bronchitis_cs

8/9/2019 Bronchitis_CS

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I.Introduction

Bronchitis is a respiratory disease in which the mucous

membrane in the lungs' bronchial passages becomes inflamed.

As the irritated membrane swells and grows thicker, it narrows

or shuts off the tiny airways in the lungs, resulting in coughing

spells accompanied by thick phlegm and breathlessness. The

disease comes in two forms: acute (lasting less than 6 weeks)

and chronic (reoccurring frequently for more than two years). In

addition, people with asthma also experience an inflammation of

the lining of the bronchial tubes called asthmatic bronchitis.

Acute bronchitis is responsible for the hacking cough and

phlegm production that sometimes accompany an upper

respiratory infection. In most cases the infection is viral in origin,

but sometimes it's caused by bacteria. If you are otherwise in

good health, the mucous membrane will return to normal after

you've recovered from the initial lung infection, which usually

lasts for several days.


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Acute bronchitis is very common among both children and

adults. The disorder often can be treated effectively without

professional medical assistance. However, if you have severe or

persistent symptoms or if you cough up blood, you should see

your doctor. If you suffer from chronic bronchitis, you are at risk

for developing cardiovascular problems as well as more serious

lung diseases and infections, you should be monitored by a

doctor.

In relation to my patient he is having the acute bronchitis, I

used several nursing interventions and bedside care to improved

his health. I give the first priority to its airway clearance because

a lot of secretions being observed. I touched the history of the

patients condition that further more relate the illness that patient

suffered; further discussion and nursing interventions done to the

patient is emphasized on this study.

Studies have shown that there are major goals to be considered

for patients having Acute Bronchitis. It includes the improvement

or maintenance of normal breathing pattern, increase activity


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tolerance, reduction of anxiety, adherence to the self-care, and

increase sense of power with decision making and absence of

complications.

During the assessment, the student nurse used the act of

collecting, organizing, validating and recording data about

patients health status through observing and interviewing the

patient/informants for within two days or two shifts.

The study focuses on the assessment data from the patients

major nursing diagnosis. It is limited also on imparting health

teachings with emphasis on the interventions and

recommendations to the patient.


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II. PROFILE OF PATIENT

y Name: ?

y

Addres: ?y Sex: Male

y Birthdate: September 15, 2003

y Age: 6 year old

y Civil Status: single

y Religion: ?

y Date of Admission: May 26,2009

y Time of Admission: 10 PM

y ChiefComplaint: cough, fever and loss of appetite

y

V

ital Signs upon Assessment:y Temperature = 37.6 0C

y Pulse Rate = 80 beats per minute

y Respiratory Rate = 20 cycles per minute

y Blood Pressure = 80/60mmHg

y Admitting Diagnosis: Acute Bronchitis

y Admitting Physician: ?

HEALTH HISTORY

From the interview conducted with the mother of the baby,

she stated that she stayed in the hospital for only three days

after giving birth to ?at four months ?was admitted to Northern

Mindanao Medical center due to pneumonia. They stayed at the

hospital for seven days. Furthermore the mother concluded that

?has completed his vaccination at the health center in theirvicinity.


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HISTORY OF PRESENT ILLNESS

A week prior to admission, the patient experienced fever

and intermittent with cough productive, loss of appetite

prompted admission.PE findings are as follow: Temperature=37.6C, Pulse Rate=80bpm, Respiratory Rate= 20cpm and weight=

16.9 kg.

III. DEVELOPMENTAL DATA

Robert Havighurst believed that learning is basic to life and

that people continue to learn throughout life. He described

growth and development as occurring during six stages, each

associated six to ten tasks to be learned.

Havighurst promoted the concept of developmental tasks in

the 1950s. a developmental task is a task which risks at or

about a certain period in the life of an individual, successful

achievement of which leads to his happiness and to success with

later tasks, while failure leads to unhappiness in the individual,

disapproval by society and difficulty with later tasks:.

(Havighurst 1972 p.2). At the early childhood, learning

physical skills necessary for ordinary games.Learning to get


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along with age mates.Building wholesome attitudes toward

oneself as a growing organism.Learning on appropriate

masculine or feminine social role.Developing concepts necessary

for everyday living.Developing conscience, morality and a scale

of values.Achieving personal independence.Developing attitudes

toward social groups and institutions.

PSYCHOSOCIAL DEVELOPMENT

Initiative adds to autonomy the quality of undertaking,

planning, and attacking a task for the sake of being active and on

the move. The child is learning to master the world around him or

her, learning basic skills and principles of physics; things fall to

the ground, not up; round things roll, how to zip and tie, count

and speak with ease. At this stage the child wants to begin and

complete his or her own actions for a purpose. Guilt is a new

emotion and is confusing to the child; he or she may feel guilty

over things which are not logically guilt producing, and he or she

will feel guilt when his or her initiative does not produce the

desired results.


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COGNITIVE DEVELOPMENT

The Intuitive (4-7 years) stage is when children start employing

mental activities to solve problems and obtain goals but they are

unaware of how they came to their conclusions. For example a

child is shown 7 dogs and 3 cats and asked if there are more

dogs than cats. The child would respond positively. However

when asked if there are more dogs than animals the child would

once again respond positively. Such fundamental errors in logic

show the transition between intuitiveness in solving problems

and true logical reasoning acquired in later years.

MORAL DEV

ELOPMENT

According to Kohlberg, e-conventional level of moral reasoning is

especially common in children, although adults can also exhibit

this level of reasoning. Reasoners in the pre-conventional level

judge the morality of an action by its direct consequences. The

pre-conventional level consists of the first and second stages of

moral development and are purely concerned with the self in an

egocentric manner.


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In Stage one (obedience and punishment driven),

individuals focus on the direct consequences that their actions

will have for themselves. For example, an action is perceived as

morally wrong if the person who commits it gets punished. The

worse the punishment for the act is, the more 'bad' the act is

perceived to be. In addition, there is no recognition that others'

points of view are any different from one's own view. This stage

may be viewed as a kind ofauthoritarianism.


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IV.ANATOMY AND PHYSIOLOGY

What is respiration?

Respiration is the act of breathing:

y inhaling (inspiration) - taking in oxygen

y exhaling (expiration) - giving off carbon dioxide

What makes up the respiratory system?

The respiratory system is made up of the organs involved in the

interchanges of gases, and consists of the:

y nose

y pharynx

y larynx

y trachea

y bronchi

y lungs

The upper respiratory tract includes the:

y nose

y nasal cavity

y ethmoidal air cells

y frontal sinuses

y maxillary sinus

y larynxy trachea

The lower respiratory tract includes the:

y lungs

y bronchi


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y alveoli

What are the functions of the lungs?

The lungs take in oxygen, which cells need to live and carry out

their normal functions. The lungs also get rid of carbon dioxide, a

waste product of the body's cells.

The lungs are a pair of cone-shaped organs made up of spongy,

pinkish-gray tissue. They take up most of the space in the chest,

or the thorax (the part of the body between the base of the neck

and diaphragm).

The lungs are enveloped in a membrane called the pleura.

The lungs are separated from each other by the mediastinum, an

area that contains the following:

y heart and its large vessels

y trachea (windpipe)

y esophagus

y thymus

y lymph nodes

y

The right lung has three sections, called lobes. The left lunghas two lobes. When you breathe, the air:enters the body

through the nose or the mouth

y travels down the throat through the larynx (voice box) and

trachea (windpipe)

y goes into the lungs through tubes called main-stem bronchi

o one main-stem bronchus leads to the right lung and

one to the left lung

o in the lungs, the main-stem bronchi divide into smaller

bronchi

o and then into even smaller tubes called bronchioles


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V.PATHOPHYSIOLOGY

Name of Patient: VankenleeLloren

Diagnosis: Acute Bronchitis___

Bronchitis means that the tubes that carry air to the lungs

(the bronchial tubes) are inflamed and irritated. When this

happens, the tubes swell and produce mucus. This makes you

cough.

Acute bronchitis usually comes on quickly and gets better

after 2 to 3 weeks. Most healthy people who get acute bronchitis

get better without any problems. See a picture of acute

bronchitis.

Viruses (corona virus,

influenza virus)

Heat and smoke inhalation

The pathogens directly attach

the tracheobronchial tree.

Inflammation of tacheobronchial tree

The airways become inflamed and narrowed from

capillary dilatation, increasedmucus production

Acute Bronchits


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VI. MEDICAL MANAGEMENT

A. Medical Orders and Rationale

DOCTORS ORDER RATIONALE

January 23,2007

>Please admit under the

service of Dr. Fernandez

>Consent to care For legal purposes

>TPR every 4 hours To monitor and provide

baseline data of the patient

> Labs:y CBC stat To determine any abnormalities

present in the blood

components.

y Urinalysis To assess renal function

> IVF= D5LR 500cc @ 60cc/hr For continuous replacement of

the fluid

>monitor I and O shift To monitor intake and output

> diet: For age

> please refer AP

Meds: Paracetamol


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VII.DIAGNOSTIC EXAMS

HEMATOLOGYDate Ordered: 5-26-2009

Results Normal Values Implications

WBC 11.17 3.8-10.8 : infection

RBC 4.62 4.2-5.6

Hemoglobin 115 140-180 : hemorrhage,

anemia

Hematocrit 0.35 .40. .54 : hemorrhage,

MCV 76 80-100 normal

MCH 25 pg/cell 27 33 pg/cell normalMCHC 33.g/dL 32 36 g/dL normal

Platelet

Count

156/mm3 150,000

400,000/mm3

: infection, DIC

Neutrophils 0.57 % .48 .73 % normal

Lymphocytes 0.37% .20 .45% normal

Monocytes 0.04% .00 .10 % normal

Eosinophils 0.02 % .00 .05 % normal

Basophils 0.0 % .00 .020 % normal

URINALYSIS

5-29-09

Color: yellow

Sp.gravity:1.015

Sugar: negative

Pus cells: 7-13

Rbc:0-2

Mucus threads: moderate

Crystals: amorphous urates few

Bacteria: moderate

BLOOD CHEM

5-27-09

Creatinine: 0-6


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CHEST P/A

5-27-09

Impression: left retrocardiac pneumonia

VIII. DRUG STUDY

Generic Name Cephalexin

Brand Name Biocef

Date Ordered 5-26-09

Classification Cephalosporin

Dosage/Route/

Frequency

250 mg tid

Mechanism of

Action

Inhibits bacterial cell wall

synthesis by binding to one or

more of the penicillin-binding

proteins

Specific Indication Treatment for bacterial

infections

Contraindication Hypersensitivity to

cephalosporin

Adverse effect diarrhea

Nursing precaution Modify dosage in patients with

with severe renal impairment.


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Calpol

Date Ordered 5-27-09

Classification Analgesic and antipyritics

Dosage/Route/ Frequency 5 ml q 4 hours

Mechanism of Action To relieve feverSpecific Indication Mild pain or fever

Contraindication Contraindicated in patient with

hypersensitivity to acetaminophen

Adverse effect Jaundice,rash, urticuria

Nursing precaution Liquid form is recommended for

children and for all patient who have

difficulty in swallowing.


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NURSING SYSTEM REVIEW CHART

Name: X Date: 5-26-09Vital Signs:

Pulse: 80bpm Temp: 37.6 cWeight: 16.9kgEENT:

impaired vision blind Swelling wound[x]pain redden [X] drainage

gums hard of hearing deaf warm to touch burning edema lesion teeth runny nose Asses eyes, ears, nose vomitingthroat for abnormality no problem

RESP: asymmetric [X] tachypnea abnormal breath sound apnea [X]rales[X] cough barrel chest _____________________

bradypnea shallow rhonci _____________________[X] Sputum diminished dyspnea __

orthopnea labored wheezing _____________________ pain cyanotic _____________________ Assess resp, rate, rhythm, depth, pattern, _____________________

breath sounds, comfort

no problem

CARDIO VASCULAR

arrhythmia tachycardia numbness _____________________ diminished pulses edema [X] fatigue _____________________ irregular bradycardia[X] murmur

tingling absent pulses pain IV siteAsses heart sounds, rate rhythm, pulse, bloodpressure, circ., fluid retention, comfort no problem

GASTRO INTESTINAL TRACT

obese distention massdysphagia rigidly painAsses abdomen, bowel habits, swallowing,bowel sounds, comfort [X] no problem

_____________________GENITO-URINARY and GYNE _____________________

pain urine color vaginal bleeding _____________________ hermaturia discharge noctoria _____________________ Asses urine freq., color, control, odor, comfort _____________________Gyn-bleeding, discharge [X] no problem

_____________________NEURO

paralysis stuporous unsteady seizures lethartic comatose [X] vertigo tremors confused vision grip Asses motor function, sensation, LOC, strength, _____________________Grip, galt, coordination, orientation, speech, _____________________ no problem

MUSCULOSKELETAL and SKIN _____________________

appliance stiffness itching petechiae _____________________[X] hot drainage prosthesis swelling

lesion poor turgor cool deformity _____________________ wound rash skin color[X] flushed atrophy[X] pain ecchymosis _____________________

diaphoretic moist Asses mobility, motion. Galt, alignment, joint function pigmented scars/skin color, texture, turgor, integrity no problem

Slightly flushed skin


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NURSING ASSESSMENT II

SUBJECTIVE OBJECTIVE

COMMUNICATION

hearing loss Comments:maulawonmna

xamao dili

kaayugatingog

. As verbalized

by the mother.

visual changes

denied

glasseslanguages

contract lens hearing

aide

R L

Pupil size: 3mm speech

difficulties

Reaction: Pupils Equally

Rounded and Reactive

to LightAccommodation

OXYGENATION

dyspnea Comments:

gahangos-

hangosgyud na

xausahay. As

verbalized by

the mother.

smoking history

cough

sputum

denied

Resp. regular irregular

Describe:

RR-32cpm. Fast breath sounds

and inspiratory rales.

R : Symmetric

L: Symmetric

CIRCULATION

chest pain Comments:

usahaymorikla

moxa nga sakit

iyadughan. Asverbalized by

the mother.

leg pain

numbness of extremities

denied

Heart Rhythm regular

irregular

Ankle edema: present

Pulse Car. Rad. DP Fem.

R 78 94 64

L 76 96 65

Comments: Palpable and pulses


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are within normal range.

NUTRITION

Diet : For age

N V Comments:nawalamna

iyagana sa

pagkaon As

verbalized

by the

mother.

Character

recent change in wt. &

appetiteswallowing difficulty

denied

dentures none

Full Partial With pt.Upper

Lower

ELIMINATION

Usual bowel pattern urinary

freq.

-every morning ___________

constipation remedy

-hot prune juice urgency

date of last BM dysuriadiarrhea character

hematuria

_____________

incontinen

ce

polyuria

foly in place

denied

Comments: Bowel sounds:

hyperactiv

e

His abdomen is

Extremely soft to

Touch.(38cms.-AG)Abdominal

Distention

Present yes

no

Urine: yellow;

hazy 950 ml

daily

MGT. OF HEALTH & ILLNESS

alcohol denied

SBE last Pap Smear

LMP: N/A

Briefly describe the pts. Ability

to follow treatments for chronic

health problems.

The pt. was able to follow

the medications prescribed by


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the physician.

SUBJECTIVE OBJECTIVE

SKIN INTEGRITYdry Comments:

ga uga jud na

iya panit. As

verbalized by

the mother.

itching

other

denied

dry cold pale

flushed warm

moist cyanotic

rashes, ulcers, decubitus

(describe size, location,

drainage)

- NONE

ACTIVITYconvulsion Comments:

ok raman na

xausahaykailihu

kkaayu.As

verbalizedby the

mother

dizziness

limited motion of joints

Limitation in

ability to

ambulate

bath self

other

denied

LOC and Orientation: Pt. is

oriented of time and space.

Gait: walker cane others

steady unsteady

sensory and motor losses in

face or extremities: NONE

ROM limitations: NONE

COMFORT/SLEEP/AWAKE

pain

Comments: okra man pud

iyapagtulog.

As verbalized

by the mother

(heart/7scale)

nocturia

facial grimaces

guardingother signs of pain:

restlessness

siderail release form

signed(60+yrs.): N/A


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sleep difficulties

denied

COPING

OccupationMembers of household. Mother

and father

Most supportive person:

parents and relatives

Observed non-verbal behavior:NONE

The person & his Phone # that

can be reached anytime:

09058562446

SPECIAL PATIENT INFORMATION (use lead pencil)

_____Daily weight ______PT/OT______

_____BP q Shift ______Irradiation

_____Neurovs ______Urine Test____

_____CVP/SG. Reading_____ _______24 HR Urine

Collection

Date

ordered

Diagnostic/

Laboratory

Exams

Date

done

5-26-09 Urinalysis 5-26-09

5-26-09 Hematology 5-26-09


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IX.IDEAL NURSING MANAGEMENT

A. Ideal Nursing Management (NCP)

Nursing Diagnosis Intervention Rationale

Hyperthermia,

related to upper

respiratory tractinfection

INDEPENDENT:

yMonitor the

patients vitalsign.

yProvide TSB

yIncrease calories

intake.

DEPENDENT:

y

AdministerIntravenous Fluid

as ordered.

yAdminister

analgesics as

ordered by the

physician

>To serve as

baseline data..

> To decrease

temperature.

> To meet the

metabolic demand.

> To replace fluid

and electrolyte loss.

> To reduce fever


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X. Actual Nursing Management (SOAPIE)

S init pa gihapon na xagamay as verbalized by the

mother

O

y Temp= 37.6

y

Slightly flushed skin

A Hyperthermia, related to upper respiratory tract

Infection

P At the end of 1hour the temperature of the patient

will be lowered

I

INTERVENTION RATIONALE

INDEPENDENT:yMonitored patients

vital sign.

y TSB provided

yBreakfast given with

bread

DEPENDENT:yAdminister

Intravenous Fluid as

ordered.

y Administer

analgesics as ordered

>To serve as baseline

data.

.

> To decrease

temperature.

> To meet the metabolic

demand.

> To replace fluid and

electrolyte loss.

> To reduce fever


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by the physician

E After of one hour patient was able to have lower

temp. and able to comply all those medicationsordered by the physician.

XI. HEALTH TEACHINGS

MEDICATIONS

The significant others was advised to comply

the prescribed medication regimen following

the prescribed dose, frequency, timing and

route necessary for his fast and effective

treatment and recovery. Patient teachings are

also imparted, regarding on precaution and

side effects of the medications.

EXERCISE Not applicable

TREATMENT

Proper compliance of the treatment regimen

should be followed as prescribed by the

doctor.

OUTPATIENT

FOLLOW UP Not applicable

DIET

Adviced the parents to offer foods rich in vit. C

and intake of calorie should be increased for

metabolism.


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XII. REFERRAL AND FOLLOW UP

Patients have always required detailed discharge

instruction to become proficient in special self-care needs when

they got home. As for my client,van, refer him for his regular

check up with his attending physician; Dr. Fernandez, and

arrange schedule of appointments regarding his follow up check

ups and his home medications.

Our client is also reminded of his medication regimen to

follow it carefully and promptly, and to report any signs ofadverse serious reactions. The mother was advice to offer fruits

and vegetables to promote body resistance.


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XIII.BILIOGRAPHYBOOK SOURCES:

y Huitt, W., & Hummel, J. (2003)

Piaget's theory of cognitive development.Educational

Psychology Interactive.

Valdosta, GA: Valdosta State University.

y Smeltzer, S; Medical Surgical Nursing; 10th Edition;

Lippincott Williams and Wilkins; 2004

y Kozier, B.; Fundamentals of Nursing; 7th Edition; Pearson

Education Corporated; First Lok Yang Road; Jurong;

Singapore

y Nettina, Sandra; et. al; The Lippincott Manual of Nursing

Practice; 7th Edition; George Washington University;

Lippincott Williams and Wilkins; Lippincott-Raven

Publishers; 1991

y Doyle, Rita M; et. al; Nursing 2006 Drug Handbook; 26th

Edition; 323 Norristown Road, Suite 200; Lippincott Williams

& Wilkin

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