broncho pneumonia cs
TRANSCRIPT
I. INTRODUCTION
Bronchopneumonia is a type ofpneumonia which results when
haematogeneous dissemination of organisms to the lung or colonization of
airways with subsequent aspiration is responsible forpulmonary infection.
As opposed to other acute bacterial or lobar pneumonias which begin in
alveoli, bronchopneumonia originates in small bronchioles. Typical
bacteria causing this form of infection include Staphylococcus aureus and
Gram-negative organisms such as Pseudomonas aeruginosa. These
organisms disseminate through the bloodstream and colonize
thebronchial or bronchiolar epithelium, but then quickly cause acute
inflammatory responses which extend outside the airway into adjacent
alveoli. The initial inflammatory response consists largely of
polymorphonuclear leukocytes which limit the extent of infection to the
peribronchiolar region. Since multiple sites are involved simultaneously a
scattered appearance of heterogeneous opacities is the usual pattern
observed on chest films (Fig.1). Eventually more and more alveoli are
affected and ultimately a homogeneous opacification simulating lobar
pneumonia may be observed. Nevertheless, because there is greater
airway involvement with bronchopneumonia, air bronchograms are
infrequent and atelectasis is more common. Peribronchial interstitial
thickening may also be seen early in the course of infection. Necrosis and
cavitation are more frequent in this type of pneumonia.Pneumatocoe les
are occasionally noted.
Clinically, patients present with fever and productive cough similar to
other bacterial infections although physical findings typical of
denseconsolidation such as bronchophony and whispering pectoriloquy
are not heard. Treatment with a variety of antibiotics usually results in
rapid clinical and radiographic resolution.
II. OBJECTIVE
General Objectives:
My general objective is to understand what Bronchopneumonia is.
Specific Objectives:
Specifically:
1.) To know what causes to have Bronchopneumonia.
2.) To know the anatomy and physiology of the body organ involved in
Bronchopneumonia.
3.) To understand the pathophysiology of Bronchopneumonia.
4.) To relate my patient chief complaint on his condition having
Bronchopneumonia.
5.) To improve myself on formulating Nursing Care Plans.
6.) To relate the medications and medical procedures done to Mr. RR on
his condition of having Bronchopneumonia.
III. HEALTH HISTORY
PATIENT’S PROFILE
Name: XY
Address: Macabalan, Lapasan Cagayan de Oro City
Civil Status: Child
Sex: Male
Age: 10 years old
Birth Date: April 8, 2000
Date Admitted: August 9, 2010
Time of Admission: 11:30 A.M
Place of Admission: NMMC
Blood Pressure: Not assesed
Respiratory Rate: 29 cpm
Pulse Rate: 116 bpm
Temperature: 37.8
Attending Physician: Dr. Macarayan
PAST HEALTH HISTORY
Mr. XY verbalized that it’s been a long time since he was confined
in the hospital, and he can’ remember it. He is conscious about his health.
He has no allergy to any foods or other stuffs He never had undergone
any surgery.
PRESENT HEALTH HISTORY
Two days prior to admission, he developed productive cough of
whitish sputum followed by low grade fever. Her mother gave him
Carbocisteine (Solmux) and Paracetamol (Biogesic),but because
symptoms persist, they consulted the doctor and was abruptly admitted.
IV. PHYSICAL ASSESSMENT
NURSING SYSTEM REVIEW CHART
Name: XYDate: Vital Signs:Pulse: BP: Temp: Height: Weight:
EENT [] impaired vision [] blind[] pain reddened [] drainage [] gums [] hard of hearing [] deaf [] burning [] edema [] lesion teeth
fever[] asses eyes, ears, nose
rashes[] throat for abnormality [X] no problemRESPIRATION
[] asymmetric [] tachypnea [] barrel chest [] apnea [] rales [X] cough [] bradypnea [] shallow [] rhonchi [] sputum [] diminished [] dyspnea [] orthopnea [] labored [] wheezing[] pain [] cyanotic[] assess resp rate, rhythm, depth, pattern[] breath sounds, comfort []no problem GASTRO INTESTINAL TRACT[] obese [] distention [] mass [] dysphagia [] rigidly [] pain [] asses abdomen, bowel habits, swallowing [] bowel sounds, comfort [X]no problemGENITO-URINARY and GYNE[] pain [] urine color [] vaginal bleeding[] hematuria [] discharge [] nocturia[] assess urine freq., control, color, odor, comfort[] grip, gait, coordination, speech, [X]no problemNEURO[] paralysis [] stuporous [] unsteady [] seizure[] lethargic [] comatose [] vertigo [] tremors[] confused [] vision [] grip[] assess motor function, sensation, LOC, strength[] grip, gait, coordination, speech, [X]no problem2MUSCULOSKELETAL and SKIN[] appliance [] stiffness [] itching [] petechiae[x] hot [] drainage [] prosthesis [] swelling[] lesion [] poor turgor [] cool [] deformity[] atrophy [] pain [] ecchymosis [] diaphoretic[] assess mobility, motion, gait, alignment, joint function
[] skin color, texture, turgor, integrity [] no problem
headache
vomiting
Skin hot to touch
Skin hot to touch
Rashes, dry
NURSING ASSESSMENT II
SUBJECTIVE
OBJECTIVE
COMMUNICATION:𓀿 Hearing Loss “ok ra ako[]visual changes panan-aw.”[x] denied
𓀿 glasses 𓀿 languages𓀿 contact lens 𓀿 hearing aide R LPupil size __3mm_ 𓀿 speech difficultiesReaction _PERRLA_
OXYGENATION:[] dyspnea “cge kog ub – hon”,[]smoking history [X] cough[] sputum[] denied
Resp. []regular 𓀿 irregularDescription Respirations are in normal depth and rhythm R Symmetrical_chest expansionL Symmetrical_chest expansion
CIRCULATION𓀿 chest pain ” wala man pud sakit sako dughan” [] leg pain []numbness of extremities [x] denied
Heart Rhythm 𓀿 regular 𓀿 irregularAnkle edema _____NONE_______________ Pulse Car Rad DP FemR _______+____72____+______+____L __+___72____+______+_____ Comments: Pulses are easily palpable
NUTRITIONDiet: Diet as tolerated𓀿 N 𓀿 V "Wala raman pud nag bag-oCharacter akung gana sa pagkaon."𓀿 recent change in weight, appetite𓀿 swallowing difficulty[x] denied
𓀿 dentures √ none Full Partial With Patient Upper 𓀿 𓀿 𓀿Lower 𓀿 𓀿 𓀿
ELIMINATION:Usual bowel pattern 𓀿 urinary frequency once/ twice a day 4x day𓀿 constipation 𓀿 urgency remedy 𓀿 dysuria None 𓀿 hematuria Date of last BM 𓀿 Incontinence 𓀿 foly in place character 𓀿 denied
Comments:"Normal ra man ang akung Bowel sounds:pagkalibang ug pagpangihi." normo-active_bowel sounds 5 clicks/min. Abdomial DistentionPresent 𓀿 yes √ no Urine* (color, consistency,dor) Amber in color
MGT. OF HEALTH & ILLNESS:[]alcohol [x] denied ( amount, frequency)_____none_____ 𓀿SBE Last Pap Smear ___N/A___________ LMP : __________ N/A _______________
Briefly describe the patient’s ability to follow treatments ( diet, meds, etc)_The client is able to follow treatment.
SUBJECTIVE OBJECTIVESKIN INTEGRITY:dry ”wla man ko gi katol2x." itching 𓀿 other 𓀿 denied
√ dry 𓀿cold pale𓀿 flushed √ warmmoist 𓀿 cyanotic* rashes, ulcers, decubitus (describe size, location, drainage) _________________________________.
ACTIVITY/SAFETY𓀿 convulsion 𓀿 dizziness limited motion Limitation in ability to []ambulate [] bathe self𓀿 other[x]denied
𓀿 LOC and orientation Conscious, and coherent; oriented to person, time and place.Gait: 𓀿 Walker 𓀿 Cane 𓀿 Other [x] steady []unsteady𓀿 sensory and motor losses in face or extremities
√ROM limitationsAble to ambulate with both extremities
COMFORT/SLEEP/AWAKE:pain (location, frequency ,remedies) 𓀿 nocturia []sleep difficulties[x] denied
√facial grimaces√guarding𓀿 other signs of pain: none
COPING:Occupation: StudentMembers of household _5 members including the parentsMost supportive person Mother
Observed non-verbal behavior __Client is responsive and cooperative
The person and his phone number that can beReached any time: (no number)
V. DEFINITION OF COMPLETE MEDICAL DIAGNOSIS
Bronchopneumonia is a type of pneumonia that is characterized by
an inflammation of the lung generally associated with, and following a bout
with bronchitis. This is really a specific type of pneumonia that is localized
in the bronchioles and surrounding alveoli. This article provides a general
overview of this condition, including symptoms and treatment options for
those who have been diagnosed with bronchopneumonia. The most
common pneumonia-causing bacterium in adults is Streptococcus
pneumoniae (pneumococcus)
Symptoms of bronchopneumonia:
Cough with greenish or yellow mucus; Fever; chest pain; Rapid,
shallow breathing; Shortness of breath; Headache; Loss of appetite;
fatigue
Treatment of bronchopneumonia:
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 one’s susceptibility
to pneumonia, since the flu precedes pneumonia development in many
cases. Unlike lobar pneumonia, in which an entire section or subdivision
of the lung may be inflamed; bronchopneumonia tends to appear in
patches in and around the small airways and passages. Outward clinical
symptoms will be similar to those of lobar pneumonia, however, and can
include fever, coughing, chest pain, chest congestion, chills, difficulty with
breathing and blood-streaked mucus that is coughed up.
Bronchopneumonia is more common in elderly people, and in association
with other viral respiratory illnesses (bronchitis), and as a complication of
those who have asthma. Pneumonia, including bronchopneumonia is a
fairly common illness and it affects millions of people annually in the
United States. The severity of the illness will depend on the type of
bacteria or infection causing the illness, as well as the overall health of the
person who has bronchopneumonia.
In order to diagnosis this illness, a doctor may take a chest X-ray, may
test a sample of the sputum, may do a CBC to get a count of the white
blood cells in the blood, may take a CAT scan, and/or may take a pleural
fluid culture of the fluid surrounding the lungs. Upon diagnosis, most
people will be treated at home with antibiotics. If the patient is suffering
from dehydration or has a severe case of bronchopneumonia, he or she
may be treated in the hospital where the illness can be more closely
monitored. With appropriate treatment, most people recover fully within a
couple weeks. Very infirm or elderly people who do not get appropriate
treatment can die from bronchopneumonia.
VI. ANATOMY AND PHYSIOLOGY
The Lungs are the principal organs of respiration. Each lung is
cone-shaped, with its base resting on the diaphragm and its apex
extending superiorly to a point about 2.5 cm above the clavicle. The right
lung has three lobes called the superior, middle and inferior lobes. The left
lung has two lobes called the superior and inferior lobes. The lobes of the
lungs are separated by deep, prominent fissures on the surface of the
lung. Each lobe is divided into bronchopulmonary segments separated
from one another by connective tissue septa, but these separations are
not visible as surface fissures. There are nine bronchopulmonary
segments in the left lung and ten in the right lung.
The main bronchi branch many times to form the tracheobronchial
tree. Each main bronchus divides into lobar bronchi as they enter their
respective lungs. The lobar (secondary) bronchi, two in he left lung and
three in the right lung, conduct air to each lobe. The lobar bronchi in turn
give rise to segmental (tertiary) bronchi, which extend to the
bronchopulmonary segments of the lungs. The bronchi continue to branch
many times, finally giving rise to bronchioles. The bronchioles also
subdivide numerous times to give rise to terminal bronchioles, which then
subdivide into respiratory bronchioles. Each respiratory bronchiole
subdivides to form alveolar ducts, which are like long, branching hallways
with many open doorways. The doorways open into alveoli, which are
small air sacs. The alveoli become so numerous that the alveolar duct wall
is little more than a succession of alveoli. The alveolar ducts end as two or
three alveolar sacs, which are chambers connected to two or more alveoli.
There are about three million alveoli in the lungs. The bronchioles are very
small airways that extend from the bronchi to the alveoli. The bronchioles
are made up of smooth muscle cells and are smaller than 1 millimeter in
diameter. The bronchioles do not have glands or cartilage. The epithelial
cells of the bronchioles are cuboidal in shape.
VII. PATHOPHYSIOLOGY
PNEUMONIA
VIII. LABORATORY
Not assessed
IX. MEDICAL MANAGEMENT
MEDICAL PROCEDURES
INTRAVENOUS THERAPY
Intravenous therapy or IV therapy is the giving of liquid substances
directly into a vein. It can be intermittent or continuous; continuous
administration is called an intravenous drip. The word intravenous simply
means "within a vein", but is most commonly used to refer to IV therapy.
Therapies administered
intravenously are often called specialty pharmaceuticals.
Compared with other routes of administration, the intravenous route is the
fastest way to deliver fluids and medications throughout the body. Some
medications, as well as blood transfusions and lethal injections, can only
be given intravenously.
NEBULIZATION
It is the process of using a nebulizer that changes liquid medicine
into fine droplets (in aerosol or mist form) that are inhaled through a
mouthpiece or mask Nebulizers is used to deliver bronchodilator (airway-
opening) medicines such as albuterol or ipratropium bromide. Nebulizers
are hand-held machines with an airflow meter that measures oxygen flow.
These machines administer a variety of medications. Nebulizers vaporize
this mixture and deliver it as a fine mist or steam. Nebulizers are usually
used in the hospital or nursing home setting.Disposable nebulizers are
often sent home with a patient and are cleaned and reused for a limited
time.
TEPIDS SPONGE BATH
Tepid sponging is a time honored and well known method of
reducing the elevated temperature. Tepid sponging is useful as an
immediate but transient measure in bringing down the temperature and it
should always be supplemented with drugs like paracetamol for a longer
antipyretic effect. A tepid sponge bath relieves fever without cooling the
body too fast. Eighty degrees Fahrenheit is still 20oF below body
temperature and yet warm enough not to drive blood from the skin,
thereby preventing the cooling from getting to the body's core. Limbs are
bathed first and then the chest, abdomen, back, and buttocks. Tepid baths
should be 80-93oF (26.7-34oC).
X. NURSING CARE MANAGEMENT
NURSING CARE PLAN
CUES NURSING DX OBJECTIVES INTERVENTIONS RATIONALE EVALUATION
Subjective Data:Pt. verbalized...“GITUGNAW KO”Objective Data- Temp: 38.1 oC- skin warm totouch- body malaise- poor appetite
- chills noted
Hyperthermiarelated to diseaseprocess asevidenced by
chills noted
That within my 8ospan of care, thepatient’s bodytemperature willlower from 38.1 oCto 37.5oC and willdemonstrateabsence of chills
- Perform tepidsponge bath- Apply cold wetcompress ifnecessary- Remove someblankets andclothes whichare notnecessary- If patient’s skinfeels cold totouch, applyfriction- Advise to wearloose andcomfortable
clothes
- Encouragepatient toincrease fluidintake- MonitorTemperature
Vaporizationof waterrelieves heatfrom thesurface of theskin To helpnormalizebodytemperature To provide airmovement, toaugment heatloss. To stimulatecirculation To be more
Comfortable
To preventdehydration To seeeffectivenessof saidinterventions
Criteria forGOAL MET:At the end of my8o span of care:- the patient’stemperature willlowers to 37.5oC- The patient willmanifest negativechilling- The patient willverbalize comfort
every 15 mins- Repeat TSB ifneeded- Administerantipyrenticdrugs asprescribed- Regulate IVF
as desired
Vaporizationof waterrelieves heatfrom thesurface of theskin Helps relief offever Helpsmaintain
hydration
CUES NURSING DX OBJECTIVES INTERVENTIONS RATIONALE EVALUATION
Subjective Data:“gi-ubo pa gihapon ko aning mga niaging adlaw. “as verbalized bythe patientObjective Data:- productive cough- body malaise
Ineffective airwayclearance relatedto the presence of
secretions
At the end of ourduty shift wemust:- be able to coughout phlegmeffectively- maintainpatient’s airway
patency
- Auscultate forbreath sound- Monitor VitalSigns- Regulate IVF asdesired- Encouragepatient to drinkmore water(should be warm)
- To identifyabnormal breathsounds- To know thestatus or progressin/of the pt.- Helps tomaintain hydrationand fluid status,as well as to thin
Criteria forGOAL MET:At the end of my8o span of care:-Patient willmaintain patentairway-Patient will beable toexpectorate
- poor appetite- use of accessorymuscles whilebreathing-with yellowishsticky mucoussecretions
-crackles breath
sound
- Teach patient todo deep breathing
exercise
-Instructpatient/family tonotifynurse/physician ofsputum colorchanges, increasework of breathing,or onset of chestpain- Encouragepatient to rest- Position patientto High-Fowler’sPosition- Administermedicines as
prescribed
viscous secretionsto allow- To liquefysecretions- To mobilizesecretions so thatpatient may beable to moreeasily expectorate
mucous
secretions
- To monitorsignal ofworsening ofcondition thatrequiresimmediatemedicalintervention toprevent furthercomplications- To promotewellness- To facilitateairway- To helps relief
cough
sputum and cougheffectively
XI. DRUG STUDY
GENERIC
NAME
BRAND NAME CLASSIFICATION MECHANISM OF
ACTION
DOSE/
FREQUENCY
INIDICATION
paracetamol Biogesic Antipyretics Paracetamol has longbeen suspected ofhaving a similarmechanism of action toaspirin because of thesimilarity in structure.That is, it has beenassumed thatparacetamol acts byreducing production ofprostaglandins, whichare involved in the painand fever processes,by inhibiting the
PRN 1 tab q 4oFor T o >37.8
For fever
cyclooxygenase (COX)enzyme as aspirindoes.
INTERACTIONS SIDE EFFECTS ADVERSE EFFECT NURSING
CONDERATIONS
Do not start, stop, or change thedosage of any medicine beforechecking with your doctor orpharmacist first. Before usingthis product, tell your doctor orpharmacist if you use any of thefollowing products: anti-seizuremedications (e.g., phenytoin,carbamazepine, phenobarbital),"blood thinners" (e.g., warfarin),isoniazid, phenothiazines (e.g.,chlorpromazine).Acetaminophenis an ingredient in manynonprescription products and insome combination prescriptionmedications.
easy bruising/bleeding,new signs of infection(e.g., fever, persistentsore throat)
Tell your doctor immediately if anyof the following symptoms of liverdamage have: persistentnausea/vomiting, yellowingeyes/skin, dark urine,stomach/abdominal pain, extremetiredness. A very serious allergicreaction to this drug is rare.However, seek immediate medicalattention if you notice anysymptoms of a serious allergic
reaction, including: rash, itching,swelling, severe dizziness, troublebreathing.If you notice other effectsnot listed above, contact your doctoror pharmacist.
GENERIC NAME BRAND NAME CLASSIFICATION MECHANISM OF
ACTION
DOSE/
FREQUENCY
INDICATION
Butamirate citrate Sinecoid Cough and cold
preparation
1 tab TID Acute cough of
any etiology
INTERACTIONS SIDE EFFECTS ADVERSE REACTIONS NURSING
CONSIDERATIONS
Rarely, skin rash, nausea,diarrhea or dizziness
GENERIC
NAME
BRAND NAME CLASSIFICATIONS MECHANISM OF
ACTION
DOSE/FREQUENCY INDICATION
Albuterol
sulphate
VentolinNebule
Inhalation solution beta2-adrenergicbronchodilator
1 neb TID VENTOLIN NEBULES InhalationSolution is indicated for the relief ofbronchospasm. This drug relaxesthe smooth muscle in the lungsand dilates airways to improve
breathing.
INTERACTIONS SIDE EFFECTS ADVERSE REACTIONS NURSING
CONSIDERATIONS
- Tell your doctor ofall prescription andnonprescriptiondrugs you may use,especially of drugsused for asthma,depression or colds;and beta-blockers(e.g., atenolol,propranolol).- Do not start or stopany medicinewithout doctor orpharmacistapproval.
Cases of urticaria,angioedema, rash,bronchospasm,hoarseness,oropharyngeal edema,and arrhythmias(including atrialfibrillation,supraventriculartachycardia,extrasystoles) have beenreported after the use ofVENTOLIN NEBULESInhalation Solution.
Tremors, Dizziness,Nervousness, Headache,Sleeplessness, Gastrointestinal,Nausea, Dyspepsia , Ear, nose,and throat, Nasal congestion,Tachycardia, Hypertension,Bronchospasm, Cough,Bronchitis, Wheezing
- Tell your doctor if you have heartdisease, high blood pressure, anoveractive thyroid gland, epilepsyor diabetes.- Tell your doctor if you ever had abad reaction to bitolterol,ephedrine, epinephrine,metaproterenol, phenylephrine,phenylpropanolamine,pseudoephedrine, or terbutaline.- Many nonprescription
productscontain these drugs (e.g., diet pillsand medication for colds andasthma), so check the labelscarefully.- Do not take any of thesemedications without consultingyour doctor (even if you never hada problem taking them before).- Do not allow anyone else to takethis medication.
XII. DISCHARGE PLAN
EXERCISE
Be sure to get enough rest and sleep on a daily basis.
Practice deep breathing and coughing exercise to easily excrete phlegm
TREATMENT
Have annual influenza vaccine after discussing appropriate timing of the
vaccination as recommended
Discuss the pneumococcal vaccine with your primary health care provider,
and have the vaccination as recommended
If you do not smoke, don’t start.
Avoid stress, fatigue, sudden changes in temperature and excessive
alcohol intake, all of this lowers resistance to
pneumonia.
HYGIENE
Take bath daily.
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Please obtain permission from the College of Nursing –
TRACE College.
Wear masks especially when traveling for the first week after being
discharged.
Promote frequent oral hygiene.
OUTPATIENT ORDERS/FOLLOW UPS
Follow up check up will be on Oct. 4, 2008, 1-6pm
DIET
Drink plenty of water (at least 8 glasses every day), especially during
warm weather.
Eat a healthy, balanced diet and take in a sufficient amount of non-
alcoholic fluids each day.