Clinical Care for a Patient with Severe Chronic Bronchitis and Emphysema

Clinical Care for a Patient with Severe Chronic Bronchitis and Emphysema 1
Clinical Care for a Patient with Severe Chronic Bronchitis and Emphysema
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Clinical Care for a Patient with Severe Chronic Bronchitis and Emphysema 2
Clinical Care for a Patient with Severe Chronic Bronchitis and Emphysema
Introduction
Bronchitis which is the inflammation of the bronchial tubes is responsible for
symptoms such as shortness of breath, cough, chest tightness, and a low fever (Agustí, 2010,
pp. 242-254). Mrs. Smith's chronic bronchitis is one of the chronic obstructive pulmonary
diseases (COPD) that overstays with the patient or keeps recurring after treatment. Patients
with chronic bronchitis produce a lot of mucus leading to coughing and acute difficulties in
breathing. Like the chronic bronchitis, Emphysema impairs the proper functioning of the
alveoli by over-inflating them causing shortness of breath. Due to its progressive nature, it
also fits in the category of COPD. This paper will draw from the case study of 78-year-old
Mrs. Smith to advance how best nurses are required to take care of patients with severe
symptoms of chronic bronchitis and emphysema.
Assessing Mrs. Smith: Primary and Secondary Assessments
Primary Assessments- The primary assessment is meant to assist the health care
practitioner (nurses) to detect and immediately defeat all immediate threats to life (Make and
Martinez, 2008, pp.884-890). The threats to life relate to the patient's ABC (Airway,
Breathing, Circulation). In effecting primary assessment, Mrs. Smith is supposed to undergo
constitutes of six components. First, the nurse is supposed to deduce a general impression of
the patient to help in deciding the seriousness of the patient's health care condition. This
includes mental status and the level of distress. The mental status of the patient is determined
by establishing whether the patient is responsive or unresponsive to various s stimuli.
Secondly, the nurse is then supposed to classify the patient on the AVPU (Alert,
Verbal, Painful, and Unresponsive) scale. In the case of Mrs. Smith, she is by and large alert
and responsive to both pain and verbal stimuli since she answers questions with a lot of ease
(Graham Harris, n.d). Thirdly, the nurse is supposed to examine the patient’s airway to

Clinical Care for a Patient with Severe Chronic Bronchitis and Emphysema 3
determine whether it is open and effectively take corrective action depending with different
etiological presentations. Fourthly, the nurse is supposed to assess the patients breathing
system by examining the chest movements, the quality of exhaled air and breath sounds.
Fifthly, the nurse is supposed to assess the patient’s circulation including bleeding and the
pulse both at the neck (carotid) and wrist (radial). Lastly, after these assessments, the nurse is
in a position to make an informed decision concerning the urgency or priority of the patient’s
health care condition.
Secondary Assessments- Engaging in secondary assessment means that Mrs. Smith's
life-threatening conditions are at bay. However, Graham (n.d) asserts that nurses ought to
keep in mind that airway; breathing and circulation need to be placed at the forefront of their
clinical reasoning. The secondary assessment is meant to explore particular medical
conditions Mrs. Smith may have. In undertaking it, Mrs. Smith's full set of vital signs and
other medical investigations must be examined, her chronic bronchitis and emphysema
medical history examined and effectively documented. Moreover, Mrs. Smith ought to
undergo a full assessment of the head to toe to establish any physical sign and symptoms
(Graham, n.d)
Expectations from Mrs. Smith Primary and Secondary Assessments
It is expected that Mrs. Smith will show signs of respiratory distress occasioned by a
blocked airway leading to the shortness of breath and coughing. The respiratory rate is
expected to increase to cater to the air deficits in the bronchial cavity. Both chronic bronchitis
and emphysema cause a patient to produce a lot of mucus which by extension lead to the
blocking of the nasal airway (Patel, et al., pp.500-505). To this end, it is expected that Mrs.
Smith will present decreased breath sounds and asymmetrical chest movements. It is further
expected that respirations with occasionally be sporadic and breathing may be characterized
by wheezing.