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INTRODUCTION
Bronchopneumonia (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,
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Treatment
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 ones susceptibility to pneumonia, since the flu
precedes pneumonia development in many cases.
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Gordons 11 Functional Pattern
1. Health Perception Health Management Pattern
BEFORE HOSPITALIZATION
According to the patient, for him, health is being free form illness, able to
play and go to school and eating nutritious foods.
The S.O states that whenever patient suffers from simple illnesses they
make him take over-the-counter medicines such as paracetamol and solmux-
syrup.
DURING HOSPITALIZATON
According to the patient, he views himself as weak and wasnt able to do
his daily activities. He manages his condition by complying with the entire
doctors order and taking adequate rest.
According to the S.O., patient has a strong sensitive smell towards
aromatic things and easily gets a headache upon smelling those.
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the same color of urine. During his stay in the hospital, he wasnt able to defecate
since day 1.
4. Activity Exercise Pattern
BEFORE HOSPITALIZATION:
According to the S.O., the patient loves to play with his playmates after
school. They usually play agawan base and tagutaguan. The S.O. also states
that the patient helps in the household chores like washing the dishes and cleaning
their table after dinner. Patient also plays with his younger brother.
DURING HOSPITALIZATION:
The patient is dependent to his parents. He said that he cant do his usual
activities because of his illness.
5. Sleep Rest Pattern
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8. Self- perception/Self-concept Pattern
He perceives his self as a caring person. Malambing po ako kina mama.
Mabait po ako sa mga kalaro ko at classmate ko. Hindi po ko nakikipag away
palagi paminsan-minsan lang pag tama po ako, as verbalized by the patient.
9. Sexual Reproduction Pattern
According to the S.O., patient K.M. was circumcised when he was five
years of age. She is aware of her sexual social status.
10. Coping Stress Management Pattern
The patient relies on her parents for support. Whenever he feels down and
sad he runs to her mother and grandmother for comfort.
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PHYSICAL ASSESSMENT
Initial Vital Sign: PR= 118 RR= 28 T= 36.8 WT: 17kgs
AREA
ASSESSED
METHOD
USED
NORMAL
FINDINGS
ACTUAL
FINDINGS
ANALYSIS
SKIN
- Color
- Texture
- Hair
distribution- Temperature
- Moisture
HAIR
Inspection
Inspection/
Palpation
Inspection
Palpation
Palpation
Light to Deepbrown
Smooth
Evenly
distributedNormally warm
Moist to dry
Brown
Smooth
Evenly
distributedBody
Temperature:37oC
Moist to dry
Normal
Normal
Normal
Normal
Normal
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AREA
ASSESSED
METHOD
USED
NORMAL
FINDINGS
ACTUAL
FINDINGS
ANALYSIS
OCULARMOVEMENT
EARS
- Symmetryand position
EXTERNALAUDITORY
CANAL
- Hearing
NOSE
- Symmetry
- Color
Inspection
Inspection
Inspection
Inspection
Inspection
Both eyes moveparallel with
each other in
directions ofgaze
Auricles are atlevel of each
other
Hears equally
in both ears
Symmetrical
Same color as
Both eyes moveparallel with
each other in
directions ofgaze
Auricles are atlevel of each
other
Hears equally
in both ears
Symmetrical
Same color as
Normal
Normal
Normal
Normal
Normal
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ASSESSED METHOD
USED
NORMAL
FINDINGS
ACTUAL
FINDINGS
ANALYSIS
UPPEREXTREMITIES
- Skin color
- Size (arms)
- Symmetry
LOWER
EXTREMITIES
- Skin color
- Size (legs)- Symmetry
Inspection
Inspection
Inspection
Inspection
InspectionInspection
Light to deepbrown
Equal Size
Symmetrical
Light to deep
brown
Equal SizeSymmetrical
Brown
Equal Size
Symmetrical
Brown
Equal SizeSymmetrical
Normal
Normal
Normal
Normal
NormalNormal
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LABORATORY RESULT
Chest X-Ray PAL Views
September 17,07
Parihilar and paracardiac infiltrates, bilateral.
Hilar nodularities
Heart is normal in size
Diaphragm and sinuses are normal
Intact bony thorax
Impression: Parahilar and Paracardiac pneumonitis, bilateral.
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Date : September 17, 2007
Examination result Normal findings Actual findings Analysis
WBC
HGB: Hemoglobin
HTC: Hematocrit
Differential count:
Segmenters
Lymphocytes
5-10 x 10 ^ 9/L
13-18 g/dL
39.0 54.0 %
0.60 0.70
0.20 0.30
8.7
11.5
35
0.76
0.24
Normal
Due to hemodilution
Due to hemodilution
Due to infection
Normal
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PATHOPHYSIOLOGY
`
Predisposing Factors:-Race
-Gender-Age
Etiologic Agent:
-Streptococcus pneumoniae-Staphylococcus Aureus
-Mycoplasma-Chlamydias
-Viruses
Precipitating Factors:-Environment
-weather
Aspiration of virulent microorganisms
Impairs extensive defense mechanism in the upper respiratory system
Bacteria reach trachea
Bacteria affects the globlet cellSystem has recognized it as irritant and
antigen
Cough reflexReaches the lungs
Inflammatory response
Cough
Increase in secretions
Inflammation of respiratory passage
A
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WBC and neutrophils migrate into the alveoli
Pyrogen is released
Fever
Impaired permeability of alveolarwalls
Fluid accumulates in alveoli
Pulmonary edema
Reduce surface area for gas exchange
Spasmodic contraction of walls of bronchi
CO2 increases and O2 decreases
Stimulate respiratory center
Bronchospasm
Failure of left side of heart
Pooling of secretions
Adventitiousbreath sounds
Unproductive coughHyperventilation Cells receive ineff icient O2
Partial cyanosis
A
Fatigue
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PATIENTS PROFILE
Name : K.M.
Age : 5
Sex : Male
Date of birth : March 06, 2000
Civil status : Single
Address : Tuao, Cagayan
Religion : Roman Catholic
Date of Admission : September 17, 2007
Chief complaint : Cough
Attending Physician : Dr. E. Babaran
Final Diagnosis : Bronchopneumonia
PATIENTS MEDICAL HISTORY
Family Health History
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ANATOMY AND PHYSIOLOGY
The lower respiratory tract
Larynx
Is located in the anterior throat, and it connects superiorly to the pharynx and
inferiorly to the trachea. It is the site of voice production. Air moving past the vocal folds
causes them to vibrate producing sound. It is also called voice box.
Trachea
It is also called windpipe. It is a membranous tube that consists of connective
tissue ad smooth muscle, reinforced with 16-20 C-shaped pieces of cartilage. It is lined
with pseudostratified columnar epithelium, which contains numerous cilia and goblet
cells. The cilia propel mucus produced by the goblet cells, as well as foreign particles
embedded in the mucus, out of the trachea, through the larynx, and into the pharynx,
from which they are swallowed.
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There are several divisions of bronchi within each lobe of the lungs. First are the
lobar bronchi (three in the right and 2 in the left lung). Lobar bronchi divide into
segmental bronchi, which are the structures identified when choosing the most effective
postural drainage position for given patient. Segmental bronchi then divide into
subsegmental bronchi. These bronchi are surrounded by connective tissue that contains
arteries, lymphatics, and nerves.
Bronchioles have no cartilage on their walls. Their patency depends entirely on
the elastic recoil of the surrounding smooth muscle and on the alveolar pressure. It
contain submucosal glands, which produce mucus that covers the inside lining of the
airway.
Terminal bronchioles do not have mucous glands or cilia. It becomes the
respiratory bronchioles which are considered to be the passageways between the
conducting airways and the gas exchange airways.
Alveoli
The lung is made up of 300 million alveoli, which are arranged in a cluster of 15
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DRUG STUDY
Name of medicine : Paracetamol
Classification : Antipyretic; Analgesic
Action : Thought to produce analgesia by blocking pain impulses by
inhibiting synthesis of prostaglandin in the CNS or of other
substances that sensitize pain receptors to stimulation. The
drug may relieve fever through central action in the
hypothalamic heat-regulating center.
Adverse Reaction : Hematologic : Hemolytic anemia, neutropenia,
leukopenia, pancytopenia.
Hepatic : Jaundice
Metabolic : Hypoglycemia
Skin : Rash, Urticaria
Contraindications : Contraindicated in patients hypertensive to drug. Use
cautiously in patients with long-term alcohol use because
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Name of medicine : Diazepam (Valium)
Classification : Minor Tranquillizer
Indication : The management of anxiety disorders or for the short-term
relief of the symptoms of anxiety. Anxiety or tension
associated with the stress of everyday life usually does not
require treatment with an anxiolytic. It is a useful adjunct
for the relief of skeletal muscle spasm due to reflex spasm
to local pathology (such as inflammation of the muscles or
joints, or secondary to trauma); spasticity caused by upper
motor neuron disorders (such as cerebral palsy and
paraplegia); athetosis; stiff-man syndrome; and tetanus. It is
also a useful adjunct in status epilepticus and severe
recurrent convulsive seizures.
Adverse Reaction : Commonly reported were drowsiness, fatigue and ataxia;
venous thrombosis and phlebitis at the site of injection.
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Nursing consideration: In pediatric use, in order to obtain maximal clinical effect
with the minimum amount of drug and thus to reduce the risk
of hazardous side effects, such as apnea or prolonged periods
of somnolence, it is recommended that the drug be given
slowly over a 3-minute period in a dosage not to exceed 0.25
mg/kg. After an interval of 15 to 30 minutes the initial
dosage can be safely repeated. If, however, relief of
symptoms is not obtained after a third administration,
adjunctive therapy appropriate to the condition being treated
is recommended.
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Name of medicine : Klaricid
Classification : Macrolides
Indication : Treat infections such as:
Throat and sinus infections
Chest infections such as bronchitis and pneumonia
Skin and skin structure infections
Ear infections particularly inflammation of the middle
ear (acute otitis media)
Adverse Reaction : Nausea, dyspepsia, abdominal pain & diarrhea, headache &
skin rash.
Contraindications : Known hypersensitivity to macrolides. Concomitant use of
clarithromycin w/ cisapride, pimozide or terfenadine.
Patients receiving terfenadine therapy w/ preexisting
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LEARNING FEEDBACK DIARY
Name: Charisse Marichu P. Baculi Date: September 05, 2007
Clinical Instructor: Mrs. Leonor De Laza Area: SPH F2 and F1
Objectives: At the end of the rotation, I will be able to:
1. Establish rapport to my patient
2. Be efficient in giving total patient care
3. Augment my skills and confidence
Not like during our past rotation, this time I felt more confident and a little
knowledgeable on the things to be done in the hospital. The hospital protocols were
clearly registered on my mind.
It was my first time to be on the area, floor 1, and it made me a little tense
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LEARNING FEEDBACK DIARY
Name: Charisse Marichu P. Baculi Date: October 01, 2007
Clinical Instructor: Mr. Randolph Balungaya Area: SPH F1
Objectives: At the end of the rotation, I will be able to:
4. Establish rapport to my patient
5. Be efficient in giving total patient care
6. Augment my skills and confidence
Not like during our past rotation, this time I felt more confident and a little
knowledgeable on the things to be done in the hospital. The hospital protocols were
clearly registered on my mind.
It was my first time to be on the area, floor 1, and it made me a little tense
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A Case
Study
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Submitted by:Jane Galiza
Charisse Marichu Baculi
(RLE- 08)
A Case
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Submitted to:
Mr. Randolph Balungaya, RN
Submitted by:
Charisse Marichu Baculi
(RLE- 08)
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ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective data:
hindi ko mailabas angplema ko po paginuubo
ako, as verbalized bythe patient.
Objective data:
crackles
difficulty
vocalizing
ineffective
coughing
Ineffective airwayclearance related to
excessive, thickenedmucus secretions as
evidenced by ineffectivecough.
At the end of 1 hour, thepatient will be able to
maintain airway potencyand expectorate/clear
secretions readily.
Elevate head of thebed/ change position
every 2 hours.
Encouraged deep-
breathing and coughingexercises.
Increase fluid intake
Provide supplementalhumidification
(nebulizer).
Monitored vital signs.
Performed chest
physiotherapy.
To take advantage ofgravity decreasing
pressure on the
diaphragm.
To mobilize
secretions.
To help liquefy
secretions.
To ascertain status andnote progress.
To assess changes andnote complications.
To loosen secretions.
Goal partially met. At theend of 1 hour, the patient
was able to maintainairway potency and
expectorate/clearsecretions readily.
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ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective data:
mainit ang pakiramdamko at giniginaw ako, as
verbalized by the patient.
Objective data:
Chills
Elevated temperature
of 38.2 0C.
Alteration in bodytemperature:
hyperthermia related toincrease pyrogens in the
body.
At the end of 2 hours, thepatient will be able to
experience improvementin infection as evidence
by normothermia andnegative sputum culture
report.
Monitor vital signs,closely monitoring
temperature fluctuations.
Monitor WBC
Encourage to increasefluid intake.
Promote surfacecooling by means ofundressing; cool/tepid
sponge bath orimmersion; local ice
packs especially in groinor axillae.
Continued fever maybe caused by drug abuse,
drug-resistant bacteria,
super infection, orinadequate lungdrainage.
High white blood cell
counts indicate thepresence of an infection
or inflammation.
Fluid loss contributesto fever.
To reduce bodytemperature/restorenormal body/organ
function.
Goal partially met. At theend of 2 hours, the
patient was able todemonstrate
improvement in infectionas evidence by:
Temperature : 37.3 0C
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ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective data:
hindi ako nakaka-tulog
ng husto dahil sa pag-ubo ko, as verbalized by
the patient.
Objective data:
Dark circles undereyes
Restlessness
Expressionless face
Frequent yawning
Disturbed sleep pattern
related to statis ofsecretions.
At the end of 2 hours, the
patient will be able toachieve optimal amounts
of sleep as evidence byrested appearance,
verbalization of feelingrested, and improvement
in sleep pattern.
Provide nursing aid:
back rub bedtime care,
pain relief, comfortableposition, and relaxationtechnique.
Attempt to allow for
sleep cycles of at least90mins.
Discourage pattern of
daytime naps unlessnecessary or part of usual
pattern.
Limit fluids before
bedtime.
To promote rest and
relaxation.
To promote
completion of onecomplete cycle and
completion of an entirecycle is necessary to
benefit from sleep.
Napping can disrupt
normal sleep pattern.
To reduce need for
voiding during night.
Goal partially met. At the
end of 2 hours, thepatient was able to
achieved optimalamounts of sleep as
evidence by restedappearance and
verbalization of feelingrested.
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ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective data:
Hindi pa siya tumataemula nung pumasok
kame dito sa hospital, asverbalized by the S.O.
Objective data:
Dull headache
Restlessness
Abdominal distention
Impaired bowel
elimination pattern r/tinadequate fluid intake
At the end of the shift,
the patient will be able topass soft, formed stool ata normal pattern of
defecation.
Auscultate abdomen
for presence, locationand characteristic of
bowel sounds.
Encourage andprovide adequate fluid
intake, including waterand high-fiber fruit
juices.
Encourage balance
fiber and bulk diet.
Encourageactivity/exercise within
limits of patients ability
To reflect bowel
activity.
To promote moist/softstool
To improve
consistency of stool andfacilitate passage throughthe colon.
To stimulatecontractions of the
intestine.
Goal partially met. At the
end of the shift, patientwas able to pass soft,formed stool at a normal
pattern of defecation.