Case

Presentation

Bronchopneumonia
PREPARED BY: SAUMYA BABY
STAFF NURSE, PEDIA WARD

DEMOGRAPHIC DATA:

NAME: HALLA TARED

MR NO: 181038
DIAGNOSIS: BRONCHOPNEUMONIA
AGE: 2 YRS OLD
GENDER: FEMALE
DATE OF ADMISSION: 10/12/12
DATE OF DISCHARGE: 17/12/12

PHYSICAL ASSESSMENT:
GENERAL ASSESSMENT:
Mild respiratory distress present
Looks lethargic
SKIN:
Dry and slightly pale
HEAD AND NECK:
No deformities found
THORAX:
Symmetrical in size
CARDIOVASCULAR:
Tachycardia and tachypnea present
GENITOURINARY:
Adequate urine output
GASTROINTESTINAL:
Abdomen is soft, not distended
MUSCULOSKELETAL:
No deformities noted.
No joint or muscle pain noted during examination
NEUROLOGY:
Growth and development is adequate as per Erikson
Psychosocial Stage

PATIENT HISTORY:

PAST MEDICAL HISTORY:

NO family history of the bronchial asthma,
bronchopneumonia, bronchiolitis.
DM
No allergic history
No previous breathlessness
History of gastroenteritis
PRESENT MEDICAL HISTORY:
Shortness of breath and fever present since 1
day at the time of admission.

TOPIC PRESENTATION:

PNEUMONIA
DEFINITION:
Pneumonia

is an inflammation of the
lung parenchyma cause by various
microorganisms including bacteria,
mycobacterium, fungi and viruses.

ANATOMY AND
PHYSIOLOGY:
LUNGS:
The lungs are paired elastic structures enclosed in
the thoracic cage which is an air tight chamber with
distensible walls
The lungs are enclosed in a serous membrane called
pleura. The mediasternum is in the middle of the
thorax between the pleural sacs that contains the
two lungs and each lung is divided into lobes. There
are several divisions of the brochi within each lobe
of the lung. The subsegmental brochi then bracnhes
into bronchioles which have no cartilage in their
wall. The lung is made up about 300 million alveoli.

PHYSIOLOGY:

ALVEOLI are tiny sacs in the lungs that

perform gas exchange.that is the main
process of respiration.
BRONCHI is basically an organ from the
respiratory system. It acts as an caliber for
the airway by conducting air into the lungs.
BRONCHIOLES are smaller airways that send
the air on to the inside walls of the lungs.

ETIOLOGY:

VIRAL

( cytomegalo virus is the most

common)
BACTERIAL

(streptococcal and staphylococcal

pneumonia)

PATHOPHYSIOLOGY
ALVEOLAR INFLAMMATION

AN EXUDATE INTERFERE WITH DIFFUSION OF O2 AND CO2

WBC, NEUTROPHIL MIGRATES TO ALVEOLI

FILLED THE AIR SPACE NORMALLY

PARTIAL OCCLUSION OF BRONCHI AND ALVEOLI

ALVEOLAR OXYGEN TENSION DECREASED

BROCHOSPASM

HYPOVENTILATION
HYPOXEMIA

LOBAR PNEUMONIA

BRONCHOPNEUMONIA

SIGNS AND SYMPTOMS:

BOOK BASE
Runny nose
Worsening cough
Fever
Increased Respiratory rate
Retraction
Wheezing
Cyanosis
Decreases breath sounds
Crackles
Chest pain
Abdominal pain
Vomiting
PATIENT MANIFESTATIONS

Tachypnea
Poor feeding
Nasal flaring
Wheezing
Severe cough
Respiratory fatigue
SOB

PRIORITIZATION OF NURSING PROBLEMS:

Ineffective breathing pattern.

Ineffective airway clearance due to
secretion.
Altered nutritional pattern less than body
requirement due to less food intake.
Hyperthermia related to infection.
Disturbed sleeping pattern due to cough
and breathing difficulty.

INTERVENTION:

Improving airway patency.

Promoting rest and conserving energy.
Promoting fluid intake and maintaining
nutrition
Promoting family knowledge
Monitoring and preventing potential
complications.
Promoting home and community based
care.

TREATMENT:

BOOK BASE
Antibiotics

e.g Ceftriaxone and other Cephalosporins.

Ampicillin
Supportive measures such IV fluids,
antipyretic, humidified O2, hydration
PATIENT TREATMENT
Treated with injection cefuroxime 500mg IV
TID, neb Ventolin, pulmicort, atrovent and
syrup adol.

COMPLICATIONS:

RESPIRATORY DISTRESS
HYPOTENSION
HEART FAILURE
CARDIAC DYSRRYTHMIAS
PERICARDITIS
MYOCARDITIS
PLEURAL EFFUSION

ASSESSMENT
CUES/EVIDENCE:
SUBJECTIVE:
Patient mother
complaints of
difficulty in
breathing.
OBJECTIVE:

Dyspnea

SOB

Respiratory
rate
changes

Coughing

Purulent
sputum

NURSING
DIAGNOSIS
Ineffective
airway clearance
related to
copious
tracheobronchial
secretion.

PLANNING
Improve airway
patency.

NURSING CARE PLAN:

IMPLEMENTATI
ON
1. Provide
fowlers
position.
2. Maintain a
clear
airway( sucti
on, CPT) as
indicated
3. Administer
humidified
O2.
4. Provide
adequate
hydration.
5. Implement
nursing
measures to
reduce pain
and anxiety.
6. Administer
medications
and
nebulization
as order.

RATIONALE
1.
2.

3.

4.

5.

6.

Helps good
air entry.
Retained
secretions
interfere with
gas
exchange.
Loosen
secretion
improve
ventilation.
Thins and
loosens
pulmonary
secretion.
Mobilize
and loosen
secretions.
Provide
toys,
watching TV,
etc.
Antibiotics
reduce
infection;
nebulization
helps
soothing and
expulsion of
secretion (e.g
inj.
Cefuroxime,
neb ventolin

EVALUATION
Relieved from
breathing
difficulty.

ASSESSMENT

NURSING
DIAGNOSIS
CUES/EVIDENCE: Hyperthermia
SUBJECTIVE: related to
Patients
infection
mother
(Bronchopneum
complaints baby onia)
having
temperature.
OBJECTIVE:

Fever

Tachypnea

Chills

Fatigue

Weakness

PLANNING
Patient will
relieve from:

Fever

Tachypnea

Chills

Fatigue

IMPLEMENTATI
RATIONALE
EVALUATION
ON
1. Remove
1. Excessive
Fever reduced.
excessive
clothing
clothing.
may
2. Provide tipid
increase
sponge bath.
temperature
3. Encourage
.
increase
2. High
fluid intake.
temperature
4. Administer iv
causes
fluids.
coagulation
5. Administer
of cell
antipyretic
protein and
(e.g syrup
cell die.
adol, rofenac
High
suppository
temperature
as per
leads to
order).
brain
damage.
3. To prevent
dehydration
due to
tachypnea
and fever.
4. To maintain
electrolyte
imbalance.
5. To reduce
body
temperature
.

ASSESSMENT
CUES/EVIDENCE
:
SUBJECTIVE:
Mother told
baby is not
taking orally
well.
OBJECTIVE:

Dehydrated

Fatigue

Drowsy

Rapid
respiratory
rate

NURSING
DIAGNOSIS
Fluid Volume
Deficit Related
To Fever and
Rapid
Respiratory Rate

PLANNING

IMPLEMENTATI
ON
Proper
1. Encourage
maintenance of
increase fluid
fluid volume and
intake.
adequate
2. Give
nutrition.
nutritionally
enrich drinks
with more
taste. Enrich
with with
electrolyte
(e.g.
Gatorade).
3. Administer IV
fluids (e.g
dextrose in
normal saline
glucose) as
per doctors
order.
4. Provide rest
with calm
and quiet
environment.

RATIONALE
1.

2.
3.

4.

EVALUATION

Rapid
Patient is
repiratory
hydrated.
rate leads to
insensible
fluid loss
during
exhalation.
To avoid
dehydration.
May helps
to provide
fluids,
calories and
electrolytes.
To maintain
electrolytes
imbalance.

NURSING HEALTH TEACHING:

Encourage mother to continue full course of
antibiotics.
Advise to increase activities gradually after fever
subsides.
Encourage follow up chest x-ray.
Increase steam inhalation.
Keep away from allergic substances.
Review principles of adequate nutrition and rest.
Recommended influenza vaccine (pneumovac) to all
patients at risk.
Refer patient for home care to facilitate adherence
to therapeutic regimen as indicated.

CONCLUSION:

Patient relieved from signs and

symptoms. Discharged
medications syrup Zinnat 125mg
(6ml) BID. Neb ventolin 0.3ml +
2ml nss and neb pulmicort
0.5ml. Review after one week.

BIBLIOGRAPHY

BRUNNER

AND SUDDARTHS. TEXT

BOOK FOR MEDDICAL SURGICAL
NURSING 12TH EDITION.

LIPPINCOTT

MANUAL OF NURSING
PRACTICE 9TH EDITION

SHUKRAN
for listening