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PRELIMINARY REPORT

BRONCHOPNEUMONIA

Prepared By :

Roy Ahmad Septiadi

1614401320224

FACULTY OF NURSING AND HEALTHY SCIENCE

INTERNATIONAL CLASS OF NURSING DIPLOMA PROGRAM

UNIVERSITY OF MUHAMMADIYAH BANJARMASIN

2016/2017
I. ANATOMY AND PHYSIOLOGY

The respiratory system consists of the nose, pharynx, larynx, trachea, bronchus,
up to the alveoli and the lungs. The nose is the first airway, has two holes. Inside there
are feathers that are useful for filtering air, dust and dirt entering the nostrils, the nose can
warm the air respiration by the mucosa (Syaifuddin, 1997) in (Gandi, 2011).
Faring is the intersection between the respiratory path and the food path, the
pharynx is below the skull base, behind the nasal cavity and the front mouth of the neck
bone. The pharynx is divided into three parts, ie the top which is parallel to the koana ie
the nasopharynx, the central part with the special fausium is called the oropharynx, and at
the bottom once called the laryngopharynx.
The trachea is an incomplete (16-20 cm) cartilage ring, 9-11 cm long and behind
it consists of connective tissue coated by smooth muscle and mucosal lining. The trachea
is separated by karina into two bronchials, the right bronchus and the left bronchus.
Bronchus is a continuation of the trachea that forms the main right and left bronchus, the
right bronchus is shorter and larger than the smaller bronchial bronchial bronchial
bronchus is called the bronchial which at its end there is a pulmonary bubble or alveoli
bubble.
The lung is a body tool consisting mostly of bubbles. The lungs are divided into
two, namely the right lung three lobes and the left lung two lobes. The lungs are located
in the chest cavity which is facing the middle of the chest cavity / mediastinum cavity.
The lungs get blood from the bronchial arteries that are rich in blood compared to the
pulmonary artery blood coming from the left atrium. The magnitude of the air load by the
lungs is 4500 ml to 5000 ml of air. Only a fraction of this air, about 1/10 or 500 ml is the
tidal air. While the lung capacity is the volume of air that can be reached in and out of the
lungs which in normal circumstances both lungs can accommodate as much as
approximately 5 liters, (Evelyn, 2006).
Breathing (respiration) is an event of breathing oxygen-enriched oxygenated air
into the body (inspiration) as well as releasing the air containing carbon dioxide residual
oxidation out of the body (expiration) that occurs due to the difference in pressure
between the pleural space and the lungs. The respiratory process consists of 3 parts:
A. Pulmonary ventilation.
Ventilation is a process of inspiration and expiration which is an active and
passive process in which the internal intercostal muscles contract and push the chest
wall slightly outward, resulting in the diaphragm down and the diaphragm muscles
contracting. At the expression of the diaphragm and the external intercostal muscles
relaxation thus the chest cavity becomes small again, then the air is pushed out.
B. Gas Diffusion.
Gas diffusion is the movement of CO2 and CO3 gases or other particles from
high pressure areas towards low pressure. Gas diffusion through respiratory
membrane influenced by membrane thickness factor, membrane surface area,
membrane composition, diffusion coefficient of O2 and CO2 and difference of O2
and CO2 gas pressure. In the diffusion of this gas that plays an important role of
alveoli and blood.
C. Gas transportation
Gas transport is the transfer of gas from the lungs to the tissues and from the
tissues to the lungs with the help of blood (blood flow). The entry of O2 into the
blood cells that join the hemoglobin which then forms oxyhemoglobin as much as
97% and the remaining 3% are transported into the plasma and cell fluids.

II. DEFNITION
Bronchopneumonia is a pneumonia involving one or more lung lobes
characterized by infiltrating spots (Whalley and Wong, 1996).
Bronchopneumonia is the frequency of pulmonary complications, prolonged
productive cough, signs and symptoms are usually increased temperature, increased
pulse, increased breathing (Suzanne G. Bare, 1993).
Bronchopneumonia is also called pneumonia lobularis, namely pneumonia caused
by bacteria, viruses, fungi and foreign objects (Sylvia Anderson, 1994).
Based on some understanding above it can be concluded that Bronkopneumonia is
inflammation of the lungs that affect one or several lung lobes characterized by
infiltrating spots caused by bacteria, viruses, fungi and foreign objects.
III. ETIOLOGY
A. Bacteria: Pneumococcus is a major cause of pneumonia, whereas in children
serotypes 14, 1, 6, and 9, Streptococcus is in children and progressive,
Staphylococcus, H. Influenza, Klebsiela, M. Tuberculosis, Mikoplasma pneumonia.
B. Virus: Virus adeno, Parainfluenza virus, Influenza virus, Virus respiratory sinsisial.
C. Mushroom: Candida, Histoplasma, Koksidioides.
D. Protozoa: Pneumokistis karinii.
E. Chemicals:
1. Aspirations of food / milk / contents of the stomach
2. Hydrocarbon poisoning (kerosene, gasoline, etc.).

IV. CLINICAL MANIFESTATION


A. Pnemonia bacteria
Symptoms:
1. Mild rhinitis
2. Anorexia
3. Restless

Continue until:

1. Fever
2. Malaise (uncomfortable)
3. Breath fast and shallow.
4. Expiration sounds.
5. Over 5 years, headache and cold
6. Less than 2 years of vomiting and mild diarrhea
7. Leukocytosis
8. Photo thoracic pneumonia width
B. Pnemonia Virus
Early symptoms:
1. Cough
2. Rhinitis

Growing up

1. mild fever, mild cough and malaise until high fever coughs are severe and lethargic.
2. Obstructive emphysema
3. Ronkhi wet.
C. Microplasma pneumonia
1. Fever
2. Headache
3. Shivering
4. Anorexia

Growing up

1. Allergic Rhinitis
2. sore throat dry bleeding cough
3. Consolidated area of the thorac examiner.

V. PATHOPHYSIOLOGY
Most of the causes of bronchopneumonia are microorganisms (fungi, bacteria,
viruses) and a small portion by other causes such as hydrocarbons (kerosene, gasoline
and the like). As well as aspiration (entry of gastric contents into the airway). Initially
microorganisms will enter through the spit spark (droplet) this inflation will enter the
upper respiratory tract and cause immunological reactions from the body. This reaction
causes inflammation, where during this inflammation the body will adjust so that the
symptoms of fever appear in patients.
This inflammatory reaction will cause a secret. The longer the secret accumulates
in the bronchus so that the flow of bronchus becomes narrower and the patient will feel
crowded. In addition to collected in the bronchus, over time the secret will reach the
pulmonary alveolus and disrupt the gas exchange system in the lung.
In addition to infecting the airways, these bacteria can also infect the gastrointestinal tract
when it is carried by the blood. This bacteria will make the normal flora in the intestine
into a pathogen agent so that problems arise GI tract.
VI. PATHWAY
VII. MEDICAL EXAMINATION
In mild disease, the virus may not need antibiotics. In patients who hospitalized
(serious illness) should be given antibiotics immediately. The selection of antibiotics is
based on age, the general state of the patient and the alleged germs.
A. Age 3 months-5 years, if toxic may be caused by Streptococcus pneumonia,
Hemophilus influenza or Staphylococci. Generally unknown to the germs, it is
practically used:
Combination:
Procaine penicillin 50,000-100,000 KI / kg / 24 hours IM, 1-2 times
daily,Chloramphenicol 50-100 mg / kg / 24 hours IV / orally, 4 times daily.
Or combination:
Ampicillin 50-100 mg / kg / 24 hours IM / IV, 4 times daily and cloxacillin 50 mg /
kg / 24 hours IM / IV, 4 times daily.
Or combination:
Erythromycin 50 mg / kg / 24 hours, orally, 4 times daily and Chloramphenicol (dose
sda).
B. Age <month, usually caused by: Streptococcus pneumonia, Staphylococci or Entero
bacteriaceae.
Combination:
Procaine penicillin 50,000-100,000 KI / kg / 24 hours IM, 1-2 times daily, and
Gentamicin 5-7 mg / kg / 24 hours, 2-3 times daily.
Or combination:
Cloxacillin 50 mg / kg / 24 hours IM / IV, 4 times daily and Gentamicin 5-7 mg / kg /
24 hours, 2-3 times daily.
This combination is also given to children over 3 months with severe malnutrition or
immunocompromized patients.
C. Children> 5 years, which is non toxic, usually caused by:
Streptococcus pneumonia:
1. IM or oral procaine penicillin
2. Phenoxymethylpenicillin 25.000-50.000 KI / kg / 24 hours orally, 4 times daily
or
3. Erythromycin (dose sda) or
4. Cotrimoxazole 6/30 mg / kg / 24 hours, orally 2 times daily.

Mycoplasma pneumonia: Erythromycin (dose sda).

D. If germs can be isolated or drug side effects (eg allergies) or unsatisfactory treatment
results, it is necessary to reevaluate whether other antibiotics should be selected.
E. The duration of antibiotics depends on:
1. patient clinical progress
2. the type of germs that cause

Indication of hospitalization:

1. There is difficulty breathing, toxic.


2. Cyanosis
3. Age less than 6 months
4. The existence of complications such as empyema
5. Suspected of Staphylococcal infection
6. Home care is not good.

Symptomatic Treatment:

1. Acids and steam.


2. Expedited if necessary

Physiotherapy:

1. Postural drainage.
2. Physiotherapy by plumping.

VIII. EXAMINATION SUPPORT


A. Laboratory Examination
1. Leukocytes increased by 15,000-40,000 / mm3
2. The rate of sedimentation of blood increases 100mm
3. ASTO increased in streptococcus infection.
4. GDA shows hypoxemia without hypercapnea or CO2 retention
5. Urine is usually older in color, there may be mild urinary albumin due to
increased body temperature.
B. Radiological Examination
Visible patches on the bronchus to the lobes.

IX. COMPLICATION
A. Atelectasis: Improper lung development.
B. Emphysema: The presence of pus in the pleural cavity.
C. Pulmonary abscess: collecting pus in inflamed lung tissue.
D. Cystomic infectio
E. Endocarditis: inflammation of the endocardium.
F. Meningitis: Inflammation of the lining of the brain.
X. BASIC THEORY OF NURSING CARE REPORT
A. Assessment
1. Identity.
Generally a child with impaired endurance will suffer recurrent pneumonia or can
not cope with this disease perfectly. In addition to decreased immune system due
to KEP, chronic disease, lung trauma, anesthesia, aspiration and antibiotic
treatment is not perfect.
2. Nursing History.
a. Main complaint.
The child is very anxious, dyspnea, rapid and shallow breathing, respiratory
lung breathing, and cyanosis around the nose and mouth. Sometimes
accompanied by vomiting and diarrhea or diarrhea, bloody stools with or
without mucus, anorexia and vomiting.
b. History of the disease now.
Bronchopneumonia is usually preceded by upper respiratory tract infection
for several days. Body temperature can rise very suddenly until 39-40oC and
sometimes accompanied by seizures due to high fever.
c. Past medical history.
Having had an infectious disease that causes the immune system to decline.
d. Family health history.
Other family members with respiratory infections can pass on to other family
members.
e. Environmental health history.
According to Wilson and Thompson, 1990 pneumonia often occurs in the
rainy season and early spring. In addition, maintenance of health and
cleanliness of the environment can also cause child suffering illness. Factory
environment or lots of smoke and dust or the environment with family
members of smokers.
f. Immunization.
Children who are not immunized are at high risk for upper or lower
respiratory tract infections because the body's defense system is not strong
enough to resist secondary infections.
g. Nutrition.
History of malnutrition or meteorismus (protein energy malnutrition = MEP).
3. Persistent examination.
a. Cardiovascular system.
Takikardi, iritability.
b. Respiratory system.
Shortness of breath, chest retraction, reported difficulty breathing, lung
breathing, rhonchi, wheezing, tachypnea, productive or non-productive
cough, asymmetric chest movement, irregular / irregular breathing, possibly
friction rub, dim percussion in the area of consolidation, sputum / Secret.
Parents are worried about the state of their increasingly congested child and
the cold.
c. Digestive system.
Child lazy to drink or eat, vomiting, weight loss, weak. In elderly people with
first-born family types, may not yet understand the purpose and manner of
feeding / liquid personde.
d. System of elimination.
Children or babies suffering from diarrhea, or dehydration, parents may not
yet understand the reason children suffer from diarrhea until dehydration
(mild to severe).
e. Nervous system.
Fever, seizures, headaches characterized by continued crying in children or
lazy drinking, crowned crown.
f. Locomotor / musculoskeletal system.
Muscle tone decreased, weak in general,
g. The endocrine system.
No abnormalities.
h. Integumentary system.
Skin turgor decreases, dry mucous membranes, cyanosis, pale, warm acral,
dry skin,.
i. Sensing system.
No abnormalities.
4. Diagnostic and results checks.
Laboratorically found lekositosis, usually 15,000 - 40,000 / m3 with a shift to the
left. LED is rising. Bronchoscopy secretion and lung function for direct preparation;
Culture and resistance test can determine / search for etiology. But this way is not
routinely done because it is difficult. In punksi for example can occur one stab and
insert germs from the outside. A photo of roentgen (chest x ray) is performed to see:
a. Complications such as empyema, atelectasis, pericarditis, pleuritis, and OMA.
b. The area of the affected lung.
c. Evaluation of treatment

In bronchopnemonia patches of infiltrates are found in one or more lobes. On


examination ABGs found PaO2 <0 mmHg.
B. Nursing Diagnosis
1. Ineffective airway clearance related to Mucus products are excessive and thick,
cough is not effective.
2. Disturbance of gas exchange related to Alveolar membrane alteration.
3. The risk of nutritional change is less than the body needs related to intake
inadekuat.
4. Hipertermi related to pulmonary inflammatory process.
C. Intervention

NO DIAGNOSE GOALS INTERVENTION RATIONAL

1 Ineffective After doing the 1. Auscultation of 1. Determine the adequacy


airway nursing intervention breath sounds of gas pertukran and the
clearance for 1x24 hours 2. Assess secret extent of mucus
related to expected to the characteristics obstruction.
Mucus patient's airway will 3. Give position for 2. Infection is characterized
products are be patented. optimal breathing by a thick and yellow
excessive and that is 35-45 0 secret
Criteria Results:
thick, cough 4. Perform a nebulizer, 3. Improve the development
is not 1. The airway is and breath of the diaphragm
effective. clean. physiotherapy 4. Nebulizer helps warm and
2. Cough is gone 5. Give an anti-infective dilute the secret.
3. X ray clean. agent according to Physiotherapy helps to
4. RR 15 - 35 X / order throw the secret away.
min. 6. Give fluids per oral 5. Inhibits the growth of
or iv line according microorganisms
to the age of the 6. An adequate liquid helps
child. to dilute the secret so that
it is easily removed

2 Disturbance After doing the 1. Assess the level of 1. This sign indicates
of gas nursing intervention consciousness hypoxia
exchange for 1x24 hours 2. Observe skin color 2. Determine the adequacy
related to expected the gas and capillary refill of circulation where it is
Alveolar exchange is normal 3. Monitor ABGs important to exchange gas
membrane for the patient. 4. Set oxygen according to the tissues
alteration. to order 3. Detect the amount of Hb
Criteria Results:
5. Reduce child activity present and the presence
1. PaO2 = 80-100 of infection
mmHg, 4. Increase gas exchange and
2. Blood pH 7.35- reduce respiratory work
7.45 5. Reduce the need for
3. Breath clean. oxygen

3 The risk of After doing the 1. Auscultation of 1. Documenting the


nutritional nursing intervention intestinal sound intestinal peristalsis
change is less for 1x24 hours 2. Assess child's daily required for digestion.
than the body expected nutritional needs 2. Helps set individual
needs related stauts are within 3. Measure arm level, child's diet
to intake normal limits. tricep thickness 3. This determines the
inadekuat. 4. Weigh the weight storage of fat and protein.
Criteria Results:
every day. 4. Increased nutrition will
1. BB increased by 5. Give the child a diet lead to weight gain.
1 kg / week as needed 5. Meet the nutritional needs.
2. Not pale
3. Anorexia is lost
4. Moist lips
4 Hipertermi After doing the 1. Measure body 1. Indication if there is a
related to nursing intervention temperature every 4 fever
pulmonary for 1x24 hours hours 2. Leukocytosis indication of
inflammatory expected body 2. Monitor the number an inflammation and / or
process. temperature within of WBC infection process
normal limits. 3. Set the antipyretic 3. Reduce fever by acting on
agent to order. the hypothalamus
Criteria Results:
4. Increase the 4. Facilitate heat losses
1. Temperature 372 circulation of the through convection
0C room with fan 5. Facilitate heat loss
2. skin warm and angina. through conduction
moist 5. Give a regular water
3. moist mucous compress
membrane.
BIBLIOGRAPHY

Gandi. (2011). Asuhan Keperawatan TB Paru. Diakses pada hari tanggal 18 Maret 2011 dari

Heather, H. (2010). Diagnosis Keperawatan: definisi dan klasifikasi 2009-2011. Jakarta: EGC

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