Assessment

HISTORY. Patients with acute bronchitis usually have a self-limiting upper respiratory infection that is associated with chills, fever (100°F to 102°F), malaise, substernal tightness and achiness, and cough. The patient describes a painful, dry cough that becomes productive with mucopuru-lent secretions for several days. The secretions generally clear as the inflammation subsides and the symptoms decrease.

Patients with chronic bronchitis usually have a history of smoking or occupational exposure to a respiratory irritant or pollutant. Patients generally seek healthcare when they become short of breath, have a cough, or notice increased sputum production. The cough may initially be more common in the winter months and gradually develop into a constant problem regardless of the season. Ask patients if they have experienced fatigue or difficulty with activities of daily living because of shortness of breath. Question their sleep patterns and positions; patients often need to sleep sitting up so that they can breathe better. Request that they explain their eating patterns because often a patient with chronic bronchitis has a poor appetite with difficulty eating because of shortness of breath. A decrease in the patient's weight leads to a decrease in the mass of the diaphragm, which contributes to poor respiratory muscle function.

PHYSICAL EXAMINATION. Patients with acute bronchitis appear acutely ill. Generally, they are febrile, mildly dehydrated, and somewhat short of breath. Patients with chronic bronchitis often appear short of breath, a condition that worsens as they speak. To help with breathing, they may use accessory muscles, such as the abdominal muscles, the sternocleidomastoids, and the intercostal muscles. Patients sometimes appear cyanotic. Some with advanced disease have a high PaCO2 that leads to disorientation, headaches, and photophobia (eyes are sensitive to light). Expect copious amounts of mucus that is gray, yellow, or white. Chronic bronchitis may lead to signs of right-sided heart failure, such as peripheral edema and neck vein distension. When you auscultate the patient's lungs, you may hear scattered, fine or coarse crackles and wheezing, and there may be a prolonged time for expiration.

PSYCHOSOCIAL. The patient with acute bronchitis has a self-limiting disease that lasts approximately 1 to 2 weeks. In contrast, a patient with chronic bronchitis is dealing with a chronic, progressive disease. As the disease progresses, patients become more and more dependent on others for assistance. They may feel isolated and depressed. Patients are limited in their mobility and frequently are homebound. Others are reluctant to go out if they are dependent on oxygen.

Diagnostic Highlights

Test Normal Result

Abnormality with Condition

Explanation

Sputum culture and Negative

Presence of bacteria or

Common organisms are

sensitivity

other microorganisms

Streptococcuspneumoniae,

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