By: Danah Macaraig Aniebee Montano Klent Nikko Melencion

OBJECTIVE
Define what Acute Bronchitis is Trace its Pathophysiology Enumerate the Signs and Symptoms And learn new clinical skills required in the management of the patient with Lung Abscess

Case Introduction

A years old female admitted to the hospital on December, 2013 at QMC. Admitting physician was Dr. Tolentino with a diagnosis of Acute Bronchitis.

Acute Bronchitis

A years old female admitted to the hospital on December, 2013 at QMC. Admitting physician was Dr. Tolentino with a diagnosis of Acute Bronchitis.

Bronchitis Causes: -Bronchitis occurs most often during the cold and flu season, usually coupled with an upper respiratory infection. Several viruses cause bronchitis, including influenza A an d B, commonly referred to as "the flu." A number of bacteria are also known to cause bronchitis, such as Mycoplasma pneumonia. Bronchitis also can occur when you inhale irritating fum es or dusts. Chemical solvents and smoke, including tobacco smoke, have been linked to acute bronchitis.

Bronchitis Symptoms: Acute bronchitismost commonly occurs after an upper respirat ory infection such as the common cold or a sinus infection. You may see symptoms such as fever with chills, muscle aches, nasal congestion, and sore throat. Cough is a common symptom of bronchitis. Wheezing may occur because of the inflammation of the airways. -This may leave you short of breath.

Signs and Symptoms

-retrosternal pain during deep breathing or couching -constant cough that may last up to a month. Cough may be dry or up with mucus. Mucus may be green, yellows, white , or have streaks of blood. Chest pain may appear. -fever, body aches, and chills -sore throat and runny or stuffy nose -short of breath and wheees when breathing. -tiredness more than usual.

Patients Data

NAME: Kaith Ayeixhia Acquiatan AGE: 11 months and 19 days GENDER: Female RELIGION: Roman Catholic BIRTH DATE: December 23, 2012 CIVIL STATUS: child NATIONALITY: Filipino ADDRESS: Tayabas, Quezon DATE OF ADMISSION: December 12, 2013 ADMITTING PHYSICIAN: Dr. Tagle

Physical Assessment

Technique SKIN Inspeciton

Normal Findings Skin is brown and

generally equal No edema Good skin turgor No lesion Temp. is warm &coo

Abnormal Findings -none

NAILS

Inspection

Clean, smooth Pink to light brown nail beds No lesion No dandruff Even in distribution

-none

HAIR

Inspection

-none

TECHNIQUE EYES Inspection

NORMAL FINDINGS Symmetrical in position Sclera is white &glossy PERRLA Brisk reaction to light

ABNORMAL None

Ears

Inspection

Equal in size Symmetrical No swelling or discharges

None

Nose

Inspection Palpation

With discharge Symmetrical No inflammation Air can be felt in both nares

Mouth and Throat Chest

Inspection Inspection Palpation Auscultation

Tongue is at midline Normal contour Tactile fremitus Bronchial breath sounds Limited chest excursion

Abdomen

Inspection Palpation

Color isconsistent withthe body No lesion or anyabnormalfindi ngs Bowel sounds isnormoactive(13/min) No tenderness

Genogram
Mother (Asthma) Father (Healthy)

Patient (Acute Bronchits)

LABORATORY

COMPLETE BLOOD COUNT

TEST RBC HEMOGLOBIN HEMATOCRIT PLATELET WBC MCV MCH MCHC VALUE 4-6x 10 12/L M- 130-180 F- 120-160 M- 0.40-0.54 F- 0.36-0.47 150-400x 10 9/L 4-11x 10 9/L 80-94 22-31uug 31-36 % 4.51 98 0.33 317 10.9 74 22 30% RESULT INTERPRETATION

SCHILLING DIFFERENTIAL COUNT

TEST Segmenters Lymphocytes Monocytes Eosinophils VALUE 0.50-0.56 0.20-0.40 0.02-0.08 0.01-0.04 0.60 0.29 0.10 0.01 RESULT INTERPRETATION

ANATOMY and PHYSIOLOGY

The word respiration describes two processes. Internal or cellular respiration is the process by which glucose or other small molecules are oxidized to produce energy: this requires oxygen and generates carbon dioxide. External respiration (breathing) involves simply the stage of taking oxygen from the air and returning carbon dioxide to it

The lungs constitute the largest organ in the respiratory system. They play an important role in respiration, or the process of providing the body with oxygen and releasing carbon dioxide. The lungs expand and contract up to 20 times per minute taking in and disposing of those gases. Air that is breathed in is filled with oxygen and goes to the trachea, which branches off into one of two bronchi. Each bronchus enters a lung. There are two lungs, one on each side of the breastbone and protected by the ribs.

Each lung is made up of lobes, or sections. There are three lobes in the right lung and two lobes in the left one. The lungs are cone shaped and made of elastic, spongy tissue. Within the lungs, the bronchi branch out into minute pathways that go through the lung tissue. The pathways are called bronchioles, and they end at microscopic air sacs called alveoli.

The alveoli are surrounded by capillaries and provide oxygen for the blood in these vessels. The oxygenated blood is then pumped by the heart throughout the body. The alveoli also take in carbon dioxide, which is then exhaled from the body.

Inhaling is due to contractions of the diaphragm and of muscles between the ribs. Exhaling results from relaxation of those muscles. Each lung is surrounded by a twolayered membrane, or the pleura, that under normal circumstances has a very, very small amount of fluid between the layers. The fluid allows the membranes to easily slide over each other during breathing.

PATHOPHYSIOLOGY
Etiologic Agent: -Bacteria -Virus Precipitating Factors: -Hospitalization -Unadvisable Envi --Smoking -Malnutrition Microorganism enter resp tract by droplet inhalation. Predisposing Factors: -Elderly Immobilization -Immune Deficiency -Long Term Illness Smoking

Widespread inflammation occurs

Thin mucous lining of the bronchi can become irritated and swollen

Cells that makes up this lining may leak fluids in response to the inflammation

Coughing as a reflex that works to clear secretions from the lungs

Alveolar fluid increases

Narrowing of airways

Ventilation decreases as secretions thickens

Mucus within the airways produces resistance in small airway and can cause severe ventilation- perfusion imbalance

Course in the Ward

Date and Time Dec 12, 2013 Doctors Order -Please admit to Pedia ward -Lab: CBC, Platelet, urinalysis, chest x-ray, ADL -IVF D5 0.3 NaCl 500 cc X 32 gtt/min Meds:Salbutamol Nebulizer q6 -Vitamin A CW P-ROD Refer Paracetamol 100mg/ml 0.9 cc q4 Nursing Implementation -obtain vital signs -instruct pt to follow the diet and the doctors order Rationale -to monitor the status of the patient

Date and Time

Doctors Order

Nsg Implementation

Rationale

12/12/13

-Pen G NU 400,000 u IVP q6 -Vit A 100,000 u SD -Salbutamol and IPM Br. ned -paracetamol 100 mg/ml 0.9 cc q4 Ppm for fever

12/12/13 4:30

-may decrease nebulization to q4 -continue meds -chest x-ray results

DRUG STUDY

Therapeutic Classification

Action

Contraindicaiton

Toxicity/ Side Effects

Implementation

Safe Doze

Salbutamol Bronchodilator (t herapeutic); adrenergics (pharmacologic)

It relieves nasal congestion and reversible bronchospasm by relaxing the smooth muscles of the bronchioles

Hypersensitivity to adrenergic amines Hypersensitivity to fluorocarbons

Nervousness Restlessness Tremor Headache Insomnia Chest pain Palpitations Angina Arrhythmias Hypertension Nausea and vomiting Hyperglycemia Hypokalemia

Assess lung sounds, PR and BP before drug administration and during peak of medication. Observe fore paradoxical spasm and withhold medication and notify physician if condition occurs. Administer PO medications with meals to minimize gastric irritation.

2 inhalations every 4-6 hours

Therapeutic Classification

Action

Contraindicaiton

Toxicity/ Side Effects

Implementation

Safe Doze

Penicilin G

Interferes Allergic to with bacteria penicilin,cep cell wall halosphorin -Antibiotic synthesis Anti-infective during active multiplicatio n, causing cell wall death and resultant bactericidal activities against susceptible bacteria

-lethargy -glossitis -wheezing -fever

-Assess for -600,000 hypersensitiv -1.2 million ity. -educate about side effect

Therapeutic Effect

Action

Contraindicatio n

Side Effects

Intervention

Dosage

Paracetamol Anti-pyretic

Symptomatic relief of pain and fever

Contraindicat ed in patients hypersensitiv e to drug.

nausea, upper stomach pain, itching, loss of appetite; dark urine, clay-colored stools; or jaundice (yellowing of the skin or eyes).

Check I&O 500 mg ratio; decreasing output may indicate renal failure.Assess for fev er and pain

NURSING CARE PLAN

Assessment
Subjective: nahihirapan ang anak kung huminga Objective: -

diagnosis
Impaired Gas Exchange

planning
At the end of the 8 hr nursing intervention, the pt will demonstrate improved ventilation an d free of symptoms of respiratory distress.

Intervention
-Assess the frequency, depth of breathing

Rationale
-gives a baseline and is useful to evaluate the degree of respiratoty distress. -oxygen delivery can be improved by a high seating position and breathing exercises.

Evaluation

-Elevate head of bed, help patients to choose a position that is easy to breathe. Encourage deep breath or breathing. - Instruct and encourage the patient on diaphragmatic breathing and effective coughing.

-techniques improve ventilation by opening the airway and clearing the airway of sputum. Improvement of gas exchange.

Collaboration: - Provide appropriate bronchodilator required.

-Bronchodilators dilate the airway and helps fight the bronchial mucosal edema and muscular spasm.

- Evaluate the effectiveness of the actions nebulizer, metered dose inhalers.

-combining medication with a nebulizer aerosolized bronchodilator commonly used to control bronchoconstrict ion. -can fix / prevent worsening hypoxia.

-Provide supplemental oxygen in accordance with the indications of blood gas analysis results and patient tolerance.

Assessment
Subjective: Di na ko makatindig ng maayos. As verbalized by client. Objective: Irritability Facial Grimace

Diagnosis
Activity Intolerance related to immobility secondary to pneumonia as manifested by irritability and facial grimace.

Planning

Intervention
Monitor v/s

Rationale
Serves as baseline data of client.

Evaluation

After 4 hours nursing intervention client will measurably increase in activity tolerance.

Encourage client to rest

To decrease clients cardiac rate.

Limit movement and encourage R.O.M. exercises.

Muscle will rest to promote strength and joint muscle To establish goal and provied positive attitude towards the client

After 4 hours of nursing intervention client participation in conditioning to enhance ability to perform.

Promote wellness and provide emotional support in the process.

Health Education

Instruct older patients regarding the need for immunization against pertussis, diphtheria, and influenza, which reduces the risk of bronchitis due to causative organisms. Instruct these patients to avoid passive environment tobacco smoke; to avoid air pollutants, such as wood, smoke, solvents, and cleaners; and to obtain medical attention for prolonged respiratory infections. Instruct parents that children may attend school or daycare without restrictions except during episodes acute bronchitis with fever. Also instruct parents that children may return to school or daycare when signs of infection have decreased, appetite returns, and alertness, strength ,and a feeling of well-being allow

M E T H

MEDICATION ENVIRONMENT TREATMENT HEALTH TEACHING

Discuss the importance of taking medication at the right time,right route at frequency Encourage to keep environment clean and with good sanitation. Provide well ventilated. Instructed to come back after one week for follow up check up. -keep back dry -increase fluid intake -give client nutritious food that is tolerable -encourage to do back tapping and vibration when coughing Observe for the signs and symptoms of infection -Diet As Tolerated

O D

OBSERVATION DIET

PROGNOSIS
Manageable with proper treatment and avoidance of known triggers such as tobacco smoke) Proper managements of any underlying disease process, such as asthma, cystic fibrosis, heart failure or tuberculosis is also key Pts need careful periodic monitoring to minimize further lung damage and progression to chronic irreversible lung disease