Liceo De Cagayan University Cagayan de Oro City

College of Nursing      

In Partial Fulfillment Of the Course Requirement

In NCM501204 Related Learning Experience

     

A Case Study on  

Bronchopneumonia 

Submitted To: Mr. Lilian Gerochi, RN

Clinical Instructor    

Submitted By:  

Ranna Lillianne Z. Escudero Cyrra Mae GoPamela Enobio

BSN-4    

   

I.                   Introduction

 

A. Overview

Bronchopneumonia is a type of pneumonia which results when haematogeneous

dissemination of organisms to the lung or colonization of airways with subsequent

aspiration is responsible for pulmonary infection. As opposed to other acute bacterial or

lobar pneumonias which begin in alveoli, bronchopneumonia originates in small

bronchioles. Typical bacteria causing this form of infection include Staphylococcus

aureus and Gram-negative organisms such as Pseudomonas aeruginosa. These organisms

disseminate through the bloodstream and colonize the bronchial or bronchiolar

epithelium, but then quickly cause acute inflammatory responses which extend outside

the airway into adjacent alveoli. The initial inflammatory response consists largely of

polymorphonuclear leukocytes which limit the extent of infection to the peribronchiolar

region. Since multiple sites are involved simultaneously a scattered appearance of

heterogeneous opacities is the usual pattern observed on chest films (Fig.1). Eventually

more and more alveoli are affected and ultimately a homogeneous opacification

simulating lobar pneumonia may be observed. Nevertheless, because there is greater

airway involvement with bronchopneumonia, air bronchograms are infrequent and

atelectasis is more common. Peribronchial interstitial thickening may also be seen early

in the course of infection. Necrosis and cavitation are more frequent in this type of

pneumonia. Pneumatocoeles are occasionally noted.

Clinically, patients present with fever and productive cough similar to other bacterial

infections although physical findings typical of dense consolidation such as

bronchophony and whispering pectoriloquy are not heard. Treatment with a variety of

antibiotics usually results in rapid clinical and radiographic resolution.

 

A.     Objective of the Study

General Objective:

This study aims to impart appropriate nursing care to patient by applying

the principles of nursing and to amend at the same time the patient’s  and her

family’s view towards proper health and wellness.

            Specific Objectives:

At the end of our exposure at the medical ward of Polymedic General

Hospital Operating Room Department, I will be able to:

Establish Rapport to the patient

Gather information on the following:

a.       General information

b.      Patient’s health

c.       Patient’s home and environment

Obtain Patient Health History.

Identify the developmental task of the patient.

Identify the existing and health threatening problems.

Present Nursing Care Plans.

Evaluate the implementation as to the degree it has met its goal.

 

 

 

B.     Scope and Limitation

 

II. Health History

A.     Patient’s Profile

 

A. FAMILY AND PERSONAL HEALTH HISTORY

 

 

B.  CHIEF COMPLAINT AND HISTORY OF PRESENT ILLNESS

II.                Growth and Development

 

 

III.             Medical Management

a.      Medical Orders and Rationales

Date and Time Medical Orders Rationale

 

 

B.     Obtained Laboratory Results

 

CBC Normal Values Results Implication

WBC 5-10x103/uL 27.89 abnormal

RBC 3.69-5.9x103/uL 3.65 abNormal

Hemoglobin 13.7-16.7 g/dL 10.1 abnormal

Hematocrit 40.00-50% 30.6 abnormal

Platelet Count 150-390x103/uL 282 Normal

Differential Count

Lymphocytes 20-50% 7.1 Infection

Monocytes 1-3% 4 abnormal

Eosinophils 8-14% 0.1 abNormal

Basophils 1% 0.1 -

MCV 70-97.00 fL 81.7 Normal

MCH 6.10-33.30 g/dL 25.4 Normal

MCHC 32.0-35 g/dL 33 abnormal

Rdw-CV 11.5-14.5% 170 -

   

C.     Drug Studies

 

II.                Pathophysiology with Anatomy and Physiology

A.     Anatomy of The Respiratory System

To better understand pneumonia, it is important to understand the basic anatomic

features of the respiratory system. The human respiratory system begins at the nose and

mouth, where air is breathed in (inspired) and out (expired). The air tube extending from

the nose is called the nasopharynx. The tube carrying air breathed in through the mouth is

called the oropharynx. The nasopharynx and the oropharynx merge into the larynx. The

oropharynx also carries swallowed substances, including food, water, and salivary

secretion that must pass into the esophagus and then the stomach. The larynx is protected

by a trap door called the epiglottis. The epiglottis prevents substances that have been

swallowed, as well as substances that have been regurgitated (thrown up), from heading

down into the larynx and toward the lungs.

A useful method of picturing the respiratory system is to imagine an upside-down

tree. The larynx flows into the trachea, which is the tree trunk, and thus the broadest part

of the respiratory tree. The trachea divides into two tree limbs, the right and left bronchi.

Each one of these branches off into multiple smaller bronchi, which course through the

tissue of the lung. Each bronchus divides into tubes of smaller and smaller diameter,

finally ending in the terminal bronchioles. The air sacs of the lung, in which oxygen-

carbon dioxide exchange actually takes place, are clustered at the ends of the bronchioles

like the leaves of a tree. They are called alveoli.

The tissue of the lung that serves only a supportive role for the bronchi,

bronchioles, and alveoli is called the lung parenchyma.

The main function of the respiratory system is to provide oxygen, the most

important energy source for the body's cells. Inspired air (the air taken in when a person

breathes) contains oxygen, and travels down the respiratory tree to the alveoli. The

oxygen moves out of the alveoli and is sent into circulation throughout the body as part of

the red blood cells. The oxygen in the inspired air is exchanged within the alveoli for the

waste product of human metabolism, carbon dioxide. The air you breathe out contains the

gas called carbon dioxide. This gas leaves the alveoli during expiration. To restate this

exchange of gases simply, you breathe in oxygen, you breathe out carbon dioxide

B. Pathophysiology Of IncomplBronchopneumonia

IV.              Nursing Assessment

NURSING SYSTEM REVIEW CHARTNURSING  ASSESSMENT II

SUBJECTIVE OBJECTIVECOMMUNICATION: [ ] hearing loss                 Comments: “wala koy [ ] visual changes            problema sa akong pan             [x] denied                        dungog ug panan-aw,”                                        As verbalized by the pt.               

                                                                                             

  [ ] glasses                             [ ] language [ ] contact lens                     [ ]  hearing aide                   R                          L Pupil size:   3 mm  Speech Difficulties: None Reaction:  Pupils Equally Round Reactive to Light and Accommodation(PERRLA)

  OXYGENATION: [ ] dyspnea                 Comments: “Dili man ko    [ ] smoking history       gapanigarilyo ug okay 15years smoking           lang man akong pag- [ ] cough                        ginhawa.” [ ] sputum                    [x] denied                                  

                                                 

Respiration:         [x ] regular          [ ] irregular   Describe: Client had regular breathing pattern during physical assessment.                                                           R.   Symmetrical to the left. L    Symmetrical to the right.  

CIRCULATION:  

[ ] chest pain                  Comments [] leg pain                    [] numbness of                 extremities               said by the pt. [x ] denied

Heart Rhythm           [x] regular      [ ] irregular   Ankle edema : None         Heart :  regular      Carotid       Radial        Dorsal Pedis     Femoral   R___+        60 bpm+_______+__________+_____ L___  +      60 bpm+______+__________+_____   Comments: All pulse sites were palpable during physical assessment.

NUTRITION: Diet:  Diet As Tolerated [ ] N          [ ] V        Comments: Wala kaayo ko                         character                      gana karun mukaon”. [ x] recent change               As verbalized by [ ] weight, appetite        [ ] swallowing                 difficulty                   [ ] denied                    

  [ ] Dentures                                   [ ] None                                  Full        Partial      With Patent   Upper                    [ x]           []             [ ]   Lower                    [ x]            []             [ ]

  ELIMINATION: Usual bowel pattern          [ ] urinary frequency        once a day.                          6X a day

Comments: Bowel        Bowel Sounds: Normoactive sound     was                      normal, urine

[ ] constipation                          [ ] urgency      remedies                               [ ] dysurria      None                                     [ ] hematuria Date of last BM                         [ ] incontinence  June 24, 2009                             [ ] polyturia  [ ] diarrhea                                [ ] foly in place       character                              [x] denied

 was yellowish   in                  Abdominal distention  color with                      Present [ ]  Yes [x] No  aromatic odor.                                                                      

MGT. OF HEALTH & ILLNESS  [ ] alcohol                                [ ] denied (amount, frequency) “Dili man ko gainom”SBE last pap smear: N/A EDC: N/A

Briefly describe the patient’s ability to follow treatments (diet, medication, etc.) for chronic health problems (if present) Patient took all the prescribed medications as prescribed by the doctor.

 

SUBJECTIVE OJECTIVE

SKIN INTEGRITY:

[ x] dry            Comments: “ Mala ug luspad [  ] itching           ang akong panit.        [x] others             [ ] denied                                                            

[x ] dry              [ ] cold           [x ] pale

[ ] flushed         [ ] warm  [ ] moist            [ ] cyanotic   *rashes, ulcers, decubitus (describe size, location,     drainage)  Patient skin was dry,pale and warm to touch.  

ATIVITY/SAFETY:

[ ] convulsion            Comments: [x] dizziness               Gapanglipong lage ko [ x] limited motion     karun.Kapoy akong       of joints             pamati sa akong lawas. “  limitation of ability    to :                              [ ] ambulate                [ ] bathe self               [ ] other                            [ ] Denied

 

LOC and Orientation: The patient was aware of time, place people and date. 

                                   [x] Gait        [ ] Walker       [x ] Care        [ ] Other [ ] Steady                     [ ] Unsteady   Sensory and motor losses in face or extremities                           numbness of lower extremities [ ] ROM limitations: Range of motion was   observed, the patient could not able to walk or move properly during the interview ,because of her numbness felt caused by induced anesthesia.

COMFORT/SLEEP/AWAKE

 () pain                       Comments: (location, frequency  

 

[x] facial grimaces

[ ] guarding

remedies)                    complained by the pt. patient. [  ] nocturia               [  ] sleep difficulties           [ x] DENIED               

  [x ] other signs of pain:verbalization of pain complaint                                  [ ] side rail release from signed (60+years): N/A

                           

COPING:

Occupation: ChildMembers of the household:  Most Supportive Person: Mother

 

Observed non-verbal behavior: moving slowly of her  lower extremities and touching abdominal part, general body weakness, and  paleness of skin Person (Phone Number):Not given

(SPECIAL PATIENT INFORMATION (USE LEAD PENCIL)

                      kilograms   Weight Daily                           N/A    PT/OT                    mmHg    BP q Shift                                N/A    Irradiation                              N/A         Neuro vs                                   N/A   Urine Test

                             N/A        CVP/SG. Reading                    N/A   24 Hour Urine Collection

 

VI. Nursing Management

A.     Ideal Nursing Management

Nursing Diagnosis Interventions Rationales

 

Nursing Diagnosis Interventions Rationale

 

Nursing Diagnosis Interventions

 

 

 

 

 

 

 

 

 

 

B.     Actual Nursing Management

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VII.           Referrals and Follow Up

Medication

            Inform patient and the significant others about the medication indicated for home

regimen, their purpose, route, frequency of administration. Explain to the patient and

family the importance of taking the prescribed drugs to promote faster recovery and for

maintenance of health as well. Warn the patient about the side effects of the drugs that

may occur during the course of pharmacologic treatment. Refer to physician any adverse

reactions or complications such as infection or hypersensitivity to provide immediate

interventions. Educating the patient and the family regarding all that pertains to

administration of medications at home is essential for an effective independent

management of the above mentioned party towards the betterment of the patient’s

condition.

 

Hygiene

          Inculcate the importance of taking a full bath everyday to achieve a refreshing

feeling thus promoting proper hygiene and cleanliness. Explain to patient the importance

of a clean environment inside and outside the home, free from sources of harmful organic

and inorganic substances. Tell the family to maintain sanitary practices especially in

disposing wastes and garbage. The first line of defense against infections and disease is

the proper hygiene. An environment having less if not free from pathogenic

microorganisms is ideal for health restoration and maintenance.

 

Spiritual

          Encourage the family to continuously provide emotional support to anchor the

patient towards recovery. Encourage the patient to establish a good relationship with

GOD to have a source of strength and ask forgiveness after committing an abortion. The

spirituality of the patient developed by the family provides a stable foundation upon

which the situation is faced with faith and hope for a better future.

 

VIII.        Evaluation and Nursing Implication

Education indeed is a revolutionary discovery for mankind. It is where we devote

ourselves unto learning the fundamentals of life and reality giving way to a more stable

foundation of growing. But education applied to nursing still follows the same concept,

but with few kicks. For knowledge in nursing is best learned outside the four corners in

our room, and requires more than just piles of books, but with actual exposure in the

hospital.

Nurses equipped with both God-given talents and attained skills marches their

way unto humanity doing what they do best, promoting health, preventing illness and

alleviating suffering. But as time passes by, situations become more complicated as

man’s needs multiply. With this in mind, nurses’ versatility takes place, as she puts into

actions all her grasped experiences and attained knowledge.

As student nurses, we should know what it takes to be an effective, who deal with

situations professionally and uses skills and knowledge imparted in the academe. We

should also know our responsibility as part of the Health Providers and not just for

achieving NCM501204, but as a stepping stone to further enhance our abilities for the

future ahead. That is why, having this case study gave us a whole new insight, not just

what we have read in the books, but through experiences we had during our exposure.

Our study was truly one of the best, for it gave us the chance to apply our

knowledge that can help us contribute further to improve the condition of the population

as a tool for us as student nurses that can enhance our understanding about people who in

the future will be the subject of our care.

 

 

                                                                                                   

Bibliography

 

     BOOKS

        Doenges, Moorhouse, Murr. “Nurses Pocket Guide”, 10th Edition. Pages 629-630.

        Kozier,et al. “Fundamentals of Nursing”. 5th Edition. Pages 106-121, 1134, 111227-1228.