Bronchiectasis: Management, Complications, Nursing Assessment&Interventions

 Bronchiectasis

Bronchiectasis is a chronic dilatation of the bronchi and bronchioles due to inflammation, chronic bacterial infection, and destruction of their walls. 

Pathophysiology and Etiology 

• Maybe a complication of lower respiratory infection. There is damage to the bronchial wall, which leads to the buildup of thick sputum, causing obstruction. 
• Chronic coughing and excess mucous production, which is often purulent. 
• May involve a single lobe or segment or one or both lungs more diffusely. 
• As the condition progresses, there may be atelectasis and fibrosis, which lead to respiratory insufficiency. 
• Common cause include pulmonary infections (including pertussis, TB); obstruction of bronchi; aspiration of foreign bodies, vomitus,  chemicals, or material from upper respiratory tract; cystic fibrosis; cilial dismotility syndrome; alpha1 antitrypsin deficiency; and immunodeficiency. 

Clinical Manifestations 

• Persistent cough with production of copious amounts of purulent sputum. 
• Intermittent hemoptysis, dyspnea 
• Recurrent fever and bouts of pulmonary infection 
• Crackles and rhonchi heard over-involved lobes. 
• Finger clubbing 

Diagnostic Evaluation 

• High-resolution CT scan is necessary for diagnosis of bronchiectasis.
• Chest X-ray may revels areas of atelectasis with widespread dilation of bronchi. 
• Sputum examination may be detecte offending pathogens. 
• PFT to evaluate airflow obstruction and impairment. 

Management 

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 may be helpful, such as postural drainage, PEP valve, flutter valve, Acapella device, Vest therapy and possibly, percussion and vibration or other methods. 
• Bronchodilators for bronchodilation and improved secretion clearance. 
• Mobilization and exercise such as in a pulmonary rehabilitation program. 
• Surgical resection (segmental resection ) when conservative management fails. 

Complications 

• Progressive excess mucus production or suppuration 
• Hemoptysis, major pulmonary hemorrhage 
• COPD, emphysema, chronic respiratory failure, pulmonary hypertension, cor pulmonale

Nursing Assessment 

• Obtain history regarding amount and characteristics of sputum produced, including hemoptysis. 
• Auscultate lungs for diffuse rhonchi and crackles. 

Nursing Diagnosis 

• Ineffective Airway Clearance related to tenacious and copious secretions 

Nursing Interventions 

Maintaining Airway Clearance 

• 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. Contraindicated with increased intracranial pressure, uncontrolled hypertension, recent face or head surgery
• Percussion and vibration may be used to assist in mobilizing secretions ( use after bronchodilators and before meals). Contraindicated with osteoporosis, known rib or vertebral fractures.
• Encourage productive Coughing to help clear secretions.
• Consider PEP valve, Acapella device or vest therapy for enhanced secretion clearance. 
• Encourage increased intake of fluids to reduce viscosity of sputum and make expectoration easier. 
• Consider vaporizer to provide humidification and keep secretions thin.