Bronchitis is a respiratory condition characterized by inflammation of the lower respiratory tract, specifically the bronchioles. This condition can either be acute or chronic.
Acute bronchitis is a common condition that usually develops from a cold or other respiratory infection and resolves within 7 to 10 days without lasting effects. Acute bronchitis may manifest with cold symptoms like muscle aches, malaise, sore throat, and rhinitis. The cough may last two to three weeks.
Chronic bronchitis is defined as inflammation of the bronchial tubes, causing a long-term cough lasting at least three months and recurring within two years. Chronic bronchitis is a form of chronic obstructive pulmonary disease (COPD).
The disease process of bronchitis itself is not contagious. However, if bronchitis symptoms are caused by an underlying respiratory illness, like a cold or the flu, this can be transmitted to others.
In this article:
- Nursing Process
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- Impaired Gas Exchange
- Impaired Spontaneous Ventilation
- Ineffective Airway Clearance
- Ineffective Breathing Pattern
Nursing Process
The goal of treatment for patients with bronchitis is to relieve symptoms and prevent complications like pneumonia. Nurses take the lead in providing supportive interventions and patient education. Nurses closely monitor patients at higher risk, such as those with compromised immune systems, to prevent worsening complications.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section, we will cover subjective and objective data related to bronchitis.
Review of Health History
1. Assess the patient’s general symptoms.
Clinical manifestations of bronchitis include the following:
- Productive cough with clear, white, or purulent sputum
- Shortness of breath
- Fatigue
- Chest discomfort
- Cold symptoms
- Body aches
- Headache
2. Review the patient’s medical history.
Chronic bronchitis is often associated with chronic lung conditions such as:
- Emphysema
- Asthma
- Cystic fibrosis
- COPD
3. Determine the patient’s triggering factors.
Acute bronchitis is often caused by viruses such as a cold or flu. Chronic bronchitis is triggered by the following:
- Air pollution
- Smoking
- Inhalation of chemicals or dust
4. Review the patient’s smoking history.
The most significant risk factor for bronchitis is smoking. Smoking continuously produces a layer of mucus in the bronchioles, making breathing more challenging.
5. Assess the patient’s immune system.
These patient populations are more susceptible to respiratory infections and bronchitis:
- Infants
- Young children
- Older adults
6. Ask the patient about the presence of heartburn.
Bronchitis can develop in patients with gastroesophageal reflux disease (GERD) or heartburn. In GERD, stomach acids enter the bronchial tree. Repeated episodes of severe heartburn can irritate the throat and increase the risk of bronchitis.
7. Consider the time of year.
Bronchitis often occurs in the setting of upper respiratory illnesses like the common cold, respiratory syncytial virus, or sinusitis, which are most common in winter months.
Physical Assessment
1. Assess the cough.
A cough is the most common symptom of bronchitis. A cough that lasts longer than five days suggests acute bronchitis. Sputum may be clear, yellow, green, or even blood-tinged.
2. Monitor for a fever.
A fever is rare with bronchitis, but when accompanied by a cough, suggests either influenza or pneumonia.
3. Consider symptoms of underlying conditions.
Conditions that impair lung function, like COPD, may also manifest with dyspnea and cyanosis.
4. Auscultate lung sounds.
Wheezes can be heard from patients with persistent bronchitis. With acute bronchitis, lung sounds may include coarse rhonchi to wheezing across lung fields after coughing.
Diagnostic Procedures
1. Bronchitis is suspected when other acute respiratory infections can be ruled out. Nasal swabs can assess for COVID-19 or influenza.
2. Use spirometry.
When spirometry is used, individuals with acute bronchitis may show temporary bronchial hyperresponsiveness. Usually, it takes six weeks for airflow obstruction and bronchial hyperresponsiveness to subside.
3. Obtain a sample for blood testing.
Procalcitonin levels can distinguish bacterial from nonbacterial infections and may help reduce unnecessary antibiotic use.
4. Prepare the patient for CXR.
A chest x-ray (CXR) is useful when pneumonia is suspected or in older adults at risk for pneumonia. A CXR may occasionally show more interstitial marks indicative of thickening bronchial walls. When infiltrates are visible on a CXR, pneumonia can be distinguished from acute bronchitis.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with bronchitis.
1. Bronchitis is rarely caused by bacteria, so antibiotics are not usually recommended. Care is supportive and centered on relieving symptoms.
2. Control the cough and sputum production.
Avoiding environmental irritants (especially cigarette smoke) is imperative to control cough and sputum production.
3. Administer medications as ordered.
Medications as recommended by the American College of Chest Physicians (ACCP) guidelines include:
- Central cough suppressants (codeine and dextromethorphan): for short-term symptomatic relief of coughing
- Short-acting beta-agonists (ipratropium bromide and theophylline): to manage symptoms such as bronchospasm, difficulty breathing, and persistent cough in stable patients
- Long-acting beta-agonist with an inhaled corticosteroid: controls chronic cough
- Short-acting agonists or anticholinergic bronchodilators: for acute exacerbation
- A short course of systemic corticosteroid: to control inflammation and swelling of the bronchioles
- Beta2-agonist bronchodilators: for patients with wheezing and cough with an underlying lung disease
- Nonsteroidal anti-inflammatory drugs (NSAIDs): for mild to moderate pain
- Albuterol and guaifenesin: for cough, difficulty of breathing, and wheezing
- Mucolytics: to reduce acute exacerbations in patients with moderate to severe COPD
- Antibiotics: for recently hospitalized patients over 65 due to acute cough, those who have diabetes mellitus, congestive heart failure, acute exacerbations of chronic bronchitis, or those taking steroids
4. Boost the immune system.
Prevent serious complications by boosting the immune system with:
- Influenza vaccination: lowers the risk of upper respiratory tract infections, decreasing the risk of acute bacterial bronchitis.
- Pneumonia vaccination: for patients over age 65 with a chronic disease.
- Zinc: results are conflicting, but supplementation with zinc may help treat or prevent respiratory infections.
5. Advise the patient when to seek urgent medical attention.
Educate the patient on the following symptoms that necessitate medical attention:
- Fever
- Cough with bloody mucus
- Dyspnea
- Symptoms that last more than three weeks
- Recurrent episodes of bronchitis
6. Reduce the risk of bronchitis or worsening complications.
Educate the patient on practices to reduce the risk of recurrent bronchitis, other respiratory diseases, or worsening complications, such as:
- Avoid smoking and secondhand smoke
- Maintain a clean environment free from dust and irritants
- Limit time with others in crowded areas, especially in winter months
- Avoid being around sick people
- Get plenty of rest
- Wash your hands frequently with soap and water
Nursing Care Plans
Once the nurse identifies nursing diagnoses for bronchitis, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for bronchitis.
Deficient Knowledge
Patient education is essential in the management of bronchitis. For effective management and prevention of complications, adherence to the treatment regimen and lifestyle modifications are essential.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Misinformation
- Inadequate access to resources
- Inadequate awareness of resources
- Inadequate commitment to learning
- Inadequate information
- Inadequate interest in learning
- Inadequate knowledge of resources
- Inadequate participation in care planning
- Lack of support for effective learning
As evidenced by:
- Inaccurate follow-through of instructions
- Inaccurate statements about a topic
- Nonadherence to appointments or medications
- Development of pneumonia or other complications
Expected outcomes:
- Patient will verbalize understanding of the causes of bronchitis and its treatment.
- Patient will implement two strategies to prevent the recurrence of bronchitis.
Assessment:
1. Assess the patient’s age and health literacy.
Acute bronchitis can affect children under 2 years old, with another peak incidence between ages 9 and 15. Chronic bronchitis is more prevalent in people over 45 years old. Learning strategies may need to be tailored depending on the patient’s age and learning ability.
2. Assess the patient’s willingness to learn.
The patient’s willingness and motivation to learn can affect the overall learning process. It may be important to include the primary caregivers and family members in providing information about the disease process and interventions to help support the patient on the road to recovery.
Interventions:
1. Provide accurate information about the disease process, prognosis, and treatment regimen.
Ensure the information provided is correct and delivered in easy-to-understand language. Provide brochures and reading materials as appropriate.
2. Reinforce learning through the provision of repetitive and follow-up sessions.
Frequent and regular education sessions can help improve medication and self-care management outcomes for those who have chronic conditions like chronic bronchitis and COPD.
3. Encourage vaccinations.
There isn’t a vaccination for bronchitis, but vaccinations for influenza can prevent the development of bronchitis, especially for those with weakened immune systems or who have a chronic respiratory condition.
4. Do not smoke or inhale toxins.
Smoking triggers airway inflammation. Keep children with asthma or cystic fibrosis away from air pollutants and secondhand smoke.
5. Wash hands and wear a mask.
Hand washing is the best way to prevent the introduction of viruses. Those with chronic respiratory conditions should consider wearing a mask in public places.
6. Educate that antibiotics won’t help.
Educate patients and families that bronchitis is rarely caused by bacteria but is often related to a virus in which antibiotics will not be helpful. If pneumonia develops, antibiotics will then be considered.
7. Include family members in patient education sessions.
Children and older adults diagnosed with bronchitis can benefit from the support they get from family members. Family members play an essential role in patient care, including decision-making, assisting in healthcare interventions, and improving the patient’s safety and quality of life.
Impaired Gas Exchange
Chronic bronchitis or other chronic underlying respiratory conditions increase the risk of impaired gas exchange.
Nursing Diagnosis: Impaired Gas Exchange
Related to:
- COPD
- Viral or bacterial infection
- Poor airway clearance
As evidenced by:
- Productive cough
- Dyspnea
- Lethargy
- Restlessness
- Abnormal rate, rhythm, and depth of breathing
- Abnormal ABGs
- Cyanosis
Expected outcomes:
- Patient will display improvement in ventilation and oxygenation as evidenced by ABGs within normal limits.
- Patient will verbalize the causative factors contributing to poor oxygenation.
- Patient will demonstrate effective breathing and coughing exercises.
Assessment:
1. Assess breath sounds.
Diffuse wheezes, high-pitched sounds, and the use of accessory muscles signal severe disease.
2. Review chest X-ray results.
A chest X-ray is not usually necessary with bronchitis but should be performed in patients when pneumonia is suspected.
3. Monitor oxygen saturation and ABGs.
Patients with COPD may present with a baseline SpO2 that is < 95%. If respiratory distress develops, analyze ABG results to determine hypoxemia or alterations in acid-base balance.
Interventions:
1. Instruct on breathing techniques and devices.
Pursed-lip breathing is especially useful in clients with COPD to help control shortness of breath. Instruct on the use of an incentive spirometer or flutter valve to strengthen the lungs and mobilize mucus.
2. Discuss exposure to lung irritants.
Chronic bronchitis is commonly associated with smoking but may also occur due to exposure to chemical fumes or air pollution. Discuss smoking cessation or other ways to reduce exposure to irritants.
3. Limit activities and encourage rest.
Rest periods help conserve energy, limit oxygen consumption, and are imperative for recovering from bronchitis.
4. Administer medications as prescribed.
Cough medications, expectorants, corticosteroids, bronchodilators, and more may be prescribed to relieve bronchitis symptoms.
Impaired Spontaneous Ventilation
Chronic bronchitis is another form of COPD that can lead to severely impaired lung function.
Nursing Diagnosis: Impaired Spontaneous Ventilation
Related to:
- Altered O2/CO2 ratio
- Respiratory distress
- Respiratory muscle fatigue
As evidenced by:
- Adventitious breath sounds
- Dyspnea
- Decreased SpO2
- Decreased PO2
- Increased PCO2
- Accessory muscle use
- Restlessness
Expected outcomes:
- Patient will demonstrate ABGs within normal parameters.
- Patient will maintain an effective airway.
- Patient will demonstrate effective coughing and expectoration of secretions.
Assessment:
1. Auscultate the lungs for adventitious breath sounds.
Wheezes and rhonchi are common in acute bronchitis. Decreased air intake or inspiratory stridor may indicate obstruction and is a serious finding.
2. Assess the patient’s blood pressure and pulse rate.
Tachycardia may be a result of hypoxia. Increased blood pressure happens initially, followed by hypotension as the patient’s condition worsens.
3. Assess respiratory rate, depth, and pattern.
Monitor for dyspnea, tachypnea, accessory muscle use, nasal flaring, and decreasing SpO2 as signs of respiratory distress.
Interventions:
1. Maintain a high Fowler’s position, as tolerated.
A sitting position helps maximize chest expansion and is usually a position of comfort with respiratory difficulty.
2. Administer oxygen.
Severe cases of hypoxia may call for supplemental oxygen.
3. Use a 0-10 scale for dyspnea.
The nurse can ask the patient to self-report their dyspnea using a 0-10 scale, just like they would to assess pain.
4. Prepare for invasive intervention.
In the event of respiratory obstruction where coughing or suctioning is ineffective, the healthcare team must prepare for intubation or even tracheostomy.
Ineffective Airway Clearance
Bronchitis is characterized by inflammation of the bronchi, which are the main airways of the lungs, causing them to become irritated and swollen. Its main symptoms include cough and mucus accumulation, leading to ineffective airway clearance.
Nursing Diagnosis: Ineffective Airway Clearance
Related to:
- Disease process
- Inflammatory process
- Excessive mucus
- Mucus plug
As evidenced by:
- Adventitious breath sounds
- Altered respiratory rhythm
- Cyanosis
- Diminished breath sounds
- Excessive sputum
- Hypoxemia
- Ineffective cough
- Ineffective sputum elimination
- Nasal flaring
Expected outcomes:
- Patient will be able to maintain an effective cough and clear breath sounds.
- Patient will demonstrate patent airways as evidenced by respiratory rate and depth within normal limits.
Assessment:
1. Assess airways for any obstruction.
Ineffective airway clearance interferes with gas exchange and must be addressed right away.
2. Auscultate breath sounds.
The presence of coarse crackles can indicate fluid or secretions in the airways. Wheezing indicates constricted airways.
3. Assess blood gas values and oxygen saturation.
Airway obstruction can cause significant oxygenation problems. Oxygen saturation of less than 90% requires intervention.
Interventions:
1. Administer supplemental oxygen as ordered.
Oxygen administration can correct hypoxemia associated with ineffective airway clearance and breathing problems.
2. Elevate the head of the bed.
An upright position allows for optimal lung expansion to facilitate efficient breathing.
3. Suction secretions as needed.
Accumulation of secretions in the airways is common in patients with bronchitis. Suctioning secretions promote airway clearance.
4. Administer expectorants.
Expectorants help expel mucus from the airway through coughing, which can clear airways and improve oxygenation.
Ineffective Breathing Pattern
Inflammation of the bronchial tubes, narrowing of the airways, and mucus may cause ineffective breathing patterns. This can result in wheezing, chest tightness, and shortness of breath.
Nursing Diagnosis: Ineffective Breathing Pattern
Related to:
- Excess mucus
- Inflammatory process
- Disease Process
- Increased respiratory effort
As evidenced by:
- Bradypnea
- Tachypnea
- Cyanosis
- Hypercapnia
- Hyperventilation
- Hypoventilation
- Hypoxemia
- Hypoxia
- Orthopnea
- Nasal flaring
- Pursed-lip breathing
- Subcostal retraction
Expected outcomes:
- Patient will demonstrate an effective breathing pattern without shortness of breath and blood gas values within normal limits.
- Patient will implement two strategies to support an effective breathing pattern.
Assessment:
1. Assess the patient’s respiratory status, rate, and rhythm.
Monitor for a respiratory rate that is too fast or slow, abnormal rhythms, the use of accessory muscles, and cyanosis to the lips that signal ineffective oxygenation.
2. Assess chest x-ray and other tests.
A chest x-ray is an expected diagnostic test to assess the lungs. Pulmonary function tests may confirm or rule out other conditions, such as COPD.
Interventions:
1. Administer medications as ordered.
Medications like inhaled bronchodilators help reduce inflammation of the airways.
2. Administer oxygen as needed.
Oxygen supplementation is essential in preventing hypoxia and correcting hypoxemia during episodes of breathing difficulties in patients with bronchitis.
3. Encourage the patient to perform pursed-lip and controlled breathing techniques.
Pursed-lip breathing can help relieve dyspnea in bronchitis and advanced COPD.
4. Encourage rest periods.
Patients with bronchitis are often easily fatigued with activity. Provide additional rest periods to prevent exacerbation of breathing difficulties and reduce anxiety with breathlessness.
5. Refer the patient to pulmonary rehabilitation.
Pulmonary rehabilitation programs are effective in the reduction of exertional dyspnea in patients who have bronchitis and COPD.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- American Lung Association. (2022, November 17). Acute bronchitis symptoms, causes & risk factors. Retrieved October 2023, from https://www.lung.org/lung-health-diseases/lung-disease-lookup/bronchitis/symptoms-diagnosis-treatment
- Beers, M.H., Fletcher, A.J., Jones, T.V., Porter, R., Berkwits, M., Kaplan, J.L. (2003). The Merck Manual of Medical Information (2nd Edition). Merck and Co., Inc.
- Bronchitis – Symptoms and causes. (2017, April 11). Mayo Clinic. Retrieved October 2023, from https://www.mayoclinic.org/diseases-conditions/bronchitis/symptoms-causes/syc-20355566
- Bronchitis: Causes, symptoms, diagnosis & treatment. (2022, September 8). Cleveland Clinic. Retrieved October 2023, from https://my.clevelandclinic.org/health/diseases/3993-bronchitis
- Bronchitis. Cleveland Clinic. Reviewed: September 08, 2022. From: https://my.clevelandclinic.org/health/diseases/3993-bronchitis
- Bronchitis. Mayo Clinic. Updated: April 11, 2017. From: https://www.mayoclinic.org/diseases-conditions/bronchitis/symptoms-causes/syc-20355566
- Bronchitis. National Heart, Lung, and Blood Institute. Updated: March 24, 2022. From: https://www.nhlbi.nih.gov/health/bronchitis
- Chest Cold (Acute Bronchitis). Centers for Disease Control and Prevention. Reviewed: July 1, 2021. From: https://www.cdc.gov/antibiotic-use/bronchitis.html
- Doenges, M.E., Moorhouse, M.F., Murr, A.C. (2006). Nursing Care Plans (8th Edition). F.A. Davis Company
- Fayyaz, J. (2023, June 18). Bronchitis treatment & management: Approach considerations, symptomatic treatment, antibiotic therapy. Diseases & Conditions – Medscape Reference. Retrieved October 2023, from https://emedicine.medscape.com/article/297108-treatment#d11
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L., Harding, M. (2014). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (9th Edition). Mosby, an imprint of Elsevier Inc.
- Singh, A., Avula, A., & Zahn, E. (2023, July 13). Acute bronchitis – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. Retrieved October 2023, from https://www.ncbi.nlm.nih.gov/books/NBK448067/
- Smeltzer, S.C., Bare, B.G. (2003). Brunner and Suddarth’s Textbook of Medical – Surgical Nursing (10th Edition). Lippincott Williams & Wilkins
- Suffering from a chest cold? (2022, August 24). Centers for Disease Control and Prevention. Retrieved October 2023, from https://www.cdc.gov/antibiotic-use/bronchitis.html
- Swearingen, P.L. (2016). All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric. Mosby, an imprint of Elsevier Inc.
- Widysanto, A., & Mathew, G. (2022, November 28). Chronic bronchitis – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. Retrieved October 2023, from https://www.ncbi.nlm.nih.gov/books/NBK482437/
