broncho pneumonia 1

8/9/2019 Broncho Pneumonia 1

1/28

INTRODUCTION

Bronchopneumonia (Lobular pneumonia) is one of two types of bacterial pneumonia as

classified by gross anatomic distribution of consolidation (solidification). In bacterial

pneumonia, invasion of the lung parenchyma by bacteria produces an inflammatory

immune response. This response leads to a filling of the alveolar sacs with exudates. The

loss of air space and its replacement with fluid is called consolidation. In

bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute

consolidation, affecting one or more pulmonary lobes.

It should be noted that although these two patterns of pneumonia, lobar and lobular, are

the classic anatomic categories of bacterial pneumonia, in clinical practice the types are

difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often

leads to lobar pneumonia as the infection progresses. The same organism may cause one

type of pneumonia in one patient, and another in a different patient. From the clinical

standpoint, far more important than distinguishing the anatomical subtype of pneumonia,


2/28

Treatment

If the cause is bacterial, the goal is to cure the infection with antibiotics. If the cause is

viral, antibiotics will NOT be effective. In some cases it is difficult to distinguish

between viral and bacterial pneumonia, so antibiotics may be prescribed. Pneumococcal

vaccinations are recommended for individuals in high-risk groups and provide up to 80

percent effectiveness in staving off pneumococcal pneumonia. Influenza vaccinations are

also frequently of use in decreasing ones susceptibility to pneumonia, since the flu

precedes pneumonia development in many cases.


3/28

Gordons 11 Functional Pattern

1. Health Perception Health Management Pattern

BEFORE HOSPITALIZATION

According to the patient, for him, health is being free form illness, able to

play and go to school and eating nutritious foods.

The S.O states that whenever patient suffers from simple illnesses they

make him take over-the-counter medicines such as paracetamol and solmux-

syrup.

DURING HOSPITALIZATON

According to the patient, he views himself as weak and wasnt able to do

his daily activities. He manages his condition by complying with the entire

doctors order and taking adequate rest.

According to the S.O., patient has a strong sensitive smell towards

aromatic things and easily gets a headache upon smelling those.


4/28

the same color of urine. During his stay in the hospital, he wasnt able to defecate

since day 1.

4. Activity Exercise Pattern

BEFORE HOSPITALIZATION:

According to the S.O., the patient loves to play with his playmates after

school. They usually play agawan base and tagutaguan. The S.O. also states

that the patient helps in the household chores like washing the dishes and cleaning

their table after dinner. Patient also plays with his younger brother.

DURING HOSPITALIZATION:

The patient is dependent to his parents. He said that he cant do his usual

activities because of his illness.

5. Sleep Rest Pattern


5/28

8. Self- perception/Self-concept Pattern

He perceives his self as a caring person. Malambing po ako kina mama.

Mabait po ako sa mga kalaro ko at classmate ko. Hindi po ko nakikipag away

palagi paminsan-minsan lang pag tama po ako, as verbalized by the patient.

9. Sexual Reproduction Pattern

According to the S.O., patient K.M. was circumcised when he was five

years of age. She is aware of her sexual social status.

10. Coping Stress Management Pattern

The patient relies on her parents for support. Whenever he feels down and

sad he runs to her mother and grandmother for comfort.


6/28

PHYSICAL ASSESSMENT

Initial Vital Sign: PR= 118 RR= 28 T= 36.8 WT: 17kgs

AREA

ASSESSED

METHOD

USED

NORMAL

FINDINGS

ACTUAL

FINDINGS

ANALYSIS

SKIN

- Color

- Texture

- Hair

distribution- Temperature

- Moisture

HAIR

Inspection

Inspection/

Palpation

Inspection

Palpation

Palpation

Light to Deepbrown

Smooth

Evenly

distributedNormally warm

Moist to dry

Brown

Smooth

Evenly

distributedBody

Temperature:37oC

Moist to dry

Normal

Normal

Normal

Normal

Normal


7/28

AREA

ASSESSED

METHOD

USED

NORMAL

FINDINGS

ACTUAL

FINDINGS

ANALYSIS

OCULARMOVEMENT

EARS

- Symmetryand position

EXTERNALAUDITORY

CANAL

- Hearing

NOSE

- Symmetry

- Color

Inspection

Inspection

Inspection

Inspection

Inspection

Both eyes moveparallel with

each other in

directions ofgaze

Auricles are atlevel of each

other

Hears equally

in both ears

Symmetrical

Same color as

Both eyes moveparallel with

each other in

directions ofgaze

Auricles are atlevel of each

other

Hears equally

in both ears

Symmetrical

Same color as

Normal

Normal

Normal

Normal

Normal


8/28

ASSESSED METHOD

USED

NORMAL

FINDINGS

ACTUAL

FINDINGS

ANALYSIS

UPPEREXTREMITIES

- Skin color

- Size (arms)

- Symmetry

LOWER

EXTREMITIES

- Skin color

- Size (legs)- Symmetry

Inspection

Inspection

Inspection

Inspection

InspectionInspection

Light to deepbrown

Equal Size

Symmetrical

Light to deep

brown

Equal SizeSymmetrical

Brown

Equal Size

Symmetrical

Brown

Equal SizeSymmetrical

Normal

Normal

Normal

Normal

NormalNormal


9/28

LABORATORY RESULT

Chest X-Ray PAL Views

September 17,07

Parihilar and paracardiac infiltrates, bilateral.

Hilar nodularities

Heart is normal in size

Diaphragm and sinuses are normal

Intact bony thorax

Impression: Parahilar and Paracardiac pneumonitis, bilateral.


10/28

Date : September 17, 2007

Examination result Normal findings Actual findings Analysis

WBC

HGB: Hemoglobin

HTC: Hematocrit

Differential count:

Segmenters

Lymphocytes

5-10 x 10 ^ 9/L

13-18 g/dL

39.0 54.0 %

0.60 0.70

0.20 0.30

8.7

11.5

35

0.76

0.24

Normal

Due to hemodilution

Due to hemodilution

Due to infection

Normal


11/28

PATHOPHYSIOLOGY

`

Predisposing Factors:-Race

-Gender-Age

Etiologic Agent:

-Streptococcus pneumoniae-Staphylococcus Aureus

-Mycoplasma-Chlamydias

-Viruses

Precipitating Factors:-Environment

-weather

Aspiration of virulent microorganisms

Impairs extensive defense mechanism in the upper respiratory system

Bacteria reach trachea

Bacteria affects the globlet cellSystem has recognized it as irritant and

antigen

Cough reflexReaches the lungs

Inflammatory response

Cough

Increase in secretions

Inflammation of respiratory passage

A


12/28

WBC and neutrophils migrate into the alveoli

Pyrogen is released

Fever

Impaired permeability of alveolarwalls

Fluid accumulates in alveoli

Pulmonary edema

Reduce surface area for gas exchange

Spasmodic contraction of walls of bronchi

CO2 increases and O2 decreases

Stimulate respiratory center

Bronchospasm

Failure of left side of heart

Pooling of secretions

Adventitiousbreath sounds

Unproductive coughHyperventilation Cells receive ineff icient O2

Partial cyanosis

A

Fatigue


13/28

PATIENTS PROFILE

Name : K.M.

Age : 5

Sex : Male

Date of birth : March 06, 2000

Civil status : Single

Address : Tuao, Cagayan

Religion : Roman Catholic

Date of Admission : September 17, 2007

Chief complaint : Cough

Attending Physician : Dr. E. Babaran

Final Diagnosis : Bronchopneumonia

PATIENTS MEDICAL HISTORY

Family Health History


14/28

ANATOMY AND PHYSIOLOGY

The lower respiratory tract

Larynx

Is located in the anterior throat, and it connects superiorly to the pharynx and

inferiorly to the trachea. It is the site of voice production. Air moving past the vocal folds

causes them to vibrate producing sound. It is also called voice box.

Trachea

It is also called windpipe. It is a membranous tube that consists of connective

tissue ad smooth muscle, reinforced with 16-20 C-shaped pieces of cartilage. It is lined

with pseudostratified columnar epithelium, which contains numerous cilia and goblet

cells. The cilia propel mucus produced by the goblet cells, as well as foreign particles

embedded in the mucus, out of the trachea, through the larynx, and into the pharynx,

from which they are swallowed.


15/28

There are several divisions of bronchi within each lobe of the lungs. First are the

lobar bronchi (three in the right and 2 in the left lung). Lobar bronchi divide into

segmental bronchi, which are the structures identified when choosing the most effective

postural drainage position for given patient. Segmental bronchi then divide into

subsegmental bronchi. These bronchi are surrounded by connective tissue that contains

arteries, lymphatics, and nerves.

Bronchioles have no cartilage on their walls. Their patency depends entirely on

the elastic recoil of the surrounding smooth muscle and on the alveolar pressure. It

contain submucosal glands, which produce mucus that covers the inside lining of the

airway.

Terminal bronchioles do not have mucous glands or cilia. It becomes the

respiratory bronchioles which are considered to be the passageways between the

conducting airways and the gas exchange airways.

Alveoli

The lung is made up of 300 million alveoli, which are arranged in a cluster of 15


16/28

DRUG STUDY

Name of medicine : Paracetamol

Classification : Antipyretic; Analgesic

Action : Thought to produce analgesia by blocking pain impulses by

inhibiting synthesis of prostaglandin in the CNS or of other

substances that sensitize pain receptors to stimulation. The

drug may relieve fever through central action in the

hypothalamic heat-regulating center.

Adverse Reaction : Hematologic : Hemolytic anemia, neutropenia,

leukopenia, pancytopenia.

Hepatic : Jaundice

Metabolic : Hypoglycemia

Skin : Rash, Urticaria

Contraindications : Contraindicated in patients hypertensive to drug. Use

cautiously in patients with long-term alcohol use because


17/28

Name of medicine : Diazepam (Valium)

Classification : Minor Tranquillizer

Indication : The management of anxiety disorders or for the short-term

relief of the symptoms of anxiety. Anxiety or tension

associated with the stress of everyday life usually does not

require treatment with an anxiolytic. It is a useful adjunct

for the relief of skeletal muscle spasm due to reflex spasm

to local pathology (such as inflammation of the muscles or

joints, or secondary to trauma); spasticity caused by upper

motor neuron disorders (such as cerebral palsy and

paraplegia); athetosis; stiff-man syndrome; and tetanus. It is

also a useful adjunct in status epilepticus and severe

recurrent convulsive seizures.

Adverse Reaction : Commonly reported were drowsiness, fatigue and ataxia;

venous thrombosis and phlebitis at the site of injection.


18/28

Nursing consideration: In pediatric use, in order to obtain maximal clinical effect

with the minimum amount of drug and thus to reduce the risk

of hazardous side effects, such as apnea or prolonged periods

of somnolence, it is recommended that the drug be given

slowly over a 3-minute period in a dosage not to exceed 0.25

mg/kg. After an interval of 15 to 30 minutes the initial

dosage can be safely repeated. If, however, relief of

symptoms is not obtained after a third administration,

adjunctive therapy appropriate to the condition being treated

is recommended.


19/28

Name of medicine : Klaricid

Classification : Macrolides

Indication : Treat infections such as:

Throat and sinus infections

Chest infections such as bronchitis and pneumonia

Skin and skin structure infections

Ear infections particularly inflammation of the middle

ear (acute otitis media)

Adverse Reaction : Nausea, dyspepsia, abdominal pain & diarrhea, headache &

skin rash.

Contraindications : Known hypersensitivity to macrolides. Concomitant use of

clarithromycin w/ cisapride, pimozide or terfenadine.

Patients receiving terfenadine therapy w/ preexisting


20/28

LEARNING FEEDBACK DIARY

Name: Charisse Marichu P. Baculi Date: September 05, 2007

Clinical Instructor: Mrs. Leonor De Laza Area: SPH F2 and F1

Objectives: At the end of the rotation, I will be able to:

1. Establish rapport to my patient

2. Be efficient in giving total patient care

3. Augment my skills and confidence

Not like during our past rotation, this time I felt more confident and a little

knowledgeable on the things to be done in the hospital. The hospital protocols were

clearly registered on my mind.

It was my first time to be on the area, floor 1, and it made me a little tense


21/28

LEARNING FEEDBACK DIARY

Name: Charisse Marichu P. Baculi Date: October 01, 2007

Clinical Instructor: Mr. Randolph Balungaya Area: SPH F1

Objectives: At the end of the rotation, I will be able to:

4. Establish rapport to my patient

5. Be efficient in giving total patient care

6. Augment my skills and confidence

Not like during our past rotation, this time I felt more confident and a little

knowledgeable on the things to be done in the hospital. The hospital protocols were

clearly registered on my mind.

It was my first time to be on the area, floor 1, and it made me a little tense


22/28

A Case

Study


23/28

Submitted by:Jane Galiza

Charisse Marichu Baculi

(RLE- 08)

A Case


24/28

Submitted to:

Mr. Randolph Balungaya, RN

Submitted by:

Charisse Marichu Baculi

(RLE- 08)


25/28

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective data:

hindi ko mailabas angplema ko po paginuubo

ako, as verbalized bythe patient.

Objective data:

crackles

difficulty

vocalizing

ineffective

coughing

Ineffective airwayclearance related to

excessive, thickenedmucus secretions as

evidenced by ineffectivecough.

At the end of 1 hour, thepatient will be able to

maintain airway potencyand expectorate/clear

secretions readily.

Elevate head of thebed/ change position

every 2 hours.

Encouraged deep-

breathing and coughingexercises.

Increase fluid intake

Provide supplementalhumidification

(nebulizer).

Monitored vital signs.

Performed chest

physiotherapy.

To take advantage ofgravity decreasing

pressure on the

diaphragm.

To mobilize

secretions.

To help liquefy

secretions.

To ascertain status andnote progress.

To assess changes andnote complications.

To loosen secretions.

Goal partially met. At theend of 1 hour, the patient

was able to maintainairway potency and

expectorate/clearsecretions readily.


26/28


Subjective data:

mainit ang pakiramdamko at giniginaw ako, as

verbalized by the patient.

Objective data:

Chills

Elevated temperature

of 38.2 0C.

Alteration in bodytemperature:

hyperthermia related toincrease pyrogens in the

body.

At the end of 2 hours, thepatient will be able to

experience improvementin infection as evidence

by normothermia andnegative sputum culture

report.

Monitor vital signs,closely monitoring

temperature fluctuations.

Monitor WBC

Encourage to increasefluid intake.

Promote surfacecooling by means ofundressing; cool/tepid

sponge bath orimmersion; local ice

packs especially in groinor axillae.

Continued fever maybe caused by drug abuse,

drug-resistant bacteria,

super infection, orinadequate lungdrainage.

High white blood cell

counts indicate thepresence of an infection

or inflammation.

Fluid loss contributesto fever.

To reduce bodytemperature/restorenormal body/organ

function.

Goal partially met. At theend of 2 hours, the

patient was able todemonstrate

improvement in infectionas evidence by:

Temperature : 37.3 0C


27/28


Subjective data:

hindi ako nakaka-tulog

ng husto dahil sa pag-ubo ko, as verbalized by

the patient.

Objective data:

Dark circles undereyes

Restlessness

Expressionless face

Frequent yawning

Disturbed sleep pattern

related to statis ofsecretions.

At the end of 2 hours, the

patient will be able toachieve optimal amounts

of sleep as evidence byrested appearance,

verbalization of feelingrested, and improvement

in sleep pattern.

Provide nursing aid:

back rub bedtime care,

pain relief, comfortableposition, and relaxationtechnique.

Attempt to allow for

sleep cycles of at least90mins.

Discourage pattern of

daytime naps unlessnecessary or part of usual

pattern.

Limit fluids before

bedtime.

To promote rest and

relaxation.

To promote

completion of onecomplete cycle and

completion of an entirecycle is necessary to

benefit from sleep.

Napping can disrupt

normal sleep pattern.

To reduce need for

voiding during night.

Goal partially met. At the

end of 2 hours, thepatient was able to

achieved optimalamounts of sleep as

evidence by restedappearance and

verbalization of feelingrested.


28/28


Subjective data:

Hindi pa siya tumataemula nung pumasok

kame dito sa hospital, asverbalized by the S.O.

Objective data:

Dull headache

Restlessness

Abdominal distention

Impaired bowel

elimination pattern r/tinadequate fluid intake

At the end of the shift,

the patient will be able topass soft, formed stool ata normal pattern of

defecation.

Auscultate abdomen

for presence, locationand characteristic of

bowel sounds.

Encourage andprovide adequate fluid

intake, including waterand high-fiber fruit

juices.

Encourage balance

fiber and bulk diet.

Encourageactivity/exercise within

limits of patients ability

To reflect bowel

activity.

To promote moist/softstool

To improve

consistency of stool andfacilitate passage throughthe colon.

To stimulatecontractions of the

intestine.

Goal partially met. At the

end of the shift, patientwas able to pass soft,formed stool at a normal

pattern of defecation.

broncho pneumonia 1

Documents