NURSING RESEARCH

Running head: CURRENT EBP – ACUTE BRONCHITIS 1

 

CURRENT EBP – ACUTE BRONCHITIS 2

 

 

 

 

 

 

Signature Assignment: Current EBP – Acute Bronchitis

Name xxxxxxx

United State University

Primary Health of Acute Clients/Families Across the Lifespan-xxxx

Professor xxxxxxx

Date xxxxx

 

 

Signature Assignment: Current EBP – Acute Bronchitis

This paper presents a comprehensive discussion of an acute health problem called acute bronchitis. The paper is grounded on two original research contributions, peer-reviewed articles, and the clinical experience of a client with acute bronchitis requiring at least two visits. Using these resources, the paper explores key concepts and differing viewpoints related to acute bronchitis, the impact of cultural/spiritual/socioeconomic considerations, and evidence-based medical guidelines, in addition to other relevant factors related to the acute health problem. The objective is to provide the reader with a deep insight into acute bronchitis with regard to clinical evaluation, symptomatic presentation, evaluation, and management of clinical guidelines.

Topic and Rationale for Selection

According to Singh, Avula, and Zahn (2021), acute bronchitis “is characterized by inflammation of the bronchial tubes (bronchi), the air passages that extend from the trachea into the small airways and alveoli.” Common symptoms of the acute health problem include cough, sputum production, nausea, fever, diarrhea, vomiting, sore throat, fatigue, headache, and muscle aches. This topic was selected because acute bronchitis is a common presentation in most primary care offices, urgent care centers, and emergency departments. Singh, Avula, and Zahn (2021) note that in the US, acute bronchitis ranks among the top ten common acute health problems among outpatients with 5% of adults being diagnosed with the condition each year. This translates to approximately 10 million visits to healthcare organizations each year.

The health problem is synonymous with the flu season, which is common during winter and autumn in the US. The disease can follow any viral upper respiratory infection with common pathogens being parainfluenza, influenza virus A or B, rhinovirus, and respiratory syncytial virus. The condition is further exacerbated by risk factors like asthma, crowding, residing in polluted areas, and a history of smoking. Considering that these are risk factors that characterize a large population of the US, the topic was selected due to its importance in public healthcare outcomes.

Evaluation of Key Concepts

According to Kinkade and Long (2016), “acute bronchitis is the result of acute inflammation of the bronchi secondary to various triggers, most commonly viral infection, allergens, pollutants, etc.” (p. 560). In addition to this, the bronchial wall’s inflammation results in the denudation of the basement membrane, the desquamation of the epithelial cell, and mucosal thickening. There are instances when a viral upper respiratory infection progresses into the lower respiratory tract infection, which leads to acute bronchitis. The findings of physical examination in acute bronchitis are diverse and include bullous myringitis, rhinorrhea, adenopathy, conjunctivitis, diffuse wheezes, inspiratory stridor, and peripheral cyanosis, among others.

Overall, acute bronchitis is likely to be diagnosed in individuals having an acute respiratory infection combined with a cough. However, it is vital to acknowledge that there are other more serious illnesses associated with the lower respiratory tract that cause a cough. Hence, Albert (2016) suggests the following studies to help in the proper diagnosis of acute bronchitis: (a) spirometry, (b) influenza tests, (c) blood culture in case there is suspicion of a bacterial super-infection, (d) sputum cytology in case there is a persistent cough, (e) chest radiography in case there is suspicion of pneumonia or the patient is elderly, (f) procalcitonin levels in order to differentiate nonbacterial and bacterial infections, and (g), complete blood count with differential.

Complete History and Physical (H&P) of the Client’s Initial Visit

History

The client is a 45-year-old male who works in a company that deals with toxic substances with strong fumes. He is a chronic smoker and has been overweight for the past three years. The client has been coughing for the past 12 days and complains of a lot of sputum. Currently, the sputum is clear-colored. The client has also had the following symptoms over the past six days: extreme fatigue, muscle aches, headache, stuffy nose, and sore throat. Consequently, these symptoms have made it challenging for him to work. Considering his job pays him based on his output, his current illness is not only affecting his health adversely but also his economic wellbeing. Therefore, the client seeks a swift and successful solution to his predicament.

Physical Examination

A physical examination of the client has revealed coarse rhonchi and wheezes, which alter in intensity and location after a productive and deep cough. Additionally, the exam shows that the client makes high-pitched continuous sounds and diffuse wheezes, which implies that he has a severe case of an acute health problem. Occasionally, the patient shows diffuse diminution of air intake, which indicates an obstruction of the trachea or major bronchi. The client also has a sustained heave along his left sternal border, which is an indicator of the right ventricular hypertrophy; a condition that is synonymous with bronchitis.

SOAP Note for the Client’s Follow-Up Visit

Subjective

The client is a 45-year-old male who visited the clinic on 02/18/2022. He complained of a consistent cough, a lot of sputum, extreme fatigue, muscle aches, headache, stuffy nose, and sore throat. A review of his systems showed that the client did not have any major health changes over the past few weeks apart from the cough. A skin exam showed no rash or itching while a HEENT exam showed that the client had normal eye and ear functioning but had a stuffy nose and sore throat. Cardiovascular and gastrointestinal functioning were also normal. The client has no known allergies. He has taken over-the-counter medication to help with the coughing with no success.

Objective

The client’s vital signs were as follows: “BP 115/75, HR 85, RR 17, Temp 96.2 (oral), SPO2 96% RA. Height: 5ft 8inch, Weight: 143 lb., BMI: 21.7.” a general survey showed that the client was calm with clear speech and congruent answers to any questions asked. However, he had dry skin and appeared older than his stated age.

Assessment

The primary diagnosis is acute bronchitis (ICD-10: J20.9). This diagnosis was made based on the symptoms such as severe cough, fatigue, mucus, and chest discomfort. The client’s diaphragm appeared flatter and lower than normal. He also had a palpable liver, which implies that overinflation could have displaced it. His smoking and regular exposure to toxic fumes at his workplace is major risk factors for bronchitis. However, standard lab tests are mandatory to prove or disprove this diagnosis.

Plan

The plan is to prescribe azithromycin to the patient. This is a drug that is effective in fighting off bacteria, a major reason behind the development of bronchitis. Additionally, Naproxen and Sumatriptan can be combined for better effect. Albert (2016) asserts that the combination of these medications results in positive clinical outcomes. The client has no allergies and is likely to benefit from these drugs. Regarding lab tests, an x-ray of the chest will be done to assess the lungs and bronchial tubes, a blood test will check for infections, a respiratory mucus test will reveal the mucus’ origin, a urine test will reveal likely inflammation origins, and spirometry will reveal the functioning of the lungs. Finally, patient education will be done to sensitize him on the proper taking of medication and the necessary lifestyle changes to be made to ensure he gets well swiftly and prevents acute bronchitis from being a chronic one.

Description of Multiple Viewpoints

According to Singh, Avula, and Zahn (2021), there are instances when secondary pneumonia develops. Often, this is indicated by fever, productive cough, and worsening symptoms. Hence, there may be a need for chest x-rays. This trend is crucial for smokers, infants/newborns, the elderly, and immunocompromised adults. Fahey et al. (2014) reveal that for patients with shortness of breath and a cough, pulmonary emboli must be in differentials. At times, spontaneous pneumomediastinum or pneumothorax can result from aggressive coughing. Once again, a chest –x-ray may be vital for acute worsening of symptoms. People diagnosed with acute bronchitis should comprehend the significance of lifestyle changes such as avoiding pollutants or quitting smoking in order to minimize recurrence of the disease or various complications. Furthermore, pneumonia and influenza immunizations for the at-risk groups may be important. Patient education such as avoiding the use of antibiotics in situations when it has not been indicated to avoid antibiotic resistance may also be necessary. However, the general population tends to go against such norms with a high number of people self-medicating on antibiotics, others refusing to be vaccinated, and others refusing to quit their poor lifestyle habits.

Merit of Evidence/ Soundness of Research

The research referenced in this article was very sound based on a variety of factors including the use of scientific research techniques, use of large sample sizes, long study-time, randomization, and result findings being closely aligned with the scientifically established guidelines regarding treatment and diagnosis. More so, the research in the articles used was done by qualified individuals with impressive academic credentials and extensive experience in their fields. The research was also published in peer-reviewed scholarly journals that referenced other credible and reliable primary and secondary sources.

Evaluation of Current EBM Guidelines

Current EBM guidelines recommend treating simple acute bronchitis using antibiotics in healthy adults. In nine randomized, controlled trials of antibiotic agents, pertinent research reveals a slight reduction in the cough duration period. However, there was no notable reduction in the period of illness (Fahey et al., 2014). Consequently, the use of antibiotics is not recommended in simple cases, taking into account the cost of antibiotics, possible side effects, and antibiotic resistance. For viral acute bronchitis, there are medical societies that advise against the use of antibiotics. Nevertheless, the majority of healthcare practitioners still prescribe antibiotics for individuals diagnosed with acute bronchitis. Current EBM guidelines not only focus on treatment but preventive measures as well. People diagnosed with acute bronchitis should comprehend the significance of lifestyle changes such as avoiding pollutants or quitting smoking in order to minimize recurrence of the disease or various complications.

Cultural, Spiritual, and Socioeconomic Considerations

When interacting with patients, healthcare practitioners should consider the role played by the client’s cultural, spiritual, and socioeconomic backgrounds. These are factors that directly impact the healthcare outcomes of the patient. For instance, there are cultural and spiritual beliefs that may cause a client to forego vital medical care. The client may choose traditional medication or adhere to his religious beliefs and stop the necessary medication. McHale (2018) advises healthcare practitioners not to get offended by such outcomes but to respect the choices of the client. More so, they can try and see the perspective of the client in order to open a proper line of communication and find alternative ways of helping their patients that will not seem offensive to them. Socioeconomic considerations should also be made. For instance, the client presented above works in a company that deals with toxic fumes. It might not be possible for the healthcare practitioner to ask the client to quit his job in order to improve his healthcare outcomes. Hence, alternative preventive solutions should be sought.

Standardized Procedure for this Diagnosis

Acute bronchitis is likely to be diagnosed in individuals having an acute respiratory infection combined with a cough. However, it is vital to acknowledge that there are other more serious illnesses associated with the lower respiratory tract that cause a cough. Hence, as aforementioned, Albert (2016) suggests the following studies to help in the proper diagnosis of acute bronchitis: (a) spirometry, (b) influenza tests, (c) blood culture in case there is suspicion of a bacterial super-infection, (d) sputum cytology in case there is a persistent cough, (e) chest radiography in case there is suspicion of pneumonia or the patient is elderly, (f) procalcitonin levels in order to differentiate nonbacterial and bacterial infections, and (g), complete blood count with differential.

How the Evidence Would Impact Practice

The evidence collected in this paper would positively impact my practice and allow me to offer high-quality healthcare services to my clients. For starters, the evidence collected has revealed the significance of offering holistic care to patients to achieve the best outcomes possible. In my practice, I would not only focus on treatment options, but I would also educate my clients to ensure that they take preventive actions in order to avoid chronic illnesses caused by the acute health problem. I would also consider how their cultures, religion, and socioeconomic backgrounds impact their ability to comprehensively accept healthcare services. The evidence collected has also shown me the importance of carrying out diverse tests during the diagnosis of a client in order to ensure accurate diagnoses are made and differential diagnoses are accurately ruled out.

Conclusion

This paper has presented a comprehensive discussion of an acute health problem called acute bronchitis. Acute bronchitis is a common presentation in most primary care offices, urgent care centers, and emergency departments. It accounts for approximately 10 million visits to healthcare organizations each year. Therefore, it is a major problem that warranted this discussion. Current EBM guidelines recommend treating simple acute bronchitis using antibiotics in healthy adults. Nevertheless, comprehensive tests should be done during diagnosis to rule out other diseases that have similar symptoms to acute bronchitis. Furthermore, his paper has revealed the significance of educating patients on preventive measures to ensure they adopt healthier lifestyles and can alleviate the risk of developing long-term illnesses. Overall, this discussion has enhanced my knowledge of a common acute health problem and has added great value to my future practice.

References

Albert, R. H. (2016). Diagnosis and treatment of acute bronchitis. American Family Physician, 82(11), 1345-1350.

Fahey, T., Smucny, J., Becker, L., & Glazier, R. (2014). Antibiotics for acute bronchitis (Cochrane Review). The Cochrane Library, (4).

Kinkade, S., & Long, N. A. (2016). Acute bronchitis. American Family Physician, 94(7), 560-565.

McHale, J. V. (2018). Ethical, cultural, and spiritual dimensions of healthcare practice. Nursing Ethics, 20(4), 365-365.

Singh, A., Avula, A., & Zahn, E. (2021). Acute bronchitis. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK448067/

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