Acute tracheobrochochitis

Acute tracheobrochochitis

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2. ACUTE TRACHEOBRONCHITIS Prepared by: RN Arpana Bhusal BNS 7/24/2022 2

3. Contents Definition Incidence Risk factors Sign and symptoms Diagnostic evaluation Prevention Treatment and Nursing management 7/24/2022 3

4. Definition Acute tracheobronchitis is a contagious viral infection that causes inflammation of t rachea and bronchial Tubes. These are the airways that carry air into your lungs. When these tubes get infected they swell, mucus (thick fluid) forms inside them. This narrows the airways, making it harder for you to breathe. 7/24/2022 4

5. Cont.. Infection or other factor that irritate the lungs cause acute bronchitis. The same viruses that causes colds and the flu often cause acute bronchitis. These viruses are spread through the air when people cough. They are also spread through physical contact. Acute bronchitis lasts from a few days to10 days. Certain substances can irritate lungs and airways and risk for acute bronchitis e.g., solid inhaling, cigarette, air pollution, dusts etc. 7/24/2022 5

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7. Incidence Acute bronchitis affects approximately 5% of adults in the U.S annually and it becomes more common during cold seasons. Generally, it depends on the season of year, vaccination status and presence of an epidemic. Acute bronchitis affects around 44 in 1000 adults (age over 16 years) per year in the U.K, with around 82% of episodes occuring in winter or autumn. 7/24/2022 7

8. Risk factor Genetic predisposition Cigarette smoke : people who smoke or who live with a smoker are at higher risk of both acute and chronic bronchitis. Low resistance : this may result from another acute illness, such as a cold, or from a chronic condition that compromises immune system. Older adults, infants and young children have greater vulnerability to infection. Exposure to irritants on the job : the risk of developing bronchitis is greater if we work around certain lung irritants, such as grains or textiles, or are exposed to chemical fumes. 7/24/2022 8

9. Cont … Gastric reflux : Repeated bouts of severe heartburn can irritate the throat and make more prone to develop bronchitis. Having allergies and asthma Working with certain substances that causes irritation of airways like: Ammonia Chlorine Minerals Dusts from farming 7/24/2022 9

10. Etiology Viral : Influenza A and B, P arainfluenza, Adenoviruses, Rhinovirus, Respiratory syncytial virus and Human metapneumovirus . Bacterial M ycoplasma pneumonia, C hlamydophila pneumonia, B ordetella pertussis, Staphylococci. 7/24/2022 10

11. Pathophysiology Due to etiological factors Microorganism enter into the respiratory tract by inhalation Widespread inflammation occurs Thin mucus lining of the bronchi can become irritated and swollen 7/24/2022 11

12. Cont.. Goblet cell metaplasia and hypersecretion of mucus Coughing as a reflex that works to clear secretion from the lungs Alveolar fluid response Narrowing of the airways 7/24/2022 12

13. Cont … ventilation decrease as a secretion thickens mucus within the airways produces resistance in small airways and can cause severe ventilation perfusion imbalance tracheobronchitis 7/24/2022 13

14. Sign and symptoms Inflammation and swelling of the bronchi Coughing Production of clear, white, yellow, grey or green mucus(sputum) Shortness of breath Wheezing Fatigue 7/24/2022 14

15. Cont … Fever and chills Feeling “wiped out” Runny, stuffy nose Chest discomfort Body aches and chills Sore throat 7/24/2022 15

16. Diagnostic evaluation Chest x-ray : a chest x-ray can help determine if there is pneumonia or another condition that may explain cough. Sputum tests : sputum sample shows neutrophil granulocyte (inflammatory white blood cell) and culture showing that has pathogenic microorganisms such as streptococcus species. Pulmonary function tests : during a pulmonary function test, a device called spirometer measures how much of air our lungs can hold and how quickly we can get air out of lungs. This tests checks for signs of anemia or emphysema. 7/24/2022 16

17. Cont.. A blood test would indicate inflammation(as indicated by raised white blood cell count and elevated C-Reactive protein ABG level Bronchoscopy High resolution computed tomography(HRCT) 7/24/2022 17

18. C omplications Chronic bronchitis Bronchiectasis Tuberculosis pneumonia Sinusitis Hemoptysis Pneumothorax 7/24/2022 18

19. Management Bed rest Increased fluids Patients with wheezing may benefit from an inhaled B2 agonist ( eg . Albuterol) or an anticholinergic (e.g., ipratropium) for <7 days If cough persists for >2 week because of airway irritation, some patients benefit from a few days of inhaled corticosteroids . Anti-inflammatory and steroid drugs like ( prednisolone ) reduces the inflammatory reaction and thus decrease the bronchial swelling and secretion of mucus 7/24/2022 19

20. Contd … Antitussives should be used only if the cough is interfering with sleep Theophylline , an oral medication that relaxes the muscles in the airways so they open up more, relieves breathing difficulties Over-the-counter ( OTC ) cough suppressants such as dextromethorphan Anti-viral medication: oseltamivir 75 mg twice daily 7/24/2022 20

21. Anti-viral medication : O seltamivir 75 mg twice daily for 5 days, Z anamivir 10mg (2 inhalations) twice daily for 5 days, P eramivir IV 600mg once Antibiotics : Azithromycin 500mg orally once for 5 days, Clarithromycin 500mg orally twice daily for 5days, Erythromycin 500mg orally 4 times daily for 14 days, Trimethoprim/ S ulfamethoxazole 1 tablet orally twice daily for 14 days 7/24/2022 21

22. Cont.. Pulmonary rehabilitation ; a pulmonary rehabilitation can teach breathing exercises and techniques that may help reduce breathlessness and improve ability to exercise. Nutrition therapy Supplemental oxygen ; in case of severe emphysema with low blood oxygen levels, using oxygen regularly at home and when exercise may provide some relief. Many people use oxygen 24 hours a day. It is usually administered via narrow tubing that fits into the nostrils. 7/24/2022 22

23. P revention Avoiding or quit smoking Avoiding lung irritants, such as smoke, dust, fumes, vapors and air pollution Wearing a mask to cover the nose and mouth when pollution levels are high Washing the hands often to limit exposure to germs and bacteria Asking about vaccinations to protect from pneumonia and flu. Avoid exposure to second hand smoke and do not expose children to second hand smoke 7/24/2022 23

24. Nursing Intervention 7/24/2022 24

25. Assessment Fever, tachypnea, mild dyspnea, pleuritic chest pain Cough with clear to purulent sputum production Diffuse rhonchi and crackles (contrast with localized crackles usually heard with pneumonia) 7/24/2022 25

26. Nursing diagnosis Impaired gas exchange related to obstructed airways Ineffective airway clearance related to presence of excessive, thickened mucous secretions Ineffective breathing pattern related to retained secretions Sleep pattern disturbance related to difficulty inbreathing Risk for spread of infection related to stasis of secretions and decreased ciliary function 7/24/2022 26

27. Nursing interventions Impaired gas exchange related to obstructed airways Encourage mobilization of secretion through ambulation, coughing, and deep breathing Encourage rest, avoidance of bronchial irritant, and a good diet to facilitate recovery Advise the patient that a dry cough may persist after bronchitis because of irritation of airways. 7/24/2022 27

28. Contd.. Advise the patient that a dry cough may persist after bronchitis because of irritation of airways. Suggest avoiding dry environments and using a humidifier at bedside Chest physiotherapy to mobilize secretions, if indicated Instruct the patient to complete the full course of prescribed antibiotics and explain the effect of meal on drug absorption. 7/24/2022 28

29. Ineffective airway clearance related to presence of excessive, thickened mucous secretions Elevate head of the bed, assist patient assume position to ease work of breathing. Encourage deep slow or pursed lip breathing as individually tolerated or indicated. Routinely monitor skin and mucous membrane color. Encourage expectoration of sputum: suction when indicated. 7/24/2022 29

30. Evaluate level of activity tolerance. Provide calm and quiet environment Monitor vital signs and cardiac rhythm Evaluate sleep patterns, note report of difficulties and whether patient feels well rested. 7/24/2022 30

31. Contd … Ineffective breathing pattern related to retained secretions Place patient in a semi-fowler’s position Place a pillow when the client is sleeping to provide adequate expansion of lung while sleeping Maintain a patent airway, suctioning of secretions may be done as ordered 7/24/2022 31

32. Cont.. Provide respiratory support. Oxygen inhalation is provided as per doctor’s order Administer prescribed cough suppressants and analgesics and be cautious, however because opioids may depress respirations more than desired 7/24/2022 32

33. Sleep pattern disturbance related to difficulty of breathing Monitor level of consciousness or mental status Promote comfort measures such as back rub and change in position as necessary Provide quiet environment Administer pain medication as ordered 7/24/2022 33

34. Cont.. Limit the fluid intake if nocturia is a problem Observe provision of emotional support 7/24/2022 34

35. Risk for spread of infection related to stasis of secretions and decreased ciliary function Review importance of breathing exercises, effective cough, frequent position changes and adequate fluid intake Turn the patient in every 2 hours Encourage increase fluid intake Recommend rinsing mouth with water to prevent risk of oral candidiasis Administer antimicrobial such as cefuroxime as indicated. 7/24/2022 35

36. References Mandal G.N., textbook of medical surgical nursing published by makalu publication house, 3 rd edition, page no: 88-90 Brunner and siddarth , textbook of medical-surgical nursing, 13 th edition page no: 104 https://www.google.com/search/Client=firefox-b-d=bronchitis @2078/03/21 Nov 2, 2019. acute bronchitis.https //www.slideshare.net@2021/07/21 at 5pm 7/24/2022 36

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