Acute Bronchitis: Diagnosis and Treatment (Nursing)

00:00 So if you got this mucus and gunk, would you expect the healthcare provider to order an antibiotic for a patient with acute bronchitis? Yes or no? Hey sweet, that's a 50-50 chance of being right or wrong. So what do you think? Do we order antibiotics for a patient who has acute bronchitis? Answer is...no. Antibiotics are for bacterial infections and the majority of bronchitis or acute bronchitis infections are caused by viruses. So you don't give an antibiotic to a patient who's likely infected with the virus because that's just going to lead to an unnecessary medication and more antibiotic resistance. And we all know what we do not need is more superbugs and antibiotic resistance. So that's why somebody with acute bronchitis, we don't normally give an antibiotic to. So with acute bronchitis, it's usually caused by a virus.

00:59 Now we've listed some of them for you there; rhinovirus, coronavirus, influenza virus, respiratory syncytial virus; those are ones that normally cause bronchitis. Now, if there is a bacterial infection, it's less than 10%. So you got like a 1 in 10 chance that it might be bacteria, we got a 9 and 10 chance that it's probably caused by a virus. So here's some of the bacteria that could possibly cause acute bronchitis, Bordetella pertussis and you see the others of them there. So keeping in mind the most important point is not to memorize the names of these viruses and bacteria. The most important point is to know: 1) We don't usually prescribe antibiotics for acute bronchitis and 2) It's because acute bronchitis is most often, 9 times out of 10, caused by a virus. Okay so how do we diagnose bronchitis? Well, the patient's going to have an acute onset of a persistent cough for 1-3 weeks. So, this is really annoying for a patient to have this cough for that lung. You'll do a physical examination. Now, make sure they're not showing any clinical signs of pneumonia. So I want to make sure they don't have a fever, they don't have a fast respiratory rate (that's tachypnea). Remember tachyp, tachy means fast. Just like tachycardia means fast cardiac heart rate, tachypnea means fast respiratory rate. And also listen for signs of consolidation. So if someone has pneumonia, their breath sounds are going to be very diminished over areas of consolidation. Now when I say consolidation, that means in that lung area it's real dense because it's filled with gunk of pneumonia. So important when someone comes in with this chronic cough, we make sure they don’t have pneumonia because that we likely would treat with antibiotics. We also want to know if the patient has ever been diagnosed with COPD. If we know they have COPD and they've had this cough for 1-3 weeks, we're going to be really suspicious that it might be a chronic bronchitis. Now we'll do a chest x-ray for patients if they're starting to show us some symptoms like they have an elevated pulse, they have an elevated respiratory rate, their temperature is up, or their pulse ox is down. That's another signal to us that we probably need to do a chest x-ray because we want to make sure we rule out pneumonia. So we don't want to mix up bronchitis for pneumonia and vice versa. So how do we treat acute bronchitis? Well usually, it takes care of itself. It's usually self-limited. That means if the patient just gets good rest, stays well hydrated, eats healthy, it should resolve without any specific therapy from us usually in about 1-3 weeks. Now antibiotics are not prescribed. Why? Right.

03:52 Because 9 times out of 10 it's going to be caused by a virus and antibiotics don't touch viruses.

03:58 So your job is to help the patient understand supportive care. Help them understand why they're not leaving with a script for an antibiotic. Help them know that it's because it's likely caused by a virus and you'll heal by yourself if you just take good care of yourself, get plenty of rest, and stay well hydrated. Now, why are we recommending that somebody with bronchitis stay well hydrated? Well when patients get dehydrated, secretions get even thicker and harder to get out. So we want them to stay well hydrated so those secretions are a little looser and easier for them to expectorate or to cough up.