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I.Introduction
Bronchitis is a respiratory disease in which the mucous
membrane in the lungs' bronchial passages becomes inflamed.
As the irritated membrane swells and grows thicker, it narrows
or shuts off the tiny airways in the lungs, resulting in coughing
spells accompanied by thick phlegm and breathlessness. The
disease comes in two forms: acute (lasting less than 6 weeks)
and chronic (reoccurring frequently for more than two years). In
addition, people with asthma also experience an inflammation of
the lining of the bronchial tubes called asthmatic bronchitis.
Acute bronchitis is responsible for the hacking cough and
phlegm production that sometimes accompany an upper
respiratory infection. In most cases the infection is viral in origin,
but sometimes it's caused by bacteria. If you are otherwise in
good health, the mucous membrane will return to normal after
you've recovered from the initial lung infection, which usually
lasts for several days.
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Acute bronchitis is very common among both children and
adults. The disorder often can be treated effectively without
professional medical assistance. However, if you have severe or
persistent symptoms or if you cough up blood, you should see
your doctor. If you suffer from chronic bronchitis, you are at risk
for developing cardiovascular problems as well as more serious
lung diseases and infections, you should be monitored by a
doctor.
In relation to my patient he is having the acute bronchitis, I
used several nursing interventions and bedside care to improved
his health. I give the first priority to its airway clearance because
a lot of secretions being observed. I touched the history of the
patients condition that further more relate the illness that patient
suffered; further discussion and nursing interventions done to the
patient is emphasized on this study.
Studies have shown that there are major goals to be considered
for patients having Acute Bronchitis. It includes the improvement
or maintenance of normal breathing pattern, increase activity
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tolerance, reduction of anxiety, adherence to the self-care, and
increase sense of power with decision making and absence of
complications.
During the assessment, the student nurse used the act of
collecting, organizing, validating and recording data about
patients health status through observing and interviewing the
patient/informants for within two days or two shifts.
The study focuses on the assessment data from the patients
major nursing diagnosis. It is limited also on imparting health
teachings with emphasis on the interventions and
recommendations to the patient.
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II. PROFILE OF PATIENT
y Name: ?
y
Addres: ?y Sex: Male
y Birthdate: September 15, 2003
y Age: 6 year old
y Civil Status: single
y Religion: ?
y Date of Admission: May 26,2009
y Time of Admission: 10 PM
y ChiefComplaint: cough, fever and loss of appetite
y
V
ital Signs upon Assessment:y Temperature = 37.6 0C
y Pulse Rate = 80 beats per minute
y Respiratory Rate = 20 cycles per minute
y Blood Pressure = 80/60mmHg
y Admitting Diagnosis: Acute Bronchitis
y Admitting Physician: ?
HEALTH HISTORY
From the interview conducted with the mother of the baby,
she stated that she stayed in the hospital for only three days
after giving birth to ?at four months ?was admitted to Northern
Mindanao Medical center due to pneumonia. They stayed at the
hospital for seven days. Furthermore the mother concluded that
?has completed his vaccination at the health center in theirvicinity.
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HISTORY OF PRESENT ILLNESS
A week prior to admission, the patient experienced fever
and intermittent with cough productive, loss of appetite
prompted admission.PE findings are as follow: Temperature=37.6C, Pulse Rate=80bpm, Respiratory Rate= 20cpm and weight=
16.9 kg.
III. DEVELOPMENTAL DATA
Robert Havighurst believed that learning is basic to life and
that people continue to learn throughout life. He described
growth and development as occurring during six stages, each
associated six to ten tasks to be learned.
Havighurst promoted the concept of developmental tasks in
the 1950s. a developmental task is a task which risks at or
about a certain period in the life of an individual, successful
achievement of which leads to his happiness and to success with
later tasks, while failure leads to unhappiness in the individual,
disapproval by society and difficulty with later tasks:.
(Havighurst 1972 p.2). At the early childhood, learning
physical skills necessary for ordinary games.Learning to get
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along with age mates.Building wholesome attitudes toward
oneself as a growing organism.Learning on appropriate
masculine or feminine social role.Developing concepts necessary
for everyday living.Developing conscience, morality and a scale
of values.Achieving personal independence.Developing attitudes
toward social groups and institutions.
PSYCHOSOCIAL DEVELOPMENT
Initiative adds to autonomy the quality of undertaking,
planning, and attacking a task for the sake of being active and on
the move. The child is learning to master the world around him or
her, learning basic skills and principles of physics; things fall to
the ground, not up; round things roll, how to zip and tie, count
and speak with ease. At this stage the child wants to begin and
complete his or her own actions for a purpose. Guilt is a new
emotion and is confusing to the child; he or she may feel guilty
over things which are not logically guilt producing, and he or she
will feel guilt when his or her initiative does not produce the
desired results.
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COGNITIVE DEVELOPMENT
The Intuitive (4-7 years) stage is when children start employing
mental activities to solve problems and obtain goals but they are
unaware of how they came to their conclusions. For example a
child is shown 7 dogs and 3 cats and asked if there are more
dogs than cats. The child would respond positively. However
when asked if there are more dogs than animals the child would
once again respond positively. Such fundamental errors in logic
show the transition between intuitiveness in solving problems
and true logical reasoning acquired in later years.
MORAL DEV
ELOPMENT
According to Kohlberg, e-conventional level of moral reasoning is
especially common in children, although adults can also exhibit
this level of reasoning. Reasoners in the pre-conventional level
judge the morality of an action by its direct consequences. The
pre-conventional level consists of the first and second stages of
moral development and are purely concerned with the self in an
egocentric manner.
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In Stage one (obedience and punishment driven),
individuals focus on the direct consequences that their actions
will have for themselves. For example, an action is perceived as
morally wrong if the person who commits it gets punished. The
worse the punishment for the act is, the more 'bad' the act is
perceived to be. In addition, there is no recognition that others'
points of view are any different from one's own view. This stage
may be viewed as a kind ofauthoritarianism.
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IV.ANATOMY AND PHYSIOLOGY
What is respiration?
Respiration is the act of breathing:
y inhaling (inspiration) - taking in oxygen
y exhaling (expiration) - giving off carbon dioxide
What makes up the respiratory system?
The respiratory system is made up of the organs involved in the
interchanges of gases, and consists of the:
y nose
y pharynx
y larynx
y trachea
y bronchi
y lungs
The upper respiratory tract includes the:
y nose
y nasal cavity
y ethmoidal air cells
y frontal sinuses
y maxillary sinus
y larynxy trachea
The lower respiratory tract includes the:
y lungs
y bronchi
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y alveoli
What are the functions of the lungs?
The lungs take in oxygen, which cells need to live and carry out
their normal functions. The lungs also get rid of carbon dioxide, a
waste product of the body's cells.
The lungs are a pair of cone-shaped organs made up of spongy,
pinkish-gray tissue. They take up most of the space in the chest,
or the thorax (the part of the body between the base of the neck
and diaphragm).
The lungs are enveloped in a membrane called the pleura.
The lungs are separated from each other by the mediastinum, an
area that contains the following:
y heart and its large vessels
y trachea (windpipe)
y esophagus
y thymus
y lymph nodes
y
The right lung has three sections, called lobes. The left lunghas two lobes. When you breathe, the air:enters the body
through the nose or the mouth
y travels down the throat through the larynx (voice box) and
trachea (windpipe)
y goes into the lungs through tubes called main-stem bronchi
o one main-stem bronchus leads to the right lung and
one to the left lung
o in the lungs, the main-stem bronchi divide into smaller
bronchi
o and then into even smaller tubes called bronchioles
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V.PATHOPHYSIOLOGY
Name of Patient: VankenleeLloren
Diagnosis: Acute Bronchitis___
Bronchitis means that the tubes that carry air to the lungs
(the bronchial tubes) are inflamed and irritated. When this
happens, the tubes swell and produce mucus. This makes you
cough.
Acute bronchitis usually comes on quickly and gets better
after 2 to 3 weeks. Most healthy people who get acute bronchitis
get better without any problems. See a picture of acute
bronchitis.
Viruses (corona virus,
influenza virus)
Heat and smoke inhalation
The pathogens directly attach
the tracheobronchial tree.
Inflammation of tacheobronchial tree
The airways become inflamed and narrowed from
capillary dilatation, increasedmucus production
Acute Bronchits
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VI. MEDICAL MANAGEMENT
A. Medical Orders and Rationale
DOCTORS ORDER RATIONALE
January 23,2007
>Please admit under the
service of Dr. Fernandez
>Consent to care For legal purposes
>TPR every 4 hours To monitor and provide
baseline data of the patient
> Labs:y CBC stat To determine any abnormalities
present in the blood
components.
y Urinalysis To assess renal function
> IVF= D5LR 500cc @ 60cc/hr For continuous replacement of
the fluid
>monitor I and O shift To monitor intake and output
> diet: For age
> please refer AP
Meds: Paracetamol
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VII.DIAGNOSTIC EXAMS
HEMATOLOGYDate Ordered: 5-26-2009
Results Normal Values Implications
WBC 11.17 3.8-10.8 : infection
RBC 4.62 4.2-5.6
Hemoglobin 115 140-180 : hemorrhage,
anemia
Hematocrit 0.35 .40. .54 : hemorrhage,
MCV 76 80-100 normal
MCH 25 pg/cell 27 33 pg/cell normalMCHC 33.g/dL 32 36 g/dL normal
Platelet
Count
156/mm3 150,000
400,000/mm3
: infection, DIC
Neutrophils 0.57 % .48 .73 % normal
Lymphocytes 0.37% .20 .45% normal
Monocytes 0.04% .00 .10 % normal
Eosinophils 0.02 % .00 .05 % normal
Basophils 0.0 % .00 .020 % normal
URINALYSIS
5-29-09
Color: yellow
Sp.gravity:1.015
Sugar: negative
Pus cells: 7-13
Rbc:0-2
Mucus threads: moderate
Crystals: amorphous urates few
Bacteria: moderate
BLOOD CHEM
5-27-09
Creatinine: 0-6
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CHEST P/A
5-27-09
Impression: left retrocardiac pneumonia
VIII. DRUG STUDY
Generic Name Cephalexin
Brand Name Biocef
Date Ordered 5-26-09
Classification Cephalosporin
Dosage/Route/
Frequency
250 mg tid
Mechanism of
Action
Inhibits bacterial cell wall
synthesis by binding to one or
more of the penicillin-binding
proteins
Specific Indication Treatment for bacterial
infections
Contraindication Hypersensitivity to
cephalosporin
Adverse effect diarrhea
Nursing precaution Modify dosage in patients with
with severe renal impairment.
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Calpol
Date Ordered 5-27-09
Classification Analgesic and antipyritics
Dosage/Route/ Frequency 5 ml q 4 hours
Mechanism of Action To relieve feverSpecific Indication Mild pain or fever
Contraindication Contraindicated in patient with
hypersensitivity to acetaminophen
Adverse effect Jaundice,rash, urticuria
Nursing precaution Liquid form is recommended for
children and for all patient who have
difficulty in swallowing.
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NURSING SYSTEM REVIEW CHART
Name: X Date: 5-26-09Vital Signs:
Pulse: 80bpm Temp: 37.6 cWeight: 16.9kgEENT:
impaired vision blind Swelling wound[x]pain redden [X] drainage
gums hard of hearing deaf warm to touch burning edema lesion teeth runny nose Asses eyes, ears, nose vomitingthroat for abnormality no problem
RESP: asymmetric [X] tachypnea abnormal breath sound apnea [X]rales[X] cough barrel chest _____________________
bradypnea shallow rhonci _____________________[X] Sputum diminished dyspnea __
orthopnea labored wheezing _____________________ pain cyanotic _____________________ Assess resp, rate, rhythm, depth, pattern, _____________________
breath sounds, comfort
no problem
CARDIO VASCULAR
arrhythmia tachycardia numbness _____________________ diminished pulses edema [X] fatigue _____________________ irregular bradycardia[X] murmur
tingling absent pulses pain IV siteAsses heart sounds, rate rhythm, pulse, bloodpressure, circ., fluid retention, comfort no problem
GASTRO INTESTINAL TRACT
obese distention massdysphagia rigidly painAsses abdomen, bowel habits, swallowing,bowel sounds, comfort [X] no problem
_____________________GENITO-URINARY and GYNE _____________________
pain urine color vaginal bleeding _____________________ hermaturia discharge noctoria _____________________ Asses urine freq., color, control, odor, comfort _____________________Gyn-bleeding, discharge [X] no problem
_____________________NEURO
paralysis stuporous unsteady seizures lethartic comatose [X] vertigo tremors confused vision grip Asses motor function, sensation, LOC, strength, _____________________Grip, galt, coordination, orientation, speech, _____________________ no problem
MUSCULOSKELETAL and SKIN _____________________
appliance stiffness itching petechiae _____________________[X] hot drainage prosthesis swelling
lesion poor turgor cool deformity _____________________ wound rash skin color[X] flushed atrophy[X] pain ecchymosis _____________________
diaphoretic moist Asses mobility, motion. Galt, alignment, joint function pigmented scars/skin color, texture, turgor, integrity no problem
Slightly flushed skin
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NURSING ASSESSMENT II
SUBJECTIVE OBJECTIVE
COMMUNICATION
hearing loss Comments:maulawonmna
xamao dili
kaayugatingog
. As verbalized
by the mother.
visual changes
denied
glasseslanguages
contract lens hearing
aide
R L
Pupil size: 3mm speech
difficulties
Reaction: Pupils Equally
Rounded and Reactive
to LightAccommodation
OXYGENATION
dyspnea Comments:
gahangos-
hangosgyud na
xausahay. As
verbalized by
the mother.
smoking history
cough
sputum
denied
Resp. regular irregular
Describe:
RR-32cpm. Fast breath sounds
and inspiratory rales.
R : Symmetric
L: Symmetric
CIRCULATION
chest pain Comments:
usahaymorikla
moxa nga sakit
iyadughan. Asverbalized by
the mother.
leg pain
numbness of extremities
denied
Heart Rhythm regular
irregular
Ankle edema: present
Pulse Car. Rad. DP Fem.
R 78 94 64
L 76 96 65
Comments: Palpable and pulses
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are within normal range.
NUTRITION
Diet : For age
N V Comments:nawalamna
iyagana sa
pagkaon As
verbalized
by the
mother.
Character
recent change in wt. &
appetiteswallowing difficulty
denied
dentures none
Full Partial With pt.Upper
Lower
ELIMINATION
Usual bowel pattern urinary
freq.
-every morning ___________
constipation remedy
-hot prune juice urgency
date of last BM dysuriadiarrhea character
hematuria
_____________
incontinen
ce
polyuria
foly in place
denied
Comments: Bowel sounds:
hyperactiv
e
His abdomen is
Extremely soft to
Touch.(38cms.-AG)Abdominal
Distention
Present yes
no
Urine: yellow;
hazy 950 ml
daily
MGT. OF HEALTH & ILLNESS
alcohol denied
SBE last Pap Smear
LMP: N/A
Briefly describe the pts. Ability
to follow treatments for chronic
health problems.
The pt. was able to follow
the medications prescribed by
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the physician.
SUBJECTIVE OBJECTIVE
SKIN INTEGRITYdry Comments:
ga uga jud na
iya panit. As
verbalized by
the mother.
itching
other
denied
dry cold pale
flushed warm
moist cyanotic
rashes, ulcers, decubitus
(describe size, location,
drainage)
- NONE
ACTIVITYconvulsion Comments:
ok raman na
xausahaykailihu
kkaayu.As
verbalizedby the
mother
dizziness
limited motion of joints
Limitation in
ability to
ambulate
bath self
other
denied
LOC and Orientation: Pt. is
oriented of time and space.
Gait: walker cane others
steady unsteady
sensory and motor losses in
face or extremities: NONE
ROM limitations: NONE
COMFORT/SLEEP/AWAKE
pain
Comments: okra man pud
iyapagtulog.
As verbalized
by the mother
(heart/7scale)
nocturia
facial grimaces
guardingother signs of pain:
restlessness
siderail release form
signed(60+yrs.): N/A
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sleep difficulties
denied
COPING
OccupationMembers of household. Mother
and father
Most supportive person:
parents and relatives
Observed non-verbal behavior:NONE
The person & his Phone # that
can be reached anytime:
09058562446
SPECIAL PATIENT INFORMATION (use lead pencil)
_____Daily weight ______PT/OT______
_____BP q Shift ______Irradiation
_____Neurovs ______Urine Test____
_____CVP/SG. Reading_____ _______24 HR Urine
Collection
Date
ordered
Diagnostic/
Laboratory
Exams
Date
done
5-26-09 Urinalysis 5-26-09
5-26-09 Hematology 5-26-09
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IX.IDEAL NURSING MANAGEMENT
A. Ideal Nursing Management (NCP)
Nursing Diagnosis Intervention Rationale
Hyperthermia,
related to upper
respiratory tractinfection
INDEPENDENT:
yMonitor the
patients vitalsign.
yProvide TSB
yIncrease calories
intake.
DEPENDENT:
y
AdministerIntravenous Fluid
as ordered.
yAdminister
analgesics as
ordered by the
physician
>To serve as
baseline data..
> To decrease
temperature.
> To meet the
metabolic demand.
> To replace fluid
and electrolyte loss.
> To reduce fever
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X. Actual Nursing Management (SOAPIE)
S init pa gihapon na xagamay as verbalized by the
mother
O
y Temp= 37.6
y
Slightly flushed skin
A Hyperthermia, related to upper respiratory tract
Infection
P At the end of 1hour the temperature of the patient
will be lowered
I
INTERVENTION RATIONALE
INDEPENDENT:yMonitored patients
vital sign.
y TSB provided
yBreakfast given with
bread
DEPENDENT:yAdminister
Intravenous Fluid as
ordered.
y Administer
analgesics as ordered
>To serve as baseline
data.
.
> To decrease
temperature.
> To meet the metabolic
demand.
> To replace fluid and
electrolyte loss.
> To reduce fever
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by the physician
E After of one hour patient was able to have lower
temp. and able to comply all those medicationsordered by the physician.
XI. HEALTH TEACHINGS
MEDICATIONS
The significant others was advised to comply
the prescribed medication regimen following
the prescribed dose, frequency, timing and
route necessary for his fast and effective
treatment and recovery. Patient teachings are
also imparted, regarding on precaution and
side effects of the medications.
EXERCISE Not applicable
TREATMENT
Proper compliance of the treatment regimen
should be followed as prescribed by the
doctor.
OUTPATIENT
FOLLOW UP Not applicable
DIET
Adviced the parents to offer foods rich in vit. C
and intake of calorie should be increased for
metabolism.
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XII. REFERRAL AND FOLLOW UP
Patients have always required detailed discharge
instruction to become proficient in special self-care needs when
they got home. As for my client,van, refer him for his regular
check up with his attending physician; Dr. Fernandez, and
arrange schedule of appointments regarding his follow up check
ups and his home medications.
Our client is also reminded of his medication regimen to
follow it carefully and promptly, and to report any signs ofadverse serious reactions. The mother was advice to offer fruits
and vegetables to promote body resistance.
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XIII.BILIOGRAPHYBOOK SOURCES:
y Huitt, W., & Hummel, J. (2003)
Piaget's theory of cognitive development.Educational
Psychology Interactive.
Valdosta, GA: Valdosta State University.
y Smeltzer, S; Medical Surgical Nursing; 10th Edition;
Lippincott Williams and Wilkins; 2004
y Kozier, B.; Fundamentals of Nursing; 7th Edition; Pearson
Education Corporated; First Lok Yang Road; Jurong;
Singapore
y Nettina, Sandra; et. al; The Lippincott Manual of Nursing
Practice; 7th Edition; George Washington University;
Lippincott Williams and Wilkins; Lippincott-Raven
Publishers; 1991
y Doyle, Rita M; et. al; Nursing 2006 Drug Handbook; 26th
Edition; 323 Norristown Road, Suite 200; Lippincott Williams
& Wilkin
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