5 Bronchitis Nursing Care Plans

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Bronchitis NCLEX Review Care Plans

Nursing Study Guide on Bronchitis

Bronchitis is a medical condition owing to viral infection of the respiratory system. It is characterized by an inflammation in the lower respiratory tract, specifically affecting the bronchioles, the small sacs of lungs, and the alveoli.

Bronchitis develops when the bronchial tubes, which acts like a tubing system that brings in oxygen to the lungs, become swollen due to blockage.

Obstruction of the airway may be brought about by the accumulation of mucus, cell debris, and fluid build-up, thereby impeding adequate respirations. When there is airway obstruction, it causes persistent dry cough and mucus to the patient.

Types of Bronchitis

There are two types of bronchitis, and these are the following:

  • Acute bronchitis – more common type of bronchitis where symptoms usually remain for several weeks, however it doesn’t cause problems beyond that time period.
  • Chronic bronchitis – considered to be a serious, long-lasting condition which may keep coming back or reappearing later on. 

Signs and Symptoms of Bronchitis

  •  Difficulty with breathing
  • Chest congestion
  • Persistent dry cough which may cause mucus to appear the color white, green, or yellow

Meanwhile, the symptoms for acute bronchitis may exhibit the following:

  • Fever and sore throat
  • Chills
  • Body pain
  • Exhaustion
  • Congestion

Causes of Bronchitis

Infections with the common viruses that cause colds and flu usually result in bronchitis. Other than infectious agents, bacteria may also cause this disease to arise. Therefore, as the body’s immune system fights off the pathogen, it correspondingly produces mucus which may obstruct the smaller airways (bronchioles), causing difficulty with breathing and respiration.

The most common causes attributed to chronic bronchitis include:

  • Smoking for an extended period of time, or exposure to secondhand smoke
  • Presence of air pollution in the environment and other debris, dust particles, and chemical fumes

Risk factors of Bronchitis

  • Smoking – smoking is the most attributable cause of chronic bronchitis. Persistent and uncontrolled smoking increases chances and risk of developing acute and chronic bronchitis.
  • Individuals who suffer from asthma or other allergies
  • Immunocompromised or having a weak immune system – for geriatric individuals, children and immunocompromised patients who are prone to catch colds, they are likely to develop bronchitis.
  • Family history from lung disease

Complications

Individuals who suffer from bronchitis are likely to develop the following problems:

  • Presence of blood or tenacious mucus when coughing
  • Inability to sleep due to excessive coughing
  • Chest pain
  • Abnormal breathing sound often resembling a barking sound
  • Weight loss

Diagnosis

A significant test of diagnosis is by having the signs and symptoms checked by physical examination. The attending physician may ask about the presence of cough, fever and cold, and possibly the appearance of mucus upon expectorating. Other tests that the attending doctor may order include:

  • Auscultation – presence of abnormal breathing sound may indicate presence of bronchitis
  • Chest X-ray – to rule out other lung diseases or conditions such as pneumonia
  • Blood tests
  • Nasal swab
  • Checking oxygen levels

Treatment for Bronchitis

Acute bronchitis is self-limiting or usually disappears after a couple of weeks. However, if the cause may be due to bacteria (which is uncommon), the attending physician may prescribe the patient antibiotics. If an individual suffers from asthma or allergies, then the attending physician may recommend use of an inhaler to help provide proper aeration by opening the airways. Other ways to ease the symptoms of acute bronchitis are the following:

  • Getting plenty of rest
  • Staying hydrated
  • Use of humidifier to loosen mucus
  • Treatment of cough with over-the-counter cough medicines

Prevention of Bronchitis

To reduce the risk of acquiring or developing bronchitis, the predisposing activity of smoking should be avoided. Other recommendations include:

  • Up-to-date flu and pertussis vaccination
  • Always perform hand sanitation or handwashing
  • Wearing of face mask in areas filled with irritants or air pollutants

Nursing Care Plans for Bronchitis

Nursing Care Plan 1

Nursing Diagnosis: Ineffective airway clearance related to trachea, bronchial obstruction, and viral infection secondary to bronchitis as evidenced by persistent dry cough, excess mucus, dyspnea, and tachypnea.

Desired Outcome: The patient will display clear coughing and breath sounds, devoid of dyspnea and presence of cyanosis.

InterventionRationale
Check the airway for any obstructions.Careful management of the airway is of prime concern since it may interfere with the gas exchange process in the patient’s body. Assurance that the airway is unobstructed should be established and assessed, most markedly in cases such as trauma, cardiac arrest, and neurological decompensation. 
The nurse should perform a respiratory assessment, remarking the patient’s breathing quality such as depth, rate, and pattern. Observe the patient for shortness of breath upon exertion, respiratory splinting and increased use of respiratory muscles.Straining and evident inspiratory effort are grounds for possible respiratory problems. Usually, deterioration in the respiratory rate and breathing rhythm are reparatory processes during airway obstruction. 
Evaluate the patient’s internal respiratory sounds using a stethoscope or perform chest auscultation. Presence of abnormal respiratory sounds may indicate potential issues of the upper quadrant of the body, but most especially as an effect of airway obstruction. Abnormal breathing may present as fluid noises or wheezing, which is usually attributed to the accumulation of mucus. 
Evaluate patient’s cough by examining its patterns such as the duration, frequency, paroxysm and activity; appearance of mucus (e.g., green, yellow, clear), its amount, viscosity (e.g., thick, bubby rubbery or frothy), or if the patient exhibits huffing, swallowing of phlegm, or having a congested nose. Coughing or rapid expulsion of air is usually carried out in a manner of expelling or clearing the respiratory pathway. If there is possible airway obstruction, then the patient might resort to coughing as a temporary airway clearance. Hence, any signs of ineffective coughing are possible determinants of suffering from bronchospasm, tenacious mucus accumulation, respiratory muscle fatigue.  
Assist the patient’s position by placing the head of the bed at a 30 degrees angle. Older children may vertically sit up while resting the head against the pillow atop the overbed tableDifficulty in lung expansion may occur, especially when the patient is assuming a supine position. Sitting or standing helps prevent the limit of lung expansion when one is under a prone or recumbent position. Doing such, elevates the patient’s breathing pattern since it allows the lungs to expand, thereby restoring proper respiration.

Nursing Care Plan 2

Nursing Diagnosis: Ineffective Breathing Pattern related to increasing respiration effort, inflammation, trachea and bronchial obstruction secondary to bronchitis as evidenced by cough, breathing difficulty, shallow breathing, dyspnea and tachypnea

Desired Outcome: The patient will demonstrate a clear respiration pace characterized by normal rate and depth of breathing, and absence of dyspnea.

InterventionRationale
Evaluate the patient’s respiratory status at an interval of 2 to 4 hours and regularly for patients suffering from a decreased respiratory rate or apneic events.When the patient is physically exhausted or may have undergone physical activity, a change in the breathing pattern is likely to occur. And oftentimes, these changes in the respiratory rate helps with the assessment of respiratory function.    
Examine the patient’s chest wall by performing chest palpation. Auscultate for any abnormal breathing pattern and noise that might reveal presence of airway obstruction or problems with inspiratory and expiratory movement of respiratory muscles. Observe for the presence of crackles and low-pitched sounds such as rhonchi.Demonstrates an inherent problem with breathing or respiratory movement. This also allows investigation of certain ailments and issues that may have cause such.
Observe the patient’s level of consciousness.Since the respiratory system brings in oxygen to the body, a compromise in its function can affect other areas of the body, particularly the brain, when there is a lack of oxygen supply. The patient may exhibit signs and symptoms of restlessness, disorientation, and impatience if there is brain hypoxia.
Evaluate and observe the patient’s respiratory status, oxygen saturation, and pulse rate using an instrument for pulse oximetry.Pulse oximetry is point-of-care testing used to screen and assess the patient’s respiratory status. This enables an overview of the efficiency of the lungs and generally determine if the patient is in need of supplemental oxygen therapy.

Nursing Care Plan 3

Nursing Diagnosis: Anxiety related to altered health status of patient and challenge for hospitalization secondary to bronchitis as evidenced by increased alertness, worry, and concern about hospitalization.

Desired Outcomes:

  • The patient will no longer feel anxiety, or his/her worries will decrease.
  • The patient will feel relaxed and at ease.
InterventionRationale
Examine the patient by validating observations with open-ended questions. Ask the patient about his/her worries and anxiety. Determine its cause, source, and triggers.Determining the cause and manifestations of anxiety helps investigate and realize possible interventions to ease it. The causes of anxiety are likely attributed to fear and doubtfulness with treatment. Hence, it is crucial to take note of the patient’s temperament and sensibilities. Employing the use of open-ended questions enables feelings of openness and control to the patient.
Impart open communication with the patient’s parents, guardian, or loved ones and accommodate their questions and inquiries with honesty and understanding.This helps build a positive environment for the patient and aids in stipulating a support system.
Encourage the patient to express his/her worries, questions or concerns about the illness, treatment plan, and care management.The patient may experience worries, and doubts. Hence, providing him/her with a chance to verbalize any feelings and worries reduces uneasiness, nervousness and distress.
Clearly explain and clarify the outline of the treatment plan, its procedures, process, tests, and diagnostic relevance to the condition.Providing the patient or even the parents, guardian and loved ones with information on the prescribed plan helps alleviate worries and anxiety. It also prevents fear of an unfamiliar situation and event.

Nursing Care Plan 4

Nursing Diagnosis: Fatigue related to increased work of breathing secondary to bronchitis as evidenced by lethargy, vulnerability, irritability, powerlessness, and incapability to eat.

Desired Outcomes: The patient will resume doing daily activities including eating and drinking on their own.

InterventionRationale
Observe the patient for any signs of weakness, lethargy and fatigue, which may present as restlessness in bed and inability to sleep.Closely observing and monitoring the patient’s ability to relax and sleep aids identify the presence of dyspnea and determine the effects of physical exertion or activity on the patient’s respiration, which may also affect sleeping and eating.
Appoint appropriate and well-thought-out schedules and allow the patient to rest in a calming and comfortable environment.This provides the patient ample time to rest and regain his/her energy reserves. It also reduces any stimuli that may arouse activity, thereby reducing the chances of fatigue.
Do not disturb the patient’s rest not unless necessary. Conduct all care processes at one occasion or time only instead of doing multiple sweeps in the patient’s schedule.The patient may have trouble recovering with his/her rest once interrupted. As much as possible, do care processes at one time as to avoid any interruptions during the patient’s rest.
Assist the patient or patient’s parents, guardians or loved ones in formulating a plan for meals, bathing and the like, which would not interfere with any rest period.The patient or parents might know well in terms of the suitable time to administer feeding and certain activities. It is important to adapt to the patient’s usual needs or pattern of actions in order to promote an effective plan.

Nursing Care Plan 5

Nursing Diagnosis: Deficient knowledge related to lack of knowledge about the respiratory syncytial virus, secondary to bronchitis as evidenced by articulation of lacking understanding and knowledge about RSV.

Desired Outcome: The patient will display clear understanding and knowledge about the disease, its transmission, method of prevention and treatment.

InterventionRationale
Determine knowledge, and information about the condition: the complications of disease, manifestations, transmission, treatment and prevention.Evaluating the existing information and literature on the disease state aids in answering doubts and worries as to its transmission. It is also necessary to provide background to the patient about its manifestations, as in respiratory distress, tachypnea and dyspnea, in order to recognize the need for proper medical attention and intervention.
Educate the patient or the parents, guardian or loved ones about the virus transmission. The direct and indirect contact by means of the mucous membranes (eyes and nose) and instruct the patient to avoid touching these areas of concern.Educating the patient about the virus’ direct and indirect contact transmission helps avoid certain activities—such as kissing, hugging, and touching fomites, that would increase risk to infection.
Explain the correct way of hand sanitation and emphasize the importance of handwashing.Handwashing is one of the best methods to ward off any contaminants, bacteria and infectious agents since the hands are the common carriers of these infective agents. This is an important measure of preventing transmission thus, promoting awareness and education helps reduce risk to possible infection.
Encourage proper nutrition and hydration—stress on the importance of a good, and balanced diet.Boosting the immune system helps the body fight off pathogens that would cause infection and diseases. It is one of the most natural and recommended ways of prevention that instills some sort of barrier that may offer protection, fast recovery, reduced risk and exhaustion.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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