Test 3 Ch.16 Bronchiectasis Flashcards
Bronchiectasis is an acquired disorder of the major bronchi and bronchioles characterized by chronic dilation and distortion of one or both bronchi, usually as a result of extensive inflammation and destruction of the
- bronchial wall cartilage
- blood vessels
- elastic tissue
- smooth muscle components
One or ______ lungs may be involved
both
Commonly limited to one lobe or segment, and is frequently found in the
lower lobes
The smaller __________ are predominantly affected
bronchi
B/c of _____________ wall destruction, normal mucociliary clearance is impaired which results in copious amounts of ____________ secretions
bronchial;
bronchial secretions
Blood that becomes foul-smelling b/c of
secondary colonization w/ anaerobic organisms
Infection and irritation may lead to
secondary bronchial smooth muscle constriction and fibrosis
The small bronchi and bronchioles distal to the affected areas become partially or totally obstructed w/ secretions, which leads to (2)
- Hyperinflation of the distal alveoli as a result of expiratory check valve obstruction
- Atelectasis, consolidation, and fibrosis as a result of complete bronchial obstruction
Based on gross anatomic appearance, the long- accepted Reid classification subdivides bronchiectasis in 3 pattern:
- Varicose (fusiform)
- Cylindrical (tubular)
- Cystic (saccular)
The bronchi are dilated and constricted in an irregular fashion similar to varicose veins, ultimately resulting in a distorted, bulbous shape. What type of bronchiectasis is this?
Varicose Bronchiectasis (Fusiform Bronchiectasis)
The bronchi are dilated and rigid and have regular outlines similar to a tube. What type of bronchiectasis is this?
Cylindrical Bronchiectasis (Tubular Bronchiectasis)
The bronchi progressively increases in diameter until they end in a large, cyst like sacs in the lung parenchyma. What type of bronchiectasis is this?
Cystic Bronchiectasis (Saccular Bronchiectasis)
This form of Bronchiectasis causes the greatest damage to the TB tree.
Cystic Bronchiectasis
Major pathological or structural changes associated w/ Bronchiectasis (7)
- Chronic dilation and distortion of bronchial airways
- Excessive production of often foul- smelling sputum
- Bronchospasm
- Hyperinflation of the alveoli
- Atelectasis
- Parenchymal consolidation and fibrosis
- Hemoptysis secondary to bronchial arterial erosion
Most causes of Bronchiectasis include a combination of…..
bronchial obstruction and infection
What is the most common cause of Bronchiectasis in children?
Cystic Fibrosis
The prevalence of non cystic fibrosis Bronchiectasis (NCFB) is
relatively low
In the U.S the incidence of NCFB is about
4.2 per 100,000 young adults
In other population, such as Polynesia, Alaska, Australia, and New Zeland the occurrence of NCFB is as high as
15 per 1000 children
The most common cause of NCFB is _______________ infection
pulmonary
The causes of Bronchiectasis are commonly classified into the following categories: (5)
- Acquired bronchial obstruction
- Congenital anatomic disorder
- Immunodeficiency states
- Abnormal secretion clearance
- Miscellaneous disorders (alpha1- antitryspin deficiency)
A routine chest radiography may reveal: (5)
- Overinflated lungs
- Marked volume loss
- Increased opacities
- Dilated fluid- filled airways
- Crowding of the bronchi atelectasis
This scan has virtually replaced bronchography. as the best tool for diagnosing NCFB _____-___________ _____________
High- resolution tomogram (HR-CT)
___________ testing can be used to determine if the Bronchiectasis demonstrates an…..
Spirometry;
obstructive or restrictive lung path-physiology
ABG measurements can confirm if the pt has
mild , moderate or sever gas exchange compromise
The following clinical manifestation result from the pathophysiologic mechanism caused (or activated) by: (5)
- Excessive bronchial secretions
- Bronchospasm
- Atelectasis
- Consolidation
- Increased alveolar- capillary membrane thickness
Depending on the amount of bronchial secretions and the degree of bronchial destruction and fibrosis/ atelectasis associated w/ Bronchiectasis, the disease may create what?
Obstructive or a restrictive lung disorder or a combination of both
Clinical manifestation: Vital signs
- Increased RR (Tachypnea)
- Stimulation of peripheral chemoreceptors (hypoxemia)
- Decreased lung compliance and increased ventilatory rate relationship
- Anxiety
- Increased HR (pulse) and BP
More physical examination for Bronchiectasis
- Use of Accessory muscles during Inspiration and Expiration
- Pursed-Lip Breathing (when obstructive)
- Increased Anteroposterior Chest Diameter (Barrel Chest) (When obstructive)
- Cyanosis
- Digital Clubbing
Peripheral Edema and Venous Distention. B/c polycythemia and cor pulmonale are associated w/ severe Bronchiectasis this may be seen:
- Distended neck veins
- Pitting edema
- Enlarged and tender liver
Cough, Sputum Production and Hemoptysis
- Chronic cough w/ production of large quantities of foul- smelling is a hallmark of Bronchiectasis
- A 24- hr collection of sputum is usually voluminous and tends to settle into several different layers
- Streaks of blood are seen frequently in the sputum, presumable from necrosis of hemoptysis
- Haemophilus influzae, Strepococcus, Pseudomans aeruginosa are commonly cultured from the sputum of a pt w/ Bronchiectasis
Chest Assessment findings: When Bronchiectasis factors are primarily obstructive:(5) (think of air)
- Decreased tactile and vocal fremitus
- Hyperresonant percussion note
- Diminished breath sounds
- Wheezing
- Crackles
Chest Assessment findings: When Bronchiectasis factors are restrictive (over areas of atelectasis and consolidation):(5)
- Increased tactile and vocal fremitus
- Bronchial breath sounds
- Crackles
- Whispered pectoriloquy
- Dull percussion note
Abnormal Lab Test and Procedures: Hematology
- Increased hematocrit and hg
- Elevated WBC if pt is acutely infected
Sputum Culture Results and Sensitivity (4)
- Streptococcus pneumoniae
- Haemophilius influnzae
- Pseudomonas aeruginosa
- Anaerobic organism
Radiologic Findings: Chest Radiographs: When Bronchiectasis is primarily obstructive (6)
- 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
- Lungs may be hyperinflated, leading to an increased functional residual capacity and depressed diaphragms
Chest Radiographs: When Bronchiectasis is primarily restrictive (3)
- Atelectasis and consolidation
- Infiltrates (suggesting PNA)
- Increased opacity
For most cases of Bronchiectasis the treatment of the underlying disease
is not possible
The general management and treatment plan is aimed at: (4)
- Controlling pulmonary infections
- Airway secretions
- Airway obstruction
- Preventing complications
What is often prescribed during periods of exacerbation?
Antibiotics, bronchodilators, and expectorants
What are the protocols to treat Bronchiectasis
- Oxygen Therapy
- Airway Clearance Therapy
- Lung Expansion Therapy
- Aerosolized Medication Therapy
- Mechanical Ventilation
This protocol is used to treat hypoxemia, decreased WOB, and decrease myocardial work
O2 Therapy
Used to mobilize secretions
Airway Clearance Therapy
Attempts to keep the distal lung units inflated to prevent atelectasis. What protocol is this?
Lung Expansion Therapy
Use of Bronchodilators and use corticosteroids is discouraged. What protocol
Aerosolized Medication Therapy
This protocol may be necessary to provide and temporarily help alveolar ventilation and eventually return pts to their baseline condition/ or spontaneous breathing
Mechanical Ventilation
These are sometimes ordered when oral liquids and aerosol therapy alone are not sufficient to facilitate expectoration
Expectorants
Used to treat associated respiratory tract infections
Antibiotics
Questions from the back
In which forms of Bronchiectasis are bronchi dilated and constructed in an irregular fashion?
- Fusiform
- Varicose
Which are common causes of acquired Bronchiectasis?
Pulmonary tuberculosis
In the primarily obstructive form of Bronchiectasis, the pt commonly demonstrates
Decreased PEFR
Which of the following radiologic findings are associated w/ Bronchiectasis that is primarily obstructive?
- Depressed or flattened diaphragms
- Long and narrow heart
- Translucent lung fields
Which is considered a hallmark of Bronchiectasis
Chronic cough and large quantities of foul- smelling sputum
Which of following are commonly cultured in sputum of pts w/ Bronchiectasis
- Streptococcus pneumoniae
- Pseudomonas aeruginosa
- Haemophilus influenzae
When the pathophysiology of Bronchiectasis is primarily obstructive, the pt demonstrates, which of the following clinical manifestations?
- Decreased tactile and vocal fremitus
- Rhonchi and wheezing
Which of the following diagnostic procedures are used to positively diagnose Bronchiectasis?
- Bronchography
- Computed tomography
Which of the following causes are related to abnormal secretion clearance
Cystic Fibrosis
Which of the following hemodynamic indices are associated w/ Bronchiectasis
- Increased mean Pulmonary artery pressure
- Increased right atrial pressure
Which of the following protocols may be of importance in the outpatient care of pts w/ Bronchiectasis
- Oxygen Therapy
- Airway Clearance Therapy
- Lung Expansion Therapy
- Aerosolized Medication Therapy
Another name for Varicose
fusiform
Another name for Cylindrical
tubular
Another name for Cystic
saccular
Yellow pages Increased RR (Tachypnea) (3)
- Stimulation of peripheral chemoreceptors (hypoxemia)
- Decreased lung compliance and increased ventilatory rate relationship
- Anxiety
Example of Acquired Bronchiectasis
- Foreign body aspiration- peanut, chicken bone, teeth
- Hilar adenopathy- TB, sarcoidosis
- COPD- chronic bronchitis
Example of Congenital Anatomic Defects
- Vascular abnormalities- pulmonary artery aneurysm
- Lymphatic abnormalities- slow growing yellow syndrome
Example of Immunodeficiency States
- IgG deficiency
- IgA deficiency
Example of Abnormal secretion clearance
- CF mucoviscidosis
- cilary defects of airway mucosa
- young syndrome
Examples of Miscellaneous disorders
- A1AT
- viral infections (influenza)
- chronic organ rejection after transplant (lung and heart transplant)
- other infections (M.TB)
