Case Study of Bronchitis

Bataan Peninsula State University Institute of Nursing & 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

Macatulad, Reymark Gabon, Jesusa Cortez, Jennifer

Bronchitis Overview Bronch Bronchiti itis s is an acute acute inflam inflammat mation ion of the air passage passages s withi within n the lungs. It occurs when the trachea (windpipe) and the large and small bron bronch chii (airw (airway ays) s) with within in the the lung lungs s beco become me infl inflam amed ed beca becaus use e of  infection or other causes.

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 The thin mucous lining of these airways can become irritated and swollen.  The cells that make up this lining may leak fluids in response to the inflammation. Coug Coughi hing ng is a refl reflex ex that that work works s to clea clearr secr secret etio ions ns from from the the lungs. Often the discomfort of a severe cough leads you to seek medical treatment. Both Both adul adults ts and and chil childr dren en can can get get bron bronch chit itis is.. Symp Sympto toms ms are are similar for both. Infa Infant nts s usual usually ly get get bron bronch chio ioli liti tis, s, whic which h invo involv lves es the the smal smalle lerr airways and causes symptoms similar to asthma.

Bronchitis Causes Bronchitis occurs most often during the cold and flu season, usually coupled with an upper respiratory infection. •

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Sever Several al viruse viruses s cause cause bronch bronchiti itis, s, includ including ing influe influenza nza A and B, commonly referred to as "the flu." A number of bacteria are also known to cause bronchitis, such as Mycoplasma pneumoniae, pneumoniae, whic which h caus causes es so-c so-cal alle led d “wal “walki king ng pneumonia”. Bronc Bronchit hitis is also also can occur occur when when you inhale inhale irrit irritati ating ng fumes fumes or dusts. Chemical solvents and smoke, including tobacco smoke, have been linked to acute a cute bronchitis. People at increased risk both of getting bronchitis and of having more severe symptoms include the elderly, those with weakened immune systems, smokers, and anyone with repeated exposure to lung irritants.

Bronchitis Symptoms Acute Acute bronch bronchiti itis s most most common commonly ly occurs occurs after after an upper upper respi respirat ratory ory infection such as the common cold or a sinus infection. You may see symptoms such as fever with chills, muscle aches, nasal congestion, and sore throat. •

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Cough is a common symptom of bronchitis. The cough may be dry dry or may may prod produc uce e phle phlegm gm.. Sign Signif ific icant ant phle phlegm gm prod produc ucti tion on suggests that the lower respiratory tract and the lung itself may be infected, and you may have pneumonia.  The cough may last for more than two weeks. Continued forceful coughi coughing ng may make make your your chest chest and abdomi abdominal nal muscle muscles s sore. sore. Coughing can be severe enough at times to injure the chest wall or even cause you to pass out. Wheezing may occur because of the inflammation of the airways.  This may leave you short of breath.

When to call the doctor Although most cases of bronchitis clear up on their own, some people may have complications that their doctor can ease. •

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Seve Severe re coug coughi hing ng that that inte interf rfer eres es with with rest rest or slee sleep p can can be reduced with prescription cough medications. Wheezing may respond to an inhaler with albuterol (Proventil, Ventolin), which dilates the airways. If fever continues beyond four to five days, see the doctor for a physical examination to rule out pneumonia. See a doctor if the patient is coughing up blood, rust-colored sputum, or an increased amount of green phlegm.

When to go to the hospital

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If the patien patientt experi experienc ences es diffic difficult ulty y breath breathing ing with with or withou withoutt wheezing and they cannot reach their doctor, go to a hospital's emergency department for evaluation and treatment.

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

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Usually no blood tests are necessary. If the doctor suspects the patient has pneumonia, a chest x-ray may be ordered. Doctors may measure the patient's oxygen saturation (how well oxygen is reaching blood cells) using a sensor placed on a finger. Sometimes a doctor may order an examination and/or culture of  a sample of phlegm coughed up to look for bacteria.

Self-Care at Home •

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By far, far, the the majo majori rity ty of case cases s of bron bronch chit itis is stem stem from from vira virall infections. This means that most cases of bronchitis are shortterm and require nothing more than treatment of symptoms to relieve discomfort. Antibiotics will not cure a viral illness. Experts in the field of infectious disease have been warning for years years that that overus overuse e of antibi antibioti otics cs is allowi allowing ng many many bacter bacteria ia to become resistant to the antibiotics available. Doctors often prescribe antibiotics because they feel pressured by people's expectations to receive them. This expectation has been fueled by both misinformation in the media and marketing by drug companies. Don't expect to receive a prescription for an antibiotic if your infection is caused by a virus. Acetaminophen (Feverall, Panadol, Tylenol), aspirin, or ibuprofen (Motrin, Nuprin, Advil) will help with fever and muscle aches. Drinking fluids is very important because fever causes the body to lose fluid faster. Lung secretions will be thinner and easier to clear when the patient is well hydrated. A cool mist vaporizer or humidifier can help decrease bronchial irritation. An over over-t -the he-c -co ounte unterr coug cough h su supp pprressa essant nt may be hel helpful pful.. Preparati Preparations ons with guaifenesin guaifenesin (Robitussi (Robitussin, n, Breonesin Breonesin,, Mucinex) Mucinex) will loosen secretions; dextromethorphan-the "DM" in most over the counte counterr medica medicatio tions ns (Benyl (Benylin, in, Pertus Pertussin sin,, Trocal Trocal,, Vicks Vicks 44 44)) suppresses cough.

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

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Medi Medica cati tion ons s to help help su supp ppre ress ss the the coug cough h or loose loosen n and clea clearr secretions may be helpful. If the patient has severe coughing spel sp ells ls they they canno cannott cont contro rol, l, see see the the doct doctor or for for pres prescr crip ipti tion on strength cough suppressants. In some cases only these stronger cough suppressants can stop a vicious cycle of coughing leading to more irritation of the bronchial tubes, which in turn causes more coughing. Bronc Bronchod hodila ilator tor inhale inhalers rs will will help help open open airway airways s and decrea decrease se wheezing.  Though antibiotics play a limited role in treating bronchitis, they become necessary in some situations. In part partic icul ular ar,, if the the doct doctor or su susp spec ects ts a bact bacter eria iall infe infect ctio ion, n, antibiotics will be prescribed. People with chronic lung problems also usually are treated with antibiotics. In rare cases, the patient may be hospitalized if they experience brea breath thin ing g diff diffic icul ulty ty that that does doesn' n'tt respo respond nd to trea treatm tmen ent. t. This This usua us uall lly y occu occurs rs beca becaus use e of a comp compli licat catio ion n of bron bronch chit itis is,, not not bronchitis itself.

Follow-up •

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 The patient should follow up with their doctor within a week after treatment for bronchitis—sooner if your symptoms worsen or do not improve. Call the doctor's office if any new problems occur.

Prevention •

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Stop smoking. Avoid exposure to irritants. Proper protection in the workplace is vital to preventing exposure.   The The dang danger ers s of seco second ndha hand nd smok smoke e are are well well docu docume ment nted ed.. Children should never be exposed to secondhand smoke inside the home.

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

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In the the case case of bron bronch chit itis is caus caused ed by expo exposu sure re to respi respira rato tory ry irritants, all the patient may need to do is keep away from the cause of irritation. Smoking cessation is recommended to prevent development of  chron hronic ic bron bronc chiti hitis s or othe otherr chr chroni onic lung ung dise diseas ase e su suc ch as emphysema. Chronic bronchitis, as its name suggests, can cause symptoms for prolonged periods and lead to other debilitating lung conditions.

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

Physical Assessment

Technique

Skin

Inspection

Normal Findings

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Palpation

Nails

Inspection

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Hair

Inspection

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Head

Inspection

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Eyes

Inspection

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Ears

Inspection

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Nose

Inspection

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Palpation

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Skin is brown and generally equal No edema Good skin turgor No lesion  Temp. is warm & cool

Clean, smooth Pink to light brown nail beds

No lesion No dandruff  Even in distribution

Symmetrical in movement & position Face is symmetrical Normocephalic

Symmetrical in position Sclera is white & glossy PERRLA Brisk reaction to light

Equal in size Symmetrical No swelling or discharges Symmetrical No inflammation Air can be felt in both nares

Abnormal Findings •

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Pale conjunctiva

Technique

Mouth & Throat

Inspection

Normal Findings

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 Tongue is at midline

Abnormal Findings • • •

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Neck 

Inspection

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Palpation

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Breast & Axilla

Inspection

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Palpation • •

Chest

Inspection Palpation Auscultation

Heart

Auscultation

Abdomen

Inspection

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Genitals

Interview

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Extremities

Inspection

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Symmetrical with normal ROM No jugular vein distention  Trachea is visible at the midline No nodule Lymph nodes are not palpable

One breast is slightly larger No nipple discharge No masses No lymph nodes palpated

Normal contour  Tactile fremitus Bronchial breath sounds

S1 & S2 heard upon auscultation

Cracked lips  Tongue is pale Dental caries present Missing tooth

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Limited chest excursion

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Limited ROM

Color is consistent with the body No lesion or any abnormal findings Bowel sounds is normo- active (13/min) No tenderness No swelling or discharges No foul smell No infestation Norma hair distribution No edema No swelling Capillary refill around 1-3 seconds

Human Respiratory System

  The The respi respirat ratory ory system system consist consists s of all the organs organs involv involved ed in breathing. These include the nose, pharynx, larynx, trachea, bronchi 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 function properly; and it helps us get rid of carbon dioxide, which is a waste product of cellular function. The nose, pharynx, larynx, trachea and bronchi all work like a system of pipes through which the air is funn funnel eled ed down down into into our our lung lungs. s. Ther There, e, in very very smal smalll air air sacs sacs call called ed alveoli, oxygen is brought into the bloodstream and carbon dioxide is pushed from the blood out into the air. When something goes wrong with with part art of the the respi espirrator atory y sy syst stem em,, su suc ch as an infec nfecti tion on like like pneumonia, it makes it harder for us to get the oxygen we need and to get rid rid of the waste waste produc productt carbon carbon dioxid dioxide. e. Common Common respi respirat ratory ory symptoms include breathlessness, cough, and chest pain.

 The Upper Airway and Trachea When you breathe in, air enters your body through your nose or mouth. From there, it travels down your throat through the larynx (or voice box) and into the trachea (or windpipe) before entering your 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

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

The Lungs Structure  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 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 product. We each have two lungs, a left lung and a right lung. These are are divi divide ded d up into into 'lob 'lobes es', ', or big big sect sectio ions ns of tiss tissue ue sepa separa rate ted d by '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 side of our chest. The lungs can also be divided up into even smaller portions, called 'bronchopulmonary segments'.  These are pyramidal-shaped areas which are also separated from each other by membranes. There are about 10 of them in each lung. Each segment receives its own blood supply and air supply.

How they work  Air Air ente enters rs your your lung lungs s thro throug ugh h a sy syst stem em of pipe pipes s call called ed the the bronchi. These pipes start from the bottom of the trachea as the left and right bronchi and branch many times throughout the lungs, until they eventually form little thin-walled air sacs or bubbles, known as the alveol alveoli. i. The alveol alveolii are where where the impor importan tantt work work of gas exchan exchange ge takes place between the air and your blood. Covering each alveolus is 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 the alveoli and the blood in the capillaries are very close together, so that oxygen and carbon dioxide can move (or diffuse) between them. So, when you breathe in, air comes down the trachea and through the bronchi into the alveoli. This fresh air has lots of oxygen in it, and some of this this oxyg oxygen en will will trav travel el acro across ss the the wall walls s of the the alve alveol olii into into your your bloods bloodstr tream eam.. Travel Traveling ing in the opposi opposite te direct direction ion is carbon carbon dioxi dioxide, de, which crosses from the blood in the capillaries into the air in the alveoli 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 dioxide.

Blood Supply  The lungs are very vascular organs, meaning they receive a very large large blood blood supply supply.. This This is because because the pulmon pulmonary ary arteri arteries, es, which which 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 lungs so that the carbon dioxide can be blown off, and more oxygen can be absorbed into the bloodstream. The newly oxygen-rich blood 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 oxygen to cells and organs.

The Work of Breathing The Pleurae   The The lung lungs s are are cove covere red d by smoo smooth th memb membra rane nes s that that we call call pleurae. The pleurae have two layers, a 'visceral' layer which sticks 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 beca becaus use e they they help help you you brea breath the e in and out out smoo smooth thly ly,, with withou outt any any fric fricti tion on.. They They also also make make su sure re that that when when your your ribc ribcag age e expan expands ds on breathing in, your lungs expand as well to fill the extra space.

The Diaphragm and Intercostal Muscles When you breathe in (inspiration), your muscles need to work to 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. 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 space in your chest and drawing air into your lungs. Other muscles, including the muscles between your ribs (the intercostal muscles) also help by moving your ribcage in and out. Breathing out (expiration) 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 

inspirati inspir ation on your your lungs lungs simply simply recoi recoill back back into into their their restin resting g positi position, on, pushing the air out as they go.

The Respiratory System Through the Ages Breathing for the Premature Baby When a baby is born, it must convert from getting all of its oxygen through the placenta to absorbing oxygen through its lungs.  This is a complicated complicated process, involving involving many changes changes in both air and 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 baby baby's 's lungs ungs may may not not yet be matur ature e eno enough ugh to cope cope with the transition. The major problem with a preterm baby's lungs is a lack of  something something called 'surfactant'. 'surfactant'. This is a substance substance produced produced by cells in the the lung lungs s whic which h help helps s keep keep the the air air sacs sacs,, or alve alveol oli, i, open open.. With Withou outt surfactant, the pressures in the lungs change and the smaller alveoli collapse.  This reduces the area across which oxygen and carbon dioxide can be exchanged, and not enough oxygen will be taken in. Normally, a fetu fetus s will will begi begin n prod produc ucin ing g surfa surfact ctan antt from from arou around nd 28 28-3 -32 2 week weeks s 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 something called 'Neonatal Respiratory Distress Syndrome', or NRDS. Sign Signs s of NRDS NRDS incl includ ude e tach tachyp ypno noea ea (ver (very y fast fast brea breath thin ing) g),, grunting, and cyanosis (blueness of the lips and tongue). Sometimes NRDS can be treated by giving the baby artificially made surfactant by a tube down into the baby's lungs.

The Respiratory System and Ageing  The normal process process of ageing is associated associated with a number number of changes in both the structure and function of the respiratory system. These include: •

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Enlargement of the alveoli. The air spaces get bigger and lose their elasticity, meaning that there is less area for gases to be exch exchang anged ed acro across ss.. This This chang change e is some someti time mes s refe referr rred ed to as 'senile emphysema'.  The compliance (or springiness) of the chest wall decreases, so that it takes more effort to breathe in and out.   The The streng strength th of the respir respirato atory ry muscle muscles s (the (the diaphr diaphragm agm and intercostal muscles) decreases. This change is closely connected to the general health of the person.

All All of thes these e chang changes es mean mean that that an olde olderr pers person on migh mightt have have more more difficulty coping with increased stress on their respiratory system, such as with an infection like pneumonia, than a younger person would.

Bronchitis

Amoxicillin Generic Name: Amoxicillin Brand Name: Amoxil, Trimox Classification: Antibiotic Mechanism of Action Inhibits bacterial cell wall mucopeptide synthesis. Indication Used Used to trea treatt many many diff differ eren entt type types s of infe infect ctio ions ns caus caused ed by bacte bacteri ria, a, such such as ear ear infe infect ctio ions ns,, blad bladde derr infe infect ctio ions, ns, pneu pneumo moni nia, a, gonorrhea, and E. coli or salmonella infection. Contraindication Hypersensitivity to penicillins, cephalosporins, or imipenem. Not used to treat severe pneumonia, empyema, bacteremia, pericarditis, meningitis, and purulent or septic arthritis a rthritis during acute stage. Adverse Reaction: CNS: Agit Ag itat atio ion; n; anxie anxiety ty;; behav behavio iora rall chan change ges; s; conf confus usio ion; n; conv convul ulsi sion ons; s; dizziness; headache; hyperactivity; insomnia. Dermatologic: Acute generaliz generalized ed exanthemat exanthematous ous pustulosis pustulosis;; erythema erythema multifor multiforme; me; ery erythem themat atou ous s macu macullopap opapul ular ar rashe ashes; s; exfo exfolliati iativ ve der dermati matiti tis; s; muco mucocu cuta tane neou ous s cand candid idia iasi sis; s; Stev Steven enss-Jo John hnso son n synd sy ndro rome me;; toxi toxic c epidermal necrolysis; urticaria. GI: Diar Diarrh rhea ea (2%) (2%);; naus nausea ea (1%) (1%);; blac black, k, hair hairy y tong tongue ue;; hemo hemorr rrha hagi gic c pseudomembranous colitis; tooth discoloration; vomiting. Genitourinary: Crystalluria; vulvovaginal mycotic infection. Hematologic-Lymphatic: Agranulocytosis; anemia; eosinophilia; hemolytic anemia; leukopenia; thrombocytopenia; thrombocytopenic purpura. Hepatic: Acute Acute cytoly cytolytic tic hepati hepatitis tis;; choles cholestat tatic ic jaundi jaundice; ce; hepati hepatic c choles cholestas tasis; is; increased ALT and AST. Hypersensitivity: Anaphylaxis; hypersensitivity vasculitis. Miscellaneous: Serum sickness–like reactions. Nursing Responsibilities Responsibilities Periodic Periodically ally assess renal, renal, hepatic, hepatic, and hematopoi hematopoietic etic function function during prolonged therapy. Patients diagnosed with gonorrhea should have a serologic test for syphilis at the time of treatment and a followup serologic test after 3 months.

Paracetamol Generic name: Paracetamol Brand Names: Biogesic Classification: Analgesic/Antipyretic Analgesic/Antipyretic Mechanism of Action Parace Paracetam tamol ol posses possesses ses promi prominen nentt antipy antipyret retic ic and analge analgesic sic effe effect cts. s. Its Its anti anti-i -inf nfla lamm mmat ator ory y acti activi vity ty is weak weak and has has no clin clinic ical al significance. The mechanism of action is related to depression of the prostaglandin synthesis by inhibition of the specific cell cyclooxygenase, and depression of the thermoregulatory center in the medull medulla a oblong oblongata. ata. Inhibi Inhibits ts prosta prostagla glandi ndins ns in CNS, CNS, but lacks lacks antiantiinflammatory effects in periphery; reduces fever through direct action on hypothalamic heat-regulating center. Indications   The preparation is indicated in diseases manifesting with pain and fever: headache, toothache, mild and moderate postoperative and injury injury pain, pain, high high temper temperatu ature, re, infect infectiou ious s dis diseas eases es and chill chills s (acute (acute catarrhal inflammations of the upper respiratory tract, flu, small-pox, parotitis, etc.). Contraindications Paracetamol should not be used in hypersensitivity to the preparation and in severe liver diseases. Adverse reactions In rare rare cases cases hyper hypersen sensit sitivi ivity ty react reaction ions, s, predom predomina inantl ntly y skin skin allergy (itching and rash), may appear. Long-term treatment with high doses doses may cause cause a toxic toxic hepati hepatitis tis with with follow following ing initia initiall sympto symptoms: ms: nau nausea, sea, vom vomiting ting,, swea sweati ting ng,, and disc discom omfo forrt. Occas ccasio iona nallly a gastrointestinal discomfort may be seen. Nursing Responsibilities Responsibilities  The preparation should be used with care in patients with liver and renal diseases. The treatment with Paracetamol may change the laboratory tests of uric acid and blood glucose analysis. In severe renal failur failure e the interv interval al betwe between en two consec consecuti utive ve taking takings s should should not be short shorter er than than 8 hour hours. s. The The treat treatme ment nt with with the the prep prepar arat atio ion n is not not advisable during the first trimester of the pregnancy. In nursing women the the prep prepar arat atio ion n sh shou ould ld be us used ed with with stri strict ctly ly obse observ rvat atio ion n of the the therapeutic dose and duration of the treatment.

Ambroxol Generic Name: Ambroxol Brand Name: Mucosulvan Classification: Expectorant/Antibiot Expectorant/Antibiotic ic Mechanism of Action When administered orally onset of action occurs after about 30 minutes. The breakdown of acid mucopolysaccharide fibers makes the sputum thinner and less viscous and therefore more easily removed by coughing. Although sputum volume eventually decreases, its viscosity remains low for as long as treatment is maintained. Indication All All form forms s of trac trache heob obro ronc nchi hiti tis, s, emph emphys ysem ema a with with bron bronch chit itis is pneu pneumo moco coni nios osis is,, chro chroni nic c infl inflam amma mato tory ry pulm pulmon onar ary y cond condit itio ions ns,, bronchiec bronchiectasis, tasis, bronchitis bronchitis with bronchospas bronchospasm m asthma. asthma. During During acute exace exacerba rbatio tions ns of bronch bronchiti itis s it should should be given given with with the appropr appropriat iate e antibiotic. Contraindication   Ther There e are no absolu absolute te contra contraind indica icatio tions ns but in patient patients s with with gastric ulceration relative caution should be observed. Adverse Reaction Occas Occasio ional nal gast gastro roin inte test stin inal al side side effe effect cts s may may occu occurr but but thes these e are are normally mild. Nursing Responsibilities Responsibilities 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.

Metoprolol Generic Name: Metoprolol Brand Name: Lopressor, Toprol-XL Classification: Beta blocker Mechanism of Action Blocks beta receptors, primarily affecting CV system (decreases heart rate, decreases contractility, decreases BP) and lungs (promotes bronchospasm). Indication Metoprolol is used to treat angina (chest pain) and hypertension (high blood pressure). It is also used to treat or prevent heart attack. Contraindication  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 syndrome, or slowheart rate. If you have any of these other conditions, you you may may need need a dose dose adju adjust stme ment nt or sp spec eciial test tests s to safe safely ly us use e metoprolol:  pheochromocytoma; or  problems with circulation (such as Raynaud's syndrome);  congestive heart failure;  asthma, bronchitis, emphysema;  diabetes;  low blood pressure; depression;  liver or kidney disease;  a thyroid disorder; or  myasthenia gravis. Adverse Reaction Cardiovascular: Hypotension; edema; flushing; bradycardia (3%); palpitations; CHF; arterial insufficiency; peripheral edema. CNS: Headache; fatigue; dizziness (10%); depression (5%); lethargy; drowsiness; forgetfulness; sleepiness (10%); vertigo; paresthesias. Dermatologic: Rash (5%); facial erythema; alopecia; urticaria; pruritus (5%). EENT: Dry eyes; visual disturbances. GI: Nausea; vomiting; diarrhea (5%); dry mouth; gastric pain; constipation; heartburn; flatulence. Genitourinary: Impotence; urinary retention; difficulty with urination. Respiratory: Shortness of breath (3%); bronchospasm; dyspnea; wheezing. Miscellaneous: Increased hypoglycemic response to insulin; may mask hypoglycemic signs; muscle cramps; asthenia; systemic lupus erythematosus; cold extremities. Nursing Responsibilities Responsibilities In patients with angina pectoris or coronary artery disease (CAD), metoprolol may cause exacerbation of angina, occurrence of MI, and ventri ventricul cular ar arrhyt arrhythmi hmias. as. Monito Monitorr patien patients ts closel closely. y. Becaus Because e CAD is common and often unrecognized, it may be prudent not to discontinue beta beta-b -bllocke ockerr the therapy apy abr abruptl uptly y in patie atient nts s bein being g tre treated ated for for hypertension.

Nursing Care Plan Assess Assessmen mentt

Subjective: 

Diagno Diagnosi si s 

“Nahihirapa n akong huminga” as verbalized.

Objective: 

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Received awake lying on bed with an ongoing IVF of PLRS 1 L at 350 cc level regulated at 10 gtts, infusing well at right arm. Conscious/c oherent DOB w/ an RR of 35 bpm noted. Body malaise noted Wheezes upon auscultation Productive cough (yellow to green sputum Restlessnes s noted Chest pain noted Discomfort noted Facial Grimace noted

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Ineffect ive airway clearan ce r/t increas ed product ion of  bronchi al secreti ons as manife sted by Body malaise Wheez es upon auscult ation Product ive cough (yellow to green sputum Restles sness Chest pain Discom fort Facial Grimac e

Planni Planning ng

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After 8 hours of  continu es nsg. Interve ntions the pt. will be able to mainta in airway patenc y Expect orate secreti ons Maintai n RR of  at least 20-25 from the initial 35 bpm Learn and perfor m breathi ng and coughi ng exercis e. Verbali zed relief  form dyspne a.

Interv Interven en tions 

Monito r Vital signs

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Place the pt. in fowler’ s or semifowler’ s positio n  Teach the pt. how to do proper deep breath ing and coughi ng exerci se Avoid expos ure to irritant s such as cigaret te smoke , aeroso l and fumes Auscul tate breath sounds Increa se fluid intake

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Suctio n as ordere d Provid e oxyge n inhalat ion as ordere d Admini ster

Rationa le 

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Serve s as basel ine data  To facilit ate maxi mum lung expa nsion Impro ves ventil ation and helps in mobil izing secre tions w/o causi ng fatigu e  To avoid allerg ic reacti on

 To ascer tain statu s and note progr ess Helps liquef  y secre tions  To clear airwa y Provi de adeq uate amou nt of  oxyg en Will

Evalua tion

medic ation as ordere d

help loose n secre tions for easy expul sion.

Nursing Care Plan Ass Assessm essmen entt

Subjective: 

Dia Diagnos gnosis is

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“Ang bigat ng pakiramda m ko” as verbalized

Objective: 

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Received awake lying on bed with an ongoing IVF of PLRS 1 L at 340 cc level regulated at 10 gtts, infusing well at right arm. Conscious/c oherent Body malaise noted Difficulty moving left arm noted Facial grimace noted Pallor noted Complains of fatigue

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Activity intolerance r/t to generalized body weakness as manifested by Conscious/c oherent Body malaise noted Difficulty moving left arm noted Facial grimace noted Pallor noted Complains of fatigue

Plann lanniin g 

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After 10 hour s of  nursi ng inter venti ons the pt. will parti cipat e willin gly in nece ssary activ ity Will be able to mov e her left arm with ease Lear n how to cons erve ener gy Verb alize relief  from fatig ue

Interven tions 

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Evalua te the pt.’s curren t activit y tolera nce Adjust activit y and reduc e intensi ty of  task that may cause undesi red physio logical chang es Increa se exerci se and activit y levels gradu ally  Teach metho ds to conser ve energ y such as sitting than standi ng while dressi ng Assist the pt. while doing ADLs Give the pt. info.  That provid es eviden ce of 

Ration ale 

Provi de coop erati ve base line

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 To prev ent over exer tion

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Enh ance activ ity toler ance

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Help s mini mize wast e of  ener gy

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Prev ent the pt. from injur y  To sust ain the pt.’s moti vatio n

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Evalua tion

progre ss

Nursing Care Plan Asse Assess ssme ment nt

Subjective: 

Diag Diagno nosi si s 

“Giniginaw ako” as verbalized

Objective: 

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Received awake lying on bed with an ongoing IVF of PLRS 1 L at 320 cc level regulated at 10 gtts, infusing well at right arm. Conscious/co herent Warm to touch noted Flushed face noted Febrile with a temperature of 38.2°C

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Ineffect ive thermo regulati on r/t increas ed body temper ature as manifes ted by Warm to touch Flushed face Febrile with a temper ature of  38.2°C

Planni ng 

Afte r8 hour s of  cont inuo us  TSB, the pt.’s tem pera ture will decr eas e fro m 38.2 to 37.5 °C

Intervent Rational ions e 

Monitor VS

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Increas e fluid intake

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Maintai n bed rest

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Provide sufficie nt clothin g Perfor m TSB

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Admini ster antipyr etics as ordered

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Serve s as baseli ne data  To help cool down core temp eratur e  To decre ase meta bolis m that produ ce heat Facilit ate comfo rt Facilit ate heat loss by mean s of  evapo ration Helps lower temp eratur e within norm al range

Evalua tion

Nursing Care Plan Asse Assess ssme ment nt

Subjective: 

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“Sumasakit ang dibdib at braso ko” as verbalized

Objective: 

Diag Diagno nosi sis s

Received awake lying on bed with an ongoing IVF of PLRS 1 L at 300 cc level regulated at 10 gtts, infusing well at right arm. Conscious/co herent Headache Restlessness Difficulty moving left arm Chest pain Pain scale of  7 out of 10 Facial grimace

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Acute pain r/t localize d inflamm ation As manifes ted by Headac he Restless ness Difficult y moving left arm Chest pain Pain scale of  7 out of  10 Facial grimace

Plan Planni ni ng 

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Afte r 10 hour s of  nsg. inter vent ions the pt.’s pain scal e will decr ease from 7 to 4  The pt. will verb alize relie f  from pain Will dem onst rate use of  rela xati on skill s

Intervent Rational ions e  

Monitor VS Perfor m pain assess ment (COLD SPA) every time pain occurs

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Encour age verbali zation of  feeling of pain

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Instruc t use of  relaxati on exercis e such as listenin g to music Provide quiet and calm environ ment Encour age adequa te rest period Admini ster analge sic as ordere d

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Pain alters VS  To rule out devel opme nt of  compl icatio ns by knowi ng allevi ating and precip itatin g factor s Pain is subje ctive & can’t be asses sed throu gh obser vation alone Prom otes relaxa tion and divert s attent ion from pain Noisy enviro nmen t stimul ates irritati on Preve nt fatigu e  To

Evalua tion

maint ain tolera ble level of  pain

Nursing Care Plan Assessmen Diagnos t is Subjective: 

“wala akong ganang kumain”

Objective:  

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Refusal to eat Poor muscle tonicity Body weakness noted Restlessn ess

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Altere d nutriti on less than body requir emen ts R/T loss of  appet ite as evide nced by dysfu nctio nal eatin g patter n.

Plannin g 

After 4 hours of  nursin g interv ention s, patien t’s appeti te will be impro ved: from 2 tables poons to at least 5 tables poons per meal.

Interventi ons 

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Monitor vital signs Weight on regular basis

Discuss eating habits includin g food preferen ces. Serve favorite foods that are not contrain dicated. Serves foods that are palatabl e and attractiv e. Prevent and minimiz e unpleasa nt odors. Emphasi ze the importan ce of  well balance d nutrition diet

Rational e 

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For baselin e data Monitor nutritio nal state and effectiv eness of  interve ntions  To appeal to client likes and dislikes

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 To stimula te the appetit e

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 To stimula te the appetit e

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May have negativ e effect on appetit e/eatin g Promot e wellnes s

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Evaluati on