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RCP 115 ch 16
Bronchiectasis
| Question | Answer |
|---|---|
| What is Bronchiectasis? | An acquired disorder of the major bronchi and bronchioles. |
| Bronchiectasis is characterized by? | - Chronic dilation and distortion of one or more bronchi. |
| Bronchiectasis is also characterized by? | - Result of extensive inflammation and destruction of bronchial wall cartilage, blood vessels, elastic tissue, and smooth muscle components. |
| With bronchiectasis one or both lungs may be involved and commonly limited to? | - A lobe or segment and is frequently found in the lower lobes. - Smaller bronchi, with less supporting cartilage, are predominantly affected. |
| What are the tree forms of bronchiectasis? | 1) Varicose bronchiectasis. (Fusiform) 2) Cylindrical bronchiectasis (Tubular). 3) Cystic bronchiectasis (Saccular) |
| What is Varicose bronchiectasis (Fusiform)? | - Bronchi are dilated and constricted in an irregular fashion similar to varicose veins. - Distorted, bulbous shape. |
| What is Cylindrical bronchiectasis (Tubular)? | Bronchi are dilated and rigid and have regular outlines similar to a tube. |
| What is Cystic bronchiectasis (Saccular)? | Bronchi progressively increased in diameter until they end in large, cystlike sacs in the lung parenchyma. |
| What are some major pathologic or structural changes? | - Chronic dilation and distortion of bronchial airways. - Excessive production of often foul smelling sputum. - Bronchospasm. - Hyperinflation of alveoli (air trapping). - Atelectasis. - Consolidation and parenchymal fibrosis. - Hemoptysis is secon |
| Most all causes of bronchiectasis include some combination of? | Bronchial obstruction and infection. |
| What is the most common cause of bronchiectasis? | CF |
| What is the prevalence of non- cystic fibrosis bronchiectasis (NCFB), it is relatively low? | - About 4.2 per 100,000 young adults in the United States. - Low incidence often attributed to early medical management. |
| Causes of bronchiectasis are commonly classified as? | - Acquired bronchial obstruction. - Congenital anatomic defects. - Immunodeficiency states. - Abnormal secretion clearance. - Miscellaneous disorders (e.g., Alpha1- antitrypsin deficiency). |
| What are some ways they diagnose bronchiectasis? | - Routine chest radiograph - High- resolution computed tomography (HR- CT). - Spirometry testing. |
| What is High- resolution computed tomography (HR- CT) used for? | - Better clarify the findings from the chest radiograph and standard CT scan. |
| What is spirometry testing for bronchiectasis used for? | Determines if an obstructive or restrictive lung pathophysiology. |
| What are some cardiopulmonary clinical manifestations of bronchiectasis? | - Excessive bronchial secretions. - Bronchospasm's. - Consolidation. - Increased alveolar- capillary membrane thickness. |
| What may be somethings that may create an obstructive or a restrictive lung disorder or a combination of both? | - Amount of bronchial secretion. - Degree of bronchial destruction. - Fibrosis/ atelectasis associated with bronchiectasis. |
| What are the physical examinations of bronchiectosis? | - V/S. - Use of accessory muscles of inspiration and expiration. - Pursed lip breathing. - Increased anteroposterior chest diameter. - Peripheral edema and venous distention. - Cough, sputum production, and hemoptysis. - Chest assessment findings. |
| Bronchiectasis V/S: | - Increased: - RR (Tachypnea). - HR (pulse). - B/P. |
| What are a couple of signs of increased anteroposterior chest diameter? (Barrel chest) (when obstructive pathology) | - Cyanosis. - Digital clubbing. |
| What is peripheral edema and venous distension? | - Distended neck pain. - Pitting edema. - Enlarged and tender liver. |
| Chronic cough with production of large quantities of foul- smelling sputum is a hallmark of what? | Bronchiectasis |
| Chest assessment findings, when primarily OBSTRUCTIVE in nature are? | - Decreased tactile and vocal fremitus. - Hyperresonant percussion note. - Diminished breath sounds. - Wheezing. - Crackles. |
| Chest assessment findings, when primarily RESTRICTIVE in nature? (I.e., over areas of atelectasis and consolidarion). | - Increased tactile and vocal fremitus. - Bronchial breath sounds. - Crackles. - Whispered pectoriloquy. - Dull percussion note. |
| PFT findings when primarily OBSTRUCTIVE in nature. (moderate to severe Bronchiectasis). Forced Expiratory Volume and Flowrate Findings: | - FVC, FEVt, FEV1/FVC ratio, FEF 25%-75 ↓. ↓. ↓ ↓ - FEF 50%, FEF 200-1200, PEFR, MVV ↓. ↓ |
| PFT findings when primarily OBSTRUCTIVE in nature. (moderate to severe Bronchiectasis). - Lung Volume and Capacity Findings: | - Vt, IRV, ERV, RV, VC N or ↑ N or ↓. N or ↓. ↑. ↓ - IC. FRC. TLC RV/TLC ratio N or ↓. ↑. N or ↑. N or ↑ |
| PFT findings when primarily RESTRICTIVE in nature. (moderate to severe Bronchiectasis). Forced Expiratory Volume and Flowrate Findings: | - FVC, FEVt, FEV/FVC ratio, FEF 25%- 75 ↓. N or ↓. N or ↑. N or ↓ - FEF 50%, FEF 200- 1200. PEFR. MVV N or ↓. N or ↓. |
| PFT findings when primarily RESTRICTIVE in nature. (moderate to severe Bronchiectasis). - Lung Volume and Capacity Findings: | - Vt IRV. ERV. RV. VC N or ↓. ↓. ↓. ↓. ↓ IC. FRC. TLC. RV/TLC ratio ↓. ↓. ↓. N |
| ABGs Bronchiectasis; Mild to Moderate Stages : Acute Alveolar Hyperventilation with Hypoxemia. (Acute Respiratory Alkalosis) | pH. PaCO2. HCO3 PaO2. SaO2/SpO2 ↑. ↓. ↓. ↓. ↓ (normal) |
| ABGs Bronchiectasis: Severe Stage; Chronic Ventilatory Failure with Hypoxemia: (Compensated Respiratory Acidosis) | pH. PaCO2. HCO3 PaO2 SaO2/SpO2 N. ↑. ↑. ↓. ↓ (significantly) |
| Acute ventilatory changes are frequently seen in patients with chronic ventilatory failure, the Respiratory Therapist MUST be FAMILIAR with- and ALERT for- THE FOLLOWING TWO DANGEROUS ARTERIAL BLOOD GAS FINDINGS: | - Acute alveolar hyperventilation superimposed on chronic ventilatory failure. (possible impending acute ventilatory failure). - Acute ventilatory failure (acute hypoventilation) superimposed on chronic ventilatory failure. |
| What are some of the abnormal lab. tests and procedures? | - Increased hematocrit and hemoglobin. - Elevated white blood count if acutely elevated. - Sputum examination: - Streptococcus pneumoniae. - Haemophilus influenzae. - Anaerobic organisms. |
| Radiologic Findings for bronchiectasis | - Chest radiograph when obstructive - Areas of consolidation and/or atelectasis. - chest radiograph when restrictive. - Increased opacity. |
| Chest radiograph when the bronchiectasis is primarily OBSTRUCTIVE in nature: | - Translucent (dark) lung fields. - Depressed or flattened diaphragms. - Long and narrow heart (pulled down by diaphragms). - Enlarged heart (when heart failure is present). - Areas of consolidation and/or atelectasis might be seen. - Tram- tracks |
| Chest radiograph when the bronchiectasis is primarily RESTRICTIVE in nature | - Atelectasis and consolidation. - Infiltrates (suggesting pneumonia). |
| General Management of Bronchiectasis | - Treatment for underlying disease may not be possible. - General treatment plan. - Chest radiograph for restriction. - Increased opacity. |
| What is the general treatment plan for bronchiectasis? | - Control pulmonary infections. - Control airway secretions and obstruction. - Preventing complications. - Antibiotics, bronchodilators, and expectorants. - CPT. - Vaccinations. |
| When the branchiectasis is primarily in nature you see this? | - Atelectasis. - Infiltrates (suggesting pneumonia). |
| What are the Respiratory Care Treatment Protocols? | - Oxygen therapy protocol - Airway clearance therapy protocol. - Lung expansion therapy protocol. - Aerosolized medication therapy protocol. - Mechanical ventilation protocol. |
Created by:
tracyb34
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