bronchiectasis

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BRONCHIECTASIS
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
Ø Productive cough
- recurrent, paroxysmal,>20 ml sputum per
day, stimulated with position changes.
Ø Exertional dyspnea.
Ø Fatigue.
Ø Weight loss.
Ø Anorexia.
Ø Fetid breath.
Ø Any combination of crackles, rhonchi and wheezing
Ø Sinusitis.
Ø Hemoptysis.

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Diagnostic measures
Ø History and Physical examination
Ø Chest x-ray.

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Ø High resolution CT scan
Ø Bronchoscopy
Ø Sputum examination
Ø Pulmonary function studies

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MANAGEMENT

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MEDICAL MANAGEMENT
Ø Postural drainage.

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

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Pharmacological management
Ø Antibiotics based on sputum production.
Ø Antipseudomonal antibiotics.
eg: Nebcin.
Ø Bronchodilators.

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Surgical management
v Surgical resection of an affected lobe.
v 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.
Activity intolerance due to fatigue, hypoxemia as
manifested by difficulty with ADL.

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bibliography
 Lewis M.S, Heitkemper M.M, Dirksen R.S(2004),
Medical Surgical Nursing, Assessment and
Management of Clinical Problems, 6th Edition,
Mosby(P), USA.
 Smeltzer C.S, Bare G.B, Hinkle L.J et.al(2004),
Brunner and Suddarth’s Textbook of Medical
Surgical Nursing, Volume 1,12th Edition,
Lippincott(P), India.