BRONCHIECTASIS
Bronchiectasis- is a chronic, irreversible dilation of the
bronchi and bronchioles.
Predisposing factors:
 Airway obstruction
 Diffuse airway injury
 Pulmonary infections and obstruction of
the bronchus or complications of long –
term pulmonary infections.
 Genetic disorders such as cystic
fibrosis
 Abnormal host defense (eg, ciliary
dyskinesia or humoral
immunodefieciency)
 Idiopathic causes
Pathophysiology
 Inflammatory process associated with
pulmonary infections damages the
bronchial wall
 Weakens/loss supporting structure
which results to productions of thick
secretions that obstruct the bronchi.
 Bronchial walls become
distended/distorted permanently thus
impedes mucucilliary clearance.
 Inflammation/infections extends to the
perbronchial tissues.
 Large amount of exudates drains freely
to the lungs mostly to the upper lobe of
the lung.
 Retention of secretions and subsequent
obstruction ultimately cause the alveoli
distal to the obstruction to collapse
(atelectasis)
 There is impairment in the matching of
ventilation to perfusion (ventilation-
perfusion imbalance) and hypoxemia.
Symptoms of Bronchiectasis
 Coughing up yellow or green mucus
every day
 Shortness of breath that gets worse
during exacerbations.
 Feeling run-down or tired, especially
during exacerbations.
 Fevers and/or chills, usually developing
during exacerbations.
 Wheezing or a whistling sound while you
breathe.
 Coughing up blood or mucus mixed with
blood, a condition called hemoptysis.
Risk factors for Absent or Dysfunctional CFTR
protein in bronchial cells in cystic fibrosis (CF)
 Having a whole-body (systemic) disease
associated with bronchiectasis like those
mentioned above.
 Chronic or severe lung infections such as
tuberculosis, or TB that damage the airways.
Medical Management
1. Postural drainage.
2. Chest physiotheraphy, including percussion and
postural drainage is important in secretion
management.
3. Smoking cessation is important because
smoking impairs bronchial drainage by
paralyzing ciliary action, increasing bronchial
secretions, and causing inflammation of the
mucous membranes.
4. Medications- vaccinations, bronchodilator
5. Antibiotic agents may be prescribed, throughout
the winter or when acute upper respiratory tract
infections occur.
Nursing Management- focuses on alleviating symptoms
and assisting the patient to clear pulmonary secretions.
 Perform postural drainage
 Avoid exposure to others with upper respiratory
and other infections.
 Assessed nutritional status and strategies are
implemented to ensure an adequate diet.
Typical posture of a person with COPD—primary
emphysema- The person tends to lean forward and
uses the accessory muscles of respiration to breathe,
focusing the shoulder girdle upward and causing
supraclavicular fossae to retract on inspiration.
Assessment
Key factors to assess in the COPD Patient’s Health
History
 Exposure to risk factors- types, intensity,
duration
 BRONCHIECTASIS
 Past medical history—resp. diseases/problems,
including asthma, allergy, sinusitis, nasal polyps,
hx of resp infection.
 Family hx of COPD or other chronic resp
diseases
 Pattern of symptom development
 Hx of exacerbations or previous hospitalizations
for resp problems
 Presence of comorbidities
 Appropriateness of current medical treatments
 Impact of disease on quality of life
 Available social and family support
 Potential for reducing risk factors (eg. Smoking
cessation)
Pulmonary Tubercolosis (PTB)
 Is a contagious disease bacterial infection that
involves the lungs. It may spread to other
organs.
 Most people recover from primary TB infection
without further evidence of the disease. The
infection may stay inactive (dormant) for years.
In some people, it becomes active again
(reactivates)
 Most people who develop symptoms of a TB
infection first became infected in the past. In
some cases, the disease becomes active within
weeks after the primary infection.
Causative agent
Pulmonary TB is caused by the bacterium
Mycobacterium tuberculosis. TB is contagious. This
means the bacteria is easily spread from an infected
person to someone else.#
Mode of Transmission
Droplets- cough or sneeze of an infected person
Who are at risk?
 Older adults
 Infants
 People with weakened immune systems, for
example due to HIV/AIDS, chemotherapy,
diabetes, or medicines that weaken the immune
system.
 Poor nutrition
Two forms of PTB
1. Latent TB: You have the germs in your body,
but your immune system stops them from
spreading. That means you don’t have any
symptoms and youre not contagious. But the
infection is still alive in your body and can one
day become active. If you are at high risk for re-
activation----for instance, you have HIV, your
primary infection was in the last 2 years, your
chest X-ray is abnormal or you are
immunocompromised----your doctor will treat
you with antibiotics to lower the risk for
developing active TB.
2. Active TB disease: This means the gers
multiply and can make you sick. You can spread
the disease to others. Ninety percent of adult
cases of active TB are from the reactivation of
latent TB infection.
Signs and Symptoms
 Cough up phlegm
 Cough up blood (hemoptysis)
 Have a consistent fever, including low-grade
fevers
 Have night sweats
 Have chest pains
 Have unexplained weight loss
 Fatigue
Pathophysio
 Once the bacteria is inhaled (droplet), it
settles to the airway, majority of the
bacilli are trapped.
 Droplet nuclei with bacilli are inhaled
enter the lung and deposit in the alveoli.
 Macrophages and T lymphocytes act
together to try to contain the infection by
forming granulomas.
 In weaker immune systems, the walls
loses integrity and the bacilli are able to
escape and spread to other alveoli or
other organs.
Pathophysio (summarized)
 Inhalation of bacilli
 Containment in a granuloma
 Breakdown of the granuloma in less
immunocompetent individuals.
Prevention of Spread:
 BRONCHIECTASIS
 Take all of your medicines as they’re prescribed,
until your doctor takes you off them.
 Keep all your doctor appointements.
 Always cover your mouth with a tissue when you
cough or you sneeze. Seal the tissue in a plastic
bag, then throw it away.
 Wash your hands after coughing or sneezing.
 Don’t visit other people and don’t invite them to
visit you.
 Stay home from work, school, or other public
places.
 Use a fan or open windows to move around
fresh air.
 Don’t use public transportation.
Diagnostics:
1. Chest X-Ray- the most common diagnostic
test that leads to the suspicion of infection is
a chest xray.
 In primary TB, an xray will show an
abnormality in the mid and lower lung
fields, and lymph nodes may be
enlarged.
 Reactivated TB bacteria usually infiltrate
the upper lobes of the lungs.
 Miliary tuberculosis exhibits diffuse
nodules at different locations in the
body.
2. The Mantoux skin test- also known as
tuberculin skin test (TST or PPD test): This
test helps identify people infected with
M.tuberculosis but who have no symptoms.
A doctor must read the test.
 The doctor will inject 5 units of
purified protein derivative (PPD) into
your skin. If a raised bump of more
than 5 mm (0.2 in) appears at the
site 48 hours later, the test may be
positive.
 This test can often indicate disease
when there is none (false positive).
Also, it can show no disease when
you may in fact have TB (false
negative)
3. Sputum Testing- sputum testing for acud
fast bacilli (AFB) is the only test that
confirms a TB diagnosis. If sputum (the
mucus you cough up) is available, or can be
induced, a lab test may give a positive result
in up to 30% of people with active disease.
Sputum or other bodily secretions such as
from your stomach or lung fluid can be
cultured for growth of mycobacteria to
confirm the diagnosis.
In may take one to three weeks to detect
growth in a culture, but eight to 12 weeks to
be certain of the diagnosis.
4. Sputum smear microscopy
 To do the TB test a very thin layer of
the sample is placed on a glass
slide, and this is called a smear. A
series of special stains are then
applied to the sample, and the
stained slide is examined under a
microscope for signs of the TB
bacteria.
 Sputum smear microscopy is
inexpensive and simple, and people
can be trained to do it relatively
quickly and easily.
 Results are available within hours.
The sensitivity though is only about
50-60%
Treatment
Latent TB
 Isoniazid (INH) isonicotinylhydrazide: This is the
most common therapy for latent TB. (take daily
for 9 months)
 Rifampicin take this antibiotic each day for
4months, option if you have side effects or
contraindications to INH
 Isoniazid and rifapentine: once a week for 3
months
Active TB
 Ethambutol
 Isoniazid
 Pyrazinamide
 Rifampicin
All of these will be taken for 6-9 months
Latent TB
 TB lives but doesn’t grow in the body.
 Doesn’t make a person feel sick or have
symptoms.
 Can’t spread from person to person.
 Can advance to TB disease.
Active TB
 BRONCHIECTASIS
 TB is active and grows in the body.
 Makes a person feel sick and have
symptoms.
 Can spread from person to person.
 Can cause death if not treated.
Multi Drug Resistance (MDR)
 Antibiotics called fluoroquinolones
 An injectable antibiotic such as amikacin,
kanamycin, and capreomycin
 Newer and antibiotic treatments, such as
bedaquiline, ethanamide, and para-amino
salicylic acid. These are given in addition to
other medications.
 Promoting airway clearance- the nurse
instructs the patient about correct positioning to
facilitate drainage and to increase fluid intake to
promote systemic hydration.
 Adherence to the treatment regimen- the
nurse should teach the patient that TB is a
communicable disease and must take his/her
medicines.
 Promoting activity and adequate nutrition
 Preventing spreading of tuberculosis
infection
 Acid-fast bacillus isolation
 Disposal
 Monitor adverse effects

A rare and serious type of the disease is called

extensively drug-resistant TB , this means that many
of the common medications --- including isoniazid,
rifampicin, fluoroquinoloness, and atleast one of the
antibiotics that are injected--- don’t knock it out.
Research shows that it can be cured around 30% to
50% of the time.

Medication side effects

Serious side effects of TB drugs aren’t common but can

be dangerous when they do occur. All tuberculosis
medications can be highly toxic to your liver.

 Nausea or vomiting
 Loss of appetite
 A yellow color to your skin (jaundice)
 Dark urine
 A fever that lasts three or more days and has no
obvious cause

Complication:

If left untreated or mistreated, pulmonary tuberculosis

may lead to:

 Respiratory failure
 Pneumothorax
 Pneumonia

Nursing Intervention