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School of Nursing
Bo. Bucal, Calamba City
Case Study
On
Acute Bronchitis
Submitted by:
Alcantara, Aris N.
3BSN1/Group 1
Submitted to:
Ms. Marissa Nobleza RN MAN
I. PATIENT’S PROFILE
Name: L.K.C.E
Age: 1 y.o
Sex: Male
Address: Barandal, Calamba City
Birthday: April 14, 2008
Birthplace: Calamba City
Civil Status: Child
Religion: Roman Catholic
Citizenship: Filipino
Occupation: None
Date of Admission: August 17, 2009
II. CHIEF COMPLAINT
K.E.L
A & W8 y.o K.E.L
HPN 1 y.o
A&W A&W
LEGEND:
B. Integument Skin
> Inspection
- brown skin color
- good skin turgor
- (-) scaling
- (-) cyanosis
- (-) edema
- (-) dryness
> Palpation
- (+) smooth and flabby skin
- (-) edema
Hair
> Inspection
- black hair evenly distributed
- wavy hair
- (-) dandruff
Nails
> Inspection
- clean, well trimmed nails
- pink nail beds
- (-) clubbing of fingers
> Palpation
- poor capillary refill (>3 seconds)
- smooth on surfaces
- skin warm to touch
C. Head > Inspection
- normocephalic
- bilaterally symmetric
- (-) lesions
>Palpation
- (+) smooth surface
Mouth
> Inspection
- pinkish gum color
- tongue in the midline
J.Lymphatic >Palpation
- No palpable lymph nodes
K. Breast and axillae > Inspection
- bilaterally symmetrical
- color the same as skin tone of extremities
- dark pigmented, not inverted, bilaterally symmetrical
nipples
- (-) lesions
P. Genitalia >Inspection
- (-) lesions
- (-) swelling
The client usually spend his day by playing his toys, watching cartoons in the television, sleeping 3-4 times a day and drinking his
milk 8-10 time a day.
Their home is just enough for their family when it comes to size. The location is suitable for accessibility of health facilities,
educational establishment and for buying their everyday needs. A quiet neighborhood. Far from pollutions of the urban areas.
Client usually wakes up at 6:00 in the morning. His mother makes sure that he will take a sleep once in the morning, once in
the afternoon and once at night.
Recreation
He usually plays a lot and watches television. Sometimes his parents bring them to malls whenever they are free of having a
leisure time.
Nutrition
The client still don’t eat solid food, instead he drinks milk 8 – 10 bottles per day. He also takes his Vitamins that is prescribed
by his pedia regularly.
According to his mother, when the client is mad he usually cries a lot and throw all of his toys everywhere. In order to stop
his crying they give him his milk.
Socio-Economic status
o Educational Background – Client is not yet schooling.
o Financial Status – His parents provide him financial support. They earn P40, 000 – P50, 000/month.
Occupational Health Pattern
o Nature of work – The client is still a child.
IX. ROLE AND RELATIONSHIP PATTERN
a. Self-Concept
Self expectation
Her mother expects him to grow up a very humble and respectful child.
Their family regularly attends the mass every Sunday. They pray for good health. His parents teaches him about God and
about Catholic religion.
X. LABORATORY FINDINGS
a. Urinalysis
b. Hematology
Actual Findings Normal Range Interpretation
Hemoglobin 12.8 Female: 12-16 Decrease in hemoglobin is a
Male: 13-18 sign anemia, or excessive fluid
Child: 14-26 intake
Hematocrit 38 Female: 36 - 57 Decreased hematocrit is a sign
Male: 40 – 54 of anemia.
White Blood Cells 4.0 x 10^9/L 5-10 x 10^9/L Decreases no. of WBC is a sign
of infection
Red Blood Cells 4.7 x 10^12/L 4 – 6.0 x 10^12/L Client’s finding is within
normal range.
Platelet Count 201 x 100^g/L 150 – 400 x 100^g/L Client’s finding is within
normal range
Monocytes - 0.02 – 0.04 Decreased no. may be a sign
of infection
Eosinophils - 0.02 - 0.05 Decreases no. may be a sign of
infection
Lymphocytes 0.41 0.25 – 0.35 Increased no. is a sign of
infection.
Acute bronchitis is an inflammation of the large bronchi (medium-sized airways) in the lungs that is usually caused by viruses or
bacteria and may last several days or weeks. Characteristic symptoms include cough, sputum (phlegm) production, and shortness of
breath and wheezing related to the obstruction of the inflamed airways. Diagnosis is by clinical examination and sometimes
microbiological examination of the phlegm. Treatment for acute bronchitis is typically symptomatic. As viruses cause most cases of
acute bronchitis, antibiotics should not be used unless microscopic examination of Gram stained sputum reveals large numbers of
bacteria.
In bronchitis, areas of the bronchial wall become inflamed and swollen, and
mucus increases. As a result, the air passageway is narrowed.
Causes
Acute bronchitis can be caused by contagious pathogens. In about half of instances of acute bronchitis a bacterial or viral
pathogen is identified. Typical viruses include respiratory syncytial virus, rhinovirus, influenza, and others.
Damage caused by irritation of the airways leads to inflammation and leads to neutrophils infiltrating the lung tissue.
Mucosal hypersecretion is promoted by a substance released by neutrophils.
Further obstruction to the airways is caused by more goblet cells in the small airways. This is typical of chronic bronchitis.
Although infection is not the reason or cause of chronic bronchitis it is seen to aid in sustaining the bronchitis.
Symptoms
o Sore throat
o Fever
o A cough that may bring up yellow or green mucus
o Chest congestion
o Shortness of breath
o Wheezing
o Chills
o Body aches
Diagnostic Examination
A physical examination will often reveal decreased intensity of breath sounds, wheezing, rhonchi and prolonged expiration. Most
doctors rely on the presence of a persistent dry or wet cough as evidence of bronchitis.
A variety of tests may be performed in patients presenting with cough and shortness of breath:
A chest X-ray that reveals hyperinflation; collapse and consolidation of lung areas would support a diagnosis of pneumonia.
Some conditions that predispose to bronchitis may be indicated by chest radiography.
A sputum sample showing neutrophil granulocytes (inflammatory white blood cells) and culture showing that has pathogenic
microorganisms such as Streptococcus spp.
A blood test would indicate inflammation (as indicated by a raised white blood cell count and elevated C-reactive protein).
XII. ANATOMY
o Respiratory System
A respiratory system's function is to allow gas exchange. The space between the
alveoli and the capillaries, the anatomy or structure of the exchange system, and the
precise physiological uses of the exchanged gases vary depending on the organism. In
humans and other mammals, for example, the anatomical features of the respiratory
system include airways, lungs, and the respiratory muscles. Molecules of oxygen and
carbon dioxide are passively exchanged, by diffusion, between the gaseous external
environment and the blood. This exchange process occurs in the alveolar region of the
lungs.
Ventilation
Exhalation
The lungs have a natural elasticity: as they recoil from the stretch of inhalation, air flows back out until the pressures in the chest
and the atmosphere reach equilibrium.
Circulation
The right side of the heart pumps blood from the right ventricle through the pulmonary semilunar valve into the pulmonary
trunk. The trunk branches into right and left pulmonary arteries to the pulmonary blood vessels. The vessels generally accompany
the airways and also undergo numerous branchings. Once the gas exchange process is complete in the pulmonary capillaries, blood
is returned to the left side of the heart through four pulmonary veins, two from each side. The pulmonary circulation has a very low
resistance, due to the short distance within the lungs, compared to the systemic circulation, and for this reason, all the pressures
within the pulmonary blood vessels are normally low as compared to the pressure of the systemic circulation loop.
Gas Exchange
The major function of the respiratory system is gas exchange between the external environment and an organism's circulatory
system. In humans and mammals, this exchange facilitates oxygenation of the blood with a concomitant removal of carbon dioxide
and other gaseous metabolic wastes from the circulation. As gas exchange occurs, the acid-base balance of the body is maintained
as part of homeostasis. If proper ventilation is not maintained, two opposing conditions could occur: 1) respiratory acidosis, a life
threatening condition, and 2) respiratory alkalosis.
Disorders of the respiratory system can be classified into four general areas:
Inhalation When inhaled, viruses and noxious gases enters the respiratory tract
Increased susceptibility of
to enter the body
respiratory infection
When infection reach the bronchial walls
BRONCHITIS
Prolonged infection of the respiratory system may lead to pneumonia
Pneumonia
XIV. MEDICAL MANAGEMENT
MEDICAL MANAGEMENT RATIONALE
MEDICATION
Hemostan Antihemorrhage and homeostasis for clinical cases
Tobramycin Anti-infective for lower respiratory infections
Salbutamol Bronchodilator and anti-asthmatic
IV THERAPY
D5LR Replacement therapy for extracellular fluid deficit
accompanied by acidosis
INTAKE AND OUTPUT MONITORING To promote expectoration of secretions
VITAL SIGNS MONITORING To assess changes and prevent further complications
Anti-Hemorrhagic
NURSING RESPONSIBILITIES
Arrange to taper dosage gradually after long-term therapy.
Provide patient with written information regarding recovery and follow-up care.
Aminoglycosides
NURSING RESPONSIBILITIES
instruct the patient on proper use of OTC preparation as indicated
Remind patient to take once daily prescription drug at bedtime for best results.
Bronchodilator
NURSING RESPONSIBILITIES
Monitor v/s
Improve patient’s compliance by giving drug
Diagnosis
Diagnosis
I: Maintained bedrest
Planning
After the nursing R: To reduce metabolic demands
intervention the
patient’s I: Administered Paracetamol
temperature will
R: To lower down temperature
lower down from
37.6°C to normal I: Monitored vital signs
range
R: To promote timely interventions as needed
A patient experiencing acute bronchitis
R: To reduce fatigue