Bronchopneumonia With

Bronchospasm in Paediatrics

CASE PRESENTATION
By Sitta Sobiriantini
 • The prevalence of asthma seems to have plateaued in
Malaysia
• 5.8% of children aged 6-7 years
• 8.9% of children aged 13-14 years

• There prevalence is higher among the urban and the

inner-city children
• 7.3% in Muar
INTRODUCTION • 13.9% in Kuala Lumpur

• Asthma is a heterogenous condition characterized by

paroxysmal or persistent symptoms such as dyspnea,
chest tightness, wheezing and cough against a
background of chronic persistent inflammation and/or
structural changes associated with airflow limitation
and airway hyperresponsiveness.

Clinical(Practice Guidelines for the Management of Childhood Asthma, 2014)

I. PATIENT BASIC INFO

Age :
Reg ID No : Gender : Female Weight :
Name : NNZ 4years 4months
SD01001xxx 16.6 kg

Diagnosis :
Admission : Broncopneumonia
Height : - Race : Malay
6/12/18 with
bronchospasm
II. BEFORE WARDED INFO
Adopted mother works as JKM
officer, adopted patient since
birth

SOSIAL Biological mother 16 y/o still

HISTORY & attending school.

HABBIT
Father of unkown background

Lives with adopted brother 11

y/o NKMI
 FAMILY
according to adopted
HISTORY mother, no family
history of asthma
 Adopted child

Birth History FTSVD

Unable to recall
birthweght
 1st hospitaisation when
PAST MEDICAL patient was 3 month old.
admitted in Kajang hospital
HISTORY for 10 days for
bronchopneumonia
 1 2 3
PAST
MEDICATION First nebu wa
taken during
last admission
Second nebu
in clinic
before
Benadryl
syrup

HISTORY to Kajang for

bronchopneu
admission
hospital
monia serdang
Allergic
NKDA (No know
drug allergy)
 Mother claimed no sick
contact at home

Other Info
Goes to a
kindergarten housing
25 children ages
ranging from 4-5
years old
III. DURING WARDED INFO

Chief
Complaint (CC) cough for past
2days

Patient with
rapid breathing
History of Present Illness (HPI)

She has chesty Has rapid breathing

cough with short with noisy
intermittent bouts breathing and
for last 2days. chest indrawing.
Review Of System On Addmission

01 02 03 04 05 06
General: BP: 105/88 PR: 150/min RR: 50/min Temp: 36.7 SpO2: 100%
Alert, active, mmHg
well
perfused,
well
hydrated,
Vital Signs - Blood Pressure
140

120

100

80
Systolic
60 Diastolic

40 Normal
Systolic: 85-100
20 mmHg
Diastolic: 55-59
0 mmHg
6 7 8 9 10 11
Vital Signs – Pulse & Respiration
200
180
160
140
120
100 PR
80 RR
60 Normal
PR : < 120/min
40 RR : 25-30/min
20
0
6 7 8 9 10 11
Vital Signs – Percentage Oxygen Saturation

101

100

99

98

97 SPO2

96

95

94
6 7 8 9 10 11
Vital Signs - Temperature

Temperature
39
38.5
38
37.5
37
36.5 Temperature
36
35.5
35
34.5
6 7 8 9 10 11
 Laboratory Investigation

NORMAL 6/11 7/11

BLOOD
CHEMISTRY

Na+ 136-145 mmol/L 137 137

K+ 3.4-4.7 mmol/L 4 4

Cl- 98-107 mmol/L 107 107

Urea 2.5-7.2 mmol/L 3.2 2.1

Creatinine 53-97 mmol/L 44

 Laboratory Investigation

NORMAL 6/11
HEMATOLOGY

Hct 36 - 44 % 35.4

HgB 12-14g/dl 12

WBC 5-15 x 109/L 14.3 x 109

RBC 4.1-5.5 x 1012/L 4.53 x 1012

PLT 150-400 x103/ml 362 x 103

Radiology

Hyperinflated with perihilar

Chest X-ray
opacity
Microbiology Test

(Culture & Sensitivity-

Nasopharyngeal Asp) - Gram Stain No Organisms Seen
(NPA)
IN WARD MEDICATIONS
Indication
Drug Name/Route Dose/Frequency Duration

Neb Ventolin/Atrovent Hrsly : 4hrsly

2hrsly : 4hrsly 6/12/2018 – 11/12/2018 Asthma controller
3hrsly : 6hrsly
IV Salbutamol
1 mcg/kg/min 3ml/hr
1.5 mcg/kg/min 4 ml/hr
2 mcg/kg/min 4 ml/hr 6/12/2018 – 9/12/2018 Bronchodilator

1 mcg/kg/min
0,5 mcg/kg/min

Iv hydrocortisone 65 mg qid 6/12/2018 – 8/12/2018 Corticosteroid/ AntiInflammation

Iv c penicilin 830000 unit Qid 6/12/2018 – 11/12/2018 Antibiotic

PCM 250 mg qid/prn 6/12/2018 – 11/12/2018 Antipiretik

T.Prednisolone 15mg OD 9/12/2018 – 11/12/2018 Corticosteroid/ AntiInflammation

IN HOME MEDICATIONS

Duration
Indication
Drug Name/Route Dose/Frequency
Start Date End Date

Salbutamol 100 mcg/dose inhalation 2 Puff when necessary 11/12/2018 10/4/2019 Asthma controller

Phenoxymethyl penicillin syr 125 250 mg Qid

11/12/2018 13/12/2018 Antibiotic
mg/5ml

T.Prednisolone 5 mg 15mg OD 11/12/2018 12/12/2018 AntiInflammation

Pharmaceutical Care Issue

PCI RECOMMENDATION OUTCOME

1. Use antibiotic for Countiunous iv penicilin C Proper Use of Antibiotic and

brochopneumonia prevent antibiotic resistance

• Monitoring parameters ;
temperature, WBC, CNS,
RR and PR
 Pharmaceutical Care Issue
PCI
2. Proper use of MDI for drug
to reach to site efficiently
MDI should be used with the
right technique.
RECOMMENDATION PLAN / OUTCOME
Children are advised to use Patient is expected to
aero chamber. understand and demonstrate
Because they cant control the again the right techniques of
breathing properly and using aero
chamber will ensure medicine gets
how to use aero chamber.
into the lungs and enhances
effectiveness
Counsel the patient on right
techniques to use aero
chamber.
Techniques to use Aero chamber

1. Hold the MDI and spacer together and shake it 5 times.

2. Ask the child to breathe out.
3. Put the mouthpiece of the spacer between the teeth.
4. Ask the child close the lips around the mouthpiece so no air can get
out.
5. Press the MDI down firmly with the thumb. (1 press will release 1 puff
dose into spacer)
6. Ask the child to take a long and slow breath as deep as possible. The
spacer will whistle if the child breathe quickly. So, ask the child to
breathe slowly.
7. Take the spacer out of mouth and ask the child to hold the breathe for
10seconds and then breathe out slowly.
8. Resume normal breathing About Kids Health, 2017
PATIENT EDUCATION

This is most crucial part which require high level of partnership between patient and the
family member with health care provider.

Explain the nature of disease and its treatment.

Emphasize that its likely to be prolonged but its long term outcome.

Recognise the symptoms of asthma, avoiding trigger factor and understand casual
mechanism of disease.

Information on medications, indications, dosages, timings and technique of delivery

using medical devices

Clinical(Practice Guidelines for the Management of Childhood Asthma, 2014)