PRADEEP'S_Acute Bronchitis

7/31/2019 PRADEEP'S_Acute Bronchitis

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BRONCHITIS

DEFINITION

Acute inflammation of the mucous membranes of the

trachea and bronchi (duration < 4 weeks).


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ETIOLOGY

1. Common respiratory tract viruses (80%)

2. Bacteria (in about 20% of cases):

Streptococcus pneumoniae

Haemophilus influenzae

Mycoplasma pneumoniae

Chlamydia

Pertussis


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3. A fungal infection (eg, Aspergillustracheobronchitis)

4. Smoking

5. Air pollution

6. Allergy to something in the air such as pollen

7. Lung disease such as asthma or emphysema


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PATHOPHYSIOLOGYDue to etiological factors

Viruses penetrate terminal bronchiolar cells--directly damaging andinflaming

Pathologic changes begin 18-24 hours after infection

Bronchiolar cell necrosis, ciliary disruption,

Edema, excessive mucus, sloughed epithelium lead to airway obstructi

and atelectasis

Signs and symptoms


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CLINICAL MANIFESTATIONS1) Initially, the patient has a dry, irritating cough and

expectorates a scanty amount of mucoid sputum.

2) Nasal congestion,

3) Dyspnea on exertionDyspnea at rest

4) Hypoxemia & hypercapnea

5)

Polycythemia6) Cyanosis

7) Bluish-red skin color

8) Pulmonary hypertensionCor pulmonale

9) Low-grade fever


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9) Headache and general malaise.

10) As the infection progresses, the patient may beshort of breath, have noisy inspiration and

expiration (inspiratory stridor and expiratory

wheeze)

11) Purulent(pus-filled) sputum

12) With severe trachea-bronchitis, blood-streaked

secretions may be expectorated as a result of the

irritation of the mucosa of the airways.


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DIAGNOSIS

1. Clinical diagnosis based on history and physical

exam

2. Supported by CXR: hyperinflation, flattened

diaphragms, air bronchograms, peribronchial

cuffing, patchy infiltrates, atelectasis.


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MANAGEMENT

a. In most cases, treatment of trachea-bronchitis is largely

symptomatic.

b. Bronchodilators Beta-adrenergic agonist: Proventil

Methylxanthines: Theophylline

Anticholinergics: Atrovent

c. Mucolytics: Mucomystd. Expectorants: Guaifenisin

e. The patient is advised to rest.

f. Increasing the vapor pressure (moisture content) in the air

will reduce irritation.

C l h i h l i h l li


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g. Cool vapor therapy or steam inhalations may help relieve

laryngeal and tracheal irritation.

h. Moist heat to the chest may relieve the soreness and pain

i. Mild analgesics or antipyretics may be indicated(e.g.diclovin).

j. Fluid intake is increased to thin the viscous and tenacious

secretions.


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g. Copious, purulent secretions that cannot be cleared by

coughing place the patient at risk for increasing airway

obstruction and the development of a more severelower respiratory tract infection, such as pneumonia.

Suctioning and bronchoscopy may be needed to

remove secretions.

g. Rarely, endotracheal intubation may be required in

cases of acute tracheobronchitis leading to acute

respiratory failure.


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NURSING MANAGEMENT

1. A primary nursing function is to encourage bronchial

hygiene, such as increasing fluid intake and directed

coughing to remove secretions.

2. The nurse should encourage and assist the patient to sit u

frequently to cough effectively and to prevent retention of

mucopurulent sputum.

3. If the patient is treated with antibiotics for an underlyinginfection, it is important to emphasize the need to complet

the full course of antibiotics prescribed.


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Nursing Diagnoses1. Ineffective airway clearancer/t bronchospasm,

ineffective cough, excessive mucus.2. Anxiety r/t difficulty breathing, fear of suffocation.

3. Ineffective therapeutic regimen management r/t

lack of information about asthma.


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PRADEEP'S_Acute Bronchitis