NR 507 Week 2: Discussion Part Two

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. 

  1. What is the etiology of bronchitis? 
  1. Describe in detail the pathophysiological process of bronchitis. 
  1. Identify hallmark signs identified from the physical exam and symptoms. 
  1. Describe the pathophysiology of complications of bronchitis. 
  1. 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). 

 

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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 

 You really identified the pathological hallmark, the pathological complication of bronchitis. Acute bronchitis is a transient inflammation of the trachea and major bronchi (Wark, 2011). Clinically, it is diagnosed on the basis of a cough and occasionally sputum, dyspnoea, and wheeze. Pathogens and allergen expose are factors that trigger acute bronchitis. Bronchitis is a self-limiting illness, but times the illness do not go away and can lead to complication such as a chronic cough, chronic bronchitis, and pneumonia 

  As nurse practitioners (NPs) it is very important that we are quick in diagnosing acute bronchitis on time by paying attention to the hallmark signs of the disease to prevent the complication of the disease such as pneumonia and chronic bronchitis, which has been linked to impaired lung function and decrease in oxygenation to tissues and organs.  These complications if not well managed can lead to death. NPs must treat patient with the right medication mucolytic drugs and antibiotics for those that develop an infection. It is also important to educate the patient on the importance of life style changes such quitting tobacco use and smoking cessation as well as teaching patients the importance of proper hand hygiene to prevent reoccurrence 

 

Wark, P. (2011). Bronchitis (acute). BMJ Clinical Evidence, 2011, 1508. Retrieved from, 

https://chamberlain.instructure.com  

I read enjoyed reading your informative post and especially like your educational area. I think too many people do not realize the value of water and hydration. You covered this area very well. Having had bronchitis, I remember being exhausted and the cure all was homemade chicken noodle soup. The old wise tales were very interesting and perhaps there was truth. And of course, there was guaifenesin, a mucoactive drug, to which the doctor stated that it would loosen the mucus to make the cough more productive. Albrecht, Dicpinigaitis & Guenin (2017) stated that the dosing range is 200 to 400 mg every 4 hours and can be taken to six times daily. There are both immediate release formulas as well as those that are extended release and is tolerable for most pediatric and adult patients. Teaching would also include to make sure that if this patient had any children or grandchildren.  Again, I really enjoyed your post.   

I found an interesting research article that I wanted to share about the use of bronchodilators. After thinking about the topic, for those with asthma, there has to be mention about bronchodilator drugs, Sarioglu, Bilen, Sackes & Gencer (2015) discussed bronchodilator drugs and antibiotics and went into detail about carbonic anhydrase (CA). Carbonic anhydrase (CA) is an enzyme controlling the acid-base balance and Sarioglu, Bilen Sacke & Gencer (2015) added that this enzyme also has a role in electrolyte secretion in tissues. In a study that looked at CA I and II activities, Sarioglu, Bilen Sacke & Gencer (2015) acknowledged that there is strong evidence that there are adverse effects when utilizing antibiotics and bronchodilator drugs because of the carbonic anhydrase inhibition. Again, this has captured my attention because we as clinicians have to look at the patient medications with a fine tooth comb in the prevention of adverse reactions. 

Reference:

Albrecht, H. H., Dicpinigaitis, P. V., & Guenin, E. P. (2017). Role of 

         guaifenesin in the management of chronic bronchitis and upper 

         respiratory tract infections. Multidisciplinary Respiratory Medicine, 121. 

         doi:10.1186/s40248-017-0113-4 

Sarioglu, N., Bilen, C., Sackes, Z., & Gencer, N. (2015). The effects of 

         bronchodilator drugs and antibiotics used for respiratory infection on   

         human erythrocyte carbonic anhydrase I and II isozymes. Archives Of 

         Physiology & Biochemistry, 121(2), 56-61. 

         doi:10.3109/13813455.2015.1011068 

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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). 

Nice job! 

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. 

That was very thorough. 

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). 

That’s correct. 

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.NR 507 Week 2: Discussion Part Two 

Excellent work here! 

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). 

What is the etiology of bronchitis? 

Bronchitis is the inflammation of the lining of the bronchial tubes, the airway that carries air to the lungs and can be acute or chronic. Acute bronchitis is caused by a viral infection which is a complication of a cold or the flu. In Tammy’s case, she developed acute bronchitis. Acute bronchitis is also called a chest cold that usually improves within ten days.  

Describe in detail the pathophysiological process of bronchitis. 

Chronic bronchitis is the continuous inflammation may cause bronchial edema to develop, which causes thickening in the mucus secretion. The secretion produced in the mucous gland and the goblets in the airway epithelium that react to the inflammation. The mucus causes decreased ciliary function to occur which inhabits the body from sweating the thick copious secretion. “Inspired irritants result in airway inflammation with infiltration of neutrophils, macrophages, and lymphocytes into the bronchial wall.” 

 

Identify hallmark signs identified from the physical exam and symptoms. 

According to the mayo clinic the signs and symptoms may include a cough, fatigue, Production of mucus (sputum), which can be transparent, white, yellowish-gray or green- rarely, it may streak with blood, Shortness of breath, Slight fever and chills and Chest discomfort. A mild headache and body aches can also associate with bronchitis. “Hypoxemia may occur with exercise.” (McCance et al, 2013). 

Describe the pathophysiology of complications of bronchitis. 

Some of the complications of bronchitis are chest pain, pneumonia, and chronic bronchitis can cause COPD (chronic obstructive pulmonary disease). “Airway obstruction results in decreased alveolar ventilation and increased PaCO2. Marked hypoxemia leads to polycythemia (overproduction of erythrocytes) and cyanosis.” (McCance et al, 2013). Chronic bronchitis (CB) is a common but variable phenomenon in chronic obstructive pulmonary disease (COPD), Ultimately there is a decline in acceleration of the lung function with a greater risk of developing airway obstruction. (Angela et al, 2018). 

 

What teaching related to her diagnosis would you provide? 

The advanced nurse practitioner should educate the patients about changing their lifestyle. If smoking is the cause, then make plans to quit smoking. Avoiding object that is irritating to the lungs, wearing a mask when around fumes and other people with a cold or flu. Hand hygiene is also essential to prevent infection. Take antibiotics, bronchodilator, expectorant, and corticosteroids as prescribed.  A humidifier would be proper equipment to utilized. 

 

References: 

Angelo Zinellu (Links to an external site.), Alessandro G. Fois (Links to an external site.), Arduino A. Mangoni (Links to an external site.), Panagiotis Paliogiannis (Links to an external site.), Elisabetta Sotgiu (Links to an external site.), Elisabetta Zinellu (Links to an external site.), Viviana Marras (Links to an external site.), Pietro Pirina (Links to an external site.), Ciriaco Carru (Links to an external site.). (2018) Systemic concentrations of asymmetric dimethylarginine (ADMA) in chronic obstructive pulmonary disease (COPD): state of the art. Amino Acids58. 
Online publication date: 27-Jun-2018. 

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. 

I enjoyed reading your post. I can relate to your teaching about ensuring that individuals with bronchitis wear a mask when around fumes and individuals with cold or flu symptoms. I was once diagnosed with bronchitis when I moved to West Virginia in 2009. I remember having a cold and I was very congested. Right after the cold subsided I started coughing like crazy every day all day. I coughed non-stop and would throw up from coughing too much for two months, I kept thinking it will go away. Every time I would fly I would be so embarrassed because I would cough non-stop on the plane. I took every over the counter cough suppressant and none of them worked. I finally went to the doctor and they prescribe bronchial dilator inhalers, but none of them worked. I went to the doctor the second time and she prescribed codeine which finally cleared my cough. I have learnt to wear a mask whenever I go outside due to high levels of pollen, once I moved Georgia and I sleep with a cool mist Humidifier. The doctors did not prescribe antibiotics because they told me it was a viral infection. They did some blood work and the blood work came back negative. 

According to Smith (2017), a systematic review shows that there was limited evidence of clinical benefit to support the utilization of antibiotics for acute bronchitis. Some patients treated with antibiotics recovered a bit more quickly with reduced cough-related outcomes. Unfortunately surveys show that 80% of patients with acute bronchitis receive antibiotics. Antibiotic overuse contributes to emergence of drug-resistant organisms. 

References 

Smith, S. M., Fahey, T., Smucny, J., & Becker, L. A. (2017). Antibiotics for acute bronchitis. The Cochrane Database Of Systematic Reviews, 6, 245.doi: 10.1002/14651858.CD000245.pud4 

   That is a great point about antibiotics treating acute bronchitis. “80% of patients with acute bronchitis receive antibiotics” is a remarkable statistic. From my personal experience with family members and patients with acute bronchitis, they too are prescribed antibiotics with no results. Due to the lack of research on antibiotics treating bronchitis, the treatment plan should be changed in hospitals/ doctor offices to avoid prolonged illness and unnecessary drug-resistant infections. Acute bronchitis is primarily caused by a virus unless a workout for bacterial infection is obtained. For general treatment, the American Lung Association recommends rest and fluids for the best treatment.  

References 

American Lung Association (2018). Lung Health and Diseases. http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/acute-bronchitis/diagnosing-and-treating-acute-bronchitis.html  

I enjoyed reading your discussion on the pathophysiology of bronchitis. What I found very interesting is the lack of knowledge I had towards understanding the pathophysiology of Bronchitis. Literature and the textbook acknowledge that a case of acute bronchitis could last over 3 weeks, with the recommended course of therapy being rest, appropriate nutrition and hydration. In addition to over the counter medication compounds of cough suppressants and expectorants (Kincade & Long, 2016). Information that was fundamental to the research of bronchitis was the causative agents and factors to diagnose acute versus chronic bronchitis. To include the importance of providing sufficient education to help the patient understand why a prescription for antibiotics is not recommended. Especially when the patient reports have discolored mucus, which convinces them they are truly sick and potentially contagious. In addition to the length of illness, especially being a timeframe greater than one week. 

References 

Kincade, S., & Long, N. A. (2016). Acute Bronchitis. American Family Physician, 94, 560-565. Retrieved from https://eds-b-ebscohost-com.chamberlainuniversity.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=13&sid=a27a2898-8e3d-4bf3-8e4b-055118eeff62%40pdc-v-sessmgr02 

    Very informative post and thank you for sharing.  Acute bronchitis and cough is one of the most commonly seen illnesses in ambulatory care and primary care centers. It is characterized by a persistent cough, which may or may not be productive in nature, and lower respiratory tract infection without complication of chronic airway or respiratory disease. Typically upper respiratory tract symptoms and postnasal drainage precede acute bronchitis, causing inflammation of trachea and bronchus (Kinkade & Long, 2016). Acute bronchitis originates from a viral infection 90% of the time and persistent, bothersome cough, lasting more than 2 weeks, is typically the symptom that causes patients to seek treatment. Intermittent wheezing and rhonchi may be auscultated in the lungs, which should clear with cough. 

    Finally, while fever may be present, it is not a common or required presentation for the diagnosis of acute bronchitis (Kinkade & Long, 2016).  Acute bronchitis is the most accurate fitting diagnosis for Tammy’s initial presentation. She has cold like symptoms that worsen into persistent cough. Symptoms are present for 3 weeks, which is a reasonable time frame for the presence of acute bronchitis. The complaints of scratchy throat may be a result of postnasal drainage, leading to the cough, which is also described as a contributing factor of acute bronchitis. 

    Chronic obstructive pulmonary disease can be classified as either chronic bronchitis, chronic inflammation of the airways with thick mucus production, or emphysema, loss of the elasticity of the alveoli. Deterioration of the alveoli results from the breakdown of elastin, causing air to become trapped. Inflammation and thick secretions noted in chronic bronchitis result from chronic exposure to irritants, decreased ciliary function, and over active goblet cells (McCance et al., 2013). Both versions of COPD lead to obstruction of the airway and increased RV, FRC. However, FVC and ERV and the amount of air exhaled in the first second of forced exhalation (FEV1) are decreased with the disease. Decline in FEV1 over the course of the disease is utilized to measure the severity of COPD and the progression of the disease process (Cerveri et al., 2012). 

References 

Cerveri, I., Corsico, A. G., Grosso, A., Albicini, F., Ronzoni, V., Tripon, B., Imberti, F., Galasson, T., Klersy, C., Luisetti, M., Pistolesi, M. (2012). The Rapid FEV1 decline in chronic obstructive pulmonary disease is associated with predominant emphysema: A longitudinal study. COPD: Journal of Chronic Obstructive Pulmonary Disease, 10(1), 55-61. doi:10.3109/15412555.2012.727920 

Colom, A. J., Maffey, A., Garcia Bournissen, F., & Teper, A. (2014). Pulmonary function of a paediatric cohort of patients with postinfectious bronchiolitis obliterans. A long term follow-up. Thorax, 70(2), 169-174. doi:10.1136/thoraxjnl-2014-205328 

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 

Perez, T., Chanez, P., Dusser, D., & Devillier, P. (2015). Prevalence and reversibility of lung hyperinflation in adult asthmatics with poorly controlled disease or significant dyspnea. Allergy, 71(1), 108-114. doi:10.1111/all.12789 

See Also: NR 507 Week 3: Discussion Part Two