How to cure pneumonia

Bronchopneumonia
INTRODUCTION
Background to the study
Bronchopneumonia is acute inflammation of the walls of the bronchioles.
It is one of two types of bacterial pneumonia the other being lobar pneumonia
Bronchopneumonia is less likely associated with streptococcus than lobar pneumonia.
Pneumonia is characterized by inflammation of the alveoli and terminal airspaces in
response to invasion by an infectious agent introduced into the lungs through
haematogenous spread or inhalation.
OBJECTIVES

To broaden my knowledge on the cause and predisposing factors of pneumonia

To give holistic nursing care to the client through the use of nursing process.

To help educate parents and client on the cause and prevention of diseases.

LITERATURE REVIEW
Introduction of the disease
Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms including bacteria, fungi and viruses.
Pneumonia can be classified as follow:
1.

Community-acquired pneumonia

2.

Hospital-acquired pneumonia

3.

Pneumonia in the immunocompromised

4.

Aspiration pneumonia

ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY SYSTEM

The respiratory system consists of the external nose, the nasal cavity, the pharynx, the
larynx, the trachea, the bronchi and the lungs.
This system is divided into:

Upper respiratory tract

Lower respiratory tract

The upper respiratory tract is made up of the following:

External nose

Nasal cavity

Pharynx

Larynx

The lower respiratory tract is made up of:

Trachea

Bronchi and bronchioles

Lungs

THE DIAGRAM OF THE RESPIRATORY SYSTEM

Source: Seeley, Stephens and Tate Eighth edition Anatomy and Physiology.
PATHOPHYSIOLOGY OF BRONCHOPNEUMONIA
Bronchopneumonia is a type of pneumonia that is distributed in a patchy fashion, having
originated in one or more localized area within the bronchi and extending to the adjacent
surrounding lung parenchyma. It is associated with organisms such as staphylococcus
aureus, klebsialla and Escherichia coli. In bronchopneumonia an inflammatory reaction
occur in the alveoli, producing an exudates that interferes with the diffusion of oxygen
and carbon-dioxide. White blood cells mainly neutrophils also migrate into the alveoli
and fill the normal air-filled spaces. Areas of the lungs become inadequately ventilated
because of secretions and mucosal oedema, which causes partial occlusion of the bronchi,
with a decrease in alveolar oxygen tension.
ETIOLOGY

Prolonged immobility and shallow breathing.

Depressed cough reflex due to medications or weak respiratory muscles.

Immunosuppression.

Smoking.

Alcohol intoxication

Respiratory therapy with improperly cleaned equipment.

CLINICAL MANIFESTATION

This depends on the type and presence of underlying disease. Common clinical
manifestations include:

Sudden onset of chills.

Rapidly rising fever (38.5oC to 40.5oC)

Pleuritic chest pain.

Deep breathing and coughing.

Tachypnea

Shortness of breathe.

Rapid and bounding pulse.

Headache.

Pharyngitis.

Mucopurulent sputum is expectorated.

Poor appetite.

Tiredness.

DIAGNOSTIC INVESTIGATIONS

Physical examination.

Chest x-ray.

Blood culture.

Sputum examination.

Bronchoscopy.

Family history of bronchopneumonia.

Dietary and medication history.

MEDICAL MANAGEMENT
The treatment of pneumonia includes administration of the appropriate antibiotics as
determined by the result of a gram stain.
SURGICAL MANAGEMENT
1.

Drainage of parapneumonic effusion with or without intrapleura instillation of a

fibrinolytic agent may be indicated.

2.

Chest tube placement for drainage of an effusion or empyema may be performed.

NURSING MANAGEMENT
Assessment
Assessment is critical in detecting pneumonia. The nurse monitors the patient for the
following: change in temperature and pulse, amount, odour and colour of secretion,
frequency and severity of cough, degree of tachypneab or shortness of breath.
Nursing diagnosis
Based on the assessment data, the major nursing diagnoses may include the following:

Ineffective airway clearance related to copious tracheobronchial secretions.

Activity intolerance related to impaired respiratory function.

Risk for deficient fluid volume related to fever and rapid respiratory rate.

Imbalanced nutrition less than body requirement related to reduced ability to

tolerate feed.

Planning and goals

The major goals and plans include:

Improve airway patency.

Rest to conserve energy.

Maintenance of adequate nutrition.

Absence of complication.

Implementation
1.

Improving airway patency.

2.

Promoting rest and conserving energy.

3.

Promoting fluid intake.

4.

Maintaining nutrition.

Evaluation
1.

Patient demonstrates improved airway patency.

2.

Patient and conserve energy by limiting activities.

3.

Patient maintains adequate hydration.

PROGNOSIS.
Most types of bacterial pneumonia can be cleared within 2 3 weeks of treatments. Viral
and mycoplasma pneumonia may take 4 6 weeks to resolve completely (Kori, 2009)
CLINICAL FEATURES PRESENTED ON ADMISSION
1.

Fast respiratory movement.

2.

Weakness

3.

Hyperthermia (temperature 38.2)

INVESTIGATION
Packed cell volume.
White blood cell

count.
Microscopic culture
and sensitivity.
Electrocardiogram
Gastric washing for
acid-fast-bacilli
MEDICAL MANAGEMENT
The medical management of Master I.E consisted of pharmacological treatment. He was
placed on the following drugs:

intravenous ceftriaxone 280mg 12hourly

intravenous amikacin 52mg 8hourly

NURSING MANAGEMENT.
Nursing Diagnosis.
1.

Ineffective breathing pattern related to bronchopneumonia.

2.

Ineffective airway clearance related to accumulation of secretions.

3.

Imbalanced nutrition less than body requirement related to weakness as manifested

by inability to tolerate feeding.
4.

Risk for ineffective health maintenance related to lack of knowledge regarding

treatment regimen after discharge.

NURSING MODEL USED IN THE MANAGEMENT OF THE PATIENT

Dorothy Orems Self-care Theory.
This theory is in three parts:
1.

Self-care deficit

2.

Self-care.

3.

Nursing system.

Types of Nursing Care Requisites

Universal self-care requisites.

Developmental self-care requisites.

Health deviation self-care requisites.

Classification of Nursing System.

1.

Wholly compensatory system.

2.

Partial compensatory system.

3.

Supportive educative system.

Application of this Model to the Care of the patient

In the care of the patient with bronchopneumonia the applicable part of orems self-care
theory is Wholly Compensatory System which involve total dependant of the patient on
the nurse to carryout self-care.
OBJECTIVE ASSESSMENT
The following should be done on the patient
Physical measurement.
Temperature:
Respiration:
Pulse:
Weight:
Height:
Urinalysis.
Colour:
Odour:

Specific gravity:
Deposit:
Amount:
Reaction:
Abnormalities:

PHYSICAL EXAMINATION
The patient must be examined using the following methods:
Inspection
Palpation
Percussion
Auscultation
DRUGS THAT CAN BE USED BY A PATIENT WITH BRONCHOPNEUMONIA
1.
CEFTRIAXONE
2.

CAPTOPRIL

3.

SPIRONOLACTONE

4.

AZITHROMYCIN

5.

FRUSEMIDE (LASIX)

6.

HYDROCHLOROTHIAZIDE

7.

AMIKACIN