I.

INTRODUCTION

Upper respiratory tract infection (URI) is a nonspecific term used to describe acute infections involving the nose, paranasal sinuses, pharynx, larynx, trachea, and bronchi. The prototype is the illness known as the common cold, which will be discussed here, in addition to pharyngitis, sinusitis, and tracheobronchitis. Influenza is a systemic illness that involves the upper respiratory tract and should be differentiated from other URIs. Viruses cause most URIs, with rhinovirus, parainfluenza virus, coronavirus, adenovirus, respiratory syncytial virus, coxsackievirus, and influenza virus accounting for most cases. Human metapneumovirus is a newly discovered agent causing URIs. Group A beta-hemolytic streptococci (GABHS) cause 5% to 10% of cases of pharyngitis in adults. Other less common causes of bacterial pharyngitis include group C betahemolytic streptococci, Corynebacterium diphtheriae, Neisseria gonorrhoeae, Arcanobacterium haemolyticum, Chlamydia pneumoniae, Mycoplasma pneumoniae, and herpes simplex virus. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common organisms that cause the bacterial superinfection of viral acute sinusitis. Less than 10% of cases of acute tracheobronchitis are caused by Bordetella pertussis, B. parapertussis, M. pneumoniae, or C. pneumoniae. Most URIs occurs more frequently during the cold winter months, because of overcrowding. Adults develop an average of two to four colds annually. Antigenic variation of hundreds of respiratory viruses results in repeated circulation in the community. A coryza syndrome is by far the most common cause of physician visits in the United States. Acute pharyngitis accounts for 1% to 2% of all visits to outpatient and emergency departments, resulting in 7 million annual visits by adults alone. Acute bacterial sinusitis develops in 0.5% to 2% of cases of viral URIs. Approximately 20 million cases of acute sinusitis occur annually in the United States. About 12 million individuals are diagnosed with acute tracheobronchitis annually, accounting for one third of patients presenting with acute cough. The estimated economic impact of non influenza-related URIs is $40 billion annually. Influenza epidemics occur every year between November and March in the Northern Hemisphere. Approximately two thirds of those infected with influenza virus exhibit clinical illness, 25 million seek health care, 100,000 to 200,000 require hospitalization, and 40,000 to 60,000 die each year as a result of related complications. The average cost of each influenza epidemic is $12 million, including the direct cost of medical care and indirect cost resulting from lost work days. Pandemics in the 20th century claimed the lives of more than 21 million people. A widespread H5N1 pandemic

in birds is ongoing, with threats of a human pandemic. It is projected that such a pandemic would cost the United States $70 to $160 billion.

The reason why i chose this patient was that her case was the most interesting among all the patients in the ward. There were a lot of problems that I could identify that caught my interest and where we can give a lot of health teachings and interventions to our client. In short, her case fits best in the criteria for choosing a case study because her diagnosis was something a common one. I also want to go deeper with this kind of case and learn more from it.

Objectives of the Study As fourth year (N107B) nursing students of Liceo de Cagayan University, within three (2) days of nursing intervention on a client with Upper Respiratory Tract Infetion at Polymedic General Hospital, Velez., I will be able to conduct a thorough and comprehensive study of the assigned patient according to the data that was gathered through a series of interviews. The condition of the aforementioned will augment and free of possible complications from the disorder. The completion of this case study enables the proponent to do the following:
1. To organize my patients data for the establishment of good background

information 2. To show the family history as well as the history of past and present illness for the knowledge of what could be the predisposing factors that might contribute to the patients illness 3. To review Patients Chart and carry out Medical Orders; thus, relate these interventions to the alleviation of the Patients health condition 4. To present the different results of the patients diagnostic exams together with the comparison of normal values for the understanding of what changes during the disease 5. To discuss the Anatomy, Physiology and Pathophysiology of the Patients health condition 6. To present the data from the nursing assessment performed on the patient using the cephalocaudal approach for the good overview of her over-all health 7. To identify Patients Clinical Manifestations as basis for a specific, measurable, attainable, realistic and time-bounded Actual and Ideal Nursing Care Plans. 8. To impart appropriate health teachings specifically for the patient to promote wellness and appropriate discharge plan

9. To have an over-all conclusion and recommendation about the care study Scope and Limitation The case study merely covers data that have been gathered through interview per assessment tool and chart referral on the day of the assessment phase in loading assigned patients and in the succeeding days of the rotation, in the care formulated and intervened to its progress as the weeks rotation ended. Thus, it is limited to the days in the rotation the student nurse interacted with the client in the hope to gather the necessary data to support the presentation which is not enough to acquire a bulk of specific details.

II. HEALTH HISTORY Patients Profile Clients Name: Age: Address: Civil Status: Spouse: Sex: Job: Nationality: Religion: Birthday: Height: Weight: Patient M. P 27 years old Zone 4, Agusan, Cagayan de Oro City Married Mr. M. D Female House wife Filipino Roman Catholic November 20, 1985 152.59 cm (52) 59 kgs

Educational Attainment: College Level Admitting Physician: Date of Admission: Time of Admission: Chief Complaint: Admitting Diagnosis: Dr. Caballero January 27, 2012 8: 35 in the morning Fever and cough Upper Respiratory Tract Infection

A. Heredofamilial Disease The patients father was diagnosed with Renal Failure, and he also had High blood pressure. While the patients mother was diagnosed with type 2 Diabetes. No other trace of underlying condition was reported by the patient. B. Diet and Lifestyle The patient was a smokes occasionaly, non-alcoholic. Her diet consist of foods rich in vegetables and fruits because she loves to eat those. She seldom consumed foods rich in fats, but she was a frequent consumer of softdrinks. She doesnt exercise since she had been very busy with school and some household chores. She always slept late at night and woke up early often.

C. Obstetrical history The patient had 2 children who was delivered on Normal Spontaneous Vaginal Delivery at Northern Mindanao Medical Center last, August 27, 2004 and September 14, 2006. D. History of admission Prior to the admission, the patient had 3 previous admissions. The first two was during the delivery of her child last 2004, 2006, and the next was last August 2012 with the same diagnosis.

Chief Complaint and History of present Illness: A case of pt. M.E., 27-year old female, married with two kid, from Zone 4, Agusan, CDO. Three (3) days prior to admission, patient noted to have productive cough with feverish sensation and decrease appetite, at January 27, 2013 at 8:35 am due to her chief complaints of productive cough she was admitted at Polymedic General Hospital Velez and she was diagnosed by Dr. Caballero that she suffered with Upper Respiratory Tract Infection

III. DEVELOPMENTAL DATA III. DEVELOPMENTAL DATA A. Freuds Psychoanalytic Theory Freud offered dynamic and psychosocial explanations for human behavior. He conceptualized what we call the psychosexual stages of development. Freud believed that there are specific stages in which an individual has a specific need, and if needs are left unfulfilled or over stimulated, according to Freud there are dramatic effects on an individuals behavior. Freuds explanation of these developmental stages provided early psychosocial explanations for an individuals deviance or abnormal behavior. Freud outlined five stages of development: the oral stage, the anal stage, the phallic stage, the latency stage, and the genital stage. Stage Genital Stage (13 and Up) Description During the final stage of psychosexual development, the individual develops a strong sexual interest in the opposite sex. Where in earlier stages the focus was solely on individuals needs, interest in the welfare of others grows during this stage. If the other stages have been completed successfully, the individual should now be wellbalanced, warm and caring. The goal of this stage is to establish a balance between the various life areas. Justification Our patient belongs in this stage. She already had a family and she was able to establish a good relationship with them. She was able to develop a sense of responsibility towards her family and was able to establish balance between the various areas of life.

B. Eriksons Stages of Psychosocial Development The Psychosocial Stages of Development developed by Erikson enumerates eight stages though which healthily developing human should pass from infancy to late adulthood. Erikson considers life as composed of sequence of levels of achievement and each stage indicates a certain task to be achieved. An achievement would mean a healthier personality while failure would also mean that the person will not be able to go to the next level and probably will lead to regression.

Stage Intimacy vs. Isolatio n Young Adulth ood (19 to 40 years)

Description Justification In the initial stage of being an adult we seek one or more Our patient she begin to share herselves more intimately companions and love. As we try with others. She explore to find mutually satisfying relationships leading toward relationships, primarily through longer term commitments marriage and friends, we with someone other than a generally also begin to start a family member. She had family, though this age has been successful completion can pushed back for many couples lead to comfortable who today don't start their relationships and a sense of families until their late thirties. If commitment, safety, and negotiating this stage is care within a relationship. successful, we can experience intimacy on a deep level.

C. Havighursts Developmental Task According to Havighurst, learning is fundamental to life and in order to have a deeper insight on growth and development, one must understand it and recognize the premise that human being continues to learn throughout life. Happiness is being achieved when a particular task of a certain age is achieved by the person successfully but if not, failure occurs which is a feeling of unhappiness and disapproval from people surrounding the client. Stage Description Justification (Ages 18-30) Selecting a mate. Our patient has already attained Learning to live with a partner. the following developments. Starting family. Rearing children. Managing home. Getting started in occupation. Taking on civic responsibility. Finding a congenial social group.

IV. MEDICAL MANAGEMENT Doctors Order Date/ Time 1/ 27/2013 Doctors Order >please admit patient under the service of Doctor Caballero Rationale of Order > To intervene & give the needed health service

>secure consent to care

> As a form for legal purposes.

>IVF: D5LR 1L @ 20 gtts/min

> for hydration

>LABS: -CBC -U/A -CXR (PA) -To monitor the blood components -To check if there is any abnormalities

MEDs 1. Ambrolex OD 75 mg/ PO 2. Brompheniramine ( Nasatapp) 1 tab BID 3. Omeprazole 4. Hexetidine (Bactidol) Gargle
5. Salbuterol

- Treatment of acute respiratory tract

diseases with impaired formation of secretions

- lowers or stops the body's reaction

to the allergen.

- used to treat gastroesophageal

reflux disease (GERD) - used for topical treatment of sore throat and oral infections - used to treat asthma and other lungrelated problems

>V/S q 4o

-to monitor baseline data

>I&O q shift >Pls inform AP

-to monitor hydration status -to inform the physician about the condition of the patient.

>refer accordingly

-for continuity of care

- used to treat certain bacterial 1/28/2013 >start Laitun 200mg IV q 12 ANST >Fluimucil 600 dissolve in a glass of water after dinner >Krerr 1 cap OD >PCM 500 mg tab q4 PRN fever
- use for hydration infections of the nose, lungs, etc.

- Treatment of respiratory affections

characterized by. thick and viscous secretions

- used over-the-counter pain reliever

and a fever reducer

> IVF to follow D5LR @ 20 gtts/ min (2 bottles) - to increase hydration status >increase IVF rate to 30 gtts/min

Laboratory Results 1/27/2013

Urine Analysis

Result Color Glucose Transparency Protein Specific Gravity Yellow Negative Clear Negative 1.015

Normal Values Pale Yellow- Amber Negative Clear to Slightly hazy Negative 1.002-1.030

Rationale Normal Normal Normal Normal Normal

Microscopic Exam: Pus Cells RBC Amourphous Urates / Phosphates Epithelial Cells Bacteria Few Occasional Negative Indicates Infection Squamous Few 1-3/hpf 0-2/hpf 0-4/hpf 0-3/hpf Normal Normal

11-21-2012 Complete Blood Count Result HCT HGB WBC PLATELET Diff. Count Neutrophils 69 50-62 % Respond to any inflammation Normal Normal Normal 40.1 12.9 8,200 310,000 Normal values 37-47vol % 12-16gms % 5,000-10,000/mm3 150,000-400,000/mm3 Implication Normal Normal Normal Normal

Granulocyte Lymphocytes Monocytes

50 43 7

43.4-76.2 % 17.4-48.2 % 4.5-10.5 %

DRUG STUDY

Generic name/Brand name Ambrolex

Classifi-cation

antibiotic

Dose/ route Frequen cy OD 75 mg PO

Mechanism of Action concentration of antibiotics when given concomitantly.

Specific indication Acute and chronic disorder of the respiratory tract associated with pathologically thickened mucus and impaired mucus transport.

Contra-indication

Adverse reaction

Nursing Precaution

There are Occasional gastrointestinal no absolute side effects may occur but these are normally mild. contraindications but in patients with gastric ulceration relative caution should be observed.

Observe respiratory rate and obtain baseline data. Check drug interactions if taking other medications. It is advisable to avoid use during the first trimester of pregnancy.

DRUG STUDY Generic /brand name Salbuterol Classifi-cation Dose/ route Frequen cy 1 neb Mechanism of Action Stimulates Beta 2 receptors of bronchioles by increasing levels which relaxes smooth muscles to produce bronchodilation. Also cause CNS stimulation, cardiac stimulation, increase in diuresis, skeletal muscle tremors and increase gastric acid secretions. Specific indication Relief of bronchospasm in bronchial asthma, chronic bronchitis, emphysema and other reversible obstructive pulmonary disease Contra-indication Adverse reaction Nursing Precaution

bronchodilator

Hypersensitivity to salbutamol, also to atropine and its derivatives. Threatened abortion during first or second trimester.

Fine skeletal muscle tremors, leg cramps, palpitations, tachycardia, hypertension, headache, nausea, vomiting, dizziness, hyperactivity, insomnia, hypotension, heartburn, epistaxis, cough

-Assess cardio- respiratory function, BP, heart rate and rhythm, and breath sounds. -Determine history of previous meds and ability to self medicate. -Monitor for evidenceof allergic action and paradoxical bronchospasm

DRUG STUDY

Generic /brand name

Classifi-cation

Dose/ route Frequen cy

Mechanism of Action

Specific indication

Contra-indication

Adverse reaction

Nursing Precaution

Omeprazole

Antisecretory Proton pump inhibitor

40mg Gastric acidReduction of IVTT OD pump inhibitor: risk of upper Suppresses GI bleeding gastric acid secretion by specific inhibition of the hydrogenpotassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production.

Contraindicated with hypersensitivity to Omeprazole or its components.

Headache, dizziness, asthenia, vertigo, insomnia, apthy, anxiety, paresthesias, dream abnormalities, rash, inflammation, urticaria, pruritus, alopecia, dry skin, diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth

-Arrange regular medical check-ups. -Advise pt to report immediately for side effects.

DRUG STUDY

Generic /brand name Paracetamol

Classifi-cation

Antipyretic

Dose/ Mechanism of route Action Frequen cy PRN for Inhibits the fever q 4 synthesis of hrs prostaglandins that may serve as mediators of pain and fever, primarily in the CNS

Specific indication >Mild pain >Fever

Contra-indication

Adverse reaction

Nursing Precaution

Hypersensitivity to acetaminophen or phenacetin; use with alcohol.

Hema: hemolytic anemia, neutropenia, leukopenia, pancytopenia. Hepa: jaundice Metabolic: hypoG GI: HEPATIC FAILURE, HEPATOTOXICITY (overdose)GU: renal failure (high doses/chronic use). Derm: rash, urticaria.

~ Advise parents or caregivers to check concentrations of liquid preparations. Errors have resulted in serious liver damage. ~ Assess fever; note presence of associated signs (diaphoresis, tachycardia, and malaise). ~ Adults should not take acetaminophen longer than 10 days and children not longer than 5 days unless directed by health care professional. ~ Advise mother or caregiver to take medication exactly as directed and not to take more than the recommended amount.

V.PATHOPHYSIOLOGY WITH ANATOMY AND PHYSIOLOGY

Respiratory system

The Respiratory System is crucial to every human being. Without it, we would cease to live outside of the womb. Let us begin by taking a look at the structure of the respiratory system and how vital it is to life. During inhalation or exhalation air is pulled towards or away from the lungs, by several cavities, tubes, and openings. The organs of the respiratory system make sure that oxygen enters our bodies and carbon dioxide leaves our bodies. The respiratory tract is the path of air from the nose to the lungs. It is divided into two sections: Upper Respiratory Tract and the Lower Respiratory Tract. Included in the upper respiratory tract are the Nostrils, Nasal Cavities, Pharynx, Epiglottis, and the Larynx. The lower respiratory tract consists of the Trachea, Bronchi, Bronchioles, and the Lungs. As air moves along the respiratory tract it is warmed, moistened and filtered. Breathing and Lung Mechanics Ventilation is the exchange of air between the external environment and the alveoli. Air moves by bulk flow from an area of high pressure to low pressure. All pressures in the respiratory system are relative to atmospheric pressure (760mmHg at sea level). Air will move in or out of the lungs depending on the pressure in the alveoli. The body changes the pressure in the alveoli by changing the volume of the lungs. As volume increases pressure decreases and as volume decreases pressure increases. There are two phases of ventilation; inspiration and expiration. During each phase the body changes the lung dimensions to produce a flow of air either in or out of the lungs. The body is able to stay at the dimensions of the lungs because of the relationship of the lungs to the thoracic wall. Each lung is completely enclosed in a sac called the pleural sac. Two structures contribute to the formation of this sac. The parietal pleura is attached to the thoracic wall where as the visceral pleura is attached to the lung itself. In-between these two membranes is a thin layer of intrapleural fluid. The intrapleural fluid completely surrounds the lungs and lubricates the two surfaces so that they can slide across each other. Changing the pressure of this fluid also allows the lungs and the thoracic wall to move together during normal breathing. Much the way two glass

slides with water in-between them are difficult to pull apart, such is the relationship of the lungs to the thoracic wall. The rhythm of ventilation is also controlled by the "Respiratory Center" which is located largely in the medulla oblongata of the brain stem. This is part of the autonomic system and as such is not controlled voluntarily (one can increase or decrease breathing rate voluntarily, but that involves a different part of the brain). While resting, the respiratory center sends out action potentials that travel along the phrenic nerves into the diaphragm and the external intercostal muscles of the rib cage, causing inhalation. Relaxed exhalation occurs between impulses when the muscles relax. Normal adults have a breathing rate of 12-20 respirations per minute. The Pathway of Air When one breathes air in at sea level, the inhalation is composed of different gases. These gases and their quantities are Oxygen which makes up 21%, Nitrogen which is 78%, Carbon Dioxide with 0.04% and others with significantly smaller portions. In the process of breathing, air enters into the nasal cavity through the nostrils and is filtered by coarse hairs (vibrissae) and mucous that are found there. The vibrissae filter macroparticles, which are particles of large size. Dust, pollen, smoke, and fine particles are trapped in the mucous that lines the nasal cavities (hollow spaces within the bones of the skull that warm, moisten, and filter the air). There are three bony projections inside the nasal cavity. The superior, middle, and inferior nasal conchae. Air passes between these conchae via the nasal meatuses. Air then travels past the nasopharynx, oropharynx, and laryngopharynx, which are the three portions that make up the pharynx. The pharynx is a funnel-shaped tube that connects our nasal and oral cavities to the larynx. The tonsils which are part of the lymphatic system, form a ring at the connection of the oral cavity and the pharynx. Here, they protect against foreign invasion of antigens. Therefore the respiratory tract aids the immune system through this protection. Then the air travels through the larynx. The larynx closes at the epiglottis to prevent the passage of food or drink as a protection to our trachea and lungs. The larynx is also our voicebox; it contains vocal cords, in which it produces sound. Sound is produced from the vibration of the vocal cords when air passes through them. The trachea, which is also known as our windpipe, has ciliated cells and mucous secreting cells lining it, and is held open by C-shaped cartilage rings. One of its functions is similar to the larynx and nasal cavity, by way of protection from dust and other particles. The dust will adhere to the sticky mucous and the cilia helps propel it back up the trachea, to where it is either swallowed or coughed up. The mucociliary escalator extends from the top of the trachea all the way down to the bronchioles, which we will discuss later. Through the trachea, the air is now able to pass into the bronchi. Inspiration Inspiration is initiated by contraction of the diaphragm and in some cases the intercostals muscles when they receive nervous impulses. During normal quiet breathing, the phrenic nerves stimulate the diaphragm to contract and move downward into the abdomen. This downward movement of the diaphragm enlarges the thorax. When necessary, the intercostal muscles also increase the thorax by contacting and drawing the ribs upward and outward.

As the diaphragm contracts inferiorly and thoracic muscles pull the chest wall outwardly, the volume of the thoracic cavity increases. The lungs are held to the thoracic wall by negative pressure in the pleural cavity, a very thin space filled with a few milliliters of lubricating pleural fluid. The negative pressure in the pleural cavity is enough to hold the lungs open in spite of the inherent elasticity of the tissue. Hence, as the thoracic cavity increases in volume the lungs are pulled from all sides to expand, causing a drop in the pressure (a partial vacuum) within the lung itself (but note that this negative pressure is still not as great as the negative pressure within the pleural cavity--otherwise the lungs would pull away from the chest wall). Assuming the airway is open, air from the external environment then follows its pressure gradient down and expands the alveoli of the lungs, where gas exchange with the blood takes place. As long as pressure within the alveoli is lower than atmospheric pressure air will continue to move inwardly, but as soon as the pressure is stabilized air movement stops. Expiration During quiet breathing, expiration is normally a passive process and does not require muscles to work (rather it is the result of the muscles relaxing). When the lungs are stretched and expanded, stretch receptors within the alveoli send inhibitory nerve impulses to the medulla oblongata, causing it to stop sending signals to the rib cage and diaphragm to contract. The muscles of respiration and the lungs themselves are elastic, so when the diaphragm and intercostal muscles relax there is an elastic recoil, which creates a positive pressure (pressure in the lungs becomes greater than atmospheric pressure), and air moves out of the lungs by flowing down its pressure gradient. Although the respiratory system is primarily under involuntary control, and regulated by the medulla oblongata, we have some voluntary control over it also. This is due to the higher brain function of the cerebral cortex. When under physical or emotional stress, more frequent and deep breathing is needed, and both inspiration and expiration will work as active processes. Additional muscles in the rib cage forcefully contract and push air quickly out of the lungs. In addition to deeper breathing, when coughing or sneezing we exhale forcibly. Our abdominal muscles will contract suddenly (when there is an urge to cough or sneeze), raising the abdominal pressure. The rapid increase in pressure pushes the relaxed diaphragm up against the pleural cavity. This causes air to be forced out of the lungs. Another function of the respiratory system is to sing and to speak. By exerting conscious control over our breathing and regulating flow of air across the vocal cords we are able to create and modify sounds. Lung Compliance Lung Compliance is the magnitude of the change in lung volume produced by a change in pulmonary pressure. Compliance can be considered the opposite of stiffness. A low lung compliance would mean that the lungs would need a greater than average change in intrapleural pressure to change the volume of the lungs. A high lung compliance would indicate that little pressure difference in intrapleural pressure is needed to change the volume of the lungs. More energy is required to breathe normally in a person with low lung compliance. Persons with low lung compliance due to disease therefore tend to take shallow breaths and breathe more frequently. Determination of Lung Compliance Two major things determine lung compliance. The first is the elasticity of the lung tissue. Any thickening of lung tissues due to disease will decrease lung compliance. The second is surface tensions at air water interfaces in the

alveoli. The surface of the alveoli cells is moist. The attractive force, between the water cells on the alveoli, is called surface tension. Thus, energy is required not only to expand the tissues of the lung but also to overcome the surface tension of the water that lines the alveoli. To overcome the forces of surface tension, certain alveoli cells (Type II pneumocytes) secrete a protein and lipid complex called ""Surfactant, which acts like a detergent by disrupting the hydrogen bonding of water that lines the alveoli, hence decreasing surface tension. Upper Respiratory Tract The upper respiratory tract consists of the nose and the pharynx. Its primary function is to receive the air from the external environment and filter, warm, and humidify it before it reaches the delicate lungs where gas exchange will occur. Air enters through the nostrils of the nose and is partially filtered by the nose hairs, then flows into the nasal cavity. The nasal cavity is lined with epithelial tissue, containing blood vessels, which help warm the air; and secrete mucous, which further filters the air. The endothelial lining of the nasal cavity also contains tiny hairlike projections, called cilia. The cilia serve to transport dust and other foreign particles, trapped in mucous, to the back of the nasal cavity and to the pharynx. There the mucus is either coughed out, or swallowed and digested by powerful stomach acids. After passing through the nasal cavity, the air flows down the pharynx to the larynx. Lower Respiratory Tract The lower respiratory tract starts with the larynx, and includes the trachea, the two bronchi that branch from the trachea, and the lungs themselves. This is where gas exchange actually takes place. 1. Larynx The larynx (plural larynges), colloquially known as the voice box, is an organ in our neck involved in protection of the trachea and sound production. The larynx houses the vocal cords, and is situated just below where the tract of the pharynx splits into the trachea and the esophagus. The larynx contains two important structures: the epiglottis and the vocal cords. The epiglottis is a flap of cartilage located at the opening to the larynx. During swallowing, the larynx (at the epiglottis and at the glottis) closes to prevent swallowed material from entering the lungs; the larynx is also pulled upwards to assist this process. Stimulation of the larynx by ingested matter produces a strong cough reflex to protect the lungs. Note: choking occurs when the epiglottis fails to cover the trachea, and food becomes lodged in our windpipe. The vocal cords consist of two folds of connective tissue that stretch and vibrate when air passes through them, causing vocalization. The length the vocal cords are stretched determines what pitch the sound will have. The strength of expiration from the lungs also contributes to the loudness of the sound. Our ability to have some voluntary control over the respiratory system enables us to sing and to speak. In order for the larynx to function and produce sound, we need air. That is why we can't talk when we're swallowing. 1. Trachea 2. Bronchi

3. Lungs The Right Primary Bronchus is the first portion we come to, it then branches off into the Lobar (secondary) Bronchi, Segmental (tertiary) Bronchi, then to the Bronchioles which have little cartilage and are lined by simple cuboidal epithelium (See fig. 1). The bronchi are lined by pseudostratified columnar epithelium. Objects will likely lodge here at the junction of the Carina and the Right Primary Bronchus because of the vertical structure. Items have a tendency to fall in it, where as the Left Primary Bronchus has more of a curve to it which would make it hard to have things lodge there.

The Left Primary Bronchus has the same setup as the right with the lobar, segmental bronchi and the bronchioles. The lungs are attached to the heart and trachea through structures that are called the roots of the lungs. The roots of the lungs are the bronchi, pulmonary vessels, bronchial vessels, lymphatic vessels, and nerves. These structures enter and leave at the hilus of the lung which is "the depression in the medial surface of a lung that forms the opening through which the bronchus, blood vessels, and nerves pass" (medlineplus.gov).

There are a number of terminal bronchioles connected to respiratory bronchioles which then advance into the alveolar ducts that then become alveolar sacs. Each bronchiole terminates in an elongated space enclosed by many air sacs called alveoli which are surrounded by blood capillaries. Present there as well, are Alveolar Macrophages, they ingest any microbes that reach the alveoli. The Pulmonary Alveoli are microscopic, which means they can only be seen through a microscope, membranous air sacs within the lungs. They are units of respiration and the site of gas exchange between the respiratory and circulatory systems.

Productive cough

colds

UPPER RESPIRATORY TRACT INFECTION

VI.NURSING REVIEW CHART (Assessment)

Name: M, E. Date: January 27, 2013 Vital Signs: Pulse: 100 bpm BP: 120/ 70 Temp.: 37.9 Height: 52 Weight: 59 kg INSTRUCTION: Place an (X) in the area of abnormalities. Write comment on the space provided. Indicate the location of the problem in the figure using (X).
EENT [] impaired vision [] blind [] Pain [] reddened [] drainage [] lesion seen [] gums [] hard of hearing [] deaf [] burning [] edema Assess eyes, ears, and nose throat for abnormality [x] no problem RESPIRATORY [] asymmetric [] tachypnea [] apnea [] rales [x] cough [] barrel chest [] bradypnea [] shallow [] rhonchi [x] sputum [] diminished [] dyspnea [] orthopnea [] labored [] wheezing [] pain [] cyanotic Assess respiration, rate, rhythm, depth, pattern, breathe sounds, comfort [] no problem CARDIO VASCULAR [] arrhythmias [] tachypnea [] numbness [] diminished pulses [] edema [] fatigue [] irregular [] bradycardia [] murmur [] tingling [] absent pulses [] pain Assess heart sounds, rate rhythm, pulse, blood pressure, circulation, fluid retention, comfort [] no problem

Productive cough Decrease appetite

Fever 37.9 Skin warm to touch

GASTROINTESTINAL TRACT [] obese [] distention [] mass [] dysphagia [] rigidity [] pain Assess abdomen, bowel habits, swallowing, bowel sounds, comfort [x] no problem
GENITO- URINARY TRACT and GYNE [] pain [] urine color [] vaginal bleeding [] hematuria [] discharges [] nocturia Assess urine freq., control, color, odor, comfort, gyne- bleeding, discharge [x] no problem NEURO [] paralysis [] stuporous [] unsteady [] seizures [] lethargic [] comatose [] vertigo [] tremors [] confuse [] vision [] grip Assess motor function, sensation, LOC, strength, grip, gait, Coordination, orientation, speech. [x] no problem MUSCULOSKELETAL and SKIN [] appliance [] flushed [] cool [] drainage [] Petechiae [] ecchymosis [] rash [] lesion [] prosthesis [] stiffness [] atrophy [] deformity [] poor turgor [x] hot [] diaphoretic [] skin color [] moist [] wound [] swelling [] itching [] pain Assess mobility, motion, galt, alignment, joint function, skin color, texture, turgor, integrity [] no problem

Fever 37.9 Skin warm to touch

VII. NURSING MANAGEMENT

Assessment

Diagnosis

Planning

Interventions

Rationale

Evaluation

Subjective:
gahi kayo akong ubo as verbalized.

Objective:
Conscious/coherent Productive cough (yellow to green sputum Restlessness noted Discomfort noted Facial Grimace noted

Ineffective airway clearance r/t increased production of bronchial secretions as manifested by Body malaise Wheezes upon auscultation Productive cough (yellow to green sputum Restlessness Chest pain Discomfort Facial Grimace

After 8 hours of continues nsg. Interventions the pt. will be able to maintain airway patency Expectorate secretions Learn and perform breathing and coughing exercise. Verbalized relief form dyspnea.

Monitor Vital signs Place the pt. in fowlers or semifowlers position Teach the pt. how to do proper deep breathing and coughing exercise Avoid exposure to irritants such as cigarette smoke, aerosol and fumes Auscultate breath sounds Increase fluid intake Suction as ordered Provide oxygen inhalation as ordered Administer medication as ordered

Serves as baseline data To facilitate maximum lung expansion Improves ventilation and helps in mobilizing secretions w/o causing fatigue To avoid allergic reaction

Patient was able to expectorate secrections, goal met.

To ascertain status and note progress Helps liquefy secretions To clear airway Provide adequate amount of oxygen Will help loosen secretions for easy expulsion.

Assessment

Diagnosis

Planning

Interventions

Rationale

Evaluation

Subjective:
Gitugnaw ko as verbalized

Objective:
Conscious/coherent Warm to touch noted Flushed face noted Febrile with a temperature of 37.9C

Ineffective thermoregulation r/t increased body temperature as manifested by Warm to touch Flushed face Febrile with a temperature of 38.2C

After 8 hours of continuous TSB, the pt.s temperature will decrease from 37.9 to 37C

Monitor VS Increase fluid intake Maintain bed rest

Serves as baseline data To help cool down core temperature To decrease metabolism that produce heat Facilitate comfort Facilitate heat loss by means of evaporation Helps lower temperature within normal range

The patient temperature is fluctuating, goal partially met.

Provide sufficient clothing Perform TSB Administer antipyretics as ordered

Assessment

Diagnosis

Planning

Interventions

Rationale

Evaluation

Subjective:
dili ko ganahan mo kaon

Objective:
Refusal to eat Poor muscle tonicity Body weakness noted Restlessness

Altered nutrition less than body requirements R/T loss of appetite as evidenced by dysfunctional eating pattern.

After 4 hours of nursing interventions, patients appetite will be improved: from 2 tablespoons to at least 5 tablespoons per meal.

Monitor vital signs Weight on regular basis

Discuss eating habits including food preferences. Serve favorite foods that are not contraindicated. Serves foods that are palatable and attractive. Prevent and minimize unpleasant odors. Emphasize the importance of well balanced nutrition diet

For baseline data Monitor nutritional state and effectiveness of interventions To appeal to client likes and dislikes To stimulate the appetite To stimulate the appetite May have negative effect on appetite/eating Promote wellness

Goal was met because the patient was able to understand the importance of nutritious food intake and was able to eat with fair appetite.

VIII. REFERRALS AND FOLLOW-UP

HEALTH TEACHINGS

The patient is instructed strict compliance of home medications: MEDICATION Instructed the patient to perform active ROM exercises and encouraged to perform ADL independently as per limitation. Instructed to follow the treatment given by the physician, which includes the proper administration of the medications, the time the medication be given and the diet that the patient must have. That treatment is necessary for the complete recovery. The patient is encouraged to visit attending physician as prescribed for follow- up check- up upon discharge. It is critically important to follow up with the doctor Instructed tofoods rich in fibers such as vegetables and also to increase the fluid intake to 6 10 glasses a day.

EXERCISES

TREATMENT

OUT-PATIENT

DIET

RECOMMENDATIONS I recommend to Pt. M, E. to follow all the imparted health teachings to prevent future reoccurrence of the said condition. She must consult his doctor even if her productive cough is gone. If symptoms re- occur she should not hesitate to ask for consultation.

IX. EVALUATION

At the end of 16 hours exposure, I was able to conduct a thorough and comprehensive study of the assigned patient according to the data that was gathered through a series of interviews. The entire exposure at Station 7 of Polymedic General Hospital assigned to a client with URTI has thought us a lot of things. That is, understanding the entire pathogenesis of the disorder its affectation and what approach are to be implemented. Thus, interventions for the clients condition were achieved with

the help and assistance of the team of caregivers in implementing effective plan of care including active participation of the client and significant others. Therapeutic relationship and communication between the caregivers and the client with the significant others contributed to the achievement of the set goals. My knowledge, skills and interpersonal relationship skills has improved accordingly in the experience of the exposure.