Pneumonia
Pneumonia (J18.9)
Common clinical symptoms of pneumonia are cough, fever, pleuritic chest pain, chills, dyspnea, and sputum production. When mucopurulent sputum is seen it is most often associated with a bacterial pneumonia, whereas a scant and watery sputum appearance is more suggestive of an atypical pathogen. Other features commonly seen in are gastrointestinal symptoms (such as, nausea, vomiting, diarrhea) and mental status changes. Chest x-ray can confirm suspicion for pneumonia (Cash & Glass, 2014).
Evidence-Based Practice Treatment
Proper diagnosing of acute bronchitis is done by performing a detailed history and physical exam that focuses on ruling out pneumonia as the primary diagnosis. Providers need to pay attention to complaints of symptoms that are systematic, such as fever, myalgia, and dyspnea. In acute bronchitis lungs sounds auscultated should be without signs of lung consolidation, such as crackles, egophony, increased fremitus, and/or dullness to percussion. If there is an absence of signs and symptoms patients do not need diagnostic testing completed (Hart, 2014).
The mainstay treatment for acute bronchitis is symptom management and supportive care. This includes over-the-counter (OTC) medications for treatment of the patient’s cough, such as Mucinex DM. Nasal saline spray will help nasal congestions symptoms. Ibuprofen or acetaminophen can be given per directions on packing to relieve fever symptoms. In a randomized control trial ibuprofen was shown to have no benefit compared with a placebo in relieving cough or congestion symptoms for patients with acute bronchitis. Antihistamines, such as Claritin 10mg oral daily, can be used in combination with decongestants to treat the patients acute cough but are not recommended by the U.S. Food and Drug Administration due to warnings for adverse effects with no benefit found when compared to placebo in relieving acute cough symptoms (Kinkade, 2016).
Multiple studies have been completed on antibiotic use in acute bronchitis and have found no improvement in symptoms when patients are prescribed antibiotics. Patients who smoke have been shown to have a significant reduction in their cough with antibiotic treatment by 0.6 days. Due to this knowledge antibiotics can play a minor role with the management of acute bronchitis in these patients (Hart, 2014).
Expected Outcomes
Patients with acute bronchitis are expected to have positive outcomes. It is important that they receive realistic education on the expectation of the duration for their cough that could last up to 3 weeks. Patients can use OTC medications for symptoms control and should be educated to rest, increase their fluids, and use a clean air humidifier for moist air to assist with symptoms. Avoidance of irritants, such as air pollution and smoke will help to decrease symptoms (Buttaro et al., 2013).
