Acute Bronchitis

By: Rolinette Dane Su

Objectives
To give facts and information about bronchitis. To acquaint us on the procedures and management of bronchitis

Introduction
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.

Review of Related Literature

Bronchitis is an inflammation or swelling of the bronchi-air passages that extend from the windpipe to the lungs. Viruses, bacteria, smoking, chemical pollutants and dust may cause the swelling. Bronchitis may occur after a bout of flue or severe cold, especially among people with weakened body resistance like smokers and alcoholics. Avoiding cigarettes, second-hand smoke, and heavy fumes can hasten recovery, because the lungs' task of filtering pollutants is made easier. (Department of Health, 2006)

 Smoking is a key risk factor for developing acute bronchitis. Any other illnesses that predispose to similar inflammation also increase that risk (for example, asthma patients and patients allergic to airborne chemicals). (O. Marzian, University of Heidelberg, 2007)

 Approximately 90% of cases of acute bronchitis are viral infections (commonly caused by rhinovirus, and influenza virus),while 10% are bacterial (commonly caused by B.pertussis, C.pneumoniae, and M.pneumoniae). (Stoppler, Melissa Conrad, 2009)

 The Philippines has 3,967,117 registered cases of acute bronchitis in 2008. (World Health Organization)

Biographic Data
Name: Patient X Address: Brgy. Sta. Elena, San Pablo City Birth Date: August 12,1999 Age: 11 Sex: Male Marital Status: Single Religion: Roman Catholic Nationality: Filipino Occupation: N/A Contact Person: Mr. X Occupation: Jeepney Driver Monthly Income: P 8000 Relationship: Father Address of Nearest Relative: Brgy. Sta. Elena, San Pablo City

Reason for Seeking Care

Patients chief complaint (patients exact words): Inuubo po ang aking anak as verbalized by the patients father. How did the symptoms of your present problem developed? Una nag umpisa siya sa simpleng ubo tapos nagkaroon siya ng sipon at lagnat as verbalized by the patients father. When did the symptoms developed? January 18, 2010, two days prior to admission. What led the patient to seek medical attention? Tumaas kasi ng sobra yung lagnat niya as verbalized by the patients father.

Medical History
Past medical history
Hypertension ( ) Diabetes ( ) Back Pain ( ) Others: Diarrhea, Fever

 Current medical history

Hypertension ( ) Diabetes ( ) Back Pain ( ) Others: None

Have he ever been hospitalized? YES ( ) NO (X). If yes, WHEN? WHY? Have he ever had surgery? No, he havent had any surgery. Is he allergic to anything in the environment or to any drugs? No, he has no known allergies. Is he taking any medication, including over-the-counter preparations, such as aspirin, vitamins, cough syrup? Yes. If so, how much do you take and how often do you take it? Oo, binibigyan ko sya ng paracetamol pag nilalagnat, as verbalized by the patients father Do you use home remedies such as homemade ointments? No, they dont use any homemade remedies. Do you use herbal preparations or take dietary supplements? No, they dont use any herbal preparations or take dietary supplements. Do you use other alternatives or complementary therapies, such as acupuncture, therapeutic massage or chiropractic? No, they dont use any alternative or complementary therapies.

Family History
Is his mother, father and siblings living? Yes, his parents and siblings are still alive.

Psychosocial History
How have you coped with medical or emotional crises in the past? Nananalangin lang kami tapos pinipilit naming siyang patawaninas verbalized by the patients father. How adequate is the emotional support he receive from family and friends? Sapat naman, pati yung mga lola nya at mga tiyuhin at tiyahin, tumutulong naman sa pag-aalaga sa kanya asverbalized by the patients father. How close do you live to health care facilities? Can you get them easily? Medio malayo sa amin as verbalized by the patients father. Do you have health insurance? Meron akong Philhealth as verbalized by the patients father. Are you on a fixed income with no extra money for health care? Meron naman akong naitatabi pagka mayroong nagkakasakit sa amin as verbalized by the patients father.

Activities of Daily Living

Diet and Elimination

Appetite: Good, he eats 3 times a day plus snacks. Special diets: None Food allergies: None Can the patients family buy enough food? Yes, they can buy enough food. Who cooks and shops at his house? Both his parents. Frequency of bowel movements and laxatives use: Once a day, without the use of laxatives.

Exercise and Sleep

How many hours of sleep at night? 9 to 10 hours What is the patients sleeping patterns like? Malalim siyang matulog as verbalized by the clients father. Does the patient felt rested after sleep? Yes, the patient feels rested after sleep.

Religious Observance
Any religious beliefs that affect diet, dress or health practices: None

REVIEWING STRUCTURES AND SYSTEMS

HEAD: No lesions, clean scalp, with short and straight hair. EYES: With pinkish conjunctiva, can look at any directions. EARS: No discharge or lesions, symmetrical. NOSE: With clear nasal discharge. MOUTH: No sores, soft and moist. NECK: Short and thin, can turn easily from side to side. RESPIRATORY PATTERN: Occasional cough, slightly elevated respiratory rate. CARDIOVASCULAR SYSTEM: Slightly elevated heart rate, no murmur. ABDOMEN/GASTROINTESTINAL SYSTEM: No distention, normal bowel sounds. HEMATOLOGICAL SYSTEM: Normal WBC. EMOTIONAL STATUS: Easily distracted, restless.

Anatomy and Physiology

 Oxygen enters the body through the nostrils and mouth then it will travel to the larynx (voice box) > trachea > bronchi > bronchial tubes > then alveoli. When the oxygen enters the alveoli, it will diffuse to the blood through the capillaries. The waste (carbon dioxide) rich blood from the veins will be released into the alveoli then exhaled out from the body. On the trachea, the air we breathe will go through a fork in the road. This fork is called the bronchial tubes. One bronchial tube will go to the left lung while the other will go to the left. These brochi will subdivide into secondary bronchi, three on the right and two on the left, each of which enters and supplies one lung lobe. These will continue to branch out for several times to become terminal bronchiole, which then divides into respiratory bronchioles (resembling an inverted tree).

 The bronchioles other than the primary bronchi are supported by small cartilage rings embedded on their walls. As you move down the tree, the cartilage becomes more and more sparse and smaller and smooth muscles becomes more abundant. The bronchioles, devoid of cartilage in their walls, are very small tubes, 1mm or less in diameter. Because much smooth muscle and no cartilage in their walls, they can constrict if the smooth muscle contracts forcefully, which occurs during asthma attacks. Each respiratory bronchiole divides to form alveolar ducts that end as clusters of air sacs called alveoli

Pathophysiology
Inhalation of dusts, smoke, fumes, and pathogens into the lungs Inflammation of the airway lining Inflammatory response of the mucous membranes within the lungs bronchial passages Mucous productions Signs and symptoms Cough ( Defense mechanism to get rid of the cause of irritation or invading pathogen) Fever (There is a presence of infection) Cold (To get rid of mucus or phlegm) Wheezing (Caused by the flow of air through narrowed bronchi) Treatment Encourage fluid intake Deep breathing and cough exercise Back tapping and chest physiotherapy If left untreated, it may lead to: Chronic Bronchitis Pneumonia

Course in the Ward

January 21, 2010 Vital signs taken and recorded Ensured adequate fluid intake and monitored intake and output Demonstrated deep breathing exercise Progress notes: Temperature-37.6C With occasional cough Restless

Hematology
Complete Blood Count
WBC

Purpose

Result

Normal Values

Significance

Used to evaluate a number of conditions and differentiates causes of alterations in the total WBC count including infection and inflammation.

9.4x109/L

(5.0-10.0)

Normal

HGB

A protein found within the RBCs that carries oxygen throughout the body. This test evaluates blood loss, blood ability, and anemia.

123g/L

(110-165)

Normal

HCT

Measures the concentration of RBC within the blood volume, the blood test evaluates blood loss, blood replacement and fluid balance. Are elements in the blood that are necessary for blood to clot, evaluates platelet production and used as screening test to platelet function

.3400/L

(.350-.500)

Normal

PLT

446x109/L

(150-450)

Normal

Drug Study
Drug Classification Action Contraindic ations
Patients allergic to cephalospo rin group of antibiotics

Adverse Nursing Reaction Consideration

Rash Diarrhea Vomiting Sores in the mouth and throat Monitor the therapy for allergic reactions

Cefuroxime 500mg.TIV every 8 hours

Antibiotic

Kills and inhibits the growth of bacteria

Drug

Classification

Action

Contraindicati ons

Adverse Reaction

Nursing Consideration

Salbutamol 5mL via nebuliz er, every 8 hours

Autonomic nervous system agent Bronchodilator (respiratory smooth muscle relaxant)

Used for the relief of bronchospa sm in conditions such as asthma and Chronic Obstructiv e Pulmonary Disease

Pregnancy blockers.

Fine skeletal muscle tremor tachycardi a Headache Dizziness arrhythmia

Wash the mouthpiece or mask with warm water and soap Use cautiously in patients with cardiovascular disease Teach the patient how to use it correctly

Drug

Classification

Action

Contraindicati ons

Adverse Reaction

Nursing Considera tion Should be given with care to patients with impaired kidney function In children, do not exceed 5 doses in 24 hours

Paracetamol Analgesic 200mg/5 and mL oral Antipyret suspensio ics n every 4 hours for fever

Used to relieve fever through central action in the hypothal amic heat regulatin g center

Hypersensi tivity

Nausea Allergic reactions Skin Rashes

Assesment
Subjective:
inuubo ang anak ko as verbalized by the patients father.

Objective:
*Occasional productive cough *Clear mucus *Temperature of 37.6C *Respiratory Rate of 22 Breaths per Minute

Nursing Diagnosis
*Ineffective airway clearance may be related to mucus secretion as evidenced by productive cough. *Potential for ineffective breathing pattern may be related to ineffective airway clearance. *Risk for impaired gas exchange may be related to ineffective breathing pattern.

Planning:
*The cough of the

Intervention:
*Monitor respiration and breath sounds

Rationale:
*To identify any respiratory diseases and/or accumulation of secretions. *To take advantage of gravity decreasing pressure on the diaphragm and enhancing drainage of/ventilation to the lungs *To maximize respiratory effort *Hydration can help liquefy viscous secretions *To prevent any factors that may cause the patient difficulty of breathing *To identify any changes in color and amount

Evaluation:
After 8 hours of Nursing Intervention: The cough of the client was lessened

client will be lessened

*The patient will establish normal breathing pattern

* The parents will have adequate information and knowledge on how to manage the childs bronchitis

*Elevate head of the bed/change position every 2 hours or as desired

*The patient will establish normal breathing pattern

* The parents will have adequate information and knowledge on how to manage the childs bronchitis

*Encourage deep breathing exercise *Ensure adequate fluid intake

*Remove environmental factors that may affect the patients breathing pattern *Provide information about the necessity of raising and expectorating secretions versus swallowing them

Discharge Planning
Provide health teachings to the parents such as:
Proper practices to maintain proper breathing patterns Maintain proper hygiene Provide time for the child to rest to prevent fatigue Give the child the prescripted medications

Evaluation of Experiences
The entire experience in the hospital was indeed a very informative experience for me. It developed my social, intellectual and communication skills. In the ward, I have learned that the proper monitoring of the patients vital signs is really important to tell the patients health status. Everyone that I met in the hospital has each given me proper knowledge and information for the welfare of my client. In this case study, I have learned the different causes of bronchitis and how does a simple causative agent trigger this disease. I also became updated to the recent development on how to take care of patients with bronchitis. This study will help us nursing students, to be aware on the disease and how to treat it.

References
Doenges, Marilyn., et al., Nurses Pocket Guide, 11th Edition Mark, D.H., Medical Care, 2005 Wenzel, G., Internal Medicine, Virginia Commonwealth University, 2007 http://wikipedia.org ndt.oxfordjournals.org/cgi/reprint/4/3/228 .pdf www.mamashealth.com