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.
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
