNE[] pain [] urine color [] vaginal bleeding[] hematuria [] discharge [] nocturia[] assess urine freq., control, color, odor, comfort[] grip, gait, coordination, speech, [X]no problemNEURO[] paralysis [] stuporous [] unsteady [] seizure[] lethargic [] comatose [] vertigo [] tremors[] confused [] vision [] grip[] assess motor function, sensation, LOC, strength[] grip, gait, coordination, speech, [X]no problem2MUSCULOSKELETAL and SKIN[] appliance [] stiffness [] itching [] petechiae[x] hot [] drainage [] prosthesis [] swelling[] lesion [] poor turgor [] cool [] deformity[] atrophy [] pain [] ecchymosis [] diaphoretic[] assess mobility, motion, gait, alignment, joint function

[] skin color, texture, turgor, integrity [] no problem

headache

vomiting

Skin hot to touch

Skin hot to touch

Rashes, dry

NURSING ASSESSMENT II

SUBJECTIVE

OBJECTIVE

COMMUNICATION:𓀿 Hearing Loss      “ok ra ako[]visual changes        panan-aw.”[x] denied                 

 𓀿 glasses                             𓀿 languages𓀿 contact lens   𓀿 hearing aide                R    LPupil size __3mm_          𓀿 speech difficultiesReaction _PERRLA_

OXYGENATION:[] dyspnea                “cge kog ub – hon”,[]smoking history      [X] cough[] sputum[] denied

 Resp.     []regular              𓀿 irregularDescription Respirations are in normal depth and rhythm R Symmetrical_chest expansionL Symmetrical_chest expansion

CIRCULATION𓀿 chest pain            ” wala man pud sakit    sako dughan” [] leg pain              []numbness of  extremities          [x] denied                                                    

Heart Rhythm 𓀿 regular 𓀿 irregularAnkle edema _____NONE_______________ Pulse     Car        Rad        DP          FemR _______+____72____+______+____L                       __+___72____+______+_____ Comments:   Pulses are easily palpable  

NUTRITIONDiet:   Diet as tolerated𓀿 N    𓀿 V               "Wala raman pud nag bag-oCharacter                  akung gana sa pagkaon."𓀿 recent change in    weight, appetite𓀿 swallowing     difficulty[x]  denied

 𓀿 dentures                        √  none                                 Full         Partial  With Patient Upper                    𓀿              𓀿                𓀿Lower                   𓀿              𓀿                𓀿

ELIMINATION:Usual bowel pattern           𓀿 urinary frequency  once/ twice a day                      4x day𓀿 constipation                    𓀿 urgency             remedy                             𓀿 dysuria         None                              𓀿  hematuria  Date of last BM                 𓀿 Incontinence     𓀿 foly in place     character                            𓀿 denied 

Comments:"Normal ra man ang   akung       Bowel sounds:pagkalibang ug pagpangihi."    normo-active_bowel                                                         sounds 5                                                                           clicks/min.              Abdomial DistentionPresent 𓀿 yes √ no                                                                                                                            Urine* (color,                                                            consistency,dor)                                                        Amber in color 

MGT. OF HEALTH & ILLNESS:[]alcohol                              [x] denied  ( amount, frequency)_____none_____ 𓀿SBE Last Pap Smear ___N/A___________    LMP : __________  N/A _______________ 

 Briefly describe the patient’s ability to follow treatments ( diet, meds, etc)_The client is able to follow treatment.

SUBJECTIVE OBJECTIVESKIN INTEGRITY:dry                 ”wla man ko gi katol2x." itching         𓀿 other 𓀿 denied

  √ dry                     𓀿cold                             pale𓀿 flushed            √ warmmoist                    𓀿 cyanotic* rashes, ulcers, decubitus (describe size, location, drainage)    _________________________________.

ACTIVITY/SAFETY𓀿 convulsion           𓀿 dizziness                  limited motion     Limitation in   ability to  []ambulate  [] bathe self𓀿 other[x]denied                                                                               

 𓀿 LOC and orientation   Conscious, and coherent; oriented to person, time and place.Gait:      𓀿 Walker     𓀿 Cane  𓀿 Other            [x] steady      []unsteady𓀿 sensory and motor losses in face or extremities

√ROM limitationsAble to ambulate with both extremities 

COMFORT/SLEEP/AWAKE:pain                            (location, frequency ,remedies)                  𓀿 nocturia                 []sleep difficulties[x] denied

 √facial grimaces√guarding𓀿 other signs of pain:   none 

COPING:Occupation:   StudentMembers of household _5 members including the parentsMost supportive person  Mother

 Observed non-verbal behavior __Client is responsive and cooperative

The person and his phone number that can beReached any time: (no number)

V. DEFINITION OF COMPLETE MEDICAL DIAGNOSIS

Bronchopneumonia is a type of pneumonia that is characterized by

an inflammation of the lung generally associated with, and following a bout

with bronchitis. This is really a specific type of pneumonia that is localized

in the bronchioles and surrounding alveoli. This article provides a general

overview of this condition, including symptoms and treatment options for

those who have been diagnosed with bronchopneumonia. The most

common pneumonia-causing bacterium in adults is Streptococcus

pneumoniae (pneumococcus)

Symptoms of bronchopneumonia:

Cough with greenish or yellow mucus; Fever; chest pain; Rapid,

shallow breathing; Shortness of breath; Headache; Loss of appetite;

fatigue

Treatment of bronchopneumonia:

If the cause is bacterial, the goal is to cure the infection with

antibiotics. If the cause is viral, antibiotics will NOT be effective. In some

cases it is difficult to distinguish between viral and bacterial pneumonia, so

antibiotics may be prescribed. Pneumococcal vaccinations are

recommended for individuals in high-risk groups and provide up to 80

percent effectiveness in staving off pneumococcal pneumonia. Influenza

vaccinations are also frequently of use in decreasing one’s susceptibility

to pneumonia, since the flu precedes pneumonia development in many

cases. Unlike lobar pneumonia, in which an entire section or subdivision

of the lung may be inflamed; bronchopneumonia tends to appear in

patches in and around the small airways and passages. Outward clinical

symptoms will be similar to those of lobar pneumonia, however, and can

include fever, coughing, chest pain, chest congestion, chills, difficulty with

breathing and blood-streaked mucus that is coughed up.

Bronchopneumonia is more common in elderly people, and in association

with other viral respiratory illnesses (bronchitis), and as a complication of

those who have asthma. Pneumonia, including bronchopneumonia is a

fairly common illness and it affects millions of people annually in the

United States. The severity of the illness will depend on the type of

bacteria or infection causing the illness, as well as the overall health of the

person who has bronchopneumonia.

In order to diagnosis this illness, a doctor may take a chest X-ray, may

test a sample of the sputum, may do a CBC to get a count of the white

blood cells in the blood, may take a CAT scan, and/or may take a pleural

fluid culture of the fluid surrounding the lungs. Upon diagnosis, most

people will be treated at home with antibiotics. If the patient is suffering

from dehydration or has a severe case of bronchopneumonia, he or she

may be treated in the hospital where the illness can be more closely

monitored. With appropriate treatment, most people recover fully within a

couple weeks. Very infirm or elderly people who do not get appropriate

treatment can die from bronchopneumonia.

VI. ANATOMY AND PHYSIOLOGY

The Lungs are the principal organs of respiration. Each lung is

cone-shaped, with its base resting on the diaphragm and its apex

extending superiorly to a point about 2.5 cm above the clavicle. The right

lung has three lobes called the superior, middle and inferior lobes. The left

lung has two lobes called the superior and inferior lobes. The lobes of the

lungs are separated by deep, prominent fissures on the surface of the

lung. Each lobe is divided into bronchopulmonary segments separated

from one another by connective tissue septa, but these separations are

not visible as surface fissures. There are nine bronchopulmonary

segments in the left lung and ten in the right lung.

The main bronchi branch many times to form the tracheobronchial

tree. Each main bronchus divides into lobar bronchi as they enter their

respective lungs. The lobar (secondary) bronchi, two in he left lung and

three in the right lung, conduct air to each lobe. The lobar bronchi in turn

give rise to segmental (tertiary) bronchi, which extend to the

bronchopulmonary segments of the lungs. The bronchi continue to branch

many times, finally giving rise to bronchioles. The bronchioles also

subdivide numerous times to give rise to terminal bronchioles, which then

subdivide into respiratory bronchioles. Each respiratory bronchiole

subdivides to form alveolar ducts, which are like long, branching hallways

with many open doorways. The doorways open into alveoli, which are

small air sacs. The alveoli become so numerous that the alveolar duct wall

is little more than a succession of alveoli. The alveolar ducts end as two or

three alveolar sacs, which are chambers connected to two or more alveoli.

There are about three million alveoli in the lungs. The bronchioles are very

small airways that extend from the bronchi to the alveoli. The bronchioles

are made up of smooth muscle cells and are smaller than 1 millimeter in

diameter. The bronchioles do not have glands or cartilage. The epithelial

cells of the bronchioles are cuboidal in shape.

VII. PATHOPHYSIOLOGY

PNEUMONIA

VIII. LABORATORY

Not assessed

IX. MEDICAL MANAGEMENT

MEDICAL PROCEDURES

INTRAVENOUS THERAPY

Intravenous therapy or IV therapy is the giving of liquid substances

directly into a vein. It can be intermittent or continuous; continuous

administration is called an intravenous drip. The word intravenous simply

means "within a vein", but is most commonly used to refer to IV therapy.

Therapies administered

intravenously are often called specialty pharmaceuticals.

Compared with other routes of administration, the intravenous route is the

fastest way to deliver fluids and medications throughout the body. Some

medications, as well as blood transfusions and lethal injections, can only

be given intravenously.

NEBULIZATION

It is the process of using a nebulizer that changes liquid medicine

into fine droplets (in aerosol or mist form) that are inhaled through a

mouthpiece or mask Nebulizers is used to deliver bronchodilator (airway-

opening) medicines such as albuterol or ipratropium bromide. Nebulizers

are hand-held machines with an airflow meter that measures oxygen flow.

These machines administer a variety of medications. Nebulizers vaporize

this mixture and deliver it as a fine mist or steam. Nebulizers are usually

used in the hospital or nursing home setting.Disposable nebulizers are

often sent home with a patient and are cleaned and reused for a limited

time.

TEPIDS SPONGE BATH

Tepid sponging is a time honored and well known method of

reducing the elevated temperature. Tepid sponging is useful as an

immediate but transient measure in bringing down the temperature and it

should always be supplemented with drugs like paracetamol for a longer

antipyretic effect. A tepid sponge bath relieves fever without cooling the

body too fast. Eighty degrees Fahrenheit is still 20oF below body

temperature and yet warm enough not to drive blood from the skin,

thereby preventing the cooling from getting to the body's core. Limbs are

bathed first and then the chest, abdomen, back, and buttocks. Tepid baths

should be 80-93oF (26.7-34oC).

X. NURSING CARE MANAGEMENT

NURSING CARE PLAN

CUES NURSING DX OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

Subjective Data:Pt. verbalized...“GITUGNAW KO”Objective Data- Temp: 38.1 oC- skin warm totouch- body malaise- poor appetite

- chills noted

Hyperthermiarelated to diseaseprocess asevidenced by

chills noted

That within my 8ospan of care, thepatient’s bodytemperature willlower from 38.1 oCto 37.5oC and willdemonstrateabsence of chills

- Perform tepidsponge bath- Apply cold wetcompress ifnecessary- Remove someblankets andclothes whichare notnecessary- If patient’s skinfeels cold totouch, applyfriction- Advise to wearloose andcomfortable

clothes

- Encouragepatient toincrease fluidintake- MonitorTemperature

Vaporizationof waterrelieves heatfrom thesurface of theskin To helpnormalizebodytemperature To provide airmovement, toaugment heatloss. To stimulatecirculation To be more

Comfortable

To preventdehydration To seeeffectivenessof saidinterventions

Criteria forGOAL MET:At the end of my8o span of care:- the patient’stemperature willlowers to 37.5oC- The patient willmanifest negativechilling- The patient willverbalize comfort

every 15 mins- Repeat TSB ifneeded- Administerantipyrenticdrugs asprescribed- Regulate IVF

as desired

Vaporizationof waterrelieves heatfrom thesurface of theskin Helps relief offever Helpsmaintain

hydration

CUES NURSING DX OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

Subjective Data:“gi-ubo pa gihapon ko aning mga niaging adlaw. “as verbalized bythe patientObjective Data:- productive cough- body malaise

Ineffective airwayclearance relatedto the presence of

secretions

At the end of ourduty shift wemust:- be able to coughout phlegmeffectively- maintainpatient’s airway

patency

- Auscultate forbreath sound- Monitor VitalSigns- Regulate IVF asdesired- Encouragepatient to drinkmore water(should be warm)

- To identifyabnormal breathsounds- To know thestatus or progressin/of the pt.- Helps tomaintain hydrationand fluid status,as well as to thin

Criteria forGOAL MET:At the end of my8o span of care:-Patient willmaintain patentairway-Patient will beable toexpectorate

- poor appetite- use of accessorymuscles whilebreathing-with yellowishsticky mucoussecretions

-crackles breath

sound

- Teach patient todo deep breathing

exercise

-Instructpatient/family tonotifynurse/physician ofsputum colorchanges, increasework of breathing,or onset of chestpain- Encouragepatient to rest- Position patientto High-Fowler’sPosition- Administermedicines as

prescribed

viscous secretionsto allow- To liquefysecretions- To mobilizesecretions so thatpatient may beable to moreeasily expectorate

mucous

secretions

- To monitorsignal ofworsening ofcondition thatrequiresimmediatemedicalintervention toprevent furthercomplications- To promotewellness- To facilitateairway- To helps relief

cough

sputum and cougheffectively

XI. DRUG STUDY

GENERIC

NAME

BRAND NAME CLASSIFICATION MECHANISM OF

ACTION

DOSE/

FREQUENCY

INIDICATION

paracetamol Biogesic Antipyretics Paracetamol has longbeen suspected ofhaving a similarmechanism of action toaspirin because of thesimilarity in structure.That is, it has beenassumed thatparacetamol acts byreducing production ofprostaglandins, whichare involved in the painand fever processes,by inhibiting the

PRN 1 tab q 4oFor T o >37.8

For fever

cyclooxygenase (COX)enzyme as aspirindoes.

INTERACTIONS SIDE EFFECTS ADVERSE EFFECT NURSING

CONDERATIONS

Do not start, stop, or change thedosage of any medicine beforechecking with your doctor orpharmacist first. Before usingthis product, tell your doctor orpharmacist if you use any of thefollowing products: anti-seizuremedications (e.g., phenytoin,carbamazepine, phenobarbital),"blood thinners" (e.g., warfarin),isoniazid, phenothiazines (e.g.,chlorpromazine).Acetaminophenis an ingredient in manynonprescription products and insome combination prescriptionmedications.

easy bruising/bleeding,new signs of infection(e.g., fever, persistentsore throat)

Tell your doctor immediately if anyof the following symptoms of liverdamage have: persistentnausea/vomiting, yellowingeyes/skin, dark urine,stomach/abdominal pain, extremetiredness. A very serious allergicreaction to this drug is rare.However, seek immediate medicalattention if you notice anysymptoms of a serious allergic

reaction, including: rash, itching,swelling, severe dizziness, troublebreathing.If you notice other effectsnot listed above, contact your doctoror pharmacist.

GENERIC NAME BRAND NAME CLASSIFICATION MECHANISM OF

ACTION

DOSE/

FREQUENCY

INDICATION

Butamirate citrate Sinecoid Cough and cold

preparation

1 tab TID Acute cough of

any etiology

INTERACTIONS SIDE EFFECTS ADVERSE REACTIONS NURSING

CONSIDERATIONS

Rarely, skin rash, nausea,diarrhea or dizziness

GENERIC

NAME

BRAND NAME CLASSIFICATIONS MECHANISM OF

ACTION

DOSE/FREQUENCY INDICATION

Albuterol

sulphate

VentolinNebule

Inhalation solution beta2-adrenergicbronchodilator

1 neb TID VENTOLIN NEBULES InhalationSolution is indicated for the relief ofbronchospasm. This drug relaxesthe smooth muscle in the lungsand dilates airways to improve

breathing.

INTERACTIONS SIDE EFFECTS ADVERSE REACTIONS NURSING

CONSIDERATIONS

- Tell your doctor ofall prescription andnonprescriptiondrugs you may use,especially of drugsused for asthma,depression or colds;and beta-blockers(e.g., atenolol,propranolol).- Do not start or stopany medicinewithout doctor orpharmacistapproval.

Cases of urticaria,angioedema, rash,bronchospasm,hoarseness,oropharyngeal edema,and arrhythmias(including atrialfibrillation,supraventriculartachycardia,extrasystoles) have beenreported after the use ofVENTOLIN NEBULESInhalation Solution.

Tremors, Dizziness,Nervousness, Headache,Sleeplessness, Gastrointestinal,Nausea, Dyspepsia , Ear, nose,and throat, Nasal congestion,Tachycardia, Hypertension,Bronchospasm, Cough,Bronchitis, Wheezing

- Tell your doctor if you have heartdisease, high blood pressure, anoveractive thyroid gland, epilepsyor diabetes.- Tell your doctor if you ever had abad reaction to bitolterol,ephedrine, epinephrine,metaproterenol, phenylephrine,phenylpropanolamine,pseudoephedrine, or terbutaline.- Many nonprescription

productscontain these drugs (e.g., diet pillsand medication for colds andasthma), so check the labelscarefully.- Do not take any of thesemedications without consultingyour doctor (even if you never hada problem taking them before).- Do not allow anyone else to takethis medication.

XII. DISCHARGE PLAN

EXERCISE

Be sure to get enough rest and sleep on a daily basis.

Practice deep breathing and coughing exercise to easily excrete phlegm

TREATMENT

Have annual influenza vaccine after discussing appropriate timing of the

vaccination as recommended

Discuss the pneumococcal vaccine with your primary health care provider,

and have the vaccination as recommended

If you do not smoke, don’t start.

Avoid stress, fatigue, sudden changes in temperature and excessive

alcohol intake, all of this lowers resistance to

pneumonia.

HYGIENE

Take bath daily.

This is a property of College of Nursing – TRACE College. No part of this

manuscript may be reproduced or transmitted in any form or by any means.

Please obtain permission from the College of Nursing –

TRACE College.

Wear masks especially when traveling for the first week after being

discharged.

Promote frequent oral hygiene.

OUTPATIENT ORDERS/FOLLOW UPS

Follow up check up will be on Oct. 4, 2008, 1-6pm

DIET

Drink plenty of water (at least 8 glasses every day), especially during

warm weather.

Eat a healthy, balanced diet and take in a sufficient amount of non-

alcoholic fluids each day.