Acute Bronchitis 

Written by Judith Ose RN, BSN, MSNc and Nwachukwu Nkechi RN, BSN, MSNc, Edited by Shirley Comer 

In general, Acute Bronchitis is a viral infection whose predominant symptom is a cough which can last up to three weeks (Hart, 2014, p. 34). Moreover, this viral infection can present like a mild cold. In addition, an individual with acute bronchitis can also present with wheezing, especially if there is an underlying disease process of asthma (Hart, 2014, p. 34).

            Antibiotics are usually not needed in the treatment of acute bronchitis unless cases of high fever, high pulse rate, and respiration are involved.

Risk factors of acute bronchitis

• Close contact with someone who has a cold or acute bronchitis
• Failure to get age-appropriate immunizations
• Exposure to tobacco smoke, fumes, dust, and air pollution

Diagnostic criteria and treatments. 

History is one of the main steps in diagnosing acute bronchitis. The following symptoms may help in the diagnosis of acute bronchitis; CBC with differential, procalcitonin to rule out a bacterial infection, blood culture if bacterial is highly suspected, chest x-ray in elderly patients or if physical findings are suggestive of pneumonia.

The most debilitating complication of this disease process is the actual cough and therefore the treatment focuses primarily on suppressing the cough The treatments for acute bronchitis include Dextromethorphan 20 mg PO, q4hrs or 60 mg extended-release liquid BID for the cough, inhaled bronchodilator albuterol 2.5 mg TID/QID by nebulizer, for wheezing, and Benzonatate  200mg and Guaifenesin 600mg PO q6hrs, for the mucus production (Hart, 2014, p.36). 

References 

Hart, A. (2014). Evidence-based diagnosis and management of  acute bronchitis. The Nurse Practitioner 39(9), 35-36 doi: 10.1097/01.NPR. 0000452978.99676.2b

Kinkade, S., & Long, N. (2016). Acute bronchitis. American Family Physician, 94(7), 560-565. Retrieved from https://www.aafp.org/afp/2016/1001/p560.pdf

Fayyaz, J. (2018). Bronchitis essential practice, background, pathophysiology. Retrieved from: https://emedicine.medscape.com/article/297108-overview   

Knutson, D., Braun, C. (2015). American family physician. Diagnosis and management of acute bronchitis retrieved from:  https://www.aafp.org/afp/2002/05/15/p2039.html           

Gout

By Kimberly Lopez RN, BSN, MSNc 

and Mia Watkins RN, BSN, MSNc

Edited by Shirley Comer

Gout is a type of arthritis that predominately affect older males, but can affect women too.  It is more common in African Americans (5%) than whites (4%) (ncbi.nlm.nih.gov).  It is caused by a build-up of uric acid in the blood; which comes from ingesting purine-rich foods and drinks such as red meat, seafood, fish, poultry, bacon, organ meats, alcohol, and chocolates (arthritis.org).  Someone affected by gout should limit their intake, if not abstain, from these foods and drinks to keep flare ups at bay. 

Risk factors for developing gout are: 1. excessive daily use of purine diet; 2. excessive alcohol usage; 3. male gender; 4. obesity; 5. hereditary; and 5. being African American.

Diagnosis is made based on symptoms, which may include, inflamed joint, (particularly the big toe), pain, and tenderness to attached limb; elevated uric acid in the blood, and synovial fluid analysis.  However, the symptoms of gout are not always obvious.  For example, a person may present with pain in the joints, but no inflammation.  The key is to look at the bigger picture, i.e. diet, lifestyle, history, and risk factors, before making a diagnosis. Aspiration and examination of synovial fluid and blood test for uric acid are done to confirm the diagnosis of gout. 

Treatment for gout includes limited purine diet, NSAIDs, and the prescription drug, colchicine.  Patients should also maintaining adequate fluid intake, reduce alcohol intake, and lose weight if obese.

References

Safe Foods for Gout. (2019). Retrieved April 25, 2019, from https://www.arthritis.org/living-with-arthritis/tools-resources/expert-q-a/gout-questions/food-for-gout.php

Singh, J. A. (2013, February). Racial and gender disparities among patients with gout. Retrieved April 15, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545402/

Dunphy, L., Winland-Brown, & J., Porter, B.O. (2015). Endocrine and metabolic problems. Primary Care: The Art and Science of Advanced Practice Nursing. Zycowicz, M., South, T., Martin-Plank, L., & Dunphy, L. (Eds.). (4^th ed., pp. 840-919). Publisher: F.A. Davis Company.

Perry, G, Castellani, R., Moreira, P., Lee, H., Zhu, X., and Smith, M. (2008). Pathology’s new role: Defining disease process and protective response. International Journal of Clinic & Experimental Pathology. 1(1):1- 4.