Nursing Diagnosis

This week, I will give you five nursing diagnosis for bronchitis.

1)  Ineffective airway clearance related to increased mucus production.  Thick mucus production is a signature sign and symptom of bronchitis, especially chronic bronchitis.  Our goal for patient would be to clear airway effectively with nursing intervention such as drinking 3 liters of water a day to thin out mucus.

2)  Activity intolerance related to ineffective ventilation and oxygenation.  Having constant shortness of breath and coughing while moving around are the major complaints from patients with bronchitis.  This is significant because it means you can't take a shower, grocery shopping, walking down the street without catching your breath or having trouble breathing.  Our nursing goal for the patient would be to tolerate daily activities without trouble breathing with nursing intervention such as daily activity such as short distance walking with time increment as tolerated.  If patient is in the hospital, maybe he/she would walk around the unit once a day and distance and frequency would increase as the patient can tolerate.  

3)  Anxiety related to changes in health status.  It is scary to have bronchitis because you can't breathe properly.  It can be overwhelming to adjust to your new health condition.  You can't live your life like you used to before you have bronchitis.  If you have chronic obstructive pulmonary disease (COPD), you will not be cured from it.  Treatment would only treat your symptoms which do not go away.  Our nursing goal for patient would be able to cope with current medical condition with friends and family with nursing interventions such as education about the illness, education about local support group, etc.  

4)  Ineffective breathing pattern related to bronchoconstriction and excessive mucus.  When you have bronchitis, your bronchi would constrict and thick mucus would be released.  It can clog up your airway making you suffocate.  Some patient with COPD with acute exacerbation would require suctioning and ventilation to breathe and to maintain a patent airway.  Our goal would be to breath effectively by using pursed-lip breathing technique and sitting in a tripod (semi-fowler) position.  It will be the nurse's responsibility to teach the patient these techniques and to practice with the patient.

5)  Acute pain related to inflammation in pleura (the thin sheet mucous tissue that wraps around your lungs).  You will hurt whenever you breathe.  Our goal is have patient's pain manage at a comfortable level per patient's report.
  

Actual/Potential	related to	plan/outcome	nursing intervention
Actual pain	related to inflammation in pleura	manage pain/ patient will report 3/10 pain by the end of shift.	offer routine/prn pain medication accordingly, assess patient’s pain level during hourly rounds.

Reference:  

NCP NANDA. (n.d.). Retrieved February 26, 2015, from http://ncpnanda.blogspot.com/2013/02/9-nursing-diagnosis-for-bronchitis.html

(n.d.). Retrieved February 26, 2015, from http://faculty.mu.edu.sa/public/uploads/1380604673.6151NANDA 2012.pdf

Should I care?

Hopefully by now, you have a pretty good idea about diagnosis, pathology, and treatment for acute and chronic bronchitis.  This week I will talk about ways nurse provide care for people with acute or chronic bronchitis.  First of all, I highly recommend you to visit the homepage of the American Lung Association.  It provides a lot of information such as different types of lung disease, up to date research information about each disease, and diagnosis and treatment for the diseases.  Since most of acute bronchitis is caused by a virus, you don't need antibiotics to treat it.  It would go away on its own.  I would recommend my patients to wash their hands with soap and warm water as often as possible, monitor for cough, maintain a nutritional diet, gets as much  sleep as possible, do not smoke, stay away from any irritants/ allergens that might trigger your asthma (because you don't want any complication with your bronchitis), have your rescue inhaler ready in case you need it, and pay attention to your vital signs such as temperature, pulse, respiration rate, and blood pressure.  You should seek medical help if your vital signs are not normal, you feel worse and your cough worsens.
As your nurse, I will pay attention to all the items listed above and report any changes to your provider.

For chronic bronchitis, also known as COPD (Chronic Obstructive Pulmonary Disease), my approach of care as a nurse would be slightly different. I recommend you to check out this website which breaks down different ways and approaches to take care of someone with COPD with tables.
http://nurseslabs.com/10-chronic-obstructive-pulmonary-disease-bronchitis-nursing-care-plans/
In addition to the approaches discussed in the link above, I would highlight the importance of clearing your secretion from your airway.  For most patients, this is a challenge.  I would recommend my patient to sit up, encourage fluid intake, take their medication according to prescription, and take deep breaths or use the incentive spirometer.  If coughing isn't enough to clear the secretion, suctioning through the nose or airway of the patient is necessary.  I would explain the steps clearly to the patient before execution.  Definitely monitor vital signs, signs and symptoms of infection, breath sounds, and provide support for the patient since this is a stressful disease without a cure.



References:
EHS: Nursing Diagnosis Care Plans, 4/e - Airway Clearance, Ineffective. (n.d.). Retrieved February 20, 2015, from http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick03.html

Hart, A., Nurse Practitioner: 18 September 2014 - Volume 39 - Issue 9 - p 32–39

doi: 10.1097/01.NPR.0000452978.99676.2b

Symptoms, Diagnosis and Treatment - American Lung Association. (n.d.). Retrieved February 20, 2015, from http://www.lung.org/lung-disease/copd/about-copd/symptoms-diagnosis-treatment.html

How to say good-bye to acute bronchitis?

Tightness at chest

Shortness of breath

Coughing like you are coughing your lungs out.

Need your inhalers to open up your airway.

Thank you for following my blog.  As you can recall, I had a battle with my acute bronchitis at the beginning of the quarter.  Because of my thick yellow phlegm and unstoppable cough that lasted for more than two weeks in addition to intermittent asthma attack at night, I received an antibiotic, erythromycin, an antitussive (cough suppressant), promethazine/codeine syrup, and an inhaler, albuterol, were prescribed to me.  Although this is not the highly recommended course of treatment for acute bronchitis, this is the common treatment.  Acute bronchitis is usually a viral infection, you would not treat a virus with antibiotics.  However, between 65 to 80% of the patients received it.  Studies have shown that antibiotics such as erythromycin, doxycycline, trimethoprim-sulfamethoxazole would only decreased the symptoms by a fraction of a day.  It is used mainly for decreasing transmission.  This is a bit shocking to me since I thought my antibiotics were effective.  I guess it was more like a placebo.  I have a history of asthma so when I cough, I always feel like coughing my lungs out.  Cough suppressant and beta2- agonist are found to be beneficial for coughing episodes for both acute and chronic bronchitis.  Nevertheless, they are for short-term use only.  There is no evidence to support the use of inhaled or injection of coritcosteroid to be effective in acute bronchitis treatment.  The bottom line is take your medications as directed and do not end of course of treatment without your provider's approval.  Usually the treatment for bronchitis has minimal side effects.  Possible side effects of antibiotics include diarrhea, nausea, and/or vomiting.  Notify your provider immediately if you have dark urine, persistent nausea/vomiting new signs of infection, and unusual tiredness.  Common side effects for cough syrup with codeine include:  blurred vision, constipation, dizziness, drowsiness, and dry mouth.  You should seek medical help ASAP if you experience allergic reaction (e.g. rash, hives, itchiness, difficulty breathing), agitation, abnormal thoughts, changes in the amount of urine produced, confusion, irregular heartbeat, etc.  You should stop your medication if you experience any of the uncommon side effects and seek medical help right away.  Or else, finish your treatment as directed.              

Reference:
Blush, R. (2013). Acute bronchitis: Evaluation and management. The Nurse Practitioner, 38(10), 14-20.
Promethazine/codeine syrup: Indications, Side Effects, Warnings - Drugs.com. (n.d.). Retrieved February 14, 2015, from http://www.drugs.com/cdi/promethazine-codeine-syrup.html

Smoking my life away...

After reading my posts from the previous weeks, you should have a basic idea of what acute bronchitis and chronic bronchitis are.  Have you ever thought of having all the symptoms such as shortness of breath, tightness at chest, wheezing, coughing nonstop, and asthma attacks due to complications can lead you to death?  Let's picture the air bubbles (air sacs) in your lungs are so inflamed that you feel like your lungs would explode.  The follow video clip shows someone's confession about their personal progression with COPD by singing.

Next, let's check out another testimony of how someone lives with COPD (chronic bronchitis).

Let's review the symptoms of COPD and learn to manage it.

This is how your lungs will look when you have COPD.

Let's think twice before you pick up your next cigarette!  

Can you hear me?

This week I will talk about how to diagnose the two types of bronchitis.  First of all, let's think about the following questions:

1)  Are you having a fever?
2)  Are you having a cough?
3)  If yes, how long have you been coughing?
4)  Are you having any nasal congestion?
5)  Are you having a runny nose?
6)  Do you feel heavy at your lungs when you breathe?
7)  Do you have a history of asthma?
8)  Do you have trouble breathing?
9)  Are you wheezing when you breathe?
10)  Are you a current smoker?
11)  If yes, how long have you been smoking?
12)  When you cough, do you cough up any phlegm or mucous?
13)  What is the color of your sputum?
14)  Are you having any shortness of breath?
15)  How often were you diagnosed with bronchitis in the past two years?

According to the nurse practitioner journal, cough is the primary symptom of bronchitis.  If you have been coughing for less than three weeks, you are having acute bronchitis.  You may also experience cold-like symptoms, such as nasal congestion, sore throat, fever, and possibly wheezing if you have a history of asthma.  If you experienced repeated bouts of bronchitis, you might be having chronic bronchitis.  

Your doctor may ask you to get a chest X-ray, to see whether it is bronchitis or other respiratory diseases such as pneumonia.  He/she may have a culture of your sputum to see if it's other type of respiratory illnesses and what antibiotic he/she can treat you with.  Lastly, you may need to have a pulmonary function test where you will blow into a spirometer to check how much air your lungs can hold and how quickly you can blow air out.  This device is used to check for asthma or emphysema.

Reference:

Bronchitis. (n.d.). Retrieved February 1, 2015, from http://www.mayoclinic.org/diseases-conditions/bronchitis/basics/tests-diagnosis/con-20014956

Hart, A., Nurse Practitioner: 18 September 2014 - Volume 39 - Issue 9 - p 32–39

doi: 10.1097/01.NPR.0000452978.99676.2b

To breathe or not to breathe?!

Welcome back!  This week I will talk about the causes (etiology) and the physiological processes (progression) of acute and chronic BRONCHITIS!!  Let's check out the following video to refresh our memory:

In other words, acute bronchitis is like having a cold in your lungs.  It is caused by either a bacteria or virus.  It can be triggered by air pollution, asthma, dust exposure, having contact with someone who's ill and not washing your hands with soap and water. The inflammation of the linings of the airway makes it very difficult for you to breathe.  Let's picture two swollen branches (bronchi) of your windpipe filled with thick mucous  in your lungs.  You try to breathe, but the air cannot get through. The friction and thick mucous from the swollen branches (bronchi) are preventing the air to go into your lungs.  This leads you to shortness of breath. You try to cough up the thick mucous to clear the airway, but it doesn't work.  However the good news is, it should go away in one to two weeks following proper medical treatment. Take a look at the following picture:

What about chronic bronchitis?  It actually has similar triggers, but SMOKING is the primary cause.  The inflammation of the linings of the airway is the same, but it is a chronic condition.  A person with chronic bronchitis will have the thick mucous cough for most days in a month and for at least three months a year for two years.  Now picture yourself coughing and having shortness of breath almost everyday in a month.  And you experience it for three months in a year for two consecutive years.  Do you still want to smoke?

Unlike acute bronchitis, chronic bronchitis will not go away in one to two weeks.  It is a life-long illness.  People with chronic bronchitis usually develop emphysema (bursting of the air bubbles in your lungs).   When they combine, it will become Chronic Obstructive Pulmonary Disease (COPD).  Chronic bronchitis can lead to other serious respiratory problems and possibly heart failure.  Let's think twice before you pick up your cigarettes.


Reference:
Understanding Chronic Bronchitis - American Lung Association. (n.d.). Retrieved January 25, 2015, from http://www.lung.org/lung-disease/bronchitis-chronic/understanding-chronic-bronchitis.html

The impact of chronic bronchitis in the U.S.

Last week, we learned about what bronchitis is.  This week, I will discuss the impact of chronic bronchitis: chronic obstructive pulmonary disease (COPD)  around the world especially the United States.  According to World Health Organization (WHO), COPD affects 65 million of people.  In 2005, 3 million of people died of this disease, which is equivalent to 5% of total death globally.  Although accurate epidemiology data is difficult and expensive to collect, it is a fact that 90% of COPD deaths occurs in low- and middle-income countries.  By 2030, COPD will become the third leading cause of death worldwide (WHO).  Up to this point, you might be convinced that COPD is not a concern in the United States, since we are a high-income country.  We have a world class health care system, we have various campaigns to educate people the consequences of tobacco smoking, which is the primary cause of COPD.  Americans would be more concerned about heart disease and lung cancer.  However, according to the American Lung Association (ALA), COPD is the third leading cause of death in the U.S.  In 2011, 10.1 millions of Americans have diagnosed with chronic bronchitis, which affects people of all ages.  Age 65 and older is the at risk population.  The prevalence of COPD is less than 4% in Washington (Hurry for Washingtonians) and Minnesota, and more than 9% in Alabama and Kentucky.  More women than men died because of COPD.  More than 70,000 women died of COPD in 2011 (ALA).

Besides looking at the general population, I also researched on how chronic bronchitis affects the U.S. military who are active in continuous combat operations.  According to the U.S. Army Medical Department Journal, in a thirteen-year period (2001-2013), the trend in rates of bronchitis was high and then it decreased slightly.  Among the 482,670 incidents of chronic obstructive disease, 57% of it were diagnosis of bronchitis.  However, between 2009 to 2013, the incidence of chronic bronchitis declined 23.6%.  The article did not explain what caused the decline; however, it is a good news.  Based on CDC's data, each American with COPD pay $6000 more for their medical treatment than someone who does not have COPD.

     

Reference:
Abraham, J. H., Clark, L. L., Sharkey, J. M., & Baird, C. P. (2014). Trends in Rates of Chronic Obstructive Respiratory Conditions Among US Military Personnel, 2001-2013. U.S. Army Medical Department Journal, 33-43.

Burden of COPD. (n.d.). Retrieved January 18, 2015, from http://www.who.int/respiratory/copd/burden/en/

Chronic Obstructive Pulmonary Disease (COPD) Fact Sheet - American Lung Association. (n.d.). Retrieved January 18, 2015, from http://www.lung.org/lung-disease/copd/resources/facts-figures/COPD-Fact-Sheet.html

Increase Expected in Medical Care Costs for COPD. (2014, July 29). Retrieved January 18, 2015, from http://www.cdc.gov/features/ds-copd-costs/