I.

Introduction

Bronchitis is a respiratory disease in which the mucous

membrane in the lungs' bronchial passages becomes inflamed.

As the irritated membrane swells and grows thicker, it narrows

or shuts off the tiny airways in the lungs, resulting in coughing

spells accompanied by thick phlegm and breathlessness. The

disease comes in two forms: acute (lasting less than 6 weeks)

and chronic (reoccurring frequently for more than two years). In

addition, people with asthma also experience an inflammation of

the lining of the bronchial tubes called asthmatic bronchitis.

Acute bronchitis is responsible for the hacking cough and

phlegm production that sometimes accompany an upper

respiratory infection. In most cases the infection is viral in origin,

but sometimes it's caused by bacteria. If you are otherwise in

good health, the mucous membrane will return to normal after

you've recovered from the initial lung infection, which usually

lasts for several days.

 Acute bronchitis is very common among both children and

adults. The disorder often can be treated effectively without

professional medical assistance. However, if you have severe or

persistent symptoms or if you cough up blood, you should see

your doctor. If you suffer from chronic bronchitis, you are at risk

for developing cardiovascular problems as well as more serious

lung diseases and infections, you should be monitored by a

doctor.

In relation to my patient he is having the acute bronchitis, I

used several nursing interventions and bedside care to improved

his health. I give the first priority to its airway clearance because

a lot of secretions being observed. I touched the history of the

patients condition that further more relate the illness that patient

suffered; further discussion and nursing interventions done to the

patient is emphasized on this study.

Studies have shown that there are major goals to be considered

for patients having Acute Bronchitis. It includes the improvement

or maintenance of normal breathing pattern, increase activity

tolerance, reduction of anxiety, adherence to the self-care, and

increase sense of power with decision making and absence of

complications.

During the assessment, the student nurse used the act of

collecting, organizing, validating and recording data about

patient’s health status through observing and interviewing the

patient/informants for within two days or two shifts.

The study focuses on the assessment data from the patient’s

major nursing diagnosis. It is limited also on imparting health

teachings with emphasis on the interventions and

recommendations to the patient.

II. PROFILE OF PATIENT

 Name: ?
 Addres: ?
 Sex: Male
 Birthdate: September 15, 2003
 Age: 6 year old
 Civil Status: single
 Religion: ?
 Date of Admission: May 26,2009
 Time of Admission: 10 PM
 Chief Complaint: cough, fever and loss of appetite
 Vital Signs upon Assessment:
 Temperature = 37.6 0C
 Pulse Rate = 80 beats per minute
 Respiratory Rate = 20 cycles per minute
 Blood Pressure = 80/60mmHg
 Admitting Diagnosis: Acute Bronchitis
 Admitting Physician: ?

HEALTH HISTORY

From the interview conducted with the mother of the baby,

she stated that she stayed in the hospital for only three days
after giving birth to ? at four months ?was admitted to Northern
Mindanao Medical center due to pneumonia. They stayed at the
hospital for seven days. Furthermore the mother concluded that ?
has completed his vaccination at the health center in their
vicinity.
HISTORY OF PRESENT ILLNESS

A week prior to admission, the patient experienced fever

and intermittent with cough productive, loss of appetite
prompted admission.PE findings are as follow: Temperature=
37.6C, Pulse Rate=80bpm, Respiratory Rate= 20cpm and weight=
16.9 kg.

III. DEVELOPMENTAL DATA

Robert Havighurst believed that learning is basic to life and

that people continue to learn throughout life. He described

growth and development as occurring during six stages, each

associated six to ten tasks to be learned.

Havighurst promoted the concept of developmental tasks in

the 1950’s. a developmental task is “a task which risks at or

about a certain period in the life of an individual, successful

achievement of which leads to his happiness and to success with

later tasks, while failure leads to unhappiness in the individual,

disapproval by society and difficulty with later tasks:.

(Havighurst 1972 p.2). At the early childhood, learning

physical skills necessary for ordinary games. Learning to get

along with age mates. Building wholesome attitudes toward

oneself as a growing organism. Learning on appropriate

masculine or feminine social role. Developing concepts

necessary for everyday living. Developing conscience, morality

and a scale of values. Achieving personal independence.

Developing attitudes toward social groups and institutions.

PSYCHOSOCIAL DEVELOPMENT

Initiative adds to autonomy the quality of undertaking,

planning, and attacking a task for the sake of being active and on

the move. The child is learning to master the world around him or

her, learning basic skills and principles of physics; things fall to

the ground, not up; round things roll, how to zip and tie, count

and speak with ease. 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.
COGNITIVE DEVELOPMENT

The Intuitive (4-7 years) stage is when children start employing

mental activities to solve problems and obtain goals but they are

unaware of how they came to their conclusions. For example a

child is shown 7 dogs and 3 cats and asked if there are more

dogs than cats. The child would respond positively. However

when asked if there are more dogs than animals the child would

once again respond positively. Such fundamental errors in logic

show the transition between intuitiveness in solving problems

and true logical reasoning acquired in later years.

MORAL DEVELOPMENT

According to Kohlberg, e-conventional level of moral reasoning is

especially common in children, although adults can also exhibit

this level of reasoning. Reasoners in the pre-conventional level

judge the morality of an action by its direct consequences. The

pre-conventional level consists of the first and second stages of

moral development and are purely concerned with the self in an

egocentric manner.
 In Stage one (obedience and punishment driven), individuals

focus on the direct consequences that their actions will have for

themselves. For example, an action is perceived as morally

wrong if the person who commits it gets punished. The worse the

punishment for the act is, the more 'bad' the act is perceived to

be. In addition, there is no recognition that others' points of view

are any different from one's own view. This stage may be viewed

as a kind of authoritarianism.
IV.ANATOMY AND PHYSIOLOGY

What is respiration?

Respiration is the act of breathing:

 inhaling (inspiration) - taking in oxygen

 exhaling (expiration) - giving off carbon dioxide

What makes up the respiratory system?

The respiratory system is made up of the organs involved in the

interchanges of gases, and consists of the:

 nose
 pharynx
 larynx
 trachea
 bronchi
 lungs

The upper respiratory tract includes the:

 nose
 nasal cavity
 ethmoidal air cells
 frontal sinuses
 maxillary sinus
 larynx
 trachea

The lower respiratory tract includes the:

 lungs
 bronchi
  alveoli

What are the functions of the lungs?

The lungs take in oxygen, which cells need to live and carry out
their normal functions. The lungs also get rid of carbon dioxide, a
waste product of the body's cells.

The lungs are a pair of cone-shaped organs made up of spongy,

pinkish-gray tissue. They take up most of the space in the chest,
or the thorax (the part of the body between the base of the neck
and diaphragm).

The lungs are enveloped in a membrane called the pleura.

The lungs are separated from each other by the mediastinum, an

area that contains the following:

 heart and its large vessels

 trachea (windpipe)
 esophagus
 thymus
 lymph nodes
 The right lung has three sections, called lobes. The left lung
has two lobes. When you breathe, the air:enters the body
through the nose or the mouth

 travels down the throat through the larynx (voice box) and
trachea (windpipe)

 goes into the lungs through tubes called main-stem bronchi

o one main-stem bronchus leads to the right lung and

one to the left lung

o in the lungs, the main-stem bronchi divide into smaller

bronchi

o and then into even smaller tubes called bronchioles

V.PATHOPHYSIOLOGY

Name of Patient: Vankenlee Lloren

Diagnosis: Acute Bronchitis___
Bronchitis means that the tubes that carry air to the lungs
(the bronchial tubes) are inflamed and irritated. When this
happens, the tubes swell and produce mucus. This makes you
cough.

Acute bronchitis usually comes on quickly and gets better

after 2 to 3 weeks. Most healthy people who get acute bronchitis
get better without any problems. See a picture of acute
bronchitis.

Viruses (corona virus, Heat and smoke inhalation

influenza virus)

The pathogens directly attach

the tracheobronchial tree.

Inflammation of tacheobronchial tree

The airways become inflamed and narrowed from

capillary dilatation, increased mucus production

Acute Bronchits
VI. MEDICAL MANAGEMENT

A. Medical Orders and Rationale

DOCTOR’S ORDER
January 23,2007
>Please admit under the
service of Dr. Fernandez
>Consent to care
>TPR every 4 hours
> Labs:
 CBC stat
 Urinalysis
> IVF= D5LR 500cc @ 60cc/hr
>monitor I and O shift
> diet: For age
> please refer AP
Meds: Paracetamol
RATIONALE
For legal purposes
To monitor and provide
baseline data of the patient
To determine any
abnormalities present in the
blood components.
To assess renal function
For continuous replacement of
the fluid
To monitor intake and output
VII. DIAGNOSTIC EXAMS

HEMATOLOGY
Date Ordered: 5-26-2009
Results Normal Values Implications
WBC 11.17 3.8-10.8 : infection
RBC 4.62 4.2-5.6
Hemoglobin 115 140-180 : hemorrhage,
anemia
Hematocrit 0.35 .40. – .54 : hemorrhage,
MCV 76 80-100 normal
MCH 25 pg/cell 27– 33 pg/cell normal
MCHC 33.g/dL 32– 36 g/dL normal
Platelet 156/mm3 150,000 – : infection, DIC
Count 400,000/mm3
Neutrophils 0.57 % .48– .73 % normal
Lymphocyte 0.37% .20– .45% normal
s
Monocytes 0.04% .00– .10 % normal
Eosinophils 0.02 % .00 – .05 % normal
Basophils 0.0 % .00– .020 % normal

URINALYSIS
5-29-09
Color: yellow
Sp.gravity:1.015
Sugar: negative
Pus cells: 7-13
Rbc:0-2
Mucus threads: moderate
Crystals: amorphous urates few
Bacteria: moderate

BLOOD CHEM
5-27-09
Creatinine: 0-6

CHEST P/A
5-27-09
Impression: left retrocardiac pneumonia

VIII. DRUG STUDY

 Generic Name  Cephalexin

 Brand Name  Biocef
 Date Ordered  5-26-09
 Classification  Cephalosporin
 Dosage/Route/  250 mg tid
Frequency
 Mechanism of  Inhibits bacterial cell wall
Action synthesis by binding to one or
more of the penicillin-binding
proteins
 Specific Indication  Treatment for bacterial
infections
 Contraindication  Hypersensitivity to
cephalosporin
 Adverse effect  diarrhea
 Nursing precaution  Modify dosage in patients with
with severe renal impairment.
 Calpol
Date Ordered 5-27-09
Classification Analgesic and antipyritics

Dosage/Route/ Frequency 5 ml q 4 hours

Mechanism of Action To relieve fever
Specific Indication Mild pain or fever
Contraindication Contraindicated in patient with
hypersensitivity to acetaminophen
Adverse effect Jaundice,rash, urticuria
Nursing precaution Liquid form is recommended for
children and for all patient who have
difficulty in swallowing.
NURSING SYSTEM REVIEW CHART

Name: X Date: 5-26-09

Vital Signs:
Pulse: 80 bpm Temp: 37.6 c Weight: 16.9kg
EENT:
□ impaired vision □ blind Swelling wound
[x] pain □ redden [X] drainage
□ gums □ hard of hearing □ deaf warm to touch
□ burning □ edema□ lesion □ teeth runny nose
Asses eyes, ears, nose vomiting
throat for abnormality □ no problem

RESP:
□ asymmetric [X] tachypnea abnormal breath sound
□ apnea [X] rales [X] cough □ barrel chest _____________________
□ bradypnea □ shallow □ rhonci _____________________
[X] Sputum □ diminished □ dyspnea __
□ orthopnea □ labored □ wheezing _____________________
Slightly flushed skin
□ pain □ cyanotic _____________________
Assess resp, rate, rhythm, depth, pattern, _____________________
breath sounds, comfort □ no problem

CARDIO VASCULAR
□ arrhythmia □ tachycardia □ numbness _____________________
□ diminished pulses □ edema [X] fatigue _____________________
□ irregular □ bradycardia [X] murmur
□ tingling □ absent pulses □ pain IV site
Asses heart sounds, rate rhythm, pulse, blood
pressure, circ., fluid retention, comfort
□ no problem

GASTRO INTESTINAL TRACT

□ obese □ distention □ mass
□dysphagia □ rigidly □ pain
Asses abdomen, bowel habits, swallowing,
bowel sounds, comfort [X] no problem
_____________________
GENITO-URINARY and GYNE _____________________
□ pain □ urine color □ vaginal bleeding _____________________
□ hermaturia □ discharge □ noctoria _____________________
Asses urine freq., color, control, odor, comfort _____________________
Gyn-bleeding, discharge [X] no problem
_____________________
NEURO
□paralysis □ stuporous □ unsteady □ seizures
□ lethartic □ comatose [X] vertigo □ tremors
□ confused □ vision □ grip
Asses motor function, sensation, LOC, strength, _____________________
Grip, galt, coordination, orientation, speech, _____________________
□ no problem

MUSCULOSKELETAL and SKIN _____________________

□ appliance □ stiffness □ itching □ petechiae _____________________
[X] hot □ drainage □ prosthesis □ swelling
□ lesion □ poor turgor □ cool □ deformity _____________________
□ wound □ rash □ skin color [X] flushed
□ atrophy [X] pain □ ecchymosis _____________________
□ diaphoretic □ moist
Asses mobility, motion. Galt, alignment, joint function pigmented scars
/skin color, texture, turgor, integrity □ no problem

NURSING ASSESSMENT II
SUBJECTIVE OBJECTIVE
COMMUNICATION
‫ٱ‬hearing loss Comments: ‫ٱ‬glasses ‫ٱ‬languages
“maulawon ‫ٱ‬contract lens ‫ٱ‬hearing
mna xa mao aide
dili kaayu R L
gatingog”. As Pupil size: 3mm ‫ٱ‬speech
verbalized by difficulties
the mother. Reaction: Pupils Equally
‫ٱ‬visual changes Rounded and Reactive
‫ٱ‬denied to Light
Accommodation
OXYGENATION
‫ٱ‬dyspnea Comments: Resp. ‫ٱ‬regular ‫ٱ‬irregular
“gahangos-
hangos gyud Describe:
na xa usahay”. RR-32cpm. Fast breath sounds
As verbalized and inspiratory rales.
by the mother.
‫ٱ‬smoking history
R : Symmetric
‫ٱ‬cough L: Symmetric
‫ٱ‬sputum
‫ٱ‬denied
CIRCULATION
‫ٱ‬chest pain Comments: Heart Rhythm ‫ٱ‬regular ‫ٱ‬irregular
“usahay Ankle edema: present
moriklamo xa
nga sakit iya
dughan”. As Pulse Car. Rad. DP Fem.
verbalized by R 78 94 64
the mother. L 76 96 65
‫ٱ‬leg pain
‫ٱ‬numbness of extremities Comments: Palpable and pulses
‫ٱ‬denied are within normal range.

NUTRITION ‫ٱ‬dentures ‫ٱ‬none

Diet : For age
‫ٱ‬N ‫ٱ‬V Comments: Full Partial With pt.
“nawala Upper ‫ٱ‬ ‫ٱ‬ ‫ٱ‬
mna iya Lower ‫ٱ‬ ‫ٱ‬ ‫ٱ‬
gana sa
pagkaon” As
verbalized
by the
mother.
Character
‫ٱ‬recent change in wt. &
appetite
‫ٱ‬swallowing difficulty
‫ٱ‬denied
ELIMINATION
Usual bowel pattern ‫ٱ‬urinary Comments: Bowel sounds:
freq. hyperactiv
-every morning ___________ e
‫ٱ‬constipation remedy His abdomen is
-hot prune juice ‫ٱ‬urgency Extremely soft to
date of last BM ‫ٱ‬dysuria Touch.(38cms.-AG)
‫ٱ‬diarrhea character Abdominal
‫ٱ‬hematuria Distention
_____________ ‫ٱ‬incontinence Present ‫ٱ‬yes ‫ٱ‬no
‫ٱ‬polyuria Urine: yellow;
‫ٱ‬foly in hazy 950 ml
place daily
‫ٱ‬denied

MGT. OF HEALTH & ILLNESS Briefly describe the pts. Ability

‫ٱ‬alcohol ‫ٱ‬denied to follow treatments for chronic
health problems.
‫ٱ‬SBElast Pap Smear The pt. was able to follow
LMP: N/A the medications prescribed by
 the physician.

SUBJECTIVE OBJECTIVE
SKIN INTEGRITY
‫ٱ‬dry Comments: ‫ٱ‬dry ‫ٱ‬cold ‫ٱ‬pale
“ga uga jud na ‫ٱ‬flushed ‫ٱ‬warm
iya panit”. As ‫ٱ‬moist ‫ٱ‬cyanotic
verbalized by
the mother. rashes, ulcers, decubitus
‫ٱ‬itching (describe size, location,
‫ٱ‬other drainage)
‫ٱ‬denied - NONE
ACTIVITY
‫ٱ‬convulsion Comments: ‫ٱ‬LOC and Orientation: Pt. is
“ok raman na xa oriented of time and space.
usahay kai lihuk Gait: ‫ٱ‬walker ‫ٱ‬cane ‫ٱ‬others
kaayu”.As
verbalizedby the ‫ٱ‬steady ‫ٱ‬unsteady
mother ‫ٱ‬sensory and motor losses in
‫ٱ‬dizziness face or extremities: NONE
‫ٱ‬limited motion of joints ‫ ٱ‬ROM limitations: NONE

Limitation in
ability to
‫ٱ‬ambulate
‫ٱ‬bath self
‫ٱ‬other
‫ٱ‬denied
COMFORT/SLEEP/AWAKE
‫ٱ‬pain ‫ٱ‬facialgrimaces
Comments: “ok ‫ٱ‬guarding
ra man pud iya ‫ٱ‬other signs of pain:
pagtulog”. As restlessness
verbalized by ‫ٱ‬siderail release form
the mother signed(60+yrs.): N/A
(heart/7scale)
‫ٱ‬nocturia
‫ٱ‬sleepdifficulties
‫ٱ‬denied

COPING
Occupation Observed non-verbal behavior:
Members of household. Mother NONE
and father
Most supportive person: The person & his Phone # that
parents and relatives can be reached anytime:
09058562446

SPECIAL PATIENT INFORMATION (use lead pencil)

_____Daily weight ______PT/OT_______

_____BP q Shift ______Irradiation
_____Neuro vs ______Urine Test____
_____CVP/SG. Reading_____ _______24 HR Urine
Collection

Date Diagnostic/ Date

ordered Laboratory done
Exams
5-26-09 Urinalysis 5-26-09
5-26-09 Hematology 5-26-09
IX.IDEAL NURSING MANAGEMENT

A. Ideal Nursing Management (NCP)

Nursing Diagnosis Intervention Rationale

Hyperthermia, INDEPENDENT:
related to upper  Monitor the >To serve as
respiratory tract patient’s vital baseline data.
infection sign. .
> To decrease
 Provide TSB temperature.
> To meet the
 Increase calories metabolic demand.
intake.

DEPENDENT: > To replace fluid

 Administer and electrolyte loss.
Intravenous Fluid
as ordered. > To reduce fever
 Administer
analgesics as
ordered by the
physician
X. Actual Nursing Management (SOAPIE)

S “init pa gihapon na xa gamay” as verbalized by the

mother

 Temp= 37.6
O  Slightly flushed skin

A Hyperthermia, related to upper respiratory tract

Infection

P At the end of 1hour the temperature of the patient

will be lowered

INTERVENTION RATIONALE
INDEPENDENT:
 Monitored patient’s >To serve as baseline
vital sign. data.
.
 TSB provided > To decrease
I temperature.
 Breakfast given with > To meet the metabolic
bread demand.

DEPENDENT:
 Administer
Intravenous Fluid as > To replace fluid and
ordered. electrolyte loss.

 Administer > To reduce fever

analgesics as
ordered by the
 physician

E After of one hour patient was able to have lower

temp. and able to comply all those medications
ordered by the physician.

XI. HEALTH TEACHINGS

The significant others was advised to comply

the prescribed medication regimen following
the prescribed dose, frequency, timing and
route necessary for his fast and effective
MEDICATIONS
treatment and recovery. Patient teachings
are also imparted, regarding on precaution
and side effects of the medications.

EXERCISE Not applicable

Proper compliance of the treatment regimen

TREATMENT should be followed as prescribed by the
doctor.

OUTPATIENT
FOLLOW UP Not applicable

Adviced the parents to offer foods rich in vit.

DIET C and intake of calorie should be increased
for metabolism.
XII. REFERRAL AND FOLLOW UP
Patients have always required detailed discharge
instruction to become proficient in special self-care needs when
they got home. As for my client,van, refer him for his regular
check up with his attending physician; Dr. Fernandez, and
arrange schedule of appointments regarding his follow up check
ups and his home medications.
Our client is also reminded of his medication regimen to
follow it carefully and promptly, and to report any signs of
adverse serious reactions. The mother was advice to offer fruits
and vegetables to promote body resistance.
XIII.BILIOGRAPHY
BOOK SOURCES:
 Huitt, W., & Hummel, J. (2003)
Piaget's theory of cognitive development. Educational
Psychology Interactive.
Valdosta, GA: Valdosta State University.

 Smeltzer, S; Medical Surgical Nursing; 10th Edition;

Lippincott Williams and Wilkins; 2004

 Kozier, B.; Fundamentals of Nursing; 7th Edition; Pearson

Education Corporated; First Lok Yang Road; Jurong;
Singapore

 Nettina, Sandra; et. al; The Lippincott Manual of Nursing

Practice; 7th Edition; George Washington University;
Lippincott Williams and Wilkins; Lippincott-Raven
Publishers; 1991

 Doyle, Rita M; et. al; Nursing 2006 Drug Handbook; 26 th

Edition; 323 Norristown Road, Suite 200; Lippincott Williams
& Wilkin