Case Study of Chronic Bronchitis

CASE STUDYOn

Chronic bronchitis

St. Paul University PhilippinesScholl of Health Sciences

Submitted by:Mary Anne Delos SantosIsle Erica C. Sto. Tomas

BSN 3

Submitted to:Ms. Shayne B. Santos, RN

(Clinical Instructor)

Nursing Health History

HISTORY OF PAST ILLNESS:

A.A. had his first hospitalization 9 months ago because of

the occurrence of his chronic bronchitis at Peoples

Emergency Hospital. He completed all his immunization. He

and his father consulted at the Barangay Health Station at

their place when he feels major complications like the

occurrence of his chronic bronchitis. He experienced

common illness such as fever and headache. According to

his father, there’s no known allergy on drugs and

medications.

HISTORY OF PRESENT ILLNESS:

Few hours prior to admission, A.A. was playing outside their

backyard with his friends. Then suddenly after a few

minutes, he experienced difficulty of breathing. Then his

father decided to be admitted at Saint Paul Hospital for

further examination. He was given a medical impression of

chronic bronchitis

PERSONAL AND SOCIAL HISTORY:

A.A. always plays outside their backyard with his friends.

After playing he will rest for an hour then take a bath.

FAMILY HISTORY:

Patient A.A has a family history of chronic bronchitis both in

the maternal and paternal sides. No history of Diabetes

Mellitus, Cancer and PTB were documented.

Gordon’s 11 Functional

Health Pattern1. Health Perception – Health Management

Before hospitalization:

SO perceives that his child is healthy because of his physical

appearance. SO manages the health of the child by giving in to the child’s

food preferences and daily activities. The SO gives initial action when

there are symptoms of illness.

During hospitalization:

SO verbalizes “He is aware that he is not in good condition

because he is in the hospital”. The SO manages the health of the patient

by following the orders of the attending physician to assist and give

comfort for the patient to have enough sleep and rest.

2. Nutrition Metabolic Pattern


The SO states that the patient usually eats 3 times a day and with

afternoon snacks and drinks 2 glasses of milk a day. He eats a lot of

vegetables like carrots, eggplant and malunggay and enough meat like

beef. He doesn’t have any allergies in food. She doesn’t have any difficulty

in swallowing and no food restriction. He drinks 6-8 glasses of water per

day and drinks milk two times a day. His weight is 25 kg and height is 43

in.


The child eats 3 times a day but with food restriction. His appetite

decreased and he eats only biscuits with soup. He drinks 4-6 glasses of

water per day. The SO states that “wala siyang ganang kumain,

nangangayayat na siya” His weight is 20 kg and height is 43 in.

3. Activity and Exercise


As the SO states, “My child spends most of the time watching TV

and performs only light exercises such as walking, running and playing

outside the house with his friends. The child brushes her teeth 3 times a

day but sometimes she can’t manage to brush. He takes a bath twice a

day.


Due to his present condition, his activity is limited from performing

vigorous exercises such as running. The child cannot manage to take a

bath and brush her teeth because of her condition. He doesn’t have any

musculoskeletal impairment, at times he roams around the hospital with

his father. He also noted that his child experiences difficulty in breathing.

4. Elimination Pattern


The child doesn’t have any problem on his elimination pattern. He

usually urinates 5-7 times a day without any difficulty. The color of his

urine is light yellow and no foul odor. He didn’t feel any pain in urination.

The child defecates once a day with semi formed brown color. SO states

that sometimes however, it is hard in consistency with dark color, which

generally depends on what he eats. He also experiences constipation and

diarrhea.


The child urinates 8-10 times in 24 hours, with yellow color

aromatic odor urine. The patient defecates once a day. “Pareho naman

yung kulay saka ung lambot ng tae niya. Wala namang pinagkaiba”, as

verbalized by the SO. The SO also states that her child perspires

profusely.

5. Rest and Sleep


The patient usually sleeps 8 to 9 hours a day and has his naps 2

hours during afternoon. He sleeps at 10 and wakes up at 7 in the morning.

There are some instances that the patient cannot sleep very well.


He sleeps at 11 and wakes up at 6 in the morning. His sleeping

pattern is irregular because of the frequent monitoring and administration

of drugs. He cannot sleep also because of environmental changes of his

surroundings.

6. Cognitive Perceptual


He is fan of reading books like story books. He was oriented to

time, place, events, and persons. He doesn’t have any problems with her

senses. He has no sensory deficit, he responds appropriately to verbal and

physical stimuli.


The client does not respond to questions asked to him because he

is irritated with the environment. The father also added that his child

experiencing shortness of breath.

7. Self-perception and Self concept


Father states that her child thought that he does not have any

disease because he can perform his ADL.


The client feels upset, unhappy and irritated due to his present

illness.

8. Role-relationship


The patient belongs to a nuclear type of family. He is pampered by

his grandparents especially his father. According to the mother the patient

likes to play with the children in the neighborhood.


The patient is not sociable with tantrums and difficult to get along

because of his present condition.

9. Coping- stress management


To cope up with stress he usually takes arrest and sleep during

afternoon. He relaxed all the time and plays toys like toy car. Father says,

“My child desires my presence always, he needs me as a companion and

comfort.


The Father says” Now that he is hospitalized he needs more

supervision and attention.

10.Sexuality reproductive

The patient was a boy and youngest among the five children of

Mr.A, all of them in the family were a masculine, his mother died when he

was still a baby. He plays toys that are for boys such as cars, trucks, and

“jollens”. He viewed his father a strong man because despite that their

mother was died when he was still a baby and he knows it.

11.Values and beliefs

He is a Roman Catholic who believes in God and a source of

strength. They are God fearing person. Their families respect the laws of

God. He always prays to ask help from above. They did not believe in

some superstitious belief such as “atang – atang.” They were not praising

the “rebulto” because they believe that God is a true person not a statue,

Gods knows that they have strong faith in Him. They also believe in “hilot”

because they know it can lessen the pain that they feel.

They believe in the presence of Christ in their everyday life and

believe that they will be healed by Him.

Anatomy and Physiology of

The Respiratory System

UPPER AIRWAY

Nose The nose is composed of an external and internal portion. The external

portion protrudes from the face and is supported by the nasal bones and cartilage. The anterior nares (nostrils) are the outside openings of the nasal cavities.

Major functions:• serves as passageway for air in pass to and from the lungs• filters impurities and aumalities and warms the air as it is inhaled• Responsible for olfaction because the olfactory receptors are

located in the nasal mucosa

Paranasal sinuses and mayolacrimal ducts This opening provokes a means of secretion of and mucous drainage into

the sinuses.

Turbinate bones (conchae) The turbinate bones or conchae (the name suggested by their shell-like

appearance) r adapted by shape and position to increase the mucous membranes surface of the nasal passages and to slightly obstruct the current of air flowing through them.

Provide a large surface area with a rich blood supply that warms and humidifies ambient air as it passes through this area.

Pharynx, or throat and adenoidsThe pharynx or throat is tubelike structure that connects the nasal and oral

cavities to the larynx. It is divided into three regions nasal, oral and laryngeal.Tha nasopharynx is located posterior to he nose and is above the soft

palate. The oropharynx houses the faucial or palatine tonsils. The laryngeal pharynx extends from the hyoid bone to the cricoid cartilage. The enyrance of the larynx is formed by the epiglottis.

The adenoids, or pharyngeal tonsils, are located in the roof of the nasopharynx. The throat is encircled by the tonsils, the adenoids, and other lymphoid tissue. These structures are important links in the chain of lymph nodes guarding the body which swings in and out to open and close the vocal cords by opening and closing the glottis.

Major function of the larynx:• serve as an airway between the pharynx and the trachea

The epiglottis protects the glottis by covering the entrance to the larynx during swallowing to prevent aspirations of fluid or food. The closing of the glottis also allows for an increase intrathroracic pressure, which is needed, for example in coughing or lifting.

LOWER AIRWAY

• Conducting airways (trachea, right and left main stem bronchi and bronchioles)• Respiratory units (respiratory bronchioles, alveolar ducts, and alveoli)

Functions providing passage way for an:• filtering• warming and humidifying functions

Trachea (windpipe)Trachea is a membranous tube that consists of connective tissue and

smooth muscles reinforce with 15-20 C-shaped pieces of cartilages. The adult trachea is about 14-16 cm in diameter. It begins immediately inferior to the cricoid cartilage of the larynx, projects through the mediastinum, and divides into the right and left primary bronchi at he level of the fifth thoracic vertebra.

The C-shaped cartilages from the anterior and lateral sides of the trachea, and they protect the trachea and maintain an open passageway for air. The posterior wall of the trachea has no cartilage and consists of a ligamentous membrane and smooth muscle.

The trachea is lined with pseudostratified columnar epithelium that contains numerous cilia and goblet cells. The cilia propel mucus produced by the goblet cells and foreign particles towards the larynx, where they enter the esophagus and are swallowed.

BronchiThe trachea divides into the left and right primary bronchi (windpipe)

because of the location of the heart in the thoracic cavity; the left primary bronchus is more horizontal than the right primary bronchus. The right primary bronchus is also shorter and wider because the right primary bronchus is more vertical than the left primary bronchus; foreign objects that enter the trachea usually lodge in the right primary bronchus. The primary bronchi extend from the trachea to the lungs. Like the trachea the primary bronchi are lined with pseudo stratified ciliated columnar epithelium and are supported by C-shaped cartilage rings.

• Hiluni-point of entry for bronchi vessels and nerves in each lung• Primary bronchi-branch several times to form the bronchial tree• Secondary bronchi-two in the left lung and three left lung, conduct any to each lobe. It also gives rise to many tertiary bronchi, which extend to the lobules of the lung• Bronchioles (tertiary bronchi) subdivided numerous times to give rise to terminal bronchioles which then subdivide into respiratory bronchioles• Respiratory bronchioles (terminal bronchi) subdivides to form alveolar duct that end as cluster of air sacs called alveoli (hallow sacs)

AlveolasIs composed of single layer of sqaumus epithelium and an elastic

basement membrane. This membrane together with endothelial and basement layers adjacent capillary form the alveolar capillary membrane or interface. Assess this membrane diffusion of carbon dioxide and oxygen occurs.

Lungs The lungs are the principal organ of respiration. The lungs themselves are

subdivided into lobes the right lung has three lobes the upper middle and lower. The left lung has only two lobes upper and lower. Air conducted to each lobe through lobar bronchi the branch of the main stem bronchi.

Ventilation requires movements of the wall of the thoracic cage and of its floor the diaphragm. The effect of these movements is to alter rarely increase and decrease the capacity of the chest. When the capacity of the chest is increased there is lowered pressure within and nulates the lungs, air enters through the trachea (inspiration). When the chest wall and diaphragm return to their previous position, the lungs recoil and force air out through the bronchi and trachea (expiration)

PleuraThe thoracic cavity is lined with a continuous serious membrane known at

the pleura. One surface of it lines the inside of the rib cage (parietal pleura) and the outer surface (visceral pleura) covers the lungs. The space between the two surfaces is known as potential space. It normally contains a few milliliters of serous fliud that prevents friction rub when the two surfaces come together

Respiratory musclesThe major function of the respiratory muscles is to pump air in and out of

the lungs/ the primary muscles of inspiration include the diaphragm, the external intercostals, the internal parasternal intercostals, and the scalene muscles. Accessory muscles that are used when breathing is labored include the sternocleidomastoids pectoralis major and minor trapezu, and laryngeal muscles.

FUNCTIONS OF THE RESPIRATORY SYSTEM• Oxygen transport• Respiration• Ventilation

Oxygen Delivery SystemThe primary function of the respiratory system is to supply the blood with

oxygen in order for the blood to deliver oxygen to all parts of the body. The respiratory system does this through breathing. When we breathe, we inhale oxygen and exhale carbon dioxide. This exchange of gases is the respiratory system's means of getting oxygen to the blood. Respiration is achieved through the mouth, nose, trachea, lungs, and diaphragm. Oxygen enters the respiratory system through the mouth and the nose. The

oxygen then passes through the larynx (where speech sounds are produced) and the trachea which is a tube that enters the chest cavity. In the chest cavity, the trachea splits into two smaller tubes called the bronchi. Each bronchus then divides again forming the bronchial tubes. The bronchial tubes lead directly into the lungs where they divide into many smaller tubes which connect to tiny sacs called alveoli. The average adult's lungs contain about 600 million of these spongy, air-filled sacs that are surrounded by capillaries. The inhaled oxygen passes into the alveoli and then diffuses through the capillaries into the arterial blood. Meanwhile, the waste-rich blood from the veins releases its carbon dioxide into the alveoli. The carbon dioxide follows the same path out of the lungs when you exhale.

The diaphragm's job is to help pump the carbon dioxide out of the lungs and pull the oxygen into the lungs. The diaphragm is a sheet of muscles that lies across the bottom of the chest cavity. As the diaphragm contracts and relaxes, breathing takes place. When the diaphragm contracts, oxygen is pulled into the lungs. When the diaphragm relaxes, carbon dioxide is pumped out of the lungs.

Drug StudySalbutamolClassification:

Bronchodilator

Action: Relaxes bronchial, uterine and vascular smooth muscle by stimulating

beta-receptors

Indications: To prevent a treat bronchospasm in patients with reversible obstructive

airway disease. To prevent exercise – induced bronchospasm

Contraindications: Contraindicated to patients hypertensive to drug. Use cautiously to patients with CV disorders Use extended-release tablets cautiously in patients with GI narrowing

Nursing Considerations: Drug may decrease sensitivity of spirometry used for diagnosis of asthma Syrup may be taken by children as young as age 2. Monitor patient closely to signs and symptoms of toxicity.

Paracetamol Classification:

Antipyretic

Action: Unknown. Thought to produce analgesia by blocking pain impulses by

inhibiting synthesis of prostaglandin in the CNS or of other substances that sensitize pain reception to stimulation.

The drug may relieve fever through central action in the hypothalamic heat – regulating center

Indication Indicated for patient with:

Mild pain Fever

Contraindication: Contraindicated in patient hypertensive to drug Use cautiously in patient with longer term alcohol use because

therapeutic doses cause hapatoxicity in these patient

Nursing Considerations: Alert: Many OTC and prescription product contain acetaminophen be aware of this when calculating total daily dose Use liquid from for children and patient who have difficulty swallowingIn children, don’t exceed five dozer in 24 ho

Albuterol SulfateClassification:

Bronchodilator

Actions: Relaxes bronchial and uterine smooth muscle by acting on beta2-

adrenergic receptors

Dosage: 0.1 mg/kg P.O. t.i.d.,not to exceed 2 mg (1 teaspoonful) t.i.d

Adverse reactions: CV: tachycardia, palpitations, hypertension EENT: drying and irritation of nose and throat (with inhaled form) GI: heartburn, nausea, vomiting

Nursing considerations: Use cautiously in cardiovascular disorders, including coronary

insufficiency and hypertension Warn patient about the possibility of paradoxical bronchospasm. If this

occurs, the drug should be discontinue immediately Albuterol reportedly produces less cardiac stimulation than other

sympathomimetics, esp iso proterenol

AmoxicillinBrand Names:

Amoxil, Wymox, Augmentin

Classification: Antibiotic

Actions: Amoxicillin, an antibiotic drug used to treat infection. It has many uses,

including the treatment of respiratory, ear, and skin infections, as well as urinary or genital infections and gonorrhea. Amoxicillin works by preventing invading bacteria from multiplying in the body.

Side effects: Anemia, anxiety or hyperactivity, confusion, diarrhea, dizziness, hives,

insomnia, nausea, skin rash, or vomiting. Indications of an allergic reaction to amoxicillin may include fever, itching, joint pain, swollen lymph nodes, skin rash, genital sores, or bruising. Amoxicillin interacts negatively with several common prescription drugs; a doctor’s approval should be obtained before taking amoxicillin with other prescriptions.

Dosage: The typical adult dose is 259 mg taken every eight hours with or without

food. Dosages for children are determined by body weight, although children

over 20 kg (44 lb) can take adult dosages.

Nursing considerations: Amoxicillin must be prescribed by a doctor. It is available in tablets, capsules, and liquid form, all of which are taken

orally. Larger doses are prescribed for certain infections, such as gonorrhea. The drug starts to work within one to two hours of treatment. Because some infections can reappear in more harmful forms if not

completely eliminated, this drug should be taken for the full length of time prescribed by a doctor, even after symptoms disappear.

Amoxicillin should not be used by patients who are allergic to penicillin antibiotics.

It also may interfere with routine tests used to monitor diabetes. Patients with asthma, colitis, diabetes, allergies (such as hay fever or

hives), liver disease, or kidney disease should advise their doctor of these conditions before taking this drug, in order to determine whether the benefits of amoxicillin exceed any potential risk.

This is also true for pregnant or nursing women.

Documents

Case Study of Chronic Bronchitis