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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/Inflammation8/12/2019 Bronchitis Report
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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.shtml8/12/2019 Bronchitis Report
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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=2848/12/2019 Bronchitis Report
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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/Bronchospasm8/12/2019 Bronchitis Report
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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/