Acute Bronchitis FALALALALA

8/13/2019 Acute Bronchitis FALALALALA

1/42

By:

Danah Macaraig

Aniebee Montano

Klent Nikko Melencion


2/42

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


3/42

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.


4/42

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.


5/42

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.


6/42

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.


7/42

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.


8/42

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


9/42

Physical Assessment


10/42

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


11/42

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


12/42

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


13/42

Genogram

Mother

(Asthma)

Father

(Healthy)

Patient

(Acute

Bronchits)


14/42

LABORATORY


15/42

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%


16/42

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


17/42

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


18/42

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.


19/42

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.


20/42

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.


21/42

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.


22/42


23/42


24/42

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


25/42

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


26/42

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


27/42

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


28/42

DRUG STUDY


29/42

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


30/42

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


31/42

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


32/42


33/42

NURSING CARE PLAN


34/42


35/42


36/42


37/42

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.


38/42

- 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.


39/42

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.


40/42

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


41/42

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


42/42

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

Acute Bronchitis FALALALALA

Documents