Bronchiectases
- 1. Ms. Amandeep Kaur Nursing Tutor MMCON
- 2. Definition Aetiology Pathogenesis Clinical manifestations Diagnosis Treatment Nursing management Summary Conclusion
- 3. Definition: Abnormal and permanent dilation of bronchi. • Focal or diffuse distribution • Clinical consequences – chronic and recurrent infection and Pooling of secretions in dilated airways. OR Bronchiectasis is defined as permanent, abnormal dilatation of one or more large bronchi.
- 5. ETIOLOGY: Bronchiectasis has both: congenital and acquired causes.
- 6. 1. Tuberculosis, 2. Pneumonia, 3. Inhaled foreign bodies, 4. Allergic bronchopulmonary aspergillosis (fungi) and bronchiol tumours are the major acquired causes of bronchiectasis.
- 7. INFECTIVE CAUSES ASSOCIATED WITH BRONCHIECTASIS INCLUDE Infections caused by the staphylococcus, klebsiella, or bordetella pertussis, the causative agent of whooping cough 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.
- 8. 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.
- 9. CONGENITAL CAUSES Kartagener syndrome/ Immotile Ciliary 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,
- 10. Also known as Broncho-malacia is a disease of the airways where cartilage in the bronchi is defective. It is a form of congenital cystic bronchiectasis, leads to collapse of the airways.
- 11. Disorder of connective tissue, resulting in abnormally long and thin digits.
- 12. 1. Cylindrical (fusiform) 2. Saccular 3. Varicose
- 14. Most severe form of bronchiectasis. The bronchi are severely dilated and the bronchi end blindly in a dilated thick walled cyst.
- 15. The bronchi resemble like varicose veins and also like serpentine. The luminal dilation is characterized by alternating areas of luminal dilation and constriction, creating a beaded appearance, and the wall thickening is irregular.
- 17. 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 dilated and distorted/ twisted
- 20. 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
- 21. 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.
- 22. 4. Recurrent pneumonia: same segment 5. Systemic manifestations: fever, weight loss
- 23. Chronic cough with foul smelling sputum production, Some people with bronchiectasis may produce frequent green/yellow sputum (up to 240ml (8 oz) daily). Pneumonia. Frequent bronchial infections and breathlessness are two possible indicators of
- 24. Dyspnoea, wheezing – widespread bronchiectasis or underlying COPD. Exacerbation of infection: Sputum volume increase, purulence or blood.
- 26. History and physical examination Chest x-ray Blood tests Checking oxygen levels in the blood Lung function tests (spirometry): Airflow obstruction – FEV1 decreased.
- 27. CT Scan: Peribronchial thickening Dilated bronchioles Sputum culture: Testing of the mucus to identify any bacteria present Pseudomonas H.influenzae.
- 28. Bronchoscopy: Obstruction – foreign body, tumor Immunoglobulin Cilia function and structure – Kartagener syndrome.
- 29. Goals: 1. Eliminate cause 2. Improve tracheo bronchial clearance 3. Control infection 4. Reverse airflow obstruction
- 30. 1. Immunoglobulin 2. Antituberculous drugs. 3. Corticosteroids. 4. Remove aspirated material Oxygen therapy Chest physio- therapy Mucolytics. Bronchodilators. Postural drainage.
- 32. Antibiotics (The choice of antibiotics should be accurately by the results of sputum culture and drug sensitivity test.) Initial Rx: Empiric coverage (amoxicillin, cotrimoxazole, levofloxacin) is often given initially, Septran Pseudomonas – Quinolone, aminoglycoside, 3rd generation cephalosporin, pipracillin.
- 33. SURGERY : Surgical management is indicated Recurrent and refractory clinical symptoms are due to a focal area of disease involvement. Surgical resection Bronchial artery embolization Although resection may be successful if disease is localized, embolization is preferable with widespread disease. Lung transplant
- 34. A catheter is used to deliver small particles that block the blood supply to the particular part of body. (Heamoptysis)
- 35. • Pneumonectomy • Lobectomy • Wedge resection • Segmentectomy • Sleeve lobectomy
- 36. A surgical procedure in which an entire lung is removed A pneumonectomy is an open chest technique (thoracotomy)
- 37. common surgical procedure removes one lobe of the lung Removal of two lobes is called bilobectomy.
- 38. Removing a lobe of the lung along with part of the bronchus (air passage) that attaches to it.
- 39. Removal of the larger portion of the lung but not the whole lobe
- 40. Natural therapy Yoga Healthy lifestyle Emotional support Drug free salt therapy
- 41. Salt therapy is a gentle, non-invasive and drug free treatment assisting the body to cleanse itself of toxins and naturally improve general health and wellbeing. The therapy involves sitting and relaxing in a specially designed salt room and breathing in the microscopic salt particles which has a positive effect on the body. The salt room itself is a micro climate that has been created free of toxins and allergens which allows the body to rest and start to naturally heal itself. Salt has natural healing properties that help sufferers of respiratory issues, skin problems and is also great for overall health.
- 42. Respiratory failure Atelectasis
- 44. Goal: Improvement in gas exchange Nursing intervention 1. Administer bronchodilators as prescribed. Inhalation is the preferred route Educate regarding types of indoor and outdoor air pollution 2. Instruct and encourage patient in diaphragmatic breathing and effective coughing.
- 45. Nursing Diagnosis: Ineffective airway clearance related to increased mucus production, ineffective cough, bronchopulmonary infection, and other complications Goal: Achievement of airway clearance
- 46. 1. Adequately hydrate the patient. 2.Use of diaphragmatic breathing and coughing techniques. 3. Assist in administering nebulizer .
- 47. 5. Avoid bronchial irritants such as cigarette smoke, aerosols, extremes of temperature, and fumes. 6. Teach early signs of infection : a. Increased sputum production b.Change in color of sputum c. Increased thickness of sputum d.Increased shortness of breath, tightness in chest, or fatigue e. Increased coughing f. Fever or chills 7. Administer antibiotics as prescribed.
- 49. Bronchiectasis , an extreme form of obstructive bronchitis, causes permanent , abnormal dilation and distortion of bronchi and bronchioles. Management of bronchiectasis is same as that for COPD