Post on 04-Apr-2018
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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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