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 PAGENO
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.
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.
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
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
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.
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
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
¾ to assess the health condition of children with broncho pneumonia.
¾ to evaluate the effectiveness of nursing care on children with
broncho pneumonia.
¾ 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
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.
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.
1. Age 2. Gender 3. Place of
birth 4. Nature of
Birth 5. Birth weight 6. Economic
status 7. Exclusive
breastfeedin g
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. Cheek the vital signs every four hours and tepid sponging 3. Provide small and
frequent bland diet fruit juices, check weight daily.
4. Administer intravenous fluids and Maintain intake and output chart 5. Provide steam
inhalation and
administer medication and taught about sputum disposal 6. Provide calm and quiet
environment.
7. Explain about disease condition, treatment, follow up and prevention of complication CHILD’S
BEHAVIOUR
INVESTIGATOR REACTIONS
STATUS OF CHILDREN WITH BRONCHO
PNEUMONIA
Mild health deterioration
Severe health deterioration Moderate health deterioration
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.
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.
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.
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
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
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.
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
• 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.
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
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
• 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.
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.
• 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.
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.
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
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
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.
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,
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
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
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
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
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
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
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
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.
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.
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.
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
¾ All the children with broncho pneumonia who were admitted
in pediatric general ward at Melmaruvathur Adhiparasakthi Institute of medical sciences and research.
¾ Mother’s of broncho pneumonia children who could understand Tamil or English.
¾ Children with broncho pneumonia between 0-12years of age.
EXCLUSION CRITERIA
¾ Children with bronchopneumonia who have other associated Disorders.
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.
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.
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.
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.
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.
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.
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
(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.
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.
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
