Faculty of nursing and health science..
PEDIATRIC /333 .
MAHMOUD BASSEM ALZGHARI..
Patient initials :T.Z.SH
Date Of Admission: 22.11.2012.
Gestational Age: (Full Term).
Age:1.2 ((one year's & two month)).
CHIEF COMPLAIN: TALA , an 1.2 years old female patient admitted to AL-AHLI
hospital complaining of sever cough , fever and running nose duration since two day
PREGNANCY HISTORY: LMP: 22.12.2010 AND EDD: 29.9.2011
TALA mother has 7 children (3 boys& 4 girls),all her pregnancies was NSVD ,with no
any complications they were full term ,when she was pregnant in TALA her pregnancy
period was 39 weeks. The mother said that she didn’t have any complications and she
had taken all vitamins required and prescribed to her such as Folic acid and Calcium
supplements, she used to visit a local clinic to do all prenatal procedures such as US,
glucose level …etc.
She didn’t have any problems during her pregnancy period.
At the end of the 39 weeks of pregnancy on 29.9.2011 at 2:30 am TALA was born by
NSVD weighing 3100 gram, TALA CC was 32 and HC was 34. She was breastfed
since first day of birth and had no difficulties with sucking.
History of present illness: A1.2 year's old female infant was healthy till 2 day who she
started with fever relived by antipyretic. Then she developed to running nose. Pt seek
OSD and seen by the Dr who ordered CBC that shows WBC 21000 & IYM 68. The
recophin 0.5 mg give. Then the pt developed cough dry in nature and pt vomiting twice
time after dry cough.
Past History: the past medical and surgical history is free
Immunizations: (Since birth till now)
Hepatitis B vaccine
Developmental Assessment Identify norms and relate to patient.
DDST (<6 yrs) or school performance (>6 yrs).
- Developmental assessment by interview:
Age: 1.2 months .
Grasp rattle ok
Chest up arm support
Sit- head steady
Head up 90
The pt hold pencil ,knows to say mama dada love to parallel play points to body parts
and smaile to the people her mother sent her to nursery school because mother was
The patient can not roll over ,he can not sit without support ,he can not crawl or pull
himself to stand or rise chest up by arm support.
The patient can follows to midline ,he also can put hands together and grasp a rattle but
he can not reach for object or throw a ball.
The patient responds to bell and turns to voice ,he can say mama and dada and another
The patient smiles responsively ,initially shy with strangers ,he can not work for toy out
of reach. But she love the people so much.
The pt under stand when mother play with her for example smaile ,clumped her hand
Psychosocial (Erikson, Piaget, Freud)
Birth _ 1 year(trust versus
Oral stage :at birth_2yesr
Reflexive behavior lead to
Major source of pleasure
seeking is centered on oral
activities such as sucking
Sense of trust is rooted in
the quality of an infants
*egocentric view of world
care and the relationship
with the primary care givers *cognitive parallels motor
*if meet trust = happy
Unmet =crying ,anxiety
Favorite toys and games: Tala love to play in games involving girls like to play in the
doll and the phone and habits which is holding Tala watching TV to watch paragraphs
Any specific habits or routines : no specific habits or routines the more things that
she do is watching T.V and playing with towels
Food preference: In terms of food considered normal to deal with food from 4 to 5
meals a day. Breastfeeding 4 times a day and night for 10.Minutes in each feed and take
artificial feeding 800 cc within 24 hours
1. The family has good live style, finical statement is good , normal culture, live in
clean and good environment. They live in Hebron city . Tala's father and mother
were still alive the age of father is Father 42 and maternal age 30 housewife mother
and father worked in construction workers in Israel. The relation between family
and neighbor good . the baby live with his parents with father's family in good
2. PT/Family strengths and weaknesses:
Strength relationship between family’s member . and good relationship between the
family and the husband’s family. as you seem to you tow family in one family
Diet: breast feeding +hospital formula. Like Tala food all dairy products, and all kinds
of homemade desserts
Prefer not to eat bananas and melons this what the mother said
Dietary habits & mealtimes :3—5 meals /day at 8am & 11am & 3pm &7pm
And artificial feeding when needed
Pt Looks well ,active ,.not cyanotic skin color pink . good appearance ,round face, pt in
good hygiene and nutrition. Pt in good growth and development wt is 8800g cannula put
on the head ,
Ht + Percentile: 63 cm
Wt + Percentile: 8800 g
Skin: uniform color of skin (pink), smooth, unbroken, warm and resilient, wet not dry.
No cyanosis no skin rashes or lesions, clean skin, no sweat. Turgor skin was done and
the result is normal (capillary refill less than 3 seconds). No Mongolian spots.
Head: Round and symmetrical face head one fourth of body size head circumference
37 cm , normal skull no cephai hematomas,no caput succedaneum fontanels anterior
is still open ,posterior triangle shaped is closed no sunken or bluging scalp is free
abrasion or laceration ,hair texture is soft normal distribution
Face: pink in color, symmetrical no lesions and scars, no voluntary movement of the face
muscle, no edema. Sunken or bulging in his face.
Neck: the neck supports the head in midline backward, and to either side. Carotid pulses
felt the neck is short and covered with folds of tissues There is no bulges or fullness in
the neck, no any deviation, masses, or nodules when palpating neck structures palpate
Eyes: The eyes are open normally. Symmetrical, normal space between them .no edema
or bruising, tears present,no cataracts no nystagmus normal alignment and range of
movement sclera is white , eyelids are normal pupils it constrict when it exposure to
light, dilate when light fades
Ears: Extends slight forward from the skull, symmetrical depressions and prominences.
Good hygiene of ears, soft yellow cerumen. No abnormal opening or discharge, pink
external canal, Normal hearing in both ears.
Nose: normal shape and size, with each side symmetric. Both nostrils equal in size.
Septum in midline and mucosal lining is pink, wet , and with obvious drainage (
running nose) because bronchitis. And wheezing sound because of partial stenosis in
Mouth & throat: the mouth surrounding by the lips .pink, smooth, and no cleft and
lips palate no lesions of lips, mucous membrane is pink, intact and moist. Tongue in
midline, freely movable, no lesions or masses under the tongue good sucking and the
growth of teeth is normal.
Chest & Lungs: skin intact Have symmetrical chest circumference 39 cm no rash or
swelling around nipple no milk or abnormal discharge from them respiratory rate is
41b/m and irregular. Lung sound have wheezing because stenosis of bronchial tube.
Heart & circulatory system: RHR(regular heart rate ), and rhythm no murmur
normal heart sounds No heart problems(PDA,ASD,VSD,…) Blood pressure within
normal 85/62 pulse 140b/min ,pulse in extremities can felt capillary refill on the nails
refill in 2 second. good peripheral perfusion no cyanosis. Femoral, carotid, and
brachial pulse is palpated
Abdomen: soft, intact skin, no lesion. Umbilicus is flat, round, and without discharge,
normal bowel sound. Pink in color, dry, concave, and flat, round in shape, normal bowel
Bowel movements: the frequency is 5—6 time / day. And it depends on amount and
quality of food that she takes. When she needs to void she need partial helping to do
Renal: Yellow and slight urine. able to urinate, Normal urinate and no oliguria or
noctoria of enuresis, and no infections no UTI. The frequency of urination is 4—6
times / day and the amount of urination about 850cc/ day.
Skeletal system: good posture spine vertebral is normal no malformation range of
motion is good , no fracture, no bone abnormalities no sclerosis or kiphosis.
Neurological system :Alert, conscious, normal tone power, no focal neurological
deficit. Pt angry and crying sometimes due to distress and hospitalization . equal muscle
tone, no nervosa, he has acceptable and cooperative behavior. No convulsive or seizure.
Alertness, reflexes :Normal reflexes at all sides, good vision & hearing and good
sensory of skin. (Moro Reflex- Rooting-sucking reflex -palmer grasp reflex-stepping –
babinski- tonic neck- Papillary reflex -Blinking reflex -Crawl) is good .
Emotional, Intellectual : Most of the time to be quiet and cooperative, but in the
absence of her mother begins to cry and scream and be too polite with nurses and the
Response to illness: Acceptor is the atmosphere of the hospital and sometimes start
screaming in the absence of the mother in the case of severe coughing and high
Sleep (nap, bedtime, rituals and pears): good sleeping pattern in prone position,
sleep 2—3 hours/day and at night about 8 o'clock until 7 o'clock.
bronchitis is a chronic inflammation of the bronchi (medium-size airways) in thelungs.
It is generally considered one of the two forms of chronic obstructive pulmonary
disease (COPD), the other being emphysema. It is defined clinically as a
persistentcough that produces sputum (phlegm) and mucus, for at least three months
per year in two consecutive years.
Signs and symptoms
Bronchitis may be indicated by a cough (also known as a productive cough, i.e. one that
produces sputum), shortness of breath (dyspnea) and wheezing. Occasionally chest
pains, fever, and fatigue or malaise may also occur. Mucus is often green or yellowish
green and also may be orange or pink, depending on the pathogen causing the
Tobacco smoking is the most common cause. Pneumoconiosis and long-term fume
inhalation are other causes. Allergies can also cause mucus hypersecretion, thus
leading to symptoms similar to asthma or bronchitis.
A physical examination will often reveal diminished breath sounds, wheezing and
prolonged exhalation. Most doctors rely on the presence of a persistent dry or wet cough
as evidence of bronchitis.
A variety of tests may be performed in patients presenting with cough and shortness of
Pulmonary Function Tests (PFT) (or spirometry) must be performed in all patients
presenting with chronic cough. An FEV1/FVC ratio below 0.7 that is not fully
reversible after bronchodilator therapy indicates the presence of COPD, that requires
more aggressive therapy and carries a more severe prognosis than simple chronic
A chest X-ray that reveals hyperinflation; collapse and consolidation of lung areas
would support a diagnosis of pneumonia. Some conditions that predispose to
bronchitis may be indicated by chest radiography.
A sputum sample showing neutrophil granulocytes (inflammatory white blood cells)
and culture showing that has pathogenic microorganisms such as Streptococcus spp.
A blood test would indicate inflammation (as indicated by a raised white blood
cell count and elevated C-reactive protein).
Neutrophils infiltrate the lung tissue, aided by damage to the airways caused by
Damage caused by irritation of the airways leads to inflammation and leads to
neutrophils being present
Mucosal hypersecretion is promoted by a substance released by neutrophils
Further obstruction to the airways is caused by more goblet cells in the small
airways. This is typical of chronic bronchitis
Although infection is not the reason or cause of chronic bronchitis it is seen to aid in
sustaining the bronchitis.
High Resolution Computed Tomography (HRCT) — This is a special type of CT
scan that provides your doctor with high-resolution images of your lungs. Having a
HRCT is no different than having a regular CT scan; they both are performed on an
open-air table and take only a few minutes.
Smoking cessation is of benefit as nicotine paralyzes the cilia comprising
the Mucociliary Escalator.
Only about 5-10% of bronchitis cases are caused by a bacterial infection. Most cases of
bronchitis are caused by a viral infection and are "self-limited" and resolve themselves
in a few weeks. For acute exacerbations of chronic bronchitis, if antibiotics are
used, amoxicillin ordoxycycline is recommended.
Ipratropium is an example of a bronchodilator that may be useful for people suffering
from chronic obstructive pulmonary disease, such as chronic bronchitis.
Albuterol is also a common drug for this disease.
Acute exacerbations of chronic bronchitis
Acute exacerbations of chronic bronchitis (AECB) are episodes of difficulty in
breathing in a person with chronic bronchitis.
During AECB, breathing becomes much more difficult because of further narrowing of
the airways, in addition to increased secretion of mucus, which often is thicker than
Treatment of AECB may include:
Antibiotics are used if a bacterial infection is the suspected cause. However,
antibiotics will not treat exacerbations caused by viruses.
URINE ANALYSIS ((23.11.2012))
Chest x-ray (22.11.2012)
The x-ray shows an inflammation of bronchial tubes.
Urine culture (22.11.2012)
The results show no growth.
Inflammation of the
R/T poor feeding and
250mg I.V q 8
to treat or
are proven or
suspected to be
is a powerful
To smooth you should avoid
taking this drug
0.5cc neb q6 hrs receptor agonist, muscles and during pregnancy and cramps,
having a direct stops
effect on smooth spasms
of sleep and
shows between 5
to 20 minutes
after using it
directly in a
form of spray
later in case of
Ipratropium is Bronchio There are no
dry mouth and
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administered by dilator to contraindications for
from hypersensitivity t
such as skin
oatropine and related
substances. For oral
. For that
purpose it is
supplied in a
canister for use
in an inhaler or
in single dose
vials for use in
a .03% nasal
sprayed into the
similar to other
angle glaucoma and
tract and urinary
What I learned from this case??
I heard the girl coughing severe coughing so I decided to study their causes and
what led them to this case
Benefited greatly from this case study ((inflammatory airways)) I've learned a
lot about her and what roads caused by method of detection and treatment method and
I managed without reference to the many references left her health care after leaving
the hospital and avoid non-hit by the disease in the coming days, and how we can
alleviate the symptoms associated with pain
In the other got many new information that I did not know before about the disease
itself and the method of treatment.
1.THE CHILD FILE .
2.FROM HIS DOCTOR.
3.FROM FAMILY (MOTHER).
4.FROM INTERNET ( GOOGLE AND OTHER WEB-SITES .
5.DRUG INFORMATION AND SIDE EFFECTS ONLINE. AVAILABLE AT: WWW.DRUGS.COM .
6.TEXTBOOK OF MEDICAL SURGICAL NURSING .
7. SELECTED NORMAL PEDIATRIC LABORATORY VALUES.