LOWER RESPIRATORY TRACT–Acute Bronchitis – Acute bronchitis is inflammation of one or more bronchi and occurs specifically in children younger than four year?. It is associated with previous upper respiratory infection.
Infection is caused by adenovirus, rhinovirus and repiratory syncytial virus . It also occur with such communicable diseases pertusis, measles, diptheria, typhoid fever and scarlet fever . Mycoplasma pneumonia may cause specially acute bronchitis in school age children.
Pathophysiology
Inflammation of bronchi and trachea lead to an increased volume of lower respiratory tract secretions. cartilaginous support of smooth muscles is not developed until adolescent years. constriction of lower airways result of lack of cartilaginous support of smooth muscles .
Clinical Treatment
– Cough expectorant
– Antibiotics as per sensitivity of causative organism
– Steam inhalation (warm moist air)
– Antipyretic medicines to relieve fever
See Also : Scope in Nursing Profession
Nursing Assessment
The affected children may have a dry hacking unproductive cough. There may be low grade fever, anterior chest pain which worsens by coughing. Occasional shortness of breath and whistling sound may be heard. Chest auscultation reveal high moist rales and pitcheel rhonchi which sound like wheezing of asthma. In later stages cough may become productive and the secretions initially clear may become purulent. Coughing or gagging of secretions may lead to vomiting.
Planning of Nursing Care
- Relieve cough and chest pain
- Administer drugs
- Provide nourishing diet and maintain hydration
- Provide chest physiotherapy
Implementation of Nursing Care– LOWER RESPIRATORY TRACT–Acute Bronchitis
As a nurse you need to provide care as per following objectives of nursing care:
Relieve Cough and Chest Pain
Cough is due to excessive secretions/mucus in lower airways and it can be relieved by steam inhalation. Cough suppressants are avoided in case of mild and moderate cough but if the child has severe paroxysmal cough that interferes with sleep, cough suppressants may be administered intermittently as per advice of the doctor.
Administer Appropriate Drugs
If the child has viral infection, antibiotics are not advised. But if infection is due to bacteria appropriate antibiotic may be given to the child as prescribed. If child has rhinitis a decongestant medication may be given as advised. Antihistamine drugs are usually avoided because they may cause dryness and thickening of mucus in the lower airways. You have to be very careful in giving the accurate dose at proper time and watch for any side effects.
Maintain Hydration and Provide Nourishing Diet
The chest physiotherapy is the most important method of clearing the mucus/ secretions from bronchial tree and your responsibility as a nurse is to assist the child in postural drainage. In case of more secretions postural drainage should be carried out three times daily. The child should be explained before carrying out the procedure. You have to ensure that child should not be wearing any constrictive cloth or belt during procedure. The child is placed in various positions, such as leaning position over the side of the bed and a Jackknife position over an elevated joint of the bed to drain different segments of lungs
Healthy children have few complications after bronchitis but the children who are malnourished and in poor health may develop otitis media, sinusitis or pneumonia.
