MANAGEMENT OF A PATIENT WITH BRONCHITIS bronchitis 10012022
MANAGEMENT OF A PATIENT WITH BRONCHITIS bronchitis 10/01/2022 1
LYAMBAI KESTONE BSc NRS STUDENT DNS UNZA, OTN, RN bronchitis 10/01/2022 2
By the end of the lecture/discussion students should acquire knowledge on the management of a patient with bronchitis 10/01/2022 3
By the end of the lecture/discussion, students should be able to: � Define bronchitis � Mention the aetiology of acute and chronic bronchitis. � Discuss the pathophysiology of acute and chronic bronchitis. � State the signs and symptoms of acute and chronic bronchitis 10/01/2022 4
� Mention the investigations done in acute and chronic bronchitis � Describe the medical management of acute and chronic bronchitis � Describe the nursing management bronchitis � State the complications of bronchitis 10/01/2022 5 of
�Bronchitis is the inflammation of the mucous membrane of the bronchial tree. �The infection can be acute or chronic bronchitis 10/01/2022 6
� This is an inflammation of the bronchi that usually lasts for a brief period of time. � It is common especially among children and older adults due to lowered immunity bronchitis 10/01/2022 7
� Mainly caused by viruses that infect the respiratory system e. g. Rhinoviruses, influenza � Bacteria – Streptococcus pneumonia and Haemophilus influenza bronchitis 10/01/2022 8
� It may also be caused by physical or chemical agents such as dust, smoke, industrial fumes � It usually follows an upper respiratory tract infection. bronchitis 10/01/2022 9
- In a healthy person the defense mechanisms of the respiratory tract usually destroy or remove inhaled microbes. - When defenses are weakened, however, the potentially pathogenic bacteria that normally reside in the nose and pharynx may colonize the mucosa of the trachea and bronchitis 10/01/2022 10
� As part of the inflammatory process, blood flow to the affected area increases causing an increase in pulmonary secretions � A painful cough with sputum production, fever wheezing and chest pains may then occur. bronchitis 10/01/2022 11
� Cough (very common) - starts out dry and irritating but becomes increasingly loose over time due to excessive production of bronchial secretions as a response to the infection. � Headache due to spasms of the smooth muscles within the scalp and brain bronchitis 10/01/2022 12
� Fever due to infection triggering thermoregulatory centre thereby raising the temperature Shortness of breath on exertion due to narrowing and blockage of the airway by the secretions. � Malaise the patient will generally feel ill as a result of infection bronchitis 10/01/2022 13
� Wheezing heard on chest examination due to narrowing of the bronchi and accumulation of secretions as a result of the inflammation. � Pain behind the sternum may be present caused by inflammation of the trachea. bronchitis 10/01/2022 14
� History and physical examination helps determine the diagnosis. � Chest x-ray helps rule out pneumonia bronchitis 10/01/2022 15
� Most cases of acute bronchitis are self limiting as they are caused by viruses. � Treatment is supportive � Bronchodilators can be given to open tight air passages e. g. Salbutamol tablet 4 mg TDS orally. bronchitis 10/01/2022 16
� Steroids like hydrocortisone 100 mg IV. This acts as an anti-inflammatory. � Antibiotics may be given if there are signs of bacterial infection otherwise they are avoided to reduce antibiotic resistance. bronchitis 10/01/2022 17
� Analgesics for pain e. g. Paracetamol 500 – 1000 mg tds. Side effects GIT disturbance, hepatic disorders. Implications administer cautiously in patients with hepatic impairment bronchitis 10/01/2022 18
� It is the presence of chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough have been excluded (Lewis etal, 2000). bronchitis 10/01/2022 19
� Chronic irritation and destruction of the cilia of the bronchi e. g. from Cigarette smoking. � Recurrent respiratory tract infection as it impairs normal defense mechanisms. bronchitis 10/01/2022 20
� Heredity, alfa antitrypsin (serum protein produced by the liver, found in lungs) deficiency results in destruction of lung tissue by proteolytic enzymes from neutrophils and macrophages. � Aging results in changes of the respiratory tract making it susceptible to infection. bronchitis 10/01/2022 21
� Irritants inhaled for a prolonged period inflame the tracheobronchiole tree. � This leads to hypertrophy of mucous glands in the tracheobronchiole tree and lead to a marked increase in mucous secreting goblet cells hence the hyper secretion of mucus production and a narrowed or blocked airway. bronchitis 10/01/2022 22
� Hypersecrection from the goblet cells blocks the free movement of the cilia. � Excess mucus in the airway leads to bronchospasms which further increases the airway resistance. � Airway stays blocked and mucus and debris accumulate in the respiratory tract bronchitis 10/01/2022 23
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� Chronic cough which is productive especially in winter months. This is due to the body’s attempt to clear the airway which is congested. � Exertional dyspnoea due to impaired gas exchange bronchitis 10/01/2022 26
� Tachypnoea as a result of increased need for ventilation � Neck veins distention due to back flow of blood as a result increased pressure in the pulmonary circulation bronchitis 10/01/2022 27
� Wheezing - musical noise as air passes through the narrowed bronchioles. � Pedal oedema due to stasis of blood as a result of the pulmonary hypertension bronchitis 10/01/2022 28
� Chest x-ray may reveal a low flat diaphragm, overdistention of the lungs. � Sputum culture may reveal many microorganisms and neutrophils. � Arterial blood gas analysis shows hypoxemia with hypercapnia. bronchitis 10/01/2022 29
- Stop smoking - Avoid air pollutants bronchitis 10/01/2022 30
� Antibiotics – to treat recurring infections. Amoxyl 500 mg tid PO x 5/7 or Pen V 500 mg � Bronchodilators and facilitate - relieve bronchospasm mucus clearance e. g. Ventolin 4 mg � Corticosteroids – reduce inflammation Hydrocortisone 100 mg stat bronchitis 10/01/2022 31
Aims � To maintain a patent airway � To promote activity tolerance � To prevent complications bronchitis 10/01/2022 32
� The room should be clean, humidified, well ventilated and quiet to prevent infection and promote comfort. � Nursed in a semi fowler’s position to promote lung expansion. bronchitis 10/01/2022 33
- Explain the condition to the patient in simple terms and in their own language. - Encourage patient to verbalize and express their fears. - Answer patient’s questions appropriately. bronchitis 10/01/2022 34
� Assess for changes in baseline respiratory function i. e. increased tachypnoea and altered breathe sounds and report the changes immediately to the in-charge or clinician. � Evaluate sputum quality and quantity, restlessness. � Weigh the patient three times weekly and assess the oedema bronchitis 10/01/2022 35
- Provide the patient with a high-energy, protein rich diet to promote quick healing. - Offer small frequent meals to conserve the patient’s energy and prevent fatigue. - Give patient enough fluids at least 3 litres a day to loosen secretions. bronchitis 10/01/2022 36
� Perform chest physiotherapy including postural drainage and chest percussion for involved lobes, several times daily to mobilize secretions. � Encourage daily activity and provide diversional therapy. � To conserve the patient’s energy and prevent fatigue, help him to alternate periods of rest and activity bronchitis 10/01/2022 37
� Administer prescribed medications and note the patient’s response to them. � Monitor the side effects of drugs such as fine tremors, tachycardia as in the case Salbutamol. bronchitis 10/01/2022 38 of
� Patient to avoid crowds and people with known infections � Encourage patient to eat food high in calories and proteins to provide adequate energy and promote healing. � Be vaccinated against flu and pneumococcal disease to protect against respiratory infections that would predispose to bronchitis 10/01/2022 39
� Avoid irritants such as second hand smoke, chemical fumes � Patient to avoid cold and windy weather and to cover his/her mouth with scarf if he/she has to go outside. � Advise patient to only take the prescribed drugs as some drugs affect the potency of other drugs. bronchitis 10/01/2022 40
� Recurrent infections of the respiratory tract due to the breach in integrity of the mucosa as a result of chronic inflammation. � Obstruction of the airways due to the hyperplasia. � Emphysema overdistention of the alveoli with destruction of the wall due to accumulation of air. bronchitis 10/01/2022 41
� Cerebral ischaemia following a fall in blood PO 2 � Right sided heart failure due to the pulmonary hypertension. � Respiratory failure due inadequate volume of inspired air available for exchange bronchitis 10/01/2022 42
� Today’s lecture has focused on bronchitis which is the inflammation of the mucous membrane of the bronchi. The condition can be acute or chronic in nature. � The predisposing factors include chronic exposure to irritants such as smoke and fumes. bronchitis 10/01/2022 43
� This causes a chronic inflammation of the mucous membrane of the bronchi presenting with hypersecretion of mucous and hence a chronic productive cough. � Untreated, the condition could lead to life threatening conditions like heart failure. bronchitis 10/01/2022 44
� Mr Chilumbwa Hatontola a retired miner of Manungu compound is admitted to your medical ward with complaints of long standing cough, difficulties in breathing and swollen lower limbs. A provisional diagnosis of chronic bronchitis is made. Identify 5 problems Mr. Hatontola is likely to have and use a nursing care plan to nurse him until discharge. bronchitis 10/01/2022 45
• Cali-Ascani A. m. , Cheever H. K. , Evans G. N. , et al, Diseases, Springhouse Corporation, Pennsylvania • Kumar P. and Clark M. (2005), Clinical Medicine, 6 th edition, Elsevier Saunders, London, UK • Lewis M. S. , Heitkemper M. M. , and Dirksen R. S. (2004), Medical -Surgical Nursing, Mosby Elsevier, USA • Longmore M. , Wilkinson B. I. , and Rajagopalan R. S. (2005), Oxford Handbook of Clinical Medicine, 6 th Edition, Oxford University Press, New York. • Monahan etal (2007), Phipps’ Medical Surgical Nursing, 8 th edition, Mosby, Missouri. bronchitis 10/01/2022 46
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