15.12 Acute Bronchitis

Acute bronchitis, or inflammation of the bronchi, is a common respiratory illness in the United States. It is most commonly caused by viruses, such as rhinovirus, influenza virus, or adenovirus. However, it can also be caused by bacteria or exposure to irritants like smoke or pollution. Acute bronchitis cases spike in the winter months due to the prevalence of the influenza virus at this time, but it can occur at any time of the year. Risk factors for the development of acute bronchitis are tobacco use, living in areas with high pollution, living in crowded residences, and a history of asthma, as well as a history of allergies.^[1]

Pathophysiology

Acute bronchitis results when an infectious organism invades the respiratory tract and starts to replicate. This triggers an inflammatory response in the bronchi, leading to irritation and increased production of mucus. In some cases, acute bronchitis can also be caused by an upper respiratory tract infection that spreads to the lower respiratory tract.^[2]

Assessment (Recognizing Cues)

Physical Exam

Common signs and symptoms of acute bronchitis are a productive and persistent cough with clear, yellowish, or purulent sputum; difficulty breathing; rhonchi or wheezing; and malaise. The cough typically lasts for 10 to 20 days but can last longer than four weeks. Prolonged coughing can also cause chest wall pain.^[3]

Initially, it may be difficult to distinguish acute bronchitis from an upper respiratory tract infection (URI). However, as the infection develops, it becomes easier to differentiate between the two disorders because a URI resolves quickly, whereas acute bronchitis tends to persist.^[4]

Potential complications of acute bronchitis are pneumonia, acute respiratory distress syndrome, and respiratory failure. Spontaneous pneumothorax can also result from chronic, forceful coughing.^[5]

Common Laboratory and Diagnostic Tests

Acute bronchitis is primarily a clinical diagnosis. The severity of the condition can be gauged based on the client’s vital signs; in clients with normal vital signs, no further diagnostic testing is typically needed. In clients with an elevated heart rate or respiratory rate, a temperature greater than 100.4 F, or the presence of egophony or fremitus on a chest examination, a chest X-ray is typically performed to rule out pneumonia or other lung issues. Egophony refers to increased resonance of voice sounds that can be heard when listening to the client’s chest. This increased resonance gives voice sounds a nasal quality and can indicate pneumonia. Fremitus refers to changes in vibration intensity when certain words are spoken while the chest is being palpated by the examiner.^[6],[7],[8]

Laboratory testing such as a complete blood count may be ordered for clients with acute bronchitis and may typically indicate elevated white blood cell counts. PCR testing of nasal secretions may be performed to identify the causative agent in specific situations.^[9]

Nursing Diagnosis (Analyzing Cues)

Nursing priorities for clients with acute bronchitis include symptom management and preventing the spread of illness to others.

Nursing diagnoses for clients with acute bronchitis are created based on the specific needs of the client, their signs and symptoms, and the etiology of the disorder. These nursing diagnoses guide the creation of client-specific care plans that encompass client outcomes and nursing interventions, as well the evaluation of those outcomes. These individualized care plans then serve as a guide for client treatment.

Possible nursing diagnoses for clients with acute bronchitis are as follows^[10]:

• Ineffective airway clearance r/t excessive mucus
• Ineffective breathing pattern r/t disease process
• Fatigue r/t disease process and excessive coughing

Outcome Identification (Generate Solutions)

Outcome identification encompasses the creation of short- and long-term goals for the client. These goals are used to create expected outcome statements that are based on the specific needs of the client. Expected outcomes should be specific, measurable, and realistic. These outcomes should be achievable within a set time frame based on the application of appropriate nursing interventions.

Sample expected outcomes include the following:

• The client will exhibit a patent airway and no signs of respiratory distress during the course of the illness.
• The client will demonstrate an appropriate respiratory rate for their age within 24 hours.
• The client will display an increase in energy and engage in age-appropriate play within one week.

Interventions (Generate Solutions & Take Action)

Medical Interventions

Medical treatment of acute bronchitis consists of supportive care. To relieve cough, nonpharmacological strategies such as hot tea, honey, ginger, and throat lozenges can be used when age appropriate. Over-the-counter medications like dextromethorphan and guaifenesin are also available for management of cough and mucus, but their use may not be appropriate for children of all ages, and parents should follow the advice of their health care provider. Over-the-counter antipyretics, such as acetaminophen or ibuprofen, can be used to manage fever.^[11]

Other medications that may be used in the medical management of acute bronchitis are bronchodilators for wheezing or short-term steroid therapy to manage inflammation. Antibiotic therapy is only used when bacteria has been identified as a causative pathogen. If acute bronchitis is caused by influenza, antiviral agents such as oseltamivir may help in reducing symptoms.^[12]

Nursing Interventions

Registered nurses plan interventions based on the expected outcomes of the client. Prior to implementation, the nurse must determine if all previously planned interventions are still suitable based on the current situation of the client.

When caring for a client with acute bronchitis, nursing interventions can be divided into nursing assessments, nursing actions, and client teaching as described in the following subsections.^[13],[14]

Nursing Assessments

• Perform a focused respiratory assessment, including airway, lung sounds, respiratory rate and pattern, pulse oximetry readings, the presence of shortness of breath, the use of accessory muscles, and the coughing pattern of the client. Changes in the client’s respiratory assessment findings can indicate worsening of their condition, bronchospasm, or the accumulation of excessive mucus.

Nursing Actions

• Administer oxygen as prescribed and as indicated.
• Encourage adequate fluid intake, as well as a humidifier, as this may help loosen mucus.
• Encourage the client to sit upright with the head of the bed 30 degrees or higher to allow for optimal lung expansion.
• Cluster nursing cares and provide rest periods when fatigue is present to allow the client to conserve energy.

Client Teaching

• Educate the client and their parents/caregivers about the need to reduce exposure to smoke, allergens, and pollution to prevent recurrent acute bronchitis and reduce the risk of complications. Clients prone to developing acute bronchitis should wear a mask when in environments with high levels of irritants or pollution.
• Teach the client and their parents/caregivers that if symptoms last longer than six weeks, the client should be reevaluated by their health care provider to ensure their initial diagnosis was accurate and no complications are present.
• Educate the client and their caregivers about proper handwashing and respiratory etiquette to help prevent the spread of infection to others.
• Encourage annual influenza and pneumonia vaccines to help prevent the development of acute bronchitis.

Evaluation (Evaluate Outcomes)

Evaluation of client outcomes refers to the process of determining whether or not client outcomes were met by the indicated time frame. This is done by reevaluating the client as a whole and determining if their outcomes have been met, partially met, or not met. If the client outcomes were not met in their entirety, the care plan should be revised and reimplemented. Evaluation of outcomes should occur each time the nurse assesses the client, examines new laboratory or diagnostic data, or interacts with another member of the client’s interdisciplinary team.