Askep Bronchopneumonia Pdf
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ASKEP BRONCHOPNEUMONIA KONSEP MEDIS A. PENGERTIAN Bronchopneumoni adalah salah satu jenis pneumonia yang mempunyai pola penyebaran berbercak, teratur dalam satu atau lebih area terlokalisasi di dalam bronchi dan meluas ke parenkim paru yang berdekatan di sekitarnya. (Smeltzer & Suzanne C, 2002: 572) Bronchopneomonia adalah penyebaran daerah infeksi yang berbercak dengan diameter sekitar 3. Daftar Askep. CA MAMAE CA RECTI APENDISITIS BPH Ca Servic CA MAMAE ENCEPHALITIS. Bronchopneumonia adalah pneumonia yang mempunyai pola penyebaran berbecak.
BRONCHOPNEUMONIA LINTU THOMASMSC NURSING II YR
INTRODUCTION DEVELOPMENTAL ANATOMY at the of 4 weeks ,the respiratory system begins as an out growth of the foregut ,it is anterior to the pharynx ,the out growth is called Lung bud or Respiratory diverticulum The endoderm lining the respiratory diverticulum give rise to the epithelium and glands of the trachea ,bronchi and alveoli Mesoderm surroundings the respiratory diverticulum give rise to connective tissue ,cartilage and smooth muscles of these structures Respiratory diverticulum elongates and form tracheal buds divides into bronchial buds ,which branches repeatedly and develop with bronchi .by 24 weeks respiratory bronchioles have developed At 6 -16 weeks all major elements of lungs have formed .Gas exchange started During 6 to 26 weeks lung tissue become vascular ,repiratory bronchioles ,alveolar ducts ,some primitive alveoli develop .20 weeks surfactant production started very small amount .Sufficient amount produced at 26 to 28 weeks of gestation At 30 weeks mature alveoli will develop
DEFINITION PNEUMONIA IT IS AN INFLAMMATORY PROCESS INVOLVING LUNG PARENCHYMA BRONCHOPNEUMONIA IT IS PRIMARILY SPREADING INFLAMMATION OF A TERMINAL BRONCHIOLES AND THEIR RELATED ALVEOLI
CLASSIFICATION OF PNEUMONIA
INCIDENCE IT IS SEEN IN AROUND 156 MILLION PEOPLE ,MORE SEEN IN CHILDRENS THAN ADULT ,28-34 % DEATH UNDER 5 YEARS ,ETIOLOGY BACTERIAL INFECTION Pneumococcus ,streptococcus ,staphylococcus ,H .influenza Viral infection :influenza virus, adenovirusFungus: Candida, HistoplasmaHypostatic pneumonia Aspiration of amniotic fluid ,food ,foreign bodies PNEUMONIA PATOGENS IN VARIOUS AGE GROUP 1-3 Months :Parainfluenza ,Influenza ,Streptococcus Pneumoniae ,Chlamydia Trachomatis 4 Months To 5 Years :Streptococcus Pneumoniae ,Chlamydia Pneumoniae ,Mycoplasma Pneumoniae 5 To 18 Years : Mycoplasma Pneumoniae ,Chlamedia Pneumoniae ,Steptococcus Pneumoniae CLINICAL FEATURES OF BRONCHOPNEUMONIAHigh fever with respiratory distress ,restlessness , air hunger and cyanosis Grunting Nasal flaring Retraction of the supra clavicular ,intercostals ,subcostal areas Tachypnea Tachycardia Abdominal distention ,liver enlargement
Features of typical and atypical pneumonia Features Typical Atypical Onset
suddenGradual Fever
++++ / _ Cough
Productive Dry Symptoms
Pulmonary Systemic Chest x ray Localized Diffuse Diagnostic evaluation of bronchopneumonia PHYSICAL EXAMINATION INSPECTION Cyanosis ,sub costal ,substernal ,intercostal retraction ,tachypnea ,nasal flaring AUSCULTATION Wheezes Sound PERCUSSION Dullness over a consolidated area PALPATION LABORATORY AND DIAGNOSTIC TESTS Pulse Oxymetry Chest X Ray Sputum Culture Blood Examination Bronchoscopy Lung Biopsy Lung Aspiration
MANAGEMENT PNEUMOCOCCAL PNEUMONIAPenicillin G 50,000 units /kg/day ,IV OR IM ,for 5-7 days Procaine penicillin 600,000 units IM/DAY Allergic to penicillin alternative amoxicillin or ampicillin ,the alternatives are ceftrioxone /cefotaxime Oxygen administrationSTAPHYLOCOCCAL PNEUMONIA Isolation of patient Antipyretics for fever Maintain hydration with 5% dextrose Antibiotics therapy (penicillin ,erythromycin ,cephalosporin)Patient not respond soon vancomycin can use
Hemophilus pneumonia Ampicillin 100 to 150 mg /kg /day and chloramphenicol 50 mg /kg /day in a four divided dose Cefotaxime 100 mg/kg /day or ceftrioxone 70 mg/kg /day are alternatively in seriously ill patient Streptococcal pneumonia Penicillin G 50,000 to 10000 units /kg/day for 7 to 10 days Supportive careAntipyretics for fever Oxygen administration Maintain hydration with iv fluid Maintain position NURSING CARE MANAGEMENT
HOME CARE MANAGEMENT Increase oral intake Provide adequate bed rest Frequently check temperature Maintain position Give antipyretics to reduce fever High humid atmosphere Regular follow up DIET Muni 3 kanchana 2 full movie.
Complication Bactermia Sepsis Breathing problem Lung abscess Respiratory distress syndrome Pleural thickening Nursing diagnosis Ineffective airway clearances related to inflammation, increased secretions ,mechanical obstruction as evidenced by presences of secretion ,productive cough ,tachypnea Ineffective breathing pattern related to inflammation as evidenced by tachypnea ,increased work of breathing Impaired gas exchange related to hyperinflation airway plugging as evidenced by cyanosis ,decreased oxygen level and alteration in blood gases Risk for infection related to presences of infectious organism as evidenced by fever or presences of viruses or bacteria on laboratory screening Activity intolerances related to high respiratory demand as evidenced by increased work of breathing
A Skep Broncho Pneumonia Pada Anak
Fluid volume deficit related to decreased oral intake Altered nutritional status less than body requirement related to feeding difficulty as evidenced by poor oral intake Fear related to difficulty in breathing ,unfamiliar situation ,procedures as evidenced by crying ,clinging and lack of co operation
Prognosis THANK YOU
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682 NOTES, CASES AND INSTRUMENTS
ing. This was grasped with a pair of automobile pliers and was readily removed after loosening it with a twisting motion. It was an old rusty knife blade, almost 4 cm. long and 13 mm. wide. There was no reaction in the eye or orbit following the operation, and the wound healed without incident.
DACRYOADENITIS FOLLOWING BRONCHOPNEUMONIA.
HOWARD M C I . MORTON, M.D., F.A.C.S.
M I N N E A P O L I S , M I N N .
It may be observed, that affections of the lacrimal glands are as infrequent as those of the lacrimal sac and duct are common. The position of the
Fig. -X-ray picture from side showing relation of blade to cranial bones.
The presence of a large foreign body transfixing the orbit with symptoms so slight that the patient did not suspect its presence is unusualin fact almost inconceivable. The absence of suppuration in the presence of a dirty, rusty piece of steel is also noteworthy. However, the feature of greatest scientific interest in this case is the rapid loss of vision in the absence of any pathology to account for it. With a normal fundus the assumption that the blindness was caused by an injury to the optic nerve behind the entrance of the arteria centralis retinae, which usually perforates the nerve sheath 10 to 15 mm. behind the eye. seems justifiable, yet the forward position of the knife blade would preclude such a possibility. The blindness and also the paralysis of the extrinsic ocular muscles can perhaps only be explained as resulting from the pressure of a blood clot which formed rapidly at the time of the injury.
lacrimal gland gives it the fullest measure of protection, and its numerous ducts emptying downward render infection from the conjunctiva less easy. Therefore, it has been observed that infections of the lacrimal gland are usually endogenous rather than exogenous.
Examination of the literature of dacryoadenitis reveals its infrequency; this applies particularly to bilateral involvement. It is, indeed a rara avis of ophthalmic practice. The case I am reporting is the first that I have met with in my practice. Arlt in his 'Lehr-buch' says that he had never seen a case of dacryoadenitis, and Hirschberg (Arch. of Ophth. Vol. 8, p. 369) states that among 22,500 recorded cases of eye disease, there was but one of suppuration of this gland. In 1886 Powers stated that one case of an abscess of this gland was mentioned in the Royal London Ophthalmic Reports. It is well to note that Cowper in Vol. 5 No. 2 of the Am. Jour, of Ophthal. re-
NOTES, CASES AND INSTRUMENTS 683
ports a case of 'Symmetric Cystic Enlargement of the Lacrimal Glands Due to Syphilis.' There was no pain or discomfort, and tenderness or redness were absent. Three or four weeks after one injection of arsphenamin the swelling entirely disappeared. In the case I am reporting there were no symptoms of inflammatory reaction, simply marked swelling under the ex-
Fig. 1.Bilateral symmetric dacryoadenitis.
ternal angular process of each eye. The bacteriologic examination was negative, simply revealing a few streptococcus albus and xerosis bacilli.
The patient consulted me February 16, 1923, and gave the following history: About five weeks previous to this date the family had been driven out of the house by fire. The weather was cold, and the patient in making the necessarily hasty escape was insufficiently clad. There was probably some irritation from smoke. As the result of these causes she developed a low grade bronchical pneumonia. Her physician informs me it was mild in degree, and her temperature did not go above 102. He saw the patient but twice, and she was confined to her bed for two weeks only. At about the time of her recovery, a swelling developed symmetrically, involving about
the outer halves of each upper lid. She did not come to see me for at least ten days after the appearance of this swelling. She stated that the appearance was very much the same as at the beginning, except not quite so noticeable. She had experienced no pain and had had no discharge from the conjunctivae. She said there had also been an entire absence of any redness or discoloration of the skin over the area of swelling.
Inspection revealed a bilateral and symmetric swelling situated in the region anterior to each lacrimal gland This was of quite noticeable degree but without change of color of the skin The outer third of each palpebra fissure was narrowed and the sulci be tween the lids and eyebrows was obliterated in the outer half of each lid. There was no dilation of the con-junctival vessels, and eversion of the lids showed no involvement of the accessory glands. There was a normal amount of lacrimal secretion, and the patient told me she had experienced no pain. There was no involvement of the parotid or sublingual glands. Pupils were normal in appearance and reaction. The excursions of the eye were normal.
Upon palpation of the swollen areas, involvement of the lacrimal glands was indicated by doughy masses projecting from under the orbital ring in the region of the lacrimal fossae. There was no tenderness experienced by the patient during this procedure. There were no signs of a synchronous involvement of the glands of Krause. The upper portions of the tarsal conjunctivae and the fornices appeared normal. The tissues of the lid did not seem to be involved, and it was clearly an involvement of the lacrimal glands alone.
It is to be recalled that in the peculiar syndrome called Mikulicz' disease, we have symmetric involvement of the glands of the head including the lacrimal glands. One such case reported by Carl Fisher, of the Mayo Clinic, some years ago, before the Minnesota Academy of Ophthalmology, forms the only exception to the previous statement regarding my
684 NOTES, CASES AND INSTRUMENTS
experience with bilateral involvement of the lacrimal gland. Dewatripont, in La Clinique Beige of Oct. 28, 1911, reports four cases of suppurative inflammation (monolateral), in which the only organism was the pneumo-coccus. He states that after the phleg-
Fig. 1.Phoria indicator on black cabinet.
Usually, second seasons aren't as good as their firsts, but Saiunkoku Monogatari does not stick to this norm. And the characters are very similar to that of the 'fushigi yuogi' characters. Overall 9 Story 8 Animation 10 Sound 10 Character 10 Enjoyment 8 Its very interesting since you don't often see main characters which are intelligent but this one differs.The only thing that i think is wrong with this one is there long and redundant dialogs its kind a boring if you would just listen for about 30 minutes of dialog then all in an instant it ends.monous inflammation set in, this organism was replaced by the streptococcus, and that these four cases arose from nasal origin.
HETEROPHORIA AND ASTIGMATISM CHARTS.
L. WEBSTER FOX, M.D., LL.D. P H I L A D E L P H I A .
There is nothing new or novel in this combination phoria chart with astigmatic chart. It does, however, make a most useful and attractive addition to the paraphernalia of the
f ophthalmic surgeon's consulting room. i This Prentice Phoria indicator (Fig. , 1.) is placed flush with the front sur-e face of lid on a black cabinet. The I cabinet is vertically positioned on a - telescoping rod with base. This tele-- scoping feature permits the operator
i I
Fig. 2.Reverse of cabinet showing astigmatic chart.
to raise and lower the apparatus to a point exactly on a level with the patient's eyes. The discs of light are arranged like a Greek Cross with the central light red, and from it radiating vertically and horizontally, one degree prism angle apart, are green lights, five-eighths of an inch in diameter. These discs of light are controlled by a switch at the examiner's table. When great accuracy is required, a Maddox Rod is placed before one eye, and at once the phoria defect is ascertained.
On the reverse side of this cabinet (Fig. 2.) we have placed an astigmatic