BRONCHIECTASIS

Prepared by : Ma. Teresa L. Gonzales

BRONCHIECTASIS
a chronic, irreversible dilation of the bronchi and bronchioles Under the new definition of COPD , it is considered a disease process separate from COPD

It may be caused by a variety of conditions, including: Airway obstruction Diffuse airway injury Pulmonary infections and obstruction of the bronchus or complication of long-term pulmonary infections

Genetic disorders such as cystic fibrosis Abnormal host defense (e.g. ciliary dykenesia or humoral immunodeficiency) Idiopathic causes

CLINICAL MANIFESTATIONS

Chronic cough and the production of sputum in copious amounts Patients who have bronchiectasis may also have HEMOPTYSIS Clubbing of the fingers also common May also have pulmonary infection

ASSESSMENT AND DIAGNOSTIC FINDINGS

Bronchiectasis is not readily diagnosed A definite sign is a prolonged history of productive cough, with sputum consistently negative for tubercle bacilli CT scan, the diagnosis for this disease

MEDICAL MANAGEMENT
To promote bronchial drainage to clear excessive secretions from the affected portion of the lungs and also to prevent infection Postural drainage is also a part of the treatment because draining of the bronchiectatic areas by gravity reduces the amount of secretions.

*A year round regimen of antibiotic agents may be prescribed with different types of antibiotics at intervals *Patients should be vaccinated against influenza and pneumococcal pneumonia *The disease may involved one or two areas of the lung that can be removed without producing respiratory insufficiency

Surgical treatment
to conserve normal pulmonary tissue and to avoid infectious complications. The objective is to obtain a dry tracheobronchial tree to prevent complications

frequently done for patients who continue to expectorate large amounts of sputum and; have repeated bouts of pneumonia and hemoptysis

TREATMENT
The goal is to treat any underlying conditions causing lung injury help remove mucus from the lungs and prevent further complications.

Treatment may include:

Bronchodilator medications Steroids Antibiotics Mucus Thinners and Expectorants Respiratory Therapy Surgery Lung Transplant

Bronchodilator Medication
Inhaled as aerosol sprays taken orally may help to relieve symptoms by relaxing and opening the air passages in the lungs.

Steroids
Inhaled as an aerosol spray can help relieve symptoms can cause side effects * It is important to discuss these side effects with your doctor before using steroids

Steroids
Inhaled as an aerosol spray can help relieve symptoms can cause side effects * It is important to discuss these side effects with your doctor before using steroids

Side effects
weakened bones high blood pressure diabetes and; cataracts

Antibiotics
may be used to help fight respiratory infections caused by bronchiectasis.

Mucus Thinners and Expectorants

help loosen and clear mucus from lungs.

Respiratory Therapy
must clear mucus from their lungs on a daily basis. This may be done with chest physical therapy, which involves vigorously clapping the back and chest to dislodge mucus from the lungs

Surgery
Lung volume reduction surgery, during which small wedges of damaged lung tissue are removed may be recommended for some patients with severe cases of bronchiectasis.

Lung Transplant
In very severe cases, lung transplantation may be an option for some patients.

NURSING

INTERVENTION

Provide supportive care and help the patient adjust to the lifestyle changes that irreversible lung damage necessitates Administer antibiotics, as ordered, and record the patients response to this medication

Give oxygen as needed Perform chest physiotherapy, including postural drainage and chest percussion for involved lobes, several times per day, especially in the early morning and before bedtime

Provide a warm, quiet, comfortable environment. Also help the patient to alternate rest and activity periods Give the patient well balanced, high calorie meals

Offer small, frequent meals or nutritional supplements Assure the patient receives adequate hydration to help thin secretions and promote easier removal Give frequent mouth care to remove foul-smelling sputum Provide patient with tissues and waxed bag in which to dispose contaminated tissues

Monitor the patients respiratory rate and pattern regularly Assess gas exchange by monitoring ABG values as ordered Observe the patients breath sounds and sputum production for changes that might indicate a respiratory infection or worsening condition

Pathophysiology

BRONCHIECTASIS
Predisposing Factors Precipitating Factors

Productive cough (purulent sputum)

Stabbing chest pain upon coughing

Pulmonary infections damaging the bronchial walls Inflammation of the bronchial walls Loss of supporting structures of the bronchi

Abnormal breath sounds (rales & crackles upon auscultation)

Permanent distention and distortion of bronchial walls Impaired mucociliary clearance Retention of secretions and subsequent obstruction affects peribronchial tissues Inflammatory scaring/fibrosis of bronchus replace the functioning of lung tissue

Dilated bronchial tubes amounts to lung abscess

Excessive exudates drains freely through the bronchus

Hemoptysis

Respiratory Insufficiency

Predisposing Factors:
Recurrent Upper & Lower respiratory infections in early childhood Measles Influenza

Tuberculosis
Immunodeficiency disorders

Diffused airway injury

Airway obstruction Immunodeficiency

Precipitating Factors:
Congenital disease such as cystic fibrosis (Genetic Disorder) Idiopathic causes

The END
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