bronchi pneumonia

Bronchitis is a respiratory disease in which the mucous membrane in the lungs' bronchial passages becomes inflamed

Table of Contents

Page Number

I. Introduction 3-4

A. Scope and Limitations

5

B. Objective of the Study

6

II. Patients Profile

7III. Growth and Development

8IV. Health History and Present Illness

9V. Medical Orders

10-12VI. Laboratory Examinations

13VII. Drug Study

14-19VIII. Anatomy and Physiology

20-21IX. Pathophysiology

22X. Health Assessment

23-26XI. Actual Nursing Management

27-29

XII. Discharge planning and referral

30XIII. Evaluation and Implications

31XIV. Bibliography

32

I. INTRODUCTION

Bronchopneumonia which is also known as 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, is identifying its causative agent and accurately assessing the extent of the disease.

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.

A. Scope and Limitation

This case presentation involves a patient named Roldan, Princess Jelou B, diagnosed with Bronchopneumonia as supplied by Dr. ApareceThe scope and limitation of this case study are as follows:

Patients history and background

Overview of the disease

Predisposing and precipitating factors of the aforementioned disease

Pathophysiology of Bronchopneumonia as the resulting diagnosis.

Nursing and Medical management administered during the confinement period

Discharge plan, referrals and recommendations pertinent to the disease condition

Assessment of the client from September 17 to September 20 of year 2008, within hospital premise.

B. Objectives of the Study

This study is conducted by the student of Team 5, NCM501205 Cluster 2 for the following purposes: Trace the disease process of the patient

Identify the health care services needed particular to patients condition

Recognize the significance of the ordered diagnostic tests in relation to the patients disease condition

Formulate and implement an effective nursing care plan especially designed for the patients problems as identified in the nursing assessment.

Inculcate health teachings and importance of following medication regimen to the patient

Explain and elaborate to patients significant others the need for encouragement and support to the patient in the latters pursuit of a better health

II. PATIENTS PROFILE

Name: Roldan, Princess Jelou B.Address: P-5 Kalid, Kibalabag Malaybalay City, BukidnonSex: FemaleStatus: ChildBirthday: January 3, 2008Place of Birth: Kalid, kibalabag Malaybalay City BukidnonAge: 8 months old

Nationality: Filipino

Religion: Baptist

Father: Querwin RoldanMother: Nylle RoldanRank in the Family: EldestNumber of siblings: 1Date of Admission: September 11, 2008Time of admission: 1:30 pm

Place of admission: Bukidnon Provincial Hospital-Malaybalay Diagnosis: Bronchopneumonia, severe community acquiredAttending Physician: Dr. Araceli ApareceIII. GROWTH AND DEVEOPMENT

One of the greatest events in life after marriage is to have a child. This was what Mr. And Mrs. Querwin Roldan had hoped and prayed for. Their prayers were answered and on January 3, 2008, Mrs. Roldan gave birth to a healthy baby girl. They named her Princess Jelou. The patient is now in 8 months old and according to Sigmund Freud Psychoanalytic Theory, he is now in the oral stage of development in which infants during this age are interested in oral stimulation or pleasure. The infant in this age, suck for enjoyment or for relief of tension as well as nourishment. The child mainly explores the world by using mouth especially the tongue. And because of this, since the port of entry of bacteria is in the mouth, the patient was able to ingest the bacterium that was held from his hand that might be contaminated and placed on his mouth. As a result it precipitated the cause and the development of the disease.IV. HEALTH HISTORY AND PRESENT ILLNESS

Health History

This is a case of a 8 months old, female, Filipino, Baptist, from Purok 5, kalid, Kibalabag, Malaybalay City, Bukidnon, who was admitted for the first time at the Bukidnon Provincial Hospital-Pedia Ward due to complaints of cough and difficulty of breathing. The informant was the mother with 90% reliability.History of Present Illness

A diagnosed case of Bronchopneumonia-severe community acquired. Four days prior to admission, the patient was experiencing cough for a long duration followed by difficulty of breathing. Because of this, her parents were alarmed of his condition and afraid of what bad will happen to her, they decided to take Princess to the hospital for admission dated September 11, 2008 at 1:30 in the afternoon.Family History

There were no known critical diseases in the family. According to the mother, her husband was having some cough. Though her husband wasnt diagnose with what type of disease it was, she thinks that it was the cause that her children was infected with the disease. Personal Health History

According to Mrs. Roldan, her child was having quite for quite a longer time,. She said that she thinks that her children got her cough from their father who had a cough. They were able to have a check-up in their health center and instructed to take herbal medications such as kalabo and gabon.V- Medical Orders

September 11, 2008

Pls. Admit to pedia ward

For immediate intervention

TPR q 4 hours

To identify Pt. conditions

NPO temporarily except meds

To avoid aspiration

CBC, platelet count, U/A, S/E

To identify any deviation

Start IVF D5 0.3% NaCl 500 cc @ 20 gtts/min

For fluid and electrolytes replacements

Pen G 350,000 U IVTT q 6 hours

To prevent infections

PCM drops.8 ml q 4 hours for fever

To decrease body temp.

O2 inhalation 1L/min

Provide O2 consumption

Refer for any unusualities

For immediate intervention

May use ampicillin 300 mg IVTT q 6 hours instead of pen G

Prevent infection, prophylaxis

May resumed feeding if not dyspneic anymore

Providing nutrient

September 12, 2008

Continue meds

For compliance and easy healing

IVTF with D5IMB 500 cc @ SR

Providing adequate F & E consumption

Gentamycin 20 mg IVTT q 12 hours now

prophylaxis

For referral to Dr. Aguirre

For another intervention and consultation

September 13, 2008

Continue meds.

For compliance

Start erythromycin 250 mg/5ml 2.5 ml 3 x a day p.o

Preventing infection in the respiratory tract

Hold feeding once Pt. dyspneic

To prevent aspiration

IVTF D5IMB 500 cc @ 35 gtts/min

For rehydration and adequate consumption

September 14, 2008

Continue meds For compliance and easy healing

IVTF D5IMB 500 cc @ SR Hydration status

September 15, 2008

Start gentamycin 20 mg slow IVTT q 12 hours For prophylaxis Nebulize salbutamol neb q 6 hours To liquefy secretion

IVTF D5IMB 500 cc @ SR To provide adequate F&E replacement

Continue meds For complianceSeptember 16, 2008

Continue meds For compliance

IVTF D5IMB 500 cc @ SR For rehydrationSeptember 17, 2008

Continue meds For complianceSeptember 18, 2008

Home per request-signed by mother For legal purposes Home meds-erytromycin 2.5 ml TID x 7 days Preventing infectionsSeptember 19, 2008


IVTF D5IMB 500 cc @ SR For rehydrationSeptember 20, 2008


VI-LABORATORY EXAMINATION

TESTRESULTSNORMAL RANGEIMPLICATION

CBC --(2/1/08) WBC

HGB

HCT

Platelet

Segmenters

lymphocytes

14.7

9.3

27.0

469,000

50

50

5.0-10.0/L

13.7-16.7 g/dl

40.5-49.7 vols %

144,000-372,000

43.4-76.2 %

17.4-46.2 %Infection

Anemia

Anemia

Iron deficiency anemia

Normal

Anemia

VII. DRUG STUDYName of Drug Generic (Brand)Date OrderedClassificationDose/ Frequency/ RouteMechanism of ActionIndication (why drug is ordered)ContraindicationSide EffectNursing Precaution

Ampicillin

Feb. 1, 2008Anti-infective Antibiotic 300 mg IVTT q 6 hoursInhibit cell wall synthesis during bacterial multiplication>For respiratory tract infection

>For GI infection

Contraindicated to hypertensive drugs or other penicillin.

Use cautiously with other drug allergy.CNS: lethargy, seizures, dizziness,

GI: Nausea, vomiting, diarrhea

SKIN: Pain at IV site

Other: hypersensitivity reactions, over growth of nonsusceptible organism

Check about allergy of penicillin.

Give drug 1-2 hours before or 2-3 after meal.

Monitor sodium level.

Notify if rash, fever, chill develop

Name of Drug Generic (Brand)Date OrderedClassificationDose/ Frequency/ RouteMechanism of ActionIndication (why drug is ordered)Contra-indicationSide EffectNursing Precaution

Gentamicin sulfateFeb. 2, 2008Anti-infective Antibiotic 20 mg IVTT q 12 hoursInhibit protein synthesis by binding directly to the ribosomal subunit;bactericidal.Serious infection caused by sentsitive strains of Pseudomonas aerruginosa, E. Coli, Proteus.

Contraindicatd to hypertensive drugs or other aminoglycoside

Use cautiously in neonate, infant,elderly ang impared renal function.CNS: fever, headache, dizziness, seizure, nunbness

EENT: blurred vision, tinnitus

GI: Nausea, vomiting,

SKIN: Pain at IV site, rash

Other: anaphylaxis,

Evaluate hearing before giving therapy.

Monitor renal function

Watch for s/sx of fever, chill, increase HR


Pen GFeb. 1, 2008Anti-infective 350,000 mg IVTT q 6Prevent bacterialcell wall synthesis during replication.

Increase amoxicillin effectiveness by inactivating betalactamases Lower respiratory tract infection cause by strain of gram positive and gram negative organism.

To prevent pneumonia.Contraindicated to hypertensive drugs or other penicillin.

Use cautiously with other drug allergy, especially to cephalosporins, because of possible cross sensitivity.CNS: neurophathy, seizures, dizziness, fatigue

GI: Nausea, vomiting, enterocolitis

Other: hypersensitivity reactions, anaphylaxis, pain

Monitor Pt. hepatic function.

Shake well before injecting

Monitor renal function closely.


ParacetamolFeb. 1, 2008Non-opioid analgesics and antipyreticsDrops 0.8 ml q 4 hours Thought to produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandins in the CNS or other substances that sensitize pain receptors to stimulation. The drug may relieve fever through the central action in the hypothalamic heat-regulating center.Use to relieve mild to moderate pain

It is also used to bring down a high temperature.Contraindicated to patients hypersensitive to drug.Hemolytic anemia, neutropenia, leulopenia, jaundice, rash, urticaria and hypoglycemia

Use liquid form for children.

For child, dont exceed 5 doses in 24 hours.

Be aware in calculating daily dose


SalbutamolFeb. 2, 2008Bronchodilator neb q 6 hoursBronchodilator.

Salbutamol is a -adrenergic stimulant which has a highly selective action on the receptors in bronchial muscle and in therapeutic doses; it has little or no action on the cardiac receptors.To prevent or treat bronchospasm in Pt. with reversible obstructive airway disease.

Treatment of acute severe asthma and in routine management of chronic bronchospasm

Contraindicated to hypertensive drugs or its ingredients.

Use cautiously with CV disorder, hyperthyroidism, or DM.CNS: tremor, nervousness, dizziness, weakness, headache

CV: tachycardia, palpitation, hypertension

EENT: Dry and irritated nose and throat, nasal congestion, hoarseness

GI: heartburn, Nausea, vomiting, anorexia

Other: hypersensitivity reactions, Monitor patient routinely

Take frequent vital signs to note side effects.

Great care is needed in patients with cardiovascular disease eg, ischemic heart disease, arrhythmia or tachycardia, hypertension


ErythromycinFeb. 3, 2008Macrolide Anti Infective250 mg/5ml 2.5 ml TID P.OInhibits bacterial protein synthesis by binding to the 50S subunit of the ribosome. Bacteristatic or bactericidal, depending on concentrationMild to moderate skin and soft tissue infectionContraindicated in pregnant patients and those hypertensive to drug or other macrolides.CNS: fever

CV: vein, irritation

EENT: hearing loss, blurred vision

GI: abdominal pain and cramping, nausea & vomiting

SKIN: urticaria, rash and eczema, dermatitis

Obtain urine specimen for sulture and sensitivity tests before giving first dose and instruct patient to report adverse reactions especially nausea, abdominal pain, vomiting and fever.

VIII. ANATOMY & PATHOPHYSIOLOGY

The lungs are located in the chest on either side of the heart. They are surrounded and protected by the ribcage. The left lung is a little smaller than the right lung because it shares space in the left side of the chest with the heart. Each lung is divided into sections (lobes). The right lung has three sections or lobes, including the: (1) Right upper lobe, which takes up the top third of the right lung; (2) Right middle lobe, which is the smallest of the three lobes and shaped like a triangle; (3) Right lower lobe, which is the largest of the three.The major fissure separates the right lower lobe from the right middle and upper lobes. The left lung is shaped slightly differently than the right. It has only two lobes - the left upper lobe and the left lower lobe. Our lungs are the main organs of the respiratory system. The lungs are located inside the upper part of our chest on either side of the heart, and they are protected by the ribcage. The breastbone (sternum) is at the center front of the chest, and the spine is at the center of the back of the chest. The inside of the chest cavity and the outside of the lungs are covered by the pleura, a slippery membrane that allows the lungs to move smoothly as they fill up with and empty out air when we inhale and exhale. Normally, there is a small amount of lubricating fluid between the two layers of the pleura. This helps the lungs glide inside the chest as they change size and shape during breathing. With each breath, our lungs are filled with air that comes into our body through the nose or mouth. It flows down the throat (pharynx) and through the voice box (larynx). A small flap of tissue (epiglottis) covers the entrance to the larynx, and it automatically closes when we swallow to prevent food or liquids from getting into our airways. Our largest airway is the windpipe (trachea), which is between three-and-a-half and six inches long and a little over half an inch in diameter. It brings air to the chest, where it branches into two smaller airways: the left and right bronchi, which lead to the left and right lungs. The bronchi themselves divide many times into smaller and smaller airways (bronchioles). Because the pattern of these increasingly smaller passages looks like an upside-down tree, this part of the system is sometimes called the bronchial tree. The airways are held open by flexible, fibrous connective tissue called cartilage. Circular airway muscles can make the airways wider or narrower. The smallest bronchiole is only half a millimeter across. At the end of each bronchiole are clusters of air sacs called alveoli. Each air sac is surrounded by a dense network of tiny blood vessels (capillaries). The extremely thin barrier between the air and the blood allows the blood to pick up oxygen and release carbon dioxide into the alveoli. IX. PATHOPHYSIOLOGYBronchoneumonia refers toa type of pneumonia that is localized, often to the bronchioles and surrounding alveoli.

Predisposing Factors

Precipitating Factors

Age

Presence of MVGender

Immunosuppresed condition

Target Organ: Lungs

Patients pulmonary defense is weak related to

clinical condition

Bacteria enters the lungs and replication occurs

and triggers pulmonary Inflammation

Immune system tries to response to presence of bacteria,

Stimulating Hypothalamus for thermal regulation

while immune system releases antibodies

Antibodies (macrophages) combat the bacteria present

In the lungs

Exudates gradually accumulate into the lungs

resulted from death of bacteria and macrophages

Irritation of the mucous membrane causing inflammation

Of the bronchial walls

Exudate fluid fills in the alveolar air spaces and

invade alveolar septa

Poor oxygen exchange within the lungs causing

Lung parenchymal dysfunction.

Multi-organs Involved

Heart, Brain, GIT

Complication

Acute Respiratory FailureX. NURSING SYSTEM REVIEW CHART

Name: Roldan, Princess Jelou Date: September 17, 2008Vital Signs:

Pulse:145bpm BP: not assessed Resp: 38 cpm Temp: 36.7C Height: not assessed Weight:not assessed

EENT:

[] impaired vision [] blind

[] pain [] reddened [] drainage

[] gums [] hard of hearing [] deaf

[] burning [] edema [] lesion [] teeth

Assess eyes, ears, nose

throat for abnormality [x] no problem

RESP.

[] asymmetric [x] tachypnea

[] apnea [] rales [x] cough [] barrel chest

[] bradypnea [] shallow [] rhonchi

[x] Sputum [] diminished [] dyspnea

[] orthopnea [] labored [] wheezing

[] pain [] cyanotic

Assess resp. rate, rhythm, depth, pattern,

breath sounds, comfort [] no problem

CARDIO VASCULAR

[] arrhythmia [] tachycardia [] numbness

[] diminishes pulses [] edema [x ]fatigue

[] irregular [] bradycardia [] murmur

[] tingling [] absent pulses [] pain

Assess heart sounds, rate, rhythm, pulse, blood

Pressure, circulation, fluid retention, comfort

[] no problem

GASTRO INTESTINAL TRACT

[] obese [] distention [] mass

[] constipation [] rigidly [] pain

Assess abdomen, bowel habits, swallowing,

Bowel sounds, comfort [] no problem

GENITO-URINARY

[] pain [] urine color [] vaginal bleeding

[] hematuria [] discharge [] nocturia

Assess urine freq., control color, odor, comfort,

GYN bleeding, discharge [x] no problem

NEURO

[] paralysis [] stuporous [] unsteady [] seizures

[] lethargic [] comatose [x] vertigo [] tremors

[] confused [] vision [] grip

Assess motor function, sensation, LOC, strength,

Grip, gait, coordination, orientation, speech

[] no problem

MUSCULOSKELITAL and SKIN

[] appliance [] stiffness [] itching [] petechiae

[] hot [] drainage [] prosthesis [] swelling

[] lesion [] poor turgor [] cool [] deformity

[] wound [] rash [] skin color [] flushed

[] atrophy [] pain [] ecchymosis

[] diaphoretic [] moist

NURSING SYSTEM REVIEW CHART

Name: Roldan, Princess Jelou Date: September 18, 2008Vital Signs:

Pulse:145bpm BP: not assessed Resp: 38 cpm Temp: 36.7C Height: not assessed Weight:not assessed

EENT:

[] impaired vision [] blind

[] pain [] reddened [] drainage

[] gums [] hard of hearing [] deaf

[] burning [] edema [] lesion [] teeth

Assess eyes, ears, nose

throat for abnormality [x] no problem

RESP.

[] asymmetric [x] tachypnea

[] apnea [] rales [x] cough [] barrel chest

[] bradypnea [] shallow [] rhonchi

[x] Sputum [] diminished [] dyspnea

[] orthopnea [] labored [] wheezing

[] pain [] cyanotic

Assess resp. rate, rhythm, depth, pattern,

breath sounds, comfort [] no problem

CARDIO VASCULAR

[] arrhythmia [] tachycardia [] numbness

[] diminishes pulses [] edema [x ]fatigue

[] irregular [] bradycardia [] murmur

[] tingling [] absent pulses [] pain

Assess heart sounds, rate, rhythm, pulse, blood

Pressure, circulation, fluid retention, comfort

[] no problem

GASTRO INTESTINAL TRACT

[] obese [] distention [] mass

[] constipation [] rigidly [] pain

Assess abdomen, bowel habits, swallowing,

Bowel sounds, comfort [] no problem

GENITO-URINARY

[] pain [] urine color [] vaginal bleeding

[] hematuria [] discharge [] nocturia

Assess urine freq., control color, odor, comfort,

GYN bleeding, discharge [x] no problem

NEURO

[] paralysis [] stuporous [] unsteady [] seizures

[] lethargic [] comatose [x] vertigo [] tremors

[] confused [] vision [] grip

Assess motor function, sensation, LOC, strength,

Grip, gait, coordination, orientation, speech

[] no problem

MUSCULOSKELITAL and SKIN

[] appliance [] stiffness [] itching [] petechiae

[] hot [] drainage [] prosthesis [] swelling

[] lesion [] poor turgor [] cool [] deformity

[] wound [] rash [] skin color [] flushed

[] atrophy [] pain [] ecchymosis

[] diaphoretic [] moist

Nursing Assessment II

Subjective Objective

COMMUNICATION:

[] Hearing Loss Comments: Makadungog

[] Visual Changes ug motan-aw man sya kung [x] Denied tawagon iya pangalan, as

verbalized by the patients mother

[] Glasses [] Languages

[] Contact Lens [] Hearing Aide

R L

Pupil Size: 2mm [] Speech Dificulties

Reaction: Both Pupils are equally round and are reactive to light accommodation.

OXYGENATION:

[x] Dyspnea Comments:Ga lisod siya[]Smoking og ginhawa usahay ,asHistory: verbalized by the mother.None

[x] Cough

[x] Sputum

[] DeniedResp. [x] Regular [] Irregular

Describe: equal lung expansionR: Crackles present

L: Crackles present

CIRCULATION:

[] Chest Pain Comments: dli paman ni sya

[] Leg Pain kstorya kung sakit,as As verbalized by the patients[] Numbness of mother Extremitries

[x] Denied

Heart Rhythm [] Regular [x] Irregular

Ankle Edema: None

Pulse: Car. Rad. DP Fem*

R: + + + NOT ASSESSED

L: + + + NOT ASSESSED

Comments: All pulses are present and palpable.

* If applicable

NUTRITION:

Diet : breastfeeding per demand[] N [] V Comments: kusog man xa[] Recent Change mo dede as verbalized by

Weight, Appetite the patients mother

[] Swallowing Difficulty

[x] Denied [] Dentures [x] None

Full Partial With PatientUpper [] [] []

Lower [] [] []

ELIMINATION:

Usual Bowel Pattern [] Urinary Frequency

2 x / day 4-5x/day

[] Constipation Remedy [] Urgency

None [] Dysuria

Date of Last BM [] Hematuria

Sept 17, 2008 [] Incontinence

[] Diarrhea Character [] Polyuria

N/A [] Foley in Place

[x] DeniedComments: Bowel sounds Bowel Sounds: Upon auscultation was Normal

normal, Abdominaldistention

Present [] Yes [x] No

*Urine(Color, Consistency, Odor)

N/A

MGT. OF HEALTH & ILLNESS:

[] Alcohol [x] Denied

(amount, frequency)

[] SBE Last Pap Smear: N/A

LMP: N/A

Briefly describe the patients ability to follow treatment (diet, meds, etc.) for chronic health problems (if present)

The patient who is diagnose with bronchopneumonia wasnt able to follow the prescribed treatment ordered for him due to lack of financial resources.

SKIN INTEGRITY:

[x] Dry Comments: uga kau iyang panit, as verbalized

[] Itching by the pts. mother[] Other

[] Denied

[x] Dry [] Cold [x] Pale

[] Flushed [] Warm

[] Moist [] Cyanotic

Rashes, Ulcers, Decubitus (describe size, location and drainage). The patient does not have rashes, ulcers, or decubitus present.

ACTIVITY/SAFETY

[] Convulsion Comments: dli paman xa[] Dizziness makalakaw-lakaw, as[] Limited Motion

of Joints verbalized by the pts mother.

Limitation in

ability to

[x] Ambulate

[x] Bathe self

[] Other

[] Denied[x] LOC and orientation: The patient is conscious and responsiveGait: [] Walker [] Cane [] Other

[] Steady [] Unsteady

[x] Sensory and motor losses in the face or extremities: None[x] ROM Limitations: None

COMFORT/SLEEP/AWAKE:

[] Pain Comments: cge xa mata mata

(Location, pagkatulog sa gabie,as verba- Frequency, lized by the pts. mother Remedies)

[] Nocturia

[x] Sleep Difficulties

[] Denied[] Facial Grimaces

[] Guarding

[] Other signs of pain: no signs of pain[] Siderail release form signed (60+years)

N/A

COPING:

Occupation: childMembers of household: 3 including the patientMost supportive person: Mother.Observed non-verbal behavior: The patient seems to not mind our presence. Readily and honestly questions given to him.

The person and his phone number that can be reached anytime: Not disclosed by the patient.

XI. NURSING CARE PLAN

CUESNURSING DIAGNOSISOBJECTIVENURSING INTERVENTIONRATIONALEEVALUATION

Subjective:

naa lang ghapon iyang ubo as verbalized by the patients mother

Objective:

>productive cough

>crackles upon auscultation

Ineffective airway clearance related to increased mucus production, fatigue, and coughAt the end of 30 min. to an hour of nursing interventions, the patient will be able to effectively clear secretions.1. Position patient in high-Fowlers or semi-Fowlers position.

2. Turn patient every 2 hours and prn.

3. Perform chest percussion and postural drainage as warranted.

4. encouraged increase in fluid intake

5. Administer bronchodilators as ordered.

1. Promotes maximal lung expansion.

2. Reposition promotes drainage of pulmonary secretions and enhances ventilation to decrease potential atelectasis.

3. Mobilizes secretions and facilitates ventilation of all lung field

4. to help loosen up secretions

5. Promotes relaxation of bronchial smooth muscle to decrease spasm, dilates airways to improve ventilation, and maximizes air exchange.

At the end of our nursing interventions the patient was able to maintain patent airway

NURSING CARE PLAN

CUESNURSING DIAGNOSISOBJECTIVENURSING INTERVENTIONRATIONALEEVALUATION

Subjective:

wla na gyud mi kwarta na ikapalit, dli nami gapautangon dnha sa pharmacy as verbalized by the patients mother.

Objectives:

> feelings of tiredness and hopelessness

> depress mood

Ineffective therapeutic management related to lack of financial supportAt the end of 30 minutes of nursing intervention, the patients mother will be encouraged to seek help to other health agencies in order to secure medications.1. Encouraged expression of feelings

2. Provided a therapeutic communication.

3. Discussed the importance of medication compliance

4. Provided alternative ways to gain free medical services.

1. To know what the mother feels towards the situation.

2. To establish trust and rapport.

3. To value the importance of taking the medications.

4. To encourage them to secure medications in other waysAt the end of our nursing intervention, our objective wasnt met because the mother refuse to ask for help to health care agencies.

NURSING CARE PLAN

CUESNURSING DIAGNOSISOBJECTIVENURSING INTERVENTIONSRATIONALEEVALUATION

Subjective:

wala pa man na nko sya gpunasan as verbalized by the patients mother.

Objectives:

foul smell

dirty clothings

wet underwearSelf care deficit related to inability to bathe oneselfAt the end of 30 minutes of nursing intervention, the patients mother will be able to bathe and change her childs clothing1. Wiped the client with wash cloth soaked in soap and water.

2. Changed the patients clothing to a cleaner one.

3. Encouraged the patients mother to changed the soiled linens.

4. Instructed the mother to wash the client everytime that he wets he solied his underwear.1. To promote cleanliness to the client as well as to the mother

2. To promote sense of well being.

3. To promote wellness and cleanliness.

4. To promote wellness and cleanlinessAt the end of 30 minutes, the patients mother was able to follow instructions in maintaining and promoting cleanliness and wellness to the patient.

XII. DISCHARGE PLANNING AND REFERRAL

A. MEDICATIONInstructed the patients mother to take home medications religiously and to report any signs of adverse reactions: erythromycin 2.5 ml three times a day for 7 days

B. EXERCISESEncouraged the patients mother to perform on her child passive range of motion exercises and to perform chest physiotherapy in order to help loosen secretions and promote lung expansion.

C. TREATMENTEncouraged the patients mother to provide adequate rest periods to the client and to observe and promote proper personal hygiene

D. OUTPATIENTEncouraged the patients mother to return to the hospital a week after discharge for a follow-up check-up from Monday to Friday, from 8:00am to 5:00pm for a follow-up check-up.

E. DIETEncouraged the patients mother to provide nutritious foods such as fruits and vegetables and to increase oral intake of fluids.

XIII. EVALUATION AND IMPLICATION

After two days of Hospital visit at the Bukidnon Provincial Hospital Malaybala- Pedia Ward, I was able to achieve the goal in rendering our hospital visit and the bedside care to our patient. I was able to do our nursing interventions as part of our nursing care plan. I can say that the prognosis is good since the disease has been diagnosed and prompted early treatment, but inspite of that there is a problem with the medication compliance because of lack of financial resources. Adequate diet and supplements was encouraged to suffice the daily requirement of the patient.

During the interview and assessment I was able to established trust and rapport with each other and implemented our nursing care as planned. The importance of follow-up check-up examinations and treatment was stressed to the family because of the complications that will brought about of the disease.XIV. BIBLIOGRAPHY

http://en.wikipedia.org/wiki/BronchopneumoniaMedical-Surgical Nursing, 10th Edition by. Smeltzer

S/Sx

Sore throat

Intermittent cough

Fever

Chilling

S/Sx

Productive Cough

Fever

Labored Breathing

Sleep disturbance

Fatigue

Depresses fontanels

D5IMB 500cc @ 35 gtts/min

Productive cough

Crackles upon auscultation

Dry skin

Sleep disturbance

Fatigue

Depressesed fontanels

D5IMB 500cc @ 35 gtts/min

Productive cough

Crackles upon auscultation

Dry skin

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bronchi pneumonia

Documents

lobular pneumonia

lobar pneumonia

patterns of pneumonia

bronchopneumonia lobular

types of bacterial pneumonia

introduction bronchopneumonia

common illness

elderly people