EFFECTIVENESS OF NURSING CARE ON CHILDREN WITH BRONCHO PNEUMONIA

By

Mrs. GNANASOUNDARI.S

Dissertation Submitted to

THE TAMILNADU Dr. M.G.R MEDICAL UNIVERSITY, CHENNAI.

IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING

MARCH – 2010.

CERTIFICATE

This is to certify that “EFFECTIVENESS OF NURSING CARE ON CHILDREN WITH BRONCHO PNEUMONIA”is a bonafide work done by Mrs.GNANASOUNDARI.S, Adhiparasakthi College of Nursing,

Melmaruvathur 603319 in partial fulfillment for the University rules and

regulations towards the award of degree of Master of Science in Nursing,

Branch – II PAEDIATRIC NURSING, under our guidance and supervision

during the academic period 2009 – 2010.

Signature: _________________

Dr.N.KOKILAVANI, M.Sc (N), M.A (Pub.Adm)., M.Phil., Phd., Principal, Adhiparasakthi College of Nursing, Melmaruvathur - 603 319, Kancheepuram District.

EFFECTIVENESS OF NURSING CARE ON CHILDREN WITH BRONCHO PNEUMONIA

By Mrs. GNANASOUNDARI.S,

M.Sc (Nursing) Degree Examination, Branch- II, Paediatric Nursing,

Adhiparasakthi College of Nursing, Melmaruvathur-603 319.

Dissertation Submitted to THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY,

CHENNAI.

IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING

MARCH – 2010.

EFFECTIVENESS OF NURSING CARE ON CHILDREN WITH BRONCHO PNEUMONIA

APPROVED BY DISSERTATION COMMITTEE

ON MARCH– 2010.

SIGNATURE

Dr. N.KOKILAVANI M.Sc(N)., M.A. (Pub. Adm)., M.Phil.,Ph.D., PRINCIPAL AND HEAD OF THE DEPARTMENT- RESEARCH,

ADHIPARASAKTHI COLLEGE OF NURSING, MELMARUVATHUR – 603 319.

SIGNATURE

PROF. B. VARALAKSHMI M.Sc(N)., M.Phil., HEAD OF THE DEPARTMENT- PAEDIATRIC NURSING,

ADHIPARASAKTHI COLLEGE OF NURSING, MELMARUVATHUR – 603 319.

SIGNATURE

DR. PADMA M.B.B.S., DCH., DNB., DEPARTMENT OF PEDIATRICS,

MELMARUVATHUR ADHIPARASAKTHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH,

MELMARUVATHUR- 603 319.

Dissertation submitted to

THE TAMILNADU Dr.M.G.R MEDICAL UNIVERSITY, CHENNAI.

IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING

MARCH – 2010.

EFFECTIVENESS OF NURSING CARE ON CHILDREN WITH BRONCHO PNEUMONIA

By

Mrs. GNANASOUNDARI.S, M.Sc. (Nursing) Degree Examination,

Branch- II Paediatric Nursing, Adhiparasakthi College of Nursing,

Melmaruvathur-603 319,

Kancheepuram Dist .

Dissertation submitted to THE TAMILNADU DR.M.G.R MEDICAL

UNIVERSITY, CHENNAI in partial fulfillment of the requirement for the

degree of MASTER OF SCIENCE IN NURSING, MARCH – 2010.

Internal Examiner External Examiner

ACKNOWLEDGEMENT

I express my deep sense of gratitude to HIS HOLINESS

ARUL THIRU AMMA, President for his blessings and guidance,

which enabled me to reach up to his step and to complete my

study.

I express my heartfelt thanks to THIRUMATHI. LAKSHMI

BANGARU ADIGALAR, Vice President, Adhiparasakthi

Charitable Medical Educational and Cultural Trust, Melmaruvathur

for given me the opportunity to pursue my study in this prestigious

institution .

With great respect and honour, I extend my thanks to our

Managing Director Sakthi Thiru. Dr. T.RAMESH M.D.,

Melmaruvathur Adhiparasakthi Institute of Medical Sciences and

Research for his excellence in providing skillful and compassionate

spirit of unstinted support throughout the study.

I am privileged to express my sincere thanks to our Director

Administration Sakthi Thirumathi. Dr. S. SREELEKHA, M.B.B.S.,

D.G.O., Melmaruvathur Adhiparasakthi Institute of Medical

Sciences and Research for her steadfast guidance and

suggestions offered during the study.

I place on record my gratitude to Dr. N. KOKILAVANI,

M.Sc.,(N), M.A., (Pub. Adm.), M.Phil., Ph.D., Principal and

Head of the Department - Research Adhiparasakthi College of

Nursing, Melmaruvathur, who is a source of glorious,

encouragement and valuable guidance to frame the study in a right

away and brought this to a find shape.

I am greatly indebted and express my gratitude to

Prof. B.VARALAKSHMI, M.Sc.,(N),M.Phil., Vice Principal cum

H.O.D of Pediatric Nursing, Adhiparasakthi College of Nursing,

Melmaruvathur for her expert advice, constant support. patience,

encouragement, guidance and suggestions to complete this study.

I would like to express my immense thanks to Dr. PADMA,

M.B.B.S., DCH.,DNB., Department of Pediatrics, Adhiparasakthi

Institute of Medical Sciences and Research, for her valuable

suggestions throughout the study.

I wish to express my heartful thanks to Prof. Mrs. ANITHA

RAJENDRABABU, M.Sc (N)., Principal, Rajalakshmi College of

Nursing, Thandalam, Chennai for her valuable suggestions during

centent validity.

I wish to extent my heartful gratitude to my guide

Mrs. D. KALAIMANI M.Sc (N)., M.Phil., Reader, Department of

Pediatric Nursing., Adhiparasakthi College of Nursing,

Melmaruvathur, for her effective guidance to complete the study.

I wish to extent my heartful gratitude to my guide

Mrs.E. SRI GNANASOUNDARI. S M.Sc (N)., M.Phil., Reader,

Department of Pediatric Nursing., Adhiparasakthi College of

Nursing, Melmaruvathur, for her effective guidance to complete the

study.

I wish to extent my heartful gratitude to my guide

Mrs. D.K. SHAKILA M.Sc (N)., M.Phil., Reader, Department of

Pediatric Nursing., Adhiparasakthi College of Nursing,

Melmaruvathur, for her effective guidance to complete the study.

My grateful thanks to Mr. B. ASHOK, M.Sc., M.Phil., in Bio-

Statistics for his constant support, patience, encouragement and

guidance in statistical analysis for this study.

I feel pleasure to extend my gratitude and sincere thanks to

Mr. A. SURIYA NARAYANAN, M.A., M. Phil., Lecturer in English,

Adhiparasakthi College of Nursing, Melmaruvathur for his constant

guidance, which led to the completion of the study.

I wish to express my thanks to all the faculties of Athiparaskthi

College of Nursring Melmaruvathur, who encouraged me and

provided support throughout my study.

I express my grateful thanks to Mr. CHANDRAN, Librarian

Adhiparasakthi College of Nursing, Melmaruvathur who helped me to

refer books and journals for my dissertation.

I would like to express my immense thanks to THE

TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY Library helped

me to refer books and journals for my dissertation.

I whole heartedly thank my wonderful parents and all my family

members who supported and showered all their blessings in

completing the dissertation.

I would like to express my special thanks to my husband and

my lovely daughter for their constant cooperation.

I would like to express my grateful thanks to my sister

who helped me throughout my study.

Finally, I thank all of them who contributed to this work in

diverse way is extensive; I remain in debt of all.

LIST OF CONTENTS

CHAPTER NO CONTENT PAGE NO

I INTRODUCTION 1

Need for the Study 3

Statement of the problem 7

Objectives 7

Operational Definition 7

Assumptions 8

Limitations 9

Conceptual Frame Work 10

II REVIEW OF LITERATURE 13

III METHODOLOGY 38

Research Design 38

Setting 38

Population 38

Sample Size 39

Sampling Technique 39

IV DATA ANALYSIS AND INTERPRETATION 40

V RESULTS AND DISCUSSION 58

VI SUMMARY AND CONCLUSION 61

BIBLIOGRAPHY 66

APPENDIXES i

LIST OF TABLES

TABLE NO TITLE PAGE NO

4.1 Score Interpretation 45

4.2 Statistical Method 46

4.3 Frequency and percentage distribution of the

demographic variable of the children with

broncho pneumonia 48

4.4 Frequency and percentage distribution of

assessments score and evaluation score of

children with broncho pneumonia. 52

4.5 Mean and standard deviation of assessment

and evaluation scores of children with

Broncho pneumonia 53

4.6 Improvement score mean and standard deviation

of assessment and evaluation score and

effectiveness of nursing care of children with

broncho pneumonia 54

4.7 Correlation between demographic variables and

effectiveness of nursing care of children with

broncho pneumonia 55

LIST OF APPENDICES

S.NO APPENDIX PAGE. NO

I. Demographic Data i

II. Rating Scale for Assessment of Children ii

With broncho pneumonia

III. Protocal for Nursing Care of Children with iii

broncho pneumonia

IV. Observation Check List for Nursing Care iv

of Children With broncho pneumonia

Nursing Process with broncho pneumonia

V. Case Analysis v

LIST OF FIGURES

FIG.NO TITLE PAGE. NO

1. 1 Conceptual Frame Work I

4.1 Frequency and percentage Distribution for II

the place of birth of the children with broncho

pneumonia

4.2 Frequency and percentage distribution for III

the birth weight of the children with broncho

pneumonia

4.3 Frequency and percentage Distribtion IV

Exclusive Breast feeding of the children with

broncho pneumonia

4.5 Frequency and percentage distribution V

for the sex of children with

broncho pneumonia

4.6 Frequency and percentage distribution VI

for the age of children with

broncho pneumonia

4.7 Mean for effectiveness of nursing care VII

on Assessment and evaluation score of

children with proncho pneumonia

CHAPTER – I

INTRODUCTION

“Today’s child is tomorrow’s citizen”. The child is the heritage

of the family and children’s health is India’s health. Just as it is

essential for the young shoot of the plant to be healthy for the

foundation of a strong healthy children also are essential for

healthy India.

World health organization (2005) stated that the children

are the future of the society and their mothers are the guardians of

that future. Children are an embodiment of our wet clay in the

potter’s hands, handle with care they become something beautiful

else they break and become discarded. They are the most

vulnerable group in the society.

Smi.L . et al., (2005) stated that respiratory system

dysfunction is a frequent health concern for children across the life

span. Rapid population growth increased industrialization and

rising use of automobiles most of the rapidly growing cities are

facing with deteriorating air frequently. The effect of exposure to

inhaled particles and gases inside and outside the home on the

health of small children is profound.

1

Every year respiratory infection in young children is

responsible for an estimated 4.1 million deaths worldwide. It is

estimated that Bangladesh, India and Nepal together account for

40% of the global respiratory infection mortality.

Hospital records from states with high infant mortality rates

show that up to 13 percent of inpatient deaths in pediatrics wards

are due to respiratory tract infection. According to WHO estimates

respiratory infection causes about 9,87,000 deaths in India of

which 9,69,100 were due to lower respiratory tract infection and

10,000 due to acute upper respiratory infection.

Daniel Bentic.M et al., (2008) reported that in developing

countries each year Pneumonia alone kills three million children,

while other acute respiratory infection causes another one million

children to die.

Thomas Cherian.J et al., (2006) reported that acute

respiratory tract infections are the most common cause of mortality

in children under five year of age in developing countries including

India. Pneumonia not associated with measles accounts for to

prevent death.

2

Pneumonia is an infection of the lungs. Many different

organisms can cause it, including bacteria, viruses, and fungi.

NEED FOR THE STUDY:

The health status of today’s children reflects the health of the

mothers. The state of children’s health at present everywhere

challenges the national and international organizations that the

children are in the front line to have a safe start in life and pursing

a future of equality and social justice. The promotive, preventive

and curative services will be effectively utilized by the under five

health of the children improves.

Staff Reporter of UNICEF said that “India tops in childhood

pneumonia case. According to the report, India, with 44 million

pneumonia cases, China with 18 million cases and Nigeria and

Pakistan with seven million cases are in the top of the chart.

New Delhi: India tops the list of 15 countries that account for

Three-quarters of childhood pneumonia cases worldwide. World

over, pneumonia kills more children than any other illness — AIDS,

malaria and measles combined —a report states Pneumonia —

the forgotten killer of children. According to the report, India, with

44 million pneumonia cases, China With 18 million cases and

3

Nigeria and Pakistan with seven million cases are in the top of the

chart.

Respiratory infections

The disease causes acute infections in any part of the

respiratory system — from the middle ear to the nose to the lungs.

Acute respiratory Infection is also a serious problem in India,

accounting for 14.3 percent deaths during infancy and 15.9 per

cent deaths among children aged between 1-5 years in India, as

per the studies undertaken by experts.

It is estimated that more than 150 million cases of

pneumonia occur every year among children under five in

developing countries, accounting for more than 95 per cent of all

new cases worldwide.

Between 11 million and 20 million children with pneumonia

will require hospitalization, and more than two million will die from

the disease, the report warns.

Stating that the incidence of pneumonia among children

decreases with age, the report says that South Asia and sub-

Saharan Africa bear the burden of more than half of the total

4

number of pneumonia episodes worldwide among children under

five.

THE UNICEF/WHO (2007) report states that effective

interventions can save over a million lives. "Preventing children

from developing pneumonia in the first place is essential for

reducing child deaths. Key prevention measures include promoting

adequate nutrition [including breast feeding and zinc intake raising

immunization rates and reducing air pollution."

Recent research also suggests that hand washing may help

reduce the incidence of pneumonia. "Prompt treatment of

pneumonia with a full course of appropriate antibiotic is life-

saving," the report notes. The UNICEF and the WHO have

published guidelines to diagnose and treat pneumonia in

community settings in developing world.

Pneumococcal pneumonia and Broncho pneumonia are

more common in infants and children. Pneumonia occurs most

often during the winter early spring. Streptococcus is the most

common and important causes of bacterial pneumonia accounting

for 90% of cases.

5

The early recognition and appropriate treatment of

respiratory infection by the paramedical personnel at the

community level, early recognition at home and timely referral and

hospitalization, when required by the mother are necessary. This

can reduce the severity of infection and totality.

Sunil Sazawal et al (2007) Stated that ARI predominantly

Pneumonia causes approximately four million deaths every year,

accounting for 1/3 of all childhood deaths in developing countries.

Kabra. S.K. et al., (2006) – mentioned that Pneumonia kills

three million children every year and the others by ARI in

developing countries.

Vingilis. E.R et al., (2006) conducted a study on the

knowledge attitude and practices of cold and flue self care and

health care utilization, among the residents of London / Windsor

and this survey revealed good knowledge about cold and flu and

understanding of appropriate physicians visits.

Ballard .T. et al.,(2005) conducted a study on the effects of

Malnutrition, Parental literacy of household crowding in relation to

ARI, on young Kenyan children. They found that more educates

6

parents offer better child care, though health knowledge and have

greater access in demanding and receiving health care.

The researcher had seen many children admitted with

bronchopneumonia and acute respiratory tract infections in the

pediatric ward of Melmaruvathur Adhiparasakthi Institute of

Medical sciences and Research. Based on this experience and

review of literature, the researcher felt that the education on

bronchopneumonia and demonstration of some of the chest

physiotherapy, breathing exercise and maintaining

thermoregulation for mothers having children with

bronchopneumonia is must and important to develop awareness,

healthy attitude in relation to prevention of further complications.

So the study is designed to determine the effectiveness of nursing

care on children with bronchopneumonia.

STATEMENT OF THE PROBLEM

EFFECTIVENESS OF NURSING CARE ON CHILDREN WITH

BRONCHO PNEUMONIA.

OBJECTIVES

to assess the health condition of children with broncho

pneumonia.

7

to evaluate the effectiveness of nursing care on children with

broncho pneumonia.

to correlate the effectiveness of nursing care and selected

demographic variables of children with broncho pneumonia.

OPERATIONAL DEFINITION:

Effectiveness:

It refers to evaluate the significant improvement of health

status of children with broncho pneumonia through efficient

nursing care.

Nursing Care:

Nursing Care refers to maintaining thermo regulation,

promote rest and comfort position steam inhalation, prevention of

infection by using barrier technique, maintenance of hydration,

maintenance of nutritional status, administration of medications,

health education on dietary management, follow up and prevention

of complication.

Children:

Group of people belonging to the age group from birth to 12

years with broncho pneumonia, admitted in Melmaruvathur

8

Adhiparasakthi Institute of Medical sciences and research,

Melmaruvathur.

Broncho Pneumonia:

It refers to the inflammation or infection of the bronchioles

and alveolar spaces of the lungs.

ASSUMPTION

1. Daily assessment of the children enables and ensures to

gain thorough knowledge about progress in children’s health

condition and provide guidelines for the nurse to implement

need based care.

2. Nursing care effectively given will maintain the respiratory

function and prevent complications of Broncho Pneumonia

LIMITATION

1. Sample size was limited to 30

2. Study was limited to children with broncho pneumonia

children at Melmaruvathur Adhiparasakthi Institute of Medical

Sciences and Research, Melmaruvathur.

3. The findings and the study cannot be generalized.

4. The period of study was limited to 6 weeks.

9

CONCEPTUAL FRAME WORK

This chapter stated that conceptual framework formalizes the

thinking process, so that other may read and know the frame of

reference, basic to research problem. The conceptual framework

also enlightens the investigator reading relevant questions on the

phenomena under study.

ORLANDO’S THEORY OF THE DELIBERATIVE NURSING

PROCESS

The conceptual framework for this study was derived from

Orlando’s Theory of the Deliberative Nursing process. Orlando’s

nursing process is totally interactive. It describes, step by step,

what goes on between a nurse and a patient in a specific

encounter.

Orlando’s nursing process is based on an individual’s

actions. The nursing process is used by a nurse to meet a patient’s

need for help; meeting this need improves the child’ behavior. This

process is also used by other health care workers. The

components of Orlando’s nursing process theory are;

Child’s behavior (Orlando uses the term patient)

Nurse (investigator) reaction, and

Nurse (investigator) activity.

10

1. Age 2. Gender 3. Place of

birth 4. Nature of

Birth 5. Birth weight 6. Economic

status 7. Exclusive

breastfeeding

8. Type of family

9. Family history of pneumonia

1. Child’s appearance

2. Type of respiration

3. Vital signs 4. Nutritional

status 5. Child

behavior status

6. Hydration status

7. Sleep pattern

DEMOGRAPHIC VARIABLES

Feed Back

1. Child looks dull, depressed, anxious and has pain in the abdomen

2. Increased body temperature , tachycardia, respiration

3. Child has poor feeding pattern and loss of appetite loss of body weight

4. Child has vomiting and looks dehydrated

5. Child has cough with sputum

6. Child has disturbed sleep pattern

7. parents are asking many questions about Broncho Pneumonia

1. Provide comfortable bed and position

2. vital signs hours and ging

3. all and and diet fruit ck weight

4. r intravenous Maintain output chart

5. am and medication about posal

6. lm and quiet nt.

7. out disease treatment, and of on

CHILD’S BEHAVIOUR

INVESTIGATOR

REACTIONS

STATUS OF CHILDREN WITH BRONCHO

PNEUMONIA

Mild health deterioration

Severe health deterioration

Moderate health deterioration

I

MODIFIED ORLANDO’S THEORY OF THE DELIBERA ING PROCESS

Cheek the every fourtepid spon

Provide smfrequent bljuices, chedaily.

Administefluids and intake and

Provide steinhalation administerand taughtsputum dis

Provide caenvironme

Explain abcondition, follow up preventioncomplicati

TIVE NURS

The frame work used in the study is based on Orlando’s

theory of the deliberative Nursing process model.

The investigator has modified Orlando’s Theory of the

deliberative nursing process.

Orlando’s theory of the deliberative nursing process consists

of,

Child Behavior:

The nursing process is set in motion by the child’s behavior.

The patient who cannot resolve a need feels helpless, and the

person’s behavior reflects this feeling. Child’s behavior can be

verbal such as complaints, requests, and demands or nonverbal

manifested such as heart rate or motor activity or vocally such as

crying. It was assessed by using questionnaire about

demographic variables.

Investigator reaction:

The investigator’s reaction to child’s behavior forms the basis

for determining how the investigator acts; it consists of perception,

thought, and feeling. In this study the investigator reaction is based

on the assessment and needs of the child with

Bronchopneumonia.

11

Investigator activity:

Investigator activity is whatever the investigator says or does

to benefit the child. It occurs after the investigator interprets the

child’s behavior. Based on the assessment of needs of the child

the investigator provided nursing care to the child.

Evaluation:

At the end of nursing care which is provided by the

investigator, effectiveness was evaluated by improved child’s

behavior and needs.

Feed back:

It provides the effectiveness of nursing care on children with

broncho pneumonia.

12

CHAPTER – II

REVIEW OF LITERATURE

Literature review is a key step in the research process. The

main goal of literature review is to develop a strong knowledge

base to carryout research activities in the education and clinical

practice.

A research must be unbiased and replicable and researches

must be aware of committing errors while planning the project,

collecting the required data, analyzing and presenting his

research.

The investigator carried out extensive review of literature

relevant to the research topic which to gain insight and to collect

information for laying the foundation of this study.

This chapter comprises of

A) Review of literature related to broncho pneumonia

B) Review of literature related to causes of Broncho

pneumonia.

C) Review of literature related to prevention and

management of broncho pneumonia.

13

A. REVIEW OF LITERATURE RELATED TO BRONCHO

PNEUMONIA

Jeeson Unni (2009) said in Mangalore Pneumococcal

conference that India leads the world in under five mortality with

twenty lakh children dying every year. Of these, four lakh death

due to pneumonia.

Srinivas.G.Kasi (2009) said that pneumonia is the forgotten

killer of children. It kills more children than any other illness-more

than AIDS, malaria and measles combined according to UNICEF

data.

Marilyn.J.Hockenberry (2008) explained that

bronchopneumonia begins in the terminal bronchioles, which

become clogged with mucopurulent exudates to form consolidated

patches in nearby lobules, also called lobular pneumonia.

SO.Sivabalan (2008) stated that the presence of rapid

respiration has acceptable sensitivity for clinical diagnosis of

bronchopneumonia. The rapid respiration for diagnosis of

bronchopneumonia is defined as respiratory rate of more than 60

breaths/minute in children below two months of age, more than 50

breaths/minute in children between two months and twelve months

of age, and more than 40 breaths/minute in children between one

14

to five years of age. For diagnosis of pneumonia in the community,

presence of rapid respiration is sufficient.

SD.Subba Rao (2008) stated that pneumonia is the

inflammation of the lung parenchyma caused by bacteria, virus or

fungus. It is one of the most frequent respiratory cause of morbidity

in children and accounts for significant mortality in children under

five years of age. Bronchopneumonia is caused by bacteria.

Charles G. Prober (2007) said that Pneumonia is a

substantial cause of morbidity and mortality in childhood

(particularly among children <5 yr of age) throughout the world,

rivaling diarrhea as a cause of death in developing countries. With

an estimated 146–159 million new episodes per yr in developing

countries, pneumonia is estimated to cause approximately 4

million deaths among children worldwide. Currently, the incidence

of community-acquired pneumonia in developed countries is

estimated to be 0.026 episodes per child-year compared to 0.280

episodes per child-year in developing countries.

Dorathy .N. Marlow (2007) stated that pneumococci does

not destroy mucosal cells or interstitial tissue but cause

15

consolidation of all or part of lobe in lobar pneumonia or

consolidation of scattered lobules in bronchopneumonia.

Indian Academy of Pediatrics (2007) explained that

pneumonia in children is a major concern in the developing

countries, because one-third of hospital outpatients comprise of

acute respiratory infections and nearly 30 percent of them are

being admitted to the hospitals for pneumonia. Pneumonia is

leading cause of death in under-five, in developing countries. In

any hospitals 90 percent of death in respiratory illness is due to

pneumonia and its related complications.

Theodore C. Sectish (2007) said that Pneumonia is an

inflammation of the parenchyma of the lungs. Although most cases

of pneumonia are caused by microorganisms, noninfectious

causes include aspiration of food or gastric acid, foreign bodies,

hydrocarbons, and lipoid substances, hypersensitivity reactions,

and drug- or radiation-induced pneumonitis. The causes of lung

infection in neonates and immune compromised hosts are distinct

from those affecting otherwise normal infants and children.

16

DISEASE CONDITION:

Bronchopneumonia

Streptococcus Pneumonia (pneumococcus) and

Mycoplasma Pneumonia both are the common bacterium which

causes in adults and children. Pneumonias tend to be the most

serious and, in adults, the most common cause of pneumonia.

Definition

Achars (2009) Broncho pneumonia is characterized

by patchy exudative consolidation of lung parenchyma due to

terminal bronchiolitis with consolidation of peribronchial alveoli.

Wongs (2005) Broncho pneumonia is defined as

inflammation of the lung parenchyma caused by bacteria, virus or

fungus. It is one of the most frequent respiratory causes of

morbidity in children and accounts for significant mortality in

children under five years of age. It is common community acquired

pneumonia.

Causes

• Pneumonia can be caused by various agents:

• Bacterial infection – pneumococcus, streptococcus,

staphylococcus, H influencza, klebsiella, tubercle bacilli

• Viral infections – influenza, measles, RSV, varicella

17

• Mycotic or fungal infections – candida, aspergillosis,

pneumocysits carinii

• Other infections agents – mycoplasma, chalmydia, etc.,

• Loffler syndrome

• Aspiration of amniotic fluid, food, foreign bodies and lipoid

substances.

Pathogenesis:

• There is initial terminal bronchiolitis with patchy consolidation

of peribronchial lung tissue.

• Bronchioles are plugged by the swollen mucosa and their

secretion. As a result air cannot enter the alveoli.

• The imprisoned air in the alveoli is absorbed causing

collapse of the alveoli.

• Collapsed areas are surrounded by areas of compensatory

emphysema.

• Consolidated areas are surrounded, from inside outwards, by

areas of congestion, collapse and emphysema.

• Resolution of the exudates usually restores normal lung

structure.

• Organization may occur and result in fibrous scarring in

some cases.

18

Stage of consolidation Grey heparisation Deposition of

fibrin and active phagocytosis

Stage of resolution Macrophages –

digestion of bacteria and fibrin

Restoration of normal lung

Stage of consolidation Red

deprivation Infiltration of

polymorphs, red cells and fibrin

`Proliferation and invasion of lung parenchyma –

reactive edema – more proliferation of

organisms

Breach in respiratory

defense mechanisms

Predisposing factors (viral infections, malnutrition,

aspiration, anatomic defects, unconsciousness

CLINICAL FEATURES OF PNEUMONIA

Infants

In infants, URTI usually precedes onset of pneumonia.

Abrupt onset of high fever, with respiratory distress, restlessness,

air hunger and cyanosis may be seen, along with grunting flaring

of the alae nasi and retraction of the supraclavicular, intercostals

and sub costal areas, tachypnea and tachycardia. Cough appears

later. In broncho pneumonia, crepitations can be heard in the early

stages. The abdomen is often distended and the liver enlarged.

The neck is kept retracted to provide adequate airway.

Children:

In children, onset is characterized by high fever and chills

with intermittent restlessness, drowsiness, rapid respirations and

19

dry cough. Cyanosis may be seen, and the child prefers to lie on

the affected side to minimize pleuritic pain.

Diagnostic evaluation

The WBC count increases up to, 40,000 cells/mm3 with

polymorph nuclear preponderance. Pneumonia can be isolated

from the nasopharyngeal secretions in pneumococcal pneumonia.

Blood cultures may be positive in about 30% of cases, provided

the information that child has not received antibiotics before the

sample is taken.

Radiological changes may be typical with well-defined

opacity. Evidence of pleural effusion can be seen. Radiograph

should be followed-up after 3 – 4 weeks and should show

complete resolution. Staphylococcal lung disease should be

suspected if there are pneumatoceles (air pockets) or

pneumothorax and other air leak findings on the x-ray.

Complications of Pneumonia

• Empyema

• Lung abscess

• Collapse

• Pyothorax /Pneumothorax, especially with staphylococcus

aureus

20

• Septicemia

• Bronchiectasis

Differential Diagnosis

It is difficult to differentiate this condition from other bacterial

and viral pneumonias. Conditions that need to be differentiated

include bronchiolitis, foreign bodies, sequestered lobe, atelectasis,

pulmonary abscess and pulmonary tuberculosis. In infants, neck

retraction can lead to a mistaken diagnosis of meningitis.

Medical Management

• General measures include oxygen, hydration, antipyretics

and nutrition in any child with pneumonia.

• Some adjuvant therapies such as humidification of inspired

air (steam inhalation) and postural drainage to remove

secretions, especially during the resolution phase, are as

important as antibiotics

• In the presence of hypoxia, oxygen therapy will be required

and when severe respiratory distress is present, the child will

require ventilatory support

• Intravenous fluids may have to be administered in sick

children with significant respiratory distress.

21

Antibiotics

Organism Preferred Antibiotic Streptococcus

pneumonia

Crystalline penicillin initially 50,000 units/kg/24

hours administered IV six hourly, followed by

procaine penicillin daily for 7-10 days

Staphylococcus

aureus

Cloxacillin, 100 mg/kg/24 hours and amikacin

Gram – negative

organisms

Cefotaxime 100 mg/kg and gentamycin or

cefotazidime and amikacin or other newer

extended spectrum cephalosporins

Hemophilus

influenzae

Ceftriaxone (100 mg/kg/24 hours) or

chloraphenicol and ampicillin (100 mg/kg/24

hours)

Prognosis

With treatment, most patients will improve within 2 weeks.

Elderly or debilitated patients may need treatment for longer. Your

doctor will want to make sure your chest x-ray becomes normal

again after you take a course of antibiotics.

Prevention

• Wash your hands frequently, especially after blowing your

nose, going to the bathroom, diapering, and before eating or

preparing foods.

• Don't smoke. Tobacco damages your lung's ability to ward

off infection.

22

• Wear a mask when cleaning dusty or moldy areas.

Vaccines can help prevent pneumonia in children, the

elderly, and people with diabetes, asthma, emphysema, HIV,

cancer, or other chronic conditions:

• Pneumococcal vaccine (Pneumovax, Prevnar) prevents

Streptococcus pneumoniae.

• Flu vaccine prevents pneumonia and other problems caused by

the influenza virus. It must be given yearly to protect against

new viral strains.

• Hib vaccine prevents pneumonia in children from Hemophilic

influenza type

B. REVIEW OF LITERATURE RELATED TO CAUSES OF

BRONCHO PNEUMONIA.

Khoja. T.A. et al ., (2009) stated that the physicians had

estimated ARI was the cause of sickness in 50% of all ill children

more than five years in 1995 none of the physicians had any

training in ARI and they were not awarding any National Protocol

or Program. A National protocol from Diagnosis and Treatment of

ARI has been distributed and leaders of PHC and 55 National

trainers have been trained.

23

McGraw (2009) reported the diagnosis and management of

pediatric pneumonia cases can present unique challenges to the

emergency physician. However, having a heightened sense of

awareness toward certain presenting signs and symptoms from

the child or parent and the appropriate emergency department

workup and management can serve to dismantle these challenges.

Pneumonia is defined pathologically as an inflammation of lower

tract lung tissue. Clinically, pneumonia is defined by the presence

of pulmonary infiltrates on a chest radiograph, usually associated

with a combination of clinical signs, such as cough, fever, chest

pain, tachypnea, and a variety of abnormal auscultatory findings.

This chapter does not discuss in detail the entities associated with

the diagnosis of pneumonia, such as interstitial processes, foreign

body aspiration, chemical inflammation, Mycobacterium

tuberculosis, and certain protozoal infections (e.g., Pneumocystis

carinii).

Dr.Nitinshah (2009) said half of all severe case of

pneumonia and pneumonia deaths are caused by pneumococcal

and almost forty percent of these deaths, nearly one lakh under-

five deaths are preventable by use of pneumococcal conjugate

vaccine in the national immunization programme.

24

Nelson.C.Chrles (2008) stated that the most bacterial agent

which is responsible for bronchopneumonia are pneumococcus,

streptococcus, staphylococcus, H.influenza, klebsiella, tubercle

bacilli.

English. R.M. Badcock J.C et al., (2008) conducted a study

in Vietnam to know the effects of Nutrition improvement project

based on home garden food production and Nutrition education on

morbidity from ARI. Found that there is a significant reduction in

the incidence of Respiratory infection as well as the incidence of

Pneumonia and severe Pneumonia.

Chye. J.K. Lim (2008) examined the pattern and the

influence of some socio demographic factors on infants mild

feedings and the protecting role of breast feeding against

infections. Their opinion was there was no significant difference in

the rates and upper respiratory infections between the infants, who

were or were not being breast fed. Breast feeding does not appear

to confer significant protection to upper respiratory infections.

Jerome Klerin (2008) anayalized that out of 2, 339 under

two years of age hospitalized for Pneumonia broncholits, and

lwango trachew bronchitis. It was found that fatality role for these

25

illnesses was 1.9 times higher in weaned infants as compared to

breast fed ones and the child is prone to get of it media.

Shama.R. Sangeetha et al., (2008) conducted a study on

642 infants to determine the incidence of Acute lower respiratory

infections and its relationship to indoor air pollution, due to the fuel

used for looking (wood or kerosene) found that Pneumonia won

the most common ailment in all the groups and a higher incidence

of Acute lower respiratory infections was found in repeated

kerosene users.

The international conference Canbera, Austrialia (2007) –

Stated that ARI kills four million children every year in developing

countries and most of their deaths are caused by pneumonia.

Bhandari.D. (2006) conducted study and said that Zink

supplementation reduces the incidence of pneumonia in children

living in a slum community in New Delhi, India. Daily elemental

Zink supplementation together with a single dose of vitamin-A

reduces the risk of pneumonia subsequently more than in children

who received daily placebo and vitamin-A.

Gadomsbi, Khalaf, Ansary and Black (2006) in a base line

study for training purposes, assess using two indications of ARI

26

the respiratory rate and chest in drawings by health personnel and

concluded that these are reliable indicators.

Khan A.Z., Tickoo. R. et al (2005) conducted a study on the

knowledge on ARI and Pneumonia relation to the literacy status of

mothers whose children suffered from ARI. The majority of the

literate mothers (75%) had complete knowledge, regarding

Management of ARI. Literacy alone was not only the factor,

responsible for developing a positive attitude and adopting correct

practice during ARI mass media and health Personal played in

equally important role.

Parthasarathy (2005) –reported that nearly five million

children die of ARI and its related complication every year in

developing countries. The world statistic shows that one child dies

of ARI every 8 second.

Pinnock Carole (2005) mentioned that vitamin A deficiency

increase susceptibility to Respiratory infection.

Dutta Mahendra and Shemma (2004) Identified that LBW

and Malnutrition have been an important factor with increase the

risk of ARI and thereby increase the risk of pneumonia in Children.

27

W.H.O Report (2000) stated that acute respiratory tract

infection (ARI) is mostly in the form of pneumonia, is the

leadership over two million children annually. Up to 40% of

children seen in health clinics are suffering from ARI and many

deaths attributed to other causes are in fact, children with ARI.

C. REVIEW OF LITERATURE RELATED TO PREVENTION AND

MANAGEMENT OF BRONCHO PNEUMONIA.

Arch Pediatr.A. Carsin E (2008) reported the cases of two

young immunocompetent children with bronchopneumonia

associating disabling, spastic cough and severe hypoxemia. In

both patients, a primary Epstein - Barr virus (EBV) infection had

been suggested based on EBV presence in nasal secretions and a

positive serology with anti-VCA immunoglobulin M. Nevertheless,

the diagnosis was not confirmed. We discuss the problems

confirming EBV responsibility in acute respiratory infections and

the pitfalls of diagnostic tests.

David Wilson (2008) explained that the nurse should assess

the general sign of bronchopneumonia are fever-usually quite high;

cough - Productive to productive with whitish sputum Tachypnea;

breathsounds- rhonchi or fine crackles; chest pain; retraction;

nasal flaring; pallor to cyanosis; behavior irritable, restless,

28

lethargic gastro intestinal anorexia, vomiting, diarrhea, abdominal

pain.

J Natl AW, Osinusi K, ( 2008) reported that acute lower

respiratory infections are more responsible for community acquired

pneumonia. Investigative tools included blood culture, hemogram,

immunoluorescence and serology. Associations of variables were

tested using standard statistical tools. Of 419 ALRI, 323 (77%) had

pneumonia, 234 (72.4%) bronchopneumonia, 66 (20.4%) lobar

pneumonia and 23 (7.1%) both. More than 70% had poor parental

socioeconomic parameters, 56.8% were overtly malnourished,

37.8% lived in overcrowded homes and 16.7% had been

potentially exposed to wood smoke.

Marilyn.J. (2008) stated that Nursing care of the child with

bronchopneumonia is primarily supportive and symptomatic but

necessitates thorough respiratory assessment and administration

of oxygen and antibiotics. The child’s respiratory rate and status,

as well as general dispositions and level of activity are frequently

assessed.

Renald.A.Dec (2008) stated that at present, syncytial

respiratory virus is the major agent of respiratory infections in

29

pediatric patients. It can determine an important respiratory

distress in particular children, as prematures with an gestational

age <32 weeks, children affected by congenital heart diseases or

bronchopneumonia dysplasia. In these patients, the prophylaxis

with palivizumab is very important to prevent chronic pulmonary

diseases.

Arch Pediatr, Marchac V. (2007) concluded acquired

bronchopneumonia is very common in children and responsible for

a great morbidity. It can be revealed by bronchiolitis, due to viral

infection, bronchitis (80% due to viruses), and pneumonia

potentially much more severe due to bacteria (60%), viruses (40%)

or both causes (20%). Being unable to exclude a bacterial origin in

pneumonia leads physicians to prescribe systematically antibiotics.

Anderson V.M, Turner T. (2007) reported that acute lower

respiratory infection in children is a major cause of morbidity and

mortality in developing countries. Viral and bacterial agents incite

characteristic host responses at the level of the bronchi,

bronchioles, alveolar walls, and air spaces that correlate with the

clinical course. A systematic review of histopathologic features will

enhance the understanding of the pathogenetic mechanisms and

cofactors that influence the disease process, particularly how

30

tissue injury may be influenced by nutritional status and access to

antibiotics. Research priorities include immunologic assessment,

micronutrient assays, and standardized autopsies in developing

countries. DNA probes for organisms and immunocytochemical

identification of cell markers in tissue promise a new era in

microscopic visualization of pathogen-host interactions

International collaborative research between ministries of public

health and medical universities must be encourages as a means of

providing technical assistance and of advancing new knowledge.

Aexheimer Andrew (2007) concluded that no drug had

been shown to prevent ARI, which is responsible to develop of

more serious illness such as pneumonia. It is provided that vit C

which neither prevents cold nor shortens the duration nor reduces

symptoms.

Barbara.a.Redding (2007) stated that child with

bronchopneumonia during hospitalization, it is necessary that the

nurse must make frequent assessment to determine the child’s

respiratory status, that is monitoring respiration for rate, depth,

type and heart rate.

Ellaine.E.Dobbins (2007) stated that bronchopneumonia

children or infants should be permitted to assume a position of

31

comfort, they generally are most comfortable in a semi erect

position. If the pneumonia is unilateral they are usually most

comfortable if they lie on the affected side to splint the chest wall

and to reduce painful pleural rubbing. Their position should be

changed two to three hours to encourage respiratory efforts and to

increase the drainage of secretions.

Khamgondar. M.B Kalkarni A.P et.al (2007) conducted a

study on 635 mothers in an urban Slum area of Nanded city, they

assessed the awareness on home Management of symptoms of

Pneumonia. And they found that 50.4% of the mothers were not

knowing a single symptoms of Pneumonia followed by 5% mothers

who were aware of rapid Abdominal movements as a symptom of

Pneumonia.

Malhotra. Krilov et al (2007) discussed about the

pathogenesis of the two diseases influenza and Respitrorary

syncytial virus in children and emphasized each infections

significance and the need for vaccines.

Pediatr Infect Dis J. (2007) stated that Upper respiratory

infections (URI) are a source of significant morbidity in childhood

and have been associated with the development of certain

32

bacterial infections. However, the high incidence of URI contrasted

with the low incidence of lower respiratory infection (LRI) suggests

a low rate of development of viral or bacterial LRI after URI.

Because the etiology of URI is primarily viral, antibiotics do not

have any significant effect on the URI episode itself but have been

used to treat URI in hopes of preventing bacterial complications

after URI.

Zimmerman R.K Bradford B.J et al., (2007) conducted a

study to understand the causes of Low childhood immunization

rates and they stated that if the goal of healthy people by 2000 is

to eliminate indigenous cases of measles free vaccine supplies of

red education are to be provided.

Abdullah broods. W. Dec (2006). conducted a study on

zinc deficiency and child health in developing countries,

expressed, that zinc supplementation is known to reduce the

incidence of Acute lower Repertory infections because ALRI

accounts for an extreme burden of morality of mortality especially

pneumonia among young children in the developing world.

Chopra Kamalesh (2006) stated that under noun shed

children are more susceptible to infection. Average duration of

33

infection was significantly longer in malnourished children. Comp

Pneumonia and Broncho pneumonia occurred 19 times more

among the malnourished than in well nourished Children.

Gomirato G. Bonomi et al., (2006) conducted studying

broncho pneumonia, after reviewing the incidence and aetiology of

the lower respiratory infections found among children, it was found

that lower respiratory infection is also major cause for

bronchopneumonia if not treated properly.

Pinnok carole (2006) mentioned that vit A deficiency

susceptibility to respirtitory infections. Hence this can be prevented

by giving vit A solution and Vit A containing foods.

Pediatric Child Health. (2006) evaluated antibiotic choices

and recommendations for duration of therapy made by pediatric

residents (PRs) and recently graduated pediatricians (RGPs) in

several typical infectious disease conditions. PRs and RGPs

made similar and reasonable recommendations, largely in line with

published guidelines, for most of the infectious disease scenarios

presented. For some conditions, a significant minority of

respondents unnecessarily recommended broad-spectrum

antibiotics. The most variable responses were for duration of

34

treatment, reflecting the lack of certainty in the published evidence

base for many conditions.

Saudi Med J. (2006) stated that acute respiratory infection of

children less than 2 years of age in Riyadh City and their socio

demographic and anthropometric correlates. They concluded the

Intervention strategies to control acute respiratory infections in

children less than 2 years of age should target working mothers,

less educated mothers, malnourished unvaccinated children and

encourage periodic follow up visits for children.

Tiwami R.R Kulkarni. P.N (2006) commented that the

common causes for delayed immunization were negligence on part

of the parent unawareness about the use of vaccines and sickness

of the child.So health education of parents was recommended.

Yao K. (2006) conducted Jiang Su Province an outbreak of

broncho pneumonitis occurred. In December the number of

admitted infant cases with broncho pneumonitis was 32% of total

hospitalized cases. The youngest infant was 28 days in age and

the oldest was one and half years. 71.5% percent occurred in

children less than six months in age. From nasopharyngeal

washing of acute cases were isolated 6 strains of viruses. The

35

result of identification of them revealed that they were respiratory

syncytital virus. 3 pairs of serum sample were collected from acute

and convalescent periods for neutralizing antibody titrations. The

result showed that specific neutralizing antibody titers increased 8-

64 fold in comparison between the acute and the convalescent.

An Med Interna. Mar (2005) explained Pneumonia is a

pathology originated from different causes, it affect principally men

and more especially at younger than 5 years and older than 65

years. The incidences stabilizing on the studied period last years.

This works must be continued for clarify if it is the same way for

the development by the different pneumonias types on this time

period and if exists the interactions between the different variables.

Klin Padiatr. Jul (2005) elaborated data on the descriptive

epidemiology of Community-acquired pneumonia (CAP) are a

prerequisite to estimate the impact of new vaccines. The incidence

and the admission rate of severe CAP is lower than in the USA.

The high rate of emphysema warrants enhanced surveillance as

an indicator for antibiotic resistance or changing impact of

pneumococcal serotypes. Misclassification, also with ICD codes, is

a major issue. Well analyzed epidemiological recruitment areas

are a valid tool to generate precise data in Germany.

36

Banga.t,Bangr.a et al., (2004) stated that neonatal

pneumonia kills about two million children a year worldwide. The

World Health Organization recommends hospitalization of all

cases of pneumonia in the first two months of infancy. In a field

trial of community based management of childhood pneumonia in

Gadchirodia, India, neonatal pneumonia contributed more than half

of the pneumonia deaths. Parents refused referral even when

advised, therefore community based health workers and traditional

birth attendants managed cases of neonatal pneumonia with co-

trimoxazole.

Nyi Nyi (2003) has highlighted that acute respiratory

infection represent either the 1st or second cause of visits to health

services, by the young children. The annual incidence of

pneumonia in developed countries shows that the most severe

manifestation. ARI is present in 3 to 4 children under 5 years of

age, but it ranges from 10 to 20 % in the developing countries,

reaching levels as high as 80% in population with a high

prevalence of malnutrition and low birth weight.

37

CHAPTER – III

METHODOLOGY

This chapter deals with the methodology adopted for the

study including the description of research approach, research

design, and population of the study, sample size, setting, Sampling

Technique, Data collection and instrument.

RESEARCH DESIGN

Evaluative research design was adopted to evaluate the

nursing care of children with broncho pneumonia. The children’s

needs and problem were assessed and nursing care was

provided.

SETTING OF THE STUDY

The study was conducted in pediatric ward at Melmaruvathur

Adhiparasakthi Institute of medical sciences and Research,

Melmaruvathur, Kanchipuram District.

POPULATION

The population of the study compromised of all the children

with broncho pneumonia who were admitted in peadiatric ward at

Melmaruvathur Adhiparasakthi Institute of medical sciences and

Research.

38

SAMPLE SIZE

Sample size consisted of 30 children who were admitted in

pediatric ward at Melmaruvathur Adhiparasakthi Institute of

Medical sciences And Research who are included in the study.

SAMPLING TECHNIQUE:

Sampling method adopted was probability sampling method.

Sampling Technique used is simple random sampling method.

E.g-by using table of random numbers.

CRITIERIA FOR SAMPLE SELECTION

INCLUSION CRITERIA

All the children with broncho pneumonia who were admitted

in pediatric general ward at Melmaruvathur Adhiparasakthi

Institute of medical sciences and research.

Mother’s of broncho pneumonia children who could

understand Tamil or English.

Children with broncho pneumonia between 0-12years of age.

EXCLUSION CRITERIA

Children with bronchopneumonia who have other associated

Disorders.

39

DESCRIPTION OF THE TOOL

Section – I: Demographic variables

Section – II: Rating scale for Assessment of child with bronco

pneumonia

Section – III: 1. Protocol for nursing care of child with broncho

pneumonia.

2. Observational check list of Nursing intervention consists of

Thermoregulation, promoting rest and comfort, steam inhalations

prevention on infection, maintenance of hydration, maintenance of

Nutritional status, Administration of medications, sputum disposal

health education and guidance and counseling.

Data Collection:

The study was conducted in Melmaruvathur Adhiparasakthi

Institute of Medical Sciences and Research. The data was

collected for a period of six weeks by using the prepared tools. The

tools were developed based on the objectives of the study and

through review of literature.

40

CHAPTER-IV

DATA ANALYSIS AND INTERPRETATION

This chapter deals with the description of the tool, report of

the pilot study, reliability, validity, informed consent, scoring,

interpretation, plan for data analysis and results.

DESCRIPTION OF THE TOOL

Details of the tools used in the study are given below

Section – I Proforma for demographic variables

Section – II Ongoing assessment with rating scale

Section – III Observational checklist of nursing care of child with

broncho pneumonia

Section – I Demographic Variables (Related to child and

family)

In this section, information on the demographic variables

such as age of the child, gender, place of birth, nature of birth,

birth weight, birth order, immunization status, exclusive breast

feeding, weaning started, type of family, education status of father

and mother, working status of father and mother, family income,

family history of pneumonia, source of health information.

41

Section–II: Ongoing Assessment with Rating Scale

This section consists of fifteen components regarding the

health condition of the children with broncho pneumonia each

components carried maximum score of three, minimum score of

one and the total score was forty five. Based on the information

the data were classified as follows.

1 – 15 Mild health deterioration

16 – 30 Moderate health deterioration

31 – 45 Sever health deterioration

After collecting the data, the data were analyzed to find out

mean, standard deviation and percentage of scores for children

with broncho pneumonia.

Section – III Observational Checklist of Nursing Care Of Child

With Broncho Pneumonia

In this section, the checklist for nursing care given to the

children was included. It consisted of maintaining thermo

regulation, Promote rest and Comfort position, Steam inhalation,

Prevention of infection by using barrier technique, Maintenance of

Hydration, Maintenance of Nutritional Status, Administration of

medications, Health education on dietary management, follow up

and prevention of complication.

42

PILOT STUDY REPORT

Pilot Study was conducted to assess the effectiveness of

nursing care on children with broncho pneumonia in

Melmaruvathur Adhiparasakthi Institute of Medical sciences and

research from 20.04.09 to 30.04.09, initially permission was

obtained from the head of the department of pediatrics to conduct

Pilot study. Six children were selected for Pilot study from pediatric

ward who met the inclusion criteria. The assessment was done by

using the planned ongoing assessment tool for the children who is

having broncho pneumonia and nursing care was given. After five

days the children were evaluated and the results were analyzed

based on the assessment score.

The data was analyzed by using paired t test statistics. The

results of the study was,

Calculated value=5.13

Tabulated value=2.269

Level of significance 0.05

The calculated value was greater than the tabulated value.

Therefore the effectiveness of nursing care was significant.

43

VALIDITY AND RELIABILITY

Effectiveness of nursing care of children with broncho

pneumonia was developed by the investigator based upon the

review of literature. The tool was evaluated by five experts for

content validity. Reliability was established by test and retest

method. The pre assessment was done first time for 6 samples

and post assessment was done after week of implementing

nursing interventions in both cases responses had difference and

some progress was found. The test was measuring the same

attribute the tool was found to reliable one.

INFORMED CONSENT

The Research committee prior to the pilot study approved

the research proposal. Permission was obtained from the

concerned authority in Melmaruvathur Adhiparasakthi Institute of

Medical Science and Research, Kanchipuram District. The oral

consent from each broncho pneumonia children’s mother was

obtained before starting the data collection. Assurance was given

to the mothers that confidentiality would be maintained.

44

DATA COLLECTION PROCEDURE

The gathering of information to address a research problem.

And the duration of the study was 6 weeks. With the prescribed

period, the investigator selected each sample in pediatric general

ward of Melmaruvathur Adhiparasakthi Institute of Medical Science

and Research. First the assessment was done by using the Rating

Scale and nursing interventions were done, then the post

assessment was done. During the data collection period,

adequate privacy has provided both in individual and group

interventions and everyone has assessed about the confidentiality

of the nursing intervention. The items were repeated for better

understanding.

SCORING INTERPREATION

Section I: The Demographic variables as mentioned earlier were

coded to assess the background of the child and family and

thereby, to subject it for statistical analysis.

Section - II: Consists of ongoing assessment rating scale

regarding health condition of the children with broncho pneumonia.

Score of (1), (2), and (3) marks were given for each option to a

question. Totally 15 questions which concludes total score of 45

marks.

45

The score can be interpreted by

Scoring interpretation = Obtained score X 100

Total score

The score were ranged as follows,

Mild – below 50%

Moderate – 51% - 75%

Severe – above 75%

Table – 4.1 Score Interpretation

Description of Health Status Percentage

Mild deterioration Below 50%

Moderate deterioration 51% - 75%

Severe deterioration Above – 75%

Section - III: Observational checklist of nursing care of children

with Broncho pneumonia.

DATA ANALYSIS PROCEDURE

The systematic organization and synthesis of research data,

and the testing of research hypothesis using those data.

Data were analyzed by descriptive statistics (frequency,

percentage, mean and standard deviation) and inferential statistics

46

(paired‘t’-test, and correlation). Correlation was used to correlate

the demographic variables and nursing intervention among

children with broncho pneumonia.

Paired‘t’ test was used to determine the effectiveness of

nursing intervention in pre and posttests.

Table 4.2 Statistical Method

S.no Data analysis Methods Remarks

1.

Descriptive analysis

The total number of

score, percentage of

score, mean and

standard deviation

To describe the demographic

variables of the

Bronchopneumonia children

2.

Inferential analysis

Paired ‘t’ test

Effectiveness of Nursing

intervention

3.

Inferential analysis

Correlation

To analyze the association

between demographic

variables and the

effectiveness of selective

nursing intervention.

47

DATA ANALYSIS AND INTERPRETATION

Section – A Frequency and percentage distribution of the

demographic variable of the children with broncho pneumonia

Section – B Frequency and percentage distribution of

assessments score and evaluation score of children with broncho

pneumonia.

Section - C Mean and standard deviation of assessment and

evaluation scores of children with Bronchopneumonia.

Section – D Improvement score mean and standard deviation of

assessment and evaluation score and effectiveness of nursing

care of children with broncho pneumonia.

Section – E The correlation between demographic variables and

effectiveness of nursing care of children with broncho pneumonia.

48

SECTION - A

Table 4.1Frequency and percentage distribution of the

demographic variable of the children with broncho pneumonia

N=30 S. No. Demographic variables No Percentage

1.

Age in years

a) 0-3 years

b) 4-6 years

c) 7 - 9 years

d) 10 - 12 years

21

6

2

1

70

20

7

3

2. Nature of birth

a) Spontaneous vaginal delivery

b) Caesarian

e) Assisted delivery

22

6

2

73

20

7

3. Birth weight

a) <2.5 kg

b) 2.6 – 3 kg

a) > 3 kg

12

16

2

40

53

7

4.

Demographic Variables related to

child.

Sex

a) Male

b) Female

18

12

60

40

49

5.

Place of birth

c) Hospital

d) Home

28

2

93

7

6.

Exclusive Breast feeding

a) 1 – 6 months

b) 6 -12 months

c) Above 1 year

22

7

1

74

23

3

7.

Weaning started at

a) < 6 months

b) > 6 months

23

7

77

23

8.

Immunization status

a) Complete for age

b) Incomplete for age

c) Non immunized

26

3

1

87

10

3

9.

Birth orders

a) 1st Born

b) 2nd Born

c) 3rd Born

d) Above 3rd

11

13

4

2

37

43

13

7

50

10.

Demographic data related to family

Type of family

a) Joint

b) Nuclear

18

12

60

40

11.

Family history of Pneumonia

a) Yes

b) No

8

22

27

73

12.

Family income per month

a) Below Rs 1000

b) Rs 1001 to 3000

c) Rs 3001 and above

13

10

7

44

33

23

13.

Area Presidents

a) Urban

b) Rural

12

18

40

60

51

Table 4.1 shows that among 30 Bronchopneumonia

children18 (60%) were belongs to Male, 12 (40%) were Female.

Among them, 21 (70%) belonged to 0 – 3 years one (3%) belongs

to 10-12 years. In that 28 (93%) were hospital delivered, and two

(7%) delivered in home. Among them 22 (73%) were by

spontaneous vaginal delivery, and two (7%) were by assisted

delivery.

Among 30 children sixteen (53%) were birth weight between

2.6 to 3kg, and two (7%) were above 3kg. According to birth order

13(43%) were second born, and two (7%) were above third born.

According to immunization status 26 (87%) were fully immunized,

and one (3%) were non immunized. According to exclusive breast

feeding 22 (74%) were belongs to one to 6 months, and 1(3%) was

above one year.

According to weaning started 23 (77%) were stared less than

6 months and seven (23%) were started more than 6 months.

According to type of family 18 (60%) were belongs to join family,

12 (40%) belongs to nuclear family. According to family history of

Pneumonia eight (27%) were had family history of pneumonia and

22 (73%) were not have family history of pneumonia. According to

family income 13 (44%) were belongs to below Rs. 1000 per

month, and seven (23%) were to above 3000 thousand per month.

52

Section –B

Table4.2 Frequency and percentage distribution of

assessments score and evaluation score of children with

broncho Pneumonia.

N=30

Mild health deterioration

> 50%

Moderate health deterioration (50%-75%)

Severe health deterioration (75%– 100%)

Health Status of the

Children No % No % No %

Assessment 1 3 6 20 23 77

Evaluation 27 90 3 10 0 0

Table 4.2 shows that among 30 broncho pneumonia children

23 (77%) had severe health deterioration, six (20%) had moderate

health deterioration. And only one (3%) had mild health

deterioration during assessment .In evaluation 27 (90%) had mild

health deterioration three (10%) had moderate deterioration and

there was no child with sever health deterioration. This shows that

nursing care of children with broncho pneumonia is highly

effective.

53

Section - C

Table4.3 Mean and standard deviation of assessment and

evaluation scores of children with broncho pneumonia.

N=30

Topic Mean Standard Deviation

Standard Error Mean

Assessment 38.63 5.26 0.96

Evaluation 17.53 3.89 0.71

Table 4.3 In Assessment, the mean is 38.63 with the

standard deviation of 5.26 and the standard error mean is 0.96.In

the evaluation, the mean was17.53 with the standard deviation of

3.89 and the standard error mean 0.71.

54

Section – D

Table 4.4 Improvement score mean and standard deviation of

assessment and evaluation score and effectiveness of

nursing care of children with broncho pneumonia

Paired differences 95% confidence interval of the

difference

Mean Std.

Deviation

Std Mean Error

LL UL

t df Significance 2

tailed

Pre Test Post Test

21.10 5.62 1.03 19.00 23.20 20.56 29.00 .00

.

Table 4.4 reveals the average of pre and post score was 21.10,

standard deviation was 5.62, standard error mean was 1.03, 95%

confidence interval of difference lower and upper was 19.00, 23.20

respectively. And the paired’t ‘is 20.56 compared with table value

at 0.001level of significance, the table value was3.102 which was

compared with calculated value 20.56 there was a high

significance between pre and post nursing care. This concludes

that nursing care was highly effective at P<0.001.

55

Section – E

Table 4.5 Correlation between demographic variables and effectiveness of nursing care of children with broncho pneumonia N=30

Assessment Evaluation

Mild Moderate Severe Mild Moderate r S.No Demographic

Variable No % No % No % No % No % No %

1.

Demographic Variables

related to child.

Sex

a) Male

b) Female

18

12

60%

40%

0

1

0

8

5

1

28

8

13

10

72

84

15

12

83

100

3

0

17

0

0.43

S

2.

Age in years

a) 0-3 years

b) 4-6 years

c) 7 - 9 years

d) 10 - 12 years

21

6

2

1

70 %

20 %

7 %

3%

0

0

0

0

0

0

0

0

2

2

1

0

10

33

50

0

19

4

1

1

90

67

50

100

21

4

2

1

100

67

100

100

0

2

0

0

0

33

0

0

0.23

S

3.

Place of birth

e) Hospital

f) Home

28

2

93%

7%

1

1

4

50

5

1

18

50

22

0

78

0

25

2

89

100

3

0

11

0

0.14

NS

56

4.

Birth weight

c) <2.5 kg

d) 2.6 – 3 kg

e) > 3 kg

12

16

2

40%

53%

7%

0

1

0

0

6

0

1

5

0

8

31

0

11

10

2

92

63

100

11

14

2

92

88

100

1

2

0

8

12

0

0.25

S

5.

Immunization status

a) Complete for age

b) Incomplete for age

c) Non immunized

26

3

1

87%

10%

3%

1

0

0

4

0

0

5

1

0

19

33

0

20

2

1

77

67

100

0

3

1

23

100

100

88

0

0

12

0

0

0.35

S

6.

Exclusive Breast feeding

a) 1 – 6 months

b) 6 -12 months

c) Above 1 year

22

7

1

74%

23%

3%

1

0

0

5

0

0

2

4

0

9

57

0

19

3

1

86

43

100

20

7

1

91

100

100

2

0

0

9

0

0

0.28

S

7.

Weaning started at

a) < 6 months

b) > 6 months

23

7

77%

23%

1

0

4

0

3

3

13

43

19

4

83

57

21

6

91

86

2

1

9

14

0.12

NS

8.

Family history of

Pneumonia

a) Yes

b) No

8

22

27%

73%

1

0

2

0

2

4

26

18

5

18

62

82

7

20

88

91

1

2

12

9

0.28

S

9.

Family income per month

a) Below Rs 1000

b) Rs 1001 to 3000

c) Rs 3001 and

above

13

10

7

44%

33%

23%

0

1

0

0

10

0

4

1

1

30

10

14

9

8

6

69

80

86

13

10

4

100

100

57

0

0

3

0

0

43

0.57

S

S-significant at p 0.001

NS- Non Significant

57

Table 4.5 reveals that the correlation between demographic

variables and the effectiveness of Nursing care among children

with broncho pneumonia. Statistically there was a significant

correlation between the demographic variables such as sex, age,

place of birth, nature of birth, birth weight, immunization status,

exclusive breast feeding, weaning started, family history of

pneumonia and type of family. But statistically there was no

significant correlation between the demographic variables such as

birth order, family income and primary source of health information

and Nursing Care.

58

II

III

IV

V

V

VI

VI

VII

VIII

CHAPTER – V

RESULTS AND DISCUSSION

The study was conducted to determine the effectiveness

nursing care of children with broncho pneumonia. The study

findings have been discussed in terms of the objectives of

theoretical basis and hypothesis. A total number of 30 samples

were selected for the study. The health condition of each and

every children was assessed every day. Based on the assessment

the nursing care was planned and implemented for the children

with broncho Pneumonia.

The First objective was to assess the health condition of the

children with broncho Pneumonia.

Table 4.2 shows that among 30 broncho pneumonia children

23 (77%) had severe health deterioration, six (20%) had moderate

health deterioration. And only one (3%) had mild health

deterioration during assessment.

Table 4.3 reveals that in Assessment, the mean is 38.63

with the standard deviation of 5.26 and the standard error mean is

0.96.

59

The Second objective was to evaluate the effectiveness of

nursing care on children with broncho pneumonia.

Table4.2 reveals that after evaluation 27 (90%) had mild

health deterioration three (10%) had moderate deterioration and

there was no child with sever health deterioration.

Table4.3 reveals that In the evaluation, the mean was17.53

with the standard deviation of 3.89 and the standard error mean

0.71. This shows that nursing care of children with

bronchopneumonia was highly effective.

Table 4.4 reveals the average of pre and post score

was21.10, Standard deviationwas 5.62, Standard error mean was

1.03, 95% confidence interval of difference lower and upper was

19.00, 23.20 respectively. And the paired t is 20.56 was compared

with table value at 1% and .001 level of significance, the table

value was 3.102 which was compared with calculated value 20.56

there was highly significance between Pre and Post Nursing care.

This concludes nursing care was highly effective at P<0.001.

Nurses working in pediatric ward should assess the children

and then plan for giving nursing care according to priority. Nursing

60

care plays a significant role in protecting the children from the

complications of broncho pneumonia.

The third objective was to find out the correlation between the

effectiveness of nursing care and selected demographic

variables of Children with broncho pneumonia.

Table 4.5 reveals that the correlation between demographic

variables and the effectiveness of Nursing care among children

with broncho pneumonia. Statistically there was significant

correlation between the demographic variables such as sex, age,

place of birth, nature of birth, birth weight, immunization status,

exclusive breast feeding, weaning started, family history of

pneumonia and type of family. But there was no correlation

between the demographic variables such as birth order family

income and primary source of health information and Nursing

Care.

This study helps to know the effectiveness of Nursing care

on Children with broncho pneumonia who were admitted in the

Pediatric ward at Melmaruvathur Adhiparasakthi Institute of

Medical Sciences and Research.

61

CHAPTER-VI

SUMMARY AND CONCLUSION

In this chapter, the summary of the study, conclusions, and

implications for nursing practice and recommendations for further

research are presented.

The purpose of the study was to evaluate effectiveness of

selective nursing intervention among children with broncho

pneumonia by using the assessment rating scale before and after

the nursing intervention in pediatric ward at Melmaruvathur

Adiparaskhi Institute of Medical Science and Research,

Melmaruvathur.

Evaluative research design was used for this study. The

conceptual frame work was based upon Modified Orlando’s theory

of the deliberative nursing process model.

The instrument used for data collection was rating scale for

assessment of children with broncho pneumonia which is used for

pretest and post test.

A simple random sampling method was used to select the

samples for the study. A sample of 30 children with

bronchopneumonia were selected descriptive statistics -frequency,

percentage, mean, standard deviation, inferential statistics-

62

paired‘t’ –test and correlation were used to analyze the data and to

test the study hypothesis.

The study findings are summarized below

1. Most of the children (70%) belong to the age group 0-3

years and the male child ratio (60%) is higher than the

female child.

2. The immunization status was87%.

3. Most of the children (93%) were born in institution

(hospitals PHC, by instrumental delivery (20%)

4. The birth weight ranges below2.5kg for (40%) children, with

presence of family history of pneumonia 27%

5. The selective nursing intervention like maintaining

thermoregulation, promoting rest and comfort, providing

steam inhalation, prevention of infection by using barrier

technique ,maintenance of hydration, maintenance of

nutritional status, administration of medications, sputum

disposal and health education on dietary management,

follow up and prevention of complications.

IMPLICATIONS FOR NURSING PRACTICE

Nursing personnel can assist, and educate the child with

bronchopneumonia and the family. Based on the individual basis,

63

early deduction can be done. The nursing personnel can assist,

and educate the child with broncho pneumonia and to their family

members. Health education, counseling should be given to the

general public on safe water and early and prompt treatment of

upper and lower respiratory tract infections.

IMPLICATIONS FOR NURSING EDUCATION

Findings of the study have some implications for nursing

education. Nursing student should be taught about the care of the

children especially, the selective and special nursing intervention

to the children and to their family members. In the nursing

curriculum, more importance should be given to

bronchopneumonia, as it is concerned with one of the main

system, the respiratory system and also interferes with the child’s

normal development.

The student can be exposed to the cerebral palsy clinic for

their effective nursing practice and continuation of nursing care, so

that they will get adequate knowledge in the practical area about

bronchopneumonia. If the students come across the children with

bronchopneumonia in the community they can do home visit,

health educate their parents regarding the care of broncho

Pneumonia.

64

IMPLICATION FOR NURSING RESEARCH

There is a need for extensive research in this area,

especially the selective nursing intervention. Because of less

concentration on broncho pneumonia. People may have

inadequate awareness about bronchopneumonia care. So, a

further research can be preceded on the nursing care

management as a longitudinal study related to the role of the

parents and the role of health workers who are involving them in

taking care of these children. Different types of research can be

done on the same bronchopneumonia. The findings of this study

will help in evaluating and extending the selective nursing

intervention in a more effective manner in the field of care among

children with bronchopneumonia.

RECOMMENDATIONS

Based on the findings of the study the investigator proposed

the following recommendations.

1. The similar study can be conducted with a post test after

one month, six months and one year interval to evaluate

the nursing care effectiveness and follow up.

2. The study can be conducted to find out the factors

responsible for causing broncho pneumonia.

65

3. A study can be conducted regarding the impact of

bronchopneumonia families, coping styles, and other

related variables such as employed parents, child with one

or more associated disorders.

4. The coping strategies of parents related to perceptions, and

attitudes towards children with broncho pneumonia scan be

studied. It will help in restructuring the negative attitudes of

parents by guidance and counseling programme.

66

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health nursing”, 1st Edition Philadelphia.

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Edition, Jaypee Brothers, New Delhi.

67

10. Hull, C. (1997) “Essentials of pediatrics”, 4th Edition,

Churchil Livingstone, Edinburgh.

11. Joy, R. (1991), “Maternal and child health nursing mosby

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medicine”, 3rd Edition, Jaypee Brothers, New Delhi.

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Edition, Lippincott, Philadelphia.

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infants and children”, 6th Edition, Mosby Publiclations

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68

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children”, Indian Journal of Pediatrics, Vol. 3.

2. Badcock.J.C. (2008), “Clinical profile and outcome of

pneumonia”, Journal of Pediatrics, Vol. 10,.

3. Banga.T. (2004), “Bacterial pneumonia”, Journal of

Pediatrics, Vol. 12.

4. Berlando, (2001), “IMNCI protocol for pneumonia”, Journal

of Pediatrics, Vol. 32.

5. Bhandari.D.(2006), “Prevention of the respiratory tract

infection among children”, Nursing journal of India, Vol.,

Lxxx.

6. Chopra Kamalesh (2006), “Pathology in pneumococcal

infection”, Journal of Clinical Perinatology. Vol 14.

7. Charles G.Prober (2007), “Common causes for

bronchopneumonia”, Journal of Pediatric, Vol, 46.

8. Chopra kamalsh, (2004), “Management of pneumonia”,

Journal of pediatrics. Vol 38.

9. Chye.J.K.Lim (2008), “Management of

Bronchopneumonia”, Indian Journal of Pediatrics, Vol 39.

69

10. Dorathy.N., (2007), “Prevention of control of Respiratory

tract infection”, Journal of Pediatrics, Vol. 42.

11. Kamalsh, (2004), “Management of pneumonia”, Journal of

pediatrics. Vol 38.

12. Khan.A.Z(2005), “Common clinical problem in Children”,

Journal of Pediatric, Vol., 36.

13. Khamgondar.M.B (2009), “Complication of upper

Respiratory tract infection”, Journal of pediatrics, Vol.,

103.

14. Khoja.T.A (2006), “Identifying children at risk of

significant respiratory tract infection”, Journal of

Pediatrics Vol., 90.

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70

APPENDIX - I

Sample No: 30

Demographic Data related to child:

1. Sex

a) Male

b) Female

2. Age in years

a) 0-3 years

b) 4-6 years

c) 7-9 years

d) 6-9 years

e) 10-12 years

3. Place of birth

a) Hospital

b) Home

4. Nature of Birth

a) Spontaneous vaginal delivery

b) Caesarian

c) Assisted Delivery

5. Birth Weight

a) <2.5 kg

b) 2.6-3kg

c) >3k

6. Birth order

a) 1st Born

b) 2nd Born

c) 3rd Born

d) Above 3rd

7. Immunization Status

a) Complete for age

b) Incomplete for age

c) Non-immunized

8. Exclusive Brest feeding

a) 1-6 months

b) 6-12 months

c) Above 1 year

9. Weaning started at

a) < 6 months

b) > 6 months

Demographic Data related to family:

10. Type of family

a) Joint

b) Nucle.

11. Family Income per month

a) Below Rs. 1000

b) Rs. 1001 – 3000

c) Rs.3001 and Above

12. Family history of Pneumonia

a) Yes

b) No

13. Primary source of information through

a) Mass media

b) Health personnel

c) Friends and relatives

APPENDIX – II

Observation checklist and Rating scale for Assessment of child

Broncho Pneumonia.

S.No Observations Day

I

DAY

II

DAY

III

DAY

IV

DAY

V

1.

2.

3.

Temperature:

a) Normal (1)

b) 98.80-1000F (2)

c) >1000F (3)

Pulse

a) Normal (1)

b) 80-100b/m (2)

c) >100b/m (3)

Respiration

a) Normal (1)

b) 22-26br/m (2)

c) >26br/m (3)

4.

5.

6.

7.

Types of Respiration

a) Normal (1)

b) Mouth breathing (2)

c) Use of accessory muscles

breathing (3)

Respiratory Sounds

a) Normal (1)

b) Adventitious

breath Sounds (2)

c) Wheezing (3)

Cough

a) No cough (1)

b) Non Productive (2)

c) Productive (3)

Sore Throat

a) Absent (1)

b) Frequent (2)

c) Difficulty in

Swallowing (3)

8.

9.

10.

11.

Sputum

a) Colorless (1)

b) White (2)

c) Purulent (3)

Chest Movement

a) Normal (1)

b) Chest retraction (2)

c) Chest indrawing (3)

Skin Color

a) Normal (1)

b) Pale (2)

c) Cyanosis (3)

Use of Accessory muscles of

Respiration

a) Mild (1)

b) Moderate (2)

c) Marked (3)

12.

13.

14.

15.

Child Behavior

a) Normal (1)

b) Restless (2)

c) Irritable (3)

Feeding Pattern

a) Normal (1)

b) Poor feeding (2)

c) Inability to feed (3)

Vomiting

a) No Vomiting (1)

b) After taking foods (2)

c) Extreme (3)

Sleep pattern

a) Normal (1)

b) Sleep disturbance (2)

c) Irritability and cry (3)

APPENDIX – III

Protocol for Nursing Care of child with Bronco Pneumonia

S.No. Nursing Care Rationale

1.

2.

3.

4.

Monitor vital signs

o Temperature

o Pulse

o Respiration

o Blood Pressure

Promote rest and comfortable

position

o Positioning

o Comfort devices

Steam inhalation

Provide steam inhalation with

prescribed medication

Prevention of infection Use barrier

technique while doing procedure

o Hand washing

o Gloving

o Masking

It helps to provide the

baseline data.

Helps to promote

comfort to the child

Helps to liquification of

sputum

Helps to Prevent

spread of infection

5.

6.

7.

8.

9.

Maintenance of hydration:

Encourage to drink plenty of water,

start IV fluid if necessary

Maintenance of Nutritional status by

providing small and frequent

semisolid diet.

Administration of medication as per

Doctor’s order

Demonstrate about sputum disposal

Health education about dietary

management, follow up and

prevention of complication

Helps to maintain the

fluid level of the child.

It helps to maintain the

Nutritional status.

It helps to reduce the

infection

Helps to prevent

spread of infection.

Helps to improve the

knowledge level of the

Mother

APPENDIX - IV Observational Checklist of Nursing Care for Nursing care of child with Broncho Pneumonia

Days S.No. Nursing Care

1 2 3 4 5

1.

2.

3.

4.

5.

6.

7

8.

9.

10.

Thermo regulation

Promote rest and Comfort position

Steam inhalation

Prevention of infection by using

barrier technique

Maintenance of Hydration

Maintenance of Nutritional Status

Administration of medications

Sputum disposal

Health education on dietary

management, breathing exercise,

follow up and prevention of

complication

Guidance and counseling

APPENDIX - V Nursing Diagnosis

1. In effective breathing pattern related to increased section

secondary to broncho pneumonia

2. Ineffective airway clearance related to mechanical obstruction,

increased sechetion.

3. Hyperthermia related to inflammation of lung parenchyma

secondary to infection.

4. Impaired Nutrition less than body regular

5. Activity intolerance related to inflammatory process.

6. Insomnia related to cough and breathing difficulty

7. High risk for fluid volume deficit rate decreased in fluid intake

APPENDIX - VI

CASE ANALYSIS

Sample-1

The child was admitted in the Pediatric ward with the complaints of

high fever, cough, restlessness, drowsiness, tachycardia and chest

retraction. Vital signs were recorded. provided supine position and

bed rest was given to the child. Administered the antibiotics and

fluids. Maintained nutritional status. Intake output chart maintained

daily, prevented the spread of infection. Health education about

given. On the fifth day symptoms of Bronchopneumonia was reduced

and the child was discharged from the pediatric ward.

Sample-2

The child was admitted in the Pediatric ward with the complaints of

high fever, cough, restlessness, drowsiness, tachycardia and chest

retraction. Vital signs were recorded. provided supine position and

bed rest was given to the child. Administered the antibiotics and

fluids. Maintained nutritional status. Intake output chart maintained

daily, prevented the spread of infection. Health education about

given. On the fifth day symptoms of Bronchopneumonia was reduced

and the child was discharged from the pediatric ward.

Sample-3

The child was admitted in the Pediatric ward with the complaints of

high fever, cough, restlessness, drowsiness, tachycardia and chest

retraction. Vital signs were recorded. provided supine position and

bed rest was given to the child. Administered the antibiotics and

fluids. Maintained nutritional status. Intake output chart maintained

daily, prevented the spread of infection. Health education about

given. On the fifth day symptoms of Bronchopneumonia was reduced

and the child was discharged from the pediatric ward.

Sample-4

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-5

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-6

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-7

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-8

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-9

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-10

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-11

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-12

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-13

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-14

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-15

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-16

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-17

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-18

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-19

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-20

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric.

Sample-21

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-22

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-23

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-24

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-25

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-26

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-27

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-28

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-29

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.

Sample-30

The child was admitted in the Pediatric ward with the

complaints of high fever, cough, restlessness, drowsiness,

tachycardia and chest retraction. Vital signs were recorded. provided

supine position and bed rest was given to the child. Administered the

antibiotics and fluids. Maintained nutritional status. Intake output chart

maintained daily, prevented the spread of infection. Health education

about given. On the fifth day symptoms of Bronchopneumonia was

reduced and the child was discharged from the pediatric ward.