Bronchiectasis

Bronchiectasis

Definition :-

     Bronchiectasis is a chronic irreversible abnormal dilation of the bronchi or bronchioles.

     It may be caused by variety of conditions.

Etiology :

·        Airway obstructions

·        Diffused airway injury.

·        Chronic pulmonary infections

·        Genetic disorders such as cystic fibrosis genetic disorder where there is abnormal transferring of  Cl^-  and Na across the epithelial membrane in and out of the cell in the body. Which leads to abnormal production of mucous.

·        Frequent exposure to respiratory tract infections in childhood.
Ex : Influenga ,URI, TB.

·        Idiopathic causes

Pathophysiology :-

• The inflammatory process associated with pulmonary infections damages the branchial wall and there is a loss of its supporting structure and result in the thick sputum that ultimately obstructs the bronchi and the wall become permanently distended and shows impaired mucociliatory clearance. 

• The retention of secretions and subsequent obstructions ultirnately cause the alveoli obstruction resulting collapse and finally inflammatory scarring or fibrosis replaces the functioning lung tissue.
  
• The patients develops respiratory insufficiency with reduced vital capacity and decreased ventilation and an increased ration of residual volume to the total lung capacity impairement in the matching of ventilation of perfusion and hypoxemia.

Vital Capacity : Maximum amount of air with expel from lungs after maximum inspiration.

Residual Volume : The amount of gas remaining in the lungs at the end of maximum exhalation.
Total lung capacity : The amount of gas remaining in the lung at the end of the maximum inspiration.

Clinical Manifestations :-

·        Chronic cough.

·        Production of purulent sputum incopious amounts.

·        Hemoptysis

·        Clubbing of finger.

·        Cyanosis.

·        Repeated episodes of pulomonary infections.

·        Crackles.

·        Recurrent fever.

Diagnostic Findings :-

·        Prolonged history productive cough with sputum consistently negative for tubercle bacilli.

·        CT scan – Bronchial dilation.

·        X – ray – Atlectasis ( Collapse of alveoli ) with wide dilation of bronchi.

Bronchiectasis x-ray

Management :

Treatment objectives are :-

·        To promote branchial drainage.

·        To clear the excessive secretions from affected portion of lungs.

·        To prevent / control the infections.

-         Postural drainage with reduces the amount of secretions and the degree of infection.

-         Sputum can be removed by suctioning.

-         Chest physio : Helps in secretion management.

-         Antimicrobial, antibiotic and mucolytic therapy.

-         Segmental resection.

-         Lobectomy.

Nursing Management :-

·        Health education on smoking cessation.

·        Encourage increased intake of fluids.

·        The patient and family are taught to perform postural drainage and to avoid exposure to others with other infections.

·        Infection control by prompt automicrobial treatment and immunization against potential pulmonary pathogens ( Influenza,Pnumococcal )

·        Consider vaporizers to provide humidification and keep secretions thin.

Patient Education :

·        Instruct the patient to avoid pulmonary irritant  ( dust, smoke )

·        Teach the patient to monitor sputum and report  if changes in quantity or character occurs.

·        Instruct the patient and family about importance of pulmonary drainage.

·        Teach the chest physiotherapy techniques and encourage the patient to engage in physical activity throughout the day to help mobilize mucus.

·        Encourage regular dental care by copious sputum production may cause the
 dental caries.

·        Emphasize the importance of influenza and pneumococcal immunizations and prompt treatment of respiratory infections.

Complications :

·        Major pulmonary hemorrhage ( Hemolysis ).

·        COPD.

·        Chronic respiratory insufficiency.

Nursing Diagnosis :

·        Ineffective airway clearance related to broncho spasm, mucus production, tenacious secretions.

·        Anxiety related to the difficulty in breathing perceive actual loss of control and fear of suffocation.

·        Ineffective therapeutic regimen related to lack of inflammation about asthma and it’s treatment.

Complications :

·        Rib fractures.

·        Pnemothorax.

·        Atlectasis.

·        Pneumonia.

·        Status Asthamaticus.

Multiple Choice Questions :

01.To do percussion and postural drainage of lungs in bronchiectasis. What body position of the patient, a nurse should use

A. Supine position

B. Prone position

C. Decubitus position

D. Semi fowlers position

Answer : 

Related Posts :

• Bronchial Asthma.

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Bronchial asthma drugs classification

Classification of Bronchial Asthma Drugs.

1)Bronchodilators : Relive Bronchospasm

2) Anti-inflammatory drugs : Prevent Bronchospasm

1)Bronchodilators : Relive Bronchospasm.

A. Adrenergic Drugs.

B. Antichoilnergic Drugs.

C. Methyl – xanthenes.

A. Adrenergic Drugs.

i. Non – selective.

ii. Selective β2 – agonists.

i. Non – selective.

• Adrenaline
• Isoprenaline
• Ephedrine

ii. Selective β2 – agonists.

• Salbutamol
• Terbutaline
• Bambuterol
•  Fenoterol 
•  Salmeterol
•  Formeterol

B. Antichoilnergic Drugs :

• Ipratropium
• Tiotropium

C. Methyl – xanthenes.

• Theophylline (anhydrous )
• Aminophylline
• Hydroxyethyl theophyline
• Choline theophyllinate
• Theophylline ethanolate or Piperazine
• Doxophylline
• Diprophylline

2. Anti – inflammatory drugs : Prevent Bronchospasm

A.Corticosteroids

B. Mast Cell Stabilizers

C. Anti-leukotriene Drugs

D. Anti – IgE antibodies

A. Corticosteroids :-

i. Inhalational :

•  Bechomethasone
• Triamcinolone
• Budesonide
•  Fluticasone
•  Flunisolide
• Ciclesonide

ii. Systemic :

• Prednisolone
• Hydrocortisone

B. Mast cell Stabilizers :

• Sod. Cromoglycate
• Nedocromyl
• Ketotifen

C. Anti-leukotriens Drugs :-

i. Leukotriene synthesis inhibitor :

•  Zileuton

ii. Leukotriene receptor antagonists :

• Montelukast
• Zafirlukast
• Pranlukast
• Iralukast

iii. Anti-IgE antibodies :

• Omalizumab

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Bronchial Asthma

Bronchial Asthma

Definition :-

          It is a chronic inflammatory disorder of the air ways in which the inflammation causes varying degree of obstruction in airways.

          Inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and persistent cough in particularly in night and early morning.

Classification :

1. Mild Intermittent.

2. Mild persist.

3. Moderate persist.

4. Severe persist.

• Mild Intermittent : 

                            Symptoms no more frequently than twice weekly.

• Mild persist :

                           Symptoms more frequent than twice weekly but less than once a day.

• Moderate persist :

                           Symptoms persist daily.

• Severe persist : 

                           Continuous symptoms with linked physical activity. 

Ethiology : -

• Allergens : Exaggerated response of Ig E
  Ex : Pollens, Dust, Grass, Animal dandruff etc. 

• Exercise induced asthma ( EIA )
• Respiratory infections.
• Food additives
• Nose and sinus problem
• Drugs
• Emotional Stress
• GERD

 Allergens : 

          In some persons, ie asthma an exaggerated Ig E response to certain allergens occurs.

Ex : Pollens, Dust, Grass, Animal Dust.

Exercised Induced Asthma :

          Asthma is induced during the physical exertion is called as exercise induced asthma ( EIA ).

          It will occur after several minutes of vigorous exercises.

Ex : Jagging, walking, Climbing slides.

Food additives : 

           Such as tartazine ( yellow dye ), Sulfites ( Bisulfites & metabolo bisulfites ), food preservatives in bear, wine etc.

Nose and Sinus Problems :

          Rhinitis, Nasal polyps, Sinusitis. 

Drugs :

          Tab : Aspirin & NSAIDS,

           Beta adrenergic blockers ( Propanol )

          It may cause asthma because they inhibit adrenergic stimulation of bronchioles and prevents the broncho dilation.
 

Emotional Stress :

          Psychological / emotional stress will also cause asthma.

GERD :

           The exact mechanism for asthma is not known in patients with hiatal hernia, excessive stress, and prior History of reflexes or ulcer diseases may have the mild reflex as asthma triggers.

Pathophysiology :

Clinical Manifestations:-

• Wheezing
• Breath lessness
• Chest tightness
• Cough
• Expiration : Prolonged ( Normal : 1: 2 )
       Expiration may be prolonged ie, instead of normal inspiratory : expiratory ratio of 1:2,
  it may prolonged to 1 : 3 or 1 : 4 during the expiration. The bronchi oles will consist.
• Bronchial spasm
• Edema and Mucus in bronchi oles.
• Airways become narrow than the usual due to the constriction of bronchi oles.
• Air trapping.
• Hyperventilation.
• Silent Chest ( Diminished breath sounds )
• Cough.
• Secretions may be thick.
• Gelatinous mucous.
• Hypoxemia.
• Restlessness.
• Increased anxiety.
• Inappropriate behavior.
• Increased pulse and B P
• Pulse paradoxes ( Drop of systolic BP in inspiration )
• Respiratious increases greater than 30 breaths/min.

Diagnositc Studies :

• A detailed history may indicate previous attacks of precipitating factors.
• PHYSICAL EXAMINATION : It reveal the previous attacks of exposure
  to allergens will be obtained.

• Pulmonary Function Test.
• Chest X-ray : Hyperventilation.
• Measurements of ABG analysis.
            ABG indicates respiratory Alkalosis, Hypercapnia ( Increased Co2 level ) and
  respiration and metabolic acidosis indicates severe disease.
• Allergy skin testing : It will determines sensitivity to specific allergens.
• Complete Blood Count ( CBP ).
• Serum electrolytes.

Medical Management :-

NAEPP : National Asthma Education & Prevention Programme

                Categories  medications into two classification.

          i) Long term control medications.

         ii) Quick relief medication.

i) Long term : To active and maintain control of persistent asthma.

ii) Quick relief : To treat the symptoms at exaversation.

Classification of Bronchial Asthma Drugs 

Bronchial Asthma Drugus.

Nursing Management :-

• Health Promotion
• Active intervention
• Nursing Assessment.
• Subjective Date :
       - Important Health information.
       - Previous Medications.
       - History of exercise.
       - Rest & Sleep patterns.
       - Food Additives.
       - Allergens.
       - Hereditary Disorders.
•  
• Obejective Date :
       - Assess the general Integument, Respiration, CVS, Possible findings,
         Like : Abnormal ABG, Decreased Spo2 Levels.

Related Posts : 

Case-01:Case Study On Bronchial Asthma
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Trachea Anatomy 
Bronchial Tree Anatomy  
Lungs Anatomy

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