UNIVERSAL COLLEGE OF PARANAQUE

Dr. A Santos Avenue, Sucat Paranaque City

COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES

Acute bronchitis measles prodrome

Submitted to: Elenita Blasco

Dean of CAHS

Submitted by: Sahagun,Jeremie

 Table of Content
I. Introduction

II. Health History

III. Gordon’s Functional Pattern

IV. Laboratory and Diagnostic Exam

V. Anatomy and Physiology

VI. Pathophysiology

VII. Drug Study

VIII. Nursing Care Plan

IX. Course in the Ward

 I. INTRODUCTION
A. Background of the Study
This study focuses on the case of a 10 months old client. For confidentiality
purposes, the researcher opted to replace the name of the patient and just call it as “tetsuya 2”.
Tetsuya 2 had been admitted at the pediatric ward of HOspital of Paranaque on December
08,2018, with the final diagnosis of Acute Bronchitis Measles Prodrome.

The latest count by the World Health Organization (WHO) Philippines office is 17,298 measles
cases as of November this year. This is 367 percent more than the 3,706 cases reported last
year
Measles is a highly-contagious airborne viral disease that used to be an epidemic until a vaccine
was developed in 1963.

Symptoms can appear around 10 days after the infection, which include high fever, cough,
runny nose, bloodshot eyes or conjunctivitis, white spots inside the mouth, and rashes on the
face, neck and whole body.

Unvaccinated children and pregnant women have the highest risks of developing measles,
which could lead to long term complications and even death.

In October this year, the Department of Health (DOH) Bicol Office reported a 300 percent
increase in measles cases in the region. DOH Bicol has monitored 239 measles cases from
January to September, which included 6 deaths. Those who died were not vaccinated.
II. HEALTH HISTORY
A. General History
Patient Name: Tetsuya 2
Sex: F
Age: 10 months
Birth Date: January 12, 2018
Address: Barangay, La Huerta, Paranaque City
Nationality: Filipino
Religion: Catholic
Date of Admission: December 8,2018
Time of Admission: 7;06 pm

B. Chief Complaint
C. History of Present Illness
D. Past History
E. Family History
F. Physical Assessment
Date of assessment by: December 8,2018 (3:00pm)
Vital Signs

Technique Used Findings Interpretation

Temperature Site: Axillary 36.5 Normal body temp
Respiratory Rate Inspection 32 Cpm
Pulse Rate 130 Bpm
III. Diagnostic/Laboratory Exam

COMPLETE BLOOD TEST

COMPONENTS NORMAL VALUES RESULTS IMPRESSION

HEMOGLOBIN (HGB) 12-15 gms% 11.8 Low hemoglobin count

due to Your body
produces fewer red
blood cells than usual
HEMATOCRIT (HCT) 37-47vol% 35.3 An insufficient supply
of healthy red blood
cells

WHITE BLOOD COUNT 5,000-10,000 10,300 A large number of

white blood cells due
to Infection,
inflammation,

DIFFERENTIAL
COMPONENTS NORMAL VALUES RESULTS IMPRESSION
STABS 3-5% 3% Normal number of
stabs
SEGMENTERS 55-65% 32% Low number of
segmenter due to
Immunosuppression
LYPHOCYTES 25-35% 65% Increase number of
lymphocytes due to
Viral infection

COMPONENTS NORMAL VALUES RESULTS IMPRESSION

PLATELET COUNT 150,000-400,00/cu mm 247,000 Normal platelet counts
Anatomy
Part I - the respiratory system

The respiratory system consists of the parried lungs and the organs that conduct air to and from the
lungs and which from the most external to internal include the nose, pharynx, larynx, trachea and
main bronchi.

Nose – is a hallow organ whose cavity is divided into two irregularly- shaped spaces (nasal fossa) by a
common cartilaginous wall (nasal septum).

 Function - provides airway for respiration, moisten and warm air, Filter air (mucus and cilia),
site of olfactory receptor used for smelling and lastly resonating chamber for sound waves.
Blood supply of nose Venous Drainage Nerve supply
 Ophthalmic Arteries  Facial Vein  Infratrochlear
 Maxillary Arteries  Ophthalmic vein  Infraorbital branch of the
 Facial Arteries Maxillary nerve

Pharynx- is a funnel shaped fibromuscular tube that extend from the base of the skull to the level of the
hyoid bone where it is continuous with the esophagus. It is a tube that is common to the digestive and
respiratory systems.

NASOPHARYNX
 Extends from the base of the
skull to the soft palate
Features:
 Pharyngeal tonsil – forms the
roof or superior surface Orifice
of auditory tube or eustachian
tube
 Torus tuburius – hood-like
structure above the opening of
the auditory tube
 Salpingopharyngeal fold -
encloses the
salpingopharyngeal muscle; it
is extending inferiorly from the
torus turubius
 Tubal tonsil – posterior to the
orifice of auditory tube
DIVISIONS OF THE PHARYNX
OROPHARYNX
 Extends from the soft palate
to the superior border of the
epiglottis
Features:
 Palatine tonsils – founded by
the palatoglossal arch and the
palatophryngeal arch
 Lingual tonsils – beneath the
posterior part of the tongue
LARYNGOPHARYNX
 Extends from the superior
border of epiglottis to the
cricoid cartilage
Features:
 Inlet of the larynx –
communication between the
laryngopharynx and larynx
 Piriform recess – space of
both sides of the inlet of the
larynx

NERVE SUPPLY OF THE BLOOD SUPPLY OF THE LYMPH DRAINAGE OF

PHARYNX
 Nasal Pharynx: Maxillary
nerve (V2)
 Oral Pharynx:
Glossopharyngeal Nerve
 Laryngeal Pharynx:
Internal Laryngeal Nerve
PHARYNX THE PHARYNX
 Ascending   Directly into the deep
pharyngeal, tonsillar cervical lymph nodes
branches of facial  Indirectly via the
arteries retropharyngeal or
 Branches of maxillary paratracheal nodes into
and lingual arteries the deep cervical nodes

LARYNX- it connects to the pharynx to the trachea and serves an important role in phonation
the frame work of the larynx is formed by the 3 unpaired ( i.e thyroid, cricoid and epiglottic) and three
paried (i.e, corniculate , cuneiform and arytenoid cartilage. Of these i.e thyroid, cricoid and arytenoid
are hyaline , and corniculate , cuneiform and epiglottis are elastic.
TRACHEA
 a cartilaginous and membranous tube
 extends from the cricoid cartilage of the larynx, on a level with C6 vertebra, to the level of the
angle of Louis (T4/5) vertebra
 The trachea divides into two main bronchi : the left and the right bronchi, at the level of the
sternal angle at the anatomical point known as the carina.
 Structure:
 a rigid fibroelastic structure
 Incomplete rings of hyaline cartilage continuously maintain the patency of the lumen.
 Lined internally with ciliated columnar epithelium.
BLOOD SUPPLY LYMPH DRAINAGE NERVE SUPPLY
 Upper 2/3 – Inferior thyroid  Pretracheal lymph nodes  Sensory nerve is from the
arteries  Paratracheal lymph nodes vagi and the recurrent
 Lower 1/3 – Bronchial  Deep cervical nodes laryngeal nerves
arteries  Sympathetic nerves supply
the trachealis muscle

BRONCHI
Right bronchus: Left Bronchus
 Wider, shorter, and more vertical in  Smaller in caliber but longer than the right
direction than the left.  It is about 5 cm. long.
 It is about 2.5 cm. Long  It enters the root of the left lung opposite
 It enters the right lung nearly opposite the T5 the T6 vertebra.
vertebra.

LUNGS
 Essential respiration organ in many air-breathing animals
 Right lung bigger than the left lung because the heart bulges more to the left
 Has a half cone shape. It has a base, apex, 2 surfaces, and 3 borders
 The base sits on the diaphragm.
 The apex projects above 1st rib and into the root of the neck.

Root and hilum of lung:

• The root of each lung is a short tubular collection of structures that together attach the lung to
structures in the mediastinum .
• The hilum, where structures enter and leave.
• Structures within each root and located in the
hilum:
• A pulmonary artery
• Two pulmonary veins
• A main bronchus
• Bronchial vessel
• Nerves
• Lymphatics
 Drug Study
Name of Drug Classification Mechanism of Indication Contraindication Side Effects Nursing
Action Consideration
Generic Name: Cephalosporin Cefixime inhibit Used to Cefixime is  Diarrhea  Observe pt. for
Cefuroxine Antibiotic bacterial cell wall and treat contraindicated in  Nausea sign and
bind with high affinity infections patient with known  Headache symptoms of
Brand Name: to penicillin-binding caused by allergy to the  Dizzy anaphylaxis
Suprax proteins in bacteria cell bacteria cephalosporin  Cough (rash, laryngeal
wall, thus interfering such as group of anitiotic  Runny nose edema,
Dosage: with peptidogly can bronchitis, contraindicated in wheezing)
 Allergic
306mg synthesis. Hence lungs. condition like reaction  Encourage diet
causing bacterial cell Antibiotic hypersensitivity. high in protein,
 DOB
Route: death. will not vitamins and
 Swelling of
IV work for mineral
cold,flu or face, lips,
tongue,
Frequency: other virus
Q8 (12,8,4) infections. throat)
Generic Name: Antipyretics Unknown though to Relief of Contraindicated in  low fever  Use liquid form
Paracetamol produce analgesia by mild pain or pt with with nausea, for children and
blocking generation of fever hypersensitive to stomach patient who have
Brand Name: pain implulese probably the drug pain, and loss difficulty
Biogesic by inhibiting of appetite; swallowing.
prostaglandin synthesis  dark urine,
Dosage: or action of other clay-colored  In children don’t
95mg substance that sensitize stools exceed five
pain receptors to  jaundice doeses in24hr
Route: mechanical or chemical (yellowing of
IV stimulation. It is the skin or
thought to fever by eyes).
Frequency: central action in the
Q4 hypothalamic heat-
regulating center
 ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

SUBJECTIVE: Risk for After 8 hours of 1. Keep nails short and 1. To minimize the trauma GOAL MET
“lagi niyang impaired skin nursing clean. and secondary infection After the nursing
nakakamot yung integrity intervention the implementation the
mga kati-kati related to patient will be 2. Wear gloves or elbow 2. To prevent scratching. patient’s mother
niya”, as raking able to maintain restrain from scratching. was able to
verbalized by the pruritus intact skin perform
mother. integrity. 3. Give clothes that are 3. Because excessive heat instructions and the
thin, loose, and not can increase itching. patient was able to
irritating. maintain intact
OBJECTIVE: skin.
 Rashes 4. Close area of pain 4. To prevent scratching.
 Skin reddness (long sleeves, long
pants, underwear layer).

5. Avoid exposure to 5. exposure to sun rays or

sunlight or heat. heat can cause rashes.
 ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

SUBJECTIVE: Deficient After 8 hours of 1. Determine who will 1. Many elderly or GOAL MET
“Hindi ko alam Knowledge nursing be the learner: patient, terminal patients may
na nakakahawa related to interventions , family, significant other, view themselves as After the nursing
pala ang tigdas new we will be able or caregiver. dependent on their implementations,
eh”, as condition to: caregiver, and therefore we were able to
verbalized by the not want to be part of the assess the patient’s
patient’s mother. 1. Assess the educational process. capabilities and
patient’s needs for learning,
willingness and 2. Assess motivation 2. Adults must see a need and was able to
capabilities for and willingness of or purpose for learning. formulate
learning. patient and caregivers to strategies for better
learn. learning as
2. Formulate 3. Cognitive impairments evidenced by:
strategies for 3. Assess ability to learn need to be identified so an
facilitation of or perform desired appropriate teaching plan  Client’s
better learning. health-related care. can be designed. cooperation
during
4. Adults learn material questioning
4. Identify priority of that is important to them.  Verbalization of
learning needs within desired to learn
the overall plan of care.
5. Adults bring many life
5. Question patient experiences to each
regarding previous learning session. Adults
experience and health learn best when teaching
teaching. builds on previous
knowledge or experience.
 6. This provides an
6. Identify any existing important starting point in
misconceptions education.
regarding material to be
taught.
7. Matching the learner's
7. Determine patient's preferred style with the
learning style, especially educational method will
if patient has learned facilitate success in
and retained new mastery of knowledge.
information in the past.
8. A first step in teaching
8. Determine patient or may be to foster increased
caregiver's self-efficacy self-efficacy in the
to learn and apply new learner's ability to learn
knowledge. the desired information or
skills.
Course in the ward
On December 08,2018, Patient Tetsuya2 Admitted at the pediatric ward. Requested to get
CBC. The patients Vital sign are taken and record as follows T= 36.5, RR =32Cpm, CR=130 Bpm.
The patient will be hooked to Intravenous Fluid of C5 500mlX 30cc/hr at the right arm. Given
paracetamol 100mg syrup 5mc.
On the next Day December 09,2019, The patient hooked to 02 in Nasal Canal 1pm, follow
up medical Nebulser and Rebulixation to Q4 with diet NPO, follow up vital sign taken
Discharge Planning
A. Medication
Fever reducers. You or your child may also take over-the-counter medications such as
acetaminophen (Tylenol, others), ibuprofen (Advil, Children's Motrin, others) or naproxen (Aleve) to
help relieve the fever that accompanies measles.

Don't give aspirin to children or teenagers who have measles symptoms. Though aspirin is approved
for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like
symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a
rare but potentially life-threatening condition, in such children.

Antibiotics. If a bacterial infection, such as pneumonia or an ear infection, develops while you or
your child has measles, your doctor may prescribe an antibiotic.

Vitamin A. Children with low levels of vitamin A are more likely to have a more severe case of
measles. Giving vitamin A may lessen the severity of the measles. It's generally given as a large dose
of 200,000 international units (IU) for children older than a year.
B. Exercise And Activates
Take it easy. Get rest and avoid busy activities.
Sip something. Drink plenty of water, fruit juice and herbal tea to replace fluids lost by fever and
sweating.
Seek respiratory relief. Use a humidifier to relieve a cough and sore throat.
Rest your eyes. If you or your child finds bright light bothersome, as do many people with measles,
keep the lights low or wear sunglasses. Also avoid reading or watching television if light from a
reading lamp or from the television is bothersome.
C. Treatment
Post-exposure vaccination. Nonimmunized people, including infants, may be given the measles
vaccination within 72 hours of exposure to the measles virus to provide protection against the
disease. If measles still develops, the illness usually has milder symptoms and lasts for a shorter
time.
Immune serum globulin. Pregnant women, infants and people with weakened immune systems
who are exposed to the virus may receive an injection of proteins (antibodies) called immune
serum globulin. When given within six days of exposure to the virus, these antibodies can prevent
measles or make symptoms less severe.
Reference:
 https://www.mayoclinic.org/diseases-
conditions/measles/diagnosis-treatment/drc-20374862
