Bronchitis Nursing Diagnosis & Care Plan

Bronchitis is a respiratory condition characterized by the inflammation and accumulation of mucus in the lower respiratory tract, specifically the bronchioles. This condition can either be acute or chronic. 

Acute bronchitis is a common condition that usually develops from a cold or other respiratory infection and resolves within 7 to 10 days without lasting effects. Acute bronchitis is often caused by viruses such as a cold or flu. Symptoms will resolve within 2-3 weeks.

Chronic bronchitis is characterized by constant inflammation of the bronchial tubes and is often associated with chronic lung conditions such as emphysema, asthma, cystic fibrosis, or COPD. Chronic bronchitis is triggered by air pollution, smoking, inhalation of chemicals, and older age. Cough associated with chronic bronchitis may last several months.

Clinical manifestations of bronchitis include cough with clear, white, or yellowish sputum, shortness of breath, fatigue, chest discomfort, and fever. Acute bronchitis may manifest with cold symptoms like body aches and headaches

While bronchitis can resemble a common cold in the first few days of the illness, additional diagnostic tests like chest x-ray, sputum tests, and pulmonary function tests may be ordered to confirm the diagnosis and rule out other causes. 

Nursing Process

The goal of treatment for patients with bronchitis is to relieve symptoms and prevent complications like pneumonia. Nurses take the lead in providing supportive interventions and patient education. Nurses closely monitor patients at higher risk, such as those with compromised immune systems, to prevent worsening complications.

Nursing Care Plans Related to Bronchitis

Ineffective Airway Clearance

Bronchitis is characterized by inflammation of the bronchi, which are the main airways of the lungs, causing them to become irritated and swollen. Its main symptoms include cough and mucus accumulation, leading to ineffective airway clearance.

Nursing Diagnosis: Ineffective Airway Clearance

Related to:

  • Disease process
  • Inflammatory process
  • Excessive mucus
  • Mucus plug

As evidenced by:

  • Adventitious breath sounds 
  • Altered respiratory rhythm
  • Cyanosis
  • Diminished breath sounds
  • Excessive sputum
  • Hypoxemia
  • Ineffective cough 
  • Ineffective sputum elimination 
  • Nasal flaring

Expected outcomes:

  • The patient will be able to maintain an effective cough and clear breath sounds
  • The patient will demonstrate patent airways as evidenced by respiratory rate and depth within normal limits

Assessment:

1. Assess airways for any obstruction.
Ineffective airway clearance interferes with gas exchange and must be addressed right away.

2. Auscultate breath sounds.
The presence of coarse crackles can indicate fluid or secretions in the airways. Wheezing indicates constricted airways.

3. Assess blood gas values and oxygen saturation.
Airway obstruction can cause significant oxygenation problems. Oxygen saturation of less than 90% requires intervention.

Interventions:

1. Administer supplemental oxygen as ordered.
Oxygen administration can correct hypoxemia associated with ineffective airway clearance and breathing problems.

2. Elevate the head of the bed.
An upright position allows for optimal lung expansion to facilitate efficient breathing.

3. Suction secretions as needed.
Accumulation of secretions in the airways is common in patients with bronchitis. Suctioning secretions promote airway clearance.

4. Administer expectorants.
Expectorants help expel mucus from the airway through coughing, which can clear airways and improve oxygenation.


Ineffective Breathing Pattern

Inflammation of the bronchial tubes, narrowing of the airways, and mucus may cause ineffective breathing patterns. This can result in wheezing, chest tightness, and shortness of breath.

Nursing Diagnosis: Ineffective Breathing Pattern

Related to:

  • Excess mucus
  • Inflammatory process
  • Disease Process
  • Increased respiratory effort

As evidenced by:

  • Bradypnea 
  • Tachypnea
  • Cyanosis 
  • Hypercapnia 
  • Hyperventilation 
  • Hypoventilation
  • Hypoxemia 
  • Hypoxia
  • Orthopnea
  • Nasal flaring
  • Pursed-lip breathing 
  • Subcostal retraction 

Expected outcomes:

  • The patient will demonstrate an effective breathing pattern without shortness of breath and blood gas values within normal limits
  • The patient will implement two strategies to support an effective breathing pattern

Assessment:

1. Assess the patient’s respiratory status, rate, and rhythm.
Monitor for a respiratory rate that is too fast or slow, abnormal rhythms, the use of accessory muscles, and cyanosis to the lips that signal ineffective oxygenation.

2. Assess chest x-ray and other tests.
A chest x-ray is an expected diagnostic test to assess the lungs. Pulmonary function tests may confirm or rule out other conditions, such as COPD.

Interventions:

1. Administer medications as ordered.
Medications like inhaled bronchodilators help reduce inflammation of the airways.

2. Administer oxygen as needed.
Oxygen supplementation is essential in preventing hypoxia and correcting hypoxemia during episodes of breathing difficulties in patients with bronchitis.

3. Encourage the patient to perform pursed-lip and controlled breathing techniques.
Pursed-lip breathing can help relieve dyspnea in bronchitis and advanced COPD.

4. Encourage rest periods.
Patients with bronchitis are often easily fatigued with activity. Provide additional rest periods to prevent exacerbation of breathing difficulties and reduce anxiety with breathlessness.

5. Refer the patient to pulmonary rehabilitation.
Pulmonary rehabilitation programs are effective in the reduction of exertional dyspnea in patients who have bronchitis and COPD.


Deficient Knowledge

Patient education is essential in the management of bronchitis. For effective management and prevention of complications, adherence to the treatment regimen and lifestyle modifications are essential.

Nursing Diagnosis: Deficient Knowledge

Related to:

  • Misinformation
  • Inadequate access to resources 
  • Inadequate awareness of resources 
  • Inadequate commitment to learning 
  • Inadequate information 
  • Inadequate interest in learning
  • Inadequate knowledge of resources 
  • Inadequate participation in care planning
  • Lack of support for effective learning

As evidenced by:

  • Inaccurate follow-through of instructions 
  • Inaccurate statements about a topic 
  • Nonadherence to appointments or medications
  • Development of pneumonia or other complications

Expected outcomes:

  • The patient will verbalize understanding of the causes of bronchitis and its treatment
  • The patient will implement two strategies to prevent the recurrence of bronchitis

Assessment:

1. Assess the patient’s age and health literacy.
Acute bronchitis can affect children under 2 years old, with another peak incidence between ages 9 and 15. Chronic bronchitis is more prevalent in people over 45 years old. Learning strategies may need to be tailored depending on the patient’s age and learning ability.

2. Assess the patient’s willingness to learn.
The patient’s willingness and motivation to learn can affect the overall learning process. It may be important to include the primary caregivers and family members in providing information about the disease process and interventions to help support the patient on the road to recovery.

Interventions:

1. Provide accurate information about the disease process, prognosis, and treatment regimen.
Ensure the information provided is correct and delivered in easy-to-understand language. Provide brochures and reading materials as appropriate.

2. Reinforce learning through the provision of repetitive and follow-up sessions.
Frequent and regular education sessions can help improve medication and self-care management outcomes for those who have chronic conditions like chronic bronchitis and COPD.

3. Encourage vaccinations.
There isn’t a vaccination for bronchitis, but vaccinations for influenza can prevent the development of bronchitis, especially for those with weakened immune systems or who have a chronic respiratory condition.

4. Do not smoke or inhale toxins.
Smoking triggers airway inflammation. Keep children with asthma or cystic fibrosis away from air pollutants and secondhand smoke.

5. Wash hands and wear a mask.
Hand washing is the best way to prevent the introduction of viruses. Those with chronic respiratory conditions should consider wearing a mask in public places.

6. Educate that antibiotics won’t help.
Educate patients and families that bronchitis is rarely caused by bacteria but is often related to a virus in which antibiotics will not be helpful. If pneumonia develops, antibiotics will then be considered.

7. Include family members in patient education sessions.
Children and older adults diagnosed with bronchitis can benefit from the support they get from family members. Family members play an essential role in patient care, including decision-making, assisting in healthcare interventions, and improving the patient’s safety and quality of life.


References

  1. ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
  2. Bronchitis. Cleveland Clinic. Reviewed: September 08, 2022. From: https://my.clevelandclinic.org/health/diseases/3993-bronchitis
  3. Bronchitis. Mayo Clinic. Updated: April 11, 2017. From: https://www.mayoclinic.org/diseases-conditions/bronchitis/symptoms-causes/syc-20355566
  4. Bronchitis. National Heart, Lung, and Blood Institute. Updated: March 24, 2022. From: https://www.nhlbi.nih.gov/health/bronchitis
  5. Chest Cold (Acute Bronchitis). Centers for Disease Control and Prevention. Reviewed: July 1, 2021. From: https://www.cdc.gov/antibiotic-use/bronchitis.html
  6. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
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Maegan Wagner, BSN, RN, CCM

Maegan Wagner is a registered nurse with over 10 years of healthcare experience. She earned her BSN at Western Governors University. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public.