PRECEPTOR :

dr. Ulynar Marpaung, SpA

BY :
Ivan Nugraha (1102010134)

Bronchopneumonia
Clerkship of Pediatrics Department
Faculty of Medicine YARSI University
Police Hospitals, Bhayangkara Tk.I Raden Said
Sukanto
 Name : G.R.A
Birth Date : March, 11th 2016
Age : 10 months old
Gender : Female
Address : Lubang Buaya, East Jakarta
Nationality : Indonesia
Religion : Moeslem
Date of admission : January, 10 th
2017
Date of examination : January, 12 th
2017

PATIENTS IDENTITIY
 PATIENTS PARENT
IDENTITY
Father Mother
Name Mr. A Mrs. N

Age 30 years old 28 years old

Job Security Housewife

Nationali Indonesian Indonesian

ty
Religion Moslem Moslem

Educatio High School High School

n
Address Jl. Makmur RT 002/007 No 51, Lubang Buaya East
Jakarta
 N G
A KI
T
Y anamnesis was taken on January 12 2017, by
OR st

I S T alloanamnesis (from patients mother)

H Chief Complaint

High fever and cough with

mucous since 7 days before
admission
Additional Complaints

Breathless since 2 days before

admission
 HISTORY
TAKING
Fever and cough
(7 days)
Went to puskesmas
High fever (6 days)
Breathless
Tested with digital (2 days)
thermometer 39,1 C, and
ever reach normal Went to 24 hours clinic,
temperature with the doctor gives Breathless with retraction
paracetamol but soon it paracetamol and in epigastrium
gets high again later ambroxol but hes not
Cough and sounds theres getting better
a mucous when cough
 Pharyngitis/Tonsilitis -
Bronchitis -

OF Bronchopneumonia -

RY SS Morbilli -

T O NE Pertussis -

I S
H TI L L Varicella
Diphteria
-
-
S
PA
Malaria -
Polio -
Enteritis -
Bacillary Dysentry -
Amoeba Dysentry -
Diarrhea -
Thypoid -
Worms -
Surgery -
Brain Concussion -
Fracture -
Drug Reaction -
Mothers She routinely checked her
condition to the nearest health
pregnan care center
No problems or diseased were

cy noted during her pregnancy

She took routine pills and

history
vitamins given by the health
associates

Labor : Clinic
Birth attendants : Doctor

Child

Mode of delivery : pervaginam
Gestation : 38 weeks

birth
Infant state : healthy
Birth weight : 2400 grams
Body length : 47 cm

history According to the mother, the

baby started to cry and the
baby's skin is red, no congenital
defects were reported
 First Dentition: 6 months

Conclusion: good motor development status

Crawlin
Sitting g
Speech 6 8
months months
Prone 5
Slant 5 months
Smile 2,5 months DEVELOPMENT
1 months HISTORY
months
Childs Eating
History
Breast Milk : Exclusively
until now
Fruit and vegetables :
Biscuits regal
Solid foods and side
dishes : Banana, Orange
IMMUNIZATION HISTORY
 PHYSICAL
EXAMINATION
General Status
General condition: Mildly ill
Awareness : Compos Mentis
Pulse : 128 x/min, regular, full,
strong
Breathing rate : 70x/min
Temperature : 37,7oC (per axilla)

Weight : 8 kg
Height : 72 cm
ANTROPOME
TRY
WFA (Weight for Age):
8 / 9,5 x 100 % = 84
% (Normal)
HFA (Height for Age):
72/73 x 100 % = 98 %
(Normal)
WFH (Weight for
height): 8/12 x 100%
= 67% (Bad)

CONCLUSION : the
patient has bad
nutrition status
 HEAD TO TOE
EXAMINATION
Head
Normocephaly, hair (black, normal distributon, not easily lifted
) sign of trauma (-), sunken fontanelle (-)
Eyes
Icteric sclera -/-, pale conjunctiva -/-, hyperaemia conjunctiva
-/- , lacrimation (-), swollen eyes (-), direct and indirect light
response ++/++
Ears
Normal shape, no wound, no bleeding ,no secretion or
serumen
Nose
Normal shape, midline septum, secretion -/-
Mouth
Lips : moist, Teeth: broken teeth, Mucous: moist, Tongue: Not
dirty, Tonsils: T1/T1, hyperemia (-), Pharynx: hyperemia (+)
Neck
Lymph node enlargement (-), scrofuloderma (-)
Thorax :
Inspection : symmetric when breathing , epigastrium retraction,
ictus cordis is not visible
Palpation : mass (-), tactile fremitus +/+
Percussion : sonor on both lungs
Auscultation
Cor : regular S1-S2, murmur (-), gallop (-)
Pulmo : vesicular +/+, Wheezing -/- , Rhonchi +/+

Abdomen :
Inspection : mass (-), scar (-)
Palpation : liver and spleen not palpable, fluid wave (-)
Percussion : shifting dullness (-)
Auscultation : normal bowel sound, bruit (-)

Vertebra
Theres does not appear scoliosis, kyphosis, and lordosis, do not look
any mass along the line of the vertebral

Ekstremities
warm, capillary refill time < 2 second, edema (-)
 INITIAL LABORATORY EXAMINATION
January 10st 2017

Hematology Result Normal Value

Haemoglobin 10,8 g/dL 12-14 g/dL
Leukocytes 8.400 u/L 5000-10.000 u/L
Hematocrits 31% 40 48 %
Trombocytes 325.000/ L 150.000
400.000/ L
Thorax Rontgen

Right and left hilus rough

Cor, sinus & diaphragma
normal
Bone and soft tissue
normal

Impression :
Bronchopneumonia
WORKING DIAGNOSIS

Bronchopneumo
nia
 MANAGEMENT
IVFD RL 800 ml/24 jam
Inj. Cefotaxime 2 x 400 mg IV
P.O Paracetamol drop 3 x 0,8 cc
P.O Ambroxol syr 3 x 0,4 cc
Inhalation ventolin : NaCl 0,9%
2cc/ 8 hours
 FOLLOW UP Hospitalization day 1
(10/01/2017)

S:
Fever (+) Cough (+), Mocous (+) Breathless (+)
O:
Compos mentis
Pulse: 120x/min strong regular; Temperature: 38,0 C, Respiratory
rate: 50x/min
Eyes: pale conjunctiva -/- , sclera icteric -/-
Mouth: dry lips, mucous moist, T1/T1, Pharynx : Hiperemia (+)
Pulmonary: epigastrium retraction (+), vesicular +/+;
rhonchi +/+, wheezing -/-
Cardio: S1/S2 reguler, no murmur, no gallop
A:
Extremities: warm, pallor (-)
BronchoBronchopneumonia
P:
IVFD RL 800 ml/24 jam
Inj. Cefotaxime 2 x 400 mg IV
P.O Paracetamol drop 3 x 0,8 cc
P.O Ambroxol syr 3 x 0,4 cc
Inhalation ventolin : NaCl 0,9% 2cc/ 8 hours
Fasting
VIDEO
FOLLOW UP Hospitalization day 2
(11/01/2017)
Laboratory Investigation
UrineJ anuary 11st 2017 (RS POLRI)
Urine Results Normal Value

Colour Yellow

Clarity Slightly Cloudy

pH 6.0 5 8.5

Etc. Bactery +
FOLLOW UP Hospitalization day 3
(12/01/2017)
Bronchopneumo
nia
 DEFINITION
Bronchopneumonia is a form of acute respiratory
infection that affects the lungs. The lungs are
made up of small sacs called alveoli, which fill
with air when a healthy person breathes. When
an individual has Bronchopneumonia, the alveoli
are filled with pus and fluid, which makes
breathing painful and limits oxygen intake.
(WHO, 2015)
 EPIDEMIOLOGY
Bronchopneumonia is the single largest infectious cause of death in children
worldwide. Bronchopneumonia affects children and families everywhere, but
is most prevalent in South Asia and sub-Saharan Africa.
ETIOLOGY
 TRANSMISSION
Bronchopneumonia can be spread in a number of ways.
The viruses and bacteria that are commonly found in a
child's nose or throat, can infect the lungs if they are
inhaled. They may also spread via air-borne droplets from
a cough or sneeze. In addition, Bronchopneumonia may
spread through blood, especially during and shortly after
birth
RISK FACTORS
Four stages of lobar
Bronchopneumonia
 &
GN MS
S I O
P T
M
SY
 Severity of
Bronchopneumonia (WHO)
Bronchopneumonia / non severe
Bronchopneumonia
- Cough
- Problems with breathing
- Tachypnoe
- No sign of severe Bronchopneumonia present

Severe Bronchopneumonia
Sign of Bronchopneumonia & >1
- Lower chest wall indrawing
- Nasal flaming
- Expiratory grunting
- No sign of very severe
Bronchopneumonia
Very severe Bronchopneumonia
Sign of severe Bronchopneumonia & >1
- Inability to feed
- Cyanosis
-Severe respiratory distress
- Impaired consciousness or convulsions
 DIAGNOSIS
Physical Examination Additional Test

1. Blood culture
1. Breathing
2. Sputum
difficulties
3. Nasopharynge
2. Crackles
al aspiration
3. Wheezing
4. Serological
4. Fever
testing
CHEST RADIOGRAPHY

Alveolar consolidations
in the left lower lobe
and in the right lower
lobe.
TREATMENT
 Initial empirical treatment based
on age and severity of
Bronchopneumonia

Age Outpatients Inpatients Inpatients

(Mild to (Moderate) (Severe)
Moderate)
3 6 months Amoxicillin with or Ceftriaxone or Ceftriaxone or
without clavulanate cefotaxim cefotaxime
Erythromycin + vancomycin

6 months 5 Amoxicillin with or Ceftriaxone, Ceftriaxone or

without clavulanate cefotaxime, cefotaxime
years Erythromycin or + macrolide +
Cefuroxime + vancomycin
macrolide

5 -18 years Macrolide

Ceftriaxone or
Ceftriaxone or
cefotaxime
cefotaxime + macrolide +
+ macrolide vancomycin
 COMPLICATIONS
Pulmonary
Pleural Effusion or
Metastatic
empyema
Meningitis
Pneumothorax
Pericarditis
Lung abscess
Endocarditis
Bronchopleural
Osteomyelitis
fistula
Septic arthritis
Acute respiratory
failure
PREVENTION
 PROGNOSIS

Overall, the prognosis is good. Most cases

of viral Bronchopneumonia resolve without
treatment, common bacterial pathogens
and atypical organisms respond to
antimicrobial therapy
 TAKE HOME MESSAGE
Bronchopneumonia is the single largest
infectious cause of death in children
worldwide
If theres a fever, cough and breathless
consider its Bronchopneumonia until
proved with chest radiography it wasnt.
Give appropriate treatment as soon as
possible to prevent Bronchopneumonia
become more severe.