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GORDON COLLEGE

COLLEGE OF NURSING
Old Hospital Road, East Tapinac Olongapo City

Telefax (057) 224-2089 Class 2011-2012

ACUTE BRONCHOPNEUMONIA

Submitted by: Bacolor, Precious Star Bartolome, Reshel Caseja, Abegail Flora, Marissa Javier, Sherilyn Lavia, Leevi Paul Ola, Julie Ann Par, Marife Wenceslao, Glenn Patrick BSN II-B3

Submitted to: Mrs. Fedesenia Abad-Hilario, RM, RN Clinical Instructor

I.

INTRODUCTION

Bronchopneumonia is an acute or chronic inflammation of the lungs, in which the alveoli and / or interstitial are affected. It is also used to describe pneumonia that is distributed in a patchy fashion, having originated in or more localized area within the bronchi and extending to the adjacent surrounding lung parenchyma. Bronchopneumonia is more common than lobar pneumonia. In general, patients with bacterial pneumonia usually have acute or chronic underlying disease that impairs host defenses. More often, pneumonia arises from normally present flora in patient whose resistance has been altered or it results from aspiration of flora present in mouth. Although most atypical pneumonias, such as those caused by viral infections, occur in previously healthy persons, when bacterial pneumonia occurs in a healthy person there is usually a history of preceding viral illness. Increasing numbers of patients who have compromised defenses against infections are susceptible to pneumonia. Included are people on corticosteroids or other immunosuppressive agents, those on broad-spectrum antimicrobials, those, and those requiring the use of advanced life support technology. Patients with impaired defenses develop hospital-acquired pneumonia from gram (-) bacilli (Klebsiella, Pseudomonas, Escherichia coli, Enterobacteriaceae, Proteus, Serratia). Bronchopneumonia is less likely than lobar pneumonia to be associated with Streptococcus. In bacterial pneumonia, invasion of the lung parenchyma by bacteria produces an inflammatory immune response. This response leads to a filling of the alveolar sacs with exudates. The loss of air space and its replacement with fluid is called consolidation. In bronchopneumonia, or lobular pneumonia, there are multiple foci of isolated, acute consolidation, affecting one or more pulmonary lobes.

Bronchial pneumonia, also known as bronchopneumonia, is an infection of the bronchial tubes of the lungs and the most common form of pneumonia in infants. If your child shows symptoms such as high fever, productive cough, loss of appetite, weakness, wheezing and difficulty in breathing, contact your pediatrician immediately.

Bronchial pneumonia affects infants more than adults because their respiratory immune system is still immature. The main cause of bronchopneumonia is a bacterium known as the pneumococcus. Other bacteria responsible for the illness are staphylococcus aureus and mycoplasma pneumoniae. Viruses such as the influenza virus or adenovirus may also cause it. Baby X , a 1 month old male and was a currently a residence of #127 Irving St. New Kalalake, Olongapo City and was admitted to James L. Gordon Memorial Hospital last January 8 2012 with a chief complaint of difficulty of breathing, and he was diagnosed with Acute Bronchopneumonia and was attended by : Dr. E. Guerero. . The mother of the client was working in a gasoline station during when she was a pregnant and she stop when she was giving birth with his baby boy.

II.

BIOGRAPHIC DATA Name: Baby X Address: #127 Irving St. New Kalalake, Olongapo City. Age: 1 month Gender: Male Religious Affiliation: Iglesia ni Cristo Marital Status: Single Occupation: N/A Room and Bed #: Room 208, Bed #B7 Chief Complaint: Difficulty of Breathing Provisional Diagnosis: Acute Bronchopneumonia Attending Physician: Dr. E. Guerero.

III.

NURSING HISTORY

a. Past Health History Baby X received BCG and Hepatitis B vaccine after birth at Cabalan Clinic (Mams Clinic) on November 28, 2011 according to his mother. Baby X has no allergies especially in medicines and he had not yet encountered accident. He was exclusively breastfed since birth up to present. There is no foreign travel that Baby X experience. The physician prescribed him medications like Ampicillin, Paracetamol and Gentamicin. b. History of Present illness The patient first experienced coughing 9 days after birth at their home. He had cough, reddening of the face and experience inspiratory effort. Consultation at Mams Clinic was done, given carbocysteine drops, Cetrizine and Cefaclor drops for four days without no improvement of cough. Four days after, cough persisited and progressed to be moved dyspnea. He was brought again to the clinic and given Cefoxine twice a day 0.6 ml, Ambroxol drops 0.5 ml twice a day, Iron Polymatrose + Folic acid drops due given for 4 days. After 2 days, antibiotic was given per IM for 2 doses persistence of symptoms with poor cry and such cyanosis prompted consultation. On January 8, 2012, the patient was admitted at James L. Gordon Memorial Hospital due to difficulty of breathing. c. Family History Baby X has a family history of asthma and hypertension. His auntie has asthma and his grandfather has a hypertension. His mother worked at Total Gasoline Station even when she is pregnant. d. Developmental history Freuds psychosexual development theory stage one is Oral which is birth to 1 year old. Freuds said that in this stage the center of pleasure is mouth because this is the major source of gratification and exploration in infant. They have a primary need, which is security. They also have a major conflict, which is weaning it, means, that transformation from breastfeeding to bottle feeding.

IV.

PATTERNS OF FUNCTIONING a. Health-perception/health-management patterns Para sa akin ang kalusugan ng aking anak ay mahalaga lalonat sanggol pa siya. Isang beses ko palang siya naidala sa center para mabigyan vaccine ng BCG at HEPA B. Pagmay lagnat ang anak ko pinapatawas naming, pag hindi na wala ang lagnat saka palang namin siya dadalhin sa doctor, pero pag ubo at sipon na dinadala na namin siya sa doctor para mabigyan ng tamang gamot. As verbalized by the mother. Interpretation: The mother of our patient still believe in grassroots health worker (magtatawas) and she also aware in health of her son but it is not enough. Analysis: Infant health supervision visits are very important to support the health of the baby and the family unit. This is the time when parents establish an ongoing partnership with a healthcare provider. A medical Home or pediatric healthcare home is identified to serve the babys health needs. The goals of health supervision visits are to identify and address the health promotion and health maintenance needs of the infant. (Fundamentals of Maternal and Child Nursing Care 2nd edition, Vol.2, chapter 29 page 1070. By London et al.) b. Nutritional- metabolic pattern Sa akin lang siya dumidede, Magana naman siyang dumidede, minsan kalahating oras lang ang pagitan ng pagdede niya. As verbalized by the mother. Interpretation: Our patient is exclusively breastfeeding baby and it is good for his health because breast milk has a lot of nutrient and it has a natural immunization called colostrums . Analysis: The American Academy of pediatrics (AAP) recommends breast milk exclusively as the optimal food for the first 6 months of life, and breastfeeding in combination with solid foods through at least 12 months of life. It believes that breastfeeding provides newborns and infants with immunologic, nutritional and psychological advantages. Secretory IgA, an immunoglobulin in colostrums and breast milk, has antiviral, antibacterial, and antigenicinhibiting properties. (Fundamentals of Maternal and Child Nursing Care 2nd edition, Vol.1, chapter 29 page 746. By London et al.)

c. Elimination pattern Dati 3 beses siyang dumudumi sa isang araw, pero ngayong nandito kami sa hospital isang beses nalang sa iasng araw, ang kulay ng dumi niya ngayon ay mayellow-yellow at hindi masyado malambot at saka parang may kasamang plema. As verbalized by the mother. Interpretation: The elimination pattern of our patient was changed from 3 times a day to once a day. The color of his stool is normal and consistency because he is breastfeeding. The phlegm presents in his stool is normal because he is taking medicine for his acute bronchi pneumonia. Patient is not constipated.

Analysis: Breastfeed infants are rarely constipated because their stools tend to be loose. Constipated may occur in formula-fed infants if their diet is deficient in fluid. This can be corrected simply with the addition of more fluid. When infants defecate, their faces turn red, and they grimace and grunt. As long as stools are not hard and contain no evidence of flesh blood, this is normal in infants behavior. (Maternal and Child Health Nursing Care 6th edition vol. 2. page.833. By Adele Pillitteri) Generally the stool of a breastfed infant are pale yellow (but may pasty green), they are more liquid and more frequent than those of formula-fed, whose stool are paler. Frequency of bowel movement varies but ranges from one every 2 to 3 days to as many as 10 daily. Mothers should be counseled that the infant is not constipated as long the bowel movement remains soft. (Fundamentals of Maternal and Child Nursing Care 2nd edition, Vol.1, chapter 26 page 661. By PEARSON, London et al) d. Activity-exercise pattern Naigagalaw na niya ang mga kamay at paa niya. Naiaangat na din niya ang kanyang ulo. Pagpinapahawak ko ang daliri ko nahahawakan na niya. As verbalized by the mother. Interpretation: The patient able to move his upper and lower extremities and he can able to get up his head. Patient has already reflexes like palmar grasp, plantar grasp, Moro reflexes, rooting and sucking those reflexes are normal in infant. Analysis: Physical activity is needed for adequate development of fine and gross motor skills in infancy. The focus is on providing only the opportunities for activity, without a need to focus on motivation. As long as infants are meeting developmental milestones and have a stimulating environment that provides opportunity for fine and gross activity, they will use their motor skills, thus enhancing their performance. Time should be provide each day for the infant to reach for objects, freely exercise legs and arms, and increasingly use head control. (Fundamentals of Maternal and Child Nursing Care 2nd edition, Vol.2, chapter 37 page 1073. By PEARSON, London et al) e. Sleep-rest pattern Palagi siyang tulog lalo na nung hindi pa siya nagkakasakit, minsan gigising lang siya para dumidede, ang tulog niya dati mga 13-14 oras sa isang araw. Pero ngayong nagkasakit siya madalas gising siya lalo nat paginu-ubo siya at saka mainit din dito sa hospital, sa bahay katabi ko siyang matulog pero dito hindi kasi walang mahigaan. As verbalized by the mother. Interpretation: The patient sleep pattern before he got sick was good, but now in his condition with acute bronchopneumonia it is difficult for him to have a regular sleep and rest. His environment is one factor of not having a good sleep. Analysis: From birth to 3 months 10-16 hours of sleep daily in about five sleep periods of 30minutes to 3 hours. (Fundamentals of Maternal and Child Nursing Care 2nd edition, Vol.2, chapter 37 page 1076. By PEARSON, London et al) Sleep needs and habits vary greatly among infants, but most require 10 to 12 hours of sleep at night and one or more several naps during the day. Parents are usually advised to let a baby sleep in a separated space rather than in their bed so that the parents do not awaken at every toss and squeak. Other parents prefer to have infants sleep with them in a family bed,

as they believe this practice promotes a feeling of security and also promotes breastfeeding. (Maternal and Child Health Nursing Care 6th edition vol. 2 page.831. By Adele Pillitteri) f. Role-relationship pattern Malapit siya sa akin at sa lola niya, mahal ko ang anak ko kahit hiwalay na kami ng tatay niya. Nakikita ko din na mahal siya ng lola niya. As verbalized by the mother. Interpretation: The patient gets the emotional support from his mother and grandmother. It is good for him to have a good relation with his relatives, especially with his mother because his mother was a single parent and family should establish a good relationship inside their house. Analysis: The family is the primary site where the infant learns to interact with other people. Therefore, family dynamics must be examined during health supervision visits. Some factors in the mental health of the parents directly affect the atmosphere in the home, and the resulting health of the baby. Depression in parents or other family members is an important condition that has the potential to influence the infants health. The desire outcomes for the infant include establishment of close relationships with parents and other family members, a stimulating home environment that is responsive to the babys temperament, and development progression in social interactions. (Fundamentals of Maternal and Child Nursing Care 2nd edition, Vol.2, chapter 37 page 1076. By PEARSON, London et al) g. Sexuality/hygiene pattern Hindi ko siya araw araw pinapaliguan kasi sabi ng nanay ko masama yong araw araw naliligo lalonat sanggol, tuwing ikalawang araw ko siya pinapaliguan. Paghindi ko siya pinaliliguan pinupunasan ko lang siya at nililinis ko din ang ari niya. Ang bibig niya ay kinukuskos ko ng lampin, ang pusod niya din nililinis ko. As verbalized by the mother. Interpretation: The patient hygiene is not properly groomed. Because his mother lack of knowledge about infants hygiene. An infant should be clean all the time because infant can easily acquire disease and their normal floras are not active yet. Analysis: Bathing removes accumulated oil, perspiration, dried skin cells, and some bacteria. It also stimulates circulation and produces a sense of well-being it is refreshing and relaxing and frequency improves morale, appearance, and self-respect. (Fundamentals of Nursing kozier and Erbs 8th Ed. Vol. 1. page 748) h. Value-belief pattern Hindi pa namin siya naihahandog (binyag) kasi masyado pa siyang baby at nagkasakit siya. As verbalized by the mother. Interpretation: The patients religion is Iglesia ni Cristo and according to his mother he need to be baptize as soon as he get well and have financial found for the said occasion. Analysis: For all religions the birth of a child is an important event giving cause for celebration. Many religions have specific ritual ceremonies that consecrate the new child to God. (Fundamentals of Nursing kozier and Erbs 8th Ed. Vol. 2. page 1048)

IV. Activities of Daily Living ADL Nutrition Before Hospitalization The patient is a pure breastfeeding. His appetite in breast milk was good. During Hospitalization The patient appetite during hospitalization is lessen, according to his mother. Interpretation And Analysis Interpretation: The patient appetite before he got sick was good but during his hospitalization it lessens because of his illness. Analysis: Nutritional needs evolve during all of infancy and child hood they support growth and development, and influence the progression of the child along the developmental path. (Fundamentals of Maternal and Child Nursing Care 2nd edition, Vol.2, chapter 37 page 1076. By PEARSON, London et al) Interpretation: The patient decreased bowel movement and voiding frequency because of his condition, he taking medication. Analysis: Frequency of bowel movement varies but ranges from one every 2 to 3 days to as many as 10 daily. Mothers should be counseled that the infant is not constipated as long the bowel movement remains soft. (Fundamentals of Maternal and Child Nursing Care 2nd edition, Vol.1, chapter 26 page 661. By PEARSON, London et al) Interpretation: Patient shows irritable because of his condition but he can still do his usual exercise. Analysis: Exercise is any bodily activity that enhances or maintains physical fitness and Overall health.

Elimination

Bowel: Patient defecates 3x a day usually in the morning, afternoon and evening with yellowish in color. Bladder: patient usually voids 8-9 times a day. Urine is yellow in color.

Patient defecation once a day.

Patient voids 6-7 times with yellowish in color.

Exercise

Patient able to perform exercise by means of sucking his thumb. Moving his upper and lower extremities and he can able to get up his head.

He has same activity but can visualize his face irritable.

Hygiene

Patients take a bath every two days.

During hospitalization just sponge bath.

(Fundamentals of Nursing kozier and Erbs 8th Ed. page 398) Interpretation: Infants should be clean all the time to have a proper hygiene. Analysis: It also stimulates circulation and produces a sense of well-being it is refreshing and relaxing and frequency improves morale, appearance, and self-respect. (Fundamentals of Nursing kozier and Erbs 8th Ed. Vol. 1. page 748) Interpretation: Patient is taking medicine but it should be in proper dosage because overdose dosage can cause other abnormalities. Analysis: medication is a substance administered for diagnosis, cure, treatment, or reliefs of a symptom or for prevention of disease. (Fundamentals of Nursing kozier and Erbs 8th Ed. page 830) Interpretation: Patient sleep and rest decrease from 14 hours to 10 hours a day it shows he disturb his condition. Analysis: Sleep problems develop in early infancy because of colic or because an otherwise healthy infants takes longer than usual to adjust to sleeping through the night. Breastfeed babies tend to awake more often than those are formula fed because breast milk is more easily digested, so infants become hungry sooner. (Maternal and Child Health Nursing Care 6th edition vol. 2 page.833. By Adele Pillitteri)

Substance use

Patient not taking any vitamins.

Patient his taking medicines for his acute broncho pneumonia like ampicilin, sulbactam, gentamicin, paracetamol and salbitamol.

Sleep and rest

He usually sleeps 1314 hours a day.

Due to his condition, patient only sleeps 10 hours a day including his nap.

NORMAL VALUES Blood type Hemoglobin 140-180

HEMATOLOGY FINDINGS Jan.8 Jan.13 Type O+ 116 113 116 Jan.19

INTERPRETATION & ANALYSIS Interpretation: The data shows a decreased hemoglobin and decreased hematocrit,increased white blood cells due to infection and also increased lymphocytes and platelet which is due to a disease process .Neutrophills is at normal range. Analysis: A low hemoglobin count can be associated with many diseases and conditions that cause your body to have too few red blood cells. This can occur if your body produces fewer red blood cells than usual, if your body destroys red blood cells faster than they can be produced or if you experience blood loss.A high number of WBCs is called leukocytosis it may be due to infectious disease and inflammatory disease. Increased lymphocytes produce antibodies and also fight viruses.According to: http://www.mayoclinic.com/hea lth/lowhemoglobin/MY01183/DSECTIO N=causes

Hematocrit WBC count Neutrophills Lymphocytes Platelet

0.40-0.50 5.0-10.0x10 0.30-0.70 0.20-0.40 150-350x10

0.32 12.23X10 0.44 0.56 361X10

0.34 15.96X10 0.44 0.56 609X10

0.32 12.23X10 0.44 0.56 361X10

URINALYSIS NORMAL VALUES FINDINGS January 10,2012 Yellow INTERPRETATION & ANALYSIS Interpretation: The data shows that the color,transparency,specific gravity,are at normal range.There is no presence of glucose and protein in the urine which is

Color

Yellow-amber

Transparency Specific Gravity

Transparent 1.010-1.025

Clear 1.010

Reaction Protein

Acidic Negative

Alkaline Negative

Glucose

Negative

Negative

normal,However RBC is in the normal range while there is an increase white blood cells due to infection. Analysis: White blood cells help fight infection through a process known as 'phagocytosis' wherein they surround the foreign organisms and then destroy it. Along with fighting infection, white blood cells also help produce, transport and distribute antibodies to build the body's immune system. According to: http://www.buzzle.com/articles/highwhite-blood-cell-count.html

Blood RBC WBC

0-1 hpf 0-2 hpf

0-1 hpf 1-4 hpf

ARTERIAL BLOOD GAS NORMAL VALUES FINDINGS JAN.8 PH 7.35-7.45 7.37 JAN.13 7.40 Interpretation: On January 8 the patients ABG is normal while on January 13 the patients ABG is Compensated Metabolic Alkalosis because the bicarbonate increased to normalize the pH. Analysis: Metabolic alkalosis is a primary increase in serum bicarbonate (HCO3-) concentration. This occurs as a consequence of a loss of H+ from the body or a gain in HCO3-. In its pure form, it manifests as alkalemia (pH >7.40). As a compensatory mechanism, metabolic alkalosis leads to alveolar hypoventilation with a rise in arterial carbon dioxide tension (PaCO2), which diminishes the change in pH that would otherwise occur. http://emedicine.medscape.com/article/243160overview INTERPRETATION & ANALYSIS

PCO2 PO2 HCO3

35-45 mmHg 80-100 mmhg 22-26

41.5 110.2 23.5

42.6 94.5 26.1

B.E O2SAT

mEq/L 96-100%

-1.7 97.9

1.1 97.2%

DATE January 11,2012

BLOOD CULTURE AND SENSITIVITY FINDINGS INTERPRETATION & ANALYSIS Interpretation: No growth after 3 days Both on January 11 and 13,there is no growth of of incubation bacteria in the blood culture and sensitivity. No growth after 5 days of incubation Analysis: If the blood culture sets are both negative, (often reported as "no growth"), the probability that a person has sepsis caused by bacteria or yeasts is low. Some microorganisms are more difficult to grow in culture, and additional blood cultures using special nutrient media may be done to try to grow and identify the pathogen. According to: http://labtestsonline.org/understanding/analytes/bloodculture/tab/test

January 13,2012

VII. PHYSICAL ASSESSMENT

General appearance Nutritional status

Norms Breastfeeding Formula milk Vitamins

Actual findings Exclusive breastfeeding

Interpretation & Analysis Interpretation: The client gets proper nutrition through his mothers milk. Analysis: Breast feeding is the preferred feeding method for newborns, because it supplies antibodies as well as nutrients. (Maternal and Child Health Nursing by Adele Piliteri vol.1 6th ed page 507) Interpretation: The client is considered as neonate. Analysis: Babies are considered neonates from birth to the end of the first month. Infants are babies from 1 month to 1 year of age. (Fundamentals in

Age appropriateness

Birth to end of first month

1 month old

Verbal behavior

Crying

Crying

Non-verbal behavior

Facial expressions

Facial expression Smiling

Nursing by Kozier and Erb vol.1 8th ed page 368) Interpretation: The clients express his feelings through crying, for example when he is hungry he cries. Analysis: Crying is their initial reaction to stress, and the major way they communicate stress. (Fundamentals in Nursing by Kozier and Erb vol.1 8th ed. page 371) Interpretation: Aside from crying the clients also express his self through facial expression. Analysis: Feelings of surprise, fear, anger, disgust, happiness, and sadness can be conveyed by facial expressions. cc464)

Measurements Vital signs Temperature Norms 37.2 C Actual findings Interpretation and analysis Interpretation: Normal temperature Analysis: The temperature of newborns is about 99F (37.2C) (Maternal and Child Health Nursing by Adele Piliteri vol.1 6th ed. Page 450) Interpretation: Normal pulse rate Analysis: Normal range by age is 80 180 bpm. (Fundamentals in Nursing by Kozier and Erb vol.1 8th ed. Page 538) Interpretation: Normal respiration rate Analysis: Normal range by age is 30 80 breaths per minute. (Fundamentals in Nursing by Kozier and Erb vol.1 8th ed. Page 538) Interpretation: Analysis:

Pulse rate

80 180 bpm

Respiration rate

30 80 breaths per minute

66 cpm

Weight

Male: 3.5kg (7.7lb)

3.8 kg

Height Head circumference

Male: 54cm (21.3in) 34 35cm (13.5 14in)

48 cm 37 cm

Interpretation: Analysis: Interpretation: Analysis:

REFLEXES Reflexes Rooting reflex Norms Stroke the side of the face near mouth; infant opens mouth and turns to the side that is stroked. Actual findings + 2 normal response Interpretation and Analysis Interpretation: When the mother holds the child and allows her breast to brush the babys cheek, the reflex makes the baby turn toward the breast. Analysis: The reflex serves to help a newborn find food. (Maternal and Child Health Nursing Vol. 1 6th Ed. Page 454) Interpretation: When the babys lips are touched, the baby makes a sucking motion. Analysis: The reflex help a newborn find food. (Maternal and Child Health Nursing Vol. 1 6th Ed. Page 454 ) Interpretation: The baby grasp the finger placed in his palm. Analysis: Newborns grasp an object placed in their palm by closing their fingers on it. (Maternal and Child Health Nursing Vol. 1 6th Ed. Page 454) Interpretation: Analysis: The reflex simulates the action of someone trying to ward off an attacker, then covering up to protect himself. (Maternal and Child Health Nursing Vol. 1 6th Ed. Page 456) Interpretation: Positive babinski sign (toes fan) Analysis: This reaction occurs because nervous system development is immature. (Maternal and Child Health Nursing Vol. 1 6th Ed. Page 456)

Sucking reflex

Place nipple or finger 3 to 4 cm into the mouth; infant sucks vigorously.

+ 2 normal response

Palmar grasp reflex

Place finger in infants palm and press; infant curls fingers around.

+ 2 normal response

Moro reflex

Loud noise or unexpected movement; infants spreads arms and legs, extending fingers, then flexes and brings hands together; may cry. When the sole of the foot is stroked in an inverted J curve from the heel upward, a newborn fans the toes (positive Babinski sign )

+ 2 normal response

Babinski reflex

+ 2 normal response

Stepping reflex

Hold infant as if weight bearing on surface; infant steps along, one foot at a time.

+ 2 normal response

Interpretation: The baby steps alternately. Analysis: Newborns who are held in a vertical position with their feet touching a hard surface will take a few quick, alternating steps. (Maternal and Child Health Nursing Vol. 1 6th Ed. Page 455)

Course in the Ward: Date Upon admission January 8,2012 3:10 pm Physicians note Patient stayed in the ward for 4 days the following medication under most nebulization had checking improvements,physician ordered ampicillin,paracetamol and Gentamycin.

January 8, 2012 3:10 pm Weight: 3.8 kg

Patient admitted to pedia ward Monitored Vital sign q2 hrs and record NPO Monitored I and O every shift and record Diagnosis: CBC CXR Urinalysis ABGs Therapeutics: IVF D5 IMB at 15-16 gtts/min. Start Ampicillin Subactam, 9.5Gentamycin nebulization Continued monitoring Breastfed with some aspiration precaution Continued medication WOF: respiratory distress

January 9, 2012 11:10 am Ampicillin Gentamycin January 10, 2012 9:30 am Weight: 3.8 kg (+) retraction Ampicillin Gentamycin

January 11, 2012 10:30 am Weight: 3.8 kg Ampicillin

nebulization to q8 hr Continued feeding with some aspiration precaution

January 12, 2012 2:10 pm Weight: 3.8 kg Ampicillin Sulbactam January 13, 2012 12:00 pm Weight: 3.8 kg O2 support January 14, 2012 (+) DOB January 15, 2012 (-) seizure (+) distressing cough January 16, 2012 9:00 am Ampicillin Gentamycin January 17, 2012 11:50 am Ampicillin Gentamycin January 18, 2012 Ampicillin Gentamycin January 19, 2012 Ampicillin Gentamycin January 20,2012 9:25 pm Weight; 3.8 kg

Consumed IV medication prior to discharge

Continued Ampicillin Still NPO

Continued monitor Still NPO O2 inhaled nasal canula Continued medication

nebulization to q12 hrs Continued medication

Monitored nebulization Continued monitor Repeated CBC Continued medication nebulization Continued monitor

VIII. PATHOPHYSIOLOGY Precipitating Factor Immune Deficiency Etiologic Agent Unknown Bacteria Predisposing Factors Age ( 1month)

Inhalation of droplet nuclei

Upper respiratory Tract

WBC

Lower Respiratory tract

12. 23 X 109/L

Invasion of lung parenchyma


Inflammatory process phagocytosis

prostaglandin synthesis
Histamine

Lymphocytes
0.56

Dilatation of BV Neutrophil Endotoxin production


0.44

Destruction of alveoli

Inflammation
Produces mucopurulent secretions

Crackles heard at right lower lobe

Hypersecretions of mucus expectorant of microorganisms as infection progresses

sputum production

cough

cyanosis

SOB

use of accessory muscle

use of subternal muscle

yellowish in color

pleuritic pain

tachypnea

irritable

RR: 66cpm

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