Feb 23, 2024 NR 507 Week 2: Discussion Part Two
NR 507 Week 2: Discussion Part Two
NR 507 Week 2: Discussion Part Two
Tammy is a 33-year-old who presents for evaluation of a cough. She reports that about 3 weeks ago she developed a “really bad cold” with rhinorrhea. The cold seemed to go away but then she developed a profound, deep, mucus-producing cough. Now, there is no rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Tammy has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves. Through and extensive work-up, she is diagnosed with bronchitis.
What is the etiology of bronchitis?
Describe in detail the pathophysiological process of bronchitis.
Identify hallmark signs identified from the physical exam and symptoms.
Describe the pathophysiology of complications of bronchitis.
What teaching related to her diagnosis would you provide?
In addition to the textbook, utilize at least one peer-reviewed, evidence based resource to develop your post.
What is the etiology of bronchitis?
There are two kinds of Bronchitis: Acute Bronchitis, that is caused by “Infections or lung irritants,” and Chronic Bronchitis, that is caused by “repeatedly breathing in fumes that irritate and damage lung and airway tissues” (National Heart, Lung, and Blood Institute, 2018). This could be like smoking or inhaling second-hand smoke. The etiology of bronchitis is the same that causes upper respiratory infections. The names of the viruses that cause bronchitis are coronavirus, rhinovirus, respiratory syncytial virus, and adenovirus. Most cases of bronchitis come from a virus instead of bacteria. Current smoking is associated with a more goblet cell hyperplasia and number, and chronic bronchitis is associated with more goblet cells, independent of the presence of airflow obstruction. This provides clinical and pathologic correlation for smokers with and without COPD (Kim et al., 2015).
Describe in detail the pathophysiological process of bronchitis.
The pathophysiological process of bronchitis is very simple. The symptoms of acute bronchitis are due to acute inflammation of the bronchial wall, which causes increased mucus production along with edema of the bronchus (National Heart, Lung, and Blood Institute, 2018). This leads to the productive cough that is the hallmark of a lower respiratory tract infection. While the infection may clear in several days, repair of the bronchial wall may take several weeks. During the period of repair, patients will continue to cough. Pulmonary function studies of patients with acute bronchitis demonstrate bronchial obstruction similar to that in asthma. As the symptoms of acute bronchitis subside, pulmonary function returns to normal. Most patients will cough for less than 2 weeks with the illness. If a patient coughs longer than 1 month then the term is post bronchitis syndrome (National Heart, Lung, and Blood Institute, 2018). The bronchial walls are trying to repair after the clearance of the infection.
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Identify hallmark signs identified from the physical exam and symptoms.
The hallmark sign and symptoms are duration of cough less than 30 days, productive cough, no history of chronic respiratory illness, and fever. Production of mucus (sputum), which can be clear, white, and yellowish-gray or green in color can occur in acute bronchitis. Acute bronchitis is caused by a virus. Cough from the irritated and inflamed bronchial epithelium and increased mucus production (McCance, Huether, Brashers and Rote, 2013).
Describe the pathophysiology of complications of bronchitis.
As with most diseases, complications can arise from bronchitis. Around one person in 20 with bronchitis may develop a secondary infection in the lungs leading to pneumonia. The infection is commonly bacterial although the initial infection that caused the bronchitis may be viral. The infection affects the tiny air sacs known as alveoli in the lungs (National Heart, Lung, and Blood Institute, 2018). Although a single episode of bronchitis usually isn’t cause for concern, it can lead to pneumonia in some people. Repeated bouts of bronchitis, however, may mean that you have chronic obstructive pulmonary disease, or COPD. Chronic bronchitis can lead to long term COPD with progressively diminishing lung reserves and breathing difficulties. COPD further raises the risk of occasional flare ups and increased risk of recurrent and frequent chest infections. When you breathe, air moves in your trachea through two tubes called bronchi. The bronchi branch out into smaller tubes called bronchioles. At the ends of the bronchioles are little air sacs called alveoli. And at the end of alveoli are capillaries, which are tiny blood vessels. Oxygen moves around in the lungs to the bloodstream through the capillaries. Carbon dioxide moves from the blood into the capillaries and then into the lungs and exhaled. The fibers in the walls of the lungs can become damage (Kim et al, 2015). They are not able to expand and make them less elastic when you exhale.
What teaching related to her diagnosis would you provide?
I would educate Tammy about second-hand exposure to smoke. This could make her bronchitis even worse if exposed. Tammy would most likely be prescribed an inhaler that would open up her bronchioles, helping her breath better. Most people should drink at least 8 eight-ounce cups of water a day. You may need to drink more liquids when you have acute bronchitis. Liquids help keep your air passages moist and help you cough up mucus. I would encourage Tammy to get plenty of rest to help fight the infection. Tammy could use a cool mist humidifier to decrease her cough and make it easier for her to breath (National Heart, Lung, and Blood Institute, 2018).
References
Kim, V., Oros, M., Durra, H., Kelsen, S., Aksoy, M., Cornwell, WD., et al. (2015) Chronic Bronchitis and Current Smoking Are Associated with More Goblet Cells in Moderate to Severe COPD and Smokers without Airflow Obstruction. PLoS ONE 10(2). Doi: https://doi.org/10.1371/journal.pone.0116108
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby.
National Heart, Lung, and Blood Institute. (2018). Bronchitis. National Institute of Health. Retrieved from https://www.nhlbi.nih.gov/health-topics/bronchitis
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Etiology of bronchitis; Acute bronchitis is due to acute infection or inflammation of the airways or bronchi (McCancance,2018).Acute bronchitis is commonly due to viruses and is usually self-limiting, and is sometimes caused by allergens, irritants, and bacteria (Fayyaz,2018). Irritants that causes bronchitis’ include smoke inhalation, polluted air inhalation, dust, among others. (Fayyaz, 2018)
That’s correct!
Pathophysiology of Acute Bronchitis: bronchitis causes the cells of the bronchial-lining tissue to become irritated and the mucous membrane becomes hyperemic and edematous, diminishing bronchial mucociliary function (Fayyaz, 2018). The air passages clogged due to debris build up and causes irritation. In other to clear the air passages the body responds by formation copious secretion of mucus that causes the patient to cough.
Good job.
HallMark Sign: From the physical examination it is indicated that the patient had a persistent productive cough lasting 3 weeks
You did not fully answer this question.
Pathophysiological complication of Acute bronchitis: Acute bronchitis if left untreated can lead to the following Chronic Bronchitis: Chronic bronchitis is a hypersecretion of mucus and chronic production of a cough for at least three months of the year especially during the winter months for at least 2 consecutive years (McCance et al, 2014).Exposure to irritants causes inflammation with infiltration of neutrophils, macrophages, and lymphocytes into the bronchial wall. Prolonged bronchial inflammation causes bronchial edema and an increase in the size and number of goblet cells, in the airway epithelium. The impaired ciliary action causes the thick and tenacious mucus not to be cleared in the lung. The lung defense mechanism is compromised leading to susceptibility to pulmonary infection. Over time the thick mucus causes hypertrophy of the bronchial smooth muscles and narrowing and obstruction of the airway during expiration. Poor oxygenation causes tidal volume decrease, hypoventilation, and hypercapnia.
Pneumonia is another complication of acute bronchitis. Inhalation of microbes or irritants in the lungs can cause pneumonia (McCance, 2014). The inflammatory process the in the alveolar, bronchioles and interstitial spaces if not addressed on time will cause excessive fluid in the lung and thickens the alveolar resulting in poor oxygenation and tissue perfusion and death in extreme cases. Typical pneumonia can be classified either as hospital-acquired infection (HAI) which means that patient was infected while receiving care in the hospital or community-acquired pneumonia (CAP) meaning that the patient had pneumonia prior to been admitted in the hospital. Know the class of pneumonia is very helpful when deciding the line of treatment because HAI is more resistant antibiotics than CAP
Very nice job here!
Family Teaching: As a primary care provider I will definitely teach the patient the importance lifestyle modification choices like smoking cessation, proper hand hygiene, and avoidance of allergens and pollutants to prevent recurrence and complications of bronchitis.
I will also teach the patients of the importance of drinking fluids to lose the mucus to avoid too much coughing that contributes to chest pain
A mucolytic can be used to clear mucus and avoid plugging. If there is an allergic component, then an anti-allergenic can help relieve symptoms and the benefit of using a humidifier in achieving symptomatic relief.
To avoid getting bronchitis’s teach patients the importance of receiving flu Receive the influenza vaccine yearly between October and December
McCance, K. I., Huether, S. E., Rote, N. S., & Brashers, V. L. (2014). The Biologic Basis for Diseases in Adult and Children(7th ed.). St Louis, Missiourouri: Mosby.
Fayyaz,, J. (2018, March 19). Bronchitis. Medscape. Retrieved from https://emedicine.medscape.com (Links to an external site.)Links to an external site.
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