BRONCHIECTASIS
Bronchiectasis is a chronic dilatation of the bronchi & bronchioles
Causes
Pulmonary infections, obstruction of the bronchus, aspiration of foreign bodies, vomitus or material from the upper respiratory tract; extrinsic pressure from tumours, dilated blood vessels and enlarged lymph node.
May occur as a result of respiratory infection in childhood, measles, influenza, tuberculosis and immunodeficiency disorders.
Pathophysiology
Infection and other etiological factors
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Damage of bronchial wall Damage -Damage to bronchial wall
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Loss of its supporting structure and produces thick sputum
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Obstructs the bronchi
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Bronchial walls become permanently distended - Retention of secretions & obstruction
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Atelectasis
Clinical Manifestations
Chronic cough with production of purulent sputum, haemoptysis, clubbing of the fingers. Exertional dyspnoea, fatigue, weight loss, anorexia and fetid breath.
Diagnostic Investigations
Prolonged history of productive cough with sputum, consistently negative for tubercle bacilli. Bronchography, bronchoscopy and computed tomography.
Medical Management
- Antibiotics are prescribed. Postural drainage drains the bronchiectatic areas by gravity reduces the amount of secretions and degree of infection.
- Beta sympathomimetics used for bronchodilation and increases mucociliary transport I of secretions. Oral fluid intake and nebulization increases the water content of the sputum
Surgical Management
- Segmental resection-removal of a segment of a lobe.
- Lobectomy-removal of a lobe.
- Pneumonectomy-Removal of an entire lung
Nursing Management
Health promotion and maintenance.
- Administer measles and pertussis vaccine.
- Detection and treatment of lower respiratory tract infection.
- Remove promptly any obstructing lesion or foreign body.
- Decrease exposure to pollution.
Acute and Chronic Intervention:
- Deep breathing and coughing exercises.
- Assist in postural drainage
- Administer prescribed antibiotics, bronchodilators and expectorants.
- Provide rest.
- Provide good nutrition.
- Provide oral hygiene frequently improves appetite.
- Adequate hydration liquefies secretions.
- Assist in nebulization.
- Encourage the patient to have regular dental care and avoid all pulmonary irritants (Cigarette smoke, noxious fumes).
- Teach patient and family to monitor sputum and report any changes in its
- character and quantity.
Complications:
Pneumonia, lung abscess, empyema, brain abscess and amyloidosis.
