Liceo De Cagayan University

Cagayan de Oro City

College of Nursing

In Partial Fulfillment
Of the Course Requirement
In NCM501204
Related Learning Experience

A Case Study on

Bronchopneumonia
Submitted To:
Mr. Lilian Gerochi, RN
Clinical Instructor

Submitted By:

Ranna Lillianne Z. Escudero

Cyrra Mae Go
Pamela Enobio
BSN-4
 I. Introduction

A. Overview

Bronchopneumonia is a type of pneumonia which results when haematogeneous

dissemination of organisms to the lung or colonization of airways with subsequent
aspiration is responsible for pulmonary infection. As opposed to other acute bacterial or
lobar pneumonias which begin in alveoli, bronchopneumonia originates in small
bronchioles. Typical bacteria causing this form of infection include Staphylococcus
aureus and Gram-negative organisms such as Pseudomonas aeruginosa. These organisms
disseminate through the bloodstream and colonize the bronchial or bronchiolar
epithelium, but then quickly cause acute inflammatory responses which extend outside
the airway into adjacent alveoli. The initial inflammatory response consists largely of
polymorphonuclear leukocytes which limit the extent of infection to the peribronchiolar
region. Since multiple sites are involved simultaneously a scattered appearance of
heterogeneous opacities is the usual pattern observed on chest films (Fig.1). Eventually
more and more alveoli are affected and ultimately a homogeneous opacification
simulating lobar pneumonia may be observed. Nevertheless, because there is greater
airway involvement with bronchopneumonia, air bronchograms are infrequent and
atelectasis is more common. Peribronchial interstitial thickening may also be seen early
in the course of infection. Necrosis and cavitation are more frequent in this type of
pneumonia. Pneumatocoeles are occasionally noted.

Clinically, patients present with fever and productive cough similar to other bacterial
infections although physical findings typical of dense consolidation such as
bronchophony and whispering pectoriloquy are not heard. Treatment with a variety of
antibiotics usually results in rapid clinical and radiographic resolution.
 A. Objective of the Study

General Objective:

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

the principles of nursing and to amend at the same time the patient’s and her
family’s view towards proper health and wellness.

Specific Objectives:

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

Hospital Operating Room Department, I will be able to:

Establish Rapport to the patient

Gather information on the following:

a. General information

b. Patient’s health

c. Patient’s home and environment

Obtain Patient Health History.

Identify the developmental task of the patient.

Identify the existing and health threatening problems.

Present Nursing Care Plans.

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

 B. Scope and Limitation

II. Health History

A. Patient’s Profile

A. FAMILY AND PERSONAL HEALTH HISTORY

B. CHIEF COMPLAINT AND HISTORY OF PRESENT ILLNESS

II. Growth and Development

III. Medical Management

a. Medical Orders and Rationales
Date and Time Medical Orders Rationale

B. Obtained Laboratory Results

CBC Normal Values Results Implication

WBC 5-10x103/uL 27.89 abnormal
3
RBC 3.69-5.9x10 /uL 3.65 abNormal
Hemoglobin 13.7-16.7 g/dL 10.1 abnormal
Hematocrit 40.00-50% 30.6 abnormal
3
Platelet Count 150-390x10 /uL 282 Normal
Differential Count
Lymphocytes 20-50% 7.1 Infection
Monocytes 1-3% 4 abnormal
Eosinophils 8-14% 0.1 abNormal
Basophils 1% 0.1 -
 MCV 70-97.00 fL 81.7 Normal
MCH 6.10-33.30 g/dL 25.4 Normal
MCHC 32.0-35 g/dL 33 abnormal
Rdw-CV 11.5-14.5% 170 -

C. Drug Studies

II. Pathophysiology with Anatomy and Physiology

A. Anatomy of The Respiratory System

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

features of the respiratory system. The human respiratory system begins at the nose and
mouth, where air is breathed in (inspired) and out (expired). The air tube extending from
the nose is called the nasopharynx. The tube carrying air breathed in through the mouth is
called the oropharynx. The nasopharynx and the oropharynx merge into the larynx. The
oropharynx also carries swallowed substances, including food, water, and salivary
secretion that must pass into the esophagus and then the stomach. The larynx is protected
by a trap door called the epiglottis. The epiglottis prevents substances that have been
swallowed, as well as substances that have been regurgitated (thrown up), from heading
down into the larynx and toward the lungs.

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

tree. The larynx flows into the trachea, which is the tree trunk, and thus the broadest part
of the respiratory tree. The trachea divides into two tree limbs, the right and left bronchi.
Each one of these branches off into multiple smaller bronchi, which course through the
tissue of the lung. Each bronchus divides into tubes of smaller and smaller diameter,
finally ending in the terminal bronchioles. The air sacs of the lung, in which oxygen-
carbon dioxide exchange actually takes place, are clustered at the ends of the bronchioles
like the leaves of a tree. They are called alveoli.

The tissue of the lung that serves only a supportive role for the bronchi,
bronchioles, and alveoli is called the lung parenchyma.
 The main function of the respiratory system is to provide oxygen, the most
important energy source for the body's cells. Inspired air (the air taken in when a person
breathes) contains oxygen, and travels down the respiratory tree to the alveoli. The
oxygen moves out of the alveoli and is sent into circulation throughout the body as part of
the red blood cells. The oxygen in the inspired air is exchanged within the alveoli for the
waste product of human metabolism, carbon dioxide. The air you breathe out contains the
gas called carbon dioxide. This gas leaves the alveoli during expiration. To restate this
exchange of gases simply, you breathe in oxygen, you breathe out carbon dioxide

B. Pathophysiology Of IncomplBronchopneumonia

IV. Nursing Assessment

NURSING SYSTEM REVIEW CHART

NURSING ASSESSMENT II
SUBJECTIVE OBJECTIVE
COMMUNICATION:
[ ] hearing loss Comments: “wala koy [ ] glasses [ ] language
[ ] visual changes problema sa akong [ ] contact lens [ ] hearing aide
pan R L
[x] denied dungog ug panan-aw,” Pupil size: 3 mm Speech Difficulties: None
As verbalized by the Reaction: Pupils Equally Round Reactive to Light and
pt. Accommodation(PERRLA)

OXYGENATION: Respiration: [x ] regular [ ] irregular

[ ] dyspnea Comments: “Dili man ko
[ ] smoking history gapanigarilyo ug okay Describe: Client had regular breathing pattern during
15years smoking lang man akong pag- physical assessment.
[ ] cough ginhawa.”
[ ] sputum R. Symmetrical to the left.
[x] denied L Symmetrical to the right.

CIRCULATION: Heart Rhythm [x] regular [ ] irregular

[ ] chest pain Comments Ankle edema : None

[] leg pain Heart : regular
[] numbness of Carotid Radial Dorsal Pedis Femoral
extremities said by the pt.
[x ] denied R___+ 60 bpm+_______+__________+_____
L___ + 60 bpm+______+__________+_____

Comments: All pulse sites were palpable during physical

assessment.
NUTRITION:
Diet: Diet As Tolerated [ ] Dentures [ ] None
[]N []V Comments: Wala kaayo
ko
character gana karun mukaon”. Full Partial With Patent
[ x] recent change As verbalized by
[ ] weight, appetite Upper [ x] [] []
[ ] swallowing
difficulty Lower [ x] [] []
[ ] denied

ELIMINATION: Comments: Bowel Bowel Sounds: Normoactive

Usual bowel pattern [ ] urinary frequency sound was
once a day. 6X a day normal, urine
[ ] constipation [ ] urgency was yellowish in Abdominal distention
remedies [ ] dysurria color with Present [ ] Yes [x] No
None [ ] hematuria aromatic odor.
Date of last BM [ ] incontinence
June 24, 2009 [ ] polyturia
[ ] diarrhea [ ] foly in place
character [x] denied
MGT. OF HEALTH & ILLNESS Briefly describe the patient’s ability to follow treatments
[ ] alcohol [ ] denied (diet, medication, etc.) for chronic health problems (if
(amount, frequency) “Dili man ko gainom” present)
SBE last pap smear: N/A Patient took all the prescribed medications as prescribed
EDC: N/A by the doctor.
 SUBJECTIVE OJECTIVE

SKIN INTEGRITY: [x ] dry [ ] cold [x ] pale

[ x] dry Comments: “ Mala ug luspad [ ] flushed [ ] warm
[ ] itching ang akong panit. [ ] moist [ ] cyanotic
[x] others
[ ] denied *rashes, ulcers, decubitus (describe size, location, drainage)
Patient skin was dry,pale and warm to touch.

ATIVITY/SAFETY:
[ ] convulsion Comments:
[x] dizziness Gapanglipong lage ko LOC and Orientation: The patient was aware of time, place
[ x] limited motion karun.Kapoy akong people and date.
of joints pamati sa akong lawas.
“ [x] Gait [ ] Walker [x ] Care [ ] Other
limitation of ability [ ] Steady [ ] Unsteady
to :
[ ] ambulate Sensory and motor losses in face or extremities
[ ] bathe self numbness of lower extremities
[ ] other [ ] ROM limitations: Range of motion was observed, the
[ ] Denied patient could not able to walk or move properly during the
interview ,because of her numbness felt caused by induced
anesthesia.

COMFORT/SLEEP/AWAKE
() pain Comments: (location, [x] facial grimaces
frequency [ ] guarding
remedies) complained by the pt.
patient. [x ] other signs of pain:verbalization of pain complaint
[ ] nocturia
[ ] sleep difficulties [ ] side rail release from signed (60+years): N/A
[ x] DENIED

COPING:
Occupation: Child Observed non-verbal behavior: moving slowly of her lower
Members of the household: extremities and touching abdominal part, general body
Most Supportive Person: Mother weakness, and paleness of skin
Person (Phone Number):Not given

(SPECIAL PATIENT INFORMATION (USE LEAD PENCIL)

kilograms Weight Daily N/A PT/OT

mmHg BP q Shift N/A Irradiation
N/A Neuro vs N/A Urine Test

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

VI. Nursing Management

A. Ideal Nursing Management

Nursing Diagnosis Interventions Rationales

Nursing Diagnosis Interventions Rationale

Nursing Diagnosis Interventions

 B. Actual Nursing Management

S
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S
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S
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 VII. Referrals and Follow Up

Medication
Inform patient and the significant others about the medication indicated for home
regimen, their purpose, route, frequency of administration. Explain to the patient and
family the importance of taking the prescribed drugs to promote faster recovery and for
maintenance of health as well. Warn the patient about the side effects of the drugs that
may occur during the course of pharmacologic treatment. Refer to physician any adverse
reactions or complications such as infection or hypersensitivity to provide immediate
interventions. Educating the patient and the family regarding all that pertains to
administration of medications at home is essential for an effective independent
management of the above mentioned party towards the betterment of the patient’s
condition.
Hygiene
Inculcate the importance of taking a full bath everyday to achieve a refreshing
feeling thus promoting proper hygiene and cleanliness. Explain to patient the importance
of a clean environment inside and outside the home, free from sources of harmful organic
and inorganic substances. Tell the family to maintain sanitary practices especially in
disposing wastes and garbage. The first line of defense against infections and disease is
the proper hygiene. An environment having less if not free from pathogenic
microorganisms is ideal for health restoration and maintenance.

Spiritual
Encourage the family to continuously provide emotional support to anchor the
patient towards recovery. Encourage the patient to establish a good relationship with
GOD to have a source of strength and ask forgiveness after committing an abortion. The
spirituality of the patient developed by the family provides a stable foundation upon
which the situation is faced with faith and hope for a better future.

VIII. Evaluation and Nursing Implication

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

ourselves unto learning the fundamentals of life and reality giving way to a more stable
foundation of growing. But education applied to nursing still follows the same concept,
but with few kicks. For knowledge in nursing is best learned outside the four corners in
our room, and requires more than just piles of books, but with actual exposure in the
hospital.
Nurses equipped with both God-given talents and attained skills marches their
way unto humanity doing what they do best, promoting health, preventing illness and
alleviating suffering. But as time passes by, situations become more complicated as
man’s needs multiply. With this in mind, nurses’ versatility takes place, as she puts into
actions all her grasped experiences and attained knowledge.
 As student nurses, we should know what it takes to be an effective, who deal with
situations professionally and uses skills and knowledge imparted in the academe. We
should also know our responsibility as part of the Health Providers and not just for
achieving NCM501204, but as a stepping stone to further enhance our abilities for the
future ahead. That is why, having this case study gave us a whole new insight, not just
what we have read in the books, but through experiences we had during our exposure.
Our study was truly one of the best, for it gave us the chance to apply our
knowledge that can help us contribute further to improve the condition of the population
as a tool for us as student nurses that can enhance our understanding about people who in
the future will be the subject of our care.

Bibliography

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

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

111227-1228.