PRESENT BY

J. NIMLID BHOWING
BSC NURSING 3RD
YEAR
PRESENT MEDICAL HISTORY:
Baby. Dhivya got admitted in SRM General Hospital. With
the chief complaints of fever, cold, wheezing for past 10 days ,
parents brought the child to out patient department
after physical examinations, lab findings. Physician was
diagnosed as Broncho Pneumonia and admitted in peadiartic
ICU.
PAST MEDICAL HISTORY:
No significant complaints of past Medical history
PRESENT SURGICAL HISTORY:
No significant of present surgical History
PAST SURGICAL HISTORY:
No significant of past surgical History.
 ANTENTAL HISTORY:
The mother underwent regular antenatal checkup. She took
iron, folic acid and calcium supplement regularly. She took 2
does of tetanus during antenatal period. There is no evidence of
maternal exposure of radiation and other complications.
INTERATAL HISTORY:
The baby was delivered by Lscs. The baby cried
immediately. Baby weight was 3.8kg. There is no history of NICU
Admission.
POSTNATAL HISTORY:
After delivery the mother and child don’t have any
complications. Breasr feeding was initiated within a hour.
 NUTRITIONAL PATTERN:
The child used to take both vegetarian and Non-
vegetarian foods.At present the child is feeded by
complementary foods like Idly,Dosa,porridge etc.she
doesn’thave any history of food allergy
SLEEP AND REST PATTERN:
The sleep pattern is disturbed because of feaver,
cold and wheezing. The child sleep for 5-6hours/day.
FAMILY HISTORY:
In her family her grandma has hypertension,
Diabetes mellitus for past 5 years. No other has any
history of Diabetes, hypertension, asthma, tuberculosis
etc
SOCIO ECONOMIC
BACKGROUND:
The child father is
breadwinner of her family.
AGE VACCINE REMARKS
AT BIRTH BCG,OPV GIVEN
6TH WEEK DPT,CPV-1,HEP(B)1 GIVEN
10TH WEEK DPT,HEP(B)2,OPV2 GIVEN
14TH WEEK DPT,HEP(B),OPV3 GIVEN
9TH MONTH MMR GIVEN
9-12TH MONTH TYPHOID 1 GIVEN
1 YEAR HEPATATIS A(1) GIVEN
16-18 MONTH DPT,H1B GIVEN
BOOSTER,HEP(A)2

2 YEARS TYPHOID(2) GIVEN

4-6 YEARS DPT,MMR NOT GIVEN
GROWTH OF DEVELOPMENT
GROSS MOTOR
 Rides bicycle without  Rides bicycle on her own,
training wheels the child runs, climbs,
 Runs, jumps, climbs jumps and moves from one
place to another
Constantly keep
constantly
moving

FINE MOTOR
 Bath self unassisted
 The child baths on her own,
 Learns cursive combs her hair, learning
handwriting cursive handwriting
 Continusaly refines
previously learned skills
 Can brush and comb
hair.
INTELLECTUAL DEVELOPMENT
 Attention span increased  The child was able to identify the
 Can describe the objects in objects
picture,knows their use  She is learning to read
 Can tell time  Can tell the correct time
 Is learning to read
 Follows rules to avoid punishment

LANGUAGE DEVELOPMENT
 Receptive language  Can repeat sentence of 5-
 Can repeat sentence of 10-12 words 8 words
 Develop sense of humor and enjoy  Reacts to jokes by
telling jokes laughing
PSYCHOSOCIAL DEVELOPMENT
 Continues to be egocentric and bossy  Wants to play with other
 Has a know it all attitude children
  The child gets jealous
Wants other children to play with
easily
 Jealous of siblings

SENSORY DEVELOPMENT
 HAS 20/20 VISION  THE CHILD HAS VERY CLEAR VISION
THAT IS 20/20.
 GENERAL APPEARANCE
POSTURE: NORMAL
BODY BUILD: LEAN
ACTIVITY: DECREASE AND DULL ACTIVITY
NOURISHMENT: MODERATE
HYDRATION: MODERATELY GOOD
VITAL SIGNS:
PARAMETERS BOOK PICTURE PATIEN REMARKS
T
PICTU
RE

TEMPERATURE 98.6F 101F HYPERTHERMIA

PULSE 90-180b/m 100b/m NORMAL
RESPIRATION 26-28bth/m 15bth/m DECREASED
PARAMETERS BOOK PICTURE PATIENT REMARKS
PICTURE

WEIGHT (Age in years 18kg DECREASED

*3)+7
6*3+7=25kg

HEIGHT (Age in years 102cm DECREASED

*6)+7
6*6+77=130cm

MIDARAM 12-17cm 16cm NORMAL

CIRCUMFEREN
CE
 GENITALIA
INTERPRETATION:
On complete Head to foot assessment
child was cold, Hyperthermia (101°F)and she
doesn’t have any complications and she
was diagnosed as BRONCHO PNEUMONIA
NAME OF THE
INVESTIGATION
PATIENT VALUE NORMAL VALUE REMARK

HAEMOGLOBIN 95mg/dl 1.1-13g/dl Mild anemia

TOTAL WBC 6,790/cumm 5000-1000/cumm Normal
COUNT
NEUTROPHILS 42ml 40-60ml Normal
LYMPHOCYTE 20ml 20-40ml Normal
ESINOPHILS 2ml 1-4ml Normal
BASOPHILS 0.9ml 0.5-1/ml Normal
MONOCYTES 3ml 0-8 Normal
PLATELET 1,70,00/cumm 1.52-472*109/ml Normal
COUNT
TOTAL RBC 4.81 5-101 Decreased
NAME OF DOSAGE ROUTE FREQUENCY
DRUG

INJ.XONE 500mg IV BD

INJ.EMESET 1mg IV TDS

NEB.ASTHALIN 0.3ml+3Nacl ORAL Q2H

SYP.PHENAGR 2ml ORAL SOS

AN

IV DNS 5000ml 12th IV 12th HOURLY

hourly
 Lungs are a pair of Respiratory organs.it is situated in thoracic
cavity .on either sides of mediasternum it rests on the diaphragm .
 COLOUR:
Brown or grey in colour
EXTERNAL
FEATURES:
Conical in shape.
 PARTS:
Apex

Base
Three borders
Two surfaces
THREE
BORDERS:
Anterior
Posterior
• TWO SURFACES:
 • Medical
 • Costal

• MEDIAL:
 Anterior part(mediastinalpart)
 Posterior part(vertebral part)

• APEX:
 It is covered by cervical pleura and supra membrane.
 It lies above the clavicle

• BASE:
 It rests on the diaphragm
 Diaphragm separates right lung from right lobe of the liver
 Diaphragm separates left lung from left lobe of stomach or spleen
BORDERS:

 ANTERIOR:
 It is straight and thin RL(Right lung)
 Not a straight borders LL(Left lung)

 POSTERIOR:
 Thick and rounded
 Related to vertebral bodies

 INFERIOR:
 It separates base from costal and medial surface

 MEDIAL SURFACE
 Posterior vertebral part
 Anterior Medial part
FISSURE AND LOBES:

• Right lung:
 Oblique fissure
 Horizontal fissure

• Left lung:
 Oblique fissure

• Right lobes:
 Upper lobes
 Lower lobes
 Middle lobes

• Left lobes:
 Upper lobes
 Lower lobes

• Hilum:
 It is a space present on a Medial surface of lung
 Through which structures entering and leaving.
• Struture:
 Pulmonary vein
 Pulmonary Artery
 Bronchial Artery
 Bronchial vein
 Bronchopulmonary lymPhnodes

Blood supply:

• Arteries:
 Bronchial vein
 Pulmonary vein

• Lymphatic drainage:
 Bronchopulmonary lymphnodes.
GAS EXCHANGE:
 The major function of the lungs is gas exchange between the lungs
and the blood.the alveolar and pulmonary capillary gases equillibrate
across the thin blood air barrier,This thin membrane is folded into
about 300 million alveoli providing an extremely large surface area
.
 The lungs are not capable of expending the breath on their own and
will only do so when there’s an increase in the volume of the
thoracic cavity .This is achieved by the muscle which pull the rib
cage.
OTHER FUNCTIONS:
 Involved in maintaining homeostasis
 Helps in the regulation of blood pressure as a part of the
renin-angiotensin system
 The lungs filter out small blood clots from vein and
prevent them from entering arteries and causing strokes
 The lungs also play a pivoted role in speech by providing
air and airflow for the creation of vocal sounds and other
paralanguage communication such assigns and gasps.

PROTECTION:
 The lung possess several characteristics which protect
against infection.
 The respiratory is lined by epithelial with hair
rhythmically like projections called cilia that beat
rhythmically and carry mucus thus mucociliary
clearance is an defence system against airborn infection.
OTHER FUNCTIONS:
 Involved in maintaining homeostasis
 Helps in the regulation of blood pressure as a part of the renin-
angiotensin system
 The lungs filter out small blood clots from vein and prevent them
from entering arteries and causing strokes
 The lungs also play a pivoted role in speech by providing air and
airflow for the creation of vocal sounds and other paralanguage
communication such as signs and gasps.

PROTECTION:
 The lung possess several characteristics which protect against
infection.
 The respiratory is lined by epithelial with hair rhythmically like
projections called cilia that beat rhythmically and carry mucus
thus mucociliary clearance is an defence system against airborn
infection.
DEFINITION
 It is a type of pneumonia that affects the bronchi in the
lungs. This condition commonly results from bacterial
infection, but viral and fungal infections can also occur in
it.

PNEUMONIA
 Pneumonia is defined as as the acute inflammation and
consolidation of lung parenchyma
BASED ON ANATOMIC BASIS:
 Lobar pneumonia
 Interstitial pneumonia
 Brancho pneumonia

ETIOLOGICAL BASIS:
 Bacterial pneumonia
 Viral pneumonia
 Fungal pneumonia
 Protozoal pneumonia

MISCELLANEOUS TYPE:
 Aspiration pneumonia
 Loefflers pneumonia
 Bacterial outside the body
 Staphylococcus
 Aures Hemophillus influenza
 Pseudomonas Aeroginosa
 E.Coli

•CLINICAL MANIFESTATION
• Book picture
 Cough
 Dyspnea present
 Chest breathing
 Chills
 Headache
 Fever
 Rapid breathing
 Difficulty in sleep

Patient picture
 Present
 Present
 Absent
 Absent
RISK FACTORS
AGE
•People who are above 65 yrs and children below 6 years to this
kind of
Disease

ENVIRONMENT
•The poor and unhygienic environment. The polluted environment
may develop bronchopneumonia

LIFE STYLE
• Poor nutrition ,smoking,and history of alcoholics

OTHER CONDITIONS
•The long term lung diseases like
COPD,asthma,bronchictasis,Respiratory infections, weaken
immune
system
Due to pathological and etiology factors.
Infection and inflammation of air sacs in both the lungs
The air sac may gill with pus or mucus secretion
It leads to fever,chill,difficulty in breathing
A variety of organisms including bacteria, fungi and virus
can cause pneumonia
Consolidation of lung tissue
Increase production of sputum
Purud
Purulent sputum
 BOOK PICTURE
 History collection
 Physical examination
 Chest x-ray
 Sputum culture
 Bronchoscopy

 PATIENT PICTURE
 History collection is done
 BOOK PICTURE
 O2 therap
 Nebulization 0.3ml+3Nacl
 Antibiotics
 Chest therapy

PATIENT PICTURE
 Inj.xone was administered chest therapy was not given
•Ineffective airway clearance related to mucus secretion as
evidenced by difficulty in breathing
•Hyperthermia related to Respiratory infections as evidenced
by monitoring temperature
•Imbalanced Nutrition related to less intake of food as
evidenced by mother verbalization
•Fear and anxiety related to Hospitalization as evidenced by
facial expressions
•Knowledge deficit related to treatment as evidenced by the
baby’s mother asking many questions
 • Subjective data:The child’s says that the baby has cough and cold.
•Objective data:The child has breathing difficulty and secretion of
mucous
•Nursing diagnosis:ineffective airway clearance related to mucous
secretion was evidenced by difficulty in breathing
• Goal:To maintain airway clearence

PLANING RATIONAL INTERVATION EXPECTE

D
OUTCOME
Monitor respiration To know the baseline Monitor respiration The child airway was
status every 2 hour status every 2 hour maintained

Administer 02 as per To decrease the Administered O2 to the

doctor order breathing child
difficulty
Give comfortable To ensure the Comfort position
position to child breathing pattern taught to the child
mother

Give nebulization to To clear the airway Nebulization given

the child passage asthmatic+0.3ml+3Nac l

Administer medication To maintain airway Medication are given

as per doctor order clerance to the child
•Subjective data:The infants mother says that the child has fever
for past
10 days
• Objective data:The child looks dull and restlessnesse
•Nursing diagnosis:hyperthermia related to improve thermo
regulation as
evidenced by temperature
• Goal:To maintain Normal body temperature

PLANNING RATIONALE INTERVENTIO EXPECTED

N OUTCOME
Check temperature To know the Temperature was
to the child baseline data checked 100F

Give a tepid sponging To maintain the Tepid sponge was Normal body
to the child normal body given temperature was
temperature maintained

Administer enter of To maintain fluid Administer fluid The temperature

fluids balance contain DNS 500ml reduce from

Administer To reduce the Administer the syrup

medication as per temperature phenagram
physician order
 DIET
 Advice the caregiver to give plenty of water
 Instruct the mother not to give spicy foods.
 Encourage the caregiver to give protein ,rich foods ,
vegetables and caloric diet to the child
MEDICATION:
 Advice the caregiver to follow the proper medication as per the
physician order.
 Encourage the attendees to follow doctors and nurses
interventions
PREVENTION:
 Instruct the caregiver to immunize the child
 Follow a healthy life
 Encourage to maintain good personal hygiene
 Baby.dhivya got admitted in SRM General hospital with the
chief complaints of fever,cold and wheezing for past 10 days
parent brought the child to out patient department. After
physical Examination and lab findings physician was
diagnosed as Broncho Pneumonia After undergoing treatment
the child has some improvement than before. I have taken
case as my clinical presentation I gained adequate knowledge
about the disease condition
REFRENCE:
 Parul Dutta A publisher of peadiatric Nursing 2nd edition pg
no 314-380
 Rimple sharma A peadiatric Nursing 4th edpg no 52-54 2nd
edition pg no 70-72