I.

Introduction
Bronchopneumonia or bronchial pneumonia (also known as lobular pneumonia) is a
type of pneumonia characterized by multiple foci of isolated, acute consolidation,
affecting one or more pulmonary lobes.

It is one of two types of bacterial pneumonia as classified by gross anatomic distribution

of consolidation (solidification), the other being lobar pneumonia.
bronchopneumonia is less likely than lobar pneumonia to be associated with
Streptococcus.

The bronchopneumonia pattern has been associated with hospital-acquired pneumonia,

and with specific organisms such as Staphylococcus aureus, Klebsiella, E. coli, and
Pseudomonas.

In bacterial pneumonia, invasion of the lung parenchyma by bacteria produces an

inflammatory immune response. This response leads to a filling of the alveolar sacs with
exudate. The loss of air space and its replacement with fluid is called consolidation. In
bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute
consolidation, affecting one or more pulmonary lobes.

It should be noted that although these two patterns of pneumonia, lobar and lobular, are
the classic anatomic categories of bacterial pneumonia, in clinical practice the types are
difficult to apply, as the patterns usually overlap. Bronchopneumonia (lobular) often
leads to lobar pneumonia as the infection progresses. The same organism may cause
one type of pneumonia in one patient, and another in a different patient. From the
clinical standpoint, far more important than distinguishing the anatomical subtype of
pneumonia, is identifying its causative agent and accurately assessing the extent of the
disease.
 Objective of the study

The objectives of the case study is to formulate a nursing care plan intended to
the client and I will be able to enumerate the care for my patient as follows; Let the
patient get plenty of rest; encourage to increase fluid intake, these will keep him
hydrated and help loosen mucus in the lungs; to take the entire course of any prescribe
medications, and stopping the medications too soon can cause the bronchopneumonia
to come and contributes to the development of antibiotic-resistant bacteria.

1To compare & contrast the ideal and actual nursing care management for these
specific disease conditions.
2To ascertain the content on the nursing assessment, diagnosis, planning,
implementation, and evaluation for these specific disease conditions;
3To comprehend on the underlying causes and health history on our client’s
medical diagnosis upon admission;
 Scope and Limitations of the Study

Since the care of the client was limited only atleast a care of 24 hours, on the first
day of duty, I was able to attend to his needs for 12 hours duty (from 7am-7pm) and
since the patient’s significant others were there, I was able to gather vital information on
the client’s history and background and as part of the health team and as a student
nurse I have to give a nursing considerations for his case, for a nursing student like me,
my priorities would be his breathing or his airways and the study would limit only the
care for the client because of the number of duty days in the hospital.
 Health History

The patient was born November 11, 2008 at Zarat, Agusan Cagayan de Oro City
on a Normal Spontaneous Vaginal Delivery of a trained hilot. His father Melvin Elib is a
welder at a junkshop, while his mother Ellen Elib is a housewife.

One day prior to admission, there was an onset of fever associated with cough
and colds and there was no medication taken.
On the day of admission, VE had onset of equal rolling of eyeball and there is
productive cough, colds and fever.
PATIENT PROFILE

NAME : Vinz Elib

ADDRESS : Agusan Cagayan de Oro City
SEX : Male
AGE : 2 years old
WEIGHT : 6.5 kilograms
HEIGHT : 2 feet
CIVIL STATUS : Child
BIRTHDATE : November 11, 2008
BIRTHPLACE : Zarat Agusan, Cagayan de Oro City
OCCUPATION : Not applicable
NATIONALITY : Filipino
RELIGION : Roman Catholic
DATE OF ADMISSION : January 20, 2011
ATTENDING PHYSICIAN : Dr. Balaguhan

B. Family and Personal Health History:

Vinz Elib a 2 year old child. Eldest son of Mr. Melvin and Ellen Elib was born last
November 11, 2008 via Normal spontaneous vaginal delivery at their house at Brgy
Zarat Agusan Cagayan de Oro City by a trained hilot. He completed his vaccination at
Agusan Health Center.
A day before VE was admitted to Puerto Sabal Hospital, he had fever ranges
from 37.9-38.6*c, productive cough, colds and a sudden rolling of his eyeballs.

C. History of Present Illness:

Last year when he had a cough, they never seek hospitalization because three
days pass the symptoms disappeared and only this time that patient was suffering from
a shortness of breath and fever, that’s why the parents decided to seek hospitalization
at Puerto Sabal Hospital, Brgy. Bugo Cagayan de Oro City.
D. Chief Complaint:
Patient was having fever of 38.6*c, productive cough, colds, shortness of breath
and sudden rolling of his eyeballs.
 DEVELOPMENTAL DATA

Freud’s Stage of Childhood

Anal stage, according to Freud the child explores Anus and rectum are the center
of pleasure. This stage occurs during toilet training. During this stages it is important to
teach our child in doing toilet training and as one of the critical stages of development
because through teaching them they will know the purpose and proper toilet etiquette
And during my care to the patient, I could say that the child developed a poor training
from his mother because he still pee and defecate on his underwear even he is not
asleep.

Erickson’s Stages of Childhood

Developmental task is to form a sense of Initiative vs. Guilt Confidence in oneself
as an originator. During this stages the child learn to develop skills and may understand
and learn from it. The patient’s health status, he needs to be corrected at all times and
adding a security such as guidance with the mother at all times that may provide him
with an active child involvement.
Piaget’s Stages of Cognitive Development
The preoperational stage extends from about 2-7 of age. Its dominant theme is
discovering operations, which are plans, strategies, and rules for solving problems and
classifying information. Preoperational children have the basic mental abilities for
mental operations. They can form mental images, and they can represent them
symbolic with words. Their immature thinking leads to unique. Striking up a
conversation about the sun night reveal two characteristics of preoperational though
animism, which is the tendency to attribute life to inanimate objects, and egocentrism,
which is the belief that everything is centered on one’s self. Another characteristic of
preoperational thought is lack of conversation is a lack of understanding that the amount
do not change when shapes change (e.g. Madden, 1986). For example, if you rolled out
a ball of clay into a log shaped, the preoperational child would say that the leg has more
clay than the ball.
 SIGNS & SYMPTOMS:

Cough (with mucus-like, greenish, or pus-like sputum chills with shaking ), fever,
easy fatigue, chest pain (sharp or stabbing increased by deep breathing or increased by
coughing), headache, loss of appetite, general discomfort, uneasiness, or ill feeling
(malaise), joint stiffness (rare), muscular stiffness (rare), rales was an Additional
symptom that may be associated with this disease: shortness of breath, clammy skin,
nasal flaring, coughing up blood, tachypnea, apnea,

MEDICAL MANAGEMENT:
The goal of treatment is to cure the infection with antibiotics. If
bronchopneumonia is caused by a virus, antibiotics will not be effective.
Supportive therapy includes oxygen and respiratory treatments to remove secretions.
And patient was also given a mucolytics to aid in excretion of the mucous
accumulated at the trachea.
Doctors Order:

1-20-2011
1Admit patient comfortably
2Secure consent to care
3Monitor vital signs every 4 hours
4Diet as tolerated
5Laboratory: CBC, Platelet count, Urine Analysis and Stool Exams
6Start venoclysis D5 0.3 NaCl 500cc @ 30 gtts/min
7Meds: Ampicillin 370 mg IVTT every 8 hours ANST ( )
Salbutamol ½ neb + 1 cc NSS every 6 hours
Paracetamol 250/5 3.5 Ml every 4 hours P.O for fever PRN
1Chest tapping each after nebulization
2Intake and Output every shift
3Please refer accordingly
1-21-2011
1May go home
2Home medications:
; Vitamin c syrup 3ml once a day for 1 month
; Follow up check up January 26,2011 in AM
 DRUG STUDY
Name of Drug : Salbutamol
Date Ordered : January 20,2011
Classification : Bronhodilators (Adrenergics)
Dose/Frequency/Route : ½ Neb + 1 CC NSS every 6 hours
Mechanism of Action:
Binds to Beta2- Adrenergic receptors in airway smooth muscle, leading to
activation of adenylcyclase and increased levels of cyclic adenosine monophosphate.
Increased in camp activate kinases, which inhibit the phosphorylation of myosin and
decreased intracellular calcium.

Specific Indication:
Used as a bronchodilator to control and prevent reversible airway obstruction
caused by asthma or COPD. Used as quick relief of bronchospasm and for prevention
of exercise-induced bronchospasm.

Contraindications:
Hypersensitivity to adrenergic amines and fluorocarbons (some inhalers).
Side Effects:
Nervousness, restlessness, tremor, headache, insomnia and chest pain.

Nursing Precautions:
USE CAUTIOUSLY IN:
Assess lung sounds, pulse, and blood pressure before administration and during
peak of medications. Note for the amount color and character of the sputum produced.
Name of Drug : Paracetamol
Date Ordered : January 20,2011
Classification : Antipyretics
Dose/Frequency/Route : 250/5 3.5 ML every 4 hours for fever PRN P.O
Mechanism of Action:
Lower fever by affecting thermoregulation in the CNS and by inhibiting the action
of prostaglandins peripherally.

Contraindications:
Avoid aspirin, ibuprofen, or ketoprofen in patients with bleeding disorders. Aspirin
and other salicylates should be avoided in children and adolescents.
Side Effects:
Nausea and vomiting
Specific Indication:
Used to lower fever of many causes (infection, inflammation, and neoplasm).
Nursing Precautions:
USE CAUTIOUSLY IN:
Asses fever; note for the presence of associated symptoms (diaphoresis,
tachycardia, and malaise).
LABORATORY FINDINGS

Urinalysis (8-11-09)
Color : Yellow Normal
Transparency : Hazy Normal
Sugar : Negative Normal
SP Gravity : 1:015 Normal
Reaction : 6.0
Albumin : Trace
Pus Cells : TWTC

Complete Blood Count (8-11-09)

RBC : 0-2 -Low RBC indicates there is
infection
Epithelium : Moderate

Platelet Count (8-11-09)

190,000/cu mm -within normal limits

 ANATOMY AND PHYSIOLOGY OF THE LUNGS
ANATOMY AND PHYSIOLOGY OF THE LUNGS

The lungs are paired, cone-shaped organs which take up most of the space in our
chests, along with the heart. Their role is to take oxygen into the body, which we need for our
cells to live and function properly, and to help us get rid of carbon dioxide, which is a waste
product. We each have two lungs, a left lung and a right lung. These are divided up into 'lobes',
or big sections of tissue separated by 'fissures' or dividers. The right lung has three lobes but
the left lung has only two, because the heart takes up some of the space in the left side of our
chest. The lungs can also be divided up into even smaller portions, called 'bronchopulmonary
segments'. These are pyramidal-shaped areas which are also separated from each other by
membranes. There are about 10 of them in each lung. Each segment receives its own blood
supply and air supply.

Alveoli- a tiny thin-walled air sac found in large numbers in each lung, through which oxygen
enters and carbon dioxide leaves the blood

Trachea- the tube in air-breathing vertebrates that conducts air from the throat to the
bronchi, strengthened by incomplete rings of cartilage.
Bronchioles- tube leading from the windpipe to a lung, which provides for the passage of air

Pulmonary Arteries- either of two arteries that carry blood in need of oxygen from the
right side of the heart to the lungs

Although the words breathing and respiration are sometimes used

interchangeably, they have distinct meanings. Breathing is the process of moving
oxygen-rich air into and out of the lungs. Respiration refers to all of the processes
involved in getting oxygen to tissues, including breathing, diffusion of oxygen from the
lungs to the blood, transport by the blood, and diffusion from the blood to tissues.
Respiration is essential for aerobic respiration, the process within cells in which
nutrients and oxygen are used to build the energy molecule adenosine triphosphate
(ATP). In aerobic respiration, body cells use oxygen to metabolize glucose, forming
carbon dioxide as a waste product that is exhaled.

Because body cells are constantly using up oxygen and producing carbon
dioxide, the lungs work continuously. An adult normally breathes from 14 to 20 times
per minute, but vigorous exercise can raise the rate to 80 breaths per minute. A child’s
rate of breathing at rest is faster than an adult’s at rest, and a newborn baby has a rate
of about 40 breaths per minute. In general, smaller animals have faster breathing rates
than larger animals. A rat, for example, breathes about 60 times per minute, while a
horse breathes only about 12 times per minute.

The process of breathing is generally divided into two phases, inspiration and
expiration. In inspiration, air is moved into the lungs. In expiration, air is forced out of the
lungs. The lungs themselves have no muscle tissue. Their movements are controlled by
the rib cage and the diaphragm. During inspiration the muscles around the rib cage
contract, lifting the ribs upward and outward, and lowering the dome of the diaphragm
until it forms a nearly flat sheet. As a result of these changes, the chest cavity expands.
Because the lungs are attached to the chest cavity, they also expand. With the
enlargement of the lungs, air pressure inside the lungs falls below the pressure of the
air outside the body, creating a partial vacuum, and air from outside the body rushes
into the lungs.
 The amount of air normally taken into the lungs in a single breath during quiet
breathing is called the tidal volume. In adults the tidal volume is equal to about 0.5 liters
(about 1 pt). The lungs can hold about ten times this volume if they are filled to capacity.
This maximum amount, called the vital capacity, is generally about 4.8 liters (about 1.3
gal) in an adult male, but varies from one individual to the next. Athletes, for example,
can have a vital capacity of as much as 5.7 liters ( 1.5 gal). The vital capacity is reached
only during strenuous exercise.

In expiration the muscles that lift the rib cage and lower the diaphragm relax. As
a result, the rib cage and the diaphragm return to their original positions, and the lungs
contract with them. With each contraction of the lungs the air inside them is forced out.

A person can alter the rate of breathing and can even stop breathing
for a short time. But it is impossible to voluntarily stop breathing
permanently because breathing, like the heartbeat, is an involuntary activity
controlled by nerve centers in the brain stem, the lower part of the brain.
These centers are connected with the muscles of the rib cage and
diaphragm, and they increase or decrease the rate of breathing according to
the needs of the body.

T:

mpaired vision [ ] blind

pain redden [ ] drainage

gums [ ] hard of hearing [ ] deaf

burning [ ] edema [ x] lesion teeth

assess eyes ears nose

throat for abnormality [ x ] no problem

P:

asymmetric [ ] tachypnea [ ] barrel chest

apnea [X] rales [X] cough

bradypnea [X] shallow [ ] rhonchi

sputum [ ] diminished [X ] dyspnea

orthopnea [ ] labored [ ] wheezing

pain [ ] cyanotic

assess resp. rate, rhythm, depth, pattern

breath sounds, comfort [x] no problem IV. Nursing System Review Chart
DIOVASCULAR:

rrhythmia [ ] tachycardia [ ]numbness

Name: Vinz Elib Date: January 20, 2011
iminished pulses [ ] edema [ ] fatigue
Blood Pressure: Not Taken Temp: 38.1 Pulse Rate:114bpm Respiratory Rate: 30 cpm
regular [ ] bradycardia [ ] mur mur

Weight:
ngling [ ] absent pulses 6.5
[ ] pain kg Height: 2 feet

ess heart sounds, rate rhythm, pulse, blood

sure, circ., fluid retention, comfort

no problem

TROINTESTINAL TRACT:
\\\\
obese [ ] distention [ ] mass

dyspagea [ ] rigidity [ ] pain

assess abdomen, bowel habits, swallowing

bowel sounds, comfort [ ] no problem

NITO – URINARY AND GYNE

pain [ ] urine [ ] color [ ] vaginal bleeding

hematuria [ ] discharge [ ] nucturia

\\\\
SUBJECTIVE OBJECTIVE
assess urine frequency, control, color, odor, comfort
COMMUNICATION: [ ] glasses [ ] languages
gyne bleeding [ ] discharge [X] no problem
[ ] hearing loss Comments: “wala [ ] contact lenses [ ] hearing aide
URO: man siyay problema
[ ] visual changes Pupil size: 3mm Right & 3mm Left Eye
sa pagLantaw ug
paralysis [ ] stuporus [ ] unsteady [ ] seizure [ ] speech difficulties
[x] denied pagDungog” As
lethargic [ ] verbalized by the
comatose [ ] vertigo [ ] tremors Reaction: Pupil Equally Round Reactive to Light
mother and Accommodation
confused [ ] vision [ ] grip
OXYGENATION: Resp. [ ] regular [X] irregular
assess motor, function, sensation, LOC, strength
[X] dyspnea Comments: “galisod Describe: Abnormal breathing pattern;
gyod
grip, gait, coordination, speech [X] no problem siya ug difficulty in breathing with only 30bpm
[ ] smoking history
ginhawa tungod
SCULOSKELETAL and SKIN:
N/A siguro sa plemas,
ug usahay kusog
appliance [ ] stiffness [X] itching [X] petechie R: Right lung is assymetrical to the left lung
[X] cough
kau na siya ug ubo”. L: Left lung is assymetrical to the Right lung
[X] [sputum
hot [ ] drainage ] prosthesis [ ] swelling
As verbalize by the
lesion [ ] poor[ turgor
] denied
[ ] cool [X] flushed mother
CIRCULATION:
atrophy [ ] pain [ ] ecchymosis [X] diaphoretic moist Heart Rhythm [X] regular [ ] irregular
assess mobility, motion gait, alignment, joint function

skin color, texture, turgor, integrity [X ] no problem

[ ] chest pain Comments: “Dili Ankle Edema none
man pud sakit iya
[ ] leg pain Pulse Car Rad. DP Fem*
dughan”as
[ ] numbness of verbalized by the R 114 114 114 *
extremities mother L 114 114 114 *
[X] denied * = Not palpated
Comments: The pulse rates are within
normal range.
NUTRITION:
Diet: Diet as Comments: ”Wala [ ]dentures [ x]none
tolerated man pud siyay
problema sa
[]N[]V
pagKaon”. As Full Partial with
Character verbalize by the patient
[ ] recent change in mother

weight appetite Upper [] [X] []

[ ] swallowing
Difficulty Lower [] [X] []
[X] denied

ELIMINATION: Comments: Bowel sound : audible

Patient has no Bowel sounds
Usual bowel pattern [ ] urinary frequency
problem in ___________________
Once a day . 4x a day . regards to her
usual bowel Abdominal Distention
[ ] constipation [ ] urgency
pattern. She Present [ ] yes [x] no
remedy [ ] dysuria eliminates at
least twice a day Urine* (color,
Water therapy [ ] hematuria
consistency, odor)
Date of last BM [ ] incontinence
urine color is yellowish,
January 19,2011 [ ] polyuria
hazy and with aromatic
[ ] diarrhea [ ] foley in place odor
character [ ] denied
None
MGT. OF HEALTH & ILLNESS: Briefly describe the patient’s ability to follow
treatments (diet, meds, etc.) for chronic
[ ] alcohol [X] denied
health problems (if present).
(amount & frequency)
The patient’s mother was able to comply
N/A with the medication and treatment regimen
[ ] SBE Last Pap Smear: Not applicable during the whole time
LMP: N/A

SUBJECTIVE OBJECTIVE
SKIN
INTEGRITY: Comments: “Uga iyang [x] dry [ ] cold [ ] pale
[X] dry pamanit ug init gunitan” as [ ] flushed [X] warm
verbalized by the mother.
[ ] other [ ] moist [ ] cyanotic
[ ] denied *rashes, ulcers, decubitus (describe
size, location, drainage: (-) rashes (-)
ulcers , (-) decubitus in the skin but it
is dry, warm nearby in the lower
extremities.
ACTIVITY/
SAFETY: Comments: ” aw wala man [ ] LOC and orientation The patient
[ ] convulsion nuon preblema maka responds properly to what the student
lihok2 pud baya siya” as nurse ask her Gait: [ ] walker
[ ] dizziness
verbalized by the mother. [ ] cane [ ] other [x ] steady
[ ] limited motion
[ ] unsteady___________
of Joints
[ ] sensory and motor losses in face or
Limitation in
Ability to extremities None
[ ] ambulate [ ] ROM limitations: The patient was
[ ] bathe self able to ambulate in any time
[ ] other
[X] denied
COMFORT/SLEE
P/AWAKE: Comments: “nah sige [X] facial grimaces
[ ] pain rana siya katulog karon” [ ] guarding
as verbalized by the
(location)
mother [X] other signs of pain: Sometimes
Frequency the patient cries when she had a
headache
Remedies
[ ] side rail release form signed (60 +
[ ] nocturia
years) N/A
[ ] sleep
difficulties
[x] denied
COPING: Both Mother and the Father Observed non-verbal behavior: He
would play all by him self and always
Occupation: Businessman and woman
saying no to what his mother offer her.
Members of household: 4 of them her mother,
The person and phone number that
father & older brother
can be reached anytime: Mrs. Mercy
Most supportive person: Both the parents of G. Hagunao 09174847889 (Globe)
the patient
Diagnostic/ I.V.
Date
Laboratory Date done Date Disc.
ordered Fluids/Blood
Exams

8-11-09 CBC 8-11-09 #3 D50.3 NaCl Ongoing

500CC @
50cc/Hour

8-11-09 Platelet Count 8-11-09

8-11-09 Urinalysis 8-11-09

 V. Nursing Management
A. Ideal Nursing Management

Nursing Management:

Ineffective airway clearance related to increase sputum production on the

bronchioles

Objectives:

At the end of 15 minutes, client will be able to demonstrate behaviors to achieve

airway clearance and display patent airway with breath sounds clearing, absence
of dyspnea

Interventions/Rationale:

Independent:
 3Monitor the patients vital signs of respiratory failure shallow respirations and
shortness of breath, and asymmetric chest movement are frequently
present because of discomfort of moving chest wall and or fluid lung.

4Elevate head of the bed, change position frequently; keeping the head
elevated lowers diaphragm, promoting chest expansion and expectoration
to keep the airway clear.

5Postural drainage to expel mucous secretions on the tracheal area

6Offer warm, rather than cold fluids; Fluids especially warm liquids aid in
mobilization and expectoration of secretions.

7Suctioning as indicated; stimulates cough or mechanically clears airway in

client who is unable to do so.

Dependent:

1Assist with/monitor effects of nebulizer treatments and other respiratory

physiotherapy. Facilitates liquefaction and removal of secretions.

2Provide supplemental fluids e.g IVF, humidified oxygen and room

humidification. Fluids are required to replace losses and aid in mobilization
of secretions, room humidification thought to improved the risk of
transmitting infection.

Nursing Management:

Acute pain

Objectives;

2At the end of 15 minutes, my patient will be able to demonstrate relaxed

manner (e.g. Stop crying and facial grimace) and engage in some activity
(e.g. laughing, can grasp things and play with the mother) appropriately.

Interventions/Rationale:
Independent:

3Monitor Vital signs;. Changes in heart rate may indicate that client is
experiencing pain, especially when other reasons for changes in vital
signs have been ruled out.

4Provide comfort measures, e.g., sense of touch, change in position, quiet

music;. Non-analgesic measures administered with gentle touch can
lessen discomfort.

5Provide quiet environment and possibly a clean and free from any harmful
stimuli

6Offer warm, rather than cold fluids;, it will aid in mobilization and
expectoration thus minimizes coughing and lessen pain.

Dependent:

1Administer analgesics as indicated by the physician;, To reduce pain

discomforts, therapy enhancing general discomforts and rest.

B. Actual Nursing Management (SOAPIE)

“ga-sakit daw iyang ulo” as verbalized by the mother

S

•1 Facial grimace
•2 Guarding and rubbing of the forehead
O •3 Crying (occasional)

Acute pain related to Decreased oxygen demand on the brain

A

Long Term: At the end of 8 hours hospital duty, the client was
P able to demonstrate relaxed manner (absence of bad facial
grimace, absence of guarding affected area, less crying) as an
evidenced that pain has already been relieved.
Short Term: At the end of 30 minutes, the pain felt by the client
was at tolerable level as evidenced by a good behavior, less
 sleeping pattern difficulties, less crying.

INTERVENTION RATIONALE

INDEPENDENT:
•1 Monitored patient’s  For monitoring the
vital signs (Temp., RR, HR) health status of client
related to pain
•2 Provided comfort  To promote sense
measures (provide touch, of comfort from the
change of position significant others
especially when lying on
bed, quite music)  To help the patient
•3 Provide quiet relaxed
environment  To promote
vasodilation to the the
•4 Offered warm, rather tracheal area and open
than cold fluids airway may promote

DEPENDENT:  To temporarily
•1 Administered relieved the pain
analgesics and as indicated discomforts

After 30 minutes, the pain felt by the patient was at tolerable
level as evidenced by a good behavior, less sleeping pattern
E difficulties

”Galisod mani siya ug ginhawa tungod siguro ni sa iyang plema”

S As verbalized by the mother

Cough with sputum production

Abnormal breathing sounds (RALES)

O Shortness of Breath
 Ineffective airway clearance related to increased sputum
A production and decreased energy.

Long Term: At the end of 8 hours hospital duty, my patient was

P able to display expectoration of secretions
Short Term: At the end of 20 minutes, patient was able to
demonstrate expectoration of secretions

INTERVENTION RATIONALE

INDEPENDENT:
•5 Monitored patient’s
vital signs (Temp., RR, HR)
especially signs of
respiratory failure (cyanosis,
severe tachypnea)
•6 Elevated head of bed,
change position of the
patient frequently offered
•7 Suctioned as
indicated (frequent or
sustained cough, distraction
related to airway clearance)
•8 Offered warm,
instead of cold fluids through
OGT
¬ Monitor especially
the respi. This indicate the
need for oxygenation and
the demand
 To facilitate airway
opening and easy for the
patient to breath
 Suctioning may
provide an airway
 May provide
vasodilatation on the area

DEPENDENT:  To facilitate easy

•3 Provided
supplemental fluids e.g.,
humidified oxygen, and
humidification.

E At the end of 20 minutes, patient was able to expectorate mucus

secretions.
HEALTH TEACHINGS

The patient’s mother was advised to follow and take the

prescribed medication regimen necessary for his fast and
effective treatment and recovery. Patient teachings are
also imparted, regarding on precaution and side effects of
the medications. The following home medications were
MEDICATIONS prescribed as follows:
1. Ascof forte for kids 5ml TID P.O for 7 days
2. Vitamin c syrup 3ml once a day for 1 month
3. Fallow up check up at OPD after 1 week after
discharged

The patient’s mother was instructed to perform Deep

breathing exercises was also stretched out for proper lung
EXERCISE expansion. She was advised not to engage in stressful
activities rather do light activities to prevent fatigue &
trigger asthma.

Proper compliance of home medications should be

TREATMENT followed as prescribed by the doctor. The patient’s mother
was advised to watch over the diet regimen and report
any unusualities observed.

Instructed patient’s mother to report to the Outpatient

OUTPATIENT clinic with Dr. Balaguhan 7 days after discharge, that is on
FOLLOW UP January 26,2011 in AM for a follow up check up and
prescription of new medications for maintenance.

The client’s mother was instructed to follow prescribed

DIET and eat nutritious food and green leafy vegetables with
fruits every meal, avoid junk foods and others that may
precipitate the asthma attack.
 Evaluation

The care plan for the patient gave me an opportunity to provide quality care for
his condition, and his main priority needs. This will also enhance my skills as a
practicing nurse that will help me to be more knowledgeable of the disease. Even if the
patient are limited conversation or cannot express his health condition that doesn’t keep
me from keeping my goals from implementing my nursing care plan and act-out
necessary intervention towards a positive outcome.

Overall, despite of the little time for caring for the patient, I was thankful for the
chance of giving care for a patient who has striving to recover from a disease , and that
kept me being inspired as a student since my goal is to provide care not only for myself
nor my family but for the whole people that needs to be cared.

Health Teachings were also given with emphasis to reinforce further recovery of
the patient are the ff:
1Encourage patient’s mother to have bed rest.

2Encourage patient’s mother to have daily exercise like walking and playing.

3Chest Tapping was taught to the mother for her son's comfort.

4Encourage signicant others, since the patient is a clild, to follow physicians order
like taking medications daily and proper diet.
 Referrals and Follow-up

Patient’s mother was required detailed discharge instruction to become proficient

in special self-care needs of her child when they got home. As for the client,Vinz Elib, I
recommended to refer his mother for his regular check up with his attending physician;
Dr. Balaguhan, and arranged schedule of appointments regarding his follow up
checkups and his home medications and also advise to go to the nearest health center
in their barangay to monitor his health condition regarding on Bronchial Asthma or
bronhopneumonia.
The client’s significant other was also reminded of the medication regimen of
their child to follow it carefully and promptly, and to report any signs of adverse serious
reactions.
PROGNOSIS
PROGNOSTIC
POOR GOOD
INDICATORS
A. Onset of illness X
B. Duration of illness X

C. Attitude and
willingness to take
X
medications
D. Precipitating factors X
E. Family support X
F. Length of stay in the
X
Hospital
 BIBLIOGRAPHY

BOOKS SOURCES:
1Huitt, W., & Hummel, J. (2003)
Piaget's theory of cognitive development. Educational Psychology Interactive.
Valdosta, GA: Valdosta State University.

2Smeltzer, S; Medical Surgical Nursing; 10th Edition; Lippincott Williams and Wilkins;
2004

3Kozier, B.; Fundamentals of Nursing; 7th Edition; Pearson Education Corporated;

First Lok Yang Road; Jurong; Singapore

4Nettina, Sandra; et. al; The Lippincott Manual of Nursing Practice; 7th Edition;
George Washington University; Lippincott Williams and Wilkins; Lippincott-Raven
Publishers; 1991

5Doyle, Rita M; et. al; Nursing 2006 Drug Handbook; 26th Edition; 323 Norristown
Road, Suite 200; Lippincott Williams & Wilkin

6Pillitteri, Adele; et.al; Maternal and Child Health Nursing, J.B. Lippincott Company,
Philadelphia
Liceo de Cagayan University

Rodolfo N. Pelaez Blvd., Carmen,

Cagayan de Oro City

College of Nursing

NCM501205

A Care Study

On

Bronchopneumonia

Submitted to:

Mary Jane Vallecera

Clinical Instructor

Submitted by:

Sheena Glaze P. Panadero

Cluster 2; Group B7