Bronchitis

WHAT WENT WRONG?
Increased mucus production, caused by infection and airborne irritants that block
airways in the lungs, results in the decreased ability to exchange gases. There are
two forms of bronchitis: acute bronchitis, where blockage of the airways is re-
versible, and chronic bronchitis, where blockage is not reversible. Patients with
acute bronchitis are symptomatic typically for 7 to 10 days often due to viral (but
sometimes bacterial) infection. Patients with chronic bronchitis will have symp-
toms of a chronic productive cough for at least 3 consecutive months in 2 consec-
utive years. There is increased mucous production, inflammatory changes, and,
ultimately, fibrosis in the airway walls. The patient with chronic bronchitis has an
increased incidence of respiratory infection.

PROGNOSIS
Patients with acute bronchitis who have a resolution of symptoms and respiratory
status will return to normal condition. Chronic bronchitis is classified as a chronic
obstructive pulmonary disease (COPD), which is often linked to smoking and has
a progressive pattern. Shortness of breath is initially present only with exertion,
and eventually is present even at rest. Patients with chronic bronchitis often develop
right-sided heart failure and peripheral or dependent edema. Patients will have
acute exacerbations of chronic bronchitis.

SIGNS AND SYMPTOMS

• Cough due to mucous production and irritation of airways.
• Shortness of breath.
• Fever in acute episodes due to infection.
• Accessory muscles are used for breathing—as respiratory effort increases,
additional muscles are necessary to assist.
• Productive cough due to irritation of airways. Mucous is a protective reac-
tion of the respiratory system.
• Weight gain secondary to edema in chronic bronchitis is due to right-sided
heart failure.
• Wheezing due to inflammation within the airways.

TEST RESULTS
• Shadows in affected area of the lungs on the chest x-ray during infection.
• Pulmonary function testing shows:
• Forced vital capacity (FVC) changes because more time is needed to
forcibly exhale an amount of air after a maximal inhalation.
• FEV1 is decreased because more time is needed for exhalation.
• Residual volume (RV) is increased due to air trapping.
• Decreased oxygen and increased carbon dioxide in arterial blood gas.

TREATMENT
Acute bronchitis is treated in the short term with symptomatic treatment and
antibiotics when a bacterial infection is present. Chronic bronchitis is treated with
a combination of medications to keep the airways open, reduce inflammation
within airways, and prevent complications or exacerbations.
• Administer beta2-agonists by inhaler or nebulizer to dilate the bronchi:
• terbutaline, albuterol, levalbuterol
• formoterol, salmeterol
• Administer anticholinergics which allow for relaxation of bronchial smooth
muscle:
• ipratropium, tiotropium inhaler
• Administer steroids to decrease inflammation within the airways
• hydrocortisone, methylprednisolone systemically
• beclomethasone, triamcinolone, fluticasone, budesonide, flunisolide inhalers
• prednisolone, prednisone orally
• Administer methylxanthines to enhance bronchodilation:
• aminophylline
• theophylline (Theo-Dur)
• Administer diuretics to reduce fluid retention in patients who develop right-
sided heart failure:
• furosemide, bumetanide
• Administer expectorant to help liquefy secretions:
• guaifenesin
• Administer antibiotics in acute exacerbation of chronic bronchitis:
• selected by culture and sensitivity study or given empirically
• Administer antacid, H2 blocker, or proton pump inhibitor to decrease the
amount of acid in stomach, reducing possible ulcer formation due to stress
of disease or medication effects.
• antacids: aluminum hydroxide/magnesium hydroxide, calcium carbonate
• H2 blockers: ranitidine, famotidine, nizatidine, cimetidine
• proton pump inhibitors: omeprazole, lansoprazole, esomeprazole, rabepra-
zole, pantoprazole
• Administer vaccines—to decrease chances of infection:
• influenza
• pneumonia
• Give 3 liters of fluid per day to help liquefy secretions
• Oxygen: 2 liters per minute via nasal canula to help meet body’s needs; low
flow rates help reduce dyspnea while avoiding CO2 retention.
• Increase protein, calories, and vitamin C in diet to meet body’s needs.
• Administer the incentive spirometer or flutter valve to encourage coughing
and expelling of mucous.
• Nocturnal negative pressure ventilation used for hypercapnic (elevated CO2
levels) patients.

NURSING DIAGNOSES
• Ineffective airway clearance
• Activity intolerance
• Ineffective breathing pattern

NURSING INTERVENTION
• Monitor respirations looking at rate, effort, use of accessory muscles, skin
color; listen to breath sounds.
• Place patient in high Fowler’s position to ease respiration.
• Weigh the patient daily. Excess fluid due to heart failure will increase weight.
Notify physician, NP, or PA of weight gain of 2 pounds in 24 hours.
• Have the patient perform the turning, coughing, and deep-breathing exer-
cises to enhance lung expansion and expel mucous.
• Monitor sputum for changes in color or amount, which may signal infection
in patients with chronic bronchitis.
• Monitor intake and output.
• Increase fluids to keep mucous thinner and easier to expel.
• Explain to the patient:
• How to administer oxygen.