SACRED HEART MEDICAL CENTER

ANGELES CITY

A CASE STUDY ENTITLED

“BRONCHOPNEUMONIA RIGHT LOBE”

Submitted By:

Bundalian, Kim T.

Forte, Rachelle

Almario, Camille Dawn

Yamat Peejay

I. OBJECTIVES

Goal: After this case study we will be able to know what Bronchopneumonia is, how its acquired and prevented, its prevention and treatment of the occurrence of brnochopneumonia

After the discussion of this case study you will be able to: Fully understand the anatomy and physiology of the respiratory tract

Comprehensively understand the disease process

Provide prompt and appropriate interventions to alleviate the condition

Make a plan of care intended for the noted problems

Impart health teachings on the management of signs and symptoms and the prevention of recurrence of BPN.

II. EPIDEMIOLOGY

Respiratory-related illness is a common disease worldwide. These types of diseases are present in varied types, one of which is Bronchopneumonia (BPN). Globally speaking, BPN affects a significant number of people. According to the Center for Disease Control and Prevention, pneumonia kills more than 4 million people every year – half of these deaths occur among children less than 5 years of age. This is greater than the number of deaths from any other infectious disease, such as AIDS, malaria or tuberculosis. The WHO Child Health Epidemiology Reference Group estimated the median global incidence of clinical pneumonia to be 0.28 episodes per child-year. This equates to an annual incidence of 150.7 million new cases, of which 11-20 million (7-13%) are severe enough to require hospital admission. Ninety-five percent of all episodes of clinical pneumonia in young children worldwide occur in developing countries. Although the diagnosis is usually made on the basis of radiographic findings in developed countries, the World Health Organization (WHO) has defined pneumonia solely on the basis of clinical findings obtained by visual inspection and timing of the respiratory rate.

III. Demographic Data:

a. Personal History

We as a group decided to give a code name to patient which is Gangnam. Mr. Gangnam is 57 year old male American born at United States of America. He is divorced with no children. He has a business in America however he decided to live here in the Philippines. At present, he and his newly partner which is a Filipina reside at Doña Maria Subdivision Angeles City. He is a Roman Catholic.

b. Socio – Economic and Cultural Factors

Mr. Gangnam is a Businessman. He stays with his newly partner lives in Doña Maria Subdivision Angeles City. He lives in an urban area wherein pollution is present due to some commercialize area or structure. .

He drinks alcoholic beverages and smoke occasionally. He loves to eat fruits, beef, fish and vegetables. He also likes to eat junk foods, processed foods and soda. His daily routine was eating, watching TV and surfing the net. He also works in the computer to monitor his business in America. He usually sleeps late due to sleeping problem. Mr. Gangnam finishes colleges with a business degree course and had a business in America wherein its income came from.

When it comes to beliefs and practices, Mr. Gangnam doesn’t believe because he believe that if there is unusual occurrence of an illness it should be directly consult to a professional so that this incidence would not be worst and can be prevented. There source of water was come from a Mineral water and they have a close drainage. There garbage was collected twice every week by a Truck accompanied by a garbage collector.

C. Pertinent Family History

Mr. Gangnam is currently in a cohabitating relationship living with his newly Filipina partner. She doesn’t have any family member living with him

On his mother side his grandmother died because of unknown causes also with grandfather died of unknown reason. The father and mother of Mr. Gangnam also died of unknown reasons or due to old age. His parents had a total of 4 children and he is the 3rd eldest; his siblings composed of 2 females and 2 males. His siblings are still alive at present and don’t have any known disease condition.

Mother Side Father Side

Broken lines – no longer living Full lines - living

Grandmother

(Unknown)

Grandfather

(Unknown)

Grandfather

(Unknown)

Grandmother

(Unknown)

Father (unknown)

Sibling 2Sibling 1 Gangnam

Bronchopneumonia Right Lobe

Sibling 3

Mother (unknown)

IV. History of Past and Present IllnessHistory of Past Illness:

Mr. Gangnam doesn’t have any past surgical procedure. He mentioned that he usually had past symptoms of cough, colds, and fever. He usually takes over the counter medication such as Paracetamol, nasal decogensatant and antitusive. But if symptoms worsen, he usually consults to a medical professional. Also he mentioned that he doesn’t have any allergies to any substances. On September 4, 2012 he has past admission to SHMC due to shortness of breath and continuous coughing and discharge last September 6, 2012.

History of Present Illness:

4 days prior to admission there is presence of continuous coughing, shortness of breath, presence of loss of appetite and presence of body malaise.

On September 10, 2012 at 8pm Mr. Gangnam was rush to the Emergency room of SHMC due to shortness of breath and continuous coughing. He was initially provided an oxygen inhalation and nebulization to ease the shortness of breath. Also he was given Furosemide ampoule so that to lower down the blood pressure which is 160/70. Mr. Gangnam was somewhat relieved but doctors decided to admit the patient to continuously monitor the condition of patient.

Physical Examination

September 10, 2012 (As lifted from chart)Vital Signs as follows:Temperature: 36.50 CPR: 73 bpmRR: 23cpmBP: 160/70Weight: 210 lbsHEENT: (+) pink palpebral conjunctivaChest & Lungs: (+) symmetrical chest expansion, (+) harsh breath soundsHeart: (-) murmurAbdomen: soft, (+) bowel soundGenitalia: (-) lesionsExtremities: (-) edema

September 12, 2012 Nurse Patient InteractionGeneral Appearance: Upon the interaction, the patient is irritable and there is presence of loss of energy due to continuous coughing. In addition patient verbalizes shortness of breathing.Vital signs as follows:Temperature: 36.20 CPR: 82 bpmRR: 24 cpm

BP: 110/80Integumentary:

a. Skin: with pink palpebral conjunctiva, with good capillary refill time of less than 3 seconds, with good skin turgor

b. Hair: black in color, combed, equally distributed, without liceHead and Face:

a. Scalp: smooth, no evidence of tenderness, flaking, scaling and redness/open lesionsb. Skull: normocephalic, no abnormal depression/elevationc. Face: symmetrical in shape with appropriateness of facial expression,

Eyes:a. General: symmetrical, with no presence of lesionsb. Eyebrows: equal distribution of hairc. Eyelids and eyelashes: symmetrical in shape, hair is evenly distributedd. Pupils: equal size, Pupil equally round reactive to light and Accommodation( PERRLA)e. Sclerae: white in color, no jaundice

Ears:a. General: both symmetrical in shape, same level with outer canthus of the eye,

Nose: a. General: not deviated, symmetrical nares, no bleeding, no exudates

 Mouth and Throat:a. Mouth: no lesion, pinkish gumb. Tongue: no lesionsc. Buccal Mucosa: moist, pinkish in color

Neck: a. General: no masses

Chest:a. General: Symmetrical chest expansionb. Respiration: shallow breathing due to continuous coughing, difficulty of Breathingc. Lungs: with harsh breath sounds

Gastrointestinal:a. Abdomen: no distention, with bowel movement,

Body Mass indexPatient’s Height: 5’5’’Weight: 210 lbsBMI-34.9 The patient’s weight is heavily overweight

V. ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY SYSTEM

Man can survive without food and water for about three days or more , but if he stops breathing for 3 to 5 minutes he will immediately die .  From this point the importance of the respiratory tract in our bodies comes.  All organs in the human body need oxygen in their metabolism and carbon dioxide to be removed from their tissues as a waste product and the respiratory tract is responsible to perform this function.  In this essay we will look at the structure and function of the respiratory tract.

The primary function of the respiratory system is gas exchange—delivering oxygen (O2) from the environment to the tissues and removing carbon dioxide (CO2) from the tissues. Generally, the respiratory system acts as a servant to the rest of the body by delivering enough O2 and removing sufficient CO2 for metabolic demands. As O2 demand increases, the body responds with a variety of mechanisms to ensure an adequate supply of O2. These physiologic mechanisms include the unique functions of several cell types in the lung, pulmonary circulation, mechanics of the respiratory system, transport of O2 and CO2 in blood, respiratory gas exchange, and coordination of all of these mechanisms by the respiratory control system.

Respiratory System, in anatomy and physiology, organs that deliver oxygen to the circulatory system for transport to all body cells. Oxygen is essential for cells, which use this vital substance to liberate the energy needed for cellular activities.

While the intake of oxygen and removal of carbon dioxide are the primary functions of the respiratory system, it plays other important roles in the body. The respiratory system helps regulate the balance of acid and base in tissues, a process crucial for the normal functioning of cells. It protects the body against disease-causing organisms and toxic substances inhaled with air. The respiratory system also houses the cells that detect smell, and assists in the production of sounds for speech.

The upper respiratory tract consists of the nose and the pharynx, or throat. The lower respiratory tract includes the larynx, or voice box; the trachea, or windpipe, which splits into two main branches called bronchi; tiny branches of the bronchi called bronchioles; and the lungs, a pair of saclike, spongy organs. The nose, pharynx, larynx, trachea, bronchi, and bronchioles conduct air to and from the lungs. The lungs interact with the circulatory system to deliver oxygen and remove carbon dioxide. In addition, there are some muscles helping in the respiratory movements which are the intercostal muscles and the diaphragm.

 

The

upper respiratory tract:

1- The nose and the nasal cavity :

 The nose forms the visible part of the upper tract which has two external openings (the nostrils). The flow of air from outside of the body to the lungs begins with the nose, which is divided into the left and right nasal passages. The nasal passages are lined with a membrane composed primarily of one layer of flat, closely packed cells called epithelial cells. Each epithelial cell is densely fringed with thousands of microscopic cilia, fingerlike extensions of the cells. Interspersed among the epithelial cells are goblet cells, specialized cells that produce mucus, a sticky, thick, moist fluid that coats the epithelial cells and the cilia. Numerous tiny blood vessels called capillaries lie just under the mucous membrane, near the surface of the nasal passages. While transporting air to the pharynx, the nasal passages play two critical roles: they filter the air to remove potentially disease-causing particles; and they moisten and warm the air to protect the structures in the respiratory system. Moreover , the nasal cavity includes paranasal sinuses which produce mucus, maintain sound and lighten the skull.

Coarse hairs found just inside the nostrils of the nose trap airborne particles as they are inhaled. The particles drop down onto the mucous membrane lining the nasal passages. The cilia embedded in the mucous membrane wave constantly, creating a current of mucus that propels the particles out of the nose or downward to the pharynx. In the pharynx, the mucus is swallowed and passed to the stomach, where the particles are destroyed by stomach acid.

In addition to their role in the respiratory system, the nasal passages house cells called olfactory receptors, which are involved in the sense of smell. When chemicals enter the nasal

passages, they contact the olfactory receptors. This triggers the receptors to send a signal to the brain, which creates the perception of smell.

2- The pharynx :

 The pharynx is a muscular tube serving to connect the nasal cavity and the mouth with the lower respiratory tract and the esophagus.  the pharynx is lined with a protective mucous membrane and ciliated cells that remove impurities from the air. In addition to serving as an air passage, the pharynx houses the tonsils, lymphatic tissues that contain white blood cells. The white blood cells attack any disease-causing organisms that escape the hairs, cilia, and mucus of the nasal passages and pharynx. The tonsils are strategically located to prevent these organisms from moving further into the body. It is divided into three parts: the nasopharynx, the oropharynx and the laryngopharynx.

 The lower respiratory tract:

1- The larynx :

 The larynx, also known as voice box, lies between the pharynx and the trachea.  The larynx is made up mainly of cartilages. . It plays a primary role in producing sound; it prevents food and fluid from entering the air passage to cause choking by allowing air to pass from the glottis which closes during swallowing; and its mucous membranes and cilia-bearing cells help filter air. The cilia in the larynx waft airborne particles up toward the pharynx to be swallowed.

2- The trachea :

The trachea is a tube beginning from the edge of the larynx and divides into two bronchi which continue into the lungs.   The trachea is formed of 15 to 20 C-shaped rings of cartilage. The sturdy cartilage rings hold the trachea open, enabling air to pass freely at all times. The open part of the C-shaped cartilage lies at the back of the trachea, and the ends of the “C” are connected by muscle tissue. The trachea allows air to pass from the larynx to the bronchi and then to the lungs. The trachea is lined with mucus membranes and with ciliated cells which are responsible for removing dirt particles from air before it enters the lungs.

3- The bronchi :

The trachea branches into two tubes, the left and right bronchi, which deliver air to the left and right lungs, respectively. Within the lungs, the bronchi branch into smaller tubes called bronchioles. The bronchi divide into smaller bronchioles which branch in the lungs forming passageways for air.   The bronchioles divide many more times in the lungs to create an impressive tree with smaller and smaller branches, some no larger than 0.5 mm (0.02 in) in diameter. These branches dead-end into tiny air sacs called alveoli. The alveoli are the functional units of the lungs and they form the site of gaseous exchange. The alveoli deliver oxygen to the circulatory system and remove carbon dioxide.

Interspersed among the alveoli are numerous macrophages, large white blood cells that patrol the alveoli and remove foreign substances that have not been filtered out earlier. The macrophages are the last line of defense of the respiratory system; their presence helps ensure that the alveoli are protected from infection so that they can carry out their vital role.

4- The lungs:

 The lungs are located in the thoracic cavity and they are covered with the pleural membranes.   The right lung has three lobes, while the left lung has two lobes only. The lungs include the bronchi, the alveoli, connective tissues, blood vessels, lymph vessels and nerves. 

The lungs are enveloped by a thin layer of mesothelial cells referred to as the pleura. This membrane is analogous to the pericardium, which covers the heart, and the peritoneum, which covers the intraabdominal organs. The "visceral" layer covering the lungs is continuous with the "parietal" layer that covers the inner surface of the chest cavity. These two layers of pleura are separated by a thin layer of fluid, which amounts to less than 10 mL in the normal adult lungs. This fluid contains a population of mesothelial cells and significant concentrations of mucopolysaccharides, which acts as a lubricant for the smooth movement of the pleural layers against one another. Expansion of the chest wall is transmitted to the lung surface through the pleural surface, but this process can be interrupted if air or excess fluid enters the pleural compartment, thereby separating the visceral and parietal layers.

The lungs are the part of the respiratory tract responsible for respiration, since the exchange of gases takes place in them.  The lungs supply the heart with oxygenated blood through the pulmonary veins and take off the deoxygenated blood through the pulmonary arteries.  Moreover, the elastic properties of the lungs enable it to inhale and exhale the air.

 In addition, the respiratory tract has very important role in maintaining the pH of the body fluids.  There are also other functions of the respiratory tract which include coughing, sneezing, crying, laughing, hiccupping and snoring.

VI. Diagnostic Procedure

Diagnostic/Laboratory

Procedures

Date

Ordered

Date

result/s

Indication/s or

Purposes

Results Normal Values Analysis and Interpretation of

Results

Complete Blood Count

(CBC)

DO: 9-10-

12

DR: 9-10-

12

CBC provides

valuable information

about the blood and

blood-forming tissues

(especially the bone

marrow), as well as

other body systems.

Abnormal results can

indicate the presence

of a variety of

conditions-including

anemia, leukemia,

and infections-

sometimes before the

patient experiences

symptoms of the

a. Hemoglobin

9-10-12

9-10-12

disease.

Measur

es the total amount of

hemoglobin in the

blood to determine

the oxygen carrying

capacity of the blood.

A decrease number

of hemoglobin

signifies anemia and

for severe case,

hypoxia. While

increase hemoglobin

signifies dehydration.

129 (140-175 gm/L) There was a decrease in the result

due to bronchopneumonia. Since

there was an accumulation of

mucus in the bronchioles,

inadequate diffusion of oxygen

through the lungs to the

bloodstream happens.

Hemoglobin which is a main

component of RBC is responsible

for 98.5% of oxygen transported in

blood. And when there is

inadequate diffusion of oxygen,

there is reduction of oxygen that

binds in the hemoglobin which

results to the death of the RBC’s.

b. Hematocrit 9-10-12

9-10-12

Measures the

percentage of RBCs

in the blood volume.

A decrease in the

number or size of red

cells also decreases

the amount of space

they occupy,

resulting in a lower

hematocrit.

Conversely, an

increase in the

number or size of red

cells increases the

amount of space they

occupy, resulting in a

higher hematocrit.

0.36 (0.41-0.50) There was a decrease in the

result due to inadequate

oxygen. Without oxygen, RBCs

die.

c. WBC 01-25-10

01-25-10

Determine the

number of circulating

15.5 (5-10 x109/L) The result is elevated indicating an

infection as an inflammatory

WBCs in the blood.

An elevated WBC

count occurs in

infection, allergy,

systemic illness,

inflammation, tissue

injury, and leukemia.

A low WBC count

may occur in some

viral infections,

immunodeficiency

states, and bone

marrow failure. The

WBC count provides

clues about certain

illnesses, and helps

physicians monitor a

patient's recovery

from others. 

response.

d. RBC 01-25-10

01-25-10

To determine the

RBC level in the

blood

3.75 (4.2-5.4x1012/L) The result is below the normal

range, which indicates that there is

a problem with regards to the RBC

concentration and oxygen supply

of the patient. This is due to the

damage in blood cell production.

This may also be an indicator the

patient for anemia.

e. Lymphocytes 01-25-10

01-25-10

Produces antibodies

responsible for

allergic reactions. A

decrease in number

will signify a

decrease in the

production of

antibodies which

results to the inability

of the body to fight

foreign

microorganisms. In

an increase of

lymphocytes, this

0.58 0.22-0.40 The patient’s lymphocytes level is

increased. An indicative that there

is a presence of infection, which is

the bodies response to produce an

inflammatory response to fight the

infection.

indicates that there is

an infection within the

body. This is a

defense mechanism

of the body by which

the lymphocytes

produce antibodies to

fight the

microorganisms.

f. Platelet count To evaluate platelet

production.

When platelets are

low, it may take

longer for the blood

to clot. When platelet

counts are too high,

unnecessary blood

clots may occur.

280 150-400x10 12/L Platelet count is within normal

range that suggests lower chances

of bleeding tendencies.

Nursing Responsibilities

Prior to Procedure:

Explain the procedure to the patient and value of the test for planning patient’s care.

Tell the patient what to expect (especially pain or discomfort) in the procedure.

Inform the patient’s SO that there is no need to restrict fluid intake of the patient prior to the procedure.

Ask the patient to relax and do not move as the start of the procedure.

During the Procedure:

Perform the procedure using heparin zed capillary tube.

Insert the needle within 45° when penetrating the skin then 15° after the needle has been inserted in the vein.

Stabilize the syringe and draw blood carefully.

After the Procedure:

Ensure subdermal bleeding has stopped before removing the pressure.

If hematoma develops at the venipuncture site, apply warm soaks. If hematoma is large, monitor pulses distal to the

venipuncture site.

Send the sample to the laboratory immediately.

Notify the physician or the laboratory of medications the patient is taking that might affect the results; they may need to be

restricted.

Document the procedure and findings.

Diagnostic/

Laboratory

Procedures

Date Ordered

Date Result(s)

Indications

or

Purposes

Results Normal Values

Analysis and

Interpretation of

results

Arterial blood gas

pH

Date Ordered:

Sept. 10, 2012

Date Result:

Sept. 10, 2012

Test measures the

acidity (pH) and the

levels of oxygen

and carbon dioxide

in the blood from an

artery. This test is

used to check how

well the lungs are

able to move

oxygen into the

blood and remove

carbon dioxide from

the blood.

7.48 7.35-7.45 The patient blood

pH is alkalinic

because of

decreased

excretion of

Hydrogen.

His pCO2 level is

low thus making it

alkalinic and this

indicate that she

ishyperventilating.

pCO2

PO2

18mmHg

108mmHg

35-45mmHg

80-100mmHg

His PO2 level is increased. Elevated pO2 levels are associated with Increased oxygen levels in the inhaled air

His HCO3 is

decreased making

the blood acidic

thus indicating

metabolic acidosis

with partial

compensation.

The patient O2sat is

normal.

HCO3

O2 sat

13.3mEq/L

99%

22-26mEq/L

97%

The patient SO2 is

normal.

SO2 96% >94%

Nursing Responsibilities

Prior:

Assess the patient’s knowledge about the test.

Explain the patient that the test is used to detect an inflammation, infection, and anemia.

Tell the patient that a blood sample will be taken. Explain who will perform the venipuncture and when.

Explain to the patient that she may feel slight discomfort from the needle puncture and the tourniquet.

Inform the patient that she should avoid strenuous exercise for 24 hours before the test.

If the patient is being treated for an infection, advise her that this test will be repeated to monitor his progress.

Notify the laboratory and physician of medications the patient is taking that may affect test results; they may need to be

restricted.

During:

Adhere to standard precaution.

Post:

Apply direct pressure to the venipuncture site until bleeding stops.

If a hematoma develops at the venipuncture site, apply warm soaks. If the hematoma is large, monitor pulses distal to the

venipuncture site.

Ensure subdermal bleeding has stopped before removing pressure

Instruct the patient that she may resume to his medications that were discontinued before the test as ordered.

Diagnostic/Laboratory

Procedures

Date

Ordered

Date

result/s

Indication/s or

Purposes

Results Normal Values(Units

used in hospital)

Analysis and

Interpretation of

Results

Chest X-ray It is done by

using a

radioactive

device. It is

usually obtain to

determine the

size, contour

and portion of

the heart or

lungs.

Use to

determine the

location and size

Ill- defined

densities are

noted in both

inner lung zones

with paratracheal

and hilar

nodularities.

Heart is not

enlarged.

Diaphragm is low

and flattened.

Bony thorax is

unremarkable.

Both lung fields are

clear, heart is in normal

size and configuration.

The results

suggest that the

patient may have

an infection

because there

were hilar

nodularities was

noted and of air

trapping.

of the heart for

the detection of

any mediastinal

abnormalities

and any cardiac

disease and

assess or

demonstrate

physiologic

alterations in the

pulmonary

circulation. This

also aids in the

visualization of

any fluid

accumulation or

any infiltrates

and secretions in

organs like the

heart and lungs

Impression:

Bilateral PNU

with air trapping.

Nursing Responsibilities

Orient client about the procedure.

Accompany clients who are confused, combative or ventilator-dependent.

Immobilize the neck for suspected spinal fracture prior to the procedure.

Assess the need for sedation.

Instruct patient to remove all clothes

Assist patient in wearing the gown

Remove all materials that might interfere with the exam example are jewelry

Ensure comfortable position for the patient.

Predisposing Factors *age (57 years old)

Precipitating Factors *respiratory infection *exposure to certain chemicals, pollutants or cigarette smoke *change in the environment

Airborne pathogen

Virulent microorganism

Acquisition of MO nasopharyngeal airway

MO lodges in the bronchi and bronchioles

Centrifugal spread to alveoli

MO infect type II alveolar cells

Multiply in the alveolus and invade alveolar epithelium

Spread of infection through alveolus to alveolus through pores of Kohn

PATHOPHYSIOLOGY:

Client-centered

Thickening of the alveolar septa by congested capillaries and leucocytic infiltration

Consolidation along lobar compartment specifically right lobe

Difficulty to expectorate secretions

Inflammatory pulmonary response

Alveolar edema

Fibrinous inflammation

Extend to pleural space

Harsh breathe sounds (September, 10 to 12,

2012)

Pleural adhesion

Inflamed and fluid filled alveolar sacs

Impaired O2 and CO2 exchange

Compromise air exchange

Impaired tse perfusion

Decreased hgb-(129 g/L) (September 10, 12)

Decreased hct- (0.36g/L) (September 10, 12)

Vascular congestion

Presence of bacteria and neutrophils

Increased neutrophils,

and fibrin

Increased WBC

13.2 .5x10 9/L (9-10-12)

Given levofloxacin and Axera (September 10 to

13, 12)

Increased neutrophils

0.83 (9-10-12)

Given levofloxacin and Axera

(September 10 to 12, 12)

Hazy infiltrate in right lower lobe in CXR

(September 10, 12)

Release of chemical mediators

Histamine Bradykinin

Increased capillary permeability

Increased fluid shifting to

interstitial tissues

Difficult to expectorate Secretions

Cough reflex (September 10 to 11, 2012)

Difflam Lozenges- sept 10-12, 2012 Flumucil 1 sachet- sept 10, 2012

Levopront syrup- sept 10-11, 2012 Benadryl syrup-sept 11-12, 2012

Prostaglandin

Stimulates goblet cells

Accumulation of secretions

Airflow obstruction

Block airflow through bronchi

DOB (September 10 to 11,

2012)

Duavent MDI- sept 10-12, 2012

Oxygen Therapy and nubulization -sept 10-11,

2012 Benadryl syrup-sept 11-12,

2012

Grunting

(September 10 to 11, 2012)

Body malaise

(September 10 to 11, 2012)

Loss of appetite

(September 10 to 11, 2012)

Difficulty of sleeping

(September 10 to 11, 2012)

ETIOLOGY

Life begins when a newborn inhales his first breath and ends just when breathing ceases. It is something we constantly do yet we rarely perceive. Respiration virtually affects the whole bodily system. A person can survive for days without food and water but absence of oxygen even for a few minutes would mean death. The vital function paired with breathing defines how a person’s life could be at stake when damage in the respiratory system occurs. Conversely, it is also through breathing that a person can acquire infirmity.

Bronchopneumonia is an infection of the lung that can be caused by nearly any class of organism known to cause human infections. These include bacteria, amoebae, viruses, fungi, and parasites. Pneumonia is also the most common fatal infection acquired by already hospitalised patients. In developing countries, pneumonia ties with diarrhea as the most common cause of death. Even in nonfatal cases, pneumonia is a significant economic burden on the health care system.

Pneumonia may be defined as to its location in the lung or origin of infection. Lobar Pneumonia occurs in one part, or lobe, of the lung while Bronchopneumonia tends to be scattered throughout the lung. As to its origin of infection, pneumonia may be classifed as either Community-Acquired Pneumonia (CAP) or Hospital-Acquired Pneumonia. People with CAP type of pneumonia contracted the infection outside a hospital setting. It is one of the most common infectious diseases. The disease often follows a viral respiratory infection such as the flu. One of the most common causes of bacterial CAP is Streptococcus pneumoniae. Other causes include Haemophilus influenzae, mycoplasma, and Chlamydia. Hospital-Acquired Pneumonia on the other hand is an infection of the lungs contracted during a hospital stay. This type of pneumonia tends to be more serious because hospital patients already have weakened defense mechanisms and the infecting organisms are usually more dangerous than those encountered in the community. Hospital patients are particularly vulnerable to gram-negative bacteria and staphylococci. Hospital-acquired pneumonia is also called nosocomial pneumonia.

PRECIPITATING AND PREDISPOSING FACTORS (Client-centered):

PREDISPOSING FACTORS

Age

Bronchopneumonia prevalence is increased in very young persons and very old

persons because of airway responsiveness and lower levels of lung function. Two thirds

of all bronchopnemonia cases are diagnosed before the patient is aged 18 years.

Approximately half of all children diagnosed with bronchopneumonia have a decrease

or disappearance of symptoms by early adulthood.

The present age of Gangnam which is 57 years old may indicate her risk of

acquiring BPN

PRECIPITATING FACTORS

Respiratory infection

Presence of microorganisms stimulates an inflammatory response that results in

influx of leukocytes in the lung parenchyma. Chemical mediators are released and

cause various responses this is due to airway hypersensitivity, bronchospasm and

increased mucus production results. Gangnam had already experienced cough for

the past 2 weeks until present

Exposure to certain chemicals, pollutants or cigarette smoke

The risk of developing some uncommon types of Pneumonia may be increased if

the patient lives near an agriculture, construction areas or certain industrial chemicals or

animals. Exposure to air pollution, toxic fumes and cigarette smoke can also contribute

lung inflammation, which makes it harder for the lungs to clear themselves.

Cold weather

Cold air causes the airways to constrict. When bronchoconstriction occurs, the

airways narrow, allowing less air to pass in and out of the bronchial tubes. This triggers

an asthma attack due to the stimulation of the pathway that causes bronchoconstriction.

Signs and Symptoms:

Dyspnea

Dyspnea, also known as difficulty of breathing, is one of the triad symptoms of

bronchopneumonia. It is caused by the decreased airway resistance during

bronchopneumonia attack. This is due to three factors. First is bronchospasm which is

brought about by chemical mediators as well as autonomic stimulation. Second is

mucosal edema or swelling which is caused by the progressive increase of fluid leakage

secondary to increased vascular permeability. Third is mucus buildup or mucus plug

formation which is due to parasympathetic stimulation as well as by the action of

leukotriene.

Presence of Adventitious lung sounds

Presence of abnormal breath sounds is due to accumulation of secretions in the

alveolar sac, which traps air producing theses distinct sounds. Wheezing is one of the

triad symptoms of bronchopneumonia. This sound is characteristic of a very small

airway. Due to bronchospasm, mucus plug, and mucosal edema, the lumen of the

bronchi is reduced to a very small diameter. Air struggles to pass by this constricted

pathway and this causes the sound heard. This may be heard during expiration and

inspiration. Rales / Crackles is due to the accumulation of secretions by bradykinin

responsible for the stimulation of goblet cells in producing mucosal secretions.

Cough

Coughing is the last triad symptom of bronchopneumonia. It is a natural reflex of

the body that is facilitated by the abdominal muscles and the diaphragm. This reflex is

triggered by an obstruction in the lower respiratory tract. During an asthma attack, there

is mucus buildup and this obstructs the airway. The body compensates by coughing, in

an effort to expel the mucus or the obstruction. Sputum is usually mucoid and clear but

may be yellow in the presence of an infection.

Body Weakness

This is due to the physical exertion brought about by compensatory mechanisms

through breathing.

Tachypnea

This is due to the stimulation of the respiratory center (medulla oblongata and

pons) by decreased pH of the blood secondary to hypercapnia/hypercarbia detected by

the chemoreceptors. The body compensates by increasing the rate of air exchange

between the lungs and the atmosphere to release the accumulated carbon dioxide

which releases H ions that cause the pH decrease. Expiration is prolonged to facilitate

more carbon dioxide expiration.

Elevated White Blood Cells

Increased in number of leukocytes is brought about by the presence of bacterial

infection in the body.

HEALTH PROMOTION AND PREVENTIVE ASPECTS OF THE DISEASE

The goals for successful management of bronchopneumonia outlined in the 2002 US

National Heart, Lung, and Blood Institute publication.

Achieve and maintain control of symptoms.

Prevent bronchopneumonia exacerbations.

Maintain pulmonary function as close to normal levels as possible.

Avoid adverse effects from bronchopneumonia medications.

Prevent the development of irreversible airflow limitation.

Prevent bronchopneumonia mortality.

Prevention

Another essential component in the treatment of bronchopneumonia is the control of

factors contributing to bronchopneumonia severity.

Wash your hands frequently, especially after blowing your nose, going to the

bathroom, diapering, and before eating or preparing foods.

Don't smoke. Tobacco damages your lung's ability to ward off infection.

Vaccines may help prevent pneumonia in children, the elderly, and people with

diabetes, asthma, emphysema, HIV, cancer, or other chronic conditions:

Drink plenty of fluids to help loosen secretions and bring up phlegm.

Get lots of rest.

Control your fever with aspirin or acetaminophen. Aspirin must NOT be given to

children.

COMPLICATIONS

Pneumonia is more likely to cause complications in older people, smokers and people with heart failure or lung disease, such as COPD. Pneumonia complications may include:

Bacteria in your bloodstream. The smallest airways in your lungs terminate in tiny air sacs called alveoli (al-VEE-o-li), where blood cells exchange carbon dioxide for oxygen. In pneumonia, alveoli contain bacteria that may enter the bloodstream during gas exchange. Infection then spreads through the bloodstream, potentially causing shock and failure of multiple organs.

Septic shock. Unchecked bacterial growth in the bloodstream can shut down normal circulation. Blood fills the veins and leaks through the walls of the capillaries, causing uncontrolled tissue swelling and possibly organ failure, which can lead to death.

Fluid accumulation and infection around your lungs. Sometimes fluid accumulates between the thin, transparent membrane (pleura) covering your lungs and the membrane that lines the inner surface of your chest wall - a condition known as pleural effusion. When the pleurae around your lungs become inflamed (pleurisy) — often as a result of pneumonia — fluid can accumulate and may become infected (empyema).

Lung abscess. Occasionally a cavity containing pus (abscess) forms within the area affected by pneumonia.

Acute respiratory distress syndrome (ARDS). When pneumonia involves most areas of both lungs, breathing is difficult and your body doesn't get enough oxygen. Underlying lung disease of any kind, but especially COPD, makes you more susceptible to AR

V. THE PATIENT AND HIS CARE

A. Medical Management

a.) IVF, Nebulization

Medical

Management /

Treatment

Date Ordered / Date

Performed / Date

Changed / Date

Discontinued

General Description Indications /

Purposes

Client's response to

the treatment

D5 0.3 NaCL Date Ordered:

January 25, 2010

Date Performed:

January 25, 2010

D5 0.3 NaCL is a

solution that is

considered hypertonic if

not introduced inside the

body but hypotonic once

inside the body. It has

less osmolality than

serum (i.e., it has less

sodium ion concentration

than serum.) It dilutes

the serum which

To correct electrolyte

imbalances and

dehydration brought

about by increased

metabolic rate by an

increase in body

temperature above

normal limits.

The client responded

well to the treatment as

evidenced by the client

did not manifest signs

of dehydration after the

administration of IVF.

Date Discontinued:

January 29, 2010

decreases serum

osmolality. Water is then

pulled from the vascular

compartment into the

interstitial fluid

compartment. Then, as

the interstitial fluid is

diluted, its osmolality

decreases which draws

water into the adjacent

cells. It can be helpful

when the cells are

dehydrated.

Nursing Responsibilities:

1. Before the procedure

Before administering and starting the IV line of the patient, identify the patient and explain the procedure to the SO to gain

trust and cooperation.

Check the orders of the doctor for IV solution.

Prepare the equipments.

Clean the site of insertion.

2. During the procedure

Check for the patency of the IV line.

Regulate the IVF.

Monitor patient’s hydration.

Become alert from fluid overload.

3. After the procedure

Instruct patient’s SO to report signs of fluid overload such as DOB.

Check the IV infusion for infiltration, pain, phlebitis and other complications of IV therapy.

Monitor site of swelling

Medical

Management /

Treatment

Date Ordered / Date

Performed / Date

Changed / Date

Discontinued

General Description Indications /

Purposes

Client's response to

the treatment

Nebulization Date Ordered: January

26, 2010

It is a method of

administering

medications through

To prevent or treat

bronchospasm, to

loosen secretions, and

The client responded

well to the treatment as

evidenced by the

Date Performed:

January 26, 2010

Date Discontinued:

January 27, 2010

the inhaled route. It is

used to disperse fine

particles of

medications into the

deeper passage of

respiratory tract where

absorption occurs.

to open narrowed

airways.

loosening of secretions

in the lungs of the

patient and being able

to expectorate it

readily.

Nursing Responsibilities:

1. Before the procedure

Obtain baseline assessment of patient’s respiratory status.

Prepare all the equipments necessary.

Explain the procedure and indication or medication.

Ensure correct delivery of the prescribed medication.

2. During the procedure

Place the client in a high- fowlers’ position.

Place mouthpiece near to the mouth and inhale deeply as dose is released.

Instruct patient’s SO to avoid accidentally spraying the inhalant into the eyes of the patient, which may blur vision

temporarily.

3. After the procedure

Provide right and accurate documentation.

DRUGS

Name ofDrug

Date ordered,Date Performed,Date Changed

Route of Administration

Indication or Purpose

General Action,ClassificationMechanism of

Action

Client’s response to medication

Paracetamol DO: 01/25/2010DP: 01/25/2010DC: 01/25/2010

(Temp: 38.5°C)

DO: 01/26/2010DP: 01/26/2010DC: 01/26/2010

(Temp: 38.5°C)

DO: 01/27/2010DP: 01/27/2010DC: 01/27/2010

(Temp: 38.3°C)

DO: 01/27/2010DP: 01/27/2010DC: 01/29/2010

77mg IV q4 PRN for fever

77 mg IV RTC

Drops 0.5 ml q4h RTC

77 mg IV RTC

Treatment to fever

Antipyretic. Reduces fever by acting directly on the hypothalamic heat-regulating center to cause vasodilation and sweating to dissipate heat

There has been a decrease in the patient’s temperature to normal temperature after continuous administration of the drug.

Nursing Responsibilities:

Before the procedure:

Wash hands before preparing medications

Read labels carefully. Check the medication orders if it is complete and legible

During the procedure:

Check the drug label three times before administering medications

For drops: Make sure that dropper will not touch the mouth of the patient upon administration.

For IV route: Check IV site carefully for signs of thrombosis or drug reaction. Clean puncture site before

administering drug

Med card/KARDEX should include the date the medications was ordered and the last date

After the procedure:

Dispose used syringes/ampules properly.

Documentation is necessary.

Name ofDrug

Date ordered,Date Performed,Date Changed

Route of Administration

Indication or Purpose

General Action,ClassificationMechanism of

Action

Client’s response to medication

Ampicillin DO: 01/25/2010DP: 01/25/2010DC: 01/26/2010

DO: 01/27/2010DP: 01/27/2010DC: 01/29/2010

385 mg IV q12

-Hold

385 mg IV q12

Treatment of infections caused by gram-positive organisms

Antibiotic. Bactericidal action against sensitive organisms; inhibits synthesis of bacterial cell wall, causing cell death.

There has been a decrease in the patient’s temperature to normal temperature after continuous administration of the drug.

Nursing Responsibilities:

Before the procedure:

Wash hands before preparing medications

Read labels carefully. Check the medication orders if it is complete and legible

Arrange patient for sensitivity test to drug

During the procedure:

Check the drug label three times before administering medications

Assess for patient’s sensitivity to drug

Check IV site carefully for signs of thrombosis or drug reaction

Clean puncture site before administering drug

Med card/KARDEX should include the date the medications was ordered and the last date

After the procedure:

Dispose used syringes/ampules properly.

Documentation is necessary.

Name ofDrug

Date ordered,Date Performed,Date Changed

Route of Administration

Indication or Purpose

General Action,ClassificationMechanism of

Client’s response to medication

ActionGentamicin Sulfate

DO: 01/25/2010DP: 01/25/2010DC: 01/26/2010

DO: 01/27/2010DP: 01/27/2010DC: 01/29/2010

20 mg IV q12

-Hold

20 mg IV q12

Serious infections when causative organisms are not known.

Aminoglycoside. Bactericidal: inhibits protein synthesis in susceptible strains of gram-negative bacteria; appears to disrupt functional integrity of bacterial cell membrane, causing cell death.

There has been a decrease in the patient’s temperature to normal temperature after continuous administration of the drug.

Nursing Responsibilities:

Before the procedure:

Wash hands before preparing medications

Read labels carefully. Check the medication orders if it is complete and legible

Arrange patient for sensitivity test to drug

During the procedure:

Check the drug label three times before administering medications

Assess for patient’s sensitivity to drug

Check IV site carefully for signs of thrombosis or drug reaction

Clean puncture site before administering drug

Med card/KARDEX should include the date the medications was ordered and the last date

After the procedure:

Ensure patient’s adequate hydration before, during and after therapy.

Dispose used syringes/ampules properly.

Documentation is necessary.

Name ofDrug

Date ordered,Date Performed,Date Changed

Route of Administration

Indication or Purpose

General Action,ClassificationMechanism of

Action

Client’s response to medication

Diazepam DO: 01/25/2010DP: 01/25/2010DC: 01/25/2010

DO: 01/25/2010DP: 01/25/2010DC: 01/27/2010

1 suppository stat

2.3 mg SIVP PRN for seizure

Muscle relaxant: adjunct for relief of reflex skeletal muscle spasm due to local pathology.

Skeletal muscle relaxant; Anxiolytic. May act in spinal cord and at supraspinal sites to produce skeletal muscle relaxation.

Active seizure episode was treated after administration of suppose tory.

Nursing Responsibilities:

Before the procedure:

Wash hands before preparing medications

Read labels carefully. Check the medication orders if it is complete and legible

Assess for allergy to drug and drug composition

During the procedure:

Check the drug label three times before administering medications

Wear clean gloves when doing the procedure.

Insert suppository in rectum and retain for 15 to 20 minutes.

Carefully monitor PR, RR, and BP during IV administration

After the procedure:

Dispose used equipment properly.

Documentation is necessary.

Name of Drug Date ordered,Date Performed,Date Changed

Route of Administration

Indication or Purpose

General Action,ClassificationMechanism of

Action

Client’s response to medication

Salbutamol DO: 01/26/2010DP: 01/26/2010DC: 01/29/2010

½ neb + 0.5 ml NSS q6h inhalation

Treatment for bronchospasm and dyspnea experienced by the patient.

Bronchodilator. Relaxes muscles in the airways and increase air flow to the lungs.

The patient manifested relief and ease in breathing.

Nursing Responsibilities:

Before the procedure:

Wash hands before preparing medications

Know the reason for which the client is receiving the medication

During the procedure:

Check the drug label three times before administering medications

Position patient to sit upright during nebulization

After the procedure:

Clean nebulizer canister after use.

Dispose used equipment properly.

Documentation is necessary.

c) Diet

Type of Diet Date OrderedDate Started

Date Changed

General Description

Indication/Purposes

Specific Food/s Taken

Client’s response/

reaction to dietNPO (if dyspneic) DO: 01/25/2010

DS: 01/25/2010DC: 01/27/2010

A diet to withhold oral food and fluids from a

patient for various reasons

To prevent the risk for aspiration of patient due to

difficulty of breathing

None The patient’s SO complied and the patient was able

to tolerate the diet.

Nursing Responsibilities:

Before the Procedure:

Check doctor’s order

Remind the patient that he should not take anything per orem.

During the Procedure:

May wet the lips with the use of cotton to prevent cracking of lips and to alleviate thirst.

Monitor intake and output

After the Procedure:

Check doctor’s order for the next prescribed diet

c.) diet

Type of Diet Date OrderedDate Started

Date Changed

General Description

Indication/Purposes

Specific Food/s Taken

Client’s response/

reaction to dietMilk feeding with strict aspiration

precaution

DO: 01/26/2010DS: 01/26/2010DC: 01/29/2010

Breastfeeding is where the infant is fed with breast milk directly from the breast of the mother rather than from a baby bottle or other container. This is always available whenever the baby is hungry. This is done by sucking the nipples of the mother properly. Also, the mother must observe for signs of aspiration

This is given to the baby to supply the nutritional supplement for the baby. Also, to prevent aspiration. Strict aspiration precaution prevents fluid from entering in the respiratory tract.

Breast milk The client tolerated the milk of the mother and did not experience diarrhea. Also, the client did not demonstrate any signs of aspiration.

Nursing Responsibilities:

Before the procedure:

Explain the importance and purpose of the prescribed diet.

Emphasize strict compliance on the diet regimen.

Instructed SO to position the patient in high or semi-fowler’s position to avoid aspiration.

The mother must always perform hand washing and proper hygiene.

Clean the nipples before breastfeeding.

During the procedure:

Assist the mother if necessary in the feeding especially in moving position.

Let the baby suck the whole areola.

After the procedure:

Continue diet prescribed

Advice the mother to clean her nipples before and after breastfeeding without soap

d) Activity

ACTIVITY

Type of activity Date orderedDate started

Date changed

General Description Indications or Purposes

Client’s response or reaction to activity

Bed Rest DO: 01/25/2010 Supine position on bed or semi-fowler to high-fowler’s position.

To decrease workload of the body and to conserve energy

The patient was able to conserve energy and unnecessary fatigue was

minimized.

Nursing Responsibilities:

BEFORE

Verify doctor's order.

Explain the necessary activity to the SO and the reason for such order.

DURING

Ensure patient’s safety.

Assess patient’s comfort.

AFTER

Inform the SO of the specific activities that patient is contraindicated.

Document as necessary

Nursing Management

1. Nursing Care Plan

Problem # 1: Ineffective Airway Clearance r/t bronchial inflammation and retained secretions in the

bronchi.

AssessmentNursing

DiagnosisScientific Explanation Objectives

Intervention

sRationale

Expected

Outcomes

S>Ǿ

O:

The patient

manifested:

>DOB

>Rales

>Nasal Flaring

>productive,

ineffective

cough

>Weakness

>Restlessness

>Increase in

respiratory

rate (63 cpm)

Ineffective

airway

clearance r/t

bronchial

inflammation

and retained

secretions in

the bronchi.

Bronchopneumonia refer

s to a type of pneumonia

that is localized, often to

the bronchioles and

surrounding alveoli.

Clinical signs include

pulmonary congestion

which may lead to

inflammation of the

bronchioles that may

result to inability to

effectively clear

secretions from the

respiratory tract which

leads to the patient’s

manifestation of

Short term:

After 2-3

hours of

nursing

interventions

the SO shall

verbalize

understanding

of the health

teachings

given and

demonstrate

behaviors to

improve

airway

>Establish

rapport.

>Monitor and

record VS.

>auscultated

the lungs

>note for the

quality, rate,

>To gain the

trust and

cooperation of

the patient and

his SO.

>To obtain

baseline data.

>to determine

presence of

adventitious

breath sounds

>this may

indicate

Short term:

The SO shall

have

verbalized

understanding

of the health

teachings

given and

shall have

demonstrated

behaviors to

improve

airway

clearance.

>PR: 190 bpm

The patient

may manifest:

>Cyanosis

>use of

accessory

muscles for

breathing

ineffective airway

clearance.

clearance.

Long term:

The patient

shall have

demonstrated

reduction of

congestion

with breath

sounds clear,

respiration

noiseless,

improved

oxygen

exchange,

secretions will

be mobilized,

airway will be

maintained

and free of

pattern and

depth of

respirations,

flaring of

nostrils, DOB,

use of

accessory

muscles for

breathing.

>Assess

patient’s

condition.

>Provide

health

teachings like

elevation of

effectiveness

of patient’s

breathing

pattern.

>To relieve

DOB and to

maintain

adequate and

patent airway.

>To promote

further lung

expansion.

Long term:

The patient

shall have

demonstrated

reduction of

congestion

with breath

sounds clear,

respiration

noiseless,

improved

oxygen

exchange,

secretions will

be mobilized,

airway will be

maintained

and free of

secretions. HOB

>Stress the

need in

changing

position every

2 hours.

>Provide

health

teachings to

keep

environment

allergen free

like dust,

feather

pillows or

smoke.

>Instruct SO

to increase

>to facilitate

drainage of

secretions.

>To prevent

further

aggravation of

the patient’s

condition.

>To liquefy

secretions.

fluid intake

>Provide

health

teachings to

provide

opportunities

for rest.

>Promote

pleasant

environment

conducive to

rest.

>encourage

increase in

oral fluid

intake within

the limits of

cardiac

secretions.

>To prevent or

lessen fatigue.

>To promote

faster recovery.

> To loosen

the secretions

and enable the

patient to

readily

reserve.

>encourage

SO to

observe

frequent oral

hygiene

>Encourage

SO to avoid

restrictive

clothing when

dressing the

patient

>Teach SO

proper

bronchial

expectorate

them.

>to prevent

colonization of

bacteria in the

oral cavity as it

serves as a

portal of exit

when

expectorating

secretions.

> this may

aggravate DOB

>to loosen

tapping and

stress its

importance

>Instruct SO

to put the

patient in an

upright

position when

feeding.

>Perform

suctioning of

secretions or

initiate

humidified

oxygen

therapy

>Administer

due

secretions

>To prevent

aspiration

>to prevent

drying of

secretions.

medications.

>To promote

wellness by

means of

Pharmaceutical

therapy.

Problem # 2: Ineffective Breathing Patient r/t airway obstruction.

ASSESSMENTNURSING

DIAGNOSISSCIENTIFIC

EXPLANATIONOBJECTIVES

NURSING

INTERVENTIONSRATIONALE

EXPECTED

OUTCOME

S=

O= the patient manifested

>Weakness>Restlessness>Poor appetite

Ineffective

Breathing

Pattern r/t

airway

obstruction

Ineffective breathing pattern as inspiration or expiration that does not provide adequate respiration. It is due to accumulation in

Short Term:

After 4 hours of Nursing interventions the patient will establish a normal respiratory pattern AEB absence of

>Monitor and Record VS

>Assess general condition

>To obtain baseline data for further comparison

>To note for any abnormalities and underlying

Short Term:

The patient shall have established a normal respiratory pattern AEB absence of tachypnea

>With nasal flaring>Poor skin turgor>DOB>cough>RR: 63 bpm

The patient may manifest:

>Cyanosis>Diaphoresis>Altered chest excursion>use of accessory muscles.

the lungs that will occlude the alveoli which in turn may lead to bronchospasm because of the release of histamine that causes narrowing of the blood vessels. This will increase the resistance where the air passage is decreased that is why air and blood couldn’t pass through it and there may be decrease exchange of gases in the lungs or may lead to DOB

tachypnea

Long Term:

After 4 days of Nursing Interventions the pt will be free from alterations in respiratory pattern AEB normal range of respiratory rate is obtained

>Determine presence of factors/physical condition as related to her condition

>Note rate and depth of respiration and type of breathing pattern

>Auscultate breath sounds and assess for air movement

>Elevate head of bed, changing of position every 2 hours

complications

>To identify causes of breathing impairment

>To determine any irregularities in the breathing pattern

>To ascertain status and note progress

>To take advantage of gravity decreasing pressure on the diaphragm

Long Term:

The pt shall have been free from alterations in respiratory pattern AEB normal range of respiratory rate is obtained

then nasal flaring. Due to pt.’s present diagnosis, she has decreased protein and caloric reserves in the body. There may be decreased strength and immunity to combat microorganisms and there is an ed risk for acquiring different diseases esp. in the respiratory system.

>Instruct SO to OFI, foods rich in Vit. C and CHON as ordered by the physician or if patient is dyspneic or placed in NPO temporarily.

>Provide rest periods such

>Keep back dry

and enhancing drainage of secretions

>To liquefy secretions, to immune system and to replace and replenish the body with protein and calories to regain health

>To promote wellness

>To prevent chilling leading to further complications

>For continuous relaxation and to reduce allergens

>Change soiled linens and clothing, as necessary

>Do bronchial tapping after each nebulisation

>Perform proper disposal of secretions if any

>Refer to Clinical Instructor then to NOD for presence of respiratory distress

>Regulate IVF

>Administer expectorants as

>To loosen up secretions

>To prevent cross contamination

>To give immediate action to the actual problems

>To maintain hydration and prevent air embolism

>To aid in removing secretions in the lung and regain health

needed and ordered

Problem # 3:Hyperthermia

AssessmentNursing

Diagnosis

Scientific

ExplanationObjectives Interventions Rationale

Expected

Outcomes

S: Ǿ

O:

The patient

manifested:

>Warm to

touch skin

>Flushed skin

>Irritability

>Weakness

>Restlessness

>temperature

of 38.5°C

Hyperthermia Bronchopneumonia

is a type of

pneumonia

characterized by

multiple foci of

isolated, acute

consolidation,

affecting one or

more pulmonary

lobes. The

inflammation of the

lungs and

bronchioles is due

Short term:

After 2-3

hours of

nursing

interventions

the

temperature

of the client

shall

decrease

from 38.5°C

to 37°C.

>Monitor and

take V/S

>Assess

client’s

condition.

>Identify

underlying

>To obtain

baseline data.

>To reduce the

client’s

temperature by

means of

conduction.

>To assess

contributing

factors.

Short term:

The

temperature of

the client shall

have

decreased

from 38.5°C to

37°C.

>RR: 63 cpm

The patient

may manifest:

>Dehydration

>Seizure

>Increase in

respiratory rate

>Tachycardia

to the infection

caused by

microorganism

which can lead to

the patient’s

manifestation of

hyperthermia which

is often, but

necessarily part of

the defensive

response of the

body to the

invasion

microorganisms.

Long term:

After 2-3 days

of nursing

intervention

the client shall

maintain a

core

temperature

within normal

range and the

SO will

demonstrate

behaviors to

monitor and

promote

normal

temperature

of the client.

cause.

>Note

chronological

and

developmental

age of client.

>Auscultate

breath sound.

>Perform TSB.

>Children are

more

susceptible to

heatstroke and

may not act on

symptoms of

hyperthermia.

>To evaluate

presence of

breath sounds

that may

indicate DOB

>To reduce the

client’s

temperature by

promoting

surface

Long term:

The client

shall have

maintained a

core

temperature

within normal

range and the

SO shall have

demonstrated

behaviors to

monitor and

promote

normal

temperature of

the client.

>Provide loose

and

comfortable

clothing

>Recommend

bed rest and

discuss the

importance of

adequate fluid

intake.

>Give health

teachings on

the ways on

how to protect

the client from

cooling.

>To support

circulating

volume and

tissue

perfusion.

>To reduce

metabolic/

oxygen

demands.

>To promote

wellness and

prevent

increase in

body

further heat

like proper

clothing and

restriction of

activity

>Administer

replacement

fluids and

electrolytes

and increase

OFI

>Administer

antipyretic

drugs as

ordered

temperature.

>To prevent

dehydration.

>To decrease

temperature by

means of

Pharmaceutical

therapy.

Problem # 4: Impaired Gas Exchange related to impairment of alveolar-capillary diffusion secondary to

retained secretions (pneumonia)

AssessmentNursing

DiagnosisScientific

ExplanationObjective Interventions Rationale

Desired Outcome

S: ØO: the patient manifested: -low hgb count (107)-low hct count (.32)-cold to touch extremities-irritability-tachypnea (63 cpm)-tachycardia (190bpm)-grunting-shallow breathing

The patient may manifest:-use of accessory muscle in breathing-cyanosis-capillary refill longer than 3

Impaired gas exchange related to impairment of alveolar-capillary diffusion secondary to retained secretions (pneumonia)

The process of the exchange of O2 & CO2 occurs in the alveolar-capillary membrane area. The relationship between ventilation and perfusion affects the efficiency of gas exchange. Pneumonia offsets the balance between the airflow and blood flow therefore causing impaired gas exchange. The changes in the alveoli impairs ventilation and the altered blood flow brought about by the

Short-term:After 4 hrs of nursing interventions the patient’s SO will be able to verbalize understanding of condition and therapeutic regimen

Long-term:After 5 days of nursing interventions, the patient will improve ventilation and adequate oxygenation of tissues

-Note respiratory rate, depth, use of accessory muscles

-Note effectiveness of cough mechanism

-Elevate head of bed / position client appropriately

-Encourage frequent position changes

-Encourage SO to have patient in bed rest and minimize activities

-To evaluate degree of compromise

-To assess for respiratory insufficiency

-To maintain airway

 

-To promote optimal chest expansion and drainage of secretions

-To preserve energy  supply

Short-term:The patient’s SO will be able to verbalize understanding of condition and therapeutic regimen after 4 hours of nursing intervention

Long-term:The patient will improve ventilation and adequate oxygenation of tissues after 5 days of nursing interventions

seconds changes in the capillaries leads to ventilation without perfusion which in the end leads to impairment of gas exchange

-Instruct patient’s SO to increase oral fluid intake of the patient

-Keep environment allergen /  pollutant free

-Administer medications as ordered

-To mobilize secretions

 -To reduce irritant effect of dust and chemicals in airways

-To treat underlying conditions using pharmacological methods

Problem # 5: Ineffective Tissue Perfusion related to impaired transport of oxygen

AssessmentNursing

DiagnosisScientific

ExplanationObjective Interventions Rationale

Desired Outcome

S: ØO: the patient manifested: -low hgb count (107)-low hct count (.32)

Ineffective tissue perfusion related to impaired transport of oxygen

Due to the impairment of gas exchange, some parts of the body do not receive adequate

Short-term:After 4 hrs of nursing interventions the patient’s SO will be able to

-Encourage quiet, restful atmosphere

-Encourage SO to loose and

-to conserve energy/lower tissue oxygen demands

-To enhance venous return 

Short-term:The patient’s SO shall have verbalized understanding of condition and therapy

-cold to touch extremities-irritability-tachypnea (63 cpm)-tachycardia (190bpm)-weakness

The patient may manifest:-pallor-use of accessory muscle in breathing-cyanosis-capillary refill longer than 3 seconds-decreased peripheral pulses-decreased urine output

amount of oxygen. This causes the patient to experience tachypnea as a result of compensation to oxygen deprivation. The oxygen being supplied in the body is not enough due to the low levels of hemoglobin which is responsible for the oxygenation of tissues thus leading to ineffective tissue perfusion

verbalize understanding of condition and therapy regimen  Long-term:After 5 days of nursing interventions the patient will have an increase in perfusion as individually appropriate

comfortable clothing

- Place patient’s head in neutral position

- Instruct patient’s SO to feed patient with foods rich in iron such as organ meat

-Instruct pt’s SO to increase foods rich in Vitamin C such as citrus fruits

-Promote adequate bed rest 

- Attend needs 

-Regulate IVF as ordered 

 

-To increase gravitational blood flow 

-To increase hgb count   

-to increase resistance against infection,

-To promote wellness  

-To promote health 

-To maintain hydration

regimen after 4 hours of nursing interventions Long-term:The patient will have an increase in perfusion as individually appropriate after 5 days of nursing interventions

-Reinforce milkfeeding as ordered

-Administer meds as ordered

-to prevent occurrence of aspiration

-To promote recovery

Problem # 6: Risk for Deficient Fluid Volume r/t fever and rapid RR

AssessmentNursing

DiagnosisScientific Explanation Objectives Interventions Rationale

Expected

Outcomes

S: Ǿ

O:

the patient

may manifest:

>Pallor

>Sunken

anterior

fontanel

>Sunken

eyeball

>Poor skin

Risk for

deficient

fluid volume

r/t fever and

rapid

respiratory

rate.

Bronchopneumonia refer

s to a type of pneumonia

that is localized, often to

the bronchioles and

surrounding alveoli. The

symptoms include fever

and increase in

respiratory rate that could

lead to insensible water

loss with could give rise

to the problem fluid

Short term:

After 2-3

hours of

nursing

interventions

the SO shall

verbalize

understanding

on the health

teachings

given to

prevent or

>Monitor and

record VS.

>assess skin

turgor,

mucous

membrane,

skin perfusion,

capillary refill

time and

electrolyte

>To obtain

baseline

data.

>to note

signs of

DHN

Short term:

The SO shall

have

verbalized

understanding

on the health

teachings

given to

prevent or

reduce the

risk of

deficient fluid

turgor

>dry skin and

mucous

membrane

>decreased

capillary refill

time

volume deficit. reduce the

risk of

deficient fluid

volume.

Long term:

After 2-3 days

of nursing

interventions

the SO shall

demonstrate

behaviors and

lifestyle

changes to

prevent the

occurrence of

fluid volume

deficit.

balance.

>Assess the

client’s

condition.

>Monitor and

record input

and output

>instruct SO

to provide

adequate rest

periods

>Instruct SO

to provide

increase fluid

intake to the

>To identify

aggravating

factors.

>to measure

and

determine if

fluid loss is

equal to

intake

>to decrease

metabolic

demands

>To

maximize

intake of

volume.

Long term:

The SO shall

have

demonstrated

behaviors and

lifestyle

changes to

prevent the

occurrence of

fluid volume

deficit.

client like

offering fluids

between

meals.

>Establish

individual fluid

needs or

replacement

schedule.

>encourage

oral hygiene

and skin care

>Discuss to

fluids.

>To prevent

occurrence

of deficit by

receiving

adequate

amounts of

fluids at a

particular

time.

>to prevent

bacterial

colonization

in the mouth

the SO the

risk factors or

potential

problems like

hypovolemic

shock and

dehydration.

>Encourage

maintaining

diary of food

or fluid intake;

number and

the amount of

voiding and

stools and so

forth.

and maintain

skin integrity

>To provide

sufficient

knowledge

on the part

of the SO.

>To ensure

accurate

picture of

fluid status.

Problem # 7:Risk for Imbalanced Nutrition: less than body requirements related to increased metabolic

needs secondary to infectious process.

CuesNursing

Diagnosis

Scientific

ExplanationObjectives

Nursing

InterventionsRationale Evaluation

S> O

O> Patient may

manifest:

-loss of weight

with inadequate

food intake.

-pale conjunctiva

and mucous

membranes.

-decreased

subcutaneous

fat/muscle mass.

Nutrition:

Imbalanced,

less than

body

requirements

related to

increased

metabolic

needs

secondary to

infectious

process.

Nutrition:

Imbalanced,

less than a

body

requirement

occurs when

intake of

nutrients is

insufficient to

meet metabolic

needs.

Due to

inflammatory

process

SHORT TERM:

After 4° of

nursing

intervention,

patient’s SO will

verbalize

understanding

of causative

factors and

necessary

interventions to

maintain

appropriate

weight.

-Establish

rapport

-Monitor VS

-assess weight,

body build and

activity

-Assess

-To gain

patient’s trust

and

cooperation.

-To get

baseline data

-to obtain data

that may be

used for

comparison

SHORT

TERM:

After 4° of

nursing

intervention,

patient’s SO

will verbalize

understanding

of causative

factors and

necessary

interventions

to maintain

causing

depleted energy

reserves,

periods of

dyspnea and

impairment of

oxygen and

carbon dioxide

transport leave

little oxygen to

meet metabolic

needs, The

signs and

symptoms of

infection makes

feeding difficult.

LONG TERM:

After 2 weeks of

nursing

intervention,

patient will

demonstrate

progressive

weight gain

towards goal.

patient’s

nutritional

status (height

and weight)

-obtain

nutritional

history from SO

-Provide SO

with information

regarding

individual

nutritional

needs.

-To evaluate

patient’s

general

nutritional

state and to

obtain

baseline

weight.

-to determine

amount and

nutritional

value of food

intake

-To

emphasize the

importance of

well-balanced

nutritious

intake.

–weight is an

appropriate

weight.

LONG TERM:

After 2 weeks

of nursing

intervention,

patient will

demonstrate

progressive

weight gain

towards goal.

-monitor weight

regularly

-Recommend/

Support

hospitalization

and instruct SO

to seek medical

assistance in

severe

malnutrition/life

threatening

situation.

-encourage SO

prepare

appealing

nutritional

meals and to

indicator of

nutritional

status.

-To help SO

understand

the

importance of

immediate

referral to the

nearest

hospital.

-to increase

appetite of the

patient when

eating.

promote

relaxing and

pleasant

environment

when feeding

-Encourage

adequate fluid

periods

-provide

increased

calorie and

CHON in the

diet

-Reinforce milk

feeding

-to prevent

DHN

-to provide

food needed

to increase

energy

-milk serves

as the primary

source of

nutrients of

infants.

Problem # 8: Disturbed sleeping pattern RT discomforts due to increased nasopharyngeal secretions

CuesNursing

DiagnosisScientific

ExplanationObjectives Interventions Rationale

Expected Outcome

S= Ø

O= the patient

manifested:

-Restlessness

-Nasal Flaring

-DOB

-non-

productive

cough

-increased

respiratory

secretions

=the patient

may manifest:

Disturbed sleeping pattern RT discomforts due to increased nasopharyngeal secretions

A client with bronchopneumonia has excessive secretions in the tracheobronchial tubes, which induces cough and dyspnea. Coughing is the body’s reflex mechanism to expel the microorganism out. Cough may occur even when a person is sleeping. Dyspnea may awake a person thereby causing interruption on sleep. These symptoms of bronchopneumonia disturb the clients sleeping pattern.

Short term:

After 3 hours

of nursing

intervention,

the client’s SO

will verbalize

understanding

of appropriate

interventions

to promote rest

and sleep.

Long Term:

After 2 days of

nursing

intervention,

the client’s SO

>Monitor and

record VS

>Obtain

information

from client’s

SO regarding

usual bedtime

and number of

sleep hours

>Provide quite

and restful

environment

>Encourage

client SO to

cuddle the

infant often

>to obtain

baseline data

>To

determine

usual sleep

pattern

>To promote

optimal sleep

>To promote

sleep and

warmth

Short term:

After 3 hours

of nursing

intervention

the client’s SO

shall verbalize

understanding

of appropriate

interventions

to promote rest

and sleep.

Long Term:

After 2 days of nursing intervention, the client’s SO shall report improvement

>lethargy will report

improvement

in sleeping

pattern.

especially

>Provide for child’s sleep time safety during bedtime

>To prevent

injury

in sleeping pattern.

Problem # 9: Activity Intolerance r/t decreased oxygen levels for metabolic demands.

AssessmentNursing

Diagnosis

Scientific

ExplanationPlanning Intervention Rationale Evaluation

S= Ø

O= patient manifested:

> productive, non-effective cough

Activity intolerance r/t decreased oxygen levels for metabolic

Inflammation serves as the pulmonary response to the offending organism. The defense

Short term:

>After 4 hours of NI, patient’s SO will demonstrate nonpharmacol

> establish rapport

> monitor & record v/s

> to allay anxiety and gain compliance

> to obtain baseline data

Short term:

After 4 hours of NI, patient’s SO shall be able to demonstrate

> nasal discharges, green in color

> adventitious breath sound (rales on both lung field)

> irritability

> weakness

> grunting

>DOB

>RR: 63 cpm

>PR:190 bpm

=the patient may manifest:

>abnormal heart rate response to activity

demands mechanism of lungs loses effectiveness thereby allowing organism to penetrate the sterile lower tract where inflammation develops. Disruption of the mechanical defenses of cough & ciliary’s motility leads to colonization of lungs & subsequent infection. Depleted energy reserves due to impairment of oxygen & carbon dioxide transport leave little O2 to meet metabolic demands w/c leads to activity intolerance.

ogical techniques to enhance activity intolerance

Long term:

> After 2 days of NI, patient will be able to demonstrate a decrease in the physiological signs of intolerance and absence of excessive demand for oxygen.

> auscultate breath sounds

> Observe for signs of respiratory distress

>note presence of factors contributing to fatigue

> stretch bed linens & clear environment

>Provide adequate rest periods

> Ascertain status & note progress.

> To assess changes & note complications

>fatigue affects the client’s actual activity to participate in activities

> To promote comfort for the patient.

>to prevent overexertion

nonpharmacological techniques to enhance activity intolerance

Long term:

> After 2 days of NI, patient shall be able to demonstrate a decrease in the physiological signs of intolerance and absence of excessive demand for oxygen.

>encourage to increase oral fluid intake

> perform bronchial tapping

> provide nebulization as ordered

> Administer drug as ordered

>for tissue perfusion & support circulating volume

>to mobilize secretions and aid in expulsion of secretion

>to loosen secretions and provide comfort

> To provide pharmacologic treatment.

2. Actual SOAPIEs

January 26, 2010

S>Ø

O>received patient on bed, supine position, asleep. With an ongoing IVF #1

500cc D50.3NaCl @ 150cc level running at 30 µgtts/min infusing on right foot.

With CRT of <3 seconds, with pink palpebral conjunctiva, with good skin turgor,

skin on axial body part is warm to touch, peripheries are cold to touch, with

grunting, with non-productive cough, with shallow breathing, with VS taken and

recorded as follows: Temp-38.5OC, PR: 190 bpm, RR: 63 cpm

A>Hyperthermia

P>after 4 hours of nursing interventions, the patient’s SO will demonstrate

behaviors to monitor and promote normothermia such as performing TSB

I>established rapport

>assessed patient’s general condition

>auscultated for breath sounds

>monitored and recorded vital signs

>rendered AM care such as diaper change and fixing of bed linens

>checked for IVF patency

>kept back dry

>instructed SO to provide loose and comfortable clothing

>instructed SO to place patient on NPO when dyspneic

>rendered TSB

>provided safety and comfort

>encouraged increase OFI of patient to maintain hydration

>instructed SO to burp patient after every feeding

>regulated IVF to 30µgtts/min

>due medications given:

Paracetamol 77mg IV q4 PRN for fever

Ampicillin 385mg IV q12

Gentamycin 20mg IV q12

>needs attended

>referred accordingly

>seen on rounds by Dr. Yabut with orders made and carried out

FTF: D50.3NaCl x 20 µgtts/min

Follow up CXR results

Salbutamol neb ½ neb + 0.5 PNSS q6h

Continue present meds

RTC Paracetamol IV

>changed IVF to #2 D50.3NaCl x 20 µgtts/min

>IV out at 12:30pm

E>Goal met AEB the patient’s SO demonstration of behaviors to monitor and

promote normothermia such as performing TSB

January 27, 2010

S>Ø

O>received patient on bed, supine position, awake, being breastfed. With CRT of

<3 seconds, with pink palpebral conjunctiva, with god skin turgor, skin on axial

body part is warm to touch, peripheries are cold to touch, without cyanosis, with

non-productive cough, with rales on both lung fields, with DOB, with VS taken

and recorded as follows: Temp-38.3OC, PR: 127 bpm, RR: 62 cpm

A>Hyperthermia

P>after 4 hours of nursing interventions, the patient will have a decrease in body

temperature within normal limits/

I>established rapport

>assessed patient’s general condition

>auscultated for breath sounds

>monitored and recorded vital signs

>rendered AM care such as fixing of bed linens and providing adequate

ventilation

>checked for IVF patency

>kept back dry

>instructed SO to provide loose and comfortable clothing

>rendered TSB

>provided safety and comfort

>encouraged increase OFI of patient to maintain hydration

>encouraged lactating mother t increase intake of foods rich in Iron (e.g. organ

meat) and Vitamin C (e.g. citrus fruits) to maintain tissue perfusion and increase

immunity of patient

>instructed SO to burp patient after every feeding

>instructed mother to position patient on upright position when feeding to prevent

aspiration

>regulated IVF to 30µgtts/min

>due medications given:

Salbutamol neb ½ neb + 0.5 PNSS q6h

>needs attended

>referred accordingly

>seen on rounds by Dr. Bondoc @ 8:30 am with orders made and carried out:

Continue meds

Continue monitoring

FTF: D50.3NaCl x 30 µgtts/min

Continue nebulization

Refer

>referred to Dr. Buendia @ 11:45 am with orders made and carried out:

Paracetamol drops O.5ml q4h RTC

E>Goal partially met AEB decrease in patient’s body temperature from 38.3OC to

37.9OC

VI. CLIENT’S DAILY PROGRESS IN THE HOSPITAL

1. Client’s Daily Progress Chart

Days January 25(Admission)

January26

January27

January28

January 29(Discharge)

Nursing Problems

Ineffective airway clearanceIneffective breathing patternHyperthermiaImpaired gas exchangeIneffective tissue perfusionRisk for deficient fluid volumeRisk for Imbalanced Nutrition: less than body requirementsDisturbed sleeping patternActivity Intolerance

Vital signsTemperature 38.5°C 38.5°C 38.3°C 36.9°C 36°CPulse Rate 168 bpm 190 bpm 127 bpm 102 bpm 118 bpmRespiratory Rate

54 cpm 63 cpm 62 cpm 36 cpm 34 cpm

Diagnostic/LaboratoryProcedures

Complete Blood Count

Hgb =107WBC=15.5Hct=0.32

RBC=3.75

Platelet=280Segmenters=0.42Lymphocyte=0.5

8Urinalysis Color= yellow

Transparency= slightly turbid

pH= 6.0Specific

Gravity= 1.010Epithelial Cells= (+)

Albumin= (-)Sugar= (-)Pus Cells/ HPF= 5-10

Chest X-RayMedical

ManagementDrugsParacetamol

Changed frequency then

HOLD (IVO)

Shifted to Oral

at 11:30 AM

(IVO)Gentamycin

HOLD (IVO)Diazepam

Suppository at ERSalbutamol

Intravenous Fluids

#1 D50.3 NaCl 500 cc x 30 µgtts/min

#2 D50.3 NaCl 500 cc x 20 µgtts/min

#3 D50.3 NaCl

500 cc x 20

µgtts/min

#4 D50.3 NaCl

500 cc x 30

µgtts/minDiet

NPO (if dyspneic)Milk Feeding with SAP

ActivityBed rest

1. Discharge Planning

a) General Condition of Client upon Discharge

Upon discharge, the patient is physically well as evidenced by stable vital

signs, good skin turgor, and capillary refill time of less than 3 seconds.

Information was provided to the SO, which are necessary to maintain

wellness.

b) METHOD

M.E.T.H.O.D

Medication

Continue medication as instructed by the doctorCo-Amoxiclav (amoxicillin + clavulanic acid) – an anti-infective to kill susceptible microorganisms Take 2 ml twice a day for 7 days Teaching points:

Patient may take the drug with or without meals Tell the SO of the patient to protect drug from

exposure to lightSalbutamol + Guaifenesin Syrup – Management of airway obstruction. Also used to reduce the viscosity of tenacious sputum & as an expectorant for productive cough.Take 2 ml twice a day for 5 daysTeaching points:

Patient should take drug with meals May give with meals if GI upset occurs Dispose secretions properly

Appetite Plus Syrup #1 - stimulates appetite & enhances wt gain w/ supplementary essential vitaminsTake 0.9 ml for one dose Teaching points:

Do not exceed recommended daily dose Patient should take drug with meals Do not give with alcohol (e.g., sedatives, analgesics)

ExercisePatient may resume normal activity Inform SO to limit tremendous activity of patientProvide adequate rest periods

Treatment Instructed the SO to comply with the therapeutic regimen of the patient.

Health Teachings

stressed and discussed the importance of compliance to instructions for check-upinstructed SO to strictly adhere with the orders for medications of patientProvide safety measures as indicated

Out-Patient Instructed SO to have a follow-up check-up of patient on 05th

Department of February, 2010 at ONA Out Patient Department Pedia.

DietInstructed patient’s SO to feed patient with nutritious foodsEncouraged SO to increase Vitamin C and Protein intake of patientInstructed to increase adequate nutritional intakeInstructed to increase oral fluid intake

VII. CONCLUSION and RECOMMENDATION

Conclusion and Recommendation

  As to the conclusion of our study, we were able to meet our objectives.

We had built rapport with our patient’s SO by using therapeutic communication.

We have obtained the necessary data for our study. We have performed physical

examination, reviewed the laboratory results, and provided interventions to the

patient’s needs. As for our long term goals, we have reviewed the medical

condition of the patient, identified precipitating and predisposing factors to the

occurrence of the disease condition, reviewed the book-based and patient-based

manifestations of the disease, correlated other factors such as relevant data,

laboratory results, abnormal findings in the physical assessment, formulated

nursing diagnoses and subsequent planning to aid the patient’s prognosis,

evaluated patient’s response to over-all interventions through the patient’s daily

progress chart, and provided health teachings upon discharge of the patient such

as the maintenance of medical managements and measures to prevent

reoccurrences or to alleviate aggravating conditions.

Pneumonia is an infection of the lung that can be caused by nearly any

class of organism known to cause human infections. These include bacteria,

amoebae, viruses, fungi, and parasites. Pneumonia is also the most common

fatal infection acquired by already hospitalized patients. A febrile convulsion is a

seizure episode associated with a febrile illness in a child between the ages of 5

months and 5 years, that lasts less than 15 minutes. A generalized seizure is one

where the child is unconscious and has stiffening of the body and then twitching

(convulsing) of both arms and legs. This is what occurs in most children.

      Early identification of causative factors for the disease condition may help

prevent some complications of the disease. Education about the warning

symptoms is also important because early recognition may help the patient’s SO

receive treatment and prevent worsening of the disease. Educating the

parents/SO with the nature of the disease, signs and symptoms, and preventive

measures is a very vital component in combating the disease. Like a student, the

SO’s need scheduled classes, planned instruction, reading materials which are

geared to educational level, demonstrations of procedures and the opportunity to

perform these procedures with supervision.

      Learning is a continuing process and patients are given with the most basic

facts regarding bronchopneumonia and benign febrile convulsion. As student

nurses, it is recommended to encourage the patient’s SO to continuously read

and learn about their disorder and to keep abreast of new developments in the

field. Knowledge and confidence go hand in hand. The more that the family

knows about the disease, the easier it will be for them to accept the condition,

control the disorder and live a normal productive life.

      As for student nurses, they are tasked to learn the different interventions that

should be given in a client who has bronchopneumonia and benign febrile

convulsion in order for them to provide their patients with the necessary care that

they need.

      Studies about the cause and different treatment with regards to this disease

do not cease as members of the medical and research fields exert effort to

always find ways to alleviate the modes of living of the people. But these have

always been a challenge. We may be too young to do such sensitive researches,

yet it does not follow that we are excused of the responsibility. We need to

provide intensive and good nursing care for our clients. They may be very difficult

to handle but let us not deprive them of the care, respect and compassion that

they all deserve.

      Proper treatment is equated to a best prognosis. With this everyone must

exert an effort to combat the progress of this condition through proper and

effective information dissemination which entails the prevention of the condition

and the need for medical attention for a higher chance of survival, and programs

in adjunct to treating this disease.

VIII. BIBLIOGRAPHY

Book References:

Black, J.M. & Hawks, J.H. (2009). Medical-Surgical Nursing: Clinical

Management for Positive Outcomes (8th ed.). Singapore: Saunders Elsevier

Karch, A.M. (2009). Nursing Drug Guide. Philadelphia: Lippincott Williams &

Wilkins.

Pilliteri, A. (2007). Maternal & Child Health Nursing: Care of the Childbearing &

Childrearing Family (5th ed.). Philadelphia: Lippincott Williams & Wilkins.

Seeley, R.R., Stephens, T.D., & Tate, P. (2007). Essentials of Anatomy &

Physiology (6th ed.). New York: McGraw Hill

Internet Sources:

Bronchopneumonia Pathophysiology - Signs, Symptoms and Treatment of

Bronchopneumonia (n.d.). Retrieved from http://www.total-health-

care.com/man-health/bronchopneumonia.htm

Neuman, M.I. (2009). Pediatrics, Pneumonia. Retrieved from

http://emedicine.medscape.com/article/803364-overview

Panayiotopoulos, C.P. (2005). The Epilepsies: Seizures, Syndromes and

Management. Retrieved from NCBI database.

Pneumonia Can Be Prevented – Vaccines Can Help (2009). Retrieved from

http://www.cdc.gov/Features/Pneumonia/

Slupsky et al. (2009). Fast, Accurate Urine Test for Pneumonia Possible, Study

Finds. ScienceDaily. Retrieved from http://www.sciencedaily.com

/releases/2009/12/091209093119.htm

What is a Febrile Seizure (Convulsion)? (2006). Retrieved from

http://www.baby-medical-questions-and-answers.com/febrile-

seizure.html