pair ppaedresentation

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MDJ3272

PAEDIATRIC NURSING

Question 5: Child Abuse

(Group C1)Dg Noraini Binti Tajudin (26172)

Shilla Binti Kilipus (25009)

MDJ 3282 Paediatric Nursing

PracticumBronchopneumonia

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Outline of Presentation Definition Sign and symptoms Risk factor Summary of patients history

Pathophysiology Investigation Complications Medical managements Nursing care plan

Patients education during discharge Conclusion References

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Bronchopneumonia

(Bronchial pneumonia )

Inflammation of the lungs beginnings in the

terminal bronchioles

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Sign and symptoms

CoughFever

Chest pain

Rapid, shallow breathingSOB

Headache

Loss of appetiteFatigue(less active)

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Risk factors

Congenital oracquired

immunodeficiency

PrematurityMalnutrition and

metabolic

derangement

Intubation and

tracheostomy

CNS depression

( inhibit coughand gag reflex)

Viral infection

predisposebacterial infection

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Sources of information : Pts mother, case notes Q,1 year 4 month (2nd child of two siblings),malay girl from

Kota Samrahan, Kuching

Comes to A&E Cuddled by his mother, weight: 6.29kg

Mother: Housewife (20 y/old) Father: Fisherman (25y/old)

1st hospitalization( August 2011)

Date of admission:7/12/12(2nd hospitalization)

Past surgical history: none Allergies: no known allergies to medication, food

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Reasons for hospitalization:

c/o:Fever 5/7, cough 5/7,less active ,rhinorrhea ,vomit x 1

after milk, tachypneic ,poor oral intake

Past medical history: premature @24/52(admitted into NICU

and was intubated),Failure to thrive, chronic lung disease,

ROP(resolved by laser therapy), resolved bilateral IVH with

hydrocephalus

Birth history: SVD, premature baby(24th week),birth

weight:695 gram

Immunization history: up to date, given palvizumab(X 4)

latest on 21/3/12 Developmental/growth pattern:weight:6.18 kg, able to sit

alone, stand with support, able to call mama, haspalmar

grasp

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Physical examination

General condition: less active, weak, irritable, difficult toapproach

Weight:6.18kg(on assessment)

V/sign:temperature:36.5 Celsius(axila),HR:124/min,RR:44/

min,Spo2:97% Oxygen 0.5L/min Lung examination: Bilateral lung crepitation,

rhonchi,subcostal and substernum recession.

Chest examination: pectus carinatum(pigeon chest)

*Medical Diagnosis: Bronchopneumonia

KIV D/C ON 22/12/2012

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Functional health pattern

Health Perception-Health Management Pattern

Parents verbalized their worries regarding child condition This is second time admitted

Admitted due to c/o:Fever 5/7, cough 5/7,less active ,rhinorrhea

,vomit x 1 after milk, tachypneic,poor oral intake

Previously well and active playing at home Child was on MDI ventolin(prn) and beclomethasone (BD)

using aerochamber (mother know how to use)

Nutritional and Metabolic Pattern

Dietary history's: B/F stopped at 3months of age, currentlygiven bottle feeding 5-6oz ,4-6hly(lactogen),semisolid food(6-9

teaspoon),porridge

Poor oral intake during sick, coughing during bottle feeding

causing vomiting

Was supplied with folic acid and multivitamin9


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Elimination Pattern

BO X 1-2/day with normal color and consistency of stool,

PU (3-4 X diapers changed) with normal color urine

Activity and exercise pattern

Active playing toys at home, wathcing tv(cartoon)

Bathing time: morning and evening

Sleep-Rest Pattern

No problem of insomnia,Usually sleep 8pm-6am,sleeping with

parents

Day sleeping(11am-2pm) initiates by bottle feeding

Sleep position: knee-chest position(longer),supine(shortly)

Cognitive-Perceptual Pattern

Child alert, responsive,irritable

Anxiety,fear to nurse

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Sensory-pattern

Hearing ,vision normal, all other sensory intact(touch,taste, smell)

Coping stress

If child upset and tired/sleepy she will cry more

Role Relationship Pattern

24 hour taken care by her mother

childs play companion :cousins Support system: parents

Stay with mother ,father ,grandfather and grand mother

sexuality

2nd child of 2 siblings Sister 4 years old

Value belief pattern

muslim11


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Pathophysiology

Microorganism

enter alveolarSpaces by droplet

inhalation(EtiologicAgent:bacteria,virus

,fungi)

Inflammation

occurs

Alveolar fluidincrease

Ventilationdecreases as

secretion thicken

Bronchopneumonia

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I nvestigation Chest X-ray : Right perihilar haziness -connection between

the mediastinum and the pleural cavities meet

Hematology report (abnormal)

a) Full blood count - Hb low(IDA)b) Differential count -Monocytes high ,neutrophils low

12 lead ECG

Normal reading (To look out for spreading of disease to heart)

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Complications*Empyema or lung abscesses - cavity containing pus

*Septic shock. Blood fills the veins and leaks through the walls ofthe capillaries, causing uncontrolled tissue swelling and possiblyorgan failure, which can lead to death

*Pleuritis. Inflammation of the pleura

*Bronchiectasis -airways that are inflamed and collapsible

*Reactive airways disease - persistent asthma

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Medical management

A) Syrup Erythromycin Ethylsuccinate 140mg BD

Actions: Treat upper and lower respiratory tract infections

Indication: Bronchopneumonia

Cautions: Impaired hepatic function, renal impairment

Side effects: Nausea, upper stomach pain, loss of appetite

Drug interactions: Verapamil , digoxin, oral anticoagulant

B) Syrup folic acid 1mg OD

Actions: To treat vitamin deficiencies

Indication: As a supplement where a poor dietary intake

Cautions: Take with or without food , allergies to contents Side effects: Diarrhea, nausea, itchiness, dizziness, allergic reaction

Drug interactions: -

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C) Syrup multivitamin 2.5ml OD

Actions: To treat vitamin deficiencies

Indication: As a supplement where a poor dietary intake

Cautions: Allergic to the contents

Side effects: Diarrhea, nausea, dizziness

Drug interactions: -

D) Syrup Prednisolone 6mg OD

Actions: To treat asthma

Indication: Child have asthma

Cautions: Take with food, allergic to the contents, eye disease,heart problems, kidney disease

Side effects: Nausea, headache, dizziness, increased sweating

Drug interactions: Aspirin, nonsteroidal anti-inflammatory drugs

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E) IV Augmentin 140mg BD

Actions: To treat bacterial infections

Indication: Broncopneumonia Cautions: Blood disorders, kidney problems, liver disease

Side effects: Diarrhea, nausea, itching, dizziness

Drug interactions: Probenecid

F) Metered dose inhaler (MDI) Salbutamol 100 mcg 8 hourly Actions: To relieve and prevent bronchospasm

Indication: Bronchopneumonia

Cautions: Allergy to contents, cardiac arrhythmia ,cardiovascular

disorders Side effects: Headache, nausea, dizziness

Drug interactions: Do not used with some beta-blockers (e.g.

propranolol) , other bronchodilators (e.g. terbutaline) and digoxin

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G) Metered dose inhaler (MDI) Beclomethasone 100 mcg BD

Actions: To treats inflammation Indication: Bronchopneumonia

Cautions: Allergic to the contents, heart problems, stomach

problems

Side effects: Headache, nausea, dizziness, upset stomach Drug interactions: Diltiazem, aspirin

H)Close monitoring of oxygen saturation

Keeps SPO2 > 95 % to prevents hpoxia ( NPO2 0.5 L/min)

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Lists of Nursing Care Plan

1) Ineffective airway clearance related accumulation ofsecretion(narrow airway) and inflammation of airwaysecondary to bronchopneumonia evidenced bytacypnea,RR:44,bilateral rhonci, generalized lungcrepitation, substernal and subcostal recession

2) Imbalanced nutrition less than body requirement relatedto poor oral intake, loss appetite, and coughingevidenced by weight loss (from 6.29kg -6.18 kg),lessactive and weak

3) Parental anxiety related to lack of knowledge about thedisease , prognosis , and treatment evidence by facialexpression and verbalization of worries by parents

4) Risk for nosocomial infection related to hospitalization19


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Nsg diagnosis : Ineffective airway clearance related to accumulation of

secretion (narrow airway) and inflammation of airway secondary to

bronchopneumonia as evidenced by tachypnea, RR:44, bilateral

rhonci, generalized lung crepitation, substernal and subcostal

recession

Goal: Patient will not having respiratory distress as evidence by RR within

normal range(24-40),minimal rhonci ,less substernal , subcostal recession

,coughing and spo2 >95% within 4 days (17/12/12 @ 11 am)

Intervention:

1) Assess the RR ,pattern, depth of respiration to identify any sign of

respiratory distress

2) Position the child in a propped up position to enhance lung expansion for

effective breathing

3) Administer oxygen 0.5 L/min via nasal prong to prevent respiratory

distress and to ensure patient receive adequate oxygenation (prevent

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4) Administer MDI Salbutamol 100mcg (2puffs,8hly) as a bronchodilator

to prevent respiratory muscle spasm and Beclomethasone 100mcg

(2puffs,BD) , Syrup Prednisolone 6mg OD to reduce the inflammation on

respiratory tract5) Watch out and explain to the parents about side effect of salbutamol and

Beclomethasone (eg: tachycardia, headache,N/V, tremors, nasal

dryness/irritation) so parents will understand more and can report as soon

if this side effect need an urgent intervention from nurses/doctor

6) Do suction via nasal when necessary to help remove the secretion out7) Encourage caregiver to give more fluid to the child to help moisten the

secretion

8) Monitor RR, SPO2 readings, breathing pattern, presence of recession

during breathing after each therapeutic intervention to evaluate the

effectiveness of the intervention

Evaluation: Patient not having respiratory distress as evidence by

comfortable, active with RR :38,less coughing ,less rhonchi and less

crepitations on lungs, spo>97% under N/P 0,5L/Min (21/12/12@11 am)21


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4) Teach caregiver to give food when child are relax, not crying ,after

enough rest and dont force child to eat if she refuse to ensure

cooperation from the child to eat

5) Provide a pleasant environment during her mealtime (eg: music,

conversation, be on her side ) and provide support to enhance her mood

to eat

6) Administer Syrup multivitamin 2.5ml OD, Syrup folic acid 1mg OD as

a dietary supplement for the child that she need for her growth and

development.

Evaluation: Patient able to maintain balance nutrition as evidence by no loss

of weight ,good tolerance to oral intake, appear energetic, active (willing to

play),and regain an appetite to eat (19/12/12 @ 11 am)

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Nsg diagnosis: Parental anxiety related to lack of knowledge about the

disease , prognosis , and treatment as evidence by facial expression

and verbalization of worries by parents

Goal: Parents will feel less anxiety during hospitalization as evidence by

verbalized, understand about the disease , prognosis , and treatment and

cheerful facial expression within 2 days (17/12/12 11am )

Intervention:1) Assess the S/S of having anxiety (eg:anger, denial ,refuse to answer

question )

2) Assess their level of anxiety and identify the other potential cause that

make them anxious to carry out appropriate intervention(eg: financial

problem)3) Assess their level of understanding regarding disease condition,

treatment ,prognosis to make sure information to be delivered to them

are according to their needs

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4) Provide and give information about their child condition, treatment and

prognosis using simple language(avoid medical jargon) to promote

understanding5) Collaborate and allow parents to participate in decision making and

procedure so they feel less anxious and more cooperative

6) Discuss the choices of treatment with parents ,so they wont feel hopeless

that will worsen their anxiety

7) Encourage parents to ask question and reply them with a calm andunhurried manner so they wont feel helpless

Evaluation: Parents have more understanding about their child's condition

,prognosis and treatment as evidenced by ability to explain when been

asked to explain by nurses, appear less anxious and having cheerfulfacial expression (19/12/12 @ 11 am )

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Patients education during discharge

-Teach mother and family importance of hand washing before touch the child

-Counsel parents regarding the need to prevent exposure to tobacco smoke,

allergens

-Educate parents about signs & symptoms of increasing respiratory distress (seek

medical attention immediately)

-Drink plenty of fluids to prevent dehydrated and help loosen mucus in their

lungs.

-Take all prescribed medications.

-Keep all of child follow-up appointments to monitor condition of lungs

-Stay rested and sleep well. Proper rest and enough sleep can help keeps immune

system strong

-Eat a healthy diet. Include plenty of fat-free dairy products,protiens, fruits,

vegetables and whole grains.

-Teach mother about the medication (name, how to used, side effect, cautions) to

prevent from wrong medication given

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Conclusion

Overall pts general conditions wasimproved

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References

Aschenbrenner, D. S., & Venable, S. (2009). Drug Therapy in Nursing. Retrieved December

17, 2012, fromhttp://books.google.com.my/books?id=5zd_W_PUwvYC&pg=PA929&dq=medication+

used+to+treat+Bronchopneumonia++in+children&hl=en&sa=X&ei=LYXUUKqCCYGS

rgfa3YGQCQ&redir_esc=y#v=onepage&q=medication%20used%20to%20treat%20Bro

nchopneumonia%20%20in%20children&f=false

Datta, BN. (2004). Textbook of Pathology . Retrieved December 17, 2012, fromhttp://books.google.com.my/books?id=3eycgFfYpBAC&pg=PT246&dq=Bronchopneum

onia&hl=en&sa=X&ei=83_UUPP2DITMrQeu7YDoCw&redir_esc=y

Dorlands Pocket 28th ed Medical Dictionary.(2011).Phildelphia:Elsevier

Health care medical soweto trust.(2005) . Primary clinical care manual. Retrieved December

17, 2012, from

http://books.google.com.my/books?id=zrGHXbW07vQC&printsec=frontcover#v=onepa

ge&q&f=false

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Lange, S. , & Walsh, G. (2002). Radiology of Chest Diseases. RetrievedDecember 17, 2012, fromhttp://books.google.com.my/books?id=3E_byg7VxrsC&pg=PA65&dq=Bronchopneumonia&hl=en&sa=X&ei=83_UUPP2DITMrQeu7YDoCw&redir_esc=y#v=onepage&q=Bronchopneumonia&f=false

Moeckel, E., & Mitha, N. (2008). Textbook of pediatric osteopathy.Retrieved December 17, 2012, fromhttp://books.google.com.my/books?id=Y9Dpcqr7PZMC&pg=PA302&dq=Bronchopneumonia+treatment+in+children&hl=en&sa=X&ei=poHUUNiNLMLirAe_tIDYAg&sqi=2&redir_esc=y#v=onepage&q=Bronchopneumonia%20treatment%20in%20children&f=false

Tessa, M., Ohansson, W.E., & Hodge, J. (2006) . Pneumonia: TheForgotten Killer of Children. Retrieved December 17, 2012, fromhttp://books.google.com.my/books?id=F_vhfZ8EFAoC&pg=PA9&dq=medication+used+to+treat+Bronchopneumonia++in+children&hl=en&sa=X&ei=LYXUUKqCCYGSrgfa3YGQCQ&redir_esc=y#v=onepage&q=medication%20used%20to%20treat%20Bronchopneumonia%20%20in%20children&f=false

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ThankYou..

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