I.

INTRODUCTION Bronchopneumonia is a type ofpneumonia which results when haematogeneous dissemination of organisms to the lung or colonization of airways with subsequent aspiration is responsible forpulmonary infection. As opposed to other acute bacterial or lobar pneumonias which begin in alveoli, bronchopneumonia originates in small bronchioles. Typical bacteria causing this form of infection include Staphylococcus aureus and Gram-negative organisms such as Pseudomonas aeruginosa. These organisms disseminate through the bloodstream and colonize thebronchial or bronchiolar epithelium, but then quickly cause acute inflammatory responses which extend outside the airway into adjacent alveoli. The initial inflammatory response consists largely of polymorphonuclear leukocytes which limit the extent of infection to the peribronchiolar region. Since multiple sites are involved simultaneously a scattered appearance of heterogeneous opacities is the usual pattern observed on chest films (Fig.1). Eventually more and more alveoli are affected and ultimately a homogeneous opacification simulating lobar pneumonia may be observed. Nevertheless, because there is greater airway involvement with bronchopneumonia, air bronchograms are infrequent and atelectasis is more common. Peribronchial interstitial thickening may also be seen early in the course of infection. Necrosis and cavitation are more frequent in this type of pneumonia.Pneumatocoe les are occasionally noted. Clinically, patients present with fever and productive cough similar to other bacterial infections although physical findings typical of denseconsolidation such as bronchophony and whispering pectoriloquy are not heard. Treatment with a variety of antibiotics usually results in rapid clinical and radiographic resolution.

II. OBJECTIVE General Objectives: My general objective is to understand what Bronchopneumonia is. Specific Objectives: Specifically: 1.) To know what causes to have Bronchopneumonia. 2.) To know the anatomy and physiology of the body organ involved in Bronchopneumonia. 3.) To understand the pathophysiology of Bronchopneumonia. 4.) To relate my patient chief complaint on his condition having Bronchopneumonia. 5.) To improve myself on formulating Nursing Care Plans. 6.) To relate the medications and medical procedures done to Mr. RR on his condition of having Bronchopneumonia.

III. HEALTH HISTORY PATIENTS PROFILE Name: XY Address: Macabalan, Lapasan Cagayan de Oro City Civil Status: Child Sex: Male Age: 10 years old Birth Date: April 8, 2000 Date Admitted: August 9, 2010 Time of Admission: 11:30 A.M Place of Admission: NMMC Blood Pressure: Not assesed Respiratory Rate: 29 cpm Pulse Rate: 116 bpm Temperature: 37.8 Attending Physician: Dr. Macarayan PAST HEALTH HISTORY Mr. XY verbalized that its been a long time since he was confined in the hospital, and he can remember it. He is conscious about his health. He has no allergy to any foods or other stuffs He never had undergone any surgery. PRESENT HEALTH HISTORY Two days prior to admission, he developed productive cough of whitish sputum followed by low grade fever. Her mother gave him Carbocisteine (Solmux) and Paracetamol (Biogesic),but because symptoms persist, they consulted the doctor and was abruptly admitted.

IV. PHYSICAL ASSESSMENT

NURSING SYSTEM REVIEW CHART Name: XY Date: Vital Signs: Pulse: Weight: EENT [] impaired vision [] blind [] pain reddened [] drainage [] gums [] hard of hearing [] deaf [] burning [] edema [] lesion teeth fever [] asses eyes, ears, nose rashes [] throat for abnormality [X] no problem RESPIRATION [] asymmetric [] tachypnea [] barrel chest [] apnea [] rales [X] cough [] bradypnea [] shallow [] rhonchi [] sputum [] diminished [] dyspnea [] orthopnea [] labored [] wheezing [] pain [] cyanotic [] assess resp rate, rhythm, depth, pattern [] breath sounds, comfort []no problem GASTRO INTESTINAL TRACT [] obese [] distention [] mass [] dysphagia [] rigidly [] pain [] asses abdomen, bowel habits, swallowing [] bowel sounds, comfort [X]no problem GENITO-URINARY and GYNE [] pain [] urine color [] vaginal bleeding [] hematuria [] discharge [] nocturia [] assess urine freq., control, color, odor, comfort [] grip, gait, coordination, speech, [X]no problem NEURO [] paralysis [] stuporous [] unsteady [] seizure [] lethargic [] comatose [] vertigo [] tremors [] confused [] vision [] grip [] assess motor function, sensation, LOC, strength [] grip, gait, coordination, speech, [X]no problem 2 MUSCULOSKELETAL and SKIN [] appliance [] stiffness [] itching [] petechiae [x] hot [] drainage [] prosthesis [] swelling [] lesion [] poor turgor [] cool [] deformity [] atrophy [] pain [] ecchymosis [] diaphoretic [] assess mobility, motion, gait, alignment, joint function [] skin color, texture, turgor, integrity [] no problem

BP:

Temp:

Height:

headache vomiting Rashes, dry Skin hot to touch

Skin hot to touch

NURSING ASSESSMENT II

OBJECTIVE

SUBJECTIVE COMMUNICATION: Hearing Loss ok ra ako []visual changes panan-aw. [x] denied OXYGENATION: [] dyspnea []smoking history [X] cough [] sputum [] denied

glasses languages contact lens hearing aide R L Pupil size __3mm_ speech difficulties Reaction _PERRLA_ Resp. []regular irregular Description Respirations are in normal depth and rhythm R Symmetrical_chest expansion L Symmetrical_chest expansion

cge kog ub hon,

CIRCULATION chest pain wala man pud dughan [] leg pain []numbness of extremities [x] denied

sakit

sako

Heart Rhythm regular irregular Ankle edema _____NONE_______________ Pulse Car Rad DP Fem R _______+____72____+______+____ L __+___72____+______+_____ Comments: Pulses are easily palpable

NUTRITION Diet: Diet as tolerated N V "Wala raman pud nag bag-o Character akung gana sa pagkaon." recent change in weight, appetite swallowing difficulty [x] denied

dentures Full Upper Lower

none Partial With Patient

ELIMINATION: Usual bowel pattern once/ twice a day constipation remedy None Date of last BM foly in place character

urinary frequency 4x day urgency dysuria hematuria Incontinence denied

Comments: "Normal ra man ang akung pagkalibang ug pagpangihi." Abdomial Distention Present yes no

Bowel sounds: normo-active_bowel sounds 5 clicks/min. Urine* (color, consistency,dor) Amber in color

MGT. OF HEALTH & ILLNESS: []alcohol [x] denied ( amount, frequency) _____none_____ SBE Last Pap Smear ___N/A___________ LMP : __________ N/A_______________

Briefly describe the patients ability to follow treatments ( diet, meds, etc) _The client is able to follow treatment.

SUBJECTIVE SKIN INTEGRITY: dry wla man ko gi katol2x." itching other denied ACTIVITY/SAFETY convulsion dizziness limited motion Limitation in ability to []ambulate [] bathe self other [x]denied

OBJECTIVE dry cold pale flushed warm moist cyanotic * rashes, ulcers, decubitus (describe size, location, drainage) _________________________________. LOC and orientation Conscious, and oriented to person, time and place. Gait: Walker Cane Other coherent;

[x] steady []unsteady sensory and motor losses in face or extremities ROM limitations Able to ambulate with both extremities

COMFORT/SLEEP/AWAKE: pain (location, frequency ,remedies) nocturia []sleep difficulties [x] denied

facial grimaces guarding other signs of pain: none

COPING: Occupation: Student Members of household _5 members including the parents Most supportive person Mother

Observed non-verbal behavior __Client is responsive and cooperative The person and his phone number that can be Reached any time: (no number)

V. DEFINITION OF COMPLETE MEDICAL DIAGNOSIS Bronchopneumonia is a type of pneumonia that is characterized by an inflammation of the lung generally associated with, and following a bout with bronchitis. This is really a specific type of pneumonia that is localized in the bronchioles and surrounding alveoli. This article provides a general overview of this condition, including symptoms and treatment options for those who have been diagnosed with bronchopneumonia. The most common pneumonia-causing bacterium in adults is Streptococcus pneumoniae (pneumococcus) Symptoms of bronchopneumonia: Cough with greenish or yellow mucus; Fever; chest pain; Rapid, shallow breathing; Shortness of breath; Headache; Loss of appetite; fatigue Treatment of bronchopneumonia: 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. Unlike lobar pneumonia, in which an entire section or subdivision of the lung may be inflamed; 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.

VI. ANATOMY AND PHYSIOLOGY

The Lungs are the principal organs of respiration. Each lung is cone-shaped, with its base resting on the diaphragm and its apex extending superiorly to a point about 2.5 cm above the clavicle. The right lung has three lobes called the superior, middle and inferior lobes. The left lung has two lobes called the superior and inferior lobes. The lobes of the lungs are separated by deep, prominent fissures on the surface of the lung. Each lobe is divided into bronchopulmonary segments separated from one another by connective tissue septa, but these separations are not visible as surface fissures. There are nine bronchopulmonary segments in the left lung and ten in the right lung. The main bronchi branch many times to form the tracheobronchial tree. Each main bronchus divides into lobar bronchi as they enter their respective lungs. The lobar (secondary) bronchi, two in he left lung and three in the right lung, conduct air to each lobe. The lobar bronchi in turn give rise to segmental (tertiary) bronchi, which extend to the bronchopulmonary segments of the lungs. The bronchi continue to branch many times, finally giving rise to bronchioles. The bronchioles also

subdivide numerous times to give rise to terminal bronchioles, which then subdivide into respiratory bronchioles. Each respiratory bronchiole subdivides to form alveolar ducts, which are like long, branching hallways with many open doorways. The doorways open into alveoli, which are small air sacs. The alveoli become so numerous that the alveolar duct wall is little more than a succession of alveoli. The alveolar ducts end as two or three alveolar sacs, which are chambers connected to two or more alveoli. There are about three million alveoli in the lungs. The bronchioles are very small airways that extend from the bronchi to the alveoli. The bronchioles are made up of smooth muscle cells and are smaller than 1 millimeter in diameter. The bronchioles do not have glands or cartilage. The epithelial cells of the bronchioles are cuboidal in shape.

VII. PATHOPHYSIOLOGY

PNEUMONIA

VIII. LABORATORY Not assessed IX. MEDICAL MANAGEMENT

MEDICAL PROCEDURES
INTRAVENOUS THERAPY Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein. It can be intermittent or continuous; continuous administration is called an intravenous drip. The word intravenous simply means "within a vein", but is most commonly used to refer to IV therapy. Therapies administered intravenously are often called specialty pharmaceuticals. Compared with other routes of administration, the intravenous route is the fastest way to deliver fluids and medications throughout the body. Some medications, as well as blood transfusions and lethal injections, can only be given intravenously. NEBULIZATION It is the process of using a nebulizer that changes liquid medicine into fine droplets (in aerosol or mist form) that are inhaled through a mouthpiece or mask Nebulizers is used to deliver bronchodilator (airwayopening) medicines such as albuterol or ipratropium bromide. Nebulizers are hand-held machines with an airflow meter that measures oxygen flow. These machines administer a variety of medications. Nebulizers vaporize this mixture and deliver it as a fine mist or steam. Nebulizers are usually used in the hospital or nursing home setting.Disposable nebulizers are often sent home with a patient and are cleaned and reused for a limited time.

TEPIDS SPONGE BATH Tepid sponging is a time honored and well known method of reducing the elevated temperature. Tepid sponging is useful as an immediate but transient measure in bringing down the temperature and it should always be supplemented with drugs like paracetamol for a longer antipyretic effect. A tepid sponge bath relieves fever without cooling the body too fast. Eighty degrees Fahrenheit is still 20oF below body temperature and yet warm enough not to drive blood from the skin, thereby preventing the cooling from getting to the body's core. Limbs are bathed first and then the chest, abdomen, back, and buttocks. Tepid baths should be 80-93oF (26.7-34oC).

X. NURSING CARE MANAGEMENT NURSING CARE PLAN CUES Subjective Data: Pt. verbalized... GITUGNAW KO Objective Data - Temp: 38.1 oC - skin warm to touch - body malaise - poor appetite - chills noted NURSING DX Hyperthermia related to disease process as evidenced by chills noted OBJECTIVES That within my 8o span of care, the patients body temperature will lower from 38.1 oC to 37.5oC and will demonstrate absence of chills INTERVENTIONS - Perform tepid sponge bath - Apply cold wet compress if necessary - Remove some blankets and clothes which are not necessary - If patients skin feels cold to touch, apply friction - Advise to wear loose and comfortable clothes - Encourage patient to increase fluid intake - Monitor Temperature every 15 mins RATIONALE Vaporization of water relieves heat from the surface of the skin To help normalize body temperature To provide air movement, to augment heat loss. To stimulate circulation To be more Comfortable To prevent dehydration To see effectiveness of said interventions Vaporization EVALUATION Criteria for GOAL MET: At the end of my 8o span of care: - the patients temperature will lowers to 37.5oC - The patient will manifest negative chilling - The patient will verbalize comfort

- Repeat TSB if needed - Administer antipyrentic drugs as prescribed - Regulate IVF as desired

of water relieves heat from the surface of the skin Helps relief of fever Helps maintain hydration

CUES NURSING DX Subjective Data: Ineffective airway gi-ubo pa clearance related gihapon ko aning to the presence of mga niaging secretions adlaw. as verbalized by the patient Objective Data: - productive cough - body malaise - poor appetite - use of accessory muscles while breathing -with yellowish sticky mucous secretions -crackles breath sound

OBJECTIVES At the end of our duty shift we must: - be able to cough out phlegm effectively - maintain patients airway patency

INTERVENTIONS - Auscultate for breath sound - Monitor Vital Signs - Regulate IVF as desired - Encourage patient to drink more water (should be warm) - Teach patient to do deep breathing exercise -Instruct patient/family to notify nurse/physician of sputum color changes, increase work of breathing, or onset of chest pain - Encourage patient to rest - Position patient to High-Fowlers Position - Administer

RATIONALE - To identify abnormal breath sounds - To know the status or progress in/of the pt. - Helps to maintain hydration and fluid status, as well as to thin viscous secretions to allow - To liquefy secretions - To mobilize secretions so that patient may be able to more easily expectorate mucous secretions - To monitor signal of worsening of condition that requires immediate

EVALUATION Criteria for GOAL MET: At the end of my 8o span of care: -Patient will maintain patent airway -Patient will be able to expectorate sputum and cough effectively

medicines as prescribed

medical intervention to prevent further complications - To promote wellness - To facilitate airway - To helps relief cough

XI. DRUG STUDY GENERIC NAME paracetamol BRAND NAME Biogesic CLASSIFICATION MECHANISM Antipyretics OF DOSE/ INIDICATION For fever ACTION FREQUENCY Paracetamol has PRN 1 tab q 4o long For T o >37.8 been suspected of having a similar mechanism of action to aspirin because of the similarity in structure. That is, it has been assumed that paracetamol acts by reducing production of prostaglandins, which are involved in the pain and fever processes, by inhibiting the cyclooxygenase (COX)

enzyme as aspirin does.

INTERACTIONS Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first. Before using this product, tell your doctor or pharmacist if you use any of the following products: anti-seizure medications (e.g., phenytoin, carbamazepine, phenobarbital), "blood thinners" (e.g., warfarin), isoniazid, phenothiazines (e.g., chlorpromazine).Acetaminophen is an ingredient in many nonprescription products and in some combination prescription medications.

SIDE EFFECTS easy bruising/bleeding, new signs of infection (e.g., fever, persistent sore throat)

ADVERSE EFFECT

NURSING CONDERATIONS Tell your doctor immediately if any of the following symptoms of liver damage have: persistent nausea/vomiting, yellowing eyes/skin, dark urine, stomach/abdominal pain, extreme tiredness. A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching, swelling, severe dizziness, trouble breathing.If you notice other effects not listed above, contact your doctor or pharmacist.

GENERIC NAME Butamirate citrate

BRAND NAME Sinecoid

CLASSIFICATION MECHANISM OF DOSE/ ACTION Cough and cold preparation FREQUENCY 1 tab TID

INDICATION Acute cough of

any etiology

INTERACTIONS

SIDE EFFECTS

ADVERSE REACTIONS Rarely, skin rash, nausea, diarrhea or dizziness

NURSING CONSIDERATIONS

GENERIC NAME Albuterol sulphate

BRAND NAME Ventolin Nebule

CLASSIFICATIONS MECHANISM OF DOSE/FREQUENCY INDICATION Inhalation solution ACTION beta2-adrenergic bronchodilator 1 neb TID VENTOLIN NEBULES Inhalation Solution is indicated for the relief of bronchospasm. This drug relaxes the smooth muscle in the lungs and dilates airways to improve breathing.

INTERACTIONS - Tell your doctor of all prescription and

SIDE EFFECTS Cases of urticaria, angioedema, rash,

ADVERSE REACTIONS Tremors, Dizziness, Nervousness, Headache,

NURSING CONSIDERATIONS - Tell your doctor if you have heart

nonprescription drugs you may use, especially of drugs used for asthma, depression or colds; and beta-blockers (e.g., atenolol, propranolol). - Do not start or stop any medicine without doctor or pharmacist approval.

bronchospasm, hoarseness, oropharyngeal edema, and arrhythmias (including atrial fibrillation, supraventricular tachycardia, extrasystoles) have been reported after the use of VENTOLIN NEBULES Inhalation Solution.

Sleeplessness, Gastrointestinal, Nausea, Dyspepsia , Ear, nose, and throat, Nasal congestion, Tachycardia, Hypertension, Bronchospasm, Cough, Bronchitis, Wheezing

disease, high blood pressure, an overactive thyroid gland, epilepsy or diabetes. - Tell your doctor if you ever had a bad reaction to bitolterol, ephedrine, epinephrine, metaproterenol, phenylephrine, phenylpropanolamine, pseudoephedrine, or terbutaline. - Many nonprescription products contain these drugs (e.g., diet pills and medication for colds and asthma), so check the labels carefully. - Do not take any of these medications without consulting your doctor (even if you never had a problem taking them before). - Do not allow anyone else

to take this medication.

XII. DISCHARGE PLAN EXERCISE Be sure to get enough rest and sleep on a daily basis. Practice deep breathing and coughing exercise to easily excrete phlegm TREATMENT Have annual influenza vaccine after discussing appropriate timing of the vaccination as recommended Discuss the pneumococcal vaccine with your primary health care provider, and have the vaccination as recommended If you do not smoke, dont start. Avoid stress, fatigue, sudden changes in temperature and excessive alcohol intake, all of this lowers resistance to pneumonia. HYGIENE Take bath daily. This is a property of College of Nursing TRACE College. No part of this manuscript may be reproduced or transmitted in any form or by any means. Please obtain permission from the College of Nursing TRACE College. Wear masks especially when traveling for the first week after being discharged. Promote frequent oral hygiene. OUTPATIENT ORDERS/FOLLOW UPS Follow up check up will be on Oct. 4, 2008, 1-6pm DIET Drink plenty of water (at least 8 glasses every day), especially during warm weather. Eat a healthy, balanced diet and take in a sufficient amount of non alcoholic fluids each day.