83608028 acute-bronchitis-case-study

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CHAPTER I
INTRODUCTION
Respiratory disorders are among the most common causes of illness and
hospitalization in children. Overall, respiratory dysfunction in children tends to be more
serious than in adults because the lumens in a child’s respiratory tract are smaller and
therefore likely to become obstructed. (Pillitteri, 2008)
While the most common respiratory diseases in children are colds and flu, there
are other lung diseases that children are also vulnerable to, which include Bronchitis.
Bronchitis refers to a nonspecific bronchial inflammation and is associated with a
number of childhood conditions. There are two types of Bronchitis: Acute Bronchitis and
Chronic Bronchitis. (Kliegman et al, 2007)

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. (Copstead et al. 2008)
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 WBC count is a reliable diagnostic indicator. A chest radiograph is required to
distinguish acute bronchitis (normal radiograph) from pneumonia (pulmonary infiltrates
on radiograph). (Copstead et al. 2008)
Treatment for patients with Acute Bronchitis is mainly symptomatic and includes
rest, humidification, and increased fluid intake. Exposure to cigarette smoke should be
avoided. Cough suppressants are not recommended unless cough interferes with the
child’s ability to rest. Antihistamines should be avoided because of their drying effect on
secretions. Antibiotics should be given only if a bacterial infection is confirmed by culture
or if the clinical picture supports the diagnosis. (Leifer et al, 2007)
The gastrointestinal system involves a long body tract with numerous organs.
Because it is so long and diverse; a multitude of possible disorders can occur along it,
including both congenital disorders and acquired illness. (Pilliteri, 2008)

Most common GI disorders seen in children are Constipation, Irritable Bowel
Syndrome, Reflux, Fecla incontinence, and Gastroenteritis. (www.aboutkidsgi.org)
Acute Gastroenteritis, an inflammation of the mucous membranes of the stomach
and intestines, is defines as diarrheal disease of rapid onset with or without
accompanying manifestations such as nausea, vomiting, fever, and abdominal pain.
Most cases of gastroenteritis are self-limited; however, more severe or prolonged
illnesses can result in dehydration with significant morbidity and mortality. (Kliegman)
Acute Gastroenteritis accounts for as many as 5 million deaths each year
worldwide. It primarily affects the small bowel and can be either viral or bacterial origin.
Both forms have similar manifestations and are considered self-limiting in the course
unless complications occur. All organisms that are implicated in gastroenteritis cause
diarrhea.
The universal manifestation of Acute Gastroenteritis is diarrhea, which occurs in
varying intensity, depending on the organisms involved and the health status of the
individual client. The diarrhea may be mild (two or three stools per day) or intense (more
than 10 watery stools per day). Nausea, vomiting, and anorexia may occur from
abdominal distention caused by increased fluid content and undigested food. Abdominal
pain, cramping, and borborygmi may occur from gas released from undigested food,
irritation of bowel mucosa, and distention of the intestines. The client may have a fever,
depending on the causative organisms.
Diagnosis for Acute Gastroenteritis is based on the history, physical exam, and
laboratory studies focused on evaluation the child’s hydration status and identifying the
causative agent. The history should include the following data: Recent exposure to
infectious agents, Travel history, and Exposure to contaminated food and water
supplies. The child’s hydration status is evaluated, including a history of fluid intake,

such as types, amounts, and how tolerated. The stooling pattern, frequency, and
volume, as well as urination frequency, amount, and color, is also investigated. Current
weight compared to pre-illness weight is useful in determining fluid loss. Generally, if no
systemic manifestations are present and if dehydration is absent diagnostic laboratory
tests are not indicated. Stool cultures should be performed for children with a fever
lasting more than 24 hours, blood or mucus in the stool, a family or household member
with similar symptoms, or a positive stool white blood cell stain. (Potts et al, 2007)
Treatment for acute gastroenteritis focuses on fluid replacement and correction
of electrolyte disturbances, and is dependent on the degree of dehydration. Initial
management should begin at home since early interventions can reduce complications
such as dehydration and poor nutrition. The most important aspect underlying home
treatment is the need to administer increased volumes of appropriate fluids as well as to
maintain caloric intake. Children with no dehydration and mild diarrhea may be treated
with 10ml/kg of ORS to replace fluis lost with each stool. However, since most children
who are not dehydrated dislike ORS, they can be offered age-appropriate foods and
additional fluids. (Potts et al, 2007)
According to the Environment health country profile conducted by the World
Health Organization, the ten leading causes of morbidity in the Philippines are diarrhea,
Bronchitis/Bronchiolitis, pneumonia, influenza, hypertension, tuberculosis, diseases of
the heart, malaria, measles, and chickenpox. (WHO, 2005)
Respiratory diseases and COPD are in the top ten causes of morbidity in the
Philippines. Research show that the incidence of Bronchitis among Metro Manila
children is 11 times the national average and that chronic cough, chronic phlegm,
wheezing and shortness breath are highest among drivers and commuters. (WHO,
2005)

PURPOSE AND OBJECTIVES
This case study aims 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 and with secondary diagnosis of Acute Gastroenteritis.
Specifically, this study seeks to accomplish the following objectives:
1. Identify the contributing factors leading to the development of the problem
2. Analyze the relationship of the factors leading to the development of the problem
3. Discuss nursing interventions that were utilized to solve the problems
4. Explain the patient’s response towards the nursing interventions being utilized
SIGNIFICANCE OF THE STUDY
The case study is conducted for the benefits of the following:

To the future patients, this case will provide them knowledge and information regarding
this condition which they might acquire in the future.
To the student nurses, this case will suffice them with knowledge that will help them
deliver proper nursing interventions for clients. It will also help them improve their clinical
skills in rendering appropriate care to the client with this kind of condition. This case will
also serve as a guide for them for future references.
To the clinical instructors, this case will equip them with additional knowledge regarding
the client’s condition thus, keeping them updated with the actions done in the clinical
area. This case will also help them evaluate their students’ clinical performances.
To the future researchers, this case will serve as a future references to their cases or
studies. It will also serve as a guide for them in making efficient case studies for future
utilization.
SCOPE AND LIMITATION
The scope of the study was focused on utilization of the nursing process in the
care of a 4 year old client diagnosed with Acute Bronchitis with asthmatic component
and Acute Gastroenteritis.

A retrospective type A of study was conducted for Mr. J.A.P. diagnosed with
Acute Bronchitis and Acute Gastroenteritis. The study was conducted on August 2 from
0600H to 1400H only. The study was conducted at the 8th
floor rear of the hospital
affiliated with the college of nursing.
The researcher was able to assess the client’s history through interview with the
patient’s significant others. Aspects that were looked into were the client’s demographic
profile, history of present illness, medications, and interventions done by the nurses and
the physicians. Other aspects that were not thoroughly assessed during the interview
were verified in the patient’s chart.
Meeting the needs of the patient, the researcher was able to perform routine vital
signs monitoring, monitoring intake and output, and assisting in the administration of
medications. Health teachings were also provided to the patient and the significant
others. All interventions were also properly documented in the patient’s chart.
Data collection was done during the duty hours between 0600H and 1400H on
August 3, 2010.
There are limitations of the study that was noted by the researcher. The
researcher wasn’t able to interview the patient directly because of his age, which is 4
years old. The researcher wasn’t also able to assess the environmental history of the
patient.
BACKGROUND OF THE STUDY
The study was conducted at a private institution located in Makati City, which
offers a wide array of services for treatment and specialization. The hospital has a vision
to be a world class hospital of everyone’s choice. Likewise, the nursing service division
has its own vision also which is to be a world class nursing services division of
everyone’s choice.

The study was conducted in the 8th
floor rear of the said constitution. It is a High
Risk Nursing Unit, admitting pediatrics from day old up to 18 years old. The unit has a
total bed capacity of 20 with 9 large private rooms and 11 small private rooms.
To meet the needs of the patients, the nursing unit maintains a nurse-patient
interaction of 1 nurse to 5 patients based on patient’s acuity.
It is manned by a unit manager, charge nurses, staff nurses, ward clerks, nursing
aides, and orderlies. The nursing staff correlates with the physician, surgical care
services, rehabilitation services, and the registered dietician to formulate the maximum
care to benefit the patient.
The nurses utilize the nursing process (ongoing multi-system physical and
psychological assessment, planning, intervention, education, and evaluation) when
rendering care to patients they serve. They observe the procedures accepted by the
hospital in the medication, delivery, administration and management, patient/family
education, nutritional support, oxygen therapy and pulse oximetry, IV line management,
complexes laboratory investigations and emergency resuscitation procedures. Moreover,
the staff practices universal precautions for infection control in doing all the day to day
procedures.
Patient A.P. was handled by the researcher who, on that time, was occupying
room 828. The researcher chose this topic because of the presence of two different
diagnoses present in the patient. The researcher also chose this topic for the reason that
it may enhance the knowledge of the researcher regarding appropriate care to pediatric
clients with these similar problems.

CHAPTER II
REVIEW OF RELATED LITERATURE
This chapter discuss about the analysis of preceding study, articles and journals
that have relationship with the present study. This chapter also deals with the
relationship between the dependent variables and independent variables identified in the
study.
ACUTE BRONCHITIS
DEFINITION
The following articles are all about the different definitions of Acute Bronchitis.
These articles will help the researchers understand more about the present condition of

the patient. These articles would also help the researcher in distinguishing the presence
of differences in the perceptions about the Acute Bronchitis.
Lewis, A., et al. (2008). Medical Surgical Nursing: Assessment and management of
clinical problems 2008. Mosby Elsevier
Acute bronchitis is an inflammation of the bronchi in the lower respiratory tract,
usually due to infection. It is one of the most common conditions seen in primary care. It
usually occurs a sequela to an upper respiratory tract infection. A type of acute
bronchitis seen in chronic obstructive pulmonary disease is acute exacerbation of
chronic bronchitis. AECB represents an acute infection superimposed on chronic
bronchitis. AECB is potentially serious condition that may lead to respiratory failure.
Pillitteri, Adele (2007). Maternal and Child Health Nursing: care of the child bearing
and childrearing family 5th edition 2007. Lippincott William and Wilkins
Bronchitis, or the inflammation of the major bronchi and trachea, is one of the
more illnesses affecting preschool and school-age children. It is characterized by fever
and cough, usually in conjunction with nasal congestion. Causative agents include the
influenza viruses, adenovirus, and Mycoplasma pneumonia, among others.
ETIOLOGY AND INCIDENCE
The following articles are all about the underlying etiology of Acute Bronchitis.
These articles will help the researcher recognize the expected causes of the condition
present in the client.
Leifer G., et al. (2007). Introductory to maternity and pediatric nursing 5th
edition
2007. Saunders Elsevier

Acute bronchitis is usually viral in origin. Rhinoviruses are the most common
causative organisms. Other viruses thought to cause bronchitis include respiratory
syncytial virus, influenza virus, parainfluenza virus, and adenovirus. Most bacterial
infections occur secondary to a primary viral infection or some other airway problem.
They may also occur as a result of foreign body aspiration. Air pollution has also been
implicated in the disease. The disorder is more common in young children and boys. It
can occur anytime but is more common during the winter months than in other seasons.
Greene, Alan. “Acute Bronchitis”. University of Maryland Medical Center. May 16,
2007 <http://www.umm.edu/careguides/000105.htm>
Bronchitis results from an infection such as colds or flu. The infection inflames
the bronchial tubes, which cause symptoms of bronchitis. Although acute bronchitis is
relatively common, some people are more prone to it than others. People at a higher risk
include smokers, individuals with respiratory illnesses such as asthma, and individuals
exposed to high levels of airborne pollutants. Although acute bronchitis itself is not
dangerous, the infection that causes the bronchitis may progress further into pneumonia.
Bronchitis may also aggravate the symptoms of asthma or other breathing disorders. Of
a young child show signs of bronchitis, consult a doctor, who may watch for any serious
developments.
“Diagnosis and Management of Acute Bronchitis”. American Academy of family
physicians”. <http://www.aafp.org/afp/2002/0515/p2039.html>
Acute bronchitis is usually caused by a viral infection. In patients younger than
one year, respiratory syncytial virus, parainfluenza virus, and coronavirus are the most
common isolates. In patients one to 10 years of age, parainfluenza virus, enterovirus,

respiratory syncytial virus, and rhinovirus predominate. In patients older than 10 years,
influenza virus, respiratory syncytial virus, and adenovirus are most frequent.
Parainfluenza virus, enterovirus, and rhinovirus infections most commonly occur
in the fall. Influenza virus, respiratory syncytial virus, and coronavirus infections are most
frequent in the winter and spring.
MANIFESTATIONS AND DIAGNOSTICS
The following articles include different signs and symptoms present in Acute
Bronchitis. These articles also include the different diagnostic procedures that should be
done to patients with Acute Bronchitis. These articles would help the researcher in
distinguishing the expected manifestations as well as be knowledgeable of the different
diagnostics that are to be done to a patient with Acute Bronchitis.
In acute bronchitis, persistent cough following an acute upper airway infection
(e.g. rhinitis, pharyngitis) is the most common symptom. Cough is often accompanied by
production of clear, mucoid sputum, although some patients produce purulent sputum.
Associated symptoms include fever, headache, malaise, and shortness of breath on
exertion. Physical examination may reveal mildly elevated temperature, pulse, and
respiratory rate with either normal breath sounds or rhonchi and expiratory wheezing.
Leifer G., et al. (2007). Introductory to maternity and pediatric nursing 5th
edition
Bronchitis is characterized by the gradual onset of rhinitis and a cough that is
initially non-productive but may change to a loosed cough with increased mucus

production. Auscultation may reveal coarse and fine, moist crackles and high pitched
rhonchi (resembling the wheezing of asthma). Associated symptoms include malaise,
low-grade fever, and increased mucus, which may be purulent. Chest radiographs are
usually normal. The diagnosis is based on clinical picture.
Cough is the most commonly observed symptom of acute bronchitis. The cough
begins within two days of infection in 85 percent of patients. Most patients have a cough
for less than two weeks; however, 26 percent are still coughing after two weeks, and a
few cough for six to eight weeks. When a patient's cough fits this general pattern, acute
bronchitis should be strongly suspected. Other signs and symptoms may include sputum
production, dyspnea, wheezing, chest pain, fever, hoarseness, malaise, rhonchi, and
rales. Each of these may be present in varying degrees or may be absent altogether.
Sputum may be clear, white, yellow, green, or even tinged with blood. Peroxidase
released by the leukocytes in sputum causes the color changes; hence, color alone
should not be considered indicative of bacterial infection.
Leifer G., et al. (2007). Introduction to maternity and pediatric nursing 5th
edition
The gradual onset of an unproductive “hacking” cough is preceded by an upper
respiratory tract infection, or cold. The cough may become productive with purulent
sputum. Children under 7 years of age cannot voluntarily cough and usually swallow
their sputum.

Chest x-rays can differentiate acute bronchitis from pneumonia because there is
no evidence of consolidation or infiltrates on x-ray with bronchitis.
Recommendations on the use of Gram staining and culture of sputum to direct
therapy for acute bronchitis vary, because these tests often show no growth or only
normal respiratory flora.6,7
In one recent study,8
nasopharyngeal washings, viral
serologies, and sputum cultures were obtained in an attempt to find pathologic
organisms to help guide treatment. In more than two thirds of these patients, a pathogen
was not identified. Similar results have been obtained in other studies. Hence, the
usefulness of these tests in the outpatient treatment of acute bronchitis is questionable.
Copstead et al. (2005). Pathophysiology third edition. Saunders Elsevier
incorporated
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.
THERAPEUTIC MANAGEMENT

The following articles include different therapeutic management for a patient with
Acute Bronchitis. These articles further help the researcher in rendering care to a patient
with Acute Bronchitis.
Leifer G., et al. (2007). Introduction to maternity and pediatric nursing 5th
edition
Treatment is mainly symptomatic and includes rest, humidification, and increased
fluid intake. Exposure to cigarette smoke should be avoided. Cough suppressants are
not recommended unless cough interferes with the child’s ability to rest. Antihistamines
should be avoided because of their drying effect on secretions. Antibiotics should be
given only if a bacterial infection is confirmed by culture or if the clinical picture supports
the diagnosis.
Acute bronchitis is usually self-limiting, and the treatment is generally supportive,
including fluids, rest, and anti-inflammatory agents. Cough suppressants or
bronchodilators may be prescribed for symptomatic treatment of nocturnal cough or
wheezing. Antibiotics generally are not prescribed unless the person has a prolonged
infection associated with constitutional symptoms. If this is an acute bronchitis due to
influenza virus, treatment with antiviral drugs – either zanamivir (Relenza) or oseltamivir
(Tamiflu) – can be started, but the antiviral drug must be initiated within 48 hours of the
onset of symptoms.
Price, et al. (2006). Pediatric Nursing, an introductory text 2006. Elsevier

As with all respiratory disorders, fluids are important. Bronchitis is generally self-
limiting and resolves in 2 to 3 weeks. Antibiotics, cough suppressants, antihistamines,
and expectorants are not indicated.
Therapy is aimed at relieving at respiratory symptoms, reducing fever, and
maintaining adequate hydration. An antibiotic is prescribed for bacterial infections if
mucus is viscid, an expectorant may be needed to help he child raise it. It is important
that children with bronchitis cough to raise accumulating sputum. Cough syrups to
suppress coughing, therefore, are rarely indicated.
ACUTE GASTROENTERITIS
DEFINITION
The following articles include different definitions of Acute Gastroenteritis. These
articles would assist the researcher in understanding more about the present condition
of the patient.
Kliegma et al. (2007). Nelson textbook of Pediatrics 18th
Edition 2007. Saunders
Elsevier
The term gastroenteritis denotes infections of the gastrointestinal tract caused by
bacterial, viral, or parasitic pathogens. Many of these infections are food-borne illnesses.
The most common manifestations are diarrhea and vomiting, which may also be
associated with systemic features such as abdominal pain and fever. The term
gastroenteritis captures the bulk of infectious causes of diarrhea.

Ignatavicious et al. (2006). Medical-Surgical Nursing: critical thinking for
collaborative care 5th
edition 2006. Elsevier
Acute Gastroenteritis is an increase in the frequency and water content of stools
or vomiting as a result of inflammation of the mucous membranes of the stomach and
intestinal tract. It primarily affects the small bowel and can be either viral or bacterial
origin. Both forms have similar manifestations and are considered self-limiting in the
course unless complications occur. All organisms that are implicated in gastroenteritis
cause diarrhea.
ETIOLOGY AND RISK FACTORS
The following articles are all about etiology and risk factors of Acute
Gastroenteritis.
Kliegma et al. (2007). Nelson textbook of Pediatrics 18th
Edition 2007. Saunders
Elsevier
Acute Gastroenteritis is due to infection acquired through the feco-oral route or
by ingestion of contaminated food or water. AGE is associated with poverty, poor
environmental hygiene, and development indices. Enteropathogens that are infectious in
small inoculums (Shigella, E. coli, noroviruses, rotavirus, Giardia lamblia,
Cryptosporidium parvum, and Entamoeba histolytica) can be transmitted by person-to-
person, whereas others such as cholera are generally a consequence of contamination
of food or water supply.

Pathogens that cause GI disease are transmitted by the fecal-oral route, from
person to person, and through ingestion of focally contaminated food and water. GI
infections are often referred to as “Food poisoning” because food is frequently the
vehicle for transmission of actively growing microbes or their toxins.
MANIFESTATIONS
The following articles show different manifestations expected to be seen in
patients with Acute Gastroenteritis. These articles will help the researcher in detecting
some manifestations that are present to his/her patient.
Black, J., et al. (2009). Medical-Surgical Nursing: clinical management for positive
outcome 2009. Elsevier
The universal manifestation of AGE is diarrhea, which occurs in varying intensity,
depending on the organisms involved and the health status of the individual client. The
diarrhea may be mild (two or three stools per day) or intense (more than 10 watery
stools per day). Nausea, vomiting, and anorexia may occur from abdominal distention
caused by increased fluid content and undigested food. Abdominal pain, cramping, and
borborygmi may occur from gas released from undigested food, irritation of bowel
mucosa, and distention of the intestines. The client may have a fever, depending on the
causative organisms.
Disease and Symptoms caused by Adenoviridae. Adenoviridae.
<http://www.stanford.edu/group/virus/adeno/2004takahashi/webpage/Disease%20
and%20Symptoms%20caused%20by%20Adenoviruses.htm>
Acute gastroenteritis symptoms, including abdominal pain and diarrhea have
been reported and are caused by serotypes 40 and 41. In children, respiratory

symptoms are also commonly found with gastrointestinal infections. These infections,
while not often identified as being specifically caused by adenoviruses, are quite
common - studies have shown that 50% of children have antibodies to adenoviruses by
the age of 4.
Viral Gastroenteritis. Center for Disease Control and Prevention. January 14, 2010.
<http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm>
The main symptoms of viral gastroenteritis are watery diarrhea and vomiting. The
affected person may also have headache, fever, and abdominal cramps ("stomach
ache"). In general, the symptoms begin 1 to 2 days following infection with a virus that
causes gastroenteritis and may last for 1 to 10 days, depending on which virus causes
the illness.
DIAGNOSIS
The following articles include methods on how to diagnose Acute Gastroenteritis.
How is gastroenteritis diagnosed? Health-cares. July 18, 2005. http://digestive-
disorders.health-cares.net/gastroenteritis-diagnosis.php
The symptoms of gastroenteritis are usually enough to identify the illness. Unless
there is an outbreak affecting several people or complications are encountered in a
particular case, identifying the specific cause of the illness is not a priority. However, if
identification of the infectious agent is required, a stool sample will be collected and
analyzed for the presence of viruses, disease-causing (pathogenic) bacteria, or
parasites.
It is important to consider infectious gastroenteritis as a diagnosis of exclusion. A few
loose stools and vomiting may be the result of systemic infection such as pneumonia,

septicaemia, urinary tract infection and even meningitis. Surgical conditions like
appendicitis, intussusception and, rarely, even Hirschsprung's disease may mislead the
clinician.
Viral Gastroenteritis. Center for Disease Control and Prevention. January 14, 2010.
<http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm>
Generally, viral gastroenteritis is diagnosed by a physician on the basis of the
symptoms and medical examination of the patient. Rotavirus infection can be diagnosed
by laboratory testing of a stool specimen. Tests to detect other viruses that cause
gastroenteritis are not in routine use.
PATHOPHYSIOLOGY
The following articles are all about the Pathophysiology of Acute Gastroenteritis.
These articles would help the researcher in understanding the progression of the said
condition.
Infection with viral and bacterial organisms can produce gastrointestinal
illnesses, in which watery diarrhea is the primary feature. These disorders can be
caused by noninflammatory, inflammatory, or penetrating mechanisms. The infecting
organisms can release enterotoxin (a noninflammatory toxic substance specific to the
intestinal mucosa), which results in diarrhea. The organism can also attach itself to
mucosal epithelium without penetrating it. Cells of the intestinal villi are then destroyed
and malabsorption results. Infections that are mediated by bacterial toxins cause the
absorptive capacity of the distal small bowel and proximal colon to be overcome,

resulting in diarrhea. Finally, the organism can penetrate the intestine, causing cellular
destruction, necrosis, and a potential for ulceration. Diarrhea occurs often with white
blood cells or red blood cells present in the stool.
Nowak, T., et al. (2005). Pathophysiology: concepts and applications for Health
Care Professionals third edition 2008. Mcgraw-Hill
Specific pathogens colonize the surface of the gastric epithelium below its mucus
layer. While unable to penetrate deeply, the organism is adapted to resist gastric acid
and thrives at the epithelial surface. It induces an infiltration of PMNs and over time,
metaplasia in the epithelium that may predispose to gastric carcinoma.
Black, J., et al. (2009). Medical-Surgical Nursing: clinical management for positive
outcome 2009. Elsevier
Normally, human flora protects the bowel from colonization of pathogens;
however, the intestinal flora can be (1) disrupted by harmful bacteria and viruses that
cause tissue damage and inflammation or (2) depressed by antibiotic therapy,
administered either orally or parenterally. Pathogens cause tissue damage and
inflammation by releasing endotoxins that stimulate the mucosal lining of the intestine,
resulting in greater secretion of water and electrolytes into the intestinal lumen. The
active secretion of chloride and bicarbonate ions in the small bowel leads to inhibition of
sodium reabsorption. To balance the excess sodium, large amounts of protein-rich fluids
are secreted into the bowel, overwhelming the large bowels ability to reabsorb the fluid
and leading to diarrhea. Pathogens also cause damage and inflammation by invading
and destroying the mucosal lining of the bowel, resulting in bleeding and ulceration.
When the integrity of the GI tract is impaired, its ability to carry out digestive and
absorptive functions can be affected.

TREATMENT AND NURSING CARE
The following articles include different nursing care and treatment for Acute
Gastroenteritis. These articles would help the researcher in dealing with the patient with
this kind of condition.
Leifer et al. (2007). Introduction to maternity and pediatric nursing 5th
edition 2007.
Saunders Elsevier
Treatment is focused on identifying and eradicating the cause. Nursing
responsibilities include teaching parents and caregivers proper and age-appropriate diet
and feeding techniques. The priority goal of care includes preventing fluid and electrolyte
imbalance. Oral rehydrating solutions such as Pedialyte, Lytren, Ricelyte, and Resol are
used for infants in small frequent feedings. The nursing care of gastroenteritis includes
maintaining intake and output records and providing skin care and frequent changes to
prevent excoriation from the frequent stools. Parents should be taught good hand
washing techniques, proper food handling, and principles of cleanliness and infection
prevention.
For clients with the most types of gastroenteritis, supportive treatment is
instituted. Therapy is focused on fluid replacement, and the amount and route of fluid
administration are determined by fluid status. For mild cases of gastroenteritis, the client
is treated on an ambulatory care basis or in the nursing home if he or she is a resident
there. If the fluid volume is severely depleted, the client is admitted to the hospital for
administration of IV fluids. Drugs that suppress intestinal motility, such as

anticholinergics and antiemetics, are not routinely given for bacterial or viral
gastroenteritis. Use of these drugs can prevent the infecting organism from being
eliminated from the body. Treatment with antibiotics may be warranted of the
gastroenteritis is due to bacterial infection with fever and severe diarrhea.
DEVELOPMENTAL AGE
The following are articles about the developmental age of the patient.
PRESCHOOLER
The preschool period traditionally includes ages 3, 4, and 5 years. Although
physical growth slows considerably during this period, personality and cognitive growth
are substantial. This is also an important period of growth for parents. They may be
unsure about how much independence and responsibility for self-care they should give
their preschooler. Most children of this age want to do things for themselves – choose
their own clothing and dress by themselves, feed themselves completely, wash their own
hair, and so forth. As a result, parents of preschooler may find their child dressed in one
red and one green sock, going to preschool with unwashed ears, or trying to eat soup
with a fork. They need reassurance that this behavior is typical and helps a child develop
more initiative and control of life. They may also need some guidance in separating
those tasks a preschooler can accomplish independently from those that still require
some adult supervision so they can set sensible limits. Setting limits protect children
from harming themselves or others while participating in all the interesting experiences
available to them.

PHYSIOLOGICAL DEVELOPMENT
Potts, et al. (2007) Pediatric Nursing; caring for children and their families. 2nd
Edition. Thomson Delmar Learning, Thomson corporation
During the preschool years, the rate of physical growth and change shows as
compared to the rate experienced during the infant and toddler years. Generally,
children will gain an average of 2.3 kg or 5 pounds per year in weight and 7.5 cm or 3
inches per year in height.
The preschool period is a time of refinement of eye-hand coordination and
muscle coordination. Walking, running, and jumping are well established by the
preschool years, and by 3 the child is able to ride a tricycle, balance on one foot for a
few seconds, jump off the bottom step, and use alternate feet when going up the stairs.
COGNITIVE DEVELOPMENT
At age 3 years, cognitive development according to Piaget is still preoperational.
Although children during this period do enter a second phase called intuitional thought,
they lack the insight to view themselves as others see them or put themselves in
another’s place. Because preschoolers cannot make this kind of mental substitution,
they feel they are always right. This causes them to argue with the forcefulness that
comes from believing they are 100% correct. This is an important point to remember
when explaining procedures to preschoolers.
MORAL DEVELOPMENT

Children of preschool age determine right from wrong based on their parents’
rules. They have little understanding of the rationale for these rules or even whether the
rules are consistent. Because preschoolers depend on their parents to supple rule for
them, when faced with a new situation they have difficulty seeing that the rules they
know may also apply to a new situation such as a hospital.
PSYCHOSOCIAL DEVELOPMENT
Erikson defines the developmental task of a preschool period as learning
initiative versus guilt. Learning initiative is learning how to do things. Children can initiate
motor activities of various sorts on their own and no longer merely respond to or imitate
the actions of other children or of their parents. The same is true for language and
fantasy activates.
ACTIVITY OF A PRESCHOOLER
Potts, et al. (2007) Pediatric Nursing; caring for children and their families. 2nd
Edition. Thomson Delmar Learning, Thomson corporation
The preschool child is refining both gross and fine motor coordination and skill.
This allows the child to participate in more physical games and sports where more
activity is used. An emphasis on physical fitness has emerged in the last few years, and
regular physical activity can benefit a child in many ways – for example – improved
ability to perform motor skills; enhanced self-confidence and body image; development

of lifetime habits; and prevention f disease processes associated with inactivity. Physical
activity can also help get rid of tension and excess energy.
STATISTICS
Philippines: Environmental Health Country Profile. http://www.wpro.who.int
The ten leading causes of morbidity are diarrhea, bronchitis/bronchiolitis,
pneumonia, influenza, hypertension, tuberculosis, diseases of the heart, malaria,
measles and chickenpox. The prevalence of communicable diseases is still very high
while that of non-communicable diseases is increasing and will continue to do so. This
double burden of disease places a great toll on the health and economy of the people
and of the nation as a whole. Respiratory diseases and COPD are in the top ten causes
of mortality in the Philippines.
Research shows that the incidence of bronchitis among Metro Manila children is
11 times the national average and that chronic cough, chronic phlegm, wheezing and
shortness of breath are highest among drivers and commuters.
SYNTHESIS
All authors of the books being used and all the internet sources stated similar
definitions of Acute Bronchitis and Acute Gastroenteritis, which refer to the inflammation
of the major bronchi in the lower respiratory tract, and infections of the gastrointestinal
tract caused by bacterial, viral, or parasitic pathogens, respectively. There were no
distinctive differences noted about the signs and symptoms, etiology, pathophysiology,
and therapeutic management of the said problems.

CHAPTER III
CLIENT PRESENTATION
This is a case of a male pediatric client with initials of J.A.P., 4 years of age,
under the services of Dr. C. and Dr. R., and is currently living at Taguig City. The patient
is a Filipino and Catholic.
The patient was admitted last July 31, 2010, accompanied by his mother and
with a chief complaint of “severe cough, nahihirapang huminga”, as verbalized by his
mother. Initial assessment was done to the patient. The assessment revealed that the
patient was awake, alert, and ambulatory. Initial vital signs were taken with results of:
Temperature – 36.2˚C, Heart rate – 125bpm, Respiratory rate – 24cpm. The patient was
not in respiratory distress with Oxygen Saturation of 98%-99%.
History of present illness revealed that the patient was apparently well until 2
weeks prior to admission, when the patient was noted to have dry cough, no colds, and

no fever. Five days prior to admission, the patient had experienced fever with a
temperature of 40˚C. The patient still had dry cough and no colds. For this reason, the
patient sought consult. His prescribed medications were given Clarithormycin, Asmalin-
broncho, Ibuprofen, and Combivent nebulization. Four days prior to admission, the
patient still suffered from dry cough and fever. The patient also experienced episodes of
vomiting. Softening of stools was also noted. They sought consult and Clarithormycin
was then shifted to Co-Amoxiclav. Three days prior to admission, there has still
persistence of symptoms with five episodes of vomiting while coughing and more than
three episodes of watery stools. The patient sought again consult and was given
Metroclorpramide, Paracetamol, Ibuprofen, Acetylcysteine and Oral Rehydration
Solution. Complete Blood Count was done and the result was within normal range. One
day prior to admission, the patient had brassy cough and decreased appetite.
Persistence of signs and symptoms was still present hence the patient was advised for
admission.
At 1215H, the patient was admitted and handed to the 8th
floor of MMC. Upon
admission, physician’s orders include vital signs monitoring every 4 hours, monitoring
intake and output, follow up results of Complete Blood Count and Chest X-ray, and
Chest Physiotherapy to be done by the pulmonary personnel. Intravenous fluid of D5 0.3
NaCl 500 ml to run at 140-141 µgtts/min and D5MMB 500 ml to run at 93-94 µgtts/min
were started upon admission.
Further assessment of the patient revealed that he was noted to have decreased
appetite and has experienced weight loss. He also experienced headache, chest pain,
and difficulty of breathing. Cough and episodes of vomiting were also noted.
On July 31, 2010, Complete Blood Count result revealed that the patient’s White
Blood Cells were low – 5.59 x 103
(NV: 6.0 – 17.5 x 10 3
). Other blood components were
within normal range: RBC – 4.7 x 106
(NV: 3.7 – 5.4 x 106
), Hematocrit – 34.90% (NV:

33%-39%), Hemoglobin – 12.20 g/dL (NV: 10.5-13.5 g/dL), Platelet count – 303,000
(NV: 150,000 – 450,000).
Chest X-ray was also done and result showed that the lungs are clear. Hila and
pulmonary vessels are within normal limits. Heart is normal in size and configuration.
Mediastinum and diaphragm are normal. Visualized bones are unremarkable. Soft
tissues do not appear unusual.
On August 1, 2010, the patient underwent skin test for cefuroxime. The result
was negative, no induration, and no erythema. The patient was afebrile and has claimed
to breathe easier than the day of admission. Patient’s vital signs were: Temperature -
37˚C, Heart rate – 82bpm, and Respiratory rate – 22cpm.
The patient was endorsed by the Clinical instructor to the researcher last August
2, 2010 however, interactions and proper interventions for the patient was yet to be
made on the following day.
The patient was first seen and handled by the researcher last August 3, 2010
from 0600H – 1400H. The researcher received the following endorsements: Patient’s
working diagnosis is - to consider Pneumonia versus Croup, and Acute Gastroenteritis,
patient was on regular diet, and hooked on an Intravenous Fluid of D5MMB 500 ml at 93
µgtts/min, located at the left peripheral line. The duties of the researcher were to monitor
vital signs every 4 hours, assist in administration of medications, and bedside care.
Medications being endorsed were: Combivent UDV 2.5ml (Ipratropium bromide +
Albuterol sulfate) 1 Unit-dose vial, three times a day; Budecort Respule 250mcg/ml
(Budesonide) 1 respule for inhalation, three times a day; Zegen vial 750mg (Cefuroxime)
1 vial every 8 hours through intravenous fluid. Chest physiotherapy was also ordered
every after nebulization, care of pulmonary personnel. At 0615H, routine rounds were
done by the bedside nurse together with the clinical instructor and the researcher. The

patient was asleep and he was with his father. Preparation of the medications was also
observed by the researcher.
At 0800H, vital signs monitoring was done by the researcher. Results were:
Temperature - 36˚C, Heart Rate – 98bpm, Respiratory rate – 20cpm. The researcher
was able to perform initial assessment to the patient. The researcher was able to
auscultate the patient’s lungs for presence of adventitious breath sounds. It was noted
that the patient had presence of occasional rhonchi on the left upper lung field. Presence
of productive cough was also noted. The patient had warm, moist skin and was positive
of dry lips. The patient was not in respiratory distress. Rapid and shallow respiration was
also observed by the researcher. The researcher was able to interview the patient’s
significant others regarding his current health status. When asked about the patient’s
health condition, the grandmother verbalized, “Medyo nahihirapan siyang huminga pero
lumuluwag naman kapag nag ne-nebulize siya”. Therefore, Ineffective Breathing
Pattern related to airflow limitation as evidenced by occurrence of dyspnea and
presence of occasional rhonchi was identified. Proper nursing interventions were
done to the patients in order to improve his breathing pattern. These include assessment
of the respiratory status as well as the presence of adventitious breath sounds, assisting
in proper positioning of the patient, elevating the head of the bed which helps in
loosening mucus secretions in the airway, encouraging the patient to perform breathing
exercises and to have adequate rest periods between activities, and encouraging the
patient to increase his fluid intake. Ineffective Airway Clearance related to inability to
clear mucus as evidenced by occurrence of dyspnea and presence of productive
cough was also identified by the researcher. Interventions done were assisting patient in
performing coughing and breathing maneuvers, monitoring vital signs and respiratory
status, assisting in administration of medications, and encouraging patient to increase
fluid intake.

Further assessment of the patient revealed that he had moist buccal mucosa and
negative of enlarged lymph nodes. Abdominal assessment revealed that the patient had
flat abdomen and normoactive bowel sounds. No cyanosis and edema were noted by
the researcher. Patient’s activity was noted to be fair; however assistance was needed
whenever the patient does his daily activities. It was also noted that he was experiencing
weakness during coughing hence; Risk for Activity Intolerance related to presence
of respiratory problem secondary to dyspnea and persistent coughing was
recognized.
History of the patient was also obtained which revealed that he had asthma,
diagnosed last 2006. He also had history of hospitalization with Pneumonia as the
cause. Family history revealed that his aunt also had asthma. Both Grandparents is
positive of hypertension and Diabetes Mellitus.
At 0830H, Combivent UDV 2.5ml (Ipratropium bromide + Albuterol sulfate) and
Budecort Respule 250mcg/ml (Budesonide) were administered by means of nebulization
therapy. Chest Physiotherapy was also done after administering nebulization treatment
to the patient. Proper health teachings were also done by the researcher.
At 1200H, vital signs monitoring was done and results showed normal results:
Temperature – 36.6˚C, Heart rate – 88bpm, and Respiratory rate – 28cpm. The client
was not in respiratory distress, was negative of cyanosis, and had an episode of post-
tussive vomiting. The patient experienced no diarrhea and vomiting however, the patient
was still susceptible of dehydration due to the previous episodes of vomiting and soft
stools. Therefore, Risk for Deficient Fluid Volume related to excessive loss through
normal route secondary to episodes of vomiting was noted by the researcher. When
asked about the nutritional status of the patient, the grandmother stated, “Hindi pa rin
siya gaano kumakain, pero mas dumami kinakain niya ngayon kaysa nung dati.” The
researcher noted that the patient could only consume three-fourth of his food. Therefore,

Risk for Imbalanced Nutrition: Less than body requirements related to decreased
appetite secondary to disease process was identified. Proper interventions were done
for these problems which include: assessing for patient’s vital signs and noting for any
signs of dehydration, encouraging patient to increase fluid intake, instructing patient to
eat small but frequent meals, noting for changes of the patient’s weight, providing
medications and supplements such as Heraclene (1mg Capsule two times a day), and
Cherifer (5ml daily; AM), and providing a safe and quiet environment. The patient’s
weight was 22.5 kilograms (Ideal Body weight: 14.3 – 23.3 kilograms).
At 1300H, the researcher accompanied the patient and his significant others to
his attending physician. Assessment was done by the physician and made an order that
the patient may go home, provided that the intravenous fluid must be consumed first.
The physician also modified the patient’s clinical diagnosis; from t/c Pneumonia versus
Croup to Acute Bronchitis with secondary diagnosis of Acute Gastroenteritis.
Intake and output was also taken and recorded: Intake – 125 ml, Urine Output –
three times, and no bowel movement.
At 1330H, endorsement was done and health teaching was conducted before the
end of the shift.
CHAPTER IV
ANALYSIS AND INTERPRETATION

I. Ineffective Airway Clearance related to inability to clear mucus as evidenced by
occurrence of dyspnea and presence of productive cough
Ineffective Airway Clearance refers to the inability to clear secretions or
obstructions from the respiratory tract to maintain a clear airway. (Doenges, 2008)
Maintaining a patent airway is vital to life. Coughing is the main mechanism for
clearing the airway. However, the cough may be ineffective in both normal and disease
states secondary to factors such as pain from surgical incisions/ trauma, respiratory
muscle fatigue, or neuromuscular weakness. Other mechanisms that exist in the lower
bronchioles and alveoli to maintain the airway include the mucociliary system,
macrophages, and the lymphatics. Factors such as anesthesia and dehydration can
affect function of the mucociliary system. Likewise, conditions that cause increased
production of secretions (e.g., pneumonia, bronchitis, and chemical irritants) can overtax
these mechanisms. Ineffective airway clearance can be an acute (e.g., postoperative
recovery) or chronic (e.g., from cerebrovascular accident [CVA] or spinal cord injury)
problem. (Gulanick, et al., 2010)
In relation to the client, he was noted to have difficulty expelling the mucus as
manifested by episodes of dyspnea. The patient has been diagnosed of Acute Bronchitis
and was positive of productive cough and occasional rhonchi on left upper lung field.
The goal of the problem is to have patent airway. Proper interventions for this
problem include: assisting patient in performing coughing and breathing maneuvers,
monitoring vital signs and respiratory status, assisting in administration of medications,
and encouraging patient to increase fluid intake.

The goal of this problem was partially met for the patient had experienced
development from the disease although there is still presence of productive cough. The
patient also claimed to breathe easily than before. (Gulanick, et al., 2010)
II. Ineffective Breathing Pattern related to airflow limitation as evidenced by
occurrence of dyspnea and presence of occasional rhonchi
Ineffective Breathing Pattern is defined as inspiration and/or expiration that does
not provide adequate ventilation. (Doenges, 2008)
Respiratory pattern monitoring addresses the patient’s ventilatory pattern, rate,
and depth. Most acute pulmonary deterioration is preceded by a change in breathing
pattern. Respiratory failure can be seen with a change in respiratory rate, change in
normal abdominal and thoracic patterns for inspiration and expiration, change in depth of
ventilation, and respiratory alternans. (Gulanick, et al., 2010)
The patient had accumulation of secretions and breathing pattern was altered because
of the presence of occasional rhonchi on the left upper lung field. The patient also
claimed to have experienced difficulty of breathing. Assessment revealed that patient
was positive of dry lips however; no signs of hypoxia were noted.
The goal of this problem is to improve breathing pattern. Proper interventions
done by the researcher include: assessment of the respiratory status as well as the
presence of adventitious breath sounds, assisting in proper positioning of the patient,
elevating the head of the bed which helps in loosening mucus secretions in the airway,
encouraging the patient to perform breathing exercises and to have adequate rest
periods between activities, and encouraging the patient to increase his fluid intake.
The goal was partially met because there was still presence of occasional
rhonchi however; ease of breathing was noted and observed by the researcher.

Presence of productive cough was still observed but the patient did not experience any
respiratory distress.
III. Risk for Deficient Fluid Volume related to excessive loss through normal route
secondary to episodes of vomiting
Risk for Deficient Fluid Volume refers to risk for experiencing vascular, cellular,
or intracellular dehydration. (Doenges, 2008)
Fluid volume deficit, or hypovolemia, occurs from a loss of body fluid or the shift
of fluids into the third space, or from a reduced fluid intake. Common sources for fluid
loss are the gastrointestinal tract, polyuria, and increased perspiration. Fluid volume
deficit may be an acute or chronic condition managed in the hospital, outpatient center,
or home setting. The therapeutic goal is to treat the underlying disorder and return the
extracellular fluid compartment to normal. Treatment consists of restoring fluid volume
and correcting any electrolyte imbalances. Early recognition and treatment are
paramount to prevent potentially life-threatening hypovolemic shock.
The patient was diagnosed to have an Acute Gastroenteritis. The patient had
experienced episodes of vomiting and soft stools. He also experienced post-tussive
vomiting. Assessment revealed that the patient had no cyanosis, no edema, and did not
manifest any signs of dehydration such as sunken eyeballs, dry skin, and poor skin
turgor.
The goal of the problem is to maintain normal fluid volume. Proper interventions
were done by the researchers such as assessing for patient’s vital signs and noting for
any signs of dehydration, encouraging patient to increase fluid intake, noting for changes
of the patient’s weight, monitoring intake and output, and providing medications as
ordered.

The goal was fully met for the patient had not experienced or manifested any
signs of dehydration. Intake and output of the patient were: Intake – 125ml, Urine Output
– three times, no bowel movement. During the researcher’s shift, the patient did not
experience episodes of vomiting and diarrhea.
IV. Risk for Imbalanced Nutrition: Less than body requirements related to
decreased appetite secondary to disease process
Risk for Imbalanced Body Nutrition: Less than body requirements refers to risk of
having insufficient intake of nutrients to meet metabolic needs.
Adequate nutrition is necessary to meet the body’s demands. Nutritional status
can be affected by disease or injury states (e.g., gastrointestinal malabsorption, cancer,
burns); physical factors (e.g., muscle weakness, poor dentition, activity intolerance, pain,
substance abuse); social factors (e.g., lack of financial resources to obtain nutritious
foods); or psychological factors (e.g., depression, boredom). During times of illness (e.g.,
trauma, surgery, sepsis, burns), adequate nutrition plays an important role in healing and
recovery. Cultural and religious factors strongly affect the food habits of patients.
(Gulanick, et al, 2010)
In relation to the patient, it was noted that he had experienced weight loss and
had decreased appetite. He could only consume three-fourth of the food beings served
to him. He also experienced episodes of vomiting which became a factor for this
problem. The patient’s weight was 22.5 kilograms (Ideal Body weight: 14.3 – 23.3
kilograms). He had a regular diet.
The goal of this problem is to promote good nutrition. Interventions were done by
the researchers to promote good nutrition. These include: instructing patient to eat small
but frequent meals, noting for changes of the patient’s weight, providing medications and

supplements such as Heraclene (1mg Capsule two times a day) and Cherifer (5ml daily;
AM), and providing a safe and quiet environment.
The goal of the problem was fully met for the patient had increased his food
intake. As verbalized by his grandmother, he had fair appetite and could consume three-
fourth of his food, not like before by which he could only consume one-half of his food.
V. Risk for Activity Intolerance related to presence of respiratory problem
secondary to dyspnea and persistent coughing
Risk for Activity Intolerance is defines as at risk of experiencing insufficient
physiological or psychological energy to endure or complete required or desired daily
activities.
Most activity intolerance is related to generalized weakness and debilitation
secondary to acute or chronic illness and disease. Activity intolerance may also be
related to factors such as obesity, malnourishment, side effects of medications (e.g., -
blockers), or emotional states such as depression or lack of confidence to exert one's
self. Nursing goals are to reduce the effects of inactivity, promote optimal physical
activity, and assist the patient to maintain a satisfactory lifestyle. (Gulanick, et al, 2010)
The patient was diagnosed with Acute Bronchitis and Acute Gastroenteritis. It
was noted that he had a fair activity but needed assistance whenever doing desired daily
activities. It was also noted that he had experienced weakness during coughing which
was a major factor for this problem.
The goal of this problem is to promote optimal physical activity. Interventions for
this problem were done by the researcher which consist of Encourage adequate rest
periods, especially before meals, other ADLs, exercise sessions, and ambulation, Assist
with ADLs as indicated; however, avoid doing for patient what he or she can do for self,

Teach ROM and strengthening exercises, and encouraging patient or relatives to
address concerns about this problem.
The goal of the problem was fully met for the patient did manifest optimal
physical activity. He was able to perform light activities such as walking. Weakness
during coughing was also minimized due to nebulization and Chest Physiotherapy.
CHAPTER V
SUMMARY OF FINDINGS
I. Factors that led to the development of the problem
 Predisposing Factors
 Age
 History
 Genetics
 Precipitating Factors
 Upper Respiratory Infection
II. Interrelationship of the factors that led to the development of the problem
Taking into account the age of the patient, he is at risk for acquiring Acute
Bronchitis with secondary diagnosis of Acute Gastroenteritis because his immune
system is still immature therefore, his body could not adequately fight the pathogens that
were entering his body. Taking into considerations the history of the patient, he had an
asthma and he also acquired Pneumonia last 2009. The patient also had an upper

respiratory infection before consulting a physician concerning the severity of the
symptoms that the patient had experienced. The genetics is also a major factor for the
development of this problem because of the risk that it may contribute to the patient.
According to the family history, the patient’s aunt also had asthma. Because of these
factors, the goal and center of the care for this patient is the elimination of the signs and
symptoms of the two clinical diagnoses.
III. Nursing Interventions rendered to the patient
1. Ineffective airway clearance related to inability to clear mucus as evidenced
by occurrence of dyspnea and presence of productive cough
 Promotive/Preventive
-Assess and monitor Vital Signs, noting changes in respiratory status.
-Auscultate lungs for presence of normal or adventitious breath sounds.
-Monitor patient’s intake and output
-Assist in proper positioning of the patient.
 Curative
-Administer Medications, as ordered, noting its effectiveness and side effects
-Consult respiratory therapist for chest physiotherapy treatment, as indicated.
 Rehabilitative
-Teach patient in performing coughing and breathing exercises.
-Instruct patient to increase fluid intake.
2. Ineffective breathing pattern related to accumulation of secretions as
evidenced by occurrence of dyspnea and presence of occasional rhonchi
-Assess respiratory rate and depth by listening to lung sounds
-Monitor patient’s breathing pattern and presence of dyspnea

-Note for retractions, nasal flaring, skin color and capillary refill.
-Position the patient properly for normal or easy breathing.
 Curative
-Administer Medications, as ordered, noting its effectiveness and side effects
 Rehabilitative
-Teach patient or relatives appropriate breathing and coughing techniques.
-Teach patient to have adequate rest periods between activities
3. Risk for Deficient Fluid Volume related to excessive loss through normal route
secondary to episodes of vomiting
-Monitor and document Vital Signs
-Assess for any signs of dehydration
-Monitor for patient’s fluid intake and output
-Note for the patient’s weight, documenting its changes.
-Encourage patient to increase fluid intake.
 Rehabilitative
-Inform patient or relatives the importance of maintaining prescribed fluid intake
and special diet considerations involved
4. Risk for Imbalanced Nutrition: Less than body requirements related to
-Assess weight, activity/rest, and body build.
-Note patient’s eating habits, including food preferences.
 Curative
-Administer vitamins, as ordered.

 Rehabilitative
-Provide relaxing and soothing environment for the patient
5. Risk for Activity Intolerance related to presence of respiratory problem
-Assess for patient’s daily activities and level of mobility.
-Encourage adequate rest periods, especially before meals, other ADLs, exercise
sessions, and ambulation.
 Rehabilitative
- Teach ROM and strengthening exercises
-Encourage patient and relatives to address concerns about this problem
-Teach patient to gradually increase activity
IV. Effectiveness of Nursing Interventions rendered to the patient
The goals of the following problems were partially met:
 Ineffective airwayclearance related to inability to clear mucus as evidenced
by occurrence of dyspnea and presence of productive cough
After rendering interventions for 8 hours, the patient still manifest signs and
symptoms but claimed to breathe easily than before. Normal vital signs were
normal throughout the researcher’s shift. Respiratory rate was normal and patient
did not manifest any signs of distress.
 Ineffective breathing pattern related to accumulation of secretions as
evidenced by occurrence of dyspnea and presence of occasional rhonchi

After rendering interventions for 8 hours, the patient did not manifest any signs of
hypoxia. Respiratory status was normal. Patient had experienced dyspnea but
was relieved with nebulization therapy.
The goals of the following problems were fully met:
 Risk for Deficient Fluid Volume related to excessive loss through normal
route secondary to episodes of vomiting
After rendering interventions for 8 hours, the patient had not experienced
vomiting and diarrhea. The patient did not also manifest any signs of
dehydration. Health teaching about increasing fluid intake was provided by the
researcher.
 Risk for Imbalanced Nutrition: Less than body requirements related to
After rendering interventions for 8 hours, the patient had increased his food
intake, from being able to consume one half of his food to three-fourth of food
being served to him. Patient’s vital signs were also noted to be within normal.
 Risk for Activity Intolerance related to presence of respiratory problem
After rendering interventions for 8 hours, the patient claimed to perform light
activities such as walking. Weakness during coughing was also minimized with
the help of nebulization and Chest Physiotherapy. Health teachings about
promoting optimal physical activity were also noted by the patient and his
relatives.
CHAPTER VI
CONCLUSION AND RECOMMENDATION

CONCLUSION
Based on the Summary of Findings, the researcher concluded that the factors
that led to the development of the problem are both predisposing and precipitating in
nature.
The actual and potential problems present were modified through the use of
appropriate nursing interventions and proper nursing care to the patient. Therefore, the
problems that were fully met consist of: Risk for deficient fluid volume related to
excessive loss through normal route secondary to episodes of vomiting, Risk for
imbalanced nutrition related to decreased appetite secondary to disease process, and
Risk for activity intolerance related to presence of respiratory problem secondary to
dyspnea and persistent coughing. There are also some problems that were partially met,
these include: Ineffective airway clearance related to inability to clear mucus as
evidenced by occurrence of dyspnea and occurrence of dyspnea and presence of
productive cough, and Ineffective breathing pattern related to accumulation of secretions
as evidenced by occurrence of dyspnea and presence of occasional rhonchi.
RECOMMENDATIONS
There were problems and weaknesses that were encountered by the researcher
during the course of data completion for the said case study. The researcher only
handled the patient for just a day and time coverage in handling and dealing with the
patient was also limited due to the condition of the patient.
As a result, the researcher was able to identify recommendations that would
assist the future researchers in doing their future case studies. The researcher
recommends that future researchers should spend more time in assessing and visiting
their patient in order to obtain a more accurate data for future utilization. Researcher

also recommends that the future researchers should have sufficient time in gathering
information about their future patient so that they would come up with more appropriate
nursing problems.
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