NR 507 Week 2 – Open Forum Discussion
Acute Bronchitis
Bronchitis is characterized by inflammation of the bronchi & usually develops after a cold. In acute bronchitis, the bronchial lining becomes irritated & inflamed & the mucous membrane becomes hyperemic & edematous, diminishing the bronchial mucociliary function (Fayyaz, 2016). This then clogs the airways & further increases irritation, causing the secretion of mucus & the distinctive cough of bronchitis. Tammy reports having a “really bad cold” with rhinorrhea approximately 3 weeks ago that has seemed to go away, but her cough still remains. She then describes her cough as deep & productive with green sputum. All of her symptoms, including her
Scratchy throats are indicative of acute bronchitis. Acute bronchitis is quite common & is one of the top conditions for which patients seek medical care.
Pertussis (Whooping Cough)
Pertussis (whooping cough) is a respiratory tract infection characterized by an uncontrollable cough. Pertussis is highly contagious, developing in approximately 80-90% of susceptible individuals who are exposed to it. Exudate forms in the respiratory tract compromise the air passages, & predispose the affected individual to atelectasis, cough, cyanosis, & pneumonia (Bocka, 2016). Pertussis is a 6-week disease divided into 3 stages: catarrhal, paroxysmal, & convalescent. In Stage 1 or the Catarrhal phase, affected individuals may have symptoms of nasal congestion, rhinorrhea, sneezing, & low-grade fever (Bocka, 2016). Tammy reported rhinorrhea with her cold approximately three weeks ago, which could possibly be explained by this stage of pertussis; however, she has not had a fever. In Stage 2 or the Paroxysmal phase, affected individuals may experience attacks of intense coughing lasting up to several minutes, occasionally followed by a loud whoop, while Stage 3- Convalescent stage is identified by a chronic cough, which may last for weeks (Brocka, 2016). Tammy’s cough could be explained using these stages of this diagnosis as well; however, Tammy has no other signs or symptoms of pertussis. Further information, evaluation, & tests will be needed to determine if Tammy indeed is suffering from pertussis.
COPD
COPD is a progressive disease that makes it difficult to breathe. It causes coughing, produces large amounts of sputum, & shortness of breath, chest tightening, & other respiratory symptoms, some of which Tammy experiences. The leading cause of COPD is cigarette smoking or long-term exposure to other lung irritants, such as air pollution, chemical fumes, or dust. Although Tammy has symptoms similar to those of COPD, there is not enough information to determine this diagnosis. I personally would like to know if Tammy has had any exposure to lung irritants or cigarette smoke before giving this diagnosis.
Tuberculosis (TB)
TB is an infectious bacterial infection that affects the lungs. A cough lasting more than three weeks is often the first symptom. It can start as a dry, irritating cough & then result in a productive cough with a lot of sputum, which may be bloodstained (Centers for Disease Prevention & Control, 2016). This diagnosis would explain Tammy’s cough but not her green sputum or scratchy throat. Further information & testing is needed to determine whether or not Tammy is infected with TB.
NR 507 Week 2 – Open Forum Discussion
Sinusitis
Symptoms of sinusitis frequently develop after a cold. The most obvious sign of sinusitis is a painful pressure in the cheeks & forehead (American Academy of Allergy, Asthma & Immunology, 2016). Tammy’s productive coughs with green sputum display symptoms that are indicative of sinusitis. Other symptoms include postnasal drip, congestion, toothache, & in cases of acute sinusitis, a fever may develop (American Academy of Allergy, Asthma & Immunology, 2016). Although Tammy experienced some symptoms that could be characterized in this diagnosis, she has not reported any congestion or feeling of facial pain or pressure, which is distinctive of sinusitis.
Based on what you have at the top of the differential, how would you treat this patient?
For the treatment of acute bronchitis, it is not recommended that antibiotics be given due to the risk of antibiotic resistance & Clostridium difficile infection. Although antibiotics are not recommended as a treatment course for bronchitis, they are still widely used. Clinical data has shown & supports the fact that antibiotics do not significantly change the course of acute bronchitis, & may provide only minimal benefit compared with the risk of antibiotic use itself (Albert, 2010). Treatment measures for acute bronchitis should be focused on symptom control & should include the administration of antitussives, expectorants, and inhaler medications.
Suppose now, the patient has a fever of 100.4 & complains of foul-smelling mucous & breath. Indeed, she complains of producing cups of mucous some days. She has some trouble breathing on moderate exertion, but this is only a minor complaint to her. How does this change your differential & why?
To me, fever always signals infection. The patient has already complained of a deep, productive cough with green sputum & now the mucous, along with her breath, is foul smelling. Tammy also reports producing copious amounts of mucous with some trouble breathing on moderate exertion. With this new information, I would possibly change my differential diagnosis to Bronchiectasis. Bronchiectasis is a condition in which the airways begin to widen & become scarred due to infection or injury to the walls of the airway (National Heart Lung & Blood Institute, 2014). With Bronchiectasis, the airways begin to lose their ability to clear mucous; when mucus can’t be cleared, it builds up & creates an environment in which bacteria can grow, resulting in serious infections of the lungs (National Heart Lung & Blood Institute, 2014).
Symptoms of Bronchiectasis that are now present with Tammy include a daily productive cough with large amounts of sputum & shortness of breath. As a provider, assessing lung sounds & function would be essential to determine if Tammy has developed this condition.
References
Albert, R. (2010). Diagnosis & treatment of acute bronchitis. American Family Physician, 82 (11). Retrieved from: http://www.aafp.org/afp/2010/1201/p1345.html#afp20101201p1345-b23
American Academy of Allergy, Asthma & Immunology. (2016). Sinusitis. Retrieved from: http://www.aaaai.org/conditions-&-treatments/allergies/sinusitis
Bocka, J. (2016). Pertussis. Medscape. Retrieved from: http://emedicine.medscape.com/article/967268-overview#a4
Centers for Disease & Prevention & Control. (2016). Tuberculosis (TB) disease: symptoms & risk factors. Retrieved from: http://www.cdc.gov/features/tbsymptoms/
Fayyaz, J. (2016). Bronchitis. Medscape. Retrieved from: http://emedicine.medscape.com/article/297108-overview#a1
National Heart Lung & Blood Institute. (2014). Explore Bronchiectasis. National Institutes of Health. Retrieved from: https://www.nhlbi.nih.gov/health/health-topics/topics/brn/diagnosis
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Question 
NR 507 Week 2 – Open Forum Discussion
As you are completing Part I of your disease process presentation, tell us about the etiology and risk factors of
your assigned disease and what you feel is the role of the family nurse practitioner in preventing the occurrence
of this disease.