INTRODUCTION

BRONCHOPNEUMONIA

Bronchopneumonia is an illness of lung 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. It is common in women and causes to the 6% deaths. 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.

CAUSES

• Bacteria
• Virus

Bacterial pneumonias tend to be the most serious and, in adults, the most common cause of
pneumonia. The most common pneumonia-causing bacterium in adults is Streptococcus pneumoniae
(pneumococcus).

RISK FACTOR

• Elderly
• Hospitalization
• Immobilization
• Immune Deficiency
• Long Term Illness
• Smoking

SYMPTOMS

• Cough with greenish or yellow mucus

• Fever
• Chest pain
• Rapid, shallow breathing
• Shortness of breath
• Headache
• Loss of appetite
• Fatigue

TREATMENT

• Hospitalization
• Intravenous Antibiotic Therapy
• Oxygen Therapy
• Rest

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 one’s susceptibility to
pneumonia, since the flu precedes pneumonia development in many cases.

COMPLICATIONS

Empyema

is a condition in which pus and fluid from infected tissue collects in a body cavity. the name comes
from the Greek word empyein meaning pus-producing (suppurate).

Pleurisy

is an inflammation of the membrane that surrounds and protects the lungs (the pleura).
Inflammation occurs when an infection or damaging agent irritates the pleural surface.

Lung abscess

is an acute or chronic infection of the lung, marked by a localized collection of pus, inflammation,
and destruction of tissue. Lung abscess is the end result of a number of different disease processes ranging
from fungal and bacterial infections to cancer.

DEMOGRAPHIC DATA

Name : Angelee Ferrer

Address: : Antonino, Alicia, Isabela
Gender : Female
Age : 1 year old
Date of Birth : August 31, 2007
Place of Birth : San Isidro, Isabela
Religion : Roman Catholic
Nationality: : Filipino
Weight : 7.8 kilos

Admission Data:

Chief Complaint : Body weakness associated with Fever & Cough for 2 days
Date of Admission : September 26, 2008
Time of Admission : 02:10 pm
Mode of Arrival : Cuddled by her mother
Clinical Diagnosis : Bronchopneumonia
Attending Physician : Dra. Mila Paguila

Latest Vital Signs

Temp : 380C
PR : 130 bpm
RR : 44 cpm

NURSING HISTORY

History of Present Illness

 Two days prior to admission, the patient experienced on and off fever associated with cough and
colds. She became weak because she cannot eat and sleep well at night. So her mother decided to rushed
her to Lucas – Paguila Hospital for medical check up but the attending physician advised the mother for
hospitalization of her child for close observation and proper treatment of her illness.

Past Medical History

When the patient is four (4) years olds, she was diagnosed of anemia and she was hospitalized
then. As she is growing, she sometime experienced fever, cough and colds but manageable and treated
with over the counter drugs and sometimes her mother used herbal medicine like lagundi for cough.

Family Medical History

The parents and other member of the family have no known illness. The patient completed her
immunization given in the Barangay Health Center.

Daily Activity Pattern

Nutritional Pattern

Prior to admission, the patient daily diet are fish and meat sometimes she eats soup of a vegetable
mixed with rice. She drinks a lot of water even after she drinks her milk.
During hospitalization, she cannot eat no solid food intake. She just drinks water and sometimes
milk.

Personal Hygiene

Prior to admission, the patient takes a bath and brushes her once a day. And at night before she
goes to bed her mother clean her with wet hand towel and change her clothes.

During confinement, the mother cleans her child of wet hand towel and changes her clothes.

Rest and Sleep Pattern

Prior to admission, the patient usually sleeps at around 8:00 pm and wakes up at 7:00 am. During
daytime she also sleeps for 2 to 3 hours every afternoon.
During confinement, she sleeps more than her usual sleeping pattern.

Exercise Pattern

Prior to her admission, the patient spends most of her time in playing. During confinement the
patient has no physical activity, she sleep most of the time.

Elimination Pattern

Prior to admission, the patient defecates once a day with no particular time. She voids 6 to 8 times
a days.
When she was hospitalized, she defecates watery stool for 2 to 3 times. And changed 3 diapers full
of urine.
DIAGNOSTIC TEST

1. ABG

is a test done to measure how much oxygen and carbon dioxide is in your blood. It also looks at the
acidity (pH) of the blood. Usually, blood gases look at blood from an artery. In rarer cases, blood from a vein
may be used.

2. CBC

Complete blood count (CBC) test measures the following:

The number of red blood cells (RBCs)

The number of white blood cells (WBCs)
The total amount of hemoglobin in the blood
The fraction of the blood composed of red blood cells (hematocrit)
The mean corpuscular volume (MCV) -- the size of the red blood cells
CBC also includes information about the red blood cells that is calculated from the other measurements:

MCH (mean corpuscular hemoglobin)

MCHC (mean corpuscular hemoglobin concentration)
The platelet count is also usually included in the CBC

3. Chest X ray

chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.

4. Pleural fluid culture

is a test that looks at a sample of fluid from the space around the lungs to find and identify
disease-causing organisms.

5. History and Physical Examination

6. CT of Chest
7. Pleural fluid gram stain
8. Sputum gram stain
9. Sputum Smear Examination

PREVENTION

Pneumoccoccal Vaccine

The pneumococcal polysaccharide vaccine helps protect against severe infections due to the
bacteria Streptococcus pneumoniae. This bacteria frequently causes meningitis and pneumonia in older
adults and those with chronic illnesses. The vaccine has not been shown to prevent uncomplicated
pneumonia.

Smoking Cessation

Hand washing
LABORATORY TEST

Radiology Result

Findings: Chest Ap and Lat

Chief Complain: Cough

Examination reveals hazy infiltrates at the lower lung.

Haziness with nodular densities is seen in both para – tracheal and perihilar spaces.
Heart and great vessels are within normal size and configuration.
Bony thorax is intact.
Both sinuses and diaphragms are normal.
Other chest structures are not remarkable.

Impression:

1) Pneumonia, right lower lung

2) Primary Koch’s infection

Complete Blood Count

Result Normal Values

WBC - 2.4 x 10³/UL Hct % Male 40 – 54
RBC 3.32 x 10/UL Female 37 – 47
HGB - 9.0 g/dl Platelet (10³/L) 140 – 440
HCT - 24.4 % Wbc (x10/L) 4.3 – 10.00
MCV - 73.5 fL Gran % 44.2 – 80.2
MCH 36.9 g/dl (x10/L) 2.0 – 8.8
PLT 1.64 x 10³/UL Lymph (10/L) 28 – 48
LYM % + 62.10 % Mono (10/L) 1.2 – 5.3
MXD 8.6 % Hgb 9/dl Male 14 – 18
Neut % -29.3 % Female 12 – 16
Lym # 1.5 x 10³/UL
Neut # .7 x10³/UL
RDW – 5D -34.5 fL
RDW - cl 12.6 %

PHYSICAL ASSESSMENT

September 26, 2008

Temp: 38°C
RR : 44 cpm
PR : 130 bpm

General Appearance: The patient is 1 year old female child, weak with fever and cough cuddled by her
mother.
 BODY PART METHOD OF FINDINGS INTERPRETATION
ASSESSMENT
Skull Inspection Normocephalic Normal
Palpation Absence of masses Normal

Hair Inspection Curly hair Normal

Face Inspection Smooth but pale looking Due to fever & colds
Eyes Inspection Pale conjunctiva Due to fever & weakness
Nose Inspection (+) mucus secretion Due to colds
Mouth
Lips Inspection Pale lips Due to fever & colds

Teeth & gums Inspection White teeth Normal

Tongue Inspection Moves freely, no Normal

tenderness
Ears Inspection Color same as facial Normal
skin; symmetrical; auricle
aligned with outer
canthus of eye, about 10’
from ventricle
Skin Inspection Smooth Norrmal
Neck Inspection Muscles equal size; head
centered Normal
-Lymph nodes Palpation Not palpable Normal
-Thyroid gland Palpation Lobes may not be
palpated Normal
Thorax Inspection Symmetrical Normal

Palpation Chest wall intact, no Normal

tenderness
Percussion Dullness Decrease confluent &
pleural effusion
Auscultation Coarse breath sound Air passing through fluid or
(Dry rales) mucus in any air passage

BODY PART METHOD OF FINDINGS INTERPRETATION

ASSESSMENT

Abdomen Inspection Flat abdominal contour Normal

Audible bowel sounds
Auscultation Tympany over the Normal
stomach and gas filled
Percussion bowels Normal
No tenderness

Palpation Normal
Upper and Lower
extremities Inspection Symmetrical Normal
Palpation (-) Tenderness Normal
DRUG STUDY

DRUG USES SIDE EFFECTS CONSIDERATIONS

Generic Name: Prophylaxis and Headache, N&V, • When given by

Salbutamol treatment of palpitations, nebulization, use face
bronchospasm d/t Tachycardia, tremor, mask or mouthpiece
Brand name: reversible obstructive bronchospasm • Monitor pulmonary status
Ventolin proventil airway disease.
Inhalation solution for
Classification: acute bronchospasm
Sympathomimetic attacks. Stimulates
beta-II receptor of
Dosage: bronchi leading to
½ tsp – tid broncho dilation

DRUG USES SIDE EFFECTS CONSIDERATION

Generic Name: Prophylaxis and Anorexia • Assess for any allergic

Hydrocortisone sodium treatment of chronic N&V reaction
succinate bronchial asthma, Lethargy • Monitor v/s, I&O, and
perennial rhinitis, Headache weight
Brand name; symptomatic Fever • Avoid alcohol and
A-hydrocort solucortef sarcoidosis Joint pain caffeine
Desquamation
Dosage: Myalgia
15 mg – IV q6 Weight loss
Hypotension
Classification:
Corticosteroids

DRUG NAME USES SIDE EFFECTS CONSIDERATION

Generic Name: Analgesics and Rare side effects: Check the time and
Paracetamol antipyretic commonly dosage before
used for relief of fever, Hives; rash; administering.
Brand Name: head aches and other Shortness of breath.
Tylenol, Biogesic minor pains and aches. Assess for possible drug
Tempra Prolonged & habitual reactions.
use may lead to liver
Route: damage or failure.
Oral, Rectal

Dosage:
Q4h/Q6h
Available forms:
Tablet and suppository

DRUG NAME USES SIDE EFFECTS CONSIDERATION

Generic Name:
Cefuroxime For lower respiratory Most common: Asses for possible S&S
tract infection due to S. Diarrhea/loose stools, of drug reaction.
Brand Name: pneumoniae, UTI’s due abdominal pain & N/V
Zinacef, Ceftin to e. coli & skin and skin Asses for anemia &
structure due to s. renal dysfunction.
Route: aureus
IV

Dosage:
125 mg/q6

Classification:
Cephalosporin, Second
Generation

DRUG NAME USES SIDE EFFECTS CONSIDERATION

Generic Name:
Ceftriaxone For lower respiratory Most common: Asses for possible S&S
tract infection due to S. Diarrhea, rash, nausea, of drug reaction.
Brand Name: pneumoniae, UTI’s due pain, induration
Rocephin to e. coli & skin and skin tenderness at injection Asses for GI disease.
structure due to s. site
Route: aureus Monitor renal
IV dysfunction.

Dosage:
250 mg

Classification:
Cephalosporin, Third
Generation

DRUG NAME USES SIDE EFFECTS CONSIDERATION

Generic Name:
Ambroxol HCL A mucolytic agent used GI side effects like Asses for possible S&S
in the treatment of epigastric pain, gastric of drug reaction.
Brand Name: respiratory disorders fullness may also occur.
Bromussyl, Ambolyt associated with viscid or Rare allergic responses Asses for GI disease.
excessive mucus. It is such as eruption,
Route: the active ingredient of urticaria & angioneurotic Monitor renal
IV link Mucosolvan or link edema may also occur. dysfunction.
Mucoangin.
Dosage & Strenth
Syrup 30mg/5 ml

PATHOPHYSIOLOGY

Etiologic Agent: Predisposing Factors:

• Bacteria * Elderly
• Virus * Hospitalization
* Immobilization
* Immune Deficiency
* Long Term Illness
* Smoking

Microorganism enter alveolar

Spaces by droplet inhalation

↓
Inflammation occurs

↓
Alveolar fluid increase

↓
Ventilation decreases as secretion thicken

↓
Bronchopneumonia

Empyema Pleurisy
(collection of pus & liquid (Inflammation of membrane)
From infected tissue)

Lung Abscess
(collection of pus, inflammation
& destruction of tissue)

↓
Cancer of the lung

↓
Death