Chronic Bronchitis
Is an inflammation of the lower airways characterized by excessive secretion of mucus, hypertrophy of mucous glands, and recurring infection, progressing to narrowing and obstruction of airflow.
Assessment:
- Signs and symptoms of chronic bronchitis (insidious onset):
- Productive cough lasting at least 3 months during a year for 2 successive years.
- Thick, gelatinous sputum (greater amounts produced during superimposed infections).
- Dyspnea and wheezing as disease progresses.
Diagnostic Evaluation:
- Pulmonary function tests, to demonstrate airflow obstruction-reduced forced expiratory volume in 1 second (FEV1), FEV1 to forced vital capacity ratio; increased residual volume to total lung capacity (TLC) ration, possibly increased TLC.
- Chest X-rays to detect hyperinflation, flattened diaphragm, increased retrosternal space, decreased vascular markings, possible bullae (all in late stages).
- Arterial blood gases, to detect decreased arterial oxygen pressure (PaO2), pH, and increased arterial carbon dioxide pressure (Paco2).
- Sputum smears and cultures to identify pathogens.
Therapeutic and Surgical Interventions:
- Smoking cessation to stop the progression and preserve lung capacity.
- Low-flow oxygen to correct severe hypoxemia in a controlled manner and minimize carbon dioxide retention.
- Home oxygen therapy, especially at night to prevent turnal oxygen desaturation.
- Pulmonary rehabilitation to reduce symptoms that limit activity.
- Chest physical therapy, including postural drainage and breathing retraining.
- Lung transplant in severe cases of alpha1-antitrypsin deficiency.
Pharmacologic Intervention:
- Bronchodilators to reduce dyspnea and control bronchospasm delivered by metered-dose inhaler, other handheld devices, or nebulization.
- Inhaled corticosteriods may be useful for some with severe airflow limitation and frequent exacerbations.
- Corticosteroids by mouth or I.V. in acute exacerbations.
- Antimicrobials to control secondary bacterial infections in the bronchial tree, thus clearing the airways.
- Alpha1-antitrypsin replacement delivered by I.V. infusion.
Nursing Interventions:
- Monitor for adverse effects of bronchodilators-tremulousness, tachycardia, cardiac arrhythmias, central nervous system stimulation, hypertension.
- Monitor oxygen saturation at rest and with activity.
- Eliminate all pulmonary irritants, particularly cigarette smoke. Smoking cessation usually reduces pulmonary irritation, sputum production, and cough. Keep the patient’s room as dust-free as possible.
- Use postural drainage positions to help clear secretions responsible for airway obstruction.
- Teach controlled coughing.
- Encourage high level of fluid intake (8 to 10 glasses; 2 to 2.5 L daily) within level of cardiac reserve.
- Give inhalations of nebulized saline to humidify bronchial tree and liquefy sputum. Add moisture (humidifier, vaporizer) to indoor air.
- Avoid dairy products if these increase sputum production.
- Encourage the patient to assume comfortable position to decrease dyspnea.
- Use pursed lip breathing at intervals and during periods of dyspnea to control rate and depth of respiration and improve respiratory muscle coordination.
- Discuss and demonstrates relaxation exercises to reduce stress, tension, and anxiety.
- Encourage frequent small meals if the patient is dyspneic; en a small increase in abdominal contents may press on diaphragm and impede breathing.
- Offer liquid nutritional supplements to improve caloric intake and counteract weight loss.
- Avoid foods producing abdominal discomfort.
- Encourage use of portable oxygen system for ambulation for patients with hypoxemia and marked disability.
- Encourage the patient in energy conservation techniques.
