Acute Bronchitis

I.
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. 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.
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.
Bronchitis may be indicated by an expectorating cough, shortness of

breath (dyspnea) and wheezing. Occasionally chest pains, fever, and fatigue
or malaise may also occur. Additionally, Bronchitis caused by Adenoviridae
may cause systemic and gastrointestinal symptoms as well. However the
coughs due to bronchitis can continue for up to three weeks or more even
after all other symptoms have subsided.
Acute bronchitis usually lasts a few days. It may accompany or closely

follow a cold or the flu, or may occur on its own. Bronchitis usually begins
with a dry cough, including waking the sufferer at night. After a few days it
progresses to a wetter or productive cough, which may be accompanied by
fever, fatigue, and headache. The fever, fatigue, and malaise may last only a
few days; but the wet cough may last up to several weeks. Should the cough
last longer than a month, some doctors may issue a referral to an
otorhinolaryngologist (ear, nose and throat doctor) to see if a condition other
than bronchitis is causing the irritation. It is possible that having irritated
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bronchial tubes for as long as a few months may inspire asthmatic conditions
in some patients.
In addition, if one starts coughing mucus tinged with blood, one should see a
doctor. In rare cases, doctors may conduct tests to see if the cause is a
serious condition such as tuberculosis or lung cancer. Acute bronchitis may
lead to pneumonia.
Inncidence rate of Acute Bronchitis is 4.6 per 100; 14.2 million cases
annually, approximately 1 in 21 individual or 4.60% or 12.5 million people in
USA Incidence extrapolations for USA for Acute Bronchitis: 12,511,999 per
year, 1,042,666 per month, 240,615 per week, 34,279 per day, 1,428 per
hour, 23 per minute, 0 per second. Note: this extrapolation calculation uses
the incidence statistic: 4.6 per 100 (NHIS96: acute bronchitis); 14.2 million
cases annually
Deaths from Acute Bronchitis 388 deaths reported in USA 1999 for
acute bronchitis and bronchiolitis (NVSR Sep 2001) Death rate extrapolations
for USA for Acute Bronchitis: 387 per year, 32 per month, 7 per week, 1 per
day, 0 per hour, 0 per minute, 0 per second. Note: this extrapolation
calculation uses the deaths statistic: 388 deaths reported in USA 1999 for
acute bronchitis and bronchiolitis (NVSR Sep 2001)
A. Current trends about the disaese condition
“Advance Toward Early Diagnosis Of Chronic Obstructive Pulmonary

Disease”
Researchers in Finland are reporting identification of the first potential

"biomarker" that could be used in development of a sputum test for early
detection of chronic obstructive pulmonary disease (COPD). That condition,
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which causes severe difficulty in breathing — most often in cigarette
smokers — affects 12 million people in the United States.
Vuokko L. Kinnula and colleagues point out that no disease marker for COPD
currently exists, despite extensive efforts by scientists to find one. Past
research pointed to a prime candidate — surfactant protein A (SP-A), which
has a major role in fighting infections and inflammation in the lung.
The scientists compared levels of a variety of proteins obtained from the
lung tissues of healthy individuals, patients with COPD, and those with
pulmonary fibrosis. They found that the lungs of COPD patients contained
elevated levels of SP-A. The scientists also found elevated levels of SP-A in
the sputum samples of COPD patients. "This suggests that SP-A might
represent a helpful biomarker in the early detection of COPD and other
related disorders," the article notes.
American Chemical Society (2008, December 17). Advance Toward Early

Diagnosis Of Chronic Obstructive Pulmonary Disease. ScienceDaily.
Retrieved June 27, 2009, from http://www.sciencedaily.com
/releases/2008/12/081208085002.htm
B. Reasons for choosing such case for presentation
I choose this case as we all know that acute bronchitis is a recurrent and
reversible disease once develop, but it can easily prevented by avoiding their
contributing factor, such as allergens, dust, pollens, prolonged exposure to
tobacco smokes and air pollutants. It can be prevented by means of
cessation of cigarette smoking and by prevention of air pollutants, therefore
this disease is disabling if not properly prevented or avoided.
C. Objectives
• NURSE CENTERED
Short term
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After 4-5 hours of nursing interventions, the student nurse shall be
able to:
• Establish rapport with the patient
• Identify the needs of the patient
• Assess the general condition of the patient
• Implement interventions that could help in maintaining the health of
the patient in a good condition
• Explain to the patient the rationale for each interventions
Long term
After 2 days of nursing interventions, the student nurse shall be able
to:
• Gain the trust and cooperation of the patient
• Know the general condition of the patient
• Identify the precipitating and predisposing factors that causes the
patient’s condition
• Give health teachings about the condition of the patient
• Help the patient recover from her condition
• CLIENT CENTERED
Short term
After 4-5 hours of nursing interventions, patient shall be able to:
• Establish rapport with the student nurse
• Listen and cooperate with the student nurse
• Verbalize feelings
• Ask questions regarding her condition
• Participate on the activities or health teachings given by the student
nurse
• Able to understand the reason for such interventions
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Long term
After 2 days of nursing interventions, the patient shall be able to:
• Trust and have a good rapport with the student nurse
• Verbalize her present condition/feelings
• State the interventions given by the student nurse for the betterment
of her condition
• Follows the activities or health teachings given by the student nurse
• Able to have an improve condition/ gain her state of wellness
II. NURSING ASSESSMENT
1. Personal Data
Patient is a six-year old female, Filipino citizen and a Roman Catholic.

She was born on the 3rd of April, 2003 via Normal Spontaneous Delivery in a
private hospital in Manila. She is the only child in her family. Currently, the
Patient Family are residing in Porac, Pampanga.
Last June 23, 2009, at 11:30 in the morning, Patient’s mother rushed
Patient to a private hospital in Angeles City with chief complaints of cough
and fever. Upon admission, Patient was diagnosed of Acute Bronchitis.
2. Pertinent Family History
Patient belongs to an extended type of family which is composed of

four members. She lives with her parents and her grandparents.
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Patient’s father is a highschool undergraduate who is currently working
as a factory worker, whereas Patient’s mother is a college graduate who is
currently working in CDC.
Patient’s Grandfather died due to Pulmonary Tubercolosis who lived

with the patient.
The Patient family owns their own house and they have been living in
their home since 2002. Their house is located along the highway. The current
residence has a living room, dining room, kitchen, two bedrooms and two
toilets. Patient’s mother also verbalized that the house is always clean;
however, trucks drive along the highway so dust always circulate around
their home. The family uses a gas stove as their means of cooking and their
water is obtained from NAWASA. Patient’s grandmother also goes to the
market to buy their food and cooks their own dishes.
The family’s source of income comes from both parents. Patient’s

Daddy earns approximately P15, 000 per month while Patient’s mother earns
approximately P20, 000. The family’s monthly expenses would include: P
10,000 per month for their food, P 600 for their telephone bill and P2,000 per
month for their electricity. And the rest are mostly saved for their other
expenses.
In terms of family's culture, beliefs and perceptions, the family consults

their private physicians, such as when it is time for her child to be
immunized as well as for early prevention of a disease condition.
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Paternal Side Maternal Side
GRANDFATHER GRANDFATHER ( + ) GRANDMOTHER

• DM GRANDMOTHER
• Asthmatic • Asthmatic
• Hypertension • Arthritis
• Asthma
AUNT 1 AUNT Uncle AUNT AUNT FATHER MOTHER Uncle AUNT Uncle 2
(+) 2 3 5 1
3 1 Uncle 2
leukem (+)
ia Uncle Uncle asthm
a,
Uncle 2 4
1 AUNT AUNT
4 6
PATIENT
ACUTE BRONCHITIS
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3. Personal History
As verbalized by Patient’s mother, she had her pre-natal visits in her

pregnancy. She believes in “paglilihi” so she tends to eat nutritious food
when she was pregnant.
As stated by Patient’s mother, Patient was fully breastfed because she

believes that the milk coming from the mother is best for babies as well as
for economical reasons. Patient was breastfed until she was 1 ½ years old.
She also mentioned that Patient is fond of eating chicken, French fries, and
vegetables. Patient only eats small amounts of food and patient’s mother
always have difficutly feeding Patient. Patient is not taking any vitamins.
Patient’s mother stated that Patient had completed his Immunization in

their local health center. These vaccines included: BCG (Bacillus Calmette
Guerin), DPT (Diphtheria, Tetanus, Pertussis), OPV (Oral Polio Vaccine),
Hepatitis B and Measles.
Growth and Development
• Erik Erikson
Patient, being 6 years of age, is in the Initiative vs. Guilt stage of
Erikson’s psychosocial conflict wherein she learns to take initiative of the
actions she wants to perform and learns to master the world around her. At
this stage the child wants to begin and complete his or her own actions for a
purpose. Guilt is a new emotion and is confusing to the child; he or she may
feel guilty over things which are not logically guilt producing, and he or she
will feel guilt when his or her initiative does not produce the desired results.
This stage is shown by her eagerness to study and to go to school as said by
her mother.
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• Jean Piaget
Patient is in the Preoperational or Egocentric stage of Piaget’s Theory
of cognitive development wherein the child does not show any particular
interest or concern with rules. It is also when children start employing mental
activities to solve problems and obtain goals but they are unaware of how
they came to their conclusions. Upon playing, mother stated that patient
shows that she is more focused on having fun rather than the rules of the
game. She also is not aware of what others think and focuses only about
having fun.
• Sigmund Freud
Based on the patient’s age, she falls under the Phallic stage of Freud’s
Psychosexual stages wherein genitals are supposed to be the primary source
of pleasure for the child. Upon observation, there were no manifestations of
this stage noted from patient’s behaviour.
4. History of Past Illnesses
Patient was hospitalized before in the same health institution with a

diagnosis of Primary Complex. When she was four years old, she was
hospitalized in a private hospital in Manila due to Patient’s eye problem.
Patient also experienced fever, cough and colds and her mother treats her
with Paracetamol. Patient is also asthmatic since birth but was managed.
5. History of Present Illness
A five days prior to admission (June 18, 2009), Patient had cough and
colds and fever and Patient’s mother managed this by giving Paracetamol.
Four days prior to admission (June 20, 2009) same signs and symptoms were
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noted and consulted their private physician and Patient was diagnosed with
Upper Respiratory Tract infection and was given Mucosolvan and Allerkid.
Condition persisted and admitted last June 23, 2009 with an admitting
diagnosis of Acute Bronchitis.
6. Physical Assessment
Initial Assessmant upon Admission (June 23 , 2009) – lifted from the

client’s chart
Vital Signs
T: 36.1o C
P: 75 bpm
R: 38 bpm
Chief complaint/s: Cough and colds
General Appearance
 (+) difficulty of breathing with used of accessory muscles
 with nasal flaring and positive rales and wheezes on both
lungs fields
 With cough and colds
 Acyanotic
 (-) Retractions
 (-) edema
 (-) rashes
 Pink Palpebral conjunctiva
1st NPI ( June 24 , 2009)

General Appearance
During the assessment, patient was wearing shirt and a pajama. she
has productive cough with clear nasal secretions. she also has
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difficulty of breathing with Rales on both lung fields and nasal
flaring.
Vital Signs
Temperature: 36.9 ˚C
Pulse Rate: 95 bpm
Respiratory rate: 26 bpm
BP: 90/60 mmHg
Cephalocaudal Assessment
Head
 Round, symmetrical & normocephalic
 No lesions, nodules or masses
 Hair is thin and well distributed; no infestations noted
 Symmetric facial features noted
Eyes
 Eyebrows are symmetrical, evenly distributed
 Eyelids no discharge / discoloration
 Eyes are equally round
 Transparent cornea
 Pink palpebral conjunctiva
Ears
 Symmetrical, no lesions, no pain
 Recoils into original position after pinching
 Auricles have same color as facial skin and aligned with outer canthus
of eye
Nose
 Not tender, uniform color
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 Nasal septum in the midline and intact
 No nodules or masses palpated
 (+) Nasal Secretions
 (+) Nasal Flaring
Mouth / Throat
 Pinkish, moist, smooth
 Tongue in central position
Neck
 No pain upon palpation, masses
 Muscles equal in size
 Head located at the center
Skin
 Capillary refill test 1-2 seconds
 Uniform in color
 Good skin turgor
 Scanty hair equally distributed
Hair
 Evenly distributed
 No pediculosis / dandruff
Thorax / Lungs
 (+) Rales on both lung fields
 (-) retraction
 Skin is intact
 Chest is symmetric
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 No masses noted
Abdomen
 Uniform color noted
 Flat and symmetric movements caused by respiration
Extremities
 Uniform in color
 No palpable nodules or masses
 Hair equally distributed
NEUROLOGICAL ASSESSMENT
CRANIAL NERVE PROCEDURE NORMAL ACTUAL

FINDINGS FINDINGS
CN I : Ask the client to Client must be Patient was able
Olfactory identify aromas able to identify to identify the
Type: Sensory with eyes the scent of an scent of alcohol
Function: Smell closed. agent with eyes with eyes closed.
closed when
asked to smell
it.
CN II: Optic Ask the client to Client must be Patient was able
Type: Sensory read a number able to read a to read the
Function: Vision written on a number number correctly
piece of paper correctly written and clearly at a
at a given on a piece of given distance
distance. paper at a given
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distance.
CN III: Make use of Pupils should Patient pupils
Oculomotor penlight in order constrict (+ constricted
Type: Motor to test papillary PERRLA ) consensually.
Function: Pupil reaction and consensually She was able to
constriction and instruct the once light open and close
raising eyelids client to open passes through. her eyelids.
and close Eyelids should
eyelids. open and close.
CN IV: Instruct client to Client must be Patient was able
Trochlear move eyes able to follow to follow the
Type: Motor downward and the pen’s pen’s movement
Function: upward without movement downward and
Oblique moving head. downward and upward without
movement of upward without moving his head.
the eye moving head.
CN VI: Tell the client to Client should be Patient was able
Abducens devoid his head able to follow to follow the
Type: Motor steadily and the lateral lateral
Function: Lateral follow the pen’s movement of movement of the
eye movement direction the pen pen.
CN VII: Facial Ask client to Client should be Patient was able
Type: Motor smile, frown, able to smile, to smile, frown
Function: and raise the frown, and raise and raise
Movement of eyebrows. the eyebrows eyebrows
muscles of the without without difficulty.
face difficulty.
CN IX: Instruct client to Client should be Patient was able
Glossopharyng swallow. able to swallow to swallow
eal without without difficulty.
Type: Motor difficulty.
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Function:
Pharyngeal
movement and
swallowing
CN XI: Ask the client to Client should be Patient was able
Accessory shrug shoulders able to shrug to shrug
Type: Motor against shoulders shoulders
Function: resistance. against against
Movement of resistance. resistance.
shoulder
muscles
CN XII: Instruct the Client should be Patient was able
Hypoglossal client to able to protrude to protrude her
Type: Motor protrude tongue tongue and tongue and
Function: and move it move it laterally, move it laterally,
Movement of laterally, downward and downward and
tongue, strength downward and upward. upward.
of the tongue upward.
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7. Diagnostic and Laboratory Procedures
DIAGNOSTIC DATE INDICATION ANALYSIS AND

AND ORDERED S AND RESULT NORMA INTERPRETATION
LABORATORY PURPOSE(S) S L
DATE
PROCEDURES VALUES
RESULT(S
) IN
1. Hematology Date The 123 g/L 120-150 The result is within
ordered: hemoglobin g/L normal range which
a. June 23 concentration means that there is
HEMOGLOBIN 2009 is a measure adequate perfusion
of the total in the body’s
Date amount of tissues.
resulted: hemoglobin in
June 23 the peripheral
2009 blood, which
reflects the
number of
RBC in the
blood. This
test evaluates
blood loss,
anemia,
18
erythropoietic
ability,
dehydration
and
polycythemia.
b.HEMATOCRI The 0.37 0.35-0.40 The result is normal

T hematocrit is with the aid of
a measure of administration of
the total IVF of PLRS which is
blood volume known to be an
that is made isotonic solution it
up by RBC. also indicates that
This test also the patient is not
evaluates suffering from
blood loss, dehydration.
anemia,
erythropoietic
ability,
dehydration
and
polycythemia.
C. This test is 4.52 X 7.50 It is decrease which
LEUKOCYTES performed to 109 -13.50 X signifies that theirs
determine the 109 is bacterial
amount of infection
WBC’s in the
blood. The
body fights
infection by
using WBC’s
19
or leukocyte.
They
encapsulate
organism and
destroy them.
d. Lymphocytes The result is with in
LYMPHOCYTE are the one’s 0.43 0.15 - normal limits that
S responsible 0.65 there is no
for activities presence of viral
of the infection or
immune inflammation.
system, which
produces
antibodies.
e. PLATELET are the cell 241 X 150-400 Normal. Normal
COUNT fragments 109 X 109 platelet counts are
circulating in not a guarantee of
the blood that adequate function.
are involved In some states the
in the cellular platelets, while
mechanisms being adequate in
of primary number, are
hemostasis dysfunctional.
leading to the
formation of
blood clots.
NURSING RESPONSIBILITIES
PRIOR TO THE PROCEDURE
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- Explain the procedure to the client
- Tell the patient that no fasting is required
DURING THE PROCEDURE

- Collect approximately 5 to 7 ml of venous blood in a lavender-top
tube; however, only 0.5 ml is required when using capillary tubes.
- Avoid hemolysis
- List on the laboratory slip any drugs that may affect test results
AFTER THE PROCEDURE

- Apply pressure to the venipuncture site.
- Explain that some bruising, discomfort and swelling may appear at
the site and warm compress can alleviate this.
- Monitor signs of infection
Diagnostic and Dates Indication Results

laboratory
procedures
CHEST X-RAY Date ordered: To identify the Radiographic report

June 23 2009 abnormalities of
the lungs and There are hazy
Date resulted: structures on the infiltrate at the left
June 23 2009 thorax and also to lower lung region.
identify the size of The rest of the lung
the heart and are clear heart and
abnormalities in great vessel with in
the ribs and normal size and
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diaphragm. configuration and
other chest
structure are not
remarkable
IMPRESSION:
Pneumonia, left
lower lobe
CHEST X-RAY
Before the procedure
1. check doctors order
2. Identify the client
3. Explain the procedure to SO and its importance
4. Inform the Patient to remove all metal objects like clothing with metal,
fastener, necklace, pins for better visualization of the chest
5. tell the patient that the test will only take a few minutes and is painless
6. assist transporting the client in going to the X-Ray room
During the procedure

1. Protect client’s other body parts from exposure to radiation
2. Wear lead apron to protect one’s self from exposure to radiation
3. assist and keep patient still as possible during the procedure
After the procedure

1. Document the time and procedure performed
Urinalysis - (or "UA") is an array of tests performed on urine and one of the
most common methods of medical diagnosis. A part of a urinalysis can be
22
performed by using urine dipsticks, in which the test results can be read as
color changes.
DIAGNOSTIC DATE INDICATIONS ANALYSIS AND

AND ORDERED AND RESULTS NORMAL INTERPRETATION
LABORATOR PURPOSE(S) VALUES
Y DATE
PROCEDURES RESULT(S
) IN
Urine Date To screen the COLOR: light yellow Slightly abnormal in
chemistry ordered: patient’s urine yellow color. Suggests
June 23 for renal or signs of
2009 urinary tract concentration of
disease. TRANSPARENCY: clear urine
Date To help detect clear
resulted: metabolic or Turbidity in urine
June 23 systemic transparency may
2009 disease indicate no
unrelated to presence of RBC ,
renal pH: acidic acidic albumin and
disorders. bacteria.
To detect
substances An acid pH (below
(drugs). 7.0)—typical of a
high-protein diet—
produces turbidity
and the formation
of oxalate, cystine,
leucine, tyrosine,
SP. GRAVITY: 1.005- amorphous urate,
1.005 1.035 and uric acid
crystals
Result within
MICROSCOPIC normal range. Urine
EXAM is not concentrated
PUS CELL: or packed with
0-1/hpf (-) other element such
as proteins.
RBC: none found
(-)
May indicate
infection
ALBUMIN: ( - )
(-)
Within normal
SUGAR: ( - ) limits, indicate no
presence of blood
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(-) in the urine.
BACTERIA: ( - )
(-) No impairment in
the permeability of
the glomelular
capillaries.
Normal finding
Normal finding
NURSING RESPONSIBILITIES:
Before:
 Check for the doctor’s order
 Inform the patient/SO before doing the procedure. Explain to the
patient’s SO the importance of the test.
 Inform the patient/SO that there is no need to restrict food or fluids
before the test.
 Explain to the patient’s So that the laboratory procedure is non-
invasive; no pain will be felt.
During:
 Assist patient in going to bathroom or CR.
 Describe the procedure for collecting a clean-catch or midstream
specimen.
 Advise the patient’s SO to wash patient’s genitalia prior to collection of
specimen.
After:
 Chart time of collection of urine specimen.
 Attach result to the chart as soon as they are available.
 Record and document findings.
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DIAGNOSTIC INDICATIO ANALYSIS AND
AND NAND RESULTS NORMAL INTERPRETATION
LABORATORY PURPOSE( VALUES
PROCEDURES S)
COLD This test in Presence of Titer The result is in
AGGLUTININS done to agglutionat above normal limit
DETERMINATION test the ion at 1.32 1.64 are meaning which
presences consider indicates that there
of unusual significan is no presence of
bacteria. t unusual bacteria.
NURSING RESPONSIBILITIES
PRIOR TO THE PROCEDURE

- Explain the procedure to the client
- Tell the patient that no fasting is required
DURING THE PROCEDURE

- Collect approximately 5 to 7 ml of venous blood in a lavender-top
tube; however, only 0.5 ml is required when using capillary tubes.
- Avoid hemolysis
- List on the laboratory slip any drugs that may affect test results
AFTER THE PROCEDURE

- Apply pressure to the venipuncture site.
- Explain that some bruising, discomfort and swelling may appear at
the site and warm compress can alleviate this.
- Monitor signs of infection
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III. ANATOMY AND PHYSIOLOGY
Respiratory System
The respiratory system functions to deliver the oxygen to the blood --
the transport medium of the cardiovascular system -- and to remove oxygen
from the blood. The actual exchange of oxygen and carbon dioxide occurs in
the lungs.
The respiratory centers in the brain stem (pons and medulla) control
respiration's rhythm, rate, and depth. Primary controlling factors include 1)
the concentration of carbon dioxide in the blood (high CO2 concentrations
initiate deeper, more rapid breathing) and 2) air pressure within lung tissue.
Expansion of the lungs stimulates nerve receptors (vagus nerve X) to signal
the brain to "turn off" inspiration. When the lungs collapse, the receptors
give the "turn on" signal, termed the Hering-Breuer inspiratory reflex. Other
regulators are: 3) an increase in blood pressure, which slows down
respiration; 4) a drop in blood acidity, which stimulates respiration; and 5) a
sudden drop in blood pressure, which increases the rate and depth of
respiration. Voluntary controls -- "holding one's breath" -- can also affect
respiration, but not indefinitely. Carbon dioxide build-up soon forces an
automatic start-up.
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The respiratory system consists of two tracts: The upper respiratory
tract includes the nose (nasal cavity, sinuses), mouth, larynx, and trachea
(windpipe). The lower respiratory tract includes the lungs, bronchi, and
alveoli.
The two lungs, one on the right and one on the left, are the body's
major respiratory organs. Each lung is divided into upper and lower lobes,
although the upper lobe of the right lung contains a third subdivision known
as the right middle lobe. The right lung is larger and heavier than the left
lung, which is somewhat smaller in size because of the predominately left-
side position of the heart.
A clear, thin, shiny coating -- the pleura -- envelopes the lungs. The
inner, visceral layer of the pleura attaches to the lungs; the outer, parietal
layer attaches to the chest wall (thorax). Pleural fluid holds both layers in
place, in a manner similar to two microscope slides that are wet and stuck
together. The lungs are separated from each other by the mediastinum, an
area that contains the heart and its large vessels, the trachea (windpipe),
esophagus, thymus, and lymph nodes. The diaphragm, the muscle that
contracts and relaxes in breathing, separates the thoracic cavity from the
abdominal cavity.
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The chart of the respiratory system shows the intricate structures
needed for breathing. Breathing is the process by which oxygen in the air is
brought into the lungs and into close contact with the blood, which absorbs it
and carries it to all parts of the body. At the same time the blood gives up
waste matter (carbon dioxide), which is carried out of the lungs when air is
breathed out.
1. The SINUSES (frontal, maxillary, and sphenoidal) are hollow spaces in the
bones of the head. Small openings connect them to the nose. The functions
they serve include helping to regulate the temperature and humidity of air
breathed in, as well as to lighten the bone structure of the head and to give
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resonance to the voice.
2. The NOSE (nasal cavity) is the preferred entrance for outside air into the
respiratory system. The hairs that line the wall are part of the air-cleaning
system.
3. Air also enter through the MOUTH (oral cavity), especially in people who
have a mouth-breathing habit or whose nasal passages may be temporarily
obstructed, as by a cold or during heavy exercise.
4. The ADENOIDS are lymph tissue at the top of the throat. When they
enlarge and interfere with breathing, they may be removed. The lymph
system, consisting of nodes (knots of cells) and connecting vessels, carries
fluid throughout the body. This system helps to resist body infection by
filtering out foreign matter, including germs, and producing cells
(lymphocytes) to fight them.
5. The TONSILS are lymph nodes in the wall of the throat (pharynx) that
often become infected. They are part of the germ-fighting system of the
body.
6. The THROAT (pharynx) collects incoming air from the nose and mouth and
passes it downward to the windpipe (trachea).
7. The EPIGLOTTIS is a flap of tissue that guards the entrance to the

windpipe (trachea), closing when anything is swallowed that should go into
the esophagus and stomach.
8. The VOICE BOX (larynx) contains the vocal chords. It is the place where
moving air being breathed in and out creates voice sounds.
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9. The ESOPHAGUS is the passage leading from the mouth and throat to the
stomach.
10. The WINDPIPE (trachea) is the passage leading from the throat (pharynx)
to the lungs.
11. The LYMPH NODES of the lungs are found against the walls of the
bronchial tubes and windpipe.
12. The RIBS are bones supporting and protecting the chest cavity. They
move to a limited degree, helping the lungs to expand and contract.
13. The windpipe divides into the two main BRONCHIAL TUBES, one for each
lung, which subdivide into each lobe of the lungs. These, in turn, subdivide
further.
14. The right lung is divided into three LOBES, or sections. Each lobe is like a
balloon filled with sponge-like tissue. Air moves in and out through one
opening -- a branch of the bronchial tube.
15. The left lung is divided into two LOBES.
16. The PLEURA are the two membranes, actually one continuous one folded
on itself, that surround each lobe of the lungs and separate the lungs from
the chest wall.
17. The bronchial tubes are lines with CILIA (like very small hairs) that have a
wave-like motion. This motion carried MUCUS (sticky phlegm or liquid)
upward and out into the throat, where it is either coughed up or swallowed.
The mucus catches and holds much of the dust, germs, and other unwanted
matte that has invaded the lungs. You get rid of this matter when you cough,
30
sneeze, clear your throat or swallow.
18. The DIAPHRAGM is the strong wall of muscle that separates the chest
cavity from the abdominal cavity. By moving downward, it creates suction in
the chest to draw in air and expand the lungs.
19. The smallest subdivisions of the bronchial tubes are called

BRONCHIOLES, at the end of which are the air sacs or alveoli (plural of
alveolus).
20. The ALVEOLI are the very small air sacs that are the destination of air
breathed in. The CAPILLARIES are blood vessels that are imbedded in the
walls of the alveoli. Blood passes through the capillaries, brought to them by
the PULMONARY ARTERY and taken away by the PULMONARY VEIN. While in
the capillaries the blood gives off carbon dioxide through the capillary wall
into the alveoli and takes up oxygen from the air in the alveoli.
Air Distribution
On inspiration, air enters the body through the nose and the mouth.
Nasal hairs and mucosa (mucus) filter out dust particles and bacteria and
warm and moisten the air. Less warming, filtering, and humidification occur
when air is inspired through the mouth.
Air travels down the throat, or pharynx, where two openings exist, one
into the esophagus for passage of food, and the other into the larynx (voice
box) and trachea (windpipe) for continued airflow. When food is swallowed,
the opening of the larynx (the epiglottis) automatically closes, preventing
food from being inhaled. When air is inspired, the walls of the esophagus are
collapsed, preventing air from entering the stomach. The larynx, which also
31
contain the vocal cords, is lined with mucus that further warms and
humidifies the air.
Air continues continues down the trachea, which branches into the
right and left bronchi. The main-stem bronchi divide into smaller bronchi,
then into even smaller tubes called bronchioles. The bronchial structures
contain hair-like, epithelial projections, called cilia, that beat rythmically to
sweep debris out of the lungs toward the pharynx for expulsion. Once in the
bronchioles, the air is at body temperature, contains 100% humidity, and is
(hopefully) completely filtered.
Bronchioles end in air sacs called alveoli -- small, thin-walled
"balloons," arranged in clusters. When you breathe in, enlarging the chest
cavity, the "balloons" expand as air rushes in to fill the vacuum. When you
breathe out, the "balloons" relax and air moves out of the lungs. It is at the
alveoli that gas exchange occurs. Tiny blood vessels, capillaries, surround
each of the alveoli. On inspiration, the concentration of dissolved oxygen is
greater in the alveoli than in the capillaries. Oxygen, therefore, diffuses
across the alveolar walls into the blood plasma. In the reverse process,
carbon dioxide concentration is greater in the blood than the alveoli, so it
passes from the blood into the alveoli and is ultimately breathed out.
As oxygen diffuses into the plasma, hemoglobin in the red blood cell
picks up the oxygen, permitting more to flow into the plasma. The oxygen-
carrying capacity of hemoglobin allows the blood to carry over 70 times
more oxygen than if the oxygen were simply dissolved in the plasma alone.
32
Therefore, the total oxygen uptake depends on: 1) the difference in oxygen
concentration between the blood and alveoli, 2) the healthy functioning of
the alveoli, and 3) the rate of respiration.
Pulmonary Circulation
The pulmonary circulatory circuit describes the process whereby
oxygen and carbon dioxide are delivered to and from the lungs. Oxygen-poor
blood travels to the right atrium via the inferior and superior vena cavae,
then to the right ventricle. The right ventricle subsequently pumps the blood
into the pulmonary artery, which branches to the right and left lungs. The
pulmonary arteries subdivide until reaching the arteriole, then capillary
levels. After gas exchange, the capillaries recombine to form venules and
veins. Ultimately two right and two left pulmonary veins carry oxygen-rich
blood to the heart for distribution, via the aorta/systemic circuit, to the rest
of the body.
33
Lung Volumes/ Capacities
The air that the lungs can hold can be divided into smaller designations
called "volumes."
The amount of air a person breathes in and out at rest is called the
Tidal Volume (Vt about 500ml). During such breathing, a person could
actually take in more air or blow more out. The additional amount a person
could inhale, such as during maximum physical activity, is called the
Inspiratory Reserve Volume (IRV 3,000 ml). The additional amount a person
could exhale is called the Expiratory Reserve Volume (ERV 1,000 ml). The
Residual Volume (RV) is the amount of air that stays in the lung even after
maximum expiration.
Breathing is an active process - requiring the contraction of skeletal

muscles. The primary muscles of respiration include the external intercostal
muscles (located between the ribs) and the diaphragm (a sheet of muscle
located between the thoracic & abdominal cavities).
The external intercostals plus the diaphragm contract to bring about

inspiration:
• Contraction of external intercostal muscles > elevation of ribs &

sternum > increased front- to-back dimension of thoracic cavity >
lowers air pressure in lungs > air moves into lungs
• Contraction of diaphragm > diaphragm moves downward > increases

vertical dimension of thoracic cavity > lowers air pressure in lungs > air
moves into lungs:
34
To exhale:
• relaxation of external intercostal muscles & diaphragm > return of

diaphragm, ribs, & sternum to resting position > restores thoracic cavity
to preinspiratory volume > increases pressure in lungs > air is exhaled
Intra-alveolar pressure during inspiration & expiration

As the external intercostals & diaphragm contract, the lungs expand.
The expansion of the lungs causes the pressure in the lungs (and alveoli) to
become slightly negative relative to atmospheric pressure. As a result, air
35
moves from an area of higher pressure (the air) to an area of lower pressure
(our lungs & alveoli). During expiration, the respiration muscles relax & lung
volume descreases. This causes pressure in the lungs (and alveoli) to
become slight positive relative to atmospheric pressure. As a result, air
leaves the lungs.
The walls of alveoli are coated with a thin film of water & this creates a
potential problem. Water molecules, including those on the alveolar walls,
are more attracted to each other than to air, and this attraction creates a
force called surface tension. This surface tension increases as water
molecules come closer together, which is what happens when we exhale &
our alveoli become smaller (like air leaving a balloon). Potentially, surface
tension could cause alveoli to collapse and, in addition, would make it more
difficult to 're-expand' the alveoli (when you inhaled). Both of these would
represent serious problems: if alveoli collapsed they'd contain no air & no
oxygen to diffuse into the blood &, if 're-expansion' was more difficult,
inhalation would be very, very difficult if not impossible. Fortunately, our
alveoli do not collapse & inhalation is relatively easy because the lungs
produce a substance called surfactant that reduces surface tension.
Role of Pulmonary Surfactant

Surfactant decreases surface tension which increases pulmonary
compliance (reducing the effort needed to expand the lungs) and reduces
tendency for alveoli to collapse.
36
Partial Pressure
Partial pressure is the individual pressure exerted independently by a
particular gas within a mixture of gasses. The air we breath is a mixture of
gasses: primarily nitrogen, oxygen, & carbon dioxide. So, the air you blow
into a balloon creates pressure that causes the balloon to expand (& this
pressure is generated as all the molecules of nitrogen, oxygen, & carbon
dioxide move about & collide with the walls of the balloon). However, the
total pressure generated by the air is due in part to nitrogen, in part to
oxygen, & in part to carbon dioxide. That part of the total pressure
generated by oxygen is the 'partial pressure' of oxygen, while that generated
by carbon dioxide is the 'partial pressure' of carbon dioxide. A gas's partial
pressure, therefore, is a measure of how much of that gas is present (e.g., in
the blood or alveoli).
The partial pressure exerted by each gas in a mixture equals the total
pressure times the fractional composition of the gas in the mixture. So, given
that total atmospheric pressure (at sea level) is about 760 mm Hg and,
further, that air is about 21% oxygen, then the partial pressure of oxygen in
the air is 0.21 times 760 mm Hg or 160 mm Hg.
37
Pathophysiology of Acute Bronchitis ( Book-Based)
a. Schematic Diagram
Non-modifiable factors Modifable Factors

-Smoke or fume inhalation
-Age (advance age/very young)
-Malnutrition or poor immune
system
-Asthma
Entry of Virulent
Microorganisms
Infectious Microorganisms lodges in the

Bronchioles
Bronchial epithelial injury
Production of Mucus from Epithelial Cells
Proliferation of
Microorganisms
Releases Toxins
Inflammatory Response
38
Bronchial Edema Release of
Chemical Mediators
Exudates Formation RALES
Histamine
Cytokines Bradykinins
Parenchymal and Alveolar
Consolidation Narrowing of
Blood Vessels
Release of Stimulation of
Pyrogens Goblet Cells
RESPIRATORY Air passes through
SECRETIONS narrowed lumen
Accumulation
of Secretions Bronchial Obstruction
ELEVATED WBC Stimulates increase
in Body
Temperature
WHEEZES AND COUGH SOB/DYSPNEA
COUGHING UP BLOOD
CHEST PAIN
HYPERTHERMIA BODY WEAKNESS
Compensatory
Mechanism
39
INCREASED RR and PR USE OF ACCESSORY
MUSCLES
Pathophysiology of Acute Bronchitis (CLIENT-CENTERED)
a. Schematic Diagram
Modifable Factors
Non-modifiable factors -Smoke or fume inhalation
-Age (advance age/very young) -Malnutrition or poor immune

system
-Asthma
Entry of Virulent
Microorganisms
Infectious Microorganisms lodges in the

Bronchioles
Bronchial epithelial injury
Production of Mucus from Epithelial Cells
Proliferation of
Microorganisms
Releases Toxins
40
Inflammatory Response
Bronchial Edema RALES Release of

June Chemical Mediators
23
2009
Exudates Formation
Histamine
Cytokines Bradykinins
Parenchymal and Alveolar
Consolidation Narrowing of
Blood Vessels
Release of Stimulation of
Pyrogens Goblet Cells
RESPIRATORY Air passes through
SECRETIONS narrowed lumen
Accumulation
of Secretions Bronchial Obstruction
Decreased WBC Stimulates increase
in Body
Temperature
WHEEZES AND COUGH SOB/DYSPNEA
NON PRODUCTIVECOUGH June 23 2009
June 23 2009 CHEST PAIN
BODY WEAKNESS
HYPERTHERMIA June 23 2009
Compensatory
June 24 2009 Mechanism
41
INCREASED RR and PR USE OF ACCESSORY
June 24 2009 MUSCLES
42
SYNTHESIS OF THE DISEASE (BOOK BASED)
Bronchitis is an inflammation of the lining of your bronchial tubes, which

carry air to and from your lungs. Bronchitis may be either acute or chronic.
Acute bronchitis is a lower respiratory tract infection that causes reversible

bronchial inflammation. In up to 95 percent of cases, the cause is viral. Acute
bronchitis is caused in most cases by a viral infection and may begin after
developing a cold or sore throat. Bronchitis usually begins with a dry cough.
After a few days it progresses to a productive cough, which may be
accompanied by fever, fatigue, and headache. The cough may last up to
several weeks. If not treated acute bronchitis can progress to pneumonia.
True acute purulent bronchitis is characterized by infection of the bronchial

tree with resultant bronchial edema and mucus formation. Because of these
changes, patients develop a productive cough and signs of bronchial
obstruction, such as wheezing or dyspnea on exertion. Unlike the chronic
inflammatory changes of asthma, the inflammation in acute bronchitis is
transient and usually resolves soon after the infection clears. In some
patients, however, the inflammation can last several months. In rare cases, a
postbronchitis cough can persist for up to six months.
Bronchitis can have causes other than infection. Bronchial wall inflammation
can occur in asthma or can be secondary to mucosal injury in an acute
event, such as smoke or chemical fume inhalation. This inflammation can
also result from chronic toxic exposure, such as cigarette smoking. It is
important to realize that when underlying inflammation is present, such as in
asthmatics or smokers, infective agents are likely to cause more severe
cough and wheezing.
Viruses are the most common cause of bronchial inflammation in otherwise

healthy adults with acute bronchitis. Only a small portion of acute bronchitis
infections are caused by nonviral agents, with the most common organism
43
being Mycoplasma pneumoniae. Study findings suggest that Chlamydia
pneumoniae may be another nonviral cause of acute bronchitis.
MODIFIABLE/ NON-MODIFIABLE FACTORS
 Non-modifiable Factors (book based)

 Age (Advanced Age/Very Young). For elderly, this is brought about
by the degenerative changes which put them at high risk in acquiring and
developing the disease condition. For young individuals especially those
newborns, they still have immature immune systems which makes them
more susceptible in acquiring the disease condition.
 Modifiable Factors
• Smoke or chemical fume inhalation. Smoking damages the

mucosal lining of the bronchus.
• Asthma. Also causes bronchial wall inflammation.
• Malnutrition and poor immune system. Improper nutrition and
poor nutrition can contribute to the development and acquiring of the
disease condition.
• Viral Infection. Mostly the cause of the disease viral infection.
• Environment. Presence of dust and pollutant may contribute in
occurrence of the said condition.
SIGNS AND SYMPTOMS
44
• Difficulty of breathing or dyspnea. This results from the
continuous narrowing and obstruction of the airways. Manifestations of
dyspnea would include:
o Nasal flaring
o Pursed-lip breathing
o Use of accesory muscles
• Chest tightness or pain. This results from the inflammation of the
airway, and due to labored breathing
• Chest Pain. Usually, it is cause by shortness of breath, wheezes and
presence of cough.
• Non-Productive/Productive Cough. Coughing is an important way
to keep the throat and airways clean. It is usually cause by the
presence of increase mucus secretion stimulated by the presence of
Microorganisms causing irritation in the lungs.
• Presence of Adventitious Sounds on the Lungs (rales, wheezes,
ronchi). Presence of abnormal breath sounds is due to accumulation
of secretions in the alveolar sac which traps air producing theses
distinct sounds. Adventitious breath sounds may also occur when
narrowing of the bronchus occurs.
• Dyspnea. This is because of the narrowing blood vessel caused by the
release of chemical mediators leading to difficulty of inspiration and
expiration.
• Shortness of Breath. It is caused by obstruction of the air passages
that may lead to labored or difficulty in breathing.
• Body Weakness. This is due to the physical exertion brought about
by compensatory mechanisms through breathing.
• Fever with Chills. Increase in body temperature is caused by the
inflammatory response of the body due to the presence of virulent
microorganisms.
45
• Coughing up Blood. It is the splitting up of blood or bloody mucus
from the lungs and throat usually cause by the extensive lesion in the
respiratory tract.
• Elevated White Blood Cells. Increased in number of leukocytes is
brought about by the presence of bacterial infection in the body.
• Increase Pulse Rate and Respiratory Rate. This is caused by
imbalance of oxygen supply and demand.
• Use of Accessory Muscle when Breathing. This is a compensatory
mechanism in order to allow proper inhalation and exhalation.
SYNTHESIS OF THE DISEASE (CLIENT CENTERED)
MODIFIABLE/ NON-MODIFIABLE FACTORS
 Non-modifiable Factors
 Age (Very Young). The patient is 6 years old.
 Modifiable Factors
• Asthma. Also causes bronchial wall inflammation. She has

asthma since birth.
46
• Malnutrition and poor immune system. Improper nutrition and
poor nutrition can contribute to the development and
acquiring of the disease condition. She has decreased
appetite.
• Viral Infection. Mostly the cause of the disease viral infection.
She was diagnose with URTI 4 days prior to admission.
• Environment. Presence of dust and pollutant may contribute in
occurrence of the said condition. Patients house is located
along the highway.
SIGNS AND SYMPTOMS
• Difficulty of breathing or dyspnea. (June 23,24 2009) This

results from the continuous narrowing and obstruction of the
airways. Manifestations of dyspnea would include:
o Nasal flaring
o Increased respiratory rate
• Non-Productive/Productive Cough. (June 23-24 2009) Coughing
is an important way to keep the throat and airways clean. It is
usually cause by the presence of increase mucus secretion
stimulated by the presence of Microorganisms causing
irritation in the lungs.
• Presence of Adventitious Sounds on the Lungs (rales) (June 23-
24 2009). Presence of abnormal breath sounds is due to
accumulation of secretions in the alveolar sac which traps air
producing theses distinct sounds. Adventitious breath sounds
may also occur when narrowing of the bronchus occurs.
• Dyspnea. (June 23-24 2009) This is because of the narrowing
blood vessel caused by the release of chemical mediators
leading to difficulty of inspiration and expiration.
47
Respiratory Rate. This is caused by imbalance of oxygen
supply and demand.
• Body Weakness. (June 23-24 2009) This is due to the physical
exertion brought about by compensatory mechanisms through
breathing.
• Fever with Chills. (June 23-24 2009) Increase in body
temperature is caused by the inflammatory response of the
body due to the presence of virulent microorganisms.
• Elevated White Blood Cells. (June 24 2009) Increased in
number of leukocytes is brought about by the presence of
bacterial infection in the body.
48
V. THE PATIENT AND HIS CARE
A. Medical Management
A.1 IVF’s and Nebulization
Medical Date General Indication( Client’s
Ordered
Manageme Description s) or Response to
Date
nt/ Performed Purpose(s) the
Date
Treatment Treatment
Changed/DC
Intravenous Date ordered: It is a hypertonic It is use to Client fluid
Fluids
June 23 2009 solution, which supply the loss due to
D5 IMB
500cc, @ 45 makes the cells necessary insensible
ugtts/min
Date started: shrink, nutrients. fluid loss was
June 23 2009 composes of And this replaced and
water and solution is nourished.
carbohydrates, given usually
as source of when serum
energy and both osmolality
cations and has
anions decreased to
dangerously
low levels.
Nursing Responsibilities:
Prior to the procedure:
 Check doctor’s order. Check for ordered IVF.
 Check for the patency of the IV tubing, cloudiness and expiration date.
 Explain the procedure, importance and its benefits to the patient’s SO.
 Secure all materials for IV insertion
49
During the procedure:
 Clean the site of administration. Choose a vein in the distal arm.
 Support client hand and maintain aseptic technique.
 Regulate the flow rate as ordered.
 Always check if it the infusion site and in place.
 Monitor I and O.
 Monitor patient for fluid overload.
 be sure that IV line is free from any kinds of bubbles.
 Make sure that all incorporated IVF’s and its desired doses are followed
according to the doctor’s order.
 Provide a splint to prevent injury of the vein.
 Inspect for level of IV always.
After the procedure:

 Monitor rate as ordered, flow and patency.
 Document the time and date.
50
Medical Date General Indication(s) or Client’s
Manageme Ordered Description Purpose(s) Response to
nt/ Date the
Treatment Performed Treatment
Date
Changed/DC
Nebulizatio Date ordered: Inhalation It aids bronchial The patient
n June 23 2009 therapy that hygiene by demonstrated
produces restoring and an improved in
Date started: droplets that maintaining the breathing
June 23 2009 are suspended mucous blanket pattern. And
in a gas such continuity, was able to
as oxygen. hydrating dried, cough out
The dug which retained secretions
was formed to secretions, more often.
mist would be promoting
inhaled better expectoration of
secretions. To
relive
bronchospasm,
to provide relief
to a
hyperresponsive
airway and to
liquefy and clear
tenacious
secretions.
51
Nursing Responsibilities
 Check doctor’s order.
 Check for the amount of medication that is to be incorporate in the
procedure.
 Explain the procedure to the patient’s S.O.
 Arranged all the material needed. Wash hand.
 Hold the mouthpiece of the nebulizer upright to avoid spilling of
medicines.
 Continue nebulization until the medication is already nebulized.
 Do chest physio-therapy after nebulisation.
 Assess the client’s vital signs after nebulization, especially the
respiratory rate.
 Document the time of the procedure was done.
B. Drugs
Name of Date Route of General Client

Drugs Ordered Administr action; Drug Response to
Generic Date ation, classification; the
Name Taken/Give Dosage Mechanism of Medication
Brand Name n and action with Actual
Date Frequenc Side Effects
Changed/D y of
C Administr
ation
Convibent Date Neb Anti asthmatic The patient
ordered: combivent maintained a
Management of
June 23 2009 plus 1 patent airway
52
nebule
reversible
Date started: fluticasone
bronchospasm
June 23 2009 q 6 hour
associated w/
weight
obstructive
22kg IVF
airway diseases
D5 IMB
in patients who
50cc
require more
than a single
bronchodilator.

Drugs Ordered Administrati action; Drug Response
Generic Date on, Dosage classification; to the
Name Taken/Give and Mechanism of Medicatio
Brand Name n Frequency action n with
Date of Actual
Changed/D Administrati Side
C on Effects
FLUTICASONE Date Route of Inhalation The client
ordered: Administratio Prophylaxis of didn’t
June 23 n: asthma experience
2009 Nebulizer broncospas
Dosage: m
Date 1 nebule
started:
53
June 23
2009
>Before administering, check for doctor’s order.
>Give drug with right dosage, route, and time for administration.
 Read the Doctor’s order before giving the medication to the patient,
and always remember the 10 R’s
 Inform the patient about the action and the purpose of the drug.
 Before giving the medication ask the patient first if she already take
the medications or not.
 Note if all the medications are available, if one of the medication are
not available make a prescription and ask the patient’s SO to buy it for
the patient.
 Check if the nebulizer is functioning
 Prepare the drug by diluting it with distilled water
 Make sure that the patient will take the medications on time.
 If the medication is an IV route, make sure that you administer it on

time.
 Always be at the bedside of the patient in order to help the patient in

taking her medications.
 Follow the directions on your prescription label
 Monitor the patient while inhaling the atomized drug if it is in proper

place
 Instruct patient to take medication as directed for the full course of

therapy.
54
 Instruct patient to take medication at evenly spaced times and to finish
the medication completely.
 Observe for side effects or allergies.
 Inform the patient on the specific time the medication is to taken

again.
 Inform patient that increased fluid intake and exercise may minimize
constipation
 Document.

Brand n Frequency action n with
Name Date of Actual
C on Effects
Paracetamol Date Route of Anti –pyretic The client
ordered: Administratio experience
Inhibits
aceteminop June 23 n: relief from
prostaglandins
hen 2009 Per Orem fever
in CNS but
Dosage:
lacks anti-
Date 1ml q 4 hrs
inflammatory
started:
effects in
June 23
periphery;
2009
reduces fever
55
through direct
action on
hypothalamic
heat-regulating
center.
Nursing responsibilities
Prior to drug administration
• Check the written medication order for completeness. It should include
the drug name, dosage, frequency, and duration of therapy.
• Check if there are any special circumstances surrounding
administration of the dose to the patient
• Be certain that you know the expected action, safe dosage range,
special instructions for administration and adverse effects associated
with drug orders
• Wash you hands
• Prepare the necessary equipment like the medication tray and
medication card.
• Prepare the dosage as ordered
• Check the label on the medication three times before administering
any drug
• Ever prepare a dosage of medication, which is discolored,
contaminated, or outdated
During drug administration

• Verify the patients name first.
• Administer once daily
• May be given with or without meals
56
After drug administration
• Assess for adverse effect of the drug
• Assess for temperature
• Documentation the procedure

Brand n Frequency action n with
Name Date of Actual
C on Effects
PEDZINC Date Route of Vit C and zinc The client
ordered: Administratio supplement to immune
June 23 n: keep child system was
2009 Per Orem strong, healthy boosted.
Dosage: and mentally
Date 5 ml syrup alert. Increase
started: once a day immunity
57
June 23 against
2009 common
infections &
everyday
stress. Reduces
the risk,
severity &
duration of
common colds,
malaria,
pneumonia &
diarrhea.
with drug orders
• Wash you hands
medication card.
any drug
58
• Administer once daily


Brand Name n Frequency action n with
Date of Actual
C on Effects
COAMOXCILAV Date Route of Lower resp The client
( Amoclav ) ordered: Administratio tract infections, reduces
June 23 n: otitis media, infection
2009 Per Orem sinusitis, skin &
Dosage: soft tissue
Date 300mg + infections, UTI,
started: 20cc IV pre & post-
June 23 diluent q surgical
2009 8hrs. procedures,
bone & joint, O
& G infections,
dental
infections.
59
with drug orders
• Wash you hands
medication card.
any drug

• Administer every 8 hours

60
C. Diet
Type Date General Indication SPECIFIC Client’s

of Diet Ordered Descriptio (s) and FOODS Response
Date n Purpose(s TAKEN and/or
Performed ) Reaction to
Date the Diet
Changed/D
C
DAT Date Nearly the A balanced The patient The patient

ordered: normal diet diet is prefers to demonstrate
June 23 on the basic necessary eat food d improved
2009 four food for the such as appetite.
groups. The recovery of bread,
Date diet must the patient soda, and
started: be that is why coffee.
June 23 withdrawn the
2009 with signs physician
of ordered a
61
aspiration. normal
diet.
However,
the SO
must
discontinue
the
patient’s
feeding if
severe
DOB
occurs to
prevent
aspiration
which may
aggravate
the
patient’s
condition.
 Check doctor’s order regarding the type of diet.
 Explain to patient’s SO regarding NPO
 Give health teachings regarding proper preparation of food for the

patient
 Always emphasized aseptic technique
 Be sure patient is taking or eating foods she can tolerate.
62
 Be sure patient is taking or eating foods she can tolerate.
 Assess for patent’s condition, how she respond to the diet.
 Provide foods which are indicated for DAT
D. Activity/Exercise
Type of Date General Indication Client’s

Exercise Ordered Descripti (s) and response or
Date on Purpose(s reaction to
Performed ) the
Date activity/exerci
Changed/D se
C
HIGH Date Head of To Relieved from

BACK ordered: bed is maximize DOB
REST June 23 elevated lung
2009 to 45-90 expansion
degrees since
Date stated: patient is
June 23 having
2009 DOB
Nursing Responsibilities
 Check doctor’s order
63
 Elevate head of bed to 45-90 degrees
 Place pillows on the side edge of the bed
 Raise side rails if the patient prefer
64
Nursing Care Plan
Problem #1 - Ineffective airway clearance r/t retained secretions in the bronchi
Assessmen Nursing Scientific Objectives Interventions Rationale Expected
t Diagnosis Explanation Outcome
S>Ø
O> patient Ineffective Inflammation and ST> after 1 1. Assess energy 1. Decrease with ST> after 1
may airway swelling of the hour of level and age, more than hour of
manifest: clearance linings of the nursing endurance and one chronic nursing
• Adventitiou r/t retained airways leads to intervention effect on chest disorder further intervention
s breath secretions narrowing and the patient expansion compromises the patient
sounds in the obstruction of the will maintenance of shall have
(crackles/w bronchi airways. The maintain ventilation maintained
heezes) inflammation patent 2. Assess 2. Changes vary patent airway
• Tachypnea also stimulates airway respiratory from minimal to
• Dyspnea production of status for rate, extreme caused LT>after 3

mucous LT>after 3 depth and ease, by obstruction days of
• Productive/
(sputum), which days of presence of (bronchial nursing
non-
can cause further nursing tachypnea, swelling), intervention
productive
obstruction of intervention dyspnea in increased mucus the patient
cough
airways. the patient relation to secretions shall have
• Cyanosis
will disease process (oversecretions demonstrated
• Difficulty of
demonstrat or decrease of goblet cells, absence/redu
vocalizing
65
• Wide-eyed e energy level tracheobronchia ction of
• orthopnea absence/red infection), congestion

uction of bronchospasm with breath
congestion and narrowing of sounds clear,
with breath air passages respiration
sounds (stmulation of noiseless,
clear, irritant receptors improve
respiration in smooth muscle oxygen
noiseless, layer of exchange
improve conducting
oxygen airways)
exchange 3. Auscultate for 3. Wheezing
adventitious results from
sounds squeezing of air
(crackles, past narrowed
wheezes) airways during
expiration caused
by
bronchospasms,
edema and
obstructive
secretions;
66
crackles result
from lung
consolidation of
leukocytes and
fibrin in an area
caused by
infectious
4. Assess for process or fluid
cough and accumulation in
sputum the lungs
production for
amount, color, 4. Changes in color
viscosity, ability to green in
to cough and morning and
expectorate yellow during day
secretions in indicate
relation to infection;
energy levels tenacious, thick
secretions
require more
enrgy and effort
5. Administer to remove and
67
bronchodilators, may cause
anti- obstruction and
inflammatories, stasis leading to
expectorants, infection and
mucolytics, anti- respiratory
infectives changes
5. Treats
bronchospasm,
6. Provide prevents or
environmental treats infection,
air liquefies
humidification\ secretions and
enhances outflow
7. Offer 2-3 L (10- and removal of
12 glasses)/day respiratory tract
unless fluids
contraindicated; 6. Adds moisture to
offer hourly the air to thin
including a mucus for easier
warm beverage removal
upon arising
8. Position in 7. Assist to
68
semi-fowler’s mobilize thin
and change secretions for
position q 2h easier removal
8. Prevents
accumulation of
secretions;
9. Perform promotes
postural comfort and ease
drainage using breathing and
gravity, decreases airflow
percussion, resistance and
vibration, avoid enhances gas
postions that distribution,
may be facilitates chest
contraindicated expansion
in the elderly 9. Raises
10. Maintain secretions, clears
activity pattern, sputum and
69
encourage increases force of
ambulation expiration
within
limitations
11. Encourage
deep breathing 10. Mobilize
and coughing secretions for
exercises by easier removal
taking a deep
breath, exhale 11. Assist in
as much as dislodging
possible, inhale secretions for
again and cough easier
twice from the expectoration by
chest initiating the
cough reflex
which protects
the lungs from
12. Suction if accumulation of
appropriate secretions by
action on
receptors in
70
tracheobronchial
13. Instruct wall
patient to avoid
milk, caffeine 12. Removes
drinks and secretions in
alcohol those too weak
to cough or with
mentation or LOC
deficits
13. Milk thickens
mucus, caffeine
14. Instruct reduces effect of
patient to avoid medication
excessively hot ( bronchodilators)
or cold fluids; , alcohol
cold air and increases cell
wind exposure dehydration and
by wearing bronchial
mask constriction
15. Encourage 14. Predisposes
cessation of to coughing
smoking; spells; dyspnea,
71
suggest bronchospasm
program to
support the
reduction or 15. Smoking
cessation of causes increased
smoking mucus,
vasoconstriction,
increased BP,
inflammation of
the lung lining,
16. Program of decreased
daily exercises; number of
supervised if macrophages in
needed airways and
mucociliary
17. Instruct blanket
patient to avoid 16. Promotes
crowds and secretion
those with upper removal
respiratory tract
infections
18. Instruct 17. Prevents
72
patient on possible
proper use of transmission of
and disposal of infection
tissues used for
expectoration
18. Prevents
transmission of
microorganism
as sputum
contains infecting
organism and
inflammatory
debris
Problem #2 - Ineffective breathing pattern r/t tracheobronchial obstruction

73
S>Ø
O> patient Ineffective Irritants inflame ST> after 1 1. Assess 1. Changes vary ST> after 1
may breathing the hour of respiratory with acuteness of hour of
manifest: pattern r/t tracheobronchial nursing status for rate, condition and are nursing
• Prolonged tracheobro tree, leading to intervention depth and ease, caused by airway intervention
dyspnea nchial increase mucus the patient presence of resistance, the patient
• Exhausted obstruction production and a will dyspnea and bronchospasm, shall have
appearanc narrowed or verbalize use of accessory decreased lung verbalized
e blocked airway. awareness muscles, expansion, awareness of
• Lethargy As the of causative lengthened dyspnea results causative
• Listlessnes inflammation factors and expiratory phase from stimulation factors and
s continues, goblet iniate of lung receptors iniate needed

and epithelial cell needed or reduced lifestyle
• Drowsy
hypertrophy. lifestyle ventilatory changes
Because the changes capacity or
natural defense breathing reserve LT>After 3
mechanism is LT>After 3 2. Limited energy days of
blocked, the days of 2. Asses energy reserve in elderly nursing
airway nursing level, fatigue quickly intervention
accumulate intervention and effect on dissipated as the patient
debris in the the patient breathing work of breathing shall be free
respiratory tract. will be free increases of cyanosis
74
of cyanosis 3. Results from and other
and other 3. Assess pain or excessive signs and
signs and chest coughing , use of symptoms of
symptoms discomfort, sore muscles for work hypoxia with
of hypoxia chest muscles, of breathing ABGs within
with ABGs effort on chest causing reduced client
within client excursion chest expansion acceptable
acceptable and shallow range
range breathing pattern
4. Changes caused
by infectious
4. Auscultate for process as
diminished or consolidation
absent breath develops;
sounds, damage to
wheezes or bronchioles
crackles restrict air
movement
5. Have client to 5. To correct
breath into hyperventilation
paper bag
6. Administer 6. Treats
75
bronchodilator bronchospasm,
as ordered prevents or
treats infection
7. Position in 7. Promotes
semi- or high comfort and ease
fowler’s of breathing and
gas distribution,
facilitates chest
expansion by
causing
abdominal
organs to sag
way from
8. Perform deep diaphragm
breathing 8. Strengthens
exercises and chest and
pursed lip abdominal
breathing, muscles to
isometric enhance
exercises for breathing ;
intercostals pursed lip
muscle and breathing
76
diaphragm prolongs
strengthening; expiratory phase
upper body and prevents
exercises by alveoli from
raising arms and collapsing to
using 2-3 lb decrease CO2
hand weight if retention
available
9. Provide proper
body alignment
in positioning for 9. Ensures optimal
sleep, use ventilation
pillows, to
elevate head
and support
chest.
10. Pace 10. Prevents
activities, allow changes in
for rest between respirations
periods of brought about by
exercises exertion
11. Instruct 11. Causes
77
patient to avoid exacerbation of
extending any dyspnea
activity beyond
baseline of
tolerance 12. Decrease
12. Encourage respiratory rate
patient of
relaxation
techniques,
guided imagery,
music when
breathing
pattern changes
or anxiety
increases
Problem #3-Impaired gas exchange r/t ventilation perfusion imbalance

78
S>Ø
O> patient impaired Bronchospastic ST> After 1 1. Assess 1. Gas exchange ST> After 1
may gas disease changes hour of respiratory carried out by hour of
manifest: exchange gas flow and nursing status for rate, pulmonary nursing
• Irritability r/t blood distribution intervention depth and ease, circulation is intervention
• Hypoxemia ventilation possibly causing, the patient dyspnea and affected by body the patient
• Hypercapni perfusion in some cases, will respiratory position and shall have
a imbalance ventilation- verbalize effort on posture as is verbalized

perfusion understandi exertion, length ventilation; it is understandin
• Confusion
mismatching. ng of the of inspiratory dependent on the g of the
• Somnolenc
With causative and expiratory matching of causative
e
bronchospasm, factors and phase ventilation and factors and
• Hypoxia
autoregulation appropriate perfusion of equal appropriate
mechanisms intervention amounts of air interventions
change blood s and blood
flow patterns in LT> after 3 entering the lungs LT> after 3
an attempt to days of at the alveoli days of
maintain a match nursing level nursing
between intervention 2. Assess for 2. O2 and CO2 intervention
ventilated the patient cyanosis and diffusion and the patient
regions and will monitor arterial exchange are shall have
perfuse regions. maintain blood gas for affected by the maintained
79
Nevertheless, adequate decreased surface area adequate
chronic oxygen and oxygen and available, oxygen and
bronchitis and carbon increase carbon thickness of the carbon
acute asthma dioxide dioxide levels, alveolocapillary dioxide levels
often result in a levels with possible membrane of with return of
low return of lowered pH; O2 both of which respiratory
ventilation/perfus respiratory saturation by characteristic of baselines
ion condition baselines oximetry aging or disease
(V/Q) with lung tissue;
associated cyanosis results
oxygen from the
desaturation and reduction in
hypoxemia. oxygenated
hemoglobin in the
blood and leads
3. Assess for to hypoxia
changes in (reduced tissue
consciousness, oxygenation)
mentation, 3. Results of
restlessness, decreased oxygen
irritability, rapid to brain tissue
fatigue with progressive
80
hypoxia
4. Position patient
in semi/high-
fowler’s using
chair or pillow 4. Promotes
on over bed breathing and gas
table to lean distribution
forward facilitates chest
expansion and
pulmonary blood
5. Breathing flow; sitting
exercise position stabilizes
chest structures
5. Restores function
of diaphragm
which decreases
6. Administer work of breathing
oxygen at 2-3 and improves gas
L/min via exchange
cannula, non 6. Maintain
breather mask adequate oxygen
level without
81
7. Instruct patient depressing
to avoid respiratory drive
activities that which increases
cause change CO2 retention
in respirations 7. Increase in
especially oxygen
shortness of consumption
breath changes
8. Instruct patient breathing pattern
to report any
changes in
fatigue level or
any mental 8. Indicates
clouding, impending
increasing hypoxia
dyspneic
episodes
9. Encourage
adequate rest
and limit 9. Help limit O2
activities to needs/consumptio
within client n
82
tolerance
10. Instruct
patient to keep
his 10. To reduce
environment irritant effect on
allergen/polluta airways
nt free
11. Encourage
cessation of 11. To improve
smoking; lung function
suggest
program to
support the
reduction or
cessation of
smoking
Problem #4 – High risk for infection r/t inadequate primary defenses (decrease ciliary action)
83
S>Ø
O> patient High risk for Smoke and other ST> After 1 1. Assess for 1. Early detection ST> After 1
may infection r/t pollutants irritate hour of increased of respiratory hour of
manifest : inadequate the airways, nursing dyspnea, infection allows nursing
• Productive primary resulting in intervention change in color for immediate intervention
cough defenses hypersecretion of the patient and viscosity of treatment the patient
• Fever (decrease mucus and will have sputum (yellow before shall have
• Restlessne ciliary inflammation. vital signs or green), respiratory vital signs
ss action) This constant within cough system is within normal
• Tiredness irritation causes normal compromise ranges

the mucus ranges 2. Administer 2. Prevents or
• Increase
secreting glands antibiotic treats LT> After 3
WBC count
and goblet cells LT> After 3 therapy respiratory days of
• Pinkish skin
to increase in days of infection if nursing
• Drowsiness
number. Ciliary nursing 3. Obtain periodic symptoms intervention
• Green or
function is intervention sputum appear the patient
yellow
reduced and the patient cultures 3. Reveal shall have
sputum
more mucus is will identify infectious agent, identified
produced. The intervention 4. Avoid smoking, evaluates effect interventions
bronchial walls s to prevent chilling, of treatment to prevent
become infection inhalation of 4. Irritates mucosa infection and
thickened, the and environmental and initiates demonstrated
84
bronchial lumen demonstrat pollutants dyspneic attack techniques to
narrows and e 5. Avoid large promote safe
mucus may plug techniques groups, 5. Prevent s environment
the airway. to promote exposure contact with
Alveoli adjacent safe potential
to the environmen 6. Proper hand infectious
bronchioles may t washing, agents
become disposal of 6. Prevents
damaged and tissues, cover transmission of
fibrosed, mouth and infectious
resulting in nose when agents from
altered function coughing, contaminated
of the alveolar cleansing and articles
macrophages. disinfection off
This is significant respiratory
because the equipment
macrophages 7. Proper
play an administration
important role in and expected 7. Prevents
destroying effect of recurrence of
particles, antibiotic infection
including therapy and to
85
bacteria. take complete
prescription
8. Instruct patient
to report fever
or change in 8. May indicate
sputum infection
9. Encourage
early 9. For mobilization
ambulation, of respiratory
deep breathing secretions
and coughing
position change
86
Problem#5 - Sleep pattern disturbance r/t internal factors of illness and psychological stress
of dyspnea
S>Ø ST>after 1
O> patient Sleep Sleeplessness ST>after 1 1. Assess 1. Provides hour of
may pattern and daytime hour of sleep pattern data for nursing
manifest: disturbance sleepiness are nursing and changes, resolving sleep intervention
• Irritability r/t internal common intervention naps and deprivation in the patient
• Frequent factors of problems. the patient frequency, relation to shall have
yawning illness and Studies indicate will amount of aging changes verbalized
• Tiredness psychologic that between 80 verbalize activity or understanding
87
• Drowsiness al stress of - 93% of people understandi sedentary of sleep
• Listlessnes dyspnea with asthma ng of sleep status, disturbance
s have sleeping disturbance awakenings
• Lethargy problems about and when they LT>after 3

three times a LT>after 3 occur and days of
• Disorientat
week. Asthma days of frequency, 2. Causes of nursing
e
has been nursing feelings of frequent intervention
• Dark circles
associated with intervention fatigue, awakenings and the patient
under eyes
snoring and the patient apathy, interruptions in shall have
obstructive sleep will report lethargy, sleep reported
apnea, a improveme impotence 3. Common improvement
condition in nt of 2. Assess causes of of sleep/rest
which blockage sleep/rest presence of insomnia and pattern
of the upper pattern dyspnea sleep
airway causes disturbance
the sleeper to pattern
temporarily stop 3. Assess
breathing, then presence of 4. Alters sleep
resume with a depression, which may
gasp, often many confusion and cause
times during anxiety irritability,
each hour of 4. Assess use lethargy, drug
88
sleep. of action,
alcohol,caffein absorption and
e,medication excretion may
regimen be delayed in
elderly and
adverse effects
and toxicity at
higher
riskExternal
stimuli
interferes with
going to sleep
and increases
wakenings as
sleep in the
elderly is of less
intensity
5. Assess 5. Prevents
environment break in
for lighting, established
noises, odors, pattern
temperature, And promotes
89
ventilation comfort and
relaxation
6. Provide before sleep
ritualistic
procedures of 6. Promotes
warm drink, falling asleep
extra covers,
clean linens,
warm bath
before bedtime
7. Provide 7. Some elderly

quiet, calm, prefer to sleep
peaceful throughout 24
environment hours with short
naps providing
adequate rest
8. Allow naps 8. Promotes

during day relaxation
90
according to before sleep
need and reduces
recognizing anxiety and
that they may tension
interfere with
sleep and
cause
insomnia 9. Depresses
9. Provide sleep
back rub,
relaxation
techniques,
imagery,
music,
massage at 10. Assist
bedtime in acceptance
10. Instru of changes and
ct patient to need for sleep
refrain from revision of
use of alcohol sleep pattern
and CNS 11. Preven
depressants ts falling asleep
91
because of
11. Infor overstimulation
m patient of
aging changes
and their
relation to
sleep changes
Problem #6 - Fatigue r/t respiratory effort

92
S>Ø
O> patient Fatigue r/t Hyperventilation ST> After 1 1. Assess for 1. Provides ST> After 1
may respiratory is triggered by hour of extreme information to hour of
manifest: effort lung receptors to nursing weakness and determine nursing
• Irritability increase lung intervention fatigue; ability effects of intervention
• Exhausted volume because the patient to rest, sleep dyspnea and the patient
appearanc of trapped air will and amount; work of shall have
e and obstructions. participate movement in breathing over participated in
• Lethargy Intrapleural and in bed period of time, therapeutic

alveolar gas therapeutic which becomes regimen
• Listlessnes
pressure rise, regimen exhaustive and
s
causing a depletes energy LT> after 3
• Drowsy
decreased LT> after 3 reserve and days of
• Disinterest
perfusion of days of 2. Accept client’s ability to rest, nursing
in
alveoli. Increased nursing report of eat, drink intervention
surroundin
alveolar gas intervention fatigue 2. To assist client the patient
gs
pressure, the patient to cope with shall have
decreased will report fatigue and to reported
ventilation, and improved manage within improved
decreased sense of 3. Establish individual limits sense of
perfusion result energy realistic goals of ability energy
in uneven with client 3. Enhances
93
ventilation- commitment to
perfusion ratios promoting
and mismatching 4. Plan care to optimal
within different allow adequate outcomes
lung segments. rest periods. 4. To maximize
Schedule participation
activities for
periods when
client has the
most energy
5. Provide 5. Temperature
environment and level of
conducive to humidity are
relief of fatigue known to affect
6. Provide exhaustion
supplemental 6. Presence of
oxygen as anemia/hypoxe
indicate mia reduces
oxygen available
for cellular
7. Encourage use uptake and
of measures to contributes to
94
prevent fatigue fatigue
(diversional 7. Provide support
activities such and conserves
as wathcing TV, energy
small frequent
feedings)
Problem #7 - Activity intolerance r/t imbalance between oxygen demand and supply
S>Ø Activity Oxygen is ST>After 1 1. Assess for 1. Promotes and ST>After 1

O> Patient intolerance needed by the hour of baseline protects hour of
may r/t body especially nursing tolerance for respiratory nursing
manifest: imbalance in the process of intervention activity, ability functions intervention
• Dyspnea between metabolism to the patient to adapt, the patient
• Tachypnea oxygen produce energy. will amount of rest shall have
• Body demand Due to excessive participate and sleep 2. Pulse increase of participated
weakness and supply mucus willingly in 2. Assess pulse 10 or more/min. willingly in

production and necessary and respirations or increase and necessary
• Use of
95
accessory decrease activities to before, during any difficulty in activities to
muscles to function of the increase and after respirations increase
breathe cilia to remove activity activity indicate that activity
• Fatigue secretions, tolerance activity limit has tolerance
• Pale nail impaired been reached
beds breathing results LT> After 3 3. Prevents
• Pale to imbalance days of 3. Provide periods dyspneic episode LT> After 3
palpebral between oxygen nursing of rest after and provides days of
conjunctiva demand and intervention activity around uninterrupted nursing
• Cyanosis supply from the the patient rest or sleep rest and sleep intervention
lungs to the body will periods; allow necessary for the patient
and retention of maintain self pacing of physical and shall have
carbon dioxide optimal activities mental health to maintained
occurs. activity prevent fatigue optimal
level within 4. Stress and activity level
energy and 4. Provide quiet, stimuli produce within energy
breathing stress free anxiety and and breathing
limitations. environment increase limitations.
respirations
5. Provide oxygen 5. Pulmonary
during activities function tests
if appropriate indicate
96
hypoxemia
during exercise
and determine
6. Assist with need for
activities as additional
needed oxygen
6. Conserves
7. Provide slowly energy and
progressive oxygen
activity/exercise consumption;
program and prevents
promote dyspnea
independent 7. Increases
ADL delivery of
participation oxygen to
8. Instruct the tissues; increases
patient to avoid tolerance to
extending activities and
activities decreases feeling
beyond fatigue of helplessness
level or
tolerance that 8. Conserves
97
may provoke energy and
dyspne prevents
exacerbation of
9. Instruct the dyspnea
patient to utilize
energy saving
devices such as
arm rest, sitting
on stool in 9. Prevents fatigue
shower, placing
articles
commonly used
within reach
10. Instruct the

patient to
schedule
activities during 10. Allows for
peak or optimal activities without
effect time of dyspneic
systemic episodes
medication; use
98
inhalers before
activity
99
ACTUAL NURSING CARE (SOAPIE)
June 24 2009
S>Ø
O>Received patient sitting on bed, awake and coherent to person place and
time, with an ongoing IVF#3 D5IMB 500cc regulated at 45 ugtts/min at a
level of 350cc, infusing well at the left hand, good skin turgor, rales on both
lung fields upon auscultation, with nonproductive cough, with nasal flaring,
CRT of 1-2 seconds with pinkish palpebral conjuctiva, with leukocytes of 4.52
dated June 24 2009 with vital signs as follows : T=36.9°C, HR= 95 bpm, RR=
26 cycles/min, BP=90/60 mmHg
A>
1. Ineffective airway clearance r/t retained secretions in the bronchi
2. Impared gas exchange r/t obstructions on the airway AEB rales upon
auscultation.
3. Ineffective protection r/t altered blood profile AEB decreased
leukocytes secondary to acute bronchitis.
P>
1. After 3° of NI the patient will maintain airway patency AEB absence of
respiratory distress.
2. After 3° of NI the patient will able to maintain adequacy of gas
exchange AEB absence of respiratory distress.
3. After 2° of NI the patient will be free from infection.
I>Established rapport
>Monitored and recorded vital signs
>Assessed patient’s condition and watch out for signs and symptoms of
respiratory distress
>provided comfort and safety measures
>kept patient’s back dry
>Encouraged to increase fiber intake and vitamin C
>Elevated the head of bed
100
>performed chest tapping/back rub to mobilize secretions
>provided nebulization as ordered
>Encourage turning position changes
>due meds given
>Further needs attended
>endorsed
E>
1. Goal met AEB patient able to maintain airway patency AEB absence
of respiratory distress.
2. Goal met AEB patient able to maintain adequacy of gas exchange
AEB absence of respiratory distress.
3. Goal met AEB patient was free from infection.
VI. CLIENT’S DAILY PROGRESS IN THE HOSPITAL
1) Client’s Daily Progress Chart

Days Admission
06/23/09 06/24/09
Nursing Problems
1.) Ineffective airway clearance r/t retained  
secretions in the bronchi
2.) Ineffective breathing pattern r/t  
tracheobronchial obstruction
3.) Impaired gas exchange r/t ventilation  
perfusion imbalance
4.) High risk for infection r/t inadequate 
primary defenses (decrease ciliary action)
5.) Sleep pattern disturbance r/t internal 
factors of illness and psychological stress of
dyspnea
6.) Fatigue r/t respiratory effort  
7.) Activity intolerance r/t imbalance  
101
between oxygen demand and supply
Vital Signs
1.) Temp. 36.1C 36.8C
2.) PR 75bpm 95bpm
3.) RR 38cpm 26cpm
4.) BP 90/60 90/60
Diagnostic/Lab Procedures
1) Hematology 
2.) CXR PA 
3.) Urinalysis 
4.) cold agglutinin determination 
1)IVF D5 IMB 500 cc  
2.) Neb  
Drugs:
• Paracetamol 
• Co amoxiclav 
• Pedzinc
• Comvibent + fluticasone  
Diet:
DAT  
Activity/Exercise
Bederest  
102
2. DISCHARGE PLANNING
A. General condition about the client upon discharge.
The client achieved his optimum health status after his hospitalization. He
has already adequate ventilation and oxygenation. No other associated signs
and symptoms of respiratory distress he appears generally in good condition.
There were no complications noted. Still, on the process of recovery.
S> Ø
O> Received patient sitting on bed, awake and coherent, with an ongoing
IVF #6 D5 IMB 500cc x 45ugtts/min at level of 300cc infusing well at the left
dorsal veinof the hand, c good skin turgor, c cough, c (-) DOB, c V/S as
follows : T=36.8, PR= 90 bpm, RR= 25, BP=90/60 mmHg
A> Readiness for enhanced well being
P> After 2 hours of nursing intervention the patient will remain free of
preventable complications/progression of illness and sequelae and will
verbalize understanding of health teachings
M>
• Paracetamol syrup 5ml every 4 hours for fever
• Co amoxiclav 300mg every 8 hours for 5 days
• Pedzinc syrup 5ml once a day
• Combivent 1 neb every 6 hours
E> May resume activities as tolerated
103
T> Home maintenance and management
H> reinforce increase fluid intake

Avoid strenuous activities
Eat high caloric foods, rich in iron and vitamin C
Encourage proper hand washing.
Have an adequate rest
Instructed patient to be in high fowler’s position whenever
experiencing DOB
O> OPD after 1 week
D> DAT; preferably hypoallergenic diet
E> Goal met as evidenced by patient remained free of preventable

complications/progression of illness and verbalized understanding of health
teachings
VII. CONCLUSION AND RECOMMENDATION:
Acute bronchitis is a lower respiratory tract infection that causes

reversible bronchial inflammation. In up to 95 percent of cases, the cause is
viral. Acute bronchitis is caused in most cases by a viral infection and may
begin after developing a cold or sore throat. Bronchitis usually begins with a
dry cough. After a few days it progresses to a productive cough, which may
be accompanied by fever, fatigue, and headache. The cough may last up to
several weeks. If not treated acute bronchitis can progress to pneumonia.
Bronchitis can have causes other than infection. Bronchial wall inflammation
can occur in asthma or can be secondary to mucosal injury in an acute
104
event, such as smoke or chemical fume inhalation. This inflammation can
also result from chronic toxic exposure, such as cigarette smoking. It is
important to realize that when underlying inflammation is present, such as in
asthmatics or smokers, infective agents are likely to cause more severe
cough and wheezing.
The role of nurses as well as student nurses as health care providers is

indeed important in order to attain the optimum level of wellness of all
clients. Suitable care must be carried out and health teachings must be
given to the client and/or relatives so that the needed care of the client is
not only bounded in the hospital rather could also be extended at home.
Thus, awareness of the disease condition will help the health care providers,
especially nurses. Enough information about diseases will help us to know
the proper interventions we can provide to our patients. It is important for
the health care provider to know the proper interventions and responsibilities
so that the patient will able to meet his/ her health needs.
Upon concluding this study, the group is fortunate enough to

understand the disease condition of the patient. It helped them to read more
topics about the patient’s condition and find ways to help the patient. It also
helped the group to understand different medications that the patient has,
and how it would affect the patient’s normal functioning. Through the case,
the student nurses were able to appreciate the value of preventing the risks
that may possibly arise from this condition and were able to gain everlasting
knowledge that will be sure of great help in rendering effective and
therapeutic care for future patients with the same case.
After having completed the said study, the group recommends the
study:
105
• to the patients who have such disease conditions that they may
become aware of the disease they have and provide appropriate self
care.
• to the health care providers especially nurses since they are the ones
who has direct interaction with the patient. Enough knowledge of the
health care providers will enable them to provide the correct
intervention for the patient.
VIII. Bibliography
BOOKS
• Seeley R.; Essentials of Anatomy and Physiology(6th edition); McGraw-
Hill;New York USA
• Doenger, et al. Nurse’s Pocket Guide (10th Edition); Schilling J. 2003
• Black, Joyce et al. Medical-Surgical Nursing. St. Louis Missouri. 2005
• Pilliteri, A., Maternal and Child Health Nursing: Care of the Childbearing ang
Childbearing Family (5th edition); Lippincott Williams and Wilkins.2007
WEB
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ANGELES UNIVERSITY FOUNDATION
COLLEGE OF NURSING
ANGELES CITY
Acute Bronchitis
SUBMITTED BY:
Bondoc, John Celestine
Group 54 BSN IV-14
SUBMITTED TO:
Elmer D. Bondoc R.N. M.N.
DATE:
June 29, 2009

Acute Bronchitis

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Acute Bronchitis

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I.

Acute bronchitis can be caused by contagious pathogens. In about half

Bronchitis may be indicated by an expectorating cough, shortness of

Acute bronchitis usually lasts a few days. It may accompany or closely

A. Current trends about the disaese condition

“Advance Toward Early Diagnosis Of Chronic Obstructive Pulmonary

Researchers in Finland are reporting identification of the first potential

American Chemical Society (2008, December 17). Advance Toward Early

B. Reasons for choosing such case for presentation

II. NURSING ASSESSMENT

Patient is a six-year old female, Filipino citizen and a Roman Catholic.

2. Pertinent Family History

Patient belongs to an extended type of family which is composed of

Patient’s Grandfather died due to Pulmonary Tubercolosis who lived

The family’s source of income comes from both parents. Patient’s

In terms of family's culture, beliefs and perceptions, the family consults

GRANDFATHER GRANDFATHER ( + ) GRANDMOTHER

As verbalized by Patient’s mother, she had her pre-natal visits in her

As stated by Patient’s mother, Patient was fully breastfed because she

Patient’s mother stated that Patient had completed his Immunization in

Growth and Development

4. History of Past Illnesses

Patient was hospitalized before in the same health institution with a

5. History of Present Illness

Initial Assessmant upon Admission (June 23 , 2009) – lifted from the

1st NPI ( June 24 , 2009)

CRANIAL NERVE PROCEDURE NORMAL ACTUAL

DIAGNOSTIC DATE INDICATION ANALYSIS AND

b.HEMATOCRI The 0.37 0.35-0.40 The result is normal

PRIOR TO THE PROCEDURE

DURING THE PROCEDURE

AFTER THE PROCEDURE

Diagnostic and Dates Indication Results

CHEST X-RAY Date ordered: To identify the Radiographic report

During the procedure

After the procedure

DIAGNOSTIC DATE INDICATIONS ANALYSIS AND

PRIOR TO THE PROCEDURE

DURING THE PROCEDURE

AFTER THE PROCEDURE

7. The EPIGLOTTIS is a flap of tissue that guards the entrance to the

15. The left lung is divided into two LOBES.

19. The smallest subdivisions of the bronchial tubes are called

Breathing is an active process - requiring the contraction of skeletal

The external intercostals plus the diaphragm contract to bring about

• Contraction of external intercostal muscles > elevation of ribs &

• Contraction of diaphragm > diaphragm moves downward > increases

• relaxation of external intercostal muscles & diaphragm > return of

Intra-alveolar pressure during inspiration & expiration

Role of Pulmonary Surfactant

Non-modifiable factors Modifable Factors

Infectious Microorganisms lodges in the

Bronchial epithelial injury

Production of Mucus from Epithelial Cells

Exudates Formation RALES

-Age (advance age/very young) -Malnutrition or poor immune

Infectious Microorganisms lodges in the

Bronchial epithelial injury

Production of Mucus from Epithelial Cells

Bronchial Edema RALES Release of

Bronchitis is an inflammation of the lining of your bronchial tubes, which

Acute bronchitis is a lower respiratory tract infection that causes reversible

True acute purulent bronchitis is characterized by infection of the bronchial