NR 507 Week 2: Discussion Part Two

Tammy is a 33-year-old who presents for evaluation of a cough. She reports that about 3 weeks ago she developed a “really bad cold” with rhinorrhea. The cold seemed to go away but then she developed a profound, deep, mucus-producing cough. Now, there is no rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Tammy has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves. Through and extensive work-up, she is diagnosed with bronchitis.

1. What is the etiology of bronchitis?
2. Describe in detail the pathophysiological process of bronchitis.
3. Identify hallmark signs identified from the physical exam and symptoms.
4. Describe the pathophysiology of complications of bronchitis.
5. What teaching related to her diagnosis would you provide?

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Tammy is a 33-year-old who presents for evaluation of a cough SAMPLE APPROACH

1. What is the etiology of bronchitis?

There are two kinds of Bronchitis: Acute Bronchitis, that is caused by “Infections or lung irritants,” and Chronic Bronchitis, that is caused by “repeatedly breathing in fumes that irritate and damage lung and airway tissues” (National Heart, Lung, and Blood Institute, 2018). This could be like smoking or inhaling second-hand smoke. The etiology of bronchitis is the same that causes upper respiratory infections. The names of the viruses that cause bronchitis are coronavirus, rhinovirus, respiratory syncytial virus, and adenovirus. Most cases of bronchitis come from a virus instead of bacteria. Current smoking is associated with a more goblet cell hyperplasia and number, and chronic bronchitis is associated with more goblet cells, independent of the presence of airflow obstruction. This provides clinical and pathologic correlation for smokers with and without COPD (Kim et al., 2015)….

Tammy is a 33-year-old who presents for evaluation of a cough SAMPLE RESPONSE

I enjoyed reading your post. I can relate to your teaching about ensuring that individuals with bronchitis wear a mask when around fumes and individuals with cold or flu symptoms. I was once diagnosed with bronchitis when I moved to West Virginia in 2009. I remember having a cold and I was very congested. Right after the cold subsided I started coughing like crazy every day all day. I coughed non-stop and would throw up from coughing too much for two months, I kept thinking it will go away. Every time I would fly I would be so embarrassed because I would cough non-stop on the plane. I took every over the counter cough suppressant and none of them worked. I finally went to the doctor and they prescribe bronchial dilator inhalers, but none of them worked. I went to the doctor the second time and she prescribed codeine which finally cleared my cough. I have learnt to wear a mask whenever I go outside due to high levels of pollen, once I moved Georgia and I sleep with a cool mist Humidifier. The doctors did not prescribe antibiotics because they told me it was a viral infection. They did some blood work and the blood work came back negative.

According to Smith (2017), a systematic review shows that there was limited evidence of clinical benefit to support the utilization of antibiotics for acute bronchitis. Some patients treated with antibiotics recovered a bit more quickly with reduced cough-related outcomes. Unfortunately surveys show that 80% of patients with acute bronchitis receive antibiotics. Antibiotic overuse contributes to emergence of drug-resistant organisms.

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