BRONCHITIS

I.                 OBJECTIVES

·         General Objective:

To learn facts related to Bronchitis and how it occurs and who is at risk of acquiring such disease.

·         Specific Objectives:

o   Be able to know the background of the disease.

o   Be able to understand and learn more about the anatomy and physiology of organs involved.

o   Be able to trace the pathophysiology of the disease.

o   Be able to know the different ways on how to prevent the occurrence of the disease.

o   Be able to develop an appropriate nursing care plan for the patient to manage the disease or condition of the patient.

MEDICAL DIAGNOSIS:

Bronchitis Overview

Bronchitis is an acute inflammation of the air passages within the lungs. It occurs when the trachea (windpipe) and the large and small bronchi (airways) within the lungs become inflamed because of infection or other causes.

·   The thin mucous lining of these airways can become irritated and swollen.

·   The cells that make up this lining may leak fluids in response to the inflammation.

·   Coughing is a reflex that works to clear secretions from the lungs. Often the discomfort of a severe cough leads you to seek medical treatment.

·   Both adults and children can get bronchitis. Symptoms are similar for both.

·   Infants usually get bronchiolitis, which involves the smaller airways and causes symptoms similar to asthma.

Bronchitis Causes

Bronchitis occurs most often during the cold and flu season, usually coupled with an upper respiratory infection.

·   Several viruses cause bronchitis, including influenza A and B, commonly referred to as "the flu."

·   A number of bacteria are also known to cause bronchitis, such as Mycoplasma pneumoniae, which causes so-called walking pneumonia.

·   Bronchitis also can occur when you inhale irritating fumes or dusts. Chemical solvents and smoke, including tobacco smoke, have been linked to acute bronchitis.

·   People at increased risk both of getting bronchitis and of having more severe symptoms include the elderly, those with weakened immune systems, smokers, and anyone with repeated exposure to lung irritants.

Bronchitis Symptoms

Acute bronchitis most commonly occurs after an upper respiratory infection such as the common cold or a sinus infection. You may see symptoms such as fever with chills, muscle aches, nasal congestion, and sore throat.

·   Cough is a common symptom of bronchitis. The cough may be dry or may produce phlegm. Significant phlegm production suggests that the lower respiratory tract and the lung itself may be infected, and you may have pneumonia.

·   The cough may last for more than two weeks. Continued forceful coughing may make your chest and abdominal muscles sore. Coughing can be severe enough at times to injure the chest wall or even cause you to pass out.

·   Wheezing may occur because of the inflammation of the airways. This may leave you short of breath.

Bronchitis Treatment

Self-Care at Home

• By far, the majority of cases of bronchitis stem from viral infections. This means that most cases of bronchitis are short-term and require nothing more than treatment of symptoms to relieve discomfort.
• Antibiotics will not cure a viral illness.
• Experts in in the field of infectious disease have been warning for years that overuse of antibiotics is allowing many bacteria to become resistant to the antibiotics available.
• Doctors often prescribe antibiotics because they feel pressured by people's expectations to receive them. This expectation has been fueled by both misinformation in the media and marketing by drug companies. Don't expect to receive a prescription for an antibiotic if your infection is caused by a virus.
• Acetaminophen (Feverall, Panadol, and Tylenol), aspirin, or ibuprofen (Motrin, Nuprin, Advil) will help with fever and muscle aches.
• Drinking fluids is very important because fever causes the body to lose fluid faster. Lung secretions will be thinner and easier to clear when the patient is well hydrated.
• A cool mist vaporizer or humidifier can help decrease bronchial irritation.
• An over-the-counter cough suppressant may be helpful. Preparations with guaifenesin (Robitussin, Breonesin, Mucinex) will loosen secretions; dextromethorphan-the "DM" in most over the counter medications (Benylin, Pertussin, Trocal, Vicks 44) suppresses cough.

Medical Treatment

Treatment of bronchitis can differ depending on the suspected cause.

• Medications to help suppress the cough or loosen and clear secretions may be helpful. If the patient has severe coughing spells they cannot control, see the doctor for prescription strength cough suppressants. In some cases only these stronger cough suppressants can stop a vicious cycle of coughing leading to more irritation of the bronchial tubes, which in turn causes more coughing.
• Bronchodilator inhalers will help open airways and decrease wheezing.
• Though antibiotics play a limited role in treating bronchitis, they become necessary in some situations.
• In particular, if the doctor suspects a bacterial infection, antibiotics will be prescribed.
• People with chronic lung problems also usually are treated with antibiotics.

• In rare cases, the patient may be hospitalized if they experience breathing difficulty that doesn't respond to treatment. This usually occurs because of a complication of bronchitis, not bronchitis itself.

Prevention

• Stop smoking.

• Avoid exposure to irritants. Proper protection in the workplace is vital to preventing exposure.

• The dangers of secondhand smoke are well documented. Children should never be exposed to secondhand smoke inside the home.

• Avoiding long exposure to air pollution from heavy traffic may help prevent bronchitis

 ANATOMY AND PHYSIOLOGY

The two lungs fill most of the thorax and each is enclosed within a double membrane known as the pleura. The right lung is the larger, being divided into three lobes, while the left is divided into two lobes. The lobes are further divided into bronchopulmonary segments, each of which has a segmental bronchus.

 Trachea, bronchi and bronchioles

The trachea branches off into the right and left bronchi. Within the lungs the bronchi branch again, forming secondary and tertiary bronchi, then smaller bronchioles, and finally terminal bronchioles. At the end of the terminal bronchioles are the alveoli. 

In all there are about 25 divisions between the trachea and the alveoli, with the structure changing progressively from the trachea to the terminal bronchioles.

The alveoli

The alveolar sacs are made up of groups of alveoli at the end of the terminal bronchioles. Each lung contains approximately 300 million alveoli, giving a total surface area of 40-80m². The epithelial lining of the alveoli consists mainly of type 1 pneumocytes, which provide a thin layer for gas exchange. They are connected to type II pneumocytes (from which they are derived) by tight junctions. Although more numerous than the type I pneumocytes, type II pneumocytes cover less epithelium. They contain vacuoles that produce the pulmonary surfactant. The alveoli also contain macrophages, which contribute towards the defense mechanisms of the lungs.

Pulmonary vasculature

Deoxygenated blood from the heart is carried to the lungs via the pulmonary artery, which divides with the bronchi and bronchioles. The alveoli are served by a diffuse network of capillaries, which provides a large surface area of approx. 30m² for gaseous exchange. Oxygenated blood from the capillary network passes into pulmonary venules, which join forming the pulmonary veins.

Another bronchiole circulatory system arises from the descending aorta, where the bronchial arteries supply oxygenated blood to the tissues of the lung, and bronchial veins drain into the pulmonary veins.

Lymphatic system

Lymphatic channels are closed vessels that are located between the alveolar cells and the endothelium of the pulmonary arterioles. Resembling capillaries, the ends of these vessels usually lie within the interstitial layer. The lymph carries proteins, lipids, dead cells and foreign particles away from the interstitial spaces, hence playing a major role in defending the lungs from disease.

  Pathophysiology

Acute bronchitis often follows a cold or infection. Other coughing conditions are often diagnosed as acute bronchitis.

Chronic bronchitis, however, is most likely due to environmental irritation of the bronchial tubes and is often caused by smoking. The initiating event in developing chronic bronchitis is chronic irritation due to inhalation of certain substances (especially cigarette smoke). The earliest clinical feature of bronchitis is increased secretion of mucus by submucousal glands of the trachea and bronchi. Damage caused by irritation of the airways leads to inflammation and infiltration of the lung tissue by neutrophils. The neutrophils release substances that promote mucosal hypersecretion. As bronchitis persists to become chronic bronchitis, a substantial increase in the number of goblet cells in the small airways is seen. This leads to further increased mucous production that contributes to the obstruction of the airways.

VII.     DISCHARGE PLANNING:

·                  Demonstrate hand-washing techniques.

·                  Instruct the patient and family to use an antibacterial soap for hand washing after toileting.

·                  Drinking fluids is very important because fever causes the body to lose fluid faster.

·                  Avoid exposure to irritants. Proper protection in the workplace is vital to preventing exposure.

·                  Avoiding long exposure to air pollution from heavy traffic may help prevent bronchitis.

·                  Teach the patient to continue the medications for the full length of therapy.

·                  Instruct him or her to space the medication evenly around the clock; take with a full glass of water; and report symptoms of difficulty of breathing, bleeding, or other new symptoms.