Medical-surgical Nursing Demystified

(^102) Medical-Surgical Nursing Demystified

• Fever in acute episodes due to infection.


• Accessory muscles are used for breathing—as respiratory effort increases,
  additional muscles are necessary to assist.


• Productive cough due to irritation of airways. Mucous is a protective reac-
  tion of the respiratory system.


• Weight gain secondary to edema in chronic bronchitis is due to right-sided
  heart failure.


• Wheezing due to inflammation within the airways.

INTERPRETING TEST RESULTS

• Shadows in affected area of the lungs on the chest x-ray during infection.


• Pulmonary function testing shows:
  
  
  • Forced vital capacity (FVC) changes because more time is needed to
    forcibly exhale an amount of air after a maximal inhalation.
  
  
  • FEV 1 is decreased because more time is needed for exhalation.
  
  
  • Residual volume (RV) is increased due to air trapping.
  
  
  
  


• Decreased oxygen and increased carbon dioxide in arterial blood gas.

TREATMENT

Acute bronchitis is treated in the short term with symptomatic treatment and

antibiotics when a bacterial infection is present. Chronic bronchitis is treated with

a combination of medications to keep the airways open, reduce inflammation

within airways, and prevent complications or exacerbations.

• Administer beta 2 -agonists by inhaler or nebulizer to dilate the bronchi:
  
  
  • terbutaline, albuterol, levalbuterol
  
  
  • formoterol, salmeterol
  
  
  
  


• Administer anticholinergics which allow for relaxation of bronchial smooth
  muscle:
  
  
  • ipratropium, tiotropium inhaler
  
  
  
  


• Administer steroids to decrease inflammation within the airways
  
  
  • hydrocortisone, methylprednisolone systemically
  
  
  • beclomethasone, triamcinolone, fluticasone, budesonide, flunisolide inhalers
  
  
  • prednisolone, prednisone orally