BRONCHIECTASIS

Bronchiectasis is a chronic irreversible dilatation of the bronchi and bronchioles due to inflammation and destruction of their walls and is generally associated with chronic lung infection and impaired airway defences.

Etio-Pathophysiology

Clinical Manifestations

• Persistent cough with production of copious amounts of purulent sputum.
• Dyspnea
• Cyanosis
• Finger clubbing
• Anorexia and generalized body malaise
• Recurrent fever and bouts of pulmonary infection
• Crackles and rhonchi heard over involved lobes
• Intermittent hemoptysis; breathlessness (only COPD with sign)

Diagnostic Evaluation

• ABG analysis reveals low PaO₂
• Bronchoscopy – direct visualization of bronchi lining using a fiberscope
• Chest X-ray may reveal areas of atelectasis with widespread dilatation of bronchi.
• Sputum examination may detect offending pathogens.
• High-resolution CT scan is useful in diagnosis of bronchiectasis.

Management

Goal: prevent progression of disease.

• Infection controlled by:
  • Smoking cessation.
  • Prompt antimicrobial treatment of exacerbations of infection.
  • Immunization against potential pulmonary pathogens (influenza and pneumococcal vaccine).
• Secretion clearance techniques, such as postural drainage, percussion and vibration or other methods.
• Bronchodilators for bronchodilation and improved secretion clearance.
• Surgical resection-when conservative management fails.
• Segmental lobectomy
• Pneumonectomy

Complications

• Progressive suppuration.
• Major pulmonary hemorrhage.
• COPD
• Atelectasis (post-surgical)
• Cardiac tamponade (post-surgical)

Nursing Management

• Encourage use of chest physical therapy techniques to empty the bronchi of accumulated secretions.
  • Assist with postural drainage positioning for involved lung segments to drain the bronchiectatic areas by gravity, thus reducing degree of infection and symptoms.
  • Use percussion and vibration to assist in mobilizing secretions.
  • Encourage productive coughing to help clear secretions.
• Consider vaporizer to provide humidification and keep secretions thin.
• Enforce Complete bed rest
• Low inflow O2 admin; (high inflow will cause respiratory arrest)
• Administer medications as ordered
  • Bronchodilators
  • Antimicrobials
  • Corticosteroids (5-10 minutes after bronchodilators)
  • Mucolytics/expectorants
• Encourage increased intake of fluids to reduce viscosity of sputum and make expectoration easier.
• Nebulize and suction client as needed
• Provide comfortable and humid environment

Health teaching

• Avoidance of smoking
• Prevent complications
  • Atelectasis
  • CO₂ narcosis => coma
  • Cor pulmonale
  • Pleural effusion
  • Pneumothorax
• Regular adherence to medications
• Importance of follow up care