Bronchiectasis

Bronchiectasis procedure in adults

1. Bronchiectasis Prepared by: RN ARPANA BHUSAL BNS 1 7/24/2022

2. Content Introduction Definition Risk factors Pathophysiology 2 7/24/2022

3. Cont … Clinical Features Diagnostic Evaluation Complications Management Nursing Management 3 7/24/2022

4. Introduction Bronchiectasis is a chronic lung disease, defined pathologically as irreversible dilation of the bronchi. The clinical course of the disease is chronic and progressive and in most cases, causes lung damage over many years. There is usually an initial event, which causes impairment of mucociliary clearance of bronchial tree. 4 7/24/2022

5. Contd… The respiratory tract becomes colonized by bacteria that inhibit the cilliary function ad promote further lung damage. the hall mark of bronchiectasis, is a chronic cough with mucopurulent or purulent sputum, lasting for months to years and may progress to chronic respiratory failure. 5 7/24/2022

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7. Definition Bronchiectasis is a condition in which the bronchial tubes in the lung become damaged from inflammation or other causes and the smooth muscles of the bronchial tubes are destroyed. In addition, elasticity of the bronchi is often lost. Bronchiectasis may be acquired or have a genetic origin. Many clinicians consider bronchiectasis to be a form of chronic obstructive pulmonary disease(COPD),it includes chronic bronchitis and emphysema. 7 7/24/2022

8. Types of bronchiectasis Cylindrical bronchiectasis Saccular bronchiectasis Varicose bronchiectasis 8 7/24/2022

9. Cylindrical bronchiectasis The luminal dilation is uniform and the wall thickening is smooth and there is failure of normal tapering of bronchi. 9 7/24/2022

10. Saccular B ronchiectasis Most severe form of bronchiectasis . The bronchi are severely dilated and the bronchi end blindly in a dilated thick walled cyst. 10 7/24/2022

11. Varicose Bronchiectasis The Bronchi resembles 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. 11 7/24/2022

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13. Risk factors People with cystic fibrosis Individuals with alpha-1 anti-proteinase(alpha-1 antitrypsin) deficiency or an embryological defect termed immotile cilia syndrome Children that develop lung infections with lung tissue destruction are risk for bronchiectasis to develop later in life People that abuse drugs and alcohol 13 7/24/2022

14. Contd… People that have recurrent lung infections, aspirate foreign bodies, have had a history of tuberculosis or inflammatory bowel disease Individuals that are exposed to toxic gases or any substances that damage lung tissue. 14 7/24/2022

15. Etiology Low Body M ass I ndex Toxic fumes, gases, smoke and other harmful substances Immunodeficiency Connective tissue diseases Exposure to chemical irritants 15 7/24/2022

16. Contd.. Rheumatoid arthritis Childhood infections like pneumonia, tuberculosis, measles, whooping cough Primary cilliary dyskinesia Exposure to chemical irritants 16 7/24/2022

17. Pathophysiology Due to etiological factors Infection and inflammation damaging the bronchial wall Permanent distension and distortion of the bronchial wall 17 7/24/2022

18. Impaired mucociliary clearance Retention of secretion and subsequent obstruction Inflammatory scarring/fibrosis of the bronchus replace the functioning the lung tissue 18 7/24/2022

19. A segment or lobe of lung collapse Bronchiectasis 19 7/24/2022

20. Clinical manifestation Coughing up lots of sputum Foul smelling mucus Tiredness and poor concentration Wheeziness 20 7/24/2022

21. Cont .. Chest pain and joint pain Recurring chest infections Abnormal chest sound weight loss A constant runny nose 21 7/24/2022

22. Cont.. Fatigue Clubbing of fingers Chronic sinusitis Some people became breathless, particularly when exercising or exerting themselves 22 7/24/2022

23. Diagnostic evaluation History collection Physical examination Chest CT scan: provides further information on disease location, presence of mediastinal lesions, and the extent of segmental involvement. Chest x-ray: increase in size and loss of definition of bronchovascular markings, crowding of bronchi, and loss of lung volume. Severe case: honeycombing appearance 23 7/24/2022

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25. Cont … HR CT(High R esolution C omputed T omography ) is gold standard for diagnostic bronchiectasis , it will show either the presence or absence of bronchial dilation Sputum culture: testing of mucous to identify any bacteria present Pseudomonas H . influenza 25 7/24/2022

26. Contd.. Lung function tests Bronchoscopy Blood tests 26 7/24/2022

27. Complications Pneumonia Lung abscess Empyema Septicemia 27 7/24/2022

28. Cont.. Corpulmonale Metastatic cerebral abscesses Secondary amyloidosis with nephrotic syndrome Recurrent pleurisy Purulent pericarditis 28 7/24/2022

29. Treatment The goals of treatment are as follows: Eliminate cause Improve tracheobronchial clearance Control infection Reverse airflow obstruction 29 7/24/2022

30. Cont.. Chest physiotherapy with percussion, postural drainage, expectorants or bronchoscopy to remove bronchial secretions. Anti microbial therapy as guided by sputum sensitivity tests Bronchodilators, sympathomimetic(Beta-Adrenergic R eceptors) Postural drainage : A technique used to mobilize large amounts of secretions in people with respiratory conditions. 30 7/24/2022

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32. Cont.. Mucolytics :helps in clearing mucus from the airways, e.g. bromhexine. Mucine, erdosteine. Inhaled aerosolized aminoglycosides to prevent pseudomonas colonization. Antibiotics : ( the choice of antibiotics should be accurate by the results of sputum culture and drug sensitivity test ) 32 7/24/2022

33. Cont.. Initial treatment : Empiric coverage( amoxcilin , cotrimoxazole, levofloxacin) is often given initially Pseudomonas- quinolone. Aminoglycoside, 3 rd generation cephalosporin, pipracilin. 33 7/24/2022

34. Cont.. Supportive treatment: Smoking cessation Avoidance of second-hand smoke Adequate nutritional intake with supplementation, if necessary Immunizations for influenza and pneumococcal pneumonia 34 7/24/2022

35. Confirmation of immunization for measles, rubella and pertussis Oxygen therapy is reserved for patients who are hypoxemic with severe disease and end-stage complications, such as corpulmonale. 35 7/24/2022

36. Surgical management Segmental resection(segment of a lobe) Lobectomy (removal of lung lobe) Pneumonectomy (removal of the entire lung) 36 7/24/2022

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38. Nursing management 38 7/24/2022

39. Nursing Assessment 1. History or presence of supporting factors: Smoking Living or working in areas with severe air pollution History of allergies in family History of acid in childhood 39 7/24/2022

40. Cont.. 2. History of the presence of triggering factors such exacerbations: Allergen (pollen, dust, skin, pollen or fungal) Excessive physical activity Air pollution Respiratory tract infections and emotional stress 40 7/24/2022

41. Cont.. 3. Physical examination by focusing on the respiratory system include: Assess the frequency and respiratory rhythm Inspect color of skin and mucous membrane Auscultation of breath sounds Assess if there is chest pain on breathing 41 7/24/2022

42. Cont.. Assess if symmetrical or asymmetrical chest expansion Assess cough(whether productive or nonproductive). Assess the level of consciousness 42 7/24/2022

43. Nursing diagnosis 1. Ineffective airway clearance related to the production of mucus and a decreased ability to cough effectively 2. Impaired gas exchange related to ventilation perfusion inequality. 3. Ineffective breathing pattern related to shortness of breath, mucus, bronchoconstriction 4. Self care deficit related to fatigue, increased work of breathing, insufficient ventilation and oxygenation 43 7/24/2022

44. Cont … 5 . Imbalanced nutrition less than body requirements related to nausea, vomiting, sputum production 44 7/24/2022

45. Nursing interventions Ineffective airway clearance related to the production of mucus and a decreased ability to cough effectively Asses color, viscosity and mount of sputum Assist client in breathing exercises Teach how to cough effectively Adjust the position of the semi-fowler to the patient 45 7/24/2022

46. Cont … Maintain fluid intake at least 2500ml/day unless otherwise indicated Perform chest physiotherapy with postural drainage techniques, percussion, chest vibrations Collaboration of bronchodilators: Nebulizer(via inhalation), collaboration of mucolytic agent and expectorant Collaboration of corticosteroids 46 7/24/2022

47. Cont.. Administer antibiotics as prescribed Encourage patient to be immunized against influenza and streptococcus pneumonia If indicated, perform postural drainage with percussion and vibration in the morning and at nights prescribed 47 7/24/2022

48. Cont.. Instruct patient to avoid bronchial irritants such as cigarette smoke, aerosols, extremes of temperature and fumes Teach early signs of infection ; Increased sputum production Change in color of sputum 48 7/24/2022

49. Cont … Increased shortness of breath, tightness in chest or fatigue Increased cough 49 7/24/2022

50. Impaired gas exchange related to ventilation perfusion inequality Administer bronchodilators as prescribed Inhalation is the preferred route Educate regarding types of indoor and outdoor air pollution Instruct and encourage patient in diaphragmatic breathing and effective coughing 50 7/24/2022

51. Cont … Administer oxygen by the prescribed method: Evaluate effectiveness, observe for signs of hypoxemia Notify physician if restlessness, anxiety, cyanosis and tachycardia is present Initiate pulse oximetry to monitor oxygen saturation Explain that no smoking is permitted by patient or visitors while oxygen is in use. 51 7/24/2022

52. Cont … Ineffective breathing pattern related to shortness of breath, mucus, bronchoconstriction Teach patient diaphragmatic and pursed lip breathing Encourage use of an inspiratory muscle trainer if prescribed. Encourage alternating activity with rest periods. Allow patient to make some decisions(bath, saving) about care based on to tolerance level 52 7/24/2022

53. Self care deficit related to fatigue, insufficient ventilation and oxygenation Teach postural drainage if indicated Encourage patient to begin to bathe themselves, dress self, walk, drink fluids. Discuss energy conservation measures Teach patient to coordinate diaphragmatic breathing with activity( e.g , walking, bending 53 7/24/2022

54. Cont.. Maintain a supportive firm attitude. Allow patient sufficient time to accomplish tasks Provide positive feedback for efforts and accomplishments Families can contribute to train and support client in the client’s ability to self-care increases Place the patient in a comfortable position for feeding which reduces the risk for aspiration 54 7/24/2022

55. 5. Imbalanced nutrition less than body requirements related to nausea, vomiting, sputum production Monitor input and output every 8 hours, the amount of food consumed and body weight are weighed each week Create a fun atmosphere, an environment free of odor during mealtimes Ascertain client’s usual dietary pattern likes/dislikes 55 7/24/2022

56. Cont … Refer patient to a dietician to monitor food plan that will be consumed Encourage clients to drink at least 3 liters of fluid per day, if not given an IV Instruct the client to avoid caffeinated beverages, junk foods Instruct the client to follow prescribed number of servings of the meals included in the meal plan 56 7/24/2022

57. References Mandal G.N., textbook of medical surgical nursing published by makalu publication house, 3 rd edition, page no: 92-93 https:// www.google.com/search/Client=firefox-b-d=bronchictasis @2021/07/12 Nov2,2019. Bronchiectasis https // www.slideshare.net@Gamandeep2021/07/10 at 5pm 57 7/24/2022

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