Acute Bronchitis: Symptoms and Treatment

Acute Bronchitis

• Inflammation of the bronchi, typically caused by a virus, but also by Streptococcus or Haemophilus influenzae.
• Often occurs secondary to upper respiratory infections (URIs).
• Can be caused by inhaled irritants.
• Symptoms include low-grade fever, tachypnea, shortness of breath, localized or sonorous wheezes, cough (initially dry, then productive), chest pain (aching or tightness), headache, and malaise.
• Diagnosed via chest x-ray to ensure clear lungs and sputum culture and sensitivity (C&S).
• Viral treatment involves symptomatic care (humidifier, vaporizer, cough suppressants, antipyretics), bronchodilators, humidified oxygen, and bed rest.
• Bacterial treatment includes antibiotics.
• Nursing interventions include teaching the splinting technique, positioning the patient in semi- or high-Fowler's, assisting with ADLs, encouraging fluid intake (3-4 liters/day), avoiding dairy, and monitoring vital signs, breath sounds, and sputum.

Legionnaires' Disease

• Life-threatening pneumonia caused by Legionella pneumophila.
• Transmitted airborne.
• Sources include water reservoirs like humidifiers, air conditioners, and whirlpool spas.
• Causes lung consolidation and necrosis, potentially leading to respiratory failure, renal failure, bacteremic shock, septic shock, and death within a week.
• Symptoms include high fever, headache, non-productive cough, diarrhea, malaise, dyspnea, chest pain on inspiration, crackles and wheezes, shock (tachycardia, hypotension), and hematuria.
• Diagnosis involves urine testing and cultures of blood, sputum, pulmonary tissue, or fluid.
• Treatment includes mechanical ventilation, IV fluids, temporary renal dialysis, IV antibiotics, oral Rifampin, antipyretics, and vasopressors.
• Nursing interventions include bed rest, elevating the head of the bed, frequent vital sign monitoring, oxygen therapy, encouraging turning, coughing, and deep breathing, assessing breath sounds and respiratory function, and monitoring urinary output.

COVID-19 (Coronavirus)

• Caused by infection with SARS-CoV-2.
• Transmitted airborne.
• Prevention includes hand washing, mask wearing, frequent cleaning, and quarantining.
• Incubation period is 2-14 days after exposure.
• Symptoms include fever, chills, cough, shortness of breath, fatigue, body aches, headache, loss of smell and/or taste, sore throat, nasal congestion, nausea, vomiting, and diarrhea.
• Severe symptoms include respiratory distress, hypoxia, pneumonia, and ARDS.
• Diagnosis involves a viral test for active infection and an antibody test for past infection.
• Treatment follows CDC guidelines, which may include vapotherm, proning, and mechanical ventilation.

Tuberculosis (TB)

• Chronic pulmonary and extrapulmonary infectious disease caused by Mycobacterium tuberculosis.
• Transmitted airborne.
• Types include TB infection (dormant, asymptomatic, non-infectious, detected by skin or blood test) and active TB disease (symptomatic and infectious; 10% of infected individuals develop active disease).
• TB is contagious and infectious, spreading through the air.
• Causes active infiltrates in the lungs.
• A positive TB skin test indicates exposure.
• A chest x-ray can reveal active disease.
• Preventative therapy may be given for positive skin tests without active disease.
• Can develop when the immune system is weakened.
• Early signs include weight loss, weakness, and productive cough.
• Later signs include night sweats, hemoptysis, and fever.
• Diagnostic tests include the Mantoux TB skin test (read 48-72 hours post-injection), sputum for AFB (three positive cultures for definitive diagnosis), chest x-ray (for infiltrates), and QuantiFERON-TB Gold (blood test).
• TB is a reportable disease requiring notification to the health department.
• Patients with active TB are placed on airborne isolation precautions.
• Treatment typically lasts 6-12 months, using first-line drugs like Isoniazid (INH), Rifampin, Pyrazinamide, and Ethambutol, or the new drug Rifaximin.
• Directly Observed Therapy (DOT) may be required for non-adherent patients.
• Isolation in negative air pressure rooms prevents spread.
• Nursing interventions include isolating suspected patients until diagnosis, teaching cough and sneeze etiquette, monitoring medication adherence and side effects, ensuring mask use during transport, educating about medications and prevention, encouraging fluid and nutrition intake, and using PPE (gloves and N95 mask).

Pneumonia

• Inflammation of the respiratory bronchioles and alveolar spaces, leading to gas exchange issues.
• More common in winter and early spring.
• Some types are communicable (e.g., mycoplasmal pneumonia).
• Caused by viruses, bacteria, fungal infections, chemicals, mycoplasma, aspiration, over-sedation, and inadequate ventilation.
• Pathophysiology involves cilia dysfunction, secretion retention and infection, inflammation leading to edema, and impaired gas exchange.
• Symptoms include fever and chills, flushed face, diaphoresis, shortness of breath and dyspnea, tachycardia, pleuritic chest pain, productive cough, crackles/rales/wheezes, decreased oxygen saturation, purulent sputum, night sweats, use of accessory muscles, and cyanosis.
• Diagnosis involves sputum culture, chest x-ray, ABGs, blood culture, electrolytes, CBC, elevated WBC count, pulse oximetry, and pulmonary function tests.
• Treatment includes antibiotics (if bacterial), symptomatic treatment (if viral), humidified oxygen (if O2 saturation below 92-95%), bed rest with head of bed elevated, cough medicines, nebulizer treatments, bronchodilators, expectorants, anti-inflammatories, antipyretics, and analgesics.
• It's important to humidify the air and consider pneumonia and flu vaccines for at-risk individuals.
• For aspiration pneumonia, elevate the head of bed after tube feeding, check tube placement prior to feeding, avoid overmedication with opioids, and encourage turning, coughing, and deep breathing.
• Encourage at least 3 liters of fluids per day, assess cough ability, change position frequently, suction as needed, and liquefy secretions with fluids; IV fluids if needed.
• Nursing interventions include maintaining a high Fowler's position, positioning the good lung down, ensuring fluids and good nutrition, keeping the room cool, providing frequent small meals, instructing patients to cover their mouth when coughing, providing rest periods, checking breath sounds frequently, assessing cough and sputum, frequent hand washing, patient education about medications and pneumonia type, increased fluids, and vaccination encouragement.

Pleural Conditions

• Pleurisy: Inflammation of the visceral and parietal pleura.
  • Causes include bacterial or viral infections, pneumonia complications, trauma, tuberculosis, and lung tumors.
  • Symptoms include severe inspiratory pain, referred pain, pleural friction rub, dyspnea, cough, and fever.
  • Treatment includes nerve block, antibiotics (if infection-related), analgesics, and oxygen.
  • Nursing interventions include positioning on the affected side for chest splinting, applying heat, elevating the head of the bed, encouraging effective coughing, and educating on sputum assessment.
• Pleural Effusion/Empyema: Fluid accumulation in the pleural space.
  • Pleural effusion is fluid accumulation
  • Empyema is infected pleural effusion.
  • Caused by inflammation of the pleural lining.

Overview of acute bronchitis, its causes, and treatments. Symptoms include cough, fever, and shortness of breath. Treatment focuses on symptomatic care or antibiotics for bacterial infections.