bronchopneumonia prepared by: saumya baby staff nurse, pedia ward
TRANSCRIPT
Case Presentation
BronchopneumoniaPREPARED BY: SAUMYA BABYSTAFF NURSE, PEDIA WARD
NAME: HALLA TARED MR NO: 181038 DIAGNOSIS: BRONCHOPNEUMONIA AGE: 2 YRS OLD GENDER: FEMALE DATE OF ADMISSION: 10/12/12 DATE OF DISCHARGE: 17/12/12
DEMOGRAPHIC DATA:
GENERAL ASSESSMENT: Mild respiratory distress present Looks lethargic SKIN: Dry and slightly pale HEAD AND NECK: No deformities found THORAX: Symmetrical in size CARDIOVASCULAR: Tachycardia and tachypnea present GENITOURINARY: Adequate urine output GASTROINTESTINAL: Abdomen is soft, not distended MUSCULOSKELETAL: No deformities noted. No joint or muscle pain noted during examination NEUROLOGY: Growth and development is adequate as per Erikson
Psychosocial Stage
PHYSICAL ASSESSMENT:
PAST MEDICAL HISTORY: NO family history of the bronchial asthma,
bronchopneumonia, bronchiolitis. DM No allergic history No previous breathlessness History of gastroenteritis
PRESENT MEDICAL HISTORY: Shortness of breath and fever present since
1 day at the time of admission.
PATIENT HISTORY:
PNEUMONIA
DEFINITION: Pneumonia is an inflammation of the
lung parenchyma cause by various microorganisms including bacteria, mycobacterium, fungi and viruses.
TOPIC PRESENTATION:
LUNGS: The lungs are paired elastic structures enclosed in
the thoracic cage which is an air tight chamber with distensible walls
The lungs are enclosed in a serous membrane called pleura. The mediasternum is in the middle of the thorax between the pleural sacs that contains the two lungs and each lung is divided into lobes. There are several divisions of the brochi within each lobe of the lung. The subsegmental brochi then bracnhes into bronchioles which have no cartilage in their wall. The lung is made up about 300 million alveoli.
ANATOMY AND PHYSIOLOGY:
ALVEOLI – are tiny sacs in the lungs that perform gas exchange.that is the main process of respiration.
BRONCHI – is basically an organ from the respiratory system. It acts as an caliber for the airway by conducting air into the lungs.
BRONCHIOLES – are smaller airways that send the air on to the inside walls of the lungs.
PHYSIOLOGY:
VIRAL ( cytomegalo virus is the most common)
BACTERIAL (streptococcal and staphylococcal pneumonia)
ETIOLOGY:
PATHOPHYSIOLOGYALVEOLAR INFLAMMATION
AN EXUDATE INTERFERE WITH DIFFUSION OF O2 AND CO2
WBC, NEUTROPHIL MIGRATES TO ALVEOLI
FILLED THE AIR SPACE NORMALLY
PARTIAL OCCLUSION OF BRONCHI AND ALVEOLI
ALVEOLAR OXYGEN TENSION DECREASED
BROCHOSPASM
HYPOVENTILATION
HYPOXEMIA
LOBAR PNEUMONIA BRONCHOPNEUMONIA
BOOK BASE Runny nose Worsening cough Fever Increased Respiratory
rate Retraction Wheezing Cyanosis Decreases breath
sounds Crackles Chest pain
Abdominal pain Vomiting PATIENT
MANIFESTATIONS Tachypnea Poor feeding Nasal flaring Wheezing Severe cough Respiratory fatigue SOB
SIGNS AND SYMPTOMS:
◦Ineffective breathing pattern.◦Ineffective airway clearance due to secretion.
◦Altered nutritional pattern less than body requirement due to less food intake.
◦Hyperthermia related to infection.◦Disturbed sleeping pattern due to cough and breathing difficulty.
PRIORITIZATION OF NURSING PROBLEMS:
Improving airway patency. Promoting rest and conserving energy. Promoting fluid intake and maintaining
nutrition Promoting family knowledge Monitoring and preventing potential
complications. Promoting home and community based
care.
INTERVENTION:
BOOK BASE Antibiotics e.g Ceftriaxone and other Cephalosporins. Ampicillin Supportive measures such IV fluids,
antipyretic, humidified O2, hydration
PATIENT TREATMENT Treated with injection cefuroxime 500mg IV
TID, neb Ventolin, pulmicort, atrovent and syrup adol.
TREATMENT:
RESPIRATORY DISTRESSHYPOTENSIONHEART FAILURE
CARDIAC DYSRRYTHMIASPERICARDITISMYOCARDITIS
PLEURAL EFFUSION
COMPLICATIONS:
ASSESSMENT NURSING DIAGNOSIS
PLANNING IMPLEMENTATION
RATIONALE EVALUATION
CUES/EVIDENCE: SUBJECTIVE:“Patient mother complaints of difficulty in breathing”. OBJECTIVE: Dyspnea SOB Respiratory
rate changes
Coughing Purulent
sputum
Ineffective airway clearance related to copious tracheobronchial secretion.
Improve airway patency.
1. Provide fowlers position.
2. Maintain a clear airway( suction, CPT) as indicated
3. Administer humidified O2.
4. Provide adequate hydration.
5. Implement nursing measures to reduce pain and anxiety.
6. Administer medications and nebulization as order.
1. Helps good air entry.
2. Retained secretions interfere with gas exchange.
3. Loosen secretion improve ventilation.
4. Thins and loosens pulmonary secretion.
Mobilize and loosen secretions.
5. Provide toys, watching TV, etc.
6. Antibiotics reduce infection; nebulization helps soothing and expulsion of secretion (e.g inj. Cefuroxime, neb ventolin and pulmicort).
Relieved from breathing difficulty.
NURSING CARE PLAN:
ASSESSMENT NURSING DIAGNOSIS
PLANNING IMPLEMENTATION
RATIONALE EVALUATION
CUES/EVIDENCE: SUBJECTIVE:“Patient’s mother complaints baby having temperature”.OBJECTIVE: Fever Tachypnea Chills Fatigue Weakness
Hyperthermia related to infection (Bronchopneumonia)
Patient will relieve from: Fever Tachypnea Chills Fatigue
1. Remove excessive clothing.
2. Provide tipid sponge bath.
3. Encourage increase fluid intake.
4. Administer iv fluids.
5. Administer antipyretic (e.g syrup adol, rofenac suppository as per order).
1. Excessive clothing may increase temperature.
2. High temperature causes coagulation of cell protein and cell die. High temperature leads to brain damage.
3. To prevent dehydration due to tachypnea and fever.
4. To maintain electrolyte imbalance.
5. To reduce body temperature.
Fever reduced.
ASSESSMENT NURSING DIAGNOSIS
PLANNING IMPLEMENTATION
RATIONALE EVALUATION
CUES/EVIDENCE: SUBJECTIVE:“Mother told baby is not taking orally well”. OBJECTIVE: Dehydrated Fatigue Drowsy Rapid
respiratory rate
Fluid Volume Deficit Related To Fever and
Rapid Respiratory Rate
Proper maintenance of fluid volume and adequate nutrition.
1. Encourage increase fluid intake.
2. Give nutritionally enrich drinks with more taste. Enrich with with electrolyte (e.g. Gatorade).
3. Administer IV fluids (e.g dextrose in normal saline glucose) as per doctors order.
4. Provide rest with calm and quiet environment.
1. Rapid repiratory rate leads to insensible fluid loss during exhalation.
2. To avoid dehydration.
3. May helps to provide fluids, calories and electrolytes.
4. To maintain electrolytes imbalance.
Patient is hydrated.
Encourage mother to continue full course of antibiotics.
Advise to increase activities gradually after fever subsides.
Encourage follow up chest x-ray. Increase steam inhalation. Keep away from allergic substances. Review principles of adequate nutrition and rest. Recommended influenza vaccine (pneumovac) to all
patients at risk. Refer patient for home care to facilitate adherence
to therapeutic regimen as indicated.
NURSING HEALTH TEACHING:
Patient relieved from signs and symptoms. Discharged
medications syrup Zinnat 125mg (6ml) BID. Neb ventolin 0.3ml +
2ml nss and neb pulmicort 0.5ml. Review after one week.
CONCLUSION:
BRUNNER AND SUDDARTHS. TEXT BOOK FOR MEDDICAL – SURGICAL NURSING 12TH EDITION.
LIPPINCOTT MANUAL OF NURSING PRACTICE 9TH EDITION
BIBLIOGRAPHY
