BRONCHOPNEUMONIA

ANISHA MANE
II ND YEAR M.SC NURSING
 PATIENT DATA:
PATIENT NAME: Mast. Altamash Saikh
AGE / SEX: 2 Years / Male
ADDRESS: Manisha Nagar, Kalva [W]
IP: 3055278
RELIGION: Muslim
BED NO: 35
DIAGNOSES: Bronchopnemonia
ADMISSION DATE: 07 / 02 / 2019
DOCTOR NAME: Dr. Rajesh Joshi
• On admission master Altamash brought with a complain of fever since 5
days, cough since 8 days, and breathlessness since 2 days.

• H / O Present Illness:2 years old male child was admitted in ward with
fever on and off, cough and breathing difficulty.

• H / O Past Illn ess: Had a history o f viral fever with cold and cough 2
months before.
 BIRTH HISTORY
• ANTENATAL- Mother attended check up regularly, no
illness during pregnancy, taken 2 doses of TT.
• INTRANATAL- Born through NVD, conducted by skilled
person at hospital, no complications, no evidence of
birth injury, cried immediately after birth, baby weight
was 2.6 kgs.
• POSTNATAL- No complication, baby was pink and active,
breast feeding started after1/2 an hour, no evidence of
congenital anomalies.
 IMMUNIZATION
• Taken all immunization according to the age group (BCG, DPT,
MEASLES,OPV)
• ANTHROPROMETRY
• Length-75 cms
• Weight-11kgs
• Head circum-45 cms Chest circum-48 cms Mid arm
circum-14 cms
FAMILY TREE:

Mr. Mohasin Mrs. Rubiya

32 years 35 years

Mast. Altamash Baby Aayan

2 years 3 months
DIETARY PATTERN:

Mast. Altamash eats both vegetarian and non vegetarian food. He is on full
diet.

SOCIO- ECONOMIC STATUS:

Mast. Altamash belongs from a low socio- economic status where the earning
member of the family is only his father. His father is taxy driver. Monthly
income of the family is between Rs.5,000- 10,000.
DEFINATION OF EMPHYMA

• Pneumonia is a breathing (respiratory) conditions in

which there is an infection and inflammations of the
lungs parenchyma cells.

• Pathologically there is consolidation of alveoli or

infiltration of the interstitial tissue with inflammatory
cell or both.
CLASSIFICATION OFPNEUMONIA
• Bronchopneumonia refers to inflammation of the lung that is centered in
the bronchioles and leads to the production of a mucopurulent exudate that
obstructs some of these small airways and causes patchy consolidation of the
adjacent lobules.
• Lobar pneumonia describes "typical" pneumonia localized to one or
more lobes of the lung in which the affected lobe or lobes are
completely consolidated.
 INCIDENCE

• The World Health Organization (WHO) estimates there are 1 5 6

m i l l i o n cases o f pneumonia each year in children younger
than five years, w i t h as many as 2 0 m i l l i o n cases severe
enough t o require hospital admission.
• Approximately one-half of children younger than five years of
age with community-acquired pneumonia (CAP) require
hospitalization.
• In the developed world, the annual incidence of pneumonia is
estimated to be 33 per 10,000 in children younger than five
years and 14.5 per 10,000 in children 0 to 16 years.
CAUSES OF EMPHYMA:

• BACTERIAL INFECTION
• Pneumococcus ,streptococcus ,staphylococcus , H.influenza

• Viral infection : Influenza virus, adenovirus

• Fungus: Candida, Histoplasma

• Aspiration of amniotic fluid ,food ,foreign bodies

PNEUMONIA PATOGENS IN VARIOUS AGEGROUP

• 1-3 Months: Parainfluenza ,Influenza ,Streptococcus

Pneumoniae.
• 4 Months To 5 Years :Streptococcus Pneumoniae,Chlamydia
Pneumoniae ,Mycoplasma Pneumoniae
• 5 To 18 Years : Mycoplasma Pneumoniae ,Chlamedia Pneumoniae
,Steptococcus Pneumoniae
RISK FACTOR:

Risk factors for lower respiratory tractinfections include:

 Gastroesophageal reflux,
 Neurologic impairment (aspiration),
 Immunocompromised states,
 Anatomic abnormalities of the respiratorytract.
 Hospitalization, especially in an ICU or requiring invasive procedures.
RISK FACTOR IN PATIENT :

• Mast Altamsh is from Mumbai. They live in a chawl, in Kalva. So one

factor could be environmental factor.

• Mast Altamsh's hygiene was another factor.

• The family belongs to the poverty line. They were not able to meet
some of their basic needs simply because of their livingcondition
INFECTIONS, ASPIRATIONS, LOW
IMMUNITY, POLLUTANTS ETC.

NEUTROPHILLIC INFILTRATIONS

ACUTE/CHRONIC INFLAMMATION
 FLUID/CELLULAR EXUDATION

EDEMA OF MUCUOUS MEMBRANE

HYPERSECREATION OF MUCUS

PERSISTENT COUGH, STAGES OF CONGESTION

IN THE ALVEOLAR SPACES WITH FLUID AND
HEMORRHAGIC EXUDATES
Signs and symptoms:
BOOK PICTURE PATIENT PICTURE

• High fever with respiratory distress ,restlessness , • High grade fever

air hunger and cyanosis • Cough
• Chest pain
• Grunting • Restlessness
• Nasal flaring • respiratory distress

• Retraction of the supra clavicular ,intercostals

,subcostal areas
• Tachypnea

• Tachycardia

• Abdominal distention ,liver enlargement

• cough,
• malaise,
• pleuritic chestpain,
 DIAGNOSIS
BOOK’S PICTURE PATIENT’S PICTURE
1. History taking 1. Patient history taken
2. Physical examination 2. Physical examination
3. Chest X-ray 3. Chest X-ray
4. Blood test, blood 4. Blood test
culture
5. Sputum examination
6. Bronchoscopy
7. Pleural fluid culture
8. Pulse oximetry
9.CT-scan 10.CBC
DIAGNOSIS IN PATIENT
INVESTIGATION PATIENT’S VALUE NORMAL VALUE

• TLC 27.31 10^3/microL 5 - 1 5 10^3/microL

• HAEMOGLOBIN 10.9 g m / d l 11 - 1 4 g m / d l

• PLATELETS 531 10^3/microL 150- 450

10^3/microL

• URINE R/E NORMAL NORMAL

• SECIFIC GRAVITY 1.15 1.003-1.035

 Physical Examiniation of patient
• Head to toe examinations done.
• Respiratory-dyspnea, nasal flaring.
• Rest of the findings were normal.

• VITAL SIGNS
1. Temperature-100F

2. Heart rate -122/m

3 . Respiration-36/m
 MEDICAL MANAGEMENT
•1. PHARMACOLOGICAL: The choice of an initial, empiric
agent is selected according to the susceptibility and
resistance patterns of the likely pathogens and
experience at the institution and the selection is
tempered by knowledge of the delivery of the drugs to
the suspected infected sites with the lungs.
1. Antibiotics agents
2. Anti inflammatory therapy
3. Anti viral
4. Bronchodilators
2. Chest physiotherapy and breathing exercise
3. Postural drainage
4. Surgical Management
• Drainage of plural effusion by continuous suction
• Reduction of pneumothorax
MEDICAL MANAGEMENT: Patient picture
S.NO DRUG FORM DOSE ROUTE TIME ACTIONS

1. ANGUMENTIN 300 IV TDS BACTERIOCIDAL

mg

2. AMIKACIN 75 mg IV BD BACTERIOCIAL

3. SYP. NOBLE 4 ml PO TDS NON-OPOID

PLUS ANALGESIC

4. IPRAVENT NEBS 1 ml PN QID BRONCHO

DILATOR

5. VANCOMYCIN 200 IV BD ANTI-INFECTIVE

mg
 COMPLICATIONS
• Pleural effusion
• Empyema
• Lung abscess
• Airway injury
• Obstructive airway secreations
• Air leak syndrome
• Chronic lungs disease
• Sepsis
NURSING MANAGEMENT
NURSING DIAGNOSIS:
1. Ineffective airway clearance related to inflammation and
accumulations of secretions as evidenced by cough with
sputum productions.
2. Impaired gas exchange related to alveolar capillary
membrane changes as evidenced by tachycardia and
restlessness.
3. Hyperthermia related to inflammatory process as evidenced by
increased body temperature.
4. Risk for fluid volume deficit related to inadequate oral intake,
fever, as evidenced by poor skin turgour.
5. Imbalanced nutrition less than body requirement related to
disease condition as evidenced by refusal of food by child.
6.Sleeping pattern disturbed related tohyperthermia and
cough as verbalized by mother’s concern for rest and
sleep.
7.Interrupted family process related to hospitalization as
evidenced by inability to fullfill daily works.
8.Knowledge deficient about the conditions, prognosis,
and treatment of pneumonia as evidenced by less
knowledge about pneumonia management.
Ineffective airway clearance related to inflammation and accumulations of
secretions as evidenced by cough with sputum productions.

• Assess airway for patency.

• Auscultate lungs for presence of normal or adventitious breath sounds.
• Assess respirations. Note quality, rate, pattern, depth, flaring of nostrils, dyspnea on
exertion, evidence of splinting, use of accessory muscles, and position for breathing.
• Note cough for efficacy and productivity.Note presence of sputum; evaluate its quality,
color, amount, odor, and consistency.Submit a sputum specimen for culture and
sensitivity testing, as appropriate.
• Assess hydration status: skin turgor, mucous membranes, tongue.
• Educate the patient in the following:
• Optimal positioning (sitting position), Position the patient upright if tolerated. Regularly
check the patient’s position to prevent sliding down in bed.
Impaired gas exchange related to alveolar capillary membrane changes as
evidenced by tachycardia and restlessness.

• Assess respiratory rate, depth, and effort, including use of accessory muscles,
nasal flaring, and abnormal breathing patterns.
• Monitor for alteration in HR.Observe for nail beds, cyanosis in skin,Monitor
oxygen saturation continuously, using pulse oximeter.blood gas (ABG)
• Position patient with head of bed elevated, in a semi-Fowler’s position
• Administer humidified oxygen through appropriate device (e.g., nasal cannula or
face mask per physician’s order).
• provide rest and minimize fatigue.
Risk for fluid volume deficit related to inadequate oral intake, fever,
as evidenced by poor skin turgour.

• Monitor and document vital signs and skin turgor and oral mucous
membranes for signs of dehydration.
• Assess color and amount of urine. Report urine output .Monitor fluid
status in relation to dietary intake. Note presence of nausea, vomiting
and fever.
• Tell the mother to feed prescribed amount of milk.
• Administer parenteral fluids as prescribed.
• Teach family members how to monitor output in the home. Instruct
them to monitor both intake and output.
Sleeping pattern disturbed related tohyperthermia and cough as verbalized
by mother ’s concern for rest and sleep.

• assess sleeping pattern and help to develop a sleeping plan.-The

nurse will provide a dark, quiet, and comfortable atmosphere for the
baby to sleep in.

• Do as much care as possiblewithout wakingup the baby and do as

much care as possible while the baby is still awake.
 HOME CARE MANAGEMENT

• Teach parents about signs and symptoms of

pneumonia.
• To teach about fluid intake.
• To Give proper rest and sleep.
• To make child to sleep in head elevated at 30
degree to ease the breathing.
• CONTACT HEALTH CARE:
• IF symptoms do not get better or get worse, child
have fever.
• Child is lethargic and weak
• Not taking feeds properly
• IMMIDIATE CARE:
• Blood in cough
• Tachycardia
• Looks very lethargic and weak
• Not able to breath properly
• Childs lips or finger nails turn black and blue
 DISCHARGE PLANNING
• Medications should be contineued on the ordered duration for the total recovery of
child.
• Deep breathing exercise should be done for the lung expansion and for the normal
breathing pattern and have adequate rest period.
• Maintain persona hygiene to prevent further infection. Baby should be bathe every
day.
• Minimul exposure to an open environment such as dusty and smoky area, which
airborn micro-organisms are present that can be a high risk factor that may cause
severity of babys condition.
• Regular consultaion to the physician to monitor the condition.
• The diet of the baby is the important factor for the recovery. Encourage to eat
nutritious food.
 BIBLLIOGRAPHY
• Lippincott, W.,& Wilkins. (2010). Essentials of pediatric Nursing. New Delhi:
Wolters Kluwer pvt Ltd. Pg.no. 106-132.

• Wong’s,Clinical Manual of Pediatric Nursing (7th edition). Mosby : Elsevier

Publications.

• Suddarth's and Brunner, “Textbook of Medical- surgical Nursing' 12 th edition wolter

kluwer/Lippincott Williams and Wilkins.

• www.google.com/Acute pyelonephritis.