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BRONCHITIS
Lecture 1 hour
JULIE JAMES ABDULLAH
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Learning Outcomes
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Describe Bronchitis .1 .1 Determine nursing
and its management intervention for the
patient with
Bronchitis
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Learning Content Outline
Definition and type .1 01 .1 05 Diagnosis
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Pathophysiology .1 .1 Complication
Etiology and risk factor .103 .1 07 Management
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Clinical manifestations .1 04 .1 Nursing intervention for the
patient with Bronchitis
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WHAT IS BRONCHITIS?
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Bronchi
Definition of Bronchitis
• Inflammation of the breathing tubes
within the lungs (bronchial tubes or
bronchi) as a result of an infection
(viral or bacterial) or a chemical
irritant (such as smoke or gastric
acid reflux).
• Person will end up with cough and
mucus.
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Type of Bronchitis
1. Acute bronchitis
• The inflammation causes swelling of the lining of these breathing
tubes, narrowing the tubes and promoting secretion of inflammatory
fluid.
• Most commonly, acute bronchitis is due to a viral infection.
• Acute bronchitis may also be called a chest cold.
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Types of Bronchitis
2. Chronic bronchitis
• more serious
• It keeps coming back or doesn’t go away.
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PATHOPHYSIOLOGY
BRONCHITIS
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Bronchitis Pathogenesis
Etiologic factor
Phagocyte migration, proinflammatory mediators releasing
(cytokines, enzymes), their storage in mucous membrane
Respiratory tract mucous Vessel reaction
membrane direct - Vasodilation
impairment
Increased permeability of vessel wall
Exudation
Mucous membrane oedema
Bronchial hypersecretion due to irritation and
dilation of goblet cells
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Pathophysiology Bronchitis
Irritant Mucus-secreting glands and Ciliary function
goblet cells increase excess decreases
mucus production
Bronchiol lumen Bronchiol wall muscles A lot of mucus
narrowing thicken collection
Bronchioles damaged Bronchitis
and fibrosed
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ETIOLOGY AND RISK
FACTOR
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Risk factor of Bronchitis
Elderly &
children Smoker
Weakened Exposure to History of
immune environmental respiratory
system irritants infection
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Etiology of Bronchitis
There are 3 common cause
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Etiology of Bronchitis
1. Virus
• Haemophilus Influenzae (Hemofilus Influenza)
• Consists of a genus of RNA capable of copying its own cells.
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Etiology of Bronchitis
2. Bacteria
a. Streptococcus
• A genus of spherical gram -positive bacteria found in the
form of chains.
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Etiology of Bronchitis
b. Staphylococcus
• A genus of gram-positive, spherical bacteria, is found in grape -
shaped bunches.
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Etiology of Bronchitis
c. Pneumococci
• Gram-positive, alpha-hemolytic diplococcus bacterium and also from
the family of the genus Streptococcus.
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Etiology of Bronchitis
3. Air pollution including cigarette smoke, chemical fumes and dust
are often the cause of chronic bronchitis.
All these conditions will cause irritation and then inflammation of the
airways
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CLINICAL
MANIFESTATIONS
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Clinical Manifestations of Bronchitis
1. Acute bronchitis 2. Chronic bronchitis
• Persistent coughing and sputum
• The cough contains little or no
phlegm production that is getting worse and
worse throughout the day and night.
• Mild fever (less than 38.3 ° C)
Usually the cough gets worse in the
• Dyspnoea
morning
• tachycardia
• Difficulty breathing and chest tightness
• Sore throat
• Sometimes it sounds ronchi
• Muscle pain
(auscultation) / wheezing
• Fatigue • Disruption during activities such as
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DIAGNOSIS
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Assessment of Bronchitis Patients
A. OBJECTIVE DATA
1. Physical Examination
i. Percussion - resonance
ii. Auscultation - normal to decreased breathing sounds, wheezes
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Assessment of Bronchitis Patients
2. Radiology
• C X R to see the condition of the lungs.
3. Lab test
• TWBC - Leucocytosis (increase in the number of leukocytes in the
blood)
• ESR (erythrocyte sedimentation rate) to see the erythrocyte
sedimentation rate
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Normal CXR
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Increased bronchial
markings (due to mucus)
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Assessment of Bronchitis Patients
• Sputum C + S (sputum culture and sensitivity)-to determine effective
micro-organisms and drugs.
• Arterial Blood Gas (ABG) - assesses the status of oxygen and carbon
dioxide in the blood
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Assessment of Bronchitis Patients
4. Lung Function Test
• test uses spirometry
• to assess lung function
• Vital capacity - the volume of air that can be inhaled into the lungs
during maximum inspiration followed by maximum expiration time
(4.8 litres)
• Tidal Volume - the volume of air inhaled and exhaled in one breath of
0.5 liters.
• Residual volume - the volume of gas in the lungs at the end of the
maximum exhalation of 1.2 liters.
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Assessment of Bronchitis Patients
B. SUBJECTIVE DATA
1. Purulent cough usually presents for acute bronchitis.
2. Fever
3. Malaise
4. Rhinorrhoea or nasal congestion
5. Sore throat
6. Wheezing
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Assessment of Bronchitis Patients
B. SUBJECTIVE DATA
7. Dyspnoea
8. Chest pain
9. Myalgias or arthralgias
10. Smoking
11. Occupational history-occupations that involve dust, dust, cold
temperatures
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MANAGEMENT
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Management
1. Pharmacology
- Antibiotic broad-spectrum
- Antipyretic
- Mucolytic agent
- Cough expectorant
- Antihistamine
- nebulizer
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Antibiotic
a. Erythromycin
• 250-500 mg PO QID atau 333 mg PO
TDS
• dose paeds: 30-50 mg/kg/d PO QID
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Antibiotic
• Contraindications: hypersensitivity;
hepatic impairment
• Precautions: discontinue if nausea,
vomiting, malaise, abdominal colic,
or fever occur
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Antibiotic
b. Clarithromycin (Biaxin)
• 250-500 mg PO bid
• Dos paeds: 7.5 mg/kg PO BID
• Precautions: diarrhoea is a possible
sign of pseudomembranous colitis;
superinfections may occur in the
event of prolonged and repeated
antibiotic therapy
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Antibiotic
c. Tetracycline (Sumycin)
• 50-500 mg PO QID
• dos paeds: <8 years: not encouraged
• >8 years: 10-20 mg/lb (25-50 mg/kg)
PO divided qid
• Kontraindikasi: hypersensitivity;
severe hepatic dysfunction
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Antibiotic
• Precautions: drug serum level
determinations in prolonged
therapy; use during tooth
development (i.e., lasting from the
latter half of pregnancy up to 8
years) can cause permanent tooth
discoloration; Fanconi like syndrome
will occur with outdated
tetracyclines
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Antibiotic
d. Doxycycline (Bio-Tab, Doryx,
Vibramycin)
• 100 mg PO BD
• dos paeds: <8 years: not encouraged
• >8 years: 2-5 mg/kg/d PO QID atau
divided q12h; not to exceed 200
mg/d
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Antibiotic
e. Trimethoprim-sulfamethoxazole
(Bactrim)
• 160 mg TMP/800 mg SMZ PO q12h
for 10-14 d dos paeds: <2 months:
contraindication
• >2 months: 15-20 mg/kg/d (TMP) PO
divided tds/qid for 14 d
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Antibiotic
• Precautions: stop if showing rash or
signs of adverse effects, changes in
haematological, goiter, diuresis.
haemolysis may occur in G6PD
deficiency; give enough fluid to
prevent crystalluria and stone
formation
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Analgesic / Antipyretic
• To control fever, myalgias and arthralgias
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Analgesic / Antipyretic
a. Ibuprofen (Ibuprin, Advil, Motrin)
• 400-800 mg PO q4-6h (dos paeds: 10
mg/kg PO q6-8h)
• Kontraindikasi: peptic ulcer disease;
recent GI bleeding or perforation;
renal insufficiency; high risk of
bleeding
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Analgesic / Antipyretic
b. Acetaminophen (Tylenol, Panadol,
Aspirin-free Anacin)
• 625-1000 mg PO q4h; not to exceed
4 g/d
• dose paeds: <12 years: 10-15
mg/kg/dose PO q4-6h PRN; not
more than 2.6 g/d
• > 12 years: 325-650 mg PO q4h; no
more than 5 doses in 24 h)
• Contraindications: G6PD Deficiency
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Bronchodilator
Make breathing easier by relaxing the muscles in the lungs and
widening the airways (bronchi).
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Bronchodilator
a. Albuterol sulfate (Proventil,
Ventolin)
• 2 puffs q4-6h or 2-4 mg PO TDS/QID
• dose paeds: 0.1-2 mg/kg PO TDS
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Antiviral
• Medications that help body to fight off certain viruses that can
cause disease.
• Antiviral drugs are also preventive.
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Antiviral
a. Oseltamivir (Tamiflu)
• Acute illness: 75 mg PO BD for 5 d
Prophylaxis: 75 mg PO QID for 10 d
• Dos paeds:
• Acute illness: <1 year: Not indicated
>1 year: <15 kg: 30 mg PO BD for 5 d
>15-23 kg: 45 mg PO BD for 5 d >23-
40 kg: 60 mg PO BD for 5 d >40 kg:
Administer as in adults
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