Bronchitis

Medicine and medical
nursing
MANAGEMENT OF A PATIENT WITH LOWER
RESPIRATORY TRACT DISORDERS.
BRONCHITIS
bronchitis 11/01/20 1
23
Presented by
KALOKONI CATHERINE
BSc NRS STUDENT RUSANGU UNIVERSITY
23
GENERAL OBJECTIVE
By the end of the lecture/discussion students

should acquire knowledge and skills in
nursing a patient with bronchitis.
.
23
SPECIFIC OBJECTIVES
By the end of the lecture/discussion, students should be able to:
 Explain briefly the defense mechanisms of the respiratory tract

 Define bronchitis
 State the aetiology of acute and chronic bronchitis.
 State the etiology and predisposing factors of bronchitis
 Discuss the pathophysiology of bronchitis.
 State the signs and symptoms of acute and chronic bronchitis
23
Specific objectives cont.
1. State the clinical features of bronchitis.
2. Outline the investigations carried out in the diagnosis of bronchitis.
3. Describe the medical and nursing management of a patient with
bronchitis.
4. State the complications of bronchitis.
5. Outline the strategies for health promotion and prevention of
bronchitis.
23
Introduction.
A daily activity that most of us rarely think about is breathing air in

and out of the lungs. The act of breathing involves two interrelated
processes- ventilation (movement of air into and out of the lungs),
and respiration (the exchange of oxygen and carbon dioxide across
cell membranes).
Proper ventilation can be maintained when airways are patent, and

adequate amount of air can move in and out of the lungs.
However due to inflammation which may be due to infection like

bronchitis, the amount of air entering and leaving the lungs can be
compromised resulting into limitation in the amount of air flow.

23
Defense mechanism of breathing
The respiratory passages that lead from the exterior to the alveoli do
more than serve as gas conduits. They also defend the body against
injurious substances as follows:-
1. They humidify and cool or warm the inspired air so that even very
hot or very cold air is at near body temperature by the time it reaches
the alveoli and therefore preventing drying and injury to the airways.
2. Bronchial secretions contain immunoglobulins (IgA) that help
resist infections and maintain the integrity of the mucosa.
23
conti
The pulmonary alveolar macrophages also referred to as “dust
cells” which are phagocytic; ingest inhaled bacteria and small
particles e. g. silica, and asbestos.
4. The hairs in the nostrils strain out many particles thus preventing
them from reaching the alveoli.
5. Very fine particles that reach the bronchi become trapped in
mucus and are removed away from the lungs by” ciliary escalator’.
 6. Particles that find their way into the airways initiate reflex
bronchial constriction and coughing thus preventing them from
reaching the alveoli
23
Definition
Bronchitis is the inflammation of the mucous membrane of

the bronchial tree. The infection can be acute or chronic
(Monahan, 2007).
Bronchitis is the inflammation of one or both bronchi

(Dorland’s Pocket Medical Dictionary).
23
ACUTE BRONCHITIS
 Acute bronchitis is the sudden inflammation of the

bronchi, and usually the trachea; thus the more correct
term for this illness is tracheobronchitis (Monahan,
2007).
 It is a short term disorder lasting from one to three

weeks, and is most common in children and older adults
due to lowered immunity
23
CHRONIC BRONCHITIS-
Chronic bronchitis is defined in clinical terms as the
presence of a chronic productive cough lasting at least
three months in each of the two successive years in a
patient whom other causes of productive cough have
been excluded (Monahan, 2007).
 It is a serious long-term disorder that often requires
regular medical treatment.
23
Aetiology
Predisposing factors include-
Bronchitis can occur due to an extension of an upper

respiratory tract infection e. g. cold or flu.
It can also occur in individuals with chronic lung disease e. g.

emphysema.
 People who are exposed to a lot of secondhand smoke.
 People with weakened immune systems due low immunity .
23
cont
6- People with gastroesophageal reflux disease (GERD) may
lead to aspiration of git contents and irritate the airways
resulting in bronchitis.
7- Those that are exposed to irritants at work, such as

chemical fumes from ammonia gas, chlorine etc.
8 People who are exposed to air pollution that originate
from vehicle exhaust, wood-burning stoves, tobacco smoke,
coal burning, and grilling food.
23
Pathophysiology
Although the single most important cause is cigarette
smoking, other air pollutants such as Sulphur dioxide, may
contribute.
These environmental irritants induce mucus glands in the

trachea and main-stem bronchi and lead to a marked increase
in mucin- secreting cells in the bronchi and bronchioles.
In the health person the defense mechanisms of the

respiratory tract usually destroy or remove inhaled microbes
23
conti
 When defenses are weakened, however, the pathogenic
bacteria that normally reside in the nose and pharynx may
colonize the mucosa of the trachea and bronchi.
The mucosa becomes inflamed in response to endotoxins

liberated by pathogens, become oedematous and hypereamic
(congested with fluid and blood).It is characterized by
increased mucus secretion accompanied by a productive
cough.
23
conti
The thickened mucosa as a result of oedema, and increased
mucus production narrows the lumen of the airway and the
patient will present with wheezing, cyanosis, shortness of breath,
and dyspnoea.
 The mucosa may undergo erosion if the irritating substance is
not identified and removed leading to bleeding and causing
hemoptysis.
23
Signs and symptoms of acute and chronic
 Coughing due to irritation of the airways by sputum.
 Production of yellow, grey, or green mucus (sputum)

secondary to infection.
 Dyspnoea and shortness of breath due to lung

congestion.
23
Signs and symptoms
 Wheezing - musical noise as air passes through the
narrowed bronchioles.
 Fever and chills due to infection.
 Chest pain or discomfort due to inflammation.

 Tachypnoea as a result of increased need for ventilation
23
Medical management
Investigations
History
 and physical examination helps determine the
diagnosis.
2. The physical examination to detect hear wheezes and
a prolongation of the exhalation of breathing,
3. Chest x-ray helps rule out pneumonia

23
Investigation
• 4. Sputum studies are done for Gram stain, culture, and

sensitivity isolate the causative agent .
• 5. Arterial blood gas measurements to rule out hypoxemia.
• 6. Pulmonary function tests are often done to assess the

Lung Function .
23
Treatment
- Stop smoking
- Avoid air pollutants
23
Treatment
Most cases of acute bronchitis are self limiting as they are caused by
viruses.
Antibiotics- effective against bacterial infections, not viral
infections, and also to prevent secondary infections.
• Amoxicillin- 500mg, tds X 5/7. or pen V 500mgs
• Side effects include diarrhoea, rashes (discontinue treatment).
• Caution: History of allergy, and renal impairment.
11/01/20 22
23
cont
• Bronchodilators - relieve bronchospasm given to open tight air
passages and facilitate mucus clearance e.g.
• . Salbutamol tablet 4mg TDS orally
• Mucolytic- To thin or loosen mucus making it easier to cough up

sputum.
• Beta-Agonists- To produce bronchodilation and improve dyspnoea.

• Aminophylline, 100mg, IV, in normal saline.
•Side effects include tachycardia, palpitation, and insomnia.
•Caution: Hypertension, peptic ulcer, epilepsy, and hyperthyroidism .
23
conti
 Corticosteroids – reduce inflammation Hydrocortisone 100mg im/iv stat
Prednisolone 10-20mg, OD, as required.
Side effects include dyspepsia, peptic ulceration, acute pancreatitis, and

osteoporosis.
5. Oxygen therapy-To improve tissue perfusion.
-4-6 liters of oxygen, via nasal catheter or face mask.
23
Complications
1) Atelectasis due to obstructed airways.
2) Cor pulmonale due to pulmonary vasoconstriction

following hypoxaemia.
3) Bronchiectasis due to due to damage and loss of

elasticity in the walls of the bronchi.
4) Pneumonia due to infection.
5) Respiratory failure due to atelectasis

23
Prevention
Bronchitis is a somewhat preventable disease. Some of
the methods include:
1. Avoiding tobacco smoke, quitting smoking, as well as

avoiding exposure to secondhand smoking.
2. Avoiding people with flu or cold.
3. Avoiding, cold damp locations or areas with a lot of

air pollution.
23
Nursing Management
23
NURSING MANAGEMENT
Aims
• To maintain a patent airway
• To promote activity tolerance
• To prevent complications
23
Environment
The room should be clean to promote comfort
Nurse patient in a humidified, well ventilated room
to prevent infection and promote comfort.
Nurse patient in a quite environment and nurse the
patient in blocks to promote rest
Nursed in a semi fowler’s position to promote lung
expansion.
23
Psychological care
• Explain the condition to the patient in simple

terms and in their own language to help him
understand his condition
• Encourage patient to verbalize and express their
fears.
• Answer patient’s questions appropriately.
23
Observations
 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.
 Assess level of consciousness/cognition and ability to protect
own airway in order to providing baseline level of care needed,
and influencing choice of interventions
 Evaluate sputum quality and quantity, restlessness.
 Weigh the patient three times weekly and assess the oedema
23
Nutrition
 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.
23
Exercises and Rest
 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
23
Medication
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 of Salbutamol.
Advise the patient to take medications as per doctors orders
23
Health Education
 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.
 Avoiding tobacco smoke, quitting smoking, as well as
avoiding exposure to secondhand smoking
23
Health Education
 Avoidirritants 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.
 Advisepatient to only take the prescribed drugs as

some drugs affect the potency of other drugs.
23
Complications
 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.
23
Complications cont.
 Cerebral ischaemia following a fall in blood PO2
 Right sided heart failure due to the pulmonary

hypertension.
 Respiratory failure due inadequate volume of

inspired air available for exchange
23
SUMMARY
 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.
 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.
23
REFERENCES
.
1. Brunner and Sundarth. (2010). Medical Surgical Nursing, Assessment and
Management of Clinical Problems. 12th Edition. Lippincott. St. Louis, Missouri.
2. Kumar et al, (2007). Robbins Basic Pathology. 8th Edition. Saunders, Elsevier,
Philadelphia.
3. Monahan et al. (2007).Phipp, s Medical -Surgical Nursing, Health and Illness
Perspective 8th edition. Mosby. Elsevier. Louis Missouri.
4. Kumar & Clark (2006). Clinical Medicine, 6th edition. Saunders, Elsevier.
Philadelphia.
5. Swearingen L.P (2003). Manual of Medical Surgical Nursing Care, Nursing
Interventions & Collaborative Management, 5th edition. Mosby St. Louis,
Missouri. .
 23

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Medicine and medical

By the end of the lecture/discussion students

 Explain briefly the defense mechanisms of the respiratory tract

2. Outline the investigations carried out in the diagnosis of bronchitis.

3. Describe the medical and nursing management of a patient with

4. State the complications of bronchitis.

5. Outline the strategies for health promotion and prevention of

A daily activity that most of us rarely think about is breathing air in

Proper ventilation can be maintained when airways are patent, and

However due to inflammation which may be due to infection like

compromised resulting into limitation in the amount of air flow.

Bronchitis is the inflammation of the mucous membrane of

Bronchitis is the inflammation of one or both bronchi

 Acute bronchitis is the sudden inflammation of the

 It is a short term disorder lasting from one to three

Bronchitis can occur due to an extension of an upper

It can also occur in individuals with chronic lung disease e. g.

7- Those that are exposed to irritants at work, such as

These environmental irritants induce mucus glands in the

In the health person the defense mechanisms of the

The mucosa becomes inflamed in response to endotoxins

 Coughing due to irritation of the airways by sputum.

 Production of yellow, grey, or green mucus (sputum)

 Dyspnoea and shortness of breath due to lung

 Fever and chills due to infection.

 Chest pain or discomfort due to inflammation.

2. The physical examination to detect hear wheezes and

a prolongation of the exhalation of breathing,

3. Chest x-ray helps rule out pneumonia

• 4. Sputum studies are done for Gram stain, culture, and

• 5. Arterial blood gas measurements to rule out hypoxemia.

• 6. Pulmonary function tests are often done to assess the

• Caution: History of allergy, and renal impairment.

• . Salbutamol tablet 4mg TDS orally

• Mucolytic- To thin or loosen mucus making it easier to cough up

• Beta-Agonists- To produce bronchodilation and improve dyspnoea.

Prednisolone 10-20mg, OD, as required.

Side effects include dyspepsia, peptic ulceration, acute pancreatitis, and

5. Oxygen therapy-To improve tissue perfusion.

-4-6 liters of oxygen, via nasal catheter or face mask.

2) Cor pulmonale due to pulmonary vasoconstriction

3) Bronchiectasis due to due to damage and loss of

4) Pneumonia due to infection.

5) Respiratory failure due to atelectasis

1. Avoiding tobacco smoke, quitting smoking, as well as

2. Avoiding people with flu or cold.

3. Avoiding, cold damp locations or areas with a lot of

• To maintain a patent airway

• To promote activity tolerance

• Explain the condition to the patient in simple

 Assess for changes in baseline respiratory function i.e. increased

 Provide the patient with a high-energy, protein

Administer prescribed medications and note the patient’s response to

Monitor the side effects of drugs such as fine tremors, tachycardia as in

Advise the patient to take medications as per doctors orders

 Patient to avoid cold and windy weather and to

 Advisepatient to only take the prescribed drugs as

 Emphysema overdistention of the alveoli with

 Right sided heart failure due to the pulmonary

 Respiratory failure due inadequate volume of

 Today’s lecture has focused on bronchitis which is the inflammation of the

 The predisposing factors include chronic exposure to irritants such as

 This causes a chronic inflammation of the mucous membrane of the