Bronchiectasis

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Bronchiectasis

  1. 1. BRONCHIECTASIS Presented by , Mr. Maheboob 1st year M.sc Nursing Govt college of nursing Holenarsipur
  2. 2. DEFINITION:  Bronchiectasis is defined as permanent, abnormal dilatation of one or more large bronchi.
  3. 3. DEFINITION: Bronchiectasis is defined as abnormal and irreversible dilatation of the bronchi and bronchioles (greater than 2mm in diameter) developing secondary to inflammatory weakening of bronchial walls.
  4. 4. ETIOLOGY: Bronchiectasis has both congenital and acquired causes.
  5. 5. THE YELLOWISH DISCOLORATION OF LUNG PARENCHYMA REFLECTS OBSTRUCTIVE PNEUMONIA.
  6. 6. ACQUIRED CAUSES  Tuberculosis,  pneumonia,  inhaled foreign bodies,  allergic bronchopulmonary aspergillosis and bronchiol tumours are the major acquired causes of Bronchiectasis.
  7. 7. INFECTIVE CAUSES ASSOCIATED WITH BRONCHIECTASIS INCLUDE  infections caused by the Staphylococcus, Klebsiella, or Bordetella pertussis, the causative agent of whooping cough.
  8. 8. ASPIRATION OF AMMONIA AND OTHER TOXIC GASES,  pulmonary aspiration,  alcoholism, heroin (drug use),  various allergies all appear to be linked to the development of Bronchiectasis
  9. 9.  Childhood Acquired Immune Deficiency Syndrome (AIDS), which predisposes patients to a variety of pulmonary ailments, such as pneumonia and other opportunistic infections.  Inflammatory bowel disease, especially ulcerative colitis.  A Hiatal hernia can cause Bronchiectasis when the stomach acid that is aspirated into the lungs causes tissue damage.
  10. 10. CONGENITAL CAUSES  Kartagener syndrome  primary immunodeficiencies  Williams-Campbell syndrome and Marfan’s syndrome.  Patients with alpha 1-antitrypsin deficiency have been found to be particularly susceptible to bronchiectasis,
  11. 11. MORPHOLOGICAL TYPES  Cylindrical or tubular bronchiectasis  Varicose  saccular or cystic bronchiectasis
  12. 12. Three different patterns of bronchiectasis have been described cylindrical bronchiectasis: the involved bronchi appear uniformly dilated varicose bronchiectasis: the affected bronchi have an irregular or beaded pattern of dilatation resembling varicose veins PATTERNS OF BRONCHIECTASIS
  13. 13. CYLINDRICAL OR TUBULAR BRONCHIECTASIS
  14. 14. Varicose bronchiectasis 4. Diagnosis – Chest CT
  15. 15.  Saccular (cystic) bronchiectasis: The bronchi have a ballooned appearance at the periphery, ending in blind sacs without recognizable bronchial structures distal to the sacs
  16. 16. CYSTIC BRONCHIECTASIS
  17. 17. Cystis / saccular bronchiectasis 4. Diagnosis – Chest CT
  18. 18. Due to etiological factor Inflammation of bronchial wall causing Loss of supporting structure Result in Thick sputum that obstruct the bronchi The bronchial wall become permanently dialated and distorted
  19. 19. PATHOPHYSIOLOGY Dilation and distortion of the bronchi Damage of airway epithelium Dilation and hyperplasia of blood capillary
  20. 20. Bronchiectasis Pathophysiology Airway Injury + Secretion Stimuli Secretion Stasis Infection Airway Destruction + Airway Dilation
  21. 21. CLINICAL MANIFESTATION 1. The production of large quantities of purulent and often foul-smelling sputum. The volume of sputum can be used for estimating the severity of the disease  Mild < 10 mL  Moderate 10~150 mL  Severe >150 mL
  22. 22. 2. Chronic cough 3. Hemoptysis: Frequent More commonly in dry variety Usually mild (blood streaking of purulent sputum) Massive hemoptysis is usually from dilated bronchial arteries or bronchial- pulmonary anastomoses under systemic pressure
  23. 23. 4. Recurrent pneumonia: same segment 5. Systemic manifestations: fever, weight loss
  24. 24. SIGNS AND SYMPTOMS  Chronic cough with foul smelling sputum production,  Some people with bronchiectasis may produce frequent green/yellow sputum (up to 240ml (8 oz) daily).  Bronchiectasis may also present with hemoptysis  Pneumonia  Bad breath indicative of active infection.  Frequent bronchial infections and breathlessness are two possible indicators of
  25. 25. DIAGNOSTIC EVALUATION:  History and physical examination  Chest x-ray  CT (computerised tomography) scan  Blood tests  Testing of the mucus to identify any bacteria present  Checking oxygen levels in the blood  Lung function tests (spirometry).
  26. 26. Dilated bronchus BRONCHIECTASIS
  27. 27. COMPLICATIONS  Progressive suppuration.  Haemoptysis, major pulmonary haemorrhage.  COPD,  emphysema,  chronic respiratory insufficiency
  28. 28. COMPLICATION Local complication  Recurrent pneumonia  Lung abcess  Empyema  Hemoptysis  Pulmonary hypertension
  29. 29. Systemic complication  Hypoproteinemia &amyloidosis  Generalized edema (100gm sputum/4_5 g protein)protein loosing pneumopathy
  30. 30. TREATMENT  Treatment of bronchiectasis includes  controlling infections and bronchial secretions,  relieving airway obstructions,  removal of affected portions of lung by surgical removal or artery embolization  preventing complications.
  31. 31. TREATMENT Therapy has several major goals: (1)Treatment of infection, particularly during acute exacerbations (2) Improved clearance of tracheobronchial secretions (3) Reduction of inflammation (4) Treatment of an identifiable underlying problem
  32. 32. TREATMENT  Medical management 1. Improving the drainage of airway 1) expectorant 2) bronchodilators 3) postural drainage
  33. 33. 2. Antibiotic  The choice of antibiotics should be accurately by the results of sputum culture and drug sensitivity test.  Empirical therapy --- antipseudomonal antibiotics.
  34. 34. ANTIBIOTICS ARE THE CORNERSTONE OF BRONCHIECTASIS MANAGEMENT  Antibiotics are used only during acute episodes  Choice of an antibiotic should be guided by gram's stain and culture of sputum  Empiric coverage (amoxicillin, co- trimoxazole,levofloxacin) is often given initially
  35. 35. BRONCHODILATER  Bronchodilators to improve obstruction and aid clearance of secretions are useful in patients with airway hyperreactivity and reversible airflow obstruction
  36. 36.  Surgical management is indicated 1. Recurrent and refractory clinical symptoms are due to a focal area of disease involvement. 2. Massive hemoptysis  Management of hemoptysis
  37. 37. Surgical resection Bronchial arterial embolization Although resection may be successful if disease is localized, embolization is preferable with widespread disease
  38. 38. NURSING MANAGEMENT:  History and physical examination  Obtain history regarding amount and characteristics of sputum produced, including haemoptysis.  Auscultate lungs for diffuse rhonchi and crackles.
  39. 39. NURSING DIAGNOSIS  Ineffective Airway Clearance related to tenacious and copious secretions

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