INTRODUCTION

a. Overview of the Case Bronchopneumonia, or bronchial pneumonia, is a type of pneumonia that originates in the bronchioles of the lungs, which are the smaller ducts of the bronchial tubes. The contagious infection is caused by a variety of bacteria, viruses, and other microorganisms.

Infant, toddler and older people can easily acquire this disease. As the Group B5 rotated in the pedia ward in Bukidnon Provincial Hospita; - Talakag, I was assigned into a 3 years old patient whose name is Ampoan, Alona Tayaotao who was diagnosed with Bronchopneumonia. It’s my first time to handle a patient with a case of bronchopneumonia and it seems to be challenging in my part as a student nurse. Through this case study I share my knowledge and care to my patient and at the same time I also gained knowledge from my patient.

b. Objective of the Study At the end of 2-days (16 hrs) duty, I will be able to bring improvement to my patient’s health status, impart health teachings and informations to the patient and to her family, thus enhancing their naked mind regarding to the illness of their daughter and poor health management. As a part of this objective, my aim is to provide nursing interventions to the identified health problems affecting the family and gain their cooperation towards the improvement of their daughter’s health condition c. Scope and Limitation of the Study The NCM501X was assigned in pedia ward of X. The study was directed to X’s health. The information gather was only limited from the assessment to the second day of our duty which is done last January 16-18, 2007. Any information verbalized by the mother and father regarding to their daughter Ampoan, Alona are included in this study. In a period of time, the interventions are not to bring patient in a full recovery but to improve the health status of the patient and to prevent complications. For the parents are included in this study in the enhancement of the patient’s health, health teaching is being done as a part of my interventions. In this way, Dole-out system is being avoided.

II. HEALTH HISTORY

a. Profile of Patient Name : X Date Assessed: January 16,2007 Age Sex Date of Birth Birth Place Nationality Religion Temperature Pulse rate Respiratory rate Blood Pressure Height: Weight Types of previous illness/ surgery Cough Cold Fever Diarrhea 3 years old Female July 5, 2003 X Filipino Roman Catholic 39.2˚ C 80 bpm 34 cpm No Opportunity 97 cm 13 kg Date January 13, 2007 January 13, 2007 January 13, 2007 January 15, 2007

Has received blood in the past _____ Yes ___/__ No If yes list dates____ Reactions___ Yes ___ No Medication Name Dose /Frequency Time of Last dose

Gabon (pabukal)

Once a day after supper

January 14, 2007

b. Family and Personal Health History Name : X(Father) Date Assessed: January 18,2007

Age Sex Date of Birth Birth Place Nationality Religion Temperature Pulse rate Respiratory rate Blood Pressure Height Weight Educational Attainment Occupation Income

32 years old Male April 16, 1974 X Filipino Roman Catholic No Opportunity No Opportunity No Opportunity No Opportunity 5’5’’ 51 kg High School, Undergraduate Farmer P1,500/month

Name : X (Mother) Date Assessed: January 17,2007 Age Sex Date of Birth Birth Place Nationality Religion Temperature Pulse rate Respiratory rate Blood Pressure Height Weight Educational Attainment Occupation Income 32 years old Female September 25, 1974 X Filipino Roman Catholic 37.2˚ C 75 bpm 18 cpm 110/90 mmHg 4’10” 44 kg Elementary, Undergraduate Housewife None

5 Children: NAME

All are still dependent on their parents. AGE EDUC. ATTAINMENT

X X. X X X

12 8 5 3 1 Health History

Grade Six Grade Two -------------

Roque, Ampoan Types of previous illness/ surgery Back ache Date December 2006

Has received blood in the past _____ Yes ___/__ No If yes list dates____ Reactions___ Yes ___ No Medication Name Dose /Frequency Time of Last dose

Lana

-------

-------

Mr. X is farmer in X. According to Mr. X, he sometimes experienced back ache due to his daily work, though it is such a hinder, he still continue to work to earn money and to raise his family. As an intervention he engaged to self treatment by placing an amount of “Lana” and rubs it to the area where pain is being identified. X Types of previous illness/ surgery Cough Cold Date December 2006 December 2006

Has received blood in the past _____ Yes ___/__ No If yes list dates____ Reactions___ Yes ___ No Medication Name Dose /Frequency Time of Last dose

Neozep

550 mg BID P.O.

-------

Last December 2006, Mrs. X experienced common cough and cold and had taken Neozep to get rid of such illness. According to Mrs. X, she got this illness due to the cold weather they have experienced last December 2006. As a treatment, MsX had taken Neozep 550 mg twice a day.

c. History of Present Illness Based on my interview with Mrs. X X regarding to her daughter’s illness, she said that no one in their family and relatives had experienced pneumonia and other respiratory problem, the most common illness that they only experienced are cough, cold and fever. She told me that, she found X to be playful with his brother and sister during the first and second week of this month but recently three days before X’s admission she found her daughter weak and experiencing fever and start to experienced dyspnea. The only thing that she suspected

regarding to the illness is the bad weather they experienced during the past few days. d. Chief Complain X fourth child of MrX and Mrs. X who was admitted last January 16, 2007 with a chief complain of cough and dry and experienced cold, fever, and diarrhea, five days prior to admission.

III. DEVELOPMENTAL DATA
X Infancy According to Erickson, the central crisis at this stage is trust vs. mistrust. Resolution at this stage determines how the person approaches subsequent developmental stages. During the first year of life, infant depend on their parents for physiologic needs. Fulfillment for this need is required for the infant to develop a basic sense of trust. As for my patient, according to her mother during her infancy period she always demand for an attention, she would really cry whenever she is being held by other person. She also manifest sucking reflex. Early childhood According to Freud’s theory this age represents the anal phase of development when rectum and anus are the especially significant areas of the body. This is the toilet training stage. Aside from her mother, Alona is being trained by her father, older brothers and sister on when and where to defecate. Based on my interview to the client’s mother, my patient is not properly trained. Though Alona give signs to her parents that she wants to defecate and able to identify where is the proper place to defecate but still she sometimes can’t help to defecate in her underwear.

IV. MEDICAL MANAGEMENT
a. Medical Orders and Rationale Date January 16, 2007 Doctor’s Order > Obtain consent Rationale >To obtain patient’s approval if there is an instance that the patient should be undergone to an operation and the hospital will not be held liable for any circumstances to come. >To determine presence of microbes, the type of organisms in the blood and the antibiotic used in which the organism is sensitive. > For fluid replacement > To maintain patient’s nutritional status.

> Laboratory: Hematology

> D5LR 500 cc at 40 mgtts./min. > Diet as Tolerated

Date

Doctor’s Order >Medications: - Paracetamol Drop 1.2 ml QID P.O. - Cefuroxime 250 mg every 8 hrs IVTT ANST (-) - Salbutamol

Rationale > Reduction of fever/ body temperature. > Serious infections of the lower respiratory tract. > Inhalation used as

1 neb every 6 hrs

quick relief agent for acute bronchospasm and for prevention of exercise induced bronchitis spasm. > Allow proper breathing > For fluid replacement

> Place patient in semifowler’s position January 17, 2007 >IVTF: > D5LR 500 cc at 40 mgtts./min. >Same meds order

> Reduction of fever/ body temperature. - Serious infections of the lower respiratory tract. - Inhalation used as quick relief agent for acute bronchospasm and for prevention of exercise induced bronchitis spasm.

> Diet as Tolerated > Maintain bed rest

> To maintain patient’s nutritional status. > Prevent over exhaustion and reduce oxygen consumption.

DRUG STUDY
Name of Patient: Ampoan, Alona
Generic name of Ordered Drug Brand Name Biogesi c Date Ordered Classification Dose/ Frequency/ Route Mechanism of Action Specific Indication Contraindication Side Effects/ Toxic Effects Nursing Precautions

Paracetamol

1/16/07

Anti-pyretic

Drop 1.2 ml QID P.O.

Inhibits the synthesis of the prostaglandin s that may serve as mediators of pain and fever primarily in the CNS.

Reduction of fever/ body temperatur e

Contraindicate d in patients hypersensitive to drug

Skin: rash, urticari a GI: Hepatic failure GU: Renal failure

-assess patient temperature before and during therapy -be alert for adverse reactions and drug interaction -give liquid form to children -warn pt. that high doses or unsupervise d long-term use can cause liver damage.

DRUG STUDY
Name of Patient: Ampoan, Alona
Generic name of Ordered Drug Brand Name Date Ordered Classification Dose/ Frequency/ Route Mechanism of Action Specific Indication Contraindication Side Effects/ Toxic Effects Nursing Precautions

Cefuroxime

_____

1/16/07

Cephalospori ns

250 mg every 8 hrs IVTT ANST (-)

Inhibits cell wall synthesis promoting osmotic instability usually bactericidal.

Serious infections of the lower respiratory tract.

Contraindicate d in patient hypersensitive drug or other cephalosporins .

CV: Phlebiti s, Throm bophle bitis GI: colitis, nausea , anorexi a, vomitin g, diarrhe a SKIN: urticari a, pain, indurati

Obtain specimen for culture and sensitivity test before giving first dose.

on Other: Serum sicknes s

DRUG STUDY
Name of Patient: Ampoan, Alona
Generic name of Ordered Drug Brand Name Date Ordered Classification Dose/ Frequency/ Route Mechanism of Action Specific Indication Contraindication Side Effects/ Toxic Effects Nursing Precautions

Salbutamol

Salbuta mol proventil

1-16-07

Therapeutic broncho – dilators pharmacologi c adrenergics

1 neb every 6 hrs

Relax Inhalation bronchial, used as uterine, quick vascular relief smooth agent for muscle by acute stimulating bronchos beta 2 pasm and receptors for preventio n of exercise induced bronchitis spasm

Hypersensitivity to adrenergic amines.

CNS: Nervou sness, restles sness, tremors , headac he, insomn ia CV: chest pain, palpitat ions GI: Nause a, vomitin

Use cautiously in cardiac disease hypertension , hyperthyroidi sm, diabetes, glaucoma.

g

V. PATHOPHYSIOLOGY W/ ANATOMY AND PHYSIOLOGY
DEFINITION: A contagious infection of the lungs. This type of pneumonia is localized mainly in the smaller branches of the bronchial tubes called bronchioles.

Predisposing Factors:
 Poor sanitized environment  Malnutrition  Age  Exposure to noxious gases.

Precipitating Factors:
 Pseudomonas aeruginosa and Klebsiella, Staphylococcus aureus, Haemophilus influenzae, Staphylococcus pneumoniae  Enteric gram-netgative bacilli, fungi, and viruses

Aspiration of microorganisms in lower respiratory tract

If defense mechanism is weak, possibility of having pneumonia could be acquired

Pathogens thrives in the bronchus of the lungs

As a defense mechanism, the body reacts by causing inflammation

From one area of bronchus, it spreads within the bronchus to lung parenchyma. Which means bronchus is constricted

Inflammation on the area of bronchus interferes with the proper diffusion of oxygen and CO2

With the interference of air exchange, patient experiences poor oxygenation due to under ventilated area of the lungs

BRONCHOPNEUMONIA Signs and Symptoms:
coughing, chest pains, fever, blood-streaked sputum, chills, dyspnea fatigue

Complications: Respiratory Acidosis

Name: X_______________________ Date: January 16, 2007____________ Vital Signs: Pulse: ________ BP: ________ Temp: ________ Height: _________ Weight: ________ EENT: Impaired vision blind pain reddened drainage gums hard of hearing deaf burning edema lesion teeth Asses eyes, ears, nose Throat for abnormality no problem RESP. asymmetric tachypnea apnea rales cough barrel chest bradypnea shallow rhonchi sputum diminished dyspnea orthopnea labored wheezing pain cyanotic Asses resp. rate, rhythm, depth, pattern breath sounds, comfort no problem CARDIO VASCULAR arrhythmia tachycardia numbness diminished pulses edema fatigue irregular bradycardia murmur tingling absent pulses pain Assess heart sounds, rate, rhythm, pulse, blood pressure, etc., fluid retention, comfort no problem GASTRO INTESTINAL TRACT obese distention mass dysphagia rigidity pain Asses abdomen, bowel habits, swallowing, bowel sounds, comfort no problem GENITO-URINARY and GYNE pain urine color vaginal bleeding hematuria discharge nocturia Assess urine freq., control, color, odor, comfort/ Gyn-bleeding, discharge no problem NEURO paralysis stuporous unsteady seizures lethargic comatose vertigo tremors confused vision grip Assess motor function, sensation, LOC, strength, grip, galt, coordination, orientation, speech. no problem MUSCULOSKELETAL and SKIN appliance stiffness itching petechiae hot drainage prosthesis swelling lesion poor turgor cool deformity wound rash skin color flushed atrophy pain ecchymosis diaphoretic moist Asses mobility, motion, galt, alignment, joint function /skin color, texture, turgor, integrity no problem Place an (X) in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure if appropriate, using (x)

VI. NURSING SYSTEM REVIEW CHART

VII. IDEAL NURSING MANAGEMENT
Name of Patient: Ampoan, Alona Nursing Diagnosis Subjective : Ineffective airway As verbalized clearance related by the patient’s to bronchial mother inflammation as “Maghilaka jud ni evidenced by siya basta dyspnea grimace maglisod na og and fatigue. ginhawa.” Objectives : 1. Dyspnea 2. Facial grimace 3. Fatigue Cues Objective Intervention Rationale Evaluation At the end of 30 1. Place patient in semiminutes the client fowler’s position. will display absence of dyspnea and feel relax. 2. Instruct patient or its watcher to change in position frequently. 1. To allow patient At the end of 30 to breath properly minutes the client was able to display 2. For absence of mobilization and dyspnea and felt expectoration of relax. secretions.

3. Decrease the 3. Increase fluid intake. viscosity of secretions. 4. Advice patient to maintain bed rest. 4. Prevent over exhaustion and reduce oxygen consumption. 5. Treatment of choice penicillin resistant streptococcal

5. Administer cephalosporin.

IDEAL NURSING MANAGEMENT

Name of Patient: Ampoan, Alona Nursing Diagnosis Subjective : Activity “Gahangoson intolerance akong anak og related to dali maski dari imbalance lang siya mag between oxygen lihok-lihok sa supply and katre” as demand as verbalized by the evidenced by patient’s mother fatigue. Objectives : 1. Fatigue 2. Exhaustion Cues Objective At the end of 30 minutes the client will display a measurable increase in tolerance to activity with absence of excessive fatigue. Intervention 1. Assist patient to assume comfortable position for rest/sleep. 2. Assist w/ self-care activity as necessary. Rationale 1. To promote relaxation. Evaluation

At the end of 30 minutes the client was able display an increase in 2. Helps balance tolerance to activity oxygen supply with absence of and demand and excessive fatigue. minimize exhaustion. 3. To promote comfort during rest. 4. Reduces stress and excess stimulation and to promote rest. 5. To provide adequate oxygen.

3. Instruct parents to clean and fix patient’s bed. 4. Advice the parents to engage patient in diversional activities as appropriate like telling stories. 5. Administer Oxygen therapy.

IDEAL NURSING MANAGEMENT

Name of Patient: Ampoan, Alona Nursing Diagnosis Subjective : Hyperthermia As verbalized related to illness by the patient’s as evidenced by mother, “duha na flushed skin and ni kaadlaw ang warm to touch. iyang hilanat.” Objectives : 1. Flushed skin 2. Temp. 39.2˚C 3. Chill Cues Objective At the end of 30 minutes the patient’s temperature will decrease. Intervention Rationale Evaluation At the end of 30 minutes the client’s temperature decreased and minimized signs of fever.

1. Perform tepid sponge 1. To reduce bath. fever. 2. Offer cool glass of water or increase fluid intake. 3. Add bed linens/blanket. 2. To prevent thirst and dehydration. 3. To minimize patient from chilling and to maintain near normal body temperature. 4. To prevent increase of metabolic rate.

4. Instruct client to maintain bed rest.

5. Administer anti-pyretic 5. To reduce fever drug as prescribed. through central action in hypothalamic heat regulating center.

Actual Nursing Management S “Kaduha siya nalibang ang akong anak karong buntaga nya basa-basa iyang tae” as verbalized by the patient’s mother O Mrs. Marilyn Ampoan.  Grimace due to abdominal pain  Pain scaled by 4 in 1-10 scaling A P  Watery stools Diarrhea related to infection as evidenced by watery stools and grimace Long term: At the end of 1 day, the patient’s stool will return to its normal consistency. Short term: At the end of 30 minutes the patient will be able I to display or verbalize that the pain has decreased. 1. Promoted bed rest 2. Restarted oral fluid intake gradually 3. Advised patient and parents to eat banana in times of diarrhea. 4. Instructed parents to clean their food utensils thoroughly and boil it. 5. Administered intravenous fluids as ordered. E At the end of 30 minutes the patient was able to display and verbalized that the pain has decreased.

VIII. REFERRALS AND FOLLOW-UP

As such I’ve told the patient’s mother and father to immediately consult the physician or nurse if any unusualities observe to prevent complications. I also told the parents of my patient to ask some questions to the physician during doctor’s round regarding to their daughter’s illness and advised them to maintain cleanliness in the area, on the bed and also provide proper hygiene to their daughter to promote comfort and to enhance wellness. In times illness or to attain free health service, I’ve advised the parents to visit their nearest Barangay Health Center and have a weekly check-up to monitor the health status of each family member, thus promoting prevention rather than cure.

IX. EVALUATION AND COMPLICATIONS
After 2-days of care that was being imparted to the patient, my objectives were fully met. As what is being said, I was able to managed the condition of my client and seen some improvement on her health in just few days. Careful assessment of the client’s health status was done. And from such examination, the client’s problems were identified. Interventions were then planned carefully and were properly addressed to her health problems. After which, her response and reaction were evaluated and important health teachings for her recovery were imparted to her mother and father and especially to my patient. During the second day of our duty, my client was able to display some improvement regarding to her actions and especially to her breathing. Diarrhea and fever were no longer present during the last day of my duty. This implies that the intervention done was effective.

BIBLIOGRAPHY

Smeltzer.Bare. Textbook on Medical-Surgical Nursing (10th edition) LippincottRaven Publisher.Copyright 1996 Wilson, Billie Ann Nurse’s Drug Guide (vol. 1 & 2) Pearson Education Inc.,Copyright 2000 Mosby’s Pocket Dictionary of Medicine, Nursing and Allied Health (4th edition) Elsevier(Singapore) PTE LTD> Copyright 2002 Doenges, Marilynn Nursing Care Plans, Guidelines for Individualizing Patient Care(6th edition) F.A Davis Company. Copyright 2000 Kozier. Erb. Blais. Wilkinson. Fundamentals in Nursing (5th Edition). Addison esley Longman Inc. 1998.

LICEO DE CAGAYAN UNIVERSITY College of Nursing NCM501202 A Care Study X Name of Client Submitted to: ______________________________ Name of Faculty As Partial Requirement for NCM501202 Submitted by: _______________________________ Name of Student Rating Scale A. Written I. INTRODUCTION a. Overview of the case b. Objective of the case c. Scope and limitation of the study II. HEALTH HISTORY a. Profile of patient b. Family and personal health history c. History of Present Illness d. Chief complain III. DEVELOPMENTAL DATA IV. MEDICAL MANAGEMENT a. Medical Orders and rationale b. Drug study V. PATHOPHYSIOLOGY W/ ANATOMY AND PHYSIOLOGY VI. NURSING ASSESSMENT (System Review and Nsg. Assessment II) VII. NURSING MANAGEMENT a. Ideal Nursing Management b. Actual Nursing Management VIII. REFERRALS AND FOLLOW-UP IX. EVALUATION AND COMPLICATIONS X. DOCUMENTATION a. Documentation of evidenced of care for 1 week rotation b. Organization/Grammar/Bibliography Total Score Equivalent Grade WEIGHT 5 RATING

5

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100

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