Case Study of Bronchitis

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Bataan Peninsula State

Bataan Peninsula State University

University

II

nstitute of Nursing &

nstitute of Nursing & Midwifery

Midwifery

Orani Campus,

Campus of Courtesy

CASE

STUDY

Of

Acute

Bronchitis

Presented by:

Group 18 – MTW

Santos, John Kenneth

Galicia, Lorryleen

Lagman, Kimberly

Cruz, Lindon

Torres, Michelle

Bautista, Renae

Sapno, Lovely

Mungcal, Precious Kate

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Macatulad, Reymark

Gabon, Jesusa

Cortez, Jennifer

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Bronchitis Overview Bronchitis Overview Bro

Bronchnchitiitis s is is an an acuacute te infinflamlammatmation ion of of the the air air paspassagesages s wiwithithin n thethe lungs. It occurs when the trachea (windpipe) and the large and small lungs. It occurs when the trachea (windpipe) and the large and small br

brononchchi i (ai(airwrwayays) s) wiwiththin in ththe e lulungngs s bebecocome me ininflflamamed ed bebecacaususe e of of infection or other causes.

infection or other causes.

•

• The thin mucous lining of these airways can The thin mucous lining of these airways can become irritated andbecome irritated and swollen.

swollen. •

• The cells that make up this lining may leak fluids in response to The cells that make up this lining may leak fluids in response to the inflammation.

the inflammation. •

• CoCougughihing ng is is a a rereflflex ex ththat at woworkrks s to to clcleaear r sesecrcretetioions ns frfrom om ththee lungs. Often the discomfort of a severe cough leads you to seek lungs. Often the discomfort of a severe cough leads you to seek medical treatment.

medical treatment. •

• BoBoth th adadulults ts anand d chchilildrdren en cacan n geget t brbrononchchititisis. . SySympmptotoms ms araree similar for both.

similar for both. •

• InInfafantnts s usuusualally ly geget t brbrononchchioiolilititis, s, whwhicich h ininvovolvlves es ththe e smsmalallelerr airways and causes symptoms similar to

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Bronchitis Causes

Bronchitis occurs most often during the cold and flu season, usually Bronchitis occurs most often during the cold and flu season, usually coupled with an upper

coupled with an upper respiratory infection.respiratory infection. •

• SevSevereral al virviruseuses s caucause se brobronchnchitiitis, s, incincludluding ing infinflueluenza nza A A and and B,B, commonly referred to as "the flu."

commonly referred to as "the flu." •

• A number of bacteria are also known to cause bronchitis, such asA number of bacteria are also known to cause bronchitis, such as Mycoplasma pneumoniae

Mycoplasma pneumoniae, , whwhicich h cacaususes es soso-c-calalleled d “w“walalkikingng pneumonia”.

pneumonia”. •

• BrBronconchithitis is alsalso o can can occoccur ur whewhen n you you inhinhale ale irirritritatiating ng fumfumes es oror dusts. Chemical solvents and smoke, including tobacco smoke, dusts. Chemical solvents and smoke, including tobacco smoke, have been linked to a

have been linked to acute bronchitis.cute bronchitis. •

• People at increased risk both of getting bronchitis and of havingPeople at increased risk both of getting bronchitis and of having more severe symptoms include the elderly, those with weakened more severe symptoms include the elderly, those with weakened immune systems, smokers, and anyone with repeated exposure immune systems, smokers, and anyone with repeated exposure to lung irritants.

to lung irritants.

Bronchitis Symptoms

Acu

Acute te brobronchnchitiitis s mosmost t comcommonmonly ly occoccurs urs aftafter er an an uppupper er rerespispiratratoryory infection such as the common cold or a sinus infection. You may see infection such as the common cold or a sinus infection. You may see symptoms such as fever with chills, muscle aches, nasal congestion, symptoms such as fever with chills, muscle aches, nasal congestion, and sore throat.

and sore throat. •

• Cough is a common symptom of bronchitis. The cough may beCough is a common symptom of bronchitis. The cough may be dr

dry y or or mamay y prprododucuce e phphlelegmgm. . SiSigngnifificicant ant phphlelegm gm prprododucuctitionon suggests that the lower respiratory tract and the lung itself may suggests that the lower respiratory tract and the lung itself may be infected, and you may have pneumonia.

be infected, and you may have pneumonia. •

• The cough may last for more than two weeks. Continued forceful The cough may last for more than two weeks. Continued forceful cou

coughighing ng may may makmake e youyour r chechest st and and abdabdomiominal nal musmusclecles s sorsore.e. Coughing can be severe enough at times to injure the chest wall Coughing can be severe enough at times to injure the chest wall or even cause you to pass out.

or even cause you to pass out. •

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

This may leave you short of breath. When to call the doctor

When to call the doctor

Although most cases of bronchitis clear up on their own, some people Although most cases of bronchitis clear up on their own, some people may have complications that their doctor

may have complications that their doctor can ease.can ease. •

• SeSevevere re cocougughihing ng ththat at ininteterfrfereres es wiwith th rerest st or or slsleeeep p cacan n bebe reduced with prescription cough medications.

reduced with prescription cough medications. •

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

Ventolin), which dilates the airways. •

• If fever continues beyond four to five days, see the doctor for aIf fever continues beyond four to five days, see the doctor for a physical examination to rule out pneumonia.

physical examination to rule out pneumonia. •

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

sputum, or an increased amount of green phlegm. When to go to the hospital

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•

• If If the the patpatienient t expexperieriencences es difdifficficultulty y brebreathathing ing wiwith th or or witwithouhoutt wheezing and they cannot reach their doctor, go to a hospital's wheezing and they cannot reach their doctor, go to a hospital's emergency department for evaluation and

emergency department for evaluation and treatment.treatment.

Exams and Tests

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

physical examination. •

• Usually no blood tests are necessary.Usually no blood tests are necessary. •

• If the doctor suspects the patient has pneumonia, a chest x-rayIf the doctor suspects the patient has pneumonia, a chest x-ray may be ordered.

may be ordered. •

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

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

a sample of phlegm coughed up to look for bacteria.

Self-Care at Home

•

• By By fafar, r, ththe e mamajojoririty ty of of cacaseses s of of brbrononchchititis is ststem em frfrom om vivirarall infections. This means that most cases of bronchitis are infections. This means that most cases of bronchitis are short-term and require nothing more than treatment of symptoms to term and require nothing more than treatment of symptoms to relieve discomfort.

relieve discomfort. •

• Antibiotics will not cure a viral illness.Antibiotics will not cure a viral illness. •

• Experts in the field of infectious disease have been warning forExperts in the field of infectious disease have been warning for yea

years rs thathat t oveoverusruse e of of antantibiibiotiotics cs is is allallowiowing ng manmany y bacbacterteria ia toto become resistant to the antibiotics available.

become resistant to the antibiotics available. •

• Doctors often prescribe antibiotics because they feel pressuredDoctors often prescribe antibiotics because they feel pressured by people's expectations to receive them. This expectation has by people's expectations to receive them. This expectation has been fueled by both misinformation in the media and marketing been fueled by both misinformation in the media and marketing by drug companies. Don't expect to receive a prescription for an by drug companies. Don't expect to receive a prescription for an antibiotic if your infection is caused by a virus.

antibiotic if your infection is caused by a virus. •

• Acetaminophen (Feverall, Panadol, Tylenol), aspirin, or ibuprofenAcetaminophen (Feverall, Panadol, Tylenol), aspirin, or ibuprofen (Motrin, Nuprin, Advil) will help with fever and

(Motrin, Nuprin, Advil) will help with fever and muscle aches.muscle aches. •

• Drinking fluids is very important because fever causes the bodyDrinking fluids is very important because fever causes the body to lose fluid faster. Lung secretions will be thinner and easier to to lose fluid faster. Lung secretions will be thinner and easier to clear when the patient is well

clear when the patient is well hydrated.hydrated. •

• A cool mist vaporizer or humidifier can help decrease bronchialA cool mist vaporizer or humidifier can help decrease bronchial irritation.

irritation. •

• AAn n ovoverer-t-thehe-c-cooununteter r cocougugh h susupppprresessasant nt mmay ay be be hehellpfpfulul.. Pre

Preparatiparations ons with with guaifeguaifenesin nesin (Rob(Robitussiitussin, n, BreoBreonesinnesin, , MuciMucinex)nex) will loosen secretions; dextromethorphan-the "DM" in most over will loosen secretions; dextromethorphan-the "DM" in most over the

the coucountenter r medmedicaicatiotions ns (Be(Benylnylin, in, PerPertustussinsin, , TroTrocalcal, , ViVicks cks 4444)) suppresses cough.

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Medical Treatment Medical Treatment

Treatment of bronchitis can differ depending on the suspected cause. Treatment of bronchitis can differ depending on the suspected cause.

•

• MeMedidicacatitionons s to to hehelp lp susuppppreress ss ththe e cocougugh h or or lolooseosen n and and clcleaearr secretions may be helpful. If the patient has severe coughing secretions may be helpful. If the patient has severe coughing sp

spelells ls ththey ey cancannonot t cocontntrorol, l, sesee e ththe e dodoctctor or fofor r prpresescrcripiptitionon strength cough suppressants. In some cases only these stronger strength cough suppressants. In some cases only these stronger cough suppressants can stop a vicious cycle of coughing leading cough suppressants can stop a vicious cycle of coughing leading to more irritation of the bronchial tubes, which in turn causes to more irritation of the bronchial tubes, which in turn causes more coughing.

more coughing. •

• BrBronconchodhodilailator tor inhinhalealers rs wilwill l helhelp p opeopen n airairwayways s and and decdecreareasese wheezing.

wheezing. •

• Though antibiotics play a limited role in treating bronchitis, they Though antibiotics play a limited role in treating bronchitis, they become necessary in some situations.

become necessary in some situations. •

• In In papartrticiculularar, , if if ththe e dodoctctor or sususpspecects ts a a babactctereriaial l ininfefectctioion,n, antibiotics will be prescribed.

antibiotics will be prescribed. •

• People with chronic lung problems also usually are treated withPeople with chronic lung problems also usually are treated with antibiotics.

antibiotics. •

• In rare cases, the patient may be hospitalized if they experienceIn rare cases, the patient may be hospitalized if they experience br

breaeaththining g didifffficicululty ty ththat at dodoesesn'n't t rerespospond nd to to trtreaeatmtmenent. t. ThThisis us

usuaualllly y ococcucurs rs bebecacaususe e of of a a cocompmplilicatcatioion n of of brbrononchchititisis, , nonott bronchitis itself.

bronchitis itself. Follow-up

Follow-up •

• The patient should follow up with their doctor within a week after The patient should follow up with their doctor within a week after treatment for bronchitis—sooner if your symptoms worsen or do treatment for bronchitis—sooner if your symptoms worsen or do not improve.

not improve. •

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

Prevention •

• Stop smoking.Stop smoking. •

• Avoid exposure to irritants. Proper protection in the workplace isAvoid exposure to irritants. Proper protection in the workplace is vital to preventing exposure.

vital to preventing exposure. •

• T The he dadangngerers s of of sesecocondndhahand nd smsmokoke e arare e wewell ll dodocucumementnteded.. Children should never be exposed to secondhand smoke inside Children should never be exposed to secondhand smoke inside the home.

the home. Outlook

Outlook

Nearly all cases of

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

• In In ththe e cacase se of of brbrononchchititis is cacausused ed by by exexpoposusure re to to rerespispiraratotoryry irritants, all the patient may need to do is keep away from the irritants, all the patient may need to do is keep away from the cause of irritation.

cause of irritation. •

• Smoking cessation is recommended to prevent development of Smoking cessation is recommended to prevent development of c

chrhrononic ic brbrononcchihititis s or or ototheher r chchrrononiic c llunung g didiseseasase e susucch h asas emphysema. Chronic bronchitis, as its name suggests, can cause emphysema. Chronic bronchitis, as its name suggests, can cause symptoms for prolonged periods and lead to other debilitating symptoms for prolonged periods and lead to other debilitating lung conditions.

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Name: Mrs. E.M.

Address: Banawang, Bagac, Bataan

Phone no: NN

Age: 51 y/o

Birthdate: June, 5 1958

Birthplace: San Fernando, La Union

Gender: Female

Marital Status: Married

Nationality: Filipino

Religion: Catholic

Occupation: Housewife

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Physical Assessment

T

Teecchhnniiqquue e NNoorrmmaal l FFiinnddiinnggs s AAbbnnoorrmmaall Findings Findings Skin

Skin InspectionInspection Palpation Palpation

•

• Skin is brown andSkin is brown and

generally equal generally equal

•

• No edemaNo edema •

• Good skin turgorGood skin turgor •

• No lesionNo lesion •

• Temp. is warm & Temp. is warm &

cool cool

•

• NoneNone

Nails

Nails InspectionInspection •• Clean, smoothClean, smooth •

• Pink to lightPink to light

brown nail beds brown nail beds

•

• NoneNone

Hair

Hair InspectionInspection •• No lesionNo lesion • • No dandruff No dandruff • • Even inEven in distribution distribution • • NoneNone Head

Head InspectionInspection •• Symmetrical inSymmetrical in

movement & movement & position position • • Face isFace is symmetrical symmetrical • • NormocephalicNormocephalic • • NoneNone Eyes

Eyes InspectionInspection •• Symmetrical inSymmetrical in

position position

•

• Sclera is white &Sclera is white &

glossy glossy

•

• PERRLAPERRLA •

• Brisk reaction toBrisk reaction to

light light

•

• Pale conjunctivaPale conjunctiva

Ears

Ears InspectionInspection •• Equal in sizeEqual in size • • SymmetricalSymmetrical • • No swelling orNo swelling or discharges discharges Nose

Nose InspectionInspection Palpation Palpation • • SymmetricalSymmetrical • • No inflammationNo inflammation •

• Air can be felt inAir can be felt in

both nares both nares

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T

Teecchhnniiqquue e NNoorrmmaal l FFiinnddiinnggs s AAbbnnoorrmmaall Findings Findings Mouth & Throat

Mouth & Throat InspectionInspection •• Tongue is at Tongue is at

midline midline

•

• Cracked lipsCracked lips •

• Tongue is pale Tongue is pale •

• Dental cariesDental caries

present present

•

• Missing toothMissing tooth

Neck

Neck InspectionInspection Palpation Palpation

•

• Symmetrical withSymmetrical with

normal ROM normal ROM

•

• No jugular veinNo jugular vein

distention distention

•

• Trachea is visible Trachea is visible

at the midline at the midline

•

• No noduleNo nodule •

• Lymph nodes areLymph nodes are

not palpable not palpable

•

• NoneNone

Breast & Axilla

Breast & Axilla InspectionInspection Palpation Palpation

•

• One breast isOne breast is

slightly larger slightly larger • • No nippleNo nipple discharge discharge • • No massesNo masses •

• No lymph nodesNo lymph nodes

palpated palpated

•

• NoneNone

Chest

Chest InspectionInspection Palpation Palpation Auscultation Auscultation

•

• Normal contourNormal contour •

• Tactile fremitus Tactile fremitus •

• Bronchial breathBronchial breath

sounds sounds

•

• Limited chestLimited chest

excursion excursion Heart

Heart AuscultationAuscultation _•_• _{S1 & S2 heard}_{S1 & S2 heard} upon upon auscultation auscultation • • NoneNone Abdomen

Abdomen InspectionInspection •• Color isColor is

consistent with consistent with the body

the body

•

• No lesion or anyNo lesion or any

abnormal abnormal findings findings

•

• Bowel sounds isBowel sounds is

normo- active normo- active (13/min) (13/min) • • No tendernessNo tenderness Genitals

Genitals InterviewInterview •• No swelling orNo swelling or

discharges discharges

•

• No foul smellNo foul smell •

• No infestationNo infestation

•

• NoneNone

Extremities

Extremities InspectionInspection •• Norma hairNorma hair

distribution distribution • • No edemaNo edema • • No swellingNo swelling •

• Capillary refillCapillary refill

around 1-3 around 1-3 seconds seconds

•

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Human Respiratory System

Th

The e rerespispiratratory ory syssystem tem conconsistsists s of of all all the the orgorgans ans invinvolvolved ed inin breathing. These include the nose, pharynx, larynx, trachea, bronchi breathing. These include the nose, pharynx, larynx, trachea, bronchi and lungs. The respiratory system does two very important things: it and lungs. The respiratory system does two very important things: it brings oxygen into our bodies, which we need for our cells to live and brings oxygen into our bodies, which we need for our cells to live and function properly; and it helps us get rid of carbon dioxide, which is a function properly; and it helps us get rid of carbon dioxide, which is a waste product of cellular function. The nose, pharynx, larynx, trachea waste product of cellular function. The nose, pharynx, larynx, trachea and bronchi all work like a system of pipes through which the air is and bronchi all work like a system of pipes through which the air is fu

funnnneleled ed dodown wn ininto to ouour r lulungngs. s. ThTherere, e, in in vevery ry smsmalall l aiair r sasacs cs cacalllleded alveoli, oxygen is brought into the bloodstream and carbon dioxide is alveoli, oxygen is brought into the bloodstream and carbon dioxide is pushed from the blood out into the air. When something goes wrong pushed from the blood out into the air. When something goes wrong wi

with th pparart t of of ththe e rresespipirratatorory y sysyststemem, , susucch h as as aan n iinfnfecectition on lilikeke pneumonia, it makes it harder for us to get the oxygen we need and to pneumonia, it makes it harder for us to get the oxygen we need and to get

get ririd d of of the the waswaste te proproducduct t carcarbon bon diodioxidxide. e. ComCommon mon rerespispiratratoryory symptoms include breathlessness, cough, and chest pain.

symptoms include breathlessness, cough, and chest pain.

The Upper Airway and Trachea The Upper Airway and Trachea

When you breathe in, air enters your body through your nose or When you breathe in, air enters your body through your nose or mouth. From there, it travels down your throat through the larynx (or mouth. From there, it travels down your throat through the larynx (or voice box) and into the trachea (or windpipe) before entering your voice box) and into the trachea (or windpipe) before entering your lungs. All these structures act to funnel fresh air down from the outside lungs. All these structures act to funnel fresh air down from the outside world into your body. The upper airway is important because it must world into your body. The upper airway is important because it must

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

and warm the air before it reaches your lungs. The Lungs

The Lungs Structure Structure

The lungs are paired, cone-shaped organs which take up most of The lungs are paired, cone-shaped organs which take up most of the space in our chests, along with the heart. Their role is to take the space in our chests, along with the heart. Their role is to take oxygen into the body, which we need for our cells to live and function oxygen into the body, which we need for our cells to live and function properly, and to help us get rid of carbon dioxide, which is a waste properly, and to help us get rid of carbon dioxide, which is a waste product. We each have two lungs, a left lung and a right lung. These product. We each have two lungs, a left lung and a right lung. These ar

are e didivivideded d up up ininto to 'l'lobobeses', ', or or bibig g sesectctioions ns of of titissssue ue sesepapararateted d byby 'fissures' or dividers. The right lung has three lobes but the left lung 'fissures' or dividers. The right lung has three lobes but the left lung has only two, because the heart takes up some of the space in the left has only two, because the heart takes up some of the space in the left side of our chest. The lungs can also be divided up into even smaller side of our chest. The lungs can also be divided up into even smaller portions, called 'bronchopulmonary segments'.

portions, called 'bronchopulmonary segments'.

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

segment receives its own blood supply and air supply. How they work

How they work Ai

Air r enenteters rs yoyour ur lulungngs s ththrorougugh h a a sysyststem em of of pipipepes s cacalllled ed ththee bronchi. These pipes start from the bottom of the trachea as the left bronchi. These pipes start from the bottom of the trachea as the left and right bronchi and branch many times throughout the lungs, until and right bronchi and branch many times throughout the lungs, until they eventually form little thin-walled air sacs or bubbles, known as the they eventually form little thin-walled air sacs or bubbles, known as the alv

alveoleoli. i. The The alvalveoleoli i are are whewhere re the the imimporportantant t worwork k of of gas gas excexchanhangege takes place between the air and your blood. Covering each alveolus is takes place between the air and your blood. Covering each alveolus is a whole network of little blood vessel called capillaries, which are very a whole network of little blood vessel called capillaries, which are very small branches of the pulmonary arteries. It is important that the air in small branches of the pulmonary arteries. It is important that the air in the alveoli and the blood in the capillaries are very close together, so the alveoli and the blood in the capillaries are very close together, so that oxygen and carbon dioxide can move (or diffuse) between them. that oxygen and carbon dioxide can move (or diffuse) between them. So, when you breathe in, air comes down the trachea and through the So, when you breathe in, air comes down the trachea and through the bronchi into the alveoli. This fresh air has

bronchi into the alveoli. This fresh air has lots of oxygen in it, and lots of oxygen in it, and somesome of

of ththis is oxoxygygen en wiwill ll trtravavel el acacroross ss ththe e wawalllls s of of ththe e alalveveololi i ininto to yoyourur blo

bloodsodstrtreameam. . TraTravelveling ing in in the the oppopposiosite te dirdirectection ion is is carcarbon bon diodioxixide,de, which crosses from the blood in

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

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Blood Supply Blood Supply

The lungs are very vascular organs, meaning they receive a very The lungs are very vascular organs, meaning they receive a very lar

large ge bloblood od supsupplyply. . ThiThis s is is becbecause ause the the pulpulmonmonary ary artarterieries, es, whiwhichch supply the lungs, come directly from the right side of your heart. They supply the lungs, come directly from the right side of your heart. They carry blood which is low in oxygen and high in carbon dioxide into your carry blood which is low in oxygen and high in carbon dioxide into your lungs so that the carbon dioxide can be blown off, and more oxygen lungs so that the carbon dioxide can be blown off, and more oxygen can be absorbed into the bloodstream. The newly oxygen-rich blood can be absorbed into the bloodstream. The newly oxygen-rich blood then travels back through the paired pulmonary veins into the left side then travels back through the paired pulmonary veins into the left side of your heart. From there, it is pumped all around your body to supply of your heart. From there, it is pumped all around your body to supply oxygen to cells and organs.

oxygen to cells and organs. The Work of

The Work of BreathingBreathing The Pleurae

The Pleurae T

The he lulungngs s arare e cocoveverered d by by smsmooooth th memembmbraranenes s ththat at we we cacallll pleurae. The pleurae have two layers, a 'visceral' layer which sticks pleurae. The pleurae have two layers, a 'visceral' layer which sticks closely to the outside surface of your lungs, and a 'parietal' layer which closely to the outside surface of your lungs, and a 'parietal' layer which lines the inside of your chest wall (ribcage). The pleurae are important lines the inside of your chest wall (ribcage). The pleurae are important be

becacaususe e ththey ey hehelp lp yoyou u brbreaeaththe e in in and and ouout t smsmooooththlyly, , wiwiththouout t ananyy fr

fricictitionon. . ThThey ey alalso so mamake ke susure re ththat at whwhen en yoyour ur riribcbcagage e exexpanpands ds onon breathing in, your lungs expand as well to fill the extra space.

breathing in, your lungs expand as well to fill the extra space. The Diaphragm and

The Diaphragm and Intercostal MusclesIntercostal Muscles

When you breathe in (inspiration), your muscles need to work to When you breathe in (inspiration), your muscles need to work to fill your lungs with air. The diaphragm, a large, sheet-like muscle which fill your lungs with air. The diaphragm, a large, sheet-like muscle which stretches across your chest under the ribcage, does much of this work. stretches across your chest under the ribcage, does much of this work. At rest, it is shaped like a dome curving up into your chest. When you At rest, it is shaped like a dome curving up into your chest. When you breathe in, the diaphragm contracts and flattens out, expanding the breathe in, the diaphragm contracts and flattens out, expanding the space in your chest and drawing air into your lungs. Other muscles, space in your chest and drawing air into your lungs. Other muscles, including the muscles between your ribs (the intercostal muscles) also including the muscles between your ribs (the intercostal muscles) also help by moving your ribcage in and out. Breathing out (expiration) help by moving your ribcage in and out. Breathing out (expiration) does not normally require your muscles to work. This is because your does not normally require your muscles to work. This is because your lungs are very elastic, and when your muscles relax at the end of lungs are very elastic, and when your muscles relax at the end of

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ins

inspirpiratiation on youyour r lunlungs gs simsimply ply rerecoicoil l bacback k intinto o thetheir ir resrestinting g pospositiition,on, pushing the air out as they go.

pushing the air out as they go.

The Respiratory System Through the Ages The Respiratory System Through the Ages Breathing for the Premature Baby

Breathing for the Premature Baby

When a baby is born, it must convert from getting all of its When a baby is born, it must convert from getting all of its oxygen through the placenta to absorbing oxygen through its lungs. oxygen through the placenta to absorbing oxygen through its lungs. This is

This is a complicata complicated process, involved process, involving many ing many changechanges s in both in both air andair and blood pressures in the baby's lungs. For a baby born preterm (before blood pressures in the baby's lungs. For a baby born preterm (before 37 weeks gestation), the change is even harder. This is because the 37 weeks gestation), the change is even harder. This is because the ba

babyby's 's llunungs gs mamay y nonot t yyet et be be mmataturure e enenoougugh h to to cocope pe wwiith th tthehe transition. The major problem with a preterm baby's lungs is a lack of transition. The major problem with a preterm baby's lungs is a lack of somet

something called 'surfacthing called 'surfactant'. This is ant'. This is a a substasubstance producence produced d by cells inby cells in th

the e lulungngs s whwhicich h hehelplps s kekeep ep ththe e aiair r sasacscs, , or or alalveveololi, i, opopenen. . WiWiththououtt surfactant, the pressures in the lungs change and the smaller alveoli surfactant, the pressures in the lungs change and the smaller alveoli collapse.

collapse.

This reduces the area across which oxygen and carbon dioxide This reduces the area across which oxygen and carbon dioxide can be exchanged, and not enough oxygen will be taken in. Normally, can be exchanged, and not enough oxygen will be taken in. Normally, a

a fefetutus s wiwill ll bebegigin n prprododucucining g sursurfafactctanant t frfrom om ararouound nd 2828-3-32 2 weweekekss gestation. When a baby is born before or around this age, it may not gestation. When a baby is born before or around this age, it may not have enough surfactant to keep its lungs open. The baby may develop have enough surfactant to keep its lungs open. The baby may develop something called 'Neonatal Respiratory Distress Syndrome', or NRDS. something called 'Neonatal Respiratory Distress Syndrome', or NRDS.

Si

Signgns s of of NRNRDS DS ininclcludude e tatachchypypnonoea ea (v(verery y fafast st brbreaeaththining)g),, grunting, and cyanosis (blueness of the lips and tongue). Sometimes grunting, and cyanosis (blueness of the lips and tongue). Sometimes NRDS can be treated by giving the baby artificially made surfactant by NRDS can be treated by giving the baby artificially made surfactant by a tube down into the baby's

a tube down into the baby's lungs.lungs.

The Respiratory System and Ageing The Respiratory System and Ageing The normal proce

The normal process of ss of ageing is associateageing is associated d with a with a numbenumber r of changesof changes in both the structure and function of the respiratory system. These in both the structure and function of the respiratory system. These include:

include: •

• Enlargement of the alveoli. The air spaces get bigger and loseEnlargement of the alveoli. The air spaces get bigger and lose their elasticity, meaning that there is less area for gases to be their elasticity, meaning that there is less area for gases to be ex

exchchanganged ed acacrorossss. . ThThis is chchangange e is is sosomemetitimemes s rerefeferrrred ed to to asas 'senile emphysema'.

'senile emphysema'. •

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

that it takes more effort to breathe in and out. •

• Th The e strstrengength th of of the the resrespirpiratoatory ry musmusclecles s (th(the e diadiaphrphragm agm andand intercostal muscles) decreases. This change is closely connected intercostal muscles) decreases. This change is closely connected to the general health of the person.

to the general health of the person. Al

All l of of ththesese e chchanganges es memean an ththat at an an ololdeder r pepersrson on mimighght t hahave ve momorere difficulty coping with increased stress on

difficulty coping with increased stress on their respiratory system, suchtheir respiratory system, such as with an infection like pneumonia, than a younger person would.

(19)

(20)

Bronchitis

(21)

(22)

Amoxicillin Amoxicillin Generic Name:

Generic Name: AmoxicillinAmoxicillin Brand Name: Amoxil, Trimox Brand Name: Amoxil, Trimox Classification: Antibiotic

Classification: Antibiotic Mechanism of Action Mechanism of Action

Inhibits bacterial cell wall mucopeptide synthesis. Inhibits bacterial cell wall mucopeptide synthesis. Indication

Indication Us

Used ed to to trtreaeat t mamany ny didiffffererenent t tytypepes s of of ininfefectctioions ns cacausused ed byby bac

bacteteriria, a, sucsuch h as as eaear r ininfefectctioionsns, , blbladaddeder r ininfefectctioions, ns, pnpneueumomoninia,a, gonorrhea, and E. coli or salmonella infection.

gonorrhea, and E. coli or salmonella infection. Contraindication

Contraindication

Hypersensitivity to penicillins, cephalosporins, or imipenem. Not Hypersensitivity to penicillins, cephalosporins, or imipenem. Not used to treat severe pneumonia, empyema, bacteremia, pericarditis, used to treat severe pneumonia, empyema, bacteremia, pericarditis, meningitis, and purulent or septic a

meningitis, and purulent or septic arthritis during acute stage.rthritis during acute stage. Adverse Reaction:

Adverse Reaction: CNS:

CNS: Ag

Agititatatioion; n; anxanxieietyty; ; bebehavhavioioraral l chchanangeges; s; coconfnfususioion; n; coconvnvululsisionons;s; dizziness; headache; hyperactivity; insomnia.

dizziness; headache; hyperactivity; insomnia. Dermatologic:

Dermatologic: Acute

Acute genergeneralizalized ed exantexanthemathematous ous pustupustulosislosis; ; eryterythema hema multmultiforiforme;me; er

eryyththemematatouous s macumacullopopapapulular ar rrasashehes; s; exexfofolliaiatitivve e dederrmamatitititis;s; mu

mucococucutataneneouous s cacandndididiaiasisis; s; StStevevenens-s-JoJohnhnsoson n sysyndndroromeme; ; totoxixicc epidermal necrolysis; urticaria.

epidermal necrolysis; urticaria. GI:

GI: Di

Diararrhrhea ea (2(2%)%); ; nanaususea ea (1(1%)%); ; blblacack, k, hahairiry y totongngueue; ; hehemomorrrrhahagigicc pseudomembranous colitis; tooth discoloration;

pseudomembranous colitis; tooth discoloration; vomiting.vomiting. Genitourinary:

Genitourinary:

Crystalluria; vulvovaginal mycotic infection. Crystalluria; vulvovaginal mycotic infection. Hematologic-Lymphatic:

Hematologic-Lymphatic:

Agranulocytosis; anemia; eosinophilia; hemolytic anemia; leukopenia; Agranulocytosis; anemia; eosinophilia; hemolytic anemia; leukopenia; thrombocytopenia; thrombocytopenic purpura.

thrombocytopenia; thrombocytopenic purpura. Hepatic:

Hepatic: Acu

Acute te cytcytolyolytic tic hephepatiatitistis; ; chocholeslestattatic ic jaujaundindice; ce; hephepatiatic c chocholeslestastasis;is; increased ALT and AST.

increased ALT and AST. Hypersensitivity: Hypersensitivity:

Anaphylaxis; hypersensitivity vasculitis. Anaphylaxis; hypersensitivity vasculitis. Miscellaneous:

Miscellaneous:

Serum sickness–like reactions. Serum sickness–like reactions. Nursing

Nursing ResponsibilResponsibilitiesities Per

Periodiciodically ally assess assess renalrenal, , hepathepatic, ic, and and hemahematopoitopoietic etic functifunctionon during prolonged therapy. Patients diagnosed with gonorrhea should during prolonged therapy. Patients diagnosed with gonorrhea should have a serologic test for syphilis at the time of treatment and a have a serologic test for syphilis at the time of treatment and a follow-up serologic test after 3 months.

(23)

Paracetamol Paracetamol

Generic name: Paracetamol Generic name: Paracetamol Brand Names: Biogesic

Brand Names: Biogesic Classification:

Classification: Analgesic/AntipyrAnalgesic/Antipyreticetic Mechanism of Action

Mechanism of Action Par

Paraceacetamtamol ol pospossessesses ses propromiminennent t antantipyipyretretic ic and and anaanalgelgesicsic ef

effefectcts. s. ItIts s anantiti-i-infnflalammmmatatorory y acactitivivity ty is is weweak ak and and hahas s no no clclininicicalal significance. The mechanism of action is related to depression of the significance. The mechanism of action is related to depression of the p

prroossttaaggllaannddiin n sysynntthheessiis s bby y iinnhhiibbiittiioon n oof f tthhe e ssppeecciiffiic c cecellll cyclooxygenase, and depression of the thermoregulatory center in the cyclooxygenase, and depression of the thermoregulatory center in the med

medullulla a obloblongongata. ata. InhInhibiibits ts proprostastaglaglandindins ns in in CNSCNS, , but but laclacks ks antanti- i-inflammatory effects in periphery; reduces fever through direct action inflammatory effects in periphery; reduces fever through direct action on hypothalamic heat-regulating center.

on hypothalamic heat-regulating center. Indications

Indications

The preparation is indicated in diseases manifesting with pain The preparation is indicated in diseases manifesting with pain and fever: headache, toothache, mild and moderate postoperative and and fever: headache, toothache, mild and moderate postoperative and inj

injury ury paipain, n, highigh h temtemperperatuature, re, infinfectectiouious s disdiseaseases es and and chichilllls s (ac(acuteute catarrhal inflammations of the upper respiratory tract, flu, small-pox, catarrhal inflammations of the upper respiratory tract, flu, small-pox, p

paarroottiittiiss, , eettcc..)).. Contraindications

Contraindications

Paracetamol should not be used

Paracetamol should not be used in hypersensitivity to thein hypersensitivity to the preparation and in

preparation and in severe liver diseases.severe liver diseases. Adverse reactions

Adverse reactions In

In rarrare e cascases es hyphyperersensensitsitiviivity ty rereactactionions, s, prepredomdominainantlntly y skiskinn allergy (itching and rash), may appear. Long-term treatment with high allergy (itching and rash), may appear. Long-term treatment with high dose

doses s may may caucause se a a toxtoxic ic hephepatiatitis tis wiwith th folfollowlowing ing iniinitiatial l symsymptoptoms:ms: na

nauusesea, a, vovommiititingng, , swsweaeatitingng, , aand nd didiscscomomfoforrtt. . OOccccasasioionanallly ly aa gastrointestinal discomfort may be seen.

gastrointestinal discomfort may be seen. Nursing

Nursing ResponsibilResponsibilitiesities

The preparation should be used with care in patients with liver The preparation should be used with care in patients with liver and renal diseases. The treatment with Paracetamol may change the and renal diseases. The treatment with Paracetamol may change the laboratory tests of uric acid and blood glucose analysis. In severe renal laboratory tests of uric acid and blood glucose analysis. In severe renal fai

failurlure e the the intinterverval al betbetweween en two two conconsecsecutiutive ve taktakingings s shoshould uld not not bebe sho

shortrter er ththan an 8 8 hohoururs. s. ThThe e trtreateatmement nt wiwith th ththe e prprepepararatatioion n is is nonott advisable during the first trimester of the pregnancy. In nursing women advisable during the first trimester of the pregnancy. In nursing women th

the e prprepepararatatioion n shshouould ld be be usused ed wiwith th ststririctctly ly obobseservrvatatioion n of of ththee therapeutic dose and duration of the treatment.

(24)

Ambroxol Ambroxol

Generic Name: Ambroxol Generic Name: Ambroxol Brand Name: Mucosulvan Brand Name: Mucosulvan Classification:

Classification: Expectorant/AntibiotExpectorant/Antibioticic Mechanism of Action

Mechanism of Action

When administered orally onset of action occurs after about 30 When administered orally onset of action occurs after about 30 minutes. The breakdown of acid mucopolysaccharide fibers makes the minutes. The breakdown of acid mucopolysaccharide fibers makes the sputum thinner and less viscous and therefore more easily removed by sputum thinner and less viscous and therefore more easily removed by coughing. Although sputum volume eventually decreases, its viscosity coughing. Although sputum volume eventually decreases, its viscosity remains low for as long as treatment is maintained.

remains low for as long as treatment is maintained. Indication

Indication Al

All l foformrms s of of trtracacheheobobroroncnchihititis, s, ememphphysysemema a wiwith th brbrononchchititisis pn

pneueumomococoniniososisis, , chchroroninic c ininflflamammamatotory ry pupulmlmononarary y cocondndititioionsns,, bronc

bronchiechiectasis, tasis, broncbronchitis hitis with with bronbronchospaschospasm m asthmasthma. a. DurinDuring g acuteacute exa

exacecerbarbatiotions ns of of brobronchnchitiitis s it it shoshould uld be be givgiven en witwith h the the apprappropropriatiatee antibiotic.

antibiotic.

Contraindication Contraindication

Th

Therere e are are no no absabsoluolute te concontratraindindicaicatiotions ns but but in in patipatientents s wiwithth gastric ulceration relative caution should be

gastric ulceration relative caution should be observed.observed. Adverse Reaction

Adverse Reaction Oc

Occascasioional nal gagaststroroininteteststininal al siside de efeffefectcts s mamay y ococcucur r bubut t ththesese e araree normally mild.

normally mild. Nursing

Observe respiratory rate and obtain baseline data. Check drug Observe respiratory rate and obtain baseline data. Check drug interactions if taking other medications.

interactions if taking other medications.

It is advisable to avoid use during the first trimester of pregnancy. It is advisable to avoid use during the first trimester of pregnancy.

(25)

Metoprolol Metoprolol

Generic Name: Metoprolol Generic Name: Metoprolol

Brand Name: Lopressor, Toprol-XL Brand Name: Lopressor, Toprol-XL Classification: Beta blocker

Classification: Beta blocker Mechanism of Action Mechanism of Action

Blocks beta receptors, primarily affecting CV system (decreases Blocks beta receptors, primarily affecting CV system (decreases heart rate, decreases contractility, decreases BP) and lungs (promotes heart rate, decreases contractility, decreases BP) and lungs (promotes bronchospasm).

bronchospasm). Indication

Indication

Metoprolol is used to treat angina (chest pain) and hypertension Metoprolol is used to treat angina (chest pain) and hypertension (high blood pressure). It is also used to treat or

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

Contraindication

You should not use this medication if you are allergic to metoprolol, You should not use this medication if you are allergic to metoprolol, or if you have a serious heart problem such as heart block, sick sinus or if you have a serious heart problem such as heart block, sick sinus syndrome, or slowheart rate. If you have any of these other conditions, syndrome, or slowheart rate. If you have any of these other conditions, yo

you u mamay y neneed ed a a dodose se adadjujuststmement nt or or spspececiial al teteststs s to to sasafefely ly ususee metoprolol:

metoprolol:



 pheochromocytoma; orpheochromocytoma; or



 problems with circulation (such as Raynaud's problems with circulation (such as Raynaud's syndrome);syndrome);



 congestive heart failure;congestive heart failure;



 asthma, bronchitis, emphysema;asthma, bronchitis, emphysema;



 diabetes;diabetes;



 low blood pressure; depression;low blood pressure; depression;



 liver or kidney disease;liver or kidney disease;



 a thyroid disorder; ora thyroid disorder; or



 myasthenia gravis.myasthenia gravis. Adverse Reaction

Adverse Reaction Cardiovascular: Cardiovascular:

Hypotension; edema; flushing; bradycardia (3%); palpitations; CHF; Hypotension; edema; flushing; bradycardia (3%); palpitations; CHF; arterial insufficiency; peripheral edema.

arterial insufficiency; peripheral edema. CNS:

CNS:

Headache; fatigue; dizziness (10%);

Headache; fatigue; dizziness (10%); depression (5%); lethargy;depression (5%); lethargy; drowsiness; forgetfulness; sleepiness (10%); vertigo; paresthesias. drowsiness; forgetfulness; sleepiness (10%); vertigo; paresthesias. Dermatologic:

Dermatologic:

Rash (5%); facial erythema; alopecia; urticaria; pruritus (5%). Rash (5%); facial erythema; alopecia; urticaria; pruritus (5%). EENT:

EENT:

Dry eyes; visual disturbances. Dry eyes; visual disturbances. GI:

GI:

Nausea; vomiting; diarrhea (5%); dry mouth; gastric

Nausea; vomiting; diarrhea (5%); dry mouth; gastric pain; constipation;pain; constipation; heartburn; flatulence.

heartburn; flatulence. Genitourinary:

Genitourinary:

Impotence; urinary retention; difficulty with

Impotence; urinary retention; difficulty with urination.urination. Respiratory:

Respiratory:

Shortness of breath (3%); bronchospasm;

Shortness of breath (3%); bronchospasm; dyspnea; wheezing.dyspnea; wheezing. Miscellaneous:

Miscellaneous:

Increased hypoglycemic response to insulin; may mask

Increased hypoglycemic response to insulin; may mask hypoglycemichypoglycemic signs; muscle cramps; asthenia; systemic lupus erythematosus; cold signs; muscle cramps; asthenia; systemic lupus erythematosus; cold extremities.

extremities. Nursing

In patients with angina pectoris or coronary artery disease (CAD), In patients with angina pectoris or coronary artery disease (CAD), metoprolol may cause exacerbation of angina, occurrence of MI, and metoprolol may cause exacerbation of angina, occurrence of MI, and ven

ventritriculcular ar arrarrhythythmihmias. as. MonMonitoitor r patpatienients ts clocloselsely. y. BecBecausause e CAD CAD isis common and often unrecognized, it may be prudent not to discontinue common and often unrecognized, it may be prudent not to discontinue be

betata-b-bllocockeker r ththeerrapapy y ababrrupuptltly y iin n ppatatieientnts s bebeining g trtreeatated ed foforr hypertension.

(26)

Nursing Care Plan

Ass

Assessessmenment t DiaDiagnognosisi s s

Pla

Planninning ng IntIntervervenen tions tions Rationa Rationa le le Evalua Evalua tion tion Subjective: Subjective:   “Nahihirapa“Nahihirapa n akong n akong huminga” huminga” as as verbalized. verbalized. Objective: Objective:   ReceivedReceived awake lying awake lying on bed with on bed with an ongoing an ongoing IVF of PLRS IVF of PLRS 1 L at 350 1 L at 350 cc level cc level regulated at regulated at 10 gtts, 10 gtts, infusing infusing well at right well at right arm. arm.   Conscious/cConscious/c oherent oherent   DOB w/ anDOB w/ an RR of 35 RR of 35 bpm noted. bpm noted.   BodyBody malaise malaise noted noted   WheezesWheezes upon upon auscultation auscultation   ProductiveProductive cough cough (yellow to (yellow to green green sputum sputum   RestlessnesRestlessnes s noted s noted 

 Chest painChest pain noted noted   DiscomfortDiscomfort noted noted   FacialFacial Grimace Grimace noted noted   IneffectIneffect ive ive airway airway clearan clearan ce r/t ce r/t increas increas ed ed product product ion of ion of bronchi bronchi al al secreti secreti ons as ons as manife manife sted by sted by   BodyBody malaise malaise   WheezWheez es upon es upon auscult auscult ation ation   ProductProduct ive ive cough cough (yellow (yellow to to green green sputum sputum   RestlesRestles sness sness   ChestChest pain pain   DiscomDiscom fort fort   FacialFacial Grimac Grimac e e   After 8After 8 hours hours of of continu continu es nsg. es nsg. Interve Interve ntions ntions the pt. the pt. will be will be able to able to mainta mainta in in airway airway patenc patenc y y   ExpectExpect orate orate secreti secreti ons ons   MaintaiMaintai n RR of n RR of at at least least 20-25 20-25 from from the the initial initial 35 35 bpm bpm   LearnLearn and and perfor perfor m m breathi breathi ng and ng and coughi coughi ng ng exercis exercis e. e.   VerbaliVerbali zed zed relief relief form form dyspne dyspne a. a.   MonitoMonito r Vital r Vital signs signs   PlacePlace the pt. the pt. in in fowler’ fowler’ s or s or semi-fowler’ fowler’ s s positio positio n n   Teach Teach the pt. the pt. how to how to do do proper proper deep deep breath breath ing ing and and coughi coughi ng ng exerci exerci se se   AvoidAvoid expos expos ure to ure to irritant irritant s such s such as as cigaret cigaret te te smoke smoke ,, aeroso aeroso l and l and fumes fumes   AusculAuscul tate tate breath breath sounds sounds   IncreaIncrea se se fluid fluid intake intake   SuctioSuctio n as n as ordere ordere d d   ProvidProvid e e oxyge oxyge n n inhalat inhalat ion as ion as ordere ordere d d   AdminiAdmini ster ster   ServeServe s as s as basel basel ine ine data data   To To facilit facilit ate ate maxi maxi mum mum lung lung expa expa nsion nsion   ImproImpro ves ves ventil ventil ation ation and and helps helps in in mobil mobil izing izing secre secre tions tions w/o w/o causi causi ng ng fatigu fatigu e e   To To avoid avoid allerg allerg ic ic reacti reacti on on   To To ascer ascer tain tain statu statu s and s and note note progr progr ess ess   HelpsHelps liquef liquef y y secre secre tions tions   To To clear clear airwa airwa y y   ProviProvi de de adeq adeq uate uate amou amou nt of nt of oxyg oxyg en en   WillWill

(27)

medic medic ation ation as as ordere ordere d d help help loose loose n n secre secre tions tions for for easy easy expul expul sion. sion.

(28)

Nursing Care Plan

As

Asssesessmsmenent t DiDiaagngnososis is PPlalannnniinn g g Interven Interven tions tions Ration Ration ale ale Evalua Evalua tion tion Subjective: Subjective: 

 “Ang bigat“Ang bigat ng ng pakiramda pakiramda m ko” as m ko” as verbalized verbalized Objective: Objective:   ReceivedReceived awake lying awake lying on bed with on bed with an ongoing an ongoing IVF of PLRS IVF of PLRS 1 L at 340 1 L at 340 cc level cc level regulated regulated at 10 gtts, at 10 gtts, infusing infusing well at right well at right arm. arm.   Conscious/cConscious/c oherent oherent   BodyBody malaise malaise noted noted   DifficultyDifficulty moving left moving left arm noted arm noted   FacialFacial grimace grimace noted noted 

 Pallor notedPallor noted

  ComplainsComplains of fatigue of fatigue   ActivityActivity intolerance intolerance r/t to r/t to generalized generalized body body weakness weakness as as manifested manifested by by   Conscious/cConscious/c oherent oherent   BodyBody malaise malaise noted noted   DifficultyDifficulty moving left moving left arm noted arm noted   FacialFacial grimace grimace noted noted 

 Pallor notedPallor noted

  ComplainsComplains of fatigue of fatigue   AfterAfter 10 10 hour hour s of s of nursi nursi ng ng inter inter venti venti ons ons the the pt. pt. will will parti parti cipat cipat e e willin willin gly gly in in nece nece ssary ssary activ activ ity ity   WillWill be be able able to to mov mov e her e her left left arm arm with with ease ease   LearLear n n how how to to cons cons erve erve ener ener gy gy   VerbVerb alize alize relief relief from from fatig fatig ue ue   EvaluaEvalua te the te the pt.’s pt.’s curren curren tt activit activit y y tolera tolera nce nce   AdjustAdjust activit activit y and y and reduc reduc e e intensi intensi ty of ty of task task that that may may cause cause undesi undesi red red physio physio logical logical chang chang es es   IncreaIncrea se se exerci exerci se and se and activit activit y y levels levels gradu gradu ally ally   Teach Teach metho metho ds to ds to conser conser ve ve energ energ y such y such as as sitting sitting than than standi standi ng ng while while dressi dressi ng ng   AssistAssist the pt. the pt. while while doing doing ADLs ADLs   GiveGive the pt. the pt. info. info. That That provid provid es es eviden eviden ce of ce of   ProviProvi de de coop coop erati erati ve ve base base line line   To To prev prev ent ent over over exer exer tion tion   EnhEnh ance ance activ activ ity ity toler toler ance ance   HelpHelp s s mini mini mize mize wast wast e of e of ener ener gy gy   PrevPrev ent ent the the pt. pt. from from injur injur y y   To To sust sust ain ain the the pt.’s pt.’s moti moti vatio vatio n n

(29)

progre progre ss ss

(30)

Nursing Care Plan

As

Assesessssmement nt DiDiagagnonosisi s s Planni Planni ng ng Intervent Intervent ions ions Rational Rational e e Evalua Evalua tion tion Subjective: Subjective:   “Giniginaw“Giniginaw ako” as ako” as verbalized verbalized Objective: Objective:   ReceivedReceived awake lying awake lying on bed with on bed with an ongoing an ongoing IVF of PLRS 1 IVF of PLRS 1 L at 320 cc L at 320 cc level level regulated at regulated at 10 gtts, 10 gtts, infusing well infusing well at right arm. at right arm.   Conscious/coConscious/co herent herent   Warm toWarm to touch noted touch noted 

 Flushed faceFlushed face noted

noted



 Febrile with aFebrile with a temperature temperature of 38.2°C of 38.2°C   IneffectIneffect ive ive thermo thermo regulati regulati on r/t on r/t increas increas ed ed body body temper temper ature ature as as manifes manifes ted by ted by   WarmWarm to to touch touch   FlushedFlushed face face   FebrileFebrile with a with a temper temper ature of ature of 38.2°C 38.2°C   AfteAfte r 8 r 8 hour hour s of s of cont cont inuo inuo us us TSB, TSB, the the pt.’s pt.’s tem tem pera pera ture ture will will decr decr eas eas e e fro fro m m 38.2 38.2 to to 37.5 37.5 °C °C   MonitorMonitor VS VS   IncreasIncreas e fluid e fluid intake intake   MaintaiMaintai n bed n bed rest rest   ProvideProvide sufficie sufficie nt nt clothin clothin g g   PerforPerfor m TSB m TSB   AdminiAdmini ster ster antipyr antipyr etics as etics as ordered ordered   ServeServe s as s as baseli baseli ne ne data data   To To help help cool cool down down core core temp temp eratur eratur e e   To To decre decre ase ase meta meta bolis bolis m m that that produ produ ce ce heat heat   FacilitFacilit ate ate comfo comfo rt rt   FacilitFacilit ate ate heat heat loss loss by by mean mean s of s of evapo evapo ration ration   HelpsHelps lower lower temp temp eratur eratur e e within within norm norm al al range range

(31)

Nursing Care Plan

As

Assesessssmement nt DiDiagagnonosisis s PlPlanannini ng ng Intervent Intervent ions ions Rational Rational e e Evalua Evalua tion tion Subjective: Subjective:   “Sumasakit“Sumasakit ang dibdib at ang dibdib at braso ko” as braso ko” as verbalized verbalized Objective: Objective:   ReceivedReceived awake lying awake lying on bed with on bed with an ongoing an ongoing IVF of PLRS 1 IVF of PLRS 1 L at 300 cc L at 300 cc level level regulated at regulated at 10 gtts, 10 gtts, infusing well infusing well at right arm. at right arm.   Conscious/coConscious/co herent herent   HeadacheHeadache   RestlessnessRestlessness   DifficultyDifficulty moving left moving left arm arm 

 Chest painChest pain



 Pain scale of Pain scale of 7 out of 10 7 out of 10   FacialFacial grimace grimace   AcuteAcute pain r/t pain r/t localize localize d d inflamm inflamm ation ation   AsAs manifes manifes ted by ted by   HeadacHeadac he he   RestlessRestless ness ness   DifficultDifficult y y moving moving left arm left arm   ChestChest pain pain   PainPain scale of scale of 7 out of 7 out of 10 10   FacialFacial grimace grimace   AfteAfte r 10 r 10 hour hour s of s of nsg. nsg. inter inter vent vent ions ions the the pt.’s pt.’s pain pain scal scal e e will will decr decr ease ease from from 7 to 7 to 4 4   The The pt. pt. will will verb verb alize alize relie relie f f from from pain pain   WillWill dem dem onst onst rate rate use use of of rela rela xati xati on on skill skill s s   MonitorMonitor VS VS   PerforPerfor m pain m pain assess assess ment ment (COLD (COLD SPA) SPA) every every time time pain pain occurs occurs   EncourEncour age age verbali verbali zation zation of of feeling feeling of pain of pain   InstrucInstruc t use of t use of relaxati relaxati on on exercis exercis e such e such as as listenin listenin g to g to music music   ProvideProvide quiet quiet and and calm calm environ environ ment ment   EncourEncour age age adequa adequa te rest te rest period period   AdminiAdmini ster ster analge analge sic as sic as ordere ordere d d   PainPain alters alters VS VS   To To rule rule out out devel devel opme opme nt of nt of compl compl icatio icatio ns by ns by knowi knowi ng ng allevi allevi ating ating and and precip precip itatin itatin g g factor factor s s   PainPain is is subje subje ctive ctive & & can’t can’t be be asses asses sed sed throu throu gh gh obser obser vation vation alone alone   PromProm otes otes relaxa relaxa tion tion and and divert divert s s attent attent ion ion from from pain pain   NoisyNoisy enviro enviro nmen nmen tt stimul stimul ates ates irritati irritati on on   PrevePreve nt nt fatigu fatigu e e   To To

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maint maint ain ain tolera tolera ble ble level level of of pain pain

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Nursing Care Plan

Assessmen Assessmen tt Diagnos Diagnos is is Plannin Plannin g g Interventi Interventi ons ons Rational Rational e e Evaluati Evaluati on on Subjective: Subjective:   “wala“wala akong akong ganang ganang kumain” kumain” Objective: Objective:   RefusalRefusal to eat to eat   PoorPoor muscle muscle tonicity tonicity   BodyBody weakness weakness noted noted   RestlessnRestlessn ess ess   AltereAltere d d nutriti nutriti on on less less than than body body requir requir emen emen ts R/T ts R/T loss loss of of appet appet ite as ite as evide evide nced nced by by dysfu dysfu nctio nctio nal nal eatin eatin g g patter patter n. n.   AfterAfter 4 4 hours hours of of nursin nursin g g interv interv ention ention s, s, patien patien t’s t’s appeti appeti te will te will be be impro impro ved: ved: from from 2 2 tables tables poons poons to at to at least least 5 5 tables tables poons poons per per meal. meal.   MonitorMonitor vital vital signs signs   WeightWeight on on regular regular basis basis   DiscussDiscuss eating eating habits habits includin includin g food g food preferen preferen ces. ces.   ServeServe favorite favorite foods foods that are that are not not contrain contrain dicated. dicated.   ServesServes foods foods that are that are palatabl palatabl e and e and attractiv attractiv e. e.   PreventPrevent and and minimiz minimiz e e unpleasa unpleasa nt odors. nt odors.   EmphasiEmphasi ze the ze the importan importan ce of ce of well well balance balance d d nutrition nutrition diet diet   ForFor baselin baselin e data e data   MonitorMonitor nutritio nutritio nal nal state state and and effectiv effectiv eness eness of of interve interve ntions ntions   To To appeal appeal to to client client likes likes and and dislikes dislikes   To To stimula stimula te the te the appetit appetit e e   To To stimula stimula te the te the appetit appetit e e   MayMay have have negativ negativ e effect e effect on on appetit appetit e/eatin e/eatin g g   PromotPromot e e wellnes wellnes s s

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