NUR250 Assessment 1 S1: Pulmonary Function Testing

NUR250 Assessment 1 S1 2020 Assessment One
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Task 1
Analysis of the case scenario suggests that the patient Laura is suffering from
bronchitis and her presenting complaints include wheezing sound during expiration,
and increase respiratory rate, increased heart rate, elevated blood pressure, high
body temperature, and a sharp pain in her chest on inspiration. Bronchitis is
characterized by an inflammation of the medium and large size airways of bronchi
that are located in the lungs, which leads to coughing. Some of the common signs
and symptoms of bronchitis comprise of shortness of breath, pain in chest, coughing
up sputum and wheezing, most of which were reported by the patient (Jackwood &
de Wit, 2020). Bronchitis can be described as a result of severe inflammation of the
bronchi, and commonly occurs due to exposure to pollutants, allergens, or viral
infection.
The pathophysiology for this condition can be accredited to the excess
production and accumulation of mucus, as a response to signals of inflammation,
which is also known as mucus metaplasia. In patients suffering from bronchitis this
hypersecretion of mucus occurs due to the goblet cells and is primarily associated
with T cells. It is thought to be e correlated to the end production of the Th2 cells
(Gelb, Christenson & Nadel, 2016). Mucus metaplasia generally causes obstruction
of airflow by luminal occlusion. The epithelial layer gradually gets thickened and
intrudes the lumen, following which the mucus brings about an alteration in surface
tension of the airways. This in turn increases the risk of collapsing, and decreases
the capability of gaseous exchange and air flow to occur inside the lungs. This
eventually contributes to inability of a person to breathe out completely. A decrease
in flow of air occurs at the time of breathing out, since pressure in the chest leads to
compression of the airways during this time (Raju et al., 2016).
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The current presentation of the patient Laura is associated with her medical
history of asthma, smoking habit, and obesity. Presence of asthma resulted in
inflammation of her airways, thus leading to chest tightness, shortness of breath, and
wheezing. It also triggered an inflammation of the bronchi, which in turn resulted in
respiratory condition and further exacerbated her health condition (Lai, Chen, Peng
& Zhan, 2017). Asthma is associated with bronchial hyperresponsiveness and
intermittent obstruction of air flow. Presentation of antigen by the dendritic cells with
cytokine and lymphocyte response also stimulated airway inflammation and resulted
in bronchitis. The inflammatory cells that are particularly associated with bronchitis
include macrophages and neutrophil granulocytes, both of which are white blood
cells.
Smokers have been found to contain an additional involvement of the Tc1
lymphocyte cells, and chemotactic factors act in the form of inflammatory mediators
and bring about the cell response. Additionally, her smoking habits might have
resulted in oxidative stress generated by the free radical concentration present in
tobacco smoke, thereby releasing inflammatory cells, and breaking down the
connective tissues present in the lungs, thus causing damage and emphysema
(Axelsson et al., 2016). This eventually contributed to poor airflow, and poor
respiratory exchange of gases. Obesity and being overweight have also been
associated with increased risk of bronchitis, since obesity results in mechanical
compression of lungs and chest cavity, thereby causing restrictive pulmonary
damage. Excess accumulation of fat also decreases compliance of the total
respiratory system, in consequence decreasing strength of the respiratory muscles
and increasing pulmonary resistance, and triggering bronchitis (Chandler, 2016).
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Task 2
Nursing Care Plan: (type in your patient’s name here and then delete these instructions)
Nursing problem: Risk of infection
Related to:
Bronchitis
Goal of care Nursing interventions Rationale Evaluation
The patient must
become free of
infection, as reported
by presence of
normal vital signs and
absence of any
indicators of
infection.
1. Educating the patient to wash
her hands
2. Encouraging the consumption of
calorie rich and protein rich food
products
3. Encouraging deep breathing
exercises
1. Hand hygiene has been
found to be one of the most
effective interventions for
decreasing risk of getting
affected with nosocomial
infections (Gould et al.,
2017). Washing hands with
soap and running water
effectively helps in
elimination of
microorganisms, and also
decreases the risk of
Normal WBC count, no inflammation,
redness or fever.
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passage in transmission from
one region of the body to
another. Taking into
consideration the fact that
bronchitis often occurs due to
bacterial
infections, introducing the
patient to practice hand
washing will also help in
limiting the spread of
microorganisms to the eyes
nose or face.
2. Proteins are also vital for
repairing the damaged
tissues of the body, and help
in protecting against bacterial
and viral infection (Tilg &
Moschen, 2015).
3. Breathing exercises improve
blood flow and reduce
inflammation, besides
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