Central Luzon Doctors Hospital

Educational Institution
San Pablo, Tarlac City





In partial fulfillment of the requirements in NCM 102(RLE-
Community health Nursing)





A case Study on:
BRONCHO PNUEMONIA








Submitted to:
Maam Raelyn Benavides RN,MSN
Clinical Instructor

Submitted by:
Baluyot, Janella
Baybin, Flori An
Corpuz, Tina
Jayme,
Leh, Luisa Tsina G.
Manzano, Ezra D.
Rafael, Diana Joy
Silverio, Everlasting


INTRODUCTION:

Our patient baby K is an eleven month baby who lives at San Pablo,
Tarlac City. Baby K was bought to the center together with her
parents who complains at cough, colds, and fever for 1 week. She
was diagnosed with bronchopneumonia.

Bronchopneumonia is an acute inflammation of the smaller bronchial
tubes with regular with irregular areas of considilation due to spread
of the inflammation into peribronchial cuveoli and the alveoli or dust
of the lungs. It is type of pneumonia characterized by an
inflammation of the lung generally associated with and following
amount with bronchitis.

Our group choose this case to acquire knowledge about
bronchopneumonia, we would use this knowledge to promote
awareness about this sickness, most especially to the people in the
community who has a little knowledge about this sickness.






















OBJECTIVES:
State the present health history of the client.
To determine the cephalocaudal assessment obtained from the
client.
Trace the pathophysiology of the clients disease
Discuss the nature of the nature of the drugs given to the client.
Provide the family with therapeutic interventions
Outline recommendations based on the case study finding.
































Nursing Health History B

a. General Description of Client
Baby K is 66 cm in height. She appeared to be drowsy in appearance. When she
went to the center to consult she was suffering from difficulty of breathing, cough,
colds and fever. She was diagnosed with Bronchopneumonia, in additional to
that baby K also looked weak.

b. Health Perception-Health Management Patterns
Baby Ks mother stated that she already had her fever for almost a week. The
mother administered tempra to cure her fever.

c. Nutritional-Metabolic Pattern
The patient is still breast feeding. But due to her sickness baby K lost her
appetite.

d. Elimination Pattern
Because of loss of appetite baby Ks elimination pattern was lessen. She
only defecates 1-2 times a day.

e. Activity-Exercise Pattern
Baby Ks primary activity would be crawling or trying to walk.
f. Sleep-Rest Pattern
As stated by the mother, Baby Ks sleep pattern is kind of disturbed
because of her sickness.
g. Cognitive-Perceptual Pattern
Baby K has no sensory defect. She communicates through crying and some
baby talk.
h. Self-Perception Self-Concept Pattern:

i. Role-Relationship Pattern
At this point of time, we cant still point out baby Ks role relationship because she
is still an infant, though her mother states that she is a behave baby.
j. Sexuality-Reproductive Pattern
Patient baby K is still a baby she is still in oral stage according to Sigmund
Freuds theory.
k. Coping-Stress Tolerance Pattern
Baby Ks copes through crying, because she is still an infant.
l. Value-Belief Pattern
Baby Ks family is Roman Catholic.






Nursing health history A

Patient: Baby K
Date of Admission: November 19 2012
Ward: Tibag, health center
Age: 11 months old
Sex: female
C/S: single
Religion: Roman Catholic
I. Chief complaint
Cough colds and fever for 1 week.
II. Past medical history
A. Immunization/tests
+ BCG
+DPT
+OPV
+HEP B
+Measles
B. Hospitalizations.
Baby ks first admission was November 19 2012. Upon consultation at Tibag
RHU they immediately confined her at Tarlac Provincial Hospital. She stayed
at NICU for 5 days and 3 days at pedia ward and was discharged November
16, 2012.
C. Injuries
NONE
D. Transfusions
NONE
E. Medications
suprax. (cefiximine)
(zinc sulfate) Diazinc
F. Allergies
NONE
III. Family History
Parents Health status
or cause of
death
Disease
present in the
family
L D




Mr. R

Mrs. M








IV. Social and personal history
Birthplace: Tarlac Provincial Hospital
Education: N/A
Birthday: December 10, 2011
Ethnic background: Pampango
Clients position in the family: Youngest child
Residence: San Pablo, Tarlac City
Home Environment: Concrete
Occupation: N/A
Financial Support System: supported by her parents.
Habits: none
Physical activity: Since baby K is still an infant, her activity are mostly
crawling and trying to walk.
Brief Description of Average Day: She wakes up early and her siblings
play with her. Baby K sleeps at noon and 8pm at night.

IV. Review of system:
General Description:
Weight Loss: +
Night sweats:
Anorexia:
Fatigue: +
Weakness: +
Skin:
Itch: +
Rash:
Lesion:
Bruising:
Bleeding:
Color Change: slightly pale
Eyes: normal
Vision:
Diplopia:
Blurring:
Excessive Tearing:
Ears: normal
Earaches:
Hearing Loss:
Discharge:
Tinnitus:
Nose:
Nasal flaring: +
Obstruction:
Epistaxis:
Discharge:

Throat and Mouth:
Sore Throat:
Bleeding Gums:
Tooth Aches:
Decay:
Cough: + Sputumum : greenish to yellowish
Neck:
Swelling:
Dysphagia: +
Others:
Extremities: normal
Joint pains:
Edema:
Varicose Veins:
Stiffness:
Claudication:
Deformities:
Neurologic System:
Headache: +
Dizziness:
Memory Loss:
Fainting:
Numbness:
Tingling:
Paralysis:
Paresis:
Seizures:
Mental Health:
Anxiety: +
Sexual Problem:
Depression:
Fears:
Insomnia:
Breast:
Lumps:
Discharge:
Pain:
Bleeding:

Cardiovascular:
Chest pain:
Palpitation:
Dyspnea on exertion: +
Edema:
PND:
Orthopnea:
Others:
Gastrointestinal System:
Food Tolerance:
Heartburn:
Nausea:
Jaundice:
Vomiting:
Pain:
Bloating:
Excessive Gas:
Constipation:
Change in BM:
Melena:

Genitourinary System:
Dysuria:
Nocturia:
Retention:
Polyuria:
Dribbling:
Hematuria:
Flank pain:

Male:
Penile Discharge:
Lesions:
Testicular pains:

Others:

Female:
Menarche: Old LMP: Cycle:

CVS:

Chest pain:
Palpitation: +
Dyspnea on Exertion:
Edema:
PND:
Orthopnea:

Others:



GIT:
Food tolerance:
Heartburn:
Nausea:
Vomiting:
Pain:
Bloating:
Excessive Gas:
Constipation:
Change in BM:
Melena:
GU:
Dysuria:
Nocturia:
Retention:
Polyuria:
Dribbling:
Hematuria:
Flank pain:

Male: Penile Discharge:
Lesions:
Testicular Pain:

Others:
Female: Menarche LMP: Cycle:

Others:
Extremities:
Joints Pain:
Varicose Veins:
Claudicatio:
Edema :
Stiffness :
Deformities :

Neuro :
Headache : +
Dizziness :
Memory loss :
Fainting :
Numbness tingling :
Paralysis :
Presis :
Seizures :
Others :

Mental Health Status :
Anxiety : +
Depression :
Insomia :
Sexual Problems



































ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM


The Nose
- Responsible in smelling something. It has two openings called nostrils;
the air enters the nasal passages through the nostrils. The air that you
breathe must be cleaned before reaching the lungs of the person.
- Cilia are a tiny hair that is responsible for protecting a person from
germs. The cilia filter the smaller particles of dust and dirt.
- Mucous membrane is a moist tissue lining in the nose that also catches
particles of dirt. It also warms and moistens the incoming air. There is
also tiny blood vessel that also warm and moisten the passing air inside
the nose.
The Pharynx
- The clean air travels from the nasal passages to the pharynx, It is located
at the back of the throat. Divided into two tubes:
- Esophagus is the tube that connects the pharynx with the stomach. It
carries food, liquids and saliva from your mouth to the stomach.
- Trachea or windpipe is a bony tube portion of the respiratory tract that
connects the larynx with the bronchial parts of the lungs. Epiglottis is the
flap cartilage located at the bottom of the pharynx. It opens and closes
the trachea. It prevents the food from going to the trachea by closing it
during swallowing. The epiglottis is open to allow the flow of air in the
breathing process most of the time.
The Larynx
- From the pharynx, the clean air moves down to the larynx.
- The Larynx or voice box is located between the pharynx and the trachea.
Humans use the larynx to breathe, talk, and swallow.
- The larynx contains the vocal cords that vibrate when air passes through
them.
The Trachea or Windpipe
- The trachea, or windpipe, is a bony tube portion of the respiratory tract
that connects the larynx with the bronchial parts of the lungs that about 13
centimeters long.
- The inner wall of the trachea is also lined with cilia. The cilia catch the
dust particles that reach the windpipe. The dust particles are then pushed
out and up toward the throat and mouth for expulsion. This is why one
coughs or sneezes just because of the dirt gets into the upper respiratory
tract. The lower end of the trachea branches into two large tubes called
the bronchi.
The Lungs
- The Lungs are the organs of respiration (in-charge for breathing). The left
bronchus leads to the left lung while the right bronchus leads to the right
lung. Each bronchus divides into smaller tubes called bronchial rami. The
bronchial rami branches off further into smaller tubes calledbronchial
tubes or bronchioles. At the ends of these bronchioles are the tiny air
sacs calledalveoli.
- The bronchioles and alveoli look like the branches of a tree. Bronchi is the
biggest branches that arecovered by cilia and a thin film of mucus. Dust
and pollen are trapped by the mucus before they reach the alveoli.
- Each of the lungs has 300 million alveoli. Alveolus is surrounded by tiny
blood vessels called capillaries. These are the smallest of blood vessels
that help to distribute oxygenated blood from the arteries to the tissues
and to feed deoxygenated blood from the tissues back to the veins.

























































Alteration in net
bacterial lung
resistance caused by
either:
-Decreased
bactericidal ability of
the alveolar
macrophages
-Extreme virulence of
the bacteria
-Increased
susceptibility of host
to infection

Acute
inflammation
occurs that
causes excess
water and
plasma
proteins go to
the dependent
areas of the
lower lobes

RBCs, fibrin, and
polymorphonuclear
leukocytes infiltrate the
alveoli

Containment of the
bacteria within the
segments of
pulmonary lobes by
cellular recruitment

Consolidation of
leukocytes and
fibrin within the
affected area

Stage of congestion:
Engorgement of alveolar
spaces with fluid and
hemorrhagic exudates

Proliferation and
rapid spread of
organism
through the lobe

Stage of red hepatization:
Coagulation of exudates occurs resulting to the red appearance of
the affected lung

Stage of gray hepatization:
The decrease in number of RBC in the exudates is replaced by neutrophils; which infiltrate the alveoli
making the lung tissue to be solid and grayish in color
Pneumonia
PHYSICAL EXAMINATION
General Survey:
Height: 66 cm.
Weight: 7.2 kg.

Skin:
Color: Slightly pale Turgor: Decreased skin turgor
State of Hydration: Good Bruises: None

Eyes:
Sclera: Moist
Pupils: Pupils Equally Reactive to Light and Accommodation

VITAL SIGNS:

Capillary Refill: 1-2 secs.
Urine Output: 4 diapers a day

DATE/ TIME CR (bpm) RR (cpm) TEMP. (C)
12-04-12 122 25 36.8

BODY POSITION AND ALIGNMENT:

Supine Fowlers Semi-Fowlers

Others:

Sitting at parents lap

Alignment: Appropriate Inappropriate

MENTAL ACUITY:

Oriented Coherent Appropriately Responsive

Others:

Disoriented Incoherent Inappropriately Responsive


SENSORY/MOTOR RESTRICTIONS:

Amputation Paralysis Deformity Fracture

Hearing Disorder Speech Paresis Gait

EMOTIONAL STATUS:

Apprehensive Angry/Hostile Depressed Euphoric

OTHER HEALTH RELATED PATTERNS:

Fatigue Restlessness Weakness Coughing

Insomnia Dizziness Pain

ENVIRONMENT:

Room Temperature: Adequate Inadequate

Lighting: Adequate Inadequate

SAFETY:

Violations of safety measures: Bed has no side rails

ACTIVITIES OF DAILY LIVING:

CANNOT PERFORM:

Feeding Brushing Teeth

Bathing Transferring

Dressing Combing

















PHYSICAL EXAMINATION FINDINGS

SKIN
Slightly pale in color
Warm and Dry

HEAD/ SKULL
Skull is round ( normocephalic and symmetric, with frontal parietal and
occipital prominences). Smooth skull contour, non tender and free from
masses and depression.
Head circumference: 42 cm.

FACE
Symmetric facial features and movements.

EYES
With white, moist, and glossy sclera. Iris are equal in size and pupils are
rounded, both eyes are symmetrically responsive to light, coordinated and
moved with parallel alignment.
Conjunctivas are slightly thinned. Cornea is transparent, smooth and
moist. Iris and pupil are round and uniform in color.

EARS
Ears are of equal sizes and similar in appearance
Non tender upon palpation

NOSE AND SINUSES
Asymmetric and tender. Mucosa is pink.

MOUTH AND PHARYNX
Lips in net position, no lesions
Pink and dry lips. Pink and moist gums. The dorsal and ventral portion of
the tongue were both smooth
Pink and smooth soft palate and hard palate

NECK
Muscles are symmetrical, head centered. Coordinated and smooth
movements with no discomfort.





THORAX/ RESPIRATORY
With rapid and shallow respirations noted
Use of accessory muscles noted with respiratory rate of 25cycles/min.
Chest move in or retract during inhalation
Productive cough noted
Pursed- lip breathing noted
Crackles heard over both lower lobes
Rales heard on late inspiration
Bronchial breath sounds heard over lung periphery
Chest circumference: 49 cm.

ABDOMEN
Paler than skin color, no rashes and lesions
Flat in contour
Soft and non tender
Chest circumference: 43 cm.

UPPER AND LOWER EXTREMITIES
Texture is uniform. Peripheral pulses were strong and palpable. Radial
pulse is 103 beats per minute.

NAILS
Slightly soft, white nails
Capillary refill of 1 second

OTHER HEALTH RELATED PROBLEMS: NONE


















Nursing Care Plan


Assessme
nt
Nursing
Diagnosis
Scientific
explanation
Planning Nursing
Intervention
Rationale Expected
outcome
Subjective
:
-hindi
siya
makahing
aas
verbalized
by the
mother
-feeling
breathless

Objective:
-nasal
flaring
-altered
chest
excursion
-
decreased
inspiratory
/expiratory
pressure
Ineffective
breathing
pattern r/t
excessive
mucous
production
There is an
obstruction
of the airway
due to too
much
production
of secretions
and where
there is a
inadequate
ventilation
that alter in
depth and
rate of
breathing
After 3
hours of
proper
nursing
interventio
n the
patient will
be able to
establish
effective
respiratory
pattern
Provide
adequate
rest periods

administer
oxygen at
lowest
concentratio
n as
indicated

suction
airway as
needed

administer
analgesic as
prescribed


maintain
emergency
equipment
in
accessible
location
to limit
fatigue
and
conserve
energy
for
manage
ment of
respirato
r y
distress

to clear
secretion
s

promote
deeper
respirati
on and
cough

when
ventilator
support
might be
needed
After 3
hours of
proper
nursing
interventi
on the
client
was able
to
establish
effective
breathing
pattern















Assessment Nursing
Diagnosi
s
Scientific
Explanation
Planning Nursing
Intervention
Rationale Evaluation
Iyak siya
ng iyak,
parang
masakit
yung
lalamunan
niya as
verbalized
by the
mother.
O:
observed
evidenced
of pain,
Expressive
behavior:
crying
Acute
pain
related
to
persiste
nt cough
Cough
occurs when
there is
irritation of
the throat
and it is
cause by an
unknown
etiology or
known
etiology. It is
categorize by
productive or
unproductive
.
After 1 hour
of nursing
intervention
the clients
mother wil
report that
pain is
relieved and
the child will
relax.
Asses for
referred
pain as
appropriate



observe
nonverbal
cues/pain
behaviors










Prevent
comfort
measures.




Instruct or
encourage
use of
relaxation
techniques
such as
focused
breathing.
Suggest
parent to be
present
during
procedures
encourage
bed rest
periods
To help
determine
possibility
of
underlying
condition
or organ
Observatio
ns
May not be
congruent
with verbal
reports or
may be
only
indicator
present
when client
is unable to
verbalize.

to promote
nonpharma
cological
pain
manageme
nt

To distract
attention
and reduce
tension.




To comfort
child



to prevent
fatigue
After 1
hour of
nursing
interventio
n the
patients
mother
verbalized
that her
child is at
ease and
pain free
ASSESSMENT NURSING
DIAGNOSIS
SCIENTIFIC
EXPLANATION
PLANNING NURSING
INTERVENTION
RATIONALE EVALU
ATION
s>nahihirapang
huminga ang anak
koas verbalized by
her mother.


O> Restlessness with
nasal flaring
>Warm, flushed
skin.
>minimal colorless
nasal secretion.
> tachycardia
>irritability
>cough









Ineffective
airway
clearance
related to
accumulation
of tracheo
bronchial
secreation.
Mucus is
produced at all
times by the
membranes lining
the air passages.
When the
membranes are
irritated or
inflamed, excess
mucus is
produced and it
will retain in
tracheobronchial
tree. The
inflammation and
increased in
secretions block
the airways
making it difficult
for the person to
maintain a patent
airway. In order to
expel excessive
secretions, cough
reflex will be
stimulated.


After 3-4
hours of
nursing
intervention
the patients
will be able
to
demonstrate
improve
airway
clearance

>Monitor and record
vital signs

>Assess patients
condition.

>Elevate head of bed
and encourage
frequent position
changes.


> Keep back dry and
loosen clothing

>Auscultate breath
sounds and assess air
movement .

>Monitor child for
feeding intolerance
and abdominal
distention

>Instruct the patient to
provide an increased
fluid intake for the
child

> Instruct the patient
to provide adequate
rest periods for the
child

> Give expectorants
and bronchodilators as
ordered.

>Administer oxygen
therapy and other
medications as
ordered.

>To obtain baseline
data


>To know the
patients general
condition

>To promote
maximal inspiration,
enhance
expectoration of
secretions in order
to improve
ventilation
>To promote
comfort and
adequate ventilation
>To ascertain status
and to note progress


>To avoid
compromising the
airway To help
liquefy the
secretions

To help liquefy the
secretions



> Rest will prevent
fatigue and decrease
oxygen demands for
metabolic demands

> To clear airway
when secretions are
blocking the airway


> indicated to
increase oxygen
saturation.


After 3-4
hours of
NI, pt.
shall
have
Demonst
rated
improve
airway
clearance







Drug study

Drug Dosage Contraindication Side Effect Adverse effect Nursing Responsibilities
Cefixime

Brand
name:
Suprax

200mg Hypersensitivity
to cephalosporin
Diarrhea
Nausea
Head ache or
Dizziness
Stomach
upset/pain
Abnormal
thinking
GI Bleeding

Adequate fluid
intake

Maintain a well
balanced diet while
taking this
medicine.

Take the medicine
as prescribed by the
doctor.