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Know presentation, DX and Management Diagnoses List (Ultimate A+ study guide)

NR 661 Know presentation, DX and Management
Diagnoses List

1. Acute bronchitis-
DESCRIPTION
Acute cough due to inflammation of the bronchioles, bronchi, and trachea; usually follows an upper respiratory infection or exposure to a chemical irritant.
ETIOLOGY
• Adenovirus
• Rhinovirus
• Influenza A and B
• Parainfluenza
RISK FACTORS
• Upper respiratory infection
• Air pollutants
• Smoking and/or secondary exposure
• Reflux esophagitis
• Allergy
• Chronic obstructive pulmonary disease
• Acute and chronic sinusitis
• Infants
• Older adults
• Immunosuppression
ASSESSMENT FINDINGS
• Cough: dry and nonproductive, then productive; may be purulent
• URI symptoms
• Fatigue
• Fever due to bacterial infection; more common in smokers and patients with COPD
• Fever due to viral cause (unusual after first few days)
• Burning sensation in chest
• Crackles, wheezes
• Chest wall pain
DIFFERENTIAL DIAGNOSIS
• Pneumonia
• Tuberculosis
• Asthma
DIAGNOSTIC STUDIES
• Decision criteria for chest radiographs: tachypnea, hypoxia, fever, abnormal lung exam
• Only consider chest X-ray if high index of suspicion for pneumonia or superimposed heart failure
• Consider PPD: expect negative results
• PREVENTION
• Smoking cessation
• Avoid known respiratory irritants
• Treat underlying conditions that contribute to risk (asthma, gastroesophageal reflux disease, etc.)
• Influenza immunization for high-risk populations
NONPHARMACOLOGIC MANAGEMENT
• Increase fluid intake
• Use humidifier
• Rest
• Smoking cessation
• Consider honey in children older than 1 year
• Patient education about disease, treatment, expected cause of cough, and emergency actions
PHARMACOLOGIC MANAGEMENT
• Cough suppressants for nighttime relief
• Avoid antihistamines
• Antibiotics if organism is bacterial
• Antivirals if influenza diagnosed
• Decongestants and antihistamines are ineffective unless sinusitis or allergy is underlying
• Bronchodilators if wheezing or prior history of asthma
Although antibiotics are commonly prescribed, they are NOT recommended.

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