BRONCHIECTASIS

▪ Bronchiectasis is a disorder
characterized by permanent,
abnormal or irreversible
dilation of the bronchial tree or
wall (bronchi and bronchioles)

▪ It is classified as one of the

obstructive lung diseases
 BRONCHIECTASIS CONT’D
▪ Bronchiectasis can occur

✓ Throughout the tracheobronchial tree

✓Confined to one segment of the lobe

✓It can also be bilateral and involves the basilar

segments of the lower lobes
 CAUSES
▪ Idiopathic cause
▪ Genetic disorder such as cystic fibrosis
▪ Improperly treated bacterial respiratory tract infections
such as PTB
▪ As a complication of measles, pneumonia, pertussis or
influenza
▪ Obstruction by foreign body e.g. tumours or stenosis
associated with recurrent infection
▪ Inhalation of corrosive gas or repeated aspiration of
gastric juices into the lungs
▪ Cigarette smoking
 FORMS OF BRONCHIECTASIS
Cylindrical tubular)
bronchiectasis
▪ This involves medium size
bronchi that are mildly
and moderately dilated.
▪ Chronic cough is a
common symptom.
▪ It is usually discovered on
CT scans of the chest.
 FORMS OF BRONCHIECTASIS
Saccular or cystic
bronchiectasis
▪ It occurs mainly in the
large bronchi
▪ It is characterized by pus-
filled cavities or cavity-
like dilation.
▪ The affected bronchi end
in sac.
▪ This distorts the airway
walls with the affected
person producing more
sputum.
 FORMS OF BRONCHIECTASIS
Varicose (fusiform)
bronchiectasis
▪ abnormal irregular
dilation of the bronchi
given the appearance of
varicose vein.
▪ Patients with this type of
bronchiectasis have
chronic productive cough
bringing up a cup or more
of discolored mucus each
day.
 PATHOPHYSIOLOGY
▪ Secondary to pulmonary infections, aspiration of
foreign bodies (vomitus) or material from upper
respiratory tract, there is damage to the bronchial wall,
which leads to the buildup of thick sputum, causing
obstruction.

▪ Proximal to the blockage, pressure of inspired air leads

to dilation of damaged bronchi
 PATHOPHYSIOLOGY CONT’D
▪ Persistent severe coughing to remove copious purulent
sputum causes intermittent increase of pressure in the
blocked bronchi further worsening the bronchial
dilation

▪ This leads to stasis of thick mucus thus reducing

expiratory airflow

▪ If blood vessels are eroded, hemoptysis may occur

▪ As the process progresses, there is atelectasis and

fibrosis, which lead to respiratory insufficiency
 CLINICAL MANIFESTATION
▪ Chronic cough with large amounts of green/yellow
purulent sputum
▪ The cough worsens in the morning and when lying
down
 CLINICAL MANIFESTATION
CONT.
▪ Wheezing
▪ Shortness of breath/difficulty in breathing
▪ Chest pain
▪ Coughing up blood (Hemoptysis)
▪ Weight loss
▪ Dull or flat sound over the area of mucus plugs
▪ On auscultation, coarse crackles with occasional
wheezes bronchial sounds is heard over involved lobe
or segment.
▪ Clubbing of fingers
Images showing clubbing of fingers
 INVESTIGATIONS
▪ History of prolong productive cough with sputum
consistently negative for TB
▪ Physical examination may reveal wheezing and
crackles on auscultation
▪ Laboratory investigations;
✓Sputum and gram stain test
✓FBC differential identify anemia and leukocytosis
▪ QuantiFERON blood test or purified protein
derivative (PPD) skin test to check for tuberculosis
▪ Chest x-ray- shows peribronchial thickening, area of
atelectasis and scattered cystic changes
▪ CT scan to confirm the diagnosis
 BRONCHOSCOPY
• This is used to look
inside the airways with
a fiberoptic camera for
tumors or foreign bodies

• It can also be done

therapeutically to
remove excessive
retained secretions.
 BRONCHOGRAPHY
• It is a radiological
technique, which involves x-
raying the respiratory tree
after coating the airways
with contrast.
• It is a reliable test that
reveals location and extend
of the disease
 MANAGEMENT
CONSERVATIVE MANAGEMENT
▪ Oral or intravenous antibiotics are given to fight
infection.
▪ Bronchodilators e.g. salbutamol
▪ Oral steroids e.g. prednisolone to reduce
inflammation
▪ Mucolytic agent e.g. acetyl cysteine
▪ Secretolytic agent e.g. ambroxol
▪ Postural drainage to aid in draining the secretions
 CONSERVATIVE MG’T CONT’D
▪ Oxygen therapy for hypoxamia
▪ Avoid smoking- to avoid bronchial stimulation and
irritations
▪ Drink plenty of fluids to make mucous secretions less
sticky.
▪ Eat nutritious food
▪ Suction PRN
 CONSERVATIVE MG’T CONT’D

▪ Avoid superimposed infections such as cold

▪ Ensure children are vaccinated against

childhood diseases such as measles, TB etc.

▪ Prepare the patient for bronchoscopy. This will

aid in the removal of secretions
 POSTURAL DRAINAGE
▪ Postural drainage uses specific positions that allow
the force of gravity to assist in the removal of
bronchial secretions.

▪ The secretions drain from the lungs through the

affected bronchioles into the bronchi and trachea and
are removed by coughing or suctioning.

▪ Postural drainage is used to prevent or relieve

bronchial obstruction caused by accumulation of
secretions.
▪ Prior to the exercise, instruct the patient to inhale
bronchodilators and mucolytic agents, if prescribed.

▪ Direct the exercise at any of the segments of the lungs.

▪ Frequently, five positions are used, one for drainage of

each lobe: head down, prone, right and left lateral, and
sitting upright
 NURSING RESPONSIBILITY
▪ The nurse should be aware of the patient’s diagnosis as
well as the lung lobes or segments involved, the cardiac
status, and any structural deformities of the chest wall
and spine.

▪ Auscultate the chest before and after the procedure

▪ Use pillows, cushions, or cardboard boxes.

▪ Perform postural drainage before meals two to four

times daily
▪ Nebulize patient with prescribed
bronchodilators or saline

▪ Position the patient to drain the lower lobes

first, then upper lobes.

▪ Makes patient as comfortable as possible in

each position and provides an emesis basin,
sputum cup, and paper tissues.
▪ Instructs the patient to remain in each position for 10
to 15 minutes

▪ Assist patient to assume a comfortable position if

position cannot be tolerated.

▪ When the patient changes position, explain how to

cough and remove secretions.

▪ If the patient cannot cough, suction the secretions

mechanically.
▪ After the procedure, notes the amount, color,
viscosity, and character of the expelled sputum.
▪ Evaluate patient’s skin color and pulse the first few
times the procedure is performed.
▪ Administer oxygen PRN during postural drainage.
▪ Perform postural drainage in a room away from
other patients and use deodorizers unless
contraindicated if the sputum is foul-smelling
▪ Encourage the patient to brush the teeth and use
mouth wash after the procedure.
VARIOUS POSITIONS
VARIOUS POSITIONS
 NURSING DIAGNOSIS
Ineffective airway clearance related to tenacious and
copious secretions
NURSING INTERVENTIONS
OBJECTIVE OUTCOME
▪ Assist with postural drainage positioning for
Maintain an effective involved lung segments to drain secretions by
airway gravity
▪ Encourage deep breathing and coughing to help
clear secretions.
▪ Encourage increased intake of fluids to reduce
viscosity of sputum and make expectoration easier
or administer I.V. fluids
▪ Administer prescribed mucolytic or secretolytics to
enhance drainage of secretion e.g., acetyl cysteine
or ambroxol
▪ Suction patient as needed to assist with removal of
secretions
▪ Administer oxygen PRN
 COMPLICATIONS
▪ Atelectasis
▪ Empyema
▪ Broncho-plural fistula
▪ Pulmonary hypertension
▪ Corpulmonale
With bronchiectasis, what substance builds up in the
lungs?
A. Mucus
B. Oxygen
C. Carbon dioxide
D. Nitrogen
Which of the following is a cause of bronchiectasis?
A. Pneumonia
B. An injury to the lungs
C. In inherited condition
D. All the answers are correct
What kind of congenital bronchiectasis causes problems
with mucus clearance and thick, stagnant secretions that
leads to obstruction and frequent infections?
A. Cystic fibrosis
B. Down syndrome
C. Peptic ulcer
D. DeGeorge syndrome
What are the hallmark symptoms of
bronchiectasis?

A. Chronic cough with production of large

quantities of foul-smelling sputum.
B. Dry irritative cough
C. Hemoptysis
D. Fever
Mr. Asare was seen at Tamale Teaching Hospital with
abnormal irregular dilation and narrowing of the
bronchi given the appearance of varicose vein. With this
type of bronchiectasis, Mr. Asare has chronic productive
cough usually up to a cupful or more of discolored
mucus each day. The most likely form of bronchiectasis
is?
A.Cylindrical bronchiectasis
B.Varicose bronchiectasis
C.Saccular bronchiectasis
D.Bronchovesicular bronchiectasis
Caring for Mr. Asare with a diagnosis of bronchiectasis, a nursing
diagnosis of ineffective airway clearance related to presence of
tracheobronchial secretions or obstruction was made. The
following nursing interventions should be taken into consideration
EXCEPT
A. Teach coughing techniques to promotes chest expansion and ventilation

B. Encourage fluid intake to ensure adequate hydration and liquefy secretions

C. Teach relaxation techniques to help reduce the patient’s anxiety and

promote airway clearance

D. Give expectorants and mucolytics as prescribed to enhance airway

clearance
What should be done to prevent bronchiectasis from
worsening?

A. Avoid air pollution

B. Vaccination against preventable diseases
C. Avoid smoking.
D. All of the above
What tests are performed in patients with suspected
bronchiectasis?

A. Sputum
B. Chest x-ray,
C. High-resolution CT of the chest,
D. Bronchoscopy
E. Sweat test for cystic fibrosis.
What are the main symptoms associated with
bronchiectasis include?
Persistent cough with purulent sputum,
I. hemoptysis
II. weight loss,
III. digital clubbing,
IV. wheezes.

A. I, II, III only

B. II, III & IV only
C. III, IV & V only
D. I, II, III, IV & V