Case of Group 55 (BPN)

I. Introduction

Pneumonia, an inflammation of the pulmonary parenchyma, is common in

childhood, occurring more frequently in infancy and early childhood. Clinically,

pneumonia may occur either as a primary disease or as a complication of another

illness.

A report published by UNICEF in cooperation with the World Health

Organization, in 2006 has identified pneumonia as the forgotten killer of children.

According to the report, pneumonia kills more children than any other illness – more

than AIDS, malaria and measles combined. Over 2 million children die from pneumonia

each year, accounting for almost 1 in 5 underfive deaths worldwide. Yet, little attention

is paid to this disease.

Pneumonia can be classified according to morphology, etiologic agent, or clinical

form. According to morphology, there are three types: Lobar pneumonia, Bronchopneumonia or Interstitial pneumonia. In this case, the study will be all about

bronchopneumonia, where it begins in the terminal bronchioles which become

clogged with mucopurulent exudate to form consolidated patches in nearby lobules.

Another way to classify it is based on the etiologic agent. It may be caused by a

virus, bacteria, mycoplasm or aspiration of foreign substances. The causative agent is

usually introduced into the lungs through inhalation or from the bloodstream. In the

whole case, it will deal about bacterial pneumonia, the causative agent of the

bronchopneumonia of the patient.

Bacterial pneumonia is often a serious infection. The pathogenetic mechanisms

involved are often aspiration or hematogenous dissemination. The cause varies

depending on the child’s age, underlying illness, and degree of immunosuppression or

immunocompetence.

In the 3-month to 5-year age group, Streptococcus pneumoniae, Moraxella

catarrhalis, and Group-A streptococci are common causes. Haemophilus influenzae

type b is causing fewer infections because of the Hib vaccine. Staphylococcus aureus

pneumonia is also now rarely seen in infants and toddlers. Mycoplasma pneumoniae

and S. pneumoniae are the dominant organisms in children over 5 years of age.

The clinical manifestations of pneumonia vary depending on the etiologic agent,

the child’s age, the child’s systemic reaction to the infection, the extent of the lesions,

and the degree of bronchial and bronchiolar obstruction. For bacterial pneumonia,

clinical manifestations are fever and toxic appearance. Infants and young children

develop more severe symptoms than older children. Respiratory distress may or may

not be present. In some cases, the only finding is an increased respiratory rate.

II. Nursing Process

A. ASSESSMENT

1. Personal History

Mother Bear mentioned that she gave birth via normal spontaneous delivery without any

complications at full term assisted by a midwife in the hospital. She was not picky on the

foods she eats during her pregnancy, she will eat whatever food is available in their

home and according to the mother, she usually have her prenatal check up at the

barangay health center.

FeedingBaby bear was breastfed right after he was born, until now.

Immunization Status

Baby bear had a complete immunization for his age. He had received 1 dose of BCG, 1

dose of DPT, 1 OPV, HepaB.

Growth and Development

Erik Erikson(Theory of Trust and

Mistrust)

Infancy- 0-1 year old

This is the period of

infancy through the

first one or two

years of life.  The

child, well - handled,

nurtured, and loved,

develops trust and

security and a basic

optimism.  Badly

handled, he

becomes insecure

and mistrustful.

Normal Response

The infant would be

able to gain a sense

of trust with his

parents, particularly

with her mother

because they are

able to meet their

responsibility to

provide warmth,

comfort, security,

sensory stimulation,

food to the infant.

Untoward Response

The infant failed to

develop a sense of

trust with his

parents, particularly

the mother because

they are not able to

provide basic

support failure to

meet infants’ needs.

Client’s response

Currently, baby bear

is within this Trust

vs. Mistrust stage.

As observed, he is

capable of

developing his trust

with his parents,

especially with his

mother. This is

evident when Baby

stops crying after

being cuddled by

his mother.

Sigmund Freud(Psychosexual Theory-Oral Stage)

Birth to 1 year old

During this stage, the

child's main focus is

around the rooting and

suckling reflex.

Pleasure and self-

gratification are

acquired by the mouth.

Because a sense of

satisfaction is being

acquired during this

stage, it also leads to a

sense of trust for the

infant.

Normal Response

The baby exhibits

concern for the

gratification that

can be felt from

oral stimuli as

evidenced by

pleasure from is

eating. The child

also engages in

activities like

sucking, biting,

swallowing and

manipulating

various parts of

the mouth.

Untoward Response

The child is

unable to elicit

gratification from

oral stimuli and is

passive in

activities like

sucking, biting,

swallowing and

manipulating

various parts of

the mouth.

Client’s Response

Baby bear is able

to demonstrate

activities such as

sucking and

swallowing.

2. Family Health Illness History

3. History of Past and Present Illness

Past Illness:

This is baby’s first hospitalization diagnosed with bronchopneumonia. He never

had any mild or severe past illness. He hasn’t developed any signs and symptoms prior

to asthma, although his family had a history of it.

Present Illness:

The patient is diagnosed with bronchopneumonia. He was admitted on

November 10, 2009. The patient experienced fever and cough last November 6, 2009.

However, mama thought that it is just a common colds and fever so she gave

paracetamol (tempra) for medications. But then on November 10, 2009 the patient

experienced difficulty of breathing and cyanosis. He was then rushed and admitted to

Mabalacat District Hospital. Due to the observed signs and symptoms manifested by the

patient, and after laboratory diagnosis was done, the doctor suspected that he has

Bronchopneumonia.

4. Physical Examination (IPPA- Cephalocaudal approach)

November 10, 2009 (Admission) With complaint of difficulty of breathing

(+) rales

Vital signs:

T: 39.6° C

P: 173 bpmR: 78 bpm

November 12, 2009 (First Nurse-Patient-Interaction 3-11 shift)

The baby is wearing white layette and pajamas, does not wear socks, mittens or bonnet

to protect him from cold.

Vital Signs:

T= 37.9 °C

P= 144bpm

R= 78bpm

I. IntegumentSkin: Has a fair complexion, the texture of skin is smooth; with normal skin turgor.

Nails: With dirty long fingernails, convex curve in shape, with smooth texture.

Performed blanch test, capillary refill return in usual color for a less than 2 seconds.

II. Head:Hair: Evenly distributed, with thin straight hair, no presence of infestation, the color of

the hair is black.

Skull: Round, normocephalic and normal contour with frontal, parietal and occipital

prominences, smooth skull contour, with no masses, depression, and nodules noted.

Scalp: The color of his scalp is slightly brown, no presence of lesions

III. Eyes:Eyebrow & Eyelashes – Black in color, skin intact, evenly distributed and

symmetrically aligned, the eyelashes are slightly curled outward, eyelids closes

symmetrically, pinkish conjunctiva, pupils equally round and reactive to light

accommodation that is when the penlight introduced the pupil constricted and vice

versa, iris black in color

IV. EarsExternal: Symmetrically distributed, auricle aligned with outer canthus of the eye

Internal: Absence of cerumen on both ears and no lesions noted.

V. Mouth and Throat No presence of sores noted

No lesions and masses noted

Lips - pinkish in color

Gums and tongue - pinkish color

VI. Nose Presence of clear nasal discharges and with no presence of nodules noted.

VII. Neck No enlargement of lymph nodes

Has coordinated movement.

VIII. Chest & Lungs: Skin in chest is free of lesions; rales heard on both lung fields upon

auscultation.

IX. Heart Normal cardiac rate.

X. Abdomen Skin integrity with uniform color, with no presence of masses, without

abdominal distention

XI. Extremities Hair is evenly distributed on both upper and lower extremities; the legs are

proportion to the body, and with no presence of masses.

November 13, 2009 (Second Nurse-Patient-Interaction 3-11 shift)

The baby was wearing white layette and pajamas. He was not wearing socks, mittens

or bonnet to protect him from cold.

Vital Signs:

T= 36.8 °C

P= 140 bpm

R= 78 bpm

I. Integumentary

Skin: Has a fair complexion, the texture of skin is smooth, with normal skin turgor.

Nails: With clean fingernails, convex curve in shape, with smooth texture. Performed

blanch test, capillary refill return in usual color for less than 2 seconds.

II. Head:Hair: Evenly distributed, with thin straight hair, the color of the hair is black.

Skull: Round, normocephalic and normal contour with frontal, parietal and occipital

prominences, smooth skull contour, with no masses, depression, and nodules noted.

Scalp: The color of his scalp is slightly brown, no presence of lesions, with no dandruff

noted.

III. Eyes:Eyebrow & Eyelashes – Black in color, skin intact, evenly distributed and

symmetrically aligned, the eyelashes are slightly curl, eyelids closes symmetrically,

pinkish conjunctiva, pupils equally round and reactive to light accommodation that is

when the penlight introduced the pupil constricted and vice versa, iris black in color

IV. EarsExternal: Symmetrically distributed, auricle aligned with outer canthus of the eye

Internal: Absence of cerumen on both ears and no lesions noted.

V. Mouth and Throat No presence of sores noted

No lesions and masses noted

Lips - pinkish in color

Gums and tongue - pinkish color

VI. Nose Presence of clear nasal discharges and with no presence of nodules noted.

VII. Neck No enlargement of lymph nodes

Has coordinated movement.

VIII. Chest & Lungs: Skin in chest is free of lesions; rales heard on both lung field upon auscultation.

IX. Heart Normal cardiac rate.

X. Abdomen Skin integrity is uniform color, with no presence of masses, without abdominal

distention.

XI. ExtremitiesHair is evenly distributed on both upper and lower extremities; the legs are proportion to

the body, and with no presence of masses.

5. Diagnostic/Laboratory Procedures

Diagnostic/Laboratory Procedures

Date Ordered

Date Results

Indication/Purposes Results Normal Values

Analysis & Interpretation

COMPLETE BLOOD COUNT

DO: 11-10-

09

DR: 11-10-09

CBC is frequently ordered for

patient’s basic screening and

diagnostic test that provides

information about hematological

system. It is needed in routine

physical examination and in

diagnosis. It helps in the

management of disease that

originated in other body system.

Generally includes absolute

numbers or percentages of

erythrocytes, leukocytes,

platelets, hemoglobin, and

hematocrit in the blood sample.

Hgb= 95 g/L Hgb= 140-170 g/L

The result show that

the patient’s

hemoglobin is below

the normal range. The

MO reached the

tracheobronchial tree

and then to the lungs

causing an irritation to

the airway and thus

excessive mucus

production are

secreted by the goblet

cell causing the mucus

production to

accumulate in the

lungs thus oxygen and

Abnormalities in Hgb indicate

defects in the red blood cell

homeostasis. This procedure is

used to assess or determine

Severity of anemia or

polycythemia& to monitor

response to therapy as well as

to measures the oxygen –

carrying capacity of the blood.

carbon dioxide

exchange are reduced,

leading to decrease

Hgb that lead to

decrease circulating

RBC’s in the blood

which are responsible

in carrying oxygen and

carbon dioxide from

the lungs. This is

caused by an

increased

compensatory

mechanism brought

about by increased

demand for oxygen in

the blood thus the

patient experiences

DOB prior to admission

due to inadequate

oxygen going to the

Hematocrit indicates the

proportion of cells and fluids in

the blood. It is useful in

evaluating dehydration and

hypovolemia. It measures the

concentration of RBC within the

blood volume.

Hct=0 .30 L/L Hct= .40-.50 L/L

lungs.

The results show that

the patient’s Hct is

below the normal

range which suggests

hemodilution. Patient

experienced sweating

and fever. This also

may be accompanied

by having decrease

Hgb and as a

compensatory

mechanism brought by

hypoxemia.

Leukocytes/WBC is

within normal level

Blood component that reports

the possible presence and

severity of infection or

inflammatory response. It is the

absolute numbers of white blood

cell circulating in the cubic

millimeter of blood. It acts as a

defense against microorganism

through phagocytosis and

produces or transport and

distributes antibodies to help

maintain immunity. Its purpose

was to determine infection or

inflammation.

Leukocyte=

7-10/L

Leukocyte=

5-10x109/L

which may indicate the

differences of every

individual’s immune

response.

The result is below the

normal level. Although

it is lower than the

normal value, it does

Immature Neutrophils that

determine bacterial infections.

To determine bacterial infection.

Lymphocyte determines the

presence of immunologic

disorder. It indicates the amount

of lymphocytes participating with

macrophages at a site of local

injury.

Segmenters=

0.30

Lymphocytes

= 0.70

Segmenters=

.45-.65

Lymphocytes

= .20-.35

not mean that bacterial

infection is not present.

It’s because of every

individual’s own

response to bacterial

invasion.

The patient’s

lymphocytes are within

normal level which

indicates that there are

neither viral infections

nor immunologic

disorder noted.

The patient’s platelet is

within the normal limits,

which implies

intactness of clotting

A blood test that is performed on

all patient who develop

petechiae, spontaneous

bleeding, or increasing heavy

menses. It is also used to

monitor the course of the

disease or therapy for

thrombocytopenia or bone

marrow failure.

Platelet

count=

313,000

150,000-

400,000 x

103/mm3 (uL)

ability. Patient is not at

risk for bleeding.

Nursing Responsibilities:

Prior During After

Check the doctor’s order.

Determine the prescribed test

and other restrictions prior to

the test.

Get the laboratory requisition

slip.

Explain to the patient what the

procedure to be done is.

Inform the patient that this

requires a blood sample.

Inform the patient how the

procedure is performed, the

equipment to be used.

No food or fluid restriction is

required prior to the exam.

Take note of the medications

Explain to the patient what test

should be done.

Prepare all the equipments to

be used.

Tell the patient when to insert

the needle for her to be

prepared.

Encourage the patient to remain

calm during the test.

Assist the patient if necessary.

Ensure a sterile blood sample

from the patient

Apply direct pressure to the

venipuncture site until bleeding

stops.

Send the blood sample to the

laboratory immediately.

Proper documentation.

Instruct patient that if hematoma

results or develops at the

venipuncture site, apply warm

compress.

the client is taking, as this may

affect the outcome of the

results.

Diagnostic/Laboratory Procedures

Date Ordered

Date Results

Indication/Purposes

Results Normal Values Analysis & Interpretation

Chest X-Ray DO:10- 11- 09

DR:

To identify the

abnormalities of the

lungs and structure

on the thorax. And

also to identify the

size of the heart and

abnormalities in the

ribs and diaphragm.

Prior During After

Check the doctor’s order.

Identify the client.

Explain to the SO that this

test assesses respiratory

status.

Tell the SO that no fasting

is required.

Inform the SO that the test

takes 5 to 10 minutes.

Describe the test to the SO

including who will perform it

and when will it take place.

Assist client and SO in

going to the x-ray room.

> If the patient is intubated, check that no tubes

have been dislodged during positioning.

> To avoid exposure to radiation, leave the room

or the immediate area while the films are being

taken. If you must stay in the area, wear a lead-

lined apronI

Inform the SO for possible

x-ray follow-up.

Document necessary

information’s.

6. Anatomy and Physiology

Primary function is to obtain oxygen for use by body's cells & eliminate

carbon dioxide that cells produce.

Includes respiratory airways leading into (& out of) lungs plus the lungs

themselves

The respiratory system is divided into Upper Respiratory System and Lower

Respiratory System and consists of the airways, the two lungs which have further

divisions, and the respiratory muscles. Within the alveoli, molecules of oxygen and

carbon dioxide are passively exchanged, through diffusion, between the gaseous

environment and the blood. “Thus, the respiratory system facilitates oxygenation of the

blood with a concomitant removal of carbon dioxide and other gaseous metabolic

wastes from the circulation”. Respiratory System also helps in maintaining the acid-base

balance of the body through the excretion of carbon dioxide from the blood.

The lungs are the major part of the Respiratory System and are considered to be

the largest organ and resemble large pink sponges because of their appearance. The

left lung is slightly smaller in size compare with the right lung because it shares space

with the heart and so as to accommodate the two. The two lungs are divided into lobes;

two in the left lung and three in the right. The pleura, which is a slippery membrane

covers and lines the inside of the chest wall. This helps the lungs move and glide

smoothly during each breath cycle.

Lower Respiratory System

Larynx        

The larynx or “voice box” is a short passageway connecting laryngopharynx with

the trachea.  It is situated at the midline of the neck anterior to the fourth through sixth

cervical vertebrae.  Its wall consists of nine pieces of cartilage.  Three occur singly

(thyroid cartilage, epiglottis, and cricoid cartilage), and three occur in pairs (arytenoid,

cuneiform, and corniculate cartilages). The lining of the larynx has cilia and goblet cells. 

The mucus produced by the said structure helps trap dust not expelled in the upper

passages. The cilia in the upper respiratory tract move mucus and trapped particles

down toward the pharynx, the cilia in the lower respiratory tract move them up toward

the pharynx.

Trachea         

The trachea or “windpipe” is a tubular passageway for air that is about 5 inches

long and 1 inch in diameter.  It is located anterior to the esophagus and extends from

the larynx towards the superior border of the fifth thoracic vertebra, thereon it divides

into right and left primary bronchi.  The epithelium on the lining of the trachea provides

the same protection as the membrane lining the nasal cavity and larynx against foreign

material such as dust.

 There are 16-20 incomplete, horizontal rings of hyaline cartilage resembling the

letter C and is stacked one on top of the other.  The open part of each cartilage ring

faces the esophagus.  The cartilage rings provide a semi-rigid support so that the

tracheal wall does not collapse inward and obstruct the air passageway and during

inhalation and expiration as well.

Bronchi

After the trachea, it divides into a right primary bronchus, which goes into the

right lung, and a left primary bronchus, which goes into the left lung.  The right primary

bronchus is more vertical, shorter, and wider than the left.  The bifurcation or the point

of intersection where the trachea divides into right and left primary bronchi is called the

carina.  Like the trachea, the primary bronchi contain incomplete rings of cartilage, and

the carina is formed by an inferior projection of the last tracheal cartilage.   The mucous

membrane of the carina is one of the most sensitive areas for triggering a cough reflex.

Going deeper into the lungs, the main or primary bronchi divide to form the

secondary (lobar) bronchi, one for each lobe of the lung (three on the right and two on

the left).  The secondary bronchi continue to branch, forming still smaller bronchi, called

tertiary (segmental) bronchi, that divide into bronchioles, which branch into even smaller

terminal bronchioles.  This branching from the trachea going down resembles an

inverted tree and is commonly referred to as the “bronchial tree”.  Some of the

bronchioles are no larger than 0.5 mm (0.02 inches) in diameter. The bronchioles divide

many more times in the lungs into an upside-down tree-like structure with progressively

smaller branches.

Alveoli

Tiny air sacs called alveoli are at the end of every bronchioles. The alveoli

comprise most of the lung tissue, with about 150 million alveoli per lung, and resemble

bunches of grapes. The alveoli send oxygen to the circulatory system while removing

carbon dioxide. Alveoli have thin elastic walls, thus allowing air to flow into them when

they expand; they collapse when the air is exhaled. Alveoli are arranged in clusters, and

a dense network of capillaries surrounds each cluster. The walls of the capillaries are

very thin; thus the air in the wall of the alveoli is very near to the blood in the capillaries

(only about 0.1 to 0.2 microns). Carbon dioxide is one of the waste products that are

excreted into the outside environment from the cells. The oxygen diffuses from the

alveoli to the capillaries since the concentration of oxygen is much higher in the alveoli

than in the capillaries. From the capillaries, the oxygen flows into larger vessels and is

then carried to the heart where it is pumped to the rest of the body. The forces of

exhalation cause the carbon dioxide to go back up through the respiratory passages

and out of the body. Numerous macrophages are interspersed among the alveoli.

Macrophages are large white blood cells that remove foreign substances from the

alveoli that have not been previously filtered out. The presence of the macrophages

ensures that the alveoli are protected from infection; they are the last line of defense of

the respiratory system.

7. The Patient and His Illness

Definition of the disease

Pneumonia is an illness of the lungs and respiratory system in which the alveoli

(microscopic air-filled sacs of the lung responsible for absorbing oxygen from the

atmosphere) become inflamed and flooded with fluid. Pneumonia can result from a

variety of causes, including infection with bacteria, viruses, fungi, or parasites, and

chemical or physical injury to the lungs.

Pneumonia is an acute infection of one or both lungs that can be caused by a

bacterium, usually Streptococcus or by a virus, fungus, or other organism. The causal

organisms reach the lungs through the respiratory passages. Usually an upper

respiratory infection precedes the disease. The lungs' air sacs fill with pus, mucus, and

other liquid and can not function properly. Oxygen cannot reach the blood. If there is not

enough oxygen in the blood, body cells cannot work right and might die. Alcoholism,

extreme youth or age, debility, immunosuppressive disorders and therapy, and

compromised consciousness are predisposing factors. When one or more entire lobes

of the lung are involved, the infection is considered a lobar pneumonia. When the

disease is confined to the air spaces adjacent to the bronchial area, it is considered a

bronchial pneumonia.

Predisposing/Precipitating Factors

Non-modifiable Factors:

Age- At extremes of ages, different body systems and processes are either

immature or degenerating. For infants, their body defenses and immunologic

responses are just starting to develop. Such condition increases their

susceptibility to different pathologic conditions.

Lack of normal anatomical structure- There are certain inherited defects of

cilia which result in less effective protection. Cigarette smoke, inhaled directly by

a smoker or second-hand by an innocent bystander, interferes significantly with

ciliary’s function, as well as inhibiting macrophage function.

Modifiable Factors:

Chronic conditions- Predispose a person to infection with pneumonia. These

include asthma, cystic fibrosis, diabetes, sickle cell anemia, lymphoma, leukemia,

emphysema and neuromuscular diseases; interfere with the seal of the epiglottis.

This increases the risk of aspiration into the lungs of those stomach contents with

their resident bacteria.

Environment- The mode of transmission of pneumonia is through airborne or

person contact because of the droplets that can be inhaled from an infected

person.

Health Status/ Body’s resistance- Health Status clearly points out on how an

individual will fight or favor a pathologic condition. Certainly, poor or unstable

health status will hasten the occurrence of any type of disease since poor health

suggests poor resistance and defense against disease.

Parasitic infection- It also includes some previously rare parasitic, such as

worms which would be able to cause illness in an individual possessing a normal

immune system.

Viruses - It interfere with ciliary’s function, allowing other microorganism

invaders (such as bacteria) access to the lower respiratory tract. In recent years

virus has resulted in a huge increase in the incidence of pneumonia. It may

cause by certain viruses and associated with symptoms of fever, cough, and

shortness of breath.

Smoke - Millions of microscopic hairs (cilia) cover the surface of the cells lining

the bronchial tubes. The hairs beat in a wave-like fashion to clear airways of

normal secretions, but irritants such as tobacco smoke paralyze the cilia,

causing secretions to accumulate. If these secretions contain bacteria, they can

develop into pneumonia.

Alcohol - interferes with normal gag reflex as well as with the action of the

white blood cells that fight infection.

Are exposed to certain chemicals or pollutants. The risk of developing some

types of pneumonia may be increased if an individual works in agriculture,

construction or around certain industrial chemicals or even with animals.

Exposure to air pollution or toxic fumes can also contribute to lung

inflammation, which makes it harder for the lungs to clear themselves.

Contact to a Person with Pneumonia – Pneumonia is a communicable

disease, thus having a close contact with person or an article, which is

contaminated, can contribute to having Pneumonia.

General signs of pneumonia:

Fever (usually quite high)

Cough: unproductive to productive with whitish sputum

Tachypnea

Breath sounds: rhonchi or fine crackles

Dullness with percussion

Chest pain

Retractions

Nasal flaring

Pallor to cyanosis (depends on severity)

Diffuse or patchy infiltration with peribronchial distribution on CXR

Irritable, restless or lethargic

Anorexia, vomiting, diarrhea, abdominal pain

Initially, the cough is usually hacking and nonproductive, and breath sounds are

diminished or heard as scattered crackles. When consolidation is present, breath

sounds may be tubular in quality with no adventitious noises. As the infection resolves,

coarse crackles and wheezing are heard, and the cough becomes productive with

purulent sputum.

Lack of specific signs indicating infection makes diagnosis in infancy particularly

difficult. An early sign of infection is often irritability or lethargy and poor feeding. Abrupt

fever may be accompanied by seizures. Respiratory distress is evident with air hunger,

tachypnea and circumoral cyanosis. Because pneumonia in newborns carries a high

morbidity and mortality, bacterial infection should be suspected in all neonates with

respiratory symptoms.

Staphylococcal pneumonia is rare but particularly progressive and must be

treated aggressively. The onset is rapid, with rapid deterioration. Conjunctivitis and

furuncles are signs of a probable staphylococcal infection.

Synthesis of the Disease (Book-based)

Invasion of microorganism which lodges in the upper respiratory tract

Reaches the lower respiratory tract causing damage to the lung tissues

Stimulates inflammatory response

Release of chemical mediators

(cytokine, bradykinin, histamine)

Attraction of neutrophils and accumulation of fibrinous exudates & bacteria

Increase in WBC

Lung parenchyma & alveoli consolidation

Bradykinin Histamine

Stimulation of hypothalamus

Increase body temperature

Hyperthermia

Stimulates goblet cells

Increase in mucosal secretions

Causes narrowing of the airways

Air passes through narrowed lumen

Cytokine

Accumulation of secretions

(+) rales

(+) cough

Decrease blood oxygenation and ineffective tissue

perfusion

DOB & Dyspnea

Synthesis of the disease (client-centered)

Invasion of microorganism which lodges in the upper respiratory tract

Reaches the lower respiratory tract causing damage to the lung tissues

Stimulates inflammatory response

Release of chemical mediators

(cytokine, bradykinin, histamine)

Attraction of neutrophils and accumulation of fibrinous exudates & bacteria

Lung parenchyma &

alveoli consolidation

Bradykinin Histamine

Stimulation of hypothalamus

Increase body temperature

Hyperthermia

Stimulates goblet cells

Increase in mucosal secretions

Causes narrowing of the airways

Air passes through narrowed lumen

Cytokine

Accumulation of secretions

(+) rales

(+) cough

Decrease blood oxygenation and ineffective tissue

perfusion

DOB & Dyspnea

(Decreased Hct and Hgb)

Non-modifiable factors: Age

Modifiable factors: Body’s resistance, contact to a person with pneumonia, environment, health status

B. PLANNING (NCP)

PROBLEM #1 Ineffective Airway Clearance r/t presence of productive cough 2º to Bronchopneumonia

ASSESSMENT NURSING DIAGNOSIS

SCIENTIFIC EXPLANATION

OBJECTIVES NURSING INTERVENTION

RATIONALE EXPECTED OUTCOMES

S = Ø

O = Patient manifested:

-Appears weak & restless

-Appears tachypneic

-With changes in rate, rhythm and depth of breathing

-With DOB and (+) wheezes on the right lung

-Appears cyanotic

-With (+) non-

Ineffective Airway Clearance r/t presence of

productive cough 2º to

Bronchopneumonia

The inflammation and increased secretions make it difficult to maintain a patent airway, which is cause by decrease ability to expel the excessive mucus produced that will lead to extensive obstruction of the airway.

SHORT-TERM:

After 4 hours of NI, the SO

will demonstrate behaviors to

improve airway

patency.

LONG-TERM:

After 4 days of NI, the

patient will be able to

maintain airway

patency.

INDEPENDENT NURSING

FUNCTION:

-Establish rapport.

-Monitor V/S especially respiratory rate

-Auscultate breath sounds, note areas of decreased/adventitious breath sounds as well as fremitus

-Elevate HOB or change position every 2 hours as necessary

- To gain patient’s trust.

-To evaluate degree of compromise

-To ascertain status and note progress or complications

-To enhance ventilation to various lung segments

SHORT-TERM:

After 4 hours of NI, the SO

shall have demonstrated behaviors to

improve airway

patency.

LONG-TERM:

After 4 days of NI, patient

shall have been able to

maintain airway

productive cough

Patient may manifest:

-Appears tachycardiac

-Wide-eyed

-Keep environment allergen-free

-Encourage client to increase OFI to at least 2000 ml/day within level of cardiac tolerance.

-Encourage adequate rest and limit activities to within client tolerance.

DEPENDENT NURSING

FUNCTION:

-Administer medications such as bronchodilators/ expectorants as indicated.

-For adequate patent airway

-To help liquefy secretions

-To promote wellness

-To treat underlying conditions and mobilize secretions

patency.

PROBLEM # 2 Hyperthermia

ASSESSMENT NURSING DIAGNOSIS

SCIENTIFIC EXPLANATION

OBJECTIVES NURSING INTERVENTION

RATIONALE EXPECTED OUTCOMES

S = Ø

O = Patient

manifested:

-Appears weak

and restless

-Diaphoretic

-warm skin

when touched

-increased

body

temperature

(T= 37.9°C)

Hyperthermia Because of the

inflammatory

response, there

will be release

of chemical

mediators.

Cytokine, a

chemical

mediator will act

on the

hypothalamus

which will result

in increase in

epinephrine

and

norepinephrine,

vasoconstriction

SHORT-

TERM:

After 4 hours

of NI, the

patient will

have

decrease in

body

temperature

from 37.9 to

37.2 ºC.

LONG-TERM:

After 3 days

INDEPENDENT

NURSING FUNCTION:

-Establish rapport.

-Monitor VS

-Kept dry back

-Encourage SO to dress

pt in comfortable and

loose clothing.

- To gain patient’s

trust.

-To obtain baseline

data.

-To prevent further

respiratory

complication.

-To promote heat

loss.

SHORT-

TERM:

After 4 hours

of NI, the

patient shall

have gained

a decrease in

body

temperature

from 37.9 to

37.2 ºC.

LONG-

TERM:

-convulsions of cutaneous

vessels. The

heat will be

produced as

peripheral

vasodilation

results in skin

flushing and

skin is warm to

touch.

of NI, the

patient will

manifest

normal VS

specifically

temperature.

-Perform TSB

-Encourage client to

increase OFI

-Encourage adequate

rest and limit activities to

within client tolerance

DEPENDENT

NURSING FUNCTION:

-Administer anti-pyretic

medication

-To promote

evaporation of heat.

-For mobilization of

secretions

-To regain lost

energy

- To decrease the

elevated body temp.

After 3 days

of NI, the

patient will

have

manifested

normal VS

specifically

temperature.

PROBLEM # 3 Ineffective Breathing Pattern r/t dyspnea 2º Bronchopneumonia

ASSESSMENT NURSING DIAGNOSIS

SCIENTIFIC EXPLANATION

OBJECTIVES NURSING INTERVENTION

RATIONALE EXPECTED OUTCOMES

S = Ø

O = Patient

manifested:

-Appears weak

& restless

Appears

tachypneic

-With changes

in rate, rhythm

and depth of

breathing

-With DOB and

(+) wheezes on

the right lung

Ineffective Breathing Pattern r/t dyspnea 2º Bronchopneumonia

In effective

Breathing

Pattern occurs

when there is

presence of

spasm and

inflammation of

the lung tissue

and

parenchyma,

these results in

inability of the

pt to move air in

and out of the

lungs as

needed to

maintain

adequate tissue

oxygenation

SHORT-

TERM:

After 4 hours

of NI, the

patient will be

able to

improve

breathing

pattern AEB

absence or

decrease

cough and

dyspnea.

INDEPENDENT

NURSING FUNCTION:

-Establish rapport.

-Monitor V/S especially

respiratory rate

-Auscultate breath

sounds, note areas of

decreased/adventitious

breath sounds as well as

fremitus

-Elevate HOB or change

position every 2 hours as

necessary

- To gain

patient’s

trust.

-To evaluate

degree of

compromise

-To ascertain

status and

note

progress or

complications

-To enhance

ventilation to

various lung

SHORT-

TERM:

After 4 hours

of NI, the

patient shall

have been

able to

improve

breathing

pattern AEB

absence or

decrease

cough and

dyspnea

-Appears

cyanotic

-With (+) non-

productive

cough

Patient may

manifest:

-irritability

-nasal flaring

and perfusion.LONG-TERM:

After 4 days

of NI, the

patient will

improve and

maintain

effective

breathing

pattern

-Keep environment

allergen-free

-Encourage client to

increase OFI to at least

2000 ml/day within level

of cardiac tolerance.

-Encourage adequate

rest and limit activities to

within client tolerance.

DEPENDENT NURSING

FUNCTION:

-Administer medications

such as bronchodilators/

expectorants as

indicated.

segments

-For

adequate

patent airway

-To help

liquefy

secretions

-To promote

wellness

- To treat

underlying

conditions

and mobilize

secretions

LONG-

TERM:

After 4 days

of NI, the

patient shall

have been

able to

improve and

maintain

effective

breathing

pattern

PROBLEM # 4 Risk for Deficient Fluid Volume r/t fever and diaphoresis 2º Bronchopneumonia

ASSESSMENT NURSING DIAGNOSIS

SCIENTIFIC EXPLANATION

OBJECTIVES NURSING INTERVENTION

RATIONALE EXPECTED OUTCOMES

O> Patient

may manifest:

-Delayed

capillary refill

-Appears

tachycardiac

-Dry mucous

membranes

-Dry skin

-Poor skin

turgor

-Sunken

anterior

Risk for Deficient Fluid Volume r/t fever and diaphoresis 2º Bronchopneumonia

Fluid volume

deficit may

result from loss

of bodily fluids,

volume and

occurs more

rapidly when

fluid inside the

lung drains due

to fever and

diaphoresis tat

serves as a

compensatory

mechanism of

the body.

Daiphoretic

episodes

SHORT-

TERM:

After 4 hours

of NI, the SO

will

demonstrate

behaviors to

monitor and

prevent fluid

deficit.

LONG-TERM:

After 4 days

of NI, patient

INDEPENDENT

NURSING

FUNCTION:

- Establish rapport.

- Monitor and record

V/S.

- Assess patient’s

condition.

-Note for signs of

- To gain pt’s

trust &

cooperation.

- To obtain

baseline data.

-To note

patient’s

progress.

-To prevent

SHORT-

TERM:

After 4 hours

of NI, the SO

shall have

demonstrated

behaviors to

monitor and

prevent fluid

deficit.

LONG-

TERM:

After 4 days

fontanelle experienced by

the patient may

lead to

decrease fluid

volume in the

body of the

patient if it is

not prevented

or given

management.

will be able to

maintain

adequate fluid

volume.

dehydration and

bleeding.

-Monitor intake and

output balance.

-Weigh client &

compare with recent

weight history.

-Keep fluids within

client’s reach and

encourage frequent

intake as needed.

-Encourage increase

intake of food rich in

iron.

further

complications.

-To monitor

hydration

status.

-To determine

occurrence of

deficit

-To maximize

intake of fluids

and prevent

dehydration.

-To replace

nutrients loss

of NI, the

patient shall

have

maintained

adequate

fluid volume.

DEPENDENT

NURSING

FUNCTION:

-Administer and

regulate IVF strictly as

ordered.

-Administer

medications as

indicated

-To replace

fluid loss or

deficit.

-To comply on

therapeutic

regimen.

Problem #5 risk for Aspiration r/t impaired swallowing

ASSESSMENT NURSING DIAGNOSIS

SCIENTIFIC EXPLANATION

OBJECTIVES NURSING INTERVENTION

RATIONALE EXPECTED OUTCOMES

O> the patient

may manifest

the following:

>Depressed

cough

>Impaired

swallowing

>Difficulty of

Breathing

>Secretions in

the nasal cavity

Risk for Aspiration r/t impaired swallowing

Owing to

inability of the

epiglottis and

true vocal cords

to move close

off trachea and

with the

presence of

secretions the

patients is at

risk for

aspiration due

to the inability

of the epiglottis

and secretions

that will block

the patients

Short term:

After 4 hours of

NI, SO will

identify

causative/ risk

factors.

Long term:

After 3 days of

NI, the pt will

experience no

aspirations

AEB noiseless

respiration,

clear breath

-Assess amount

and consistency of

respiratory

secretions and

strength of gag/

cough reflex.

-Suction as needed

-Assist with

postural drainage

-Determined the

best position, head

-To asses

contributing factors.

-To clear

secretions

-To mobilized

thickened

secretions that may

Short term:

After 4 hours

of NI, the SO

shall have

identified

causative/ risk

factors.

Long term:

After 3 days of

NI, the pt shall

have

experienced

no aspirations

AEB noiseless

airway. sounds clear,

odorless

secretions

of bed elevated to

30 degrees and

propped on right

side

interfere with

swallowing.

-Because upper

airway patency is

facilitated by

upright position and

turning to right side

decreases

likelihood of

drainage into

trachea

respiration,

clear breath

sounds clear,

odorless

secretions

C. IMPLEMENTATION

1. MEDICAL MANAGEMENT

1.a. Intravenous fluids:

MEDICAL MANAGEMENT & TREATMENT

DATE ORDERED, DATE GIVEN/PERFORMED, DISCONTINUED

GENERAL DESCRIPTION

INDICATIONS OR PURPOSES

CLIENT’S RESPONSE TO TREATMENT

D5 0.3 NaCl 500cc

x 40 ugtts/min

D5 0.3 NaCl 500cc

x 40 ugtts/min

DO: 11-10-09

DP: 11-10-09

DC: 11-11-09

DO: 11-10-09

DP: 11-11-09

DC: 11-11-09

Hypertonic solution that

provides Na, Cl, and

Sugar. This solution

draws water from

intracellular to the

extracellular

compartment and cause

cell to shrink. These

solutions are given

cautiously and usually

when serum osmolality

has decreased to

dangerous low levels.

It draws water out in

tissue space into the

bloodstream, so that

the kidneys will

eliminate excess fluid,

since the pt. has fluid-

filled alveolar sacs. It

is also used for route

of medication.

No untoward

reaction noted.

NURSING RESPONSIBILITIES:

Before

Check for the doctor’s order.

When inserting an IV line to a patient, always prepare all the materials needed.

Wash hands thoroughly before performing the procedure.

Identify the correct patient by checking the name on the chart or by asking the

patient.

Explain the procedure to the SO.

During:

Maintain the use of aseptic technique.

Hook the IVF bottle properly.

After

Regulate and monitor infusion rate.

Monitor patient’s response to the fluid and monitor the vital signs.

Check the IV insertion site for signs of infiltration: bulging, pain, and redness.

Document the essential information.

MEDICAL MANAGEMENT & TREATMENT

DATE ORDERED, DATE GIVEN/PERFORMED, DISCONTINUED

GENERAL DESCRIPTION

INDICATIONS OR PURPOSES

CLIENT’S RESPONSE TO THE TREATMENT

Salbutamol-neb 1

ml q 12°

Salbutamol-neb 1

ml q 4°

DO: 11-10-09

DP: 11-10-09

DC: 11-11-09

DO: 11-11-09

DP: 11-11-09 (continuous)

Nebulization is

used to dispense

fine particles of

medication into the

deeper passages of

the respiratory tract

Prevention and

treatment of

bronchospasms

used to loosen

secretions; relieve

pt. from dyspnea.

The pt loosened

his secretions and

the PR and RR

are in normal

range (11/11/09-

discharge)

1.b. Nebulization

NURSING RESPONSIBILITIES:

Before

Check for the doctor’s order.

Prepare all the materials and equipments needed.

Add the prescribed amount of medication.

Wash hands thoroughly before performing the procedure.

Identify the correct patient by checking the name on the chart or by asking the

patient.

Explain the procedure to the SO.

Show the nebulizer equipment to the SO and teach them on how to use it

correctly.

During

Monitor for chest expansion.

After

Monitor the heart rate after the treatment for patient’s using bronchodilator drugs

(Bronchodilator may cause tachycardia, palpitations, dizziness, nausea or

nervousness).

Record medication used and description of secretion (If there are presence of

secretions).

Disassemble and clean nebulizer after each use.

Each patient should have their own breathing circuit (Nebulizer, tubing, and

mouthpiece). Through proper cleaning, sterilization, and storage of equipment,

organisms can prevent form entering the lungs.

Document all necessary information.

1.c. Drugs

Name of Drugs; Generic & Brand Name

Date Ordered, Date Performed/Given, Discontinued

Route of Administration

Dosage & Frequency

Mechanism of Action

Indication or Purpose

Client’s Response to the Meds w/ Actual S/E

Generic Name:

Cefuroxime

Classification:

Anti-infective

DO: 11-10-09

DP: 11-10-09

100 mg IV q 6° Mechanism of Action

Bind to bacterial cell

membrane causing

cell death.

Treatment of

respiratory

tract

infections.

No allergic reactions

noted. The client’s

fever declines and

no other signs of

infection were noted.

NURSING RESPONSIBILITIES:

Before

Check for the doctor’s order.

Prepare all the materials and equipments needed.

Prepare the exact amount of medication.

Wash hands thoroughly before performing the procedure.

Identify the correct patient by checking the name on the chart or by asking the

patient.

Explain the procedure to the SO, the purpose and the action of the drug.

Obtain a history to determine previous use of and reactions to penicillin or

cephalosporin.

During

Clean the IV insertion site for medications with a cotton ball with alcohol.

Gradually inject the drug into the port.

After

Observe patient for signs of anaphylaxis (rashes, pruritus, wheezing) discontinue

medication and notify physician or other HCP immediately if the symptoms occur

and advise SO to also notify any HCP if signs of anaphylaxis occur.

Assess patient for renal or liver dysfunction and adjust dose accordingly.

Monitor for dose related adverse CNS effect and nephrotoxicity.

Document all necessary information.

Name of Drugs; Generic & Brand Name

Date Ordered, Date Performed/Given, Discontinued

Route of Administration

Dosage & Frequency

Mechanism of Action

Indication or Purpose

Client’s Response to the Meds w/ Actual S/E

Generic Name:

Ambroxol

Classification:

Mucolytic

DO: 11-10-09

DP: 11-10-09

5 ml PO q 4° Splits links in the

mucoproteins

contained in

respiratory mucus

secretions,

decreasing the

viscosity of the

mucus.

Treatment of

respiratory

disorders

associated

with viscid or

excessive

mucus.

No adverse

reactions noted. The

client loosened his

secretions.

NURSING RESPONSIBILITIES:

Before

Check for the doctor’s order.

Prepare all the materials and equipments needed.

Wash hands thoroughly before performing the procedure.

Prepare the exact amount of medication.

Identify the correct patient by checking the name on the chart or by asking the

patient.

Explain the procedure to the SO.

Explain to the SO the proper administration of the drug

During

Allow the SO to administer the medication and assist him/her.

After

Advise the SO to report signs of allergy.

Assess patient for renal and hepatic dysfunction and adjust dose accordingly.

Instruct SO not to exceed recommended dosage and frequency.

Document all necessary information.

Name of Drugs; Generic & Brand Name

Date Ordered, Date Performed/Given, Discontinued

Route of Administration

Dosage & Frequency

Mechanism of Action Indication or Purpose

Client’s Response to the Meds w/ Actual S/E

Generic Name:

Paracetamol

Classification:

Anti-pyretic

DO: 11-10-09

DP: 11-10-09

5 ml PO q 4° Mechanism of Action

Decreases fever by

acting directly on the

hypothalamic heat-

regulating center to

cause vasodilation and

sweating, which helps

dissipate heat.

To reduce

fever in

bacterial or

viral

infections.

The client’s

temperature lowered

after administration

and there are no

side effects or

adverse reactions

noted.

NURSING RESPONSIBILITIES:

Before

Check for the doctor’s order.

Prepare all the materials and equipments needed.

Prepare the exact amount of medication.

Check the latest temperature of the patient.

Identify the correct patient by checking the name on the chart or by asking the

patient.

Explain the procedure to the SO.

Explain the right administration of the drug to the SO.

During

Allow the SO to administer the medication and assist him/her.

After

Report paleness, weakness and heart beat skips; s/sx of hemolytic anemia.

Report for any symptoms of abdominal pain, yellow discoloration of skin and

eyes, dark urine, itching or clay-colored stools because it may indicate liver

toxicity.

S/sx of acute toxicity that requires immediate reporting includes nausea and

vomiting or abdominal pain.

Advise SO to notify HCP when the signs mentioned above occur.

Instruct SO to notify if fever do not improve within 3 days.

Instruct SO not to exceed recommended dosage and frequency.

Document all necessary information.

Name of Drugs; Generic & Brand Name

Date Ordered, Date Performed/Given, Discontinued

Route of Administration

Dosage & Frequency

Mechanism of Action

Indication or Purpose

Client’s Response to the Meds w/ Actual S/E

Generic Name:

Hydrocortisone

Classification:

Antiasthmatics

DO: 11-11-09

DP: 11-11-09

70 mg IV now then

35 mg IV q 8°

Produces intense

metabolic effects.

Suppression

of

inflammation

The client did not

develop any adverse

reactions.

NURSING RESPONSIBILITIES:

Before

Check for the doctor’s order.

Prepare all the materials and equipments needed.

Prepare the exact amount of medication.

Wash hands thoroughly before performing the procedure.

Identify the correct patient by checking the name on the chart or by asking the

patient.

Explain the procedure to the SO, the purpose and the action of the drug.

Assess patient for signs of adrenal insufficiency (hypotension, weight loss,

weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness).

During

Clean the IV insertion site for medications with a cotton ball with alcohol.

Gradually inject the drug into the port.

Assess patient for signs of adrenal insufficiency (hypotension, weight loss,

weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness).

After

Report worsening of condition or lack of improvement may need dosage

adjustment.

Report any fever, sore throat or muscle aches, sudden weight gain or swelling of

extremities.

Use appropriate prescribed form only as directed; call with questions or

problems.

Assess patient for renal or liver dysfunction and adjust dose accordingly.

Document all necessary information.

1.d. Diet

TYPE OF DIET

DATE ORDERED; DATE PERFORMED; DATE CHANGED

GENERAL DESCRIPTION

INDICATIONS AND PURPOSES

SPECIFIC FOODS TAKEN

CLIENT’S RESPONSE TO DIETS

Milk Feeding with

Strict Aspiration

Precaution (SAP)

DO: 11-10-09 The pt. can drink

milk formula but

with Strict

Aspiration

Precaution (SAP)

which will prevent

for further

complications

such as aspiration

pneumonia.

To give the client

adequate nutrition

Breast milk The client remains

good in terms of

nutritional status

and was

prevented from

aspiration.

NURSING RESPONSIBILITIES:

Before

Verify doctor’s order.

Check the patient’s identity.

Instruct SO to feed with strict aspiration precaution.

During

Assist client’s SO in feeding.

Stress to the SO the importance in complying with the diet.

After

Assess the health status of the patient.

Compare previous health status from the present.

Document all necessary information.

2. NURSING MANAGEMENT

Keep a record of the vital signs and monitor

Perform regular assessment of patient’s general condition

Encourage bed rest

Keep the back dry

Maintain high-calorie, high protein diet, adequate vitamin intake (especially Vit.

C) and increase fluid intake

Turn patient frequently

Raise the head of the bed

Perform TSB for fever

Monitor ABG

Administer bronchodilators

Perform chest physiotherapy

Provide a calm, quiet environment for the patient

Teach the SO to avoid activities of the client that increases oxygen demand

Teach SO and encourage proper secretions disposal. Tell the SO to sneeze and

cough into a disposable tissue and wrap it in a plastic bag

Teach SO and encourage to do proper handwashing, especially after handling

secretions, going to the bathroom and before and after eating

Teach SO to avoid patient’s exposure to irritants

Administer medications as prescribed

D. EVALUATION

1. Client’s Daily Progress

Days November 10, 2009

(Admission)

November 11, 2009

November 12, 2009

November 13, 2009

November 14, 2009

November 15, 2009

November 16, 2009

Nursing Problems

1. Ineffective Airway

Clearance

2. Hyperthermia

3. Ineffective Breathing

Pattern

4. Risk for Deficient Fluid

Volume

5. Risk for Aspiration

Vital Signs

T 39.6°C 37.4°C 37.9°C 36.8°C 36.8°C 37°C 37.2°C

CR 173 bpm 136 bpm 144 bpm 140 bpm 110 bpm

RR 78 cpm 56 cpm 78 cpm 78 cpm 44 cpm

Diagnostic/Lab Procedures

1. CBC

2. Chest X-Ray

Medical Management

1. D5 0.3 NaCl

Drugs

1. Salbutamol neb

2. Cefuroxime

3. Ambroxol

4. Paracetamol

5. Hydrocortisone

Diet

Milk Feedings with Strict Aspiration Precaution

2. Discharge Planning

Baby Bear was discharged last November 16, 2009. Unfortunately, the

student nurses did not see him and was not able to handle the patient upon his

discharge.

M: >Cefalozine drops 1 ml BID x I week

>Salbutamol (Efamed) syrup 2.5 ml TID

>Prednisone 1.75 ml BID after feeding x 3 days

E: >instruct mother to provide adequate rest periods

>instruct SO to allow tolerable play activities

T: >Ø

H: >encourage adequate rest periods

>encourage mother to provide comport and safety measures

>encourage SO to keep pt’s back dry

>instruct SO to keep allergen-free environment

O: >instruct mother to return after a few days for follow-up check-up to the

hospital

D: >encourage SO to increase fluid intake of the baby

>instruct the mother to feed the infant as long as he wants

III. CONCLUSION, SOCIOGRAM, BIBLIOGRAPHY

Conclusion:

There are different types of pneumonia and it depends on how you classify it.

Through this case study, the group was able to learn and understand the disease

bronchopneumonia; therefore it gave knowledge in proper management, prevention and

treatment of the said disease. As a student nurse, it is very important to know many

things including the disease condition.

This is a disease that when given prompt treatment and proper attention could

give a good prognosis. But when neglected, it could lead you to a more severe condition

just like other diseases. Nowadays, it is not a difficult condition to cure since we have so

many available ways and medications to manage such disease. However, there are

also an increasing number of factors that predispose everyone in acquiring the different

types of Pneumonia depending on what causes it but there are ways to prevent from

having them especially through good hygiene practices, having a clean and safe

environment and practicing healthy lifestyle.

Sociogram:

DAY 1: November 12, 2009

Symbols and their Interpretation:

- Nursing student - Nursing Interventions

- Health Assessment - Interaction

- Baby Bear

DAY 2: November 13, 2009

Symbols and their Interpretation:

- Nursing student - Nursing Interventions

- Health Assessment - Interaction

- Baby Bear

References:

A. Books:

Black, Joyce, and Hawks, Jane Hokanson: Medical-Surgical Nursing, ed 7.

Elsevior Inc., 2004.

Hockenberry, M.J. and Wilson, D. (2007). Wong’s Nursing Care of Infants and

Children, 8th ed. Mosby: Philippines.

Deglin, H.D. and Vallerand, A.H. (2007). Davis’s Drug Guide for Nurses, 10 th ed.

F.A. Davis Company: Philadelphia, Pennsylvania.

Karch, A.M. (2010). Nursing Drug Guide. Lippincott Williams and Wilkins:

Philadelphia, Pennsylvania.

B. Internet:

http://en.wikipedia.org/wiki/Pneumonia

http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35692

http://health.yahoo.com/infectiousdisease-overview/pneumonia-topic- overview/

healthwise--hw63870.html

http://www.acponline.org/ear/vas2001/pneumonia.html