Bicol University College of Nursing Legazpi City

A Case Study of BRONCHOPNEUMONIA

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS IN NCM 102

Submitted by: Group 4 Malacad, Dane Carmela Monsalve, Kerensa Ortega, Daryl Nuyda, Aljo Pagdagdagan, Lyderlee Poguilla, Trexy Publico, Jesse Rey Puentebella, Michelle May BSN II-A

Submitted to: Heintje T. Llana, RN Instructor

INTRODUCTION Pneumonia is an inflammation of the lungs caused by an infection. It is also called Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our health. Although pneumonia is a special concern for the older adults and those with chronic illnesses. It can also strike young and healthy people as well. It is a common illness that affects thousands of people each year in the Philippines, thus, it remains an important cause of morbidity and mortality in the country. There are many kinds of pneumonia that range in seriousness from mild to lifethreatening. In infectious pneumonia, bacteria, viruses, fungi or other organisms attack the lungs, leading to inflammation that makes it hard for an individual to breathe. Pneumonia can affect one or both lungs. In young and healthy individual, early treatment with antibiotics can cure bacterial pneumonia. The drugs used to fight pneumonia are determined by the germ causing pneumonia and the doctors findings. It is best to do everything we can to prevent pneumonia, but if one get sick, recognizing and treating the disease early offers the best chance for a full recovery. A case with a diagnosis of Pneumonia may catch ones attention, though the disease is just like an ordinary cough and fever, it can lead to death especially when there is no immediate intervention done. Since the case is an infant, an appropriate care has to be done to promote faster recovery for the patient. Treating patients with pneumonia is necessary to prevent its spread to others and make them as another victim of this illness. Bronchopneumonia is an illness of the lungs which is caused by different organism like bacteria, viruses, and fungi and characterized by acute inflammation of the walls of the bronchioles. It is also known as pneumonia. Streptococcus pneumoniae (pneumococcus) and Mycoplasma pneumoniae both are the common bacterium which causes bronchopneumonia in the adults and children. Acute inflammation of the walls of the smaller bronchial tubes, with varying amounts of pulmonary consolidation due to spread of the inflammation into peribronchiolar alveoli and the alveolar ducts; may become confluent or may be hemorrhagic. In Philippines, the case of pneumonia is one of leading cause of mortality and morbidity among Filipinos, 75-85% of the population acquired the disease and the one affected the disease are those who are in low income status and the below poverty line individual. (www.DOH.org/pneumonia)

DEFINITION OF TERMS

Bradypnea - slower than normal rate (<10 breaths/minute), with normal dept and regular rhythm Dyspnea distressful sensation of uncomfortable breathing that may be caused by certain heart conditions Empyema inflammatory fluid and debris in the pleural space. It results from an untreated pleural-space infection that progress from free-flowing pleural fluid to a complex collection in the pleural space.

Hypoxemia decrease in arterial oxygen tension in the blood Mycoplasma pneumonia another type of Community Acquired Pneumonia (CAP), occurs most often in children and young adults and is spread by infected respiratory droplets through person-to-person contact

Pleural effusion abnormal accumulation of fluid in the pleural space Pleural cavity the area between the parietal and visceral pleurae a potential space Substernal Retraction indrawing beneath the breastbone, commonly manifested to infant and neonate with respiratory distress Thoracentesis insertion of a needle into the space to remove fluid that has accumulated and decrease pressure on the lung tissue; may also be used diagnostically to identify potential causes of a pleural effusion

Thoracostomy - done to drain fluid, blood, or air from the space around the lungs

OBJECTIVES General: After 30 minutes of case presentation, the student nurse will be able to present the summary of the different aspect of the clients case in order to promote further consciousness and awareness of the condition for the promotion of health and prevention of further complications as equally significant to the clients wellness. Specific: After a week of accomplishing this case study, the student nurses will be able to: accomplish assessment to gather pertinent data about the client as deemed relevant to the case name the major health problem of the client defined the technical terms found in the course of study to facilitate better understanding present the anatomy and physiology discuss the pathophysiology of the clients disease condition present laboratory studies conducted therein present other ideal laboratory studies and their implication to support the diagnosis of the disease determine the appropriate nursing diagnosis for the clients case create a plan of care appropriate for the clients condition commit to effectively execute or implement nursing care plan for the client, including all nursing interventions suited evaluate the efficiency of the nursing care provided according to the nursing care plan

PATIENTS PROFILE Name: Baby Jesse Address: #156 Basud, Polangui, Albay Age: 6 months old Birth date: February 18, 2011 Birthplace: Dr. Isip Hospital Gender: Male Religion: Roman Catholic Nationality: Filipino Fathers name : Felly Baguio Rone Mothers name: Neiva Dumanjug Rone Date of Admission: December 30, 2010 Time of Admission: 6:25 AM Chief Complaint: on and off cough associated with fever Admitting Diagnosis: Bronchopneumonia Admitting Physician: Dr. Alimyon Isip, MD

PERSONAL HISTORY: DEMOGRAPHIC DATA Baby Jesse is a 6 months old infant; male, 1st child of Mr. and Mrs. Rone, are living in #156 Basud, Polangui, Albay. He was born last 18th of February in Dr. Isip Hospital and was delivered via normal spontaneous delivery .Mrs. Rone and Baby Jesse stayed in the hospital for three (3) days, then was discharge. After 4 days, Mr. and Mrs. Rone returned, exclaiming that baby Jesse is manifesting on and off cough associated with fever and was immediately checked by the physician on duty and diagnose of Bronchipneumonia. Informant: Mrs. Rone, mother of the patient

SOCIOECONOMIC AND CULTURAL FACTORS Family is living a typical life in Polangui. Mr. Rone is a security guard of a certain bank in their area earning atleast Php5000 a month, a graduate of HS and reached the 2nd year level of his course criminology, and Mrs. Rone is a housewife, has finished HS and did not continue college due to financial constraint in their family. Parents of Mrs. Rone seldom help them in their financial needs. Mr. and Mrs. Rone are both Roman Catholic and is closed to God and has several health beliefs and practices that were learned from their parents. A belief of the hilot is one health belief they are still giving their credence. FAMILY HEALTH ILLNESS: HEREDITARY DISEASE IN THE FAMILY According to Mr and Mrs. Rone, the family does not have any hereditary disease. Any of both sides of the family die because of aging and accident EXISTING DISEASES IN THE FAMILY Mr. Rones mother is still alive and in good health condition and his father died because of old age. Mrs. Rones father does not have any disease at present and her mother already died because of old age also.

HISTORY OF PRESENT ILLNESS: When Mrs. Rone finally went home he noticed that Baby Jesse was in good condition, evident with a normal brown skin. 3 days prior to admission, Baby Jesse experienced on and off cough and associated with fever, with intercostals retraction, rapid and shallow breathing.

PHYSICAL ASSESSMENT A 4-month old baby boy Weigh 6.8 kilograms Cyanosis noted upon coughing Rapid shallow breathing noted Expressed his self through crying Skin is warm to touch Irritability noted due to his condition

Neurological The patient can able to expressed his self through crying. Eye/Vision Our patient, have pale conjunctiva due to fever. Eyelashes present curving outward. No lesions noted on the eyelid. Pupil equal, round, reactive to light and accommodation. Ears/Hearing Our patient doesnt have hearing problem, no discharges, symmetrical, no swelling and tenderness. Can respond normal voice tone. Intact with no lesions. Nose Our patient doesnt have nasal problem, any discharges, any swelling and tenderness noted upon inspection and uniform in color. Mouth/Tongue/Teeth/ Speech The patient had a pallor lips, reddened gums, without teeth. Thin whitish coating noted in the tongue, it moves freely without lesions. Throat/Neck Neck is symmetrical with head, can turned head from right to left gradually, but with resistance, no palpable lymph nodes. Respiratory System Patient use accessory muscle in order to breathe normally, presence of wheezing sound is heard upon auscultation and in normal hearing, with respiratory rate of 60-42 cpm., and nebulization was given. Circulatory/Cardiovascular Patient has a heart rate of 156-140 beats per minute. No edema and swelling noted. Good capillary refill less than 2sec. Gastrointestinal Flat abdominal contour, no tenderness or distention. Thorax had dullness of sound due to decrease confluent and pleural effusion.

Genitourinary Patient had excessive urination, with minimum of 800cc per diaper Musculoskeletal The patient had normal upper and lower extremities, symmetrical and no tenderness Integumentary The patient's skin was warm to touch, he experience on and off fever, with good skin turgor. Negative of rashes, sores, and lesions.

ANATOMY AND PHYSIOLOGY

A respiratory system functions to allow gas exchange. The gases that are exchanged, the anatomy or structure of the exchange system and the precise physiological uses of the exchanged gases vary depending on the organism.

The respiratory system can be conveniently subdivided into an upper respiratory tract (or conducting zone) and lower respiratory tract (respiratory zone), trachea and lungs. The conducting zone starts with the nares (nostrils) of the nose, which open into the nasopharynx (nasal cavity). The primary functions of the nasal passages are to: 1) filter, 2) warm, 3) moisten, and 4) provide resonance in speech. The nasopharnyx opens into the oropharynx (behind the oral cavity). The respiratory is an intricate arrangement of spaces and passageways that conduct air from outside the body into the lungs and finally into the blood as well as expelling waste gasses. This system is responsible for the mechanical process of breathing, with average adult breathing about 12 to 20 times per minute. When engaged in strenuous acuities, the rate and depth of breathing increases in order to handle the increased concentrations of carbon dioxide in the blood. Breathing is typically an involuntary process but can be consciously stimulated of in holding your breath.

Nostrils/Nasal Cavities During inhalation, air enters the nostrils and passes into the nasal cavities where foreign bodies are removed, the air is heated and moisturized before it is brought further into the body. It is part of the body that houses our sense of smell. Sinuses The sinuses are small cavities that are lined with mocuos membrane within the bones of the skull. Pharynx The pharynx, or throat carries foods and liquids into the digestive tract and also carries air into the respiratory tract Larynx The larynx or voice box is located between the pharynx and trachea. It is the location of the Adams apple, which in reality is the thyroid gland and houses the vocal cords. Trachea The trachea or windpipe is tube that extends from the lower edge of the larynx to the upper part of the chest and conducts air between the larynx nd the lungs. Lungs The lungs are the organ in which the exchange of gasses takes place. The lungs are made up of extremely thin and silicate tissues. At the lungs, the bronchi subdides, becoming progressively smaller as they branch through the lung tissue, until they reach the tiny air sacks of the lungs called the alveoli. It is the alveoli that gasses enter and leave the blood stream. Bronchi The trachea divides into two part called bronchi, which enters the lungs. Bronchioles The bronchi sudide creating a network of smaller branches, with the smallest one being the bronchioles. There are more than one million bronchioles in each lung. Alveoli The alveoli are tiny air sacks that are enveloped n the network of capillariesit is here that the air we breathe is diffused into the blood, and waste gasses are returned for elimination.

PATHOPHYSIOLOGY
Predisposing factors Precipitating factors

Age (very young) Gender

Exposure (living)

Daily Activities Environment Diet

Pathological Entry (inhalation) of organism: Bacteria or Viruses

Occurrence of localized

Mucus

Manifested by

Diminished
production

Bacteria invades alveolar cell in the lungs

Sign and Symptoms

Formation of
Hyaline membrane

Bronchopneumonia Airway Obstructio Pulmonary Edema

Fever Cough Chest pain Rapid, shallow breathing Shortness of breath Headache Loss of appetite Fatigue
Chest Thoracostomy Tube

A. B. C. urs:

If disorderDaily Environment Diet

If disorder is Treated,

Empyema Lung Abscess Pleurisy Pericarditis

Normal breathing pattern Normal respiratory rate Breath sounds

DIAGNOSTIC AND LABORATORY PROCEDURES URINALYSIS Color: pale yellow Transparency: clear Sp. Gravity: 1.010 pH: 6.0 Microscopic findings RBC: 0-1/hpf Pus cells 0-1/hpf Epithelial cells: rare Crystals: Amorphous Urates (PD 4) rare/hpf Bacteria: rare HEMATOLOGY TEST Hematocrit Hemoglobin White cell count Platelet count Segmenters Lymphocytes Blood Type NORMAL VALUES 35.0-50.0% 12.0-16.5 g/dl 5,000-10,000mm 150,000-400,000/mm 55-65% 25-35% RESULT 33.0 11.0 3,600 275,000 42 58 B RH type(+)

BLOOD CHEMISTRY TEST NORMAL VALUES 136-145 mEq/L 3.5-5 mEq/L RESULT

Sodium Potassium

132.7 mEq/L 3.23 mEq/L

RADIOGRAPHIC REPORT

Chest X-ray: There are inhomogeneous parasites in both lower lung fields. The cilia and pulmonary vascular markings are within normal limits. The trachea is midline The heart is not enlarged. The hemi diaphragms and costophrenic angles are intact. The rest of the osseous and soft tissue structures are unremarkable.

Impression:

PNEUMONIA, BILATERAL FOLLOW UP CHEST X-RAY IS SUGGESTED.

DISCHARGE TEACHING PLAN

The medication of the patient is very important to continue depending on the duration that the doctor ordered for the total recovery of the patient. Patient with Bronchopneumonia needs to have deep breathing exercise for lung expansion and clearing for progressive normal breathing pattern and have adequate rest periods. The client must relax in order to recover his present condition and instructed significant others for minimal exposure to an open environment such as dusty and smoky area, which airborne microorganisms are present that can be a high risk factor that may cause severity of her condition. It is also important to maintain proper hygiene to prevent further infection. Significant others of the patient instructed that the baby should be bathe everyday. Regular consultation to the physician can be factor for recovery to assess and monitor his condition The diet of the patient is also a factor for fast recovery. Encouraged to eat nutritious foods intended for respiratory problem patient, the family of the patient plays a big role for the fast recovery