38. UNIT 3_LRTD_BRONCHITIS_BMMSCM-1.pptx

Bronchitis

1. NAMWIANGA MISSION COLLEGE OF NURSING COURSE: MEDICINE AND MEDICAL NURSING TOPIC: BRONCHITIS MS CHIINGO

2. INTRODUCTION Proper lung function is essential for quality of life, yet there are many ways this can be disrupted including disease and infection. If not monitored and treated these can cause spasms, sputum retention, inflammation and irritation which all leading to poor lung function, increased work of breathing and reduced quality of life.

3. INTRODUCTION CONT’ Acute bronchitis is one of the most-common diseases. About 5% of adults are affected, and about 6% of children have at least one episode a year.

4. GENERAL OBJECTIVE At the end of the lecture/discussion, Student nurses should gain knowledge and understanding of bronchitis and be able to manage a patient with bronchitis.

5. SPECIFIC OBJECTIVES At the end of the lesson students should be able to: Define Bronchitis Outline the causes/ risk factors of Bronchitis Describe the types of bronchitis Explain the pathology of Bronchitis State the signs and symptoms of Bronchitis Discuss the medical management of Bronchitis Outline the complications of Bronchitis

6. DEFINITIONS Bronchitis is an inflammation of bronchial tubes (the tubes that carry air to the lungs and makeup the bronchial tree) (Davis, 2017). Bronchitis is an inflammation of the bronchi usually caused by an infection (Berkow R. et al, 1997).

7. EPIDEMIOLOGY Bronchitis is one of the Chronic Obstructive Pulmonary Diseases (COPD). COPDs kill around 30,000 people per year in the UK alone and it is estimated that around 3 million people in the UK have COPD, 2 million of which are undiagnosed.

8. EPIDEMIOLOGY Chronic Bronchitis occurs in 3.4 to 22% of the US adult population and rates are even higher in patients with COPD. The prevalence of the disease has a great impact on society and on the health care system around the world.

9. CAUSES Microorganisms – viruses and bacteria. Extension of infection from the trachea Traumatic injuries Excessive cold air Smoking Over exposure to industrial fumes Bacteria are less common causes of bronchitis .:

10. CAUSES CONT’ Bacterial causes include: Mycoplasma Streptococcus Bordetella Moraxella Haemophilus Chlamydia pneumoniae

11. CAUSES CONT’ Viral causes: Influenza (the same virus that causes colds) Parainfluenza Rhinovirus Adenovirus Corona viruses

12. RISK FACTORS CONT’ RISK FACTORS Factors that increase risk of bronchitis include: Cigarette smoke. People who smoke or who live with a smoker are at higher risk of both acute bronchitis and chronic bronchitis.

13. RISK FACTORS CONT’ Low resistance. This may result from another acute illness, such as a cold, or from a chronic condition that compromises the immune system. Older adults, infants and young children have greater vulnerability to infection .

14. RISK FACTORS CONT’ Exposure to irritants in work places. The risk of developing bronchitis is greater if one works around certain lung irritants, such as grains or textiles, or are exposed to chemical fumes. Gastric reflux.  Repeated bouts of severe heartburn can irritate the throat and predispose to developing bronchitis .

15. TYPES OF BRONCHITIS T here is acute and chronic bronchitis; 1. Acute bronchitis - is when it only lasts for about a week or a little longer and then goes away. Acute bronchitis is characterized by the development of a cough, with or without the production of sputum, mucus that is expectorated (coughed up) from the respiratory tract.

16. TYPES OF BRONCHITIS CONT’ Acute bronchitis often occurs during the course of an acute viral illness such as the common cold or influenza. Virus cause about 90% of acute cases .

17. TYPES OF BRONCHITIS CONT’ 2.Chronic bronchitis - lasts for at least 3 months to 2 years. Chronic bronchitis, is the type of chronic obstructive pulmonary disease characterized by the presence of a productive cough that lasts for three months or more per year for atleast two years.

18. TYPES OF BRONCHITIS CONT’ Chronic bronchitis is most often develops due to recurrent injury to the airways caused by inhaled irritants. Cigarette smoking is the most common cause, followed by air pollution and occupational exposure to irritants.

19. PATHOPHYSIOLOGY Chronic bronchitis results in hypertrophy and hyperplasia of the bronchial mucous glands following the exposure. This leads to increased mucus production, ciliary damage, squamous metaplasia of the columnar epithelium, and chronic leukocytic and lymphocytic infiltration of bronchial walls.

20. PATHOPHYSIOLOGY CONT’ Hyper secretion from the goblet cells blocks the free movement of cilia, which normally sweep dust irritants and mucus from the airway. This results in the disappearance of cilia and consequently alters the function of the alveolar macrophages, leading to increased bronchial infections .

21. PATHOPHYSIOLOGY CONT’ As a result, the airway stays blocked, and mucus and debris accumulate in the respiratory tract thus narrowing the airway lumen leading to diminished airflow. Greater resistance to airflow increases the work of breathing. The epithelial layer becomes ulcerated and when the ulcer heals the walls thicken leading to further narrowing of the airways (Stanley , et al , 2012 ).

22. SIGNS AND SYMPTOMS ACUTE BRONCHITIS Cough with mucus, Chest discomfort Soreness in the throat Shortness of breath. Children may also have Runny nose/Mild fever

23. SIGNS AND SYMPTOMS CONT’ Fever - this is related to the reaction of the body to the presence of the pathogenic organism which also increases the basal metabolic rate with more heat production leading to raised temperature. Dyspnoea - this occurs following the inflammatory reactions and excessive mucus production which results in obstruction of air flow through the respiratory tract .

24. SIGNS AND SYMPTOMS CONT’ Wheezing – this occurs as air passes through an obstructed airway producing a wheezy sound. Cough- this occurs due to irritations in the respiratory tract by inflammatory reactions . Chest pains - this occurs in an attempt for the inflamed alveoli to expand and accommodate air entry .

25. SIGNS AND SYMPTOMS CONT’ Haemoptysis- this is coughing of blood following the rupture of capillaries following continuous vigorous coughing and sneezing reflexes in an attempt to expectorate the irritant. Cyanosis - this is the blueish discoloration of the mucus membrane and body peripherals due to reduced oxygen supply as a result of obstruction in the air way .

26. MANAGEMENT Investigations History taking- about the symptoms and in particular the cough. They may also ask about the patient's medical history, whether they have recently suffered from a cold or flu, whether they smoke, or whether they have been exposed to substances such as dust, fumes, vapors, or air pollution .

27. MANAGEMENT CONT’ Physical examination- use a stethoscope to listen for any abnormal sounds in the lungs. Throat swab- for microscopy, culture and sensitivity to isolate the causative organism and antibiotic it is sensitive to . Chest x-ray - shows hyper infiltration and increased Broncho vascularity.

28. MANAGEMENT CONT’ Sputum culture - this may reveal many microorganisms and neutrophils. Pulmonary function tests- this will demonstrate increased residue volume, reduced vital capacity and forced expiratory flow and normal static compliance and diffusing capacity .

29. MANAGEMENT CONT’ Arterial blood gas analysis - this is done which will display a reduced PaO2 and normal or increased PaCO2. Full blood count- this will show elevated WBCs and ESR as a sign of presence of infection.

30. MANAGEMENT CONT’ Treatment Supportive treatment: Bed rest and supportive care such as reducing coughing are the main treatments for acute bronchitis. Stay well hydrated by drinking fluids Use a humidifier to moisten the air .

31. MANAGEMENT CONT’ Avoid dairy products because they thicken mucous secretions Avoid alcohol and caffeine because of potential drug interactions Avoid exposure to environmental smoke and other air pollutants .

32. MANAGEMENT CONT’ Drugs: Cough suppressants such as Mucolytics (Mucinex , Mucomyst):  These medicines help remove sticky mucus from the airways. Acetaminophen and NSAIDs :  Nonsteroidal anti-inflammatory drugs (NSAIDs) and/or acetaminophen (Tylenol and others) may reduce inflammation and/or discomfort .

33. MANAGEMENT CONT’ Inhaler bronchodilators (Ventolin 4mg 8 hourly for 5 days):   This medicine opens airways, which makes it easier to breathe. Antibiotics (Amoxicillin 500mg 8 hourly for 5 days):  Acute bronchitis is treated with antibiotics only if the cause is bacterial (suspected or diagnosed). Oxygen therapy in severe cases, 5-6 liters per minute.

34. MANAGEMENT CONT’ Nursing management Nursing Priorities Maintain airway patency. Assist with measures to facilitate gas exchange. Enhance food/ fluid intake. Prevent complications and slow progression of condition.

35. MANAGEMENT CONT’ Provide information about disease process, prognosis, and treatment regimen. Prevent environmental irritants. Ensure the room is warm.

36. COMPLICATIONS OF BRONCHITIS Broncho pneumonia Acute respiratory failure Pneumonia Atelectasis Bronchiectasis Right sided heart failure

37. SUMMARY Bronchitis can be caused by viruses, bacteria, and other particles that irritate the bronchial tubes. Acute bronchitis is a short term illness that often follows a cold or viral infection.

38. SUMMARY CONT’ Chronic bronchitis is a long-term illness and can be the result of environmental factors or extended illness. Cigarette smoking is the most common cause of chronic bronchitis.

39. REFERENCES Drake RL, Vogl AW, Mitchell AW, (2010), Gray's Anatomy for Students. 2nd ed. Edinburgh: Churchill Livingstone. Charles Patrick Davis , (2017), medicine net.com, accessed from https://www.medicinenet.com/bronchitis_acute/article.htm#what_are_the_possible_complications_of_acute_bronchitis , on 05/ 06/ 2018 at 09:00 hours. McIntosh J . , (2017), medical news today, accessed from , https://www.medicalnewstoday.com/articles/8888.php , on 05/06/ 2018 at 10:00 hours.  ( Chisholm L.,  D'Autremont K.,  Abdullzaher E.M., et al., 2015), Physiopedia , accessed from https://www.physio-pedia.com/Contribute#Content_Contributions , on 05/ 06/ 2018 at 18:00 hours