Definition

Bronchopneumonia or bronchial pneumonia is the acute inflammation of

the walls of the bronchioles. It is a type of pneumonia characterized by
multiple foci of isolated, acute consolidation, affecting one or more
pulmonary lobules.
Pneumonia is the inflammation of the lung caused by bacteria in which the
air sacs become filled with inflammatory cells and the lung becomes solid.
The symptoms include those of any infection (fever, malaise, headache, etc.,)
together with cough and chest pain.
Statistics
It is estimated that, worldwide, some 4 million children under five years of
age, die each year from acute respiratory infection (ARI) with the most of
these deaths caused by pneumonia in developing countries.
In 1989, when the program for Control Acute Respiratory Infections (CARI) of
the Philippines was launched, the death toll from pneumonia among children
under the age of five years was 25,000. The latest statistics (2006) disclosed
that almost 60 out of 1000 children under five children suffer from pneumonia
and five in every 11,000 die from the disease. The Department of Health
believes that if health workers used a standard method of detecting and
managing ARIs specially pneumonia, infant deaths could be cut by half,
saving 50,000 lives a year. Pneumonia can be categorized by type of
infiltrate: lobar pneumonia and bronchopneumonia.
Nursing Care Plans
Ineffective Airway Clearance
NDx: Ineffective airway clearance r/t accumulation of tracheobronchial
secretions
Mucus is produced at all times by the membranes lining the air passages.
When the membranes are irritated or inflamed, excess mucus is produced
and it will retain in tracheobronchial tree. The inflammation and increased in
secretions block the airways making it difficult for the person to maintain a
patent airway. In order to expel excessive secretions, cough reflex will be
stimulated. An increased in RR will also be expected as a compensatory
mechanism of the body due to obstructed airways.
Nursing
Interventions
SHORT
Restless
Monitor
ness with TERM:After 3and record
4
hours
of
NI,
nasal
vital signs

Assessment

Planning

Expected
Outcome
To obtain SHORT
baseline data TERM:After 34 hours of NI,

Rationale

flaring
pt.s SO will
be able to
With
demonstrate
rales on
both lung improve
airway
fields
warm, clearance AEB
reduction of
flushed
congestion
skin
with breath
minimal sounds clear
colorless
and RR
nasal
improveLONG
secretions TERM:
tachypn After 2-3 days
ea AEB
of NI, pt. will
RR=53bpm be able to
establish and
DOB
tachyca maintain
airway
rdia
patency.
irritabilit
y
chest
indrawing
cough
cyanosi
s
noisy
breathing
pallor
changes
in RR and
rhythm
risk for
infection
orthopn
ea
tachypne
a

Assess
patients
condition.
Elevate
head of bed
and
encourage
frequent
position
changes.
Keep back
dry and
loosen
clothing
Auscultate
breath sounds
and assess air
movement
Monitor
child for
feeding
intolerance
and
abdominal
distention
Instruct the
SO to provide
an increased
fluid intake for
the child
Instruct the
SO to provide
adequate
rest periods
for the child
Give
expectorants
and
bronchodilator
s as ordered.
Administer
oxygen
therapy and
other
medications
as ordered.

To know

pt. shall have

the patients demonstrated
improve
general
airway
condition
clearance AEB
To
reduction of
promote
congestion
maximal
with breath
inspiration,
sounds clear
enhance
and RR
expectoration
improve
of secretions
in order to
LONG TERM:
improve
ventilation
After 2-3 days
To
of NI, pt. shall
promote
have
comfort and
established
adequate
and
ventilation
maintained
To
airway
ascertain
patency.
status and to
note progress
To avoid
compromisin
g the airway
To help
liquefy the
secretions
Rest will
prevent
fatigue and
decrease
oxygen
demands for
metabolic
demands
To further
mobilize
secretions
To clear
airway when
secretions
are blocking
the airway
indicated
to increase

oxygen
saturation.
Impaired Gas Exchange
NDx: Impaired gas exchange related to inflammation of airways and
accumulation of sputum affecting O2 and CO2 transport
The exchange in oxygenation and carbon dioxide gases is impeded due to the
obstruction caused by the accumulation of bronchial secretions in the alveoli.
Oxygen cannot diffuse easily.
Nursing
Expected
Rationale
Interventions
Outcome
SHORT
Restles SHORT
Monitor
To obtain
TERM:After
6
sness
and record
baseline data TERM:Patient
hours
of
NI,
vital signs
with
Cyanosis of shall
pt will be able
demonstrate
Observe
nasal
nail beds may
to
improvement
flaring
color of skin,
represent
demonstrate
in gas
mucous
vasoconstrictio
With
improvement
exchange AEB
membranes
n or the bodys
rales on
in gas
a decrease in
and nail
response to
both lung exchange
respiratory
beds, noting
fever/ chills
fields
AEB a
rate to
presence of
To promote normalLONG
Metabol decrease in
peripheral
maximal
ic acidosis respiratory
TERM:Patient
cyanosis.
inspiration,
shall
Circum- rate to
Elevate
enhance
normalLONG
demonstrate
oral
head of bed
expectoration improved
TERM:
cyanosis
and
of secretions in ventilation and
DOB
encourage
order to
adequate
After 1-2 days
frequent
improve
oxygenation of
of
NI,
pt
will
tachypn
position
ventilation
tissues AEB
be able to
ea
changes.

To
avoid
absence of
demonstrate
Keep
coughing
symptoms
back dry.
of respiratory
Rest will
improved
distress.

Promote
prevent
fatigue
ventilation
and decrease
and adequate
adequate
oxygen
oxygenation
rest periods
demands for
of tissues AEB
Change
metabolic
absence of
position q 2
demands
symptoms of
hrs.
respiratory
To promote
Keep
distress.
drainage of
environment
secretions
allergen free
To reduce
Suction
irritant effects
secretions
on airways
PRN

Assessment

Planning

 To clear

Instruct

SO to
increase fluid
intake of the
child
Administer
oxygen
therapy as
ordered.

airway when
secretions are
blocking the
airway
indicated to
increase
oxygen
saturation
To liquefy
secretions
O2 therapy is
indicated to
increase
oxygen
saturation

Hyperthermia
A person experiences hyperthermia due to the inflammatory process wherein
the body tries to compensate and adapt to the dse. condition. As a defense
mechanism, the body produces host inflammatory cells causing fever.
Interleukin-1 function as a pyrogens that acts on the hypothalamus. 1L-1 act
as a hormone where it is carried by the inflammation site of production to the
CNS, where it acts directly on the hypothalamic thermal control center, thus
elevating the thermal set point.
Nursing
Expected
Rationale
Interventions
Outcome
Increa Short-term:After
Assess
To have Short-term:After
3
hours
of
3 hours of
se body
pts condition
baseline
nursing
nursing
temp. at
and
data.
interventions
37.9C interventions
monitored
To
the
pts
the pts
vital
signs.
Skin
promote heat
temperature
temperature
Perform
is warm
loss by
will be decrease
shall have
to touch.
tepid sponge
evaporation
to normal limits
decreased to
bath
and
With from 37.9 to
normal limits
conduction.
Instruct
flushed 37.5CLongfrom 37.9 to
To support 37.5CLongskin.
the SO to
term:
provide an
circulating
Increa After 3 days of
term:
increase
fluid
volume and After 3 days of
se in RR nursing
intake for the
tissue
nursing
chills interventions
child.
perfusion.
the pt will be
interventions

Maintain

To
able
to
maintain
the pt shall be
lack of
patent
promote
pts
a
temp.
within
able to maintain
appetit
airway
and
safety
and
to
normal
range
.
a temp. within
e
provide
avoid chills.

Assessment Planning

blanket for
the child.
Maintain
bed rest and
adequate
rest periods.
Ask SO to
provide high
caloric diet
for the child
Administer
antipyretic
s as
ordered.

To reduce

metabolic
demands/
Oxygen
consumption.
To meet
increase
normal range .
metabolic
demands.
To lower
the
temperatur
e.

Disturbed Sleeping Pattern

NDx: Disturbed Sleep Pattern r/t difficulty of breathing
Sleep is disrupted when a person experiences unpleasant sensation arising
from difficulty of breathing and ineffective expectoration of mucus secretions
in the airways.
Nursing
Expected
Rationale
Interventions
Outcome
change Short
Monitor
To have Short Term:After
Term:After 3
3 hours of
s in
vital signs
a
hours
of
behavior
comparable nursing
Encourag
nursing
interventions
(irritability)
baseline
e SO to
interventions
the SO shall
data-to
restless
increase
the SO will be
have verbalized
promote
intake of
DOB
able to
understanding
drowsiness
warm milk
nasal verbalize
of sleep
To
for the child
flaring
understanding
disturbance and
promote
Provide a
of sleep
identified
The
comfort and
quiet
disturbance
interventions to
patient
relaxation
environment
and identify
promote sleep
may
/sleep
for the childfor the
manifest: interventions to
periods for
instruct SO
promote
sleep
child.Long
lack of
the child
to provide a
for
the
Term:
interest in

To
dim
child.Long
After 3 days of
food
environment
promote
Term:
nursing
weight
for the child
comfort for interventions,
After 3 days of
loss
the child
Advise SO
nursing
the SO shall
DOB
To avoid have reported
to provide
interventions,
blanket for
chills and to improvement in
SO will be able
tachypn to report
the child
promote
sleep pattern
ea
Instruct SO
comfort
improvement in
for the child
to elevate
sleep pattern of

Assessment

Planning

the child.

HOB

To
maximize
lung
expansion
of the
child and
to
decrease
DOB

Risk for Infection

NDx: Risk for infection (spread) related to inadequate secondary
defenses(decrease hemoglobin, hematocrit and immunosuppression
Immuno-suppression due to decrease in hemoglobin, leukopenia, and
suppress inflammatory response gives a greater opportunity for pathogenic
bacteria to invade and inoculate in a specific body part of a susceptible
human body. Thus, leading to a further damage or infection.
Nursing
Expected
Rationale
Interventions
Outcome
Short
term:
ever of
Monitor v/s
To know Short term:
After
6
hours
The patients
38.3C
closely,
potential
S.O shall have
especially
fatal
presenc of nursing
interventions
during
complication verbalized
e of
the patients
her
initiation of
that may
adventitiou
S.O will
understandin
therapy.
occur.
s sounds in
verbalize her
g of individual
Instruct the
To
both lung
understandin
causative/risk
field.
S.O concerning
promote
g of individual
factors and
about the
safety
producti causative/risk
demonstrate
disposition of
disposal of
ve cough
factors and
lifestyle
secretions and
secretions
skin
demonstrate
changes to
report changes
and to assess
pale in
lifestyle
prevent
in color,
for the
color
changes to
further
amount and
resolution of
infection.Long
restless prevent
odor of
pneumonia
further
term:
ness
secretions.
or
infection.Long
The patient
activity
development

Encourage
shall have
intolerance term:
of secondary
the SO to
After 1-2 days
been free
infection.
fever
perform good
of nursing
from possible
To reduce spread of
hand washing
cough interventions
techniques.
spread or
and colds the patient
infection.
acquisition of
Encourage
pallor will be free
infection.
adequate rest.
cyanosis from possible
To
spread of
Stress the
DOB
enhance fast
infection.
importance of
tachypn
recovery and
increasing the

Assessment

Planning

childs
nutritional
intake.
Encourage
the mother to
keep an eye to
the baby and
observe
anything that
the baby is
putting in his
mouth.
Ask SO to
provide a good
hygiene for the
child. (bed
bath)
Ask SO to
provide an
adequate safe
drinking
milk/water for
the child
Ask SO to
keep the child
warm and to
provide blanket
Administer
antimicrobial
s as ordered.

ea
tachycard
ia

regain
strength.
A good
nutritional
intake can
strengthen
body immune
defense.
6. To
prevent entry
of microbes.
To
eliminate MO
To prevent
GI
disturbance
To avoid
chills and to
prevent the
child from
having fever
To combat
microbial
pneumonia
s.

Risk for Imbalanced Nutrition

NDx: Risk for imbalanced nutrition, less than body requirement related to
decrease nutrient absorption
A disruption in the mucosal barrier causes gastric acid to come into contact
with gastric tissues and damage them causing irritation or inflammation. This
leads to alteration of the mucosal barrier impairing the absorption process
with in the stomach and putting the patient at high risk for imbalance
nutrition less than body requirements.
Assessment

pallor
lack of
appetite
lack of

Nursing
Rationale
Interventions
SHORT
Monitor
To have
TERM:After 3
vital signs
baseline
hours of Nursing
data
Assess for
Interventions,
Can be
difficulty of
Planning

Expected
Outcome
SHORT
TERM:The SO
shall have
verbalized

the SO will be
able to verbalize
interest to understanding
food offeredof causative
type of factors when
food cannot known and
necessary
meet the
metabolic interventions for
demand of the child.LONG
TERM:
the child
After 2 days of
(powder
milk, milo, Nursing
Interventions,
chips)
constipa the patient will
be able to
tion
demonstrate
diarrhea behaviors,
weight lifestyle
loss
changes to
regain and/or
pallor
maintain
appropriate
weight.

swallowing
and the
ability to
swallow
Encourag
e family
members to
prepare food
of patients
preferencesdevelop meal
plan with the
patient
Ask the
mother to
join the
child
during
meal time

factors that
can affect understanding
ingestion of causative
factors when
and
causative known and
of altered necessary
interventions
nutrition
for the child.
To
maintain
LONG TERM:
adequate
caloric
The client shall
intake
have
To meet
demonstrated
the
behaviors,
nutritional lifestyle
needs of
changes to
the client regain and/or
maintain
To
appropriate
enhance weight.
intake