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RCP 115 ch 16


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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