ACUTE BRONCHITIS

Definition

• Acute bronchitis is an infection of the lower respiratory tract that is generally an acute sequel to an upper respiratory tract infection.
• Acute bronchitis is swelling and inflammation of the main air passages to the lungs. This swelling narrows the airways, making it harder to breathe and causing other symptoms, such as a cough. Acute means the symptoms have only been present for a short time.

Pathophysiology

 

Etiology

1. Acute bronchitis usually follows a cold or flu-like infection.
2. A virus causes mostly infection.
3. Sometimes, bacteria also infect the airways. This is called a secondary infection.

Clinical Manifestations

The symptoms of acute bronchitis may include:

• Dyspnea, - Shortness of breath that gets worse with activity
• Tachypnea
• Chest discomfort
• Cough that produces mucus; it may be clear or yellow-green
• Fatigue
• Fever -- usually low-grade
• Diffuse rhonchi and crackles heard on auscultation.
• Wheezing, if patient with asthma
• If bronchitis with pneumonia, symptoms likely to have a high fever and chills, feel sicker, or feel short of breath.
• Even after acute bronchitis has cleared, a dry cough present up to 1 to 4 weeks.

Diagnostic Evaluation

• History and Physical Examination
• Chest X-ray-no evidence of infiltrates or consolidation.
• Sputum for gram stain, culture & sensitivity - to determine presence of bacterial infection.
• Spirometry to determine peak expiratory flow (may be decreased).

Management

• Most cases no need to take antibiotics for acute bronchitis.
• The infection will usually go away on its own within 1 week.
• Some steps to get relief:
  • Drink plenty of fluids.
  • If with asthma or another chronic lung condition, use inhaler (such as albuterol).
  • Rest.
  • Use a humidifier or steam in the bathroom.
• If symptoms do not improve, than -
  • Antibiotic therapy for 7 to 10 days may be indicated for patients with underlying respiratory problems or chronic illness.
  • Hydration and humidification.
  • Secretion clearance interventions (controlled cough, positive expiratory pressure valve therapy, chest physical therapy).
  • Bronchodilators for bronchospastic cough and bronchial irritation.
  • Symptom management for fever, cough.

Nursing care

• Obtain history of upper airway infection, course and length of symptoms.
• Assess severity of cough and characteristics of sputum production.
• Auscultate chest for diffuse rhonchi and crackles as opposed to localized crackles usually heard with pneumonia.
• Administer or teach self-administration of antibiotics as ordered.
• Encourage mobilization of secretions, through hydration, chest physical therapy, and coughing.
• Educate patient that beverages with caffeine or alcohol do not promote hydration because of their diuretic effect.
• If ordered, administer or teach self-administration of inhaled bronchodilators to reduce bronchospasm and enhance secretion clearance.
• Caution patients on the use of over-the-counter cough suppressants, antihistamines, and decongestants that may cause drying and retention of secretions.
• Cough preparations containing the mucolytic guaifenesin may be appropriate.