Transcript Bronchopneumonia

Bronchopneumonia
PREPARED BY: SAUMYA BABY
STAFF NURSE, PEDIA WARD
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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
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
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.
PNEUMONIA
DEFINITION:
 Pneumonia is an inflammation of the lung
parenchyma cause by various
microorganisms including bacteria,
mycobacterium, fungi and viruses.
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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.
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.
 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
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BOOK BASE
Runny nose
Worsening cough
Fever
Increased Respiratory
rate
Retraction
Wheezing
Cyanosis
Decreases breath sounds
Crackles
Chest pain
Abdominal pain
Vomiting
PATIENT
MANIFESTATIONS
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Tachypnea
Poor feeding
Nasal flaring
Wheezing
Severe cough
Respiratory fatigue
SOB
◦ 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.
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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.
BOOK BASE
 Antibiotics
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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.
RESPIRATORY DISTRESS
HYPOTENSION
HEART FAILURE
CARDIAC DYSRRYTHMIAS
PERICARDITIS
MYOCARDITIS
PLEURAL EFFUSION
ASSESSMENT
CUES/EVIDENCE:
SUBJECTIVE:
“Patient mother
complaints of
difficulty in
breathing”.
OBJECTIVE:
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Dyspnea
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SOB
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Respiratory
rate changes
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Coughing
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Purulent
sputum
NURSING
DIAGNOSIS
Ineffective airway
clearance related
to copious
tracheobronchial
secretion.
PLANNING
Improve airway
patency.
IMPLEMENTATION
1.
2.
3.
4.
5.
6.
Provide
fowlers
position.
Maintain a
clear airway(
suction, CPT)
as indicated
Administer
humidified
O2.
Provide
adequate
hydration.
Implement
nursing
measures to
reduce pain
and anxiety.
Administer
medications
and
nebulization
as order.
RATIONALE
1.
2.
3.
4.
5.
6.
EVALUATION
Helps good air
Relieved from
entry.
breathing
Retained
difficulty.
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
and pulmicort).
ASSESSMENT
CUES/EVIDENCE:
SUBJECTIVE:
“Patient’s mother
complaints baby
having
temperature”.
OBJECTIVE:
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Fever
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Tachypnea
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Chills
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Fatigue
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Weakness
NURSING
DIAGNOSIS
Hyperthermia
related to infection
(Bronchopneumoni
a)
PLANNING
Patient will relieve
from:
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Fever
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Tachypnea
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Chills
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Fatigue
IMPLEMENTATION
1.
2.
3.
4.
5.
Remove
excessive
clothing.
Provide tipid
sponge bath.
Encourage
increase fluid
intake.
Administer iv
fluids.
Administer
antipyretic
(e.g syrup
adol, rofenac
suppository as
per order).
RATIONALE
1.
2.
3.
4.
5.
Excessive
clothing may
increase
temperature.
High
temperature
causes
coagulation
of cell protein
and cell die.
High
temperature
leads to brain
damage.
To prevent
dehydration
due to
tachypnea
and fever.
To maintain
electrolyte
imbalance.
To reduce
body
temperature.
EVALUATION
Fever reduced.
ASSESSMENT
CUES/EVIDENCE:
SUBJECTIVE:
“Mother told baby
is not taking orally
well”.
OBJECTIVE:
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Dehydrated
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Fatigue
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Drowsy
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Rapid
respiratory
rate
NURSING
DIAGNOSIS
Fluid Volume
Deficit Related To
Fever and Rapid
Respiratory Rate
PLANNING
Proper
maintenance of
fluid volume and
adequate
nutrition.
IMPLEMENTATION
1.
2.
3.
4.
Encourage
increase fluid
intake.
Give
nutritionally
enrich drinks
with more
taste. Enrich
with with
electrolyte
(e.g.
Gatorade).
Administer IV
fluids (e.g
dextrose in
normal saline
glucose) as per
doctors order.
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.
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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.
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.
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BRUNNER AND SUDDARTHS. TEXT BOOK
FOR MEDDICAL – SURGICAL NURSING
12TH EDITION.

LIPPINCOTT MANUAL OF NURSING
PRACTICE 9TH EDITION
SHUKRAN
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