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BRONCHOPNEUMONIA
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
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
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
3. Chest X ray
chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and
diaphragm.
is a test that looks at a sample of fluid from the space around the lungs to find
and identify disease-causing organisms.
PREVENTION
Pneumoccoccal Vaccine
Hand washing
A respiratory system functions to allow gas exchange. The gases that are
exchanged, the anatomy or structure of the exchange system and the precise
physiological uses of the exchanged gases vary depending on the organism. In humans
and other mammals, for example, the anatomical features of the respiratory system
include airways, lungs, and the respiratory muscles. Molecules of oxygen and carbon
dioxide are passively exchanged, by diffusion, between the gaseous external environment
and the blood. This exchange process occurs in the alveolar region of the lungs.
THE NOSE
THE PHARYNX
1. Upper naso-pharynx
2. Middle oropharynx
3. Lower laryngopharynx
THE NASOPHARYNX
THE OROPHARYNX
• Extends front soft palate down to the epiglottis (base of the tongue)
• It contains the palatine and lingual tonsils.
THE LARYNGOPHARYNX
The narrow zone between the hyoid bone and the entrance to the esophagus.
THE LARYNX
THE TRACHEA
• Extends from the level of the sixth cerebral vertebra, at the base of the larynx, to
the level of the fifth thoracic vertebra.
• is a tubular structure with 4.25 inch length and 1 inch in diameter.
• At its caudal limit the trachea divides to form primary bronchi.
• Lies anterior to the esophagus.
• Along the length of the trachea are 15-20 c-shapes in pieces of hyaline cartilage
(tracheal cartilages)
• The tracheal muscle holds the two sides of the c-shaped c
• Trachea is lined with pseudo stratified ciliated columnar epithelium.
• The trachea branches within the mediastum, forming the left and right bronchi.
(Extra pulmonary bronchi)
• Each bronchus enters a lung at groove, The Hilus.
• Each bronchus branches into increasingly smaller passageway to conduct air into
the lungs.
• The primary bronchi branch into as many secondary bronchi
(Intrapulmonary bronchi)
• As there are lobes in each lung
• The smallest passageway is the bronchioles.
THE LUNGS
• The thoracic cavity is bounded by the ribcage and the muscular diaphragm.
• The mediastinum divides the region into TWO PLEURAL CAVITIES.
• The pleural cavity is lined with a serous membrane, THE PLEURA.
• Parietal pleura line the thoracic wall, diaphragm, and mediastinum.
• Visceral pleura cover the surfaces of the lungs.
• The alveolar walls are made of simple squamous pulmonary epithelium.
• Scattered among epithelium are surfactant cells that secretes oil coating to prevent
the alveoli from sticking together after exhalation.
• Also the alveolar walls are macrophages that phagocytes debris or potential
pathogens.
• Pulmonary capillaries cover the exterior of the alveoli.
DEMOGRAPHIC DATA
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
Temp : 380C
PR : 130 bpm
RR : 44 cpm
NURSING HISTORY
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.
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.
The parents and other member of the family have no known illness. The patient
completed her immunization given in the Barangay Health Center.
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.
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.
Socio-Cultural Health
Cultural Health
Recreational Pattern
The patient loves to play with her cousins sometime she play alone while
watching TV. And she is the joy of the family.
Environmental Pattern
They live a very simple and quite life. Her family lives in her grandfather house,
two storey house made of concrete materials. The surrounding is safe and very quite to
live in.
Economic Pattern
The patient father is a tricycle driver while the mother is a plain house wife who
took care of the patient. According to the mother, income from tricycle is not enough
that’s why the patient grandfather is supporting them financially.
Interaction Pattern
The patient is the joy of the family. She is very sweet to her grandparents. And
friendly to other child of her age.
Cognitive Pattern
The patient can recognized object and person. She knows already to express what
she likes and don’t likes. At her age now, she can recognize some color like red and
yellow.
Coping Pattern
The presence of her father and her mother makes everything light for her. She
feels safe, happy and smiles a lot when her parents are with her.
PHYSICAL ASSESSMENT
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.
Classification:
Corticosteroids
Dosage:
Q4h/Q6h
Available forms:
Tablet and
suppository
Classification:
Cephalosporin,
Second Generation
Classification:
Cephalosporin,
Third Generation
Radiology Result
Impression:
DISCHARGE PLANNING
4. The SO must understand the purpose of her medication when and how to take
those.
BRONCHOPNEUMONIA
Case Study
Submitted By:
Submitted to:
PATHOPHYSIOLOGY
↓
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
Pathophysiology:
Viral Infection
These are characterized by the accumulation of mononuclear cells in the submucosa and
perivascular space, resulting in partial obstruction of the airway. They clinically manifest
as wheezing and crackles.
Disease progresses when the alveolar type II cells lose their structural integrity and
surfactant production is diminished, a hyaline membrane forms, and pulmonary edema
develops.
Bacterial Infection
The alveoli fill with proteinaceous fluid, which triggers a brisk influx of red blood cells
and polymorphonuclear cells (red hepatization) followed by the deposition of fibrin and
the degradation of inflammatory cells (gray hepatization).
During resolution, intra - alveolar debris is ingested and removed by the alveolar
macrophages. This consolidation leads to decreased air entry and dullness to percussion.
Inflammation in the small airways leads to crackles. Wheezing is less common than in
viral infections.
Inflammation and pulmonary edema resulting from these infections causes the lungs to
become stiff and less distensible, thereby decreasing tidal volume. The patient must
increase his respiratory rate to maintain adequate ventilation.