Clinical Decision Task 2022

Task 1
Laura Purple is a 59 years old patient who is admitted to the Clinical
Decision Unit with bronchitis. This current condition is characterized by
the inflammation of the patient’s bronchial tubes, which implies that the
airways are adversely impacted. Patients diagnosed with bronchitis, such
as Laura, exhibit continuous breathing challenges, cough, and thickened
mucus (Mejza et al., 2017). In some cases, patients could experience
swollen airways and subsequent chest congestion. In severe cases, the
patient could exhibit shortness of breath.
Clinical evidence has characterized the pathophysiology of bronchitis with
persistent inflammation of the airways. Bronchitis emanates from the
acute inflammation of the bronchial tubes. The inflammation originates
from different triggers encountered by the patient. Clinical assessments
have ascertained that the bronchial inflammation triggers include a range
of factors such as allergens, pollutants, and viral infections (Miele et al.,
2016). The occurrence of the inflammation of the tubes triggers the
thickening of the mucosa membrane. It also paves the way for the
desquamation of the epithelial cells. Subsequently, the inflammation of
the bronchial tubes also fosters the denudation of the underlying
membrane. Under these scenarios, it is possible for the infection on the
upper part of the respiratory system to extend to the lower tract, which
leads to an acute version of bronchitis. The inflammation, denudation, and
the desquamation cause the exhibited symptoms such as the increased
thick mucus secretion, irritating cough, and shortness of breath.
Obstruction and infection of the airways cause chest pain, chest
congestion, and discomfort from the swollen airways (Mejza et al., 2017).
If not addressed in time, acute bronchitis could lead to adverse outcomes
based on the nature of the presented pathophysiology.
Bronchitis is linked to different risk factors such as a history of smoking,
living in a place that experiences constant pollution, having a history of
asthma, and spending a lot of time in crowded places (Miele et al., 2016).
Laura has a history of asthma and she smokes 20 cigarettes per day. The
patient is also hyperlipidaemia and she is obese. The current presentation
relates to past medical history. Asthma is a risk factor for bronchitis.
Asthma is a condition that is caused by the inflammation of the airways
leading to the tightening of the muscles around the tubes. Asthma also
causes the swelling of the airways, which narrows the bronchioles. The
pathophysiology of asthma paves the way for bronchitis. Additionally,
smoking also impacts the airways by creating an environment that
supports inflammation and the narrowing of the airways. A significant
number of patients with hyperlipidaemia and high BMI are also diagnosed
with bronchitis (Dixon & Peters, 2018). Laura’s history is associated with
both hyperlipidaemia and high BMI, which explains the relationship
between her current presentation and health history.
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Last name__ _student number_NUR250 S1 2020 Assessment 1

Task 2
Nursing Care Plan: Laura Purple
Nursing problem: Risk of infection
Related to: The desquamation of the epithelial cells, denudation of the underlying membrane, and the possibility of the
infection on the upper part extending to the lower tract
Goal of care Nursing interventions Rationale Evaluation
To mitigate
inflammation
To eliminate the
desquamation of
the epithelial cells
To eradicate
denudation of the
underlying
membrane
Pharmacological intervention using
Azithromycin and Ipratropium
bromide as chartered by the clinician
Proper hygiene to prevent further
exposure to infections while at the
hospital and while interacting with
the nurses
Regular review of the progress to
determine any existing
contraindications that could
negatively impact the treatment
process
The use of recommended
medication reduced the effect of
the pathophysiology of bronchitis
to reduce the exposure of Laura to
potential infections.
The pharmacological interventions
focus on the restoration of the
normal respiratory function (Tran
et al., 2019).
Azithromycin and Ipratropium
bromide is recommended for
patients with acute bronchitis
(Tran et al., 2019).
No more breathing challenges
Cough cessation
No more thickened mucus
No more swollen airways and
subsequent chest congestion as
depicted by second chest X-ray
Nursing problem: Impaired tissue perfusion
Related to: The inflammation of the airways that relates to obstruction as depicted by the expiratory wheezing exhibited by Laura
Goal of care Nursing interventions Rationale Evaluation
Enhance and sustain
patency
Reduce expiratory
wheezing
Encourage Laura to occasionally
maintain a position that improves and
sustain patency
Oxygen therapy to increase Laura’s
oxygen concentration over time
Through oxygen therapy,
enhanced patency, simple
exercises, and medication, it will
be possible to enhance Laura’s
perfusion.
Laura’s oxygen saturation increases
over time
Cessation of the expiration wheezing
earlier depicted by Laura
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Last name__ _student number_NUR250 S1 2020 Assessment 1

Improve patient’s
comfort Administering medications as
chartered to reduce inflammation of
Laura’s airways
Commence simple motor exercises to
encourage perfusion while in bed
Exercise therapy and oxygen
therapy have been clinically
associated with increased
perfusion among patients (Braz &
Fisher, 2016).
Medication reduces inflammation
and obstruction of the airways,
which also increases the perfusion
rate (Tran et al., 2019).
Laura acknowledging increased
comfort with time
Increased patency regardless of the
position in bed
Nursing problem: Knowledge deficit
Related to: The risky and adverse behavioural and lifestyle tendencies practices by Laura and paving the way to poor health
Goal of care Nursing interventions Rationale Evaluation
Laura to know how
specific lifestyles
factors and
behaviours paves
the way for poor
health
Educate Laura on how smoking is
negatively impacting her health and
increasing the risk factors to different
conditions
To work with Laura to establish a
smoking cessation plan, which will
subsequently reduce her exposure to
smoking-related risk factors
Educate Laura on risks associated
with high BMI and obesity to
understand the dangers she is facing
To work with Laura to establish a
weight management plan, which will
subsequently reduce her exposure to
obesity-related risk factors
Through education interventions,
Laura will understand the risk
exposure originating from the
nature of her lifestyle
Patient education enhances the
prevention of behaviour-related
diagnosis (Durrer et al., 2019;
Hilleary et al., 2019).
The prevention of smoking and
proper weight management
reduces the risk of bronchitis and
related conditions (Pinheiro et al.,
2018; Skaaby et al., 2017).
Laura starting to reduce her smoking
rate per day
Laura showing commitment to
adherence to a healthy diet and
weight management interventions
Laura showing a positive attitude
towards physical activity and regular
exercise as a move towards weight
management
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Last name__ _student number_NUR250 S1 2020 Assessment 1