This document provides information about acute tracheobronchitis. It defines acute tracheobronchitis as a contagious viral infection that causes inflammation of the trachea and bronchial tubes, narrowing the airways. Risk factors include smoking, exposure to irritants, and genetic predisposition. Signs and symptoms include cough, mucus production, shortness of breath, and wheezing. Treatment involves rest, increased fluids, inhaled bronchodilators, cough suppressants, and antibiotics if a bacterial infection is present. Nursing care focuses on airway clearance, breathing exercises, maintaining a patent airway, monitoring for complications, and preventing spread of infection.

1. 7/24/2022 1

2. ACUTE TRACHEOBRONCHITIS
Prepared by:
RN Arpana Bhusal
BNS
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3. Contents
 Definition
 Incidence
 Risk factors
 Sign and symptoms
 Diagnostic evaluation
 Prevention
 Treatment and
 Nursing management
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4. Definition
 Acute tracheobronchitis is a contagious viral infection that causes
inflammation of trachea and bronchial Tubes. These are the
airways that carry air into your lungs. When these tubes get
infected they swell, mucus (thick fluid) forms inside them. This
narrows the airways, making it harder for you to breathe.
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5. Cont..
 Infection or other factor that irritate the lungs cause acute
bronchitis. The same viruses that causes colds and the flu often
cause acute bronchitis. These viruses are spread through the air
when people cough. They are also spread through physical
contact. Acute bronchitis lasts from a few days to10 days.
 Certain substances can irritate lungs and airways and risk for
acute bronchitis e.g., solid inhaling, cigarette, air pollution, dusts
etc.
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7. Incidence
 Acute bronchitis affects approximately 5% of adults in the U.S
annually and it becomes more common during cold seasons.
Generally, it depends on the season of year, vaccination status and
presence of an epidemic.
 Acute bronchitis affects around 44 in 1000 adults (age over 16
years) per year in the U.K, with around 82% of episodes occuring
in winter or autumn.
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8. Risk factor
 Genetic predisposition
 Cigarette smoke: people who smoke or who live with a smoker
are at higher risk of both acute and chronic bronchitis.
 Low resistance: this may result from another acute illness, such
as a cold, or from a chronic condition that compromises immune
system. Older adults, infants and young children have greater
vulnerability to infection.
 Exposure to irritants on the job: the risk of developing
bronchitis is greater if we work around certain lung irritants, such
as grains or textiles, or are exposed to chemical fumes.
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9. Cont…
 Gastric reflux: Repeated bouts of severe heartburn can irritate
the throat and make more prone to develop bronchitis.
 Having allergies and asthma
 Working with certain substances that causes irritation of airways
like:
• Ammonia
• Chlorine
• Minerals
• Dusts from farming
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10. Etiology
 Viral :
• Influenza A and B, Parainfluenza, Adenoviruses, Rhinovirus,
Respiratory syncytial virus and Human metapneumovirus.
 Bacterial
• Mycoplasma pneumonia, Chlamydophila pneumonia, Bordetella
pertussis, Staphylococci.
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11. Pathophysiology
Due to etiological factors
Microorganism enter into the respiratory tract by inhalation
Widespread inflammation occurs
Thin mucus lining of the bronchi can become irritated and swollen
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12. Cont..
Goblet cell metaplasia and hypersecretion of mucus
Coughing as a reflex that works to clear secretion from the lungs
Alveolar fluid response
Narrowing of the airways
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13. Cont…
ventilation decrease as a secretion thickens
mucus within the airways produces resistance in small
airways and can cause severe ventilation perfusion imbalance
tracheobronchitis
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14. Sign and symptoms
 Inflammation and swelling of the bronchi
 Coughing
 Production of clear, white, yellow, grey or green mucus(sputum)
 Shortness of breath
 Wheezing
 Fatigue
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15. Cont…
 Fever and chills
 Feeling “wiped out”
 Runny, stuffy nose
 Chest discomfort
 Body aches and chills
 Sore throat
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16. Diagnostic evaluation
 Chest x-ray: a chest x-ray can help determine if there is
pneumonia or another condition that may explain cough.
 Sputum tests: sputum sample shows neutrophil granulocyte
(inflammatory white blood cell) and culture showing that has
pathogenic microorganisms such as streptococcus species.
 Pulmonary function tests: during a pulmonary function test, a
device called spirometer measures how much of air our lungs can
hold and how quickly we can get air out of lungs. This tests
checks for signs of anemia or emphysema.
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17. Cont..
 A blood test would indicate inflammation(as indicated by raised
white blood cell count and elevated C-Reactive protein
 ABG level
 Bronchoscopy
 High resolution computed tomography(HRCT)
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18. Complications
 Chronic bronchitis
 Bronchiectasis
 Tuberculosis
 pneumonia
 Sinusitis
 Hemoptysis
 Pneumothorax
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19. Management
 Bed rest
 Increased fluids
 Patients with wheezing may benefit from an inhaled B2 agonist (eg.
Albuterol) or an anticholinergic (e.g., ipratropium) for <7 days
 If cough persists for >2 week because of airway irritation, some patients
benefit from a few days of inhaled corticosteroids.
 Anti-inflammatory and steroid drugs like (prednisolone) reduces the
inflammatory reaction and thus decrease the bronchial swelling and
secretion of mucus
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20. Contd…
 Antitussives should be used only if the cough is interfering with
sleep
 Theophylline, an oral medication that relaxes the muscles in the
airways so they open up more, relieves breathing difficulties
 Over-the-counter (OTC) cough suppressants such as
dextromethorphan
 Anti-viral medication: oseltamivir 75 mg twice daily
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21.  Anti-viral medication: Oseltamivir 75 mg twice daily for 5 days,
Zanamivir 10mg (2 inhalations) twice daily for 5 days, Peramivir
IV 600mg once
 Antibiotics: Azithromycin 500mg orally once for 5 days,
Clarithromycin 500mg orally twice daily for 5days,
Erythromycin 500mg orally 4 times daily for 14 days,
Trimethoprim/Sulfamethoxazole 1 tablet orally twice daily for 14
days
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22. Cont..
 Pulmonary rehabilitation; a pulmonary rehabilitation can teach
breathing exercises and techniques that may help reduce
breathlessness and improve ability to exercise.
 Nutrition therapy
 Supplemental oxygen; in case of severe emphysema with low
blood oxygen levels, using oxygen regularly at home and when
exercise may provide some relief. Many people use oxygen 24
hours a day. It is usually administered via narrow tubing that fits
into the nostrils.
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23. Prevention
 Avoiding or quit smoking
 Avoiding lung irritants, such as smoke, dust, fumes, vapors and
air pollution
 Wearing a mask to cover the nose and mouth when pollution
levels are high
 Washing the hands often to limit exposure to germs and bacteria
 Asking about vaccinations to protect from pneumonia and flu.
 Avoid exposure to second hand smoke and do not expose children
to second hand smoke
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24. Nursing Intervention
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25. Assessment
 Fever, tachypnea, mild dyspnea, pleuritic chest pain
 Cough with clear to purulent sputum production
 Diffuse rhonchi and crackles (contrast with localized crackles
usually heard with pneumonia)
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26. Nursing diagnosis
 Impaired gas exchange related to obstructed airways
 Ineffective airway clearance related to presence of excessive,
thickened mucous secretions
 Ineffective breathing pattern related to retained secretions
 Sleep pattern disturbance related to difficulty inbreathing
 Risk for spread of infection related to stasis of secretions and
decreased ciliary function
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27. Nursing interventions
 Impaired gas exchange related to obstructed airways
• Encourage mobilization of secretion through ambulation,
coughing, and deep breathing
• Encourage rest, avoidance of bronchial irritant, and a good diet
to facilitate recovery
• Advise the patient that a dry cough may persist after bronchitis
because of irritation of airways.
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28. Contd..
• Advise the patient that a dry cough may persist after bronchitis
because of irritation of airways. Suggest avoiding dry
environments and using a humidifier at bedside
• Chest physiotherapy to mobilize secretions, if indicated
• Instruct the patient to complete the full course of prescribed
antibiotics and explain the effect of meal on drug absorption.
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29.  Ineffective airway clearance related to presence of excessive,
thickened mucous secretions
• Elevate head of the bed, assist patient assume position to ease
work of breathing.
• Encourage deep slow or pursed lip breathing as individually
tolerated or indicated.
• Routinely monitor skin and mucous membrane color.
• Encourage expectoration of sputum: suction when indicated.
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30.  Evaluate level of activity tolerance. Provide calm and quiet
environment
 Monitor vital signs and cardiac rhythm
 Evaluate sleep patterns, note report of difficulties and whether
patient feels well rested.
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31. Contd…
 Ineffective breathing pattern related to retained secretions
• Place patient in a semi-fowler’s position
• Place a pillow when the client is sleeping to provide adequate
expansion of lung while sleeping
• Maintain a patent airway, suctioning of secretions may be done as
ordered
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32. Cont..
• Provide respiratory support. Oxygen inhalation is provided as per
doctor’s order
• Administer prescribed cough suppressants and analgesics and be
cautious, however because opioids may depress respirations more
than desired
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33.  Sleep pattern disturbance related to difficulty of breathing
• Monitor level of consciousness or mental status
• Promote comfort measures such as back rub and change in
position as necessary
• Provide quiet environment
• Administer pain medication as ordered
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34. Cont..
• Limit the fluid intake if nocturia is a problem
• Observe provision of emotional support
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35.  Risk for spread of infection related to stasis of secretions and
decreased ciliary function
• Review importance of breathing exercises, effective cough,
frequent position changes and adequate fluid intake
• Turn the patient in every 2 hours
• Encourage increase fluid intake
• Recommend rinsing mouth with water to prevent risk of oral
candidiasis
• Administer antimicrobial such as cefuroxime as indicated.
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36. References
 Mandal G.N., textbook of medical surgical nursing published by
makalu publication house, 3rd edition, page no: 88-90
 Brunner and siddarth, textbook of medical-surgical nursing, 13th
edition page no: 104
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