22508056 Case Study of Bronchitis

7/30/2019 22508056 Case Study of Bronchitis

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Bataan Peninsula State UniversityInstitute of Nursing & Midwifery

Orani Campus,

Campus of Courtesy

CASE

STUDYOf

Acute

Bronchitis

Presented by:Group 18 MTW

Santos, John KennethGalicia, LorryleenLagman, Kimberly

Cruz, LindonTorres, MichelleBautista, RenaeSapno, Lovely

Mungcal, Precious Kate


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Macatulad, ReymarkGabon, JesusaCortez, Jennifer


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Bronchitis Overview

Bronchitis is an acute inflammation of the air passages within thelungs. It occurs when the trachea (windpipe) and the large and smallbronchi (airways) within the lungs become inflamed because of

infection or other causes.

The thin mucous lining of these airways can become irritated andswollen.

The cells that make up this lining may leak fluids in response tothe inflammation.

Coughing is a reflex that works to clear secretions from thelungs. Often the discomfort of a severe cough leads you to seek

medical treatment.

Both adults and children can get bronchitis. Symptoms aresimilar for both.

Infants usually get bronchiolitis, which involves the smallerairways and causes symptoms similar to asthma.


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Bronchitis Causes

Bronchitis occurs most often during the cold and flu season, usuallycoupled with an upper respiratory infection.

Several viruses cause bronchitis, including influenza A and B,commonly referred to as "the flu."

A number of bacteria are also known to cause bronchitis, such asMycoplasma pneumoniae, which causes so-called walkingpneumonia.

Bronchitis also can occur when you inhale irritating fumes ordusts. Chemical solvents and smoke, including tobacco smoke,have been linked to acute bronchitis.

People at increased risk both of getting bronchitis and of havingmore severe symptoms include the elderly, those with weakenedimmune systems, smokers, and anyone with repeated exposureto lung irritants.

Bronchitis Symptoms

Acute bronchitis most commonly occurs after an upper respiratoryinfection such as the common cold or a sinus infection. You may seesymptoms such as fever with chills, muscle aches, nasal congestion,

and sore throat.

Cough is a common symptom of bronchitis. The cough may bedry or may produce phlegm. Significant phlegm productionsuggests that the lower respiratory tract and the lung itself maybe infected, and you may have pneumonia.

The cough may last for more than two weeks. Continued forcefulcoughing may make your chest and abdominal muscles sore.Coughing can be severe enough at times to injure the chest wallor even cause you to pass out.

Wheezing may occur because of the inflammation of the airways.This may leave you short of breath.

When to call the doctor

Although most cases of bronchitis clear up on their own, some peoplemay have complications that their doctor can ease.

Severe coughing that interferes with rest or sleep can bereduced with prescription cough medications.

Wheezing may respond to an inhaler with albuterol (Proventil,Ventolin), which dilates the airways.

If fever continues beyond four to five days, see the doctor for aphysical examination to rule out pneumonia.

See a doctor if the patient is coughing up blood, rust-coloredsputum, or an increased amount of green phlegm.

When to go to the hospital


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If the patient experiences difficulty breathing with or withoutwheezing and they cannot reach their doctor, go to a hospital'semergency department for evaluation and treatment.

Exams and Tests

Doctors diagnose bronchitis generally on the basis of symptoms and aphysical examination.

Usually no blood tests are necessary.

If the doctor suspects the patient has pneumonia, a chest x-raymay be ordered.

Doctors may measure the patient's oxygen saturation (how welloxygen is reaching blood cells) using a sensor placed on a finger.

Sometimes a doctor may order an examination and/or culture ofa sample of phlegm coughed up to look for bacteria.

Self-Care at Home

By far, the majority of cases of bronchitis stem from viralinfections. This means that most cases of bronchitis are short-term and require nothing more than treatment of symptoms torelieve discomfort.

Antibiotics will not cure a viral illness.

Experts in the field of infectious disease have been warning foryears that overuse of antibiotics is allowing many bacteria tobecome resistant to the antibiotics available.

Doctors often prescribe antibiotics because they feel pressuredby people's expectations to receive them. This expectation hasbeen fueled by both misinformation in the media and marketingby drug companies. Don't expect to receive a prescription for anantibiotic if your infection is caused by a virus.

Acetaminophen (Feverall, Panadol, Tylenol), aspirin, or ibuprofen(Motrin, Nuprin, Advil) will help with fever and muscle aches.

Drinking fluids is very important because fever causes the bodyto lose fluid faster. Lung secretions will be thinner and easier toclear when the patient is well hydrated.

A cool mist vaporizer or humidifier can help decrease bronchialirritation.

An over-the-counter cough suppressant may be helpful.Preparations with guaifenesin (Robitussin, Breonesin, Mucinex)will loosen secretions; dextromethorphan-the "DM" in most overthe counter medications (Benylin, Pertussin, Trocal, Vicks 44)suppresses cough.


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Medical Treatment

Treatment of bronchitis can differ depending on the suspected cause.

Medications to help suppress the cough or loosen and clearsecretions may be helpful. If the patient has severe coughingspells they cannot control, see the doctor for prescriptionstrength cough suppressants. In some cases only these strongercough suppressants can stop a vicious cycle of coughing leadingto more irritation of the bronchial tubes, which in turn causesmore coughing.

Bronchodilator inhalers will help open airways and decreasewheezing.

Though antibiotics play a limited role in treating bronchitis, theybecome necessary in some situations.

In particular, if the doctor suspects a bacterial infection,antibiotics will be prescribed.

People with chronic lung problems also usually are treated withantibiotics.

In rare cases, the patient may be hospitalized if they experiencebreathing difficulty that doesn't respond to treatment. Thisusually occurs because of a complication of bronchitis, not

bronchitis itself.

Follow-up

The patient should follow up with their doctor within a week aftertreatment for bronchitissooner if your symptoms worsen or donot improve.

Call the doctor's office if any new problems occur.

Prevention

Stop smoking.

Avoid exposure to irritants. Proper protection in the workplace isvital to preventing exposure.

The dangers of secondhand smoke are well documented.Children should never be exposed to secondhand smoke insidethe home.

Outlook

Nearly all cases of acute bronchitis clear up completely over time.

In the case of bronchitis caused by exposure to respiratoryirritants, all the patient may need to do is keep away from thecause of irritation.

Smoking cessation is recommended to prevent development ofchronic bronchitis or other chronic lung disease such asemphysema. Chronic bronchitis, as its name suggests, can causesymptoms for prolonged periods and lead to other debilitatinglung conditions.


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Name: Mrs. E.M.

Address: Banawang, Bagac, Bataan

Phone no: NN

Age: 51 y/o

Birthdate: June, 5 1958

Birthplace: San Fernando, La Union

Gender: Female

Marital Status: Married

Nationality: Filipino

Religion: Catholic

Occupation: Housewife


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Physical Assessment

Technique Normal Findings AbnormalFindings

Skin Inspection

Palpation

Skin is brown andgenerally equal

No edema

Good skin turgor

No lesion

Temp. is warm &cool

None

Nails Inspection

Clean, smooth Pink to light

brown nail beds

None

Hair Inspection No lesion

No dandruff

Even indistribution

None

Head Inspection Symmetrical inmovement &

position Face is

symmetrical

Normocephalic

None

Eyes Inspection Symmetrical inposition

Sclera is white &glossy

PERRLA

Brisk reaction to

light

Pale conjunctiva

Ears Inspection Equal in size

Symmetrical

No swelling ordischarges

Nose Inspection

Palpation

Symmetrical

No inflammation

Air can be felt inboth nares


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Technique Normal Findings AbnormalFindings

Mouth & Throat Inspection Tongue is at

midline

Cracked lips

Tongue is pale Dental caries

present

Missing tooth

Neck Inspection

Palpation

Symmetrical withnormal ROM

No jugular veindistention

Trachea is visibleat the midline

No nodule

Lymph nodes arenot palpable

None

Breast & Axilla Inspection

Palpation

One breast isslightly larger

No nippledischarge

No masses

No lymph nodespalpated

None

Chest InspectionPalpation

Auscultation

Normal contour

Tactile fremitus

Bronchial breathsounds

Limited chestexcursion

Heart Auscultation S1 & S2 hearduponauscultation

None

Abdomen Inspection Color isconsistent withthe body

No lesion or anyabnormalfindings

Bowel sounds isnormo- active(13/min)

No tenderness

Genitals Interview No swelling ordischarges

No foul smell

No infestation

None

Extremities Inspection Norma hairdistribution

No edema

No swelling

Capillary refillaround 1-3seconds

Limited ROM


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Human Respiratory System

The respiratory system consists of all the organs involved inbreathing. These include the nose, pharynx, larynx, trachea, bronchiand lungs. The respiratory system does two very important things: itbrings oxygen into our bodies, which we need for our cells to live andfunction properly; and it helps us get rid of carbon dioxide, which is awaste product of cellular function. The nose, pharynx, larynx, trachea

and bronchi all work like a system of pipes through which the air isfunneled down into our lungs. There, in very small air sacs calledalveoli, oxygen is brought into the bloodstream and carbon dioxide ispushed from the blood out into the air. When something goes wrongwith part of the respiratory system, such as an infection likepneumonia, it makes it harder for us to get the oxygen we need and toget rid of the waste product carbon dioxide. Common respiratorysymptoms include breathlessness, cough, and chest pain.

The Upper Airway and Trachea

When you breathe in, air enters your body through your nose ormouth. From there, it travels down your throat through the larynx (orvoice box) and into the trachea (or windpipe) before entering your

lungs. All these structures act to funnel fresh air down from the outsideworld into your body. The upper airway is important because it must
http://www.virtualmedicalcentre.com/humanatlas1/vmc_white.asp?anid=0215


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always stay open for you to be able to breathe. It also helps to moistenand warm the air before it reaches your lungs.

The Lungs

Structure

The lungs are paired, cone-shaped organs which take up most ofthe space in our chests, along with the heart. Their role is to takeoxygen into the body, which we need for our cells to live and functionproperly, and to help us get rid of carbon dioxide, which is a wasteproduct. We each have two lungs, a left lung and a right lung. Theseare divided up into 'lobes', or big sections of tissue separated by'fissures' or dividers. The right lung has three lobes but the left lunghas only two, because the heart takes up some of the space in the leftside of our chest. The lungs can also be divided up into even smaller

portions, called 'bronchopulmonary segments'.

These are pyramidal-shaped areas which are also separated from eachother by membranes. There are about 10 of them in each lung. Eachsegment receives its own blood supply and air supply.

How they work

Air enters your lungs through a system of pipes called thebronchi. These pipes start from the bottom of the trachea as the leftand right bronchi and branch many times throughout the lungs, until

they eventually form little thin-walled air sacs or bubbles, known as thealveoli. The alveoli are where the important work of gas exchangetakes place between the air and your blood. Covering each alveolus isa whole network of little blood vessel called capillaries, which are verysmall branches of the pulmonary arteries. It is important that the air inthe alveoli and the blood in the capillaries are very close together, sothat oxygen and carbon dioxide can move (or diffuse) between them.So, when you breathe in, air comes down the trachea and through thebronchi into the alveoli. This fresh air has lots of oxygen in it, and someof this oxygen will travel across the walls of the alveoli into yourbloodstream. Traveling in the opposite direction is carbon dioxide,

which crosses from the blood in the capillaries into the air in the alveoliand is then breathed out. In this way, you bring in to your body theoxygen that you need to live, and get rid of the waste product carbondioxide.


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Blood Supply

The lungs are very vascular organs, meaning they receive a verylarge blood supply. This is because the pulmonary arteries, whichsupply the lungs, come directly from the right side of your heart. Theycarry blood which is low in oxygen and high in carbon dioxide into yourlungs so that the carbon dioxide can be blown off, and more oxygencan be absorbed into the bloodstream. The newly oxygen-rich bloodthen travels back through the paired pulmonary veins into the left sideof your heart. From there, it is pumped all around your body to supplyoxygen to cells and organs.

The Work of Breathing

The Pleurae

The lungs are covered by smooth membranes that we callpleurae. The pleurae have two layers, a 'visceral' layer which sticksclosely to the outside surface of your lungs, and a 'parietal' layer whichlines the inside of your chest wall (ribcage). The pleurae are importantbecause they help you breathe in and out smoothly, without anyfriction. They also make sure that when your ribcage expands onbreathing in, your lungs expand as well to fill the extra space.

The Diaphragm and Intercostal Muscles

When you breathe in (inspiration), your muscles need to work tofill your lungs with air. The diaphragm, a large, sheet-like muscle whichstretches across your chest under the ribcage, does much of this work.At rest, it is shaped like a dome curving up into your chest. When youbreathe in, the diaphragm contracts and flattens out, expanding thespace in your chest and drawing air into your lungs. Other muscles,including the muscles between your ribs (the intercostal muscles) alsohelp by moving your ribcage in and out. Breathing out (expiration)

does not normally require your muscles to work. This is because yourlungs are very elastic, and when your muscles relax at the end of


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inspiration your lungs simply recoil back into their resting position,pushing the air out as they go.

The Respiratory System Through the Ages

Breathing for the Premature Baby

When a baby is born, it must convert from getting all of itsoxygen through the placenta to absorbing oxygen through its lungs.This is a complicated process, involving many changes in both air andblood pressures in the baby's lungs. For a baby born preterm (before37 weeks gestation), the change is even harder. This is because thebaby's lungs may not yet be mature enough to cope with thetransition. The major problem with a preterm baby's lungs is a lack ofsomething called 'surfactant'. This is a substance produced by cells inthe lungs which helps keep the air sacs, or alveoli, open. Without

surfactant, the pressures in the lungs change and the smaller alveolicollapse.

This reduces the area across which oxygen and carbon dioxidecan be exchanged, and not enough oxygen will be taken in. Normally,a fetus will begin producing surfactant from around 28-32 weeksgestation. When a baby is born before or around this age, it may nothave enough surfactant to keep its lungs open. The baby may developsomething called 'Neonatal Respiratory Distress Syndrome', or NRDS.

Signs of NRDS include tachypnoea (very fast breathing),

grunting, and cyanosis (blueness of the lips and tongue). SometimesNRDS can be treated by giving the baby artificially made surfactant bya tube down into the baby's lungs.

The Respiratory System and Ageing

The normal process of ageing is associated with a number of changesin both the structure and function of the respiratory system. Theseinclude:

Enlargement of the alveoli. The air spaces get bigger and lose

their elasticity, meaning that there is less area for gases to beexchanged across. This change is sometimes referred to as'senile emphysema'.

The compliance (or springiness) of the chest wall decreases, sothat it takes more effort to breathe in and out.

The strength of the respiratory muscles (the diaphragm andintercostal muscles) decreases. This change is closely connectedto the general health of the person.

All of these changes mean that an older person might have moredifficulty coping with increased stress on their respiratory system, such

as with an infection like pneumonia, than a younger person would.


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Bronchitis


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AmoxicillinGeneric Name: AmoxicillinBrand Name: Amoxil, TrimoxClassification: Antibiotic

Mechanism of ActionInhibits bacterial cell wall mucopeptide synthesis.

IndicationUsed to treat many different types of infections caused by

bacteria, such as ear infections, bladder infections, pneumonia,gonorrhea, and E. coli or salmonella infection.

ContraindicationHypersensitivity 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; toxicepidermal necrolysis; urticaria.

GI:Diarrhea (2%); nausea (1%); black, hairy tongue; hemorrhagicpseudomembranous 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 sicknesslike reactions.

Nursing ResponsibilitiesPeriodically assess renal, hepatic, and hematopoietic function

during prolonged therapy. Patients diagnosed with gonorrhea shouldhave a serologic test for syphilis at the time of treatment and a follow-up serologic test after 3 months.


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ParacetamolGeneric name: ParacetamolBrand Names: BiogesicClassification: Analgesic/Antipyretic

Mechanism of ActionParacetamol possesses prominent antipyretic and analgesiceffects. Its anti-inflammatory activity is weak and has no clinicalsignificance. The mechanism of action is related to depression of theprostaglandin synthesis by inhibition of the specific cellcyclooxygenase, and depression of the thermoregulatory center in themedulla oblongata. Inhibits prostaglandins in CNS, but lacks anti-inflammatory effects in periphery; reduces fever through direct actionon hypothalamic heat-regulating center.

Indications

The preparation is indicated in diseases manifesting with painand fever: headache, toothache, mild and moderate postoperative andinjury pain, high temperature, infectious diseases and chills (acutecatarrhal inflammations of the upper respiratory tract, flu, small-pox,parotitis, etc.).

ContraindicationsParacetamol should not be used in hypersensitivity to the

preparation and in severe liver diseases.

Adverse reactions

In rare cases hypersensitivity reactions, predominantly skinallergy (itching and rash), may appear. Long-term treatment with highdoses may cause a toxic hepatitis with following initial symptoms:nausea, vomiting, sweating, and discomfort. Occasionally agastrointestinal discomfort may be seen.

Nursing ResponsibilitiesThe preparation should be used with care in patients with liver

and renal diseases. The treatment with Paracetamol may change thelaboratory tests of uric acid and blood glucose analysis. In severe renalfailure the interval between two consecutive takings should not be

shorter than 8 hours. The treatment with the preparation is notadvisable during the first trimester of the pregnancy. In nursing womenthe preparation should be used with strictly observation of thetherapeutic dose and duration of the treatment.


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AmbroxolGeneric Name: AmbroxolBrand Name: MucosulvanClassification: Expectorant/Antibiotic

Mechanism of ActionWhen administered orally onset of action occurs after about 30minutes. The breakdown of acid mucopolysaccharide fibers makes thesputum thinner and less viscous and therefore more easily removed bycoughing. Although sputum volume eventually decreases, its viscosityremains low for as long as treatment is maintained.

IndicationAll 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 appropriateantibiotic.

ContraindicationThere are no absolute contraindications but in patients with

gastric ulceration relative caution should be observed.

Adverse ReactionOccasional gastrointestinal side effects may occur but these arenormally mild.

Nursing ResponsibilitiesObserve 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.


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MetoprololGeneric Name: MetoprololBrand Name: Lopressor, Toprol-XLClassification: Beta blocker

Mechanism of ActionBlocks beta receptors, primarily affecting CV system (decreasesheart rate, decreases contractility, decreases BP) and lungs (promotesbronchospasm).

IndicationMetoprolol is used to treat angina (chest pain) and hypertension

(high blood pressure). It is also used to treat or prevent heart attack.

ContraindicationYou should not use this medication if you are allergic to metoprolol,

or if you have a serious heart problem such as heart block, sick sinussyndrome, or slowheart rate. If you have any of these other conditions,you may need a dose adjustment or special tests to safely usemetoprolol:

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 ReactionCardiovascular: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 hypoglycemicsigns; muscle cramps; asthenia; systemic lupus erythematosus; coldextremities.

Nursing ResponsibilitiesIn patients with angina pectoris or coronary artery disease (CAD),

metoprolol may cause exacerbation of angina, occurrence of MI, andventricular arrhythmias. Monitor patients closely. Because CAD iscommon and often unrecognized, it may be prudent not to discontinuebeta-blocker therapy abruptly in patients being treated for

hypertension.


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Nursing Care Plan

Assessment Diagnosis

Planning Interventions

Rationale

Evaluation

Subjective: Nahihirapa

n akonghumingaasverbalized.

Objective: Received

awake lyingon bed withan ongoingIVF of PLRS1 L at 350cc levelregulated at10 gtts,infusingwell at rightarm.

Conscious/coherent

DOB w/ anRR of 35bpm noted.

Bodymalaisenoted

Wheezesuponauscultation

Productivecough(yellow togreen

sputum Restlessnes

s noted

Chest painnoted

Discomfortnoted

FacialGrimacenoted

Ineffectiveairwayclearance r/tincreasedproduction of

bronchialsecretions asmanifested by

Bodymalaise

Wheezes uponauscultation

Product

ivecough(yellowtogreensputum

Restlessness

Chestpain

Discomfort

Facial

Grimace

After 8hoursofcontinues nsg.Interventionsthe pt.will be

able tomaintainairwaypatency

Expectoratesecretions

Maintain RR ofat

least20-25fromtheinitial35bpm

Learnandperformbreathing and

coughingexercise.

Verbalizedreliefformdyspnea.

Monitor Vitalsigns

Placethe pt.infowlers or

semi-fowlersposition

Teachthe pt.how todoproperdeepbreathing

andcoughingexercise

Avoidexposure toirritants suchascigarette

smoke,aerosol andfumes

Auscultatebreathsounds

Increasefluidintake

Suction asordered

Provideoxygeninhalation asordered

Administer

Serves asbaselinedata

Tofacilitatemaxi

mumlungexpansion

Improvesventilationandhelpsinmobilizing

secretionsw/ocausingfatigue

Toavoidallergicreaction

Toascertainstatus andnoteprogress

Helpsliquefy

secretions

Toclearairway

Provideadequateamount ofoxyg

en Will


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medicationasordered

helploosensecretionsfor

easyexpulsion.


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Nursing Care Plan

Assessment Diagnosis Planning

Interventions

Rationale

Evaluation

Subjective: Ang bigat

ngpakiramdam ko asverbalized

Objective: Received

awake lyingon bed withan ongoingIVF of PLRS1 L at 340cc levelregulatedat 10 gtts,infusingwell at rightarm.

Conscious/coherent

Bodymalaisenoted

Difficultymoving leftarm noted

Facialgrimacenoted

Pallor noted

Complainsof fatigue

Activityintolerancer/t togeneralizedbodyweaknessasmanifestedby

Conscious/coherent

Bodymalaisenoted

Difficultymoving leftarm noted

Facialgrimacenoted

Pallor noted

Complains

of fatigue

After10hours ofnursinginterventions

thept.willparticipatewillinglyinnecessaryactivity

Willbeabletomove herleftarmwithease

Learnhow

toconserveenergy

Verbalizerelieffromfatigue

Evaluate thept.scurrentactivitytolerance

Adjustactivity andreduceintensity oftaskthatmaycauseundesired

physiologicalchanges

Increaseexercise andactivitylevelsgradually

Teachmethods toconserveenergy suchassittingthanstandingwhile

dressing

Assistthe pt.whiledoingADLs

Givethe pt.info.

Thatprovides

evidence of

Providecooperativebaseline

To

preventoverexertion

Enhanceactivitytoler

ance

Helpsminimizewaste ofenergy

Preventthept.frominjury

Tosustainthept.smoti

vation


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progress


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Nursing Care Plan

Assessment Diagnosis

Planning

Interventions

Rationale

Evaluation

Subjective: Giniginaw

ako asverbalized

Objective: Received

awake lyingon bed withan ongoingIVF of PLRS 1L at 320 cclevelregulated at10 gtts,infusing wellat right arm.

Conscious/coherent

Warm totouch noted

Flushed facenoted

Febrile with atemperatureof 38.2C

Ineffectivethermoregulation r/tincreasedbodytemper

atureasmanifested by

Warmtotouch

Flushedface

Febrilewith atemperature of

38.2C

After 8hours ofcontinuous

TSB,the

pt.stemperaturewilldecreasefrom38.2to37.5

C

MonitorVS

Increase fluidintake

Maintain bed

rest

Providesufficientclothing

Perform TSB

Administer

antipyretics asordered

Serves asbaselinedata

Tohelpcooldown

coretemperature

Todecreasemetabolismthatproduce

heat Facilit

atecomfort

Facilitateheatlossbymeans of

evaporation

Helpslowertemperaturewithinnormalrange


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Nursing Care Plan

Assessment Diagnosis Planning

Interventions

Rationale

Evaluation

Subjective: Sumasakit

ang dibdib atbraso ko asverbalized

Objective: Received

awake lyingon bed withan ongoingIVF of PLRS 1L at 300 cclevelregulated at10 gtts,infusing wellat right arm.

Conscious/coherent

Headache

Restlessness

Difficultymoving leftarm

Chest pain

Pain scale of7 out of 10

Facialgrimace

Acutepain r/tlocalizedinflammation

Asmanifested by

Headache

Restlessness

Difficultymovingleft arm

Chestpain

Painscale of7 out of

10 Facial

grimace

After 10hours ofnsg.interventionsthe

pt.spainscalewilldecreasefrom7 to4

Thept.will

verbalizerelieffrompain

Willdemonstrateuseofrela

xationskills

MonitorVS

Perform painassessment(COLDSPA)every

timepainoccurs

Encourageverbalizationoffeelingof pain

Instruct use ofrelaxationexercise suchaslistening tomusic

Providequietandcalmenvironment

Encourageadequate restperiod

Administeranalgesic asordered

PainaltersVS

Toruleoutdevelopment of

complications byknowingalleviatingandprecipitatingfactors

Painissubjective&cantbeassessedthroughobservation

alone Prom

otesrelaxationanddivertsattentionfrompain

Noisyenvironmentstimulatesirritation

Preventfatigue

To


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maintaintolerablelevelof

pain


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Nursing Care Plan

Assessment

Diagnosis

Planning

Interventions

Rationale

Evaluation

Subjective: wala

akongganangkumain

Objective: Refusal

to eat

Poormuscletonicity

Bodyweaknessnoted

Restlessness

Alterednutritionlessthanbodyrequiremen

ts R/Tlossofappetite asevidencedbydysfunctionaleating

pattern.

After4hoursofnursinginterventions,

patientsappetite willbeimproved:from2tablespoonsto atleast

5tablespoonspermeal.

Monitorvitalsigns

Weightonregularbasis

Discusseatinghabitsincluding foodpreferences.

Servefavoritefoodsthat arenotcontrain

dicated. Serves

foodsthat arepalatable andattractive.

Preventandminimizeunpleasa

nt odors.

Emphasize theimportance ofwellbalancednutritiondiet

Forbaseline data

Monitornutritionalstateandeffectiv

enessofinterventions

Toappealtoclientlikesanddislikes

To

stimulate theappetite

Tostimulate theappetite

Mayhave

negative effectonappetite/eating

Promotewellness


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22508056 Case Study of Bronchitis

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