Ch. 16 Flashcards
What are the anatomic alteration of the lungs for broncheactasis?
chronic dilation and dis- tortion of one or more bronchi—usually as a result of exten- sive inflammation and destruction of the bronchial wall cartilage, blood vessels, elastic tissue, and smooth muscle components.
Frequently found in lower lobes; smaller bronchi are predominantly affected
What are the three patterns at bronchiectasis is divided into?
• Varicose (fusiform)
• Cylindrical (tubular)
• Cystic (saccular)
What is varicose (fusiform) bronchiectisis?
• Bronchi are dilated and constricted in an irregular fashion similar to varicose veins
• distorted bulbous shape
What is cylindrical (tubular) bronchiectasis?
• bronchi are dilated and rigid
• regular outlines similar to a tube
• x-ray shows dilated bronchi fail to taper for 6 to 10 generations
• appear to end abruptly because of mucous obstruction
What is cystic saccular broncheactasis?
• Bronchi progressively increase in diameter until the end in large cystlike sacs lung parenchyma
• greatest damage to TB tree
• composed of fibrous tissue
What are the pathologic and structural changes associated with bronchiectisis?
• Chronic dilation and distortion of bronchial airways
• Excessive production of often foul-smelling sputum
• Bronchospasm
• Hyperinflation of alveoli (air trapping)
• Atelectasis
• Consolidation and parenchymal fibrosis
• Hemoptysis secondary to bronchial arterial erosion
What is the etiology and epidemiology of bronchiectisis?
cystic fibrosis is the most common cause of bronchiectasis in children
The prevalence of noncystic fibrosis bronchiectasis (NCFB) in developed nations is relatively low.
What are the causes of broncheactasis?
What is the diagnosis for bronchiectasis?
overinflated lungs or marked volume loss, increased opacities, dilated fluid-filled airways, crowding of the bronchi, and atelectasis.
crowding of the bronchi, loss of bronchovascular markings and, in more severe cases, honey- combing, air-fluid levels, and fluid-filled nodules.
What are the clinical manifestations for bronchiectasis?
• excessive bronchial secretions
• bronchospasm
• atelectasis
• consolidation
• increased alveolar- capillary membrane thickness
What is the clinical data obtained at the patient’s bedside for broncheactasis?
the disease may create an obstructive or a restrictive lung disorder or a combination of both.
What are the vital signs for broncheactasis?
• increased respiratory rate (tachypnea)
• increased RR
• increased heart rate
What are the pathophysiologic mechanisms for bronchiectisis?
• Use of accessory muscles during inspiration and expiration
• pursed lip breathing (obstructive)
• barrel chest (obstructive)
• peripheral edema and venous distention
• cyanosis
• Digital clubbing
What will happen for a patient with broncheactasis?
Cough, sputum production, and hemoptysis
What are the pathologic factors in obstructive bronchiectasis?
• Decreased tactile and vocal fremitus
• Hyperresonant percussion note
• Diminished breath sounds
• Wheezing
• Crackles
What are the pathologic factors for restrictive broncheactasis?
• Increased tactile and vocal fremitus
• Bronchial breath sounds
• Crackles
• Whispered pectoriloquy
• Dull percussion note
What are the PFTs for moderate to severe bronchiectasis in obstructive lung pathophysiology?
Everything is decreased
What are the lung volume at capacity findings for moderate to severe obstructive bronchiectasis?
What are the PFTs for moderate to severe restrictive bronchiectasis?
FEV/FVC ratio is the only thing increased; because they can’t take in enough air because lung is smaller
What are the lung capacities and volumes for moderate to severe restrictive bronchiectasis?
Everything is decreased
What will the ABG look like for mild to moderate bronchiectasis?
pH is the only thing increased
What will the ABG look like for a severe stage of bronchiectasis?
What are the oxygen indices for mild to severe bronchiectasis?
The only things inc are the pulmonary shunt fraction and O2 extraction ratio.
What are the hemodynamic indices for moderate to severe bronchiectasis?
Everything thing is increased and normal
What is the hematology for bronchiectais?
• Inc. HT and HB
• Inc. elevated WBC count if pt is acutely infected
What is the sputum examination for bronchiectasis?
• Streptococcus pneumoniae
• Haemophilus influenzae
• Pseudomonas aeruginosa
What are the radiological findings for obstructive bronchiectasis?
• Translucent (dark) lung fields
• Depressed or flattened diaphragms
• Long and narrow heart (pulled down by diaphragms)
• Enlarged heart (when heart failure is present)
• Tram-tracks
What are the differences between the radiologic findings on a CF x-ray and bronchiectasis x-ray?
• Long and narrow heart (pulled down by diaphragms)
• Enlarged heart (when heart failure is present)
present in bronchiectasis not CF
What is the general management of bronchiectasis?
controlling pulmonary infections, airway secretions, and airway obstruction and preventing complications. Antibiotics (tailored to the patients sputum cultures and sensitivities), bronchodilators and expectorants
What are the respiratory care treatment protocols for bronchiectasis?
• O2 therapy protocol
• airway clearance therapy protocol
• lung expansion therapy protocol
• aerosolized medication therapy protocol
• mechanical ventilation protocol
What happens is the O2 therapy protocol for bronchiectasis?
treats hypoxemia, decrease the work of breathing, and decrease myocardial work.
What does the airway clearance protocol do in bronchiectasis?
Clears excessive secretions using…
• Directed cough
• Exercise breathing programs
• Autogenic breathing
• Forced expiration
• Chest physical therapy (CPT) (postural drainage [PD],
hand or mechanical chest clapping)
• Suctioning
• Positive expiratory pressure (PEP)
• Oscillatory PEP (e.g., flutter valve acapella device)
• High frequency chest wall compression
What does the lung expansion therapy protocol do?
Attempts to keep distal lung units inflated may involve the use of deep breathing and coughing and incentive spirometry
What does the aerosolized medication therapy protocol do?
induce bronchial smooth muscle relaxation, particularly in patients with spirometrically-proven reversible airway obstruction
What does the mechanical ventilation protocol do for bronchiectasis?
to provide and help improve alveolar ventilation and eventually return the patient to spontaneous breathing.
What are the meds usually given for bronchiectasis?
Expectorants sometimes are ordered when oral liquids and aerosol therapy alone are not sufficient to facilitate expectoration
Ex. Mucolytics (Acetylcysteine)
What antibiotic is used for bronchiectasis?
Hypertonic saline
