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8/13/2019 Acute Bronchitis FALALALALA
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By:
Danah Macaraig
Aniebee Montano
Klent Nikko Melencion
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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
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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.
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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.
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Bronchitis Causes:
-Bronchitis occurs most often during the cold and fluseason, usually coupled with an upper respiratoryinfection.
Severalviruses cause bronchitis, including influenza A and B, commonly referred to as "the flu."
A number of bacteria are also known to causebronchitis, such as
Mycoplasma pneumonia.
Bronchitisalso can occur when you inhale irritating fumes or dusts. Chemical solvents and smoke, includingtobacco smoke, have been linked to acute bronchitis.
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Bronchitis Symptoms:
Acute bronchitis-most commonly occurs after an upper respiratory infection such as the common cold or a
sinus infection. You may see symptoms such asfever with chills, muscle aches, nasalcongestion, and sore throat.
Cough is a common symptom of bronchitis.
Wheezing may occur because of theinflammation of the airways.
-This may leave you short of breath.
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Signs and Symptoms
-retrosternal pain during deep breathing orcouching
-constant cough that may last up to a month.
Cough may be dry or up with mucus. Mucusmay be green, yellows, white , or have streaksof 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.
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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
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Physical Assessment
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Technique Normal Findings Abnormal
Findings
SKIN Inspeciton Skin is brown andgenerally equal
No edemaGood skin turgor
No lesion
Temp. is warm
&coo
-none
NAILS Inspection Clean, smooth
Pink to light
brown nail beds
-none
HAIR Inspection No lesion
No dandruffEven in
distribution
-none
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TECHNIQUE NORMAL
FINDINGS
ABNORMAL
EYES Inspection Symmetrical in
position
Sclera is white&glossy
PERRLA
Brisk reaction to
light
None
Ears Inspection Equal in size
Symmetrical
No swelling or
discharges
None
Nose Inspection
Palpation
Symmetrical
No inflammation
Air can be felt in
both nares
With discharge
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Mouth and
Throat
Inspection Tongue is at
midline
Chest Inspection
Palpation
Auscultation
Normal contour
Tactile fremitus
Bronchial breath
sounds
Limited chest
excursion
Abdomen Inspection
Palpation
Color
isconsistent
withthe body
No lesion or
anyabnormalfindings
Bowel sounds
isnormo-
active(13/min)
No tenderness
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Genogram
Mother
(Asthma)
Father
(Healthy)
Patient
(Acute
Bronchits)
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LABORATORY
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COMPLETE BLOOD COUNT
TEST VALUE RESULT INTERPRETATION
RBC 4-6x 10 12/L 4.51
HEMOGLOBIN M- 130-180
F- 120-160
98
HEMATOCRIT M- 0.40-0.54
F- 0.36-0.47
0.33
PLATELET 150-400x 10 9/L 317
WBC 4-11x 10 9/L 10.9
MCV 80-94 74
MCH 22-31uug 22
MCHC 31-36 % 30%
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SCHILLING DIFFERENTIAL COUNT
TEST VALUE RESULT INTERPRETATION
Segmenters 0.50-0.56 0.60
Lymphocytes 0.20-0.40 0.29
Monocytes 0.02-0.08 0.10
Eosinophils 0.01-0.04 0.01
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ANATOMY and PHYSIOLOGY
The word respiration describes twoprocesses.
Internal or cellular respiration is the process
by which glucose or other small moleculesare oxidized to produce energy: thisrequires oxygen and generates carbondioxide.
External respiration (breathing) involvessimply the stage of taking oxygen from theair and returning carbon dioxide to it
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The lungs constitute the largest organ in therespiratory system. They play an important role inrespiration, or the process of providing the bodywith oxygen and releasing carbon dioxide. Thelungs expand and contract up to 20 times perminute taking in and disposing of those gases.
Air that is breathed in is filled with oxygen andgoes to the trachea, which branches off into one of
two bronchi. Each bronchus enters a lung. Thereare two lungs, one on each side of the breastboneand protected by the ribs.
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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.
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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.
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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 two-layered 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.
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PATHOPHYSIOLOGYEtiologic Agent:
-Bacteria-Virus
Precipitating Factors:
-Hospitalization-Unadvisable Envi
--Smoking
-Malnutrition
Predisposing Factors:
-Elderly Immobilization-Immune Deficiency
-Long Term Illness
Smoking
Microorganism enter resp
tract by droplet inhalation.
Widespread inflammation
occurs
Thin mucous lining of the
bronchi can become irritated
and swollen
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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
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Course in the WardDate and Time Doctors Order Nursing
Implementation
Rationale
Dec 12, 2013 -Please admit to
Pedia ward
-Lab: CBC,
Platelet,
urinalysis, chest
x-ray, ADL
-IVF D5 0.3 NaCl
500 cc X 32
gtt/min
-obtain vital signs
-instruct pt to
follow the diet
and the doctors
order
-to monitor the
status of the
patient
Meds:Salbutamol
Nebulizer q6-Vitamin A
CW P-ROD
Refer
Paracetamol
100mg/ml0.9 cc q4
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Date and Time Doctors Order Nsg
Implementation
Rationale
12/12/13 -Pen G NU400,000 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
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DRUG STUDY
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Therapeutic
Classification
Action Contraindicaiton Toxicity/ Side
Effects
Implementation Safe Doze
Salbutamol
Bronchodilator (t
herapeutic);adrenergics
(pharmacologic)
It relieves nasal
congestion and
reversible
bronchospasm byrelaxing the
smooth muscles
of the
bronchioles
Hypersensitivity
to adrenergic
amines
Hypersensitivityto fluorocarbons
Nervousness
Restlessness
Tremor
HeadacheInsomnia
Chest pain
Palpitations
Angina
Arrhythmias
Hypertension
Nausea and
vomitingHyperglycemia
Hypokalemia
Assess lung
sounds, PR and
BP before drug
administrationand during peak
of medication.
Observe fore
paradoxical
spasm and
withhold
medication and
notify physicianif condition
occurs.
Administer PO
medications with
meals to
minimize gastric
irritation.
2 inhalations
every 4-6 hours
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Therapeutic
Classification
Action Contraindicaiton Toxicity/ Side
Effects
Implementation Safe Doze
Penicilin G
-Antibiotic
Anti-infective
Interferes
with bacteria
cell wall
synthesis
during active
multiplicatio
n, causing
cell wall
death andresultant
bactericidal
activities
against
susceptible
bacteria
Allergic to
penicilin,cep
halosphorin
-lethargy
-glossitis
-wheezing
-fever
-Assess for
hypersensitiv
ity.
-educate
about side
effect
-600,000
-1.2 million
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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-coloredstools; or
jaundice
(yellowing of
the skin or
eyes).
Check I&O
ratio;
decreasing
output may
indicate renal
failure.-
Assess for fev
er and pain
500 mg
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NURSING CARE PLAN
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Assessment diagnosis planning Intervention Rationale Evaluation
Subjective:
nahihirapan ang
anak kung huminga
Objective:-
Impaired Gas
Exchange
At the end of the 8
hr nursing
intervention, the pt
will demonstrate
improvedventilation an d free
of symptoms of
respiratory distress.
-Assess the
frequency, depth of
breathing
-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.
Collaboration:
- Provide
appropriate
bronchodilator
required.
-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.
-techniques
improve ventilation
by opening the
airway and clearing
the airway of
sputum.
Improvement of gas
exchange.
-Bronchodilators
dilate the airway
and helps fight the
bronchial mucosal
edema and
muscular spasm.
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- Evaluate the
effectiveness of
the actions
nebulizer,
metered dose
inhalers.
-Provide
supplemental
oxygen in
accordance with
the indications
of blood gasanalysis results
and patient
tolerance.
-combining
medication with
a nebulizer
aerosolized
bronchodilator
commonly used
to control
bronchoconstrict
ion.
-can fix / prevent
worsening
hypoxia.
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Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective:
Di na ko makatindigng maayos. As
verbalized by client.
Objective:
Irritability
Facial Grimace
Activity Intolerancerelated to immobility
secondary to pneumonia
as manifested by
irritability and facial
grimace.
After 4 hoursnursing
intervention
client will
measurably
increase in
activitytolerance.
Monitor v/s
Encourage client
to rest
Limit movement
and encourageR.O.M.
exercises.
Promote
wellness and
provideemotional
support in the
process.
Serves as
baseline data ofclient.
To decrease
clients cardiac
rate.
Muscle willrest to
promote
strength and
joint muscle
To establish
goal and
provied
positive
attitude
towards the
client
After 4 hoursof nursing
intervention
client
participation
in
conditioningto enhance
ability to
perform.
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Health Education
Instruct older patients regarding the need forimmunization against pertussis, diphtheria, and influenza,which reduces the risk of bronchitis due to causativeorganisms.
Instruct these patients to avoid passive environment
tobacco smoke; to avoid air pollutants, such as wood,smoke, solvents, and cleaners; and to obtain medicalattention for prolonged respiratory infections.
Instruct parents that children may attend school ordaycare without restrictions except during episodes acutebronchitis with fever. Also instruct parents that childrenmay return to school or daycare when signs of infectionhave decreased, appetite returns, and alertness, strength,and a feeling of well-being allow
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M MEDICATION Discuss the importance of taking medication at the righttime,right route at frequency
E ENVIRONMENT Encourage to keep environment clean and with good
sanitation. Provide well ventilated.
T TREATMENT Instructed to come back after one week for follow upcheck up.
H HEALTH TEACHING -keep back dry
-increase fluid intake
-give client nutritious food that is tolerable
-encourage to do back tapping and vibration whencoughing
O OBSERVATION Observe for the signs and symptoms of infection
D DIET -Diet As Tolerated
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PROGNOSIS
Manageable with proper treatment and
avoidance of known triggers such as tobacco
smoke)
Proper managements of any underlying diseaseprocess, 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