Bronchiectasis

WHAT WENT WRONG?
Bronchi and bronchioles become abnormally and permanently dilated, caused by
infection and inflammation. This results in excessive production of mucous that
obstructs the bronchi. There is some obstruction of the airways and a chronic
infection. The changes within the lung can be localized or generalized. The lung
may develop areas of atelectasis where thick mucous obstructs the smaller air-
ways, making the mucous difficult to expel. This results in inflammation and
infection of the airways and leads to bronchiectasis.

PROGNOSIS
Early diagnosis and appropriate treatment of infections are essential for manage-
ment. Postural drainage and chest physical therapy aid in movement of mucous
from the airways. The difficulty in breathing is caused by excess mucus similar to
patients with Chronic Obstructive Pulmonary Disease (COPD) (emphysema or
chronic bronchitis).

SIGNS AND SYMPTOMS

• Difficult breathing (dyspnea) due to the mucous production and irritation
within the airways.
• Productive, foul-smelling odorous cough, due to thick, difficult-to-expel,
tenacious mucous, often with bacterial colonization.
• Cough may be worse when lying down.
• Recurrent bronchial infections.
• Hemoptysis (blood-tinged or bloody mucous).
• Loss of weight because patients are not eating well, due to respiratory
changes and foul-smelling mucous with cough. Increased respiratory effort
requires more calories to meet normal requirements.
• Crackles or rhonchi on inspiration due to mucous build-up.
• Anemia of chronic disease.
• Cyanosis.
• Clubbing of the fingers.

TEST RESULTS
• Culture and sensitivity of sputum to identify bacteria and appropriate anti-
biotics.
• Shadows in affected area of the lungs on the chest x-ray.
• CT scan or high-resolution CT will show areas of bronchiectasis.
• Decreased lung vital capacity on pulmonary function test.

TREATMENT
Treatment is focused on getting enough oxygen to meet current needs of the patient,
expel mucous, and treat infections.
• Supplemental oxygen to help meet body’s needs.
• Postural drainage to assist with drainage of secretions.
• Chest PT to loosen secretions.
• Remove excessive secretions during a bronchoscopy.
• Administer bronchodilators to help keep airways open:
• albuterol, levalbuterol
• Administer antibiotics to treat infection:
• selected based on the results of a culture and sensitivity study

NURSING DIAGNOSES
• Ineffective airway clearance
• Imbalanced nutrition: less than what the body requires

NURSING INTERVENTION
• Monitor respiratory rate, effort, breath sounds, skin color, and use of acces-
sory muscles.
• Impaired gas exchange
• Perform chest percussion to help loosen secretions.
• Explain to the patient:
• That family member can perform chest PT.
• How to do postural drainage.
• How to administer oxygen.
• How to properly administer medications.