Respiratory Infections
ACUTE TRACHEOBRONCHITIS
Acute
tracheobronchitis, an acute inflammation of the mucous membranes of the trachea
and the bronchial tree, often follows infection of the upper respiratory tract.
A patient with a viral in-fection has decreased resistance and can readily
develop a sec-ondary bacterial infection. Thus, adequate treatment of upper
respiratory tract infection is one of the major factors in the pre-vention of
acute bronchitis. Aside from infection, inhalation of physical and chemical
irritants, gases, and other air contaminants can also cause acute bronchial
irritation.
In
acute tracheobronchitis, the inflamed mucosa of the bronchi produces
mucopurulent sputum, often in response to Streptococcuspneumoniae,
Haemophilus influenzae, and
Mycoplasma pneumoniae. In addition, a fungal infection (eg, Aspergillus tracheobronchitis) may also
cause tracheobronchitis. A sputum culture is essential to identify the specific
causative organism.
Initially,
the patient has a dry, irritating cough and expectorates a scanty amount of
mucoid sputum. The patient complains of sternal soreness from coughing and has
fever or chills and night sweats, headache, and general malaise. As the
infection pro-gresses, the patient may be short of breath, have noisy
inspiration and expiration (inspiratory stridor and expiratory wheeze), and
produce purulent (pus-filled)
sputum. With severe tracheobron-chitis, blood-streaked secretions may be
expectorated as a result of the irritation of the mucosa of the airways.
Antibiotic
treatment may be indicated depending on the symp-toms, sputum purulence, and
results of the sputum culture. Anti-histamines are usually not prescribed
because they may cause excessive drying and make secretions more difficult to
expectorate. Expectorants may be prescribed, although their efficacy is
ques-tionable. Fluid intake is increased to thin the viscous and tenacious
secretions. Copious, purulent secretions that cannot be cleared by coughing
place the patient at risk for increasing airway obstruc-tion and the
development of a more severe lower respiratory tract infection, such as
pneumonia. Suctioning and bronchoscopy may be needed to remove secretions.
Rarely, endotracheal intubation may be required in cases of acute
tracheobronchitis leading to acute respiratory failure. This may be necessary
for patients who are se-verely debilitated or who have coexisting diseases that
also impair the respiratory system.
In
most cases, treatment of tracheobronchitis is largely symp-tomatic. The patient
is advised to rest. Increasing the vapor pres-sure (moisture content) in the
air will reduce irritation. Cool vapor therapy or steam inhalations may help
relieve laryngeal and tracheal irritation. Moist heat to the chest may relieve
the sore-ness and pain. Mild analgesics or antipyretics may be indicated.
Acute
tracheobronchitis is frequently treated in the home setting. A primary nursing
function is to encourage bronchial hygiene, such as increasing fluid intake and
directed coughing to remove secretions. The nurse should encourage and assist
the patient to sit up frequently to cough effectively and to prevent retention
of mucopurulent sputum. If the patient is treated with antibiotics for an
underlying infection, it is important to emphasize the need to complete the
full course of antibiotics prescribed. Fatigue is a consequence of
tracheobronchitis; therefore, the nurse must cau-tion the patient against
overexertion, which can induce a relapse or exacerbation of the infection.
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