BRONCHIECTASIS

Definition :

👉A chronic dilation of the bronchi and bronchioles due to inflammation and destruction of their walls (bronchial walls).

 It is a dx that causes local irreversible dilation of the bronchial tree.

It is an obstructive lung dx that occurs basically as a result of bronchial obstruction,leading to infection and inflammation.

NOTE:✏It is more of a complication of other conditions.

CAUSES/ETIOLOGY:

🐒Cystic fibrosis 

🐒Bordotella pertussis Infections 

🐒Ciliary dysfunction syndrome

🐒Congenital abnormalities 

🐒Tb

🐒Airway obstruction of any kind

🐒Aspiration of foreign body or vomitus 

🐒Immuno-deficiency 

🐒M.Orgs (Viruses, bacteria,fungi).

PATHOPHYSIOLOGY:

👠Any of the above causes would lead to damage and dilatation of the bronchial wall,which would result in formation of scar tissue.

👠The surrounding scar tissue contracts, thereby causing secondary inflammatory changes and further obstructing the airway.

👠In an attempt to clear the airway,there is secretion of thick sputum which builds up and also causes obstruction.

👠The bronchial secretions which are unable to be cleared,pools up towards the lower lobes and increases the risk for further infection in that area.

👠This infection leads to collection of exudates such as pus.

👠Irritation of the airway leads to severe coughing;and as the process progresses, there is atelectasis and fibrosis which causes respiratory insufficiency.

CLINICAL MANIFESTATIONS:

✔Chronic cough with purulent sputum

✔Intermittent hemoptysis

✔Fever and malaise

✔Crackles and rhonchi heard over involved lobes.

✔Finger clubbing 

✔Anorexia and weight loss 

✔Reduced or absent breath sound.

 DIAGNOSTIC EVALUATIONS:

🏃Sputum sample/culture (May reveal offending organism).

🏃Chest X-Ray (may reveal areas of atelectasis and widespread of bronchial dilation ).

🏃CT-Scan (will show the thickened and dilated airways).

MGT:

NOTE👌✏Mgt of bronchiectasis is not curative.

Goal of mgt is prevent progression of dx,reduce risk of infection,reduce bronchial secretions and prevent complications.

 Medical management :

💊Postural drainage(Essential to drain the bronchial tree of excessive secretions).

💊Antibiotics. E.g. Ciprofloxacin(to halt invading pathogens).

💊Bronchodilators(for Bronchodilation and improved clearance of secretion).

💊Antipyrexia (To relieve fever).

💊Immunization against potential pulmonary pathogens.e.g.. Influenza and pneumococcal vaccines.

💊Surgical resection(If conservative mgt fails).

Nursing Management :

💉Routine assessment of vital signs especially RR.

💉Assist with postural drainage positioning for the involved lung segments to drain the area of excess secretions(by gravity).

💉Teach coughing and breathing exercises(To help cellar secretions).

💉Encourage increased intake of fluids (To reduce viscosity of sputum and make expectoration easier).

💉Ensure adequate rest (To conserve energy).

💉Encourage adequate nutrition(To meet tissue requirement).

💉Encourage oral care(To stimulate appetite, and promote fresh breathe).

💉Keep pt warm when pyretic(using blankets,warm drinks and prescribed antipyretics).

On discharge:

🏈Instruct pt to avoid noxious fumes,dusts,smoke,and other pulmonary irritants. 

🏈Teach pt to monitor sputum and report any changes in its quantity and xteristics.

🏈Encourage postural drainage before rinsing in the morning(Cuz sputum accumulates during the night).

🏈Encourage physical activities as tolerated (To mobilize mucus and aid easy expulsion).

🏈Emphasize the importance of influenza and Pneumococcal immunization and prompt txt of all respiratory infections(Note:Bronchiectasis is a complication of other respiratory dxs).

NURSING DIAGNOSES:

🐤Ineffective airway clearance rt copious secretions eb chronic cough.

🐤Impaired breathing pattern related to damage to the bronchial wall eb abnormal breathe sounds(Rhonchi and crackles).

🐤Hyperthermia rt alteration in T regulating centre by inflammation eb T reading of 38.5°C.

🐤Imbalanced Nutrition less than body requirement rt decreased appetite/inability to ingest food nutrients eb weight loss.

COMPLICATIONS:

⚠Pneumonia 

⚠Empyema

⚠Abscess

⚠Emphysema

⚠COPD

⚠Hemoptysis

⚠Pulmonary fibrosis 

⚠Cor pulmonale

⚠Progressive suppuration.