Latest posts

Acute Bronchitis

Description
  • Is an infection of the lower respiratory tract that generally follows an upper respiratory tract infection. As a result of this viral (most common) or bacterial infection, the airways become inflamed and irritated, and mucus production increases.

Causes
  • Acute bronchitis is usually caused by viruses. Established risk factors include a history of smoking, occupational exposures, air pollution, reduced lung function, and heredity. Children of parents who smoke are at higher risk for pulmonary infections that may lead to bronchitis.

Assessment:
  • Fever, tachypnea, mild dyspnea, pleuritic chest pain (possible).
  • Cough with clear to purulent sputum production.
  • Diffuse rhonchi and crackles(contrast with localized crackles usually heard with pneumonia).

Diagnostic Evaluation:
  • Chest X-ray may rule out pneumonia. In bronchitis, films show no evidence of lung infiltrates or consolidation.

Primary Nursing Diagnosis
  • Impaired gas exchange related to obstructed airways

Medical Management:
  • Chest physiotherapy to mobilize secretions, if indicated.
  • Hydration to liquefy secretions.

Pharmacologic Interventions:
  • Inhaled bronchodilators to reduce bronchospasm and promote sputum expectoration.
  • A course of oral antibiotics such as a macrolide may be instituted, but is controversial.
  • Symptom management for fever and cough.

Nursing Interventions:
  • Encourage mobilization of secretion through ambulation, coughing, and deep breathing.
  • Ensure adequate fluid intake to liquefy secretions and prevent dehydration caused by fever and tachypnea.
  • Encourage rest, avoidance of bronchial irritant, and a good diet to facilitate recovery.
  • Instruct the patient to complete the full course of prescribed antibiotics and explain the effect of meals on drug absorption.
  • Caution the patient on using over-the-counter cough suppressants, antihistamines, and decongestants, which may cause drying and retention of secretions. However, cough preparations containing the mucolytic guaifenesin may be appropriate.
  • Advise the patient that a dry cough may persist after bronchitis because of irritation of airways. Suggest avoiding dry environments and using a humidifier at bedside. Encourage smoking cessation.
  • Teach the patient to recognize and immediately report early signs and symptoms of acute bronchitis.

Documentation Guidelines
  • Respiratory status of the patient: Respiratory rate, breath sounds, use of oxygen, color of nail beds and lips; note any respiratory distress
  • Response to activity: Degree of shortness of breath with any exertion,degree of fatigue
  • Comfort, body temperature
  • Response to medications, oxygen,and breathing treatments
  • Need for assistance with activities of daily living
  • Response to diet and increased caloric intake, daily weights

Discharge and Home Healthcare Guidelines
  1. Medications. Be sure that the patient understands all medications, including the dosage, route, action, and adverse effects. Patients on aminophylline should have blood levels drawn as ordered by the physician. Before being discharged from the hospital, the patient should demon- strate the proper use of metered-dose inhalers.
  2. Complications. Instruct patients to notify their primary healthcare provider of any change in the color or consistency of their secretions. Green-colored secretions may indicate the pres- ence of a respiratory infection. Patients should also report consistent, prolonged periods of dyspnea that are unrelieved by medications.
  3. Follow-up. Consider that patients with severe disease may need assistance with activities of daily living after discharge. Note any referrals to social services. Send patients home with a diet, provided by the dietitian and reinforced by the nurse, which provides a high-caloric intake. Encourage the patient to cover the face with a scarf if he or she goes out-of-doors in the winter. If the patient continues to smoke,provide the name of a smoking cessation program or a support group. Encourage the patient to avoid irritants in the air.

No comments