NUR250 | Assessment 1 | S1 2020 Assessment One Template

NUR250 Assessment 1 S1 2020
Assessment One Template
Task 1
Laura is 59 years old female and got admitted with Bronchitis. Bronchitis is an inflammation
of the bronchial tubes lining which transports oxygen towards and away from the lungs.
Bronchitis is one of the forms of chronic obstructive pulmonary disease (COPD). Bronchitis
can occur in both acute and chronic bronchitis form. Acute bronchitis is very common, and it
usually develop due to cold or other respiratory infection. However, chronic bronchitis occurs
as a serious condition. Smoking is the predisposing factor for the chronic bronchitis, and it
presents in the form of constant irritation or inflammation. Due to irritation and
inflammation, mucous membrane become hyperemic and edematous which diminish
bronchial mucocilliary function. Hence, there is development of copious mucus secretion.
Hence, patients with bronchitis often have cough (Lai, Chen, Peng, and Zhan, 2017).
Excessive mucus secretion is also termed as the mucous metaplasia. This hypersecretion of
mucus usually occurs due to goblet cells hyperplasia. T cell actions are responsible for the
mechanisms of mucous metaplasia. Cellular response in chronic bronchitis usually occur due
to Th1 inflammatory cells which are mainly responsible for the cytokine production
attributable for mucus secretion and deposition. Mucus metaplasia produces airflow
obstruction through different mechanisms such as luminal occlusion, epithelial layer
thickening of the airway lumen and alteration in the surface tension of airway. All these are
the predisposing factors for the airway collapse which results in reduced capacity of airflow
and gas exchange. Severity of the bronchitis is dependent on the extent of blockade of small
airways due to mucus. Other manifestations include poor ciliary function, distal airway
occlusion, ineffective cough, respiratory muscle weakness and reduced peak expiratory flow.
Past medical history of Laura pointed out that she was suffering through Asthma. It is
evident that Laura is associated with dyspnea which indicate shortness breath. Asthmatic
patients are usually associated with the dyspnea; moreover, shortness of breath also occur due
to deposition of mucus in the airways. Research established that asthma is a predisposing
factor for bronchitis. It is mainly due to constriction of lungs in Asthma. People with asthma
can develop asthmatic bronchitis. Asthmatic lung become susceptible to the infection which
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is a significant predisposing factor for the development of bronchitis. Smoking is also a
prominent risk factor for the development of bronchitis. Moreover, asthma patients with
smoking habit are more susceptible for the development of bronchitis (Siafakas, Corlateanu
and Fouka, 2017).
Medical history of Laura mentioned about her asthma; moreover, she was having habit of
smoking and she used to smoke around 20 cigarettes per day. Abnormal oxygen saturation
level (Stat -93%) and breathing rate (28 bpm) are the indicators of respiratory tract
abnormalities. Laura is exhibiting both these respiratory tract abnormalities which mainly
occur in Laura due to current medical condition which is bronchitis and past medical
condition like asthma. Moreover, smoking is also responsible for respiratory tract
abnormalities. Laura also exhibiting expiratory wheeze. Expiratory wheeze mainly occurs
due to narrowing of the respiratory tract. However, both bronchitis and asthma in Laura are
responsible for the narrowing of the respiratory tract (Kim and Criner, 2013).
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Task 2
Nursing Care Plan :
Nursing problem: Risk of infection
Related to:
Stasis of secretions and reduced ciliary actions.
Goal of care Nursing interventions Rationale Evaluation
To reduce or prevent
risk of infection in
Laura and make her
totally free from risk of
infection.
Assess importance of breathing exercise,
effective cough, enough fluid consumption
and frequent position changing.
Ensure that patient and healthcare workers
to wash and sanitise hands ion regular
basis.
Teach Laura about the manifestations of
the pulmonary infections such as change in
colour of sputum and occurrence of fever
and chills.
Recommend to rinse mouth with hot water.
Cleaning and properly drying nebuliser and
respiratory equipment.
These mobilizing activities facilitate
mobilization and expectoration of
secretions which can minimise
pulmonary infection risk. More amount
of fluid consumption also promotes
liquification of the secretions
(Stromberg, Dallred, and deWit, 2016).
Hands are primary source of infection;
hence, hand sanitisation can effectively
prevent infection (Peate, 2016).
Early recognition of infection can be
helpful in early prevention of infection
(Brown, Edwards, Buckley, and Aitken,
2019).
It would be helpful in preventing oral
candidiasis (Peate, 2016).
Water is a common source of bacterial
infection (Brown, Edwards, Buckley,
and Aitken, 2019; Howcroft, Walters,
Laura is infection free.
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Wood-Baker, and Walters, 2015)
Nursing problem: Impaired tissue perfusion
Related to:
Reduced oxygen supply to the tissues due to ineffective berating.
Goal of care Nursing interventions Rationale Evaluation
To normalise the
oxygen supply to the
tissues.
Improve respiratory rate to the normal
level.
Teach to use accessory muscles for
breathing.
Normalise abnormal arterial blood gases.
Administer oxygen to the lowest possible
concentration.
Administer prescribed medications for
respiratory diseases.
Maintain calm attitude while dealing with
Improvement in the respiratory rate to
the normal level would be helpful in
maintaining adequate amount of oxygen
in the blood circulation which can
supply adequate oxygen to the tissues
(Peate, 2016).
It would be helpful in improving the
breathing pattern (Brown, Edwards,
Buckley, and Aitken, 2019).
Reduced oxygen and increased carbon
dioxide levels in the blood lead to less
supply of oxygen to the tissues
(Stromberg, Dallred, and deWit, 2016).
Normalise blood oxygen level (Peate,
2016).
Medications for respiratory disease help
in relaxing airways, improve breathing
pattern and maintain normal blood gas
levels (Brown, Edwards, Buckley, and
Aitken, 2019).
It would be helpful in relieving anxiety
Adequate amount oxygen available in
blood circulation for tissue distribution.
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