Case of Group 55 (BPN)

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I. Introduction

Pneumonia, an inflammation of the pulmonary parenchyma, is common in childhood, occurring more frequently in infancy and early childhood. Clinically, pneumonia may occur either as a primary disease or as a complication of another illness. A report published by UNICEF in cooperation with the World Health Organization, in 2006 has identified pneumonia as the forgotten killer of children. According to the report, pneumonia kills more children than any other illness more than AIDS, malaria and measles combined. Over 2 million children die from pneumonia each year, accounting for almost 1 in 5 underfive deaths worldwide. Yet, little attention is paid to this disease. Pneumonia can be classified according to morphology, etiologic agent, or clinical form. According to morphology, there are three types: Lobar pneumonia, Bronchopneumonia or Interstitial pneumonia. In this case, the study will be all about bronchopneumonia, where it begins in the terminal bronchioles which become clogged with mucopurulent exudate to form consolidated patches in nearby lobules. Another way to classify it is based on the etiologic agent. It may be caused by a virus, bacteria, mycoplasm or aspiration of foreign substances. The causative agent is usually introduced into the lungs through inhalation or from the bloodstream. In the whole case, it will deal about bacterial pneumonia, the causative agent of the bronchopneumonia of the patient. Bacterial pneumonia is often a serious infection. The pathogenetic mechanisms involved are often aspiration or hematogenous dissemination. The cause varies depending on the childs age, underlying illness, and degree of immunosuppression or immunocompetence. In the 3-month to 5-year age group, Streptococcus pneumoniae, Moraxella catarrhalis, and Group-A streptococci are common causes. Haemophilus influenzae

type b is causing fewer infections because of the Hib vaccine. Staphylococcus aureus pneumonia is also now rarely seen in infants and toddlers. Mycoplasma pneumoniae and S. pneumoniae are the dominant organisms in children over 5 years of age. The clinical manifestations of pneumonia vary depending on the etiologic agent, the childs age, the childs systemic reaction to the infection, the extent of the lesions, and the degree of bronchial and bronchiolar obstruction. For bacterial pneumonia, clinical manifestations are fever and toxic appearance. Infants and young children develop more severe symptoms than older children. Respiratory distress may or may not be present. In some cases, the only finding is an increased respiratory rate.

II. Nursing Process

A. ASSESSMENT

1. Personal History Mother Bear mentioned that she gave birth via normal spontaneous delivery without any complications at full term assisted by a midwife in the hospital. She was not picky on the foods she eats during her pregnancy, she will eat whatever food is available in their home and according to the mother, she usually have her prenatal check up at the barangay health center. Feeding Baby bear was breastfed right after he was born, until now. Immunization Status Baby bear had a complete immunization for his age. He had received 1 dose of BCG, 1 dose of DPT, 1 OPV, HepaB.

Growth and Development Erik Erikson (Theory of Trust and Mistrust) Infancy- 0-1 year old This is the period of The infant would be The infant failed to Currently, baby bear infancy through the able to gain a sense develop a sense of is within this Trust first one or two of trust her with his trust with his vs. Mistrust stage. of parents, This crying is after years of life. The parents, particularly parents, particularly As observed, he is mother the mother because capable basic with failure his Normal Response Untoward Response Clients response

child, well - handled, with

nurtured, and loved, because they are they are not able to developing his trust develops trust and able to meet their provide security and a basic responsibility optimism. handled, becomes and mistrustful. Badly provide he comfort, to support to especially with his mother. stops mother. evident when Baby being cuddled by his

warmth, meet infants needs. security,

insecure sensory stimulation, food to the infant.

Sigmund Freud (Psychosexual Theory-Oral Stage) Birth to 1 year old

Normal Response

Untoward Response

Clients Response

During this stage, the The baby exhibits The child's main focus is concern suckling Pleasure gratification and for the unable around the rooting and gratification self- oral stimuli

child to

is Baby bear is able elicit to demonstrate and from activities such as in swallowing. like

that gratification as passive by activities

reflex. can be felt from oral stimuli and is sucking are evidenced

acquired by the mouth. pleasure from is sucking, Because a sense of eating. The child swallowing satisfaction acquired is during

biting, and of

being also engages in manipulating this activities like various and of parts biting, the mouth.

stage, it also leads to a sucking, sense of trust for the swallowing infant.

manipulating various parts the mouth.

2. Family Health Illness History

3. History of Past and Present Illness Past Illness: This is babys first hospitalization diagnosed with bronchopneumonia. He never had any mild or severe past illness. He hasnt developed any signs and symptoms prior to asthma, although his family had a history of it. Present Illness: The patient is diagnosed with bronchopneumonia. He was admitted on November 10, 2009. The patient experienced fever and cough last November 6, 2009. However, mama thought that it is just a common colds and fever so she gave paracetamol (tempra) for medications. But then on November 10, 2009 the patient experienced difficulty of breathing and cyanosis. He was then rushed and admitted to Mabalacat District Hospital. Due to the observed signs and symptoms manifested by the patient, and after laboratory diagnosis was done, the doctor suspected that he has Bronchopneumonia. 4. Physical Examination (IPPA- Cephalocaudal approach) November 10, 2009 (Admission)

With complaint of difficulty of breathing (+) rales

Vital signs: T: 39.6 C P: 173 bpm R: 78 bpm

November 12, 2009 (First Nurse-Patient-Interaction 3-11 shift) The baby is wearing white layette and pajamas, does not wear socks, mittens or bonnet to protect him from cold. Vital Signs: T= 37.9 C P= 144bpm R= 78bpm I. Integument Skin: Has a fair complexion, the texture of skin is smooth; with normal skin turgor. Nails: With dirty long fingernails, convex curve in shape, with smooth texture. Performed blanch test, capillary refill return in usual color for a less than 2 seconds. II. Head: Hair: Evenly distributed, with thin straight hair, no presence of infestation, the color of the hair is black. Skull: Round, normocephalic and normal contour with frontal, parietal and occipital prominences, smooth skull contour, with no masses, depression, and nodules noted. Scalp: The color of his scalp is slightly brown, no presence of lesions III. Eyes: Eyebrow & Eyelashes Black in color, skin intact, evenly distributed and symmetrically aligned, the eyelashes are slightly curled outward, eyelids closes symmetrically, pinkish conjunctiva, pupils equally round and reactive to light accommodation that is when the penlight introduced the pupil constricted and vice versa, iris black in color

IV. Ears External: Symmetrically distributed, auricle aligned with outer canthus of the eye Internal: Absence of cerumen on both ears and no lesions noted. V. Mouth and Throat

No presence of sores noted No lesions and masses noted Lips - pinkish in color Gums and tongue - pinkish color

VI. Nose

Presence of clear nasal discharges and with no presence of nodules noted.

VII. Neck

No enlargement of lymph nodes Has coordinated movement.

VIII. Chest & Lungs:

Skin in chest is free of lesions; rales heard on both lung fields upon

auscultation. IX. Heart

Normal cardiac rate.

X. Abdomen

Skin integrity with uniform color, with no presence of masses, without

abdominal distention XI. Extremities

Hair is evenly distributed on both upper and lower extremities; the legs are

proportion to the body, and with no presence of masses.

November 13, 2009 (Second Nurse-Patient-Interaction 3-11 shift) The baby was wearing white layette and pajamas. He was not wearing socks, mittens or bonnet to protect him from cold. Vital Signs: T= 36.8 C P= 140 bpm R= 78 bpm I. Integumentary Skin: Has a fair complexion, the texture of skin is smooth, with normal skin turgor. Nails: With clean fingernails, convex curve in shape, with smooth texture. Performed blanch test, capillary refill return in usual color for less than 2 seconds. II. Head: Hair: Evenly distributed, with thin straight hair, the color of the hair is black. Skull: Round, normocephalic and normal contour with frontal, parietal and occipital prominences, smooth skull contour, with no masses, depression, and nodules noted. Scalp: The color of his scalp is slightly brown, no presence of lesions, with no dandruff noted. III. Eyes: Eyebrow & Eyelashes Black in color, skin intact, evenly distributed and symmetrically aligned, the eyelashes are slightly curl, eyelids closes symmetrically, pinkish conjunctiva, pupils equally round and reactive to light accommodation that is when the penlight introduced the pupil constricted and vice versa, iris black in color

IV. Ears External: Symmetrically distributed, auricle aligned with outer canthus of the eye Internal: Absence of cerumen on both ears and no lesions noted. V. Mouth and Throat

No presence of sores noted No lesions and masses noted L