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CASE SCENARIO ON Chronic Bronchitis

Mr. Guevarra, a 62-year-old auto mechanic, presents with progressive shortness of breath for several days after developing a cold. He coughs up a cup of yellow-green sputum daily and has a history of similar episodes. On examination, he is cyanotic and using accessory muscles to breathe, with diminished breath sounds and crackles bilaterally. He has a long history of smoking and works in a damp environment.

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Macy Abella
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56 views2 pages

CASE SCENARIO ON Chronic Bronchitis

Mr. Guevarra, a 62-year-old auto mechanic, presents with progressive shortness of breath for several days after developing a cold. He coughs up a cup of yellow-green sputum daily and has a history of similar episodes. On examination, he is cyanotic and using accessory muscles to breathe, with diminished breath sounds and crackles bilaterally. He has a long history of smoking and works in a damp environment.

Uploaded by

Macy Abella
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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CASE SCENARIO ON OXYGENATION/ CHRONIC BRONCHITIS

SCENARIO: Mr. Guevarra is a 62-year-old auto mechanic who presents with


progressive shortness of breath for the past several days. His problem began four days
ago when "I got a cold." His "cold" consisted of a sore throat, rhinorrhea and myalgia.
His job forces him to work in the cold and damp air. At first he just felt tired but later
he developed a cough* and shortness of breath. Initially, the cough was dry but within
24 hours of onset, it produced abundant yellow-green sputum. He states, "I cough up a
cup of this stuff every day." He didn't think much of the cough because he continually
coughs during the winter of each year. His wife states that he "hacks and spits up"
every morning when he gets up from bed. The shortness of breath has worsened so
that he can hardly speak now. He also has pain in the left side of his chest when he
coughs. He becomes very tired after walking up a flight of stairs or during a coughing
spell. He denies hemoptysis, night sweats, chills, and paroxysmal nocturnal dyspnea.
However, he does complain of swelling of his ankles: "I've had this for more than a
year."

Mr. Guevarra has been treated for high blood pressure, pneumonias and infections of
his hands. He has been treated for similar episodes of coughing and shortness of
breath during the past two years. Once he was hospitalized because "I was drinking
too much and my pancreas acted up." A previous doctor gave him nitroglycerin. He
smokes 1-2 packs of cigarettes per day and has done so for the past 35 years.

PHYSICAL EXAMINATION: The patient appears much older than he stated age of
62 years. He speaks with difficulty, quickly becoming breathless. There is cyanosis
which intensifies during coughing spells. Blood pressure is 146/82 mmHg. Apical
heart rate is 96/minute and regular. Respiratory rate is 28/minute. Temperature is
38.4C.

Examination of the head and neck reveals the use of accessory muscles during
respiration. The chest reveals use of accessory respiratory muscles. Respiration rate is
increased; respiration is regular and longer in expiration. Breath sounds are
diminished bilaterally. Coarse crackles, rhonchi and expiratory wheezes are heard
bilaterally. Most of these sounds clear with coughing.

The medical practitioner prescribed an aerosal inhaler (bronchodilator) to relieve


present symptoms.

Pre- Work:

1. Review the anatomy and physiology of the Respiratory System.


2. Study the difference between Acute and Chronic Bronchitis.

Guide Questions:

1. During initial assessment, identify abnormal findings.


2. Provide 2 nursing diagnosis appropriate to the case scenario and justify.
3. Identify possible diagnostic procedures relevant to the case.
4. Please provide a list of medical management related to the scenario and make a
medication cards.
5. Explain how the Spirometry is performed and its significance.
6. What therapeutic communication techniques can be use to facilitate good nurse-
patient relationship.
7. Briefly discuss immediate nursing interventions applicable to this case.
8. Formulate a teaching plan for the patient.

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