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INTRODUCTION
Acute bronchitis is an inflammation of the large bronchi (medium-sized
airways) in the lungs that is usually caused by viruses or bacteria and may
last several days or weeks. Characteristic symptoms include cough, sputum
(phlegm) production, and shortness of breath and wheezing related to the
obstruction of the inflamed airways. Diagnosis is by clinical examination and
sometimes microbiological examination of the phlegm. Treatment for acute
bronchitis is typically symptomatic. As viruses cause most cases of acute
bronchitis, antibiotics should not be used unless microscopic examination of
Gram stained sputum reveals large numbers of bacteria.
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bronchial tubes for as long as a few months may inspire asthmatic conditions
in some patients.
In addition, if one starts coughing mucus tinged with blood, one should see a
doctor. In rare cases, doctors may conduct tests to see if the cause is a
serious condition such as tuberculosis or lung cancer. Acute bronchitis may
lead to pneumonia.
Inncidence rate of Acute Bronchitis is 4.6 per 100; 14.2 million cases
annually, approximately 1 in 21 individual or 4.60% or 12.5 million people in
USA Incidence extrapolations for USA for Acute Bronchitis: 12,511,999 per
year, 1,042,666 per month, 240,615 per week, 34,279 per day, 1,428 per
hour, 23 per minute, 0 per second. Note: this extrapolation calculation uses
the incidence statistic: 4.6 per 100 (NHIS96: acute bronchitis); 14.2 million
cases annually
Deaths from Acute Bronchitis 388 deaths reported in USA 1999 for
acute bronchitis and bronchiolitis (NVSR Sep 2001) Death rate extrapolations
for USA for Acute Bronchitis: 387 per year, 32 per month, 7 per week, 1 per
day, 0 per hour, 0 per minute, 0 per second. Note: this extrapolation
calculation uses the deaths statistic: 388 deaths reported in USA 1999 for
acute bronchitis and bronchiolitis (NVSR Sep 2001)
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which causes severe difficulty in breathing — most often in cigarette
smokers — affects 12 million people in the United States.
Vuokko L. Kinnula and colleagues point out that no disease marker for COPD
currently exists, despite extensive efforts by scientists to find one. Past
research pointed to a prime candidate — surfactant protein A (SP-A), which
has a major role in fighting infections and inflammation in the lung.
The scientists compared levels of a variety of proteins obtained from the
lung tissues of healthy individuals, patients with COPD, and those with
pulmonary fibrosis. They found that the lungs of COPD patients contained
elevated levels of SP-A. The scientists also found elevated levels of SP-A in
the sputum samples of COPD patients. "This suggests that SP-A might
represent a helpful biomarker in the early detection of COPD and other
related disorders," the article notes.
I choose this case as we all know that acute bronchitis is a recurrent and
reversible disease once develop, but it can easily prevented by avoiding their
contributing factor, such as allergens, dust, pollens, prolonged exposure to
tobacco smokes and air pollutants. It can be prevented by means of
cessation of cigarette smoking and by prevention of air pollutants, therefore
this disease is disabling if not properly prevented or avoided.
C. Objectives
• NURSE CENTERED
Short term
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After 4-5 hours of nursing interventions, the student nurse shall be
able to:
• Establish rapport with the patient
• Identify the needs of the patient
• Assess the general condition of the patient
• Implement interventions that could help in maintaining the health of
the patient in a good condition
• Explain to the patient the rationale for each interventions
Long term
After 2 days of nursing interventions, the student nurse shall be able
to:
• Gain the trust and cooperation of the patient
• Know the general condition of the patient
• Identify the precipitating and predisposing factors that causes the
patient’s condition
• Give health teachings about the condition of the patient
• Help the patient recover from her condition
• CLIENT CENTERED
Short term
After 4-5 hours of nursing interventions, patient shall be able to:
• Establish rapport with the student nurse
• Listen and cooperate with the student nurse
• Verbalize feelings
• Ask questions regarding her condition
• Participate on the activities or health teachings given by the student
nurse
• Able to understand the reason for such interventions
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Long term
After 2 days of nursing interventions, the patient shall be able to:
• Trust and have a good rapport with the student nurse
• Verbalize her present condition/feelings
• State the interventions given by the student nurse for the betterment
of her condition
• Follows the activities or health teachings given by the student nurse
• Able to have an improve condition/ gain her state of wellness
1. Personal Data
Last June 23, 2009, at 11:30 in the morning, Patient’s mother rushed
Patient to a private hospital in Angeles City with chief complaints of cough
and fever. Upon admission, Patient was diagnosed of Acute Bronchitis.
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Patient’s father is a highschool undergraduate who is currently working
as a factory worker, whereas Patient’s mother is a college graduate who is
currently working in CDC.
The Patient family owns their own house and they have been living in
their home since 2002. Their house is located along the highway. The current
residence has a living room, dining room, kitchen, two bedrooms and two
toilets. Patient’s mother also verbalized that the house is always clean;
however, trucks drive along the highway so dust always circulate around
their home. The family uses a gas stove as their means of cooking and their
water is obtained from NAWASA. Patient’s grandmother also goes to the
market to buy their food and cooks their own dishes.
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7
Paternal Side Maternal Side
AUNT 1 AUNT Uncle AUNT AUNT FATHER MOTHER Uncle AUNT Uncle 2
(+) 2 3 5 1
3 1 Uncle 2
leukem (+)
ia Uncle Uncle asthm
a,
Uncle 2 4
1 AUNT AUNT
4 6
PATIENT
ACUTE BRONCHITIS
8
9
3. Personal History
• Erik Erikson
Patient, being 6 years of age, is in the Initiative vs. Guilt stage of
Erikson’s psychosocial conflict wherein she learns to take initiative of the
actions she wants to perform and learns to master the world around her. 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.
This stage is shown by her eagerness to study and to go to school as said by
her mother.
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• Jean Piaget
Patient is in the Preoperational or Egocentric stage of Piaget’s Theory
of cognitive development wherein the child does not show any particular
interest or concern with rules. It is also when children start employing mental
activities to solve problems and obtain goals but they are unaware of how
they came to their conclusions. Upon playing, mother stated that patient
shows that she is more focused on having fun rather than the rules of the
game. She also is not aware of what others think and focuses only about
having fun.
• Sigmund Freud
Based on the patient’s age, she falls under the Phallic stage of Freud’s
Psychosexual stages wherein genitals are supposed to be the primary source
of pleasure for the child. Upon observation, there were no manifestations of
this stage noted from patient’s behaviour.
A five days prior to admission (June 18, 2009), Patient had cough and
colds and fever and Patient’s mother managed this by giving Paracetamol.
Four days prior to admission (June 20, 2009) same signs and symptoms were
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noted and consulted their private physician and Patient was diagnosed with
Upper Respiratory Tract infection and was given Mucosolvan and Allerkid.
Condition persisted and admitted last June 23, 2009 with an admitting
diagnosis of Acute Bronchitis.
6. Physical Assessment
General Appearance
(+) difficulty of breathing with used of accessory muscles
with nasal flaring and positive rales and wheezes on both
lungs fields
With cough and colds
Acyanotic
(-) Retractions
(-) edema
(-) rashes
Pink Palpebral conjunctiva
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difficulty of breathing with Rales on both lung fields and nasal
flaring.
Vital Signs
Temperature: 36.9 ˚C
Pulse Rate: 95 bpm
Respiratory rate: 26 bpm
BP: 90/60 mmHg
Cephalocaudal Assessment
Head
Round, symmetrical & normocephalic
No lesions, nodules or masses
Hair is thin and well distributed; no infestations noted
Symmetric facial features noted
Eyes
Eyebrows are symmetrical, evenly distributed
Eyelids no discharge / discoloration
Eyes are equally round
Transparent cornea
Pink palpebral conjunctiva
Ears
Symmetrical, no lesions, no pain
Recoils into original position after pinching
Auricles have same color as facial skin and aligned with outer canthus
of eye
Nose
Not tender, uniform color
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Nasal septum in the midline and intact
No nodules or masses palpated
(+) Nasal Secretions
(+) Nasal Flaring
Mouth / Throat
Pinkish, moist, smooth
Tongue in central position
Neck
No pain upon palpation, masses
Muscles equal in size
Head located at the center
Skin
Capillary refill test 1-2 seconds
Uniform in color
Good skin turgor
Scanty hair equally distributed
Hair
Evenly distributed
No pediculosis / dandruff
Thorax / Lungs
(+) Rales on both lung fields
(-) retraction
Skin is intact
Chest is symmetric
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No masses noted
Abdomen
Uniform color noted
Flat and symmetric movements caused by respiration
Extremities
Uniform in color
No palpable nodules or masses
Hair equally distributed
NEUROLOGICAL ASSESSMENT
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distance.
CN III: Make use of Pupils should Patient pupils
Oculomotor penlight in order constrict (+ constricted
Type: Motor to test papillary PERRLA ) consensually.
Function: Pupil reaction and consensually She was able to
constriction and instruct the once light open and close
raising eyelids client to open passes through. her eyelids.
and close Eyelids should
eyelids. open and close.
CN IV: Instruct client to Client must be Patient was able
Trochlear move eyes able to follow to follow the
Type: Motor downward and the pen’s pen’s movement
Function: upward without movement downward and
Oblique moving head. downward and upward without
movement of upward without moving his head.
the eye moving head.
CN VI: Tell the client to Client should be Patient was able
Abducens devoid his head able to follow to follow the
Type: Motor steadily and the lateral lateral
Function: Lateral follow the pen’s movement of movement of the
eye movement direction the pen pen.
CN VII: Facial Ask client to Client should be Patient was able
Type: Motor smile, frown, able to smile, to smile, frown
Function: and raise the frown, and raise and raise
Movement of eyebrows. the eyebrows eyebrows
muscles of the without without difficulty.
face difficulty.
CN IX: Instruct client to Client should be Patient was able
Glossopharyng swallow. able to swallow to swallow
eal without without difficulty.
Type: Motor difficulty.
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Function:
Pharyngeal
movement and
swallowing
CN XI: Ask the client to Client should be Patient was able
Accessory shrug shoulders able to shrug to shrug
Type: Motor against shoulders shoulders
Function: resistance. against against
Movement of resistance. resistance.
shoulder
muscles
CN XII: Instruct the Client should be Patient was able
Hypoglossal client to able to protrude to protrude her
Type: Motor protrude tongue tongue and tongue and
Function: and move it move it laterally, move it laterally,
Movement of laterally, downward and downward and
tongue, strength downward and upward. upward.
of the tongue upward.
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7. Diagnostic and Laboratory Procedures
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erythropoietic
ability,
dehydration
and
polycythemia.
19
or leukocyte.
They
encapsulate
organism and
destroy them.
d. Lymphocytes The result is with in
LYMPHOCYTE are the one’s 0.43 0.15 - normal limits that
S responsible 0.65 there is no
for activities presence of viral
of the infection or
immune inflammation.
system, which
produces
antibodies.
e. PLATELET are the cell 241 X 150-400 Normal. Normal
COUNT fragments 109 X 109 platelet counts are
circulating in not a guarantee of
the blood that adequate function.
are involved In some states the
in the cellular platelets, while
mechanisms being adequate in
of primary number, are
hemostasis dysfunctional.
leading to the
formation of
blood clots.
NURSING RESPONSIBILITIES
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- Explain the procedure to the client
- Tell the patient that no fasting is required
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diaphragm. configuration and
other chest
structure are not
remarkable
IMPRESSION:
Pneumonia, left
lower lobe
CHEST X-RAY
Before the procedure
1. check doctors order
2. Identify the client
3. Explain the procedure to SO and its importance
4. Inform the Patient to remove all metal objects like clothing with metal,
fastener, necklace, pins for better visualization of the chest
5. tell the patient that the test will only take a few minutes and is painless
6. assist transporting the client in going to the X-Ray room
Urinalysis - (or "UA") is an array of tests performed on urine and one of the
most common methods of medical diagnosis. A part of a urinalysis can be
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performed by using urine dipsticks, in which the test results can be read as
color changes.
Result within
MICROSCOPIC normal range. Urine
EXAM is not concentrated
PUS CELL: or packed with
0-1/hpf (-) other element such
as proteins.
RBC: none found
(-)
May indicate
infection
ALBUMIN: ( - )
(-)
Within normal
SUGAR: ( - ) limits, indicate no
presence of blood
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(-) in the urine.
BACTERIA: ( - )
(-) No impairment in
the permeability of
the glomelular
capillaries.
Normal finding
Normal finding
NURSING RESPONSIBILITIES:
Before:
Check for the doctor’s order
Inform the patient/SO before doing the procedure. Explain to the
patient’s SO the importance of the test.
Inform the patient/SO that there is no need to restrict food or fluids
before the test.
Explain to the patient’s So that the laboratory procedure is non-
invasive; no pain will be felt.
During:
Assist patient in going to bathroom or CR.
Describe the procedure for collecting a clean-catch or midstream
specimen.
Advise the patient’s SO to wash patient’s genitalia prior to collection of
specimen.
After:
Chart time of collection of urine specimen.
Attach result to the chart as soon as they are available.
Record and document findings.
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DIAGNOSTIC INDICATIO ANALYSIS AND
AND NAND RESULTS NORMAL INTERPRETATION
LABORATORY PURPOSE( VALUES
PROCEDURES S)
COLD This test in Presence of Titer The result is in
AGGLUTININS done to agglutionat above normal limit
DETERMINATION test the ion at 1.32 1.64 are meaning which
presences consider indicates that there
of unusual significan is no presence of
bacteria. t unusual bacteria.
NURSING RESPONSIBILITIES
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III. ANATOMY AND PHYSIOLOGY
Respiratory System
The respiratory system functions to deliver the oxygen to the blood --
the transport medium of the cardiovascular system -- and to remove oxygen
from the blood. The actual exchange of oxygen and carbon dioxide occurs in
the lungs.
The respiratory centers in the brain stem (pons and medulla) control
respiration's rhythm, rate, and depth. Primary controlling factors include 1)
the concentration of carbon dioxide in the blood (high CO2 concentrations
initiate deeper, more rapid breathing) and 2) air pressure within lung tissue.
Expansion of the lungs stimulates nerve receptors (vagus nerve X) to signal
the brain to "turn off" inspiration. When the lungs collapse, the receptors
give the "turn on" signal, termed the Hering-Breuer inspiratory reflex. Other
regulators are: 3) an increase in blood pressure, which slows down
respiration; 4) a drop in blood acidity, which stimulates respiration; and 5) a
sudden drop in blood pressure, which increases the rate and depth of
respiration. Voluntary controls -- "holding one's breath" -- can also affect
respiration, but not indefinitely. Carbon dioxide build-up soon forces an
automatic start-up.
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The respiratory system consists of two tracts: The upper respiratory
tract includes the nose (nasal cavity, sinuses), mouth, larynx, and trachea
(windpipe). The lower respiratory tract includes the lungs, bronchi, and
alveoli.
The two lungs, one on the right and one on the left, are the body's
major respiratory organs. Each lung is divided into upper and lower lobes,
although the upper lobe of the right lung contains a third subdivision known
as the right middle lobe. The right lung is larger and heavier than the left
lung, which is somewhat smaller in size because of the predominately left-
side position of the heart.
A clear, thin, shiny coating -- the pleura -- envelopes the lungs. The
inner, visceral layer of the pleura attaches to the lungs; the outer, parietal
layer attaches to the chest wall (thorax). Pleural fluid holds both layers in
place, in a manner similar to two microscope slides that are wet and stuck
together. The lungs are separated from each other by the mediastinum, an
area that contains the heart and its large vessels, the trachea (windpipe),
esophagus, thymus, and lymph nodes. The diaphragm, the muscle that
contracts and relaxes in breathing, separates the thoracic cavity from the
abdominal cavity.
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The chart of the respiratory system shows the intricate structures
needed for breathing. Breathing is the process by which oxygen in the air is
brought into the lungs and into close contact with the blood, which absorbs it
and carries it to all parts of the body. At the same time the blood gives up
waste matter (carbon dioxide), which is carried out of the lungs when air is
breathed out.
1. The SINUSES (frontal, maxillary, and sphenoidal) are hollow spaces in the
bones of the head. Small openings connect them to the nose. The functions
they serve include helping to regulate the temperature and humidity of air
breathed in, as well as to lighten the bone structure of the head and to give
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resonance to the voice.
2. The NOSE (nasal cavity) is the preferred entrance for outside air into the
respiratory system. The hairs that line the wall are part of the air-cleaning
system.
3. Air also enter through the MOUTH (oral cavity), especially in people who
have a mouth-breathing habit or whose nasal passages may be temporarily
obstructed, as by a cold or during heavy exercise.
4. The ADENOIDS are lymph tissue at the top of the throat. When they
enlarge and interfere with breathing, they may be removed. The lymph
system, consisting of nodes (knots of cells) and connecting vessels, carries
fluid throughout the body. This system helps to resist body infection by
filtering out foreign matter, including germs, and producing cells
(lymphocytes) to fight them.
5. The TONSILS are lymph nodes in the wall of the throat (pharynx) that
often become infected. They are part of the germ-fighting system of the
body.
6. The THROAT (pharynx) collects incoming air from the nose and mouth and
passes it downward to the windpipe (trachea).
8. The VOICE BOX (larynx) contains the vocal chords. It is the place where
moving air being breathed in and out creates voice sounds.
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9. The ESOPHAGUS is the passage leading from the mouth and throat to the
stomach.
10. The WINDPIPE (trachea) is the passage leading from the throat (pharynx)
to the lungs.
11. The LYMPH NODES of the lungs are found against the walls of the
bronchial tubes and windpipe.
12. The RIBS are bones supporting and protecting the chest cavity. They
move to a limited degree, helping the lungs to expand and contract.
13. The windpipe divides into the two main BRONCHIAL TUBES, one for each
lung, which subdivide into each lobe of the lungs. These, in turn, subdivide
further.
14. The right lung is divided into three LOBES, or sections. Each lobe is like a
balloon filled with sponge-like tissue. Air moves in and out through one
opening -- a branch of the bronchial tube.
16. The PLEURA are the two membranes, actually one continuous one folded
on itself, that surround each lobe of the lungs and separate the lungs from
the chest wall.
17. The bronchial tubes are lines with CILIA (like very small hairs) that have a
wave-like motion. This motion carried MUCUS (sticky phlegm or liquid)
upward and out into the throat, where it is either coughed up or swallowed.
The mucus catches and holds much of the dust, germs, and other unwanted
matte that has invaded the lungs. You get rid of this matter when you cough,
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sneeze, clear your throat or swallow.
18. The DIAPHRAGM is the strong wall of muscle that separates the chest
cavity from the abdominal cavity. By moving downward, it creates suction in
the chest to draw in air and expand the lungs.
20. The ALVEOLI are the very small air sacs that are the destination of air
breathed in. The CAPILLARIES are blood vessels that are imbedded in the
walls of the alveoli. Blood passes through the capillaries, brought to them by
the PULMONARY ARTERY and taken away by the PULMONARY VEIN. While in
the capillaries the blood gives off carbon dioxide through the capillary wall
into the alveoli and takes up oxygen from the air in the alveoli.
Air Distribution
On inspiration, air enters the body through the nose and the mouth.
Nasal hairs and mucosa (mucus) filter out dust particles and bacteria and
warm and moisten the air. Less warming, filtering, and humidification occur
when air is inspired through the mouth.
Air travels down the throat, or pharynx, where two openings exist, one
into the esophagus for passage of food, and the other into the larynx (voice
box) and trachea (windpipe) for continued airflow. When food is swallowed,
the opening of the larynx (the epiglottis) automatically closes, preventing
food from being inhaled. When air is inspired, the walls of the esophagus are
collapsed, preventing air from entering the stomach. The larynx, which also
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contain the vocal cords, is lined with mucus that further warms and
humidifies the air.
Air continues continues down the trachea, which branches into the
right and left bronchi. The main-stem bronchi divide into smaller bronchi,
then into even smaller tubes called bronchioles. The bronchial structures
contain hair-like, epithelial projections, called cilia, that beat rythmically to
sweep debris out of the lungs toward the pharynx for expulsion. Once in the
bronchioles, the air is at body temperature, contains 100% humidity, and is
(hopefully) completely filtered.
Bronchioles end in air sacs called alveoli -- small, thin-walled
"balloons," arranged in clusters. When you breathe in, enlarging the chest
cavity, the "balloons" expand as air rushes in to fill the vacuum. When you
breathe out, the "balloons" relax and air moves out of the lungs. It is at the
alveoli that gas exchange occurs. Tiny blood vessels, capillaries, surround
each of the alveoli. On inspiration, the concentration of dissolved oxygen is
greater in the alveoli than in the capillaries. Oxygen, therefore, diffuses
across the alveolar walls into the blood plasma. In the reverse process,
carbon dioxide concentration is greater in the blood than the alveoli, so it
passes from the blood into the alveoli and is ultimately breathed out.
As oxygen diffuses into the plasma, hemoglobin in the red blood cell
picks up the oxygen, permitting more to flow into the plasma. The oxygen-
carrying capacity of hemoglobin allows the blood to carry over 70 times
more oxygen than if the oxygen were simply dissolved in the plasma alone.
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Therefore, the total oxygen uptake depends on: 1) the difference in oxygen
concentration between the blood and alveoli, 2) the healthy functioning of
the alveoli, and 3) the rate of respiration.
Pulmonary Circulation
The pulmonary circulatory circuit describes the process whereby
oxygen and carbon dioxide are delivered to and from the lungs. Oxygen-poor
blood travels to the right atrium via the inferior and superior vena cavae,
then to the right ventricle. The right ventricle subsequently pumps the blood
into the pulmonary artery, which branches to the right and left lungs. The
pulmonary arteries subdivide until reaching the arteriole, then capillary
levels. After gas exchange, the capillaries recombine to form venules and
veins. Ultimately two right and two left pulmonary veins carry oxygen-rich
blood to the heart for distribution, via the aorta/systemic circuit, to the rest
of the body.
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Lung Volumes/ Capacities
The air that the lungs can hold can be divided into smaller designations
called "volumes."
The amount of air a person breathes in and out at rest is called the
Tidal Volume (Vt about 500ml). During such breathing, a person could
actually take in more air or blow more out. The additional amount a person
could inhale, such as during maximum physical activity, is called the
Inspiratory Reserve Volume (IRV 3,000 ml). The additional amount a person
could exhale is called the Expiratory Reserve Volume (ERV 1,000 ml). The
Residual Volume (RV) is the amount of air that stays in the lung even after
maximum expiration.
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To exhale:
35
moves from an area of higher pressure (the air) to an area of lower pressure
(our lungs & alveoli). During expiration, the respiration muscles relax & lung
volume descreases. This causes pressure in the lungs (and alveoli) to
become slight positive relative to atmospheric pressure. As a result, air
leaves the lungs.
The walls of alveoli are coated with a thin film of water & this creates a
potential problem. Water molecules, including those on the alveolar walls,
are more attracted to each other than to air, and this attraction creates a
force called surface tension. This surface tension increases as water
molecules come closer together, which is what happens when we exhale &
our alveoli become smaller (like air leaving a balloon). Potentially, surface
tension could cause alveoli to collapse and, in addition, would make it more
difficult to 're-expand' the alveoli (when you inhaled). Both of these would
represent serious problems: if alveoli collapsed they'd contain no air & no
oxygen to diffuse into the blood &, if 're-expansion' was more difficult,
inhalation would be very, very difficult if not impossible. Fortunately, our
alveoli do not collapse & inhalation is relatively easy because the lungs
produce a substance called surfactant that reduces surface tension.
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Partial Pressure
Partial pressure is the individual pressure exerted independently by a
particular gas within a mixture of gasses. The air we breath is a mixture of
gasses: primarily nitrogen, oxygen, & carbon dioxide. So, the air you blow
into a balloon creates pressure that causes the balloon to expand (& this
pressure is generated as all the molecules of nitrogen, oxygen, & carbon
dioxide move about & collide with the walls of the balloon). However, the
total pressure generated by the air is due in part to nitrogen, in part to
oxygen, & in part to carbon dioxide. That part of the total pressure
generated by oxygen is the 'partial pressure' of oxygen, while that generated
by carbon dioxide is the 'partial pressure' of carbon dioxide. A gas's partial
pressure, therefore, is a measure of how much of that gas is present (e.g., in
the blood or alveoli).
The partial pressure exerted by each gas in a mixture equals the total
pressure times the fractional composition of the gas in the mixture. So, given
that total atmospheric pressure (at sea level) is about 760 mm Hg and,
further, that air is about 21% oxygen, then the partial pressure of oxygen in
the air is 0.21 times 760 mm Hg or 160 mm Hg.
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Pathophysiology of Acute Bronchitis ( Book-Based)
a. Schematic Diagram
-Asthma
Entry of Virulent
Microorganisms
Proliferation of
Microorganisms
Releases Toxins
Inflammatory Response
38
Bronchial Edema Release of
Chemical Mediators
Histamine
Cytokines Bradykinins
Parenchymal and Alveolar
Consolidation Narrowing of
Blood Vessels
Release of Stimulation of
Pyrogens Goblet Cells
RESPIRATORY Air passes through
SECRETIONS narrowed lumen
Accumulation
of Secretions Bronchial Obstruction
ELEVATED WBC Stimulates increase
in Body
Temperature
WHEEZES AND COUGH SOB/DYSPNEA
COUGHING UP BLOOD
CHEST PAIN
HYPERTHERMIA BODY WEAKNESS
Compensatory
Mechanism
39
INCREASED RR and PR USE OF ACCESSORY
MUSCLES
Pathophysiology of Acute Bronchitis (CLIENT-CENTERED)
a. Schematic Diagram
Modifable Factors
Non-modifiable factors -Smoke or fume inhalation
-Asthma
Entry of Virulent
Microorganisms
Proliferation of
Microorganisms
Releases Toxins
40
Inflammatory Response
Histamine
Cytokines Bradykinins
Parenchymal and Alveolar
Consolidation Narrowing of
Blood Vessels
Release of Stimulation of
Pyrogens Goblet Cells
RESPIRATORY Air passes through
SECRETIONS narrowed lumen
Accumulation
of Secretions Bronchial Obstruction
Decreased WBC Stimulates increase
in Body
Temperature
WHEEZES AND COUGH SOB/DYSPNEA
NON PRODUCTIVECOUGH June 23 2009
June 23 2009 CHEST PAIN
BODY WEAKNESS
HYPERTHERMIA June 23 2009
Compensatory
June 24 2009 Mechanism
41
INCREASED RR and PR USE OF ACCESSORY
June 24 2009 MUSCLES
42
SYNTHESIS OF THE DISEASE (BOOK BASED)
Bronchitis can have causes other than infection. Bronchial wall inflammation
can occur in asthma or can be secondary to mucosal injury in an acute
event, such as smoke or chemical fume inhalation. This inflammation can
also result from chronic toxic exposure, such as cigarette smoking. It is
important to realize that when underlying inflammation is present, such as in
asthmatics or smokers, infective agents are likely to cause more severe
cough and wheezing.
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being Mycoplasma pneumoniae. Study findings suggest that Chlamydia
pneumoniae may be another nonviral cause of acute bronchitis.
Modifiable Factors
44
• Difficulty of breathing or dyspnea. This results from the
continuous narrowing and obstruction of the airways. Manifestations of
dyspnea would include:
o Nasal flaring
o Pursed-lip breathing
o Use of accesory muscles
• Chest tightness or pain. This results from the inflammation of the
airway, and due to labored breathing
• Chest Pain. Usually, it is cause by shortness of breath, wheezes and
presence of cough.
• Non-Productive/Productive Cough. Coughing is an important way
to keep the throat and airways clean. It is usually cause by the
presence of increase mucus secretion stimulated by the presence of
Microorganisms causing irritation in the lungs.
• Presence of Adventitious Sounds on the Lungs (rales, wheezes,
ronchi). Presence of abnormal breath sounds is due to accumulation
of secretions in the alveolar sac which traps air producing theses
distinct sounds. Adventitious breath sounds may also occur when
narrowing of the bronchus occurs.
• Dyspnea. This is because of the narrowing blood vessel caused by the
release of chemical mediators leading to difficulty of inspiration and
expiration.
• Shortness of Breath. It is caused by obstruction of the air passages
that may lead to labored or difficulty in breathing.
• Body Weakness. This is due to the physical exertion brought about
by compensatory mechanisms through breathing.
• Fever with Chills. Increase in body temperature is caused by the
inflammatory response of the body due to the presence of virulent
microorganisms.
45
• Coughing up Blood. It is the splitting up of blood or bloody mucus
from the lungs and throat usually cause by the extensive lesion in the
respiratory tract.
• Elevated White Blood Cells. Increased in number of leukocytes is
brought about by the presence of bacterial infection in the body.
• Increase Pulse Rate and Respiratory Rate. This is caused by
imbalance of oxygen supply and demand.
• Use of Accessory Muscle when Breathing. This is a compensatory
mechanism in order to allow proper inhalation and exhalation.
Non-modifiable Factors
Age (Very Young). The patient is 6 years old.
Modifiable Factors
46
• Malnutrition and poor immune system. Improper nutrition and
poor nutrition can contribute to the development and
acquiring of the disease condition. She has decreased
appetite.
• Viral Infection. Mostly the cause of the disease viral infection.
She was diagnose with URTI 4 days prior to admission.
• Environment. Presence of dust and pollutant may contribute in
occurrence of the said condition. Patients house is located
along the highway.
47
Respiratory Rate. This is caused by imbalance of oxygen
supply and demand.
• Body Weakness. (June 23-24 2009) This is due to the physical
exertion brought about by compensatory mechanisms through
breathing.
• Fever with Chills. (June 23-24 2009) Increase in body
temperature is caused by the inflammatory response of the
body due to the presence of virulent microorganisms.
• Elevated White Blood Cells. (June 24 2009) Increased in
number of leukocytes is brought about by the presence of
bacterial infection in the body.
48
V. THE PATIENT AND HIS CARE
A. Medical Management
A.1 IVF’s and Nebulization
Medical Date General Indication( Client’s
Ordered
Manageme Description s) or Response to
Date
nt/ Performed Purpose(s) the
Date
Treatment Treatment
Changed/DC
Intravenous Date ordered: It is a hypertonic It is use to Client fluid
Fluids
June 23 2009 solution, which supply the loss due to
D5 IMB
500cc, @ 45 makes the cells necessary insensible
ugtts/min
Date started: shrink, nutrients. fluid loss was
June 23 2009 composes of And this replaced and
water and solution is nourished.
carbohydrates, given usually
as source of when serum
energy and both osmolality
cations and has
anions decreased to
dangerously
low levels.
Nursing Responsibilities:
Prior to the procedure:
Check doctor’s order. Check for ordered IVF.
Check for the patency of the IV tubing, cloudiness and expiration date.
Explain the procedure, importance and its benefits to the patient’s SO.
Secure all materials for IV insertion
49
During the procedure:
Clean the site of administration. Choose a vein in the distal arm.
Support client hand and maintain aseptic technique.
Regulate the flow rate as ordered.
Always check if it the infusion site and in place.
Monitor I and O.
Monitor patient for fluid overload.
be sure that IV line is free from any kinds of bubbles.
Make sure that all incorporated IVF’s and its desired doses are followed
according to the doctor’s order.
Provide a splint to prevent injury of the vein.
Inspect for level of IV always.
50
Medical Date General Indication(s) or Client’s
Manageme Ordered Description Purpose(s) Response to
nt/ Date the
Treatment Performed Treatment
Date
Changed/DC
Nebulizatio Date ordered: Inhalation It aids bronchial The patient
n June 23 2009 therapy that hygiene by demonstrated
produces restoring and an improved in
Date started: droplets that maintaining the breathing
June 23 2009 are suspended mucous blanket pattern. And
in a gas such continuity, was able to
as oxygen. hydrating dried, cough out
The dug which retained secretions
was formed to secretions, more often.
mist would be promoting
inhaled better expectoration of
secretions. To
relive
bronchospasm,
to provide relief
to a
hyperresponsive
airway and to
liquefy and clear
tenacious
secretions.
51
Nursing Responsibilities
Prior to the procedure:
Check doctor’s order.
Check for the amount of medication that is to be incorporate in the
procedure.
Explain the procedure to the patient’s S.O.
Arranged all the material needed. Wash hand.
During the procedure:
Hold the mouthpiece of the nebulizer upright to avoid spilling of
medicines.
Continue nebulization until the medication is already nebulized.
Do chest physio-therapy after nebulisation.
After the procedure:
Assess the client’s vital signs after nebulization, especially the
respiratory rate.
Document the time of the procedure was done.
B. Drugs
52
nebule
reversible
Date started: fluticasone
bronchospasm
June 23 2009 q 6 hour
associated w/
weight
obstructive
22kg IVF
airway diseases
D5 IMB
in patients who
50cc
require more
than a single
bronchodilator.
53
June 23
2009
Nursing Responsibilities:
>Before administering, check for doctor’s order.
>Give drug with right dosage, route, and time for administration.
Prior to the procedure:
Read the Doctor’s order before giving the medication to the patient,
and always remember the 10 R’s
Inform the patient about the action and the purpose of the drug.
Before giving the medication ask the patient first if she already take
the medications or not.
Note if all the medications are available, if one of the medication are
not available make a prescription and ask the patient’s SO to buy it for
the patient.
Check if the nebulizer is functioning
Prepare the drug by diluting it with distilled water
During the procedure:
Make sure that the patient will take the medications on time.
54
After the procedure:
Instruct patient to take medication at evenly spaced times and to finish
the medication completely.
Inform patient that increased fluid intake and exercise may minimize
constipation
Document.
55
through direct
action on
hypothalamic
heat-regulating
center.
Nursing responsibilities
Prior to drug administration
• Check the written medication order for completeness. It should include
the drug name, dosage, frequency, and duration of therapy.
• Check if there are any special circumstances surrounding
administration of the dose to the patient
• Be certain that you know the expected action, safe dosage range,
special instructions for administration and adverse effects associated
with drug orders
• Wash you hands
• Prepare the necessary equipment like the medication tray and
medication card.
• Prepare the dosage as ordered
• Check the label on the medication three times before administering
any drug
• Ever prepare a dosage of medication, which is discolored,
contaminated, or outdated
56
After drug administration
• Assess for adverse effect of the drug
• Assess for temperature
• Documentation the procedure
57
June 23 against
2009 common
infections &
everyday
stress. Reduces
the risk,
severity &
duration of
common colds,
malaria,
pneumonia &
diarrhea.
Nursing responsibilities
Prior to drug administration
• Check the written medication order for completeness. It should include
the drug name, dosage, frequency, and duration of therapy.
• Check if there are any special circumstances surrounding
administration of the dose to the patient
• Be certain that you know the expected action, safe dosage range,
special instructions for administration and adverse effects associated
with drug orders
• Wash you hands
• Prepare the necessary equipment like the medication tray and
medication card.
• Prepare the dosage as ordered
• Check the label on the medication three times before administering
any drug
• Ever prepare a dosage of medication, which is discolored,
contaminated, or outdated
58
During drug administration
• Verify the patients name first.
• Administer once daily
• May be given with or without meals
59
Nursing responsibilities
Prior to drug administration
• Check the written medication order for completeness. It should include
the drug name, dosage, frequency, and duration of therapy.
• Check if there are any special circumstances surrounding
administration of the dose to the patient
• Be certain that you know the expected action, safe dosage range,
special instructions for administration and adverse effects associated
with drug orders
• Wash you hands
• Prepare the necessary equipment like the medication tray and
medication card.
• Prepare the dosage as ordered
• Check the label on the medication three times before administering
any drug
• Ever prepare a dosage of medication, which is discolored,
contaminated, or outdated
60
C. Diet
61
aspiration. normal
diet.
However,
the SO
must
discontinue
the
patient’s
feeding if
severe
DOB
occurs to
prevent
aspiration
which may
aggravate
the
patient’s
condition.
Nursing Responsibilities:
Check doctor’s order regarding the type of diet.
62
Be sure patient is taking or eating foods she can tolerate.
D. Activity/Exercise
Nursing Responsibilities
63
Elevate head of bed to 45-90 degrees
64
Nursing Care Plan
Problem #1 - Ineffective airway clearance r/t retained secretions in the bronchi
Assessmen Nursing Scientific Objectives Interventions Rationale Expected
t Diagnosis Explanation Outcome
S>Ø
O> patient Ineffective Inflammation and ST> after 1 1. Assess energy 1. Decrease with ST> after 1
may airway swelling of the hour of level and age, more than hour of
manifest: clearance linings of the nursing endurance and one chronic nursing
• Adventitiou r/t retained airways leads to intervention effect on chest disorder further intervention
s breath secretions narrowing and the patient expansion compromises the patient
sounds in the obstruction of the will maintenance of shall have
(crackles/w bronchi airways. The maintain ventilation maintained
heezes) inflammation patent 2. Assess 2. Changes vary patent airway
• Tachypnea also stimulates airway respiratory from minimal to
65
• Wide-eyed e energy level tracheobronchia ction of
66
crackles result
from lung
consolidation of
leukocytes and
fibrin in an area
caused by
infectious
4. Assess for process or fluid
cough and accumulation in
sputum the lungs
production for
amount, color, 4. Changes in color
viscosity, ability to green in
to cough and morning and
expectorate yellow during day
secretions in indicate
relation to infection;
energy levels tenacious, thick
secretions
require more
enrgy and effort
5. Administer to remove and
67
bronchodilators, may cause
anti- obstruction and
inflammatories, stasis leading to
expectorants, infection and
mucolytics, anti- respiratory
infectives changes
5. Treats
bronchospasm,
6. Provide prevents or
environmental treats infection,
air liquefies
humidification\ secretions and
enhances outflow
7. Offer 2-3 L (10- and removal of
12 glasses)/day respiratory tract
unless fluids
contraindicated; 6. Adds moisture to
offer hourly the air to thin
including a mucus for easier
warm beverage removal
upon arising
8. Position in 7. Assist to
68
semi-fowler’s mobilize thin
and change secretions for
position q 2h easier removal
8. Prevents
accumulation of
secretions;
9. Perform promotes
postural comfort and ease
drainage using breathing and
gravity, decreases airflow
percussion, resistance and
vibration, avoid enhances gas
postions that distribution,
may be facilitates chest
contraindicated expansion
in the elderly 9. Raises
10. Maintain secretions, clears
activity pattern, sputum and
69
encourage increases force of
ambulation expiration
within
limitations
11. Encourage
deep breathing 10. Mobilize
and coughing secretions for
exercises by easier removal
taking a deep
breath, exhale 11. Assist in
as much as dislodging
possible, inhale secretions for
again and cough easier
twice from the expectoration by
chest initiating the
cough reflex
which protects
the lungs from
12. Suction if accumulation of
appropriate secretions by
action on
receptors in
70
tracheobronchial
13. Instruct wall
patient to avoid
milk, caffeine 12. Removes
drinks and secretions in
alcohol those too weak
to cough or with
mentation or LOC
deficits
13. Milk thickens
mucus, caffeine
14. Instruct reduces effect of
patient to avoid medication
excessively hot ( bronchodilators)
or cold fluids; , alcohol
cold air and increases cell
wind exposure dehydration and
by wearing bronchial
mask constriction
15. Encourage 14. Predisposes
cessation of to coughing
smoking; spells; dyspnea,
71
suggest bronchospasm
program to
support the
reduction or 15. Smoking
cessation of causes increased
smoking mucus,
vasoconstriction,
increased BP,
inflammation of
the lung lining,
16. Program of decreased
daily exercises; number of
supervised if macrophages in
needed airways and
mucociliary
17. Instruct blanket
patient to avoid 16. Promotes
crowds and secretion
those with upper removal
respiratory tract
infections
18. Instruct 17. Prevents
72
patient on possible
proper use of transmission of
and disposal of infection
tissues used for
expectoration
18. Prevents
transmission of
microorganism
as sputum
contains infecting
organism and
inflammatory
debris
73
S>Ø
O> patient Ineffective Irritants inflame ST> after 1 1. Assess 1. Changes vary ST> after 1
may breathing the hour of respiratory with acuteness of hour of
manifest: pattern r/t tracheobronchial nursing status for rate, condition and are nursing
• Prolonged tracheobro tree, leading to intervention depth and ease, caused by airway intervention
dyspnea nchial increase mucus the patient presence of resistance, the patient
• Exhausted obstruction production and a will dyspnea and bronchospasm, shall have
appearanc narrowed or verbalize use of accessory decreased lung verbalized
e blocked airway. awareness muscles, expansion, awareness of
• Listlessnes inflammation factors and expiratory phase from stimulation factors and
74
of cyanosis 3. Results from and other
and other 3. Assess pain or excessive signs and
signs and chest coughing , use of symptoms of
symptoms discomfort, sore muscles for work hypoxia with
of hypoxia chest muscles, of breathing ABGs within
with ABGs effort on chest causing reduced client
within client excursion chest expansion acceptable
acceptable and shallow range
range breathing pattern
4. Changes caused
by infectious
4. Auscultate for process as
diminished or consolidation
absent breath develops;
sounds, damage to
wheezes or bronchioles
crackles restrict air
movement
5. Have client to 5. To correct
breath into hyperventilation
paper bag
6. Administer 6. Treats
75
bronchodilator bronchospasm,
as ordered prevents or
treats infection
7. Position in 7. Promotes
semi- or high comfort and ease
fowler’s of breathing and
gas distribution,
facilitates chest
expansion by
causing
abdominal
organs to sag
way from
8. Perform deep diaphragm
breathing 8. Strengthens
exercises and chest and
pursed lip abdominal
breathing, muscles to
isometric enhance
exercises for breathing ;
intercostals pursed lip
muscle and breathing
76
diaphragm prolongs
strengthening; expiratory phase
upper body and prevents
exercises by alveoli from
raising arms and collapsing to
using 2-3 lb decrease CO2
hand weight if retention
available
9. Provide proper
body alignment
in positioning for 9. Ensures optimal
sleep, use ventilation
pillows, to
elevate head
and support
chest.
10. Pace 10. Prevents
activities, allow changes in
for rest between respirations
periods of brought about by
exercises exertion
11. Instruct 11. Causes
77
patient to avoid exacerbation of
extending any dyspnea
activity beyond
baseline of
tolerance 12. Decrease
12. Encourage respiratory rate
patient of
relaxation
techniques,
guided imagery,
music when
breathing
pattern changes
or anxiety
increases
78
S>Ø
O> patient impaired Bronchospastic ST> After 1 1. Assess 1. Gas exchange ST> After 1
may gas disease changes hour of respiratory carried out by hour of
manifest: exchange gas flow and nursing status for rate, pulmonary nursing
• Irritability r/t blood distribution intervention depth and ease, circulation is intervention
• Hypoxemia ventilation possibly causing, the patient dyspnea and affected by body the patient
• Hypercapni perfusion in some cases, will respiratory position and shall have
79
Nevertheless, adequate decreased surface area adequate
chronic oxygen and oxygen and available, oxygen and
bronchitis and carbon increase carbon thickness of the carbon
acute asthma dioxide dioxide levels, alveolocapillary dioxide levels
often result in a levels with possible membrane of with return of
low return of lowered pH; O2 both of which respiratory
ventilation/perfus respiratory saturation by characteristic of baselines
ion condition baselines oximetry aging or disease
(V/Q) with lung tissue;
associated cyanosis results
oxygen from the
desaturation and reduction in
hypoxemia. oxygenated
hemoglobin in the
blood and leads
3. Assess for to hypoxia
changes in (reduced tissue
consciousness, oxygenation)
mentation, 3. Results of
restlessness, decreased oxygen
irritability, rapid to brain tissue
fatigue with progressive
80
hypoxia
4. Position patient
in semi/high-
fowler’s using
chair or pillow 4. Promotes
on over bed breathing and gas
table to lean distribution
forward facilitates chest
expansion and
pulmonary blood
5. Breathing flow; sitting
exercise position stabilizes
chest structures
5. Restores function
of diaphragm
which decreases
6. Administer work of breathing
oxygen at 2-3 and improves gas
L/min via exchange
cannula, non 6. Maintain
breather mask adequate oxygen
level without
81
7. Instruct patient depressing
to avoid respiratory drive
activities that which increases
cause change CO2 retention
in respirations 7. Increase in
especially oxygen
shortness of consumption
breath changes
8. Instruct patient breathing pattern
to report any
changes in
fatigue level or
any mental 8. Indicates
clouding, impending
increasing hypoxia
dyspneic
episodes
9. Encourage
adequate rest
and limit 9. Help limit O2
activities to needs/consumptio
within client n
82
tolerance
10. Instruct
patient to keep
his 10. To reduce
environment irritant effect on
allergen/polluta airways
nt free
11. Encourage
cessation of 11. To improve
smoking; lung function
suggest
program to
support the
reduction or
cessation of
smoking
Problem #4 – High risk for infection r/t inadequate primary defenses (decrease ciliary action)
Assessmen Nursing Scientific Objectives Interventions Rationale Expected
t Diagnosis Explanation Outcome
83
S>Ø
O> patient High risk for Smoke and other ST> After 1 1. Assess for 1. Early detection ST> After 1
may infection r/t pollutants irritate hour of increased of respiratory hour of
manifest : inadequate the airways, nursing dyspnea, infection allows nursing
• Productive primary resulting in intervention change in color for immediate intervention
cough defenses hypersecretion of the patient and viscosity of treatment the patient
• Fever (decrease mucus and will have sputum (yellow before shall have
84
bronchial lumen demonstrat pollutants dyspneic attack techniques to
narrows and e 5. Avoid large promote safe
mucus may plug techniques groups, 5. Prevent s environment
the airway. to promote exposure contact with
Alveoli adjacent safe potential
to the environmen 6. Proper hand infectious
bronchioles may t washing, agents
become disposal of 6. Prevents
damaged and tissues, cover transmission of
fibrosed, mouth and infectious
resulting in nose when agents from
altered function coughing, contaminated
of the alveolar cleansing and articles
macrophages. disinfection off
This is significant respiratory
because the equipment
macrophages 7. Proper
play an administration
important role in and expected 7. Prevents
destroying effect of recurrence of
particles, antibiotic infection
including therapy and to
85
bacteria. take complete
prescription
8. Instruct patient
to report fever
or change in 8. May indicate
sputum infection
9. Encourage
early 9. For mobilization
ambulation, of respiratory
deep breathing secretions
and coughing
position change
86
Problem#5 - Sleep pattern disturbance r/t internal factors of illness and psychological stress
of dyspnea
Assessmen Nursing Scientific Objectives Interventions Rationale Expected
t Diagnosis Explanation Outcome
S>Ø ST>after 1
O> patient Sleep Sleeplessness ST>after 1 1. Assess 1. Provides hour of
may pattern and daytime hour of sleep pattern data for nursing
manifest: disturbance sleepiness are nursing and changes, resolving sleep intervention
• Irritability r/t internal common intervention naps and deprivation in the patient
yawning illness and Studies indicate will amount of aging changes verbalized
87
• Drowsiness al stress of - 93% of people understandi sedentary of sleep
88
sleep. of action,
alcohol,caffein absorption and
e,medication excretion may
regimen be delayed in
elderly and
adverse effects
and toxicity at
higher
riskExternal
stimuli
interferes with
going to sleep
and increases
wakenings as
sleep in the
elderly is of less
intensity
5. Assess 5. Prevents
environment break in
for lighting, established
noises, odors, pattern
temperature, And promotes
89
ventilation comfort and
relaxation
6. Provide before sleep
ritualistic
procedures of 6. Promotes
warm drink, falling asleep
extra covers,
clean linens,
warm bath
before bedtime
90
according to before sleep
need and reduces
recognizing anxiety and
that they may tension
interfere with
sleep and
cause
insomnia 9. Depresses
9. Provide sleep
back rub,
relaxation
techniques,
imagery,
music,
massage at 10. Assist
bedtime in acceptance
10. Instru of changes and
ct patient to need for sleep
refrain from revision of
use of alcohol sleep pattern
and CNS 11. Preven
depressants ts falling asleep
91
because of
11. Infor overstimulation
m patient of
aging changes
and their
relation to
sleep changes
92
S>Ø
O> patient Fatigue r/t Hyperventilation ST> After 1 1. Assess for 1. Provides ST> After 1
may respiratory is triggered by hour of extreme information to hour of
manifest: effort lung receptors to nursing weakness and determine nursing
• Irritability increase lung intervention fatigue; ability effects of intervention
• Exhausted volume because the patient to rest, sleep dyspnea and the patient
93
ventilation- commitment to
perfusion ratios promoting
and mismatching 4. Plan care to optimal
within different allow adequate outcomes
lung segments. rest periods. 4. To maximize
Schedule participation
activities for
periods when
client has the
most energy
5. Provide 5. Temperature
environment and level of
conducive to humidity are
relief of fatigue known to affect
6. Provide exhaustion
supplemental 6. Presence of
oxygen as anemia/hypoxe
indicate mia reduces
oxygen available
for cellular
7. Encourage use uptake and
of measures to contributes to
94
prevent fatigue fatigue
(diversional 7. Provide support
activities such and conserves
as wathcing TV, energy
small frequent
feedings)
Problem #7 - Activity intolerance r/t imbalance between oxygen demand and supply
Assessmen Nursing Scientific Objectives Interventions Rationale Expected
t Diagnosis Explanation Outcome
• Body demand Due to excessive participate and sleep 2. Pulse increase of participated
95
accessory decrease activities to before, during any difficulty in activities to
muscles to function of the increase and after respirations increase
breathe cilia to remove activity activity indicate that activity
• Fatigue secretions, tolerance activity limit has tolerance
• Cyanosis supply from the the patient rest or sleep rest and sleep intervention
lungs to the body will periods; allow necessary for the patient
and retention of maintain self pacing of physical and shall have
carbon dioxide optimal activities mental health to maintained
occurs. activity prevent fatigue optimal
level within 4. Stress and activity level
energy and 4. Provide quiet, stimuli produce within energy
breathing stress free anxiety and and breathing
limitations. environment increase limitations.
respirations
5. Provide oxygen 5. Pulmonary
during activities function tests
if appropriate indicate
96
hypoxemia
during exercise
and determine
6. Assist with need for
activities as additional
needed oxygen
6. Conserves
7. Provide slowly energy and
progressive oxygen
activity/exercise consumption;
program and prevents
promote dyspnea
independent 7. Increases
ADL delivery of
participation oxygen to
8. Instruct the tissues; increases
patient to avoid tolerance to
extending activities and
activities decreases feeling
beyond fatigue of helplessness
level or
tolerance that 8. Conserves
97
may provoke energy and
dyspne prevents
exacerbation of
9. Instruct the dyspnea
patient to utilize
energy saving
devices such as
arm rest, sitting
on stool in 9. Prevents fatigue
shower, placing
articles
commonly used
within reach
98
inhalers before
activity
99
ACTUAL NURSING CARE (SOAPIE)
June 24 2009
S>Ø
O>Received patient sitting on bed, awake and coherent to person place and
time, with an ongoing IVF#3 D5IMB 500cc regulated at 45 ugtts/min at a
level of 350cc, infusing well at the left hand, good skin turgor, rales on both
lung fields upon auscultation, with nonproductive cough, with nasal flaring,
CRT of 1-2 seconds with pinkish palpebral conjuctiva, with leukocytes of 4.52
dated June 24 2009 with vital signs as follows : T=36.9°C, HR= 95 bpm, RR=
26 cycles/min, BP=90/60 mmHg
A>
1. Ineffective airway clearance r/t retained secretions in the bronchi
2. Impared gas exchange r/t obstructions on the airway AEB rales upon
auscultation.
3. Ineffective protection r/t altered blood profile AEB decreased
leukocytes secondary to acute bronchitis.
P>
1. After 3° of NI the patient will maintain airway patency AEB absence of
respiratory distress.
2. After 3° of NI the patient will able to maintain adequacy of gas
exchange AEB absence of respiratory distress.
3. After 2° of NI the patient will be free from infection.
I>Established rapport
>Monitored and recorded vital signs
>Assessed patient’s condition and watch out for signs and symptoms of
respiratory distress
>provided comfort and safety measures
>kept patient’s back dry
>Encouraged to increase fiber intake and vitamin C
>Elevated the head of bed
100
>performed chest tapping/back rub to mobilize secretions
>provided nebulization as ordered
>Encourage turning position changes
>due meds given
>Further needs attended
>endorsed
E>
1. Goal met AEB patient able to maintain airway patency AEB absence
of respiratory distress.
2. Goal met AEB patient able to maintain adequacy of gas exchange
AEB absence of respiratory distress.
3. Goal met AEB patient was free from infection.
101
between oxygen demand and supply
Vital Signs
1.) Temp. 36.1C 36.8C
2.) PR 75bpm 95bpm
3.) RR 38cpm 26cpm
4.) BP 90/60 90/60
Diagnostic/Lab Procedures
1) Hematology
2.) CXR PA
3.) Urinalysis
4.) cold agglutinin determination
1)IVF D5 IMB 500 cc
2.) Neb
Drugs:
• Paracetamol
• Co amoxiclav
• Pedzinc
• Comvibent + fluticasone
Diet:
DAT
Activity/Exercise
Bederest
102
2. DISCHARGE PLANNING
The client achieved his optimum health status after his hospitalization. He
has already adequate ventilation and oxygenation. No other associated signs
and symptoms of respiratory distress he appears generally in good condition.
There were no complications noted. Still, on the process of recovery.
S> Ø
O> Received patient sitting on bed, awake and coherent, with an ongoing
IVF #6 D5 IMB 500cc x 45ugtts/min at level of 300cc infusing well at the left
dorsal veinof the hand, c good skin turgor, c cough, c (-) DOB, c V/S as
follows : T=36.8, PR= 90 bpm, RR= 25, BP=90/60 mmHg
P> After 2 hours of nursing intervention the patient will remain free of
preventable complications/progression of illness and sequelae and will
verbalize understanding of health teachings
M>
• Paracetamol syrup 5ml every 4 hours for fever
• Co amoxiclav 300mg every 8 hours for 5 days
• Pedzinc syrup 5ml once a day
• Combivent 1 neb every 6 hours
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T> Home maintenance and management
Bronchitis can have causes other than infection. Bronchial wall inflammation
can occur in asthma or can be secondary to mucosal injury in an acute
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event, such as smoke or chemical fume inhalation. This inflammation can
also result from chronic toxic exposure, such as cigarette smoking. It is
important to realize that when underlying inflammation is present, such as in
asthmatics or smokers, infective agents are likely to cause more severe
cough and wheezing.
After having completed the said study, the group recommends the
study:
105
• to the patients who have such disease conditions that they may
become aware of the disease they have and provide appropriate self
care.
• to the health care providers especially nurses since they are the ones
who has direct interaction with the patient. Enough knowledge of the
health care providers will enable them to provide the correct
intervention for the patient.
VIII. Bibliography
BOOKS
• Seeley R.; Essentials of Anatomy and Physiology(6th edition); McGraw-
Hill;New York USA
• Doenger, et al. Nurse’s Pocket Guide (10th Edition); Schilling J. 2003
• Black, Joyce et al. Medical-Surgical Nursing. St. Louis Missouri. 2005
• Pilliteri, A., Maternal and Child Health Nursing: Care of the Childbearing ang
Childbearing Family (5th edition); Lippincott Williams and Wilkins.2007
WEB
• http://health.yahoo.com/respiratory-overview/acute-bronchitis-topic-
overview/healthwise--hw32162.html
• http://en.wikipedia.org/wiki/Acute_bronchitis
• http://www.webmd.com/a-to-z-guides/acute-bronchitis-topic-overview
• http://www.peacehealth.org/kbase/topic/major/hw32160/descrip.htm
• http://en.wikipedia.org/wiki/Bronchitis
• http://www.nlm.nih.gov/medlineplus/asthma.html#cat1
• http://www.healthline.com/adamcontent/asthma/3
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• http://www.answers.com/topic/bronchopneumonia
• http://www.sciencedaily.com /releases/2008/12/081208085002.htm
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ANGELES UNIVERSITY FOUNDATION
COLLEGE OF NURSING
ANGELES CITY
Acute Bronchitis
SUBMITTED BY:
Bondoc, John Celestine
Group 54 BSN IV-14
SUBMITTED TO:
Elmer D. Bondoc R.N. M.N.
DATE:
June 29, 2009