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Chapter: Medical Surgical Nursing: Management of Patients With Chest and Lower Respiratory Tract Disorders

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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.

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.

Pathophysiology

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.

Clinical Manifestations

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.

 

Medical Management

 

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.

 

Nursing Management

 

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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