In this position, a patient leans forward on a fixed surface, supporting themselves with their arms. The tripod position is usually seen in patients who are experiencing severe respiratory distress. By leaning forward, the patient is using additional muscles to lift the anterior wall of the chest, making it easier to breathe.
Dry air can cause further irritation of inflamed airways in patients with chronic bronchitis. Adding moisture to the air or humidifying oxygen delivered via nasal cannula or mask can prevent further irritation and prevent drying of mucus secretions.
Pursed lip breathing is encouraged in patients with chronic bronchitis to prevent air trapping, and collapse of the bronchioles upon expiration. In this disease, alveoli cannot re-expand normally, which causes bronchiolar collapse. Using pursed lip breathing prolongs expiration of air and creates positive pressure to help keep alveoli open and functioning.
Fluid intake should be at least three liters per day, to prevent dehydration and drying of mucus secretions. Patients should be carefully monitored for signs of fluid overload such as dyspnea and edema.
Arterial blood gas results should be used to monitor the effectiveness of oxygen therapy in patients with chronic bronchitis. Keep in mind, however, that these patients may have a higher tolerance for carbon dioxide, which would be reflected in their lab results.
Patients who experience a sudden increase in sputum volume, difficulty breathing, or change in sputum appearance, should seek medical attention, as these can be early signs of worsening chronic bronchitis. Exacerbations can be treated using short-acting bronchodilators, and early detection improves outcomes in patients.
In patients with chronic bronchitis, the respiratory center in the brain develops a high tolerance to carbon dioxide in response to chronic hypoxemia. It is important to remember that administering a high flow of oxygen to these patients can take away their drive to breath. Therefore, the lowest effective oxygen flow rate should be used when administering oxygen therapy.
Continuous positive airway pressure (CPAP) may be beneficial in patients who require additional breathing assistance. The positive pressure in CPAP works to keep the alveoli open, ultimately preventing bronchiolar collapse. Chest physiotherapy, using percussion and vibration, can be beneficial in patients who have difficulty clearing respiratory secretions on their own. In severe cases of respiratory distress, a patient may require intubation to facilitate breathing.
Patients with COPD, especially chronic bronchitis, are more susceptible to infections. This is due to the decreased functioning of respiratory cilia, and excess respiratory secretions.
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