Otterbein University Digital Commons @ Otterbein

Nursing Student Class Projects (Formerly MSN) Student Research & Creative Work

Summer 2020

Bronchiectasis: Pathophysiology and Management

Olivia Fleetwood Otterbein University, [email protected]

Follow this and additional works at: https://digitalcommons.otterbein.edu/stu_msn

Part of the Nursing Commons

Recommended Citation Fleetwood, Olivia, "Bronchiectasis: Pathophysiology and Management" (2020). Nursing Student Class Projects (Formerly MSN). 444. https://digitalcommons.otterbein.edu/stu_msn/444

This Project is brought to you for free and open access by the Student Research & Creative Work at Digital Commons @ Otterbein. It has been accepted for inclusion in Nursing Student Class Projects (Formerly MSN) by an authorized administrator of Digital Commons @ Otterbein. For more information, please contact [email protected]. Bronchiectasis: Pathophysiology and Management Olivia Fleetwood CCRN, BSN & SRNA, DNP Student Otterbein University, Westerville, Ohio

Pathophysiology of Bronchiectasis Nursing Implications Airway with Bronchiectasis Normal Airway References

Significance of Nurses play a large role in helping • Educate patients on the importance Introduction Signs and Symptoms those diagnosed with this disease. Some of smoking cession Pathophysiology implementations that nurses can apply to • Promote healthy diets to prevent Bronchiectasis is a chronic the primary symptoms of bronchiectasis their practice to help these patients malnutrition. include: respiratory condition that can decrease Due to the differing causes of include: (Uzel et al,. 2020) A persistent cough the quality of life of patients with this • bronchiectasis, it is important for • Providing education about Some clinical manifestations of the Trouble clearing mucus disease. It is a critical and essential topic • health care professionals to identify bronchiectasis to the patient and disease that nurses may expect to find Reoccurring lung infections for discussion amongst health care • the possible causes and disease family members include fatigue, difficulty with daily Shortness of breath professionals, especially nurse • overlap in order to identify and treat • Teach patients different airway activities and persistent cough. Activity Intolerance/Fatigue anesthetists, due to its increased risk of • patients with bronchiectasis clearing techniques to help On clinical examination, there Chronic Rhinosinusitis surgical complications and long-term • effectively. According to a study by manage secretions may be coarse crackles, wheeze, large Weight loss effects. Health care professionals taking • Uzel et al, (2020) “all patients with • Help with self-image by airway rhonchi (low pitched snore-like (Pickstock, 2020) Additional Resources care of these patients need to know bronchiectasis should have sputum encouraging patients or sounds) on auscultation of the Once bronchiectasis is suspected, different techniques to manage and microbiological results in order to advocating for a psychology chest, and finger clubbing may be de Souza Simoni, L., dos Santos, D., de the main diagnostic features are: improve the quality of life with these detect P. aeruginosa as soon as consult Present. In addition, lower pulse oximetry Souza, H., Baddini-Martinez, J., Internal diameter of a bronchus is patients. This poster seeks to educate • possible. As P. aeruginosa accompanies • Provide health promotion readings may be common due to the Santos, M., & Gastaldi, A. (2019). wider than its adjacent pulmonary and inform those in the medical severe disease and mortality” (269). suggestions such as tolerable increase of alveolar dead space and https://radiopaedia.org/articles/bronchiectasis https://radiopaedia.org/cases/normal-chest-x-ray Acute effects of oscillatory pep and profession about bronchiectasis and artery exercise to help maintain or decreased sputum expectoration thoracic compression on secretion Failure of the bronchi to taper help increase awareness on this critical • Documentation of patient’s history improve lung function (Pickstock, 2020). removal and impedance of the Visualization of bronchi in the outer airway disease. • is very important and needs to be top respiratory system in non–cystic 1–2 cm of the lung fields. priority to accurately be able to Surgical fibrosis bronchiectasis. Respiratory (King, 2009) The conclusion of the study shows monitor and treat patients with this Airway Clearing Techniques Care, 64(7), 818–827. Underlying Diagnostic tests include: that bronchiectasis is associated with disease. Initial tests carried out in Complications https://doi.org/10.4187/respcare.060 Sputum culture increased risk of developing PPCs after • primary care might include a sputum Airway clearance techniques are For patients with severe bronchiectasis 25 Pathophysiology Chest x-ray surgery(40.3% vs. 21.6%, P = 0.001). • culture to identify pathogens and utilized in patients with stable who are unable to clear secretions at all and Surgery of any kind can pose risks Guan, W., Yuan, J., Li, H., Huang, Y., Bronchiectasis is a chronic disease High resolution computer The authors suggest that clinicians • enable targeted antibiotic treatment. bronchiectasis and can account for are having a very difficult time breathing, and complications to patients during and Chen, C., Gao, Y., Chen, R., & Zhong, characterized by irreversible tomography scan (HRCT) should review the presence and extent (Pickstock, 2020). improvement in sputum expectoration, mechanical ventilation may be required. after surgery. Patients with N. (2018). Health perception and Spirometry of bronchiectasis carefully before thickening and bronchial dilatation, • and lung function. Intubation is necessary to be able to open bronchiectasis have an even higher risk behaviors in adults with impaired mucociliary clearance, and (Pickstock, 2020) extra-thoracic surgery to be aware of Treatment options for those with Different techniques that can be used the patient’s airway with positive end of surgical complications due to the bronchiectasis. Respiratory Care, repeated bronchial infections that lead The majority of respiratory tract the potential complications (Yang et al., bronchiectasis include: with these patients include breathing pressure which assists with gas exchange altered diameter of the bronchioles, the 64(4), 462–472. to progressive lung damage (Corso et infections in primary care are self 2020). • Antibiotic treatment specific to treatments, airway oscillatory devices, and can help remove secretions with increased sputum production, and the https://doi.org/10.4187/respcare.063 al., 2020). limiting, however patients presenting bacteria found in sputum culture high frequency chest wall oscillation and suctioning. This is the treatment that is used fatigue accompanied by this disease. 94 The damage causing bronchial with persistent cough and daily • Surgery to remove the diseased positive expiratory pressure. when none of the other treatments are A retrospective analysis performed King, P. (2009). The pathophysiology of dilation is characterized by production of a large volume of sputum parts of the lung Nebulizer breathing treatments can working and should only be used in severe by Yang et al. (2020) assessed whether bronchiectasis. International Journal deficiency/loss of elastin and, in more with recurrent infections should alert • Lung transplant help deliver medication deep into the cases. bronchiectasis further increased the Conclusion of Chronic Obstructive Pulmonary advanced disease, by destruction of clinicians to the possibility of • Inhalers/home oxygen patient’s lungs which helps mobilize Health technology has expanded and is presence of postoperative pulmonary Disease, 411. muscle and cartilage. There is variable Bronchiectasis sputum and make it easier for the patient becoming more accessible to patients to https://doi.org/10.2147/copd.s6133 (Uzel et al,. 2020) complications (PPC) following extra Bronchiectasis is a condition that bronchial wall fibrosis, atelectasis and (Pickstock, 2020). to expectorate. help improve their lives. Home breathing Naseri, Z., Sherafat, S., Abrishami pulmonary surgery. requires teamwork amongst all parabronchial pneumonic change There are many different airway treatments and oscillatory devices are Moghaddam, H., Modaresi, M., Pak, The PPC in this study is defined as; medical professionals, from inpatient (King, 2009). Unfortunately, more oscillation devices that can help patients available for patients who are more N., & Zamani, F. (2018). Semi- • respiratory infection, surgical interventions to outpatient studies need to be conducted to mobilize secretions as well. Incentive independent in their care and can help lead automatic methods for airway and • respiratory failure monitoring, to make sure that those determine the cause of the loss of spirometers assist in opening patient’s to less hospital visits and less disruption to adjacent vessel measurement in • pleural effusion living with bronchiectasis can have the elastin and destruction of muscles. lungs and help decrease the risk of daily activities. bronchiectasis patterns in lung hrct • Atelectasis best quality of life with this condition. Patients who are most at risk of pneumonia. The flutter valve or Acapella (Halon, 2019) images of cystic fibrosis patients. • Pneumothorax Health care workers must understand developing bronchiectasis include: is more commonly used for these Journal of Digital Imaging, 31(5), 727– Acapella • Bronchospasm the pathophysiology behind this • Those with abnormal lung anatomy patients. This plastic device puts positive 737. https://doi.org/10.1007/s10278- Device These complications were evaluated condition to help reduce poor • History of childhood infections due pressure back into the airway and helps 018-0076-9 within the first seven postoperative outcomes and anticipate the to viruses (tuberculosis) shake up mucus so that it is easier to clear days. complications these patients may have, • Patients with immunodeficiencies out of the lungs. Bronchial dilation in bronchiectasis especially during and after surgery. such as HIV, lymphoma, myeloma, Airway oscillatory devices are very leads to impaired mucociliary clearance Staying up to date on the current and immunoglobulin disorders helpful in the mobilization of mucus and and failure to adequately clear mucus. • Patients with Chronic Obstructive airway clearing techniques and can be very beneficial in loosening deep High- Although the cause of PPC are not well Pulmonary Disease (COPD) and management of these patients in the mucus. There are several types of Frequency known, the altered mucociliary clearance Asthma hospital can save lives and make a devices, the most common being vests Chest wall and mucus trapping probably cause • Patients with Cystic Fibrosis have difference with patients suffering from that create vibrations to loosen mucus. Oscillation atelectasis in bronchiectasis patients by the highest risk this condition. This technique should be avoided in Vest hindering mucus expectoration However, in some patients, there may patients who are elderly or frail. (Yang et al., 2020). be no clear initiating event or underlying cause (Pickstock, 2020). https://my.clevelandclinic.org/health/diseases/21144-bronchiectasis https://justnebulizers.com https://respiratorycare.hill- /products/acapella-valve rom.com/en/patients/products/the-vest-system-105/