BRONCHIECTASIS

BRONCHIECTASIS – abnormal permanent dilation of bronchus resulting to destruction of muscular & elastic tissues of alveoli.

Predisposing factors:

1. Recurrent upper & lower RI

2. Congenital anomalies

3. Tumors

4. Trauma

S/Sx:

1. Productive cough
2. Dyspnea
3. Anorexia, gen body malaise- all energy are used to increase respiration.
4. Cyanosis
5. Hemoptisis

Dx:

1. ABG – PO2 decrease
2. Bronchoscopy – direct visualization of bronchus using fiberscope.

Nsg Mgt: before bronchoscopy

1. Consent, explain procedure – MD/ lab explain RN

2. NPO

3. Monitor VS

Nsg Mgt after bronchoscopy

1. Feeding after return of gag reflex

2. Instruct client to avoid talking, smoking or coughing

3. Monitor signs of frank or gross bleeding

4. Monitor of laryngeal spasm

- DOB

- Prepare at bedside tracheostomy set

Mgt: same as emphysema except Surgery

Pneumonectomy – removal of affected lung

Segmental lobectomy – position of pt – unaffected side

PULMONARY EMPHYSEMA – irreversible terminal stage of COPD

- Characterized by inelasticity of alveolar wall leading to air trapping, leading to maldistribution of gases.

- Body will compensate over distension of thoracic cavity

- Barrel chest

Predisposing factor:

1. Smoking

2. Allergy

3. Air pollution

4. High risk – elderly

5. Hereditary - a 1 anti trypsin to release elastase for recoil of alveoli.

S/Sx:

1. Productive cough
2. Dyspnea at rest – due terminal
3. Anorexia & gen body malaise
4. Rales/ rhonchi
5. Bronchial wheezing
6. Decrease tactile fremitus (should have vibration)– palpation – “99”. Decreased - with air or fluid
7. Resonance to hyperresonance – percussion
8. Decreased or diminished breath sounds
9. Pathognomonic: barrel chest – increase post/ anterior diameter of chest
10. Purse lip breathing – to eliminated PCO2
11. Flaring of alai nares

Diagnosis:

1. Pulmonary function test – decrease vital lung capacity

2. ABG –

- Panlobular / centrolobular emphysema

pCO2 increase

pO2 decrease – hypoxema resp acidosis Blue bloaters

- Panacinar/ Centracinar

pCO2 decrease

pO2 increase – hyperaxemia resp alkalosis Pink puffers

Nursing Mgt:

1. CBR
2. Meds –

a.) Bronchodilators

b.) Corticosteroids

c.) Antimicrobial agents

d.) Mucolytics/ expectorants

3. O2 – Low inflow
4. Force fluids
5. High fowlers
6. Neb & suction
7. Institute

P – posture

E – end

E – expiratory to prevent collapse of alveoli

P – pressure

8. HT

a.) Avoid smoking

b.) Prevent complications

1.) Cor pulmonary – R ventricular hypertrophy

2.) CO2 narcosis – lead to coma

3.) Atelectasis

4.) Pneumothorax – air in pleural space

9. Adherence to meds