NUR250 Medical Surgical Nursing Assessment 1: Bronchitis Care Plan

This document is a comprehensive assessment for a NUR250 Medical Surgical Nursing course, focusing on the care of a 59-year-old patient, Laura Purple, suffering from bronchitis. The assignment begins with an analysis of the patient's current medical condition, including elevated respiratory and heart rates, chest pain, and low oxygen levels, followed by an explanation of the pathophysiology of bronchitis, its causes, and the relationship between the patient's current presentation and past medical history, including asthma, smoking, and type 2 diabetes. The core of the assignment is a detailed nursing care plan addressing the risks of infection, impaired tissue perfusion, and knowledge deficit, with specific interventions, rationales, and evaluation criteria. It also includes patient education topics on managing multiple chronic conditions, risks associated with smoking and drinking. Finally, the assignment provides information on two medications: Prednisolone and Salbutamol, detailing their mechanisms of action, rationales for prescription, and potential side effects. The assignment aims to provide a practical application of nursing knowledge and care planning in a real-world scenario.

NUR250 Assessment 1 S1 2020
Assessment One Template
Task 1: Consideration of the Patient
Current Medical Condition of the Patient:
59 year old Laura Purple is suffering from bronchitis. The respiratory rate was found to be
28 breath per minute in her, which is a higher rate than normal. Her heart rate and blood pressure
were also found to be higher than the normal range. The oxygen level in the blood was low and the
patient also stated to be experiencing a sharp pain in the chest. Her body temperature was also
higher than usual suggesting a feverish condition.
Pathophysiology of the Disease:
Bronchitis event involves an episode of inflammation in the bronchi. Various triggering
aspects, such as smoking, environmental pollution along with bacterial or viral infection trigger this
inflammatory event. As a result, various lymphocyte cells migrate in the area and triggers the edema
or the swelling. There is also an event of hypertrophy of the mucous glands, which results in the
increased mucous production. The resulting event of those combined effect is that the airway
becomes narrower and the patient experience a shortness of breath or difficulty with breathing.
There are also vigorous coughing can be observed in the patients as a reflexive event in an attempt
to clear the airway from the excessive mucous (Singh, Avula & Zahn, 2019).
A blockage in the respiratory tract is associated with a lower supply of oxygen in the blood.
As a result of that event there is not a sufficient supply of oxygen in the heart muscles either, which
is the reason for the patients to experience a sharp and achy pain in the chest ( Singh, Avula & Zahn,
2019).
Relation between Current Presentation and Past Medical History:
Laura had a medical history of multiple disease conditions along with a habit of smoking
heavily. She had an asthma condition, which means she already had an inflammation in her lower
respiratory tract. The disease condition is also associated with a blockage in her respiratory tract due
to an excessive accumulation of mucous. Thus it can be assumed that the progression of her asthma
disease condition resulted in her developing the bronchitis condition. The heavy smoking habit also
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had played a role in increasing the severity of her symptoms by initiating additional inflammatory
response in the bronchi of the patient (Liu et al., 2015). Due to a significant blockage of airway, her
body was experiencing a low supply of oxygen. The fever condition was a response to the
inflammation (Walter, Hanna-Jumma, Carraretto & Forni, 2016).
She had type 2 diabetes. Thus glucose level in her blood was higher along with a high lipid
level as well, resulting from her hyperlipidaemia condition. She also had obesity and she did not
adopt proper control measures to manage all these conditions. All of those medical conditions along
with the behavioural factors are associated with an increased risk of hypertension condition and
cardiovascular disease condition in the patient (Tackling & Borhade, 2019). Thus those were the
possible reasons for her experiencing a high HR and a high BP.
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Task 2: Care Plan
Nursing Care Plan: Ms Laura Purple
Nursing problem: Risk of infection
Related to:
Respiratory tract infections, which can be either viral or bacterial infections.
Goal of care Nursing interventions Rationale Evaluation
The possible risk of the
patient developing the
microbial infections
should be lowered.
1. Firstly, there should be a regular blood
test to check the WBC count in the
patient.
2. Secondly, proper sanitisation and
disinfection practice should be
maintained around the patient.
1. The while blood cell (WBC) count
is considered to be an effective
indicator for detecting a microbial
infection in the patient (Williams
et al., 2015).
2. It has been found from the studies
that a practice to maintain proper
sanitisation and disinfection
lowers the risks of nosocomial
infections in the patients
(Klompas, 2017). Pneumococcal
infection is considered to be a
common nosocomial infection.
Considering the patient’s condition
an additional pneumonia event
can increase the mortality risk in
her (Koulenti, Tsigou & Rello,
2017).
1. A regular blood test will assure a rapid
detection of the microbial infection in
the patient and thus timely action can
be taken to avoid severe patient
outcomes.
2. The second intervention will effectively
lower the risk of infection in the
patients.
Nursing problem: Impaired tissue perfusion
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Related to:
Lower oxygen supply to the important tissues, including the tissues present in the heart through blood.
Goal of care Nursing interventions Rationale Evaluation
Prevention of the adverse
effects resulting from the
tissue perfusion.
1. Improvement of blood flow via
lowering the high blood pressure in
the patient by the application of
medications.
2. Prevention of further tissue perfusion
in the patient by a better management
of T2DM and hyperlipidaemia
condition in the patient.
1. A normal blood pressure in the
body help the heart to function
properly and thus an appropriate
blood flow is also maintained all
through the body (Rehman &
Nelson, 2019).
2. It has been found from the studies
that the T2DM and the
hyperlipidaemia conditions are
associated with the risk of
impaired tissue perfusion in the
individuals (Strain & Paldanius,
2018). Thus a proper management
of those disease condition is most
likely to reduce the further risks of
tissue perfusion in the patient.
1. There will be an improved BP in the
patient and thus the risks associated
with impaired tissue perfusion will be
lowered.
2. The risk of further occurrence of tissue
perfusion will be lowered.
Nursing problem: Knowledge deficit
Related to:
Poor management of the already present chronic disease conditions.
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Goal of care Nursing interventions Rationale Evaluation
Making the patient
understand the
importance of the proper
management of her
disease and the health
risks associated with her
behavioural practices.
1. Proper education on the health risks
associated with the disease conditions
and how to manage those disease
conditions should be provided to the
patients.
2. Laura should also be taught about the
possible health risks associated with
her habit of smoking and drinking on a
regular basis.
It has been found from the studies that a
proper patient education improves the
self-care efficiency in the patients
(Paterick, Patel, Tajik & Chandrasekaran,
2017). This involves proper self-
management of the disease conditions
along with an improved behavioural
aspects.
1. The patient will be more aware of her
health risks associated with her disease
conditions.
2. She will be motivated to quit her habits.
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Task 3: Patient Education
Topic-1: Successful Management of All the Disease Conditions
The patient has many chronic disease conditions, which presents significant risks to her
health. Most of those conditions are comorbid conditions, which can increase the risk of mortality in
her, if those conditions are not properly managed. As for example, the type 2 diabetes mellitus
(T2DM), obesity and hyperlipidaemia are important comorbid conditions that increase the risk of
various cardiovascular diseases in the patients (Iglay et al., 2016). There should be a proper
explanation of all the health risks provided to Laura. She should be taught about the strategies to
manage all these disease conditions properly.
The management strategies for her T2DM condition will involve a regular monitoring of her
blood glucose level, practicing a proper a healthy diet habit, taking proper medications and finally
developing a regular exercising habit (Goyal & Jialal, 2019). The management strategy for her obesity
condition will also involve her following a healthy diet and regular exercise along with a regular
monitoring of her body weight (Yumuk et al., 2015). The management of hyperlipidaemia condition
will also involve following all those strategies mentioned before, such as healthy diet and exercises
(Dandapat & Robinson, 2016). To manage the asthma condition Laura should be taught to take her
medications on a regular basis and to consult a physician to perform a regular check-up (Agarwal et
al., 2015).
The patient should be provided with a proper diet chart, which will be easy for her to follow.
She should also be advised about which exercises she must perform, considering her asthma
condition.
Topic-2: Risks of Smoking and Drinking
The patient is a heavy smoker as she consumes about 20 cigarettes per day. She is also an
asthma patient. This behavioural aspect of her is closely associated with the worsening of her disease
conditions (Chatkin & Dullius, 2016). She also have obesity along with her T2DM conditions. Smoking
can cause a progression of these disease conditions as well (Kim, Jeong, Yoo, Oh & Kang, 2016). Along
with that she also have a habit of drinking wine on a regular basis. The danger of drinking is
associated with her T2DM condition, hyperlipidaemia condition and also with her obesity conditions.
Wine contains a high level of sugar, which can increase the risk of her developing hyperglycaemia,
which is a serious comorbid condition that is closely associated with T2DM. Alcoholic beverages
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increase the triglyceride level in the body, which is dangerous for both her obesity condition and
hyperlipidaemia conditions (Feingold & Grunfeld, 2018). Laura should be made known about all
these facts in order to make her understand the importance of changing her lifestyle by quitting
those habits.
The management strategies will involve motivating the patient to quit those habits of
smoking and drinking initially. She should be advised to attend various social groups to stay
motivated about quitting smoking and drinking. She should also be advised to seek professional help,
such as rehabilitation centres if she faces difficulty with quitting those habits (Cooney et al., 2017).
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Task 4: Medication
Medication 1: Prednisolone
Mechanism of Action:
Prednisolone can be described as an anti-inflammatory agent, which is also corticosteroid in
nature. This drug binds to the glucocorticoid receptors. The binding of this drug inhibits the pro-
inflammatory signals and promote the anti-inflammatory signals instead. There is a wide range of
gene activation that helps in decreasing the leucocyte migration, vasodilation event and also in
decreasing the permeability of the capillaries. As a result the inflammation event is suppressed in the
body of an individual. This is a drug that has a short-term effect (Puckett, Sharma & Kasi, 2019).
Rationale for the Prescription in the Patient:
The patient was admitted to the hospital with bronchitis condition, which can also be
described as an inflammation of the bronchi. She also had a history of asthma, which again is an
inflammation of the lower part of the respiratory system. Thus it was important to lower the effects
of inflammation in the patient in order to provide her relief with her symptoms ( Puckett, Sharma &
Kasi, 2019). After the administration of this prednisolone drug, the edema and the excess mucous
secretions will be decreased and thus it will be easier for the patient to breathe.
Possible Side Effects:
There are many common adverse effects that are associated with the use of this drug, such
as development of bruises on the skin, nausea, gastrointestinal problems, insomnia and various
others. The drug has a mild immunosuppressive effect if used in a lower dose. However, a higher
dose might cause severe immunosuppression in an individual (Puckett, Sharma & Kasi, 2019).
Medication 2: Salbutamol
Mechanism of Action:
The salbutamol drug is a beta-2 receptor agonist. The drug binds to the beta-2 adrenergic
receptors that are present in the smooth muscle cells in the wall of the respiratory tract. The binding
if those drugs activates those receptors and as a result, there is a rapid activation of the enzyme
adenyl cyclase. The action of the enzyme involves a rapid production of the cyclic AMP (cAMP)
molecules. An increased level of cAMP leads to the activation of protein kinase A. The activity of this
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enzyme lowers the intracellular concentration of the calcium ions, which in turn leads to the
relaxation of the smooth muscle cells (Ullmann, Caggiano & Cutrera, 2015). This event increases the
diameter of the respiratory airway and thus allows patients to breathe properly.
Rationale for the Prescription in the Patient:
The patient had a past history of asthma condition. The condition involves an incident of
narrow airway in the lower respiratory tract due to the fact that the smooth muscle cells of the
respiratory wall are unable to contract (Quirt, Hildebrand, Mazza, Noya and Kim, 2018). Thus this
drug was prescribed to her for the management of this disease condition.
Possible Side Effects:
The side effects of the salbutamol involves an increased heart rate (tachycardia), chest pain
(angina), headache, insomnia, nausea, dizziness, muscle cramps, muscle tremors, fatigue, altered
sensation of taste and various others (Ullmann, Caggiano & Cutrera, 2015).
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References
Agarwal, R., Dhooria, S., Aggarwal, A. N., Maturu, V. N., Sehgal, I. S., Muthu, V., ... & Jindal, S. K.
(2015). Guidelines for diagnosis and management of bronchial asthma: Joint ICS/NCCP (I)
recommendations. Lung India: official organ of Indian Chest Society, 32(Suppl 1), S3.
doi: 10.4103/0970-2113.154517
Chatkin, J. M., & Dullius, C. R. (2016). The management of asthmatic smokers. Asthma research and
practice, 2(1), 10. doi: 10.1186/s40733-016-0025-7
Cooney, J. L., Cooper, S., Grant, C., Sevarino, K., Krishnan-Sarin, S., Gutierrez, I. A., & Cooney, N. L.
(2017). A randomized trial of contingency management for smoking cessation during
intensive outpatient alcohol treatment. Journal of Substance Abuse Treatment, 72, 89-96.
https://doi.org/10.1016/j.jsat.2016.07.002
Dandapat, S., & Robinson, J. G. (2016). Guidelines for management of hyperlipidemia: implications
for treatment of patients with stroke secondary to atherosclerotic disease. Current neurology
and neuroscience reports, 16(3), 24. doi: 10.1007/s11910-016-0621-1
Feingold, K. R., & Grunfeld, C. (2018). Obesity and dyslipidemia. In Endotext [Internet]. MDText. com,
Inc.. https://www.ncbi.nlm.nih.gov/books/NBK305895/
Goyal, R., & Jialal, I. (2019). Diabetes Mellitus Type 2.
https://www.ncbi.nlm.nih.gov/books/NBK513253/
Iglay, K., Hannachi, H., Joseph Howie, P., Xu, J., Li, X., Engel, S. S., ... & Rajpathak, S. (2016).
Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes
mellitus. Current Medical Research and Opinion, 32(7), 1243-1252. doi:
10.1185/03007995.2016.1168291.
Kim, Y., Jeong, S. M., Yoo, B., Oh, B., & Kang, H. C. (2016). Associations of smoking with overall
obesity, and central obesity: a cross-sectional study from the Korea National Health and
Nutrition Examination Survey (2010-2013). Epidemiology and health, 38.
doi: 10.4178/epih.e2016020
Klompas, M. (2017). What is new in the prevention of nosocomial pneumonia in the ICU?. Current
opinion in critical care, 23(5), 378-384. doi: 10.1097/MCC.0000000000000443
Koulenti, D., Tsigou, E., & Rello, J. (2017). Nosocomial pneumonia in 27 ICUs in Europe: perspectives
from the EU-VAP/CAP study. European journal of clinical microbiology & infectious
diseases, 36(11), 1999-2006. https://link.springer.com/article/10.1007/s10096-016-2703-z
11
Double click here to fill in this footer
Last name__ _student number_NUR250 S1 2020 Assessment 1

Liu, Y., Pleasants, R. A., Croft, J. B., Wheaton, A. G., Heidari, K., Malarcher, A. M., ... & Strange, C.
(2015). Smoking duration, respiratory symptoms, and COPD in adults aged≥ 45 years with a
smoking history. International journal of chronic obstructive pulmonary disease, 10, 1409.
doi: 10.2147/COPD.S82259
Paterick, T. E., Patel, N., Tajik, A. J., & Chandrasekaran, K. (2017). Improving health outcomes through
patient education and partnerships with patients. Proceedings (Baylor University. Medical
Center), 30(1), 112. doi: 10.1080/08998280.2017.11929552
Puckett, Y., Sharma, B., & Kasi, A. (2019). Cancer, Intraductal Papillary Mucinous Cancer Of The
Pancreas (IPMN). https://www.ncbi.nlm.nih.gov/books/NBK534809/
Quirt, J., Hildebrand, K., Mazza, J., Noya, F. and Kim, H., 2018. Asthma. Allergy, Asthma & Clinical
Immunology, [online] 14(S2). doi: 10.1186/s13223-018-0279-0
Rehman, S., & Nelson, V. L. (2019). Blood Pressure Measurement. In StatPearls [Internet]. StatPearls
Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482189/
Singh, A., Avula, A., & Zahn, E. (2019). Acute Bronchitis.
https://www.ncbi.nlm.nih.gov/books/NBK448067/
Strain, W. D., & Paldanius, P. M. (2018). Diabetes, cardiovascular disease and the
microcirculation. Cardiovascular diabetology, 17(1), 57. doi: 10.1186/s12933-018-0703-2
Tackling, G., & Borhade, M. B. (2019). Hypertensive Heart Disease.
https://www.ncbi.nlm.nih.gov/books/NBK539800/
Ullmann, N., Caggiano, S., & Cutrera, R. (2015, December). Salbutamol and around. In Italian journal
of pediatrics (Vol. 41, No. 2, p. A74). BioMed Central. doi: 10.1186/1824-7288-41-S2-A74
Walter, E. J., Hanna-Jumma, S., Carraretto, M., & Forni, L. (2016). The pathophysiological basis and
consequences of fever. Critical Care, 20(1), 200. doi: 10.1186/s13054-016-1375-5
Williams, D. J., Hall, M., Auger, K. A., Tieder, J. S., Jerardi, K., Queen, M. A., ... & Shah, S. S. (2015).
Association of white blood cell count and c-reactive protein with outcomes in children
hospitalized with community-acquired pneumonia. The Pediatric infectious disease
journal, 34(7), 792. doi: 10.1097/INF.0000000000000724
Yumuk, V., Tsigos, C., Fried, M., Schindler, K., Busetto, L., Micic, D., ... & Obesity Management Task
Force of the European Association for the Study of Obesity. (2015). European guidelines for
obesity management in adults. Obesity facts, 8(6), 402-424.
https://dx.doi.org/10.1159%2F000442721
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