Acute Bronchitis Nursing Care Plan & Management

Notes

Description
  • Is an infection of the lower respiratory tract that generally follows an upper respiratory tract infection. As a result of this viral (most common) or bacterial infection, the airways become inflamed and irritated, and mucus production increases.
Causes
  • Acute bronchitis is usually caused by viruses. Established risk factors include a history of smoking, occupational exposures, air pollution, reduced lung function, and heredity. Children of parents who smoke are at higher risk for pulmonary infections that may lead to bronchitis.

Acute Bronchitits

Assessment:
  • Fever, tachypnea, mild dyspnea, pleuritic chest pain (possible).
  • Cough with clear to purulent sputum production.
  • Diffuse rhonchi and crackles(contrast with localized crackles usually heard with pneumonia).
Diagnostic Evaluation:
  • Chest X-ray may rule out pneumonia. In bronchitis, films show no evidence of lung infiltrates or consolidation.
Primary Nursing Diagnosis
  • Impaired gas exchange related to obstructed airways
Medical Management:
  • Chest physiotherapy to mobilize secretions, if indicated.
  • Hydration to liquefy secretions.
Pharmacologic Interventions:
  • Inhaled bronchodilators to reduce bronchospasm and promote sputum expectoration.
  • A course of oral antibiotics such as a macrolide may be instituted, but is controversial.
  • Symptom management for fever and cough.
Nursing Interventions:
  • Encourage mobilization of secretion through ambulation, coughing, and deep breathing.
  • Ensure adequate fluid intake to liquefy secretions and prevent dehydration caused by fever and tachypnea.
  • Encourage rest, avoidance of bronchial irritant, and a good diet to facilitate recovery.
  • Instruct the patient to complete the full course of prescribed antibiotics and explain the effect of meals on drug absorption.
  • Caution the patient on using over-the-counter cough suppressants, antihistamines, and decongestants, which may cause drying and retention of secretions. However, cough preparations containing the mucolytic guaifenesin may be appropriate.
  • 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. Encourage smoking cessation.
  • Teach the patient to recognize and immediately report early signs and symptoms of acute bronchitis.
Documentation Guidelines
  • Respiratory status of the patient: Respiratory rate, breath sounds, use of oxygen, color of nail beds and lips; note any respiratory distress
  • Response to activity: Degree of shortness of breath with any exertion,degree of fatigue
  • Comfort, body temperature
  • Response to medications, oxygen,and breathing treatments
  • Need for assistance with activities of daily living
  • Response to diet and increased caloric intake, daily weights
Discharge and Home Healthcare Guidelines
  1. Medications. Be sure that the patient understands all medications, including the dosage, route, action, and adverse effects. Patients on aminophylline should have blood levels drawn as ordered by the physician. Before being discharged from the hospital, the patient should demon- strate the proper use of metered-dose inhalers.
  2. Complications. Instruct patients to notify their primary healthcare provider of any change in the color or consistency of their secretions. Green-colored secretions may indicate the pres- ence of a respiratory infection. Patients should also report consistent, prolonged periods of dyspnea that are unrelieved by medications.
  3. Follow-up. Consider that patients with severe disease may need assistance with activities of daily living after discharge. Note any referrals to social services. Send patients home with a diet, provided by the dietitian and reinforced by the nurse, which provides a high-caloric intake. Encourage the patient to cover the face with a scarf if he or she goes out-of-doors in the winter. If the patient continues to smoke,provide the name of a smoking cessation program or a support group. Encourage the patient to avoid irritants in the air.

 

 

Sources:
ADAM for Images
Marilyn Sawyer Sommers, RN, PhD, FAAN , Susan A. Johnson, RN, PhD, Theresa A. Beery, PhD, RN , DISEASES AND DISORDERS A Nursing
Therapeutics Manual, 2007 3rd ed
Lippincott Review Series

Exam

Welcome to your MSN Exam for Bronchitis (Acute & Chronic)! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 20 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Tips For Success

  • Read each question carefully. Take your time and don't rush.
  • Understand the rationale behind each answer. This will not only help you during this exam, but also assist in reinforcing your learning.
  • Don't be discouraged by incorrect answers. Use them as an opportunity to learn and improve.
  • Take breaks if you need them. It's not a race, and your understanding is what's most important.
  • Keep a positive attitude and believe in your ability to succeed.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Think about which intervention would most effectively help to thin out the mucus, making it easier for the patient to expectorate.

1 / 20

1. Nurse Sarah is caring for Mr. Thompson, a patient who has been admitted to the hospital with acute bronchitis. One challenge is managing the expectoration of thick sputum. As she develops a plan of care, what nursing action should she consider as most effective for this issue?

💡 Hint

Think about which condition is most likely to place additional stress on the respiratory system and therefore increase oxygen demands.

2 / 20

2. Nurse Emily is caring for Karen, a patient with chronic bronchitis. Emily has formulated a nursing diagnosis of "Activity intolerance related to inadequate oxygenation and dyspnea." To help Karen minimize this problem, Emily plans to educate her on conditions that could heighten her oxygen demands. What should Emily recommend Karen avoid?

💡 Hint

Consider which breathing technique is most effective in increasing oxygenation and reducing the work of breathing in chronic respiratory conditions.

3 / 20

3. Nurse Emily is educating Mr. Wilson, a patient with chronic bronchitis, on effective breathing exercises to help manage his condition. What key point should she include in her teaching?

💡 Hint

Reflect on the overall nature, treatment requirements, and common causes of chronic bronchitis to identify what is true.

4 / 20

4. Nurse William is counseling Mrs. Adams, a 55-year-old patient who has been recently diagnosed with chronic bronchitis. During their conversation, Nurse William aims to provide accurate information about the condition. Which statement should Nurse William confirm as true regarding chronic bronchitis?

💡 Hint

This term is often used to describe a specific type of chronic obstructive pulmonary disease (COPD) characterized by certain physical appearances and breathing patterns.

5 / 20

5. Nurse Amelia is reviewing medical terms with her team during their weekly meeting. She asks her colleagues what the term "pink puffer" refers to, particularly when describing a female client. What condition is this term associated with?

💡 Hint

Reflect on the various attributes of a cough commonly seen in patients with bronchitis, from its duration to its nature.

6 / 20

6. Nurse Michelle is reviewing patient charts and comes across a new admission diagnosed with bronchitis. She recalls the characteristics of a cough commonly associated with this condition. Which of the following best describes such a cough?

💡 Hint

Keep in mind that chronic bronchitis can lead to various complications affecting multiple body systems, so consider a comprehensive set of symptoms.

7 / 20

7. Nurse Thomas is discussing chronic bronchitis during a respiratory health seminar. He wants to make sure the attendees are aware of additional symptoms that might manifest with chronic bronchitis. Which of the following should he include in his discussion?

💡 Hint

Think about the residual symptoms that might linger after the primary infection of acute bronchitis has resolved.

8 / 20

8. Nurse Emily is leading a community health seminar and addresses misconceptions about acute bronchitis. She poses the question, "Is it uncommon to experience a dry, nagging cough that persists for several weeks even after acute bronchitis has cleared?" What is the correct statement?

💡 Hint

Reflect on the major risk factors associated with the development of chronic bronchitis.

9 / 20

9. Nurse Laura is conducting a smoking cessation workshop and meets Mr. Thompson, a 52-year-old lifelong smoker concerned about respiratory issues. Nurse Laura wants to stress the link between smoking and chronic bronchitis. Is it correct for Nurse Laura to inform Mr. Thompson that cigarette smoking is the primary cause of chronic bronchitis?

💡 Hint

Prioritize the actions that directly address life-threatening conditions, such as low oxygen levels, before other steps.

10 / 20

10. Nurse Sophia is doing her morning rounds and is currently attending to Mr. Johnson, an 80-year-old man with a history of chronic bronchitis. During her assessment, she notes that the pulse oximeter shows an O2 saturation level of 76%. What should be Nurse Sophia's immediate course of action?

💡 Hint

This term is often used to describe a specific type of chronic obstructive pulmonary disease (COPD) where the individual may exhibit certain physical characteristics such as cyanosis.

11 / 20

11. Nurse William is discussing clinical terms with his team during a shift change. He brings up the term "blue bloater" and asks his colleagues which condition it typically describes, especially in reference to a male client. What does this term refer to?

💡 Hint

Consider which lifestyle changes could help in alleviating symptoms like mucus production and enhancing overall lung function.

12 / 20

12. Nurse Ethan is consulting with Mr. Wallace, a 45-year-old patient who has chronic bronchitis and recently suffered an acute exacerbation. As part of the patient education, Nurse Ethan is advising Mr. Wallace on lifestyle changes that could help manage his condition effectively. Which lifestyle modification should Nurse Ethan recommend as the most appropriate?

💡 Hint

Consider the condition most likely to present with sudden difficulty breathing and chest pain, especially in the context of a traumatic injury like a motor vehicle accident.

13 / 20

13. Nurse Olivia is attending to Mr. Johnson, a 62-year-old male who was involved in a motor vehicle accident as an unrestrained driver. He is in the emergency department complaining of difficulty breathing and chest pain. Upon auscultation, Nurse Olivia notes an absence of breath sounds in the upper lobe of the lung. What condition might Mr. Johnson have?

💡 Hint

Consider which condition would most likely result in decreased to absent breath sounds on one entire side of the chest.

14 / 20

14. Nurse Sara is evaluating Jackson, a patient who has been experiencing shortness of breath. Upon auscultation, she finds decreased to absent breath sounds on the right side of his chest, from apex to base. What condition would be most likely to cause these findings?

💡 Hint

Consider the condition that is most likely to occur in the context of recent orthopedic surgery and that can lead to acute respiratory symptoms and hypoxia.

15 / 20

15. Nurse Ethan is caring for Mr. Davis, a 67-year-old patient who recently had surgery on his right femur. Suddenly, Mr. Davis develops acute shortness of breath and progressive hypoxia. Nurse Ethan needs to determine the most probable cause of these symptoms. What should he consider?

💡 Hint

Consider which condition is often triggered by severe trauma or injury to the lungs and can result in rapid, life-threatening respiratory failure.

16 / 20

16. Nurse Laura is caring for Johnny, a firefighter who was involved in putting out a house fire. Johnny has been admitted for smoke inhalation and has developed severe hypoxia 48 hours post-incident, requiring intubation and mechanical ventilation. Which condition is Johnny most likely experiencing?

💡 Hint

Consider the full range of symptoms that can initially present in a case of bronchitis.

17 / 20

17. Nurse Rachel is conducting a health education session focusing on respiratory issues, including bronchitis. She wants to inform the audience about the initial symptoms they should be aware of. What should Nurse Rachel include in her teaching?

💡 Hint

Think about the muscles involved in the coughing process and how forceful, sustained coughing might affect them.

18 / 20

18. Nurse Hannah is providing care to Ms. Rodriguez, a 50-year-old patient who has been experiencing a persistent, forceful cough for several days. Ms. Rodriguez complains of aching chest and abdominal muscles. Nurse Hannah contemplates whether the continued forceful coughing could be responsible for these aches. Is this a plausible explanation?

💡 Hint

Consider the factors that make individuals more susceptible to acute bronchitis, as well as its common origins and affected areas.

19 / 20

19. Nurse Sophia is holding a workshop on respiratory diseases and has a segment focused on acute bronchitis. She aims to clarify some common misconceptions about the condition. Which statement should Nurse Sophia confirm as true regarding acute bronchitis?

💡 Hint

Focus on the symptom that is almost always present in cases of bronchitis and often prompts individuals to seek medical care.

20 / 20

20. Nurse Emma is conducting a health education session for a group of patients at risk for developing respiratory illnesses. One topic on the agenda is bronchitis, and Nurse Emma wants to highlight its most prevalent symptom. Which symptom should she emphasize as being the most common in bronchitis?

Nursing Care Plan

Ineffective Airway Clearance
Assessment

Patient may manifest

  • Wheezes/crackles on auscultation on the BLF
  • Subcostal retraction
  • Nasal flaring
  • Presence of non-productive cough
  • Increase RR above normal range
Nursing Diagnosis
  • Ineffective Airway Clearance
Outcomes
  • Patient will demonstrate effective clearing of secretions.
  • Patient will maintain effective airway clearance.
Nursing Interventions
  • Position head midline with flexion on appropriate for age/condition
    • Rationale: To gain or maintain open airway
  • Elevate HOB
    • Rationale: To decrease pressure on the diaphragm and enhancing drainage
  • Observe S/Sx of infections
    • Rationale: To identify infectious process
  • Auscultate breath sounds & assess air mov’t
    • Rationale: To ascertain status & note progress
  • Instruct the patient to increase fluid intake
    • Rationale: To help to liquefy secretions.
  • Demonstrate effective coughing and deep-breathing techniques.
    • Rationale: To maximize effort
  • Keep back dry
    • Rationale: To prevent further complications
  • Turn the patient q 2 hours
    • Rationale: To prevent possible aspirations
  • Demonstrate chest physiotherapy, such as bronchial tapping when in cough, proper postural drainage.
    • Rationale: These techniques will prevent possible aspirations and prevent any untoward complications
  • Administer bronchodilators if prescribed.
    • Rationale: More aggressive measures to maintain airway patency.

Ineffective Breathing Pattern
Assessment

Patient may manifest

  • Wheezes/crackles on auscultation on the BLF
  • Subcostal retraction
  • Nasal flaring
  • Presence of non-productive cough
  • Increase RR above normal range
Nursing Diagnosis
  • Ineffective Breathing Pattern RT Retained Secretions
Outcomes
  • Patient will improve breathing pattern.
  • Patient will maintain a respiratory rate within normal limits.
Nursing Interventions
  • Place patient in semi-fowlers position
    • Rationale: To have a maximum lung expansion
  • Increase fluid intake as applicable
    • Rationale: To liquefy secretions
  • Keep patient back dry
    • Rationale: To avoid stasis of secretions and avoid further complication
  • Change position every 2 hours
    • Rationale: To facilitate secretion mov’t and drainage
  • Perform CPT
    • Rationale: To loosen secretion
  • Place a pillow when the client is sleeping
    • Rationale: To provide adequate lung expansion while sleeping.
  • Instruct  how to splint the chest wall with a pillow for comfort during coughing and elevation of head over body as appropriate
    • Rationale: To promote physiological ease of maximal inspiration
  • Maintain a patent airway, suctioning of secretions may be done as ordered
    • Rationale: To remove secretions that  obstructs the airway
  • Provide respiratory support. Oxygen inhalation is provided per doctor’s order
    • Rationale: To aid in relieving patient from dyspnea
  • Administer prescribed cough suppressants and analgesics and be cautious, however, because opioids may depress respirations more than desired.
    • Rationale: To promote deeper respirations and cough

Impaired Gas Exchange
Assessment

Patient may manifest

  • Appearance of bluish extremities when in cough (cyanosis), lips
  • Lethargy
  • Restlessness
  • Hypercapnea
  • Hypoxemia
  • Abnormal rate, rhythm, depth of breathing
  • Diaphoresis
Nursing Diagnosis
  • Impaired Gas Exchange RT Altered Oxygen Balance
Outcomes
  • Patient will improve ventilation and adequate oxygenation of tissues
  • Patient will minimize or totally be free of symptoms of respiratory distress.
Nursing Interventions
  • Monitor level of consciousness or mental status
    • Rationale: Restlessness,anxiety, confusion, somnolence are common manifestation of hypoxia and hypoxemia.
  • Assist the client into the High-Fowlers position
    • Rationale: The upright position allows full lung excursion and enhances air exchange
  • Increase patient’s fluid intake
    • Rationale: To help liquefy secretions
  • Encourage expectoration
    • Rationale: To eliminate thick, tenacious, copious secretions which contribute for the impairment of gas exchange.
  • Encourage frequent position changes
    • Rationale: To promote drainage of secretions
  • Encourage adequate rest & limit activities to within client tolerance
    • Rationale: Helps limit oxygen needs/consumption
  • Promote calm/restful environments
    • Rationale: To correct/improve existing deficiencies
  • Administer supplemental oxygen judiciously as indicated
    • Rationale: May correct or prevent worsening of hypoxia.
  • Administer meds as indicated such as bronchodilators
    • Rationale: To treat the underlying condition

Sleep Pattern Disturbance
Assessment

Patient may manifest

  • Irritability
  • Restlessness
  • Lethargy
  • Changes in posture
  • Difficulty of breathing which worsens at night
Nursing Diagnosis
  • Sleep Pattern Disturbance RT Difficulty of Breathing
Outcomes
  • Patient will identify individually appropriate interventions to promote sleep.
  • Patient will be able to report improvements in sleep/rest pattern.
Nursing Interventions
  • Monitor level of consciousness or mental status
    • Rationale: Restlessness, anxiety,confusion, somnolence are common manifestation of hypoxia and hypoxemia.
  • Promote comfort measures such as back rub and change in position as necessary
    • Rationale: To provide non pharmacologic management
  • Observe provision of emotional support
    • Rationale: Lack of knowledge and problems, relationships may create tension. Interfering with sleep routines based on adult schedules may not meet child’s needs.
  • Provide quiet environment.
    • Rationale: To promote an environment conducive to sleep.
  • Increase patient’s fluid intake
    • Rationale: To help liquefy secretions
  • Encourage expectoration
    • Rationale: To eliminate thick, tenacious, copious secretions which contribute for the DOB
  • Limit the fluid intake in evening if nocturia is a problem
    • Rationale: To reduce need for nighttime elimination
  • Obtain feedback from SO regarding usual bedtime, rituals/routines
    • Rationale: To determine usual sleep patterns & provide comparative baseline
  • Provide safety for patient sleep time safety
    • Rationale: To promote comfort/safety
  • Recommend mid morning nap if one required
    • Rationale: Napping esp. in the afternoon can disrupt normal sleep pattern
  • Administer pain medication as ordered.
    • Rationale: To relieve discomfort and take maximum advantage of sedative effect

Risk for Spread of Infection
Assessment

Patient may manifest

  • Body temperature above normal range
  • Dehydration
  • Increase WBC count
  • Presence of increase mucus production
Nursing Diagnosis
  • Risk for Spread of Infection RT Stasis of Secretions & Decreased Ciliary Action
Outcomes
  • Patient will identify interventions  to prevent and/or reduce the risk of infection
  • Patient will have minimize or totally be free from the risk of infection.
Nursing Interventions
  • Review importance of breathing exercises, effective cough, frequent position changes, and adequate fluid intake
    • Rationale: These activities promote mobilization and expectoration of secretions to reduce the risk of developing pulmonary infection.
  • Turn the patient q 2 hours
    • Rationale: To facilitate secretion mov’t and drainage
  • Encourage increase fluid intake
    • Rationale: To liquefy secretions
  • Stress the importance of handwashing to SO’s
    • Rationale: Handwashing is the primary defense against the spread of infection
  • Teach the SO’s how to care for and clean respiratory equipment
    • Rationale: Water in respiratory equipment is a common source of bacterial growth
  • Teach the SO’s the manifestations of pulmonary infections (change in color of sputum, fever, chills) , self-care and when to call the physician
    • Rationale: Early recognition of manifestations can lead to a rapid diagnosis.
  • Recommend rinsing mouth with water
    • Rationale: To prevent risk of oral candidiasis.
  • Administer antimicrobial such as cefuroxime as indicated.
    • Rationale: Given prophylactically to reduce any possible complications

Other Possible Nursing Care Plans
  • High risk for suffocation
  • High risk for aspiration
  • Anxiety RT acute breathing difficulties
  • Activity Intolerance RT inadequate oxygenation
  • Imbalanced Nutrition: Less than body requirements RT reduced appetite and dyspnea (for emphysema)