CARE PLAN OF CHILD WITH BRONCHOPNEUMONIA

Introduction: My self Archana Sahoo studying in msc nursing final year in RDMCON, Bhopal.
As a part of my clinical posting I was posted in mother ward at kamla Nehru hospital Bhopal
to complete the requirement of child health nursing.
Demographic data

Name of the child - shivani

Age of the child - 6 months
Gender - Female
Unit/ Ward - Pediatric unit/mother ward
Diagnosis - Bronchopneumonia
Address - Gandhi nagar bhopal
Date of admission -
Religion - hindu

Chief complaints
Fever x 10 days
Cough x 10 days
Breathlessness x 10 days

MEDICAL HISTORY
Past Medical history – shivani did not have any disease in past. She is admitted in kamla
Nehru hospital .

Present Medical history – History dates back 10 days when patient complains of fever which
was acute in onset, continuous, associated with chills, moderate in grade and relieved with
medication.
Cough was gradual in onset, dry in nature, more at night associated with rhinnorhoea.
Child also has breathlessness associated with excessive crying, irritability and decreased
appetite.

SURGICAL HISTORY- no any surgery in past

FAMILY HISTORY

a) Family tree
There are four family members in shivani’s family. There is no history of hereditary
disease in the family. Her grandma is a known case of Diabetes Mellitis.
 52

30 2
6

Female
6 months
Male

Patient

Died

Family composition

S. Name of the Relation Age Gender Marital Education Occupati- Health

no Family ship to Status on status
member the Head
of
Family
1. Mr. shyam Father 30 Male Married 10th std. Auto Good
yrs driver
Mrs. Geeta
2. Mother 26 Female Married 5th std. House Good
Mrs. yrs Wife
3. ramvati Grandm 52 Female Married Illiterate House Good
other yrs Wife
4. Shivani Herself 6 Female _ - - -
Mo
nths

SOCIOECONOMIC HISTORY
Family income in rupees per month - Rs. 6000/month
Housing facility – 4 members are living in a rented house which contains only one
room, no separate kitchen, uses fire wood for cooking. They drink corporation water and
using common toilet for defecation.

BIRTH HISTORY
a) Prenatal history – Age of the mother during pregnancy was 25 years. shivani is a
consanguineous child. Mother did not have infectious diseases and TORCH during pregnancy.
She had not taken any medicine during her antenatal period. It was her 1st pregnancy. Mother
had taken TT injection during 6th and 7th month of her pregnancy.
 b) Natal history – Birth order was 1st. Delivery was conducted in home. It was a normal
delivery. Birth weight of the child was about 2.5kg. APGAR score is not available. Mother
reported that child was pink in color at birth.

c) Postnatal/Neonatal history – Child was cried immediately after birth.

IMMUNIZATION HISTORY

AGE NAME OF VACCINES DOSE ROUTE CHILD

HAS
RECIEVED
At birth BCG 0.1ml I/D 
OPV-0 dose 2 drops Oral 
Hep. B-1st dose 0.5ml I/M X
1.5 months DPT- 1st dose 0.5ml I/M X
HIB- 1st dose 0.5ml I/M X
OPV- 1st dose 2 drops Oral 
Hep.B- 2nd dose 0.5ml I/M X
2.5 month DPT- 2nd dose 0.5ml I/M X
HIB- 2nd dose 0.5ml I/M X
OPV- 2nd dose 2 drops Oral 
3.5 months DPT-3rd dose 0.5 ml I/M X
HIB- 3rd dose 0.5ml I/M X
OPV- 3rd dose 2 drops Oral 
6-9 months OPV- 4th dose 2 drops Oral 
Hep.B-3rd dose 0.5 ml I/M X

Diet history- Exclusive breast feeding was done till 5 months of age. Additional foods started
at 5 months of age which include curd, khichdi, daal, bread, mashed bananas and mashed
potatoes. But now she is taking only mother’s milk.

Elimination pattern- Bowel movements are regular. There is no history of diarrhea and
constipation. Bowel and bladder control is not attained.

Developmental history

S.No. Milestones Normal age of Child’s age of attaining

attaining Milestones
Milestones
1. Head holding 2 months 1.5 months
2. Sits independently 6 months 7 months
 PHYSICAL EXAMINATION- HEAD TO TOE ASSESSMENT

General appearance – shivani has thin body built. Skin is mild pale from outside. She is dull
but well oriented to time, place and person. The child is irritable and anxious.

Anthropometric measurements

S.No. Measurements Child’s measurements Expected

measurements
1. Height in inches 66 cm 65-68 cm
2. Weight 7 kg 7-8 kg
3. Head circumference 43 cm 43-43.5 cm

Vital sign assessment

S.No. Vital Signs Child’s Values Normal Values

1. Temperature 101.2 F 98.4 F
2. Pulse 118/minute 90/minute
3. Respiration 50/minute 16-24/minute
4. Blood pressure 120/70mm of Hg 110/70mm of Hg

ASSESSMENT OF HEAD TO TOE

Integument-
No bad odor was there. Skin was pale in color. It was warm to touch. Skin texture is
smooth and skin turger is good. Skin lesions were absent.

Nails –
Nail color is slight pink. Shape is normal. Nails are clean and cut properly.

Hair –
Color of hair is black and texture is good. Scalp is clean.

Head and Neck –

Skull size is normal and it is symmetrical. Neck stiffness was not found. Lymph nodes
are normal in size.

Ears –
Position and placement of ears is normal. Hearing capacity is also normal. There was no
discharge from ears.

Eyes –
There is no ptosis or drooping of eyelids, eyebrows are also normal. No discoloration of
sclera is found. Pupils are equal, round, reacting to light and accommodating to light
normally. Visual aquity is 20/20.
Nose –
Size and shape is normal. Foul smell was absent. Nasal flaring and frost bite are not
found. Rhinorrhoea was present.
Mouth & lips –
Lips are pink in color. Mouth and lips are symmetrical. Moisture is normal. Buccal
mucosa and tongue are normal. She has 4 teeth. Tonsils and voice are normal.
Thorax & lungs –
Lungs and thorax are symmetrical. Child has difficulty in breathing. Cough was present
and wheezing sounds were heard on percussion and auscultation.
Heart –
Shape and size are normal. Heart is symmetrical. S1 and S2 sounds heard on
auscultation, no abnormal sound was heard.
Abdomen –
There was no scar on abdomen. Ascitis and abdominal distention were also absent.
Peristaltic waves are not visible.
Umbilicus –
Discharge and bad odor were not found from umbilicus.
Groin –
Hernia was not present.
Genitalia –
Size and shape is normal. No abnormal discharge was found.
Anal region –
Fissures/prolapse and congenital anomalies are not found.
Breasts –
Normal in shape and size.
Spine –
Spine curvatures are normal. Abnormalities like discoloration, hair growth and dimple
are not found.
Extremities –
Gait is normal. Creases in palm and muscle strength are normal. Child feels pain during
movements.

REFLEXES

Deep tendon reflexes

Biceps - Normal
Triceps - Normal
Brachioradialis - Normal
Patellar - Normal
Kneejerk - Normal
Achilles – Normal
Superficial reflexes
Abdominal - Normal
Cromastric - Normal
Anal – Normal
MENTAL STATUS
Ability to respond and follow directions is normal.
Active – She is dull and fatigued due to disease condition.
Articulation - Normal

PAIN ASSESSMENT
Pain is assessed by

FLACC Scale
Category Scoring
1 2 3
Face No particular expression Occasional grimace or frown, Frequent to constant
or smile withdrawn, disinterested quivering chin, clenched jaw
Legs Normal position or Uneasy, restless, tense Kicking, or legs drawn up
relaxed
Activity Lying quietly, normal Squirming, shifting back and forth, Arched, rigid or jerking
position, moves easily tense
Cry No cry (awake or Moans or whimpers; occasional Crying steadily, screams or
asleep) complaint sobs, frequent complaints
Consolability Content, relaxed Reassured by occasional touching, Difficult to console or
hugging or being talked to, comfort
distractible
Each of the five categories (F) Face; (L) Legs; (A) Activity; (C) Cry; (C) Consolability is scored
from 0-2, which results in a total score between zero and ten. Pain rate is

FINAL IMPRESSION
Shivani is irritable and anxious. Anthropometric measurements and vital signs are within
normal range. Head, neck, ears, eyes, nose, mouth, lips and all other body parts are normal.
Wheezing sounds were heard on auscultation. Heart sounds are normal. Child is fully conscious.
Pain rate is.

INVESTIGATIONS

S.No. Investigations Normal values Findings Remarks

1. Hb. 12-14 gm% 9 gm% Decreased
2. TLC 4000-14000/cumm 16,200/cumm Normal
3. DLC
N 40-75% 66% Normal
L 26-40% 31% Normal
M 6-20% 02% Decreased
E 1-2% 01% Increased
4. ESR 10-20mm/hr 18mm/hr Increased
5. S. Creatinine 0.5-1.4mg/dl 0.27mg/dl Normal
6. Blood urea

MEDICATION

S. Medicatio Dose Route Action Side-effects Nursing

No. n responsibilities
1. Inj.C-tri 250 I/V Anibiotic Antibiotic- -Assess for possible
mg associated signs and symptoms
colitis( severe of drug reaction.
abdominal -Assess for anemia
pain, and renal
tenderness; dysfunction.
fever; watery, -Assess moth for
severe white patches on
diarrhea), other mucus membranes,
superinfections tongue.
may result - Monitor bowel
from altered activity/stool
bacterial consistency
balance. carefully; mild GI
Nephrotoxicity effects may be
may occur, tolerable, but
especially with increasing severity
preexisting may indicate onset of
renal disease. antibiotic- associated
Severe colitis.
hypersensitivit -Monitor I & O,
y renal function
reaction( sever reports for
e pruritus, nephrotoxicity.
angioedema, -Be alert for
bronchospasm, superinfection;
anaphylaxis), severe genital/anal
particularly in pruritus, abdominal
patients with pain, severe mouth
history of soreness, moderate
 allergies, to severe diarrhea.
especially
penicillin.

2. Inj. 75 I/V Antibioti - Check for 5 Rights

Amikacin Mg c Allergy, - Check vital signs of
Ataxia, the child
Nausea, -Check the mental
Deafness, status of the child if
Vertigo, he has alteration in
Diarrhoea consciousness.
-Prevent the child
from falls and
injuries.
-Maintain I/O charts.
-Check
sign/symptoms of
dehydration and start
fluids as required by
oral or I/V route.
-Check limbs for
sensation

3. Inj. 25 I/V Bronchod -Consult the

Derriphyll Mg ilator Nausea, physician if burning
in GI sensation in chest or
Disturbances, abdomen occurs.
Dizziness, -Provide diet which
Headache, is rich in vitamin and
Hepatitis. protein.
-Perform tests
related to liver
functioning to detect
liver complications.

-Check the time and

dosage before
administering.
4. Syrup 125 Oral Antipyret
Nimusole mg ic Early : -Assess for possible
Plus Anorexia, drug reactions.
nausea,
diaphoresis, -Assess for clinical
general improvement and
weakness with relief of pain, fever.
in first 12-24 Therapeutic blood
hours. serum level: 10-30
mcg/ml ; toxic serum
Later: level : >200mcg/ml.
Vomiting, right
upper quadrant -Maintain oral
tenderness; hygiene after giving
elevated liver syrup to the child to
function tests prevent bad odor and
with in 48-72 bad taste.
hours after
ingestion.