INTRODUCTION

Pneumonia is an inflammation of the lungs caused by an infection. It is also

called Pneumonitis or Bronchopneumonia. Pneumonia can be a serious
threat to our health. Although pneumonia is a special concern for older
adults and those with chronic illnesses, it can also strike young, healthy people
as well. It is a common illness that affects thousands of people each year in
the Philippines, thus, it remains an important cause of morbidity and mortality
in the country.
There are many kinds of pneumonia that range in seriousness from mild to
life-threatening. In infectious pneumonia, bacteria, viruses, fungi or other
organisms attack your lungs, leading to inflammation that makes it hard to
breathe. Pneumonia can affect one or both lungs. In the young and healthy,
early treatment with antibiotics can cure bacterial pneumonia. The drugs used to
fight pneumonia are determined by the germ causing the pneumonia and
the judgment of the doctor. It’s best to do everything we can to prevent
pneumonia, but if one do get sick, recognizing and treating the disease early
offers the best chance for a full recovery.
A case with a diagnosis of Pneumonia may catch one’s attention, though the
disease is just like an ordinary cough and fever, it can lead to death especially
when no intervention or care is done. Since the case is a toddler, an
appropriate care has to be done to make the patient’s recovery faster.
Treating patients with pneumonia is necessary to prevent its spread to
others and make them as another victim of this illness.

ANATOMY AND PHYSIOLOGY

The lungs constitute the largest organ in the respiratory system. They
play an important role in respiration, or the process of providing the body
with oxygen and releasing carbon dioxide. The lungs expand and contract up
to 20 times per minute taking in and disposing of those gases.
Air that is breathed in is filled with oxygen and goes to the trachea, which
branches off into one of two bronchi. Each bronchus enters a lung. There are
two lungs, one on each side of the breastbone and protected by the ribs.
Each lung is made up of lobes, or sections. There are three lobes in the right
lung and two lobes in the left one. The lungs are cone shaped and made of
elastic, spongy tissue. Within the lungs, the bronchi branch out into minute
pathways that go through the lung tissue. The pathways are called
bronchioles, and they end at microscopic air sacs called alveoli. The alveoli
are surrounded by capillaries and provide oxygen for the blood in these
vessels. The oxygenated blood is then pumped by the heart throughout the
body. The alveoli also take in carbon dioxide, which is then exhaled from the
body.
Inhaling is due to contractions of the diaphragm and of muscles between the
ribs. Exhaling results from relaxation of those muscles. Each lung is
surrounded by a two-layered membrane, or the pleura, that under normal
circumstances has a very, very small amount of fluid between the layers.
The fluid allows the membranes to easily slide over each other during
breathing.

PATHOPHYSIOLOGY

Pneumonia is a serious infection or inflammation of your

lungs. The air sacs in the lungs fill with pus and other liquid. Oxygen has
trouble reaching your blood. If there is too little oxygen in your blood, your
body cells can’t work properly. Because of this and spreading infection
through the body pneumonia can cause death. Pneumonia affects

your lungs in two ways. Lobar pneumonia affects a section (lobe)

of a lung. Bronchial pneumonia (or bronchopneumonia) affects patches
throughout both lungs.
Bacteria are the most common cause of pneumonia. Of these,
Streptococcus pneumoniae is the most common. Other pathogens include
anaerobic bacteria, Staphylococcus aureus, Haemophilus influenzae,
Chlamydia pneumoniae, C. psittaci, C. trachomatis, Moraxella (Branhamella)
catarrhalis, Legionella pneumophila, Klebsiella pneumoniae, and other gram-
negative bacilli. Major pulmonary pathogens in infants and children are
viruses: respiratory syncytial virus, parainfluenza virus, and influenza A and B
viruses. Among other agents are higher bacteria including Nocardia and
Actinomyces sp; mycobacteria, including Mycobacterium tuberculosis and atypical
strains; fungi, including Histoplasma capsulatum, Coccidioides immitis,
Blastomyces dermatitidis, Cryptococcus neoformans, Aspergillus fumigatus,
and Pneumocystis carinii; and rickettsiae, primarily Coxiella burnetii (Q
fever).
The usual mechanisms of spread are inhaling droplets small enough to
reach the alveoli and aspirating secretions from the upper airways. Other
means include hematogenous or lymphatic dissemination and direct spread
from contiguous infections. Predisposing factors include upper respiratory
viral infections, alcoholism, institutionalization, cigarette smoking, heart
failure, chronic obstructive airway disease, age extremes, debility,
immunocompromise (as in diabetes mellitus and chronic renal failure),
compromised consciousness, dysphagia, and exposure to transmissible
agents.
Typical symptoms include cough, fever, and sputum production,
usually developing over days and sometimes accompanied by pleurisy.
Physical examination may detect tachypnea and signs of consolidation, such
as crackles with bronchial breath sounds. This syndrome is commonly
caused by bacteria, such as S. pneumoniae and H. influenzae.
NURSING ACTIONS
INDEPENDENT
• positioning of the patient with head on mid line, with slight flexion
rationale: to provide patent, unobstructed airway , maximum lung
excursion
• auscultating patient’s chest
rationale: to monitor for the presence of abnormal breath sounds
• provide chest and back clapping with vibration
rationale: chest physiotheraphy facilitates the loosening of secretions
• considering that the patient is an infant, and has developed a strong
stranger anxiety
as manifested by “white coat syndrome” , it is a nursing action to play
with the patient.
rationale: to establish rapport, and gain the patients trust
DEPENDENT
• administer due medications as ordered by the physician,
bronchodilators, anti pyretics and anti biotics
rationale: bronchodilators decrease airway resistance, secondary to
bronchoconstriction,
anti pyretics alleviate fever, antibiotics fight infection
• placing patient on TPN prn
rationale: to compensate for fluid and nutritional losses during
vomiting
COLLABORATIVE
• assist respiratory therapist in performing nebulization of the patient
rationale: nebulization is a favourable route of administering
bronchodilators
and aid in expectorating secretions, hence patient’s breathing
Treatment:
If the cause is bacterial, the doctor will try to cure the infection with
antibiotics. If the cause is viral, typical antibiotics will NOT be effective.
Sometimes, however, your doctor may use antiviral medication. It may be
difficult to distinguish between viral and bacterial pneumonia, so you may
receive antibiotics.
Patients with mild pneumonia who are otherwise healthy are usually treated
with oral macrolide antibiotics (azithromycin, clarithromycin, or
erythromycin).
Patients with other serious illnesses, such as heart disease, chronic
obstructive pulmonary disease, or emphysema, kidney disease, or diabetes
are often given one of the following:
• Fluoroquinolone (levofloxacin (Levaquin), sparfloxacin (Zagam), or
gemifloxacin (Factive), moxifloxacin (Avelox)
• High-dose amoxicillin or amoxicillin-clavulanate, plus a macrolide
antibiotic (azithromycin, clarithromycin, or erythromycin)
Many people can be treated at home with antibiotics. If you have an
underlying chronic disease, severe symptoms, or low oxygen levels, you will
likely require hospitalization for intravenous antibiotics and oxygen therapy.
Infants and the elderly are more commonly admitted for treatment of
pneumonia.
You can take these steps at home:
• Drink plenty of fluids to help loosen secretions and bring up phlegm.
• Get lots of rest. Have someone else do household chores.
• Control your fever with aspirin or acetaminophen. DO NOT give aspirin
to children.
When in the hospital, respiratory treatments to remove secretions may be
necessary. Occasionally, steroid medications may be used to reduce
wheezing if there is an underlying lung disease.
 Republic of the Philippines
Nueva Ecija University of Science and Technology
COLLEGE OF NURSING
Cabanatuan City

BRONCHOPNEUMONIA

Submitted by:
Ruth Castro
Sheen De Guzman
Charmaine Cuevo
Ruth Costales
Russel Cajucom

Submitted to:
Ms. Joan Lopez, RN