SUBMITTE TO:

Mrs. INDHRANI
Lecturer
Pediatric Nursing
Varalakshmi College of Nursing
Bangalore

SUBMITTED BY:

Mrs.SUJATHA
1ST YEAR M. Sc Nursing
Varalakshmi College of Nursing
Bangalore

PAEDIATRIC NURSING
CARE PLAN.
I. GENERAL INFORMATION
Name of the child

: Master . Nitesh

Gender

: male

Age

: 2.7years

Religion

: Hindu

Date of admission

: 18 01 2009

IP.No

: 540251

Provisional diagnosis

: Broncho Pneumonia.

Final diagnosis

: Broncho Pneumonia

II. INTRODUCTION
As a part of my clinical requirement when I had been posted to Vani Vilas Hospital, I selected a
patient by name master Nitesh who is been diagnosed as gastroenteritis to provide complete
nursing care by using a nursing Process. I provided her care from 19.01.09 to 21.01.09.
III. REASON FOR HOSPITALISATION
The child has difficulty in breathing some wheezing sounds during breathing.
IV.PAST SIGNIFICANT MEDICAL AND SURGICAL HISTORY
The child has no history of any past medical or surgical history.
V. PRESENT MEDICAL AND SURGICAL HISTORY
Mother of the child complained that the child had cold and cough since 3 days after which he
developed a serious condition and was unable to breathe adequately due to which he was having
difficulty and wheezing type of breath sounds could be heard he also has fever since 3 days of
intermittent type .the child is feeling very lethargic and refusal to diet.

VI. SIGIFICANT FAMILY HISTORY

Theres no history of any familial diseases or any congenital diseases in the family or siblings
and no history of hypertension and diabetes mellitus.

VII. PRENATAL HISTORY:

There is not consangeous marriage. Antenatal period mother has all antenatal checkups
and had been immunized there was no history of any abnormal condition during pregnancy.
During pregnancy there was no history of illness during the pregnancy. Intake of mother during
pregnancy mother had only iron and folic acid tablets and didnt have any other drugs that could
affect the pregnancy.
VIII.NATAL HISTORY
After the full term the baby was delivered by lower segment caesarean section and baby
weighed around 2.3 kgs and cried immediately with the apgar scoring to 8 at 1 min and 10 at 5
min.
POSTNATAL HISTORY:
The child was normal breast feed and there was no complication during the postnatal
period. There were no signs of infection .the mother had normal involution of the uterus.
IX. NEONATAL HISTORY
Condition of child at birth- The child was normal during the birth and did not show any
congenital abnormality or signs of distress
Birth weight- 2.3kgs
History of illness up to 1 month - child had fever of intermittent type for 2 days which was
relived on administering medicine and latter was apparently alright and had no complaints and
was healthy.

X.IMMUNISATION SECHDULE
Sl. No

Name of the
Scheduled time of
Route of
Given
Not
vaccine
administration
administration
given
1
BCG
At birth
Intradermal
Yes
2,
Oral polio
At birth, up to 5
oral
Yes
vaccine
years
3.
DPT
6wks,10 wks.14wks
Intramuscular
Yes
4.
MMR
9 months
subcutaneous
Yes
5.
Hepatitis
6wks,10 wks,
intramuscular
Yes
IX.NUTRITIONAL HISTORY
Till the 7 months of age of the child he was under breast feeding and additional feeding
started from 8th month. At present the child has one chapatti in morning with 1 glass of mild and
midmorning has 4 biscuits afternoon has 1 cup rise dal at 4 pm has 1 cup of mild with 2 biscuits
and at 6pm has any one fruit and at 8 pm 1 chapatti and water intake is up to 1 liter.
APPETITE- presently due to his disease condition is reduced and the child refuses for the feeds
and feels very lethargic.
Nutritional assessment

The child weighs 12kgs which is on average to his age his anthropometric
measurements are nearly to the normal measures hence the child is not malnourished his
nutritional status is to the moderate level.
X. GROTH DEVELOPMENT ASSESSMENT
1. Developmental history: The child has attained all milestones. He has attained control over
his head during his 4 the month and sitting during 7th month crawling at 9 months and walks
without support since 13 months he has almost got control over the bladder and bowel both
during night and day since on 2months back.
2. Motor development: Gross motor activity the child rides tricycle .He jumped off bottom
step and stands on one foot for few seconds ,goes upstairs using alternate feet ,may till come
down using both feet on step child may try to dance ,but balance is not adequate for
complex activities .

3. Fine motor activity builds town of 9 or 10 cubes, in drawing copies a circle .imitates a
cross names, what he has a drawn, but he cannot stick figures.

4. Sensory motor development: Child puts on clothes on his own. feet himself and wear
shoes put son the shoe place ,takes both with assistance knows fire hurts him and his vision
is improved he does not have steroposis and binocular vision.

5. Self care: Eats on his own washes hands after eating on and dresses himself ,tries to groom
his hair on own.

6. Psychosocial development: According to Erick Ercikson the development task at this stage
is Sense of initiative v/s guilt.4-5years has identifies with the same sex partners and peers
able to judge right from wrong, good from bad.
7. Psychosexual development: According to Sigmund Freud this is an age so Phallic stage
(3-6) yrs were the child is more attached to the mother than to the father this is called
Oedipus complex.

8. Intellectual development: Remember things, books and searches for the objects that have
been lost for a long time knows many things and identifies colors around him.
9. Language development: Uses complete sentences of 3 4 words ,talks regardless of wither
anyone is paying attention ,constantly as question ,known simple songs and names colour
and asks questions.
XI. PHYSICAL EXAMINATION
General appearance

: the child is moderately built.

Behavior

: the child is very dull and feels very lethargic

Emotional stability

: the child quite anxicious and feels fear after seeing doctors and

nurses
Level of consciousness

: the chills are conscious and well oriented to time and a place.

VITAL SIGNS
Temperature : 100o F
Pulse

: 100 bt/m

Respiration : 24 breath /m

ANTHROPOMETERIC MEASUREMENTS.
Birth weight

: 2.3kgs

Present weight

: 10kgs

Length /height

: 92cm

Head circumference

: 46cm

Mid arm circumference

: 13cm

Chest circumference.

: 48cm

SKIN: child skin is in dark colour, turgor is normal. Pruritis is absent and even purpuric spots
are absent.

HEAD & HAIR: Anterior fontanel and posterior fontanels are closed. Sutures are normal and
there is no widening of the sutures. Scalp veins are not visible and crack-pot sign is absent. Hair
is clean, black in colour and well distributed.
FACE: Face of the child doesnt have any puffiness or any old man looks.

EYES: The child has normal vision as 20/20. Corneal reflex is present; eyelids are open and
close completely. No history of conjunctiva, cataract and squint. Pupil reacts equal to the light.
Eyebrows alignment is symmetrical

EARS: Ears position is normal without any discharges from the ears. Hearing activity is normal
and equal on both ears he responds to the questions and whispered voice.
NOSE: The shape and size of the nose is slightly small. Child doesnt have deviated nasal
septum and the nostrils are blocked.

MOUTH: the child open and close the mouth normally and no difficulty or pain. Halitosis is
absent. Lips are in brown in colour, teeth are healthy. Plaque is moist and childs palate doesnt
have any abnormality like cleft lip and cleft palate. Child has the gag reflex.
NECK: Neck movements are normal at 1800. Trachea located at center. There is no thyroid
enlargement and even neck veins are normal.

CHEST AND LUNGS: Chest movements are symmetrical with intercostals retractions since
one month. Respiratory rate is 24 breaths/ min with regular movements and long with wheezing
sounds.
CARDIO VASCULAR SYSTEM: Pulse rate is 124 beats/ min with regular pattern. There is
no palpitation. Blood pressure is 100/80 mm of Hg. The child doesnt have any congenital
abnormalities in his previous medical and surgical history.
ABDOMEN: the child doesnt have any sign of abdominal distension, bowel sounds are present
with regular movements. Other organs like liver and spleen are not palpable. Ascots are absent.
Umbilicus is normal and visible veins and palpable mass are absent.

GENTALIA: Anal opening is present and passes stool normally but he has diarrhoea at present.
The child doesnt excoriate during passing of stools. Inguinal fistula is absent

RENAL SYSTEM: the urine colour is amber with no odor. Micuration frequency is 6 times/
day with each time quantity around 20 25 ml. the child complains burning sensation during the
voiding.

MUSCULOSKELETAL SYSTEM
Posture: the child is unable to extend his legs straight and does not sit or stand independently
needs support of the parents.
Gait: unsteady doesnt walk normally has less balance due to weakness.
Upper extremity: has wasting of muscles and has no strength in carrying slight little objects.

Lower extremity: wasting of muscles and has no strength in walking on independently.

Muscle tone: moderate
Ankle edema : absent
Congenital deformity- there is no signs of any of the congenital abnormality.

CENTRAL NERVOUS SYSTEM: Spine is normal with absence of spino bifida. Cranial
nerves are normal. Glasgow coma scale is conscious and oriented to place and time.
Moro reflex absent as the child is a toddler.
Sucking reflex absent
Plantar reflex present

DISCRIPTION OF DISEASE
Bronchopneumonia is an acute or chronic inflammation of the lungs, in which the alveoli and / or
interstitial are affected. Pneumonias are the most common cause of death among infectious diseases.
They take the fifth place in the statistics of diseases causing death.

CAUSES OF BRONCHOPNEUMONIA
In most cases it occurs because of descends (which is going down) infection of the bronchi in an acute
bronchitis. Inflammatory foci in different sizes are formed in the lung parenchym, which contain purulent
exudates when there are bacterial causal. These sections are hardened, greyish in color, they could be
great number or merge between each other (confluent pneumonia).
It usually affects mostly children and elderly people, because it develops due to the low body resistance
and impaired defense function of the respiratory tract.
Bronchopneumonia can also be secondary (complication of some other disease):
Viral infection (influenza, measles)
Aspiration of food or vomiting
Obstruction of bronchus with foreign body, neoplasm and others.
Inhalation of poisonous gases
Major surgery
Severe chronic diseases (tuberculosis), malnutrition
Hipostatics long lying after suffering stroke

Symptoms in croupous pneumonia

The disease often begins after colds and the occurrence of labial herpes.
Sudden onset with fever and high temperature (about one week, bad general condition);
Cough, dyspnea (difficult breathing) with the participation of nostrils in breathing.

 Brownish-red sputa on the second day with plenty of leucocytes.

Chest pain when breathing due to the accompanying pleurisy.
Chest pain when breathing due to the accompanying pleurisy.
Laboratory data - acceleration of ESR, blood count leucocytosis (increased leucocytes),toxic granulations, eosinopenia (reduction of
eosinophils), lymphopenia (reduction of lymphocytes).
X-ray examination thick, comparatively sharply outlined large overshadowing
Symptoms in atypical pneumonia
1. Slow start
2. Headache
3. Muscle pain (myalgia)
4. Little temperature (without fever)
5. Dry irritating cough without expectoration (spitting)
6. Weak auscultatory findings (rales almost missing)
Complications of the bronchopneumonia
Septic distribution to the pneumonia agents through the blood with the development of otitis, meningitis,
brain abscess, endocarditis.
Pleura damage pleurisy, pleural effusion, pleural empyema.
Recurrent pneumonia, affecting other lung sections.
Chronic pneumonia
Cardiovascular disease
Respiratory deficiency
Thromboembolic complications due to bed rest
Acute renal insufficiency in dehydration
Treatment of bronchopneumonia
General events
Physical calmness, when there is temperature bed rest and thrombo-embolic prevention.
Secretory means, breathing exercises, inhalation therapy (humidification)
Treatment of heart failure
In the presence of hypoxia, oxygen through nasal probe is given. In the development of acute
respiratory insufficiency, mechanical ventilation should be done
Sufficient imports of liquids (depending on the increased losses due to high temperature)

XII. INVESTIGATIONS DONE

SL. NAME OF THE TEST
NORMAL
NO
VAULES
1.
Blood test
3.5 5.6 mEq/l
RBCount

PATIENT
VALUES
4.5 mEq/l

REMARKS

No deviation

2.
3.
4.

Differential
count
WBC
Eosinophils
Basophils
ESR
Lymphocytes

Protein
Urea
Creatinine

6000
5000/cumm
2- 3%
0 0.5 %
< 20 -30mm/ hr
51 %
1.6 7.4 mg/dl
20-40 mg /dl
0.6 1.2mg/dl

12000 / cumm
5%
1%
35 mm / hour
48 %

No deviation
Increased
Increased
Increased
No deviation

1.67
38.3mg /dl
0.9mg/dl

Hypoproteemia
Hyper uremia
No deviation

TREATMENT
Antibiotics
1. After taking bronchial secretions (sputum), unintentional treatment should immediately start without
awaiting the results of bacteriological examination.
2.Targeted treatment is started after receiving the results of microbiology, according the antibiograma. If
necessary the antibiotic have to be changed.
3. In severe cases, blind treatment of bronchopneumonia is undertaken with a combination of 2
antibiotics.

IN MY PATIENT
XIII. MEDICATIONS
Sl.

Name of

No

Medication

Inj Agumentin

Inj amikacin

Route

Dose

Freq

IV

45mg

BD

IV

10mg

BD

Action

Clavulanic acid has a high

affinity for and binds to
certain beta lactamases that
generally
inactivate
amoxicillin by hydrolyzing
it with beta lactogen ring
It binds 30s ribosomal
subunits of susceptible
bacteria ,thus inhibiting its
protein synthesis

Side effects

Nausea
,vomiting
Diarrohea

and

Renal
impairment and
vertigo

Inj

Benzyl IV

penicillin

Inj
Gentamycin

250m

BD

IV

12.5
mg

Bd

They act by interfering in

with synthesis of bacterial
peptidoglycen
cell
wal.pencillin diffuse well
into tissue and body fluids
,but penetration into the
CSF is poor excepts when
the menninges are inflamed
It binds to 30 s and 50 s
ribosomal
subunits
of
susceptible
bacteria
disrupting
protein
synthesis, thus rendering
the bacterial cell membrane
defective.

Fever,hypersens
etivityand
urticaria

Nephro toxicity
and ototoxicity

XIV. IDENTIFICATION OF PROBLEMS ACCORDING TO PRIORITY

Altered body temperature and body discomfort related to the infection
Imbalanced nutrition: less than body requirement related to loss of appetite, lack of
intake of food, and anxiety, loss of appetite as evidenced by considerable loss of weight
and changes paleness of eye.
Anxiety related to treatment process and fear of complications as manifested by
restlessness-increased awake ness, facial tension

ASSESSMENT

INTERVENTIONS

EVALUATION

To maintain the
normal body
The mother complain that temperature and body temperature and
the child having high body
reduction of fever
discomfort related to
temperature
the disease condition.

- Regularly monitor the

temperature and vital signs of
the child and record.

The child fever

was decreased.

OBJECTIVE DATA

- provide tepid sponging tot eh

child to reduce the fever.

SUBJECTIVE DATA:

On observation the child

had fever of 100 degree
Fahrenheit and had body
discomfort

NURSING
DIAGNOSIS

Altered

OBJECTIVES

body

- assess the type of fever its

intensity and frequency.

- provide comfortable clothes

and loosen the tight clothes.
-Provide adequate ventilation to
the child and fresh cool air.
-provide some cool drinks to
drink
-Administer the antipyretic
medication to the child as per
doctors orders Paracetamal
150ms TID
- Also check for the signs of
convulsions and dehydration.

ASSESSMENT

SUBJECTIVE DATA:

NURSING
DIAGNOSIS

Imbalanced nutritional
status less than body
The mother complaints requirement resulted to
that the child is
loss of appetite and
refusing to take feeds. refusal to the feeds
which is evidenced by
weight loss.
OJECTIVE DATA :
On observation the
child is irritable and
doesnt take feeds and
refuses to feeds.

OBJECTIVE

PLANNING

EVALUATION

To maintain the
nutritional status
of the child by
regular feeding
practices,

Assess the dietary pattern to the child

present and before the condition and
calculate the calorie requirement for the
child

The nutritional
status of the child
is improved.

- plan a diet which fulfills the needs of the

child
- Collect the detailed history of the childs
likes and dislikes in food preparation.
- explain the mother the importance of
maintenance of diet and its modified
preparations which she could prepare.
- modify the look of the food into pleasant
colour, taste and smell that would attract
the child to have it.
- check the weight of the child regularly
-avoid food items that are harmful to the
child health condition.
- The food should be rich in green leafy
vegetable and fruits.
-advise to drink adequate amount of water
so as to maintain fluid and electrolyte
balance.

ASSESSMENT

NURSING
DIANOSIS

OBJECTIVES

PLANNING

EVALUATION

SUBJECTIVE DATA:

Activity intolerance
related to generalized
weakness, fatigue,
imbalance between
oxygen supply and
demand.

To improve the
health status of the
child and relive
weakness

- assess the child level of

physical tolerance.

The activity
intolerance of the
child was reduced
and the health status
of the child was
improved.

Mother complains that

the child is very dull and
inactive and feels very
tired on doing slight
activity.

- anticipate childs need for rest

as evidenced by irritability, short
attention span and fretfulness:
assist child in those activities of
daily living that may be beyond
tolerance.

OBJECTIVE DATA:
On observation the child
looked to be very dull
and lethargic and had
generalized weakness.

- provide divers ional activated

appropriate to the childs age
and interest to conserve energy.
Instruct child to rest when
feeling tired.
- provide quiet environment to
promote sleep.
- organize activities for
maximum sleep time.
- schedule visiting to allow for
sufficient rest.
- encourage parents to remain
with child to decrease separation
and anxiety,

ASSESSSMENT

NURSING
DIAGNOSIS

OBJECTIVES

PLANNING

EVALUATION

SUBJECTIVE DATA;

Anxiety and fear related

to distressing procedures
,events,

To reduce stress and

fear.

-prepare child as needed to

reduce fear of the unknown
and to promote cooperation.

Anxiety and fear of the

child was reduced.

The child complains that

he has fear of injections.

OBJECTVIE DATA
On observation the child
started to cry when a
nurse took the tray near
him to perform a
procedure he ahs hear of
procedures and this
Stressing events.

- involve parents to unable

them to serve as effective
resources for their child.
- recognize developmental
fears associated with illness
and procedures to ensure
appropriate intervention.
- provide age appropriate
explanations for procedures
the child may see or hear
performed on other patients to
decrease childs fear.
- provide privacy for any
procedures that exposes the
body.
- answer questions and
explain purpose of activated
Keep child and family
informed of progress.

ASSESSMENT

NURSING
DIAGNOSIS

OBJECTIVE

PLANNING

EVALUATION

SUBJECTIVE DATA:
Mother complains that
the child doesnt co
operate in bathing and
doesnt maintain
hygiene.

Bathing /hygiene and

dressing /grooming self
care deficit related to
physical or cognitive
disability, mechanical
restrictions.

To improve personal
hygiene

- allow child to help plan own

daily routine and choose from
alternative when appropriate to
promote sense of control.
Encourage participation in self
care activities according to
development level and
capabilities to promote mastery
and decrease regression.

Child has improved

personal hygiene.

OBJECTIVE DATA :
On observation the child
was found to have lack
of personal hygiene.

- provide devices and equipment

and methods to assist the child
in self care.
-bath the child daily and keep
the skin dry.
- advocate for child sized
features that foster
independence (eg.bathroom
door handles low enough for
children to reach)
- assist with dressing, grooming,
bathing as indicated.

XVI. CONCLUSION.
After providing care to the patient by using nursing theory, better changes can be seen in Mast. Niteshs both physically and mentally.
Now client and his family understand his condition and better cope up with the situation.