00:00
Okay so let's break that down for you. As a nurse, what do
you want to educate the patient
about specifically? Well, make sure any patient knows when
they should contact their
healthcare provider. So somebody that we think has acute
bronchitis, we want them to know
"Hey if you have any signs of a new onset of fever, call us.
If it gets harder for you to breathe,
call us. If your symptoms are lasting longer than 3-4 weeks,
call us." And lastly, "Oh bloody
sputum, what you're coughing up looks bloody, definitely
call us." Now, don't use that alarmed
face with the patient, but what I want you to recognize is
no matter which patient you're
interacting with, no matter what their diagnosis is, it's
very important that you help them
understand the symptoms and signals that mean hey, they need
a healthcare professional to
check this out because they might be getting into some
trouble or complications. Now acute
bronchitis is usually caused by virus and you'll educate
them why we're not giving them the
antibiotic. Why do we keep talking about it? Because it's a
major patient dissatisfier. A lot of
times patients live with the misconception that they didn't
get the care they need, want them
to understand because we think it's caused by a virus, we
don't want to give you an antibiotic
because that's going to make more superbugs like MRSA and
VRE and we have enough of that
already. So you want to reinforce with them we have paid
attention to them, we have done a
detailed assessment, we've ruled out pneumonia. If we're
worried about them having pneumonia,
we would give an antibiotic. But since we think it's
bronchitis, we think it's viral, that's why
they're not getting an antibiotic. Don't rush through this
point. It's really important that you
clearly articulate in a way that the patient can understand.
Now you can talk to them about
the appropriate over-the-counter medications for supportive
care so we're going to kind of
deal with the symptoms. They're going to have symptoms that
maybe similar feel like a common
cold symptom when someone has bronchitis. So you can
recommend acetaminophen which
they may know is Tylenol or NSAIDs. They may know like an
ibuprofen or Aleve. That might help
them with headache, muscle pain, or joint pain. Now, they
might also consider antihistamines
or decongestants. Intranasal or inhaled ones are usually
much better for them. They'll help
with that additional relief if it's appropriate for them.
So, if they can handle a nose spray,
that's usually better for an antihistamine or a
decongestant. Be careful with decongestants if
the patient has any cardiac history because a lot of the
decongestants cause vasoconstriction.
02:47
If someone already has a cardiac history, that's not a good
idea. So, make sure the patient
is aware of that and the possible risk with the decongestant
if they have cardiovascular
disease. Now the cough. This is annoying for the patient and
it's annoying for those that they
live with. Why? Because the cough always seems to be worse
at night. So, we want to make
sure that they're getting good rest and so are the rest of
the people in their family. So, we
can deal with a cough with maybe some throat lozenges, warm
beverages. I love ginger tea
to take the ginger root and make some tea out of it. It's
very soothing when it goes down. We
also want them to avoid tobacco or smoke exposure. So
whether they smoke or someone
around them smokes, they get 2nd hand smoke, they really
need to avoid that on any day but
especially if they're dealing with bronchitis. Now we talked
about the over-the-counter, that's
what OTC means, over-the-counter drugs that they could
consider and also dextromethorphan
or guaifenesin. Now, dextromethorphan is in a lots of
different products. That's the one that
will help with cough. But guaifenesin is one that will help
thin those secretions. Nice to think
this was nonsense. Right? These are some brand names you
might recognize as like Mucinex.
04:10
I thought that was silly. They had a killer advertising
campaign is on mucus people but I
didn't think it was real. I thought if you just drink water
this would be fine until I got sick and
tried some of this miracle drug and it worked amazing in my
body. So for combination of the
dextromethorphan and the guaifenesin, that's going to be
really helpful to patients to actually
feel better, it will make them easier to get rid of those
secretions even in dealing with
suppressing that cough. So, that's my personal favorite and my
go to when I don't feel good.
04:46
Now bronchodilators. What we know about those, "Hey,
wouldn't that be helpful in acute
bronchitis?" Well if we do, we'll use a short-acting beta-2
adrenergic agonist but you only use
those in patients who are really having pretty significant
issues. They don't have that
wheezing or we know they have some other underlying
pulmonary disease. So your average
patient with acute bronchitis is not going to go home with a
SABA, a short-acting beta-2
adrenergic agonist. But, if the patient is wheezing or
having some pretty significant respiratory
problems or we know they already have some other pulmonary
disease issues, they probably
will make sure that they have one of these available to
them.