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Pamantasan ng Lungsod ng Maynila

(University of the City of Manila)


Intramuros, Manila

COLLEGE OF NURSING

Submitted by:
Tan, Maria Daniela Isabel C.
BSN 2 BLOCK 2

Submitted to:
Prof. Ronie M. Tiamson, RN, RM, MAN,

March 2016

I.

Introduction
Acute bronchitis is a syndrome, usually viral in origin, with cough as a
prominent feature. It refers to an inflammation of the bronchi or air passage of
the lungs. It is a breathing disorder affecting the expiratory function in most
cases, some infections also occur in the nose and throat.
The presentation of acute bronchitis is usually mild and self-limited, requiring
only supportive treatment. Cough may be productive or nonproductive.
Associated symptoms include low-grade fever, chest discomfort, sore throat,
and fatigue. In children, the smaller airways are easily obstructed by
inflammation, so that severe obstruction may occur. The smallness of airways
in proportion to body size is due to a smaller lumen in relation to the vessel
wall.
There are different ways on how to diagnose a patient with acute
bronchitis. Diagnosis of acute bronchitis is usually based on the clinical
presentation, with recent onset of cough being the distinctive hallmark.
Neither the appearance of purulent sputum nor a white blood cell count is a
reliable indicator. A chest radiograph is required to distinguish acute
bronchitis from pneumonia.
Treatment for patients with acute bronchitis is mainly symptomatic and includes

rest, humidification, and increased fluid intake. Exposure to cigarette smoke should
be avoided.
II.

Objectives
General Objective:
The aim of this case study is to analyze the contributing factors
leading to the development of the problem through the use of the nursing
process on the care of a pediatric client diagnosed with acute bronchitis.
Specific Objective:

To be able to know more about acute bronchitis.

To be able to trace the pathophysiology of acute bronchitis.

Enumerate the different signs and symptoms of acute bronchitis.

Determine the common drugs for acute bronchitis.

Identify and understand different types of medical treatment


necessary for treating acute bronchitis.

III.

Formulate and apply nursing care plans.

Evaluate the patients response based on the interventions give

DEMOGRAPHIC PROFILE:

Patient N is a male 1 year and 10 month old child, born on April 29, 2014, in Manila. He
is a catholic and living at 11th Street Port Area Manila. The child is kg and cm. He is
admitted last February 15, 2016. The student nurse seen and received the patient at
February 18, 2016. Source of information Patients parents and grandparents (40%), and
the patients chart (60%)

IV.

CHIEF COMPLAINT:

inuubo siya ng tatlong araw na, tapos ang taas ng lagnat nag-39C, tas nagsuka siya
kahapon, pero konti lang as verbalized by the Father of the patient.

V.

HISTORY OF PRESENT ILLNESS

VI.

PAST MEDICAL HEALTH HISTORY


Patient N has no noted injuries, hospitalizations or surgeries. There were no
known allergies and no current medication before the patient was admitted,
and has completed immunizations such as BCG, Hepatitis B Vaccine, OPV,
DPT, AMV and MMR.

VII.

FAMILY HEALTH HISTORY


Patient N is the third child in the family. His eldest brother is 7 years old, and
was said to be diagnosed of a respiratory related illness when he was an
infant; his sister is 5 years old. Their mother is 27 years old and also has a
respiratory related illness, the father said he has no known illness. The
grandfather of the patient from the mother side was already deceased due to
Tuberculosis; his grandmother is 53 years old and has no known disease. His
grandfather from the father side is 65 years old with Hypertension; his

VIII.
IX.
X.
XI.

grandmother is 57 years old and has no known disease.


PEDIATRIC DEVELOPMENTAL MILESTONES
REVIEW OF SYSTEMS
PHYSICAL ASSESSMENT
ANATOMY AND PHYSIOLOGY

Anatomy
The respiratory system (also referred to as the ventilator system) is a complex biological system
comprised of several organs that facilitate the inhalation and exhalation of oxygen and carbon
dioxide in living organisms (or, in other words, breathing).
For all air-breathing vertebrates, respiration is handled by the lungs, but these are far from the only
components of the respiratory system. In fact, the system is composed of the following biological
structures: nose and nasal cavity, mouth, pharynx, larynx, trachea, bronchi and bronchioles, lungs
and the muscles of respiration.
A properly functioning respiratory system is a vital part of our good health. Respiratory infections
can be acute and sometimes life threatening. They can also be chronic, in which case they place
tremendous long term stress on the immune system, endocrine system, HPA axis, and much
more.
Nose and Nasal Cavity

The nose and nasal cavity constitute the main external opening of the respiratory system. They
represent the entryway to the respiratory tract a passage through the body which air uses for
travel in order to reach the lungs. The nose is made out of bone, muscle, cartilage and skin, while
the nasal cavity is, more or less, hollow space. Although the nose is typically credited as being the
main external breathing apparatus, its role is actually to provide support and protection to the nasal
cavity. The cavity is lined with mucus membranes and little hairs that can filter the air before it goes
into the respiratory tract. They can trap all harmful particles such as dust, mold and pollen and
prevent them from reaching any of the internal components. At the same time, the cold outside air is
warmed up and moisturized before going through the respiratory tract. During exhalation, the warm
air that is eliminated returns the heat and moisture back to the nasal cavity, so this forms a
continuous process.
Oral cavity
The oral cavity, more commonly referred to as the mouth, is the only other external component that
is part of the respiratory system. In truth, it does not perform any additional functions compared to
the nasal cavity, but it can supplement the air inhaled through the nose or act as an alternative when
breathing through the nasal cavity is not possible or exceedingly difficult. Normally, breathing
through nose is preferable to breathing through the mouth. Not only does the mouth not possess
the ability to warm and moisturize the air coming in, but it also lacks the hairs and mucus
membranes to filter out unwanted contaminants. On the plus side, the pathway leading from the
mouth is shorter and the diameter is wider, which means that more air can enter the body at the
same speed.
Pharynx
The pharynx is the next component of the respiratory tract, even though most people refer to it
simply as the throat. It resembles a funnel made out of muscles that acts as an intermediary
between the nasal cavity and the larynx and esophagus. It is divided into three separate sections:
nasopharynx, oropharynx and laryngopharynx. The nasopharynx is the upper region of the
structure, which begins at the posterior of the nasal cavity and simply allows air to travel through it
and reach the lower sections. The oropharynx does something similar, except it is located at the
posterior of the oral cavity. Once the air reaches the laryngopharynx, something called the epiglottis
will divert it to the larynx. The epiglottis is a flap that performs a vital task, by switching access
between the esophagus and trachea. This ensures that air will travel through the trachea, but that
food which is swallowed and travels through the pharynx is diverted to the esophagus.
Larynx
The larynx is the next component, but represents only a small section of the respiratory tract that
connects the laryngopharynx to the trachea. It is commonly referred to as the voice box, and it is
located near the anterior section of the neck, just below the hyoid bone. The aforementioned
epiglottis is part of the larynx, as are the thyroid cartilage, the cricoid cartilage and the vocal folds.
Both cartilages offer support and protection to other components, such as the vocal folds and the
larynx itself. The thyroid cartilage also goes by a more common name the Adams apple
although, contrary to popular belief, it is present in both men and women. It is typically more

pronounced in adult males. The vocal folds are mucous membranes that tense up and vibrate in
order to create sound, hence the term voice box. The pitch and volume of these sounds can be
controlled by modifying the tension and speed of the vocal folds.
Trachea
The trachea is a longer section of the respiratory tract, shaped like a tube and approximately 5
inches in length. It has several C-shaped hyaline cartilage rings which are lined with pseudostratified
ciliated columnar epithelium. Those rings keep the trachea open for air all the time. They are Cshaped in order to allow the open end to face the esophagus. This allows the esophagus to expand
into the area normally occupied by the trachea in order to permit larger chunks of food to pass
through. The trachea, more commonly referred to as the windpipe, connects the larynx to the
bronchi and also has the role of filtering the air prior to it entering the lungs. The epithelium which
lines the cartilage rings produces mucus which traps harmful particles. The cilia then move the
mucus upward towards the pharynx, where it is redirected towards the gastrointestinal tract in order
for it to be digested.
Bronchi
The lower end of the trachea splits the respiratory tract into two branches that are named the
primary bronchi. These first run into each of the lungs before further branching off into smaller
bronchi. These secondary bronchi continue carrying the air to the lobes of the lungs, then further
split into tertiary bronchi. The tertiary bronchi then split into even smaller sections that are spread out
throughout the lungs called bronchioles. Each one of these bronchioles continues to split into even
smaller parts called terminal bronchioles. At this stage, these tiny bronchioles number in the millions,
are less than a millimeter in length, and work to conduct the air to the lungs alveoli. The larger
bronchi contain C-shaped cartilage rings similar to the ones used in the trachea to keep the airway
open. As the bronchi get smaller, so do the rings that become progressively more widely spaced.
The tiny bronchioles do not have any kind of cartilage and instead rely on muscles and elastin.
This system creates a tree-like pattern, with smaller branches growing from the bigger ones. At the
same time, it also ensures that air from the trachea reaches all the regions of the lungs. Besides
simply carrying the air, the bronchi and bronchioles also possess mucus and cilia that further refine
the air and get rid of any leftover environmental contaminants. The walls of the bronchi and
bronchioles are also lined with muscle tissue, which can control the flow of air going into the lungs.
In certain instances, such as during physical activity, the muscles relax and allow more air to go into
the lungs.
Lungs
The lungs are two organs located inside the thorax on the left and right sides. They are surrounded
by a membrane that provides them with enough space to expand when they fill up with air.
Because the left lung is located lateral to the heart, the organs are not identical: the left lung is
smaller and has only 2 lobes while the right lung has 3. Inside, the lungs resemble a sponge made
of millions and millions of small sacs that are named alveoli. These alveoli are found at the ends of
terminal bronchioles and are surrounded by capillaries through which blood passes. Thanks to an

epithelium layer covering the alveoli, the air that goes inside them is free to exchange gasses with
the blood that goes through the capillaries.
Muscles of Respiration
The last component of the respiratory system is a muscle structure known as the muscles of
respiration. These muscles surround the lungs and allow the inhalation and exhalation of air. The
main muscle in this system is known as the diaphragm, a thin sheet of muscle that constitutes the
bottom of the thorax. It pulls in air into the lungs by contracting several inches with each breath. In
addition to the diaphragm, multiple intercostal muscles are located between the ribs and they also
help compress and expand the lungs.
Physiology of the Respiratory System
The respiratory system has a complex physiology and is responsible for multiple functions. There
are multiple roles performed by the respiratory system: pulmonary ventilation, external respiration,
internal respiration, transportation of gases and homeostatic control of respiration. (3) Here is a brief
description of each of those functions.
Pulmonary Ventilation
Pulmonary ventilation is the main process by which air flows in and out of the lungs. This is done
through the contraction of muscles, as well as through a negative pressure system that is
accomplished by the pleural membrane covering the lungs. When the lungs are completely sealed
in this membrane, they remain at a pressure that is slightly lower than the pressure of the lungs at
rest. As a result of this, the air passively fills the lungs until there is no more pressure difference. At
this point, if necessary, additional air can be inhaled by contracting the diaphragm as well as the
surrounding intercostal muscles. During exhalation, the muscles relax and this reverses the
pressure dynamic, increasing the pressure on the outside of the lungs and forcing air to escape
them until both pressures equalize again. Thanks to the elastic nature of the lungs, they revert back
to their state at rest and the entire process repeats itself.
External Respiration
External respiration is a process that allows an exchange of gases to take place between the air
located in the alveoli and the blood that is traveling through the capillaries. This is possible through a
difference in pressure between the oxygen and carbon dioxide located in the air, and the oxygen
and carbon dioxide in the blood. As a result of this, oxygen from the air is transferred to the blood
while carbon dioxide from the blood goes into the air. The useful oxygen is then carried out
throughout the body while the carbon dioxide is dispelled through exhalation.
Internal Respiration
Internal respiration is a similar process except it involves gas exchange between the blood in the
capillaries and body tissue. Again, a difference in pressure allows oxygen to leave the blood and
enter the tissue while carbon dioxide does the opposite.
Transportation of Gases

This function of the respiratory system enables oxygen and carbon dioxide to travel throughout the
body to wherever they are needed. Most of the gases are carried through blood attached to
transport molecules such as hemoglobin, although blood plasma will also have a minimal content of
gas. Almost 99% of the entire oxygen found in the human body is transported by hemoglobin. Most
of the carbon dioxide is transported from all areas of the body back to the lungs by plasma in the
form of bicarbonate ions. This is created from a catalytic reaction (caused by a carbonic anhydrase
enzyme) between water and carbon dioxide, which combine to form carbonic acid. The carbonic
acid then splits into hydrogen and bicarbonate ions, with the latter eventually being transformed into
carbon dioxide again, taken to the lungs and exhaled.
Homeostatic Control of Respiration
The last physiological role of the respiratory system is the homeostatic control of respiration or, in
other words, the bodys ability to maintain a steady breathing rate. This is termed eupnea. This state
should remain constant until the body has a demand for increased oxygen and carbon dioxide
levels due to increased exertion, most likely caused by physical activity. When this happens,
chemoreceptors will pick up on the increased partial pressure of the oxygen and carbon dioxide and
send triggers to the brain. The brain will then signal the respiratory center to make adjustments to
the breathing rate and depth in order to face the increased demands.

XII.

Etiologic
Agent:
Bacteria

Pathophysiology

Precipitating
Factors:
Hospitalizatio
n
Smoking
Malnutrition
Widespread inflammation occurs

Microorganism enter respiratory tract by droplet inhalation

Predisposing
Factors:
Immune
Deficiency
Long term
illness

Thin mucous lining of the bronchi can become irritated and swollen

Cells that make up this lining may leak fluids in response to the inflammation

Coughing as reflex that works to clear secretions from the lungs

XIII.

DIAGNOSTIC PROCEDURES

Alveolar fluid increase narrowing of airways


DIAGNOSTIC TESTS

Complete Blood Count - A complete blood count (CBC) is a blood test used to evaluate
your overall health and
detect decreases
a wide range
of disorders,
including anemia, infection and
Ventilation
as secretions
thickens
leukemia. A complete blood count test measures several components and features of
your
blood,
including:
Redsevere
blood ventilation
cells, which
carry oxygen.
Mucus
within
the airways
cause
produces
resistance in small airways and can
perfusion imbalance
FEB. 17, 2016

WBC
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
RBC
HGB
HCT
MCV
MCH
MCHC
RDW
PLATELETS

NORMAL VALUES
5.0-15.5
18-55
35-75
2-9
0.4
0.2
4.2-6.1
12-28
27-52
60-98
27-31
33-37
11.5-14.5
150-450

6.4

5.54
10.9
33.0
59.6
19.7
33.0
17.2
40

21.4
42.3
36.3
0
0

Urinalysis - Urinalysis is a test that evaluates a sample of your urine. Urinalysis is used
to detect and assess a wide range of disorders, such as urinary tract infection, kidney
disease and diabetes. Urinalysis involves examining the appearance, concentration and
content of urine.
FEB. 17, 2016
RESULT
PHYSICAL
Color
Transparency
MICROSCOPIC
Epithelial Cell
Mucus Thread
Amorphous Urate
Amorphous Phosphate
WBC
RBC
CHEMICAL
Albumin
Sugar
Specific Gravity
pH

Light Yellow
Slightly Turbid

Few
Moderate
Moderate

Negative
Negative
0.15
6.0

34
13

Electrolyte Tests - electrolytes includes the measurement of sodium, potassium,


chloride, and bicarbonate. These ions are measured to assess renal (kidney), endocrine
(glandular), and acid-base function, and are components of both renal function and
comprehensive metabolic biochemistry profiles.
NORMAL VALUES
134-145 mmol/L
3.40-5.00 mmol/L
93-109 mmol/L

Sodium
Potassium
Chloride

XIV.

MEDICAL-SURGICAL MANAGEMENT

Medications:

RESULT
130.0 L
4.85 L
102.6 L

Erythromycin Ethylsuccinate Mythrocin (60 mL) 400mg / 5 mL


[Antibacterial (Suspension)]

Salbutamol Aero-vent 1mg / mL (2.5 mg / 2.5 mL) (Bronchodilator)

1 nobule Salbutamol Sulfate 2.5 mg / 500mcg per 2.5 mL

XV.

DRUG STUDY

XVI.

NURSING CARE PLAN

XVII.

DISCHARGE PLAN