Bronchitis Report

8/12/2019 Bronchitis Report

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Acute BronchitisBy: Rolinette Dane Su


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Objectives

To give facts and information aboutbronchitis.

To acquaint us on the procedures and

management of bronchitis


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Introduction

ACUTE BRONCHITISis aninflammationof the large bronchi(medium-sized airways) in the lungsthat

is usually caused by virusesor bacteriaand may last several days or weeks.Characteristic symptoms include cough,sputum(phlegm) production, andshortness of breath and wheezing relatedto the obstruction of the inflamedairways.
http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Bronchushttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Sputumhttp://en.wikipedia.org/wiki/Sputumhttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Bronchushttp://en.wikipedia.org/wiki/Inflammation


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Review of Related Literature

Bronchitis is an inflammation or swelling ofthe bronchi-air passages that extend from thewindpipe to the lungs. Viruses, bacteria,smoking, chemical pollutants and dust may

cause the swelling. Bronchitis may occur aftera bout of flue or severe cold, especially amongpeople with weakened body resistance likesmokers and alcoholics. Avoiding cigarettes,second-hand smoke, and heavy fumes can

hasten recovery, because the lungs' task offiltering pollutants is made easier.(Department of Health, 2006)
http://www.cardiologychannel.com/smoking/index.shtmlhttp://www.cardiologychannel.com/smoking/index.shtml


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Smoking is a key risk factor fordeveloping acute bronchitis. Any otherillnesses that predispose to similar

inflammation also increase that risk (forexample, asthmapatients and patientsallergic to airborne chemicals). (O.

Marzian, University of Heidelberg, 2007)
http://www.medicinenet.com/script/main/art.asp?articlekey=284http://www.medicinenet.com/script/main/art.asp?articlekey=6748http://www.medicinenet.com/script/main/art.asp?articlekey=6748http://www.medicinenet.com/script/main/art.asp?articlekey=284


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Approximately 90% of cases of acutebronchitis are viral infections (commonlycaused by rhinovirus, and influenza

virus),while 10% are bacterial (commonlycaused by B.pertussis, C.pneumoniae,and M.pneumoniae). (Stoppler, Melissa

Conrad, 2009)


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The Philippines has 3,967,117 registeredcases of acute bronchitis in 2008. (WorldHealth Organization)


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Biographic Data

Name: Patient X Address: Brgy. Sta. Elena, San Pablo City Birth Date: August 12,1999 Age: 11 Sex: Male

Marital Status: Single Religion: Roman Catholic Nationality: Filipino Occupation: N/A Contact Person: Mr. X

Occupation: Jeepney Driver Monthly Income: P 8000 Relationship: Father Address of Nearest Relative: Brgy. Sta. Elena, San Pablo City


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Reason for Seeking Care

Patients chief complaint (patients exact words):Inuubo po ang aking anak as verbalized by thepatients father.

How did the symptoms of your present problem

developed? Una nag umpisa siya sa simplengubo tapos nagkaroon siya ng sipon at lagnat asverbalized by the patients father.

When did the symptoms developed? January 18,2010, two days prior to admission.

What led the patient to seek medical attention?Tumaas kasi ng sobra yung lagnat niya asverbalized by the patients father.


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Medical History

Past medical history Hypertension ( )

Diabetes ( )

Back Pain ( )

Others: Diarrhea, Fever


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Current medical history

Hypertension ( )

Diabetes ( )

Back Pain ( )

Others: None


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Have he ever been hospitalized? YES ( ) NO (X). If yes,WHEN? WHY?

Have he ever had surgery? No, he havent had anysurgery.

Is he allergic to anything in the environment or to anydrugs? No, he has no known allergies.

Is he taking any medication, including over-the-counterpreparations, such as aspirin, vitamins, cough syrup?

Yes. If so, how much do you take and how often do you

take it? Oo, binibigyan ko sya ng paracetamol pagnilalagnat, as verbalized by the patients father

Do you use home remedies such as homemadeointments? No, they dont use any homemade remedies.

Do you use herbal preparations or take dietarysupplements? No, they dont use any herbal preparations

or take dietary supplements.

Do you use other alternatives or complementarytherapies, such as acupuncture, therapeutic massage orchiropractic? No, they dont use any alternative orcomplementary therapies.


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Family History

Is his mother, father and siblingsliving? Yes, his parents and siblings arestill alive.


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Psychosocial History How have you coped with medical or emotional crises in the

past? Nananalangin lang kami tapos pinipilit namingsiyang patawaninas verbalized by the patients father.

How adequate is the emotional support he receive fromfamily and friends? Sapat naman, pati yung mga lola nya atmga tiyuhin at tiyahin, tumutulong naman sa pag-aalaga sa

kanya asverbalized by the patients father. How close do you live to health care facilities? Can you get

them easily? Medio malayo sa amin as verbalized by thepatients father.

Do you have health insurance? Meron akong Philhealth asverbalized by the patients father.

Are you on a fixed income with no extra money for healthcare? Meron naman akong naitatabi pagka mayroongnagkakasakit sa amin as verbalized by the patients father.


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Activities of Daily Living

Diet and Elimination Appetite: Good, he eats 3 times a day plus

snacks.

Special diets: None

Food allergies: None

Can the patients family buy enough food?Yes, they can buy enough food.

Who cooks and shops at his house? Both his

parents. Frequency of bowel movements and laxatives

use: Once a day, without the use of laxatives.


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Exercise and Sleep

How many hours of sleep at night? 9 to 10hours

What is the patients sleeping patterns like?Malalim siyang matulog as verbalized by theclients father.

Does the patient felt rested after sleep? Yes, thepatient feels rested after sleep.


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Religious Observance

Any religious beliefs that affect diet,dress or health practices: None


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REVIEWING STRUCTURES

AND SYSTEMS

HEAD: No lesions, clean scalp, with short and straight hair. EYES: With pinkish conjunctiva, can look at any directions. EARS: No discharge or lesions, symmetrical. NOSE: With clear nasal discharge. MOUTH: No sores, soft and moist.

NECK: Short and thin, can turn easily from side to side. RESPIRATORY PATTERN: Occasional cough, slightly

elevated respiratory rate. CARDIOVASCULAR SYSTEM: Slightly elevated heart rate,

no murmur. ABDOMEN/GASTROINTESTINAL SYSTEM: No

distention, normal bowel sounds. HEMATOLOGICAL SYSTEM: Normal WBC. EMOTIONAL STATUS: Easily distracted, restless.


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Anatomy and Physiology


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Oxygen enters the body through the nostrils andmouth then it will travel to the larynx (voice box) >trachea > bronchi > bronchial tubes > then alveoli.

When the oxygen enters the alveoli, it will diffuse tothe blood through the capillaries.

The waste (carbon dioxide) rich blood from the veinswill be released into the alveoli then exhaled out fromthe body.

On the trachea, the air we breathe will go through afork in the road. This fork is called the bronchial tubes.

One bronchial tube will go to the left lung while theother will go to the left.

These brochi will subdivide into secondary bronchi,three on the right and two on the left, each of whichenters and supplies one lung lobe.

These will continue to branch out for several times tobecome terminal bronchiole, which then divides intorespiratory bronchioles (resembling an inverted tree).


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The bronchioles other than the primarybronchi are supported by small cartilage ringsembedded on their walls.

As you move down the tree, the cartilagebecomes more and more sparse and smallerand smooth muscles becomes more abundant.

The bronchioles, devoid of cartilage in their

walls, are very small tubes, 1mm or less indiameter. Because much smooth muscle and nocartilage in their walls, they can constrict if thesmooth muscle contracts forcefully, whichoccurs during asthma attacks.

Each respiratory bronchiole divides to formalveolar ducts that end as clusters of air sacscalled alveoli


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PathophysiologyInhalation of dusts, smoke, fumes, and pathogens into the lungs

Inflammation of the airway lining

Inflammatory response of the mucous membranes within the lungs bronchialpassages

Mucous productions

Signs and symptomsCough ( Defense mechanism to get rid of the cause of irritation or invading pathogen)

Fever (There is a presence of infection)Cold (To get rid of mucus or phlegm)

Wheezing (Caused by the flow of air through narrowed bronchi)

TreatmentEncourage fluid intake

Deep breathing and cough exerciseBack tapping and chest physiotherapy

If left untreated, it may lead to:

Chronic Bronchitis

Pneumonia


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Course in the Ward

January 21, 2010

Vital signs taken andrecorded

Ensured adequate fluidintake and monitoredintake and output

Demonstrated deepbreathing exercise

Progress notes:

Temperature-37.6C

With occasional cough

Restless

H l


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HematologyComplete Blood

CountPurpose Result Normal Values Significance

WBC Used to evaluate a

number ofconditions anddifferentiatescauses ofalterations inthe total WBCcountincluding

infection andinflammation.

9.4x109/L (5.0-10.0) Normal

HGB A protein foundwithin theRBCs thatcarries oxygenthroughoutthe body. Thistest evaluatesblood loss,blood ability,and anemia.

123g/L (110-165) Normal


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HCT Measures theconcentrationof RBCwithin thebloodvolume, the

blood testevaluatesblood loss,bloodreplacementand fluidbalance.

.3400/L (.350-.500) Normal

PLT Are elements inthe bloodthat arenecessary forblood to clot,evaluates

plateletproductionand used asscreening testto plateletfunction

446x109/L (150-450) Normal


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Drug Study

Drug Classification Action Contraindications AdverseReaction NursingConsideration

Cefuroxime

500mg.TIV

every 8hours

Antibiotic Kills andinhibits

thegrowth

of

bacteria

Patients

allergic to

cephalosporingroup

of

antibiotics

Rash

Diarrhea

Vomiting

Sores in the

mouth and

throat

Monitor the

therapy for

allergicreactions


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Drug Classification Action Contraindications AdverseReaction NursingConsideration

Salbutamol

5mL vianebuliz

er,

every 8

hours

Autonomic

nervous systemagent

Bronchodilator

(respiratory

smooth muscle

relaxant)

Used for the

relief ofbronchospa

smin

conditions

such as

asthmaand

Chronic

Obstructiv

e

Pulmonary

Disease

Pregnancy

-blockers.

Fine

skeletalmuscle

tremor

tachycardi

a

Headache

Dizziness

arrhythmia

Wash the

mouthpiece ormask with

warm water

and soap

Use cautiously

in patients with

cardiovascular

disease

Teach the

patient how to

use it correctly
http://en.wikipedia.org/wiki/Bronchospasmhttp://en.wikipedia.org/wiki/Bronchospasmhttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Asthmahttp://en.wikipedia.org/wiki/Bronchospasmhttp://en.wikipedia.org/wiki/Bronchospasm


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Drug Classification Action Contraindications AdverseReaction NursingConsidera

tionParacetamol

200mg/5mL oralsuspension every 4hours forfever

Analgesic

andAntipyretics

Used to

relievefeverthroughcentralaction inthehypothalamic heatregulating center

Hypersensi

tivity

Nausea

Allergicreactions

Skin

Rashes

Should be

given withcare to

patients

with

impaired

kidney

function

In

children,

do not

exceed 5

doses in

24 hours


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Assesment

Subjective:

inuubo ang anak ko as verbalized by the patients father.

Objective:*Occasional productive cough

*Clear mucus

*Temperature of 37.6C

*Respiratory Rate of 22 Breaths per Minute


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Nursing Diagnosis

*Ineffective airway clearance may be related to mucus

secretion as evidenced by productive cough.

*Potential for ineffective breathing pattern may be related toineffective airway clearance.

*Risk for impaired gas exchange may be related to ineffective

breathing pattern.

Planning: Intervention: Rationale: Evaluation:


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Planning:

*The cough of the

client will be lessened

*The patient will

establish normal

breathing pattern

* The parents will

have adequate

information and

knowledge on how to

manage the childs

bronchitis

Intervention:

*Monitor respiration

and breath sounds

*Elevate head of the

bed/change positionevery 2 hours or as

desired

*Encourage deep

breathing exercise

*Ensure adequate fluid

intake

*Remove environmental

factors that may affect

the patients breathingpattern

*Provide information

about the necessity of

raising and

expectorating secretions

versus swallowing them

Rationale:

*To identify any

respiratory diseases

and/or accumulation of

secretions.

*To take advantage of

gravity decreasingpressure on the

diaphragm and

enhancing drainage

of/ventilation to the

lungs

*To maximize

respiratory effort

*Hydration can help

liquefy viscous

secretions

*To prevent any factors

that may cause the

patient difficulty ofbreathing

*To identify any

changes in color and

amount

Evaluation:

After 8 hours of

Nursing

Intervention:

The cough of the

client was lessened

*The patient will

establish normal

breathing pattern

* The parents will

have adequateinformation and

knowledge on how to

manage the childs

bronchitis


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Discharge Planning

Provide health teachings to the parentssuch as:

Proper practices to maintain proper

breathing patterns

Maintain proper hygiene

Provide time for the child to rest to prevent

fatigue Give the child the prescripted medications


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Evaluation of Experiences

The entire experience in the hospital was indeed a

very informative experience for me. It developed mysocial, intellectual and communication skills. In theward, I have learned that the proper monitoring ofthe patients vital signs is really important to tell thepatients health status. Everyone that I met in the

hospital has each given me proper knowledge andinformation for the welfare of my client.

In this case study, I have learned the differentcauses of bronchitis and how does a simple

causative agent trigger this disease. I also becameupdated to the recent development on how to takecare of patients with bronchitis. This study will helpus nursing students, to be aware on the disease andhow to treat it.


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References

Doenges, Marilyn., et al., Nurses PocketGuide, 11th Edition

Mark, D.H., Medical Care, 2005

Wenzel, G., Internal Medicine, VirginiaCommonwealth University, 2007

http://wikipedia.org

ndt.oxfordjournals.org/cgi/reprint/4/3/228.pdf

www.mamashealth.com
http://wikipedia.org/http://wikipedia.org/http://wikipedia.org/http://wikipedia.org/

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