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
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