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CASE
STUDY
Of
Acute
Bronchitis
Presented by:
Group 18 – MTW
Santos, John Kenneth
Galicia, Lorryleen
Lagman, Kimberly
Cruz, Lindon
Torres, Michelle
Bautista, Renae
Sapno, Lovely
Mungcal, Precious Kate
Macatulad, Reymark
Gabon, Jesusa
Cortez, Jennifer
Bronchitis Overview
• The thin mucous lining of these airways can become irritated and
swollen.
• The cells that make up this lining may leak fluids in response to
the inflammation.
Bronchitis occurs most often during the cold and flu season, usually
coupled with an upper respiratory infection.
Bronchitis Symptoms
• The cough may last for more than two weeks. Continued forceful
coughing may make your chest and abdominal muscles sore.
Coughing can be severe enough at times to injure the chest wall
or even cause you to pass out.
• If fever continues beyond four to five days, see the doctor for a
physical examination to rule out pneumonia.
Self-Care at Home
• People with chronic lung problems also usually are treated with
antibiotics.
Follow-up
• The patient should follow up with their doctor within a week after
treatment for bronchitis—sooner if your symptoms worsen or do
not improve.
Prevention
• Stop smoking.
Outlook
When you breathe in, air enters your body through your nose or
mouth. From there, it travels down your throat through the larynx (or
voice box) and into the trachea (or windpipe) before entering your
lungs. All these structures act to funnel fresh air down from the outside
world into your body. The upper airway is important because it must
always stay open for you to be able to breathe. It also helps to moisten
and warm the air before it reaches your lungs.
The Lungs
Structure
These are pyramidal-shaped areas which are also separated from each
other by membranes. There are about 10 of them in each lung. Each
segment receives its own blood supply and air supply.
The lungs are very vascular organs, meaning they receive a very
large blood supply. This is because the pulmonary arteries, which
supply the lungs, come directly from the right side of your heart. They
carry blood which is low in oxygen and high in carbon dioxide into your
lungs so that the carbon dioxide can be blown off, and more oxygen
can be absorbed into the bloodstream. The newly oxygen-rich blood
then travels back through the paired pulmonary veins into the left side
of your heart. From there, it is pumped all around your body to supply
oxygen to cells and organs.
The Pleurae
This reduces the area across which oxygen and carbon dioxide
can be exchanged, and not enough oxygen will be taken in. Normally,
a fetus will begin producing surfactant from around 28-32 weeks
gestation. When a baby is born before or around this age, it may not
have enough surfactant to keep its lungs open. The baby may develop
something called 'Neonatal Respiratory Distress Syndrome', or NRDS.
• Enlargement of the alveoli. The air spaces get bigger and lose
their elasticity, meaning that there is less area for gases to be
exchanged across. This change is sometimes referred to as
'senile emphysema'.
• The compliance (or springiness) of the chest wall decreases, so
that it takes more effort to breathe in and out.
• The strength of the respiratory muscles (the diaphragm and
intercostal muscles) decreases. This change is closely connected
to the general health of the person.
All of these changes mean that an older person might have more
difficulty coping with increased stress on their respiratory system, such
as with an infection like pneumonia, than a younger person would.
Bronchitis
Amoxicillin
Generic Name: Amoxicillin
Brand Name: Amoxil, Trimox
Classification: Antibiotic
Mechanism of Action
Inhibits bacterial cell wall mucopeptide synthesis.
Indication
Used to treat many different types of infections caused by
bacteria, such as ear infections, bladder infections, pneumonia,
gonorrhea, and E. coli or salmonella infection.
Contraindication
Hypersensitivity to penicillins, cephalosporins, or imipenem. Not
used to treat severe pneumonia, empyema, bacteremia, pericarditis,
meningitis, and purulent or septic arthritis during acute stage.
Adverse Reaction:
CNS:
Agitation; anxiety; behavioral changes; confusion; convulsions;
dizziness; headache; hyperactivity; insomnia.
Dermatologic:
Acute generalized exanthematous pustulosis; erythema multiforme;
erythematous maculopapular rashes; exfoliative dermatitis;
mucocutaneous candidiasis; Stevens-Johnson syndrome; toxic
epidermal necrolysis; urticaria.
GI:
Diarrhea (2%); nausea (1%); black, hairy tongue; hemorrhagic
pseudomembranous colitis; tooth discoloration; vomiting.
Genitourinary:
Crystalluria; vulvovaginal mycotic infection.
Hematologic-Lymphatic:
Agranulocytosis; anemia; eosinophilia; hemolytic anemia; leukopenia;
thrombocytopenia; thrombocytopenic purpura.
Hepatic:
Acute cytolytic hepatitis; cholestatic jaundice; hepatic cholestasis;
increased ALT and AST.
Hypersensitivity:
Anaphylaxis; hypersensitivity vasculitis.
Miscellaneous:
Serum sickness–like reactions.
Nursing Responsibilities
Periodically assess renal, hepatic, and hematopoietic function
during prolonged therapy. Patients diagnosed with gonorrhea should
have a serologic test for syphilis at the time of treatment and a follow-
up serologic test after 3 months.
Paracetamol
Generic name: Paracetamol
Brand Names: Biogesic
Classification: Analgesic/Antipyretic
Mechanism of Action
Paracetamol possesses prominent antipyretic and analgesic
effects. Its anti-inflammatory activity is weak and has no clinical
significance. The mechanism of action is related to depression of the
prostaglandin synthesis by inhibition of the specific cell
cyclooxygenase, and depression of the thermoregulatory center in the
medulla oblongata. Inhibits prostaglandins in CNS, but lacks anti-
inflammatory effects in periphery; reduces fever through direct action
on hypothalamic heat-regulating center.
Indications
The preparation is indicated in diseases manifesting with pain
and fever: headache, toothache, mild and moderate postoperative and
injury pain, high temperature, infectious diseases and chills (acute
catarrhal inflammations of the upper respiratory tract, flu, small-pox,
parotitis, etc.).
Contraindications
Paracetamol should not be used in hypersensitivity to the
preparation and in severe liver diseases.
Adverse reactions
In rare cases hypersensitivity reactions, predominantly skin
allergy (itching and rash), may appear. Long-term treatment with high
doses may cause a toxic hepatitis with following initial symptoms:
nausea, vomiting, sweating, and discomfort. Occasionally a
gastrointestinal discomfort may be seen.
Nursing Responsibilities
The preparation should be used with care in patients with liver
and renal diseases. The treatment with Paracetamol may change the
laboratory tests of uric acid and blood glucose analysis. In severe renal
failure the interval between two consecutive takings should not be
shorter than 8 hours. The treatment with the preparation is not
advisable during the first trimester of the pregnancy. In nursing women
the preparation should be used with strictly observation of the
therapeutic dose and duration of the treatment.
Ambroxol
Generic Name: Ambroxol
Brand Name: Mucosulvan
Classification: Expectorant/Antibiotic
Mechanism of Action
When administered orally onset of action occurs after about 30
minutes. The breakdown of acid mucopolysaccharide fibers makes the
sputum thinner and less viscous and therefore more easily removed by
coughing. Although sputum volume eventually decreases, its viscosity
remains low for as long as treatment is maintained.
Indication
All forms of tracheobronchitis, emphysema with bronchitis
pneumoconiosis, chronic inflammatory pulmonary conditions,
bronchiectasis, bronchitis with bronchospasm asthma. During acute
exacerbations of bronchitis it should be given with the appropriate
antibiotic.
Contraindication
There are no absolute contraindications but in patients with
gastric ulceration relative caution should be observed.
Adverse Reaction
Occasional gastrointestinal side effects may occur but these are
normally mild.
Nursing Responsibilities
Observe respiratory rate and obtain baseline data. Check drug
interactions if taking other medications.
It is advisable to avoid use during the first trimester of pregnancy.
Metoprolol
Generic Name: Metoprolol
Brand Name: Lopressor, Toprol-XL
Classification: Beta blocker
Mechanism of Action
Blocks beta receptors, primarily affecting CV system (decreases
heart rate, decreases contractility, decreases BP) and lungs (promotes
bronchospasm).
Indication
Metoprolol is used to treat angina (chest pain) and hypertension
(high blood pressure). It is also used to treat or prevent heart attack.
Contraindication
You should not use this medication if you are allergic to metoprolol,
or if you have a serious heart problem such as heart block, sick sinus
syndrome, or slowheart rate. If you have any of these other conditions,
you may need a dose adjustment or special tests to safely use
metoprolol:
pheochromocytoma; or
problems with circulation (such as Raynaud's syndrome);
congestive heart failure;
asthma, bronchitis, emphysema;
diabetes;
low blood pressure; depression;
liver or kidney disease;
a thyroid disorder; or
myasthenia gravis.
Adverse Reaction
Cardiovascular:
Hypotension; edema; flushing; bradycardia (3%); palpitations; CHF;
arterial insufficiency; peripheral edema.
CNS:
Headache; fatigue; dizziness (10%); depression (5%); lethargy;
drowsiness; forgetfulness; sleepiness (10%); vertigo; paresthesias.
Dermatologic:
Rash (5%); facial erythema; alopecia; urticaria; pruritus (5%).
EENT:
Dry eyes; visual disturbances.
GI:
Nausea; vomiting; diarrhea (5%); dry mouth; gastric pain; constipation;
heartburn; flatulence.
Genitourinary:
Impotence; urinary retention; difficulty with urination.
Respiratory:
Shortness of breath (3%); bronchospasm; dyspnea; wheezing.
Miscellaneous:
Increased hypoglycemic response to insulin; may mask hypoglycemic
signs; muscle cramps; asthenia; systemic lupus erythematosus; cold
extremities.
Nursing Responsibilities
In patients with angina pectoris or coronary artery disease (CAD),
metoprolol may cause exacerbation of angina, occurrence of MI, and
ventricular arrhythmias. Monitor patients closely. Because CAD is
common and often unrecognized, it may be prudent not to discontinue
beta-blocker therapy abruptly in patients being treated for
hypertension.
Nursing Care Plan
Facilit
ate
heat
loss
by
mean
s of
evapo
ration
Helps
lower
temp
eratur
e
within
norm
al
range
Nursing Care Plan
To
maint
ain
tolera
ble
level
of
pain
Nursing Care Plan