Nursing Guide to Bronchitis: Nursing Diagnosis, Interventions, & Care Plans

Bronchitis is a type of respiratory condition that is described by inflammation of the bronchial tubes. Because the bronchial tubes are responsible for carrying air to patients’ lungs, this leads to symptoms such as coughing, mucus production, shortness of breath, and chest discomfort.  

Bronchitis can be classified into two types: acute and chronic. Acute bronchitis is typically caused by a viral infection and is self-limiting, lasting for a few days to weeks. Chronic bronchitis, a form of chronic obstructive pulmonary disease (COPD), is indicated by a productive cough that lasts for at least three months and occurs for two consecutive years. 

While acute bronchitis usually can resolve on its own, chronic bronchitis is long term and requires ongoing management. Both forms of bronchitis can significantly affect quality of life, especially for individuals with comorbidities like pre-existing respiratory conditions or weakened immune systems. 

Etiology and epidemiology 

The etiology of bronchitis is based on whether it is acute or chronic. Acute bronchitis is commonly caused by viruses, such as those related to the common cold or flu. In some cases, bacteria may cause bronchitis, though this is less common. Chronic bronchitis, on the other hand, is most often linked to long-term irritation of the airways, primarily due to smoking. Other environmental factors, such as air pollution, dust, and chemical fumes, can also contribute to the development of chronic bronchitis. 

Key risk factors 

• Smoking (primary risk factor for chronic bronchitis) 
• Exposure to environmental irritants (e.g., pollution, dust, chemical fumes) 
• History of respiratory infections 
• Weakened immune system 
• Asthma or other chronic respiratory conditions 
• Repeated exposure to lung irritants (e.g., occupational hazards) 

ICD-10 code 

• ICD-10 code for acute bronchitis: J20.9 (Acute bronchitis, unspecified) 
• ICD-10 code for chronic bronchitis: J42 (Unspecified chronic bronchitis) 

Source: ICD-10 Data and ICD-10 Data 

Bronchitis Diagnosis 

Bronchitis is primarily diagnosed based on clinical history and physical examination. A thorough assessment of symptoms, medical history, and risk factors, including smoking and environmental exposure, is critical. Laboratory tests and imaging are usually not necessary for uncomplicated acute bronchitis but may be required to rule out other conditions in chronic cases. 

Common bronchitis symptoms 

• Persistent cough (Acute: dry or minimally productive; Chronic: productive with excessive mucus) 
• Chest discomfort or tightness 
• Wheezing or shortness of breath 
• Fatigue 
• Sore throat or runny nose (especially in acute bronchitis) 
• Low-grade fever (common in acute bronchitis) 

Diagnostic tests 

• Chest X-ray: This can be used to rule out pneumonia or other lung conditions, especially in patients with chronic bronchitis. The American College of Chest Physicians recommends a chest X-ray when specific criteria like these are met:  
  • A heart rate of 100 beats per minute  
  • A respiratory rate greater than 24 breaths per minute 
  • An oral body temperature higher than 38° C 
  • Chest examination results indicating egophony or fremitus  
• Pulmonary function tests: This is recommended for chronic bronchitis to assess lung capacity and function, particularly if COPD is suspected. 
• Sputum culture: This may be done if bacterial bronchitis is suspected, although viral bronchitis is more common. 
• Polymerase chain reaction (PCR): Consider this when pertussis, mycoplasma or influenza are suspected. 
• Oximetry: This assesses oxygen saturation, especially in patients with shortness of breath or pre-existing lung disease. 

Differential diagnosis includes pneumonia, asthma, bronchiectasis, and COPD. 

Management 

The management of bronchitis depends on whether it is acute or chronic. Acute bronchitis is generally self-limiting and managed with supportive care, while chronic bronchitis requires ongoing treatment to reduce symptoms and prevent complications. 

Bronchitis treatment options 

Acute bronchitis 

• Rest and hydration: Encourage patients to rest and drink plenty of fluids to help thin mucus. 
• Cough suppressants: This can be helpful for dry, irritating coughs that interfere with sleep (e.g., dextromethorphan). 
• Expectorants: This can help loosen mucus, making it easier to cough up. 
• Inhalers: Bronchodilators may be prescribed to relieve wheezing or shortness of breath, especially in individuals with asthma or pre-existing lung conditions. 
• Antibiotics: This isn’t typically recommended unless bacterial infection is confirmed. 

Chronic bronchitis (COPD) 

• Smoking cessation: This is the most critical intervention for chronic bronchitis. Quitting smoking slows the progression of the disease. 
• Bronchodilators: Inhaled bronchodilators, such as short-acting beta-agonists (e.g., albuterol) or long-acting bronchodilators, can help open the airways and reduce symptoms. 
• Corticosteroids: Inhaled corticosteroids may be used to reduce airway inflammation in chronic bronchitis, especially during exacerbations. 
• Oxygen therapy: This may be necessary for patients with severe chronic bronchitis and low blood oxygen levels. 
• Pulmonary rehabilitation: A structured program that includes exercise, breathing techniques, and education aimed to improve lung function and quality of life. 
• Antibiotics: This may be prescribed during exacerbations if there’s evidence of a bacterial infection. 

Bronchitis nursing care plan 

Nursing considerations 

Nurses help patients in managing bronchitis, particularly in educating patients on symptom management, smoking cessation, and preventing complications. For chronic bronchitis, monitoring lung function and preventing exacerbations are key components of care. 

Assessment 

• Respiratory status: Monitor for signs of respiratory distress, including increased work of breathing, wheezing, or decreased breath sounds.
• Cough and sputum: Assess the nature of the cough (dry or productive) and the appearance of sputum (color, consistency, amount).
• Vital signs: Monitor for fever, increased heart rate, and oxygen saturation.
• Smoking history: Evaluate the patient’s smoking history and willingness to quit.
• Environment: Assess exposure to environmental irritants that may exacerbate symptoms. 

Nursing diagnosis/risk for 

• Ineffective airway clearance related to mucus production and bronchial inflammation
• Impaired gas exchange related to airway obstruction and inflammation
• Risk for infection related to impaired lung function and chronic bronchial irritation
• Knowledge deficit related to the disease process and smoking cessation 

Interventions 

• Administer medications. Provide bronchodilators, corticosteroids, or cough medications as prescribed.
• Encourage airway clearance. Teach effective coughing techniques, chest physiotherapy, or the use of expectorants to help clear mucus.
• Provide smoking cessation support. Offer counseling and resources for smoking cessation, including nicotine replacement therapy if needed.
• Monitor oxygen levels. Provide supplemental oxygen as needed and monitor for hypoxemia in patients with chronic bronchitis.
• Promote hydration. Encourage fluid intake to help thin secretions and ease airway clearance. 

Expected outcomes 

• The patient will demonstrate effective airway clearance with reduced coughing and improved breath sounds.
• The patient will maintain adequate oxygenation, as evidenced by normal oxygen saturation levels.
• The patient will verbalize an understanding of smoking cessation strategies and commit to reducing or quitting smoking.
• The patient will exhibit decreased symptoms of bronchitis with effective use of prescribed medications. 

Individual/caregiver education 

Education can help individuals manage bronchitis, prevent complications, and improve their quality of life. Consider the following when providing patient education for bronchitis: 

• Smoking cessation: Educate patients on the benefits of quitting smoking, and provide resources such as quit lines, support groups, or medications like nicotine patches or gum.
• Medication adherence: Instruct patients to use inhalers and medications as prescribed, explaining how bronchodilators and corticosteroids help manage symptoms.
• Recognizing exacerbations: Teach patients with chronic bronchitis to recognize early signs when their symptoms are worsening, such as increased shortness of breath, more frequent coughing, or changes in sputum, and when to seek medical help.
• Infection prevention: Encourage good hand hygiene, avoiding close contact with people who are sick, and getting the flu and pneumonia vaccines to reduce the risk of respiratory infections. 

References 

1. American Lung Association. (2023). Bronchitis. Retrieved from https://www.lung.org/lung-health-diseases/lung-disease-lookup/bronchitis
2. ICD-10 Data. (2023). J20.9 - Acute bronchitis, unspecified. Retrieved from https://www.icd10data.com/ICD10CM/Codes/J00-J99/J20-J22/J20-/J20.9
3. Centers for Disease Control and Prevention (CDC). (2023). Chronic bronchitis and COPD. Retrieved from https://www.cdc.gov/copd/index.html