LICEO DE CAGAYAN UNIVERSITY

COLLEGE OF NURSING

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS

IN

NCM50120O
Submitted to:

Mrs. Livia B. Dato RN

Clinical Instructor

Submitted by:

Acebu, Kirk

Bacan, Marjorie
Baculanta, Rojelyn
Balagot, Julie Mae
Baran, Jayzel
Baterna, Carousel
Blanco, Maureen
Bustallino, Aiko
Caintoy, Jim
TABLE OF CONTENTS

I. Introduction and patient profile

II. Developmental Data
III. Health history
IV. History of present illness and assessment
V. Diagnostic exam
VI. Anatomy and Physiology and pathophysiology
VII. Medical Management (Doctors orders)
VIII. Ideal Nursing Managements
IX. Actual Nursing Management
X. Discharge Plan and Prognosis
XI. Evaluation and Implication
XII. Bibliography
I . Introduction

a.Overview of the case

Acute bronchitis is inflammation of the upper airways, commonly following a URI (upper
respiratory tract infection). The cause is usually a viral infection, though it is sometimes
a bacterial infection; the pathogen is rarely identified. The most common symptom is
cough, with or without fever, and possibly sputum production. In patients with COPD,
hemoptysis, burning chest pain, and hypoxemia may also occur. Diagnosis is based on
clinical findings. Treatment is supportive; antibiotics are necessary only for selected
patients with chronic lung disease. Prognosis is excellent in patients without lung
disease, but in patients with COPD, acute respiratory failure may result.

Acute bronchitis is frequently a component of a URI caused by rhinovirus,

parainfluenza, influenza A or B, respiratory syncytial virus, coronavirus, or human
metapneumovirus. Less common causes may be Mycoplasma pneumoniae, Bordetella
pertussis, and Chlamydia pneumoniae. Patients at risk include those who smoke and
those with COPD or other diseases that impair bronchial clearance mechanisms, such
as cystic fibrosis or conditions leading to bronchiectasis

Symptoms are a nonproductive or minimally productive cough accompanied or

preceded by URI symptoms. Subjective dyspnea results from chest pain or tightness
with breathing, not from hypoxia, except in patients with underlying lung disease. Signs
are often absent but may include scattered bronchi and wheezing. Sputum may be
clear, purulent, or, occasionally, bloody. Sputum characteristics do not correspond with
a particular etiology. Mild fever may be present, but high or prolonged fever is unusual
and suggests influenza or pneumonia.

Diagnosis is based on clinical presentation. Chest x-ray is necessary only if findings

suggest pneumonia (eg, abnormal vital signs, crackles, signs of consolidation,
hypoxemia). Elderly patients are the occasional exception. They may require chest x-
ray for productive cough and fever in the absence of auscultatory findings (particularly if
there is a history of COPD or another lung disorder).
Objective of the Study

b.General Objectives:

At the end of this care study, the students shall enhance their knowledge base, improve
their immediate skills, and manifest positive attitude and behavior towards the care of
the patient diagnosed with acute bronchitis.

Specific Objectives:

• Define important terms used in the presentation correctly.

• Show the pathophysiology of acute bronchitis correctly.
• Present care study appropriately.

c. Scope and Limitations

The care study is about a patient who had been diagnosed with Acute Bronchitis at
Polymedic General Hospital. The scope of this study covers from the patient’s profile,
family and personal health history, developmental data, and as well as with his medical
and nursing management.
The study has limited information due to time bounded span and incomplete and
lacking of information of the patient from her personal chart. The patient was being
assessed and cared of for only 1 day, on September 18, 2009.
Patient Profile

Name: Diaz, Lorijean L.

Age: 47 years old

Birthday: July 20, 1962

Birthplace: Macasandig, Cagayan de Oro City

Sex: Female

Status: Married

Nationality: Filipino

Religion: Roman Catholic

Educational Attainment: College Graduate

Occupation: Government Employee

Income: 7,000/ month

II. Developmental Data

Researchers have advanced several theories about the various stages and aspects
of growth and development. In order to enhance our understanding to our patient,
different theories were used to relate it to her.
Our first theory is the theory of Pscyhosocial by Erick Erickson where our patient
belongs to the middle adult stage where generativity v stagnation is the task.
Positive outcomes from this crisis stage depend on contributing positively and
unconditionally. We might also see this as an end of self-interest. Having children is not
a prerequisite for Generativity, just as being a parent is no guarantee that Generativity
will be achieved. Caring for children is the common Generativity scenario, but success
at this stage actually depends on giving and caring - putting something back into life, to
the best of one's capabilities.Stagnation is an extension of intimacy which turns inward
in the form of self-interest andself-absorption. It's the disposition that represents feelings
of selfishness, self-indulgence, greed, lack of interest in young people and future
generations, and the wider world. Generativity v Stagnation Care & Production (giving
unconditionally in support of children and/or for others, community, society and the
wider world where possible and applicable, altruism, contributing for the greater good,
making a positive difference, building a good legacy, helping others through their own
crisis stages mid-adult / children, community / 'giving back

Our patient belongs to the middle-aged adult, from 35-65, have been called the
years of Generativity v stagnation. We can say that the patient had positively
accomplished the previous stages. But, since she has been hospitalized, We have
observed that she is worried about her condition. The good thing about our patient is
she has a very positive outlook in life. She follows all the treatments and takes the
medications as prescribed. She has a good relationship with her childrens giving care
and unconditional support not just for her own children but for others.
 The second theory is Developmental Task by Robert Havighurst
Middle Age (30-60)
(Ages 30-60)
Assisting teenage children to become responsible and happy adults. * Achieving adult
social and civic responsibility. * Reaching and maintaining satisfactory performance in
one’s occupational career. * Developing adult leisure time activities. * Relating oneself
to one’s spouse as a person. * To accept and adjust to the physiological changes of
middle age. * Adjusting to aging parents.

Our patient belongs to the middle age with his corresponding task to be achieved
and has achieved. In his current stage, she already achieved the selecting of mate
where he married with her good husband. She had fulfilled her role as a good mother.
She has been a good wife to her husband. In assisting teenage children to become
responsible and happy adults, we believed that she has fully achieved this since she
has a good relationship with her children. In accepting and adjusting to the physiologic
changes of middle age, we have observed that she has fully accepted his condition and
has adjusted to the changes being experienced in the middle age stage.

The third theory is the Cognitive developmental stage of Piaget’s

Piaget concluded that there were four different stages in the cognitive
development of children. The first was the Sensory Motor Stage, which occurs in
children from birth to approximately two years. The Pre-operational Stage is next, and
this occurs in children aged around two to seven years old. Children aged around seven
to eleven or twelve go through the Concrete Operational stage, and adolescents go
through the Formal Operations Stage, from the age of around eleven to sixteen or more.

Formal operational stage (Adolescence and adulthood). In this stage, intelligence

is demonstrated through the logical use of symbols related to abstract concepts. Early in
the period there is a return to egocentric thought. Only 35% of high school graduates in
industrialized countries obtain formal operations; many people do not think formally
during adulthood. Can think logically about abstract propositions and test hypotheses
systematically becomes concerned with the hypothetical, the future, and ideological
problems.

Our patient belongs to Formal Operations Stage (11yrs-more) .In the formal
operational stage of adolescence; the structures of development become the abstract,
logically organized system of adult intelligence. When faced with a complex problem,
the adolescent speculates about all possible solutions before trying them out in the real
world. The formal operational stage begins around age 11 and is fully achieved by age
15, bringing with it the capacity for abstraction. This permits adolescents to reason
beyond a world of concrete reality to a world of possibilities and to operate logically on
symbols and information that do not necessarily refer to objects and events in the real
world.

Since our patient has been hospitalized, she was knowledgeable enough to
handle her situation. She was able to find solutions to her problems encountered.
Facing each of her problems was been a positive outlook in her life. She was an open-
minded person to thinks deeply about what are the things happened and soon to be
happen.

The 4th theory is psychosexual development of Sigmund Freud

Sigmund Freud believed that each stage of a child's development beginning at birth is
directly related to specific needs and demands, each based on a particular body part
and all rooted in a sexual base. While simplification of his theories is necessary in order
to give an overview, he held beliefs that are quite complex. In order to understand the
basics of his developmental stages, it is important to note a few things: Freud's age
ranges varied a bit over the course of his work, largely because he acknowledged that
development can vary a bit from individual to individual. Additionally, experience of the
stages may overlap at times. Finally, Freud believed that the way that parents handle
their children during each of the stages has a profound and lasting impact on the overall
development of the child's psyche.
Our patient belongs to The Genital Stage: From Puberty On

In this final stage of psychosexual development, Freud theorized that the onset of
puberty represented the reawakening of sexual urges. At this more mature age,
however, adolescents focus not only on their genitals, but also on developing sexual
relationships with Normal" heterosexuality. According to Freud, heterosexual
intercourse should be the goal of psychosexual development (a position that has since
been questioned by feminists and queer theorists. In this way, the individual enters
adulthood and ensures the survival of the species. For Freud, a desire for oral or anal
pleasure constitutes a fixation on or a regression to an earlier stage in one's
psychosexual development. Members of the opposite sex and on seeking sexual
satisfaction.

Characteristics were energy is directed toward attaining a mature sexual

relationship. Inability to resolve conflicts can result in sexual problems, such as frigidity,
impotence, and the inability to have a satisfactory sexual relationship.

Since our patient belongs to the psychosexual development under from puberty
stage, she has the mature age by developing sexual relationship with her husband. She
was been separated with her parents after marriage and build up with her own family
with the help of her husband. She has been an independent person and in terms of
decision making, she is fully creative on it.
III. Health History
According to Mrs. Lorijean Diaz, neither of her parents has the history of having
respiratory distress. She mentioned that her father was a hypertensive. And her mother
had no major illness or problematic health condition. She is the youngest of all 5
siblings. A college graduate and married at the age of 28 years old, blessed with 4
siblings. She worked in the government for almost 3 years at Cagayan de Oro city.

She stated during physical assessment that she believed she acquired her
condition because of her activities everyday she go to worked. Every time she felt sweat
she goes directly to the air condition room to keep herself cool. She didn’t even
manage to drink water because she claimed that water was just a tasteless. And she
added every time she goes to her work, she always inhaled the air pollution from the
jeepneys and other garbage’s. After worked, she followed shopping in the market.

IV. History of present illness

A case of pt. Mrs. Lorijean Diaz, 47, female, married from Cagayan de Oro city
and admitted on September 16,2009 due to persistent coughing and on and off fever. 8
days PTA, had amount of productive cough of yellowish phlegm, consulted with
Attending Physician, 4 days PTA and was given solmux and unrecalled antibiotics.
Cough persisted without relief from the prescribed med.
Nursing Assessment (System Review)
Nursing System Review Chart I

Name:Diaz, Lorijean L. Date: September 16,2009

Vital Signs:
Pulse: 85b/m BP: 100/90 mmhg Temp: 37 c Respi: 22 cyc/m Height: 5’0”
Weight: 55 kls

EENT
( ) impaired vision ( ) blind ( ) pain ( ) hard of hearing

( ) reddened ( ) drainage ( ) gums ( ) deaf

( ) burning ( ) edema ( ) lesion ( ) teeth

(x) No problem Deep

shallow
RESP:
breathing
( ) asymmetric ( ) tachypnea
Wheezing
( ) apnea ( ) rales (x) cough sound

( ) barrel chest ( ) bradypnea

Chest
(x) shallow ( ) bronchi (x) sputum pain
Upon
( ) diminished (x) dyspnea coughin

( ) orthopnea ( ) labored

(x) wheezing (x) chest pain ( ) cyanotic

( ) no problem

CARDIO VASCULAR

( )arrhythmia ( ) tachycardia ( ) numbness

( ) diminished pulses ( ) edema ( ) fatigue

( ) irregular ( ) bradycardia ( ) murmur

( ) tingling ( ) absent pulses ( ) pain

(x) No problem

GASTRO INTESTINAL TRACT

Productive
( )obese ( )distention ( ) mass cough,
yellowish in
( ) dysphasia ( ) rigidity ( ) pain color of
pleghm
(x) No problem

GENITO-URINARY and GYNE

( ) pain ( ) urine color ( )vaginal bleeding Weak in

appearanc
( ) hermaturia ( )discharge ( ) noctoria e

(x) No problem

NEURO

( ) paralysis ( ) stuporous ( ) unsteady ( ) seizures

Dry skin,
( ) lethargic ( ) comatose ( ) vertigo ( ) tremors pale

( ) confused ( ) vision ( ) grip

(X) No problem

MUSCULOSKELETAL and SKIN

( ) appliance ( ) stiffness ( ) itching ( ) petechiae

Dark
( ) hot ( ) drainage ( ) prosthesis ( )swelling brown
skin color
( ) lesion ( ) poor turgor ( ) cool ( ) deformity

( ) wound ( ) rash ( ) skin color ( ) flushed

( ) atrophy ( ) pain ( ) ecchymosis

( ) diaphoretic ( ) moist(x) No problem

NURSING ASSESSMENT II
SUBJECTIVE OBJECTIVE

COMMUNICATION :

( ) hearing Loss Comments: ok ( ) glasses ( ) languages

( ) visual Changes ra man aku pan ( ) contract lens ( ) hearing aide

(x) denied dungog”as ( )s speech difficulties

verbalized by the Pupil Size: 3mm

patient. Reaction: PERRLA

OXYGENATION :

( ) dyspnea Comments: “cge ko Resp. ( ) regular (/) irregular

( ) smoking history ubo naa pd plemas” Describe: Deep shallow breathing

as verbalized by
the
R: Assymmetric to the right lung
Patient.
L: Assymmetric to the left lung
(/) cough

(/ ) sputum

( ) denied

CIRCULATION :

(/) Chest pain Comments: “sakit Heart Rhythm ( /) regular ( ) irregular

akng dughan pag Ankle Edema: theres no noted ankle

mag ubo’’ as verbalized by the patient edema

( ) Leg pain Pulse Car. Rad. DP Fem

() Numbness R 85 + + +

Of extremities L 85 + + +

( ) Denied Comments: pulses are papable

NUTRITION :
Diet DAT Dentures None

() N () V Comments:” () ( /)

Character “ok rman kaon rman ko FULL PARTIAL with patient

Bsan unsa ila ihatag” Upper: ( ) (/) ()

( ) Recent change as verbalized by the

In weight, appetite patient Lower: ( ) (/) ()

( ) Swallowing

difficulty

(/) denied

ELIMINATION :

Usual bowel pattern urinary frequency Comments: patient’s Bowel Sounds

OK
Once a day 3-4 times a
day Vowel sound was Abdominal

( /) constipation ( ) urgency Hypoactive. Her last Distention

remedy ( ) dysuria bowel was September 16,2009 Present

( /) yes ( )no
none ( ) hematuria
Urine*
Date of last BM ( ) incontinence (color,consistency, odor) patient’s urine
color was light yellow
September 16,2009 ( ) polyuria
.
( ) Diarrhea ( ) foly in place

Character ( ) denied

MGT. OF HEALTH ILLNESS Briefly describe the patient’s abiltity to

follow treatments for chronic health
( ) Alcohol ( /) denied problems.
(amount , frequency) Patient was able to comply with her
medications and treatment regimen as
“Dili man ku gabisyo”as verbalized by the prescribed by the physician
patient.

SBE: Last Pap Smear n/a

LMP: n/a
SUBJECTIVE OBJECTIVE

SKIN INTEGRITY: (/) Dry ( ) cold (/) pale

sComments:”wala man () Flushed ( ) warm

( /) Dry pud katol-katol” () Moist ( ) cyanotic

( ) Itching as verbalized by the patient

() other The patient was affebrile with 37.0 degree

celcius
() Denied

ACTIVITY/SAFETY: ( ) LOC and Orientation: patient is

( ) Convulsion Comments: “maka- oriented to time and place

() dizziness lihoklihok man ko.

Gait: (/) walker () cane ( ) other
() limited motion wala man problema’
( ) sensory and motor lossess in face or
of joints as verbalized by the extremities no noted motor lossess in her face
and extremities
Limitation in patient.
ROM limitations: patient has no limitation in
Ability to range of motion
() Ambulate

() Bathe self

(/) denied

COMFORT/SLEEP/AWAKE: ( ) Facial Grimaces

() Pain Comments: “maka- ( ) Guarding

(location) mata ko ug hutoyon ko” ( ) Other signs of pain : there is no other

signs of pain noted
frequency as verbalized by the patient
( ) siderail release form signed ( 60 + years)
remedies) N/A
() Nocturia

(/) sleep difficulties

Denied
COPING: Observed non-verbal behavior: no noted

Occupation: Self employed The person and his phone number that can be
reached any time: Not given an opportunity.
Members of Household: 8

Most supportive Person: her childrens

Special patient information (use lead pencil)

55 kls . Daily weight ____ PT/OT ____
Every 4 hours Bp q shift ____ Irradiation ___
________ Neuro vs ____ Urine test ____
________ CVP/SG. Reading ___ ____ 24 hours Urine collection _
DATE DIAGNOSTIC/LABORATO DATE DATE I.V DATE
ORDERE RY DONE ORDER FLUIDS/BLO DISC.
D EXAM ED OD
Sept.16, Complete blood count Sept.16,09 Sept.16, PLR;TL@KV On
09 09 O going

Urinalysis Sept.16,09
Sept.16,
09
Sept.16, Blood chemistry Sept.16,09
09

Sept.16 , Sept.16,09
Chest X-ray
09

V. Diagnostic Exams
Hematology Report
Test Results Normal Values Remarks
WBC 15.35 10^3/uL 5.0-10.0 Abnormal findings
RBC 4.17 10^6/uL 3.69-5.90 Normal Findings
Hemoglobin 11.8 g/dL 11.70-14.00 Normal findings
Hematocrit 35.9 % 34-.10-44.00 Normal findings
MCV 86.1 fL 70.00-97.00L Normal Findings
MCH 28.3 pg 26.10-33.30 Normal Findings
MCHC 32.9 g/dL 32.0-35.00 Normal Findings
Differential counts
Lymphocytes 8.3 % 20.0-40.0 Abnormal findings
Neutrophils 86.8 % 55.0-62.0 Abnormal findings
Platelet 639 10^3/uL 150.0-390.0 Abnormal findings
Monocytes 3.7 % 4.0-10.0 Abnormal Findings

Urinalysis
Test Results Normal values remarks
Color Light Yellow straw yellow to Normal findings
amber
Clarity Slightly cloudy Transparent Concentrated urine,
also due to
medication
pH 7.5 4.5-8 Normal findings
Specific Gravity 1.010 1.010-1.025 Normal findings
Proteins Negative Negative glomerulonephritis,
pyelonephritis,
nephrotic
syndrome, pre-
eclampsia,
malignancies,
heavy exercise,
stress, CHF,
malignant
hypertension
Glucose Negative Negative Normal findings
Sediments/microscopic
Examination
Epithelial cell 2-4
RBC Plenty
Mucus threads None seen negative infection

Blood Chemistry
Test Results Normal values Remarks
Creatinine 0.50 mgs/dL 0.70-1.30 Abnormal findings
Potassium 3.27 meq/L 3.50-5.50 Abnormal findings
Na+ 142.40 meq/L 153.00-155.00 Normal findings

September 16, 2009-10-09

EXAMINATION: CHEST PA

There is no evidence of active parenchynal infiltrates.

Heart is not enlarged.
Aorta is unremarkable.
Sinuses are Intact.

IMPRESSION:
No radiographic abnormalities in the chest.
VI. Anatomy and physiology with pathophysiology

UPPER RESPIRATORY TRACT

Respiration is defined in two ways. In common usage, respiration refers to the act of
breathing, or inhaling and exhaling. Biologically speaking, respiration strictly means the
uptake of oxygen by an organism, its use in the tissues, and the release of carbon
dioxide. By either definition, respiration has two main functions: to supply the cells of the
body with the oxygen needed for metabolism and to remove carbon dioxide formed as a
waste product from metabolism. This lesson describes the components of the upper
respiratory tract.
The upper respiratory tract conducts air from outside the body the lower respiratory tract
and helps protect the body from irritating substances. The upper respiratory tract
consists of the following structures:

The nasal cavity, the mouth, the pharynx, the epiglottis, the larynx, and the upper
trachea. The esophagus leads to the digestive tract.

One of the feature of both the upper and lower respiratory tracts is the mucoclliary
apparatus that protects the airways from irritating substances, and is composed of the
ciliated cells and mucus-producing glands in the nasal epithelium. The glands produce a
layer of mucus that traps unwanted particles as they are inhaled. These are the
posterior pharynx, from whereby they are either swallowed, spat out, sneezed, or blow
out

Air passes through each of the structures of the upper respiratory tract on its way to the
lower respiratory tract. When a person at rest inhales, air enters via the nose and
mouth. The nasal cavity filters, warms, and humidifies air. The pharynx or throat is a
tube like structure that connects the back of the nasal cavity and mouth to the larynx, a
passageway for air, and the esophagus, a passageway for food. The pharynx serves as
a common hallway for the respiratory and digestive tracts, allowing both air and food to
pass through before entering the appropriate passageways.

The pharynx contains a specialized flap-like structure called the epiglottis that lowers
over the larynx to prevent the inhalation of food and liquid into the lower respiratory
tract.

The larynx, or voice box, Is a unique structure that contains the vocal cords, which are
essential for human speech. Small and triangular in shape, the larynx extends from the
epiglottis to the trachea. The larynx helps control movement of the epiglottis, in addition,
the larynx has specialized muscular folds that close it off and also prevent food foreign
objects, and secretions such as saliva from entering the lower respiratory tract.
In descending order, these generations of branches include:
 trachea
 right bronchus and left bronchus
 secondary bronchi
 tertiary bronchi
 bronchioles
 terminal bronchioles
 respiratory bronchioles
 alveoli

THE LUNGS
The thoracic cage, or ribs, and the diaphragm bound the thoracic cavity. There are two
lungs that occupy a significant portion of this cavity. The diaphragm is a broad, dome-
shaped muscle that separates the thoracic and abdominal cavities and generates most
of the work of breathing. The inter-costal muscles, located between the ribs, also aid in
respiration. The internal intercostals muscles lie close to the lungs and are covered by
the external intercostal muscles. The lungs are cone-shaped organs that are soft,
spongy and normally pink. The lungs cannot expand or contract on their own, but their
softness allows them to change shape in response to breathing. The lungs rely on
expansion and contraction of the thoracic cavity to actually generate inhalation and
exhalation. This process requires contraction of the diaphragm.
 Pathophysiology
Definition: Acute bronchitis is an infection of the bronchial (say: “brawn-kee-ull”) tree.
The bronchial tree is made up of the tubes that carry air into your lungs. When these
tubes get infected, they swell and mucus (thick fluid) forms inside them. This makes it
hard for you to breathe.
Predisposing factor: Precipitating factor:
Inhalation of the polluted air in the
- exposure to the polluted air
- Age (older adults are at greater risk because normal aging surroundings.
or illness weaken their immune system)
- Malnutrition (a poor diet or one too low calories puts
someone at greater risk)

Microorganisms

Entry into the nasal passages

s/sx:
Travel around the pharynx and to larynx s/sx:
-fever
Deposit into the bronchioles -cough with
-
yellowish
wheezin
Multiplication of microorganisms pleghm
g sound
-body aches
-pain Neutrophils and macrophages engulf by microorganism
when
Partial occlusion of the bronchi or alveoli

s/sx:
Interferes with the diffusion of oxygen and carbon dioxide
-
Areas of the lungs are not adequately ventilated shortness
of breath

Medical management Continuation of

replication

Treated Death
VII. Medical Management (Doctors order)

DATE DOCTOR’S ORDER RATIONALE

September 16, 2009 - pls. admit under - for further evaluation of
the service of Dr. the patient
8:05 am Go
- leave consent to - for patient and doctor’s
care protection in case of any
problems may occur

- TPR q 4 -TPR taking are done to

provide accurate
monitoring of vital signs
considering that
fluctuations in vital signs
especially temperature
may indicate presence of
infection.
- DAT-
-this provides adequate
nutrition

- Start with PLR iL

@ KVO
-for medication purposes

- Diagnostics: CBC,
Chest X-ray,
Urinalysis -Done to determine/
confirm provisional
diagnosis and check for
other abnormalities. They
- Meds: also provide baseline
data for future
comparison.
-Medications are
- Ultramox prescribed to relieve
(amoxicillin) 1.5 symptoms, control, and
mg q PO ANST (-) prevent further
complications.
 - Duavent I neb q
8hrs (salbutamol)

- Referral is order so to
- Refer accordingly provide medical
management for any
condition abnormalities

-to medical management

- Continue meds
September 17,2009

9:00am -for medication purposes

- IVTF PLR il @
same rate

-patient’s condition is
improved
- MGH tomorrow
AM
September 18,2009-10-
10:15am

- Shift ultramox to 1 -for medication purposes

gram/tab BID to
start tonight

- IVF to consume - For medication

purposes

- Ff up tue 9/22/09
- For further
monitoring of
the patient’s
 condition

Nursing Management

Ideal Nursing Management

1. Nursing Management:

• Impaired Gas exchange related to altered delivery of oxygen (hypoventilation)

Objectives:

• At the end of 15 minutes my client will be able to participate in actions to

maximize oxygenation and demonstrate improved ventilation and oxygenation of
tissues within client’s acceptable range and absence of symptoms of respiratory
distress.

Interventions/Rationale:

Independent:

• Pt will need to have breath sounds monitored q 4° to determine if pneumonia is

progressing. For baseline data’s for determining the progress of the disease.

• O2 sats should be done regularly ( at least q4°during acute phase) to make sure
that patient is getting adequate perfusion.

• Make sure to give all scheduled antibiotics on schedule so that therapeutic

ranges are maintained. To avoid any delayed of therapeutic effects.

• Any s/s of infection must be monitored and reported to MD.

• Elevate head and encourage the watcher to change porition of the baby;
Enhance expectoration of secretions to improved ventilation

Dependent:

• Administer Oxygen therapy by appropriate means; e.g. nasal prongs, mask,

venture mask.; The purpose of O2 therapy is to maintain PaO2 greater thatn
90% o2 saturation.
2. Nursing Management:

• Ineffective airway clearance related to increase sputum production and decrease

energy.

Objectives:

• At the end of 15 minutes, client will be able to demonstrate behaviors to achieve

airway clearance and display patent airway with breath sounds clearing, absence
of dyspnea, cyanosis.

Interventions/Rationale:

Independent:

• Monitor the patients vital signs of respiratory failure ( cyanosis, severe

tachypnea); Tachypnea, shallow respirations, and asymmetric chest movement
are frequently present because of discomfort of moving chest wall and or fluid
lung.

• Elevate head of the bed, change position frequently; keeping the head elevated
lowers diaphragm, promoting chest expansion and expectoration to keep the
airway clear.

• Suctioning as indicated; stimulates cough or mechanically clears airway in client

who is unable to do so especially infants.

• Offer warm, rather than cold fluids; Fluids especially warm liquids aid in
mobilization and expectoration of secretions.

Dependent:

• Assist with/monitor effects of nebulizer treatments and other respiratory

physiotherapy. Facilitates liquefaction and removal of secretions.

• Provide supplemental fluids e.g IVF, humidified oxygen and room humidification.
Fluids are required to replace losses and aid in mobilization of secretions, room
humidification thought to improved the risk of transmitting infection.
3. Nursing Management:

• Acute pain related to persistent coughing.

Objectives;

• At the end of 15 minutes, my patient will be able to demonstrate relaxed manner

(e.g. Stop crying) and engage in some activity (e.g. laughing, can grasp things)
appropriately.

Interventions/Rationale:

Independent:

• Monitor Vital signs;. Changes in heart rate mey indicate that client is
experiencing pain, especially when other reasons for changes in vital signs have
been ruled out.

• Provide comfort measures, e.g., sense of touch, change in position, quiet music;.
No analgesic measures administered with gentle touch can lessen discomfort.

• Offer frequent oral hygiene;, mouth breathing and oxygen therapy can initiate
and dry out mucous membranes, potentiating general discomfort.

• Offer warm, rather than cold fluids;, it will aid in mobilization and expectoration
thus minimizes coughing and lessen pain.

Dependent:

• Administer analgesics and antitussives as indicated by the physician;, To reduce

excess mucus, therapy enhancing general discomforts and rest.
X. Discharge Plan and Prognosis
The Group advised the patient to have a frequent monthly check-up to let her know
about the improvement of her health. She can have it their nearest Barangay Health
Center. But in emergency cases, she should immediately seek for medical assistance at
the nearest hospital.

We encouraged patient of any little alteration of the normal condition and functioning
should be given an immediate treatment and should not be ignored. A simple disease
can easily be treated and thus, avoiding any fatal consequences. We instructed to have
the following take home medication: ultramox (amoxicillin and sulbactam) 1grm/tab BID
PO and duavent ( salbutamol and 2 practropicen) 1tab q 8 and frequent intake of fluids,
adequate rest and encourage to have a adequate nutrition.

The prognosis is good since the onset and duration of illness and precipitating
factors were identified. Immediate management response was provided to the patient to
address her condition. The patient also positively complied with medications and
adhered to treatment plan. Family support has also been evident while in the hospital.

XI. Evaluation and Implication

Mrs. Diaz was diagnosed with Acute Bronchitis. In span of two 1 day, we have
provided the care and maintenance he needed like morning care, vital signs monitoring,
giving medications, and nebulizing.

The patient immediately responded to the treatment due to the proper care given
among medical team coupled with the support of significant others. It resulted to better
improvement of the patient’s condition.
This implies that a patient like Mrs. Diaz needs a holistic approach for a faster health
improvement. Increased rate of recovery will be manifested if the patient and her family
fully cooperate towards the treatment given by the medical team.

XII. Bibliography

• Kozier, et. al (1998). Fundamentals of Nursing.

Pearson education Asia pte Ltd. 5th edition: Philippine

• Doenges, et. al. (1997) Nursing Care Plan.

F>A/ Davis Company. Philadelphia. 14th edition

• Deglin, et. al. (1997). Davi’s drug guide for nurses.

F>S. Davis company. Philadelphia. 5th edition

• www.yahoo.com
Generic Brand Date Classifica- Dose/ Mechanism of Specific Contra- Side Nursing
Name of Name Orde- tion Frequency/ action Indication indication Effects/ Precaution
Ordered red Route Toxic
Drug Effects
Ultramo Amoxicillin Septem Amoxicillin,p 1.5 mg/tab penicillin which Treatment hypersens Nausea, - asses fluid
x ber enicillin PO kills bacteria by of itivity vomiting, status during
16,2009 interfering with tracheobron enterocolitis therapy. Monitor
the synthesis of chitis, , dyspepsia, daily weight,
the bacterial pneumonia, epigastralgi intake and
cell wall. It bronchopne a, glossitis, output, amount
binds to umonia. stomatitis, and location of
penicillin- and edema, lung
binding proteins diarrhea. sounds.
(PBPs) on the
- monitor blood
bacterial cell
pressure.
wall and blocks
peptidoglycan
synthesis.
Generic Brand Date Classifica-tion Dose/ Mechanism of Specific Contra- Side Nursing
Name of Name Orde- Frequenc action Indication indication Effects/ Precaution
Ordered red y/ Toxic
Drug Route Effects
Duavent Salbutam Septem Bronchodilator I neb q 8 Acts relatively relief and hypersensit Anxiety, -check urine pH
ol ber Antiasthmatic hr at beta2 prevention ivity tremors,
16,2009 & COPD adrenergic of broncho headache, -protect solution

Preparations receptors to -spasm in -history of vertigo, from light

cause broncho patient with stoke weakness,

-dilation and reversible nausea,
-CAD
vasodilation obstructive vomiting
airway
disease

-prevention
of exercise
induced
broncho
-spasm
IX. Actual Nursing Management

CUES OBJECTIVE NURSING NURSING RATIONALE EVALUATION

DIAGNOSIS INTERVENTION

Subjective: At the end of 30 Ineffective airway 1.Assess for -Respiratory rate At the end of 30
min, the patient will clearance related to changes in and rhythm min, the patient was
“cge man ku ubo be able to improve thickened mucus respiratory rate changes are early able to improved
naa pud plemas”as airway production as and depth sign respiratory airway
verbalized by the evidenced by compromise
patient changes in rate and
depth of respiration -This prevents
Objective:
2. Encourage to dehydration from
increased fluid increased
• coughing insensible loss and
intake unless
• weak contraindicated keeps the
• shortness of secretions thin
breath 3. Do chest
tapping -to mobilize
secretions and
facilitate airway

4. Demonstrate the -helps mobilize the

coughing and secretions
breathing exercise

5. Administer
medications as -a bronchodilator
prescribed such as that opens the air
duavent passages, making it
easier to breathe
CUES OBJECTIVE NURSING NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION

Subjective: At the end of 30 Ineffective 1.Elevate head of -promoting chest At the end of 30
mins, the patient breathing Pattern the bed/change expansion,mobilization mins, the patient
“galisod ku ginhawa” will be able to related to copious position frequently of secretions. was able to
as verbalized by the improve secretions as improved
patient ventilation and evidenced by 2. Encourage deep - to mobilize secretions ventilation and
provide adequate changes in breathing and provided an
Objective: oxygenation depth/rate of coughing exercise adequate
respiration oxygenation.
• body
3. Provide routine - alleviate the
weakness
comfort measures discomfort
• shortness of (backrub,chest
breath tapping)

4. Maintain Bed
- prevents over
rest
exhaustion and
reduces oxygen
consumption
5. Administer
medication as - a bronchodilator that
prescribed such as helps to lessen the
duavent secretions
CUES OBJECTIVE NURSING NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION

Subjective: At the end of 30 Impaired Gas 1. Assess -Useful in evaluating At the end of 30
mins, the patient Exchange related respiratory the degree of mins, the patient
“galisod ko ginhawa will be able to to altered oxygen rate, depth. respiratory distress and was able to
tungod sa aku ubo” improve supply as / or chronicity the improved
ventilation and evidenced by 2. Elevate Head disease process ventilation and
As verbalized by the provide adequate inability to move of bed. Assisst provided adequate
patient oxygenation secretions client to - Oxygen delivery may oxygenation
Objective: assume be improved by upright
position to position/breathing
• Shortness of ease work of exercises to decrease
breath breathing. airway collapse,
dyspnea, and work of
• Body 3. Encourage breathing.
weakness significant
others to have - this measures
frequent promote maximal
position inspiration, enhance
changes of a expectoration of
patient. secretions to improve
ventilation
4. Assess/
routinely - Duskiness and central
montitor cyanosis indicate
skin/mucous advanced hypoxemia
membrane
color

5. Administer
- helps to liquefy the
medication as
secretions
ordered like
vitromox.