BRONCHIECTASIS

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By, RAIZA RAJU

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anatomy

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Definition
Bronchiectasis is a chronic, irreversible dilation of the bronchi, and bronchioles. Under the new definition of COPD, it is considered a disease process separate from COPD.
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etiology
*Airway obstruction *Infectious agents Adenovirus Influenza virus Staphylococcus aureus Klebsiella Anaerobics M.Avium *Diffuse airway injury *Pulmonary infections and obstruction of bronchus
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Pathophysiology
PREDISPOSING FACTORS Respiratory infections in childhood. Measles. TB Influenza CAUSAL FACTORS *Airway obstruction Diffuse airway injury. Pulmonary infections. Genetic disorder.

Inflammatory process
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Damages bronchial wall

Loss of supporting structures

Thick sputum production

Permanent distension and distortion of bronchial walls, impaired mucociliary clearance

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Saccular bronchiectasis

Cylindric bronchiectasis

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Clinical manifestations

Productive cough - recurrent, paroxysmal,>20 ml sputum per day, stimulated with position changes.

Exertional dyspnea. Fatigue. Weight loss. Anorexia. Fetid breath. Any combination of crackles, rhonchi and wheezing Sinusitis. Hemoptysis.
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Diagnostic measures

History and Physical examination Chest x-ray.

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High resolution CT scan

Bronchoscopy Sputum examination Pulmonary function studies

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MANAGEMENT

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MEDICAL MANAGEMENT

Postural drainage.

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Chest physiotherapy.

Maintain good hydration. Reduce exposure to excessive air pollutants. Avoid cigarette smoking. Positive Expiratory Pressure(PEP) - breathing maneuver against on expiratory resistance.
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Pharmacological management

Antibiotics based on sputum production. Antipseudomonal antibiotics. eg: Nebcin.

Bronchodilators.

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Surgical management
v

Surgical resection of an affected lobe.

Lung transplantation.

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NURSING DIAGNOSIS

Ineffective airway clearance related to expiratory airflow obstruction as manifested by abnormal breath sounds. Ineffective breathing pattern related to increased mucus production as manifested by shortness of breath. Self care deficits related to fatigue secondary to increased work of breathing and insufficient ventilation as manifested by inability to do ADL to full extend. intolerance due to fatigue, hypoxemia as manifested by difficulty with ADL.
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Activity

Lewis M.S, Heitkemper M.M, Dirksen R.S(2004), Medical Surgical Nursing, Assessment and Management of Clinical Problems, 6th Edition, Mosby(P), USA.

bibliography

Smeltzer C.S, Bare G.B, Hinkle L.J et.al(2004), Brunner and Suddarths Textbook of Medical Surgical Nursing, Volume 1,12th Edition, Lippincott(P), India.

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