(BRONCHOPNEUMONIA WITH DOWN SYNDROME)

NCH RESPI-WARD

INTRODUCTION: STATISTICS

WORLDWIDE*WHO: “150 million cases of pneumonia occur

annually among children younger than 5 years old.”   PHILIPPINES*DOH: “829 cases of pneumonia per 100,000 occur

annually among children younger than 5 years old.”

PERSONAL DATA:

 NAME: Baby RN ADDRESS: Crame, San Juan AGE: 1 year/ 9 mos. GENDER: Male DATE OF ADMISSION: Nov. 17, 2011 (12:45pm) Thursday CHIEF COMPLAINT: dry cough, colds, fever

DIAGNOSIS: BPN. Mod. Distress w/ down syndrome

HEALTH HISTORYPAST HEALTH HISTORY:Baby RN has Down syndrome before he is diagnosed to have

bronchopneumonia. PRESENT HEALTH HISTORY:3 days PTA: dry cough, colds, fever, irritability FAMILY HEALTH HISTORY:The parents of the patient have no family illness and anomalies (as

interviewed)

COURSE IN THE WARD:MGH (no IV, no medication, no oxygen support)

Activity of Daily Living:

Day1 Day2

Nutrition:

-breastfeed Good at sucking (lactating mother)

Good at sucking (lactating mother)

-lunch Good at sucking (lactating mother)

Good at sucking (lactating mother)

-dinner Good at sucking (lactating mother)

Good at sucking (lactating mother)

Sleep pattern:

-hrs. of sleep 9 to 10 hrs. 9 to 10 hrs.

Elimination:

-urine 1 1

-stool 1 2

PHYSICAL ASSESSMENT:

ASSESSSING THE SKULL AND FACE (inspection method)

ASSESSMENT FINDINGS

Size, shape and symmetry Rounded and symmetrical

Nodules and masses No nodules and masses

Facial features Symmetrical features

Facial grimace Slightly irritated and shows discomfort

ASSESSING THORAX (inspection method)ASSESSMENT FINDINGS

Shape and symmetry Chest symmetrical

Spinal alignment (posterior) No deformities

Breathing pattern (anterior) Rhythmic, fast (tachypnea-31bpm)

ASSESSING PERIPHERAL VASCULAR SYSTEM (upon touching the patient while taking vital

signs)

ASSESSMENT FINDINGS

Peripheral pulses Symmetric pulse volumes

Peripheral perfusions Skin: not cold or warm, moisture

Capillary refill test Immediate return of color, no cyanosis

NEUROLOGIC ASSESMENT:

LEVELS OF CONCIOUSNESS

NURSING CARE DONE LOC

VS checking (8:00 am and 12:00 NN)

Alert, oriented, awake

Morning care (8:30 am) Alert, oriented, awake

DOWN SYNDROME : TRISOMY 21(ABNORMAL FINDINGS)

Legend:-not able to observe (NA)-observed (O)-not observed (NO)

INTRODUCTION OF THE DISEASE:

Bronchopneumonia:- type of pneumonia that is characterized by an

inflammation of the lung due to infection- localized in the bronchioles (first airway

branches) and surrounding alveoli (tiny air sacs act as the primary gas exchange units of the lung)

ANATOMY AND PHYSIOLOGY:

PATHOPHYSIOLOGY:

•aspirstion of Streptococcus pneumoniae•adherence to alveolar walls

•inflammatory response•damage to lung parenchyma (bronchioles,alveoli)

PREDISPOSING AND PRECIPITATING FACTORS:

*PREDISPOSING FACTORS:-Malnutrition-Place of residence

*PRECIPITATING FACTORS:-Heredity 

COMPLICATIONS:

1.)Empyema: is a collection of pus within a naturally existing anatomical cavity, such as the lung pleura.

2.)Pleurisy: is an inflammation of the pleura, the lining of the pleural cavity surrounding the lungs.

3.)Lung Abscess: necrosis of the pulmonary tissue and formation of cavities

4.)Pericarditis: is an inflammation of the pericardium (the fibrous sac surrounding the heart).

LABORATORY EXAMINATION:

LABORATORY TESTS RESULT NORMAL COUNT REMARKS

1.) CBC -hemoglobin: 125-hematocrit: 0.37-red blood cell count: 4.00-white blood cell count: 14.41-hetotrophils: 0.80-lymphocytes: 0.19-monocyte: 0.01

PLATELET ADEQUATE

2.) PLATELET 314 150 to 450

3.) xray N/A N/A N/A

NCP: BRONCHOPNEUMONIAASSESSMENT

NURSING DIAGNOSIS

RATIONALE PLANNING INTERVENTION

RATIONALE EVALUATION

*SUBJECTIVE CUES: “Inuubo at sinisipon” as verbalized by the patients mother. *irritability *OBJECTIVE CUES: *VS: -temp.37 ° C-CR 167bpm-RR 28bpm

*ineffective breathing pattern r/t BPN as manifested by dry cough and colds

“nurse pocket guide” (12th edition) By: Doonges and Murmur

After 30 mins. to 1hr. of nursing interven-tion: -normal:VS -decrease: irritability -relieved:Dry cough and colds

*increase fluid intake: -water therapy-citrus fruits *complete rest and sleep *keep environment clean

*to strengthen immune system * to facilitate comfort and decrease irritability *to avoid virus and bacteria

Within 30 mins. To 1hr. of rendering nursing intervention: Goal met! *vital signs:NORMAL *pan scale of 2-10 * irritability:Relieved *dry cough and colds: relieved

NCP: DOWN SYNDROMEASSESSMENT

NURSING DIAGNOSIS

RATIONALE

PLANNING INTERVENTION

RATIONALE

EVALUATION

*SUBJECTIVE CUES: “special child ang anak ko at napansin ko ito mula nung mag iisang taon na siya”As verbalized by the patients mother *OBJECTIVE CUES: -facial grimace:Irritability,Discomfort,Stress,Anxiety

*alterations on the mood of the patient r/t down syndrome as manifested by Irritability,DiscomfortStress,Anxiety

“fundamental of nursing” KOZIER&ERBS 8th edition, vol.1

After 30 mins. of nursing interven-tion: *decreased: irritability, discomfort, anxiety and stress of the patient *establish rapport and therapeutic relationship to the patient

*play with the patient and let him feel that he can trust you and you understand him and his situation

*establishing rapport and therapeutic relationship will decrease the patients feeling of Irritability,DiscomfortStress,Anxiety

Within 30 mins. Of rendering nursing intervention: Goal met! *patients irritability, discomfort, anxietyand stress is relieved

DRUG STUDY:

GENERIC NAME BRAND NAME CLASSIFICATION CONTRA-INDICATIONS

SIDE EFFECTS

Cefuroxime Axetil

cefurox ANTI INFECTIVES hypersensitivity Skin rash, urticuria, fever, GI disturbance, nausea and vomitting

INDICATIONS NURSING RESPONSIBILITY

Treatment against: -H.influenzae-S.aureus-S.pneumoniae-Klebsiella spp.

if given to pregnant and lactating women: *may cause bleeding

DISCHARGE PLANNING:M-medications*Dependent intervention: physicians orderE-exercise and environment*Exercise: N/A*Environment: keep the patient away from smoky and duty areaT-treatment*Dependent intervention: physicians order*Home-based care: cleaning the surroundingsH-health teachings*Explain the common causes of the disease and how it is acquired and how to avoid it.O-out patient*MGH*consult a doctor again if there are complications and problems encounteredD-diet*Nutritious foods: vegetables, fruits, vitamin c supplementS-spiritual*Emotional support for the family of the patient

REFERENCES:

1. Seeley’s Principle of Anatomy and Physiology 2. The Filipino Doctor’s Drug Guide 10th edition (2011) 3. Nanda 2009 4. www.wikipedia.com

5. www.allnurses.com

THANK YOU!!!GOOD DAY