Pair Ppaedresentation
Transcript of Pair Ppaedresentation
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MDJ3272
PAEDIATRIC NURSING
Question 5: Child Abuse
(Group C1)Dg Noraini Binti Tajudin (26172)
Shilla Binti Kilipus (25009)
MDJ 3282 Paediatric Nursing
PracticumBronchopneumonia
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Outline of Presentation Definition Sign and symptoms Risk factor Summary of patients history
Pathophysiology Investigation Complications Medical managements Nursing care plan
Patients education during discharge Conclusion References
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Bronchopneumonia
(Bronchial pneumonia )
Inflammation of the lungs beginnings in the
terminal bronchioles
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Sign and symptoms
CoughFever
Chest pain
Rapid, shallow breathingSOB
Headache
Loss of appetiteFatigue(less active)
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Risk factors
Congenital oracquired
immunodeficiency
PrematurityMalnutrition and
metabolic
derangement
Intubation and
tracheostomy
CNS depression
( inhibit coughand gag reflex)
Viral infection
predisposebacterial infection
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Sources of information : Pts mother, case notes Q,1 year 4 month (2nd child of two siblings),malay girl from
Kota Samrahan, Kuching
Comes to A&E Cuddled by his mother, weight: 6.29kg
Mother: Housewife (20 y/old) Father: Fisherman (25y/old)
1st hospitalization( August 2011)
Date of admission:7/12/12(2nd hospitalization)
Past surgical history: none Allergies: no known allergies to medication, food
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Reasons for hospitalization:
c/o:Fever 5/7, cough 5/7,less active ,rhinorrhea ,vomit x 1
after milk, tachypneic ,poor oral intake
Past medical history: premature @24/52(admitted into NICU
and was intubated),Failure to thrive, chronic lung disease,
ROP(resolved by laser therapy), resolved bilateral IVH with
hydrocephalus
Birth history: SVD, premature baby(24th week),birth
weight:695 gram
Immunization history: up to date, given palvizumab(X 4)
latest on 21/3/12 Developmental/growth pattern:weight:6.18 kg, able to sit
alone, stand with support, able to call mama, haspalmar
grasp
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Physical examination
General condition: less active, weak, irritable, difficult toapproach
Weight:6.18kg(on assessment)
V/sign:temperature:36.5 Celsius(axila),HR:124/min,RR:44/
min,Spo2:97% Oxygen 0.5L/min Lung examination: Bilateral lung crepitation,
rhonchi,subcostal and substernum recession.
Chest examination: pectus carinatum(pigeon chest)
*Medical Diagnosis: Bronchopneumonia
KIV D/C ON 22/12/2012
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Functional health pattern
Health Perception-Health Management Pattern
Parents verbalized their worries regarding child condition This is second time admitted
Admitted due to c/o:Fever 5/7, cough 5/7,less active ,rhinorrhea
,vomit x 1 after milk, tachypneic,poor oral intake
Previously well and active playing at home Child was on MDI ventolin(prn) and beclomethasone (BD)
using aerochamber (mother know how to use)
Nutritional and Metabolic Pattern
Dietary history's: B/F stopped at 3months of age, currentlygiven bottle feeding 5-6oz ,4-6hly(lactogen),semisolid food(6-9
teaspoon),porridge
Poor oral intake during sick, coughing during bottle feeding
causing vomiting
Was supplied with folic acid and multivitamin9
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Elimination Pattern
BO X 1-2/day with normal color and consistency of stool,
PU (3-4 X diapers changed) with normal color urine
Activity and exercise pattern
Active playing toys at home, wathcing tv(cartoon)
Bathing time: morning and evening
Sleep-Rest Pattern
No problem of insomnia,Usually sleep 8pm-6am,sleeping with
parents
Day sleeping(11am-2pm) initiates by bottle feeding
Sleep position: knee-chest position(longer),supine(shortly)
Cognitive-Perceptual Pattern
Child alert, responsive,irritable
Anxiety,fear to nurse
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Sensory-pattern
Hearing ,vision normal, all other sensory intact(touch,taste, smell)
Coping stress
If child upset and tired/sleepy she will cry more
Role Relationship Pattern
24 hour taken care by her mother
childs play companion :cousins Support system: parents
Stay with mother ,father ,grandfather and grand mother
sexuality
2nd child of 2 siblings Sister 4 years old
Value belief pattern
muslim11
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Pathophysiology
Microorganism
enter alveolarSpaces by droplet
inhalation(EtiologicAgent:bacteria,virus
,fungi)
Inflammation
occurs
Alveolar fluidincrease
Ventilationdecreases as
secretion thicken
Bronchopneumonia
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I nvestigation Chest X-ray : Right perihilar haziness -connection between
the mediastinum and the pleural cavities meet
Hematology report (abnormal)
a) Full blood count - Hb low(IDA)b) Differential count -Monocytes high ,neutrophils low
12 lead ECG
Normal reading (To look out for spreading of disease to heart)
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Complications*Empyema or lung abscesses - cavity containing pus
*Septic shock. Blood fills the veins and leaks through the walls ofthe capillaries, causing uncontrolled tissue swelling and possiblyorgan failure, which can lead to death
*Pleuritis. Inflammation of the pleura
*Bronchiectasis -airways that are inflamed and collapsible
*Reactive airways disease - persistent asthma
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Medical management
A) Syrup Erythromycin Ethylsuccinate 140mg BD
Actions: Treat upper and lower respiratory tract infections
Indication: Bronchopneumonia
Cautions: Impaired hepatic function, renal impairment
Side effects: Nausea, upper stomach pain, loss of appetite
Drug interactions: Verapamil , digoxin, oral anticoagulant
B) Syrup folic acid 1mg OD
Actions: To treat vitamin deficiencies
Indication: As a supplement where a poor dietary intake
Cautions: Take with or without food , allergies to contents Side effects: Diarrhea, nausea, itchiness, dizziness, allergic reaction
Drug interactions: -
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C) Syrup multivitamin 2.5ml OD
Actions: To treat vitamin deficiencies
Indication: As a supplement where a poor dietary intake
Cautions: Allergic to the contents
Side effects: Diarrhea, nausea, dizziness
Drug interactions: -
D) Syrup Prednisolone 6mg OD
Actions: To treat asthma
Indication: Child have asthma
Cautions: Take with food, allergic to the contents, eye disease,heart problems, kidney disease
Side effects: Nausea, headache, dizziness, increased sweating
Drug interactions: Aspirin, nonsteroidal anti-inflammatory drugs
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E) IV Augmentin 140mg BD
Actions: To treat bacterial infections
Indication: Broncopneumonia Cautions: Blood disorders, kidney problems, liver disease
Side effects: Diarrhea, nausea, itching, dizziness
Drug interactions: Probenecid
F) Metered dose inhaler (MDI) Salbutamol 100 mcg 8 hourly Actions: To relieve and prevent bronchospasm
Indication: Bronchopneumonia
Cautions: Allergy to contents, cardiac arrhythmia ,cardiovascular
disorders Side effects: Headache, nausea, dizziness
Drug interactions: Do not used with some beta-blockers (e.g.
propranolol) , other bronchodilators (e.g. terbutaline) and digoxin
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G) Metered dose inhaler (MDI) Beclomethasone 100 mcg BD
Actions: To treats inflammation Indication: Bronchopneumonia
Cautions: Allergic to the contents, heart problems, stomach
problems
Side effects: Headache, nausea, dizziness, upset stomach Drug interactions: Diltiazem, aspirin
H)Close monitoring of oxygen saturation
Keeps SPO2 > 95 % to prevents hpoxia ( NPO2 0.5 L/min)
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Lists of Nursing Care Plan
1) Ineffective airway clearance related accumulation ofsecretion(narrow airway) and inflammation of airwaysecondary to bronchopneumonia evidenced bytacypnea,RR:44,bilateral rhonci, generalized lungcrepitation, substernal and subcostal recession
2) Imbalanced nutrition less than body requirement relatedto poor oral intake, loss appetite, and coughingevidenced by weight loss (from 6.29kg -6.18 kg),lessactive and weak
3) Parental anxiety related to lack of knowledge about thedisease , prognosis , and treatment evidence by facialexpression and verbalization of worries by parents
4) Risk for nosocomial infection related to hospitalization19
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Nsg diagnosis : Ineffective airway clearance related to accumulation of
secretion (narrow airway) and inflammation of airway secondary to
bronchopneumonia as evidenced by tachypnea, RR:44, bilateral
rhonci, generalized lung crepitation, substernal and subcostal
recession
Goal: Patient will not having respiratory distress as evidence by RR within
normal range(24-40),minimal rhonci ,less substernal , subcostal recession
,coughing and spo2 >95% within 4 days (17/12/12 @ 11 am)
Intervention:
1) Assess the RR ,pattern, depth of respiration to identify any sign of
respiratory distress
2) Position the child in a propped up position to enhance lung expansion for
effective breathing
3) Administer oxygen 0.5 L/min via nasal prong to prevent respiratory
distress and to ensure patient receive adequate oxygenation (prevent
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4) Administer MDI Salbutamol 100mcg (2puffs,8hly) as a bronchodilator
to prevent respiratory muscle spasm and Beclomethasone 100mcg
(2puffs,BD) , Syrup Prednisolone 6mg OD to reduce the inflammation on
respiratory tract5) Watch out and explain to the parents about side effect of salbutamol and
Beclomethasone (eg: tachycardia, headache,N/V, tremors, nasal
dryness/irritation) so parents will understand more and can report as soon
if this side effect need an urgent intervention from nurses/doctor
6) Do suction via nasal when necessary to help remove the secretion out7) Encourage caregiver to give more fluid to the child to help moisten the
secretion
8) Monitor RR, SPO2 readings, breathing pattern, presence of recession
during breathing after each therapeutic intervention to evaluate the
effectiveness of the intervention
Evaluation: Patient not having respiratory distress as evidence by
comfortable, active with RR :38,less coughing ,less rhonchi and less
crepitations on lungs, spo>97% under N/P 0,5L/Min (21/12/12@11 am)21
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4) Teach caregiver to give food when child are relax, not crying ,after
enough rest and dont force child to eat if she refuse to ensure
cooperation from the child to eat
5) Provide a pleasant environment during her mealtime (eg: music,
conversation, be on her side ) and provide support to enhance her mood
to eat
6) Administer Syrup multivitamin 2.5ml OD, Syrup folic acid 1mg OD as
a dietary supplement for the child that she need for her growth and
development.
Evaluation: Patient able to maintain balance nutrition as evidence by no loss
of weight ,good tolerance to oral intake, appear energetic, active (willing to
play),and regain an appetite to eat (19/12/12 @ 11 am)
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Nsg diagnosis: Parental anxiety related to lack of knowledge about the
disease , prognosis , and treatment as evidence by facial expression
and verbalization of worries by parents
Goal: Parents will feel less anxiety during hospitalization as evidence by
verbalized, understand about the disease , prognosis , and treatment and
cheerful facial expression within 2 days (17/12/12 11am )
Intervention:1) Assess the S/S of having anxiety (eg:anger, denial ,refuse to answer
question )
2) Assess their level of anxiety and identify the other potential cause that
make them anxious to carry out appropriate intervention(eg: financial
problem)3) Assess their level of understanding regarding disease condition,
treatment ,prognosis to make sure information to be delivered to them
are according to their needs
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4) Provide and give information about their child condition, treatment and
prognosis using simple language(avoid medical jargon) to promote
understanding5) Collaborate and allow parents to participate in decision making and
procedure so they feel less anxious and more cooperative
6) Discuss the choices of treatment with parents ,so they wont feel hopeless
that will worsen their anxiety
7) Encourage parents to ask question and reply them with a calm andunhurried manner so they wont feel helpless
Evaluation: Parents have more understanding about their child's condition
,prognosis and treatment as evidenced by ability to explain when been
asked to explain by nurses, appear less anxious and having cheerfulfacial expression (19/12/12 @ 11 am )
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Patients education during discharge
-Teach mother and family importance of hand washing before touch the child
-Counsel parents regarding the need to prevent exposure to tobacco smoke,
allergens
-Educate parents about signs & symptoms of increasing respiratory distress (seek
medical attention immediately)
-Drink plenty of fluids to prevent dehydrated and help loosen mucus in their
lungs.
-Take all prescribed medications.
-Keep all of child follow-up appointments to monitor condition of lungs
-Stay rested and sleep well. Proper rest and enough sleep can help keeps immune
system strong
-Eat a healthy diet. Include plenty of fat-free dairy products,protiens, fruits,
vegetables and whole grains.
-Teach mother about the medication (name, how to used, side effect, cautions) to
prevent from wrong medication given
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Conclusion
Overall pts general conditions wasimproved
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References
Aschenbrenner, D. S., & Venable, S. (2009). Drug Therapy in Nursing. Retrieved December
17, 2012, fromhttp://books.google.com.my/books?id=5zd_W_PUwvYC&pg=PA929&dq=medication+
used+to+treat+Bronchopneumonia++in+children&hl=en&sa=X&ei=LYXUUKqCCYGS
rgfa3YGQCQ&redir_esc=y#v=onepage&q=medication%20used%20to%20treat%20Bro
nchopneumonia%20%20in%20children&f=false
Datta, BN. (2004). Textbook of Pathology . Retrieved December 17, 2012, fromhttp://books.google.com.my/books?id=3eycgFfYpBAC&pg=PT246&dq=Bronchopneum
onia&hl=en&sa=X&ei=83_UUPP2DITMrQeu7YDoCw&redir_esc=y
Dorlands Pocket 28th ed Medical Dictionary.(2011).Phildelphia:Elsevier
Health care medical soweto trust.(2005) . Primary clinical care manual. Retrieved December
17, 2012, from
http://books.google.com.my/books?id=zrGHXbW07vQC&printsec=frontcover#v=onepa
ge&q&f=false
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Lange, S. , & Walsh, G. (2002). Radiology of Chest Diseases. RetrievedDecember 17, 2012, fromhttp://books.google.com.my/books?id=3E_byg7VxrsC&pg=PA65&dq=Bronchopneumonia&hl=en&sa=X&ei=83_UUPP2DITMrQeu7YDoCw&redir_esc=y#v=onepage&q=Bronchopneumonia&f=false
Moeckel, E., & Mitha, N. (2008). Textbook of pediatric osteopathy.Retrieved December 17, 2012, fromhttp://books.google.com.my/books?id=Y9Dpcqr7PZMC&pg=PA302&dq=Bronchopneumonia+treatment+in+children&hl=en&sa=X&ei=poHUUNiNLMLirAe_tIDYAg&sqi=2&redir_esc=y#v=onepage&q=Bronchopneumonia%20treatment%20in%20children&f=false
Tessa, M., Ohansson, W.E., & Hodge, J. (2006) . Pneumonia: TheForgotten Killer of Children. Retrieved December 17, 2012, fromhttp://books.google.com.my/books?id=F_vhfZ8EFAoC&pg=PA9&dq=medication+used+to+treat+Bronchopneumonia++in+children&hl=en&sa=X&ei=LYXUUKqCCYGSrgfa3YGQCQ&redir_esc=y#v=onepage&q=medication%20used%20to%20treat%20Bronchopneumonia%20%20in%20children&f=false
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ThankYou..
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