Case Study Case Study about about

Pneumonia withPneumonia withBronchial Bronchial AsthmaAsthma

I. Introduction:I. Introduction: This is a case of a 1 year old child This is a case of a 1 year old child

who was diagnosed who was diagnosed Pneumonia with Pneumonia with Bronchial Asthma.Bronchial Asthma.

Definition of PneumoniaDefinition of Pneumonia Definition of Bronchial AsthmaDefinition of Bronchial Asthma Etiologic AgentEtiologic Agent

II. Goals and II. Goals and ObjectivesObjectives

III. Client’s ProfileIII. Client’s ProfileA. Socio-demographic dataA. Socio-demographic data Patient X is a 1- year old Filipina female who is living with her family at Patient X is a 1- year old Filipina female who is living with her family at

Zone 1 Agusan, Cagayan de Oro City. Her religion is Roman Catholic. Zone 1 Agusan, Cagayan de Oro City. Her religion is Roman Catholic. She has no allergies reported. Patient has a Pneumonia, Bronchial She has no allergies reported. Patient has a Pneumonia, Bronchial Asthma.Asthma.

Patient X was admitted last February 9, 2010 at NMMC-P3F3 Pediatric Patient X was admitted last February 9, 2010 at NMMC-P3F3 Pediatric Respiratory Ward because of having an onset productive cough Respiratory Ward because of having an onset productive cough associated with fever. With that, patient X was admitted.B. associated with fever. With that, patient X was admitted.B.

B. Vital signsB. Vital signs The patient vital signs are one of the most important data that should be The patient vital signs are one of the most important data that should be

given a direct attention because it will serve as basis in determining any given a direct attention because it will serve as basis in determining any risk factors towards the patient. The increase and decreased of the vital risk factors towards the patient. The increase and decreased of the vital sign of the patient must be monitored in order to determined whether the sign of the patient must be monitored in order to determined whether the patient is at risk or not.patient is at risk or not.

The patient had the following vital signs upon admission: PR- 165 bpm ; The patient had the following vital signs upon admission: PR- 165 bpm ; RR- 68 cpm; and temp- 36.5°C .RR- 68 cpm; and temp- 36.5°C .

IV. Physical AssessmentIV. Physical Assessment Health perception and management pattern (pre-Health perception and management pattern (pre-

hospitalization)hospitalization) Nutrition-Metabolic Pattern (MGH – still in)Nutrition-Metabolic Pattern (MGH – still in) Elimination pattern (pre-hospitalization)Elimination pattern (pre-hospitalization) Activities of daily living (ADL) (pre-hospitalization)Activities of daily living (ADL) (pre-hospitalization) Self-perception and self-concept pattern (while confined)Self-perception and self-concept pattern (while confined) Activities Tolerance-Exercise pattern (while confined)Activities Tolerance-Exercise pattern (while confined) Sleep rest pattern (while confined)Sleep rest pattern (while confined) Cognitive-Perception (while confined)Cognitive-Perception (while confined) Role-Relationship Pattern (while confined)Role-Relationship Pattern (while confined) Values – Belief PatternValues – Belief Pattern

V. Neurological AssessmentV. Neurological Assessment Appropriate behavior/communication Appropriate behavior/communication

CryingCrying Emotional State Emotional State AnxiousAnxious SkinSkin

General ColorGeneral Color

PallorPallor EyesEyes

ConjunctivaConjunctiva PalePale

MouthMouth LipsLips

PallorPallor Respiratory StatusRespiratory Status

Breathing PatternBreathing PatternIrregular (68 cpm- tachypnea)Irregular (68 cpm- tachypnea)

Breath SoundsBreath SoundsWheezing during expirationWheezing during expiration

VI. Anatomy and PhysiologyVI. Anatomy and Physiology

ORGANS OF THE RESPIRATORY ORGANS OF THE RESPIRATORY SYSTEMSYSTEM

THE UPPER RESPIRATORYTHE UPPER RESPIRATORY NOSENOSE NASAL CAVITYNASAL CAVITY PHARYNXPHARYNX

THE LOWER RESPIRATORYTHE LOWER RESPIRATORY LARYNXLARYNX BRONCHIAL TREEBRONCHIAL TREE LUNGSLUNGS

VII. VII. PATHOPHYSIOLOGY PATHOPHYSIOLOGY

OF PNEUMONIA OF PNEUMONIA WITH BRONCHIAL WITH BRONCHIAL

ASTHMAASTHMA

VIII. Laboratory Test ResultsVIII. Laboratory Test Results HemoglobinHemoglobin

11.2g/dl(12.0-16.0)11.2g/dl(12.0-16.0) Low Hgb suggest an anemia. Anemia can be due to nutritional deficiencies, Low Hgb suggest an anemia. Anemia can be due to nutritional deficiencies,

blood loss, destruction of blood cells internally, or failure to produce blood in blood loss, destruction of blood cells internally, or failure to produce blood in the bone marrow.the bone marrow.

HematocritHematocrit 35.8%(37.0-47.0)35.8%(37.0-47.0) Low Hct suggests an anemia.Low Hct suggests an anemia.

MCVMCV 62.9fL(82.0-98.0)62.9fL(82.0-98.0) Low MCV may indicate microcytic anemia.Low MCV may indicate microcytic anemia.

MCHMCH 19.7pg(27.0-31.0)19.7pg(27.0-31.0) Low MCH may indicate microcytic anemia.Low MCH may indicate microcytic anemia.

MCHCMCHC 31.3g/dL(31.5-35.0)31.3g/dL(31.5-35.0) It is below the normal range but may indicate anemia.It is below the normal range but may indicate anemia.

Differential CountDifferential Count LymphocyteLymphocyte

74.8%(17.4-48.2)74.8%(17.4-48.2) High lymphocyte compensates to fight the bacteria found in the body.High lymphocyte compensates to fight the bacteria found in the body.

NeutrophilNeutrophil 10.9%(43.4-76.2)10.9%(43.4-76.2) Low neutrophil indicates that the patient is vulnerable to infection Low neutrophil indicates that the patient is vulnerable to infection

thus, she may acquire viral and or bacterial acquired condition easily.thus, she may acquire viral and or bacterial acquired condition easily. MonocyteMonocyte

12.6%(4.5-10.5)12.6%(4.5-10.5) High monocyte may indicate bacterial infection.High monocyte may indicate bacterial infection.

EosinophilsEosinophils 0.4%(1.0 – 3.0)0.4%(1.0 – 3.0) It is below normal range that may suggest asthma.It is below normal range that may suggest asthma.

IX. NURSING IX. NURSING CARE PLANCARE PLAN

X. DRUG STUDYX. DRUG STUDY

Zinc SulfateZinc Sulfate SalbutamolSalbutamol CefuroximeCefuroxime Ipratropium BicarbonateIpratropium Bicarbonate ParacetamolParacetamol HydrocortisoneHydrocortisone

XI. Discharge PlanningXI. Discharge Planning MM-edication to take-edication to take EE-xercise-xercise TT-reatment-reatment HH-ygiene-ygiene OO-ut patient follow up-ut patient follow up DD-iet-iet

XII. HEALTH TEACHINGXII. HEALTH TEACHINGThe best way to control this is prevention.The best way to control this is prevention. Teach the family about the management required for the disorder.Teach the family about the management required for the disorder. Keep your environment clear of potential allergens.Keep your environment clear of potential allergens. Pay attention to the weather and take precautions when you know weather or air pollution Pay attention to the weather and take precautions when you know weather or air pollution

conditions may affect you. You may need to stay indoors or limit your exercise to indoor conditions may affect you. You may need to stay indoors or limit your exercise to indoor activities.activities.

Be smart about exercise.Be smart about exercise. Encourage significant others to do chest tapping to facilitate mobilization of secretion.Encourage significant others to do chest tapping to facilitate mobilization of secretion. Encourage to change patient's position regularly to facilitate drainage and mobilization of Encourage to change patient's position regularly to facilitate drainage and mobilization of

secretion.secretion. Encourage to provide well ventilated area.Encourage to provide well ventilated area. Instruct to give medications at the right route, dose, and time.Instruct to give medications at the right route, dose, and time. Remind significant others to always assess to patient needs.Remind significant others to always assess to patient needs. Instruct significant others to keep child always clean and dry.Instruct significant others to keep child always clean and dry. Advise to go to the physician if signs and symptoms of pneumonia and bronchial asthma are Advise to go to the physician if signs and symptoms of pneumonia and bronchial asthma are

observed.observed. Teach the folks the importance of monitoring the progress and compliance with the treatment Teach the folks the importance of monitoring the progress and compliance with the treatment

regimen.regimen. Patient needs health promotions activities and health screening.Patient needs health promotions activities and health screening. Emphasize to the significant others the importance of having regular check-up to know her Emphasize to the significant others the importance of having regular check-up to know her

present condition.present condition.

XIII. LEARNING XIII. LEARNING EXPERIENCEEXPERIENCE

THANK THANK YOU!!!!YOU!!!!