BRONCHIECTASIS

PREPARED BY : ELVIASTEFENI HAMID BADARIAH BAHARUN

1

Figure 1 : A description of human respiratory system with bronchiectasis

DEFINITION
Chronic dilation of bronchi and its branches.

BRONCHIECTASIS ETIOLOGY
2 types : congenital and acquired bronchiectasis Main causes of acquired bronchiectasis : - pulmonary infection (TB) - chronic URTI - other respiratory complication

Figure 2 : Comparison between normal bronchus and bronchiectasis 4

PATHOPHYSIOLOGY
Causes : pulmonary infection , etc. Bronchi distend and less elastic Large amount of sputum produced Chronic cough Dilation of bronchi and its branches (bronchiectasis)

Figure 3 : coloured bronchogram (Xray) of human lung showing bronchiectasis

Figure 4 : Gross specimen of human lung with bronchiectasis

SIGNS & SYMPTOMS

Dyspnea Body weight reduces Fatigue Productive cough with purulent sputum Using breath accessory muscle when breathing Can causes CHF : peripheral edema ,PaCO2 increase Polycythaemia : Hb and HCt increase Clubbing finger Crackles Odor breath

Figure 5 : Clubbing finger

Clubbing underlying part of nail tissues become thick

COMPLICATION
Cor pulmonary Pneumonia Hemoptisis

DIAGNOSTIC TEST
ABG > PaCO2 increase CBC > Polycythaemia : Hb and HCt increase CXR > hyperinflation lungs CHF : cardiomegali Average rate of blood flow in the pulmonary decrease ,lungs volume increase

10

MEDICAL SURGICAL MANAGEMENT

MEDICAL - help to dispel sputum
maintain Oxygenation >ABG & Oximetry postural drainage aerosol/inhaler suctioning if necessary calibrate body weight every day monitor I/O chart genetic study and counselling

11

PHARMACOLOGICAL
- Acetylcystein (mucomyst) and other mucolytic - Antibiotic

- Pneumococcal vaccine (Pneumovax 23) - Bronchodilator - Anti-inflammatory (steroid : prenidsone) via inhalation beclomethasone dipropionate - If CHF ,give digoxin (Lanoxin) ,diuretic : furosemide (lasix) and potassium supplement

12

Figure 6 : Acetylcysteine is a mucolytic drug that breaks down mucus, the substance that lubricates many parts of the body such as the mouth, throat, and lungs. 13

Figure 7 : Pneumococcal vaccine

14

DIET
- take more carbohydrate and calorie intake - increase fluid intake when there is no contra-indication - If have CHF ,take low sodium diet

ACTIVITY - Confine physical activity during acute attack

- Encourage client to RIB - Increase gentle exercise as the client can tolerate - Rehabilitation activity

15

NURSING PROCESS
ASSESSMENT
> Subjective Data

- history of respiratory infection (TB or other infection)

- patient or family history : cystic fibrosis - how the disease show its symptom ,period time of disease ,the severe of symptom > Objective Data - changes of consciousness stage - dyspnea ,tachypnea and cyanosis - breathing by using accessory muscle - pulse increase because of hypoxia - body temperature increase and purulent sputum - crackles breath sound - sign and symptom of CHF (peripheral edema)

16

NURSING CARE PLAN

Nursing diagnosis
breathing disorder (not effective) related to increases of secretion and rate of sputum viscosity. Aim normal breathing sound ,RR ,breathing pattern and ABGs in a normal bound.

Nursing intervention
Observe the level of patient consciousness ,pattern ,breathing effort and uses of accessory muscle ,position that can make patient to breath comfortable. Assess vital sign Lungs auscultation Treatment must not bothering patient especially when they are resting Asses sputum : amount ,color ,viscosity ,odor Give medicine and respiratory treatment as order by doctor Monitor ABG or pulse Oximetry Suctioning if necessary Give O2 as appropriate indication Prepare suitable diet prescription including supplement If there is no contra-indication >increase fluid intake Make postural drainage as suitable indication Teach patient how to make a deep breath and effective cough

17

Evaluation
Client can breath normally. Sputum production decrease or completely recover.

NURSING CARE PLAN

Nursing diagnosis imbalance nutritional intake related to increases of energy needed to nurse the breathing function Aim no changes of patient body weight (does not reduce)/still in the ideal body weight range

18

Nursing intervention
Prepare condusive environment as a place for entertaining food Foremost food to avoid fatigue because of treatment and medicine Give appropriate diet and liked by the client Give respiratory treatment to help patient breathing Assess body weight and compare with the ideal body weight of client Assess client nutritional intake and assess the accurate diet including supplement as ordered by doctor

Evaluation
Client have enough nutritional needs to avoid low body weight problem Client have enough rest Client can do their normal daily activities

IDEAL BODY WEIGHT

Ideal body weight = (height 100) 10% (height 100) When > 10% it is overweight When > 20% it is obesity Eg : height = 161cm ,weight = 58kg Ideal body weight = (161 100) 10% (161 100) =61 6.1 = 54.9kg (55KG) Body weight 58kg is still in bound > 10%

20

THANK YOU