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(ROS and RNS, respectively), and a range of cytokines, chemokines and growth factors” (Hiemstra et al., 2015, p. 1151). This inflammatory cascade leads to vascular permiability causing edema as well as damage to the cilia and desquamation
and sloughing of the epithelial walls, commonly resulting in phlem (Blush 2013). Mucins (glycoproteins that make up mucous) also act as a barrier in the lower respiratory tract and are signaled as well by the TLR to increase the production of mucous in an attempt to clean the lung as well as trap the causative agent (Hiemstra et al., 2015). The presentation is an inflammed airway potentially filled with debris. The cough represents a protective mechanism to help remove this debris.You also ask, “…how does the treatment serve to reverse the pathological cellular activity?” A trick question!!! 90% of bronchitis is caused by a viral infection and those bacterial causes also are generally self-limiting (Grimone, Arcangelo, & Wittbrodt, 2017). The recommendation by the Centers for Disease Control and Protection (n.d.) is to avoid the use of antibiotics in bronchitis. Hart (2014) noted many of the comfort measures such as the use of antitussives or antihistamines do not have evidence-based support. Using antihistamines can actually worsen the presentation as adequate fluids are needed to produce mucous, which serves as part of the body’s protective mechanisms (Grimone et al., 2017). So how does treatment serve to reverse the pathological cellular activity? It does not (unless there is a secondary infection), the provider suggests comfort measures such as increasing fluids and sucking on lozenges as the infection resolves.ReferencesBlush III, R. R. (2013). Acute bronchitis. Nurse Practitioner, 38(10), 14-20. doi:10.1097/01.NPR.0000434092.41971.adCenters for Disease Control and Prevention (CDC). (n.d.). Acute cough illness (acute bronchitis): Physician information sheet. Retrieved from CDC website -materials/hcp/adult-acute-cough-illness.htmlBrashers, V. L. & Huether, S. E. (2017). Alterations of pulmonary function in children. In S. E. Huether & K. L. McCance, Grimone, A. J., Arcangelo, V. P., & Wittbrodt, E. T. (2017). Bronchitis and pneumonia. In V. P. Arcangelo, A. M. Peterson, V. Wilbur, & J. A. Reinhold (Eds.), Pharmacotherapeutics for advanced practice (4th ed., pp. 4-7425).Philadelphia: Wolters Kluwer.Hart, A. M. (2014). Evidence-based diagnosis and management of acute bronchitis. The Nurse Practitioner, 39(9), 32-39. doi:10.1097/01.NPR.0000452978.99676.2bHiemstra, P. S., McCray, P. B., & Bals, R. (2015). The innate immune function of airway epithelial cells in inflammatory lung disease. The European Respiratory Journal, 45(4), 1150–62. (Eds.), Understanding pathophysiology(6th ed., pp. 715-729). St. Louis, MO: Mosby.Katy,I would support the diagnosis of croup you chose. Although this 6-year-old child is outside of the typical age descried by Brashers and Huether (2017) as 6 months to 5 years of age, the barking cough is indicative. Early in my career I worked in a children’s emergency room. While orienting, I was so impressed with my preceptor who could seemingly diagnose from across the room. The child who would sit still, not appearing ill and then a few minutes later