Wesleyan University –Philippines

College of Nursing and Allied Medical Sciences

Mabini Extension, Cabanatuan City 3100

Acute Bronchitis
(Case study)

Joshua B. Alcantara
BSN 3-4

Definition

1
 What is acute bronchitis? Acute bronchitis is the inflammation of the lining of the
bronchitis, occurs when the airways of the lungs swell and produce mucus. That is what causes
you to cough. Acute bronchitis can last for as little as three weeks.
-Acute bronchitis is characterized by swelling and inflammation of the main passages that carry
air to the lungs. This swelling constricts the airways, making it difficult to breathe. Other
bronchitis symptoms include a cough and coughing up mucus. Acute means that the symptoms
have only been present for a short period of time.

Anatomy and Physiology

When acute bronchitis occurs, it almost always comes after having a cold or flu-like
illness. The bronchitis infection is caused by a virus. At first, it affects your nose, sinuses, and
throat. Then it spreads to the airways that lead to your lungs.

Pathophysiology
Acute bronchitis is caused by an acute inflammation of the bronchi caused by a variety of
triggers, most commonly viral infection, allergens, pollutants, and so on. Inflammation of the
bronchial wall causes mucosal thickening, epithelial-cell desquamation, and basement membrane
denudation. A viral upper respiratory infection can sometimes progress to a lower respiratory
tract infection, resulting in acute bronchitis.

Signs and symptoms

Symptoms of acute bronchitis last less than 3 weeks and can include:

 Coughing with or without mucus

 Soreness in the chest
 Feeling tired (fatigue)
 Mild headache
 Mild body aches
 Sore throat

Laboratory test
2
Pulmonary function test
Pulmonary function testing is a comprehensive examination of the respiratory system that
includes a patient history, physical examinations, and pulmonary function tests. The primary
goal of pulmonary function testing is to determine the degree of pulmonary impairment.
Low- Lower than normal results may suggest obstructive or restrictive lung disease. The volume
of air that is forcefully exhaled in one second after a maximal inhalation. Lower than normal
results may suggest obstructive or restrictive lung disease.
High-this may mean there is too much gas in your lungs - called lung hyperinflation. This is
when gas gets trapped in the lungs and makes them inflate too much. Lung hyperinflation can
happen with obstructive conditions like COPD, bronchitis and bronchiolitis.

 Sputum tests. Sputum is the mucus that you cough up from your lungs. It can be tested to
see if you have illnesses that could be helped by antibiotics. Sputum can also be tested for
signs of allergies.

 Chest X-ray. A chest X-ray can help determine if you have pneumonia or another
condition that may explain your cough. This is especially important if you ever were or
currently are a smoker.

Diagnostic test
Spirometer
This is a test to see how well your lungs work. It assesses how much air your lungs can
hold and how quickly you can expel it. Along with your bronchitis, the test can help your doctor
determine whether you have asthma or another breathing problem.
-Your result is considered “normal” if your score is 80 percent or more of the predicted value

Medical Management
Protrusive and Antitussives
Antitussive therapy controls, prevents, or eliminates cough, while protrusive therapy
makes cough more effective.

Generic Brand Dosage INDICATION/ NURSING

3
 Drug Study

Name Name ACTION / IMPLICATION /

CONTRAINDICATION NURSING
RESPONSIBILITY
Acetaminophen Tylenol 300 Mg- Indication: Acetaminophen is
30 Mg The combination of intended for temporary
Tablet acetaminophen and codeine is use only - should not be
used to treat mild to moderate given for more than 4 -
pain. When taken for an 5 days without
extended period of time, it does physician reassessment.
not become habit-forming. 2. Severe hepatic
However, acetaminophen may damage is sometimes
have other side effects. not apparent until
several days after over
Action: dosage.
Reduction of the COX
pathway activity by
acetaminophen is thought to
inhibit the synthesis of
prostaglandins in the central
nervous system, leading to its
analgesic and antipyretic effects

Contraindication:
 Caloric undernutrition.
 Acute liver failure.
 Liver problems.
 Condition where the
body is unable to
maintain adequate blood
flow called shock.
 Acetaminophen
overdose.

Generi Brand Dosag INDICATION/ ACTION / NURSING

c Name e CONTRAINDICATION IMPLICATION /

4
Name NURSING
RESPONSIBILITY
Albuterol Ventolin 2-4 mg Indication: Nursing
sulfate PO, TID Treatment and prevention of Considerations: Before
bronchospasm (acute or severe) and after administration,
in patients with reversible monitor respiratory rate,
obstructive airway disease. oxygen saturation, and
lungs sounds. Wait at
Action: least 2 minutes between
Albuterol acts on beta-2 inhalations if more than
adrenergic receptors to relax the one are ordered.
bronchial smooth muscle. It also
inhibits the release of immediate
hypersensitivity mediators from
cells, especially mast cells.
Although albuterol also affects
beta-1 adrenergic receptors, this
is minimal and has little effect on
the heart rate.

Contraindication:
 Overactive thyroid gland.
 Diabetes.
 Metabolic condition
where the body cannot
adequately use sugars
called ketoacidosis.
 Excess body acid.
 Low amount of potassium
in the blood.
 High blood pressure.

Generic Brand Dosage INDICATION/ NURSING

Name Name ACTION / IMPLICATION /
CONTRAINDICATION NURSING
RESPONSIBILITY
Prednison Sterapred 5-60 Indication: Keep an eye out for

5
e mg/day personality changes such
It delayed-release
PO as depression, euphoria,
corticosteroid used to treat a
restlessness,
variety of diseases, including
immunosuppressive/endocrine,hallucinations, and
psychosis. Notify your
rheumatic, collagen,
doctor if these changes
dermatologic, allergic states,
become a problem. Be on
ophthalmic, and respiratory the lookout for symptoms
conditions. of hypokalemia and
metabolic acidosis, such
Action: as hyperventilation,
Prednisone reduces cardiac arrhythmias,
inflammation by inhibiting dizziness, and confusion.
polymorph nuclear leukocyte
migration and reversing
increased capillary
permeability. It also
suppresses the immune system
by lowering immune system
activity and volume.

Contraindication:
 Active, untreated
tuberculosis.
 Inactive tuberculosis.
 Herpes simplex
infection of the eye.
 Herpes simplex
infection.
 Infection due to a
fungus.
 Intestinal infection
caused by the
roundworm
Strongyloides.

Generic Brand Dosag INDICATION/ NURSING

Name Name e ACTION / IMPLICATION /
CONTRAINDICATION NURSING
RESPONSIBILITY

6
 Budesonid Pulmicort 0.25 mg, Indication:  History: Untreated
e Respules 0.5 mg, PULMICORT RESPULES is local nasal infections,
and 1 approved for the treatment of nasal trauma, septal
mg per asthma and as a preventative ulcers, recent nasal
2 mL measure. PULMICORT surgery, lactation
RESPU RESPULES is NOT intended  Physical: BP, P,
LES to treat acute bronchospasm. auscultation; R,
ampule adventitious sounds;
Action: examination of nares
This medication belongs to the
corticosteroid class of drugs. It
works directly in the lungs to
improve breathing by reducing
airway irritation and swelling.
To be effective, this
medication must be taken on a
regular basis.

Contraindication:
 Hypersensitivity.
Acute infections
uncontrolled by
antimicrobial
chemotherapy.

Surgical Management
Pulmonary (lung) resection- A lung resection, also called a pulmonary resection, is surgery to
remove part or all of your lung.

7
 Complication

Chronic bronchitis - A lung condition that develops over time in which the bronchi (large air
passages that lead to the lungs) become inflamed and scarred. This causes the bronchi to make
large amounts of mucus and can lead to a chronic cough and breathing problems.
Pneumonia- Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs
are made up of small sacs called alveoli, which fill with air when a healthy person breathes.
When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes
breathing painful and limits oxygen intake.
Bronchopneumonia is a type of pneumonia that causes inflammation in the alveoli. Someone
with bronchopneumonia may have trouble breathing because their airways are constricted.
: Pneumonia is a category of lung infections. It occurs when viruses, bacteria, or fungi cause
inflammation and infection in the alveoli (tiny air sacs) in the lungs. Bronchopneumonia is a type
of pneumonia that causes inflammation in the alveoli.
Bronchiechtasis- An irreversible condition marked by chronic abnormal dilation of bronchi and
destruction of bronchial walls •Occurs throughout the tracheobronchial tree or can be confined to
one segment or lobe.

Nursing Care Plan

Assessment Diagnosis Planning Intervention Rationale Evaluation

 Tachypnea, Ineffective airway Short Term: Short Term: - The patient
mild dyspnea, clearance related to After 15 mins -Check for -The airway have clear
and pleuritic trachea, bronchial of nursing airway and any must be coughing and
chest pain obstruction, and intervention obstruction. carefully breathing

8
 (possible). viral infection the patient will (Independent) managed sounds. The
 Cough with secondary to be able to: because it may improvement
purulent to bronchitis as -The patient’s interfere with was visible.
clear sputum evidenced by airway will the gas
production. persistent dry change. exchange Goal Met
 Spread cough, excess -The patients process in the
rhonchi and mucus, dyspnea breathing will patient's body.
crackles and tachypnea. improve.
(contrast with -The patients -Examine the -Straining and
localized cough will patient for obvious
crackles
subsides. exertional inspiratory
usually heard
shortness of effort are
with
pneumonia). Long Term breath, indicators of
After a week respiratory potential
of nursing splinting, and respiratory
intervention increased use problems.
the patient will of respiratory
have: muscles.
-The patients (Independent)
respiratory -Examine the -Coughing or
sound will patient's cough rapid
improve patterns, such expulsion of
-The patient’s as duration and air is typically
condition will frequency by performed to
be improved. using expelling or
stethoscope. clearing the
(Independent) respiratory
Long Term pathway.
-Assess the -The presence
patient's of abnormal
internal respiratory
respiratory sounds may
sounds or indicate
perform chest potential upper
auscultation. quadrant
(Dependent) issues,
-Refer patient - This is to
to ensure proper
pulmonologist. treatment if
(Collaborative) the patient's
condition is
that serious.

Discharge Plan

Medication

9
Ascertain that the patient understands all medications, including the dosage, route of
administration, mode of action, and side effects. Patients taking aminophylline should have
blood levels drawn as directed by their doctor. The patient should demonstrate proper use of
metered-dose inhalers before being discharged from the hospital.

Complication
Instruct patients to notify their primary care provider if the color or consistency of their
secretions changes. A respiratory infection may be indicated by green-colored secretions.
Patients should also report persistent, prolonged dyspnea that is not relieved by medications.

Follow up check up
Consider that patients with severe disease may require assistance with daily living activities after
discharge. Make a note of any referrals to social services. Send patients home with a high-calorie
diet recommended by the dietitian and reinforced by the nurse. Encourage the patient to wear a
scarf to cover his or her face if going outside in the winter. Provide the name of a smoking
cessation program or a support group if the patient continues to smoke. Encourage the patient to
avoid airborne irritants.

10